bluuebunny/crossref_metadata_2025 huggingface dataset:
Buprenorphine Medication for Opioid Use Disorder: A Study of Factors Associated With Postpartum Treatment Retention
Authors: Ray‐Griffith Shona , Tharp Emily , Coker Jessica L. , Catlin David , Knight Bettina , Stowe Zachary N.
Published: July 2020

Background and Objectives

The factors associated with medication for opioid use disorder (MOUD) treatment retention among pregnant women with opioid use disorder (OUD) are largely unknown. This study sought to characterize factors associated with postpartum treatment retention.

Methods

A retrospective chart review from 2014 to 2017 was conducted among women with OUD in pregnancy treated with buprenorphine. Women were assigned to the treatment retention group if they attended an appointment within 10 to 14 weeks postpartum. Others were assigned to the dropout group. The groups were compared using bivariate analysis for sociodemographic variables, obstetrical and neonatal outcomes, clinical and subjective opioid withdrawal symptoms, buprenorphine dosage, urine drug toxicology (UDT) results, and other factors.

Results

A total of 64 pregnancies received treatment until delivery, and 47 (73.1%) were retained in treatment by 12 weeks postpartum. The treatment dropout group had lower buprenorphine doses at delivery, a higher percentage of benzodiazepine positive UDT, and number of UDT positive for benzodiazepine in the third trimester. Breastfeeding rates were higher in the treatment retention group.

Discussion and Conclusions

Future research of variables related to postpartum treatment retention is needed to provide guidelines regarding MOUD during the perinatal period and to optimize maternal and fetal well‐being.

Scientific Significance

This study supports previous recommendations that aggressive treatment of withdrawal symptoms in pregnant women with OUD is needed to maximize treatment retention. This is the first study to find that breastfeeding was associated with postpartum treatment retention; while, increased use of benzodiazepines during pregnancy was associated with postpartum treatment dropout. (Am J Addict 2021;30:43–48)
Population growth, ageing and obesity do not sufficiently explain the increased utilization of total knee replacement in Australia
Authors: Trieu Jason , Dowsey Michelle M. , Schilling Chris , Spelman Tim , Choong Peter F.
Published: July 2020

Background

The utilization of total knee replacement (TKR) has increased significantly. The objective of this study was to assess the impact of changes in population demography (population growth, ageing and gender) and body mass indices (BMIs) on the additional volume of knee replacement surgery undertaken in Australia.

Methods

Using national data, we compared estimates based on changes in population demography and BMIs to the reported increase in TKR between 2007 and 2017. The costs of additional surgery were estimated using the National Hospital Cost Data Collection.

Results

An additional 25 814 TKRs were performed in 2017 compared to 2007. Contributions from population growth, ageing and changing BMIs were 27.1%, 10.4%, and 6.3%–15.3%, respectively. Other drivers contributed between 47.2% and 56.2%, representing 12 176–14 506 TKRs at a financial cost of A$320.9 million to A$382.3 million per year in 2017.

Conclusion

The volume of additional surgery being performed considerably exceeded estimates based on changing population demography and rising rates of obesity. The other drivers of additional TKR utilization will likely have significant implications for the health budget and warrant further investigation. This may involve an examination of the current indications for surgery and the cost‐effectiveness of TKR in various settings, reviewing patient expectations and preferences, and assessing the impact of policies which relate to the funding and provision of TKR.
Practical engagements in legal geography: Collaborative feminist approaches to immigration advocacy in Denmark
Authors: Jacobsen Malene H.
Published: July 2020

In this paper, I examine how collaboration can yield new insights into inquiries of legal geography and transform the ways that legal work is carried out. Drawing on feminist methodologies, I put forward feminist legal collaboration – a method and praxis – through which legal geographers can address the everyday manifestations and contestations of power in relation to law and space, while at the same time build alliances with people whose (legal) rights are currently contested. I reflect on my experiences of doing everyday collaborative work with legal practitioners, activists, and forced migrants at community centres in Denmark. Through two empirical examples of legal collaboration, I show how collaboration offers insights into migration law and legal procedures that are impossible to gain from just reading the law. The process of collaborating can teach us about the politics in law and reveal political possibilities within these socio‐legal spaces. We might think of feminist legal collaboration as a method and praxis that takes place through direct engagement with the law and legal practices in order to co‐produce knowledge and radically reconfigure existing approaches to legal counselling. The feminist legal collaborative approach, which I put forward here, is not limited to research on the legal geographies of (forced) migration. Rather, I imagine that feminist legal collaboration can be used in relation to different legal issues, grounded in the local empirical context(s) and attending to the needs and injustices on the ground.
Effects of feeding mother liquor, by‐product of monosodium glutamate, on digestibility, energy and nitrogen balances, and rumen condition in Thai native bulls
Authors: Katsumata Sachi , Angthong Wannna , Narmsilee Ramphrai , Oishi Kazato , Hirooka Hiroyuki , Kumagai Hajime
Published: July 2020

Four Thai native bulls were used to evaluate the availability of mother liquor (ML), by‐product of monosodium glutamate, as a replacement of soybean meal (SBM) consisting of 10% in concentrate. The SBM was replaced by the ML at 0% (C), 20% (T1), 40% (T2), and 60% (T3), and the experiment was a randomized block design experiment. The animals were fed concentrate and roughage (60:40, on a dry matter [DM] basis). There were no significant differences in the digestibility of DM, crude protein, ether extract, acid detergent fiber expressed exclusive of residual ash and non‐fibrous carbohydrate, and energy and nitrogen balances among the treatments. However, the digestibility of the neutral detergent fiber in T2 was lower than the other treatments (p < .05). The valeric acid of T2 was lower than those of C and T1 and the iso‐valeric acid of T3 was the lowest (p < .05), followed by those of T2, T1, and C at 4 hr post‐feeding. No significant differences were observed in the ruminal total VFA concentrations, pH, and NH3‐N among the treatments. These results suggested that SBM could be replaced by the ML up to 60% without adverse effects on nitrogen and energy balance, rumen conditions, and blood metabolites in Thai native bulls.
Accuracy of selected neurological clinical tests in diagnosing MRI‐detectable forebrain lesion in dogs
Authors: Chan MK , Jull P
Published: July 2020

This retrospective case study aims to evaluate the accuracy of menace response, response to nasal stimulation and proprioceptive placing in diagnosing forebrain lesion in dogs. A total of 145 client‐owned dogs investigated by magnetic resonance imaging study of the brain between December 2017 and June 2019 were evaluated. Seventy‐one dogs with no magnetic resonance imaging‐detectable intracranial and significant cerebrospinal fluid abnormality or recent history of seizure (<48 h) served as controls. Binary regression analysis was performed to determine the sensitivity, specificity and likelihood ratios of each selected test. Older age at presentation was a significant risk factor for the presence of a forebrain lesion. Menace (62.5%) and proprioceptive deficits (40.5%) were common findings in all dogs. They were also significantly associated with the presence of forebrain abnormality. Moreover, they were more sensitive (77.3% and 82.2%, respectively) and specific (50.0% and 62.5%, respectively) when applied to dogs aged 6 years or older. Nonetheless, all of these tests' likelihood ratios, and thus reliability are poor. These neurological tests are commonly employed for diagnosing forebrain disease in dogs, yet are not highly accurate in diagnosing forebrain abnormality. Clinicians should interpret these clinical test results along with the patient history when designing a diagnostic plan.
Maximum likelihood abundance estimation from capture‐recapture data when covariates are missing at random
Authors: Liu Yang , Liu Yukun , Li Pengfei , Zhu Lin
Published: July 2020

In capture‐recapture experiments, individual covariates may be subject to missingness, especially when the number of captures is small. When the covariate information is missing at random, the inverse probability weighting method and the multiple imputation method are widely used to obtain point estimators of the abundance. These estimators are then used to construct Wald‐type confidence intervals. However, such intervals may have seriously inaccurate coverage probabilities. In this paper, we propose a maximum empirical likelihood (EL) estimation approach for the abundance in the presence of missing covariates. We show that the maximum EL estimator is asymptotically normal, and that the EL ratio statistic for the abundance has a chi‐square limiting distribution with one degree of freedom. Simulations indicate that the proposed estimator has a smaller mean square error than existing estimators, and the proposed EL ratio confidence interval usually has more accurate coverage probabilities than the existing Wald‐type confidence intervals. We illustrate the proposed method by analyzing data collected in Hong Kong for the yellow‐bellied prinia, a bird species.
Young people's decision making involvement and educational attainment
Authors: Nguyen Bich Diep
Published: July 2020

Increasing participation in family decision making is an integral part of adolescent development. This paper uses longitudinal data from four low and middle income countries—Ethiopia, India, Peru and Vietnam—to assess the relationship between young people's involvement in schooling decision making and schooling outcomes. In the pooled sample, compared to young adults who indicate to have no say in educational choices at age 19, adolescents who make these decisions unilaterally or jointly with parents are on average 17%–23% more likely to drop out by age 22. The effects are, however, heterogenous across countries.
Cardiovascular fitness and executive functioning in primary school‐aged children
Authors: Meijer Anna , Königs Marsh , de Bruijn Anne G. M. , Visscher Chris , Bosker Roel J. , Hartman Esther , Oosterlaan Jaap
Published: July 2020

Previous research in children has shown that higher cardiovascular fitness is related to better executive functioning. However, the available literature is hampered by methodological limitations. The present study investigates the relationship between cardiovascular fitness and executive functioning in a large sample of healthy children (N = 814). Cardiovascular fitness was assessed with estimated VO2Max from 20 m Shuttle Run Test performance. Executive functioning was assessed using a set of computerized neurocognitive tasks aimed at executive functions (working memory, motor inhibition, interference control) and lower‐level neurocognitive functions (information processing and attention). Dependent measures derived from the neurocognitive tests were subjected to principal component analysis. Mixed model analyses tested the relation between cardiovascular fitness and neurocognitive functioning components. Results showed that children with higher cardiovascular fitness performed better on the neurocognitive function components Information Processing and Control, Visuospatial Working Memory and Attention Efficiency. The following measures contained in these components contributed to the observed relations: information processing measures, visuospatial working memory, and speed of alerting attention. No relationship was found between cardiovascular fitness and the other components: Verbal Working Memory, Attention Accuracy, and Interference Control. The present study suggests that there is a relationship between cardiovascular fitness and a specific set of executive functions and lower level neurocognitive functions. These findings highlight the importance of cardiovascular fitness for the overall health of school‐aged children.
Epigenetic control of exercise adaptations in the equine athlete: Current evidence and future directions
Authors: Denham Joshua , McCluskey Michael , Denham Michele M. , Sellami Maha , Davie Allan J.
Published: July 2020

Horses (Equus ferus caballus) have evolved over the past 300 years in response to man‐made selection for particular athletic traits. Some of the selected traits were selected based on the size and horses’ muscular power (eg Clydesdales), whereas other breeds were bred for peak running performance (eg Thoroughbred and Arabian). Although the physiological changes and some of the cellular adaptations responsible for athletic potential of horses have been identified, the molecular mechanisms are only just beginning to be comprehensively investigated. The purpose of this review was to outline and discuss the current understanding of the molecular mechanisms underpinning the athletic performance and cardiorespiratory fitness in athletic breeds of horses. A brief review of the biology of epigenetics is provided, including discussion on DNA methylation, histone modifications and small RNAs, followed by a summary and critical review of the current work on the exercise‐induced epigenetic and transcriptional changes in horses. Important unanswered questions and currently unexplored areas that deserve attention are highlighted. Finally, a rationale for the analysis of epigenetic modifications in the context with exercise‐related traits and ailments associated with athletic breeds of horses is outlined in order to help guide future research.
The impact of prenatal counselling on mothers of surviving children with hypoplastic left heart syndrome: A qualitative interview study
Authors: Bertaud Sophie , Lloyd David F. A. , Sharland Gurleen , Razavi Reza , Bluebond‐Langner Myra
Published: July 2020

Objective

To explore the role of antenatal counselling in how parents make treatment decisions following an antenatal diagnosis of Hypoplastic Left Heart Syndrome (HLHS).

Background

Antenatal counselling is a critical part of patient management following a diagnosis of fetal congenital heart disease; however, there is a very limited evidence base examining how parents actually experience antenatal counselling and make decisions in this context.

Methods

Semi‐structured interviews were conducted with women who had received an antenatal diagnosis of HLHS. Interviews were digitally recorded, anonymised and transcribed verbatim. A thematic content analysis was performed using a constant comparative approach.

Results

Eight mothers of surviving children with HLHS were interviewed. Eight key themes emerged including new perspectives on how women receive antenatal counselling and how it affects their decision making. Three themes in particular are new to the literature: (a) Mothers of children with HLHS reported feelings of intense guilt that arose in the antenatal period around potentially causing the condition in their child. (b) For this group of women, recollections of perceived pessimism during antenatal counselling had a lasting impact. (c) Despite support from partners or extended family, women nevertheless experienced a strong sense that antenatal decision making was largely a ‘maternal’ responsibility.

Conclusions

When recounting their experiences of antenatal counselling, mothers of surviving children with HLHS offer new perspectives that can guide fetal cardiologists in how best to support their individual patients. Further research is needed to comprehensively understand the experience of prospective parents counselled for severe forms of fetal congenital heart disease.
Political culture and ducal authority in Aquitaine, c. 900–1040
Authors: McNair Fraser
Published: July 2020

The development of ducal authority in tenth‐century Aquitaine was a major change in the region's political culture. The emergence of a regional, aristocratic polity was a shift from the Carolingian past, and historians have proffered several explanations for it. This article examines several models for the development of principalities: as the expressions, however compromised, of ethnic separatism; as the evolved forms of ninth‐century administrative structures; and as aristocratic power constellations no different from any other. It traces the history of Aquitaine from the first duke, William the Pious, in the early tenth century, to the Poitevin dukes of the mid‐eleventh century. The post‐Carolingian duchy of Aquitaine, it is argued, is best understood not as an ethnic or an institutional formative, but as the distinctive expression of a changing regional political culture.
Effects of nisin concentration on properties of gelatin film‐forming solutions and their films
Authors: Luciano Carla Giovana , Tessaro Larissa , Lourenço Rodrigo Vinicius , Bittante Ana Mônica Quinta Barbosa , Fernandes Andrezza Maria , Moraes Isabel Cristina Freitas , do Amaral Sobral Paulo José
Published: July 2020

The addition of nisin into a gelatin matrix can change properties of the film. The aim of this work was to develop gelatin‐based films containing different nisin concentrations in order to study their influence on the film's antimicrobial and physical properties and their rheological properties as a film‐forming solution (FFS). The FFS was characterised by rheological assays, and the gelatin‐based active films were characterised and assessed by the effects of nisin concentrations on their various properties, including antimicrobial activity. Nisin's concentration affected not only its viscoelastic properties of FFS but also its film solubility in water, film surface roughness and light barrier. The addition of nisin also slightly modified the water contact angle and the mechanical properties of the gelatin films. Finally, the films demonstrated activity against Staphylococcus aureus and Listeria monocytogenes at concentrations above 56 mg of nisin g−1 of gelatin.
Actual and perceived knowledge of research ethics guidelines in a sample of public health clinicians
Authors: Rouse Donna M. , Tynan Anna
Published: July 2020

Background

The conduct of research by clinicians is vital to maintain evidence‐based practice and currency of clinician knowledge. However, the ability to conduct valid research is contingent on several factors including the knowledge of research ethics guidelines applicable within the researcher's location.

Aims

To compare the actual and perceived knowledge of research ethics guidelines in a sample of healthcare clinicians in a public health service.

Methods

A prospective cross‐sectional design utilising an anonymous online survey.

Results

Of the 432 valid responses, 8% were totally well calibrated on perceived and actual knowledge. A further 9% were totally miscalibrated on all items. The remaining 83% of respondents were variously miscalibrated on 1–4 items. The majority of miscalibrated responses represented overconfidence.

Conclusions

Clinicians are not as knowledgeable as they think about research ethics. This has implications for help‐seeking behaviours within this population and highlights challenges for stakeholders in the provision of research support and education.
Clinical implications of elective replacement indicator setting changes in patients with dual‐chamber pacemaker devices
Authors: Phillips Kari A. , Ponamgi Shiva , Mundell Benjamin , Krushelnytskyy Mykhaylo , Li Zhuo , Rea Robert , Deshmukh Abhishek , McLeod Christopher , Espinosa Raul E. , Osborn Michael , Friedman Paul A. , Mulpuru Siva K. , Cha Yong‐Mei , Neutzling Lori B. , Munger Thomas , Kancharla Krishna , Asirvatham Samuel J.
Published: July 2020

Objective

This study sought to determine if single‐chamber operation and/or loss of rate response (RR) during elective replacement indicator (ERI) in patients with dual‐chamber pacemakers lead to increased symptom burden, healthcare utilization, and atrial fibrillation (AF).

Background

Dual‐chamber pacemakers often change from dual‐ to single‐chamber pacing mode and/or lose RR functionality at ERI to preserve battery. Single‐chamber pacing increases the incidence of heart failure, AF, and pacemaker syndrome suggesting these changes may be deleterious.

Methods

A retrospective analysis of 700 patients was completed. Three comparisons were analyzed: Comparison 1: mode change and RR loss versus no change; Comparison 2: RR loss only versus no change; Comparison 3: mode change only versus no change (in patients with no RR programmed at baseline).

Results

In Comparison 1, 121 (46%) patients with setting changes experienced symptoms (most often dyspnea and fatigue/exercise intolerance) versus 3 (4%) without setting changes (p < .0001). Similar results were noted in Comparisons 2 and 3 (p = .0016 and p = .0001, respectively). In Comparison 1, patients with setting change sought provider contact more than patients without setting changes (p = .0001). A significant difference was not noted in Comparison 2 or 3. Overall 14 (2%) patients were hospitalized, all of whom had setting changes.

Conclusions

Setting changes at ERI including a change from dual‐ to single‐chamber pacing and/or loss of RR results in a significantly increased symptom burden and increased healthcare utilization.
Clinical utility of local impedance monitoring during pulmonary vein isolation
Authors: Masuda Masaharu , Kanda Takashi , Kurata Naoya , Asai Mitsutoshi , Iida Osamu , Okamoto Shin , Ishihara Takayuki , Nanto Kiyonori , Tsujimura Takuya , Matsuda Yasuhiro , Hata Yosuke , Uematsu Hiroyuki , Mano Toshiaki
Published: July 2020

Introduction

Local impedance (LI) at the tip of ablation catheter can be measured using a recently available technology. We aimed to explore target LI measurements at each radiofrequency application (RFA) for creating sufficient ablation lesions during pulmonary vein (PV) isolation.

Methods

This prospective study included 15 consecutive patients scheduled to undergo an initial ablation of paroxysmal atrial fibrillation (AF). Circumferential ablation around both ipsilateral PVs was performed using a 4‐mm irrigated ablation catheter with an LI sensor. Point‐by‐point ablation was used with a 4‐mm inter‐ablation‐point distance. Operators were blinded to LI measurements during the procedure. Creation of sufficient ablation lesions was assessed by the absence of a conduction gap.

Results

After first‐pass encircling PV antrum ablation, left atrium to PV conduction remained in 12 of 30 (40%) ipsilateral PVs. Mapping using the minibasket catheter identified 48 ablation points through which the propagation wave entered the PV. At ablation points with a gap, the LI drop during RFA was half that at points without a gap (12 ± 7 vs. 23 ± 12 Ω; p < .001). The generator impedance drop did not differ between ablation points with and without a gap (12 ± 7 vs. 14 ± 10  Ω; p = .10). An LI drop of 13.4 Ω predicted sufficient lesion formation without a gap with a sensitivity of 0.78, specificity of 0.75, and predictive accuracy of 0.75.

Conclusion

An LI drop of 13.4 Ω at each RFA under the conditions of a 4‐mm inter‐ablation‐point distance and RFA duration ≥20 s may facilitate creation of sufficient lesions during PV isolation.
Hsp90 inhibition and co‐incubation with pertuzumab induce internalization and degradation of trastuzumab: Implications for use of T‐DM1
Authors: Skeie Marianne , Nikolaysen Filip , Chitano Ylenia , Stang Espen
Published: July 2020

The receptor tyrosine kinase HER2 is associated with a number of human malignancies and is an important therapeutic target. The antibody‐drug conjugate trastuzumab emtansine (T‐DM1; Kadcyla®) is recommended as a first‐line treatment for patients with HER2‐positive metastatic breast cancer. T‐DM1 combines the antibody‐induced effects of the anti‐HER2 antibody trastuzumab (Herceptin®) with the cytotoxic effect of the tubulin inhibitor mertansine (DM1). For DM1 to have effect, the T‐DM1‐HER2 complex has to be internalized and the trastuzumab part of T‐DM1 has to be degraded. HER2 is, however, considered endocytosis‐resistant. As a result of this, trastuzumab is only internalized to a highly limited extent, and if internalized, it is rapidly recycled. The exact reasons for the endocytosis resistance of HER2 are not clear, but it is stabilized by heat‐shock protein 90 (Hsp90) and Hsp90 inhibitors induce internalization and degradation of HER2. HER2 can also be internalized upon activation of protein kinase C, and contrary to trastuzumab alone, the combination of two or more anti‐HER2 antibodies can induce efficient internalization and degradation of HER2. With intention to find ways to improve the action of T‐DM1, we investigated how different ways of inducing HER2 internalization leads to degradation of trastuzumab. The results show that although both Hsp90 inhibition and activation of protein kinase C induce internalization of trastuzumab, only Hsp90 inhibition induces degradation. Furthermore, we find that antibody internalization and degradation are increased when trastuzumab is combined with the clinically approved anti‐HER2 antibody pertuzumab (Perjeta®).
Two‐hundred million years of anuran body‐size evolution in relation to geography, ecology and life history
Authors: Womack Molly C. , Bell Rayna C.
Published: July 2020

Surprisingly, little is known about body‐size evolution within the most diverse amphibian order, anurans (frogs and toads), despite known effects of body size on the physiological, ecological and life‐history traits of animals more generally. Here, we examined anuran body‐size evolution among 2,434 species with over 200 million years of shared evolutionary history. We found clade‐specific evolutionary shifts to new body‐size optima along with numerous independent transitions to gigantic and miniature body sizes, despite the upper limits of anuran body size remaining quite consistent throughout the fossil record. We found a weak, positive correlation between a species’ body size and maximum latitude and elevation, including a dearth of small species at higher elevations and broader latitudinal and elevational ranges in larger anurans. Although we found modest differences in mean anuran body size among microhabitats, there was extensive overlap in the range of body sizes across microhabitats. Finally, we found that larger anurans are more likely to consume vertebrate prey than smaller anurans are and that species with a free‐swimming larval phase during development are larger on average than those in which development into a froglet occurs within the egg. Overall, anuran body size does not conform to geographic and ecological patterns observed in other tetrapods but is perhaps more notable for variation in body size within geographic regions, ecologies and life histories. Here, we document this variation and propose target clades for detailed studies aimed at disentangling how and why variation in body size was generated and is maintained in anurans.
A journey through the Amazon Middle Earth reveals Aspidoras azaghal (Siluriformes: Callichthyidae), a new species of armoured catfish from the rio Xingu basin, Brazil
Authors: Tencatt Luiz F. C. , Muriel‐Cunha Janice , Zuanon Jansen , Ferreira Marlon F. C. , Britto Marcelo R.
Published: July 2020

Aspidoras azaghal n. sp. was discovered during a multitaxonomic scientific expedition to the remote Amazon Terra do Meio region in tributaries to the rio Xingu basin, Pará, Brazil. The new species can be promptly distinguished from its congeners by the following combination of features: (a) absence of the first dorsal‐fin element; (b) parieto‐supraoccipital fontanel located medially on bone; (c) absence of a longitudinal dark‐brown or black stripe along flank midline; (d) ventral surface of trunk covered by clearly smaller, irregular and/or roundish platelets; (e) inner laminar expansion of infraorbital 1 well developed; (f) relatively wide frontal bone, with width equal to half of entire length; (g) absence of a thick, longitudinal conspicuous dark‐brown stripe along dorsal portion of flank; and (h) poorly developed serrations on posterior margin of the pectoral‐fin spine. Besides morphological evidence, the molecular analyses indicated significant differences between the new species and its congeners, with A. albater and A. raimundi as its closest species, showing 6.53% of genetic differentiation in both cases. The intraspecific molecular data revealed gene flow (peer fixation index, FST = 0.05249, P > 0.05, for the cytochrome oxidase I (COI) marker and FST = ‐0.01466, P > 0.05, for the control region) between specimens upstream and downstream from a 30‐m height waterfall at the type‐locality, which therefore represent a single population. Furthermore, it was possible to observe a unidirectional gene flow pattern, with genetic diversity increasing in the downstream direction.
A serious gaming approach to understanding household flood risk mitigation decisions
Authors: Gordon Julien N. , Yiannakoulias Niko
Published: July 2020

Voluntary household decisions about whether or not to structurally mitigate or insure can directly and indirectly influence the flood vulnerability of a community. We look to understand the factors that influence flood risk mitigation decisions using a serious game experiment. Serious games can augment existing data collection methods used to understand flood risk mitigation by tracking decisions over multiple turns within an experimental research framework. In this game, participants choose where to live and how to distribute income given information about flood risks. We analysed data using a generalised linear mixed model that accounted for repeated‐measures effects. Experiencing an in‐game flood had a strong positive association with mitigation decisions, compared to a much weaker effect of a participant having experienced a flood in real‐life. We find that real‐life low‐income individuals were no less likely to implement in‐game mitigation measures than their higher‐income counterparts, suggesting that low income and/or cost is a practical barrier to risk mitigation. Our findings also suggest that incentivising flood risk mitigation should be done quickly following a flood.
Patient Factors Linked with Return Acute Healthcare Use in Older Adults by Discharge Disposition
Authors: Keim Susan K. , Ratcliffe Sarah J. , Naylor Mary D. , Bowles Kathryn H.
Published: July 2020

OBJECTIVES

Compare patient characteristics by hospital discharge disposition (home without services, home with home healthcare (HHC) services, or post‐acute care (PAC) facilities). Examine timing and rates of 30‐day healthcare utilization (rehospitalization, emergency department (ED) visit, or observation (OBS) visit) and patient characteristics associated with rehospitalization by discharge location.

DESIGN

Retrospective analysis of hospital administrative and clinical data.

SETTING AND PARTICIPANTS

A total of 3,294 older adult inpatients discharged home with or without HHC services or to a PAC facility.

MEASUREMENTS

Patient‐level sociodemographic and clinical characteristics. Number of and time to occurrences of rehospitalization or ED/OBS visit within 30 days of hospital discharge.

RESULTS

Most rehospitalizations and ED/OBS visits occurred within 14 days from hospital discharge. Patients who returned within 24 hours came mostly from inpatient rehabilitation facilities (IRFs). More intense levels of PAC services were linked with higher rehospitalization risk. However, specific predictors differed by discharge location. Being unemployed, being single, and having more comorbidities were most associated with rehospitalization in those who went home with or without services, whereas patients rehospitalized from IRFs were younger, with less chronic illness burden, but greater and recent functional decline. Those discharged with HHC services had more return ED/OBS visits.

CONCLUSIONS

Although sicker patients were referred for more intense levels of PAC services, patients with greater chronic illness burden were still most often rehospitalized. In addition to unique patient differences, rehospitalizations from IRF within 24 hours suggest systems factors are contributory. Most return acute healthcare utilization occurred within 14 days; therefore, interventions should focus on smoothing transitions to all discharge locations. Because predictors of rehospitalization risk differed by discharge disposition, future research is necessary to study approaches aimed at matching patients' care needs with the most suitable PAC services at the right time. J Am Geriatr Soc 68:2279–2287, 2020.
Neonatal Candida auris infection: Management and prevention strategies – A single centre experience
Authors: Chandramati Jayasree , Sadanandan Laleet , Kumar Anil , Ponthenkandath Sasidharan
Published: July 2020

Aim

Our aim was to identify the clinical features and outcome of multidrug resistant Candida auris (CA) infection in neonates.

Methods

This is a retrospective case cohort study of 17 neonates who developed sepsis caused by CA infection in a tertiary care neonatal intensive care unit over 3 years. The risk factors, clinical features, treatment and outcome were studied.

Results

The mean gestation was 32.4 ± 4.9 weeks with overall mortality of 41%. Clinical features were indistinguishable from other causes of sepsis. CA was sensitive to micafungin but resistant to fluconazole and had variable sensitivity to voriconazole and amphotericin. Survival improved to 83% when infants were treated with a combination of micafungin and amphotericin. Non‐survivors were of lower birthweights and had other risk factors.

Conclusions

The management guidelines and infection control measures are described in this largest series of neonatal CA infection. Treatment with a combination of amphotericin and micafungin improved the outcome.
Scalable solvent-free production of liposomes
Authors: Khadke Swapnil , Roces Carla B , Donaghey Rachel , Giacobbo Valeria , Su Yang , Perrie Yvonne
Published: July 2020

Objectives

A major challenge faced with the manufacture of liposomes is the high volumes of organic solvents used during manufacturing. Therefore, we have implemented an organic solvent-free production method for drug-loaded liposomes and demonstrated its applicability with both aqueous core-loaded and bilayer-loaded drugs.

Methods

Liposomes were produced by high shear mixing dry powder lipids with an aqueous buffer, followed by down-sizing using a Microfluidizer processor. Liposomes were purified via tangential flow filtration and characterised in terms of size, polydispersity index, zeta potential and drug loading.

Key findings

Doxorubicin-loaded PEGylated liposomes can be manufactured using this solvent-free method with particle sizes of 100–110 nm, low polydispersity index (PDI) (<0.2) and high drug loading (97–98%). If required, liposomes can be further down-sized via microfluidic processing without impacting drug loading. Similar results were achieved with non-PEGylated liposomes. With bilayer-loaded amphotericin B liposomes, again liposomes can be prepared within a clinically appropriate size range (100–110 nm in size, low PDI) with high drug loading (98–100%).

Conclusions

We apply a simple and scalable solvent-free method for the production of both aqueous core or bilayer drug-loaded liposomes.
Stellate ganglion ischemia on the prevention of pulmonary vasospasm during bilateral carotid artery ligation: The first experimental study
Authors: Arslan Remzi , Aydin Muhammed E. , Karadag Mehmet K. , Caglar Ozgur , Karadeniz Erdem , Aydin Mehmet D.
Published: July 2020

Fatal pulmonary edema and hemorrhage are significant complications of endovascular treatment in steno‐occlusive carotid artery disease; a rational mechanism has not been adequately examined in the literature so far. We investigated if cervical sympathetic ganglia ischemia prevents pulmonary vasospasm on the prognosis of bilateral common carotid artery ligation (BCCAL). Twenty‐three adult New Zealand rabbits (4.2 ± 0.3 kg) were randomly divided into three groups: the control group (G1, n = 5), the sham group (G2, n = 6), and the BCCAL group (G3, n = 12). Common carotid arteries were dissected bilaterally in G2/G3, and permanent BCCAL was applied to only in G3. All animals were followed for 3 weeks and decapitated under general anesthesia. Histopathological changes in stellate ganglia and severity of pulmonary vasospasm‐related lung edema and hemorrhage were investigated. Results were analyzed by the Kruskal–Wallis test. Two animals of G3 dead within three weeks and the remainder were sacrificed three weeks later. Subpleural petechial foci and an endotracheal bloody fluid collection were grossly observed in the lungs. Histopathologically, pulmonary artery vasospasm, perivascular and subintimal edema, interalveolar hemorrhage, and alveolar wall destructions were observed with less ischemic‐degenerated neuron density‐determined stellate ganglia animals. Neurodegeneration of stellate ganglia may have a beneficial effect on the prevention of lung injury during steno‐occlusive carotid artery disease.
Lymph node dissection and recurrent laryngeal nerve protection in minimally invasive esophagectomy
Authors: Wang Zhen , Mao Yousheng , Gao Shugeng , Li Yin , Tan Lijie , Daiko Hiroyuki , Liu Shuoyan , Chen Chun , Koyanagi Kazuo , He Jie
Published: July 2020

Until now, neoadjuvant therapy plus surgical resection of the primary tumor and potential metastatic lymph nodes (LNs) has been the current optimal treatment for locally advanced thoracic esophageal cancer (EC). LN metastasis is one of the most negative prognostic factors for thoracic esophageal squamous cell carcinoma (ESCC). However, the extent of LN dissection for thoracic ESCC has long been controversial worldwide. LNs along the recurrent laryngeal nerve (RLN) were reported to have the highest frequency of metastases in thoracic ESCC, so lymphadenectomy along the bilateral RLN is necessary but quite challenging because of a high frequency of recurrent nerve palsy and related postoperative complications. With the development of minimally invasive devices and techniques in recent years, minimally invasive esophagectomy (MIE) has been widely applied in EC surgery. The topics of what the optimal extent of lymphadenectomy is and how the recurrent nerve should be well protected during MIE have been debated in recent years. The purpose of our review is specifically to address the patterns of LN metastasis, the extent of LN dissection, and the protection of the RLN in MIE for thoracic ESCC.
Knowledge Spillovers, Competition and Innovation Success
Authors: Arvanitis Spyros , Seliger Florian , Woerter Martin
Published: July 2020

We study the relationship between a patent‐based measure of knowledge spillovers that calculates technological proximity based on technologically relevant firms and innovation success. We find – for a representative sample of Swiss firms – that knowledge spillovers have a positive and significant association with the commercial success of innovative products. The paper shows the importance of market conditions for the relationship of spillovers with innovation performance: It is only positive and significant in markets with a medium number of competitors in the main product market, but not in monopolistic or polypolistic market structures.
Herbal derivatives in the management of mouth opening in oral submucous fibrosis—A network meta‐analysis
Authors: Rajesh Kashyap Roopashri , Shanker Kashyap Rajesh
Published: July 2020

Objectives

Oral submucous fibrosis is a potentially malignant disorder commonly seen in Asian countries. In this disease, the mucosa becomes stiff and patients have difficulty in mouth opening, thus affecting their quality of life. Recently, practitioners are focusing on herbal derivatives instead of commonly practiced intralesional steroids for the management of this disorder. Hence, we conducted a network meta‐analysis of randomized clinical trials on herbal derivatives to identify the most effective treatment for oral submucous fibrosis.

Materials and methods

Electronic search for articles published in various journals was undertaken through various search engines till January 2020. 14 articles were selected which had performed randomized control trials of herbal derivatives against control/placebo. Frequentist network meta‐analysis was performed using R studio software, and effective treatment ranking was derived.

Results

The treatment ranking was generated, and relative to mouth opening, the most effective treatment was lycopene administered along with vitamin E and the second effective drug was aloe vera gel.

Conclusion

This network meta‐analysis highlights the efficacy of some of the drugs of herbal origin which can be implemented by the practitioners in the management of initial stages of oral submucous fibrosis.
Disrupted neural signals in patients with concomitant exotropia
Authors: Xi Sida , Yao Jing , Zhang Shujie , Liu Rui , Wu Lianqun , Ye Xinpei , Zhang Peng , Wen Wen , Zhao Chen
Published: July 2020

Purpose

Decreased binocular and oculomotor function in strabismics has recently been considered as cortical in origin. This study aimed to investigate functional abnormalities using a frequency‐specific neuroimaging method in patients with concomitant exotropia (XT), and to demonstrate the clinical implications.

Methods

Resting‐state functional magnetic resonance imaging data were collected in 26 XT patients and 26 matched controls. To evaluate the local spontaneous neural activity, the amplitude of low frequency fluctuations (ALFF) was calculated in the typical frequency band (0.01–0.08 Hz) as well as five narrowly‐defined frequency bands (slow‐6: 0–0.01 Hz, slow‐5: 0.01–0.027 Hz, slow‐4: 0.027–0.073 Hz, slow‐3: 0.073–0.167 Hz, and slow‐2: 0.167–0.25 Hz), respectively.

Results

Patients with XT showed decreased ALFF in the bilateral parieto‐occipital sulcus (POS), and increased ALFF in the bilateral thalamus within the typical frequency band. Frequency‐dependent ALFF alterations were found in the higher visual areas such as the right lateral occipital complex (LOC). Furthermore, ALFF in the right LOC in the slow‐5 band was positively correlated with fusion control score (r = 0.70, p < 0.0001) and binocular function score (r = 0.67, p = 0.0002). Regression analyses showed that early age of onset remained the only significant explanatory factor for ALFF reduction in the right POS in the typically‐measured frequency band (also referred to as the typical frequency band) (Odds ratio, 0.038; 95% confidence interval, 0.001 to 0.075).

Conclusions

Our findings provide spatial information regarding the functionally disrupted regions in XT. Moreover, the frequency‐dependent ALLF alteration in the right LOC might reflect a potential plastic capacity in binocular function, which could be a potential objective index for evaluating disease severity.
Factors contributing to the distress, concerns, and needs of UK Neuroscience health care workers during the COVID‐19 pandemic
Authors: Cipolotti Lisa , Chan Edgar , Murphy Patrick , van Harskamp Natasja , Foley Jennifer A.
Published: July 2020

COVID‐19 research from China suggests health care workers are at risk of distress, have specific concerns, and need support. It remains unknown whether findings are applicable to UK health care staff and whether psychological support based on generic approaches is effective. We administered an online survey at a leading neuroscience hospital in the UK to examine how individual staff characteristics contribute to distress, concerns, and interventions most valued during the COVID‐19 pandemic. We found a high incidence of distress, particularly in females and staff with previous mental health history. Concerns fell into three factors: ‘risk of infection’, ‘work challenges’, and ‘social change’, and were affected by professional role and contact with COVID‐19 patients. These three factors predicted distress. Psychological support and clear updates were deemed most useful, with specific needs affected by age, professional role, and contact with COVID‐19 patients. This is the first documentation of a high incidence of psychological distress predicted by three types of concerns in health care workers of a neuroscience hospital. Distress, concerns, and interventions most valued were all affected by individual staff characteristics. These findings highlight the importance of providing stratified, one to one support interventions, tailored to professional group, and background, rather than more generic approaches.

Practitioner points

The COVID‐19 pandemic has resulted in a high incidence of psychological distress in UK health care staff.

Distress, concerns, and interventions most valued are influenced by individual staff characteristics.

Stratified, one‐to‐one support interventions, tailored to professional group, and background, rather than more generic approaches for stress reduction and resilience, are crucial.
Regulating havens: The role of hard and soft governance of tax experts in conditions of secrecy and low regulation
Authors: Killian Sheila , O'Regan Philip , Lynch Ruth , Laheen Martin , Karavidas Dionysios
Published: July 2020

International tax governance is significant societally as it impacts both inequality and the capacity of governments to deliver on their social contracts. Tax experts forma key, under‐researched, heterogeneous element of the tax ecosystem, subject to a range of hard and soft governance influences. While problematic tax regimes are appropriately identified by reference to lax regulation or financial opacity, few empirical studies explore how operating in these jurisdictions affects the governance of tax experts individually. Using international survey data, we find that the influence of soft governance on tax experts varies across conditions of secrecy or lax regulation. Soft governance, including that of the workplace and the profession, is most influential in challenging regimes. Beyond a tipping point of economic freedom, regulatory knowledge and the threat of sanction become less influential. Elements along the continuum between hard and soft governance interact in a non‐homogenous way that indicates a role for professional bodies and firms in tax governance.
The effect of a Durbin–Watson pretest on confidence intervals in regression
Authors: Kabaila Paul , Farchione Davide , Alhelli Samer , Bragg Nathan
Published: July 2020

Consider a linear regression model and suppose that our aim is to find a confidence interval for a specified linear combination of the regression parameters. In practice, it is common to perform a Durbin–Watson pretest of the null hypothesis of zero first‐order autocorrelation of the random errors against the alternative hypothesis of positive first‐order autocorrelation. If this null hypothesis is accepted then the confidence interval centered on the ordinary least squares estimator is used; otherwise the confidence interval centered on the feasible generalized least squares estimator is used. For any given design matrix and parameter of interest, we compare the confidence interval resulting from this two‐stage procedure and the confidence interval that is always centered on the feasible generalized least squares estimator, as follows. First, we compare the coverage probability functions of these confidence intervals. Second, we compute the scaled expected length of the confidence interval resulting from the two‐stage procedure, where the scaling is with respect to the expected length of the confidence interval centered on the feasible generalized least squares estimator, with the same minimum coverage probability. These comparisons are used to choose the better confidence interval, prior to any examination of the observed response vector.