bluuebunny/crossref_metadata_2025 huggingface dataset:
Plymouth Tube Company: How to Build Ownership Consensus
Authors: Ward John L.
Published: March 2021

Plymouth Tube, a family business, was a manufacturer of precision tubing and extruded shapes for aerospace, desalination, medical, mining, energy, and water industries globally. Founded in 1924, as of 2012 it employed 770 people at thirteen plants in seven U.S. states and had sales of about $240 million. The family had twenty members across three generations, including spouses. The board was composed of eight members, three from the family and five who were independent. Stacy, age 30, was the only fifth-generation family member working for the company. Her father, Van, age 64 and a fourth-generation member, had been in the business for forty years and had succeeded his father as president, CEO, and chairman.

In early 2013, management presented a very large expansion project that was riskier than previous recent investments to the board, and requested the board's approval. Independent board members asked Van to obtain feedback from the family about the proposal. Van asked Stacy to direct the process for informing the family, asking for their input, and communicating it back to the board.

How should Stacy conduct the process? What should be done with the information once it has been gathered? Should family members be involved in this type of business decision? Based on the information given in the case, is this a good investment?
How to Motivate the Fifth Generation?
Authors: Ward John L.
Published: March 2021

In mid-2013, the Lee family, which owned the Hong Kong based food and health product giant Lee Kum Kee (LKK), struggled with how best to increase involvement of the fifth generation (G5), the children of the company's current fourth-generation (G4) senior executives and governance leaders. Only two of the fourteen G5 members had joined the company, and few had expressed interest in further involvement, including in the multiple learning and development programs the business offered, such as a mentoring program. Many of the G5 cousins had expressed little interest in business careers in general, and none of them currently was serving as an LKK intern. G4 members observed that their children were busy with family obligations, hobbies, and emerging careers outside the business. G5's lack of interest in business and governance roles was part of a growing pattern of low family engagement in general, exhibited by the cancellation of recent family retreats (once an annual tradition) because of apathy and some underlying conflict. A history of splits among past generations of the Lee family regarding business leadership made the engagement issue even more meaningful and critical.

Students will consider the challenge from the point of view of G4 family members David Lee, chairman of the family's Family Office, and his sister, Elizabeth Mok, who ran the Family Learning and Development Center. They and their three siblings saw engaging the next generation as a top priority, one related to key concepts including family-business continuity, generational engagement and empowerment, succession, emotional ownership, and intrinsic/extrinsic motivation.
Survey to detect tick‐borne encephalitis virus from human‐feeding ticks in Hokkaido, Japan
Authors: Sasaki Kenta , Honma Masaru , Nakao Minoru , Sasaki Mizuki , Hashimoto Yoshio , Ishida‐Yamamoto Akemi , Yoshii Kentaro
Published: March 2021

A tick infestation is one of the most common arthropod‐related skin diseases in Hokkaido, the northernmost island of Japan. Ticks also act as an infectious disease vector for humans. Tick‐borne encephalitis (TBE), a highly mortal central nervous system infection caused by TBE virus (TBEV), has sporadically occurred there recently. However, there have been no epidemiological data on the current surveillance of human tick bites and the prevalence of TBEV in human‐feeding ticks. This study was performed to clarify those indeterminate issues. One hundred and fifty‐three ixodid ticks feeding on humans were collected from 150 outpatients in Hokkaido during the season of April to August 2018. None of the cases showed any infectious symptoms. These ticks were morphologically identified to species, and a cytopathic assay on baby hamster kidney cells was carried out to detect TBEV from each tick. The tick collection consisted of 108Ixodes persulcatus(one nymph and 107 adult females), 44 femaleIxodes ovatus, and one femaleHaemaphysalis japonica. No tick extracts showed positive results of the cytopathic assay, suggesting the non‐existence of TBEV in the present specimens. However, the survey to detect TBEV from human‐feeding ticks is still important to monitor the occurrence of TBE, because human tick bites byI. ovatus, a possible vector of TBEV, are increasing even in the northern and eastern areas of Hokkaido.
Comparative drought sensitivity of co‐occurring white spruce and paper birch in interior Alaska
Authors: Sullivan Patrick F. , Brownlee Annalis H. , Ellison Sarah B. Z. , Cahoon Sean M. P.
Published: March 2021

Numerous recent studies have argued that moisture limitation is leading to growth declines and mortality of black spruce (Picea mariana) and white spruce (Picea glauca) in the North American boreal forest. A parallel line of research suggests that increasingly common severe wildfires are altering successional pathways and leading to long‐term replacement of spruce forests with those dominated by paper birch (Betula papyrifera, Betula neoalaskana) and trembling aspen (Populus tremuloides). When both conifers and deciduous trees establish after fire, this biome shift hypothesis implicitly assumes that deciduous species will outcompete the conifers, owing to their more rapid vertical growth and because they might be less sensitive to warm and dry conditions.

We established a research site in a white spruce‐paper birch forest on an east‐facing slope in interior Alaska and tested the hypothesis that Alaska paper birch are better adapted to warm and dry conditions than white spruce. Over 6 years (2013–2018), we made hourly measurements of microclimate and xylem sap flux of both species. We also collected increment cores and conducted climate‐growth analyses for both species.

During our 6‐year study, growing seasons with low volumetric soil water content (SWC) were those that followed shallow winter snowpacks and had limited summer rainfall, not necessarily those with warm air temperature. Both species were sensitive to moisture limitation. The tree‐ring data revealed significant positive effects of cumulative water year precipitation on radial growth, with a steeper slope for paper birch than for white spruce. Radial growth of both species was also positively related to mean water year air temperature. Sap flux density declined progressively for white spruce over the range of observed SWC and abruptly for paper birch when SWC fell below ~15%.

Synthesis. Our results show that, while paper birch might be less sensitive to mild drought than white spruce, it may be more sensitive to severe drought, raising questions about the ability of paper birch to outcompete co‐occurring white spruce in a drier climate.
The evolutionary trade‐offs in phage‐resistant Klebsiella pneumoniae entail cross‐phage sensitization and loss of multidrug resistance
Authors: Majkowska‐Skrobek Grazyna , Markwitz Pawel , Sosnowska Ewelina , Lood Cédric , Lavigne Rob , Drulis‐Kawa Zuzanna
Published: March 2021

Bacteriophage therapy is currently being evaluated as a critical complement to traditional antibiotic treatment. However, the emergence of phage resistance is perceived as a major hurdle to the sustainable implementation of this antimicrobial strategy. By combining comprehensive genomics and microbiological assessment, we show that the receptor‐modification resistance to capsule‐targeting phages involves either escape mutation(s) in the capsule biosynthesis cluster or qualitative changes in exopolysaccharides, converting clones to mucoid variants. These variants introduce cross‐resistance to phages specific to the same receptor yet sensitize to phages utilizing alternative ones. The loss/modification of capsule, the main Klebsiella pneumoniae virulence factor, did not dramatically impact population fitness, nor the ability to protect bacteria against the innate immune response. Nevertheless, the introduction of phage drives bacteria to expel multidrug resistance clusters, as observed by the large deletion in K. pneumoniae 77 plasmid containing blaCTX‐M, ant(3″), sul2, folA, mph(E)/mph(G) genes. The emerging bacterial resistance to viral infection steers evolution towards desired population attributes and highlights the synergistic potential for combined antibiotic‐phage therapy against K. pneumoniae.
Gender Matters: A Multilevel Analysis of Gender and Voice at Work
Authors: Cooper Rae , Mosseri Sarah , Vromen Ariadne , Baird Marian , Hill Elizabeth , Probyn Elspeth
Published: March 2021

The role of gender in shaping a range of work experiences and outcomes is well documented, yet there remains limited knowledge of the gendered dimensions of voice. In addressing the understudied topic of gender and voice, we propose a multilevel framework for analysing the relationship, which goes beyond thinking of gender only in terms of individual‐level gender identities. We conceptualize gender at three levels – as embedded in individual identities, in organizational policies and practices and in labour market segmentations – and show that gender, at each level, is associated with variations in worker voice opportunities and practices. We test our model using data from a mixed‐methods Australian study that consisted of a national survey with young working women and men and a series of targeted focus groups with young working women. We find no individual‐level differences in women's and men's reported voice, measured as managerial consultation and as perceived influence over workplace matters. However, we do find a diminished voice among both women and men employed within specific gendered work environments, namely in organizations where workers perceive high levels of gender inequality and in women‐dominated industries. Qualitative findings provide additional detail on how women's voice materializes and is constrained within gendered work settings.
The effects of feed and energy costs on broiler farm decisions: A dynamic programming approach
Authors: Padilla Samantha L. , Liverpool‐Tasie Lenis Saweda O. , Myers Robert J.
Published: March 2021

We explore the decision‐making process of commercial poultry enterprises facing rising input costs in Nigeria. Using a cross‐sectional dataset and a 1‐year weekly panel of farm inputs and prices, we employ a discrete time, discrete control and state space dynamic programming (DP) model, disaggregated by farm size, to determine optimal decisions. In the presence of high feed costs and increased energy use, the optimal strategy for medium‐sized farms is to sell and exit the industry. However, it remains profitable for large firms to stay in the sector. The findings indicate that broiler farms need larger batch sizes to withstand input price increases and rising energy costs. While Nigeria has seen a rapid growth of commercial livestock enterprises, the sensitivity of the poultry industry to changes in feed prices is a major threat to the sector and highlights the importance of acquiring higher batch sizes and employing other risk management tools, such as contracts to forward price input.
The relationship between coping strategies and psychological distress in Chinese older adults with multiple chronic conditions
Authors: Cheng Cheng , Inder Kerry , Chan Sally Wai‐chi
Published: March 2021

Objective

To examine the relationship between socio‐demographic and clinical variables, physical function, coping strategies and symptoms of anxiety and depression in Chinese older adults with multiple chronic conditions (MCCs).

Methods

A secondary analysis of data from a prior cross‐sectional survey investigated coping and mental health among adults with multiple chronic conditions living in China. A convenience sample of 185 adults with MCCs was recruited from a university‐affiliated hospital between November 2017 and May 2018 in Northern Anhui, China.

Results

Of the 185 participants, 63% of participants had scores indicating symptoms of anxiety and 54% had scores indicating depression. Stepwise regression models explained 47% of the total variance for the levels of anxiety and 34% for the levels of depression. In the anxiety model, gender, body pain, physical functioning, positive adaptation, denial and disengagement coping, and spiritual coping showed significant associations. In the depression model, gender, physical functioning, positive adaptation and spiritual coping showed significant associations.

Conclusions

This study demonstrates the need to screen for anxiety and depression among older adults with MCCs. Individualised interventions that address coping strategies should be encouraged to maintain psychological well‐being in this population.
H19 promotes aerobic glycolysis, proliferation, and immune escape of gastric cancer cells through the microRNA‐519d‐3p/lactate dehydrogenase A axis
Authors: Sun Linqing , Li Juntao , Yan Wenying , Yao Zhendong , Wang Ruoqin , Zhou Xiaojun , Wu Hongya , Zhang Guangbo , Shi Tongguo , Chen Weichang
Published: March 2021

Long noncoding RNAs (lncRNAs) have been investigated in multiple human cancers including gastric cancer (GC). Our research aims to explore the role of H19 in aerobic glycolysis, proliferation, and immune escape of GC cells. The expression of H19 in GC samples was analyzed using Gene Expression Profiling Interactive Analysis, Gene Expression Omnibus data, and real‐time quantitative PCR analysis. Relative quantification of glucose consumption and lactate production from cell supernatant were applied to assess the aerobic glycolysis of GC cells. Subcellular fractionation, luciferase reporter, and western blot assays certified the binding between genes. Cell Counting Kit‐8 and colony formation assays were used to determine GC cell proliferation. Flow cytometry, ELISA, and real‐time quantitative PCR assays were applied to analyze the immunosuppressive effect of H19. H19 was highly expressed in samples of patients with GC, and associated with tumor growth in vivo. H19 knockdown suppressed glucose consumption, lactate production, and proliferation of GC cells by regulating the microRNA (miR)‐519d‐3p/lactate dehydrogenase A (LDHA) axis. Both miR‐519d‐3p depletion and LDHA overexpression could reverse the H19 knockdown‐induced decrease in aerobic glycolysis and proliferation. Moreover, conditioned medium from stable knockdown H19 GC cells modulated the activity of immune cells including γδT cells, Jurkat cells, and tumor‐associated macrophages in a miR‐519d‐3p/LDHA/lactate axis‐dependent manner. The H19/miR‐519d‐3p/LDHA axis mainly contributed to aerobic glycolysis, proliferation, and immune escape of GC cells.
MZT2A promotes NSCLC viability and invasion by increasing Akt phosphorylation via the MOZART2 domain
Authors: Wang Huanxi , Jiang Xizi , Cheng Yu , Ren Hongjiu , Hu Yujiao , Zhang Yao , Su Hongbo , Zou Zifang , Wang Qiongzi , Liu Zongang , Zhang Jiameng , Qiu Xueshan
Published: March 2021

Mitotic spindle organizing protein 2A (MZT2A) is localized at the centrosome and regulates microtubule nucleation activity in cells. This study assessed the role of MZT2A in non–small‐cell lung cancer (NSCLC). Differential MZT2A expression was bioinformatically assessed using TCGA database, the GEPIA database, and Kaplan‐Meier survival data to determine the association between MZT2A expression and NSCLC prognosis. Furthermore, NSCLC tissue specimens were evaluated by immunohistochemistry. MZT2A was overexpressed or knocked down in NSCLC cells using cDNA and siRNA, respectively. The cells were subjected to various assays and treated with the selective Akt inhibitor LY294002 or co‐transfected with galectin‐3‐binding protein (LGALS3BP) siRNA. MZT2A mRNA and protein levels were upregulated in NSCLC lesions and MTZ2A expression was associated with poor NSCLC prognosis. MZT2A protein was also highly expressed in NSCLC cells compared with the expression in normal bronchial cells. MZT2A expression promoted NSCLC cell viability and invasion, whereas MTZ2A siRNA had the opposite effect on NSCLC cells in vitro. At the protein level, MZT2A induced Akt phosphorylation, promoting NSCLC proliferation and invasion (but the selective Akt inhibitor blocked these effects) through upregulation of LGALS3BP via the MTZ2A MOZART2 domain, whereas LGALS3BP siRNA suppressed MTZ2A activity in NSCLC cells. The limited in vivo experiments confirmed the in vitro data. In conclusion, MZT2A exhibits oncogenic activity by activating LGALS3BP and Akt in NSCLC. Future studies will assess MTZ2A as a biomarker to predict NSCLC prognosis or as a target in the control of NSCLC progression.
Intraoperative botulinum toxin injection for superficial partial parotidectomy: A prospective pilot study
Authors: Lee Dong‐Joo , Lee Yu‐Mi , Park Hye‐Jin , Lee Jung Woo , Cha Wonjae
Published: March 2021

Objectives

Sialocele and salivary fistula are not serious but troublesome complications after parotidectomy. Various modalities have been introduced to prevent postoperative saliva‐related complications. However, clinical trials assessing the prophylactic use of botulinum toxin (BTX) for parotidectomy have not been conducted yet. Herein, we report a pilot study investigating the safety and efficacy of intraoperative BTX (iBTX) injection in partial superficial parotidectomy (PSP).

Participants

Patients with benign parotid tumour were prospectively recruited for this clinical trial from 2017 to 2019. The study participants underwent PSP with iBTX injection. We retrospectively reviewed the clinical information of all the consecutive patients who underwent PSP without iBTX from 2013 to 2019. These patients were divided into two groups: the iBTX group (n = 36) and the control group (n = 54).

Results

Permanent facial palsy was not observed in either group. Two patients (3.7%) had transient marginal palsy in the control group but none had it in the iBTX group. The incidence of sialocele was significantly lower in the iBTX group than in the control group (2.8% vs. 20.4%, P < .05). Although the incidence of salivary fistula was lower in the iBTX group than in the control group (0% vs. 7.4%), no significant difference was determined between the two groups (P = .147). Total drainage volume was significantly lower in the iBTX group than in the control group (55.0 mL vs. 116.6 mL, P < .001).

Conclusions

iBTX injection may be safe and effective in reducing sialocele and postoperative drainage in PSP. It might be a useful option to prevent saliva‐related complications after PSP.
The Molecular Microscope (MMDXR) interpretation of thoracic and abdominal allograft biopsies: Putting things in perspective for the clinician
Authors: Randhawa Parmjeet
Published: March 2021

The Molecular Microscope System (MMDXR) has significant potential to enhance biopsy interpretation. However, discussions of MMDx do not acknowledge the basic accuracy of histology readings, and the ability of pathology as a stand‐alone tool to guide patient management. MMDx overstates its ability to automatically correct for problems in biopsy readings. Assertions of accuracy approaching 99% are not supported by “real world” data. The high rate of discrepancies between MMDx® and standard biopsy readings can be attributed to the summation of many factors other than histology interpretation, including molecular noise, assay thresholding, limited sensitivity of microarray technology for low expression genes, errors in classifier development, narrow data interpretation, and lack of spatial context. It is not widely recognized that molecular signatures are not disease‐specific and are affected by the stage of disease as well as the extent of tissue injury. The effect of sampling error on MMDx performance is significantly under‐estimated, particularly in heart and lung biopsies. Therefore, MMDx reports should always be interpreted in the context of conventional biopsy readings. The clinical picture and conventional biopsy reading should be allowed to over‐ride the molecular interpretation when there is concern that confounding factors are at play.
Automated analysis of cortical volume loss predicts seizure outcomes after frontal lobectomy
Authors: Whiting Alexander C. , Morita‐Sherman Marcia , Li Manshi , Vegh Deborah , Machado de Campos Brunno , Cendes Fernando , Wang Xiaofeng , Bingaman William , Jehi Lara E.
Published: March 2021

Objective

Patients undergoing frontal lobectomy demonstrate lower seizure‐freedom rates than patients undergoing temporal lobectomy and several other resective interventions. We attempted to utilize automated preoperative quantitative analysis of focal and global cortical volume loss to develop predictive volumetric indicators of seizure outcome after frontal lobectomy.

Methods

Ninety patients who underwent frontal lobectomy were stratified based on seizure freedom at a mean follow‐up time of 3.5 (standard deviation [SD] 2.5) years. Automated quantitative analysis of cortical volume loss organized by distinct brain region and laterality was performed on preoperative T1‐weighted magnetic resonance imaging (MRI) studies. Univariate statistical analysis was used to select potential predictors of seizure freedom. Backward variable selection and multivariate logistical regression were used to develop models to predict seizure freedom.

Results

Forty‐eight of 90 (53.3%) patients were seizure‐free at the last follow‐up. Several frontal and extrafrontal brain regions demonstrated statistically significant differences in both volumetric cortical volume loss and volumetric asymmetry between the left and right sides in the seizure‐free and non–seizure‐free cohorts. A final multivariate logistic model utilizing only preoperative quantitative MRI data to predict seizure outcome was developed with a c‐statistic of 0.846. Using both preoperative quantitative MRI data and previously validated clinical predictors of seizure outcomes, we developed a model with a c‐statistic of 0.897.

Significance

This study demonstrates that preoperative cortical volume loss in both frontal and extrafrontal regions can be predictive of seizure outcome after frontal lobectomy, and models can be developed with excellent predictive capabilities using preoperative MRI data. Automated quantitative MRI analysis can be quickly and reliably performed in patients with frontal lobe epilepsy, and further studies may be developed for integration into preoperative risk stratification.
“Urchin pinning”: Behavioural observations reveal how hungry urchins actively prey upon their sea star predators
Authors: Clements Jeff C. , Dupont Sam , Jutfelt Fredrik
Published: March 2021

Green sea urchins (Strongylocentrotus droebachiensis) are dominant components of benthic ecosystems that form aggregations and can transform entire kelp forests into barren systems. While these urchins are known to unwittingly consume practically anything in their path while grazing, detailed descriptions of active predatory behaviour on known predators (i.e., predator–prey reversal) are undocumented. Here, we use laboratory observations to describe the behavioural tactics used by starved S. droebachiesis to actively attack and consume sea stars, Crossaster papposus—a known predator of S. droebachiensis. We observed urchins preying on three separate sea stars, with one being substantially consumed by urchins within 24 hr. Urchins exhibited a direct mode of attack on sea stars by individually mounting and consuming the tips of the arms. Interestingly, we did not observe any conflict between individual urchins for attacking the sea star despite there being ≈80 starving urchins in the tank (and only 10–12 arms on the sea stars). Some sea stars did not attempt to escape urchin predation at all, while others attempted to escape by fleeing and lifting arms on top of the urchins. Given that sensory perception in sea stars is largely derived from the arm tips, we suggest that urchins directly attack and consume many sea star arm tips in an attempt to “pin” sea stars before consuming them. As such, we term this predatory behaviour “urchin pinning.” These observations ultimately provide the first detailed behavioural documentation of how urchins actively prey on a known predator and provide a basis for a wealth of future research.
Thermoelectric properties of tungsten‐titanium‐phosphate glass‐ceramics
Authors: Moore Lisa , Aitken Bruce , Work Kim , Stapleton Erika , Davis Ronald
Published: March 2021

The thermoelectric properties of tungsten‐titanium phosphate glass‐ceramics, which were described in previous articles, were measured as a function of composition, ceram temperature, and measurement temperature. The glass‐ceramics comprise tungsten monophosphate crystals, (PO2)4(WO3)2 m, in a matrix of TiP2O7. The glass‐ceramics behave as n‐type semiconductors with nearly metallic behavior. Conduction occurs along percolating networks of primarily m6 and m7 crystals. The highest electrical conductivities and (absolute) Seebeck coefficients were measured on a glass‐ceramic containing large, interconnecting, prismatic, m7 crystals. At 777°C, the electrical conductivity reached nearly 5500 S/m and the Seebeck coefficient was −60 µV/K. Thermal conductivity was in the 2.5‐3 W/m.K range, and the maximum ZT obtained was 0.007. This ZT is two orders of magnitude lower than those of the best bulk, polycrystalline, n‐type, oxide thermoelectric materials. The exceptional property of the tungsten‐titanium phosphate glass‐ceramics is their high electrical conductivity when compared with oxide glasses.
Social acceptance of death and its implication for end‐of‐life care
Authors: Ruíz‐Fernández María Dolores , Fernández‐Medina Isabel María , Granero‐Molina José , Hernández‐Padilla José Manuel , Correa‐Casado Matías , Fernández‐Sola Cayetano
Published: March 2021

Aims

To understand how the social patterns about death influence end‐of‐life care from the perspective of healthcare professionals.

Design

A qualitative study according to the theory of Glaser and Strauss.

Methods

A purposeful sample of 47 participants with different roles (nurses, physicians and clinical psychologists) were involved in four focus groups and 17 interviews in 2017–2019. Responses were audio‐recorded, transcribed verbatim and analysed using computer‐assisted qualitative data.

Results

A core category ‘the theory of social patterns about death’ emerged, which is explained by three categories: the culture of concealment and stubbornness towards death, the effort and internal work to make death a part of existence, and the influence of the social patterns of coping with death on end‐of life care and healthcare professionals. Our results suggest that social coping with death is affected by a network of concealment and obstinacy towards death.

Conclusion

Recognizing death as part of life and thinking about death itself are social coping strategies. Although healthcare professionals occupy a privileged place in this process, the culture of concealment of death influences end‐of‐life care.

Impact

The social process that leads to the loneliness of the dying in our days has been theorized. However, social acceptance of death also influences healthcare professionals’ attitudes towards death. Thus, healthcare professionals’ own attitudes may affect the end‐of‐life care given to dying individuals and their families. The social patterns of death may contribute to the healthcare professionals’ negative attitudes towards death. The concept of dignified death has been linked to the notion of humanization of healthcare. Death should be approached from a more naturalistic perspective by healthcare professionals, healthcare and academic institutions.
The 2018 EFP/AAP periodontitis case classification demonstrates high agreement with the 2012 CDC/AAP criteria
Authors: Ortigara Gabriela Barbieri , Mário Ferreira Ticiane de Góes , Tatsch Karen Finger , Romito Giuseppe Alexandre , Ardenghi Thiago Machado , Sfreddo Camila Silveira , Moreira Carlos Heitor Cunha
Published: March 2021

Aim

To investigate the agreement between the 2018 EFP/AAP periodontitis case classification and the 2012 CDC/AAP criteria.

Materials and Methods

This cross‐sectional study assessed a population‐based sample from a rural area in southern Brazil. A complete periodontal examination was performed at six sites/tooth. The periodontitis case definition was estimated and compared according to the 2018 EFP/AAP classification and the 2012 CDC/AAP criteria (reference). Diagnostic tests included sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and area under ROC curve (AUC).

Results

Five hundred and eighty‐eight subjects with ≥6 teeth each were included. Based on the 2018 EFP/AAP classification, 71.1% of the subjects were classified as stage III/IV showing 100% agreement with 2012 CDC/AAP criteria for the severe category. For the moderate and severe classification, the 2018 EFP/AAP SN was 99.8% and 100%, SP 13.6% and 43.6%, PPV 83.4% and 47.4%, and NPV 93.7% and 100%, respectively. The AUC was 0.9059 (95% CI = 0.879–0.933) and the optimal cut‐off based on the curve was stage III.

Conclusions

The 2018 EFP/AAP periodontitis case classification showed high agreement with the 2012 CDC/AAP criteria in a rural sample with high periodontitis occurrence.
Environmental factors affecting Edwardsiella ictaluri‐induced mortality of riverine ayu, Plecoglossus altivelis (Temminck & Schlegel)
Authors: Takeuchi Hisato , Hiratsuka Motoyuki , Hori Kazutomo , Oinuma Hiroki , Umino Yoshiyuki , Nakano Daiki , Iwadare Mayu , Tomono Ryuji , Imai Toshihiro , Mashiko Hirohito , Namba Aki , Takase Tomohiro , Shimizu Sonoko , Nakai Toshihiro , Mano Nobuhiro
Published: March 2021

We analysed the predisposing factors for Edwardsiella ictaluri infection in the riverine ayu Plecoglossus altivelis on the basis of environmental and epidemiological data obtained in a tributary to and the lower reaches of the Tama River, Japan, in July and August 2011–2015. Mortality of ayu due to E. ictaluri infection was observed only in the tributary in August 2012 and 2013; both periods were unusually hot. During these mortality events, daily average water temperatures rose approximately 3–4°C over 4–8 days, reaching the optimum temperature for E. ictaluri infection (>25°C) and approaching the upper tolerable limit for ayu (30°C). Diurnal water temperature ranges (DWTRs) in the tributary during the mortality events exceeded 6°C, which was 1–2°C greater than in the lower reaches. Experimental infection of ayu with E. ictaluri resulted in higher mortality when exposed to 6°C DWTR than to 4°C DWTR. Furthermore, water levels in the tributary were generally low in August 2012 and 2013 because of low rainfall. From these results, we conclude that unusually high‐water temperatures combined with high DWTRs and low water levels drove riverine ayu mortality from E. ictaluri infection.
Systemic quinolones and risk of acute liver failure III: A nested case–control study using a US electronic health records database
Authors: Taher Mohamed Kadry , Crispo James A G , Fortin Yannick , Moog Ryan , McNair Douglas , Bjerre Lise M , Momoli Franco , Mattison Donald , Krewski Daniel
Published: March 2021

Background and Aim

Quinolones are globally popular antibiotics with proven potency, broad coverage, and reasonable safety. However, some concerns were raised as to their possible association with acute liver failure (ALF). The aim of this study is to assess ALF risk within 30 days of receiving a systemically administered quinolone antibiotic, in individuals with no history of liver/diseases.

Methods

We conducted a nested case–control study using electronic health records from the Cerner Health Facts. The initial cohort (n = 35 349 943) included all patients who were admitted between 2000 and 2016, with no history of liver diseases, and had a minimum medical history of one year. Eligible cases were inpatients who were first diagnosed with ALF between 2010 and 2015. Using incidence density sampling, each case was matched with up to five unique controls by sex, race, age at index encounter, and period‐at‐risk. We used conditional logistic regression to calculate the odds ratio and 95% confidence interval for ALF risk, upon adjusting for exposure to other medications, and major confounders (diabetes mellitus and alcohol abuse). We used the STROBE Statement for reporting on our study.

Results

We identified 3151 cases and 15 657 controls. Our primary analysis did not reveal an association between quinolones and ALF risk. However, some risk was identified among those with no or few comorbidities, those ≤ 60 years of age, women, men, African Americans, and Caucasians.

Conclusion

Although our study does not suggest an overall association between quinolones and ALF, elevated risks seen in some subgroups warrant further investigation.
Towards “mobility is medicine”: Socioecological factors and hospital mobility in older adults
Authors: Pavon Juliessa M. , Fish Laura J. , Colón‐Emeric Cathleen S. , Hall Katherine S. , Morey Miriam C. , Pastva Amy M. , Hastings Susan N.
Published: March 2021

Background

Understanding the factors that influence hospital mobility, especially in the context of a heightened focus on falls prevention, is needed to improve care.

Objective

This qualitative study uses a socioecological framework to explore factors that influence hospital mobility in older adults.

Design

Qualitative research

Participants

Semi‐structured interviews and focus groups were conducted with medically‐ill hospitalized older adults (n = 19) and providers (hospitalists, nurses, and physical and occupational therapists (n = 48) at two hospitals associated with an academic health system.

Approach

Interview and focus group guides included questions on perceived need for mobility, communication about mobility, hospital mobility culture, and awareness of patients' walking activity. Data were analyzed thematically and mapped onto the constructs of the socioecological model.

Key Results

A consistent theme among patients and providers was that “mobility is medicine.” Categories of factors reported to influence hospital walking activity included intrapersonal factors (patients' health status, fear of falls), interpersonal factors (patient‐provider communication about mobility), organizational factors (clarity about provider roles and responsibilities, knowledge of safe patient handling, reliance on physical therapy for mobility), and environmental factors (falls as a never event, patient geographical locations on hospital units). Several of these factors were identified as potentially modifiable targets for intervention. Patients and providers offered recommendations for improving awareness of patient's ambulatory activity, assigning roles and responsibility for mobility, and enhancing education and communication between patients and providers across disciplines.

Conclusion

Patients and providers identified salient factors for future early mobility initiatives targeting hospitalized older adults. Consideration of these factors across all stages of intervention development and implementation will enhance impact and sustainability.
Musculoskeletal modelling of the Nile crocodile (Crocodylus niloticus) hindlimb: Effects of limb posture on leverage during terrestrial locomotion
Authors: Wiseman Ashleigh L. A. , Bishop Peter J. , Demuth Oliver E. , Cuff Andrew R. , Michel Krijn B. , Hutchinson John R.
Published: March 2021

We developed a three‐dimensional, computational biomechanical model of a juvenile Nile crocodile (Crocodylus niloticus) pelvis and hindlimb, composed of 47 pelvic limb muscles, to investigate muscle function. We tested whether crocodiles, which are known to use a variety of limb postures during movement, use limb orientations (joint angles) that optimise the moment arms (leverages) or moment‐generating capacities of their muscles during different limb postures ranging from a high walk to a sprawling motion. We also describe the three‐dimensional (3D) kinematics of the crocodylian hindlimb during terrestrial locomotion across an instrumented walkway and a treadmill captured via X‐ray Reconstruction of Moving Morphology (biplanar fluoroscopy; ‘XROMM’). We reconstructed the 3D positions and orientations of each of the hindlimb bones and used dissection data for muscle lines of action to reconstruct a focal, subject‐specific 3D musculoskeletal model. Motion data for different styles of walking (a high, crouched, bended and two types of sprawling motion) were fed into the 3D model to identify whether any joints adopted near‐optimal poses for leverage across each of the behaviours. We found that (1) the hip adductors and knee extensors had their largest leverages during sprawling postures and (2) more erect postures typically involved greater peak moment arms about the hip (flexion‐extension), knee (flexion) and metatarsophalangeal (flexion) joints. The results did not fully support the hypothesis that optimal poses are present during different locomotory behaviours because the peak capacities were not always reached around mid‐stance phase. Furthermore, we obtained few clear trends for isometric moment‐generating capacities. Therefore, perhaps peak muscular leverage in Nile crocodiles is instead reached either in early/late stance or possibly during swing phase or other locomotory behaviours that were not studied here, such as non‐terrestrial movement. Alternatively, our findings could reflect a trade‐off between having to execute different postures, meaning that hindlimb muscle leverage is not optimised for any singular posture or behaviour. Our model, however, provides a comprehensive set of 3D estimates of muscle actions in extant crocodiles which can form a basis for investigating muscle function in extinct archosaurs.
Influence of anxiety and resilience on depression among hospital nurses: A comparison of nurses working with confirmed and suspected patients in the COVID‐19 and non‐COVID‐19 units
Authors: Doo Eun‐Young , Kim Miyoung , Lee Soyoung , Lee Su Young , Lee Ka Young
Published: March 2021

Aims and objectives

This study aimed to compare anxiety, resilience, and depression between COVID‐19 unit (confirmed patients and suspected patients) and non‐COVID‐19 unit nurses and assess their effects on depression.

Background

Nurses working during the global pandemic are known to be physically and psychologically exhausted, and experience severe anxiety and depression. However, there is a lack of studies comparing anxiety and depression between COVID‐19 and non‐COVID‐19 unit nurses.

Design

Descriptive research study.

Methods

This study was conducted on 64 nurses who directly worked for more than a month in a COVID‐19 unit of a general hospital with nationally designated negative‐pressure isolation beds and 64 nurses working in a non‐COVID‐19 unit. Data were collected through questionnaires and were analysed using SPSS 25.0. Reporting of this research adheres to the STROBE guidelines.

Results

Anxiety and depression were significantly higher in nurses working with patients suspected to have COVID‐19 rather than nurses working with confirmed COVID‐19 patients and non‐COVID‐19 patients. Resilience was significantly lower in suspected patient unit nurses than in COVID‐19 unit nurses. Anxiety was the major factor predicting depression in both COVID‐19 unit (confirmed patients and suspected patients) and non‐COVID‐19 unit nurses with 76.6%, 80.7%, and 63.6% explanatory power, respectively.

Conclusions

Among nurses working in COVID‐19 units, suspected patients unit nurses had higher depression than confirmed patients unit nurses due to an unsafe facility environment, insufficient personal protective equipment, and unknown conditions of the patients. Thus, interventions which have a high impact on depression need to be provided to relieve anxiety.

Relevance to clinical practice

The nursing organisation must provide comprehensive support including coordinated shifts, internal motivation, incentives, up‐to‐date information, and clear infection prevention guidelines to relieve anxiety caused by exhaustive workload, uncertainty of infectious diseases, and lack of human and material resources.
Clinical presentation, treatment, and outcomes associated with vaginal intraepithelial neoplasia: A retrospective study of 118 patients
Authors: Yu Dake , Qu Pengpeng , Liu Meihua
Published: March 2021

The incidence of vaginal intraepithelial neoplasia (VAIN) is increasing annually; however, the reported values are likely underestimated. Risk factors for VAIN include advanced age, human papillomavirus (HPV) infection, history of hysterectomy, and simultaneous or previous cervical intraepithelial neoplasia (CIN) or cervical cancer cervical cancer. The most common presentation is abnormal cytology without clinical symptoms. Despite various treatment modalities available, the rate of disease recurrence is high, and its malignant potential has been documented. This study aimed to examine demographic and clinical characteristics and associated treatment outcomes of patients with VAIN. We retrospectively reviewed clinicopathologic data and clinical outcomes of patients diagnosed with VAIN at a single center between January 2010 and December 2017. Overall, 118 patients were included (average age 49.81 ± 9.77 years; range, 26–70 years). The distribution of the histologic grade was as follows: VAIN1, 30.5%; VAIN2, 41.5%; and VAIN3, 28.0%. In total, 97 (82.2%) patients had either prior or simultaneous cervical lesions, CIN (35.6%), or cervical cancer (55, 46.6%). A total of 100 cases (84.7%) were diagnosed using colposcopy and 18 (15.3%) were diagnosed by pathological accident after hysterectomy. Thin‐prep cytology test (TCT) results were available for 112 (94.9%) patients, and 111 (94.1%) patients had abnormal cytology findings. Most patients were confirmed as HPV positive (115, 97.5%), and 84 (71.2%) patients were confirmed as positive for high‐risk HPV types. Forty‐two (35.6%) patients underwent hysterectomy before VAIN diagnosis, and the median interval between hysterectomy and VAIN diagnosis was 26.5 (range: 3–68) months. Most surgical indications were HPV‐related diseases (34, 80.9%), such as CIN (8, 19.0%) or cervical cancer (26, 61.9%). Eight patients had no history of cervical lesions. A total of 100 patients underwent initial treatment. During the median follow‐up period of 29 (range: 9–96) months, 78 (78%) patients experienced disease remission after initial treatment, 7 (7%) experienced disease recurrence, 10 (10%) had persistent disease, and 5 (5%) had progressive disease. Finally, two patients developed vaginal cancer without death. Colposcopy should be performed before vaginal hysterectomy for VAIN, particularly HPV‐related cases. The incidence of VAIN was 20% after hysterectomy owing to non‐HPV‐related lesions; thus, this part of the screening should not be discontinued. VAIN grade 2,3 and VAIN associated with CIN or cervical cancer are disease types more likely to recur and progress to invasive cancer; active medical intervention is recommended.
Gene polymorphism associated with TGF‐β1 and susceptibility to preeclampsia: A meta‐analysis and trial sequential analysis
Authors: Liu Jing , Song Guang , Zhao Ge , Meng Tao
Published: March 2021

Aim

Mounts of researches focused on the link between transforming growth factor‐beta 1 (TGF‐β1) polymorphisms and preeclampsia (PE) which is a hypertensive multisystemic disorder affecting pregnancy. However, the results were inconsistent. Thus, a meta‐analysis was performed to obtain more conclusive results.

Methods

Eligible studies were searched in PubMed, Web of Science, EMBASE, and Scopus. Odds ratios (ORs) with 95% confidence intervals (CIs) were utilized to evaluate the relationship between six TGF‐β1 polymorphisms (rs1800468, rs1800469, rs1800470, rs1800471, rs4803455, and rs4803457) and PE susceptibility in five genetic models. The subgroup stratified analysis and trial sequential analysis were performed.

Results

Fourteen studies were included in this meta‐analysis with 1941 PE patients and 2488 healthy women. There was no statistically significant association between these six TGF‐β1 polymorphisms and PE within five genetic models in the overall population (all p > 0.05). Subgroup stratified analysis revealed there was statistically significant association between TGF‐β1 rs1800469 polymorphism and PE within the allele, recessive, and homozygous model in Asian (OR = 1.17, 95% CI = 1.02–1.35; OR = 1.35, 95% CI = 1.06–1.72; OR = 1.48, 95% CI = 1.07–2.05, respectively; all p < 0.05). Trial sequential analysis indicated sufficient proof of such association in the Asian population.

Conclusions

TGF‐β1 rs1800469 is a possible risk factor for PE in Asian populations.
Human papillomavirus sequencing reveals its usefulness for the management of HIV‐infected women at risk for developing cervical cancer
Authors: Piyathilake Chandrika J. , Kumar Ranjit , Crowley Michael R. , Badiga Suguna , Burkholder Greer A.
Published: March 2021

Aim

Next‐generation sequencing (NGS) is able to describe the composition of human papillomaviruses (HPVs) as percent (%) reads rather than positive/negative results. Therefore, we used this unique approach to assess the prevalence of cervical HPVs of HIV infected (HIV+) in order to understand the determinants of being infected with higher % reads of high risk (HR)‐HPVs and cervical abnormalities of atypical squamous cells of unknown significance or higher (ASCUS+).

Methods

Study included 66 women characterized for relevant risk factors/cytology. Receiver‐operating curve curve was used to derive the optimal % read cut point to identify ASCUS+ in relation to any HR‐HPV genotype or other specific HPV genotypes. The determinants of ASCUS+ and HR‐HPVs were tested using logistic regression.

Results

Women with >20% reads of any HR‐HPV or >12% any HR‐HPV other than HPV 16/18 were 5.7 and 12.6 times more likely to be diagnosed with ASCUS+, respectively. Lower CD4 count was a significant determinant of >20% reads of HR‐HPV (odds ratio [OR] = 4.1) or >12% any HR‐HPV other than HPV 16/18 (OR = 4.5).

Conclusion

We envision that the NGS‐based HPV detection will be more accurate for screening and management of HIV+ at risk for developing cervical cancer (CC). We raise concerns regarding the limitations of 16/18‐based HPV testing for triage and the efficacy of current HPV vaccines for preventing CC in HIV+.
Innate and adaptive immune responses following PD‐L1 blockade in treating chronic murine alveolar echinococcosis
Authors: Jebbawi Fadi , Bellanger Anne‐Pauline , Lunström‐Stadelmann Britta , Rufener Reto , Dosch Michel , Goepfert Christine , Gottstein Bruno , Millon Laurence , Grandgirard Denis , Leib Stephen L. , Beldi Guido , Wang Junhua
Published: March 2021

Background

Programmed death‐1 (PD‐1) and programmed death ligand‐1 (PD‐L1) immune checkpoint blockade are efficacious in certain cancer therapies.

Objectives

The present study aimed to provide a picture about the development of innate and adaptive immune responses upon PD‐L1 blockade in treating chronic murine AE.

Methods

Immune treatment started at 6 weeks post‐E. multilocularis infection, and was maintained for 8 weeks with twice per week anti‐PD‐L1 administration (intraperitoneal). The study included an outgroup‐control with mice perorally medicated with albendazole 5 d/wk, and another one with both treatments combined. Assessment of treatment efficacy was based on determining parasite weight, innate and adaptive immune cell profiles, histopathology and liver tissue cytokine levels.

Results/conclusions

Findings showed that the parasite load was significantly reduced in response to PD‐L1 blockade, and this blockade (a) contributed to T‐cell activity by increasing CD4+/CD8+ effector T cells, and decreasing Tregs; (b) had the capacity to restore DCs and Kupffer cells/Macrophages; (c) suppressed NKT and NK cells; and thus (d) lead to an improved control of E. multilocularis infection in mice. This study suggests that the PD‐L1 pathway plays an important role by regulating adaptive and innate immune cells against E. multilocularis infection, with significant modulation of tissue inflammation.