bluuebunny/crossref_metadata_2025 huggingface dataset:
How “Dynamic CEOs” outperformed by adopting a transformation mindset
Authors: Cooney Haynes , Korsten Peter , Marshall Anthony
Published: July 2021

Purpose

The recent IBM Institute for Business Value CEO survey of 3,000 chief executives globally offers insight into CEO attitudes and behaviors in order to discern the strategies and actions most highly correlated to successful digital transformation and performance.

Design/methodology/approach

The IBM Institute for Business Value, in collaboration with the Oxford Economics, surveyed 3,000 CEOs and senior public sector executives between September and November 2020. The analysis identified a group of CEOs whose outlook on transformation and success with digital implementation sets them apart from others.

Findings

These Dynamic CEOs, who represent 38 percent of all commercial leaders in the IBM IBV research, shared two crucial insights: that traditional business models no longer differentiate their organizations; their organization?s digital transformation journey will never be complete.

Practical/implications

These Dynamic CEOs are almost 70 percent more likely to lead high performing organizations than other top leaders.

Originality/value

Almost 90 percent of Dynamic CEOs expect their business and IT investments to deliver a material improvement in business performance over the next three years, with the greatest emphasis on investments in customer experience improvement, decision-making processes and business agility.
Duck Tembusu virus induces stronger cellular responses than Japanese encephalitis virus in primary duck neurons and fibroblasts
Authors: Kulprasertsri Sittinee , Kobayashi Shintaro , Aoshima Keisuke , Kobayashi Atsushi , Kimura Takashi
Published: July 2021

Duck Tembusu virus (DTMUV) and Japanese encephalitis virus (JEV) are mosquito‐borne flaviviruses. These two viruses infect ducks; however, they show different neurological outcomes. The mechanism of DTMUV‐ and JEV‐induced neuronal death has not been well investigated. In the present study examined the differences in the mechanisms involved in virus‐induced cell death and innate immune responses between the DTMUV KPS54A61 strain and the JEV JaGAr‐01 strain using primary duck neurons (DN) and duck fibroblasts (CCL‐141). DN and CCL‐141 were permissive for the infection and replication of these two viruses, which up‐regulated the expression of innate immunity genes. Both DTMUV and JEV induced cell death via a caspase‐3‐dependent manner; however, DTMUV triggered more cell death than did JEV in both CCL‐141 and DN. These findings suggest that DTMUV infection causes apoptosis in duck neurons and fibroblasts more strongly than JEV. The levels of the mRNA expression of innate immunity‐related genes after DTMUV infection were generally higher than the levels after JEV infection, suggesting that DTMUV‐induced immune response in duck cells may exhibit toxic effects rather than protective effects.
High salinity gradients and intermediate spatial scales shaped similar biogeographical and co‐occurrence patterns of microeukaryotes in a tropical freshwater‐saltwater ecosystem
Authors: Zhu Changyu , Liu Weiwei , Li Xinghao , Xu Yusen , El‐Serehy Hamed A. , Al‐Farraj Saleh A. , Ma Honggang , Stoeck Thorsten , Yi Zhenzhen
Published: July 2021

Microeukaryotes play key ecological roles in the microbial web of aquatic ecosystems. However, large knowledge gaps urgently need to be filled regarding the biogeography with associated shaping mechanisms and co‐occurrence patterns of microeukaryotes under freshwater‐saltwater gradients, especially true in tropical regions. Here, we investigated microeukaryotes of six mixed freshwater‐saltwater regions in the Pearl River Estuary and surrounding coasts in southern China, with salinity ranging 0.1–32.0% and distances spanned up to 500 km, using molecular ecological methods. Results indicate that the biogeography of abundant and rare microeukaryotic communities was similar, both their co‐occurrence patterns and biogeographical patterns were driven by deterministic and stochastic processes. The environmental factors with higher selective pressure than dispersal limitation meant that the role of deterministic process in structuring communities was more significant than that of stochastic process, and salinity played important role in structuring both microeukaryotic communities and networks. The abundant communities had stronger influence on entire microeukaryotic communities and seemed to be more sensitive to environmental changes than their rare counterparts, while rare ones had stronger interspecific relationships. Finally, the geographic scale and environmental gradients of study regions should firstly be clarified in future research on the ecological processes of microeukaryotes before conclusions are drawn.
A systematic review on outcome reporting in randomised controlled trials assessing treatment interventions in pregnant women with pregestational diabetes
Authors: Kgosidialwa O , Bogdanet D , Egan A , Newman C , O'Shea PM , Biesty L , McDonagh C , O'Shea C , Devane D , Dunne F ,   the INSPIRED research group
Published: July 2021

Background

Pregestational diabetes mellitus (PGDM) is associated with adverse pregnancy outcomes. Studies assessing interventions to improve maternal and infant outcomes have increased exponentially over recent years. Several outcomes in this field of maternal diabetes are rare, making it difficult to synthesise evidence.

Objectives

To collect outcomes reported in studies assessing treatment interventions in pregnant women with PGDM.

Search strategy

CENTRAL, Web of Science, Medline, CINAHL, Embase and ClinicalTrials.gov from their inception until 27 January 2020.

Selection criteria

Any randomised controlled trial assessing treatment interventions in pregnant women with PGDM reported in English.

Data collection and analysis

Two independent reviewers assessed the suitability of articles and retrieved the data. Outcomes extracted from the literature were broadly categorised into maternal, fetal/infant or other outcomes by the study advisory group.

Main results

Sixty‐seven of the 1475 studies identified fulfilled the inclusion criteria. The median number of outcomes reported per study was 15 (range 1–46). The majority of studies were from North America and Europe. Insulin and metformin were the most commonly investigated pharmacological interventions. Glucose monitoring was the most assessed technological intervention. In all, 131 unique outcomes were extracted: maternal (n = 69), fetal/infant (n = 61) and other (n = 1).

Conclusions

Outcome reporting in treatment interventions trials of pregnant women with PGDM is varied, making it difficult to synthesise evidence, especially for rare outcomes. Systems are needed to standardise outcome reporting in future clinical trials and so facilitate evidence synthesis in this area of maternal diabetes.

Registration

The systematic review was registered prospectively with the International Prospective Register of Systematic Reviews (PROSPERO) database (Registration number CRD42020173549).

Tweetable abstract

Outcome reporting is heterogeneous in intervention trials of pregnant women with diabetes existing before pregnancy.
Risk factors for perioperative blood transfusions after urogenital fistula repair in Uganda: a retrospective cohort study
Authors: Potluri TK , Holt LM , Tanner JP , Wasingya L , Duffy S , Greene KA
Published: July 2021

Objective

To determine the incidence of and risk factors for perioperative blood transfusions after urogenital fistula repairs in Uganda.

Design

A retrospective cohort study.

Setting

A community hospital in Masaka, Uganda.

Population

Women who underwent fistula repair at the Kitovu Hospital between 2013 and 2019.

Methods

Retrospective review of demographics and clinical perioperative characteristics of patients surgically treated for urogenital fistula. Patient characteristics were compared between those who did and those who did not require a blood transfusion.

Main outcome measures

Need for perioperative blood transfusion and risk factors.

Results

A total of 546 patients treated for urogenital fistulas were included in this study. The median age was 31.1 ± 13.2 years. A vaginal surgical approach was used in the majority of patients (84.6%). Complications occurred in 3.5% of surgical repairs, and the incidence of blood transfusions was 6.2%. In multivariable analyses, for each gram per deciliter (g/dl) increase in preoperative haemoglobin, the odds of blood transfusion decreased by approximately 28% (adjusted OR 0.72, 95% CI 0.59–0.86). Women who had their fistula repaired abdominally were 3.4 times more likely to require transfusions (95% CI 1.40–8.08).

Conclusions

The incidence of blood transfusions among urogenital fistula repairs in our population is twice that of developed nations. An abdominal surgical approach to urogenital fistula is a significant risk factor for perioperative blood transfusions. The timing of the repair may warrant further study.

Tweetable abstract

One of the first studies to look at blood transfusion risk factors after fistula repair in a low‐resource setting.
Integrated analysis of probability of type 2 diabetes mellitus with polymorphisms and methylation of KCNQ1 gene: A nested case‐control study
Authors: Hu Fulan , Zhang Yanyan , Qin Pei , Zhao Yang , Liu Dechen , Zhou Qionggui , Tian Gang , Li Quanman , Guo Chunmei , Wu Xiaoyan , Qie Ranran , Huang Shengbing , Han Minghui , Li Yang , Zhang Ming , Hu Dongsheng
Published: July 2021

Background

To estimate the associations between single‐nucleotide polymorphisms (SNPs) and methylation of KCNQ1 gene and type 2 diabetes mellitus (T2DM) risk and the interactions among SNPs, methylation, and environmental factors on T2DM risk.

Methods

We genotyped five SNPs and tested methylation at 39 CpG loci of KCNQ1 in 290 T2DM cases and 290 matched controls nested in the Rural Chinese Cohort Study. Conditional logistic regression model was used to estimate the associations between SNPs and KCNQ1 methylation and T2DM risk. Multifactor dimensionality reduction (MDR) analysis was used to estimate the effect of the interactions SNPs‐SNPs, SNPs‐methylation, methylation‐methylation and SNPs, and methylation‐environment on T2DM risk.

Results

Probability of T2DM was decreased with rs2283228 of KCNQ1 (CA vs AA, odds ratio [OR] = 0.65, 95% confidence interval [CI] 0.42‐0.99). T2DM probability was significantly increased with rs2237895 combined with hypertriglyceridemia (OReg = 2.76, 95% CI 1.35‐5.62), with hypertension (OReg = 2.23, 95% CI 1.25‐3.98), and with body mass index (BMI; OReg = 1.93, 95% CI 1.12‐3.34). T2DM probability was associated with methylation of CG11 and CG41 (OR = 1.89, 95% CI 1.23‐2.89, P = .003). It was significantly associated with the interaction between BMI, hypertriglyceridemia, and CG5 methylation (P = .028 and .028), and the combined effects of CG11 with hypertriglyceridemia and hypertension. On MDR analysis, no significant interaction was observed.

Conclusion

T2DM probability was reduced 35% with rs2283228 polymorphism. It was associated with rs2237895 combined with hypertension, with BMI and with hypertriglyceridemia. The methylation at two CpG loci of KCNQ1 significantly increased T2DM risk by 89%.
Tropical forests structure and diversity: A comparison of methodological choices
Authors: de Souza Cléber Rodrigo , Coelho de Souza Fernanda , Maia Vinícius A. , de Aguiar‐Campos Natália , Coelho Polyanne A. , Farrapo Camila L. , Santos Alisson B. M. , Araújo Felipe C. , Gianasi Fernanda M. , Paula Gabriela G. P. , Morel Jean D. , Fagundes Nathalle C. A. , Garcia Paulo O. , Santos Paola F. , Silva Wilder B. , Fontes Marco A. L. , Santos Rubens M.
Published: July 2021

Large‐scale data compilation is increasing steadily in tropical forest research, but the lack of standardized methods for data collection limits drawing inference from large datasets and cross‐biome analyses. Different inclusion methods and minimum tree diameter threshold are among these varying factors. To tackle this issue, we evaluated how different approaches for tree sampling affects our understanding of diversity and functioning in different tropical vegetation types.

We used a unique dataset of 44 inventory plots (43.54 ha) encompassing an aridity gradient: evergreen moist forests, semideciduous and deciduous tropical forests. Data were collected using the by‐tree inclusion method, in which, all stems are measured if the equivalent diameter of the tree reaches the minimum threshold. We simulated the impact of adopting different inclusion methods (by‐stem and by‐tree) and different minimum diameter thresholds on the estimation of number of trees and stems, biomass and species richness. We used linear and nonlinear mixed models to investigate the effect of minimum diameter threshold and inclusion method on our different response variables. We also evaluated species chance to be sampled under different minimum inclusion criteria.

Inclusion method and minimum diameter threshold mainly affect the estimation of number of trees and stems and species richness, especially in deciduous and semideciduous forests, where resprouting is a prevalent strategy. In these forests, many trees that have several stems do not reach the minimum size individually when adopting the by‐stem method, yet they do reach the minimum size threshold when all stems are considered together. For these environments under water stress, our analysis showed that using large minimum sizes, such as the 10 cm typically used in rainforests, implies large sampling losses, especially when used jointly with the by‐stem inclusion method.

The by‐tree inclusion method represents an alternative approach that offers a more reliable sampling in different vegetation types, particularly in those habitats where resprouting is a widely encountered strategy along all age classes. We demonstrate the infeasibility of adopting broad and standard minimum thresholds for different tropical vegetation types, particularly considering their widely different ecological strategies.
Epidural space “ballooning” during local anaesthetic injection in infants and children: An ultrasound observational study
Authors: Yagihara Masahiro , Uemura Aki , Nakajima Yoshiki
Published: July 2021

Background

Infants and children require a larger dose of a local anaesthetic (LA) to establish epidural analgesia than adults, but the reason for this remains unclear. We hypothesised that prominent ventro‐dorsal expansion of the epidural space limits cranio‐caudal spread of LA in infants. Accordingly, we studied the dimensions of the epidural space with real‐time ultrasound (US) before and after epidural injection.

Methods

Ninety‐six infants and children aged 0–12 years who underwent abdominal surgery under combined epidural and general anaesthesia were examined in this prospective observational study. Using a micro‐convex probe, US recordings of the posterior epidural space were performed while a LA (0.5 ml kg−1) was infused at 0.54 ml s−1. The width in the ventro‐dorsal dimension (VDD) of the posterior epidural space before and after injection was recorded; the change in VDD was defined as “ballooning”. Correlations between “ballooning” and patient age, body mass index, and volume and rate of LA administration were analysed.

Results

“Ballooning” correlated positively but weakly with age (R2 = 0.25; p < .001) and the infused LA volume (R2 = 0.32; p < .001). The “magnitude of ballooning” (“ballooning” per ml of injected LA) correlated negatively but weakly with age (R2 = 0.27; p < .001).

Conclusions

“Magnitude of ballooning” of the epidural space become inconspicuous with growing during epidural injection. This effect may slow the cranio‐caudal spread of LA and explain partially why larger volumes of LA are required to effect a block in children.
Developing a prototype dental trauma e‐learning course for medical education
Authors: Yeng Thai , O’Sullivan Anthony J. , Shulruf Boaz
Published: July 2021

This article aims to demonstrate how an expert feedback process was used to identify emerging issues within a prototype extracurricular course on dental trauma and show how the feedback was addressed prior to piloting the course more widely. Dowse’s Design Research Model was adapted for the design and development of a prototype dental trauma e‐learning course. This paper will focus on step five, gathering expert feedback and the evaluation process. Four critical features emerged from the feedback that ought to be incorporated into the e‐learning course design, namely, 1) keep resources clinically relevant; 2) keep resources simple to learn; 3) make resources easy to understand; and 4) support self‐learning. The results demonstrate the value of an expert feedback process for improving a prototype designed to address a major gap in knowledge among medical doctors identified in the literature.
The right supraclavicular fossa ultrasound view for correct catheter tip positioning in right subclavian vein catheterisation: a prospective observational study
Authors: Adrian M. , Kander T. , Lundén R. , Borgquist O.
Published: July 2021

Central venous catheter misplacement is common (approximately 7%) after right subclavian vein catheterisation. To avoid it, ultrasound‐guided tip navigation may be used during the catheterisation procedure to help direct the guidewire towards the lower superior vena cava. We aimed to determine the number of central venous catheter misplacements when using the right supraclavicular fossa ultrasound view to aid guidewire positioning in right infraclavicular subclavian vein catheterisation. We hypothesised that the incidence of catheter misplacements could be reduced to 1% when using this ultrasound technique. One ‐hundred and three adult patients were prospectively included. After vein puncture and guidewire insertion, we used the right supraclavicular fossa ultrasound view to confirm correct guidewire J‐tip position in the lower superior vena cava and corrected the position of misplaced guidewires using real‐time ultrasound guidance. Successful catheterisation of the right subclavian vein was achieved in all patients. The guidewire J‐tip was initially misplaced in 15 patients, either in the ipsilateral internal jugular vein (n = 8) or in the left brachiocephalic vein (n = 7). In 12 patients it was possible to adjust the guidewire J‐tip to a correct position in the lower superior vena cava. All ultrasound‐determined final guidewire J‐tip positions were consistent with the central venous catheter tip positions on chest X‐ray. Three out of 103 catheters were misplaced, corresponding to an incidence (95%CI) of 2.9 (0.6–8.3) %. Although the hypothesis could not be confirmed, this study demonstrated the usefulness of the right supraclavicular fossa ultrasound view for real‐time confirmation and correction of the guidewire position in right infraclavicular subclavian vein catheterisation.
In‐depth analysis of risk factors for pseudophakic retinal detachments and retinal breaks
Authors: Gabriel Maximilian , Großpötzl Manuel , Wallisch Fabian , Djavid Daniel , Pregartner Gudrun , Haas Anton , Wedrich Andreas , Mayer‐Xanthaki Christoph
Published: July 2021

Purpose

To provide a detailed analysis of risk factors for pseudophakic retinal detachments (PRD) and pseudophakic retinal breaks (PRB).

Materials and methods

We reviewed the medical records of cataract surgeries between 1996 and 2017 at a tertiary care hospital in Austria. A Cox proportional‐hazard regression model was used to analyse risk factors for PRD and PRB.

Results

Sixty‐five thousand six hundred and sixty‐two eyes (45 043 patients) underwent phacoemulsification, and 393 eyes (cumulative incidence 0.6%) were diagnosed with PRD (327 eyes) or PRB (66 eyes) during the follow‐up (median 7.1 years, range 0–21). Calculation of adjusted hazard ratios (HR) revealed a hierarchy of risk factors for either event including (from the highest to the lowest risk) posterior capsular rupture (PCR), patient age <65 years (compared with the age group >75 years), male gender and high myopia. Diabetes mellitus was associated with a lower risk. PCR was the strongest risk factor for PRD both in patients with and without perioperative vitrectomy (i.e. vitreous loss), but time to PRD was significantly reduced only following PCR with vitrectomy.

Conclusions

Posterior capsular rupture, young patient age, male gender and high myopia were risk factors for PRD, but diabetes mellitus was associated with a lower risk. PCR had the strongest association with PRD, regardless of the need for perioperative vitrectomy due to vitreous loss. Time to PRD was reduced in patients with PCR and vitrectomy compared with PCR without the need for vitrectomy or uneventful surgery.
Communicating group norms through election results
Authors: Syfers Lily , Gaffney Amber M. , Rast David E. , Estrada Dennis A.
Published: July 2021

In a representative democracy, leaders (ideally) who are elected through the electorates should indicate consensus that the newly elected leader truly does represent the majority of the nation or the group. That is, once elected, can the ensuing perceptions of the electorate’s consensus provide the newly elected leader with a sense of legitimacy and the ability to represent the group? Two experiments demonstrate that the perceptions of group consensus stemming from democratic elections can imbue newly elected leaders (even if they were once deviant) with legitimacy. Study 1 (N = 158) demonstrates that normative leaders are perceived as more legitimate than deviant leaders when elected with high voting consensus, which increased the perceived prototypicality of the normative leader through greater perceptions of legitimacy. Study 2 (N = 182) showed that newly elected leaders (vs. candidates) are perceived as more legitimate, which in turn, increases the group’s perceptions of the once deviant leader’s prototypicality, granted that the leader is democratically elected. Results suggest that democratic elections create conditions under which once deviant leaders can gain in perceived prototypicality and create lasting changes to the group identity.
Women doctors in female urology: current status and implications for future workforce
Authors: Pirpiris Athina , Chan Garson , O’Connell Helen E. , Gani Johan
Published: July 2021

Objective

To objectively determine the percentage of female trainees and consultants who are interested in their career being focussed on female urology (FU) in order to facilitate the improved planning for the future of this sub‐specialty.

Subjects and methods

This was an international cross‐sectional study spanning 1 year, from December 2018 to December 2019. An anonymous, voluntary survey was generated using the online survey generator Survey monkey®. The survey was sent to urology consultants and trainees who were female from Australia, New Zealand, and Canada.

Results

The total response rate to the survey was 61%. Up to 50% of female consultants and trainees selected a career in FU due to their gender, but up to 75% of respondents were also interested in FU of their own accord. Common concerns held by a majority of respondents included both the medical community’s and the public’s lack of awareness of FU as a component of urological expertise. Despite these concerns, most of the trainees were not concerned regarding their future work opportunities in FU, and many had intentions to pursue a fellowship in FU.

Conclusion

Female urology is an increasingly popular sub‐specialisation of urology, given the steady increase in the intake of female trainees. Similar trends were identified internationally. Urology training in this area will need to continue to increase the community’s and the primary health care referrer’s awareness in order to ensure the continued success and growth of the sub‐specialty.
The distributional consequences of rent‐seeking
Authors: Angelopoulos Angelos , Angelopoulos Konstantinos , Lazarakis Spyridon , Philippopoulos Apostolis
Published: July 2021

We analyze the distributional effects of rent‐seeking via the financial sector in a model calibrated to US data. Rent‐seeking implies a misallocation of resources that increases wealth inequality among non‐rent‐seekers and for the whole economy. A deterioration in institutional quality implying more rent‐seeking leads to welfare losses for non‐rent‐seekers, especially for those with higher earnings and initial wealth, because they are most affected by the deterioration of the aggregate economy. On the other hand, welfare gains are larger for rent seekers with higher earnings and wealth, who have an increased resource extraction capacity.
Canals, climate, and corruption: The provisioning of public infrastructure under uncertainty
Authors: Vallury Sechindra , Leonard Bryan
Published: July 2021

We develop a two‐stage model to study the strategic interaction between a politician (the principal) and a bureaucrat (the agent) over the level of infrastructure provision with uncertainty about possible weather shocks. The bureaucrat chooses how much effort to contribute to infrastructure maintenance and the politician offers either a lump‐sum wage (non‐corrupt) contract or proportional bribe (corrupt) contract to induce effort. The degree of uncertainty about weather shocks, the size of the fixed wage, and the level of external monitoring to detect corruption all interact to affect (a) the politician's choice of contract and (b) whether this choice improves infrastructure outcomes. Our results suggest that curbing corruption is most likely to yield improvements in infrastructure provision when climate uncertainty is low and when bureaucratic wages are relatively high. If climate uncertainty is high, increasing monitoring has an unambiguous negative effect on infrastructure provision. Previous literature has focused either on public goods provision but not corruption or on bribery in a regulatory context that lacks public goods provision. We extend both literatures by analyzing how bribes between government officials affect a principal's ability to more effectively incentivize public goods provision by her agent.
The hemostatic and thrombotic complications of liver disease
Authors: McMurry Hannah Stowe , Jou Janice , Shatzel Joseph
Published: July 2021

Hepatic cirrhosis leads to numerous hematologic derangements resulting in a complex and tenuously rebalanced hemostatic milieu. The utility of common hematologic tests including the INR and aPTT in assessing hemostatic and thrombotic risk in patients with cirrhosis is limited, and consensus on transfusion thresholds and proper management of thrombotic complications continues to evolve. This review summarizes the pathophysiology of key derangements of hemostasis including those of platelets, von Willebrand factor, pro‐ and anticoagulation factors, and fibrin. Additionally, the pathogenesis, consequences, optimal management, and prevention of major thrombotic and bleeding complications in cirrhosis arte discussed.
Neuroprotective effects of four different fluids on cerebral ischaemia/reperfusion injury in rats through stabilization of the blood–brain barrier
Authors: Shan Reai , Zhou Hongyan , Liu Xinfang , Su Guangjun , Liu Guangsen , Zhang Xiaoli , Sun Cong , Yu Zining , Zhan Lifang , Huang Zhihua
Published: July 2021

Protecting the blood–brain barrier (BBB) is a potential strategy to treat cerebral ischaemic injury. We previously reported that hypertonic sodium chloride hydroxyethyl starch 40 (HSH) treatment alleviates brain injury induced by transient middle cerebral artery occlusion (tMCAO). However, other fluids, including 20% mannitol (MN), 3% hypertonic sodium chloride (HTS) and hydroxyethyl starch 130/0.4 solution (HES), have the same effect as HSH in cerebral ischaemia/reperfusion injury (CI/RI) remains unclear. The present study evaluated the protective effects of these four fluids on the BBB in tMCAO rats. Sprague–Dawley (SD) rats were randomly assigned to six groups. A CI/RI rat model was established by tMCAO for 120 min followed by 24 h of reperfusion. The sham and tMCAO groups were treated with normal saline (NS), whereas the other four groups were treated with the four fluids. After 24 h of reperfusion, neurological function, brain oedema, brain infarction volume, permeability of the BBB, cortical neuron loss and protein and mRNA expression were assessed. The four fluids (especially HSH) alleviated neurological deficits and decreased the infarction volume, brain oedema, BBB permeability and cortical neuron loss induced by tMCAO. The expression levels of GFAP, IL‐1β, TNF‐α, MMP‐9, MMP‐3, AQP4, MMP‐9, PDGFR‐β and RGS5 were decreased, whereas the expression levels of laminin and claudin‐5 were increased. These data suggested that small‐volume reperfusion using HSH, HES, MN and HTS ameliorated CI/RI, probably by attenuating BBB disruption and postischaemic inflammation, with HSH exerting the strongest neuroprotective effect.
Decision support system for major depression detection using spectrogram and convolution neural network with EEG signals
Authors: Loh Hui Wen , Ooi Chui Ping , Aydemir Emrah , Tuncer Turker , Dogan Sengul , Acharya U. Rajendra
Published: July 2021

The number of Major Depressive Disorder (MDD) patients is rising rapidly these days following the incidence of COVID‐19 pandemic. It is challenging to detect MDD through personal interviews and by observing electroencephalogram (EEG) signals. Hence, an automated MDD detection system developed using deep learning techniques can help reduce the workload of clinicians by diagnosing MDD accurately. In this study, we have proposed a novel deep learning model based on Convolutional Neural Network (CNN) and spectrogram images. In this work, Short‐Time Fourier Transform (STFT) is first applied to the EEG signals to obtain spectrogram images of MDD patients and healthy subjects. These spectrogram images are then fed to the CNN model for automated detection of MDD patients and healthy subjects. The EEG signals used in this study were obtained from public database with 34 MDD patients and 30 healthy subjects. The highest classification accuracy, precision, sensitivity, specificity, and F1‐score of 99.58%, 99.40%, 99.70%, 99.48%, and 99.55% respectively were obtained with hold‐out validation. Our MDD detection model is highly accurate and needs to be validated with more diverse MDD database before it can be used in clinical settings. Also, we plan to use our developed prototype to detect depression using other physiological signals like electrocardiogram (ECG) and speech signals for accurate and faster diagnosis.
Targeting cannabinoid receptor 2 (CB2) limits collagen production—An in vitro study in a primary culture of human fibroblasts
Authors: Correia‐Sá Inês , Carvalho Cláudia , A. Machado Vera , Carvalho Sofia , Serrão Paula , Marques Marisa , Vieira‐Coelho Maria A.
Published: July 2021

Previous studies showed that cannabinoid 2 (CB2) receptor is involved in skin inflammation, fibrogenesis and re‐epithelialization in mice, indicating that this receptor may be implicated in wound healing. Thus, topical use of cannabinoids may have a role in local fibrotic and wound healing diseases such as scars or keloids. We investigate the effect of the CB2 selective receptor agonist (6aR,10aR)‐3‐(1,1‐Dimethylbutyl)‐6a,7,10,10a‐tetrahydro‐6,6,9‐trimethyl‐6H‐dibenzo[b,d]pyran (JWH133) and the CB2 selective receptor antagonist (6‐Iodo‐2‐methyl‐1‐[2‐(4‐morpholinyl)ethyl]‐1H‐indol‐3‐yl)(4‐methoxyphenyl)‐methanone (AM630), on primary cultures of human fibroblasts. Primary cultures of adult human fibroblasts were obtained from abdominal human skin samples. Fibroblasts pretreated with JWH133 and/or AM630 were stimulated with TGF‐β (10 ng/ml). Fibroblast activation into myofibroblasts was quantified by the expression of alpha‐smooth muscle actin (α‐SMA) using Immunocytochemistry and Western Blot assays. Collagen content was quantified with the Sirius red staining assay. Upon human fibroblasts stimulation with TGF‐β, a significant increase on α‐SMA and CB2 receptor expression was observed. In these cells, JWH133 decreased α‐SMA expression and collagen content. However, this effect was not observed in resting human fibroblasts. AM630 decreased α‐SMA expression and collagen content in both resting and activated fibroblasts. This effect was time‐ and concentration‐dependent with an IC50 value of 11 μM. The CB2 receptor appears to be involved in fibroblast repair during skin wound healing in humans, as TGF‐β increases CB2 receptor expression and JWH133 produces an anti‐fibrotic effect in human fibroblasts. AM630 also showed an anti‐fibrotic effect hypothesizing that other cannabinoid receptors, such as TRPV, may be involved in this response.
Spatial variation in direct and indirect effects of climate and productivity on species richness of terrestrial tetrapods
Authors: Barreto Elisa , Rangel Thiago F. , Coelho Marco Túlio P. , Cassemiro Fernanda A. S. , Zimmermann Niklaus E. , Graham Catherine H.
Published: July 2021

Aim

We aimed to dissect the spatial variation of the direct and indirect effects of climate and productivity on global species richness of terrestrial tetrapods.

Location

Global.

Time period

Present.

Major taxa studied

Terrestrial tetrapods.

Methods

We used a geographically weighted path analysis to estimate and map the direct and indirect effects of temperature, precipitation and primary productivity on species richness of terrestrial tetrapods across the globe.

Results

We found that all relationships shift in magnitude, and even in direction, among taxonomic groups, geographical regions and connecting paths. Direct effects of temperature and precipitation are generally stronger than both indirect effects mediated by productivity and direct effects of productivity.

Main conclusions

Richness gradients seem to be driven primarily by effects of climate on organismal physiological limits and metabolic rates rather than by the amount of productive energy. Reptiles have the most distinct relationships across tetrapods, with a clear latitudinal pattern in the importance of temperature versus water.
What defines quality of care for older people in aged care? A comprehensive literature review
Authors: Cleland Jenny , Hutchinson Claire , Khadka Jyoti , Milte Rachel , Ratcliffe Julie
Published: July 2021

The quality of the care provided to frail older people in aged care is a concern for all Australians and for the citizens of many other countries internationally. This paper summarizes the methods and findings from an Australian study commissioned by the Royal Commission into Aged Care Quality and Safety to identify and synthesize international literature relating to the quality of care in aged care. A comprehensive literature review was undertaken to search and identify the literature (grey and peer reviewed) relating to quality of care and/or person‐centered care in aged care. The review identified nine key themes as salient to the quality of care experience, which include treating the older person with respect and dignity; acknowledging and supporting their spiritual, cultural, religious and sexual identity; the skills and training of the aged care staff providing care; relationships between the older person and the aged care staff; social relationships and the community; supporting the older person to make informed choices; supporting the older person's health and well‐being; ensuring the delivery of safe care in a comfortable service environment; and the ability to make complaints and provide feedback to the aged care organization. In practice, particularly in the context of residential care, quality of care has traditionally been measured using clinical indicators of care quality. These findings highlight the central importance of person‐centered care and care experience as fundamental tenets of the quality of aged care service delivery in Australia and internationally. Geriatr Gerontol Int 2021; 21: 765–778.
Efficacy and safety of apararenone (MT‐3995) in patients with nonalcoholic steatohepatitis: A randomized controlled study
Authors: Okanoue Takeshi , Sakamoto Michiie , Harada Kenichi , Inagaki Masaya , Totsuka Naoko , Hashimoto Gaia , Kumada Hiromitsu
Published: July 2021

Aim

To evaluate the efficacy, safety, and tolerability of apararenone 10 mg/day in patients with nonalcoholic steatohepatitis (NASH).

Methods

In this multicenter, randomized, double‐blind, placebo‐controlled phase II study, patients received apararenone 10 mg or placebo once daily for 72 weeks. The primary efficacy end‐point was percent change in serum alanine aminotransferase (ALT) from baseline to 24 weeks after randomization. Secondary efficacy end‐points included changes in liver fibrosis markers. Adverse drug reactions (ADRs) and serum potassium levels were evaluated.

Results

Forty‐eight patients were randomly assigned to treatment (placebo, 23; apararenone, 25). The percent change in ALT at 24 weeks was −3.0% and −13.7% with placebo and apararenone, respectively (p = 0.308). The apararenone group showed greater reductions from baseline in fibrosis markers (type IV collagen 7S and procollagen‐3 N‐terminal peptide) and noninvasive tests of fibrosis (enhanced liver fibrosis score and Fibrosis‐4 index) at all time points versus placebo. The percentage of patients with improvement of 1 point or more in fibrosis stage/without nonalcoholic fatty liver disease activity score worsening was 41.7% with apararenone and 26.1% with placebo (p = 0.203). Adverse drug reactions were reported in three (13.0%) and three (12.5%) patients in the placebo and apararenone groups, respectively. Serum potassium levels increased in the apararenone group during the study and decreased to near baseline after the end of treatment.

Conclusions

In patients with NASH, apararenone 10 mg/day for 72 weeks was effective in decreasing ALT levels, improved multiple potential fibrosis markers, and was safe and well tolerated. Pathological findings showed anti‐inflammatory and antifibrotic effects of apararenone.
Barriers and facilitators of shared decision making in acutely ill inpatients with schizophrenia—Qualitative findings from the intervention group of a randomised‐controlled trial
Authors: Becher Stefanie , Holzhüter Fabian , Heres Stephan , Hamann Johannes
Published: July 2021

Background

Shared decision making (SDM) is appreciated as a promising model of communication between clinicians and patients. However, in acute mental health settings, its implementation is still unsatisfactory.

Objective

The aim of this study is to examine barriers and facilitators of SDM with acutely ill inpatients with schizophrenia.

Design

A qualitative interview study was performed.

Setting and Participants

The analysis is based on interviews with participants (patients and staff members) of the intervention group of the randomised‐controlled SDMPLUS trial that demonstrated a significant improvement of SDM measures for patients with schizophrenia on acute psychiatric wards.

Main Variables Studied

Interviews addressed treatment decisions made during the current inpatient stay. The interviews were analysed using qualitative content analysis.

Results

A total of 40 interviews were analysed and 131 treatment decisions were identified. According to the interviewees, SDM had taken place in 29% of the decisions, whereas 59% of the decisions were made without SDM. In 16%, a clear judgement could not be made. Barriers and facilitators of SDM were categorised into patient factors, clinician factors, setting factors and others. Clinicians mostly reported patient factors (e.g., symptoms) as barriers towards SDM, which were not mirrored on the patients' side. Facilitators included patient as well as clinician behaviour during consultations.

Conclusion

Even in the context of a successful SDM intervention, the implementation of SDM for patients in the very acute stages of schizophrenia is often not possible. However, strong facilitators for SDM have also been identified, which should be used for further implementation of SDM.

Patient or Public Contribution

During the development of the study protocol, meetings with user representatives were held.
Kojic acid and tea polyphenols inactivate Escherichia coli O157:H7 in vitro and on salmon fillets by inflicting damage on cell membrane and binding to genomic DNA
Authors: Wang Ruifei , Fang Meimei , Hu Xinyi , Yu Yigang , Xiao Xinglong
Published: July 2021

The development of effective natural antibacterial agents is important due to the insecurity of synthetic antimicrobial agents and consumer preferences. In this study, kojic acid (KA) and tea polyphenols (TP) were found to exhibit synergistic inhibitory effect against Escherichia coli O157:H7 with a fractional inhibitory concentration index of 0.25. KA combined with TP at 25% of their minimum inhibitory concentrations (MICs) completely inactivated E. coli O157:H7 within 4 h. Subsequently, propidium iodide uptake tests, genomic DNA interaction analysis, molecular docking, field emission scanning electron microscopy and biofilm formation assay were conducted to understand the synergistic antibacterial mechanism of KA‐TP. The results demonstrated that KA‐TP attacked the cell membrane cooperatively, thus disturbing membrane integrity and cell structure, and KA could bind to the genomic DNA to affect the biofilm formation of E. coli O157:H7. Moreover, the contamination of E. coli O157:H7 on raw salmon fillets was eliminated to varying degrees after soaking treatments with KA and/or TP for 30 min. The depuration effect was further enhanced when KA combined with TP, and more than 2‐log reduction of E. coli O157:H7 was obtained under the treatment of KA‐TP at 2 MIC, suggesting that KA‐TP may serve as a natural compound disinfectant for ready‐to‐eat aquatic products.
Efficacy of Lactobacillus vaginal suppositories for the prevention of recurrent cystitis: A phase II clinical trial
Authors: Sadahira Takuya , Wada Koichiro , Araki Motoo , Mitsuhata Ritsuko , Yamamoto Masumi , Maruyama Yuki , Iwata Takehiro , Watanabe Masami , Watanabe Toyohiko , Kariyama Reiko , Nasu Yasutomo , Ishii Ayano
Published: July 2021

Objectives

To prospectively assess the efficacy and safety of Lactobacillus vaginal suppositories for the prevention of recurrent cystitis.

Methods

In this single‐arm, open‐label, phase II clinical trial, participants used vaginal suppositories containing the GAI 98322 strain of Lactobacillus crispatus for 1 year either every 2 days or three times per week. The primary end‐point was the response rate, as assessed by the number of episodes of recurrent cystitis during the year of administration. The secondary end‐points were the response rate, as assessed by episodes of recurrent cystitis during the 1 year after completion of the administration period; the total number of episodes of recurrent cystitis before, during and after administration; adverse events; and changes in urine bacteria and the vaginal microbiome.

Results

A total of 28 women were enrolled, and 21 completed the study. A total of 18 patients achieved an effective response (86%) during administration. The suppressive effects of Lactobacillus vaginal suppositories on episodes of cystitis continued up to 1 year after the last suppository was administered. There was a significant reduction in the mean number of episodes of cystitis, both during and after administration of Lactobacillus vaginal suppositories. No treatment‐related adverse events were observed. Amplicon sequencing analysis of the vaginal microbiome showed that Lactobacillus species colonized the vagina during the periods when episodes of cystitis were absent.

Conclusions

Vaginal suppositories containing the GAI 98322 strain of Lactobacillus crispatus effectively prevent episodes of recurrent cystitis, both during administration and for at least 1 year after administration.
The Experiences of Community‐dwelling older adults during the COVID‐19 Lockdown in Wuhan: A qualitative study
Authors: Yang Qing , Wang Yuxin , Tian Chong , Chen Yuan , Mao Jing
Published: July 2021

Aims

To explore the experiences of community‐dwelling older adults in Wuhan during the coronavirus disease 2019 lockdown.

Design

An empirical phenomenological approach was used to conduct a qualitative study.

Methods

We performed semi‐structured, in‐depth telephone interviews between July 24 and August 2, 2020. A purposive sample of 18 participants (≥65 years old) who lived in Wuhan during the lockdown was recruited, including both infected and uninfected people. Data summarization and theme categories refinement were performed following Colaizzi's phenomenological approach.

Results

Four main theme categories emerged. First, the ‘Challenges’ posed by the epidemic. Older adults were challenged with barriers in seeing a doctor and daily life inconveniences. And they experienced negative emotions, whether infected or not. The second domain was ‘multi‐dimensional support’, which helped older people went through the difficult period. The third domain was ‘resilience amid challenges’. Although they experienced physical and psychological distress, most of them could self‐adjust and achieve transcendence from the unique experience. Lastly, the remaining impact after the epidemic affected older adults. Some still had mental burdens, while others thought they have benefited from the quarantine time (e.g. regular diet, learning new skills).

Conclusion

The epidemic and lockdown of the city brought significant physical and mental challenges to community‐dwelling older adults. Active adaptation and multifaceted support helped them through this period. However, the mental burdens after the epidemic still require attention. These experiences would provide guidelines for the protection of vulnerable populations during public health emergencies.

Impact

The results of the study suggested that certain social dynamics and individual behaviours helped the elderly to better cope with the stressful lockdown period. The findings in this study provided guidelines on how to reduce the negative effects on older adults during the pandemic and enlighten studies concerning the well‐being of older adults or other vulnerable people in future crises.
Ownership concentration, ownership identity and seasoned equity offerings probabilities: Evidence from Germany
Authors: Rojahn Joachim , Zechser Florian
Published: July 2021

This study analyzes the effect of ownership concentration and ownership identity on the probability of seasoned equity offerings (SEOs) in the German stock market. In Germany, equity issues require shareholder approval by a supermajority vote of 75% at shareholder meetings. This study contributes to the literature by testing the non‐monotonic effect of ownership concentration on the SEO probability. While low levels of ownership concentration can be expected to increase SEO probabilities, for example, through signaling effects, high levels of ownership concentration beyond the 25% blocking minority imply a negative effect, likely driven by the largest shareholder's willingness to maintain control. After constructing a control group using propensity score matching, we find that SEO likelihood is positively affected by the ownership concentration of the largest shareholder, as long as the 25% blocking threshold is not reached, regardless of the largest shareholder's identity. However, once this threshold is exceeded, the SEO likelihood decreases significantly as the equity stake of the largest shareholder increases. Nonetheless, when we control for the identity of the owners with equity stakes above the 25% threshold, the negative effects are predominantly not statistically significant at common levels.