bluuebunny/crossref_metadata_2025 huggingface dataset:
Medicare Part D: Time for Re‐Modernization?
Authors: Trish Erin E.
Published: October 2019

Objective

To understand the mechanisms that have held Part D beneficiary premiums stable despite increasing reinsurance subsidies.

Data Sources

Secondary data on Part D plan bids, federal subsidies, and claims from 2007 through 2015.

Study Design

Comparisons of standardized, enrollment‐weighted average Part D plan bids and reinsurance bids with plan and reinsurance liability calculated from Part D claims data.

Data Collection/Extraction Methods

Part D plan payment data were merged with premium data to derive plan bids, which were merged with claims‐based spending measures.

Principal Findings

Plan bids and reinsurance bids increasingly diverged from the spending observed in the claims data over the study period. This divergence was attributable to the growth in rebates and systematic under‐bidding of expected reinsurance payments, enabling plans to hold premiums low and collect excess federal subsidies of approximately 3 percent of total Part D spending in 2015.

Conclusions

Revenue from rebates and excess federal subsidies via reinsurance reconciliation has played an important role in holding Part D premiums low, despite increasing federal reinsurance subsidies. While policy makers should consider implementing reforms to address these misincentives in the program, doing so is likely to result in unavoidable premium increases to levels more reflective of actual net spending.
Patients with life‐limiting illness presenting to the emergency department
Authors: Ragg Michael , Ragg James , Milnes Sharyn , Bailey Michael , Orford Neil
Published: October 2019

Objective

To examine characteristics, outcomes and flow for patients over the age of 45 years with a life‐limiting illness (LLI) presenting to a regional ED.

Methods

Retrospective, observational cohort study of patients with LLI in an Australian regional ED over a 15‐day period. Eligible patients were 45 years of age or older who fulfilled criteria for having an LLI. Data included demographics, diagnosis for current presentation, presence of advance care documentation, LLI category, admission and discharge destination from ED, ED and hospital length of stay and outcome for patients admitted to the acute hospital.

Results

A total of 152 (12%) patients had an LLI. The LLI group were older, had a significantly longer median length of stay in the ED (5.9 [interquartile range 4.0–8.4] vs 3.9 h [interquartile range 2.5–6.3], P < 0.0001) and were less likely to leave the ED within 4 h (26% vs 51.5%, P < 0.0001). Forty‐six percent of patients with an LLI had some form of advanced care documentation. Patients with an LLI were more likely to require hospital admission. In relation to illness trajectory, the frailty/dementia trajectory group had comparatively the longest ED length of stay with less than 10% leaving the ED within 4 h. This group were more likely to be discharged to a residential care facility.

Conclusion

A significant proportion of patients 45 years or older had an LLI which had implications for their length of ED stay and discharge destination.
Microbial degradation of steroid sex hormones: implications for environmental and ecological studies
Authors: Chiang Yin‐Ru , Wei Sean Ting‐Shyang , Wang Po‐Hsiang , Wu Pei‐Hsun , Yu Chang‐Ping
Published: October 2019

Steroid hormones modulate development, reproduction and communication in eukaryotes. The widespread occurrence and persistence of steroid hormones have attracted public attention due to their endocrine‐disrupting effects on both wildlife and human beings. Bacteria are responsible for mineralizing steroids from the biosphere. Aerobic degradation of steroid hormones relies on O2 as a co‐substrate of oxygenases to activate and to cleave the recalcitrant steroidal core ring. To date, two oxygen‐dependent degradation pathways – the 9,10‐seco pathway for androgens and the 4,5‐seco pathways for oestrogens – have been characterized. Under anaerobic conditions, denitrifying bacteria adopt the 2,3‐seco pathway to degrade different steroid structures. Recent meta‐omics revealed that microorganisms able to degrade steroids are highly diverse and ubiquitous in different ecosystems. This review also summarizes culture‐independent approaches using the characteristic metabolites and catabolic genes to monitor steroid biodegradation in various ecosystems.
Tau inhibits PKA by nuclear proteasome‐dependent PKAR2α elevation with suppressed CREB/GluA1 phosphorylation
Authors: Ye Jinwang , Yin Yaling , Liu Huanhuan , Fang Lin , Tao Xiaoqing , Wei Linyu , Zuo Yue , Yin Ying , Ke Dan , Wang Jian‐Zhi
Published: October 2019

Intraneuronal accumulation of wild‐type tau plays a key role in Alzheimer's disease, while the mechanisms underlying tauopathy and memory impairment remain unclear. Here, we report that overexpressing full‐length wild‐type human tau (hTau) in mouse hippocampus induces learning and memory deficits with remarkably reduced levels of multiple synapse‐ and memory‐associated proteins. Overexpressing hTau inhibits the activity of protein kinase A (PKA) and decreases the phosphorylation level of cAMP‐response element binding protein (CREB), GluA1, and TrkB with reduced BDNF mRNA and protein levels both in vitro and in vivo. Simultaneously, overexpressing hTau increased PKAR2α (an inhibitory subunit of PKA) in nuclear fraction and inactivated proteasome activity. With an increased association of PKAR2α with PA28γ (a nuclear proteasome activator), the formation of PA28γ‐20S proteasome complex remarkably decreased in the nuclear fraction, followed by a reduced interaction of PKAR2α with 20S proteasome. Both downregulating PKAR2α by shRNA and upregulating proteasome by expressing PA28γ rescued hTau‐induced PKA inhibition and CREB dephosphorylation, and upregulating PKA improved hTau‐induced cognitive deficits in mice. Together, these data reveal that intracellular tau accumulation induces synapse and memory impairments by inhibiting PKA/CREB/BDNF/TrkB and PKA/GluA1 signaling, and deficit of PA28γ‐20S proteasome complex formation contributes to PKAR2α elevation and PKA inhibition.
What supports allied health students tothink, feel and actas a health professional in a rural setting? Perceptions of allied health staff
Authors: Furness Linda , Tynan Anna , Ostini Jenny
Published: October 2019

Objective

Clinical placements in rural locations provide student health professionals with diverse learning opportunities. Engaging in clinical work and learning from role models and peers in the workplace are primary ways students develop professional skills, behaviour and identities as a health professional. The purpose of this study was to examine the influences supporting allied health students undertaking clinical placements in a rural health service tothink, feel and actas a health professional from the perspective of allied health staff.

Design

A qualitative study comprising focus group discussions was conducted.

Setting

The study was conducted in a rural health service in Queensland, Australia.

Participants

Seventeen allied health staff whose roles support clinical placement education in the health service

Main outcome measures

This study identified clinical placement factors which can support allied health studentsthinking, feeling and actingas a health professional.

Results

Thematic analysis was used to understand staff perceptions of how rural placements support students tothink, feel and actas a health professional. Key placement actions included taking advantage of the diverse learning experiences in a rural area, facilitating student connectedness in the workplace and grading learning to support independence and autonomy for practice.

Conclusions

Findings from this study show that the diverse work environment and experiences in a rural setting provide unique opportunities for students to begin tothink, feel, and actas a health professional. Strategies identified might be applied in other similar contexts.
Current management of patients with melanoma who are found to be sentinel node‐positive
Authors: Nijhuis Amanda A. G. , Spillane Andrew J. , Stretch Jonathan R. , Saw Robyn P. M. , Menzies Alexander M. , Uren Roger F. , Thompson John F. , Nieweg Omgo E.
Published: October 2019

Background

The results of the DeCOG‐SLT and MSLT‐II studies, published in 2016 and mid‐2017, indicated no survival benefit from completion lymph node dissection (CLND) in melanoma patients with positive sentinel nodes (SNs). Subsequently, several studies have been published reporting a benefit of adjuvant systemic therapy in patients with stage III melanoma. The current study assessed how these findings influenced management of SN‐positive patients in a dedicated melanoma treatment centre.

Methods

SN‐positive patients treated at Melanoma Institute Australia between July 2017 and December 2018 were prospectively identified. Surgeons completed a questionnaire documenting the management of each patient. Information on patients, primary tumours, SNs, further treatment and follow‐up was collected from patient files, the institutional research database and pathology reports.

Results

During the 18‐month study period, 483 patients underwent SN biopsy. A positive SN was found in 61 (13%). Two patients (3%) requested CLND because of anxiety about observation in view of unfavourable primary tumour and SN characteristics. The other 59 patients (97%) were followed with a four‐monthly ultrasound examination of the relevant lymph node field(s). Two of them (3%) developed an isolated nodal recurrence after 4 and 11 months of follow‐up. Fifty‐seven patients (93%) were seen following the publication of the first two adjuvant systemic therapy studies in November 2017; 46 (81%) were referred to a medical oncologist to discuss adjuvant systemic therapy, which 32 (70%) chose to receive.

Conclusion

At Melanoma Institute Australia most patients with an involved SN are now managed without CLND. The majority are referred to a medical oncologist and receive adjuvant systemic therapy.
A high‐resolution diatom‐based Middle and Late Holocene environmental history of the Little Belt region, Baltic Sea
Authors: Warnock Jonathan , Andrén Elinor , Juggins Steve , Lewis Jonathan , Ryves David B. , Andrén Thomas , Weckström Kaarina
Published: October 2019

The large‐scale shifts in the salinity of the Baltic Sea over the Holocene are well understood and have been comprehensively documented using sedimentary proxy records. More recent work has focused on understanding how past salinity fluctuations have affected other ecological parameters (e.g. primary productivity, nutrient content) of the Baltic basin, and salinity changes over key events and over short time scales are still not well understood. The International Ocean Drilling Program Expedition 347 cored the Baltic basin in order to collect basin‐wide environmental records through a glacial–interglacial cycle. Site M0059 is located in the Little Belt between the Baltic Sea and the Atlantic Ocean. A composite splice section from Site M0059 was analysed at a decadal resolution to study changes in salinity, nutrient conditions and other surface water column parameters based on changes in diatom assemblages and on quantitative diatom‐based salinity inferences. A mesotrophic slightly brackish assemblage is seen in the lowermost analysed depths, corresponding to 7800–7500 cal. a BP. An increase in salinity and nutrient content of the water column leads into a meso‐eutrophic brackish phase. The observed salinity increase is rapid, lasting from 7500 to 7150 cal. a BP. Subsequently, the Little Belt becomes oligotrophic and is dominated by tychopelagic diatoms from c. 7100 to c. 3900 cal. a BP. This interval contains some of the highest salinities observed followed by diatom assemblages similar to those of the Northern Atlantic Ocean, composed primarily of cosmopolitan open ocean marine diatoms. A return to tychopelagic productivity is seen from 3850 to 980 cal. a BP. Anthropogenic eutrophication is detected in the last 300 years of the record, which intensifies in the uppermost sediments. These results represent the first decadally resolved record in the region and provide new insight into the transition to a brackish basin and subsequent ecological development.
Metabolomics analysis in adults with high bone mass identifies a relationship between bone resorption and circulating citrate which replicates in the general population
Authors: Hartley April , Paternoster Lavinia , Evans David M. , Fraser William D. , Tang Jonathan , Lawlor Debbie A. , Tobias Jon H. , Gregson Celia L.
Published: October 2019

Objective

Bone turnover, which regulates bone mass, may exert metabolic consequences, particularly on markers of glucose metabolism and adiposity. To better understand these relationships, we examined cross‐sectional associations between bone turnover markers (BTMs) and metabolic traits in a population with high bone mass (HBM, BMD Z‐score ≥+3.2).

Design

β‐C‐terminal telopeptide of type‐I collagen (β‐CTX), procollagen type‐1 amino‐terminal propeptide (P1NP) and osteocalcin were assessed by electrochemiluminescence immunoassays. Metabolic traits, including lipids and glycolysis‐related metabolites, were measured using nuclear magnetic resonance spectroscopy. Associations of BTMs with metabolic traits were assessed using generalized estimating equation linear regression, accounting for within‐family correlation, adjusting for potential confounders (age, sex, height, weight, menopause, bisphosphonate and oral glucocorticoid use).

Results

A total of 198 adults with HBM had complete data, mean [SD] age 61.6 [13.7] years; 77% were female. Of 23 summary metabolic traits, citrate was positively related to all BTMs: adjusted ββ‐CTX = 0.050 (95% CI 0.024, 0.076), P = 1.71 × 10−4, βosteocalcin = 6.54 × 10−4 (1.87 × 10−4, 0.001), P = .006 and βP1NP = 2.40 × 10−4 (6.49 × 10−5, 4.14 × 10−4), P = .007 (β = increase in citrate (mmol/L) per 1 µg/L BTM increase). Inverse relationships of β‐CTX (β = −0.276 [−0.434, −0.118], P = 6.03 × 10−4) and osteocalcin (−0.004 [−0.007, −0.001], P = .020) with triglycerides were also identified. We explored the generalizability of these associations in 3664 perimenopausal women (age 47.9 [4.4] years) from a UK family cohort. We confirmed a positive, albeit lower magnitude, association between β‐CTX and citrate (adjusted βwomen = 0.020 [0.013, 0.026], P = 1.95 × 10−9) and an inverse association of similar magnitude between β‐CTX and triglycerides (β = −0.354 [−0.471, −0.237], P = 3.03 × 10−9).

Conclusions

Bone resorption is positively related to circulating citrate and inversely related to triglycerides. Further studies are justified to determine whether plasma citrate or triglyceride concentrations are altered by factors known to modulate bone resorption, such as bisphosphonates.
Antimicrobial resistance trends in bacterial keratitis over 5 years in Sydney, Australia
Authors: Cabrera‐Aguas Maria , Khoo Pauline , George C. R. Robert , Lahra Monica M. , Watson Stephanie L.
Published: October 2019

Importance

Antimicrobial resistance (AMR) patterns in bacterial keratitis may fluctuate in a geographic location over time.

Background

To investigate any change in AMR patterns in Sydney, Australia.

Design

Retrospective case series.

Participants

All patients with microbial keratitis who underwent a corneal scrape and culture from 2012 to 2016 at the Sydney Eye Hospital.

Methods

Matrix‐assisted laser desorption ionization‐time of flight (MALDI‐TOF) mass spectrometry identified organisms. The Calibrated Dichotomous Susceptibility method determined antibiotic susceptibilities.

Main Outcome Measures

Isolated organisms and antibiotic susceptibilities.

Results

There were 1084 corneal scrapes from 957 patients. The mean age was 54 years (range 18‐100) and 52% were male. Cultures were positive in 711 of 1084 scrapes (66%), with 884 organisms identified. Of the bacteria isolated, 685 of 884 (78%) were Gram‐positive and 199 of 884 (22%) were Gram‐negative. Overall, the most common bacteria were coagulase‐negative Staphylococci (CoNS) (405/884, 46%).

Methicillin‐resistance was detected in 7% of Staphylococcus aureus isolates (7/103). Methicillin‐resistance in CoNS (ie, also cefalotin resistance) was reported in 19% of isolates and ciprofloxacin 8%. For methicillin‐sensitive S aureus (MSSA), 5% of isolates were resistant to ciprofloxacin. For Corynebacterium spp., 34% of isolates were resistant to chloramphenicol and 9% to ciprofloxacin.

The most common Gram‐negative bacteria was Pseudomonas aeruginosa (109/199, 55%). One case was resistant to ciprofloxacin.

Conclusions and Relevance

Coagulase‐negative staphylococcal species were the most frequently suspected of causing bacterial keratitis. Increased resistance to cefalotin was identified for CoNS and to ciprofloxacin for Corynebacterium spp., MSSA and P aeruginosa compared to a previous study in Sydney in 2002 to 2003.
The Production of Community in Community Land Trusts
Authors: Kruger Richard , DeFilippis James , Williams Olivia R. , Esfahani Azadeh Hadizadeh , Martin Deborah G. , Pierce Joseph
Published: October 2019

This paper explores the ways notions of community are produced and understood by homeowners/ members, staff, and board members of eight Community Land Trusts (CLTs) in the state of Minnesota. The CLT model utilizes a mixed property regime that ensures the permanent affordability of land to make it accessible to low–income people. In most cases, CLT land is made up of noncontiguous parcels spread across a neighborhood or municipality, embedded in an existing landscape of geographic and social communities. CLTs have been lauded as agents in and for community control of urban land tenure, yet there has been little scholarship on what exactly “community” means to those involved. This article addresses this gap through an analysis of the empirical findings of a three–year study of CLTs in Minnesota in which participants were asked to think through how they conceptualized the community in the CLTs they were a part of. Our findings show that little sense of community exists among the CLT homeowners we interviewed. Despite this, CLT homeowners did feel a sense of community in their relationships with CLT staff members, and, interestingly, expressed a feeling of (imagined) community with future CLT homeowners.
Depressive symptoms and traumatic dental injuries among adolescents
Authors: Randhawa Shanza S. , Marcenes Wagner , Stansfeld Stephen A. , Bernabé Eduardo
Published: October 2019

Background/Aim

A previous cross‐sectional study found that young adults with depression were more likely to have traumatic dental injuries (TDIs). The aim of this study was to determine the relationship between depressive symptoms during early and middle adolescence, and TDIs at age 15‐16 years.

Method

This study used longitudinal data from phases 1 and 3 of the Research with East London Adolescents Community Health Survey (RELACHS), a school‐based survey following a representative, multi‐ethnic sample of adolescents attending public schools in East London (England). Information on depressive symptoms was collected using the Short Moods and Feelings Questionnaire (SMFQ) during early (age 11‐12 years) and middle adolescence (age 15‐16 years). TDIs were identified during clinical examinations in phase 3 when pupils were 15‐16 years old. Logistic regression was used to test the association between depressive symptoms at different stages of adolescence and TDIs adjusting for confounders (age, gender, ethnicity, parental employment and overjet).

Results

Depressive symptoms were reported by 24% and 32% of adolescents in early and middle adolescence, respectively. Evidence of TDIs was found in 18% of adolescents at age 15‐16 years. Adolescents with depressive symptoms, either in early or middle adolescence, had greater odds of experiencing TDIs. However, these estimates were not statistically significant. In regression models adjusted for confounders, the odds of having TDIs were 1.23 (95% CI: 0.77‐1.96) and 1.23 (95% CI: 0.76‐1.95) among pupils with depressive symptoms in early and middle adolescence, respectively.

Conclusion

There was no association between depressive symptoms and TDIs in early and middle adolescents.
Exogenous P compounds differentially interacted with N availability to regulate enzymatic activities in a meadow steppe
Authors: Wang Ruzhen , Cao Yanzhuo , Wang Hongyi , Dijkstra Feike A. , Jiang Jinglun , Zhao Ruonan , Ma Wang , Li Tianpeng , Dorodnikov Maxim , Wang Zhengwen , Sardans Jordi , Peñuelas Josep
Published: October 2019

Increased inputs of ecosystem nitrogen (N) and phosphorus (P) may affect the activity of soil enzymes that play essential roles in the metabolization of carbon (C), N and P for microbial growth. However, the associations between soil enzymatic activities and N and P availability remain poorly understood. We conducted a study in a meadow steppe to elucidate the effects of the addition of N, as ammonium nitrate (NH4NO3), and two forms of P with contrasting solubility, comprising monopotassium phosphate (KH2PO4) and the less soluble triple superphosphate (Ca(H2PO4)2, on activity of β‐glucosidase (BG), N‐acetyl‐glucosaminidase (NAG) and acid and alkaline phosphomonoesterases (PMEs). In general, there was a positive effect of N on BG, NAG and alkaline PME activity as a result of enhanced soil N availability, plant–microbe nutrient competition and plant P uptake. Addition of KH2PO4 increased activity of BG, NAG and alkaline PME, but had no impact on acid PME activity. Addition of Ca(H2PO4)2 increased NAG activity, but only increased activity of BG and alkaline PME with the addition of N. Concentration of soil available P and microbial biomass P increased with added P, particularly KH2PO4. These results provide the first evidence for the N‐ and P‐mediated stimulation of microbial activity depending on the chemical form of added P in this ecosystem. Relationships between activity of BG and NAG, and between that of NAG and PME, were allometric, indicating disproportionate changes in activity of these soil enzymes. This further suggests shifts in microbial acquisition of C, N and P along with increases in availability of N and P that may potentially affect plant productivity. We conclude that scenarios of global environmental change, in which ecosystem availability of N and P is affected, may result in variable activity responses among soil enzymes, and the chemical form of P input should be considered as an important factor influencing meadow steppe grassland ecosystem function.

Highlights

Chemical N and P increased enzyme activity but effects varied with P form and rate.

N addition promoted soil enzyme activity through enhanced plant–microbe interactions.

N availability mediated positive enzymatic responses to P addition.

Enzymatic stoichiometry indicated disproportionate changes in microbial C, N and P acquisition.
Demultilateralisation: A cognitive psychological perspective
Authors: van Aaken Anne , Vasel Johann Justus
Published: October 2019

This contribution seeks to illuminate the looming phenomenon of demultilateralisation and the return of and to the nation state, i.e. closure. Whereas many reasons for opening and closure have been discussed by Habermas in his eminent essay, we aim at providing an additional dimension, taking a psychological point of view and analysing this proclivity from a behaviourally informed perspective. Following a short recapitulation of the evolution towards postnationalism, we briefly sketch the current phenomenon of demultilateralisation and renationalisation. We then contribute to the current debate by providing cognitive psychological insights drawing on well‐researched biases that offer the greatest potential to explain the current outbreak of closing tendencies, namely prospect theory, including the endowment effect, framing, the availability bias and so‐called hawkish biases. This may add an explanatory dimension to why nationalistic politics have become again the beguiling sanctuary of the people. We attempt to define scope conditions of closure.
Habermas's European constitution: Catalyst, reconstruction, refounding
Authors: Walker Neil
Published: October 2019

Jürgen Habermas has long been one of the EU's most prominent and influential critical friends, engaged as much at the level of legal and political praxis as social theory. In particular, he has a close and complex longstanding interest in the idea of an EU constitution. On the occasion of his 90th birthday, I want to discuss three treatments of the EU constitution located in Habermas's work: constitution as catalyst, as reconstruction, and as refounding. We find the different treatments, and the priorities that underscore them, emphasised at different times—partly reflecting changing political circumstances. We also observe some tension between the different approaches. Yet, as someone broadly sympathetic to his overall project, I argue that the best understanding of the Habermasian position, and certainly the most attractive version of that position in today's political climate, involves reconciling all three treatments within a single package.
Restoration‐mediated secondary contact leads to introgression of alewife ecotypes separated by a colonial‐era dam
Authors: Reid Kerry , Carlos Garza John , Gephard Steven R. , Caccone Adalgisa , Post David M. , Palkovacs Eric P.
Published: October 2019

Secondary contact may have important implications for ecological and evolutionary processes; however, few studies have tracked the outcomes of secondary contact from its onset in natural ecosystems. We evaluated an anadromous alewife (Alosa pseudoharengus) reintroduction project in Rogers Lake (Connecticut, USA), which contains a landlocked alewife population that was isolated as a result of colonial‐era damming. After access to the ocean was restored, adult anadromous alewife were stocked into the lake. We assessed anadromous juvenile production, the magnitude and direction of introgression, and the potential for competition between ecotypes. We obtained fin clips from all adult alewife stocked into the lake during the restoration and a sample of juveniles produced in the lake two years after the stocking began. We assessed the ancestry of juveniles using categorical assignment and pedigree reconstruction with newly developed microhaplotype genetic markers. Anadromous alewives successfully spawned in the lake and hybridized with the landlocked population. Parentage assignments revealed that male and female anadromous fish contributed equally to juvenile F1 hybrids. The presence of landlocked backcrosses shows that some hybrids were produced within the first two years of secondary contact, matured in the lake, and reproduced. Therefore, introgression appears directional, from anadromous into landlocked, in the lake environment. Differences in estimated abundance of juveniles of different ecotypes in different habitats were also detected, which may reduce competition between ecotypes as the restoration continues. Our results illustrate the utility of restoration projects to study the outcomes of secondary contact in real ecosystems.
Marital Interventions: Participation, Helpfulness, and Change in a Nationally Representative Sample
Authors: White Thomas Jack Esplin , Duncan Stephen F. , Yorgason Jeremy B. , James Spencer L. , Holmes Erin K.
Published: October 2019

Objective

To examine how often early‐married couples have participated in marital interventions and how helpful and change‐producing these interventions are perceived to be in a national probability sample.

Background

Past research provides an unclear view of frequency of participation in marital interventions yet suggests that participation is both helpful and change‐producing. However, these studies are limited by their demographics, regions, and samples. A nationally representative, population‐level study of newlywed couples would help overcome these limitations and provide generalizable answers to the field.

Method

A sample of 1,562 individuals who indicated participation in a marriage intervention either before or after marriage was drawn from a nationally representative sample known as the Couple Relationships and Transition Experiences (CREATE) survey. Multilevel models were used to address the research questions.

Results

Just under 2 in 5 (38.3%) early‐married individuals participated in an intervention designed to prepare for or strengthen their marriage. Counseling was perceived to be the most helpful and change‐producing intervention, with religiosity, education, and gender moderating this association.

Conclusion

This study provides a first‐of‐its‐kind national picture of participation rates and perceptions of the effectiveness of marriage interventions among early‐married couples.

Implications

Findings may help energize marketing and outreach efforts and may encourage varied strategies to increase participation rates.
Stream metabolism controls diel patterns and evasion of CO2 in Arctic streams
Authors: Rocher‐Ros Gerard , Sponseller Ryan A. , Bergström Ann‐Kristin , Myrstener Maria , Giesler Reiner
Published: October 2019

Streams play an important role in the global carbon (C) cycle, accounting for a large portion of CO2 evaded from inland waters despite their small areal coverage. However, the relative importance of different terrestrial and aquatic processes driving CO2 production and evasion from streams remains poorly understood. In this study, we measured O2 and CO2 continuously in streams draining tundra‐dominated catchments in northern Sweden, during the summers of 2015 and 2016. From this, we estimated daily metabolic rates and CO2 evasion simultaneously and thus provide insight into the role of stream metabolism as a driver of C dynamics in Arctic streams. Our results show that aquatic biological processes regulate CO2 concentrations and evasion at multiple timescales. Photosynthesis caused CO2 concentrations to decrease by as much as 900 ppm during the day, with the magnitude of this diel variation being strongest at the low‐turbulence streams. Diel patterns in CO2 concentrations in turn influenced evasion, with up to 45% higher rates at night. Throughout the summer, CO2 evasion was sustained by aquatic ecosystem respiration, which was one order of magnitude higher than gross primary production. Furthermore, in most cases, the contribution of stream respiration exceeded CO2 evasion, suggesting that some stream reaches serve as net sources of CO2, thus creating longitudinal heterogeneity in C production and loss within this stream network. Overall, our results provide the first link between stream metabolism and CO2 evasion in the Arctic and demonstrate that stream metabolic processes are key drivers of the transformation and fate of terrestrial organic matter exported from these landscapes.
Soil microbial biomass increases along elevational gradients in the tropics and subtropics but not elsewhere
Authors: He Xianjin , Hou Enqing , Veen G. F. , Ellwood M. D. Farnon , Dijkstra Paul , Sui Xinghua , Zhang Shuang , Wen Dazhi , Chu Chengjin
Published: October 2019

Aim

Our aim is to use elevational gradients to quantify the relationship between temperature and ecosystem functioning. Ecosystem functions such as decomposition, nutrient cycling and carbon storage are linked with the amount of microbial biomass in the soil. Previous studies have shown variable relationships between elevation and soil microbial biomass (SMB). Understanding the biological mechanisms linking SMB with elevational gradients will shed light on the environmental impacts of global warming.

Location

Global.

Time period

2002–2018.

Major taxa studied

Soil microbes.

Method

We performed a global meta‐analysis of the relationships between SMB and elevation. Data were collected from 59 studies of 73 elevational transects from around the world.

Results

We found no consistent global relationship between SMB and elevation. SMB increased significantly with elevation in the tropics and subtropics, but not in other climate zones. However, we found consistent positive relationships between SMB, soil organic carbon and total nitrogen concentrations.

Main conclusions

Our results suggest that global warming will impact tropical and subtropical ecosystems more severely than colder regions. Tropical ecosystems, already at risk from species extinctions, will likely experience declines in SMB as the climate warms, resulting in losses of fundamental ecosystem functions such as nutrient cycling and carbon storage.
The association between poverty indicators and material hardship in South Korea
Authors: Weon Soyoon , Rothwell David W.
Published: October 2019

The construct of material hardship has been introduced to broaden the understanding of living conditions beyond household income. However, much remains unclear about how much variation in material hardship can be explained by income and other economic indicators such as asset holdings. To get advance knowledge on these related but distinct relationships, using the Korean Welfare Panel Study we tested the association between material hardship and three poverty indicators (joint income‐asset, asset‐only, and income‐only). For income poverty and asset poverty, we found a statistically significant association between a household’s poverty condition and material hardship. The joint income‐asset poor were most likely to experience hardship (with respect to food, utility, and health). In addition, householders who rented rather than owned their own home, and householders whose heads were younger, single, less‐educated, and only temporarily employed suffered more hardship than their counterparts. Future longitudinal research that identifies the casual relationships between poverty and hardship is needed.

Key Practitioner Message: •Considering only overall hardship may mask within‐group differences in living conditions; thus, practitioners may gain greater insight into client populations by assessing various types of hardships such as food, utility, and health; •Because the asset‐only poor suffer from hardship despite their above‐poverty‐level income, the asset poverty‐related programs should be more responsive to the problems of the asset poor; •Based on our findings showing that the income‐only poor, especially the relatively older age group, suffers from difficulties in cash flow despite their high homeownership rate, policies are needed to help older homeowners leverage their home equity or other real estate to alleviate their financial difficulties.
Negative pressure wound therapy with instillation: International consensus guidelines update
Authors: Kim Paul J. , Attinger Christopher E. , Constantine Thomas , Crist Brett D. , Faust Elizabeth , Hirche Christoph R. , Lavery Lawrence A. , Messina Valerie J. , Ohura Norihiko , Punch Laurie J. , Wirth Garrett A. , Younis Ibby , Téot Luc
Published: October 2019

The use of negative pressure wound therapy with instillation and dwell time (NPWTi‐d) has gained wider adoption and interest due in part to the increasing complexity of wounds and patient conditions. Best practices for the use of NPWTi‐d have shifted in recent years based on a growing body of evidence and expanded worldwide experience with the technology. To better guide the use of NPWTi‐d with all dressing and setting configurations, as well as solutions, there is a need to publish updated international consensus guidelines, which were last produced over 6 years ago. An international, multidisciplinary expert panel of clinicians was convened on 22 to 23 February 2019, to assist in developing current recommendations for best practices of the use of NPWTi‐d. Principal aims of the meeting were to update recommendations based on panel members' experience and published results regarding topics such as appropriate application settings, topical wound solution selection, and wound and patient characteristics for the use of NPWTi‐d with various dressing types. The final consensus recommendations were derived based on greater than 80% agreement among the panellists. The guidelines in this publication represent further refinement of the recommended parameters originally established for the use of NPWTi‐d. The authors thank Karen Beach and Ricardo Martinez for their assistance with manuscript preparation.
Strengthening boron carbide through lithium dopant
Authors: He Yi , Shen Yidi , Tang Bin , An Qi
Published: October 2019

The high strength of boron carbide (B4C) is essential in its engineering applications such as wear‐resistance and body armors. Here, by employing density functional theory simulations, we demonstrated that the strength of B4C can be enhanced by doping lithium to boron‐rich boron carbide (B13C2) to form r‐LiB13C2. The bonding analysis on r‐LiB13C2 indicates that the electron counting rule (or Wade's rule) is satisfied in r‐LiB13C2 whose formula can be written as r‐Li+(B12)2‐(CB+C). The shear deformation on r‐LiB13C2 indicates that its ideal shear strength is larger than that of B4C because of the existing of Li dopant. The failure process of r‐LiB13C2 under ideal shear deformation initiates from breaking the icosahedral‐icosahedral B‐B bonds. Then these B atoms react with the middle B in the C‐B‐C chain, resulting in the disintegration of icosahedral clusters and brittle failure. More interesting, the nanotwinned r‐LiB13C2 is even stronger than r‐LiB13C2 because of the directional nature of covalent bonding at the twin boundaries. This suggests that the nanotwinned r‐LiB13C2 has a significant enhanced strength compared to B4C. Our simulation results illustrate the deformation mechanism of Li‐doped boron carbide and its nanotwinned microstructure. We proposed to improve the strength of boron carbide by doping Li into B13C2 and increasing its twin densities.
Genetic risk scores to predict the prognosis of chronic heart failure patients in Chinese Han
Authors: Li Shiyang , Sun Yang , Hu Senlin , Hu Dong , Li Chenze , Xiao Lei , Chen Yanghui , Li Huihui , Cui Guanglin , Wang Dao Wen
Published: October 2019

Chronic heart failure (CHF) has poor prognosis and polygenic heritability, and the genetic risk score (GRS) to predict CHF outcome has not yet been researched comprehensively. In this study, we sought to establish GRS to predict the outcomes of CHF. We re‐analysed the proteomics data of failing human heart and combined them to filter the data of high‐throughput sequencing in 1000 Chinese CHF cohort. Cox hazards models were used based on single nucleotide polymorphisms (SNPs) to estimate the association of GRS with the prognosis of CHF, and to analyse the difference between individual SNPs and tertiles of genetic risk. In the cohort study, GRS encompassing eight SNPs harboured in seven genes were significantly associated with the prognosis of CHF (P = 2.19 × 10−10 after adjustment). GRS was used in stratifying individuals into significantly different CHF risk, with those in the top tertiles of GRS distribution having HR of 3.68 (95% CI: 2.40‐5.65 P = 2.47 × 10−10) compared with those in the bottom. We developed GRS and demonstrated its association with first event of heart failure endpoint. GRS might be used to stratify individuals for CHF prognostic risk and to predict the outcomes of genomic screening as a complement to conventional risk and NT‐proBNP.
Exosomes from human urine‐derived stem cells enhanced neurogenesis via miR‐26a/HDAC6 axis after ischaemic stroke
Authors: Ling Xiaozheng , Zhang Guowei , Xia Yuguo , Zhu Qingwei , Zhang Juntao , Li Qing , Niu Xin , Hu Guowen , Yang Yunlong , Wang Yang , Deng Zhifeng
Published: October 2019

Endogenous neurogenesis holds promise for brain repair and long‐term functional recovery after ischaemic stroke. However, the effects of exosomes from human urine‐derived stem cells (USC‐Exos) in neurogenesis remain unclear. This study aimed to investigate whether USC‐Exos enhanced neurogenesis and promoted functional recovery in brain ischaemia. By using an experimental stroke rat model, we found that intravenous injection of USC‐Exos enhanced neurogenesis and alleviated neurological deficits in post‐ischaemic stroke rats. We used neural stem cells (NSCs) subjected to oxygen‐glucose deprivation/reoxygenation (OGD/R) as an in vitro model of ischaemic stroke. The in vitro results suggested that USC‐Exos promoted both proliferation and neuronal differentiation of NSCs after OGD/R. Notably, a further mechanism study revealed that the pro‐neurogenesis effects of USC‐Exos may be partially attributed to histone deacetylase 6 (HDAC6) inhibition via the transfer of exosomal microRNA‐26a (miR‐26a). Taken together, this study indicates that USC‐Exos can be used as a novel promising strategy for brain ischaemia, which highlights the application of USC‐Exos.
Procalcitonin utilization in the real world: An observational study of antibiotic prescribing practices
Authors: Choi Justin J. , Cornelius‐Schecter Anna , Hayden Joshua A. , Jannat‐Khah Deanna Pereira , O’Connell Alexander , Baduashvili Amiran , Lee Jennifer , McCarthy Matthew W.
Published: October 2019

Objectives

This study aims to better understand and describe antibiotic prescribing practices and adherence to a procalcitonin (PCT)‐guided algorithm in patients undergoing serum PCT testing in adult hospitalized patients.

Methods

We performed an observational, retrospective study of 201 randomly selected patients who are aged ≥18 years, admitted to the general medicine floors or step‐down unit between 1 January 2017 and 31 December 2017, and had serum PCT testing. Physician adherence to a PCT‐guided algorithm was assessed through chart review.

Results

We found an overall adherence of 64.7%. Adherence was highest for PCT values above 0.25 ng/mL (82.8% for 0.25‐0.50 ng/mL and 83.6% for >0.50 ng/mL). Adherence was lower for PCT values less than 0.25 ng/mL (59% for <0.1 ng/mL and 38% for 0.1‐0.24 ng/mL). Serial testing was performed in 10% of patients.

Conclusions

Hospital‐based providers are more likely to overrule the algorithm and either initiate or continue antibiotics when guidelines encourage discontinuing antibiotics. These findings have important implications for antimicrobial stewardship and patient care and suggest that hospital‐based providers may benefit from targeted didactics regarding the interpretation of the serum PCT assay.
Endocranial morphology of the Brazilian Permian dicynodont Rastodon procurvidens (Therapsida: Anomodontia)
Authors: de Simão‐Oliveira Daniel , Kerber Leonardo , L. Pinheiro Felipe
Published: October 2019

Dicynodontia is a major clade of terrestrial tetrapods that greatly diversified during the Permian and Triassic periods, reaching a worldwide distribution. In this study, the endocranial cavity of the Brazilian Permian dicynodont Rastodon procurvidens is described based on a digital endocast obtained using digital imaging (X‐ray computed tomography) and 3D modeling. It was possible to reconstruct the brain, olfactory bulbs, inner ear, some neurovascular canals, cranial nerves, the nasal cavity, and the maxillary recesses. The endocast of R. procurvidens preserves a typical plesiomorphic morphology of non‐mammaliaform therapsids, being predominantly tubular and displaying a relatively short and robust hindbrain. Encephalization quotients (EQs) were calculated for R. procurvidens, resulting in EQs of 0.09 ± 0.03 and 0.13 ± 0.05 (Jerison’s EQ and Manger’s EQ, respectively). Finally, some biological implications of the endocast morphology were inferred for R. procurvidens. Its inner ear is especially small, and its orientation implies a slightly downturned head posture in life. Furthermore, the presence of uncompressed maxillary recesses in R. procurvidens indicates a correlation between the enlargement of the recesses and the reduction of the tusks, also seen in other dicynodonts with reduced tusks.
Phytochemical profile and protective effect of Ocimum basilicum aqueous extract in doxorubicin/irradiation-induced testicular injury
Authors: Ibrahim Rasha Y M , Mansour Suzan M , Elkady Wafaa M
Published: October 2019

Objectives

Combined chemotherapy and radiotherapy usually associated with various comorbidities especially on rapidly proliferating cells as testis. This study aimed to characterize main constituents of Ocimum basilicum L. (OB) aqueous extract and examine its protective effect on doxorubicin/irradiation (DOXO/IR)-induced testicular injury in rats.

Methods

Spectrophotometric analysis showed considerable amount of polyphenolic (146.31 µg/mg) and flavonoid contents (28.63 µg/mg); UPLC-ESI-MS/MS analysis revealed that the major flavonoid was apigenin-O-glucoside (7.53%) followed by luteolin (5.94%), while rosmarinic acid was the major polyphenolic (15.76%) followed by caftaric acid (9.39%); rutin and querctin were also present and were quantified using high-performance liquid chromatography. Administration of OB extract (200 mg/kg per day; p.o.) to DOXO/IR rats resulted in marked improvement of associated testicular damage.

Key findings

Ocimum basilicum L. significantly decreased testicular levels of nuclear factor-kappa B and B-cell lymphoma-2 (Bcl2)-associated protein X, along with caspase-3 immunohistochemical staining. In addition, OB elevated testicular total antioxidant capacity, nuclear erythroid-related factor-2, Bcl2 and testosterone contents and Ki-67 immunohistochemical staining. Such changes were also accompanied by restoration of testicular architecture.

Conclusions

The study highlights the protective role of OB aqueous extract in hampering most of the harmful chemotherapy/radiotherapy-induced outcomes via its antioxidant, antiapoptotic and cell regeneration abilities. Such findings may offer an incentive in expanding its use during chemotherapy and radiotherapy.
Length–weight relationships of five catfish species (Siluriformes) from the Ganga River, India
Authors: Gupta Deepmala , Dwivedi Arvind Kumar , Tripathi Madhu
Published: October 2019

Knowledge of the length–weight relationships (LWRs) of fish is an important tool to understand fish body form, growth pattern, stock management and their conservation. The present study focused on investigating the length–weight relationships for five catfish species, Pachypterus atherinoides (Bloch, 1794), belonging to family Horabagridae; Batasio batasio (Hamilton, 1822) family Bagridae; Bagarius yarrelli (Sykes, 1839), family Gogangra viridescens (Hamilton, 1822); and Sisor rhabdophorus (Hamilton, 1822) belonging to family Sisoridae. Specimens were collected from the middle stretch of the Ganga River in India from November 2016 to May 2018. A total of 174 specimens of five fish species were collected, and their total lengths were measured to the nearest centimetre and the body weight to the nearest gram. The value of the parameter slope (b) of LWRs of the five species ranged from 2.86 (B. yarrelli) to 3.16 (G. viridescens), with a mean value of 2.99. The results of the present study documented the new maximum total length (TL) for P. atherinoides and S. rhabdophorus. The present study also provides the first reference regarding LWRs for S. rhabdophorus.
Empowering residents to drive societal change: tips for creating an effective health advocacy curriculum
Authors: Marwaha Seema , Bacchus C Maria
Published: October 2019

Reflecting on physicians’ duty to tackle societal issues, the authors advocate for resident‐led curricula that use new digital platforms to make health advocacy teaching effective.