bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of good governance, sustainable development and aid on quality of life: Evidence from sub‐saharan Africa
Authors: Sarpong Steve Yaw , Bein Murad A.
Published: January 2021

The paper empirically investigates the effects of governance (GGov), official development assistance (ODA), sustainability [adjusted net savings (ANS)], and macroeconomic variables on the quality of life [human development index (HDI)] for selected sub‐Saharan African (SSA) countries using the most recent data from 2000 to 2017. The study employed different panel techniques. The findings provide insightful and interesting empirical results that resonate with the magnitude of a significant of the role of GGov on ANS and HDI. Our study shows that GGov is important to improve HDI. Additionally, ANS has important implications on the well‐being of human existence in SSA. In addition to these, this study found that macroeconomic variables such as trade openness and economic growth, wealth, and opportunity creation factors like urbanization and electrification rate are essential. Furthermore, empirical results revealed that ODA has a negative and significant association with HDI, which is in line with some of the existing literature. Our findings have several implications for organizations such as the World Bank, International Monetary Fund, and African Development Bank. This study serves as a policy instrument and guides in coordinating SSA on promoting HDI.
Strategic or Silencing? Line Managers’ Repurposing of Employee Voice Mechanisms for High Performance
Authors: Mowbray Paula K. , Wilkinson Adrian , Tse Herman H. M.
Published: January 2021

In this paper, we explore how the pressure to deliver high performance influences line managers in their shaping and repurposing of employee voice mechanisms to encourage improvement‐oriented voice in organizations. Using qualitative data (50 semi‐structured interviews) from two case studies, including a manufacturing organization and a university, we find line managers were proactive in the (re)shaping and repurposing of employee voice mechanisms in response to the high‐performance strategy. Where there was less HR support given to line managers, we found line managers were more inclined to create their own voice mechanisms. However, we observed that a focus on improvement‐oriented voice associated with employer interests diverted employee‐interest voice away from collective and formal channels, into more informal channels. We indicate the dangers of prioritizing an employer‐interest, improvement‐oriented voice approach.
The life cycle and field epidemiology of Uromycladium acaciae (Pucciniales) on Acacia mearnsii in South Africa
Authors: Fraser Stuart , McTaggart Alistair R. , Roux Jolanda , Nel Johan , Potgieter James , Shuey Louise S. , Somchit Chanatda , Wingfield Mike J.
Published: January 2021

Uromycladium acaciae has damaged plantations of Acacia mearnsii in southern Africa since 2013. Uredinia of a species of Uromycladium have been known on A. mearnsii in South Africa since the 1980s. However, the recent damage is associated with telia and spermogonia. Uredinia and telia were previously treated as conspecific with a phylogenetic species concept. However, uredinia did not form after previous artificial inoculation experiments with teliospores. Controlled studies identified the optimum conditions for basidiospore infection, but the optimum conditions for sporulation and dispersal have not been identified. To investigate the life cycle and field epidemiology of Uromycladium on A. mearnsii, spores were trapped weekly and development of disease symptoms and plant phenology were monitored monthly at three plantations. Telia and spermogonia developed independently from uredinia, and nucleotide polymorphisms between rDNA of uredinia and telia were fixed based on high throughput sequencing and PCRs. All three weather variables measured had a significant effect on teliospore abundance at two of the three sites. Teliospore abundance was greatest during trapping periods when mean relative humidity was high, mean rainfall was 4–5 mm day−1 and mean temperature was 15–16°C. Teliospore counts peaked at the end of summer, potentially the result of epidemic build‐up. Results support the hypothesis that despite sharing a most recent common ancestor, uredinia on A. mearnsii in southern Africa are independent to the life cycle of the telial rust, which likely constitutes a new introduction. Furthermore, teliospores of U. acaciae disperse under wet conditions, and the wet season between October and March is the optimal period for wattle rust development.
Morphometric analysis of the intercarpal ligaments of the equine proximal carpal bones during simulated flexion and extension of cadaver limbs
Authors: Olusa Timothy A. O. , Akbar Zeeshan , Murray Christina M. , Davies Helen M. S.
Published: January 2021

Despite many reported cases of carpal lameness associated with intercarpal ligament injuries in horses, the morphometry, movement pattern and general intrinsic biomechanics of the carpus are largely unknown. Using osteoligamentous preparation of the carpus prepared from 14 equine cadaver forelimbs (aged 9.62 ± 4.25 years), locomotory simulations of flexion and extension movements of the carpal joint were carried out to observed carpal biomechanics and, thereafter, the limbs were further dissected to obtain morphometric measurements of the medial and lateral collateral ligaments (MLC and LCL); medial and lateral palmar intercarpal ligaments (MPICL and LPICL); intercarpal ligaments between radial (Cr) and intermediate (Ci) carpal bones (Cr‐Ci ICL); and intercarpal ligaments between Ci and ulnar (Cu) carpal bones (Ci‐Cu ICL). The Cr, Ci, Cu and Ca are held together by a series of intercarpal ligaments and move in unison lateropalmarly during flexion, and mediodorsally during extension with a distinguishable proximo‐distal sliding movement (gliding) of Cr and Ci against each other during movement. The mean length of MCL (108.82 ± 9.64 mm) was significantly longer (p = 0.042) than LCL (104.43 ± 7.65 mm). The Cr‐Ci ICL has a dorsopalmar depth of 37.58 ± 4.14 mm and a midpoint width of 12.05 ± 3.09 mm and its fibres ran diagonally from the medial side of the Ci in a proximo‐palmar disto‐dorsal direction (i.e. palmarodistally) to the lateral side of the Cr. The specialized movement of the Cr‐Ci ICL, which appeared to be further facilitated by a longer MCL suggest a biomechanical function by which carpal damage may be minimized in the equine carpus.
‘No zone’ approach to the management of stable penetrating neck injuries: a systematic review
Authors: Chandrananth Meera L. , Zhang Andrew , Voutier Catherine R. , Skandarajah Anita , Thomson Benjamin N. J. , Shakerian Rezvaneh , Read David J.
Published: January 2021

Background

Aim: to review outcomes of the ‘no zone’ approach to penetrating neck injuries (PNIs) with the advent of high‐fidelity computed tomography‐angiography (CT‐A) in order to determine the most appropriate management for stable PNIs. Design: Systematic review. Population: Retrospective and prospective cohort studies of patients who sustained penetrating neck trauma, as defined by an injury which penetrates the platysma, and whose initial management involved CT‐A evaluation.

Methods

An extensive literature search was performed in July 2019 using the following databases: Pubmed Central, EMBASE, Medline and Cochrane CENTRAL. Only studies published in English from the last 15 years were included.

Results

Nine cohort studies met inclusion criteria. There has been an increase in CT‐A focussed evaluation of PNIs in recent years. CT‐A is a highly sensitive and specific imaging choice and reduces negative neck exploration rates. A new management algorithm for stable patients involving initial radiological assessment using CT‐A, and subsequent selective surgical exploration, is safe and effective.

Conclusion

The results of this review provide level 2A evidence that the ‘no zone’ approach to PNIs, complemented by CT‐A and thorough clinical assessment, is a safe management strategy which reduces negative neck exploration rates.
Addition of liver stiffness enhances the predictive accuracy of the PAGE‐B model for hepatitis B‐related hepatocellular carcinoma
Authors: Chon Hye Yeon , Lee Han Ah , Suh Sang Jun , Lee Jung Il , Kim Byung Seok , Kim In Hee , Lee Chang Hyeong , Jang Byoung Kuk , Lee Hyun Woong , Hwang Jae Seok , Lee Chang Hun , Lee Jin‐Woo , Yu Jung Hwan , Seo Yeon Seok , Yim Hyung Joon , Kim Seung Up ,   The Korean Transient Elastography Study Group
Published: January 2021

Background

The modified PAGE‐B (mPAGE‐B) and PAGE‐B models reliably predict the risk of developing chronic hepatitis B (CHB)‐related hepatocellular carcinoma (HCC).

Aim(s)

To investigate whether the addition of liver stiffness (LS) value, assessed using transient elastography, enhanced the predictive accuracies of these models

Methods

Patients with CHB who started anti‐viral therapy (AVT) between 2007 and 2017 were enrolled. The training (Yonsei University Hospital) and validation (seven Korean referral institutes) cohorts contained 1211 and 973 patients, respectively.

Results

Based on multivariate analysis, older age (hazard ratio [HR] = 1.051, 95% confidence interval [CI] = 1.031‐1.071), male sex (HR = 2.265, 95% CI = 1.463‐3.506), lower platelet count (HR = 0.993, 95% CI = 0.989‐0.997) and greater LS values (HR = 1.015, 95% CI = 1.002‐1.028) were independently associated with an increased risk of HCC development (all P < 0.05). Thus, we developed a modified PAGELS‐B model (maximum score 34) that included age, male sex, platelet count and LS value. The integrated area under the curve of the modified PAGELS model was greater than those of the PAGE‐B and mPAGE‐B models (0.760 vs 0.714 and 0.716, respectively) in the derivation dataset. The cumulative HCC incidence was significantly higher in the high‐risk (modified PAGE‐BLS score ≥ 24) group than in the intermediate‐risk (modified PAGELS‐B score 12‐24) or low‐risk (modified PAGELS‐B score < 12) group (all P < 0.001). Similar results were observed in the validation cohort.

Conclusions

The predictive accuracies of the PAGE‐B and mPAGE‐B models were validated in Korean patients with CHB receiving AVT. However, the modified PAGELS‐B model featuring the addition of LS value showed higher predictability than the PAGE‐B and mPAGE‐B models.
Thick skin cutters of Siberian frozen mummies—The coevolutionary adaptation of Eurasian Ice Age spotted hyenas
Authors: Diedrich Cajus G.
Published: January 2021

Siberian extinct top predators—Ice Age spotted hyenas—are discovered in the permafrost of Yakutia in‐between frozen mammoth, rhinoceros, bison or horse carcasses, such as in Mongolia at new open‐air sites. Historic described European holotypes and new crania from Siberia, Mongolia, and Europe allow presenting the monophyly of Crocuta reaching back 2.53 Mio years (Late Pliocene). Spotted hyenas coevolved in dental change and body size to their largest guilt, thick‐skinned elephants and rhinoceroses. The Late Pleistocene (MIS 5d‐3, 113.00–25.000 BP) Crocuta crocuta spelaea (Goldfuss, 1823) is proven to have scavenged Siberian woolly rhinoceros Coeleodonta antiquitatis (Blumenbach, 1799) carcasses. Rhino mummy skins have scavenging signs attributable only to hyenas. Chew cuts of breaking‐cutting scissor dentition are found at mummy skins. The last Eurasian hyenas left always similar chew‐damaged woolly rhinoceroses’ crania with braincase openings and damaged mandibles, whereas their deep bite scratches are often found on the distal joints of long bones. Strongest rhino bone damage is found at natal den sites (cave or open air), to which hyenas imported guilt to their cubs. The recently known Ice Age spotted hyena palaeobiogeography overlaps exactly with those of woolly rhinoceros and mammoths. All reached Bering Straits.
Inhibition of the sodium–glucose co‐transporter SGLT2 by canagliflozin ameliorates diet‐induced obesity by increasing intra‐adipose sympathetic innervation
Authors: Yang Xuping , Liu Qinhui , Li Yanping , Ding Yi , Zhao Yan , Tang Qin , Wu Tong , Chen Lei , Pu Shiyun , Cheng Shihai , Zhang Jinhang , Zhang Zijing , Huang Ya , Li Rui , Zhao Yingnan , Zou Min , Shi Xiongjie , Jiang Wei , Wang Rui , He Jinhan
Published: January 2021

Background and Purpose

Inhibition of the sodium–glucose cotransporter 2 (SGLT2) induces hypoglycaemia by increasing urinary glucose excretion and increasing the use of fat. However, the underlying mechanism is poorly understood. This study was aimed to determine the effects of canagliflozin, a selective SGLT2 inhibitor, on diet‐induced obesity and the underlying mechanism(s).

Experimental Approach

Adult C57BL/6J male mice were fed with a standard chow diet or high‐fat diet supplemented with vehicle or canagliflozin. Whole body energy expenditure was monitored by metabolic cages, noradrenaline levels were measured by HPLC, glucose uptake was measured by PET/CT, and mRNA and protein expression were measured by RT‐PCR and western blotting analysis.

Key Results

Mice treated with canagliflozin were resistant to high‐fat diet‐induced obesity and its metabolic consequences. Canagliflozin treatment decreased fat mass and increased energy expenditure via increasing thermogenesis and lipolysis in adipose tissue. Mechanistically, SGLT2 inhibition by canagliflozin elevated adipose sympathetic innervation and fat mobilization via a β3‐adrenoceptor‐cAMP‐PKA signalling pathway. Finally, we showed that canagliflozin improved insulin resistance and hepatic steatosis in mice fed with a high‐fat diet.

Conclusions and Implications

Chronic inhibition of SGLT2 increased energy consumption by increasing intra‐adipose sympathetic innervation to counteract diet‐induced obesity. The present study reveals a new therapeutic function for SGLT2 inhibitors in regulating energy homeostasis.
The impact of postoperative complications and delay of adjuvant chemotherapy on oncological outcomes in patients with colorectal cancer
Authors: Fransgaard Tina , Caspar Thygesen Lau , Gögenur Ismail
Published: January 2021

Aim

Postoperative complications are believed to result in poorer long‐term oncological outcomes. The contribution of time to chemotherapy has not been analysed in detail. Our aim was to examine the association between postoperative complications and long‐term oncological outcomes and overall survival, and the influence of delay in chemotherapy on these outcomes.

Method

The study was a nationwide register‐based observational study that included patients undergoing surgery for colorectal cancer and receiving adjuvant chemotherapy in Denmark between 2010 and 2015. Information regarding postoperative complications was obtained from the Danish Colorectal Cancer Group national clinical registry. A Cox regression model was used to estimate disease‐free survival, recurrence‐free survival and all‐cause mortality in patients surviving for 180 days or more after surgery.

Results

A total of 4083 patients were included, of whom 690 had postoperative complications. Postoperative complications were associated with increased odds of delay to adjuvant chemotherapy (odds ratio 4.56, 95% CI 3.67–5.66, p < 0.0001). An unadjusted analysis revealed that patients with complications had poorer disease‐free survival and recurrence‐free survival and had increased all‐cause mortality. In multivariate analysis, postoperative complications were not associated with poorer disease‐free survival [hazard ratio (HR) 1.02, 95% CI 0.88–1.18, p = 0.80] recurrence‐free survival (HR 1.05, 95% CI 0.89–1.25, p = 0.56) or all‐cause mortality (HR 1.04, 95% CI 0.86–1.26, p = 0.67).

Conclusion

This study showed no association between the occurrence of postoperative complications and long‐term prognosis when adjusting for time to adjuvant chemotherapy.
Patient engagement in an online coaching intervention for parents of children with suspected developmental delays
Authors: Ogourtsova Tatiana , O’Donnell Maureen E , Filliter Jillian H , Wittmeier Kristy ,   BRIGHT Coaching Group, Majnemer Annette
Published: January 2021

Aim

To evaluate patient engagement processes in the development of a new health coaching intervention for parents of children with suspected developmental delays.

Method

A cross‐sectional mixed‐method study design was used. Researchers (n=18) and patient‐partners (n=9) were surveyed using the Public and Patient Engagement Evaluation Tool (PPEET) in areas of: (1) communication/supports for participation; (2) sharing views/perspectives; (3) impacts/influence of engagement initiative; and (4) final thoughts/satisfaction. Descriptive statistics and an inductive thematic‐based approach were used to analyse the data.

Results

For both study groups, high agreement, with responses largely ranging between ‘agree’ to ‘strongly agree’, was noted on all four sections of the PPEET. Qualitative reports reflected that patient engagement was important, meaningful, and had a significant impact on the quality of the project and on the professional development of researchers in their understanding and use of patient‐oriented methodology. Patient‐partners noted challenges related to having realistic deadlines in providing feedback and a lack of a broader range of representation among members.

Interpretation

The benefits and challenges of applying patient‐oriented strategies to a multicentre trial were highlighted. These will be used to enhance our engagement processes.

What this paper adds

Researchers and patient‐partners reported successful and beneficial patient engagement.

Enablers included members’ commitment, communication, partnership, and supports.

Engagement barriers were mainly reported by patient‐partners rather than researchers.

Barriers included communication issues, group homogeneity, and task management difficulties.

Patient engagement enhanced the relevance and quality of the research project.
Privacy preservation of data using modified rider optimization algorithm: Optimal data sanitization and restoration model
Authors: Shivashankar Mohana , Mary Sahaaya Arul
Published: January 2021

Data preservation is the mechanism of protecting and safeguarding the confidentiality and integrity of data. Data stored in huge databases may contain metadata, elements that may be imprecise and unstable, It may include sensitive data, personal profiles and so on, which is vulnerable to third parties such as hackers or attackers. They may misuse the data and as a consequence of this the confidentiality and privacy of the data gets lost. There is a need to conserve the data and make it available for reuse when needed. Hence, it needs a proficient method to maintain and protect individuals' data privacy regarding confidentiality and reliability. This paper intends to develop an advanced model for privacy preservation of huge data with the accomplishment of two stages, namely data sanitization and data restoration. Data sanitization process preserves the safety of sensitive data stored in huge databases, by means of hiding those sensitive data from unauthorized users. Data restoration is the process of recovering or restoring of data that is sanitized at the sender side. Concerning the secrecy, there is a need for an optimal key to hide the sensitive data at sender as well as receiver side. Subsequent to the data sanitization, it requires the same key to restore the sanitized data. Thus, the optimal key generation plays a vital role to maintain privacy preservation. In order to choose an optimal key, a modified Rider optimization Algorithm (ROA) named as Randomized ROA (RROA) model is implemented in this work. Furthermore, the efficiency of the proposed work is compared over the state‐of‐the‐arts models by concerning the sanitization as well as restoration efficiency.
Examination of the effects of technological device use on preschool children's quality of life: An exploratory and cross‐sectional study
Authors: Topan Aysel , Kuzlu Ayyildiz Tülay
Published: January 2021

Aim

This exploratory and cross‐sectional study aimed to evaluate the effects of technological device use on preschool children's life quality.

Methods

One hundred twenty‐five preschool students were recruited from two kindergartens affiliated to the Directorate of National Education in provincial centre of Zonguldak, Turkey. Personal Information Form and Quality of Life Scale for Young Children (KINDL Quality of Life Scale) were tools for data, collected by the researcher herself from parents through face‐to‐face interview method.

Results

It was found in the study that 54.4% of the parents and 42.4% of their children who were involved in the study were frequently used technological devices. Mean score of the children's KINDL Quality of Life Scale was 79.2 (9.5; range 57–99). When comparing this score and its subscales with children's desire to not sleep due to playing virtual games and so forth, the differences between all the other subscales except self‐esteem were significant (p < 0.05). A significant difference was also found between the children's sleeping hours and subscales such as self‐esteem, physical and emotional health (p < 0.05).

Conclusion

The results show that more than half of the parents and their children frequently use the technological devices. Healthcare providers should inform the parents regarding the possibly negative consequences such as negatively affecting the children's quality of life.
Outcomes of ureterolysis for primary retroperitoneal fibrosis: A single‐center experience
Authors: Bozaci Ali Cansu , Altan Mesut , Haberal Hakan Bahadir , Söğütdelen Emrullah , Aki Fazil Tuncay , Erkan İlhan
Published: January 2021

Objective

To report our experience with ureterolysis for the management of retroperitoneal fibrosis.

Methods

The data of 25 patients who underwent ureterolysis due to primary retroperitoneal fibrosis between 2002 and 2017 were reviewed retrospectively. Initial symptoms, laterality, renal function status (initial/final), operation complications and serum creatinine levels (diagnosis/preoperative/6 months, 12 months postoperatively) were recorded. After surgery, patients were followed up by ultrasonography and serum creatinine levels. Patients with impaired results underwent furosemide renogram and/or late phase of computed tomography. Factors affecting final serum creatinine levels were evaluated. The χ2‐test was used for nominal data among groups. The level of statistical significance was set as P < 0.05.

Results

A total of 19 patients (76%) were operated bilaterally. The mean follow‐up period was 46.2 ± 9.2 months. Among 44 operated renal units, non‐functioning kidney developed in seven (15.9%). A total of 34 renal units (77.3%) did not require any additional surgical intervention, and two underwent balloon dilatation (4.5%), one (2.25%) followed with double J stent changes. Two patients developed end‐stage renal disease secondary to bilateral unresolved obstruction. High final serum creatinine levels developed in eight (32%) patients without dialysis. Eight patients (32%) were treated with immunosuppressive therapy for systemic recurrence. There was a significant relationship between preoperative serum creatinine levels with final serum creatinine levels (P = 0.005). There was no statistically significant relationship between diagnosis serum creatinine levels with final serum creatinine levels and postoperative dialysis requirement (P = 0.79 and P = 0.817, respectively).

Conclusions

Ureterolysis provides acceptable success with low complication rates in patients with retroperitoneal fibrosis. Preoperative high‐serum creatinine levels can be considered as a risk factor for long‐term renal impairment and these patients should be followed closely.
Selection on vocal output affects laryngeal morphology in rats
Authors: Lesch Raffaela , Schwaha Thomas , Orozco Andrea , Shilling Margaret , Brunelli Susan , Hofer Myron , Bowling Daniel L. , Zimmerberg Betty , Fitch William Tecumseh
Published: January 2021

Although laryngeal morphology often reflects adaptations for vocalization, the structural consequences of selection for particular aspects of vocal behavior remain poorly understood. In this study, we investigated the effects of increased ultrasonic calling in pups on the adult larynx morphology in selectively bred rat lines. Laryngeal morphology was assessed using multiple techniques: mineralized cartilage volumes were compared in 3D‐models derived from microCT scans, internal structure was compared using clearing and staining procedures combined with microscopy, cellular structure was compared using histology and microscopy, and element composition was assessed with scanning energy dispersive X‐ray spectroscopy. Our results show that adult rats from lines bred to produce ultrasonic calls at higher rates as pups have shorter vocal folds and a more mineralized thyroid cartilage compared to rats bred to produce ultrasonic calls at lower rates. The change in vocal fold length appears to account for differences in low‐frequency calls in these two rat lines. We suggest that the observed increases in mineralization of the thyroid cartilage in the high‐ultrasound lineage provide increased reinforcement of the laryngeal structure during ultrasonic call production. Our findings therefore demonstrate an effect of selection for vocal behavior on laryngeal morphology, with acoustic consequences.
Building toward a solid foundation: The effect of thinking concretely about the future
Authors: Waites Stacie F. , Farmer Adam , Esmark Jones Carol L.
Published: January 2021

According to construal level theory, consumers tend to think about their future abstractly, making it unclear and inexact. Here, a new approach is developed to help people enhance their future‐oriented outcomes by priming them to think about their future concretely. Two experiments show that priming a concrete mindset about the future leads to enhanced future‐oriented outcomes. Specifically, the studies show that participants discounted current funds in favor of future gains less when they were primed with a concrete mindset. Opportunity cost consideration is shown to be the mechanism driving this effect. Though research suggests that most consumers do not consider opportunity costs unless they are explicitly presented to them, priming a concrete mindset increases consideration of opportunity costs so that consumers can make better current decisions that will enhance their future‐oriented outcomes. This research helps to better understand why thinking concretely about the future is beneficial to future‐oriented outcomes.
Forward rank‐dependent performance criteria: Time‐consistent investment under probability distortion
Authors: He Xue Dong , Strub Moris S. , Zariphopoulou Thaleia
Published: January 2021

We introduce the concept of forward rank‐dependent performance criteria, extending the original notion to forward criteria that incorporate probability distortions. A fundamental challenge is how to reconcile the time‐consistent nature of forward performance criteria with the time‐inconsistency stemming from probability distortions. For this, we first propose two distinct definitions, one based on the preservation of performance value and the other on the time‐consistency of policies and, in turn, establish their equivalence. We then fully characterize the viable class of probability distortion processes and provide the following dichotomy: it is either the case that the probability distortions are degenerate in the sense that the investor would never invest in the risky assets, or the marginal probability distortion equals to a normalized power of the quantile function of the pricing kernel. We also characterize the optimal wealth process, whose structure motivates the introduction of a new, ‘distorted’ measure and a related market. We then build a striking correspondence between the forward rank‐dependent criteria in the original market and forward criteria without probability distortions in the auxiliary market. This connection also provides a direct construction method for forward rank‐dependent criteria. Finally, our results on forward rank‐dependent performance criteria motivate us to revisit the classical (backward) setting. We follow the so‐called dynamic utility approach and derive conditions for existence and a construction of dynamic rank‐dependent utility processes.
Incidence, predisposing conditions and outcomes of cutaneous mucormycosis: A national database study
Authors: Kato Hirotaka , Foster Corey M. , Karri Kishore
Published: January 2021

Background

The body of evidence on cutaneous mucormycosis is largely derived from case reports or single‐centre databases.

Objectives

Our study aimed to describe incidence, predisposing factors and inpatient outcomes of cutaneous mucormycosis in the United States.

Methods

We conducted a population‐based retrospective study using the National Inpatient Sample 2016‐17 data. Fifty‐six discharges had a diagnosis of cutaneous mucormycosis on the International Classification of Diseases, tenth revision. Descriptive analysis was performed for the demographics, predisposing factors, length of stay (LOS), cost and inpatient mortality. The NIS represents 20% of all discharges in the United States, which allowed us to estimate the national incidence of cutaneous mucormycosis.

Results

An estimated total of 280 admissions occurred between 2016 and 2017, indicating 3.9 cases per million admissions across the United States. The estimated incidence rate was 0.43 cases per million people per year. Median age was 49.5 (19–59) years, 44.6% were female, and 54.9% were Caucasian. We identified haematologic malignancies (48.2%) and solid organ transplantations (10.7%), often accompanied by skin/soft tissue or post‐procedural infections, were the most common predisposing conditions. Median LOS was 15 (6–31) days, median total charges were 187,030 (65,962–446,265) USD, and in‐hospital mortality rate was 16.1%.

Conclusions

In current clinical practice, physicians may encounter cutaneous mucormycosis most commonly in severely immunocompromised hosts with haematologic malignancies or transplantations, accompanied by skin/soft tissue or post‐procedural infections. A high index of suspicion and prompt tissue sampling in at‐risk groups is important to improve the outcomes.
A mixed turbidite – contourite system related to a major submarine canyon: The Marquês de Pombal Drift (south‐west Iberian margin)
Authors: Mencaroni Davide , Urgeles Roger , Camerlenghi Angelo , Llopart Jaume , Ford Jonathan , Sanchez Serra Cristina , Meservy William , GrÀcia EulÀlia , Rebesco Michele , Zitellini Nevio
Published: January 2021

Synchronous interaction between bottom currents and turbidity currents has been reported often in channel–levée systems where the thickness of the turbidity currents exceeds that of the levées. Such interplay between along‐slope and down‐slope sedimentary processes is one of the mechanisms by which ‘mixed turbidite–contourite systems’ can originate. However, bottom currents flow over large areas of the seafloor, including continental slopes characterized by deeply incised submarine canyons rather than channel levées. In these cases, a direct interaction between along‐slope and down‐slope currents is, theoretically, unlikely to take place. In this study, oceanographic, swath bathymetry, multichannel seismic data and sediment cores are used to investigate a 25 km long, 10 km wide and up to 0.5 km thick deep‐sea late Quaternary deposit that sits adjacent to the north‐west flank of one of the major canyons in the North Atlantic, the São Vicente Canyon, in the Alentejo Basin (south‐west Iberian margin). The area receives the influence of a strong bottom current, the Mediterranean Outflow Water, which has swept the continental slope at different water depth ranges during glacial and interglacial periods. Architectural patterns and sediment characteristics suggest that this sedimentary body, named Marquês de Pombal Drift, is the result of the interaction between the Mediterranean Outflow Water (particularly during cold periods) and turbidity currents flowing along the São Vicente Canyon. Because the canyon is incised significantly deeper (ca 1.5 km) than the thickness of turbidity currents, an additional process, in comparison to earlier models, is needed to allow the interaction with the Mediterranean Outflow Water and transport sediment out of the canyon. In the São Vicente Canyon, and likely in other canyons worldwide, interaction of turbidity currents with contour currents requires intermediate nepheloid layers that export the finer‐grained fraction of turbidity currents out of the canyon at the boundary between major water masses.
Autonomy, incentive and trade: How does trade liberalisation reshape corporate decentralisation in China?
Authors: Li Xiaoyang , Zhou Xuan
Published: January 2021

We study how trade liberalisation affects the extent of corporate decentralisation using the World Bank enterprise survey in China. In particular, we examine the autonomy of production, investment and employment decision and the incentive compensation of CEOs of subsidiary firms after China's entry in the World Trade Organization (WTO). We show that subsidiary firm CEOs receive more decision autonomy and higher powered incentives when facing increased foreign competition in output market. In contrast, subsidiary CEOs receive less decision autonomy and flat incentive compensation when foreign competition in subsidiaries’ input market intensifies. When examining subsidiary CEOs’ autonomy in different decisions, we find that CEOs’ investment autonomy is more responsive to foreign competition than employment and production autonomy. We explain this difference through the agency cost angle by showing that firms whose CEOs with greater investment autonomy tend to spend more on managerial perks. Taken together, this paper sheds new light on how trade liberalisation reshapes firms’ decentralisation decisions in a multi‐tasking principal‐agent setting.
Prevalence and intensity of gastrointestinal parasites in the vulnerable spur-thighed tortoise (Testudo graeca) from the central-western of Morocco
Authors: Laghzaoui El-Mustapha , Amahmid Omar , Abbad Abdelaziz , El Mouden El Hassan
Published: January 2021

This study was undertaken to determine the prevalence and intensity of gastrointestinal parasites in wild Testudo graeca tortoises in Morocco. A total of 102 tortoises sampled in two arid areas: Central Jbilets Mountains (CJM) and Sidi Kaouki Forest (SKF) were macroscopically examined and subjected to qualitative (flotation and Baermann techniques) and quantitative (McMaster technique) microscopic examinations. The identified gastrointestinal parasites belong to two nematode families (Pharyngodonidae and Ascarididae) and three protozoa families (Balantidiidae, Eimeriidae and Entamoebidae). 92.1% of tortoises were determined to harbor one or more parasite types. Oxyurid adults were the most frequently encountered with a prevalence of 22.7% and 72.4% in CJM and SKF, respectively. Nematode eggs were found in almost all individuals of both populations studied. The prevalence of protozoa was 9.1% and 3.4% in CJM and SKF, respectively. Oxyurid adults showed the highest intensity in SKF (36.5 ± 30.2) whereas, ascarid adults are absent in CJM. Statistical analysis showed that the prevalence of infection by ascarids was significantly higher in adults than in juveniles. The intensity of infection by ascarid and oxyurid eggs differed significantly between sexes and localities, respectively. Our results showed a difference of infection between the two localities, which could be in relation with habitat quality. SKF is affected by both agriculture and overgrazing. In addition, the tortoises from this locality are active for a large part of the year, which increases their chance of encountering the parasites.
The Effect of Player Contact Characteristics on Head Impact Exposure in Youth Football Games
Authors: DiGuglielmo Daniella M. , Kelley Mireille E. , Espeland Mark A. , Gregory Zachary A. , Payne Tanner D. , Jones Derek A. , Filben Tanner M. , Powers Alexander K. , Stitzel Joel D. , Urban Jillian E.
Published: January 2021

To reduce head impact exposure (HIE) in youth football, further understanding of the context in which head impacts occur and the associated biomechanics is needed. The objective of this study was to evaluate the effect of contact characteristics on HIE during player versus player contact scenarios in youth football. Head impact data and time-synchronized video were collected from 4 youth football games over 2 seasons in which opposing teams were instrumented with the Head Impact Telemetry (HIT) System. Coded contact characteristics included the player’s role in the contact, player speed and body position, contact height, type, and direction, and head contact surface. Head accelerations were compared among the contact characteristics using mixed-effects models. Among 72 instrumented athletes, 446 contact scenarios (n = 557 impacts) with visible opposing instrumented players were identified. When at least one player had a recorded impact, players who were struck tended to have higher rotational acceleration than players in striking positions. When both players had a recorded impact, lighter players and taller players experienced higher mean head accelerations compared with heavier players and shorter players. Understanding the factors influencing HIE during contact events in football may help inform methods to reduce head injury risk.
Reconciling atmospheric CO
2
, weathering, and calcite compensation depth across the Cenozoic
Authors: Komar Nemanja , Zeebe Richard E.
Published: January 2021

Cenozoic carbon dioxide, weathering, and calcite compensation depth reconciled in a comprehensive carbon cycle model.
Persistence of mature dendritic cells, T
H
2A, and Tc2 cells characterize clinically resolved atopic dermatitis under IL-4Rα blockade
Authors: Bangert Christine , Rindler Katharina , Krausgruber Thomas , Alkon Natalia , Thaler Felix M. , Kurz Harald , Ayub Tanya , Demirtas Denis , Fortelny Nikolaus , Vorstandlechner Vera , Bauer Wolfgang M. , Quint Tamara , Mildner Michael , Jonak Constanze , Elbe-Bürger Adelheid , Griss Johannes , Bock Christoph , Brunner Patrick M.
Published: January 2021

Specific immune cell populations resist anti–IL-4Rα therapy in atopic dermatitis, indicative of “disease memory” in healed skin.
Lessons in Public (Mis)communication about the Laboratory from the COVID-19 Pandemic
Authors: Mazer Benjamin L.
Published: January 2021

The coronavirus disease 2019 (COVID-19) pandemic has put the clinical laboratory in the spotlight. The news media is regularly seeking out interviews with microbiologists, infectious disease specialists, and pathologists.
Accuracy of periocular lesion assessment using telemedicine
Authors: Kang Swan , Dehabadi Mohammad , Sim Dawn A , Thomas Peter B M , Appiah Ewusi Doris , Ezra Daniel
Published: January 2021

Objectives

To assess the agreement in diagnosis and management plans reached between clinicians reviewing eyelid lesions remotely and in face-to-face clinics.

Methods

In this single-centre observational case series, data were prospectively collected on 50 consecutive adults referred with eyelid lesions suitable to be seen by a nurse. A proforma was completed to gather salient information. A nurse specialist saw patients in face-to-face clinics and collected information using the proforma, devising a diagnosis and management plan. Photographs of the eyelid lesions were taken by a medical photographer. A subsequent remote review was completed by an oculoplastic consultant using the proforma information and photographs in the absence of the patient. The diagnosis and management plan constructed by the nurse specialist were compared with those reached by the consultant.

Results

Complete data were available for 44 consecutive cases. There was an overall 91% agreement (40 cases out of 44) between the diagnoses reached by the nurse specialist, and the remote reviewer; kappa coefficient 0.88 (95% CI 0.76 to 0.99). There was an overall 82% agreement (36 out of 44 cases) in the management plans devised by the nurse-led clinic and remote reviewer; kappa coefficient 0.74 (95% CI 0.58 to 0.90). The average time taken for a remote reviewer to reach a diagnosis and management plan was 1 min and 20 s.

Conclusions

This study evaluated the feasibility of assessing eyelid lesions using asynchronous telemedicine. There was overall a high rate of concordance in the diagnosis reached, and management devised between the clinic and remote review.
Sexual behaviour patterns and STI risk: results of a cluster analysis among men who have sex with men in Portugal
Authors: Blondeel Karel , Dias Sonia , Furegato Martina , Seuc Armando , Gama Ana , Fuertes Ricardo , Mendão Luís , Temmerman Marleen , Toskin Igor
Published: January 2021

Objectives

Portugal has the highest HIV incidence rate in Western Europe. The proportion assigned to sexual contact between men recently increased to more than 30% of all HIV infections. Men who have sex with men (MSM) are vulnerable to the acquisition of other sexually transmitted infections (STIs), increasing the per-contact risk of HIV infection. Building on syndemic theory, the aim of this analysis was to identify patterns of current sexual behaviour in MSM, and explore their relationship with self-reported current, past STI diagnoses and HIV positive serostatus.

Design

A cross-sectional behavioural survey was conducted in Portugal among MSM, using a community-based participatory research approach. Hierarchical cluster analysis was used to identify patterns including behavioural and demographic factors.

Results

The analysis resulted in six clusters. Three clusters showed higher rates of current STI diagnosis (ranging from 11.7% to 17.1%), past STI diagnosis (ranging from 25.5% to 41.5%) and HIV positive serostatus (ranging from 13.0% to 16.7%). From the three clusters scoring lower on current and past STI and HIV diagnoses, one was characterised by a high number of sexual partners (62% had more than 12 partners in the last year), a high proportion (94.6%) of frequent visits to gay venues to meet sexual partners and high alcohol use (46.1%). The other two clusters scored lower on high risk sexual behaviour.

Conclusion

Factors other than sexual behaviour appear to reinforce the vulnerability to STIs and HIV of some MSM in this study, suggesting a syndemic of STIs, HIV and other adverse conditions. More research is needed to better understand the drivers of the STI/HIV epidemic in Portuguese MSM, using a concept that goes beyond risk behaviour, to develop effective combination prevention interventions.
Estimating the return on investment of the Bureau of Tobacco Free Florida tobacco control programme from 1999 to 2015
Authors: Nonnemaker James , MacMonegle Anna J , Mann Nathan , Woodlea Robyn , Duke Jennifer , Porter Lauren
Published: January 2021

Objective

To assess the return on investment (ROI) of the Florida tobacco control programme, the Bureau of Tobacco Free Florida (BTFF), in terms of healthcare expenditure savings and mortality cost saved as a result of reduced mortality due to the programme from 1999 to 2015.

Methods

We use a synthetic control method to estimate the impact of the BTFF on smoking-attributable mortality, years of life lost (YLL), healthcare expenditures, and the economic value of premature mortality due to smoking in Florida from 1999 through 2015. We calculated an ROI for healthcare expenditures and for the value of life years saved.

Results

From 1999 to 2015, adult smoking prevalence in Florida averaged 0.98 percentage points lower than prevalence in the synthetic control states (19.6% vs 20.6%). The ROI over the period from 1999 to 2015 was 9.61 for healthcare expenditures and 112.44 for premature mortality. These ROIs suggest that for every US$1 of expenditure by BTFF, smoking-attributable healthcare expenditures decreased by almost US$11 and reductions in the economic costs associated with YLL due to smoking-attributable mortality totaled approximately US$113.

Conclusions

Our results suggest the BTFF resulted in fewer YLL, substantial healthcare cost savings and substantial savings in terms of mortality costs. The positive ROIs for healthcare expenditures and premature mortality suggest that the BTFF is a good investment of public funds.
Tourniquet use in total knee replacement surgery: a feasibility study and pilot randomised controlled trial (SAFE-TKR study)
Authors: Wall Peter David Henry , Ahmed Imran , Edwin Claire , Farhan-Alanie Muhamed M , Parsons Helen , Price Andrew James , Warwick Jane , Hutchinson Charles E , Underwood Martin , Metcalfe Andrew
Published: January 2021

Introduction

Tourniquets are routinely used during total knee replacement (TKR) surgery. They could increase the risk of thromboembolic events including cerebral emboli, cognitive decline, pain and other adverse events (AEs). A randomised controlled trial to assess whether tourniquet use might safely be avoided is therefore warranted but it is unclear whether such a trial would be feasible.

Methods

In a single-site feasibility study and pilot randomised controlled trial, adults having a TKR were randomised to surgery with an inflated tourniquet versus a non-inflated tourniquet. Participants underwent brain MRI preoperatively and within 2 days postoperatively. We assessed cognition using the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and Oxford Cognitive Screen (OCS) and thigh pain using a Visual Analogue Scale at baseline and days 1 and 2, and 1 week postsurgery. AEs related to surgery were recorded up to 12 months.

Results

We randomised 53 participants (27 tourniquet inflated and 26 tourniquet not inflated). Fifty-one participants received care per-protocol (96%) and 48 (91%) were followed up at 12 months. One new ischaemic brain lesion was detected. Of the cognitive tests, MoCA was easy to summarise, sensitive to change with lower ceiling effects compared with OCS and MMSE. There was a trend towards more thigh pain (mean 49.6 SD 30.4 vs 36.2 SD 28 at day 1) and more AEs related to surgery (21 vs 9) in participants with an inflated tourniquet compared with those with a tourniquet not inflated.

Conclusion

A full trial is feasible, but using MRI as a primary outcome is unlikely to be appropriate or feasible. Suitable primary outcomes would be cognition measured using MoCA, pain and AEs, all of which warrant investigation in a large multicentre trial.

Trial registration number

ISRCTN20873088.