bluuebunny/crossref_metadata_2025 huggingface dataset:
Bootstrap procedures for detecting multiple persistence shifts in heteroskedastic time series
Authors: Kejriwal Mohitosh , Yu Xuewen , Perron Pierre
Published: May 2020

This article proposes new bootstrap procedures for detecting multiple persistence shifts in a time series driven by non‐stationary volatility. The assumed volatility process can accommodate discrete breaks, smooth transition variation as well as trending volatility. We develop wild bootstrap sup‐Wald tests of the null hypothesis that the process is either stationary [I(0)] or has a unit root [I(1)] throughout the sample. We also propose a sequential procedure to estimate the number of persistence breaks based on ordering the regime‐specific bootstrap p‐values. The asymptotic validity of the advocated procedures is established both under the null of stability and a variety of persistence change alternatives. A comparison with existing tests that assume homoskedasticity illustrates the finite sample improvements offered by our methods. An application to OECD inflation rates highlights the empirical relevance of the proposed approach and weakens the case for persistence change relative to existing procedures.
Family caregiver's experience of caring for an older adult with delirium: A systematic review
Authors: Shrestha Priyanka , Fick Donna M.
Published: May 2020

Aim

To enhance understanding of how family caregivers perceive the experience of caring for an older adult with delirium across care settings and to identify the challenges in recognising and managing delirium to inform future research and best practices.

Method

A systematic literature review was conducted in five databases per the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses criteria. Primary or secondary peer‐reviewed articles published between 1987 and October 2018 describing the experiences of family caregivers caring for older adults with delirium or delirium superimposed on dementia were included in the review. Mixed Method Appraisal Tool (MMAT) was used to evaluate the methodological quality. A thematic synthesis of results was conducted to extract relevant data as per the aims of the study.

Results

Eighteen articles met the eligibility criteria, which were reviewed and analysed in regard to purpose, sample, research design, variables and results. Seven themes emerged in the process. The current challenges and gaps in our knowledge of this phenomenon have also been highlighted, which should be helpful to inform best practices, and finally, an agenda for future research is proposed.

Conclusion

Family caregivers are an important partner in the detection and management of delirium. The impact of caring for an older adult with delirium on the family caregivers should not be overlooked. This paper highlights the dearth of research on family caregiver's experience of caring for older adults with delirium and even less in the context of delirium superimposed on dementia. More research is required to further understand the family caregiver's experience and their challenges in order to support them in their caregiving role and to determine their needs and preferences of being involved in the plan of care.

Implications for practice

These findings suggest that family caregivers are a valuable resource in the recognition and management of delirium and should be included as care partners in the health care team, while also catering to their health and well‐being in the process.
Cardiac functions in children with steroid‐sensitive nephrotic syndrome
Authors: Nalcacioglu Hulya , Ozkaya Ozan , Kafali Hasan Candas , Tekcan Demet , Baysal Kemal
Published: May 2020

Background

The aim of the present study was to evaluate the presence of cardiac systolic and diastolic dysfunction in pediatric patients with steroid‐sensitive nephrotic syndrome (NS).

Methods

The study population consisted of 19 patients with debut‐relapse of NS aged 1–18 years and 30 sex and age‐matched healthy controls. Blood and urine samples, two M‐mode conventional echocardiograms and tissue Doppler velocity imaging were evaluated in both attack and remission periods.

Results

With regard to conventional pulse wave Doppler (cPWD), steroid‐sensitive NS patients (both in debut / relapse and in remission periods) had a higher peak of late diastolic flow velocities (A peak), and patients in debut / relapse had a lower E/A ratio than the control group, indicating diastolic dysfunction (overall P = 0.003 and P = 0.006, respectively). Based on tissue Doppler velocity imaging echocardiography results, patients in debut/relapse had a higher A′ and a lower E′/A′ ratio (overall P < 0.001 and P = 0.001, respectively). There was also a significant difference in the cPWD E/TDI E′ ratio between the patients showing an increased cPWD E/TDI E′ ratio in remission periods compared to in debut/relapse periods (P = 0.09). The albumin levels were positively correlated with E′/A′ and E/ E′ ratio (r = 0.609; P = 0.007, r = 0.472; P = 0.041 respectively).

Conclusions

Systolic cardiac functions are preserved but diastolic functions are affected in steroid‐sensitive NS patients both in debut/relapse and in remission periods in a relatively short time. The persistence of left ventricular (LV) dysfunction during the remission period requires special attention during the follow up for early detection of cardiac abnormalities.
Sustainable human resource training system for promoting school health in Japan
Authors: Tomokawa Sachi , Miyake Kimihiro , Asakura Takashi
Published: May 2020

Background

It is essential to develop relevant human resources and sustainable training systems to promote school health.

Methods

This paper reviewed the structure of human resources and relevant training systems for school health in Japan and identified current strengths and challenges.

Results

Our review identified seven key points: (i) a legal basis for the allocation of human resources to schools; (ii) established training systems for school health human resources; (iii) uniformity and quality of teacher training curricula; (iv) establishment of teacher‐training institutions; (v) education centers in every prefecture; (vi) allocation of supervisors for Yogo teachers to every prefectural and municipal education board; and (vii) various study group activities at the district and school levels.

Conclusions

Based on these results, we proposed some useful ideas for developing human resources to promote school health in countries outside Japan, especially for developing countries. First, it is necessary to clarify the required competencies for school health among school staff and establish teacher‐training systems based on the required competencies in each country. It is also necessary to consider possible collaboration with existing community health workers, such as doctors, nurses, midwives, nutritionists, and community health workers by providing short‐term training on school health. Second, it is important to train and assign specialists to teacher‐training institutions that can provide education and conduct research on school health. Third, it is helpful to enhance the functions of in‐service training at the prefectural or district level and introduce lesson study on school health.
The Role of Political Ideology in Public Opinion toward Enumerated Antibullying Policies in Public Schools
Authors: Winburn Jonathan , Winburn Amanda
Published: May 2020

All 50 U.S. states now have some type of Antibullying law on the books, and since the initial passage of these bills, many states are now moving into the next phase of policy implementation by reforming and updating their initial legislation. While the initial adoption phase in most states was of low salience and noncontroversial for the public, there is now a more politically divisive debate surrounding the topic: enumerating the laws to protect specific groups. We discuss the use of Antibullying policies around the country along with the political debate over enumeration. Empirically, we examine public attitudes toward adding enumerated protections to existing Antibullying laws for various groups. Using a survey experiment from the 2016 Cooperative Congressional Election Study, we find that public support for enumeration depends on both the group characteristics considered for protection and individuals' ideology.

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Use of day services improved cognitive function in patients with Alzheimer's disease
Authors: Honjo Yasuyuki , Ide Kazuki , Takechi Hajime
Published: May 2020

Aim

Day services (DS) are part of the public nursing care system in Japan. The purpose of DS is to help elderly individuals maintain mental and physical functions, eliminate feelings of isolation among homebound users, and reduce the burden of care on family members. However, the relationship between DS and the progression of Alzheimer's disease (AD) remains unclear.

Methods

We retrospectively analyzed 161 AD patients based on available Mini‐Mental State Examination (MMSE) scores. The patients were divided into two groups: those who started to use DS (n = 106) and those who did not use DS (n = 55). We then compared the groups’ MMSE scores between the first memory clinic visit and the 6‐month point.

Results

There were no significant differences between the two groups with regard to sex and the number of family members, but the non‐DS group was younger, had more education, and had better MMSE scores at the first visit. At 6 months, we found a significant improvement in the MMSE scores of DS users, reflecting improved cognitive function. In addition, lower MMSE score at the first visit was associated with greater improvement in MMSE score at 6 months. Interestingly, the frequency of DS use had no significant effect on MMSE score. However, after approximately 6 months, DS use significantly improved the cognitive function of AD patients.

Conclusions

DS use significantly improved the cognitive function of AD patients. However, most DS users in Japan are older and have severe dementia. Patients who are younger, have more education, or have mild dementia dislike using DS. As a significant difference was found in the MMSE scores between the two groups after 6 months, DS use appears to be a useful non‐drug therapy.
The emergence of a right to clean air: Transforming European Union law through litigation and citizen science
Authors: Misonne Delphine
Published: May 2020

Air quality is a matter of rights. A substantive right to clean air for individuals has emerged from European Union legislation, the corollary of duties made ever tighter by the Court of Justice of the European Union (CJEU). In delivering on these developments, reliance on two factors was and remains of crucial importance: litigation and citizen science. The present article focuses on the CJEU’s interpretation of European Union law on ambient air quality and on how that interpretation impacts domestic jurisdictions. The article explores the apparent absence of rights talk in such legislation, while showing in parallel how air quality, health and rights constantly intersect and form an undeniable backdrop, or context, that favours – and even requires – a stricter protection of individuals against air quality degradation.
The function, format, and performance of Margaret Tudor's January 1522 diplomatic memorial
Authors: Newsome Helen
Published: May 2020

This paper offers a detailed analysis of a holograph memorial (also referred to as ‘articles’ or ‘instructions’) sent by Margaret Tudor, Queen of Scots, to the English court in January 1522, in an effort to persuade Henry VIII to agree to a renewal of Anglo‐Scots peace. Despite their prevalence in many diplomatic correspondence collections, there has been little study on the exact nature and purpose of the memorial genre, or analysis of how the memorial differed from the medieval and early modern letter. Through an analysis of this holograph memorial, I offer some initial thoughts on the format, function and performative impact of the memorial genre, as well as exploring why Margaret chose to send a memorial (and accompanying correspondence) to Henry VIII in January 1522 instead of a more conventional letter. This case study shows that Margaret Tudor was a skilled writer, well‐versed in the mechanisms of diplomatic literacy, who held a central role in the mediation of Anglo‐Scots diplomatic relations and communication in the early sixteenth century.
Regulation of RNA granules by FMRP and implications for neurological diseases
Authors: Lai Austin , Valdez‐Sinon Arielle N. , Bassell Gary J.
Published: May 2020

RNA granule formation, which can be regulated by RNA‐binding proteins (RBPs) such as fragile X mental retardation protein (FMRP), acts as a mechanism to control both the repression and subcellular localization of translation. Dysregulated assembly of RNA granules has been implicated in multiple neurological disorders, such as amyotrophic lateral sclerosis. Thus, it is crucial to understand the cellular pathways impinging upon granule assembly or disassembly. The goal of this review is to summarize recent advances in our understanding of the role of the RBP, FMRP, in translational repression underlying RNA granule dynamics, mRNA transport and localized. We summarize the known mechanisms of translational regulation by FMRP, the role of FMRP in RNA transport granules, fragile X granules and stress granules. Focusing on the emerging link between FMRP and stress granules, we propose a model for how hyperassembly and hypoassembly of RNA granules may contribute to neurological diseases.
Gender differences in academic rank among faculty surgeons at US veterinary schools in 2019
Authors: Giuffrida Michelle A. , Steffey Michele A. , Balsa Ingrid M. , Morello Samantha L. , Kapatkin Amy S.
Published: May 2020

Objective

To describe academic rank, gender, surgical career length, and publication record of academic veterinary surgeons and to estimate the association between gender and higher academic rank.

Study design

Cross‐sectional study.

Sample

Residency‐trained surgeons at US veterinary schools in 2019.

Methods

Surgeons were identified via institutional websites. Data including surgeon gender, academic title, and year of board certification were collected from public resources. Publication record was measured by using author h‐indices obtained from Scopus. Data were analyzed with descriptive and inferential statistics.

Results

Three hundred eighteen surgeons were identified from 30 institutions, including 162 (51%) women and 156 (49%) men. Women represented 66% of instructors and assistant professors, and men represented 60% of associate and full professors. This distribution differed significantly (P < .001). Author h‐index was associated with career length but not gender. Men were 2.5 times more likely than women to be associate or full professors (odds ratio 2.52, 95% CI 1.03‐6.14, P = .042) after adjustment for career length and h‐index.

Conclusion

Female surgery faculty at US veterinary schools in 2019 were concentrated in lower academic ranks and were less likely than male surgery faculty to be associate or full professors after adjustment for career length and publication record.

Impact

A gender gap exists in academic veterinary surgery in the United States. It is critical to recognize that women's increasing participation in veterinary medicine has not been matched by equal representation in all areas. Additional efforts are warranted to identify contributing factors and implement strategies to improve gender inclusion.
Estimating acute human leptospirosis incidence in northern Tanzania using sentinel site and community behavioural surveillance
Authors: Maze Michael J. , Sharples Katrina J. , Allan Kathryn J. , Biggs Holly M. , Cash‐Goldwasser Shama , Galloway Renee L. , de Glanville William A. , Halliday Jo E. B. , Kazwala Rudovick R. , Kibona Tito , Mmbaga Blandina T. , Maro Venance P. , Rubach Matthew P. , Cleaveland Sarah , Crump John A.
Published: May 2020

Many infectious diseases lack robust estimates of incidence from endemic areas, and extrapolating incidence when there are few locations with data remains a major challenge in burden of disease estimation. We sought to combine sentinel surveillance with community behavioural surveillance to estimate leptospirosis incidence. We administered a questionnaire gathering responses on established locally relevant leptospirosis risk factors and recent fever to livestock‐owning community members across six districts in northern Tanzania and applied a logistic regression model predicting leptospirosis risk on the basis of behavioural factors that had been previously developed among patients with fever in Moshi Municipal and Moshi Rural Districts. We aggregated probability of leptospirosis by district and estimated incidence in each district by standardizing probabilities to those previously estimated for Moshi Districts. We recruited 286 community participants: Hai District (n = 11), Longido District (59), Monduli District (56), Moshi Municipal District (103), Moshi Rural District (44) and Rombo District (13). The mean predicted probability of leptospirosis by district was Hai 0.029 (0.005, 0.095), Longido 0.071 (0.009, 0.235), Monduli 0.055 (0.009, 0.206), Moshi Rural 0.014 (0.002, 0.049), Moshi Municipal 0.015 (0.004, 0.048) and Rombo 0.031 (0.006, 0.121). We estimated the annual incidence (upper and lower bounds of estimate) per 100,000 people of human leptospirosis among livestock owners by district as Hai 35 (6, 114), Longido 85 (11, 282), Monduli 66 (11, 247), Moshi Rural 17 (2, 59), Moshi Municipal 18 (5, 58) and Rombo 47 (7, 145). Use of community behavioural surveillance may be a useful tool for extrapolating disease incidence beyond sentinel surveillance sites.
Species delineation in the speciation grey zone—The case of Diopatra (Annelida, Onuphidae)
Authors: Elgetany Asmaa H. , van Rensburg Hendré , Hektoen Martin , Matthee Conrad , Budaeva Nataliya , Simon Carol A , Struck Torsten H.
Published: May 2020

Taxonomy based on morphology can be difficult. The challenges arise from different sources such as poor original descriptions, new records based on inadequate knowledge, uncritical application of general assumptions or presence of complexes of cryptic species. One example of problematic taxonomy is the genus Diopatra Audouin & Milne Edwards, 1833 (Onuphidae, Annelida) and within it the two species Diopatra aciculata and D. neapolitana. The species exhibit great similarity between them casting doubts on their validity as separate species. Our study aims to investigate whether D. aciculata and D. neapolitana should be synonymized, using an integrative taxonomic approach. Therefore, we assessed 22 morphological characters of 70 specimens including one specimen, which might have been erroneously assigned to D. dentata. Additionally, sequence information of five different molecular markers (i.e., 16S rDNA, COI, 28S, ITS1 and ITS2) was gathered to delineate possible species boundaries between these two species. Our results show some evidence for delineating the two species, but they are not conclusive due to both presence of shared morphological characters and conflicting evidence in the molecular data. Accordingly, our results neither confirm nor disprove complete speciation and both species seem to be in the grey zone of speciation. In conclusion, considering taxonomic stability and slight support by morphological characters, we still regard each as two independent species.
Information and Communication Technology in Higher Education of Uganda and Education Implications: A Case of Kyambogo University
Authors: Lubaale Grace
Published: May 2020

The emergence of knowledge society globally today has created new challenges for Higher Education (HE) particularly with the development of Information Communication Technology (ICT) at a speed that has no match in history yet HE in Uganda is still lagging behind. The paper aims at unraveling the role and challenges of using ICT in HE of Uganda and education implications in order to provide the way forward with Kyambogo University as a case. This study used a mixed methods approach that combined desk review and interviews. The paper reveals the role of ICT in HE as central in the teaching-learning process, on the learner and learning and on the academic staff and teaching while the challenges as; learners, economy, equipment and academic staff which poses as a drawback in the teaching –learning process. The paper concludes that ICT is central in the teaching-learning process as well as in the management of HE institutions. The way forward rests majorly in the newly created ICT Ministry with effective implementation of ICT Policy 2014 to improve the livelihoods of Ugandans by ensuring the availability of accessible, efficient, reliable and affordable ICT services in which HE will benefit automatically hence its effective application and use in the teaching-learning process.
The effect of size range on ultrasound-induced translations in microbubble populations
Authors: Supponen Outi , Upadhyay Awaneesh , Lum Jordan , Guidi Francesco , Murray Todd , Vos Hendrik J. , Tortoli Piero , Borden Mark
Published: May 2020

Microbubble translations driven by ultrasound-induced radiation forces can be beneficial for applications in ultrasound molecular imaging and drug delivery. Here, the effect of size range in microbubble populations on their translations is investigated experimentally and theoretically. The displacements within five distinct size-isolated microbubble populations are driven by a standard ultrasound-imaging probe at frequencies ranging from 3 to 7 MHz, and measured using the multi-gate spectral Doppler approach. Peak microbubble displacements, reaching up to 10 μm per pulse, are found to describe transient phenomena from the resonant proportion of each bubble population. The overall trend of the statistical behavior of the bubble displacements, quantified by the total number of identified displacements, reveals significant differences between the bubble populations as a function of the transmission frequency. A good agreement is found between the experiments and theory that includes a model parameter fit, which is further supported by separate measurements of individual microbubbles to characterize the viscoelasticity of their stabilizing lipid shell. These findings may help to tune the microbubble size distribution and ultrasound transmission parameters to optimize the radiation-force translations. They also demonstrate a simple technique to characterize the microbubble shell viscosity, the fitted model parameter, from freely floating microbubble populations using a standard ultrasound-imaging probe.
Stakeholders’ Perceptions of Implementation of a Comprehensive School Physical Activity Program: A Review
Authors: Mulhearn Shannon C. , Kulinna Pamela Hodges , Webster Collin
Published: May 2020

The Comprehensive School Physical Activity Program (CSPAP) is a whole-school model for increasing opportunities throughout the school day for access to physical activity (PA). Opportunities for PA during the school day are an important part of the field of kinesiology and critical to individuals’ developing patterns of lifetime PA. Guided by Guskey’s theory of teacher change, this scoping literature review summarizes findings from 29 studies that collected data concerning the perceptions of stakeholders in a CSPAP. Teachers’ lifelong learning process is the focus, including K-12 classroom and physical education teachers and students, as well as current preservice classroom and physical education teacher education students and education faculty at teacher-preparation institutions. Positive perceptions of CSPAP programs were reported by all stakeholder groups. Although studies often include barriers to implementation, the stakeholders generally shared strategies to overcoming these and focused on benefits to the school setting that the researchers explained in their discussions.
Evolution of vegetation and climate variability on the Tibetan Plateau over the past 1.74 million years
Authors: Zhao Yan , Tzedakis Polychronis C. , Li Quan , Qin Feng , Cui Qiaoyu , Liang Chen , Birks H. John B. , Liu Yaoliang , Zhang Zhiyong , Ge Junyi , Zhao Hui , Felde Vivian A. , Deng Chenglong , Cai Maotang , Li Huan , Ren Weihe , Wei Haicheng , Yang Hanfei , Zhang Jiawu , Yu Zicheng , Guo Zhengtang
Published: May 2020

Low- and high-latitude influences have shaped the evolution of the Tibetan Plateau climate over the past 1.74 million years.
Permafrost thawing puts the frozen carbon at risk over the Tibetan Plateau
Authors: Wang Taihua , Yang Dawen , Yang Yuting , Piao Shilong , Li Xin , Cheng Guodong , Fu Bojie
Published: May 2020

A large quantity of soil organic carbon frozen in permafrost on the Tibetan Plateau will be at risk under future climate warming.
KAGUYA observation of global emissions of indigenous carbon ions from the Moon
Authors: Yokota Shoichiro , Terada Kentaro , Saito Yoshifumi , Kato Daiba , Asamura Kazushi , Nishino Masaki N. , Shimizu Hisayoshi , Takahashi Futoshi , Shibuya Hidetoshi , Matsushima Masaki , Tsunakawa Hideo
Published: May 2020

KAGUYA observed global emissions of carbon ions from the Moon, which have possibly existed since its birth.
Life cycle of a cyanobacterial carboxysome
Authors: Hill Nicholas C. , Tay Jian Wei , Altus Sabina , Bortz David M. , Cameron Jeffrey C.
Published: May 2020

Single cell and organelle measurements reveal activity dynamics and degradation of the carbon-fixing cyanobacterial carboxysome.
Development of an inactivated vaccine candidate for SARS-CoV-2
Authors: Gao Qiang , Bao Linlin , Mao Haiyan , Wang Lin , Xu Kangwei , Yang Minnan , Li Yajing , Zhu Ling , Wang Nan , Lv Zhe , Gao Hong , Ge Xiaoqin , Kan Biao , Hu Yaling , Liu Jiangning , Cai Fang , Jiang Deyu , Yin Yanhui , Qin Chengfeng , Li Jing , Gong Xuejie , Lou Xiuyu , Shi Wen , Wu Dongdong , Zhang Hengming , Zhu Lang , Deng Wei , Li Yurong , Lu Jinxing , Li Changgui , Wang Xiangxi , Yin Weidong , Zhang Yanjun , Qin Chuan
Published: May 2020

Vaccine candidate tested in monkeys

Global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to an urgent race to develop a vaccine. Gao
et al.
report preclinical results of an early vaccine candidate called PiCoVacc, which protected rhesus macaque monkeys against SARS-CoV-2 infection when analyzed in short-term studies. The researchers obtained multiple SARS-CoV-2 strains from 11 hospitalized patients across the world and then chemically inactivated the harmful properties of the virus. Animals were immunized with one of two vaccine doses and then inoculated with SARS-CoV-2. Those that received the lowest dose showed signs of controlling the infection, and those receiving the highest dose appeared more protected and did not have detectable viral loads in the pharynx or lungs at 7 days after infection. The next steps will be testing for safety and efficacy in humans.

Science
, this issue p.
77
Evaluation of NG-Test Carba 5 for Rapid Phenotypic Detection and Differentiation of Five Common Carbapenemase Families: Results of a Multicenter Clinical Evaluation
Authors: Jenkins Stephen , Ledeboer Nathan A. , Westblade Lars F. , Burnham Carey-Ann D. , Faron Matthew L. , Bergman Yehudit , Yee Rebecca , Mesich Brian , Gerstbrein Derek , Wallace Meghan A. , Robertson Amy , Fauntleroy Kathy A. , Klavins Anna S. , Malherbe Rianna , Hsiung Andre , Simner Patricia J.
Published: May 2020

NG-Test Carba 5 is a rapid
in vitro
multiplex immunoassay for the phenotypic detection and differentiation of five common carbapenemase families (KPC, OXA-48-like, VIM, IMP, and NDM) directly from bacterial colonies. The assay is simple to perform and has recently received U.S. Food and Drug Administration clearance. A method comparison study was performed at geographically diverse medical centers (
n 
= 3) in the United States, where 309
Enterobacterales
and
Pseudomonas aeruginosa
isolates were evaluated by NG-Test Carba 5 (NG Biotech, Guipry, France), the Xpert Carba-R assay (Cepheid, Inc.
Genome Sequence of the Oleaginous Yeast Rhodotorula paludigena Strain CM33, a Potential Strain for Biofuel Production
Authors: Gosalawit Chotika , Imsoonthornruksa Sumeth , Udomsil Natteewan , Ketudat-Cairns Mariena
Published: May 2020

The genome sequence of
Rhodotorula paludigena
strain CM33, an oleaginous yeast isolated from castor bean (
Ricinus
sp.) in Thailand, is reported here. Genome sequencing and assembly yielded 20,657,327 bases with a 64.3% G+C content.
An Extensive Meta-Metagenomic Search Identifies SARS-CoV-2-Homologous Sequences in Pangolin Lung Viromes
Authors: Wahba Lamia , Jain Nimit , Fire Andrew Z. , Shoura Massa J. , Artiles Karen L. , McCoy Matthew J. , Jeong Dae-Eun
Published: May 2020

Meta-metagenomic searches allow for high-speed, low-cost identification of potentially significant biological niches for sequences of interest.
Lack of Evidence for Microbiota in the Placental and Fetal Tissues of Rhesus Macaques
Authors: Theis Kevin R. , Romero Roberto , Winters Andrew D. , Jobe Alan H. , Gomez-Lopez Nardhy
Published: May 2020

Microbial invasion of the amniotic cavity (i.e., intra-amniotic infection) has been causally linked to pregnancy complications, especially preterm birth. Therefore, if the placenta and the fetus are typically populated by low-biomass microbial communities, current understanding of the role of microbes in reproduction and pregnancy outcomes will need to be fundamentally reconsidered. Could these communities be of benefit by competitively excluding potential pathogens or priming the fetal immune system for the microbial bombardment it will experience upon delivery? If so, what properties (e.g., microbial load and community membership) of these microbial communities preclude versus promote intra-amniotic infection? Given the ramifications of thein uterocolonization hypothesis, critical evaluation is required. In this study, using multiple modes of microbiologic inquiry (i.e., culture, quantitative real-time PCR [qPCR], and DNA sequencing) and controlling for potential background DNA contamination, we did not find consistent evidence for microbial communities in the placental and fetal tissues of rhesus macaques.
Area-level socioeconomic disparity trends in nutritional status among 5–6-year-old children in Israel
Authors: Loewenberg Weisband Yiska , Kaufman-Shriqui Vered , Wolff Sagy Yael , Krieger Michal , Abu Ahmad Wiessam , Manor Orly
Published: May 2020

Objective

This study aimed to assess area-level socioeconomic position (SEP) disparities in nutritional status, to determine whether disparities differed by sex and to assess whether nutritional status and disparities changed over time.

Design

We used repeated cross-sectional data from a national programme that evaluates the quality of healthcare in Israel to assess children’s nutritional status.

Setting

The study included all Israeli residents aged 7 years during 2014–2018 (n=699 255).

Methods

SEP was measured based on the Central Bureau of Statistics’ statistical areas, and grouped into categories, ranging from 1 (lowest) to 10 (highest). We used multivariable multinomial regression to assess the association between SEP and nutritional status and between year and nutritional status. We included interactions between year and SEP to assess whether disparities changed over time.

Results

Children in SEP 1, comprised entirely of children from the Bedouin population from Southern Israel, had drastically higher odds of thinness compared with those in the highest SEP (Girls: OR 5.02, 99% CI 2.23 to 11.30; Boys: OR 2.03, 99% CI 1.19 to 3.48). Odds of obesity were highest in lower-middle SEPs (ORSEP 5 vs 10 1.84, 99% CI 1.34 to 2.54). Prevalence of overweight and obesity decreased between 2014 and 2018, normal weight increased and thinness did not change. SEP disparities in thinness decreased over time in boys but showed a reverse trend for girls. No substantial improvement was seen in SEP disparities for other weight categories.

Conclusions

Our study demonstrates the need to consider initiatives to combat the considerable SEP disparities in both thinness and obesity.
Partial recovery of vegetative state after a massive ischaemic stroke in a child with sickle cell anaemia
Authors: Machado Calixto , Rodríguez-Rojas Rafael , Leisman Gerry
Published: May 2020

A 15-year-old patient with sickle cell disease with recessive homozygous haemoglobin S/HbSS suffered several crises developmentally after the last of which the patient fell into coma. CT scan then revealed a large infarct of the right cerebral hemisphere. Three weeks after the event, the patient began to demonstrate spontaneous eye opening and spastic quadriparesis with no evidence of command-following, gestural or verbal communication, visual pursuit or purposeful motor behaviour. Our case was in an ‘unresponsive wakefulness syndrome’ with atrophy of lateral and frontal regions of both hemispheres, demonstrated by MRI and preservation of circulation in the posterior arterial system, documented by MR angiography. Currently observed are spontaneous eye opening, preserved visual and auditory startle reflexes, normal brainstem reflexes, and grasp, palmomental and sucking reflexes. Our case demonstrates partial recovery of awareness with significant brain lesions, reflecting preserved brain activity as an indication of the modular nature of functional networks.
Chemotherapy-sparing treatment of haemophagocytic lymphohistiocytosis with intravenous immunoglobulins and corticosteroids
Authors: Chen Evan C , Stefely Jonathan A , Dey Bimalangshu R , Dzik Walter H
Published: May 2020

Haemophagocytic lymphohistiocytosis (HLH) can be a rapidly fatal disease. Current treatment in adults is extrapolated from the HLH-2004 protocol that specifies a regimen of etoposide, dexamethasone and cyclosporine. However, HLH presents as a spectrum of disease severity. A therapeutic challenge arises for milder cases where the harms of potent chemotherapy such as etoposide may outweigh its benefit. We present a case of an adult with HLH who developed significant pancytopenia but was otherwise not critically ill and who responded to treatment with a chemotherapy-sparing approach consisting of intravenous immunoglobulins and corticosteroids alone. The case illustrates that tailored therapy may allow effective treatment of the disorder while minimising therapy-related toxicities.
Painless type A aortic dissection
Authors: Becerra-Gonzales Victor G , Calfa Marian , Sancassani Rhea
Published: May 2020

Aortic dissection is an uncommon diagnosis that typically presents with acute onset of severe pain. It rarely presents with minimal to no symptoms, which carries a higher mortality risk given the delay in diagnosis. An adequate interpretation of risk factors, clinical findings and auxiliary tests constitutes a greater value for clinicians to detect this life-threatening condition. This report describes a case of type A aortic dissection in an asymptomatic patient presenting with an abnormal electrocardiogram (ECG).
Agenesis of the long head of the biceps brachii tendon: ignored variations of the anatomy and the next tendon to disappear?
Authors: Traverso Aurélien , Piasecki Krzysztof , Gallusser Nicolas , Farron Alain
Published: May 2020

Bilateral agenesis of the long head of the biceps brachial tendon (LHB) is a very rare variation of the anatomy. We report a case of an 18-year-old man with bilateral agenesis of the long head of the biceps brachii tendon. We present initial findings, radiographical examinations and the follow-up of an unusual entity. Diagnosis of agenesis of the LHB can be challenging especially in cases of traumatic shoulder pain. It is not a very known entity because of its rareness. However, it could be associated with other congenital anomalies. The absence of the LHB is easily ignored in the diagnostic process. Clinical examination should be a pitfall, radiological examination is helpful to confirm the suspicion of LHB absence. MRI is often the first choice, although ultrasonography is cheaper and much easier to access and it is an excellent tool to visualise this anatomic variation with empty or shallow intertubercular groove.
iOCT-assisted macular hole surgery: outcomes and utility from the DISCOVER study
Authors: Yee Philina , Sevgi Duriye Damla , Abraham Joseph , Srivastava Sunil K , Le Thuy , Uchida Atsuro , Figueiredo Natalia , Rachitskaya Aleksandra V , Sharma Sumit , Reese Jamie , Ehlers Justis P
Published: May 2020

Background/aims

This study aimed to characterise the clinical outcomes and utility of intraoperative optical coherence tomography (iOCT)-assisted macular hole (MH) repair.

Methods

This was a post hoc analysis of eyes in the Determination
of feasibility of Intraoperative Spectral domain microscope Combined/integrated
OCT
Visualization
during En face Retinal and ophthalmic surgery (DISCOVER) study undergoing surgical MH repair with use of iOCT. Functional and surgical outcome data were collected through 12 months postoperatively. MH closure rate, postoperative visual acuity (VA), percentage of cases in which iOCT provided valuable feedback and altered surgical decision making were measured.

Results

Eighty-four eyes were included in this study. The mean preoperative VA measured 20/114. The mean postoperative VA improved to 20/68 (p<0.001) at month 1, 20/48 (p<0.001) at month 3 and 20/45 (p<0.001) at month 12 or later. In 43 cases (51%), surgeons reported that iOCT provided valuable information (eg, confirming release of vitreomacular traction and identification of occult residual membranes). In 10 cases (12%), iOCT data specifically altered surgical decision making. Postoperative day 1 transtamponade OCT confirmed tissue apposition and apparent hole closure in 74% of eyes (21/26). All five open holes on postoperative day 1 closed following positioning. Single-surgery MH closure was achieved in 97.6% of cases. One persistent MH was successfully closed with a subsequent surgical repair for a final overall closure rate of 98.8%. Due to chronicity and MH size, additional repair was not recommended for the single remaining persistent MH.

Conclusion

This study suggests that iOCT may have important utility in MH surgery, including impacting surgical decision making. iOCT-assisted MH surgery resulted in significant improvement in VA and high single-surgery success rate.
Cost of hospital treatment of type 1 diabetes (T1DM) and type 2 diabetes (T2DM) compared to the non-diabetes population: a detailed economic evaluation
Authors: Stedman Mike , Lunt Mark , Davies Mark , Livingston Mark , Duff Christopher , Fryer Anthony , Anderson Simon George , Gadsby Roger , Gibson Martin , Rayman Gerry , Heald Adrian
Published: May 2020

Objectives

Other than age, diabetes is the largest contributor to overall healthcare costs and reduced life expectancy in Europe. This paper aims to more exactly quantify the net impact of diabetes on different aspects of healthcare provision in hospitals in England, building on previous work that looked at the determinants of outcome in type 1 diabetes (T1DM) and type 2 diabetes (T2DM).

Setting

NHS Digital Hospital Episode Statistics (HES) in England was combined with the National Diabetes Audit (NDA) to provide the total number in practice of people with T1DM/T2DM.

Outcome measures

We compared differences between T1DM/T2DM and non-diabetes individuals in relation to hospital activity and associated cost.

Results

The study captured 90% of hospital activity and £36 billion/year of hospital spend. The NDA Register showed that out of a total reported population of 58 million, 2.9 million (6.5%) had T2DM and 240 000 (0.6%) had T1DM. Bed-day analysis showed 17% of beds are occupied by T2DM and 3% by T1DM. The overall cost of hospital care for people with diabetes is £5.5 billion/year. Once the normally expected costs including the older age of T2DM hospital attenders are allowed for this fell to £3.0 billion/year or 8% of the total captured secondary care costs. This equates to £560/non-diabetes person compared with £3280/person with T1DM and £1686/person with T2DM. For people with diabetes, the net excess impact on non-elective/emergency work is £1.2 billion with additional estimated diabetes-related accident & emergency attendances at 440 000 costing the NHS £70 million/year. T1DM individuals required five times more secondary care support than non-diabetes individuals. T2DM individuals, even allowing for the age, require twice as much support as non-diabetes individuals.

Conclusions

This analysis shows that additional cost of provision of hospital services due to their diabetes comorbidities is £3 billion above that for non-diabetes, and that within this, T1DM has three times as much cost impact as T2DM. We suggest that supporting patients in diabetes management may significantly reduce hospital activity.
How was cognitive behavioural therapy for mood disorder implemented in Japan? A retrospective observational study using the nationwide claims database from FY2010 to FY2015
Authors: Hayashi Yuta , Yoshinaga Naoki , Sasaki Yosuke , Tanoue Hiroki , Yoshimura Kensuke , Kadowaki Yuko , Arimura Yasuji , Yanagita Toshihiko , Ishida Yasushi
Published: May 2020

Objectives

To clarify the dissemination status of cognitive behavioural therapy (CBT) in Japan under the national health insurance scheme.

Design

Retrospective observational study.

Setting

National Database of Health Insurance Claims and Specific Health Checkups of Japan.

Participants

Patients who received CBT under the national health insurance scheme from fiscal years (FY) 2010 to 2015.

Primary and secondary outcome measures

We estimated the change rate and the standardised claim ratio (SCR) for the number of patients receiving CBT and analysed the association between the CBT status and several regional factors.

Results

We found that (a) a total of 60 304 patients received CBT during the study period; (b) the number of patients receiving CBT was highest in the first year (−1.8% from FY2010 to FY2015); (c) the number of patients who received CBT per 100 000 population decreased (or remained at zero) in most prefectures (32 out of 47); (d) there was a maximum 424.7-fold difference between prefectures in the standardised claim ratio for CBT and (e) the number of registered CBT institutions was significantly associated with the number of patients who received CBT.

Conclusions

The provision of CBT did not increase in the first 6 years (FY2010–2015) after its coverage in Japan’s national health insurance scheme. Further studies including a questionnaire survey of registered CBT institutions are required to get more detailed information on the dissemination of CBT in Japan.
Women’s self-reported experiences using misoprostol obtained from drug sellers: a prospective cohort study in Lagos State, Nigeria
Authors: Stillman Melissa , Owolabi Onikepe , Fatusi Adesegun O , Akinyemi Akanni I , Berry Amanda L , Erinfolami Temitope P , Olagunju Olalekan S , Väisänen Heini , Bankole Akinrinola
Published: May 2020

Objectives

This study aimed to assess the safety and effectiveness of self-managed misoprostol abortions obtained outside of the formal health system in Lagos State, Nigeria.

Design

This was a prospective cohort study among women using misoprostol-containing medications purchased from drug sellers. Three telephone-administered surveys were conducted over 1 month.

Setting

Data were collected in 2018 in six local government areas in Lagos State.

Participants

Drug sellers attempted to recruit all women who purchased misoprostol-containing medication. To remain in the study, participants had to be female and aged 18–49, and had to have purchased the medication for the purpose of abortion. Of 501 women initially recruited, 446 were eligible for the full study, and 394 completed all three surveys.

Primary and secondary outcome measures

Using self-reported measures, we assessed the quality of information provided by drug sellers; the prevalence of potential complications; and the proportion with completed abortions.

Results

Although drug sellers provided inadequate information about the pills, 94% of the sample reported a complete abortion without surgical intervention about 1 month after taking the medication. Assuming a conservative scenario where all individuals lost to follow-up had failed terminations, the completion rate dropped to 87%. While 86 women reported physical symptoms suggestive of complications, only six of them reported wanting or needing health facility care and four subsequently obtained care.

Conclusions

Drug sellers are an important source of medical abortion in this setting. Despite the limitations of self-report, many women appear to have effectively self-administered misoprostol. Additional research is needed to expand the evidence on the safety and effectiveness of self-use of misoprostol for abortion in restrictive settings, and to inform approaches that support the health and well-being of people who use this method of abortion.
Nasal fentanyl alone plus buccal midazolam: an open-label, randomised, controlled feasibility study in the dying
Authors: Perkins Paul , Parkinson Anne , Akyea Ralph Kwame , Husbands Emma
Published: May 2020

Introduction

Many patients want to stay at home to die. They invariably become unable to take oral medication during their terminal phase. Symptoms are usually controlled by subcutaneous medications. There have been no studies on nasal fentanyl (NF) or buccal midazolam (BM) to control symptoms in the dying.

Objective

To establish how best to conduct a definitive, randomised controlled trial (RCT) to determine whether NF and BM administered by families, for patients dying at home, lead to faster and better symptom control and fewer community nursing visits than standard breakthrough medication by healthcare professionals.

Methods

This open-label mixed-method feasibility RCT compared the efficacy of NF and BM by family members to standard breakthrough medication by nurses for the terminally ill in a specialist palliative care unit. Partway through the study, a third observational arm was introduced where BM alone was used. The primary outcomes were whether recruitment and randomisation were possible, assessment of withdrawal and drop-out, and whether the methods were acceptable and appropriate.

Results

Administration of NF and BM was acceptable to patients and families. Both were well tolerated. We were unable to obtain quality of life data consistently but did get time period data for dose-controlled symptoms.

Conclusions

Study participation in a hospice population of the dying was acceptable. The results will help guide future community study planning.

Trial registration number

NCT02009306.