bluuebunny/crossref_metadata_2025 huggingface dataset:
The Dictator's Power‐Sharing Dilemma: Countering Dual Outsider Threats
Authors: Paine Jack
Published: September 2020

Dictators face a power‐sharing dilemma: Broadening elite incorporation mitigates prospects for outsider rebellions (by either elites excluded from power or the masses), but it raises the risk of insider coups. This article rethinks the theoretical foundations of the power‐sharing dilemma and its consequences. My findings contrast with and provide conditionalities for a “conventional threat logic,” which argues that large outsider threats compel dictators to create broader‐based regimes, despite raising coup risk. Instead, I analyze a game‐theoretic model to explain why the magnitude of the elite outsider threat ambiguously affects power‐sharing incentives. Dictators with weak coup‐proofing institutions or who face deeply entrenched elites take the opposite actions predicted by the conventional logic. An additional outsider threat from the masses can either exacerbate or eliminate the power‐sharing dilemma with elites, depending on elite affinity toward mass rule. Examining the elite‐mass interaction also generates new implications for how mass threats affect the likelihood of coups and regime overthrow.
Long‐term outcomes after plaque incision and grafting for Peyronie’s disease: comparison of porcine dermal and bovine pericardium grafts
Authors: Fiorillo Alessandro , Droghetti Matteo , Palmisano Franco , Bianchi Lorenzo , Piazza Pietro , Sadini Paolo , Masetti Martina , Molinaroli Enrico , Gentile Giorgio , Vagnoni Valerio , Franceschelli Alessandro , Colombo Fulvio
Published: September 2020

Background

Plaque incision and grafting (PEG) is one of the mainstays in surgical therapy for severe penile curvature in Peyronie’s disease (PD). Different kinds of grafts are available for covering albugineal defects during PEG, both allografts and xenografts. However, to date, none of these proved superior to others.

Objectives

To compare two different types of xenograft, porcine dermal matrix and bovine pericardium matrix in PEG for PD.

Materials and methods

From 2010 to 2019, 63 patients with PD underwent PEG, using porcine dermal (n = 25; Group 1) and bovine pericardium (n = 38; Group 2) grafts. Long‐term outcomes were evaluated through multi‐disciplinary questionnaires administration by phone interview. The following items were considered: correction of penile bending, quality of erection, intercourse ability, penile shortening, and sensitiveness. Overall satisfaction and impact of surgery on sexual activity and quality of life were also investigated.

Results

Plaque median (IQR) size was 29 (22‐33) mm and was smaller in Group 1 (27.5 vs. 31 mm; P = .03). Complete follow‐up data were available for 53 patients (84%). Considering post‐operative outcomes, no differences were found when considering ED rates, penile shortening, sensitiveness, complications, and penile straightening (all P > .1). Patients in Group 2 were more likely to have palpable penile nodules at follow‐up (20.6 vs. 0%; P = .03). However, patient’s post‐operative sexual life satisfaction was consistent between the two groups, with just 1 (5.3) and 8 (23.5) patients in Group 1 and 2 respectively referring a worsening in sexual life satisfaction (P = 0.2). At follow‐up, 84.9% of patients that would still undergo surgery for PD, with no statistical difference between the two groups (P = .4).

Conclusions

Corporoplasty with PEG is an effective treatment for men with PD. Porcine dermal and bovine pericardium xenografts seem to have similar long‐term outcomes.
Prolonged ECG with a novel recorder utilizing electrode belt and mobile device in patients with recent embolic stroke of undetermined source: A pilot study
Authors: Lumikari Tuomas Jussi , Pirinen Jani , Putaala Jukka , Sibolt Gerli , Kerola Anne , Pakarinen Sami , Lehto Mika , Nieminen Tuomo
Published: September 2020

Background

Paroxysmal atrial fibrillation (pAF) is a major risk factor for ischemic stroke, but challenging to detect with routine short‐term monitoring methods. In this pilot study, we present a novel method for prolonged ECG and screening for pAF in patients with a recent embolic stroke of unknown source (ESUS).

Methods

Fifteen patients aged ≥ 50 years with a recent ESUS were assigned to wear an external electrode belt‐based 1‐lead ECG device (Beat2Phone) continuously for 2 weeks (wear time). The device was operated via a mobile phone application in nonhospital conditions. The primary outcome was patient adherence to monitoring. Secondary outcomes were incidence of new pAF, quality‐wise comparison to Holter, and usability of the novel ECG monitoring method with Systems Usability Scale (SUS). We also performed a 24‐ to 48‐hr comparison between simultaneous Beat2Phone ECG and a standard Holter in 6 patients.

Results

Wear time of Beat2Phone device was over 80% in 5 (33.3%) patients, 50%–80% in 7 (46.6%) patients, and less than 50% in 3 (20%) patients. We detected pAF ≥ 30 s in 1 patient (6.7%). In the simultaneous monitoring with Beat2Phone and Holter, there were a total of 817 (out of 1979) analyzable periods of sinus rhythm or premature atrial or ventricular beats (Cohen's Kappa coefficient 0.92 ± 0.02 between Beat2Phone and Holter), and no pAF events. Beat2Phone ECG showed remarkable SUS scores in user evaluations (average score: 81.4 out of 100 on SUS).

Conclusions

Beat2Phone device was easy to use among ESUS patients and in optimal conditions provided high‐quality 1‐lead ECG signal for diagnosing pAF.

Clinical trial registration

The study was not registered, as it was a nonrandomized single‐arm pilot study.
The role of chromosomal microarray analysis among fetuses with normal karyotype and single system anomaly or nonspecific sonographic findings
Authors: Hui Annie Sy , Chau Matthew Hoi Kin , Chan Yiu Man , Cao Ye , Kwan Angel Hw , Zhu Xiaofan , Kwok Yvonne K. , Chen Zihan , Lao Terence T. , Choy Kwong Wai , Leung Tak Yeung
Published: September 2020

Introduction

Chromosomal microarray analysis is recommended as the first‐tier test for the evaluation of fetuses with structural anomalies. This study aims to investigate the incremental diagnostic yield of chromosomal microarray over conventional karyotyping analysis in fetuses with anomalies restricted to one anatomic system and those with nonspecific anomalies detected by sonography.

Material and methods

This is a retrospective cohort analysis of 749 fetuses undergoing prenatal diagnosis for abnormal ultrasound findings isolated to one anatomic system and normal karyotype, utilizing chromosomal microarray. Overall, 495 (66%) fetuses had anomalies confined to one anatomic system and 254 (34%) had other nonspecific anomalies including increased nuchal translucency (≥3.5 mm), cystic hygroma, intrauterine growth restriction and hydrops fetalis.

Results

Fetuses with ultrasound anomalies restricted to one anatomic system had a 3.0% risk of carrying a pathogenic copy number variant; the risk varied dependent on the anatomic system affected. Fetuses with confined anomalies of the cardiac system had the highest diagnostic yield at 4.6%, but there were none in the urogenital system. Fetuses with nonspecific ultrasound anomalies had the highest diagnostic yield in fetuses with an intrauterine growth restriction at 5.9%. Overall, fetuses with a nonspecific ultrasound anomaly were affected with pathogenic copy number variants in 1.6% in the cases.

Conclusions

The diagnostic yield of chromosomal microarray in fetuses with normal karyotype and ultrasound abnormality confined to a single anatomic system was highest if it involved cardiac defects or intrauterine growth restriction. This diagnostic yield ranges from 0% to 4.6% depending on the anatomic system involved. Chromosomal microarray has considerable diagnostic value in these pregnancies.
Characteristics and short‐term obstetric outcomes in a case series of 67 women test‐positive for SARS‐CoV‐2 in Stockholm, Sweden
Authors: Remaeus Katarina , Savchenko Julia , Brismar Wendel Sophia , Brusell Gidlöf Sebastian , Graner Sophie , Jones Elin , Molin Johanna , Saltvedt Sissel , Wallström Tove , Pettersson Karin
Published: September 2020

Introduction

The Stockholm region was the first area in Sweden to be hit by the pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). The national guidelines on the care of women with a positive test for SARS‐CoV‐2 (detection with polymerase chain reaction [PCR]) recommend individualized antenatal care, mode of delivery based on obstetric considerations, and no routine separation of the mother and the newborn. Breastfeeding is encouraged, and although there is no specific recommendation regarding wearing a face mask to prevent viral transmission to the newborn while nursing, instructions are given to keep high hygiene standards. All studies based on cases tested on hospital admission will capture more women with pregnancy complications than in the general population. Our aim was to describe the clinical characteristics of SARS‐CoV‐2‐positive women and their neonates, and to report short‐term maternal and neonatal outcomes.

Material and methods

A retrospective case series with data from medical records including all test‐positive women (n = 67) who gave birth to 68 neonates from 19 March to 26 April 2020 in Stockholm, Sweden. Means, proportions and percentages were calculated for clinical characteristics and outcomes.

Results

The mean age was 32 years, 40% were nulliparous and 61% were overweight or obese. Further, 15% had diabetes and 21% a hypertensive disease. Seventy percent of the women had a vaginal birth. Preterm delivery occurred in 19% of the women. The preterm deliveries were mostly medically indicated, including two women who were delivered preterm due to severe coronavirus disease 19 (COVID‐19), corresponding to 15% of the preterm births. Four women (6%) were admitted to the intensive care unit postpartum but there were no maternal deaths. There were two perinatal deaths (one stillbirth and one neonatal death). Three neonates were PCR‐positive for SARS‐CoV‐2 after birth.

Conclusions

In this case series of 67 women testing positive for SARS‐CoV‐2 with clinical presentations ranging from asymptomatic to manifest COVID‐19 disease, few women presented with severe COVID‐19 illness. The majority had a vaginal birth at term with a healthy neonate that was negative for SARS‐CoV‐2.
Intrapartum zigzag pattern of fetal heart rate is an early sign of fetal hypoxia: A large obstetric retrospective cohort study
Authors: Tarvonen Mikko , Hovi Petteri , Sainio Susanna , Vuorela Piia , Andersson Sture , Teramo Kari
Published: September 2020

Introduction

The aim of the present study was to identify possible associations of fetal heart rate (FHR) patterns during the last 2 hours of labor with fetal asphyxia expressed by umbilical artery acidemia at birth and with neonatal complications in a large obstetric cohort.

Material and methods

Cardiotocographic recordings from 4988 singleton term childbirths over 1 year were evaluated retrospectively and blinded to the pregnancy and neonatal outcomes in a university teaching hospital in Helsinki, Finland. Umbilical artery pH, base excess and pO2, low Apgar scores at 5 minutes, need for intubation and resuscitation, early neonatal hypoglycemia, and neonatal encephalopathy were used as outcome variables. According to the severity of the neonatal complications at birth, the cohort was divided into three groups: no complications (Group 1), moderate complications (Group 2) and severe complications (Group 3).

Results

Of the 4988 deliveries, the ZigZag pattern (FHR baseline amplitude changes of >25 bpm with a duration of 2‐30 minutes) occurred in 11.7%, late decelerations in 41.0%, bradycardia episodes in 52.9%, reduced variability in 36.7%, tachycardia episodes in 13.9% and uterine tachysystole in 4.6%. No case of saltatory pattern (baseline amplitude changes of >25 bpm with a duration of >30 minutes) was observed. The presence of the ZigZag pattern or late decelerations, or both, was associated with cord blood acidemia (odds ratio [OR] 3.3, 95% confidence interval [CI] 2.3‐4.7) and severe neonatal complications (Group 3) (OR 3.3, 95% CI 2.4‐4.9). In contrast, no significant associations existed between the other FHR patterns and severe neonatal complications. ZigZag pattern preceded late decelerations in 88.7% of the cases. A normal FHR preceded the ZigZag pattern in 90.4% of the cases, whereas after ZigZag episodes, a normal FHR pattern was observed in only 0.9%.

Conclusions

ZigZag pattern and late decelerations during the last 2 hours of labor are significantly associated with cord blood acidemia at birth and neonatal complications. The ZigZag pattern precedes late decelerations, and the fact that normal FHR pattern precedes the ZigZag pattern in the majority of the cases suggests that the ZigZag pattern is an early sign of fetal hypoxia, which emphasizes its clinical importance.
Is sleep deficit associated with infertility and recurrent pregnancy losses? Results from a prospective cohort study
Authors: Stocker Linden Jane , Cagampang Felino Ramon , Lu Shilong , Ladyman Tom , Cheong Ying Chin
Published: September 2020

Introduction

Biological rhythms, the innate cycle of changes in the body’s physiological functions, are circadian if they have a 24‐hour period. It is known that sleep is a key feature of human circadian rhythm but the relation between sleep and female fertility is largely unknown. This paucity of research is surprising given that circadian rhythms are paramount to human physiology and sleep is related to major female reproductive events. This study was designed to investigate whether there is a difference between the sleep and activity parameters of women with poor reproductive outcome compared with healthy, fertile parous women (comparator group) using subjective (questionnaires) and objective (actigraphy and light exposure) measures.

Material and methods

A prospective cohort study in a tertiary in vitro fertilization referral center in the UK; composed of three study groups: women diagnosed with recurrent implantation failure, women with recurrent miscarriage (RM) and a comparison group (fertile women without endometrial pathology). Comparison women were selected gynecology patients without endometrial disease (ie perineal complaints or altruistic egg donors). Primary outcome was differences in objective length of sleep in each of the participant groups using actigraphy. Secondary outcomes were subjective sleep quality and quantity, using participant questionnaires, light exposure, and the feasibility of machine learning in activity‐pattern interpretation.

Results

Women with recurrent implantation failure slept daily on average for 7 hours 35 minutes (± 57 min), 53 minutes less than the comparison group (P = .03), although quality of their objective sleep, and quantity of their subjective sleep, were not significantly different. Women with recurrent miscarriage slept less that the comparison women (36 minutes less/night) but more than women with recurrent implantation failure (17 minutes more/night). No difference in light exposure was found between recurrent miscarriage and the recurrent implantation failure and comparison groups.

Conclusions

This study demonstrates an objective observation of sleep time reduction in women with subfertility, although it is not yet clear if this association is casual. Given our increased understanding of the internal body clock and circadian rhythm on fertility, our observation warrants further investigation.
Three cases of Charles Bonnet Syndrome in patients with advanced glaucomatous visual field loss but preserved visual acuity
Authors: Lomo Trine , Singh Amardeep , Peters Dorothea
Published: September 2020

Purpose

To describe three cases of Charles Bonnet syndrome (CBS) in glaucoma patients with preserved visual acuity.

Methods

Three glaucoma patients who had taken part in a recent CBS study were interviewed about their hallucinations. The patients underwent macular optical coherence tomography (OCT) of both eyes. The visual function was evaluated with visual field measurement (Humphrey visual field analyser) and visual acuity testing (Snellen scale).

Results

All three patients had preserved visual acuity (≥0.5 in both eyes) and at least one eye with advanced visual field defect (Mean Deviation worse than −12.00 decibel). They all reported vivid visual hallucinations with insight into the unreal nature of the hallucinations.

Conclusion

Charles Bonnet syndrome can occur in glaucoma despite preserved visual acuity. Awareness of this relation is desirable among clinicians, as it will improve communication with patients.
Prevalence and risk factors for depressive symptoms in patients with neovascular age‐related macular degeneration who present for anti‐VEGF therapy
Authors: Vu Kim Van , Mitchell Paul , Dharamdasani Detaram Harshil , Burlutsky George , Liew Gerald , Gopinath Bamini
Published: September 2020

Purpose

To examine the prevalence and risk factors for depressive symptoms in patients with neovascular age‐related macular degeneration (nAMD) presenting for anti‐vascular endothelial growth factor (anti‐VEGF) therapy.

Methods

In a clinic‐based cohort of 547 patients with nAMD who presented for treatment, the Centre of Epidemiological Studies Depression 10‐point scale (CES‐D‐10) and Mental Health Index (MHI) component of the 36‐item Short Form Survey were administered to assess for the presence of depressive symptoms. Logistic regression analyses were used to calculate odds ratios and 95% confidence intervals for factors associated with an increased likelihood of depressive symptoms.

Results

The prevalence of depressive symptoms was 42.04% and 31.78% as per the CES‐D‐10 and MHI scales, respectively. Poor self‐rated health (SRH) is associated with increased odds of depressive symptoms [multivariable‐adjusted OR: 3.00 (95% CI 1.90–4.73) for CES‐D‐10; OR: 2.67 (95% CI 1.67–4.28) for MHI]. Impaired activities of daily living (ADLs) [multivariable‐adjusted OR: 2.62 (95% CI 1.56–4.38) for CES‐D‐10; OR: 3.59 (95% CI 2.10–6.15) for MHI] and a visual function score within the two lowest quartiles were also associated with increased odds of depressive symptoms using both scales.

Conclusion

A high prevalence of depressive symptoms was observed among nAMD patients presenting for treatment. Poorer SRH, ADL impairment and reduced visual function were associated with increased odds of depressive symptoms.
Birth weight increases with birth order despite decreasing maternal pregnancy weight gain
Authors: Bohn Claudia , Vogel Mandy , Poulain Tanja , Spielau Ulrike , Hilbert Cornelia , Kiess Wieland , Körner Antje
Published: September 2020

Aim

We investigated whether birth order is an influencing factor for birth weight independent from maternal factors.

Methods

Data were obtained from the longitudinal cohort study LIFE Child and included 1864 children, of which 526 were only children. The 1338 siblings were ranked into first‐borns (n = 570), second‐borns (n = 606) and third‐or‐later‐borns (n = 162). Children born prematurely, suffering from chronic or syndromic diseases, were excluded. We performed intra‐family comparisons to reduce bias and assessed the impact of perinatal parameters, such as birth order on birth weight, using mixed models.

Results

Birth weight increased with birth order. In univariate analyses, birth order had a significant effect on birth weight‐SDS with second‐borns having 0.29 SDS (app. 130 g) and third‐borns 0.40 SDS (app. 180 g) higher values than first‐borns (P < .001). Maternal pregnancy weight gain was associated with higher birth weight‐SDS (P < .01) in univariate analysis, though maternal pregnancy weight gain was lower for higher birth orders. Multivariate analyses revealed that being a second or third‐or‐later‐born child had a stronger impact on birth weight than all maternal factors.

Conclusion

Birth order must be considered a potential risk factor for higher birth weight. Maternal pregnancy weight gain is not the driving factor for higher birth weight in siblings.
A possible interplay between HR‐HPV and stemness in tumor development: an in vivo investigation of CD133 as a putative marker of cancer stem cell in HPV18‐infected KB cell line
Authors: de Maria Salvatore , Santoro Angela , Fuggetta Maria Pia , Rocchetti Romina , Cottarelli Andrea , Lanzilli Giulia , Stiuso Paola , Angelico Giuseppe , Spadola Saveria , Franco Zannoni Gian , Rubini Corrado , Emanuelli Monica , Carmela Pedicillo Maria , Pannone Giuseppe , Muzio Lorenzo Lo
Published: September 2020

High‐risk HPVs (HR‐HPVs) are DNA viruses considered as primary etiologic factors in malignancies of the low female genital tract. Their presence has also been documented in oropharyngeal and laryngeal cancers. However, HPV infection is considered a necessary but not sufficient cause of tumoral development; meantime, increasing evidences on the tumorigenic role of cancer stem cells (CSCs) have been documented in the literature. CSCs represent a small subpopulation of neoplastic cells with self‐renewal potential, capable of maintaining tumor growth and cell differentiation, also involved in metastatic process, recurrence, and resistance to chemotherapeutic agents. In the present study, performed on KB cell lines, we evaluated the tumor forming potential of CSCs, and their relationship with the HPV infection status. We started our study by identifying the most aggressive cell line on the minimal number of cells being able of growth in vivo in a model of athymic nude mice (BALB/c nu/nu). We used an oral‐derived KB cell line separated in the KB‐CD133+ and KB‐CD133‐ populations, by using immunomagnetic beads and fluorescence‐activated cell sorting (FACS). The separated populations were injected in athymic nude mice (BALB/c nu/nu). Xenograft tumors have been analyzed for tumor size, CD133 expression by immunohistochemistry (IHC) and for DNA HR‐HPV integration by in situ hybridization (ISH), comparing CD133‐enriched xenograft tumors versus the CD133 non‐enriched ones. On standard conditions, the KB cell line has a poor population of glycosylated CD133 marker (<5.0%) when investigated with antibodies versus CD133, and more specifically its glycosylated epitope (AC133). Enriched CD133 KB cells possess a higher capacity of tumor growth in xenograft models of nude mice when compared to KB CD133‐negative cells. We observed that the AC133 epitope, extensively used to purifying hematopoietic stem cells, is able to select an epithelial subpopulation of cancer stem cells with aggressive behavior. We retain that CD133 may be a useful target in anticancer strategies including pharmacological and immunological therapies.
Where is the city in “The Right to the City”? The colliding politics of place‐making in a resettlement colony in Delhi’s periphery
Authors: Bose Debangana
Published: September 2020

This paper reframes the motto of the right to the city by examining the colliding practices of place‐making among diverse residents such as displaced slum dwellers, rural migrants, and low‐income newcomers in a resettlement colony in Delhi's periphery. Moving beyond this conceptualisation of the “city” within the right to the city motto as an emancipatory and ideal one, I shed light on the “kind” of a city the diverse actors produce in Delhi's periphery. Refraining from suggesting a normative conceptualisation, I argue that the right to the city as practised on the ground is also a right to co‐create an ever‐emerging city with colliding trajectories of opportunities and constraints beyond an inclusive and emancipatory city, as generally perceived.
Larval cranial anatomy of the Eastern Ghost Frog (Heleophryne orientalis)
Authors: Lukas Paul
Published: September 2020

Heleophryne orientalis is endemic to the Western Cape Province of South Africa. Its tadpole lives in swift‐flowing mountain streams attached to rocks and feeding on algae. Little is known about the morphology of Heleophrynids despite their important systematic position as sister taxon to all remaining Neobatrachians. Herein, I describe the external morphology as well as skeletal and muscular features of a tadpole of H. orientalis at Gosner stage 28 by using standard histology and 3D reconstruction. Derived features of this tadpole include the presence of two additional mandibular cartilages and a suprarostral cartilage without any muscular attachments. A mandibulosuprarostral ligament is absent. The presence of two M. levator mandibulae longus profundus portions and the post‐orbital origination of the M. suspensorioangularis is unusual in anuran tadpoles.
Alterations in resting‐state global brain connectivity in bipolar I disorder patients with prior suicide attempt
Authors: Cheng Xiaofang , Chen Jianshan , Zhang Xiaofei , Zhang Yihe , Wu Qiuxia , Ma Qing , Sun Jiaqi , Zou Wenjin , Lin Taifeng , Zhong Liangda , Deng Wenhao , Sun Xiaoyi , Cui Liqian , Cheng Xiongchao , Chen Yingmei , Cai Yinglian , Zheng Chaodun , Cheng Daomeng , Yang Chanjuan , Ye Biyu , Zhang Xiangyang , Wei Xinhua , Cao Liping
Published: September 2020

Background

Bipolar I disorder (BD‐I) is associated with a high risk of suicide attempt; however, the neural circuit dysfunction that confers suicidal vulnerability in individuals with this disorder remains largely unknown. Resting‐state functional magnetic resonance imaging (rs‐fMRI) allows non‐invasive mapping of brain functional connectivity. The current study used an unbiased voxel‐based graph theory analysis of rs‐fMRI to investigate the intrinsic brain networks of BD‐I patients with and without suicide attempt.

Methods

A total of 30 BD‐I patients with suicide attempt (attempter group), 82 patients without suicide attempt (non‐attempter group), and 67 healthy controls underwent rs‐fMRI scan, and then global brain connectivity (GBC) was computed as the sum of connections of each voxel with all other gray matter voxels in the brain.

Results

Compared with the non‐attempter group, we found regional differences in GBC values in emotion‐encoding circuits, including the left superior temporal gyrus, bilateral insula/rolandic operculum, and right precuneus (PCu)/cuneus in the bipolar disorder (BD) attempter group, and these disrupted hub‐like regions displayed fair to good power in distinguishing attempters from non‐attempters among BD‐I patients. GBC values of the right PCu/cuneus were positively correlated with illness duration and education in the attempter group.

Conclusions

Our results indicate that abnormal connectivity patterns in emotion‐encoding circuits are associated with the increasing risk of vulnerability to suicide attempt in BD patients, and global dysconnectivity across these emotion‐encoding circuits might serve as potential biomarkers for classification of suicide attempt in BD patients.
Effectiveness of immersive virtual reality using head‐mounted displays on learning performance: A meta‐analysis
Authors: Wu Bian , Yu Xiaoxue , Gu Xiaoqing
Published: September 2020

With the availability of low‐cost high‐quality head‐mounted displays (HMDs) since 2013, there is a growing body of literature investigating the impact of immersive virtual reality (IVR) technology on education. This meta‐analysis aims to synthesize the findings on the overall effects of IVR using HMDs compared to less immersive desktop virtual reality (DVR) and other traditional means of instruction. A systematic search was carried out on the literature published between 2013 and 2019. Thirty‐five randomized controlled trials (RCTs) or quasi‐experimental studies were identified. We conducted an analysis using the random effects model (REM) to calculate the pooled effect size. The studies were also coded to examine the moderating effects of their characteristics, such as learner stage, learning domain, learning application type, testing format, control group treatment and learning duration, on the outcome measure. The results showed that IVR using HMDs is more effective than non‐immersive learning approaches with a small effect size (ES = 0.24). The key findings of the moderator analysis were that HMDs have a greater impact (a) on K‐12 learners; (b) in the fields of science education and specific abilities development; (c) when offering simulation or virtual world representations; and (d) when compared with lectures or real‐world practices. The meta‐analysis also suggested that HMDs can improve both knowledge and skill development, and maintain the learning effect over time.

Practitioner Notes

What is already known about this topic

Head‐mounted displays (HMDs) have been widely applied in various disciplines across both K‐12 and post‐secondary education.

HMDs have a positive impact on learning attitudes and perceptions.

HMDs have produced mixed results on learning performance.

What this paper adds

Immersive virtual reality (IVR) using HMDs is more effective than non‐immersive learning approaches with a small effect size.

The critical factors of learning implementation and research design moderate the impact of HMDs on learning performance.

HMDs can improve both knowledge and skill development and maintain the learning effect over time.

Implications for practice and/or policy

HMD‐based immersive learning appears to be a better complement to non‐immersive learning approaches.

Theory‐driven learning design should be incorporated to guide HMD‐based teaching and learning practice.
Essentialism affects the perceived compatibility of minority culture maintenance and majority culture adoption preferences
Authors: Moftizadeh Nali , Zagefka Hanna , Mohamed Abdinasir
Published: September 2020

This paper presents two cross‐sectional survey studies, both conducted in Britain, which focus on how different cultural identities are managed in multicultural settings. Specifically, the studies explored the extent to which essentialism moderates the perceived compatibility of acculturation orientations, heritage culture maintenance and majority culture adoption. In study 1, participants (N = 198) were Somali minority members living in the UK. It was found when minority members essentialized Britishness themselves, and when they perceived that British people essentialized Britishness, they saw a desire to maintain the culture of origin and a desire adopt the majority culture as conflicting with each other. In study 2, participants (N = 200) were white British majority members living in the UK. Findings showed that when white British majority members essentialized Britishness, they too perceived the two acculturation preferences as being incompatible with each other. Taken together, these studies show that essentializing British identity can lead to a view that the majority and minority cultures are mutually exclusive. Implications for intergroup relations and integration into British society are discussed.
Inhibition of γ‐glutamyltransferase ameliorates ischaemia‐reoxygenation tissue damage in rats with hepatic steatosis
Authors: Kubota Ryuichi , Hayashi Nobuhiko , Kinoshita Kaori , Saito Takashi , Ozaki Kazuaki , Ueda Yoshimichi , Tsuchishima Mutsumi , Tsutsumi Mikihiro , George Joseph
Published: September 2020

Background and Purpose

Hepatic steatosis may be associated with an increased γ‐glutamyltransferase (γ‐GT) levels. Ischaemia‐reoxygenation (IR) injury causes several deleterious effects. We evaluated the protective effects of a selective inhibitor of γ‐GT in experimentally induced IR injury in rats with obesity and steatosis.

Experimental Approach

Otsuka Long‐Evans Tokushima Fatty (OLETF) rats with hepatic steatosis were used in the current study. The portal vein and hepatic artery of left lateral and median lobes were clamped to induce ischaemia. Before clamping, 1 ml of saline (IR group) or 1‐ml saline containing 1 mg·kg−1 body weight of GGsTop (γ‐GT inhibitor; IR‐GGsTop group) was injected into the liver via the inferior vena cava. Blood flow was restored after at 30 min of the start of ischaemia. Blood was collected before, at 30 min after ischaemia and at 2 h and 6 h after reoxygenation. All the animals were killed at 6 h and the livers were collected.

Key Results

Treatment with GGsTop resulted in significant reduction of serum ALT, AST and γ‐GT levels and hepatic γ‐GT, malondialdehyde, 4‐hydroxy‐2‐nonenal and HMGB1 at 6 h after reoxygenation. Inhibition of γ‐GT retained normal hepatic glutathione levels. There was prominent hepatic necrosis in IR group, which is significantly reduced in IR‐GGsTop group.

Conclusion and Implications

Treatment with GGsTop significantly increased hepatic glutathione content, reduced hepatic MDA, 4‐HNE and HMGB1 levels and, remarkably, ameliorated hepatic necrosis after ischaemia‐reoxygenation. The results indicated that GGsTop could be an appropriate therapeutic agent to reduce IR‐induced liver injury in obesity and steatosis.
Quebec’s resilient redistribution model: Activation policies in the 2010s
Authors: Dinan Shannon , Noël Alain
Published: September 2020

Compared to the rest of Canada, Quebec has an ambitious and redistributive social model, which includes an elaborate set of Active Labour Market Policies (ALMP), with higher expenditures as a percentage of GDP, an encompassing coverage, and collaborative, multipartite governance arrangements. Since the 2008 recession, however, most OECD countries have implemented retrenchment measures, market enforcement, and individual action plans to their ALMP. Using provincial, federal, and OECD data and reports, this article maps the recent evolution of Quebec’s ALMP in light of these trends. Quebec’s model appears largely resilient, despite declining expenditures and modest concessions to conditionality in social assistance.
A Mendelian randomization study identified obesity as a causal risk factor of uterine endometrial cancer in Japanese
Authors: Masuda Tatsuo , Ogawa Kotaro , Kamatani Yoichiro , Murakami Yoshinori , Kimura Tadashi , Okada Yukinori
Published: September 2020

Causal inference is one of the challenges in epidemiologic studies. Gynecologic diseases have been reported to have association with obesity, however the causality remained controversial except for uterine endometrial cancer. We conducted two‐sample Mendelian randomization (MR) analysis using the large‐scale genome‐wide association study (GWAS) results of gynecologic diseases and body mass index (BMI) in the Japanese population to assess causal effect of BMI on gynecologic diseases. We first conducted GWAS of ovarian cancer, uterine endometrial cancer, uterine cervical cancer, endometriosis, and uterine fibroid (n = 647, 909, 538, 5236, and 645 cases, respectively, and 39 556 shared female controls), and BMI (81 610 males and non‐overlapping 23 924 females). We then applied two‐sample MR using 74 BMI‐associated variants as instrumental variables. We observed significant causal effect of increased BMI on uterine endometrial cancer (β = 0.735, P = .0010 in inverse variance‐weighted analysis), which is concordant with results of European studies. Causal effect of obesity was not apparent in the other gynecologic diseases tested. Our MR analyses provided strong evidence of the causal role of obesity in gynecologic diseases etiology, and suggested a possible preventive effect of intervention for obesity.
Efficacy of argon‐helium cryoablation and its effects on immune function of patients with neck malignant tumours
Authors: Zheng Zheng , Zhao Yingchun , An Yonghui , Li Na , Bo Changwen , Ma Wenhua , Guo Ying , Zou Changpeng , Tian Bo , Zhang Sujing
Published: September 2020

Objectives

Our study aimed to investigate the clinical efficacy of argon‐helium cryoablation and its effects on the immune function of patients with neck malignant tumours.

Design

Retrospective study.

Setting

Single‐institution academic tertiary care centre.

Methods

Totally, 180 patients harbouring head and neck malignant tumours were divided into the argon‐helium cryoablation group (n = 150) and the radiotherapy group (n = 50). The efficacy of the two groups was compared, and the immune function was observed.

Results

The short‐term clinical effect of the argon‐helium cryoablation group was significantly higher than that of the radiotherapy group (P < .05). After treatment, the CD3+, CD4+, CD8+ and CD4+/CD8+ of the argon‐helium cryoablation group were significantly better than those of the radiotherapy group (P < .001). The results of TNF‐α, IL‐1 β and CRP in the argon‐helium cryoablation group were significantly better than that in the radiotherapy group (P < .001).

Conclusion

Argon‐helium cryoablation could effectively improve the immune function, 5‐year survival rate and local remission rate.
Impact of a community‐acquired pneumonia care bundle in North East England from 2014 to 2017—A quality improvement project
Authors: Morrow Gerry , Roberts Anthony , Newton Julia , Rees Jon , Walkley Michael , Flavell Linda
Published: September 2020

Objectives

To explore the impact of implementation of Community‐Acquired Pneumonia (CAP) quality care bundle.

Setting

Eight acute hospitals in the North East of England and North Cumbria.

Participants

ICD‐10 coded CAP aged >18 were identified. A total of 16 201 CAP patients were discharged 2016/2017 (15 707; 2015/2016 and 10 733; 2014/2015).

Outcome measures

Secondary User Service (SUS) data were collected monthly from April 2014 to 2017. Data were pseudonymised and data flows governed by Data Sharing Agreements. CAP measures were based on British Thoracic Society guidance and agreed following clinician consultation. CAP admissions and individual organisational compliance with and impact of, CAP quality bundle measures was explored.

Results

Average length of stay (LOS) was 10.4 days (median 6) 25% >13 days. Crude in‐hospital mortality rate was 17.6%, significantly lower (95% CI) than 19.1% in 2015/2016 and 19.3% in 2014/2015. Emergency readmissions within 28 days were 19.7% (19.2%; 2015/2016, 17.9%; 2014/2015). A total of 39.5% of patients received all appropriate care measures. Compliance has improved over time, although not for all hospitals. Most quality measures have higher mortality for those passing measures compared to those failing (P < .05 95% CI). Giving oxygen, had a significantly higher emergency readmission rate, 3.3% higher (95% CI 1.1% to 5.5%). Appropriate antibiotics and recording CURB‐65 scores reduced the emergency readmission rates (−2.7% (95% CI −4.5% to −0.8%) −2.6% (95% CI −3.8% to −1.4%), respectively, (P = ns)).

Conclusion

CAP accounts for significant bed days, mortality and readmissions. Although mortality was lower, LOS and readmission rates were not, despite improvements in compliance after implementation of the care bundle. Care bundle use remained sub‐optimal.
Sensitisation of severe asthma in different occupations: A multicentre study in China
Authors: Hu Haisheng , Xue Mingshan , Wei Nili , Zheng Peiyan , Wu Ge , An Nairui , Huang Huimin , Sun Baoqing
Published: September 2020

Objective

This was the first multicentre study assessing the sensitisation patterns in patients with severe asthma by different occupations as well as different regions of China, and aimed to provide evidence for the prevention of sensitised patients with severe asthma.

Methods

A total of 676 adults were included and assigned to three cohorts. Cohort A was comprised of severe asthma patients without smoking (n = 454), cohort B comprised severe asthmatic patients who were ex‐smokers (n = 149), and cohort C comprised non‐asthma individuals (n = 73). All study subjects underwent testing of serum sIgE level of house dusts mix (hx2), foods mix (fx5), moulds mix (mx2), tree pollen mix (tx4) and weed pollen mix (wx5) simultaneously.

Results

Overall, the positive rates of hx2, fx5, mx2, tx4 and wx5 were 37.6%, 11.9%, 16.6%, 9.0% and 9.5% in severe asthmatic patients, respectively. Comparing cohort A with cohort B, the hx2 positive rates in cohort A were higher in fulltime homemaker (30.0% vs. 0.0%) and medical staff (40.0% vs. 0.0%, P < 0.05). However, the mx2 positive rates in cohort B were higher in businessman (30.0% vs. 7.0%) and the tx4 positive rates in cohort B were higher in drivers (35.7% vs. 0.0%, P < 0.05). The optimal scale analysis showed that severe asthmatic patients who work indoor were more prone to be allergic to house dusts (Cronbach's alpha = 76.4%).

Conclusion

Patients with severe asthma in different occupations exhibited different sensitisation patterns. Avoid being contact with house dust and application of indoor air purifier should be considered for severe asthma patients.
Radioactive seeds insertion with chemotherapy for advanced non‐small‐cell lung cancer: A meta‐analysis
Authors: Wu Hong , Li Lei , Yang Jing , Yang Zhi‐Min
Published: September 2020

Background

Non‐small‐cell lung cancers (NSCLCs) are only eligible to undergo curative surgical resection in <20% of patients. In patients with inoperable NSCLC, computed tomography (CT)‐guided radioactive seed insertion (RSI) is a common treatment practice.

Objectives

To assess the relative efficacy of chemotherapy alone versus chemotherapy in combination with CT‐guided RSI in patients with advanced NSCLC.

Methods

We searched the Pubmed, Embase, and Cochrane Library databases for relevant articles published as of July 2020. Complete and total response rates (CR and TR, respectively) served as the primary endpoints for this meta‐analysis, with disease control (DC) rate, myelosuppression rate, progression‐free survival (PFS), overall survival (OS), and CT‐guided RSI‐related pneumothorax serving as secondary endpoints.

Results

In total, eight studies incorporating 281 patients that underwent combination treatment and 297 patients that underwent chemotherapy along were included in this meta‐analysis. The CR (21.5% vs. 4.0%, P < 0.00001), TR (73.8% vs. 42.6%, P < 0.00001), and DC (94.1% vs. 78.2%, P < 0.00001) rates were significantly higher for patients in the combined treatment group relative to patients in the chemotherapy only group. Furthermore, pooled PFS (P < 0.00001) and OS (P = 0.0006) were significantly longer for patients in the combined treatment group, whereas no differences in pooled myelosuppression rates were observed between groups (34.3% vs. 30.7%, P = 0.47). The pooled rate of CT‐guided RSI‐related pneumothorax was 15%.

Conclusions

Combination chemotherapy and CT‐guided RSI can significantly improve clinical response and prolong survival in advanced‐stage NSCLC patients without inducing other significant toxic side effects.
The relation between distant metastasis and genetic change type in stage IV lung adenocarcinoma patients at diagnosis
Authors: Ermin Sinem , Batum Özgür , Saka Güvenç Merve , Diniz Gülden , Ayrancı Aysu , Erdoğan Kadri Murat , Yücel Nur , Yıldırım Eylem , Özdemir Taha Reşid , Hacar Alev Gülşah , Güldaval Filiz , Koç Altuğ , Aydoğdu Zekiye , Balcı Günseli , Özyılmaz Berk , Akşit Yaşar Hacer , Özer Kaya Özge , Gayaf Mine , Kırbıyık Özgür , Aksel Nimet , Kutbay Yaşar Bekir , Ursavaş Tuba Nihal , Karadeniz Gülistan , Polat Gülru , Kömürcüoğlu Berna , Çırak Ali Kadri , Yılmaz Ufuk
Published: September 2020

Introduction

Brain metastasis prevalence is higher in patients with positive epidermal growth factor receptor (EGFR) mutation, anaplastic lymphoma kinase (ALK) and C‐ROS oncogene 1 (ROS‐1) fusion change in lung adenocarcinoma.

Objectives

The purpose of our study is to investigate the relation between the genetic change type and the initial distant metastasis in stage IV lung adenocarcinoma patients with genetic changes.

Methods

The study was conducted between January 2007 and December 2018 in a retrospective fashion with patients who had lung cancer diagnosed as stage IV adenocarcinoma. The relation between genetic mutation change (EGFR, ALK or ROS‐1) and distant metastasis was analysed.

Results

A total of 845 patients were included in the study. The median age was 62 (28‐88). It was determined that lung and pleura metastases were more frequent at a significant level in patients with positive EGFR mutation (P = 0.032, P = 0.004, respectively). In patients with positive ALK fusion change, pleura metastasis was determined to be more frequent (P = 0.001). Multiple metastases were determined to be significantly more in patients with positive ALK fusion change than single metastasis (P = 0.02).

Conclusion

In patients with EGFR mutant lung adenocarcinoma, lung and pleura metastasis is more frequent and pleura metastasis is more frequent in ALK positive adenocarcinoma. Additionally, multiple organ metastases are higher in ALK positive lung adenocarcinoma.
Newly diagnosed multiple myeloma patients treated with tandem auto‐allogeneic stem cell transplant have better overall survival with similar outcomes at time of relapse compared to patients who received autologous transplant only
Authors: LeBlanc Richard , Claveau Jean‐Sébastien , Ahmad Imran , Delisle Jean‐Sébastien , Bambace Nadia , Bernard Léa , Cohen Sandra , Kiss Thomas , Lachance Silvy , Landais Séverine , Roy Denis Claude , Sauvageau Guy , Roy Jean
Published: September 2020

Background

Long‐term survival in patients progressing after tandem autologous‐allogeneic stem cell transplant (SCT) has been reported, suggesting a persistent graft‐vs‐myeloma (GvM) effect even after post‐transplant progression.

Methods

In order to confirm this observation, we updated the results of our previously published cohort of 92 newly diagnosed myeloma patients who received tandem transplant and compared them with 81 contemporary patients who received autologous transplant only.

Results

With a median follow‐up of 13.1 and 10.2 years, respectively, median overall survival (OS) in the tandem group has not been reached, compared with 6.1 years after auto‐SCT (P ≤ .001). Disease progression occurred less frequently after tandem transplant, with an estimated 10‐year cumulative incidence of 49% vs 76% (P ≤ .001). Cumulative incidence of extensive chronic graft‐vs‐host disease (cGVHD) was high at 83%, with modest benefits on OS (60% vs 49%, P = .550) but sharp improvement of progression‐free survival (PFS; 55% vs 10%, P = .002) at 10 years associated with development of cGVHD. After first progression, median OS was 5.8 years in tandem and 5.2 years in the auto‐group (P = .062); median PFS was also similar.

Conclusion

Despite confirmation of better outcomes after upfront tandem transplant, our data do not support persistence of a strong, clinically significant graft‐vs‐myeloma effect after first progression, emphasizing the need to better characterize the GvM effect.
A retrospective cohort study exploring diltiazem as a pharmaco‐enhancer for tacrolimus, in a post–heart transplant setting
Authors: Lodha Abhijit R. , Pillai Ashwin , Sheth Kaushik , Hiremath Jagdish
Published: September 2020

Background

A significant proportion of heart transplant–associated expenditure are attributable to immunosuppressants. Post‐transplant hypertension adds to the pill burden and subsequent costs. In this study, we describe the effect of diltiazem—the antihypertensive and pharmaco‐enhancer—on reducing the required oral dose of tacrolimus.

Methods

We included 17 recipients who had successfully undergone heart transplants but later developed post‐transplant hypertension and were treated with diltiazem. Serum trough levels of the immunosuppressant tacrolimus were measured every 2 weeks. Required doses before and after the introduction of diltiazem were compared. Patients were assessed at each follow‐up visit for any evidence of toxicity. Medication‐related expenditure was estimated based on government‐mandated standardized retail price.

Results

The power of the study was 98.92% at α = 0.05. The mean tacrolimus dose required prior to initiation of diltiazem was 5.85 ± 1.55 mg. After initiating diltiazem, the mean required doses reduced to 2.88 ± 1.24 mg (p < .0001). Relatively, the required doses reduced by 52.4 ± 10.9%—independently of age, sex, and dose of diltiazem. Medication‐related monthly expenditure reduced by 50.3 ± 10.4%. No patient demonstrated evidence of toxicity.

Conclusions

Concomitant use of diltiazem and tacrolimus can safely, effectively, and predictably reduce the required dose of tacrolimus and significantly reduce corresponding costs.