bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spectral signatures in the UV range can be combined with secondary plant metabolites by deep learning to characterize barley–powdery mildew interaction
Authors: Brugger Anna , Schramowski Patrick , Paulus Stefan , Steiner Ulrike , Kersting Kristian , Mahlein Anne‐Katrin 
Published: May 2021

AbstractIn recent studies, the potential of hyperspectral sensors for the analysis of plant–pathogen interactions was expanded to the ultraviolet range (UV; 200–380 nm) to monitor stress processes in plants. A hyperspectral imaging set‐up was established to highlight the influence of early plant–pathogen interactions on secondary plant metabolites. In this study, the plant–pathogen interactions of three different barley lines inoculated with Blumeria graminis f. sp. hordei (Bgh, powdery mildew) were investigated. One susceptible genotype (cv. Ingrid, wild type) and two resistant genotypes (Pallas 01, Mla1‐ and Mla12‐based resistance and Pallas 22, mlo5‐based resistance) were used. During the first 5 days after inoculation (dai) the plant reflectance patterns were recorded and plant metabolites relevant in host–pathogen interactions were studied in parallel. Hyperspectral measurements in the UV range revealed that a differentiation between barley genotypes inoculated with Bgh is possible, and distinct reflectance patterns were recorded for each genotype. The extracted and analysed pigments and flavonoids correlated with the spectral data recorded. A classification of noninoculated and inoculated samples with deep learning revealed that a high performance can be achieved with self‐attention networks. The subsequent feature importance identified wavelengths as the most important for the classification, and these were linked to pigments and flavonoids. Hyperspectral imaging in the UV range allows the characterization of different resistance reactions, can be linked to changes in secondary plant metabolites, and has the advantage of being a non‐invasive method. It therefore enables a greater understanding of plant reactions to biotic stress, as well as resistance reactions.
Exploring autonomic regulation in children with ADHD with and without comorbid anxiety disorder through three systematic levels of cardiac vagal control analysis: Rest, reactivity, and recovery
Authors: Robe Andreea , Păsărelu Costina‐Ruxandra , Dobrean Anca 
Published: May 2021

AbstractAutonomic nervous system (ANS) dysregulation, characterized by reduced vagally mediated Heart Rate Variability (HRV), has been associated with Attention‐Deficit/ Hyperactivity Disorder (ADHD). This study investigated the dynamic vagal modulation of cardiac output in response to shifts in environmental demands in children and adolescents with ADHD, with and without a comorbid anxiety disorder. High‐frequency HRV (HF‐HRV) measures were obtained from 46 children and adolescents ranging from 6 to 17 (M = 9.38; SD = 2.31) years old, during three successive experimental conditions: a baseline recording followed by a sustained attention task, and a post‐task recovery period. Findings support the reliability of the d2 Test, a cancelation test of attention and concentration, to induce parasympathetic withdrawal and extend prior work on “vagal flexibility”. Further, these findings suggest a pattern of group differences in ANS functioning in children with ADHD, with and without a comorbid anxiety disorder. Only the ADHD without comorbid anxiety group showed a normative autonomic response to the cognitive challenge (reduced HF‐HRV). The participants did not display an adaptive process of restoration following the cognitive challenge; the HRV suppression was prolonged during post‐task recovery period, suggesting that ANS responded as if the cognitive stressor was still present. The current paper covers and discusses theoretical implications for the abnormalities in neurophysiological functioning and the different physiological responses in the two ADHD subtypes.
GIS‐based groundwater quality assessment using GQIs and fuzzy‐logic approach
Authors: Chaudhry Akshay Kumar , Sachdeva Payal 
Published: May 2021

AbstractThis study proposes the evaluation of GIS‐based groundwater quality index (GQI) and spatial variability with a hybrid system that combines Fuzzy Logic with GIS‐based GQI. A case study in the semi‐arid area of Punjab, namely Rupnagar, illustrates the proposed hybrid outline. Two GIS‐based GQI models GQI‐10 (using ten water quality parameters (WQPs)) and GQI‐6 (using six “apprehensive/crucial” WQPs), as well as hybrid Fuzzy Logic GIS‐based GQI (FGQI) (using six crucial WQPs) models, were developed using trapezoidal membership functions and rule sets based on expert's knowledge. Performance comparison of GQI models showed that the FGQI model predicts improved groundwater quality than the GQI‐10 and GQI‐6. FGQI model variance, RMSE, and R2 values are 84.25, 6.49, 0.89, respectively. Results have shown that the developed FGQI model is successful and GQI modelling suggests the use of northern and central groundwater without treatment to be unsafe for drinking purposes.
Regulation of cerebral blood flow by arterial PCO2 independent of metabolic acidosis at 5050 m
Authors: Caldwell Hannah G. , Smith Kurt J. , Lewis Nia C.S. , Hoiland Ryan L. , Willie Christopher K. , Lucas Samuel J.E. , Stembridge Michael , Burgess Keith R. , MacLeod David B. , Ainslie Philip N. 
Published: May 2021

Key points
We investigated the influence of arterial PCO2 (PaCO2) with and without experimentally altered pH on cerebral blood flow (CBF) regulation at sea level and with acclimatization to 5050 m.
At sea level and high altitude, we assessed stepwise alterations in PaCO2 following metabolic acidosis (via 2 days of oral acetazolamide; ACZ) with and without acute restoration of pH (via intravenous sodium bicarbonate; ACZ+HCO3−).
Total resting CBF was unchanged between trials at each altitude even though arterial pH and [HCO3−] (i.e. buffering capacity) were effectively altered.
The cerebrovascular responses to changes in arterial [H+]/pH were consistent with the altered relationship between PaCO2 and [H+]/pH following ACZ at high altitude (i.e. leftward x‐intercept shifts).
Absolute cerebral blood velocity (CBV) and the sensitivity of CBV to PaCO2 was unchanged between trials at high altitude, indicating that CBF is acutely regulated by PaCO2 rather than arterial pH.
AbstractAlterations in acid‐base balance with progressive acclimatization to high altitude have been well‐established. However, how respiratory alkalosis and the resultant metabolic compensation interact to regulate cerebral blood flow (CBF) is uncertain. We addressed this via three separate experimental trials at sea level and following partial acclimatization (14 to 20 days) at 5050 m; involving: (1) resting acid‐base balance (control); (2) following metabolic acidosis via 2 days of oral acetazolamide at 250 mg every 8 h (ACZ; pH: Δ ‐0.07 ± 0.04 and base excess: Δ ‐5.7 ± 1.9 mEq⋅l–1, trial effects: P < 0.001 and P < 0.001, respectively); and (3) after acute normalization of arterial acidosis via intravenous sodium bicarbonate (ACZ + HCO3−; pH: Δ ‐0.01 ± 0.04 and base excess: Δ ‐1.5 ± 2.1 mEq⋅l–1, trial effects: P = 1.000 and P = 0.052, respectively). Within each trial, we utilized transcranial Doppler ultrasound to assess the cerebral blood velocity (CBV) response to stepwise alterations in arterial PCO2 (PaCO2), i.e. cerebrovascular CO2 reactivity. Resting CBF (via Duplex ultrasound) was unaltered between trials within each altitude, indicating that respiratory compensation (i.e. Δ ‐3.4 ± 2.3 mmHg PaCO2, trial effect: P < 0.001) was sufficient to offset any elevations in CBF induced via the ACZ‐mediated metabolic acidosis. Between trials at high altitude, we observed consistent leftward shifts in both the PaCO2‐pH and CBV‐pH responses across the CO2 reactivity tests with experimentally reduced arterial pH via ACZ. When indexed against PaCO2 – rather than pH – the absolute CBV and sensitivity of CBV‐PaCO2 was unchanged between trials at high altitude. Taken together, following acclimatization, CO2‐mediated changes in cerebrovascular tone rather than arterial [H+]/pH is integral to CBF regulation at high altitude.
Reliability of the ForceFrame With and Without a Fixed Upper-Limb Mold in Shoulder Rotation Strength Assessments Compared With Traditional Hand-Held Dynamometry
Authors: Couch Jamon , Sayers Marc , Pizzari Tania 
Published: May 2021

Context: An imbalance between shoulder internal rotation (IR) and external rotation (ER) strength in athletes is proposed to increase the risk of sustaining a shoulder injury. Hand-held (HHD) and externally fixed dynamometry are reliable forms of assessing shoulder IR and ER strength. A new externally fixed device with an attachable fixed upper-limb mold (The ForceFrame) exists; however, its reliability in measuring shoulder strength is yet to be investigated. Objective: To determine the test–retest reliability of the ForceFrame, with and without the fixed upper-limb mold, in the assessment of shoulder IR and ER strength, as compared with HHD. Design: Test–retest reliability study. Setting: Laboratory, clinical. Participants: Twenty-two healthy and active individuals were recruited from the university community and a private physiotherapy practice. Main Outcome Measures: Maximal isometric shoulder IR and ER strength was measured using the ForceFrame and traditional HHD in neutral and at 90° shoulder abduction. Mean (SD) strength measures were calculated. Test–retest reliability was analyzed using intraclass correlation coefficients (3, 1). The SEM and minimal detectable change were calculated. Results: Good to excellent test–retest reliability was found for all shoulder strength tests across HDD and ForceFrame dynamometry (intraclass correlation coefficients [3, 1] = .854–.916). The minimal detectable changes ranged between 25.61 and 41.84 N across tests. Test–retest reliability was not affected by the dynamometer or testing position. Conclusions: The results from this study indicate that both the ForceFrame and HHD are suitable for measuring shoulder strength in clinical practice. The use of the fixed upper-limb mold with the ForceFrame does not improve reliability.
Challenges in maintaining medicine quality while aiming for universal health coverage: a qualitative analysis from Indonesia
Authors: Hasnida Amalia , Kok Maarten Olivier , Pisani Elizabeth 
Published: May 2021

IntroductionIndonesia, the world’s fourth most populous nation, is close to achieving universal health coverage (UHC). A widely-publicised falsified vaccine case in 2016, coupled with a significant financial deficit in the national insurance system, has contributed to concern that the rapid scale-up of UHC might undermine medicine quality. We investigated the political and economic factors that drive production and trade of poor-quality medicines in Indonesia.MethodsWe reviewed academic publications, government regulations, technical agency documents and news reports to develop a semi-structured questionnaire. We interviewed healthcare providers, policy-makers, medicine regulators, pharmaceutical manufacturers, patients and academics (n=31). We included those with in-depth knowledge about the falsified vaccine case or the pharmaceutical business, medicine regulation, prescribing practice and the implementation of UHC. We coded data using NVivo software and analysed by constant comparative method.ResultsThe scale-up of UHC has cut revenues for physicians and pharmaceutical manufacturers. In the vaccine case, free, quality-assured vaccines were available but some physicians, seeking extra revenue, promoted expensive alternatives. Taking advantage of poor governance in private hospitals, they purchased cut-price ‘vaccines’ from freelance salespeople.A single-winner public procurement system which does not explicitly consider quality has slashed the price paid for covered medicines. Trade, industrial and religious policies simultaneously increased production costs, pressuring profit margins for manufacturers and distributors. They reacted by cutting costs (potentially threatening quality) or by market withdrawal (leading to shortages which provide a market for falsifiers). Shortages and physician-promoted irrational demand push patients to buy medicines in unregulated channels, increasing exposure to falsified medicines.ConclusionMarket factors, including political pressure to reduce medicine prices and healthcare provider incentives, can drive markets for substandard and falsified medicines. To protect progress towards UHC, policy-makers must consider the potential impact on medicine quality when formulating rules governing health financing, procurement, taxation and industry.
Protocol for individual participant data meta-analysis of randomised controlled trials of patients with psychosis to investigate treatment effect modifiers for CBT versus treatment as usual or other psychosocial interventions
Authors: Sudell Maria , Tudur-Smith Catrin , Liao Xiaomeng , Longden Eleanor , Dunn Graham , Kendall Tim , Emsley Richard , Morrison Anthony , Varese Filippo 
Published: May 2021

IntroductionAggregate data meta-analyses have shown heterogeneous treatment effects for cognitive–behavioural therapy (CBT) for patients with schizophrenia spectrum diagnoses. This heterogeneity could stem from specific intervention or patient characteristics that could influence the clinical effectiveness of CBT, termed treatment effect modifiers. This individual participant data meta-analysis will investigate a range of potential treatment effect modifiers of the efficacy of CBT.Methods and analysisWe will perform a systematic review and meta-analysis of studies investigating CBT versus treatment as usual, or CBT versus other psychosocial interventions, for patients with schizophrenia spectrum diagnoses. The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE and the online clinical trials registers of the US government, European Union, WHO and Current Controlled Trials will be searched. Two researchers will screen titles and abstracts identified by the search. Individual participant data will be requested for any eligible study, for the primary outcome (overall psychotic symptoms), secondary outcomes and treatment effect modifiers. Data will be checked and recoded according to an established statistical analysis plan. One-stage and two-stage random effects meta-analyses investigating potential treatment effect modifiers will be conducted. A list of potential treatment effect modifiers for CBT will be produced, motivating future research into particular modifiers.Ethics and disseminationThis study does not require ethical approval as it is based on data from existing studies, although best ethical practice for secondary analysis of clinical data will be followed. The findings will be submitted for publication in peer-reviewed journals, and promoted to relevant stakeholders.PROSPERO registration numberCRD42017060068.
Meta-analysis of the prognostic value of pretreatment serum ferritin in hepatobiliary and pancreas (HBP) cancers
Authors: Lin Shuwen , Fang Yinghua , Lin Ye , Mo Zhikang , Hong Xiaocheng , Jian Zhixiang , Ji Chenggang 
Published: May 2021

Background and objectivesStudies have shown that serum ferritin (SF) has unfavourable prognostic value in hepatobiliary and pancreas (HBP) cancers. This meta-analysis aimed to comprehensively assess the prognostic role of pretreatment SF in patients with HBP cancers.MethodsEligible studies published before January 2020 were obtained through a comprehensive search in the PubMed, Web of Science, Cochrane Library and EMBASE databases. Pooled HRs and 95% CIs were then employed as effect sizes.ResultsSeven studies comprising 1244 patients were pooled. Elevated pretreatment SF was associated with worse overall survival (OS) (HR 1.60, 95% CI 1.36 to 1.88, p<0.001) and recurrence-free survival/progression-free survival/time to recurrence (HR 1.70, 95% CI 1.15 to 2.52, p=0.008). Significant prognostic value of elevated pretreatment SF on OS was detected in the subgroups regardless of the cancer type, race, SF cut-off value, tumour-node-metastasis stage and Newcastle-Ottawa Scale score.ConclusionElevated pretreatment SF was associated with worse survival outcome of patients with HBP cancers. As such, it may serve as a novel prognostic biomarker for HBP cancers.
Retrospective delirium ascertainment from case notes: a retrospective cohort study
Authors:   Geriatric Medicine Research Collaborative
Published: May 2021

ObjectivesThis study sets out to ascertain if recognition of delirium impacts on patient outcomes.DesignRetrospective cohort study.SettingUnscheduled admissions to acute care trust/secondary care UK hospitals.ParticipantsSix hundred and fifty-six older adults aged ≥65 years admitted on 14 September 2018.MeasurementsDelirium was ascertained retrospectively from case notes using medical notes. Documented delirium was classified as recognised delirium and retrospectively ascertained delirium was classified as unrecognised delirium.Primary and secondary outcome measuresPrimary outcome measure: inpatient mortality. Secondary outcome measures: length of stay, discharge destination.ResultsDelirium was present in 21.1% (132/626) of patients at any point during admission. The presence of delirium was associated with increased mortality (HR 2.65, CI 1.40 to 5.01). Recognition of delirium did not significantly impact on outcomes.ConclusionsDelirium is associated with adverse outcomes in hospitalised older adults. However, there is insufficient evidence that recognition of delirium affects outcomes. However, delirium recognition presents an opportunity to discuss a person’s overall prognosis and discuss this with the patient and their family. Further research is needed to assess the pathophysiology of delirium to enable development of targeted interventions towards improved outcomes in patients with delirium.
eTRIOtrial: study protocol of a randomised controlled trial of online education modules to facilitate effective family caregiver involvement in oncology
Authors: Juraskova Ilona , Laidsaar-Powell R , Keast Rachael , Schofield Penelope , Costa Daniel SJ , Kay Judy , Turner Sandra , Koczwara Bogda , Saunders Christobel , Jefford Michael , Yates Patsy , Boyle Frances , White Kate , Miller Annie , Morton Rachael L , Butt Zoe , Butow Phyllis 
Published: May 2021

ObjectiveInformal family caregivers play a crucial role in cancer care. Effective caregiver involvement in cancer care can improve both patient and caregiver outcomes. Despite this, interventions improving the caregiver involvement are sparse. This protocol describes a randomised controlled trial evaluating the combined effectiveness of novel online caregiver communication education modules for: (1) oncology clinicians (eTRIO) and (2) patients with cancer and caregivers (eTRIO-pc).Methods and analysisThirty medical/radiation/surgical oncology or haematology doctors and nurses will be randomly allocated to either intervention (eTRIO) or control (anAustralian State Government Healthwebsite on caregivers) education conditions. Following completion of education, each clinician will recruit nine patient–caregiver pairs, who will be allocated to the same condition as their recruiting clinician. Eligibility includes any new adult patient diagnosed with any type/stage cancer attending consultations with a caregiver. Approximately 270 patient–caregiver pairs will be recruited. The primary outcome is caregiver self-efficacy in triadic (clinician–patient–caregiver) communication. Patient and clinician self-efficacy in triadic communication are secondary outcomes. Additional secondary outcomes for clinicians include preferences for caregiver involvement, perceived module usability/acceptability, analysis of module use, satisfaction with the module, knowledge of strategies and feedback interviews. Secondary outcomes for caregivers and patients include preferences for caregiver involvement, satisfaction with clinician communication, distress, quality of life, healthcare expenditure, perceived module usability/acceptability and analysis of module use. A subset of patients and caregivers will complete feedback interviews. Secondary outcomes for caregivers include preparedness for caregiving, patient–caregiver communication and caring experience. Assessments will be conducted at baseline, and 1 week, 12 weeks and 26 weeks post-intervention.Ethics and disseminationEthical approval has been received by the Sydney Local Health District Human Research Ethics Committee (REGIS project ID number: 2019/PID09787), with site-specific approval from each recruitment site. Protocol V.7 (dated 1 September 2020) is currently approved and reported in this manuscript. Findings will be disseminated via presentations and peer-reviewed publications. Engagement with clinicians, media, government, consumers and peak cancer groups will facilitate widespread dissemination and long-term availability of the educational modules.Trial registration numberACTRN12619001507178.
Assessing risk of self-harm in acute paediatric settings: a multicentre exploratory evaluation of the CYP-MH SAPhE instrument
Authors: Manning Joseph C , Carter Tim , Walker Gemma , Coad Jane , Aubeeluck Aimee 
Published: May 2021

ObjectiveTo psychometrically assess the Children and Young People-Mental Health Self-harm Assessment in Paediatric healthcare Environments (CYP-MH SAPhE) instrument for the identification of immediate risk of self-harm in CYP, aged 10–19 years, in acute paediatric wards or emergency departments.DesignThe CYP-MH SAPhE Instrument was developed through a robust scoping review and Delphi consensus with 30 clinicians/topic experts. To evaluate the psychometric properties, a multicentre exploratory study was conducted.SettingThree acute hospitals in the UK.Participants163 CYP presenting at acute hospital settings with primary mental health (cases) or physical health (non-cases) conditions.Primary and secondary outcome measuresPsychometric properties of the CYP-MH SAPhE instrument were evaluated through Principle Axis Factoring (PAF) with Oblimin (Kaiser normalisation) alongside measures of internal consistency (Cronbach’s α), convergent, discriminant and face validity.ResultsPAF of the dichotomous items (n=9) loaded onto three factors (1) behaviours and intentions; (2) suicidality and (3) self-harm. Factors 1 (Cronbach’s α=0.960) and 3 (Cronbach’s α=1) had high internal consistency. There was: good level of agreement between raters (kappa=0.65); a moderately positive correlation between the CYP-MH SAPhE instrument and the Columbia-Suicide Severity Rating Scale; and discrimination between cases and non-cases across the three factors (factor 1: m=88 vs 70; factor 2: m=102 vs 70; factor 3: m=104 vs 68). Assessment of face validity resulted in six items being removed, culminating in an eight question, rapid assessment instrument.ConclusionsThe results support the CYP-MH SAPhE Tool as a potentially reliable and valid instrument to identify immediate risk of self-harm in CYP presenting to acute paediatric healthcare environments, which is a burgeoning and significant global health issue.