bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Multi‐Level Governance in Shaping Regional Growth and Competitiveness in the Basque Country
Authors: Gray Caroline
Published: October 2022

In light of ongoing debates in England over the urgency of new devolution deals to ‘level up’ the country, this article investigates how devolved powers have been used to transform and sustain the economy in one of the most economically successful regions in Europe: the Basque Country. Drawing upon interviews conducted with Basque politicians, researchers and practitioners, the article examines the role that multi‐level governance and public‐private collaboration have played in shaping the region's economic development, as well as the challenges that derive from its complex institutional structure. The article concludes by suggesting that one of the most significant takeaways from the Basque experience is the importance of using devolution to build a collaborative web of actors and institutions at regional and local level with an enduring common knowledge and purpose that far outlives any one government, as well as the social capital needed to sustain that.
A prospective cohort study of cigarette smoking, alcohol drinking and liver cancer incidence in Chinese men
Authors: Zhang Yan , Li Zhuo Ying , Shen Qiu Ming , Tuo Jia Yi , Tan Jing Yu , Tan Yu Ting , Li Hong Lan , Xiang Yong Bing
Published: October 2022

Objectives

Population‐based prospective studies on the associations of cigarette smoking, alcohol drinking, and primary liver cancer remain limited in Mainland China. Our study was designed to evaluate such relationships in middle‐aged Chinese men.

Methods

Self‐reported habits of cigarette smoking and alcohol drinking were obtained from all cohort members at the baseline survey. The outcomes were identified through in‐person follow‐up and annual record linkage to multiple statistics of vital and cancer registration. Age‐adjusted and multivariable‐adjusted hazard ratio (HR) and their corresponding 95% confidence interval (CI) were estimated utilizing the Cox regression model.

Results

After a median follow‐up of 12.31 years, 329 cases of incident primary liver cancer occurred among 45 266 male participants. Compared with never smoker, former smoker was positively associated with liver cancer risk, with a multivariable‐adjusted HR of 1.42 (95% CI 1.02–1.98). Individuals who had smoked for more than 40 years had a 49% increased risk of liver cancer (HR≥40 years 1.49, 95% CI 1.04–2.14). The association of alcohol drinking with liver cancer showed no statistical significance.

Conclusions

Our study provided evidence that cigarette smoking was positively associated with an increased liver cancer risk among Chinese men. Attention to such non‐viral modifiable risk factors to prevent liver cancer effectively is needed.
Novel nomogram model for predicting 6‐week mortality in liver cirrhosis patients with acute upper gastrointestinal bleeding
Authors: Zhou Yu Fen , Xu Ying , Ding Yan Fei , Yu Xiao Jun , Wu Yun Lin , Chen Ping , Zou Duo Wu
Published: October 2022

Objective

To develop and validate a nomogram for predicting 6‐week mortality in patients with liver cirrhosis and acute upper gastrointestinal bleeding (UGIB) and to compare it with other commonly used scoring systems.

Methods

This retrospective study included cirrhotic patients with acute UGIB hospitalized between January 2013 and December 2020. Random sampling was used to divide patients into the training (n = 676) and validation cohorts (n = 291) at a 7:3 ratio. Multivariate logistic stepwise regression was used to establish a model for predicting 6‐week mortality. Multiple indicators were used to validate the nomogram, including the area under the receiver operating characteristic curve (AUROC), calibration curve, and decision curve analysis (DCA).

Results

In the training cohort, total bilirubin (TBIL) (odds ratio [OR] 1.75, 95% confidence interval [CI] 1.22–2.50), hemoglobin (Hb) (OR 0.97, 95% CI 0.95–0.99), C‐reactive protein (OR 2.79, 95% CI 1.30–6.07), prothrombin time (OR 1.17, 95% CI 1.05–1.30), and hepatic encephalopathy (stage I–II: OR 4.15, 95% CI 1.73–9.61; stage III–IV: OR 19.6, 95% CI 5.33–76.8) were identified as independent factors of 6‐week mortality. The AUROC of the UGIB‐LC score was 0.873 (95% CI 0.820–0.927), which was higher than that of the Child–Pugh score (0.781), model for end‐stage liver disease score (0.766), and neutrophil‐to‐lymphocyte ratio (0.716).

Conclusion

The UGIB‐LC score is useful for predicting 6‐week mortality in patients with liver cirrhosis and acute UGIB, which is superior to the other three scoring systems.
An electrogenetic toggle switch model
Authors: Grozinger Lewis , Heidrich Elizabeth , Goñi‐Moreno Ángel
Published: October 2022

Synthetic biology uses molecular biology to implement genetic circuits that perform computations. These circuits can process inputs and deliver outputs according to predefined rules that are encoded, often entirely, into genetic parts. However, the field has recently begun to focus on using mechanisms beyond the realm of genetic parts for engineering biological circuits. We analyse the use of electrogenic processes for circuit design and present a model for a merged genetic and electrogenetic toggle switch operating in a biofilm attached to an electrode. Computational simulations explore conditions under which bistability emerges in order to identify the circuit design principles for best switch performance. The results provide a basis for the rational design and implementation of hybrid devices that can be measured and controlled both genetically and electronically.
Nodule‐type pneumonitis mimicking lung abscess or tumor recurrence on chest computed tomography identified as osimertinib‐induced pneumonitis: A case report
Authors: Otsuki Ayumu , Homma Yuya , Yoshimi Michinori , Ito Hiroyuki , Nakashima Kei
Published: October 2022

Osimertinib‐induced pneumonitis usually manifests as ground glass opacities (GGO) on chest computed tomography (CT) scans. Here, we encountered a case involving a 42‐year‐old woman who had nodule‐type pneumonitis mimicking lung abscess or tumor recurrence caused by osimertinib. When a nodular pattern is seen on the chest CT scan of a patient receiving osimertinib treatment, drug‐induced pneumonitis should be considered as a differential diagnosis. To the best of our knowledge, this is the first case of osimertinib‐induced pneumonitis that manifested as a nodule‐type pneumonitis mimicking lung abscess or tumor recurrence on chest CT scan.
Validity and test–retest reliability of the Ugandan version of the Pediatric Evaluation of Disability Inventory (PEDI‐UG) in children and youth with cerebral palsy
Authors: Amer Ahmed , Hermansson Liselotte , Jarl Gustav , Kamusiime Sauba , Forssberg Hans , Andrews Carin , Kakooza‐Mwesige Angelina , Eliasson Ann Christin
Published: October 2022

Background

Validity of the Ugandan version of the Pediatric Evaluation of Disability Inventory (PEDI‐UG) was previously investigated on typically developing children. This study aimed to investigate the validity, test–retest reliability and minimal detectable change (MDC) of the PEDI‐UG in children and youth (C&Y) with cerebral palsy (CP).

Method

A cross‐sectional study design with 118 C&Y with CP (44.7% girls) aged 10 months–22.5 years were included in the study; 37 of them completed the PEDI‐UG twice to investigate test–retest reliability, determined by calculating the intraclass correlation coefficient (ICC). Additionally, data from 249 typically developing children were used for differential item functioning (DIF) analysis. The validity of the PEDI‐UG was investigated by Rasch analysis. The Kruskal–Wallis test and Spearman's correlation coefficient were calculated to investigate associations between PEDI‐UG scores and external classification systems.

Results

The principal component analysis of residuals indicated unidimensionality in all domains. The ICC values were excellent (0.98–0.99), and the MDCs were less than 6 and 13 (on a 0–100 scale) for the functional skills and caregiver assistance parts, respectively. The four‐category caregiver assistance rating scale fulfilled the criteria for the analysis of rating scale functioning. In total, 78 of 189 items in the functional skills domain and two items in the caregiver assistance domain demonstrated DIF between C&Y with CP and TD children. The Kruskal–Wallis test (p < 0.05) and Spearman's correlation (coefficients of −0.93 to −0.78) supported the validity of PEDI‐UG.

Conclusion

The current diagnose‐specific version of PEDI‐UG demonstrates evidence for validity as a measure of ability in C&Y with CP in Uganda and other similar settings, being a promising tool for use in clinical practice and research. Conversion tables and MDC values are provided to facilitate clinical adoption of the measure.
Hypo‐ or hyperarousal? The mechanisms underlying social information processing in autism
Authors: Yi Li , Wang Qiandong , Song Ci , Han Zhuo Rachel
Published: October 2022

Autistic children tend to show divergent social information processing, and controversies exist regarding the mechanisms underlying this processing. In this article, we summarize and categorize the current theories and evidence related to hypo‐ and hyperarousal accounts of social information processing in autism. The hypo‐arousal account proposes reduced motivation or sensitivity to process social information and is supported by behavioral, eye‐tracking, and neuroimaging studies. Recent evidence has challenged this account, highlighting the role of eye gaze in interpreting the hypo‐brain activation. The hyperarousal account posits that social context could evoke anxiety and discomfort in autistic children, which could interfere with their social information processing and result in social avoidance. Most research in this field has studied children and adolescents, but some studies have included adults since autism is a lifelong condition. Here, we highlight the importance of considering the heterogeneity of arousal patterns in autistic children when developing individualized supporting protocols.
‘My World, a click’: Preschool children photograph spaces of their daily lives
Authors: Askouni Nelli , Fakou Emilia , Vouvousira Stefania
Published: October 2022

The paper examines the ways in which preschool children represent the spaces of their daily lives. It is based on the analysis of photographs taken by pupils from two kindergartens located in non‐privileged neighbourhoods of Athens. The children photographed the spaces where they live and move, and talked about their photos. The analysis maps these spaces and explores the social parameters (social class, ethnicity) that shape the children's relationship with private and public space. Thus, photographs become tools that provide a deeper understanding of the children's social worlds and highlight the importance of the social spaces where their practices and experiences are shaped.
Self‐withdrawal from scheduled bariatric surgery: Qualitative study exploring patient and healthcare provider perspectives
Authors: Martin Mary I. , Ha Vanessa , Fasola Laurie , Dalgarno Nancy , Zevin Boris
Published: October 2022

The objective of the study was to explore the experience of patients who self‐withdrew from their scheduled bariatric surgery (BS) after completing the lengthy multidisciplinary assessment and optimization process, and to examine how these withdrawals affect healthcare providers (HCPs) in a Bariatric Centre of Excellence (BCoE). Interviews were conducted with patients who self‐withdrew, within 1 month, from scheduled BS. Additionally, a focus group with HCPs from the same BCoE was completed. The data were analysed using an inductive, emergent thematic approach with open coding in NVivo 12, with comparative analysis to identify common themes between groups. Eleven patients and 14 HCPs participated. HCPs identified several behavioural and logistical red flags among patients who self‐withdrew from scheduled BS. Patients and HCPs felt the decision was appropriate, owing to a patient's lack of mental preparedness for change, social supports, or fears of postoperative complications. HCPs reported frustration and described negative impacts on clinic efficiency. Additional mental health resources for patients contemplating self‐withdrawal, such as peer support, were suggested. In conclusion, a patient's decision to self‐withdraw from a scheduled BS is often sudden, definite, and associated with anxiety, fear of surgical risks and post‐operative complications. Additional mental health resources at a BCoE may be beneficial to support patients at risk of self‐withdrawal from scheduled BS.
Bi‐directional relations between behavioral problems and executive function: Assessing the longitudinal development of self‐regulation
Authors: Li Chen , Hart Emma R. , Duncan Robert J. , Watts Tyler W.
Published: October 2022

During childhood, the ability to limit problem behaviors (i.e., externalizing) and the capacity for cognitive regulation (i.e., executive function) are often understood to develop in tandem, and together constitute two major components of self‐regulation research. The current study examines bi‐directional relations between behavioral problems and executive function over the course of childhood and adolescence. Relying on a diverse sample of children growing up in low‐income neighborhoods, we applied a random intercept cross‐lagged panel model to longitudinally test associations between behavioral problems and executive function from age 4 through age 16. With this approach, which disaggregated between‐ and within‐child variation, we did not observe significant cross‐lagged paths, suggesting that within‐child development in one domain did not strongly relate to development in the other. We also observed a moderate correlation between the stable between‐child components of behavioral problems and executive function over time in our preferred model, suggesting that these two domains may be relatively distinct when modeled from early childhood through adolescence.
Progressive slowing of clonic phase predicts postictal generalized EEG suppression
Authors: Vlachou Maria , Ryvlin Philippe , Arbune Anca Adriana , Armand Larsen Sidsel , Skræp Sidaros Annette , Cacic Hribljan Melita , Fabricius Martin , Beniczky Sándor
Published: October 2022

Objective

Postictal generalized electroencephalography (EEG) suppression (PGES) is a surrogate marker of sudden unexpected death in epilepsy (SUDEP). It is still unclear which ictal phenomena lead to prolonged PGES and increased risk of SUDEP. Semiology features of generalized convulsive seizure (GCS type 1) have been reported as a predictor of prolonged PGES. Progressive slowing of clonic phase (PSCP) has been observed in GCSs, with gradually increasing inhibitory periods interrupting the tonic contractions. We hypothesized that PSCP is associated with prolonged PGES.

Methods

We analyzed 90 bilateral convulsive seizures in 50 consecutive patients (21 female; age: 11–62 years, median: 31 years) recruited to video‐EEG monitoring. Five raters, blinded to all other data, independently assessed the presence of PSCP. PGES and seizure semiology were evaluated independently. We determined inter‐rater agreement (IRA) for the presence of PSCP, and we evaluated its association, as well as that of other ictal features, with the occurrence of PGES, prolonged PGES (≥20 s) and very prolonged PGES (≥50 s) using multivariate logistic regression analysis.

Results

We found substantial IRA for the presence of PSCP (percent agreement: 80%; beyond‐chance agreement coefficient: .655). PSCP was an independent predictor of the occurrence of PGES and prolonged PGES (p < .001). All seizures with very prolonged PGES had PSCP. GCS type 1 was an independent predictor of occurrence of PGES (p = .02) and prolonged PGES (p = .03) but not of very prolonged PGES. Only half of the seizures with very prolonged PGES were GCS type 1.

Significance

PSCP predicts prolonged PGES, emphasizing the importance of gradually increasing inhibitory phenomena at the end of the seizures. Our findings shed more light on the ictal phenomena leading to increased risk of SUDEP. These phenomena may provide basis for algorithms implemented into wearable devices for identifying GCS with increased risk of SUDEP.
Do Merkel complexes initiate mechanical itch?
Authors: Bataille‐Savattier Adeline , Le Gall‐Ianotto Christelle , Lebonvallet Nicolas , Misery Laurent , Talagas Matthieu
Published: October 2022

Itch is a common sensation which is amenable to disabling patients' life under pathological and chronic conditions. Shared assertion easily limits itch to chemical itch, without considering mechanical itch and alloknesis, its pathological counterpart. However, in recent years, our understanding of the mechanical itch pathway, particularly in the central nervous system, has been enhanced. In addition, Merkel complexes, conventionally considered as tactile end organs only responsible for light touch perception due to Piezo2 expressed by both Merkel cells and SA1 Aβ‐fibres ‐ low threshold mechanical receptors (LTMRs) ‐, have recently been identified as modulators of mechanical itch. However, the tactile end organs responsible for initiating mechanical itch remain unexplored. The consensus is that some LTMRs, either SA1 Aβ‐ or A∂‐ and C‐, are cutaneous initiators of mechanical itch, even though they are not self‐sufficient to finely detect and encode light mechanical stimuli into sensory perceptions, which depend on the entire hosting tactile end organ. Consequently, to enlighten our understanding of mechanical itch initiation, this article discusses the opportunity to consider Merkel complexes as potential tactile end organs responsible for initiating mechanical itch, under both healthy and pathological conditions. Their unsuspected modulatory abilities indeed show that they are tuned to detect and encode light mechanical stimuli leading to mechanical itch, especially as they host not only SA1 Aβ‐LTMRs but also A∂‐ and C‐fibres.
Classify nodes based on their degree distribution: A more scalable method for influence maximization
Authors: Boroujeni Rouhollah Javadpour , Soleimani Seyfollah
Published: October 2022

One of the main problems in viral marketing is influence maximization (IM). With a social network and a predefined propagation model, the aim is to seek a subset of nodes that spread the influence widely into the network. Most scalable methods with provable approximation guarantees are presented for this problem based on the reverse influence sampling (RIS) framework. The RIS framework has two phases: sampling and node selection. The sampling phase encountered two challenges in the sampling phase: the number of required samples and the sampling method. Most methods have focused on the first challenge, that is, sample size, and have tried to provide a rigid sample size. In this paper, we focus on the second challenge: how to improve the precision of sampling. We propose to use stratified sampling rather than simple random sampling. Since the degree of each node is one of the affecting factors in the diffusion process. This issue leads us to use stratified sampling based on a degree distribution. The results show that with the application of the proposed method, the solution can estimate with fewer samples, which is faster than the state‐of‐the‐art methods.
Performance measurement in the public sector: Mapping 20 years of survey research
Authors: van der Kolk Berend
Published: October 2022

This paper maps 20 years of survey research on performance measurement (PM) practices in public sector organizations. Cumulative findings from the discipline of accounting enhance the understanding of public sector PM and its antecedents and effects. Four maps are presented that visualize the relationships among key variables from prior research in four empirical settings: government, health, education, and other domains. Furthermore, this review distinguishes between individual‐level and organization‐level effects of PM, and includes reflections on the appreciation of PM by public sector employees. The findings highlight that PM use and attributes such as fairness, subjectivity, and clarity significantly impact the outcomes yielded by PM systems. This paper contributes by synthesizing prior research on public sector PM and by identifying research gaps, areas of debate, and avenues for future research. In addition, findings from this review have the potential to add nuance to the sometimes‐polarized debate on the acclaimed “benefits” and “costs” of PM in the public sector.
Softening response of cast Al‐Si‐Cu samples tested under low‐cycle‐fatigue and fatigue‐creep regime and elevated temperate: Experimental and analysis
Authors: Cao Zicong , Zhang Weizheng
Published: October 2022

In this paper, the strain‐controlled low‐cycle‐fatigue (LCF) test and low‐cycle‐fatigue‐creep (LCFC) test of a cast Al‐Si‐Cu alloy at 350°C were investigated. A significant softening behavior can be observed in the tests, the strain amplitude has an effect on softening speed, and the dwell time has an effect on both softening ratio and softening speed. Microscopic observation indicated that the compressive load of creep could result in a significant amount of plastic deformation and lead to the eutectic silicon particles rupture and the propagation of dimples, causing the softening behavior and the decrease of failure life of Al‐Si‐Cu alloy. Based on the experiment data, a modified visco‐plasticity model combining Chaboche model and θ‐projection model was proposed to capture the cyclic stress response. The modified model could simulate the softening behavior and hysteresis loop for LCF test and LCFC test of Al‐Si‐Cu alloy accurately.
Migration, gentrification and housing crisis. The case of Peruvians living in Abasto (Buenos Aires)
Authors: Cuberos‐Gallardo Francisco J.
Published: October 2022

The neighbourhood of Abasto has been home to many Peruvian immigrants since the 1990s. Now, this population is suffering the effects of a notable increase in real estate value intensely. This work analyses the specific mechanisms that provoke a differentiated exposure of Peruvian neighbours to gentrification, as well as the differentiated responses of migrants to the housing crisis. This paper is an ethnographic account about the strategies developed by Peruvian families in the context of gentrification. For this purpose, an abundance of material collected through observation, in‐depth interviews and a rigorous review of bibliographic and documentary material is provided. The results demonstrate how the condition of migrant as in‐betweeners represents an overexposure to the effects of the housing crisis for this population. In this context, there is also an unequivocal tendency for migrants to develop autonomous strategies against gentrification.
Review: Elaboration, structure, and mechanical properties of oxynitride glasses
Authors: Duval Alexis , Houizot Patrick , Rouxel Tanguy
Published: October 2022

Oxynitride glasses are glasses where threefold coordinated nitrogen atoms substitute for twofold oxygen ones, hence resulting in a larger interatomic cross‐linking degree. Such glasses were first observed at the grain boundary in silicon nitride ceramics, where they govern the high‐temperature behavior. Later, they were prepared as bulk materials and motivated numerous researches, thanks to their large viscosity, glass transition range, elastic moduli, hardness, and fracture toughness among inorganic and non‐metallic glasses. In different chemical systems that were investigated, the synthesis routes and the sources for these exceptional mechanical properties are reviewed. Oxynitride glasses are not easy to process and suffer from the loss of transparency as nitrogen is incorporated over some critical content. Nevertheless, they are attractive “specialty” glasses in various niche areas, thanks to their large refractive index and dielectric constant, improved chemical durability, high softening point, etc., and majorly to their exceptional mechanical properties.
Metabolome and transcriptome integration reveals metabolic profile of hepatocellular carcinoma
Authors: Hou Guojun , Xu Wenfang , Ding Dongyang , Tian Tao , Liu Gang , Yang Yuan , Liu Hui , Zhou Weiping
Published: October 2022

Background and Aim

Accumulated evidence highlights the role of metabolites in cancer diagnosis. However, the diagnosis of hepatocellular carcinoma (HCC), especially its early diagnosis, is still very difficult. The main purposes of the study are to explore the comprehensive characteristic metabolites of HCC through an integrated nontargeted metabolomics and transcriptomics approach and evaluate the diagnostic value of some metabolic changes in HCC.

Methods

Dysregulated metabolites and pathways in HCC were identified by nontargeted metabolomics analysis of 72 pairs of matched liver tissues, including HCC tissue (HCT) and adjacent noncancerous tissue (ANT). Meanwhile, to ensure the reliability of the results, metabolic enzymes were quantified at the mRNA level by RNA sequencing. To facilitate the utilization of this information, a diagnostic model was developed based on binary logistic regression using 63 HCC serum samples collected from the aforementioned 72 patients and 40 noncancer serum samples.

Results

The results showed that 267 metabolites were significantly altered in HCT. These differential metabolites binding to related differential metabolic enzyme genes were enriched in 14 metabolic pathways. And combination of 5‐oxoproline, taurocholenate sulfate, and maltose could be used as a novel candidate early serum diagnostic marker for HCC.

Conclusions

We profiled the metabolic features of HCC and found global biochemical pathway aberration. The diagnostic potential of differential metabolites found in serum tissues, further validated in liver samples, showed that 5‐oxoproline, taurocholenate sulfate, and maltose combination had a high accuracy for hepatocellular carcinoma detection, especially for alpha fetoprotein negative patients.
Patient‐reported geriatric assessment‐based frailty index among older adults with gastrointestinal malignancies
Authors: Giri Smith , Al‐Obaidi Mustafa , Harmon Christian , Clark Deanna , Ubersax Clare , Dai Chen , Young‐Smith Crystal , Outlaw Darryl , Gbolahan Olumide , Khushman Moh'd , Bhatia Smita , Williams Grant R.
Published: October 2022

Background

Older adults with cancer are at increased risk of treatment‐related toxicities and excess mortality. We evaluated whether a patient‐reported geriatric assessment (GA) based frailty index can identify those at risk of adverse outcomes.

Methods

Older adults (≥60 years) enrolled in a single‐institutional prospective registry underwent patient‐reported GA at initial evaluation in our medical oncology clinic. Using deficit accumulation method, we constructed a 44‐item frailty index (CARE‐FI), categorizing patients as robust, pre‐frail, and frail. The primary outcome was overall survival (OS). Secondary outcomes included (a) functional decline at 3 months post‐therapy (b) incident grade ≥3 treatment‐related toxicities at six‐month post‐treatment. We used multivariate Cox and logistic regression models respectively to study the impact of frailty on primary and secondary outcomes.

Results

We identified 589 older adults with a median age of 69 years; 55% males and 73% Whites. Overall, 168 (29%) were pre‐frail and 230 (39%) frail. Being frail (vs. robust) was associated with worse OS (Hazards Ratio, HR 1.83, 95% Confidence Interval, CI 1.34–2.49, p < 0.001) after adjusting for age, sex, race/ethnicity, cancer type, cancer stage, and line of therapy. Similarly, frailty was associated with increased risk of functional decline (OR 3.01; 95% CI 1.33–6.81; p = 0.008) and grade ≥3 non‐hematologic toxicities (OR 3.65; 95% CI 1.54–8.69; p = 0.003) but not hematologic toxicities (OR 1.01; 95% CI 0.46–2.22; p = 0.97).

Conclusions

Our frailty index using a patient‐reported GA is a robust predictor of survival, functional decline, and treatment related toxicity among older adults with GI malignancies.
Predictive validity of the Westmead Post‐Traumatic Amnesia Scale for functional outcomes in school‐aged children who sustained traumatic brain injury
Authors: Briggs Rachel , Epps Adrienne , Brookes Naomi , Tate Robyn , Lah Suncica
Published: October 2022

The Westmead Post‐Traumatic Amnesia Scale (WPTAS) is routinely used for the assessment of post‐traumatic amnesia (PTA) in children who sustained traumatic brain injury (TBI). Yet, the WPTAS' predictive validity for functional outcomes is largely unknown. We aimed to determine whether PTA duration measured by the WPTAS (i) differentially predicts functional outcomes and (ii) contributes to predictions of outcomes beyond the Glasgow Coma Scale (GCS) in children who sustained TBI. Participants were children and adolescents with moderate‐to‐severe TBI (n = 55) aged 8–15 years. PTA duration was assessed with the WPTAS. Outcomes at the first outpatient follow‐up were scored on the Kings Outcome Scale for Childhood Head Injury (KOSCHI) and the TBI Outcome Domain Scale‐Extended (ODS‐E). Longer PTA and lower GCS were both significantly correlated with worse (i) global outcomes: presence of disability on the KOSCHI and lower score on the ODS‐E and (ii) select specific outcomes on the ODS‐E: mobility, mood and cognition. PTA duration predicted cognitive outcome on the ODS‐E independently, beyond GCS. Together, PTA duration and GCS, predicted the global KOSCHI outcome, as well as the ODS‐E mobility and mood outcomes. Neither GCS nor PTA duration correlated with the ODS‐E communication, impulsivity/disinhibition, headache, fatigue, sensory impairments or somatic complaints outcomes. PTA duration measured by the WPTAS is a significant unique predictor of functional cognitive outcomes in children who sustained moderate‐to‐severe TBI, and in combination with the GCS, a significant predictor of global, and several specific functional outcomes.
Clinical outcomes of hereditary angioedema on multiparous women
Authors: Karabiber Esra , Kendirlinan Reşat , Çerçi Pamir
Published: October 2022

Objective

Significant concerns for patients with hereditary angioedema (HAE) include hormonal fluctuations and drug safety during pregnancy. The impact of the disease on childbearing in multiparous women remains to be elucidated. We aimed to investigate the clinical course and impacts of multiparity on HAE patients.

Study design

This observational study included 15 multiparous women with HAE; a total of 88 pregnancies were assessed using a questionnaire and the patient's medical records.

Results

The median age was 36 (IQR, 33–39). Of 72 resulted in healthy babies without any congenital abnormalities. In sixteen pregnancies, 12 (13.6%) ended with spontaneous abortion; three resulted in stillbirth and one neonatal death. Two‐thirds of the patients (n = 10) enounced a worsening in the frequency of angioedema attacks during pregnancy. There was no statistically significant difference compared with the nonpregnant period (p = 0.283). One‐fifth of the patients (n = 3) reported alleviation in attacks. While most deliveries were vaginally (n = 57 babies), 19 deliveries in six patients were by cesarean section. None of the patients were aware of the diagnosis of HAE prior to their first pregnancies. After the diagnosis was made, eight patients received 263 vials of plasma‐derived C1‐inhibitor concentrate during a total of 13 pregnancies. No adverse events were reported.

Conclusion

We conclude that our results on clinical course and outcomes of HAE in multiparous patients are consistent with the literature. A greater focus on multiparous HAE patients could produce exciting findings.
Therapeutic efficacy of metronidazole by needle‐free jet injection combined with blue light therapy in Moderate‐to‐Severe facial acne vulgaris
Authors: Yi Lu , Gao Lihua , Lv Lv , Zhang Bo , Chen Fangru , Yang Fengyuan , Yan Wenjie , Jiang Lijun , Li Nianzhen , Lao Yuanqing , Lu Jianyun , Huang Xi
Published: October 2022

Background

Acne vulgaris is one of the most common dermatological diseases. Some topical treatments for acne used in combination, such as blue light and topical antibiotics (such as metronidazole) by needle‐free jet injection (NFJI), are becoming prevalent in clinical practice, but the efficacy remains uncertain.

Methods

In order to investigate the effect of blue light combined with metronidazole by NFJI in the treatment of acne, the 251 enrolled patients were randomly assigned into the blue light group, metronidazole (MNZ) group, and MNZ + blue light group, and then received 6‐weeks' treatment. A variety of objective and subjective methods such as clinical pictures, skin barrier physiological parameters (including trans‐epidermal water loss (TEWL), stratum corneum hydration, facail surface sebum, erythema and pigmentation), the Investigator Global Assessment score, acne lesion count assessment, Patients' Self‐Assessment, and VAS score were used to evaluate the efficacy and side effects of the treatments.

Results

Compared to the baseline, the MNZ + blue light group showed significant improvement in acne lesion count reduction, TEWL, straum corneum hydration, facial surface sebum and erythema (p < 0.05). The MNZ + blue light group showed significant differences compared with the MNZ group and blue light group in terms of acne lesion count reduction and erythema (p < 0.05) Compared to the MNZ group, the MNZ + blue light group demonstrated significant improvement in TEWL and sebum (p < 0.05). While compared to the blue light group, the MNZ + blue light group showed significant improvement in hydration (p < 0.05). There was no statistically significant difference among the three groups in pigmentation (p > 0.05).

Conclusion

The combination of MNZ by NFJI and blue light has a synergistic effect and can relieve acne skin lesion within 6 weeks in the treatment of moderate and moderate–to–severe facial acne vulgaris, meanwhile, this method has a good safety.
Different vitiligo characteristics as predictors of increased risk of metabolic syndrome and insulin resistance: A case–control study
Authors: Ibrahim Sarah , El‐Tahlawi Samar , Mogawer Rania M. , El Ansary Mervat , Esmat Samia , El‐Hawary Marwa
Published: October 2022

Background

Autoimmune and metabolic disturbances have been reported in association with vitiligo, highlighting possible systemic associations that should be considered.

Aims

To assess the possible association of metabolic syndrome (MetS) as well as insulin resistance (IR) with vitiligo in different age groups.

Methods

This case–control study included 142 patients with vitiligo aging ≥ 6 years and 142 age‐ and sex‐matched controls. Participants were assessed for MetS using the International Diabetes Federation (IDF) criteria in addition to IR via homeostasis model assessment of IR (HOMA‐IR). The study was registered at Clinical Trials.gov, Identifier: NCT03622320, on August 9, 2018.

Results

As per the IDF criteria, patients with vitiligo showed significantly more frequent association with high fasting plasma glucose levels, high blood pressure readings, central obesity, dyslipidemia, and MetS than controls (p = 0.020, p = 0.034, p = 0.014, p < 0.001, and p = 0.002, respectively). Moreover, patients with vitiligo have significantly higher levels of fasting insulin and HOMA‐IR (p ≤ 0.001). Results obtained from patients with vitiligo and controls with coexistent MetS/IR demonstrated vitiligo as a risk factor for both MetS and IR. Univariate and multivariate logistic regression highlighted that older age was the significant independent predictor for MetS and IR.

Conclusion

Patients with vitiligo showed a significantly higher incidence of MetS than controls. Vitiligo per se can be considered a risk factor for MetS and IR. Therefore, regular follow‐up and early metabolic derangement diagnoses are mandatory.
Real‐world effectiveness and safety of collagenase clostridium histolyticum‐aaes injections for the treatment of thigh cellulite in women: An open‐label study interim analysis
Authors: Joseph John H. , Dayan Steven H. , Bhatia Ashish C. , Fabi Sabrina G. , Shridharani Sachin M. , Donofrio Lisa , Montes Jose R. , Palm Melanie D. , Liu Genzhou , Hernandez David , Edgecombe Jill , Vijayan Saji , Robinson Deanne Mraz
Published: October 2022

Background

Collagenase clostridium histolyticum‐aaes (CCH‐aaes) is approved in the United States for moderate‐to‐severe cellulite in the buttocks of adult women.

Aim

Interim analysis to evaluate efficacy/safety of CCH‐aaes in the treatment of thigh cellulite.

Methods

Data were analyzed from a phase 3, open‐label study (REAL). Women with mild‐to‐moderate cellulite on both thighs (Clinician Reported Photonumeric Cellulite Severity Scale score, 2 or 3) received ≤0.84 mg (volume, 18 ml) of CCH‐aaes subcutaneously, in up to 12 dimples per posterolateral thigh, in up to 3 treatment sessions (Days 1, 22, and 43). Follow‐up was on Day 90 (interim cutoff). A subset of women participated in the concurrent study (PIXELS), which included high‐definition photography and 3D‐image scanning of treatment areas.

Results

Twenty‐two women (44 thighs) were included in the interim analysis (mean age, 42.3 years; thighs with mild cellulite, 68.2%). Investigators reported high percentages of responders (score of “improved” or better on Investigator Global Aesthetic Improvement Scale) at Day 90 for either thigh (86.4%; primary endpoint) or both thighs (72.7%). Patient‐reported bother due to cellulite was reduced at Day 90; mean change was 15.3 points (85.5% reduction) in BODY‐Q Appraisal of Cellulite Scale total score (possible range, 11–44). In PIXELS analysis, Day 90 3D‐image scans showed improvement from baseline in skin roughness in some of the treated thigh areas. The most commonly reported adverse events were injection‐site bruising and pain (95.5% and 50.0% of patients, respectively).

Conclusions

CCH‐aaes treatment of mild‐to‐moderate thigh cellulite was effective and generally well tolerated, with markedly reduced cellulite‐related bother.
Efficacy and safety of thrombolytic therapy for portal venous system thrombosis: A systematic review and meta‐analysis
Authors: Gao Fangbo , Wang Le , Pan Jiahui , Yin Yuhang , Wang Jing , Xu Xiangbo , Xu Shixue , Mancuso Andrea , Qi Xingshun
Published: October 2022

Background and aims

The role of thrombolytic therapy in patients with portal venous system thrombosis (PVST) remains ambiguous. This study aimed to systematically collect available evidence and evaluate the efficacy and safety of thrombolysis for PVST.

Methods

Eligible studies were searched via PubMed, EMBASE, and Cochrane Library databases. Among the cohort studies, meta‐analyses were performed to assess the outcomes of PVST patients receiving thrombolysis. Pooled proportions were calculated. Among the case reports and case series, logistic regression analyses were performed to identify the risk factors for outcomes of PVST patients receiving thrombolysis. Odds ratios (ORs) were calculated.

Results

Among the 2134 papers initially identified, 29 cohort studies and 131 case reports or case series were included. Based on the cohort studies, the pooled rates of overall response to thrombolytic therapy, complete recanalization of PVST, bleeding events during thrombolysis, further bowel resection, thrombosis recurrence, and 30‐day mortality were 93%, 58%, 18%, 3%, 1%, and 4%, respectively. Based on the case reports and case series, acute pancreatitis (OR = 0.084), history of liver transplantation (OR = 13.346), and interval between onset of symptoms and initiation of thrombolysis ≤14 days (OR = 3.105) were significantly associated with complete recanalization of PVST; acute pancreatitis (OR = 6.556) was significantly associated with further bowel resection; but no factors associated with the overall response to thrombolytic therapy, bleeding events during thrombolysis, thrombosis recurrence, and 30‐day mortality were identified or could be calculated.

Conclusion

Early initiation of thrombolysis should be effective for the treatment of PVST. But its benefits for PVST secondary to acute pancreatitis are weakened.
Oral healthcare visits among sexual minority adolescents ages 14–18, 2019, USA
Authors: Griner Stacey B. , Yockey Robert A. , Forschner Caylee N.
Published: October 2022

Objective

Health disparities persist among sexual minority (SM) adolescents (i.e., bisexual, lesbian/gay) compared to heterosexual adolescents, however, research is limited on oral health. The purpose of this study was to examine reported recency of dental visits by sexual orientation among a national sample of adolescents.

Methods

Data from the 2019 Youth Risk Behavior Surveillance Survey (n = 12,673 adolescents, 14–18 years old) were analyzed. We assessed dental care in the past 12 months or more based on sexual orientation (“lesbian/gay,” “bisexual,” “not sure”). Adjusted, sex‐stratified, multinomial logistic regression analyses were used to determine conditional associations.

Results

Bisexual boys (aRR:2.50), “not sure” boys (aRR:3.55), and “not sure” girls (aRR:2.32) were at increased relative risk for not going to the dentist compared to heterosexual adolescents.

Conclusions

Findings indicate gaps in oral healthcare access among SM adolescents, specifically bisexual and not sure youth. Results can be used to increase access to preventive dental care among SM adolescents.
An assessment of compliance with optimal fluoride levels for oral health benefit by New Zealand drinking water suppliers
Authors: Chambers Tim , Hobbs Matt , Broadbent Jonathan M.
Published: October 2022

Objectives

Community water fluoridation (CWF) has proven oral health benefits. We investigated whether drinking water suppliers are meeting New Zealand CWF targets (0.7–1.0 ppm) to ensure these benefits.

Methods

We retrieved fluoride testing data from 25 supplies serving 2,059,000 people (82% of people on a fluoridated supply), for the years 1992–2022 (22,220 weekly observations). We descriptively assessed compliance with fluoride targets in this convenience sample.

Results

The mean fluoride level was 0.66 ppm (SD 0.28). Water suppliers achieved fluoride targets 54.1% of the time (range 4.2%–77.9%). Fluoride concentration fell short of the target in 42.2% of observations, exceeded but under the maximum acceptable value (MAV) in 3.6%, and in excess of the MAV in 0.1%. The percentage of compliant observations was greater in larger than smaller supplies.

Conclusions

Noncompliance with CWF targets was common. Epidemiological studies that rely on fluoridation status as their exposure may underestimate the oral health benefits of CWF. Our results highlight future challenges with the feasibility of expanding CWF under new legislation as well as the weaknesses in drinking water surveillance.
The genomic basis of reproductive and migratory behaviour in a polymorphic salmonid
Authors: Tigano Anna , Russello Michael A.
Published: October 2022

Recent ecotypic differentiation provides unique opportunities to investigate the genomic basis and architecture of local adaptation, while offering insights into how species form and persist. Sockeye salmon (Oncorhynchus nerka) exhibit migratory and resident (“kokanee”) ecotypes, which are further distinguished into shore‐spawning and stream‐spawning reproductive ecotypes. Here, we analysed 36 sockeye (stream‐spawning) and kokanee (stream‐ and shore‐spawning) genomes from a system where they co‐occur and have recent common ancestry (Okanagan Lake/River in British Columbia, Canada) to investigate the genomic basis of reproductive and migratory behaviour. Examination of the genomic landscape of differentiation, differences in allele frequencies and genotype–phenotype associations revealed three main blocks of sequence differentiation on chromosomes 7, 12 and 20, associated with migratory behaviour, spawning location and spawning timing. Structural variants identified in these same areas suggest they could contribute to ecotypic differentiation directly as causal variants or via maintenance of their genomic architecture through recombination suppression mechanisms. Genes in these regions were related to spatial memory and swimming endurance (SYNGAP, TPM3), as well as eye and brain development (including SIX6), potentially associated with differences in migratory behaviour and visual habitats across spawning locations, respectively. Additional genes (GREB1L, ROCK1) identified here have been associated with timing of migration in other salmonids and could explain variation in timing of O. nerka spawning. Together, these results based on the joint analysis of sequence and structural variation represent a significant advance in our understanding of the genomic landscape of ecotypic differentiation at different stages in the speciation continuum.
Meta‐analysis of major histocompatibility complex (MHC) class IIA reveals polymorphism and positive selection in many vertebrate species
Authors: Dearborn Donald C. , Warren Sophie , Hailer Frank
Published: October 2022

Pathogen‐mediated selection and sexual selection are important drivers of evolution. Both processes are known to target genes of the major histocompatibility complex (MHC), a gene family encoding cell‐surface proteins that display pathogen peptides to the immune system. The MHC is also a model for understanding processes such as gene duplication and trans‐species allele sharing. The class II MHC protein is a heterodimer whose peptide‐binding groove is encoded by an MHC‐IIA gene and an MHC‐IIB gene. However, our literature review found that class II MHC papers on infectious disease or sexual selection included IIA data only 18% and 9% of the time, respectively. To assess whether greater emphasis on MHC‐IIA is warranted, we analysed MHC‐IIA sequence data from 50 species of vertebrates (fish, amphibians, birds, mammals) to test for polymorphism and positive selection. We found that the number of MHC‐IIA alleles within a species was often high, and covaried with sample size and number of MHC‐IIA genes assayed. While MHC‐IIA variability tended to be lower than that of MHC‐IIB, the difference was only ~25%, with ~3 fewer IIA alleles than IIB. Furthermore, the unexpectedly high MHC‐IIA variability showed clear signatures of positive selection in most species, and positive selection on MHC‐IIA was stronger in fish than in other surveyed vertebrate groups. Our findings underscore that MHC‐IIA can be an important target of selection. Future studies should therefore expand the characterization of MHC‐IIA at both allelic and genomic scales, and incorporate MHC‐IIA into models of fitness consequences of MHC variation.
Teaching the tools: Focusing effort and engagement when improving medical education
Authors: Alexander Kirsty , Shearer Heather
Published: October 2022

Alexander and Shearer discuss how utilising Quality Improvement (QI) tools when planning and prioritising curriculum processes may reduce evaluation fatigue and increase stakeholders' sense of ownership in QI.