bluuebunny/crossref_metadata_2025_split huggingface dataset:
Arid/humid patterns over Asia in response to national-committed emission reductions under the Paris agreement
Authors: Wang Fang , Zhang Jintao 
Published: March 2020

AbstractThe evolution of regional arid/humid patterns caused by global climate change deserves attention. We investigated the changes in the area of arid/humid climate regions over Asia under the aegis of national-committed emission reductions to comply with the Paris Agreement using an ensemble of 17 global climate models (GCMs) from the Fifth Coupled Climate Model Intercomparison Project (CMIP5) archives. Our results indicated an overall trend towards aridity in a future warmer climate based on an aridity index (AI), defined as the ratio of precipitation to potential evapotranspiration (PET). In the future, the humid region will contract and the arid region and arid/humid transition zones will expand. Compared with the present period, arid/humid region switch is projected to occur in a land area of 2512.8 × 103 km2 over Asia under the Intended Nationally Determined Contributions (INDC)-pledge scenario. If global warming is controlled to the ambitious 2.0 °C and 1.5 °C scenarios instead of that of the INDC-pledge scenario, a decrease in the changes in the area of arid/humid regions by more than half would be expected. In addition, the arid/humid regions with continuous global warming are estimated to contract/expand greatly. Changes in the spatial pattern of the arid/humid zones over Asia show strong similarities between multi-model simulations, although there are some differences in detail.
Vaginal, sexual and urinary symptoms following hysterectomy: a multi-centre randomized controlled trial
Authors: Ekanayake Chanil , Pathmeswaran Arunasalam , Herath Rasika , Wijesinghe Prasantha 
Published: March 2020

Abstract
Background
Hysterectomy is the most common major gynaecological procedure. The aim of this study was to study vaginal, sexual and urinary symptoms following total abdominal hysterectomy (TAH), non-descent vaginal hysterectomy (NDVH) and total laparoscopic hysterectomy (TLH) in a low resource setting.

Methods
A multi-centre randomized controlled trial (RCT) was conducted in two public sector hospitals in Sri Lanka. Participants were patients requiring hysterectomy for non-malignant uterine causes. Exclusion criteria were uterus> 14 weeks, previous pelvic surgery, medical illnesses which contraindicated laparoscopic surgery, and those requiring incontinence surgery or pelvic floor surgery.
Vaginal, sexual function and urinary symptoms were assessed by the validated translations of ICIQ-VS and ICIQ-FLUTS questionnaires. Post-operative improvement (pre-operative – post-operative) was assessed.

Results
There was an improvement (median (IQ1-IQ3) in vaginal symptoms [TAH 6(2–8) vs 4(0–8), p < 0.001; NDVH 6(4–8.5) vs 5(0–8), p < 0.001; TLH 4(2–10.5) vs 4(0–10), p < 0.001], urinary flow symptoms [TAH 2(1–4) vs 1 (0–3), p < 0.001; NDVH 3 (2–5) vs 2 (0.5–4), p < 0.001; TLH 1(1–4) vs 1(0–3), p < 0.05], urinary voiding symptoms [TAH 0(0–0) vs 0(0–0), p = 0.20; NDVH 0(0–1) vs 0(0–0.8), p < 0.05; TLH 0(0–0) vs 0(0–0), p < 0.05] and urinary incontinence symptoms [TAH 0(0–2) vs 0(0–2), p = 0.06; NDVH 0(0–3) vs 0(0–3), p < 0.001; TLH 0(0–3) vs 0(0–2), p < 0.05] at 1-year (TAH n = 47, NDVH n = 45, TLH n = 47). There was an improvement in sexual symptoms only in the TLH group [TAH 0(0–11.5) vs 0(0–14), p = 0.08); NDVH 0(0–0) vs 0(0–0), p = 0.46; TLH 0(0–0) vs 0(0–4), p < 0.05].
There was no significant difference among the three different routes in terms of vaginal symptoms score [TAH 2 (0–2), NDVH 0 (0–2), TLH 0 (0–2), p = 0.33], sexual symptoms [TAH 0 (0–0), NDVH 0 (0–0), TLH 0 (0–0), p = 0.52], urinary flow symptoms [TAH 0 (0–1), NDVH 0 (0–1), TLH 0 (0–2), p = 0.56], urinary voiding symptoms [TAH 0 (0–0), NDVH 0 (0–0), TLH 0 (0–0), p = 0.64] and urinary incontinence symptoms [TAH 0 (0–0), NDVH 0 (0–1), TLH 0 (0–1), p = 0.35] at 1-year.

Conclusions
There was a post-operative improvement in vaginal symptoms and urinary symptoms in all three groups. There was no significant difference in pelvic organ symptoms between the three routes; TAH, NDVH and TLH.

Trial registration
Sri Lanka clinical trials registry, SLCTR/2016/020 and the International Clinical Trials Registry Platform, U1111–1194-8422, on 26 July 2016. Available from: http://slctr.lk/trials/515
Effectiveness of alternative measures to reduce antimicrobial usage in pig production in four European countries
Authors:   on the behalf of the MINAPIG Consortium, Raasch Svenja , Collineau Lucie , Postma Merel , Backhans Annette , Sjölund Marie , Belloc Catherine , Emanuelson Ulf , Beilage Elisabeth grosse , Stärk Katharina , Dewulf Jeroen 
Published: March 2020

Abstract
Background
The reduction of antimicrobial usage (AMU) is in the focus in modern pig production. The objective of this study was to assess the effectiveness of alternatives to reduce AMU at herd level. In a prospective study, 68 farrow-to-finish pig herds located in Belgium, France, Germany and Sweden were recruited on a voluntary basis to implement tailor-made intervention plans to reduce their AMU. Alternative measures included improvement of biosecurity (n = 29 herds), vaccination (n = 30), changes of feeding schemes or drinking water quality (n = 45), improved pig health and welfare care (n = 21) as well as changes in stable climate and zootechnical measures (n = 14). Herds were followed for 1 year after implementation of measures. Annual antimicrobial expenditures or treatment records, as well as disease incidence scores were collected and compared to those of the year before intervention. AMU was measured as the treatment incidence and calculated by age category, antimicrobial class and administration route.

Results
Compliance with the intervention plans was high (median 93%). AMU was significantly reduced following the implementation of alternative measures: in the median herd of the four countries, pigs were treated before intervention 25% of their expected lifespan (200 days from birth to slaughter) and after intervention 16%. AMU of suckling and weaned pigs were significantly reduced by 37 and 54%, respectively. The usage of polymyxins and tetracyclines was significantly reduced by 69 and 49%, respectively. AMU via feed and water, as well as parenteral AMU were significantly reduced by 46 and 36%, respectively. Herds with a higher AMU level before intervention achieved a bigger reduction. The majority of disease incidence were similar before and after intervention, with a few exceptions of disorders related to the gastro-intestinal tract in suckling pigs (decreased) and in breeding pigs (increased).

Conclusion
Following tailor-made implementation of alternative measures, a substantial reduction of AMU in pig production was achievable without jeopardizing animal health. The AMU reduction in the youngest age categories (suckling and weaned pigs) and the reduction of group treatments via feed and water was in line with the recent European Guidelines on the prudent use of antimicrobials in veterinary medicine.
Evaluating the feasibility and acceptability of the Namaste Care program in long-term care settings in Canada
Authors: Kaasalainen Sharon , Hunter Paulette V. , Dal Bello-Haas Vanina , Dolovich Lisa , Froggatt Katherine , Hadjistavropoulos Thomas , Markle-Reid Maureen , Ploeg Jenny , Simard Joyce , Thabane Lehana , van der Steen Jenny T. , Volicer Ladislav 
Published: March 2020

AbstractBackgroundResidents living and dying in long-term care (LTC) homes represent one of society’s most frail and marginalized populations of older adults, particularly those residents with advanced dementia who are often excluded from activities that promote quality of life in their last months of life. The purpose of this study is to evaluate the feasibility, acceptability, and effects of Namaste Care: an innovative program to improve end-of-life care for people with advanced dementia.MethodsThis study used a mixed-method survey design to evaluate the Namaste Care program in two LTC homes in Canada. Pain, quality of life, and medication costs were assessed for 31 residents before and 6 months after they participated in Namaste Care. The program consisted of two 2-h sessions per day for 5 days per week. Namaste Care staff provided high sensory care to residents in a calm, therapeutic environment in a small group setting. Feasibility was assessed in terms of recruitment rate, number of sessions attended, retention rate, and any adverse events. Acceptability was assessed using qualitative interviews with staff and family.ResultsThe feasibility of Namaste Care was acceptable with a participation rate of 89%. However, participants received only 72% of the sessions delivered and only 78% stayed in the program for at least 3 months due to mortality. After attending Namaste Care, participants’ pain and quality of life improved and medication costs decreased. Family members and staff perceived the program to be beneficial, noting positive changes in residents. The majority of participants were very satisfied with the program, providing suggestions for ongoing engagement throughout the implementation process.ConclusionsThese study findings support the implementation of the Namaste Care program in Canadian LTC homes to improve the quality of life for residents. However, further testing is needed on a larger scale.
On the volatility of daily stock returns of Total Nigeria Plc: evidence from GARCH models, value-at-risk and backtesting
Authors: Emenogu Ngozi G. , Adenomon Monday Osagie , Nweze Nwaze Obini 
Published: March 2020

AbstractThis study investigates the volatility in daily stock returns for Total Nigeria Plc using nine variants of GARCH models: sGARCH, girGARCH, eGARCH, iGARCH, aGARCH, TGARCH, NGARCH, NAGARCH, and AVGARCH along with value at risk estimation and backtesting. We use daily data for Total Nigeria Plc returns for the period January 2, 2001 to May 8, 2017, and conclude that eGARCH and sGARCH perform better for normal innovations while NGARCH performs better for student t innovations. This investigation of the volatility, VaR, and backtesting of the daily stock price of Total Nigeria Plc is important as most previous studies covering the Nigerian stock market have not paid much attention to the application of backtesting as a primary approach. We found from the results of the estimations that the persistence of the GARCH models are stable except for few cases for which iGARCH and eGARCH were unstable. Additionally, for student t innovation, the sGARCH and girGARCH models failed to converge; the mean reverting number of days for returns differed from model to model. From the analysis of VaR and its backtesting, this study recommends shareholders and investors continue their business with Total Nigeria Plc because possible losses may be overcome in the future by improvements in stock prices. Furthermore, risk was reflected by significant up and down movement in the stock price at a 99% confidence level, suggesting that high risk brings a high return.
The incidence of depression and anxiety in patients with ankylosing spondylitis: a systematic review and meta-analysis
Authors: Park Jamie YE. , Howren Alyssa M. , Zusman Enav Z. , Esdaile John M. , De Vera Mary A. 
Published: March 2020

Abstract
Background
As awareness for the importance of mental health continues to expand in rheumatology, it is important to understand the epidemiology of psychiatric complications in ankylosing spondylitis (AS) with the ultimate goal of future prevention and improved quality of care. This study aims to review evidence on the incidence and determinants of depression and/or anxiety among patients with AS.

Methods
We searched Medline, Embase, Cochrane Database of Systematic Reviews, CINAHL Complete, and PsycINFO for full-length observational studies that involved a sample or population of patients with AS and assessed depression and/or anxiety. Primary outcomes extracted were: 1) risk estimates for depression and/or anxiety (e.g., relative risk [RR]); and 2) determinants or factors identified as independent predictors of depression and/or anxiety using multivariable regression approaches and corresponding estimates (e.g., odds ratios [OR]). Where relevant, we pooled estimates using random effects models.

Results
Out of 783 titles from our search strategy, we reviewed 39 manuscripts. Four studies assessed the incidence of depression and meta-analyzing reported estimates from three of these studies yielded a pooled RR of 1.51 (95% CI 1.28 to 1.79). Differences in risk of depression among men and women with AS were inconclusive, suggesting need for further study. The incidence of anxiety was comparatively less studied with only one included study reporting a hazard ratio of 1.85 (95% CI 1.37 to 2.49). Education level was a key determinant, with lower levels associated with higher odds of depression (OR 6.65; 9% CI 1.36 to 32.51) and anxiety (OR 9.31; 9% CI 1.39 to 62.19) among AS patients.

Conclusions
Our systematic review and meta-analysis shows an increased risk of depression and anxiety among patients with AS. These findings suggest the importance of monitoring and care for psychiatric conditions in AS.
Unmet needs in ankylosing spondylitis patients receiving tumour necrosis factor inhibitor therapy; results from a large multinational real-world study
Authors: Deodhar A. , Strand V. , Conaghan P. G. , Sullivan E. , Blackburn S. , Tian H. , Gandhi K. , Jugl S. M. , Alten R. 
Published: March 2020

AbstractBackgroundSymptoms and comorbidities of ankylosing spondylitis (AS) considerably reduce health-related quality of life (HRQoL) and ability to work. This real-world study assessed rates of tumour necrosis factor inhibitor (TNFi) use and switching, treatment failure, and associations between failing TNFi and HRQoL, work productivity and activity impairment (WPAI).MethodsAS patients and their treating physicians completed questionnaires capturing patient demographics, clinical status, TNFi treatment history, reasons for switching TNFi, HRQoL and WPAI. Current TNFi was determined as “failing” if, after ≥3 months, physician-rated disease severity had worsened, remained severe, was “unstable/deteriorating”, physicians were dissatisfied with disease control and/or did not consider treatment a “success”.ResultsThe analysis included 2866 AS patients from 18 countries. Of 2795 patients with complete treatment data, 916 (32.8%) patients had never received TNFi therapy, 1623 (58.1%) patients were receiving their 1st TNFi and 200 (7.2%) patients had ever received ≥2 TNFi (treatment switch). Primary or secondary lack of efficacy were the commonest reasons for switching, and the mean delay in switching after primary lack of efficacy was 11.1 months. 232 (15.4%) patients on TNFi were currently “failing” who, compared to those with treatment success, reported poorer HRQoL: 5-dimension EuroQoL (EQ-5D-3 L): 0.63 vs. 0.78; Medical Outcomes Study Short-Form Health Survey version 2 (SF-36v2) mental component summary (MCS): 41.8 vs. 46.3; physical component summary (PCS): 40.2 vs. 45.1; impaired work productivity: 46.4% vs. 25.0%; and activity: 44.5% vs. 29.6%; allP < 0.001.ConclusionsAmong AS patients, switching TNFi is uncommon and delayed by nearly 1 year despite primary lack of efficacy. Patients currently failing TNFi experience worse physical function, HRQoL and work productivity.
Serum Leptin in Hospitalized Community-Acquired Pneumonia Children under the Age of Five Years
Authors: Abouhussein Heba , Mohamed Shereen , Dougman Talal , ElHawary Rabab 
Published: March 2020

Abstract
Background
Community-acquired pneumonia (CAP) accounts for 19% of the world’s total deaths among all age groups yearly, with highest rates in children less than 5 years. This study is designed to evaluate the serum leptin level in hospitalized children under the age of 5 years with CAP.

Results
This prospective cross-sectional study included CAP children under the age of 5 years. Forty-one patients admitted to pediatric intensive care unit (PICU) and 41 patients admitted to general ward were enrolled. Patients with any other cause that may elevate serum leptin were excluded. Serum leptin was measured on the day of admission. The PICU patients had a significantly higher median serum leptin than that of the ward patients (p < 0.001). C-reactive protein (CRP) level was significantly higher in patients with elevated serum leptin than in patients with normal serum leptin (p = 0.001). There was a significant association between high serum leptin and positive sputum cultures (p < 0.001), particularly cultures growing more than one organism (p < 0.001). There was a positive, weak correlation between serum leptin and length of stay (r = 0.30, p = 0.007). Serum leptin showed good discrimination between PICU admissions and inpatient ward admissions (AUC = 0.777, p < 0.001); at a cut-off value of > 29.6 pg/ml, serum leptin had a sensitivity of 70.7% and a specificity of 87.8%

Conclusion
We may conclude that CAP patients with a serum leptin level above 29.6 pg/ml should be considered for PICU admission.
Structured Psychological Support for people with personality disorder: feasibility randomised controlled trial of a low-intensity intervention
Authors: Crawford Mike J. , Thana Lavanya , Parker Jennie , Turner Oliver , Carney Aidan , McMurran Mary , Moran Paul , Weaver Timothy , Barrett Barbara , Roberts Sarah , Claringbold Amy , Bassett Paul , Sanatinia Rahil , Spong Amanda 
Published: March 2020

Background
National guidance cautions against low-intensity interventions for people with personality disorder, but evidence from trials is lacking.

Aims
To test the feasibility of conducting a randomised trial of a low-intensity intervention for people with personality disorder.

Method
Single-blind, feasibility trial (trial registration: ISRCTN14994755). We recruited people aged 18 or over with a clinical diagnosis of personality disorder from mental health services, excluding those with a coexisting organic or psychotic mental disorder. We randomly allocated participants via a remote system on a 1:1 ratio to six to ten sessions of Structured Psychological Support (SPS) or to treatment as usual. We assessed social functioning, mental health, health-related quality of life, satisfaction with care and resource use and costs at baseline and 24 weeks after randomisation.

Results
A total of 63 participants were randomly assigned to either SPS (n = 33) or treatment as usual (n = 30). Twenty-nine (88%) of those in the active arm of the trial received one or more session (median 7). Among 46 (73%) who were followed up at 24 weeks, social dysfunction was lower (−6.3, 95% CI −12.0 to −0.6, P = 0.03) and satisfaction with care was higher (6.5, 95% CI 2.5 to 10.4; P = 0.002) in those allocated to SPS. Statistically significant differences were not found in other outcomes. The cost of the intervention was low and total costs over 24 weeks were similar in both groups.

Conclusions
SPS may provide an effective low-intensity intervention for people with personality disorder and should be tested in fully powered clinical trials.
Differential Frequency of CYP2R1 Variants Across Populations Reveals Pathway Selection for Vitamin D Homeostasis
Authors: Casella Alex , Long Caela , Zhou Jingman , Lai Meizan , O’Lear Lauren , Caplan Ilana , Levine Michael A , Roizen Jeffrey D 
Published: March 2020

Abstract

Context
Normal vitamin D homeostasis is necessary to ensure optimal mineral metabolism. Dietary insufficiency of vitamin D and the lack of sunlight each have well understood roles in vitamin D deficiency; however, the extent to which common genetic variations in vitamin D metabolizing enzymes contribute to alterations in vitamin D homeostasis remains uncertain.

Objective
To examine the possibility that common coding variation in vitamin D metabolizing enzymes alters vitamin D homeostasis we determined the effect of 44 nonsynonymous polymorphisms in CYP2R1, the vitamin D 25-hydroxylase, on enzyme function.

Results
Twenty-one of these polymorphisms decreased activity, while 2 variants increased activity. The frequency of CYP2R1 alleles with decreased 25-hydroxylase activity is 3 in every 1000 Caucasians and 7 in every 1000 African Americans. In populations where exposure to sunlight is high, alleles with decreased function occur at a frequency as high as 8%. The pattern of selected variation as compared to nonselected variation is consistent with it being the result of positive selection for nonfunctional alleles closer to the equator. To examine this possibility, we examined the variation pattern in another protein in the vitamin D pathway, the vitamin D binding protein (GC protein). The pattern of selected variation in the GC protein as compared to nonselected variation is also consistent with it being the result of positive selection for nonfunctional alleles closer to the equator.

Conclusions
CYP2R1 polymorphisms have important effects on vitamin D homeostasis, and the geographic variability of CYP2R1 alleles represents an adaptation to differential exposures to UVB irradiation from sunlight.
Serum Androgens Are Independent Predictors of Insulin Clearance but Not of Insulin Secretion in Women With PCOS
Authors: Tosi Flavia , Dal Molin Francesca , Zamboni Federica , Saggiorato Enrica , Salvagno Gian Luca , Fiers Tom , Kaufman Jean-Marc , Bonora Enzo , Moghetti Paolo 
Published: March 2020

Abstract

Context/Objective
In insulin-resistant individuals, hyperinsulinemia is a key compensatory mechanism, aimed at maintaining glucose homeostasis. Increased secretion and reduced clearance of insulin may both potentially contribute to this phenomenon. Insulin resistance and hyperinsulinemia are common findings in women with polycystic ovary syndrome (PCOS). While there is some information on insulin secretion, very few studies have investigated metabolic clearance rate of insulin (MCRI) in these women. Moreover, there is paucity of data on the relationships between MCRI and the pathophysiological characteristics of PCOS. The aim of the study was to explore these issues.

Patients
One hundred ninety women with PCOS, diagnosed according to the Rotterdam criteria, with normal glucose tolerance.

Design
Assessment of MCRI and clinical, hormonal, and metabolic characteristics of subjects. MCRI and insulin sensitivity were measured by the hyperinsulinemic euglycemic clamp. Serum androgens were assessed by liquid chromatography-mass spectrometry and equilibrium dialysis. A historical sample of healthy women was used to define the corresponding reference intervals.

Results
MCRI was impaired in about two-thirds of women with PCOS. Subjects with low MCRI differed from those with normal MCRI for a number of anthropometric, metabolic, and endocrine features. In multivariate analysis, the degree of adiposity, estimates of insulin secretion, and serum androgen concentrations were independent predictors of MCRI. Conversely, age, adiposity, MCRI, and insulin sensitivity, but not serum androgens, were independent predictors of insulin secretion.

Conclusions
In women with PCOS, metabolic clearance of insulin is reduced, contributing to generating hyperinsulinemia. Serum androgens are independent predictors of this phenomenon.