bluuebunny/crossref_metadata_2025 huggingface dataset:
Migration, Religion, and Residential Segregation at the Urban Level: The Case of Muslim Migrants in Rome and Milan
Authors: Artero Maurizio , Chiodelli Francesco
Published: September 2019

This article investigates residential segregation at the intraurban level of migrants in two Italian cities, Rome and Milan, considering religion as a point of reference in light of its pivotal role in terms of identity references for many migrants. The article focuses in particular on Muslim migrants—due to both the magnitude of their presence and complex issues related to their settlement in Italian cities. The analysis shows a low level of intraurban residential segregation of Muslim migrants in both cities, with some relevant differences related to national subgroups (e.g., a higher concentration for people coming from Bangladesh and Pakistan), so that religion seems not yet to be a main driver of residential choice for Muslim migrants. In light of both the low level of segregation of Muslim migrants and some features of Italian urban policies on migration and religion, we argue that residential concentration can currently play a beneficial role in terms of the insertion of migrants in Italian cities and fulfillment of some of their needs (e.g., availability of minority places of worship).
Effect of varying the vanadium thickness layer of V2O5/V/V2O5 film on its microstructural and thermochromic properties
Authors: Khanyile Bhekumuzi Sfundo , Mtshali Christopher , Madiba Itani Given , Simo Aline , Numan Nagla , Kaviyarasu Kasinathan , Matinise Nolubabalo , Nkosi Mlungisi , Moloi Sabata Jonas , Maaza Malik
Published: September 2019

In this study, V2O5/V/V2O5 sandwich-structured films were deposited on glass substrates by electron beam evaporation. The thickness of the first (bottom) V2O5 layer was 40 nm and the last (top) layer was 20 nm, while that of the sandwiched vanadium layer varied up to 12 nm for different samples. The effects of varying the thickness of the sandwiched vanadium layer on microstructural and thermochromic properties of the as-deposited and thermal annealed films were investigated. Ultrahigh-resolution scanning electron microscopy revealed the presence of nanostructures with various irregular shapes on the surfaces of all films. Also, the atomic force microscopy revealed an average roughness of ∼10–38 nm for increasing thickness of the sandwiched vanadium layer. X-ray powder diffraction measurements showed the presence of the monoclinic VO2 (M) crystal structure of the films with (011) preferred orientation at 27.94° for both 7 and 12 nm thicknesses of the sandwiched vanadium layers. The varying thickness of the sandwiched vanadium layers enhanced phase transition temperature values to ∼33.92 and ∼29.11 °C for both 7 and 12 nm thicknesses of the sandwiched layers, respectively. These enhanced transition temperature values, as a result of thickness variation of the sandwiched vanadium layers, pointed toward utilization of this method in the successful synthesis of VO2 films for thermochromic windows application and optoelectronics.
Major subpopulations of
Plasmodium falciparum
in sub-Saharan Africa
Authors: Amambua-Ngwa Alfred , Amenga-Etego Lucas , Kamau Edwin , Amato Roberto , Ghansah Anita , Golassa Lemu , Randrianarivelojosia Milijaona , Ishengoma Deus , Apinjoh Tobias , Maïga-Ascofaré Oumou , Andagalu Ben , Yavo William , Bouyou-Akotet Marielle , Kolapo Oyebola , Mane Karim , Worwui Archibald , Jeffries David , Simpson Vikki , D’Alessandro Umberto , Kwiatkowski Dominic , Djimde Abdoulaye A.
Published: September 2019

Ebb and flow of parasite populations

The population genetics of the malaria parasite
Plasmodium falciparum
across Africa is poorly understood but important to know for grasping the risks and dynamics of the spread of drug resistance. Harnessing the power of genomics, Amambua-Ngwa
et al.
of the Plasmodium Diversity Network Africa found substantial population structure within Africa that is consistent with human and vector population divergence (see the Perspective by Sibley). Specific signatures of selection by antimalarial drugs were detected, along with indications of the effect of colonization and slavery. Furthermore, whole-genome sequencing showed that there is extensive gene flow among the different regions and that Ethiopia has a distinctive population of
P. falciparum
, which may be indicative of coexistence with another malaria parasite,
P. vivax.

Science
, this issue p.
813
; see also p.
752
Programmable CRISPR-responsive smart materials
Authors: English Max A. , Soenksen Luis R. , Gayet Raphael V. , de Puig Helena , Angenent-Mari Nicolaas M. , Mao Angelo S. , Nguyen Peter Q. , Collins James J.
Published: September 2019

A CRISPR set of materials

CRISPR technology is best known as a gene editing tool. English
et al.
developed a group of stimuli-responsive hydrogels to respond to the programmable nuclease Cas12a (see the Perspective by Han
et al.
). The materials undergo molecular to macroscopic changes after Cas12a-dependent cleavage of double- or single-stranded DNA integrated into the gel. The authors show controlled release of particles linked to or imprisoned within the DNA, degradation of a gel with DNA solely forming the cross-links, and permeabilization of a gel with DNA partially forming the cross-links. These tools allow for the production of materials that release encapsulated nanoparticles and cells, act as degradable fuses, and enable remote radio-frequency identification signaling.

Science
, this issue p.
780
; see also p.
754
Ultrafast laser welding of ceramics
Authors: Penilla E. H. , Devia-Cruz L. F. , Wieg A. T. , Martinez-Torres P. , Cuando-Espitia N. , Sellappan P. , Kodera Y. , Aguilar G. , Garay J. E.
Published: September 2019

Joining the laser welding club

Laser welding is an integral part of modern manufacturing, but it fractures ceramic materials. Penilla
et al.
developed two methods for welding ceramics using ultrafast lasers. One method tunes the ceramic properties, allowing the laser to transit through the ceramic and weld at the interface between pieces. The other method optimizes a gap between pieces to efficiently deposit energy. Both methods leverage short but energetic pulses to create a melt pool that allows ceramics to be joined, without the high temperature used for traditional ceramic welds.

Science
, this issue p.
803
Images from the surface of asteroid Ryugu show rocks similar to carbonaceous chondrite meteorites
Authors: Jaumann R. , Schmitz N. , Ho T.-M. , Schröder S. E. , Otto K. A. , Stephan K. , Elgner S. , Krohn K. , Preusker F. , Scholten F. , Biele J. , Ulamec S. , Krause C. , Sugita S. , Matz K.-D. , Roatsch T. , Parekh R. , Mottola S. , Grott M. , Michel P. , Trauthan F. , Koncz A. , Michaelis H. , Lange C. , Grundmann J. T. , Maibaum M. , Sasaki K. , Wolff F. , Reill J. , Moussi-Soffys A. , Lorda L. , Neumann W. , Vincent J.-B. , Wagner R. , Bibring J.-P. , Kameda S. , Yano H. , Watanabe S. , Yoshikawa M. , Tsuda Y. , Okada T. , Yoshimitsu T. , Mimasu Y. , Saiki T. , Yabuta H. , Rauer H. , Honda R. , Morota T. , Yokota Y. , Kouyama T.
Published: September 2019

Landing on the surface of Ryugu

In October 2018, the Hayabusa2 spacecraft dropped the Mobile Asteroid Surface Scout (MASCOT) lander onto the surface of the asteroid (162173) Ryugu. Jaumann
et al.
analyzed images taken by the MASCOT camera during its descent and when resting on the surface. Colored light-emitting diodes were used to illuminate the lander's surroundings at night and produce color images. Ryugu's surface is dominated by two types of rock, but there is no evidence for fine-grained dust. Millimeter-sized inclusions in the rocks are similar to those present in carbonaceous chondrite meteorites. MASCOT operated for 17 hours on the surface before its nonrechargeable batteries ran out.

Science
, this issue p.
817
Genomic analysis informs malaria evolution
Authors: Sibley Carol Hopkins
Published: September 2019

Updated analysis of
Plasmodium falciparum
malaria reveals markers of antimalarial resistance
Exome sequencing in patients with antiepileptic drug exposure and complex phenotypes
Authors: Jackson Adam , Ward Heather , Bromley Rebecca Louise , Deshpande Charulata , Vasudevan Pradeep , Scurr Ingrid , Dean John , Shannon Nora , Berg Jonathon , Holder Susan , Baralle Diana , Clayton-Smith Jill
Published: September 2019

Introduction

Fetal anticonvulsant syndrome (FACS) describes the pattern of physical and developmental problems seen in those children exposed to certain antiepileptic drugs (AEDs) in utero. The diagnosis of FACS is a clinical one and so excluding alternative diagnoses such as genetic disorders is essential.

Methods

We reviewed the pathogenicity of reported variants identified on exome sequencing in the Deciphering Developmental Disorders (DDD) Study in 42 children exposed to AEDs in utero, but where a diagnosis other than FACS was suspected. In addition, we analysed chromosome microarray data from 10 patients with FACS seen in a Regional Genetics Service.

Results

Seven children (17%) from the DDD Study had a copy number variant or pathogenic variant in a developmental disorder gene which was considered to explain or partially explain their phenotype. Across the AED exposure types, variants were found in 2/15 (13%) valproate exposed cases and 3/14 (21%) carbamazepine exposed cases. No pathogenic copy number variants were identified in our local sample (n=10).

Conclusions

This study is the first of its kind to analyse the exomes of children with developmental disorders who were exposed to AEDs in utero. Though we acknowledge that the results are subject to bias, a significant number of children were identified with alternate diagnoses which had an impact on counselling and management. We suggest that consideration is given to performing whole exome sequencing as part of the diagnostic work-up for children exposed to AEDs in utero.
Universal artificial intelligence platform for collaborative management of cataracts
Authors: Wu Xiaohang , Huang Yelin , Liu Zhenzhen , Lai Weiyi , Long Erping , Zhang Kai , Jiang Jiewei , Lin Duoru , Chen Kexin , Yu Tongyong , Wu Dongxuan , Li Cong , Chen Yanyi , Zou Minjie , Chen Chuan , Zhu Yi , Guo Chong , Zhang Xiayin , Wang Ruixin , Yang Yahan , Xiang Yifan , Chen Lijian , Liu Congxin , Xiong Jianhao , Ge Zongyuan , Wang Dingding , Xu Guihua , Du Shaolin , Xiao Chi , Wu Jianghao , Zhu Ke , Nie Danyao , Xu Fan , Lv Jian , Chen Weirong , Liu Yizhi , Lin Haotian
Published: September 2019

Purpose

To establish and validate a universal artificial intelligence (AI) platform for collaborative management of cataracts involving multilevel clinical scenarios and explored an AI-based medical referral pattern to improve collaborative efficiency and resource coverage.

Methods

The training and validation datasets were derived from the Chinese Medical Alliance for Artificial Intelligence, covering multilevel healthcare facilities and capture modes. The datasets were labelled using a three-step strategy: (1) capture mode recognition; (2) cataract diagnosis as a normal lens, cataract or a postoperative eye and (3) detection of referable cataracts with respect to aetiology and severity. Moreover, we integrated the cataract AI agent with a real-world multilevel referral pattern involving self-monitoring at home, primary healthcare and specialised hospital services.

Results

The universal AI platform and multilevel collaborative pattern showed robust diagnostic performance in three-step tasks: (1) capture mode recognition (area under the curve (AUC) 99.28%–99.71%), (2) cataract diagnosis (normal lens, cataract or postoperative eye with AUCs of 99.82%, 99.96% and 99.93% for mydriatic-slit lamp mode and AUCs >99% for other capture modes) and (3) detection of referable cataracts (AUCs >91% in all tests). In the real-world tertiary referral pattern, the agent suggested 30.3% of people be ‘referred’, substantially increasing the ophthalmologist-to-population service ratio by 10.2-fold compared with the traditional pattern.

Conclusions

The universal AI platform and multilevel collaborative pattern showed robust diagnostic performance and effective service for cataracts. The context of our AI-based medical referral pattern will be extended to other common disease conditions and resource-intensive situations.
Observational longitudinal multicentre investigation of acute pancreatitis (GOULASH PLUS): follow-up of the GOULASH study, protocol
Authors: Mikó Alexandra , Erőss Bálint , Sarlós Patrícia , Hegyi Jr Péter , Márta Katalin , Pécsi Dániel , Vincze Áron , Bódis Beáta , Nemes Orsolya , Faluhelyi Nándor , Farkas Orsolya , Papp Róbert , Kelemen Dezső , Szentesi Andrea , Hegyi Eszter , Papp Mária , Czakó László , Izbéki Ferenc , Gajdán László , Novák János , Sahin-Tóth Miklós , Lerch Markus M , Neoptolemos John , Petersen Ole H , Hegyi Péter
Published: September 2019

Background

Acute pancreatitis (AP) is an inflammatory condition that can lead to late consequences. Recurrent AP (RAP) develops in 20% of patients and chronic pancreatitis (CP) occurs in 7%–12.8%. However, we do not have sufficient information to establish an evidence-based statement to define early CP, or how to prevent its development.

Aim

The aim of this study was to understand the influencing factors and to determine which parameters should be measured or used as a biomarker to detect the early phase of CP.

Methods/Design

This is an observational prospective follow-up study of the GOULASH-trial (ISRTCN 63827758) in which (1) all severity of pancreatitis are included; (2) patients receive only therapeutic modalities which are accepted by the evidence based medicine (EBM) guideline; (3) whole blood, serum and plasma samples are stored in our biobank; and (4) large amount of variables are collected and kept in our electronic database including anamnestic data, physical examination, laboratory parameters, imaging, therapy and complications. Therefore, this fully characterised patient cohort are well suitable for this longitudinal follow-up study. Patients’ selection: patients enrolled in the GOULASH study will be offered to join to the longitudinal study. The follow-up will be at 1, 2, 3, 4, 5 and 6 years after the episode of AP. Anamnestic data will be collected by questionnaires: (1) diet history questionnaire, (2) 36-Item Short-Form Health Survey, (3) physical activity questionnaire and (4) stress questionnaire. Genetic tests will be performed for the genes associated with CP. The exocrine and endocrine pancreatic, liver and kidney functions will be determined by laboratory tests, stool sample analyses and imaging. Cost-effectiveness will be analysed to examine the relationship between events of interest and health-related quality of life or to explore subgroup differences.

Conclusion

This study will provide information about the risk and influencing factors leading to CP and identify the most useful measurable parameters.

Trial registration number

ISRCTN63396106
Children and Young People’s Health Partnership (CYPHP) Evelina London model of care: protocol for an opportunistic cluster randomised controlled trial (cRCT) to assess child health outcomes, healthcare quality and health service use
Authors: Newham James Joseph , Forman Julia , Heys Michelle , Cousens Simon , Lemer Claire , Elsherbiny Mohamed , Satherley Rose-Marie , Lingam Raghu , Wolfe Ingrid
Published: September 2019

Introduction

Children and young people (CYP) in many high-income settings have poor healthcare outcomes, especially those with long-term conditions (LTCs). Emergency and outpatient hospital service use is increasing unsustainably. To address these problems, the Children and Young People’s Health Partnership (CYPHP) has developed and is evaluating an integrated model of care as part of a health systems strengthening programme across two boroughs of London, UK that are characterised by mixed ethnic populations and varying levels of deprivation. The CYPHP Evelina London model of care comprises proactive case-finding and triage, specialist clinics and transformative education and training for professionals working with CYP. Services are delivered by multidisciplinary health teams with an emphasis on increased coordination across primary, community and hospital settings and integration of physical and mental healthcare that accounts for the CYP’s social context.

Methods and analysis

The phased roll out of the CYPHP Evelina London model allows an opportunistic population-based evaluation using a cluster randomised controlled trial design. Seventy general practices across two London boroughs, grouped into 23 clusters, were randomised to provide either the CYPHP model of care (n=11) or enhanced usual care (n=12).

The evaluation will measure the impact of the CYPHP Evelina London model of care on child and parent health and well-being, healthcare quality and health service use up to 2 years postimplementation. A population-level evaluation will use routinely collected pseudonymised healthcare data to conduct a service-use analysis for all CYP registered with a participating general practice (n=~90 000) with the rate of non-elective admissions as the primary outcome. We will seek consent from a subset of this population, with specific conditions (target n=2138) to assess the impact on patient-reported outcomes using the Paediatric Quality of Life Inventory (PedsQL) and Warwick-Edinburgh Mental Well-Being Scale (WEBWMS) as, respectively, the child- and parent-related primary outcomes.

Ethics and dissemination

Ethics approval obtained from South West-Cornwall & Plymouth Research Ethics Committee. Results will be submitted for publication in peer-reviewed journals. Findings will be generalisable to community-based models of care, especially in urban settings. Our process evaluation will identify barriers and enablers of implementation and delivery of care salient to the context and condition.

Trial registration number

NCT03461848; Pre-results.
Effect of different ranges of systolic blood pressure on left ventricular structure and diastolic function in a Chinese population: a cross-sectional population-based Shunyi study
Authors: Yongtai Liu , Jinzhi Lai , Lixin Zhou , Feifei Zhai , Dingding Zhang , Zhuang Tian , Yanlin Zhu , Wei Chen , Hua Bai , Hui Wang , Yicheng Zhu , Liying Cui , Zhengyu Jin , Zhang Shuyang
Published: September 2019

Objectives

To evaluate the effect of different ranges of systolic blood pressure (SBP) on left ventricular (LV) geometry and diastolic function in Chinese population.

Design

Cross-sectional study.

Setting

Peking Union Medical College Hospital in Beijing, China.

Participants

All inhabitants aged 35 years or older, living in five villages of Shunyi were invited. Exclusion criteria included individuals who declined participation, presence of moderate to severe valvular heart disease, persistent atrial fibrillation and suboptimal echocardiograms.

Interventions

The baseline data of 1051 participants were analysed. The relationship between SBP and LV geometric and diastolic function assessed by echocardiography was analysed after adjusting for conventional cardiac risk factors.

Results

The adjusted value of SBP was independently associated with LV hypertrophy (LVH) and LV diastolic dysfunction (LVDDF) (all p<0.01). Setting individuals with SBP <120 mm Hg as the reference group (group 1), those with SBP between 120 mm Hg and 140 mm Hg (group 2) had higher risk odds of LVH and those with SBP ≥140 mm Hg (group 3) had higher risk odds of LVH and LVDDF (all p<0.01). With the increase of SBP, LV mass index (LVMI) and E/e′ stepwise increased and e′ stepwise decreased significantly from group 1 to 3 (all p<0.05). In the whole population, SBP was independently correlated with LVMI, LVEDD, Left Atrial Volume Index, e′, and E/e′ (all p<0.01).

Conclusions

SBP was independently related to LVH and LVDDF, SBP between 120 and 140 mm Hg was independently related to worse LV remodelling and diastolic function, these findings indicated the potential benefit of intensive SBP control.
The dietary education trial in carbohydrate counting (DIET-CARB Study): study protocol for a randomised, parallel, open-label, intervention study comparing different approaches to dietary self-management in patients with type 1 diabetes
Authors: Ewers Bettina , Vilsbøll Tina , Andersen Henrik Ullits , Bruun Jens Meldgaard
Published: September 2019

Introduction

Clinical guidelines recommend that patients with type 1 diabetes (T1D) learn carbohydrate counting or similar methods to improve glycaemic control. Although systematic educating in carbohydrate counting is still not offered as standard-of-care for all patients on multiple daily injections (MDI) insulin therapy in outpatient diabetes clinics in Denmark. This may be due to the lack of evidence as to which educational methods are the most effective for training patients in carbohydrate counting. The objective of this study is to compare the effect of two different educational programmes in carbohydrate counting with the usual dietary care on glycaemic control in patients with T1D.

Methods and analysis

The study is designed as a randomised controlled trial with a parallel-group design. The total study duration is 12 months with data collection at baseline, 6 and 12 months. We plan to include 231 Danish adult patients with T1D. Participants will be randomised to one of three dietician-led interventions: (1) a programme in basic carbohydrate counting, (2) a programme in advanced carbohydrate counting including an automated bolus calculator or (3) usual dietary care. The primary outcome is changes in glycated haemoglobin A1c or mean amplitude of glycaemic excursions from baseline to end of the intervention period (week 24) between and within each of the three study groups. Other outcome measures include changes in other parameters of plasma glucose variability (eg, time in range), body weight and composition, lipid profile, blood pressure, mathematical literacy skills, carbohydrate estimation accuracy, dietary intake, diet-related quality of life, perceived competencies in dietary management of diabetes and perceptions of an autonomy supportive dietician-led climate, physical activity and urinary biomarkers.

Ethics and dissemination

The protocol has been approved by the Ethics Committee of the Capital Region, Copenhagen, Denmark. Study findings will be disseminated widely through peer-reviewed publications and conference presentations.

Trial registration number

ClinicalTrials.gov Registry (NCT03623113).
Stereotyping as a barrier to the social participation of older adults with low vision: a qualitative focus group study
Authors: Fraser Sarah , Beeman Irene , Southall Kenneth , Wittich Walter
Published: September 2019

Objective

In order to better understand the barriers that limit the social participation of older people with low vision, the aim of this study was to describe and clarify the factors that shape the social participation of older adults with vision loss.

Methods

As part of a study on rehabilitation access barriers, six qualitative focus groups were conducted in a private room in a hospital, with 21 individuals with low vision (aged 38–92 years) who had or had not accessed low vision services. During the focus groups, participants often spoke of the challenges they faced when interacting with people with ‘normal’ vision; this discussion led to a modification of the interview guide in order to capture barriers to social participation. Focus group discussions were audiotaped and transcribed, and content analysis was conducted.

Results

Content analysis revealed that personal as well as environmental factors influenced the social participation of older adults with low vision. Four themes emerged: 1) experiencing the onset of impairment and degenerating ability, 2) the physical environment, 3) attitudes and responses from others and 4) individual internal attitude and responses during social interactions. Lived and perceived stigma from the perspective of the insider (person living with low vision) interacting with an outsider (person with ‘normal’ vision) and difficult environmental contexts were described as barriers to social participation and optimal functioning.

Conclusion

At a personal level, transitioning from an outsider to an insider influenced self-identity and social participation. Further, insiders experiencing stereotypes associated with older adults who are blind had a negative impact on their social participation. Findings highlight the importance of stigma and stereotyping in the lived experience of older adults with low vision. Stigma is persistent, but strategies to reduce stigma will ultimately facilitate the social participation of older adults with low vision.
Management and outcomes of gastrointestinal congenital anomalies in low, middle and high income countries: protocol for a multicentre, international, prospective cohort study
Authors: Wright Naomi Jane
Published: September 2019

Introduction

Congenital anomalies are the fifth leading cause of death in children <5 years of age globally, contributing an estimated half a million deaths per year. Very limited literature exists from low and middle income countries (LMICs) where most of these deaths occur. The Global PaedSurg Research Collaboration aims to undertake the first multicentre, international, prospective cohort study of a selection of common congenital anomalies comparing management and outcomes between low, middle and high income countries (HICs) globally.

Methods and analysis

The Global PaedSurg Research Collaboration consists of surgeons, paediatricians, anaesthetists and allied healthcare professionals involved in the surgical care of children globally. Collaborators will prospectively collect observational data on consecutive patients presenting for the first time, with one of seven common congenital anomalies (oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation and Hirschsprung's disease).

Patient recruitment will be for a minimum of 1 month from October 2018 to April 2019 with a 30-day post-primary intervention follow-up period. Anonymous data will be collected on patient demographics, clinical status, interventions and outcomes using REDCap. Collaborators will complete a survey regarding the resources and facilities for neonatal and paediatric surgery at their centre.

The primary outcome is all-cause in-hospital mortality. Secondary outcomes include the occurrence of post-operative complications. Chi-squared analysis will be used to compare mortality between LMICs and HICs. Multilevel, multivariate logistic regression analysis will be undertaken to identify patient-level and hospital-level factors affecting outcomes with adjustment for confounding factors.

Ethics and dissemination

At the host centre, this study is classified as an audit not requiring ethical approval. All participating collaborators have gained local approval in accordance with their institutional ethical regulations. Collaborators will be encouraged to present the results locally, nationally and internationally. The results will be submitted for open access publication in a peer reviewed journal.

Trial registration number

NCT03666767
‘What happens when I can no longer care?’ Informal carers’ concerns about facing their own illness or death: a qualitative focus group study
Authors: Greenwood Nan , Pound Carole , Brearley Sally
Published: September 2019

Objectives

Older informal carers play an increasingly important role in supporting others with long-term health conditions. This study aimed to explore in depth the perspectives of older carers (70+ years) supporting others with a variety of conditions and disabilities focusing on their thoughts and experiences about when they are unable to continue caring.

Design

Qualitative with four focus groups.

Setting

Greater London, UK.

Participants

28 older carers (70+ years) recruited from the voluntary sector participated in this study. Most were women and many were spouses caring for partners with age-related conditions such as dementia, arthritis and visual impairment. Nearly a third were parents of adult children with severe physical or cognitive disabilities.

Findings

Thematic analysis identified two main aspects for carers when contemplating the future—when they are unable to care in the short term or long term if they die or can no longer manage. Themes included the following: the impact of age, health conditions and relationships on future planning; anxiety about future care; carers’ ambivalence and challenges in broaching the subject; interventions that might help older carers talk about and plan for the future of those they care for.

Conclusions

Services need to be open to talking about this difficult topic. Our findings suggest that frank discussions about when older carers cannot care and having plans in place, whether these are financial or address other practical issues, makes it easier for all concerned. However, this issue is not easily broached and its timing and ways to access this support must be carefully and individually gauged. Future research with more diverse demographic groups is needed to improve understanding of these carers’ perspectives. Research is also needed to develop interventions to support older carers to talk about and plan for the future.
Risk factors forStaphylococcus aureusbacteremia in patients with rheumatoid arthritis and incidence compared with the general population: protocol for a Danish nationwide observational cohort study
Authors: Dieperink Sabine Sparre , Glintborg Bente , Oestergaard Louise Bruun , Nørgaard Mette , Benfield Thomas , Mehnert Frank , Petersen Andreas , Hetland Merete Lund
Published: September 2019

Introduction

Staphylococcus aureusbacteremia (SAB) is an invasive infection with high mortality and morbidity. Rheumatoid arthritis (RA) is associated with increased risk of infections due to the disease per se and the use of antirheumatic treatments. Few minor studies have previously investigated risk of SAB in patients with RA and indicated increased risk compared with the general population. This nationwide observational study aims to investigate incidence of and risk factors for SAB in adult patients with RA compared with the general population. The effect of disease characteristics (eg, joint erosions, disease duration and activity), different antirheumatic treatments and smoking on SAB risk will be evaluated.

Methods and analysis

All adults (>18 years of age) alive and living in Denmark in 1996–2017 will be identified in The Danish Civil Registration System. Incident patients with RA are identified in the Danish National Patient Registry (DNPR) and the nationwide rheumatology registry, DANBIO, in which information on, for example, antirheumatic treatments, disease characteristics and smoking is collected prospectively in routine care. Information on comorbidities, invasive procedures and prescribed drugs are identified in the DNPR and in The Register of Medicinal Product Statistics. Socioeconomic status is evaluated in national registers on income and education. Incident cases of first-time SAB are identified in The Danish National SAB Database. All registers are linked on an individual level by unique civil registration numbers. Incidence rates and incidence rate ratios will be analysed using Poisson regression models and the impact of possible risk factors will be evaluated.

Ethics and dissemination

All data will be handled in accordance with the General Data Protection Regulation (EU) 2016/679. No ethical approval is necessary in Denmark when handling registry data only. The results will be presented in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology initiative in international peer-reviewed journals and at medical conferences.

Trial registration number

NCT03908086.
Physicians’ perceptions of palliative sedation for existential suffering: a systematic review
Authors: Rodrigues Paulo , Menten Johan , Gastmans Chris
Published: September 2019

Background

Palliative sedation for existential suffering (PS-ES) is a controversial clinical intervention. Empirical studies about physicians’ perceptions do not converge in a clear position and current clinical practice guidelines do not agree either regarding this kind of intervention.

Aim

To gain deeper insight into physicians’ perceptions of PS-ES, the factors influencing it, the conditions for implementing it and the alternatives to it.

Design

Systematic review of qualitative, quantitative and mixed-methods studies following thePeer Review Electronic Search StrategiesandPreferred Reporting Items for Systematic Reviews and Meta-analysesprotocols; quality appraisal and thematic synthesis methodology.

Data sources

Seven electronic databases (PubMed, CINAHL, Embase, Scopus, Web of Science, PsycINFO, PsycARTICLES) were exhaustively searched from inception through March 2019. Two reviewers screened paper titles, abstracts and full texts. We included only peer-reviewed journal articles published in English, French, German, Dutch, Spanish, Italian or Portuguese that focused on physicians’ perceptions of PS-ES.

Results

The search yielded 17 publications published between 2002 and 2017. Physicians do not hold clear views or agree if and when PS-ES is appropriate. Case-related and individual-related factors that influenced physicians’ perceptions were identified. There is still no consensus regarding criteria to distinguish between necessary and sufficient conditions for invoking PS-ES. Some alternatives to PS-ES were identified.

Conclusions

To date, there is still no consensus on physicians’ perceptions of PS-ES. Further research is necessary to understand factors that influence physicians’ perceptions and philosophical-ethical presuppositions underlying this perceptions.
Revising ethical guidance for the evaluation of programmes and interventions not initiated by researchers
Authors: Watson Samuel I , Dixon-Woods Mary , Taylor Celia A , Wroe Emily B , Dunbar Elizabeth L , Chilton Peter J , Lilford Richard J
Published: September 2019

Public health and service delivery programmes, interventions and policies (collectively, ‘programmes’) are typically developed and implemented for the primary purpose of effecting change rather than generating knowledge. Nonetheless, evaluations of these programmes may produce valuable learning that helps determine effectiveness and costs as well as informing design and implementation of future programmes. Such studies might be termed ‘opportunistic evaluations’, since they are responsive to emergent opportunities rather than being studies of interventions that are initiated or designed by researchers. However, current ethical guidance and registration procedures make little allowance for scenarios where researchers have played no role in the development or implementation of a programme, but nevertheless plan to conduct a prospective evaluation. We explore the limitations of the guidance and procedures with respect to opportunistic evaluations, providing a number of examples. We propose that one key missing distinction in current guidance is moral responsibility: researchers can only be held accountable for those aspects of a study over which they have control. We argue that requiring researchers to justify an intervention, programme or policy that would occur regardless of their involvement prevents or hinders research in the public interest without providing any further protections to research participants. We recommend that trial consent and ethics procedures allow for a clear separation of responsibilities for the intervention and the evaluation.
Contacting gamete donors to facilitate diagnostic genetic testing for the donor-conceived child: what are the rights and obligations of gamete donors in these cases? A response to Hortonet al
Authors: Frith Lucy
Published: September 2019

In their paper Hortonet alargue that it is acceptable to contact an anonymous egg-donor to facilitate diagnostic genetic testing for the donor conceived child, despite the donor, ‘indicating on a historical consent form that she did not wish to take part in future research, and that she did not wish to be informed if she was found to be a carrier of a “harmful inherited condition”’. There are a number of claims embedded in Hortonet al’s position that it is acceptable to contact the donor and request that she at least think about participating in genetic testing. In this response. I will go through their main claims and argue that the area of genomic medicine does not justify exceptions to general consent conditions as the authors suppose and conclude that the donor should not be contacted. I will then go on to suggest a policy change that would address Hortonet al’s concerns but would not involve over-riding any previously expressed wishes.
Risk factors for blood‐contaminated cerebrospinal fluid collection in dogs
Authors: Nagendran Aran , Sanchez‐Masian Daniel , Bersan Erika , Cooper Camilla Jayne , Gonçalves Rita
Published: September 2019

Objective

To determine the risk factors for blood contamination during cerebrospinal fluid (CSF) collection in dogs.

Study design and methods

This is a prospective study of 170 CSF samples. Data collected included signalment of the patient, body condition score, site of CSF collection (cerebellomedullary cistern (CMC) or lumbar cistern (LC)), number of attempts, clinician expertise, final diagnosis, time of day, skull conformation and day of the week. Analysis of the CSF samples was then performed, and the presence of blood contamination (red blood cells >500/µl) was recorded. Logistic regression was used to quantify the association of potential risk factors of the procedure. Multivariate analysis was performed on the variables that were statistically significant.

Results

Of the 170 CSF samples, 53 per cent were collected from the CMC (n=90) and 47 per cent from the LC (n=80). Blood contamination was seen in 20 per cent (n=34) of the samples, 8.9 per cent (n=8) in CMC and 32.5 per cent (n=26) in LC samples. Increased odds of obtaining a contaminated CSF sample were associated with lower level of clinician expertise (odds ratio: 2.5; 95 per cent confidence interval: 0.9–6.7; P=0.046) and with LC versus CMC collection site (odds ratio: 8.1; 95 per cent confidence interval: 2.1–12.9; P=0.001).

Clinical significance

There is increased likelihood of blood contamination when collecting CSF from the LC compared with the CMC site. Increased clinician experience reduced the risk of CSF blood contamination, but none of the other variables examined significantly influenced this.
A Roadmap to User-Controllable Social Exploratory Search
Authors: Sciascio Cecilia Di , Brusilovsky Peter , Trattner Christoph , Veas Eduardo
Published: September 2019

Information-seeking tasks with learning or investigative purposes are usually referred to as exploratory search. Exploratory search unfolds as a dynamic process where the user, amidst navigation, trial and error, and on-the-fly selections, gathers and organizes information (resources). A range of innovative interfaces with increased user control has been developed to support the exploratory search process. In this work, we present our attempt to increase the power of exploratory search interfaces by using ideas of social search—for instance, leveraging information left by past users of information systems. Social search technologies are highly popular today, especially for improving ranking. However, current approaches to social ranking do not allow users to decide to what extent social information should be taken into account for result ranking. This article presents an interface that integrates social search functionality into an exploratory search system in a user-controlled way that is consistent with the nature of exploratory search. The interface incorporates control features that allow the user to (i) express information needs by selecting keywords and (ii) to express preferences for incorporating social wisdom based on tag matching and user similarity. The interface promotes search transparency through color-coded stacked bars and rich tooltips. This work presents the full series of evaluations conducted to, first, assess the value of the social models in contexts independent to the user interface, in terms of objective and perceived accuracy. Then, in a study with the full-fledged system, we investigated system accuracy and subjective aspects with a structural model revealing that when users actively interacted with all of its control features, the hybrid system outperformed a baseline content-based–only tool and users were more satisfied.
A Game-theoretic Taxonomy and Survey of Defensive Deception for Cybersecurity and Privacy
Authors: Pawlick Jeffrey , Colbert Edward , Zhu Quanyan
Published: September 2019

Cyberattacks on both databases and critical infrastructure have threatened public and private sectors. Ubiquitous tracking and wearable computing have infringed upon privacy. Advocates and engineers have recently proposed using defensive deception as a means to leverage the information asymmetry typically enjoyed by attackers as a tool for defenders. The term deception, however, has been employed broadly and with a variety of meanings. In this article, we survey 24 articles from 2008 to 2018 that use game theory to model defensive deception for cybersecurity and privacy. Then, we propose a taxonomy that defines six types of deception: perturbation, moving target defense, obfuscation, mixing, honey-x, and attacker engagement. These types are delineated by their information structures, agents, actions, and duration: precisely concepts captured by game theory. Our aims are to rigorously define types of defensive deception, to capture a snapshot of the state of the literature, to provide a menu of models that can be used for applied research, and to identify promising areas for future work. Our taxonomy provides a systematic foundation for understanding different types of defensive deception commonly encountered in cybersecurity and privacy.
Life Ascending: Mechanism and Process in Physiological Adaptation to High-Altitude Hypoxia
Authors: Storz Jay F. , Scott Graham R.
Published: September 2019

To cope with the reduced availability of O2 at high altitude, air-breathing vertebrates have evolved myriad adjustments in the cardiorespiratory system to match tissue O2 delivery with metabolic O2 demand. We explain how changes at interacting steps of the O2 transport pathway contribute to plastic and evolved changes in whole-animal aerobic performance under hypoxia. In vertebrates native to high altitude, enhancements of aerobic performance under hypoxia are attributable to a combination of environmentally induced and evolved changes in multiple steps of the pathway. Additionally, evidence suggests that many high-altitude natives have evolved mechanisms for attenuating maladaptive acclimatization responses to hypoxia, resulting in counter-gradient patterns of altitudinal variation for key physiological phenotypes. For traits that exhibit counteracting environmental and genetic effects, evolved changes in phenotype may be cryptic under field conditions and can only be revealed by rearing representatives of high- and low-altitude populations under standardized environmental conditions to control for plasticity.
Inhibition of MAPK and STAT3-SOCS3 by Sakuranetin Attenuated Chronic Allergic Airway Inflammation in Mice
Authors: Santana Fernanda P. R. , da Silva Rafael C. , Grecco Simone dos S. , Pinheiro Aruanã J. M. C. R. , Caperuto Luciana C. , Arantes-Costa Fernanda M. , Claudio Samuel R. , Yoshizaki Kelly , Macchione Mariângela , Ribeiro Daniel A. , Tibério Iolanda F. L. C. , Lima-Neto Lídio G. , Lago João H. G. , Prado Carla M.
Published: September 2019

Asthma allergic disease is caused by airway chronic inflammation. Some intracellular signaling pathways, such as MAPK and STAT3-SOCS3, are involved in the control of airway inflammation in asthma. The flavonoid sakuranetin demonstrated an anti-inflammatory effect in different asthma models. Our aim was to clarify how sakuranetin treatment affects MAPK and STAT3-SOCS3 pathways in a murine experimental asthma model. Mice were submitted to an asthma ovalbumin-induction protocol and were treated with vehicle, sakuranetin, or dexamethasone. We assayed the inflammatory profile, mucus production, and serum antibody, STAT3-SOCS3, and MAPK levels in the lungs. Morphological alterations were also evaluated in the liver. LPS-stimulated RAW 264.7 cells were used to evaluate the effects of sakuranetin on nitric oxide (NO) and cytokine production.In vivo, sakuranetin treatment reduced serum IgE levels, lung inflammation (eosinophils, neutrophils, and Th2/Th17 cytokines), and respiratory epithelial mucus production in ovalbumin-sensitized animals. Considering possible mechanisms, sakuranetin inhibits the activation of ERK1/2, JNK, p38, and STAT3 in the lungs. No alterations were found in the liver for treated animals. Sakuranetin did not modifyin vitrocell viability in RAW 264.7 and reduced NO release and gene expression of IL-1βand IL-6 induced by LPS in these cells. In conclusion, our data showed that the inhibitory effects of sakuranetin on eosinophilic lung inflammation can be due to the inhibition of Th2 and Th17 cytokines and the inhibition of MAPK and STAT3 pathways, reinforcing the idea that sakuranetin can be considered a relevant candidate for the treatment of inflammatory allergic airway disease.
Adrenal Venous Sampling in Primary Aldosteronism: The Usefulness of Contralateral Suppression Index
Authors: Treistman Natalia , Moraes Aline Barbosa , Cozzolino Stéphanie , Teixeira Patrícia de Fatima dos Santos , Vieira Neto Leonardo
Published: September 2019

Adrenal venous sampling (AVS) is the gold standard test to differentiate the unilateral from the bilateral form in patients with primary aldosteronism (PA) although it may be a difficult procedure, especially the successful cannulation of the right adrenal vein. In this report, we describe a 49-year-old female patient diagnosed with PA, after investigating resistant hypertension and refractory hypokalemia. Abdominal computed tomography scan revealed a 2.5 cm adenoma on the right adrenal vein. AVS was performed under cosyntropin infusion. Aldosterone and cortisol concentrations were obtained from the right and left adrenal veins and inferior vena cava (IVC). Cortisol on each adrenal vein divided by cortisol on IVC confirmed successful cannulation of the left side only, which makes it impossible to calculate the lateralization index (LI). From the data on the left adrenal vein and IVC, the aldosterone-to-cortisol ratio divided by the IVC aldosterone-to-cortisol ratio was less than 1.0, suggesting that the left adrenal vein was suppressed with the excess aldosterone originating from the contralateral side (contralateral suppression index (CSI)). Right adrenalectomy was performed; postoperative hypoaldosteronism was confirmed. This report highlights the importance of CSI obtained in AVS when technical difficulties occur making it impossible to obtain LI, which is most commonly used to decide between surgical and clinical management of PA.