bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enhancement of polyphenolic content extraction rate with maximal antioxidant activity from green tea leaves by cold plasma
Authors: Keshavarzi Maryam , Najafi Gholamhassan , Ahmadi Gavlighi Hassan , Seyfi Pourya , Ghomi Hamid 
Published: September 2020

AbstractA dielectric barrier discharge (DBD) atmospheric cold plasma was evaluated as a tool to increase the extraction rate of total phenolic content (TPC) and antioxidant activity from green tea leaves. The effects of nitrogen DBD cold plasma on changes of color and surface morphology were investigated. Optimum conditions of cold plasma treatment (treatment time and generation power) were obtained by response surface methodology. After the nitrogen DBD cold plasma at 15 W of the generation power for 15 min, the TPC and antioxidant activity of green tea increased by 41.14% and 41.06%, respectively. The catechin also increased by 103.12%. The scanning electron microscopy results showed cell ablation and ruptures of the green tea leaf surface after nitrogen DBD cold plasma treatment.Practical ApplicationThe developed DBD cold plasma source fed by nitrogen gas can be a suitable procedure for green and useful extraction of phenolic compounds from natural sources in the food industries.
When Hedging Goes Wrong: Lessons from Ukraine’s Failed Hedge of the EU and Russia
Authors: Smith Nicholas Ross 
Published: September 2020

AbstractWhen confronted by the competing zero‐sum regional strategies of the EU and Russia between 2010 and 2013, Ukraine chose to aggressively pursue a dual‐aligned hedge. This policy choice, in part, helped precipitate a disastrous outcome: the Ukraine crisis. Using the insights of the literature on smaller power hedging and regional security complex theory, it is argued that Viktor Yanukovych misperceived the geopolitical feedback emanating from the Eastern Europe security complex, leading it to pursuing a suboptimal foreign policy. Hedging was still the optimal foreign policy for Ukraine, but arguably a more modest form of hedging was required. It is argued that Ukraine’s experience raises important questions about the actorness of smaller powers to pursue hedging strategies in geopolitically‐charged regional security complexes.
Lung adenocarcinoma with tumor resolution and dystrophic calcification after salvage surgery following immune checkpoint inhibitor therapy: A case report
Authors: Sumi Toshiyuki , Uehara Hirofumi , Masaoka Toshiaki , Tada Makoto , Keira Yoshiko , Kamada Koki , Shijubou Naoki , Yamada Yuichi , Nakata Hisashi , Mori Yuji , Chiba Hirofumi 
Published: September 2020

A clinical trial of immune checkpoint inhibitors for advanced non‐small cell lung cancer reported an overall survival plateau with a long tail to the survival curve, suggesting that immune checkpoint inhibitors prolong survival. However, little evidence supports the efficacy of immune checkpoint inhibitors as neoadjuvant chemotherapy. We performed salvage surgery on a patient who was treated with an anti‐programmed cell death protein‐1 (PD‐1) antibody and whose tumor size had not changed over time. A 69‐year‐old Japanese female with advanced lung adenocarcinoma was initially administered pembrolizumab therapy; however, owing to the development of various immune‐related adverse events (irAEs), the patient was switched to chemotherapy following steroid therapy. The tumor continued to shrink and calcification within the tumor increased. We performed salvage surgery following which the tumor cells disappeared and necrosis and calcification were detected in the tumor. We concluded that if calcification develops within the tumor and tumor shrinkage is maintained after treatment with anti‐PD‐1 drugs, the calcification may be dystrophic owing to drug‐induced tumor necrosis, and salvage surgery might be beneficial in removing the tumor.Key pointsSignificant findings of the study
If calcification develops within the tumor and tumor shrinkage is maintained after treatment with anti‐PD‐1 drugs, the calcification may be dystrophic owing to tumor necrosis caused by drug effects, and salvage surgery might be beneficial in removing the tumor.
What this study adds
This study showed the efficacy of immune checkpoint inhibitors as neoadjuvant chemotherapy to be followed by salvage surgery for unresectable advanced lung adenocarcinoma.
Prognostic factors for survival in patients with metastatic lung adenocarcinoma: An analysis of the SEER database
Authors: Campos‐Balea Begoña , de Castro Carpeño Javier , Massutí Bartomeu , Vicente‐Baz David , Pérez Parente Diego , Ruiz‐Gracia Pedro , Crama Leonardo , Cobo Dols Manuel 
Published: September 2020

BackgroundLung adenocarcinoma (ADC) is the main cause of death related to lung cancer. The aim of this study was to identify poor prognostic factors for overall survival (OS) in patients with stage IV lung ADC in real‐world clinical practice.MethodsPatients were selected from the Surveillance Epidemiology and End Results (SEER) database. Chi‐square bivariate analysis was used for the association of binary qualitative variables. A multivariate Cox regression analysis was performed to determine the impact of these prognostic factors on OS.ResultsA total of 46 030 patients were included (51.3% men, mean age 67.03 ± 11.6), of whom 41.3% presented with metastases in bone, 28.9% in brain, 17.1% in liver and 31.8% in lung. Patients with liver metastases presented with two or more metastatic sites more frequently than patients without liver metastases (P < 0.001). Male sex (HR 0.78, 95% CI: 0.76–0.80), age ≥ 65 years (HR 1.37, 95% CI: 1.33–1.40), lack of family support (HR 0.80, 95% CI: 0.78–0.81) and presence of liver (HR 1.45, 95% CI: 1.40–1.50), bone (HR 1.21, 95% CI: 1.18–1.24) or brain metastases (HR 1.18, 95% CI: 1.15–1.21) were identified as poor prognostic factors for OS. Patients with liver metastasis showed the highest hazard ratio value (P < 0.001).ConclusionsThe presence of liver metastases was the worst prognostic factor for patients with metastatic lung ADC. This factor should be considered as a stratification factor for future studies evaluating new cancer treatments including immunotherapy.Key pointsSignificant findings of the study
Regression analysis identified poor prognostic factors for overall survival. Factors were male sex, age ≥ 65 years, lack of family support and presence of liver, bone and brain metastases.
Patients with liver metastasis showed the highest HR (HR = 1.45 95% CI: 1.40–1.50).
This study included the highest number of adenocarcinoma patients analyzed so far (N = 46 030).
What this study adds
The presence of liver metastases should be considered as a stratification factor for future studies evaluating new cancer treatments including immunotherapy.
Mathematical and simulation methods for deriving extinction thresholds in spatial and stochastic models of interacting agents
Authors: Ovaskainen Otso , Somervuo Panu , Finkelshtein Dmitri 
Published: September 2020

Abstract

In ecology, one of the most fundamental questions relates to the persistence of populations, or conversely to the probability of their extinction. Deriving extinction thresholds and characterizing other critical phenomena in spatial and stochastic models is highly challenging, with few mathematically rigorous results being available for discrete‐space models such as the contact process. For continuous‐space models of interacting agents, to our knowledge no analytical results are available concerning critical phenomena, even if continuous‐space models can arguably be considered to be more natural descriptions of many ecological systems than lattice‐based models.

Here we present both mathematical and simulation‐based methods for deriving extinction thresholds and other critical phenomena in a broad class of agent‐based models called spatiotemporal point processes. The mathematical methods are based on a perturbation expansion around the so‐called mean‐field model, which is obtained at the limit of large‐scale interactions. The simulation methods are based on examining how the mean time to extinction scales with the domain size used in the simulation. By utilizing a constrained Gaussian process fitted to the simulated data, the critical parameter value can be identified by asking when the scaling between logarithms of the time to extinction and the domain size switches from sublinear to superlinear.

As a case study, we derive the extinction threshold for the spatial and stochastic logistic model. The mathematical technique yields rigorous approximation of the extinction threshold at the limit of long‐ranged interactions. The asymptotic validity of the approximation is illustrated by comparing it to simulation experiments. In particular, we show that species persistence is facilitated by either short or long spatial scale of the competition kernel, whereas an intermediate scale makes the species vulnerable to extinction.

Both the mathematical and simulation methods developed here are of very general nature, and thus we expect them to be valuable for predicting many kinds of critical phenomena in continuous‐space stochastic models of interacting agents, and thus to be of broad interest for research in theoretical ecology and evolutionary biology.
Factors that affect health‐care workers’ practices of medication administration to aged care residents with swallowing difficulties: An Australia‐wide survey study
Authors: Sefidani Forough Aida , Lau Esther T. L. , Steadman Kathryn J. , Kyle Greg J. , Cichero Julie A. Y. , Serrano Santos Jose Manuel , Nissen Lisa M. 
Published: September 2020

AbstractObjectivesTo understand the barriers and facilitators of medication administration to aged care residents with swallowing difficulties.MethodsHealth‐care workers in aged care facilities across Australia involved in medication administration to residents completed an online survey.ResultsOf 355 respondents, 90.9% reported ‘everyday’ encounters with residents with swallowing difficulties and 94.1% modified medications to facilitate administration. Time constraints (63.4%) and workload (69.0%) were common barriers. Only 39.0% believed swallowing abilities are considered at the prescribing stage. Pill size (95.8%), polypharmacy (75.2%) and lack of alternative formulations (74.9%) contributed to these challenges. Support from other health‐care professionals (91.5%) and training (85.9%) were the most favoured facilitators.ConclusionHealth‐care workers are faced with various challenges when caring for residents with swallowing difficulties. Promoting multidisciplinary collaborations, provision of training and medication review services, and improving skill mix and staffing composition in aged care facilities are needed to address these challenges.
Rapid uptake of early medical abortions in the Northern Territory: A family planning‐based model
Authors: Murdoch Jacqueline , Thompson Kirsten , Belton Suzanne 
Published: September 2020

BackgroundAbortion law reform does not necessarily translate into services, especially for those in regional areas. Although abortion has been legal in the Northern Territory (NT) since 1974, prior to 2017 legislation change, early medical abortions (EMAs) were effectively prohibited in primary care. In July 2017, Family Planning Welfare Association of the Northern Territory (FPNT) was awarded funding to provide EMAs free of charge for Medicare eligible clients.AimsTo describe the demographics and clinical outcomes of clients accessing the EMA service in the first 12 months after legislation change.Materials and MethodsRetrospective audit of FPNT’s Unplanned Pregnancy Database from 1 July 2017 to 30 June 2018 and analysis of the NT Government’s Termination of Pregnancy 12 Month Data Report.ResultsOf 742 abortions in the NT in the first 12 months after legislation change, 426 were EMAs prescribed at FPNT. Eleven percent of these (47/426) were for Aboriginal or Torres Strait Islander women and 15% (64/426) were for women from Remote or Very Remote Australia. Outcomes were definitively documented for 326 (77%); 5% of these required further misoprostol and 99% had a complete abortion without surgical intervention. Eighty‐six percent (281/326) commenced effective hormonal contraception following their EMA.ConclusionsProviding funding to a Family Planning service was effective in devolving the majority of abortions from tertiary to primary healthcare and increasing the use of effective contraception. Some women remain under‐represented, particularly women from more remote areas of the NT. Further work is required to ensure equity of access to services for these women.
Provision of assisted reproductive technologies (ART) to Aboriginal and Torres Strait Islander peoples: Limited engagement in an online survey of Medical Directors of ART services
Authors: Gilbert Emily W. , Boyle Jacqueline A. , Campbell Sandra K. , Rumbold Alice R. 
Published: September 2020

Current knowledge about infertility and access to infertility treatment among Aboriginal and Torres Strait Islander peoples is extremely limited. We conducted an online survey of Medical Directors of registered ART providers in Australia (n = 59) to obtain preliminary information on this topic. Six (10%) Directors responded; only two reported routinely collecting the Aboriginal and Torres Strait Islander status of clients. While the low response rate prevents generalising the findings, the poor engagement may indicate gaps in awareness of fertility issues for this group. This warrants further investigation, to understand whether Aboriginal and Torres Strait Islander people are appropriately accessing infertility care.
Evaluation of the Spring Seedling Project—Zhaotong Program: A study of a novel continuing medical education program for rural doctors in China
Authors: Gu Jie , Zhu Shanzhu , Chen Taojian , Tang Juntao , Pan Zhigang , Gong Jian , Shou Juan , Yang Hua , Du Zhaohui 
Published: September 2020

AbstractObjectiveTo evaluate the effectiveness of the Spring Seedling Project‐Zhaotong program, a novel continuing medical education program, to improve the knowledge and skills of rural doctors in China.DesignAn uncontrolled single‐group pre‐ and post‐intervention design based on quantitative and qualitative methods.SettingZhaotong is a prefecture‐level city located in Yunnan, China.ParticipantsA total of 1866 country doctors practising in Zhaotong were enrolled.InterventionsThe Zhaotong program consisted of three stages: remote education, workshops conducted in Zhaotong and field training in Shanghai.Main outcome measuresThe effectiveness of the remote education and Zhaotong workshop stages was assessed based on differences between pre‐ and post‐training test scores. Qualitative comments were collected to assess the experience of country doctors following the Shanghai field training stage.ResultsIn total, 1866 country doctors (46.9% males; mean age: 38.2 ± 9.2 years) participated in the program. The average score of the post‐training test was higher than that of the pre‐training test, both online (P < .001) and offline (P < .001). In regard to the Zhaotong workshops, with the exception of incisions/suturing, the average scores of cardiopulmonary resuscitation, gynaecological examinations and child growth/development were improved after training (P < .001). Qualitative analysis showed that Shanghai field training enhanced understanding of general practice, with the majority of country doctors indicating that they would apply what they learned in daily practice.ConclusionThis study introduced an comprehensive form of continuing medical education for rural doctors in Zhaotong and proved the effectiveness of this program and also provided a reference point for the future development of continuing medical education.
Rethinking access for minority segments in rural health: An LGBTQI+ perspective
Authors: Lewis Clifford 
Published: September 2020

AbstractThis paper nuances the notion of access when considering minority segments and their use of health care services in rural communities. It argues that access needs to be considered as both the availability and the perceived ability to use a service without fear of retribution. By taking such a stance, this paper addresses the inequality in LGBTQI+ care in rural communities. It claims equitable care can only be achieved if the appropriate environment is created where individuals can disclose their identity and seek appropriate treatment. Given the complexity surrounding rural communities, their prevailing culture and perceptions, as well as stigmas and poor health outcome, a multilevel approach is taken to identify implications. It is argued that to address the individual and systemic barriers to equitable health care, a human rights‐centred approach to health needs to be adopted considering the individual, the community and the health system.
Quality assessment of a screening algorithm for diabetic retinopathy: prolongation of screening intervals with minimal effect of HbA1c and arterial hypertension on the length of intervals
Authors: Byberg Stine , Vistisen Dorte , Jørgensen Marit Eika , Diaz Lars Jorge , Valerius Marianne , Hajari Javad Nouri , Lund‐Andersen Henrik 
Published: September 2020

AbstractPurposeAt Steno Diabetes Center Copenhagen (SDCC), diabetic retinopathy (DR) screening intervals are based on quantification of retinal lesions. Screening intervals are, for the milder forms of DR, prolonged to 2–3 years. The purpose of the present study was to evaluate the effect of the prolongation on developing unexpected events and to evaluate the effect of HbA1c and arterial hypertension.MethodsWe assessed 18 972 screening intervals from 6000 patients from 1/1‐2003 to 1/5‐2017 for occurrence of unexpected events, defined as: (1) DR progression requiring treatment, at the following screening date, and (2) DR‐related hospital contact within the planned interval. We modelled the effect of several risk factors for developing unexpected events in a Cox regression. Furthermore, we assessed the risk of unexpected events in a logistic regression analysis using cubic splines to model the effect of HbA1c, stratified by arterial hypertension status.Results16 283 (86%) intervals followed the planned interval and among those, only 86 (0.5%) experienced unexpected events. Intervals of dysregulated patients (86% of all intervals) did not experience more unexpected events, compared with well‐regulated patient intervals (Hazard Ratio: 1.12, 95% CI: 0.55–2.27). We found a nonlinear effect of HbA1c on the risk of unexpected events which peaked around HbA1c levels of 80 mmol/mol. Having arterial hypertension slightly increased the risk of unexpected events.ConclusionsThe present study supports the validity of the current algorithm. We found no increased risk of unexpected events among dysregulated intervals but a nonlinear effect of HbA1c. Age, diabetes duration and diabetes type were significantly associated with unexpected events.
Past 12‐month history of single and multiple suicide attempts among a national sample of school‐going adolescents in Tonga
Authors: Pengpid Supa , Peltzer Karl 
Published: September 2020

AbstractIntroductionSuicide attempt may be common among adolescents. Less is known about this in the Pacific Island country, Tonga. Therefore, this analysis estimated the frequency of suicide attempts as well as its associated factors among adolescents in Tonga.MethodCross‐sectional data of 3333 adolescents (median age = 14 years) that took part in the “2017 Tonga Global School‐Based Student Health Survey (GSHS)” were analyzed.ResultsAlmost one in seven students (16.5%) had attempted suicide in the past year (8.8% once and 7.7% more than once). Female sex, loneliness, having no close friends, often bullied, frequently in a physical fight, frequently truant from school, ever amphetamine use, and past‐month tobacco use were associated with ≥2 suicide attempts. Multiple suicide attempts increased with an increase in psychosocial distress, health risk behaviors, and social‐environmental factors.ConclusionAlmost one in seven students attempted suicide in the past year and several risk variables were found.
Does CSR make better citizens? The influence of employee CSR programs on employee societal citizenship behavior outside of work
Authors: Lewin Lisa D. , Warren Danielle E. , AlSuwaidi Mohammed 
Published: September 2020

AbstractWhile corporate social responsibility (CSR) is expected to benefit the firm and attract employees, few have examined the effects of CSR on employees outside of work. Extending the organizational citizenship literature, we conceptualize employee engagement in CSR at work and outside of work as a form of “societal citizenship behavior.” Across two studies of working adults, we examine the relationship between identification with an employer that engages in CSR and different forms of employee societal citizenship behaviors (e.g., donations, volunteering) outside of work. In Study 1 (N = 430 employees), we focus upon CSR donation programs and find that identification with an employer that engages in CSR and participating in employer CSR donation programs affect employee citizenship behavior (donations) outside of work. In Study 2 (N = 285 employees), we examine a broader set of citizenship behaviors inside and outside of work and find the relationships hold. Identification with an employer that engages in CSR relates positively to citizenship behavior at work and outside of work. In total, our study results suggest that employer CSR affects employee citizenship behaviors outside of work. We end with directions for future research.
Impact of enantiomer‐specific changes in pharmacokinetics between infants and adults on the target concentration of racemic ketorolac: A pooled analysis
Authors: Cloesmeijer Michael E. , van Esdonk Michiel J. , Lynn Anne M. , Smits Anne , Tibboel Dick , Daali Youssef , Olkkola Klaus T. , Allegaert Karel , Mian Paola 
Published: September 2020

AimsKetorolac is a nonsteroidal anti‐inflammatory racemic drug with analgesic effects only attributed to its S‐enantiomer. The aim of this study is to quantify enantiomer‐specific maturational pharmacokinetics (PK) of ketorolac and investigate if the contribution of both enantiomers to the total ketorolac concentration remains equal between infants and adults or if a change in target racemic concentration should be considered when applied to infants.MethodsData were pooled from 5 different studies in adults, children and infants, with 1020 plasma concentrations following single intravenous ketorolac administration. An allometry‐based enantiomer‐specific population PK model was developed with NONMEM 7.3. Simulations were performed in typical adults and infants to investigate differences in S‐ and R‐ketorolac exposure.ResultsS‐ and R‐ketorolac PK were best described with a 3‐ and a 2‐compartment model, respectively. The allometry‐based PK parameters accounted for changes between populations. No maturation function of ketorolac clearance could be identified. All model parameters were estimated with adequate precision (relative standard error <50%). Single dose simulations showed that a previously established analgesic concentration at half maximal effect in adults of 0.37 mg/L, had a mean S‐ketorolac concentration of 0.057 mg/L, but a mean S‐ketorolac concentration of 0.046 mg/L in infants. To match the effective adult S‐ketorolac‐concentration (0.057 mg/L) in typical infants, the EC50‐racemic should be increased to 0.41 mg/L.ConclusionEnantiomer‐specific changes in ketorolac PK yield different concentrations and S‐ and R‐ketorolac ratios between infants and adults at identical racemic concentrations. These PK findings should be considered when studies on maturational pharmacodynamics are considered.