bluuebunny/crossref_metadata_2025 huggingface dataset:
Disciplining entrenched managers through corporate governance reform: Implications for risk‐taking behavior
Authors: Pryshchepa Oksana
Published: March 2021

Research question/issue This paper examines how enhanced monitoring by corporate boards following the passage of the Sarbanes–Oxley Act of 2002 and concurrent reforms to stock exchange rules (SOX) mitigated risk‐related agency conflicts prevalent in entrenched firms.

Research findings/insights Post‐SOX, entrenched firms increased risky and value‐enhancing investments. These investments were financed by reductions in financial slack and dividend payouts and by lower cost of debt. The specific mechanism driving the positive changes in corporate policies of entrenched firms is the SOX requirement of an independent compensation committee. Managers of entrenched firms previously noncompliant with this requirement are rewarded with more equity‐based pay after SOX, which strengthened their incentives to pursue value‐creating riskier investments. Only firms with low information asymmetry benefit from this requirement.

Theoretical/academic implications The paper provides evidence of a disciplining effect of the critically important governance legislation on firms with entrenched management. The findings suggest that, by imposing an additional layer of discipline on managers, SOX increased managers' willingness to take on riskier but more value‐enhancing projects that were previously stifled in entrenched firms. The paper underscores the roles of an independent compensation committee and information cost in alleviating managerial risk avoidance.

Practitioner/policy implications The paper has implications for the ongoing debate among policymakers and legislators on the costs and benefits of SOX and for future governance reforms. Legal enforcement of stricter board requirements can realign investment policies with shareholders' interests even in the presence of value‐reducing firm‐specific arrangements that entrench managers. However, majority independent board and fully independent audit and compensation committees do not rein in chief executive officer (CEO)'s risk aversion. It is a fully independent compensation committee that is instrumental in incentivizing CEOs to pursue risky projects that also add value. Firms and policymakers need to be aware that the effectiveness of the independent compensation committee in designing optimal pay policies depends on the access to timely and accurate information. Other mechanisms need to be considered to enhance risk‐taking in entrenched firms operating in high cost information environments.
Immunosuppressive effect of mesenchymal stem cells on lung and gut CD8+ T cells in lipopolysaccharide‐induced acute lung injury in mice
Authors: Xu Yanping , Zhu Jiaqi , Feng Bing , Lin Feiyan , Zhou Jiahang , Liu Jingqi , Shi Xiaowei , Lu Xuan , Pan Qiaoling , Yu Jiong , Zhang Ying , Li Lanjuan , Cao Hongcui
Published: March 2021

Objectives

Acute lung injury (ALI) not only affects pulmonary function but also leads to intestinal dysfunction, which in turn contributes to ALI. Mesenchymal stem cell (MSC) transplantation can be a potential strategy in the treatment of ALI. However, the mechanisms of synergistic regulatory effects by MSCs on the lung and intestine in ALI need more in‐depth study.

Materials and methods

We evaluated the therapeutic effects of MSCs on the murine model of lipopolysaccharide (LPS)‐induced ALI through survival rate, histopathology and bronchoalveolar lavage fluid. Metagenomic sequencing was performed to assess the gut microbiota. The levels of pulmonary and intestinal inflammation and immune response were assessed by analysing cytokine expression and flow cytometry.

Results

Mesenchymal stem cells significantly improved the survival rate of mice with ALI, alleviated histopathological lung damage, improved intestinal barrier integrity, and reduced the levels of inflammatory cytokines in the lung and gut. Furthermore, MSCs inhibited the inflammatory response by decreasing the infiltration of CD8+ T cells in both small‐intestinal lymphocytes and Peyer's patches. The gut bacterial community diversity was significantly altered by MSC transplantation. Furthermore, depletion of intestinal bacterial communities with antibiotics resulted in more severe lung and gut damages and mortality, while MSCs significantly alleviated lung injury due to their immunosuppressive effect.

Conclusions

The present research indicates that MSCs attenuate lung and gut injury partly via regulation of the immune response in the lungs and intestines and gut microbiota, providing new insights into the mechanisms underlying the therapeutic effects of MSC treatment for LPS‐induced ALI.
Desarrollo de ecuaciones y software para la estimación de peso en niños y niñas con parálisis cerebral
Authors: Ruiz Brunner Maria de las Mercedes , Cieri Maria Elisabeth , Butler Charlene , Cuestas Eduardo
Published: March 2021

Objetivo

Desarrollar ecuaciones y software para estimar peso usando medidas de segmentos corporales en niños con parálisis cerebral (PC).

Método

Este fue un estudio transversal. Se incluyeron niños y adolescentes con PC de ambos sexos de 2 a 19 años de cinco ciudades de Argentina. Se recolectó el peso, la circunferencia media del brazo (CMB) y covariables clínicas. Se desarrollaron modelos de regresión lineal con el peso como variable dependiente y las medidas de los segmentos corporales como predictores, y se compararon paraR2,R2ajustado y la raíz cuadrada media del error.

Resultados

En total, se incluyeron 381 niños y adolescentes con diagnóstico confirmado de PC (edad media 10 años y 5 meses [DE 4 años 9 meses], rango de 2 a 19 años; 231 hombres, 150 mujeres). La función motora gruesa basada en el Sistema de clasificación de función motora gruesa (GMFCS) fue la siguiente: nivel I, 59; II, 55; III, 59; IV, 69; V, 139. Se analizó la interacción entre el peso y otras variables como CMB, sexo, GMFCS y edad. El coeficiente de correlación de concordancia entre el peso estimado y el observado fue de 0,94 (IC 95%: 0,93–0,95). A partir de los resultados de las ecuaciones, se desarrolló una herramienta de software gratuita, denominada Calculador de Peso PC.

Interpretación

El peso de los niños con parálisis cerebral se puede predecir utilizando CMB, GMFCS y edad. Calculador de Peso PC se puede utilizar en la práctica clínica cuando no se puede obtener el peso directo.

Lo que agrega este artículo

Se pueden utilizar ecuaciones para estimar el peso en niños con parálisis cerebral a través de segmentos corporales.

El peso se puede estimar considerando la edad y la función motora gruesa.

La diferencia promedio entre los pesos estimados y observados fue de 119g.
Effect of secretions from the ant species Camponotus compressus and Messor himalayanus on Bactrocera dorsalis
Authors: Abbas Khalid , Shah Zaib Muhammad , Zakria Muhammad , Zaka Syed Muhammad , Hameed Yasir , Sarmad Muhammad , Zia Ahmed , Wang Man Qun
Published: March 2021

The mango fruit fly, Bactrocera dorsalis (Hendel) (Diptera: Tephritidae), is a devastating pest of mango fruit. The present study was performed to investigate the potential of ants as biocontrol agents against B. dorsalis. The two predatory ant species Camponotus compressus (Fabricius) and Messor himalayanus (Forel) (Hymenoptera: Formicidae) were used in field and laboratory experiments against B. dorsalis. Mangifera indica (L.) (Anacardiaceae) mangoes were exposed to various numbers of ants. Females of B. dorsalis were monitored for landing, oviposition, and time spent on treated and untreated mango fruits. In a Y‐tube olfactometer, the response was tested of B. dorsalis towards mangoes that were either exposed or not to ants. Results showed that female adults oviposited 5× more on unexposed mangoes than on exposed mangoes. Ant secretions affected the behavior of B. dorsalis and reduced oviposition, number of landings, and time spent on the fruits. It can be concluded that a population of B. dorsalis might be controlled using the secretions of ants.
Mobile brain/body imaging of landmark‐based navigation with high‐density EEG
Authors: Delaux Alexandre , de Saint Aubert Jean‐Baptiste , Ramanoël Stephen , Bécu Marcia , Gehrke Lukas , Klug Marius , Chavarriaga Ricardo , Sahel José‐Alain , Gramann Klaus , Arleo Angelo
Published: March 2021

Coupling behavioral measures and brain imaging in naturalistic, ecological conditions is key to comprehend the neural bases of spatial navigation. This highly integrative function encompasses sensorimotor, cognitive, and executive processes that jointly mediate active exploration and spatial learning. However, most neuroimaging approaches in humans are based on static, motion‐constrained paradigms and they do not account for all these processes, in particular multisensory integration. Following the Mobile Brain/Body Imaging approach, we aimed to explore the cortical correlates of landmark‐based navigation in actively behaving young adults, solving a Y‐maze task in immersive virtual reality. EEG analysis identified a set of brain areas matching state‐of‐the‐art brain imaging literature of landmark‐based navigation. Spatial behavior in mobile conditions additionally involved sensorimotor areas related to motor execution and proprioception usually overlooked in static fMRI paradigms. Expectedly, we located a cortical source in or near the posterior cingulate, in line with the engagement of the retrosplenial complex in spatial reorientation. Consistent with its role in visuo‐spatial processing and coding, we observed an alpha‐power desynchronization while participants gathered visual information. We also hypothesized behavior‐dependent modulations of the cortical signal during navigation. Despite finding few differences between the encoding and retrieval phases of the task, we identified transient time–frequency patterns attributed, for instance, to attentional demand, as reflected in the alpha/gamma range, or memory workload in the delta/theta range. We confirmed that combining mobile high‐density EEG and biometric measures can help unravel the brain structures and the neural modulations subtending ecological landmark‐based navigation.
Seasonal patterns and associations in the incidence of acute ischemic stroke requiring mechanical thrombectomy
Authors: Bücke Philipp , Henkes Hans , Arnold Guy , Herting Birgit , Jüttler Eric , Klötzsch Christof , Lindner Alfred , Mauz Uwe , Niehaus Ludwig , Reinhard Matthias , Waibel Stefan , Horvath Thomas , Bäzner Hansjörg , Aguilar Pérez Marta
Published: March 2021

Background

In order to identify risk periods with an increased demand in technical and human resources, we tried to determine patterns and associations in the incidence of acute ischemic stroke due to embolic large vessel occlusions (eLVO) requiring mechanical thrombectomy (MT).

Methods

We conducted a time series analysis over a 9‐year period (2010–2018) based on observational data in order to detect seasonal patterns in the incidence of MT due to eLVO (n = 2628 patients). In a series of sequential negative binominal regression models, we aimed to detect further associations (e.g., temperature, atmospheric pressure, air pollution).

Results

There was a 6‐month seasonal pattern in the incidence of MT due to eLVO (p = 0.024) peaking in March and September. Colder overall temperature was associated with an increase in MT due to eLVO (average marginal effect [AME], [95% CI]: −0.15 [−0.30–0.0001]; p = 0.05; per °C). A current increase in the average monthly temperature was associated with a higher incidence of MT due to eLVO (0.34 [0.11–0.56]; p = 0.003). Atmospheric pressure was positively correlated with MT due to eLVO (0.38 [0.13–0.64]; p = 0.003; per hectopascal [hPa]). We could detect no causal correlation between air pollutants and MT due to eLVO.

Conclusions

Our data suggest a 6‐month seasonal pattern in the incidence of MT due to eLVO peaking in spring and early autumn. This might be attributed to two different factors: (1) a current temperature rise (comparing the average monthly temperature in consecutive months) and (2) colder overall temperature. These results could help to identify risk periods requiring an adaptation in local infrastructure.
Cerebral cavernous malformations: Prevalence of cardiovascular comorbidities and allergic diseases compared to the normal population
Authors: Dammann Philipp , Saban Dino Vitali , Herten Annika , Chen Bixia , Zhu Yuan , Santos Alejandro , Rauschenbach Laurèl , Wrede Karsten , Jabbarli Ramazan , Schmidt Börge , Jöckel Karl‐Heinz , Kleinschnitz Christoph , Forsting Michael , Sure Ulrich
Published: March 2021

Background

To determine the prevalence of cardiovascular comorbidities and allergic diseases in patients with cavernous malformations of the central nervous system compared to the normal population.

Methods

Clinical and magnetic resonance imaging data of 1352 patients with cerebral cavernous malformations (CCM) from an observational, cross‐sectional, single‐institutional study were analyzed and compared to an age‐and‐gender stratified and matched sample from a population‐based, epidemiological study assessing cardiovascular risk factors in the local normal population of the same area (RECALL study).

Results

Of 1352 patients, 810 (60%) were female. Mean age was 40.4 ± 16 years. 221 patients (16%) suffered from familial disease. Presence of cardiovascular risk factors and intake of certain drugs in the overall cohort was mostly equal to the normal population reference sample (n = 786). The prevalence of allergic diseases was found to be significantly higher in all CCM patients compared to the normal population (30% vs. 20%, odds ratio [OR] 1.35 [1.12–1.63]) and in sporadic CCM cases compared to the normal population and familial cases (32% vs. 20% (OR 1.46 [1.19–1.78], p = 0.0001) and 22% vs. 20%, respectively).

Conclusions

We present novel data on CCM using a large single‐institution and population‐based setup. The study elaborates disease characteristics of CCM patients in detail. For the first time, evidence for an unexplained high prevalence of allergic diseases in this patient population is described (differing between sporadic and familial cases), supporting the hypothesis that immune response is involved in the pathogenesis of CCM.
Inhibition of pyruvate oxidation as a versatile stimulator of the hair cycle in models of alopecia
Authors: Flores Aimee , Choi Sekyu , Hsu Ya‐Chieh , Lowry William E.
Published: March 2021

Hair follicle stem cells (HFSCs) are known to be responsible for the initiation of a new hair cycle, but typically remain quiescent for very long periods. In alopecia, or hair loss disorders, follicles can be refractory to activation for years or even permanently. Alopecia can be triggered by autoimmunity, age, chemotherapeutic treatment, stress, disrupted circadian rhythm or other environmental insults. We previously showed that hair follicle stem cells and the hair cycle can be manipulated by regulation of pyruvate entry into mitochondria for subsequent oxidation to fuel the TCA cycle in normal adult mice with typical hair cycling. Here, we present new data from our efforts to develop murine models of alopecia based on environmental triggers that have been shown to do the same in human skin. We found that inhibition of pyruvate transport into mitochondria can accelerate the hair cycle even during refractory hair cycling due to age, repeated chemotherapeutic treatment and stress. Hair cycle acceleration in these alopecia models led to the formation of histologically normal hair follicles within 30–40 days of treatment without any overt signs of toxicity or deleterious effects. Therefore, we propose inhibition of pyruvate entry into mitochondria as a versatile treatment strategy for alopecia in humans.
Ultra‐high‐frequency ultrasound and machine learning approaches for the differential diagnosis of melanocytic lesions
Authors: Faita Francesco , Oranges Teresa , Di Lascio Nicole , Ciompi Francesco , Vitali Saverio , Aringhieri Giacomo , Janowska Agata , Romanelli Marco , Dini Valentina
Published: March 2021

Malignant melanoma (MM) is one of the most dangerous skin cancers. The aim of this study was to present a potential new method for the differential diagnosis of MM from melanocytic naevi (MN). We examined 20 MM and 19 MN with a new ultra‐high‐frequency ultrasound (UHFUS) equipped with a 70 MHz linear probe. Ultrasonographic images were processed for calculating 8 morphological parameters (area, perimeter, circularity, area ratio, standard deviation of normalized radial range, roughness index, overlap ratio and normalized residual mean square value) and 122 texture parameters. Colour Doppler images were used to evaluate the vascularization. Features reduction was implemented by means of principal component analysis (PCA), and 23 classification algorithms were tested on the reduced features using histological response as ground‐truth. Best results were obtained using only the first component of the PCA and the weighted k‐nearest neighbour classifier; this combination led to an accuracy of 76.9%, area under the ROC curve of 83%, sensitivity of 84% and specificity of 70%. The histological analysis still remains the gold‐standard, but the UHFUS images processing using a machine learning approach could represent a new non‐invasive approach.
On‐line modelling and planning for urban traffic control
Authors: Pozanco Alberto , Fernández Susana , Borrajo Daniel
Published: March 2021

Urban Traffic Control is a key problem for most big cities. Current approaches to handle the city traffic rely on controlling traffic lights. The systems in operation range from static control of traffic light phases to adaptive systems based on numeric models and traffic sensors. Recently, some planning‐based approaches have also been proposed. These approaches work at a higher level of abstraction, but have been found to work well if complemented by low‐level systems. We have identified two main difficulties for the wide use of planning techniques in this domain: generating the control models is a difficult task; and some algorithms scale poorly. In this paper we present Automated Planning for Traffic Control (APTC), a control system based on Automated Planning, that successfully overcomes these two problems. It combines techniques that continuously: learn an accurate planning model; and also divide the city for distributed reasoning in order to scale to large city networks. Experimental results show that APTC outperforms static approaches as well as other planning‐based systems. We also show that the combination of both approaches improves compared with using only one of them.
Speaking ability progress of language learners in online and face‐to‐face courses
Authors: Peterson Jeff
Published: March 2021

This study's goal was to determine if appropriately designed, completely virtual formats of language courses are able to engender in students speaking ability progress comparable to that fostered within traditional face‐to‐face (F2F) classrooms. The study further sought to clarify language learners' perceptions of online Japanese courses. The speaking ability of all participants was assessed at the beginning and end of their Japanese language course. A mixed‐design analysis of variance was conducted to analyze the effect of course type on speaking ability. Results showed that participant speaking ability improved significantly over time regardless of course type (online or F2F). This study also revealed that the majority of participants were able to use online tools with ease and found the online format to be an effective method of learning Japanese. Two principal reasons for studying Japanese online are reported. Implications and suggestions are discussed.
Changing climate associated with the range‐wide decline of an estuarine finfish
Authors: Erickson Kenneth A. , West Joe , Dance Michael A. , Farmer Troy M. , Ballenger Joseph C. , Midway Stephen R.
Published: March 2021

Southern flounder (Paralichthys lethostigma) are a coastal flatfish species that supports recreational and commercial fisheries but are currently experiencing range‐wide declines. To quantify the range‐wide declines and investigate the role of climate in these declines, fishery‐independent sampling data of age‐0 flounder were obtained from 34 estuaries representing four states in the Gulf of Mexico (TX, LA, AL, and FL) and three states in the Southeastern United States Atlantic Ocean (FL, SC, and NC) spanning from 1976 to 2019. Generalized additive models (GAM) were used to estimate age‐0 recruitment trends. Spatial and temporal synchrony analyses were then conducted using annual GAM‐predicted values to determine if trends were similar between estuaries in close proximity, and if declines occurred at the same time. Because the species is dependent on physical transport (i.e., winds and tides) for recruitment, hourly wind speed, wind direction, water temperature, and air temperature were obtained for estuaries with non‐zero sampling totals and long‐term data sets. Only six estuaries showed significant relationships between age‐0 flounder indices and growing degree days. However, all estuaries with wind data showed significant relationships between age‐0 flounder indices and hourly summed wind speed. Southern flounder also have environmental sex determination, meaning warming estuaries could also account for population changes and declines. We document that water temperatures in the same space and time where southern flounder sexually determine are warmer now than even a decade ago, which could masculinize populations and substantially change population demographics. These results illustrate the vulnerability of estuarine finfish populations to climate change and increased climate variability. Understanding how climate acts on southern flounder biology may help managers respond to and prevent fishery collapses.
Rescuing gender: An exploration of embodied resilience‐making in the Chilean miners' catastrophe
Authors: Valenzuela Francisco , Sanfuentes Matías , Castillo Alejandro
Published: March 2021

In this paper, we explore the theoretical and empirical links between gender and resilience within the context of crisis management by developing a theoretically oriented analysis of the iconic case of the 33 Chilean miners rescue. Analytic focus is placed on the capacity of resilience‐promoting actors to embody and transform the discursive and practical dimensions of gendered regimes that predominate at an organizational level. As a result, we can distinguish four distinct modalities—normative redefinition, emotional reaccommodation, resistance, and affective affirmation—through which the gendered dimension of resilience becomes undone and redone, based on the action of alternative rationalities and affects. Overall, our findings indicate that resilience cannot be made possible without effectively disputing the norms that dispose how bodies, in all their diversity, are able to be recognized and socially experienced to face and manage crises effectively.
Case report of Capnocytophaga canimorsus septicemia with infective endocarditis in a hemodialysis patient: A not widely known dog pathogen
Authors: Oluyombo Rotimi , Tsiouli Eleni , Gunda Smita S.
Published: March 2021

Keeping pets as a companion is a global phenomenon. This relationship, however, is not entirely free of risk as some diseases can be transmitted to human beings. It is important to emphasize safety among pet owners, particularly in people with chronic illness as they may have increased vulnerability to infection which could arise from an intimate relationship. We report an uncommon etiology of sepsis complicated with infective endocarditis in a 63‐year old dog‐owner who was on hemodialysis. To the best of our knowledge, this is the first case of Capnocytophaga canimorsus infective endocarditis (IE) ever reported in a patient undergoing hemodialysis.
Bismuth salts with versus without acid suppression for Helicobacter pylori infection: A transmission electron microscope study
Authors: Chiang Tsung‐Hsien , Chen Chieh‐Chang , Tseng Ping‐Huei , Liou Jyh‐Ming , Wu Ming‐Shiang , Shun Chia‐Tung , Lee Yi‐Chia , Graham David Y.
Published: March 2021

Background

Bismuth oxychloride produced by interaction of bismuth compounds with gastric acid is believed to damage Helicobacter pylori. The effect of bismuth salts on H. pylori in the presence of strong acid suppression is unknown. This randomized trial aimed to determine effects of bismuth subcitrate on H. pylori with and without acid suppression.

Methods

H. pylori ‐positive participants were allocated (1:1:1) to receive (a) no treatment (control), (b) colloidal bismuth subcitrate (CBS, 125 mg/tab), or (c) CBS plus high‐dose proton‐pump inhibitor (PPI), esomeprazole 40 mg q.i.d. for 3 days. In the treatment groups, CBS was given: 1 dose, 1 hour before endoscopy, 1 dose, 4 hours before endoscopy, or q.i.d. 24 hours before endoscopy. The study end‐points were evaluated using transmission electron microscopy to observe the morphological changes of H. pylori in antral and corpus biopsies.

Results

Twenty‐seven H. pylori carriers were enrolled in this trial with qualitative end‐points. In the no treatment group, active budding and replication of H. pylori were observed. In the CBS group, cellular swelling, vacuolization, structural degradation, and cell wall eruption of H. pylori were observed, with no apparent association with when the CBS was given. Among those receiving high‐dose PPI‐plus CBS or CBS only, there were no differences in number of H. pylori present or severity of bacterial damage whether CBS was given 1, 4, or 24 hours before endoscopy.

Conclusions

Based on direct morphological evaluation, the toxic effect of CBS treatment on H. pylori was demonstrated independent of acid suppression with PPI.
Circular ribonucleic acid nei‐like deoxyribonucleic acid glycosylase 3 governs the microribonucleic acid ‐3150b‐3p/laminin subunit gamma 1 network to partially promote the development of hepatocellular carcinoma
Authors: Li Zhenjie , Zhang Jinping , Jiang Yuanyuan , Bao Jie , Li Dongying
Published: March 2021

Aim

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors, and its progression is implicated in the dysregulation of circular ribonucleic acids (RNAs). This study aimed to investigate the role of circular RNA nei‐like DNA glycosylase 3 (circNEIL3) in HCC.

Methods

Real‐time quantitative PCR was used for expression analysis of circNEIL3, microRNA‐3150b‐3p (miR‐3150b‐3p) and laminin subunit gamma 1 (LAMC1) message RNA. MTT assay, colony formation assay, wound healing assay, transwell assay, and flow cytometry assay were performed for functional analyses on cell proliferation, migration, invasion, apoptosis, and cycle. The expression of marker proteins and LAMC1 protein was quantified by western blot. The interaction between miR‐3150b‐3p and circNEIL3 or LAMC1 was confirmed by dual‐luciferase reporter assay or RNA immunoprecipitation assay. An animal study was performed to confirm the role of circNEIL3 in vivo.

Results

CircNEIL3 was upregulated in tumor tissues and HCC cell lines. CircNEIL3 knockdown significantly suppressed HCC cell proliferation, migration and invasion and induced cell apoptosis and cell cycle arrest. MiR‐3150b‐3p was a target of circNEIL3, and its inhibition largely reversed the functional effects of circNEIL3 knockdown on cell behaviors. Moreover, LAMC1 served as a target of miR‐3150b‐3p, and its expression was elevated in HCC tissues and cells. LAMC1 overexpression recovered HCC cell proliferation, migration and invasion that were blocked by miR‐3150b‐3p restoration. Additionally, circNEIL3 knockdown inhibited tumor growth in mice.

Conclusion

CircNEIL3 dysregulation was responsible for the partial development of HCC by regulating the miR‐3150b‐3p/LAMC1 regulatory network.
Mycophenolate mofetil as adjunctive therapy to corticosteroids for the treatment of pyoderma gangrenosum: a case series and literature review
Authors: Hrin Matthew L. , Bashyam Arjun M. , Huang William W. , Feldman Steven R.
Published: March 2021

Pyoderma gangrenosum is a rare neutrophilic dermatosis that is commonly treated with systemic corticosteroids; however, their potent side effects may warrant tapering, and non‐steroidal systemic immunosuppressants may help maintain or bolster disease clearance during weaning. Although cyclosporine is regarded as a favorable corticosteroid‐sparing agent, it is associated with several side effects, such as renal toxicity and hypertension, that may limit its feasibility. Mycophenolate mofetil is a well‐tolerated alternative with limited data. Institutional review board approval was obtained to review patients from a single institution who received mycophenolate mofetil for pyoderma gangrenosum between January 1, 2010, and December 31, 2019. A systematic MEDLINE (PubMed) review was performed of articles containing linked keywords: “mycophenolate mofetil” and “pyoderma gangrenosum”. Patient demographics, presentation details, and treatment regimen characteristics were recorded. Fourteen of our pyoderma gangrenosum patients were treated with mycophenolate mofetil concomitantly with prednisone. Ninety‐three percent of our patients achieved improvement within 12 months (mean 4.5 months), including five patients who experienced complete healing. Outcomes in literature patients were comparable; 77% either improved or maintained clearance with mycophenolate mofetil. Greater than 80% of total patients experienced healing or adequate disease control at a median dose of 2000 mg daily. The most common side effects of mycophenolate mofetil were myelosuppression and gastrointestinal upset, which were both seen in 18% of patients. Although this study is subject to publication bias, mycophenolate mofetil appears to be an efficacious and well‐tolerated adjunctive therapy option for pyoderma gangrenosum.
Lung cancer screening in Australia and New Zealand: the evidence and the challenge
Authors: Manners David , Dawkins Paul , Pascoe Diane , Crengle Sue , Bartholomew Karen , Leong Tracy L.
Published: March 2021

Lung cancer remains the commonest cause of cancer death in Australia and New Zealand. Targeted screening of individuals at highest risk of lung cancer aims to detect early stage disease, which may be amenable to potentially curative treatment. While current policy recommendations in Australia and New Zealand have acknowledged the efficacy of lung cancer screening in clinical trials, there has been no implementation of national programmes. With the recent release of findings from large international trials, the evidence and experience in lung cancer screening has broadened. This article discusses the latest evidence and implications for Australia and New Zealand.
Altered bowel habit and rectal bleeding in pregnancy: the importance of recognising undiagnosed inflammatory bowel disease
Authors: Singh Gurpreet , Prentice Ralley , Langsford David , Christensen Britt , Garg Mayur
Published: March 2021

Worsening of disease activity during pregnancy in patients with known inflammatory bowel disease, especially ulcerative colitis (UC), is well recognised, but the diagnosis of new‐onset or previously undiagnosed UC in pregnancy has been inadequately studied to date. Recognition of gastrointestinal symptoms in pregnancy as potentially indicating UC is of paramount importance, as this allows appropriate investigation and instigation of therapies to optimise maternal and foetal outcomes. Here, we report three cases of women with gastrointestinal symptoms in pregnancy with disparate outcomes.
Real‐world off‐label use of icatibant for acute management of non‐hereditary angioedema
Authors: Le Thanh‐Thao (Adriana) , Smith William , Hissaria Pravin
Published: March 2021

We retrospectively examined the indications and efficacy of off‐label use of the bradykinin B2 receptor antagonist icatibant. The clinical heterogeneity, variability of response to icatibant and lack of efficacy of adrenaline described in this audit highlights both the need for biomarkers that can rapidly distinguish between histaminergic and non‐histaminergic angioedema, and for guidelines to improve the utility of icatibant in the non‐hereditary angioedema setting.
Lessons from China on different approaches to pension coverage extension
Authors: Zhao Litao , He Xiaobin
Published: March 2021

Achieving universal pension coverage is both an aspiration and a challenge for many developing economies. Traditional contributory schemes are less effective in extending pension coverage to workers who are not in the formal sectors of the economy. As an alternative, non‐contributory schemes have gained popularity in recent years. China’s pension reforms mirror this global trend. The introduction of a contribution‐based pension scheme for urban employees (Employees’ Pension) was followed by a scheme for rural and urban residents (Residents’ Pension), which is partly government financed and partly contributory, with multiple options for premium payment. This study uses nationally representative survey data collected in 2016 to compare the inclusiveness of the two schemes. It finds that access to the Residents’ Pension scheme is more equal than the Employees’ Pension. Lower status workers in terms of education, employment, income and hukou‐migration are more likely to participate in the Residents’ Pension as opposed to the Employees’ Pension, compared with higher status workers. The Chinese experience suggests that a workable solution for pension extension in low‐ and middle‐income countries is to have a scheme that is flexible, affordable and responsive to the diverse needs of the population.
The sustainability of China’s Urban Employees’ Pension Programme: A case of getting old before getting rich?
Authors: Cousins Mel
Published: March 2021

This article examines the sustainability of China’s Urban Employees’ Pension Programme – the main component in China’s overall old‐age support system. It looks at the sustainability of the programme generally and, in particular, at case studies of two areas (Tianjin municipality and Guangxi province) to highlight both the extent of regional variations and the common challenges facing Chinese policy‐makers. It discusses a number of key issues that should assist policy‐makers to address the challenge of population ageing. It concludes that the challenge facing China is no more severe than that already faced by other countries in Europe and Asia. Moreover, the ageing of the population is not uniform across the regions of China. Consequently, those areas where the demographic shift is more advanced will provide some opportunity for policy experimentation. Given the experience to date of slow progress on various aspects of pension policy reform, the article suggests that it seems unlikely that paradigmatic change will be significant. Nonetheless, the study suggests a range of parametric policy measures that China should consider. The challenge facing China’s policy‐makers is to ensure that China gets old and rich at the same time.
The course of readmission in frail older cardiac patients
Authors: Rijpkema Corinne J. , Verweij Lotte , Jepma Patricia , Latour Corine H. M. , Peters Ron J. G. , Scholte Op Reimer Wilma J. M. , Buurman Bianca M.
Published: March 2021

Aim

The aim of this study is to explore patients’ and (in)formal caregivers’ perspectives on their role(s) and contributing factors in the course of unplanned hospital readmission of older cardiac patients in the Cardiac Care Bridge (CCB) program.

Design

This study is a qualitative multiple case study alongside the CCB randomized trial, based on grounded theory principles.

Methods

Five cases within the intervention group, with an unplanned hospital readmission within six months after randomization, were selected. In each case, semi‐structured interviews were held with patients (n = 4), informal caregivers (n = 5), physical therapists (n = 4), and community nurses (n = 5) between April and June 2019. Patients’ medical records were collected to reconstruct care processes before the readmission. Thematic analysis and the six‐step analysis of Strauss & Corbin have been used.

Results

Three main themes emerged. Patients experienced acute episodes of physical deterioration before unplanned hospital readmission. The involvement of (in)formal caregivers in adequate observation of patients’ health status is vital to prevent rehospitalization (theme 1). Patients and (in)formal caregivers’ perception of care needs did not always match, which resulted in hampering care support (theme 2). CCB caregivers experienced difficulties in providing care in some cases, resulting in limited care provision in addition to the existing care services (theme 3).

Conclusion

Early detection of deteriorating health status that leads to readmission was often lacking, due to the acuteness of the deterioration. Empowerment of patients and their informal caregivers in the recognition of early signs of deterioration and adequate collaboration between caregivers could support early detection. Patients’ care needs and expectations should be prioritized to stimulate participation.

Impact

(In)formal caregivers may be able to prevent unplanned hospital readmission of older cardiac patients by ensuring: (1) early detection of health deterioration, (2) empowerment of patient and informal caregivers, and (3) clear understanding of patients’ care needs and expectations.
Using Holocene fossils to model the future: Distribution of climate suitability for tuatara, the last rhynchocephalian
Authors: Jarvie Scott , Worthy Trevor H. , Saltré Frédérik , Scofield R. Paul , Seddon Philip J. , Cree Alison
Published: March 2021

Aim

Correlative species distribution models (SDMs) are typically trained using only the contemporary distribution of species; however, recent records might reflect an incomplete description of a species' niche, limiting the reliability of predictions. SDMs linking fossil records have the potential to improve conservation decisions under human‐induced climate change. Here, we built SDMs using presence records from contemporary and Holocene records to enable estimations of climatically suitable area under current and future climate scenarios.

Location

Aotearoa New Zealand

Taxon

Tuatara, Sphenodon punctatus

Methods

For an evolutionary relict found in Aotearoa New Zealand, the tuatara (Sphenodon punctatus), we built SDMs using presence records from contemporary and Holocene records to estimate climatically suitable area under current and future climate scenarios. We also use our detailed knowledge of the Holocene distribution and remnant populations to examine niche shifts following the arrival of humans and associated introduction of mammalian predators. To build SDMs, we use presence records from four sources: (a) remnant populations, (b) radiocarbon‐dated fossil deposits from the Holocene, (c) other fossil deposits containing tuatara bones of Holocene age and iv) islands from which tuatara are known or highly likely to have become extinct.

Results

We found shifts in the niche of tuatara due to niche unfilling. Incorporating locations of Holocene deposits and/or all past locations in SDMs led to larger areas of climatically suitable area being identified compared to SDMs derived from remnant populations only. Using all presence records, under climate change projections for 2090, climatically suitable area increased slightly. However, many areas retain potential as translocation sites (e.g. northern South Island), some areas become unsuitable (e.g. inland Canterbury) and/or involve extrapolation into novel climates (e.g. Northland).

Main Conclusion

SDMs incorporating locations of Holocene deposits and/or all past locations identified areas of critical habitat for tuatara under current and future climate scenarios, that would not have been identified using contemporary occurrences only. Our results highlight the need to consider past locations when assessing habitat suitability for conservation translocations, both for tuatara and other relict species.
Wellbeing of CAMHS staff and changes in working practices during the COVID‐19 pandemic
Authors: Bentham Charlotte , Driver Katie , Stark Daniel
Published: March 2021

Introduction

The coronavirus disease 2019 pandemic has necessitated significant changes in working practices across healthcare services. The current study aimed to assess the wellbeing of health professionals and quantify the adaptations to working practices in a Child and Adolescent Mental Health Service (CAMHS) during the pandemic.

Method

The study was conducted in a UK CAMH team six weeks into lockdown measures. All clinicians were invited to complete a survey eliciting their experiences of working practices during the pandemic, degree of worry about the virus and mental wellbeing.

Results

Clinicians had significantly lower levels of mental wellbeing during the pandemic than population normative data, to the extent that some clinicians were classified as at heightened risk of depression. A significant shift to remote working, reduction in face‐to‐face appointments, and decrease in clinicians' perceived ability to undertake clinical tasks was observed. Themes emerging from clinicians' experiences of working during the pandemic include being supported within the team, providing a service, working adaptations, and working as a team. A further theme highlights the needs of clinicians to complete their clinical role effectively.

Conclusion

CAMHS clinicians require additional support, training, and guidance during a pandemic to promote mental wellbeing and effectiveness in completing clinical tasks.
Non‐pharmacological management of hypertension
Authors: Verma Narsingh , Rastogi Smriti , Chia Yook‐Chin , Siddique Saulat , Turana Yuda , Cheng Hao‐min , Sogunuru Guru Prasad , Tay Jam Chin , Teo Boon Wee , Wang Tzung‐Dau , TSOI Kelvin Kam Fai , Kario Kazuomi
Published: March 2021

Hypertension is an insidious disease which predisposes to cardiovascular complications and if not treated properly can lead to various serious complications. Economic limitations, having additional benefits with few or almost no side effects have made non‐pharmacological management of hypertension an attractive approach for dealing with hypertension, in developed and developing countries alike. A MEDLINE search was done for relevant references with emphasis on original studies, randomized controlled trials, and meta‐analyses for this review paper. Lifestyle modifications including changes in the dietary pattern, adopting special diets with low sodium, saturated fat and high calcium, magnesium and potassium and trying the new methods like time restricted meal intake which work in tandem with the circadian rhythm are opening new vistas in the field of non‐pharmacological management of hypertension. Lifestyle modifications that effectively lower blood pressure are increased physical activity, weight loss, limited alcohol consumption, relaxation techniques of Yoga, Acupuncture, Tai chi, mindfulness‐based stress‐reduction program, and Transcendental Meditation. Air pollution of the surrounding air is linked with poor health outcomes and is a major contributor to the global burden of disease. Fine particulate matter <2.5 μm in diameter (PM2.5) is strongly associated with cardiovascular morbidity and mortality. Short‐term PM exposure (hours to weeks) increases the likelihood of adverse cardiovascular events including myocardial infarction, stroke, and heart failure, and longer‐term exposure multiplies that risk. Non‐pharmacological methods should be initiated early phase of disease and should be continued with medication.
Depicting the composition of gut microbiota in children with tic disorders: an exploratory study
Authors: Xi Wenjie , Gao Xuefeng , Zhao Huijun , Luo Xi , Li Jianfeng , Tan Xinjie , Wang Lei , Zhao Jian‐Bo , Wang Jing , Yang Guang , Liu Li‐Ying , Wang Yang‐Yang , Peng Lihua , Zou Li‐Ping , Yang Yunsheng
Published: March 2021

Background

Symptom improvement in children with tic disorder (TD) following fecal microbiota transplantation led us to investigate the gut microbiota in TD. This exploratory study aims to depict the gut microbial profile in patients with TD and explore the impact of dopamine receptor antagonist (DRA) drugs on the composition and metabolic function of the gut microbiota.

Methods

The gut microbiota were profiled in fecal samples of 49 children with TD and 50 matched healthy controls (HC) using shotgun metagenomic sequencing. A random forest (RF) model was constructed using the gut bacterial species to distinguish TD from HC. Associations between clinical metadata and microbial abundance or function were analyzed using MaAsLin2 and Spearman correlation.

Results

The gut microbiota in children with TD was featured by higher abundances of Bacteroides plebeius and Ruminococcus lactaris (a potential pro‐inflammatory taxon) and lower abundances of Prevotella stercorea and Streptococcus lutetiensis compared to HC. The constructed RF model accurately distinguished TD from HC based on the gut microbiota profile, resulting in an AUC of 0.884. Significant correlations were observed between tic symptom severity and the abundances of multiple bacterial species and gut microbiota metabolic functions. Multivariate analysis identified an upregulation of 4‐aminobutanoate (GABA) degradation in the gut microbiota associated with TD status. The gut microbiota of DRA‐treated TD children showed a distinct gut microbiota compared to the treatment‐naïve group, represented by an increase in some potential enteric pathogens such as Escherichia coli, a decline in several species including Akkermansia muciniphila, and alterations in various metabolic functions.

Conclusions

Bacterial species promoting inflammatory responses and those modulating neurotransmitters such as GABA may be involved in the pathogenesis of TD. The use of DRA drugs is likely to induce overgrowth of some enteric pathogens and alter the gut microbiota metabolism.
Basal insulin requirement in patients with type 1 diabetes depends on the age and body mass index
Authors: Mitsui Yukari , Kuroda Akio , Ishizu Masashi , Mori Hiroyasu , Kurahashi Kiyoe , Kondo Takeshi , Yoshida Sumiko , Akehi Yuko , Aihara Ken‐ichi , Endo Itsuro , Abe Masahiro , Matsuhisa Munehide
Published: March 2021

Aims/Introduction

To investigate the basal insulin requirement in patients with type 1 diabetes who are on multiple daily injections (MDI) and to assess the patient characteristics that affect the percent of total daily basal insulin dose to the total daily insulin dose (%TBD/TDD).

Materials and Methods

The subjects of this study were 67 inpatients with type 1 diabetes who were served diabetic meals of 25–30 kcal/kg standard body weight during several weeks of hospitalization. The basal insulin requirement was adjusted to keep the blood glucose level from bedtime to before breakfast within a 30 mg/dL difference. The bolus insulin dose before the meal was adjusted to keep the blood glucose level below 140 and 200 mg/dL before and 2 h after each meal, respectively. The total daily insulin dose (TDD), the percent of total daily basal insulin dose (TBD) to TDD (%TBD/TDD), and clinical characteristics were collected.

Results

The median (Q1, Q3) of TDD was 33.0 (26.0, 49.0) units, and the %TBD/TDD was 24.1 ± 9.8%. The %TBD/TDD was positively correlated with the body mass index (BMI) and negatively correlated with the age at the onset and at the examination according to a univariate analysis. However, the %TBD/TDD was dependent on the BMI (β = 0.340, P = 0.004) and the age at examination (β = −0.288, P = 0.012) according to the multiple regression analysis.

Conclusions

The average %TBD/TDD in patients with type 1 diabetes on MDI was approximately 24% under inpatient conditions. The basal insulin requirement was dependent on the BMI and the age at examination.