bluuebunny/crossref_metadata_2025 huggingface dataset:
Silicone Additive Manufactured Indices Performed from a Virtual Diagnostic Waxing for Direct Composite Diastema Closure Combined with Resin Infiltration Technique on White Spot Lesions: A Case Report
Authors: Revilla‐León Marta , Fountain Joshua , Piedra‐Cascón Wenceslao , Zandinejad Amirali , Özcan Mutlu
Published: August 2019

The present article describes the resin infiltration technique to address white spots lesions presented on anterior and premolar teeth of a young patient after orthodontic treatment and the digital workflow for planning a diastema closure on the maxillary anterior teeth using facial photographs, an intraoral scanner, a facially driven diagnostic waxing using a dental computer‐aided design (CAD) software, and 3‐piece additive manufactured (AM) clear silicone indices. The virtual design of the silicone indices was completed using an open‐source CAD software and included a flexible clear buccal piece, flexible clear lingual piece, and rigid clear custom tray. The unique 3‐piece index design allows a horizontal path of insertion, controlled uniform thickness of the indices, flexible and rigid material properties combination, accurate translation of the diagnostic waxing into the patient´s mouth, and digital storage of the designs.
Self–other personality agreement and internalizing problems in adolescence
Authors: Luan Ziyan , Bleidorn Wiebke
Published: August 2019

Objective

Achieving a clear self‐view is a lifelong task that is particularly salient during adolescence. Theory and research suggest that close others’ perceptions of individuals’ personality may influence the formation and maintenance of coherent self‐views. The degree to which adolescents develop a stable and coherent self‐view, in turn, may have perennial influences on their mental health and well‐being. This 1‐year longitudinal study investigated the associations between the agreement of self‐ and other‐rated Big Five personality traits and internalizing problems in adolescence.

Method

Participants were 570 Dutch adolescents (51% girls), their mothers, friends, and siblings. We examined the cross‐sectional and longitudinal associations between self–other personality agreement and internalizing problems using polynomial regression analyses and response surface analyses.

Results

Results indicated strong main effects of self‐ and other‐rated personality traits on internalizing problems but provided little evidence for longitudinal associations between self–other personality agreement and internalizing problems.

Conclusion

Our results cast doubt on the generalizability of the beneficial effects of self–other agreement documented in the adult literature to adolescents but highlight the importance of self‐ and other‐rated personality in youth's mental health development. Discussion focuses on the theoretical implications and recommendations for future investigations of self–other agreement.
Mummified fossil of Keteleeria from the Late Pleistocene of Maoming Basin, South China, and its phytogeographical and paleoecological implications
Authors: Huang Lu‐Liang , Jin Jian‐Hua , Oskolski Alexei A.
Published: August 2019

Keteleeria is a small genus of Pinaceae now mainly restricted to eastern Asia. Although this genus has been documented with a wide distribution in the geologic record of Europe, North America, and Asia, its history in low‐latitude areas (including South China) has remained obscure. In this paper, a fossil wood of Keteleeria sp. is described from the Late Pleistocene (29–27 ka BP) of the Maoming Basin, South China. This wood is the most ancient megafossil evidence of Keteleeria within the modern distribution area of this genus. The fossil records of Keteleeria suggests that this thermophyllous genus migrated into South China by the Middle Pleistocene escaping from glacial cooling and became widespread over this region in the Late Pleistocene beginning from the interglacial stage preceding the Last Glacial Maximum. The analysis of growth rings in the fossil wood and its comparison with those of modern Keteleeria davidiana (Bertrand) Beissner indicates that in the Late Pleistocene of Maoming Basin (29–27 ka BP) there was a humid climate with less pronounced seasonality of precipitation than that seen in the subtropical monsoonal climate of modern northeastern Vietnam. Apparently, the Maoming Basin was influenced by interglacial regime with summer–monsoon circulation. The previously proposed method to distinguish between evergreen and deciduous conifers based on growth ring anatomy, is not reliable because of the wide variance and ambiguity in its results.
Improvement of gel properties of mackerel mince by phlorotannin extracts from sporophyll of Undaria pinnatifidai and UVA induced cross‐linking
Authors: Jiang Di , Bai Ying , He Baoyu , Sui Yue , Dong Xiufang , Yu Chenxu , Qi Hang
Published: August 2019

The effects of phlorotannin extracts (PTE) (from sporophyll of Undaria pinnatifida) added at different concentration (0, 1.6, 8, and 40 mg/g protein) with and without ultraviolet A (UVA) irradiation treatment on gel properties of mackerel (Scomberomorus niphonius) mince (MM) were investigated. The results indicated that both the breaking force and water‐holding capacity (WHC) of the MM gel increased with addition of PTE, and the highest breaking force and WHC were observed with 40 mg/g PTE under UVA irradiation. Low‐field nuclear magnetic resonance revealed that free water significantly decreased in this PTE‐MM gel as well. UVA irradiation treatment led to reduction of total sulfhydryls and free amines in the PTE‐MM gel, indicating more cross‐linking between proteins. Electrophoresis results indicated that myosin heavy chains were aggregated in the UVA‐treated PTE‐MM gel. The microstructure of the UVA‐treated PTE‐MM gel showed that protein formed more evenly distributed cross‐linked structures and was more compact than the untreated control gel. As a conclusion, PTE addition with UVA irradiation is shown to improve gelling properties of mackerel mince.
Sexual dimorphism in the size and shape of the raptorial pedipalps of Giant Whip Spiders (Arachnida: Amblypygi)
Authors: McLean C.J. , Garwood R.J. , Brassey C.A.
Published: August 2019

Sexual dimorphism in the form of elaborate crests, horns and swellings can be a clear indicator of the differing evolutionary pressures to which males and females are subject. However, dimorphism can also be expressed in more subtle shape differences not outwardly obvious to the observer. Whip spiders (Amblypygi) possess a unique pair of spined pedipalps hypothesized to primarily function in prey capture, but also serving multiple other functions. Little is known regarding the intraspecific shape variation of these limbs and its potential causes. Because a role during courtship and male contest has also been hypothesized, sexual selection may contribute to shape differences. As such, we hypothesize that sexual dimorphism will be present in the size and shape of amblypygid pedipalps, with male contest selecting for longer and thicker pedipalps, and larger spines in males. This study aims to test this hypothesis, by quantifying the contribution of ontogeny and sexual dimorphism to shape within the raptorial pedipalps of Damon variegatus. Discriminant function analysis using GMM landmark data reveals statistically significant sexual shape dimorphism in both the tibia and femur of the pedipalp. Contrary to our hypothesis, males display a more gracile pedipalp morphology with reduced spination. Sex differences in the allometric slope and overall size were also found in a number of linear appendicular metrics using Type‐II regression. Males have statistically longer pedipalp tibiae, whip femora, and leg two femora. We propose that males have evolved a longer pedipalps in the context of display contest rather than physical aggression. The elongation of structures used in display‐based contest and courtship found herein further emphasizes the contribution of visual cues to the evolution of morphology more broadly.
Metabolic syndrome, but not non‐alcoholic fatty liver disease, increases 10‐year mortality: A prospective, community‐cohort study
Authors: Niriella Madunil A. , Kasturiratne Anuradhani , Beddage Thulani U. , Withanage Shanthi A. , Goonatilleke Dilith C. , Abeysinghe Chathurika P. , De Mel Ruvini T. , Balapitiya Thilini L. , De Silva Shamila T. , Dassanayake Anuradha S. , De Silva Arjuna P. , Pathmeswaran Arunasalam , Wickramasinghe Ananda R. , Kato Nirihiro , de Silva Hithanadura J.
Published: August 2019

Background

Data on outcomes of non‐alcoholic fatty liver disease (NAFLD) from South Asia are lacking. We compared mortality, among those with‐ and without‐NAFLD, after 10‐years follow‐up among urban, adult Sri Lankans.

Method

Participants (aged 35‐64 years), selected by age‐stratified random sampling, were screened by structured‐interview in 2007. Anthropometric measurements, liver ultrasonography and biochemical/serological tests were done. NAFLD was diagnosed on ultrasound criteria, safe‐alcohol consumption (Asian‐standards) and absence of hepatitis B/C. Subjects without NAFLD were those without any ultrasound criteria of fatty liver, safe‐alcohol consumption and absence of hepatitis B/C. The cohort was re‐evaluated to assess mortality in 2017. Participants or their households were contacted by telephone/post, and deaths confirmed by home‐visits and death certificate review. Cox‐regression was used to determine predictors of all‐cause mortality (ACM) and cardiovascular mortality (CVM) in those with‐ and without‐NAFLD.

Results

2724 (91.2%) of 2985 original participants were contacted (851‐with NAFLD and 1072‐without NAFLD). Overall there were 169 (6.2%) deaths [41‐deaths among NAFLD (17‐cardiovascular; 9‐cancer‐related; 4‐liver‐specific; 11‐other) and 79‐deaths among no‐NAFLD (28‐cardiovascular; 17‐cancer‐related; 1‐liver‐specific; 33‐other)]. Metabolic syndrome (MetS), low‐education level, higher age and male‐gender independently predicted ACM. MetS, increasing age and male‐gender independently predicted CVM. NAFLD did not predict either ACM or CVM. In those with NAFLD, MetS and age >55‐years were independently associated with ACM, while MetS and male‐gender were associated with CVM.

Conclusion

In this community‐based study, increasing age, male‐gender and MetS, but not NAFLD, predicted 10‐year ACM and CVM. Among those with NAFLD, only those metabolically abnormal were at a higher risk for mortality.
Sex‐specific changes in the aphid DNA methylation landscape
Authors: Mathers Thomas C. , Mugford Sam T. , Percival‐Alwyn Lawrence , Chen Yazhou , Kaithakottil Gemy , Swarbreck David , Hogenhout Saskia A. , van Oosterhout Cock
Published: August 2019

Aphids present an ideal system to study epigenetics as they can produce diverse, but genetically identical, morphs in response to environmental stimuli. Here, using whole genome bisulphite sequencing and transcriptome sequencing of the green peach aphid (Myzus persicae), we present the first detailed analysis of cytosine methylation in an aphid and investigate differences in the methylation and transcriptional landscapes of male and asexual female morphs. We found that methylation primarily occurs in a CG dinucleotide (CpG) context and that exons are highly enriched for methylated CpGs, particularly at the 3′ end of genes. Methylation is positively associated with gene expression, and methylated genes are more stably expressed than unmethylated genes. Male and asexual female morphs have distinct methylation profiles. Strikingly, these profiles are divergent between the sex chromosome and the autosomes; autosomal genes are hypomethylated in males compared to asexual females, whereas genes belonging to the sex chromosome, which is haploid in males, are hypermethylated. Overall, we found correlated changes in methylation and gene expression between males and asexual females, and this correlation was particularly strong for genes located on the sex chromosome. Our results suggest that differential methylation of sex‐biased genes plays a role in aphid sexual differentiation.
Evolution of the visual sensory system in cichlid fishes from crater lake Barombi Mbo in Cameroon
Authors: Musilova Zuzana , Indermaur Adrian , Bitja‐Nyom Arnold Roger , Omelchenko Dmytro , Kłodawska Monika , Albergati Lia , Remišová Kateřina , Salzburger Walter
Published: August 2019

In deep‐water animals, the visual sensory system is often challenged by the dim‐light environment. Here, we focus on the molecular mechanisms involved in rapid deep‐water adaptations. We examined visual system evolution in a small‐scale yet phenotypically and ecologically diverse adaptive radiation, the species flock of cichlid fishes in deep crater lake Barombi Mbo in Cameroon, West Africa. We show that rapid adaptations of the visual system to the novel deep‐water habitat primarily occurred at the level of gene expression changes rather than through nucleotide mutations, which is compatible with the young age of the radiation. Based on retinal bulk RNA sequencing of all eleven species, we found that the opsin gene expression pattern was substantially different for the deep‐water species. The nine shallow‐water species feature an opsin palette dominated by the red‐sensitive (LWS) opsin, whereas the two unrelated deep‐water species lack expression of LWS and the violet‐sensitive (SWS2B) opsin, thereby shifting the cone sensitivity to the centre of the light spectrum. Deep‐water species further predominantly express the green‐sensitive RH2Aα over RH2Aβ. We identified one amino acid substitution in the RH2Aα opsin specific to the deep‐water species. We finally performed a comparative gene expression analysis in retinal tissue of deep‐ vs. shallow‐water species. We thus identified 46 differentially expressed genes, many of which are associated with functions in vision, hypoxia management or circadian clock regulation, with some of them being associated with human eye diseases.
Effects of moderate and severe hypocapnia on intracerebral perfusion and brain tissue oxygenation in piglets
Authors: Ringer Simone K. , Clausen Nicola G. , Spielmann Nelly , Weiss Markus
Published: August 2019

Background

Hypocapnia is a common alteration during anesthesia in neonates.

Aim

To investigate the effects of hypocapnia and hypocapnia combined with hypotension (HCT) on cerebral perfusion and tissue oxygenation in anesthetized piglets.

Method

Thirty anesthetized piglets were randomly allocated to groups: moderate hypocapnia (mHC), severe hypocapnia (sHC), and HCT. Cerebral monitoring comprised a tissue oxygen partial pressure and a laser Doppler probe inserted into the brain tissue as well as a near‐infrared spectroscopy (NIRS) sensor placed on the skin, measuring regional oxygen saturation. Hypocapnia was induced by hyperventilation (target PaCO2 mHC: 3.7‐4; sHC: 3.1‐3.3 kPa) and hypotension by blood withdrawal and nitroprusside infusion (mean blood pressure: 35‐38 mm Hg). Data were analyzed at baseline, during (Tr20, Tr40, Tr60) and after (Post20, Post40, Post60) treatment.

Results

Compared to baseline, tissue oxygen partial pressure decreased significantly and equally during all treatments (mean [SD] at baseline: mHC 35.7 [32.45]; sHC: 28.1 [20.24]; HCT 25.4 [10.3] and at Tr60: mHC: 29.9 [27.36]; sHC: 22.2 [18.37]; HCT: 18.4 [9.5] mm Hg). Decreased laser Doppler flow was detected with all treatments at Tr20 (mHC: 0.9 [0.18]; sHC: 0.88 [0.15]; HCT: 0.97 [0.13] proportion from baseline). Independently of group, regional oxygen saturation varied only after reverting and not during treatment. Blood lactate, pH, HCO3−, and PaO2 increased during treatment with no differences between groups.

Conclusion

This animal model revealed reduced cerebral blood flow and brain tissue oxygenation during hypocapnia without detectable changes in regional oxygen saturation as measured by NIRS. Changes occurred as early as during moderate hypocapnia.
TaCYP81D5, one member in a wheat cytochrome P450 gene cluster, confers salinity tolerance via reactive oxygen species scavenging
Authors: Wang Meng , Yuan Jiarui , Qin Lumin , Shi Weiming , Xia Guangmin , Liu Shuwei
Published: August 2019

As one of the largest gene families in plants, the cytochrome P450 monooxygenase genes (CYPs) are involved in diverse biological processes including biotic and abiotic stress response. Moreover, P450 genes are prone to expanding due to gene tandem duplication during evolution, resulting in generations of novel alleles with the neo‐function or enhanced function. Here, the bread wheat (Triticum aestivum) gene TaCYP81D5 was found to lie within a cluster of five tandemly arranged CYP81D genes, although only a single such gene (BdCYP81D1) was present in the equivalent genomic region of the wheat relative Brachypodium distachyon. The imposition of salinity stress could up‐regulate TaCYP81D5, but the effect was abolished in plants treated with an inhibitor of reactive oxygen species synthesis. In SR3, a wheat cultivar with an elevated ROS content, the higher expression and the rapider response to salinity of TaCYP81D5 were related to the chromatin modification. Constitutively expressing TaCYP81D5 enhanced the salinity tolerance both at seedling and reproductive stages of wheat via accelerating ROS scavenging. Moreover, an important component of ROS signal transduction, Zat12, was proven crucial in this process. Though knockout of solely TaCYP81D5 showed no effect on salinity tolerance, knockdown of BdCYP81D1 or all TaCYP81D members in the cluster caused the sensitivity to salt stress. Our results provide the direct evidence that TaCYP81D5 confers salinity tolerance in bread wheat and this gene is prospective for crop improvement.
Identifying electrophysiological markers of autism spectrum disorder and schizophrenia against a backdrop of normal brain development
Authors: Edgar J. Christopher
Published: August 2019

An examination of electroencephalographic and magnetoencephalographic studies demonstrates how age‐related changes in brain neural function temporally constrain their use as diagnostic markers. A first example shows that, given maturational changes in the resting‐state peak alpha frequency in typically developing children but not in children who have autism spectrum disorder (ASD), group differences in alpha‐band activity characterize only a subset of children who have ASD. A second example, auditory encoding processes in schizophrenia, shows that the complication of normal age‐related brain changes on detecting and interpreting group differences in neural activity is not specific to children. MRI studies reporting group differences in the rate of brain maturation demonstrate that a group difference in brain maturation may be a concern for all diagnostic brain markers. Attention to brain maturation is needed whether one takes a DSM‐5 or a Research Domain Criteria approach to research. For example, although there is interest in cross‐diagnostic studies comparing brain measures in ASD and schizophrenia, such studies are difficult given that measures are obtained in one group well after and in the other much closer to the onset of symptoms. In addition, given differences in brain activity among infants, toddlers, children, adolescents, and younger and older adults, creating tasks and research designs that produce interpretable findings across the life span and yet allow for development is difficult at best. To conclude, brain imaging findings show an effect of brain maturation on diagnostic markers separate from (and potentially difficult to distinguish from) effects of disease processes. Available research with large samples already provides direction about the age range(s) when diagnostic markers are most robust and informative.
An approach to study the local embryo effect on gene expression in the bovine oviduct epithelium in vivo
Authors: Rodríguez‐Alonso Beatriz , Hamdi Meriem , Sánchez José María , Maillo Veronica , Gutierrez‐Adan Alfonso , Lonergan Pat , Rizos Dimitrios
Published: August 2019

This study aimed to examine the local embryo effect on the transcriptomic response of the epithelial cells of the oviduct in vivo. Fifteen heifers were synchronized and artificially inseminated to a standing heat. All heifers were slaughtered on Day 2.5 after oestrus. The oviducts from 13 animals were isolated, trimmed free of tissue and divided between ampulla/isthmus. The ipsilateral isthmus was divided into smaller sections (2 cm). Each section was sequentially flushed until the embryo was located (4/13) and then opened and scraped longitudinally to obtain the epithelial cells. Cells were snap‐frozen in LN2 for gene expression analysis. All recovered embryos were found at the beginning of the isthmus. The 2 cm sections selected for the transcriptomic analysis were as follows: embryo section (in which the embryo was found); proximal section (through which the embryo had passed); distal section (on the uterine side of the embryo); and contralateral section (section from the contralateral isthmus). The expression pattern of eight genes (STK32A, KERA, QRFPR, MCTP1, PRELP, VAT1L, SOCS3 and CCL20) differentially expressed between the isthmus of pregnant (multiple embryo model) and cyclic heifers were assessed by RT‐qPCR. One‐way ANOVA and t test was used for statistical analysis. Comparisons between ipsilateral and contralateral oviduct or along the ipsilateral oviduct resulted in no differences for all genes. Despite the failure to detect a site‐specific response of a single embryo on the abundance of distinct transcripts in the bovine oviduct in vivo on Day 2.5, the current methodology with proposed modifications would be useful for future studies to examine the local embryo effect.
Linkage disequilibrium and effective population size in Gir cattle selected for yearling weight
Authors: Toro Ospina Alejandra M. , Maiorano Amanda Marchi , Curi Rogério A. , Pereira Guilherme L. , Zerlotti‐Mercadante Maria Eugenia , dos Santos Gonçalves Cyrillo Joslaine Noely , Aspilcueta‐Borquis Rusbel R. , de V. Silva Josineudson A. II
Published: August 2019

Linkage disequilibrium (LD) plays an important role in genomic selection and mapping of quantitative trait loci (QTL). This study investigated the pattern of LD and effective population size (Ne) in Gir cattle selected for yearling weight. For this purpose, 173 animals with imputed genotypes (from 18 animals genotyped with the Illumina BovineHD BeadChip and 155 animals genotyped with the Bovine LDv4 panel) were analysed. The LD was evaluated at distances of 25–50 kb, 50–100 kb, 100–500 kb and 0.5–1 Mb. The Ne was estimated based on 5 past generations. The r2 values (a measure of LD) were, respectively, .35, .29, .18 and .032 for the distances evaluated. The LD estimates decreased with increasing distance of SNP pairs and LD persisted up to a distance of 100 kb (r2 = .29). The Ne was greater in generations 4 and 5 (24 and 30 animals, respectively) and declined drastically after the last generation (12 animals). The results showed high levels of LD and low Ne, which were probably due to the loss of genetic variability as a consequence of the structure of the Gir population studied.
Psychological reactance and negative emotional reactions in the link between psychological control and adolescent adjustment
Authors: Laird Robert D. , Frazer Andrew L.
Published: August 2019

Researchers consistently report links between psychological control and adolescent behavior problems, but the processes linking psychological control with behavior problems are unclear. Adolescents’ negative emotional reactions and psychological reactance were tested as potential longitudinal mediators linking parental psychological control with both internalizing and externalizing behavior problems. Data were collected from a sample of 242 adolescents (M age = 15.4 at Time 1; 50.8% female; 50% white, non‐Hispanic, 18% African American, 16% Hispanic, and 16% of other or multiple ethnicities) at three time points over a 2‐year period. Adolescents self‐reported depressive symptoms, antisocial behavior, negative emotional reactions, and psychological reactance. Adolescents and their parents provided ratings of parental psychological control. Cross‐sectional models replicated patterns previously reported suggesting that negative emotional reactions and reactance mediate between psychological control and internalizing and externalizing behavior problems. However, in cross‐lagged panel models, neither negative emotional reactions nor reactance emerged as a mediator between psychological control and internalizing or externalizing problems. In contrast, results suggested that psychological control is an outcome of rather than contributor to, negative emotional reactions. Moreover, the addition of random intercepts to cross‐lagged models indicated that associations between psychological control, emotional and behavioral reactions, and internalizing/externalizing behavior may represent stable trait‐like patterns.
Subnational home market bias in Vietnam: Evidence from enterprise‐level data
Authors: Co Catherine Y. , Nguyen Thu Kim , Tran Que Nguyet , Nguyen Tung Nhu
Published: August 2019

This paper contributes to the home (market) bias literature where administrative or political borders limit trade across borders. Home bias is well documented at the national and subnational level. To sort out macro (e.g., location characteristics) and micro (e.g., enterprise characteristics) factors behind home bias, we use small and medium‐sized enterprise (SME) data from Vietnam. Using the fractional multinomial logit model, we find that the proportion of SME sales outside of their home markets is positively associated with enterprise size, age, number of business association memberships and the distance of SMEs' most important supplier. In contrast, the proportion of SME sales to neighbouring provinces is negatively associated with the share of SME production for final consumption. Besides enterprise‐level frictions, market characteristics matter too. The proportion of SME sales to customers in their home markets is negatively associated with home or neighbouring provinces' governance quality, while the proportion of sales to customers in neighbouring provinces is positively associated with these areas' governance quality. These suggest that good governance frees SME resources for use in selling to less familiar markets.
Laryngopyocele in a case of bilateral mixed laryngocele: an impending airway emergency
Authors: Saravanam Prasanna Kumar , Manimaran Vinoth , Ramadhan Mohamed , Prakash Gowthame Kanagasabai
Published: August 2019

Laryngopyocele is a rare complication involving the laryngocele which can present with acute airway compromise. A 31-year-old man presented with acute onset respiratory distress and dysphagia. He had swelling on either side of upper aspect of the neck with tenderness on left side. Videolaryngoscopy using 70° rigid Hopkins rod telescope showed a swelling in the left pyriform sinus pushing the ipsilateral vocal cord. However, glottic space was adequate. Contract-enhanced CT scan of the neck confirmed left-sided mixed laryngopyocele with contralateral mixed laryngocele. Patient underwent excision of both the lesions in a single stage by transcervical approach. Laryngopyocele in a case of bilateral mixed laryngocele presenting as an impending airway emergency has not been reported in literature. The diagnostic and therapeutic challenges are discussed here along with review of literature.
Diagnostic conundrum: simultaneous gallstone ileus and a gas-filled inguinal hernia in a patient with lower abdominal pain
Authors: Whitworth Jacob , James Richard , Hopkins James
Published: August 2019

Gallstone ileus and small bowel diverticulosis are uncommon pathologies. However, the simultaneous presentation of both in this patient provided a diagnostic puzzle for the surgical and radiological teams at our institution. The imaging also demonstrated several typical features for the pathologies in question. Ultimately the management of the patient was not compromised by the diagnostic dilemma, but the imaging findings represent a useful learning opportunity for all radiologists and general surgeons.
Duplication of 1q31.3q41 in two affected siblings due to paternal insertional translocation
Authors: Sihombing Nydia Rena Benita , de Leeuw Nicole , van Bokhoven Hans , Faradz Sultana MH
Published: August 2019

We report two sisters with developmental delay and dysmorphic features, as well as a history of seizures. Both sisters have short stature, microcephaly and shared facial dysmorphisms. We detected an 18.1 Mb interstitial gain in 1q31.3q41 and a 140 kb interstitial loss in 7p11.2 in both siblings by using array analysis in the older sister and copy number variation analysis in whole exome sequencing data in the younger sister. We further examined parental chromosomes and found an insertional translocation in the unaffected father, having a 46,XY,ins(7;1)(p11.2;q31.3q41) karyotype. A 1.8 Mb loss at the rearranged 1q segment was subsequently detected on additional array analysis in the father, as well as the 140 kb loss in 7p11.2. We describe the clinical consequences of the 18.1 Mb duplication of the long arm of chromosome 1 due to an unbalanced paternal insertional translocation and compare these with the clinical phenotypes of patients with an overlapping 1q duplication.
Systematic ultrastructural comparison of swept-source and full-depth spectral domain optical coherence tomography imaging of diabetic macular oedema
Authors: Mitsch Christoph , Lammer Jan , Karst Sonja , Scholda Christoph , Pablik Eleonore , Schmidt-Erfurth Ursula Margarethe
Published: August 2019

Background/Aims

Optical coherence tomography (OCT) is commonly used to diagnose and assess diabetic macular oedema (DME). Swept-source OCT (SS-OCT) promises improved imaging depth and more independence from media opacities. Heidelberg Spectralis full-depth imaging (FDI) combines details at different depths to one representation. The aim of this study was to determine the comparability of the imaging methods concerning DME ultrastructure.

Methods

Two graders assessed the presence of typical DME phenomena in eyes with centre-involving DME on Topcon Atlantis SS-OCT and Heidelberg Spectralis FDI spectral-domain OCT (SD-OCT) B-scans. Retinal layer segmentation was corrected and choroidal layers were manually segmented. Graders measured cyst and subretinal fluid (SRF) diameters and counted hyper-reflective foci (HRF). Findings were recorded and statistically analysed.

Results

Statistically significant systematic biases (Spectralis-Atlantis) were found for the HRF count (outside the central mm, −6.39, p=0.0338), chorioretinal thickness (central mm: −35.45 µm, p=0.00034), choroidal thickness (central mm: −60.97 µm, p=0.00004) and Sattler’s layer thickness (−42.69 µm, p=0.0001). Intergrader agreement was excellent or very good for posterior vitreous detachment, vitreomacular attachment (central mm) and SRF presence in both devices. Manually delineated Sattler’s layer thickness showed an intraclass correlation of 0.85 with FDI SD-OCT but 0.26 with SS-OCT (p=0.003).

Conclusion

Prominent aspects such as cysts in the outer nuclear layer and SRF can be identified with comparable confidence, while a significant systematic bias underlies chorioretinal, choroidal and Sattler’s layer thickness and HRF count. Specialists should use the same device at every examination during longitudinal clinical consideration or cross-sectional evaluation of these ultrastructural biomarkers.
Effects of expanding a non-contributory health insurance scheme on out-of-pocket healthcare spending by the poor in Turkey
Authors: Tirgil Abdullah , Dickens William T , Atun Rifat
Published: August 2019

Introduction

Insufficient or no health insurance creates financial access barriers to healthcare services, especially for vulnerable populations. The Green Card scheme, a non-contributory government-funded health insurance scheme for the poor in Turkey, was expanded in 2003–2006 and has provided citizens with extended benefits. We study the effects of this expansion of the Green Card scheme on out-of-pocket healthcare expenditures for low-income households.

Methods

We use difference-in-differences study design to examine the causal impact of having a Green Card on financial protection in terms of out-of-pocket health expenditures and catastrophic expenditures for the poor in Turkey. In addition, we implement quantile regression analysis to examine how the benefits expansion affects the poor who have the largest out-of-pocket expenditures and are in the upper tail of the health spending distribution.

Results

We find that the expansion of benefits coverage leads to significant reductions in annualised out-of-pocket healthcare expenditures for dental care, diagnostics services, pharmaceuticals and total medical spending. We show that the decline in spending by Green Card beneficiaries corresponds to about 33% as per cent of total per-household medical spending. Quantile regression analysis shows that the scheme is even more effective at reducing expenditures for those people facing large health expenditures. The scheme reduces the incidence of catastrophic expenditures by nearly 50% among those with the largest annual out-of-pocket expenditures.

Conclusions

Increasing benefits coverage for a non-contributory insurance programme leads to financial protection for the poor by reducing out-of-pocket and catastrophic health expenditures. It is even more effective at reducing out-of-pocket health spending for those whose health expenditures that lie on the high end of healthcare spending distribution.
Do you recommend cancer screening to your patients? A cross-sectional study of Norwegian doctors
Authors: Bringedal Berit , Fretheim Atle , Nilsen Stein , Isaksson Rø Karin
Published: August 2019

Objective

Guidelines for cancer screening have been debated and are followed to varying degrees. We wanted to study whether and why doctors recommend disease-specific cancer screening to their patients.

Design

Our cross-sectional survey used a postal questionnaire. The data were examined with descriptive methods and binary logistic regression.

Setting

We surveyed doctors working in all health services.

Participants

Our participants comprised a representative sample of Norwegian doctors in 2014/2015.

Primary and secondary outcome measures

The primary outcome is whether doctors reported recommending their patients get screening for cancers of the breast, colorectum, lung, prostate, cervix and ovaries. We examined doctors’ characteristics predicting adherence to the guidelines, including gender, age, and work in specialist or general practice. The secondary outcomes are reasons given for recommending or not recommending screening for breast and prostate cancer.

Results

Our response rate was 75% (1158 of 1545). 94% recommended screening for cervical cancer, 89% for breast cancer (both established as national programmes), 42% for colorectal cancer (upcoming national programme), 41% for prostate cancer, 21% for ovarian cancer and 17% for lung cancer (not recommended by health authorities). General practitioners (GPs) adhered to guidelines more than other doctors. Early detection was the most frequent reason for recommending screening; false positives and needless intervention were the most frequent reasons for not recommending it.

Conclusions

A large majority of doctors claimed that they recommended cancer screening in accordance with national guidelines. Among doctors recommending screening contrary to the guidelines, GPs did so to a lesser degree than other specialties. Different expectations of doctors’ roles could be a possible explanation for the variations in practice and justifications. The effectiveness of governing instruments, such as guidelines, incentives or reporting measures, can depend on which professional role(s) a doctor is loyal to, and policymakers should be aware of these different roles in clinical governance.
Impact of family physicians on cervical cancer screening: cross-sectional questionnaire-based survey in a region of southern Poland
Authors: Nessler Katarzyna , Chan Sze Kay Florence , Ball Francis , Storman Monika , Chwalek Michal , Krztoń-Królewiecka Anna , Kryj-Radziszewska Elżbieta , Windak Adam
Published: August 2019

Background

Despite worldwide efforts in encouraging routine pap smears for early detection of cervical cancer, Poland’s screening rate lags behind the rest of the European Union at 20.2%. Family physicians (FPs) in Poland rarely perform pap smears, and little is known about the experiences and attitudes of Polish patients regarding pap smear screening in a primary healthcare (PHC) setting.

Methods

A cross-sectional questionnaire-based survey was performed. Questionnaires were distributed among 43 FPs and 418 of their patients in one Polish region. The data from patients were associated with the doctors’ characteristics. Descriptive statistics, the χ2test and the Mann-Whitney U test were used for analysis.

Results

Nearly two-thirds of patients (66%) declared willingness to undergo free pap smear screening by their FPs, with the most common reason being time saved. Among those objecting to receive pap smears from their FPs, immediate specialist care provided by gynaecologists in case of adverse results was the main concern. The factors that positively influenced the patients’ decision to undergo cervical cancer screening in PHC were: (1) living in a city with more than 100 000 inhabitants, (2) being single, (3) having a female FP or (4) a physician with specialty training in family medicine.

Conclusion

There is high level of acceptance for pap smears performed in PHC offices among patients in Poland. They are more likely to comply with the screening due to easy access. Establishing a solid physician–patient relationship is also crucial in encouraging screening.
Impact of a system-wide quality improvement initiative on blood pressure control: a cohort analysis
Authors: Pfoh Elizabeth R , Martinez Kathryn , Vakharia Nirav , Rothberg Michael
Published: August 2019

Objective

To assess the impact of a quality improvement programme on blood pressure (BP) control and determine whether medication intensification or repeated measurement improved control.

Design

Retrospective cohort comparing visits in 2015 to visits in 2016 (when the programme started).

Subjects

Adults with ≥1 primary care visit between January and June in 2015 and 2016 and a diagnosis of hypertension in a large integrated health system.

Measures

Elevated BP was defined as a BP ≥140/90 mm Hg. Physician response was defined as: nothing; BP recheck within 30 days; or medication intensification within 30 days. Our outcome was BP control (<140/90 mm Hg) at the last visit of the year. We used a multilevel logistic regression model (adjusted for demographic and clinical variables) to identify the effect of the programme on the odds of BP control.

Results

Our cohort included 111 867 adults. Control increased from 72% in 2015 to 79% in 2016 (p<0.01). The average percentage of visits with elevated blood pressure was 31% in 2015 and 25% in 2016 (p<0.01). During visits with an elevated BP, physicians were more likely to intensify medication in 2016 than in 2015 (43% vs 40%, p<0.01) and slightly more likely to obtain a BP recheck (15% vs 14%, p<0.01). Among patients with ≥1 elevated BP who attained control by the last visit in the year, there was 6% increase from 2015 to 2016 in the percentage of patients who received at least one medication intensification during the year and a 1% increase in BP rechecks. The adjusted odds of the last BP reading being categorised as controlled was 59% higher in 2016 than in 2015 (95% CI 1.54 to 1.64).

Conclusion

A system-wide initiative can improve BP control, primarily through medication intensification.
Surgical cordotomy helps psychosocial suffering
Authors: Abdul-Razzak Amane , Murray Alison , Duplessis Stephan
Published: August 2019

A young woman was admitted to our palliative care unit with severe pain to her right hip and leg. Her pain was uncontrolled despite aggressive use of opioids, adjuvant pain medications and spinal analgesia. She experienced significant psychological and social distress, but engaging in therapies with our multidisciplinary team proved difficult. Surgical cordotomy was pursued, which improved the physical pain and allowed her to re-engage in social and familial roles and meaningful activities. This case gives context to discuss the complex interactions between physical pain and psychosocial suffering. It is challenging to determine the relative contributions of physical, psychological, existential and social suffering, and this case highlights the complex relationships between these domains. In this case, managing the physical pain by means of a surgical cordotomy allowed the patient the opportunity to address other domains of suffering.
Public perception towards bystander cardiopulmonary resuscitation
Authors: Becker Torben K , Gul Sarah S , Cohen Scott A , Maciel Carolina B , Baron-Lee Jacqueline , Murphy Travis W , Youn Teddy S , Tyndall Joseph A , Gibbons Clay , Hart Lizzy , Alviar Carlos L
Published: August 2019

Objective

Bystander cardiopulmonary resuscitation (CPR) after out-of-hospital cardiac arrest (OHCA) improves survival and neurological outcomes. Nonetheless, many OHCA patients do not receive bystander CPR during a witnessed arrest. Our aim was to identify potential barriers to bystander CPR.

Methods

Participants at CPR training events conducted in the USA between February and May 2018 answered a 14-question survey prior to training. Respondents were asked about their overall comfort level performing CPR, and about potential concerns specific to performing CPR on a middle-aged female, a geriatric male, and male and female adolescent patients. Open-ended responses were analysed qualitatively by categorising responses into themes.

Results

Of the 677 participants, 582 (86.0%) completed the survey, with 509 (88.1%) between 18 and 29 years of age, 341 (58.6%) without prior CPR training and 556 (96.0%) without prior CPR experience. Across all four scenarios of patients in cardiac arrest, less than 65% of respondents reported that they would be ‘Extremely Likely’ (20.6%–29.1%) or ‘Moderately Likely’ (26.9%–34.8%) to initiate CPR. The leading concerns were ‘causing injury to patient’ for geriatric (n=193, 63.1%), female (n=51, 20.5%) and adolescent (n=148, 50.9%) patients. Lack of appropriate skills was the second leading concern when the victim was a geriatric (n=41, 13.4%) or adolescent (n=68, 23.4%) patient, whereas for female patients, 35 (14.1%) were concerned about exposing the patient or the patient’s breasts interfering with performance of CPR and 15 (6.0%) were concerned about being accused of sexual assault. Significant differences were observed in race, ethnicity and age regarding the likelihood of starting to perform CPR on female and adolescent patients.

Conclusions

Participants at CPR training events have multiple concerns and fears related to performing bystander CPR. Causing additional harm and lack of skills were among the leading reservations reported. These findings should be considered for improved CPR training and public education.
Artificial womb technology and the significance of birth: why gestatelings are not newborns (or fetuses)
Authors: Romanis Elizabeth Chloe
Published: August 2019

In a recent publication, I argued that there is a conceptual difference between artificial womb (AW) technology, capable of facilitating gestation ex utero, and neonatal intensive care, providing incubation to neonates born prematurely. One of the reasons I provided for this distinction was that the subjects of each process are different entities. The subject of the process of gestation ex utero is a unique human entity: a ‘gestateling’, rather than a fetus or a newborn preterm neonate. Nick Colgrove wrote a response to my paper, claiming that my distinction between the subject of an AW and a newborn (in intensive care) was false. He claims that I have not accounted for the proper definition of ‘birth’ and that gestatelings are not a distinct product of human reproduction. Further, Colgrove posits that even if I can successfully distinguish gestatelings from preterms, such a distinction is morally irrelevant because the entities would have the same moral status. In this paper, I address the three challenges raised and defend the claim that gestatelings are unique entities. Moreover, I argue that moral status should not be considered ipso facto determinative in the debate about AWs.
Prevalence of bacteria and changes in trends in antimicrobial resistance ofEscherichia coliisolated from positive canine urinary samples from an Australian referral hospital over a 5‐year period (2013–2017)
Authors: Roberts Madeleine , White Joanna , Lam Amy
Published: August 2019

Lower urinary tract disease is common in dogs with approximately 14% developing a bacterial lower urinary tract infection (UTI) during their lifetime. Empirical antimicrobials are often prescribed while waiting urine culture and susceptibility results. Regional knowledge of bacterial prevalence and antimicrobial resistance patterns aids veterinarians in antimicrobial choice. This study aimed to identify the prevalence of uropathogens in canine urine tract isolates and to assess for changes in antimicrobial resistance ofEscherichia coli(E. coli) over a 5‐year study period at a large multidisciplinary private referral hospital in Australia (January 2013–December 2017). The proportion of resistant isolates was compared across 5 years (Fisher's exact test and Cochran Armitage test for trend) for select antimicrobials towardsE. coli. A total of 246 positive urine cultures were included.E. coliwas the most prevalent uropathogen at 64%, followed byProteussp.,Staphylococcussp. andEnterococcussp., respectively (9%, 8% and 7%).E. coliwas most commonly resistant to amoxicillin at 41%. There was no statistically significant difference, nor trend, in resistance ofE. coliisolates towards the selected antimicrobials over the 5 years. Resistance towards trimethoprim–sulfonamide was lower at 15%. This information will aid local veterinarians in selecting empirical antimicrobials pending culture results for the treatment of UTIs in dogs.
A note on falling-head and rising-tail permeability tests on saturated soils in centrifuge
Authors: Lei G.H. , Liu F.X. , Xia S.W.
Published: August 2019

The falling-head and rising-tail method for permeability test allows for both inflow and outflow rates to be conveniently measured. This helps to detect any possible swelling or consolidation of specimen during testing and to identify the continuity of flow of water through the specimen. It has been widely adopted to measure the hydraulic conductivity of saturated porous media of extremely low permeability, such as hydraulic barrier soil materials. Centrifuge permeameter test with this method has recently been devised to accelerate water flow and reduce the time needed for testing. The accompanying equation for calculating hydraulic conductivity is, however, found to be simplified because it was formulated by idealizing such a variable-head test as multiple segmental constant-head tests. In this paper, a new generalized equation is established based strictly on the variable head. Moreover, based on curve matching between the rates of flow into and out of the soil specimen, an approach is also proposed to identify the continuity state of flow. The data relevant to this state are extracted for performing the calculation of hydraulic conductivity. The practical application of the proposed equation and its associated approach is illustrated through a reanalysis of recently published experimental data in the literature.