bluuebunny/crossref_metadata_2025 huggingface dataset:
From mine to part: directed energy deposition of iron ore
Authors: Naesstroem Himani , Brueckner Frank , Kaplan Alexander F.H.
Published: August 2021

Purpose

This paper aims to gain an understanding of the behaviour of iron ore when melted by a laser beam in a continuous manner. This fundamental knowledge is essential to further develop additive manufacturing routes such as production of low cost parts and in-situ reduction of the ore during processing.

Design/methodology/approach

Blown powder directed energy deposition was used as the processing method. The process was observed through high-speed imaging, and computed tomography was used to analyse the specimens.

Findings

The experimental trials give preliminary results showing potential for the processability of iron ore for additive manufacturing. A large and stable melt pool is formed in spite of the inhomogeneous material used. Single and multilayer tracks could be deposited. Although smooth and even on the surface, the single layer tracks displayed porosity. In case of multilayered tracks, delamination from the substrate material and deformation can be seen. High-speed videos of the process reveal various process phenomena such as melting of ore powder during feeding, cloud formation, melt pool size, melt flow and spatter formation.

Originality/value

Very little literature is available that studies the possible use of ore in additive manufacturing. Although the process studied here is not industrially useable as is, it is a step towards processing cheap unprocessed material with a laser beam.
How frugal innovation shape global sustainable supply chains during the pandemic crisis: lessons from the COVID-19
Authors: Dubey Rameshwar , Bryde David James , Foropon Cyril , Tiwari Manisha , Gunasekaran Angappa
Published: August 2021

Purpose

The COVID-19 crisis has created enormous strain in global supply chains. The disruption has caused severe shortages of critical items, including personal protective equipment (e.g. face masks), ventilators and diagnostics. The failure of the industry to meet the sudden demand for these necessary items has caused a severe humanitarian crisis. These situations, resulting from the COVID-19, crisis have led to the informal growth of frugal innovation in sustainable global supply chains. This paper aims to provide a detailed overview of drivers of frugal-oriented sustainable global supply chains, following lessons acquired from emerging countries’ attempts to deal with the COVID-19 pandemic.

Design/methodology/approach

The authors used a focused group approach to identify the drivers and this paper further validated them using existing literature published in international peer-reviewed journals and reports. The authors adopted total interpretive structural modeling (TISM) to analyze the complex relationships among identified drivers.

Findings

The authors present a theoretical framework to explain how the drivers are interlinked. This paper has developed the framework through a synthesis of the TISM modeling and Matrice d’impacts croisés multiplication appliquée á un classment analysis. This paper observed that government financial support, policies and regulations, under the mediating effect of leadership and the moderating effect of national culture and international rules and regulations, has a significant effect on the adoption of emerging technology, volunteering initiatives and values and ethics. Further, emerging technology, volunteering initiative and values and ethics have a significant effect on supply chain talent and frugal engineering. These results provide some useful theoretical insights that may help in further investigating the role of frugal innovations in other contexts.

Originality/value

The authors find that outcomes of the methodical contributions and the resulting managerial insights can be categorized into four levels. Industry and researchers alike can use the study to develop the decision-support systems guiding frugal-oriented sustainable global supply chains amid the COVID-19 pandemic and in recovering them thereafter. Suggestions for future research directions are offered and discussed.
The Missing Politics of UK Pensions Provision
Authors: Berry Craig
Published: August 2021

Pensions provision in the UK has been undergoing upheaval for several decades, as an already liberal regime has gradually been further liberalised, resulting in the rollout of defined contribution provision via the pseudo‐compulsory automatic enrolment system. Yet, the system is dysfunctional, insofar as it replaces the institutional guarantors essential to pensions provision with hazy notions of individual responsibility. The ability of capitalism to reproduce itself is jeopardised as a result. Increasingly, the state, despite scaling back the state pension system, is intervening to subsidise and substitute for a marketised system. Despite the significant risk of poor outcomes for millions of savers in the automatic enrolment system, and the integral role of the state in private provision, pensions policy receives little attention in political debates, or by political scientists. This is driven in part by a lack of salience among the public, which is itself a result of the peculiar temporality of pensions. Yet it is a product also of the disciplinary norms of political science, and the positionality of political scientists.
Microbial community succession on submerged vertebrate carcasses in a tidal river habitat: Implications for aquatic forensic investigations
Authors: Wallace John R. , Receveur Joseph Paul , Hutchinson Phillip H. , Kaszubinski Sierra Frances , Wallace Harrison E. , Benbow M. Eric
Published: August 2021

Death investigations in aquatic ecosystems are challenging due to abiotic and biotic factors that may influence the estimation of a postmortem submersion interval (PMSI). In this study, we examined bacterial changes throughout the decomposition process on porcine carcasses submerged in a tidal‐influenced river and identified predictors of epinecrotic community succession. Fetal porcine (Sus scrofa) carcasses (N = 6) were submerged with epinecrotic samples collected every 3 days (6 collections) over a period of 19 days (~7415 accumulated degree hours (ADH)). Amplicon sequencing was performed using the Illumina MiSeq platform (16S V4 region, 2 × 250 bp format) to identify changes in bacterial relative abundance and diversity. To match bacterial succession with rough taphonomy, carcasses were visually assessed at each sampling time point to determine the decomposition stage. Notably, the three most abundant families were Moraxellaceae, Burkholderiaceae (Proteobacteria), and Clostridiaceae (Firmicutes), though communities composition varied significantly across decomposition stages. Greater bacterial phylogenetic diversity was observed in in latter decomposition stages (advanced floating decay, sunken remains). Random Forest Models were built to predict ADH and explained 77%–80.8% of variation in ADH with an error rate of +/−1943.2 ADH (Root Mean Square Error) or approx. ±2.7 days at the mean water temperature of this study. This study provided a useful model that could be used to estimate a PMSI in this river system utilizing bacterial community succession, and thus, potentially improve the accuracy of such estimations to be used in the court of law.
Commotio cordis: A case report of a fatal blow
Authors: Nazer Dena , Kannikeswaran Nirupama , Schmidt Carl
Published: August 2021

Commotio cordis secondary to a blunt blow to the chest wall can result in ventricular fibrillation and sudden death in children. While it is commonly reported in adolescents during sporting activities, it may result from non‐accidental trauma especially in infants and younger children. We report a case of a 6‐month‐old baby boy who presented to the emergency department in cardiac arrest. The patient's hospital records, postmortem imaging, and the autopsy results were reviewed. External examination of the infant did not reveal any evidence of trauma. Postmortem imaging revealed multiple healing posterior rib fractures and a metaphyseal corner fracture, both considered fractures highly specific for physical abuse. The autopsy revealed a structurally normal heart with no microscopic abnormalities. The infant's father confessed to hitting the child on the chest after which the child became unresponsive. Given the constellation of postmortem imaging and autopsy findings in addition to the father's confession, the child's death was ruled as a homicide secondary to commotio cordis. Since there are no structural and microscopic abnormalities in the heart autopsy in cases of commotio cordis, timely on‐scene investigation and a thorough investigation regarding the mechanism of injury are required to make this diagnosis. Early identification of non‐accidental trauma is crucial and can prevent further abuse in other siblings.
Surgical perspective in neoadjuvant chemoimmunotherapy for stage II–III non‐small cell lung cancer
Authors: Hong Tao , Sun Teng , Zhang Miao , Liu Xinlong , Yuan Yanliang , Dolo Ponnie Robertlee , Chen Bi , Zhang Hao
Published: August 2021

Background

There are many studies on neoadjuvant immunotherapy for locally advanced non‐small cell lung cancer (NSCLC) patients. Expert consensus recommends neoadjuvant immunotherapy for patients with resectable stage IB–IIIA NSCLC. However, there are few clinical studies or cases to verify this.

Methods

Data were collected from all NSCLC patients who underwent surgical resection after neoadjuvant chemoimmunotherapy admitted to the Affiliated Hospital of Xuzhou Medical University and Xuzhou Central Hospital between September 2020 and April 2021. Data collected included patient information, relevant examination results, intraoperative parameters, postoperative complications, pathological changes, and 90‐day mortality.

Results

In total, 25 patients achieved R0 resection. Eleven (44%) patients completed surgery by thoracotomy, and three (12%) procedures were changed from minimally invasive procedures due to dense adhesions of hilar lymph nodes, which rendered it difficult to dissect the blood vessels. Thirteen (52%) patients achieved a major pathological response (MPR) with eight (32%) of these patients having a pathological complete response (pCR). Twenty‐two (88%) patients showed radiological regression, and three (12%) patients had stable disease. The median drainage time was 8.50 (3–27) days. Thirteen (52%) postoperative complications were observed, but none were above grade 3.

Conclusions

In this study, neoadjuvant chemoimmunotherapy was found to reduce tumor volume, cause pathological downstaging, and raise the surgical resection rate of patients with locally advanced NSCLC, and achieve a 100% R0 resection rate. There was an acceptable rate of postoperative complications. Thus, neoadjuvant chemoimmunotherapy is safe and practical.
‘For me, it didn’t seem as drastic a step as being controlled by insulin’: A qualitative investigation of expectations and experiences of non‐insulin injectable therapy among adults with type 2 diabetes
Authors: Holmes‐Truscott Elizabeth , Schipp Jasmine , Dunning Trisha , Furler John , Hagger Virginia , Holloway Edith E. , Manski‐Nankervis Jo‐Anne , Shaw Jonathan E. , Skinner Timothy , Speight Jane
Published: August 2021

Aims

This qualitative study aims to explore beliefs, attitudes and experiences of injectable glucagon‐like‐peptide‐1 receptor agonists (GLP‐1RAs) use and discontinuation, as well as attitudes to further injectable treatment intensification, among adults with type 2 diabetes (T2D).

Methods

Nineteen in‐depth semi‐structured interviews lasting (mean ± standard deviation) 45 ± 18 min were conducted, face‐to‐face (n = 14) or via telephone (n = 5). Transcripts were analysed using inductive template analyses. Eligible participants were English‐speaking adults with T2D who had recently initiated (≤3 years) GLP‐1RA treatment.

Results

Participants were aged 28–72 years, who predominantly lived in metropolitan areas (n = 15), and had an experience of daily (n = 11) and/or once‐weekly (n = 13) GLP‐1RA formulations. Six participants had discontinued treatment and seven had trialled two or more formulations. Expectations and experiences of GLP‐1RA were related to the perceived: (1) symbolism and stigma of injectable diabetes treatment; (2) ease of injectable administration and device preferences; (3) treatment convenience and social impact; (4) treatment efficacy and benefits, and; (5) negative treatment side effects. Some participants reported increased receptiveness to insulin therapy following their GLP‐1RA experience, others emphasised unique concerns about insulin beyond injectable administration.

Conclusions

This study provides a novel understanding of expectations and experience of non‐insulin injectables among Australian adults with T2D. Our data suggest expectations may be informed by attitudes to insulin therapy, while perceived treatment benefits (e.g. weight‐related benefits, administration frequency) may motivate uptake and ongoing use despite concerns. Experience of GLP‐1RA injections may impact receptiveness to future insulin use.
Efficacy and safety of liraglutide in type 1 diabetes by baseline characteristics in the ADJUNCT ONE and ADJUNCT TWO randomized controlled trials
Authors: Dejgaard Thomas F. , von Scholten Bernt J. , Christiansen Erik , Kreiner Frederik F. , Bardtrum Lars , von Herrath Matthias , Mathieu Chantal , Madsbad Sten ,   ADJUNCT ONE and ADJUNCT TWO Investigators
Published: August 2021

Aim

To evaluate 26 weeks of liraglutide treatment in type 1 diabetes (T1D) by subgroups in the ADJUNCT ONE and ADJUNCT TWO trials.

Materials and Methods

ADJUNCT ONE and ADJUNCT TWO were randomized controlled phase 3 trials in 1398 and 835 participants with T1D treated with liraglutide (1.8, 1.2, or 0.6 mg) or placebo (adjuncts to insulin). This post hoc analysis evaluated treatment effects by subgroups: HbA1c (< or ≥8.5%), body mass index (BMI; < or ≥27 kg/m2), and insulin regimen (basal bolus or continuous subcutaneous insulin infusion).

Results

In both trials at week 26, reductions in HbA1c, body weight, and daily insulin dose did not differ significantly (P > .05) by baseline HbA1c or BMI. Risk of clinically significant hypoglycaemia or hyperglycaemia with ketosis did not differ significantly (P > .05) by baseline HbA1c, BMI, or insulin regimen. At week 26 in ADJUNCT ONE, these risks did not differ (P > .05) between treatment groups. Placebo‐adjusted reductions in HbA1c, body weight, and insulin dose (−0.30%‐points, −5.0 kg, and −12%, respectively, with liraglutide 1.8 mg), were significant (P < .05), greater than at week 52, and similar to those in ADJUNCT TWO (−0.35%, −4.8 kg, and −10%, respectively, with liraglutide 1.8 mg).

Conclusions

In ADJUNCT ONE and ADJUNCT TWO, the efficacy and glycaemic safety of liraglutide did not depend on subgroups, leaving residual beta‐cell function as the only identified variable impacting the effect of glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) in T1D. These findings support a role for GLP‐1 RAs as adjuncts to insulin in T1D, warranting further study.
Glycaemic efficacy of an expanded dose range of dulaglutide according to baseline glycated haemoglobin (HbA1c) subgroup: Post hoc analysis of AWARD‐11
Authors: Frias Juan P. , Bonora Enzo , Cox David A. , Bethel M. Angelyn , Kwan Anita Y.M. , Raha Sohini , Malik Raleigh E.
Published: August 2021

The AWARD‐11 trial demonstrated the safety and efficacy of dulaglutide 3.0 and 4.5 mg compared to dulaglutide 1.5 mg in patients with type 2 diabetes inadequately controlled with metformin. This post hoc analysis examined the change from baseline in glycated haemoglobin (HbA1c) and proportions of patients achieving HbA1c <7% at weeks 36 and 52 with dulaglutide 1.5 mg, 3.0 mg or 4.5 mg across clinically relevant baseline HbA1c subgroups (<8%; 8.0% to < 9.0%; 9.0% to < 10%; and ≥ 10%). Mean reductions in HbA1c were observed across all baseline HbA1c subgroups at 36 weeks (range of HbA1c change: 1.5 mg: −1.0% to −2.2%; 3.0 mg: −1.2% to −2.5%; and 4.5 mg: −1.2% to −3.2%). More patients randomized to 3.0 mg or 4.5 mg (vs. 1.5 mg) achieved HbA1c <7% at 36 weeks regardless of baseline HbA1c; the difference in proportions was greater at higher baseline HbA1c (P‐interaction = 0.096). Similar patterns in glycaemic improvement and proportions achieving HbA1c <7% were observed at 52 weeks. Hypoglycaemia and gastrointestinal adverse events were similar among the HbA1c subgroups. Glycaemic control was improved with dulaglutide dose escalation from 1.5 mg to 3.0 mg or 4.5 mg across baseline HbA1c subgroups (<8%; 8.0% to < 9.0%; 9.0% to < 10%; and ≥ 10%).
Do U.S. firms disguise acquisitions to avoid taxes?
Authors: Harris Jeremiah , O'Brien William
Published: August 2021

Our study finds evidence consistent with U.S. multinational firms disguising domestic acquisitions as corporate reorganizations to avoid repatriation‐related taxes. We find that a combination of high potential repatriation costs and large overseas earning balances is positively associated with domestic acquisition volume, but only in deals with low visibility to regulators and investors. Consistent with repatriations of overseas cash, these firms’ low visibility acquisitions (but not their higher visibility counterparts) are associated with 4%–7% lower overseas earnings balances. After a 2017 tax reform reduced the value of this technique, the positive relation between low visibility acquisitions and repatriation costs disappears or reverses.
Risk‐Based Wellhead Protection Decision Support: A Repeatable Workflow Approach
Authors: Fienen Michael N. , Corson‐Dosch Nicholas T. , White Jeremy T. , Leaf Andrew T. , Hunt Randall J.
Published: August 2021

Environmental water management often benefits from a risk‐based approach where information on the area of interest is characterized, assembled, and incorporated into a decision model considering uncertainty. This includes prior information from literature, field measurements, professional interpretation, and data assimilation resulting in a decision tool with a posterior uncertainty assessment accounting for prior understanding and what is learned through model development and data assimilation. Model construction and data assimilation are time consuming and prone to errors, which motivates a repeatable workflow where revisions resulting from new interpretations or discovery of errors can be addressed and the analyses repeated efficiently and rigorously. In this work, motivated by the real world application of delineating risk‐based (probabilistic) sources of water to supply wells in a humid temperate climate, a scripted workflow was generated for groundwater model construction, data assimilation, particle‐tracking and post‐processing. The workflow leverages existing datasets describing hydrogeology, hydrography, water use, recharge, and lateral boundaries. These specific data are available in the United States but the tools can be applied to similar datasets worldwide. The workflow builds the model, performs ensemble‐based history matching, and uses a posterior Monte Carlo approach to provide probabilistic capture zones describing source water to wells in a risk‐based framework. The water managers can then select areas of varying levels of protection based on their tolerance for risk of potential wrongness of the underlying models. All the tools in this workflow are open‐source and free, which facilitates testing of this repeatable and transparent approach to other environmental problems.
Primary headaches among gender dysphoric female‐to‐male individuals: A cross‐sectional survey on gender transition experience
Authors: Yalinay Dikmen Pınar , Ertas Mustafa , Kosak Seda , Cimentepe Cagrı , Kocoglu Mahmut , Oztosun Gulsen , Direk Tecirli Nese , Onur Aysevener Elif
Published: August 2021

Objective

To investigate the frequency, attack characteristics, and treatment experiences of migraine and tension‐type headache (TTH) among gender dysphoric female‐to‐male (FtM) participants as well as in relation to psychiatric comorbidities and real‐life experience that relates to being transgender in Turkey.

Background

There are only a few publications to date on transgender individuals with headache. Further studies to understand the distinctive needs might provide better management.

Methods

A total of 88 gender dysphoric FtM individuals (mean (SD) age: 24.8 (5.7) years) were included on a voluntary basis in this cross‐sectional survey. Each participant filled out the questionnaire form that elicited items on sociodemographic characteristics, Gender Identity Transition Inventory, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Headache Questionnaire.

Results

Overall, 32/88 (36.4%; 95% confidence interval [CI]: 27.0%–47.0%) participants were diagnosed with migraine, and 36/88 (40.9%; 95% CI: 31.5%–52.3%) participants were diagnosed with TTH. High rates of unemployment, smoking, and social drinking were observed in our sample compared with the general population in Turkey. The three‐item ID migraine screener was positive in 20.5% (18/88 patients) of our population. Patients with migraine in comparison with patients with TTH had statistically significantly higher BDI [12.0 (1–50) vs. 7.0 (0–33); p = 0.013] and BAI [13 (1–48) vs. 5 (0–22); p = 0.016] scores, longer headaches in the past month [median 3 vs. 1 day; p < 0.001], higher Numerical Rating Scale scores for headache severity [7 (2–10) vs. 5 (1–9), p < 0.001], and higher likelihood of menstruation acting as a triggering factor [8/32 patients (25.0%) vs. 0/36 patients (0.0%); p = 0.001] as well as increased rates of previously given diagnosis by a physician [15/32 patients (46.9%) vs. 4/36 patients (11.1%); p < 0.001], a greater number of neuroimaging tests being performed [12/32 patients (37.5%) vs. 3/36 patients (9.1%); p = 0.012], and a higher rate of emergency room utilization [7/32 patients (21.9%) vs. 1/36 patients (2.8%); p = 0.039] for headache.

Conclusions

In the FtM transgender population we investigated, migraine and TTH were quite common. The screening and early recognition of comorbid migraine, as well as the comorbid depression and anxiety, seem to be important in gender dysphoric FtM individuals. Further studies are needed to better understand the potential interaction of migraine with comorbid psychiatric disorders and the prevalence of headache types and gender‐affirmative hormone treatment outcomes in the transgender population.
High thermoelectric performance of (Bi1‐xPrx)2(Te0.9Se0.1)3 alloys prepared by high‐pressure sintering method
Authors: Zou Ping , Lv Dan , Xu Guiying
Published: August 2021

In this article, n‐type (Bi1‐xPrx)2(Te0.9Se0.1)3 (x = 0, .002, .004, .008) alloys were fabricated by high‐pressure sintering (HPS) method together with annealing. The effect of high pressure and Pr contents on the microstructure and thermoelectric performance of samples were explored in detail. The results show that the HPS samples are composed of nanoparticles. Pr doping has significant impacts on the electrical and thermal transport properties of the Bi2Te2.7Se0.3 alloys. The HPS sample with x = .004 shows the maximum ZT value of .31 at 473 K, which is enhanced by 41% to compare with the Pr‐free sample. Annealing can improve the thermoelectric properties by increasing the electrical transport properties and decreasing the thermal conductivity simultaneously. As a result, the highest ZT value of 1.06 is achieved for the annealed sample with x = .004 at 373 K, which is beneficial to the thermoelectric power generation.
A Critical Review of LASSO and Its Derivatives for Variable Selection Under Dependence Among Covariates
Authors: Freijeiro‐González Laura , Febrero‐Bande Manuel , González‐Manteiga Wenceslao
Published: August 2021

The limitations of the well‐known LASSO regression as a variable selector are tested when there exists dependence structures among covariates. We analyse both the classic situation withn≥pand the high dimensional framework withp > n. Known restrictive properties of this methodology to guarantee optimality, as well as inconveniences in practice, are analysed and tested by means of an extensive simulation study. Examples of these drawbacks are showed making use of different dependence scenarios. In order to search for improvements, a broad comparison with LASSO derivatives and alternatives is carried out. Eventually, we give some guidance about what procedures work best in terms of the considered data nature.
Nurse anesthetist attitudes towards parental presence during anesthesia induction‐ a nationwide survey
Authors: Andersson Lisbet , Almerud Österberg Sofia , Årestedt Kristofer , Johansson Pauline
Published: August 2021

Aims

To describe nurse anesthetists’ attitudes towards the importance of parental presence during their child's anaesthesia induction and to explore associating factors.

Design

A cross‐sectional design.

Methods

Nurse anesthetists from 55 Swedish hospitals were asked to participate (n = 1,285). A total of 809 completed the questionnaire, Families' Importance in Nursing Care‐Nurses' Attitudes (FINC‐NA) during 2018. Data were analysed by descriptive statistics and multiple linear regression analysis.

Results

Nurse anesthetists generally had a positive attitude towards the importance of parental presence. They reported a more positive attitude in family as a resource in nursing care (median = 40) followed by family as a conversational partner (median = 25), family not as a burden (median = 17) and family as its own resource (median = 13). Multiple linear regression analyses showed that working in a district hospital, working only with children, having routines/memorandum about parental presence, being a woman, allowing both parents to be present in their child's anaesthesia and greater experience of children's anesthesia, were associated with a more positive attitude.

Conclusion

This nationwide survey contributes important knowledge for understanding nurse anesthetists' attitudes and the result shows that nurse anesthetists generally have a positive attitude towards the importance of parents. Areas of improvement were, however, identified; the nurses tend to not value family as its own resource and family as a conversational partner highly.

Impact

Nurse anesthetists have a crucial role in children's anesthesia care since the quality of parental presence experience depends on a positive attitude from the nurses. Parental involvement is important to establish a child‐centered anaesthesia care, which should be highlighted in the education of nurse anesthetists. Parental involvement should also be addressed in healthcare policies and routines should be established.
Comparison of the levels of 25(OH) vitamin D3 in women with gestational diabetes mellitus and normoglycemic pregnant women
Authors: Teotia Nikunj , Singh Amrita , Kunwar Shipra , Kumari Shweta , Rathore Brijesh Singh
Published: August 2021

Introduction

Gestational diabetes mellitus (GDM) is a public health problem that currently affects a large part of the female population and has short‐ and long‐term consequences for the fetus and the mother. It has been reported that GDM affects 1%–14% of all pregnancies, and that its incidence has been steadily rising. In recent years while exploring the etiological factors responsible for the emergence of insulin resistance particularly that of transient nature, vitamin D has emerged as one of the possible factors. Although systematic review and metaanalysis of observational studies show that low blood vitamin D level during pregnancy is associated with 1.8 times higher odds of GDM as compared to those having normal blood vitamin D levels; however, individual observational studies about maternal vitamin D status and risk of GDM are conflicting,

The aim of this study is to compare the levels of 25(OH) vitamin D in women with gestational diabetes mellitus and normoglycemic pregnant women to assess the pathogenic role of vitamin D in the causation of GDM.

Materials and Methods

This study was conducted in the Department of Obstetrics and Gynecology, Era's Lucknow Medical College and Hospital (ELMCH), Lucknow from December 2018 to November 2020 The present study was an analytical case–control study, in which a total of 30 pregnant women in 24–28 weeks of gestation diagnosed as GDM using Diabetes in Pregnancy Study Group criteria were enrolled as cases while another 30 pregnant women in same gestational age range with normoglycemic profile were enrolled as controls. The 25(OH)D levels were assessed by the chemiluminecence immunoassay. The statistical analysis was performed using SPSS (Statistical Package for Social Sciences) Version 21.0.

Results

On multivariate analysis, vegetarian diet and GDM were found to be significantly associated with vitamin D deficiency. The present study endorsed the relationship between vitamin D deficiency and GDM and showed a high prevalence of vitamin D deficiency, and that too at severe level could result in GDM. Appropriate awareness and intervention strategies are warranted on a larger sample.
Evaluating the renal safety of tenofovir disoproxil fumarate in hepatitis B patients without chronic kidney disease
Authors: Tsai Hsin‐Ju , Chuang Ya‐Wen , Yang Sheng‐Shun , Chang Yan‐Zin , Chang Horng‐Rong , Lee Teng‐Yu
Published: August 2021

The nephrotoxicity of tenofovir disoproxil fumarate (TDF) in chronic hepatitis B (CHB) patients without chronic kidney disease (CKD) remains controversial. We aimed to evaluate nephrotoxicity of TDF in this population. In this hospital‐based cohort study, CHB patients who received either TDF or entecavir (ETV) therapy, and did not have underlying CKD, were retrospectively recruited from January, 2008 to January, 2019. After excluding those with confounding conditions, 257 TDF‐treated patients were matched through propensity scores with 514 ETV‐treated patients. Cumulative incidences of, and hazard ratios (HRs) for the CKD guideline‐defined renal dysfunction, were analysed. The mean decline in glomerular filtration rate was similar over 60 months (TDF vs. ETV: 10.1 ml/min/1.73 m2, 95% confidence interval [CI]: 7.4–12.7 vs. 8.0 ml/min/1.73 m2, 95% CI: 6.4–9.6; p = .34). The 5‐year cumulative incidence of renal dysfunction was not significantly different (TDF vs. ETV: 10.4%, 95% CI: 5.6–18.0 vs. 5.8%, 95% CI: 3.6–9.0; p = .18). However, in multivariable stratified analysis, TDF was associated with an increased risk of renal dysfunction in the elderly (age ≥60 years), when compared to ETV (HR 2.86, 95% CI: 1.02–8.01; p < .05). For confirming the effect of TDF amongst the elderly, 61 TDF‐treated patients were further matched with 183 ETV‐treated patients, with 5‐year cumulative incidence of renal dysfunction being significantly higher in TDF users (TDF vs. ETV: 34.4%, 95% CI: 17.7–59.8 vs. 15.5%, 95% CI: 9.4–25.1; p < .05). TDF use was independently related to renal dysfunction (HR 2.71, 95% CI: 1.19–6.14; p < .05). Although TDF is generally safe for CHB patients without CKD, it is best to be avoided in the elderly.
Baseline HBV‐DNA load plus AST/ALT ratio predicts prognosis of HBV‐related hepatocellular carcinoma after hepatectomy: A multicentre study
Authors: Shen Junyi , Dai Junlong , Zhang Yu , Xie Fei , Yu Yu , Li Chuan , Wen Tianfu
Published: August 2021

Hepatitis B viral (HBV) load and hepatic enzymes play a critical role in hepatocellular carcinoma (HCC) development. However, the clinical significance of these in HBV‐related HCC patients after hepatectomy remains unclear. In this study, we analysed 1,940 HBV‐related HCC patients who underwent hepatectomy from four hospitals in west China. Risk classification was constructed based on baseline HBV‐DNA load and AST/ALT ratio. Based on the HBV‐DNA load and AST/ALT ratio classification, four types with distinguishable prognoses were established. Type 1 patients had the best prognosis with 5‐year overall survival (OS) of 69.8%, followed by type 2 and type 3 patients, whereas type 4 patients had the worst prognosis with 5‐year OS of 42.7%. Similarly, the four types had statistically different recurrence‐free survival. This classification was significantly associated with HCC recurrence (hazard ratio [HR]:1.492, p < .001) and long‐term survival (HR: 1.574, p = .001). Pathologically, type 4 correlated with more advanced tumours considering tumour size and microvascular invasion than those in type 1, 2, or 3. Moreover, type 4 patients had more severe hepatic inflammation in underlying liver. Conversely, type 1 patients had an active tumour immune microenvironment as indicated by more CD8+ T cell infiltration and less PD‐L1 expression. In conclusion, the classfication based on baseline HBV‐DNA load and AST/ALT ratio could effectively stratify HBV‐related HCC patients with distinguishable prognoses after hepatectomy.
Linking functional diversity, trait composition, invasion, and environmental drivers in boreal wetland plant assemblages
Authors: Allen Brandon E. , Azeria Ermias T. , Bried Jason T.
Published: August 2021

Questions

A range of landscape and local environmental factors, including invasion, interact with species functional diversity and trait composition to shape biodiversity patterns and ecosystem function of wetlands. A trait‐based, mechanistic understanding of community assembly holds promise for wetland conservation, but this has been rarely examined across scales. We examined: (a) the relative influence of climate, landscape matrix, and local physicochemistry on invasion intensity and functional diversity in boreal wetland plant assemblages; and (b) the ecological traits linked to these environmental factors.

Location

One hundred fifty‐three wetlands across the Boreal Forest of Alberta, Canada.

Methods

We used data on invasion intensity, using two terrestrial invaders (Sonchus arvensis and Cirsium arvense), and environmental factors at local and landscape levels. We used eight traits from 366 vascular plants to assess functional diversity and invasion responses to environmental gradients (generalized linear models) and individual species trait–environment relationships (community‐weighted mean redundancy analysis, fourth‐corner analysis).

Results

Landscape matrix and the degree of invasion were the primary drivers of functional diversity, while invasion intensity was driven by physicochemistry and functional diversity. Community trait–environment patterns clearly separated wetlands by invasion status. Uninvaded wetlands were surrounded by lowland conifers and composed of stress‐tolerant associated traits, while invaded wetlands contained high levels of disturbance and traits associated with high resource availability and reproduction rates. This division was further supported by individual trait–environment relationships.

Conclusions

Landscape matrix was the dominant driver of functional diversity and composition pattern, while the local physicochemistry and surrounding land‐cover matrix helped explain invasion. Our analysis revealed some of the mechanistic relationships shaping plant community assembly across boreal wetlands, information that can help resource managers identify, predict, and alleviate possible threats from landscape anthropogenic disturbances to wetland ecological integrity.
More than merely verbal disputes
Authors: Miranda Vilchis Rogelio
Published: August 2021

It is fundamental that, in philosophy, we make sure that we are not mistaking merely verbal disputes, or “conceptual” disputes, for substantive ones. This essay presents a tripartite framework that is useful for clarifying cases where it is difficult to tell whether we are engaged in substantive or non‐substantive disputes. For this purpose, the essay offers some combinatorial possibilities between the following levels: verbal, conceptual, and objectual. We need to distinguish whether we are arguing about the world, concepts, or words to avoid talking at cross‐purposes and to recognize when our disputes are not worth the time. Distinguishing between these three levels can also throw light and guide research on conceptual engineering, metalinguistic negotiations, metaontology, and so on.
How and why to express the emotions: A taxonomy of emotional expression with historical illustrations
Authors: Bennett Christopher
Published: August 2021

Recent writing on the expression of emotion has explored the idea that there is a symbolic dimension to many “expressive actions.” This paper aims to situate and better understand the “symbolic expression” account by exploring its position in a framework of views from the history of philosophy regarding emotion, action out of emotion, and their place in the good human life. The paper discusses a number of competing views that can be found in this tradition, ranging from irrationalism, through irenicism, self‐externalization, and cognitivism to the symbolist tradition itself. In looking specifically at the roots of symbolism, the paper departs from the common view that Aristotelianism is the central tradition, for us, of thinking about philosophy of the emotions. It suggests that we can get a better grip on the source of these ideas by looking rather at how thinkers in the post‐Kantian and Romantic tradition wrestled with the question of the freedom and rationality of behaviour out of emotion.
A phenomenological reflection on women's lived experience of giving in circumstances of material scarcity
Authors: Emerson Amanda M.
Published: August 2021

There is a robust body of research that examines problems women with criminal‐legal system involvement face, the support they need, how they get it, from whom, and how they use it. Rarely do we pause to consider what resources such women already have, the support they give, or what those experiences teach us about how to support them. In this study, my purpose was to reflect on the phenomenon of giving as experienced by women who have few material resources and whose lives have been disrupted by repeat incarcerations. I analyzed four lived experience descriptions of giving from interviews conducted in 2016–2017 with 10 women who had significant histories of criminal‐legal system involvement, unstable housing, and little or no income. Using concepts from hermeneutic phenomenology and the practice of phenomenological study described by Max Van Manen, I analyzed giving wholistically, selectively, and in detail. I discerned that the women's experience of giving was relationally structured as exchange, with both past and future aspects. In selective and detailed analysis, themes of “taking in” and “being there” and a gem or essential feature of automaticity/personhood presented themselves. Women found meaning, value, and a sense of belonging in giving to others even when they struggled to meet their own needs. The findings suggest potential directions for nursing practice, research, and advocacy, including work to recognize, build on, and remunerate women's affiliative care‐giving and support—while also putting pressure on community health and social services delivery systems to better serve those in need.
Ethnic minority patients in healthcare from a Scandinavian welfare perspective: The case of Denmark
Authors: Halberg Nina , Larsen Trine S. , Holen Mari
Published: August 2021

The Scandinavian welfare states are known for their universal access to healthcare; however, health inequalities affecting ethnic minority patients are prevalent. Ethnic minority patients' encounters with healthcare systems are often portrayed as part of a system that represents objectivity and neutrality. However, the Danish healthcare sector is a political apparatus that is affected by policies and conceptualisations. Health policies towards ethnic minorities are analysed using Bacchi's policy analysis, to show how implicit problem representations are translated from political and societal discourses into the Danish healthcare system. Our analysis shows that health policies are based on different ideas of who ethnic minority patients are and what kinds of challenges they entail. Two main issues are raised: First, ethnic minorities are positioned as bearers of ‘culture’ and ‘ethnicity’. These concepts of ‘othering’ become both explanations for and the cause of inappropriate healthcare behaviour. Second, the Scandinavian welfare states are known for their solidarity, collectivism, equality and tolerance, also grounded in a postracial, colour‐blind and noncolonial past ideology that forms the societal self‐image. Combined with the ethical and legal responsibility of healthcare professionals to treat all patients equally, our findings indicate little leeway for addressing the discrimination experienced by ethnic minority patients.
Treatment utilization and drug survival of systemic medications among commercially insured children with psoriasis
Authors: Wan Joy , Shin Daniel B. , Gelfand Joel M.
Published: August 2021

Background/Objectives

Systemic medications and phototherapy are used to treat pediatric psoriasis, but real‐world data on treatment utilization and persistence are limited. The study objective was to determine systemic and phototherapy treatment utilization and compare drug survival among systemics in pediatric psoriasis.

Methods

Using United States commercial insurance claims data, a cross‐sectional analysis was conducted to describe the prevalence of systemic treatment and phototherapy use among patients <18 years old with psoriasis. We compared drug survival among new users of methotrexate, adalimumab, etanercept, and ustekinumab using a retrospective cohort design.

Results

Among 13 759 patients, 14.6% used systemic or phototherapy treatment during 2001‐2016, with rising utilization of systemics over this period. Among 579 new users of methotrexate, adalimumab, etanercept, and ustekinumab, the median durations of the initial treatment course were 141 (IQR 59‐314), 179 (79‐339), 175 (90‐419), and 216 (64‐435) days, respectively (P = .04). Drug discontinuation was less likely among ustekinumab (HR 0.47 [95% CI 0.27‐0.83]), etanercept (0.74 [0.59‐0.92]), and adalimumab (0.75 [0.55‐1.02]) initiators than methotrexate initiators after adjustment for sociodemographic factors and psoriatic arthritis. Drug survival differences were limited to systemic‐naïve patients. Potential limitations include short follow‐up and residual confounding.

Conclusions

Utilization of systemic therapies for pediatric psoriasis is increasing, but differences in drug survival exist.
The psychobiological links between chronic stress‐related diseases, periodontal/peri‐implant diseases, and wound healing
Authors: Decker Ann M. , Kapila Yvonne L. , Wang Hom‐Lay
Published: August 2021

Chronic stress is a relevant disease to periodontal practice, encompassing 25%‐28% of the US population (American Psychological Association 2015). While it is well established that chronic psychologic stress can have significant deleterious systemic effects, only in recent decades have we begun to explore the biochemical, microbial, and physiologic impacts of chronic stress diseases on oral tissues. Currently, chronic stress is classified as a “risk indicator” for periodontal disease. However, as the evidence in this field matures with additional clinically controlled trials, more homogeneous data collection methods, and a better grasp of the biologic underpinnings of stress‐mediated dysbiosis, emerging evidence suggests that chronic stress and related diseases (depression, anxiety) may be significant contributing factors in periodontal/peri‐implant disease progression and inconsistent wound healing following periodontal‐related therapeutics. Ideal solutions for these patients include classification of the disease process and de‐escalation of chronic stress conditions through coping strategies. This paper also summarizes periodontal/implant‐related therapeutic approaches to ensure predictable results for this specific patient subpopulation.
Myeloid‐derived suppressor cells in obesity‐associated periodontal disease: A conceptual model
Authors: Kwack Kyu Hwan , Maglaras Victoria , Thiyagarajan Ramkumar , Zhang Lixia , Kirkwood Keith L.
Published: August 2021

Periodontitis is a common chronic inflammatory disease characterized by destruction of the supporting structures of the teeth. Severe periodontitis is highly prevalent—affecting 10%‐15% of adults—and carries several negative comorbidities, thus reducing quality of life. Although a clear relationship exists between severity of obesity and incidence of periodontal disease, the biologic mechanisms that support this link are incompletely understood. In this conceptual appraisal, a new “two‐hit” model is presented to explain obesity‐exacerbated periodontal bone loss. This proposed model recognizes a previously unappreciated aspect of myeloid‐derived suppressor cell population expansion, differentiation, and activity that can participate directly in periodontal bone loss, providing new mechanistic and translational perspectives.
Paradigm shift in the pathogenesis and treatment of oral cancer and other cancers focused on the oralome and antimicrobial‐based therapeutics
Authors: Radaic Allan , Ganther Sean , Kamarajan Pachiyappan , Grandis Jennifer , Yom Sue S. , Kapila Yvonne L.
Published: August 2021

The oral microbiome is a community of microorganisms, comprised of bacteria, fungi, viruses, archaea, and protozoa, that form a complex ecosystem within the oral cavity. Although minor perturbations in the environment are frequent and compensable, major shifts in the oral microbiome can promote an unbalanced state, known as dysbiosis. Dysbiosis can promote oral diseases, including periodontitis. In addition, oral dysbiosis has been associated with other systemic diseases, including cancer. The objective of this review is to evaluate the epidemiologic evidence linking periodontitis to oral, gastrointestinal, lung, breast, prostate, and uterine cancers, as well as describe new evidence and insights into the role of oral dysbiosis in the etiology and pathogenesis of the cancer types discussed. Finally, we discuss how antimicrobials, antimicrobial peptides, and probiotics may be promising tools to prevent and treat these cancers, targeting both the microbes and associated carcinogenesis processes. These findings represent a novel paradigm in the pathogenesis and treatment of cancer focused on the oral microbiome and antimicrobial‐based therapies.
Environmental Ethics: The State of the Question
Authors: Hourdequin Marion
Published: August 2021

Environmental ethics, as an academic field, was born out of professional philosophers' frustrations with anthropocentrism. In particular, philosophers such as Richard Sylvan and Holmes Rolston III found that canonical Western philosophy overlooked important questions regarding human relations to nonhuman animals and the broader world. Because many other traditions attend more closely to these relations, it is helpful to contextualize the initial development of academic environmental ethics as a critical response to a particular kind of deficiency characteristic of the Western tradition. In recent decades, the field has grown and broadened, and a more pluralistic, interdisciplinary, intercultural, and intersectional environmental ethics is emerging. This article traces developments in the field of environmental ethics during the last fifty years, beginning with discussions of the value of nature, deep ecology, the land ethic, environmental virtue ethics, and environmental pragmatism. Next, I turn to approaches that integrate social and environmental concerns through lenses that consider power dynamics and challenge relations of domination and oppression, bringing into focus questions of environmental and ecological justice. The final section considers some of the distinctive challenges associated with what some have dubbed “the Anthropocene,” noting that the nature and designation of this epoch remain contested.