bluuebunny/crossref_metadata_2025 huggingface dataset:
Participation of children in school health in Japan
Authors: Tomokawa Sachi , Miyake Kimihiro , Takeuchi Rie , Kokudo Shohei , Asakura Takashi
Published: June 2020

Background

The importance of promoting child participation in school health has been emphasized internationally. This study examined ways in which Japan's school health system involves children, and factors enabling child participation in this system. It also suggests strategies to promote child participation in school health in developing countries.

Methods

We conducted a document review to clarify the importance of, and recent trends in, child participation in school health. We summarized the system of child participation in school health in Japan and examined factors enabling child participation.

Results

We identified the following four factors that enable child participation in school health in Japan: (i) having an explicit legal basis for participatory activities at the national level; (ii) having clear notification, in relevant administrative documents at the prefectural and municipal levels, of the necessity for children's voluntary participation; (iii) establishing a system for teachers to provide support for participatory activities at the school level, and (iv) having a shared understanding among stakeholders about the pedagogical importance of participatory activities in school health.

Conclusions

To promote child participation in school health activities in developing countries, it is necessary to describe clearly the importance, benefits, impacts, and purposes of child participation in relevant legal and administrative documents at relevant administrative levels. Schools should also ensure that stakeholders have a common understanding of the educational benefits of child participation considering the cultural context of each country. It is helpful to conduct appropriate training for teachers to enable them to facilitate child participation.
Evaluation of DNA and RNA quality from archival formalin‐fixed paraffin‐embedded tissue for next‐generation sequencing – Retrospective study in Japanese single institution
Authors: Fujii Tomomi , Uchiyama Tomoko , Matsuoka Minami , Myojin Tomoya , Sugimoto Sumire , Nitta Yuji , Okabe Fumi , Sugimoto Aya , Sekita‐Hatakeyama Yoko , Morita Kohei , Itami Hiroe , Hatakeyama Kinta , Ohbayashi Chiho
Published: June 2020

Genetic analysis on formalin‐fixed paraffin‐embedded (FFPE) tissue specimens has become a mainstream method, from conventional direct sequencing to comprehensive analysis using next‐generation sequencing (NGS). In this study, we evaluated the quality of DNA and RNA extracted from FFPE sections, derived from surgical specimens of different tumor types. Electrophoresis was performed using a 4200 TapeStation to evaluate DNA and RNA fragmentation. DNA Ct values were higher and significantly increased over a period of 4 years compared with those from cell lines or frozen tissues. The RNA integrity number equivalent (RIN) ranged from 1 to 4.1 and DV200 ranged from 7.3 to 81%. Twelve of the 108 cases were analyzed by NGS using the AmpliSeq Cancer HotSpot Panel v2 on a Miniseq system. A sufficient number of reads and coverage were obtained in all cases. Our results revealed that NGS analysis was sufficient for FFPE‐derived DNA within 4 years of preservation. Conversely, approximately 20% of the RNA derived from FFPE within 4 years from the collection could be inappropriate for gene analysis based on RIN and DV200. It was suggested that FFPE would be adequate for genetic analysis, although it is desirable to store frozen specimens for the tumor tissues to be subjected to genetic analysis.
Elastin and collagen IV double staining: A refined method to detect blood vessel invasion in breast cancer
Authors: Fujisawa Masayoshi , Omori Masako , Doihara Hiroyoshi , Than Ye‐Min , Swe Hnin Wint Wint , Yoshimura Teizo , Matsukawa Akihiro
Published: June 2020

Blood vessel invasion (BVI) is a prognostic indicator in various cancers. Elastic stain, which highlights blood vessel walls, is commonly used to detect BVI. In the breast, however, its diagnostic usefulness is limited because it also highlights some intraductal carcinoma components, which often mimic BVI. In this study, we aimed to improve BVI detection in breast cancer and developed a double staining: Victoria blue for elastin and immunohistochemistry for collagen IV. Collagen IV fibers were retained along the basement membranes of intraductal carcinoma components, whereas they were rearranged or lost in BVI. From these observations, we defined BVI as the presence of tumor cells inside an elastic ring with a rearrangement or loss of collagen IV fibers. Using these criteria, we found BVI in 148 cases (49%) among 304 cases of primary operable invasive breast carcinoma, and the presence of BVI correlated significantly with poor prognosis. By contrast, we detected BVI in 94 cases (31%) or 14 cases (5%) by elastic van Gieson or CD31 immunostaining among the same cases, respectively, with no statistically significant association with prognosis. Thus, elastin and collagen IV double staining facilitates the detection of BVI in breast cancer and is useful to predict prognosis.
Genomic‐based ancillary assays offer improved diagnostic yield of effusion cytology with potential challenges in malignant pleural mesothelioma
Authors: Kinoshita Yoshiaki , Hamasaki Makoto , Matsumoto Shinji , Yoshimura Masayo , Sato Ayuko , Tsujimura Tohru , Kamei Toshiaki , Kawahara Kunimitsu , Nabeshima Kazuki
Published: June 2020

BRCA1‐associated protein 1 (BAP1) or methylthioadenosine phosphorylase (MTAP) immunohistochemistry (IHC) or 9p21 fluorescence in situ hybridization (FISH) are useful for the diagnosis of malignant pleural mesothelioma (MPM). However, the effect of these assays on the diagnostic yield of effusion cytology in MPM cases with suspicious cytomorphology or the diagnostic challenges in BAP1 or MTAP IHC have not been fully elucidated. Two cohorts of cytologic preparations obtained from pleural effusions were examined: MPM cases in cohort 1 were used to evaluate whether BAP1 or MTAP IHC or 9p21 FISH increase the diagnostic yield of effusion cytology; cohort 2 included cases suspicious for MPM, to which BAP1 or MTAP IHC was applied to clarify the challenges in the clinical assessment of these assays. In cohort 1 (n = 28), either assay elevated 62.5% of class II or III cases to class V. In cohort 2 (n = 139), 21.7% of BAP1 immunocytochemistry in smears and 10.6% of BAP1 IHC and 9.4% of MTAP IHC in cell blocks, were identified to be challenging. The application of genomic‐based assays increased the diagnostic yield of effusion cytology in the diagnosis of MPM. However, diagnostic challenges limit the application of these assays in some cases.
Nitrate reductase is required for salicylic acid‐induced water stress tolerance of pepper by upraising the AsA‐GSH pathway and glyoxalase system
Authors: Kaya Cengiz
Published: June 2020

A trial was conducted to evaluate whether nitrate reductase (NR) participates in salicylic acid (SA)‐improved water stress (WS) tolerance in pepper (Capsicum annuum L.) plants. Before starting WS treatment, 0.5 mM SA was applied to half of the well‐watered (WW) plants as well as to WS‐plants as a foliar spray once a day for a week. The soil water holding capacity was maintained at 40 and 80% of the full water storing capacity for WS and and well‐watered (WW) plants, respectively. Water stress caused substantial decreases in total plant dry weight, Fv/Fm, chlorophyll a and b, relative water content, leaf water potential (ΨI) by 53, 37, 49, 21, 36 and 33%, respectively relative to control, but significant increases in malondialdehyde (MDA), hydrogen peroxide (H2O2), electrolyte leakage (EL), methylglyoxal (MG), proline, key antioxidant enzymes' activities, NO and NR activity. The SA reduced oxidative stress, but improved antioxidant defence system, ascorbate‐glutathione (AsA‐GSH) cycle enzymes, glyoxalase system‐related enzymes, glyoxalase I (Gly I) and glyoxalase II (Gly II), plant growth, photosynthetic traits, NO, NR and proline. SA‐induced WS tolerance was further improved by supplementation of sodium nitroprusside (SNP), a donor of NO. NR inhibitor, sodium tungstate (ST) was applied in conjunction with SA and SA + SNP to the WW and WS‐plants to assess whether NR contributes to SA‐improved WS tolerance. ST abolished the beneficial effects of SA by reducing NO and NR activity in WS‐pepper, but the application of SNP along with SA + ST reversed negative effects of ST, showing that NO and NR are jointly needed for SA‐induced WS tolerance of pepper plants.
Protective effect of vitamin C and lycopene on the in vitro fertilization capacity of sex‐sorted bull sperm by inhibiting the oxidative stress
Authors: Zhang Pei‐Pei , Wang Jing‐Jing , Li Chong‐Yang , Hao Hai‐sheng , Wang Hao‐Yu , Du Wei‐Hua , Pang Yun‐Wei , Zhao Shan‐Jiang , Zou Hui‐Ying , Hao Tong , Yang Sha , Ruan Wei‐Min , Huang Jin‐Ming , Jiao Peng‐cheng , Zhu Hua‐Bin , Zhao Xue‐Ming
Published: June 2020

The fertilization capacity of sex‐sorted sperms is seriously decreased, which inhibits its wide application. However, little information is still available about the effect of vitamin C (VC) and lycopene (Lyc) on the fertilization capacity of sex‐sorted bull sperm. In this study, the washing medium and fertilization medium of sex‐sorted sperm from three bull individuals were supplemented with different concentrations of VC (0, 1 × 10–3, 1 × 10–4, 1 × 10–5, 1 × 10–6 M) or Lyc (0, 1 × 10–4, 1 × 10–5, 1 × 10–6, 1 × 10–7). After washing twice and incubation for 1.5 hr, the malondialdehyde (MDA) level, phosphatidylserine (PS) translocation, membrane potential (Δψm) and IVF (in vitro fertilization) ability of sex‐sorted sperm were investigated. For the sex‐sorted sperm of bulls A, B and C, 1 × 10–3 M VC or 1 × 10–4 M Lyc treatment significantly decreased their MDA levels and PS translocation and increased their Δψm levels and cleavage rates after IVF. When blastocysts were concerned, 1 × 10–4 M Lyc significantly improved the blastocyst rates and their IFN‐tau expression of bulls A and C. In conclusion, supplementation of 1 × 10–3 M VC or 1 × 10–4 M Lyc in washing and fertilization medium contributed greatly to improving the fertilization capacity of sex‐sorted bull sperm during IVF procedure.
A Risk Analysis Framework for Cyber Security and Critical Infrastructure Protection of the U.S. Electric Power Grid
Authors: Baggott Sean S. , Santos Joost R.
Published: June 2020

The purpose of this article is to introduce a risk analysis framework to enhance the cyber security of and to protect the critical infrastructure of the electric power grid of the United States. Building on the fundamental questions of risk assessment and management, this framework aims to advance the current risk analysis discussions pertaining to the electric power grid. Most of the previous risk‐related studies on the electric power grid focus mainly on the recovery of the network from hurricanes and other natural disasters. In contrast, a disproportionately small number of studies explicitly investigate the vulnerability of the electric power grid to cyber‐attack scenarios, and how they could be prevented or mitigated. Such a limited approach leaves the United States vulnerable to foreign and domestic threats (both state‐sponsored and “lone wolf”) to infiltrate a network that lacks a comprehensive security environment or coordinated government response. By conducting a review of the literature and presenting a risk‐based framework, this article underscores the need for a coordinated U.S. cyber security effort toward formulating strategies and responses conducive to protecting the nation against attacks on the electric power grid.
Evaluation of preventive laser photobiomodulation in patients with head and neck cancer undergoing radiochemotherapy: Laser in patients with head and neck cancer
Authors: Dantas Juliana Borges de Lima , Martins Gabriela Botelho , Lima Hayana Ramos , Carrera Manoela , Reis Sílvia Regina de Almeida , Medrado Alena Ribeiro Alves Peixoto
Published: June 2020

Aims

This study aimed to evaluate the effect of laser photobiomodulation in the prevention of oral mucositis (OM), salivary hypofunction and referred pain in patients with head and neck cancer.

Methods and results

This randomized clinical study divided patients into two groups: the laser group (LG, n = 30) and the control group (CG, n = 24). The LG (InGaAlP, 660 nm, 86.7 mW, 2 J/cm2) participated in the preventive protocol, while the CG underwent a simulated procedure without light emission. The degree of OM, salivary flow, and referred pain were evaluated at five different periods of radiotherapy. Both groups showed a significant increase in the degree of OM (P < .01). Regarding OM, salivary flow, and oral pain, there were no significant differences between the groups.

Conclusions

The laser photobiomodulation protocol used in this study was not effective in preventing radiochemotherapy‐induced OM, salivary hypofunction, and referred pain in patients with head and neck cancer. Notably, although the development of OM did not differ significantly according to the use of laser therapy, the severity of oral mucositis was reduced in patients who underwent laser therapy compared to that in patients who did not.
Matched retrospective study of infective endocarditis among solid organ transplant recipients compared to non‐transplant: Seven‐year experience in a US Referral Center
Authors: Chuang Sally , Shrestha Nabin K. , Brizendine Kyle D.
Published: June 2020

Background

Infective endocarditis (IE) is a rare complication following solid organ transplant (SOT); data on the clinical features and outcomes of IE in SOT recipients in the modern era are limited.

Methods

We conducted a single‐center retrospective cohort study of IE diagnosed from 1/2008‐12/2014 in SOT recipients, who were matched by age and microorganism to cases of IE in non‐SOT, to describe the clinical features and outcomes.

Results

There were 14 cases of IE identified in SOT recipients matched to 56 non‐SOT controls. Median time from transplant to IE was 1017 days (IQR 379‐1830). Compared to non‐SOT patients, SOT patients were more likely to be undergoing current hemodialysis (16% vs 36%) and to possess indwelling central venous catheters within the 30 days prior to diagnosis of IE (27% vs 50%). No SOT patients had documented drug use as a risk factor for IE whereas 6 (11%) non‐SOT did. Enterococcus was the most common etiologic agent and was isolated in 50% of cases; only one fungal infection was identified, a mixed infection with Candida. Thirty‐day mortality was 14% in SOT patients, significantly higher versus no deaths in non‐SOT (P = .037).

Conclusions

The present study illustrates a change in epidemiology of IE in SOT patients characterized by IE that generally occurs more than one‐year post‐transplant, is due to bacterial infection rather than fungus, and appears to be health care associated. Multicenter studies are merited to explore transplant‐specific risk factors for IE in the special population of SOT patients.
Outcome of a dog undergoing definitive‐intent intensity‐modulated radiation therapy for an intranasal ganglioneuroma
Authors: Kitagawa Keita , Reich Sessaly N. , Desai Noopur , Policelli Rachel , Zimmerman Annie , Sledge Dodd , Vilar Saavedra Paulo
Published: June 2020

An 11‐year‐old intact male Shiloh Shepherd was presented for evaluation of epistaxis, decreased nasal airflow, and destructive caudal nasal lesion identified using CT. Histopathologic evaluation of the nasal mass was consistent with a ganglioneuroma. The dog was treated with 10 × 4.2 Gy using IMRT technique. Post radiation therapy (RT), improvement in clinical signs were noted. Tumor progressed in size based on CT evaluation at 49 days, 3, and 6 months post‐treatment. A grade 2 oral mucositis was the only RT side effect noted. Radiation therapy as described above was completed without evidence of high‐grade radiation toxicities and has potential to improve clinical signs but failed to induce tumor response.
Experimental Investigation of the Transient Patterns and Pressure Evolution of Tip Leakage Vortex and Induced-Vortices Cavitation in an Axial Flow Pump
Authors: Xi Shen , Desheng Zhang , Bin Xu , Yongxin Jin , Weidong Shi , van Esch B.P.M. (Bart)
Published: June 2020

Cavitating flow is extremely complex in axial and mixed flow pumps, resulting in several adverse effects on pump performance. In this paper, the tip leakage vortex (TLV) cavitation patterns in an axial flow pump model were studied based on high-speed photography and transient pressure measurements. The TLV cavitation morphology and transient development of the induced suction-side-perpendicular cavitating vortices (SSPCVs) were investigated at multi-operating conditions. The time-domain of the transient pressure was employed to clarify the relationship between the tip cavitation and the pressure field. The results showed that cavitation inception occurred earlier with an unstable TLV cavitation shape at part-load conditions. Cavitation was more intense with a decrease of the cavitation number, presenting a larger area of triangular cavitation with the shedding of SSPCV. The inception of SSPCV was attributed to the tail of the shedding cavitation cloud originally attached to the suction surface (SS) of the blade, moving in the direction of the adjacent blade perpendicular to the SS, resulting in a flow blockage. With a further decrease in pressure, the SSPCVs grew in size and strength, accompanied by a rapid degradation in performance of the pump. The cavitation images and the corresponding circumferential pressure distributions showed that the lowest pressure point coincided with the SS corner. After this position, the pressure fluctuated as the cavitation intensity changed. The transient characteristics of SSPCV are a basis for revealing the instability mechanism of its evolution in the axial flow pump.
The effects of refraction and caustics on autoproducts
Authors: Worthmann Brian M. , Dowling David R.
Published: June 2020

Quadratic products of complex amplitudes from acoustic fields with nonzero bandwidth, denoted “autoproducts,” can mimic acoustic fields at frequencies lower or higher than the bandwidth of the original field. While this mimicry has been found to be very promising for a variety of signal processing applications, its theoretical extent has, thus far, only been considered under the most elementary ray approximation. In this study, the combined effects of refraction and diffraction are considered in environments where refraction causes neighboring rays to cross and form caustics. Acoustic fields on and near caustics are not well-predicted by elementary ray-acoustic theory. Furthermore, caustics introduce frequency dependence to the nearby acoustic field and a phase shift on the acoustic waves that passes through them. The effects these caustics have on autoproducts is assessed here using two simple, range-independent waveguides with index of refraction (n) profiles that are n2-quadratic and n2-linear. It is found that in multipath regions where rays have passed through differing numbers of caustics, the ability of autoproducts to mimic out-of-band fields is substantially hindered.
“The Best Recovery You Could Possibly Get”: Sleep, Rest, and the National Basketball Association
Authors: Barnes Sarah
Published: June 2020

This article contextualizes recent concerns about rest in the National Basketball Association by considering the concurrent rise of a promotional sleep culture. This work builds upon Grant Farred’s analysis of the event of the Black athletic body at rest. Drawing on research from the cultural studies of sport and the critical sleep literature, the author complicates the idea that rest, broadly conceived of as sleep, is a straightforward route to resistance or refusal. Instead of dislodging underlying racial logics or capitalist expectations, the promotion of sleep among National Basketball Association players makes their recovery habits subject to greater surveillance and commodification. Such developments have obvious consequences for athletes and sport systems. What is less apparent is how these social forces also shape collective understandings of sleep difficulties and how to solve them.
Rap Sessions From the Field: Intersectional Conversations With Jemele Hill, Bun B, Fat Joe, and IDK
Authors: Harrison C. Keith , Saunders Reggie
Published: June 2020

To end this special issue, Dr. C. Keith Harrison and Reggie Saunders connected with individuals that exist at the intersection of hip-hop culture and sport. This series of interviews begins with Jemele Hill, an American sports journalist and activist. A graduate from Michigan State University, Jemele also served as an adjunct professor at the University of Central Florida from 2012 to 2014 teaching undergraduate sport business management students practical lessons about sport media. Reggie has been an adjunct faculty member at University of Central Florida since 2015, co-teaching innovation and entrepreneurship in sport/entertainment with Harrison. Reggie follows with an interview with Bun B, one half of the Texas rap duo, UGK and currently an adjunct professor at Rice University teaching a course on religion and hip-hop. New York rapper and entrepreneur, Fat Joe weighs in briefly on the topic, and Reggie closes out by interviewing rapper and Washington DC native, IDK. IDK is known for his hit song 24, and has a notable fan in Kevin Durant, National Basketball Association superstar and fellow Washington, DC native.
Snoek-type damping performance in strong and ductile high-entropy alloys
Authors: Lei Zhifeng , Wu Yuan , He Junyang , Liu Xiongjun , Wang Hui , Jiang Suihe , Gu Lin , Zhang Qinghua , Gault Baptiste , Raabe Dierk , Lu Zhaoping
Published: June 2020

We developed high-temperature high-damping high-entropy alloys with superior mechanical properties via Snoek relaxation.
Spontaneous and field-induced crystallographic reorientation of metal electrodeposits at battery anodes
Authors: Zheng Jingxu , Yin Jiefu , Zhang Duhan , Li Gaojin , Bock David C. , Tang Tian , Zhao Qing , Liu Xiaotun , Warren Alexander , Deng Yue , Jin Shuo , Marschilok Amy C. , Takeuchi Esther S. , Takeuchi Kenneth J. , Rahn Christopher D. , Archer Lynden A.
Published: June 2020

Metals use a chemotaxis-like process to overcome diffusion limitations and prevent dendritic electrodeposition in batteries.
Revealing the plasma membrane in GPCR signaling
Authors: Foley John F.
Published: June 2020

The structure of a membrane-embedded, activated D
2
dopamine receptor will help in the development of more selective therapeutics.
Porcine Enterotoxigenic Escherichia coli Strains Differ in Their Capacity To Secrete Enterotoxins through Varying YghG Levels
Authors: Wang Haixiu , Sanz Garcia Raquel , Cox Eric , Devriendt Bert
Published: June 2020

Enterotoxigenic
E. coli
strains are a major health concern. Enterotoxins secreted by enterotoxigenic
E. coli
are crucial for diarrhea induction. Enterotoxin secretion levels differ between strains; however, it is currently unclear what drives these differences. The discrepancy in the production and secretion capacities of enterotoxins in ETEC is important to clarify their function involved in diarrhea induction. Our results further deepen our understanding of how type II secretion system (T2SS) components of ETEC control enterotoxin secretion levels and may lay the foundation for a better understanding of ETEC molecular pathogenesis.
A Comprehensive View of Translesion Synthesis in Escherichia coli
Authors: Fujii Shingo , Fuchs Robert P.
Published: June 2020

The lesion bypass pathway, translesion synthesis (TLS), exists in essentially all organisms and is considered a pathway for postreplicative gap repair and, at the same time, for lesion tolerance. As with the saying “a trip is not over until you get back home,” studying TLS only at the site of the lesion is not enough to understand the whole process of TLS. Recently, a genetic study uncovered that polymerase V (Pol V), a poorly expressed
Escherichia coli
TLS polymerase, is not only involved in the TLS step
per se
but also participates in the gap-filling reaction over several hundred nucleotides.
Antigenic Characterization of New Lineage II Insect-Specific Flaviviruses in Australian Mosquitoes and Identification of Host Restriction Factors
Authors: Harrison Jessica J. , Hobson-Peters Jody , Colmant Agathe M. G. , Koh Joanna , Newton Natalee D. , Warrilow David , Bielefeldt-Ohmann Helle , Piyasena Thisun B. H. , O’Brien Caitlin A. , Vet Laura J. , Paramitha Devina , Potter James R. , Davis Steven S. , Johansen Cheryl A. , Setoh Yin Xiang , Khromykh Alexander A. , Hall Roy A.
Published: June 2020

The globally important flavivirus pathogens West Nile virus, Zika virus, dengue viruses, and yellow fever virus can infect mosquito vectors and be transmitted to humans and other vertebrate species in which they cause significant levels of disease and mortality. However, the subgroup of closely related flaviviruses, known as lineage II insect-specific flaviviruses (Lin II ISFs), only infect mosquitoes and cannot replicate in cells of vertebrate origin. Our data are the first to uncover the mechanisms that restrict the growth of Lin II ISFs in vertebrate cells and provides new insights into the evolution of these viruses and the mechanisms associated with host switching that may allow new mosquito-borne viral diseases to emerge. The new reagents generated in this study, including the first Lin II ISF-reactive monoclonal antibodies and Lin II ISF mutants and chimeric viruses, also provide new tools and approaches to enable further research advances in this field.
Chromosome Segregation in Bacillus subtilis Follows an Overall Pattern of Linear Movement and Is Highly Robust against Cell Cycle Perturbations
Authors: El Najjar Nina , Geisel David , Schmidt Felix , Dersch Simon , Mayer Benjamin , Hartmann Raimo , Eckhardt Bruno , Lenz Peter , Graumann Peter L.
Published: June 2020

We have followed the segregation of origin regions on the
Bacillus subtilis
chromosome in the fastest practically achievable temporal manner, for a large fraction of the cell cycle. We show that segregation occurred in highly variable patterns but overall in an almost linear manner throughout the cell cycle. Segregation was slowed down, but not arrested, by treatment of cells that led to transient blocks in DNA replication, showing that segregation is highly robust against cell cycle perturbation. Computer simulations based on entropy-driven separation of newly synthesized DNA polymers can recapitulate sudden bursts of movement and segregation patterns compatible with the observed
in vivo
patterns, indicating that for
Bacillus
, segregation patterns may include entropic forces helping to separate chromosomes during the cell cycle.
Supplemental Material: Plate boundary trench retreat and dextral shear drive intracontinental fault-slip histories: Neogene dextral faulting across the Gabbs Valley and Gillis Ranges, Central Walker Lane, Nevada
Authors: Lee J. , al. et
Published: June 2020

Figure 2. Layer A. Shaded relief map showing major Quaternary faults in central Walker Lane, Mina deflection, northern Eastern California shear zone, and western Basin and Range Province. Heavy black arrow in the northwest corner of the map shows the present-day azimuth of motion of the Sierra Nevada block with respect to the central Great Basin (SN-CBG) (Bennett et al., 2003). Fault abbreviations: APHF—Agai Pah Hills fault; BSF—Benton Spring fault; CF—Coaldale fault; CVF—Clayton Valley fault; EIFZ—Eastern Inyo fault zone; EPF—Emigrant Peak fault; FLVFCDV—Fish Lake Valley–Furnace Creek–Death Valley fault zone; GHF—Gumdrop Hills fault; HLF—Honey Lake fault; HMF—Hunter Mountain fault; IHF—Indian Head fault; MVF—Mohawk Valley fault; OF—Olinghouse fault; OVF—Owens Valley fault; PLF—Pyramid Lake fault; PSF—Petrified Spring fault; PVF—Panamint Valley fault; QVF—Queen Valley fault; SLF—Stateline fault; SNFF—Sierra Nevada frontal fault zone; WMF—White Mountains fault zone; WRF—Wassuk Range fault; WSF—Warm Springs fault. Layer B. Geographic names. Layer C. Tectonic domains. Semi-transparent brown shows the Walker Lane–northern Eastern California shear zone. Layer D. Yellow dashed polygon shows the location of the Gabbs Valley–Gillis Ranges (GVGR) field area (see Fig. 3). Layer E. Yellow stars show the locations of documented middle Miocene fault-slip initiation age. Numbers in the stars are tied to numbers in Table 3. Layer F. Thin blue arrows show GPS velocities relative to stable North America (ITRFNA2005 reference frame) from Lifton et al. (2013), and heavy multi-colored arrows show GPS velocities relative to stable North America (NA12 North America reference frame) from Bormann et al. (2016). GPS velocity scales are in the upper right corner of the map. Maps, labels, and data sets for this figure are organized in a series of layers that may be viewed separately or in combination using the capabilities of the Acrobat (PDF) layering function (click “Layers” icon along vertical bar on left side of window for display of available layers; turn layers on or off by clicking the box that encompasses the layer label located within the gray box in the lower left corner of the map).
Sarcopenia, physical frailty, undernutrition and obesity cooccurrence among Portuguese community-dwelling older adults: results from Nutrition UP 65 cross-sectional study
Authors: Sousa-Santos Ana Rita , Afonso Cláudia , Borges Nuno , Santos Alejandro , Padrão Patrícia , Moreira Pedro , F Amaral Teresa
Published: June 2020

Objectives

To investigate the coexistence of sarcopenia, frailty, undernutrition and obesity and to identify the factors associated with the cooccurrence of these conditions in an older population.

Design

Cross-sectional.

Setting

Portugal.

Participants

1454 older adults with 65 years or older, from Nutrition UP 65 study.

Primary and secondary outcome measures

Sarcopenia was identified using the European Working Group on Sarcopenia in Older People 2 guidelines and physical frailty using Fried phenotype. Mini-Nutritional Assessment-Short Form was used to ascertain undernutrition, and obesity was evaluated by body mass index.

Results

57.3% presented at least one condition, 38.0% were identified with one and 19.3% were identified with two or more conditions. When all preconditions were considered, 95.7% of the older adults presented at least one of these preconditions or conditions. Multinomial logistic regression multivariate analysis revealed that being male (OR 0.61; 95% CI 0.43 to 0.88), being married or in a common-law marriage (OR 0.58; 95% CI 0.40 to 0.84) and having a higher educational level (OR 0.23; 95% CI 0.07 to 0.73) were inversely associated with having two or more conditions, while age >75 years (OR 1.60; 95% CI 1.14 to 2.24), a poor self-perception of health status (OR 5.61; 95% CI 3.50 to 9.01), ≥5 medications (OR 3.11; 95% CI 1.77 to 5.46) and cognitive impairment (OR 1.84; 95% CI 1.37 to 2.48) were directly associated.

Conclusions

Almost three out of five older adults presented at least one of the conditions related to nutritional status, and about one in five had two or more of these occurrences. However, the low coexistence observed between all of these reinforces the need to assess them all individually during the geriatric assessment.
Individual breastfeeding support with contingent incentives for low-income mothers in the USA: the ‘BOOST (Breastfeeding Onset & Onward with Support Tools)’ randomised controlled trial protocol
Authors: Washio Yukiko , Collins Bradley N , Hunt-Johnson Alison , Zhang Zugui , Herrine Gail , Hoffman Matthew , Kilby Linda , Chapman Donna , Furman Lydia M
Published: June 2020

Introduction

National breastfeeding rates have improved in recent years, however, disparities exist by socioeconomic and psychosocial factors. Suboptimal breastfeeding overburdens the society by increasing healthcare costs. Existing breastfeeding supports including education and peer support have not been sufficient in sustaining breastfeeding rates especially among low-income women. The preliminary outcomes of contingent incentives for breastfeeding in addition to existing support show promising effects in sustaining breastfeeding among mothers in the Special Supplemental Nutrition Programme for women, infants and children (WIC).

Methods and analysis

This trial uses a parallel randomised controlled trial. This trial is conducted at two sites in separate states in the USA. Mothers who were enrolled in WIC and initiated breastfeeding are eligible. Participants (n=168) are randomised into one of the two study groups: (1) standard care control (SC) group consisting of WIC breastfeeding services plus home-based individual support or (2) SC plus breastfeeding incentives (SC +BFI) contingent on demonstrating successful breastfeeding. All participants receive standard breastfeeding services from WIC, home-based individual support and assessments. Participants in SC receive financial compensation based on the number of completed monthly home visits, paid in a lump sum at the end of the 6-month intervention period. Participants in SC +BFI receive an escalating magnitude of financial incentives contingent on observed breastfeeding, paid monthly during the intervention period, as well as bonus incentives for selecting full breastfeeding food packages at WIC. The primary hypothesis is that monthly incentives contingent on breastfeeding in SC +BFI will significantly increase rates of any breastfeeding compared with SC. The primary outcome is the rate of any breastfeeding over 12 months. Randomisation is completed in an automated electronic system. Staff conducting home visits for support and assessments are blinded to study groups.

Ethics and dissemination

The Advarra Institutional Review Board has approved the study protocol (Pro00033168). Findings will be disseminated to our participants, scientific communities, public health officials and any other interested community members.

Trial registration number

NCT03964454
Efficacy of prehospital National Early Warning Score to predict outpatient disposition at an emergency department of a Japanese tertiary hospital: a retrospective study
Authors: Endo Takuro , Yoshida Toru , Shinozaki Tomohiro , Motohashi Takako , Hsu Hsiang-Chin , Fukuda Shunsuke , Tsukuda Jumpei , Naito Takaki , Morisawa Kenichiro , Shimozawa Nobuhiko , Taira Yasuhiko , Fujitani Shigeki
Published: June 2020

Objectives

The National Early Warning Score (NEWS) was originally developed to assess hospitalised patients in the UK. We examined whether the NEWS could be applied to patients transported by ambulance in Japan.

Design

This retrospective study assessed patients and calculated the NEWS from paramedic records. Emergency department (ED) disposition data were categorised into the following groups: discharged from the ED, admitted to the ward, admitted to the intensive care unit (ICU) or died in the ED. The predictive performance of NEWS for patient disposition was assessed using receiver operating characteristic curve analysis. Patient dispositions were compared among NEWS-based categories after adjusting for age, sex and presence of traumatic injury.

Setting

A tertiary hospital in Japan.

Participants

Overall, 2847 patients transported by ambulance between April 2017 and March 2018 were included.

Results

The mean (±SD) NEWS differed significantly among patients discharged from the ED (n=1330, 3.7±2.9), admitted to the ward (n=1263, 60.3±3.8), admitted to the ICU (n=232, 9.4±4.0) and died in the ED (n=22, 110.7±2.9) (p<0.001). The prehospital NEWS C-statistics (95% CI) for admission to the ward, admission to the ICU or death in the ED; admission to the ICU or death in the ED; and death in the ED were 0.73 (0.72–0.75), 0.81 (0.78–0.83) and 0.90 (0.87–0.93), respectively. After adjusting for age, sex and trauma, the OR (95% CI) of admission to the ICU or death in the ED for the high-risk (NEWS ≥7) and medium-risk (NEWS 5–6) categories was 13.8 (8.9–21.6) and 4.2 (2.5–7.1), respectively.

Conclusion

The findings from this Japanese tertiary hospital setting showed that prehospital NEWS could be used to identify patients at a risk of adverse outcomes. NEWS stratification was strongly correlated with patient disposition.
Bridging the gap between policy and practice: a qualitative analysis of providers’ field experiences tinkering with directly observed therapy in patients with drug-resistant tuberculosis in Addis Ababa, Ethiopia
Authors: Mussie Kirubel Manyazewal , Gradmann Christoph , Manyazewal Tsegahun
Published: June 2020

Objectives

Drug-resistant tuberculosis (DR-TB) is one of the major public health threats in low-income countries such as Ethiopia. It is intertwined with larger socioeconomic and political factors that complicate its management and control. Whether directly observed therapy (DOT) is serving its purpose—better patient adherence and treatment outcome—still remains a debatable issue. To contribute to this discussion, this study explored health workers’ field experiences tinkering with DOT in patients with DR-TB in Addis Ababa, Ethiopia.

Design

A qualitative study using in-depth interviews and focus group discussion.

Setting

Ten public healthcare facilities: eight health centres at Addis Ababa Health Bureau level and two TB-specialised hospitals at the Federal Health Bureau level in Ethiopia.

Participants

18 healthcare providers working with DR-TB patients.

Results

Three findings emerged from the analysis. First, the purpose of DOT is to ensure that patients go to healthcare facilities and swallow pills under the observation of a healthcare provider. Thus, its rigid application could lead to the emergence of more DR-TB. Second, DOT should be tinkered with and its practice improved by incorporating more counselling and health education, with more flexibility towards, and attentiveness of, patient context. Third, there exists a family-like patient-provider relationship, and providers do understand their patients and empathise with them to provide better healthcare services.

Conclusion

If rigidly implemented, DOT could lead to more DR-TB—a problem DOT was invented to resolve. Front-line healthcare providers are sensitive to the tragic experiences of DR-TB patients and empathise with them. Thus, they do not strictly implement DOT and are willing to take any blame resulting from tinkering with it. It is high time to shape the practice of DOT for DR-TB patients, with meaningful contributions from front-line healthcare providers.
Efficiency and scale effect of county public hospitals in Shandong Province, China: a cross-sectional study
Authors: Li Qian , Tian Liqi , Jing Xiaolin , Chen Xianghua , Li Jiangfeng , Chen Huixin
Published: June 2020

Objective

To evaluate the efficiency of county public hospitals in Shandong Province following China’s new medical reform and compare the efficiency of hospitals with different bed sizes for improving efficiency.

Design and setting

This was a cross-sectional study on the efficiency and size of 68 county public hospitals in China in 2017.

Outcome measures

Data envelopment analysis was used to calculate the efficiency scores of hospitals and to analyse the slack values of inefficient hospitals. The actual number of open beds, doctors, nurses and total expenditure were selected as inputs, and the total number of annual visits, discharges and total income were selected as outputs. The Kruskal-Wallis H test was employed to compare the efficiency of hospitals with different bed sizes. The χ2 test was used to compare the returns to scale (RTS) of hospitals with different bed sizes.

Results

Twenty (29.41%) hospitals were efficient. There were 27 hospitals with increasing returns to scale, 23 hospitals with constant returns to scale and 18 hospitals with decreasing returns to scale (DRS). The differences in technical efficiency (p=0.248, p>0.05) and pure technical efficiency (p=0.073, p>0.05) were not statistically significant. However, the differences in scale efficiency (p=0.047, p<0.05) and RTS (p<0.001) were statistically significant. Hospitals with DRS began to appear at 885 beds. All sample hospitals with more than 1100 beds were already saturated and some hospitals even had a negative scale effect.

Conclusions

The government and hospital managers should strictly control the bed size in hospitals and make hospitals resume operating in the interests of public welfare. Interventions that rationally allocate health resources and improve the efficiency of medical workers are conducive to solving redundant inputs and insufficient outputs.
Socioeconomic inequalities in the prevalence of complex multimorbidity in a Norwegian population: findings from the cross-sectional HUNT Study
Authors: Vinjerui Kristin Hestmann , Bjerkeset Ottar , Bjorngaard Johan H , Krokstad Steinar , Douglas Kirsty A , Sund Erik R
Published: June 2020

Objectives

Multimorbidity, the co-occurrence of multiple long-term conditions, is common and increasing. Definitions and assessment methods vary, yielding differences in estimates of prevalence and multimorbidity severity. Sociodemographic characteristics are associated with complicating factors of multimorbidity. We aimed to investigate the prevalence of complex multimorbidity by sex and occupational groups throughout adulthood.

Design

Cross-sectional study.

Setting

The third total county survey of The Nord-Trøndelag Health Study (HUNT), 2006–2008, Norway.

Participants

Individuals aged 25–100 years with classifiable occupational data and complete questionnaires and measurements.

Outcome measure

Complex multimorbidity defined as ‘the co-occurrence of three or more chronic conditions affecting three or more different body (organ) systems within one person without defining an index chronic condition’.

Analysis

Logistic regression models with age and occupational group were specified for each sex separately.

Results

38 027 of 41 193 adults (55% women) were included in our analyses. 54% of the participants were identified as having complex multimorbidity. Prevalence differences in percentage points (pp) of those in the low occupational group (vs the high occupational group (reference)) were 19 (95% CI, 16 to 21) pp in women and 10 (8 to 13) pp in men at 30 years; 12 (10 to 14) pp in women and 13 (11 to 15) pp in men at 55 years; and 2 (−1 to 4) pp in women and 7 (4 to 10) pp in men at 75 years.

Conclusion

Complex multimorbidity is common from early adulthood, and social inequalities persist until 75 years in women and 90 years in men in the general population. These findings have policy implications for public health as well as healthcare, organisation, treatment, education and research, as complex multimorbidity breaks with the specialised, fragmented paradigm dominating medicine today.
Patient-centred and family-centred care of critically ill patients who are potential organ donors: a qualitative study protocol of family member perspectives
Authors: Zheng Katina , Sutherland Stephanie , Cardinal Pierre , Meade Maureen , Landriault Angele , Vanderspank-Wright Brandi , Valiani Sabira , Shemie Sam , Appleby Amber , Keenan Sean , Weiss Matthew , Werestiuk Kim , Kramer Andreas H , Kawchuk Joann , Beed Stephen , Dhanani Sonny , Pagliarello Giuseppe , Chasse Michaël , Lotherington Ken , Gatien Mary , Parsons Kim , Chandler Jennifer , Nickerson Peter , Kutsogiannis Jim , Sarti Aimee J
Published: June 2020

Introduction

In a patient-centred and family-centred approach to organ donation, compassion is paramount. Recent guidelines have called for more research, interventions and approaches aimed at improving and supporting the families of critically ill patients. The objective of this study is to help translate patient-centred and family-centred care into practice in deceased organ donation.

Methods and analysis

This will be a national, qualitative study of family members of deceased organ donors in Canada. We will include family members who had been approached regarding an organ donation decision, including those who agreed and declined, at least 2 months and no later than 3 years after the patients’ death. Data collection and analysis is ongoing and will continue until September 2020 to include approximately 250 participants. Family members will be identified and recruited from provincial organ donation organisation databases. Four experienced qualitative researchers will conduct telephone interviews in English or French with audio-recording for subsequent transcription. The research team will develop a codebook iteratively through this process using inductive methods, thus generating themes directly from the dataset.

Ethics and dissemination

Local research ethics boards (REB) at all participating sites across Canada have approved this protocol. The main REB involved is the Ottawa Health Science Network REB. Data collection began in August 2018. Publication of results is anticipated in 2021. Study findings will help improve healthcare provider competency in caring for potential organ donors and their families and improve organ donation consent rates. Findings will also help with the development of educational materials for a competency-based curriculum for critical care residents.
A questionnaire study of the negative outcomes for UK health professional volunteers in low and middle income countries
Authors: Tyler Natasha , Ackers Helen Louise , Ahmed Anya , Byrne Ged , Byrne-Davis Lucie
Published: June 2020

Introduction

Past research has reported considerable benefits of international health professional volunteering for British healthcare professionals; however, there are also some negative outcomes reported. Negative outcomes reportedly happen on a personal, professional and organisational level. However, there is little evidence of the frequency they might occur.

Methods

We aimed to understand what the negative outcomes of health professional volunteering in low-income and middle-income countries were, and how frequently they occurred, in an opportunistic sample of UK health professionals. We used a questionnaire developed using potential negative outcomes reported in the peer-reviewed papers. We conducted secondary analysis on cross-sectional questionnaire data from 222 healthcare professionals.

Results

This research provides an indication of the frequency that negative outcomes might occur. Post hoc analyses revealed that some outcomes were experienced by the majority of health professional volunteers, for example, lack of formal recognition (131/169, 78%) and financial cost (92/169, 68%). While others happened less, for example, a reliance on agency or locum work (12/169, 7%) and loss of pension (31/169, 18%).

Conclusion

The outcomes reported in this research quantify some of the concerns that have been raised in previous literature. Negative outcomes might be associated with certain features of volunteering and further research is needed to prospectively compare different features. Organisers of volunteering opportunities should be aware of the potential negative outcomes and engage with the research into negative outcomes to generate and apply findings about minimising potential negative outcomes, carefully balancing these against the needs of the host country.