bluuebunny/crossref_metadata_2025 huggingface dataset:
Combining comparative genomic analysis with machine learning reveals some promising diagnostic markers to identify five common pathogenic non‐tuberculous mycobacteria
Authors: Jia Xinmiao , Yang Linfang , Li Cuidan , Xu Yingchun , Yang Qiwen , Chen Fei
Published: May 2021

Non‐tuberculous mycobacteria (NTM) can cause various respiratory diseases and even death in severe cases, and its incidence has increased rapidly worldwide. To date, it’s difficult to use routine diagnostic methods and strain identification to precisely diagnose various types of NTM infections. We combined systematic comparative genomics with machine learning to select new diagnostic markers for precisely identifying five common pathogenic NTMs (Mycobacterium kansasii, Mycobacterium avium, Mycobacterium intracellular, Mycobacterium chelonae, Mycobacterium abscessus). A panel including six genes and two SNPs (nikA, benM, codA, pfkA2, mpr, yjcH, rrl C2638T, rrl A1173G) was selected to simultaneously identify the five NTMs with high accuracy (> 90%). Notably, the panel only containing the six genes also showed a good classification effect (accuracy > 90%). Additionally, the two panels could precisely differentiate the five NTMs from M. tuberculosis (accuracy > 99%). We also revealed some new marker genes/SNPs/combinations to accurately discriminate any one of the five NTMs separately, which provided the possibility to diagnose one certain NTM infection precisely. Our research not only reveals novel promising diagnostic markers to promote the development of precision diagnosis in NTM infectious, but also provides an insight into precisely identifying various genetically close pathogens through comparative genomics and machine learning.
Novel virocell metabolic potential revealed in agricultural soils by virus‐enriched soil metagenome analysis
Authors: Braga Lucas P. P. , Coutinho Felipe H. , Amgarten Deyvid E. , Kot Witold , Hansen Lars , Setubal João C. , Philippot Laurent
Published: May 2021

Viruses are now recognized as important players in microbial dynamics and biogeochemical cycles in the oceans. Yet, compared with aquatic ecosystems, virus discovery in terrestrial ecosystems has been challenging partly due to the inherent complexity of soils. To expand our understanding of soil viruses and their putative contributions to soil microbial processes, we analysed metagenomes of community‐level virus‐enriched suspensions by tangential flow filtration obtained from two French agricultural soils. We found viral sequences representing a total of 239 viral operational taxonomic units that corresponded to 29.5% of the mapping reads in the metagenomic datasets. The analysis of their genomic sequences revealed novel virocell metabolic potential with implications to virus–host interactions, carbon cycling, plant‐beneficial functions in the rhizosphere, horizontal gene transfer and other relevant microbial strategies applied to survive in soils.
Expanded Auditor's Report Disclosures and Loan Contracting*
Authors: Porumb Vlad‐Andrei , Zengin‐Karaibrahimoglu Yasemin , Lobo Gerald J. , Hooghiemstra Reggy , de Waard Dick
Published: May 2021

Starting in October 2013, auditors of premium‐listed firms in the United Kingdom are mandated to prepare an expanded auditor's report that provides details on audit procedures, risks of material misstatement (RMMs), and materiality thresholds. This regulatory change is important to study, because it aims to increase the informational value of the traditional, highly standardized, pass‐or‐fail auditor's report. We examine whether the disclosures in the expanded auditor's report provide information that is relevant for adopting firms' loan contracting terms in the post‐adoption period. Our results indicate that the introduction of the expanded auditor's report is associated with reduced loan spread and longer maturity for loan facilities of adopting firms relative to non‐adopting UK firms. When we focus on adopting firms in the post‐adoption period, we find that the number of “unique RMMs” mentioned in the auditor's report, but not in the audit committee report, are positively associated with loan spread but are not associated either with loan maturity or the number of lenders in the loan syndicate. Additional tests show that the benefits, in terms of a reduced spread, of having a lower number of “unique RMMs” accrue mostly to adopters with a poor information environment. Taken together, our results provide preliminary evidence that the expanded auditor's report disclosures contain relevant information for loan contracting in the United Kingdom. This study highlights the unique role of the expanded auditor's report in providing information relevant to lenders and supports standard setters' efforts to enrich its informational content.
Age‐related telomere attrition causes aberrant gene expression in sub‐telomeric regions
Authors: Dong Xiao , Sun Shixiang , Zhang Lei , Kim Seungsoo , Tu Zhidong , Montagna Cristina , Maslov Alexander Y. , Suh Yousin , Wang Tao , Campisi Judith , Vijg Jan
Published: May 2021

Telomere attrition has been proposed as a biomarker and causal factor in aging. In addition to causing cellular senescence and apoptosis, telomere shortening has been found to affect gene expression in subtelomeric regions. Here, we analyzed the distribution of age‐related differentially expressed genes from the GTEx RNA sequencing database of 54 tissue types from 979 human subjects and found significantly more upregulated than downregulated genes in subtelomeric regions as compared to the genome‐wide average. Our data demonstrate spatial relationships between telomeres and gene expression in aging.
Antiphospholipid antibodies and pregnancy outcome of assisted reproductive treatment: A systematic review and meta‐analysis
Authors: Gao Rui , Zeng Rujun , Qing Pingying , Meng Cheng , Cheng Kemin , Zhang Sirui , Chen Hanxiao , Jin Xiaolei , Qin Lang , Li Tao
Published: May 2021

Problem

Antiphospholipid antibodies (aPLs) are a group of autoantibodies associated with a variety of pregnancy complications, but the impact of aPL on the outcomes of assisted fertility treatment (ART) is controversial. This systematic review and meta‐analysis were designed to explore the association between aPL and ART outcomes and to explore in which stages does aPL play a role.

Method of Study

PubMed and Cochrane database were systematically retrieved, and odds ratios (ORs) or risk ratios (RRs) with 95% confidence intervals (CIs) were calculated in a random‐effect model or fixed‐effect model according to the heterogenicity assessed by the Cochran Q and I2 statistic test. Of 246 records identified by the search, 10 case‐control studies and 13 cohort studies that explored the association between aPL and in vitro fertilization (IVF) and/or intracytoplasmic sperm injection (ICSI) were analyzed.

Results

The results showed that aPL positive rate was higher in females who failed in IVF/ICSI than those who succeeded in IVF/ICSI (OR: 3.62, 95% CI: 1.95–6.74). This study also indicated that females positive for aPL have a higher miscarriage rate (RR: 1.68, 95% CI: 1.24–2.28) than those negative for aPL, but live birth rate, biochemical pregnancy rate, and clinical pregnancy rate were similar between two groups (RR: 1.01, 95% CI: 0.91–1.12; RR: 1.18, 95% CI: 0.57–2.43 and RR: 0.95, 95% CI: 0.80–1.13).

Conclusions

There was higher aPL prevalence in females with adverse IVF/ICSI outcomes. It seems that aPL mainly affects the miscarriage rate, but has little effect on live birth rate, biochemical pregnancy rate, and clinical pregnancy rate. Routine detection of aPL before IVF/ICSI treatment is meaningful.
Resilience interventions in physicians: A systematic review and meta‐analysis
Authors: Angelopoulou Paraskevi , Panagopoulou Efharis
Published: May 2021

The aim of this review was to evaluate the effectiveness of interventions in promoting resilience among physicians. Previous reviews concerning resilience did not assess effectiveness in a systematic way using meta‐analytic methods. PubMed, PsycINFO, and Cochrane Register of Controlled Trials were searched from inception to January 31, 2020. Randomized clinical trials, non‐randomized clinical trials, and repeated‐measures studies of intervention designs targeting at resilience in physicians were included. Eleven studies were included in the review (n = 580 physicians). Research findings suggest that interventions for resilience in physicians were associated with small but significant benefits. Subgroup analyses suggested small but significantly improved effects for emotional–supportive–coping interventions (Hedges's g = 0.242; 95% CI, 0.082–0.402, p = .003) compared with mindfulness–meditation–relaxation interventions (Hedges's g = 0.208; 95% CI, 0.131–0.285, p = .000). Interventions that were delivered for more than a week indicated higher effect (Hedges's g = 0.262; 95% CI, 0.169–0.355, p = .000) compared with interventions delivered for up to a week (Hedges's g = 0.172; 95% CI, −0.010 to 0.355, p = .064). Results were not influenced by the risk of bias ratings. Findings suggest that physicians can benefit in their personal levels of resilience from attending an intervention specifically designed for that reason for more than a week. Moreover, policy‐makers should view current results as a significant source of redesigning healthcare systems and promoting attendance of resilience interventions by physicians. Future research should address the need for more higher‐quality studies and improved study designs.
Does the length of time dried distillers' grain with solubles substitution for soybean meal affect physiological indicators and meat quality in finishing lambs?
Authors: Karaca Serhat , Erdoğan Sibel , Güney Mehtap , Çakmakçı Cihan , Sarıbey Muammer , Kor Aşkın , Ülker Hasan
Published: May 2021

This study examined how inclusion of dried distillers' grains with solubles (DDGS) in finishing lamb diets for different periods affects some physiological indicators and meat quality. A total of 40 male lambs were divided into four groups according to feeding regimen during the 120‐day finishing period as follows: C120: no DDGS included in diet for 120 days; D120: DDGS included in diet for 120 days; D75: no DDGS included in diet for 45 days + DDGS included in diet for 75 days; D45: no DDGS included in diet for 75 days + DDGS included in diet for 45 days. Dietary inclusion rate of DDGS was 27.5%. Fattening performance and rumen parameters were not affected by treatment. Feeding regimens had no significant effect on meat quality except the instrumental tenderness and juiciness score. DDGS fed lambs had higher level of total trans fatty acids and n‐6/n‐3 ratio in meat. 10t‐C18:1, 11t‐C18:1 and 9c,11t conjugated linoleic acid contents of adipose tissue were higher in all the DDGS groups compared with C120 lambs (p < .001). These results suggest that soybean meal can be replaced with corn DDGS in lamb diets for up to 120 days during the finishing period with no adverse effects on some physiological response feedlot performance and meat quality.
Screening and monitoring of the BTKC481S mutation in a real‐world cohort of patients with relapsed/refractory chronic lymphocytic leukaemia during ibrutinib therapy
Authors: Bödör Csaba , Kotmayer Lili , László Tamás , Takács Ferenc , Barna Gábor , Kiss Richárd , Sebestyén Endre , Nagy Tibor , Hegyi Lajos László , Mikala Gábor , Fekete Sándor , Farkas Péter , Balogh Alexandra , Masszi Tamás , Demeter Judit , Weisinger Júlia , Alizadeh Hussain , Kajtár Béla , Kohl Zoltán , Szász Róbert , Gergely Lajos , Gurbity Pálfi Timea , Sulák Adrienn , Kollár Balázs , Egyed Miklós , Plander Márk , Rejtő László , Szerafin László , Ilonczai Péter , Tamáska Péter , Pettendi Piroska , Lévai Dóra , Schneider Tamás , Sebestyén Anna , Csermely Péter , Matolcsy András , Mátrai Zoltán , Alpár Donát
Published: May 2021

The Bruton's tyrosine kinase (BTK) inhibitor ibrutinib has revolutionised the therapeutic landscape of chronic lymphocytic leukaemia (CLL). Acquired mutations emerging at position C481 in the BTK tyrosine kinase domain are the predominant genetic alterations associated with secondary ibrutinib resistance. To assess the correlation between disease progression, and the emergence and temporal dynamics of the most common resistance mutation BTKC481S, sensitive (10−4) time‐resolved screening was performed in 83 relapsed/refractory CLL patients during single‐agent ibrutinib treatment. With a median follow‐up time of 40 months, BTKC481S was detected in 48·2% (40/83) of the patients, with 80·0% (32/40) of them showing disease progression during the examined period. In these 32 cases, representing 72·7% (32/44) of all patients experiencing relapse, emergence of the BTKC481S mutation preceded the symptoms of clinical relapse with a median of nine months. Subsequent Bcl‐2 inhibition therapy applied in 28/32 patients harbouring BTKC481S and progressing on ibrutinib conferred clinical and molecular remission across the patients. Our study demonstrates the clinical value of sensitive BTKC481S monitoring with the largest longitudinally analysed real‐world patient cohort reported to date and validates the feasibility of an early prediction of relapse in the majority of ibrutinib‐treated relapsed/refractory CLL patients experiencing disease progression.
Gynaecological and reproductive health of women with telomere biology disorders
Authors: Giri Neelam , Alter Blanche P. , Savage Sharon A. , Stratton Pamela
Published: May 2021

Reproductive health may be adversely impacted in women with dyskeratosis congenita (DC) and related telomere biology disorders (TBD). We evaluated gynaecological problems, fertility, and pregnancy outcomes in 39 females aged 10–81 years who were followed longitudinally in our DC/TBD cohort. Twenty‐six had bone marrow failure and 12 underwent haematopoietic cell transplantation. All attained menarche at a normal age. Thirteen women reported menorrhagia; ten used hormonal contraception to reduce bleeding. Nine experienced natural normal‐aged menopause. Gynaecological problems (endometriosis = 3, pelvic varicosities = 1, cervical intraepithelial neoplasia = 1, and uterine prolapse = 2) resulted in surgical menopause in seven. Twenty‐five of 26 women attempting fertility carried 80 pregnancies with 49 (61%) resulting in livebirths. Ten (38%) women experienced 28 (35%) miscarriages, notably recurrent pregnancy loss in five (19%). Preeclampsia (n = 6, 24%) and progressive cytopenias (n = 10, 40%) resulted in maternal‐fetal compromise, including preterm (n = 5) and caesarean deliveries (n = 18, 37%). Gynaecological/reproductive problems were noted mainly in women with autosomal‐dominant inheritance; others were still young or died early. Although women with TBDs had normal menarche, fertility, and menopause, gynaecological problems and pregnancy complications leading to caesarean section, preterm delivery, or transfusion support were frequent. Women with TBDs will benefit from multidisciplinary, coordinated care by haematology, gynaecology and maternal‐fetal medicine.
How do child welfare referrals in Sweden match children's self‐reporting of severe exposure?
Authors: Kalin Torbjörn , Persdotter Birgitta , Ahlgren Thorbjörn , Gerdner Arne
Published: May 2021

Child welfare services (CWS) rely on referrals from professionals and civilians to address maltreatment and behavioural problems. To our knowledge, no prior study explored to what extent children who self‐reported severe exposure to maltreatment or behavioural problems are referred to the CWS. This study is based on two data sets on a Swedish community sample of 1884 children: (i) self‐reports in four waves during adolescence, including indicators of severe exposure, and (ii) a retrospective systematic review of all children's CWS records at age 18. According to self‐reports, 445 matched one or more indicators of severe exposure. In total, 389 children of the total sample were referred, but only 169 of the self‐reported severely exposed. Severely exposed children were more likely to be referred than other children, adjusting for several background factors. Children who did not experience severe exposure but lived in single‐parent families, teenage parent families, poor families or immigrant families were more likely to be referred to CWS than other children. The findings are discussed from a children's rights perspective and inequity in relation to social work practice. In conclusion, although the referral rates are high, many children who are severely exposed to child maltreatment and behavioural problems remain undetected.
Naltrexone is neuroprotective against traumatic brain injury in mu opioid receptor knockout mice
Authors: Wang Yu‐Syuan , Hung Tsai‐Wei , Bae Eun‐Kyung , Wu Kuo‐Jen , Hsieh Wei , Yu Seong‐Jin
Published: May 2021

Aims

Naltrexone is a mu opioid receptor (MOR) antagonist used to treat drug dependence in patients. Previous reports indicated that MOR antagonists reduced neurodegeneration and inflammation after brain injury. The purpose of this study was to evaluate the neuroprotective effect of naltrexone in cell culture and a mouse model of traumatic brain injury (TBI).

Methods

The neuroprotective effect of naltrexone was examined in primary cortical neurons co‐cultured with BV2 microglia. Controlled cortical impact (CCI) was delivered to the left cerebral cortex of adult male MOR wild‐type (WT) and knockout (KO) mice. Naltrexone was given daily for 4 days, starting from day 2 after lesioning. Locomotor activity was evaluated on day 5 after the CCI. Brain tissues were collected for immunostaining, Western, and qPCR analysis.

Results

Glutamate reduced MAP2 immunoreactivity (‐ir), while increased IBA1‐ir in neuron/BV2 co‐culture; both responses were antagonized by naltrexone. TBI significantly reduced locomotor activity and increased the expression of IBA1, iNOS, and CD4 in the lesioned cortex. Naltrexone significantly and equally antagonized the motor deficits and expression of IBA1 and iNOS in WT and KO mice. TBI‐mediated CD4 protein production was attenuated by naltrexone in WT mice, but not in KO mice.

Conclusion

Naltrexone reduced TBI‐mediated neurodegeneration and inflammation in MOR WT and KO mice. The protective effect of naltrexone involves non‐MOR and MOR mechanisms.
Does Infant‐Directed Speech Help Phonetic Learning? A Machine Learning Investigation
Authors: Ludusan Bogdan , Mazuka Reiko , Dupoux Emmanuel
Published: May 2021

A prominent hypothesis holds that by speaking to infants in infant‐directed speech (IDS) as opposed to adult‐directed speech (ADS), parents help them learn phonetic categories. Specifically, two characteristics of IDS have been claimed to facilitate learning: hyperarticulation, which makes the categories more separable, and variability, which makes the generalization more robust. Here, we test the separability and robustness of vowel category learning on acoustic representations of speech uttered by Japanese adults in ADS, IDS (addressed to 18‐ to 24‐month olds), or read speech (RS). Separability is determined by means of a distance measure computed between the five short vowel categories of Japanese, while robustness is assessed by testing the ability of six different machine learning algorithms trained to classify vowels to generalize on stimuli spoken by a novel speaker in ADS. Using two different speech representations, we find that hyperarticulated speech, in the case of RS, can yield better separability, and that increased between‐speaker variability in ADS can yield, for some algorithms, more robust categories. However, these conclusions do not apply to IDS, which turned out to yield neither more separable nor more robust categories compared to ADS inputs. We discuss the usefulness of machine learning algorithms run on real data to test hypotheses about the functional role of IDS.
Compositionality in a Parallel Architecture for Language Processing
Authors: Baggio Giosuè
Published: May 2021

Compositionality has been a central concept in linguistics and philosophy for decades, and it is increasingly prominent in many other areas of cognitive science. Its status, however, remains contentious. Here, I reassess the nature and scope of the principle of compositionality (Partee, 1995) from the perspective of psycholinguistics and cognitive neuroscience. First, I review classic arguments for compositionality and conclude that they fail to establish compositionality as a property of human language. Next, I state a new competence argument, acknowledging the fact that any competent user of a language L can assign to most expressions in L at least one meaning which is a functiononlyof the meanings of the expression's parts and of its syntactic structure. I then discuss selected results from cognitive neuroscience, indicating that the human brain possesses the processing capacities presupposed by the competence argument. Finally, I outline a language processing architecture consistent with the neuroscience results, where semantic representations may be generated by a syntax‐driven streamandby an “asyntactic” processing stream, jointly or independently. Compositionality is viewed as a constraint on computation in the former stream only.
Testing the Reference of Biological Kind Terms
Authors: Devitt Michael , Porter Brian C.
Published: May 2021

Recent experimental work on “natural” kind terms has shown evidence of both descriptive and nondescriptive reference determination. This has led some to propose ambiguity or hybrid theories, as opposed to traditional description and causal‐historical theories of reference. Many of those experiments tested theories against referential intuitions. We reject this method, urging that reference should be tested against usage, preferably by elicited production. Our tests of the usage of a biological kind term confirm that there are indeed both descriptive and causal‐historical elements to the reference determination of some natural kind terms. We argue that to accommodate our results and earlier ones, we should abandon the common assumption that any one theory of reference fits all natural kind terms. Rather, it is likely that some terms are descriptive, some causal‐historical, some ambiguous, and some hybrid. This substantive conclusion is accompanied by a methodological one. Our experiments, like some earlier ones, found participants contradicting both each other and themselves. We argue that these contradictions indicate a lack of linguistic competence with the term. We conclude that these experiments have been faulty, because they test terms that are novel to participants and/or use fantastical vignettes. We provide some suggestions for future research.
Phonation Types Matter in Sound Symbolism
Authors: Akita Kimi
Published: May 2021

Sound symbolism is a non‐arbitrary correspondence between sound and meaning. The majority of studies on sound symbolism have focused on consonants and vowels, and the sound‐symbolic properties of suprasegmentals, particularly phonation types, have been largely neglected. This study examines the size and shape symbolism of four phonation types: modal and creaky voices, falsetto, and whisper. Japanese speakers heard 12 novel words (e.g., /íbi/, /ápa/) pronounced with the four types of phonation and rated the size and roundedness/pointedness each of the 48 stimuli seemed to represent on seven‐point scales. The results showed that phonation types as well as consonantal and vocalic features influenced the ratings. Creaky voice was associated with larger and more pointed images than modal voice, which was in turn associated with larger and more pointed images than whisper. Falsetto was also associated with roundedness but not with smallness. These results shed new light on the acoustic approaches to sound symbolism and suggest the significance of phonation types and other suprasegmental features in the phenomenon.
The telediagnosis of double aortic arch using spatio‐temporal image correlation
Authors: Inamura Noboru , Taniguchi Takeshi , Takada Nori
Published: May 2021

We diagnosed two cases of double aortic arch (DAA) remotely. In both cases, the right aortic arch was suspected, and a remote diagnosis was requested. We performed a remote diagnosis by the spatio‐temporal image correlation (STIC) method. DAA was diagnosed by detecting the left aortic arch in an axial transverse section in the three‐vessel trachea view. Since the STIC method can make multiple cross sections, making a diagnosis by the STIC method was useful for the remote diagnosis of these patients. In particular, HD flow render mode clearly showed left aortic arch, so it was possible to diagnose DAA.
Contesting the preferred creditor status of the League of Nations, 1931–3†
Authors: Zendejas Juan Flores
Published: May 2021

This article analyses the defaults of the League loans, which were private loans promoted by the League of Nations to support governments in central and eastern Europe in the 1920s. Previous works have argued that governments refused to grant these loans preferred status. However, this article shows that at the onset of the crisis, investors and governments treated these loans differently. It provides an empirical analysis to test whether there was a common element in the pricing of these loans and whether they enjoyed seniority compared to other, non‐League loans. The findings show that there was a common factor driving the bond prices of these loans at the onset of the 1931 banking crisis. This article demonstrates that while these loans were not legally senior, certain governments granted the League loansde factopreferred status under the assumption that averting default would foster renewed support from the League. Archival evidence is provided to show that governments ceased to grant the League loans exceptional treatment when the expected support from the League did not materialize, which further weakened the ability of the League to secure emergency lending.
Scoping review of stepped care interventions for mental health and substance use service delivery to youth and young adults
Authors: Berger Mai , Fernando Saranee , Churchill AnnMarie , Cornish Peter , Henderson Joanna , Shah Jai , Tee Karen , Salmon Amy
Published: May 2021

Aims

Many young people with mental health and/or substance use concerns do not have access to timely, appropriate, and effective services. Within this context, stepped care models (SCMs) have emerged as a guiding framework for care delivery, inspiring service innovations across the globe. However, substantial gaps remain in the evidence for SCMs as a strategy to address the current systemic challenges in delivering services for young people. This scoping review aims to identify where these gaps in evidence exist, and the next steps for addressing them.

Methods

A scoping review was conducted involving both peer‐reviewed and grey literature. Eligible studies explored SCMs implemented in the various health care settings accessed by young people aged 12–24 seeking treatment for mental health and substance use challenges. After screening titles and abstracts, two reviewers examined full‐text articles and extracted data to create a descriptive summary of the models.

Results

Of the 656 studies that were retrieved, 51 studies were included and grouped by study team for a final yield of 43 studies. Almost half of the studies were focused on the adult population (i.e., 18 and over), and most did not specify interventions for young people. Among the SCMs, substantial variability was found in almost every aspect of the models.

Conclusions

Considering the current body of evidence, there is an urgent need for a consensus position on the definition, implementation, and outcome measures required for rigorously assessing the utility of SCMs for young people.
A knowledge‐based self‐pre‐diagnosis system to predict Covid‐19 in smartphone users using personal data and observed symptoms
Authors: Çelik Ertuğrul Duygu , Çelik Ulusoy Demet
Published: May 2021

Covid‐19 is an acute respiratory infection and presents various clinical features ranging from no symptoms to severe pneumonia and death. Medical expert systems, especially in diagnosis and monitoring stages, can give positive consequences in the struggle against Covid‐19. In this study, a rule‐based expert system is designed as a predictive tool in self‐pre‐diagnosis of Covid‐19. The potential users are smartphone users, healthcare experts and government health authorities. The system does not only share the data gathered from the users with experts, but also analyzes the symptom data as a diagnostic assistant to predict possible Covid‐19 risk. To do this, a user needs to fill out a patient examination card that conducts an online Covid‐19 diagnostic test, to receive an unconfirmed online test prediction result and a set of precautionary and supportive action suggestions. The system was tested for 169 positive cases. The results produced by the system were compared with the real PCR test results for the same cases. For patients with certain symptomatic findings, there was no significant difference found between the results of the system and the confirmed test results with PCR test. Furthermore, a set of suitable suggestions produced by the system were compared with the written suggestions of a collaborated health expert. The suggestions deduced and the written suggestions of the health expert were similar and the system suggestions in line with suggestions of the expert. The system can be suitable for diagnosing and monitoring of positive cases in the areas other than clinics and hospitals during the Covid‐19 pandemic. The results of the case studies are promising, and it demonstrates the applicability, effectiveness, and efficiency of the proposed approach in all communities.
The Brazilian Cerrado is becoming hotter and drier
Authors: Hofmann Gabriel S. , Cardoso Manoel F. , Alves Ruy J. V. , Weber Eliseu J. , Barbosa Alexandre A. , de Toledo Peter M. , Pontual Francisco B. , Salles Leandro de O. , Hasenack Heinrich , Cordeiro José L. P. , Aquino Francisco E. , de Oliveira Luiz F. B.
Published: May 2021

The Brazilian Cerrado is a global biodiversity hotspot with notoriously high rates of native vegetation suppression and wildfires over the past three decades. As a result, climate change can already be detected at both local and regional scales. In this study, we used three different approaches based on independent datasets to investigate possible changes in the daytime and nighttime temperature and air humidity between the peak of the dry season and the beginning of the rainy season in the Brazilian Cerrado. Additionally, we evaluated the tendency of dew point depression, considering it as a proxy to assess impacts on biodiversity. Monthly increases of 2.2−4.0℃ in the maximum temperatures and 2.4−2.8℃ in the minimum temperatures between 1961 and 2019 were recorded, supported by all analyzed datasets which included direct observations, remote sensing, and modeling data. The warming raised the vapor pressure deficit, and although we recorded an upward trend in absolute humidity, relative humidity has reduced by ~15%. If these tendencies are maintained, gradual air warming will make nightly cooling insufficient to reach the dew point in the early hours of the night. Therefore, it will progressively reduce both the amount and duration of nocturnal dewfall, which is the main source of water for numerous plants and animal species of the Brazilian Cerrado during the dry season. Through several examples, we hypothesize that these climate changes can have a high impact on biodiversity and potentially cause ecosystems to collapse. We emphasize that the effects of temperature and humidity on Cerrado ecosystems cannot be neglected and should be further explored from a land use perspective.
Restoration of forest resilience to fire from old trees is possible across a large Colorado dry‐forest landscape by 2060, but only under the Paris 1.5℃ goal
Authors: Baker William L.
Published: May 2021

Fire‐prone dry forests often face increasing fires from climate change with low resistance and resilience due to logging of large, old fire‐resistant trees. Their restoration across large landscapes is constrained by limited mature trees, physical settings, and protection. Active restoration has been costly and shown limited effectiveness, but lower cost passive restoration is less studied. I used GIS and machine learning to see whether passive restoration of old trees could overcome constraints in time, by 2060, across 667,000 ha of montane forests in the San Juan Mountains, Colorado, where temperatures are increasing faster than the global average. Random Forest models of physical locations of reconstructed historical old growth (OG) and relatively frequent fire (RFF) show historical OG with RFF was favored between 6.1 and 7.9℃ annual mean temperatures. Random Forest models projected that similar temperature‐suitable locations were moved into the current middle montane ca 2015, and would be extended to just below the upper limit of the montane if the Paris 1.5℃ goal is reached, but beyond if not. US Forest Service common stand exam data, which covered ~15% of the study area and included 26,149 tree ages, show the highest potential for restoring resistance and resilience from old trees is a ≥120‐year age class. This class could become a ≥160‐year age class, which meets old‐growth age criteria, over 81% of the area by ca 2060, nearly fully restoring historical old‐growth levels. Half this age class is already protected, and much of the remainder could be retained using evidence‐based diameter caps. Datasets thus are sufficient to show that passive restoration of old‐tree resistance and resilience to fire is feasible by ca 2060 across a large montane landscape, although contingent on global success in achieving the Paris 1.5℃ goal. Passive restoration may be viable elsewhere.
Global quantitative synthesis of effects of biotic and abiotic factors on stemflow production in woody ecosystems
Authors: Zhang Yafeng , Wang Xinping , Pan Yanxia , Hu Rui , Chen Ning
Published: May 2021

Aim

Stemflow has been increasingly recognized as an indispensable component in water and nutrient budgets within vegetated ecosystems. Here we aim to quantify the stemflow percentage (St, %) of incident precipitation (i.e. stemflow production) at a global scale, and to provide a systematic evaluation on how biotic and abiotic factors affect St.

Location

Global.

Time period

1970–2019.

Major taxa studied

Woody plants (trees and shrubs).

Methods

We compiled a global stemflow dataset from 234 peer‐reviewed papers, which included 488 observations of St and the related biotic (stand characteristics) and abiotic factors (climate variables) at 283 sites within terrestrial woody plant ecosystems. We explored the global pattern of St and performed a machine learning method (boosted regression trees) to model the effects of biotic and abiotic variables on St.

Results

Globally, the median (interquartile range, IQR) St was 2.7% (1.0–6.3%). We found that St in arid zones (type B in the Köppen‐Geiger climate classification) was significantly higher (p < .01) than in other climate types, and we also detected a significant difference (p < .01) in St between trees (median: 2.4%; IQR: 1.0–5.3%) and shrubs (median: 7.2%; IQR: 5.2–11.9%). Predictor variables that substantially accounted for the explained deviance of the final model included vegetation height (27.0%), mean annual precipitation (16.1%), mean annual temperature (14.4%), stand density (10.8%), stand age (8.9%) and bark type (5.5%). In contrast, leaf area index, diameter at breast height, basal area, phenology type, life‐form and leaf type were classified as low importance.

Main conclusions

Our synthesis provides a cross‐site comparison of St, and gives a holistic view on how climate variables and stand characteristics contribute to and affect global stemflow production.
e‐Oral health interventions for older patients in an outreach primary dental care centre: A pilot trial nested acceptability study
Authors: Wanyonyi Kristina , Couch Courtney , John Jeyanthi , Louca Chris
Published: May 2021

Objective

To compare the acceptability and perceived helpfulness of an e‐Oral Health intervention in form of text messages versus standard dental leaflets provided after a dental visit to patients aged 65 years and over.

Background

Oral health care needs for older people are increasing. Remote interventions using e‐Health can ensure oral care is provided despite physical hindrances or situations where dental appointments are limited such as has happened more widely during the COVID‐19 pandemic.

Materials and methods

Mixed‐method nested study within a pilot trial. Dental patients (n = 150) at an outreach primary dental care centre, ≥ 65 years old, were recruited and randomly allocated to e‐Oral health text messages or leaflet intervention arms. Post‐intervention (6 months), participants responded to open and closed‐ended two‐way survey phone texts. Survey questions investigated: (a) whether they would recommend the intervention, (b) intervention helpfulness and (c) OPEN feedback. Average helpfulness scores (Scale:1= Very Helpful to 5= Not Helpful at All) were compared for each arm using Independent Sample t‐test. Percentage of participants providing positive recommendations in each arm were compared using chi‐squared tests. Qualitative findings were analysed using thematic analysis.

Results

N = 68 (45%) responded. Mean helpfulness scores in text group M = 2.2, SD=1.1) and leaflet group M = 2.3, SD=1.9, P = .29. Amongst the text arm respondents, 89% compared with 68.2% in leaflet arm; P = .005 would recommend the intervention. Four qualitative themes were outlined: intervention approach, content, behavioural impact and recommendations.

Conclusion

e‐Oral Health text interventions are acceptable and helpful to older people, but these messages need to be tailored.
Adherence to prophylaxis and its association with activation of self‐management and treatment satisfaction
Authors: Hoefnagels Johanna Wilhelmina , Schrijvers Liesbeth Hélène , Leebeek Frank W. G. , Eikenboom Jeroen , Schols Saskia E. M. , Smit Cees , Schutgens Roger E. G. , Gouw Samantha C. , Fischer Kathelijn ,   the Haemophilia in the Netherlands 6 Steering Group
Published: May 2021

Introduction

Prophylactic replacement therapy (prophylaxis) in patients with haemophilia (PWH) requires lifelong, frequent (self)infusions. Prophylaxis effectiveness depends on adherence, and the drivers of treatment adherence among PWH are unclear.

Aim

To quantify prophylaxis adherence and associations between adherence and patients’ treatment attitudes and satisfaction in a large cohort of children and adults with haemophilia.

Methods

In a nationwide, cross‐sectional, questionnaire‐based study, PWH with complete information currently using prophylaxis were selected. Validated Hemophilia Regimen Treatment Adherence Scale‐Prophylaxis (VERITAS‐Pro; normalised score range: 0–100, optimum 0) measured treatment adherence; the Patient Activation Measure (PAM‐13; total score range 0–100, optimum 100) measured activation of self‐management; Hemophilia Patient Satisfaction Scale (Hemo‐Sat; range 0–100, optimum 0) measured treatment satisfaction. Groups were compared according to age (children: <12 years; adolescents: 12–18 years; adults >18 years) and adherence levels using non‐parametric tests, and correlations were assessed using Spearman's rho.

Results

Among 321 participants (median age 33 years, interquartile range [IQR]:15–54 years), adherence was high (median VERITAS‐Pro total score 17, 89% adherent) but worsened with age, with median scores of 5, 14 and 20 in children, adolescents, adults, respectively (p < .001). Attitudes towards treatment (median 66 vs. 68) participants and treatment satisfaction (12 vs. 10) were similar between adherent and non‐adherent patients. The VERITAS‐Pro total score was moderately correlated with PAM‐13 (r = .41) but not with Hemo‐Sat (r = −.11).

Discussion

Prophylaxis adherence was high (89%) but decreased significantly with age and was not correlated with treatment attitude or treatment satisfaction.
Evaluation of an intervention to promote minimally invasive dentistry (MID) in an Australian community dental agency—A pilot study
Authors: Nguyen Tan Minh , Tonmukayakul Utsana , Calache Hanny
Published: May 2021

Objectives

To evaluate the impact of an intervention consisting of a 1‐day continuing professional development (CPD) education programme on the International Caries Classification and Management System (ICCMS™), and monthly performance feedback, and to promote minimally invasive dentistry (MID) for children aged under 12 years in an Australian community dental agency. The a priori hypotheses assumed the intervention would increase preventive services, and treatment demand was met.

Methods

A quasi non‐randomized controlled trial with convenience sampling method was adopted. Fourteen dental practitioners received the intervention. The prevalence of dental caries and gingivitis in Australian children was used to determine the treatment demand and used as the performance benchmark. Ten types of preventive and non‐preventive dental services were examined. A Difference‐in‐Differences (DiD) of 12‐month pre‐ (baseline) and post‐intervention analysis was performed.

Results

The intervention group demonstrated increases in topical fluoride application and dietary analysis and advice services. The standard care group had increases in oral prophylaxis or scale and clean, topical fluoride application and oral hygiene instructions (p‐value <0.05). The DiD analysis confirmed the above findings in the intervention group, while other preventive services declined. In the intervention group, the performance benchmark for oral prophylaxis or scale and clean and oral hygiene instructions was met at baseline and post‐intervention.

Conclusions

Only a few preventive services had already met the performance benchmark. The intervention was associated with varied changes to preventive and non‐preventive dental services. More robust study design addressing the study limitations and validating the performance benchmark is required.
Partial unilateral lentiginosis: a clinicopathological analysis of 32 cases on the head and neck area in Korea
Authors: Kim Hak Tae , Choi Myoung Eun , Na Hyoungmin , Lee Woo Jin , Won Chong Hyun , Lee Mi Woo , Choi Jee Ho , Chang Sung Eun
Published: May 2021

Background

Partial unilateral lentiginosis (PUL) is a rare acquired circumscribed hyperpigmentation characterized by multiple simple lentigines involving half of the body. Since the previous studies of PUL were mostly based on case reports and the current literature lacks well‐designed retrospective studies that involve a large number of cases, PUL is not a well‐defined entity, and differential diagnosis with nevus spilus is still difficult. This study aims to evaluate clinical and histopathological characteristics and treatment outcomes of PUL on head and neck area of Koreans.

Methods

Thirty‐two patients with PUL on head and neck area were diagnosed clinicohistopathologically at the Asan Medical Center from 2004 to 2017. Their medical records, photographs, and biopsy specimens were reviewed, and immunohistochemical staining for protein kinase C (PKC)‐βΙΙ was evaluated for melanogenic activity.

Results

Four patients (12.5%) of PUL had congenital lesions, and 24 (75.0%) had age of onset younger than 10 years. Confluency of lentiginous lesions (100%) and mild to moderate background interlesional hyperpigmentation (90.6%) were observed. The lentiginous lesions showed increased melanocytes, melanophages, basal melanins, lentiginous hyperplasia, and perivascular inflammatory cells compared with background interlesional hyperpigmentation, and PKC‐βΙΙ was focally positive in 7 of 12 stained PUL lesions. Among the 16 patients who received laser treatments, 10 (62.5%) showed more than 50% of improvement.

Conclusions

The findings of this study will allow for improved diagnosis of PUL and understanding of its features, which may facilitate proper management in the future.
Prevalence of mental disorders in school children and adolescents in China: diagnostic data from detailed clinical assessments of 17,524 individuals
Authors: Li Fenghua , Cui Yonghua , Li Ying , Guo Lanting , Ke Xiaoyan , Liu Jing , Luo Xuerong , Zheng Yi , Leckman James F.
Published: May 2021

Background

To date, no national‐scale psychiatric epidemiological survey for children and adolescents has been conducted in China. In order to inform government officials and policymakers and to develop a comprehensive plan for service providers, there was a clear need to conduct an up‐to‐date systematic nationwide psychiatric epidemiological survey.

Methods

We conducted a two‐stage large‐scale psychiatric point prevalence survey. Multistage cluster stratified random sampling was used as the sampling strategy. Five provinces were selected by comprehensively considering geographical partition, economic development, and rural/urban factors. In Stage 1, the Child Behavior Checklist was used as the screening tool. In Stage 2, Mini‐International Neuropsychiatric Interview for Children and Adolescents and a diagnostic process based on the Diagnostic and Statistical Manual were used to make the diagnoses. Sampling weights and poststratification weights were employed to match the population distributions. Exploratory analyses were also performed using socio‐demographic factors. Prevalence in socio‐demographic factor subgroups and overall were estimated. Rao‐Scott adjusted chi‐square tests were utilized to determine if between‐group differences were present. Factor interactions were checked by logistic regression analyses.

Results

A total of 73,992 participants aged 6–16 years of age were selected in Stage 1. In Stage 2, 17,524 individuals were screened and diagnosed. The weighted prevalence of any disorder was 17.5% (95% CI: 17.2–18.0). Statistically significant differences in prevalence of any psychiatric disorder were observed between sexes [χ2(1, N = 71,929) = 223.0, p < .001], age groups [χ2(1, N = 71,929) = 18.6, p < .001] and developed vs. developing areas [χ2(1, N = 71,929) = 2,129.6, p < .001], while no difference was found between rural and urban areas [χ2(1, N = 71,929) = 1.4, p = .239]. Male, younger individuals, children, and adolescents from developed areas had higher prevalence of any psychiatric disorder. The prevalence of any psychiatric disorder was found to decrease with the age in the male group, while the female group increased with the age. Individuals diagnosed with attention‐deficit hyperactivity disorder, oppositional defiant disorder, a tic disorder, conduct disorder, and major depression disorder had the highest rates of comorbidity.

Conclusions

The prevalence of any psychiatric disorder we found is the highest ever reported in China. These results urgently need to be addressed by public mental health service providers and policymakers in order to provide access to the necessary treatments and to reduce the long‐term negative impact of these conditions on families and the society as a whole.
Association between Grit Scales and adherence to regular hospital visits among Japanese patients with type 2 diabetes: Prospective observational study
Authors: Nakanishi Shuhei , Shimoda Masashi , Tatsumi Fuminori , Kohara Kenji , Obata Atsushi , Sanada Junpei , Fushimi Yoshiro , Mune Tomoatsu , Kaku Kohei , Kaneto Hideaki
Published: May 2021

This study examined the association between Grit Scales and adherence to a schedule of regular hospital visits among Japanese type 2 diabetes patients. Patients with type 2 diabetes who visited the outpatient clinic as new patients comprised the study’s participants. Self‐administered Short Grit Scale data were obtained from 122 patients at the first consultation and were then observed for 1 year. As the results, 21 participants failed to attend the hospital. In a logistic regression analysis, the Grit Scale as a continuous variable was positively associated with adherence to regular clinical visits. Its odds ratio and 95% confidential interval was 9.68 and 2.87–32.65 (P = 0.0003). In conclusion, it is likely that the Grit Scale is closely associated with adherence to regular hospital visits among Japanese type 2 diabetes patients.
Reply to: Comment on: Family caregiver assessment in primary care: How to strengthen the healthcare triad?
Authors: Fortinsky Richard H.
Published: May 2021

This letter comments on the letter by Conceição Balsinha in this issue.