bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment effects on count outcomes with non‐normal covariates
Authors: Kiefer Christoph , Mayer Axel
Published: May 2021

The effects of a treatment or an intervention on a count outcome are often of interest in applied research. When controlling for additional covariates, a negative binomial regression model is usually applied to estimate conditional expectations of the count outcome. The difference in conditional expectations under treatment and under control is then defined as the (conditional) treatment effect. While traditionally aggregates of these conditional treatment effects (e.g., average treatment effects) are computed by averaging over the empirical distribution, a recently proposed moment‐based approach allows for computing aggregate effects as a function of distribution parameters. The moment‐based approach makes it possible to control for (latent) multivariate normally distributed covariates and provides more reliable inferences under certain conditions. In this paper we propose three different ways to account for non‐normally distributed continuous covariates in this approach: an alternative, known non‐normal distribution; a plausible factorization of the joint distribution; and an approximation using finite Gaussian mixtures. A saturated model is used for categorical covariates, making a distributional assumption obsolete. We further extend the moment‐based approach to allow for multiple treatment conditions and the computation of conditional effects for categorical covariates. An illustrative example highlighting the key features of our extension is provided.
G protein‐coupled estrogen receptor 1: a novel target to treat cardiovascular disease in a sex‐specific manner?
Authors: Dinh Quynh Nhu , Vinh Antony , Arumugam Thiruma V. , Drummond Grant R. , Sobey Christopher G.
Published: May 2021

As an agonist of the classical nuclear receptors, estrogen receptor‐α and ‐β (NR3A1/2), estrogen has been assumed to inhibit the development of cardiovascular disease in premenopausal women. Indeed, reduced levels of estrogen after menopause are believed to contribute to accelerated morbidity and mortality rates in women. However, estrogen replacement therapy has variable effects on cardiovascular risk in postmenopausal women, including increased serious adverse events. Interestingly, preclinical studies have shown that selective activation of the novel membrane‐associated G protein‐coupled estrogen receptor, GPER, can promote cardiovascular protection. These benefits are more evident in ovariectomised than intact females or in males. It is therefore possible that selective targeting of the GPER in postmenopausal women could provide cardiovascular protection with fewer adverse effects that are caused by conventional ‘receptor non‐specific’ estrogen replacement therapy. This review describes new data regarding the merits of targeting GPER to treat cardiovascular disease with a focus on sex differences.
Benefits and harms of hemithyroidectomy, total or near‐total thyroidectomy in 1–4 cm differentiated thyroid cancer
Authors: Xu Yang , Huang Kunzhai , Huang Peiyin , Ke Najun , Zeng Jinyang , Wang Liying , Liu Changqin , Shi Xiulin , Guo Fangting , Su Lijia , Lin Mingzhu , Li Xuejun , Xiao Fangsen
Published: May 2021

Objective

For 1–4 cm differentiated thyroid cancer (DTC), current ATA guideline recommended hemithyroidectomy (HT) as an acceptable alternative initial procedure to total or near‐total thyroidectomy (TT). The aim of this study was to evaluate benefits and harms of HT, TT in 1–4 cm DTC.

Design

Retrospective cohort study.

Patients

DTC patients aged 18 years or older who underwent initial thyroidectomy in a tertiary medical centre were included from January 2008 to July 2018.

Measurements

The structural persistent/recurrent disease, reoperation rates and surgical complications were compared using Cox proportional regression and logistic regression. Propensity score matching was performed to adjust for related clinicopathological variables.

Results

Among 1824 DTC patients, 795 patients sized 1–4 cm were included. A total of 286 patients underwent HT and 509 patients underwent TT. In the matched analysis, no significant difference in disease‐free survival (DFS) between HT and TT was observed during the median follow‐up period of 56.5 months (hazard ratio [HR] 0.86; 95% CI, 0.37–2.00; p = .733). The difference in DFS between two groups was consistent regardless of age, sex, tumour size, follow‐up duration. Meanwhile, HT was associated with a decreased risk of surgical complications (odds ratio [OR] 0.47, 95% CI 0.31–0.71, p < .001), as well as lower proportion of levothyroxine replacement (p = .007). Two cases in HT group received reoperation. Further multivariate analysis showed surgical procedure was not associated with structural persistence/recurrence (HR 0.68; 95%CI, 0.29–1.58, p = .367).

Conclusions

For patients with 1–4 cm DTC without clinical evidence of lymph node metastasis or extrathyroidal extension, HT was associated with lower risk of surgical complications than TT while provided similar benefits as TT.
Methodology for identification of new target molecules in neuroimmunological disorders
Authors: Sawai Setsu , Mori Masahiro , Kuwabara Satoshi
Published: May 2021

Autoantibodies have been identified as key players in several neuroimmunological disorders such as autoimmune encephalitis, CNS demyelinating diseases, neuropathies, and neuromuscular junction disorders. Recent advances of proteomic technologies enable scientists to determine the target protein of autoantibodies. These methods are divided into three categories, namely, (1) mass spectrometry (MS)‐based method, (2) gene expression library screening, and (3) protein microarray. MS‐based methods can analyze posttranslationally modified proteins or conformational proteins, while gene expression library screening cannot. However, in MS‐based methods, protein‐abundant bias could prevent the identification of the target protein, and DNA sequencing could be more easily performed than MS‐based methods. Therefore, a sound knowledge of the advantages and limitations of each technique is required for selection of the optimal methodology for antigen identification in neuroimmunological disorders.
Clinical performance of implant crowns with customized zirconia abutments: A prospective cohort study with a 4.5‐ to 8.8‐year follow‐up
Authors: Fonseca Manrique , Molinero‐Mourelle Pedro , Forrer Fiona Alena , Schnider Nicole , Hicklin Stefan Paul , Schimmel Martin , Brägger Urs
Published: May 2021

Objective

To assess the clinical and esthetic outcomes and patient satisfaction of screw‐retained one‐piece implant crowns fabricated with zirconia abutments after a 4.5‐ to 8.8‐year follow‐up.

Material and methods

Thirty‐two patients (12 women and 20 men), who received 40 implant single crowns in anterior and premolar sites, were included in this prospective study. All restorations were based on ceramic hand‐veneered customized CAD/CAM zirconia abutments. The follow‐up consisted of clinical and radiological examinations. The pink esthetic score–white esthetic score (PES‐WES) was used to evaluate the esthetic outcome. Patients’ satisfaction was assessed via visual analog scale (VAS).

Results

Implant and prosthetic survival rates were 100% and 97.5%, respectively. Mean marginal bone loss was −0.17 mm (SD 1.16 mm). Probing depth was ≤4 mm in 98.7% and 5 mm in 1.3% of the sites; 8.3% of them were bleeding on probing positive. No technical or biological complications were observed except for one abutment fracture. The mean PES‐WES scores were 7.0 and 7.1, respectively. VAS scores (10‐point) of 9.41 for function and 9.26 for esthetics showed high patient satisfaction.

Conclusion

After a mean observation period of 6 years and 7 months, screw‐retained implant crowns based on veneered customized CAD/CAM zirconia abutments with conical connection showed very good clinical performance and may be recommended for the replacement of missing anterior and premolar teeth.

(ClinicalTrials.gov # NCT04370314).
Effect of previous implant failure on the prognosis of subsequent implants: A retrospective study
Authors: Leisner Laura , Kronsteiner Dorothea , Rammelsberg Peter
Published: May 2021

Objectives

To compare the long‐term survival of dental implants placed in patients with and without a history of implant failure.

Material and methods

Within a retrospective analysis, an experimental group was selected consisting of 59 patients with 137 implants placed after previous failure. The control group included 1,072 patients with 2,664 implants without previous failure. Kaplan–Meier curves were used to describe the group‐specific long‐term implant survival. Mixed‐effects Cox regression models were applied to examine the effects of patient‐ and site‐specific risk factors. To take multiple implants into account, a random intercept model was applied.

Results

During the observation period of up to 15 years, 11 implants (8%) failed in the experimental group and 74 implants (2.5%) in the control group (p < .001). Five‐year cumulative survival was 96.8% (95% CI 0.96–0.98) in the control group and 91.5% (95% CI 0.86–0.97) in the experimental group. The variables group assignment and simultaneous augmentation had a significant effect on survival, but this effect was lost in the random intercept model. The effect of implant location remained, whereby the risk of failure was five times lower for mandible implants, irrespective of group (p = .013; 95% CI 0.103–0.767; HR: 0.281).

Conclusions

Long‐term implant survival was lower in the experimental group than in the control group. The effect of previous failure was negligible. However, a patient‐specific “clustering effect” was observed. Irrespective of previous implant failure, the risk of long‐term failure is two times higher for maxillary implants than for mandibular implants.
A comprehensive data‐level investigation of cancer diagnosis on imbalanced data
Authors: Gupta Surbhi , Gupta Manoj Kumar
Published: May 2021

Cancer is one of the leading causes of death in the world. Cancer research is vital as the prognosis of cancer enables clinical applications for patients. In this study, we have proposed the Stacked Ensemble Model (Stacking of bagged and boosted learners) for the automatic disease diagnosis. The experimental results prove the superiority of the proposed method to conventional machine learning techniques. In the empirical study, the performance of eight data handling methods and 14 classification methods is compared to obtain prediction results. The performance of the model has been evaluated on five benchmark datasets. The appreciable Area under the Curve scores achieved by the proposed methodology on Cervical Cancer (0.98), Mesothelioma (0.93), Breast Cancer (0.99), Prostate Cancer (0.97), and Hepatitis‐C Virus (0.998) datasets make this work more significant than the previously published works. The experimental results show that our proposed method is superior to conventional machine learning techniques and the proposed model contributes in the form of an efficient computational model.
SETD2 epidermal deficiency promotes cutaneous wound healing via activation of AKT/mTOR Signalling
Authors: Li Xiaoxue , Liu Changwei , Zhu Yiwen , Rao Hanyu , Liu Min , Gui Liming , Feng Wenxin , Tang Huayuan , Xu Jin , Gao Wei‐Qiang , Li Li
Published: May 2021

Objectives

Cutaneous wound healing is one of the major medical problems worldwide. Epigenetic modifiers have been identified as important players in skin development, homeostasis and wound repair. SET domain–containing 2 (SETD2) is the only known histone H3K36 tri‐methylase; however, its role in skin wound healing remains unclear.

Materials and Methods

To elucidate the biological role of SETD2 in wound healing, conditional gene targeting was used to generate epidermis‐specific Setd2‐deficient mice. Wound‐healing experiments were performed on the backs of mice, and injured skin tissues were collected and analysed by haematoxylin and eosin (H&E) and immunohistochemical staining. In vitro, CCK8 and scratch wound‐healing assays were performed on Setd2‐knockdown and Setd2‐overexpression human immortalized keratinocyte cell line (HaCaT). In addition, RNA‐seq and H3K36me3 ChIP‐seq analyses were performed to identify the dysregulated genes modulated by SETD2. Finally, the results were validated in functional rescue experiments using AKT and mTOR inhibitors (MK2206 and rapamycin).

Results

Epidermis‐specific Setd2‐deficient mice were successfully established, and SETD2 deficiency resulted in accelerated re‐epithelialization during cutaneous wound healing by promoting keratinocyte proliferation and migration. Furthermore, the loss of SETD2 enhanced the scratch closure and proliferation of keratinocytes in vitro. Mechanistically, the deletion of Setd2 resulted in the activation of AKT/mTOR signalling pathway, while the pharmacological inhibition of AKT and mTOR with MK2206 and rapamycin, respectively, delayed wound closure.

Conclusions

Our results showed that SETD2 loss promoted cutaneous wound healing via the activation of AKT/mTOR signalling.
ERK/Drp1‐dependent mitochondrial fission contributes to HMGB1‐induced autophagy in pulmonary arterial hypertension
Authors: Feng Wei , Wang Jian , Yan Xin , Zhang Qianqian , Chai Limin , Wang Qingting , Shi Wenhua , Chen Yuqian , Liu Jin , Qu Zhan , Li Shaojun , Xie Xinming , Li Manxiang
Published: May 2021

Objectives

High‐mobility group box‐1 (HMGB1) and aberrant mitochondrial fission mediated by excessive activation of GTPase dynamin‐related protein 1 (Drp1) have been found to be elevated in patients with pulmonary arterial hypertension (PAH) and critically implicated in PAH pathogenesis. However, it remains unknown whether Drp1‐mediated mitochondrial fission and which downstream targets of mitochondrial fission mediate HMGB1‐induced pulmonary arterial smooth muscle cells (PASMCs) proliferation and migration leading to vascular remodelling in PAH. This study aims to address these issues.

Methods

Primary cultured PASMCs were obtained from male Sprague‐Dawley (SD) rats. We detected RNA levels by qRT‐PCR, protein levels by Western blotting, cell proliferation by Cell Counting Kit‐8 (CCK‐8) and EdU incorporation assays, migration by wound healing and transwell assays. SD rats were injected with monocrotaline (MCT) to establish PAH. Hemodynamic parameters were measured by closed‐chest right heart catheterization.

Results

HMGB1 increased Drp1 phosphorylation and Drp1‐dependent mitochondrial fragmentation through extracellular signal‐regulated kinases 1/2 (ERK1/2) signalling activation, and subsequently triggered autophagy activation, which further led to bone morphogenetic protein receptor 2 (BMPR2) lysosomal degradation and inhibitor of DNA binding 1 (Id1) downregulation, and eventually promoted PASMCs proliferation/migration. Inhibition of ERK1/2 cascade, knockdown of Drp1 or suppression of autophagy restored HMGB1‐induced reductions of BMPR2 and Id1, and diminished HMGB1‐induced PASMCs proliferation/migration. In addition, pharmacological inhibition of HMGB1 by glycyrrhizin, suppression of mitochondrial fission by Mdivi‐1 or blockage of autophagy by chloroquine prevented PAH development in MCT‐induced rats PAH model.

Conclusions

HMGB1 promotes PASMCs proliferation/migration and pulmonary vascular remodelling by activating ERK1/2/Drp1/Autophagy/BMPR2/Id1 axis, suggesting that this cascade might be a potential novel target for management of PAH.
Bettering the devil you know: Can we drive predator adaptation to restore native fauna?
Authors: Manning Adrian D. , Andrewartha Tim A. , Blencowe Anton , Brewer Kyle , Gordon Iain J. , Evans Maldwyn J.
Published: May 2021

Predation of threatened fauna by native and introduced predators can drive extinction and prevent population recovery. Most predator management involves exclusion or culling. Evidence suggests that exclusion may have detrimental effects on a prey species' predator awareness. At the same time, culling can cause selection of control‐resistant predators. There is increasing interest in harnessing evolutionary processes to drive adaptation of threatened fauna to cope, but there is limited attention on trying this from the predator direction. We need to shift the survival advantage away from predators that avoid lethal control, and go on to kill, towards those that demonstrate behaviors that reduce impact on threatened fauna. Instead of driving undesirable predator selection, could we select through management actions desirable traits to make them “less lethal” to threatened fauna? We draw on experimental research on predator aversion that suggests there may be an alternative way to mitigate the impacts of predators, while maintaining the learning opportunities of prey species. Using the case study of the invasive red fox in Australia, we propose a conceptual framework within which future research and management could occur to select for these desirable traits in predators and develop practical regimes for predator impact mitigation.
Current status and further potential of lung donation after circulatory death
Authors: Ehrsam Jonas P , Benden Christian , Immer Franz F , Inci Ilhan
Published: May 2021

Chronic organ shortage remains the most limiting factor in lung transplantation. To overcome this shortage, a minority of centers have started with efforts to reintroduce donation after circulatory death (DCD). This review aims to evaluate the experimental background, the current international clinical experience, and the further potential and challenges of the different DCD categories. Successful strategies have been implemented to reduce the problems of warm ischemic time, thrombosis after circulatory arrest, and difficulties in organ assessment, which come with DCD donation. From the currently reported results, controlled‐DCD lungs are an effective and safe method with good mid‐term and even long‐term survival outcomes comparable to donation after brain death (DBD). Primary graft dysfunction and onset of chronic allograft dysfunction seem also comparable. Thus, controlled‐DCD lungs should be ceased to be treated as marginal and instead be promoted as an equivalent alternative to DBD. A wide implementation of controlled‐DCD‐lung donation would significantly decrease the mortality on the waiting list. Therefore, further efforts in establishment of legislation and logistics are crucial. With regard to uncontrolled DCD, more data are needed analyzing long‐term outcomes. To help with the detailed assessment and improvement of uncontrolled or otherwise questionable grafts after retrieval, ex‐vivo lung perfusion is promising.
Heart transplantation from donors with left ventricular ejection fraction under forty percent
Authors: Poptsov Vitalii , Khatutskiy Valery , Skokova Anastasiia , Krasivskyi Ihor , Sabashnikov Anton , Merkle‐Storms Julia , Spirina Ekaterina
Published: May 2021

Background

Heart transplantation (HTx) remains the treatment of choice for patients with end‐stage advanced heart failure. In 2016, the Shumakov National Medical Research Center commenced performing HTx from donors with abnormal left ventricular systolic function (LVEF < 40%). The aim of this study was to evaluate early and late outcomes of recipients after HTx from donors with abnormal LV systolic function.

Methods

Four hundred eighty seven patients underwent HTx in our institution from January 2016 to December 2018. 27 (5.5%) patients were transplanted using cardiac allografts from donors with LVEF <40%.

Results

A total of 47 donors with LVEF <40% were evaluated for potential donation. Most heart donors revealed a left ventricular ejection fraction ranging between 30% and 40%. Twenty‐five recipients required urgent HTx. Four recipients presented with early allograft dysfunction. All surviving recipients demonstrated early (85.2%) or delayed (14.8%) recovery of systolic function (LVEF > 60%).

Conclusion

The use of dysfunctional donor hearts with impaired LV systolic function may be a realistic approach for expanding the donor pool. However, organs from such donors should be used for recipient cohorts requiring an urgent HTx, particularly for those with pretransplant mechanical circulatory support allowing for hemodynamic support in cases of early graft dysfunction in the post‐transplant period.
National assessments of species vulnerability to climate change strongly depend on selected data sources
Authors: Scherrer Daniel , Esperon‐Rodriguez Manuel , Beaumont Linda J. , Barradas Víctor L. , Guisan Antoine
Published: May 2021

Aim

Correlative species distribution models (SDMs) are among the most frequently used tools for conservation planning under climate and land use changes. Conservation‐focused climate change studies are often conducted on a national or local level and can use different sources of occurrence records (e.g., local databases, national biodiversity monitoring) collated at different geographic extents. However, little is known about how these restrictions in geographic space (i.e., Wallacean shortfall) can lead to restrictions in environmental space (i.e., Hutchinsonian shortfall) and accordingly affect conclusions about a species’ vulnerability to climate change.

Location

Americas with a focus on Mexico.

Methods

We present an example study constructing SDMs for three Mexican tree species (Alnus acuminata,Liquidambar styracifluaandQuercus xalapensis) using datasets collated at a global (Americas), national (Mexico) and local (cloud forests of eastern Mexico) level to demonstrate the potential effects of a Wallacean shortfall on the estimation of the environmental niche—and thus on a Hutchinsonian shortfall—its projection in space and time and, consequently, on species’ potential vulnerability to climate change.

Results

The consequence of using the three datasets was species‐specific and strongly depended on the extent to which the Wallacean shortfall affected estimations of environmental niches (i.e., Hutchinsonian shortfall). Where restrictions in geographic space lead to an underestimation of the environmental niche, vulnerability to climate change was estimated to be substantially higher. Additionally, the restrictions in geographic space may increase the likelihood of issues with non‐analogue climates, increasing model uncertainty.

Main conclusion

We recommend assessing the extent to which a species’ entire realized environmental niche is captured within the target conservation area, and increasing the geographic extent, if needed, to account for environments and occurrences reflecting potential future conditions. This way, the risk of underestimating the climatic potential of the species (i.e., Hutchinsonian shortfall), as well as the errors induced by extrapolation into “locally novel” climates, can be minimized.
The top 10 research priorities in diabetes and pregnancy according to women, support networks and healthcare professionals
Authors: Ayman Göher , Strachan James A. , McLennan Niamh , Malouf Reem , Lowe‐Zinola Jack , Magdi Fida , Roberts Nia , Alderdice Fiona , Berneantu Iuliana , Breslin Niki , Byrne Caroline , Carnell Sonya , Churchill David , Grisoni Jeannie , Hirst Jane E. , Morris Anna , Murphy Helen R. , O’Brien Jane , Schmutz Caroline , Shah Kamini , Singal Ankita S. , Strachan Mark W. J. , Cowan Katherine , Knight Marian
Published: May 2021

Aims

To undertake a Priority Setting Partnership (PSP) to establish priorities for future research in diabetes and pregnancy, according to women with experience of pregnancy, and planning pregnancy, with any type of diabetes, their support networks and healthcare professionals.

Methods

The PSP used established James Lind Alliance (JLA) methodology working with women and their support networks and healthcare professionals UK‐wide. Unanswered questions about the time before, during or after pregnancy with any type of diabetes were identified using an online survey and broad‐level literature search. A second survey identified a shortlist of questions for final prioritisation at an online consensus development workshop.

Results

There were 466 responses (32% healthcare professionals) to the initial survey, with 1161 questions, which were aggregated into 60 unanswered questions. There were 614 responses (20% healthcare professionals) to the second survey and 18 questions shortlisted for ranking at the workshop. The top 10 questions were: diabetes technology, the best test for diabetes during pregnancy, diet and lifestyle interventions for diabetes management during pregnancy, emotional and well‐being needs of women with diabetes pre‐ to post‐pregnancy, safe full‐term birth, post‐natal care and support needs of women, diagnosis and management late in pregnancy, prevention of other types of diabetes in women with gestational diabetes, women's labour and birth experiences and choices and improving planning pregnancy.

Conclusions

These research priorities provide guidance for research funders and researchers to target research in diabetes and pregnancy that will achieve greatest value and impact.
Bridging the gap: A new integrated early intervention service for young people with complex mental health issues
Authors: White Caitlin , Nash Louise , Karageorge Aspasia , van der Pol Renae , Hunt Glenn E. , Hamilton Blake , Isobel Sophie
Published: May 2021

Aim

Two integrated headspace Early Intervention Teams (hEITs) were established in 2017 to bridge gaps between headspace, the national primary care youth mental health programme in Australia, and the state funded secondary and tertiary mental health services. This study aims to describe functioning and outcomes of patients referred to hEIT over a 6‐month period.

Methods

A retrospective file audit was conducted for all patients accepted into the service over a 6‐month period in 2018. Measures of distress, functioning and client satisfaction were collected and analysed. Exemplar vignettes were created to construct hypothetical examples and illustrate research findings.

Results

At admission, the three most common presentations were depression/anxiety, trauma and stress related, and psychotic disorders. During their time in the service, young people displayed a statistically significant improvement in functioning, reduction in self‐harm in those 18 years and under, and a trend to reduction in distress scores. hEIT delivered a broad range of services covering social, occupational, educational, medical and mental health care, and the service was experienced positively by the patient cohort.

Conclusions

hEIT appears to meet the needs of young people requiring greater care than primary care services can deliver. The integrated, wrap‐around care coordination facilitates treatments across social, educational and health domains. Further exploration of young people who disengage from care, improved outcome data reporting and economic evaluation are indicated.
Relationship between plasma rabbit anti‐thymocyte globulin concentration and immunosuppressive therapy response in patients with severe aplastic anemia
Authors: Narita Atsushi , Muramatsu Hideki , Ichikawa Daisuke , Hamada Motoharu , Nishikawa Eri , Suzuki Kyogo , Kawashima Nozomu , Okuno Yusuke , Nishio Nobuhiro , Hama Asahito , Yamazaki Hirohito , Nakao Shinji , Kojima Seiji , Takahashi Yoshiyuki
Published: May 2021

Objectives

Patients with acquired aplastic anemia (AA) without HLA‐matched sibling donors or aged >40 years receive immunosuppressive therapy (IST) with anti‐thymocyte globulin (ATG). We investigated the relationship between plasma rabbit ATG (r‐ATG) concentration and IST response.

Methods

From May 2012 to October 2017, 81 patients with severe AA who required initial IST were included. A 1:1 block randomization was employed for 2.5 and 3.5 mg/kg doses of r‐ATG.

Results

No significant difference in response rates was observed between the 2.5 and 3.5 mg/kg groups (63% vs. 58%, P = .894). Median r‐ATG concentrations on days 14 and 28 after IST were 15.2 (0.0‐97.7) and 1.8 (0.0‐74.9 µg/mL), respectively. According to r‐ATG concentration, response rates were significantly higher in the group with higher r‐ATG concentration than in those with lower r‐ATG concentration (day 14, 88% vs. 52%; P = .006 and day 28, 79% vs. 46%; P = .005). In multivariate analysis, higher r‐ATG concentrations at day 28 were independent predictors of favorable response to IST at 6 months (odds ratio, 0.29; 95% confidence interval, 0.09‐0.93; P = .037).

Conclusions

The present data indicate that higher r‐ATG concentration at day 28 resulted in improved IST response.
Guillain–Barré syndrome in Eastern China: A study of 595 patients
Authors: Song Yan , Zhang Yong , Yuki Nobuhiro , Wakerley Benjamin R. , Liu Chen , Song Jin , Wang Min , Feng Xungang , Hao Yanlei , Wang Yuzhong
Published: May 2021

Background and purpose

This study aimed to investigate geographical differences in the clinical features of Guillain–Barré syndrome (GBS) between patients from our region in Eastern China and patients from other areas.

Methods

A total of 595 patients fulfilling the diagnostic criteria ​for GBS or its variants were included from two large hospitals located in Eastern China. Data collection included demographics, antecedent events, clinical presentation and signs, electrophysiological subtypes, treatment, complications during hospitalization, clinical severity at nadir, and outcome at 12 months, and these data were compared to data from a study conducted in Southern China and the Europe/Americas section of the International GBS Outcome Study.

Results

The median (interquartile range) age of patients was 50 (36–61) years, the ratio of men to women was 1.2, and 49% of patients had antecedent events. Patients in our region of Eastern China had pure motor predominant GBS (158/340, 46%) and 30% (103/340) had complications during hospitalization. Patients aged over 60 years had a lower frequency of antecedent infections and single, axonal subtypes, but higher disability scores at entry, nadir, and 12 months. When compared with the Europe/Americas data, our patients had a lower frequency of antecedent infection (46% vs. 63%), cranial nerve involvement (43% vs. 49%), sensory deficits (45% vs. 69%), pain (19% vs. 57%) and mechanical ventilation (11% vs. 17%), but a higher frequency of axonal subtype (35% vs. 6%). There was a higher frequency of patients with antecedent gastroenteritis (16% vs. 8%), mechanical ventilation (11% vs. 8%) and axonal subtypes (35% vs. 19%) in our region in Eastern China than in Southern China.

Conclusions

Patients with GBS in Eastern China showed significant clinical heterogeneity and differences when compared to other geographic areas.
Increased branched‐chain amino acids at baseline and hours before a spontaneous seizure in the human epileptic brain
Authors: Ong Caroline , Damisah Eyiyemisi C. , Gruenbaum Shaun E. , Dhaher Roni , Deng Yanhong , Sandhu Mani Ratnesh S. , Zaveri Hitten P. , Spencer Dennis D. , Eid Tore
Published: May 2021

The objective of this study was to monitor the extracellular brain chemistry dynamics at baseline and in relation to spontaneous seizures in human patients with refractory epilepsy. Thirty patients with drug‐resistant focal epilepsy underwent intracranial electroencephalography and concurrent brain microdialysis for up to 8 continuous days. Extracellular brain glutamate, glutamine, and the branched‐chain amino acids (BCAAs) valine, leucine, and isoleucine were quantified in the dialysis samples by liquid chromatography–tandem mass spectrometry. Extracellular BCAAs and glutamate were chronically elevated at baseline by approximately 1.5–3‐fold in brain regions of seizure onset and propagation versus regions not involved by seizures. Moreover, isoleucine increased significantly above baseline as early as 3 h before a spontaneous seizure. BCAAs play important roles in glutamatergic neurotransmission, mitochondrial function, neurodegeneration, and mammalian target of rapamycin signaling. Because all of these processes have been implicated in epilepsy, the results suggest a novel role of BCAAs in the pathogenesis of spontaneous seizures.
Shaping cultural participation through social media
Authors: Arnaboldi Michela , Diaz Lema Melisa L
Published: May 2021

The public sector has embraced a user‐orientation paradigm, which has expanded through the open and democratic medium of social media. Although the potential of this digital technology and its visible outcomes have been analyzed in previous studies, there is virtually nothing on the complexity behind its implementation. This paper uses a case study involving three Italian museums to explore how social media strategy is shaped and enacted through their day‐to‐day business and activity. Museums are an ideal field for this kind of research because of the central role played by cultural participation and social media's critical function in pursuing new audiences. The study reveals a deep change to practice, touching praxes and practitioner skills, and modifying strategies planned around the user's approach, in the duality between authoritative and democratic voices. The findings disclose an emergent heterogeneity that is mapped along social media practices and the various associations linked to the praxes, opening the way for future studies concerned with the link between a user's (traditional) physical experience on social media and the level of democracy in user engagement.
Characterization of thermal aging effects on the creep performance of T91 using small punch creep testing
Authors: Ó'Murchú Cathal , Leen Seán B. , O'Donoghue Padraic E. , Barrett Richard A.
Published: May 2021

This paper is concerned with the development and application of a small punch creep testing method for assessment of the effects of thermal aging and associated precipitate coarsening on the high temperature creep life and deformation behavior of a 9Cr ferritic–martensitic steel. The tests are conducted on P91 steel, for both aged (up to 1 year) and unaged specimens, at temperatures of 600°C. The unaged test results are shown to be consistent with previously published creep tensile test rupture life data in terms of Chakrabarty membrane stress. Aging is shown to have a significant, detrimental effect on creep life and deformation rate. The steady‐state displacement rate, time to failure, and displacement at failure data, for both aged and unaged, were successfully correlated via the modified Monkman–Grant relationship.
Application of the Failure Assessment Diagram approach for contact fatigue damage evaluation in railway wheel steels
Authors: Donzella Giorgio , Danesi Andrea , Mazzù Angelo , Petrogalli Candida , Ghidini Andrea , Faccoli Michela
Published: May 2021

A Failure Assessment Diagram (FAD), developed for rolling contact, was specifically formulated for railway wheel steels. The FAD allows combining a multiaxial fatigue criterion with the linear elastic fracture mechanics concept; in particular, it was used to assess the fatigue failure in wet contact, related to the pressurization of the fluid entrapped in surface cracks. The approach was applied to the results of previous bi‐disc tests carried out on three railway wheel steels, subjected first to a dry rolling‐sliding contact step, then to a wet contact step. The crack size distribution after the dry contact step was evaluated by a statistical approach; subsequently, the stress intensity factor during the wet contact step was estimated by finite elements. The results of the FAD agreed with the damage observed on the cross section of the specimens at the end of the tests. Furthermore, the FAD was used to determine the maximum allowable crack to prevent rolling contact fatigue, this way showing its potential as a damage tolerant approach.
How tree species, tree size, and topographical location influenced tree transpiration in northern boreal forests during the historic 2018 drought
Authors: Gutierrez Lopez Jose , Tor‐ngern Pantana , Oren Ram , Kozii Nataliia , Laudon Hjalmar , Hasselquist Niles J.
Published: May 2021

Trees in northern latitude ecosystems are projected to experience increasing drought stress as a result of rising air temperatures and changes in precipitation patterns in northern latitude ecosystems. However, most drought‐related studies on high‐latitude boreal forests (>50°N) have been conducted in North America, with few studies quantifying the response in European and Eurasian boreal forests. Here, we tested how daily whole‐tree transpiration (Q, Liters day−1) and Q normalized for mean daytime vapor pressure deficit (QDZ, Liters day−1 kPa−1) were affected by the historic 2018 drought in Europe. More specifically, we examined how tree species, size, and topographic position affected drought response in high‐latitude mature boreal forest trees. We monitored 30 Pinus sylvestris (pine) and 30 Picea abies (spruce) trees distributed across a topographic gradient in northern Sweden. In general, pine showed a greater QDZ control compared to spruce during periods of severe drought (standardized precipitation–evapotranspiration index: SPEI < −1.5), suggesting that the latter are more sensitive to drought. Overall, QDZ reductions (using non‐drought QDZ as reference) were less pronounced in larger trees during severe drought, but there was a species‐specific pattern: QDZ reductions were greater in pine trees at high elevations and greater in spruce trees at lower elevations. Despite lower QDZ during severe drought, drought spells were interspersed with small precipitation events and overcast conditions, and QDZ returned to pre‐drought conditions relatively quickly. This study highlights unique species‐specific responses to drought, which are additionally driven by a codependent interaction among tree size, relative topographic position, and unique regional climate conditions.
Soil carbon balance of afforested peatlands in the maritime temperate climatic zone
Authors: Jovani‐Sancho Antonio Jonay , Cummins Thomas , Byrne Kenneth A.
Published: May 2021

Drainage and conversion of natural peatlands to forestry increases soil CO2 emissions through decomposition of peat and modifies the quantity and quality of litter inputs and therefore the soil carbon balance. In organic soils, CO2 net emissions and removals are reported using carbon emission factors (EF). The choice of specific default Tier 1 EF values from the IPCC 2013 Wetlands supplement depends on land‐use categories and climate zones. However, Tier 1 EF for afforested peatlands in the temperate maritime climate zone are based on data from eight sites, mainly located in the hemiboreal zone, and the uncertainty associated with these default values is a concern. In addition, moving from Tier 1 to higher‐Tier carbon reporting values is highly desirable when large areas are affected by land‐use changes. In this study, we estimated site‐specific soil carbon balance for the development of Tier 2 soil CO2‐C EFs for afforested peatlands. Soil heterotrophic respiration and aboveground tree litterfall were measured during two years at eight afforested peatland sites in Ireland. In addition, fine‐root turnover rate and site‐specific fine‐root biomass were used to quantify belowground litter inputs. We found that drainage of peatlands and planting them with either Sitka spruce or lodgepole pine, resulted in soils being net carbon sources. The soil carbon balance at multi‐year sites varied between 63 ± 92 and 309 ± 67 g C m−2 year−1. Mean CO2‐C EF for afforested peatlands was 1.68 ± 0.33 t CO2‐C ha−1 year−1. The improved CO2‐C EFs presented here for afforested peatlands are proposed as a basis to update national CO2‐C emissions from this land‐use class in Ireland. Furthermore, new data from these sites will significantly contribute to the development of more reliable IPCC default Tier 1 CO2‐C EFs for afforested peatlands in the maritime temperate climate zone.
Quality Assurance for In Situ Uranium Concentration Measurements of Aqueous Samples from Mineral Processing Studies Using a Portable XRF Analyser in Compliance with ISO/IEC 17025 Requirements
Authors: Abukashabeh Ahmad , Abu‐Halimeh Rachael
Published: May 2021

The method developed in this article aims to control the quality of uranium leaching and processing measurements at the Jordan Atomic Energy Commission, through the instant determination of uranium in aqueous samples without chemical preparation using portable X‐Ray Fluorescence (pXRF) analysis. Acidic and alkaline samples were analysed via pXRF then compared with results from ICP‐MS/ICP‐AES. The pXRF method validation, in view of ISO/IEC 17025:2017 requirements, was applied to real samples and simulated uranium ore solutions from single uranium and two other certified reference materials. The slopes acquired from correlations between pXRF results and reference values were 1.026, 1.021 and 0.9664, respectively, with correlation coefficients (r2) approaching 1.0. Precision calculations showed values < 5% RSD for samples having uranium contents > 10 mg l−1, while this value was ±10% at 5 mg l−1. The detection and quantification limits were determined as 2.5 and 7.7 mg l−1, respectively. Relative expanded uncertainty was found to equal 12.5% with a coverage factor k = 2 at the quantification limit. Finally, a paired t‐test and linear regression combining the pXRF results and reference values obtained by ICP‐MS and ICP‐AES demonstrated no significant difference at the 95% confidence level. This work eventually led to the laboratory’s ISO/IEC 17025:2017 accreditation for this method.
Hungry for power? Regional elites and the architecture of government
Authors: Tatham Michaël , Bauer Michael W.
Published: May 2021

How can we better understand the architecture of government? Governmental structures are regularly altered by the dispersion of power upward and downward to supranational and subnational bodies. The preferences of citizens and élites in this regard are well documented at the national and EU levels. However, the preferences of regional élites remain somewhat of a black box. What are their preferences when it comes to the distribution of competences across the regional‐national‐EU triptych? This article pits three explanations against one another. They concern scale, identity, and institutional effects. These explanations are evaluated against a database containing information on over 1,300 regional élites in 68 regions and 12 countries. Overall, while scale and institutional logics do play a role, identity logics prevail. These findings support a strand of literature stressing the importance of community and attachment in shaping the structure of government beyond what scale and institutional logics predict.
Dissonance in the discourse of the duration of diabetes: A mixed methods study of patient perceptions and clinical practice
Authors: Ledford Christy J. W. , Fulleborn Stephanie T. , Jackson Jeremy T. , Rogers Tyler , Samar Haroon
Published: May 2021

Background

Remission of diabetes can be rewarding for patients and physicians, but there is limited study of how patients perceive the timeline of a disease along the continuum of glycaemic control.

Objective

To explore how patients perceive the timeline of diabetes along the continuum of glycaemic control and their goals of care and to identify whether family physicians communicate the principles of regression and remission of diabetes.

Design

Mixed methods approach of qualitative semi‐structured interviews with purposive sampling followed by cross‐sectional survey of physicians.

Participants

Thirty‐three patients living with prediabetes (preDM) or type 2 diabetes mellitus (T2DM) at medical centres in Georgia and Nevada; and 387 family physicians providing primary care within the same health system.

Results

Patients described two timelines of diabetes: as a lifelong condition or as a condition that can be cured. Patients who perceived a lifelong condition described five treatment goals: reducing glucose‐related laboratory values, losing weight, reducing medication, preventing treatment intensification and avoiding complications. For patients who perceived diabetes as a disease with an end, the goal of care was to achieve normoglycaemia. In response to patient vignettes that described potential cases of remission and regression, 38.2% of physician respondents would still communicate that a patient has preDM and 94.6% would tell the patient that he still had diabetes.

Conclusions

Most physicians here exhibited reluctance to communicate remission or regression in patient care. Yet, patients describe two different potential timelines, including a subset who expect their diabetes can be ‘cured’. Physicians should incorporate shared decision making to create a shared mental model of diabetes and its potential outcomes with patients.

Patient or Public Contribution

In this mixed methods study, as patients participated in the qualitative phase of this study, we asked patients to tell us what additional questions we should ask in subsequent interviews. Data from this qualitative phase informed the design and interpretation of the quantitative phase with physician participants.
Assessing and promoting partnership between patients and health‐care professionals: Co‐construction of the CADICEE tool for patients and their relatives
Authors: Pomey Marie‐Pascale , Clavel Nathalie , Normandin Louise , Del Grande Claudio , Philip Ghadiri Djahanchah , Fernandez‐McAuley Isabel , Boivin Antoine , Flora Luigi , Janvier Annie , Karazivan Philippe , Pelletier Jean‐François , Fernandez Nicolas , Paquette Jesseca , Dumez Vincent
Published: May 2021

Context

Partnership between patients and health‐care professionals (HCPs) is a concept that needs a valid, practical measure to facilitate its use by patients and HCPs.

Objective

To co‐construct a tool for measuring the degree of partnership between patients and HCPs.

Design

The CADICEE tool was developed in four steps: (1) generate key dimensions of patient partnership in clinical care; (2) co‐construct the tool; (3) assess face and content validity from patients’ and HCPs’ viewpoints; and (4) assess the usability of the tool and explore its measurement performance.

Results

The CADICEE tool comprises 24 items under 7 dimensions: 1) relationship of Confidence or trust between the patient and the HCPs; 2) patient Autonomy; 3) patient participation in Decisions related to care; 4) shared Information on patient health status or care; 5) patient personal Context; 6) Empathy; and 7) recognition of Expertise.

Assessment of the tool's usability and measurement performance showed, in a convenience sample of 246 patients and relatives, high face validity, acceptability and relevance for both patients and HCPs, as well as good construct validity.

Conclusions

The CADICEE tool is developed in co‐construction with patients to evaluate the degree of partnership in care desired by patients in their relationship with HCPs. The tool can be used in various clinical contexts and in different health‐care settings.

Patient or Public Contribution

Patients were involved in determining the importance of constructing this questionnaire. They co‐constructed it, pre‐tested it and were part of the entire questionnaire development process. Three patients participated in the writing of the article.