bluuebunny/crossref_metadata_2025 huggingface dataset:
Generic preference‐based health‐related quality of life in children with neurodevelopmental disorders: a scoping review
Authors: Lamsal Ramesh , Finlay Brittany , Whitehurst David G T , Zwicker Jennifer D
Published: June 2019

Aim

To describe how generic preference‐based health‐related quality of life (HRQoL) instruments have been used in research involving children with neurodevelopmental disorders (NDD).

Method

A systematic search of nine databases identified studies that used generic preference‐based HRQoL instruments in children with NDD. Data extracted following the Preferred Reporting Items for Systematic Review and Meta‐Analyses extension for Scoping Review guidelines included type of NDD, instrument used, respondent type, justification, and critical appraisal for these selections.

Results

Thirty‐six studies were identified: four cost–utility analyses; 15 HRQoL assessments; five economic burden studies; three intervention studies; and nine ‘other’. The Health Utilities Index (Mark 2 and Mark 3) and EuroQoL 5D (EQ‐5D; three‐level EQ‐5D, five‐level EQ‐5D, and the youth version of the EQ‐5D) instruments were most frequently used (44% and 31% respectively). The relatively low use of these instruments overall may be due to a lack of psychometric evidence, inconsistency in justification for and lack of clarity on appropriate respondent type and age, and geographical challenges in applying preference weights.

Interpretation

This study highlights the dearth of studies using generic preference‐based HRQoL instruments in children with NDD. The use of cost–utility analysis in this field is limited and validation of these instruments for children with NDD is needed. The quality of data should be considered before guiding policy and care decisions.

What this paper adds

Limited use of generic preference‐based health‐related quality of life (HRQoL) instruments in studies on children with neurodevelopmental disorders.

Only 11% of studies were cost–utility analyses.

Inconsistencies in justification for choosing generic preference‐based HRQoL instruments and respondent types.
Home‐based action observation treatment for children with unilateral cerebral palsy: strategies to promote intervention engagement
Authors: Brandão Marina de Brito
Published: June 2019

This commentary is on the original article by Nuara et al. on pages 1314–1322 of this issue.
Bunching up the background betters bias in species distribution models
Authors: Vollering Julien , Halvorsen Rune , Auestad Inger , Rydgren Knut
Published: June 2019

Sets of presence records used to model species’ distributions typically consist of observations collected opportunistically rather than systematically. As a result, sampling probability is geographically uneven, which may confound the model's characterization of the species’ distribution. Modelers frequently address sampling bias by manipulating training data: either subsampling presence data or creating a similar spatial bias in non‐presence background data. We tested a new method, which we call ‘background thickening’, in the latter category. Background thickening entails concentrating background locations around presence locations in proportion to presence location density. We compared background thickening to two established sampling bias correction methods – target group background selection and presence thinning – using simulated data and data from a case study. In the case study, background thickening and presence thinning performed similarly well, both producing better model discrimination than target group background selection, and better model calibration than models without correction. In the simulation, background thickening performed better than presence thinning when the number of simulated presence locations was low, and vice versa. We discuss drawbacks to target group background selection, why background thickening and presence thinning are conservative but robust sampling bias correction methods, and why background thickening is better than presence thinning for small sample sizes. Particularly, background thickening is advantageous for treating sampling bias when data are scarce because it avoids discarding presence records.
Accounting for long‐term directional trends on year‐to‐year synchrony in species fluctuations
Authors: Lepš Jan , Götzenberger Lars , Valencia Enrique , de Bello Francesco
Published: June 2019

What determines the stability of communities under environmental fluctuations remains one of the most debated questions in ecology. Scholars generally agree that the similarity in year‐to‐year fluctuations between species is an important determinant of this stability. Concordant fluctuations in species abundances through time (synchrony) decrease stability while discordance in fluctuations (anti‐synchrony) should stabilize communities. Researchers have interpreted the community‐wide degree of synchrony in temporal fluctuations as the outcome of different processes. However, existing synchrony measures depend not only on year‐to‐year species fluctuations, but also on long‐term directional trends in species composition, for example due to land‐use or climate change. The neglected effect of directional trends in species composition could cause an apparent increase in synchrony that is not due to year‐to‐year fluctuations, as species that simultaneously increase (or decrease) in abundance over time will appear correlated, even if they fluctuate discordantly from year to year. The opposite pattern is also conceivable, where different species show contrasting trends in their abundances, thus overestimating year‐to‐year anti‐synchrony. Therefore, trends in species composition may limit our understanding of potential ecological mechanisms behind synchrony between species. We propose two easily implementable solutions, with corresponding R functions, for testing and accounting for the effect of trends in species composition on overall synchrony. The first approach is based on computing synchrony over the residuals of fitted species trends over time. The second approach, applicable to already existing indices, is based on three‐terms local variance, i.e. computing variance over three‐years‐long, movable windows. We demonstrate these methods using simulations and data from real plant communities under long‐term directional changes, discussing when one approach can be preferred. We show that accounting for long‐term temporal trends is necessary and that separation of effect of trends and year‐to‐year fluctuation provides a better understanding of ecological mechanisms and their connections with ecological theory.
The function of three main call types in common cuckoo
Authors: Xia Canwei , Deng Zhuqing , Lloyd Huw , Møller Anders Pape , Zhao Xiaomeng , Zhang Yanyun
Published: June 2019

Acoustic signals play a key role in shaping the relationships in birds. Common cuckoosCuculus canorusare known to produce various call types, but the function of these calls has only been studied recently. Here, we used a combination of field recordings (conducted in 2017) and playback experiments (conducted in 2018) to investigate the functional significance of common cuckoo calls. We found significant differences in the characteristics between male two‐element “cu‐coo” and three‐element “cu‐cu‐coo” calls, with these two call types being used in different contexts. The three‐element male “cu‐cu‐coo” calls were associated with females emitting their “bubbling” call. Playback experiments revealed that both males and females exhibit stronger responses to playing female “bubbling” calls than with the calls of the Eurasian sparrowhawk (Accipter nisus) serving as a control, suggesting a significant intraspecific communication function for this call type. However, we did not find any evidence to support mate attraction in male calls, as females were not stimulated by playback of male calls compared with sparrowhawk calls in the control group.
Salience in the noticing and production of L2 arabic forms
Authors: Nassif Lama
Published: June 2019

This study investigated the effect that the salience of an L2 form has on learner noticing and production of the form. The study also explored the effects that task type (output vs. input) has on form noticing and production. The study targeted three Arabic forms: a low salient form (the future tense) and two salient ones (time telling and time connectors). Eighty beginning‐level learners of Arabic were assigned to two treatment conditions: output and input. The output group described a picture story; listened to, read, and underlined an Arabic speaker's description of the story; and redid the picture description. The input group answered pre‐text exposure questions; listened to, read, and underlined the same model description; and answered posttext exposure questions. There was an immediate posttest, and a delayed posttest and interviews two weeks later. The findings suggest that the salience of the target forms affected form noticing and production, but task type only had a mediating effect on production; output did not promote learner noticing of L2 forms better than input, but it did lead to partial gains in form production.
Global simulation as a mediating tool for teaching and learning language and culture as discourse
Authors: Michelson Kristen
Published: June 2019

This article reports on a multiliteracies‐based experiential learning curriculum designed for intermediate French built upon the framework of a global simulation pedagogy. Students adopted the roles of fictitious characters living together in an apartment building in Paris and carried out written and spoken tasks through the voice of their character, in dialogic response to an emerging story‐world that integrated both imagined and real‐world current events, and whose discourses were mediated by texts of various genres. Findings from this study demonstrate the way that some students appropriated forms of discourse based on their situated identities and genre conventions of literacy tasks. Implications from these findings point to both the pedagogical possibilities for teaching language, culture, and discourse holistically and the carefulness with which such curricula must be designed if classroom foreign language instruction is to help prepare students for real‐world literacy practices.
Teachers as good mothers, mothers as good teachers: Functional and ideological work–family alignment in the South Korean teaching profession
Authors: Kang Miliann , Park Hye Jun , Park Juyeon
Published: June 2019

As one of the largest women‐dominated employment niches in many national contexts, the teaching profession has been widely studied, yet the gender, work and family negotiations within this profession deserve fuller attention. The case study of South Korean teachers, one of the most highly qualified teaching workforces in the world, illuminates how particular professions create specific challenges as well as supports for work and family that can counter national patterns of women's low labour force participation. This study engages with theoretical debates regarding ‘work–family conflict' and ‘work–life balance' to develop the alternative framework of ‘work–family alignment' giving greater attention to cultural, ideological and functional dimensions within specific occupations and national contexts. However, rather than expanding opportunities for women, work–family alignment often depends on conformity to normative gender roles — both at work and within families. Nonetheless, the framework of work–family alignment can inform policy implementation by demonstrating that both functional and ideological supports are needed for workplace and state policies to be effective.
The Moltke Myth in German–Turkish relation
Authors: Stein Oliver
Published: June 2019

Helmuth von Moltke, who worked in the Ottoman Empire between 1835 and 1839, is generally considered the founder of German–Turkish friendship. However, it is forgotten that close relations between Prussia and the Ottoman Empire began under Frederick the Great. This article will deal with Moltke's role in Prussian–Ottoman relations on the basis of literature, testimonies, and files. Here, the contradiction between the low importance of his activity in the Ottoman Empire and the well‐kept myth of his person as a central identification figure for the German–Turkish relations becomes clear. The study focuses on the German perspective but also incorporates the Turkish Moltke myth.
Digital droplet PCR‐based chimerism analysis for monitoring of hematopoietic engraftment after allogeneic stem cell transplantation
Authors: Mika Thomas , Baraniskin Alexander , Ladigan Swedlana , Wulf Gerald , Dierks Sascha , Haase Detlef , Schork Karin , Turewicz Michael , Eisenacher Martin , Schmiegel Wolff , Schroers Roland , Klein‐Scory Susanne
Published: June 2019

Introduction

Allogeneic hematopoietic stem cell transplantation (alloHSCT) is a curative approach for multiple hematologic diseases. The success of alloHSCT is evaluated by analyzing the proportion of living donor cells in blood and bone marrow samples of the recipient (chimerism analysis). To monitor the engrafted cells, donor's individual genetic markers are analyzed in peripheral blood and bone marrow samples, usually by using short tandem repeat (STR) analysis. An alternative method to measure chimerism is based on insertion and deletion markers (InDels) analyzed by digital droplet PCR (ddPCR); however, this approach is rarely evaluated in clinical practice.

Methods

In this study, we examined the usefulness of ddPCR‐based chimerism analysis against the standard STR analysis in samples around day+30 after alloHSCT in clinical practice using peripheral blood and bone marrow samples.

Results

The median absolute difference between ddPCR and STR analysis was 0.55% points for bone marrow chimerisms and 0.25% points for peripheral blood chimerisms, respectively, including variation in the range of maximum 2% for both methods. The results of every single sample gave the same clinical message.

Conclusion

According to our data, chimerism analysis by ddPCR has an excellent correlation with STR‐based analyses. Due to its fast and easy applicability, the ddPCR technique is suitable for chimerism monitoring in clinical practice.
Regulatory T cells in cancer: where are we now?
Authors: Gallimore Awen , Quezada Sergio A. , Roychoudhuri Rahul
Published: June 2019

There have been substantial strides forward in our understanding of the contribution of regulatory T (Treg) cells to cancer immunosuppression. In this issue, we present a series of papers highlighting emerging themes on this topic relevant not only to our understanding of the fundamental biology of tumour immunosuppression but also to the design of new immunotherapeutic approaches. The substantially shared biology of CD4+ conventional T (Tconv) and Treg cells necessitates a detailed understanding of the potentially opposing functional consequences that immunotherapies will have on Treg and Tconv cells, a prominent example being the potential for Treg‐mediated hyperprogressive disease following anti‐PD‐1 therapy. Such understanding will aid patient stratification and the rational design of combination therapies. It is also becoming clear, however, that Treg cells within tumours exhibit distinct biological features to both Tconv cells and Treg cells in other tissues. These distinct features provide the opportunity for development of targeted immunotherapies with greater efficacy and reduced potential for inducing systemic toxicity.
Rapid synthesis of Gd2Zr2O7 glass‐ceramics using spark plasma sintering
Authors: Shu Xiaoyan , Chen Shunzhang , Hou Chenxi , Xie Yi , Zhang Haibin , Li Bingsheng , Yang Yushan , Wang Xiaoqiang , Li Linyan , Lu Xirui
Published: June 2019

Glass‐ceramics are possible host matrix for high level waste immobilization. The Gd2Zr2O7 glass‐ceramic matrix was successfully synthesized using spark plasma sintering (SPS) method in 5 minutes. The phase transition with sintering temperature was studied using X‐ray diffraction, Raman and transmission electron microscopy. It revealed that samples kept a main defected fluorite phase as being sintered below 1800°C. Glass phase increased rapidly beyond 1850°C. The amorphous structure became the main body at 1900°C, with nanoscale crystal scattered in the bulk. With the increase of glass phase, the grain boundary became almost indistinguishable. The relationship between the final phase of Gd2Zr2O7 with its synthetic temperature range and corresponding technology was reviewed. Gd2Zr2O7 glass‐ceramics could be acquired by extending the sintering temperature beyond 1850°C using SPS method.
The holistic assessment and care planning in partnership intervention study (HAPPI): A protocol for a feasibility, cluster randomized controlled trial
Authors: Lyndon Helen , Latour Jos M. , Marsden Jonathan , Campbell Sarah , Stevens Kara , Kent Bridie
Published: June 2019

Aim

During an initial phase of this research, an e‐Delphi survey was conducted to gain consensus among stakeholders on the components of a nurse‐led assessment and care planning intervention for older people who live with frailty in primary care. This feasibility randomized controlled trial (fRCT) will test the proposed intervention and its implementation and determine methods for the design of a conclusive randomized controlled trial.

Methods

The fRCT, with embedded qualitative study, aims to recruit 60 participants. Moderately and severely frail older people will be identified using the electronic frailty index (eFI) and the intervention will be delivered by senior community nurses. The control participants will receive usual primary care for frailty. The study is funded by the National Institute of Health Research (NIHR; funding granted in May 2016, ref: ICA‐CDRF‐2016‐02‐018) and received NHS and University Research Ethics Committee approval in 2018.

Discussion

There is evidence that the delivery of complex interventions for community‐dwelling older people can reduce care home and hospital admissions and falls, there is less evidence for the benefit of any specific type or intensity of intervention or the additional benefits of targeting the frail population. This trial will determine feasibility of the intervention, define recruitment and retention parameters and trial logistics, and decide outcome measures.

Impact

This study aims to address the limitations of current research by using a systematic method of frailty diagnosis and participant identification, trialling implementation of a person‐centred intervention, and testing of feasibility parameters.

Trial registration number: ISRCTN: 74345449.
An intervention based on protective factors to improve resilience for breast cancer patients: Study protocol for a randomized controlled trial
Authors: Jiang Xiaoxiao , Yang Yajuan , Li Huiping , Li Shuwen , Su Dan , Zhang Ting , Zhang Maomao
Published: June 2019

Aim

To present a study protocol for evaluating the feasibility and effectiveness of an individual face‐to‐face intervention based on protective factors to improve resilience among breast cancer patients.

Background

Research involving the effectiveness of universal interventions to improve resilience for breast cancer patients has seldom been reported and there is an urgent need to find a more acceptable, cost‐effective method of providing emotional support. Through health education and psychological interventions, increasing protective factors could promote recovery to the original condition and improve resilience.

Design

A randomized controlled trial of an individual face‐to‐face intervention.

Methods

A total of 160 adults diagnosed with confirmed breast cancer will be recruited. The patients will be randomly assigned to the control group (N = 80) or the intervention group (N = 80). An intervention focusing on protective factors will be implemented in the intervention group. A survey of the patients from the two groups will be conducted at baseline, 1, 3, 6, and 12 months. The primary outcome is resilience, measured by the 14‐item Resilience Scale. Secondary outcomes include self‐efficacy, optimism, perceived social support, and mastery. The Chinese versions of the General Self‐Efficacy Scale, revised Life Orientation Test, Multidimensional Scale of Perceived Social Support, and Self‐Mastery Scale will be used to measure the four protective factors.

Impact

One‐to‐one and face‐to‐face interventions have many potential advantages for inpatients, including convenience, accessibility and individuality. Once its effectiveness is confirmed, the intervention will be implemented broadly and make support available for a large number of patients.
Postpartum breastfeeding experiences in the traditional‐biomedical crossroads: A qualitative study using drawing with Vietnamese and Myanmarese refugee women in Australia
Authors: Joseph June , Liamputtong Pranee , Brodribb Wendy
Published: June 2019

Aims

To explore how postpartum support networks, hospital stay and healthcare services had an impact on breastfeeding experiences of refugee women from Vietnam and Myanmar in Brisbane, Australia.

Design

A qualitative study guided by feminist methodological inquiry.

Methods

Semi‐structured interviews and drawing exercises were conducted with recent (<10 years) and established (≥10 years) refugee women between July 2015 ‐ June 2016. Verbal data were analysed thematically, whereas drawings were analysed with the critical visual analytical framework.

Results

The findings reflect how 36 mothers negotiated their breastfeeding experiences in the “traditional‐biomedical” intersection (major theme) in face of changing support networks, social structures, hospital policies and postpartum services postresettlement (sub‐themes). Tensions of cultural unfamiliarity in the western setting generally contributed to early breastfeeding cessation among recent arrivals, whereas social (extended families, tertiary education) and cultural (English literacy) capitals and a longer stay in Australia enabled established arrivals to integrate the traditional and western biomedical beliefs.

Conclusion

The ability of established arrivals to integrate both traditional and western worldviews may assist in addressing breastfeeding uncertainties that affect recent arrivals. Perspectives of midwives from the western postnatal spheres merit future exploration.

Impact

Positive early breastfeeding experiences lead to its long‐term success. By identifying the impact that conflicting beliefs have on breastfeeding experiences of refugees in the western biomedical environment, this study suggests how interventions that focus on reinforcing maternal cultural and social capital could benefit community empowerment, healthcare and policy sectors nationally and globally.
Patient–provider perspectives on self‐management support and patient empowerment in chronic care: A mixed‐methods study in a rural sub‐Saharan setting
Authors: Angwenyi Vibian , Aantjes Carolien , Bunders‐Aelen Joske , Lazarus Jeffrey V. , Criel Bart
Published: June 2019

Aim

To explore how provision of self‐management support to chronically‐ill patients in resource‐limited settings contributes to patient empowerment in chronic care.

Design

Concurrent descriptive mixed methods research.

Methods

A survey of 140 patients with chronic conditions administered at four time‐points in 12 months. We conducted 14 interviews and four focus‐group discussions with patients (N = 31); 13 healthcare provider interviews; and observations of four patient‐support group meetings. Data were collected between April 2016 ‐ May 2017 in rural Malawi. Qualitative data were analysed using a thematic approach and descriptive statistical analysis performed on survey data.

Results

Healthcare professionals facilitated patient empowerment through health education, although literacy levels and environmental factors affected self‐management guidance. Information exchanged during patient–provider interactions varied and discussions centred around medical aspects and health promoting behaviour. Less than 40% of survey patients prepared questions prior to clinic consultations. Health education was often unstructured and delegated to non‐physician providers, mostly untrained in chronic care. Patients accessed psychosocial support from volunteer‐led community home‐based care programmes. HIV support‐groups regularly interacted with peers and practical skills exchanged in a supportive environment, reinforcing patient's self‐mangement competence and proactiveness in health care.

Conclusion

For optimal self‐management, reforms at inter‐personal and organizational level are needed including; mutual patient‐provider collaboration, diversifying access to self‐management support resources and restructuring patient support‐groups to cater to diverse chronic conditions.

Impact

Our study provides insights and framing of self‐management support and empowerment for patients in long‐term care in sub‐Saharan Africa. Lessons drawn could feed into designing and delivering responsive chronic care interventions.
Prognostic value of morning surge of blood pressure in middle‐aged treated hypertensive patients
Authors: Coccina Francesca , Pierdomenico Anna M. , Cuccurullo Chiara , Vitulli Piergiusto , Pizzicannella Jacopo , Cipollone Francesco , Pierdomenico Sante D.
Published: June 2019

We investigated the prognostic value of morning surge (MS) of blood pressure (BP) in middle‐aged treated hypertensive patients. The occurrence of a composite end point (coronary events, stroke, and heart failure requiring hospitalization) was evaluated in 1073 middle‐aged treated hypertensive patients (mean age 49 years). Patients with preawakening MS of BP above the 90th percentile (27/20.5 mm Hg for systolic/diastolic BP) were defined as having high MS of BP. During the follow‐up (mean 10.9 years), 131 cardiovascular events occurred. After adjustment for various covariates, including known risk markers and ambulatory BP parameters, patients with high MS of systolic BP (hazard ratio 1.81, 95% confidence interval 1.10‐2.96) and those with high MS of diastolic BP (hazard ratio 1.98, 95% confidence interval 1.19‐3.28) were at higher cardiovascular risk than those with normal MS. In middle‐aged treated hypertensive patients, high MS of systolic and diastolic BP is independently associated with increased cardiovascular risk.
Cordycepin ameliorates cardiac hypertrophy via activating the AMPKα pathway
Authors: Wang Hui‐Bo , Duan Ming‐Xia , Xu Man , Huang Si‐Hui , Yang Jun , Yang Jian , Liu Li‐Bo , Huang Rong , Wan Chun‐Xia , Ma Zhen‐Guo , Wu Qing‐Qing , Tang Qi‐Zhu
Published: June 2019

Increase of myocardial oxidative stress is closely related to the occurrence and development of cardiac hypertrophy. Cordycepin, also known as 3'‐deoxyadenosine, is a natural bioactive substance extracted from Cordyceps militaris (which is widely cultivated for commercial use in functional foods and medicine). Since cordycepin suppresses oxidative stress both in vitro and in vivo, we hypothesized that cordycepin would inhibit cardiac hypertrophy by blocking oxidative stress‐dependent related signalling. In our study, a mouse model of cardiac hypertrophy was induced by aortic banding (AB) surgery. Mice were intraperitoneally injected with cordycepin (20 mg/kg/d) or the same volume of vehicle 3 days after‐surgery for 4 weeks. Our data demonstrated that cordycepin prevented cardiac hypertrophy induced by AB, as assessed by haemodynamic parameters analysis and echocardiographic, histological and molecular analyses. Oxidative stress was estimated by detecting superoxide generation, superoxide dismutase (SOD) activity and malondialdehyde levels, and by detecting the protein levels of gp91phox and SOD. Mechanistically, we found that cordycepin activated activated protein kinase α (AMPKα) signalling and attenuated oxidative stress both in vivo in cordycepin‐treated mice and in vitro in cordycepin treated cardiomyocytes. Taken together, the results suggest that cordycepin protects against post‐AB cardiac hypertrophy through activation of the AMPKα pathway, which subsequently attenuates oxidative stress.
Dehydrocostus lactone attenuates osteoclastogenesis and osteoclast‐induced bone loss by modulating NF‐κB signalling pathway
Authors: Hu Bin , Wu Fengfeng , Shi Zhongli , He Bin , Zhao Xiang , Wu Haobo , Yan Shigui
Published: June 2019

Osteolysis is characterized by overactivated osteoclast formation and potent bone resorption. It is enhanced in many osteoclast‐related diseases including osteoporosis and periprosthetic osteolysis. The shortage of effective treatments for these pathological processes emphasizes the importance of screening and identifying potential regimens that could attenuate the formation and function of osteoclasts. Dehydrocostus lactone (DHE) is a natural sesquiterpene lactone containing anti‐inflammatory properties. Here, we showed that DHE suppressed receptor activator of nuclear factor‐κB ligand (RANKL)‐induced osteoclast formation and osteoclast marker gene expression. It also inhibited F‐actin ring formation and bone resorption in a dose‐dependent manner in vitro. Moreover, DHE inhibited the RANKL‐induced phosphorylation of NF‐κB, mitigated bone erosion in vivo in lipopolysaccharide‐induced inflammatory bone loss model and particle‐induced calvarial osteolysis model. Together, these results suggest that DHE reduces osteoclast‐related bone loss via the modulation of NF‐κB activation during osteoclastogenesis indicating that it might be a useful treatment for osteoclast‐related skeletal disorders.
Developmental trajectories of behaviour problems and prosocial behaviours of children with intellectual disabilities in a population‐based cohort
Authors: Bailey Tom , Totsika Vasiliki , Hastings Richard P. , Hatton Chris , Emerson Eric
Published: June 2019

Background

The study examined developmental trajectories of prosocial behaviours, internalising and externalising behaviour problems in children with intellectual disabilities (ID) between pre‐school and middle childhood.

Method

Growth models examined the best‐fitting trajectories for internalising and externalising behaviour problems, as well as prosocial behaviours, in 555 children with ID between the ages of three and 11 years from the UK Millennium Cohort Study. Models were also fitted to examine the association of child outcomes with time‐varying maternal psychological distress and life satisfaction. Finally, models were extended to compare trajectories with typically developing children.

Results

Externalising behaviour problems and prosocial behaviours generally improved, whereas internalising problems did not change systematically over time. A cubic trend indicated a slowing down of improvement between ages 5 and 7 for prosocial behaviours and externalising problems. Maternal psychological distress positively co‐varied with internalising and externalising behaviour problems over time. Life satisfaction was not related to changes in child behaviours over time. Compared to behavioural trajectories in typical development, intercepts were worse and trajectories also differed in the ID group.

Conclusions

Over an 8‐year period, externalising behaviour problems and prosocial behaviours of children with ID tended to improve. These behavioural improvements slowed between five and seven years, possibly coinciding with school‐related environmental changes. Children with ID significantly differ from children with typical development in both the initial level of difficulties (exhibiting higher externalising and internalising behaviours, and lower prosocial behaviours) and subsequent development as they age, showing comparatively lower decreases in both externalising and internalising behaviours, and lower increases in prosocial behaviours. Findings also highlight the significant role of maternal mental health problems in the trajectory of child behaviour problems.
Painful and non‐painful diabetic polyneuropathy: Clinical characteristics and diagnostic issues
Authors: Gylfadottir Sandra Sif , Weeracharoenkul Danita , Andersen Signe Toft , Niruthisard Supranee , Suwanwalaikorn Sompongse , Jensen Troels Staehelin
Published: June 2019

Diabetic neuropathy (DN) is a common complication of diabetes and can be either painful or non‐painful. It is challenging to diagnose this complication, as no biomarker or clear consensus on the clinical definition of either painful or non‐painful DN exists. Hence, a hierarchical classification has been developed categorizing the probability of the diagnosis into: possible, probable or definite, based on the clinical presentation of symptoms and signs. Pain is a warning signal of tissue damage, and non‐painful DN therefore represents a clinical and diagnostic challenge because it often goes unnoticed until irreversible nerve damage has occurred. Simple clinical tests seem to be the best for evaluation of DN in the general care for diabetes. Screening programs at regular intervals might be the most optimal strategy for early detection and interventions to possibly prevent further neuronal damage and to lower the economic burden of this complication.
Somite development in the avian tail
Authors: Draga Margarethe , Heim Kathrin , Batke Renate , Wegele Martin , Pröls Felicitas , Scaal Martin
Published: June 2019

Somites are epithelial segments of the paraxial mesoderm. Shortly after their formation, the epithelial somites undergo extensive cellular rearrangements and form specific somite compartments, including the sclerotome and the myotome, which give rise to the axial skeleton and to striated musculature, respectively. The dynamics of somite development varies along the body axis, but most research has focused on somite development at thoracolumbar levels. The development of tail somites has not yet been thoroughly characterized, even though vertebrate tail development has been intensely studied recently with respect to the termination of segmentation and the limitation of body length in evolution. Here, we provide a detailed description of the somites in the avian tail from the beginning of tail formation at HH‐stage 20 to the onset of degeneration of tail segments at HH‐stage 27. We characterize the formation of somite compartment formation in the tail region with respect to morphology and the expression patterns of the sclerotomal marker gene paired‐box gene 1 (Pax1) and the myotomal marker genes MyoD and myogenic factor 5 (Myf5). Our study gives insight into the development of the very last segments formed in the avian embryo, and provides a basis for further research on the development of tail somite derivatives such as tail vertebrae, pygostyle and tail musculature.
Moving on from Quality Assurance: Exploring Systems that Measure both Process and Personal Outcomes in Disability Services
Authors: Jade McEwen , Christine Bigby , Jacinta Douglas
Published: June 2019

Systems that measure service quality in disability organizations commonly review service delivery processes, rather than quality of life outcomes for service users. Disadvantages of measuring processes rather than outcomes are that funders and regulators may fail to identify poor quality support until major crises occur. One solution has been the development of quality systems that combine measuring processes and the personal outcomes of service users, though the efficacy of such systems has not been explored. The aim of this article was to identify quality systems that combine measurement of processes and personal outcomes, and explore the advantages and limitations of these to inform future development of quality assurance systems. The study used an internationally accepted eight domain quality of life framework and a qualitative content analysis to map and evaluate the characteristics of three combined quality systems currently used in the disability sector; the Care Quality Commission framework for community adult social care services, the adult social care outcomes framework and personal outcome measures. The three systems were unbalanced, focusing more on procedure than personal outcomes. None of the systems measured personal outcomes comprehensively against all eight quality of life domains and the rigor applied to such measurement varied markedly. Combined systems have potential to compensate for limitations of systems that measure either processes or outcomes, but could be improved by a greater focus on measuring service user outcomes, including all quality of life domains and use of mixed methods such as interviews and observation of the support people receive.
Lidocaine for chemical cardioversion of orthodromic atrioventricular reciprocating tachycardia in dogs
Authors: Wright Kathy N. , Nguyenba Thaibinh , Irvin Holly M.
Published: June 2019

Background

Typical atrioventricular accessory pathways (APs) are composed of myocardial cells. They provide electrical connections between atria and ventricles separate from the normal conduction system. Accessory pathways can participate in a macroreentrant circuit resulting in orthodromic atrioventricular reciprocating tachycardia (OAVRT).

Hypothesis

Because of ultrastructural similarities of typical AP cells to ventricular myocardial cells, we hypothesized lidocaine would be effective in blocking AP conduction, thus terminating OAVRT.

Animals

Thirty‐two consecutive client‐owned dogs presenting with narrow complex tachyarrhythmias were confirmed to have OAVRT by electrophysiologic study (EPS).

Methods

Prospective, nonrandomized, single‐arm study with lidocaine administered IV to dogs during OAVRT in 2 mg/kg boluses to a cumulative dose of 8 mg/kg or development of adverse effects. Electrocardiograms were monitored continuously. Subsequent EPS was performed to confirm OAVRT and the absence of other tachycardia mechanisms.

Results

Twenty‐seven dogs experienced OAVRT cardioversion with lidocaine, before or at the time of adverse effects. Orthodromic atrioventricular reciprocating tachycardia in 5 dogs did not cardiovert before adverse effects, precluding additional dosing. Median total lidocaine dose for cardioversion was 2 mg/kg (interquartile range, 2‐5.5 mg/kg). Dogs with right free wall APs had a significantly higher rate of cardioversion than did dogs with right posteroseptal APs.

Conclusions and Clinical Importance

Lidocaine successfully cardioverted OAVRT in 84.4% of dogs in our study before adverse effects precluded additional dosing. In 5 dogs with dose limited by adverse effects, it is unknown whether cardioversion would have occurred at a higher cumulative dose.
Metabolically healthy versus unhealthy obesity and risk of fibrosis progression in non‐alcoholic fatty liver disease
Authors: Kim Yejin , Chang Yoosoo , Cho Yong Kyun , Ahn Jiin , Shin Hocheol , Ryu Seungho
Published: June 2019

Background & Aims

Little is known about the impact of metabolically healthy obesity on fibrosis progression in non‐alcoholic fatty liver disease (NAFLD). We investigated the association of body mass index (BMI) category, body fat percentage and waist circumference with worsening of noninvasive fibrosis markers in metabolically healthy and unhealthy individuals with NAFLD.

Methods

A cohort study was performed on 59 957 Korean adults with NAFLD (13 285 metabolically healthy and 46 672 metabolically unhealthy individuals) who were followed for a median of 7.7 years. Being metabolically healthy was defined as not having any metabolic syndrome component and having a homoeostasis model assessment of insulin resistance <2.5. Progression from low to intermediate or high probability of advanced fibrosis was assessed using the NAFLD fibrosis score (NFS).

Results

During 339 253.1 person‐years of follow‐up, 9857 subjects with low NFS at baseline progressed to intermediate or high NFS. Among metabolically healthy individuals, the multivariable‐adjusted HRs (95% CI) for NFS worsening comparing BMIs 23‐24.9, 25‐29.9 and ≥30 with a BMI of 18.5‐22.9 kg/m2 were 1.19 (1.00‐1.42), 1.79 (1.52‐2.10) and 3.52 (2.64‐4.69), respectively, whereas the corresponding HRs (95% CI) in metabolically unhealthy individuals were 1.37 (1.24‐1.52), 2.18 (1.99‐2.39) and 4.26 (3.83‐4.75). A similar trend was observed in the analyses using body fat and waist circumference.

Conclusion

In the large‐scale cohort of young and middle‐aged individuals with NAFLD, BMI was positively associated with worsening of noninvasive fibrosis marker regardless of metabolic health status. Excess adiposity per se, even without accompanying metabolic health status, may contribute to fibrosis progression in NAFLD.
Rebalancing the UK Economy
Authors: Sinclair Peter
Published: June 2019

This paper explores five dimensions in which key aspects of the United Kingdom economy appear to be out of balance. These are: intertemporally; internationally; interpersonally; intergenerationally; and in its allocation of capital. It proceeds to consider possible measures that might help to rectify those imbalances.
Perceptions of commercial snack food and beverages for infant and young child feeding: A mixed‐methods study among caregivers in Kathmandu Valley, Nepal
Authors: Sharma Nisha , Ferguson Elaine L. , Upadhyay Atul , Zehner Elizabeth , Filteau Suzanne , Pries Alissa M.
Published: June 2019

Ensuring nutritious complementary feeding is vital for child nutrition. Prior research in Kathmandu Valley found high consumption rates of commercially produced snack foods among young children, which are often energy‐dense/nutrient poor. This mixed‐methods study was conducted to elicit Nepali caregivers' perceptions of commercial snack foods and beverages and factors influencing their use for young child feeding. Seven facilitated focus group discussions (FGD) were conducted with Kathmandu Valley caregivers of children 12–23 months, and a survey of 745 primary caregivers of children 12–23 months of age was then conducted. During the FGD, caregivers reported commonly providing commercial food and beverage products to their children as snacks, and 98.6% of caregivers participating in the survey reported feeding their child such a food in the previous week. Because of processing and packaging, snack foods were not trusted by many FGD participants and considered as “junk foods” and not healthy for children. However, commercial snack foods were consistently ranked highly on convenience, both because of minimal preparation and ease of feeding; 48.5% of all surveyed caregivers reported providing a snack food because of convenience. Other family members' diets or provision of snack foods as treats also influenced children's consumption of these snack foods and beverages. This study indicates that caregivers of young children prefer snack options that are nutrient rich; however, this may conflict with preferences for foods that require minimal preparation and are appealing to young children. Such findings carry programmatic implications for interventions aiming to address children's diet quality in urban Nepal.
Simulated and experimental estimates of hydrodynamic drag from bio‐logging tags
Authors: Zhang Ding , van der Hoop Julie M. , Petrov Victor , Rocho‐Levine Julie , Moore Michael J. , Shorter K. Alex
Published: June 2019

Drag force acting on swimming marine mammals is difficult to measure directly. Researchers often use simple modeling and kinematic measurements from animals, or computational fluid dynamics (CFD) simulations to estimate drag. However, studies that compare these methods are lacking. Here, computational simulation and physical experiments were used to estimate drag forces on gliding bottlenose dolphins (Tursiops truncatus). To facilitate comparison, variable drag loading (no‐tag, tag, tag + 4, tag + 8) was used to increase force in both simulations and experiments. During the experiments, two dolphins were trained to perform controlled glides with variable loading. CFD simulations of dolphin/tag geometry in steady flow (1–6 m/s) were used to model drag forces. We expect both techniques will capture relative changes created by experimental conditions, but absolute forces predicted by the methods will differ. CFD estimates were within a calculated 90% confidence interval of the experimental results for all but the tag condition. Relative drag increase predicted by the simulation vs. experiment, respectively, differed by between 21% and 31%: tag, 4% vs. 33%; tag + 4, 47% vs. 68%; and tag + 8, 108% vs. 77%. The results from this work provide a direct comparison of computational and experimental estimates of drag, and provide a framework to quantify uncertainty.
An undergraduate school for the nation: the effect of military service on veterans' social perceptions
Authors: Rosman Elisheva
Published: June 2019

The role of the military as a ‘school for the nation' has been debated in many contexts. It seems that, at best, the effect of military service on bridging social schisms and promoting national cohesion is limited. However, despite scholarship, many Israelis believe that their military service in the Israel Defense Forces (IDF) has caused them to accept members of out‐groups as part of their own in‐group. Likewise, some Western countries have begun to discuss reinstating conscription for similar reasons. This paper examines the extended effect of contact hypothesis in the military, both in practice and as an element capable of bringing about a change in veterans' thinking. It asks: are veterans who had diverse friendships during their service more willing to have diverse friendships in the future? If so, do they attribute their ability and willingness to include others within their in‐group to their military service? Based on the findings from a study of Israeli undergraduates, the paper demonstrates that while indeed service friendships (‘army buddies') may be short‐lived, service alongside members of out‐groups has certain longer‐term effects and influences the social perception of veterans, in both positive and negative ways. This seems to indicate that conscription can have social effects and impacts veterans' social thinking.
Prevalence of, and predictors of, bile acid diarrhea in outpatients with chronic diarrhea: A follow‐up study
Authors: Lim Shujing Jane , Gracie David J. , Kane John S. , Mumtaz Saqib , Scarsbrook Andrew F. , Chowdhury Fahmid U. , Ford Alexander C. , Black Christopher J.
Published: June 2019

Background

23‐seleno‐25‐homo‐tauro‐cholic acid (SeHCAT) scanning to rule out bile acid diarrhea (BAD) in patients with chronic diarrhea has a high yield. Our previous study showed that patients with terminal ileal (TI) Crohn's disease, TI resection, or cholecystectomy were highly likely to have an abnormal scan. As a result, we encouraged clinicians to use a therapeutic trial of a bile acid sequestrant in these patients, instead of scanning. This may have reduced diagnostic yield of the test, so we examined this issue, as well as factors predicting an abnormal scan, in a large cohort of patients referred subsequently.

Methods

We retrospectively identified 1,071 consecutive patients with chronic diarrhea undergoing SeHCAT scanning at Leeds Teaching Hospitals Trust from 2012 to 2016. We reviewed electronic patient records to obtain information on presenting gastrointestinal symptoms and any proposed risk factors for BAD. BAD was categorized according to subtype and severity.

Key Results

As expected, indications for scanning changed between 2012 and 2016, with a significant reduction in referrals with TI Crohn's disease or resection year‐on‐year (P < 0.001). Despite this, 457 (42.7%) patients had BAD and there was no downward trend in yield of SeHCAT during the 5 year period (P = 0.39). Overall, 51.6% had type II BAD, 36.1% type III, and 12.3% type I. BAD was mild in 31.7%, moderate in 34.4%, and severe in 33.9%. In total, 653 (61.0%) patients had no known risk factors, other than chronic diarrhea, but 233 (35.7%) of these individuals had BAD, and in 143 (61.4%), this was moderate or severe.

Conclusions and Inferences

Despite reduced referrals for SeHCAT scanning in those with clear risk factors for BAD, the yield remained > 40%. One‐third of those without known risk factors had BAD.