bluuebunny/crossref_metadata_2025 huggingface dataset:
Cost‐effectiveness of Endoscopic Polypectomy in Clinic compared to Endoscopic Sinus Surgery: A modelling study
Authors: Kumar Srishti , Thavorn Kednapa , van Katwyk Sasha , Lasso Andrea , Kilty Shaun J
Published: March 2020

Objective

To compare costs and quality‐adjusted life years of patients receiving endoscopic polypectomy in the clinic those receiving endoscopic sinus surgery from the perspective of Canada's health system.

Method

We developed a Markov model to simulate costs and quality‐adjusted life years among a cohort of patients with chronic rhinosinusitis with polyps who received endoscopic polypectomy in clinic or endoscopic sinus surgery, over a patient's lifetime. Our study focused on patients with chronic rhinosinusitis with polyps who have the predominant symptom of bilateral nasal obstruction. Cost data were obtained from Canadian sources. Health utility values were derived from Sino‐nasal Outcome Test (SNOT‐22) scores reported in the published literature. A cycle length of six months was used. Both costs and quality‐adjusted life years were discounted using an annual rate of 1.5%. We conducted one‐way and probabilistic sensitivity analyses to assess the robustness of the study findings.

Results

Endoscopic polypectomy in clinic was a cost‐saving option as it had a lower cost (C$736 vs. C$6,728) and produced more quality‐adjusted life years (13.85 vs 13.06) compared to endoscopic sinus surgery. Our findings were, however, highly sensitive to health utility values. Results from probabilistic sensitivity analysis showed that endoscopic polypectomy in clinic had a lower cost and was more effective compared to endoscopic sinus surgery in 99.86% of iterations.

Conclusion

From the perspective of the publicly funded healthcare system, endoscopic polypectomy in clinic was economically attractive compared to endoscopic sinus surgery for chronic rhinosinusitis with polyps patients who have a primary symptom of bilateral nasal obstruction. The cost‐effectiveness results are, however, highly dependent on the relative impact of endoscopic polypectomy in the clinic and endoscopic sinus surgery on post‐surgery health utility values.
Opening the black box: Personalizing type 2 diabetes patients based on their latent phenotype and temporal associated complication rules
Authors: Yousefi Leila , Swift Stephen , Arzoky Mahir , Saachi Lucia , Chiovato Luca , Tucker Allan
Published: March 2020

It is widely considered that approximately 10% of the population suffers from type 2 diabetes. Unfortunately, the impact of this disease is underestimated. Patient's mortality often occurs due to complications caused by the disease and not the disease itself. Many techniques utilized in modeling diseases are often in the form of a “black box” where the internal workings and complexities are extremely difficult to understand, both from practitioners' and patients' perspective. In this work, we address this issue and present an informative model/pattern, known as a “latent phenotype,” with an aim to capture the complexities of the associated complications' over time. We further extend this idea by using a combination of temporal association rule mining and unsupervised learning in order to find explainable subgroups of patients with more personalized prediction. Our extensive findings show how uncovering the latent phenotype aids in distinguishing the disparities among subgroups of patients based on their complications patterns. We gain insight into how best to enhance the prediction performance and reduce bias in the models applied using uncertainty in the patients'
data.
Competition for nectar resources does not affect bee foraging tactic constancy
Authors: Lichtenberg Elinor M. , Richman Sarah K. , Irwin Rebecca E. , Bronstein Judith L.
Published: March 2020

1. Competition alters animal foraging, including promoting the use of alternative resources. It may also impact how animals feed when they are able to handle the same food with more than one tactic. Competition likely impacts both consumers and their resources through its effects on food handling, but this topic has received little attention.

2. Bees often use two tactics for extracting nectar from flowers: they can visit at the flower opening, or rob nectar from holes at the base of flowers. Exploitative competition for nectar is thought to promote nectar robbing. If so, higher competition among floral visitors should reduce constancy to a single foraging tactic as foragers will seek food using all possible tactics. To test this prediction, field observations and two experiments involving bumble bees visiting three montane Colorado plant species (Mertensia ciliata, Linaria vulgaris, Corydalis caseana) were used under various levels of inter‐ and intra‐specific competition for nectar.

3. In general, individual bumble bees remained constant to a single foraging tactic, independent of competition levels. However, bees that visited M. ciliata in field observations decreased their constancy and increased nectar robbing rates as visitation rates by co‐visitors increased.

4. While tactic constancy was high overall regardless of competition intensity, this study highlights some intriguing instances in which competition and tactic constancy may be linked. Further studies investigating the cognitive underpinnings of tactic constancy should provide insight on the ways in which animals use alternative foraging tactics to exploit resources.
Alteration of free amino acid concentrations in insect galls induced by Andricus mukaigawae (Hymenoptera; Cynipidae)
Authors: Yang Xiao‐Hui , Li Xiang‐Mei , Zhu Dao‐Hong
Published: March 2020

1. Insect galls are abnormal plant growths that develop in response to a stimulus provided by a galling insect. The nutrition hypothesis suggests that the concentrations of nutritive compounds in galls are changed to provide optimum nutrition for the larvae and adults of galling insects.

2. To test the nutrition hypothesis, we determined the concentrations of 20 free amino acids in galls and in galled and ungalled twigs of Quercus fabri during the larval and adult stages of Andricus mukaigawae using high‐performance liquid chromatography with ultraviolet–visible detection.

3. At the larval stage, the concentrations of 12 out of 20 amino acids in A. mukaigawae galls were significantly higher than those in galled and ungalled twigs. Asparagine and tryptophan were the most abundant nonessential and essential amino acids, respectively, in A. mukaigawae galls.

4. At the adult stage, the concentrations of most amino acids, except proline, were significantly lower in A. mukaigawae galls than in galled and ungalled twigs. The A. mukaigawae adults may not manipulate amino acid levels because the adults do not feed on galls. The decrease of amino acid levels in adult galls may be viewed as a depletion.

5. The composition of free amino acids in A. mukaigawae galls was significantly different from the composition in galled and ungalled twigs in both the larval and adult stages.

6. Our results may support the nutrition hypothesis. We suggest that a high concentration of proline in A. mukaigawae galls may protect larvae and adults from plant defense responses.
Predators weaken prey intraspecific competition through phenotypic selection
Authors: Siepielski Adam M. , Hasik Adam Z. , Ping Taylor , Serrano Mabel , Strayhorn Koby , Tye Simon P.
Published: March 2020

Predators have a key role shaping competitor dynamics in food webs. Perhaps the most obvious way this occurs is when predators reduce competitor densities. However, consumption could also generate phenotypic selection on prey that determines the strength of competition, thus coupling consumptive and trait‐based effects of predators. In a mesocosm experiment simulating fish predation on damselflies, we found that selection against high damselfly activity rates – a phenotype mediating predation and competition – weakened the strength of density dependence in damselfly growth rates. A field experiment corroborated this finding and showed that increasing damselfly densities in lakes with high fish densities had limited effects on damselfly growth rates but generated a precipitous growth rate decline where fish densities were lower – a pattern expected because of spatial variation in selection imposed by predation. These results suggest that accounting for both consumption and selection is necessary to determine how predators regulate prey competitive interactions.
Trade‐offs in soil carbon protection mechanisms under aerobic and anaerobic conditions
Authors: Huang Wenjuan , Ye Chenglong , Hockaday William C. , Hall Steven J.
Published: March 2020

Oxygen (O2) limitation is generally understood to suppress oil carbon (C) decomposition and is a key mechanism impacting terrestrial C stocks under global change. Yet, O2 limitation may differentially impact kinetic or thermodynamic versus physicochemical C protection mechanisms, challenging our understanding of how soil C may respond to climate‐mediated changes in O2 dynamics. Although O2 limitation may suppress decomposition of new litter C inputs, release of physicochemically protected C due to iron (Fe) reduction could potentially sustain soil C losses. To test this trade‐off, we incubated two disparate upland soils that experience periodic O2 limitation—a tropical rainforest Oxisol and a temperate cropland Mollisol—with added litter under either aerobic (control) or anaerobic conditions for 1 year. Anoxia suppressed total C loss by 27% in the Oxisol and by 41% in the Mollisol relative to the control, mainly due to the decrease in litter‐C decomposition. However, anoxia sustained or even increased decomposition of native soil‐C (11.0% vs. 12.4% in the control for the Oxisol and 12.5% vs. 5.3% in the control for the Mollisol, in terms of initial soil C mass), and it stimulated losses of metal‐ or mineral‐associated C. Solid‐state 13C nuclear magnetic resonance spectroscopy demonstrated that anaerobic conditions decreased protein‐derived C but increased lignin‐ and carbohydrate‐C relative to the control. Our results indicate a trade‐off between physicochemical and kinetic/thermodynamic C protection mechanisms under anaerobic conditions, whereby decreased decomposition of litter C was compensated by more extensive loss of mineral‐associated soil C in both soils. This challenges the common assumption that anoxia inherently protects soil C and illustrates the vulnerability of mineral‐associated C under anaerobic events characteristic of a warmer and wetter future climate.
Number of functional teeth more strongly predicts all‐cause mortality than number of present teeth in Japanese older adults
Authors: Maekawa Kenji , Ikeuchi Tomoko , Shinkai Shoji , Hirano Hirohiko , Ryu Masahiro , Tamaki Katsushi , Yatani Hirofumi , Kuboki Takuo ,   Kusatsu ISLE Study Working Group Collaborators, Kimura‐Ono Aya , Kikutani Takeshi , Suganuma Takashi , Ayukawa Yasunori , Gonda Tomoya , Ogawa Toru , Fujisawa Masanori , Ishigaki Shoichi , Watanabe Yutaka , Kitamura Akihiko , Taniguchi Yu , Fujiwara Yoshinori , Edahiro Ayako , Ohara Yuki , Furuya Junichi , Nakajima Junko , Umeki Kento , Igarashi Kentaro , Horibe Yasuhiro , Kugimiya Yoshihiro , Kawai Yasuhiko , Matsumura Hideo , Ichikawa Tetsuo , Ohkawa Shuji
Published: March 2020

Aim

Previous studies on the association between intraoral conditions and mortality in community‐dwelling older individuals reported that fewer present teeth (PT) are significant risk factors for mortality. However, how the number of PT relative to the number of functional teeth (FT), including both present and rehabilitated teeth, influences mortality has not been investigated fully. This study examined the impact of the number of FT on mortality among community‐dwelling Japanese older adults.

Methods

This study was a retrospective, observational and population‐based follow‐up study, which examined 1188 older individuals who participated in an annual geriatric health examination from 2009 to 2015. The average follow‐up period was 1697.0 ± 774.5 days. The primary outcome was all‐cause mortality at follow‐up. The numbers of PT and FT of each participant were counted during an oral examination. In addition, demographics, clinical variables, blood nutrient markers, physical functions and perceived masticatory function were measured.

Results

Kaplan–Meier analysis, followed by a log‐rank test, revealed that fewer PT (P < 0.001) and FT (P = 0.002) were significantly associated with a reduced survival rate. Cox's proportional hazard analysis indicated that the number of FT, but not the number of PT, was a significant independent mortality risk factor after adjusting for demographics, clinical variables, nutrient markers and physical functioning (P = 0.036, hazard ratio: 2.089).

Conclusions

Current results suggest that the number of FT more strongly predicts all‐cause mortality than the number of PT among community‐dwelling older adults. Further studies are necessary to consider the confounding of socioeconomic status and disability status. Geriatr Gerontol Int 2020; ••: ••–••.
Recombinant factor VIII Fc fusion protein for the treatment of severe haemophilia A: Final results from the ASPIRE extension study
Authors: Nolan Beatrice , Mahlangu Johnny , Pabinger Ingrid , Young Guy , Konkle Barbara A. , Barnes Chris , Nogami Keiji , Santagostino Elena , Pasi K. John , Khoo Liane , Winding Bent , Yuan Huixing , Fruebis Joachim , Rudin Dan , Oldenburg Johannes
Published: March 2020

Introduction

The efficacy and safety of recombinant factor VIII Fc fusion protein (rFVIIIFc) as an extended half‐life treatment for severe haemophilia A were demonstrated in the Phase 3 A‐LONG and Kids A‐LONG studies. Eligible subjects who completed A‐LONG and Kids A‐LONG could enrol in ASPIRE (NCT01454739), an open‐label extension study.

Aim

To report the long‐term safety and efficacy of rFVIIIFc in subjects with severe haemophilia A who enrolled in ASPIRE.

Methods

Previously treated subjects received one or more of the following regimens: individualized prophylaxis (IP), weekly prophylaxis, modified prophylaxis or episodic treatment. Subjects could switch treatment regimen at any time. The primary endpoint was inhibitor development.

Results

A total of 150 subjects from A‐LONG and 61 subjects from Kids A‐LONG enrolled in ASPIRE. Most subjects received the IP regimen (A‐LONG: n = 110; Kids A‐LONG: n = 59). Median (range) treatment duration in ASPIRE for subjects from A‐LONG and Kids A‐LONG was 3.9 (0.1‐5.3) years and 3.2 (0.3‐3.9) years, respectively. No inhibitors were observed (0 per 1000 subject‐years; 95% confidence interval, 0‐5.2) and the overall rFVIIIFc safety profile was consistent with prior studies. For subjects on the IP regimen, annualized bleed rates (ABR) remained low (median overall ABR for adults and adolescents was <1.0) and extended‐dosing intervals were maintained (median of 3.5 days) for the majority of subjects in ASPIRE.

Conclusion

ASPIRE results, which include up to 5 years of follow‐up data, confirm earlier reports on the consistent and well‐characterized safety and efficacy of rFVIIIFc treatment for severe haemophilia A.
Experimental models and methods for cutaneous wound healing assessment
Authors: Masson‐Meyers Daniela S. , Andrade Thiago A. M. , Caetano Guilherme F. , Guimaraes Francielle R. , Leite Marcel N. , Leite Saulo N. , Frade Marco Andrey C.
Published: March 2020

Wound healing studies are intricate, mainly because of the multifaceted nature of the wound environment and the complexity of the healing process, which integrates a variety of cells and repair phases, including inflammation, proliferation, reepithelialization and remodelling. There are a variety of possible preclinical models, such as in mice, rabbits and pigs, which can be used to mimic acute or impaired for example, diabetic and nutrition‐related wounds. These can be induced by many different techniques, with excision or incision being the most common. After determining a suitable model for a study, investigators need to select appropriate and reproducible methods that will allow the monitoring of the wound progression over time. The assessment can be performed by non‐invasive protocols such as wound tracing, photographic documentation (including image analysis), biophysical techniques and/or by invasive protocols that will require wound biopsies. In this article, we provide an overview of some of the most often needed and used: (a) preclinical/animal models including incisional, excisional, burn and impaired wounds; (b) methods to evaluate the healing progression such as wound healing rate, wound analysis by image, biophysical assessment, histopathological, immunological and biochemical assays. The aim is to help researchers during the design and execution of their wound healing studies.
Shannon's Entropy and Its Generalisations Towards Statistical Inference in Last Seven Decades
Authors: Nanda Asok K. , Chowdhury Shovan
Published: March 2020

Starting from the pioneering works of Shannon and Weiner in 1948, a plethora of works have been reported on entropy in different directions. Entropy‐related review work in the direction of statistical inference, to the best of our knowledge, has not been reported so far. Here, we have tried to collect all possible works in this direction during the last seven decades so that people interested in entropy, specially the new researchers, get benefited.
Cryopreserved human skin allografts promote angiogenesis and dermal regeneration in a murine model
Authors: Henn Dominic , Chen Kellen , Maan Zeshaan N. , Greco Autumn H. , Moortgat Illouz Sylvia E. , Bonham Clark A. , Barrera Janos A. , Trotsyuk Artem A. , Padmanabhan Jagannath , Momeni Arash , Wan Derrick C. , Nguyen Dung , Januszyk Michael , Gurtner Geoffrey C.
Published: March 2020

Cryopreserved human skin allografts (CHSAs) are used for the coverage of major burns when donor sites for autografts are insufficiently available and have clinically shown beneficial effects on chronic non‐healing wounds. However, the biologic mechanisms behind the regenerative properties of CHSA remain elusive. Furthermore, the impact of cryopreservation on the immunogenicity of CHSA has not been thoroughly investigated and raised concerns with regard to their clinical application. To investigate the importance and fate of living cells, we compared cryopreserved CHSA with human acellular dermal matrix (ADM) grafts in which living cells had been removed by chemical processing. Both grafts were subcutaneously implanted into C57BL/6 mice and explanted after 1, 3, 7, and 28 days (n = 5 per group). A sham surgery where no graft was implanted served as a control. Transmission electron microscopy (TEM) and flow cytometry were used to characterise the ultrastructure and cells within CHSA before implantation. Immunofluorescent staining of tissue sections was used to determine the immune reaction against the implanted grafts, the rate of apoptotic cells, and vascularisation as well as collagen content of the overlaying murine dermis. Digital quantification of collagen fibre alignment on tissue sections was used to quantify the degree of fibrosis within the murine dermis. A substantial population of live human cells with intact organelles was identified in CHSA prior to implantation. Subcutaneous pockets with implanted xenografts or ADMs healed without clinically apparent rejection and with a similar cellular immune response. CHSA implantation largely preserved the cellularity of the overlying murine dermis, whereas ADM was associated with a significantly higher rate of cellular apoptosis, identified by cleaved caspase‐3 staining, and a stronger dendritic cell infiltration of the murine dermis. CHSA was found to induce a local angiogenic response, leading to significantly more vascularisation of the murine dermis compared with ADM and sham surgery on day 7. By day 28, aggregate collagen‐1 content within the murine dermis was greater following CHSA implantation compared with ADM. Collagen fibre alignment of the murine dermis, correlating with the degree of fibrosis, was significantly greater in the ADM group, whereas CHSA maintained the characteristic basket weave pattern of the native murine dermis. Our data indicate that CHSAs promote angiogenesis and collagen‐1 production without eliciting a significant fibrotic response in a xenograft model. These findings may provide insight into the beneficial effects clinically observed after treatment of chronic wounds and burns with CHSA.
Habitats and fish communities at mesophotic depths in the Mexican Pacific
Authors: Hollarsmith Jordan A. , Ramírez‐Ortiz Georgina , Winquist Tallulah , Velasco‐Lozano Manuel , DuBois Katherine , Reyes‐Bonilla Héctor , Neumann Kyle C. , Grosholz Edwin D.
Published: March 2020

Aim

Mesophotic ecosystems, found at the limit of light penetration in the ocean, are rich in biodiversity and harbour unique ecological communities. However, they remain among the least studied habitat zones on earth due to the high costs and technological limitations. Here, we characterize mesophotic communities in two marine reserves across a range of habitat types, depths and temperatures using submersible technologies, with the goal of understanding the processes that structure these communities across biogeographical regions.

Location

The Bay of La Paz and the Revillagigedo Archipelago, Mexico.

Taxa

Fish and algal species.

Methods

We used a small and inexpensive remotely operated vehicle (ROV) to conduct roving‐swim surveys of major habitat types in depths from 12 to 94 m. With the resulting binary data on the presence of fish species, we used generalized linear mixed models and canonical correspondence analysis to determine whether biogenic habitat, depth and/or temperature best explained species richness and community structure across reef and non‐reef substrate.

Results

We identified 72 species or genera, including new depth records for nine fish species and a new geographical record for one fish species. Our surveys included large undocumented rhodolith beds (free‐living coralline algae) and mesophotic algal communities, in addition to diverse communities of soft corals and sponges. Fish species richness was positively associated with rocky substrate and warmer water, and reef fish communities differed significantly by depth, temperature and biogenic habitat.

Main conclusion

Our results highlight the importance of biogenic habitat in structuring communities across gradients of depth and temperature. We also demonstrate the effectiveness of a small and economical ROV for conducting mesophotic surveys in remote regions. Our methods and results provide a framework that can be used to greatly increase the biogeographical and taxonomic scope of mesophotic research, especially for readily identifiable taxa such as fish.
Linking learner factors, teaching context, and engagement patterns withMOOClearning outcomes
Authors: Deng Ruiqi , Benckendorff Pierre , Gannaway Deanne
Published: March 2020

Prior studies of MOOC learners have focused almost exclusively on behavioural and social aspects of engagement. This paper extends the scope of previous studies by adopting a multi‐dimensional, person‐centred approach to investigate learner engagement in MOOCs. An analysis of 1,452 self‐administered survey responses uncovered three prototypical categories of MOOC learners based on patterns of behavioural, cognitive, emotional and social engagement: (a) “Individually Engaged” learners, (b) “Least Engaged” learners and (c) “Wholly Engaged” learners. The study revealed significant differences among the three cohorts of MOOC participants with respect to learner factors (gender, origin, motivation), teaching context (course level, course duration, form of the assessment) and learning outcomes (course completion, perceived quality of instruction). The results of this study suggest that adopting a multi‐dimensional, person‐centred approach can be useful for researchers and practitioners to classify MOOC learners into subpopulations, design effective educational interventions that best engage different types of learners, and provide support and scaffolding to individuals with idiosyncratic or problematic engagement patterns.
Personalized application of three different concentrations of iodinated contrast media in coronary computed tomography angiography
Authors: Zhang Meng , Hao Panpan , Jiang Chenyu , Hao Guoxiang , Li Bin , Hu Peixin , Chen Qingjie , Chen Yuguo , Zhang Aifeng , Zhang Yun , Liu Yanping
Published: March 2020

No study has evaluated the impact of different iodinated contrast media on coronary contrast enhancement, using an injection protocol according to body surface area (BSA). Thus, the present study aimed to examine the usefulness and safety of personalized application of different iodine concentrations of contrast media in coronary computed tomographic (CT) angiography with a 2nd dual‐source CT scanner in eliminating differences in coronary contrast enhancement based on a BSA‐adapted injection protocol of contrast media. A total of 270 enrolled participants were randomly assigned to three groups: ioversol 320, ioversol 350 and iopromide 370 (n = 90 per group). The three groups were administered contrast media at a BSA‐adjusted volume and flow rate with a fixed injection time of 15 seconds, and they subsequently received a 30‐mL saline flush. All patients were scanned with a prospective electrocardiogram‐gated protocol in a craniocaudal direction using a second‐generation 128‐slice dual‐source CT system. The three iodinated contrast media used in coronary CT angiography exhibited similar diagnostic quality and safety. No significant differences were found in the contrast enhancement degrees, image quality scores, radiation doses and incidences of adverse effects among the three groups. The three contrast media used in coronary CT angiography with 320, 350 and 370 mg/mL iodine, respectively, have comparable diagnostic quality and safety. However, more large‐scale, multinational, multi‐centre and prospective trials are warranted.
Chemokine receptor 5 blockade modulates macrophage trafficking in renal ischaemic‐reperfusion injury
Authors: Yoo Kyung Don , Cha Ran‐hui , Lee Sunhwa , Kim Ji Eun , Kim Kyu Hong , Lee Jong Soo , Kim Dong Ki , Kim Yon Su , Yang Seung Hee
Published: March 2020

Chemokine receptor 5 (CCR5) is a pivotal regulator of macrophage trafficking in the kidneys in response to an inflammatory cascade. We investigated the role of CCR5 in experimental ischaemic‐reperfusion injury (IRI) pathogenesis. To establish IRI, we clamped the bilateral renal artery pedicle for 30 min and then reperfused the kidney. We performed adoptive transfer of lipopolysaccharide (LPS)‐treated RAW 264.7 macrophages following macrophage depletion in mice. B6.CCR5−/− mice showed less severe IRI based on tubular epithelial cell apoptosis than did wild‐type mice. CXCR3 expression in CD11b+ cells and inducible nitric oxide synthase levels were more attenuated in B6.CCR5−/− mice. B6.CCR5−/− mice showed increased arginase‐1 and CD206 expression. Macrophage‐depleted wild‐type mice showed more injury than B6.CCR5−/− mice after M1 macrophage transfer. Adoptive transfer of LPS‐treated RAW 264.7 macrophages reversed the protection against IRI in wild‐type, but not B6.CCR5−/− mice. Upon knocking out CCR5 in macrophages, migration of bone marrow‐derived macrophages from wild‐type mice towards primary tubular epithelial cells with recombinant CCR5 increased. Phospho‐CCR5 expression in renal tissues of patients with acute tubular necrosis was increased, showing a positive correlation with tubular inflammation. In conclusion, CCR5 deficiency favours M2 macrophage activation, and blocking CCR5 might aid in treating acute kidney injury.
Alcohol‐induced impaired insulin secretion in a Japanese population: 5‐year follow up in the Gifu Diabetes Study
Authors: Ueda Natsumi , Yamamoto Mayumi , Nakamura Mitsuhiro , Motooka Yumi , Nakayama Yoko , Nonoyama Yukiko , Oba Shino , Horikawa Yukio , Nagata Chisato , Yabe Daisuke ,   Gifu Diabetes Study Group
Published: March 2020

Aims/Introduction

Although moderate alcohol consumption lowers the risk of type 2 diabetes in European populations, the same cannot be assumed for Japanese patients with diabetes related to low insulin secretion rather than resistance. We aimed to evaluate the effects of daily alcohol consumption on glucose tolerance and diabetes development risk in Japanese populations.

Materials and methods

This retrospective study randomly enrolled 452 men and 659 women aged 40–78 years in 2005 (Gifu, Japan). The participants completed a 75‐g oral glucose tolerance test and medical questionnaire. The homeostasis model assessment of insulin resistance, homeostasis model assessment of β‐cell function and insulinogenic index were used to estimate insulin sensitivity and secretion. The relationships between alcohol consumption and these parameters were analyzed using logistic regression after adjusting for potential confounders. The 5‐year changes in hemoglobin A1c levels were also evaluated.

Results

The adjusted odds ratios for elevated homeostasis model assessment of β‐cell function values (<40%) in the 0–19.9 g/day, 20.0–39.9 g/day and ≥ 40 g/day alcohol consumption groups were 0.98, 1.46 and 2.68, respectively. Alcohol consumption induced a significant decrease in the insulin secretion level among the ≥40 g/day drinkers, especially in men. However, there was no risk of increased insulin resistance based on the homeostasis model assessment of insulin resistance (<2.5) results. The 5‐year risk of elevated hemoglobin A1c levels (≥6.5%) was increased according to increase in alcohol consumption in both men and women.

Conclusions

Daily alcohol consumption was associated with reduced insulin secretion and an increased diabetes development risk in Japanese populations.
Teledermatology – its place in modern skin healthcare worldwide
Authors: Burg G.
Published: March 2020

Linked article: V. Andrees, et al. J Eur Acad Dermatol Venereol 2020; 34: 733–745. https://doi.org/10.1111/jdv.16070.
A Novel Intervention to Identify and Report Suspected Abuse in Older, Primary Care Patients
Authors: Ejaz Farida K. , Rose Miriam , Reynolds Courtney , Bingle Catherine , Billa Deborah , Kirsch Raymond
Published: March 2020

BACKGROUND

Previous research has identified several barriers faced by clinicians in detecting and reporting elder abuse, such as lack of knowledge about the process to report suspected cases of abuse and lack of access to experts to consult with. A novel intervention was designed and tested that embedded two Adult Protective Services (APS) specialists in a healthcare system operating primary care clinics serving a large Medicare population.

OBJECTIVES

To examine the types of roles the APS specialists played in the healthcare system and the number and types of cases of suspected abuse among older patients that clinicians consulted them about and reported to APS.

DESIGN

Cross‐sectional, exploratory study.

SETTING

Primary care clinics in five regions of Texas.

PARTICIPANTS

Older patients of primary care clinics.

INTERVENTION

APS specialists and project staff trained clinicians on how to identify and report abuse, neglect, and exploitation among older patients. The specialists were also available in person or by telephone and email to consult with clinicians about patients suspected of being abused by others or being self‐neglecting.

MEASUREMENTS

Data were obtained by conducting semistructured telephone interviews with APS specialists; and from APS specialistsʼ written documentation/notes of consultations with clinicians regarding suspicion of abuse among patients and whether a report to APS was warranted.

RESULTS

The APS specialists trained clinicians on abuse, consulted with clinicians, and served as a liaison between the healthcare system and APS. During the project, clinicians reported 529 older patients to APS, and 386 patients received one or more services documented by APS at case closure. These cases involved 902 allegations of various types of abuse, of which the most common was self‐neglect (617 or 68%).

CONCLUSION

Embedding APS specialists in a large healthcare system led to cliniciansʼ increased awareness of the importance of identifying and reporting elder abuse, particularly self‐neglect. J Am Geriatr Soc 68:1748‐1754, 2020.
Braincase anatomy of Almadasuchus figarii (Archosauria, Crocodylomorpha) and a review of the cranial pneumaticity in the origins of Crocodylomorpha
Authors: Leardi Juan Martín , Pol Diego , Clark James Matthew
Published: March 2020

Almadasuchus figarii is a basal crocodylomorph recovered from the Upper Jurassic levels of the Cañadón Calcáreo Formation (Oxfordian–Tithonian) of Chubut, Argentina. This taxon is represented by cranial remains, which consist of partial snout and palatal remains; an excellently preserved posterior region of the skull; and isolated postcranial remains. The skull of the only specimen of the monotypic Almadasuchus was restudied using high‐resolution computed micro tomography. Almadasuchus has an apomorphic condition in its skull shared with the closest relatives of crocodyliforms (i.e. hallopodids) where the quadrates are sutured to the laterosphenoids and the otoccipital contacts the quadrate posterolaterally, reorganizing the exit of several cranial nerves (e.g. vagus foramen) and the entry of blood vessels (e.g. internal carotids) on the occipital surface of the skull. The endocast is tubular, as previously reported in thalattosuchians, but has a marked posterior step, and a strongly projected floccular recess as in other basal crocodylomorphs. Internally, the skull of Almadasuchus is heavily pneumatized, where different air cavities invade the bones of the suspensorium and braincase, both on its dorsal or ventral parts. Almadasuchus has a large basioccipital recess, which is formed by cavities that excavate the basioccipital and the posterior surface of the basisphenoid, and unlike other crocodylomorphs is connected with the basisphenoid pneumatizations. Ventral to the otic capsule, a pneumatic cavity surrounded by the otoccipital and basisphenoid is identified as the rhomboidal recess. The quadrate of Almadasuchus is highly pneumatized, being completely hollow, and the dorsal pneumatizations of the braincase are formed by the mastoid and facial antra, and a laterosphenoid cavity (trigeminal diverticulum). To better understand the origins of pneumatic features in living crocodylomorphs we studied cranial pneumaticity in the basal members of Crocodylomorpha and found that: (a) prootic pneumaticity may be a synapomorphy for the whole clade; (b) basisphenoid pneumaticity (pre‐, postcarotid and rostral recesses) is a derived feature among basal crocodylomorphs; (c) quadrate pneumatization is acquired later in the history of the group; and (d) the rhomboidal sinus is a shared derived trait of hallopodids and crocodyliforms. The marine thallatosuchians exhibit a reduction of the pneumaticity of the braincase and this reduction is evaluated considering the two phylogenetic positions proposed for the clade.
Association between serum 25‐hydroxyvitamin D levels and the presence and severity of striae gravidarum in primigravid women
Authors: Hocaoglu Emre , Hocaoglu Meryem , Akdeniz Esra
Published: March 2020

Background

Striae gravidarum (SG) are a form of scarring on the skin observed during pregnancy and an important cosmetic problem. Vitamin D plays an important role in the skin.

Aims

To assess the association between serum 25‐hydroxyvitamin D (25(OH)D) levels and the presence and severity of SG in primigravid women.

Methods

The study included 91 primigravid women at the gestational age of 36‐41 weeks. Patients were examined and divided into two groups with respect to whether they had SG or not. Striae were scored using the numerical scoring system of Atwal et al. The serum 25(OH)D levels were evaluated.

Results

While 55 patients (60.5%) had SG, 36 (39.5%) did not. The mean serum 25(OH)D level of women with SG was 17.69 ± 9.81 ng/mL and of women without SG was 21.18 ± 11.71 ng/mL. There was no statistically significant difference between two groups (P = .144). Multivariate logistic regression analysis has shown that women who have normal values of serum 25(OH)D (≥30 ng/mL) have a lower risk of having SG than women who have scarce levels of serum 25(OH)D (<20 ng/mL) after adjusting for confounding factors (adjusted odds ratio = 0.18, 95% confidence interval: 0.04‐0.72, P = .015). According to the results of the linear‐by‐linear test, the association between serum 25(OH)D levels and the severity of SG was not found significant (P = .82).

Conclusions

This is the first study to show that having normal values of serum 25(OH)D is linked to a lower risk of having SG than scarce levels. Therefore, management of vitamin D deficiency might help prevent SG in primigravid women.
Homecare professionals’ observation of deteriorating, frail older patients: A mixed‐methods study
Authors: Strømme Torunn , Aase Karina , Tjoflåt Ingrid
Published: March 2020

Aim and objectives

To develop knowledge about homecare professionals’ observational competence in early recognition of deterioration in frail older patients.

Background

The number of frail older patients in homecare has been rising, and these patients are at higher risk of deterioration and mortality. However, studies are scarce on homecare professionals’ recognition and response to clinical deterioration in homecare.

Design

This study applies an explorative, qualitative, mixed‐methods design.

Methods

The data were collected in two homecare districts in 2018 during 62 hr of participant observation, as well as from six focus group interviews. The data were subjected to qualitative content analyses. The Standards for Reporting Qualitative Research (SRQR) checklist was used to report the results.

Results

The data analyses revealed two main themes and five sub‐themes related to homecare professionals’ observational practices. The first main theme entailed patient‐situated assessment of changes in patients’ clinical condition, that is, the homecare professionals’ recognised changes in patients’ physical and mental conditions. The second theme was the organisational environment, in which planned, practical tasks and collaboration and collegial support were emphasised.

Conclusions

The homecare professionals in the two districts varied in their ability to recognise signs of patient deterioration. Their routines are described in detailed work plans, which seemed to affect assessment of their patients’ decline.

Relevance for clinical practice

The results can inform homecare services on how homecare professionals’ observational competence and an appropriate organisational system are essential in ensuring early detection of deterioration in frail older patients.
Decision‐making in multiagency multiteam systems operating in extreme environments
Authors: Waring Sara , Moran Jami‐Louise , Page Rachel
Published: March 2020

Extreme environments such as disasters are often managed by several teams working towards a shared goal but with unique sub‐goals at individual and team levels. Whilst these multiteam systems provide potential access to a wide pool of knowledge and resources, public inquiries repeatedly highlight coordination difficulties, leading to conflicting decisions and actions. However, limited research has focused on examining the inter‐team processes used to coordinate decisions in situ within extreme environments in order to cross‐validate theory. Accordingly, the following study analyses naturalistic observations conducted during two large‐scale live disaster response exercises in order to examine (1) what inter‐team processes are used to coordinate decisions, and (2) the extent to which they correspond with a linear phase‐based ‘Joint Decision Model’ (JDM) introduced to national UK disaster response guidance. Findings show responders frequently either revert to gathering information rather than progressing to take action, or take action without deliberately considering options, powers, and policies to form a plan. These non‐linear decision processes remain largely similar across both exercises, indicating that the initial implementation of national JDM guidance has not yet led to substantial changes. Further focus is needed to identify mechanisms for improving coordination in practice, including the form and frequency of training required to maintain such complex skills.

Practitioner points

Difficulties coordinating information, decisions, and actions are repeatedly identified in multiteam systems operating in extreme environments.

Limited research has focused on examining inter‐team processes used to coordinate decisions in situ within extreme environments, posing implications for developing targeted interventions.

Findings highlight a tendency for multiagency discussions to either revert back to information gathering rather than progressing to form and implement plans, or moving straight from information gathering to implementing decisions without consciously forming plans.

Strong leadership is vital for steering multiagency meetings but chairing these complex discussions is a cognitively demanding task.
Implementing a State‐Adopted High School Health Curriculum: A Case Study
Authors: Eisman Andria B. , Kilbourne Amy M. , Ngo Quyen , Fridline Judy , Zimmerman Marc A. , Greene Dana , Cunningham Rebecca M.
Published: March 2020

BACKGROUND

The Michigan Model for Health™ (MMH) is the official health curriculum for the State of Michigan and prevailing policy and practice has encouraged its adoption. Delivering evidence‐based programs such as MMH with fidelity is essential to program effectiveness. Yet, most schools do meet state‐designated fidelity requirements for implementation (delivering 80% or more of the curriculum).

METHODS

We collected online survey (N = 20) and in‐person interview (N = 5) data investigating fidelity and factors related to implementation of the MMH curriculum from high school health teachers across high schools in one socioeconomically challenged Michigan county and key stakeholders.

RESULTS

We found that 68% of teachers did not meet state‐identified standards of fidelity for curriculum delivery. Our results indicate that factors related to the context and implementation processes (eg, trainings) may be associated with fidelity. Teachers reported barriers to program delivery, including challenges with adapting the curriculum to suit their context, competing priorities, and meeting students' needs on key issues such as substance use and mental health issues.

CONCLUSIONS

Multiple factors influence the fidelity of health curriculum delivery in schools serving low‐income students. Investigating these factors guided by implementation science frameworks can inform use of implementation strategies to support and enhance curriculum delivery.
Diuretic use in infants with developing or established chronic lung disease: A practice looking for evidence
Authors: Tan Catherine , Sehgal Kartik , Sehgal Kunal , Krishnappa Srinath B , Sehgal Arvind
Published: March 2020

Aim

The objective was to assess respiratory efficacy of hydrochlorothiazide and spironolactone and ascertain any adverse effects.

Methods

Data from 2014 to 2018 was analysed for infants <28 weeks' gestational age (GA) administered oral diuretics. Impact on respiratory support, weight gain and electrolyte status was assessed as a pre‐post intervention study.

Results

Of 491 infants, 117 (24%) were administered diuretics for evolving or established bronchopulmonary dysplasia. GA and birthweight of the cohort were 25.7 ± 1.1 weeks and 779 ± 172 g, respectively. Median (interquartile range) chronological age and GA at the start of diuretics was 45 (22, 62) days and 32.1 (30.1, 35.1) weeks, respectively. In 71/117 (61%) infants, diuretics were started at <36 weeks GA. Of them 63 (88.7%) went on to develop bronchopulmonary dysplasia. Median duration of diuretics was 38 (18–52) days. Modest improvement was noted in respiratory parameters (ventilator pressure (cm of H2O), 8.8 ± 0.4 vs. 8.8 ± 0.5, P = 0.39, oxygen requirement (%), 32 ± 1 vs. 30 ± 1, P = 0.07 and pO2 (mm Hg) 34.5 ± 1.3 vs. 36.6 ± 1, P = 0.04. Ninety‐eight (84%) infants developed hyponatraemia (<135 mmol/L); sodium supplements were administered in 58/98 (59%) infants. In one third infants, phosphate levels dropped below 1.8 mmol/L, needing supplementation. Weight gain (g/kg/day) slowed down significantly (18.2 ± 2.1 to 10 ± 2.9, P = <0.001).

Conclusions

Use of diuretics was associated with modest improvements in respiratory support requirements but was associated with significant electrolyte abnormalities and slowdown in weight gain (or weight loss).
A sematic and prior‐knowledge‐aided monocular localization method for construction‐related entities
Authors: Fang Qi , Li Heng , Luo Xiaochun , Li Chengqian , An Wangpeng
Published: March 2020

The real‐time location of construction‐related entities is some of the most useful basic information for automated construction management. However, the implementation of most existing localization methods is limited due to the weak adaptability to construction sites. In this paper, we enhance the monocular vision technique for the localization of construction‐related entities by a sematic and prior knowledge‐based method. A deep learning algorithm is employed to segment the sematic instance in the images, and then the prior knowledge model specifies projection strategies for entities corresponding to various scenarios. Results show that the proposed method achieves satisfying positioning accuracy, is robust in low‐ratio occlusions, and can help facilitate safety early warning, activity recognition, and productivity analysis.
Comparison of the Efficiency and Safety of Total Ankle Replacement and Ankle Arthrodesis in the Treatment of Osteoarthritis: An Updated Systematic Review and Meta‐analysis
Authors: Li Yuhan , He Jinquan , Hu Yongcheng
Published: March 2020

While osteoarthritis is a common degenerative disease, ankle osteoarthritis is a subdivision that has received little attention. Two effective ways to treat osteoarthritis of the ankle are total ankle replacement (TAR) and ankle arthrodesis (AAD). Whether TAR or AAD is more beneficial for treatment is controversial. The purpose of this meta‐analysis was to compare the efficiency (clinical outcome and patient satisfaction) and safety (complications and survival) of these two procedures. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement was performed as a guideline for this study. Three electronic databases, PubMed, Web of Science, and Cochrane Library, were searched up to May 2019, with no language restrictions. Prospective or retrospective comparative studies were identified. The outcomes included clinical outcome, patient satisfaction, complications, and survival. Review Manager (Revman) 5.3 software was used to conduct the data analysis. We only selected literature from the past 5 years (no earlier than 2015). Seven comparative studies were included. There were six cohort studies and one cross‐sectional study. The Newcastle–Ottawa Scale (NOS) was used to assess the quality of cohort studies, and The Agency for Healthcare Research and Quality (AHRQ) checklist was chosen to assess the quality of cross‐sectional studies. No significant difference was observed for efficiency and safety. Clinical outcome was included in five studies with four different scoring systems. Two of them used the American Orthopaedic Foot & Ankle Society (AOFAS) questionnaire scores to assess the two procedures (mean difference, −4.26; 95% confidence interval [CI], −11.37–2.85; P = 0.24; I2 = 1%). Patient satisfaction (risk ratio [RR], 0.96; 95% CI, 0.65–1.40; P = 0.82; I2 = 54%), complications (RR, 1.15; 95% CI, 0.16–8.21; P = 0.89; I2 = 84%), and survival (RR, 1.91; 95% CI, 0.33–11.08; P = 0.47; I2 = 90%) showed no significant difference between the TAR group and the AAD group. This meta‐analysis showed no statistically significant difference between TAR and AAD in clinical outcome, patient satisfaction, complications, and survival. This revealed that TAR and AAD could appear to have similar results in these aspects. Therefore, the present results are not sufficient to conclude which of these two methods is better. Further studies are needed to obtain more clues.