bluuebunny/crossref_metadata_2025 huggingface dataset:
Herbivore dung stoichiometry drives competition between savanna trees and grasses
Authors: Sitters Judith , Olde Venterink Harry
Published: February 2021

The balance between trees and grasses is a key aspect of savanna ecosystem functioning, and so far, believed to be regulated by resource availability, fire frequency and consumption by mammalian herbivores. Herbivores, however, also impact plant communities through the deposition of growth‐limiting nutrients in their dung and urine. Little attention has been paid to the fact that savanna herbivores produce dung containing different concentrations of nutrients and it remains unknown what the effect of this variation is on tree–grass interactions.

Here, we investigate if stoichiometric differences in dung from browsers and grazers from an African savanna are large enough to influence competitive interactions between N2‐fixing trees and grasses. We performed a competition experiment with seedlings of three common N2‐fixing tree species and three common C4 grass species from a Kenyan savanna. Plants were grown in mesocosms as monocultures or mixtures with dung from either zebra (grazer) or giraffe (browser).

We show that variation in dung nitrogen (N) to phosphorus (P) ratio between these herbivores was large enough to drive the competitive outcome between tree seedlings and grasses. Under zebra dung with a low N:P ratio (3.5), tree seedlings had an advantage due to increased nodulation and N2 fixation. Under giraffe dung with a high N:P ratio (6.4), grasses suppressed nodulation and tree seedling growth.

Synthesis. We identify another potentially important mechanism by which mammalian herbivores can stimulate ecosystem stability, namely through the N:P ratio of their dung. This illustrates how connected browsing and grazing herbivores are in African savannas, through the forage quality they consume, the N:P stoichiometry of their dung and subsequent effects on plant competition.
Exposing wind stress as a driver of fine‐scale variation in plant communities
Authors: Momberg Mia , Hedding David W. , Luoto Miska , le Roux Peter C.
Published: February 2021

The effects of temperature and precipitation, and the impacts of changes in these climatic conditions, on plant communities have been investigated extensively. The roles of other climatic factors are, however, comparatively poorly understood, despite potentially also strongly structuring community patterns. Wind, for example, is seldom considered when forecasting species responses to climate change, despite having direct physiological and mechanical impacts on plants. It is, therefore, important to understand the magnitude of potential impacts of changing wind conditions on plant communities, particularly given that wind patterns are shifting globally.

Here, we examine the relationship between wind stress (i.e. a combination of wind exposure and wind speed) and species richness, vegetation cover and community composition using fine‐scale, field‐collected data from 1,440 quadrats in a windy sub‐Antarctic environment.

Wind stress was consistently a strong predictor of all three community characteristics, even after accounting for other potentially ecophysiologically important variables, including pH, potential direct incident solar radiation, winter and summer soil temperature, soil moisture, soil depth and rock cover. Plant species richness peaked at intermediate wind stress, and vegetation cover was highest in plots with the greatest wind stress. Community composition was also related to wind stress, and, after the influence of soil moisture and pH, had a similar strength of effect as winter soil temperature.

Synthesis. Wind conditions are, therefore, clearly related to plant community characteristics in this ecosystem that experiences chronic winds. Based on these findings, wind conditions require greater attention when examining environment–community relationships, and changing wind patterns should be explicitly considered in climate change impact predictions.
Dispersal limitation and weaker stabilizing mechanisms mediate loss of diversity with edge effects in forest fragments
Authors: Krishnadas Meghna , Stump Simon Maccracken
Published: February 2021

Whether fragmented ecosystems can maintain diversity is a key ecological question. The ability of fragmented forests to support diversity is determined by both landscape‐scale metapopulation dynamics and within‐patch mechanisms that govern species coexistence. Within‐patch dynamics can be affected by proximity to forest edges. Edge effects on abiotic and biotic processes can alter species' performance and species interactions, but it is unclear how edge effects bear upon the long‐term ability of fragmented forests to maintain diversity.

We apply modern coexistence theory as a framework to predict the impact of edge effects on species coexistence. Using field data for a tropical tree community, we parameterized a spatially explicit simulation model to quantify how habitat and density dependence during seedling establishment affect diversity of later life stages. We matched simulated future communities to observed patterns of diversity and community structure for established seedlings and adults, coupled with sensitivity analysis of simulated effects.

We found that early recruitment dynamics contributed to community structure at older life stages, corroborating empirical work on the importance of early life‐stage dynamics for diversity. Edge effects reduced the diversity maintained in patches. The progressive loss of diversity was not due to changes in relative competitive ability (fitness differences), but due to weaker stabilization via density‐dependent seed mortality. Results were robust to wide changes in the absolute values of model parameters, suggesting that variation in the strength of individual processes did not change their relative importance for diversity.

Synthesis. Weakening of stabilizing processes that promote species self‐limitation in ecological communities could compromise the ability of habitat fragments to maintain diversity. Quantifying the relative importance of intraspecific versus interspecific interactions—to assess stabilizing mechanisms and fitness differences—can help evaluate when habitat amount versus quality plays a larger role in maintaining diversity of fragments.
‘Living in a Zoom world’: Survey mapping how COVID‐19 is changing family therapy practice in the UK
Authors: Mc Kenny Richard , Galloghly Emily , Porter Catherine M. , Burbach Frank R.
Published: February 2021

Following the COVID‐19 pandemic, psychological therapies rapidly moved online in mid‐2020. The Association for Family Therapy and Systemic Practice in the UK (AFT) surveyed the attitudes and practices of systemic therapists in the UK in early October 2020, exploring members’ views and gathered information about ongoing needs. A sample of 312 people were included in a mixed methods analysis. In total, 65% of respondents felt their overall experience of using online video technology professionally was positive, further reflected in responses to two open‐ended questions. Detailed thematic analysis revealed that many positive comments were related to the practical advantages of online working, whilst many negative comments were related to technique and the therapeutic relationship. Possible respondent biases are discussed, and the implications of this change in practice are explored. It remains to be seen if this marks the beginning of a more permanent shift in our field as we explore the potential of new technologies.

Practitioner Points

The vast majority of UK systemic therapists felt that their experience of online video technology was positive.

They noted many practical advantages but also identified many challenges regarding therapeutic techniques and the therapeutic relationship.

Therapists developed a range of creative solutions to maximise the therapeutic opportunities of online video.
“It is not just about doing or saying the right things”: Working systemically with parents whose children are placed in public care
Authors: Syrstad Ellen , Ness Ottar
Published: February 2021

This article explores the possibilities of a systemic approach in the support of parents whose children are placed in public care. The article is based on a qualitative study interviewing six parents who have received support from Norwegian Family Counselling Services (FCS) and seven systemic family therapists from FCS. Both groups were interviewed individually and in focus groups. The findings suggest that parents experienced less judgement from therapists in FCS than from caseworkers in CPS. Even if it could be challenging, the systemic therapists found a systemic approach useful to help parents develop agency and make meaning of their lives, as the parents struggled to have agency and understand why their children were placed in care. The article concludes that systemic approaches can be useful in these cases, combined with appropriate child protection interventions as necessary.

It is a challenge for the Child Protection Services (CPS) to support parents after their children are placed in public care.

Parents’ feelings of powerlessness towards the CPS made them align with the CPS’s requirements even when they did not understand or disagreed with the requirements.

Systemic family therapy seems to be a promising approach for working with parents to explore their own narratives, to improve and contextualise their meaning‐making.
Treatment efficacy of multiple family therapy in helping Hong Kong Chinese parents recover from depression
Authors: Ma Joyce L. C. , Xia Lily L. L. , Yau‐Ng Monica , Yan‐Yee Cindy Yiu
Published: February 2021

This paper reports on the results of a clinical study that assessed the treatment efficacy of an adapted model of multiple family therapy (MFT) in helping Hong Kong Chinese parents recovering from depression. A total of sixty‐one depressed parents were assigned to either the control group (CG) or the experimental group (EG) on the basis of their motivation and commitment to the MFT programme. Data were collected using standardised measures in the pre‐treatment phase (T1), in the post‐treatment phase (T2) and at a three‐month follow‐up (T3). No significant difference was found between the EG and the CG in regard to the effect of MFT on the parental and family functioning of the depressed parents. However, after the MFT, the EG depressed parents’ level of psychological distress was significantly reduced, an effect which was sustained at 3‐month follow‐up. Clinical and research implications of the study are discussed.

Practitioner points

Multiple family therapy (MFT) is useful for Hong Kong Chinese parents with depression in recovery.

Depressed parents’ psychological distress was reduced after MFT.

Depressed parents with lower levels of education are likely to need support or interventions additional to MFT.
The implementation cost of a safety‐net hospital program addressing social needs in Atlanta
Authors: MacLeod Kara E. , Chapel John M. , McCurdy Matthew , Minaya‐Junca Jasmin , Wirth Diane , Onwuanyi Anekwe , Lane Rashon I.
Published: February 2021

Objective

To describe the cost of integrating social needs activities into a health care program that works toward health equity by addressing socioeconomic barriers.

Data Sources/Study Setting

Costs for a heart failure health care program based in a safety‐net hospital were reported by program staff for the program year May 2018–April 2019. Additional data sources included hospital records, invoices, and staff survey.

Study Design

We conducted a retrospective, cross‐sectional, case study of a program that includes health education, outpatient care, financial counseling and free medication; transportation and home services for those most in need; and connections to other social services. Program costs were summarized overall and for mutually exclusive categories: health care program (fixed and variable) and social needs activities.

Data Collection

Program cost data were collected using a activity‐based, micro‐costing approach. In addition, we conducted a survey that was completed by key staff to understand time allocation.

Principal Findings

Program costs were approximately $1.33 million, and the annual per patient cost was $1455. Thirty percent of the program costs was for social needs activities: 18% for 30‐day supply of medications and addressing socioeconomic barriers to medication adherence, 18% for mobile health services (outpatient home visits), 53% for navigating services through a financial counselor and community health worker, and 12% for transportation to visits and addressing transportation barriers. Most of the program costs were for personnel: 92% of the health care program fixed, 95% of the health care program variable, and 78% of social needs activities.

Discussion

Historically, social and health care services are funded by different systems and have not been integrated. We estimate the cost of implementing social needs activities into a health care program. This work can inform implementation for hospitals attempting to address social determinants of health and social needs in their patient population.
Be happy to be successful: a mediational model of PERMA variables
Authors: Goh Pei Shan , Goh Yong Wah , Jeevanandam Loshnah , Nyolczas Zsuzsa , Kun Agota , Watanabe Yayoi , Noro Ikuko , Wang Rong , Jiang Jiang
Published: February 2021

To conceptualize how employees’ perception of job performance might be generated, the present study tested a process model of Seligman's (2011, The Journal of Positive Psychology 13, 333) PERMA. Hierarchical regression and mediation analyses were conducted on 648 working adults from Hungary, Japan, China and Australia. A significant mediation effect of Positive Relationships and Meaning on the pathway from Positive Emotions to Accomplishment was found. Meaning was a stronger mediator than Positive Relationships. The indirect effect of Engagement as a mediator between Positive Emotions and Accomplishment was not significant, contrary to past empirical evidence of Engagement as a mediator. These findings demonstrate the significance of examining PERMA with a holistic approach. The implications of this study on workplace performance interventions are also discussed.
The chemistry and sensory characteristics of new herbal tea‐based kombuchas
Authors: Zhang Jing , Van Mullem Joshua , Dias Disney Ribeiro , Schwan Rosane Freitas
Published: February 2021

Kombucha is a black tea‐based, non‐alcoholic beverage fermented by yeast and bacteria are known for its refreshing scent and taste and presents biological characteristics, namely antioxidant, antimicrobial and anti‐inflammatory activity. The present study compared traditional kombucha prepared with black tea and green tea to kombuchas produced with several alternative substrates, including white tea, chrysanthemum, honeysuckle, and mint infusions. Throughout the fermentation process, liquid and gas chromatography analyzed sugars, ethanol, organic acids, and volatile compounds. Sugar consumption was substrate‐dependent, with mint kombucha having the highest amount of residual sugar and honeysuckle having the lowest. Forty‐six volatile organic compounds were detected, including alcohols, esters, acids, aldehydes, ketones, and other compounds. Twenty‐two compounds were produced during the fermentation and identified in all kombuchas; some of these compounds represented fruity and floral aromas. Another 24 compounds were substrate specific. Notably, the herb‐based kombuchas (chrysanthemum, honeysuckle, and mint) contained several compounds absent in the tea‐based kombuchas and are associated with minty, cooling, and refreshing aromas. Mint and green tea kombucha attained the highest and lowest overall sensorial acceptance ratings, respectively. This study demonstrated herbal substrates' suitability to prepare kombucha gastronomically with volatile compound and flavor profiles distinct from tea‐based kombuchas.

Practical Application

The kombucha beverage is a low‐caloric functional drink that is increasingly popular around the world. While it is traditionally produced with black or green tea, this paper explores its production based on other herbal and floral infusions. The kombucha analogs presented in this paper can provide consumers with healthy alternatives for sugary soft drinks while also offering a broader range of flavors.
Major royal jelly proteins prevents NAFLD by improving mitochondrial function and lipid accumulation through activating the AMPK / SIRT3 pathway in vitro
Authors: Zhang Xiaochen , Lu Xinyang , Zhou Yingjun , Guo Xinyu , Chang Yaning
Published: February 2021

Nonalcoholic fatty liver disease (NAFLD) is a metabolic syndrome, whose main characteristics are excessive lipid accumulation and oxidative stress. Major royal jelly proteins (MRJPs) is a kind of water‐soluble protein, which is abundant in royal jelly (RJ). The aim of this study was to evaluate the effect of MRJPs on lipid accumulation and oxidative stress of liver cells. Here, we first optimized the conditions for extracting MRJPs from RJ and identified the extraction effect and product by SDS‐PAGE. Then, we used oleic acid (OA) of 1.0 mM to induce hepatocytes for 24 hr to establish a stable cell models of lipid accumulation, and we found that pre‐administration (24 hr) of MRJPs (0.2, 0.5, and 1.0 g/L) could significantly reduce the lipid drop content and triglyceride level in the model cells, and simultaneously reduce the alanine aminotransferase and aspertate aminotransferase levels in the cell culture supernatant. In addition, pre‐incubation (24 hr) with MRJPs (0.2, 0.5, and 1.0 g/L) could restore superoxide dismutase (SOD) level and mitochondrial membrane potential as compared with OA group. Furthermore, MRJPs administration significantly upregulated the expression of Silent Information Regulator 2 Associated Protein 3, mitochondrial superoxide dismutase (SOD2), and cytochrome c oxidase subunit IV in OA‐treated HepG2 cells. The study for the first time provides evidences on the lipid‐lowering effect of MRJPs at the cellular level, which can further provide support for the development and application of polypeptide drugs in the future, and can also provide a choice for the prevention and treatment of liver metabolic diseases represented by NAFLD.

Practical Application

Our study proved that MRJPs had substantial preventing effect on OA‐induced lipid accumulation and mitochondrial dysfunction in HepG2 cells. This research can further provide theoretical support for the development and application of peptide drugs in the future. Besides, it can not only further broaden our understanding of NAFLD and other diseases, but also provide ideas for research on oxidative stress and lipid accumulation in the body.
Determination of optimum ripening time in hard cooked cheeses (Reggianito type) using survival analysis statistics: Modified versus traditional cheese making technology
Authors: Lorena Garitta , Ayelén Vélez , Graciela Rodríguez , M. Cristina Perotti , Erica Hynes
Published: February 2021

In this work, we determined optimum ripening time of hard cooked cheeses made by traditional technology or by an innovative process aimed at accelerating flavor formation. For that purpose, we applied survival analysis statistics. Experimental cheese making (E) included homogenization of milk fat, unpasteurized cheese milk, changes in cooking temperature, and a curd‐washing step, while traditional cheese making (T) followed a classic hard‐cooked cheese making. Cheeses were ripened for 215 days and samples were analyzed at 76, 112, 128, 152, and 215 days. Consumers (250) were recruited and divided into five groups of 50 consumers for each stage. At each sampling time, consumers assessed whether the sample was “under‐ripe,” “ok,” or “over‐ripe.” Optimum ripening time could be estimated only for E cheeses, with a high percentage of rejection. For T cheeses, it was not possible to determine the optimum ripening time because the rejection by over‐ripening was never reported. We verified consumer segmentation: a small percentage found E cheese under‐ripe and a high percentage found it over‐ripe. Many consumers qualified E cheeses as too spicy, especially at the end of ripening. Spicy flavor is usually perceived before than the texture and evidenced an acceleration of the flavor formation. We concluded that the innovative intervention in cheese making technology was successful in accelerating cheese ripening. It also had potential to develop a new cheese product targeted at consumers who chose/prefer good spicy flavor.

Practical Application

Survival analysis is a useful methodology to determine the optimum ripening time of foods based on consumer data. In this work, it evidenced that the proposed innovative cheese making was successful in accelerating the formation of cheese flavor, and had the potential to develop a new cheese product targeted at consumers who chose/prefer good spicy flavor.
Physicochemical characterization of oil, antioxidant potential, and phenolic profile of seeds isolated from Tunisian pomegranate (Punica granatum L.) cultivars
Authors: Khemakhem Maissa , Zarroug Youkabed , Jabou Khaled , Selmi Sawsen , Bouzouita Nabiha
Published: February 2021

Pomegranate (Punica granatum L.) seeds oils (PSO) from three Tunisian varieties namely Jebali, Testouri, and Gabsi were extracted by ultrasonic‐assisted extraction and analyzed for their physicochemical properties, fatty acids (FA) profile, and sterol composition. PSO of Gabsi and Testouri showed the best quality indexes in terms of peroxide and acid values and the highest oxidative stability index was observed for PSO of Gabsi ecotype (2.534 hr). Polyphenol content of PSO of Gabsi ecotype (886.909 mg/kg) was roughly 3 and 23 times higher than that of Jebali and Testouri ecotypes, respectively. Twelve FAs were identified by GC/FID. Punicic acid was the major compounds ranged from 81.53% (Testouri) to 86.41% (Gabsi). The unsaturated/saturated FA ratios of PSO were 14.53, 15.95, and 18.68, respectively for Gabsi, Testouri, and Jebali, respectively. Phytosterols were also identified and β‐sitosterol was the major compound in PSO. In addition, the phytochemical and antioxidant properties of phenolic extracts obtained from pomegranate seeds residues were investigated. Pomegranate seeds extract (PSE) of Gabsi cultivar showed the highest content of polyphenols (64.762 mg CAE/g) and flavonoids (7.127 mg RE/g). Antioxidant potential of extracts was performed using DPPH test and total antioxidant capacity (TAC). Results revealed that Gabsi cultivar was the most reactive extract with EC50 of 0.105 mg/mL for DPPH test and 40.622 mg AA/g for TAC. Phenolic profiles of PSE were also investigated. Results showed the importance of cultivar selection in the potential use of bioactive compounds of seeds as nutraceutical ingredients in food and chemical industries.

Practical Application

Three Tunisian pomegranate cultivars namely Jebali, Testouri, and Gabsi were investigated for their seeds oil and phenolic composition. Pomegranate seeds oil (PSO) are rich in bioactive polyunsaturated fatty acids and phytosterols that can be of interest in several food and chemical industrial applications. Moreover, pomegranate seeds extracts are a natural source of antioxidant components, such as phenolic compounds, that can be used by the pharmaceutical industry as promising nutraceutical ingredients. The obtained results can be used to provide guidance on cultivar selection during industrial applications.
The mediation role of SOCS3 methylation in the effect of serum testosterone on type 2 diabetes
Authors: Wang Lulu , Liu Xiaotiao , Wei Dandan , Kang Ning , Nie Luting , Liu Pengling , Fan Keliang , Zhang Li , Hou Jian , Li Xing , Xu Shunqing , Jing Tao , Li Wenjie , Wang Chongjian , Mao Zhenxing , Huo Wenqian
Published: February 2021

Background

Previous studies reported that testosterone and DNA methylation of suppressor of cytokine signaling‐3 (SOCS3) were associated with type 2 diabetes (T2D). Testosterone affects SOCS3 gene expression. Therefore, we aimed to investigate how the SOCS3 methylation mediates the relationship between testosterone and T2D among Chinese rural adults.

Methods

A case‐control study comprised 365 T2D patients and 651 controls was conducted. Liquid chromatography‐tandem mass spectrometry and MethylTarget were used to determine the levels of serum testosterone and DNA methylation of SOCS3 gene, respectively. The odds ratio (OR) of testosterone or SOCS3 methylation for T2D was calculated using logistic regression models, and β value of testosterone for SOCS3 methylation was evaluated by linear regression models. Furthermore, through mediation analysis the mediating effect of SOCS3 methylation on the association of testosterone with T2D was estimated.

Results

After adjusting for multiple variables, the protective effect of testosterone on T2D was found in men (OR = 0.61, 95% confidence interval [CI]: 0.47‐0.80), and the methylation of Chr17:76356190 or Chr17:76356199 was negatively related to T2D in both men and women. Moreover, testosterone was positively associated with Chr17:76356190 methylation in men and Chr17:76356199 methylation in women (both P < .05). The mediation analysis showed that the Chr17:76356190 methylation partly mediated effect of testosterone on T2D in men was approximately 8.2%.

Conclusions

High levels of serum testosterone in men and Chr17:76356190 and Chr17:76356199 (SOCS3) methylation were related to a lower prevalent T2D. In addition, Chr17:76356190 methylation partially mediated the effect of testosterone on T2D in Chinese rural men.
eDNAFlow, an automated, reproducible and scalable workflow for analysis of environmental DNA sequences exploiting Nextflow and Singularity
Authors: Mousavi‐Derazmahalleh Mahsa , Stott Audrey , Lines Rose , Peverley Georgia , Nester Georgia , Simpson Tiffany , Zawierta Michal , De La Pierre Marco , Bunce Michael , Christophersen Claus T.
Published: February 2021

Metabarcoding of environmental DNA (eDNA) when coupled with high throughput sequencing is revolutionising the way biodiversity can be monitored across a wide range of applications. However, the large number of tools deployed in downstream bioinformatic analyses often places a challenge in configuration and maintenance of a workflow, and consequently limits the research reproducibility. Furthermore, scalability needs to be considered to handle the growing amount of data due to increase in sequence output and the scale of project. Here, we describe eDNAFlow, a fully automated workflow that employs a number of state‐of‐the‐art applications to process eDNA data from raw sequences (single‐end or paired‐end) to generation of curated and noncurated zero‐radius operational taxonomic units (ZOTUs) and their abundance tables. This pipeline is based on Nextflow and Singularity which enable a scalable, portable and reproducible workflow using software containers on a local computer, clouds and high‐performance computing (HPC) clusters. Finally, we present an in‐house Python script to assign taxonomy to ZOTUs based on user specified thresholds for assigning lowest common ancestor (LCA). We demonstrate the utility and efficiency of the pipeline using an example of a published coral diversity biomonitoring study. Our results were congruent with the aforementioned study. The scalability of the pipeline is also demonstrated through analysis of a large data set containing 154 samples. To our knowledge, this is the first automated bioinformatic pipeline for eDNA analysis using two powerful tools: Nextflow and Singularity. This pipeline addresses two major challenges in the analysis of eDNA data; scalability and reproducibility.
Higher vs lower doses of dexamethasone in patients with COVID‐19 and severe hypoxia (COVID STEROID 2) trial: Protocol and statistical analysis plan
Authors: Munch MW , Granholm Anders , Myatra SN , Vijayaraghavan BKT , Cronhjort Maria , Wahlin RR , Jakob Stephan M. , Cioccari Luca , Kjær MN , Vesterlund GK , Meyhoff TS , Helleberg Marie , Møller MH , Benfield Thomas , Venkatesh Balasubramanian , Hammond Naomi , Micallef Sharon , Bassi Abhinav , John Oommen , Jha Vivekanand , Kristiansen KT , Ulrik CS , Jørgensen VL , Smitt Margit , Bestle Morten H. , Andreasen AS , Poulsen LM , Rasmussen BS , Brøchner AC , Strøm Thomas , Møller Anders , Khan MS , Padmanaban Ajay , Divatia JV , Saseedharan Sanjith , Borawake Kapil , Kapadia Farhad , Dixit Subhal , Chawla Rajesh , Shukla Urvi , Amin Pravin , Chew Michelle S. , Gluud Christian , Lange Theis , Perner Anders
Published: February 2021

Background

The coronavirus disease 2019 (COVID‐19) pandemic has resulted in millions of deaths and overburdened healthcare systems worldwide. Systemic low‐dose corticosteroids have proven clinical benefit in patients with severe COVID‐19. Higher doses of corticosteroids are used in other inflammatory lung diseases and may offer additional clinical benefits in COVID‐19. At present, the balance between benefits and harms of higher vs. lower doses of corticosteroids for patients with COVID‐19 is unclear.

Methods

The COVID STEROID 2 trial is an investigator‐initiated, international, parallel‐grouped, blinded, centrally randomised and stratified clinical trial assessing higher (12 mg) vs. lower (6 mg) doses of dexamethasone for adults with COVID‐19 and severe hypoxia. We plan to enrol 1,000 patients in Denmark, Sweden, Switzerland and India. The primary outcome is days alive without life support (invasive mechanical ventilation, circulatory support or renal replacement therapy) at day 28. Secondary outcomes include serious adverse reactions at day 28; all‐cause mortality at day 28, 90 and 180; days alive without life support at day 90; days alive and out of hospital at day 90; and health‐related quality of life at day 180. The primary outcome will be analysed using the Kryger Jensen and Lange test adjusted for stratification variables and reported as adjusted mean differences and median differences. The full statistical analysis plan is outlined in this protocol.

Discussion

The COVID STEROID 2 trial will provide evidence on the optimal dosing of systemic corticosteroids for COVID‐19 patients with severe hypoxia with important implications for patients, their relatives and society.
Analyst bias and forecast consistency
Authors: Byun Sanghyuk , Roland Kristin
Published: February 2021

We contribute to the literature examining inconsistent analyst forecast revisions. While prior research suggests inconsistent analyst forecasts are less accurate, we find this result is sensitive to both the definition and direction of inconsistency. We define consistency relative to each analyst’s own forecast error and find the relation between analyst characteristics and the likelihood of issuing an inconsistent forecast differs depending on the direction of the revision. Specifically, less accurate analysts are more likely to issue an inconsistent positive revision and have higher future accuracy than their consistent counterparts. Our results suggest that analysts derive a benefit (better future accuracy) from issuing upward forecast revisions in the period immediately following an earnings announcement regardless of the resulting forecast pattern.
Mouse eradication is required to prevent local extinction of an endangered seabird on an oceanic island
Authors: Jones C. W. , Risi M. M. , Osborne A. M. , Ryan P. G. , Oppel S.
Published: February 2021

Petrels (Procellariidae) are a highly diverse family of seabirds, many of which are globally threatened due to the impact of invasive species on breeding populations. While predation by invasive cats and rats has led to the extinction of petrel populations, the impact of invasive house miceMus musculusis slower and less well documented. However, mice impact small burrow‐nesting species such as MacGillivray’s prionPachyptila macgillivrayi, a species classified as endangered because it has been extirpated on islands in the Indian Ocean by introduced rodents. We use historic abundance data and demographic monitoring data from 2014 to 2020 to predict the population trajectory of MacGillivray’s prion on Gough Island with and without a mouse eradication using a stochastic integrated population model. Given very low annual breeding success (0.01 fledglings per breeding pair in ‘poor’ years (83%) or 0.38 in ‘good’ years (17%),n = 320 nests over 6 years) mainly due to mouse predation, our model predicted that the population collapsed from ~3.5 million pairs in 1956 to an estimated 175,000 pairs in 2020 despite reasonably high adult survival probability (ϕ = 0.901). Based on these parameters, the population is predicted to decline at a rate of 9% per year over the next 36 years without a mouse eradication, with a 31% probability that by 2057, the MacGillivray’ prion population would become extremely vulnerable to extinction. Our models predict population stability (λ = 1.01) and a lower extinction risk (<10%) if mouse eradication on Gough Island restores annual breeding success to 0.519, which is in line with that of closely related species on predator‐free islands. This study demonstrates the devastating impacts that introduced house mice can have on small burrowing petrels and highlights the urgency to eradicate invasive mammals from oceanic islands.
Strong effects of radio‐tags, social group and release date on survival of reintroduced grey partridges
Authors: Homberger Benjamin , Jenni Lukas , Duplain Jérôme , Lanz Michael , Schaub Michael
Published: February 2021

Animal reintroductions are important tools for conservation but often fail for reasons poorly understood. Biological and methodological factors can affect reintroduction success in complex manners. Investigating dispersal after release often relies on the use of biologging devices but individuals cope differently with these devices. They can detrimentally affect the performance of individuals depending on life‐history stage and may provide flawed conclusions, because inference drawn from tagged individuals cannot be readily generalized to non‐tagged individuals. Furthermore, environmental conditions during the release period or the expression of social behaviour such as the coordination of flocking behaviour can affect the outcome of reintroductions. In a reintroduction project involving 1385 grey partridges (Perdix perdix) released in 54 social groups (i.e. coveys), we investigated whether individual biweekly post‐release survival varied throughout different life‐history stages and was affected by radio‐tags of different weight (8 vs. 11 g), covey affiliation and release date. We conducted experiments in captivity to evaluate whether physiological stress, body condition and individual take‐off performance were affected by radio‐tags. During the first month after release survival was low in radio‐tagged and untagged birds. Throughout the second‐ and third‐month post‐release, negative effects of radio‐tags on survival were apparent. Four months after release, the survival of radio‐tagged and untagged birds converged. Consequently, the annual survival of untagged birds was more than five times higher than that of radio‐tagged birds. We did not find clear negative effects of radio‐tags on stress hormone levels but take‐off performance tended to be lower in tagged birds. Survival strongly decreased with later release date and differed between coveys. The use of radio‐tags can detrimentally affect individual survival and reintroduction success of grey partridges. The risk and benefits of radio‐tags should be balanced and releases in reintroductions should be conducted under the most favourable social and environmental conditions.
Cannabis use does not impact on type 2 diabetes: A two‐sample Mendelian randomization study
Authors: Baumeister Sebastian‐Edgar , Nolde Michael , Alayash Zoheir , Leitzmann Michael , Baurecht Hansjörg , Meisinger Christa
Published: February 2021

Cannabis has effects on the insulin/glucose metabolism. As the use of cannabis and the prevalence of type 2 diabetes increase worldwide, it is important to examine the effect of cannabis on the risk of diabetes. We conducted a Mendelian randomization (MR) study by using 19 single‐nucleotide polymorphisms (SNPs) as instrumental variables for lifetime cannabis use and 14 SNPs to instrument cannabis use disorder and linking these to type 2 diabetes risk using genome‐wide association study data (lifetime cannabis use [N = 184,765]; cannabis use disorder [2387 cases/48,985 controls], type 2 diabetes [74,124 cases/824,006 controls]). The MR analysis suggested no effect of lifetime cannabis use (inverse‐variance weighted odds ratio [95% confidence interval] = 1.00 [0.93–1.09], P value = 0.935) and cannabis use disorder (OR = 1.03 [0.99–1.08]) on type 2 diabetes. Sensitivity analysis to assess potential pleiotropy led to no substantive change in the estimates. This study adds to the evidence base that cannabis use does not play a causal role in type 2 diabetes.
Long‐term durability of uterine artery embolisation for treatment of symptomatic adenomyosis
Authors: Ma Jolande , Brown Bevan , Liang Eisen
Published: February 2021

Background

Failing conservative therapies, uterine artery embolisation (UAE) has been proposed as a uterine‐sparing option for treatment of symptomatic adenomyosis. UAE appears effective at short‐term; however long‐term durability is less well established.

Aims

To evaluate the long‐term clinical efficacy of UAE for treatment of adenomyosis.

Materials and Methods

One hundred and four women with initial clinical success following UAE for adenomyosis (results previously published) were further followed with a two‐part online survey. Part one inquired about menopause, symptom recurrence, need for further intervention and overall satisfaction. Part two comprised the Uterine Fibroid Symptom and health‐related Quality of Life (UFS‐QOL) questionnaire. Maintenance of clinical success was defined as remaining ‘happy’ or ‘very happy’ with overall outcome, no recurrence of symptoms, or need for further intervention.

Results

Of those women with initial success, 91/104 (88%) participated in this long‐term study at mean 52 months following UAE. Maintenance of clinical success was demonstrated in 82/91 (90%) women. For the remaining 9/91 (10%) women, mean time to failure was 31 months. There were 53/91 (58%) women who reached menopause at mean age of 51.5 years, occurring at mean 30 months post‐UAE. UFS‐QOL demonstrated significant decrease in symptom severity from 58.9 to 20.0 (P < 0.001); and significant increase in QOL from 40.3 to 86.3 (P < 0.001).

Conclusions

Long‐term durability of UAE for treatment of adenomyosis was demonstrated, with cumulative success rate of 80% at mean 52 months. UAE did not appear to bring forward menopause. UAE should be considered as an alternative to hysterectomy to treat adenomyosis.
Managing a rare complication of HELLP syndrome in Australia: Spontaneous liver haematoma in pregnancy
Authors: Gupta Akhil , Joseph Shantha Rose , Jeffries Bill
Published: February 2021

Spontaneous subcapsular haematoma of the liver is a rare but life‐threatening complication of pregnancy. Prevention of maternal and fetal death requires early identification and specialised management. We report three cases of spontaneous liver haematoma in pregnancy from our institution between 2011 and 2018. We conducted a systematic search of online databases using search terms, (‘liver’ AND ‘pregnancy’) AND (‘haematoma’ OR ‘rupture’) in order to present a narrative review of the literature and a systematic management framework. Our series is the first Australian report of spontaneous subcapsular haematoma in pregnancy with one fetal death in utero but no maternal deaths. Our systematic search of online databases revealed 45 similar reports in the last ten years. Individual patient data were available for 73 cases. The overwhelming majority of these reports were single cases or small case series. We estimate the mean maternal mortality rate to be 15% but fetal mortality was substantially greater than 15% (although data for neonatal outcomes was incomplete). There was one case report of liver transplantation with excellent maternal and fetal outcome. In the last five years, modern diagnostic techniques and therapeutic options have significantly reduced maternal and fetal mortality. Hepatic artery embolisation is a minimally invasive approach under guidance of imaging and is likely to achieve the best maternal and fetal outcomes. Based on our literature review, we have provided a systematic management framework for spontaneous liver haematoma in pregnancy.
RACS and its Fellows: a contribution to sustainable healthcare improvement in South East Asia
Authors: Hollands Michael , Hisham Abdullah Noor , Kong James , Moss Daliah , Pusponegro Aryono , Wora‐Urai Nopadol , Soe Zaw Wai
Published: February 2021

The question of whether small non‐government organizations with comparatively small budgets can make a substantial contribution to sustainable improvement in health care in low‐ and middle‐income countries is crucial to funding global surgical projects. The Royal Australasian College of Surgeons and its Fellows have partnered with local organizations and clinicians to deliver a wide range of projects in South East Asia. These projects have proved sustainable and have increased healthcare capacity in these nations. This provides strong evidence that small non‐government organizations such as the Royal Australasian College of Surgeons can make a major contribution to global surgeryI
Potential importance of vital capacity for the safety of laparoscopic surgery for colorectal cancer in patients with pulmonary dysfunction
Authors: Akabane Miho , Matoba Shuichiro , Fujii Takatsugu , Hiramatsu Kosuke , Okazaki Naoto , Hanaoka Yutaka , Toda Shigeo , Kuroyanagi Hiroya
Published: February 2021

Background

We examined the safety of laparoscopic surgery for colorectal cancer (CRC) in patients with pulmonary dysfunction, and evaluated risk factors (RF) for post‐operative complications.

Methods

We defined pulmonary dysfunction as having any diagnosed pulmonary disease with spirometry findings of obstructive or restrictive defects. Clinicopathological factors of 213 patients with pulmonary dysfunction who underwent laparoscopic surgery for CRC at Toranomon Hospital from 1999 to 2016 were evaluated to retrospectively identify RFs for any post‐operative complications and major complications, namely post‐operative pulmonary complications (PPCs). Examined preoperative factors included age, gender, body mass index, tumour location, smoking history, percentage vital capacity (%VC), forced expiratory volume in 1 s (FEV1.0), a ratio of FEV1.0 to forced vital capacity and American Society of Anesthesiologists physical status grade. Intraoperative factors, such as operative time, blood loss and blood transfusion, were also assessed.

Results

Forty patients (18.8%) developed any complications including PPCs. Multivariate analysis revealed that male, rectal cancer and spirometry findings (both low FEV1.0 (0.8 L) and low %VC (<95)) were RFs (P = 0.026, 0.003 and 0.007, respectively). Six cases (2.8%) developed PPCs. The prevalence of PPCs was higher in patients with both low %VC (<95%) and low FEV1.0 (<0.8 L), with statistical significance (P = 0.006).

Conclusion

Our study suggested that not only low FEV1.0 but also low %VC was an important RF for post‐operative complications after laparoscopic surgery for CRC.
Safety and outcomes after oesophagectomy in southern New Zealand: a 25‐year audit of a low volume centre
Authors: Elliott Thomas B. , Cha Ryan , Clifford Kari , Popadich Aleksandra , Nagra Sonal
Published: February 2021

Background

Over the last 2 decades, outcomes for oesophageal cancer have improved due to advances in surgical and oncological practice. Optimizing outcomes by centralization of oesophagectomy to high‐volume centres has been observed. The aim of this study was to establish if technical and oncological outcomes after oesophagectomy in southern New Zealand are comparable to recent benchmarks.

Methods

Consecutive patients undergoing oesophagectomy for cancer and benign pathology at Dunedin Hospital from 1995 to 2019 were prospectively audited. For malignant cases, histology was obtained retrospectively along with details of neo‐adjuvant and adjuvant therapy. The primary outcome was disease‐specific survival, stratified by time, resection margin, and TNM staging. Secondary outcomes included mortality and morbidity of oesophagectomy. Complications were graded using the Clavien‐Dindo classification.

Results

Oesophagectomy was performed in 108 patients, and 99 patients had surgery for oesophageal malignancy. The median survival was 35.3 (95% confidence interval (CI) 30.0–93.4) months and the 5‐year survival overall was 41.7%. Comparing survival in patients undergoing oesophagectomy up to 2006 and afterwards showed an improvement in 5‐year survival (30.3%, 95% CI (14.2–60.0) versus 47.8%, 95% CI (32.5, not reached), respectively, P = 0.041). There were two perioperative deaths (1.8%), six clinical anastomotic leaks (5.5%), four anastomotic strictures (3.7%) and five chylothoraces (4.6%).

Conclusion

This 25‐year survey of oesophagectomy in southern New Zealand audits the results of a low volume centre, where a variety of neo‐adjuvant treatments have been used. Despite this, perioperative morbidity, mortality and survival are comparable to those achieved by international high‐volume centres.
Efficacy of bilateral lateral rectus recession versus unilateral recession and resection for basic‐type intermittent exotropia: a meta‐analysis
Authors: Wang Xi , Zhu Qiurong , Liu Longqian
Published: February 2021

Purpose

To investigate the efficacy of bilateral lateral rectus recession (BLR) versus unilateral recession and resection (RR) for the treatment of patients with basic‐type intermittent exotropia (IXT).

Methods

We systematically searched the EMBASE, PubMed, Web of Science and Cochrane Library databases for relevant studies published before April 2020 with no language restrictions. Related studies meeting the eligibility criteria were included. The primary outcomes were success rate and mean postoperative deviation. Odds ratios (ORs) and weighted mean differences (MDs) with 95% confidence intervals (CIs) were calculated.

Results

From 1243 screened articles, a total of 10 studies involving 967 patients were included in the analysis. No differences were observed in success rates between the BLR and RR groups at 1‐day to 1‐week postoperatively (OR: 0.9, 95% CI: 0.53 to 1.53, p = 0.69), or at 6‐month postoperatively (OR: 1.11, 95% CI: 0.59 to 2.11, p = 0.74), or at the last follow‐up visit (OR: 0.76, 95% CI: 0.44 to 1.34, p = 0.34). The unsatisfactory effects (the overcorrection and undercorrection rates) between the two groups were comparable. In addition, there were no significant differences between the two groups in postoperative deviation at 1‐day to 1‐week postoperatively (MD: 0.03, 95% CI: −1.32 to 1.27, p = 0.97), or at 6‐month postoperatively (MD: 1.42, 95% CI: −0.43 to 3.27, p = 0.13) or at the last follow‐up visit (MD: 0.29, 95% CI: −1.39 to 1.97, p = 0.74).

Conclusion

This meta‐analysis provides evidence that both the BLR and RR procedures have similar efficacy for the treatment of basic‐type IXT.