bluuebunny/crossref_metadata_2025 huggingface dataset:
The effects of amended sustainability reporting requirements on corporate social responsibility reporting and firm value: the moderating role of assurance
Authors: Bakry Ahmed Elsayed Awad , Azhar Zubir , Kishan K.
Published: July 2023

Purpose

To assist Malaysian public-listed companies (PLCs) in preparing corporate social responsibility (CSR) reports, Bursa Malaysia Berhad (BMB) launched the second edition of the Sustainability Reporting Guide (SRG) in 2018. This new SRG edition has several additional requirements for CSR reporting (CSRR), the most important of which is a chapter on assurance which provides detailed guidance on how it may be carried out. This study aims to determine whether the new SRG edition influences the extent of CSRR, and whether such effect is moderated by the provision of assurance on CSRR. It also aims to identify whether amending CSRR regulations and providing assurance on such reporting indirectly influences firm value through the possible improvement in the extent of CSRR.

Design/methodology/approach

This study performed a content analysis of the CSRR of a sample of Malaysian PLCs that maintained their positions among the top 100 companies by market capitalization between 2017 and 2020 to determine the extent of CSRR for the two years before and two years after the implementation of the new edition of SRG. This study conducted different statistical analyses to indicate whether the implementation of the second edition of SRG has an effect on enhancing the extent of CSRR, and whether the provision of assurance on such reporting moderates such an effect. This study then used instrumental variable regressions to examine the influence of the predicted extent of CSRR on firms’ value measured by Tobin’s Q.

Findings

This study found that the implementation of the second edition of SRG has a positive and significant influence on the extent of CSRR. This effect is strengthened by the provision of assurance on CSRR. Instrumental variable regressions also indicate that enhancing the extent of CSRR affected by the second edition of SRG is linked to higher firm value.

Originality/value

To the best of the authors’ knowledge, this study is one of the first to assess the determinants and implications of CSRR among Malaysian companies after adopting the second edition of SRG.
Service user participation in decision-making – a qualitative study from a services user’s perspective
Authors: Bendtsen Kronkvist Maria , Dahlqvist Jönsson Patrik , Forsberg Karl-Anton , Sandlund Mikael
Published: July 2023

Purpose

The purpose of this study is to describe participation in decision-making among service users with severe mental illness.

Design/methodology/approach

Service users want to participate in decision-making and in the planning of their care. There are widely known methods, such as shared decision-making, that could be used to facilitate service user participation. Three focus group interviews were conducted with the participation of 14 persons with mental illness and/or substance abuse who were service users at two Swedish Homes for Care and Residence (HVB). Data were analyzed by qualitative content analysis.

Findings

Two themes emerged: service users’ involvement in decisions is hampered by the professionals’ approach and adequate information and experience of participation means greater empowerment.

Research limitations/implications

Although it is known that service users would like to have more influence, and that methods like shared decision-making are recommended to empower service users and improve the decision process, research on these matters is limited.

Practical implications

This study reveals that there is a need of more systematic decisional support, such as shared decision-making, so that service users can be seen as important persons not only in guidelines and policy documents but also in clinical practice.

Social implications

The findings indicate that service users do not participate in decisions systematically, although policies, guidelines and laws providing that service users should be offered an active part in decision-making with regard to their care and treatment.

Originality/value

Although it is known that service users would like to have more influence, and that methods like shared decision-making are recommended to empower service users and improve their decision process, research on these matters is limited. The findings indicate that service users do not participate in decisions systematically, even though policies, guidelines and laws are in place stipulating that service users should be offered an active part in decision-making with regard to their own care and treatment. The results of this project bring improvement opportunities to light.
Finite element and generalized regression neural network modelling of multiple cracks growth under the influence of multiple crack parameters
Authors: Hidayat Mas Irfan P. , Pramata Azzah D. , Airlangga Prima P.
Published: July 2023

Purpose

This study presents finite element (FE) and generalized regression neural network (GRNN) approaches for modeling multiple crack growth problems and predicting crack-growth directions under the influence of multiple crack parameters.

Design/methodology/approach

To determine the crack-growth direction in aluminum specimens, multiple crack parameters representing some degree of crack propagation complexity, including crack length, inclination angle, offset and distance, were examined. FE method models were developed for multiple crack growth simulations. To capture the complex relationships among multiple crack-growth variables, GRNN models were developed as nonlinear regression models. Six input variables and one output variable comprising 65 training and 20 test datasets were established.

Findings

The FE model could conveniently simulate the crack-growth directions. However, several multiple crack parameters could affect the simulation accuracy. The GRNN offers a reliable method for modeling the growth of multiple cracks. Using 76% of the total dataset, the NN model attained an R2 value of 0.985.

Research limitations/implications

The models are presented for static multiple crack growth problems. No material anisotropy is observed.

Practical implications

In practical crack-growth analyses, the NN approach provides significant benefits and savings.

Originality/value

The proposed GRNN model is simple to develop and accurate. Its performance was superior to that of other NN models. This model is also suitable for modeling multiple crack growths with arbitrary geometries. The proposed GRNN model demonstrates its prediction capability with a simpler learning process, thus producing efficient multiple crack growth predictions and assessments.
Communication to protect brand image during a terrorism crisis: Application of situational crisis communication theory
Authors: Domschat Laura , Stephens Melodena , Saeed Hamid
Published: July 2023

We examined the impact of attributed responsibility and crisis communication for a terrorism crisis on brand image. This crisis scenario involved the loss of life. Using an experimental design methodology and based on the response of 209 respondents, we find that brand image, as expected decreases post‐terrorism. Various types of communication responses were ranked as appropriate and assessed as to impact on the brand. We found that during an event involving the loss of life, the public wanted the brand to apologize and compensate for the grief and loss, irrespective of attribution. The least appropriate communication strategies were justification and excuse and inappropriate communication decreased brand image more than after the attack. This could be because there was insufficient information at that moment to prove guilt or innocence, and the public wanted some form of retribution, perhaps as a method of dealing with the shock and grief. The communications perceived as more appropriate, for example, apology and compensation, were shown to increase the brand image to a higher level immediately after the attack than before the attack. This paper adds to our knowledge of situational crisis communication theory and extends the theory on definition of terrorism, complation of communication strategies, and on suggests how to prevent brand image loss or brand burn during a terrorism crisis.
Effects of state reinsurance programs on health insurance exchange premiums and insurer participation
Authors: Oyeka Onyinye , Wehby George L.
Published: July 2023

Objective

The aim of the study was to estimate the effect of the state‐based reinsurance programs through the section 1332 State Innovation Waivers on health insurance marketplace premiums and insurer participation.

Data Source

2015 to 2022 Robert Wood Johnson Foundation Health Insurance Exchange Compare Datasets.

Study Design

An event study difference‐in‐differences (DD) model separately for each year of implementation and a synthetic control method (SCM) are used to estimate year‐by‐year effects following program implementation.

Data Collection/Extraction Methods

Not applicable.

Principal Findings

Reinsurance programs were associated with a decline in premiums in the first year of implementation by 10%–13%, 5%–19%, and 11%–17% for bronze, silver, and gold plans (p < 0.05). There is a trend of sustained declines especially for states that implemented their programs in 2019 and 2020. The SCM analyses suggest some effect heterogeneity across states but also premium declines across most states. There is no evidence that reinsurance programs affected insurer participation.

Conclusion

State‐based reinsurance programs have the potential to improve the affordability of health insurance coverage. However, reinsurance programs do not appear to have had an effect on insurer participation, highlighting the need for policy makers to consider complementary strategies to encourage insurer participation.
The fatter the tail, the shorter the sail
Authors: Alsunbul Saad , Alzugaiby Basim , Chaudhry Sajid , Boujlil Rhada
Published: July 2023

Guided by the extreme value theory, this study empirically investigates the impact of tail risk measures on financial distress of publicly traded bank holding companies (BHCs) in the United States. Our results show that tail risk measures namely, value‐at‐risk and expected shortfall, are significantly and positively related to banks distress risk. Implying that BHCs with more frequent extreme negative daily equity returns induce higher tail risks, thereby increasing their likelihood of experiencing financial distress. Our results also show that tail risk measures enhance the explanatory power of traditional models explaining banks distress risk based on accounting information. These results indicate that market discipline is generally beneficial in managing and regulating banks, bolstering claims of the importance of macro‐prudential supervision of financial institutions.
The prevalence and associations of Australian early‐career general practitioners' provision of after‐hours care
Authors: Turnock Allison , Fielding Alison , Moad Dominica , Tapley Amanda , Davey Andrew , Holliday Elizabeth , Ball Jean , Bentley Michael , FitzGerald Kristen , Kirby Catherine , Spike Neil , van Driel Mieke L. , Magin Parker
Published: July 2023

Introduction

Access to after‐hours care (AHC) is an important aspect of general practice service provision.

Objective

To establish the prevalence and associations of early‐career GPs' provision of AHC.

Design

An analysis of data from the New alumni Experiences of Training and independent Unsupervised Practice (NEXT‐UP) cross‐sectional questionnaire‐based study. Participants were early‐career GPs (6‐month to 2‐year post‐Fellowship) following the completion of GP vocational training in NSW, the ACT, Victoria or Tasmania. The outcome factor was ‘current provision of after‐hours care’. Associations of the outcome were established using multivariable logistic regression.

Findings

Three hundred and fifty‐four early‐career GPs participated (response rate 28%). Of these, 322 had responses available for analysis of currently performing AHC. Of these observations, 128 (40%) reported current provision of AHC (55% of rural participants and 32% of urban participants). On multivariable analysis, participants who provided any AHC during training were more likely to be providing AHC (odds ratio (OR) 5.51, [95% confidence interval (CI) 2.80–10.80], p < 0.001). Current rural location and in‐training rural experience were strongly associated with currently providing AHC in univariable but not multivariable analysis.

Discussion

Early‐career GPs who provided AHC during training, compared with those who did not, were more than five times more likely to provide after‐hours care in their first 2 years after gaining Fellowship, suggesting participation in AHC during training may have a role in preparing registrars to provide AHC as independent practitioners.

Conclusion

These findings may inform future GP vocational training policy and practice concerning registrars' provision of AHC during training.
Lymph node dissection during radical cystectomy for bladder cancer: A two‐center comparative study of robotic versus open surgery
Authors: Sasaki Yutaro , Daizumoto Kei , Fukuta Kyotaro , Shiozaki Keito , Nishiyama Mitsuki , Utsunomiya Seiya , Kobayashi Saki , Seto Kosuke , Ueno Yoshiteru , Tomida Ryotaro , Kusuhara Yoshito , Fukawa Tomoya , Nakanishi Ryoichi , Yamaguchi Kunihisa , Yamamoto Yasuyo , Izaki Hirofumi , Takahashi Masayuki
Published: July 2023

Introduction

This study was performed to evaluate the safety and efficacy of lymph node dissection (LND) during robot‐assisted radical cystectomy (RARC) compared with open radical cystectomy (ORC).

Methods

From October 2003 to December 2021, 122 patients underwent LND during RARC and 103 patients underwent LND during ORC at Tokushima University Hospital and Tokushima Prefectural Central Hospital. We investigated the safety and efficacy of LND during RARC by comparing the surgical and oncological outcomes between the two groups.

Results

The patients were significantly older in the RARC than the ORC group. The operative time was significantly shorter and the estimated blood loss was significantly lower in the RARC than the ORC group. Although the lymph node yield was significantly higher in the RARC than the ORC group, there was no significant difference in lymph node positivity between the groups. There was no significant difference in the incidence of local recurrence or distant metastasis between the two groups. The 5‐year survival rates (overall survival, cancer‐specific survival, and recurrence‐free survival) were not different between the RARC and ORC groups.

Conclusion

This study suggests that the surgical and oncological safety and efficacy of LND during RARC are greater than those of LND during ORC. We believe that LND during RARC is a higher‐quality procedure than LND during ORC.
An evidence‐based demand management strategy using a hub and spoke training model reduces waiting time for children's therapy services: An implementation trial
Authors: Harding Katherine E. , Lewis Annie K. , Dennett Amy , Hughes Kylie , Clarke Michelle , Taylor Nicholas F.
Published: July 2023

Background

Waiting lists for community‐based paediatric therapy services are common and lead to poorer health outcomes, anxiety and missed opportunities for treatment during crucial developmental stages. The Specific Timely Appointments for Triage (STAT) model has been shown to reduce waiting lists in a range of health settings.

Aims

To determine whether providing training and support in the STAT model to champions within five community health centres using a remote ‘hub and spoke’ approach could reduce waiting time from referral to first appointment.

Methods

Representatives from five community health centres providing paediatric therapy services (speech therapy, occupational therapy and other allied health services) participated in five online workshops over 6 months. They were guided sequentially through the steps of the STAT model: understanding supply and demand, reducing backlogs, preserving space for new patients based on demand and redesigning models of care to maintain flow. Waiting time was measured in three consecutive years (pre, during and post intervention) and compared using the Kruskal–Wallis test. Employee satisfaction and perception of the model were explored using surveys.

Results

Data from 2564 children (mean age 3.2 years, 66% male) showed a 33% reduction in waiting time from the pre‐intervention (median 57 days) to the post‐intervention period (median 38 days, p < 0.01). The total number of children waiting was observed to reduce from 335 immediately prior to the intervention (mean per centre 67, SD 25.1) to 112 (mean 22, SD 13.6) after implementation (t[8] = 3.56, p < 0.01). There was no impact on employee satisfaction or other aspects of service delivery.

Conclusion

Waiting lists are a major challenge across the health system. STAT provides a practical, low‐cost, data‐driven approach to tackling waiting times. This study demonstrates its effectiveness in paediatric therapy services and provides evidence for a ‘hub and spoke’ approach to facilitate implementation that could be provided at scale.
Distinct CRTH2+CD161+ (peTh2) memory CD4+ T‐cell cytokine profiles in food allergy and eosinophilic gastrointestinal disorders
Authors: Makiya Michelle A. , Brown Thomas , Holland Nicole , Wetzler Lauren , Ware JeanAnne M. , Khoury Paneez , Frischmeyer‐Guerrerio Pamela A. , Klion Amy D. , Kuang Fei Li
Published: July 2023

Introduction

Although IgE‐mediated food allergy (FA) and eosinophilic gastrointestinal disorders (EGID) are clinically distinct and treated differently, pathogenic effector Th2 (peTh2) cells are implicated in the pathogenesis of both FA and EGID. The aim of this study was to better characterize peTh2 cells in the context of FA and EGID and the overlap between these two conditions.

Methods

Peripheral blood peTh2 cells (CD3+CD4+CD27−CD49d+CRTH2+CD161+) were profiled by intracellular cytokine flow cytometry in the following patient cohorts: patients with FA alone (n = 8), FA and food‐triggered EGID (EGID+FA+FT, n = 7), food‐triggered EGID alone (EGID+FT, n = 7), EGID without FA or specific food triggers (ONLY_EGID, n = 9), and healthy volunteers (HV, n = 7). Overnight peripheral blood mononuclear cell (PBMC) culture supernatants were assessed for cytokine production by multiplex analysis.

Results

CRTH2+CD161+ (peTh2) memory CD4+ T cells were significantly increased in both patients with FA and those with ALL_EGID (inclusive of EGID+FA+FT, EGID+FT and ONLY_EGID) when compared to HV. However, ALL_EGID patients, particularly those with EGID+FA+FT, had significantly elevated IL‐5+IL‐13+ peTh2 cells, whereas FA patients had significantly elevated IFN‐γ or IL‐17A‐expressing peTh2 cells. This finding was supported by increased spontaneous IL‐5 and IL‐13 production in overnight cultures of PBMC from EGID+FA+FT patients compared to spontaneous IL‐10 and IFN‐γ production by PBMC from FA patients. FA patients had increased IL‐9, IL‐10, IL‐17A, and IFN‐γ production in overnight cultures of stimulated PBMC.

Conclusions

EGID and IgE‐mediated FA share a common cell subtype defined by specific surface markers and termed CRTH2+CD161+ (peTh2) memory CD4+ T cells. However, the cytokine profiles of these CRTH2+CD161+ (peTh2) memory CD4+ T cells are markedly different between the two disorders.
Biofilm formation on metal alloys and coatings, zirconia, and hydroxyapatite as implant materials in vivo
Authors: Meier Donat , Astasov‐Frauenhoffer Monika , Waltimo Tuomas , Zaugg Lucia K. , Rohr Nadja , Zitzmann Nicola U.
Published: July 2023

Objectives

Composition of implant material and its surface structure is decisive for oral biofilm accumulation. This study investigated biofilm formation on eight different materials.

Materials and Methods

Eighteen healthy subjects wore intraoral splints fitted with two sets of eight materials for 24 h: zirconia [ZrO2]; silver‐gold–palladium [AgAuPd]; titanium zirconium [TiZr]; Pagalinor [PA]; hydroxyapatite [HA]; silver‐platinum [AgPt]; titanium aluminum niobium [TAN]; titanium grade4 [TiGr4]. Total biomass was stained by safranin to assess plaque accumulation while conventional culturing (CFU) was conducted to investigate viable parts of the biofilm. Cell viability of human gingival fibroblasts (HGF‐1) was assessed in vitro. Statistical evaluation was performed with linear mixed‐effects models to compare materials (geometric mean ratios, 95% CI), with the level of significance set at ɑ = .05.

Results

Less biofilm mass and CFU were found on noble metal alloys (AgPt, AgAuPd, and PA). Compared to AgPt, PA had 2.7‐times higher biofilm mass value, AgAuPd was 3.9‐times, TiGr4 was 4.1‐times, TiZr was 5.9‐times, TAN was 7.7‐times, HA was 7.8‐times, and ZrO2 was 9.1‐times higher (each p < .001). Similarly, CFU data were significantly lower on AgPt, AgAuPd had 4.1‐times higher CFU values, PA was 8.9‐times, TiGr4 was 11.2‐times, HA was 12.5‐times, TiZr was 13.3‐times, TAN was 16.9‐times, and ZrO2 was 18.5‐times higher (each p < .001). HGF‐1 viability varied between 47 ± 24.5% (HA) and 94.4 ± 24.6% (PA).

Conclusion

Noble alloys are considered as beneficial materials for the transmucosal part of oral implants, as less biofilm mass, lower bacterial counts, and greater cell viability were detected than on titanium‐ or zirconia‐based materials.
An artificial intelligence algorithm for the classification of sphenoid sinus pneumatisation on sinus computed tomography scans
Authors: Taylor Alon , Habib Al‐Rahim , Kumar Ashnil , Wong Eugene , Hasan Zubair , Singh Narinder
Published: July 2023

Background

Classifying sphenoid pneumatisation is an important but often overlooked task in reporting sinus CT scans. Artificial intelligence (AI) and one of its key methods, convolutional neural networks (CNNs), can create algorithms that can learn from data without being programmed with explicit rules and have shown utility in radiological image classification.

Objective

To determine if a trained CNN can accurately classify sphenoid sinus pneumatisation on CT sinus imaging.

Methods

Sagittal slices through the natural ostium of the sphenoid sinus were extracted from retrospectively collected bone‐window CT scans of the paranasal sinuses for consecutive patients over 6 years. Two blinded Otolaryngology residents reviewed each image and classified the sphenoid sinus pneumatisation as either conchal, presellar or sellar. An AI algorithm was developed using the Microsoft Azure Custom Vision deep learning platform to classify the pattern of pneumatisation.

Results

Seven hundred eighty images from 400 patients were used to train the algorithm, which was then tested on a further 118 images from 62 patients. The algorithm achieved an accuracy of 93.2% (95% confidence interval [CI] 87.1–97.0), 87.3% (95% CI 79.9–92.7) and 85.6% (95% CI 78.0–91.4) in correctly identifying conchal, presellar and sellar sphenoid pneumatisation, respectively. The overall weighted accuracy of the CNN was 85.9%.

Conclusion

The CNN described demonstrated a moderately accurate classification of sphenoid pneumatisation subtypes on CT scans. The use of CNN‐based assistive tools may enable surgeons to achieve safer operative planning through routine automated reporting allowing greater resources to be directed towards the identification of pathology.
Efficacy of a novel self‐assembling peptide gel for initial hemostasis during cold snare polypectomy for multiple duodenal adenomas
Authors: Dohi Osamu , Seya Mayuko , Yoshida Naohisa
Published: July 2023

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Is socio‐economic status associated with risk of childhood type 1 diabetes? Literature review
Authors: Lopez‐Doriga Ruiz Paz , Stene Lars C.
Published: July 2023

Aims

Studies of social inequality and risk of developing type 1 diabetes are inconsistent. The present review aimed to comprehensively review relevant literature and describe what has been reported on socio‐economic status or parental occupation and risk of type 1 diabetes in children.

Methods

We searched for publications between 1 January 1970 and 30 November 2021. We focused on the most recent and/or informative publication in cases of multiple publications from the same data source and referred to these as primary studies.

Results

Our search identified 69 publications with relevant data. We identified eight primary cohort studies with individual‐level data, which we considered the highest quality of evidence. Furthermore, we identified 13 primary case–control studies and 14 semi‐ecological studies with area‐level socio‐economic status variables which provided a weaker quality of evidence. Four of eight primary cohort studies contained data on maternal education, showing non‐linear associations with type 1 diabetes that were not consistent across studies. There was no consistent pattern on the association of parental occupation and childhood‐onset type 1 diabetes.

Conclusions

There is a need for more high‐quality studies, but the existing literature does not suggest a major and consistent role of socio‐economic status in the risk of type 1 diabetes.
Bioclimatic variables and their impact on the potential distribution of Brenneria goodwinii in Europe
Authors: Tkaczyk Miłosz
Published: July 2023

Brenneria goodwinii is a Gram‐negative bacterium associated with the phenomenon of Acute Oak Decline (AOD), which has played a very important role in the decline of oak populations in Europe in recent years. In this paper, the Maxent model was developed to detect the trend in the distribution of B. goodwinii in Europe. Generated from confirmed location data and bioclimatic variables, the Maxent model achieved high predictive accuracy as measured by parameters such as AUC and AUCdiff. Nineteen bioclimatic variables available on the WorldClim portal for the years 1970–2000 were used to create the model. The generated model allows to determine the most useful bioclimatic variables to assess the maximum entropy of the habitat in terms of the occurrence of B. goodwinii. In addition, the model identified areas of Europe where the probabilities of fit for bacteria are >.7. These areas include Great Britain, France, Belgium, the Netherlands, Germany, Denmark, Spain, Portugal and Italy.
Venetoclax‐based therapy for relapsed or refractory acute myeloid leukaemia following intensive induction chemotherapy
Authors: Kristensen Daniel Tuyet , Brøndum Rasmus Froberg , Ørskov Andreas Due , Marcher Claus Werenberg , Schöllkopf Claudia , Sørensen Anne Louise Tølbøll , Severinsen Marianne Tang , Bøgsted Martin , Roug Anne Stidsholt
Published: July 2023

Background

The treatment of relapsed or refractory (R/R) acute myeloid leukaemia (AML) remains challenging and outcomes extremely poor. The introduction of venetoclax has transformed the treatment of AML and emerging data suggest that venetoclax‐based therapy may enforce salvage treatment.

Materials and Methods

In this nationwide Danish retrospective study, we analysed treatment outcomes of venetoclax‐based salvage treatment for R/R AML between 2019 and 2022. Only venetoclax‐naive patients who had previously received treatment with intensive chemotherapy therapy were included.

Results

The cohort consisted of 43 R/R patients with a median age of 57 years. Nine (20.9%) were primary refractory and 34 (79.1%) patients had relapsed, including 21 after previous allogeneic stem cell transplantation. The overall response rate was 76.2% including 61.9% with composite complete remission (CRc: CR + CRi). Among CRc‐responders with information on measurable residual disease (MRD), 8/13 (61.5%) obtained an MRD‐negativity response. The overall survival was 9.3 months for all patients with an estimated 1‐year overall survival of 34%. For CRc‐responders the median overall survival was 13.3 months, and the median relapse‐free survival was 12.8 months.

Conclusion

Venetoclax‐based salvage treatment for R/R AML produced high response rates; however, for most patients the response was of limited duration. This study is limited by an observational design and prone to selection bias.
Near‐death experiences are associated with rapid eye movement (REM) sleep intrusions in migraine patients, independent of migraine aura
Authors: Raffaelli Bianca , Kull Pia , Mecklenburg Jasper , Lange Kristin S. , Overeem Lucas H. , Fitzek Mira P. , Siebert Anke , Steinicke Maureen , Triller Paul , Neeb Lars , Dreier Jens P. , Reuter Uwe , Kondziella Daniel
Published: July 2023

Background and purpose

Migraine aura, near‐death experiences (NDEs), and rapid eye movement (REM) sleep intrusions might share common mechanisms. Here, we investigated the prevalence of NDEs and REM sleep intrusions in people with migraine. We hypothesized that NDEs and REM sleep intrusions are more prevalent in migraine patients with aura than in those without.

Methods

We conducted a prospective cross‐sectional cohort study at a tertiary headache center, based on a prespecified sample size (n = 808). Migraine patients completed a series of questionnaires, including questions about demographic and headache characteristics, the 16‐item Greyson NDE scale, four questions about REM sleep intrusions, and the Depression, Anxiety, and Stress Scale 21 (DASS‐21).

Results

Of 808 migraine patients (mean age 44.4 ± 13.3 years, 87.0% women), 353 (43.7%) had a current or previous history of migraine aura. Prevalence of NDE was 2.7% and not different in patients with and without aura (2.8% vs. 2.6%; p > 0.999). REM sleep intrusions were reported by 5.4% of participants and in a similar proportion of patients with and without aura (6.3% vs. 4.9%; p = 0.43). However, participants with REM sleep intrusions had had an NDE more often than participants without REM sleep intrusions (n = 5/44, 11.4% vs. n = 17/754, 2.2%; p = 0.005). Higher DASS‐21 scores were associated with REM sleep intrusions (p < 0.001).

Conclusions

In this tertiary center cohort study, the prevalence of NDE and REM sleep intrusions was not influenced by migraine aura status. However, we identified an association between NDE and REM sleep intrusions, which corroborates the notion that they might share pathophysiological mechanisms.
Altered frequency of FOXP3+ regulatory T cells is associated with development of inhibitors in patients with severe hemophilia A
Authors: Arandi Nargess , Zekavat Omid Reza , Shokrgozar Negin , Shahsavani Amin , Golmoghaddam Hossein , Kalani Mehdi
Published: July 2023

Introduction

The development of anti‐factor VIII (FVIII) antibodies or “inhibitors” is a major complication following FVIII replacement therapy in patients with severe hemophilia A (HA), rendering the treatment inefficient. Data on the role of regulatory T cells (Tregs) in inhibitor formation in these patients are rare. Herein, we aimed to investigate whether a difference in the FOXP3+ Tregs is linked to the formation of the inhibitors in severe HA patients.

Methods

In this cross‐sectional study, 32 patients with severe HA (8 patients with inhibitors and 24 without inhibitors) and 24 healthy controls were enrolled. The frequency of FOXP3+ Tregs was determined using multicolor flow cytometry method.

Results

Our results showed that the median level of CD4+CD25+FOXP3+ Tregs did not significantly differ between HA patients and healthy controls and between HA patients with and without inhibitors (P > 0.05). However, patients with inhibitors had significantly lower amounts of CD4+CD25−FOXP3+ Tregs compared to those without inhibitors as well as healthy controls (*P = 0.012 and *P = 0.004, respectively). The frequency of CD4+CD25+ T cells was significantly higher in HA patients who developed inhibitors compared to the inhibitor‐negative ones whereas they were lower in inhibitor‐negative patients compared to the healthy controls (*P = 0.013 and *P = *0.029, respectively). The percentages of CD4+CD25+ T cells were positively correlated with the levels of inhibitors in HA patients (r = 0.45, *P = 0.021).

Conclusion

Our data demonstrated for the first time that the CD4+CD25−FOXP3+ Tregs might be implicated in the prevention of inhibitor formation in severe HA patients.
Associations between symptoms and functional capacity in patients after COVID‐19 infection and community controls
Authors: Huynh Quan , Wexler Noah , Smith Joel , Wright Leah , Ho Felicia , Allwood Richard , Sata Yusuke , Manca Stefano , Howden Erin , Marwick Thomas H.
Published: July 2023

Background

Post‐acute sequelae of COVID‐19 (PASC or ‘long COVID’) reflect ongoing symptoms, but these are non‐specific and common in the wider community. Few reports of PASC have been compared with a control group.

Aims

To compare symptoms and objective impairment of functional capacity in patients with previous COVID‐19 infection with uninfected community controls.

Methods

In this community‐based, cross‐sectional study of functional capacity, 562 patients from Western Melbourne who had recovered from COVID‐19 infections in 2021 and 2022 were compared with controls from the same community and tested for functional capacity pre‐COVID‐19. Functional impairment (<85% of the predicted response) was assessed using the Duke Activity Status Index (DASI) and 6‐min walk distance (6MWD) test. A subgroup underwent cardiopulmonary exercise testing before and after exercise training.

Results

Of 562 respondents (age 54 ± 12 years, 69% women), 389 were symptomatic. Functional impairment (<85% predicted metabolic equivalent of tasks) was documented by DASI in 149 participants (27%), and abnormal 6MWD (<85% predicted) was observed in 14% of the symptomatic participants. Despite fewer risk factors and younger age, patients with COVID‐19 had lower functional capacity by 6MWD (P < 0.001) and more depression (P < 0.001) than controls. In a pilot group of seven participants (age 58 ± 12 years, two women, VO2 18.9 ± 5.7 mL/kg/min), repeat testing after exercise training showed a 20% increase in peak workload.

Conclusions

Although most participants (69%) had symptoms consistent with long COVID, significant subjective functional impairment was documented in 27% and objective functional impairment in 14%. An exercise training programme might be beneficial for appropriately selected patients.
SMAD4 regulates the progression of cholangiocarcinoma by modulating the expression of STING1
Authors: Shi An‐da , Zhao Li‐ming , Sheng Guo‐li , Zhang Ge‐ning , Tang Yong‐chang , Li Kang‐shuai , Zhang Zong‐li
Published: July 2023

SMAD4 is a tumour suppressor and an important regulator of tumour immune scape which is downregulated in cholangiocarcinoma (CCA). STING1 is a vital sensing factor of abnormal DNA; however, the correlation between SMAD4 and STING1 and the role of the SMAD4‐STING1 interaction in the progression of CCA have not yet been evaluated. Public database was analysed to reveal the expression of SMAD4 and STING1. A cohort comprising 50 iCCA, 113 pCCA and 119 dCCA patients was assembled for the study. Immunohistochemistry was employed to evaluate the expression levels of STING1 and SMAD4. In vitro transwell and CCK8 assays, along with luciferase reporter assay, were conducted to analyse the potential regulatory mechanisms of SMAD4 on the expression of STING1. Expression of SMAD4 and STING1 were downregulated in CCA tumours and STING1 expression correlated with SMAD4 expression. The overexpression of SMAD4 was found to suppress the migration, invasion and proliferation capabilities of CCA cells; whereas, the knockdown of SMAD4 enhanced these abilities. Furthermore, it was observed that SMAD4 translocated into the nucleus following TGF‐β1 stimulation. Knockdown of SMAD4 resulted in the inhibition of STING1 transcriptional activity, whereas the overexpression of SMAD4 promoted the transcriptional activity of STING1. Clinically, low STING1 and SMAD4 expression indicated poor prognosis in CCA, and simultaneously low expression of STING1 and SMAD4 predicts poorer patient survival. SMAD4 regulates the expression of STING1 through its transcription regulating function. Dual low expression of STING1 and SMAD4 had more power in predicting patient survival. These results indicate that SMAD4‐silenced CCA may downregulate its STING1 expression to adapt to the immune system.
Sweeteners allulose and neotame for potential use in house fly baits
Authors: Taylor Elizabeth E. , Barguez‐Arias Noah N. , Herrera Roseleen , King Bethia H. , Burgess Edwin R.
Published: July 2023

The house fly, Musca domestica, is a cosmopolitan filth fly pest common in agricultural and urban areas where decaying organic matter is available for larval development. Adult M. domestica are nuisances and vectors of disease. When sanitation, screens, and sticky fly strips fail to control house fly populations, insecticide baits are often used. The use of baits can lead to the evolution of resistance, including not only physiological resistance to the toxicant but also behavioural resistance to the phagostimulant and to the toxicant. Here, the non‐nutritive sweeteners neotame and allulose were examined for their suitability as replacement phagostimulants in insecticidal baits for house flies. Suitability was assessed using proboscis extension response (PER) and consumption experiments. Allulose was further examined for insecticidal activity. Dry neotame elicited no PER, and it would not easily go into solution, so it was not examined in solution. Both in dry form and in solution, allulose elicited some PER and consumption, but only half or less of what sucrose or fructose elicited. Flies fed allulose alone had lower survival rates than flies fed sucrose alone. When given both allulose and sucrose, flies survived at similar rates to flies only fed sucrose. Neotame is not recommended as a replacement phagostimulant in bait formulations. Allulose alone is not recommended as a replacement phagostimulant. It remains to be seen whether combining allulose with sucrose as the phagostimulant in baits would result in as much bait consumption as just sucrose. If so, it might be worth testing whether the combination could serve as a rotational phagostimulant to prevent behavioural resistance to sucrose from evolving.
The nutritional impact of CD19‐targeted CAR‐T therapy versus BEAM chemotherapy for adult patients with lymphoma
Authors: Ahern Katie , Pham James , Sanderson Robin , Correia De Farias Madson , Walsh Kevin
Published: July 2023

Background

Chimeric antigen receptor T (CAR‐T) cell therapy is a novel therapy demonstrating durable remissions in patients with refractory or relapsing non‐Hodgkin's B‐cell lymphoma. Maintaining a patient's nutritional status has been demonstrated to improve outcomes in cancer treatment. However, no studies have investigated how CAR‐T therapy affects nutritional status, nor compared its impact with other cancer treatments for this patient group. The primary aim of the present study was to investigate the effect of CAR‐T therapy on the prevalence of nutrition impact symptoms (NIS) and nutritional status within 30 days post‐treatment of patients with lymphoma compared to a conditioning regimen for autologous haematopoetic stem cell transplant (carmustine/BCNU, Etoposide, cytarabine/Ara‐C, Melphalan [BEAM] auto‐haematopoetic stem cell transplant [HSCT]).

Methods

Clinical notes of patients with lymphoma who underwent either CAR‐T therapy or BEAM auto‐HSCT between 2018 and 2021 were reviewed. Data extracted included body weight measurements and NIS, including decreased appetite, nausea, vomiting, diarrhoea, constipation, mucositis, cytokine release syndrome (CRS) and neurotoxicity at baseline and 30 ± 7 days post‐treatment.

Results

In total, 129 adults with lymphoma (n = 88 CAR‐T vs. n = 41 BEAM) were included. Nutritional status was assessed in both groups at baseline prior to treatment. Mean absolute weight change was significantly different between groups (3.05 kg in CAR‐T, −5.9 kg in BEAM, p ≤ 0.001). This was also significant when weight loss was categorised into percentage weight loss (p = 0.01). CAR‐T patients experienced a significantly lower prevalence of decreased appetite (52.3% vs. 97.6%) nausea (25% vs. 78%,) vomiting (10.2% vs. 53.7%), diarrhoea (43.2% vs. 96.7%) and mucositis (5.7% vs. 75.6%) combined across all levels of severity compared to BEAM chemotherapy (all p ≤ 0.01). CRS and neurotoxicity, which are specific side effects of CAR‐T therapy, were moderately positively associated with weight loss.

Conclusions

Weight loss, percentage weight loss and NIS were significantly reduced in CAR‐T compared to BEAM treatment. However, patients who experienced neurotoxicity during treatment did have significant weight loss.
Collaborative leadership to support sustainability in practice for dietitians as allied health professionals
Authors: Pettinger Clare , Tripathi Smita , Shoker Benji , Hodge Gary
Published: July 2023

Background

Allied health professionals (AHPs) have an important role to support the Greener National Health Service (NHS) agenda. Dietitians are AHPs who are already demonstrating strong influence on food sustainability advocacy. There is call for more collaboration across the health professions to optimise “green” leadership in the pursuit of planetary health. The present study aimed to investigate the perceived role of AHP leaders and future leaders around more sustainable healthcare practices.

Methods

A mixed methods approach using audio‐recorded semi‐structured interviews with strategic AHP leaders (n = 11) and focus groups with student AHPs (n = 2). Standardised open‐ended questions considered concepts of (i) leadership, (ii) green agenda, (iii) collaboration and (iv) sustainability. Purposive sampling used already established AHP networks. Thematic analysis systematically generated codes and themes with dietetic narratives drawn out specifically as exemplars.

Results

The findings represent diverse AHP voices, with six of 14 AHPs analysed, including dietetic (future) leaders. Three key themes emerged: (1) collective vision of sustainable practice; (2) empowering, enabling and embedding; and (3) embracing collaborative change. Dietetic specific narratives included food waste, NHS food supply chain issues, and tensions between health and sustainability advice.

Conclusions

The present study shows that collaborative leadership is a core aspiration across AHP leaders and future leaders to inform the green agenda. Despite inherent challenges, participant perceptions illustrate how “change leadership” might be realised to support the net zero agenda within health and social care. Dietitians possess the relevant skills and competencies, and therefore have a fundamental role in evolving collaborative leadership and directing transformational change towards greener healthcare practices. Recommendations are made for future leaders to embrace this agenda to meet the ambitious net zero targets
I Want to Marry Rich: Why Cash Makes You a Desirable Partner
Authors: Carnes Christina Matz , Deb Palash , O'Brien Jonathan
Published: July 2023

Both academics and practitioners frequently argue that ‘excessive’ firm cash reserves are likely to be squandered and thus may actually be detrimental to firm performance. Contrary to this narrative, we show that large cash reserves can have strong benefits for firms. Specifically, being cash‐rich helps firms form more strategic partnerships because cash helps assure potential partners that the focal firm will be able to adapt to unfolding contingencies. This assurance is particularly relevant in industry conditions that make disruptions either more likely or more costly. We explain how such disruptions arise due to uncertainty about partners' behaviours and thereby extend the literature in the area of transaction cost economics by shifting the focus from intentional opportunism to encompass unintentional factors that can impede a firm's ability to honour partnership agreements. This shift highlights a beneficial role of excess cash that is often overshadowed by the popular narrative on its wastefulness.
Integrated care models for co‐occurring alcohol use disorders and alcohol‐associated liver disease in rural communities: Telehealth considerations and opportunities
Authors: Osman Marcus , Koneru Gopala , Weber Andrea
Published: July 2023

Alcohol use disorders (AUD) and alcohol‐associated liver disease (ALD) have growing impacts on public health, yet many do not receive evidence‐based care. People with co‐occurring AUD and ALD, especially those in rural communities with less access to specialty care, are most in need of novel integrated care models. The use of telehealth to facilitate co‐location within an integrated care model may help to improve access to AUD and ALD care while reducing barriers and improving recovery outcomes for both the substance use disorder and liver disease.
The effects of orally administered trazodone on ambulation and recumbency in healthy horses
Authors: Hobbs Kallie , Luethy Daniela , Davis Jennifer , Mallicote Martha , Torcivia Catherine , Kulp Jeaneen , Stefanovski Darko , Futterman Catherine , Cooper Freya , van Eps Andrew
Published: July 2023

Background

Trazodone, a serotonin receptor antagonist and reuptake inhibitor, might be a useful adjunctive treatment in the initial management of horses with acute laminitis if it minimizes ambulation or encourages recumbency.

Objectives

(1) Evaluate the effects of PO trazodone on ambulatory activity and recumbency in healthy horses; and (2) assess the pharmacokinetics of multiple PO doses of trazodone.

Animals/Methods

In a randomized cross‐over design, 8 healthy horses received placebo or trazodone at 2 doses (2.5 and 7.5 mg/kg) PO q12h for 48 hours with a 14‐day washout period between treatments. Forelimb step frequency was measured using a hoof‐mounted accelerometer and continuous video monitoring was used to detect recumbency. Groups were compared using repeated measures analysis of variance with Tukey's post hoc test. Trazodone and m‐chlorophenylpiperazine (m‐CPP) plasma concentrations were determined by ultra‐high performance liquid chromatography‐tandem mass spectrometry and pharmacokinetics were analyzed using noncompartmental methods.

Results

Step frequency was lower in horses receiving 7.5 mg/kg trazodone than in the control group (mean step reduction: 44% ± 11%). Steps‐area under the curve were significantly lower in the 7.5 mg/kg group (mean ± SD: 3375 ± 525 steps × hour) as compared to the 2.5 mg/kg group (mean ± SD: 5901 ± 2232; P = .02) and compared to control (mean ± SD: 6590 ± 1241; P = .001). No difference was found in the number of recumbent episodes (P = .92) or total duration of recumbency (P = .9). Trazodone and m‐CPP achieved steady‐state concentrations, with an accumulation ratio of 1.45 ± 0.2.

Conclusions and Clinical Importance

Although it did not affect recumbency, trazodone at 7.5 mg/kg q12h decreased step frequency by approximately 44%.
‘Two Armies flye in…’: Battle scenes in English Renaissance theatre
Authors: Dahl Christian
Published: July 2023

One of the most spectacular characteristics of English Renaissance theatre is the propensity for battle scenes. Between 1576 and 1616, battle scenes appear in a third of all surviving plays and, judging from the titles, the frequency may have been even higher in the lost plays. The popularity of battle scenes is indicative both of early modern fascination with history as spectacle and of the imminence of contemporary warfare, especially in the final decades of the reign of Elizabeth I. Based on quantitative studies, this paper offers a survey of the evolution and proliferation of battle scenes in the late sixteenth and early seventeenth centuries, and I will critically assess the general assumption that battle scenes eventually waned from the early modern stage as a consequence of the ascent to the throne of the peace‐seeking James I. For reasons to be discussed, it is quite unlikely that James's doctrine on foreign politics had any significant effect on the staging of war in theatre.