bluuebunny/crossref_metadata_2025 huggingface dataset:
Prenatal predictors of motor function in children with open spina bifida: a retrospective cohort study
Authors: Corroenne R , Yepez M , Pyarali M , Johnson RM , Whitehead WE , Castillo HA , Castillo J , Mehollin‐Ray AR , Espinoza J , Shamshirsaz AA , Nassr AA , Belfort MA , Cortes MS
Published: September 2020

Objective

To identify predictors for intact motor function (MF) at birth and at 12 months of life in babies with prenatally versus postnatally repaired open spina bifida (OSB).

Design

Retrospective cohort study.

Setting

Texas Children's Hospital, 2011–2018.

Population

Patients who underwent either prenatal or postnatal OSB repair.

Methods

Prenatal MF of the lower extremities was evaluated by ultrasound following a metameric distribution at the time of diagnosis (US1), 6 weeks postoperatively (or 6 weeks after initial evaluation in postnatally repaired cases) (US2) and at the last ultrasound before delivery (US3). At birth and at 12 months, MF was assessed clinically. Intact MF (S1) was defined as the observation of plantar flexion of the ankle. Results from logistic regression analysis are expressed as odds ratios (95% confidence intervals, P values).

Results

A total of 127 patients were included: 93 with prenatal repair (51 fetoscopic; 42 open hysterotomy repair) and 34 with postnatal repair. In the prenatal repair group, predictors for intact MF at birth and at 12 months included: absence of clubfeet (OR 11.3, 95% CI 3.2–39.1, P < 0.01; OR 10.8 95% CI 2.4–47.6, P < 0.01); intact MF at US1 (OR 19.7, 95% CI 5.0–76.9, P < 0.01; OR 8.7, 95% CI 2.0–38.7, P < 0.01); intact MF at US2 (OR 22, 95% CI 6.5–74.2, P < 0.01; OR 13.5, 95% 3.0–61.4, P < 0.01); intact MF at US3 (OR 13.7, 95% CI 3.4–55.9, P < 0.01; OR 12.6, 95% CI 2.5–64.3, P < 0.01); and having a flat lesion (OR 11.2, 95% CI 2.4–51.1, P < 0.01; OR 4.1, 95% CI 1.1–16.5, P = 0.04). In the postnatal repair group, the only predictor of intact MF at 12 months was having intact MF at birth (OR 15.2, 95% CI 2.0–113.3, P = 0.03).

Conclusions

The detection of intact MF in utero from mid‐gestation to delivery predicts intact MF at birth and at 12 months in babies who undergo prenatal OSB repair.

Tweetable abstract

Detection of intact motor function in utero predicts intact motor function at birth and at 1 year in fetuses who undergo prenatal OSB repair.
New evidence of state variation in Medicaid payment policies for dual Medicare‐Medicaid enrollees
Authors: Roberts Eric T. , Nimgaonkar Alok , Aarons Joshua , Tomko Heather , Shartzer Adele , Zuckerman Stephen B. , Everette James A.
Published: September 2020

Objective

To develop the first longitudinal database of state Medicaid policies for paying the cost sharing in Medicare Part B for services provided to dual Medicare‐Medicaid enrollees (“duals”) and an index summarizing the impact of these policies on payments for physician office services.

Data sources

Medicaid policy data collected from electronic sources and inquiries with states.

Study design

We constructed a national database of Medicaid payment policies for the period 2004‐2018, consolidating information from online Medicaid policy documents, state laws, and policy data reported to us by state Medicaid programs. Using this database and state Medicaid fee schedules, we constructed a Medicaid payment index for duals. This index represented the proportion of the Medicare allowed amount that physicians would expect to be paid from Medicare and Medicaid for a subset of physician office services (evaluation and management services) based on annual state payment policies and Medicaid fee schedules.

Principal findings

In 2018, 42 states had policies to limit Medicaid payments of Medicare cost sharing when Medicaid's fee schedule was lower than Medicare's—an increase from 36 such states in 2004. In the preponderance of states with these policies, combined Medicare and Medicaid payments for evaluation and management services provided to duals averaged 78 percent of the Medicare allowed amount for these services, reflecting relatively low Medicaid fee schedules in these states. In 2013 and 2014, physicians who qualified for the Affordable Care Act's Medicaid “fee bump” were paid 100 percent of the Medicare allowed amount for these services.

Conclusions

Medicaid programs vary across states and over time in their payments of cost sharing for physician office services provided to duals. Our database and index can facilitate monitoring of these policies and research on the consequences of policy changes for duals.
Esophageal symptoms versus epigastric symptoms: Relevance for diagnosis of gastroesophageal reflux disease
Authors: Zhang Meng Yu , Tan Nian Di , Li Yu Wen , Sifrim Daniel , Pandolfino John E. , Xiao Ying Lian , Chen Min Hu
Published: September 2020

Objective

Although pathological acid reflux in patients with reflux symptoms is uncommon, it affects one‐third of patients with epigastric symptoms in China. The aim of this study was to evaluate and compare the relevance of esophageal and epigastric symptoms in diagnosing gastroesophageal reflux disease (GERD) in China.

Methods

Consecutive outpatients with predominantly esophageal symptoms (heartburn, regurgitation, chest pain, dysphagia) or predominantly epigastric symptoms (epigastric pain, epigastric burning, early satiety, postprandial fullness) were enrolled. Patients underwent upper endoscopy and esophageal function tests, and took proton pump inhibitor (PPI) treatment. The prevalence of GERD and PPI efficacy was assessed and compared among patients with different dominant symptoms.

Results

Altogether 374 patients (244 with predominantly esophageal symptoms and 130 with predominantly epigastric symptoms) were enrolled. Patients with predominantly epigastric symptoms had a slightly lower prevalence of reflux esophagitis and pathological acid reflux but a significantly lower PPI response rate than those with predominantly esophageal symptoms. Multivariable logistic regression analysis revealed that the predominant symptom was independently associated with PPI efficacy but could not predict the objective existence of GERD. GERD was objectively found in 136 patients, 30% of whom complained of predominantly epigastric symptoms and had similar reflux profiles and symptom outcomes as patients with predominantly esophageal symptoms.

Conclusions

Approximately 30% of patients with GERD complain of predominantly epigastric symptoms and have comparable reflux profiles and symptom outcomes as those with predominantly esophageal symptoms. Epigastric symptoms may be part of the diagnosis for GERD in a Chinese population. The study was registered with Clinicaltrials.gov (NCT02506634).
Spread through air spaces (STAS) in invasive mucinous adenocarcinoma of the lung: Incidence, prognostic impact, and prediction based on clinicoradiologic factors
Authors: Lee Min A. , Kang Jun , Lee Ho Yun , Kim Wooil , Shon Insuk , Hwang Na Young , Kim Hong Kwan , Choi Yong Soo , Kim Jhingook , Zo Jae Ill , Shim Young Mog
Published: September 2020

Background

Spread through air spaces (STAS) has recently been demonstrated to exhibit a negative impact on lung adenocarcinoma prognosis. However, most of these studies investigated STAS in nonmucinous adenocarcinoma. Here, we investigated the incidence of STAS in invasive mucinous adenocarcinoma (IMA) of the lung and evaluated whether tumor STAS was a risk factor of disease recurrence in IMA. We also examined clinicoradiologic factors in patients with IMA harboring STAS.

Methods

We reviewed pathologic specimens and imaging characteristics of primary tumors from 132 consecutive patients who underwent surgical resection for IMA to evaluate STAS. Patients with and without STAS were compared with respect to clinical characteristics as well as computed tomography (CT) imaging using logistic regression. The relationships between all variables including STAS and survival were analyzed.

Results

Among a total of 132 patients, full pathologic specimens were available for 119 patients, and STAS was observed in 86 (72.3%). IMA patients with STAS were significantly associated with older age, presence of lobulated and spiculated margins on CT scan (P = 0.009, P = 0.006, and P = 0.027). In multivariate analysis for overall survival (OS), STAS was a borderline independent poor prognostic predictor (P = 0.028). Older age, history of smoking, higher T stage, presence of lymph node metastasis, and consolidative morphologic type remained independent predictors for OS.

Conclusions

STAS was associated with reduced OS and was a borderline independent poor prognostic factor in IMA. IMA with STAS was associated with older age and presence of lobulated and spiculated margins on CT scan.

Key points

Significant findings of the study

Compared with other subtypes, IMA shows a higher incidence of STAS, which is an independent poor prognostic predictor even in IMA. Lobulated and spiculated margins on CT are associated with STAS.

What this study adds

Considering that STAS can carry the potential for aerogenous metastasis, predicting STAS using preoperative surrogate CT imaging is desirable to avoid limited resection.
GPX8 promotes migration and invasion by regulating epithelial characteristics in non‐small cell lung cancer
Authors: Zhang Jun , Liu Yun , Guo Yan , Zhao Qiang
Published: September 2020

Background

Non‐small cell lung cancer (NSCLC) is the most common cause of cancer‐related death worldwide. The family of glutathione peroxidase (GPX), an important antioxidant enzyme in human tissues, has been discovered to play a key role in the development of cancers. GPX8 is the most promising molecule of the family in a therapeutic strategy against a variety of cancers.

The main purpose of this study was to examine and analyze the function and clinical value of GPX8 in NSCLC.

Methods

Immunohistochemistry (IHC), western blot analysis and quantitative real‐time polymerase chain reaction (qPCR) were used to assess GPX8 expression and its clinical significance in NSCLC. A series of cell biology experiments and bioinformatic analysis tools were further used to study the function of GPX8.

Results

GPX8 expression in tumor tissues was much higher than that in normal lung tissues. High expression of GPX8 in NSCLC was correlated with a worse clinical outcome and prognosis. Furthermore, GPX8 could inhibit the apoptosis of tumor cells and promote its migration and invasion.

Conclusions

Our results conclusively demonstrated that GPX8 could affect the oncogenesis and prognosis of NSCLC via regulating epithelial characteristics. The study also illustrated that GPX8 could serve as a prognostic predictor and potential therapeutic target for NSCLC.
South West and North Central Nigeria: Assessment of cassava mosaic disease and field status of African cassava mosaic virus and East African cassava mosaic virus
Authors: Eni Angela O. , Efekemo Oghenevwairhe P. , Onile‐ere Olabode A. , Pita Justin S.
Published: September 2020

Cassava mosaic disease (CMD), caused by cassava mosaic begomoviruses (CMBs), is a major threat to cassava production in Nigeria. The predominant CMBs in Nigeria are African cassava mosaic virus (ACMV), East African cassava mosaic virus (EACMV) and East African cassava mosaic Cameroon virus (EACMCV), which are transmitted through infected stem cuttings and whitefly vectors. This study was conducted in 2015 and 2017 to assess the epidemiology of CMD and the current distribution of CMBs in cassava farms in South West (SW) and North Central (NC) Nigeria. A survey of cassava farms was undertaken, and samples representative of disease symptoms were collected and assessed using molecular techniques. A total of 184 and 328 cassava farms were sampled in 2015 and 2017, respectively. CMD incidence for both regions surveyed was 43.80 and 12.25% in 2015 and 2017, respectively. Fields in SW recorded a higher incidence rate in 2015 (SW: 45.11%, NC: 42.47%), while the reverse occurred in 2017 (SW: 10.90%, NC: 14.01%). Overall, the CMD incidence in Benue State (NC) was significantly higher than other locations surveyed in both years. CMD symptom severity and mean whitefly population were higher in SW Nigeria in the two survey years. ACMV was widespread across both zones, occurring in 79.1% (453/613) and 54.8% (386/704) of cassava leaf samples analysed in 2015 and 2017, respectively. EACMV was detected in only 6.0% (37/613) and 4.7% (33/704) of all cassava leaf samples analysed in 2015 and 2017, respectively. Overall, a higher proportion of infected samples were found in NC in both 2015 (NC: 85.2%, SW: 75.4%) and 2017 (NC: 73.6%, SW: 45.2%). Detection using strain‐specific primers revealed that 97% of EACMV positive samples were indeed infected by the EACMCV strain of the virus. As previously reported, samples with mixed infections showed a higher symptom severity than samples with single ACMV or EACMV infections. This study provides an update to the distribution of CMBs in SW and NC Nigeria and will be useful in development of monitoring and management strategies for the disease in both regions.
Does Investor Sentiment Affect the Value Relevance of Accounting Information?
Authors: He Wen , Hong Ki Hoon , Wu Eliza
Published: September 2020

We investigate whether investor sentiment affects the relationships between accounting variables and contemporaneous stock returns. Using price‐relevant accounting variables identified by Chen and Zhang (2007) and the investor sentiment index constructed by Baker and Wurgler (2006), we find that the value relevance of accounting variables is collectively lower in high sentiment periods than in low sentiment periods. More importantly, earnings yield appears to be more related to contemporaneous stock returns in high sentiment periods, while other accounting variables are more related to stock returns in low sentiment periods. The effect of investor sentiment on the value relevance of accounting information is stronger for firms that are more difficult to value and to arbitrage.
Prevalence of Cusp of Carabelli and its caries susceptibility – an ambidirectional cohort study
Authors: Bhavyaa R , Sujitha P , Muthu MS , Kirthiga M
Published: September 2020

Background/Aim

To investigate the susceptibility of Cusp of Carabelli (CoC) to caries in 3‐ to 4‐year‐old children.

Methods

The prevalence of CoC was obtained, by two calibrated examiners using 2128 maxillary posterior sectional die models of 1064 caries‐free children (that were prepared 8 months back). Four months after recording the CoC, prospective clinical examination of above‐mentioned children was carried out by a calibrated third examiner. International Caries Detection and Assessment System was used to record caries of the mesiopalatal surfaces (site of CoC) of the primary maxillary second molars. Data were expressed in numbers and percentages and subjected to chi‐square and logistic regression analyses.

Results

The prevalence of CoC was 90.6%. The incidence of caries in association with CoC was 10.5%, and this association was statistically significant (0.004), with an odds ratio of 4.7. A statistically significant association was found between positive and negative expression of CoC and caries (0.001), with an odds ratio of 7.7 in positive expression and 4.1 in negative expression.

Conclusion

The prevalence of CoC was high, with an increased risk for caries with a positive cusp expression. This highlights the need for closer assessment of the mesiopalatal surfaces of primary maxillary second molars during examination.
Follow‐up after treatment of high‐grade cervical dysplasia: The utility of six‐month colposcopy and cytology and routine 12‐month colposcopy
Authors: Morton Rhett , Mylvaganam Gaithri , Anderson Lyndal , Farrell Rhonda , Carter Jonathan , Pather Selvan , Saidi Samir
Published: September 2020

Background

Australian Cervical Screening Program guidelines no longer recommend colposcopy and cytology at six months following treatment of cervical intraepithelial neoplasia (CIN2/3) and a co‐test of cure can be performed at 12 months without colposcopy.

Aims

To determine the usefulness of six‐month colposcopy and cytology and routine colposcopy with co‐testing at 12 months in detecting persistent or recurrent disease in patients treated for CIN2/3.

Materials and Methods

We conducted a review of all patients with histologically proven CIN2/3 who underwent a cervical excisional procedure between March 2012 and March 2017 in one specialised centre.

Results

We examined 1215 cases and 750 remained after exclusions for analysis. At six months (722 cases, 96.2%) seven of 42 (16.7%) patients with high‐grade cytology had a high‐grade colposcopy and 24 of 42 (57.1%) had a normal colposcopy. Persistent CIN2/3 was diagnosed in 12 cases (1.7%) and only 1/3 had a high‐grade colposcopy. Cytology was more useful than colposcopy in detecting persistent disease. At 12 months (638 cases, 85%) routine colposcopy at the time of co‐testing had a high false positive rate with all high‐grade changes negative on biopsy and co‐test. Recurrent CIN2/3 was diagnosed in five cases, and four had normal colposcopy at co‐testing.

Conclusions

There may be a delay in detection of persistent/recurrent CIN2/3 in a small number of cases without six‐month colposcopy and cytology; however, it is not likely to negatively impact overall clinical outcome. Co‐testing at 12 months following treatment of CIN2/3 without colposcopy is safe and routine colposcopy at collection of the co‐test can be omitted.
The axis of the receptor for advanced glycation endproducts in asthma and allergic airway disease
Authors: Perkins Timothy N. , Donnell Mason L. , Oury Tim D.
Published: September 2020

Asthma is a generalized term that describes a scope of distinct pathologic phenotypes of variable severity, which share a common complication of reversible airflow obstruction. Asthma is estimated to affect almost 400 million people worldwide, and nearly ten percent of asthmatics have what is considered “severe” disease. The majority of moderate to severe asthmatics present with a “type 2‐high” (T2‐hi) phenotypic signature, which pathologically is driven by the type 2 cytokines Interleukin‐(IL)‐4, IL‐5, and IL‐13. However, “type 2‐low” (T2‐lo) phenotypic signatures are often associated with more severe, steroid‐refractory neutrophilic asthma. A wide range of clinical and experimental studies have found that the receptor for advanced glycation endproducts (RAGE) plays a significant role in the pathogenesis of asthma and allergic airway disease (AAD). Current experimental data indicates that RAGE is a critical mediator of the type 2 inflammatory reactions which drive the development of T2‐hi AAD. However, clinical studies demonstrate that increased RAGE ligands and signaling strongly correlate with asthma severity, especially in severe neutrophilic asthma. This review presents an overview of the current understandings of RAGE in asthma pathogenesis, its role as a biomarker of disease, and future implications for mechanistic studies, and potential therapeutic intervention strategies.
Defining the impact of Peyronie's disease on the psychosocial status of gay men
Authors: Salter Carolyn A. , Nascimento Bruno , Terrier Jean‐Etienne , Taniguchi Hisanori , Bernie Helen , Miranda Eduardo , Jenkins Lawrence , Schofield Elizabeth , Mulhall John P.
Published: September 2020

Background

Little sexual health research has been conducted in gay men. Anecdotally, this population seems to experience more bother related to Peyronie's disease (PD).

Objectives

To examine the impact of PD on psychosocial factors in gay vs straight men.

Materials and Methods

All PD patients who were seen in the sexual medicine clinic were included. They completed three instruments: the PD questionnaire (PDQ), Self‐Esteem and Relationship (SEAR) questionnaire, and a depression questionnaire (CES‐D). We described demographics and sexual variables by sexual orientation. We then compared PDQ items and summary scores by sexual orientation, using a series of independent samples t tests.

Results

34 consecutive gay and 464 straight men were included. Age and baseline characteristics were similar between the two cohorts, with the exception that fewer gay men were partnered (56% vs 87%, P < .01), and those with a partner had a shorter relationship duration: 109 ± 9 months vs 262 ± 175 months, P < .01. For the SEAR questionnaire, gay men demonstrated a more significant psychosocial impact of PD overall with lower SEAR sums (41 vs 57, P = .01) and a lower sexual relationship subdomain score (28 vs 47, P < .01). 41% of gay men vs 26% of straight men had CES‐D scores consistent with depression as defined by a score of ≥16 (P = .09). In the PDQ domains, gay men scored less favorably with regard to bother scores (7 vs 5, P = .03) and pain scores (8 vs 4, P = .04).

Discussion

Gay men with PD experience significantly more psychosocial impact as evidenced by less favorable SEAR sum and sexual relationship scores, CES‐D scores, and PDQ pain and bother domain scores.

Conclusion

The psychosocial impact of PD is significant in all men, but it appears to be greater in gay men.
Ureteric complications and left retroperitoneal abdominal aortic surgery
Authors: Williams Alex C. , Bailey Damian M. , Lewis Michael H. , White Richard D. , Williams Ian M.
Published: September 2020

Background

Open surgery for abdominal aortic aneurysms in the UK is usually performed via a midline transperitoneal incision. However, the left retroperitoneal (RP) approach may be beneficial for juxtarenal abdominal aortic aneurysms and certain physiological reasons. One potential disadvantage is that the left kidney usually requires mobilization anteromedially risking injury to the renal tract and possibly the ureter.

Methods

In this retrospective study, the time of onset, clinical presentation and treatment of left renal tract complications are scrutinized and discussed. Reasons for open aortic surgery as opposed to endovascular repair being undertaken were documented. Also, the aortic cross‐clamp positions and type of reconstruction were examined.

Results

A total of 208 patients underwent RP aortic surgery for aneurysmal disease. The aortic cross‐clamp positions were infrarenal in 115 (55%), suprarenal in 78 (38%) and supra‐superior mesenteric artery or supracoeliac in 15 (7%). Two percent (4/208) sustained ureteric complications and all occurred in the upper third of the left ureter. The time of onset of symptoms ranged from 2 to 14 days post‐operatively with a median of 3.5. Clinical signs were non‐specific including pyrexia, tachycardia and flank pain.

Conclusion

Ureteric complications following left RP aortic surgery is uncommon and usually occurs in the upper third of the renal tract. Trauma appears to be the most common cause, although ureteric ischaemia can occur but presents later particularly in those with comorbidities.
The migration–family nexus in East Asia: Chinese family and the invisible within
Authors: Momesso Lara , Cheng Isabelle
Published: September 2020

Rapid economic growth in East Asia brings with it not only a development ‘miracle’ but also increased migration within and from China as well as in the Northeast–Southeast Asia corridors. The expanding migration flows make Chinese families in Singapore, Taiwan, mainland China and Hong Kong one of the most noticeable groups whose life trajectory is punctuated by migration. This special issue is a collective endeavour to explore deeply the internal dynamics between Chinese family members across generations in regard to care, production and reproduction in light of the challenges and opportunities brought about by neoliberal globalisation.
The Conditional Effects of Candidate Sex and Sexism on Perceived Electability and Voting Intentions: Evidence from the 2020 Democratic Primary
Authors: Franks Andrew S.
Published: September 2020

In each of two studies, six past or present Democratic presidential candidates (3 males, 3 females) were selected to construct groups of male and female candidates roughly matched in terms of prominence and ideological position. In Study 1, a conditional effect of candidate sex was found such that female candidates suffered deficits in voting intentions in participants at or above the 68th percentile in hostile sexism even when accounting for candidate familiarity. Simultaneously, sexism on its own predicted increased support for Donald Trump over the entire Democratic field. In Study 2, the conditional effect of candidate sex on voting intentions was positive (predicting greater support for women) for participants below the 26th percentile on sexism and negative for those above the 53rd percentile on sexism even when accounting for perceived electability, competence, and trustworthiness. The interaction also predicted perceived electability in an examination of conditional direct and indirect effects.
Ability of plant species to colonise human‐disturbed habitats: Role of phylogeny and functional traits
Authors: Mudrák Ondřej , Řehounková Klára , Vítovcová Kamila , Tichý Lubomír , Prach Karel
Published: September 2020

Question

Which species are successful colonisers of disturbed sites; species adapted to seed dispersal, resistance to abiotic stress, or competition ability? Are successful adaptations for colonisation shared by phylogenetically related species?

Location

Czech Republic, Central Europe.

Methods

We used two indices of plant species’ colonisation ability (developed from an extensive dataset of dated successional series for 1,531 plant species of the Czech Republic): index of colonisation potential (ICP), which is corrected for mass effect (species’ frequency in the landscape acquired from Czech National Phytosociological Database, accounting for more common colonisation events of frequent species), and index of colonisation success (ICS), which is solely based on actual species frequencies in disturbed habitats. We also used preferences for successional age (median of age of sites that species had colonised). We correlated these indices with plant functional traits for three functional groups (woody species, non‐woody perennial polycarpic, and non‐woody monocarpic species) either considering the phylogenetic history of a species or not.

Results

Woody species were the best colonisers and had the highest preferences for late‐successional stages. Non‐woody monocarpic species had a higher ICP than polycarpic species while their ICS were comparable. The best predictor of colonisation ability of both monocarpic and polycarpic non‐woody species was canopy height, indicating importance of competition. Other successful colonisers were species with seed traits promoting dispersal (low seed mass or low seed terminal velocity). We did not find traits suitable for adverse biotic conditions (high specific leaf area, SLA), low canopy height) to be important. Successional age preference of species was indicated mainly by seed traits (seed mass, seed longevity), which highly corresponded with species’ phylogenetic history.

Conclusions

Colonisation of disturbed sites is limited by seed dispersal and competitive interactions rather than an adverse abiotic environment.
Recommendations on COVID‐19 triage: international comparison and ethical analysis
Authors: Jöbges Susanne , Vinay Rasita , Luyckx Valerie A. , Biller‐Andorno Nikola
Published: September 2020

On March 11, 2020 the World Health Organization classified COVID‐19, caused by Sars‐CoV‐2, as a pandemic. Although not much was known about the new virus, the first outbreaks in China and Italy showed that potentially a large number of people worldwide could fall critically ill in a short period of time. A shortage of ventilators and intensive care resources was expected in many countries, leading to concerns about restrictions of medical care and preventable deaths. In order to be prepared for this challenging situation, national triage guidance has been developed or adapted from former influenza pandemic guidelines in an increasing number of countries over the past few months. In this article, we provide a comparative analysis of triage recommendations from selected national and international professional societies, including Australia/New Zealand, Belgium, Canada, Germany, Great Britain, Italy, Pakistan, South Africa, Switzerland, the United States, and the International Society of Critical Care Medicine. We describe areas of consensus, including the importance of prognosis, patient will, transparency of the decision‐making process, and psychosocial support for staff, as well as the role of justice and benefit maximization as core principles. We then probe areas of disagreement, such as the role of survival versus outcome, long‐term versus short‐term prognosis, the use of age and comorbidities as triage criteria, priority groups and potential tiebreakers such as ‘lottery’ or ‘first come, first served’. Having explored a number of tensions in current guidance, we conclude with a suggestion for framework conditions that are clear, consistent and implementable. This analysis is intended to advance the ongoing debate regarding the fair allocation of limited resources and may be relevant for future policy‐making.
Why IRBs should protect bystanders in human research
Authors: Kimmelman Jonathan
Published: September 2020

Many types of human research activities present risks and burdens to third parties (e.g., bystanders). Few human protection policies directly address the protection of research bystanders, though some address it in passing. In what follows, I re‐iterate reasons why bystanders are entitled to protections. I also argue that Institutional Review Boards (IRBs) are in the best position to signal to researchers and sponsors that bystanders should be protected in research. In some cases, IRB review would consist of evaluating bystander protection strategies directly; in other cases, this might entail merely certifying that another institutions, like a drug regulator, has taken adequate measures to protect the welfare of research bystanders.
Computerised risk scores to guide recognition and diagnosis in patients with possible heparin‐induced thrombocytopenia
Authors: Gallo Tyler , Curry Steven C. , Raschke Robert A.
Published: September 2020

The heparin‐induced thrombocytopenia computerised risk (HIT‐CR) score is designed to aid in the diagnosis of HIT. We sought to evaluate its potential clinical utility. In this retrospective cohort study, we collected HIT‐CR scores on all inpatients receiving heparin over a 4‐month period and performed chart reviews on the subset who independently underwent clinical diagnostic testing for HIT to identify patients with HIT. In all, 34 342 patients received heparin, 1744 had high‐risk HIT‐CR scores of ≥3 and 220 had the maximal risk score of 4. Only 6% of high‐risk and 10% of maximal‐risk patients underwent testing for HIT. Conversely, among all 317 patients who underwent independent testing for HIT, 67% had low‐risk HIT‐CR scores (<3). Among patients independently tested, the positive predictive value (PPV) was 6·6% [95% confidence interval (CI) 4·9–8·8%] and the negative predictive value (NPV) was 99·5% (95% CI 97·1–99·9%) at a HIT‐CR score cut‐off of 3, and the PPV was 22·7% (95% CI 12·7–37·4%) and NPV was 99·0% (95% CI 97·6–99·6%) at a cut‐off of 4. This study suggests clinicians fail to test most high‐risk patients and unnecessarily test many low‐risk patients for HIT. A reasonable approach to clinical application of HIT‐CR scores would be recommending no testing for patients with a score of <3 and recommend testing for patients with a score of 4.
The So‐Called Borderline Patient: Aetiology, Diagnosis, and Treatment
Authors: Trimboli Frank , Marshall Rycke L.
Published: September 2020

This short paper examines the relationship between borderline psychopathology and various theories regarding the aetiology of this disorder. In the formation of borderline personality organization, distinct structural alterations in personality development are thought to arise from both genetic/neurobiological and environmental/trauma factors. We concur that these variables are instrumental in the formation of borderline personality organization. However, we believe that genetic/neurobiological variables are more closely related to developmental deficits, whereas environmental/trauma factors are primarily associated with either arrested development or regressive phenomenon. Regardless of aetiology, the resultant borderline personality organization disorders may present with comparable symptoms. Further, we hypothesize that the prognosis for response to treatment is related primarily to whether the borderline disorder arises from developmental deficits, arrested development, or regressive phenomena. Diagnostic indicators and treatment considerations for each of the borderline aetiologies are presented.
Winnicott's Notion of ‘Holding’ as Applied to Serious Physical Illness
Authors: Vickers Neil
Published: September 2020

In this paper, I describe some of the ways in which D.W. Winnicott's notion of ‘holding’ might be seen as something intimates do for one another across the life cycle. Drawing on a wide selection of Winnicott's writings on the subject, I identify five characteristics of holding that many, perhaps most, Western adults take for granted in ordinary life. Holding enables us to split off catastrophe. It reduces our dependence and increases our sense of autonomy. It contains unmourned losses and sponsors transitional experience. It enables us to form psychosomatic communities with others. I then consider some of the ways in which these characteristics are thrown into jeopardy when serious physical illness arises.
Function and therapeutic potential of G protein‐coupled receptors in epididymis
Authors: Zhang Daolai , Wang Yanfei , Lin Hui , Sun Yujing , Wang Mingwei , Jia Yingli , Yu Xiao , Jiang Hui , Xu Wenming , Sun Jin‐Peng , Xu Zhigang
Published: September 2020

Infertility rates for both females and males have increased continuously in recent years. Currently, effective treatments for male infertility with defined mechanisms or targets are still lacking. G protein‐coupled receptors (GPCRs) are the largest class of drug targets, but their functions and the implications for the therapeutic development for male infertility largely remain elusive. Nevertheless, recent studies have shown that several members of the GPCR superfamily play crucial roles in the maintenance of ion–water homeostasis of the epididymis, development of the efferent ductules, formation of the blood–epididymal barrier and maturation of sperm. Knowledge of the functions, genetic variations and working mechanisms of such GPCRs, along with the drugs and ligands relevant to their specific functions, provide future directions and a great arsenal for new developments in the treatment of male infertility.
Beyond COVID‐19: Five commentaries on reimagining governance for future crises and resilience
Authors: Brousselle Astrid , Brunet‐Jailly Emmanuel , Kennedy Christopher , Phillips Susan D. , Quigley Kevin , Roberts Alasdair
Published: September 2020

Several Canadian and international scholars offer commentaries on the implications of the COVID‐19 pandemic for governments and public service institutions, and fruitful directions for public administration research and practice. This second suite of commentaries considers the challenges confronting governments as a result of the COVID‐19 pandemic and in the decades to come with an increasingly broad lens: the need to understand and rethink the architecture of the state given recent and future challenges awaiting governments; the need to rethink government‐civil society relations and policies to deliver services for increasingly diverse citizens and communities; the need for new repertoires and sensibilities on the part of governments for recognizing, anticipating, and engaging on governance risks despite imperfect expert knowledge and public skepticism; how the COVID‐19 crisis has caused us to reconceive international and sub‐national borders where new “borders” are being drawn; and the need to anticipate a steady stream of crises similar to the COVID‐19 pandemic arising from climate change and related challenges, and develop new national and international governance strategies for fostering population and community resilience.
Long‐term health‐related quality of life in persons diagnosed with an insulinoma in Finland 1980‐2010
Authors: Peltola Elina , Hannula Päivi , Huhtala Heini , Sintonen Harri , Metso Saara , Sand Juhani , Laukkarinen Johanna , Tiikkainen Mirja , Schalin‐Jäntti Camilla , Sirén Jukka , Soinio Minna , Nuutila Pirjo , Moilanen Leena , Ebeling Tapani , Jaatinen Pia
Published: September 2020

Objective

Insulinomas are rare pancreatic neoplasms, which can usually be cured by surgery. As the diagnostic delay is often long and the prolonged hyperinsulinemia may have long‐term effects on health and the quality of life, we studied the long‐term health‐related quality of life (HRQoL) in insulinoma patients.

Design, patients and measurements

The HRQoL of adults diagnosed with an insulinoma in Finland in 1980‐2010 was studied with the 15D instrument, and the results were compared to those of an age‐ and gender‐matched sample of the general population. The minimum clinically important difference in the total 15D score has been defined as ±0.015. The clinical characteristics, details of insulinoma diagnosis and treatment, and the current health status of the subjects were examined to specify the possible determinants of long‐term HRQoL.

Results

Thirty‐eight insulinoma patients participated in the HRQoL survey (response rate 75%). All had undergone surgery with a curative aim, a median of 13 (min 7, max 34) years before the survey. The insulinoma patients had a clinically importantly and statistically significantly better mean 15D score compared with the controls (0.930 ± 0.072 vs 0.903 ± 0.039, P = .046) and were significantly better off regarding mobility, usual activities and eating. Among the insulinoma patients, younger age at the time of survey, higher level of education and smaller number of chronic diseases were associated with better overall HRQoL.

Conclusions

In the long term, the overall HRQoL of insulinoma patients is slightly better than that of the general population.
Behind the Scaffolding: Manipulations of Time, Delays, and Power in Tarlabaşı, Istanbul
Authors: Arıcan Alize
Published: September 2020

Taksim 360, located in the Tarlabaşı neighborhood of Istanbul, is one of the first state‐led urban transformation projects in Turkey. Originally scheduled to be finished in 2014, the project is still under construction. Concordant with broader discussions, Tarlabaşı’s urban transformation has been largely studied through spatial lenses centered on accumulation by dispossession and displacement. These works assume that urban transformation projects necessarily follow a linear trajectory from inception to completion. Building on and diverging from this body of research, I examine the relationships between construction companies, subcontractors, and politicians involved in Taksim 360 through ethnographic fieldwork and media analysis with a critical emphasis on temporality. I argue that urban transformation in fact works through manipulations of time, which necessitates a temporal analytical lens that does not take teleologies of buildings projects for granted. It is specificallythrough delaysthat economic and political power is exerted, navigated, and negotiated within Taksim 360 using legal contracts, work stoppages, and stand‐offs; conjuring of continued investment; and improvisations with labor and political capital. And so, delays emerge asmodus operandiof urban transformation rather than measures of its failures or successes
On the value of Burmese amber for understanding insect evolution: Insights from †Heterobathmilla– an exceptional stem group genus of Strepsiptera (Insecta)
Authors: Pohl Hans , Wipfler Benjamin , Boudinot Brendon , Georg Beutel Rolf
Published: September 2020

Burmese amber and amber from other periods and regions became a rich source of new extinct insect species and yielded important insights in insect evolution in the dimension of time. Amber fossils have contributed to the understanding of the phylogeny, biology, and biogeography of insects and other groups, and have also gained great importance for dating molecular trees. Another major potential is the documentation of faunal, floral and climatic shifts. Evolutionary transitions can be well‐documented in amber fossils and can reveal anatomical transformations and the age of appearance of structural features. Here, using a new stem group species of Strepsiptera from Burmite, we evaluate this potential of amber insect fossils to assess the current phylogeny of Strepsiptera, with the main emphasis on the early splitting events in the stem group. Amber fossils have greatly contributed to the understanding of the evolution of Strepsiptera in the late Mesozoic and the Cenozoic. †Heterobathmilla kakopoiosPohl and Beutelgen. et sp. n.described here is placed in the stem group of the order, in a clade with †Kinzelbachilla(†Kinzelbachillidae) and †Phthanoxenos(†Phthanoxenidae). †Phthanoxenidae has priority over †Kinzelbachillidae, and the latter is synonymised. The superb details available from this new fossil allowed us to explore unique features of the antennae, mouthparts, and male copulatory apparatus, and to provide a phylogenetic hypothesis for the order. The younger †Protoxenosfrom Eocene Baltic amber was confirmed as sister to all remaining extinct and extant groups of Strepsiptera, whereas the position of the Cretaceous †Cretostylopsin the stem group remains ambivalent. While the value of Burmite and amber from other periods has a recognized impact on our knowledge of the evolution in various lineages, this new fossil does not fundamentally change our picture of the phylogeny and evolution of early Strepsiptera. However, it offers new insights into the morphological diversity in the early evolution of the group.
Further considerations of the best indicator for the harmful use of alcohol
Authors: Rehm Jürgen , Manthey Jakob , Franklin Ari , Shield Kevin D.
Published: September 2020

Introduction and Aims

We discuss the rejoinder of Sherwin to our review which came to the result that adult alcohol per capita consumption is the best indicator for the harmful use of alcohol for the sustainable development goals.

Design and Methods

Scientific discourse.

Results

Sherwin suggested two additional indicators, ‘age‐standardised prevalence of heavy episodic drinking among adolescents and adults’ and ‘alcohol‐related morbidity and mortality among adolescents and adults’. Given that these indicators should be part of the comprehensive sustainable development goals, we do not believe that three indicators for one target make sense. In addition, both suggested indicators are can only be derived using adult alcohol per capita consumption as basis.

Discussion and Conclusions

Adult per capita consumption should remain the indicator for the sustainable development goals.
Industry views about the Banned Drinker Register in the Northern Territory: Early lessons from a qualitative evaluation
Authors: Adamson Elizabeth , Clifford Sarah , Wallace Tessa , Smith James A.
Published: September 2020

Introduction and Aims

The Northern Territory Government has recently planned and implemented an extensive suite of alcohol harm minimisation policies, including the reintroduction of the Banned Drinker Register (BDR). It is an explicit alcohol supply reduction measure that places persons who consume alcohol at harmful levels onto a register, prohibiting the purchase of alcohol from take‐away liquor outlets. This paper explores industry stakeholders' perspectives regarding the extent to which the BDR is meeting its objectives to improve community health and safety by reducing alcohol‐related harms.

Design and Methods

Interviews and one focus group were conducted with 66 alcohol industry stakeholders from urban and remote locations. Focusing on outcomes both central (crime and safety) and peripheral (health and therapeutic support) to the stakeholders' interest, the authors used inductive thematic analysis to examine participants' perceptions about the effectiveness of the BDR.

Results

Analysis revealed mixed views about the effectiveness of the BDR. There is a tension between the objective to address public amenity and decrease crime, as expressed by the participants, compared to the health‐focused approach to therapeutic services and referrals identified in other sources.

Discussion and Conclusions

Drawing on these findings, alongside other relevant sources, the authors argue there is a need for a more effective communication strategy to the public and professional community to enhance the capacity of the BDR to meet its goals. The authors recognise the limitations of alcohol industry stakeholder views and identify the need for a comprehensive evaluation approach that includes multiple stakeholder perspectives.
Artificial intelligence in endoscopy: Present and future perspectives
Authors: Sumiyama Kazuki , Futakuchi Toshiki , Kamba Shunsuke , Matsui Hiroaki , Tamai Naoto
Published: September 2020

Artificial intelligence (AI) has been attracting considerable attention as an important scientific topic in the field of medicine. Deep‐leaning (DL) technologies have been applied more dominantly than other traditional machine‐learning methods. They have demonstrated excellent capability to retract visual features of objectives, even unnoticeable ones for humans, and analyze huge amounts of information within short periods. The amount of research applying DL‐based models to real‐time computer‐aided diagnosis (CAD) systems has been increasing steadily in the GI endoscopy field. An array of published data has already demonstrated the advantages of DL‐based CAD models in the detection and characterization of various neoplastic lesions, regardless of the level of the GI tract. Although the diagnostic performances and study designs vary widely, owing to a lack of academic standards to assess the capability of AI for GI endoscopic diagnosis fairly, the superiority of CAD models has been demonstrated for almost all applications studied so far. Most of the challenges associated with AI in the endoscopy field are general problems for AI models used in the real world outside of medical fields. Solutions have been explored seriously and some solutions have been tested in the endoscopy field. Given that AI has become the basic technology to make machines react to the environment, AI would be a major technological paradigm shift, for not only diagnosis but also treatment. In the near future, autonomous endoscopic diagnosis might no longer be just a dream, as we are witnessing with the advent of autonomously driven electric vehicles.
Gender differences in mothers’ spatial language use and children’s mental rotation abilities in Preschool and Kindergarten
Authors: Ralph Yvonne K. , Berinhout Kate , Maguire Mandy J.
Published: September 2020

Mental rotation has emerged as an important predictor of success in Science, Technology, Engineering, and Math (STEM). By the age of 4.5 years, boys outperform girls in these abilities. Because parents use less spatial language with girls at this age (Pruden and Levine, 2017), the amount of spatial language that children are exposed to at home is believed to be one potential contributor to this disparity in preschool age children. To date, it is unclear if this gender difference continues when children enter school. To address this question in this study, children not yet in kindergarten (PreK) and kindergarten and first grade children (K+) were recorded playing with their mothers using magnetic tile toys followed by children's completion of a mental rotation task. As expected, mothers used more spatial language with PreK boys than girls; however, this relationship reversed in K+, with mothers using significantly more spatial language with girls than boys. Surprisingly, despite this, boys outperformed girls on the mental rotation task. These findings suggest that although girls’ exposure to spatial language is higher after entry into school, this language difference is not reflected in increases in mental rotation abilities. Thus, earlier exposure to spatial language may be vital for the development of mental rotation abilities.