bluuebunny/crossref_metadata_2025 huggingface dataset:
Diversity for Restoration (D4R): Guiding the selection of tree species and seed sources for climate‐resilient restoration of tropical forest landscapes
Authors: Fremout Tobias , Thomas Evert , Taedoumg Hermann , Briers Siebe , Gutiérrez‐Miranda Claudia Elena , Alcázar‐Caicedo Carolina , Lindau Antonia , Mounmemi Kpoumie Hubert , Vinceti Barbara , Kettle Chris , Ekué Marius , Atkinson Rachel , Jalonen Riina , Gaisberger Hannes , Elliott Stephen , Brechbühler Esther , Ceccarelli Viviana , Krishnan Smitha , Vacik Harald , Wiederkehr‐Guerra Gabriela , Salgado‐Negret Beatriz , González Mailyn Adriana , Ramírez Wilson , Moscoso‐Higuita Luis Gonzalo , Vásquez Álvaro , Cerrón Jessica , Maycock Colin , Muys Bart
Published: November 2021

At the start of the UN Decade of Ecosystem Restoration (2021–2030), the restoration of degraded ecosystems is more than ever a global priority. Tree planting will make up a large share of the ambitious restoration commitments made by countries around the world, but careful planning is needed to select species and seed sources that are suitably adapted to present and future restoration site conditions and that meet the restoration objectives.

Here we present a scalable and freely available online tool, Diversity for Restoration (D4R), to identify suitable tree species and seed sources for climate‐resilient tropical forest landscape restoration.

The D4R tool integrates (a) species habitat suitability maps under current and future climatic conditions; (b) analysis of functional trait data, local ecological knowledge and other species characteristics to score how well species match the restoration site conditions and restoration objectives; (c) optimization of species combinations and abundances considering functional trait diversity or phylogenetic diversity, to foster complementarity between species and to ensure ecosystem multifunctionality and stability; and (d) development of seed zone maps to guide sourcing of planting material adapted to present and predicted future environmental conditions. We outline the various elements behind the tool and discuss how it fits within the broader restoration planning process, including a review of other existing tools.

Synthesis and applications. The Diversity for Restoration tool enables non‐expert users to combine species traits, environmental data and climate change models to select tree species and seed sources that best match restoration site conditions and restoration objectives. Originally developed for the tropical dry forests of Colombia, the tool has now been expanded to the tropical dry forests of northwestern Peru–southern Ecuador and the countries of Burkina Faso and Cameroon, and further expansion is underway. Acknowledging that restoration has a wide range of meanings and goals, our tool is intended to support decision making of anyone interested in tree planting and seed sourcing in tropical forest landscapes, regardless of the purpose or restoration approach.
The invasion paradox dissolves when using phylogenetic and temporal perspectives
Authors: Ernst Adrienne R. , Barak Rebecca S. , Hipp Andrew L. , Kramer Andrea T. , Marx Hannah E. , Larkin Daniel J.
Published: November 2021

The prediction that higher biodiversity leads to denser niche packing and thus higher community resistance to invasion has long been studied, with species richness as the predominant measure of diversity. However, few studies have explored how phylogenetic and functional diversity, which should represent niche space more faithfully than taxonomic diversity, influence community invasibility, especially across longer time frames and over larger spatial extents.

We used a 15‐year, 150‐site grassland dataset to assess relationships between invasive plant abundance and phylogenetic, functional and taxonomic diversity of recipient native plant communities. We analysed the dataset both pooled across all surveys and longitudinally, leveraging time‐series data to compare observed patterns in invasion with those predicted by two community assembly processes: biotic resistance and competitive exclusion. We expected more phylogenetically and functionally diverse communities to exhibit greater resistance to invasion.

With the pooled dataset, we found support for the long‐standing observation that communities with more native species have lower abundance of invasive species, and a more novel finding that more phylogenetically diverse communities had higher abundance of invasive species. We found no influence of aggregate (multivariate) functional diversity on invasion, but assemblages with taller plants, lower variability in plant height and lower seed mass were less invaded. Viewed longitudinally, the phylogenetic diversity relationship was reversed: the most phylogenetically diverse communities were most resistant to invasion. This apparent discrepancy suggests invasion dynamics are influenced by both site attributes and biotic resistance and emphasizes the value in studying invasion across time.

Synthesis. Our results provide insight into the nuances of the diversity–invasibility relationship: invasion dynamics differed for different dimensions of diversity and depending on whether the relationship was evaluated longitudinally. Our findings highlight the limitations of using single time‐point ‘snapshots’ of community composition to infer invasion mechanisms.
Differences in trends of perceived inpatient care quality based on regional socioeconomic level in the United States and Taiwan
Authors: Yoon Grace H. , Cheng Shou‐Hsia
Published: November 2021

Objective

To examine perceived inpatient care quality according to regional socioeconomic status (SES), measured by regional household income, across the United States and Taiwan.

Data sources

Patient Experience in Hospital Care (PEHC) survey 2018–2019 data from National Taiwan University; US Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) 2018–2019 data from CMS.gov; and household income and facility data from publicly accessible databases.

Study design

This retrospective study used multivariate logistic regression to estimate the effect of household income on the rate of positive inpatient experiences in Taiwan and the United States, adjusting for hospitals' teaching status and ownership, and physician density.

Data collection

Hospital administrators for HCAHPS and PEHC's research teams invited patients who received inpatient care during the data collection period in the United States and Taiwan, respectively. The analysis included 1024 facilities from nine US states and 350 facilities from twenty major cities/counties in Taiwan.

Principal findings

Perceived inpatient care quality was higher in the United States than in Taiwan for the three experience measures. In Taiwan, hospitals with higher regional SES were less likely to receive a highly positive response for perceived respect, accommodation quality, and understanding upon discharge, with odds ratios (ORs) ranging from 0.83 to 0.88. In contrast, in the United States, higher regional SES was associated with a higher likelihood of a positive response for accommodation quality and understanding upon discharge (ORs = 2.51 and 1.48). Regional physician density and individual hospital characteristics show varying effects on perceived quality between Taiwan and the United States.

Conclusions

Higher overall experience scores in the United States are consistent with higher spending on health care compared with Taiwan. Varying associations between regional SES and perceived inpatient care quality highlight how systemic and cultural differences between the two countries affect scoring patterns.
Modelling changing patterns in the COVID‐19 geographical distribution: Madrid’s case
Authors: Maza Adolfo , Hierro María
Published: November 2021

We analyse the transmission factors shaping the spatial distribution of COVID‐19 infections during the distinct phases of the pandemic’s first wave in Madrid, Spain, by fitting a spatial regression model capturing neighbourhood effects between municipalities. Our findings highlight that factors such as population, mobility, and tourism were instrumental in the days before the national lockdown. As a result, already in the early part of the lockdown phase, a geographical pattern emerged in the spread of the disease, along with the positive (negative) impact of age (wealth) on virus transmission. Thereafter, spatial links between municipalities weakened, as the influences of mobility and tourism were eroded by mass quarantine. However, in the de‐escalation phase, mobility reappeared, reinforcing the geographical pattern, an issue that policymakers must pay heed to. Indeed, a counterfactual analysis shows that the number of infections without the lockdown would have been around 170% higher.
Students as digital multimodal text designers: A study of resources, affordances, and experiences
Authors: Dahlström Helene
Published: November 2021

This paper addresses how students design multimodal digital text when making digital stories in school. Drawing on the perspective of ‘multiliteracies’, multimodal analysis of video recordings was used to understand the data. Findings revealed that (a) multimodal digital text making requires particular digital and modal text‐making skills and knowledge, such as knowledge of photography, film, film editing, image searching, and audio recording; (b) students' prior knowledge was crucial for mastering the digital and modal affordances offered when making digital stories; and (c) making multimodal digital texts in school offers increased opportunities for students to perform and succeed in text making. These findings point to the need for schools to offer education that makes it possible for all students to gain knowledge and master skills needed for contemporary text making. Such knowledge goes beyond skills and practices needed when making paper‐based text, and borders on other disciplines such as art and technology.

Practitioner notes

What is already known about this topic

Text making in the 21st century entails working in various modes, such as images, writing, and video, and is often performed with digital resources.

Today's students must be competent in designing multimodal texts that are commonly associated with digital technology and multimedia.

Students' modal choices when creating digital texts are influenced by prior experiences and knowledge of text‐making practices obtained outside school.

What this paper adds

This paper provides examples of the differing prerequisites of students designing a digital multimodal story.

This paper offers insights into the particular digital and modal text‐making skills and knowledge necessary for students to become competent text makers.

Multimodal digital texts activities in school offers increased opportunities for students to perform and succeed in text making.

Implications for practice and/or policy

The results of this study have implications for literacy practices as well what is included in the literacy curriculum. This study provides implications for education that intends to reduce inequalities in students' prerequisites concerning making digital multimodal texts, and examines the text‐making experiences, knowledge, and skills students already possess upon entering the classroom.

Classroom‐based instruction and opportunities for digital creation can bridge the gap between student's informal text‐making activities and formal text‐making activities at school and help to close the digital divide among students.
Inhibition of BACE1 and amyloid β aggregation by polyketide from Streptomyces sp.
Authors: Yokoya Masashi , Nakai Keiyo , Kawashima Miki , Kurakado Sanae , Sirimangkalakitti Natchanun , Kino Yoshihiro , Sugita Takashi , Kimura Shinya , Yamanaka Masamichi , Saito Naoki
Published: November 2021

Alzheimer's disease (AD) causes cognitive impairment in the elderly and is a severe problem worldwide. One of the major reasons for the pathogenesis of AD is thought to be due to the accumulation of amyloid beta (Aβ) peptides that result in neuronal cell death in the brain. In this study, bioassay‐guided fractionation was performed to develop seed compounds for anti‐AD drugs that can act as dual inhibitors of BACE1 and Aβ aggregation from secondary metabolites produced by Streptomyces sp. To improve the solubility, the crude extracts were methylated with trimethylsilyl (TMS) diazomethane and then purified to yield polyketides 1–5, including the new compound 1. We synthesized the compounds 6 and 7 (original compounds 2 and 3, respectively), and their activities were evaluated. KS‐619‐1, the demethylated form of 4 and 5, was isolated and evaluated for its inhibitory activity. The IC50 values for BACE1 and Aβ aggregation were found to be 0.48 and 1.1 μM, respectively, indicating that KS‐619‐1 could be a lead compound for the development of therapeutic agents for AD.
‘With every fibre of their being’: Perspectives of healthcare professionals caring for children with non‐malignant life‐limiting conditions
Authors: Kiernan Gemma , Hurley Fiona , Price Jayne
Published: November 2021

Background

Children with non‐malignant life‐limiting conditions (NMLLCs) constitute the largest proportion of children requiring palliative care. In part, due to technological advances, growing numbers of such children are experiencing improved survival. Care is mostly provided at home by the family, with significant professional input at different points in the child's life trajectory. This study explored the experience of healthcare professionals caring for this cohort of children.

Methods

A qualitative descriptive study design using single‐occasion one‐to‐one semi‐structured interviews collected data from 12 healthcare professionals' including nurses, social workers and doctors. Data were analysed using thematic analysis.

Results

The findings highlighted the unfailing determination and dedication of healthcare professionals who provided care despite challenges with what seemed like ‘with every fibre of their being’. Three key themes marked such strength and commitment; those were ‘being there’, ‘being focused’ and ‘being strong’. ‘Being there’ explicitly highlighted expert care that was individualized and responsive to the child and family's unique needs. The provision of such care was often threatened and potentially compromised by the intricacies and challenges associated with children's palliative care (CPC) and service provision. ‘Being focused’ captured the sense that the healthcare professionals remained entirely focused on providing expert care despite these challenges. ‘Being strong’ epitomized the personal and professional impact on healthcare professionals who are working in this area and the manner in which they sustain themselves in ‘being focused’ and in ‘being there’.

Conclusions

The healthcare professionals demonstrated their unwavering commitment to deliver quality care required by children and families, however against a background of issues relating to organizational constraints. The findings have implications for education/service providers such as the need for specific palliative care education at both pre‐registration level and continuing professional development.
Correlation between head tremble and the severity of Parkinson’s disease
Authors: Yang Jingsheng , Guo Quanhao , Zou Xianwei , Wang Meng , Wen Yanxia , Chen Xiaqing , Weng Xiechuan , Xu Fan
Published: November 2021

Introduction

Parkinson's (PD) is a common degenerative disease of the central nervous system. It affects more than 6 million individuals worldwide. The typical clinical manifestations include static tremor, slow movement, and unstable posture. However, the correlation between head tremor and the severity of PD remains unclear.

Methods

In the current study, 18 patients and 18 healthy subjects were recruited to undergo a phonation test. Noldus facereader 7.0 software was used to analyze the range of head trembling between the two groups.

Results

The data revealed that patients with PD had significant differences in the x‐, y‐, and z‐axis of head movement with respect to the specific pronunciation syllables compared with the normal group. Moreover, the head movement of the patients with PD was positively correlated with the severity of the disease in the single, double, and multiple syllable tests. In the phonetic test, the head displacement of patients with PD was significantly greater than that of healthy individuals, and the displacement range was positively correlated with the severity of the disease.

Conclusion

These pieces of evidence suggested that the measurement of head displacement assists the early diagnosis and severity of the disease.
Amount of Learning and Signal Stability Modulate Emergence of Structure and Iconicity in Novel Signaling Systems
Authors: Kempe Vera , Gauvrit Nicolas , Panayotov Nikolay , Cunningham Sheila , Tamariz Monica
Published: November 2021

Iterated language learning experiments that explore the emergence of linguistic structure in the laboratory vary considerably in methodological implementation, limiting the generalizability of findings. Most studies also restrict themselves to exploring the emergence of combinatorial and compositional structure in isolation. Here, we use a novel signal space comprising binary auditory and visual sequences and manipulate the amount of learning and temporal stability of these signals. Participants had to learn signals for meanings differing in size, shape, and brightness; their productions in the test phase were transmitted to the next participant. Across transmission chains of 10 generations each, Experiment 1 varied how much learning of auditory signals took place, and Experiment 2 varied temporal stability of visual signals. We found that combinatorial structure emerged only for auditory signals, and iconicity emerged when the amount of learning was reduced, as an opportunity for rote‐memorization hampers the exploration of the iconic affordances of the signal space. In addition, compositionality followed an inverted u‐shaped trajectory raising across several generations before declining again toward the end of the transmission chains. This suggests that detection of systematic form‐meaning linkages requires stable combinatorial units that can guide learners toward the structural properties of signals, but these combinatorial units had not yet emerged in these unfamiliar systems. Our findings underscore the importance of systematically manipulating training conditions and signal characteristics in iterated language learning experiments to study the interactions between the emergence of iconicity, combinatorial and compositional structure in novel signaling systems.
Effects of surgical masks on the responses to constant work‐rate cycling performed at different intensity domains
Authors: Jesus João P. , Gomes Miguel , Dias‐Gonçalves André , Correia Joana M. , Pezarat‐Correia Pedro , Mendonca Goncalo V.
Published: November 2021

We aimed at examining the impact of wearing surgical face masks on exercise performance. Thirty‐two healthy adults (16 males and 16 females) completed a graded exercise test to measure peak oxygen uptake (VO2peak) and the ventilatory threshold (VT). Then, on separate days, all participants performed resting and standardized protocols (moderate intensity: 25% infra‐VT; severe intensity: 25% supra‐VT) on two different conditions (with and without a surgical mask). The use of masks reduced both VO2 and minute ventilation during moderate and severe exercise (p < 0.0001), and this effect was particularly pronounced during severe exercise. Time to exhaustion was also shortened by ~10% on the face mask condition (p = 0.014). In contrast, neither heart rate nor the respiratory exchange ratio was affected by masking. The submaximal VO2 was similar between the two epochs of analysis obtained during moderate cycling (i.e. 3–6 min vs. 7–10 min) and this occurred similarly between conditions. In conclusion, the impact of the surgical masks on exercise capacity is particularly pronounced during severe exercise performed at constant work rate. Ultimately, this may implicate a considerable impairment of structured or even unstructured strenuous physical activity. Clinical Trials registration number: NCT04963049.
Environmental and socioeconomic correlates of extinction risk in endemic species
Authors: Pouteau Robin , Brunel Caroline , Dawson Wayne , Essl Franz , Kreft Holger , Lenzner Bernd , Meyer Carsten , Pergl Jan , Pyšek Petr , Seebens Hanno , Weigelt Patrick , Winter Marten , van Kleunen Mark
Published: November 2021

Aim

Our current understanding of the causes of global extinction risk is mostly informed by the expert knowledge‐based “threats classification scheme” of the IUCN Red List of Threatened Species. Studies based on this dataset came to different conclusions about the relative importance of threats to species, depending on which taxonomic groups and levels of extinction risk were considered, and which version of the database was used. A key reason may lie in data limitations as causes of threat are well known for charismatic and well‐studied species, but not for the majority of species assessed. Here, we aim to fill current knowledge gaps about the importance of drivers of global extinction risks by focusing on endemic species.

Location

Global.

Methods

We examined country‐level variation in the proportion of globally threatened and extinct endemic species (Index of Threat, IoT) with a range of spatially explicit information about anthropogenic pressures, mitigation measures and data limitations.

Results

IoT coincided with several anthropogenic pressures, with substantial differences among kingdoms, life‐forms, levels of extinction risk and geographic locations. IoT of plants, particularly tropical woody plants of moderate extinction risk, was higher in countries with higher GDP and more invasive species. Furthermore, IoT of animals, particularly tropical mammals and invertebrates of moderate extinction risk, was higher in countries with higher GDP and smaller roadless areas.

Main conclusions

The extinction crisis for endemic species is associated with a complex network of potential drivers that need to be considered in concert in conservation policy and practice. Although our results require careful interpretation and remain sensitive to data limitations, we encourage similar studies at smaller scales to identify potential drivers of extinction risk at a higher resolution, particularly in regions where species assessments have been conducted consistently or on organisms with a uniform response time to pressures.
Regulating cryptocurrencies checkpoints: Fighting a trench war with cavalry?
Authors: Soana Giulio
Published: November 2021

The rise of cryptocurrencies during the last decade has caused growing concerns among national and international regulators. One of the risks identified is that these instruments may constitute an innovative tool for criminals when laundering money. This risk has been confirmed by numerous recent cases which have underlined the criminogenic potential of cryptocurrencies. Through the V antimoney laundering (AML) Directive, the European legislator has first regulated this emerging issue. This legislation extends the AML duties to two players of the cryptocurrencies market: exchangers and wallet providers. This choice, however, does not exploit the opportunities offered by cryptocurrencies and fails to provide a customized regulatory framework. By maintaining a traditional regulatory approach centered on intermediaries it misses the key innovation of blockchain technology: disintermediation. Compared with traditional online money flows, intermediaries are not necessary nor fundamental in the cryptocurrencies environment. Failing to adapt to this reality, the Directive is employing chivalry to fight a trench war. To guarantee the integrity of this market, the policymaker has to abandon the traditional intermediary‐centred approach in favor of a strategy that seizes the new opportunities offered by blockchain. This paper advocates for a shift from an individual‐centered approach to financial crime control to a transaction‐centered one.
Mapping the Spatial Conditions of Polycentric Urban Development in Europe: An Open‐source Software Tool
Authors: Caset Freke , Derudder Ben , Van Migerode Céline , De Wit Bart
Published: November 2021

Urban polycentricity has become a key concept in urban and regional studies and is increasingly adopted as an organizational framework for conducting empirical research. Within this literature, polycentric urban regions are commonly defined as territories that have multiple, proximately located (sub)centers and are characterized by balanced urban development. However, analytical‐operational frameworks to identify and classify PURs are often ad hoc efforts to answer a specific research question and underlying work is often shelved rather than shared and/or made accessible. As a result, challenges associated with generalizability, reproducibility, and replicability clearly loom large in the urban polycentricity literature. Against this backdrop, this article describes the discrepancy between a rich debate on polycentricity and the paucity of tools enabling the disambiguation and reproducibility of results claimed by various authors around this polysemic concept. We present an online and open tool—PURban—that brings together the major analytical‐operational frameworks and data sets in urban polycentricity research and allows parametrizing key operational choices. To illustrate the tool, we demonstrate how it facilitates the identification, mapping and analysis of degrees of morphological polycentricity in European urban systems. We conclude by reflecting on how this tool can act as a catalyst for future research on urban polycentricity.
Knowledge and attitude of caregivers of people with dementia
Authors: Parveen Shaheena , Mehra Aseem , Kumar Krishan , Grover Sandeep
Published: November 2021

Aim

This study aimed to evaluate the knowledge and attitude of caregivers of people with dementia towards the disease (Alzheimer disease). The secondary objective of the study was to assess the association of attitude and knowledge towards dementia.

Methods

In total, 50 patients with dementia and their caregivers were included in the present study. Caregivers were evaluated on the Dementia Attitude Scale and Alzheimer's Disease Knowledge Scale (ADKS) to assess the level of knowledge and attitude.

Results

The mean age of patients was 72.2 years, and the majority of them were men, married, from joint/extended family setup, urban background, and upper or upper‐middle socioeconomic status. The mean age of the caregivers was 48.04 years, and the majority was educated more than the matric level. Nearly half of the caregivers were children, and about one‐third were the spouse of the person with dementia. The mean duration of the caregiver role was 3.6 ± 3.0 years, while the average time spent in caregiving was 7.4 ± 2.9 h/day. Using the Alzheimer's Disease Knowledge Scale, the mean knowledge score for the caregivers was 16.9 ± 2.7. In terms of individual items on the knowledge scale, most of the caregivers were aware of most aspects of dementia. In terms of the mean weighted score, the maximum score was for the domains of course and symptoms and this was followed by the domain of “treatment and management.” The lowest score was obtained for the domain of assessment and diagnosis on ADKS. On the Dementia Attitude Scale, the mean total score was 76.4 ± 18.4. The mean total score for the knowledge domain was higher than the support domain.

Conclusion

The current study suggests that most caregivers with dementia have a reasonable level of knowledge about dementia. However, in terms of attitude, caregivers of people with dementia have a less positive attitude towards dementia. The study's finding suggests that there is a need to evaluate the knowledge and attitude of the caregivers of people with dementia and the gaps must be addressed to improve the outcome, both for the people with dementia and their caregivers. Geriatr Gerontol Int 2022; 22: 19–25.
Limestone quarries are the most important refuge for a formerly widespread grassland butterfly
Authors: Münsch Thorsten , Fartmann Thomas
Published: November 2021

Calcareous grasslands have an outstanding value for nature conservation. However, during the last century, they have suffered from severe area loss, fragmentation and degradation.

Here, we studied the influence of macroclimate, landscape quality and habitat quality on populations of the Silver‐studded Blue, Plebejus argus, in calcareous grasslands and limestone quarries in a Central European landscape.

Our study revealed that limestone quarries, especially those being actively managed, are the most important refuge for P. argus. Originally, the species was common in calcareous grasslands across the study area. More recently, however, patch occupancy was five times higher at quarries compared to calcareous grasslands and mean adult abundance nearly four times higher at occupied quarries than at occupied grasslands. The key driver of patch occupancy and adult abundance was a high abundance of the host plant. Adult abundance, additionally, increased with a sparse vegetation and a high cover of bedrock.

The deterioration of habitat quality due to abandonment and decreasing grazing intensity has resulted in a strong decline of P. argus in calcareous grasslands. In contrast, quarries exhibit a very low successional speed due to their shallow soils. Hence, they are characterised by a high habitat quality for P. argus, i.e. dense stands of the host plant L. corniculatus, which grow on skeletal soils providing warm microclimatic conditions.

Preserving limestone quarries with their early‐successional stages is of crucial importance for the conservation of P. argus.
Sensitive detection of GATA1 mutations using complementary DNA‐based analysis for transient abnormal myelopoiesis associated with the Down syndrome
Authors: Mizuta Shumpei , Yamane Noriko , Mononobe Saya , Watanabe Asami , Kitamura Ritsuko , Takahara Tadamori , Matsushima Chieko , Yoshida Atushi , Okamoto Seiji , Tanaka Kuniaki , Iwai Atsushi , Ikegawa Atsuko , Wada Takahito , Usami Ikuya , Maihara Toshiro , Komai Takao , Heike Toshio , Nishida Yoshinobu , Kobayashi Kenichiro
Published: November 2021

Introduction

GATA1 mutation plays an important role in initiating transient abnormal myelopoiesis (TAM) and in the clonal evolution towards acute megakaryoblastic leukaemia (AMKL) associated with Down syndrome (DS). This study aimed to develop and validate the clinical utility of a complementary DNA (cDNA) analysis in parallel with the conventional genomic DNA (gDNA) Sanger sequencing (Ss), as an initial screening test for GATA1 mutations.

Methods

GATA1 mutations were evaluated using both gDNA and cDNA in 14 DS patients using Ss and fragment analysis (FA), respectively.

Results

The detection sensitivity of conventional gDNA sequencing was limited in low blast percentage TAM (LBP‐TAM); however, cDNA‐based Ss readily detected all the pathognomonic GATA1 mutations. The cDNA‐based FA readily detected GATA1 frameshift mutation with a reliable sensitivity ranging from 0.005% to 0.01% of clonal cells.

Conclusions

GATA1 mutations are heterogeneous; therefore, we would like to propose a dual cDNA and gDNA analysis as a standard diagnostic approach, especially for LBP‐TAM. cDNA‐based FA promises an excellent sensitivity for detecting frameshift GATA1 mutations in the longitudinal clonal evolution towards AMKL without using a patient specific primer.
Laboratory methods for monitoring argatroban in heparin‐induced thrombocytopenia
Authors: Guy Susan , Kitchen Steve , Hopkins Barbara , Chunara Zunaid , Stephenson‐Brown Alex , van Veen Joost J.
Published: November 2021

Introduction

The Summary of Product Characteristics for the direct thrombin inhibitor argatroban states monitoring should be by activated partial thromboplastin time (APTT), with a target range of 1.5‐3.0 times the patients' baseline APTT. APTT may be influenced by coagulopathies, lupus anticoagulant and raised FVIII levels. Previous studies have shown sensitivity differences of APTT reagents to argatroban. Some recent publications have favoured the use of anti‐IIa methods to determine the plasma drug concentration of argatroban. This study aims to compare the anti‐IIa assays: Hemoclot thrombin inhibitor assay (HTI) and Ecarin chromogenic assay (ECA) alongside the APTT.

Methods

Residual plasma of 25 samples from 8 patients (3 with COVID‐19 and HIT: n = 18, 5 with HIT: n = 7) was tested at two sites: site A: Sysmex CS5100 by HTI and APTT (Actin FS and SynthASil), and also on Stago STA Compact Max: ECA and APTT (CK Prest); and site B: Stago STA R Max 2 by ECA and APTT (Cephascreen).

Results

Mean APTT ratio was 1.96 (Actin FS), 1.84 (SynthASil), 1.59 (CK Prest) and 2.48 (Cephascreen). Mean argatroban concentration by HTI was 0.60 µg/mL and by ECA was 0.65 µg/mL (site A) and 0.70 µg/mL (site B). There was a poor correlation to HTI in APTT ratios (range r2 = .0235‐0.4181) with stronger correlations between ECA methods to HTI (r2 = .8998 site A, r2 = .8734 site B).

Conclusion

This study confirms previous publications on the unsuitability of APTT and expands this by being multisited and included APTT reagents that use mechanical clot detection. Both anti‐IIa methods are more suitable.
Early diagnosis of craniofacial necrotising fasciitis: Analysis of clinical risk factors
Authors: Lee Da Woon , Ryu Heongrae , Choi Hwan Jun , Heo Nam Hun
Published: November 2021

Necrotising fasciitis (NF) is a rapidly progressing fatal disease. Craniofacial necrotising fasciitis (CNF) is limited to the region above the mandibular margin, and early diagnosis is particularly difficult in the absence of related studies. Ten‐year data of patients with craniofacial infection were collected from four separate hospitals. Based on the diagnostic criteria, patients were classified into abscess and CNF. The risk factors for early diagnosis were analysed by comparing the two groups. Simple abscess was found in 176 patients, and CNF was detected in 25 patients. The risk factors associated with CNF include old age, presence of odontogenic infection, elevated white blood cell count (WBC), increased C‐reactive protein (CRP), high levels of creatinine (Cr) and glucose (Glu) and low levels of haemoglobin (Hb) and albumin (Alb). In addition, fever above 38°C and sinusitis at the time of admission and progressive sepsis after admission were also risk factors. Among the statistically significant risk factors, low Alb level showed the greatest association with CNF progression. Appropriate management of CNF via early diagnosis and extensive surgical intervention based on identified risk factors can reduce the mortality rate, complications and unnecessary medical expenses. Clinical question/level of evidence: Diagnostic, III.
Mutual fund performance and changes in factor exposure
Authors: Bessler Wolfgang , Conlon Thomas , de Mingo‐López Diego Víctor , Matallín‐Sáez Juan Carlos
Published: November 2021

In this article, we examine whether active mutual funds that markedly change their exposure to systematic risk factors subsequently outperform. We propose a new returns‐based approach to assess the degree to which mutual funds adjust their risk exposure, with the benefit of not requiring periodically updated information related to funds' portfolio holdings. Applying this measure to active US mutual funds from 1990 to 2016, we provide evidence that mutual fund managers exhibiting substantial changes in their risk exposure generate alphas that are significantly higher than those with limited exposure variation. Other characteristics such as fund tracking errors, fund size, and investment style, or holdings‐based measures cannot explain these findings. Analyzing the long‐term persistence of active management, we provide evidence that the outperformance is due to managers' skill rather than to luck. Our findings contribute to the empirical evidence suggesting that active management may in some cases, produce short‐term performance persistence.
Empowering patients with the PREPARE advance care planning program results in reciprocal clinician communication
Authors: Nouri Sarah , Street Richard L. , Barnes Deborah E. , Shi Ying , Volow Aiesha M. , Li Brookelle , Alexander Stewart C. , Sudore Rebecca L.
Published: November 2021

Background

The patient‐directed PREPAREforYourCare.org program empowers patients to participate in advance care planning (ACP) discussions with clinicians. Our goal was to determine whether PREPARE could reciprocally increase clinician ACP communication.

Methods

In a secondary analysis of two trials evaluating the efficacy of PREPARE plus an easy‐to‐read advance directive (AD) versus an AD alone, patients were included if they were ≥55 years old, English‐ or Spanish‐speaking, and had ≥2 chronic conditions. We audio‐recorded postintervention primary care visits and used the validated clinician–patient participation coding scheme to calculate the number of clinician ACP utterances concerning information‐giving, recommendations, or supportive talk. We examined differences by study arm using mixed effects negative binomial models, stratifying by language. To assess possible mediation, we adjusted for active patient participation (e.g., asking questions or stating preferences).

Results

Three hundred ninety‐three visits were audio‐recorded (177 in PREPARE arm and 216 in AD‐only arm). Recordings included 179 clinicians (mean 2.2 [SD 1.9] patients each). Patients' mean age was 66 ± 8 years, 31% had limited health literacy, and 25% were Spanish‐speaking. Exactly 67% of recordings included information‐giving, 85% recommendations, and 62% supportive talk. PREPARE resulted in 51% more clinician supportive talk versus the AD alone (mean 4.5 [8.9] vs. 2.9 [6.0] utterances; incidence rate ratio 1.51 [95% CI 1.02–2.24]). Effects were most pronounced among Spanish speakers. There were no differences in information‐giving or recommendations. After adjusting for active patient participation, no differences in supportive talk remained.

Conclusions

The patient‐directed PREPARE program was associated with greater clinician supportive ACP communication with older adults compared with an AD alone; the effect was most pronounced among Spanish speakers and was mediated by active patient participation. Thus, PREPARE helps patients be more engaged communicators, which in turn encourages clinicians to be more supportive of patients. Enhanced patient–clinician communication represents an important mechanism by which PREPARE may decrease disparities in ACP.
Factors associated with changes in inpatients’ smoking pattern during hospitalization and one month after discharge: A cohort study
Authors: Feliu Ariadna , Ravara Sofia , Papadakis Sophia , Enriquez Marta , Antón Laura , Saura Judith , Company Assumpta , Romero Olga , Ripoll Ruth , Ruz Angels , Precioso José , Pascoal Ivone , Videira Lídia , Correia Claudia , Ferreira Soraia , Fernández Esteve , Martínez Cristina
Published: November 2021

Introduction

Smokers are frequent users of healthcare services. Admissions to hospital can serve as a “teachable moment” for quitting smoking. Clinical guidelines recommend initiating smoking cessation services during hospitalization; however, in Southern European countries less than 5% of inpatients receive a brief intervention for smoking cessation.

Objectives

The aims of this study were (i) to examine rates of smoking abstinence during and after hospitalization; (ii) to measure changes in smoking patterns among persons who continued smoking after discharge; and (iii) to identify predictors of abstinence during hospitalization and after discharge.

Methods

A cohort study of a representative sample of current adult smokers hospitalized in two Spanish and two Portuguese hospitals. We surveyed smokers during hospitalization and recontacted them one month after discharge. We used a 25‐item ad hoc questionnaire regarding their smoking pattern, the smoking cessation intervention they have received during hospitalization, and hospital and sociodemographic characteristics. We performed a descriptive analysis using the chi‐square test and a multivariate logistic regression to characterize the participant, hospital, and smoking cessation intervention (5As model) characteristics associated with smoking abstinence.

Results

Smoking patients from both countries presented high abstinence rates during hospitalization (Spain: 76.4%; Portugal: 70.2%); however, after discharge, their abstinence rates decreased to 55.3% and 46.8%, respectively. In Spain, smokers who tried to quit before hospital admission showed higher abstinence rates, and those who continued smoking reduced a mean of five cigarettes the number of cigarettes per day (p ≤ 0.001). In Portugal, abstinence rates were higher among women (p = 0.030), those not living with a smoker (p = 0.008), those admitted to medical‐surgical wards (p = 0.035), who consumed their first cigarette within 60 min after waking (p = 0.006), and those who were trying to quit before hospitalization (p = 0.043).

Conclusions

Half of the smokers admitted into the Spanish hospitals are abstinent one month after discharge or have reduced their cigarettes per day. Nevertheless, success rates could be increased by implementing evidence‐based tobacco cessation programs at the organizational‐level, including post‐discharge active quitting smoking support.

Clinical relevance

Three‐quarters of the inpatients who smoke remain abstinent during hospitalization and over half achieve to maintain their abstinence or at least reduce their consumption one month after discharge, proving that admission to hospitals is an excellent teachable moment to quit smoking.
Telecommuting and gender inequalities in parents' paid and unpaid work before and during theCOVID‐19 pandemic
Authors: Lyttelton Thomas , Zang Emma , Musick Kelly
Published: November 2021

Objective

This study examines the relationship between telecommuting and gender inequalities in parents' time use at home and on the job before and during the COVID‐19 pandemic.

Background

Telecommuting is a potential strategy for addressing the competing demands of work and home and the gendered ways in which they play out. Limited evidence is mixed, however, on the implications of telecommuting for mothers' and fathers' time in paid and unpaid work. The massive increase in telecommuting due to COVID‐19 underscores the critical need to address this gap in the literature.

Method

Data from the 2003–2018 American Time Use Survey (N = 12,519) and the 2020 Current Population Survey (N = 83,676) were used to estimate the relationship between telecommuting and gender gaps in parents' time in paid and unpaid work before and during the pandemic. Matching and quasi‐experimental methods better approximate causal relationships than prior studies.

Results

Before the pandemic, telecommuting was associated with larger gender gaps in housework and work disruptions but smaller gender gaps in childcare, particularly among couples with two full‐time earners. During the pandemic, telecommuting mothers maintained paid work to a greater extent than mothers working on‐site, whereas fathers' work hours did not differ by work location.

Conclusion

In the context of weak institutional support for parenting, telecommuting may offer mothers a mechanism for maintaining work hours and reducing gender gaps in childcare, while exacerbating inequalities in housework and disruptions to paid work.
Dyadic employment biographies and within‐couple wealth inequality in Britain and Western Germany
Authors: Nutz Theresa , Gritti Davide
Published: November 2021

Objective

This study examines how the interplay of both partners' employment biographies is associated with the within‐couple gender wealth gap in later life in Britain and Western Germany, including married couples born between the 1920s and 1960s.

Background

Although it is well‐known that women own less personal wealth than their male partners on average, variation in the gender wealth gap across partners' employment constellations and contexts remains unaddressed. Following the life course paradigm, this study theorizes how individual wealth accumulation, within‐couple redistribution processes, and institutional arrangements shape the within‐couple gender wealth gap in later life.

Method

The analyses rely on retrospective employment and prospective survey data from Britain (UKHLS; Wave 8; 2016–2018) and Germany (SOEP, 2017). Sequence and cluster analyses detect patterns of dyadic employment biographies (ages 20–55) among different‐sex couples in their first marriage and OLS regressions associate them with the within‐couple gender wealth gap.

Results

The within‐couple gender wealth gap to the disadvantage of women existed in Britain and Western Germany, with considerably larger inequality in Germany. German male breadwinner couples, particularly those with longer periods of female homemaking and part‐time employment, showed higher levels of wealth inequality. Whereas dyadic employment biographies were not clearly associated with the gender wealth gap in Britain, stable arrangements of female full‐time employment reduced the gap in Germany.

Conclusion

A similar division of labor throughout the life course can result in different levels of the within‐couple gender wealth gap in later life across country contexts, particularly depending on the housing system.
Comparing objective wakefulness and vigilance tests to on‐the‐road driving performance in narcolepsy and idiopathic hypersomnia
Authors: Bijlenga Denise , Urbanus Bram , van der Sluiszen Nick N. J. J. M. , Overeem Sebastiaan , Ramaekers Jan G. , Vermeeren Annemiek , Lammers Gert Jan
Published: November 2021

Patients with narcolepsy or idiopathic hypersomnia (IH) are at increased risk of driving accidents. Both excessive daytime sleepiness, i.e. unwanted sleep episodes during the day, and disturbed vigilance are core features of these disorders. We tested on‐the‐road driving performance of patients with narcolepsy or IH coming in for a routine driving fitness evaluation and examined: (1) correlations between driving performance and the Maintenance of Wakefulness Test (MWT), Sustained Attention to Response Task (SART) and Psychomotor Vigilance Test (PVT) as objective tests; (2) the predictive power of the MWT and SART for increased risk of impaired driving; (3) the best set of objective predictors for increased risk of impaired driving. Participants were 44 patients (aged 18–75 years) with narcolepsy type 1 (NT1), type 2 (NT2) or IH. They completed the MWT, SART, PVT, a subjective sleepiness questionnaire, and a standardised on‐the‐road driving test. The standard deviation of the lateral position (SDLP) was used as outcome measure of driving performance. The MWT had low correlation with the SDLP (ρ = −0.41 to −0.49,p < 0.01). The SART and PVT had low correlations with SDLP (ρ = 0.30 andρ = 0.39, respectively, bothp < 0.05). The predictive power of MWT for an increased risk of impaired driving was significant, but low (area under the curve = 0.273,p = 0.012), and non‐significant for SART. We conclude that in our present group, none of the tests had adequate ability to predict impaired driving, questioning their use for clinical driving fitness evaluation in narcolepsy and IH. Real‐time monitoring of sleepiness while driving seems more promising in these patients.