bluuebunny/crossref_metadata_2025_split huggingface dataset:
Functional diversity metrics can perform well with highly incomplete data sets
Authors: Stewart Kerry , Carmona Carlos P. , Clements Chris , Venditti Chris , Tobias Joseph A. , González‐Suárez Manuela 
Published: September 2023

Abstract

Characterising changes in functional diversity at large spatial scales provides insight into the impact of human activity on ecosystem structure and function. However, the approach is often based on trait data sets that are incomplete and unrepresentative, with uncertain impacts on functional diversity estimates.

To address this knowledge gap, we simulated random and biased removal of data from three empirical trait data sets: an avian data set (9579 species), a plant data set (2185 species) and a crocodilian data set (25 species). For these data sets, we assessed whether functional diversity metrics were robust to data incompleteness with and without using imputation to fill data gaps. We compared two metrics each calculated with two methods: functional richness (calculated with convex hulls and trait probabilities densities) and functional divergence (calculated with distance‐based Rao and trait probability densities).

Without imputation, estimates of functional diversity (richness and divergence) for birds and plants were robust when 20%–70% of species had missing data for four out of 11 and two out of six continuous traits, respectively, depending on the severity of bias and method used. However, when missing traits were imputed, functional diversity metrics consistently remained representative of the true value when 70% of bird species were missing data for four out of 11 traits and when 50% of plant species were missing data for two out of six traits. Trait probability densities and distance‐based Rao were particularly robust to missingness and bias when combined with imputation. Convex hull‐based estimations of functional richness were less reliable. When applied to a smaller data set (crocodilians, 25 species), all functional diversity metrics were much more sensitive to missing data.

Expanding global morphometric data sets to represent more taxa and traits, and to quantify intraspecific variation, remains a priority. In the meantime, our results show that widely used methods can successfully quantify large‐scale functional diversity even when data are missing for half of species, provided that missing traits are estimated using imputation. We recommend the use of trait probability densities or distance‐based Rao when working with large incomplete data sets and filling data gaps with imputation.
Prehospital lung ultrasound in acute heart failure: Impact on diagnosis and treatment
Authors: Russell Frances M. , Supples Michael , Tamhankar Omkar , Liao Mark , Finnegan Patrick 
Published: September 2023

AbstractObjectivePatients with acute heart failure (AHF) are commonly misdiagnosed and undertreated in the prehospital setting. These delays in diagnosis and treatment have a direct negative impact on patient outcomes. The goal of this study was to determine the diagnostic accuracy of paramedics with and without the use of lung ultrasound (LUS) for the diagnosis of AHF in patients with dyspnea in the prehospital setting. Secondarily, we assessed LUS impact on rate of and time to initiation of HF therapies.MethodsThis was a prospective interventional study on a consecutive sample of patients transported to the hospital by one emergency medical services agency. Adult patients (>18 years) with a chief complaint of dyspnea were included. LUS was performed by trained paramedics and was defined as positive for AHF if both anterior–superior lung zones had greater than or equal to three B‐lines or bilateral B‐lines were visualized on a four‐view protocol. Paramedic diagnosis was compared to hospital discharge diagnosis which served as the criterion standard.ResultsOf the 264 included patients, 94 (35%) had a final diagnosis of AHF. Forty total patients had a LUS performed; 17 of these patients had a final diagnosis of AHF. Sensitivity and specificity for AHF by paramedics were 23% (95% confidence interval [CI] 0.14–0.34) and 97% (95% CI 0.92–0.99) without LUS and 71% (95% CI 0.44–0.88) and 96% (95% CI 0.76–0.99) with the use of LUS. In the 94 patients with AHF, 14% (11/77) received HF therapy prehospital without the use of LUS and 53% (9/17) with the use of LUS. LUS improved frequency of treatment by 39%. Median time to treatment was 21 min with LUS and 169 min without.ConclusionsLUS improved paramedic sensitivity and accuracy for diagnosing AHF in the prehospital setting. LUS use led to higher rates of prehospital HF therapy initiation and significantly decreased time to treatment.
Beyond high‐risk: analysis of the outcomes of extreme‐risk patients in the National Emergency Laparotomy Audit
Authors: Javanmard‐Emamghissi H. , Doleman B. , Lund J. N. , Lockwood S. , Hare S. , Pearce L. , Moug S. , Tierney G. M. 
Published: September 2023

SummaryPatients who require emergency laparotomy are defined as high risk if their 30‐day predicted risk of mortality is ≥ 5%. Despite a large difference in the characteristics of patients with a mortality risk score of between 5% and 50%, these outcomes are aggregated by the National Emergency Laparotomy Audit (NELA). Our aim was to describe the outcomes of the cohort of patients at extreme risk of death, which we defined as having a NELA‐predicted 30‐day mortality of ≥ 50%. All patients enrolled in the NELA database between December 2012 and 2020 were included. We compared patient characteristics; length of hospital stay; rates of unplanned return to the operating theatre; and 90‐day survival in extreme‐risk groups (predicted ≥ 50%) and high‐risk patients (predicted 5–49%). Of 161,337 patients, 5193 (3.2%) had a predicted mortality of ≥ 50%. When patients were further subdivided, 2437 (47%) had predicted mortality of 50–59% (group 50–59); 1484 (29%) predicted mortality of 60–69% (group 60–69); 840 (16%) predicted mortality of 70–79% (group 70–79); and 423 (8%) predicted mortality of ≥ 80% (group 80+). Extreme‐risk patients were significantly more likely to have been admitted electively than high‐risk patients (p < 0.001). Length of stay increased from a median (IQR [range]) of 26 (16–43 [0–271]) days in group 50–59 to 35 (21–56 [0–368]) days in group 80+, compared with 17 (10–30 [0–1136]) days for high‐risk patients. Rates of unplanned return to the operating theatre were higher in extreme‐risk groups compared with high‐risk patients (11% vs. 8%). The 90‐day survival was 43% in group 50–59, 34% in group 60–69, 27% in group 70–79 and 17% in group 80+. These data underscore the need for a differentiated approach when discussing risk with patients at extreme risk of mortality following an emergency laparotomy. Clinicians should focus on patient priorities on quantity and quality of life during informed consent discussions before surgery. Future work should extend beyond the immediate postoperative period to encompass the longer‐term outcomes (survival and function) of patients who have emergency laparotomies.
The role of platelet P2Y12 receptors in inflammation
Authors: Parker William A. E. , Storey Robert F. 
Published: September 2023

AbstractInflammation is a complex pathophysiological process underlying many clinical conditions. Platelets contribute to the thrombo‐inflammatory response. Platelet P2Y12 receptors amplify platelet activation, potentiating platelet aggregation, degranulation and shape change. The contents of platelet alpha granules, in particular, act directly on leucocytes, including mediating platelet–leucocyte aggregation and activation via platelet P‐selectin. Much evidence for the role of platelet P2Y12 receptors in inflammation comes from studies using antagonists of these receptors, such as the thienopyridines clopidogrel and prasugrel, and the cyclopentyltriazolopyrimidine ticagrelor, in animal and human experimental models. These suggest that antagonism of P2Y12 receptors decreases markers of inflammation with some evidence that this reduces incidence of adverse clinical sequelae during inflammatory conditions. Interpretation is complicated by pleiotropic effects such as those of the thienopyridines on circulating leucocyte numbers and of ticagrelor on adenosine reuptake. The available evidence suggests that P2Y12 receptors are prominent mediators of inflammation and P2Y12 receptor antagonism as a potentially powerful strategy in a broad range of inflammatory conditions.LINKED ARTICLESThis article is part of a themed issue on Platelet purinergic receptor and non‐thrombotic disease. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v181.4/issuetoc
Endoscopic pressure study integrated system for the diagnosis of achalasia
Authors: Nishikawa Yohei , Inoue Haruhiro , Shimamura Yuto , Navarro Marc Julius , Kawamata Natsuki , Azuma Daisuke , Ushikubo Kei , Kimoto Yoshiaki , Yamamoto Kazuki , Fujiyoshi Yusuke , Okada Hiroki , Tanaka Ippei , Toshimori Akiko , Tanabe Mayo , Onimaru Manabu 
Published: September 2023

ObjectivesThe endoscopic pressure study integrated system (EPSIS) is a novel diagnostic tool used to evaluate lower esophageal sphincter (LES) function. EPSIS allows the measurement of intragastric pressure (IGP) during gastric insufflation through esophagogastroduodenoscopy (EGD) and records its pressure waveform. This study aimed to assess the usefulness and applicability of EPSIS as an adjunct diagnostic modality for achalasia.MethodsThis case–control study was conducted using a database of patients who underwent EGD, barium swallow (BS), high‐resolution manometry (HRM), and EPSIS between January 2022 and December 2022. The achalasia (experimental) group (n = 35) consisted of patients with a definitive diagnosis of achalasia. The control group (n = 34) consisted of patients with no abnormalities in EGD, BS, or HRM and no abnormal acid reflux confirmed with 24‐h pH‐impedance monitoring. EPSIS findings were compared between the two groups and characterized by the waveform pattern (uphill or flat), maximum IGP (IGP‐Max), pressure difference, and the gradient of the waveform.ResultsAll patients in the achalasia group showed an uphill pattern, in contrast to 21 patients (61.8%) in the control group. IGP‐Max demonstrated the best diagnostic accuracy for achalasia, with a cut‐off value of 15.8 mmHg (100% sensitivity, 58.8% specificity, and area under the curve [AUC] 0.78). The pressure gradient also demonstrated good diagnostic accuracy, with a cut‐off value of 0.40 mmHg/s (80% sensitivity, 61.8% specificity, and AUC 0.76).ConclusionThis study demonstrated that EPSIS can be applied as a diagnostic modality in patients with achalasia.
PERcutaneous transhepatic CHOLangioscopy using a new single‐operator short cholangioscope (PERCHOL): European feasibility study
Authors: Pérez‐Cuadrado‐Robles Enrique , Phillpotts Simon , Bronswijk Michiel , Conrad Claudio Cim , Binda Cecilia , Monino Laurent , Basiliya Kirill , Hollenbach Marcus , Papaefthymiou Apostolis , Alric Hadrien , Quénéhervé Lucille , Di Gaeta Alessandro , Pioche Mathieu , Khani Aria , Lorenzo Diane , Moreels Tom G. , Rahmi Gabriel , Boeken Tom , Fabbri Carlo , Prat Frédéric , Laleman Wim , Cellier Christophe , Van der Merwe Schalk , Webster George , Ellrichmann Mark 
Published: September 2023

ObjectivesA new short device for percutaneous endoscopic cholangioscopy was recently developed. However, feasibility and safety has not yet been evaluated. The aim of this study was to assess clinical success, technical success, and adverse events (AEs).MethodsThis observational multicenter retrospective study included all patients who underwent percutaneous cholangioscopy using a short cholangioscope between 2020 and 2022. The clinical success, defined as the complete duct clearance or obtaining at least one cholangioscopy‐guided biopsy, was assessed. The histopathological accuracy, technical success, and the AE rate were also evaluated.ResultsFifty‐one patients (60 ± 15 years, 45.1% male) were included. The majority of patients had altered anatomy (n = 40, 78.4%), and biliary stones (n = 34, 66.7%) was the commonest indication. The technique was predominantly wire‐guided (n = 44, 86.3%) through a percutaneous sheath (n = 36, 70.6%) following a median interval of 8.5 days from percutaneous drainage. Cholangioscopy‐guided electrohydraulic lithotripsy was performed in 29 cases (56.9%), combined with a retrieval basket in eight cases (27.6%). The clinical success was 96.6%, requiring a median of one session (range 1–3). Seventeen patients (33.3%) underwent cholangioscopy‐guided biopsies. There were four (7.8%) cholangioscopy‐related AEs (cholangitis and peritonitis). Overall, the technical success and AE rates were 100% and 19.6%, respectively, in a median follow‐up of 7 months.ConclusionPercutaneous endoscopic cholangioscopy with a new short device is effective and safe, requiring a low number of sessions to achieve duct clearance or accurate histopathological diagnosis.
Torque teno virus‐DNA load as individual cytomegalovirus risk assessment parameter upon allogeneic hematopoietic stem cell transplantation
Authors: Spiertz Arlene , Tsakmaklis Anastasia , Farowski Fedja , Knops Elena , Heger Eva , Wirtz Maike , Kaiser Rolf , Holtick Udo , Vehreschild Maria J. G. T. , Di Cristanziano Veronica 
Published: September 2023

AbstractBackgroundImmune recovery following allogeneic hematopoietic stem cell transplantation (allo‐HSCT) decisively influences the occurrence of opportunistic infections, one of the leading causes of death among this group of patients. Yet, today, there are no laboratory parameters mirroring immune function sufficiently. Torque teno virus (TTV) has already proven itself as a functional immune marker in other settings.AimsIn this analysis, we investigated whether monitoring of TTV‐DNA load in whole blood is able to provide additional information on the capacity of the immune system to control cytomegalovirus (CMV) replication in allo‐HSCT recipients.MethodsWhole blood samples from 59 patients were collected upon allo‐HSCT (between Day −7 and +10), on Day +14, +21, +28, +56, +90, and +365 post‐transplant. TTV‐DNA loads and other relevant clinical information were correlated with the risk of CMV infections or reactivations, defined by evidence of viral replication in blood.ResultsCMV serostatus of the recipient and a TTV load below 1000 copies/mL upon allo‐HSCT were significantly associated with an increased incidence of CMV infection or reactivation.ConclusionsQuantification of TTV load in the early phase of allo‐HSCT procedure could provide additional information in order to identify patients at risk for CMV infection or reactivation.
Dermoscopy of atypical pigmented lesions of the face: Variation according to facial areas
Authors: Tognetti Linda , Cartocci Alessandra , Cinotti Elisa , D'Onghia Martina , Żychowska Magdalena , Moscarella Elvira , Dika Emi , Farnetani Francesca , Guida Stefania , Paoli John , Lallas Aimilios , Tiodorovic Danica , Stanganelli Ignazio , Longo Caterina , Suppa Mariano , Zalaudek Iris , Argenziano Giuseppe , Perrot Jean Luc , Rubegni Giovanni , Cataldo Gennaro , Rubegni Pietro 
Published: September 2023

AbstractAtypical pigmented facial lesions (aPFLs)—including lentigo maligna (LM) and lentigo maligna melanoma (LMM), solar lentigo (SL), pigmented actinic keratosis (PAK), atypical nevi (AN), seborrheic keratosis (SK) and lichen planus‐like keratosis (LPLK)—can exhibit clinical and dermoscopic overlapping features. We aimed to investigate if and how 14 dermoscopic features suggestive for the aforementioned aPFLs vary according to six facial sites among 1197 aPFLs cases (excised to rule out malignancy) along with lesion and patients' metadata. According to distribution and association analysis, aPFLs on the forehead of a male patient aged > 69 years displaying the obliterated follicular openings pattern, appear to be more at risk of malignancy. Of converse, aPFLs of the orbital/cheek/nose area with evident and regular follicular openings with diameter < 10 mm in a female aged below 68 are probably benign. The obliterated follicular openings, keratin plugs, evident and regular follicular openings and target‐like pattern features differed significantly among six facial areas in all aPFLs cases. Lesion of the nose may show both features suggestive of malignancy and benignity (e.g. many SL and PAK may display target‐like pattern and some LM/LMM cases display keratin plugs and evident and follicular openings), making these features less specific.
A consumer cross‐over trial suggests that there are significant seasonal changes of the tensile properties (wet) of human hair
Authors: Wortmann Franz J. , Wortmann Gabriele 
Published: September 2023

AbstractObjectivesThrough the cooperation with an industrial partner, we gained a set of data for the tensile properties (wet) of human hair. The hair samples originated from a cross‐over study with two groups of individuals, using for a topical application sequentially two products (A and B). Each phase of the study lasted 6 months. The phases of the study by chance covered first largely the winter and then the summer period. Initially, tensile variables were chosen, which not only reflect the mechanical properties of hair (modulus, break strain, and break stress) but which are also considered to have a good connection to practice‐relevant hair properties. The initial analysis of the data showed that changes were observed for the variables due to the treatment phases. However, these were either small or difficult to interpret.MethodsAgainst this background and using two‐factor analysis of variance, we investigated the hypothesis that the tensile properties of hair (wet) may show significant seasonal changes. For this, we chose those two independent variables, which reflect the properties of the intermediate filaments (modulus) and the matrix (break strain) in the composite structure of the hair cortex.ResultsThe results support the ‘seasonal’ hypothesis and clearly show that the variables show significant changes from Winter to Summer (modulus: 10% increase; break strain: 3% decrease). The seasonal effect was thus a major reason, why the first stage of the analysis of the data was inconclusive.ConclusionsThe tensile properties of the main morphological components of the cortex show distinct seasonal changes. Towards the summer, the hair becomes stiffer and more brittle. Furthermore, the results suggest that seasonal effects may need to be taken into account when conducting studies on lengths of hair grown during different seasons.
Reliability and validity of the revised Rushton Moral Resilience Scale for healthcare workers
Authors: Rushton Cynda H. , Hanson Ginger C. , Boyce Danielle , Holtz Heidi , Nelson Katie E. , Spilg Edward G. , Robillard Rébecca 
Published: September 2023

AbstractAimTo refine the Rushton Moral Resilience Scale (RMRS) by creating a more concise scale, improving the reliability, particularly of the personal integrity subscale and providing further evidence of validity.BackgroundHealthcare workers are exposed to moral adversity in practice. When unable to preserve/restore their integrity, moral suffering ensues. Moral resilience is a resource that may mitigate negative consequences. To better understand mechanisms for doing so, a valid and reliable measurement tool is necessary.DesignCross‐sectional survey.MethodsParticipants (N = 1297) had completed ≥1 items on the RMRS as part of the baseline survey of a larger longitudinal study. Item analysis, confirmatory factor analyses, reliability analyses (Cronbach's alpha), and correlations were used to establish reliability and validity of the revised RMRS.ResultsItem and confirmatory factor analysis were used to refine the RMRS from 21 to 16 items. The four‐factor structure (responses to moral adversity, personal integrity, relational integrity and moral efficacy) demonstrated adequate fit in follow‐up confirmatory analyses in the initial and hold‐out sub‐samples. All subscales and the total scale had adequate reliabilities (α ≥ 0.70). A higher‐order factor analysis supports the computation of either subscale scores or a total scale score. Correlations of scores with stress, anxiety, depression and moral distress provide evidence of the scale's validity. Reliability of the personal integrity subscale improved.Conclusion and ImplicationsThe RMRS‐16 demonstrates adequate reliability and validity, particularly the personal integrity subscale. Moral resilience is an important lever for reducing consequences when confronted with ethical challenges in practice. Improved reliability of the four subscales and having a shorter overall scale allow for targeted application and will facilitate further research and intervention development.Patient/Public ContributionData came from a larger study of Canadian healthcare workers from multiple healthcare organizations who completed a survey about their experiences during COVID‐19.
Treating facial overfilled syndrome with impaired facial expression—Presenting clinical experience with ultrasound imaging
Authors: Schelke Leonie , Harris Steven , Cartier Hugues , Alfertshofer Michael , Doestzada Marwah , Cotofana Sebastian , Velthuis Peter J. 
Published: September 2023

AbstractBackgroundFacial overfilled syndrome is an adverse event following minimally invasive soft tissue filler injections. It presents in most cases as excess midfacial volume and/or as unnatural smile which is difficult to detect due to the absence of standardized evaluation methods.ObjectiveTo showcase how to identify, evaluate, and treat facial overfilled syndrome by utilizing facial ultrasound and simultaneous hyaluronidase injections.MethodsTwenty‐eight consecutive patients (26 females, 2 males) were enrolled in this study in which facial ultrasound was performed to evaluate the location previously implanted filler material. The position of the oral commissure was objectively measured in relation to bony landmarks, and the severity of lateral canthal lines was assessed by independent and blinded raters.ResultsThe material was identified in 35.7% inside the subdermal fatty layer, in 28.6% inside the deep supra‐periosteal fatty layer, in 10.7% inside the fibrous layer deep to the subdermal fatty layer, whereas in 25.0%, the product was not possible to locate clearly inside one specific layer. On average, 81.6 I.U. [range: 75–150] of hyaluronidase were injected. Lateral canthal line severity was before the treatment 2.28 (1.4) and was after the hyaluronidase treatment 2.02 (1.3) with p = 0.578. The position of the oral commissure increased by 0.60 cm in vertical and by 0.30 cm in horizontal directions (both p < 0.001).ConclusionFacial overfilled syndrome following aesthetic soft tissue filler injections can present as excess midfacial volume but also as unnatural smile. Targeted hyaluronidase injections into the culprit pockets inside the midfacial soft tissues have shown to re‐establish a natural smile, to reduce excess midfacial volume, and to decrease lateral canthal line severity.