bluuebunny/crossref_metadata_2025 huggingface dataset:
Distribution of tumor subtypes in bilateral breast cancer: Comparison between synchronous and metachronous cancer
Authors: Kim Haeyoung , Lee Hyebin , Choi Doo Ho , Park Won , Cho Won Kyung , Nam Seok Jin , Lee Jeong Eon , Kim Seok Won , Lee Sei Kyung , Cho Eun Yoon , Cho Soo Youn
Published: October 2020

Aim

This study was performed to evaluate patterns of breast cancer subtypes in Korean patients with synchronous (SBC) or metachronous bilateral breast cancer (MBC).

Methods

We retrospectively reviewed records of 302 patients with SBC (n = 161) or MBC (n = 141) who received curative surgery at our hospital between 1995 and 2013. Expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) was determined by immunohistochemistry (IHC) staining. We categorized breast cancers into the following subtypes: ER+ or PR+, HER2− (i.e., luminalA); ER+ or PR+, HER2+ (i.e., luminalB HER2+); ER−, PR− and HER2+ (i.e., HER2‐enriched); ER−, PR− and HER2− (i.e., triple negative, TN).

Results

More patients with MBC were ≤40 years at the time of breast cancer diagnosis than patients with SBC (34.6% vs. 19.3%, P < 0.01). The proportion of subtypes in SBC and MBC were as follows: luminalA, 65.8% vs. 45.0%; luminalB, HER2+, 9.0% vs. 8.5%; HER2‐enriched, 4.1% vs. 12.1%; and TN, 11.2% vs. 31.2%, respectively (P < 0.01). The 10‐year overall survival rate in patients with SBC and MBC was 89.0% and 93.6%, respectively. The 10‐year disease‐free survival rate in patients with SBC and MBC was 79.6% and 80.9%, respectively. Locoregional recurrence was found in 2.5% of patients with SBC and 9.9% of patients with MBC. Distant metastasis occurred in 8.7% of patients with SBC and 4.9% of patients with MBC.

Conclusion

The distribution of breast cancer subtypes was different between SBC and MBC. TN‐subtype was profoundly more frequent in MBC whereas luminal‐subtype was most frequently found among SBC.
Media Coverage of Environmental Pollution and the Investment of Polluting Companies*
Authors: Chang Ying , He Yu , Jin Xingye , Li Tao , Shih Chia Mei
Published: October 2020

Employing a textual analysis of China’s provincial newspapers, this study examines the effect of local media coverage of environmental pollution on corporate investment. Using a sample of publicly listed firms in polluting industries, we document a significantly positive effect of media coverage on both the total investment and green investment of these firms. Further analyses reveal that the positive effect of pollution‐related media coverage on investment is more pronounced when firms have weak governance mechanisms. Overall, our findings imply that media not only play an important monitoring role but also enhance corporate social responsibility.
Are we over‐diagnosing vasa praevia? The experience and lessons learned in a tertiary centre
Authors: La Stephanie , Melov Sarah J. , Nayyar Roshini
Published: October 2020

Background

Vasa praevia (VP) is a rare obstetric condition in which unprotected fetal vessels transverse the cervix, are vulnerable to rupture during labour and may result in rapid exsanguination of the fetus. Antenatal diagnosis of VP has resulted in excellent outcomes. However, there are little data available on the false positive rates for the antenatal diagnosis of VP. Improving accuracy of the diagnosis of VP can potentially improve outcomes and reduce unnecessary intervention.

Aims

To assess our accuracy in the diagnosis of VP, examine our false positive diagnoses of VP and suggest strategies during antenatal ultrasound to aid in the antenatal diagnosis of VP.

Material and Methods

We conducted a retrospective descriptive study of women diagnosed with VP antenatally over 11 years at a single tertiary hospital and eligible patients were identified from obstetric databases. All medical records, including ultrasound reports, were reviewed and compared with the placental histological findings and both operative and midwifery documentation of the cord insertion.

Results

Twenty‐three women (25 babies) were diagnosed with VP and underwent a caesarean section delivery at a mean gestational age of 36 weeks. The false positive rate in our series was 17% (4/23).

Conclusions

Our study highlights the importance of postnatal confirmation of the diagnosis of VP and careful documentation of intraoperative findings of the placenta and cord insertion. We suggest strategies to aid in the accurate diagnosis of VP, thereby improving clinical decision‐making and reducing unnecessary intervention.
Sparse vector error correction models with application to cointegration‐based trading
Authors: Lu Renjie , Yu Philip L.H. , Wang Xiaohang
Published: October 2020

Inspired by constructing large‐size cointegrated portfolios, this paper considers a vector error correction model and develops the adaptive Lasso estimator of the cointegrating vectors. The asymptotic properties of the estimators and the oracle property of the adaptive Lasso are derived. An optimisation algorithm for estimating the model parameters is proposed. The simulation study shows the effectiveness of the parameter estimation procedures and the forecasting performance of our model. In the empirical study, we apply the proposed method to construct the sparse cointegrated portfolios with or without market‐neutral property. The trading performances of different types of cointegrated portfolios are evaluated using the Dow Jones Industrial Average composite stocks. The empirical findings reveal that the sparse cointegrated market‐neutral portfolios of a number of securities are capable to benefit the investors who wish to construct statistical arbitrage portfolios which are market‐neutral.
Carotid artery tortuosity may pose a problem during insertion of the tunneled catheter for hemodialysis
Authors: Gołębiowski Tomasz , Poznański Paweł , Kusztal Mariusz , Miś Marcin , Szczurowska Agata , Letachowicz Krzysztof , Konieczny Andrzej , Majchrzak Konrad , Janczak Dariusz , Krajewska Magdalena
Published: October 2020

Tortuosity of the carotid artery is usually an asymptomatic vascular abnormality and is discovered accidentally during cerebral angiography. These vascular changes may aggravate surgical procedures in the neck region. We described a technique of permanent catheter insertion in patients with renal graft failure in whom renal replacement therapy was necessary. Severe tortuosity of cervical arteries may make this procedure more difficult, necessitating a special technique, that is, full image monitoring.
Longitudinal retinal layer changes in preclinical Alzheimer’s disease
Authors: van de Kreeke Jacoba A. , Nguyen Hoang Ton , Konijnenberg Elles , Tomassen Jori , den Braber Anouk , ten Kate Mara , Yaqub Maqsood , van Berckel Bart , Lammertsma Adriaan A. , Boomsma Dorret I. , Tan H. Stevie , Visser Pieter Jelle , Verbraak Frank D.
Published: October 2020

Purpose

Several studies found reduced retinal thickness on optical coherence tomography (OCT) in Alzheimer’s disease (AD), even in preclinical stages, labelling this technique of interest as biomarker. In this study, we examine retinal thickness changes in preclinical AD, as defined by cognitively normal individuals with amyloid‐beta (Aβ) on positron emission tomography (PET).

Methods

For this monocentre study, 145 cognitively healthy monozygotic twins aged ≥ 60 were included from the Netherlands Twin Register taking part in the EMIF‐AD PreclinAD study. At baseline, participants underwent [18F] flutemetamol PET that was visually rated for cortical Aβ. Binding potential was calculated as continuous measure for Aβ. Optical coherence tomography (OCT) was performed at baseline and after 22 months to assess changes in total and individual inner retinal layer thickness in the macular region (ETDRS circles) and peripapillary retinal nerve fibre layer thickness. Differences in rate of change between amyloid‐beta positive and negative individuals and associations between binding potential and change in retinal thickness were evaluated.

Results

Sixteen participants (11%) were positive for Aβ. Change in retinal thickness did not differ in any region between Aβ+ and Aβ− individuals. A positive association between binding potential and change in inner plexiform layer thickness was observed in the inner macular ring (beta = 1.708, CI = 0.575 to 2.841, p = 0.003).

Conclusion

Aβ+ individuals did not differ in rate of change of any retinal layer compared to controls, but higher binding potential at baseline was associated with less IPL thinning over time. Optical coherence tomography (OCT) as a longitudinal screening tool for preclinical AD seems limited, but IPL changes offer leads for further research.
The territorial dimension of the United Nations Sustainable Development Goals
Authors: Medeiros Eduardo
Published: October 2020

This paper intends to fill a gap in available literature by debating the role of human geography in the elaboration of the United Nations Sustainable Development Goals. More particularly, it elaborates on the relevance of spatial planning and territorial cohesion processes to implement sustainable development.
Learning in non‐avian reptiles 40 years on: advances and promising new directions
Authors: Szabo Birgit , Noble Daniel W. A. , Whiting Martin J.
Published: October 2020

Recently, there has been a surge in cognition research using non‐avian reptile systems. As a diverse group of animals, non‐avian reptiles [turtles, the tuatara, crocodylians, and squamates (lizards, snakes and amphisbaenids)] are good model systems for answering questions related to cognitive ecology, from the role of the environment on the brain, behaviour and learning, to how social and life‐history factors correlate with learning ability. Furthermore, given their variable social structure and degree of sociality, studies on reptiles have shown that group living is not a pre‐condition for social learning. Past research has demonstrated that non‐avian reptiles are capable of more than just instinctive reactions and basic cognition. Despite their ability to provide answers to fundamental questions in cognitive ecology, and a growing literature, there have been no recent systematic syntheses of research in this group. Here, we systematically, and comprehensively review studies on reptile learning. We identify 92 new studies investigating learning in reptiles not included in previous reviews on this topic – affording a unique opportunity to provide a more in‐depth synthesis of existing work, its taxonomic distribution, the types of cognitive domains tested and methodologies that have been used. Our review therefore provides a major update on our current state of knowledge and ties the collective evidence together under nine umbrella research areas: (i) habituation of behaviour, (ii) animal training through conditioning, (iii) avoiding aversive stimuli, (iv) spatial learning and memory, (v) learning during foraging, (vi) quality and quantity discrimination, (vii) responding to change, (viii) solving novel problems, and (ix) social learning. Importantly, we identify knowledge gaps and propose themes which offer important future research opportunities including how cognitive ability might influence fitness and survival, testing cognition in ecologically relevant situations, comparing cognition in invasive and non‐invasive populations of species, and social learning. To move the field forward, it will be immensely important to build upon the descriptive approach of testing whether a species can learn a task with experimental studies elucidating causal reasons for cognitive variation within and among species. With the appropriate methodology, this young but rapidly growing field of research should advance greatly in the coming years providing significant opportunities for addressing general questions in cognitive ecology and beyond.
Molecular design aided by random forests and synthesis of potent trypanocidal agents as cruzain inhibitors for Chagas disease treatment
Authors: de Albuquerque Sérgio , Cianni Lorenzo , de Vita Daniela , Duque Carla , Gomes Ana S. M. , Gomes Paula , Laughton Charles , Leitão Andrei , Montanari Carlos A. , Montanari Raphael , Ribeiro Jean F. R. , da Silva João Santana , Teixeira Cátia
Published: October 2020

Cruzain is an established target for the identification of novel trypanocidal agents, but how good are in vitro/in vivo correlations? This work describes the development of a random forests model for the prediction of the bioavailability of cruzain inhibitors that are Trypanosoma cruzi killers. Some common properties that characterize drug‐likeness are poorly represented in many established cruzain inhibitors. This correlates with the evidence that many high‐affinity cruzain inhibitors are not trypanocidal agents against T. cruzi. On the other hand, T. cruzi killers that present typical drug‐like characteristics are likely to show better trypanocidal action than those without such features. The random forests model was not outperformed by other machine learning methods (such as artificial neural networks and support vector machines), and it was validated with the synthesis of two new trypanocidal agents. Specifically, we report a new lead compound, Neq0565, which was tested on T. cruzi Tulahuen (β‐galactosidase) with a pEC50 of 4.9. It is inactive in the host cell line showing a selectivity index (SI = EC50cyto/EC50T. cruzi) higher than 50.
Improving parents' knowledge of early signs of paediatric eye disease: A double‐blind randomized controlled trial
Authors: Staffieri Sandra E. , Rees Gwyneth , Sanfilippo Paul G. , Cole Stephen , Mackey David A. , Hewitt Alex W.
Published: October 2020

Importance

Educating parents to recognize signs of eye disease and consult a healthcare professional is critical to timely diagnosis, intervention and outcomes.

Background

We evaluate the effectiveness of an eye‐health information pamphlet on parents' level of concern and help‐seeking intention should they hypothetically observe leukocoria or strabismus in their child.

Design

Double‐blind, randomized controlled trial conducted at a metropolitan antenatal outpatient clinic.

Participants

In total, 518 pregnant women were enrolled in the study.

Methods

After completing a study‐specific, pre‐test survey describing hypothetical clinical scenarios at baseline, participants were randomly assigned to receive a pamphlet on either paediatric eye health (intervention) or infant play (control). The post‐test survey was sent by email 2 weeks after baseline.

Main outcome measures

A change in the parents' level of concern if they observed leukocoria or strabismus and a change in their help‐seeking intention if they hypothetically observed leukocoria or strabismus in their child.

Results

Of the 518 women, 382 (73.7%) completed the post‐test survey. At follow‐up, women who received the intervention were more likely to report a higher level of concern if they observed leukocoria (OR 1.711 [CI: 1.176‐2.497] P = .005]) and were less likely to delay help‐seeking (OR 0.560 [CI 0.382‐0.817] P = .003). No change in the level of concern for strabismus was identified between the groups; however, at follow‐up, women who received the intervention were less likely to delay help‐seeking (OR 0.318 [CI 0.125‐0.806] P = .016).

Conclusion and relevance

Providing parents with relevant, evidence‐based information can significantly improve their knowledge and positively influence help‐seeking intentions if leukocoria or strabismus are observed.
Cutis laxa: A comprehensive overview of clinical characteristics and pathophysiology
Authors: Beyens Aude , Boel Annekatrien , Symoens Sofie , Callewaert Bert
Published: October 2020

Cutis laxa (CL) syndromes comprise a rare group of multisystem disorders that share loose redundant skin folds as hallmark clinical feature. CL results from impaired elastic fiber assembly and homeostasis, and the known underlying gene defects affect different extracellular matrix proteins, intracellular trafficking, or cellular metabolism. Due to the underlying clinical and molecular heterogeneity, the diagnostic work‐up of CL patients is often challenging. In this review, we provide a practical approach to the broad differential diagnosis of CL syndromes, provide an overview of the molecular pathogenesis of the different subtypes, and suggest general management guidelines.
Patient‐based outcomes with conventional or mini‐implants immediately loaded with locator‐retained mandibular overdentures: A cohort study
Authors: Mifsud David P. , Cortes Arthur R. G. , Attard Nikolai J.
Published: October 2020

Background

Little is known on the effect of varying implant diameters, especially with mini implants (ie, less than 3 mm in diameter), on oral health‐related quality of life (OHrQoL).

Purpose

To compare OHrQoL and satisfaction in patients with mandibular overdentures immediately retained by either two conventional or two mini‐implants.

Materials and methods

Edentulous patients receiving immediately loaded overdentures retained by Locators on either two conventional diameter (4.1 mm) or two mini (2.9 mm or less) implants were selected based on available buccal‐lingual ridge width in the intraforaminal area. Two questionnaires were used (Oral Health Impact Profile‐14 [OHIP‐14]; and Denture Satisfaction Questionnaire [DSQ]) to determine OHrQoL and overall denture satisfaction. Questionnaires were filled out at six different time points up to a 1‐year follow‐up. Mann‐Whitney U test was used for group comparisons. Friedman and Wilcoxon tests were used to identify changes within group along the time points. Correlation between OHIP‐14 and DSQ was assessed with Spearman test.

Results

A total of 48 patients were analyzed and equally distributed to each group. The conventional group presented a significantly smaller change of OHIP functional score from the baseline to the first week of follow‐up after surgery (P = .017). In addition, total DSQ scores were significantly higher for the conventional group at 12 weeks (P = .022) and there was a significant difference between groups in satisfaction with mandibular prosthesis at 24 weeks (P = .034). Correlation between OHIP‐14 and DSQ was not significant (P > .05). Individual results of each group (ie, within group analysis) over all assessed time points revealed a significant OHrQoL (P = .001 for conventional, P = .006 for mini‐implants) and satisfaction (P < .001 for both groups) improvement in both groups.

Conclusion

Mandibular overdentures retained by two conventional or mini‐implants lead to a significant and comparable improvements in OHrQoL and satisfaction over a 1‐year follow‐up.
Slower recovery of outpatient clinics than inpatient services for stroke and other neurological diseases after COVID‐19 Pandemic
Authors: Zhao Jing , Wang Yong , Fisher Marc , Liu Renyu
Published: October 2020

Background

In this brief report, we investigated the impact of COVID‐19 on outpatient stroke clinics and inpatient services and their recovery process.

Methods

We sent a survey to physicians worldwide through the network of the World Stroke Organization to investigate the impact of COVID‐19 on stroke clinics. To farther along in recovering from the outbreak, we reviewed stroke and other neurology outpatient clinic visits (approximately 50% were stroke related) and the number of inpatient services from December 2019 to July 2020 in a large neurology department in Shanghai, China, where there was no official city lockdown.

Results

We received 112 valid survey responses from 46 countries, representing all continents except for Antarctica. Only seven of the survey responders (7/112, 6.3%) reported that they have kept their outpatient clinics open as usual, but they did exercise increased precautions for COVID‐19 by following recent guidelines regarding use of personal protective equipment and isolation techniques. The remainder of the respondents have either reduced outpatient clinic services or suspended outpatient clinics completely. Telephone consultation or telemedicine with video capability was used for new patients or follow‐ups, with limited in‐person evaluations when necessary. Outpatient clinic visits and inpatient services from a large tertiary hospital in China decreased dramatically during the peak period of the outbreak, but then rebounded back quickly following the partial or full recovery from the outbreak. Compared with the recovery process of inpatient services, outpatient clinic visits decreased faster and recovered much slower. This is consistent with our global survey data which indicates that some outpatient clinics have rescheduled their outpatient visits for 3 to 6 months.

Conclusions

The COVID‐19 pandemic caused a significant drop of in‐person outpatient visits and inpatient services. Clinic visits recovered slower than inpatient services in stroke and other neurological diseases after the pandemic.
Clinical and endoscopist factors associated with post‐colonoscopy colorectal cancer in a population‐based sample
Authors: Dossa Fahima , Sutradhar Rinku , Saskin Refik , Hsieh Eugene , Henry Pauline , Richardson Devon P. , Leake Pierre‐Anthony , Forbes Shawn S. , Paszat Lawrence F. , Rabeneck Linda , Baxter Nancy N.
Published: October 2020

Aim

Factors associated with verified post‐colonoscopy colorectal cancers (PCCRC) have not been well defined and survival for these patients is not well described. We aimed to assess the association of patient, tumour and endoscopist characteristics with PCCRC.

Methods

Using population‐based data, we identified individuals diagnosed with CRC from 1 January 2000 to 31 December 2005 who underwent a colonoscopy within 3 years prior to diagnosis. Detected cancers were those diagnosed ≤6 months following colonoscopy; PCCRC were diagnosed >6 months to ≤3 years following colonoscopy. Post‐colonoscopy and detected cancers were verified through chart review using a hospital‐based simple random sampling frame. We used multivariable conditional logistic regression to determine the association of patient, tumour and endoscopist factors with PCCRC and compared overall survival using Cox proportional hazard models.

Results

Using the random sampling frame, we identified 498 patients with PCCRC and 498 with detected CRC; we obtained records and confirmed 367 patients with PCCRC and 412 with detected cancers. In multivariable analysis, patient age (OR 1.01; 95% CI 1.00–1.03) and tumour location (distal vs. proximal OR 0.36; 95% CI 0.25–0.53) were associated with PCCRC; endoscopist quality measures were not significantly associated with PCCRC. We did not find significant differences in overall survival between PCCRC and detected cancers (hazard ratio 1.12; 95% CI 0.92–1.32).

Conclusion

Although endoscopic quality measures are important for CRC prevention, endoscopist factors were not associated with PCCRC. This study highlights the need for further research into the role of tumour biology in PCCRC development.
Does pediatric heart transplant survival differ with various cardiac preservation solutions?
Authors: Shaw Taylor B. , Lirette Seth , Carter Kristen T. , Kutcher Matthew E. , Baran David A. , Copeland Jack G. , Copeland Hannah
Published: October 2020

Background

Few studies directly compare outcomes between the most commonly used preservation solutions in pediatric heart transplantation in a large cohort of recipients. The purpose of this study is to investigate the effect of cardiac preservation solution on survival in pediatric heart transplant recipients.

Methods

The United Network for Organ Sharing (UNOS) database was retrospectively reviewed from 01/2004‐03/2018 for pediatric donor hearts. Saline, University of Wisconsin (UW), “cardioplegia,” Celsior, and Custodiol preservation solutions were evaluated. The primary endpoints were recipient survival at 30 days, 1 year, and long term.

Results

After exclusion criteria, 3012 recipients had preservation solution data available. The most common preservation solution used was UW in 1203 patients (40%), followed by Celsior in 542 (18%), cardioplegia in 461 (15%), saline in 408 (14%), and Custodiol in 398 (13%). Survival of recipients whose donor hearts were procured with UW was as follows: 97%—30 day, 92%—1 year; Celsior: 97%—30 day, 92%—1 year; cardioplegia: 97%—30 day, 91%—1 year; saline: 97%—30 day, 91%—1 year; and Custodiol: 96%—30 day and 92%—1 year. Analysis of Cox models for 30‐day and long‐term survival revealed no statistical differences when comparing UW to Celsior (p = .333), cardioplegia (p = .914), saline (p = .980), or Custodiol (p = .642) in adjusted models.

Conclusions

There were no significant differences in 30‐day or 1‐year survival detected between commonly used preservation solutions in the pediatric heart transplant population.
Sustained type 1 diabetes self‐management: Specifying the behaviours involved and their influences
Authors: Hamilton K. , Stanton‐Fay S. H. , Chadwick P. M. , Lorencatto F. , de Zoysa N. , Gianfrancesco C. , Taylor C. , Coates E. , Breckenridge J. P. , Cooke D. , Heller S. R. , Michie S. ,   the DAFNEplus study group
Published: October 2020

Aims

Sustained engagement in type 1 diabetes self‐management behaviours is a critical element in achieving improvements in glycated haemoglobin (HbA1c) and minimising risk of complications. Evaluations of self‐management programmes, such as Dose Adjustment for Normal Eating (DAFNE), typically find that initial improvements are rarely sustained beyond 12 months. This study identified behaviours involved in sustained type 1 diabetes self‐management, their influences and relationships to each other.

Methods

A mixed‐methods study was conducted following the first two steps of the Behaviour Change Wheel framework. First, an expert stakeholder consultation identified behaviours involved in self‐management of type 1 diabetes. Second, three evidence sources (systematic review, healthcare provider‐generated ‘red flags’ and participant‐generated ‘frequently asked questions’) were analysed to identify and synthesise modifiable barriers and enablers to sustained self‐management. These were characterised according to the Capability‐Opportunity‐Motivation‐Behaviour (COM‐B) model.

Results

150 distinct behaviours were identified and organised into three self‐regulatory behavioural cycles, reflecting different temporal and situational aspects of diabetes self‐management: Routine (e.g. checking blood glucose), Reactive (e.g. treating hypoglycaemia) and Reflective (e.g. reviewing blood glucose data to identify patterns). Thirty‐four barriers and five enablers were identified: 10 relating to Capability, 20 to Opportunity and nine to Motivation.

Conclusions

Multiple behaviours within three self‐management cycles are involved in sustained type 1 diabetes self‐management. There are a wide range of barriers and enablers that should be addressed to support self‐management behaviours and improve clinical outcomes. The present study provides an evidence base for refining and developing type 1 diabetes self‐management programmes.
China–Japan development finance competition and the revival of mercantilism
Authors: Chen Muyang
Published: October 2020

Motivation

Advanced industrial economies that used to advocate and implement charitable foreign assistance have started to (re)adopt mercantilist development finance by using official development finance credits to support private firms. This seems to be in response to the mercantilist practice of emerging Southern development partners.

Purpose

This article compares mercantilist practice by Northern and Southern development partners by examining how and why the public financial agencies of China and Japan offer state‐backed credits to businesses in different ways.

Approach and methods

The practices of China's two national policy banks—China Development Bank (CDB) and Export‐Import Bank of China (Chexim), were compared to those of Japan's two public financial agencies—Japan International Cooperation Agency (JICA) and Japan Bank for International Cooperation (JBIC).

Quantitative data was obtained from published primary sources, including official histories, annual reports and financial statements of the agencies as well as public financial almanacs and policy documents. In the absence of official data, open‐source secondary data collected by research institutes and agencies was used.

Between 2016 and 2019, the author conducted 59 interviews in China and 15 in Japan with officials of the financial agencies, their clients, other stakeholders and researchers.

Findings

Chinese firms rely largely on public financial agencies to win international contracts. Japanese firms borrow from public financial agencies primarily for overseas investment projects, which may also attract private finance.

Policy implications

China's rise has triggered Japan as well as other older industrial economies to respond by (re)adopting mercantilist development finance policies to encourage commercial investors to engage in development co‐operation. However, the looser relations between state and firms in older industrial economies such as Japan makes it harder to encourage private firms to follow state strategies and invest in underdeveloped regions.
Phenology of feeding preference in post‐diapause Baltimore checkerspot (Euphydryas phaeton) caterpillars
Authors: Arriens June V. , Brown Leone M. , Crone Elizabeth E.
Published: October 2020

1. Host plant use has important life history impacts for caterpillars, and this can change throughout development. Although food quality is important for all caterpillar instars, previous work has found a decreased diet preference in late instars, possibly owing to greater intake requirements.

2. Baltimore checkerspot butterflies are highly specialised in their diet as pre‐diapause caterpillars but are less specialised post‐diapause. This study investigated phenological changes in Baltimore checkerspot caterpillar preference and performance on different post‐diapause host plants in the field and lab.

3. Caterpillar preference and performance in the lab on four post‐diapause host plants followed the same rank order. The highest ranked plant was their main host plant, followed by an alternative host used for oviposition in some populations, then a commonly observed post‐diapause‐only host, and finally a previously unrecorded post‐diapause host plant.

4. In contrast to lab results, field observations showed a decrease throughout the season in the use of the main host plant, turtlehead.

5. This study's findings suggest that necessity and food availability drive the post‐diapause Baltimore checkerspot caterpillar diet in the field more than preference. These results also highlight that, even in relatively well‐studied species, field and laboratory observations can yield conflicting results. In this case, the contrast is most likely due to the different constraints in lab versus field conditions, such as the costs of finding preferred plants in the field.
EAN consensus statement for management of patients with neurological diseases during the COVID‐19 pandemic
Authors: von Oertzen T. J. , Macerollo A. , Leone M. A. , Beghi E. , Crean M. , Oztuk S. , Bassetti C. , Twardzik A. , Bereczki D. , Di Liberto G. , Helbok R. , Oreja‐ Guevara C. , Pisani A. , Sauerbier A. , Sellner J. , Soffietti R. , Zedde M. , Bianchi E. , Bodini B. , Cavallieri F. , Campiglio L. , Maia L. F. , Priori A. , Rakusa M. , Taba P. , Moro E. , Jenkins T. M. ,   for the EANcore COVID‐19 task force
Published: October 2020

Background and purpose

The recent SARS‐CoV‐2 pandemic has posed multiple challenges to the practice of clinical neurology including recognition of emerging neurological complications and management of coexistent neurological diseases. In a fast‐evolving pandemic, evidence‐based studies are lacking in many areas. This paper presents European Academy of Neurology (EAN) expert consensus statements to guide neurologists caring for patients with COVID‐19.

Methods

A refined Delphi methodology was applied. In round 1, statements were provided by EAN scientific panels (SPs). In round 2, these statements were circulated to SP members not involved in writing them, asking for agreement/disagreement. Items with agreement >70% were retained for round 3, in which SP co‐chairs rated importance on a five‐point Likert scale. Results were graded by importance and reported as consensus statements.

Results

In round one, 70 statements were provided by 23 SPs. In round two, 259/1061 SP member responses were received. Fifty‐nine statements obtained >70% agreement and were retained. In round three, responses were received from 55 co‐chairs of 29 SPs. Whilst general recommendations related to prevention of COVID‐19 transmission had high levels of agreement and importance, opinion was more varied concerning statements related to therapy.

Conclusion

This is the first structured consensus statement on good clinical practice in patients with neurological disease during the COVID‐19 pandemic that provides immediate guidance for neurologists. In this fast‐evolving pandemic, a rapid response using refined Delphi methodology is possible, but guidance may be subject to change as further evidence emerges.
Tachykinin antagonists ameliorate surgically induced impairment of gastrointestinal motility in rats
Authors: Umer Artur , Ługowska‐Umer Hanna , Schönborn‐Kellenberger Oliver , Korolkiewicz Paweł K. , Sein‐Anand Łukasz , Kocic Ivan , Korolkiewicz Roman P.
Published: October 2020

The protective effects of tachykinin receptor antagonists: SR140333 (NK1 receptor), SR48968 (NK2 receptor), and SB222200 (NK3 receptor) were tested in rats against a surgically induced postoperative inhibition of gut motility, a common complication of abdominal surgery. The small intestinal transit of Evans blue was measured 24‐h post‐surgery in untreated rats and animals subjected to skin incision, laparotomy, or laparotomy followed by gut evisceration and manipulation. Surgical procedures were conducted under diethyl ether anesthesia. In comparison to untreated and ether‐anesthetized rats, animals undergoing skin incision, laparotomy, or laparotomy with gut evisceration and manipulation showed a significant decrease in the intestinal transit of Evans blue. The pretreatment with NK1 (3–100 µg/kg), NK2 (3–30 µg/kg), and NK3 (10–300 µg/kg) blockers before surgery ameliorated the inhibitory effects of gut manipulation in a dose‐dependent manner. Moreover, the submaximal and maximal doses of NK3 antagonists showed a trend toward reversing not only the inhibition caused by gut manipulation but also laparotomy. An additive effect of combining submaximal doses of NK1‐3 blockers was observed in animals pretreated with NK1 + NK2 compared to single‐agent NK1 and NK2. Additionally, doublets: NK1 + NK3 or NK2 + NK3 and a triplet: NK1 + NK2 + NK3 proved to be more effective than NK2 antagonist alone. In contrast, NK1‐3 blockers have not markedly affected the intestinal propulsion in untreated rats or animals subjected to skin incision or laparotomy. NK1‐3 blockers ameliorated the suppressed small‐bowel gut motility 24 post‐surgery. Combined pretreatment with NK1‐3 antagonists provided selective, additive benefits compared to single agents.
Single‐molecule analysis of dynamics and interactions of the SecYEG translocon
Authors: Koch Sabrina , Seinen Anne‐Bart , Kamel Michael , Kuckla Daniel , Monzel Cornelia , Kedrov Alexej , Driessen Arnold J.M.
Published: October 2020

Protein translocation and insertion into the bacterial cytoplasmic membrane are the essential processes mediated by the Sec machinery. The core machinery is composed of the membrane‐embedded translocon SecYEG that interacts with the secretion‐dedicated ATPase SecA and translating ribosomes. Despite the simplicity and the available structural insights on the system, diverse molecular mechanisms and functional dynamics have been proposed. Here, we employ total internal reflection fluorescence microscopy to study the oligomeric state and diffusion of SecYEG translocons in supported lipid bilayers at the single‐molecule level. Silane‐based coating ensured the mobility of lipids and reconstituted translocons within the bilayer. Brightness analysis suggested that approx. 70% of the translocons were monomeric. The translocons remained in a monomeric form upon ribosome binding, but partial oligomerization occurred in the presence of nucleotide‐free SecA. Individual trajectories of SecYEG in the lipid bilayer revealed dynamic heterogeneity of diffusion, as translocons commonly switched between slow and fast mobility modes with corresponding diffusion coefficients of 0.03 and 0.7 µm2·s−1. Interactions with SecA ATPase had a minor effect on the lateral mobility, while bound ribosome:nascent chain complexes substantially hindered the diffusion of single translocons. Notably, the mobility of the translocon:ribosome complexes was not affected by the solvent viscosity or macromolecular crowding modulated by Ficoll PM 70, so it was largely determined by interactions within the lipid bilayer and at the interface. We suggest that the complex mobility of SecYEG arises from the conformational dynamics of the translocon and protein:lipid interactions.
The molecular species responsible for α1‐antitrypsin deficiency are suppressed by a small molecule chaperone
Authors: Ronzoni Riccardo , Heyer‐Chauhan Nina , Fra Annamaria , Pearce Andrew C. , Rüdiger Martin , Miranda Elena , Irving James A. , Lomas David A.
Published: October 2020

The formation of ordered Z (Glu342Lys) α1‐antitrypsin polymers in hepatocytes is central to liver disease in α1‐antitrypsin deficiency. In vitro experiments have identified an intermediate conformational state (M*) that precedes polymer formation, but this has yet to be identified in vivo. Moreover, the mechanism of polymer formation and their fate in cells have been incompletely characterised. We have used cell models of disease in conjunction with conformation‐selective monoclonal antibodies and a small molecule inhibitor of polymerisation to define the dynamics of polymer formation, accumulation and secretion. Pulse‐chase experiments demonstrate that Z α1‐antitrypsin accumulates as short‐chain polymers that partition with soluble cellular components and are partially secreted by cells. These precede the formation of larger, insoluble polymers with a longer half‐life (10.9 ± 1.7 h and 20.9 ± 7.4 h for soluble and insoluble polymers, respectively). The M* intermediate (or a by‐product thereof) was identified in the cells by a conformation‐specific monoclonal antibody. This was completely abrogated by treatment with the small molecule, which also blocked the formation of intracellular polymers. These data allow us to conclude that the M* conformation is central to polymerisation of Z α1‐antitrypsin in vivo; preventing its accumulation represents a tractable approach for pharmacological treatment of this condition; polymers are partially secreted; and polymers exist as two distinct populations in cells whose different dynamics have likely consequences for the aetiology of the disease.
Spatial structure in protected forest‐grassland mosaics: Exploring futures under climate change
Authors: Fair Kathyrn R. , Anand Madhur , Bauch Chris T.
Published: October 2020

In mosaic ecosystems, multiple land types coexist as alternative stable states exhibiting distinct spatial patterns. Forest‐grassland mosaics are ecologically valuable, due to their high species richness. However, anthropogenic disturbances threaten these ecosystems. Designating protected areas is one approach to preserving natural mosaics. Such work must account for climate change, yet there are few spatially explicit models of mosaics under climate change that can predict its effects. We construct a spatially explicit simulation model for a natural forest‐grassland mosaic, parameterized for Southern Brazil. Using this model, we investigate how the spatial structure of these systems is altered under climate change and other disturbance regimes. By including local spatial interactions and fire‐mediated forest recruitment, our model reproduces important spatial features of protected real‐world mosaics, including the number of forest patches and overall forest cover. Multiple concurrent changes in environmental conditions have greater impacts on tree cover and spatial structure in simulated mosaics than single changes. This sensitivity reflects the narrow range of conditions under which simulated mosaics persist and emphasizes their vulnerability. Our model predicts that, in protected mosaics, climate change impacts on the fire‐mediated threshold to recruitment will likely result in substantial increases in forest cover under Representative Concentration Pathway (RCP) 8.5, with potential for mosaic loss over a broad range of initial forest cover levels. Forest cover trajectories are similar until 2150, when cover increases under RCP 8.5 outpace those under RCP 2.6. Mosaics that persist under RCP 8.5 may experience structural alterations at the patch and landscape level. Our simple model predicts several realistic aspects of spatial structure as well as plausible responses to likely regional climate shifts. Hence, further model development could provide a useful tool when building strategies for protecting these ecosystems, by informing site selection for conservation areas that will be favourable to forest‐grassland mosaics under future climates.
Development of a European consensus from dentists, dental hygienists and physicians on a standard for oral health care in care‐dependent older people: An e‐Delphi study
Authors: Charadram Nattida , Maniewicz Sabrina , Maggi Stefania , Petrovic Mirko , Kossioni Anastassia , Srinivasan Murali , Schimmel Martin , Mojon Philippe , Müller Frauke ,   e‐Delphi working group
Published: October 2020

Objectives

This study aimed to obtain a consensus on oral health policy, access to dental care, oral hygiene measures and training levels.

Background

Poor oral health is widespread in care‐dependent older people, but no consensus for a minimum standard of oral health care exists yet.

Methods

The e‐Delphi approach was applied to a selected panel of interdisciplinary experts. Data analysis was based on three measurements: (a) ≥70% of experts’ opinion fall into category “agree or strongly agree,” (b) median score on the 5‐point Likert scale ≥4, (c) interquartile range ≤1.

Results

A total of 31 experts from 17 European countries participated in this survey. Agreement was achieved for a compulsory dental examination when an elder is admitted to a long‐term care (LTC) facility. Older people should brush their teeth twice/day and regularly clean interproximal spaces and oral mucosa. Dentures should be rinsed after meals and cleaned twice/day. The use of denture cleansing tablets was considered necessary. Dentures should be removed before sleeping and stored dry. A 5000 ppm fluoride toothpaste should be applied daily in elder with high caries risk. A short report on the oral health status of the elder should be included in the geriatric assessment. All experts concluded that the knowledge and the training in oral health care for caregivers and family members of care‐dependent older people were imperative.

Conclusions

Using the e‐Delphi method, multidisciplinary healthcare professionals from different countries agreed on certain cardinal recommendations for a standard oral health care for care‐dependent older people.
Venous thromboembolism after delayed surgery for a hip fracture: A retrospective cohort study
Authors: Yoon Jae Youn , Kim Shinseok , Chang Jae Suk , Yoon Pil Whan , Kim Ji Wan
Published: October 2020

Aim

The purpose of this study was to investigate the demographic characteristics and prevalence of postoperative venous thromboembolism (VTE) in delayed hip fracture patients referred to our hospital (a tertiary referral center), and further verify the effect of intensive prophylaxis protocol in preventing the occurrence of VTE.

Methods

We retrospectively evaluated 264 hip fracture patients whose surgery was delayed by >24 h. The patients were divided into two groups, according to the VTE prophylaxis protocol (conventional vs intensive). We evaluated the time from injury to surgery, and analyzed the prevalence of postoperative symptomatic VTE between the groups. The patient outcome measures, including in‐hospital mortality and 30‐day‐mortality after hip surgery, were also evaluated.

Results

The mean time from injury to operation was 127.4 h (95% confidence interval 92.2–162.7 h). The incidence of postoperative symptomatic VTE was 5.9% in the conventional prophylaxis group and 0.8% in the intensive prophylaxis group. The intensive prophylaxis group had a significantly lower incidence of postoperative VTE (P = 0.036). Eight patients with deep vein thrombosis on preoperative screening who underwent inferior vena cava filter insertion did not develop postoperative symptomatic VTE. Logistic regression analysis results also showed that the protocol statistically reduced the development of VTE (odds ratio 0.14, 95% CI 0.02–1.21, P = 0.042).

Conclusions

Delayed hip fracture surgery resulted in a higher incidence of VTE in patients who received conventional prophylaxis; however, our intensive prophylaxis protocol successfully prevented postoperative symptomatic VTE, including pulmonary embolism. Geriatr Gerontol Int 2020; 20: 1151–1156.
Achieving high convective volume in hemodiafiltration: Lessons learned after successful implementation in the HDFit trial
Authors: Guedes Murilo , Dambiski Ana Claudia , Canhada Sinaia , Barra Ana Beatriz L. , Poli‐de‐Figueiredo Carlos Eduardo , Cuvello Neto Américo Lourenço , Canziani Maria Eugênia F. , Strogoff‐de‐Matos Jorge Paulo , Raimann Jochen G. , Larkin John , Canaud Bernard , Pecoits‐Filho Roberto ,   For the HDFIT Study Investigators
Published: October 2020

Background and objectives

High‐volume online hemodiafiltration (OL‐HDF) associates with improved outcomes compared to hemodialysis (HD), provided adequate dosing is achieved as estimated from convective volume (CV). Achievement of high CV and its impact on biochemical indicators following a standardized protocol converting HD patients to OL‐HDF has not been systematically reported. We assessed the success of implementation of OL‐HDF in clinics naïve to the modality.

Design, setting, participants, and measurements

We analyzed the results of the implementation of postdilution OL‐HDF in patients randomized to the HDF arm of a clinical trial (impact of hemoDiaFIlTration on physical activity and self‐reported outcomes: a randomized controlled trial (HDFit) trial [ClinicalTrials.gov:NCT02787161]). The day before randomization of the first patient to OL‐HDF at each clinic staff started a 3‐day in‐person training module on operation of Fresenius 5008 CorDiax machine in HDF mode. Patients were converted from high‐flux HD to OL‐HDF under oversight of trainers. OL‐HDF was performed over a 6‐months follow‐up with a CV target of 22 L/treatment. We characterized median achieved CV >22 L/treatment record and analyzed the impact of HDF on biochemical variables.

Results

Ninety‐seven patients (mean age 53 ± 16 years, 29% with diabetes, and 11% had a catheter) from 13 clinics randomized to the OL‐HDF arm of the trial were converted from HD to HDF. Median CV > 22 L/treatment was achieved in 99% (94/95) of OL‐HDF patients throughout follow‐up. Monthly mean CV ranged from 27.1 L to 27.5 L. OL‐HDF provided an increased single pool Kt/V at 3‐months (0.2 [95% CI: 0.1–0.3]) and 6‐months (0.2 [95% CI: 0.1–0.4]) compared to baseline, and reduced phosphate at 3‐months (−0.4 mg/dL [95% CI: −0.8 to −0.12]) of follow‐up.

Conclusions

High‐volume online hemodiafiltration was successfully implemented with 99% of patients achieving protocol defined CV target. Monthly mean CV was consistently >22 L/treatment during follow‐up. Kt/V increased, and phosphate decreased with OL‐HDF. Findings resulting from a short training period in several dialysis facilities appear to suggest HDF is an easily implementable technique.