bluuebunny/crossref_metadata_2025_split huggingface dataset:
Democracy in flux: a systemic view on the impact of COVID-19
Authors: Parry Lucy J. , Asenbaum Hans , Ercan Selen A. 
Published: December 2020

Purpose
The purpose of this paper is to demonstrate how a systemic view of democracy can provide insights into the myriad ways in which the COVID-19 pandemic affects democracies worldwide. This enables the authors to offer practical suggestions for strengthening democracy through meaningful participation in the spaces where deficits are most apparent.

Design/methodology/approach
The authors use the systems approach that has emerged from the deliberative and participatory democracy literature in recent years to map out the impacts of COVID-19. In this paper, the authors set out this approach as an agenda for future, more comprehensive research.

Findings
The authors’ preliminary overview suggests that democratic spaces are reconfigured during COVID-19, with participatory spaces shrinking, overlapping and invading each other. Based on the systemic overview, the authors suggest participatory interventions to address particular points of weakness such as accountability.

Originality/value
Taking a systemic approach to analysing COVID-19’s impacts on democracy enables the authors to understand the pressure points where democratic values and participation are under strain and where citizens’ participation is essential not only for strengthening democracy but also addressing the public health challenge of COVID-19.
Predicting the global invasion of Drosophila suzukii to improve Australian biosecurity preparedness
Authors: Maino James L. , Schouten Rafael , Umina Paul 
Published: December 2020

Abstract

Predicting biological invasions remains a challenge to applied ecologists and limits pre‐emptive management of biosecurity threats. In the last decade, spotted‐wing drosophila Drosophila suzukii has emerged as an internationally significant agricultural pest as it rapidly spread across Europe and the Americas. However, the underlying drivers of its global invasion remain unstudied, while countries like Australia, presently free from D. suzukii, require robust estimates of spread and establishment potential to aid development of effective preparedness strategies.

Here, we analysed the ecoclimatic and human‐mediated drivers of the global invasion of D. suzukii to understand historical spread patterns and improve forecasts of future spread potential. Using a modular approach, climate‐driven population dynamics were linked in space via dispersal processes to simulate spread at continental scales. Combined with biological parameters measured in laboratory studies, the spread model was parameterized and validated on international spread data.

Model accuracy was high and was able to predict 83% of regional presence–absence through time in the United States and, without further model fitting, 78% of the variation in the Europe incursion. Omitting human‐assisted spread from the model reduced predictability by over 20%, highlighting the large anthropogenic influence in this modern biological invasion. Economic activity (GDP) rather than human population density was more strongly associated with human‐mediated spread. Simulations predicted that eastern Australian coastal regions, particularly those near major cities with high economic activity, will result in the fastest spread of D. suzukii.

Synthesis and applications. Incursions of Drosophila suzukii into Australia will have significant consequences for horticultural industries with the predicted speed of spread making eradication programs extremely difficult. However, the identified areas of significant fruit production, and high environmental suitability and economic activity will form a logical means for prioritizing industry preparedness. In light of our findings, a key component of preparedness strategies will be the ability of fruit producers to rapidly transition to effective management of D. suzukii.
Understanding how health systems facilitate primary care redesign
Authors: Harvey Jillian B. , Vanderbrink Jocelyn , Mahmud Yasmin , Kitt‐Lewis Erin , Wolf Laura , Shaw Bethany , Ridgely M. Susan , Damberg Cheryl L. , Scanlon Dennis P. 
Published: December 2020

AbstractObjectiveTo understand how health systems are facilitating primary care redesign (PCR), examine the PCR initiatives taking place within systems, and identify barriers to this work.Study SettingA purposive sample of 24 health systems in 4 states.Study DesignData were systematically reviewed to identify how system leaders define and implement initiatives to redesign primary care delivery and identify challenges. Researchers applied codes which were based on the theoretical PCR literature and created new codes to capture emerging themes. Investigators analyzed coded data then produced and applied a thematic analysis to examine how health systems facilitate PCR.Data CollectionSemi‐structured telephone interviews with 162 system executives and physician organization leaders from 24 systems.Principal FindingsLeaders at all 24 health systems described initiatives to redesign the delivery of primary care, but many were in the early stages. Respondents described the use of centralized health system resources to facilitate PCR initiatives, such as regionalized care coordinators, and integrated electronic health records. Team‐based care, population management, and care coordination were the most commonly described initiatives to transform primary care delivery. Respondents most often cited improving efficiency and enhancing clinician job satisfaction, as motivating factors for team‐based care. Changes in payment and risk assumption as well as community needs were commonly cited motivators for population health management and care coordination. Return on investment and the slower than anticipated rate in moving from fee‐for‐service to value‐based payment were noted by multiple respondents as challenges health systems face in redesigning primary care.ConclusionsGiven their expanding role in health care and the potential to leverage resources, health systems are promising entities to promote the advancement of PCR. Systems demonstrate interest and engagement in this work but face significant challenges in getting to scale until payment models are in alignment with these efforts.
Are health systems redesigning how health care is delivered?
Authors: Scanlon Dennis P. , Harvey Jillian B. , Wolf Laura J. , Vanderbrink Jocelyn M. , Shaw Bethany , Shi Yunfeng , Mahmud Yasmin , Ridgely M. Susan , Damberg Cheryl L. 
Published: December 2020

AbstractObjectiveTo explore why and how health systems are engaging in care delivery redesign (CDR)—defined as the variety of tools and organizational change processes health systems use to pursue the Triple Aim.Study SettingA purposive sample of 24 health systems across 4 states as part of the Agency for Healthcare Research and Quality's Comparative Health System Performance Initiative.Study DesignAn exploratory qualitative study design to gain an “on the ground” understanding of health systems’ motivations for, and approaches to, CDR, with the goals of identifying key dimensions of CDR, and gauging the depth of change that is possible based on the particular approaches to redesign care being adopted by the health systems.Data CollectionSemi‐structured telephone interviews with health system executives and physician organization leaders from 24 health systems (n = 162).Principal FindingsWe identify and define 13 CDR activities and find that the health systems’ efforts are varied in terms of both the combination of activities they are engaging in and the depth of innovation within each activity. Health system executives who report strong internal motivation for their CDR efforts describe more confidence in their approach to CDR than those who report strong external motivation. Health system leaders face uncertainty when implementing CDR due to a limited evidence base and because of the slower than expected pace of payment change.ConclusionsThe ability to validly and reliably measure CDR activities—particularly across varying organizational contexts and markets—is currently limited but is key to better understanding CDR’s impact on intended outcomes, which is important for guiding both health system decision making and policy making.
Descriptive morphometry and stereology in accessing the testis structure and function of the marsupial Philander frenatus (Olfers, 1818) (Didelphimorphia: Didelphidae)
Authors: Ferreira Vanessa de Freitas , Dias Fernanda Carolina Ribeiro , Costa Kyvia Lugate Cardoso , da Matta Sérgio Luis Pinto , de Melo Fabiano Rodrigues , de Melo Fabiana Cristina Silveira Alves 
Published: December 2020

AbstractPhilander frenatus is an important marsupial for the maintenance and conservation of the Atlantic Rainforest, however, it has biological characteristics that are still little explored. The study of the reproductive biology is an important key to understand the species reproductive strategies and to improve the development of conservation and management activities. The present study aimed to conduct a histological and morphometric investigation of the testis structure and function of P. frenatus. The average body and testicular weight were 445 g and 0.74 g, respectively, with a gonadosomatic index of 0.17%. The seminiferous tubules occupying 64.95% of the organ, totalising 9.26 m per gram of testis. The tubulesomatic and epitheliumsomatic indexes were 0.10% and 0.07%, respectively. Philander frenatus showed cell loss of approximately 98% during the proliferative phase and the spermatogenic yield was 10.3 cells. The high loss during the mitotic phase contributed to the low spermatogenic yield. The testicular parenchyma was composed of 35% of intertubular components, one of the highest proportions observed in mammals. Leydig cells were responsible for approximately 25% of the testes, followed by lymphatic space (6.44%), blood vessels and connective tissue (4% together). The organisation of the intertubular components resembles the Fawcett III category. The volume and number of Leydig cell per gram of testis were 2,627.12 µm3 and 91.28 × 106 cells, respectively. High investment in the intertubular compartment, specifically number and volume of Leydig cells in P. frenatus is consistent with territorial behaviour and polygynic mating system, which have greater androgenic capacity.
Will the asthma revolution fostered by biologics also benefit adult ICU patients?
Authors: Bourdin Arnaud , Charriot Jérémy , Boissin Clément , Ahmed Engi , Suehs Carey , De Sevin Arthur , Volpato Mathilde , Pahus Laurie , Gras Delphine , Vachier Isabelle , Halimi Laurence , Hamerlijnck Dominic , Chanez Pascal 
Published: December 2020

AbstractPurposeAsthma exacerbations are inflammatory events that rarely result in full hospitalization following an ER visit. Unfortunately, certain patients require prolonged support, including occasional external lung support through ECMO or ECCOR (with subsequent further exposure to other life‐threatening issues), and some die. In parallel, biologics are revolutionizing severe asthma management, mostly in T2 high patients.MethodsWe extensively reviewed the current unmet needs surrounding ICU‐admitted asthma exacerbations, with a focus on currently available drugs and the underlying biological processes involved. We explored whether currently available T2‐targeting drugs can reasonably be seen as potential players not only for relapse prevention but also as candidate drugs for a faster resolution of such episodes. The patient's perspective was also sought.ResultsAbout 30% of asthma exacerbations admitted to the ICU do not resolve within five days. Persistent severe airway obstruction despite massive doses of corticosteroids and maximal pharmacologically induced bronchodilation is the main cause of treatment failure. Previous ICU admission is the main risk factor for such episodes and may eventually be considered as a T2 surrogate marker. Fatal asthma cases are hallmarked by poorly steroid‐sensitive T2‐inflammation associated with severe mucus plugging. New, fast‐acting T2‐targeting biologics (already used for preventing asthma exacerbations) have the potential to circumvent steroid sensitivity pathways and decrease mucus plugging. This unmet need was confirmed by patients who reported highly negative, traumatizing experiences.ConclusionsThere is room for improvement in the management of ICU‐admitted severe asthma episodes. Clinical trials assessing how biologics might improve ICU outcomes are direly needed.
The structural evolution of pull‐apart basins in response to changes in plate motion
Authors: Farangitakis Georgios‐Pavlos , McCaffrey Ken J. W. , Willingshofer Ernst , Allen Mark B. , Kalnins Lara M. , van Hunen Jeroen , Persaud Patricia , Sokoutis Dimitrios 
Published: December 2020

AbstractPull‐apart basins are structural features linked to the interactions between strike‐slip and extensional tectonics. Their morphology and structural evolution are determined by factors such as extension rate, the basin length/width ratio, and changes in extension direction. In this work, we investigate the effect of a change in the plate motion direction on a pull‐apart basin's structure, using analogue modelling experiments with a two‐layer ductile‐brittle configuration to simulate continental crust rheology. We initially impose orthogonal extension on an interconnected rift and strike‐slip system to drive pull‐apart development. Subsequently, we rotate the relative motion vector, imposing transtensional deformation and continuing with this new relative motion vector to the end of the experiment. To compare with natural examples, we analyse the model using seismic interpretation software, generating 3D fault structure and sedimentary thickness interpretations. Results show that the change in the direction of plate motion produces map‐view sigmoidal oblique slip faults that become normal‐slip when deformation adjusts to the new plate motion vector. Furthermore, sediment distribution is strongly influenced by the relative plate rotation, changing the locus of deposition inside the basin at each model stage. Finally, we compare our observations to seismic reflection images, sedimentary package thicknesses and fault interpretations from the Northern Gulf of California and find good agreement between model and nature. Similar fault arrays occur in the Bohai Basin in northern China, which suggests a rotational component in its evolution. More broadly, such similar structures could indicate a role for oblique extension and fault rotation in any pull‐apart basin.
Risk stratification for the prognosis of patients with chemoresistant urothelial cancer treated with pembrolizumab
Authors: Kobayashi Takashi , Ito Katsuhiro , Kojima Takahiro , Kato Minoru , Kanda Souhei , Hatakeyama Shingo , Matsui Yoshiyuki , Matsushita Yuto , Naito Sei , Shiga Masanobu , Miyake Makito , Muro Yusuke , Nakanishi Shotaro , Kato Yoichiro , Shibuya Tadamasa , Hayashi Tetsutaro , Yasumoto Hiroaki , Yoshida Takashi , Uemura Motohide , Taoka Rikiya , Kamiyama Manabu , Ogawa Osamu , Kitamura Hiroshi , Nishiyama Hiroyuki ,   the Japan Urological Oncology Group
Published: December 2020

AbstractThe use of immune checkpoint inhibitors to treat urothelial carcinoma (UC) is increasing rapidly without clear guidance for validated risk stratification. This multicenter retrospective study collected clinicopathological information on 463 patients, and 11 predefined variables were analyzed to develop a multivariate model predicting overall survival (OS). The model was validated using an independent dataset of 292 patients. Patient characteristics and outcomes were well balanced between the discovery and validation cohorts, which had median OS times of 10.2 and 12.5 mo, respectively. The final validated multivariate model was defined by risk scores based on the hazard ratios (HRs) of independent prognostic factors including performance status, site of metastasis, hemoglobin levels, and the neutrophil‐to‐lymphocyte ratio. The median OS times (95% confidence intervals [CIs]) for the low‐, intermediate‐, and high‐risk groups (discovery cohort) were not yet reached (NYR) (NYR–19.1), 6.8 mo (5.8‐8.9), and 2.3 mo (1.2‐2.6), respectively. The HRs (95% CI) for OS in the low‐ and intermediate‐risk groups vs the high‐risk group were 0.07 (0.04‐0.11) and 0.23 (0.15‐0.37), respectively. The objective response rates for in the low‐, intermediate‐, and high‐risk groups were 48.3%, 28.8%, and 10.5%, respectively. These differential outcomes were well reproduced in the validation cohort and in patients who received pembrolizumab after perioperative or first‐line chemotherapy (N = 584). In conclusion, the present study developed and validated a simple prognostic model predicting the oncological outcomes of pembrolizumab‐treated patients with chemoresistant UC. The model provides useful information for external validation, patient counseling, and clinical trial design.
全基因體定序對兒童神經疾病的診斷率和治療影響
Authors: 秀芬 李 , 上 遲景 , 啟仁 蔡 
Published: December 2020

目的探討全基因體定序 (WGS) 對兒童神經疾病的診斷率及治療影響。方法從 2016 年 1 月至 2019 年 12 月, 使用全基因體定序對疑似患有遺傳性神經疾病的兒科病人進行評估。符合條件的病人依其臨床表現型分為四組: 神經發展障礙病人、癲癇病人、神經肌肉疾病病人及運動障礙病人。我們描述全基因體定序的診斷率及經全基因體定序確診後對病人治療的影響。結果共有 214 例病人 (男性 128 例, 女性 86 例) 接受了全基因體定序檢測, 病人平均 (SD) 發病年齡為 13.8 (27.6) 個月, 範圍為 1 天至 15 年 5 個月, 接受全基因體定序檢測的平均 (SD) 年齡為 71.7 (58.9) 個月, 範圍從 8 天到 18 歲。 43.9% 的病人經由全基因體定序檢測得到診斷, 其中診斷率最高的是神經肌肉疾病病人 62.5%, 其餘依序為癲癇病人 47.5%, 神經發展障礙病人 41.1% 及運動障礙病人 15.4%。 94位經全基因體定序診斷的病人均獲得了遺傳諮詢, 並有 23.4% 的病人在接受全基因體定序確診後立即改變了治療策略。解釋全基因體定序使兒童神經科醫師能夠將基因體數據整合到臨床診斷, 並針對此一臨床上遺傳異質性疾病調整治療策略, 進而改善病人的臨床預後。我們的研究中, 顯著比例的病人經由全基因體定序得到診斷 (43.9%), 臨床醫師可依這些結果直接調整病人的治療方向, 進而改善病人的臨床預後 (23.4%) 。
Husserl on the overlap of pure and empirical concepts
Authors: Wolf W. Clark 
Published: December 2020

AbstractThis essay clarifies Edmund Husserl's view of “pure” concepts, with a view to its contemporary metaphilosophical significance. It is argued that Husserl's conception of pure concepts is unique in that he allows overlap between pure and empirical concepts. This overlap leads to a potential for confusion between pure and empirical concepts which I label “amphiboly,” following Kant's use of the term. The essay begins by clarifying Husserl's view of the divergence in concept formation between empirical and pure concepts, and then articulates the specific properties of pure concepts that allow an empirical overlap. These properties include the modality and range of the extension of the concepts, the ordering of objects under the concept, and the mental faculty required to identify an object under the concept. Once we see the source of amphiboly in Husserl's view, it can be observed that many concepts of interest to philosophy, even outside phenomenology proper, are potentially subject to amphibolous uses. Thus, Husserl's view can be a general hermeneutical resource for clarifying the nature of philosophical concepts.
I am ready to see you now, Doctor! A mixed‐method study of the Let's Discuss Health website implementation in Primary Care
Authors: Lussier Marie‐Thérèse , Richard Claude , Binta Diallo Fatoumata , Boivin Nathalie , Hudon Catherine , Boustani Élie , Witteman Holly , Jbilou Jalila 
Published: December 2020

AbstractBackgroundLet's Discuss Health (LDH) is a website that encourages patients to prepare their health‐care encounters by providing communication training, review of topics and questions that are important to them.ObjectiveTo describe LDH implementation during primary care (PC) visits for chronic illnesses.MethodsDesign: Descriptive mixed‐method study. Setting: 6 PC clinics. Participants: 156 patients and 51 health‐care providers (HCP). Intervention: LDH website implementation. Outcome Measures: Perceived quality and usefulness of LDH; perceived quality of HCP‐patient communication; patient activation; LDH integration in routine PC practices and barriers to its use.ResultsPatients reported a positive perception of the website in that it helped them to adopt an active role in the encounters; recall their visit agenda and reduce encounter‐related stress; feel more confident to ask questions, feel more motivated to prepare their future medical visits and improve their chronic illness management. However, a certain disconnect emerged between HCP and patient perceptions as to the value of LDH in promoting a sense of partnership and collaboration. The main barriers to the use of LDH are HCP lack of interest, limited access to technology, lack of time and language barriers.ConclusionOur findings indicate that it is advantageous for patients to prepare their medical encounters. However, the study needs to be replicated in other medical environments using larger and more diverse samples.Patient and Public ContributionPatient partners were involved in the conduct of this study.
The role of governance in quality education in sub‐Saharan Africa
Authors: Asongu Simplice A. , Odhiambo Nicholas M. 
Published: December 2020

AbstractThis paper examines the nexus between governance and education quality in a panel of 49 sub‐Saharan African countries over the 2000–2012 period. Ordinary least squares (OLS) and quantile regression (QR) are employed as estimation strategies. The following findings are established. First, from the OLS, governance variables are negatively correlated with poor education quality. Second, with regards to QR, about half of the governance dynamics are not significantly correlated with poor education quality in the lowest quantile of poor education quality. With the exception of corruption control, the other governance dynamics are negatively correlated with poor education quality in a non‐monotonic pattern.
Relationship between lactate dehydrogenase and albuminuria in Chinese hypertensive patients
Authors: Cai Xiaoqi , Wang Tingjun , Ye Chaoyi , Xu Guoyan , Xie Liangdi 
Published: December 2020

AbstractLactate dehydrogenase (LDH) has been reported to be positively correlated with albuminuria assessed by urinary albumin‐to‐creatinine ratio (UACR) in patients with sickle cell disease; both LDH and albuminuria are positively associated with the severity of hypertension (HTN). Here, a cross‐sectional study was performed to investigate the association between LDH and albuminuria in Chinese hypertensives. A total of 1169 Chinese individuals (aged 58.0 ± 11.5 years, 60.4% male), who were admitted to our hospital, were included in this study. Based on the level of LDH, all hypertensives (n = 802) were divided into three groups: HTN1 (lowest tertile of LDH, n = 264), HTN2 (mediate tertile of LDH, n = 268), and HTN3 (highest tertile of LDH, n = 270). Hypertensives with hyperhomocysteinemia were defined as hypertensives with homocysteine ≥15μmol/L. Meanwhile, 367 normotensives served as controls. Compared with normotensives, the levels of LDH and UACR were significantly higher in hypertensives (p < .05). There was an increasing trend of albuminuria (UACR ≥30 mg/g) from control, HTN1, HTN2 to HTN3 group (4% vs. 12.1% vs. 14.9% vs. 19.6%, χ2 = 38.886, p < .001). Stepwise multiple regression analysis showed an independent association between LDH and UACR in patients with HTN (β = 0.085, p < .05), but not in normotensives. After further stratification in hypertensive patients, this correlation remained in the male (β = 0.161, p < .001), elderly (age ≥65 years, β = 0.174, p < .001) and especially hypertensives with hyperhomocysteinemia (β = 0.402, p < .001). LDH combined with white blood cell (WBC) counts was observed to have better discrimination for albuminuria than creatinine united with cystatin C in hypertensives according to receiver operation characteristic curves (area under curve: 0.637 vs. 0.535, z = 2.563, p = .0104). In conclusion, the level of LDH was associated with albuminuria in Chinese patients with HTN, particularly in hypertensives with hyperhomocysteinemia. LDH combined with WBC provided better prediction of albuminuria than routine renal function assessment in hypertensives. Further studies are needed to confirm LDH as an early marker for the risk of kidney involvement among hypertensives.