bluuebunny/crossref_metadata_2025 huggingface dataset:
Endoscopic features of isolated and traditional serrated adenoma‐associated superficially serrated adenomas of the colorectum
Authors: Mizuguchi Yasuhiko , Tanaka Yusaku , Cho Hourin , Sekiguchi Masau , Takamaru Hiroyuki , Yamada Masayoshi , Sakamoto Taku , Matsuda Takahisa , Hashimoto Taiki , Sekine Shigeki , Saito Yutaka
Published: April 2021

Background and Aim

Superficially serrated adenoma (SuSA) is a recently proposed subtype of colorectal serrated lesions. It is characterized by distinct clinicopathological and molecular features, including mixed serrated and adenomatous histology and frequent genetic alterations involving KRAS and RSPO. This study aimed to characterize the endoscopic features of isolated and traditional serrated adenoma (TSA)‐associated SuSAs.

Methods

We retrospectively evaluated the endoscopic findings of 25 isolated SuSAs and 21 TSA‐associated SuSAs that were histologically and molecularly characterized.

Results

SuSAs appeared as a sessile polyp or slightly elevated lesion located mostly in the sigmoid colon and rectum (88%). The size was between 3 and 20 mm (median, 6 mm). Most of them exhibited KRAS mutations (96%) and RSPO fusions/overexpression (92%). Endoscopically, many lesions had a whitish color (84%), a distinct border (96%), an irregular border (76%), and a lobulated surface (72%). However, diminutive lesions exhibited overlapping features with hyperplastic polyps. On narrow‐band imaging, vessel patterns were invisible or appeared as lacy microvessels in most lesions (80%). Chromoendoscopy invariably showed stellar or elongated/branched stellar pits, indicating a serrated microarchitecture. Most TSA‐associated SuSAs typically presented as polyps with a two‐tier raised appearance, consisting of whitish lower and reddish higher components corresponding to a SuSA and a TSA, respectively.

Conclusions

SuSAs exhibit several characteristic endoscopic features on white‐light and image‐enhanced endoscopy. Diminutive lesions exhibit endoscopic features overlapping with hyperplastic polyps. Nonetheless, the endoscopic diagnosis of larger and TSA‐associated SuSAs may be feasible.
Comparative analysis of the diagnostic value of several methods for the diagnosis of patent foramen ovale
Authors: Liu Fangfang , Kong Qingyu , Zhang Xiaojun , Li Yan , Liang Shimin , Han Shuang , Li Guishuang
Published: April 2021

The aim of this research was to compare the sensitivity and positive predictive value of contrast transcranial Doppler (c‐TCD), contrast transthoracic echocardiography (c‐TTE), and contrast transesophageal echocardiography (c‐TEE), to determine the best method for diagnosing patent foramen ovale (PFO) and to provide a reference for the further improvement of clinical practice. We investigated 161 patients who suffered from migraines, cryptogenic stroke, TIA, and cerebral infarction of unknown cause. All patients underwent transcatheter examination, and the results of the right heart catheterization (RHC) were considered the gold standard for PFO diagnosis. The present study revealed that c‐TTE with the Valsalva maneuver had a higher sensitivity in detecting PFO related right‐to‐left shunt (PFO‐RLS), c‐TCD performed similarly to c‐TEE but maybe produce more false positives. Moreover, when we observed color shunt from the slit‐like channel between the septum primum and the septum secundum on TEE, the positive predictive value was the highest. Patients with suspected PFO should be examined with c‐TTE and c‐TEE for confirmation. When there were a large number of bubbles in the left heart, especially in the presence of color shunt, the positive predictive value was the highest. The positive results of c‐TCD only point out the presence of right‐to‐left shunt and cannot exclude extracardiac shunt, so c‐TCD should not be used as a screen for PFO, additional measures such as c‐TTE and c‐TEE should be used.
ClimPlant: Realized climatic niches of vascular plants in European forest understoreys
Authors: Vangansbeke Pieter , Máliš František , Hédl Radim , Chudomelová Markéta , Vild Ondřej , Wulf Monika , Jahn Ute , Welk Erik , Rodríguez‐Sánchez Francisco , De Frenne Pieter
Published: April 2021

Motivation

Detailed knowledge on the climatic tolerances of species is crucial to understand, quantify and predict the impact of climate change on biodiversity and ecosystem functions. However, quantitative data are limited; often, only expert‐based qualitative estimates are available. With the ClimPlant database, we capitalize on the link between species distribution ranges and macroclimate to infer the realized climatic niches of 968 European forest plant species.

Main types of variables contained

The ClimPlant database contains information on the distribution of monthly, growing‐season and annual mean, minimum and maximum temperature and total precipitation within the distribution range of 968 European forest plants.

Spatial location and grain

Europe in 10 arc‐min grid cells; the study area has been cropped rectangularly at 15° W (Atlantic Ocean), 60° E (Ural Mountains), 25° N (Sahara) and 75° N (Arctic Ocean).

Time period and grain

The distribution ranges of forest plant species are based on two renowned distribution atlases. The monthly mean, minimum and maximum temperature and precipitation between 1970 and 2000 were extracted from WorldClim v.2.

Major taxa and level of measurement

Nine hundred and sixty‐eight vascular plant species of European forests, with taxonomy following the Euro+Med PlantBase nomenclature .

Software format

Data in 56 CSV files, with 1,000 values for monthly, growing season and annual observations of mean, minimum and maximum temperature and precipitation in the distribution range for every species. One summary CSV file with summary statistics (mean, median, fifth and 95th percentile), for every species, of each climatic variable, together with seven key geographical descriptors: area of the distribution range, latitude and longitude of the centroid, and northern, eastern, western and southern range limits within the study area.
Lynch syndrome screening in colorectal cancer: results of a prospective 2‐year regional programme validating the NICE diagnostics guidance pathway throughout a 5.2‐million population
Authors: West Nicholas P , Gallop Niall , Kaye Danny , Glover Amy , Young Caroline , Hutchins Gordon G A , Brockmoeller Scarlet F , Westwood Alice C , Rossington Hannah , Quirke Philip ,   the Yorkshire Cancer Research Bowel Cancer Improvement Programme Group
Published: April 2021

Aims

Screening all patients newly diagnosed with colorectal cancer (CRC) for possible Lynch syndrome (LS) has been recommended in the United Kingdom since the National Institute for Health and Care Excellence (NICE) released new diagnostics guidance in February 2017. We sought to validate the NICE screening pathway through a prospective regional programme throughout a 5.2‐million population during a 2‐year period.

Methods and results

Pathology departments at 14 hospital trusts in the Yorkshire and Humber region of the United Kingdom were invited to refer material from patients with newly diagnosed CRC aged 50 years or over between 1 April 2017 and 31 March 2019 for LS screening. Testing consisted of immunohistochemistry for MLH1, PMS2, MSH2 and MSH6 followed by BRAF mutation analysis ± MLH1 promoter methylation testing in cases showing MLH1 loss. A total of 3141 individual specimens were submitted for testing from 12 departments consisting of 3061 unique tumours and 2791 prospectively acquired patients with CRC. Defective mismatch repair (dMMR) was observed in 15% of cases. In cases showing MLH1 loss, 76% contained a detectable BRAF mutation and, of the remainder, 77% showed MLH1 promoter hypermethylation. Of the patients included in the final analysis, 81 (2.9%) had an indication for germline testing.

Conclusion

LS screening using the NICE diagnostics guidance pathway is deliverable at scale identifying significant numbers of patients with dMMR. This information is used to refer patients to regional clinical genetics services in addition to informing treatment pathways including the use of adjuvant/neoadjuvant chemotherapy and immunotherapy.
Clinical applications of monitoring immune status with 90 immune cell subsets in human whole blood by 10‐color flow cytometry
Authors: Wang Weiwei , Li Haibo , Zhang Lihua , Jiang Wenli , Shen Lisong , Fan Guang
Published: April 2021

Introduction

The immune system may involve and predict the different prognosis and therapy consequences. So, it's important to monitor and evaluate the immune status before and after treatments.

Methods

Flow cytometry is the best technology to perform immune monitoring, because it can detect immune cells using small amount of sample in a short time. The whole blood is the ideal sample for immune status monitoring, since it includes almost all the immune cells and it's relatively easy to obtain and less invasive than bone marrow or lymph node.

Results

Here we developed and validated a 10‐color panel with only four tubes containing 29 antibodies to monitor 90 immune cell subsets in 2 ml whole blood samples. The major immune cell populations detected by our panel included T cell subsets (CD3+total T, Th, Tc, Treg, CD8hi, CD8low, αβTCR, γδTCR, naïve, and memory T), T cell activation markers (CD25, CD69, and HLA‐DR) and one immune checkpoint PD1, B cell subsets (B1, switched memory, non‐switched, naïve B, and CD27‐IgD‐B cells), neutrophils, basophils, four monocytic cell subsets, dendritic cells (pDCs and mDCs), and four NK cell subsets. These panels of antibodies had been applied to monitor immune status (percentage and absolute number) in total 303 cases with various diseases, such as leukemia (AML, CML, MM, and ALL), lymphoma (B cells and NK/T cells), cancers (colon, lung, prostate, and breast), immune deficiencies, and autoimmune diseases.

Conclusion

We provided proof of feasibility for clinical monitoring immune status and guiding immunotherapy by multicolor flow cytometry testing.
Social support and sleep quality in patients with stroke: The mediating roles of depression and anxiety symptoms
Authors: Zhao Yaling , Hu Bo , Liu Qingwei , Wang Ying , Zhao Yuxue , Zhu Xiuli
Published: April 2021

Background

Research has demonstrated that higher social support is associated with better psychological health, quality of life, cognition, activities of daily living and social participation, but the relationship between social support and sleep quality remains unknown.

Aims

This study aimed to assess the incidence of poor sleep quality, clarify the relationship between social support and sleep quality amongst stroke patients and determine whether anxiety and depression symptoms mediate this relationship.

Methods

We conducted a quantitative, cross‐sectional study involving 238 patients with stroke (median age of 61 [range 29–87] years, 68.1% male) recruited from a comprehensive tertiary care hospital between September 2019 and January 2020. A self‐administered, structured questionnaire was used for the survey. The mediating effect of anxiety and depression symptoms was assessed using the bootstrap method via Model 4 (parallel mediation) of the SPSS PROCESS macro.

Results

Results showed that the incidence of poor sleep quality amongst stroke patients was 65%. Mediation analysis showed that social support exerted significant direct effects on sleep quality, and anxiety and depression symptoms mediated the relationship between social support and sleep quality.

Conclusion

Measures should be taken to enhance social support to improve the sleep quality of stroke patients.
Inhibition of CD38 and supplementation of nicotinamide riboside ameliorate lipopolysaccharide‐induced microglial and astrocytic neuroinflammation by increasing NAD+
Authors: Roboon Jureepon , Hattori Tsuyoshi , Ishii Hiroshi , Takarada‐Iemata Mika , Nguyen Dinh Thi , Heer Collin D. , O'Meally Denis , Brenner Charles , Yamamoto Yasuhiko , Okamoto Hiroshi , Higashida Haruhiro , Hori Osamu
Published: April 2021

Neuroinflammation is initiated by activation of the brain's innate immune system in response to an inflammatory challenge. Insufficient control of neuroinflammation leads to enhanced or prolonged pathology in various neurological conditions including multiple sclerosis and Alzheimer's disease. Nicotinamide adenine dinucleotide (NAD+) plays critical roles in cellular energy metabolism and calcium homeostasis. Our previous study demonstrated that deletion of CD38, which consumes NAD+, suppressed cuprizone‐induced demyelination, neuroinflammation, and glial activation. However, it is still unknown whether CD38 directly affects neuroinflammation through regulating brain NAD+ level. In this study, we investigated the effect of CD38 deletion and inhibition and supplementation of NAD+ on lipopolysaccharide (LPS)‐induced neuroinflammation in mice. Intracerebroventricular injection of LPS significantly increased CD38 expression especially in the hippocampus. Deletion of CD38 decreased LPS‐induced inflammatory responses and glial activation. Pre‐administration of apigenin, a flavonoid with CD38 inhibitory activity, or nicotinamide riboside (NR), an NAD+ precursor, increased NAD+ level, and significantly suppressed induction of cytokines and chemokines, glial activation and subsequent neurodegeneration after LPS administration. In cell culture, LPS‐induced inflammatory responses were suppressed by treatment of primary astrocytes or microglia with apigenin, NAD+, NR or 78c, the latter a specific CD38 inhibitor. Finally, all these compounds suppressed NF‐κB signaling pathway in microglia. These results suggest that CD38‐mediated neuroinflammation is linked to NAD+ consumption and that boosting NAD+ by CD38 inhibition and NR supplementation directly suppress neuroinflammation in the brain.

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Outcomes of small‐cell versus large‐cell gastroenteropancreatic neuroendocrine carcinomas: A population‐based study
Authors: Abdel‐Rahman Omar , Fazio Nicola
Published: April 2021

The recent World Health Organization classification for gastroenteropancreatic neuroendocrine neoplasms (GEP‐NENs) classified poorly differentiated GEP‐NENs into small cell and large cell categories. The present study aimed to assess the differences in outcomes between patients with both histological categories. The Surveillance, Epidemiology and End Results (SEER) database (1975‐2016) was accessed and patients with small cell and large cell GEP‐neuroendocrine carcinomas (NECs) were extracted. Differences in survival outcomes were explored through Kaplan‐Meier survival estimates and multivariable Cox regression models. In total, 2204 patients with GEP‐NEC were identified in the survival cohort, including 1698 patients with small cell NEC (77%) and 506 patients with large cell NEC (23%). Using Kaplan‐Meier analysis/log‐rank testing, large cell GEP‐NEC was associated with better overall survival compared to small cell NEC (P < 0.01). Using multivariable Cox regression analysis, large cell GEP‐NEC was associated with better overall survival (large cell GEP‐NEC versus small cell GEP‐NEC, hazard ratio = 0.77; 95% confidence interval = 0.68‐0.86) and cancer‐specific survival (large cell GEP‐NEC versus small cell GEP‐NEC, hazard ratio = 0.79; 95% 95% confidence interval = 0.69‐0.91). Patients with small cell GEP‐NEC have worse survival outcomes compared to those with large cell GEP‐NEC. Further efforts are needed to identify biological differences and treatment sensitivities between both histological categories.
They Are Partners in Care: A Qualitative Exploration of Physicians’ Perceptions of Primary Care Advanced Practice Nurses
Authors: Soh Barnabas Felix Jia Ren , Ang Wei How Darryl , De Roza Jacqueline Giovanna , Quek Imm Pin , Lim Pui San , Lau Ying
Published: April 2021

Purpose

This study explores physicians’ perceptions of the advanced practice nurse (APN) role in the primary care setting in Singapore.

Methods and Design

A descriptive qualitative design utilizing face‐to‐face semistructured interviews was conducted on a purposive sample of 16 primary care physicians from six primary care clinics. Thematic analysis and constant comparative analysis were used.

Findings

Three themes were identified: a collaborative partner in primary care, a conduit for specialist care and information, and a leader in community care. Physicians generally reported positivity about the clinical role of APNs and their potential in leading community care. However, they verbalized role ambiguity beyond clinical practice.

Conclusions

Physicians viewed primary care APNs as competent healthcare professionals. They viewed APNs as specialists in their fields, with the potential for expanding their services into the community. However, there remains gaps in physicians’ understanding of the primary care APNs’ nonclinical roles. The findings from this study indicate a need for nursing schools and nurse leaders to increase awareness of the complete APN role among physicians. APNs’ roles in educating healthcare professionals and delivering care to the community can be further developed.

Clinical Relevance

APNs are at the forefront in leading nursing care. There is a need to develop greater collaborative partnerships while delineating their respective roles in patient care.
3D skull modelling and description of a new baurusuchid (Crocodyliformes, Mesoeucrocodylia) from the Late Cretaceous (Bauru Basin) of Brazil
Authors: Darlim Gustavo , Montefeltro Felipe C. , Langer Max C.
Published: April 2021

Baurusuchidae is one of the most diverse groups of South American notosuchians, unambiguously recorded in Late Cretaceous deposits of Brazil and Argentina. The group is characterized by a reduced tooth formula, a lateromedially compressed rostrum, and a verticalized quadrate, representing one of the top predators of their faunas. Historically, skull morphology is the most employed tool to investigate the relationships of baurusuchids, as most of the species have been primarily based on cranial remains. The present study describes a new baurusuchid species from the Bauru Basin of Brazil, based on the first tridimensional digital reconstruction of individualized skull bones for Notosuchia, and discusses its phylogenetic position within the group. The new species differs from all the other known baurusuchids by a depression on the posterior portion of the nasal bearing a crest, an infraorbital crest of the jugal that extends until the anterior margin of the lacrimal, the dorsal surface of the frontal lacking a longitudinal crest or depression, and the lateral convexity of the squamosal prongs participating in the occipital wall. The new taxon is consistently positioned as sister to the remaining baurusuchines, with Aplestosuchus sordidus and Stratiotosuchus maxhechti, as successive sister‐taxa to a monophyletic Baurusuchus (Ba. albertoi, Ba. Salgadoensis, and Ba. pachecoi). Our updated phylogenetic analysis helps to differentiate the two major Baurusuchidae lineages, Baurusuchinae and Pissarrachampsinae. Yet, the new species shares morphological features with both groups, suggesting the occurrence of “Zones of Variability” in the radiation of Baurusuchidae.
A case of synchronous high‐grade cervical intraepithelial neoplasia and metastatic squamous cell carcinomas of unknown primary in rectum
Authors: Orisaka Syunsuke , Nakamura Mitsuhiro , Obata Takeshi , Iwadare Junpei , Mizumoto Yasunari , Fujiwara Hiroshi
Published: April 2021

We report a case of synchronous high‐grade cervical intraepithelial neoplasia (CIN) and metastatic squamous cell carcinomas (SCCs) of unknown primary in the rectum. A 74‐year‐old woman was diagnosed with CIN3 by biopsy of the uterine cervix. Magnetic resonance imaging showed two masses in the outer rectal wall. They were diagnosed as SCCs by transrectal biopsy from one mass. On surgical treatment, CIN3 and SCCs in the rectum were identified, respectively. Pathological analysis revealed that SCCs were observed in serosa of the rectum, not mucosa, indicating that these tumors were metastatic SCCs. Gene analysis showed HPV31‐positive and TP53 mutation in CIN3, and HPV16‐positive in rectal SCCs. Pretreatment examination did not detect the primary site of metastatic SCCs in the rectum. We diagnosed the patient with synchronous CIN3 and metastatic SCCs of unknown primary in the rectum. In this case, gene analysis was useful to clarify the relationship between CIN3 and SCCs.
Moving beyond assumptions: Polyploidy and environmental effects explain a geographical parthenogenesis scenario in European plants
Authors: Karbstein Kevin , Tomasello Salvatore , Hodač Ladislav , Lorberg Ellen , Daubert Mareike , Hörandl Elvira
Published: April 2021

Geographical parthenogenesis (GP) describes the phenomenon that apomicts tend to have larger distribution areas and/or occur at higher altitudes or latitudes compared to sexual relatives. However, the complex effects of genome‐wide heterozygosity, ploidy, reproduction mode (sexual vs. apomictic), and environment shaping GP of plants are still not well understood. We ascertained ploidy and reproduction mode by flow cytometry of 221 populations, and added genomic RADseq data (maximum 33,165 loci) of 80 taxa of the Ranunculus auricomus polyploid plant complex in temperate Europe. We observed 7% mainly diploid sexual, 28% facultative apomictic (mean sexuality 7.1%), and 65% obligate apomictic populations. Sexuals occupied a more southern, smaller distribution area, whereas apomicts expanded their range to higher latitudes. Within the complex, we detected three main genetic clusters and highly reticulate relationships. A genetically‐informed path analysis using GLMMs revealed several significant relationships. Sexuality of populations (percent of sexual seeds) was higher in diploids compared to polyploids, associated with more petals, and similar between forests and open habitats. In contrast to other apomictic plant complexes, sexuality was mainly positively correlated to solar radiation and isothermality, which fits the southern distribution. We found up to three times higher heterozygosity in polyploids compared to diploids, and generally more heterozygous individuals in forests compared with open habitats. Interestingly, we revealed a previously unknown positive association between heterozygosity and temperature seasonality, suggesting a higher resistance of polyploids to more extreme climatic conditions. We provide empirical evidence for intrinsic and extrinsic factors shaping the GP pattern in a polyploid plant complex.
Comparison of the effects of corticosteroid and hyaluronic acid‐carboxymethylcellulose solution on selective nerve root block for lumbar radiculopathy: A prospective, double‐blind, randomized controlled clinical trial
Authors: Ko Sangbong , Jun ChungMu , Lee Jae Jun , Nam Junho
Published: April 2021

Background

Selective nerve root block (SNRB) was shown to effectively control radiating pain and reduce the need for surgical intervention. However, repetitive injections may trigger corticosteroid‐induced side effects (hypercorticism, hyperglycemia, or fluid retention). This study aims to compare the potency of hyaluronic acid‐carboxymethylcellulose (HA‐CMC) solution versus that of corticosteroids regarding lower leg radiating pain (LLRP) improvement and functional outcome.

Methods

Among 128 patients, 44 patients who complain about having LLRP due to lumbar spinal stenosis and do not have neurological symptoms requiring surgery were enrolled for this study. Group A with 22 patients injected with cocktail A (local anesthetics and corticosteroid) and group B with 22 patients injected with cocktail B (local anesthetics and HA‐CMC). Outcome measures were the visual analog scale (VAS), Oswestry Disability Index (ODI), and short form‐36 (SF‐36). All patients were asked to fill in the questionnaires during the follow‐up assessment period at 3 days, 7 days, 2 weeks, 6 weeks, and 12 weeks.

Results

In all time periods, there were no statistical differences between the two groups for VAS scores and VAS improvement over time, ODI scores and ODI improvement over time, and SF‐36 PCS scores and SF‐36 mental component score scores. Additionally, the 95% confidence interval of the difference in VAS score improvement between the 2 groups in all time periods was within VAS 5.0, which is the minimum clinically relevant difference.

Conclusions

Considering the adverse effects of corticosteroids, and the similar LLRP improvements, functional outcome, and quality of life, the HA‐CMC solution may be an alternative option to corticosteroid in SNRB.
From rule‐takerto rule‐promotingregulatory state: South Korea in the nearly‐globalcompetition regime
Authors: Cho Moohyung , Büthe Tim
Published: April 2021

When rapid economic growth catapults a country within a few years from the margins of the global economy to middle power status, does global regulatory governance need to brace for a challenge to the status quo? To answer this question, we extend the power transition theory of global economic governance to middle powers: A rising middle power should be expected to challenge the international regulatory status quo only if increasing issue‐specific strength of its regulatory state coincides with preferences that diverge from the preferences of the established powers, which are enshrined in the status quo. We examine this argument empirically, focusing on South Korea in the realm of competition law and policy. We find that South Korea, a non‐participant in the international competition regime until the 1980s, developed in the 1990s substantial regulatory capacity and capability and thus “spoiler potential.” At the same time, however, its policy preferences converged upon the norms and practices established by the United States and the European Union, albeit with some distinct elements. Under these conditions, we expect a transition from rule‐taker to rule‐promoter. We find that South Korea has indeed in recent years begun to actively promote well‐established competition law and policy norms and practices – supplemented by its distinct elements – through technical assistance programs, as well as various bilateral channels and multilateral institutions. The findings suggest that the power transition theory of global economic governance is usefully applicable to middle powers, too.
Preoperative use of pirfenidone and reduced risk of postoperative severe respiratory complications in patients with idiopathic pulmonary fibrosis: Propensity score‐matched analysis using a nationwide database in Japan
Authors: Urushiyama Hirokazu , Jo Taisuke , Hasegawa Wakae , Ando Takahiro , Sakamoto Yukiyo , Uda Kazuaki , Matsui Hiroki , Fushimi Kiyohide , Yasunaga Hideo , Nagase Takahide
Published: April 2021

Background and objective

Patients with idiopathic pulmonary fibrosis (IPF) often develop postoperative severe respiratory complications such as acute exacerbation. Pirfenidone, an oral anti‐fibrotic drug, may reduce the incidence of such complications. However, the preventive effect of pirfenidone on postoperative severe respiratory complications remains unclear.

Methods

We identified patients with IPF who underwent surgery with general anaesthesia from July 2010 to March 2018 using the Diagnosis Procedure Combination database. We compared the occurrence of postoperative severe respiratory complications (receiving mechanical ventilation under endotracheal intubation and/or intravenous infusion of a high‐dose corticosteroid and in‐hospital death within 30 days after surgery) between patients who did and did not receive preoperative treatment with pirfenidone. Pearson's chi‐square test and logistic regression analysis fitted with a generalized estimating equation were conducted in 1:4 propensity score‐matched patients.

Results

Among 631 patients identified, 19% were treated with pirfenidone before surgery. The 30‐day mortality rate was 3.1% and 1.7% in the control patients (n = 510) and pirfenidone‐treated patients (n = 121), respectively. In the propensity score‐matched population, preoperative treatment with pirfenidone was significantly associated with a lower proportion of postoperative severe respiratory complications (OR: 0.24; 95% CI: 0.07–0.76; p = 0.015).

Conclusion

In this Japanese nationwide cohort, preoperative treatment with pirfenidone was significantly associated with a lower risk of postoperative severe respiratory complications in patients with IPF. Preoperative pirfenidone may thus be useful in preventing postoperative severe respiratory complications in patients with IPF who are planning to undergo surgery with general anaesthesia.
Spending from Regulated Retirement Drawdowns: The Role of Implied Endorsement*
Authors: Alonso‐García Jennifer , Bateman Hazel , Bonekamp Johan , Stevens Ralph
Published: April 2021

We fielded an online survey in the Netherlands and Australia to explore the influence of an implied endorsement nudge, conveyed by a government‐regulated drawdown from pension wealth, on spending patterns in retirement. The implied endorsement nudge was effective. It influenced the preferred retirement spending patterns of around 30 percent of survey participants, particularly those with fewer financial resources and low pension capability. Australian participants were more likely to follow the nudge where it was framed as implicit government advice, while the Dutch were more likely to respond to a suggestion that the nudge was a recommendation from peers. Our results provide support for a regulated drawdown rule as part of a strategy to guide spending patterns in retirement.
Profiling children longitudinally: A three‐year follow‐up study of perceived and actual motor competence and physical fitness
Authors: Estevan Isaac , Menescardi Cristina , García‐Massó Xavier , Barnett Lisa M. , Molina‐García Javier
Published: April 2021

Longitudinal designs enhance our understanding of children's development and its influence on movement behaviors and health. This three‐year follow‐up study aimed to develop profiles according to perceived and actual motor competence (MC) (locomotion, object control, and overall) and physical fitness in boys and girls longitudinally including children's temporal migrations among clusters in terms of profiling trends. A secondary aim was to compare physical activity participation and weight status at each time point according to these profiles. One hundred and four typically developing Spanish children (45.8% girls) between 4 and 9 years old at baseline participated in this study. Data were collected at three time points one year apart, between January 2016 and May 2018. A self‐organizing map and K‐means cluster analysis were used to classify and visualize the values and temporal trajectories longitudinally. The study of the profiles in three consecutive years revealed five profiles, three for boys [ie, profile 1 (aligned—high), profile 2 (aligned‐partially—low perception‐medium actual MC and fitness), and profile 3 (non‐aligned—medium perception‐low actual MC and fitness)]; and two for girls [ie, profile 4 (aligned—high) and profile 5 (aligned—low)]. For highly perceived and capable children, boys (profile 1) and girls (profile 4), there was a tendency for higher physical activity participation and lower body mass index and waist circumference over time compared to their counterparts who had medium and/or low levels in perception and actual MC and fitness (P < .05). As children age, those with low values in perceived and actual MC and fitness in object control skills will present a higher probability of maintaining unhealthy lifestyles. So, prior intervention, children's profiles identification should be analyzed according to the type of MC.
A Systems Approach to Understanding Community Power in the Debate over Confederate Monuments
Authors: Gåddie Keith , Evans Jocelyn J.
Published: April 2021

Objective

We explore the role of local institutions, public architecture, and Confederate memorialization to institutionalize racialized public spaces.

Method

Applying an Eastonian model in an American political development framework, data on government development, postbellum county creation, courthouse construction, and Confederate memorialization are examined for 161 Georgia counties.

Results

Commemorative landscapes, courthouse design, courthouse ground memorials, and other local memorialization reinforce a “Lost Cause” narrative.

Conclusions

American apartheid policies were translated from culture to policy to the built environment. They remain as echoes of spatial strategies of white supremacy, facilitated by hyperlocalism in government control. The result was a facially neutral, fundamentally unequal public space perpetuated in a dynamic system where marginalized voices and their feedback are diminished and then muted in the political environment.
Policy Innovativeness and Sexual Freedom
Authors: Bose Feler
Published: April 2021

The policy innovation literature does not mention any systemic analysis of sexual freedom laws. Sexual freedom, since the sexual revolution of the 1960s, has been increasing over the past few decades in the United States at the state level and hence is an appropriate area to study in terms of innovativeness. Data collected from 1960 to 2010 show that variables such as Ideology, Income, Religious and Racial fractionalization are important for sexual freedom innovation. In this article, I also innovate in how I calculate the sexual freedom innovativeness score that was necessitated because of the way sexual freedom laws were coded.
Conic reformulations for Kullback-Leibler divergence constrained distributionally robust optimization and applications
Authors: Kocuk Burak
Published: April 2021

In this paper, we consider a Kullback-Leibler divergence constrained distributionally robust optimization model. This model considers an ambiguity set that consists of all distributions whose Kullback-Leibler divergence to an empirical distribution is bounded. Utilizing the fact that this divergence measure has an exponential cone representation, we obtain the robust counterpart of the Kullback-Leibler divergence constrained distributionally robust optimization problem as a dual exponential cone constrained program under mild assumptions on the underlying optimization problem. The resulting conic reformulation of the original optimization problem can be directly solved by a commercial conic programming solver. We specialize our generic formulation to two classical optimization problems, namely, the Newsvendor Problem and the Uncapacitated Facility Location Problem. Our computational study in an out-of-sample analysis shows that the solutions obtained via the distributionally robust optimization approach yield significantly better performance in terms of the dispersion of the cost realizations while the central tendency deteriorates only slightly compared to the solutions obtained by stochastic programming.
Determination of Effective Drag Forces and Torques for Jam Release During Drilling and Workover Operations in Directional Wells
Authors: Ding Yanan , Wang Haiwen , Yang Daoyong
Published: April 2021

Excessive frictions in directional wells lead to various downhole problems such as pipe stuck that requires frequent workover operations, during which it is very challenging to accurately determine the effective drag (axial) forces and torques for releasing a jam at a stuck position due to the complex downhole situations. In this study, mathematical models have been formulated, validated, and applied to accurately determine such forces and torques in directional wells by taking the frictions caused by string-stiffness into account. The stiffness-based contact (normal) force is correlated with the deflection of a string segment by treating the bending segment as a simple beam that has both continuous and point contacts with the wellbore wall. Subsequently, the conventional soft-string model proposed by Johancsik et al. in 1984 is modified through coupling such a contact-force term into the original equations. Both the original soft-string model and the modified model are employed to perform the force and torque calculations for two field wells, based on which the effect of string-stiffness and the associated sensitivities are analyzed. Comparing the modified model with the conventional model, it has been found from their field applications that effective drag forces and torques for releasing a jam at a stuck point can be determined with an averaged relative deviation of 23.35% and 37.59%, respectively, indicating a considerable effect of string-stiffness that cannot be neglected for an accurate and efficient operation of jam release.
Effects of COVID-19 Lockdown and a Subsequent Retraining Period on Elite Athletes’ Workload, Performance, and Autonomic Responses: A Case Series
Authors: Valenzuela Pedro L. , Rivas Fernando , Sánchez-Martínez Guillermo
Published: April 2021

Purpose: To describe the effects of COVID-19 lockdown and a subsequent retraining on the training workloads, autonomic responses, and performance of a group of elite athletes. Methods: The training workloads and heart rate variability (assessed through the log-transformed root mean square of successive R–R intervals) of 7 elite badminton players were registered daily during 4 weeks of normal training (baseline), 7 to 10 weeks of lockdown, and 6 to 8 weeks of retraining. Physical performance was assessed at baseline and after each phase by means of a countermovement jump and the estimated squat 1-repetition maximum. Results: A reduction in training workloads was observed in all participants during the lockdown (−63.7%), which was accompanied by a reduced heart rate variability in all but one participant (−2.0%). A significant reduction was also observed for countermovement jump (−6.5%) and 1-repetition maximum performance (−11.5%), which decreased in all but one participant after the lockdown. However, after the retraining phase, all measures returned to similar values to those found at baseline. At the individual level, there were divergent responses, as exemplified by one athlete who attenuated the reduction in training workloads and increased her performance during the lockdown and another one who markedly reduced his workload and performance, and got injured during the retraining phase. Conclusions: Although there seems to be a large interindividual variability, COVID-19 lockdown is likely to impose negative consequences on elite athletes, but these detrimental effects might be avoided by attenuating reductions in training workloads and seem to be overall recovered after 6 to 8 weeks of retraining.
Markers of Polyfunctional SARS-CoV-2 Antibodies in Convalescent Plasma
Authors: Natarajan Harini , Crowley Andrew R. , Butler Savannah E. , Xu Shiwei , Weiner Joshua A. , Bloch Evan M. , Littlefield Kirsten , Wieland-Alter Wendy , Connor Ruth I. , Wright Peter F. , Benner Sarah E. , Bonny Tania S. , Laeyendecker Oliver , Sullivan David , Shoham Shmuel , Quinn Thomas C. , Larman H. Benjamin , Casadevall Arturo , Pekosz Andrew , Redd Andrew D. , Tobian Aaron A. R. , Ackerman Margaret E.
Published: April 2021

Convalescent plasma has been deployed globally as a treatment for COVID-19, but efficacy has been mixed. Better understanding of the antibody characteristics that may contribute to its antiviral effects is important for this intervention as well as offer insights into correlates of vaccine-mediated protection.
Case-Control Microbiome Study of Chronic Otitis Media with Effusion in Children Points at Streptococcus salivarius as a Pathobiont-Inhibiting Species
Authors: Jörissen Jennifer , van den Broek Marianne F. L. , De Boeck Ilke , Van Beeck Wannes , Wittouck Stijn , Boudewyns An , Van de Heyning Paul , Topsakal Vedat , Van Rompaey Vincent , Wouters Ine , Van Heirstraeten Liesbet , Van Damme Pierre , Malhotra-Kumar Surbi , Theeten Heidi , Vanderveken Olivier M. , Lebeer Sarah
Published: April 2021

The majority of probiotics marketed today target gastrointestinal health. This study searched for bacteria native to the human upper respiratory tract, with a beneficial potential for respiratory and middle ear health.
Dual RNA Sequencing Meta-analysis in
Plasmodium
Infection Identifies Host-Parasite Interactions
Authors: Mukherjee Parnika , Burgio Gaétan , Heitlinger Emanuel
Published: April 2021

Malaria still causes about 400,000 deaths a year and is one of the most studied infectious diseases. The disease is studied in mice and monkeys as lab models to derive potential therapeutic intervention in human malaria.
Managing valproic acid toxicity-related hyperammonaemia: an unpredicted course
Authors: Pagali Sandeep , Edquist Christopher , O'Rourke Nicholas
Published: April 2021

A 20-year-old woman presented following an intentional overdose of valproic acid. Use of valproic acid, either acute or chronic, can result in hyperammonaemia. Mild hyperammonaemia with chronic use is mostly asymptomatic but can also present with concern for encephalopathy. Acute valproic acid toxicity results in significant hyperammonaemia, which can contribute to encephalopathy. Levocarnitine is the treatment of choice in valproic acid toxicity-related hyperammonaemia. For severe cases of encephalopathy, intermittent haemodialysis can also be considered. To our knowledge, this is the first case report to clearly show symptom relapse and hyperammonaemia after discontinuing levocarnitine. We recommend levocarnitine therapy for at least 72 hours, followed by an additional 24 hours of monitoring for symptom relapse and hyperammonaemia after levocarnitine discontinuation.
Factors associated with testing positive for syphilis among MSM who present as sexual contacts of syphilis from a clinic-based population
Authors: Richardson Daniel , Pickering Alice , Nichols Kayleigh , Buss Zoe , Trotman Daniel , Fitzpatrick Colin , Williams Deborah
Published: April 2021

Objectives

There has been a significant increase in syphilis in men who have sex with men (MSM) in the UK over the past 20 years. Partner notification strategies have increased the number of MSM attending STI clinics as sexual contacts of syphilis. Current guidelines suggest testing and consideration of presumptive antimicrobial treatment. Syphilis treatment with benzathine penicillin requires clinic resources, is painful and is associated with complications. It is important we consider strategies to rationalise presumptive antimicrobial use and promote antimicrobial stewardship.

Methods

We aimed to determine if there are any factors associated with having syphilis among MSM attending as sexual contacts of syphilis in a cross-sectional study. We examined the clinical records of MSM attending as sexual contacts of syphilis from January to December 2019.

Results

Of the 6613 MSM who attended for STI testing, 142 of 6613 (2.1%) presented as sexual contacts of syphilis. The median age was 40 years (IQR=31–51), 43 of 142 (30%) were HIV positive, 38 of 142 (27%) had been diagnosed and treated for syphilis in the past, and 11 of 142 (8%) presented with symptoms (possible lesions of primary or secondary syphilis). Thirteen (9%, 95% CI=4.4 to 13.9) tested positive for syphilis on the day of presentation. MSM who were symptomatic (genital ulcer or body rash), HIV positive or had a history of syphilis were significantly more likely to test positive for syphilis (OR=51.88, 95% CI: 3.01 to 893.14, p=0.007).

Conclusions

We have shown that in our clinic-based population of MSM who presented as sexual contacts of syphilis, the factors associated with testing positive for syphilis were: having HIV, having a history of syphilis or presenting with symptoms (possible lesions of primary or secondary syphilis). These factors could be used to rationalise antibiotic treatment among MSM presenting as sexual contacts of syphilis. Further research is needed to validate this finding in other populations of MSM and people affected by syphilis.
A scoping review of exercise referral schemes involving qualified exercise professionals in primary health care
Authors: O’Brien Myles W. , Bray Nick W. , Kivell Matthew J. , Fowles Jonathon R.
Published: April 2021

Qualified exercise professionals (QEPs) have the training, knowledge, and scope of practice to effectively provide physical activity counselling, prescribe exercise, and deliver exercise programming to patients with or without chronic diseases. Healthcare providers identify an interest in referring patients to QEPs; however, the impact of exercise referral schemes (ERS) involving QEPs on patients’ physical health is unclear. A scoping review regarding the available evidence of ERS involving healthcare provider referrals to QEPs was performed. A literature search was conducted in 6 databases (initially: n = 6011 articles), yielding n = 23 articles examining QEP delivered physical activity counselling (n = 7), QEP supervised exercise training (n = 4), or some combination (n = 12). Although studies were heterogeneous in methods, procedures, and populations, ERSs increased patients’ subjective physical activity levels. Few studies incorporated objective physical activity measures (n = 5/23), and almost half measured aerobic fitness (n = 11/23). ERS involving a QEP that includes activity counselling and/or exercise programming/training report favourable impacts on patients’ subjectively measured physical activity and objectively measured aerobic fitness. Based on the existing literature on the topic, this scoping review provides recommendations for designing and evaluating ERS with QEPs that include: objective measures, long-term follow-up, QEP qualifications, and the cost-effectiveness of ERS.

Novelty: ERS involving QEPs report increased patients’ perceived physical activity level and may improve patients’ cardiorespiratory fitness. Promoting the collaboration of QEPs with other healthcare providers can enhance patients’ physical fitness and health. This scoping review provides recommendations for the design and evaluation of ERS involving QEPs.
Community-level functional traits of alpine vascular plants, bryophytes, and lichens after long-term experimental warming
Authors: van Zuijlen Kristel , Klanderud Kari , Dahle Oda Sofie , Hasvik Åshild , Knutsen Maria Skar , Olsen Siri Lie , Sundsbø Snorre , Asplund Johan
Published: April 2021

We measured community-level traits of vascular plants, lichens, and bryophytes in an alpine Dryas octopetala L. heath in Finse, Norway, after nearly two decades of experimental warming by open-top chambers. We hypothesized that under warming (1) vascular plant traits would shift from resource conservative towards more resource acquisitive, and (2) lichen and bryophyte traits would shift to those associated with drier conditions, due to increased evapotranspiration. Both hypotheses were not supported, as vascular plant nitrogen concentration decreased, whereas carbon to nitrogen ratio increased with warming, indicative of a less resource acquisitive strategy, and lichen specific thallus area and water holding capacity were unresponsive. Bryophyte specific shoot length increased, and carbon concentration and water holding capacity tended to decrease under warming, concurrent with increased vegetation height and litter cover indicating stronger competition from vascular plants. Intraspecific variation was most important for vascular plant and lichen traits, whereas species turnover was the main driver of bryophyte trait variation. This indicates that bryophytes may be affected more strongly by future warming than vascular plants and lichens in our study system. We highlight the importance of studying traits of different primary producer groups simultaneously, as they may respond differently to the same environmental changes.