bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of ecological specialization in shaping patterns of insular communities
Authors: Sfenthourakis Spyros , Triantis Kostas A. , Proios Konstantinos , Rigal Francois 
Published: November 2020

AbstractAimResearch on the response of species richness to area and environmental heterogeneity so far has not addressed possible effects of species’ differences in ecological specialization. Herein we provide a new metric, ‘ecorichness’, in an attempt to fill this gap.LocationAegean islands (Greece).TaxonTerrestrial isopods.Methods‘Ecorichness’ estimates an island's biodiversity by integrating species richness and the specialists‐generalists spectrum. We calculated ‘ecorichness’ for terrestrial isopods from 43 Aegean islands based on the habitats they exploit. ‘Ecorichness’ then was regressed on area, habitat diversity and the K‐parameter of the Choros model using linear and quadratic models, compared based on AICc. A reduced data set, without halophilous species and coastal habitats, as well as an alternative description of habitat diversity, also was explored. The small island effect (SIE) thresholds identified using both a path analysis approach and piecewise continuous linear models were compared to the area of maximum ‘ecorichness’.Results‘Ecorichness’ response to area and habitat heterogeneity was best fitted by quadratic models with peaks located at an area similar to the SIE threshold identified by path analysis. Different measures of habitat diversity produced similar patterns. Exclusion of coastal species and habitats shows that the response of ‘ecorichness’ to area is mostly shaped by the increasing contribution of specialists in the assemblages of larger islands.Main conclusions‘Ecorichness’ facilitates exploration of the role of ecological specialization in shaping community patterns. It can be applied to different community data sets, whenever habitat range exploitation can be quantified. Results from the case study accord with previous suggestions that the relative contribution of generalists and specialists differs between small and large island communities.
Embryology of the naso‐palatal complex in Gekkota based on detailed 3D analysis in Lepidodactylus lugubris and Eublepharis macularius
Authors: Kaczmarek Paweł , Metscher Brian , Rupik Weronika 
Published: November 2020

AbstractThe vomeronasal organ (VNO), nasal cavity, lacrimal duct, choanal groove, and associated parts of the superficial (soft tissue) palate are called the naso‐palatal complex. Despite the morphological diversity of the squamate noses, little is known about the embryological basis of this variation. Moreover, developmental data might be especially interesting in light of the morpho‐molecular discordance of squamate phylogeny, since a ‘molecular scenario’ implies an occurrence of unexpected scale of homoplasy also in olfactory systems. In this study, we used X‐ray microtomography and light microscopy to describe morphogenesis of the naso‐palatal complex in two gekkotans: Lepidodactylus lugubris (Gekkonidae) and Eublepharis macularius (Eublepharidae). Our embryological data confirmed recent findings about the nature of some developmental processes in squamates, for example, involvement of the lateral nasal prominence in the formation of the choanal groove. Moreover, our study revealed previously unknown differences between the studied gekkotans and allows us to propose redefinition of the anterior concha of Sphenodon. Interpretation of some described conditions might be problematic in the phylogenetic context, since they represent unknown: squamate, nonophidian squamate, or gekkotan features.
Bioactivity of abobotulinum toxin is preserved till 2 weeks upon storage at room temperature: Half body comparative study on rabbit model
Authors: Esme Pelin , Botsali Aysenur , Erbil Hakan , Aksoy Okan Ali , Caliskan Ercan 
Published: November 2020

AbstractBackgroundBreakages of the cold chain of botulinum neurotoxin A (BONT‐A) preparations is not a rare event and occurs due to several unexpected and unintentional reasons during daily practice and intervention schedules could not be proposed due to the lack of data.ObjectiveTo investigate the heat stability of abobotulinum toxin A (AboBONT‐A) in terms of efficacy and duration of action upon storage at room temperature (25°C) for 2, 4, and 8 weeks.Methods and MaterialsTwenty rabbits were divided into four groups and received an injection of ideally stored AboBONT‐A (Group 1) and stored AboBONT‐A for 2 (Group 2), 4 (Group 3), and 8 weeks (Group 4) at room temperature into the anterior auricular muscle. All rabbits were followed up and photographed by weekly for 16 weeks. Grade of paralysis was evaluated by using a modified visual scoring system.ResultsNo significant alteration was found in initial potency of stored AboBONT‐A at room temperature for up to 4 weeks. Storage at room temperature for 2 weeks did not affect the duration of action (group 2; P = .69), and faster recovery was observed in group 3 and group 4.ConclusionThe bioactivity of AboBONT‐A is not altered till 2 weeks upon storage at room temperature.
How long and how much? Wait times and costs for initial private child mental health appointments
Authors: Mulraney Melissa , Lee Cindy , Freed Gary , Sawyer Michael , Coghill David , Sciberras Emma , Efron Daryl , Hiscock Harriet 
Published: November 2020

AimTo determine: (i) wait times and out‐of‐pocket costs for children attending private specialists for initial mental health appointments; and (ii) whether these differed between specialists working in metropolitan versus rural areas and in low, medium and high socio‐economic areas.MethodsProspective secret shopper study whereby a researcher posed as a parent seeking an appointment for her child with anxiety or attention‐deficit/hyperactivity disorder. We contacted 317 private paediatrician, psychiatrist and psychologist practices in Victoria and South Australia between 12 March and 5 May 2019.ResultsOne third (29.8%) of private practices were closed to new referrals. The average wait times for paediatricians, psychiatrists, and psychologists were 44, 41 and 34 days, respectively. Average out‐of‐pocket costs quoted were AU$120 for paediatricians, AU$176 for psychiatrists and AU$85 for psychologists.ConclusionParents face extensive wait times and substantial out‐of‐pocket costs when seeking private mental health services for their child.
Comparing prescribing patterns for topical corticosteroids based on their FDA indication by age
Authors: Freeze Megan E. , Balogh Esther A. , Cline Abigail , Feldman Steven R. , Fleischer Alan B. 
Published: November 2020

AbstractBackground/ObjectivesAtopic dermatitis (AD) affects up to 20% of the pediatric population, with a growing prevalence over the past 30 years. Topical corticosteroids (TCS) are commonly used as a first‐line topical therapy for AD and are prescribed in 59% of all AD visits. However, some topical corticosteroids are prescribed outside of their age range indications. This paper aims to explore the frequency with which topical corticosteroids are prescribed for AD outside of their FDA‐approved age range.MethodsData on prescribing patterns for AD were obtained from the National Ambulatory Medical Care Survey (NAMCS). We assessed the frequency of off‐label use of topical corticosteroids with respect to age indications in four specific age‐groups, as delineated in the data (0‐1, 2‐7, 8‐18, and 19+ years).ResultsAll prescribed topical corticosteroids found in the NAMCS database have an indication for AD or other inflammatory dermatoses or pruritic dermatoses. However, some medications were prescribed outside of their FDA‐approved age indications. These off‐label prescription rates ranged from 52% for desoximetasone to 0% for halobetasol and alclometasone, or rates lower than could be detected by our study.ConclusionsMuch like other medications for AD treatment, TCS are sometimes used off‐label. The off‐label use of topical corticosteroids to treat pediatric AD highlights a gap between clinical practice and regulating guidelines. Additional pediatric studies would offer a greater body of evidence to maintain or expand label indications for the use of TCS in younger patients.
Robust Tests for Treatment Effect in Survival Analysis under Covariate-Adaptive Randomization
Authors: Ye Ting , Shao Jun 
Published: November 2020

SummaryCovariate-adaptive randomization is popular in clinical trials with sequentially arrived patients for balancing treatment assignments across prognostic factors that may have influence on the response. However, existing theory on tests for the treatment effect under covariate-adaptive randomization is limited to tests under linear or generalized linear models, although the covariate-adaptive randomization method has been used in survival analysis for a long time. Often, practitioners will simply adopt a conventional test to compare two treatments, which is controversial since tests derived under simple randomization may not be valid in terms of type I error under other randomization schemes. We derive the asymptotic distribution of the partial likelihood score function under covariate-adaptive randomization and a working model that is subject to possible model misspecification. Using this general result, we prove that the partial likelihood score test that is robust against model misspecification under simple randomization is no longer robust but conservative under covariate-adaptive randomization. We also show that the unstratified log-rank test is conservative and the stratified log-rank test remains valid under covariate-adaptive randomization. We propose a modification to variance estimation in the partial likelihood score test, which leads to a score test that is valid and robust against arbitrary model misspecification under a large family of covariate-adaptive randomization schemes including simple randomization. Furthermore, we show that the modified partial likelihood score test derived under a correctly specified model is more powerful than log-rank-type tests in terms of Pitman’s asymptotic relative efficiency. Simulation studies about the type I error and power of various tests are presented under several popular randomization schemes.
First report of cross resistance to silver and antibiotics in Klebsiella pneumoniae isolated from patients and polluted water in Tunisia
Authors: Ben Miloud Samar , Ali Md Muntasir , Boutiba Ilhem , Van Houdt Rob , Chouchani Chedly 
Published: November 2020

AbstractKlebsiella pneumoniae, ubiquitously found in a variety of environmental sources, is an important pathogen in burn wounds and nosocomial infections. Burn wounds have been commonly treated with silver compounds, which are also used in a multitude of (non)medical products. As the latter increased silver discharge into different environments, we evaluated and compared silver resistance in K. pneumoniae isolates collected from patients hospitalized at the Charles‐Nicolle hospital (Tunis, Tunisia) with isolates collected from different metal polluted waters in the north and south of Tunisia. All K. pneumoniae isolates harboured blaTEM‐1 and blaSHV‐1. In addition, all clinical isolates showed a multidrug phenotype and harboured the blaCTX‐M‐15, blaOXA‐1 and blaNDM‐1. Furthermore, all isolates showed resistance to silver nitrate. The silver resistance determinant, screened via the silE gene, was located for all isolates on a large plasmid with a size similar to pMG101. This study showed cross‐resistance between silver and beta‐lactams in clinical as well as environmental K. pneumoniae isolates from Tunisia and showed for the first time that NDM‐1‐producing K. pneumoniae developed resistance to silver.
Calibration of an Electrical Analog Model of Liver Hemodynamics in Fontan Patients
Authors: Abbasi Bavil Elyar , Doyle Matthew G. , Debbaut Charlotte , Wald Rachel M. , Mertens Luc , Forbes Thomas L. , Amon Cristina H. 
Published: November 2020

Abstract
Fontan associated liver disease is a common complication in patients with Fontan circulation, who were born with a single functioning heart ventricle. The hepatic venous pressure gradient (HVPG) is used to assess liver health and is a surrogate measure of the pressure gradient across the entire liver (portal pressure gradient (PPG)). However, it is thought to be inaccurate in Fontan patients. The main objectives of this study were (1) to apply an existing detailed lumped parameter model (LPM) of the liver to Fontan patients using patient-specific clinical data and (2) to determine whether HVPG is a suitable measurement of PPGs in these patients. An existing LPM of the liver blood circulation was applied and tuned to simulate patient-specific liver hemodynamics. Geometries were collected from seven adult Fontan patients and used to evaluate model parameters. The model was solved and tuned using waveform measurements of flows, inlet and outlet pressures. The predicted ratio of portal to hepatic venous pressures is comparable to in vivo measurements. The results confirmed that HVPG is not suitable for Fontan patients, as it would underestimate the portal pressures gradient by a factor of 3 to 4. Our patient-specific liver model provides an estimate of the pressure drop across the liver, which differs from the clinically used metric HVPG. This work represents a first step toward models suitable to assess liver health in Fontan patients and improve its long-term management.
Seroprevalence of SARS-CoV-2 antibodies in children: a prospective multicentre cohort study
Authors: Waterfield Thomas , Watson Chris , Moore Rebecca , Ferris Kathryn , Tonry Claire , Watt Alison , McGinn Claire , Foster Steven , Evans Jennifer , Lyttle Mark David , Ahmad Shazaad , Ladhani Shamez , Corr Michael , McFetridge Lisa , Mitchell Hannah , Brown Kevin , Amirthalingam Gayatri , Maney Julie-Ann , Christie Sharon 
Published: November 2020

BackgroundStudies based on molecular testing of oral/nasal swabs underestimate SARS-CoV-2 infection due to issues with test sensitivity, test timing and selection bias. The objective of this study was to report the presence of SARS-CoV-2 antibodies, consistent with previous infection.DesignThis multicentre observational cohort study, conducted between 16 April to 3 July 2020 at 5 UK sites, recruited children of healthcare workers, aged 2–15 years. Participants provided blood samples for SARS-CoV-2 antibody testing and data were gathered regarding unwell contacts and symptoms.Results1007 participants were enrolled, and 992 were included in the final analysis. The median age of participants was 10·1 years. There were 68 (6.9%) participants with positive SARS-CoV-2 antibody tests indicative of previous SARS-CoV-2 infection. Of these, 34/68 (50%) reported no symptoms prior to testing. The presence of antibodies and the mean antibody titre was not influenced by age. Following multivariable analysis four independent variables were identified as significantly associated with SARS-CoV-2 seropositivity: known infected household contact OR=10.9 (95% CI 6.1 to 19.6); fatigue OR=16.8 (95% CI 5.5 to 51.9); gastrointestinal symptoms OR=6.6 (95% CI 3.0 to 13.8); and changes in sense of smell or taste OR=10.0 (95% CI 2.4 to 11.4).DiscussionChildren demonstrated similar antibody titres in response to SARS-CoV-2 irrespective of age. Fatigue, gastrointestinal symptoms and changes in sense of smell or taste were the symptoms most strongly associated with SARS-CoV-2 antibody positivity.Trial registration numberNCT0434740.
Agreement and predictive value of the Rockwood Clinical Frailty Scale at emergency department triage
Authors: Shrier William , Dewar Colin , Parrella Piervirgilio , Hunt David , Hodgson Luke Eliot 
Published: November 2020

AimTo determine the agreement and predictive value of emergency department (ED) triage nurse scoring of frailty using the Rockwood Clinical Frailty Scale (CFS) when compared with inpatient medical assessment using the same scale.MethodsProspective, dual-centre UK-based study over a 1-year period (1 April 2017 to 31 March 2018) of CFS recorded digitally at nursing triage on ED arrival and on hospital admission by a medical doctor. Inclusion criteria were emergency medical admission in those aged ≥65 staying at least one night in hospital with a CFS completed in both ED and at hospital admission. Agreement between ED triage nurse and inpatient hospital physician was assessed using a weighted Kappa statistic and Spearman’s correlation coefficient. The ability of the ED to diagnose frailty (defined by a CFS ≥5) was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and receiver operating characteristic (ROC) curves. At both time points the ability of the CFS to predict inpatient mortality was also assessed.ResultsFrom 29 211 admissions aged ≥65 who stayed at least one night in hospital, 12 385 (42.3%) were referred from the ED. Of the ED referrals, 8568 cases (69.2%) were included with paired CFS performed. Median age was 84 (IQR 77 to 89) with an inpatient mortality of 6%. Median CFS in ED was 4 (3 to 5) and on hospital admission 5 (4 to 6). Agreement between the ED CFS and admission CFS was weak (Kappa 0.21, 95% CI 0.19 to 0.22, rs0.366). The area under the ROC curve (AUC) was 0.67 (95% CI 0.66 to 0.68) for the ED CFS ability to predict an admission CFS ≥5. To predict inpatient mortality the ED CFS AUC was 0.56 (0.53 to 0.59) and admission CFS AUC 0.70 (0.68 to 0.73).ConclusionAgreement between ED CFS and inpatient CFS was found to be weak. In addition the ability of ED CFS to predict clinically important outcomes was limited. NPV and PPV for ED CFS cut-off value of ≥5 were found to be low. Further work is required on the feasibility, clinical impact and appropriate tools for screening of frailty in EDs.
Secondary transfer of emergency stroke patients eligible for mechanical thrombectomy by air in rural England: economic evaluation and considerations
Authors: Coughlan Diarmuid , McMeekin Peter , Flynn Darren , Ford Gary A , Lumley Hannah , Burgess David , Balami Joyce , Mawson Andrew , Craig Dawn , Rice Stephen , White Phil 
Published: November 2020

BackgroundMechanical thrombectomy (MT) is a time-sensitive emergency procedure for patients who had ischaemic stroke leading to improved health outcomes. Health systems need to ensure that MT is delivered to as many patients as quickly as possible. Using decision modelling, we aimed to evaluate the cost-effectiveness of secondary transfer by helicopter emergency medical services (HEMS) compared with ground emergency medical services (GEMS) of rural patients eligible for MT in England.MethodsThe model consisted of (1) a short-run decision tree with two branches, representing secondary transfer transportation strategies and (2) a long-run Markov model for a theoretical population of rural patients with a confirmed ischaemic stroke. Strategies were compared by lifetime costs: quality-adjusted life years (QALYs), incremental cost per QALY gained and net monetary benefit. Sensitivity and scenario analyses explored uncertainty around parameter values.ResultsWe used the base case of early-presenting (<6 hours to arterial puncture) patient aged 75 years who had stroke to compare HEMS and GEMS. This produced an incremental cost-effectiveness ratio (ICER) of £28 027 when a 60 min reduction in travel time was assumed. Scenario analyses showed the importance of the reduction in travel time and futile transfers in lowering ICERs. For late presenting (>6 hours to arterial puncture), ground transportation is the dominant strategy.ConclusionOur model indicates that using HEMS to transfer patients who had stroke eligible for MT from remote hospitals in England may be cost-effective when: travel time is reduced by at least 60 min compared with GEMS, and a £30 000/QALY threshold is used for decision-making. However, several other logistic considerations may impact on the use of air transportation.
Technical factors associated with first-pass success during endotracheal intubation in children: analysis of videolaryngoscopy recordings
Authors: Miller Kelsey A , Monuteaux Michael C , Nagler Joshua 
Published: November 2020

BackgroundFirst-pass success (FPS) during intubation is associated with lower morbidity for paediatric patients. Using videolaryngoscopy (VL) recordings, we reviewed technical aspects of intubation, including factors associated with FPS in children.MethodsWe performed a retrospective study of intubation attempts performed using video-assisted laryngoscopy in a paediatric ED between January 2014 and December 2018. Data were abstracted from a quality assurance database, the electronic medical record and VL recordings. Our primary outcome was FPS. Intubation practices were analysed using descriptive statistics. Patient and procedural characteristics associated with FPS in univariate testing and clinical factors identified from the literature were included as covariates in a multivariable logistic regression. An exploratory analysis examined the relationship between position of the glottic opening on the video screen and FPS.ResultsIntubation was performed during 237 patient encounters, with 231 using video-assisted laryngoscopy. Data from complete video recordings were available for 129 attempts (59%); an additional 31 (13%) had partial recordings. Overall, 173 (73%) of first attempts were successful. Adjusting for patient age, placing the blade tip into the vallecula adjusted OR ((aOR) 7.2 (95% CI 1.7 to 30.1)) and obtaining a grade 1 or 2a-modified Cormack-Lehane glottic view on the videolaryngoscope screen (aOR 6.1 (95% CI 1.5 to 25.7) relative to grade 2b) were associated with increased FPS in the subset of patients with complete recordings. Exploratory analysis suggested that FPS is highest (81%) and duration is shortest when the glottic opening is located in the second quintile of the video screen.ConclusionsPlacement of the blade tip into the vallecula regardless of blade type, sufficient glottic visualisation and locating the glottic opening within the second quintile of the video screen were associated with FPS using video-assisted laryngoscopy in the paediatric ED.
Exosomes derived from Fusobacterium nucleatum-infected colorectal cancer cells facilitate tumour metastasis by selectively carrying miR-1246/92b-3p/27a-3p and CXCL16
Authors: Guo Songhe , Chen Jun , Chen Fangfang , Zeng Qiuyao , Liu Wan-Li , Zhang Ge 
Published: November 2020

ObjectiveExosomes released from tumour cells are packed with unique RNA and protein cargo, and they are emerging as an important mediator in the communication network that promotes tumour progression. The facultative intracellular bacterium Fusobacterium nucleatum (Fn) is an important colorectal cancer (CRC)-associated bacterium. To date, the function of exosomes from Fn-infected CRC cells has not been explored.DesignExosomes were isolated by sequential differential centrifugation and verified by transmission electron microscopy, NanoSight analysis and Western blotting. Given that exosomes have been shown to transport miRNAs and proteins to alter cellular functions, we performed miRNA sequencing and proteome analysis of exosomes from Fn-infected and non-infected cells. The biological role and mechanism of exosomes from Fn-infected cells in CRC tumour growth and liver metastasis were determined in vitro and in vivo.ResultsWe demonstrated that exosomes delivered miR-1246/92b-3p/27a-3p and CXCL16/RhoA/IL-8 from Fn-infected cells into non-infected cells to increase cell migration ability in vitro and promote tumour metastasis in vivo. Finally, both circulating exosomal miR-1246/92b-3p/27a-3p and CXCL16 levels were closely associated with Fn abundance and tumour stage in patients with CRC.ConclusionThis study suggests that Fn infection may stimulate tumour cells to generate miR-1246/92b-3p/27a-3p-rich and CXCL16/RhoA/IL-8 exosomes that are delivered to uninfected cells to promote prometastatic behaviours.