bluuebunny/crossref_metadata_2025 huggingface dataset:
What is the practice of spiritual care? A critical discourse analysis of registered nurses’ understanding of spirituality
Authors: Louise Cooper Katherine , Luck Lauretta , Chang Esther , Dixon Kathleen
Published: October 2020

Spirituality has been a part of nursing for many centuries and represents an essential value for people, including nurses and patients. Cumulative evidence points to the positive contribution of spiritually on health and wellbeing. However, there is little clarity about what spirituality means. The literature reveals that nurses have ascribed a diversity of interpretations to spirituality. However, no studies have investigated how registered nurses construct their understanding of spirituality using a critical discourse analysis approach. Therefore, the aim of this study was to uncover how registered nurses construct their understanding of spirituality using a critical discourse analysis approach. Twenty registered nurses from a non‐denominational public hospital and a faith‐based private hospital were interviewed about their understanding of spirituality and practice of spiritual care. A critical discourse analysis approach was used in the examination of the interview texts to uncover underlying social and power features. Links were made between the linguistic features the registered nurses used in their interviews and the broader social context of the study. Three discourses emerged from the interview texts. These include constructing spirituality through personal religious beliefs discourse, holistic discourse and empathetic care discourse. The findings of this study have implications for nurse education and policy makers.
A LMDI decomposition analysis of carbon dioxide emissions from the electric power sector in Northwest China
Authors: Mai Lina , Ran Qiying , Wu Haitao
Published: October 2020

Taking advantage of the electrification strategy, Northwest China has made full use of its natural resources endowment, to develop renewable energy as the substitution of thermal power. To evaluate carbon dioxide (CO2) emissions from electric power sector, an extended Kaya identity equation and the Logarithmic mean Divisia index decomposition method are applied to Northwest China from 1998 to 2017. Six explaining factors are analyzed, including carbon intensity, energy mixes, generating efficiency, electrification, economy and population. The results show that driving forces of CO2 emissions from electricity system varied greatly among provinces. Generally, economic growth has mainly contributed to increase CO2 emission, while the improvement in the power‐generating efficiency has crucially decreased CO2 emission. In 2017, Promoting electrification directly increased CO2 emissions from electric system, but indirectly reduced CO2 emissions from the whole region by 5.10% through the estimation of a clean development mechanism method. Therefore, local governments are suggested continuing to promote electrification to guide future emission reduction, while enterprises and individuals need to make their own contributions to low‐carbon development.

Recommendations for Resource Managers:

Variations of carbon dioxide (CO2) emissions of all five provinces in Northwest China are analyzed.

Logarithmic mean Divisia index analysis is used to study the main drivers of CO2 emission change.

Improvements in the generating efficiency significantly reduced CO2 emissions.

Due to electrification effects, CO2 emissions from electric power increased, but CO2 emissions from the region decreased.

Economy effects were still the biggest drivers affecting CO2 emission.
Robustness of a meta‐network to alternative habitat loss scenarios
Authors: Santos Micaela , Cagnolo Luciano , Roslin Tomas , Ruperto Emmanuel F. , Bernaschini María Laura , Vázquez Diego P.
Published: October 2020

Studying how habitat loss affects the tolerance of ecological networks to species extinction (i.e. their robustness) is key for our understanding of the influence of human activities on natural ecosystems. With networks typically occurring as local interaction networks interconnected in space (a meta‐network), we may ask how the loss of specific habitat fragments affects the overall robustness of the meta‐network. To address this question, for an empirical meta‐network of plants, herbivores and natural enemies we simulated the removal of habitat fragments in increasing and decreasing order of area, age and connectivity for plant extinction and the secondary extinction of herbivores, natural enemies and their interactions. Meta‐network robustness was characterized as the area under the curve of remnant species or interactions at the end of a fragment removal sequence. To pinpoint the effects of fragment area, age and connectivity, respectively, we compared the observed robustness for each removal scenario against that of a random sequence. The meta‐network was more robust to the loss of old (i.e. long‐fragmented), large, connected fragments than of young (i.e. recently fragmented), small, isolated fragments. Thus, young, small, isolated fragments may be particularly important to the conservation of species and interactions, while contrary to our expectations larger, more connected fragments contribute little to meta‐network robustness. Our findings highlight the importance of young, small, isolated fragments as sources of species and interactions unique to the regional level. These effects may largely result from an unpaid extinction debt, whereby younger fragments are likely to lose species over time. Yet, there may also be more long‐lasting effects from cultivated lands (e.g. water, fertilizers and restricted cattle grazing) and network complexity in small, isolated fragments. Such fragments may sustain important biological diversity in fragmented landscapes, but maintaining their conservation value may depend on adequate restoration strategies.
Clostridial Gas Gangrene ‐ A Rare but Deadly Infection: Case series and Comparison to Other Necrotizing Soft Tissue Infections
Authors: Leiblein Maximilian , Wagner Nils , Adam Elisabeth H , Frank Johannes , Marzi Ingo , Nau Christoph
Published: October 2020

Objective

Clostridial gas gangrene (GG) or clostridial myonecrosis is a very rare but life‐threatening necrotizing soft tissue infection (NSTI) caused by anaerobic, spore‐forming, and gas‐producing clostridium subspecies. It is the most rapidly spreading and lethal infection in humans, also affecting muscle tissue. The high mortality, of up to 100%, in clostridial GG is mediated by potent bacterial exotoxins. Necrotizing fasciitis (NF) is an important differential diagnosis, most often caused by group A streptococci, primarily not affecting musculature but the subcutaneous tissue and fascia. In the early stages of the infection, it is difficult to distinguish between GG and NF. Therefore, we compare both infection types, identify relevant differences in initial clinical presentation and later course, and present the results of our patients in a retrospective review.

Methods

Patients diagnosed with GG from 2008 to 2018 in our level one trauma center were identified. Their charts were reviewed retrospectively and data analyzed in terms of demographic information, microbiological and histological results, therapeutic course, outcome, and mortality rates. The laboratory risk indicator for NF (LRINEC) score was applied on the first blood work acquired. Results were compared to those of a second group diagnosed with NF.

Results

Five patients with GG and nine patients with NF were included in the present study. Patients with GG had a mortality rate of 80% compared to 0% in patients with NF. In eight patients with NF, affected limbs could be salvaged; one NF underwent amputation. LRINEC did not show significant differences between the groups; however, C‐reactive protein was significantly increased (P = 0.009) and hemoglobin (Hb) was significantly decreased (P = 0.02) in patients with GG. Interleukin‐6 and procalcitonin levels did not show significant difference. Patients with GG were older (70.2 vs 50 years). Of the isolated bacteria, 86% were sensitive to the initial calculated antibiotic treatment with ampicillin‐sulbactam or imipenem plus metronidazole plus clindamycin.

Conclusion

Both GG and NF need full‐scale surgical, antibiotic, and intensive care treatment, especially within the first days. Among patients with NSTI, those with clostridial GG have a significantly increased mortality risk due to early septic shock caused by clostridial toxins. In the initial stages, clinical differences are hardly detectable. Immediate surgical debridement is the key to successful therapy for NSTI and needs to be performed as early as possible. However, patients should be treated in a center with an experienced interdisciplinary intensive care team based on a predetermined treatment plan.
Home sweet host: A cross‐country perspective on prudential and monetary policy spillovers through global banks
Authors: Avdjiev Stefan , Hardy Bryan , McGuire Patrick , von Peter Goetz
Published: October 2020

Prudential regulation of banks is multi‐layered: policy changes by home‐country authorities affect banks’ global operations across many jurisdictions; policy changes by host‐country authorities shape banks’ operations in the host jurisdiction regardless of the nationality of the parent bank. Do these policies create (unintended) cross‐border spillovers? Similarly, monetary policy actions by major central banks may also have effects on the behaviour of banks in other countries. This paper examines the effect that changes in home‐ and host‐country prudential measures have on cross‐border dollar credit provision, and how these interact with US monetary policy. We first run panel regressions with both layers of regulation, to examine which has a greater effect on cross‐border lending. We then use a novel approach to decompose growth in cross‐border bank lending into separate home, host and common components, and then match each with the corresponding home or host policies. Our results suggest that prudential policies can have spillover effects, which depend on the instrument used and on whether a bank's home or host country implemented them. Home policies tend to have larger spillovers on cross‐border US dollar lending than host policies. We also find that a tightening of US monetary policy can compound the spillovers of some prudential measures.
Mass Gatherings, Health, and Well‐Being: From Risk Mitigation to Health Promotion
Authors: Hopkins Nick , Reicher Stephen
Published: October 2020

Mass gatherings are routinely viewed as posing risks to physical health. However, social psychological research shows mass gathering participation can also bring benefits to psychological well‐being. We describe how both sets of outcomes can be understood as arising from the distinctive forms of behavior that may be found when people—even strangers—come to define themselves and each other in terms of a shared social identity. We show that many of the risks and benefits of participation are products of group processes; that these different outcomes can have their roots in the same core processes; and that knowledge of these process provides a basis for health promotion interventions to mitigate the risks and maximize the benefits of participation. Throughout, we offer practical guidance as to how policy makers and practitioners should tailor such interventions.
Integration of reactive oxygen species and hormone signaling during abiotic stress
Authors: Devireddy Amith R. , Zandalinas Sara I. , Fichman Yosef , Mittler Ron
Published: October 2020

Each year, abiotic stress conditions such as drought, heat, salinity, cold and particularly their different combinations, inflict a heavy toll on crop productivity worldwide. The effects of these adverse conditions on plant productivity are becoming ever more alarming in recent years in light of the increased rate and intensity of global climatic changes. Improving crop tolerance to abiotic stress conditions requires a deep understanding of the response of plants to changes in their environment. This response is dependent on early and late signal transduction events that involve important signaling molecules such as reactive oxygen species (ROS), different plant hormones and other signaling molecules. It is the integration of these signaling events, mediated by an interplay between ROS and different plant hormones that orchestrates the plant response to abiotic stress and drive changes in transcriptomic, metabolic and proteomic networks that lead to plant acclimation and survival. Here we review some of the different studies that address hormone and ROS integration during the response of plants to abiotic stress. We further highlight the integration of ROS and hormone signaling during early and late phases of the plant response to abiotic stress, the key role of respiratory burst oxidase homologs in the integration of ROS and hormone signaling during these phases, and the involvement of hormone and ROS in systemic signaling events that lead to systemic acquired acclimation. Lastly, we underscore the need to understand the complex interactions that occur between ROS and different plant hormones during stress combinations.
Cytokinin biosynthesis and transport for systemic nitrogen signaling
Authors: Sakakibara Hitoshi
Published: October 2020

The plasticity of growth and development in response to environmental changes is one of the essential aspects of plant behavior. Cytokinins play an important role as signaling molecules in the long‐distance communication between organs in systemic growth regulation in response to nitrogen. The spatial distribution of the expression sites of cytokinin biosynthesis genes leads to structural differences in the molecular species transported through the xylem and phloem, giving root‐borne trans‐hydroxylated cytokinins, namely trans‐zeatin (tZ) type, a specialized efficacy in regulating shoot growth. Furthermore, root‐to‐shoot translocation via the xylem, tZ, and its precursor, the tZ riboside, controls different sets of shoot growth traits to fine‐tune shoot growth in response to nitrogen availability. In addition to nitrogen, photosynthetically generated sugars positively regulate de novo cytokinin biosynthesis in the roots, and contribute to plant growth under elevated CO2 conditions. In shoot‐to‐root signaling, cytokinins also play a role in the regulation of nutrient acquisition and root system growth in cooperation with other types of signaling molecules, such as C‐TERMINALLY ENCODED PEPTIDE DOWNSTREAMs. As cytokinin is a key regulator for the maintenance of shoot apical meristem, deepening our understanding of the regulatory mechanisms of cytokinin biosynthesis and transport in response to nitrogen is important not only for basic comprehension of plant growth, but also to ensure the stability of agricultural production.
Globalisation and government spending: Evidence for the ‘hyper‐globalisation’ of the 1990s and 2000s
Authors: Anderson Edward , Obeng Samuel
Published: October 2020

In this paper, we provide an up‐to‐date empirical assessment of the relationship between economic globalisation and government spending for the ‘hyper‐globalisation’ period of the 1990s and 2000s. We use data on government consumption spending and more disaggregated spending components (e.g., social welfare). We also use a range of globalisation measures, including the most recent version of the KOF globalisation index, and a combination of econometric methods, including fixed‐effects and instrumental variable (IV) estimation. The results suggest that hyper‐globalisation has had divergent and conflicting effects on consumption spending: while de jure trade globalisation has tended to raise spending, de jure financial globalisation has tended to reduce it. We also find evidence that the positive effect of de facto trade globalisation on spending weakened significantly during the 1990s and 2000s, in comparison with earlier decades. These effects could have contributed to the growing political backlash witnessed against globalisation since the early 2000s.
Investigation of the electrical behavior of AlGaN/GaN high electron mobility transistors grown with underlying GaN:Mg layer
Authors: Mahaboob Isra , Novak Steven W. , Rocco Emma , Hogan Kasey , Shahedipour-Sandvik Fatemeh
Published: October 2020

In the current study, the electrical behavior of the AlGaN/GaN high electron mobility transistors (HEMTs) grown with an underlying GaN:Mg layer is detailed. It is shown that the activation of the buried p-GaN layer is achieved without hydrogen diffusion out of the layer. Reversal in the electrical behavior of the two-dimensional electron gas (2DEG) is also observed in the as-grown structure based on the p-GaN activation sequence. This behavior is attributed to the complex role played by hydrogen in the overgrown HEMT layers. The results of this study provide new insights into the development of metal organic chemical vapor deposition grown HEMTs with activated buried p-GaN films.
Opto-electrical characterization of quaternary sputtered copper indium gallium selenide nanorods via glancing angle deposition
Authors: Brozak Matthew , Badraddin Emad , Karabacak Tansel , Walsh Thomas
Published: October 2020

Nanorod arrays have become an attractive alternative to their thin film and bulk counterparts in photovoltaic and photoconductivity research. This is mainly attributed to their superior optical and electrical properties. Light trapping and unique bandgap geometries in vertically aligned nanostructures result in high optical absorption and provide enhanced carrier collection by utilizing a fully depleted p-n junction between the anode and cathode via an isolated “capping” construction. The combination of these two features leads to the development of high efficiency nanostructured devices that can be utilized in solar cells and photodetectors. Optical absorption properties, geometry, and opto-electrical properties of nanorod arrays of CuInxGa(1−x)Se2 (CIGS), a p-type semiconductor with a wide bandgap ranging from 1.0 to 1.7 eV, are compared to their thin film counterparts. Utilizing a radio frequency sputtering system, a quaternary target, and glancing angle deposition technique, both isolated vertical arrays of CIGS nanorods and “core-shell” devices were fabricated, while conventional film devices were fabricated by normal incidence deposition. Scanning electron microscopy images indicated a successful growth of CIGS nanorods. Optical absorption and opto-electrical performance were found to be strongly improved by the presence of the isolated nanorod structures through spectroscopic reflectometry and responsivity testing under a solar simulator.
Internationalizing Sport Management Programs: No Longer a Luxury, But a Necessity
Authors: Weese W. James (Jim)
Published: October 2020

Sport participation, consumption, and management are internationally focused, and the popularity of sport on an international scale shows no signs of slowing down. In fact, there is evidence that the internationalization of sport is rapidly increasing. Most North American institutions of higher learning are similarly focused and have internationalization as a high strategic priority. One could argue that sport management academic programs have not kept pace with these developments that have influenced our field and environment. While progress has been made, there is more to be done. The author chronicles the developments in the internationalization of both sport and higher education and offers eight suggestions to help sport management academicians effectively and efficiently internationalize their programs. Implementing some or all of these suggestions may better prepare graduates in their future endeavors and more effectively align sport management programs with the goals of their respective institution. Internationalization of the discipline would hold useful and practical applications for sport management students and programs.
Prolonged Outbreak of Multidrug-Resistant Shigella sonnei Harboring
bla
CTX-M-27
in Victoria, Australia
Authors: Ingle Danielle J. , Andersson Patiyan , Valcanis Mary , Barnden Jessica , da Silva Anders Gonçalves , Horan Kristy A. , Seemann Torsten , Easton Marion , Williamson Deborah A. , Sherry Norelle L. , Howden Benjamin P.
Published: October 2020

In Australia, cases of shigellosis usually occur in returned travelers from regions of shigellosis endemicity or in men who have sex with men. Resistance to multiple antibiotics has significantly increased in
Shigella sonnei
isolates and represents a significant public health concern. We investigate an outbreak of multidrug-resistant
S. sonnei
in Victoria, Australia. We undertook whole-genome sequencing of 54 extended-spectrum-beta-lactamase (ESBL)-producing
S. sonnei
isolates received at the Microbiological Diagnostic Unit Public Health Laboratory between January 2019 and March 2020.
Akkermansia muciniphila and Its Pili-Like Protein Amuc_1100 Modulate Macrophage Polarization in Experimental Periodontitis
Authors: Mulhall Hannah , DiChiara Jeanne M. , Deragon Matthew , Iyer Radha , Huck Olivier , Amar Salomon
Published: October 2020

Periodontitis is a chronic inflammatory disease triggered by dysbiosis of the oral microbiome.
Porphyromonas gingivalis
is strongly implicated in periodontal inflammation, gingival tissue destruction, and alveolar bone loss through sustained exacerbation of the host response. Recently, the use of other bacterial species, such as
Akkermansia muciniphila
, has been suggested to counteract inflammation elicited by
P. gingivalis
. In this study, the effects of
A. muciniphila
and its pili-like protein Amuc_1100 on macrophage polarization during
P. gingivalis
infection were evaluated in a murine model of experimental periodontitis.
ISG15 Connects Autophagy and IFN-γ-Dependent Control of Toxoplasma gondii Infection in Human Cells
Authors: Bhushan Jaya , Radke Joshua B. , Perng Yi-Chieh , Mcallaster Michael , Lenschow Deborah J. , Virgin Herbert W. , Sibley L. David
Published: October 2020

Interferon(s) provide the primary defense against intracellular pathogens, a property ascribed to their ability to upregulate interferon-stimulated genes. Due to the sequestered niche occupied by
Toxoplasma gondii
, the host has elaborated intricate ways to target the parasite within its vacuole. One such mechanism is the recognition by a noncanonical autophagy pathway that envelops the parasite-containing vacuole and stunts growth in human cells. Remarkably, autophagy-dependent growth restriction requires interferon-γ, yet none of the classical components of autophagy are induced by interferon. Our studies draw a connection between these pathways by demonstrating that the antiviral protein ISG15, which is normally upregulated by interferons, links the autophagy-mediated control to ubiquitination of the vacuole. These findings suggest a similar link between interferon-γ signaling and autophagy that may underlie defense against other intracellular pathogens.
Molecular Mimicry: a Paradigm of Host-Microbe Coevolution Illustrated by
Legionella
Authors: Mondino Sonia , Schmidt Silke , Buchrieser Carmen
Published: October 2020

Through coevolution with host cells, microorganisms have acquired mechanisms to avoid the detection by the host surveillance system and to use the cell’s supplies to establish themselves. Indeed, certain pathogens have evolved proteins that imitate specific eukaryotic cell proteins, allowing them to manipulate host pathways, a phenomenon termed molecular mimicry. Bacterial “eukaryotic-like proteins” are a remarkable example of molecular mimicry. They are defined as proteins that strongly resemble eukaryotic proteins or that carry domains that are predominantly present in eukaryotes and that are generally absent from prokaryotes.
Structure-Based Modification of an Anti-neuraminidase Human Antibody Restores Protection Efficacy against the Drifted Influenza Virus
Authors: Jiang Haihai , Peng Weiyu , Qi Jianxun , Chai Yan , Song Hao , Bi Yuhai , Rijal Pramila , Wang Haiyuan , Oladejo Babayemi O. , Liu Jinhua , Shi Yi , Gao George F. , Townsend Alain R. , Wu Yan
Published: October 2020

The immune system produces antibodies to protect the human body from harmful invaders. The monoclonal antibody (MAb) is one kind of effective antivirals. In this study, we isolated an antibody (Z2B3) from an H7N9 influenza virus-infected child. It shows cross-reactivity to both group 1 (N1) and group 2 (N9) neuraminidases (NAs) but is sensitive to N1 NA with a K432E substitution. Structural analysis of the NA-antibody fragment antigen-binding (Fab) complex provides a clue for antibody modification, and the modified antibody restored binding and inhibition to recently drifted N1 NA and regained protection against the variant influenza strain. This finding suggests that antibodies to NA may be a useful therapy and can be in principle edited to defeat drifted influenza virus.
Copy Number of an Integron-Encoded Antibiotic Resistance Locus Regulates a Virulence and Opacity Switch in Acinetobacter baumannii AB5075
Authors: Anderson Sarah E. , Chin Chui Yoke , Weiss David S. , Rather Philip N.
Published: October 2020

Acinetobacter baumanniiremains a leading cause of hospital-acquired infections. Widespread multidrug resistance in this species has prompted the WHO to name carbapenem-resistantA. baumanniias its top priority for research and development of new antibiotics. Many strains ofA. baumanniiundergo a high-frequency virulence switch, which is an attractive target for new therapeutics targeting this pathogen. This study reports a novel mechanism controlling the frequency of switching in strain AB5075. The rate of switching from the virulent opaque (VIR-O) to the avirulent translucent (AV-T) variant is positively influenced by the copy number of an antibiotic resistance locus encoded on a plasmid-borne composite integron. Our data suggest that this locus encodes a small RNA that regulates opacity switching. Low-switching opaque variants, which harbor a single copy of this locus, also exhibit decreased virulence. This study increases our understanding of this critical phenotypic switch, while also identifying potential targets for virulence-basedA. baumanniitreatments.
RIPK3-Dependent Recruitment of Low-Inflammatory Myeloid Cells Does Not Protect from Systemic
Salmonella
Infection
Authors: Satkovich John , Anderson Christopher J. , Medina Christopher B. , Ottolini Matteo , Lukens John R. , Kendall Melissa M.
Published: October 2020

Macrophages employ multiple strategies to limit pathogen infection. For example, macrophages may undergo regulated cell death, including RIPK3-dependent necroptosis, as a means of combatting intracellular bacterial pathogens. However, bacteria have evolved mechanisms to evade or exploit immune responses.
Salmonella
is an intracellular pathogen that avoids and manipulates immune detection within macrophages. We examined the contribution of RIPK3 to
Salmonella
-induced macrophage death. Our findings indicate that noninvasive
Salmonella
does not naturally induce necroptosis, but it does so when caspases are inhibited. Moreover, RIPK3 induction (following caspase inhibition) does not impact host survival following
Salmonella
systemic infection. Finally, our data show that RIPK3 induction results in recruitment of low-inflammatory myeloid cells, which was unexpected, as necroptosis is typically described as highly inflammatory. Collectively, these data improve our understanding of pathogen-macrophage interactions, including outcomes of regulated cell death during infection
in vivo
, and reveal a potential new role for RIPK3 in resolving inflammation.
Atmospheric dust flux in northeastern Gondwana during the peak of the late Paleozoic ice age
Authors: Sardar Abadi Mehrdad , Soreghan Gerilyn S. , Hinnov Linda , Heavens Nicholas G. , Gleason James D.
Published: October 2020

The silicate mineral fraction of shallow marine carbonates archives dust contributions to the Central Persian Terranes along the northeastern margin of Gondwana (∼30ºS paleolatitude), enabling reconstruction of atmospheric dust loading and circulation for intervals of the late Paleozoic ice age. The Central Persian Terranes hosted cyclic deposition of warm water carbonates from middle Pennsylvanian to earliest Permian time, and our data set includes two ∼28 m sections from the Moscovian and Asselian sampled at 20 cm intervals. Bounding surfaces between successive cycles (high-frequency sequences) are recognized by either abrupt basinward shifts in facies or subtle exposure features; these high-frequency sequences range from 1 m to 5 m thick and are interpreted to record glacioeustatic variations. Time series analysis of the dust fraction through the studied interval supports the hypothesis of orbital forcing for the dust signal. The stratigraphic pattern of the dust flux indicates minimal flux during interglacial highstands (0.19−0.27 g/cm2/kyr) and peak flux during glacial lowstands (3.77−4.57 g/cm2/kyr) after accounting for hiatal time at sequence boundaries. Grain size analysis of the dust for all samples (n = 230) reveals modal sizes (volume-based) of 1−15 µm through the Moscovian interval and 10−75 µm through the Asselian interval. Dust deposition increased during glacial times relative to interglacial times by a factor of 16 to 19. Additionally, the Asselian interval exhibits higher dust flux overall relative to the Moscovian interval, which is interpreted to reflect the more extreme icehouse conditions of the Asselian. Variation in the dust content through the studied sections provides an indicator of temporal changes in atmospheric loading that varied at both glacial−interglacial and higher-frequency (<104 yr) scales. Geochemical data reveal that the Arabian−Nubian Shield and southwestern Pangaea (South America) are the most likely sources of dust deposition in the Central Persian Terranes, with sources shifting during different phases. Increased dust flux during glacials likely reflects multiple factors, including enhanced aridity in the source region, exposure of shelf regions, and potential changes in winds. However, the discrepancy in model reconstructions of the amplitude of glacial−interglacial dust variations indicates that increased production of dust sourced by dynamic glaciation played a large role in enhancing dust flux during glacial phases.
Effect of bariatric surgery on circulating and urinary mitochondrial DNA copy numbers in obesity with or without diabetes
Authors: Seo Mihae , Kim Hyoungnae , Noh Hyunjin , Jeon Jin Seok , Byun Dong Won , Kim Sang Hyun , Kim Hye Jeong , Suh Kyoil , Park Hyeong Kyu , Kwon Soon Hyo
Published: October 2020

Introduction

Recent studies have suggested that extracellular circulating and urinary mitochondrial DNA (mtDNA) are associated with mitochondrial dysfunction in obesity and type 2 diabetes mellitus (T2DM). However, the changes to cell-free serum and urinary mtDNA after bariatric surgery in patients with obesity with T2DM have not been investigated to date.

Research design and methods

We prospectively recruited patients with obesity (n=18), and with obesity and T2DM (n=14) who underwent bariatric surgery, along with healthy volunteers (HV) as a control group (n=22). Serum and urinary mitochondrial nicotinamide adenine dinucleotide dehydrogenase subunit-1 (mtND-1) and cytochrome-c oxidase 3 (mtCOX-3) copy numbers were measured using quantitative PCR (qPCR). The mtDNA copy numbers of patients with obesity (with and without T2DM) were followed up 6 months after surgery.

Results

The copy numbers of urinary mtND-1 and mtCOX-3 in patients with obesity, with or without T2DM, were higher than those in the HVs. Moreover, urinary mtCOX-3 copy number increased in patients with obesity with T2DM compared with patients with obesity without T2DM (p=0.018). Meanwhile, serum mtCOX-3 copy numbers in HV were higher in both obesity patient groups (p=0.040). Bariatric surgery reduced urinary mtND-1 and mtCOX-3 copy numbers, as well as serum mtCOX-3 copy numbers only in patients with obesity with T2DM.

Conclusion

These results suggest that T2DM induces greater kidney mitochondrial dysfunction in patients with obesity, which can be effectively restored with bariatric surgery.
Andalusian program for early detection of diabetic retinopathy: implementation and 15-year follow-up of a population-based screening program in Andalusia, Southern Spain
Authors: Rodriguez-Acuña Rafael , Mayoral Eduardo , Aguilar-Diosdado Manuel , Rave Reyes , Oyarzabal Beatriz , Lama Carmen , Carriazo Ana , Martinez-Brocca Maria Asuncion
Published: October 2020

Introduction

Diabetic retinopathy (DR) is a preventable cause of vision loss and blindness worldwide. We aim at analyzing the impact of a population-based screening program of DR using retinal photography with remote reading in terms of population coverage, diagnosis of asymptomatic DR and impact on visual disability, in the region of Andalusia, Spain, in the period 2005–2019.

Research design and methods

Descriptive study. Sociodemographic and clinical features included in the Andalusian program for early detection of diabetic retinopathy (APDR) were analyzed. Population coverage, annual incidence of DR, and DR severity gradation were analyzed. Estimated data on prevalence and incidence of legal blindness due to DR were included.

Results

407 762 patients with at least one successful DR examination during the study period were included. Most of the performed retinographies (784 584, 84.3%) were ‘non-pathological.’ Asymptomatic DR was detected in 52 748 (5.9%) retinographies, most of them (94.2%) being classified as ‘mild to moderate non-proliferative DR.’ DR was detected in 44 815 patients, while sight-threatening DR (STDR) in 6256 patients; cumulative incidence of DR was 11.0% and STDR was 1.5%, as DR and STDR was detected in 44 815 and 6256 patients, respectively. Annual incidence risk per patient recruitment year progressively decreased from 22.0% by January 2005 to 3.2% by June 2019.

Conclusions

Implementation of a long-term population-based screening program for early detection of DR is technically feasible and clinically viable. Thus, after 15 years of existence, the program has enabled the screening of the vast majority of the target population allowing the optimization of healthcare resources and the identification of asymptomatic DR.
Is there variation in private payor payments to cancer surgeons? A cross-sectional study in the USA
Authors: Bongiovanni Tasce , Kim Simon P , Kim Anthony , Killelea Brigid , Gross Cary P
Published: October 2020

Objectives

Although demand for price transparency in healthcare is growing, variation in private payors’ payments to surgeons for oncologic resection has not been well characterised. Our aim was to assess variation of private payors’ payments to surgeons for cancer resection using data based on fee-for-service allowed amounts, billed by a large mix of commercial payors and third-party administrators.

Setting

Fair Health (FH), an independent, not-for-profit organisation that collects and compiles claims data from payors nationwide. FH maintains the nation’s largest repository of privately billed medical and dental claims representing over 125 million covered lives in the USA.

Participants

We performed a cross-sectional study assessing private payer data for five common types of cancer surgery: simple mastectomy (SM), modified radical mastectomy (MRM), open lobectomy, video-assisted thoracoscopic surgery (VATS) lobectomy and radical prostatectomy during 2012 and 2013.

Primary and secondary outcome measures

To assess variation across regions, we compared regional median allowed payments. To assess intraregion variability, we evaluated the distribution of regional IQRs of allowed payments.

Results

Median allowed payments varied substantially across regions. For SM, median allowed payments ranged from $550 in the least expensive to $1380 in the costliest region. For MRM, the range was $842–$1760, for lobectomy $326–$3066, for VATS $317–$3307 and for prostatectomy $1716–$4867. There was also substantial variation within geographic areas. For example, the mean IQRs in surgeon payment within regions were: SM $577 (25th percentile) to $1132 (75th percentile); MRM $850–$1620; lobectomy $861–$2767; VATS $1024–$3122; and prostatectomy $2286–$3563.

Conclusions

There is a wide range of variation both across and within geographic regions in allowed amounts of surgeon payments for common oncologic resections. Transparency about these allowed amounts may have a profound impact on patient and employer choice and facilitate future assessments of value in cancer care.
Efficacy and safety of cilostazol-nimodipine combined therapy on delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage: a prospective, randomised, double-blinded, placebo-controlled trial protocol
Authors: Dawley Troy , Claus Chad F , Tong Doris , Rajamand Sina , Sigler Diana , Bahoura Matthew , Garmo Lucas , Soo Teck M , Kelkar Prashant , Richards Boyd
Published: October 2020

Introduction

Delayed cerebral ischaemia (DCI) due to cerebral vasospasm (cVS) remains the foremost contributor to morbidity and mortality following aneurysmal subarachnoid haemorrhage (aSAH). Past efforts in preventing and treating DCI have failed to make any significant progress. To date, our most effective treatment involves the use of nimodipine, a calcium channel blocker. Recent studies have suggested that cilostazol, a platelet aggregation inhibitor, may prevent cVS. Thus far, no study has evaluated the effect of cilostazol plus nimodipine on the rate of DCI following aSAH.

Methods and analysis

This is a multicentre, double-blinded, randomised, placebo-controlled superiority trial investigating the effect of cilostazol on DCI. Data concerning rates of DCI, symptomatic and radiographic vasospasm, length of intensive care unit stay, and long-term functional and quality-of-life (QoL) outcomes will be recorded. All data will be collected with the aim of demonstrating that the use of cilostazol plus nimodipine will safely decrease the incidence of DCI, and decrease the rates of both radiographic and symptomatic vasospasm with subsequent improvement in long-term functional and QoL outcomes when compared with nimodipine alone.

Ethics and dissemination

Ethical approval was obtained from all participating hospitals by the Ascension Providence Hospital Institutional Review Board. The results of this study will be submitted for publication in peer-reviewed journals.

Trial registration number

NCT04148105
Pushing the limits of recovery in chronic stroke survivors: a descriptive qualitative study of users perceptions of the Queen Square Upper Limb Neurorehabilitation Programme
Authors: Kelly Kate , Brander Fran , Strawson Amanda , Ward Nick , Hayward Kathryn
Published: October 2020

Introduction

The Queen Square Upper Limb (QSUL) Neurorehabilitation Programme is a clinical service within the National Health Service in the UK that provides 90-hours of therapy over 3-weeks to stroke survivors with persistent upper limb impairment. This study aimed to explore the perceptions of participants of this programme, including clinicians, stroke survivors and caregivers.

Design

Descriptive qualitative. Data analysis was performed using a conventional thematic content approach to identify main themes by four researchers to avoid any potential bias or personal motivations, promoting confirmability.

Setting

Clinical outpatient neurorehabilitation service.

Participants

Clinicians (physiotherapists, occupational therapists, rehabilitation assistants) involved in the delivery of the QSUL Programme, as well as stroke survivors and caregivers who had participated in the programme were purposively sampled. Each focus group followed a series of semi-structured, open questions that were tailored to the clinical or stroke group. One independent researcher facilitated all focus groups, which were audio-recorded and transcribed verbatim by a professional transcription agency.

Results

Four focus groups were completed: three including stroke survivors (n=16) and caregivers (n=2), and one including clinicians (n=11). The main stroke survivor themes related to psychosocial aspects of the programme (‘you feel valued as an individual’), as well as the behavioural training provided (‘gruelling, yet rewarding’). The main clinician themes also included psychosocial aspects of the programme (‘patient driven ethos—no barriers, no rules’) and knowledge, skills and resources of clinicians (‘it is more than intensity, it is complex’).

Conclusions

As an intervention, stroke survivors and clinicians consider the QSUL Programme to be both comprehensive and complex. The nature of the interventions in the programme spans psychosocial and behavioural domains. We suggest the future clinical trials of upper limb rehabilitation consider testing the efficacy of these multiple interacting components.
Piloting a web-based systematic collection and reporting of patient-reported outcome measures and patient-reported experience measures in chronic heart failure
Authors: Pennucci Francesca , De Rosis Sabina , Passino Claudio
Published: October 2020

Objectives

To evaluate the feasibility of a digital and continuous collection and reporting of patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) for chronic heart failure (CHF).

Design

A single-site pilot study was settled for evaluating the feasibility of the intervention, both using qualitative and quantitative data (ie, workshop, surveys).

Setting

The pilot has been implemented in a Tuscan specialised hospital (Italy).

Participants

162 patients were involved. Inclusion criteria were: a previous diagnosis of HF, age ≥18 years, absence of cognitive impairment or active tumours, ability to provide informed consent to study participation.

Intervention

The continuous collection and reporting of PROMs and PREMs has been designed and implemented in 2018. PREMs questionnaires for patients were developed, while Kansas City Cardiomyopathy Questionnaire-12 was used for assessing PROMs. Questionnaires are administered at specific time points: discharge; 30 days, 7 and 12 months after the discharge. Enrolment of patients, administration and real-time reporting of questionnaires are carried on through a digital platform.

Outcome measures

Enrolment, response and drop-out rates were considered to assess the feasibility of the intervention. Qualitative data were collected during meetings and workshops with health workers. The representativeness of the recruited sample with respect to the population characteristics was also evaluated.

Results

The system has been successfully implemented during 2018. Response rates have been consistently above 50%, demonstrating patients’ transversal willingness to participate. All the involved stakeholders acknowledged the feasibility of the design. The recruited sample is significantly different in terms of age and educational level compared with the overall population characteristics.

Conclusion

It is possible to run a web-based systematic collection and reporting system for CHF patient-reported data. Systematic collection and reporting of PROMs and PREMs data allows professionals to increasingly assume CHF patient perspective in their daily work. Limitations will be used to improve the system.
Neuroimaging in the effect of transcranial magnetic stimulation therapy for patient with depression: a protocol for a coordinate-based meta-analysis
Authors: Deng Yongyan , Li Wenyue , Zhang Bin
Published: October 2020

Introduction

As a prevalent psychiatric disease, depression is a life-threatening mental disorder that may cause work disability and premature death. Transcranial magnetic stimulation (TMS) is a non-invasive neuromodulation procedure, which has been reported to have a significant effect on antidepressant treatment in recent years. However, the parameters of TMS for depression that can produce the best clinical benefits remain unknown. In the present study, we will evaluate the effect of TMS treatment for depression from the perspective of functional neuroimaging by performing a meta-analysis based on included studies.

Methods and analysis

Two independent reviewers will search published studies in the following five databases: PubMed, Web of Science, Embase, China National Knowledge Infrastructure and WANGFANG DATA from inception to 1 June 2020. Then we will select studies according to predesigned inclusion and exclusion criteria. After extracting data from included studies, activation likelihood estimation will be applied to data synthesis. Any disagreement will be checked by the third reviewer who will also make the final decision.

Ethics and dissemination

This work does not require ethics approval as it will be based on published studies. This review will be published in peer-reviewed journals.

PROSPERO registration number

CRD42020165436.
Accuracy of potential diagnostic indicators for coeliac disease: a systematic review protocol
Authors: Elwenspoek Martha Maria Christine , Jackson Joni , Dawson Sarah , Everitt Hazel , Gillett Peter , Hay Alastair D , Jones Hayley E , Lane Deborah L , Mallett Susan , Robins Gerry , Sheppard Athena Louise , Stubbs Jo , Thom Howard , Watson Jessica , Whiting Penny
Published: October 2020

Introduction

Coeliac disease (CD) is a systemic immune-mediated disorder triggered by gluten in genetically predisposed individuals. CD is diagnosed using a combination of serology tests and endoscopic biopsy of the small intestine. However, because of non-specific symptoms and heterogeneous clinical presentation, diagnosing CD is challenging. Early detection of CD through improved case-finding strategies can improve the response to a gluten-free diet, patients’ quality of life and potentially reduce the risk of complications. However, there is a lack of consensus in which groups may benefit from active case-finding.

Methods and analysis

We will perform a systematic review to determine the accuracy of diagnostic indicators (such as symptoms and risk factors) for CD in adults and children, and thus can help identify patients who should be offered CD testing. MEDLINE, Embase, Cochrane Library and Web of Science will be searched from 1997 until 2020. Screening will be performed in duplicate. Data extraction will be performed by one and checked by a second reviewer. Disagreements will be resolved through discussion or referral to a third reviewer. We will produce a narrative summary of identified prediction models. Studies, where 2×2 data can be extracted or reconstructed, will be treated as diagnostic accuracy studies, that is, the diagnostic indicators are the index tests and CD serology and/or biopsy is the reference standard. For each diagnostic indicator, we will perform a bivariate random-effects meta-analysis of the sensitivity and specificity.

Ethics and dissemination

Results will be reported in peer-reviewed journals, academic and public presentations and social media. We will convene an implementation panel to advise on the optimum strategy for enhanced dissemination. We will discuss findings with Coeliac UK to help with dissemination to patients. Ethical approval is not applicable, as this is a systematic review and no research participants will be involved.

PROSPERO registration number

CRD42020170766.