bluuebunny/crossref_metadata_2025 huggingface dataset:
Is disinvestment from alcohol and drug treatment services associated with treatment access, completions and related harm? An analysis of English expenditure and outcomes data
Authors: Roscoe Suzie , Pryce Robert , Buykx Penny , Gavens Lucy , Meier Petra S.
Published: May 2021

Introduction

The positive impact of substance use treatment is well‐evidenced but there has been substantial disinvestment from publicly funded treatment services in England since 2013/2014. This paper examines whether this disinvestment from adult alcohol and drug treatment provision was associated with changes in treatment and health outcomes, including: treatment access, successful completions from treatment, alcohol‐specific hospital admissions, alcohol‐specific mortality and drug‐related deaths.

Methods

Annual administrative data from 2013/2014 to 2018/2019 was matched at local government level and multi‐level time series analysis using linear mixed‐effect modelling conducted for 151 upper‐tier local authorities in England.

Results

Between 2013/2014 and 2018/2019, £212.2 million was disinvested from alcohol and drug treatment services, representing a 27% decrease. Concurrently, 11% fewer people accessed, and 21% fewer successfully completed, treatment. On average, controlling for other potential explanatory factors, a £10 000 disinvestment from alcohol and drug treatment services was associated with reductions in all treatment outcomes, including 0.3 fewer adults in treatment (95% confidence interval 0.16–0.45) and 0.21 fewer adults successfully completing treatment (95% % confidence interval 0.12–0.29). A £10 000 disinvestment from alcohol treatment was not significantly associated with changes in alcohol‐specific hospital admissions or mortality, nor was disinvestment from drug treatment associated with the rate of drug‐related deaths.

Discussion and Conclusions

Local authority spending cuts to alcohol and drug treatment services in England were associated with fewer people accessing and successfully completing alcohol and drug treatment but were not associated with changes in related hospital admissions and deaths.
Metastatic Crohn’s disease: an underestimated entity
Authors: Ickrath Franziska , Stoevesandt Johanna , Schulmeyer Lena , Glatzel Caroline , Goebeler Matthias , Kerstan Andreas
Published: May 2021

Cutaneous metastatic Crohn’s disease (MCD) is a rare but challenging dermatologic manifestation of Crohn’s disease. It is histologically defined as the presence of non‐caseating granulomas at skin sites separated from and non‐contiguous to the gastrointestinal tract. Cutaneous metastatic Crohn’s disease should be distinguished from the much more frequent contiguous cutaneous manifestations of Crohn’s disease that present at perianal or, less common, peristomal sites with direct extension from the intestine to the adjacent skin. Versatile clinical presentation and the fact that occurrence can predate the initial diagnosis of Crohn’s disease may lead to misdiagnosis, delayed treatment and underreporting. As case numbers are small and randomized controlled studies on management are lacking, the therapeutic approach remains challenging and is often unsatisfactory. We here performed a systematic literature search identifying 264 published pediatric and adult cases of MCD and additionally report three of our own cases. Our review summarizes clinical characteristics, putative etiopathology, histologic findings, differential diagnoses and treatment options for MCD.
Analytical guidelines to increase the value of community science data: An example using eBird data to estimate species distributions
Authors: Johnston Alison , Hochachka Wesley M. , Strimas‐Mackey Matthew E. , Ruiz Gutierrez Viviana , Robinson Orin J. , Miller Eliot T. , Auer Tom , Kelling Steve T. , Fink Daniel
Published: May 2021

Aim

Ecological data collected by the general public are valuable for addressing a wide range of ecological research and conservation planning, and there has been a rapid increase in the scope and volume of data available. However, data from eBird or other large‐scale projects with volunteer observers typically present several challenges that can impede robust ecological inferences. These challenges include spatial bias, variation in effort and species reporting bias.

Innovation

We use the example of estimating species distributions with data from eBird, a community science or citizen science (CS) project. We estimate two widely used metrics of species distributions: encounter rate and occupancy probability. For each metric, we critically assess the impact of data processing steps that either degrade or refine the data used in the analyses. CS data density varies widely across the globe, so we also test whether differences in model performance are robust to sample size.

Main conclusions

Model performance improved when data processing and analytical methods addressed the challenges arising from CS data; however, the degree of improvement varied with species and data density. The largest gains we observed in model performance were achieved with 1) the use of complete checklists (where observers report all the species they detect and identify, allowing non‐detections to be inferred) and 2) the use of covariates describing variation in effort and detectability for each checklist. Occupancy models were more robust to a lack of complete checklists. Improvements in model performance with data refinement were more evident with larger sample sizes. In general, we found that the value of each refinement varied by situation and we encourage researchers to assess the benefits in other scenarios. These approaches will enable researchers to more effectively harness the vast ecological knowledge that exists within CS data for conservation and basic research.
Variability of echocardiographic measures of left ventricular diastolic function. The HUNT study
Authors: Letnes Jon Magne , Eriksen‐Volnes Torfinn , Nes Bjarne , Wisløff Ulrik , Salvesen Øyvind , Dalen Håvard
Published: May 2021

Objective

Investigate variability related to image acquisition and reading process for echocardiographic measures of left ventricular (LV) diastolic function, and its influence on classification of LV diastolic dysfunction (LVDD).

Methods

Forty participants (19 women) mean age 62 (28–88) years underwent echocardiographic examinations twice by different echocardiographers and blinded analyses by four readers in a cross‐sectional design. Measurements included quantification of two‐ (2D) and three‐dimensional (3D) recordings of the left atrium (LA) (maximal) volume (LAVmax) and spectral Doppler blood flow and tissue velocities for assessment of LV diastolic function. Variability and reproducibility measures were calculated using variance component analyses and Kappa statistics.

Results

Image acquisition influenced variability more than image reading (mean 24% and 4% of variance, respectively), but variability from image reading was especially important for 2D LAVmax (16% of variance) compared to 4% for 3D LAVmax, which was reflected in better agreement for 3D measures. The variability of measures used in classification of LVDD had clinical significance, and agreement across the four raters in classification using current recommendations was only fair (Kappa 0.42), but the agreement improved when using 3D LAVmax (Kappa 0.58). Agreement and reliability measures were reported for all measures.

Conclusion

Performing a new image acquisition influenced variability more than a introducing a new image reader, but there were differences across the different measures. LAVmax by 3D is superior to 2D with respect to lower variability. The variability of diastolic measures influences the reliability of LVDD classification, and this should be taken into account in the everyday clinic.
The contribution of phenotypic traits, their plasticity, and rapid evolution to invasion success: insights from an extraordinary natural experiment
Authors: Castillo Maria L. , Schaffner Urs , van Wilgen Brian W. , Le Roux Johannes J.
Published: May 2021

The context‐depency of biological invasions makes it difficult to understand why some species become succesfull invaders and others not. Such understanding requires studying closely‐related invasive and non‐invasive alien taxa sharing the same introduction history in the same environment. We identified this unusual situation in Kenya where the individuals that founded invasive Prosopis juliflora and non‐invasive P. pallida populations are still present in original plantations. We evaluated field‐measured traits, conducted glasshouse experiments simulating different nitrogen and water availability treatments, and did reciprocal transplants to compare functional traits and plasticity between the founders of both species (i.e. ‘invasive–non‐invasive congeners' comparison), and between P. juliflora individuals from plantations and invaded sites (i.e. testing for rapid evolution during invasion). We found that planted individuals of P. julifora and P. pallida differed in a number of key traits related to performance and spread (root:shoot ratio, number of stems and susceptibility to seed damage) as well as in levels of phenotypic plasticity in growth responses to resource availability, which may explain their differential invasiveness. Offspring of invasive P. juliflora individuals had higher seed mass and production, germination, survival, produced more stems, matured earlier and had higher plasticity compared with those of founder individuals, indicative of rapid post‐introduction evolution. By using this exceptional study system, we show that differences in values of only a few key traits, increased phenotypic plasticity and post‐introduction evolution have all contributed to the success of P. juliflora as an invasive species in Kenya.
Outcomes in young adults with acute ischemic stroke undergoing endovascular thrombectomy: A real‐world multicenter experience
Authors: Yeo Leonard Leong‐Litt , Chen Vanessa Hui En , Leow Aloysius Sheng‐Ting , Meyer Lukas , Fiehler Jens , Tu Tian‐Ming , Tham Carol Huilian , Sia Ching‐Hui , Jamous Ala , Behme Daniel , Kastrup Andreas , Papanagiotou Panagiotis , Styczen Hanna , Forsting Michael , Lee Tsong‐Hai , Chu Chan‐Lin , Fischer Sebastian , Maus Volker , Abdullayev Nuran , Kabbasch Christoph , Mönch Sebastian , Maegerlein Christian , Arnberg Fabian , Andersson Tommy , Holmin Staffan , Teoh Hock‐Luen , Paliwal Prakash , Ahmad Aftab , Gopinathan Anil , Yang Cunli , Seet Raymond Chee‐Seong , Chan Bernard Poon‐Lap , Sharma Vijay K. , Tan Benjamin Yong‐Qiang
Published: May 2021

Endovascular thrombectomy (EVT) is the standard of care for anterior circulation acute ischemic stroke (AIS) with large vessel occlusion (LVO). Young patients with AIS‐LVO have distinctly different underlying stroke mechanisms and etiologies. Much is unknown about the safety and efficacy of EVT in this population of young AIS‐LVO patients.

All consecutive AIS‐LVO patients aged 50 years and below were included in this multicenter cohort study. The primary outcome measured was functional recovery at 90 days, with modified Rankin Scale of 0–2 deemed as good functional outcome.

A total of 275 AIS‐LVO patients that underwent EVT from 10 tertiary centers in Germany, Sweden, Singapore, and Taiwan were included. Successful reperfusion was achieved in 85.1% (234/275). Good functional outcomes were achieved in 66.0% (182/275). Arterial dissection was the most prevalent stroke etiology (42/195, 21.5%). National Institutes of Health Stroke Scale (NIHSS) score at presentation was inversely related to good functional outcomes (aOR: 0.92, 95% CI: 0.88–0.96 per point increase, p < 0.001). Successful reperfusion (aOR: 3.22, 95% CI: 1.44–7.21, p = 0.005), higher ASPECTS (aOR: 1.21, 95% CI: 1.01–1.44, p = 0.036), and bridging intravenous thrombolysis (aOR: 2.37, 95% CI: 1.29–4.34, p = 0.005) independently predicted good functional outcomes. Successful reperfusion was inversely associated with in‐hospital mortality (aOR: 0.14, 95% CI: 0.03–0.57, p = 0.006). History of hypertension strongly predicted in‐hospital mortality (aOR: 4.59, 95% CI: 1.10–19.13, p = 0.036).

While differences in functional outcomes exist across varying stroke aetiologies, high rates of successful reperfusion and good outcomes are generally achieved in young AIS‐LVO patients undergoing EVT.
Diagnostic accuracy of the Dysphagia Trained Nurse Assessment tool in acute stroke
Authors: Benfield Jacqueline K. , Wilkinson Gwenllian , Everton Lisa F. , Bath Philip M. , England Timothy J.
Published: May 2021

Background and purpose

Comprehensive swallow screening assessments to identify dysphagia and make early eating and drinking recommendations can be used by trained nurses. This study aimed to validate the Dysphagia Trained Nurse Assessment (DTNAx) tool in acute stroke patients.

Methods

Participants with diagnosed stroke were prospectively and consecutively recruited from an acute stroke unit. Following a baseline DTNAx on admission, participants underwent a speech and language therapist (SLT) bedside assessment of swallowing (speech and language therapist assessment [SLTAx]), videofluoroscopy (VFS) and a further DTNAx by the same or a different nurse.

Results

Forty‐seven participants were recruited, of whom 22 had dysphagia. Compared to SLTAx in the identification of dysphagia, DTNAx had a sensitivity of 96.9% (95% confidence interval [CI] 83.8–99.9) and specificity of 89.5% (95% CI 75.2–97.1). Compared to VFS in the identification of aspiration, DTNAx had a sensitivity of 77.8% (95% CI 40.0–97.2) and a specificity of 81.6% (95% CI 65.7–92.3). Over 81% of the diet and fluid recommendations made by the dysphagia trained nurses were in absolute agreement compared to SLTAx. Both DTNAx and SLTAx had low diagnostic accuracy compared to the VFS‐based definition of dysphagia.

Conclusions

Nurses trained in DTNAx showed good diagnostic accuracy in identifying dysphagia compared to SLTAx and in identifying aspiration compared to VFS. They made appropriate diet and fluid recommendations in line with SLTs in the early management of dysphagia.
Dentist‐administered cognitive behavioural therapy versus four habits/midazolam: An RCT study of dental anxiety treatment in primary dental care
Authors: Hauge Mariann Saanum , Stora Bent , Vassend Olav , Hoffart Asle , Willumsen Tiril
Published: May 2021

The study aimed to test the effectiveness of cognitive behavioural therapy (CBT) administered by a general dental practitioner (GDP) in a general dental practice. In a two‐arm parallel randomised controlled trial, the experimental group received a short dentist‐administered CBT‐intervention (D‐CBT). A best‐practice control group (FHM) received dental treatment during sedation with midazolam combined with an evidence‐based communication model (The Four Habits Model). Ninety‐six patients with self‐reported dental anxiety were allocated to the treatment arms at a 1:1 ratio. Modified Dental Anxiety Scale (MDAS) scores spanned from 12 to 25, and 82 patients (85%) had a score of 19 or more, indicating severe dental anxiety. In both treatment arms, scores on MDAS and Index of Dental Anxiety and Fear (IDAF‐4C) decreased significantly, but no differences were found between treatment arms. Mean reductions were: MDAS scores: −6.6 (SD = 0.5); IDAF‐4C scores: −1.0 (SD = 1.1). In conclusion, local GDPs in general dental practices with proper competence have the ability for early detection of dental anxiety and, with the use of a manual‐based D‐CBT or FHM treatment, GDPs could offer efficient first‐line treatment suitable for dental anxiety of varying severities.
Depth‐based barotrauma severity, reflex impairment and stress response in two species of ice‐angled fish
Authors: Althoff Andrew L. , Suski Cory D. , Louison Michael J.
Published: May 2021

Barotrauma is a frequent event in fish captured from depth, and anglers often attempt to remedy this problem by venting fish. Barotrauma has been frequently assessed in fish during the warm water season, but no work has been done during winter ice angling, and the need and/or effectiveness of venting for ice‐angled fish has not been quantified. To answer these questions, bluegill Lepomis macrochirus Rafinesque and black crappie Pomoxis nigromaculatus (Lesueur) were angled through the ice, barotrauma assessed, and the effect of venting on reflex responsiveness and blood glucose levels after 1 or 2.5 h of holding were determined. Greater capture depths resulted in more severe barotrauma, with bluegill experiencing symptoms at shallower depths than black crappie. Bluegill reflex action mortality predictor (RAMP) scores improved more than black crappie scores following venting. These results suggest barotrauma impacts fish in winter fisheries in a similar fashion to fish in warmer conditions, with species‐specific differences in their susceptibility to barotrauma and their response to venting.
Asymmetric density‐dependent competition and predation between larval salamanders
Authors: Anderson Thomas L. , Burkhart Jacob J. , Davenport Jon M.
Published: May 2021

Body size differences among consumers often lead to asymmetric interactions, with larger individuals typically being stronger competitors and/or predators on small individuals. These types of interaction are particularly exemplified in freshwater pond communities, where substantial size variation exists both within and among species of top consumers. We investigated whether density dependence can modify the outcome of size‐structured interactions between larval stages of two pond‐breeding salamanders, Ambystoma annulatum and Ambystoma opacum. Size structure exists in populations of these species due to variation in the timing of breeding, which we hypothesised would amplify predation rates and competitive asymmetries from the early‐arriving species (A. annulatum) on the later‐arriving species (A. opacum).

We manipulated the relative densities of both A. annulatum and A. opacum in outdoor mesocosms. We maintained the experiment through metamorphosis, and analysed size at metamorphosis, larval period length and survival of each species.

Ambystoma annulatum imparted a strong density‐dependent effect on A. opacum through a combination of predation and competition. Survival of A. opacum was negatively related to the density of A. annulatum. For the A. opacum that survived, body size was reduced and larval period lengthened at higher A. annulatum densities, indicative of interspecific competition that was partly explained by resource pre‐emption. In contrast, A. annulatum was only affected by intraspecific density‐dependent competition.

Our results suggest that density‐dependent effects reinforce asymmetric interactions among larval salamanders. However, the intensity of the asymmetric interactions is mediated by the arrival time and size of conspecifics. Specifically, earlier‐arriving species can negatively affect the later‐arriving species via size‐mediated predation and competition.

The interactive effects of density dependence and arrival time of community members are probably a common mechanism generating size variability in ecological communities. Yet, most studies only evaluate one mechanism or the other. By interweaving these two processes, our work displays the importance of understanding context‐dependence in species interactions.
Verrucous carcinoma of the oesophagus is a genetically distinct subtype of oesophageal squamous cell carcinoma
Authors: Isidro Raymond A , Dong Fei , Hornick Jason L , Wee Jon O , Agoston Agoston , Patil Deepa T. , Deshpande Vikram , Zhao Lei
Published: May 2021

Aims

Oesophageal verrucous carcinoma (VSCC) is a rare and morphologically distinct type of oesophageal squamous cell carcinoma (SCC). Diagnosing VSCC on biopsy material is challenging, given the lack of significant atypia and the presence of keratinising epithelium and exophytic growth. The molecular pathogenesis of VSCC remains unclear. The aim of this study was to characterise the genomic landscape of VSCC in comparison to conventional oesophageal SCC.

Methods and results

Three cases of VSCC from the Brigham and Women’s Hospital pathology archive were identified. Formalin‐fixed, paraffin‐embedded (FFPE) tumour tissue was used for p16 immunohistochemistry (IHC), high‐risk human papillomavirus (HPV) in‐situ mRNA hybridisation (ISH) and DNA isolation. Tumour DNA was sequenced using a targeted massively parallel sequencing assay enriched for cancer‐associated genes. Three additional cases of VSCC were identified by image review of The Cancer Genome Atlas (TCGA) oesophageal SCC cohort. VSCC cases were negative for p16 IHC and high‐risk HPV ISH. TP53 mutations (P < 0.001) and copy number variants (CNVs) for CDKN2A (P < 0.001), CDKN2B (P < 0.01) and CCND1 (P < 0.01) were absent in VSCC and significantly less frequent in comparison to conventional SCC. Five VSCC cases featured SMARCA4 missense mutations or in‐frame deletions compared to only four of 88 conventional SCC cases (P < 0.001). VSCC featured driver mutations in PIK3CA, HRAS and GNAS. Recurrent CNVs were rare in VSCC.

Conclusions

VSCC is not only morphologically but also genetically distinct from conventional oesophageal SCC, featuring frequent SMARCA4 mutations and infrequent TP53 mutations or CDKN2A/B CNVs. Molecular findings may aid in establishing the challenging diagnosis of VSCC.
Evaluation of plasma and urinary levels of vascular endothelial growth factor and matrix metalloproteinase‐9 in patients with infantile hemangioma
Authors: Rotter Anita , Lima Xinaida T. , Oliveira Zilda N. P.
Published: May 2021

Background

The pathogenesis of infantile hemangioma (IH) is not fully understood. It has been suggested that angiogenic factors increase in the proliferative stage, decreasing subsequently in the regression phase.

Objectives

To evaluate vascular endothelial growth factor (VEGF) and matrix metalloproteinase 9 (MMP‐9) levels, according to infantile hemangioma (IH) growth stages and size, and to compare these levels in patients with IH and control subjects.

Methods

This cross‐sectional study included 68 patients with IH and 25 control subjects. Plasma and urinary MMP‐9 and VEGF levels were evaluated during proliferative and regression phases. These levels were correlated with tumor size measured by ultrasonography. Nonparametric tests were performed.

Results

Among 68 patients with IH, 55 (81%) were female. Age ranged from 1 to 40 months (median 7.0 months). There was no difference in plasma and urinary levels of VEGF and MMP‐9 between patients and control subjects. There were no significant differences in these levels between IH patients younger or older than 12 months of age, as a cutoff between proliferative and involution phases. No significant correlation was observed between tumor size and levels of the markers (R < 0.20 and P > 0.05 for all comparisons).

Conclusion

In our large sample, levels of VEGF and MMP‐9 did not reflect the characteristic increased angiogenesis in patients with IH when compared to healthy subjects. In addition, these markers were not increased in the proliferative stage of the IH and did not correlate with tumor size.
Triangular extension of hinge flaps: A novel technique to resolve stomal stenosis and prevent restenosis in staged buccal mucosal urethroplasty
Authors: Azuma Ryuichi , Horiguchi Akio , Ojima Kenichiro , Shinchi Masayuki , Aizawa Tetsushi , Tsuchiya Masato , Nakayama Eiko , Nagano Hisato , Ito Keiichi , Asano Tomohiko , Kiyosawa Tomoharu
Published: May 2021

Objectives

To verify the utility of triangular extension of a hinge flap in buccal mucosal staged urethroplasty to resolve stomal stenosis after the first stage and ultimately prevent restenosis.

Methods

A total of 23 patients (triangular extension group) were studied in 2013–2019. In the first stage, buccal mucosa was transplanted, and an extended triangle portion of the mucosa was placed beside the proximal and/or distal stoma that was created when the stricture segment of the urethra was resected. In the second stage, during tubularization of the urethral plate, an incision was made at the stoma to increase the caliber to which the triangular extension was inserted. The procedure was considered successful when a 17‐Fr flexible cystoscope passed through the reconstructed urethra at 6 months after the second‐stage urethroplasty and no additional surgery or bougie dilation required. The clinical course of the triangular extension group was compared with 24 patients who underwent conventional staged urethroplasty (control group).

Results

In total, 20 patients from each group underwent second‐stage surgery. No patients in the triangular extension group required additional revision surgery because of stomal stenosis after first‐stage surgery, whereas five (20%) control patients did. Urethroplasty was successful in 19 patients (95%) in the triangular extension group and in 19 patients (95%) in the control group. Uroflowmetry after the second‐stage surgery indicated that the mean maximum urinary flow rate was 21.5 and 15.8 mL/s after triangular extension and the control procedure, respectively (P = 0.027).

Conclusions

The triangular extension technique reduces the need for revision surgery and prevents postoperative restenosis.
Paediatric dental outcomes among children exposed to chemotherapy in utero
Authors: Iyer Neel S. , Trager Lauren , Gaughan John , Akoto Serwaa , Cardonick Elyce
Published: May 2021

Aim

Our study prospectively evaluated dental development in children exposed to chemotherapy in utero compared with unexposed controls.

Design

Women who received chemotherapy while pregnant were enrolled in a research registry. After age two, each child's dentist was asked to complete a questionnaire about dental abnormalities and malformations, as well as for their unexposed siblings. Multivariate linear regression adjusting for age was used to compare the groups.

Results

Dental information was received for 67 exposed children and 59 controls. The majority of mothers were treated for breast cancer (79.1%) and primarily received doxorubicin (89.6%) and cyclophosphamide (80.6%). Mean gestational age at first exposure was 20.7 (±5.7) weeks. Mean age at dental evaluation was 8.0 (±4.3) years for exposed and 10.4 (±5.1) years for controls (P < .01). Missing teeth, tooth size, shape, and color did not differ significantly between groups. There was no statistical difference in dental caries, facial abnormalities, or abnormalities of enamel or gingiva. There was no association between any chemotherapy agent or regimen and increased risk of dental abnormalities.

Conclusions

Overall, there was no difference in dental abnormalities between groups. These negative findings may be because no one received chemotherapy prior to 14 weeks when formation of primary teeth was beginning.
Knowledge, attitude, and practice of nurses in intensive care unit on preventing medical device–related pressure injury: A cross‐sectional study in western China
Authors: Zhang Ya‐Bin , He Li , Gou Ling , Pei Ju‐Hong , Nan Rui‐Ling , Chen Hai‐Xia , Wang Xing‐Lei , Du Ye‐Hui , Yan Hui , Dou Xin‐Man
Published: May 2021

The knowledge, attitude, and practice of nurses in intensive care units (ICUs) are determinants for the efficacy of preventing the medical device–related pressure injury (MDRPI). The aim of this study was to determine the level and factors of knowledge, attitude, and practice of nurses' ICUs on preventing medical MDRPI in western China. An annual cross‐sectional study was conducted in hospitals of western China from May 2020 to September 2020. Nurses' knowledge and attitudes were assessed using Clinical Nurses Prevention MDRPI of Critically Ill Patients for the Knowledge, Attitude, Practice Assessment Scale. SPSS software version 25.0 and independent t‐test, Chi‐square, Fisher exact, one‐way analysis of variance, and multiple linear regression tests were used for data analysis. A total of 1002 nurses in ICUs from 37 hospitals in Gansu Province, China, participated in this study. The scores of overall KAP, knowledge, attitudes, and practice were 149.17 ± 24.62, 53.83 ± 12.23, 37.24 ± 6.35 and 58.10 ± 9.83, respectively. There was a positive and significant relationship between three variables. Findings revealed that nurses' knowledge score in the Tertiary hospital was higher than scores of other hospitals as 3.840 units. Moreover, the knowledge score and practice score of nurses with bachelor's degree or above were higher than other nurses and are 0.978 and 1.106 units, respectively. Based on the findings, practice of nurses increased by 0.992 units, with a 1‐year increase in work experience of nurses in the ICU. The levels of knowledge, attitude, and practice of nurse in ICUs on preventing MDRPI were acceptable. The findings of the study highlight that a comprehensive approach should be conducted for raising the level of knowledge, attitude, and practice of nurses' ICUs on preventing medical MDRPI, as well as improving the quality of care for critically ill patients.
Fast grain‐boundary diffusion paths in ionic solids: Space‐charge layers versus interfacial core
Authors: Parras Jana P. , Feldmann Gereon , De Souza Roger A.
Published: May 2021

The accelerated diffusion of ions along grain boundaries in ionic solids may occur along two possible paths: (a) the interface core (IC), as known for metals; and (b) space‐charge layers (SCLs), located adjacent to the core, in which the point defects responsible for diffusion are accumulated. In this study, we examined whether it is possible, on the basis of diffusion profiles, to discriminate between IC and SCL diffusion paths. Taking cation diffusion along grain boundaries in MO2 oxides as our example system, we used finite‐element‐method (FEM) calculations to obtain cation diffusion profiles for various combinations of fast grain‐boundary diffusion along the two possible diffusion paths. Three characteristics of the grain‐boundary feature in diffusion profiles were investigated: the quantitative description of this grain‐boundary “tail”, its dependence on diffusion time, and its dependence on temperature (activation enthalpy). For all calculated diffusion profiles, with varying ratios of IC to SCL diffusion, no criterion was found that allowed the dominant diffusion path to be identified. Consideration of the activation enthalpies, however, may provide an indication of the dominant path: If the activation energy for grain‐boundary diffusion approaches or equals the activation enthalpy for bulk diffusion, one may conclude that SCL diffusion dominates.
Modulation of wall thickness of Al‐doped ZnO nanotubes by nanolamination of atomic layer deposition for oxygen sensing
Authors: Kei Chi‐Chung , Wang Chih‐Chieh , Perng Tsong‐Pyng
Published: May 2021

The high surface‐to‐volume ratio and feature dimensions of the gas sensors are the key factors for improving the gas response. In this study, a novel method to prepare an Al‐doped ZnO (AZO) nanotube oxygen sensor with tunable wall thickness is reported via the ZnO–Al2O3 nanolamination of atomic layer deposition (ALD) using tris(8‐hydroxyquinoline) gallium nanowire (GaQ3NW) as a template. The ALD of Al2O3 significantly enhances wall uniformity and decreases the wall thickness of the AZO nanotubes. In addition, the incorporation of Al2O3 allows full coverage of AZO on GaQ3NWs. With an increase in the Al2O3 fraction, the carrier concentration increases, but the depth of the depletion layer and gas response of the nanotube sensor are reduced. The gas response of the nanotubes is inversely proportional to wall thickness, suggesting that it is a function of the surface‐to‐volume ratio. When the wall thickness is decreased to 12 nm, the gas response of AZO nanotubes with 2% Al increases significantly to 7. This can be explained by the grain control model, because thin wall leads to the formation of fully charge‐depleted nanotubes.
Meta‐analysis: Interleukin 6 gene ‐174G/C polymorphism associated with type 2 diabetes mellitus and interleukin 6 changes
Authors: Cheng Hao , Zhu Wenbin , Zhu Mou , Sun Yan , Sun Xiaojie , Jia Di , Yang Chao , Yu Haitao , Zhang Chunjing
Published: May 2021

The gene coding interleukin 6 (IL‐6) is a promising candidate in predisposition to type 2 diabetes mellitus (T2DM). This study aimed to meta‐analytically examine the association of IL‐6 gene −174G/C polymorphism with T2DM and circulating IL‐6 changes across −174G/C genotypes. Odds ratio (OR) and standard mean difference (SMD) with 95% confidence interval (CI) were calculated. Twenty‐five articles were meta‐analysed, with 20 articles for T2DM risk and 9 articles for circulating IL‐6 changes. Overall, there was no detectable significance for the association between −174G/C polymorphism and T2DM, and this association was relatively obvious under dominant model (OR: 0.82, 95% CI: 0.56‐1.21). Improved heterogeneity was seen in some subgroups, with statistical significance found in studies involving subjects of mixed races (OR: 0.63, 95% CI: 0.46‐0.86). Begg's and filled funnel plots, along with Egger's tests revealed week evidence of publication bias. In genotype‐phenotype analyses, carriers of −174CC and −174CG genotypes separately had 0.10 and 0.03 lower concentrations (pg/mL) of circulating IL‐6 than −174GG carriers. Albeit no detectable significance for the association of −174G/C with T2DM, our findings provided suggestive evidence on a dose‐dependent relation between −174G/C mutant alleles and circulating IL‐6 concentrations, indicating possible implication of this polymorphism in the pathogenesis of T2DM.
Can information economics explain the organization of productive facilities?
Authors: Lederer Phillip J. , Zheng Xiaobo
Published: May 2021

A management system exists to coordinate, control, and make decisions about activities within an organization. These functions are information intensive, and therefore the design of management hierarchy has much to do with information‐processing economics. Most economic entities' management structures are described by “an organization chart” which is a network of departments. The goal of this paper is to take an analytical look at management hierarchy modeled as a tree with information‐processing departments at nodes. Two key assumptions about information processing are made: first, data's arrival patterns are uncertain as are processing times and that creates queuing delays, and second, data processing rates fall when data come from a variety of sources. Forthcoming results seem to accord more closely to empirical data than past work. Large increases in cost parameters or data flow rates do not change the hierarchy's structure very much. At higher tiers departments have more capacity and operate at lower utilizations, and managers have more subordinates, thus their work is less specialized and more complex. Included case studies support the latter assertion. We find that a large drop in information technology cost, or increased importance of quick customer response due to competition does not reduce the hierarchy height as effectively as decentralization. This implies that the historically recognized delayering of firms is principally due to reorganization to decentralize information processing.
Pasteurella spp. Infections in Atlantic salmon and lumpsucker
Authors: Sandlund Nina , Rønneseth Anita , Ellul Rebecca Marie , Nylund Stian , Sandlund Liv
Published: May 2021

The use of cleaner fish as a delousing method in Norwegian salmonid aquaculture has increased tremendously over the last few years. This has led to the emergence of a new large industry of farming lumpsuckers (Cyclopterus lumpus L.).

The use of lumpsuckers as cleaner fish has, however, not been problem‐free. Bacterial diseases cause high mortalities with pasteurellosis as one of the major emerging diseases. During the past few years, outbreaks of pasteurellosis in farmed Atlantic salmon (Salmo salar L.) have become more frequent. This has led to an increasing concern that this disease will become common in salmon farming as well. The purpose of this study was to investigate the susceptibility of Atlantic salmon to Pasteurella spp. infection and the possibility of lumpsuckers transmitting pasteurellosis to Atlantic salmon. Atlantic salmon were experimentally challenged, either by bath or by cohabitation with challenged lumpsuckers, using two different strains of Pasteurella spp. (originating from lumpsucker and Atlantic salmon, respectively). No clinical signs of pasteurellosis were observed on any of the Atlantic salmon. The lumpsuckers were, however, equally susceptible to both isolates. In addition, clear differences in histopathological changes were observed between individuals challenged with the two isolates.
Are there sex differences in potentially inappropriate prescribing in adults with multimorbidity?
Authors: Ukhanova Maria , Markwardt Sheila , Furuno Jon P. , Davis Laura , Noble Brie N. , Quiñones Ana R.
Published: May 2021

Background/objectives

Limited knowledge exists regarding sex differences in prescribing potentially inappropriate medications (PIMs) for various multimorbidity patterns. This study sought to determine sex differences in PIM prescribing in older adults with cardiovascular‐metabolic patterns.

Design

Retrospective cohort study.

Setting

Health and Retirement Study (HRS) 2004–2014 interview data, linked to HRS‐Medicare claims data annualized for 2005–2014.

Study sample

Six thousand three‐hundred and forty‐one HRS participants aged 65 and older with two and more chronic conditions.

Measurements

PIM events were calculated using 2015 American Geriatrics Society Beers Criteria. Multimorbidity patterns included: “cardiovascular‐metabolic only,” “cardiovascular‐metabolic plus other physical conditions,” “cardiovascular‐metabolic plus mental conditions,” and “no cardiovascular‐metabolic disease” patterns. Logistic regression models were used to determine the association between PIM and sex, including interaction between sex and multimorbidity categories in the model, for PIM overall and for each PIM drug class.

Results

Women were prescribed PIMs more often than men (39.4% vs 32.8%). Overall, women had increased odds of PIM (Adj. odds ratio [OR] = 1.30, 95% confidence interval [CI]: 1.16–1.46). Women had higher odds of PIM than men with cardiovascular‐metabolic plus physical patterns (Adj. OR = 1.25, 95% CI: 1.07–1.45) and cardiovascular‐metabolic plus mental patterns (Adj. OR = 1.25, 95% CI: 1.06–1.48), and there were no sex differences in adults with a cardiovascular‐metabolic only patterns (Adj. OR = 1.13, 95% CI: 0.79–1.62). Women had greater odds of being prescribed the following PIMs: anticholinergics, antidepressants, antispasmodics, benzodiazepines, skeletal muscle relaxants, and had lower odds of being prescribed pain drugs and sulfonylureas compared with men.

Conclusion

This study evaluated sex differences in PIM prescribing among adults with complex cardiovascular‐metabolic multimorbidity patterns. The effect of sex varied across multimorbidity patterns and by different PIM drug classes. This study identified important opportunities for future interventions to improve medication prescribing among older adults at risk for PIM.
Social involvement, socio‐economic status and subjective well‐being of parents of offspring with intellectual and developmental disabilities
Authors: Gur A. , Rimmerman A.
Published: May 2021

Background

The study explores whether households' socio‐economic status and social involvement can moderate the association between stress and subjective well‐being among parents of offspring with intellectual and developmental disabilities (IDD).

Method

The random national sample comprised 301 parents caring for offspring with IDD. Measurements consist of a household income survey, a questionnaire on resources and stress, a social involvement questionnaire and a personal well‐being index. Using PROCESS software, a regression‐based path analysis has been used to test the moderating effect of social involvement and socio‐economic status on the association between stress and subjective well‐being.

Results

Social involvement moderated the association between parental stress and subjective well‐being. At high levels of parental stress only, parents with increased social involvement reported better subjective well‐being. Significant interaction was observed between stress and socio‐economic status.

Conclusions

Among parents raising offspring with IDD, social involvement may enhance the relationship between parental stress and subjective well‐being. At lower stress levels, better socio‐economic status is associated with increased subjective well‐being.
Trust Us to Repay: Social Trust, Long‐Term Interest Rates, and Sovereign Credit Ratings
Authors: Bergh Andreas , Bjørnskov Christian
Published: May 2021

This paper asks whether the sensitivity of market long‐term interest rates and credit ratings is associated with cross‐country differences in social trust. We note a number of theoretical mechanisms that suggest that macroeconomic shocks are more likely to be effectively dealt with in higher‐trust societies. A set of panel estimates across middle‐ and high‐income countries reveals that interest rates and credit ratings are substantially more sensitive to inflation and growth problems in low‐trust countries. This finding sheds light on the differential market reactions to macroeconomic problems in seemingly comparable countries.
Credit Lines and the Liquidity Insurance Channel
Authors: ACHARYA VIRAL V. , ALMEIDA HEITOR , IPPOLITO FILIPPO , PEREZ‐ORIVE ANDER
Published: May 2021

We suggest a new mechanism—the liquidity insurance channel—based on the widespread reliance of high credit quality firms on bank credit lines for liquidity management. Our model matches the patterns of usage of loans and credit lines in the cross‐section of firms and defines the conditions under which shocks to bank health affect primarily low or high credit quality firms. Our framework can explain why credit line origination is more cyclical than loan origination. Overall, we uncover a novel interaction between bank health and economic activity through the provision of bank credit lines to high credit quality firms.
The role and clinical benefits of high‐intensity focused electromagnetic devices for non‐invasive lipolysis and beyond: A narrative review and position paper
Authors: Goldberg David J. , Enright Kaitlyn M. , Goldfarb Richard , Katz Bruce , Gold Michael
Published: May 2021

Background

In 2018, the first device to use high‐intensity focused electromagnetic (HIFEM) technology to non‐invasively build muscle was brought to market. Even more recently, the first HIFEM and radiofrequency combination device designed to both build muscle and eliminate fat cells came into use (HIFEM+). In view of the increase in recently published original data pertaining to HIFEM, an advisory board recently convened to discuss the group's clinical experiences with this technology.

Aim

Communicate an advisory group's recommendations for the current use of HIFEM+ technology for aesthetic indications.

Methods

An advisory board meeting to discuss challenges and opportunities for HIFEM devices in aesthetic medicine took place in November 2020, via remote conference. The expert advisory board consisted of a group of senior aesthetic physicians regularly treating patients with non‐invasive body contouring devices. A narrative review of the literature and key recommendations from the meeting are presented herein.

Results

To date, the combined results of several clinical studies (including over 500 patients and 30 investigators) support that patients treated with HIFEM+ experience on average, 30% less fat, 25% more muscle, 19% reduction in abdominal separation and up to 5.9 cm reduction in waist circumference. Moreover, HIFEM+ induces a 30% increase in satellite cell content, which is similar to the 36% increase observed following twelve weeks of exercise.

Conclusions

The advisory board unanimously agreed on several messages related to HIFEM technology, including that the pairing of HIFEM and radiofrequency (HIFEM+) enables a higher intensity of muscle stimulation and lipolysis, compared to HIFEM alone.
Predicting Positive Youth Development from Self‐Regulation and Purpose in Early Adolescence
Authors: Linver Miriam R. , Urban Jennifer Brown , Chen Wei‐Lin , Gama Lauren , Swomley Victoria Illnick
Published: May 2021

A Positive Youth Development (PYD) perspective emphasizes adolescents’ potential for healthy, successful development. Researchers have introduced a variety of constructs that may promote PYD. For example, Intentional Self‐Regulation (ISR) enables youth to seek out and use resources in the environment; purpose can help youth navigate and overcome obstacles. We examine connections between ISR, purpose and two PYD outcomes: confidence and connection. Data come from 763 Scottish youth (ages 12–14). We estimated fixed‐effects regression models predicting confidence and connection from both ISR and purpose, confirming outcomes were independently associated with one or both predictors. Our findings are especially salient to the field of youth purpose, linking purpose with specific PYD outcomes.
Differences in Specific Mass Density Between Dinoflagellate Life Stages and Relevance to Accumulation by Hydrodynamic Processes
Authors: Persson Agneta , Smith Barry C. , Alix Jennifer H. , Li Yaqin , Holohan Bridget A. , Wikfors Gary H.
Published: May 2021

One previously unstudied aspect of differences between sexual and asexual life stages in large‐scale transport and accumulation is density (mass per unit volume) of cells in each life stage. The specific density was determined for Scrippsiella lachrymosa cells in medium with and without nitrogen (N) enrichment through density‐gradient centrifugation. Growth medium without N addition is often called “encystment medium” when used for the purpose of resting cyst formation in cyst‐forming dinoflagellates; mating gametes are usually seen after 2–3 days. Significant differences in specific density were found after 2 days in encystment medium simultaneously with the observation of typical gamete swimming behavior and mating. The specific density of cells in encystment medium was 1.06 g · cm−3; whereas, the specific density of cells in growth medium was 1.11 g · cm−3. Cells in encystment medium were found to have significantly increased lipid content, reduced chlorophyll content, and reduced internal complexity. The findings may explain differential transport of less dense and chemotactically aggregating gametes into surface blooms in contrast to denser vegetative cells that perform daily vertical migration and do not aggregate. Passive accumulation of non‐migrating gametes into layers in stagnant water also can be explained, as well as sinking of zygotes when the storage of highly dense starch increases. Resting cysts had a density of over 1.14 g · cm−3 and would sink to become part of the silt fraction of the sediment. We suggest that differences in behavior and buoyancy between sexual and asexual life stages cause differences in cell accumulation, and therefore large‐scale, environmental transport could be directly dependent upon life‐cycle transitions.