bluuebunny/crossref_metadata_2025 huggingface dataset:
Message in a bottle: How evidence‐based medicine and a programme change model improved asthma management in a low‐income emergency department in Papua New Guinea
Authors: Heath Rebecca , Tomaszewski Paul , Kuri Michael , Atua Vincent , Phillips Georgina
Published: December 2018

Objective

To improve asthma care in a complex, low resource, developing country setting. This observational study was carried out in a challenging low‐income real‐life setting in the ED at Modilon Hospital, Papua New Guinea. The only government hospital in Madang Province, with 258 beds, it provides medical care to a population of nearly 700 000 people of whom 40% live on less than US$1.25/day.

Methods

An asthma management analysis questionnaire followed by action research, with a four‐step programme change model (exposure, adoption, implementation and practice), were used to develop and implement new department asthma guidelines. Staff perceptions were gathered via discussion groups and questionnaire.

Results

Asthma management initially involved frequent antibiotics, intravenous steroids, multiple short acting bronchodilators (oral, inhaled and nebulised) and limited oral steroids. No spacers, preventative inhaled steroid therapy or asthma action plans were used. On review after new guideline implementation staff felt antibiotic dispensing and concurrent use of multiple short acting oral bronchodilators decreased and spacer, preventer therapy and action plan use increased.

Conclusion

This project highlights the difficulties experienced with change management, both in general and in a limited resource setting. Lack of data limits conclusions about asthma management improvement. However, positive trends were apparent and make this approach reasonable for those considering change management strategies in a similar setting.
Efficacy of Long‐Term Treatment With Tolvaptan to Prolong the Time Until Dialysis Initiation in Patients With Chronic Kidney Disease and Heart Failure
Authors: Tanaka Akihito , Hiramatsu Emiko , Watanabe Yu , Ito Chiharu , Shinjo Hibiki , Otsuka Yasuhiro , Takeda Asami
Published: December 2018

The short‐term effectiveness of tolvaptan (TLV) against heart failure has been established. TLV is known to decrease the worsening of renal function more than loop diuretics. Long‐term TLV administration decreases the rate of re‐hospitalization in heart failure and prevents deterioration of kidney function. If repeated hospitalization for heart failure can be prevented in patients having concurrent chronic kidney disease (CKD), the period until dialysis initiation may be prolonged. We investigated whether long‐term TLV management can extend the period until dialysis initiation in patients with CKD and heart failure. A retrospective, observational study was conducted among patients with CKD stage G4 and G5 admitted because of heart failure between April 2013 and July 2018. They were divided into those with TLV and those without TLV. They were followed up until August 2018 and relevant data was collected. Data from 115 patients (68 men and 47 women), with a mean age of 73.4 ± 11.9 (median 76.0 and IQR 66.5–82.0) years and a mean eGFR of 11.8 ± 5.7 (median 9.9 and IQR 7.5–14.8) mL/min/1.73m2 were included in the analysis. Twenty‐five patients had received long‐term TLV treatment, and 90 had not. Multivariate analysis after adjustment showed that long‐term use of TLV significantly lowered the hazard ratio (HR) for time taken to reach dialysis initiation (HR: 0.3286, 95%CI: 0.1282–0.8423, P = 0.0205). Propensity score‐matched analysis showed similar results (HR: 0.3220, 95%CI: 0.1107–0.9369, P = 0.0376). In patients with CKD G4 and G5 and heart failure, long‐term treatment with TLV can prolong the time until dialysis initiation.
CICERO AS OVERLIVER
Authors: KEITEL ELIZABETH
Published: December 2018

Aside from his actual exile, Cicero describes himself as an exile and overliver in two other stressful periods: during the civil war of 49 and during life at Rome under Caesar's autocracy. Scholars have long noted the exile imagery in Cicero's letters of 46–45, but not in those of 49. Also unnoticed is the image of the overliver, well known from epic and tragedy, who, shamed by a single event, feels he has lived too long yet cannot escape life. In the first two periods, Cicero also deftly employs the themes and figures of lamentation to underline his distress and his liminal state as an overliver and to rebut Atticus' criticism of his self-pity. This self-presentation, sustained over three lengthy and traumatic episodes of Cicero's life, contrasts with his occasional assumption of literary exempla for his own behaviour.
PLINY'S TACITUS: THE POLITICS OF REPRESENTATION
Authors: EDWARDS REBECCA
Published: December 2018

As Eleanor Winsor Leach and others have demonstrated, in the corpus of the Letters Pliny represents different aspects of his ideal self through the way he characterizes his relationships with his correspondents. This paper examines more closely the letters to and about Tacitus, disregarding intertextual references between the works of Tacitus and Pliny (a well-mined field), and shifting the focus to the friendly competition Pliny creates with Tacitus. In particular, Pliny arranges the ‘Tacitus cycle’ into three sections which highlight their roles as orators, patrons, and literary figures. In each of these, Pliny shows that he and his friend are similar in their goals, but unique in their styles and methods. Thus, Pliny creates a world where he is both inferior and superior to his former mentor, as in Laelius' paradox — ‘maximum est in amicitia parem esse inferiori’ (Cic. Amic. 19.69).
THE ANCIENT EPISTOLARY COLLECTION REDUX: ‘SOCRATES’ AND CICERO IN PETRARCH'S FAM. 1.1
Authors: VASALY ANN
Published: December 2018

The introductory letter of Petrarch's collection of prose epistles (Epistolae Familiares) includes a number of traditional programmatic elements, including a dedication to his close friend Ludwig Van Kempen, a narrative describing the collection's genesis, and a defence of its style and contents, rooted in the example of Cicero's letters to Atticus, Quintus, and Brutus, which Petrarch had discovered some five years earlier. In other ways, Fam. 1.1 is an absolutely unprecedented introduction to an epistolary collection — ultimately staging within the letter a kind of ‘conversion narrative’ that transforms the yet-uncompleted collection into an instantiation of the spiritual journey of its author.
Examining the relationship between farm size and productive efficiency: a Bayesian directional distance function approach
Authors: Khataza Robertson R.B. , Hailu Atakelty , Doole Graeme J. , Kragt Marit E. , Alene Arega D.
Published: December 2018

Achieving sustainable food security and increased farm income will depend on how efficient production systems are in converting available inputs to produce outputs. Using data from Malawi, we estimate a Bayesian directional technology distance function to examine the relationship between farm size and technical efficiency. Our results support the existence of an inverse relationship between farm size and productive efficiency, where small farms are more efficient than large farms. On average, farms exhibit inefficiency levels of 60%, suggesting that productivity could be improved substantially. Improving productive efficiency and food security will require farms to operate in ways where the size of cultivated area is matched by nonland production inputs such as labor, fertilizer, and improved seeds. The results highlight the need for policies that could incentivize farmers to adopt productivity‐enhancing technologies and, where possible, to allocate excess land to lease markets.
Revisiting the impact of ejaculatory abstinence on semen quality and intracytoplasmic sperm injection outcomes
Authors: Borges E. , Braga D. P. A. F. , Zanetti B. F. , Iaconelli A. , Setti A. S.
Published: December 2018

Background

Regulatory bodies recommend inconsistent ejaculatory abstinence lengths before semen analysis. The literature exploring the effect of ejaculatory abstinence length on the outcomes of intracytoplasmic sperm injection is scarce.

Objective

To study the influence of ejaculatory abstinence length on semen quality and intracytoplasmic sperm injection outcomes.

Materials and methods

This prospective cohort study included 818 patients undergoing conventional semen analysis from October 2015 to October 2016, in a private university‐affiliated IVF centre. Generalized linear models adjusted for potential confounders were used to investigate the associations between ejaculatory abstinence length and seminal parameters and intracytoplasmic sperm injection outcomes.

Results

Increasing ejaculatory abstinence length was positively correlated with semen volume, sperm concentration, total sperm count, total motile sperm count and sperm DNA fragmentation index. Significant inverse correlations were observed between ejaculatory abstinence length and fertilization rate, blastocyst formation rate, implantation rate and pregnancy rate. A discriminant analysis showed a mean ejaculatory abstinence length in the positive pregnancy group of 3.14 ± 1.64 days and 4.83 ± 3.66 days in the negative pregnancy group. A cut‐off point was established halfway between ejaculatory abstinence length averages, at 4 days. The ejaculatory abstinence ≤4 days group showed significant lower semen volume, sperm concentration, total sperm count and total motile sperm count compared to ejaculatory abstinence > 4 days group. The ejaculatory abstinence ≤ 4 days group showed significant lower sperm DNA fragmentation index, and higher rates of fertilization, high‐quality embryos on day 3, blastocyst development, implantation and pregnancy compared to ejaculatory abstinence > 4 days group. The implantation rate was significantly higher and the pregnancy rate tended to be higher with one day of ejaculatory abstinence, compared to 2–4 days of ejaculatory abstinence.

Conclusions

Ejaculatory abstinence periods of >4 days have a detrimental effect on sperm DNA and intracytoplasmic sperm injection outcomes. One day of ejaculatory abstinence significantly improves implantation rate and tends to increase pregnancy rate, compared to 2, 3 and 4 days of ejaculatory abstinence.
Women Sustaining Community: The Politics of Agro‐Ecology in Quilombo Tourism in Southern Brazil
Authors: Montero Carla Guerrón
Published: December 2018

This article analyses how a gendered perspective on community‐based tourism (CBT) contributes to the realisation of identity and sovereignty of quilombos. It examines the potential sustainability of CBT coupled with agro‐ecological practices within the context of gendered identity politics. Drawing from in‐depth ethnographic and archival research conducted between February and July 2015 at Campinho da Independência (Rio de Janeiro, Brazil), the article discusses how female leaders integrate sustainable agro‐ecological practices and CBT with environmental education in what they call ‘ethno‐ecological tourism’. This approach to CBT strengthens a proudly defiant version of Afro‐Brazilian ethnic identity vis‐à‐vis the state.
Middle to Late Pleistocene lake‐level fluctuations of Lake El'gygytgyn, far‐east Russian Arctic
Authors: Fedorov Grigory , Andreev Andrei A. , Raschke Elena , Wennrich Volker , Schwamborn Georg , Glushkova Olga Y. , Juschus Olaf , Zander Anja , Melles Martin
Published: December 2018

Lake El'gygytgyn, located in central Chukotka, Russian Arctic, was the subject of an international drilling project that resulted in the recovery of the longest continuous palaeoclimatic and palaeoenvironmental record for the terrestrial Arctic covering the last 3.6 million years. Here, we present the reconstruction of the lake‐level fluctuations of Lake El'gygytgyn since Marine Isotope Stage (MIS) 7 based on lithological and palynological as well as chronological studies of shallow‐water sediment cores and subaerial lake terraces. Reconstructed lake levels show an abrupt rise during glacial–interglacial terminations (MIS 6/5 and MIS 2/1) and during the MIS 4/3 stadial–interstadial transition. The most prominent lowstands occurred during glacial periods associated with a permanent lake‐ice cover (namely MIS 6, MIS 4 and MIS 2). Major triggering mechanisms of the lake‐level fluctuations at Lake El'gygytgyn are predominantly changes in air temperature and precipitation. Regional summer temperatures control the volume of meltwater supply as well as the duration of the lake‐ice cover (permanent or seasonal). The duration of the lake‐ice cover, in turn, enables or hampers near‐shore sediment transport, thus leading to long‐term lake‐level oscillations on glacial–interglacial time scales by blocking or opening the lake outflow, respectively. During periods of seasonal ice cover the lake level was additionally influenced by changes in precipitation. The discovered mechanism of climatologically driven level fluctuations of Lake El'gygytgyn are probably valid for large hydrologically open lakes in the Arctic in general, thus helping to understand arctic palaeohydrology and providing missing information for climate modelling.
Injecting drug use is an independent risk factor for reincarceration after release from prison: A prospective cohort study
Authors: Winter Rebecca J. , Stoové Mark , Agius Paul A. , Hellard Margaret E. , Kinner Stuart A.
Published: December 2018

Introduction and Aims

Once involved in the criminal justice system, people who inject drugs (PWID) have a high probability of multiple system encounters. Imprisonment typically fails to rehabilitate PWID, who upon return to the community are at considerable risk of returning to injecting drug use (IDU) and poor health and social outcomes. We examined the effect of IDU resumption, and a suite of other sociodemographic, criminogenic, health and behavioural indicators, on the timing of reincarceration among adults with a history of IDU following release from prison.

Design and Methods

Structured interviews were conducted with 561 PWID in Queensland, Australia prior to release from prison and approximately 1, 3 and 6 months post‐release. Data were linked prospectively with correctional records and the National Death Index. Data collected at multiple time‐points were treated as time‐varying covariates. Kaplan–Meier survival estimates and Cox proportional hazards models were used to estimate the rate and hazards of reincarceration.

Results

Sixty‐eight percent of participants (n = 350) were reincarcerated over a combined observation time of 1043.5 years, representing a rate of 33.5 per 100 person‐years (95% confidence interval [CI] 30.2–37.2). Time‐invariant predictors of reincarceration in PWID were: male gender (adjusted hazard ratio [AHR] = 1.62, 95% CI 1.19–2.21), older age at release (AHR = 0.97, 95% CI 0.95–1.00), previous adult (AHR = 2.00, 95% CI 1.41–2.84) or juvenile (AHR = 1.78, 95% CI 1.27–2.49) imprisonment, shorter imprisonment (≤90 days vs. >365 days, AHR = 2.09, 95% CI 1.30–3.34), release on parole (AHR = 2.29, 95% CI 1.82–2.88) and drug‐related sentence (AHR = 1.84, 95% CI 1.34–2.53). Time‐varying predictors included resumption of IDU (AHR = 2.04, 95% CI 1.60–2.61), unemployment (AHR = 1.53, 95% CI 1.07–2.19) and low perceived social support (AHR = 1.41, 95% CI 1.05–1.90). Very‐high psychological distress at the most recent interview was protective against reincarceration (AHR = 0.65, 95% CI 0.44–0.95).

Discussion and Conclusions

Efforts to prevent resumption of IDU and address disadvantage, social inclusion and health service access in ex‐prisoners through the scale‐up and integration of prison‐based and post‐release interventions are likely to reap both public health and criminal justice benefits.
Morpho‐regulation in diverse chicken feather formation: Integrating branching modules and sex hormone‐dependent morpho‐regulatory modules
Authors: Widelitz Randall B. , Lin Gee‐Way , Lai Yung‐Chih , Mayer Julie A. , Tang Pin‐Chi , Cheng Hsu‐Chen , Jiang Ting‐Xin , Chen Chih‐Feng , Chuong Cheng‐Ming
Published: December 2018

Many animals can change the size, shape, texture and color of their regenerated coats in response to different ages, sexes, or seasonal environmental changes. Here, we propose that the feather core branching morphogenesis module can be regulated by sex hormones or other environmental factors to change feather forms, textures or colors, thus generating a large spectrum of complexity for adaptation. We use sexual dimorphisms of the chicken to explore the role of hormones. A long‐standing question is whether the sex‐dependent feather morphologies are autonomously controlled by the male or female cell types, or extrinsically controlled and reversible. We have recently identified core feather branching molecular modules which control the anterior‐posterior (bone morphogenetic orotein [BMP], Wnt gradient), medio‐lateral (Retinoic signaling, Gremlin), and proximo‐distal (Sprouty, BMP) patterning of feathers. We hypothesize that morpho‐regulation, through quantitative modulation of existing parameters, can act on core branching modules to topologically tune the dimension of each parameter during morphogenesis and regeneration. Here, we explore the involvement of hormones in generating sexual dimorphisms using exogenously delivered hormones. Our strategy is to mimic male androgen levels by applying exogenous dihydrotestosterone and aromatase inhibitors to adult females and to mimic female estradiol levels by injecting exogenous estradiol to adult males. We also examine differentially expressed genes in the feathers of wildtype male and female chickens to identify potential downstream modifiers of feather morphogenesis. The data show male and female feather morphology and their color patterns can be modified extrinsically through molting and resetting the stem cell niche during regeneration.
The widening spectrum of myelin oligodendrocyte glycoprotein antibody‐associated disorders in children
Authors: O'toole Orna
Published: December 2018

This commentary is on the case series by Ramanathan et al. on pages 610–614 of this issue.
Mixture of tree species enhances stability of the soil bacterial community through phylogenetic diversity
Authors: Zhang Xiao , Huang Yongtao , Liu Shirong , Fu Shenglei , Ming Angang , Li Xiangzhen , Yao Minjie , Li Huan , Tian Chao
Published: December 2018

The composition of tree species might influence microbial diversity considerably, yet investigation of the consequences of changes in diversity for stability of the microbial community is still in its early stages. Understanding how diversity governs community stability is vital for predicting the response of an ecosystem to environmental changes. Phylogenetic diversity (PD) describes the distinct evolution of species in a community, and might be useful for estimating the effects of biodiversity on ecosystem function and stability. High‐throughput 16S rRNA gene sequencing was used to examine soil bacterial phylogenetic distances, phylogenetic diversity and interactions between individuals in five single‐species plantations and three mixed‐species plantations. The plantations were established on the same initial substrate, and sampling was at 68 relatively spatially independent sites. Our results showed that mixed tree species enhanced soil bacterial phylogenetic diversity and community stability, and that phylogenetic diversity had a positive effect on stability of the soil microbial community. We also found evidence that microbial communities characterized by distantly related species with weak interactions were more stable in mixed plantations than communities with strong interactions in single‐species plantations. These results may be explained by the “insurance hypothesis”, that large phylogenetic diversity of microbial communities, which share different ecological niches, insures them against decline in their stability. This is because, even if some microbial species fail to deal with environmental change, others might not necessarily be affected similarly. Our findings demonstrate that phylogenetic diversity is the main controlling factor of the variation in stability across sites and requires more attention in sustainable forest management.

Highlights

Mixed species considerably improved stability of the soil bacterial community.

Bacterial phylogenetic diversity was greater in mixed‐ than in single‐species plantations.

Mixed species resulted in weak microbial interactions in a community.

There was a strong relation between phylogenetic diversity and stability.
A comparison of the effects of natural vegetation regrowth with a plantation scheme on soil structure in a geological hazard‐prone region
Authors: Wang Xia , Huang Zheng , Hong Miaomiao M. , Zhao Yun F. , Ou Yan S. , Zhang Jian
Published: December 2018

The effects of natural vegetation regrowth and plantation schemes on soil aggregate structure and total soil porosity were examined at a typical landslide hazard site in a semi‐humid region in northwest China. The schemes were started in 2008 using four plots, two of which were kept bare; in one natural local vegetation was allowed to grow and in the other planting was managed. Analysis of soil samples (0–100 cm) taken in 2016 indicated that the proportion of soil aggregates <0.25 mm was 43.22 and 29.01% under natural vegetation and plantation, respectively, which was significantly greater than that in the plots kept bare (23%). Soil tensile stress increased from approximately 12 kPa in the bare plots to 18.34 and 16.45 kPa under natural vegetation and plantation, respectively. Total soil porosity, water retention and rate of infiltration increased, whereas bulk density decreased considerably, after 8 years under natural vegetation and plantation in comparison with those properties in the bare plots. Furthermore, natural vegetation had a greater effect than the plantation on soil structure in terms of aggregation and total porosity. The findings of this study provide some insight into the effects of native vegetation and a plantation on soil structure in semi‐humid regions as a prerequisite to the control of both soil erosion and slope stability in regions prone to seismic activity.

Highlights

Soil structure was analysed after 8 years of natural vegetation regrowth and plantation.

Eight years of revegetation improved aggregation and total porosity compared with bare land.

Natural vegetation affected soil structure more than the plantation did.

Our results provide some insight into a prerequisite to control soil erosion and slope stability in unstable regions.
Evolutionary dynamics of specialisation in herbivorous stick insects
Authors: Larose Chloé , Rasmann Sergio , Schwander Tanja
Published: December 2018

Understanding the evolutionary dynamics underlying herbivorous insect mega‐diversity requires investigating the ability of insects to shift and adapt to different host plants. Feeding experiments with nine related stick insect species revealed that insects retain the ability to use ancestral host plants after shifting to novel hosts, with host plant shifts generating fundamental feeding niche expansions. These expansions were, however, not accompanied by expansions of the realised feeding niches, as species on novel hosts are generally ecologically specialised. For shifts from angiosperm to chemically challenging conifer hosts, generalist fundamental feeding niches even evolved jointly with strong host plant specialisation, indicating that host plant specialisation is not driven by constraints imposed by plant chemistry. By coupling analyses of plant chemical compounds, fundamental and ecological feeding niches in multiple insect species, we provide novel insights into the evolutionary dynamics of host range expansion and contraction in herbivorous insects.
Cystic intra‐abdominal testicles: Standing laparoscopic removal in two colts
Authors: Rijkenhuizen A. B. M. , Lichtenberg D. , Weitkamp K.
Published: December 2018

This case report describes the laparoscopic approach for removal of cystic intra‐abdominal testicles in the standing colt. One 3‐year‐old Tobiano and one 2‐year‐old Warmblood colts were referred for abdominal cryptorchidectomy. The horses were clinically and ultrasonographically examined and a presumptive diagnosis of unilateral abdominal cryptorchidism was made. A laparoscopic approach via the flank was used to localise each abdominal testicle. In both colts the abdominal testicle was enlarged and cystic. Each spermatic cord was ligated and fluid was aspirated from the testicle. By reducing the size of the mass minimally invasive removal through an enlarged instrumental portal was possible. Histopathology revealed a cystic rete testis in the Tobiano and a teratoma in the Warmblood. In these cases the cystic enlarged testicles were nonpainful and were incidental findings. A cystic testicle might be developmental (Tobiano case) or arise due to neoplastic transformation (Warmblood case). The laparoscopic approach for enlarged cyst‐like testicles in the standing horse offers a secure minimally invasive method for removal.
RagA, an mTORC1 activator, interacts with a hedgehog signaling protein, WDR35/IFT121
Authors: Sekiguchi Takeshi , Furuno Nobuaki , Ishii Takashi , Hirose Eiji , Sekiguchi Fumiko , Wang Yonggang , Kobayashi Hideki
Published: December 2018

Small Ras‐like GTPases act as molecular switches for various signal transduction pathways. RagA, RagB/RagC and RagD are small Ras‐like GTPases that play regulatory roles in mTORC1. Lack of proper activation of mTORC1 can lead to diseases, such as cancer and diabetes. In this study, we found an interaction between RagA and WDR35. Mutations of WDR35 may cause genetic diseases including Sensenbrenner syndrome. WDR35 seems to be a hedgehog signaling protein with a possible ciliary function and a possible upstream regulator of RagA. RagB is a homologue of RagA and is also associated with WDR35. WDR35 is present in the endoplasmic reticulum, but usually not in lysosomes, where Rag family proteins act as an mTORC1 switch. Over‐expression of WDR35 results in decreased phosphorylation of ribosome S6 protein in a RagA‐, RagB‐ and RagC‐dependent manner. Thus, WDR35 is associated with RagA, RagB and RagC and might negatively influence mTORC1 activity.
Rescue therapy for chronic hepatitis C virus infection after repeated treatment failures: Impact on disease progression and risk of hepatocellular carcinoma
Authors: Hanafy Amr Shaaban , Soliman Shaimaa , Abd‐Elsalam Sherief
Published: December 2018

Aim

Retreatment after previous failure of direct‐acting antivirals for hepatitis C virus (HCV) infection is a challenging decision. The importance of achieving viral eradication on modification of disease progression and outcome, including the risk of hepatocellular carcinoma (HCC), remains a critical issue to be evaluated.

Methods

One hundred patients with repeated failure of sofosbuvir and ribavirin or triple therapy with sofosbuvir, ribavirin, and daclatasvir were divided into a study group (n = 50) given rescue therapy (sofosbuvir, daclatasvir, simeprevir, and ribavirin) or a control group (n = 50) matched for age, sex, and pretreatment variables (Child–Turcotte–Pugh score and Fibrosis‐4 score). Follow‐up was undertaken after the last non‐response to detect serious adverse events, such as hepatic decompensation and development of HCC.

Results

The study group achieved sustained virologic response (SVR) in 47 of 50 (94%) patients. The control group had significantly higher HCC rates than the study group (7 vs. 1 patients), with an odds ratio of 5.44. The rescue therapy was associated with significantly longer time to the occurrence of adverse events. Repeated treatment failures were associated with progression of FibroScan values in the control group (21 ± 4.5 vs. 10 ± 1.5 kPa, P = 0.001); achieving SVR in the study group stopped fibrosis progression despite non‐significant increase from baseline (13.2 ± 3.2 vs. 10.6 ± 0.6, P = 0.12).

Conclusions

Rescue treatment for HCV infection was highly effective in achieving SVR, less expensive than the newer agents, and is associated with diminished risk of serious adverse events, mainly HCC in these patients.
Partial replacement of meat by sugar cane fibre: cooking characteristics, sensory properties of beef burgers and in vitro fermentation of sugar cane fibre
Authors: Pluschke Anton M. , Feng Guangli , Williams Barbara A. , Gidley Michael J.
Published: December 2018

In this study, sugar cane fibre (SCF) partially replaced meat in beef burger formulations. The effects of SCF on cook yield, dimensional changes, sensory characteristics of beef burgers and in vitro gut fermentation characteristics were evaluated. Replacing beef with 1 to 5% SCF in burgers significantly increased cook yields from 13.8 ± 0.3 to 59.1 ± 0.3% due to its high water‐binding capacity of 5.89 ± 0.08 g g−1 and oil‐binding capacity of 4.68 ± 0.03 g g−1. The inclusion of SCF improved cooking properties whilst improving sensory characteristics. Burgers with 1% SCF had the highest overall acceptability. SCF was steadily fermented with a porcine faecal inoculum for up to 72 h, producing short‐chain fatty acids. The characteristics of high water/oil binding and fermentability suggest that SCF has the potential to provide a range of dietary fibre benefits, and therefore deserves further study.
Pediatric voiding cystourethrography: An essential examination for urologists but a terrible experience for children
Authors: Johnin Kazuyoshi , Kobayashi Kenichi , Tsuru Teruhiko , Yoshida Tetsuya , Kageyama Susumu , Kawauchi Akihiro
Published: December 2018

Voiding cystourethrography is the most important fluoroscopic examination in pediatric urology for the investigation of lower urogenital tract diseases, such as vesicoureteral reflux or urethral stricture. However, this invasive procedure imposes a significant burden on children and their parents, and recently there has been a paradigm shift in the diagnosis and treatment of vesicoureteral reflux. In the 2011 revision, the American Academy of Pediatrics guidelines on urinary tract infection recommended abandoning routine voiding cystourethrography after the first febrile urinary tract infection. In 2014, the randomized intervention for children with vesicoureteral reflux study recommended discontinuation of routine continuous antibiotic prophylaxis for vesicoureteral reflux. The time is now ripe to radically reconsider indications for voiding cystourethrography and the procedure itself.
Cost‐effectiveness of home blood pressure telemonitoring and case management in the secondary prevention of cerebrovascular disease in Canada
Authors: Padwal Raj S. , So Helen , Wood Peter W. , Mcalister Finlay A. , Siddiqui Muzaffar , Norris Colleen M. , Jeerakathil Tom , Stone James , Valaire Shelley , Mann Balraj , Boulanger Pierre , Klarenbach Scott W.
Published: December 2018

Home blood pressure (BP) telemonitoring and pharmacist case management reduce BP, but cost‐effectiveness assessments are mixed. We examined the incremental cost‐effectiveness of this intervention vs usual care in Canadians with cerebrovascular disease. A Markov decision model cost‐utility analysis examining community‐residing, high‐risk patients with a recent nondisabling cerebrovascular event was created. A lifetime time horizon and health care payer perspective were used. Achieved BP, future cardiovascular risks, and attendant consequences on quality‐adjusted life years and Canadian dollar costs were modeled. BP telemonitoring was assumed to occur for 3 months, then quarterly. Life tables were used to determine overall mortality, adjusted by cardiovascular disease mortality. Relative efficacies of intervention‐associated BP lowering, resource use, and costs were obtained from Canadian published literature. Reduction in systolic BP of 9.7 mmHg was used in the base case; subsequently, robust sensitivity analyses were conducted. The results showed that, over the lifetime horizon, telemonitoring with case management led to net health care savings of $1929 Canadian and increased per‐patient QALYs by 0.83. These findings were robust to sensitivity analysis, with the intervention remaining dominant or highly cost‐effective. Increasing telemonitoring costs by 50% still resulted in the intervention being dominant; if the costs of telemonitoring plus case management were 2‐3 times base case cost, incremental cost‐effectiveness was $1200‐$4700 per quality‐adjusted life year gained. In conclusion, home BP telemonitoring and pharmacist case management poststroke lowered costs and improved QALYs. Strategies and funding for broad implementation of this dominant strategy should be implemented.
A convenient method to verify the accuracy of oscillometric blood pressure monitors by the auscultatory method: A smartphone‐based app
Authors: Zhang Zhi , Xi Weichun , Wang Bingjiang , Chu Guang , Wang Fang
Published: December 2018

It is recommended that oscillometric devices be calibrated by auscultation when first used, but this is difficult in practice. Here, we introduce a smartphone‐based technique to verify the accuracy of blood pressure monitors (BPMs). We enrolled 99 consecutive subjects and tested 6 brands of BPMs in this study. During measurements of electronic oscillometric BPMs, Korotkoff sounds were simultaneously collected using a stethoscope head beneath a cuff connected to a smartphone, and an app named Accutension Stetho could then yield an auscultatory BP reading as a reference. Next, differences in BP between the different BPMs and Accutension Stetho were determined. The percentage of BP differences falling within 5, 10, and 15 mm Hg; the mean (MD) value; and the standard deviation (SD) of BP differences and deflation errors were analyzed among all the BPMs. We found that the percentages of SBP differences falling within 5 mm Hg of the 6 BPMs were 80%, 79%, 77%, 72%, 68%, and 63%, in turn. The deflation rates among the 6 BPMs were 2.23, 3.48, 6.10, 2.44, 3.66, and 4.85 mm Hg/beat, respectively. Deflation errors, which were defined as deflation prior to the end of the Korotkoff sounds, existed in 4 BPMs. In conclusion, Accutension Stetho could detect BP differences between oscillometric BPM readings and simultaneous auscultatory readings. Diastolic BP was overestimated when the device deflated prior to the end of the Korotkoff sounds. Using the app, it is possible to evaluate the accuracy of BPMs among the same subjects.
Vitamin D, bone mineral density and risk of fracture in people with intellectual disabilities
Authors: Frighi V. , Morovat A. , Andrews T. M. , Rana F. , Stephenson M. T. , White S. J. , Fower E. , Roast J. , Goodwin G. M.
Published: December 2018

Background

People with intellectual disabilities (IDs) have very high rates of osteoporosis and fractures, to which their widespread vitamin D deficiency and other factors could contribute. We aimed to assess in people with IDs previously treated for vitamin D deficiency (1) long‐term adherence to vitamin D supplementation and (2) bone mineral density (BMD), as an indicator for risk of fractures, according to vitamin D supplementation and other factors.

Method

We recorded height, weight, medical, pharmacological, dietary and lifestyle assessment. Blood sample were taken for vitamin D and related analytes. dual‐energy X‐ray absorptiometry for BMD was performed.

Results

Of 51 study participants (mean [standard deviation, SD] age 51.5 [13.6] years, 57% male), 41 (80.4%) were taking vitamin D and 10 were not. Mean [SD] serum vitamin D was 81.3 [21.3] vs. 25.2 [10.2] nmol/L (P < 0.0001), respectively. Thirty‐six participants underwent a dual‐energy X‐ray absorptiometry scan, which showed osteoporosis in 23.7% and osteopenia in 52.6%. Participants on vitamin D had higher BMD than those who were not, a statistically significant difference when confounders (lack of mobility and hypogonadism) were removed. BMD was significantly different according to mobility, particularly in wheelchair users, in whom hip BMD was 33% lower (P < 0.0001) than in participants with normal mobility. Participants still taking vitamin D showed a 6.1% increase in BMD at the spine (P = 0.003) after mean [SD] 7.4 [1.5] years vitamin D treatment.

Conclusions

In people with IDs and previous vitamin D deficiency, BMD increases on long‐term vitamin D supplementation. However, additional strategies must be considered for osteoporosis and fracture prevention in this population.
Lack of evidence for synaptic high‐affinity γ‐hydroxybutyric acid (GHB) transport in rat brain synaptosomes and 11 Na+‐dependent SLC neurotransmitter transporters
Authors: Thiesen Louise , Frølund Bente , Wellendorph Petrine
Published: December 2018

γ‐Hydroxybutyric acid (GHB) is an endogenous compound proposed to act as a neurotransmitter. Na+‐dependent, high‐affinity GHB transport has long been considered important evidence supporting this hypothesis. However, the molecular identity of such a high‐affinity transporter remains unknown. In this study, we sought to identify and characterize GHB synaptic transport through a series of studies using both native and recombinant systems with the ultimate aim of providing evidence to clarify the proposed role of GHB as a neurotransmitter in the mammalian brain. Native [3H]GHB transport was studied in isolated rat brain synaptosomes and compared to synaptic membranes. As a targeted approach, GHB was also screened against a panel of Na+‐dependent SLC6 neurotransmitter transporters recombinantly expressed in Xenopus laevis oocytes or tsA201 cells. Finally, the low‐affinity GHB transporters, MCT1/2 and SMCT1, were probed as GHB transporters in L‐[14C]lactate uptake assays in synaptosomes. We found no evidence of high‐affinity [3H]GHB transport in purified rat brain cortical or striatal synaptosomes or at any of the 11 SLC6 transporters tested. Instead, our results indicate the binding of [3H]GHB to an unidentified membrane component, distinct from any of the known GHB targets. In accordance with others, we found that GHB and the analog 3‐hydroxycyclopent‐1‐enecarboxylic acid (HOCPCA) can, in millimolar concentrations, inhibit L‐[14C]lactate uptake at MCT1 and/or MCT2 and that this also can occur in synaptosomes. In conclusion, through a variety of in vitro pharmacological studies, we were unsuccessful in identifying a specific synaptic high‐affinity transporter for GHB. Our findings emphasize the need to reevaluate GHB's role as a potential neurotransmitter.

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The Friction Clasp
Authors: Belles Donald M.
Published: December 2018

This clinical report describes a modification of the conventional direct retainer design, which incorporates advantages of the dual path partial denture, but with a greater ease of design and fabrication. The main advantage of this technique is minimizing the clasp display on Class III and Class IV removable partial denture prostheses. A clinical example using this design is described.
Risk Preference Theory and Gender Differences in Religiousness: A Replication and Extension
Authors: Hoffmann John P.
Published: December 2018

Almost 25 years ago, Miller and Hoffmann developed a theory of risk preferences as a way to account for gender differences in religiousness. Although several subsequent studies have purportedly examined the theory, there has been no genuine replication of their empirical analysis. This study provides a replication and extension using three nationally representative samples of adolescents in the United States: the 2015 Monitoring the Future (n = 2,292) study, the 2010 National Survey of Drug Use and Health (n = 18,394), and the 2005 National Survey of Youth and Religion (n = 2,059). The results provide modest support for risk preference theory: the introduction of risk preferences diminishes the female‐male difference in religiousness among youth in all three data sets. However, there is also evidence that risk behaviors and religious affiliation may be more important than risk preferences in accounting for gender differences in religiousness.
From Marx to Market: Lawyers, European Law, and the Contentious Transformation of the Port of Genoa
Authors: Pavone Tommaso
Published: December 2018

What happens when international courts are asked to tackle local political controversies and their judgments subsequently spark contentious resistance? In the European Union (EU), scholars have posited that the politicization of the often-liberalizing rulings of the European Court of Justice (ECJ) provokes Euroscepticism and noncompliance. In contrast, I argue that contentious politics may also produce permissive conditions for activist “Eurolawyers” to promote awareness of EU law and mobilize support for liberalization. To unpack this claim, I conduct an intensive case study of perhaps the most explosive controversy in Italy to generate litigation before the ECJ: The 1991 “Port of Genoa” case, where the public monopoly rights of a centuries-old dockworkers' union were challenged. Leveraging interviews, court and newspaper records, public opinion data, and litigation statistics, I trace how—despite dockworkers' vigorous resistance—a pair of entrepreneurial lawyers liberalized Italy's largest port by combining strategic litigation with a public relations campaign to mobilize a compliance constituency. I conclude with insights the case study offers into the contemporary politics of transnational governance.
A review of pregnancy iPhone apps assessing their quality, inclusion of behaviour change techniques, and nutrition information
Authors: Brown Hannah M. , Bucher Tamara , Collins Clare E. , Rollo Megan E.
Published: December 2018

Smartphone apps for use in pregnancy are common and could influence lifestyle behaviours, but they have not been evaluated. This review aimed to assess the quality of iPhone pregnancy apps and whether they included behaviour change techniques (BCTs) and/or pregnancy‐specific nutrition information. A keyword search of the Australian iTunes app store was conducted. For inclusion, apps had to be available at no cost, in English, intended for use by pregnant women, and contain nutrition information. App quality was assessed using the Mobile Application Rating Scale (MARS). Absence or presence of BCTs was assessed using the CALO‐RE taxonomy, with type of nutrition information included also reported. The initial key word search identified 607 apps, with 51 iPhone apps included in final evaluation. Mean overall MARS quality rating score was 3.05 out of 5 (1 = inadequate; 5 = excellent). The functionality subscale scored highest (mean = 3.32), and aesthetics scored lowest (mean = 2.87). Out of a possible 40 BCTs, 11 were present across the apps with a median of three BCTs (range: 0–6) identified per app. The median number of pregnancy‐specific nutrition topics per app was three (range 0 to 7). Despite the availability of a large number of iPhone pregnancy apps, few are of high quality, with only a small number of BCTs used and limited inclusion of pregnancy‐specific nutrition information. It is important to be aware of limitations within current pregnancy apps before recommending usage during this key life stage.
The RCC1 family protein SAB1 negatively regulates ABI5 through multidimensional mechanisms during postgermination in Arabidopsis
Authors: Ji Hongtao , Wang Shuangfeng , Cheng Chunhong , Li Ran , Wang Zhijuan , Jenkins Gareth I. , Kong Fanjiang , Li Xia
Published: December 2018

Abscisic acid‐insensitive 5 (ABI5) is an essential and conserved plant basic leucine zipper transcription factor whose level controls seed germination and postgerminative development. It has been demonstrated that activity of ABI5 is transcriptionally and post‐translationally regulated. However, transcriptional regulation of ABI5 is not fully understood.

Here, we identified SAB1 (Sensitive to ABA 1) as a novel negative regulator of ABI5 that simultaneously regulates its stability, promoter binding activity and histone methylation‐mediated gene silencing of ABI5. SAB1 encodes a Regulator of Chromatin Condensation 1 (RCC1) family protein and is expressed in an opposite pattern to that of ABI5 during early seedling growth in response to abscisic acid (ABA). SAB1 mutation results in enhanced ABA sensitivity and acts upstream of ABI5.

SAB1 physically interacts with ABI5 at phosphoamino acid Ser‐145, and reduces the phosphorylation of ABI5 and the protein stability. SAB1 reduces ABI5 binding activity to its own promoter, leading to reduced transcriptional level of ABI5. SAB1 inactivates ABI5 transcription by increasing the level of histone H3K27me2 in the ABI5 promoter.

Our findings have identified SAB1 as a crucial new component of ABA signaling which modulates early development of plant by precisely controlling ABI5 activity through multiple mechanisms.
A Better Understanding of Granger Causality Analysis: A Big Data Environment
Authors: Song Xiaojun , Taamouti Abderrahim
Published: December 2018

This paper aims to provide a better understanding of the causal structure in a multivariate time series by introducing several statistical procedures for testing indirect and spurious causal effects. In practice, detecting these effects is a complicated task, since the auxiliary variables that transmit/induce indirect/spurious causality are very often unknown. The availability of hundreds of economic variables makes this task even more difficult since it is generally infeasible to find the appropriate auxiliary variables among all the available ones. In addition, including hundreds of variables and their lags in a regression equation is technically difficult. The paper proposes several statistical procedures to test for the presence of indirect/spurious causality based on big data analysis. Furthermore, it suggests an identification procedure to find the variables that transmit/induce the indirect/spurious causality. Finally, it provides an empirical application where 135 economic variables were used to study a possible indirect causality from money/credit to income.
Prevalence of spontaneous type I ECG pattern, syncope, and other risk markers in sudden cardiac arrest survivors with Brugada syndrome
Authors: Leong Kevin M.W. , Ng Fu Siong , Jones Sian , Chow Ji‐Jian , Qureshi Norman , Koa‐Wing Michael , Linton Nicholas W.F. , Whinnett Zachary I. , Lefroy David C. , Davies David Wyn , Lim Phang Boon , Peters Nicholas S. , Kanagaratnam Prapa , Varnava Amanda M.
Published: December 2018

Introduction

A spontaneous type I electrocardiogram (ECG) pattern and/or unheralded syncope are conventionally used as risk markers for primary prevention of sudden cardiac arrest/death (SCA/SCD) in Brugada syndrome (BrS). In this study, we determine the prevalence of conventional and newer markers of risk in those with and without previous aborted SCA events.

Methods

All patients with BrS were identified at our institute. History of symptoms was obtained from medical tests or from interviews. Other markers of risk were also obtained, such as presence of (1) spontaneous type I pattern, (2) fractionated QRS (fQRS), (3) early repolarization (ER) pattern, (4) late potentials on signal‐averaged ECG (SAECG), and (5) response to programmed electrical stimulation.

Results

In 133 patients with Bars, 10 (7%) patients (mean age = 39 ± 11 years; nine males) were identified with a previous ventricular fibrillation/ventricular tachycardia episode (n = 8) or requiring cardio‐pulmonary resuscitation (n = 2). None of these patients had a prior history of syncope before their SCA event. Only two (20%) patients reported a history of palpitations or dizziness. None had apneic breathing and three (30%) patients had a family history of SCA. From their ECGs, a spontaneous pattern was only found in one (10%) of these patients. Further, 10% of patients had fQRS, 17% had late potentials on SAECG, 20% had deep S waves in lead I, and 10% had an ER pattern in the peripheral leads. No significant differences were observed in the non‐SCA group.

Conclusion

The majority of BrS patients with previous aborted SCA events did not have a spontaneous type I and/or prior history of syncope. Conventional and newer markers of risk appear to only have limited ability to predict SCA.