bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring differences within the low‐income population in urban China: A case study in Kunming, Yunnan Province
Authors: Hou Xueying , Chen Guo , Wu Gongsheng
Published: May 2020

This study focuses on differences between people in Kunming, China who are categorised as low income. Whereas in the existing literature low‐income people in urban China are generally described as comprising heterogeneous groups based on case studies of coastal megacities, this study offers a much‐needed comprehensive, micro‐level analysis to identify and differentiate low‐income groups from each other, based on the case of an inland megacity. A population sample from a number of low‐income neighbourhoods is used to analyse the differentiation among the urban low‐income population. According to the results from a latent class cluster analysis, low‐income urban people can be divided into five groups: low‐income locals with some employment‐relevant abilities; low‐income migrants; low‐income locals with limited employment‐relevant abilities; inherited socialist low income; and low‐income with high mobility. Of these groups, the inherited socialist low‐income group and the low‐income locals with limited employment‐relevant abilities were found to be the most vulnerable, given that the people in these two groups were the poorest and had few abilities pertinent to improving their ability to make a living and, therefore, few prospects of improving their standard of living. The low‐income locals with some employment‐relevant abilities had the potential to gain employment, yet evinced the lowest labour participation rate. The members of the low‐income migrant group had limited skills and most were excluded from city welfare and formal employment systems. The low‐income with high mobility had weak competitive abilities in the labour market and experienced difficulty obtaining stable employment. The study clearly shows that there is an urgent need to adopt different measures for the distinct groups of urban low‐income thus identified.
Examining the relationships between cognitive activation, self‐efficacy, socioeconomic status, and achievement in mathematics: A multi‐level analysis
Authors: Li Hui , Liu Jian , Zhang Dan , Liu Hongyun
Published: May 2020

Background

Previous studies have suggested that teachers’ frequent use of cognitive activation strategies in mathematics lessons is positively associated with students’ mathematics achievement.

Aims

This study aims to investigate the possible mediating role of mathematics self‐efficacy in the association between cognitive activation and achievement in mathematics classrooms. Besides that, we explored the moderating role of students’ socioeconomic status (SES) in the relationships between cognitive activation, mathematics self‐efficacy, and mathematics achievement.

Samples

This study employed data from a project of the National Assessment Center for Education Quality (NACEQ) in China. A sample with 8707 fourth‐grade primary students and 129 mathematics teachers was analysed.

Methods

The multi‐level analysis was used in this study with students representing the level‐1 units and teachers representing the level‐2 units.

Results

Based on a large‐scale standard assessment and survey in China, this study showed that cognitive activation was positively related to mathematics performance overall. Mathematics self‐efficacy played a vital mediating role in the association between cognitive activation and mathematics achievement. The indirect relationship between cognitive activation and mathematics achievement via mathematics self‐efficacy was moderated by SES both at the student level and the teacher level.

Conclusions

Our study suggests the importance of cognitively activating instruction, especially for students with lower SES and classes with lower average SES.
A systematic review on Transoral robotic surgery (TORS) for carcinoma of unknown primary origin: Has tongue base mucosectomy become indispensable?
Authors: van Weert Stijn , Rijken Johannes A. , Plantone Francesca , Bloemena Elisabeth , Vergeer Marije R. , Lissenberg‐ Witte Birgit I. , Leemans C. René
Published: May 2020

Background

Transoral robotic surgery (TORS) is increasingly used in head and neck surgery and in carcinoma of unknown primary (CUP) origin specifically. Due to the rising incidence of human papillomavirus (HPV)‐related oropharyngeal squamous cell carcinoma (OPSCC), there is a rationale for finding ways to de‐escalate treatment strategies. This review aims to test the hypothesis that TORS is a meaningful adjunct in the diagnostic (and therapeutic) pathway in CUP in head and neck.

Methods

A structured search of the literature was performed with the search terms ‘TORS’ and ‘Carcinoma of Unknown Primary’.

Results

Two hundred and seventy four cases of CUP in which TORS was used were identified for further analysis. Workup for CUP was comparable in all series with regard to physical examination, fine and/or gross needle examination of cervical nodes, fibre optic endoscopy, imaging and robot assisted mucosectomy of the base of tongue (BOT). Identification rate of the primary tumour was 72% on average (range 17%‐ 90%), and 55%‐ 96% were HPV positive. Clear margins were achieved in 60% (range 0%‐85%) of resected occult tumours. Complication rate of TORS BOT mucosectomy was low with mainly grade I‐III sequelae according to Clavien–Dindo.

Conclusions

Transoral robotic surgery seems to be a useful and safe adjunct in the diagnostic and therapeutic pathway in case of CUP in an era of increasing incidence of HPV‐positive OPSCC.
Elucidating the socio‐demographics of wildlife tolerance using the example of the red fox (Vulpes vulpes) in Germany
Authors: Kimmig Sophia E. , Flemming Danny , Kimmerle Joachim , Cress Ulrike , Brandt Miriam
Published: May 2020

As a consequence of increasing human‐wildlife encounters, the associated potential for human‐wildlife conflict rises. The dependency of conservation management actions on the acceptance or even the participation of people requires modern conservation strategies that take the human dimension of wildlife management into account. In the first place, conservationists therefore need to understand how people perceive wildlife. In the present study, we examined how wildlife perception varies with people's socio‐demographic backgrounds in terms of age, gender, and education as well as the settlement structure of people's living environment and their general life satisfaction, using the red fox (Vulpes vulpes) as a model species. We used an interview‐based survey of 2,646 participants, representative for the German population, for investigating their knowledge about, risk perception of, and attitude toward red foxes. We found a negative correlation between age and the risks perceived regarding foxes. Moreover, men held a more positive attitude and perceived less risk than women. Higher education was also associated with lower risk perception and a more positive attitude. The results further indicated that people who live in rural areas perceived higher risks regarding foxes and showed a less positive attitude than people in urban or suburban areas. Finally, people who perceived higher risks and held a less positive attitude supported lethal population management actions more often. However, we also found that perceived risks decreased with participants' general life satisfaction. Hence, wildlife perception is affected by various factors. Understanding the factors affecting wildlife perception is crucial for environmental communication and for fostering acceptance of conservation measures to improve conservation strategies.
Anaplastic large cell lymphoma diagnosed from ascitic and pleural fluid effusion cytology in a paediatric patient
Authors: Stephen Norton , Ravi Soundarya , Balakrishnan Karuna , Siddaraju Neelaiah , Basu Debdata , Gochhait Debasis , Ganesan Prasanth
Published: May 2020

Anaplastic large cell lymphoma is commonly diagnosed on biopsy or fine needle aspiration but it is very rarely reported in fluid cytology. However, this tumor can be easily diagnosed and confirmed from the cytosmears of serous effusion samples.
PVC nest boxes are less at risk of occupancy by feral honey bees than timber nest boxes and natural hollows
Authors: Berris Karleah K. , Barth Michael
Published: May 2020

Feral European Honey Bee (Apis mellifera) has been identified as a potential nest competitor for Australian hollow nesting species, but few studies have investigated the impact of feral honey bee competition on Threatened species. Our study used data from Glossy Black‐cockatoo (Calyptorhynchus lathami halmaturinus) nests on Kangaroo Island, monitored and managed over an 11‐year period, and found 12% of nests became occupied by feral honey bees during that period. Our results indicate that feral honey bees were less likely to occupy nest boxes made of PVC (5%) compared with wooden nest boxes (24%) or natural hollows in Eucalyptus trees (14%). The removal of feral honey bee hives from nests is a priority for long‐term conservation of glossy black‐cockatoos on Kangaroo Island. We recommend that PVC nest boxes are chosen for future nesting habitat restoration, due to the more frequent use of wooden nest boxes by feral honey bees.
Temperature‐related breakdowns in the coordination of mating in Enchenopa binotata treehoppers (Hemiptera: Membracidae)
Authors: Leith Noah T. , Jocson Dowen I. , Fowler‐Finn Kasey D.
Published: May 2020

Temperature influences the expression of a wide range of behavioral traits in ectotherms, including many involved in the initiation of pair formation and mating. Although opportunities to mate are thought to be greatest when male and female activity overlap, sex‐specific behaviors and physiology could result in mismatched thermal optima for male and female courtship. Here, we investigate how conflicts in the thermal sensitivity of male and female courtship activity affect patterns of mating across temperatures in Enchenopa binotata treehoppers (Hemiptera: Membracidae). These plant‐feeding insects coordinate mating with plant‐borne vibrational signals exchanged in male–female duets prior to pair formation. We manipulated temperature across an ecologically relevant range (18–36ºC) and tested the likelihood of individual male and female E. binotata to engage in courtship activity using vibrational playbacks. We then staged male–female mating interactions across the same temperature range and quantified the thermal sensitivity of mating‐related behaviors across stages of mating. Specifically, we measured the timing of duetting, the likelihood for key pre‐copulatory behaviors to occur, whether the pair mated, and copulation duration. We found sex‐specific thermal sensitivity in courtship activity: Males showed a clear peak of activity at intermediate temperatures (27–30ºC), while females showed highest activity at the hotter thermal extreme. Mating rates, courtship duets, and copulatory attempts were less likely to occur at thermal extremes. Also, duetting occurred earlier and copulation was shortest at higher temperatures. Overall, our data suggest that sexes differ in how temperature affects mating‐related activity and some processes involved in mate coordination may be more sensitive than others across variable thermal environments.
Parent Education: What We Know and Moving Forward for Greatest Impact
Authors: Morris Amanda Sheffield , Jespersen Jens E. , Cosgrove Kelly T. , Ratliff Erin L. , Kerr Kara L.
Published: May 2020

The available literature on parent education is growing rapidly. With numerous sources indicating that quality parenting is one of the best predictors of one's developmental trajectory across the lifespan, it has become increasingly necessary to identify the most effective programs and tools for supporting parenting skills and promoting positive child development. In this article, we describe key aspects of the best evidence‐based practices in the current parent education literature, including program implementation, program content, common themes, and an overview of some of the most promising parent education programs available for early childhood, middle childhood, and adolescence. Conclusions and suggestions for future work and applications are also discussed.
Moderate disturbances accelerate forest transition dynamics under climate change in the temperate–boreal ecotone of eastern North America
Authors: Brice Marie‐Hélène , Vissault Steve , Vieira Willian , Gravel Dominique , Legendre Pierre , Fortin Marie‐Josée
Published: May 2020

Several temperate tree species are expected to migrate northward and colonize boreal forests in response to climate change. Tree migrations could lead to transitions in forest types, but these could be influenced by several non‐climatic factors, such as disturbances and soil conditions. We analysed over 10,000 forest inventory plots, sampled from 1970 to 2018 in meridional Québec, Canada, to identify what environmental conditions promote or prevent regional‐scale forest transitions. We used a continuous‐time multi‐state Markov model to quantify the probabilities of transitions between forest states (temperate, boreal, mixed, pioneer) as a function of climate (mean temperature and climate moisture index during the growing season), soil conditions (pH and drainage) and disturbances (severity levels of natural disturbances and logging). We further investigate how different disturbance types and severities impact forests' short‐term transient dynamics and long‐term equilibrium using properties of Markov transition matrices. The most common transitions observed during the study period were from mixed to temperate states, as well as from pioneer to boreal forests. In our study, transitions were mainly driven by natural and anthropogenic disturbances and secondarily by climate, whereas soil characteristics exerted relatively minor constraints. While major disturbances only promoted transitions to the pioneer state, moderate disturbances increased the probability of transition from mixed to temperate states. Long‐term projections of our model under the current environmental conditions indicate that moderate disturbances would promote a northward shift of the temperate forest. Moreover, disturbances reduced turnover and convergence time for all transitions, thereby accelerating forest dynamics. Contrary to our expectation, mixed to temperate transitions were not driven by temperate tree recruitment but by mortality and growth. Overall, our results suggest that moderate disturbances could catalyse rapid forest transitions and accelerate broad‐scale biome shifts.
Delay in OnabotulinumtoxinA Treatment During the COVID‐19 Pandemic‐Perspectives from a Virus Hotspot
Authors: Ali Ashhar
Published: May 2020

The COVID‐19 pandemic has undoubtedly changed our practice of medicine. With our collective resources and attention focused on caring for those afflicted with the disease, other medical conditions have temporarily but understandably faced constraint. For migraine patients who often require in‐person visits for infusions and procedures, this has become particularly challenging. Here, we share our experience in navigating this exigency amidst a local surge of COVID‐19.
LncRNA MEG3 contributes to drug resistance in acute myeloid leukemia by positively regulating ALG9 through sponging miR‐155
Authors: Yu Yanan , Kou Daqing , Liu Bing , Huang Yiran , Li Shuangda , Qi Yu , Guo Yanru , Huang Tong , Qi Xia , Jia Li
Published: May 2020

Introduction

The development of drug resistance is the main obstacle for successful treatment in acute myeloid leukemia (AML). Noncoding RNAs have been implicated in biological function in AML drug resistance. Aberrant protein glycosylation is associated with AML progression. The aim of the study was to explore the potential regulatory mechanism of lncRNA MEG3/miR‐155/ALG9 axis in drug resistance of AML.

Methods

QRT‐PCR and Western blot were used for comparison analyses of ALG9, MEG3, and miR‐155 levels. CCK‐8 and colony formation assays were determined for drug sensitivity and proliferative capability of AML cells. Luciferase reporter assay was used to confirm the targets of miR‐155.

Results

The mannosyltransferase ALG9 and MEG3 was downregulated in peripheral blood mononuclear cells (PBMCs) of M5/multidrug resistance (MDR) AML patients and adriamycin (ADR)‐resistant AML cell lines, which determined a positive correlation in AML patients. Low expression of ALG9 and MEG3 predicted poor prognosis of AML patients. The altered level of ALG9 was found corresponding to the drug‐resistant phenotype and sphere formation of AML cells. MiR‐155 was overexpressed in M5/MDR patients and ADR‐resistant AML cells, as well as inversely correlated to ALG9 expression. MEG3 was a direct target of miR‐155 and could sponge miR‐155 in AML cells. MEG3 interacted with miR‐155 to regulate ALG9 expression, which reversed the effects of ALG9 regulation on proliferation and drug resistance in AML cells.

Conclusion

MEG3 sponged miR‐155 by competing endogenous RNA (ceRNA) mechanism, which further modulated ALG9 expression and AML procession, providing a novel therapeutic target for AML chemoresistance.
Understanding diagnostic settings and carer experiences for dementia diagnosis in Australia
Authors: Ng Natalie Su Quin , Ayton Darshini , Workman Barbara , Ward Stephanie Alison
Published: May 2020

Background

Australian guidelines advocate referral to comprehensive memory services for dementia diagnosis, but many patients may be diagnosed elsewhere.

Aims

To determine common settings for dementia diagnosis in Australia and to compare patient and carer experience between settings.

Methods

Exploratory cross‐sectional study of patients with dementia admitted to a Melbourne sub‐acute hospital. Patients who had capacity to participate were included; carers were recruited for patients without capacity. Participants completed an interviewer‐administered survey which asked them to recall the diagnostic setting, discussions about diagnosis and management (clinical care) and overall experience of diagnosis. Descriptive statistics were applied and open‐ended questions were analysed using inductive and deductive coding approaches.

Results

From 81 eligible participants, 74 consented to participate (one patient, 74 carers). Participants reported dementia diagnosis occurred a median of 24 months before interview, in the following settings: hospitals (31.3%), private specialist clinics (29.7%), memory clinics (14.9%), general practice (13.5%), community health services (9.5%) and residential care (1.4%). Recall of discussions about dementia‐modulating medications was higher in participants diagnosed in memory clinics and private specialist clinics (70%) compared to other settings (15%) (P < 0.001). Discussion about living circumstances was highest in hospitals (87% vs 40%) (P < 0.001). One third of participants reported dissatisfaction with their experience. Reported satisfaction was highest for memory clinics.

Conclusion

Results suggest majority of people with dementia are diagnosed outside memory services. Significant variability exists in experiences between services, with a high proportion of participants expressing dissatisfaction with their experience with dementia diagnosis. Strategies to standardise diagnosis of dementia, measure and improve quality of care across all settings are required.
Efficacy of microneedling versus fractional Er:YAG laser in facial rejuvenation
Authors: Robati Reza M. , Hamedani Behnaz , Namazi Nastaran , Niknejad Nasim , Gheisari Mehdi
Published: May 2020

Background

Microneedling and fractional lasers have been used in facial rejuvenation with acceptable results and low adverse effects.

Aims

To compare the efficacy of microneedling with fractional Er:YAG in facial skin rejuvenation.

Patients/Methods

This study was planned as a split‐face clinical trial. Volunteers were randomly allocated to receive three monthly treatments on each side of the face, one with fractional Er:YAG laser and one with microneedling. The assessments included investigating clinical outcomes by two blinded dermatologists accompanied by measuring skin biophysical characteristics including cutaneous resonance running time (CRRT) and transepidermal water loss (TEWL). Moreover, possible adverse effects, downtime, and patients' satisfaction were recorded at baseline, 1 month after each treatment, and 3 months after the last treatment session. The protocol was approved by the Iranian Registry of Clinical Trials (IRCT20160820029436N3).

Results

Of the 32 selected volunteers, 24 subjects completed the study. The clinical assessment showed a significant improvement of the face appearance along with a significant reduction in dyschromia, and periorbital wrinkling (P‐value < .05), with both procedures without any considerable difference between two methods. Moreover, the patients showed substantial satisfaction with both modalities with no statistically significant difference. Mean TEWL and CRRT values also decreased significantly in both groups with no considerable difference. The downtime was significantly shorter in the microneedling‐treated side. There were no long‐lasting or severe adverse effects after treatment with both methods.

Conclusion

Microneedling and fractional Er:YAG laser have comparable efficacy in facial rejuvenation, but little downtime of the former makes it preferable for many patients.
Fabrication of a Toe Prosthesis with Paintable and Interchangeable Nail: A Clinical Report
Authors: Colebeck Amanda , Canallatos Paul , McLean Terrence , Catanese Laura , Pawenski Edward , Burke Mark , Sullivan Maureen
Published: May 2020

This report describes the treatment of a 44‐year‐old woman with history of left great toe amputation due to surgical complications from metatarsophalangeal joint fusion procedure. The fabrication of a prosthetic great toe with interchangeable nail that is paintable is described in detail. This prosthetic demonstrates that the clinical and laboratory techniques used in fabrication of traditional maxillofacial prosthetics can be adapted for the fabrication of somatic prosthetics to enhance quality of life.
Perspectives of crisis intervention for people diagnosed with “borderline personality disorder”: An integrative review
Authors: Warrender Dan , Bain Heather , Murray Ian , Kennedy Catriona
Published: May 2020

Accessible Summary

What is known on the subject?

People diagnosed with “BPD” often experience crisis and use services

“BPD” is a controversial diagnosis, and the experience of crisis and crisis intervention is not well understood

What this paper adds to existing knowledge?

People diagnosed with “BPD” have different experiences of crisis, and using the diagnosis alone as a basis for deciding care and treatment is not appropriate

There are many human factors which can influence how professionals deliver care to people diagnosed with “BPD”

What are the implications for practice?

The education of staff, views on responsibility, team conflicts and access to clinical supervision can have an impact on how care is delivered, and should be addressed by organizations providing crisis care.

Access to care often occurs when a person is self‐harming or suicidal, but does not address underlying distress. Crisis care should go beyond managing behaviour and address any underlying needs.

Introduction

“Borderline personality disorder” (“BPD”) is associated with frequent use of crisis intervention services. However, no robust evidence base supports specific interventions, and people's experiences are not well understood.

Aim

To explore the experiences of stakeholders involved in the crisis care of people diagnosed with “BPD.”

Method

Integrative review with nine databases searched January 2000 to November 2017. The search filtered 3,169 titles and abstracts with 46 full‐text articles appraised and included.

Results

Four themes were constructed from thematic analysis: crisis as a recurrent multidimensional cycle, variations and dynamics impacting on crisis intervention, impact of interpersonal dynamics and communication on crisis, and balancing decision‐making and responsibility in managing crisis.

Discussion

Crisis is a multidimensional subjective experience, which also contributes to distress for family carers and professionals. Crisis interventions had limited and subjective benefit. They are influenced by accessibility of services, different understandings of “BPD” and human dynamics in complex decision‐making, and can be experienced as helpful or harmful.

Implications for practice

Subjectivity of crisis experiences shows limitations of the diagnostic model of “BPD,” emphasizing that interventions should remain person‐centred. While thresholds for intervention are often met after self‐harm or suicidality, professionals should review approaches to care and support people with underlying distress.
Non‐invasive detection of portal hypertension by enhanced liver fibrosis score in patients with different aetiologies of advanced chronic liver disease
Authors: Simbrunner Benedikt , Marculescu Rodrig , Scheiner Bernhard , Schwabl Philipp , Bucsics Theresa , Stadlmann Alexander , Bauer David J. M. , Paternostro Rafael , Eigenbauer Ernst , Pinter Matthias , Stättermayer Albert Friedrich , Trauner Michael , Mandorfer Mattias , Reiberger Thomas
Published: May 2020

Background and Aims

The enhanced liver fibrosis (ELF) score comprises serum markers of fibrogenesis and matrix remodelling and was developed to detect liver fibrosis, however, it may also be useful for the non‐invasive detection of portal hypertension (PHT).

Methods

ELF score and its single components (TIMP1/PIIINP/HA) were analysed in 201 patients with advanced chronic liver disease (ACLD; ie hepatic venous pressure gradient (HVPG) ≥6 mm Hg). Patients with pre‐/post‐hepatic PHT, hepatocellular carcinoma beyond Milan criteria, and history of TIPS implantation or liver transplantation were excluded.

Results

ELF and its single components correlated with HVPG in the overall cohort: ELF: r = .443, TIMP1: r = .368, PIIINP:r = .332, and HA:r = .419 (all P < .001). The strength of the correlation between ELF and HVPG decreased in higher HVPG strata: 6‐9 mm Hg:r = .569(P = .004), 10‐19 mm Hg:r = .304 (P = .001) and ≥20 mm Hg:r = −.023(P = .853).

Area under the receiver operating characteristics (AUROC) of ELF score to detect clinically significant PHT (CSPH; HVPG ≥ 10 mm Hg) was 0.833. Importantly, HA alone yielded an AUROC of 0.828. Detection of CSPH in strictly compensated ACLD (cACLD) patients was less accurate: AUROC: 0.759 (P < .001). CSPH was ruled‐in by ELF ≥ 11.1 with a PPV of 98% (sensitivity: 61%/specificity: 92%/NPV:24%), but CSPH could not be ruled‐out.

ELF score had a low AUROC of 0.677 (0.60‐0.75; P < .001) for the diagnosis of high‐risk PHT (HRPH; HVPG ≥ 20mm Hg) and, thus, HRPH could not be ruled‐in by ELF. However, ELF < 10.1 ruled‐out HRPH with a NPV of 95% (sensitivity: 97%/specificity: 26%/PPV: 39%).

Conclusion

The ELF score correlates with HVPG at values <20 mm Hg. An ELF ≥ 11.1 identifies patients with a high probability of CSPH, while an ELF < 10.1 may be used to rule‐out HRPH.
Birth Spacing and Child Health Trajectories
Authors: Miller Ray , Karra Mahesh
Published: May 2020

Using longitudinal data on a cohort of over 4,000 children from four low‐ and middle‐income countries, we document the association between birth spacing and child growth trajectories. We find declines in child height at age 1 among children who are born within three years of an older sibling. However, we also observe catch‐up growth for closely spaced children as they age. We find no evidence that catch‐up growth is driven by remedial health investments after birth, suggesting substitutability in underlying biological processes. We also find that very widely spaced children (preceding birth interval of more than seven years) are similar in height at age 1 as children who are spaced three to seven years apart, but outgrow their more closely spaced counterparts as they age. However, further sibling comparisons suggest that the growth premium that is observed for very widely spaced children may be driven by unobserved confounding factors.
Cost of hospitalization for bronchiectasis exacerbation in children
Authors: Goyal Vikas , McPhail Steven M. , Hurley Frank , Grimwood Keith , Marchant Julie M. , Masters I. Brent , Chang Anne B.
Published: May 2020

Background and objective

Despite paediatric bronchiectasis being recognized increasingly worldwide, prior reports of hospitalization costs for bronchiectasis in children are lacking. This study aimed to (i) identify health service costs of hospitalizations and (ii) factors associated with these costs in children admitted to an Australian paediatric hospital following an acute exacerbation of their bronchiectasis.

Methods

Demographic and hospital resource use data were prospectively recorded for 100 hospitalizations in 80 children aged <18 years admitted consecutively to the QCH, Brisbane, Australia. Costs (2016 AUD) were obtained from the hospital's Finance Department. Linear regressions, with bootstrap resampling to quantify uncertainty, were used to estimate factors affecting cost of hospitalization.

Results

The 100 hospitalizations (48 males) had a median (IQR) age of 6.04 (4.04–9.85) years. Their mean (SD) LOS was 12.30 (4.60) days. The mean (SD) direct health service cost was AUD 30 182 (13 998) per hospitalization. The greatest contributor to costs was health professional wages, accounting for 70% of the cost per episode. LOS, younger age at admission and number of bronchiectatic lobes affected were associated with higher costs, whilst HITH service was associated with lower cost. The cost to families on average was AUD 2669.50 (SD: 991.50) per hospitalization when accounting for lost wages and opportunity cost.

Conclusion

The per episode healthcare cost burden of hospitalizations for paediatric bronchiectasis exacerbations is substantial. Interventions that prevent hospitalized exacerbations and reduce severity of childhood bronchiectasis with even moderate effectiveness are likely to result in substantial hospital costs savings.
Determinants of multidrug‐resistant tuberculosis in São Paulo—Brazil: a multilevel Bayesian analysis of factors associated with individual, community and access to health services
Authors: Arroyo Luiz Henrique , Yamamura Mellina , Ramos Antônio Carlos Vieira , Campoy Laura Terenciani , Crispim Juliane de Almeida , Berra Thais Zamboni , Alves Luana Seles , Alves Yan Mathias , dos Santos Felipe Lima , Souza Ludmilla Leidianne Limirio , Bruce Alexandre Tadashi Inomata , de Andrade Hamilton Leandro Pinto , Bollela Valdes Roberto , Krainski Elias Teixeira , Nunes Carla , Arcêncio Ricardo Alexandre
Published: May 2020

Objective

Multidrug‐resistant tuberculosis (MDR‐TB) remains a serious public health problem worldwide. Accordingly, this study sought to identify individual, community and access to health services risk factors for MDR‐TB.

Methods

Retrospective cohort of all TB cases diagnosed between 2006 and 2016 in the state of São Paulo. A Bayesian spatial hierarchical analysis with a multilevel design was carried out.

Results

It was identified that the history of previous TB treatment (Odds Ratios [OR]:13.86, 95% credibility interval [95% CI]:12.06–15.93), positive sputum culture test (OR: 5.26, 95% CI: 4.44–6.23), diabetes mellitus (OR: 2.34, 95% CI: 1.87–2.91), residing at a standard address (OR: 2.62, 95% CI: 1.91–3.60), positive sputum smear microscopy (OR: 1.74, 95% CI: 1.44–2.12), cavitary pulmonary TB (OR: 1.35, 95% CI: 1.14–1.60) and diagnosis performed due to spontaneous request (OR: 1.26; 95% CI: 1.10–1.46) were associated with MDR‐TB. Furthermore, municipalities that performed HIV tests in less than 42.65% of patients with TB (OR: 1.50, 95% CI: 1.25–1.79), that diagnosed TB cases only after death (OR: 1.50, 95% CI: 1.17–1.93) and that had more than 20.16% of their population with income between ¼ and ½ of one minimum wage (OR: 1.56, 95% CI: 1.30–1.87) were also related to the MDR‐TB.

Conclusions

Knowledge of these predictive factors may help to develop more comprehensive disease prevention strategies for MDR‐TB, avoiding the risks expressed regarding drug resistance expansion.
Core spliceosomal Sm proteins as constituents of cytoplasmic mRNPs in plants
Authors: Hyjek‐Składanowska Malwina , Bajczyk Mateusz , Gołębiewski Marcin , Nuc Przemysław , Kołowerzo‐Lubnau Agnieszka , Jarmołowski Artur , Smoliński Dariusz Jan
Published: May 2020

In recent years, research has increasingly focused on the key role of post‐transcriptional regulation of messenger ribonucleoprotein (mRNP) function and turnover. As a result of the complexity and dynamic nature of mRNPs, the full composition of a single mRNP complex remains unrevealed and mRNPs are poorly described in plants. Here we identify canonical Sm proteins as part of the cytoplasmic mRNP complex, indicating their function in the post‐transcriptional regulation of gene expression in plants. Sm proteins comprise an evolutionarily ancient family of small RNA‐binding proteins involved in pre‐mRNA splicing. The latest research indicates that Sm could also impact on mRNA at subsequent stages of its life cycle. In this work we show that in the microsporocyte cytoplasm of Larix decidua, the European larch, Sm proteins accumulate within distinct cytoplasmic bodies, also containing polyadenylated RNA. To date, several types of cytoplasmic bodies involved in the post‐transcriptional regulation of gene expression have been described, mainly in animal cells. Their role and molecular composition in plants remain less well established, however. A total of 222 mRNA transcripts have been identified as cytoplasmic partners for Sm proteins. The specific colocalization of these mRNAs with Sm proteins within cytoplasmic bodies has been confirmed via microscopic analysis. The results from this work support the hypothesis, that evolutionarily conserved Sm proteins have been adapted to perform a whole repertoire of functions related to the post‐transcriptional regulation of gene expression in Eukaryota. This adaptation presumably enabled them to coordinate the interdependent processes of splicing element assembly, mRNA maturation and processing, and mRNA translation regulation, and its degradation.
Attitudes and willingness to donate blood among gay and bisexual men in Australia
Authors: Clackett Shawn , Seed Clive R. , Prestage Garrett , Hammoud Mohamed A. , Hoad Veronica , Saxton Peter , Haire Bridget , Holt Martin , Jin Fengyi , Bourne Adam , Maher Lisa , Kaldor John
Published: May 2020

BACKGROUND

Men who have sex with men in Australia are currently ineligible to donate blood (are “deferred”) for 12 months since last oral or anal sexual contact with another man. In Australia and overseas, there has been limited research on attitudes and perceptions related to blood donation in this population.

STUDY DESIGN AND METHODS

Questions on blood donation histories and attitudes toward the deferral policy were included in the questionnaire of an online prospective cohort of gay and bisexual men (GBM) living in Australia.

RESULTS

In 2018, 1595 GBM responded to the survey. In this sample, 28.7% reported previously donating blood. Among the remaining men who had never donated blood, 64.5% expressed an interest in doing so. Nearly all men indicated they were not willing to abstain from sex with another man for 12 months in order to donate, and the vast majority believed the rule was unfair, too strict, and homophobic. Three‐quarters (77.7%) said that if the policy changed, they would likely donate blood. Age and openness about oneʼs sexuality were independently associated with oneʼs willingness to donate blood in the absence of the deferral.

CONCLUSION

There was a high level of willingness and desire to donate blood among GBM. However, rather than abstaining from sex in order to donate, many men comply with the deferral policy and do not donate. A less conservative deferral policy may increase donations from GBM.
Red blood cell transfusions alter splanchnic oxygenation response to enteral feeding in preterm infants: an observational pilot study
Authors: Martini Silvia , Spada Caterina , Aceti Arianna , Rucci Paola , Gibertoni Dino , Battistini Barbara , Arcuri Santo , Faldella Giacomo , Corvaglia Luigi
Published: May 2020

BACKGROUND

Preterm infants often require red blood cell (RBC) transfusions, which may impair splanchnic hemodynamics, thus predisposing to necrotizing enterocolitis (NEC). The aim of this study was to evaluate whether RBC transfusions alter splanchnic oxygenation patterns in response to enteral feeding in this population.

MATERIALS AND METHODS

Preterm neonates (gestational age < 32 weeks and/or birth weight < 1500 g) requiring RBC transfusions for anemia underwent a 12‐hour Near Infrared Spectroscopy monitoring of splanchnic (SrSO2) and cerebral (CrSO2) oxygenation, including the transfusion period, one feed before and one after. Splanchnic‐cerebral oxygenation ratio (SCOR) was also calculated. Patterns of CrSO2, SrSO2, and SCOR changes from baseline (Δ) in response to feed before and after transfusion were analyzed.

RESULTS

Twenty neonates were enrolled; none of them developed any gastrointestinal complication within 48 hours after transfusion. Pre‐transfusion ΔSrSO2 and ΔSCOR increased significantly in response to feeding; on the contrary, a significant post‐prandial decrease of ΔSrSO2 and ΔSCOR occurred after transfusion (p < 0.05). No difference in pre‐ and post‐transfusion ΔCrSO2 patterns was observed.

CONCLUSIONS

In preterm infants, RBC transfusions may alter splanchnic oxygenation response to enteral feeds. Whether these changes are involved in the pathogenesis of transfusion‐associated NEC has to be evaluated in further larger trials.
Hematology of the keeled box turtle (Cuora mouhotii)
Authors: Cerreta Anthony J. , Houck Emma L. , Stowe Devorah M. , Lewbart Gregory A.
Published: May 2020

A healthy adult, intact female keeled box turtle (Cuora mouhotii) was found to have a marked heterophilic leukocytosis using normal hematologic parameters established for the eastern box turtle (Terrapene carolina carolina), a related chelonian species. This animal was monitored with serial complete blood counts (CBCs) over the next 15 years despite remaining asymptomatic for an infectious condition. Retrospective CBC data were compiled from 38 presumably healthy keeled box turtles to establish hematologic values for comparison in this species. Using this species‐specific data, over the 15‐year period, the female keeled box turtle had two times where the white blood cell (WBC) count was greater than 2 standard deviations (SD) above the mean, six times where the WBC count was greater than 1 SD above the mean, six times where the PCV was greater than 2 SD above the mean, and eight times where the PCV was greater than 1 SD above the mean. Infection and inflammation are the most common causes of leukocytosis in reptiles; however, given the clinical presentation of this patient, it was postulated that these clinicopathologic changes could be secondary to a stress response. Establishing reference intervals and understanding how stress impacts CBC parameters are important for evaluating the health status of keeled box turtles kept in captivity and for assessing the effects of environmental changes on the health status of wild populations of this endangered chelonian species.
European Council Note - 20/21 February: Coming to Terms with Failure
Authors: Ludlow Peter
Published: May 2020

The latest Briefng Note documents and seeks to explain a failure. The special European Coun cil of 20-21 February did not just fail to reach an agreement on the EU's Multiannual Financial Framework for 2021-2027. It failed to indicate how one might be reached in the coming weeks or
months. MFF negotiations are always diffcult and, in order to fnish the job, the heads of state and government had had to meet at least twice on previous occasions. The breakdown on this occasion was however ominously complete. There are many reasons for this failure. Four nevertheless appear
to have been particularly relevant: ˙ The lethal juxtaposition of three irreconcilable factors. Firstly, the emergence over the pre vious fve years of a new, more ambitious EU agenda in the face of climate change and other major challenges, all of which required, and therefore raised
expectations of, more rather than less EU expenditure. Secondly, the dependence of a huge clientele in most if not all member states on the maintenance of EU funding for Cohesion and the Common Agricultural Policy. Thirdly, Brexit, which meant that at a time when it needed to spend more, the
EU was bound to have revenue at least 10 billion euros per annum less than in the current MFF. ˙ The entrenchment of group think. Caucuses are normal and healthy. Before and at the February European Council, however, the two main caucuses, the Frugal Four, led by Mark Rutte, and the
Cohesion Group, led by Antonio Costa, displayed levels of collective intran sigence which made agreement impossible. ˙ The inability of Angela Merkel to take the lead in breaking the impasse. Macron's marginal utility was par for the course as far as French presidents in MFF negotiations
are concerned. Merkel, whose position at home had been seriously undermined in the previous fortnight in Thuringia and then in Berlin, could not however step into the breach, even though on the Friday morning she tried to do so. ˙ The failure of Charles Michel, the European Council
president, to maintain his grip on a process which, as a result of his own initiative, had become Michelsache as much as if not more than Chefsache . Since 21 February, the MFF negotiations have been overtaken by the Covid-19 crisis. This has at one and the same time made
an early resumption of the process improbable and cast doubts on some of the factors which militated against success in February. In a situation of unprec edented gravity, European Council members, both severally and collectively, have been chal lenged 'to think outside the box', particularly
about the role of public fnance in facilitating post-crisis recovery. And some at least have begun to do so At the same time, the stock of the intransigents in general and of Mark Rutte in particular has fallen sharply. Thirdly, Michel has been given a fresh lease of life. Whenever therefore
the MFF negotiations resume they will do so in a very different environment.
Multiple acid‐base and electrolyte disturbances upregulate NBCn1, NBCn2, IRBIT and L‐IRBIT in the mTAL
Authors: Wang Jin‐Lin , Wang Xiao‐Yu , Wang Deng‐Ke , Parker Mark D. , Musa‐Aziz Raif , Popple Jacob , Guo Yi‐Min , Min Tian‐Xin , Xia Tian , Tan Min , Liu Ying , Boron Walter F. , Chen Li‐Ming
Published: May 2020

Key points

The roles of the Na+/HCO3– cotransporters NBCn1 and NBCn2 as well as their activators IRBIT and L‐IRBIT in the regulation of the mTAL transport of NH4+, HCO3–, and NaCl are investigated.

Dietary challenges of NH4Cl, NaHCO3 or NaCl all increase the abundance of NBCn1 and NBCn2 in the outer medulla.

The three challenges generally produce parallel increases in the abundance of IRBIT and L‐IRBIT in the outer medulla.

Both IRBIT and L‐IRBIT powerfully stimulate the activities of the mTAL isoforms of NBCn1 and NBCn2 as expressed in Xenopus oocytes.

Our findings support the hypothesis that NBCn1, NBCn2, IRBIT and L‐IRBIT appropriately promote NH4+ shunting but oppose HCO3– and NaCl reabsorption in the mTAL, and thus are at the nexus of the regulation pathways for multiple renal transport processes.

The medullary thick ascending limb (mTAL) plays a key role in urinary acid and NaCl excretion. NBCn1 and NBCn2 are present in the basolateral mTAL, where NBCn1 promotes NH4+ shunting. IRBIT and L‐IRBIT (the IRBITs) are two powerful activators of certain acid‐base transporters. Here we use western blotting and immunofluorescence to examine the effects of multiple acid‐base and electrolyte disturbances on expression of NBCn1, NBCn2 and the IRBITs in rat kidney. We also use electrophysiology to examine the functional effects of IRBITs on NBCn1 and NBCn2 in Xenopus oocytes. NH4Cl‐induced metabolic acidosis (MAc) substantially increases protein expression of NBCn1 and NBCn2 in the outer medulla (OM) of rat kidney. Surprisingly, NaHCO3‐induced metabolic alkalosis (MAlk) and high‐salt diet (HSD) also increase expression of NBCn1 and NBCn2 (effect of NaHCO3 > HSD). Moreover, all three challenges generally increase OM expression of the IRBITs. In Xenopus oocytes, the IRBITs substantially increase the activities of NBCn1 and NBCn2. We propose that upregulation of basolateral NBCn1 and NBCn2 plus the IRBITs in the mTAL: (1) promotes NH4+ shunting by increasing basolateral HCO3– uptake to neutralize apical NH4+ uptake during MAc; (2) inhibits HCO3– reabsorption during MAlk by opposing HCO3− efflux via the basolateral anion exchanger AE2; and (3) inhibits NaCl reabsorption by mediating (with AE2) net NaCl backflux into the mTAL cell during HSD. Thus, NBCn1, NBCn2 and the IRBITs are at the nexus of the regulatory pathways for multiple renal transport processes.
Geometrical Nonlinear Effects in the Dynamic Response of Sandwich Beams
Authors: Odessa Itay , Rabinovitch Oded , Frostig Yeoshua
Published: May 2020

The geometrical nonlinear dynamic response of sandwich beams is studied using a dynamic high-order nonlinear model. The model is derived using the variational principle of virtual work and uses the Extended High-Order Sandwich Panel Theory approach with consideration of two interfaces between the three layers. A first-order shear deformation theory is adopted for the face sheets, while the kinematic assumption of high-order small deformations that account for out-of-plane compressibility are considered for the core layer. The nonlinearity of the dynamic model is introduced by considering geometrically nonlinear kinematic relations in the face sheets. The nonlinear kinematic relations and the dynamic modeling aim to evaluate the effects of the two features and their coupling on the response. The nonlinear dynamic response of sandwich beams is studied through two numerical cases and comparison of the nonlinear results with their linear counterparts. The first case looks into the coupling of the global geometrical nonlinear behavior with the dynamic behavior. The second case focuses on the local instability of the face sheets and its interaction with the compressibility of the core in the dynamic response of soft core sandwich beams. The comparison of linear and nonlinear dynamic response in the two cases sheds light on the coupling of the geometrical nonlinear and dynamic behaviors. Among other features, the latter is expressed by nonlinear attractors, higher modes response, nonlinear frequency response, and significant wrinkling response.
Fast Simulation of a Single Degree-of-Freedom System Consisting of An Iwan Element Using the Method of Averaging
Authors: Shetty Drithi , Allen Matthew
Published: May 2020

While Iwan elements have been used to effectively model the stiffness and energy dissipation in bolted joints, integrating the equations of motion of these elements is fairly expensive since implicit schemes, such as Newmark’s methods, need to be used. This paper presents a method of simulating dynamic systems containing nonlinear Iwan elements that significantly reduce the computation cost by using closed-form expressions for stiffness and damping in the microslip regime and an averaging method for regions of time in which no external force is applied. The proposed algorithm is demonstrated on a single degree-of-freedom (SDOF) system to evaluate the range over which it retains accuracy and the improvement in performance it offers. Although the current implementation is limited to SDOF systems, it can be used to simulate the response of each mode in structures exhibiting weak nonlinearity that can be modeled using the modal Iwan approach. To verify this, the dynamic response of a finite element model of a beam assembly, integrated using the Newmark-β method, has been compared with its equivalent modal model integrated using the proposed algorithm. The results show that the algorithm accurately predicts the response in a fraction of the time taken by implicit integration schemes, so long as the modes remain uncoupled and weakly nonlinear.