bluuebunny/crossref_metadata_2025 huggingface dataset:
Gender‐based violence before, during, and after cyclones: slow violence and layered disasters
Authors: Rezwana Nahid , Pain Rachel
Published: May 2020

This paper investigates the mutual relationship between gender‐based violence (GBV) and cyclone‐related disasters. Evidence is sparse on this topic, especially in‐depth research attending to the cultural and socioeconomic aspects of locality. The work reported here is based on a case study of a coastal district of Bangladesh (Barguna)—conducted shortly after Cyclone Roanu struck the country in May 2016—that aimed to shed light on the mechanisms linking GBV to cyclones through the eyes of survivors. The paper maps out the different forms, experiences, and impacts of GBV before, during, and after cyclones, and argues that such events lead directly and indirectly to GBV, and that GBV makes women and children more vulnerable to the effects of disasters. Climate change, economic losses, and poverty compound this cyclical relationship. A conceptual framing, drawing on the notion of ‘slow violence’, is developed to understand the layering of diverse types of violence that operate on seemingly different temporal and spatial scales.
Implications of Prelecture Material on Cognitive Load and Instructional Effectiveness in Cross‐Disciplinary IS Education: The Nexus of Benford's Law and SQL
Authors: Mills Robert J. , Beaulieu Tanya Y. , Feldon David F. , Olsen David H.
Published: May 2020

For some time, there has been a call for cross‐disciplinary teaching within the business disciplines. With the rise of data and analytics, there is an opportunity for cross‐disciplinary teaching by integrating technology throughout the business curriculum. However, many business professors have little experience in cross‐disciplinary teaching. We hope to rectify this by introducing an approach that uses prelecture material to prepare students for learning concepts and terms that are not core to the focal class. In a study that combines Structured Query Language (SQL) coding with an audit principle called Benford's Law, we analyze the impact of adding prelecture material about Benford's Law on student's cognitive load, knowledge gained, and instructional efficiency. Results indicate that students who received a prelecture on Benford's Law outperformed the control group in performance measures related to Benford's Law, and that the instructional efficiency on Benford's Law was also higher for the treatment group. We did not find any significant differences in cognitive load between the two groups, nor did the treatment group perform significantly better when tested on the SQL concepts. We conclude that cross‐discipline teaching is a fine balance between each discipline and communicating to students the importance of both disciplines is key.
The potential of the solitary parasitoidMicroctonus brassicaefor the biological control of the adult cabbage stem flea beetle,Psylliodes chrysocephala
Authors: Jordan Anna , Broad Gavin R. , Stigenberg Julia , Hughes Jessica , Stone Jake , Bedford Ian , Penfield Steven , Wells Rachel
Published: May 2020

The cabbage stem flea beetle (CSFB),Psylliodes chrysocephalaL. (Coleoptera: Chrysomelidae), is a major pest of oilseed rape,Brassica napusL. (Brassicaceae), within the UK and continental Europe. Following the withdrawal of many broad‐spectrum pesticides, most importantly neonicotinoids, and with increased incidence of pyrethroid resistance, few chemical control options remain, resulting in the need for alternative pest management strategies. We identified the parasitoid waspMicroctonus brassicae(Haeselbarth) (Hymenoptera: Braconidae) within CSFB collected from three independent sites in Norfolk, UK. Parasitism of adult CSFB was confirmed, and wasp oviposition behaviour was described. Moreover, we show that within captive colonies parasitism rates are sufficient to generate significant biological control of CSFB populations. A sequence of theM. brassicaemitochondrial cytochrome oxidase 1 (MT‐CO1) gene was generated for rapid future identification. Moroccan specimens ofMicroctonus aethiopoides(Loan), possessing 90% sequence similarity, were the closest identified sequenced species. This study represents the first description published in English of this parasitoid of the adult cabbage stem flea beetle.
Changes in soil organic carbon under perennial crops
Authors: Ledo Alicia , Smith Pete , Zerihun Ayalsew , Whitaker Jeanette , Vicente‐Vicente José Luis , Qin Zhangcai , McNamara Niall P. , Zinn Yuri L. , Llorente Mireia , Liebig Mark , Kuhnert Matthias , Dondini Marta , Don Axel , Diaz‐Pines Eugenio , Datta Ashim , Bakka Haakon , Aguilera Eduardo , Hillier Jon
Published: May 2020

This study evaluates the dynamics of soil organic carbon (SOC) under perennial crops across the globe. It quantifies the effect of change from annual to perennial crops and the subsequent temporal changes in SOC stocks during the perennial crop cycle. It also presents an empirical model to estimate changes in the SOC content under crops as a function of time, land use, and site characteristics. We used a harmonized global dataset containing paired‐comparison empirical values of SOC and different types of perennial crops (perennial grasses, palms, and woody plants) with different end uses: bioenergy, food, other bio‐products, and short rotation coppice. Salient outcomes include: a 20‐year period encompassing a change from annual to perennial crops led to an average 20% increase in SOC at 0–30 cm (6.0 ± 4.6 Mg/ha gain) and a total 10% increase over the 0–100 cm soil profile (5.7 ± 10.9 Mg/ha). A change from natural pasture to perennial crop decreased SOC stocks by 1% over 0–30 cm (−2.5 ± 4.2 Mg/ha) and 10% over 0–100 cm (−13.6 ± 8.9 Mg/ha). The effect of a land use change from forest to perennial crops did not show significant impacts, probably due to the limited number of plots; but the data indicated that while a 2% increase in SOC was observed at 0–30 cm (16.81 ± 55.1 Mg/ha), a decrease in 24% was observed at 30–100 cm (−40.1 ± 16.8 Mg/ha). Perennial crops generally accumulate SOC through time, especially woody crops; and temperature was the main driver explaining differences in SOC dynamics, followed by crop age, soil bulk density, clay content, and depth. We present empirical evidence showing that the FAO perennialization strategy is reasonable, underscoring the role of perennial crops as a useful component of climate change mitigation strategies.
Building a new scale to measure worries about oral hygiene self‐management in vulnerable older adults
Authors: Schensul Jean J. , Salvi Apoorva , Ha Toan , Reisine Susan , Li Jianghong , Moni Yacihuilca
Published: May 2020

Objective

This paper describes a new scale to measure worries about self‐management of oral hygiene in low‐income older adults.

Background

Oral hygiene that prevents oral diseases and worsening of chronic conditions improves with instruction, but other cognitive/emotional factors impede oral hygiene practice especially among older adults. Many scales measure dental anxiety, but none measures oral hygiene self‐management worries.

Materials and Methods

Formative research with diverse older adults 55‐95 in low‐income housing identified scale items. A 23‐item scale was tested in a pilot intervention study (n = 84) and formalised with a new sample (N = 331).

Results

In both studies, PCA/factor analysis produced two subscales: (a) worries about cleaning teeth and (b) consequences of cleaning. Chronbach's alpha coefficient evaluated internal consistency, and Pearson's r and Kendall tau/Spearman's rho evaluated scale predictability, convergent and divergent validity. The scale and subscales showed good internal consistency in both studies (over 0.90) and stability T0 0.90; T1: 0.90). In the larger sample, statistically significant correlations between the scale, subscales; plaque score, and similar scales (perceived risk of oral health problems, and fears of oral diseases) demonstrated convergent validity. For divergent validity, the worries scale, not the GOHAI, a similar scale measuring oral health life quality, was associated with Plaque Score. Each scale was associated with different mediators suggesting different constructs.

Conclusion

The overall scale has good internal consistency, test‐retest reliability, predictability and convergent and divergent validity. It captures a psycho‐emotional construct useful in oral health research and hygiene education with older adults.
Persistent infection of Helicobacter pylori affects weight loss in obese population compared with persistent negative: A case‐control study based on healthy Chinese
Authors: Zhang Jinshun , Chen Yahong , Chen Weiling , Xu Hongfang , Wang Huihong , Chen Lijuan , Ye Yafei , Wang Zhongtai , Ye Juanjuan
Published: May 2020

Background

The relationship between Helicobacter pylori (H pylori) and body mass index (BMI) is still inconclusive. Not only the high rate of H pylori infection but also the increasing higher BMI levels are endangering Chinese today.

Methods

The aim of this research was to evaluate the association between different situations of H pylori infection and BMI values or levels in Chinese healthy population. A total of 39 091 individuals aged from 18 years to 80 years, performed healthy examination including a 13C/14C urease breath test (13C/14C‐UBT), were included. Among them, 30 224 individuals only had one time of health examination, and 8867 had two or more times. A case‐cohort data of 8752 with an interval time more than 6 months, collected by the first and the last time, were established from the latter. BMI groups are classified according to the China recommendation: low weight (<18.5 kg/m2), normal weight (18.5 ~ 23.9 kg/m2), overweight (24.0 ~ 27.9 kg/m2), and obesity (≥28.0 kg/m2).

Results

The rate of H pylori infection among low weight, normal weight, overweight, and obesity was 43.2%, 44.7%, 46.4%, and 48.0%, respectively (P = .000). H pylori infection increased the risk of higher level of BMI (OR = 1.077, 95% confidence interval = 1.036‐1.119, χ2 = 14.048, P = .000) with adjustments for sex and age. In the case‐control study, the rate of persistent negative, persistent infection, new infection, and eradicated infection was 39.5%, 25.8%, 15.8%, and 18.9%, respectively, with a median interval time of 13 months. The mean obesity BMI descend values in the persistent negative subgroup were lower than those in the persistent infection subgroup (−0.21 ± 1.19 kg/m2 vs −0.003 ± 1.01 kg/m2, P = .021). But the change of BMI classifications had no difference between the subgroups of H pylori infection in different BMI levels.

Conclusions

H pylori infection was positively correlated with higher BMI levels. And H pylori persistent infection had a negative effect on the fall of BMI values in Chinese obese population.
Programming for Immigrant Women in Canada: Is Entrepreneurship Neglected?
Authors: Kalu Kenneth , Okafor Oliver Nnamdi
Published: May 2020

This study examines the demand and supply dynamics of entrepreneurship support services for new immigrant women in the Toronto Census Metropolitan Area (CMA), Ontario, Canada. Empirical evidence presented in this study reveals significant unmet needs for entrepreneurship support services. Major reasons for the inability of settlement agencies to meet the entrepreneurship needs of new immigrants include prioritization of other support services and lack of funding. The study identifies unfamiliarity with the Canadian environment, discrimination, business regulations that are difficult to satisfy, and unlikely tendencies of the immigrants to ask for support as some of the key challenges to entrepreneurship among immigrant women. However, these challenges may be ameliorated with enhanced entrepreneurship and language training, information awareness campaigns and more funding, among other factors. The findings have practical implications for accountable governments and non‐governmental organizations as they design and/or redesign immigration and settlement policies to facilitate integration of new immigrants.
Magnesium isoglycyrrhizinate prevents the nonalcoholic hepatic steatosis via regulating energy homeostasis
Authors: Jiang Wenjiao , Xu Shiyu , Guo Huijie , Lu Li , Liu Jie , Wang Guangji , Hao Kun
Published: May 2020

Non‐alcoholic fatty liver disease is a public health problem worldwide associated with high morbidity and hepatic steatosis, but no effective therapeutic interventions. Magnesium isoglycyrrhizinate (MGIG), a derivative of an active component of Glycyrrhiza glabra, is widely used for the treatment of inflammatory liver diseases due to its potent anti‐inflammatory and hepatoprotective activities. Hence, this study aimed to study the effects of MGIG on hepatic steatosis in mice fed a high‐fat diet (HFD). Oil Red O staining and transmission electron microscopy revealed a decrease in lipid accumulation in the liver after MGIG treatment along with improved mitochondrial ultramicrostructures. Metabonomic analysis demonstrated that MGIG intervention increased glutamate utilization in mitochondria by promoting the uptake of glutamate into the tricarboxylic acid (TCA) cycle. The NAD+/NADH ratio and the expression of other lipid‐metabolism‐related genes were increased in MGIG‐treated livers. Transcriptome sequencing showed that the expression of TLR4, an isoform of the innate immunity Toll‐like receptors (TLRs), was significantly decreased after MGIG treatment, suggesting a link between the anti‐inflammatory effects of MGIG and its suppression of lipidation. Our results reveal the potent effects of MGIG on lipid metabolism and suggest that hepatic TLR4 might be a crucial therapeutic target to regulate energy homeostasis in hepatic steatosis.
Construction of a ceRNA coregulatory network and screening of hub biomarkers for salt‐sensitive hypertension
Authors: Zhang Ling , Qi Han , Liu Zheng , Peng Wen‐Juan , Cao Han , Guo Chun‐Yue , Sun Yan‐Yan , Pao Christine , Xiang Yu‐Tao
Published: May 2020

Salt‐sensitive hypertension (SSH) is an independent risk factor for cardiovascular disease. The regulation of long non‐coding RNAs, mRNAs and competing endogenous RNAs (ceRNAs) in the pathogenesis of SSH is uncertain. An RNA microarray was performed to discover SSH‐associated differentially expressed lncRNAs (DElncRNAs) and mRNAs (DEmRNAs), and 296 DElncRNAs and 44 DEmRNAs were identified, and 247 DElncRNAs and 44 DEmRNAs among these RNAs were included in the coexpression network. The coregulatory network included 23 ceRNA loops, and six hub RNAs (lnc‐ILK‐8:1, lnc‐OTX1‐7:1, lnc‐RCAN1‐6:1, GIMAP8, SUV420H1 and PIGV) were identified for further population validation. The ceRNA correlations among lnc‐OTX1‐7:1, hsa‐miR‐361‐5p and GIMAP8 were confirmed in SSH and SRH patients. A larger‐sample validation confirmed that GIMAP8, SUV420H1 and PIGV were differentially expressed between the SSH and SRH groups. In addition, SUV420H1 was included in the SSH screening model, and the area under the curve of the model was 0.720 (95% CI: 0.624‐0.816). Our study explored the transcriptome profiles of SSH and constructed a ceRNA network to help elucidate the mechanism of SSH. In addition, SUV420H1 was identified as a hub element that participates in SSH transcriptional regulation and as a potential biomarker for the early diagnosis of SSH.
Circular RNA circMDM2 accelerates the glycolysis of oral squamous cell carcinoma by targeting miR‐532‐3p/HK2
Authors: Zheng Zhao , Ma Xiaozhou , Li Hongfa
Published: May 2020

Circular RNAs (circRNAs) function as an essential regulator in the progression of oral squamous cell carcinoma (OSCC). However, the potential roles and mechanism of circRNAs in OSCC are still elusive. Here, this research investigates the roles and molecular mechanism of novel circRNA (circMDM2) in OSCC progression. Clinically, circMDM2 was overexpressed in OSCC tissue and cells, and the overexpression served as a poor prognostic factor for OSCC patients. Functionally, cellular experiments confirmed that circMDM2 accelerated OSCC cell proliferation and glycolysis in vitro and circMDM2 knockdown repressed the tumour growth in vivo. Mechanistically, circMDM2 sponged miR‐532‐3p to promote the hexokinase 2 (HK2), forming the circMDM2/miR‐532‐3p/HK2 axis. In conclusion, these findings demonstrated that circMDM2/miR‐532‐3p/HK2 axis promotes the proliferation and glycolysis of OSCC, rendering a potential diagnostic biomarker and prospective therapeutic target for OSCC.
Simultaneous borrowing of information across space and time for pricing insurance contracts: An application to rating crop insurance policies
Authors: Liu Yong , Ker Alan P.
Published: May 2020

Changing climate and technology can often lead to nonstationary losses across both time and space for a variety of insurance lines including property, catastrophe, health, and life. As a result, naive estimation of premium rates using past losses will tend to be biased. We present three successively flexible data‐driven methodologies to nonparametrically smooth across both space and time simultaneously, thereby appropriately incorporating possibly nonidentically distributed data into the rating process. We apply these methodologies in estimating U.S. crop insurance premium rates. Crop insurance, with global premiums totaling $4.1 trillion in 2018, is an interesting application as losses exhibit both temporal and spatial nonstationarity. We find significant borrowing of information across both time and space. We also find all three methodologies improve both the stability and accuracy of crop insurance premium rates. The proposed methods may be of relevance for other lines of insurance characterized by spatial and/or temporal nonstationary losses.
Changes in long‐chain fatty acid composition of milk fat globule membrane and expression of mammary lipogenic genes in dairy cows fed sunflower seeds and rumen‐protected choline
Authors: Lashkari Saman , Moller Jeppe W. , Jensen Søren K. , Hellgren Lars I. , Sørensen Martin T. , Theil Peter K. , Sejrsen Kristen
Published: May 2020

The aim of this experiment was to investigate the effect of dietary supplementation of crushed high oleic sunflower seeds (HOS) and rumen‐protected choline (RPC) on the fatty acid (FA) profile of phospholipids and sphingomyelin and mammary transcription of genes that are important for milk fat synthesis and de novo synthesis of sphingolipids. Twenty‐four cows were divided into four groups that either received an unsupplemented diet (Control), the Control diet supplemented with 50 g RPC per day, a diet supplemented with HOS at 10% of dry matter, or RPC and HOS in combination (RPC + HOS). RPC supplementation had no effect on the FA composition of milk or sphingomyelin. Cows receiving RPC and RPC + HOS had increased incorporation of C22:5 (n‐3) into phospholipids. Milk FA proportion of C18:0 and C18:1 isomers was increased in cows receiving HOS (HOS and RPC + HOS). Sphingomyelin proportion of C22:0 was increased in cows receiving HOS and RPC + HOS, at the expense of C23:0. HOS supplementation further increased the proportion of unsaturated fatty acids (UFA) in milk phospholipids. HOS supplementation increased mammary transcription of UDP‐glucose ceramide glycosyltransferase (UGCG), sterol response element‐binding protein cleavage‐activating protein (SCAP) and peroxisome proliferation‐activated receptor Gamma subunit C 1b (PPARGC1b), and reduced transcription of insulin induced gene 1 (INSIG1) and fatty acid‐binding protein 3 (FABP3). Dietary supplementation of RPC increased mammary transcription of fatty acid desaturase 1 (FADS1) and longevity assurance gene 2 (LASS2), and reduced transcription of sphingomyelin synthase (SGMS). The results show that the FA profile of milk phospholipids is sensitive to dietary lipid supplementation and, to a minor degree, RPC supplementation. Furthermore, transcription of genes that are important for milk fat synthesis and sphingolipids synthesis is affected by dietary supplementation of RPC and HOS.
Rapid desensitisation for antibiotic anaphylaxis prior to surgical removal of teeth
Authors: Chung P. , Dhanrajani P.
Published: May 2020

We present a case report of a 59‐year‐old female presenting for extraction of multiple teeth but known to have anaphylaxis to multiple antibiotics. She underwent rapid desensitization to intravenous Cephazolin 24 hours prior to surgery. The surgery preceded uneventfully.
Expression of CA2 and CA9 carbonic anhydrases in ulcerative colitis and ulcerative colitis‐associated colorectal cancer
Authors: Nakada Norihiro , Mikami Tetuo , Horie Kayo , Nagashio Ryo , Sakurai Yasutaka , Sanoyama Itaru , Yoshida Tsutomu , Sada Miwa , Kobayashi Kiyonori , Sato Yuichi , Okayasu Isao , Murakumo Yoshiki
Published: May 2020

Ulcerative colitis (UC) is characterized by chronic inflammation in the colonic mucosa and submucosa with repeating relapse and remission, but the pathogenesis is unknown. Patients with long‐standing UC are at high risk of neoplasm development. The aim of the present study was to identify molecules whose expression is associated with UC and UC‐associated colorectal cancer (UCCA). Biopsy specimens from UC and normal colonic mucosae were analyzed using a proteomics approach, in which carbonic anhydrase 2 (CA2) was identified as a molecule downregulated in UC mucosae. Immunohistochemically, CA2 expression was detected in normal and diverticulitis mucosal epithelia, and its expression decreased as UC activity increased. CA2 expression was almost undetectable in UCCA. We also analyzed the expression of another carbonic anhydrase, CA9, and its upstream molecule, hypoxia‐inducible factor‐1α (HIF‐1α), both of which are induced under hypoxic conditions. It was revealed that CA9 expression was relatively low in normal, diverticulitis and UC mucosae, and was upregulated in UCCA. HIF‐1α expression was consistently low in all tissue types examined. In conclusion, these results suggest that CA2 and CA9 may be possible indicators of UC activity and UCCA development, respectively.
Insertional mutagenesis of Brachypodium distachyon using the Tnt1 retrotransposable element
Authors: Nandety Raja Sekhar , Serrani‐Yarce Juan C. , Gill Upinder S. , Oh Sunhee , Lee Hee‐Kyung , Zhang Xinji , Dai Xinbin , Zhang Wenchao , Krom Nick , Wen Jiangqi , Zhao Patrick X. , Mysore Kirankumar S.
Published: May 2020

Brachypodium distachyon is an annual C3 grass used as a monocot model system in functional genomics research. Insertional mutagenesis is a powerful tool for both forward and reverse genetics studies. In this study, we explored the possibility of using the tobacco retrotransposon Tnt1 to create a transposon‐based insertion mutant population in B. distachyon. We developed transgenic B. distachyon plants expressing Tnt1 (R0) and in the subsequent regenerants (R1) we observed that Tnt1 actively transposed during somatic embryogenesis, generating an average of 6.37 insertions per line in a population of 19 independent R1 regenerant plants analyzed. In seed‐derived progeny of R1 plants, Tnt1 segregated in a Mendelian ratio of 3:1 and no new Tnt1 transposition was observed. A total of 126 flanking sequence tags (FSTs) were recovered from the analyzed R0 and R1 lines. Analysis of the FSTs showed a uniform pattern of insertion in all the chromosomes (1–5) without any preference for a particular chromosome region. Considering the average length of a gene transcript to be 3.37 kb, we estimated that 29 613 lines are required to achieve a 90% possibility of tagging a given gene in the B. distachyon genome using the Tnt1‐based mutagenesis approach. Our results show the possibility of using Tnt1 to achieve near‐saturation mutagenesis in B. distachyon, which will aid in functional genomics studies of other C3 grasses.
Metabolomic profiling of wild‐type and mutant soybean root nodules using laser‐ablation electrospray ionization mass spectrometry reveals altered metabolism
Authors: Agtuca Beverly J. , Stopka Sylwia A. , Evans Sterling , Samarah Laith , Liu Yang , Xu Dong , Stacey Minviluz G. , Koppenaal David W. , Paša‐Tolić Ljiljana , Anderton Christopher R. , Vertes Akos , Stacey Gary
Published: May 2020

The establishment of the nitrogen‐fixing symbiosis between soybean and Bradyrhizobium japonicum is a complex process. To document the changes in plant metabolism as a result of symbiosis, we utilized laser ablation electrospray ionization‐mass spectrometry (LAESI‐MS) for in situ metabolic profiling of wild‐type nodules, nodules infected with a B. japonicum nifH mutant unable to fix nitrogen, nodules doubly infected by both strains, and nodules formed on plants mutated in the stearoyl‐acyl carrier protein desaturase (sacpd‐c) gene, which were previously shown to have an altered nodule ultrastructure. The results showed that the relative abundance of fatty acids, purines, and lipids was significantly changed in response to the symbiosis. The nifH mutant nodules had elevated levels of jasmonic acid, correlating with signs of nitrogen deprivation. Nodules resulting from the mixed inoculant displayed similar, overlapping metabolic distributions within the sectors of effective (fix+) and ineffective (nifH mutant, fix−) endosymbionts. These data are inconsistent with the notion that plant sanctioning is cell autonomous. Nodules lacking sacpd‐c displayed an elevation of soyasaponins and organic acids in the central necrotic regions. The present study demonstrates the utility of LAESI‐MS for high‐throughput screening of plant phenotypes. Overall, nodules disrupted in the symbiosis were elevated in metabolites related to plant defense.
Primer caso de EXIT (tratamiento exútero intraparto) en el Hospital Universitario San Ignacio: presentación de caso
Authors: Acosta Rodríguez Ana María , Mateus Carolina , Baquero María , Gómez Paola , Lalinde Juan , Martínez Rodolfo , Fajardo Angélica , Ospina García Juan Camilo
Published: May 2020

El artículo es la presentación del primer procedimiento exútero intraparto (EXIT), realizado en el Hospital Universitario San Ignacio y realizado por un grupo interdisciplinario (anestesiología, otorrinolaringología pediátrica, neonatología y ginecología). La ejecución de la estrategia EXIT es poco frecuente. Su objetivo es asegurar la vía aérea del neonato durante el parto cuando existe riesgo de obstrucción, dada por compresión secundaria a masas cervicales o mediastinales, malformaciones congénitas craneofaciales o de la vía aérea. Esta estrategia busca disminuir el riesgo de mortalidad del neonato. El caso corresponde al de una mujer primigestante de 33 años, con edad gestacional de 38 semanas y diagnóstico a la semana 25 de lesión quística cervical en el feto. Durante la atención del parto se aseguró intraparto la vía aérea del neonato con intubación orotraqueal y, a su vez, se disminuyeron los riesgos de morbimortalidad de la madre. En este caso, se trataba de una malformación vascular linfática macroquística. El objetivo del artículo es destacar que, con una adecuada planeación y diagnóstico prenatal de las malformaciones cervicales, mejora significativamente el pronóstico del paciente, así como sus resultados a corto y largo plazo.
Effective Feedback, An Essential Component of all Stages in Medical Education
Authors: Kuhlmann Lüdeke Angelika Beatriz Ellen , Guillén Olaya Javier Fabricio
Published: May 2020

Feedback as a teaching-learning strategy has been present in medical education for a few decades. Nonetheless, its application across the globe is considered suboptimal at best. Characteristics, conventions and recommendations for its delivery have been emphasized over the years in the literature available, but new approaches highlight the need to evaluate feedback with a greater focus on the social interaction involved and the actual impact it has on the learning process of students. Modern competency-based medical programs, with its stakeholders, staff members and educators, require a serious commitment towards its proper implementation, through robust frameworks and monitoring systems, designed according to every institution´s particular needs. Preceptors and students need to be properly trained and empowered in this skill, for most effective and successful results in improving learning and performance. This effort is fundamental for trainees to acquire clinical competence to defined standards, guarantee preparedness to work in unsupervised practice and ensure patient welfare.
Neural fluctuation cues for simultaneous notched-noise masking and profile-analysis tasks: Insights from model midbrain responses
Authors: Maxwell Braden N. , Richards Virginia M. , Carney Laurel H.
Published: May 2020

Results of simultaneous notched-noise masking are commonly interpreted as reflecting the bandwidth of underlying auditory filters. This interpretation assumes that listeners detect a tone added to notched-noise based on an increase in energy at the output of an auditory filter. Previous work challenged this assumption by showing that randomly and independently varying (roving) the levels of each stimulus interval does not substantially worsen listener thresholds [Lentz, Richards, and Matiasek (1999). J. Acoust. Soc. Am. 106, 2779–2792]. Lentz et al. further challenged this assumption by showing that filter bandwidths based on notched-noise results were different from those based on a profile-analysis task [Green (1983). Am. Psychol. 38, 133–142; (1988). (Oxford University Press, New York)], although these estimates were later reconciled by emphasizing spectral peaks of the profile-analysis stimulus [Lentz (2006). J. Acoust. Soc. Am. 120, 945–956]. Here, a single physiological model is shown to account for performance in fixed- and roving-level notched-noise tasks and the Lentz et al. profile-analysis task. This model depends on peripheral neural fluctuation cues that are transformed into the average rates of model inferior colliculus neurons. Neural fluctuations are influenced by peripheral filters, synaptic adaptation, cochlear amplification, and saturation of inner hair cells, an element not included in previous theories of envelope-based cues for these tasks. Results suggest reevaluation of the interpretation of performance in these paradigms.
A spherical expansion for audio sounds generated by a circular parametric array loudspeaker
Authors: Zhong Jiaxin , Kirby Ray , Qiu Xiaojun
Published: May 2020

The existing non-paraxial expression of audio sounds generated by a parametric array loudspeaker (pal) is hard to calculate due to the fivefold integral in it. A rigorous solution of the Westervelt equation under the quasilinear approximation is developed in this paper for circular PALs by using the spherical harmonics expansion, which simplifies the expression into a series of threefold summations with uncoupled angular and radial components. The angular component is determined by Legendre polynomials and the radial one is an integral involving spherical Bessel functions, which converge rapidly. Compared to the direct integration over the whole space, the spherical expansion is rigorous, exact, and can be calculated efficiently. The simulations show the proposed expression can obtain the same accurate results with a speed of at least 15 times faster than the existing one.
Looking for Information in All the Right Places? Outlet Types of Social Media Information and National Basketball Association Fan Desires
Authors: Lewis Melvin , Brown Kenon A. , Hakim Samuel D. , Billings Andrew C. , Blakey Carla H.
Published: May 2020

A national sample of 390 self-identified National Basketball Association (NBA) fans were asked motivational differences regarding use of four unique forms of social media information offerings: team-managed, media-managed, fan-managed and player-managed outlets. While entertainment emerged as the top motivational factor across all four offerings, many significant differences were found among the four information offerings in relation to 12 key uses and gratifications. Revealing which information offerings users tend to use when attempting to fulfill a specific gratification, this study yields insights for academicians and sport practitioners, pinpointing distinctive features of different social media platforms to frame social media goals, as well as matching the perceived strengths and features of a particular platform and information offering.
Intralipid and haemodialysis in caffeine overdose
Authors: Harsten Rebecca , Tetlow Simon John , Chan Torbert , Ankuli Akshaya
Published: May 2020

A 26-year-old woman presented after an intentional ingestion of 20 g of caffeine. She suffered a profound respiratory alkalosis with metabolic acidosis, hypokalaemia and sustained polymorphic ventricular tachycardia. She was treated with intravenous intralipid and haemodialysis, and her arrhythmia was controlled using magnesium sulphate. Once invasively ventilated and unable to hyperventilate the patient became acidotic and required intravenous bicarbonate to correct her acid–base status. Two days following the overdose the patient was extubated, haemodialysis was stopped and norepinephrine was weaned off. The patient was discharged after a further 7 days. Serial caffeine levels were taken during this patient’s care; the highest measured caffeine concentration 7 hours after ingestion was 147.1 mg/L. The known lethal dose of caffeine is 80 mg/L. Intralipid and haemodialysis represent a new and viable treatment in life-threatening caffeine overdose. Intravenous magnesium may terminate unstable arrhythmias in caffeine-poisoned patients.
Prediagnostic loss to follow-up in an active case finding tuberculosis programme: a mixed-methods study from rural Bihar, India
Authors: Garg Tushar , Gupta Vivek , Sen Dyuti , Verma Madhur , Brouwer Miranda , Mishra Rajeshwar , Bhardwaj Manish
Published: May 2020

Objective

To quantify the prediagnostic loss to follow-up (PDLFU) in an active case finding tuberculosis (TB) programme and identify the barriers and enablers in undergoing diagnostic evaluation.

Design

Explanatory mixed-methods design.

Setting

A rural population of 1.02 million in the Samastipur district of Bihar, India.

Participants

Based on their knowledge of health status of families, community health workers or CHWs (called accredited social health activist or locally) and informal providers referred people to the programme. The field coordinators (FCs) in the programme screened the referrals for TB symptoms to identify presumptive TB cases. CHWs accompanied the presumptive TB patients to free diagnostic evaluation, and a transport allowance was given to the patients. Thereafter, CHWs initiated and supported the treatment of confirmed cases. We included 13 395 community referrals received between January and December 2018. To understand the reasons of the PDLFU, we conducted in-depth interviews with patients who were evaluated (n=3), patients who were not evaluated (n=4) and focus group discussions with the CHWs (n=2) and FCs (n=1).

Outcome measures

Proportion and characteristics of PDLFU and association of demographic and symptom characteristics with diagnostic evaluation.

Results

A total of 11 146 presumptive TB cases were identified between January and December 2018, out of which 4912 (44.1%) underwent diagnostic evaluation. In addition to the free TB services in the public sector, the key enablers were CHW accompaniment and support. The major barriers identified were misinformation and stigma, deficient family and health provider support, transport challenges and poor services in the public health system.

Conclusion

Finding the missing cases will require patient-centric diagnostic services and urgent reform in the health system. A community-oriented intervention focusing on stigma, misinformation and patient support will be critical to its success.
Challenges of university nursing transfer students in an Asian context: a qualitative study
Authors: Ching Shirley S Y , Zhang Lillian Weiwei , Guan Gwendoline Yuanyuan , Cheung Kin
Published: May 2020

Objectives

To explore the social and academic experiences of nursing transfer students’ (NTSs) in an Asian context.

Design

A descriptive qualitative study design using focus groups and individual interviews with Chinese NTSs. The data were transcribed verbatim and analysed by using qualitative content analysis.

Setting

A university offering preregistration nursing programmes in Hong Kong.

Participants

Chinese NTSs studying in a 3-year special pattern within a 5-year Bachelor of Nursing programme in a university in Hong Kong.

Results

Four main categories were identified: ‘expectations about study at the beginning of the programme’, ‘challenges during transition’, ‘coping by prioritising’ and ‘our world is small’. The NTSs had clear goals for becoming professional nurses and consequently aimed at higher academic achievements throughout the study. They anticipated enjoying university life at the beginning of their study; however, the challenges caused by heavy study workloads and transition from passive to independent learning approaches, compounded by the limited time of 3-year study, forced them to develop coping strategies to reconcile and prioritise their preconceived notions, academic pursuits, social engagements and personal well-being. Their high prioritisation of good academic performance confined their university lives to the small world of the academic arena.

Conclusions

The study identified challenges faced by NTSs in adjusting to university study. Suggestions are offered to different stakeholders to address the issues at individual, institutional and government levels so as to enhance NTSs’ learning experiences at university.
Mucosal inflammation predicts response to systemic steroids in immune checkpoint inhibitor colitis
Authors: Mooradian Meghan J , Wang Daniel Y , Coromilas Alexandra , Lumish Melissa , Chen Tianqi , Giobbie-Hurder Anita , Johnson Douglas B. , Sullivan Ryan J. , Dougan Michael
Published: May 2020

Background

Immune-related colitis is a common, often serious complication of immune checkpoint inhibition (ICI). Although endoscopy is not strictly recommended for any grade of diarrhea/colitis, emerging evidence suggests that endoscopic evaluation may have important therapeutic implications. In this retrospective study, we sought to comprehensively characterize the clinical and histologic features of ICI-induced colitis with a specific focus on evaluating the prognostic role of endoscopy.

Methods

Data were collected from the medical records of 130 patients with confirmed ICI-induced colitis. In a subset of patients (n=44) with endoscopic and pathologic data, endoscopic data were scored using the Mayo Endoscopic Score (MES) with scores ranging from 0 (no inflammation) to 3 (colonic ulceration). The impact of infliximab on antitumor outcomes was evaluated using progression-free survival (PFS) and overall survival (OS).

Results

We identified 130 patients with ICI-induced colitis across two institutions. All patients were treated with corticosteroids. Additional and/or alternative immunosuppression was employed in 59 cases, with 52 patients (42%) requiring at least one infusion of infliximab 5 mg/kg. Endoscopic assessment with biopsy was performed in 123 cases of suspected colitis (95%), with 44 cases available for MES tabulation. Presence of ulceration (MES 3) was associated with use of infliximab (p=0.008) and MES was significantly higher in patients who received infliximab compared with those who did not (p=0.003) with a median score of 2.5; conversely, those with an MES of zero rarely required secondary immunosuppression. Notably, symptoms of colitis based on Common Terminology Criteria for Adverse Events grade had no association with endoscopic findings based on MES classification. After adjustment for baseline patient and disease characteristics, there was no significant difference in steroid duration or cancer-related outcomes in patients treated with infliximab.

Conclusions

In our study, we demonstrate the association of endoscopic features, specifically the MES, with immunosuppressive needs. Importantly, we also show that MES was not related to severity of patient symptoms. The data suggest that endoscopic features can guide clinical decision-making better than patient symptoms, both identifying high-risk patients who will require infliximab and those who are likely to respond to initial corticosteroids.
Nivolumab and dinutuximab beta in two patients with refractory neuroblastoma
Authors: Ehlert Karoline , Hansjuergens Ina , Zinke Andreas , Otto Sylke , Siebert Nikolai , Henze Guenter , Lode Holger
Published: May 2020

Background

Neuroblastoma (NB) is the most frequent extracranial solid tumor in children. More than 50% of patients present with widespread (stage M) or refractory disease. In these patients, event-free and overall survival was improved by the addition of the anti-disialoganglioside antibody dinutuximab beta (DB) following multimodal conventional therapy. However, the prognosis of patients with refractory/relapsed NB remains poor. In the past decade, immunotherapy approaches with checkpoint inhibitors were approved for patients with certain malignant diseases such as melanoma or Hodgkin lymphoma. In preclinical models, DB resulted in an upregulation of the programmed cell death protein 1 (PD-1) checkpoint in NB cell lines and a combined treatment of DB with a murine anti-PD-1 checkpoint inhibitor showed a synergistic effect in a NB mouse model.

Case presentations

Two patients were admitted with refractory metastatic NB. In the 4-year-old girl, NB was diagnosed in 2013. She completed her first-line therapy with a first remission in 2015, but suffered a relapse in 2017. Treatment with chemotherapy and DB resulted in progressive disease after transient improvement. In the 17-year-old young man, NB was first diagnosed in April 2010. After two local relapses in 2011 and 2014, a metastatic relapse and a large abdominal tumor bulk were found in 2018. Despite transient improvement with multimodal therapy, progressive metastatic disease was observed in May 2019. Both patients had a satisfactory quality of life. Therefore, treatment with DB and nivolumab was performed—in the girl from October 2018 until August 2019, in the young man since June 2019. Tolerance to treatment was excellent. The girl continues to be in complete remission 6 months after therapy was stopped. In the young man, the soft tissue lesions disappeared completely, the skeletal lesions regressed substantially after 9 months of his still ongoing treatment.

Conclusions

The combination of DB with the checkpoint inhibitor nivolumab led to complete and a very good partial remission in two patients with relapsed/refractory NB. Prospective trials are warranted to clarify the role of this novel approach in a larger number of patients.
Ethical considerations for epidemic vaccine trials
Authors: Monrad Joshua Teperowski
Published: May 2020

Vaccines are a powerful measure to protect the health of individuals and to combat outbreaks such as the COVID-19 pandemic. An ethical dilemma arises when one effective vaccine has been successfully developed against an epidemic disease and researchers seek to test the efficacy of another vaccine for the same pathogen in clinical trials involving human subjects. On the one hand, there are compelling reasons why it would be unethical to trial a novel vaccine when an effective product exists already. First, it is a firm principle of medical ethics that an effective treatment or vaccine should not be withheld from patients if their life may depend on it. Second, since epidemic outbreaks often emerge in settings with less-resourced health systems, there is a pronounced risk that any trial withholding an effective vaccine would disproportionately affect the vulnerable populations that historically have been exploited for biomedical research. Third, clinical trials for novel vaccines may be at odds with efforts to control active outbreaks. On the other hand, it may be justified to conduct a trial for a candidate vaccine if it is expected to have certain advantages compared with the existing product. This essay discusses key factors for comparing vaccines against epidemic pathogens, including immunological, logistical and economic considerations. Alongside a case study of the development of vaccines for Ebola, the essay seeks to establish a general framework that should be expanded and populated by immunologists, epidemiologists, economists and bioethicists, and ultimately could be applied to the case of COVID-19 vaccines.
Intra-arterial chemotherapy for retinoblastoma: transradial and transfemoral approach
Authors: Sweid Ahmad , Jabbour Pascal
Published: May 2020

Intraarterial chemotherapy (IAC) for retinoblastoma has notably changed the natural history of the disease and stands as an encouraging example of selective drug delivery. Targeted drug delivery allows achieving a high drug concentration within target tissue along with low systemic concentration. This maintains a high safety profile along with a high efficacy rate (97%).1–4 Increasing experience, refinements of the technique, and positive results of IAC over the past decade have expanded the indications to deliver treatment to a larger population. The most recent improvement introduced in our practice was administering the therapy using the transradial approach. Herein, we demonstrate the technique for IAC using both the transradial and transfemoral approach (video 1).
Intravenous cangrelor and oral ticagrelor as an alternative to clopidogrel in acute intervention
Authors: Linfante Italo , Ravipati Kaushik , Starosciak Amy Kathryn , Reyes Dennys , Dabus Guilherme
Published: May 2020

Background

Dual antiplatelet therapy (DAP) is necessary to prevent thromboembolic events during carotid stenting, stent-assisted coil embolization, and implant of flow diverters (FD). However, DAP in the acute phase may be challenging. An intravenous alternative, cangrelor, has rapid onset, short plasma half-life, and more reliable antiplatelet action for acute interventions. The study objective was to evaluate feasibility and safety of IV cangrelor during acute neuroendovascular surgery procedures.

Methods

We performed a retrospective analysis of our database of patients treated with stent-assisted coil embolization, FD placement for aneurysmal subarachnoid hemorrhage (aSAH), or stenting for acute internal carotid artery (ICA) occlusion where IV cangrelor was used. Morbidity, mortality, incidence of thromboembolic events, hemorrhages, and 90-day outcomes were reported.

Results

Ten patients were found in our database from June 2018 through January 2019. Four patients had aSAH, four had middle cerebral artery strokes with tandem lesions, one had an ICA occlusion, and one had a vertebral artery aneurysm. One of the ten patients experienced a thrombotic event. One patient developed new post-procedural bleeding and two had worsening intracranial hemorrhage. Five patients were discharged home in stable condition, two to acute rehabilitation, one to a nursing facility, and two others expired (likely the result of the severe and evolving strokes). Of the eight who were discharged, six (75%) had a good 90-day functional outcome (modified Rankin Scale 0–2).

Conclusion

Acute administration of IV cangrelor with or without oral ticagrelor is a feasible antiplatelet treatment option for acute neuroendovascular procedures.