bluuebunny/crossref_metadata_2025_split huggingface dataset:
Twenty years of drought‐mediated change in snag populations in mixed‐conifer and ponderosa pine forests in Northern Arizona
Authors: Ganey Joseph L. , Iniguez Jose M. , Vojta Scott C. , Iniguez Amy R. 
Published: March 2021

AbstractBackgroundSnags (standing dead trees) are important biological legacies in forest systems, providing numerous resources as well as a record of recent tree mortality. From 1997 to 2017, we monitored snag populations in drought-influenced mixed-conifer and ponderosa pine (Pinus ponderosa) forests in northern Arizona.ResultsSnag density increased significantly in both forest types. This increase was driven largely by a pulse in snag recruitment that occurred between 2002 and 2007, following an extreme drought year in 2002, with snag recruitment returning to pre-pulse levels in subsequent time periods. Some later years during the study also were warmer and/or drier than average, but these years were not as extreme as 2002 and did not trigger the same level of snag recruitment. Snag recruitment was not equal across tree species and size classes, resulting in significant changes in species composition and size-class distributions of snag populations in both forest types. Because trees were far more abundant than snags in these forests, the effect of this mortality pulse on tree populations was far smaller than its effect on snag populations. Snag loss rates increased over time during the study, even though many snags were newly recruited. This may reflect the increasing prevalence of white fir snags and/or snags in the smaller size classes, which generally decay faster than snags of other species or larger snags. Thus, although total numbers of snags increased, many of the newly recruited snags may not persist long enough to be valuable as nesting substrates for native wildlife.ConclusionsIncreases in snag abundance appeared to be due to a short-term tree mortality “event” rather than a longer-term pattern of elevated tree mortality. This mortality event followed a dry and extremely warm year (2002) embedded within a longer-term megadrought. Climate models suggest that years like 2002 may occur with increasing frequency in the southwestern U.S. Such years may result in additional mortality pulses, which in turn may strongly affect trajectories in abundance, structure, and composition of snag populations. Relative effects on tree populations likely will be smaller, but, over time, also could be significant.
Psychometric characteristics of the of COVID Stress Scales-Arabic version (CSS-Arabic) in Egyptian and Saudi university students
Authors: Abbady Adel S. , El-Gilany Abdel-Hady , El-Dabee Fathy A. , Elsadek Adel M. , ElWasify Mahmoud , Elwasify Mohamed 
Published: March 2021

Abstract
Background
Mental health sufferings due to the COVID-19 pandemic were reported in many countries worldwide. However, there is a lack of a validated Arabic tool to measure stress related to this pandemic in the Arab countries. This study aims to translate into Arabic and measure the psychometric characteristics of the previously developed English COVID Stress Scales (CSS). Using a forward-backward translation, the CSS was translated into Arabic and 22 jurors assessed its content validity. An online-based survey was carried out among 1080 university students (Egyptian and Saudi) to assess internal consistency and validity of the Arabic version (CSS-Arabic) using Cronbach’s α and factor analysis.

Results
The content validity indices of the scale were 0.943 and 0.932 for both relevance and clarity. The internal consistency of the total CSS-Arabic was satisfactory (with α = 0.94) within the acceptable range for different subscales. Confirmatory factor analysis reveals 5-factor model with 36 retained items similar to the original English CSS.

Conclusions
CSS-Arabic is a reliable and valid self-reporting tool for screening of stress due to COVID-19 among the university students. Further work should be done by healthcare providers to assess the magnitude of the stress during the COVID-19 pandemic.
Evaluation of glycemic abnormalities in children and adolescents with β-thalassemia major
Authors: M. Diab Aliaa , S. Abdelmotaleb Ghada , Abdel-Azim Eid Khaled , Sebaey S. Mostafa Enas , Sabry Ahmed Eman 
Published: March 2021

Abstract
Background
The quality of life of B-thalassemia major (β-TM) patients has improved with the use of frequent blood transfusions. However, this leads to chronic iron overload with its sequelae, as prediabetes and diabetes mellitus. This study aimed to assess insulin resistance and glucose abnormalities in a sample of B-thalassemia major patients in Benha, Egypt.

Results
This case-control study included 40 B-thalassemia major patients on regular blood transfusion and iron chelation. Their ages ranged from 8 to 16 years, and 30 normal age and sex-matched controls. Thorough clinical examination was performed including weight (kg), height (m), body mass index (BMI) (kg/m2), and liver and spleen size. Laboratory investigations were done in the form of complete blood count, liver enzymes, serum ferritin, fasting plasma insulin, and fasting, and 2 h postprandial plasma glucose. Insulin resistance (IR) was calculated using the Homeostasis Model Assessment of insulin resistance (HOMA-IR) index. Insulin resistance was found in 27.5% of thalassemic patients; 18.2% of them had diabetes, 72.7% were prediabetics (with impaired fasting glycemia), and 9.1% had normal fasting and 2 h postprandial plasma glucose level. Insulin resistance increased significantly with increased blood transfusion duration, serum ferritin, liver enzymes, fasting plasma insulin, fasting plasma glucose, and 2 h postprandial plasma glucose (ROC). The curve analysis showed that the duration of blood transfusion, serum ferritin, fasting plasma insulin, fasting, and 2 h postprandial plasma glucose could significantly predict insulin resistance at a certain cut-off point.

Conclusion
Our data show that HOMA-IR can be used to detect insulin resistance in β-TM patients on long-term blood transfusions, especially patients with high serum ferritin and impaired liver enzymes.
Identification and expression analysis of antigenic sites of hepatitis C virus genotype 3a NS3 and NS5A genes of local isolate
Authors: Sabri Sabeen , Khan Muhammad Idrees , Rafique Shazia , Ali Amjad , Khan Muhammad Saleem 
Published: March 2021

Abstract
Background
Hepatitis C virus, a silent killer, has infected 71 million people globally. The recombinant viral antigenic proteins might be used in the early diagnosis of HCV infection. The NS3 and NS5A genes of HCV function in HCV replication and influence host cellular factors that are involved in HCV pathogenesis. The current study was designed to select NS3 and NS5A antigenic sites, amplified, cloned, and expressed in order to find out better assays for diagnosis or drug and vaccine development. The antigenic sites within NS3 and NS5A genes were selected and confirmed through sequencing and were cloned. The antigenic recombinant proteins were expressed in bacterial strain E. coli BL21ply*, and the expression was confirmed by western blotting by using gene-specific and vector-specific antibodies.

Results
Specific antigenic regions within the NS3 and NS5A genes of the HCV 3A genotype were amplified. PCR results showed 328 bp and 747 bp antigenic regions, respectively. The regions were confirmed by DNA sequencing and cloned into a bacterial expression vector. Expression analysis showed 12 kDa and 28 kDa of NS3 and NS5A antigenic recombinant proteins, respectively. Taken together, these studies will help to analyze the genetic variability within the local HCV isolates as these antigenic recombinant proteins were quite important in the screening of HCV-infected patients.

Conclusions
This study might help to enhance the progress in the treatment of HCV infection through the modeling of HCV non-structural genes (NS3 and NS5A) from local isolate, and it might also present the viral genes as potential therapeutic targets.
Using epidemiological evidence to forecast population need for early treatment programmes in mental health: a generalisable Bayesian prediction methodology applied to and validated for first-episode psychosis in England
Authors: McDonald Keltie , Ding Tao , Ker Hannah , Dliwayo Thandiwe Rebecca , Osborn David P.J. , Wohland Pia , Coid Jeremy W. , French Paul , Jones Peter B. , Baio Gianluca , Kirkbride James B. 
Published: March 2021

BackgroundMental health policy makers require evidence-based information to optimise effective care provision based on local need, but tools are unavailable.AimsTo develop and validate a population-level prediction model for need for early intervention in psychosis (EIP) care for first-episode psychosis (FEP) in England up to 2025, based on epidemiological evidence and demographic projections.MethodWe used Bayesian Poisson regression to model small-area-level variation in FEP incidence for people aged 16–64 years. We compared six candidate models, validated against observed National Health Service FEP data in 2017. Our best-fitting model predicted annual incidence case-loads for EIP services in England up to 2025, for probable FEP, treatment in EIP services, initial assessment by EIP services and referral to EIP services for ‘suspected psychosis’. Forecasts were stratified by gender, age and ethnicity, at national and Clinical Commissioning Group levels.ResultsA model with age, gender, ethnicity, small-area-level deprivation, social fragmentation and regional cannabis use provided best fit to observed new FEP cases at national and Clinical Commissioning Group levels in 2017 (predicted 8112, 95% CI 7623–8597; observed 8038, difference of 74 [0.92%]). By 2025, the model forecasted 11 067 new treated cases per annum (95% CI 10 383–11 740). For every 10 new treated cases, 21 and 23 people would be assessed by and referred to EIP services for suspected psychosis, respectively.ConclusionsOur evidence-based methodology provides an accurate, validated tool to inform clinical provision of EIP services about future population need for care, based on local variation of major social determinants of psychosis.
Bedtime Salivary Cortisol as a Screening Test for Cushing Syndrome in Children
Authors: Ueland Grethe Å , Kellmann Ralf , Jørstad Davidsen Melissa , Viste Kristin , Husebye Eystein S , Almås Bjørg , Storr Helen L , Sagen Jørn V , Mellgren Gunnar , Júlíusson Petur B , Methlie Paal 
Published: March 2021

Abstract

Background
Diagnosing Cushing syndrome (CS) can be challenging. The 24-hour urine free cortisol (UFC) measurement is considered gold standard. This is a laborious test, dependent on correct urine collection. Late-night salivary cortisol is easier and is used as a screening test for CS in adults, but has not been validated for use in children.

Objective
To define liquid chromatography tandem mass spectrometry (LC-MS/MS)-based cutoff values for bedtime and morning salivary cortisol and cortisone in children, and validate the results in children with and without CS.

Methods
Bedtime and morning salivary samples were collected from 320 healthy children aged 4 to 16 years. Fifty-four patients from the children’s outpatient obesity clinic and 3 children with pituitary CS were used for validation. Steroid hormones were assayed by LC-MS/MS. Cutoff levels for bedtime salivary cortisol and cortisone were defined by the 97.5% percentile in healthy subjects.

Results
Bedtime cutoff levels for cortisol and cortisone were 2.4 and 12.0 nmol/L, respectively. Applying these cutoff levels on the verification cohort, 1 child from the obesity clinic had bedtime salivary cortisol exceeding the defined cutoff level, but normal salivary cortisone. All 3 children with pituitary CS had salivary cortisol and cortisone far above the defined bedtime cutoff levels. Healthy subjects showed a significant decrease in salivary cortisol from early morning to bedtime.

Conclusions
We propose that bedtime salivary cortisol measured by LC-MS/MS with a diagnostic threshold above 2.4 nmol/L can be applied as a screening test for CS in children. Age- and gender-specific cutoff levels are not needed.
Computation of epistemic uncertainty due to limited data samples in small field dosimetry using Fuzzy Set Theory
Authors: Chaudhary Rahul Kumar , Kumar Rajesh , Sharma SD , Datta D 
Published: March 2021

Objective:
To estimate the epistemic (or fuzzy) uncertainty, arising due to limited data samples in the measurement of the output factors (OFs) of the small fields using Fuzzy Set Theory (FST).

Methods:
EBT3 film samples of size 50 × 50 mm2 were used for the measurement of the OF of stereotactic radiosurgery (SRS) cones of size 4, 6, 7.5, 10, 12.5 and 15 mm diameter, normalized with respect to the output of 100 × 100 mm2 open field size. Three measurements were done per cone/field size. Red color channel was chosen for the dosimetry purpose, net optical density (NOD) was converted to the dose using non-linear relation. To estimate the epistemic uncertainty associated with the measured OFs due to limited number of data samples, a triangular fuzzy number (TFN) was assumed as the fuzziness in the dose delivered by the individual SRS cone/field. Uncertainty in the OF was estimated by applying the Fuzzy Vertex Method (FVM). The membership functions of the OF were constructed for each cone size and the nature of the uncertainty in the OF of the cones was expressed in the terms of its fuzziness. For the sake of completeness of the study, the statistical uncertainty involved in the procedure has also been calculated.

Results:
The statistical and fuzzy uncertainties in the measurement of OF of cones range from 3.28 to 6.25% and 2.58 to 5.44% respectively. The smallest cone of 4 mm has the largest values of statistical and fuzzy uncertainties. The membership functions of the OF for the studied cones were triangular in nature.

Conclusion:
The epistemic uncertainty arising due to limited number of data samples holds a significant fraction of the prescribed dose, and therefore, should not be ignored in the total uncertainty estimation.

Advances in knowledge:
This study highlights the significance of epistemic component of measurement uncertainty arising out due to the insufficient/limited number of measurements of a quantity.
PRISMA flow diagrams for living systematic reviews: a methodological survey and a proposal
Authors: Kahale Lara A. , Elkhoury Rayane , El Mikati Ibrahim , Pardo-Hernandez Hector , Khamis Assem M. , Schünemann Holger J. , Haddaway Neal R. , Akl Elie A. 
Published: March 2021

Background: While the PRISMA flow diagram is widely used for reporting standard systematic reviews (SRs), it was not designed for capturing the results of continual searches for studies in living systematic reviews (LSRs). The objectives of this study are (1) to assess how published LSRs report on the flow of studies through the different phases of the review for the different updates; (2) to propose an approach to reporting on that flow. Methods: For objective 1, we identified all LSRs published up to July 2020. We abstracted information regarding their general characteristics and how they reported on search results. For objective 2, we based our proposal for tailored PRISMA approaches on the findings from objective 1, as well as on our experience with conducting Cochrane LSRs. Results: We identified 108 living publications relating to 32 LSRs. Of the 108 publications, 7% were protocols, 24% were base versions (i.e., the first version), 62% were partial updates (i.e., does not include all typical sections of an SR), and 7% were full updates (i.e., includes all typical sections of an SR). We identified six ways to reporting the study flow: base separately, each update separately (38%); numbers not reported (32%); latest update separately, all previous versions combined (20%); base separately, all updates combined (7%); latest update version only (3%); all versions combined (0%). We propose recording in detail the results of the searches to keep track of all identified records. For structuring the flow diagram, we propose using one of four approaches. Conclusion: We identified six ways for reporting the study flowthrough the different phases of the review for the different update versions. We propose to document in detail the study flow for the different search updates and select one of our four tailored PRISMA diagram approaches to present that study flow.
Time to reconsider the routine use of tourniquets in total knee arthroplasty surgery
Authors: Ahmed Imran , Chawla Amit , Underwood Martin , Price Andrew J. , Metcalfe Andrew , Hutchinson Charles E. , Warwick Jane , Seers Kate , Parsons Helen , Wall Peter D. H. 
Published: March 2021

AimsMany surgeons choose to perform total knee arthroplasty (TKA) surgery with the aid of a tourniquet. A tourniquet is a device that fits around the leg and restricts blood flow to the limb. There is a need to understand whether tourniquets are safe, and if they benefit, or harm, patients. The aim of this study was to determine the benefits and harms of tourniquet use in TKA surgery.MethodsWe searched MEDLINE, EMBASE, Cochrane Central Register of Controlled trials, and trial registries up to 26 March 2020. We included randomized controlled trials (RCTs), comparing TKA with a tourniquet versus without a tourniquet. Outcomes included: pain, function, serious adverse events (SAEs), blood loss, implant stability, duration of surgery, and length of hospital stay.ResultsWe included 41 RCTs with 2,819 participants. SAEs were significantly more common in the tourniquet group (53/901 vs 26/898, tourniquet vs no tourniquet respectively) (risk ratio 1.73 (95% confidence interval (CI) 1.10 to 2.73). The mean pain score on the first postoperative day was 1.25 points higher (95% CI 0.32 to 2.19) in the tourniquet group. Overall blood loss did not differ between groups (mean difference 8.61 ml; 95% CI -83.76 to 100.97). The mean length of hospital stay was 0.34 days longer in the group that had surgery with a tourniquet (95% CI 0.03 to 0.64) and the mean duration of surgery was 3.7 minutes shorter (95% CI -5.53 to -1.87).ConclusionTKA with a tourniquet is associated with an increased risk of SAEs, pain, and a marginally longer hospital stay. The only finding in favour of tourniquet use was a shorter time in theatre. The results make it difficult to justify the routine use of a tourniquet in TKA surgery. Cite this article: Bone Joint J 2021;103-B(5):830–839.
Patterns of referral for fractured nose during major sporting events: a 10-year follow up
Authors: Hamrang-Yousefi S , Kingsley-Smith H , Munroe-Gray T , Anyanechi M , Rollin M 
Published: March 2021

Introduction Nasal fracture is a common form of ear, nose and throat (ENT) trauma with prompt referral required for assessment and potentially manipulation of nasal bones. The aetiology of nasal fracture is multifactorial, and injury occurs across all ages. Previous study has suggested a temporal relationship between nasal injury and major sporting events. Methods A total of 1966 adult patients with nasal injuries referred to emergency clinics across three London ENT centres between September 2016 and August 2019 were analysed. Results The majority of those referred were male (66.58%). Mean age at referral was 36.29±18.38 in males and 49.14±21.43 in females; 10.27% were 75 years and over. Incidence was highest during April–September 2018 (p=0.02). Mean incidence was higher in this period in the male 16–35 subgroup (p=0.039), with 53.1% of their injuries concentrated between Friday and Sunday. Conclusions Most nasal injuries occurred in young males. Mean age at referral was higher in females, and there was slightly increased incidence in over-75s, predominantly females. This incidence could be due to increased longevity or greater tendency to injury in females of this age. The injury patterns across the week also differed, with males injured proportionately more at the weekend. Nasal injury referrals of young men increased around the 2018 summer period, coinciding with the 2018 FIFA World Cup. This lends support to the association between major sporting events and the incidence of nasal injury, particularly in young males.
Early onset of neurological features differentiates two outbreaks of Lassa fever in Ebonyi state, Nigeria during 2017–2018
Authors: Chika-Igwenyi Nneka M. , Harrison Rebecca E. , Psarra Christina , Gil-Cuesta Julita , Gulamhusein Maria , Onwe Emeka O. , Onoh Robinson C. , Unigwe Uche S. , Ajayi Nnennaya A. , Nnadozie Ugochukwu U. , Ojide Chiedozie K. , Nwidi Damian U. , Ezeanosike Obumneme , Sampson Emeka , Adeke Azuka S. , Ugwu Collins N. , Anebonam Uchenna , Tshiang Jacques K. , Maikere Jacob , Reid Anthony 
Published: March 2021

Lassa fever (LF) is an acute viral haemorrhagic illness with various non-specific clinical manifestations. Neurological symptoms are rare at the early stage of the disease, but may be seen in late stages, in severely ill patients.The aim of this study was to describe the epidemiological evolution, socio-demographic profiles, clinical characteristics, and outcomes of patients seen during two Lassa fever outbreaks in Ebonyi State, between December 2017 and December 2018.Routinely collected clinical data from all patients admitted to the Virology Centre of the hospital during the period were analysed retrospectively. Out of a total of 83 cases, 70(84.3%) were RT-PCR confirmed while 13 (15.7%) were probable cases. Sixty-nine (83.1%) patients were seen in outbreak 1 of whom 53.6% were urban residents, while 19%, 15%, and 10% were farmers, students and health workers respectively. There were 14 (16.8%) patients, seen in second outbreak with 92.9% rural residents. There were differences in clinical symptoms, signs and laboratory findings between the two outbreaks. The case fatality rates were 29.9% in outbreak 1 and 85.7% for outbreak 2. Neurological features and abnormal laboratory test results were associated with higher mortality rate, seen in outbreak 2. This study revealed significant differences between the two outbreaks. Of particular concern was the higher case fatality during the outbreak 2 which may be from a more virulent strain of the Lassa virus. This has important public health implications and further molecular studies are needed to better define its characteristics.