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Md Aminul Islam

and 3 more

The increasing salinization of coastal areas of Bangladesh reduces options for rice intensification but offers a suitable environment for shrimp and salt farming. Under these contested land use settings, adaptation decisions to address salinity require an understanding of the salinity perspectives of all farmer types. Primary data was collected from randomly selected rice, shrimp and salt farmers in two coastal sub-districts through semi-structured interviews at household level. Also, key informant interviews (KIIs) were conducted with personnel from research and extension organisations from different levels (e.g. national and local). Salinity perceptions among the various types of farmer differed. While the majority of rice farmers (87%) perceived increased salinity, just over half of the salt and shrimp farmers perceived that salinity has decreased over the past 20 years. Most rice farmers (62%) perceived anthropogenic factors as the main cause of increased salinity, while the majority of shrimp and salt farmers focused more on natural factors. Rice farmers perceived under saline conditions a yield loss (42%), followed by less income (30%). In contrast, shrimp farmers (70%) and salt farmers (55%) perceived production gains when high salinity prevailed. Rice farmers’ adaptation preferences to cope with salinity is development of salinity-tolerant rice varieties that have greater tolerance at the reproductive stages, while shrimp and salt farmers’ preferences are engineering-based solutions. Thus, research and extension services on integrated coastal resources management need to consider all livelihood perspectives, as this approach could accelerate the pace of achieving the SDGs (i.e.. SDG-1, SDG-2 and SGD-3).

Mohammed Al-Sadawi

and 7 more

Abstract: Background: This meta-analysis assessed the relationship between Obstructive Sleep Apnea (OSA) and echocardiographic parameters of diastolic dysfunction (DD), which are used in the assessment of Heart Failure with Preserved Ejection Fraction (HFpEF). Methods: We searched the databases including Ovid MEDLINE, Ovid Embase Scopus, Web of Science, Google Scholar, and EBSCO CINAHL from inception up to December 26th, 2020. The search was not restricted to time, publication status or language. Comparisons were made between patients with OSA, diagnosed in-laboratory polysomnography (PSG) or home sleep apnea testing (HSAT), and patients without OSA in relation to established markers of diastolic dysfunction. Results: Primary search identified 2512 studies. A total of 18 studies including 2509 participants were included. The two groups were free of conventional cardiovascular risk factors. Significant structural changes were observed between the two groups. Patients with OSA exhibited greater LAVI (3.94 CI [0.8, 7.07]; p=0.000) and left ventricular mass index (11.10 CI [2.56,19.65]; p=0.000) as compared to control group. The presence of OSA was also associated with more prolonged DT (10.44 ms CI [0.71,20.16]; p=0.04), IVRT (7.85 ms CI[4.48, 11.22]; p=0.000), and lower E/A ratio (-0.62 CI [-1,-0.24]; p=0.001) suggestive of early DD. The E/e’ ratio (0.94 CI[0.44, 1.45]; p=0.000) was increased. Conclusion: An association between OSA and echocardiographic parameters of DD was detected that was independent of conventional cardiovascular risk factors. OSA may be independently associated with DD perhaps due to higher LV mass. Investigating the role of CPAP therapy in reversing or ameliorating diastolic dysfunction is recommended.

Seo Baik

and 1 more

Objectives: To examine the effects of estrogen on all-cause mortality, cancers, cardiovascular (CV) conditions, and dementia. Design: Retrospective observational study Setting: United States 2007-2018 Population: 1.5 million women aged over 65 in Medicare. Method: Cox regression with time-varying estrogen type, route, and strength as well as patient’s characteristics. Main Outcome(s): all-cause mortality; 5 cancers- breast, lung, endometrial, colorectal, ovarian cancers; 6 CV conditions- ischemic heart diseases, heart failure, venous thromboembolism, stroke, atrial fibrillation, acute myocardial infarction; and dementia. Results: Compared to counterparts, estrogen monotherapy (ET) exhibited a significant, 21% (HR=0.79; 95% CI 0.77-0.81), reduction in mortality risk. The reduction was greater with estradiol (HR=0.76; 95% CI 0.73-0.78) than conjugated estrogen (HR=0.83; 95% CI 0.80-0.86), and with topical (HR=0.69; 95% CI 0.66-0.71) than oral preparations (HR=0.86; 95% CI 0.83-0.89). ET also exhibited significant risk reductions for all study cancers, breast (HR=0.83; 95% CI 0.80-0.85), lung (HR=0.89; 95% CI 0.85-0.93), endometrial (HR=0.68; 95% CI 0.63-0.73), colorectal (HR=0.87; 95% CI 0.82-0.92) and ovarian (HR=0.86; 95% CI 0.80-0.92). Different dose levels exhibited similar risk reduction in mortality and cancers. ET slightly increased the overall CV risk, mostly risks of ischemic heart diseases and stroke. However, such risks occurred with CEE, oral, and high dose ET. Both combination therapy (HR=1.19; 95% CI 1.08-1.31) and progestogen monotherapy (HR=1.16; 95% CI 1.08-1.26) exhibited a significantly increased risk of breast cancer. No HT exhibited an increased risk of dementia. Conclusions: Among senior female Medicare beneficiaries, the effect of hormone therapy varies by type, route, and strength of estrogen.

Tina Christmann

and 7 more

Aims: Amidst the Campos the Altitude (Highland Grasslands) in the Brazilian Atlantic Forest, woody communities grow either clustered in tree islands or interspersed within the herbaceous matrix. The functional ecology, diversity and biotic processes shaping these communities are largely unstudied. We characterised the functional assembly and diversity of these tropical montane woody communities and investigated how those communities fit within the Grime’s CSR (C – competitor, S – stress-tolerant, R – ruderal) scheme, what trade-offs they exhibit and how traits and functional diversity vary in response to bamboo invasion. Methods: We sampled five leaf traits and wood density along transects covering the woody communities both inside tree islands and outside (i.e. woody plants in the grasslands community) to characterise the functional ecology of the community. We used Kruskal-Wallis test, t-test and variation partitioning to determine effects of inside vs outside the tree island and bamboo invasion on traits, woody species diversity and functional diversity. Results: We found a general SC/S strategy with drought-related functional trade-offs. Woody plants in tree islands had more acquisitive traits, whereas woody plants within the grasslands had more conservative traits. Trait variation was mostly taxonomically driven, and species composition varied between inside and outside tree islands. Leaf thickness, wood density and foliar water uptake were unrelated to CSR-strategies, suggesting independent trait dimensions and multiple drought-coping strategies within the predominant S-strategy. Bamboo-invaded islands showed lower Simpson diversity, lower functional dispersion, lower foliar water uptake and greater leaf thickness than non-invaded tree islands. Conclusions: The observed functional assembly in response to bamboo and facilitation have implications for future forest expansion and response of the communities to climate change. Further studies on eco-physiological and establishment traits and the mechanisms behind biotic interactions are needed to better understand the response of these communities to future environmental changes.

Chathura Perera

and 4 more

Abstract Aim: The invasion process is a complex, context-dependent phenomenon; nevertheless, it can be described using the PAB framework. This framework encompasses the joint effect of propagule pressure (P), abiotic characteristics of the environment (A), and biotic characteristics of both the invader and recipient vegetation (B). We analyzed the effectiveness of proxies of PAB factors to explain the spatial pattern of Solidago canadensis and S. gigantea invasion using invasive species distribution models. Location: Carpathian Mountains and their foreground, Central Europe. Methods: The data on species presence or absence were from an atlas of neophyte distribution based on a 2 × 2 km grid, covering approximately 31,200 km2 (7752 grid cells). Proxies of PAB factors, along with data on historical distribution of invaders were used as explanatory variables in Boosted Regression Trees models to explain the distribution of invasive Solidago. The areas with potentially lower sampling effort were excluded from analysis based on a target species approach. Results: Proxies of the PAB factors helped to explain the distribution of both S. canadensis and S. gigantea. Distributions of both species were limited climatically because a mountain climate is not conducive to their growth; however, the S. canadensis distribution pattern was correlated with proxies of human pressure, whereas S. gigantea distribution was connected with environmental characteristics. The varied responses of species with regard to distance from their historical distribution sites indicated differences in their invasion drivers. Main conclusions: Proxies of PAB are helpful in the choice of explanatory variables as well as the ecological interpretation of species distribution models. The results underline that human activity can cause variation in the invasion of ecologically similar species.

Josephine Grenzer

and 5 more

1. Plant-soil feedback (PSF) has gained attention as a mechanism promoting plant growth and coexistence. However, because most PSF research has measured monoculture growth in greenhouse conditions, field-based PSF experiments remain an important frontier for PSF research. 2. Using a four-year, factorial field experiment in Jena, Germany, we measured the growth of nine grassland species on soils conditioned by each of the target species (i.e., PSF). Plant community models were parameterized with or without these PSF effects, and model predictions were compared to plant biomass production in new and existing diversity-productivity experiments. 3. Plants created soils that changed subsequent plant biomass by 36%. However, because they were both positive and negative, the net PSF effect was 14% less growth on ‘home’ than ‘away’ soils. At the species level, seven of nine species realized non-neutral PSFs, but the two dominant species grew only 2% less on home than away soils. At the species*soil type level, 31 of 72 PSFs differed from zero. 4. In current and pre-existing diversity-productivity experiments, nine-species plant communities produced 37 to 29% more biomass than monocultures due primarily to selection effects. Null and PSF models predicted 29 to 28% more biomass for polycultures than monocultures, again due primarily to selection effects. 5. Synthesis: In field conditions, PSFs were large enough to be expected to cause roughly 14% overyielding due to complementarity, however, in plant communities overyielding was caused by selections effects, not complementarity effects. Further, large positive and large negative PSFs were associated with subdominant species, suggesting there may be selective pressure for plants to create neutral PSF. Broadly, results highlighted the importance of testing PSF effects in communities because there are several ways in which PSFs may be more or less important to plant growth in communities than suggested from simple PSF values.

Amjad Bani Hani

and 7 more

Objectives: A retrospective review of adolescent and adult patients with Atrial Septal Defect (Secundum ASD) who underwent secundum ASD closure by transcatheter closure (TCC) or surgery at Jordan University Hospital (JUH). We seek to illustrate the importance of a multidisciplinary Heart Team in low-volume centres, and report the experience and outcomes of this approach. Methodology: A retrospective observational study of 42 patients who underwent secundum ASD closure by TCC or surgery at JUH. We utilised the hospital’s electronic record system to attain patients’ information, and SPSS and Microsoft Excel were used to analyse the data. Results: 42 patients with secundum ASD were treated during the period between January 2015 and December 2019. The mean age of participants was 34.1 (± 14.3). A total of 34 patients underwent TCC, seven surgical closure, and one a hybrid approach. There were no incidents of mortality, but two minor morbidities were reported. After an average follow-up period of 13.2-/+13.6 months, with a range of 1-47 months , most patients experienced an improvement in their symptoms. There was also a significant reduction of the right ventricular dimension: Conclusion: A Heart Team approach is necessary as the use of minimally invasive cardiac surgery MICS and Transcatheter closure TCC continues to advance. A Heart Team provides patients with a variety of safe and cosmetic solutions that facilitate rapid management and recovery by encouraging the merits and avoiding the complications of each modality. Ultimately, the Heart Team allows low-volume centres to achieve excellent outcomes.

Xinyue Zhu

and 4 more

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Mohammed Al-Sadawi

and 7 more

Abstract: Background: This meta-analysis assessed the relationship between Obstructive Sleep Apnea (OSA) and echocardiographic parameters of diastolic dysfunction (DD), which are used in the assessment of Heart Failure with Preserved Ejection Fraction (HFpEF). Methods: We searched the databases including Ovid MEDLINE, Ovid Embase Scopus, Web of Science, Google Scholar, and EBSCO CINAHL from inception up to December 26th, 2020. The search was not restricted to time, publication status or language. Comparisons were made between patients with OSA, diagnosed in-laboratory polysomnography (PSG) or home sleep apnea testing (HSAT), and patients without OSA in relation to established markers of diastolic dysfunction. Results: Primary search identified 2512 studies. A total of 18 studies including 2509 participants were included. The two groups were free of conventional cardiovascular risk factors. Significant structural changes were observed between the two groups. Patients with OSA exhibited greater LAVI (3.94 CI [0.8, 7.07]; p=0.000) and left ventricular mass index (11.10 CI [2.56,19.65]; p=0.000) as compared to control group. The presence of OSA was also associated with more prolonged DT (10.44 ms CI [0.71,20.16]; p=0.04), IVRT (7.85 ms CI[4.48, 11.22]; p=0.000), and lower E/A ratio (-0.62 CI [-1,-0.24]; p=0.001) suggestive of early DD. The E/e’ ratio (0.94 CI[0.44, 1.45]; p=0.000) was increased. Conclusion: An association between OSA and echocardiographic parameters of DD was detected that was independent of conventional cardiovascular risk factors. OSA may be independently associated with DD perhaps due to higher LV mass. Investigating the role of CPAP therapy in reversing or ameliorating diastolic dysfunction is recommended.

Huseyin Kazan

and 6 more

Objective: To investigate the factors, especially preoperative urinalysis, predicting postoperative early infection after retrograde intrarenal surgery (RIRS) in 1-2 cm renal stones. Methods: Of the 642 patients who underwent RIRS between September 2013 and July 2019, 289 patients with a total stone size of 1-2 cm were included in the study. Patients were divided into two groups as with and without postoperative urinary tract infection. The demographic data and perioperative findings of all patients were retrospectively reviewed. Sterile urine cultures were obtained in all patients during the preoperative 30-day period and urine analysis values were included in the data. Results: Urinary system infection (UTI) was seen in 20 (6.9%) of 289 patients. Patient demographics were similar between groups. There was no statistically significant difference between the two groups in terms of stone diameter and stone localization (median diameter 13.5 vs 15, p=0.285). Patients with postoperative UTI had a higher rate of UTI history (55% vs 20.5%, p=0.000) and longer operative times (62.5 vs 60 min., p=0.008). Rate of pyuria, leukocyte esterase and nitrite positivity were observed more frequently in patients with postoperative UTI. In multivariate analysis, UTI history, prolonged operative time, and nitrite positivity were found to be independent risk factors for postoperative UTI. Conclusion: Nitrite positivity in preoperative urinanalysis, history of UTI and prolonged operation time are the factors that predict the postoperative infection in RIRS for stones between 1-2 cm.

Gunter Sturm

and 38 more

Background: There is controversy whether taking β-blockers or ACE inhibitors (ACEI) is a risk factor for more severe systemic insect sting reactions (SSR) and whether it increases the number or severity of adverse events (AE) during venom immunotherapy (VIT). Methods: In this open, prospective, observational, multicenter trial, we recruited patients with a history of a SSR and indication for VIT. The primary objective of this study was to evaluate whether patients taking β-blockers or ACEI show more systemic AE during VIT compared to patients without such treatment. Results: In total, 1,425 patients were enrolled and VIT was performed in 1,342 patients. Of all patients included, 388 (27.2%) took antihypertensive (AHT) drugs (10.4% took β-blockers, 11.9% ACEI, 5.0% β-blockers and ACEI). Only 5.6% of patients under AHT treatment experienced systemic AE during VIT as compared with 7.4% of patients without these drugs (OR: 0.74, 95% CI: 0.43–1.22, p=0.25). The severity of the initial sting reaction was not affected by the intake of β-blockers or ACEI (OR: 1.14, 95% CI: 0.89–1.46, p=0.29). In total, 210 (17.7%) patients were re-stung during VIT and 191 (91.0%) tolerated the sting without systemic symptoms. Of the 19 patients with VIT treatment failure, 4 took β-blockers, none an ACEI. Conclusions: This trial provides robust evidence that taking β-blockers or ACEI does neither increase the frequency of systemic AE during VIT nor aggravate SSR. Moreover, results suggest that these drugs do not impair effectiveness of VIT. (Funded by Medical University of Graz, Austria; Clinicaltrials.gov number, NCT04269629)

Nazanin Kermani

and 12 more

Background. Patients with severe asthma may have a greater risk of dying from COVID-19 disease. Angiotensin converting enzyme-2 (ACE2) and the enzyme proteases, transmembrane protease serine 2 (TMPRSS2) and FURIN, are needed for viral attachment and invasion into host cells. Methods. We examined microarray mRNA expression of ACE2, TMPRSS2 and FURIN in sputum, bronchial brushing and bronchial biopsies of the European U-BIOPRED cohort. Clinical parameters and molecular phenotypes, including asthma severity, sputum inflammatory cells, lung functions, oral corticosteroid (OCS) use, and transcriptomic-associated clusters, were examined in relation to gene expression levels. Results. ACE2 levels were significantly increased in sputum of severe asthma compared to mild-moderate asthma. In multivariate analyses, sputum ACE2 levels were positively associated with OCS use and male gender. Sputum FURIN levels were significantly related to neutrophils (%) and the presence of severe asthma. In bronchial brushing samples, TMPRSS2 levels were positively associated with male gender and body mass index, whereas FURIN levels with male gender and blood neutrophils. In bronchial biopsies, TMPRSS2 levels were positively related to blood neutrophils. The neutrophilic molecular phenotype characterised by high inflammasome activation expressed significantly higher FURIN levels in sputum than the eosinophilic Type 2-high or the pauci-granulocytic oxidative phosphorylation phenotypes. Conclusion. Levels of ACE2 and FURIN may differ by clinical or molecular phenotypes of asthma. Sputum FURIN expression levels were strongly associated with neutrophilic inflammation and with inflammasome activation. This might indicate the potential for a greater morbidity and mortality outcome from SARS-CoV-2 infection in neutrophilic severe asthma.

Mehmet Pehlivaoğlu

and 5 more

Aim: This study evaluated the effect of intracavitary levobupivacaine infusion diluted with locally applied isotonic solution for pain control in cystoscopy. Methods: Included in this study are 100 patients who had previously undergone transurethral tumor resection for bladder tumor and were followed up by cystoscopy. The patients were randomized into five groups (n = 20). In the first, second, third, and fourth groups, 4, 6, 8, and 10 mL of levobupivacaine HCl (5.0 mg/mL) were mixed with 26, 24, 22, and 20 mL of isotonic solution, respectively. Hence, the total mixture was 30 mL for each group. The fifth group was the control group. In this group, the standard method commonly used in most clinics was utilized. That is, a gel containing Cathejell-2% lidocaine (25 mg lidocaine) was applied. Cystoscopic interventions were performed with a 17.5 Fr rigid cystoscope and 0°, 30°, and 70° lens. During cystoscopy and 30 min later, the pain status of patients was assessed using the Visual Analogue Scale (VAS), and patient satisfaction was questioned. Results: The mean VAS score during and after the cystoscopy procedure was significantly lower in the levobupivacaine groups compared to the lidocaine group. In addition, patient satisfaction in the levobupivacaine groups was significantly higher than in the lidocaine group. No drug-related side-effects were observed in all groups. Conclusion: Thus, levobupivacaine is a more effective drug than lidocaine alone to control pain during cystoscopy. The use of levobupivacaine is recommended to prevent possible complications of general anesthesia by eliminating the need for the aforementioned as well as its cost-saving advantage.

Yanhui Dong

and 4 more

Groundwater age is often used to estimate groundwater recharge through a simplified analytical approach. This estimated recharge is thought to be representative of the mean recharge between the point of entry and the sampling point. However, given the complexity in actual recharge, whether the mean recharge is reasonable is still unclear. This study examined the validity of the method to estimate long-term average groundwater recharge and the possibility of obtaining reasonable spatial recharge pattern. We first validated our model in producing reasonable age distributions using a constant flux boundary condition. We then generated different flow fields and age patterns by using various spatially-varying flux boundary conditions with different magnitudes and wavelengths. Groundwater recharge was estimated and analyzed afterwards using the method at the spatial scale. We illustrated the main findings with a field example in the end. Our results suggest that we can estimate long-term average groundwater recharge with 10% error in many parts of an aquifer. The size of these areas decreases with the increase in both the amplitude and the wavelength. The chance of obtaining a reasonable groundwater recharge is higher if an age sample is collected from the middle of an aquifer and at downstream areas. Our study also indicates that the method can also be used to estimate local groundwater recharge if age samples are collected close to the water table. However, care must be taken to determine groundwater age regardless of conditions.

Xinyi Guan

and 4 more

Adriana Bustamante

and 3 more

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