bluuebunny/crossref_metadata_2025 huggingface dataset:
Systematization of absorptive capacity microprocesses for knowledge identification in project management
Authors: Moraes Alan Tadeu de , Silva Luciano Ferreira da , Oliveira Paulo Sergio Gonçalves de
Published: August 2020

Purpose

This study aims to systematize the acquisition phase of absorptive capacity microprocesses that contribute to project management (PM) knowledge identification.

Design/methodology/approach

An exploratory and descriptive qualitative research was adopted. The first stage consisted of building the conceptual framework based on four systematic-literature-reviews. The data collection process in the second phase involved in-depth interviews, which are adequate to understand the interviewee’s reality. The sample composition consisted of 15 respondents who are PM professionals with an average of 15 years of experience. Each interviewee was chosen based on their expertise and ability to transmit the entire management process of several projects. The data were analyzed using the Atlas. Tecnology information software following the grounded theory technique with three coding cycles: open, axial and selective.

Findings

Based on the results, the authors organized the microprocesses into three groups: events, social interaction and the use of tools and techniques.

Research limitations/implications

The primary limitation of the study was the number of respondents. Future studies will be able to identify other microprocesses and evaluate their role in the knowledge identification process.

Practical implications

This study presents a systematization of microprocesses in knowledge identification, as it occurs in the context of PM. Based on the results of this study, organizations will be able to choose the microprocesses that best fit their operations and activities according to the complexity, innovation and/or criticality of their projects.

Originality/value

The systematic literature review revealed a gap in the knowledge identification phase of knowledge management as it pertains to PM. Thus, this study presents a systematization of how knowledge identification occurs in the context of PM.
The dark side of sales technologies: how technostress affects sales professionals
Authors: Pullins Ellen , Tarafdar Monideepa , Pham Phuoc
Published: August 2020

Purpose

This article evaluates the effect of technostress due to implementation of sales technologies on sales professionals in terms of changes in job satisfaction and role stress and potential mitigation strategies including technostress inhibitors and job commitment.

Design/methodology/approach

The study utilizes a survey data collection from sales professionals in B2B consultative roles selling to business customers from construction, industrial supply and business service firms, including items that explore before and after factors around a customer relationship management implementation.

Findings

Technostress results in a decrease in job satisfaction and an increase in role stress of sales professionals. Job commitment moderates the decrease in job satisfaction, i.e. the higher the job commitment the less significant the decrease in job satisfaction.

Practical implications

Sales forces need to implement technostress inhibitors to help mitigate the effects of technostress in exacerbating other sales professional stressors. These inhibitors should be contextualized to the unique situation of the sales organization.

Originality/value

The study examines the dark side of sales technologies. Our research expands current understanding by considering new relations among technostress-creating conditions and two work-related outcomes that are salient to sales professionals, namely role stress and job satisfaction. Further, we investigate the change in these outcomes before and after the implementation of sales technologies rather than only considering them at one point of time, after the fact.
Leveraging Prescription Drug Monitoring Programs to Evaluate Opioid Policy Interventions
Authors: Weiner S.
Published: August 2020

Research Objective

A variety of state and federal policies have been enacted to curtail prescription opioid overdoses, including implementation of statewide opioid prescribing guidelines and rescheduling of hydrocodone from DEA Schedule III to Schedule II. We aimed to use data from the Ohio Prescription Drug Monitoring Program (PDMP) to evaluate the effects of these policies.

Study Design

Retrospective study of all opioid prescriptions dispensed in the state of Ohio from 2010 to 2017. We first determined the number and characteristics of opioid prescriptions stratified by specialty. We then used an interrupted time series analysis to determine the effect on opioid prescribing after (a) the release of statewide opioid prescribing guidelines in 2012 and (b) the federal rescheduling of hydrocodone in 2014.

Population Studied

The state of Ohio. Prescriptions for the nine most common pill form opioid pain relievers dispensed in Ohio were included. The PDMP includes all prescriptions dispensed to individuals in the state, regardless of payer.

Principal Findings

The number and characteristics of opioid prescriptions and trends over time varied greatly between different prescriber specialties. The mean number of pills/prescription and morphine content of the prescriptions were highest for physical medicine/rehabilitation (91.2 pills, 1532 mg, n = 1 680 579), anesthesiology/pain (89.3 pills, 1484 mg, n = 3 261 449), hematology/oncology (88.2 pills, 1534 mg, n = 516,596), and neurology (84.4 pills, 1230 mg, n = 573 389). Overall, family medicine (21.8%) and internal medicine (17.6%) prescribed the most opioids. The implementation of emergency department opioid prescribing guidelines was associated with a 12% decrease (95% CI −17.7% to −6.3%) in the level of statewide total prescriptions/month and an additional decrease of 0.9% (95% CI −1.1% to −0.7%) relative to the trend before the guidelines. Rescheduling of hydrocodone was associated with a level change of −26 358 (95% CI −36 700 to −16 016) prescriptions (−5.8%) and an additional decrease of −1568 (95% CI −2296 to −839) prescriptions/month. Rescheduling was associated with a temporary substitution effect (increase) of codeine and with a decrease in the prescribing of tramadol.

Conclusions

The characteristics of opioid prescriptions vary widely by specialty and suggest the need for specialty‐specific guidance. Opioid guidelines targeting the emergency department were associated with a decrease in prescribing beyond the secular trend. The rescheduling of hydrocodone was associated with a decrease in hydrocodone prescriptions beyond the secular trend, but also appeared to affect the prescribing of other opioids as well.

Implications for Policy or Practice

PDMPs are state‐based prescribing databases that can be used to influence prescriber decision‐making at the point of care. However, their powerful data can also be used to describe prescribing behaviors overall and evaluate the effectiveness of implemented opioid‐related policies.
Estimation in English auctions with unobserved heterogeneity
Authors: Hernández Cristián , Quint Daniel , Turansick Christopher
Published: August 2020

We propose a framework for identification and estimation of a private values model with unobserved heterogeneity from bid data in English auctions, using variation in the number of bidders across auctions, and extend the framework to settings where the number of bidders is not cleanly observed in each auction. We illustrate our method on data from eBay Motors auctions. We find that unobserved heterogeneity is important, accounting for two thirds of price variation after controlling for observables, and that welfare measures would be dramatically misestimated if unobserved heterogeneity were ignored.
Tau‐induced upregulation of C/EBPβ‐TRPC1‐SOCE signaling aggravates tauopathies: A vicious cycle in Alzheimer neurodegeneration
Authors: Ye Jinwang , Yin Ying , Yin Yaling , Zhang Huaqiu , Wan Huali , Wang Lu , Zuo Yue , Gao Di , Li Mengzhu , Li Jun , Liu Yanchao , Ke Dan , Wang Jian‐Zhi
Published: August 2020

Intracellular accumulating of the hyperphosphorylated tau plays a pivotal role in neurodegeneration of Alzheimer disease (AD), but the mechanisms underlying the gradually aggravated tau hyperphosphorylation remain elusive. Here, we show that increasing intracellular tau could upregulate mRNA and protein levels of TRPC1 (transient receptor potential channel 1) with an activated store‐operated calcium entry (SOCE), an increased intraneuronal steady‐state [Ca2+]i, an enhanced endoplasmic reticulum (ER) stress, an imbalanced protein kinases and phosphatase, and an aggravated tauopathy. Furthermore, overexpressing TRPC1 induced ER stress, kinases‐phosphatase imbalance, tau hyperphosphorylation and cognitive deficits in cultured neurons and mice, while pharmacological inhibiting or knockout TRPC1 attenuated the hTau‐induced deregulations in SOCE, ER homeostasis, kinases‐phosphatase balance, and tau phosphorylation level with improved synaptic and cognitive functions. Finally, an increased CCAAT‐enhancer‐binding protein (C/EBPβ) activity was observed in hTau‐overexpressing cells and the hippocampus of the AD patients, while downregulating C/EBPβ by siRNA abolished the hTau‐induced TRPC1 upregulation. These data reveal that increasing intracellular tau can upregulate C/EBPβ‐TRPC1‐SOCE signaling and thus disrupt phosphorylating system, which together aggravates tau pathologies leading to a chronic neurodegeneration.
O‐HEALTH‐EDU: A scoping review on the reporting of oral health professional education in Europe
Authors: Dixon Jonathan , Manzanares‐Cespedes Cristina , Davies Julia , Vital Sibylle , Gerber Gabor , Paganelli Corrado , Akota Ilze , Greiveldinger Alyette , Murphy Denis , Quinn Barry , Roger‐Leroi Valerie , Tubert‐Jeannin Stephanie , Field James
Published: August 2020

Introduction

The variability in oral health professional education is likely to impact on the management of oral health needs across Europe. This scoping review forms the initial part of a larger EU‐funded collaborative Erasmus + project, ‘O‐Health‐Edu’. The aim of this scoping review is to investigate how oral health professional education in Europe is reported.

Methods

The PRISMA and Arksey & O’Malley methodological frameworks for scoping reviews were used to guide reviewers in answering the research question “How is oral health professional education reported in Europe?”. The search strategy encompassed published literature searches, internet searches and further searching of relevant documents from educational organisations, regulators and professional bodies. Once the search strategy was developed, it was sent to key stakeholders for consultation. Sources were reviewed by two authors (JD, JF) and included in the review if they reported on oral health professional education in Europe.

Results

A total of 508 sources were retrieved from all of the searches. A total of 405 sources were excluded as they did not report on the topic of interest, leaving 103 sources that reported on oral health professional education in Europe. Handsearching the references of published sources lead to a further 41 sources being screened, of which, 15 were included. In total, 33 duplications were removed and the final number of included sources was 85. The average year of publication for the included sources was 2007, with sources most commonly published in journals dedicated to dental education. Surveys represented the most common form of reporting. From the data obtained, four broad themes of reporting were evident: dental education at a programme level, dental education at a discipline level, other oral health professional education, and postgraduate education and continuous professional development.

Conclusion

The reporting of dental and oral health professional education in Europe is limited. Whilst there are many useful documents that provide guidelines on dental education, there is limited knowledge on how education is implemented and delivered. There is a greater need for comprehensive educationally driven programme‐level data on oral health professional education across Europe.
Private Equity and Portfolio Companies: Lessons from the Global Financial Crisis
Authors: Bernstein Shai , Lerner Josh , Mezzanotti Filippo
Published: August 2020

Critics of private equity have warned that the high leverage often used in PE‐backed companies could contribute to the fragility of the financial system during economic crises. The proliferation of poorly structured transactions during booms could increase the vulnerability of the economy to downturns. The alternative hypothesis is that PE, with its operating capabilities, expertise in financial restructuring, and massive capital raised but not invested (“dry powder”), could increase the resilience of PE‐backed companies.

In their study of PE‐backed buyouts in the U.K.—which requires and thereby makes accessible more information about private companies than, say, in the U.S.—the authors report finding that, during the 2008 global financial crisis, PE‐backed companies decreased their overall investments significantly less than comparable, non‐PE firms. Moreover, such PE‐backed firms also experienced greater equity and debt inflows, higher asset growth, and increased market share. These effects were especially notable among smaller, riskier PE‐backed firms with less access to capital, and also for those firms backed by PE firms with more dry powder at the crisis onset. In a survey of the partners and staff of some 750 PE firms, the authors also present compelling evidence that PEs firms play active financial and operating roles in preserving or restoring the profitability and value of their portfolio companies.
Board 3.0: What the Private‐Equity Governance Model Can Offer Public Companies∗
Authors: Gilson Ronald J. , Gordon Jeffrey N.
Published: August 2020

The authors view board structures as an adaptive institution that responds to the key challenges faced by public companies: helping management solve the problems of production and organization of large‐scale enterprise; limiting managerial agency costs; serving as a delegated monitor of the firm's compliance obligations; and responding to the governance environment of changing shareholder ownership patterns. U.S. company board structures are shown to have evolved over time, often through discontinuous lurches, as particular functions have waxed and waned in importance.

This article is part of a larger project that traces two iterations of the public company board, what the authors call Board 1.0 (the “advisory board”) and Board 2.0 (the “monitoring board”). The authors argue in particular that Board 2.0, as embedded in both current practice and regulation, now fails the functional fit test for many companies. First, it does not scale to match the dramatic increase in the size and complexity of many modern public corporations. Second, at a time of reconcentrated ownership achieved through institutional investors and increased activism, it does not have the expertise and commitment needed to resolve the tension between managerial or market myopia, or “short‐termism,” and managerial “hyperopia.”

This article holds out an optional alternative, Board 3.0, which would bring to the public company board some strategies used by private equity firms for their portfolio company boards. Such “Portco” boards consist of directors who are “thickly informed,” “heavily resourced,” and “intensely interested.” Bringing such “empowered directors” to public company boards could facilitate evolution of the public company board model in response to dramatic changes in the corporate business environment. The authors also suggest possible routes for implementing Board 3.0, including the enlisting of PE firms as “relational investors” that would have both capacity and incentives to engineer changes in board structure.
University of Texas Roundtable on LP Perspectives on the State of Private Equity
Authors: Wiles Ken , Tull Tom , Halaska Chris , Wanstrath Shelby , Valdez Russell
Published: August 2020

In this wide‐ranging discussion among four limited partner investors in private equity, the LPs commented on the rates of return they expect from PE, the fees they pay their general partners, and the length of their time commitments to PE investments. After noting the enormous growth in the value of assets under private management, and the reduction in public equity investment by many large institutional investors, each of the four LPs said that their institutions expected to maintain or continue to increase their proportion of portfolio investment in PE. The LP panelists were virtually unanimous in expecting PE rates of return in the 9%‐11% range, as compared to 7%‐8% for public equities. The panelists also seemed to agree that although committing to PE investments for terms longer than the traditional seven to ten years could result in higher returns and lower costs, they were reluctant to make such commitments because they valued the financial flexibility afforded by shorter holding periods.

Several LPs claimed that their institutions were scrutinizing the explicit and implicit fees charged by the GPs, and the level of fees was encouraging LPs to co‐invest in deals alongside the GPs. And in response to a closing suggestion that the recent flurry of IPOs could signify the beginning of a major reversal away from private capital, another LP expressed strong doubt, noting that “the private ownership model has clearly shown superior governance, and greater ability to manage leveraged capital structures and create value than public companies over the long term.”
Development of a Frailty Index from Routine Hospital Data in Perioperative and Critical Care
Authors: Darvall Jai N. , Greentree Kate , Loth Joel , Bose Tony , De Silva Anurika , Braat Sabine , Lim Wen K. , Story David A.
Published: August 2020

BACKGROUND/OBJECTIVES

Frailty is common in surgical and intensive care unit (ICU) populations, yet it is not routinely measured. Frailty indices are able to quantify this condition across a range of health deficits. We aimed to develop a frailty index (FI) from routinely collected hospital data in a surgical and ICU population.

DESIGN

Prospective observational single‐center cohort study.

SETTING

Tertiary referral metropolitan Australian hospital.

PARTICIPANTS

A total of 336 individuals aged 65 and older undergoing surgery or aged 50 and older admitted to the ICU.

MEASUREMENTS

Routine admission health data were used to derive an FI comprising 36 health deficits. We examined the FI correlation with existing frailty tools (Clinical Frailty Scale [CFS] and Edmonton Frail Scale [EFS]) and assessed its predictive ability for negative outcomes including 30‐day mortality.

RESULTS

Median FI was .17 (interquartile range [IQR]) = .10–.24) for ICU patients and .17 (IQR = .11–.25) for surgical patients; maximum FI was .58, and 25% (95% confidence interval [CI] = 10.4–29.6) of patients overall were diagnosed with frailty (FI score ≥.25). Correlation was strong between the FI and the EFS: ρ = .76 (95% CI = .70–.83) for ICU patients and .71 (95% CI = .64–.78) for surgical patients, and the CFS was .77 (95% CI = .70–.84) for ICU patients and .72 (95% CI = .65–.79) for surgical patients. The FI had good discriminative ability for prediction of 30‐day mortality in ICU patients (multivariate odds ratio for each increase in FI of .1 = 2.04 [95% CI = 1.19–3.48]), comparable with the performance of the Acute Physiology and Chronic Health Evaluation III score (ICU patients) and the Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity score (surgical patients).

CONCLUSION

It is feasible to construct an FI from hospital admission data in a cohort of critically ill and surgical patients.
Action representation deficits in adolescents with developmental dyslexia
Authors: van de Walle de Ghelcke Alice , Skoura Xanthi , Edwards Martin Gareth , Quercia Patrick , Papaxanthis Charalambos
Published: August 2020

Developmental dyslexia (DD), a severe and frequent disorder of reading acquisition, is characterized by a diversity of cognitive and motor deficits whose interactions still remain under debate. Although deficits in the automatization of sensorimotor control have been highlighted, internal action representation allowing prediction has never before been investigated. In this study, we considered action representation of 18 adolescents with pure DD and 18 age‐matched typical readers. Participants actually and mentally performed a visually guided pointing task involving strong spatiotemporal constraints (speed/accuracy trade‐off paradigm). While actual and mental movement times of typical readers were isochronous and both conformed to Fitts’ law, the movement times of dyslexics differed between conditions, and only the actual movement times conformed to Fitts’ law. Furthermore, the quality of motor imagery correlated with word reading abilities. This suggests that the process of action representation is impaired in pure DD and supports the sensorimotor perspective of DD. Theoretical implications are discussed.
The relationship of psychosocial well‐being and social support with pregnant women's perceptions of traumatic childbirth
Authors: Yalnız Dilcen Hacer , Aslantekin Filiz , Aktaş Naciye
Published: August 2020

Aim

This study was conducted to investigate the correlation of psychosocial health and social support with traumatic birth perception in pregnant women.

Method

The data of this descriptive epidemiological study were obtained from 461 pregnant women who visited a Family Health Center (FHC) between August 2018 and 2019. The data were collected by the face‐to‐face interview method, using a Participant Information Form, the Psychosocial Health Assessment in Pregnancy and Perceived Social Support and Traumatic Birth Perception Scales.

Results

Traumatic birth perception was negatively correlated with the Psychosocial Health in Pregnancy Scale and its subscales, as well as being negatively correlated with the Perceived Social Support Scale and its subscales. According to this result, it was determined that traumatic birth perception increases as psychosocial problems increase. As the perceived social support of pregnancy and spouse relationship, especially related to familial relationships, decreases, the perception of traumatic birth increases.

Conclusion

According to the results of the study, psychosocial assessment and screening of social support status in pregnant women are recommended as part of the routine clinical practices of midwives and nurses. In this regard, support may be obtained from international practices and experience.
Construction of Cultural Identity through Language Education of Junior-Senior High Schools in China during 1949-1997
Authors: Jia Di , Shao Hongxue , Zhang Chi
Published: August 2020

The construction of cultural identity is a very complex issue and is affected by many factors, one of which is education. To make Chinese people acknowledge their own political civilization and cultural tradition, after the founding of the People's Republic of China in 1949, the Chinese education departments integrated Marxist education by using Chinese language courses in junior-senior high schools (JSHSs) as a medium. To achieve such integration, Chinese language courses must teach language knowledge while disseminating Marxism. A large number of works with Sinicized Marxism content was included in textbooks and interpreted according to relevant theories. Additionally, teachers of Chinese language courses must have high literacy regarding Marxist theory. Judging from the current social reality, the Chinese language courses in China’s JSHSs have prompted the adherence, identification and internalization of Marxism among JSHS students since the founding of the People’s Republic of China and have laid the foundation for the formation of a socio-political culture guided by Marxism in the general public.
Molybdenum diselenide thin films grown by atomic layer deposition: An XPS analysis
Authors: Rodriguez-Pereira Jhonatan , Zazpe Raul , Charvot Jaroslav , Bureš Filip , Macak Jan M.
Published: August 2020

Molybdenum diselenide (MoSe2) thin films were deposited on annealed titanium foils by atomic layer deposition using suitable precursors. In this paper, a detailed x-ray photoelectron spectroscopy analysis of the MoSe2 film is presented. Survey spectra, Mo 3d, Se 3d, Mo 3p, Se LMM, Se 3p, C 1s, and Se 4s core level along with the valence band spectra were measured. Quantitative analysis indicates a surface composition of MoSe1.8, suggesting a deficiency of selenium on the surface.
The Annual Periodization of Training Volumes of International-Level Cross-Country Skiers and Biathletes
Authors: Myakinchenko Evgeny B. , Kriuchkov Andrey S. , Adodin Nikita V. , Feofilaktov Victor
Published: August 2020

Purpose: To compare the training-volume (TrV) distribution of Russian international-level male biathletes, female biathletes, and cross-country skiers (XC) during an annual cycle. Methods: Day-to-day TrVs were recorded and averaged for a 5-year period for male biathletes (n = 6), female biathletes (n = 8), and XC (n = 14) with VO2max values of 77.7 (3.8), 64.6 (1.9), and 79.4 (3.5) mL·min−1·kg−1, respectively. Results: The volumes of low- and moderate-intensity endurance training and all types of nonspecific endurance and strength training gradually decreased toward the competition period. However, the volumes and proportions of high-intensity endurance training and specific exercises (roller skiing, skiing, and shooting during high-intensity endurance training) increased by the time of the competition period. The total volume of training, volumes of low- and moderate-intensity endurance training, moderate- and high-load strength training (70%–95% 1RM), and power/speed loads did not increase gradually but reached their maximum immediately after a short stage of initial training. All teams employed the “pyramid” model of intensity distribution. Compared with the biathletes, XC demonstrated a larger (P < .01) annual volume of endurance training (~190 h), low-intensity endurance training (~183 h), and strength training (~818 sets). They also engaged in more upper-body and core-strength exercises (~769 sets), and they reached their maximum aerobic TrVs in June, while the biathletes reached theirs in July. Conclusions: In recent decades, the traditional model of periodization has been altered. The Russian XC and biathletes had significant differences in TrVs.
Losing Sleep Over It: Sleep in Basketball Players Affected by Game But Not Training Workloads
Authors: Fox Jordan L. , Scanlan Aaron T. , Stanton Robert , O’Grady Cody J. , Sargent Charli
Published: August 2020

Purpose: To examine the impact of workload volume during training sessions and games on subsequent sleep duration and sleep quality in basketball players. Methods: Seven semiprofessional male basketball players were monitored across preseason and in-season phases to determine training session and game workloads, sleep duration, and sleep quality. Training and game data were collected via accelerometers, heart-rate monitors, and rating of perceived exertion (RPE) and reported as PlayerLoad™ (PL), summated heart-rate zones, and session RPE (sRPE). Sleep duration and sleep quality were measured using wrist-worn activity monitors in conjunction with self-report sleep diaries. For daily training sessions and games, all workload data were independently sorted into tertiles representing low, medium, and high workload volumes. Sleep measures following low, medium, and high workloads and control nights (no training/games) were compared using linear mixed models. Results: Sleep onset time was significantly later following medium and high PL and sRPE game workloads compared with control nights (P < .05). Sleep onset time was significantly later following low, medium, and high summated heart-rate-zones game workloads, compared with control nights (P < .05). Time in bed and sleep duration were significantly shorter following high PL and sRPE game workloads compared with control nights (P < .05). Following low, medium, and high training workloads, sleep duration and quality were similar to control nights (P > .05). Conclusions: Following high PL and sRPE game workloads, basketball practitioners should consider strategies that facilitate longer time in bed, such as napping and/or adjusting travel or training schedules the following day.
A New Taxonomy for Postactivation Potentiation in Sport
Authors: Boullosa Daniel , Beato Marco , Dello Iacono Antonio , Cuenca-Fernández Francisco , Doma Kenji , Schumann Moritz , Zagatto Alessandro Moura , Loturco Irineu , Behm David G.
Published: August 2020

Postactivation potentiation (PAP) mechanisms and responses have a long scientific history. However, to this day there is still controversy regarding the mechanisms underlying enhanced performance after a conditioning activity. More recently, the term postactivation performance enhancement (PAPE) has been proposed with differing associated mechanisms and protocols than with PAP. However, these 2 terms (PAP and PAPE) may not adequately describe all specific potentiation responses and mechanisms and can also be complementary, in some cases. Purpose: This commentary presents and discusses the similarities and differences between PAP and PAPE and, subsequently, elaborates on a new taxonomy for better describing performance potentiation in sport settings. Conclusion: The elaborated taxonomy proposes the formula “Post-[CONDITIONING ACTIVITY] [VERIFICATION TEST] potentiation in [POPULATION].” This taxonomy would avoid erroneous identification of isolated physiological attributes and provide individualization and better applicability of conditioning protocols in sport settings.
Designed protein logic to target cells with precise combinations of surface antigens
Authors: Lajoie Marc J. , Boyken Scott E. , Salter Alexander I. , Bruffey Jilliane , Rajan Anusha , Langan Robert A. , Olshefsky Audrey , Muhunthan Vishaka , Bick Matthew J. , Gewe Mesfin , Quijano-Rubio Alfredo , Johnson JayLee , Lenz Garreck , Nguyen Alisha , Pun Suzie , Correnti Colin E. , Riddell Stanley R. , Baker David
Published: August 2020

Logic at the cell surface

A major challenge in medical interventions is to target only diseased cells. Although there are biomarkers characteristic of certain cancers, for example, it is unlikely that a single marker can specify a particular cell type. Lajoie
et al.
addressed this problem by designing protein switches called Co-LOCKR that bind to antigens on the cell surface and activate through a conformational change only when there is a precise combination of antigens. They designed switches that can perform AND, OR, and NOT logic. On the path toward applying this technology, they used Co-LOCKR to direct chimeric antigen receptor T cells to tumor cells expressing specific antigens.

Science
, this issue p.
1637
Structural basis of transcription-translation coupling
Authors: Wang Chengyuan , Molodtsov Vadim , Firlar Emre , Kaelber Jason T. , Blaha Gregor , Su Min , Ebright Richard H.
Published: August 2020

Cryo-EM structures of
Escherichia coli
transcription-translation complexes reveal how bacterial transcription and translation are coupled.
Adjuvant β-Lactam Therapy Combined with Vancomycin or Daptomycin for Methicillin-Resistant Staphylococcus aureus Bacteremia: a Systematic Review and Meta-analysis
Authors: Wang Chunjiang , Ye Chao , Liao Linglong , Wang Zhaohui , Hu Ying , Deng Chao , Liu Liang
Published: August 2020

Infections due to methicillin-resistant
Staphylococcus aureus
bacteremia (MRSAB) seriously threaten public health due to poor outcomes and high mortality. The objective of this study is to perform a systematic review and meta-analysis of the current evidence on adjuvant β-lactam (BL) therapy combined with vancomycin (VAN) or daptomycin (DAP) for MRSAB. PubMed, Embase, and Cochrane Library were systematically searched for publications reporting clinical outcomes of BLs+VAN or BLs+DAP for adult patients with MRSAB through 5 April 2020.
Clinical features to distinguish meningitis among young infants at a rural Kenyan hospital
Authors: Obiero Christina W , Mturi Neema , Mwarumba Salim , Ngari Moses , Newton Charles , Boele van Hensbroek Michael , Berkley James Alexander
Published: August 2020

Background

Detection of meningitis is essential to optimise the duration and choice of antimicrobial agents to limit mortality and sequelae. In low and middle-income countries most health facilities lack laboratory capacity and rely on clinical features to empirically treat meningitis.

Objective

We conducted a diagnostic validation study to investigate the performance of clinical features (fever, convulsions, irritability, bulging fontanel and temperature ≥39°C) and WHO-recommended signs (drowsiness, lethargy, unconsciousness, convulsions, bulging fontanel, irritability or a high-pitched cry) in discriminating meningitis in young infants.

Design

Retrospective cohort study.

Setting

Kilifi County Hospital.

Patients

Infants aged <60 days hospitalised between 2012 and 2016.

Main outcome measure

Definite meningitis defined as positive cerebrospinal fluid (CSF) culture, microscopy or antigen test, or leucocytes ≥0.05 x 10∧9/L.

Results

Of 4809 infants aged <60 days included, 81 (1.7%) had definite meningitis. WHO-recommended signs had sensitivity of 58% (95% CI 47% to 69%) and specificity of 57% (95% CI 56% to 59%) for definite meningitis. Addition of history of fever improved sensitivity to 89% (95% CI 80% to 95%) but reduced specificity to 26% (95% CI 25% to 27%). Presence of ≥1 of 5 previously identified signs had sensitivity of 79% (95% CI 69% to 87%) and specificity of 51% (95% CI 50% to 53%).

Conclusions

Despite a lower prevalence of definite meningitis, the performance of previously identified signs at admission in predicting meningitis was unchanged. Presence of history of fever improves the sensitivity of WHO-recommended signs but loses specificity. Careful evaluation, repeated assessment and capacity for lumbar puncture and CSF microscopy to exclude meningitis in most young infants with potential signs are essential to management in this age group.
Preterm delivery and long term mortality in women: national cohort and co-sibling study
Authors: Crump Casey , Sundquist Jan , Sundquist Kristina
Published: August 2020

Objectives

To examine the long term mortality associated with preterm delivery in a large population based cohort of women, and to assess for potential confounding by shared familial factors.

Design

National cohort study.

Setting

Sweden.

Participants

All 2 189 477 women with a singleton delivery in 1973-2015.

Main outcome measures

All cause and cause specific mortality up to 2016, identified from nationwide death records. Cox regression was used to calculate hazard ratios while adjusting for confounders, and co-sibling analyses assessed the potential influence of unmeasured shared familial (genetic and environmental) factors.

Results

In 50.7 million person years of follow-up, 76 535 (3.5%) women died (median age at death was 57.6). In the 10 years after delivery, the adjusted hazard ratio for all cause mortality associated with preterm delivery (<37 weeks) was 1.73 (95% confidence interval 1.61 to 1.87), and when further stratified was 2.20 (1.63 to 2.96) for extremely preterm delivery (22-27 weeks), 2.28 (2.01 to 2.58) for very preterm delivery (28-33 weeks), 1.52 (1.39 to 1.67) for late preterm delivery (34-36 weeks), and 1.19 (1.12 to 1.27) for early term delivery (37-38 weeks) compared with full term delivery (39-41 weeks). These risks declined but remained significantly raised after longer follow-up times: for preterm versus

full term births, 10-19 years after delivery, the adjusted hazard ratio was 1.45 (95% confidence interval 1.37 to 1.53); 20-44 years after delivery, the adjusted hazard ratio was 1.37 (1.33 to 1.41). These findings did not seem to be attributable to shared genetic or environmental factors within families. Several causes were identified, including cardiovascular and respiratory disorders, diabetes, and cancer.

Conclusions

In this large national cohort of women, the findings suggested that preterm and early term delivery were independent risk factors for premature mortality from several major causes. These associations declined over time but remained raised up to 40 years later.
Air pollution and family related determinants of asthma onset and persistent wheezing in children: nationwide case-control study
Authors: Holst Gitte J , Pedersen Carsten B , Thygesen Malene , Brandt Jørgen , Geels Camilla , Bønløkke Jakob H , Sigsgaard Torben
Published: August 2020

Objective

To identify risk factors (air pollution and family related) for the onset of asthma and persistent wheezing in children.

Design

Nationwide case-control study.

Setting

Denmark.

Participants

All Danish children born from 1997 to 2014 and followed for asthma onset and persistent wheezing from age 1 year to 15 years.

Main outcome measure

Onset of asthma and persistent wheezing.

Results

A higher incidence of asthma was found in children of parents with asthma (adjusted hazard ratio 2.29 (95% confidence interval 2.22 to 2.35) and mothers who smoked during pregnancy (1.20, 1.18 to 1.22), whereas a lower incidence was found in children of parents with high educational attainment (0.72, 0.69 to 0.75) and high incomes (0.85, 0.81 to 0.89). Exposure to particulate matter ≤2.5 µm (PM2.5) and ≤10 µm (PM10) and nitrate was associated with an increased risk of asthma and persistent wheezing, with hazard ratios per 5 µg/m3increase in pollutant concentrations 1.05 (1.03 to 1.07) for PM2.5, 1.04 (1.02 to 1.06) for PM10, and 1.04 (1.03 to 1.04) for nitrogen dioxide. Only the positive association of PM2.5with asthma and persistent wheezing remained robust across the different models and in sensitivity analyses.

Conclusions

The findings of this study suggest that children exposed to higher levels of PM2.5are more likely to develop asthma and persistent wheezing than children who are not exposed. Other risk factors associated with these outcomes were parental asthma, parental education, and maternal smoking during pregnancy.
Facilities are substantially more influential than care providers in the quality of delivery care received: a variance decomposition and clustering analysis in Kenya, Malawi and India
Authors: Helfinstein Sarah , Jain Mokshada , Ramesh Banadakoppa Manjappa , Blanchard James , Kemp Hannah , Gothalwal Vikas , Namasivayam Vasanthakumar , Kumar Pankaj , Sgaier Sema K
Published: August 2020

Introduction

Improving the quality of care during childbirth is essential for reducing neonatal and maternal mortality. One barrier to improving quality of care is understanding the appropriate level to target interventions. We examine quality of care data during labour and delivery from multiple countries to assess whether quality varies primarily from nurse to nurse within the same facility, or primarily between facilities.

Methods

To assess the relative contributions of nurses and facilities to variance in quality of care, we performed a variance decomposition analysis using a linear mixed effect model on two data sources: (1) the number of vital signs assessed for women in labour from a study of nurse practices in Uttar Pradesh, India; 2) broad-scale indices of respectful and competent care generated from Service Provision Assessments in Kenya and Malawi. We used unsupervised clustering, a data mining technique that groups objects together based on similar characteristics, to identify groups of facilities that displayed distinct patterns of vital signs assessment behaviour.

Results

We found 3–10 times more variance in quality of care was explained by the facility where a patient received care than by the nurse who provided it. The unsupervised clustering analysis revealed groups of facilities with highly distinctpatternsof vital signs assessment, even when overall rates of vital signs assessments were similar (eg, some facilities consistently test fetal heart rate, but not other vitals, others only blood pressure).

Conclusion

Facilities within a region can vary substantially in the quality of care they provide to women in labour, but within a facility, nurses tend to provide similar care. This holds true both for care that can be influenced by equipment availability and technical training (eg, vital signs assessment), as well as cultural aspects (eg, respectful care).
Psychological distress among refugees in Germany: a cross-sectional analysis of individual and contextual risk factors and potential consequences for integration using a nationally representative survey
Authors: Walther Lena , Kröger Hannes , Tibubos Ana Nanette , Ta Thi Minh Tam , von Scheve Christian , Schupp Jürgen , Hahn Eric , Bajbouj Malek
Published: August 2020

Objectives

Responding to the mental health needs of refugees remains a pressing challenge worldwide. We estimated the prevalence of psychological distress in a large refugee population in Germany and assessed its association with host country factors amenable to policy intervention and integration indicators.

Design

A cross-sectional and population-based secondary analysis of the 2017 wave of the IAB-BAMF-SOEP refugee survey.

Setting

Germany.

Participants

2639 adult refugees who arrived in Germany between 2013 and 2016.

Main outcome measures

Psychological distress involving symptoms of depression, anxiety and post-traumatic stress disorder was measured using the Refugee Health Screener-13.

Results

Almost half of the population surveyed (41.2% (95% CI: 37.9% to 44.6%)) was affected by mild, moderate or severe levels of psychological distress. 10.9% (8.4% to 13.5%) of the population screened positive for severe distress indicative of an urgent need for care. Prevalence of distress was particularly high for females (53.0% (47.2% to 58.8%)), older refugees (aged ≥55, 70.4% (58.5% to 82.2%)) and Afghans (61.5% (53.5% to 69.5%)). Individuals under threat of deportation were at a greater risk of distress than protection status holder (risk ratio: 1.55 (95% CI: 1.14 to 2.10)), single males at a greater risk than males with nuclear families living in Germany (1.34 (1.04 to 1.74)) and those in refugee housing facilities at a greater risk than those in private housing (1.21 (1.02 to 1.43)). Distressed males had a lower likelihood of employment (0.67 (0.52 to 0.86)) and reduced participation in integration courses (0.90 (0.81 to 0.99)). A trend of reduced participation in educational programmes was observed in affected females (0.42 (0.17 to 1.01)).

Conclusion

The finding that a substantial minority of refugees in Germany exhibits symptoms of distress calls for an expansion of mental health services for this population. Service providers and policy-makers should consider the increased prevalence among female, older and Afghan refugees, as well as among single males, residents in housing facilities and those under threat of deportation. The associations between mental health and integration processes such as labour market, educational programme and integration course participation also warrant consideration.
ENACT (ENvironmental enrichment for infants; parenting with Acceptance and Commitment Therapy): a randomised controlled trial of an innovative intervention for infants at risk of autism spectrum disorder
Authors: Whittingham Koa , McGlade Andrea , Kulasinghe Kavindri , Mitchell Amy E , Heussler Honey , Boyd Roslyn N
Published: August 2020

Introduction

Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental condition with impacts on behaviour, cognition, communication, social interaction and family mental health. This paper reports the protocol of a randomised controlled trial (RCT) of a very early intervention, ENACT (ENvironmental enrichment for infants; parenting with Acceptance and Commitment Therapy), for families of infants at risk of ASD.

Methods and analysis

We aim to recruit 66 mothers of infants at risk of ASD (ie, infants with a sibling or parent diagnosed with ASD) to this RCT. Families will be randomly assigned to care-as-usual or ENACT. ENACT is a very early intervention, leveraging parent–child interactions to improve early social reciprocity, while supporting parental mental health and the parent–child relationship through Acceptance and Commitment Therapy. Intervention content is delivered online (approximately 8 hours) and supported by more than 7 consultations with a clinician. Parents will perform the social reciprocity intervention with their child (30 min per day). Assessments at four time points (baseline, 3 months, 6 months, and 12 months corrected age) will assess parent–infant interaction, parental mental health, infant development and early ASD markers. Analysis will be by intention to treat using general linear models for RCTs.

Ethics and dissemination

This protocol has been approved by the Children’s Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC/19/QCHQ/50131) and the University of Queensland Human Research Ethics Committee (2019000558). If efficacy is demonstrated, the intervention has the potential for wide and accessible dissemination.

Trial registration number

Australian New Zealand Clinical Trials Registry (ACTRN12618002046280).
Multiple-dose tranexamic acid for perioperative blood loss in total knee arthroplasty in patients with rheumatoid arthritis：a single-blinded, randomised, parallel-controlled study protocol in China
Authors: Kang Bing-Xin , Xu Hui , Gao Chen-Xin , Zhong Sheng , Zhang Jing , Xie Jun , Sun Song-Tao , Ma Ying-Hui , Zhai Wei-Tao , Xiao Lian-Bo
Published: August 2020

Introduction

This clinical trial is designed to evaluate the effect of multiple-dose tranexamic acid (TXA) on perioperative blood loss in patients with rheumatoid arthritis (RA).

Methods and analysis

A randomised, single-blinded, parallel-controlled study will be designed. Patients with RA (age 50–75 years) undergoing unilateral primary end-stage total knee arthroplasty will be randomly divided into group A or group B. Group A will be treated with one dose of TXA (1 g; intravenous injection 3 hours postsurgery) and group B with three doses (1 g; intravenous injection at 3, 6 and 12 hours postsurgery) after surgery. The primary outcomes will be evaluated with blood loss, maximum haemoglobin drop and transfusion rate. The secondary outcomes will be evaluated with knee function and complications.

Ethics and dissemination

The Shanghai Guanghua Hospital of Integrated Traditional Chinese Medicine and Western Medicine Ethics Committee approved in this study in July 2019. Informed consent will be obtained from all participants. Results of the trial will be published in the Dryad and repository in a peer-reviewed journal. Additionally, deidentified data collected and analysed for this study will be available for review from the corresponding author on reasonable request.

Trial registration number

ChiCTR1900025013.