bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of low vs high haemoglobin transfusion trigger on cardiac output in patients undergoing elective vascular surgery: Post‐hoc analysis of a randomized trial
Authors: Møller Anders , Wetterslev Jørn , Shahidi Saeid , Hellemann Dorthe , Secher Niels H. , Pedersen Ole B. , Marcussen Klaus V. , Ramsing Benedicte G. U. , Mortensen Anette , Nielsen Henning B. 
Published: November 2020

AbstractBackgroundDuring vascular surgery, restricted red‐cell transfusion reduces frontal lobe oxygen (ScO2) saturation as determined by near‐infrared spectroscopy. We evaluated whether inadequate increase in cardiac output (CO) following haemodilution explains reduction in ScO2.MethodsThis is a post‐hoc analysis of data from the Transfusion in Vascular surgery (TV) Trial where patients were randomized on haemoglobin drop below 9.7 g/dL to red‐cell transfusion at haemoglobin below 8.0 (low‐trigger) vs 9.7 g/dL (high‐trigger). Fluid administration was guided by optimizing stroke volume. We compared mean intraoperative levels of CO, haemoglobin, oxygen delivery, and CO at nadir ScO2 with linear regression adjusted for age, operation type and baseline. Data for 46 patients randomized before end of surgery were included for analysis.ResultsThe low‐trigger resulted in a 7.1% lower mean intraoperative haemoglobin level (mean difference, −0.74 g/dL; P < .001) and reduced volume of red‐cell transfused (median [inter‐quartile range], 0 [0‐300] vs 450 mL [300‐675]; P < .001) compared with the high‐trigger group. Mean CO during surgery was numerically 7.3% higher in the low‐trigger compared with the high‐trigger group (mean difference, 0.36 L/min; 95% confidence interval (CI.95), −0.05 to 0.78; P = .092; n = 42). At the nadir ScO2‐level, CO was 11.9% higher in the low‐trigger group (mean difference, 0.58 L/min; CI.95, 0.10‐1.07; P = .024). No difference in oxygen delivery was detected between trial groups (MD, 1.39 dLO2/min; CI.95, −6.16 to 8.93; P = .721).ConclusionVascular surgical patients exposed to restrictive RBC transfusion elicit the expected increase in CO making it unlikely that their potentially limited cardiac capacity explains the associated ScO2 decrease.
Genotype‐guided antiplatelet treatment versus conventional therapy: A systematic review and meta‐analysis
Authors: Zhang Hanxu , Xiang Qian , Liu Zhiyan , Mu Guangyan , Xie Qiufen , Zhou Shuang , Ma Lingyue , Wang Zining , Hu Kun , Wang Zhe , Cui Yimin 
Published: November 2020

AimThis meta‐analysis was carried out to explore if a personalized antiplatelet strategy based on genotyping is superior to conventional therapy.MethodsPubMed, Web of Science, EMBASE and the Cochrane Library were searched from the inception of each database to 5 May 2020. Studies reporting endpoints in genotype‐guided treatment group and conventional treatment group were included. The endpoint results were presented as the risk ratio (RR), with 95% confidence interval (CI).ResultsA total of 10 561 patients from 16 studies (eight randomized controlled trials [RCT] and eight cohort studies) were included in the meta‐analysis. The rates of major adverse cardiovascular events (MACE), stent thrombosis and myocardial infarction (MI) were significantly lower in the genotype‐guided group than in the conventional treatment group (RR 0.56, 95% CI 0.44‐0.73, P < .0001; RR 0.40, 95% CI 0.24‐0.67, P = .0005; RR 0.45, 95% CI 0.35‐0.58, P < .00001, respectively). A significant difference was found between the two groups in major bleeding (RR 0.73, 95% CI 0.55‐0.98, P = .04), which was not robust after sensitivity analysis.ConclusionGenotype‐guided antiplatelet treatment could decrease the risk of MACE, stent thrombosis and MI in patients with coronary artery disease or undergoing percutaneous coronary intervention, without increasing the risk of bleeding over a long follow‐up period. The decreased risk of efficacy outcomes was more obvious in cohort studies. Well‐organized RCTs and clinical trials are required to verify the benefit of genotype‐guided therapy.
Cognitive load and online course quality: Insights from instructional designers in a higher education context
Authors: Caskurlu Secil , Richardson Jennifer C. , Alamri Hamdan A. , Chartier Katherine , Farmer Tadd , Janakiraman Shamila , Strait Marquetta , Yang Mohan 
Published: November 2020

AbstractThis multiple case study investigates instructional designers’ perceptions of online course quality, their use of cognitive load strategies when designing online courses, and whether utilization of these strategies contribute to online course quality. The participants of this study were instructional designers (n = 5) who worked in various campus programs at a large Midwestern university. Data sources included pre‐interview survey, semi‐structured interview and sample course design documents. Employing a pattern matching technique, the results showed that instructional designers (a) define online course quality based on established standards and rubrics; (b) apply cognitive load strategies intuitively while designing online courses; and (c) consider CLT design strategies as an element contributing to course quality. The results also showed instructional designers’ use of cognitive load strategies mainly focused on reducing extraneous cognitive load. Implications for practice and research as well as directions for future research are discussed.
Practitioner NotesWhat is already known about this topic

Cognitive load theory (CLT) provides empirically tested strategies to manage cognitive load in different settings
CLT strategies has a positive impact on student learning processes and outcomes
When designing online courses, it is important for faculty to collaborate with instructional designers to manage cognitive load and improve online course quality
There is a need to investigate instructional designers’ perceptions of online course quality and their use of CLT strategies when designing online courses
What this paper adds

Provides a deep understanding of instructional designers perspectives on online course quality, application of CLT strategies while designing online courses and how application of these strategies contribute to the online course quality
Although instructional designers identify multiple CLT strategies from their work and perceive CLT strategies as an element contributing to course quality, they apply these strategies innately
Implications for practice and/or policy

Multiple stakeholders should be involved in determining online course quality
Collaboration between faculty and instructional designers is essential to manage cognitive load and increase online course quality
CLT and related theories should be emphasized in instructional design programs
Future research should focus on how instructional designers integrate CLT strategies into the systematic instructional design process and instructional designers’ decision‐making process through think‐aloud and/or journaling efforts
Vertical stratification of seed‐dispersing vertebrate communities and their interactions with plants in tropical forests
Authors: Thiel Sarina , Tschapka Marco , Heymann Eckhard W. , Heer Katrin 
Published: November 2020

ABSTRACTVertical stratification (VS) is a widespread phenomenon in plant and animal communities in forests and a key factor for structuring their species richness and biodiversity, particularly in tropical forests. The organisms composing forest communities adjust and shape the complex three‐dimensional structure of their environment and inhabit a large variety of niches along the vertical gradient of the forest. Even though the degree of VS varies among different vertebrate groups, patterns of compositional stratification can be observed across taxa. Communities of birds, bats, primates, and non‐flying small mammals are vertically stratified in terms of abundance, species richness, diversity, and community composition. Frugivorous members of these taxa play important roles as seed dispersers and forage on fruit resources that, in turn, vary in quantity and nutritional value along the vertical gradient. As a consequence, plant–seed disperser interaction networks differ among strata, which is manifested in differences in interaction frequencies and the degree of mutual specialization. In general, the canopy stratum is composed of strong links and generalized associations, while the lower strata comprise weaker links and more specialized interactions. Investigating the VS of communities can provide us with a better understanding of species habitat restrictions, resource use, spatial movement, and species interactions. Especially in the face of global change, this knowledge will be important as these characteristics can imply different responses of species and taxa at a fine spatial scale.
Conflicting and harmonious sibling relationships of children and adolescent siblings of children with autism spectrum disorder
Authors: Guidotti Laura , Musetti Alessandro , Barbieri Gian Luca , Ballocchi Ilenia , Corsano Paola 
Published: November 2020

AbstractBackgroundThe presence of a child with autism spectrum disorder (ASD) could have a strong psychological and emotional impact on typical development (TD) siblings, with different ways of adjustment and perception of fraternal relationships. In this study, we aimed to investigate the experience of the TD siblings of children with ASD, combining both quantitative and qualitative methodologies.MethodAn explanatory sequential design was employed. Forty‐four TD siblings of children with ASD, aged 6 to 17 years old, participated in the study. Each participant completed the Sibling Relationship Inventory that investigated warmth, rivalry and conflict in sibling relationships. Moreover, in order to thoroughly evaluate the participants' perception of their sibling relationship, they were asked to draw themselves with their sibling with ASD in a condition of harmony and conflict. The drawings were collected and coded using the well‐validated Pictorial Assessment of Interpersonal Relationships. Quantitative and qualitative analyses were conducted.ResultsIn general, TD siblings showed affection for their siblings with ASD. However, males showed more conflict than females. Quantitative analyses of the drawings showed high levels of similarity between the siblings, despite the disability. In drawings, greater cohesion emerged in conditions of harmony and greater distancing in situations of conflict. Content analysis of the drawings showed that the conflict is represented mainly at home and the siblings often show opposite emotions, with TD siblings experiencing negative emotions. Moreover, adolescent TD siblings displayed more annoyance, shame and embarrassment than child TD siblings.ConclusionsIt is important to combine quantitative and qualitative tools to understand the experience of TD siblings in detail. In particular, drawing is a useful tool for providing quantitative and qualitative information, supplying rich and detailed information that can be well integrated with the results coming from quantitative tools.
Repetitive nasal allergen challenge in allergic rhinitis: Priming and Th2‐type inflammation but no evidence of remodelling
Authors: Orban Nara T. , Jacobson Mikila R. , Nouri‐Aria Kayhan T. , Durham Stephen R. , Eifan Aarif O. 
Published: November 2020

AbstractBackgroundLocal tissue eosinophilia and Th2 cytokines are characteristic features of seasonal allergic rhinitis. Airway remodelling is a feature of asthma whereas evidence for remodelling in allergic rhinitis (AR) is conflicting.ObjectiveBy use of a novel human repetitive nasal allergen challenge (RAC) model, we evaluated the relationship between allergic inflammation and features of remodelling in AR.MethodsTwelve patients with moderate–severe AR underwent 5 alternate day challenges with diluent which after 4 weeks were followed by 5 alternate day challenges with grass pollen extract. Nasal symptoms, Th1/Th2 cytokines in nasal secretion and serum were evaluated. Nasal biopsies were taken 24 hours after the 1st and 5th challenges with diluent and with allergen. Sixteen healthy controls underwent a single challenge with diluent and with allergen. Using immunohistochemistry, epithelial and submucosal inflammatory cells and remodelling markers were evaluated by computed image analysis.ResultsThere was an increase in early and late‐phase symptoms after every allergen challenge compared to diluent (both P < .05) with evidence of both clinical and immunological priming. Nasal tissue eosinophils and IL‐5 in nasal secretion increased significantly after RAC compared to corresponding diluent challenges (P < .01, P = .01, respectively). There was a correlation between submucosal mast cells and the early‐phase clinical response (r = 0.79, P = .007) and an association between epithelial eosinophils and IL‐5 concentrations in nasal secretion (r = 0.69, P = .06) in allergic rhinitis. No differences were observed after RAC with regard to epithelial integrity, reticular basement membrane thickness, glandular area, expression of markers of activation of airway remodelling including α‐SMA, HSP‐47, extracellular matrix (MMP7, 9 and TIMP‐1), angiogenesis and lymphangiogenesis for AR compared with healthy controls.ConclusionNovel repetitive nasal allergen challenge in participants with severe persistent seasonal allergic rhinitis resulted in tissue eosinophilia and increases in IL‐5 but no structural changes. Our data support no link between robust Th2‐inflammation and development of airway remodelling in AR.
How to screen for at‐risk alcohol use in transplant patients? From instrument selection to implementation of the AUDIT‐C
Authors: Verhalle Lieza , Van Bockstaele Kristof , Duerinckx Nathalie , Vanhoof Jasper , Dierickx Katrien , Neyens Leen , Van Cleemput Johan , Gryp Sabine , Kums Dominica , De Bondt Katleen , Schaevers Veronique , Demuynck Florian , Dewispelaere Anne , Dobbels Fabienne ,   the Transplantation Innovation Team (TRANSIT)
Published: November 2020

AbstractBackgroundGiven that drinking >2–3 units of alcohol daily might already have adverse health effects, regular screening of at‐risk drinking is warranted. We aimed to select and pilot a short instrument to accurately screen for at‐risk drinking in transplant patients.Methodology and resultsFive consecutive steps were completed: A comprehensive literature review identified 24 possible self‐report instruments (step 1). These instruments were scored on six yes/no criteria (ie, length, concept measured, diagnostic accuracy, population, manual available, cost) (step 2). Four nurses piloted three instruments with the highest score and were interviewed on their experiences with using the AUDIT‐C, TWEAK, and Five Shot. The AUDIT‐C was the easiest to use and score, and items were clear. Cognitive debriefings with 16 patients were conducted to verify clarity of instructions and items, and suggestions were incorporated into a modified version of the AUDIT‐C (step 4). A convenience sample of 130 Dutch‐speaking heart transplant patients completed the modified AUDIT‐C during a scheduled visit (Step 5), revealing that 27.6% of patients showed at‐risk drinking.ConclusionThe AUDIT‐C might be a suitable instrument to identify at‐risk drinking in routine post‐transplant follow‐up. Further validation, however, is indicated.
Estimation of Body Fat Percentage for Clinical Pharmacokinetic Studies in Children
Authors: Green Thomas P. , Binns Helen J. , Wu Huali , Ariza Adolfo J. , Perrin Eliana M. , Quadri Maheen , Hornik Christoph P. , Cohen‐Wolkowiez Michael 
Published: November 2020

Obesity is a prevalent childhood condition and the degree of adiposity appears likely to be an important covariate in the pharmacokinetics (PKs) of many drugs. We undertook these studies to facilitate the evaluation and, where appropriate, quantification of the covariate effect of body fat percentage (BF%) on PK parameters in children. We examined two large databases to determine the values and variabilities of BF% in children with healthy body weights and in those with obesity, comparing the accuracy and precision of BF% estimation by both clinical methods and demographically derived techniques. Additionally, we conducted simulation studies to evaluate the utility of the several methods for application in clinical trials. BF% was correlated with body mass index (BMI), but was highly variable among both children with healthy body weights and those with obesity. Bio‐impedance and several demographically derived techniques produced mean estimates of BF% that differed from dual x‐ray absorptiometry by < 1% (accuracy) and a SD of 5% or less (precision). Simulation studies confirmed that when the differences in precision among the several methods were small compared with unexplained between‐subject variability of a PK parameter, the techniques were of similar value in assessing the contribution of BF%, if any, as a covariate for that PK parameter. The combination of sex and obesity stage explained 68% of the variance of BF% with BMI. The estimation of BF% from sex and obesity stage can routinely be applied to PK clinical trials to evaluate the contribution of BF% as a potential covariate.
Insights for protection of high species richness areas for the conservation of Mesoamerican endemic birds
Authors: Ramírez‐Albores Jorge E. , Prieto‐Torres David A. , Gordillo‐Martínez Alejandro , Sánchez‐Ramos Luis E. , Navarro‐Sigüenza Adolfo G. 
Published: November 2020

AbstractAimTo assess the representativeness values of Mesoamerican endemic birds within the current network of protected areas (PAs) to determine high‐priority and complementary conservation areas to maximize the long‐term protection of species.LocationFrom central Mexico to southern Panama.MethodsWe selected 180 bird species that are geographically restricted to Mesoamerica and estimated their potential ranges using species distribution models. Then, using two different removal rules in ZONATION software, we assessed the species’ representativeness levels within the current PA network. We also defined forest remnants that could be used to strategically expand PAs (to reach Aichi biodiversity targets) and maximize the species protection, explicitly considering anthropic pressures.ResultsCurrent PAs cover ~13% of the land area of Mesoamerica, representing an average of ~19% of the total potential distribution for the endemic bird species considered. We also observed that there is <30% overlap between current PAs and the priority areas we define. Our prioritization analyses showed that strategically increasing protection coverage to 17%, as stipulated in the Aichi targets, would substantially increase the representativeness values of PAs (regardless of the removal rule used) and would increase the range by >35% for all species and >29% for threatened species. The consensus priority conservation areas identified were mainly distributed in Costa Rica (~48%), Mexico (~28%), and Panama (~10%).Main conclusionsConsistent with the global picture, Mesoamerican PAs showed low representativeness of their vulnerable endemic avifauna; therefore, well‐informed decisions to guide conservation strategies are imperative. We provide insights about where future conservation efforts should focus to accomplish a representative and well‐connected regional PA network.
Brain malformations and cognitive performance in spina bifida
Authors: Schneider Joanna , Mohr Naomi , Aliatakis Niko , Seidel Ulrich , John Rainer , Promnitz Gabriel , Spors Birgit , Kaindl Angela M 
Published: November 2020

AimTo systematically characterize radiological features of patients with spina bifida, their relationship to cognitive function, and differences between spina bifida aperta (SBA) and spina bifida occulta (SBO).MethodIn a retrospective study of 265 patients (117 females, 148 males; median age at imaging 11y, range 1–47y; SBA n=206, SBO n=59), the radiological phenotype was assessed through magnetic resonance imaging (MRI) (SBA n=171, SBO n=59). In 126 patients (SBA n=116, SBO n=10) Kaufman Assessment Battery for Children (KABC) or Wechsler Intelligence Scale for Children, Fourth Edition (WISC‐IV) and Wechsler Adult Intelligence Scale, Fourth Edition (WAIS‐IV) were performed.ResultsPatients with spina bifida show numerous brain malformations, always present for SBA but rarely for SBO. The most frequent brain malformations in SBA included abnormal corpus callosum (69%), hypoplastic pons (50%), and hypoplastic mesencephalon (20%). Cognitive total IQ scores were below average in 44% (KABC) to 49% (WISC‐IV) of children with SBA, while almost all children with SBO scored at least average. Stenogyria (p=0.006), pons (p=0.003), and mesencephalon hypoplasia (p=0.01) correlated with lower total IQ score and verbal comprehension. Various brain malformations correlate significantly with several cognitive domains, while lesion level only correlates with processing speed.InterpretationIQ scores were significantly lower in patients with SBA than in patients with SBO. Verbal competence, perceptual reasoning, and working memory were significantly impaired for SBA and correlated with stenogyria and abnormalities of the midbrain and corpus callosum.What this paper adds

Brain malformations occur more frequently in spina bifida aperta (SBA) than in spina bifida occulta (SBO).

Cognitive impairment is less frequent in SBO.

Hydrocephalus, stenogyria, midbrain, and corpus callosum abnormalities are associated with lower cognitive function.

Difference in prognosis in SBO versus SBA can alter prenatal counselling.
Sitagliptin for the prevention and treatment of perioperative hyperglycaemia in patients with type 2 diabetes undergoing cardiac surgery: A randomized controlled trial
Authors: Cardona Saumeth , Tsegka Katerina , Pasquel Francisco J. , Jacobs Sol , Halkos Michael , Keeling W. Brent , Davis Georgia M. , Fayfman Maya , Albury Bonnie , Urrutia Maria A. , Galindo Rodolfo J. , Migdal Alexandra L. , Macheers Steven , Guyton Robert A. , Vellanki Priyathama , Peng Limin , Umpierrez Guillermo E. 
Published: November 2020

AbstractAimTo assess whether treatment with sitagliptin, starting before surgery and continued during the hospital stay, can prevent and reduce the severity of perioperative hyperglycaemia in patients with type 2 diabetes undergoing coronary artery bypass graft (CABG) surgery.Materials and MethodsWe conducted a double‐blinded, placebo‐controlled trial in adults with type 2 diabetes randomly assigned to receive sitagliptin or matching placebo starting 1 day prior to surgery and continued during the hospital stay. The primary outcome was difference in the proportion of patients with postoperative hyperglycaemia (blood glucose [BG] > 10 mmol/L [>180 mg/dL]) in the intensive care unit (ICU). Secondary endpoints included differences in mean daily BG in the ICU and after transition to regular wards, hypoglycaemia, hospital complications, length of stay and need of insulin therapy.ResultsWe included 182 participants randomized to receive sitagliptin or placebo (91 per group, age 64 ± 9 years, HbA1c 7.6% ± 1.5% and diabetes duration 10 ± 9 years). There were no differences in the number of patients with postoperative BG greater than 10 mmol/L, mean daily BG in the ICU or after transition to regular wards, hypoglycaemia, hospital complications or length of stay. There were no differences in insulin requirements in the ICU; however, sitagliptin therapy was associated with lower mean daily insulin requirements (21.1 ± 18.4 vs. 32.5 ± 26.3 units, P = .007) after transition to a regular ward compared with placebo.ConclusionThe administration of sitagliptin prior to surgery and during the hospital stay did not prevent perioperative hyperglycaemia or complications after CABG. Sitagliptin therapy was associated with lower mean daily insulin requirements after transition to regular wards.