bluuebunny/crossref_metadata_2025 huggingface dataset:
Performance of early risk assessment tools to predict the later development of gestational diabetes
Authors: Kotzaeridi Grammata , Blätter Julia , Eppel Daniel , Rosicky Ingo , Mittlböck Martina , Yerlikaya‐Schatten Gülen , Schatten Christian , Husslein Peter , Eppel Wolfgang , Huhn Evelyn A. , Tura Andrea , Göbl Christian S.
Published: June 2021

Background

Several prognostic models for gestational diabetes mellitus (GDM) are provided in the literature; however, their clinical significance has not been thoroughly evaluated, especially with regard to application at early gestation and in accordance with the most recent diagnostic criteria. This external validation study aimed to assess the predictive accuracy of published risk estimation models for the later development of GDM at early pregnancy.

Methods

In this cohort study, we prospectively included 1132 pregnant women. Risk evaluation was performed before 16 + 0 weeks of gestation including a routine laboratory examination. Study participants were followed‐up until delivery to assess GDM status according to the IADPSG 2010 diagnostic criteria. Fifteen clinical prediction models were calculated according to the published literature.

Results

Gestational diabetes mellitus was diagnosed in 239 women, that is 21.1% of the study participants. Discrimination was assessed by the area under the ROC curve and ranged between 60.7% and 76.9%, corresponding to an acceptable accuracy. With some exceptions, calibration performance was poor as most models were developed based on older diagnostic criteria with lower prevalence and therefore tended to underestimate the risk of GDM. The highest variable importance scores were observed for history of GDM and routine laboratory parameters.

Conclusions

Most prediction models showed acceptable accuracy in terms of discrimination but lacked in calibration, which was strongly dependent on study settings. Simple biochemical variables such as fasting glucose, HbA1c and triglycerides can improve risk prediction. One model consisting of clinical and laboratory parameters showed satisfactory accuracy and could be used for further investigations.
Development of Hymenoscyphus fraxineus on seedlings from different half‐sib lines of Fraxinus angustifolia in Serbia
Authors: Vemić Aleksandar , Kerkez Janković Ivona , Kudláček Tomáš , Jung Thomas , Šijačić‐Nikolić Mirjana , Nonić Marina , Milenković Ivan
Published: June 2021

For the long‐term goal of improving planting success and reforestation of floodplain forests, an underbark inoculation test was performed using one‐year‐old seedlings from ten different half‐sib lines of narrow‐leaved ash (Fraxinus angustifolia) to examine the variability of host susceptibility to the ash dieback pathogen Hymenoscyphus fraxineus. Sizes of necrotic lesions, production of epicormic shoots and mortality was recorded in all inoculated seedlings 76 days after inoculation. Mortality of different half‐sib lines ranged between 13.3% and 80%. Only one of the tested half‐sib lines showed necrotic lesion sizes, production of epicormic sprouts and percentage of mortality substantially lower than all the other nine half‐sib‐lines of the respective symptom traits. About 20% of half‐sib lines had reduced only one of these three symptoms. The other 70% of tested half‐sib lines had large necrotic lesions, abundant occurrence of epicormic sprouts and high percentage of mortality. Mortality was also significantly influenced by seedling height at the time of inoculation with taller seedlings developing mortality more slowly than smaller seedlings. This study demonstrates significant differences in the susceptibility to H. fraxineus between different half‐sib lines of F. angustifolia and the influence of seedling height on the development of ash dieback.
Nilotinib‐induced bone marrow CD34+/lin‐Ph+ cells early clearance in newly diagnosed CP‐Chronic Myeloid Leukemia: Final report of the PhilosoPhi34 study
Authors: Pungolino Ester , D'adda Mariella , De Canal Gabriella , Trojani Alessandra , Perego Alessandra , Elena Chiara , Lunghi Francesca , Turrini Mauro , Borin Lorenza , Iurlo Alessandra , Latargia Maria Luisa , Carraro Maria Cristina , Spina Francesco , Artale Salvatore , Anghilieri Michela , Molteni Alfredo , Caramella Marianna , Baruzzo Giacomo , Nichelatti Michele , Di Camillo Barbara , Cairoli Roberto
Published: June 2021

Chronic Myeloid Leukemia is a clonal disorder characterized by the presence of the Ph‐chromosome and the BCR‐ABL tyrosine‐kinase (TK). Target‐therapy with Imatinib has greatly improved its outcome. Deeper and faster responses are reported with the second‐generation TKI Nilotinib. Sustained responses may enable TKI discontinuation. However, even in a complete molecular response, some patients experience disease recurrence possibly due to persistence of quiescent leukemic CD34+/lin−Ph+ stem cells (LSCs). Degree and mechanisms of LSCs clearance during TKI treatment are not clearly established. The PhilosoPhi34 study was designed to verify the in‐vivo activity and timecourse of first‐line Nilotinib therapy on BM CD34+/lin−Ph+ cells clearance. Eighty‐seven CP‐CML patients were enrolled. BM cells were collected and tested for Ph+ residual cells, at diagnosis, 3, 6 and 12 months of treatment. FISH analysis of unstimulated CD34+/lin− cells in CCyR patients were positive in 8/65 (12.3%), 5/71 (7%), 0/69 (0%) evaluable tests, respectively. Per‐Protocol analysis response rates were as follows: CCyR 95% at 12 months, MR4.5 31% and 46% at 12 and 36 months, respectively. An exploratory Gene Expression Profiling (GEP) study of CD34+/lin− cells was performed on 30 patients at diagnosis and after, on 79 patients at diagnosis vs 12 months of nilotinib treatment vs 10 healthy subjects. Data demonstrated some genes significantly different expressed: NFKBIA, many cell cycle genes, ABC transporters, JAK‐STAT signaling pathway (JAK2). In addition, a correlation between different expression of some genes (JAK2, OLFM4, ICAM1, NFKBIA) among patients at diagnosis and their achievement of an early and deeper MR was observed.
Empirical abundance distributions are more uneven than expected given their statistical baseline
Authors: Diaz Renata M. , Ye Hao , Ernest S. K. Morgan
Published: June 2021

Exploring and accounting for the emergent properties of ecosystems as complex systems is a promising horizon in the search for general processes to explain common ecological patterns. For example the ubiquitous hollow‐curve form of the species abundance distribution is frequently assumed to reflect ecological processes structuring communities, but can also emerge as a statistical phenomenon from the mathematical definition of an abundance distribution. Although the hollow curve may be a statistical artefact, ecological processes may induce subtle deviations between empirical species abundance distributions and their statistically most probable forms. These deviations may reflect biological processes operating on top of mathematical constraints and provide new avenues for advancing ecological theory. Examining ~22,000 communities, we found that empirical SADs are highly uneven and dominated by rare species compared to their statistical baselines. Efforts to detect deviations may be less informative in small communities—those with few species or individuals—because these communities have poorly resolved statistical baselines. The uneven nature of many empirical SADs demonstrates a path forward for leveraging complexity to understand ecological processes governing the distribution of abundance, while the issues posed by small communities illustrate the limitations of using this approach to study ecological patterns in small samples.
Contribution of sleep disturbances to fatigue in multiple sclerosis: a prospective study using clinical and polysomnographic parameters
Authors: Riccitelli Gianna C. , Disanto Giulio , Sacco Rosaria , Sparasci Davide , Sacco Leonardo , Castelnovo Anna , Miano Silvia , Manconi Mauro , Gobbi Claudio , Zecca Chiara
Published: June 2021

Background and purpose

Fatigue is amongst the most frequent and disabling symptoms of multiple sclerosis and a close relation between fatigue and sleep quality has been hypothesized. In this study the contribution of sleep disturbances measured by clinical and polysomnographic parameters to fatigue in multiple sclerosis was investigated.

Methods

This was a prospective instrumental study performed at the Neurocenter of Southern Switzerland. Demographic data and clinical characteristics including fatigue (as measured by the modified fatigue impact scale [MFIS]), neurological disability, psychiatric symptoms, medications and sleep‐related variables were collected at baseline visit and by a home full‐night polysomnography. The associations between sleep‐related variables and the MFIS were tested using partial correlations adjusted by demographic and sleep‐unrelated clinical factors.

Results

Seventy‐six patients were included in the study, of whom 53 (69.7%) had an MFIS ≥38 points (median 49.5, interquartile range 31.0–62.0). MFIS scores were positively associated with age, neurological disability, symptoms of depression and anxiety, and use of benzodiazepines and selective serotonin reuptake inhibitors. When adjusting for these variables, the presence of restless legs syndrome (RLS) (r = 0.37, p = 0.005) and periodic leg movements index (r = −0.33, p = 0.014) were associated with MFIS. Excessive daytime sleepiness, total sleep time, sleep efficiency, respiratory disturbances, and percentage of time spent in the different sleep stages (N1, N2, N3 and rapid eye movement) were not associated with fatigue.

Conclusions

Multiple sclerosis patients with a diagnosis of RLS had significantly higher global fatigue scores compared to those without RLS. Future studies should investigate whether medical treatment of RLS can ameliorate fatigue.
Blood–brain barrier leakage and hemorrhagic transformation: The Reperfusion Injury in Ischemic StroKe (RISK) study
Authors: Arba Francesco , Piccardi Benedetta , Palumbo Vanessa , Biagini Silvia , Galmozzi Francesco , Iovene Veronica , Giannini Alessio , Testa Giuseppe Dario , Sodero Alessandro , Nesi Mascia , Gadda Davide , Moretti Marco , Lamassa Maria , Pescini Francesca , Poggesi Anna , Sarti Cristina , Nannoni Stefania , Pracucci Giovanni , Limbucci Nicola , Nappini Sergio , Renieri Leonardo , Grifoni Stefano , Fainardi Enrico , Inzitari Domenico , Nencini Patrizia
Published: June 2021

Background and purpose

In patients with acute ischemic stroke treated with reperfusion therapy we aimed to evaluate whether pretreatment blood–brain barrier (BBB) leakage is associated with subsequent hemorrhagic transformation (HT).

Methods

We prospectively screened patients with acute ischemic stroke treated with intravenous thrombolysis and/or endovascular treatment. Before treatment, each patient received computed tomography (CT), CT angiography, and CT perfusion. We assessed pretreatment BBB leakage within the ischemic area using the volume transfer constant (Ktrans) value. Our primary outcome was relevant HT, defined as hemorrhagic infarction type 2 or parenchymal hemorrhage type 1 or 2. We evaluated independent associations between BBB leakage and HT using logistic regression, adjusting for age, sex, baseline stroke severity, Alberta Stroke Program Early CT Score (ASPECTS) ≥ 6, treatment type, and onset‐to‐treatment time.

Results

We enrolled 171 patients with available assessment of BBB leakage. The patients' mean (±SD) age was 75.5 (±11.8) years, 86 (50%) were men, and the median (interquartile range) National Institutes of Health Stroke Scale score was 18 (12–23). A total of 32 patients (18%) received intravenous thrombolysis, 102 (60%) underwent direct endovascular treatment, and 37 (22%) underwent both. Patients with relevant HT (N = 31;18%) had greater mean BBB leakage (Ktrans 0.77 vs. 0.60; p = 0.027). After adjustment in the logistic regression model, we found that BBB leakage was associated both with a more than twofold risk of relevant HT (odds ratio [OR] 2.50; 95% confidence interval [CI] 1.03–6.03 per Ktrans point increase; OR 2.34; 95% CI 1.06–5.17 for Ktrans values > 0.63 [mean BBB leakage value]) and with symptomatic intracerebral hemorrhage (OR 4.30; 95% CI 1.13–13.77 per Ktrans point increase).

Conclusion

Pretreatment BBB leakage before reperfusion therapy was associated with HT, and may help to identify patients at risk of HT.
Locomotor activity rhythms in laboratory‐reared adults of the mangrove cricket, Apteronemobius asahinai
Authors: Sakura Kazuki , Numata Hideharu
Published: June 2021

Adults of the mangrove cricket, Apteronemobius asahinai, collected in the field continuously show a circatidal rhythm in their locomotor activity. However, it remained unclear whether adult crickets reared from eggs in the laboratory, without cyclic tidal influence, show the circatidal rhythm. We show that under constant red dim light, slightly less than half of crickets showed a circatidal rhythm continuously for more than 10 days. On the other hands, Some others showed a unimodal daily rhythm either before or after the tenth day in the activity recording. Thus, some environmental factors other than the laboratory conditions should be required in order for all crickets to express a clear circatidal rhythm. Even under constant light, unimodal daily rhythm appeared. The unimodal daily rhythm was entrained to light–dark cycles in some crickets, but not in the others. Therefore, we cannot conclude whether the unimodal daily rhythm is a circadian rhythm or a rhythm derived from a circatidal rhythm with its period doubled.
Conceptualizing the clinical decision‐making process in managing temporomandibular disorders: A qualitative study
Authors: Ilgunas Aurelia , Lövgren Anna , Fjellman‐Wiklund Anncristine , Häggman‐Henrikson Birgitta , Karlsson Wirebring Linnea , Lobbezoo Frank , Visscher Corine M. , Durham Justin
Published: June 2021

Management of patients with temporomandibular disorders (TMD) appears to be more challenging than for other dental conditions. This study aimed to explore the decision‐making process in TMD management, and thereby to conceptualize the decision‐making process in dentistry. Individual semi‐structured interviews were conducted during 2018 and 2019 with a purposive sample of 22 general dental practitioners from the Public Dental Healthcare Services and private practices in the Region of Västerbotten, Northern Sweden. The interviews were analysed using the Grounded Theory approach of Charmaz. Data analysis resulted in the core category ‘Combining own competence and others’ expectations in the desire to do the right thing’. The dentists showed interest in and a desire to apply professional knowledge, but also reflected on challenges and complexity in the decision‐making process for TMD. The challenges were primarily related to organisational factors and lack of self‐confidence. This identifies a need for re‐organisation of daily clinical management in dentistry, and a need for more postgraduate training to improve self‐confidence. The complexity of the decision‐making process for TMD makes the study findings applicable in other dental situations.
Impaired social attention detected through eye movements in children with early‐onset epilepsy
Authors: Hunter Matthew B. , Chin Richard F. M.
Published: June 2021

Objectives

Children with early‐onset epilepsy (CWEOE; epilepsy onset before 5 years) exhibit impaired social functioning, but social attention has not yet been examined. In this study we sought to explore visual attention via eye tracking as a component of social attention and examine its relationship with social functioning and Autism Spectrum Disorder (ASD) risk scores.

Methods

Forty‐seven CWEOE (3–63 months) and 41 controls (3–61 months) completed two eye‐tracking tasks: (1) preference for social versus nonsocial naturalistic scenes, and (2) face region preference task. ASD risk was measured via the Modified Checklist for Autism in Toddlers or Conners Early Childhood Total Score. Social functioning was assessed via the Greenspan Social‐Emotional Growth Chart, or Infant‐Toddler Social & Emotional Assessment Competence Scale, or Conners Early Childhood Social Functioning Scale, depending on age. Fixation preferences for social scenes and eyes were compared between groups and evaluated by age and social functioning scores.

Results

Regression analysis revealed that CWEOE viewed the social scene to a significantly less degree than controls. The greatest difference was found between the youngest CWEOE and controls. Fixation duration was independently and significantly related to social functioning scores. There were no significant differences between CWEOE and controls in the face scanning task, and there was no significant relationship between either task and ASD risk scores.

Significance

CWEOE exhibit task‐specific atypical social attention early in the course of the disease. This may be an early marker of impaired social development, and it suggests abnormal social brain development.
Kainate receptors: from synaptic activity to disease
Authors: Negrete‐Díaz José Vicente , Falcón‐Moya Rafael , Rodríguez‐Moreno Antonio
Published: June 2021

Kainate receptors (KARs) are glutamate receptors that participate in the postsynaptic transmission of information and in the control of neuronal excitability, as well as presynaptically modulating the release of the neurotransmitters GABA and glutamate. These modulatory effects, general follow a biphasic pattern, with low KA concentrations provoking an increase in GABA and glutamate release, and higher concentrations mediating a decrease in the release of these neurotransmitters. In addition, KARs are involved in different forms of long‐ and short‐term plasticity. Importantly, altered activity of these receptors has been implicated in different central nervous system diseases and disturbances. Here, we describe the pre‐ and postsynaptic actions of KARs, and the possible role of these receptors in disease, a field that has seen significant progress in recent years.
Language teacher perspectives on stress and coping
Authors: Gregersen Tammy , Mercer Sarah , MacIntyre Peter D.
Published: June 2021

Every person's response to adversity is unique. Whereas some come out stronger as a result of responding to a challenge, others find their fundamental assumptions about themselves and their lives severely challenged. In education, while some teachers might burn out and leave the profession precipitously, many survive the challenges and transform teaching into their lifelong passion. What factors help explain why some language teachers remain resilient and experience growth after trauma, while others suffer a sense of loss, depleted psychological resources, and ultimately succumb to the pressures of the job, leaving the profession or burning out? The purpose of this study was to seek answers to this question in the context of teaching during the Covid‐19 pandemic, which represents a specific unprecedented type of adversity. To do this, 765 foreign language teachers worldwide answered an online questionnaire that asked three open‐ended questions about the stressors and uplifts they were experiencing during the first few months of the pandemic. Respondents were invited to offer their advice to other language teachers who were facing the challenge of teaching during this time.
Barriers toward equity: Recognizing biliteracy of all students in Minnesota
Authors: de Galbert Pierre Gaspard , Woogen Eve
Published: June 2021

Education actors in the United States are increasingly promoting language skills development of our students. The Seal of Biliteracy (SoBL) has grown into a popular initiative to promote biliteracy and recognize students who demonstrate skills in English and another language. However, the language used to promote biliteracy and the criteria put in place to award the SoBL risk exacerbating differences in opportunities between linguistic communities rather than promote speakers of all languages. Minnesota introduced the SoBL through a law explicitly aimed at supporting education for English language learners. This paper critically reviews the goals of the SoBL initiative, describes the approaches Minnesota has taken to support English language learners to earn the seal and discusses the practical challenges schools and districts face. States and districts need to explicitly address these barriers to avoid increasing inequities through the SoBL.
Microbial consortia in an ice‐covered high‐altitude lake impacted by additions of dissolved organic carbon and nutrients
Authors: Dory Flavia , Cavalli Laurent , Franquet Evelyne , Claeys‐Bruno Magalie , Misson Benjamin , Tatoni Thierry , Bertrand Céline
Published: June 2021

High‐altitude lakes are sentinels of change. Anticipated increases in inputs of dissolved organic carbon (DOC) from catchments in high‐altitude lakes could affect planktonic interactions, especially if inputs occur during the winter ablation phase. However, the responses of plankton communities to added DOC interacting with nutrients during this period are still not well understood.

We sampled under‐ice water and used a multifactorial experimental design to investigate the DOC effect on planktonic organisms (phytoplankton and heterotrophic prokaryotic plankton [HPP]) and their interactions during the winter ablation phase. The plankton community was subjected to DOC additions (0, 2, 4, and 6 mg C/L) under two nutrient‐availability treatments (natural concentrations or enriched in N and P), two light conditions (dark or light), and two temperature conditions (10 or 18℃).

We found HPP to be co‐limited by N, P, and C in our microcosms. Added glucose as available C‐source for bacterioplankton was highly consumed at the end of the experiments. This consumption was not always related to an increase of the HPP biomass, due to a rising predatory control by ciliates and mixotrophic phytoplankton over bacteria. In dark conditions, the biomasses of both autotrophic and mixotrophic phytoplankton were substantially reduced, and the HPP biomass under DOC and nutrient additions principally depended on the predatory control exerted by ciliates. In light conditions, a diversification of top‐down control over bacteria was observed, with the HPP response to DOC and nutrient additions depending on both mixotrophs and ciliates. Moreover, when heterotrophic ciliates and mixotrophs were present together in the experiments, the ciliates replaced the mixotrophs in phagotrophy over bacteria.

Our experimental results indicate that DOC inputs can rapidly alter the trophic interactions of the planktonic food web, depending on nutrient limitation in high‐altitude lakes. We found decreased commensalistic interactions between bacteria and phytoplankton, but increased competition and predation, after DOC additions.

The expected future scenario of global change during the ablation phase is likely to change the balance between heterotrophic and autotrophic processes in planktonic food webs by increasing heterotrophic processes. These changes could have major repercussions on energy transfer from the base to the top of the food chain in high‐altitude lakes.

Exploring the planktonic response to rapid environmental changes during the ablation phase appears to be crucial in order to determine how vulnerable high‐altitude lakes are to future change.
Contrasting recovery trajectories of four reintroduced populations of the Endangered Mauritius Kestrel (Falco punctatus)
Authors: Nicoll Malcolm A. C. , Jones Carl G. , Groombridge Jim G. , Henshaw Sion , Ruhomaun Kevin , Tatayah Vikash , Zuel Nicolas , Norris Ken
Published: June 2021

Conservation translocations are commonly used in recovery programmes for threatened species from a wide range of taxa but outcomes can vary considerably both within and between programmes, and the causes of success or failure are often unclear. Central to understanding translocation success is the implementation of an accompanying monitoring programme, enabling the drivers of population establishment and persistence to be explored within a population ecology framework. Here we review and assess the outcome of a translocation programme for the Endangered Mauritius Kestrel, which involved the initial translocation of captive‐reared Kestrels into four isolated populations and long‐term nest‐site management and monitoring. We show that after 20 years these four populations have different recovery trajectories including local extinction, recent decline and comparative stability. We explore the demographic drivers behind these trajectories and how they have been influenced, and could potentially be manipulated, by conservation management actions. Metrics of breeding performance differed between populations and in part this was driven by nest‐site selection, with Kestrels nesting more frequently, laying larger clutch sizes and rearing larger broods in nestboxes. We found no compelling evidence for inter‐population variation in survival rates. Simulating population trajectories under a range of conservation management scenarios, including further conservation translocations or a scaling up of nest‐site management, suggested that the latter would be a more effective, practical long‐term solution for the population currently in decline. Our findings provide valuable insights into the merits of monitoring, population demographic reviews and the challenges associated with identifying and mitigation for the drivers of rarity in threatened species.
Multiple nonlinear regression model of cutting force for C/SiC composites by laser‐assisted micromachining
Authors: Zhai Changtai , Xu Jinkai , Nie Xiaoyu , Tian Jiwen , Yu Huadong
Published: June 2021

Based on the response surface methodology (RSM), laser‐assisted micromachining (LAMM) experiments of carbon fiber reinforced silicon carbide matrix(C/SiC) composites have been carried out to obtain the data of three‐direction cutting forcesFx,Fy,Fz, and result‐forceFin the cutting process. A stepwise regression method is used to screen out the factors that significantly affected the cutting force, and hence a multivariate nonlinear mathematical regression model has been established. Through the analysis of variance and regression analysis, the R2 of the regression model is the cutting forceFx: 0.975, the cutting forceFy: 0.970, the cutting forceFz: 0.972, the resultant forceF: 0.987, and the probabilityp > F‐values are all less than 0.001. The model analysis results show that the main effects and interactions of the three factors of laser power, cutting speed, and cutting depth significantly influence the cutting force. The main effect of the most considerable influence on the resultantFis cutting depth, followed by cutting speed and laser power, and the interactive effect is cutting speed and cutting depth. The experimental results show that the model prediction results are in good agreement with the experimental results.
Improvement of low carbon MgO‐C refractories by MA‐CA2 additives fabricated from metallurgical waste
Authors: Tang Shaopeng , Fu Lvping , Gu Huazhi , Wang Ting , Huang Ao , Wu Jianfang , Lv Renxiang
Published: June 2021

In the present work, MA‐CA2 material was fabricated by adding industrial alumina into industrial waste residue, and its effect on the physical properties, oxidation resistance, slag resistance, and thermal shock resistance when it was added to the composition of a low carbon MgO‐C refractory was discussed in detail. Although the introduction of MA‐CA2 material led to a slight inferior slag corrosion resistance, the volume stability and oxidation resistance of refractories were improved. Moreover, the samples containing MA‐CA2 addition showed significantly lower thermal expansion coefficients and increased thermal shock resistance performance. However, owing to the dissolution of SiO2 impurity into the MA‐CA2 material, an excessive addition of MA‐CA2 material would increase the liquid phase amount in the sample during the heat treatment and slag attack, resulting in a performance degradation. In this study, the best comprehensive performance of the MgO‐C refractory was obtained with 6 wt% MA‐CA2 addition.
A yoghurt containing galactooligosaccharides and having low‐lactose level improves calcium absorption and retention during growth: experimental study
Authors: Seijo Mariana , Bonanno Marina Soledad , Vénica Claudia Inés , Marotte Clarisa , Pita Martín de Portela María Luz , Bergamini Carina Viviana , Wolf Irma Verónica , Perotti María Cristina , Zeni Susana Noemí
Published: June 2021

Dairy products are essential to ensure calcium recommendations to achieve optimal peak bone mass and avoid bone loss. However, high prevalence of lactose malabsorption decreases milk‐derived foods consumption. The use of β‐galactosidase, which hydrolyses lactose to galactooligosaccharides (GOS) is an alternative to develop a low‐lactose yoghurt (EY) where prebiotics (GOS) and probiotics (Lactobacilli) coexist. The effects of two diets based on EY or standard yoghurt without GOS (Y) on calcium absorption and bone retention were evaluated and compared, in growing rats. Control group received AIN 93‐G diet. Male weaning rats were fed one of these three diets for 28 days. EY group showed the highest increase in faecal Lactobacillus colonies, in short‐chain fatty acids production, in intestinal crypt deep, and the lowest caecum pH. Calcium absorption (%) increased significantly as follows: EY>Y>control (P < 0.05). EY and control showed similar calcium content in femur, bone mineral content and density, and total epiphyseal cartilage while Y showed the lowest value (P < 0.05). Conclusion: YE presented some advantages compared to Y regarding calcium absorption and bone retention since Y could not match bone growth and quality of control group. EY was an effective low lactose‐dairy product for delivering prebiotics and probiotics into gut, to enhance gut health and calcium bioavailability that improved bone development in a period of high calcium requirements as growth stage. Even more important is that EY could represent an efficient therapeutic strategy to achieve calcium recommendations in people who avoid dairy product consumption due to unpleasant symptoms of lactose intolerance.
The effect of aromatherapy on fatigue in adults receiving haemodialysis treatment: A systematic review and meta‐analysis of randomised controlled trials
Authors: Yangöz Şefika Tuğba , Turan Kavradım Selma , Özer Zeynep
Published: June 2021

Aim

To synthesise the effect of aromatherapy on fatigue in adults receiving haemodialysis treatment in randomised controlled trials.

Design

A systematic review and meta‐analysis of randomised controlled trials following the Cochrane methods.

Data resources

Systematic search was carried out using the Cochrane Library, CINAHL, Council of Higher Education National Thesis Center, Networked Digital Library of Theses & Dissertations, Science Direct, Springer Link, Scopus, PubMed, ProQuest, Ovid, ULAKBIM Turkish National Databases and Web of Science without year limitation for studies published in the English language. The review covered the period between 1960 and April 2020.

Review methods

Three authors reviewed the risk of bias independently and systematically using the Cochrane Collaboration tool.

Results

Eight studies with 606 participants were included in this systematic review and meta‐analysis. Aromatherapy was applied through inhalation and massage methods and performed from 2 to 30 min and in 3 to 30 sessions. There was no significant publication bias. Aromatherapy had a large effect on fatigue in adults receiving haemodialysis treatment and high heterogeneity.

Conclusion

Aromatherapy has a high and positive effect on fatigue in the adults receiving haemodialysis and can be used as an effective intervention in the management of fatigue.

Impact

Aromatherapy may help to reduce the severity of fatigue in adults receiving haemodialysis. The findings of this systematic review and meta‐analysis will contribute to the use of aromatherapy in the management of fatigue and conduction of randomised controlled trials related to aromatherapy.
Examining the expectations of healing care environment of hospitalized children with cancer based on Watson's theory of human caring
Authors: Gürcan Meltem , Atay Turan Sevcan
Published: June 2021

Aim

To describe the expectations of children with cancer about the healing care environment during hospitalization based on Watson's Theory of Human Caring.

Design

A descriptive qualitative research design was used in this study.

Methods

Data were collected between December 2019 and February 2020 from purposively selected children with cancer in a paediatric haematology and oncology clinic at a university hospital in Turkey. Twelve participants (7 females and 5 males) aged 10–17 were recruited to carry out individual semi‐structured interviews. All interviews were recorded via a digital audio recorder and transcribed verbatim. The content analysis method was used to analyse the data.

Findings

As a result of the analysis, three main themes with related sub‐themes were identified that revealed the expectations of children with cancer: ‘healing care behaviors’, ‘creating the physical environment of the hospital’ and ‘support from the social environment’.

Conclusion

Watson's Theory of Human Caring may be a useful and applicable guide for drawing a conceptual framework of the expectations of children with cancer regarding a healing care environment. The study revealed these children's need for humanistic, compassionate, honest and problem‐focused care. In addition, participants wished for improvements in the physical environment. They also stated that they feel lonely and need social support from their family, peers and society.

Impact

This study presents a comprehensive picture of the expectations regarding a healing care environment (caring behaviours and physical and social aspects) of hospitalized children with cancer undergoing treatment. The qualitative findings generated by our study have the potential to facilitate these children's healthy adjustment to the hospital environment and procedures during hospitalization. Knowledge acquired through this study may be used to shape nursing care, enhance the healing care environment, and ensure that hospital design and setting are acceptable to and appropriate for paediatric patients.
Learning about a serious disease: When a personalized message is harmful unless you are happy
Authors: Kühl Tim , Münzer Stefan
Published: June 2021

According to the personalization principle, addressing learners by means of a personalized compared to a nonpersonalized message can foster learning. Interestingly, though, a recent study found that the personalization principle can invert for aversive contents. The present study investigated whether the negative effect of a personalized message for an aversive content can be compensated when learners are in a happy mood. It was hypothesized that the negative effect of a personalized compared to a nonpersonalized message would only be observable for participants in a sad mood, while for participants in a happy mood a personalized message should be beneficial. A 2 × 2 between‐subject design with mood (happy vs. sad) and personalization (personalized vs. nonpersonalized message) was used (N = 125 University students). Mood was experimentally varied prior to learning. Learning outcomes were measured by a retention and a transfer test. Results were essentially in line with the assumption: For participants in the sad mood condition, a negative effect of a personalized message was observable for retention and transfer. For participants in the happy mood condition, a positive effect of personalized message was observable for retention, but no effect for transfer. Note that the manipulation check measure for the mood induction procedure did not detect differences between conditions; this may be due to a shortcoming of the used measure (as indicated by an additional evaluation study). The study emphasizes the importance to consider the inherent emotional content of a topic, such as its aversive nature, since the emotional content of a topic can be a boundary condition for design principles in multimedia learning. The study also highlights the complex interplay of externally induced and inherently arising emotions.
Thrombospondin‐4 promotes bladder cancer cell migration and invasion via MMP2 production
Authors: Chou Kuang‐Yu , Chang An‐Chen , Ho Chao‐Yen , Tsai Te‐Fu , Chen Hung‐En , Chen Po‐Chun , Hwang Thomas I‐Sheng
Published: June 2021

Bladder cancer (BC) is the second most common urological tumour in Western countries. Approximately, 80% of patients with BC will present with non‐muscle invasive bladder cancer (NMIBC), whereas a quarter will have muscle invasive disease (MIBC) at the time of BC diagnosis. However, patients with NMIBC are at risk of BC recurrence or progression into MIBC, and an MIBC prognosis is determined by the presence of progression and metastasis. Matrix metalloproteinase 2 (MMP2), a type of matrix metalloproteinase (MMP), plays a major role in tumour invasion and is well‐characterized in BC prognosis. In BC, the mechanisms regulating MMP2 expression, and, in turn, promote cancer invasion, have hardly been explored. Thrombospondin‐4 (THBS4/TSP4) is a matricellular glycoprotein that regulates multiple biological functions, including proliferation, angiogenesis, cell adhesion and extracellular matrix modelling. Based on the results of a meta‐analysis in the Gene Expression Profiling Interactive Analysis 2 database, we observed that TSP4 expression levels were consistent with overall survival (OS) rate and BC progression, with the highest expression levels observed in the advanced stages of BC and associated with poor OS rate. In our pilot experiments, incubation with recombinant TSP4 promoted the migration and invasion in BC cells. Furthermore, MMP2 expression levels increased after recombinant TSP4 incubation. TSP4‐induced‐MMP2 expression and cell motility were regulated via the AKT signalling pathway. Our findings facilitate further investigation into TSP4 silencing‐based therapeutic strategies for BC.
The Effects of Supranational Delegation on Policy Development
Authors: Citi Manuele , Jensen Mads Dagnis
Published: June 2021

Studies on delegation to international organizations have extensively examined the determinants of supranational delegation. Yet, systematic empirical accounts on the effects of different types and degrees of delegation on policy developments remain limited. This paper addresses this gap by using a novel dataset that combines delegation data from the Treaty of Rome with data on legislation and case law developed by the European authorities (1958–2000). The analysis produces three findings. First, a higher level of delegation of legislative and executive functions has a positive effect on the volume of secondary legislation, but no effect on the volume of case law. Second, a higher level of judicial delegation has a positive effect on the volume of case law, while limiting legislative activity. Third, the precision of the Treaty provisions constrains the volume of secondary legislation. The findings show how the type and intensity of supranational delegation shape supranational policy development.
Kratom exposures among older adults reported to U.S. poison centers, 2014–2019
Authors: Graves Janessa M. , Dilley Julia A. , Terpak Lucia , Brooks‐Russell Ashley , Whitehill Jennifer M. , Klein Tracy A. , Liebelt Erica
Published: June 2021

Background

In recent years, use of the herbal supplement kratom has increased in the United States. The reasons for use include pain relief, particularly as a substitute for opioids.

Objectives

To describe epidemiologic trends in kratom‐related exposures among older adults reported to U.S. poison centers.

Design

Retrospective analysis of American Association of Poison Control Center's National Poison Data System (NPDS).

Setting

Data from all U.S. poison centers from 2014 to 2019 were examined.

Participants

Kratom exposure cases involving adults aged 18 and older. Kratom cases were identified by product and NPDS generic codes. Non‐human and information‐only calls were excluded. Data were examined for all calls for exposures among adults, with a focus on older adults aged 60–69 years and above 70 years.

Measurements

Descriptive analyses were used to characterize individual demographic, exposure information, clinical effects, and medical outcomes associated with kratom exposures among older adults. Comparisons across age groups (18–59, 60–69, and 70+ years) were made using Fisher's exact tests.

Results

Among 3484 kratom‐related exposures reported between 2014 and 2019, 4.6% (n = 162) were among adults over 60 years. The number of kratom‐related exposures increased over time. Most cases originated with calls from healthcare facilities (81.1%) and involved kratom as a single ingestant (63.0%). The reason for most ingestions was intentional (74.5%). One in five exposures among adults aged 70 and older involved an adverse reaction (e.g., drug interaction; 21.9%), compared with 12.3% among ages 60–69 and 9.6% among ages 18–59 years. Neurological and cardiovascular clinical effects were observed. Twenty‐three deaths were observed among older adults.

Conclusion

Healthcare providers and older adult patients should be aware of the potential risks of kratom use, including medication interactions and falls. When reviewing medication lists, providers should query this population for all medications and substances being used, especially in people being treated for pain.
Ponesimod protects against neuronal death by suppressing the activation of A1 astrocytes in early brain injury after experimental subarachnoid hemorrhage
Authors: Zhang Lifang , Guo Kecheng , Zhou Jian , Zhang Xianhui , Yin Shigang , Peng Jianhua , Liao Yuyan , Jiang Yong
Published: June 2021

As an important initiator and responder of brain inflammation in the central nervous system (CNS), astrocytes transform into two new reactive phenotypes with changed morphology, altered gene expression and secretion profiles, termed detrimental A1 and beneficial A2. Inflammatory events have been shown to occur during the phase of early brain injury (EBI) after subarachnoid hemorrhage (SAH). However, the phenotype transformation of astrocytes as well as its potential contribution to inflammatory status in the EBI of SAH has yet to be determined. In the present study, both in vivo and in vitro models of SAH were established, and the polarization of astrocytes after SAH was analyzed by RNA‐seq, western blotting, and immunofluorescence staining. The effect of astrocytic phenotype transformation on neuroinflammation was examined by real‐time quantitative PCR (RT‐qPCR) and enzyme‐linked immunosorbent assay (ELISA). We demonstrated that astrocytes were transformed into A1 astrocytes and caused neuronal death through the release of pro‐inflammatory factors in EBI after SAH. Importantly, Ponesimod, an S1PR1 specific modulator, exerted neuroprotective effects through the prevention of astrocytic polarization to the A1 phenotype as proved by immunofluorescence, neurological tests, and TUNEL study. We also revealed the role of Ponesimod in modulating astrocytic response was mediated by the signal transducer and activator of transcription 3 (STAT3) signaling. Our study suggested that Ponesimod may be a promising therapeutic target for the treatment of brain injury following SAH.

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The multiple faces of the oxytocin and vasopressin systems in the brain
Authors: Grinevich Valery , Ludwig Mike
Published: June 2021

Classically, hypothalamic neuroendocrine cells that synthesise oxytocin and vasopressin were categorised in two major cell types: the magnocellular and parvocellular neurones. It was assumed that magnocellular neurones project exclusively to the pituitary gland where they release oxytocin and vasopressin into the systemic circulation. The parvocellular neurones, on the other hand, project within the brain to regulate discrete brain circuitries and behaviours. Within the last few years, it has become evident that the classical view of these projections is outdated. It is now clear that oxytocin and vasopressin in the brain are released extrasynaptically from dendrites and from varicosities in distant axons. The peptides act principally to modulate information transfer through conventional synapses (such as glutamate synapses) by actions at respective receptors that may be preferentially localised to synaptic regions (on either side of the synapse) to alter the ‘gain’ of conventional synapses.
Turning point and oscillatory cycles: Concepts, measurement, and use
Authors: Kulish Mariano , Pagan Adrian
Published: June 2021

The early history of cycles research involved locating turning points in the data. Later, the development of methods such as spectral analysis led to a focus on oscillations. A distinction between cycles and oscillations is needed—both imply turning points, but turning points can occur without oscillations. Turning points can be identified in nonstationary series but, as it is hard to define oscillations nonparametrically in such a series, harmonic models tend to be used to capture any oscillatory phenomena. One needs to check then that oscillations are not just being imposed by the model. We show that often there are no oscillations in the series the models are applied to. When they are present it has been argued that one needs to pay attention to medium‐term oscillations of 8–30 years rather than the standard 2–8 years of the business cycle. We analyze whether there is much merit in this argument and conclude there is not. Beaudry et al. (2020,American Economic Review,110, 1–47) contention that there is a cycle of 9/10 years in series such as hours per capita is also examined and we find that there is little evidence for it. Moreover, if there is in fact such an oscillation it accounts for less than 1% of the variance of the series. Comparative studies of models based on endogenous versus exogenous technology as well as limit cycles due to accumulation and complementarity mechanisms are also examined.
Prospective risk of stillbirth and neonatal complications for monochorionic diamniotic and dichorionic diamniotic twins after 24 weeks of gestation
Authors: Yu Florrie Nga Yui , Mak Annisa Shui Lam , Chan Ngai Man , Siu Kiu Lok , Ma Teresa Wei Ling , Leung Kwok Yin
Published: June 2021

Introduction

Our study compared the prospective risks of intrauterine fetal death (IUFD), neonatal death (NND), perinatal death (PND), and neonatal morbidities in monochorionic diamniotic (MCDA) and dichorionic diamniotic (DCDA) twin pregnancies.

Methods

This retrospective cohort study included twin pregnancies who had antenatal care and delivery in a public hospital from 2011 to 2018. Exclusion criteria included monoamnionicity, one/both twin miscarriage, twin‐twin transfusion syndrome, or lethal congenital abnormalities. All twins were managed in multiple pregnancy clinic with standardized protocols. Gestational age‐specific IUFD, NND, PND, and neonatal morbidity rates were compared according to chorionicity.

Results

Three hundred seventy‐eight MCDA and 1282 DCDA twins were included. MCDA twins had higher risks of PND (1.9% vs. 0.7% in DCDA twins, p = 0.05), composite neonatal morbidity (p = 0.01), preterm delivery (p < 0.01), and low birth weight (p < 0.01). The prospective risk of IUFD was 0.6% and 0.4% for MCDA and DCDA twins, respectively after 34 weeks' gestation. No NND occurred among deliveries after 30 weeks. The risk of neonatal morbidity of MCDA twins fell from 22.7% at 34 weeks to 2.7% at 37 weeks (p < 0.01). For DCDA twins, the risk of morbidity fell insignificantly from 36 to 38 weeks (4.0% vs. 3.4%, p = 0.60). Logistic regression analysis suggested that the increased risk of perinatal morbidities was related to the higher rate of preterm delivery in MCDA twins rather than chorionicity.

Conclusion

With close fetal monitoring, the risk of late IUFD in twin pregnancies without major complications is low. Perinatal morbidity can be minimized by avoiding late preterm deliveries in twin pregnancies.