bluuebunny/crossref_metadata_2025 huggingface dataset:
Requirement of mental health referral letters for staged and revision genital gender‐affirming surgeries: An unsanctioned barrier to care
Authors: Yuan Nance , Chung Theodore , Ray Edward C. , Sioni Caitlin , Jimenez‐Eichelberger Alma , Garcia Maurice M.
Published: May 2021

Background

The World Professional Association for Transgender Health (WPATH) recommends referral letters from two mental health providers within one year of gender‐affirming genital surgery (gGAS) to ensure patient readiness before primary surgeries. Many U.S. health insurance plans will not authorize second‐ and third‐stage surgeries or revision surgeries without two referral letters. Such requirements are not supported by WPATH guidelines.

Objectives

This study investigates insurance requirements for referral letters and their negative impact on care.

Materials and methods

We retrospectively reviewed all gGAS cases over a 4‐year period at our tertiary care medical center. Referral letter requirements for insurance authorization were documented. The nation's largest insurance companies, including commercial, state‐, and federally funded plans, were contacted to confirm requirements. We prospectively recorded time needed to complete insurance authorization for a patient subset. WPATH publications were reviewed.

Results

Nearly all reviewed U.S. health insurance plans required annually updated referral letters for each gGAS procedure, including staged and revision surgeries. No updated letters changed clinical management. Referral letter requirements delayed care. WPATH states that letters should not be needed for staged surgeries. Some plans required letters even for initial surgical consultation, a practice not supported by WPATH.

Discussion and Conclusion

Insurance companies’ requirements for referral letters impede care and contradict WPATH guidelines. We advocate that, at minimum, referral letters should not be required for surgical consultations or for staged or revision surgeries after a patient has already had first‐stage primary gGAS. Universal referral letter requirements provide minimal clinical value, delay care, increase costs, and exacerbate gender dysphoria by invalidating gender transition. As with all procedures, surgeons themselves should be responsible for assessing patients’ surgical readiness. Significant changes in mental health status or social situation should prompt surgeons to seek reassessment. WPATH recommendations regarding referral letters should be clarified and consolidated into a single document.
Histopathology of myopic cobblestones
Authors: Jonas Shefali B. , Jonas Rahul A. , Panda‐Jonas Songhomitra , Jonas Jost B.
Published: May 2021

Purpose

To search for the histological correlate of peripheral ‘cobblestones’ in highly myopic eyes.

Methods

The histomorphometric investigation included histologic sections of enucleated eyes of Caucasian patients. Using light microscopy, we measured the thickness of the retina, Bruch’s membrane (BM) and choriocapillaris.

Results

The study included 50 eyes (mean age:60.6 ± 18.7 years;axial length:26.5 ± 3.8 mm), with cobblestone regions detected in 7 eyes. BM thickness and choriocapillaris thickness in the cobblestone region were thinner (1.1 ± 0.2 µm versus 2.4 ± 0.8 µm; p < 0.001 and 1.6 ± 0.5 µm versus 2.6 ± 1.9 µm; p = 0.02, respectively), and just outside of the cobblestone region they were thicker (3.3 ± 0.6 µm versus 2.4 ± 0.8 µm; p = 0.005 and 5.7 ± 1.6 µm versus 2.6 ± 1.9 µm; p = 0.002, respectively) than in corresponding regions of eyes without cobblestones. Within the group of eyes with cobblestones, BM thickness (1.1 ± 0.2 mm versus 3.3 ± 0.6 mm; p < 0.001), choriocapillaris thickness (1.6 ± 0.5 mm versus 5.7 ± 1.6 mm; p < 0.001) and choriocapillaris density (48±15 µm/300 µm versus 159 ± 66 µm/300 µm;PP=0.002) were significantly lower in the cobblestone region than just outside of the cobblestone region. The cobblestone regions were characterized by firm adhesion of disorganized retina with thinned BM, few retinal pigment epithelium (RPE) islands within cobblestone regions, and absence of regional scleral or overall choroidal thinning. BM was mono‐layered within, and double‐layered outside of cobblestone regions, with the inner layer missing within the cobblestone region (except for the RPE islands).

Conclusions

Peripheral cobblestone regions in highly myopic eyes are characterized by marked BM thinning with absence of an inner BM layer, almost complete RPE absence, choriocapillaris thinning and firm connection of a disorganized retina to BM. These findings may help elucidating the process of axial elongation in myopic eyes.
The investigation and provenance of glass vessel fragments attributed to the Tomb of Amenhotep II, KV35, Valley of the Kings
Authors: Kemp Victoria , Brownscombe Will , Shortland Andrew
Published: May 2021

Four polychrome glass fragments, excavated from tomb KV35 in the Valley of the Kings, attributed to Amenhotep II, were analysed to further investigate the composition and provenance of early Late Bronze Age (LBA) glasses. An additional fragment, EA64163, cited by the British Museum as being stylistically analogous to the fragments from KV35, although with a findspot simply recorded as ‘Thebes’, was also analysed. Laser ablation inductively coupled plasma mass spectrometry (LA‐ICP‐MS) analysis was used to analyse multiple colours on the fragments to determine the major element composition, the colouring strategies and to establish provenance using trace element analysis. The resulting data obtained were compared with four polychrome fragments of standard LBA Egyptian composition, excavated from the palace of Amenhotep III at Malkata, previously analysed by scanning electron microscopy with wavelength dispersive spectroscopy (SEM‐WDS). Analysis showed that the glasses excavated from KV35 are standard LBA glass of Egyptian composition and were most likely produced in Egypt during the 18th Dynasty. The fragment EA64163 is a low magnesia, low potash glass comparable with Iron Age composition and therefore should be reconsidered as a later glass. The analysis of glasses excavated from a reliable, early Egyptian context supports the proposition that glass technology for multiple colours was established in Egypt at least as early as 1400 bce.
Recent developments of HDAC inhibitors: Emerging indications and novel molecules
Authors: Bondarev Andrey D. , Attwood Misty M. , Jonsson Jörgen , Chubarev Vladimir N. , Tarasov Vadim V. , Schiöth Helgi B.
Published: May 2021

The histone deacetylase (HDAC) enzymes, a class of epigenetic regulators, are historically well established as attractive therapeutic targets. During investigation of trends within clinical trials, we have identified a high number of clinical trials involving HDAC inhibitors, prompting us to further evaluate the current status of this class of therapeutic agents. In total, we have identified 32 agents with HDAC‐inhibiting properties, of which 29 were found to interact with the HDAC enzymes as their primary therapeutic target. In this review, we provide an overview of the clinical drug development highlighting the recent advances and provide analysis of specific trials and, where applicable, chemical structures. We found haematologic neoplasms continue to represent the majority of clinical indications for this class of drugs; however, it is clear that there is an ongoing trend towards diversification. Therapies for non‐oncology indications including HIV infection, muscular dystrophies, inflammatory diseases as well as neurodegenerative diseases such as Alzheimer's disease, frontotemporal dementia and Friedreich's ataxia are achieving promising clinical progress. Combinatory regimens are proving to be useful to improve responsiveness among FDA‐approved agents; however, it often results in increased treatment‐related toxicities. This analysis suggests that the indication field is broadening through a high number of clinical trials while several fields of preclinical development are also promising.
Impact investments, evil investments, and something in between: Comparing social banks' investment criteria and strategies with depositors' investment preferences
Authors: Höhnke Nikolas , Homölle Susanne
Published: May 2021

Since the global financial crisis in 2007, social banks have been flooded with deposits. Previous studies have indicated that customers hold deposits with social banks due to social banks' special placement of assets. However, to date it has been far from clear how social banks select their investments, and consequently to what extent the placement of assets meets depositors' preferences. The purpose of this paper is, therefore, to investigate whether the characteristics of social banks’ placement of assets are relevant to depositors’ choice of social banks. A two‐stage study is conducted, using data collected via a document analysis of social banks' investment criteria, a survey of social banks, and an online survey of 609 depositors. The results imply that the characteristics of social banks' placement of assets are indeed relevant to depositors' choice of social banks, but do not explain customer behaviour entirely. Furthermore, the findings indicate that a relevant proportion of customers hold deposits with social banks to avoid “evil” rather than necessarily creating “good.” Based on the findings, a theoretical framework of depositors' choice of social banks is presented that goes far beyond previous explanations by considering various types of social depositors, banks, and borrowers.
A phase I open label dose‐escalation study to evaluate the tolerability, safety and immunological efficacy of sub‐urothelial durvalumab injection in adults with muscle‐invasive or high‐risk non‐muscle‐invasive bladder cancer (SUBDUE‐1, SUB‐urothelial DUrvalumab injection‐1 study): clinical trial protocol
Authors: Moe Andrew , Liow Elizabeth , Redfern Andrew , Swarbrick Nicole , Ferguson Tom , Davis Ian D. , Hayne Dickon
Published: May 2021

Objectives

This article presents the clinical trial protocol for a phase I open label dose‐escalation study to evaluate the tolerability, safety and immunological efficacy of sub‐urothelial durvalumab injection in adults with muscle‐invasive or high‐risk non‐muscle‐invasive bladder cancer (NMIBC), the SUB‐urothelial DUrvalumab injection‐1 study (SUBDUE‐1). The primary objectives of this study are to assess the safety of sub‐urothelial injection of durvalumab using patient reported outcome measures and observed local or systemic adverse events. The secondary objectives are to examine the local immunological efficacy of sub‐urothelial administration of durvalumab.

Patients and Methods

The SUBDUE‐1 trial will include adult patients with either high‐risk NMIBC or MIBC, who are scheduled for radical cystectomy or who have refused or are unsuitable for systemic neoadjuvant chemotherapy. Three fixed total dose levels of durvalumab (25, 75, 150 mg) will be studied to identify a dose suitable to be taken forward into phase II trials. The primary endpoint is to evaluate the safety and tolerability of the trial intervention in terms of the incidence and severity of adverse events and the potential establishment of dose‐limiting toxicities. The secondary efficacy endpoints include rates of pT0 status at resection, lymph node status, as well as the change in distribution of tumour‐infiltrating lymphocytes and tumour‐activated macrophages between pre‐ and post‐injection bladder biopsies. Translational studies will focus on bladder tumour molecular sub‐typing, immune infiltrate characterisation, and immune checkpoint protein expression relative to efficacy end‐points.

Outcome and Significance

If proven safe and effective, this novel strategy comprising sub‐urothelial durvalumab injections aimed at promoting an anti‐tumour immune reaction, will provide additional treatment options for reducing tumour recurrence and progression in treatment‐naïve patients with high‐risk NMIBC or in patients with bacille Calmette–Guérin‐refractory NMIBC. Local administration of durvalumab may be associated with a reduced rate of immunological side‐effects and lower costs when compared to systemic delivery.
A review of developments in industrial hair colorant actives for oxidative dyes
Authors: Towns Andrew
Published: May 2021

This paper reviews developments in industrial colorants as active ingredients of commercial products that rely on oxidative chemistry for the coloration of human hair. After outlining the regulatory challenges faced by the industry, which are shaping the landscape of colorant usage, the most commercially important actives utilised in oxidative hair colorant formulations are surveyed from the perspective of their chemistry and economics. Some developments in the form of recently introduced actives are also described.
TrendPowerTool: A lookup tool for estimating the statistical power of a monitoring program to detect population trends
Authors: Weiser Emily L. , Diffendorfer Jay E. , Lopez‐Hoffman Laura , Semmens Darius , Thogmartin Wayne E.
Published: May 2021

A simulation‐based power analysis can be used to estimate the sample sizes needed for a successful monitoring program, but requires technical expertise and sometimes extensive computing resources. We developed a web‐based lookup app, called TrendPowerTool (https://www.usgs.gov/apps/TrendPowerTool/), to provide guidance for ecological monitoring programs when resources are not available for a simulation‐based power analysis. TrendPowerTool is implemented through the shiny package in R, but is accessible through a webpage without the need for users to install any software. By drawing on results of 1.4 million scenarios that we simulated on a supercomputer, TrendPowerTool quickly and easily provides an estimate of the statistical power to detect a population trend of a particular magnitude with a planned monitoring program, based on user‐specified parameters for the monitoring design and population of interest. TrendPowerTool provides a user‐friendly interface that retrieves results instantaneously, facilitating the important step of conducting a power analysis when designing monitoring programs.
Prevalence of iron deficiency in heart transplant recipients
Authors: Brautaset Englund Kristine V , Østby Charlotte M , Tjønnås Gry , Gude Einar , Andreassen Arne K , Gullestad Lars , Broch Kaspar
Published: May 2021

Background

Optimal iron management is crucial to marginal patients such as heart transplant recipients. As inflammatory mechanisms are present in transplant recipients, the definition of iron deficiency used in the general population might not be appropriate.

Objective

To evaluate the prevalence and determinants of iron deficiency in Norwegian heart transplant recipients.

Methods

We consecutively assessed iron parameters in all Norwegian heart transplant recipients at their annual follow‐up. Several definitions of iron deficiency suggested in the literature were assessed: ferritin <100 µg/L, or ferritin 100‐300 µg/L combined with transferrin saturation of <20% (IDHF); ferritin <100 µg/L (IDF100); transferrin saturation of <20% (IDTsat), and ferritin <30 µg/L (IDF30).

Results

179 of 378 heart transplant recipients (47%) had iron deficiency defined as IDHF. 152 patients (40%) had IDF100, and 103 patients (27%) had IDTsat. 17 patients (5%) had IDF30. 88 patients (23%) had a C‐reactive protein (CRP) >5.0 µg/L.

Conclusion

Iron deficiency defined as IDHF, IDF100, or IDTsat is prevalent in the heart transplant population, while IDF30 is not. Further research is required to identify the mechanisms of iron homeostasis in heart transplant recipients and to establish a definition of iron deficiency suitable for this population.
Epiphytic macrolichen communities take decades to recover after high‐severity wildfire in chaparral shrublands
Authors: Miller Jesse E. D. , Weill Alexandra M. , Villella John
Published: May 2021

Aim

Fire regimes are shifting globally due to climate change, land management practices and population growth, putting species at risk if they are unable to adapt to more frequent or severe wildfires. While many fire‐adapted species may be able to accommodate some amount of change in fire regimes, fire‐sensitive or late‐successional species that colonize fire‐prone ecosystems between wildfires may be especially vulnerable to more frequent or severe fires. Here, we seek to understand the rate of lichen recolonization after high‐severity fires in an ecosystem that is experiencing increasing fire frequency.

Location

The Inner North Coast Range of California, USA.

Methods

Using a chronosequence of wildfires in a Northern California chaparral shrubland, we compare lichen communities among sites that burned 3, 13, 22, 30 and 65 years previously, as well as old‐growth chaparral sites without a recorded fire over the past century.

Results

We find that lichen richness increases consistently with time since fire but begins to level off 20–30 years following fire, roughly corresponding to the closure of the shrub canopy. Some taxa and guilds were found only in old‐growth chaparral.

Conclusions

Our findings highlight that fire‐intolerant organisms may be relatively slow to recolonize landscapes after high‐severity fire and that the majority of chaparral lichen taxa may be lost where fire intervals shorten to <20 years, which has already occurred in some parts of California.
Reproductive traits explain occupancy of predicted distributions in a genus of eastern North American understory herbs
Authors: Miller Chelsea N. , Papeş Monica , Schilling Edward E. , Kwit Charles
Published: May 2021

Aim

Abiotic, biotic and dispersal factors interact to shape species distributions. At broad geographic extents, abiotic factors are thought to exert the greatest influence on the distribution, while biotic and dispersal factors strongly influence the distribution regionally and locally. We test whether reproductive traits relating to biotic and dispersal factors explain differences between estimated potential and occupied geographic distributions for 21 species of Trillium.

Location

Eastern North America.

Methods

Fundamental niches and associated predicted suitable distributions were estimated using climate‐calibrated ecological niche models. We defined occupied distributions as the intersection between known ranges and predicted suitable areas (PSAs). Proportional occupancy of the predicted suitable distribution (PO) was calculated by dividing the area of the occupied distribution by the PSA. We related reproductive traits (ovule number, seed set, number of seeds/plant, seed mass, adult biomass, flower type: sessile/pedicellate) to PO using beta regression models. AICc was used to assess model fit.

Results

There was considerable variation in PO across species (1.1%–96%, mean = 51%). Eighty‐five percent of species with PO < 60% were sessile; 88% of species with PO > 60% were pedicellate. The best‐fit beta regression (pseudo R2 = .70) yielded significantly lower PO for sessile‐flowered species; ovule number and seed mass were also significant predictors of PO.

Main conclusions

Variation in PO among study species can be explained by flower type, ovule number and seed mass—biotic traits related to dispersal ability. We posit that variation in dispersal potential stemming from primary and long‐distance dispersers is related to occupancy of the predicted suitable distribution in Trillium. We exemplify a scenario in which life history traits explain why some species are range‐restricted when their close relatives are widespread. Our methodology constitutes a powerful comparative framework that can be applied to diverse biological systems to inform conservation of rare species.
Clustering of blood cell count abnormalities and future risk of death
Authors: Patti Giuseppe , Lio Veronica , Di Martino Giuseppe , Ricci Fabrizio , Renda Giulia , Melander Olle , Engström Gunnar , Hamrefors Viktor , De Caterina Raffaele , Fedorowski Artur
Published: May 2021

Background

The identification of novel predictors of poor outcome may help stratify cardiovascular risk. Aim was to evaluate the individual contribution of blood cell count parameters, as well as their clustering, on the risk of death and cardiovascular events over the long term in the population‐based Malmö Diet and Cancer Study cohort.

Methods

In 30,447 individuals (age 57 ± 8 years), we assessed the incidence of all‐cause death (primary endpoint) and major adverse cardiovascular events (MACE, secondary outcome measure) according to absence or presence of one, two and three factors at baseline out of the following: anaemia, leukocytosis and thrombocytosis. Median follow‐up was 16 years.

Results

The percentages of all‐cause death were 19.5% in individuals without factors, 21.3% in those with one factor, 27.4% with two and 46.4% with three (log‐rank test P < .001). The crude incidence of MACE was 28.0%, 29.2%, 35.5% and 57.1%, respectively (log‐rank test P < .001). At multivariate analysis, we found a stepwise increase in overall mortality with increasing number of prevalent factors (one factor: HR 1.23, 95% CI 1.14‐1.31, P < .001; two factors: 1.61, 1.37‐1.89, P < .001; three factors: 2.69, 1.44‐5.01, P = .002, vs no factor). Similar findings were observed for the incidence of MACE (one factor: adjusted HR 1.18, 95% CI 1.11‐1.24, P < .001; two factors: 1.52, 1.33‐1.76, P < .001; three factors: 2.03, 1.21‐3.67, P < .001, vs no factor).

Conclusions

The easily assessable clustering of anaemia, leukocytosis and thrombocytosis heralds higher incidence of death and adverse cardiovascular events.
White matter abnormalities in a patient with visual snow syndrome: New evidence from a diffusion tensor imaging study
Authors: Latini Francesco , Fahlström Markus , Marklund Niklas , Feresiadou Amalia
Published: May 2021

Background

Visual snow syndrome (VSS) is a neurological condition characterized by flickering dots throughout the entire visual field. Both the pathophysiology and possible location of VSS are still under debate. White matter abnormalities were investigated using diffusion tensor imaging (DTI) in a patient with VSS.

Methods

A 28‐year‐old patient with VSS and 10 healthy controls were investigated with DTI. Diffusion parametric maps were calculated and reconstructed using q‐space diffeomorphic reconstruction. White matter pathways of the dorsal, ventral, integrative visual streams and thalamic connectivity were tracked. Then, they were applied to each subject's parameter map, stretched to the same length, and sampled along the tracts for regional analyses of DTI parameters.

Results

Compared with healthy controls, our patient displayed higher axial diffusivity (AD) and radial diffusivity (RD) in the dorsal visual stream (cingulum, arcuate fasciculus, horizontal indirect anterior segment of the superior longitudinal fasciculus), in the ventral visual stream (fronto‐occipital fasciculus, inferior longitudinal fasciculus) and in the integrative visual stream (indirect posterior component of the superior longitudinal fasciculus, vertical occipital fasciculus). Higher AD and RD were also detected in acoustic and optic radiations, and in thalamic radiations distal to the thalamus.

Conclusion

This VSS patient displayed multiple, bilateral white matter changes in the temporo‐parieto‐occipital junction in white matter pathways related to vision. We encourage the study of white matter pathology using DTI in complex neurological syndromes including VSS.
Beneficial effects of coagulase‐negative Staphylococci on Staphylococcus aureus skin colonization
Authors: Bier Katharina , Schittek Birgit
Published: May 2021

Our skin is constantly exposed to a large number of pathogens while at the same time undergoing selective colonization by commensal microorganisms such as coagulase‐negative Staphylococci. Staphylococcus aureus, however, is a facultative pathogen that is usually absent from healthy skin but frequently colonizes the inflamed skin of atopic dermatitis patients, where it further promotes inflammation. Enhanced S. aureus skin colonization was shown to correlate with a loss of microbiome diversity indicating a role for skin commensals to shape pathogen colonization. Together, keratinocytes and immune cells in the skin need to discriminate commensals from pathogens and orchestrate subsequent immune reactions in response to colonizing microbes. However, the mechanisms how individual commensals cooperate with keratinocytes and the immune system of the skin to prevent pathogen colonization are barely understood. In this review, we discuss the current knowledge on the functional effects of coagulase‐negative staphylococci, the most frequently isolated skin commensals, on S. aureus skin colonization.
Redefining risk in data‐poor fisheries
Authors: Grewelle Richard E. , Mansfield Elizabeth , Micheli Fiorenza , De Leo Giulio
Published: May 2021

The productivity susceptibility analysis (PSA) is a widely used method to rapidly assess species risk to fishing activities in data‐poor fisheries. A step in ecological risk assessments and used in data‐poor assessment for sustainable fisheries certification programmes (e.g. MSC) and recommendation lists (e.g. Seafood Watch), the PSA is semi‐quantitative, yet little attention has been given to the theoretical basis of this analysis. Current thresholds designating low‐, medium‐ and high‐risk categories divide the PSA plot by equal area, assuming area corresponds to likelihood. We show that plot area does not correspond to likelihood, however, and existing thresholds need revision due to the non‐uniform distribution of vulnerability scores on the PSA plot. The probability of medium risk assignment increases with the number of attributes used to characterize productivity and susceptibility. Here, we present a novel and statistically robust method to derive vulnerability, where threshold values between the risk categories are adjusted with the number of attributes used in the assessment. Our comprehensive framework accounts for all variations in the method, including logarithmic scaling of axes, weighting of attributes and scoring procedures. Simulated results across a range of conditions and comparative evaluation of 302 species in five studies show that one‐third of species may be re‐categorized with the new PSA approach. Importantly, the existing PSA approach underestimates risk by up to 35% when compared with the new method. These findings have strong implications for management of data‐poor fisheries. We recommend adoption of this approach to the PSA to better resolve species’ risk.
Integrative Systemic Supervision: Promoting Supervisees’ Theoretical Integration in Systemic Therapy
Authors: He Yaliu , Hardy Nathan R. , Russell William P.
Published: May 2021

Integrative systemic therapy (IST) is a meta‐theoretical perspective, grounded in systemic theory and integration, that transcends therapy models in individual, couple, and family therapy. To foster supervisees’ theoretical integration and systemic thinking, two of IST’s primary tools—the essence diagram and blueprint—are described and applied to inform an integrative, systemic meta‐perspective for supervision. Recommendations, specific guiding questions, and examples are provided to operationalize these tools in the multi‐level supervision system (i.e., supervisor–supervisee–client system). IST supervisors and other supervisors who are interested in integrative, systemic training can use these tools to guide the process of supervision and strengthen supervisees’ ability to hypothesize, plan, converse, and read clients’ feedback in relation to the various tasks of therapy. The essence diagram and blueprint are applied to facilitate case consultation and cultivate the development of supervisees’ clinical competencies. Particularly, the problem‐solving focus of IST has been adapted to include a competency‐based and professional growth‐oriented dimension for supervision to better promote supervisees’ development. Lastly, the advantages and challenges of IST‐influenced supervision are discussed.
Rotifers stimulate the specific uptake rate in lotic phototrophic biofilms
Authors: Liu Yang , Tackx Michèle , Dauta Alain , Julien Frédéric , Buffan‐Dubau Evelyne
Published: May 2021

Stream biofilms can improve water quality (e.g. excessive nitrogen loads) because their microorganisms such as microphytobenthos and bacteria, are involved in self‐depuration processes in the biofilm. In marine sediments, meiofauna can influence primary productivity of phototrophic biofilms, stimulate bacterial growth, and exert a significant role on nitrogen cycling. We hypothesised that in rivers biofilms, increased meiofauna abundance in combination with nutrient enrichment can lead to improve biofilm nutrient uptake ability.

River biofilms (from the Garonne River, France) were incubated in flumes supplied with natural river water. The uptake rates of the biofilms as well as the response of microorganisms were studied under different conditions of meiofaunal density and concentration over a 10‐day experiment.

Rotifers dominated the meiofauna community in all biofilms. Under high nitrate conditions, the biofilm uptake rate was significantly higher in meiofauna‐enriched than non‐enriched biofilms over the first 2 days. This suggests that under high nitrate concentration conditions, high densities of rotifers enhanced the nitrogen uptake capacity of phototrophic biofilm despite a lower biomass. Densities of rotifers and bacteria in biofilms were positively correlated under enriched conditions suggesting that these two communities interacted over the experimental period. Signature pigment concentrations show that, under low concentrations of , biomasses of diatoms and green microalgae were higher in meiofaunal‐enriched than non‐enriched biofilms, indicating that rotifer activity favoured biomass accumulation of these algae.

This study demonstrates that meiofauna inhabiting biofilms may contribute to the limitation of nitrogen loads in stream water and supports the thesis that the potential interactions between faunal groups and microbial communities of biofilms merits further investigation to improve our understanding of processes which regulate interactions between biofilms and the overlying water in rivers.
Progression of behavioral deficits during periadolescent development differs in female and male DISC1 knockout rats
Authors: Glenn Melissa J. , Batallán Burrowes Ariel A. , Yu Waylin , Blackmer‐Raynolds Lisa , Norchi Amanda , Doak Amanda L.
Published: May 2021

Mutations in the disrupted in schizophrenia‐1 (DISC1) gene are associated with an increased risk of developing psychological disorders including schizophrenia, bipolar disorder, and depression. Assessing the impact of knocking out genes, like DISC1, in animal models provides valuable insights into the relationship between the gene and behavioral outcomes. Previous research has relied on mouse models to assess these impacts, however these may not yield as reliable or rich a behavioral analysis as can be obtained using rats. Thus, the goal of the present study was to characterize the behavioral effects of a biallelic functional deletion of the DISC1 gene in the Sprague Dawley rat. Female and male wild type and DISC1 knockout rats were assessed beginning just prior to weaning and during the post‐weaning periadolescent period. The primary outcomes evaluated were activity, anxiety, responses to novel objects and conspecifics, and prepulse inhibition. These behaviors were selected as analogous indices of psychological dysfunction in humans. The DISC1 knockout had significant effects on behavior, although the kind and magnitude of deficits was different for females and males: in females, effects included hyperactivity, aversion to novelty, and a modest prepulse inhibition deficit; in males, effects in anxiety and neophobia were mild but their prepulse inhibition deficit was large. These data confirm that the DISC1 knockout rat model is an excellent way to reproduce and study symptoms of psychological disorders and provides compelling evidence for differential consequences of its dysfunction for females and males in the progression and emergence of specific behavioral deficits.
Chromatin remodeling in replication‐uncoupled maintenance DNA methylation and chromosome stability: Insights from ICF syndrome studies
Authors: Unoki Motoko
Published: May 2021

Immunodeficiency, centromeric instability, and facial anomalies (ICF) syndrome is characterized by frequent appearance of multiradial chromosomes, which are distinctive chromosome fusions that occur at hypomethylated pericentromeric regions comprising repetitive sequences, in activated lymphocytes. The syndrome is caused by mutations in DNMT3B, ZBTB24, CDCA7, or HELLS. De novo DNA methylation is likely defective in patients with ICF syndrome harboring mutations in DNMT3B, whereas accumulating evidence suggests that replication‐uncoupled maintenance DNA methylation of late‐replicating regions is impaired in patients with ICF syndrome harboring mutations in ZBTB24, CDCA7, or HELLS. ZBTB24 is a transcriptional activator of CDCA7, and CDCA7 and HELLS compose a chromatin remodeling complex and are involved in the maintenance DNA methylation through an interaction with UHRF1 in a feed‐forward manner. Furthermore, our recent studies possibly provided the missing link between DNA hypomethylation and the formation of the abnormal chromosomes; it could occur via aberrant transcription from the hypomethylated regions, followed by pathological R‐loop formation. The homologous‐recombination dominant condition caused by a defect in nonhomologous end joining observed in several types of ICF syndrome could facilitate the formation of multiradial chromosomes. Here, the latest knowledge regarding maintenance DNA methylation and chromosome stability provided by those studies is reviewed.
Efficacy and safety of subcutaneous prophylaxis with dalcinonacog alfa in adults with haemophilia B
Authors: Mahlangu Johnny , Levy Howard , Lee Martin , Del Greco Frank
Published: May 2021

Aim

Phase 2b study to assess efficacy, safety, thrombogenicity, immunogenicity and tolerability with 28 days of daily dosing of subcutaneous (SQ) dalcinonacog alfa as prophylaxis for haemophilia B (HB).

Methods

Adult males with a confirmed diagnosis of congenital HB (factor IX [FIX] activity <2%) received daily dalcinonacog alfa 100 IU/kg SQ until day 28. The primary efficacy endpoint was the number of participants who achieved a steady‐state FIX activity level ≥12%. Tolerability, thrombogenicity and immunogenicity were study safety endpoints.

Results

Of 6 participants who received study drug, one discontinued the study on day 7 due to injection‐site reactions (ISR). Of the 5 participants completing the study, FIX activity level exceeded 12% in 3 participants at day 7, increasing to 4 participants on days 14, 21 and 28 and all 5 at day 29. Pharmacokinetic findings (including mean alpha and beta half‐life of 5.3 days and 3.9 days, respectively, and mean residence time of 6.2 days) supported prolonged effects. Thrombogenicity markers remained normal throughout prophylactic injections or showed some initial increases followed by decreases with continued dosing. Two participants had anti‐drug antibodies to dalcinonacog alfa at study end, none had neutralizing antibody. Two participants had ISR, both resolved. Reports of redness, swelling, tenderness or pain among the first 3 participants prompted dose‐splitting for the last 3 participants, leading to fewer ISR.

Conclusion

Subcutaneous dalcinonacog alfa is effective in raising FIX levels into the mild haemophilia range, comparable to intravenous extended half‐life FIX clotting factors.
Enhanced red emission and improved thermal quenching of CaAlSiN3:Eu2+ phosphors via boron doping
Authors: Lu Xiangyu , Yuan Hailong , Huang Zhifeng , Zhou Yujuan , Chen Fei , Shen Qiang
Published: May 2021

The development of high‐performance phosphors is required for phosphor‐converted white light‐emitting diodes. However, most approaches are unable to achieve optimum emission intensity and thermal quenching simultaneously. Here, a series of CaAlSiN3:Eu2+ (CASN:Eu2+) red‐emitting phosphors doped with B were synthesized using field‐assisted sintering technology. Compared with CASN:Eu2+, the B‐doped phosphor exhibited high external quantum efficiency (EQE) and good thermal quenching performance. With boron doping, the EQE of CaAlSiN3:Eu2+ shows an obvious growth, increasing from 48.83% to 70.68%. Meanwhile, thermal quenching performance has also been greatly improved, which is strongly associated with the band structure of Eu2+ and the crystal structure of CASN. The location of B in the crystal lattice was studied and the mechanism of improving thermal quenching via B doping was discussed in detail. Finally, a white LED fabricated by the combination of a GaN blue chip (450 nm) with the as‐synthesized red phosphors and Y3(Al, Ga)5O12:Ce3+ green phosphors (531 nm), shows a high color rendering index (Ra =91.6). This study offers a novel method to improve luminescence properties of CASN:Eu2+ red‐emitting phosphors, which may broaden their application in solid‐state lighting devices.
Risk versus recovery: Care planning with individuals on community treatment orders
Authors: Dawson Suzanne , Muir‐Cochrane Eimear , Simpson Alan , Lawn Sharon
Published: May 2021

Community treatment orders (CTOs) require individuals with a mental illness to accept treatment from mental health services. CTO legislation in South Australia states that treatment and care should be recovery‐focused, although justification for use is predominantly risk‐based, and care often coercive. Although CTOs are contested, individuals, families, and clinicians frequently engage in care planning within this context. This paper examines how the concepts of risk and risk management impact care planning from the perspectives of individuals on CTOs, their families, and clinicians. Ethnographic methods of observation and interview provided a detailed account of the perspectives of each group over an 18‐month period from two community mental health teams in South Australia. Findings show that care planning occurred within a culture of practice dominated by risk. Risk, however, was understood differently by each participant group, with the dominant narrative informed by biogenetic understandings of mental illness. This dominance impacted on the positioning of participant groups in care planning, focus of care contacts, and care options available. To improve care experiences and outcomes for individuals on CTOs, narrow conceptualizations of risk and recovery need to broaden to include an understanding of personal and social adversities individuals face. A broader understanding should reposition participants in the care planning context and rebalance care discussions, from a focus on clinical recovery to recovering citizenship.
Spin glass behavior and exchange bias effect in GaFeO3‐type iron oxide
Authors: Lin Xiaoxia , Wang Jianlin , Fu Zhengping , Huang Qiuping , Lu Yalin
Published: May 2021

GaFeO3‐type iron oxide is a promising room‐temperature multiferroic material due to its large magnetization and polarization. To expand the scope of its application, it is crucial to control the magnetic properties. Based on introducing the ferromagnetic (FM) Fe3O4 in the antiferromagnetic (AFM) GaFeO3 to build the FM‐AFM interface by changing the Ga/Fe ratio, Ga0.69Fe1.31O3 (GFO) was successfully grown by the floating zone method. The resulting sample was characterized by X‐ray diffraction (XRD), and its magnetic properties were measured using a superconducting quantum interference device (SQUID). The temperature‐dependent AC susceptibility measurement shows that the spin glass‐like behavior of GFO at temperatures close to 50 K is a manifestation of the geometrical frustration arising from cation site disorder. In addition, the magnetic property measurement shows that the magnetic transition temperature Tc is at 650 K, which is introduced by Fe3O4 and suppresses the ferromagnetic transition around 320 K of GFO. Interestingly, the observed exchange bias effect, which does not exist in the bulk GaFeO3‐type family, is attributed to the formation of an FM/AFM interface due to the existence of FM Fe3O4 in the GFO. This study provides a new perspective on the properties of the GaFeO3‐type family for potential applications in spintronic devices.
A mixed methods study on the manifestations of behavioural symptoms of dementia among veterans with and without posttraumatic stress disorder
Authors: Kang Bada , Karel Michele J. , Corazzini Kirsten N. , McConnell Eleanor S.
Published: May 2021

Aims

To explore how behavioural symptoms of dementia are manifested among veterans in residential long‐term care settings, in the context of personal, interpersonal/social and environmental triggers and how the manifestations differ between veterans with and without posttraumatic stress disorder.

Design

Secondary analysis using a mixed methods approach.

Methods

We analysed text data from a stratified random sample of 66 cases derived from the programme evaluation dataset of the Staff Training in Assisted Living Residences‐Veterans Health Administration (STAR‐VA) intervention from 2013 to 2016, using framework analysis. The detailed behavioural assessment descriptions in this dataset are consistent with contemporary non‐pharmacologic symptom management. Qualitative categories were converted to quantitative variables for two group comparisons.

Results

Four patterns emerged linking specific types of triggers and behavioural symptoms: (1) unmet physical needs or emotional distress triggers non‐aggressive behaviours; (2) unsolicited direct care approach triggers care refusal, resistance or combativeness; (3) interpersonal interactions interfering with self‐direction trigger aggressive behaviours; and (4) uncontrolled stimulation from environments trigger non‐aggressive behaviours. The organisational culture of care influenced how staff conceptualised behavioural symptoms. Veterans with co‐existing posttraumatic stress disorder and dementia tended to exhibit rejection of care with aggression compared to those with dementia alone.

Conclusion

Contextualised accounts of behavioural symptoms of dementia revealed symptom heterogeneity, with different clusters of multi‐level triggers arising from specific personal, interpersonal and environmental circumstances. Distinct patterns of symptom manifestations between veterans with and without posttraumatic stress disorder suggest a tailored approach is required to meet each veteran's unique biopsychosocial needs.

Impact

Classifying behavioural symptoms with their triggers rather than solely by behaviours provides important new information for developing person‐centred, non‐pharmacological interventions to improve outcomes for veterans with dementia. Multi‐level interventions should be considered to meet veteran's needs that account for their earlier life history and current life circumstances.
Accounting for inter‐annual variability alters long‐term estimates of climate suitability
Authors: Gardner Alexandra S. , Gaston Kevin J. , Maclean Ilya M. D.
Published: May 2021

Aim

Species respond to environmental conditions and so reliable assessments of climate suitability are important for predicting how climate change could alter their distributions. Long‐term average climate data are often used to evaluate the climate suitability of an area, but in these aggregated climate datasets, inter‐annual variability is lost. Due to non‐linearity in species’ biological responses to climate, estimates of long‐term climate suitability from average climate data may be biased and so differ from estimates derived from the average annual suitability over the same period (average response). We investigate the extent to which such differences manifest in a regional assessment of climate suitability for 255 plant species across two 17‐year time periods.

Location

Cornwall in South‐West England provides a case study.

Taxon

Plantae.

Methods

We run a simple mechanistic climate suitability model and derive quantitative estimates of climate suitability for 1984–2000 and 2001–2017. For each period, we run the model using climate data representing average monthly values for that period. We then run the model for each year using monthly climate data for that year and average the annual suitability scores across each period (average response). We compare estimates of climate suitability from these two approaches.

Results

Average climate data gave higher estimates of suitability than the average response, suggesting bias against years of poor suitability in temporally aggregated climate datasets. Differences between suitability estimates were larger in areas of high climate variability and correlated with species’ environmental requirements, being larger for species with small thermal niches and narrow ranges of precipitation tolerance.

Main Conclusions

Incorporating inter‐annual variability into climate suitability assessments or understanding the extent to which average climate data might obscure this variance will be important to predict reliably the impacts of climate change on species distributions and should be considered when using mechanistic species distribution models.
Robotic assisted cryothermic biatrial Cox‐Maze
Authors: Roberts Harold G. , Wei Lawrence M. , Dhamija Ankit , Cook Chris. C. , Badhwar Vinay
Published: May 2021

Introduction

Robotic cryothermic Cox‐Maze (CM) IV is a minimally invasive procedure that reliably replicates the biatrial lesion set of the CM III by utilizing cryothermia as a single power source.

Methods

Herein we describe a step by step creation of the biatrial CM III lesion sets utilizing the minimally invasive robotic platform.

Results

Technical details are reviewed for this single incision, single stage, highly effective option for stand‐alone or concomitant surgical ablation of atrial fibrillation (AF).

Conclusion

Robotic cryothermic CM IV can be safely performed as a stand‐alone or concomitant procedure, and offers a comprehensive surgical ablation solution for patients with AF.
Persistent hypertension after preeclampsia in a group of Cameroonians: Result of a cross‐sectional study and perspectives to reduce its burden in Limited Income Countries
Authors: Nganou‐Gnindjio Chris Nadège , Kenmogne Denise , Essama Doris Bibi , Nkeck Jan Rene , Yanwou Nathan , Foumane Pascal
Published: May 2021

Preeclampsia/eclampsia significantly increases the risk of future hypertension. Several factors may be involved in this process. The purpose of this study was to identify them in Cameroonians. We conduct a cross‐sectional study including women aged 18 to 45 years, who deliver between December 2011 and 2016, and were diagnosed and followed up for preeclampsia/eclampsia in two major obstetrical and gynecologic units in Yaoundé (Cameroon). Those with persistent high‐blood pressure after 6 months were classified as persistent hypertension (PH). Associated factors were investigated using multivariate analysis with logistic regression and presented with an adjusted odds ratio (aOR) and the 95% confidence interval. 92 participants were included, with 30 (32.6%) with PH. The independent factors associated with PH were as follows: maternal age during preeclampsia above 30 years (aOR = 6.30 [1.1; 35.4], p = .03), at least five deliveries prior preeclampsia (aOR = 1.50 [2; 6.6], p = .008), and family history of diabetes (aOR = 14.8 [2.6; 85.7], p = .003). About one in three women with preeclampsia/eclampsia will have PH. The clinician needs to pay more attention to the potential risk factors identified above. More appropriate strategies need to address the burden of this condition in the context of low resources.