bluuebunny/crossref_metadata_2025 huggingface dataset:
It's economic size, stupid! How global advocacy mirrors state power
Authors: Hanegraaff Marcel , Poletti Arlo
Published: February 2020

Numerous empirical studies suggest that global interest communities are heavily biased in favor of wealthier countries. This research note critically reviews these works suggesting that they (i) lack a benchmark to assess the biased nature of global interest communities and (ii) conflate the concepts of “wealth” (based on GDP per capita) and “economic power” (based on GDP) into one analytical category. As a corrective to these problems, we compare variation in global interest group mobilization across countries to the size of these countries' national economies. Relying on an original dataset mapping interest groups communities at the World Trade Organization (1997–2012) and the United Nations Climate Summits (1997–2011), we show that (i) global interest representation almost perfectly reflects differences in countries' relative economic power and (ii) contrary to the conventional wisdom, wealthier countries are, relative to their economic size, actually underrepresented in global interest communities.
Exploring the Path of Rural Tourism in China——Taking Yuanjia Village in Shaanxi as an Example
Authors: Wu Zhenghai
Published: February 2020

Implementing the strategy of revitalizing the countryside is a major decision-making arrangement made by the Chinese government, and it is the general leader of the work of "agriculture, rural areas and farmers" in the new era. This article aims at rural tourism under the background of urban-rural coordination and rural revitalization. Taking Yuanjia Village's rural tourism as an example, it summarizes the basic practices of rural tourism development in Yuanjia Village. Based on the practical experience of rural tourism development in Yuanjia Village, it proposes the development of rural tourism. The overall idea is that the successful mechanism of Yuanjia Village's development of rural tourism lies in: Cohesion and courage are the primary prerequisites for the development of rural tourism; integrating resources and creating characteristics are the basic conditions for the development of rural tourism; sharing benefits and co-governance is rural Fundamental guarantee for tourism development; integration of cultural tourism and cultural people is the inner soul of rural tourism development.
Escuchando las músicas planetarias: dieciocho siglos de interpretaciones musicales de modelos cosmológicos en Occidente (hacia 120-1987)
Authors: Hasler Johann F. W.
Published: February 2020

Este artículo presenta un barrido bibliográfico a través de la metodología de lectura crítica y posterior catalogación de los diversos modelos que se han desarrollado en Occidente, desde el siglo I hasta finales del siglo XX, con la meta de tratar de interpretar las posiciones o velocidades de los planetas como alturas musicales. Se concluye que estos modelos pueden catalogarse en tres grandes familias: derivados de la interpretación de las velocidades orbitales de los planetas como frecuencias más altas o más bajas, derivados de las proporciones de las distancias de los planetas entre sí (para interpretar dichas distancias como intervalos musicales) y derivados de una combinación entre ambos cuando ni las distancias ni las velocidades son fijas, como en el caso del modelo de órbitas elípticas y las tres leyes de movimiento planetario de Kepler. El aporte original de este artículo consiste en que presenta dichos modelos en un texto compacto y su clara clasificación, lo que facilita enormemente su utilización práctica para la creación musical, o bien en composición preescrita, o bien para extemporización en tiempo real, y así posibilita la utilización artística de modelos cuyo alcance histórico ha estado circunscrito al ámbito teórico de la música especulativa o de la percepción sonora de modelos cosmológicos.
Variaciones del paisaje: arqueología del paisaje en la creación artística
Authors: Rojas Valencia Pedro Antonio
Published: February 2020

Este artículo es una revisión de los estudios del paisaje y su relación con las artes plásticas. Por esta razón, se realiza un breve recuento histórico de las maneras en que se ha comprendido el paisaje en este campo, por lo que se utilizarán herramientas arqueológicas en el sentido otorgado a este término por Michel Foucault. Teniendo como punto de partida los estudios de diferentes autores como Kenneth Clark, Jean- Marc Besse, Nicolás Gómez y Adolfo León Grisales, es posible contrastar sus distintas clasificaciones y proponer cuatro variaciones: los paisajes de semejanzas referidos a imágenes simbólicas de elementos naturales de la Antigüedad; los paisajes de la distancia que, gracias a los desarrollos de la perspectiva moderna, se refieren a imágenes donde se representan grandes extensiones en el horizonte; los paisajes de las sensaciones donde la imagen romántica se sirve de las impresiones del artista y sus necesidades expresivas; y, finalmente, los paisajes de los encuentros donde podemos hallar propuestas de artistas contemporáneos que dejan de pensar el paisaje como un objeto y comprenden como un campo complejo de relaciones donde se encuentran inscritos. Posteriormente, se presenta una discusión respecto de las conclusiones que estudiosos como Javier Maderuelo y Alain Roger han extraído de la historia y del “origen” del concepto de paisaje en Occidente, con lo que se señala la urgencia de cuestionar, así sea por un breve instante, los enunciados que asocian el paisaje con la contemplación, la mirada antropocéntrica y la estetización de la naturaleza.
Dual functions of insect wings in an odor-guided aeronautic navigation
Authors: Li Chengyu , Dong Haibo , Zhao Kai
Published: February 2020

Insects can detect and locate distant odor sources (food, mate, etc.) by tracking odor plumes, which is key to their survival. During an odor-guided navigation, flapping wings have been speculated to actively draw odorants to the antennae and enhance olfactory sensitivity. Utilizing an in-house computational fluid dynamics solver, we have quantified the odor plume structures of a fruit fly in a forward flight motion and have confirmed that the flapping wings induce a strong vortex flow over the insect's head, thereby enhancing the odor mass flux around the antennae (by ~1.8 times). To further understand the function of different wing area in terms of aerodynamics and olfaction, we designed an altered fruit fly wing by removing its trailing-edge portion; subsequent simulations showed that this altered wing has an improved lift production but with significantly reduction of the induced odor mass flux. Contrary to the common belief that the wing shapes of an insect are optimized only for aerodynamic performance, our results suggest that, because both aerodynamic and olfactory functions are indispensable during the odor-guided navigation, insects may sacrifice some aerodynamic potential to enhance olfactory detection; and the shape and size of the wing may be a balance between the two functions. Furthermore, we found that higher wing beat frequency and wing reversal phase induce higher odor mass flux, while lower beat frequency and downstroke phase produce better lift coefficient, which indicates another balance between the two functions.
Numerical Analysis of Sweeping Jets for Active Flow Control Application
Authors: Aram Shawn
Published: February 2020

It has become apparent recently that the fluidic oscillators, also known as sweeping jets, can be used to create a combination of steady (streamwise vortices) and unsteady (spanwise vortices) forcing mechanisms which have the potential to fulfill many of the promises of active separation control. The fluidic oscillators contain no moving parts, but produce an unsteady component via a natural feedback loop inherent to their geometry. The oscillations are entirely self-induced and self-sustaining. Their simple and robust design and their effectiveness over a wide range of flow conditions make them more attractive than other flow control devices, such as synthetic jets and plasma actuators. Figure 1 shows the instantaneous jet generated in quiescent environment using the Improved Delayed Detached Eddy Simulation (IDDES) model, where the Large Eddy Simulation (LES) branch of the IDDES model is able to capture the turbulence structures properly.

An instantaneous iso-surface of vorticity magnitude, colored by streamwise velocity for flow over a wall-mounted hump is depicted in Figure 2. As expected, a massive flow separation occurs behind the hump in the uncontrolled condition (Figure 2 (a)), with a nearly two-dimensional free shear layer at the edge of the separation line. Breakdown of the shear layer by an array of sweeping jets located slightly downstream of the separation line is seen in Figure 2 (b), which is followed by the elimination of the separation region behind hump. The three-dimensional structures generated by the sweeping jets are smaller and closer to the hump wall than those produced by the steady jets shown in Figure 2 (c). Presence of a large region of reversed flow near the hump wall in its aft section is also seen in the case of the steady jet. This study indicates a superior effectiveness of sweeping jets on separated flows.
Numerical Analysis of an Active Thermomagnetic Device for Thermal Energy Harvesting
Authors: Phillips Makita R. , Carman Gregory P.
Published: February 2020

The abundance of low-grade waste heat necessitates energy harvesting devices to convert thermal energy to electrical energy. Through magnetic transduction, thermomagnetics can perform this conversion at reasonable efficiencies. Thermomagnetic materials use thermal energy to switch between magnetic and non-magnetic states and convert thermal energy into electrical energy. In this study, we numerically analyzed an active thermomagnetic device for thermal energy harvesting composed of gadolinium (Gd) and neodymium iron boron (NdFeB). A parametric study to determine the device efficiency was conducted by varying the gap distance, heat source temperature, and Gd thickness. Furthermore, the effect of the thermal conductance and applied field was also evaluated. It was found that the relative efficiency for smaller gap distances ranges from ∼15% to 28%; the largest allowable volume of Gd should be used and higher applied field leads to higher efficiencies.
Theory of Non-Dimensional Groups in Film Effectiveness Studies
Authors: Ornano Francesco , Povey Thomas
Published: February 2020

The desire to improve gas turbines has led to a significant body of research concerning film cooling optimization. The open literature contains many studies considering the impact on film cooling performance of both geometrical factors (hole shape, hole separation, hole inclination, row separation, etc.) and physical influences (effect of density ratio (DR), momentum flux ratio, etc.). Film cooling performance (typically film effectiveness, under either adiabatic or diabatic conditions) is almost universally presented as a function of one or more of three commonly used non-dimensional groups: blowing—or local mass flux—ratio, density ratio, and momentum flux ratio. Despite the abundance of papers in this field, there is some confusion in the literature about the best way of presenting such data. Indeed, the very existence of a discussion on this topic points to lack of clarity. In fact, the three non-dimensional groups in common use (blowing ratio (BR), density ratio, and momentum flux ratio) are not entirely independent of each other making aspects of this discussion rather meaningless, and there is at least one further independent group of significance that is rarely discussed in the literature (specific heat capacity flux ratio). The purpose of this paper is to bring clarity to this issue of correct scaling of film cooling data. We show that the film effectiveness is a function of 11 (additional) non-dimensional groups. Of these, seven can be regarded as boundary conditions for the main flow path and should be matched where complete similarity is required. The remaining four non-dimensional groups relate specifically to the introduction of film cooling. These can be cast in numerous ways, but we show that the following forms allow clear physical interpretation: the momentum flux ratio, the blowing ratio, the temperature ratio (TR), and the heat capacity flux ratio. Two of these parameters are in common use, a third is rarely discussed, and the fourth is not discussed in the literature. To understand the physical mechanisms that lead to each of these groups being independently important for scaling, we isolate the contribution of each to the overall thermal field with a parametric numerical study using 3D Reynolds-averaged Navier–Stokes (RANS) and large eddy simulations (LES). The results and physical interpretation are discussed.
Facile Synthesis of Novel Parallelogram-Like NH4CoPO4 · H2O/Ni3(PO4)2 · 8H2O/MnO2 Composites for High-Performance Supercapacitors
Authors: Zhang Yong , Mei Han-Xin , Yang Jing , Gao Hai-Li , Jia Xiao-Dong
Published: February 2020

To construct novel multicomponent transition metal oxides with the synergistic effect is always the most important strategy to improve the electrochemical performance of supercapacitor electrode materials. Here, a new type of parallelogram-like NH4CoPO4 · H2O/Ni3(PO4)2 · 8H2O/MnO2 (NNM) composites were successfully prepared by a simple hydrothermal method, and the addition amount of MnO2 was adjusted in detail. The morphology, structure, composition, particle size, and distribution of the electrode were characterized by scanning electron microscope (SEM), X-ray diffraction (XRD), Raman spectrum, and laser particle size analyzer. The results showed that when MnO2 was added at 9.7 wt%, the resulting NNM-9.7 composite exhibited a parallelogram-like morphology with an average length, width. and thickness of 5, 3, and 0.2 µm, respectively. The results of cyclic voltammetry (CV), galvanostatic charge–discharge (GCD), and electrochemical impedance spectroscopy (EIS) show that the NNM-9.7 electrode has large specific surface area, good conductivity, and abundant porosity, which makes it to have high-specific capacity (1180 F g−1, 1 A g−1) and excellent rate retention (980 F g−1, 10 A g−1) when compared with other electrodes, which is better than most reported electrodes of nickel–cobalt oxides/hydroxides. These results indicate that the novel NNM-9.7 composite with parallelogram-like shape and its synthesis method may provide a feasible solution for supercapacitors' material issues.
Comparison of fin whale 20 Hz call detections by deep-water mobile autonomous and stationary recorders
Authors: Fregosi Selene , Harris Danielle V. , Matsumoto Haruyoshi , Mellinger David K. , Negretti Christina , Moretti David J. , Martin Stephen W. , Matsuyama Brian , Dugan Peter J. , Klinck Holger
Published: February 2020

Acoustically equipped deep-water mobile autonomous platforms can be used to survey for marine mammals over intermediate spatiotemporal scales. Direct comparisons to fixed recorders are necessary to evaluate these tools as passive acoustic monitoring platforms. One glider and two drifting deep-water floats were simultaneously deployed within a deep-water cabled hydrophone array to quantitatively assess their survey capabilities. The glider was able to follow a pre-defined track while float movement was somewhat unpredictable. Fin whale (Balaenoptera physalus) 20 Hz pulses were recorded by all hydrophones throughout the two-week deployment. Calls were identified using a template detector, which performed similarly across recorder types. The glider data contained up to 78% fewer detections per hour due to increased low-frequency flow noise present during glider descents. The glider performed comparably to the floats and fixed recorders at coarser temporal scales; hourly and daily presence of detections did not vary by recorder type. Flow noise was related to glider speed through water and dive state. Glider speeds through water of 25 cm/s or less are suggested to minimize flow noise and the importance of glider ballasting, detector characterization, and normalization by effort when interpreting glider-collected data and applying it to marine mammal density estimation are discussed.
The distribution of speaker information in Dutch fricatives /s/ and /x/ from telephone dialogues
Authors: Smorenburg Laura , Heeren Willemijn
Published: February 2020

Although previous work has shown that some speech sounds are more speaker-specific than others, not much is known about the speaker information of the same segment in different linguistic contexts. The present study, therefore, investigated whether Dutch fricatives /s/ and /x/ from telephone dialogues contain differential speaker information as a function of syllabic position and labial co-articulation. These linguistic effects, established in earlier work on read broadband speech, were first investigated. Using a corpus of Dutch telephone speech, results showed that the telephone bandwidth captures the expected effects of perseverative and anticipatory labialization for dorsal fricative /x/, for which spectral peaks fall within the telephone band, but not for coronal fricative /s/, for which the spectral peak falls outside the telephone band. Multinomial logistic regression shows that /s/ contains slightly more speaker information than /x/ in telephone speech and that speaker information is distributed across the speech signal in a systematic way; even though differences in classification accuracy were small, codas and tokens with labial neighbors yielded higher scores than onsets and tokens with non-labial neighbors for both /s/ and /x/. These findings indicate that speaker information in the same speech sound is not the same across linguistic contexts.
A spatial correlation model for broadband surface noise
Authors: Ren Chao , Huang Yiwang
Published: February 2020

The spatial correlation function for broadband ocean surface noise is considered in horizontally stratified media. It is expressed as an integral over the correlation function of the sound field radiated by a single noise source in the waveguide, assuming spatially uncorrelated noise sources with the same intensity that are distributed on the sea surface uniformly. An equation for the spatial-temporal correlation coefficient of the surface noise in a certain frequency band can then be derived. Numerical simulations are carried out for band limited white noise and wind noise, which show that the fluctuation of the correlation coefficient decreases with increasing bandwidth.
The Elevation Training Mask: A Critically Appraised Topic
Authors: Cox Andrew , Fyock-Martin Marcie B. , Martin Joel R.
Published: February 2020

Clinical Question: Does the elevation training mask (ETM) increase VO2max in healthy individuals who are physically active? Clinical Bottom Line: The current best evidence shows no difference in VO2max improvement compared to training without wearing the ETM while following an exercise program. Several studies demonstrated improvement in measures of respiratory function when wearing the ETM. Further research should investigate changes in physiological variables other than VO2max, specifically those related to respiratory function.
Instrument-Assisted Soft Tissue Mobilization for Improving Ankle Dorsiflexion Range of Motion in Healthy Patients: A Critically Appraised Topic
Authors: Gardiner-Shires Alison M. , Seffrin Cristina B.
Published: February 2020

Clinical Question: In a healthy population, is instrument-assisted soft tissue mobilization beneficial in improving ankle dorsiflexion range of motion as compared to other therapeutic interventions? Clinical Bottom Line: For healthy patients, there is moderate-quality evidence to support the short-term use of instrument-assisted soft tissue mobilization for improving ankle dorsiflexion range of motion.
Man or Machine: Fantasy Football and Dehumanization of Professional Athletes
Authors: Larkin Ben , Dwyer Brendan , Goebert Chad
Published: February 2020

Fantasy sport has seen substantial growth over the last several decades, provoking research on how participation impacts the perceptions of teams and players. Following research in the field of economics, which has found that contexts promoting the assignment of economic value to humans result in dehumanization, the authors explored the dehumanization of professional athletes among fantasy football participants. Specifically, given that fantasy football requires participants to view players in terms of value in drafts, trades, and waiver claims, this should theoretically force participants to view them as commodities more so than humans. Across three implicit association test experiments and a qualitative study, the authors found fantasy football participants to be more apt to associate humanness with athletes on their fantasy roster(s) than non-fantasy-eligible athletes. Furthermore, qualitative insights indicate that participation in fantasy can serve to humanize players in a way that traditional sport consumption does not. Theoretical and practical implications are discussed.
Targeting Asymptomatic Bacteriuria in Antimicrobial Stewardship: the Role of the Microbiology Laboratory
Authors: Wiley Zanthia , Jacob Jesse T. , Burd Eileen M.
Published: February 2020

This minireview focuses on the microbiologic evaluation of patients with asymptomatic bacteriuria, as well as indications for antibiotic treatment. Asymptomatic bacteriuria is defined as two consecutive voided specimens (preferably within 2 weeks) with the same bacterial species, isolated in quantitative counts of ≥10
5
CFU/ml in women, including pregnant women; a single voided urine specimen with one bacterial species isolated in a quantitative count ≥10
5
CFU/ml in men; and a single catheterized urine specimen with one or more bacterial species isolated in a quantitative count of ≥10
5
CFU/ml in either women or men (or ≥10
2
CFU/ml of a single bacterial species from a single catheterized urine specimen).
Modified Sialic Acids on Mucus and Erythrocytes Inhibit Influenza A Virus Hemagglutinin and Neuraminidase Functions
Authors: Barnard Karen N. , Alford-Lawrence Brynn K. , Buchholz David W. , Wasik Brian R. , LaClair Justin R. , Yu Hai , Honce Rebekah , Ruhl Stefan , Pajic Petar , Daugherity Erin K. , Chen Xi , Schultz-Cherry Stacey L. , Aguilar Hector C. , Varki Ajit , Parrish Colin R.
Published: February 2020

Sialic acids (Sia) are involved in numerous different cellular functions and are receptors for many pathogens. Sia come in chemically modified forms, but we lack a clear understanding of how they alter interactions with microbes. Here, we examine the expression of modified Sia in mouse tissues, on secreted mucus in saliva, and on erythrocytes, including those from IAV host species and animals used in IAV research. These Sia forms varied considerably among different animals, and their inhibitory effects on IAV NA and HA activities and on bacterial sialidases (neuraminidases) suggest a host-variable protective role in secreted mucus.
Encephalitic Alphaviruses Exploit Caveola-Mediated Transcytosis at the Blood-Brain Barrier for Central Nervous System Entry
Authors: Salimi Hamid , Cain Matthew D. , Jiang Xiaoping , Roth Robyn A. , Beatty Wandy L. , Sun Chengqun , Klimstra William B. , Hou Jianghui , Klein Robyn S.
Published: February 2020

VEEV, WEEV, and eastern equine encephalitis virus (EEEV) are emerging infectious diseases in the Americas, and they have caused several major outbreaks in the human and horse population during the past few decades. Shortly after infection, these viruses can infect the CNS, resulting in severe long-term neurological deficits or death. Neuroinvasion has been associated with virus entry into the CNS directly from the bloodstream; however, the underlying molecular mechanisms have remained largely unknown. Here, we demonstrate that following peripheral infection alphavirus augments vesicular formation/trafficking at the BBB and utilizes Cav-MT to cross an intact BBB, a process regulated by activators of Rho GTPases within brain endothelium.
In vivo
examination of early viral entry in Cav-1-deficient mice revealed significantly lower viral burdens in the brain than in similarly infected wild-type animals. These studies identify a potentially targetable pathway to limit neuroinvasion by alphaviruses.
Gas-containing iliopsoas bursitis in the setting of degenerative osteoarthritis
Authors: Raymond Lauren , Christiansen Sandy
Published: February 2020

This is a case of a 77-year-old woman with a 4.0 cm gas-containing iliopsoas bursa collection in the setting of mild-to-moderate degenerative joint disease. Given the limited extent of this patient’s osteoarthritis and the absence of infectious signs or symptoms, both of which are typically related to gas collections at the hip, it was difficult to determine the aetiology of the patient’s gas collection, whether it was related to her pain, and how best to manage her symptoms. Even in the setting of her MRI findings, which showed the gas collection lifting the iliopsoas tendon off the bone, the gas-containing bursa ultimately appeared to be a minor component of the patient’s pain and definitive treatment of her underlying joint disease with a total hip arthroplasty allowed for successful pain management. Our case report demonstrates an unusual presentation of iliopsoas bursitis with a surprising response to medical, interventional and surgical management.
Prospective exploratory study to assess the safety and efficacy of aflibercept in cystoid macular oedema associated with retinitis pigmentosa
Authors: Strong Stacey A , Peto Tunde , Bunce Catey , Xing Wen , Georgiou Michalis , Esposti Simona Degli , Kalitzeos Angelos , Webster Andrew , Michaelides Michel
Published: February 2020

Aims

To report the safety and efficacy of intravitreal aflibercept (Eylea) (ivA) for retinitis pigmentosa-associated cystoid macular oedema (RP-CMO) at 12 months via mean central macular thickness (CMT) and reported adverse events.

Methods

A prospective, exploratory, phase II, non-randomised, single-centre, open-label, 1-arm clinical trial involving 30 eyes of 30 patients. Serial ivA was given via loading dose (three injections) followed by treat and extend protocol over 12 months.

Results

Twenty-nine out of 30 (96.7%) patients completed 12 months of follow-up. A total of four to 11 injections per patient were given over the 12 month study. No statistically significant reduction of CMT or visual acuity (VA) improvement was demonstrated in the group overall. Eleven out of 29 (37.9%) participants were considered as ‘responders’, demonstrating at least an 11% reduction of CMT at 12 months on spectral domain optical coherence tomography compared with baseline. A reduction of CMT by mean (SD) 28.1% (12.9 %) was observed in responders at 12 months, however, no statistically significant corresponding improvement in best corrected VA was seen. Baseline characteristics were similar between responder and non-responder groups. No clinically significant adverse events were deemed secondary to ivA.

Conclusion

This first prospective exploratory study demonstrates both the safety and acceptability of serial ivA in patients with RP-CMO, effective at reducing CMT in 37.9% of patients. All patients demonstrating anatomical response did so after their first injection. Longer duration of CMO did not negatively affect response to anti-VEGF. Further study in a larger cohort of patients with shorter CMO duration would be valuable to better establish the utility of VEGF blockade in RP-CMO.

Trial registration numbers

EudraCT (2015-003723-65); ClinicalTrials.gov (
NCT02661711
).
Estimating uncertainty in geospatial modelling at multiple spatial resolutions: the pattern of delivery via caesarean section in Tanzania
Authors: Ruktanonchai Corrine Warren , Nieves Jeremiah J , Ruktanonchai Nick W , Nilsen Kristine , Steele Jessica E , Matthews Zoe , Tatem Andrew J
Published: February 2020

Visualising maternal and newborn health (MNH) outcomes at fine spatial resolutions is crucial to ensuring the most vulnerable women and children are not left behind in improving health. Disaggregated data on life-saving MNH interventions remain difficult to obtain, however, necessitating the use of Bayesian geostatistical models to map outcomes at small geographical areas. While these methods have improved model parameter estimates and precision among spatially correlated health outcomes and allowed for the quantification of uncertainty, few studies have examined the trade-off between higher spatial resolution modelling and how associated uncertainty propagates. Here, we explored the trade-off between model outcomes and associated uncertainty at increasing spatial resolutions by quantifying the posterior distribution of delivery via caesarean section (c-section) in Tanzania. Overall, in modelling delivery via c-section at multiple spatial resolutions, we demonstrated poverty to be negatively correlated across spatial resolutions, suggesting important disparities in obtaining life-saving obstetric surgery persist across sociodemographic factors. Lastly, we found that while uncertainty increased with higher spatial resolution input, model precision was best approximated at the highest spatial resolution, suggesting an important policy trade-off between identifying concealed spatial heterogeneities in health indicators.
The predictive power of health system environments: a novel approach for explaining inequalities in access to maternal healthcare
Authors: Sochas Laura
Published: February 2020

Introduction

The growing use of Geographic Information Systems (GIS) to link population-level data to health facility data is key for the inclusion of health system environments in analyses of health disparities. However, such approaches commonly focus on just a couple of aspects of the health system environment and only report on the average and independent effect of each dimension.

Methods

Using GIS to link Demographic and Health Survey data on births (2008–13/14) to Service Availability and Readiness Assessment data on health facilities (2010) in Zambia, this paper rigorously measures the multiple dimensions of an accessible health system environment. Using multilevel Bayesian methods (multilevel analysis of individual heterogeneity and discriminatory accuracy), it investigates whether multidimensional health system environments defined with reference to both geographic and social location cut across individual-level and community-level heterogeneity to reliably predict facility delivery.

Results

Random intercepts representing different health system environments have an intraclass correlation coefficient of 25%, which demonstrates high levels of discriminatory accuracy. Health system environments with four or more access barriers are particularly likely to predict lower than average access to facility delivery. Including barriers related to geographic location in the non-random part of the model results in a proportional change in variance of 74% relative to only 27% for barriers related to social discrimination.

Conclusions

Health system environments defined as a combination of geographic and social location can effectively distinguish between population groups with high versus low probabilities of access. Barriers related to geographic location appear more important than social discrimination in the context of Zambian maternal healthcare access. Under a progressive universalism approach, resources should be disproportionately invested in the worst health system environments.
Analysis of age–sex and deprivation stratified trends in assault deaths in Scotland (1974–2015) to identify age, period or cohort effects
Authors: Parkinson Jane , Minton Jon , McCartney Gerry
Published: February 2020

Objectives

Mortality rates in Scotland are higher, and health inequalities are greater, than in the rest of Western and Central Europe. There was a marked divergence during the 1980s and 1990s in the Scottish rates partly due to rises in alcohol-related and drug-related deaths, suicide and deaths by assault. This study examines whether age, period or cohort effects account for the trends in death by assault in Scotland and any sex or deprivation inequalities in these.

Design

We calculated crude and age-standardised mortality rates for deaths by assault for Scottish men and women from 1974 to 2015 for the population overall and for populations stratified by Carstairs area of deprivation. We examined age–sex stratified trends to identify obvious age–period–cohort effects.

Setting

This study was conducted in Scotland.

Participants

Men and women whose registered death by the International Classification of Diseases was due to assault from 1974 to 2015 (n=3936) were included in this study.

Results

Whereas age-standardised mortality rates from this cause fell gradually for women since 1974, for men they increased in the early 1990s and remained higher until around 2006, before falling. Death by assault was substantially more common among men aged around 15–50 years and in the most deprived areas. There was little change in the age groups most impacted over time, which made cohort effects unlikely. A period effect for the 15 years until 2006, with a consistent age–sex–area deprivation patterning, was evident.

Conclusions

Mortality due to assault in Scotland is unequally felt, with young men living in the most deprived areas suffering the highest rates. There is a 15-year period effect up until 2006, impacting on young men as an age–period interaction, with no obvious cohort effects. Exploration of the demographics of criminological data may identify age, period or cohort effects among perpetrators of assault.
The IMpact of Vertical HIV infection on child and Adolescent SKeletal development in Harare, Zimbabwe (IMVASK Study): a protocol for a prospective cohort study
Authors: Rukuni Ruramayi , Gregson Celia , Kahari Cynthia , Kowo Farirayi , McHugh Grace , Munyati Shungu , Mujuru Hilda , Ward Kate , Filteau Suzanne , Rehman Andrea M , Ferrand Rashida
Published: February 2020

Introduction

The scale-up of antiretroviral therapy (ART) across sub-Saharan Africa (SSA) has reduced mortality so that increasing numbers of children with HIV (CWH) are surviving to adolescence. However, they experience a range of morbidities due to chronic HIV infection and its treatment. Impaired linear growth (stunting) is a common manifestation, affecting up to 50% of children. However, the effect of HIV on bone and muscle development during adolescent growth is not well characterised. Given the close link between pubertal timing and musculoskeletal development, any impairments in adolescence are likely to impact on future adult musculoskeletal health. We hypothesise that bone and muscle mass accrual in CWH is reduced, putting them at risk of reduced bone mineral density (BMD) and muscle function and increasing fracture risk. This study aims to determine the impact of HIV on BMD and muscle function in peripubertal children on ART in Zimbabwe.

Methods and analysis

Children with (n=300) and without HIV (n=300), aged 8–16 years, established on ART, will be recruited into a frequency-matched prospective cohort study and compared. Musculoskeletal assessments including dual-energy X-ray absorptiometry, peripheral quantitative computed tomography, grip strength and standing long jump will be conducted at baseline and after 1 year. Linear regression will be used to estimate mean size-adjusted bone density and Z-scores by HIV status (ie, total-body less-head bone mineral content for lean mass adjusted for height and lumbar spine bone mineral apparent density. The prevalence of low size-adjusted BMD (ie, Z-scores <−2) will also be determined.

Ethics and dissemination

Ethical approval for this study has been granted by the Medical Research Council of Zimbabwe and the London School of Hygiene and Tropical Medicine Ethics Committee. Baseline and longitudinal analyses will be published in peer-reviewed journals and disseminated to research communities.
Protocol for a feasibility study: a brief self-compassion intervention for adolescents with type 1 diabetes and disordered eating
Authors: Boggiss Anna L , Consedine Nathan S , Jefferies Craig , Bluth Karen , Hofman Paul L , Serlachius Anna S
Published: February 2020

Introduction

Adolescents with type 1 diabetes are at a higher risk of developing psychiatric disorders, particularly eating disorders, compared with their healthy peers. In turn, this increases the risk for sub-optimal glycaemic control and life-threatening diabetes-related complications. Despite these increased risks, standard diabetes care does not routinely provide psychological support to help prevent or reduce mental health risks. There is an urgent need to develop ‘clinically usable’ psychosocial interventions that are acceptable to patients and can be realistically integrated into clinical care. This study aims to examine the feasibility and acceptability of a brief self-compassion intervention for adolescents with type 1 diabetes and disordered eating behaviour.

Methods and analysis

This feasibility study will examine the effectiveness of a brief self-compassion intervention, compared with a waitlist control group. Participants aged 12–16 years will be recruited from three diabetes outpatient clinics in Auckland, New Zealand. The brief self-compassion intervention is adapted from the standardised ‘Making Friends with Yourself’ intervention and will be delivered in a group format over two sessions. Apart from examining feasibility and acceptability through the flow of participants through the study and qualitative questions, we will assess changes to disordered eating behaviour (primary outcome), self-care behaviours, diabetes-related distress, self-compassion, stress and glycaemic control (secondary outcomes). Such data will be used to calculate the required sample size for a fully powered randomised controlled trial.

Ethics and dissemination

This trial has received ethics approval from the Health and Disability Ethics Committee (research project number A+8467). Study results will be disseminated through peer-reviewed journals and conferences.

Trial registration number

ANZCTR (12619000541101).
Identification of tumor immune infiltration-associated lncRNAs for improving prognosis and immunotherapy response of patients with non-small cell lung cancer
Authors: Sun Jie , Zhang Zicheng , Bao Siqi , Yan Congcong , Hou Ping , Wu Nan , Su Jianzhong , Xu Liangde , Zhou Meng
Published: February 2020

Background

Increasing evidence has demonstrated the functional relevance of long non-coding RNAs (lncRNAs) to immunity regulation and the tumor microenvironment in non-small cell lung cancer (NSCLC). However, tumor immune infiltration-associated lncRNAs and their value in improving clinical outcomes and immunotherapy remain largely unexplored.

Methods

We developed a computational approach to identify an lncRNA signature (TILSig) as an indicator of immune cell infiltration in patients with NSCLC through integrative analysis for lncRNA, immune and clinical profiles of 115 immune cell lines, 187 NSCLC cell lines and 1533 patients with NSCLC. Then the influence of the TILSig on the prognosis and immunotherapy in NSCLC was comprehensively investigated.

Results

Computational immune and lncRNA profiling analysis identified an lncRNA signature (TILSig) consisting of seven lncRNAs associated with tumor immune infiltration. The TILSig significantly stratified patients into the immune-cold group and immune-hot group in both training and validation cohorts. These immune-hot patients exhibit significantly improved survival outcome and greater immune cell infiltration compared with immune-cold patients. Multivariate analysis revealed that the TILSig is an independent predictive factor after adjusting for other clinical factors. Further analysis accounting for TILSig and immune checkpoint gene revealed that the TILSig has a discriminatory power in patients with similar expression levels of immune checkpoint genes and significantly prolonged survival was observed for patients with low TILSig and low immune checkpoint gene expression implying a better response to immune checkpoint inhibitor (ICI) immunotherapy.

Conclusions

Our finding demonstrated the importance and value of lncRNAs in evaluating the immune infiltrate of the tumor and highlighted the potential of lncRNA coupled with specific immune checkpoint factors as predictive biomarkers of ICI response to enable a more precise selection of patients.
Poor outcome with anti-programmed death-ligand 1 (PD-L1) antibody due to poor pharmacokinetic properties in PD-1/PD-L1 blockade-sensitive mouse models
Authors: Kurino Taiki , Matsuda Reiko , Terui Ayu , Suzuki Hiroyuki , Kokubo Tomomi , Uehara Tomoya , Arano Yasushi , Hisaka Akihiro , Hatakeyama Hiroto
Published: February 2020

Background

Recently, antiprogrammed cell death protein 1 (aPD-1) and antiprogrammed death-ligand 1 (aPD-L1) monoclonal antibodies (mAbs) have been approved. Even though aPD-1 and aPD-L1 mAbs target the same PD-1/PD-L1 axis, it is still unclear whether both mAbs exert equivalent pharmacological activity in patients who are sensitive to PD-1/PD-L1 blockade therapy, as there is no direct comparison of their pharmacokinetics (PK) and antitumor effects. Therefore, we evaluated the differences between both mAbs in PK and therapeutic effects in PD-1/PD-L1 blockade-sensitive mouse models.

Methods

Herein, murine breast MM48 and colon MC38 xenografts were used to analyze the pharmacological activity of aPD-1 and aPD-L1 mAbs. The PK of the mAbs in the tumor-bearing mice was investigated at low and high doses using two radioisotopes (Indium-111 and Iodine-125) to evaluate the accumulation and degradation of the mAbs.

Results

aPD-1 mAb showed antitumor effect in a dose-dependent manner, indicating that the tumor model was sensitive to PD-1/PD-L1 blockade therapy, whereas aPD-L1 mAb failed to suppress tumor growth. The PK study showed that aPD-L1 mAb was accumulated largely in normal organs such as the spleen, liver, and kidney, resulting in low blood concentration and low distributions to tumors at a low dose, even though the tumors expressed PD-L1. Sufficient accumulation of aPD-L1 mAb in tumors was achieved by administration at a high dose owing to the saturation of target-mediated binding in healthy organs. However, degradation of aPD-L1 mAb in tumors was greater than that of aPD-1 mAb, which resulted in poor outcome presumably due to less inhibition of PD-L1 by aPD-L1 mAb than that of PD-1 by aPD-1 mAb.

Conclusion

According to the PK studies, aPD-1 mAb showed linear PK, whereas aPD-L1 mAb showed non-linear PK between low and high doses. Collectively, the poor PK characteristics of aPD-L1 mAb caused lower antitumor activity than of aPD-1 mAb. These results clearly indicated that aPD-L1 mAb required higher doses than aPD-1 mAb in clinical setting. Thus, targeting of PD-1 would be more advantageous than PD-L1 in terms of PK.
Poor prognosis associated with TERT gene alterations in meningioma is independent of the WHO classification: an individual patient data meta-analysis
Authors: Mirian Christian , Duun-Henriksen Anne Katrine , Juratli Tareq , Sahm Felix , Spiegl-Kreinecker Sabine , Peyre Matthieu , Biczok Annamaria , Tonn Jörg-Christian , Goutagny Stéphane , Bertero Luca , Maier Andrea Daniela , Møller Pedersen Maria , Law Ian , Broholm Helle , Cahill Daniel P. , Brastianos Priscilla , Poulsgaard Lars , Fugleholm Kåre , Ziebell Morten , Munch Tina , Mathiesen Tiit
Published: February 2020

Background

TERT gene alterations (TERT-alt) have been linked to increased risk of recurrence in meningiomas, whereas the association to mortality largely remain incompletely investigated. As incongruence between clinical course and WHO grade exists, reliable biomarkers have been sought.

Methods

We applied the Preferred Reporting Items for Systematic Review and Meta-Analyses of individual participant data Statement. We compiled data from eight studies and allocated patients to TERT-alt (n=59) or TERT promoter wild-type (TERTp-wt; n=618). We compared the two groups stratified for WHO grades as: incidence rates, survival probabilities and cumulative recurrences. We estimated the effects of WHO grade, age at diagnosis and sex as HRs.

Results

TERT-alt occurred in 4.7%, 7.9% and 15.4% of WHO-I/WHO-II/WHO-III meningiomas, respectively. The median recurrence-free survival was 14 months for all TERT-alt patients versus 101 months for all TERTp-wt patients. The HR for TERT-alt was 3.74 in reference to TERTp-wt. For all TERT-alt patients versus all TERTp-wt patients, the median overall survival was 58 months and 160 months, respectively. The HR for TERT-alt was 2.77 compared with TERTp-wt. TERT-alt affected prognosis independent of WHO grades. Particularly, the recurrence rate was 4.8 times higher in WHO-I/-II TERT-alt patients compared with WHO-III TERTp-wt patients. The mortality rate was 2.7 times higher in the WHO-I and WHO-II TERT-alt patients compared with WHO-III TERTp-wt patients.

Conclusions

TERT-alt is an important biomarker for significantly higher risk of recurrence and death in meningiomas. TERT-alt should be managed and surveilled aggressively. We propose that TERT-alt analysis should be implemented as a routine diagnostic test in meningioma and integrated into the WHO classification.

Trial registration number

PROSPERO: CRD42018110566.
Patients with markedly elevated D-dimer who do not have pulmonary embolism
Authors: Lim Jeren , Cardle Calum , Isles Chris
Published: February 2020

Objective

To determine the cause of a markedly raised D-dimer among patients in whom a diagnosis of pulmonary embolism (PE) has been excluded by CT pulmonary angiogram (CTPA) with particular reference to new cases of cancer and aortic dissection.

Methods

One thousand consecutive patients, suspected of PE, who had undergone CTPA and for whom a D-dimer had been requested, were seen between 2012 and 2016. Retrospectively we examined the case records of all those in the top quintile of the D-dimer distribution whose CTPA was negative for PE. D-dimer in the top quintile ranged from 7.5 to 260 times upper limit normal.

Results

Eighty-five patients fulfilled our inclusion criteria. The likely causes of their very high D-dimer were infection (n=35, 41.2%), cardiovascular disease (n=12, 14.1% including two patients with previously undiagnosed aortic dissection), surgery or trauma (n=12, 14.1%), new or active cancer (n=9, 10.6% comprising six new cancers and three patients with cancers diagnosed previously that were considered to be active) and miscellaneous causes (n=17, 20.0%). Thirty-five patients (43.5%) died over a 2-year follow-up. Kaplan-Meier survival analysis showed poorer outcomes for patients with new or active cancer, when compared with those with no known cancer (p<0.001).

Conclusions

We have shown that a small proportion of patients suspected of PE whose D-dimers are markedly elevated have diagnoses we would not want to miss including previously unsuspected cancer and aortic dissection. Further studies will be required to define the optimal workup of patients with extremely high D-dimer who do not have venous thromboembolism