bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of a nutrition screening tool to improve nutritional status of children with cancer in Singapore’s largest paediatric hospital
Authors: Han Wee Meng , Koo Jasly YS , Lim Yan Yin , Iyer Prasad , Ong Chengsi , Tong Jasper WK , Chan Mei Yoke 
Published: March 2021

Poor nutritional status in children with cancer can impact treatment outcomes and mortality. Nutrition screening is a simple yet effective approach to identify malnutrition risk for early intervention. We aim to improve the identification of children with cancer at high risk of malnutrition, so that nutritional intervention and rehabilitation can commence early for these children. Our multidisciplinary team conducted a root cause analysis and concluded that the generic screening tool did not differentiate malnutrition risk for different cancer types, stage and intensity of treatment. Hence, a screening tool that considered the identified factors was tested for reliability and validity first. Subsequently, we used the Plan, Do, Study, Act model with two improvement cycles to put in place a systematic process to facilitate the implementation. The interventions included (1) instituting the tool in the electronic medical records and (2) direct referral to dietitian based on screening score.We compared pre- and post-implementation cohorts and demonstrated better identification of nutritionally at-risk patients (36.4%–85.7%, p<0.001) with the new tool as well as improved timeliness of nutritional intervention (3 days to 1 day from admission, p=0.010). A lower malnutrition rate (17.4%–6.5%, p<0.001) in the postimplementation cohort was also demonstrated. Nutritional intervention within 48 hours of admission led to an overall positive weight change at 3 months (+2.68%, IQR: −1.14 to 9.09 vs −0.43%, −6.60 to 2.29; p=0.036) in the malnourished patients from both cohorts. Further studies will be conducted to evaluate the scale of the effectiveness of early intervention and close nutritional monitoring, in improving the nutritional status of children with cancer. The collaborative partnership among the doctors, nurses and dietitians has helped to streamline and simplify nutrition screening, making it an efficient and sustainable system in our hospital.
Lower medial hamstring activity after ACL reconstruction during running: a cross-sectional study
Authors: Einarsson Einar , Thomson Athol , Sas Bart , Hansen CLint , Gislason Magnus , Whiteley Rodney 
Published: March 2021

ObjectiveAnterior cruciate ligament reconstruction (ACLR) predisposes footballers for subsequent ACL and hamstring (HS) injury. This case series examines HS muscle activation patterns during the running in ACLR patients (bone-patellar tendon-bone (BTB) and (HS) graft) after completion of functional criteria allowing return to training.MethodsElectromyography (EMG) recorded from medial and lateral HS bilaterally during treadmill running (12, 14 and 16 km/hour) from 21 male ACLR patients on average 7 months from surgery (5-9) that underwent (HS) (n=12) or BTB reconstruction (n=9) were compared with 19 healthy runners. Main outcome measures: EMG signal was normalised to peak during the running. Pairwise comparisons were made for each muscle group examining stance and swing activation for mean and peak EMG for each patient group and leg.ResultsSignificantly lower relative peak activation in stance (not swing) phase for medial HS was seen for all conditions with effect sizes ranging from −0.63 (controls, BTB non-injured leg) to −1.09 (HS injured). For lateral HS only BTB injured were significantly lower in stance phase (−1.05)ConclusionACLR patients show neuromuscular alterations during different phases of running. The finding of reduced medial HS activity in stance phase might have implications for knee instability and HS muscle injury on resumption of sport.
Incidence, predictors and mortality risk of new heart failure in patients hospitalised with atrial fibrillation
Authors: Weber Courtney , Hung Joseph , Hickling Siobhan , Nedkoff Lee , Murray Kevin , Li Ian , Briffa Tom G 
Published: March 2021

ObjectiveTo determine the incidence, risk predictors and relative mortality risk of incident heart failure (HF) in patients following atrial fibrillation (AF) hospitalisation.MethodsThe Western Australian Hospitalisation Morbidity Data Collection was used to identify patients aged 25–94 years with index (first-in-period) AF hospitalisation, but without a prior HF admission, between 2000 and 2013. We evaluated the risk of incident HF hospitalisation within 3 years after AF admission, and the impact of HF hospitalisation on all-cause mortality.ResultsThe cohort comprised 52 447 patients, 57.5% men, with a median age of 73.1 (IQR 63.2-80.8) years. At 3 years after AF discharge, the cumulative incidence of HF (n=6153) was 11.7% (95% CI 11.5% to 12.0%) and all-cause death (n=9702) was 18.5% (95% CI 18.2% to 18.8%). Independent predictors of incident HF included advancing age, any history of myocardial infarction (MI), peripheral vascular disease, valvular heart disease, chronic kidney disease, chronic obstructive pulmonary disease, hypertension, diabetes, obesity and excessive alcohol use (all p<0.001). Patients hospitalised for first-ever HF compared with those without HF hospitalisation had an adjusted HR of 3.3 (95% CI 3.1 to 3.4) for all-cause mortality (p<0.001). Independent predictors of HF were also shared with those for mortality, with the exception of hypertension.ConclusionHospitalisation for new HF is common in patients with AF and independently associated with a 3-fold hazard for death. The clinical predictors of incident HF emphasise the importance of integrated management of common comorbid conditions and lifestyle risk factors in patients with AF to reduce their morbidity and mortality.
Host response to immune checkpoint inhibitors contributes to tumor aggressiveness
Authors: Khononov Irina , Jacob Eyal , Fremder Ella , Dahan Nili , Harel Michal , Raviv Ziv , Krastev Boris , Shaked Yuval 
Published: March 2021

BackgroundImmune checkpoint inhibitors (ICIs) have made a paradigm shift in clinical oncology due to unprecedented long-term remissions. However, only a small proportion of patients respond to ICI therapy. It is, therefore, essential to understand the mechanisms driving therapy resistance and to develop strategies for increasing response rates. We previously demonstrated that in response to various cancer treatment modalities, the host activates a range of biological processes that promote tumor regrowth and metastasis. Here, we characterize the host-mediated response to ICI therapy, and investigate its contribution to therapy resistance.MethodsTumor cell migration, invasion and motility were assessed in the presence of plasma from ICI-treated mice and patients. Immune cell composition in peripheral blood and tumors of ICI-treated mice was assessed by flow and mass cytometry. Plasma host factors driving tumor aggressiveness were identified by proteomic profiling, followed by bioinformatic analysis. The therapeutic effect of inhibiting host-mediated processes in ICI-treated mice was assessed in a tumor model.ResultsTumor cells exhibit enhanced migratory and invasive properties in vitro on exposure to plasma from anti-PD1-treated mice. Moreover, mice intravenously injected with plasma-exposed tumor cells display increased metastatic burden and mortality rate in comparison to control arms. Furthermore, tumors from anti-PD1-treated mice as well as Matrigel plugs containing plasma from anti-PD1-treated mice are highly infiltrated with immune cell types associated with both antitumor and protumor activity. These collective findings suggest that anti-PD1 treatment induces a systemic host response that potentially counteracts the drug’s therapeutic activity. Proteomic profiling of plasma from anti-PD1-treated mice reveals an activation of multiple biological pathways associated with tumor aggressiveness. Consequently, blocking IL-6, one of the key drivers of the identified biological pathways, counteracts ICI-induced metastatic properties in vitro and improves ICI treatment efficacy in vivo. Lastly, plasma samples from ICI-treated non-small cell lung cancer patients differentially affect tumor cell aggressiveness in vitro, with enhanced tumor cell motility correlating with a worse clinical outcome.ConclusionsICI therapy induces host-mediated processes that contribute to therapy resistance. Identification and analysis of such processes may lead to the discovery of biomarkers for clinical response and strategies for overcoming therapy resistance.
Prevalence of heated tobacco product use in Japan: the 2020 JASTIS study
Authors: Odani Satomi , Tabuchi Takahiro 
Published: March 2021

BackgroundJapan is the leading market for heated tobacco products (HTPs). We assessed the latest prevalence of HTP use including novel products (Ploom S, glo sens, and Pulze).MethodsData were obtained from an internet-based, self-reported survey conducted during February-March 2020 with individuals aged 15–74 years in Japan(n=9044). Prevalence of current (past 30-day) HTP use and cigarette smoking was computed. Poison regression analysis was conducted to examine predictors of HTP use among current cigarette smokers (n=1478). All analyses were weighted to account for selection bias in the internet survey using a nationally representative sample of Japanese population.ResultsIn 2020, prevalence of current HTP use and cigarette smoking was 10.9% and 25.9% in Japan, respectively. The most commonly used HTP brand was IQOS (5.7%) followed by Ploom TECH/Ploom TECH+ (5.4%) and glo (2.6%). Use of Ploom S, glo sens and Pulze was 1.6%, 0.8% and 0.6%, respectively. Among current cigarette smokers, 34.9% of those who were interested in quitting smoking and 30.5% of those who were not interested in quitting reported concurrent use of HTP, respectively (difference not significant). Cigarette smokers who reported having multiple chronic conditions (aPR=2.31), alcohol consumption (aPR=2.07), and e-cigarette use (aPR=1.88) were more likely to use an HTP compared to those who did not report such characteristics.ConclusionsHTP use remained prevalent in Japan. One in three current cigarette smokers used HTPs regardless of whether they were interested inquitting smoking. Continuedsurveillance is important to inform national and global tobaccocontrol strategies.
Metabolic performance and thermal preference of westslope cutthroat trout (Oncorhynchus clarkii lewisi) and non-native trout across an ecologically relevant range of temperatures1
Authors: Macnaughton Camille J. , Durhack Travis C. , Mochnacz Neil J. , Enders Eva C. 
Published: March 2021

The physiology and behaviour of fish are strongly affected by ambient water temperature. Physiological traits related to metabolism, such as aerobic scope (AS), can be measured across temperature gradients, and the resulting performance curve reflects the thermal niche that fish can occupy. We measured AS of westslope cutthroat trout (Oncorhynchus clarkii lewisi) at 5, 10, 15, 20, and 22 °C and compared temperature preference (T pref) of the species with non-native brook trout (Salvelinus fontinalis), brown trout (Salmo trutta), and rainbow trout (Oncorhynchus mykiss). Intermittent-flow respirometry experiments demonstrated that metabolic performance of westslope cutthroat trout was optimal at ∼15 °C and decreased substantially beyond this temperature, until lethal temperatures at ∼25 °C. Adjusted T pref across species were comparatively high, ranging from 17.8 to 19.9 °C, with the highest T pref observed for westslope cutthroat trout. Results suggest that although westslope cutthroat trout is considered a cold-water species, they do not prefer or perform as well in cold water (≤10 °C) and thus can occupy a warmer thermal niche than previously thought. The metabolic performance curve (AS) can be used to develop species‐specific thermal criteria to delineate important thermal habitats and guide conservation and recovery actions for westslope cutthroat trout.
Thermal regime and state of hydration of the Antarctic upper mantle from regional-scale electrical properties
Authors: Wannamaker Philip E. , Stodt John A. , Hill Graham J. , Maris Virginie , Kordy Michal A. 
Published: March 2021

Abstract
Large-scale electrical resistivity investigations of the Antarctic crust and upper mantle utilizing the magnetotelluric method (MT) are limited in number compared to temperate regions, but provide physical insights hard to achieve with other techniques. Key to the method's success are the instrumentation advances that allow microvolt (µV)-level measurements of the MT electric field in the face of mega-ohm (MΩ) contact resistances. Primarily in this chapter, we reanalyse existing data from three campaigns over the Antarctic interior using modern 3D non-linear inversion analysis, and offer additional geophysical conclusions and context beyond the original studies. A profile of MT soundings over the transitional Ellsworth–Whitmore block in central West Antarctica implies near-cratonic lithospheric geothermal conditions with interpreted graphite–sulfide horizons deformed along margins of high-grade silicate lithological blocks. Reanalysis of South Pole soundings confirms large-scale low resistivity spanning Moho depths that is consistent with limited seismic tomography and elevated crustal thermal regime inferences. Upper mantle under a presumed adiabatic thermal gradient below the Ross Ice Shelf near the central Transantarctic Mountains appears to be of a moderately hydrated state but not sufficient to induce melting. The degree of hydration there is comparable to that below the north-central Great Basin province of the western USA.
Abstract P13: Faster Treatment Speed is Not Associated With Bleeds: Intravenous Alteplase Treatment in the Ultra-Early Time Window is Safe
Authors: Provencher Michelle , Scherman Ashley , Baraban Elizabeth , Jackson Robert , Stuchiner Tamela L , Cox Kailey L , McDonald Kristen , Tarpley Jason W , Kansara Amit , Rogers Bronwyn S , Van Horn Christine , Teeter Lisa , Fitzgerald Darcie D , Cowell Leigh 
Published: March 2021

Previous studies have shown that faster Door to Needle (DTN) treatment times are associated with better outcomes for acute ischemic stroke patients. With the continued push for faster times, we aimed to determine if DTN treatment times in the 30- vs 45-minute time window yielded statistically significant differences in outcomes or complications.
Data obtained from a multi-state stroke registry included acute ischemic stroke patients ≥18 years of age discharged between January 2017 and April 2020, and treated with IV alteplase with DTN times between 25-30 or 40-45 minutes. Outcomes were 90-day Modified Rankin Score (mRS) (0-2 vs 3-6), discharge disposition [home or inpatient rehabilitation facility (IRF) vs other location], complications (any treatment-related complication vs none), and hospital length of stay (LOS). Patients with a documented reason for delay or who received thrombectomy were excluded. Outcomes of patients with 25- to 30-minute DTN times were compared to those with 40- to 45-minute DTN times using generalized linear models and multiple linear regression, adjusting for admission NIHSS, age, gender, race/ethnicity, and medical history.

Compared to the 20-25 minute group, patients treated in the 40-45 minute window had higher odds of a documented 90-day mRS of 3 or more (Adjusted Odds Ratio (AOR)=1.19, p=0.253, n=201 ) and treatment-related complication (AOR=1.35, p=0.569) and lower odds of discharge to home or IRF (AOR=0.846, p=0.359). There was little difference in LOS (β=-0.008, p=0.847). None of the outcomes reached statistical significance.
Administering alteplase in the 25- to 30-minute window is safe and did not result in an increase in bleeding complications. Although faster treatment times trended toward better outcomes, there was no statistically significant difference between the 25-30 and 40-45 minute DTN treatment times.
Health-Related Quality of Life Among Patients With Acute Ischemic Stroke and Large Vessel Occlusion in the ESCAPE Trial
Authors: Joundi Raed A. , Rebchuk Alexander D. , Field Thalia S. , Smith Eric E. , Goyal Mayank , Demchuk Andrew M. , Dowlatshahi Dar , Poppe Alexandre Y. , Williams David J. , Mandzia Jennifer L. , Buck Brian H. , Jadhav Ashutosh P. , Pikula Aleksandra , Menon Bijoy K. , Hill Michael D. 
Published: March 2021

Background and Purpose:
Endovascular thrombectomy (EVT) reduces 90-day disability in patients following acute ischemic stroke due to large vessel occlusion. Patient-reported outcome measures after EVT, such as health-related quality of life and specific functional domains, are less well described.

Methods:
We report outcomes on the EuroQol-5D (EQ-5D) from the ESCAPE (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times) randomized controlled trial at 90 days after stroke. Death was assigned an index value of 0 for EQ-5D. We used quantile regression to evaluate the association between EVT and EQ-5D index scores and logistic regression for the association between EVT and symptom-free status among 90-day survivors for each EQ-5D dimension (self-care, usual activities, mobility, pain/discomfort, and anxiety/depression), assessing for modification by age or sex and adjusting for baseline factors including stroke severity, affected hemisphere, and receipt of alteplase. Lastly, the association between severe disability at 90 days and EQ-5D was evaluated with assessment for modification by EVT, age, and sex.

Results:

There were 165 patients randomized to EVT and 150 patients randomized to control. Median EQ-5D was significantly higher for those who received EVT compared with best medical management (0.80 versus 0.60;
P
<0.001). After accounting for the greater number of deaths in the elderly, there was evidence of modification of treatment effect by age, with older age associated with a larger effect size difference in EQ-5D with EVT. Those receiving EVT had higher odds of symptom-free status in self-care, usual activities, mobility for those aged 60 to 79 years, and pain/discomfort for women, but there was no association with anxiety/depression. Severe disability at 90 days was associated with lower EQ-5D in older compared with younger individuals, and the association was not modified by EVT.

Conclusions:
Patients treated with EVT report substantially improved health-related quality of life, with relatively greater impact in older individuals and observed benefit across multiple dimensions.
Exploring the Collateral Damage of the COVID-19 Pandemic on Stroke Care
Authors: Balucani Clotilde , Carhuapoma J. Ricardo , Canner Joseph K. , Faigle Roland , Johnson Brenda , Aycock Anna , Phipps Michael S. , Schrier Chad , Yarbrough Karen , Toral Linda , Groman Susan , Lawrence Erin , Aldrich Eric , Goldszmidt Adrian , Marsh Elizabeth , Urrutia Victor C. 
Published: March 2021

Background and Purpose:
During the coronavirus disease 2019 (COVID-19) pandemic, the various emergency measures implemented to contain the spread of the virus and to overcome the volume of affected patients presenting to hospitals may have had unintended consequences. Several studies reported a decrease in the number of stroke admissions. There are no data on the impact of the COVID-19 pandemic on stroke admissions and stroke care in Maryland.

Methods:
A retrospective analysis of quality improvement data reported by stroke centers in the State of Maryland. The number of admissions for stroke, overall and by stroke subtype, between March 1 and September 30, 2020 (pandemic) were compared with the same time period in 2019 (prepandemic). Median last known well to hospital arrival time, the number of intravenous thrombolysis and thrombectomy were also compared.

Results:

During the initial 7 months of the pandemic, there were 6529 total admissions for stroke and transient ischemic attack, monthly mean 938 (95% CI, 837.1–1038.9) versus prepandemic 8003, monthly mean 1156.3 (CI, 1121.3–1191.2),
P
<0.001. A significant decrease was observed in intravenous thrombolysis treatments, pandemic 617, monthly mean 88.1 (80.7–95.6) versus prepandemic 805, monthly mean 115 (CI, 104.3–125.6),
P
<0.001; there was no significant decrease for thrombectomies. The pandemic decreased the probability of admissions for stroke and transient ischemic attack by 19%, for acute ischemic stroke by 20%, for the number of intravenous thrombolysis performed by 23%. There was no difference in the number of admissions for subarachnoid hemorrhage, pandemic 199, monthly mean 28.4 (CI, 22.5–34.3) versus prepandemic 217, monthly mean 31 (CI, 23.9–38.1), respectively,
P
=0.507.

Conclusions:
Our findings suggest that the COVID-19 pandemic adversely affected the acute care of unrelated cerebrovascular emergencies.
Can God Deliver His Servants? Two Theological Problems in the Daniel Narratives (Dan 1:9; 3:17–18)
Authors: Golan Naama , Gordin Shai 
Published: March 2021

Abstract
This article addresses two cases from the narratives in Daniel in which a similar theological question arises concerning the uncertainty of God’s ability to deliver his servants: (1) The chief officer’s denial of Daniels’ request (Dan 1:10) despite the fact that God granted Daniel grace and compassion from the chief officer, and (2) the speech of Shadrach, Meshach, and Abednego (Dan 3:17–18), in which they entertain the possibility that God will not, or perhaps cannot, save them. Commentators and translators throughout the generations have struggled with these theological problems, and we can identify a clear trend seeking to read the relevant verses in a way that removes the uncertainty, replacing it with certain faith in God’s deliverance.
In this article, we demonstrate how this interpretive trend surprisingly continues even with modern biblical scholars. Based on a literary analysis, we suggest that reading the MT version without altering it to conform with certain theological preconceptions may shed new light on the Daniel narratives, thereby exposing their deep and complex message.
Of Conflict and Collapse: Rethinking State Formation in Post-Gaddafi Libya
Authors: Badi Emadeddin 
Published: March 2021

Abstract
This paper explores the relationships between the Libyan state and society, and the ways in which these dynamics affected the subsequent civil wars in 2011 and onwards. Beyond the commonly-studied impact of oil and state rentierism, this paper demonstrates that the enduring centralization of the state, Gaddafi’s dystopian governance system, the socio-economic and political cultures pre-2011, and the interplay between local systems of legitimacy and central authority have played an underappreciated role in the contemporary Libyan landscape. The continuities and discontinuities of order that defined and characterized the Libyan state before and after 2011 are thus dissected. An exploration of the appositeness of Eurocentric theories of statehood to the Libyan landscape unveils the pillars of legitimacy that defined Libyan statehood pre-Gaddafi. This sheds light both on how the Gaddafi regime sought to control society by often manipulating these pillars and on the ways in which Libyan society either directly and indirectly resisted his rule or rested in complacency. This covert resistance, which turned overt, widespread, and violent in 2011, paved the way for a discursive mutation of “tribalism.” This notion morphed from one of a group behavioral binding mechanism tied to blood lineage into one underpinned by notions of solidarity that override kinship. This analysis in turn elucidates the precarity of the Libyan state and explains the subsequent turmoil in the country post-2011, characterized notably by the emergence of armed non-state actors. A key discontinuity identified is in the realm of foreign influencers that have exploited long-standing domestic grievances and weaponized Libya’s traditional pillars of legitimacy, thus tearing at its society’s social fabric.