bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring supply chain issues affecting food access and security among urban poor in South Africa
Authors: Tuomala Virva , Grant David B.
Published: October 2021

Purpose

Access to food through retail supply chain distribution can vary significantly among the urban poor and leads to household food insecurity. The paper explores this sustainable supply chain phenomenon through a field study among South Africa's urban poor.

Design/methodology/approach

Urban metabolic flows is the theoretical basis in the context of supply chain management (SCM). The field study comprised 59 semi-structured interviews in one South African township. Data were recorded, transcribed and translated, and coded using NVivo 12 to provide an inventory of eight themes categorized and patterned from the analysis.

Findings

Findings indicate societal factors play a significant role affecting food distribution, access and security from a spatial perspective of retail outlet locations and a nutritional standpoint regarding quality and quantity of food.

Research limitations/implications

The study is exploratory in one township, and while rigorously conducted, the generalizability of findings is limited to this context.

Practical implications

The study practically contributes by providing guidance for food retailers and policymakers to include nutritional guidelines in their distribution planning, as well as the dynamics of diverse neighbourhoods that exist in modern urban contexts.

Social implications

New forms of retail food distribution can provide better security and access to food for the urban poor, contributing to Sustainable Development Goals (SDGs) 2 Zero Hunger and 11 Liveable Cities.

Originality/value

The study is interdisciplinary and contributes by linking UN SDGs and SCM through urban metabolic flows from development studies as an overarching framework to enable analysis of relationships between physical, social and economic factors in the urban environment.
Risk management in residential projects in the United States: implementation status, evaluation techniques and barriers
Authors: Adamtey Simon , Kereri James Ogechi
Published: October 2021

Purpose

Residential projects frequently suffer from low-risk management (RM) implementation and, consequently, are more likely to fail to meet performance objectives. With RM becoming an essential requirement, the purpose of this study is to investigate RM implementation in terms of status, risk analysis techniques, barriers and impact of RM on residential projects across the USA.

Design/methodology/approach

Data were collected from 105 general contractors who had completed 3,265 residential projects in the past five years. Data collection was through a US national survey sent out through emails between August and November 2019 to residential general contractor firms. The firms were randomly selected from national organizations, such as the National Association of Home Builders, Associated General Contractors of America and Associated Builders and Contractors.

Findings

The analysis indicated that RM implementation is still extremely low at 22.27%. However, there was an increase in RM implementation as the cost and duration of projects increased. Direct judgment is the most used technique. Also, the one-sample t-test indicated that the barriers have a significant impact on RM implementation. Multinomial logistic regression results indicated that the impact of lack of management support, lack of money or budget, the complexity of analytical tools and lack of time to perform analysis predict the impact on the overall performance of construction projects. Overall, the results provide empirical evidence, which can influence management’s decision-making regarding RM and improve implementation in residential projects.

Originality/value

There is a lack of empirical evidence on the impact of barriers to RM implementation on the performance of construction projects. This research contributes to the body of knowledge by bridging this gap through a robust analysis of data collected from real residential projects.
A strategic entrepreneurship framework for an emerging economy: reconciling dynamic capabilities and entrepreneurial orientation
Authors: Mustafa Muhammad Bilal , Saleem Irfan , Dost Mir
Published: October 2021

Purpose

This study aims to use dynamic capability theory to investigate the effect of entrepreneurial orientation and dynamic capabilities (DC) on the firm’s entrepreneurial performance through strategic entrepreneurship (SE).

Design/methodology/approach

To address the research objective, the authors obtained data from larger organisations operating in an emerging Pakistani economy.

Findings

Findings reveal that, in emerging markets, DC are essential elements that influence the organisation’s opportunity-seeking and advantage-seeking behaviours to ensure the firm’s entrepreneurial performance.

Research limitations/implications

The present study implies that training is needed for the managers and team leaders of emerging market corporates to think entrepreneurially by revising the strategic goals of the corporate.

Practical implications

SE-based executive training should also be compulsory for the top management teams, including the board of directors for larger firms.

Social implications

SE is a critically important business concept and should be taught in the emerging market’s business schools as a course at the graduate level.

Originality/value

This paper strengthens entrepreneurship literature by using a unique context of an emerging market and suggests a unique SE-based framework for the firms operating in emerging markets.
How could external auditors assess the rationalization of fraud?
Authors: Kassem Rasha
Published: October 2021

Purpose

This study aims to explore methods that external auditors can use to assess the rationalization of fraud in fraud risk assessment in auditing.

Design/methodology/approach

An online questionnaire was used to collect data from 150 Big 4 auditors.

Findings

The results reveal a total of 18 methods that auditors can use to assess the rationalization of fraud. However, some methods were recommended more than others by the auditors in this study. These methods include incorporating the assessment of rationalization into the assessment of motives for fraud and integrity, understanding the client’s business and regulatory environment, inquiring management and the board of directors about past fraud cases and observing management responses and reactions during auditors’ inquiry about fraud-related matters.

Practical implications

The guidance provided by this study could help enhance auditors’ skills in assessing fraud risks, which, in turn, may increase the likelihood of detecting fraud. The guide could also be helpful for audit firms in their fraud training programs.

Originality/value

This study is the first to explore methods for assessing the rationalization of fraud by drawing on the experience and insights of Big 4 auditors.
Effects of faults in the application of fire retardants in correlation with the efficiency of fire retardant materials on fire performance
Authors: Lubloy Eva , Enczel David Istvan , Takács Lajos Gábor , Cimer Zsolt , Biró András
Published: October 2021

Purpose

Fire protection regulations are difficult to comply with in the case of wooden structures because of the fact that wood is a combustible material. The fire protection of wood can be solved with coatings or by the application of flame retardants.

Design/methodology/approach

The standard of MSZ EN 1995‐1‐2 currently does not allow the consideration of fire retardants in case of scaling the fire load. In spite of the aforementioned, today there are many types of retardants on the market that are reliable and allow us to achieve a better fire protection classification.

Findings

The question is how sensitive a wood preservative is to a construction fault, or what would be the result of the erroneously applied fire retardant to the fire protection characteristics of timber used in constructions.

Originality/value

During the research, five different fire retardants were tested on three types of wood and their behaviour was monitored under controlled laboratory circumstances. When selecting the wood, it was important to take the wood species that are most commonly used in the construction industry, and their density should be as different as possible. During the tests, the wood preservative was applied incorrectly, modelling the following cases: applying less or more wood preservatives, and creating small and large faults.
Assurance quality, disclosed connectivity of the capitals and information asymmetry – An interaction analysis for the case of integrated reporting
Authors: Grassmann Michael , Fuhrmann Stephan , Guenther Thomas W.
Published: October 2021

Purpose

Credibility concerns regarding integrated reports can harm the intended decrease of information asymmetry between a firm and its investors. Therefore, it is crucial to examine whether voluntary third-party assurance enhances the credibility of integrated reports and, thus, decreases information asymmetry. Furthermore, this study aims to investigate the interaction effect between assurance quality and the disclosed connectivity of the capitals, a distinguishing feature of integrated reports.

Design/methodology/approach

Content analysis is performed of the 176 assurance statements included in the 269 integrated reports of Forbes Global 2000 firms disclosed from 2013 to 2015 and the 269 integrated reports themselves. Regression analyzes are applied to examine the associations between assurance, the disclosed connectivity of the capitals and information asymmetry.

Findings

The presence of an assurance statement in an integrated report significantly decreases information asymmetry. Surprisingly, assurance quality is not significantly associated with information asymmetry. However, an interaction analysis reveals that combining high assurance quality with high disclosed connectivity of the capitals allows a significant decrease in information asymmetry.

Research limitations/implications

The paper demonstrates that the connectivity of the capitals of integrated reports and assurance quality are connected and together are associated with information asymmetry.

Practical implications

The results imply, both for report preparers and standard setters, that assurance quality is advantageous only when combined with disclosed connectivity of the capitals.

Social implications

More information on non-financial information measured by the connectivity of the capitals of integrated reporting has an interaction effect together with assurance quality on information asymmetry.

Originality/value

This paper builds on a unique data set derived from the contents of integrated reports and accompanying assurance statements. Furthermore, it extends the integrated reporting literature by investigating the interaction between assurance quality and the disclosed connectivity of the capitals, which had not previously been examined in combination.
Knitted cardiac mesh to support left ventricular hypertrophy: an in vivo experimental study: supporting left ventricular hypertrophy using cardiac support mesh
Authors: Elgohary Doaa H. , Khalifa Tamer F. , Salem Mona M. , M. Aly Nermin , Hassan Elham , Shamaa Ashraf A.
Published: October 2021

Purpose

The purpose of this work is to perform an application study on experimental animals (dogs) to investigate the efficiency of using weft knitted mesh fabric as cardiac support mesh to support left ventricular hypertrophy.

Design/methodology/approach

In this work, weft-knitted mesh sample “Knitted Cardiac Support Mesh” manufactured using Nylon (6, 6) yarns, with count 20 Denier and medium mesh size, was placed around the two ventricles to prevent further dilatation, support and reduce left ventricular wall stress.

Findings

Medical textile is a rapidly expanding field in technical textiles that are widely used in a variety of medical applications. One of these medical textile applications is “Knitted Cardiac Support Mesh”, which is used in the treatment of Dilated Cardiomyopathy.

Originality/value

After the implantation of the manufactured Knitted Cardiac Support Mesh around the myocardium, all dogs survived for three months before being euthanized, and some clinical examinations were performed to investigate and evaluate the sample performance. It was demonstrated from the experimental application, that the nylon mesh sample performed the best during the surgical operation due to its good ability to stretch and recover at a moderate rate, as well as the textile mesh lightweight.
The predictive ability of stock market factors
Authors: Elgammal Mohammed Mohammed , Ahmed Fatma Ehab , McMillan David Gordon
Published: October 2021

Purpose

This paper aims to ask whether a range of stock market factors contain information that is useful to investors by generating a trading rule based on one-step-ahead forecasts from rolling and recursive regressions.

Design/methodology/approach

Using USA data across 3,256 firms, the authors estimate stock returns on a range of factors using both fixed-effects panel and individual regressions. The authors use rolling and recursive approaches to generate time-varying coefficients. Subsequently, the authors generate one-step-ahead forecasts for expected returns, simulate a trading strategy and compare its performance with realised returns.

Findings

Results from the panel and individual firm regressions show that an extended Fama-French five-factor model that includes momentum, reversal and quality factors outperform other models. Moreover, rolling based regressions outperform recursive ones in forecasting returns.

Research limitations/implications

The results support notable time-variation in the coefficients on each factor, whilst suggesting that more distant observations, inherent in recursive regressions, do not improve predictive power over more recent observations. Results support the ability of market factors to improve forecast performance over a buy-and-hold strategy.

Practical implications

The results presented here will be of interest to both academics in understanding the dynamics of expected stock returns and investors who seek to improve portfolio performance through highlighting which factors determine stock return movement.

Originality/value

The authors investigate the ability of risk factors to provide accurate forecasts and thus have economic value to investors. The authors conducted a series of moving and expanding window regressions to trace the dynamic movements of the stock returns average response to explanatory factors. The authors use the time-varying parameters to generate one-step-ahead forecasts of expected returns and simulate a trading strategy.
Enhanced densely dehazing network for single image haze removal under railway scenes
Authors: Zhao Ruhao , Ma Xiaoping , Zhang He , Dong Honghui , Qin Yong , Jia Limin
Published: October 2021

Purpose

This paper aims to propose an enhanced densely dehazing network to suit railway scenes’ features and improve the visual quality degraded by haze and fog.

Design/methodology/approach

It is an end-to-end network based on DenseNet. The authors design enhanced dense blocks and fuse them in a pyramid pooling module for visual data’s local and global features. Multiple ablation studies have been conducted to show the effects of each module proposed in this paper.

Findings

The authors have compared dehazed results on real hazy images and railway hazy images of state-of-the-art dehazing networks with the dehazed results in data quality. Finally, an object-detection test is taken to judge the edge information preservation after haze removal. All results demonstrate that the proposed dehazing network performs better under railway scenes in detail.

Originality/value

This study provides a new method for image enhancing in the railway monitoring system.
Seed predation is key to preventing population growth of the weed Alopecurus myosuroides
Authors: Daouti Eirini , Jonsson Mattias , Vico Giulia , Menegat Alexander
Published: October 2021

Seed predation can reduce the abundance and spread of unwanted vegetation in agricultural and other semi‐natural ecosystems. However, knowledge of how variations in seed predation rates affect plant species population dynamics is needed for decision making and knowledge‐based ecosystem management.

We developed a stage‐classified stochastic matrix population model for Alopecurus myosuroides Huds. (blackgrass), an annual plant species thriving as a weed in temperate agroecosystems of Western and Northern Europe. The model was parameterised using empirical demographic data from long‐term experiments in Swedish winter wheat fields, including information on post‐dispersal seed losses by vertebrate and invertebrate seed predators.

For agroecosystems with highly effective weed control measures (e.g. chemical and mechanical weed control), model simulations showed that seed losses via seed predation need to reach at least 78% at peak seed shedding to suppress population growth of A. myosuroides.

The field experiment showed that vertebrates were most important for seed predation in July, at peak seed shedding. In August, after crop harvest, invertebrates were responsible for almost all seed predation. The model indicated that weed seed predation was much more important for weed regulation when it occurred before crop harvest in July. Vertebrates most strongly reduced population growth of A. myosuroides, although both vertebrates and invertebrates were needed to prevent it entirely.

Synthesis and applications. We showed that weed seed predation by vertebrate and invertebrate seed predators is key for reducing the population growth of winter annual weeds like A. myosuroides in intensively managed agroecosystems. Therefore, protection of weed seed predators is essential for making management of unwanted vegetation less dependent on chemical and mechanical measures.
Raw milk processing by high‐intensity ultrasound and conventional heat treatments: Microbial profile by amplicon sequencing and physical stability during storage
Authors: Scudino Hugo , Guimarães Jonas T , Cabral Lucélia , Centurion Victor Borin , Gomes Andresa , Orsi Arthur S , Cunha Rosiane L , Sant’Ana Anderson S , Cruz Adriano G
Published: October 2021

This study aimed to evaluate the effects of conventional heat treatments (high‐temperature–short‐time and low‐temperature–low‐time) and high‐intensity ultrasound (HIUS) on the physical stability and bacterial diversity of whole milk during refrigerated storage. HIUS processing used an energy density of 3 kJ/mL and an ultrasound intensity of 90 W/cm2. The most abundant bacterial genera found in raw milk were Acinetobacter and Pseudomonas. After processing and storage for 7 days, Acinetobacter, Kluyvera and Serratia were the dominant genera in almost all samples, and Pseudomonas was the most abundant in HIUS‐processed milk. Only the HIUS process reduced the fat droplet size (<1 µm), providing better physical stability during the storage period.
First‐trimester maternal haemodynamic adaptation to pregnancy and placental, embryonic and fetal development: the prospective observational Rotterdam Periconception cohort
Authors: Reijnders IF , Mulders AGMGJ , Koster MPH , Kropman ATM , Koning AHJ , Willemsen SP , Steegers EAP , Steegers‐Theunissen RPM
Published: October 2021

Objective

To investigate whether first‐trimester maternal haemodynamic adaptation impacts placental, embryonic and fetal development as well as birth outcomes in pregnancies with and without placenta‐related complications.

Design

Prospective observational cohort.

Setting

A Dutch tertiary hospital.

Population

Two hundred and fourteen ongoing pregnancies.

Methods

At 7, 9 and 11 weeks of gestation, we assessed maternal haemodynamic adaptation (mean arterial blood pressure [MAP], uterine artery [UtA] blood flow) and placental development (placental volume [PV], uteroplacental vascular volume [uPVV]) using three‐dimensional power Doppler ultrasound volumes, and embryonic development (crown–rump length, embryonic volume). At 22 and 32 weeks of gestation, fetal development was assessed by estimated fetal weight. Birth outcomes (birthweight, placental weight) were extracted from medical records. Linear mixed modelling and linear regression analyses were applied.

Main outcome measures

Birthweight centile and placental weight.

Results

In placenta‐related complications (n= 55, 25.7%), reduced haemodynamic adaptation, i.e. higher UtA pulsatility index (PI) and resistance index (RI) trajectories, was associated with smaller increase in PV (β = −0.559, 95% CI −0.841 to −0.278, P< 0.001; β = −0.579, 95% CI −0.878 to −0.280, P< 0.001) and uPVV trajectories (UtA PI: β = −0.301, 95% CI −0.578 to −0.023, P= 0.034). At birth, reduced haemodynamic adaptation was associated with lower placental weight (UtA PI: β = −0.502, 95% CI −0.922 to −0.082, P= 0.022; UtA RI: β = −0.435, 95% CI −0.839 to −0.032, P= 0.036). In pregnancies without placenta‐related complications, higher MAP trajectories were positively associated with birthweight centile (β = 0.398, 95% CI 0.049–0.748, P= 0.025).

Conclusions

Reduced first‐trimester maternal haemodynamic adaptation impacts both placental size and vascularisation and birthweight centile, in particular in pregnancies with placenta‐related complications.

Tweetable abstract

Reduced first‐trimester maternal haemodynamic adaptation to pregnancy impairs early placental development.
Financial impacts of the Medicaid expansion on community health centers
Authors: Luo Qian , Moghtaderi Ali , Markus Anne , Dor Avi
Published: October 2021

Objective

To determine the impacts of the Medicaid expansion on revenues, costs, assets, and liabilities of federally funded community health centers.

Data sources

We combined data from the Uniform Data System, Internal Revenue Service nonprofit tax returns, and county‐level characteristics from the Census Bureau. Our final dataset included 5841 center‐year observations.

Study design

We used difference‐in‐differences model to estimate the fiscal impacts of the Medicaid expansion on community health centers. We employed event study models, state‐specific trend models, and placebo law tests as robustness checks.

Data collection methods

Not applicable.

Principal findings

On the revenue side, we found a $2.08 million relative increase (p = 0.002) in Medicaid revenues, offset by a $0.44 million decrease (p = 0.015) in total grants among community health centers in expansion states compared with centers in non‐expansion states. On the expenditure side, we found a large but not statistically significant $0.98 million relative increase (p = 0.201) in total expenditures among centers in expansion states. Uncompensated care for health centers in expansion states decreased by $1.19 million (p < 0.001) relative to their counterparts in non‐expansion states.

Conclusions

Community health centers in expansion states benefited from the increased, stable revenue stream from Medicaid expansions. While Medicaid revenue increased as a result of the policy, we find no major evidence of substitution away from other revenue lines, with one notable exception (i.e., substitution away from state and local government grants). From a policy perspective, these results are encouraging as the Biden Administration starts to implement the safety‐net enhancements from the American Rescue Plan Act of 2021 and as more non‐expansion states are considering opting into Medicaid expansions. It is anticipated that these added revenue streams will help to sustain health centers in the delivery of health care services to the underserved population.
The effect of fat and coffee concentration on the consumer acceptance of iced‐coffee beverages
Authors: Mahmud M M Chayan , Shellie Robert A. , Mohebbi Mohammadreza , Mahato Dipendra Kumar , Keast Russell
Published: October 2021

The fat content of a product has the potential to influence consumer liking via mouthfeel, taste, and aroma modification. This study aims to determine the effects of fat and coffee concentration on sensory attributes and consumer liking of iced‐coffee beverages. Nine iced‐coffee beverages were formulated: low fat–low coffee; medium fat–low coffee; high fat–low coffee; low fat–medium coffee; medium fat–medium coffee; high fat–medium coffee; low fat–high coffee; medium fat–high coffee; and high fat–high coffee. Fat content was adjusted using different concentrations of cream, and coffee using different concentrations of Nescafé Blend 43. Regular coffee consumers (n = 231) rated their overall liking using a 9‐point hedonic scale and completed a ranked preference based on degree of liking of all samples. Consumers also rated liking for sensory attributes: appearance, aroma, sweetness, coffee intensity, mouthfeel, and aftertaste. There were significant relationships between 1/ fat and 2/ coffee and liking of iced‐coffee beverages (p < 0.001). There were three clusters of consumers based on iced‐coffee preferences. Response surface curve indicated that overall liking of iced‐coffee beverages increased with the increase of fat and coffee concentration to a certain level, then continuing to increase the fat and coffee concentration decreases overall liking. The finding of this study provides valuable information on how fat and coffee concentrations can be adjusted to modify consumer acceptance of iced‐coffee beverages.

Practical Application

The results of this research could be applied to reformulate iced‐coffee beverages, while ensuring consumer acceptance. In addition, this research provides evidence that sweetness, aftertaste, coffee‐intensity, and mouthfeel are important sensory attributes associated with consumer liking of iced‐coffee beverages.
Lysis‐Hi‐C as a method to study polymicrobial communities and eDNA
Authors: Hill Bravada M. , Bisht Karishma , Atkins Georgia Rae , Gomez Amy A. , Rumbaugh Kendra P. , Wakeman Catherine A. , Brown Amanda M. V.
Published: October 2021

Microbes interact in natural communities in a spatially structured manner, particularly in biofilms and polymicrobial infections. While next generation sequencing approaches provide powerful insights into diversity, metabolic capacity, and mutational profiles of these communities, they generally fail to recover in situ spatial proximity between distinct genotypes in the interactome. Hi‐C is a promising method that has assisted in analysing complex microbiomes, by creating chromatin cross‐links in cells, that aid in identifying adjacent DNA, to improve de novo assembly. This study explored a modified Hi‐C approach involving an initial lysis phase prior to DNA cross‐linking, to test whether adjacent cell chromatin can be cross‐linked, anticipating that this could provide a new avenue for study of spatial‐mutational dynamics in structured microbial communities. An artificial polymicrobial mixture of Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli was lysed for 1–18 h, then prepared for Hi‐C. A murine biofilm infection model was treated with sonication, mechanical lysis, or chemical lysis before Hi‐C. Bioinformatic analyses of resulting Hi‐C interspecies chromatin links showed that while microbial species differed from one another, generally lysis significantly increased links between species and increased the distance of Hi‐C links within species, while also increasing novel plasmid‐chromosome links. The success of this modified lysis‐Hi‐C protocol in creating extracellular DNA links is a promising first step toward a new lysis‐Hi‐C based method to recover genotypic microgeography in polymicrobial communities, with potential future applications in diseases with localized resistance, such as cystic fibrosis lung infections and chronic diabetic ulcers.
Thoracic mesenchymal malignant tumors and programed cell death ligand‐1 status: Clinicopathologic and prognostic analysis of eight pulmonary sarcomatoid carcinomas and eight malignant mesotheliomas
Authors: Otsubo Kanji , Sakai Hiroki , Kimura Hiroyuki , Miyazawa Tomoyuki , Marushima Hideki , Kojima Koji , Furuya Naoki , Mineshita Masamichi , Chosokabe Motohiro , Koike Junki , Saji Hisashi
Published: October 2021

Background

The current study aimed to evaluate the significance of clinicopathological factors, particularly the immunohistochemistry of programed cell death ligand‐1 (PD‐L1), in eight cases each of pulmonary sarcomatoid carcinoma (PSC) and malignant pleural mesothelioma (MPM) at our hospital.

Methods

From January 2004 to December 2020, a total of 16 consecutive patients (eight with PSC and eight with MPM diagnosed via surgical resection or biopsy) were included in this study. After retrospectively reviewing the patient characteristics, the associations between PD‐L1 status and age, sex, stage, histological type, and prognosis were investigated.

Results

PD‐L1‐positive staining was observed in four (50%) PSC cases and one (12.5%) MPM case. Among the four PD‐L1‐positive PSC cases, two showed high PD‐L1 expression in the vimentin‐positive sarcomatoid compartment. Moreover, among those with PSC, two survived for about 10 years, whereas the others died within 5 years. No clear correlation was found between PD‐L1 expression and prognosis. Among the patients with MPM, four survived for more than 2 years, with the longest being 9 years. Among MPM cases who received nivolumab, one patient with positive PD‐L1 staining in the sarcomatoid survived, whereas the other with negative PD‐L1 staining did not.

Conclusion

The present study showed that sarcomatoid carcinoma had a higher PD‐L1 expression compared to non‐small‐cell lung cancer and that both PSC and MPM tended to exhibit PD‐L1 positivity in the sarcomatoid compartment. Moreover, while immune checkpoint inhibitors may somewhat prolong the prognosis of both tumors, further studies with a larger cohort are necessary to confirm our results.
Real‐world evidence of age‐independent electroconvulsive therapy efficacy: A retrospective cohort study
Authors: Luccarelli James , McCoy Thomas H. , Seiner Stephen J. , Henry Michael E.
Published: October 2021

Objectives

Electroconvulsive therapy (ECT) is an effective treatment for depressive disorders and approved for use in adolescents and adults, but it is unclear whether efficacy or cognitive side effect burden differs with age or if effectiveness in usual clinical practice matches that in prospective studies. We examined the effects of ECT on depression and cognition in a large clinical cohort.

Methods

A retrospective cohort study of patients ages 16 and older receiving ECT between 2011 and 2020 and who were evaluated with the Quick Inventory of Depressive Symptomatology (QIDS), the Behavior and Symptom Identification Scale‐24 (BASIS‐24), and the Montreal Cognitive Assessment (MoCA) at baseline and after treatment #10.

Results

Among 1698 patients, ECT was associated with a decrease in depression symptoms (QIDS reduction from 17.1 ± 4.9 to 10.1 ± 5.2) and improvement in self‐reported mental health (BASIS‐24 scores improved from 1.92 ± 0.55 to 1.17 ± 0.60). There was a reduction in MoCA scores from 25.8 ± 3.1 to 25.4 ± 3.1. In multivariate models, age was not associated with a differential QIDS or BASIS‐24 response, but older age was associated with a lesser reduction in MoCA.

Conclusion

Among 1698 patients aged 16 and older, ECT was associated with improvement in depression and overall self‐reported mental health, with a slight decrease in cognition. Age was not associated with changes in efficacy, but older age was associated with a lesser cognitive change as measured by the MoCA. These results provide normative data of real‐world effectiveness of ECT, and add further support to its utility in patients with severe psychiatric illness.
A retrospective analysis of the investigative practices of acute limb ischaemia presenting with an unknown aetiology
Authors: Nath Karthik , Reyaldeen Reza , Mack Kathyrn , Sistla Laxmi , Palamuthusingam Dharmenaan , Zahir Syeda Farah , Dave Richa , Muller Juanita , McCann Andrew
Published: October 2021

Background

Acute limb ischaemia (ALI) is a limb and life‐threatening condition with significant morbidity. There are currently no consensus recommendations for the investigative practices to determine the aetiology of ALI presenting without a known aetiology. We undertook a detailed analysis of all investigations performed to identify an underlying precipitant in those with unexplained ALI and formulated a suggested diagnostic algorithm for the evaluation of unexplained ALI.

Methods

ALI cases presenting to a tertiary referral centre over a 3‐year period were reviewed, and known aetiologies, and investigations undertaken to determine the underlying aetiology of unexplained ALI were obtained.

Results

Unexplained ALI was found in 27 of 222 patients (12%), of which 21 (78%) had a cause for ALI established after further investigations. Six patients had no cause identified despite extensive work‐up. Most patients with unexplained ALI had a cardioembolic source identified as the underlying cause (62%), and this included atrial fibrillation, infective endocarditis, cardiac myxoma and intra‐cardiac thrombus. Other causes of unexplained ALI were detected by computed tomography (CT) imaging and included newly diagnosed significant atherosclerotic disease (19%), embolism from isolated proximal large vessel thrombus (10%) and metastatic malignancy (10%). There were no cases attributed to inherited thrombophilias, myeloproliferative neoplasms or anti‐phospholipid syndrome.

Conclusion

Among patients with unexplained ALI, the majority had a cardioembolic source highlighting the importance of comprehensive cardiac investigations. A subset of patients had alternative causes identified on CT imaging. These data support the use of a collaborative and integrative diagnostic algorithm in the evaluation of unexplained ALI.
Determinants of re‐compensation in patients with hepatitis B virus‐related decompensated cirrhosis starting antiviral therapy
Authors: Kim Tae Hyung , Um Soon Ho , Lee Young‐Sun , Yim Sun Young , Jung Young Kul , Seo Yeon Seok , Kim Ji Hoon , An Hyunggin , Yim Hyung Joon , Yeon Jong Eun , Byun Kwan Soo
Published: October 2021

Background

Despite antiviral therapy, liver function often fails to recover in patients with hepatitis B virus (HBV)‐related decompensated cirrhosis.

Aim

To establish a prognostic model to predict re‐compensation in patients starting potent nucleos(t)ide analogue (NUC) therapy

Methods

We analysed 311 consecutive patients with HBV‐related decompensated cirrhosis treated with entecavir or tenofovir. The primary outcome was re‐compensation, defined as recovery to a Child–Pugh score of 5. The BC2AID score was developed from a cohort of 152 subjects based on competing risk models and validated in another cohort of 159 subjects.

Results

Re‐compensation occurred in 57.2% and 66.7% of the subjects in the derivation and validation cohorts, respectively. Six independent predictors for re‐compensation were identified in the derivation cohort and these comprised the BC2AID score: bilirubin ≤5 mg/dL (adjusted sub‐distribution hazard ratio [aSHR] 2.18), absence of severe complications (aSHR 2.78), alpha‐fetoprotein (AFP) ≥50 ng/mL (aSHR 2.54), alanine aminotransferase ≥200 IU/L (aSHR 2.62), international normalised ratio ≤1.5 (aSHR 2.37) and ≤6 months from initial decompensation until initiation of NUCs (aSHR 4.79). In the validation cohort, the area under the receiver operating characteristic curve of the BC2AID score for re‐compensation within 1 year of NUC therapy was significantly higher than that of the Child–Pugh, MELD, MELDNa and BE3A scores (0.813 vs 0.691, 0.638, 0.645 and 0.624, respectively; all P < 0.05).

Conclusions

Six clinical parameters, including AFP and the timing of antiviral therapy, were combined into a scoring system to accurately predict early re‐compensation in patients with HBV‐related decompensated cirrhosis.
Senescent murine femoral arteries undergo vascular remodelling associated with accelerated stress‐induced contractility and reactivity to nitric oxide
Authors: Lubomirov Lubomir T. , Jänsch Monique Heidrun , Papadopoulos Symeon , Schroeter Mechthild M. , Metzler Doris , Bust Maria , Hescheler Jürgen , Grisk Olaf , Ritter Oliver , Pfitzer Gabriele
Published: October 2021

This work explored the mechanism of augmented stress‐induced vascular reactivity of senescent murine femoral arteries (FAs). Mechanical and pharmacological reactivity of young (12–25 weeks, y‐FA) and senescent (>104 weeks, s‐FAs) femoral arteries was measured by wire myography. Expression and protein phosphorylation of selected regulatory proteins were studied by western blotting. Expression ratio of the Exon24 in/out splice isoforms of the regulatory subunit of myosin phosphatase, MYPT1 (MYPT1‐Exon24 in/out), was determined by polymerase chain reaction (PCR). While the resting length–tension relationship showed no alteration, the stretch‐induced‐tone increased to 8.3 ± 0.9 mN in s‐FA versus only 4.6 ± 0.3 mN in y‐FAs. Under basal conditions, phosphorylation of the regulatory light chain of myosin at S19 was 19.2 ± 5.8% in y‐FA versus 49.2 ± 12.6% in s‐FA. Inhibition of endogenous NO release raised tone additionally to 10.4 ± 1.2 mN in s‐FA, whereas this treatment had a negligible effect in y‐FAs (4.8 ± 0.3 mN). In s‐FAs, reactivity to NO donor was augmented (pD2 = −4.5 ± 0.3 in y‐FA vs. ‐5.2 ± 0.1 in senescent). Accordingly, in s‐FAs, MYPT1‐Exon24‐out‐mRNA, which is responsible for expression of the more sensitive to protein‐kinase G, leucine‐zipper‐positive MYPT1 isoform, was increased. The present work provides evidence that senescent murine s‐FA undergoes vascular remodelling associated with increases in stretch‐activated contractility and sensitivity to NO/cGMP/PKG system.
Interrogating glacier mass balance response to climatic change since the Little Ice Age: reconstructions for the Jotunheimen region, southern Norway
Authors: Hiemstra John F. , Young Giles H. F. , Loader Neil J. , Gordon Penny R.
Published: October 2021

Developing a long‐term understanding of the cryosphere is important in the study of past climatic change. Here we used a nested approach combining diverse instrumental (monthly meteorological data from four weather stations, as well as gridded data) and proxy data (based on blue intensity measurements from local tree ring records) to create a reconstruction of past summer temperature for the central Jotunheimen area in southern Norway. This record was then used to reconstruct annual glacier mass balance from 1962, the start of the yearly measurements, back to 1722, immediately prior to the regional Little Ice Age maximum. Our reconstruction of the ‘average’ Jotunheimen cumulative glacier mass balance is based on three representative glaciers (Storbreen, Hellstugubreen and Gråsubreen) that were synthesized into one composite record which we term ‘Gjennomsnittsbreen’ (‘mean glacier’ in Norwegian) to filter out localized controls on the behaviour of individual glaciers. While not ignoring the role of precipitation on glacier mass balance, our reconstruction demonstrates that glaciers in this region exhibit a strong summer temperature control and appear to have been declining more or less continuously since the mid‐18th century. However, it also shows that this long‐term trend of overall retreat in Jotunheimen is punctuated by relatively short‐lived periods of neutral or occasionally positive glacier mass balance, signifying periods of stillstand or small‐scale glacier advance. These periods or ‘events’ in our reconstruction were compared with an independent record of 12 moraine‐building events developed using lichenometry. A minimum of 10 of the moraine‐building events identifiable in our reconstruction were also identifiable in the lichenometric data which affords confidence in the performance of our interrogative model. A critical implication of this successful glacier mass balance reconstruction based on just summer temperature is that for Jotunheimen – in contrast to Norwegian maritime glaciers further to the west – there is no need (as was proposed in some previous studies) to invoke large, prolonged increases in winter snowfall to explain glacier advances, not even for events such as the Little Ice Age.
Azithromycin alleviates the severity of rheumatoid arthritis by targeting the unfolded protein response component of glucose‐regulated protein 78 (GRP78)
Authors: Zhang Yongli , Ge Luna , Song Guanhua , Zhang Ruojia , Li Shufeng , Shi Haojun , Zhang Hongchang , Li Yi , Pan Jihong , Wang Lin , Han Jinxiang
Published: October 2021

Background and Purpose

Azithromycin is a macrolide antibiotic with anti‐inflammatory properties. We aim to substantiate the treatment potential of azithromycin in rheumatoid arthritis.

Experimental Approach

Gene expression profiles were collected by RNA sequencing and the effects of azithromycin were assessed by in vitro and in vivo assays on the effects of azithromycin‐mediated blockade of glucose‐regulated protein 78 (GRP78). Anti‐inflammatory activity of azithromycin was measured in fibroblast‐like synoviocytes from rheumatoid arthritis patients and in collagen‐induced arthritis in DBA/1 mice. Characterization of the binding of azithromycin to GRP78 was performed using drug affinity responsive target stability, proteomics and cellular thermal shift assays. Azithromycin‐mediated inhibition of GRP78 and its relationship to its anti‐arthritic activity was assessed.

Key Results

Azithromycin reduced proinflammatory factor production, cell migration, invasion and chemoattraction and enhanced apoptosis, reducing the deleterious inflammatory response of rheumatoid arthritis fibroblast‐like synoviocytes in vitro. Azithromycin ameliorated the severity of collagen‐induced arthritis lesions as efficiently as the TNFα inhibitor etanercept. Transcriptional analyses suggested that azithromycin treatment impairs signalling cascades associated with cholesterol and lipid biosynthesis. GRP78 was identified as a novel target of azithromycin. Azithromycin‐mediated activation of the unfolded protein response via the inhibition of GRP78 activity is required not only for inducing the expression of C/EBP‐homologous protein (ChOP) but also for the activating sterol‐regulatory element binding protein (SREBP) and its targeted genes involved in cholesterol and lipid biosynthetic processes. Furthermore, deletion of GRP78 abolished the anti‐arthritic activity of azithromycin.

Conclusion and Implications

These findings indicate that azithromycin can used to treat rheumatoid arthritis.
P90 ribosomal S6 kinase confers cancer cell survival by mediating checkpoint kinase 1 degradation in response to glucose stress
Authors: Ma Ying , Cui Danrui , Wang Linchen , Wang Yue , Yang Fei , Pan Hui , Gong Longyuan , Zhang Minrun , Xiong Xiufang , Zhao Yongchao
Published: October 2021

In solid tumors, cancer cells have devised multiple approaches to survival and proliferate in response to glucose starvation that is often observed in solid tumor microenvironments. However, the precise mechanisms are far less known. Herein, we report that glucose deprivation activates 90‐kDa ribosomal S6 kinase (p90 RSK), a highly conserved Ser/Thr kinase, and activated p90 RSK promotes cancer cell survival. Mechanistically, activated p90 RSK by glucose deprivation phosphorylates checkpoint kinase 1 (CHK1), a key transducer in checkpoint signaling pathways, at Ser280 and triggers CHK1 ubiquitination mediated by SCFβ‐TrCP ubiquitin ligase and proteasomal degradation, subsequently suppressing cancer cell apoptosis induced by glucose deprivation. Importantly, we identified an inverse correlation between p90 RSK activity and CHK1 levels within the solid tumor mass, with lower levels of CHK1 and higher activity of p90 RSK in the center of the tumor where low glucose concentrations are often observed. Thus, our study indicates that p90 RSK promotes CHK1 phosphorylation at Ser280 and its subsequent degradation, which allows cancer cells to escape from checkpoint signals under the stress of glucose deprivation, leading to cell survival and thus contributing to tumorigenesis.
The commissioning of infant mental health services in the United Kingdom: A study of stakeholder views
Authors: Homonchuk Olha , Barlow Jane
Published: October 2021

Context

Infant regulatory disturbances are common and stable over time and can compromise infant outcomes across a range of developmental domains. Many such problems have their origins within the parent–infant relationship and specialized parent–infant relationship teams provide support and intervention that is explicitly aimed at addressing such relationship difficulties. However, there are currently only around 27 such teams across the United Kingdom, and just under half of CAMHS do not accept referrals of children under 2 years of age.

Aim

The current research aimed to examine the views of commissioners of children's services regarding the reasons for commissioning (or not) infant mental health services.

Method

Fourteen in‐depth interviews were conducted with a range of stakeholders involved in commissioning children's services across 14 areas of England, half of which were commissioning specialized infant mental health services. A thematic analysis was undertaken.

Results

A total of five themes emerged from the data as being key factors in the commissioning of infant mental health services: pressure from local practitioners, policy transfer through policy networks, opportunity for long‐term cost reduction, potential to embed the service model within existing services and perinatal mental health funding.

Conclusion

As with commissioning more widely, the commissioning of infant mental health services is a complex process, with a range of factors influencing whether such services are commissioned or not, and data to suggest that the process is currently driven by informal and contingent factors, as much as by the evidence regarding what works.
The prevalence of CFTR mutations in patients with chronic rhinosinusitis: A systematic review and meta‐analysis
Authors: Yong Michael , Hernaiz‐Leonardo Juan Carlos , Alqunaee Marwan , Quon Bradley S , Javer Amin
Published: October 2021

Objectives

Undetected cystic fibrosis transmembrane regulator (CFTR) mutations may predispose individuals to develop CRS independent of formal CF diagnosis. The objective of this study was to determine the prevalence of CFTR mutations among individuals with CRS.

Design

A systematic search following PRISMA guidelines was performed. A meta‐analysis was performed to calculate pooled estimates for the prevalence of any CFTR mutation and for the DF508 mutation.

Setting and participants

The systematic search included all studies identifying adults diagnosed with CRS, with no limitation to region or publication date. Studies had to identify a sample of patients previously diagnosed with CRS but not with CF and reporting testing for the prevalence of CF or the CFTR gene mutation.

Main outcome measures

Prevalence of CFTR mutations among the general CRS population, with subgroup analysis of individuals with the dF508 mutation.

Results and conclusions

The 6 included studies represented five countries: the United States, the UK, France, Poland and Finland. The pooled prevalence of CFTR mutations of any kind in CRS subjects without CF was 5.65% (RE 95% CI 2.99 – 10.41). The overall prevalence for the dF508 mutation was 4.22% (RE 95% CI 1.71 – 10.07). These estimates were significantly higher than the baseline estimated prevalence of CFTR carrier status of 3%–4% in the general population. However, the clinical relevance of the presence of CFTR mutations in CRS patients who have not been diagnosed with CF is currently unclear. Future studies should include sweat chloride testing as a measure of CFTR function.