bluuebunny/crossref_metadata_2025 huggingface dataset:
Fragmented QRS as a predictor of subclinical cardiovascular disease in patients with chronic kidney disease
Authors: Toraman Aysun , Eren Berna , Yılmaz Ilknur , Duzgun Fatih , Taneli Fatma , Kursat Seyhun
Published: January 2020

Background

Fragmented QRS (fQRS) on surface electrocardiogram is correlated with increased cardiovascular risk and mortality in normal population.

Aims

To investigate the presence of fQRS and its association with subclinical atherosclerosis and vascular calcification in chronic kidney disease (CKD) patients without cardiovascular disease.

Methods

A total of 129 CKD (63 males and 66 females) patients was enrolled for the study. Carotid intima‐media thickness (CIMT) measurement and coronary artery calcification score (CACS) were performed by the same radiologist. A 12‐lead electrocardiogram recording was used to detect fQRS.

Results

The mean age was 55.1 ± 15.1 years. fQRS was detected in 45% of patients. There was not any significant difference between patients with or without fQRS in terms of demographic parameters and comorbid diseases except for diabetes and hyperlipidaemia. The mean CIMT of CKD patients was 0.66 ± 0.18 mm and it was significantly higher in fQRS(+) group compared to the fQRS(−) group. Similarly CACS values were higher in fQRS(+) group. In the logistic regression analysis, fQRS remained significantly associated with CIMT (β = 0.220, t = 2.567, P = 0.011) (independent variables: CIMT, CACS, sodium and glomerular filtration rate (modification of diet in renal disease–glomerular filtration rate)).

Conclusions

This is the first study in the literature showing the relation of fQRS with CIMT and CACS in patients with CKD without known cardiovascular disease.
Tolerability and efficacy of sacubitril/valsartan in clinical practice
Authors: Nandal Savvy , Chow Chee Loong , Hannah Vikki , Vaddadi Gautam , Van Gaal William
Published: January 2020

Background

Heart failure (HF) is a major cause of morbidity and mortality. Sacubitril/valsartan has demonstrated reductions in HF hospitalisation, and all‐cause mortality in patients with heart failure with reduced ejection fraction.

Aims

To assess the tolerability and efficacy of sacubitril/valsartan in an intention to treat patient cohort.

Methods

Sixty‐five patients who were commenced on sacubitril/valsartan in 2017 at a major metropolitan centre in Victoria were retrospectively audited. Clinical outcomes and quality of life scores were obtained pre and post sacubitril/valsartan commencement through phone and regular clinic follow up, 6–12 months after commencement of sacubitril/valsartan.

Results

Fourteen percent of patients were able to achieve maximal dose (97/103 mg twice daily) whilst 37% remained on 49/51 mg and 23% on 24/26 mg. The mean systolic blood pressure reduced from 118 ± 18 mmHg to 109 ± 15 mmHg with symptomatic hypotension (30%) being the most common side‐effect leading to dose reduction or drug cessation. Left ventricular ejection fraction improved from 29.1 ± 9.7% to 33.8 ± 9.9% (P < 0.05) on drug. There was also a significant improvement in quality of life scores; EQ5D‐VAS 40 pre versus 67 post sacubitril/valsartan (P < 0.05), and New York Heart Association class (P < 0.05). Importantly, 10 patients lost an existing indication for device based therapy after treatment with sacubitril/valsartan.

Conclusions

Sacubitril/valsartan is a much needed therapeutic advancement in the treatment of HF. Our study indicates it is well tolerated with improvements in cardiac function and symptoms. Sacubitril/valsartan could redefine the definition of ‘optimal medical therapy’ when assessing patients for device based therapies.
Do historic log buildings provide evidence of reforestation following depopulation of Indigenous Peoples?
Authors: de Graauw Kristen K. , Hessl Amy E.
Published: January 2020

Aim

To test the previously published hypothesis that there was widespread reforestation following the depopulation of Indigenous Peoples in the 16th and 17th centuries.

Location

The central Appalachian Mountains of eastern North America.

Taxon

Quercus alba, Liriondendron tulipifera

Methods

To test for reforestation following depopulation, we used tree‐ring evidence of tree recruitment, early radial growth and growth releases from 18 historic log buildings (n = 361 logs) and eight old‐growth forest sites (n = 197 trees). We used inner‐ring dates to determine if a synchronous recruitment event(s) was present at historic sites but absent from old‐growth sites following depopulation. We used cluster analysis to determine if historic logs established in a clearing (fast early growth) or under a canopy (slow early growth). Similarly, we calculated disturbance rates (growth releases per 100 years) to determine if historic logs grew in a clearing (low disturbance) or under a canopy (high disturbance).

Results

Historic log and old‐growth forest sites both document a period of elevated recruitment beginning in the 1670s. This event was observed in previous studies and across site types, suggesting that either climate variability or the absence of low‐intensity land use (e.g. fire) may have also contributed to forest establishment. Most historic sites (61%–83%) had fast early growth, indicating growth of trees in high‐light conditions. The rate of disturbance was lower at historic sites with fast early growth (5.3 events/century, 95% Cl [3.6, 7.0]) than at old‐growth sites with slow early growth (23.5 events/century, 95% Cl [17.5, 29.5]), consistent with the idea that most historic logs were harvested from fast‐growing, second‐growth forests that established after depopulation.

Main Conclusions

Our results support the hypothesis of reforestation in upland forests of the central Appalachian Mountains following depopulation and suggest that upland forests, at the time of European immigration, were at least in part, a legacy of indigenous land use practices. However, the timing of a regional drought event, depopulation and subsequent recruitment of trees, all within the period of ~1650–1690 CE, warrants further research into interactions between indigenous land use and climate during a pivotal period in North American history.
Relationship between sugar content in sweet potato and vibration acoustic signal eigenvalues
Authors: Liu Yang , Zhang Tong , Zheng Ming‐Zhu , Liu Hui‐Min , Zhang Yang
Published: January 2020

In this research, a nondestructive testing method based on knock‐generated vibration acoustic signals was explored for measuring the content of total sugar in sweet potato for the first time. Vibration acoustic signals were acquired using a self‐made signal collection platform and processed on the basis of time‐frequency theory and Hilbert transform. Results indicated that total sugar content showed significantly positive correlations with waveform index, sound intensity and frequency energy of 600–800 KHz (p < .01), but negative correlations with frequency energy of 0–1 KHz, 3–4 KHz, 5–6 KHz, 9–10 KHz, and 0–200 Hz (p < .01). The eigenvalues could be reduced to three principle components by principle component analysis. Hence, vibration acoustical signals could be recognized as an ideal nondestructive method for predicting total sugar concentration in sweet potato.

Practical applications

Although the chemical methods are commonly used for quantitative analysis of food components, they suffer from some disadvantages, such as time‐consuming procedures and destructiveness of tested samples. In recent 30 years, acoustic technology has been widely applied in food quality classification and detection, especially vibration acoustical signals are considered as alternative technology for measuring the texture and quality of food. The acoustical signals of knocking vibration belong to mutation signals, which are frequently excavated and analyzed by Hilbert‐Huang transform. Thus, in this work, a relationship between total sugar of sweet potato and acoustic eigenvalues mainly analyzed by Hilbert‐Huang transform was established for the first time. It is hoped that present study will provide evidence for the applications of acoustic signals on foods detection without sample destructiveness.
Edible films containing carvacrol and cinnamaldehyde inactivate Escherichia coli O157:H7 on organic leafy greens in sealed plastic bags
Authors: Zhu Libin , Olsen Carl , McHugh Tara , Friedman Mendel , Levin Carol E. , Jaroni Divya , Ravishankar Sadhana
Published: January 2020

The antimicrobial effects of apple‐, carrot‐, and hibiscus‐based edible films containing carvacrol and cinnamaldehyde against Escherichia coli O157:H7 on organic leafy greens in sealed plastic bags were investigated. Fresh‐cut Romaine and Iceberg lettuce, and mature and baby spinach leaves were inoculated with E. coli O157:H7 and placed into Ziploc® bags. Edible films were then added to the bags, which were stored at 4°C. The evaluation of samples taken at days 0, 3, and 7 showed that on all leafy greens, 3% carvacrol‐containing films had the greatest effect against E. coli O157:H7, reducing the bacterial population by about 5 log CFU/g on day 0. All three types of 3% carvacrol‐containing films reduced E. coli O157:H7 by about 5 log CFU/g at day 0. The 1.5% carvacrol‐containing films reduced E. coli O157:H7 by 1–4 logs CFU/g at day 7. Films with 3% cinnamaldehyde showed reduction of 0.6–3 logs CFU/g on different leafy greens.
Simian immunodeficiency virus infection and flow cytometric characterization of Japanese macaque (Macaca fuscata) hematopoietic cells
Authors: Tsukamoto Tetsuo , Nakamura Katsuki , Okada Seiji
Published: January 2020

We characterized Japanese macaque (Macaca fuscata) hematopoietic cells using flow cytometry and identified 28 cross‐reactive anti‐human antibody clones. Furthermore, productive infection of peripheral T lymphocytes with simian immunodeficiency virus (SIV) in vitro was confirmed by intracellular SIV p27 staining. This study could facilitate using Japanese macaques as models for human hematological and immunological disorders and infectious diseases.
Double bereavement, mental health consequences and support needs of children and young adults—When a divorced parent dies
Authors: Marcussen Jette , Thuen Frode , O'Connor Maja , Wilson Rhonda L. , Hounsgaard Lise
Published: January 2020

Aims and objectives

To explore how children and young adults from divorced families experience double bereavement when they lose a divorced parent with cancer and how the double bereavement influences their mental health consequences and need of support.

Background

Children and young people who are confronted with the cancer and death of a parent is a highly stressful life event, which is associated with an increased risk of mental health problems, especially when children experience divorced parental cancer and death.

Design

Participant observations and interviews with a phenomenological‐hermeneutic approach and COREQ standards for reporting qualitative research.

Methods

We conducted 340 hr of participant observations within nine different support groups totalling 27 children and young adults from divorced families and included 28 interviews with participants and relatives. Analyses are based on Ricoeur's theory of interpretation: naïve reading, structural analysis, interpretation and discussion.

Results

The experiences with double bereavement identified three main themes: 1. navigating through multiple transitions and disruptions within two family worlds; 2. consequences for mental health including stress overload and disruptions to well‐being; and 3. need for accessible support derived from close relationships and professionals within and in‐between family worlds.

Conclusion

Children and young adult's double bereavement includes multiple transitions and disruptions often related to stress overload and mental health problems. Support from close relationships and professionals is experienced as helpful in the prevention and mitigation of mental health problems.

Relevance to clinical practice

There is a need for targeted accessible support availability to children, young adults and their families when a divorced parent is dying of cancer in clinical practice. Our findings suggest that specific health policies for health professionals should be developed to target improved support for these families.
Effects of Temperature on The UV‐B Sensitivity of Toxic Cyanobacteria Microcystis aeruginosa CS558 and Anabaena circinalis CS537
Authors: Islam Md Ashraful , Beardall John
Published: January 2020

Rising global temperatures have been suggested to favor cyanobacteria over eukaryotic algae, but UV‐B fluxes are also predicted to remain high and may interact with temperature to affect algal growth. To understand the interactive effects of temperature and UV‐B radiation, cultures of Microcystis aeruginosa and Anabaena circinalis were grown at either 25 or 30°C and then exposed to an acute irradiance of UV‐B (1.4 W m−2). Both species showed differences in growth rates at both temperature regimes. The growth rates of M. aeruginosa (0.41 ± 0.02 day−1) and A. circinalis (0.38 ± 0.01 day−1) were higher at 25 and 30°C, respectively. Rates of damage (k) and repair (r) were calculated from the kinetics of change in effective quantum yield, Fv'/Fm'. Analysis of the estimates of r and k shows that M. aeruginosa exhibited relatively high values for both parameters, compared to A. circinalis, at both growth temperatures. In both species, repair rates were higher at 30°C than at 25°C but in A. circinalis damage was also greater at the higher temperature. In contrast, M. aeruginosa showed a lower damage rate at the higher temperature. For both species, the ratio of r:k was higher at the higher temperature. However, the percent inhibition of effective quantum yield by UV‐B was greater in A. circinalis than in M. aeruginosa as the r:k was lower A. circinalis. Therefore, it could be concluded that temperature may influence growth and bloom formation of cyanobacteria and that different species may respond differently to UV‐B and temperature interactions.
SUPPRESSOR OF MAX2 1‐LIKE 5 promotes secondary phloem formation during radial stem growth
Authors: Wallner Eva‐Sophie , Tonn Nina , Shi Dongbo , Jouannet Virginie , Greb Thomas
Published: January 2020

As a pre‐requisite for constant growth, plants produce vascular tissues at different sites within their post‐embryonic body. Interestingly, the formation of vascular tissues during longitudinal and radial expansion of shoot and root axes differs fundamentally with respect to its anatomical configuration. This raises the question to which level regulatory mechanisms of vascular tissue formation are shared throughout plant development. Here, we show that, similar to primary phloem formation during longitudinal growth, the cambium‐based formation of secondary phloem depends on the function of SUPPRESSOR OF MAX2 1‐LIKE (SMXL) genes. In particular, local SMXL5 deficiency results in the absence of secondary phloem. Moreover, the additional disruption of SMXL4 activity increases tissue production in the cambium region without secondary phloem being formed. Using promoter‐reporter lines, we observed that SMXL4 and SMXL5 activities are associated with different stages of secondary phloem formation in the Arabidopsis stem. Based on genome‐wide transcriptional profiling and expression analyses of phloem‐related markers, we concluded that early steps of phloem formation are impaired in smxl4;smxl5 double mutants and that the additional cambium‐derived cells fail to establish phloem‐related features. Our results showed that molecular mechanisms determining primary and secondary phloem formation share important properties, but differ slightly with SMXL5 playing a more dominant role in the formation of secondary phloem.
Effects of 0.02% netarsudil ophthalmic solution on intraocular pressure of normotensive dogs
Authors: Yang Vanessa Y. , Miller Paul E. , Keys Deborah A. , La Croix Noelle C.
Published: January 2020

Objectives

To evaluate the effect of QD or BID 0.02% netarsudil ophthalmic solution (Aerie Pharmaceuticals) on intraocular pressure (IOP) in normotensive dogs and to describe any adverse effects.

Animals studied

Normotensive Labrador retriever dogs were included in this study: 10 received netarsudil in one eye and artificial tears in the contralateral eye QD, and 10 received netarsudil in one eye and artificial tears in the contralateral eye BID.

Procedures

Intraocular pressure curves were acquired over a 3‐day acclimation period, 5‐day dosing period (QD or BID—10 dogs/group), and 3‐day recovery period. Toxicity was assessed daily using slit‐lamp biomicroscopy and the semiquantitative preclinical ocular toxicology scoring system.

Results

Once‐daily dosing did not lower IOP over the entire 5‐day dosing period (95% CI 0.1 to −0.9 mm Hg,P = .20) or on the last day of dosing (95% CI 0.4 to −0.9 mm Hg,P = .65). Twice‐daily dosing resulted in a statistically significant, but clinically unimportant, IOP reduction over the entire 5‐day dosing period (−0.6 mm Hg; 95% CI 0.05 to −1.1 mm Hg,P = .02) and on the last day of dosing (−0.9 mm Hg; 95% CI 0.2 to −1.5 mm Hg,P = .003). Adverse events were limited to transient mild‐to‐moderate conjunctival hyperemia during the dosing phase in eyes receiving netarsudil vs control (P < .0001).

Conclusions

Netarsudil 0.02% ophthalmic solution twice daily resulted in a small, statistically significant, but clinically unimportant, IOP reduction in normotensive dogs. Future studies should investigate efficacy in glaucomatous dogs.
Derivation of a Design Solution for the Conservation of a Historical Payab in the Redevelopment of Doloeei, Gonabad
Authors: Tafahomi Rahman , Nadi Reihaneh
Published: January 2020

This paper aims to demonstrate the conservation process of historic underground water access or Payab by proposing a multistage decision-making design in Gonabad city, northeast part of Iran. The Payab was in the center axis of a street in the proposed development of a new road which appeared to be against the new construction. The challenge was to develop the new road in the central axis without disturbing much the historic structure in the location. Hence, a request was made to keep both the new road and the historic Payab structure with a design solution. In order to tackle the design solution requested, a qualitative methodology was designed by way of site surveys, site documentation, graphical analysis and interviews. The findings of the research demonstrated contradicting opinions among the governors-laypeople, youngers-elders and males and females about the historic structure. Based on the findings, it was proposed that a protective shield, which aimed to conserve the historic structure under the weight of the new road is required, with a new entrance to be provided through an adjacent sidewalk to achieve consensus among those of diverse ideas. As a conclusion, conservation projects as demonstrated in this paper, like any other conservation projects elsewhere are faced with budget limitation, poor planning and the support it needed. As the historic structure has been part of the local built environment, the integration with other architectural elements in the context is of paramount importance to support the sustainability of the local built environment.
The Effect Of Parenting Style On Adolescent’s Perception Towards Road Safety
Authors: Morshidi Mohammad , Muhammad Hussien Muhammad Zaly Shah
Published: January 2020

The purview of this paper is to analyze the relationships between parenting styles and adolescent risk behaviors on the road due to the critical parental role in preventing crashes among teens. The objectives  of this research are to list different parenting styles that may influence adolescent behavior, to assess the relationship between parenting styles and adolescent’s perception towards road safety, to determine which parenting style that promotes a desirable street protection habits among adolescent, and to propose a framework that integrated parenting style to road safety program. Descriptive and statistical analyses are used in this paper to interpret the data taken from 298 questionnaire-respondents which the parallel between the desired parenting style and the adolescent’s good perception of road safety is cast using the Pearson Correlation Coefficient. A quantitative approach is employed in processing the data taken from those selected respondents then the qualitative data is composed and operated to complete the quantitative data by giving more comprehensive knowledge over the argumentation and more description of the quantitative result. More so, the study supports the substantial influence of parenting style on adolescent development such as the adolescents who are raised in authoritative households consistently demonstrate higher protective and fewer risk behaviors than adolescents from non-authoritative families.
The Use of Web 2.0: GoAnimate.Com in Arabic Language Learning Activities at Universiti Malaysia Kelantan/ Penggunaan Aplikasi Web 2.0: GoAnimate.Com dalam Aktiviti Pembelajaran Bahasa Arab di Universiti Malaysia Kelantan
Authors: Abdul Hai Amanee , Amiruddin Ahmad Zaki , Abdul Rahman Ahmad , Wan Daud Wan Ab Aziz
Published: January 2020

This study is designed to present a web 2.0 application that provides multimedia and animated video known as GoAnimate.Com which has been used as a learning activity tool directly in Arabic teaching and learning (T&L) process. This activity was implemented in the class whereby the students were actively involved as practitioners and the teachers played the role as facilitators. The guidance to use GoAnimate.Com was explained to students by teachers before dividing them into groups. Each group were asked to prepare an animated video containing simple Arabic conversation using GoAnimate.Com application. Quantitative method was utilized  to make this study successful by using the instrument of questioners prepared to identify students’ perception towards GoAnimate.Com application and their preference of using this application in Arabic T&L at  University Malaysia Kelantan (UMK). The result of this study has indicated  that student’s perception towards GoAnimate.Com application in learning Arabic is high with the overall mean score of 4.05. This study has shown  that the usage of GoAnimate.Com can increase students’ engagement and involvement in learning Arabic. Nevertheless, it is hoped that the outcome  of this study  can provide an alternative approach and various strategies in Arabic T&L towards Education 4.0 in the Forth Industrial Revolution era (IR4.0).
Iban Sebuyau Youth Slang: Radial Network Category Framework Analysis/ Slanga Remaja Iban Sebuyau: Analisis Kerangka Kategori Jaringan Radial
Authors: Ringit Clinton , Abdul Wahab Hamidah
Published: January 2020

Slang is a free-grammatical rule of language phenomenon that exhibits the invention of vocabulary in a community groups in order to strengthen social identity. Overall, there are 15 data of Iban Sebuyau teenagers slang which has been acquired and separated into noun categories (eight data) and verbs (seven data). This study will analyze seven types of words of Iban Sebuyau teenagers’ slang in Sarawak via the verb category. Besides, the slang of Iban Sebuyau teenagers’ data will be examined based on the Radial Network Category Framework as suggested by Lakoff (1987). Accordingly, this study applied qualitative methods to obtain field sampling based on 10 teenagers in Sebuyau which has been selected based on their comprehension on the slang. As a result, the findings shows that there are in total of 7 data of Iban Sebuyau  teenagers slang has been obtained in verb categories such as merueh, ngaga’ peta, ngangat nyawa, belagu, nunjuk langit, melabur, and fogging. Overall, the Radial Network Category Framework approach able to describe the extensive meaning of Iban Sebuyau teenagers slang.
Quantum mirrors of log Calabi–Yau surfaces and higher-genus curve counting
Authors: Bousseau Pierrick
Published: January 2020

Gross, Hacking and Keel have constructed mirrors of log Calabi–Yau surfaces in terms of counts of rational curves. Using $q$-deformed scattering diagrams defined in terms of higher-genus log Gromov–Witten invariants, we construct deformation quantizations of these mirrors and we produce canonical bases of the corresponding non-commutative algebras of functions.
Performance of the QIAstat-Dx Gastrointestinal Panel for Diagnosing Infectious Gastroenteritis
Authors: Boers Stefan A. , Peters Cas J. A. , Wessels Els , Melchers Willem J. G. , Claas Eric C. J.
Published: January 2020

Detection and identification of enteropathogens that cause infectious gastroenteritis are essential steps for appropriate patient treatment and effective isolation precautions. Several syndrome-based tests have recently become available, with the gastrointestinal panel (GIP) assay on the QIAstat-Dx as the most recent addition to the syndromic testing landscape.
Microglia
Authors: Perry V. Hugh
Published: January 2020

The concept of the immunological privilege of the central nervous system (CNS) has had a profound influence on studies of interactions between the immune system and the CNS. At one time there was considerable debate as to whether there were any cells in the CNS of myeloid origin, but we now know that there are a number of populations of myeloid cells in specialized compartments of the CNS and that there is an ongoing bidirectional dialogue between the CNS and the immune system. We briefly review what we know of the different myeloid populations, in particular the microglia: their phenotype and function; their role in CNS homeostasis; and also their role in pathology, focusing on chronic neurodegeneration.
A Multifunctional Polysaccharide Utilization Gene Cluster in
Colwellia echini
Encodes Enzymes for the Complete Degradation of κ-Carrageenan, ι-Carrageenan, and Hybrid β/κ-Carrageenan
Authors: Christiansen Line , Pathiraja Duleepa , Bech Pernille Kjersgaard , Schultz-Johansen Mikkel , Hennessy Rosanna , Teze David , Choi In-Geol , Stougaard Peter
Published: January 2020

Here, we report that a recently described bacterium,
Colwellia echini
, harbors a large number of enzymes enabling the bacterium to grow on κ-carrageenan and agar. The genes are organized in two clusters that encode enzymes for the total degradation of κ-carrageenan and agar, respectively. As the first, we report on the structure/function relationship of a new class of enzymes that hydrolyze furcellaran, a partially sulfated β/κ-carrageenan. Using an
in silico
model, we hypothesize a molecular structure of furcellaranases and compare structural features and active site architectures of furcellaranases with those of other GH16 polysaccharide hydrolases, such as κ-carrageenases, β-agarases, and β-porphyranases. Furthermore, we describe a new class of enzymes distantly related to GH42 and GH160 β-galactosidases and show that this new class of enzymes is active only on hybrid β/κ-carrageenan oligosaccharides. Finally, we propose a new model for how the carrageenolytic enzyme repertoire enables
C. echini
to metabolize β/κ-, κ-, and
ι-
carrageenan.
Puupehenone, a Marine-Sponge-Derived Sesquiterpene Quinone, Potentiates the Antifungal Drug Caspofungin by Disrupting Hsp90 Activity and the Cell Wall Integrity Pathway
Authors: Tripathi Siddharth K. , Feng Qin , Liu Li , Levin David E. , Roy Kuldeep K. , Doerksen Robert J. , Baerson Scott R. , Shi Xiaomin , Pan Xuewen , Xu Wen-Hui , Li Xing-Cong , Clark Alice M. , Agarwal Ameeta K.
Published: January 2020

Fungal infections cause more fatalities worldwide each year than malaria or tuberculosis. Currently available antifungal drugs have various limitations, including host toxicity, narrow spectrum of activity, and pathogen resistance. Combining these drugs with small molecules that can overcome these limitations is a useful strategy for extending their clinical use. We have investigated the molecular mechanism by which a marine-derived compound potentiates the activity of the antifungal echinocandin caspofungin. Our findings revealed a mechanism, different from previously reported caspofungin potentiators, in which potentiation is achieved by the disruption of Hsp90 activity and signaling through the cell wall integrity pathway, processes that play important roles in the adaptation to caspofungin in fungal pathogens. Given the importance of stress adaptation in the development of echinocandin resistance, this work will serve as a starting point in the development of new combination therapies that will likely be more effective and less prone to pathogen resistance.
mSphere of Influence: Synthetic Biology of Natural Product Biosynthesis
Authors: Walker Mark C.
Published: January 2020

Mark Walker studies the biosynthesis and engineering of bacterial natural products with the long-term goal of identifying new antibiotic compounds. In this mSphere of Influence, he reflects on how “Direct cloning and refactoring of a silent lipopeptide biosynthetic gene cluster yields the antibiotic taromycin A” by K. Yamanaka, K. A. Reynolds, R. D. Kersten, K. S.
Linking postglacial landscapes to glacier dynamics using swath radar at Thwaites Glacier, Antarctica
Authors: Holschuh N. , Christianson K. , Paden J. , Alley R.B. , Anandakrishnan S.
Published: January 2020

Ice sheets reshape Earth’s surface. Maps of the landscape formed by past ice sheets are our best tool for reconstructing historic ice sheet behavior. But models of glacier erosion and deposition that explain mapped features are relatively untested, and without observations of landforms developing in situ, postglacial landscapes can provide only qualitative insight into past ice sheet conditions. Here we present the first swath radar data collected in Antarctica, demonstrating the ability of swath radar technology to map the subglacial environment of Thwaites Glacier (West Antarctica) at comparable resolutions to digital elevation models of deglaciated terrain. Incompatibility between measured bedform orientation and predicted subglacial water pathways indicates that ice, not water, is the primary actor in initiating bedform development at Thwaites Glacier. These data show no clear relationship between morphology and glacier speed, a weak relationship between morphology and basal shear stress, and highlight a likely role for preexisting geology in glacial bedform shape.
Modeling the dynamics of a Late Triassic vertebrate extinction: The Adamanian/Revueltian faunal turnover, Petrified Forest National Park, Arizona, USA
Authors: Hayes Reilly F. , Puggioni Gavino , Parker William G. , Tiley Catherine S. , Bednarick Amanda L. , Fastovsky David E.
Published: January 2020

The coincidence of a diverse vertebrate assemblage with a high-precision geochronology and lithostratigraphy in Petrified Forest National Park (Arizona, USA) allows Bayesian quantification of the dynamics of a Late Triassic vertebrate extinction and replacement, the Adamanian/Revueltian (A/R) faunal turnover. This approach uniquely identifies probabilities for the tempo of the replacement of the Adamanian assemblage by that of the Revueltian, precisely tracking the turnover. While the method does not designate the moment of extinction, there is a negligible probability that all Adamanian extinctions, as well as all Revueltian originations, are synchronous. A protracted A/R turnover is incompatible with the geologically instantaneous Manicouagan impact (215.4 ± 0.20 Ma; Québec, Canada) as a dominant causal mechanism. This analytical framework constitutes a flexible means of reconstructing biotic turnover in a variety of deep time contexts.
Late Paleogene emergence of a North American loess plateau
Authors: Fan Majie , Feng Ran , Geissman John W. , Poulsen Christopher J.
Published: January 2020

The relative roles of tectonics and global climate in forming the hydroclimate for widespread eolian deposition remain controversial. Oligocene loess has been previously documented in the interior of western United States, but its spatiotemporal pattern and causes remain undetermined. Through new stratigraphic record documentation and data compilation, we reveal the time transgressive occurrence of loess beginning in the latest Eocene in the central Rocky Mountains, that expands eastward to the Great Plains across the Eocene-Oligocene transition (EOT). Our climate simulations show that moderate uplift of the southern North America Cordillera initiated drying in the Cordilleran hinterland and immediate foreland, forming a potential dust source and sink, and global cooling at the EOT expanded the drying and eolian deposition eastward by causing retreat of the North American Monsoon. Therefore, the eolian deposition reflects continental aridification induced both by regional tectonism and global climate change during the late Paleogene.
LIFEStyle, Prevention and Risk of Acute PaNcreatitis (LIFESPAN): protocol of a multicentre and multinational observational case–control study
Authors: Koncz Balázs , Darvasi Erika , Erdősi Dalma , Szentesi Andrea , Márta Katalin , Erőss Bálint , Pécsi Dániel , Gyöngyi Zoltán , Girán János , Farkas Nelli , Papp Maria , Fehér Eszter , Vitális Zsuzsanna , Janka Tamás , Vincze Áron , Izbéki Ferenc , Dunás-Varga Veronika , Gajdán László , Török Imola , Károly Sándor , Antal Judit , Zádori Noémi , Lerch Markus M , Neoptolemos John , Sahin-Tóth Miklós , Petersen Ole H , Hegyi Péter
Published: January 2020

Introduction

Acute pancreatitis (AP) is a life-threatening inflammatory disease of the exocrine pancreas which needs acute hospitalisation. Despite its importance, we have significant lack of knowledge whether the lifestyle factors elevate or decrease the risk of AP or influence the disease outcome. So far, no synthetising study has been carried out examining associations between socioeconomic factors, dietary habits, physical activity, chronic stress, sleep quality and AP. Accordingly, LIFESPAN identifies risk factors of acute pancreatitis and helps to prepare preventive recommendations for lifestyle elements.

Methods and analysis

LIFESPAN is an observational, multicentre international case–control study. Participating subjects will create case and control groups. The study protocol was designed according to the SPIRIT guideline. Patients in the case group (n=1700) have suffered from AP (alcohol-induced, n=500; biliary, n=500; hypertriglyceridemiainduced, n=200; other, n=500); the control group subjects have no AP in their medical history. Our study will have three major control groups (n=2200): hospital-based (n=500), population-based (n=500) and aetiology-based (alcohol, n=500; biliary, n=500 and hypertriglyceridemia, n=200). All of them will be matched to the case group individually by gender, age and location of residence. Aggregately, 3900 subjects will be enrolled into the study. The study participants will complete a complex questionnaire with the help of a clinical research administrator/study nurse. Analysis methods include analysis of the continuous and categorical values.

Ethics and dissemination

The study has obtained the relevant ethical approval (54175-2/2018/EKU) and also internationally registered (ISRCTN25940508). After obtaining the final conclusions, we will publish the data to the medical community and will also disseminate our results via open access.

Trial registration number

ISRCTN25940508; Pre-results.
Unravelling the role of leadership in motivation of health workers in a Moroccan public hospital: a realist evaluation
Authors: Belrhiti Zakaria , Van Damme Wim , Belalia Abdelmounim , Marchal Bruno
Published: January 2020

Objectives

This study aimed at opening the black box of the relationship between leadership and motivation of health workers by focusing on a high-performance hospital in Morocco.

Design

We adopted the realist evaluation approach and used the case study design to test the initial programme theory we formulated on the basis of a scoping review on complex leadership. We used the Intervention-Context-Actors-Mechanism-Outcome Configuration as a heuristic tool to identify plausible causal configurations.

Settings

Since 2000, the Ministry of Health in Morocco initiated many reforms in the frame of the governmental deconcentration process called ‘advanced regionalisation’. The implementation of these reforms is hampered by inadequate human resource management capacities of local health system managers. Yet, the National ‘Concours Qualité’, a national quality assurance programme implemented since 2007, demonstrated that there are many islands of excellence. We explore how leadership may play a role in explaining these islands of excellence.

Participants

We carried out a document review, 18 individual interviews and 3 group discussions (with doctors, administrators and nurses), and non-participant observations during a 2-week field visit in January–February 2018.

Results

We confirmed that effective leaders adopt an appropriate mix of transactional, transformational and distributed leadership styles that fits the mission, goals, organisational culture and nature of tasks of the organisation and the individual characteristics of the personnel when organisational culture is conducive. Leadership effectiveness is conditioned by the degree of responsiveness to the basic psychological needs of autonomy, competence and relatedness, perceived organisational support and perceived supervisor support. Transactional and overcontrolling leadership behaviour decreased the satisfaction of the need for autonomy and mutual respect. By distributing leadership responsibilities, complex leaders create an enabling environment for collective efficacy and creative problem solving.

Conclusions

We found indications that in the Moroccan context, well-performing hospitals could be characterised by a good fit between leadership styles, organisational characteristics and individual staff attributes.
Differences in reimbursement listing of anticancer therapies in China: an observational study
Authors: Guan Xiaodong , Zhang Yichen , Wushouer Haishaerjiang , Shi Luwen , Ross-Degnan Dennis , Wagner Anita Katharina
Published: January 2020

Objective

Access to highly priced anticancer medications usually requires insurance coverage. A first step towards coverage of such medications is their inclusion in reimbursement lists. We assessed listing for reimbursement in China between 2009 and 2018 of anticancer medications on the WHO’s Essential Medicines List.

Setting and study design

Using publicly available data, we assessed which anticancer medications listed in the 20th WHO Model List of Essential Medicines (EML) were included in China’s National Reimbursement Drug List (NRDL). For five targeted anticancer medications on the WHO EML, we also assessed inclusion in the 31 Chinese Provincial Reimbursement Drug Lists (PRDLs). Logistic regression was used to test whether inclusion of targeted anticancer medications was associated with provincial economic levels.

Primary outcome measures

Inclusion of five targeted anticancer medications in the NRDL and PRDLs before and after 2017.

Results

The 2017 NRDL included all anticancer medications on the WHO EML (except for one not approved in China at the time), and by 2018, all 31 PRDLs listed the targeted anticancer medications except for nilotinib; four provinces had covered all five targeted medications before the 2017 NRDL coverage mandate. Provincial economic level and regional incidence of specific cancers seemed unrelated to the inclusion of five targeted anticancer medications in PRDLs.

Conclusion

Our findings suggest that by including medications in the national and provincial reimbursement lists, China has taken an important first step in promoting access to targeted anticancer medications. Further research is needed to determine whether inclusion in PRDLs improved the availability, appropriate use and affordability of highly priced targeted anticancer medications in China.
Study protocol for the road to hierarchical diabetes management at primary care (ROADMAP) study in China: a cluster randomised controlled trial
Authors: Jia Weiping , Zhang Puhong , Duolikun Nadila , Zhu Dalong , Li Hong , Bao Yuqian , Li Xian , Liu Yu
Published: January 2020

Introduction

Diabetes management in primary care remains suboptimal in China, despite its inclusion in the essential public health service (EPHS). We aimed to evaluate the effectiveness of a mobile health (mHealth) based and three-tiered diabetes management system in diverse Chinese contexts.

Methods and analysis

This is a cluster randomised controlled trial, named road to hierarchical diabetes management at primary care (ROADMAP). 19 008 patients with type 2 diabetes (T2D) were recruited from primary care clinics in 864 communities across 144 counties/districts of 24 provinces. Eligible participants were adult patients diagnosed with T2D and registered for diabetes management in communities. Patients within the same communities (clusters) were randomly allocated into the intervention or control arm for 1 year in a 2:1 ratio. The control arm patients received usual care as EPHS packaged: at least four blood glucose (BG) and blood pressure (BP) tests, and lifestyle and medication instruction, yearly, from primary care providers. The intervention arm patients received at least two BG and one BP tests, monthly, and lifestyle and treatment instruction from a three-tiered contracted team. A mHealth platform,Graded ROADMAP,enabled test results uploading and sharing, and patient referral within the team. The intervention participants will be further divided into basic or intensive intervention group according to whether they were actively using theYour DoctorApp. The primary outcome is the BG control rate with glycated haemoglobin (HbA1c)<7.0%. Secondary outcomes include control rates and changes of ABC (HbA1c, BP and low-density lipoprotein cholesterol) and fasting BG, hypoglycaemia episodes and health-related quality of life (EuroQol (EQ-5D)).

Ethics and dissemination

The trial has been approved by the Institutional Review Board at Shanghai Sixth People's Hospital. Findings on the intervention effectiveness will be disseminated through peer-reviewed journals, conference presentations and other relevant mechanisms.

Trial registration number

ChiCTR-IOC-17011325.
Value of an outpatient transition clinic for young people with inflammatory bowel disease: a mixed-methods evaluation
Authors: Sattoe Jane N T , Peeters Mariëlle A C , Haitsma Jannie , van Staa AnneLoes , Wolters Victorien M , Escher Johanna C
Published: January 2020

Objective

Developing and evaluating effective transition interventions for young people (16–25 years) with inflammatory bowel disease (IBD) is a high priority. While transition clinics (TCs) have been recommended, little is known about their operating structures and outcomes. This study aimed to gain insight into the value of a TC compared with direct handover care.

Design

Controlled mixed-methods evaluation of process outcomes, clinical outcomes and patient-reported outcomes.

Setting

Two outpatient IBD clinics in the Netherlands.

Participants

Data collection included: semistructured interviews with professionals (n=8), observations during consultations with young people (5×4 hours), medical chart reviews of patients transferred 2 to 4 years prior to data collection (n=56 in TC group; n=54 in control group) and patient questionnaires (n=14 in TC group; n=19 in control group).

Outcomes

Data were collected on service structures and daily routines of the TC, experienced barriers, facilitators and benefits, healthcare use, clinical outcomes, self-management outcomes and experiences and satisfaction of young people with IBD.

Results

At the TC, multidisciplinary team meetings and alignment of care between paediatric and adult care providers were standard practice. Non-medical topics received more attention during consultations with young people at the TC. Barriers experienced by professionals were time restrictions, planning difficulties, limited involvement of adult care providers and insufficient financial coverage. Facilitators experienced were high professional motivation and a high case load. Over the year before transfer, young people at the TC had more planned consultations (p=0.015, Cohen’s d=0.47). They showed a positive trend in better transfer experiences and more satisfaction. Those in direct handover care more often experienced a relapse before transfer (p=0.003) and had more missed consultations (p=0.034, Cohen’s d=−0.43) after transfer.

Conclusion

A TC offer opportunities to improve transitional care, but organisational and financial barriers need to be addressed before guidelines and consensus statements in healthcare policy and daily practice can be effectively implemented.
Australia’s awareness of cardiac arrest and rates of CPR training: results from the Heart Foundation's HeartWatch survey
Authors: Cartledge Susie , Saxton Danielle , Finn Judith , Bray Janet E
Published: January 2020

Objective

We aimed to provide the first national estimates of cardiopulmonary resuscitation (CPR) training and awareness of cardiac arrest.

Design

A retrospective analysis of a national cross-sectional survey was undertaken. Data were collected online from adults in July 2017 as part of the Heart Foundation of Australia’s HeartWatch survey. We used logistic regression to examine demographic factors associated with CPR training.

Participants

A national cohort was invited to participate in the survey using purposive, non-probability sampling methods with quotas for age, gender and area of residence, in order to reflect the wider Australian population. The final sample consisted of 1076 respondents.

Main outcome measure

To determine an estimation of the prevalence of cardiac arrest awareness and CPR training at a national level and the relationship of training to demographic factors.

Results

The majority (76%) of respondents were born in Australia with 51% female and 66% aged between 35 and 64 years. Only 16% of respondents could identify the difference between a cardiac arrest and a heart attack. While 56% reported previous CPR training, only 22% were currently trained (within 1 year). CPR training was associated with younger age (35 to 54 years) (OR 1.45, 95% CI 1.06 to 2.0), being born in Australia (OR 1.59, 95% CI 1.17 to 2.17) and higher levels of education (university, OR 1.86, 95% CI 1.35 to 2.57). CPR training increased confidence in respondents ability to perform effective CPR and use a defibrillator. Lack of CPR training was the most common reason why respondents would not provide CPR to a stranger.

Conclusions

There is a need to improve the community’s understanding of cardiac arrest, and to increase awareness and training in CPR. CPR training rates have not changed over the past decades—new initiatives are needed.