bluuebunny/crossref_metadata_2025 huggingface dataset:
Association between discontinuing chronic opioid therapy and newly diagnosed substance use disorders, accidents, self‐inflicted injuries and drug overdoses within the prescribers' health care system: a retrospective cohort study
Authors: Hayes Corey J. , Krebs Erin E. , Li Chenghui , Brown Joshua , Hudson Teresa , Martin Bradley C.
Published: September 2021

Background and aim

Prescribers are commonly confronted with discontinuing opioid therapy among patients prescribed chronic opioid therapy (COT). This study aimed to measure the association between discontinuing COT and diagnoses of substance use disorders (SUDs) and opioid‐related adverse outcomes (AOs).

Design

Retrospective cohort study.

Setting

United States Veterans Healthcare Administration.

Participants

Veterans with chronic pain on COT who discontinued opioid therapy were compared with those continuing COT using data from fiscal years 2009 to 2015.

Measurements

Newly diagnosed substance use disorders (SUD composite; individual types: opioid, non‐opioid drug and alcohol use disorders) and opioid‐related adverse outcomes (AO composite; individual types: accidents resulting in wounds/injuries, opioid‐related accidents/overdoses, alcohol and non‐opioid medication‐related accidents/overdoses, self‐inflicted injuries and violence‐related injuries) were evaluated. Primary analyses were conducted using 1:1 matching of discontinuers with those continuing COT based on propensity score and index date (±180‐day window). Sensitivity analyses were conducted using logistic regressions with stabilized inverse probability of treatment weighting (SIPTW) and instrumental variable (IV) models.

Findings

A total of 15 695 (75.4%) and 17 337 (76.6%) discontinuers were matched with those continuing COT among the cohorts testing SUD and AO development respectively. In the primary propensity score matched analyses, the composite SUD outcome was not different between discontinuers and those continuing COT (OR = 0.932, 95% CI = 0.850, 1.022). The composite AO outcome was lower among discontinuers (OR = 0.660, 95% CI = 0.623, 0.699) compared with those continuing COT. SIPTW analyses found lower SUD (OR = 0.789, 95% CI = 0.743, 0.837), and AO (OR = 0.660, 95% CI = 0.623, 0.699) rates among discontinuers. IV models found mixed and sometimes contradictory results.

Conclusions

Discontinuing patients from chronic opioid therapy appears to be associated with decreased diagnoses for opioid‐related adverse outcomes. The association with substance use disorders appears to be inconclusive.
Clinical assessment of liver metabolism during hypothermic oxygenated machine perfusion using microdialysis
Authors: Patrono Damiano , Roggio Dorotea , Mazzeo Anna Teresa , Catalano Giorgia , Mazza Elena , Rizza Giorgia , Gambella Alessandro , Rigo Federica , Leone Nicola , Elia Vincenzo , Dondossola Daniele , Lonati Caterina , Fanelli Vito , Romagnoli Renato
Published: September 2021

Background

While growing evidence supports the use of hypothermic oxygenated machine perfusion (HOPE) in liver transplantation, its effects on liver metabolism are still incompletely understood.

Methods

To assess liver metabolism during HOPE using microdialysis (MD), we conducted an open‐label, observational pilot study on 10 consecutive grafts treated with dual‐HOPE (D‐HOPE). Microdialysate and perfusate levels of glucose, lactate, pyruvate, glutamate, and flavin mononucleotide (FMN) were measured during back table preparation and D‐HOPE and correlated to graft function and patient outcome.

Results

Median (IQR) MD and D‐HOPE time was 228 (210, 245) and 116 (103, 143) min. Three grafts developed early allograft dysfunction (EAD), with one requiring retransplantation. During D‐HOPE, MD glucose and lactate levels increased (ANOVA = 9.88 [p = 0.01] and 3.71 [p = 0.08]). Their 2nd‐hour levels were higher in EAD group and positively correlated with L‐GrAFT score. 2nd‐hour MD glucose and lactate were also positively correlated with cold ischemia time, macrovesicular steatosis, weight gain during D‐HOPE, and perfusate FMN. These correlations were not apparent when perfusate levels were considered. In contrast, MD FMN levels invariably dropped steeply after D‐HOPE start, whereas perfusate FMN was higher in dysfunctioning grafts.

Conclusion

MD glucose and lactate during D‐HOPE are markers of hepatocellular injury and could represent additional elements of the viability assessment.
Usefulness of a stepwise training program for laparoscopic gastrectomy
Authors: Nishi Masaaki , Shimada Mitsuo , Yoshikawa Kozo , Tokunaga Takuya , Kashihara Hideya , Takasu Chie , Yoshimoto Toshiaki , Iwahashi Shoko
Published: September 2021

Introduction

Laparoscopic gastrectomy (LG) is a complicated procedure with a long learning curve. This study was performed to investigate the usefulness of our stepwise training program for LG for improving the quality of the surgery.

Methods

The stepwise training method comprised the following four steps: (1) basic training using a dry box and checking by mentors; (2) advanced training, including the use of animals and cadavers; (3) clinical experience, including standardization and preoperative three‐dimensional simulation; and (4) self‐assessment and feedback. In total, 153 patients who underwent curative gastrectomy for gastric cancer were included in this study.

Results

The operative time gradually decreased for both laparoscopic distal gastrectomy (LDG) (2013, 395 minutes; 2017, 278 minutes; P < .001; ρ = −0.68) and laparoscopic total gastrectomy (LTG) (2013, 476 minutes; 2017, 319 minutes; P < .001; ρ = −0.56). The blood loss volume gradually decreased for both LDG (2013, 43.0 mL; 2017, 18.6 mL; P < .005; ρ = −0.30) and LTG (2013, 143.8 mL; 2017, 13.5 mL; P < .005; ρ = −0.41).

Conclusions

Our stepwise training program contributes to reduce operation time and blood loss in LG.
Rethinking the issue of reparations for Black Americans
Authors: Chapman Audrey R.
Published: September 2021

The differential impact of the COVID‐19 pandemic on communities of color in the United States along with the civil unrest taking place in 2020 in response to the killing of unarmed Black men and women by the police have increased awareness of the structural racism pervading US society. These developments have reraised the issue of reparations for Black Americans, usually proposed in the context of providing financial compensation for the injustices of slavery to the descendants of those who were enslaved. This paper will discuss the systematic racial inequality and structural racism in US society that have significantly disadvantaged racial and ethnic minorities while giving advantages to white Americans, which most recently have resulted in significantly higher mortality and morbidity among Black, Hispanic, and Native Americans during the pandemic. The paper will conceptualize reparations within the context of theories of reparative justice. It will also consider whether reparations are owed, and if so, by whom, to whom, and in what form. The final section will offer a proposal for collective reparations to the Black community and other people of color.
The predictive value of patient, therapist, and in‐session ratings of motivational factors early in remote cognitive behavioural therapy for severe health anxiety
Authors: Malins Sam , Moghaddam Nima , Morriss Richard , Schröder Thomas , Brown Paula , Boycott Naomi
Published: September 2021

Objectives

Remote psychotherapy and the prevalence of Severe Health Anxiety (SHA) are both growing as a result of the COVID‐19 pandemic. Remotely delivered Cognitive Behavioural Therapy (rCBT) for SHA is evidenced as effective, but many who seek help do not benefit. Motivational processes can influence outcomes, but it is unclear what assessment methods offer the best clinical utility in rCBT for SHA.

Design

This study compared the predictive validity of patient, therapist and in‐session ratings of motivational factors taken at session two of rCBT for SHA among high healthcare users experiencing multimorbidity.

Methods

Motivational factors were assessed for 56 participants who attended at least two sessions of CBT for SHA delivered via video‐conferencing or telephone. Following session two, therapists and patients completed online assessments of patient motivation. Two trained observers also rated motivational factors and therapeutic alliance from in‐session interactions using session two recordings and transcripts. Multilevel modelling was used to predict health anxiety and a range of secondary health outcomes from motivation assessments.

Results

Where patients were more actively engaged in discussion of positive changes during session two, greater outcome improvements ensued in health anxiety and all secondary outcomes. Conversely, larger proportions of session two spent describing problems predicted poorer outcomes. Therapist and patient assessments of motivation did not predict health anxiety, but therapist assessments of client confidence and motivation predicted all secondary outcomes.

Conclusions

Motivation remains an important process in CBT when delivered remotely, and motivational factors may predict outcomes more consistently from in‐session interactions, compared to self‐reports.
Interactive effects of elevation and newly paved road on avian community composition in a scientific reserve, Bioko Island, Equatorial Guinea
Authors: Miller Steven C. , Wiethase Joris H. , Motove Etingue Amancio , Franklin Elaine , Fero Maximilliano , Wolfe Jared D. , Gonder Mary K. , Powell Luke L.
Published: September 2021

Understanding interactive effects between anthropogenic disturbance and abiotic factors on species turnover can help to identify and prioritize conservation of potentially vulnerable tropical bird communities. We investigated the potential factors influencing avian understory community composition along with a recently constructed road across three elevations (300, 800, and 1200 m), each with two sampling sites (road edge vs. interior forest), over a four‐year period on Bioko Island, Equatorial Guinea. Insectivorous species were the most abundant guild‐sampled accounting for 55% of total species diversity within the dataset followed by frequent mixed‐flock followers (48%). Habitat associated with elevation was the most significant factor influencing the composition of avian communities. Additionally, we identified species with clear statistical associations for each elevation: the yellow‐lored bristlebill (Bleda notatus), olive sunbird (Cyanomitra obscura), and white‐tailed warbler (Poliolias lopezi). We found evidence for significant community differences between the disturbance edge and interior forest transects at 300 m only. Likewise, understory insectivores were found at higher numbers within the interior forest transect at this elevation. Based on the data presented here, we suggest low elevation avian understory insectivores should be considered focal species for future assessment studies in this area. Furthermore, since many traditional protected areas focus on upland habitat containing high species endemism, our findings emphasize the importance of equally conserving lowland elevations as they may house commonly overlooked, yet important and diverse segments of the bird community.

Abstract in Spanish is available with online material.
The effects of reward on children’s Stroop performance: Interactions with temperament
Authors: Bryant Lauren J. , Cuevas Kimberly
Published: September 2021

The effects of rewards on executive function (EF) reflect bidirectional interactions among motivational and executive systems that vary with age and temperament. However, methodological limitations hinder understanding of the precise influences of incentives on early EF, including the role of reward sensitivity. In this within‐subjects study, ninety‐three 3.5‐ to 5‐year‐olds (42 girls; 22% Hispanic; 78% White) residing in the United States completed equivalent EF measures (Stroop and non‐Stroop phases) in both rewarded and non‐rewarded conditions. Rewards enhanced Stroop accuracy and slowed overall response times (ds = 0.29–0.40). Critically, children with low parent‐reported reward sensitivity exhibited greater reward‐based increases in Stroop accuracy (r = −.30). These findings provide valuable insights on early motivation–cognition integration, highlighting temperament as a mechanism underlying these interactions.
Objective Analysis Of Voice Quality In Patients With Thyroid Pathology
Authors: León Gómez Nieves María , Delgado Hernández Jonathan , Luis Hernández Jorge , Artazkoz del Toro Juan José
Published: September 2021

Objective

The goal of this study is to analyze the voice in patients with thyroid pathology through two objective indexes with great diagnostic accuracy. Overall vocal quality was evaluated with the Acoustic Voice Quality Index (AVQI v.03.01) and the breathy voice with the Acoustic Breathiness Index (ABI).

Design

Observational case‐control study.

Setting

Hospital Universitario Nuestra Señora de Candelaria.

Participants

Fifty‐eight subjects, 29 controls and 29 thyroidectomy candidates.

Main outcome measures

All participants with thyroid pathology completed the Spanish version of Voice Handicap Index‐10. Also, patient complaints relating to possible laryngeal dysfunction were assessed through closed questions. A sustained vowel and three phonetically balanced sentences were recorded for each subject (118 samples). AVQI v.03.01 and ABI were assessed using the Praat program. Two raters perceptually evaluated each voice sample by using the Grade parameter of GRABS scale.

Results

Acoustic analysis shows that 55.17% of subjects present values above the pathological threshold of the AVQI, and 58.62% above that of the ABI. Results of the Student’s test comparisons of the AVQI and ABI values between the control group and the thyroid group show significantly higher values of AVQI (t[56] = −3.85, p < .001) and ABI (t[54.39] = −4.82, p < .001) in thyroidectomy candidates.

Conclusion

A mild decrease in vocal quality is part of the symptomatology presented by thyroidectomy candidates.
Comparison of COVID‐19 studies registered in the clinical trial platforms: A research ethics analysis perspective
Authors: Buruk Banu , Guner Muberra Devrim , Ekmekci Perihan Elif , Celebi Aksuyek Savas
Published: September 2021

Background

The coronavirus disease (COVID‐19) treatment must be based on scientific methods such as clinical trials. Trials involving human subjects and those requiring a risk‐benefit analysis may occasionally face challenges owing to the time limitations in the pandemic.

Methodology

This study analyses the WHO's International Clinical Trials Registry Platform and clinicaltrials.gov, where most COVID‐19 clinical trials are registered, according to ethical criteria including study design, conflicts of interest, enrollment of healthcare workers, study locations, site‐, design‐, and participant‐related issues. The discussion is based on three aspects: the quality of the information to be produced, the relevance to significant health problems, and the creation or evaluation of interventions, policies, or practices that promote individual or public health.

Results

There were significant differences between the two platforms regarding the investigational medicinal product (IMP), the comparator, ethics committee/institutional review board approval, plan to share individual participant data, study phase, site, IMP, and design‐related issues. Conflict of interest, sponsor information, and management of vulnerable groups were the main areas wherein both platforms lacked sufficient information.

Conclusion

With this analysis, we aimed to define a minimum set of ethical criteria for clinical trial platforms to obtain standardization between these two platforms.
Long‐term effects of dapagliflozin plus saxagliptin versus glimepiride on a background of metformin in patients with type 2 diabetes: Results of a 104‐week extension to a 52‐week randomized, phase 3 study and liver fat MRI substudy
Authors: Frías Juan P. , Maaske Jill , Suchower Lisa , Johansson Lars , Hockings Paul D. , Iqbal Nayyar , Wilding John P. H.
Published: September 2021

Aim

To report the results of a 104‐week extension to a 52‐week study in which dapagliflozin plus saxagliptin (DAPA+SAXA) improved glycaemic control, liver fat and metabolic variables compared with glimepiride (GLIM) in participants with type 2 diabetes (T2D) receiving background metformin.

Materials and methods

This extension to a 52‐week global, multicentre, parallel‐group, active‐controlled, double‐blind study (NCT02419612) continued randomized participants (1:1) on DAPA+SAXA (10/5 mg) plus placebo, or GLIM (1‐6 mg) plus placebo, once daily. Eligible participants were aged ≥18 years, had T2D (glycated haemoglobin [HbA1c] 58.5‐91.3 mmol/mol [7.5%‐10.5%]), and a body mass index of 20.0 to 45.0 kg/m2, and were receiving metformin (MET; ≥1500 mg/d). Key outcomes were: requirement for treatment intensification, based on HbA1c ≥53 mmol/mol (7%); achieving therapeutic glycaemic response; and changes in adipose tissue and liver fat on magnetic resonance imaging in a substudy.

Results

Overall, 382 participants entered and 338 completed the 104‐week extension period (MRI substudy, n = 82). The need for treatment intensification during the 156‐week period was lower for DAPA+SAXA+MET (37.0%) than GLIM+MET (55.6%; hazard ratio 0.52, 95% confidence interval [CI] 0.39‐0.68; P < 0.001). At week 156, 21.4% of DAPA+SAXA+MET versus 11.7% of GLIM+MET participants achieved therapeutic glycaemic response (HbA1c <53 mmol/mol; odds ratio 2.1, 95% CI 1.23‐3.42; P = 0.006). DAPA+SAXA+MET led to greater adjusted mean reductions from baseline in liver fat and visceral and subcutaneous adipose tissue volumes versus GLIM+MET at week 122 (least‐squares mean difference from GLIM+MET −4.89%, −0.41 L and −0.44 L, respectively; nominal P values ≤ 0.008). Safety was consistent with that of the monocomponents.

Conclusions

Overall, glycaemic control, metabolic benefits and efficacy were better maintained with DAPA+SAXA+MET than with GLIM+MET in T2D.
Casein kinase 1 epsilon and circadian misalignment impact affective behaviours in mice
Authors: Zhou Lili , Fitzpatrick Karrie , Olker Christopher , Vitaterna Martha H. , Turek Fred W.
Published: September 2021

Affective behaviours and mental health are profoundly affected by disturbances in circadian rhythms. Casein kinase 1 epsilon (CSNK1E) is a core component of the circadian clock. Mice with tau or null mutation of this gene have shortened and lengthened circadian period respectively. Here, we examined anxiety‐like, fear, and despair behaviours in both male and female mice of these two different mutants. Compared with wild‐type mice, we found reductions in fear and anxiety‐like behaviours in both mutant lines and in both sexes, with the tau mutants exhibiting the greatest phenotypic changes. However, the behavioural despair had distinct phenotypic patterns, with markedly less behavioural despair in female null mutants, but not in tau mutants of either sex. To determine whether abnormal light entrainment of tau mutants to 24‐h light–dark cycles contributes to these phenotypic differences, we also examined these behaviours in tau mutants on a 20‐h light–dark cycle close to their endogenous circadian period. The normalized entrainment restored more wild‐type‐like behaviours for fear and anxiety, but it induced behavioural despair in tau mutant females. These data show that both mutations of Csnk1e broadly affect fear and anxiety‐like behaviours, while the effects on behavioural despair vary with genetics, photoperiod, and sex, suggesting that the mechanisms by which Csnk1e affects fear and anxiety‐like behaviours may be similar, but distinct from those affecting behavioural despair. Our study also provides experimental evidence in support of the hypothesis of beneficial outcomes from properly entrained circadian rhythms in terms of the anxiety‐like and fear behaviours.
Why immanent critique?
Authors: Diehl Sanford
Published: September 2021

This article defends the principle, central to the Frankfurt School tradition of critical social theory, that social criticism should rely only on normative criteria that are “immanent” to the society under evaluation. My argument turns on the claim that a normative theory can have a practical aim that places legitimate constraints on its contents. For example, since the aim of advice is to contribute to the advisee's deliberation about what to do, a judgment about what someone should do is good advice only if that person could take it up in her own deliberation. I argue that there is a valuable kind of social criticism analogous to advice, which aims to contribute to the reflection of members of society on how to orient themselves practically to their social world. Drawing on the work of Bernard Williams, I suggest that concrete normative ideals can be so permeated by the needs, social relations, and concepts of one society that they are not real options in a sufficiently different social milieu. Because such criteria cannot serve as a genuine basis for practical orientation to the social world, they are ineligible for use in social criticism of this kind.
Military and nonmilitary stressors associated with mental health outcomes among female military spouses
Authors: Sullivan Kathrine S. , Park Yangjin , Riviere Lyndon A.
Published: September 2021

Objective

This study uses a stress process framework and person‐centered methods to describe patterns of concurrent stressors across multiple domains and to associate patterns with female military spouse mental health.

Background

Most military families are resilient. However, a subset of military spouses experiences adverse outcomes in the context of war‐related stress. To date, a focus on military‐specific stressors has largely obscured the effects of stress unrelated to military service on the well‐being of military spouses.

Methods

Data were drawn from a 2012 survey of 343 U.S. Army spouses, measuring intrapersonal (e.g., adverse childhood experiences), family (e.g., work–family conflict), and military stressors (e.g., cumulative deployments). Outcomes included moderate or more severe depression, anxiety, and posttraumatic stress disorder (PTSD).

Results

The three‐step method of latent class analysis identified three classes: low (58.86% of participants), moderate (21.62%), and high (19.52%) stress. Prevalence of mental health problems was significantly elevated in the high‐stress class. In this group, 35.3%, 36.3%, and 39.5% of spouses' screenings indicated at least moderate depression, anxiety, and PTSD symptomatology, compared with 3.0%, 3.9%, and 2.7% in the low‐stress group.

Conclusions

Results suggest many military spouses have low stress exposure across domains and low rates of mental health symptoms. However, a subset of spouses may experience both intrapersonal and family‐level risk associated with elevated rates of mental health problems.

Implications

Findings highlight the critical role of nonmilitary stressors in the lives of military spouses and the importance of assessing for and providing support to spouses around these issues.
Stock assessment on fishery‐dependent data: Effect of data quality and parametrisation for a red snapper fishery
Authors: Tagliarolo Morgana , Cope Jason , Blanchard Fabian
Published: September 2021

Data availability, and unreported and unregulated fishing are significant obstacles to evaluating stock status, especially in tropical areas. Limitations in data quantity and quality can lead to model misspecification and erroneous data treatments, potentially causing important changes in model outputs and subsequent management implications. Red snapper Lutjanus purpureus (Poey) in French Guiana provides an example of a stock with a long‐time series of fishery‐dependent data subject to large uncertainty. A flexible catch‐at‐age model (Stock Synthesis) was applied to the available data and compared to an historically applied assessment approach. Inter‐model variability based on different model specifications and data treatments were compared to identify better the status of the resource. Results showed that a major source of uncertainty in the model was the inclusion of a catch‐per‐unit‐effort abundance index with questionable ability to track abundance. The Stock Synthesis model provided a more flexible and viable method than the virtual population analysis approach. Despite large uncertainty, models depicted a similar trend with a notable stock depletion in the late 1990s but with two distinct biomass trends in more recent years depending on the treatment. To reduce uncertainty and preserve this important economic resource, new data collection programmes and management policies are needed.
Associations between HIV, antiretroviral therapy and preterm birth in the US Women’s Interagency HIV Study, 1995–2018: a prospective cohort
Authors: Venkatesh Kartik K. , Edmonds Andrew , Westreich Daniel , Dionne‐Odom Jodie , Weiss Deborah Jones , Sheth Anandi N. , Cejtin Helen , Seidman Dominika , Kassaye Seble , Minkoff Howard , Atrio Jessica , Rahangdale Lisa , Adimora Adaora A.
Published: September 2021

Objective

To evaluate the associations of HIV infection with preterm birth (PTB), and of HIV antiretroviral therapy (ART) with PTB.

Methods

We analysed singleton live‐born pregnancies among women from 1995 to 2019 in the Women's Interagency HIV Study, a prospective cohort of US women with, or at risk for, HIV. The primary exposures were HIV status and ART use before delivery [none, monotherapy or dual therapy, or highly active antiretroviral therapy (HAART)]. The primary outcome was PTB < 34 weeks, and, secondarily, < 28 and < 37 weeks. We analysed self‐reported birth data, and separately modelled the associations between HIV and PTB, and between ART and PTB, among women with HIV. We used modified Poisson regression, and adjusted for age, race, parity, tobacco use and delivery year, and, when modelling the impact of ART, duration from HIV diagnosis to delivery, nadir CD4 count, and pre‐pregnancy viral load and CD4 count.

Results

We analysed 488 singleton deliveries (56% exposed to HIV) to 383 women. The risk of PTB < 34 weeks was similar among women with and without HIV, but the risk of PTB < 37 weeks was higher [32% vs. 23%; adjusted risk ratio (aRR) = 1.43; 95% confidence interval (CI): 1.07–1.91] among women with HIV. The risk of PTB < 34 weeks was lower among women with HIV receiving HAART than among those receiving no ART (7% vs. 26%; aRR:0.19; 95% CI: 0.08–0.44). The associations between HAART and PTB < 28 and < 37 weeks were similar.

Conclusions

Antiretroviral therapy exposure was associated with a decreased risk of PTB among a US cohort of women with HIV. Given the growing concerns about ART and adverse pregnancy outcomes, this finding that ART may be protective for PTB is reassuring.
A prospective cohort study evaluating the outcome of root canal retreatment in symptomatic mandibular first molars with periapical lesions
Authors: Serefoglu Burcu , Miçooğulları Kurt Seniha , Kandemir Demirci Gözde , Kaval Mehmet Emin , Çalışkan Mehmet Kemal
Published: September 2021

Aim

To evaluate the impact of various predictors on the outcome of root canal retreatment in symptomatic mandibular first molars with periapical lesions after a minimum of 2 years.

Methodology

One hundred and twenty previously root canal treated symptomatic mandibular first molars with periapical lesions which were diagnosed as symptomatic apical periodontitis or acute apical abscess with localized intraoral swelling were included. Root canal retreatment was performed by an experienced endodontist using a standardized treatment protocol. The teeth were followed up clinically and radiographically and the radiographic outcome was assessed using a modified periapical index scale (PAI). The cumulative success proportion and the influence of predictors on the outcome of the root canal retreatment were analysed using Kaplan–Meier analyses and log‐rank tests, and the hazard ratios for the predictors were also investigated using Univariate Cox Proportional Hazard regression analysis at a significance level of 5%.

Results

Of the 120 teeth, 103 teeth were re‐examined with an 85% recall rate. The cumulative success rate was 88% in which 64% were healed and 24% were healing, and failure rate was recorded as 12%. None of the preoperative predictors, including age, gender, soft tissue tenderness, intraoral swelling, size of the lesion, PAI score, apical level and density of root canal filling before root canal retreatment, nor intraoperative predictors, such as active exudate drainage, density of root canal filling after root canal retreatment and restoration type had an influence on the outcome of root canal retreatment (p > .05). The only factor that significantly reduced the success rate of root canal retreatment was the apical level of the root canal filling; when it was more than 2 mm short of the radiographic apex in teeth where apical patency was not established, the success was significantly lower (p = .023).

Conclusions

Root canal retreatment in symptomatic mandibular first molars with periapical lesions resulted in a success rate of 88%. None of the predictors had a significant influence on the outcome, except for the apical level of the root canal filling after root canal retreatment with short root fillings being associated with significantly more post‐treatment endodontic disease.
The influence of inner packaging’s number cue on consumption
Authors: Jin Yufang , Xu Xiaoxia , Zurawicki Leon , Liu Raymond
Published: September 2021

Product packaging clues can lead to overconsumption and even obesity. While combined packaging represents a common packaging practice, it has not been addressed much in academia. To help clarify how marketers can optimize the relationship between the packaging’s number cues and consumption, this paper explores the effect of the quantity of inner packaging on consumption when the external packaging number is fixed. Across two experiments conducted in China, this study proposes that consumption increases with the number of the inner packages, while the total quantity of products is held constant and the Perceived Package Consumption Count acts as a partial mediator. For the restrained dieters, however, the effect of the packaging’s number cue on consumption disappears. The findings of this study have significant implications for consumers, marketers, and policymakers.
Moderating effect of work‐related social support on the relationship between role conflicts and job satisfaction among female nurses pursuing a further degree in China
Authors: Li Caifu , Song Rhayun , Fan Xing , Zhou Zanhua , Xu Lijuan
Published: September 2021

Aim

This study aimed to determine the moderating effect of work‐related social support on the relationship between work–family–school role conflicts and job satisfaction among female registered nurses pursuing further degrees in China.

Methods

The study had a cross‐sectional correlational design. Convenience sampling was applied to recruit participants from eight hospitals in China from January to August 2017. SPSS software and the PROCESS macro were used to conduct the data analyses in the present study.

Results

A total of 320 nurses were included in the present study. Work–family–school role conflicts were negatively correlated with job satisfaction (r = −0.21, P < 0.001). Work‐related social support was a significant moderator (interaction effect: β = 0.22, P = 0.039) on the relationship between work–family–school role conflicts and job satisfaction.

Conclusions

The study revealed that when nurses perceived that they received a low or moderate level of social support in the workplace that strengthened the relationship between work–family–school role conflicts and job satisfaction. Hospital administrators should implement school‐ and family‐friendly policies that increase the social support provided to nurses pursuing further degrees to balance their responsibilities of work, family and school and to improve their job satisfaction.
How family policies redefine families: The case of mainland China–Hong Kong cross‐border families
Authors: Chee Wai‐chi
Published: September 2021

During China's one‐child policy era (1979–2015), birth tourism in Hong Kong (HK) became a way for Chinese parents who wanted more children to avoid the regulations. From 2003 to 2012, about 200,000 babies were born in HK to mainland Chinese parents. This paper explores how the one‐child policy, migration regulations, and welfare provision jointly influence family practices of mainland parents who gave birth in HK. Data are drawn from ethnographic research conducted with 45 mothers staying in HK on temporary visas to look after their HK‐born children. Research findings show these parents need to negotiate with the following contradictory circumstances: a one‐child policy that disregarded cultural preference for sons; migration regimes that separated parent from child and thus challenged the cultural ideal of an intact family; and welfare policies that stigmatized the parents as irresponsible in a context where families are widely regarded as care providers.
Tetraspanin CD53 modulates lymphocyte trafficking but not systemic autoimmunity in Lyn‐deficient mice
Authors: Yeung Louisa , Gottschalk Timothy A , Hall Pam , Tsantikos Evelyn , Gallagher Rebecca H , Kitching A Richard , Hibbs Margaret L , Wright Mark D , Hickey Michael J
Published: September 2021

The leukocyte‐restricted tetraspanin CD53 has been shown to promote lymphocyte homing to lymph nodes (LNs) and myeloid cell recruitment to acutely inflamed peripheral organs, and accelerate the onset of immune‐mediated disease. However, its contribution in the setting of chronic systemic autoimmunity has not been investigated. We made use of the Lyn−/− autoimmune model, generating Cd53−/−Lyn−/− mice, and compared trafficking of immune cells into secondary lymphoid organs and systemic autoimmune disease development with mice lacking either gene alone. Consistent with previous observations, absence of CD53 led to reduced LN cellularity via reductions in both B and T cells, a phenotype also observed in Cd53−/−Lyn−/− mice. In some settings, Cd53−/−Lyn−/− lymphocytes showed greater loss of surface L‐selectin and CD69 upregulation above that imparted by Lyn deficiency alone, indicating that absence of these two proteins can mediate additive effects in the immune system. Conversely, prototypical effects of Lyn deficiency including splenomegaly, plasma cell expansion, elevated serum immunoglobulin M and anti‐nuclear antibodies were unaffected by CD53 deficiency. Furthermore, while Lyn−/− mice developed glomerular injury and showed elevated glomerular neutrophil retention above than that in wild‐type mice, absence of CD53 in Lyn−/− mice did not alter these responses. Together, these findings demonstrate that while tetraspanin CD53 promotes lymphocyte trafficking into LNs independent of Lyn, it does not make an important contribution to development of autoimmunity, plasma cell dysfunction or glomerular injury in the Lyn−/− model of systemic autoimmunity.
Minimum Steiner trees on a set of concyclic points and their center
Authors: Whittle David , Brazil Marcus , Grossman Peter Alexander , Rubinstein Joachim Hyam , Thomas Doreen A.
Published: September 2021

Consider a configuration of points comprising a point q and a set of concyclic points R that are all a given distance r from q in the Euclidean plane. In this paper, we investigate the relationship between the length of a minimum Steiner tree (MStT) on and a minimum spanning tree on R. We show that if the degree of q in the MStT is 1, then the difference between these two lengths is at least , and that this lower bound is tight. This bound can be applied as part of an efficient algorithm to find the solution to the prize‐collecting Euclidean Steiner tree problem, as outlined in an earlier paper.
Single‐cell RNA sequencing analysis to characterize cells and gene expression landscapes in atrial septal defect
Authors: Wang Zunzhe , Wang Huating , Zhang Ya , Yu Fangpu , Yu Liwen , Zhang Cheng
Published: September 2021

This study aimed to characterize the cells and gene expression landscape in atrial septal defect (ASD). We performed single‐cell RNA sequencing of cells derived from cardiac tissue of an ASD patient. Unsupervised clustering analysis was performed to identify different cell populations, followed by the investigation of the cellular crosstalk by analysing ligand‐receptor interactions across cell types. Finally, differences between ASD and normal samples for all cell types were further investigated. An expression matrix of 18,411 genes in 6487 cells was obtained and used in this analysis. Five cell types, including cardiomyocytes, endothelial cells, smooth muscle cells, fibroblasts and macrophages were identified. ASD showed a decreased proportion of cardiomyocytes and an increased proportion of fibroblasts. There was more cellular crosstalk among cardiomyocytes, fibroblasts and macrophages, especially between fibroblast and macrophage. For all cell types, the majority of the DEGs were downregulated in ASD samples. For cardiomyocytes, there were 199 DEGs (42 upregulated and 157 downregulated) between ASD and normal samples. PPI analysis showed that cardiomyocyte marker gene FABP4 interacted with FOS, while FOS showed interaction with NPPA. Cell trajectory analysis showed that FABP4, FOS, and NPPA showed different expression changes along the pseudotime trajectory. Our results showed that single‐cell RNA sequencing provides a powerful tool to study DEG profiles in the cell subpopulations of interest at the single‐cell level. These findings enhance the understanding of the underlying mechanisms of ASD at both the cellular and molecular level and highlight potential targets for the treatment of ASD.
The Federal Enforcement Threat: The Effect of Overfiling Under the Resource Conservation and Recovery Act
Authors: Cecot Caroline
Published: September 2021

States and the federal government typically share responsibility for environmental enforcement, with many states acquiring primary authority to enforce federal law. Under most federal environmental statutes, the U.S. Environmental Protection Agency (EPA) retains the right to “overfile,” or file its own enforcement action against a violator in addition to a state enforcement action. This article empirically tests the effect of EPA's ability to overfile on the state's enforcement strategy in the context of the Resource Conservation and Recovery Act (RCRA). In Harmon Industries v. Browner, 191 F.3d 894 (8th Cir., 1999 the Harmon decision), the Court of Appeals for the Eighth Circuit held that the EPA does not have the authority to overfile under RCRA. Other circuits, particularly the 10th Circuit, have disagreed with the Eighth Circuit's conclusion, holding that the EPA retains such authority, and the Supreme Court has never resolved this issue. This article predicts that states within the Eighth Circuit with preferences for lower environmental enforcement would impose more lenient penalties after the Harmon decision, and it tests this prediction using several proxies for state environmental enforcement preferences. I find that states in the Eighth Circuit with Republican governors were more likely to lower the final penalty amount from the proposed penalty amount after the Harmon decision. In other estimations, I also find that states in the Eighth Circuit with Republican governors collected less, on average, in final penalty amount per enforcement action after the Harmon decision. Other proxies for lower enforcement preferences, however, were not associated with consistent statistically significant effects. Because the governor arguably has the strongest influence on state enforcement policy, the results provide some support for the model's preference‐based predictions. Overall, the results suggest that the existence of a specific and relatively infrequent type of federal enforcement action—EPA's ability to overfile—could have a substantial effect on overall environmental enforcement through its ability to affect the enforcement efforts of certain states. These findings shed light on how federal enforcement efforts might matter in the context of cooperative federalism.
Exploring the impact of diagnostic imaging decision support embedded in an electronic referral solution on the appropriate ordering of magnetic resonance imaging for patients with knee pain: a retrospective chart review
Authors: Mohammed Heba Tallah , Payson Lori‐Anne , Gillan Caitlin , Mathews Jisla , Diep Justin , Sadri‐Gerrior Jessica , Hamann Karyssa , Brodrecht Diana
Published: September 2021

Rational and objective

Requests for magnetic resonance imaging (MRI) exams have notably increased in Canada. However, many of these exams may not always be indicated. The Joint Department of Medical Imaging and the eReferral Program have worked collaboratively to embed an integrated clinical decision support (DS) tool within the eReferral process for diagnostic imaging requests. This retrospective chart review aimed to assess the necessity of MRI exams for knee pain patients at the point of referral in relation to the referral method (no DS tools within fax‐ vs. DS tools within eReferral).

Methods

Seven hundred and seventeen medical charts of routine MRI referral requests to an Ontario Hospital for patients with knee complaints were reviewed during the study period. The necessity of the MRI exams was evaluated using the supporting algorithm and knee pathway appropriateness guidelines. MRI exams were considered necessary if requested for symptoms or signs that align with best‐practice standards, complemented with sound clinical assessment or history of a radiography scan before ordering an MRI.

Results

In general, MRI requests made through eReferral were 13.289 times more likely to be necessary orders than those made through fax. The likelihood of referring patients for a necessary MRI exam was higher for eReferral than fax for the year 2018/2019 (53.0% vs. 26.8%, P < 0.001) and for the year 2019/2020 (58.5% vs. 16.3%, P < 0.001). In addition, the rate of ordering X‐ray as the proper initial imaging scan for patients presenting with knee pain has steadily increased by 10% over the year for users of the eReferral platform compared to a decrease of 7% for those using fax.

Conclusion

Our findings highlight the positive impact of integrating DS tools at the point of referral in supporting the ordering of necessary MRI scans, suggesting that service re‐design and implementation of automated assistive technology services would impact patient care.
Mitigation of fouling during milk processing in polytetrafluoroethylene‐titanium dioxide coated plate heat exchanger
Authors: Bangavadi Munivenkatappa Manjunatha , Franklin Magdaline Eljeeva Emerald , Dhotre Ananta V. , Pushpadass Heartwin A. , Shivanand  , Anthonysamy Arputharaj , Mandhyan Pradeep Kumar , Patil Prashant G.
Published: September 2021

An attempt was made to mitigate fouling during milk processing in plate heat exchanger by modifying SS316 surface with the coating of polytetrafluoroethylene (PTFE) and titanium dioxide (TiO2) nanoparticles. The surface characteristics of PTFE‐TiO2coated and conventional SS316 plates, and their thermal performance during heating of milk in batches for 8 hr were compared. It was observed that the static contact angles of water on SS316 and PTFE‐TiO2coated plates were 66.8 ± 6.3° and 112.8 ± 0.8°, while for milk they were 61.0 ± 6.1° and 97.5 ± 1.1°, respectively. The increase in contact angle for coated surface was suggestive of weaker interaction between the fluid and surface, and enhancement in hydrophobicity. Overall heat transfer coefficients for uncoated and coated plates ranged from 354.36 to 952.26 Wm−2 K−1and 477.11 to 593.73 Wm−2 K−1, whereas the fouling factor was 1.723 × 10−3and 0.412 × 10−3m2KW−1, respectively. As deposition of foulants occurred, the overall heat transfer coefficient of SS316 and coated surfaces dropped by 62.15 and 19.40%, respectively, from the initial value, resulting in crossover of the curves at 310 min of heating milk. After 480 min of heating milk, the fouling factor of SS316 plates was at least four times higher than that of PTFE‐TiO2coated plates. The PTFE‐TiO2coating mitigated the deposition of milk foulants by 20 times than that of SS316 surface.

Practical Applications

Fouling of plate heat exchangers (PHE) during milk processing is an unsolved problem causing significant loss in heat transfer performance, increased pressure drop in flow between plates, loss of process time due to cleaning and impairment of product quality. The high surface free energy and hydrophilic adhesion of SS316 to milk act as stimulants to fouling. Modification of SS316 plates in PHE with coating of polytetrafluroethylene and titanium dioxide nanoparticles mitigates fouling. Coated plates maintain the heat transfer performance of the plates for extended time and reduce the cleaning requirement. Also, savings in harsh chemicals, water, and pumping costs could be realized.
Southeast and East Asian immigrant women’s transnational postpartum experiences: A meta‐ethnography
Authors: Vo Timothea
Published: September 2021

The increase in births to Southeast and East Asian (SEEA) immigrants in their adopted countries is of international importance. SEEA women experience the postpartum period differently than that of the general population. Despite the documented difference, there is limited representation of SEEA women in the literature. The purpose of this meta‐ethnography is to synthesise the qualitative findings from different research studies examining the experiences of SEEA immigrant women during the first 4–6 weeks of the postpartum period and has been written in adherence with enhancing transparency in reporting the synthesis of qualitative research (PRISMA). Noblit and Hare's meta‐ethnographic approach was used. Seven articles (four qualitative and three mixed‐methods studies) were reviewed, analysed and synthesised. Four themes emerged: two were facilitators of birth culture (availability and quality of social support and maternity care provider cultural knowledge and response) and two were barriers to birth culture (lack of structural and social support and cultural alienation after childbirth). Due to lack of structural and social support in SEEA immigrant women's adopted countries, they also experienced social and economic hardships after childbirth and made conscious decisions to modify their postpartum cultural practices out of convenience and practicality. SEEA immigrant women also experienced discrimination from maternity care providers, which prevented them from fully engaging in postpartum cultural practices. Maternity care providers can advocate and intervene for SEEA immigrant women by eliciting any postpartum cultural beliefs, assess their social and economic needs early on in prenatal care and make culturally congruent referrals based on those assessments.