bluuebunny/crossref_metadata_2025_split huggingface dataset:
Resetting PPP in Infrastructure Model in India Post-COVID-19 Pandemic
Authors: Kudtarkar Sandeep G. 
Published: January 2021

This article has set out to understand why a large number of public–private partnership (PPP) projects delayed stalled and terminated in the largest PPP program in India. Based on quantitative and case-study-based qualitative research, this study finds that the incomplete nature of PPP contracts, uncertainty and information asymmetry leads to adverse selection, moral hazard, opportunism and holdup of the PPP projects. The inefficacious and inequitable allocation of risks among stakeholders and lack of contract management skills in project authorities exaggerated the problems, and the final outcome is a large number of failed projects and no participation from private developers in future projects defeating the very purpose of adopting the PPP model to build public infrastructure. This study proposes a 20-point conceptual institutional framework suggesting policy and project-level measures for effective execution of the future PPP program in India and developing countries with similar socioeconomic environment post-COVID-19 pandemic amid recessionary conditions. JEL Codes: E6, H5, N7, O2, R4
Cyber democracy for better board representation? The effect of e-voting on excess control in an emerging economy
Authors: Yang Kuo-Pin , Chou Christine , Schwarz Gavin M 
Published: January 2021

With a growth in shareholder activism, the influence of shareholders on the make-up and selection of board members is increasingly acknowledged but under-explored. Focusing on one element of activism, this article considers the adoption and use of electronic voting (e-voting) for board elections in emerging economies, testing its effect on the excess control of controlling shareholders. Using a sample of board elections at 809 publicly listed Taiwanese companies, results challenge convention on governance and shareholder democracy. We show that adopting e-voting counterintuitively leads to greater levels of excess control which subsequently harms firm performance—an effect more pronounced in firms characterized by a pyramidal control structure and family-controlled firms. Findings offer an alternative view on shareholder democracy, revisiting expectations of benefits accrued from e-voting. JEL Classification: M10, L21, L25
The five-repetition sit-to-stand test is a predictive factor of severe exacerbations in COPD
Authors: Medina-Mirapeix Francesc , Bernabeu-Mora Roberto , Valera-Novella Elisa , Gacto-Sánchez Mariano , Bernabeu-Mora Myriam , Sánchez-Martínez María Piedad 
Published: January 2021

Background: Although the six-minute-walk test (6MWT) has been used to predict chronic obstructive pulmonary disease (COPD) exacerbations, additional research is necessary to identify more rapid, simpler tests that are directly associated with exacerbations, such as the five-repetition sit-to-stand (5STS) test and 4-m gait speed (4MGS) test. Aims: To determine the ability of the 5STS and 4MGS tests in predicting severe exacerbations in stable COPD over the following year, and to assess the ability of the best prognostic test to identify patients at high risk of hospital admission correctly. Methods: This prospective study included 137 patients with stable COPD. Multiple logistic regression models were constructed to assess whether the 6MWT, 5STS, and 4MGS tests were associated with severe exacerbations in the year following the test. Receiver-operating characteristic curves and the area under the curve (AUC) were evaluated to determine the accuracy of each test for identifying patients with severe exacerbations. Results: Scores of <350 m for the 6WMT and ⩽2 for the 5STS test were associated with severe exacerbations in the model adjusted for age and the number of exacerbations in the previous year. The 5STS test and the 6MWT had very similar predictive and discriminative abilities. Odds ratios were 3.20 (95% confidence interval [CI] 1.14–8.96) and 3.84 (95% CI 1.14–12.94) and AUCs were 0.793 (95% CI 0.704–0.882) and 0.783 (95% CI 0.686–0.879), respectively. Conclusions: The 5STS test predicted the risk of severe exacerbation within the following year among patients with COPD. The 5STS test could replace the 6MWT for identifying patients at high risk of hospital admission.
The prevalence and predictors of Stroke among atrial fibrillation patients attending at Gondar University Referral Hospital, Northwest Ethiopia
Authors: Gedamu Yonas , Taddese Asefa Adimasu , Abdulkadir Mohamed , Hailu Workagegnehu , Abdu Oumer 
Published: January 2021

Introduction: Recently, stroke is becoming the major public health problem in developing countries including Ethiopia. Atrial fibrillation patients are the most vulnerable group for the occurrence of stroke. Knowing the predictors and being aware for it is important for preventing severe complications and death. Therefore, the aim of this study is to assess the prevalence of stroke and identifying significant predictors. Methods: A hospital-based cross-sectional study was performed from 1 December 2018 to 30 September 2019 at University of Gondar Referral Hospital. A total of 242 patients with atrial fibrillation were included in the study. Atrial fibrillation patients were diagnosed by using 12 lead electrocardiographic tracing, in addition to thorough medical history and physical examination and analyzed by the Modular ECG Analysis System (MEANS). We used Epi info 7 and SPSS version 22 software for data entry and analysis purpose, respectively. Both bivariable and multivariable binary logistic regression model were computed to show the relationship of dependent and independent variables. Result: The prevalence of stroke among atrial fibrillation patients was 19.4% (95% confidence interval (CI): 14.9–25.2). Patients with heart failure (adjusted odds ratio (AOR): 5.70, 95% CI: 2.50–13.24) and thyroid disorder (AOR: 4.98, 95% CI: 1.47–16.85) are at risk of developing stroke. Conclusion: The prevalence of stroke was higher compared with others studies. Patients with heart failure and thyroid disorders were the risk factor for the development of stroke; therefore, physicians and cardiologists may better to consider all these two disorders when they diagnose stroke in patients with atrial fibrillation.
Comparison of CALGB 10403 (Alliance) and COG AALL0232 toxicity results in young adults with acute lymphoblastic leukemia
Authors: Advani Anjali S. , Larsen Eric , Laumann Kristina , Luger Selina M. , Liedtke Michaela , Devidas Meenakshi , Chen Zhiguo , Yin Jun , Foster Matthew C. , Claxton David , Coffan Kristin , Tallman Martin S. , Appelbaum Frederick R. , Erba Harry , Stone Richard M. , Hunger Stephen P. , McNeer Jennifer L. , Loh Mignon L. , Raetz Elizabeth , Winick Naomi , Carroll William , Larson Richard A. , Stock Wendy 
Published: January 2021

Abstract
Adolescents and young adults (AYAs) with acute lymphoblastic leukemia have improved outcomes when treated with pediatric-inspired regimens. CALGB 10403 was the largest prospective study to evaluate the feasibility of using a pediatric regimen in AYAs with acute lymphoblastic leukemia up to 40 years of age. This article presents the toxicity events observed in the CALGB 10403 study and compares these toxicities vs those observed among AYAs treated on the same arm of the companion Children’s Oncology Group (COG) AALL0232 study. Toxicities in CALGB 10403 were similar to those observed in COG AALL0232. Some grade 3 to 4 adverse events were more often reported in CALGB 10403 compared with COG AALL0232 (hyperglycemia, hyperbilirubinemia, transaminase elevation, and febrile neutropenia). Adverse events correlated with body mass index ≥30 kg/m2 and some with increasing age. The mortality rate in CALGB 10403 was low (4%) and similar to that in the COG AALL0232 trial. A caveat to this analysis is that only 39% of CALGB 10403 patients completed all planned protocol treatment. In COG AALL0232, although 74% of patients aged &lt;18 years completed treatment, only 57% of patients aged ≥18 years completed treatment. This scenario suggests that issues associated with age and treating physician may be a factor. Due to its improved survival rates compared with historical controls, the CALGB 10403 regimen is now a standard of care. The hope is that the rate of protocol completion will increase as more familiarity is gained with this regimen. These trials were registered at www.clinicaltrials.gov as #NCT00558519 (CALGB 10403) and #NCT00075725 (COG AALL0232).
Antigen density dictates RBC clearance, but not antigen modulation, following incompatible RBC transfusion in mice
Authors: Arthur Connie M. , Allen Jerry William L. , Verkerke Hans , Yoo Justin , Jajosky Ryan P. , Girard-Pierce Kathryn , Chonat Satheesh , Zerra Patricia , Maier Cheryl , Rha Jen , Fasano Ross , Josephson Cassandra D. , Roback John D. , Stowell Sean R. 
Published: January 2021

AbstractIncompatible red blood cell (RBC) transfusion can result in life-threatening transfusion complications that can be challenging to manage in patients with transfusion-dependent anemia. However, not all incompatible RBC transfusions result in significant RBC removal. One factor that may regulate the outcome of incompatible RBC transfusion is the density of the incompatible antigen. Despite the potential influence of target antigen levels during incompatible RBC transfusion, a model system capable of defining the role of antigen density in this process has not been developed. In this study, we describe a novel model system of incompatible transfusion using donor mice that express different levels of the KEL antigen and recipients with varying anti-KEL antibody concentrations. Transfusion of KEL+ RBCs that express high or moderate KEL antigen levels results in rapid antibody-mediated RBC clearance. In contrast, relatively little RBC clearance was observed following the transfusion of KEL RBCs that express low KEL antigen levels. Intriguingly, unlike RBC clearance, loss of the KEL antigen from the transfused RBCs occurred at a similar rate regardless of the KEL antigen density following an incompatible transfusion. In addition to antigen density, anti-KEL antibody levels also regulated RBC removal and KEL antigen loss, suggesting that antigen density and antibody levels dictate incompatible RBC transfusion outcomes. These results demonstrate that antibody-induced antigen loss and RBC clearance can occur at distinct antigen density thresholds, providing important insight into factors that may dictate the outcome of an incompatible RBC transfusion.
Adoptive therapy with CMV-specific cytotoxic T lymphocytes depends on baseline CD4+ immunity to mediate durable responses
Authors: Fabrizio Vanessa A. , Rodriguez-Sanchez M. Irene , Mauguen Audrey , Dahi Parastoo B. , Doubrovina Ekaterina , O’Reilly Richard J. , Prockop Susan E. 
Published: January 2021

AbstractAdoptive cell therapy using cytomegalovirus (CMV)-specific cytotoxic T lymphocytes (CMV-CTLs) has demonstrated efficacy posttransplant. Despite the predicted limited engraftment of CMV-CTLs derived from third-party donors, partially matched third-party donor–derived CMV-CTLs have demonstrated similar response rates to those derived from primary hematopoietic cell transplantation donors. Little is known about the mechanisms through which adoptive cellular therapies mediate durable responses. We performed a retrospective analysis of patients receiving CMV-CTLs for treatment of CMV viremia and/or disease after allogeneic transplant between September of 2009 and January of 2018. We evaluated whether response to adoptively transferred CMV-CTLs correlated with immune reconstitution (IR), using validated CD4+ IR milestones of 50 × 106/L and 200 × 106/L. In this analysis, a cohort of 104 patients received CMV-CTLs derived from a primary transplant donor (n = 25), a third-party donor (n = 76), or both (n = 3). Response to therapy did not increase the likelihood of achieving CD4+ IR milestones at 1 (P = .53 and P &gt; .99) or 2 months (P = .12 and P = .33). The origin of CMV-CTLs did not impact subsequent CD4+ IR. CMV-CTLs appeared to interact with host immunity in mediating responses. Recipients with a baseline CD4 &gt;50 × 106/L had higher response to therapy (P = .02), improved overall survival (P &lt; .001), and protection from CMV-related death (P = .002). Baseline endogenous immunity appears to improve CMV-related and overall survival in this cohort and can be an important marker at the initiation of therapy.
Associations between hyperhomocysteinemia and the presence and severity of acute coronary syndrome in young adults ≤ 35 years of age
Authors: Sun Jiayin , Han Wei , Wu Sijing , Jia Shuo , Yan Zhenxian , Guo Yonghe , Zhao Yingxin , Zhou Yujie , Liu Wei 
Published: January 2021

Abstract
Background
The prevalence of acute coronary syndrome (ACS) continues to increase among young Chinese adults. Homocysteine (HCY) has been suggested as a promoter of atherosclerosis leading to coronary artery disease (CAD). Yet, it remains uncertain whether HCY is associated with the ACS and the severity of coronary artery stenosis in young adults.

Methods
Young patients (18–35 years of age) diagnosed with ACS who underwent coronary angiography (CAG) at Anzhen Hospital between January 2013 and June 2019 were assigned to the ACS group. As confirmed by CAG during the same period, an equivalent age-matched population without CAD was assigned to the non-CAD group. A serum HCY level > 15 µmol/L was defined as hyperhomocysteinemia (HHCY). The Gensini score assessed the severity of coronary artery stenosis.

Results
A total of 1103 participants, including 828 ACS patients and 275 non-CAD subjects, were enrolled in this study. Young ACS patients had higher level of serum HCY and greater prevalence of HHCY compared with non-CAD subjects [for HCY, 16.55 (11.93–29.68) vs 12.50 (9.71–17.42), P < 0.001; for HHCY prevalence, 62.08% vs 26.18%, P < 0.001]. Multivariate logistic regression analysis with the stepwise method indicated that HHCY was an independent predictor associated with the presence of ACS, after adjusting for traditional confounders (OR, 4.561; 95% CI, 3.288–6.327; P < 0.001). Moreover, young ACS patients with HHCY had increased prevalence of ST-segment elevation myocardial infarction (STEMI) (P = 0.041), multi-vessel disease (P = 0.036), and decreased value of left ventricular ejection fraction (LVEF) (P = 0.01). Also, the HCY level was significantly correlated with Gensini Score in ACS patients (r = 0.142, P < 0.001).

Conclusion
HHCY is significantly associated with the presence of ACS and the severity of coronary artery stenosis in young adults ≤ 35 years of age.
A rare case of adult herpes simplex encephalitis complicated with rhabdomyolysis
Authors: Yu Qinwei , Han Chao , Pei Lei , Huang Jinsha , Xu Yan , Wang Tao 
Published: January 2021

Abstract
Background
Compelling evidence indicates that status epilepticus is a prevalent cause of rhabdomyolysis. However, cases of rhabdomyolysis induced by a single seizure accompanied by viral encephalitis are rarely reported. Herein, we present a case of adult Herpes Simplex Encephalitis complicated with rhabdomyolysis.

Case presentation
A 32-year-old male was patient presented with fever accompanied by episodes of convulsions, myalgia, and oliguria, which exacerbated the delirium. Routine blood examination showed impaired kidney function and elevated myoglobin (Mb) and creatine phosphokinase (CK) levels. MRI scanning revealed a damaged frontotemporal lobe and limbic system. In addition, herpes simplex virus (HSV) pathogen was identified in the cerebrospinal fluid thus indicating HSV infection. Therefore, a diagnosis of rhabdomyolysis triggered by HSV infection accompanied by epilepsy was made. Notably, the patient recovered well after early intervention and treatment.

Conclusion
The case presented here calls for careful analysis of rhabdomyolysis cases with unknown causes, minor seizures, and without status epilepticus. This case also indicates that HSV virus infection might contribute to the rhabdomyolysis.
Molecular subtypes based on DNA methylation predict prognosis in lung squamous cell carcinoma
Authors: Li Xiu-Shen , Nie Ke-Chao , Zheng Zhi-Hua , Zhou Rui-Sheng , Huang Yu-Sheng , Ye Zeng-Jie , He Fan , Tang Ying 
Published: January 2021

Abstract
Background
Due to tumor heterogeneity, the diagnosis, treatment, and prognosis of patients with lung squamous cell carcinoma (LUSC) are difficult. DNA methylation is an important regulator of gene expression, which may help the diagnosis and therapy of patients with LUSC.

Methods
In this study, we collected the clinical information of LUSC patients in the Cancer Genome Atlas (TCGA) database and the relevant methylated sequences of the University of California Santa Cruz (UCSC) database to construct methylated subtypes and performed prognostic analysis.

Results
Nine hundred sixty-five potential independent prognosis methylation sites were finally identified and the genes were identified. Based on consensus clustering analysis, seven subtypes were identified by using 965 CpG sites and corresponding survival curves were plotted. The prognostic analysis model was constructed according to the methylation sites’ information of the subtype with the best prognosis. Internal and external verifications were used to evaluate the prediction model.

Conclusions
Models based on differences in DNA methylation levels may help to classify the molecular subtypes of LUSC patients, and provide more individualized treatment recommendations and prognostic assessments for different clinical subtypes. GNAS, FZD2, FZD10 are the core three genes that may be related to the prognosis of LUSC patients.
Study protocol: randomized controlled trial of opioid-free vs. traditional perioperative analgesia in elective orthopedic surgery
Authors: Shing Elaine Z. , Leas Daniel , Michalek Caleb , Wally Meghan K. , Hamid Nady 
Published: January 2021

Abstract
Background
The medical community is beginning to recognize the contribution of prescription opioids in the growing national opioid crisis. Many studies have compared the safety and efficacy of alternative analgesics to opioids, but none utilizing a completely opioid-free perioperative protocol in orthopedics.

Methods
We developed and tested an opioid-free perioperative analgesic pathway (from preoperative to postoperative period) among patients undergoing common elective orthopedic procedures. Patients will be randomized to receive either traditional opioid-including or completely opioid-free perioperative medications. This study is being conducted across multiple orthopedic subspecialties in patients undergoing the following common elective orthopedic procedures: single-level or two-level ACDF/ACDA, 1st CMC arthroplasty, Hallux Valgus/Rigidus corrections, diagnostic knee arthroscopies, total hip arthroplasty (THA), and total shoulder arthroplasty/reverse total shoulder arthroplasty (TSA/RTSA). The primary outcome measure is pain score at 24 h postoperatively. Secondary outcome measures include pain scores at additional time points, medication side effects, and several patient-reported variables such as patient satisfaction, quality of life, and functional status.

Discussion
We describe the methods for a feasibility randomized controlled trial comparing opioid-free perioperative analgesics to traditional opioid-including protocols. We present this study so that it may be replicated and incorporated into future studies at other institutions, as well as disseminated to additional orthopedic and/or non-orthopedic surgical procedures. The ultimate goal of presenting this protocol is to aid recent efforts in reducing the impact of prescription opioids on the national opioid crisis.

Trial registration
The protocol was approved by the local institutional review board and registered with clinicaltrials.gov (Identifier: NCT04176783) on November 25, 2019, retrospectively registered
Quality of online self-management resources for adults living with primary brain cancer, and their carers: a systematic environmental scan
Authors: Schaefer Isabelle , Heneka Nicole , Luckett Tim , Agar Meera R. , Chambers Suzanne K. , Currow David C. , Halkett Georgia , Disalvo Domenica , Amgarth-Duff Ingrid , Anderiesz Cleola , Phillips Jane L. 
Published: January 2021

Abstract
Background
A primary brain cancer diagnosis is a distressing, life changing event. It adversely affects the quality of life for the person living with brain cancer and their families (‘carers’). Timely access to evidence-based information is critical to enabling people living with brain cancer, and their carers, to self-manage the devastating impacts of this disease.

Method
A systematic environmental scan of web-based resources. A depersonalised search for online English-language resources published from 2009 to December 2019 and designed for adults (> 25 years of age), living with primary brain cancer, was undertaken using the Google search engine. The online information was classified according to: 1) the step on the cancer care continuum; 2) self-management domains (PRISMS taxonomy); 3) basic information disclosure (Silberg criteria); 4) independent quality verification (HonCode); 5) reliability of disease and treatment information (DISCERN Sections 1 and 2); and readability (Flesch-Kincaid reading grade).

Results
A total of 119 online resources were identified, most originating in England (n = 49); Australia (n = 27); or the USA (n = 27). The majority of resources related to active treatment (n = 76), without addressing recurrence (n = 3), survivorship (n = 1) or palliative care needs (n = 13). Few online resources directly provided self-management advice for adults living with brain cancer or their carers. Just over a fifth (n = 26, 22%) were underpinned by verifiable evidence. Only one quarter of organisations producing resources were HonCode certified (n = 9, 24%). The median resource reliability as measured by Section 1, DISCERN tool, was 56%. A median of 8.8 years of education was required to understand these online resources.

Conclusions
More targeted online information is needed to provide people affected by brain cancer with practical self-management advice. Resources need to better address patient and carer needs related to: rehabilitation, managing behavioural changes, survivorship and living with uncertainty; recurrence; and transition to palliative care. Developing online resources that don’t require a high level of literacy and/or cognition are also required.