bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and validation of a 6‐item Revised UCLA Loneliness Scale (RULS‐6) using Rasch analysis
Authors: Wongpakaran Nahathai , Wongpakaran Tinakon , Pinyopornpanish Manee , Simcharoen Sutapat , Suradom Chawisa , Varnado Pairada , Kuntawong Pimolpun
Published: January 2020

Objective

The UCLA Loneliness Scale, containing 20 items, is one of the commonly used loneliness scales. Some shorter versions have been developed using factor analysis. The study aimed to shorten the UCLA Loneliness Scale using Rasch and factor analysis methods and test the psychometric properties of the new scale.

Methods

The full sample of the study included 719 respondents, divided into three subsamples (205, 324, and 190 for samples 1–3, respectively). The original, 20‐item Revised UCLA Loneliness Scale (R‐ULS) was shortened using 205 students (sample 1); the shortened scale was then validated for construct and concurrent validity with 324 students (sample 2) and 190 clinical participants (sample 3). Confirmatory factor analysis and Rasch analysis were used for construct validity. Convergent, discriminant, and concurrent validity were assessed by exploring the correlation with other psychological measurements.

Results

In sample 1, the R‐ULS was shortened to a 6‐item scale (RULS‐6) that fits the Rasch model. The RULS‐6 met the criteria of unidimensionality and local independence without differential item functioning due to age and sex, and good targeting the clinical sample. Person Separation Index (PSI) reflected that reliability from the Rasch perspective was acceptable. However, collapsing categories 2 (sometime) and 3 (rarely) may be required in a clinical sample. When tested in samples 2 and 3, the RULS‐6 fits the Rasch measurement model. Convergent and discriminant validity were demonstrated with interpersonal problems and attachment scales. As expected, a positive correlation was found between RULS‐6 and anxiety, depression subscale, interpersonal difficulties, and somatization subscales denoting concurrent validity. Cronbach’s alpha of the RULS‐6 was good (.83).

Conclusion

Using Rasch analysis, the proposed RULS‐6 constituted a 70% reduction of the number of original items, yet preserved the psychometric properties in independent samples of students and psychiatric outpatients.

Statement of contribution

What is already known on this subject?

The UCLA Loneliness Scale is a common instrument used to gauge loneliness levels.

The 20‐item revised scale (R‐ULS) has acceptable psychometric properties but its construct varies.

Due to the length of the questionnaire, administration of R‐ULS is not always practical.

Short versions vary in items and were developed with classic test theory (e.g., factor analysis).

Rasch analysis – providing more accuracy based on measurement theory – could be used instead.

What does this study add?

Using a Rasch analysis approach, a 6‐item scale of loneliness (RULS‐6) was created.

The RULS‐6 was tested in student and clinical samples, meeting Rasch measurement model criteria.

The RULS‐6 showed promising psychometrics to be used in both non‐clinical and clinical samples.
‘It’s like being conscripted, one volunteer is better than 10 pressed men’: A qualitative study into the views of people who plan to opt‐out of organ donation
Authors: Miller Jordan , Currie Sinéad , McGregor Lesley M. , O’Carroll Ronan E.
Published: January 2020

Objectives

To overcome the shortage of organ donors, Scotland and England are introducing an opt‐out organ donor registration system in 2020. This means individuals will be automatically considered to consent for donation unless they actively opt‐out of the register. Research has found that emotional barriers play a key role in donor decisions under opt‐in legislation, yet little is known about factors that influence donor decisions under opt‐out consent. Our objectives were to investigate attitudes towards organ donation and opt‐out consent from individuals who plan to opt‐out, and to explore the reasons why they plan to opt‐out.

Design

Qualitative interview study.

Methods

Semi‐structured interviews were conducted with 15 individuals from Scotland (n = 14) and England (n = 1) who self‐reported the intention to opt‐out of the register following the legislative change to opt‐out. The interviews were transcribed verbatim and analysed using thematic analysis.

Results

Three main themes were identified: (1) consent versus coercion, which describes the perception of freedom of choice under an opt‐in system and fears of ‘government interference’ and threatened autonomy under opt‐out, (2) self‐protection, encompassing fears of medical mistrust, bodily integrity concerns, and apprehension regarding the recipient selection process, and lastly, (3) ‘riddled with pitfalls’, which includes the notion that opt‐out consent may increase susceptibility of stigma and reproach when registering an opt‐out decision.

Conclusions

This study reinforces existing opt‐in literature surrounding medical mistrust and bodily integrity concerns. A threat to one’s autonomous choice and heightened reactance arising from perceptions of unwarranted government control have emerged as novel barriers.

Statement of contribution

What is already known about this subject?

Although around 90% of individuals in the United Kingdom support organ donation, just 40% are actively registered as donors. As part of measures to improve rates of organ transplantation, Scotland and England are moving to an opt‐out organ donation consent system in 2020.

Existing research has shown that feelings and emotions are important factors that influence donor relevant decisions under the current opt‐in system, but little research has explored potential deterrents under the new plans for opt‐out consent.

Minimizing the number of people opting out of the donor register is key to ensure sustained rates of transplantation.

What does this study add?

This study explored why people plan to opt‐out of the new system in Scotland and England.

Medical mistrust and bodily integrity concerns remain as salient barriers under opt‐out laws.

Fears of unwarranted government control and a perceived threat to one’s freedom of choice emerged as a novel barrier.
Metastatic role of mammalian target of rapamycin signaling activation by chemoradiotherapy in advanced rectal cancer
Authors: Shiratori Hiroshi , Kawai Kazushige , Okada Masamichi , Nozawa Hiroaki , Hata Keisuke , Tanaka Toshiaki , Nishikawa Takeshi , Shuno Yasutaka , Sasaki Kazuhito , Kaneko Manabu , Murono Koji , Emoto Shigenobu , Ishii Hiroaki , Sonoda Hirofumi , Ushiku Tetsuo , Ishihara Soichiro
Published: January 2020

Postoperative distant metastasis dramatically affects rectal cancer patients who have undergone neoadjuvant chemoradiotherapy (NACRT). Here, we clarified the association between NACRT‐mediated mammalian target of rapamycin (mTOR) signaling pathway activation and rectal cancer metastatic potential. We performed immunohistochemistry for phosphorylated mTOR (p‐mTOR) and phosphorylated S6 (p‐S6) on surgical specimen blocks from 98 rectal cancer patients after NACRT (cohort 1) and 80 colorectal cancer patients without NACRT (cohort 2). In addition, we investigated the association between mTOR pathway activity, affected by irradiation, and the migration ability of colorectal cancer cells in vitro. Based on the results of the clinical study, p‐mTOR was significantly overexpressed in cohort 1 (with NACRT) as compared to levels in cohort 2 (without NACRT) (P < .001). High p‐mTOR and p‐S6 levels correlated with the development of distant metastasis only in cohort 1. Specifically, high p‐S6 expression (HR 4.51, P = .002) and high pathological T‐stage (HR 3.73, P = .020) after NACRT were independent predictors of the development of distant metastasis. In vitro, p‐S6 levels and migration ability increased after irradiation in SW480 cells (TP53 mutation‐type) but decreased in LoVo cells (TP53 wild‐type), suggesting that irradiation modulates mTOR signaling and migration through cell type‐dependent mechanisms. We next assessed the expression level of p53 by immunostaining in cohort 1 and demonstrated that p‐S6 was overexpressed in samples with high p53 expression as compared to levels in samples with low p53 expression (P = .008). In conclusion, p‐S6 levels after NACRT correlate with postoperative distant metastasis in rectal cancer patients, suggesting that chemoradiotherapy might modulate the mTOR signaling pathway, promoting metastasis.
Clear‐cell variant of superficial cutaneous leiomyosarcoma associated with RB1 mutation: Clinical, dermoscopic, and histopathological characteristics
Authors: Atzori Laura , Pilloni Luca , Zanniello Ramona , Ferreli Caterina , Rongioletti Franco
Published: January 2020

Leiomyosarcoma is a relatively rare soft tissue tumor whose clear‐cell variant has only been reported in leiomyosarcomas of the uterus. We report here for the first time a primary cutaneous clear‐cell leiomyosarcoma in the trunk skin of a 49‐year‐old man, characterized by a very indolent clinical and dermoscopic presentation, mimicking a dermatofibroma. Genetic analysis of the otherwise healthy patient revealed a germline mutation in the retinoblastoma 1 gene (RB1); the same mutation was found in his son, who had previously developed retinoblastoma. Moreover, the mother of the patient had died of uterine leiomyosarcoma with clear‐cell changes. Mutations in the RB1 gene occur commonly in human neoplasms. In this patient, we were able to link his clear‐cell variant of cutaneous leiomyosarcoma with the loss of retinoblastoma protein expression, as revealed by immunohistochemical staining analysis.
“Thinking and Working Politically”: The case of donor‐supported reform coalitions in the Philippines
Authors: Clarke Gerard
Published: January 2020

Motivation

Reform coalitions represent a potential means for donors to support macro‐political reform in developing countries, enabling them to avoid the limitations of micro‐political or public sector reform where appropriate circumstances exist. Donor support for reform coalitions, however, is difficult to engineer and fraught with political risk, including the risk of partisan taint.

Purpose

This article therefore explores the efforts of Australian Aid and the World Bank to promote reform coalitions and constituencies in the Philippines during the presidency of Benigno S. Aquino III (2010–2016) and to institutionalize the reform agenda of his administration.

Approach and Methods

It draws on a range of sources including programme design documents, mid‐term and end‐of‐term reviews, and contextual policy documents. It also draws on economic and governance data sets to explore relevant correlations.

Findings

It finds that second‐generation reform coalitions brought together stakeholders from government, the private sector and civil society and promoted economic and other reforms. These donor strategies arguably failed, however, with the election of Rodrigo Duterte in May 2016. He was critical of Aquino’s record in office and ostensibly committed to reverse engineering many of the Aquino administration’s achievements. The article critiques a governance‐centric explanatory chain of causation and proposes an expanded politics‐centric chain.

Policy Implications

In conceptual terms, planning of reform coalition activities must better account for dominant coalitions and the political settlements which they underpin, and must set out explicit theories of change, specifying distinct political pathways to change. In operational terms, donors must work to avoid traditional “transactional” relationships in favour of more innovative “transformative” ones and must balance “strategic opportunism” with strategic retreat and adaptation where necessary.
Higher early recurrence risk and potential benefit of dual antiplatelet therapy for minor stroke with watershed infarction: subgroup analysis of CHANCE
Authors: Pu Y. , Liu X. , Wang Y. , Meng X. , Jing J. , Zou X. , Pan Y. , Wang A. , Zhao X. , Johnston S. C. , Wang Y. , Atchaneeyasakul K. , Liebeskind D. S. , Liu L. ,   the CHANCE Investigators
Published: January 2020

Background and purpose

The aim was to explore the risk of early stroke recurrence within 3 months after watershed infarction and to investigate whether early dual antiplatelet therapy is more effective in decreasing such risk.

Methods

Patients enrolled in the Clopidogrel in High‐risk Patients with Acute Non‐disabling Cerebrovascular Events (CHANCE) trial and who had acute infarction on diffusion‐weighted imaging were included in this subgroup analysis. All magnetic resonance images were read centrally by two neurologists who were blinded to the patients’ baseline and outcome information. The primary outcome was any stroke recurrence within 3 months. The hazard ratios were adjusted by known predictors of stroke recurrence.

Results

Of the 1089 patients with magnetic resonance imaging data enrolled in CHANCE, 834 (76.58%) patients had acute infarcts on diffusion‐weighted imaging. The median and range of duration from randomization to stroke recurrence was 1.5 (1–6) days. Patients with watershed infarction had higher risk of stroke recurrence than those without (17.20% vs. 6.34%) within the first week after initial stroke; the hazard ratio (95% confidence interval) was 2.799 (1.536–5.101) adjusted by age, sex, smoking, body mass index, medical history, time to randomization, open‐label aspirin dose at first day, single or dual antiplatelet therapy, National Institutes of Health Stroke Scale score at randomization, in‐hospital treatment and white matter lesions,P < 0.001. There was no interaction between antiplatelet therapy and the presence of watershed infarction (P = 0.544).

Conclusions

Minor stroke with watershed infarction has high recurrent risk in the first week. Dual antiplatelet therapy may be safely implemented, yet watershed infarction mechanisms of hypoperfusion and emboli may not be addressed.
Clinical implications of head‐shaking nystagmus in central and peripheral vestibular disorders: is perverted head‐shaking nystagmus specific for central vestibular pathology?
Authors: Yang T.‐H. , Lee J.‐H. , Oh S.‐Y. , Kang J.‐J. , Kim J.‐S. , Dieterich M.
Published: January 2020

Background and purpose

The patterns of head‐shaking nystagmus (HSN) aid in differentiation between central and peripheral vestibular disorders, and perverted HSN (pHSN) has been considered a central sign. The aim was to determine the characteristics of HSN in a large number of patients with either peripheral or central vestibular disorders in a dizziness clinic of a university hospital.

Methods

The medical records of 7544 dizzy patients were reviewed during a year and 822 patients with a clinical diagnosis of vestibular disorders were recruited. The findings of spontaneous nystagmus (SN) and HSN in these patients were compared with those of healthy controls (n = 48).

Results

A total of 217 of the 822 patients (26.4%) were classified as having a central vestibular disorder, whilst 397 (48.3%) had a peripheral vestibular disorder. In the peripheral vestibular disorder group, SN was observed in 14.1% and HSN in 40.8%, amongst whom 24.1% were the pHSN form. In the central group, SN was observed in 17.5% and HSN in 24.0% of whom 57.7% was pHSN. HSN was more frequently observed in the peripheral vestibular disorder group than in the central group (40.8% vs. 24.0%, P < 0.01). However, the proportion of pHSN was significantly increased in the central group compared to the peripheral vestibular patient group (57.7% vs. 24.1%, P < 0.01).

Conclusions

Since pHSN is not specific for central vestibular disorders, other clinical features should be considered in pursuing a central lesion in patients with pHSN.
Stabilization of the TAK1 adaptor proteins TAB2 and TAB3 is critical for optimal NF‐κB activation
Authors: Braun Harald , Staal Jens
Published: January 2020

TAB2 and TAB3 bind to K63‐linked polyubiquitin chains and recruit the critical kinase MAP3K7 (TAK1). The polyubiquitin‐recruited TAK1/TAB2/TAB3 complex comes in close proximity with the IKK (IKKα/IKKβ/IKKγ) complex, which is recruited to M1‐linked polyubiquitin chains via the IKKγ (NEMO) component. Together, the two complexes activate the NF‐κB family of transcription factors. NF‐κB transcription factors are critical mediators of pro‐inflammatory signals and must be tightly regulated at multiple levels. Recently, it was discovered that one such point of regulation occurs at the level of TAB2 and TAB3 protein stability by the deubiquitinase USP15.

Comment on: https://doi.org/10.1111/febs.15202
Temperature elevation reduces the sensitivity of invasive cladoceran Daphnia lumholtzi to filamentous cyanobacterium Raphidiopsis raciborskii
Authors: Wejnerowski Łukasz , Sikora‐Koperska Anna , Dawidowicz Piotr
Published: January 2020

Exotic cladoceran Daphnia lumholtzi is a highly invasive species in the north and south American continents and can potentially also invade European freshwaters and outcompete native Daphnia populations. However, European waterbodies are frequently dominated by less edible filamentous cyanobacteria including also invaders such as Raphidiopsis raciborskii, which might affect the fitness of D. lumholtzi. Furthermore, temperature may influence the sensitivity of D. lumholtzi to R. raciborskii filaments.

In this study, we determined whether the presence of R. raciborskii could obstruct the invasion of Europe by D. lumholtzi, through reducing its fitness, and whether this depends on temperature. We compared the population growth rate (r) and the somatic growth rate of D. lumholtzi maintained at two temperatures (20 or 26°C) and fed with two diets: green microalgae alone or green microalgae mixed with filaments of R. raciborskii. Three clones of D. lumholtzi were used to evaluate potential variation in response to the treatments among different clones.

At 20°C, the population growth rate of D. lumholtzi fed with cyanobacterial filaments declined sharply. This reduction was caused by increased egg abortion, egg degeneration, and mortality of newborn daphnids. At 26°C, R. raciborskii lost its harmful effect on the population growth of D. lumholtzi. The presence of cyanobacteria did reduce the somatic growth rate of D. lumholtzi at both temperatures and in all three clones except for one that had a similar somatic growth rate on both diets at 26°C.

The presence of filamentous cyanobacteria does affect growth in D. lumholtzi and may thereby substantially reduce its invasive potential, but only at lower temperatures. Therefore, the presence of filamentous cyanobacteria may not present an obstacle to the invasion of Europe by D. lumholtzi in a warmer future climate.
Oral health knowledge, beliefs and practices among community‐dwelling older adults in Shanghai, China: A cross‐sectional analysis
Authors: Ye Sheng , Chen Liqun
Published: January 2020

Objective

To assess oral health knowledge, beliefs and practices among community‐dwelling older adults in Shanghai, China.

Background

China is ageing faster than other developing countries. Four National Oral Health Surveys have been carried out in China between 1983 and 2015, focused on clinical oral examinations.

Materials and methods

A cross‐sectional study was conducted among 983 participants aged 60‐93 years old, drawn from two community health service centres of Pudong New Area in Shanghai. Data were collected using a Chinese language questionnaire of oral health knowledge, beliefs and practices based on the Knowledge, Attitudes (beliefs) and Practices (KAP) model. The scale ranges were knowledge 0‐19, beliefs 0‐17 and practices 0‐55, where a higher score indicated a more accurate perception. Multivariate analysis explored the related factors using IBM SPSS Statistics version 22.0.

Results

Mean (SD) scores of this questionnaire were oral health knowledge 13.0 (3.6), beliefs 13.0 (3.2) and practices 31.2 (11.2). Geographic location, age group, employment status, education and monthly household income showed significant statistical association with these scores (P < .001). Only three sociodemographic variables (education, age group and employment status) remained significant after further multiple regression analysis (P < .001).

Conclusions

The level of oral health knowledge, beliefs and practices among older adults in Shanghai, China, was not high. Younger and working individuals with higher level of education showed good oral health knowledge, beliefs and practices. Community‐based oral health strategies are needed to increase oral health knowledge, in particular of oral daily cleaning, and improve beliefs and practices in regular dental visits.
A qualitative evaluation of participants' experiences of using co‐design to develop a collective leadership educational intervention for health‐care teams
Authors: Pallesen Kirsten Siig , Rogers Lisa , Anjara Sabrina , De Brún Aoife , McAuliffe Eilish
Published: January 2020

Introduction

Co‐design involves stakeholders as design partners to ensure a better fit to user needs. Many benefits of involving stakeholders in design processes have been proposed; however, few studies have evaluated participants’ experience of co‐design in the development of educational interventions. As part of a larger study, health‐care professionals, researchers and patients co‐designed a collective leadership intervention for health‐care teams. This study evaluated their experiences of the co‐design process.

Methods

Semi‐structured interviews were conducted with individuals (n = 10) who took part in the co‐design workshops. Interviews were audio‐recorded, transcribed verbatim and analysed thematically.

Results

Four key themes were identified from the data: (a) Managing expectations in an open‐ended process; (b) Establishing a positive team climate; (c) Focusing on frustrations—challenging but informative; and (d) Achieving a genuine co‐design partnership.

Conclusions

The development of a positive team climate is essential to the co‐design process. Organizers should focus on building strong working relationships from the beginning to enable open discussion. Organizers of co‐design should be conscious of establishing and maintaining a genuine partnership where participants are involved as equal partners and co‐creators. This can be done through the continuous use of feedback to allow participants to influence the workshop directions, and through limiting researcher domination. Lastly, co‐design can be daunting, but organizers can positively impact participants’ experience by acknowledging the emergent nature of the process in order to reduce participant apprehension, thereby limiting the barriers to participation.
Language attitudes and the ‘ITA problem’: Undergraduate reactions to instructors' (non)nativeness and pitch variation
Authors: Lindemann Stephanie , Clower Amy
Published: January 2020

This language attitudes study investigates the roles of international teaching assistants' (ITAs') pitch variation and native language in listener reactions. Ninety‐five undergraduates rated native speakers of English and Korean, who had recorded a teaching‐related text once with monotone intonation and once with more varied intonation, on traits used in language attitude (status, solidarity) and ITA (teaching competence, comprehensibility) research. Teacher competence ratings were closely linked to attitudinal ratings. Greater pitch variation was rated more positively on both, while native language played little role. Positive ratings of Korean speakers may be attributed to listeners' difficulty in identifying their (nativelike) accents. Native language was nevertheless central to comprehensibility ratings. Implications include the need to recognize listener as well as speaker roles in (I)TA training and research.
‘Social Citizenship’ at the Street Level? EU Member State Administrations Setting a Firewall
Authors: Heindlmaier Anita
Published: January 2020

European integration, and especially the European Court of Justice, has challenged the national character of social rights; the latter have become increasingly transnational. This contribution examines the impact of the Court at the street level. It analyses how Member State administrations handle the social rights of mobile EU citizens in practice in case they are granted discretion. Therefore, a framework of shades of compliance is developed that captures Member State responses to EU law beyond the dichotomy of compliance and non‐compliance. I argue that Member State administrations tend to make the access to social benefits difficult. Still, there may be differences in the shade of compliance on the ground. Surprisingly, these differences cannot be explained by the party‐political environment but depend to a high degree on exposedness. The claim is empirically supported by a comparative study of Austrian welfare (and migration) administrations' practices.
Social capital and periodontal disease in Hispanic/Latino adults in the United States: Results from the Hispanic Community Health Study/Study of Latinos
Authors: Laniado Nadia , Badner Victor M. , Sanders Anne E. , Singer Richard H. , Finlayson Tracy L. , Hua Simin , Kaste Linda M. , Isasi Carmen R.
Published: January 2020

Aims

To examine the association of social capital with periodontal disease severity.

Materials and Methods

We analysed data obtained from 3,994 men and women aged 18–74 years in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study (HCHS/SOL SCAS). From 2008 to 2011, dentists assessed periodontitis status with a full‐mouth periodontal examination. Periodontitis was classified using standardized case definitions. Multivariable logistic regression estimated odds of moderate–severe periodontitis associated with two measures of social capital: structural support (Social Network Index) and functional support (Interpersonal Support Evaluation List).

Results

For US‐born participants, for each additional person in their social network, the adjusted odds of moderate–severe periodontitis was reduced 17% (OR = 0.83, 95% CI = 0.71, 0.96). However, no association was found between functional support and periodontal disease severity.

Conclusions

Greater structural social support was associated with a lower prevalence of moderate–severe periodontitis in US‐born Hispanics/Latinos. These findings suggest that US‐born Hispanics/Latinos with less social support represent a vulnerable segment of the population at high‐risk group for periodontal disease.
Frequency, risk factors and prognosis of systemic haematologic malignancies, cutaneous and other neoplasms in lymphomatoid papulosis: where are we now?
Authors: Rongioletti F.
Published: January 2020

Linked article: R.C. Melchers et al. J Eur Acad Dermatol Venereol 2020; 34: 260–266. https://doi.org/10.1111/jdv.16065.
Phenotypic switch to eczema in patients receiving biologics for plaque psoriasis: a systematic review
Authors: Al‐Janabi A. , Foulkes A.C. , Mason K. , Smith C.H. , Griffiths C.E.M. , Warren R.B.
Published: January 2020

The use of biologic therapies for the treatment of chronic plaque psoriasis has been linked to the development of atopic eczema, amongst other cutaneous adverse events. This can cause diagnostic confusion and create difficulty in the management of patients with plaque psoriasis. The main objective of this systematic review was to review all cases of eczema, including atopic eczema, reported in patients treated with biologics for chronic plaque psoriasis. PubMed, Medline and Embase databases were used to identify studies reporting eczema in patients treated with biologic therapy for chronic plaque psoriasis. A total of 92 patients were identified from 24 studies, with patients treated with either: adalimumab; etanercept; infliximab; ixekizumab; secukinumab; or ustekinumab. Factors common to some reported cases include: a prior history of atopy; eosinophilia; raised serum immunoglobulin E. Twenty‐three had documented treatment outcomes; 14 had biologic therapy discontinued or switched. Management strategies included topical or oral corticosteroids, and treatment with alternative systemic agents such as ciclosporin or apremilast. This adverse event occurred in 1.0–12.1% of patients within trial data and observational studies. This review demonstrates that there are consistent reports of a switch to an atopic eczema phenotype from psoriasis in patients taking biologics inhibiting tumour necrosis factor alpha and the interleukin (IL)‐17/IL‐23 axis. The majority stopped the implicated biologic, but conservative management was successful in some cases. Those with an atopic diathesis may be more at risk. Elucidation of mechanisms and risk factors would contribute to optimal therapy selection for individual patients.
Energy use in the global food system
Authors: Usubiaga‐Liaño Arkaitz , Behrens Paul , Daioglou Vassilis
Published: January 2020

The global food system is a major energy user and a relevant contributor to climate change. To date, the literature on the energy profile of food systems addresses individual countries and/or food products, and therefore a comparable assessment across regions is still missing. This paper uses a global multi‐regional environmentally extended input–output database in combination with newly constructed net energy‐use accounts to provide a production and consumption‐based stock‐take of energy use in the food system across different world regions for the period 2000–2015. Overall, the ratio between energy use in the food system and the economy is slowly decreasing. Likewise, the absolute values point toward a relative decoupling between energy use and food production, as well as to relevant differences in energy types, users, and consumption patterns across world regions. The use of (inefficient) traditional biomass for cooking substantially reduces the expected gap between per capita figures in high‐ and low‐income countries. The variety of energy profiles and the higher exposure to energy security issues compared to the total economy in some regions suggests that interventions in the system should consider the geographical context. Reducing energy use and decarbonizing the supply chains of food products will require a combination of technological measures and behavioral changes in consumption patterns. Interventions should consider the effects beyond the direct effects on energy use, because changing production and consumption patterns in the food system can lead to positive spillovers in the social and environmental dimensions outlined in the Sustainable Development Goals.
Banks' Funding Stress, Lending Supply, and Consumption Expenditure
Authors: DAMAR H. EVREN , GROPP REINT , MORDEL ADI
Published: January 2020

We employ a unique identification strategy linking survey data on household consumption expenditure to bank‐level data to estimate the effects of bank funding stress on consumer credit and consumption expenditures. We show that households whose banks were more exposed to funding shocks report lower levels of nonmortgage liabilities. This, however, only translates into lower levels of consumption for low‐income households. Hence, adverse credit supply shocks are associated with significant heterogeneous effects.
An Evaluation of Working on What Works (WOWW): A Solution‐Focused Intervention for Schools
Authors: Wallace Laura B. , Hai Audrey Hang , Franklin Cynthia
Published: January 2020

Working on What Works (WOWW) is a manualized, 10‐week classroom intervention based on solution‐focused brief therapy. This study evaluates WOWW using a randomized experimental, posttest‐only design. The study included 30 fourth and fifth grade classrooms, containing 30 teachers and 413 students. Results indicate no significant differences between WOWW and control groups for student internalizing and externalizing behaviors, student–teacher relationships, student academic performance, or teacher sense of efficacy. However, students in the WOWW group had significantly fewer days absent from school compared with the control group. Additionally, teachers' ratings on WOWW classrooms' performance improved significantly more than teachers' ratings on the control classrooms. Results from this study show that WOWW is a feasible intervention for therapists to use in schools and can be implemented across classrooms in both public and private schools. WOWW has potential to improve student attendance and classroom performance, both of which are important areas of concern for schools.
Associations Between Domain Differentiated Sibling Conflict and Adolescent Problem Behavior
Authors: Odudu Christopher , Williams Maya , Campione‐Barr Nicole
Published: January 2020

Objective

The present study examines sibling conflict across two domains and their associations with externalizing behaviors (discussed as problem behavior in this article) 1 year later.

Background

The close‐natured relationship of siblings often leads to sibling conflict. Previous research has found that sibling conflict can be categorized into the following two content domains: invasion of personal (IP) and equality and fairness (EF). These domains of conflict are differential predictors of adolescent adjustment problems, particularly internalizing problems; however, less is known about the link between specific domains of conflict and problem behavior.

Method

Using Actor Partner Interdependence Modeling, purposive sampling was conducted to recruit a sample of 145 sibling dyads (N = 290) adolescents in 8th, 10th, or 12th grades with a sibling no more than 4 years younger. Adolescents were administered questionnaires assessing the frequency and intensity of sibling conflict and individual problem behavior.

Results

The results suggest that more intense IP and EF sibling conflicts were more strongly associated with later adjustment problems than frequent IP and EF sibling conflicts. Furthermore, mixed‐sex sibling dyads and younger siblings were at greater risk for later problem behavior when engaged in intense IP and EF sibling conflicts.

Conclusion

The findings of the present study underscore the importance of considering the content of sibling conflict and the contextual factors of siblings as they have differential impacts on adolescent problem behavior.
Nutrition Policies, Practices, and Environments in Low‐Income Georgia Elementary Schools, United States, 2015‐2017
Authors: Guglielmo Dana , Chantaprasopsuk Sicha , Kay Christi M. , Hyde Eric T. , Stewart Chris , Gazmararian Julie A.
Published: January 2020

BACKGROUND

A nutritious diet can prevent obesity and chronic disease and improve academic performance, yet many children have energy‐dense, nutrient‐poor diets. The objective of this study was to assess nutrition policies, practices, and environments in Georgia Supplemental Nutrition Assistance Program Education (SNAP‐Ed) elementary schools and compare them across school‐level demographic characteristics.

METHODS

We distributed a cross‐sectional online survey to administrators, grade level chairs, and nutrition managers from 113 Georgia SNAP‐Ed elementary schools during 2015–2017. Logistic regression, one‐way ANOVA, and Tukey's tests were performed to assess differences by free and reduced‐price lunch eligibility and percentage black. Fisher's exact and Rao‐Scott chi‐square tests were performed to assess differences by school size and geography.

RESULTS

The majority of schools established wellness policies and committees, provided nutrition education, and offered fresh fruits and/or vegetables daily. Fewer schools had policies limiting sugar‐sweetened foods within classrooms or had established a school garden. There were minimal significant differences in survey responses across school‐level demographics.

CONCLUSIONS

Georgia SNAP‐Ed elementary schools are providing healthy nutrition settings for their students in a number of areas, and can further improve by establishing more comprehensive wellness policies, a committee to enforce them, and engaging children in hands‐on nutrition education activities.
Acute and outpatient service utilisation prior to, during, and following enrolment in community‐based mental health treatment among children and youth in Central Ontario: A proof of concept for cross‐sectoral data linkage
Authors: Gatov Evgenia , Muir Lindsay , Mowat Vicki , Elkader Alex , Yang Julie , Kopp Alexander , Cairney John
Published: January 2020

Aim

Given the fragmentation of mental health and addictions (MHA) services for children and youth, comprehensive data on utilisation patterns are lacking. We sought to describe MHA‐related service use across the community, acute and outpatient sectors.

Methods

We used linked health‐administrative data sets to identify a cohort of individuals aged <18 who received MHA treatment in a large community organisation in Ontario, Canada between 1 April 2007 and 31 March 2012. We described their socio‐demographic characteristics, examined their MHA‐related concurrent service use in acute care and outpatient physician settings (primary care providers, paediatricians and psychiatrists), and compared service utilisation prior to, during and following enrolment using Poisson regressions.

Results

Among 7285 children and youth receiving community MHA treatment, there were 481 concurrent MHA‐related emergency department visits, 173 hospitalisations and 12140 outpatient physician visits. The average age at enrolment was 10.5 years, and 64% of clients were enrolled for ≥3 months. MHA‐related emergency department use significantly declined from 1 year prior, compared to 1 year following receipt of community MHA treatment (112 vs. 82 visits per 1000 person‐years, P < 0.001), particularly in females, ages 10–14, those living in higher‐income neighbourhoods and urban areas, and those with anxiety disorders. MHA hospitalisations also declined (45 vs. 32, P < 0.001), while outpatient physician visits increased (1750 vs. 1874, P < 0.001).

Conclusions

Our study suggests that community‐based MHA treatment may be effective in diverting children and youth away from acute care and highlights the importance of data linkage as a means to better understand the complexity of cross‐sectoral MHA service use.
How are depression and suicidal ideation associated with multiple health risk behaviours among adolescents? A secondary data analysis using the 2016 Korea Youth Risk Behavior Web‐based Survey
Authors: Kim Eun‐Mi , Kim Heejung , Park Eunhee
Published: January 2020

Accessible summary

What is known on the subject?

Adolescents who partake in one health risk behaviour (HRB) easily adopt other HRBs, simultaneously or subsequently.

Multiple HRBs might threaten adolescents’ future health in adulthood.

Adolescents with psychological problems have higher rates of smoking, alcohol use, early sexual initiation and activity, and illicit substance use compared with others.

What does this paper add to existing knowledge?

A considerable number of Korean adolescents with mental health problems were engaged in multiple HRBs. For those with mental health problems, more than half of the Korean adolescents with multiple HRBs tended to use alcohol and cigarettes concurrently.

Korean adolescents who felt depressed and had suicidal ideation were more likely to engage in a greater number of HRBs.

Substance abuse is the most prevalent problem that is combined with other HRBs among those with depression and suicidal ideation compared to those who exhibited other HRBs.

What are the implications for practice?

When mental health nurses working in schools and community centres for mental health identify Korean adolescents with significant depression and suicide ideation levels, they should also assess adolescents’ engagement in multiple HRBs.

Population‐based campaigns and policy changes that emphasize both psychological health and risky behaviour reduction among adolescents should be provided simultaneously to students and school nurses.

Introduction

There is limited understanding about whether poor mental health is associated with certain combinations of multiple health risk behaviours (HRBs) such as smoking, drinking, early sexual activity and substance abuse.

Aim

To determine the prevalence of multiple HRBs and to identify associations between poor mental health and multiple HRBs as the number of HRBs increases.

Methods

This cross‐sectional study was conducted using the 2016 Korea Youth Risk Behavior Web‐based Survey (N = 65,528). Descriptive statistics and multinomial logistic regression analyses were conducted using the complex sample data.

Results

Overall, 28.6% and 13.9% of Korean adolescents were involved in one or multiple HRBs, respectively. Adolescents who were depressed (OR = 1.43–4.47, 95% CI = 1.37–1.49 to 3.23–6.20) and/or who had suicidal ideation (OR = 1.33–3.19, 95% CI = 1.25–1.42 to 2.25–4.51) were more likely to engage in multiple HRBs.

Discussion

A considerable numbers of Korean adolescents are engaged in multiple HRBs. When adolescents self‐reported depression and suicidal ideation, they were more likely to engage in a greater number of HRBs than single HRB.

Implications for practice

Tailored interventions to decrease multiple HRBs should be designed and provided by considering adolescents’ mental health status and needs.
A same day ‘test and treat’ model for chronic HCV and HBV infection: Results from two community‐based pilot studies in Egypt
Authors: Shiha Gamal , Soliman Reham , Serwah Abdalhamed , Mikhail Nabiel N. H. , Asselah Tarik , Easterbrook Philippa
Published: January 2020

Prompt access to confirmatory viral load testing and staging of liver disease are key barriers in uptake of treatment for chronic hepatitis B and C infection. Our objective was to establish the feasibility of a same day ‘test and treat’ model in two distinct community‐based settings in Egypt through use of key point‐of‐care (POC) portable tools for HCV and HBV viral load assessment and staging of liver disease followed by treatment initiation. Community sites were a village in northern Egypt (site 1) and a government office in Cairo (site 2). The following model was adopted: community awareness raising in the week before project initiation; site assessment to ensure optimal placement and calibration of equipment and clinical care set‐up; transfer of key portable laboratory instruments to the sites (four cartridge GeneXpert, FibroScan and abdominal ultrasound); screening using rapid diagnostic tests for HCV‐Ab and HBsAg, with immediate venous or finger‐stick blood sampling for HCV‐RNA and HBV‐DNA assay, FibroScan staging of liver disease and ultrasound screening for liver cancer. At site 1, 475 individuals were screened over a single day, 125 were positive for HCV‐Ab and 4 for HBsAg, 43 of 56 new HCV diagnoses were HCV RNA positive, and 3 of 4 HBsAg positive were HBV DNA positive, 40 initiated HCV treatment, and one HBV treatment . At site 2, 3188 individuals were screened over 3 days, 157 were positive for HCV‐Ab, and 27 for HBsAg; 38 of 76 new HCV diagnoses were HCV RNA positive, and 15 of 18 HBsAg positive were HBV‐DNA positive. Across both sites, 78 patients were counselled and initiated on treatment for HCV and 12 for HBV within 3 and 4 hours, respectively, of initial positive rapid diagnostic test result. We have shown the feasibility of a same day ‘test and treat’ model for chronic HCV and HBV infection in two community‐based settings in Egypt that achieved high levels of linkage to care and initial treatment.
Acute kidney injury due toLeptospira interrogansin 4 foals and use of renal replacement therapy with intermittent hemodiafiltration in 1 foal
Authors: Fouché Nathalie , Graubner Claudia , Lanz Simone , Schweighauser Ariane , Francey Thierry , Gerber Vinzenz
Published: January 2020

Four 2‐month‐old foals were presented to an equine hospital with acute kidney injury caused byLeptospira interrogansinfection. Clinical signs were nonspecific and included lethargy, fever, and unwillingness to nurse. The most important hematologic and clinicopathologic findings were azotemia, anemia, thrombocytopenia, hyponatremia, and hypochloremia. The diagnosis was based on urinary real‐time PCR, serology using a microscopic agglutination test, or both. The most important serovars involved wereL. interrogansserogroup australis serovar BratislavaandAustralis. Treatment consisted of IV fluid therapy and antimicrobial treatment. Renal replacement therapy with hemodiafiltration was performed in 1 of the foals. All foals survived to discharge. This report highlights the importance of early diagnosis and treatment in foals with acute kidney injury caused byL. interrogansinfection.
Between trust and control: Teachers' assessment conceptualisations within programmatic assessment
Authors: Schut Suzanne , Heeneman Sylvia , Bierer Beth , Driessen Erik , van Tartwijk Jan , van der Vleuten Cees
Published: January 2020

Objectives

Programmatic assessment attempts to facilitate learning through individual assessments designed to be of low‐stakes and used only for high‐stake decisions when aggregated. In practice, low‐stake assessments have yet to reach their potential as catalysts for learning. We explored how teachers conceptualise assessments within programmatic assessment and how they engage with learners in assessment relationships.

Methods

We used a constructivist grounded theory approach to explore teachers' assessment conceptualisations and assessment relationships in the context of programmatic assessment. We conducted 23 semi‐structured interviews at two different graduate‐entry medical training programmes following a purposeful sampling approach. Data collection and analysis were conducted iteratively until we reached theoretical sufficiency. We identified themes using a process of constant comparison.

Results

Results showed that teachers conceptualise low‐stake assessments in three different ways: to stimulate and facilitate learning; to prepare learners for the next step, and to use as feedback to gauge the teacher's own effectiveness. Teachers intended to engage in and preserve safe, yet professional and productive working relationships with learners to enable assessment for learning when securing high‐quality performance and achievement of standards. When teachers' assessment conceptualisations were more focused on accounting conceptions, this risked creating tension in the teacher‐learner assessment relationship. Teachers struggled between taking control and allowing learners' independence.

Conclusions

Teachers believe programmatic assessment can have a positive impact on both teaching and student learning. However, teachers' conceptualisations of low‐stake assessments are not focused solely on learning and also involve stakes for teachers. Sampling across different assessments and the introduction of progress committees were identified as important design features to support teachers and preserve the benefits of prolonged engagement in assessment relationships. These insights contribute to the design of effective implementations of programmatic assessment within the medical education context.
Deciphering the role of the capsule of Klebsiella pneumoniae during pathogenesis: A cautionary tale
Authors: Rendueles Olaya
Published: January 2020

Extracellular capsule polysaccharides increase the cellular fitness under abiotic stresses and during competition with other bacteria. They are best‐known for their role in virulence, particularly in human hosts. Specifically, capsules facilitate tissue invasion by enhancing bacterial evasion from phagocytosis and protect cells from biocidal molecules. Klebsiella pneumoniae is a worrisome nosocomial pathogen with few known virulence factors, but the most important one is its capsule. In this issue, Tan et al. assess the fitness advantage of the capsule by competing a wild‐type strain against four different mutants where capsule production is interrupted at different stages of the biosynthetic pathway. Strikingly, not all mutants provide a fitness advantage. They suggest that some mutants have secondary defects altering virulence‐associated phenotypes and blurring the role of the capsule in pathogenesis. This study indicates that the K1 capsule in K. pneumoniae is not required for gut colonization but that it is critical for bloodstream dissemination to other organs. These results contribute to clarify the contradictory literature on the role of the Klebsiella capsule during infection. Finally, the varying fitness effects of different capsule mutations observed for K. pneumoniae K1 might apply also to other capsulated diderm bacteria that are facultative or emerging pathogens.