bluuebunny/crossref_metadata_2025 huggingface dataset:
Preparation of fortified bread by incorporating blends of Helianthus annuus and Myristica fragrans flours: Assessment of functional, physicochemical, and organoleptic properties
Authors: Aziz Mahwash , Ramzan Rabia , Muhammad Zafarullah , Khalid Nazia , Batool Rizwana
Published: September 2022

Bread is a fundamental food in many countries and comes in various forms. Bread fortified with functional ingredients attracted growing research in recent years. In the present investigation, fortification of whole wheat flour with nutmeg powder was carried out at different levels WSN1 (4% nutmeg), WSN2 (10% sunflower + 4% nutmeg), WSN3 (20% sunflower+4% nutmeg), and WSN4 (30% sunflower + 4% nutmeg). The functional attributes of flour blends were investigated. Furthermore, fortified bread during eight days of storage was determined for compositional analysis and total caloric value. The functional characteristics, that is, water and oil holding capacity (1.88–2.16 and 2.32–4.10, respectively), emulsion activity (40.13–57.58), and stability (38.04–49.83), swelling (15.02–17.25) and foaming stability (13.96–21.39) improved highly significantly by fortification. The minerals content was observed in WSN4 > WSN3 > WSN2 > WSN1 > WSN0 order. The maximum DPPH was observed in WSN4 as 44.28 ± 0.03%. From the current results, based on organoleptic properties, the incorporation of sunflower at about 20% with 4% nutmeg is better and acceptable (7.49 ± 0.01) for the commercialization of products in the industrial sector.

Novelty impact statement

The findings of this study are important from the nutritional point of view as bread fortification with natural sources will help to reduce nutritional deficiencies. Incorporating sunflower seeds and nutmeg flour blends in whole wheat flour to prepare fortified bread enhanced bread's nutritional value and improved bread quality characteristics. Utilizing the flour blends could be a promising approach to making fortified bread having a balanced amino acid profile to meet the Lysine deficiency in whole wheat flour.
Structural characterization and oxidative stability of black cumin oil oleogels prepared with natural waxes
Authors: Orhan Necla Ozdemir , Eroglu Zeynep
Published: September 2022

In this study, black cumin oil (BCO) oleogel was produced using natural waxes (beeswax: BW, sunflower wax: SFW, and carnauba wax: CW) to offer a healthy alternative to shortening. Oiling‐off was observed only in the BW oleogel (3.88 ± 0.02%). The CW oleogel had the lowest Ea (354.82 kJ/mol), indicating greater resistance to thermal degradation. The highest G′ and G″ were observed in the CW oleogel, while the lowest was observed in the BW oleogel. All oleogel samples displayed weak gel properties (tan δ > 0.1), but the lowest tan δ value belonged to the CW oleogel (0.12). After 4 weeks of storage, the peroxide values of the oleogels were lower than those of bulk oil (p < .05). Finally, the oxidation results showed that the BCO structuring by the waxes effectively protected it from oxidation over eight weeks of storage.

Novelty impact statement

The most important innovation of the present study was to investigate the effect of BCO oleogelation on the stability of thymoquinone, the main phenolic compound of BCO. The BCO oleogels had higher thymoquinone content during the first half of the storage period compared with bulk BCO, showing that the oleogel network provides a protective effect against oxidation and thermal degradation.
Lactoperoxidase partitioning from whey using the reverse micelles of non‐ionic/ionic mixed surfactants: Improvement of back extraction
Authors: Karanth Shwetha , Iyyaswami Regupathi
Published: September 2022

The reverse micellar system formed with a mixture of ionic and non‐ionic surfactants, AOT (Sodium bis[2‐ethyl hexyl] sulfosuccinate)/Tween 80 in isooctane, was studied for the selective extraction of Bovine Lactoperoxidase (LP) from acid whey. The effect of pH and ionic strength of acid whey and surfactant concentrations were studied and a maximum of 86% LP was extracted from acid whey at pH 9.5 with the addition of 0.2 M KCl to the reverse micelles formed with AOT (115 mM)/Tween 80 (23 mM). The back extraction of LP was studied at different aqueous stripping phase pH, ionic strength and concentration of counter‐ionic surfactant Cetyltrimethylammonium bromide (CTAB). The back extraction of 112% with 80% LP recovery was achieved when the stripping phase pH was 10.5 with 1.5 M KCl and 60 mM CTAB. The antimicrobial activity of the extracted LP showed reduction in colony‐forming units of S. aureus.

Novelty impact statement

The reverse micelles formed with AOT/Tween 80 surfactant mixture minimize the pH‐dependent denaturation of LP and widen the pH window (7.5–9.5) for LP extraction. The back extraction of LP from the reverse micellar phase to aqueous stripping phase was improved by the addition of CTAB as counter‐ionic surfactant. A purification fold of 11.26 achieved with minimal loss in activity of LP by retaining the native Antimicrobial characteristic.
Cold extraction of minimally processed Stevia UEM‐13 leaves: Amylase inhibition and increased bioaccessibility of bioactive compounds by microencapsulation
Authors: Zorzenon Maria Rosa T. , Cabeça Cynthia Letícia S. , Nogueira Natani C. , Aristides Lorena G. B. , Cordeiro Erika B. , Dacome Antonio S. , Mareze‐Costa Cecilia E. , Fernandes Paula G. M. , da Costa Silvio Claudio
Published: September 2022

Sweeteners and other bioactives present in the leaves of Stevia rebaudiana have shown functional and nutritional benefits in several pathologies. The number of consumers of teas and plant extracts has grown significantly, but little is known about cold extraction, especially of Stevia. Thus, the objectives of this study were to perform a semi‐continuous cold percolation extraction of minimally processed Stevia UEM‐13 leaves and to microencapsulate this extract with maltodextrin by Spray Dryer, in order to evaluate possible functional effects of the free and microencapsulated extract. The extract had 25.27 g/100 g of steviol glycosides, quantified by HPLC (11.9% rebaudioside A and 10.2% stevioside) and 72.36 μgGAE/mg of total phenolic compounds. The antioxidant capacity was 50.2% for DPPH radical and 28.4% for ABTS·+. The microencapsulation presented efficiency of 70.59%, with well‐defined spheres by visualization through scanning electron microscopy. The free and microencapsulated extract (0.5 mg/ml) decreased the enzymatic activity of α‐amylase with possible non‐competitive or mixed inhibition in a dose‐independent manner and also showed good acceptance in the preliminary sensory test with little bitter and herbaceous residual. The bioaccessibility of bioactive compounds (sweeteners, total phenolics, antioxidant activity for DPPH and ABTS·+ radicals) was evaluated by simulating in vitro digestion and those that were microencapsulated showed higher bioaccessibility for all conditions (mouth, gastric, and intestinal conditions). Thus, it is suggested the direct use or application in food of the microencapsulated extract obtained in cold of Stevia leaves, for the preservation of bioactive compounds and possible functional activities.

Novelty impact statement

Cold extraction of Stevia leaves shows similar yields to hot extraction and contains significant contents of phenolic compounds and antioxidant activity.

The cold extract 0.5 mg/ml contains possible antidiabetic property presenting α‐amylase enzyme inhibition.

The microencapsulation of the crude stevia extract preserves the bioactive compounds and antioxidant activity on simulated in vitro digestion.
Numerical optimization approach for the development of Giloy stem (Tinospora cordifolia) extract based functional yoghurt
Authors: Kumar Nitin , Sahu Jatindra K. , Kumar Ankur , Naik Satyanarayan
Published: September 2022

Functional yoghurt is a prominent fermented milk product. It is popular among all age groups and has considerable significance due to the presence of active nutrients to fulfill the human dietary needs. Tinospora cordifolia (giloy) is extensively discussed during the recent pandemic owing to its high antioxidant, anti‐inflammatory, and strong immunity boosting properties. This investigation has been aimed to optimize functional yoghurt impregnated with ultrasound assisted giloy stem extract. Central composite rotatable design (CCRD) was used for experimental design of process parameters (giloy stem extract, total soluble solid, and incubation temperature). Functional yoghurt formulation was optimized based on different (whiteness index, overall acceptability, pH, syneresis, firmness, DPPH scavenging activity, and complex viscosity) responses. The results revealed that giloy stem extract and total soluble solid exhibited maximum effects on all the responses. Numerical optimization revealed the optimum combination of giloy stem extract, total soluble solid, and incubation temperature as 0.08%, 9.1%, and 45°C, respectively. At this optimum condition, the whiteness index, overall acceptability (OA), pH, syneresis, firmness, DPPH scavenging activity, and complex viscosity values of optimized functional yoghurt were 84.513, 8.567, 4.193, 47.268%, 281.19 N, 56.78%, and 76.89 cP, respectively. This study established the effect of giloy extract addition, total soluble solids, and incubation temperature on yoghurt preparation and subsequent changes in its properties.

Novelty impact statement

Giloy stem extract (GSE) enriched functional yoghurt was developed having high antioxidant activities.

Ultrasound assisted GSE improved the texture and overall desirability of functional yoghurt.

Derived the optimum conditions which might be replicated and scaled up for pilot scale production.
Simulating future flood risks under climate change in the source region of the Indus River
Authors: Rizwan Muhammad , Li Xin , Chen Yingying , Anjum Lubna , Hamid Shanawar , Yamin Muhammad , Chauhdary Junaid Nawaz , Shahid Muhammad Adnan , Mehmood Qaisar
Published: September 2022

Pakistan experiences extreme flood events almost every year during the monsoon season. Recently, flood events have become more disastrous as their frequency and magnitude have increased due to climate change. This situation is further worsened due to the limited capacity of existing water reservoirs and their ability to absorb and mitigate peak floods. Thus, the simulation of stream flows using projected data from climate models is essential to assess flood events and proper water resource management in the country. This study investigates the future floods (in near future and far future periods) using the integrated flood analysis system (IFAS) model under the RCP2.6, RCP4.5, and RCP8.5 climate change scenarios. Downscaled and bias corrected climatic data of six general circulation models and their ensemble were used in this study. The IFAS model simulated the stream flow efficiently (R2 = 0.86–0.93 and Nash–Sutcliffe efficiency = 0.72–0.92) in the Jhelum River basin (JRB), Kabul River basin (KRB), and upper Indus River basin (UIRB) during the calibration and validation periods. The simulation results of the model showed significant impact of projected climate change on stream flows that will cause the mean monthly stream flow in the JRB to be lower, while that of the KRB and UIRB to be higher than that of the historical period. The highest flow months are expected to shift from May–June (Jhelum basin) and June–July (Kabul basin) to April–May with no changes in the UIRB. Higher frequencies of low to medium floods are projected in the KRB and UIRB, while the JRB expects fewer flood events. Based on the results from the IFAS model, it is concluded that stream flow in the study area will increase with several flood events.
Treatment limitations and clinical outcomes in critically ill frail patients with and without COVID‐19 pneumonitis
Authors: Subramaniam Ashwin , Tiruvoipati Ravindranath , Pilcher David , Bailey Michael
Published: September 2022

Background

The presence of treatment limitations in patients with frailty at intensive care unit (ICU) admission is unknown. We aimed to evaluate the presence and predictors of treatment limitations in patients with and without COVID‐19 pneumonitis in those admitted to Australian and New Zealand ICUs.

Methods

This registry‐based multicenter, retrospective cohort study included all frail adults (≥16 years) with documented clinical frailty scale (CFS) scores, admitted to ICUs with admission diagnostic codes for viral pneumonia or acute respiratory distress syndrome (ARDS) over 2 years between January 01, 2020 and December 31, 2021. Frail patients (CFS ≥5) coded as having viral pneumonitis or ARDS due to COVID‐19 were compared to those with other causes of viral pneumonitis or ARDS for documented treatment limitations.

Results

884 frail patients were included in the final analysis from 129 public and private ICUs. 369 patients (41.7%) had confirmed COVID‐19. There were more male patients in COVID‐19 (55.3% vs 47.0%; p = 0.015). There were no differences in age or APACHE‐III scores between the two groups. Overall, 36.0% (318/884) had treatment limitations, but similar between the two groups (35.8% [132/369] vs 36.1% [186/515]; p = 0.92). After adjusting for confounders, increasing frailty (OR = 1.72; 95%‐CI 1.39–2.14), age (OR = 1.05; 95%‐CI 1.04–1.06), and presence of chronic respiratory condition (OR = 1.58; 95%‐CI 1.10–2.27) increased the likelihood of instituting treatment limitations. However, the presence of COVID‐19 by itself did not influence treatment limitations (odds ratio [OR] = 1.39; 95%‐CI 0.98–1.96).

Conclusions

The proportion of treatment limitations was similar in patients with frailty with or without COVID‐19 pneumonitis at ICU admission.
Do higher public debt levels reduce economic growth?
Authors: Heimberger Philipp
Published: September 2022

While the effect of higher public debt levels on economic growth has received much attention, the literature partly points to contradictory results. This paper applies meta‐regression methods to 816 estimates from 47 primary studies. The unweighted mean of the reported results suggests that a 10 percentage points increase in public‐debt‐to‐GDP is associated with a decline in annual growth rates by 0.14 percentage points, with a 95% confidence interval from 0.09 to 0.19 percentage points. However, we cannot reject a zero effect after correcting for publication bias. Furthermore, the meta‐regression analysis shows that tackling endogeneity between public debt and growth leads to less adverse effects of public debt. In testing for nonlinear effects, our results do not point to a uniform public‐debt‐to‐GDP threshold beyond which growth slows. Threshold estimates are sensitive to data and econometric choices. These findings imply a lack of evidence of a consistently negative growth effect of higher public‐debt‐to‐GDP. The main policy implication is that there should be caution with regard to “one‐size‐fits‐all” fiscal policy prescriptions in dealing with higher public debt levels.
Management of advanced ovarian cancer in Leicester: The benefits of a paradigm shift in surgical approach
Authors: Barakat Anas , Ismail Aemn , Chattopadhyay Supratik
Published: September 2022

Aim

Surgery for advanced ovarian cancer (AOC) has evolved over the past decade to ingeminate the need to offer maximum effort surgery (MES). The aim of this study is to analyze the implementation of a paradigm shift in the surgical management of women with AOC at the University Hospitals of Leicester NHS Trust (UHL) in 2015, until 2020, compared to 2011–2014.

Methods

Retrospective cohort study of women with AOC who underwent cytoreductive surgery (CRS) in the UHL. The two groups were: 153 women from January 2011 to December 2014 (group 1), 136 women from January 2015 to January 2020 (group 2).

Results

In group 1, the 1, 3, and 5 years overall survival rates (OS) were, 90.4%, 33.7%, and 19.3%, compared to 90.2%, 55.4%, and 29.7%, respectively, in group 2 (p = 0.012). Significantly more women had CRS in group 2: 45—Primary debulking surgery (PDS) and 57—interval debulking surgery (IDS) versus 17—PDS & 67—IDS in group 1 (p < 0.001). Surgical complexity score (modified Aletti score) was higher in group 2 compared to group 1 (p = <0.001). No significant difference was noted in the postoperative complications, in group 2, in women who underwent PDS versus IDS, yet PDS was associated with higher OS.

Conclusions

MES/CRS in women with AOC significantly improves OS. Our data highlights the importance of a dedicated team to implement this change in cancer centers. Where possible, suitable women with AOC likely to have complete cytoreduction based on preoperative assessment, should be offered PDS.
Related amyloid burden and cortical atrophy in individuals with subtle cognitive decline
Authors: Cersonsky Tess E. K. , Mechery Shanti , Thompson Louisa , Lee Athene , Alber Jessica , Sarkar Indra Neil , Brick Leslie Ann D.
Published: September 2022

Background and Purpose

Subtle cognitive decline represents a stage of cognitive deterioration in which pathological biomarkers may be present, including early cortical atrophy and amyloid deposition. Using individual items from the Montreal Cognitive Assessment and k‐modes cluster analysis, we previously identified three clusters of individuals without overt cognitive impairment: (1) High Performing (no deficits in performance), (2) Memory Deficits (lower memory performance), and (3) Compound Deficits (lower memory and executive function performance). In this study, we sought to understand the relationships found in our clusters between cortical atrophy on MR and amyloid burden on PET.

Methods

Data were derived from the Alzheimer's Disease Neuroimaging Initiative and comprised individuals from our previous analyses with available MR and amyloid PET scans (n = 272). Using multiple‐group structural equation modeling, we regressed amyloid standardized uptake value ratio on volumetric regions to simultaneously evaluate unique associations within each cluster.

Results

In our Compound Deficits cluster, greater whole cerebral amyloid burden was significantly related to right entorhinal cortical and left hippocampal atrophy, rs = –.412 (p = .005) and –.304 (p = .049), respectively. Within this cluster, right entorhinal cortical atrophy was significantly related to greater amyloid burden within multiple frontal regions.

Conclusions

The Compound Deficits cluster, which represents a group potentially at higher risk for decline, was observed to have significantly more cortical atrophy, particularly within the entorhinal cortex and hippocampus, associated with whole brain and frontal lobe amyloid burden. These findings point to a pattern of early pathological deterioration that may place these individuals at risk for future decline.
Clinical‐based oral rehabilitation programme improved the oral diadochokinesis and swallowing function of older patients with dementia: A randomised controlled trial
Authors: Chen Ming‐An , Liu Ching‐Kuan , Yang Yuan‐Han , Huang Shun‐Te , Yen Cheng‐Wei , Kabasawa Yuji , Huang Hsiao‐Ling
Published: September 2022

Objective

To evaluate the effectiveness of a clinical‐based oral function intervention on oral function and care behaviours in older patients with mild dementia.

Method

Participants were randomly assigned to the experimental group (EG) and control group (CG). Both groups received a leaflet on oral health‐related knowledge, and the EG also received an oral function intervention, which was a brief one‐on‐one lesson concerning oral exercise and preventive oral care. Oral exercise included turning the head, pouting lips, bulging cheeks, stretching tongue, articulation exercise and salivary gland massages. A reminder phone call was made every 2 weeks. Perceived xerostomia and dysphagia, plaque index (PI), Winkel tongue‐coating index (WTCI), repetitive saliva‐swallowing test (RSST), oral diadochokinesis (DDK) and oral care behaviours were recorded at baseline and at 3‐month follow‐up. Generalised Estimating Equations (GEE) were used to analyse the indicated effects.

Results

The EG (n = 59) exhibited greater improvement to the CG (n = 55) in RSST [β = 0.7; effect size (ES) = 0.45], the syllables /pa/ (β = 3.1; ES = 0.37) and /ka/ (β = 2.7; ES = 0.40) in oral DDK, PI (β = −0.2; ES = 0.52) and WTCI (β = −0.8; ES = 0.38). Moreover, the EG exhibited better preventive behaviours in regular dental visits [adjusted odds ratio (aOR) = 2.2], daily mouth cleaning frequency (aOR = 1.6) and mouth cleaning before sleep (aOR = 1.3).

Conclusion

The brief clinical‐based intervention was effective in improving the swallowing function, oral DDK and plaque control of older patients with mild dementia at 3‐month follow‐up.
Ageism toward older adults during the COVID‐19 pandemic: Intergenerational conflict and support
Authors: Sutter Alina , Vaswani Mamta , Denice Patrick , Choi Kate H. , Bouchard Joanie , Esses Victoria M.
Published: September 2022

A cross‐national representative survey in Canada and the U.S. examined ageism toward older individuals during the first year of the COVID‐19 pandemic, including ageist consumption stereotypes and perceptions of older people's competence and warmth. We also investigated predictors of ageism, including economic and health threat, social dominance orientation, individualism and collectivism, social distancing beliefs, and demographics. In both countries, younger adults were more likely to hold ageist consumption stereotypes, demonstrating intergenerational conflict about the resources being used by older people. Similarly, young adults provided older people with the lowest competence and warmth scores, though adults of all ages rated older individuals as more warm than competent. Particularly among younger individuals, beliefs about group‐based dominance hierarchies, the importance of competition, and the costs of social distancing predicted greater endorsement, whereas beliefs about interdependence and the importance of sacrificing for the collective good predicted lower endorsement of ageist consumption stereotypes. Support for group‐based inequality predicted lower perceived competence and warmth of older individuals, whereas beliefs about interdependence and the importance of sacrificing for the collective good predicted higher perceived competence and warmth of older individuals. Implications for policies and practices to reduce intergenerational conflict and ageist perceptions of older individuals are discussed.
Mycophenolate mofetil and telmisartan for the treatment of proteinuria secondary to minimal change disease podocytopathy in a dog
Authors: Travail Victoria , Cianciolo Rachel E. , Peak Kerry , Di Bella Andrea
Published: September 2022

A 3‐year‐old entire female Springer Spaniel, with a previous diagnosis of meningoencephalitis of unknown origin diagnosed 2 years before presentation and treated with long term administration of prednisolone, developed proteinuria. Laboratory findings revealed hypoalbuminemia, hypercholesterolemia, and proteinuria. Further investigations excluded underlying causes. Renal biopsies were performed. The glomeruli and the tubulointerstitial compartment did not show any anomalies on light microscopy and immunofluorescence staining did not reveal abnormalities. Transmission electron microscopy revealed moderate podocyte injury consisting of foot process effacement and microvillus transformation of the cytoplasm. The dog was diagnosed with primary minimal change disease of the podocytes and treated with telmisartan and mycophenolate mofetil. Abnormalities of serum albumin, cholesterol, and proteinuria resolved within 4 weeks. Minimal change disease has been reported in dogs, but this is a case report of proteinuria secondary to minimal change disease successfully treated with mycophenolate mofetil and telmisartan.
Low anti‐HBc levels are associated with lower risk of virological relapse after nucleos(t)ide analogue cessation in HBe antigen‐negative patients
Authors: Ohlendorf Valerie , Wübbolding Maximilian , Gineste Paul , Höner Zu Siederdissen Christoph , Bremer Birgit , Wedemeyer Heiner , Cornberg Markus , Maasoumy Benjamin
Published: September 2022

Background and Aims

Low anti‐HBc serum levels at the time of therapy cessation were linked to a higher relapse risk in predominantly HBeAg‐positive cohorts. We investigated the association of anti‐HBc levels with relapse in HBeAg‐negative patients.

Methods

Serum levels of anti‐HBc, HBsAg and HBcrAg were determined in 136 HBeAg‐negative patients, participating in a vaccination trial (ABX‐203, NCT02249988), before treatment cessation or vaccination. Importantly, vaccination showed no impact on relapse. The correlation between the biomarkers and their predictive value for relapse (HBV DNA >2000 IU/ml ± ALT >2xULN) was investigated.

Results

After therapy cessation 50% (N = 68) of patients relapsed. Median anti‐HBc prior to treatment stop was significantly higher among relapsers compared to off‐treatment responders (520 IU/ml vs. 330 IU/mL, p = .0098). The optimal anti‐HBc cut‐off to predict relapse was 325 IU/ml according to the Youden‐Index. About 35% of patients with anti‐HBc level < 325 IU/ml versus 60% of those with values ≥325 IU/mL relapsed (p = .0103; sensitivity 50%, specificity 75%). Combining the optimal cut‐offs of HBsAg (>3008 IU/mL) or HBcrAg (≥1790 U/ml) with anti‐HBc increased the proportion of patients with relapse to 80% (p < .0001) and 74% (p = .0006), respectively.

Conclusion

In contrast to predominantly HBeAg‐positive cohorts, in our cohort of HBeAg‐negative patients lower anti‐HBc levels are associated with a significantly lower relapse risk after nucleos(t)ide analogue cessation. The vast majority of included patients were either genotype B or C and the applicability to other genotypes has to be further evaluated. However, anti‐HBc level as an indicator of the host response might be prospectively further explored for prediction models.
Barriers and perceived benefits of early mobilisation programmes in Dutch paediatric intensive care units
Authors: Geven Barbara M. , Maaskant Jolanda M. , van Woensel Job B. M. , Verbruggen Sascha C. A. T. , Ista Erwin
Published: September 2022

Background

Early mobilisation of critically ill adults has been proven effective and is safe and feasible for critically ill children. However, barriers and perceived benefits of paediatric intensive care unit (PICU) staff involvement in mobilising critically ill children are largely unknown.

Aim

To explore the barriers and perceived benefits regarding early mobilisation of critically ill children as perceived by PICU staff.

Study design

A cross‐sectional survey study among staff from seven PICUs in the Netherlands has been carried out.

Results

Two hundred and fifteen of the 641 health care professionals (33.5%) who were invited to complete a questionnaire responded, of whom 159 (75%) were nurses, 40 (19%) physicians, and 14 (6%) physical therapists. Respondents considered early mobilisation potentially beneficial to shorten the duration of mechanical ventilation (86%), improve wake/sleep rhythm (86%) and shorten the length of stay in the PICU (85%). However, staff were reluctant to mobilise patients on extracorporeal membrane oxygenation (ECMO) (63%), and patients with traumatic brain injury (49%). Perceived barriers to early mobilisation were hemodynamic instability (78%), risk of dislocation of lines/tubes (74%), and level of sedation (62%). In total, 40.3% of PICU nurses stated that physical therapists provided enough support in their PICU, but 84.6% of the physical therapists believed support was sufficient.

Conclusion

Participating PICU staff considered early mobilisation as potentially beneficial in improving patient outcomes, although barriers were noted in certain patient groups.

Relevance to clinical practice

We identified barriers to early mobilisation which should be addressed in implementation research projects in order to make early mobilisation in critically ill children work.
Complete Theory for CCE Under Heterogeneous Slopes and General Unknown Factors
Authors: Stauskas Ovidijus
Published: September 2022

A recent study of Westerlund (CCE in Panels with General Unknown Factors, The Econometrics Journal, 21, 264‐276, 2018) showed that a very popular common correlated effects (CCE) estimator is significantly more applicable than it was thought before. Specifically, the common factors can have much more general time series properties than stationarity. This helps to alleviate the uncertainty over deterministic model components (e.g. trends) since they can be treated as unknown, similarly to unobserved stochastic (possibly non‐stationary) factors. While very promising, these theoretical results concern only the baseline scenario of the pooled (CCEP) estimator in the restrictive case of homogeneous model parameters, which is asymptotically biased and requires bias correction. Economic theory often hints at individuals exhibiting slope heterogeneity, which is a more realistic case when CCE is unbiased. Therefore, it is natural to extend the findings on general unknown factors to the case of unit‐specific slopes and understand if unbiasedness still holds, which would be an empirically handy feature. It is especially interesting, because many previous studies on heterogeneous slopes did not rigorously account for the usual situation when the factors are proxied by more explanatory variables than needed. Hence, the current study introduces more completeness in the CCE theory. We demonstrate that save for some regularity conditions, CCEP and the mean group (CCEMG) estimators are asymptotically normal and unbiased under heterogeneous slopes and general unknown factors.
Computer‐aided Design of Distal Femoral Osteotomy for the Valgus Knee and Effect of Correction Angle on Joint Loading by Finite Element Analysis
Authors: Wu Yanfei , Jin Xin , Zhao Xingwen , Wang Ying , Bai Haohao , Lu Bin , Tong Xue , Ma Jianxiong , Ma Xinlong
Published: September 2022

Objective

Lateral open‐wedge distal femoral osteotomy (DFO) has been used to treat valgus deformity of the knee, with good clinical outcomes. However, there is a lack of biomechanical studies regarding the angle of correction. The objective of this study was to apply computer‐aided design (CAD) for osteotomy planning in a three‐dimensional (3D) anatomical model and to assess the biomechanical differences among the varying correction angles on joint loading by finite element analysis (FEA).

Methods

To model different angles of lateral open‐wedge DFO correction, the CAD software package Mimics 21.0 was used to accurately simulate the operated knee. The femur was cut to 0°, 2°, 4°, 6°, 8°, and 10° of varus (equivalent to hip‐knee‐ankle angles of 180°, 178°, 176°, 174°, 172°, and 170°, respectively). The original knee model and the corrected models were processed by FE software. Then, the FE models were subjected to an axial force to obtain the von Mises stress (VMS) and shear stress distributions within the femoral cartilages and menisci.

Results

Under a compressive load of 740 N, the highest VMS in lateral and medial compartments of the intact knee model was 3.418 and 3.303 MPa. The maximum value of both the VMS and the shear stress in the lateral compartment decreased as the varus angle increased, but the corresponding values in the medial compartment increased. When the hip‐knee‐ankle (HKA) angle was 180°, the VMS in the lateral and medial compartments was balanced (3.418 and 3.303 MPa, respectively). Meanwhile, when the HKA angle was 178° (3.488 and 3.625 MPa, respectively), the shear stress in the lateral and medial compartments was balanced. In addition, the magnitude of change in the stress was significantly higher in the medial compartment (90.9%) than in the lateral compartment (19.3%).

Conclusion

The optimal correction angle of the valgus knee is close to neutral alignment or slightly varus (0° ‐ 2°). Overcorrection is not recommended, as it can result in a steep increase of the stress within the medial compartment and may accelerate the process of medial compartment OA.
The roles of divergent and parallel molecular evolution contributing to thermal adaptive strategies in trees
Authors: Ahrens Collin W. , Watson‐Lazowski Alexander , Huang Guomin , Tissue David T. , Rymer Paul D.
Published: September 2022

Local adaptation is a driver of biological diversity, and species may develop analogous (parallel evolution) or alternative (divergent evolution) solutions to similar ecological challenges. We expect these adaptive solutions would culminate in both phenotypic and genotypic signals. Using two Eucalyptus species (Eucalyptus grandis and Eucalyptus tereticornis) with overlapping distributions grown under contrasting ‘local’ temperature conditions to investigate the independent contribution of adaptation and plasticity at molecular, physiological and morphological levels. The link between gene expression and traits markedly differed between species. Divergent evolution was the dominant pattern driving adaptation (91% of all significant genes); but overlapping gene (homologous) responses were dependent on the determining factor (plastic, adaptive or genotype by environment interaction). Ninety‐eight percent of the plastic homologs were similarly regulated, while 50% of the adaptive homologs and 100% of the interaction homologs were antagonistical. Parallel evolution for the adaptive effect in homologous genes was greater than expected but not in favour of divergent evolution. Heat shock proteins for E. grandis were almost entirely driven by adaptation, and plasticity in E. tereticornis. These results suggest divergent molecular evolutionary solutions dominated the adaptive mechanisms among species, even in similar ecological circumstances. Suggesting that tree species with overlapping distributions are unlikely to equally persist in the future.
The plant cytoskeleton takes center stage in abiotic stress responses and resilience
Authors: Kumar Sunil , Jeevaraj Theboral , Yunus Mohd H. , Chakraborty Subhra , Chakraborty Niranjan
Published: September 2022

Stress resilience behaviours in plants are defensive mechanisms that develop under adverse environmental conditions to promote growth, development and yield. Over the past decades, improving stress resilience, especially in crop species, has been a focus of intense research for global food security and economic growth. Plants have evolved specific mechanisms to sense external stress and transmit information to the cell interior and generate appropriate responses. Plant cytoskeleton, comprising microtubules and actin filaments, takes a center stage in stress‐induced signalling pathways, either as a direct target or as a signal transducer. In the past few years, it has become apparent that the function of the plant cytoskeleton and other associated proteins are not merely limited to elementary processes of cell growth and proliferation, but they also function in stress response and resilience. This review summarizes recent advances in the role of plant cytoskeleton and associated proteins in abiotic stress management. We provide a thorough overview of the mechanisms that plant cells employ to withstand different abiotic stimuli such as hypersalinity, dehydration, high temperature and cold, among others. We also discuss the crucial role of the plant cytoskeleton in organellar positioning under the influence of high light intensity.
Assessing agreement on Canadian pediatric critical care training objectives in Japan
Authors: Akamine Yoko , Ide Kentaro , Kawaguchi Atsushi
Published: September 2022

Background

Japan has no accredited learning objectives for pediatric critical care medicine trainees. This study examined the extent of agreement among a panel of Japanese pediatric intensive care unit (PICU) directors regarding the need for the Canadian learning objectives in pediatric critical care knowledge and technical skills training.

Methods

Using a two‐round Delphi survey, we developed consensus among directors of PICUs in Japan on the Canadian training objectives in pediatric critical care medicine. To assess agreement, we applied a four‐point Likert scale (1 = unnecessary, 2 = relatively unnecessary, 3 = relatively necessary, 4 = necessary). We conducted a web‐based survey and an Excel‐based survey over 4 week periods for the first and second rounds, respectively. Consensus was set at ≥80% agreement; items rated 3 or 4 by ≥80% participants in either rounds were included in the final list.

Results

Of the 36 PICU directors invited, 32 (88.9%) completed all survey rounds. In the first round, 164 items were agreed to be necessary, one item was deemed unnecessary, the directors did not reach agreement on 15 items, and these items were included in the second round. In the second round, five items were agreed to be necessary and agreement could not be reached on 10 items. Finally, there was agreement on 169 (94.9%) of the Canadian learning objectives after the two‐round Delphi survey. Sixteen participants commented that non‐technical skills, such as communication, collaboration, management, and education, were important additional objectives.

Conclusions

Strong consensus was observed among Japanese pediatric critical care experts concerning the Canadian learning objectives for pediatric critical care knowledge and technical skills training.
Therapeutic Implications of UVB Irradiation in Cancer by Enhancing Anti‐Tumor Immunity†
Authors: Hafeez Bilal Bin , Alvarado Ed W. , Kim Dae Joon
Published: September 2022

The UVB irradiation is well known for its impact on the development of skin cancer. However, low UVB irradiation plays a protective role against various human diseases including cancer through its effect on tumor suppression. This article summarizes the key findings of the paper by Park et al., which describes a novel molecular mechanism of moderate UVB irradiation in suppressing the growth of melanoma and colorectal cancer. Key observations in this article are that moderate UVB irradiation can enhance tumor immunity by (1) increased infiltration of CD4+ and CD8+ T cells; (2) increased infiltration of CD103+ conventional type 1 dendritic cells (cDC1); and (3) a significant decrease of M2 tumor associate macrophages (TAMs) into the tumor. The authors further identified the role of Batf3 transcription factor in moderate UVB irradiation‐mediated anti‐tumor immune response. Deletion of Batf3 transcription factor reversed the tumor suppressive effect with decreased CD103+ cDC1 cell infiltration. This pre‐clinical study provides a very novel mechanistic insight into the utilization of moderate UVB irradiation for the management of melanoma and colorectal cancer. This study further provides the direction of new future research to explore moderate UVB irradiation in combination with checkpoint blockade antibodies to enhance immunotherapeutic response against various solid tumors.
The past, present, and potential future of phosphorus management in the Florida Everglades
Authors: Zacharias Quinn , Kaplan David
Published: September 2022

The Florida Everglades, the largest subtropical wetland in North America, is in the midst of one of the most comprehensive and expensive environmental restoration efforts in history. Over the past 150 years, the Everglades has suffered substantial degradation due to massive drainage projects, polluting agricultural practices, and urban population growth. Decades of scientific investigation have shown that phosphorus (P) pollution is a primary driver of this environmental decline. This paper reviews how and why specific P‐management goals and strategies have been adopted in support of Everglades restoration, focusing on the often‐contentious process for converting science into restoration policies and standards. We synthesize current P‐management successes, failures, and tradeoffs, including the challenge of balancing multiple hydrologic and water quality restoration goals with the priorities and values of a diverse group of stakeholders. We then highlight promising future directions for Everglades P policy and propose questions to help guide the discussion of future restoration priorities and research needs in this and other complex social–ecological systems. The overall goals of this review are thus twofold: (1) to support an in‐depth understanding of the past, present, and potential future of P management approaches in this globally unique social–ecological system; and (2) to provide a broader framework for understanding how the coevolution of science and policy can support or undermine large‐scale ecosystem restoration.
Generalizing the information content for stepped wedge designs: A marginal modeling approach
Authors: Li Fan , Kasza Jessica , Turner Elizabeth L. , Rathouz Paul J. , Forbes Andrew B. , Preisser John S.
Published: September 2022

Stepped wedge trials are increasingly adopted because practical constraints necessitate staggered roll‐out. While a complete design requires clusters to collect data in all periods, resource and patient‐centered considerations may call for an incomplete stepped wedge design to minimize data collection burden. To study incomplete designs, we expand the metric of information content to discrete outcomes. We operate under a marginal model with general link and variance functions, and derive information content expressions when data elements (cells, sequences, periods) are omitted. We show that the centrosymmetric patterns of information content can hold for discrete outcomes with the variance‐stabilizing link function. We perform numerical studies under the canonical link function, and find that while the patterns of information content for cells are approximately centrosymmetric for all examined underlying secular trends, the patterns of information content for sequences or periods are more sensitive to the secular trend, and may be far from centrosymmetric.
Observations on hydronephrosis after pig kidney transplantation in baboons
Authors: Foote Jeremy B , Bikhet Mohamed H. , Hansen‐Estruch Christophe , Javed Mariyam , Ayares David , Hara Hidetaka , Humar Abhinav , Eckhoff Devin E. , Cooper David K. C.
Published: September 2022

We have seen hydronephrosis (obstructive nephropathy) at necropsy in 3 of 11 (21%) genetically‐engineered pig kidneys that functioned in baboons for >36 days, even when the clinical and histopathological features of rejection were minimal. We briefly report one such case and illustrate the macroscopic and microscopic appearances of such a kidney and ureter. The causes of the observed changes remain uncertain. In our small experience, there seems to be no correlation between the development of hydronephrosis and (i) the surgical technique, (ii) the genotype of the pig, (iii) the length of the pig ureter, or (iv) the immunosuppressive and anti‐inflammatory therapy administered. We suggest that the distal ureteric thickening may be the result of an inflammatory response. In two cases, we resolved the problem by carrying out a secondary side‐to‐side anastomosis between the proximal pig ureter and the baboon bladder.
Podoplanin promotes the carcinogenicity of gastric cancer by activating ezrin and mediating the crosstalk between tumour cells and cancer‐associated fibroblasts
Authors: Tian Yueli , Chen Xin , Wang Xiaodong , Song Ying
Published: September 2022

Gastric cancer (GC) is a frequent malignant disease and the main cause of cancer‐related death in the world. Podoplanin (PDPN) has been proved to be involved in the progression of various cancers. However, the role and biological mechanism of PDPN in GC are still vague. In our study, we detected the expression of PDPN in GC tissues and cell lines using RT‐qPCR, western blot and datasets. The overall survival of GC patients was analysed with a Kaplan–Meier plot. The effects of PDPN overexpression and silencing on GC cell progression were assessed by Cell Counting Kit‐8, flow cytometry and a wound healing assay. Besides, the modulation of PDPN on ezrin activation was investigated. We further explored the role of PDPN in the crosstalk between GC cells and cancer associated fibroblasts (CAFs). Results showed that PDPN was upregulated in GC tissues and cell lines. High expression of PDPN was correlated with poor prognosis of GC patients. PDPN positively regulated the viability, migration and invasion, but inhibited apoptosis, of GC cells by mediating the activation of ezrin. Meanwhile, the change in PDPN in GC cells activated CAFs and promoted the production of cytokines secreted by CAFs, which induced the progression of GC cells. These findings may provide a novel target for GC therapy.
Influence of Different Flow Solvers and Off-Design Conditions on the Determination of Fan-Rotor Wakes for Broadband Noise Prediction
Authors: Meier zu Ummeln Robert , Moreau Antoine , Schnoes Markus
Published: September 2022

The acoustic interaction of fan-rotor wakes with the downstream stator vanes is considered as an important noise source of an aircraft engine. The turbulence induced by the rotor generates a stochastic acoustic source that appears as broadband noise in the acoustic spectrum. During the preliminary design phase of an engine, established meanline and throughflow solvers usually do not resolve turbulence and associated unsteady flow parameters. But such solvers provide rotor pressure losses that can be used to estimate the mean and turbulent rotor wakes. A crucial step is the deduction of turbulence parameters from the mean wakes. A semi-empirical model for rotor-wake turbulence estimation is presented in this paper. The meanline method and the throughflow solver are compared to three-dimensional computational flow simulations investigating the capabilities of the different solvers to provide flow data for broadband wake interaction noise prediction. The methods are applied to a representative modern fan stage at a comprehensive number of operating points, comprising several speed lines from surge to choking conditions. Microphone measurements are consulted to assess the noise predictions. The evaluation confirms the applicability of the meanline and throughflow method in combination with the turbulence model for broadband noise estimation during the preliminary design phase. The underestimated turbulence in the tip region of the fan is found to be negligible even during off-design conditions.
Machine Learning-Enabled Prediction of Transient Injection Map in Automotive Injectors With Uncertainty Quantification
Authors: Mondal Sudeepta , Magnotti Gina M. , Lusch Bethany , Maulik Romit , Torelli Roberto
Published: September 2022

Accurate prediction of injection profiles is a critical aspect of linking injector operation with engine performance and emissions. However, highly resolved injector simulations can take one to two weeks of wall-clock time, which is incompatible with engine design cycles with desired turnaround times of less than a day. Hence, it is important to reduce the time-to-solution of the internal flow simulations by several orders of magnitude to make it compatible with engine simulations. This work demonstrates a data-driven approach for tackling the computational overhead of injector simulations, whereby the transient injection profiles are emulated for a side-oriented, single-hole diesel injector using a Bayesian machine-learning framework. First, an interpretable Bayesian learning strategy was employed to understand the effect of design parameters on the total void fraction field. Then, autoencoders are utilized for efficient dimensionality reduction of the flowfields. Gaussian process models are finally used to predict the spatiotemporal void fraction field at the injector exit for unknown operating conditions. The Gaussian process models produce principled uncertainty estimates associated with the emulated flowfields, which provide the engine designer with valuable information of where the data-driven predictions can be trusted in the design space. The Bayesian flowfield predictions are compared with the corresponding predictions from a deep neural network, which has been transfer-learned from static needle simulations from a previous work by the authors. The emulation framework can predict the void fraction field at the exit of the orifice within a few seconds, thus achieving a speed-up factor of up to 38 × 106 over the traditional simulation-based approach of generating transient injection maps.