bluuebunny/crossref_metadata_2025 huggingface dataset:
Acclimation of the photosynthetic apparatus and alterations in sugar metabolism in response to inoculation with endophytic fungi
Authors: Rozpądek Piotr , Nosek Michał , Domka Agnieszka , Ważny Rafał , Jędrzejczyk Roman , Tokarz Krzysztof , Pilarska Maria , Niewiadomska Ewa , Turnau Katarzyna
Published: December 2018

The role of an endophytic Zygomycete Mucor sp. in growth promotion and adaptation of the photosynthetic apparatus to increased energy demands of its hosts Arabidopsis arenosa and Arabidopsis thaliana was evaluated. Inoculation with the fungus improved the water use efficiency of the plants and allowed for them to utilize incident light for photochemistry more effectively by upregulating the expression of several photosystem I‐ and II‐related genes and their respective proteins, proteins involved in light harvesting in PSII and PSI and carbon assimilation. This effect was independent of the ability of the plants to acquire nutrients from the soil. We hypothesize that the accelerated growth of the symbiotic plants resulted from an increase in their demand for carbohydrates and carbohydrate turnover (sink strength) that triggered a simultaneous upregulation of carbon assimilation. Arabidopsis plants inoculated with Mucor sp. exhibited upregulated expression in several genes encoding proteins involved in carbohydrate catabolism, sugar transport, and smaller starch grains that indicate a significant upregulation of carbohydrate metabolism.
Epidermolysis bullosa simplex–generalized severe type due to keratin 5 p.Glu477Lys mutation: Genotype‐phenotype correlation and in silico modeling analysis
Authors: Lalor Leah , Titeux Matthias , Palisson Francis , Fuentes Ignacia , Yubero María J. , Tasanen Kaisa , Huilaja Laura , Has Cristina , Tadini Gianluca , Haggstrom Anita N. , Hovnanian Alain , Lucky Anne W.
Published: December 2018

Background/Objectives

Epidermolysis bullosa is a group of diseases caused by mutations in skin structural proteins. Availability of genetic sequencing makes identification of causative mutations easier, and genotype‐phenotype description and correlation are important. We describe six patients with a keratin 5 mutation resulting in a glutamic acid to lysine substitution at position 477 (p.Glu477Lys) who have a distinctive, severe and sometimes fatal phenotype. We also perform in silico modeling to show protein structural changes resulting in instability.

Methods

In this case series, we collected clinical data from six patients with this mutation identified from their national or local epidermolysis bullosa databases. We performed in silico modeling of the keratin 5‐keratin 14 coil 2B complex using CCBuilder and rendered with Pymol (Schrodinger, LLC, New York, NY).

Results

Features include aplasia cutis congenita, generalized blistering, palmoplantar keratoderma, onychodystrophy, airway and developmental abnormalities, and a distinctive reticulated skin pattern. Our in silico model of the keratin 5 p.Glu477Lys mutation predicts conformational change and modification of the surface charge of the keratin heterodimer, severely impairing filament stability.

Conclusions

Early recognition of the features of this genotype will improve care. In silico analysis of mutated keratin structures provides useful insights into structural instability.
A field portable method for the semi‐quantitative estimation of dehydration tolerance of photosynthetic tissues across distantly related land plants
Authors: López‐Pozo Marina , Flexas Jaume , Gulías Javier , Carriquí Marc , Nadal Miquel , Perera‐Castro Alicia V. , Clemente‐Moreno María José , Gago Jorge , Núñez‐Olivera Encarnación , Martínez‐Abaigar Javier , Hernández Antonio , Artetxe Unai , Bentley Joanne , Farrant Jill M. , Verhoeven Amy , García‐Plazaola José Ignacio , Fernández‐Marín Beatriz
Published: December 2018

Desiccation tolerant (DT) plants withstand complete cellular dehydration, reaching relative water contents (RWC) below 30% in their photosynthetic tissues. Desiccation sensitive (DS) plants exhibit different degrees of dehydration tolerance (DHT), never surviving water loss >70%. To date, no procedure for the quantitative evaluation of DHT extent exists that is able to discriminate DS species with differing degrees of DHT from truly DT plants. We developed a simple, feasible and portable protocol to differentiate between DT and different degrees of DHT in the photosynthetic tissues of seed plants and between fast desiccation (< 24 h) tolerant (FDT) and sensitive (FDS) bryophytes. The protocol is based on (1) controlled desiccation inside Falcon tubes equilibrated at three different relative humidities that, consequently, induce three different speeds and extents of dehydration and (2) an evaluation of the average percentage of maximal photochemical efficiency of PSII (Fv/fm) recovery after rehydration. Applying the method to 10 bryophytes and 28 tracheophytes from various locations, we found that (1) imbibition of absorbent material with concentrated salt‐solutions inside the tubes provides stable relative humidity and avoids direct contact with samples; (2) for 50 ml capacity tubes, the optimal plant amount is 50–200 mg fresh weight; (3) the method is useful in remote locations due to minimal instrumental requirements; and (4) a threshold of 30% recovery of the initial Fv/fm upon reaching RWC ≤ 30% correctly categorises DT species, with three exceptions: two poikilochlorophyllous species and one gymnosperm. The protocol provides a semi‐quantitative expression of DHT that facilitates comparisons of species with different morpho‐physiological traits and/or ecological attributes.
Resisting Racist Propaganda: Distorted Visual Communication and Epistemic Activism
Authors: Medina José
Published: December 2018

This article explores how racist propaganda works in visual communication and how such propaganda can be resisted. The article analyzes how photography has created new possibilities for the insidious dissemination of racist messages and discusses ways of resisting these visually transmitted propagandistic messages. The two sections of the article focus on examples of racist propaganda in visual culture: in section 1, the focus is on the propagandistic use of photography in the early twentieth century by the pro‐lynching movement; and in section 2, the focus is on racist subtexts in communication that is both visual and verbal in mass media in recent decades. In both sections, the paper discusses how to neutralize and counter propaganda in visual culture by means of what the author terms “epistemic activism,” which consists in practices of interrogation and resistance that unmask, disrupt, and uproot biases and insensitivity. The article discusses different instances of epistemic activism that make explicit and effectively criticize racist subtexts in visual communication. The instances of epistemic activism discussed include the pamphlets of the anti‐lynching movement, critiques of visual artists and scholars, and the critical responses of online activists. The article argues that epistemic activism can produce critical viewership by disrupting the passive reception of visual messages and triggering more active and critical modes of viewing images. The author concludes by emphasizing the urgent need for epistemic activism that promotes critical awareness of the subtexts embedded in visual communication and a sense of critical responsibility in the production, consumption, and recirculation of images.
Do State‐Customized TANF Work Policies Actually Reduce Unemployment?*
Authors: Kim Na Yeon , Berry Frances Stokes
Published: December 2018

Objectives

This study seeks to test the impact of states’ worker supplement programs on the unemployment rates of low‐income females. Worker supplement programs were implemented to cover more needy people and to meet tougher work requirements in response to the enactment of Deficit Reduction Act of 2005.

Methods

We utilize a difference‐in‐differences method using panel data for 50 states over a nine‐year period (2005–2013).

Results

Our empirical analysis shows that states implementing worker supplement programs achieve lower unemployment among low‐income females compared with states that did not implement the programs. We also find that states with higher total taxable resources per capita have a negative association with unemployment rates of low‐income females, while a longer duration of a state's unemployment insurance program is positively related to the unemployment status of low‐income females.

Conclusions

States can effectively reduce the unemployment of low‐income females by reallocating Temporary Assistance for Needy Families and/or Maintenance of Effort funds and investing in worker supplement programs.
Characterization of the novel HLA‐B*15:435 allele by next‐generation sequencing in a Chinese family
Authors: Zou Hong‐Yan , Zhong Yan‐Ping , Hong Wen‐Xu
Published: December 2018

HLA‐B*15:435 has 5 nt changes from HLA‐B*15:09:01 in exon 3 and 4.
Reciprocal transplant experiments testing the performance of common and early flowering types of Imperata cylindrica in Japan
Authors: Nomura Yasuyuki , Yasuda Kentaro , Nishiwaki Aya , Tominaga Tohru
Published: December 2018

We performed reciprocal transplant experiments in Miyazaki, Kyoto, and Akita to differentiate the effects of environmental factors and genetic variations on biomass production and heading time in common (C‐) and early flowering (E‐) types of Imperata cylindrica. In our experiments, we used 10 and 11 accessions of the C‐ and E‐types, respectively, collected across the distribution range of the two types in Japan. Three ramets for each accession were potted in each of the experimental fields and cultivated from June 2016 through November 2017. All accessions were grouped based on their origins: low‐latitude group (LG), mid‐latitude group (MG), and high‐latitude group (HG). The biomasses of the C‐types in the MG were heavier than those of the C‐types in the LG and HG in all experimental fields. E‐type accessions with origins close to the respective experimental fields tended to have higher biomasses than accessions collected further away. C‐type plants grew more vigorously than E‐type plants in Miyazaki and Kyoto, but biomass growth was similar between the types in Akita. Thus, we did not detect clear local adaptation measured as biomass production in the C‐type. However, each accession of the E‐type appeared to be locally adapted. The competitive abilities of the C‐ and E‐type accessions from Tohoku were similar. The flowering periods of the two types did not overlap in any of the experimental fields. Hence, although wild crosses between the two types occur in Tohoku, between‐type hybridization was improbable under the conditions of our common garden experiment.
The Impact of Workers’ Remittances on Economic Growth: Panel Data Approach for Selected Country Group
Authors: Polat Burçak
Published: December 2018

Recent decade has witnessed the growing importance of remittances as a source of foreign income for many developing countries. Thus, as the value of remittances around the world increases, many researchers attempt to analyze the remittances’ effects on economic performance. Yet, real effect of remittances on economic growth rate is still controversial issue in the literature. Therefore, main objective of this study is to analyze the linkage between economic growth rates and remittance inflows into eight largest recipient countries of the global remittances by employing panel data analysis for the period 1990-2015. Our findings reveal that there is no significant relationship between remittances and growth. Yet, the study has empirically proved that growth is positively associated with gross capital formations and GDP per capita while it is negatively related with inflation and openness index.
Evaluation of triage quality in the emergency department: a scoping review protocol
Authors: Jesus Ana Paula Santos de , Vilanova Vanessa Cordeiro , Coifman Alyne Henri Motta , Moura Bruna Roberta Siqueira , Nishi Fernanda Ayache , Pedreira Larissa Chaves , Batista Ruth Ester Assayag , Cruz Diná de Almeida Lopes Monteiro da
Published: December 2018

Review objective/questions:

The objective of this scoping review is to explore the existing literature on the evaluation of the quality of triage for patients of all ages and medical conditions in emergency departments (EDs).

The question for this review is: How is triage in the ED evaluated? More specifically, we are interested in answering the following sub-questions:
Diagnostic accuracy of computed tomography coronary angiography utilizing recent advances in technology in patients with high heart rates: a systematic review protocol
Authors: Mander Gordon T.W. , Dobeli Karen , Steffensen Caitlin , Munn Zachary
Published: December 2018

Objective:

The objective of this review is to determine the diagnostic accuracy of computed tomography coronary angiography (CTCA) using recent scan technologies for detecting coronary artery disease (CAD) in adults with high heart rates.

Introduction:

Invasive coronary angiography is the gold standard for detecting significant CAD, but it is costly and carries risks of complications. Computed tomography coronary angiography has a high sensitivity for diagnosing CAD, although image quality may be affected by elevated heart rates. Recent technological advances in scanner design may increase the diagnostic accuracy of CTCA.

Inclusion criteria:

This review will consider diagnostic test accuracy studies that include adults 18 years and older with a heart rate greater than 65 beats per minute who have undergone CTCA to diagnose CAD (greater than 50% stenosis). Eligible studies will compare invasive coronary angiography with computed tomography scanner technologies that use either single- or dual-source scanner configuration in prospective electrocardiogram scan acquisition mode, and with a total scanner coverage equal to or greater than 128 detector-rows. Studies published in English from 2007 will be considered.

Methods:

PubMed, Embase, CINAHL and Scopus will be searched, along with Google Scholar, the NIHR-HTA register, computed tomography vendors and conference abstracts. Screening of potential titles and abstracts, retrieval of full-text studies, assessment of methodological quality and data extraction will be performed independently by two reviewers. Meta-analyses will be performed, if possible, and a Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Summary of Findings presented.
On the Identification and Decomposition of the Unsteady Losses in a Turbine Cascade
Authors: Lengani D. , Simoni D. , Pichler R. , Sandberg R. D. , Michelassi V. , Bertini F.
Published: December 2018

The present paper describes the application of proper orthogonal decomposition (POD) to large eddy simulation (LES) of the T106A low-pressure-turbine profile with unsteady incoming wakes at two different flow conditions. Conventional data analysis applied to time averaged or phase-locked averaged flow fields is not always able to identify and quantify the different sources of losses in the unsteady flow field as they are able to isolate only the deterministic contribution. A newly developed procedure allows such identification of the unsteady loss contribution due to the migration of the incoming wakes, as well as to construct reduced order models that are able to highlight unsteady losses due to larger and/or smaller flow structures carried by the wakes in the different parts of the blade boundary layers. This enables a designer to identify the dominant modes (i.e., phenomena) responsible for loss, the associated generation mechanism, their dynamics, and spatial location. The procedure applied to the two cases shows that losses in the fore part of the blade suction side are basically unaffected by the flow unsteadiness, irrespective of the reduced frequency and the flow coefficient. On the other hand, in the rear part of the suction side, the unsteadiness contributes to losses prevalently due to the finer scale (higher order POD modes) embedded into the bulk of the incoming wake. The main difference between the two cases has been identified by the losses produced in the core flow region, where both the largest scale structures and the finer ones produces turbulence during migration. The decomposition into POD modes allows the quantification of this latter extra losses generated in the core flow region, providing further inputs to the designers for future optimization strategies.
Dynamic Balance During Human Movement: Measurement and Control Mechanisms
Authors: Neptune Richard R. , Vistamehr Arian
Published: December 2018

Walking can be exceedingly complex to analyze due to highly nonlinear multibody dynamics, nonlinear relationships between muscle excitations and resulting muscle forces, dynamic coupling that allows muscles to accelerate joints and segments they do not span, and redundant muscle control. Walking requires the successful execution of a number of biomechanical functions such as providing body support, forward propulsion, and balance control, with specific muscle groups contributing to their execution. Thus, muscle injury or neurological impairment that affects muscle output can alter the successful execution of these functions and impair walking performance. The loss of balance control in particular can result in falls and subsequent injuries that lead to the loss of mobility and functional independence. Thus, it is important to assess the mechanisms used to control balance in clinical populations using reliable methods with the ultimate goal of improving rehabilitation outcomes. In this review, we highlight common clinical and laboratory-based measures used to assess balance control and their potential limitations, show how these measures have been used to analyze balance in several clinical populations, and consider the translation of specific laboratory-based measures from the research laboratory to the clinic.
Fundamental Roles of Axial Stretch in Isometric and Isobaric Evaluations of Vascular Contractility
Authors: Caulk Alexander W. , Humphrey Jay D. , Murtada Sae-Il
Published: December 2018

Vascular smooth muscle cells (VSMCs) can regulate arterial mechanics via contractile activity in response to changing mechanical and chemical signals. Contractility is traditionally evaluated via uniaxial isometric testing of isolated rings despite the in vivo environment being very different. Most blood vessels maintain a locally preferred value of in vivo axial stretch while subjected to changes in distending pressure, but both of these phenomena are obscured in uniaxial isometric testing. Few studies have rigorously analyzed the role of in vivo loading conditions in smooth muscle function. Thus, we evaluated effects of uniaxial versus biaxial deformations on smooth muscle contractility by stimulating two regions of the mouse aorta with different vasoconstrictors using one of three testing protocols: (i) uniaxial isometric testing, (ii) biaxial isometric testing, and (iii) axially isometric plus isobaric testing. Comparison of methods (i) and (ii) revealed increased sensitivity and contractile capacity to potassium chloride and phenylephrine (PE) with biaxial isometric testing, and comparison of methods (ii) and (iii) revealed a further increase in contractile capacity with isometric plus isobaric testing. Importantly, regional differences in estimated in vivo axial stretch suggest locally distinct optimal biaxial configurations for achieving maximal smooth muscle contraction, which can only be revealed with biaxial testing. Such differences highlight the importance of considering in vivo loading and geometric configurations when evaluating smooth muscle function. Given the physiologic relevance of axial extension and luminal pressurization, we submit that, when possible, axially isometric plus isobaric testing should be employed to evaluate vascular smooth muscle contractile function.
Overall Image of the Tooth Surface Properties of Skew Gears
Authors: Otake Yoshichi
Published: December 2018

The geometrical tooth surface properties of skew gears have a significant influence on gear performance. We consider the contact line angle, slip rate, and relative curvature as tooth surface properties. An overall image of the tooth surface properties is an effective means of optimization. However, this whole image is unknown, because the tooth surface properties are represented by four elements of the tooth surface, and it is difficult to express them in one coordinate space. This problem is overcome by expressing the tooth surface properties using three elements. First, three-element expressions for the tooth surface properties are derived and the tooth surface property space, which expresses the overall image of the tooth surface properties, is constructed using the three elements as coordinate axes. Next, the characteristic surface of the tooth surface property space is clarified and an image of the space is simulated. From this, it is possible to visually and intuitively capture the features of the tooth surface property space, i.e., the whole image. Finally, the wide range of applications of the tooth surface property space is discussed. This demonstrates that the tooth surface property space provides important indicators and standards for the future development and designs.
Nuclear Communication Campaign in Spain: Basic Nuclear Fusion Course
Authors: Fernández-Cosials Kevin , Barbas Alfonso , García Laruelo José
Published: December 2018

Nuclear energy has created controversy since its conception during the 1950s. Arguments against it have been constant through the years until the current state on which the majority of western societies are against it as seen in recent surveys. Additionally, confidence in science and scientists is also relatively low. In Spain, these two facts are related with science alphabetization; an average person with lower science alphabetization tends to be more negative about science, and specifically, about nuclear energy science. In this aspect, as science affects major decisions in society, in democracy, it is important that the public is able to interpret scientific information. It is in this context that Jóvenes Nucleares appeared: an organization created by the Spanish Nuclear Society and formed by young people interested in nuclear energy. One of its main goals was the spreading of nuclear science into society. This was made through lectures at high schools, content creation, and enveloping communication campaigns. A skeptical approach has always been taken trying to separate from the lobby argumentation and promoting a strong critical thought. In this paper, as an example of communication campaign, the Basic Nuclear Fusion Course is presented. This campaign involved the creation of the informative content, gathering it into a book, the development of a lecture (consisting of nine topics related to nuclear fusion) to be delivered in universities or high schools, and a strong advertisement effort through social media and presentations in congresses. This campaign has been possible thanks to voluntary work; the main cost of the campaign was the book printing. The early results predict a great support to this new format included into the Jóvenes Nucleares divulgation activities as perceived in the attendance and feedback provided by the audience. With these activities, Jóvenes Nucleares aspires to put another grain of sand toward narrowing the gap between science and society.
Effect of Tumor Volume on Drug Delivery in Heterogeneous Vasculature of Human Brain Tumors
Authors: Bhandari Ajay , Bansal Ankit , Jain Rishav , Singh Anup , Sinha Niraj
Published: December 2018

Drug distribution in tumors is strongly dependent on tumor biological properties such as tumor volume, vasculature, and porosity. An understanding of the drug distribution pattern in tumors can help in enhancing the effectiveness of anticancer treatment. A numerical model is employed to study the distribution of contrast agent in the heterogeneous vasculature of human brain tumors of different volumes. Dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI) has been done for a number of patients with different tumor volumes. Leaky tracer kinetic model (LTKM) is employed to obtain perfusion parameters from the DCE-MRI data. These parameters are used as input in the computational fluid dynamics (CFD) model to predict interstitial fluid pressure (IFP), interstitial fluid velocity (IFV), and distribution of the contrast agent in different tumors. Numerical results demonstrate that the IFP is independent of tumor volume. On the other hand, the IFV increases as the tumor volume increases. Further, the concentration of contrast agent also increases with the tumor volume. The results obtained in this work are in line with the experimental DCE-MRI data. It is observed that large volume tumors tend to retain a higher concentration of contrast agent for a longer duration of time because of large extravasation flux and slow washout as compared to smaller tumors. These results may be qualitatively extrapolated to chemotherapeutic drug delivery, implying faster healing in large volume tumors. This study helps in understanding the effect of tumor volume on the treatment outcome for a wide range of human tumors.
Vehicle Path-Tracking Linear-Time-Varying Model Predictive Control Controller Parameter Selection Considering Central Process Unit Computational Load
Authors: Wang Zejiang , Bai Yunhao , Wang Junmin , Wang Xiaorui
Published: December 2018

Model predictive control (MPC) has drawn a considerable amount of attention in automotive applications during the last decade, partially due to its systematic capacity of treating system constraints. Even though having received broad acknowledgements, there still exist two intrinsic shortcomings on this optimization-based control strategy, namely the extensive online calculation burden and the complex tuning process, which hinder MPC from being applied to a wider extent. To tackle these two drawbacks, different methods were proposed. Nevertheless, the majority of these approaches treat these two issues independently. However, parameter tuning in fact has double-sided effects on both the controller performance and the real-time computational burden. Due to the lack of theoretical tools for globally analyzing the complex conflicts among MPC parameter tuning, controller performance optimization, and computational burden easement, a look-up table-based online parameter selection method is proposed in this paper to help a vehicle track its reference path under both the stability and computational capacity constraints. matlab-carsim conjoint simulations show the effectiveness of the proposed strategy.
FZD
5
is a Gα
q
-coupled receptor that exhibits the functional hallmarks of prototypical GPCRs
Authors: Wright Shane C. , Cañizal Maria Consuelo Alonso , Benkel Tobias , Simon Katharina , Le Gouill Christian , Matricon Pierre , Namkung Yoon , Lukasheva Viktoria , König Gabriele M. , Laporte Stéphane A. , Carlsson Jens , Kostenis Evi , Bouvier Michel , Schulte Gunnar , Hoffmann Carsten
Published: December 2018

Ligand binding induces conformational changes in FZD
5
, activation of heterotrimeric G proteins, and G
q
-dependent signaling.
Functional selectivity profiling of the angiotensin II type 1 receptor using pathway-wide BRET signaling sensors
Authors: Namkung Yoon , LeGouill Christian , Kumar Sahil , Cao Yubo , Teixeira Larissa B. , Lukasheva Viktoriya , Giubilaro Jenna , Simões Sarah C. , Longpré Jean-Michel , Devost Dominic , Hébert Terence E. , Piñeyro Graciela , Leduc Richard , Costa-Neto Claudio M. , Bouvier Michel , Laporte Stéphane A.
Published: December 2018

Bioluminescence-based biosensors enable comprehensive profiling of G protein–coupled receptor signaling bias.
How sustainable household environment and knowledge of healthy practices relate to childhood morbidity in South Asia: analysis of survey data from Bangladesh, Nepal and Pakistan
Authors: Hasan Md Masud , Richardson Alice
Published: December 2018

Objectives

Prevalence of diarrhoea and acute respiratory infection (ARI) is considerably high among South Asian children. The objective of this study is to compare the associations of sustainable household environment and knowledge of healthy practices with episodes of these diseases among the children in the region.

Design

The study analysed the latest, nationally representative and cross-sectional Demographic and Health Survey data.

Setting

Data from three countries were analysed: Bangladesh, Nepal and Pakistan.

Participants

Women aged between 12 and 49 years living in selected households provided information on 23 940 of their children under the age of 5 years.

Primary outcomes measures

The morbidity status of the children was recorded with respect to episodes of diarrhoea and/or ARI in the 2 weeks preceding data collection.

Results

Consuming unhygienic drinking water increased the risks of childhood diarrhoea, and use of solid fuel for indoor cooking increased the risk of ARI, across all three countries investigated. However, far more significant were the effects of mother’s education, with incomplete primary education leading to an odds of diarrhoea approaching twice that of a mother with secondary education or higher (OR 1.70 in Bangladesh, 95% CI 1.16 to 2.49).

Conclusions

Results from the current research underline the importance of developing and implementing integrated strategic plans for mothers and children in the countries investigated. Promoting hygienic water and sanitation facilities can help reduce the prevalence of childhood diarrhoea. Replacing indoor solid fuel cooking arrangements with cleaner fuel or more airy conditions can help reduce the prevalence of ARI. However, these strategies need to be integrated with education for women to raise the likelihood that reduced risks are actually realised.
What do adolescents with asthma really think about adherence to inhalers? Insights from a qualitative analysis of a UK online forum
Authors: De Simoni Anna , Horne Robert , Fleming Louise , Bush Andrew , Griffiths Chris
Published: December 2018

Objective

To explore the barriers and facilitators to inhaled asthma treatment in adolescents with asthma.

Design

Qualitative analysis of posts about inhaler treatment in adolescents from an online forum for people with asthma. Analysis informed by the Perceptions and Practicalities Approach.

Participants

Fifty-four forum participants (39 adolescents ≥16 years, 5 parents of adolescents, 10 adults with asthma) identified using search terms ‘teenager inhaler’ and ‘adolescent inhaler’.

Setting

Posts from adolescents, parents and adults with asthma taking part in the Asthma UK online forum between 2006 and 2016, UK.

Results

Practical barriers reducing the ability to adhere included forgetfulness and poor routines, inadequate inhaler technique, organisational difficulties (such as repeat prescriptions), and families not understanding or accepting their child had asthma. Prompting and monitoring inhaler treatment by parents were described as helpful, with adolescents benefiting from self-monitoring, for example, by using charts logging adherence. Perceptions reducing the motivation to adhere included asthma representation as episodic rather than chronic condition with intermittent need of inhaler treatment. Adolescents and adults with asthma (but not parents) described concerns related to attributed side effects (eg, weight gain) and social stigma, resulting in ‘embarrassment of taking inhalers’. Facilitators to adherence included actively seeking general practitioners’/consultants’ adjustments if problems arose and learning to deal with the side effects and stigma. Parents were instrumental in creating a sense of responsibility for adherence.

Conclusions

This online forum reveals a rich and novel insight into adherence to asthma inhalers by adolescents. Interventions that prompt and monitor preventer inhaler use would be welcomed and hold potential. In clinical consultations, exploring parents’ beliefs about asthma diagnosis and their role in dealing with barriers to treatment might be beneficial. The social stigma of asthma and its role in adherence were prominent and continue to be underestimated, warranting further research and action to improve public awareness of asthma.
Cost-effectiveness of therapist-guided internet-delivered cognitive behaviour therapy for paediatric obsessive–compulsive disorder: results from a randomised controlled trial
Authors: Lenhard Fabian , Ssegonja Richard , Andersson Erik , Feldman Inna , Rück Christian , Mataix-Cols David , Serlachius Eva
Published: December 2018

Objectives

To evaluate the cost-effectiveness of a therapist-guided internet-delivered cognitive behaviour therapy (ICBT) intervention for adolescents with obsessive–compulsive disorder (OCD) compared with untreated patients on a waitlist.

Design

Single-blinded randomised controlled trial.

Setting

A research clinic within the regular child and adolescent mental health service in Stockholm, Sweden.

Participants

Sixty-seven adolescents (12–17 years) with a Diagnostic and Statistical Manual of Mental Disorders Fifth Edition diagnosis of OCD.

Interventions

Either a 12-week, therapist-guided ICBT intervention or a wait list condition of equal duration.

Primary outcome measures

Cost data were collected at baseline and after treatment, including healthcare use, supportive resources, prescription drugs, prescription-free drugs, school absence and productivity loss, as well as the cost of ICBT. Health outcomes were defined as treatment responder rate and quality-adjusted life years gain. Bootstrapped mixed model analyses were conducted comparing incremental costs and health outcomes between the groups from the societal and healthcare perspectives.

Results

Compared with waitlist control, ICBT generated substantial societal cost savings averaging US$−144.98 (95% CI −159.79 to –130.16) per patient. The cost reductions were mainly driven by reduced healthcare use in the ICBT group. From the societal perspective, the probability of ICBT being cost saving compared with waitlist control was approximately 60%. From the healthcare perspective, the cost per additional responder to ICBT compared with waitlist control was approximately US$78.

Conclusions

The results suggest that therapist-guided ICBT is a cost-effective treatment and results in societal cost savings, compared with patients who do not receive evidence-based treatment. Since, at present, most patients with OCD do not have access to evidence-based treatments, the results have important implications for the increasingly strained national and healthcare budgets. Future studies should compare the cost-effectiveness of ICBT with regular face-to-face CBT.

Trial registration number

NCT02191631.
Geriatrician-led evidence-based Falls Prevention Clinic: a prospective 12-month feasibility and acceptability cohort study among older adults
Authors: Davis Jennifer C , Dian Larry , Parmar Naaz , Madden Kenneth , Khan Karim M , Chan Wency , Cheung Winnie , Rogers Jessica , Liu-Ambrose Teresa
Published: December 2018

Objective

We assessed the feasibility and acceptability of delivering a geriatrician-led evidence-based Falls Prevention Clinic to older adults with a history of falls.

Design

12-month prospective cohort study.

Setting

Vancouver Falls Prevention Clinic, Vancouver, British Columbia, Canada (www.fallsclinic.ca).

Participants

188 community-dwelling older adults aged ≥70 years who received a baseline assessment at the Vancouver Falls Prevention Clinic due to having had at least one fall resulting in medical attention in the previous 12 months. Fifty-six per cent of participants were also participating in a randomised controlled trial.

Measurements

Feasibility was ascertained by measuring demand (clinic attendance). Acceptability was measured by compliance with recommendations, completion of monthly fall calendars and patient experience.

Results

The attendance was 65% of those eligible and invited. This indicates feasibility for demand. 155 received at least one of the following clinical management recommendations from four domains (compliance reported in %): (1) medication changes (78%); (2) exercise prescription (58%); (3) referrals to other healthcare professionals (78%); and/or (4) lifestyle modifications (35%) excluding exercise. Overall compliance to all recommendations was 69%. Patient experience was related to factors impacting patient perceived physical benefit and attributes influencing patient satisfaction.

Conclusion

This study demonstrated the feasibility and acceptability of a multifactorial intervention approach based on best available evidence-based medicine.
Cumulative network-meta-analyses, practice guidelines and actual prescriptions of drug treatments for postmenopausal osteoporosis: a study protocol for cumulative network meta-analyses and meta-epidemiological study
Authors: Kataoka Yuki , Luo Yan , Chaimani Anna , Onishi Akira , Kimachi Miho , Tsujimoto Yasushi , Murad Mohammad Hassan , Li Tianjing , Cipriani Andrea , Furukawa Toshi A
Published: December 2018

Introduction

Cumulative network meta-analysis (NMA) is a method to provide a global comparison of multiple treatments with real-time update to evidence users. Several studies investigated the ranking of cumulative NMA and the recommendations of practice guidelines. However, to the best of our knowledge, no study has evaluated the cumulative NMA ranking and prescription patterns. Here, we present a protocol for a meta-epidemiological investigation to compare the results of cumulative NMA with the recommendations in postmenopausal osteoporosis practice guidelines and with the actual prescriptions.

Method and analysis

We will use the data of primary trials from the upcoming postmenopausal osteoporosis clinical practice guideline of the Endocrine Society. We will conduct cumulative NMA using all eligible trials and generate hierarchy of treatment rankings by using the surface under the cumulative ranking curve. We will search practice guidelines in relevant society websites. Two review authors will extract the practice recommendations. We will use data from the Medical Expenditures Panel Survey, a US representative sample of the non-institutionalised population, to determine the prescription patterns.

Ethics and dissemination

Because all data will be retrieved from public databases, institutional review board approval is not required. We will publish our findings in a peer-reviewed journal and present key findings at conferences.

Trial registration number

UMIN000031894: Pre-results.
Nonverbal synchrony as a behavioural marker of patient and physician race-related attitudes and a predictor of outcomes in oncology interactions: protocol for a secondary analysis of video-recorded cancer treatment discussions
Authors: Hamel Lauren M , Moulder Robert , Albrecht Terrance L , Boker Steven , Eggly Susan , Penner Louis A
Published: December 2018

Introduction

Racial disparities in cancer treatment contribute to racial disparities in mortality rates. The quality of patient–physician communication during clinical interactions with black patients and non-black physicians (racially discordant) is poorer than communication quality with white patients (racially concordant). Patient and physician race-related attitudes affect the quality of this communication. These attitudes are likely expressed through subtle non-verbal behaviours, but prior research has not examined these behaviours. Nonverbal synchrony, the coordination of physical movement, reflects the preinteraction attitudes of participants in interactions and predicts their postinteraction perceptions of and affect towards one another. In this study, peer reviewed and funded by the National Institute of Minority Health and Health Disparities (R21MD011766), we will investigate non-verbal synchrony in racially concordant and discordant interactions to better understand racial disparities in clinical communication.

Methods and analysis

This secondary analysis includes racially concordant (n=163) and racially discordant (n=68) video-recorded oncology interactions, patient and oncologist self-reported race-related attitudes, perceptions of the interaction and observer ratings of physician patient-centred communication and patient and physician affect and rapport. In aim 1, we will assess and compare non-verbal synchrony between physicians and patients in racially concordant and discordant interactions. In aim 2, we will determine the influence of non-verbal synchrony on patient and physician affect and communication. In aim 3, we will examine possible causes (ie, race-related attitudes) and consequences (ie, negative perceptions) of non-verbal synchrony in racially discordant interactions. In aim 4, we will develop and test a mediational model linking physician and patient race-related attitudes to non-verbal synchrony and, in turn, interaction outcomes.

Ethics and dissemination

The parent and current studies were approved by the Wayne State University Institutional Review Board. Since only archival data will be used, ethical or safety risks are low. We will disseminate our findings to relevant conferences and journals.
Household structure and its association with sexual risk behaviours and sexual health outcomes: evidence from a British probability sample survey
Authors: Curtis Tyrone J , Field Nigel , Clifton Soazig , Mercer Catherine H
Published: December 2018

Objectives

Economic and social changes over the last 20 years have led to changes in the living situations of young people in Britain. A person’s home-life context might influence their sexual behaviour, with implications for their sexual healthcare needs; we investigated this hypothesis.

Methods

Britain’s third National Survey of Sexual Attitudes and Lifestyles, a probability sample survey undertaken in 2010–2012, interviewed 15 162 men and women aged 16–74 years in Britain (with 3869 aged 16–24 years). We examined household structure by gender and age group. We then focused on sexually experienced young people (aged 16–24 years), and used multivariable models to explore associations between household structure, sexual risk behaviours and sexual health outcomes, independent of confounders including age, relationship status, employment and area of residence.

Results

Young people were most likely to be living with parents (women 57.1% (95% CI 54.5% to 59.6%) and men 68.7% (95% CI 65.4% to 71.8%)) or non-relatives (women 10.5% (95% CI 8.5% to 12.9%) and men 12.6% (95% CI 10.1% to 15.6%)). Among the 81.3% of young people who were sexually experienced, compared with young women living with parents (reference category), young women living alone or with non-relatives had a higher likelihood of reporting ≥2 sexual partners (adjusted OR 1.54 (95% CI 1.03 to 2.31); 1.76 (95% CI 1.03 to 3.00), respectively). Women living alone were also more likely to have had unsafe sex (2.04 (95% CI 1.38 to 3.02)). Despite these differences in sexually transmitted infection (STI) risk, there was no difference in sexual healthcare-seeking behaviour. Young men and women living with partners reported lower levels of sexual risk behaviours.

Conclusions

Our study suggests household structure may influence the sexual behaviour of young people in Britain. Given changes in their living arrangements, the role of household structure in sexual health research should be further investigated, and also considered as a possible marker for STI risk in clinical consultations.
Prognostic accuracy of different disseminated intravascular coagulation criteria in critically ill adult patients: a protocol for a systematic review and meta-analysis
Authors: Yoshimura Jumpei , Yamakawa Kazuma , Kodate Akira , Kodate Mari , Fujimi Satoshi
Published: December 2018

Introduction

Disseminated intravascular coagulation (DIC) is a common and serious condition that can lead to poor outcomes in critically ill patients. To make a correct diagnosis and improve the outcome of patients with DIC, several organisations have put forward DIC scoring systems. However, which criteria is the best to use for diagnosing DIC remains a continuing controversy even though many studies have been conducted to validate the diagnostic accuracy of each DIC scoring system.

Methods and analysis

We will conduct a systematic review and meta-analysis of the diagnostic accuracy of DIC criteria for the prediction of mortality in critically ill adult patients. The primary objective is to assess the predictive values of the DIC criteria of Japanese Association for Acute Medicine, International Society on Thrombosis and Haemostasis, Japanese Ministry of Health and Welfare, Korean Society on Thrombosis and Hemostasis and Chinese Diagnostic Scoring System for 28-day mortality. We will search electronic bibliographic databases such as MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials. Two reviewers will independently screen titles and abstracts, perform full article reviews and extract study data. We will report study characteristics and assess methodological quality using the Quality of Diagnostic Accuracy Studies-II tool. If pooling is appropriate, we will compute parameter estimates using bivariate random-effects and hierarchical summary receiver operating characteristic models to produce summary receiver operating curves, summary operating points (pooled sensitivity and specificity) and 95% confidence regions around the summary operating points. Clinical and methodological subgroup and sensitivity analyses will be performed to explore heterogeneity.

Ethics and dissemination

This systematic review will help physicians diagnose DIC accurately and improve their clinical practice in critically ill settings. Approval from an ethics committee is not required. The findings will be disseminated through publication in a peer-reviewed journal.

PROSPERO registration number

CRD42017079350.
Roll-your-own cigarette use and smoking cessation behaviour: a cross-sectional population study in England
Authors: Jackson Sarah E , Shahab Lion , West Robert , Brown Jamie
Published: December 2018

Objectives

Roll-your-own (RYO) cigarettes have become popular in the UK and reduce the cost of smoking, potentially mitigating the impact of tax increases on quitting. We examined whether RYO cigarette use was associated with reduced motivation to quit smoking, incidence of quit attempts and quit success.

Design

Cross-sectional survey.

Setting

England.

Participants

38 590 adults who reported currently smoking or having stopped within the past 12 months.

Main outcome measures

Motivation to quit smoking, quit attempt in the last year, motives for quitting and quit success were regressed onto RYO cigarette use, adjusting for sociodemographic variables and level of cigarette addiction. Mediation by weekly spending on smoking was tested.

Results

Compared with manufactured cigarette smokers, RYO smokers had lower odds of high motivation to quit (OR=0.77, 95% CI 0.73 to 0.81) or having made a quit attempt (OR=0.87, 95% CI 0.84 to 0.91). Among those who had attempted to quit smoking, quit success did not differ by cigarette type (OR=1.00, 95% CI 0.89 to 1.12), but RYO smokers were less likely to report cost of smoking as a motive to quit (OR=0.68, 95% CI 0.61 to 0.74). Spending on smoking mediated the association between RYO use and quit attempts (β=−0.02, SE=0.003, 95% CI −0.03 to −0.02).

Conclusions

In England, compared with smokers of manufactured cigarettes, RYO cigarette smokers appear to have lower motivation to quit and lower incidence of quit attempts but similar success of quit attempts. The lower cost of RYO smoking appears to mediate the lower incidence of quit attempts among RYO users.