bluuebunny/crossref_metadata_2025 huggingface dataset:
Does money “buy” tolerance toward damage‐causing wildlife?
Authors: Kansky Ruth , Kidd Martin , Fischer Joern
Published: August 2020

The Kavango‐Zambezi Transfrontier Conservation Area supports large‐scale migrations of wildlife that occur in a mixed agri‐conservation landscape in five Southern African countries. Human–Wildlife Conflict is a key challenge and understanding the drivers of communities' willingness to coexist with wildlife is thus critical. Community based natural resource management (CBNRM) is a widely used economic approach to foster human‐wildlife coexistence with the assumption that monetary benefits can “buy” tolerance by offsetting the disservices of living with wildlife. We tested this assumption and hypothesized that Namibians would be more tolerant towards wildlife than Zambians because they received higher monetary benefits from wildlife. We used the Wildlife Tolerance Model (WTM) as the framework to define tolerance and identify tolerance drivers. We found Namibians tolerance was higher for lion, elephant and hyena but not for kudu and baboon. After controlling for confounding variables of the WTM that could potentially explain differences in tolerance, contrary to expectation, the monetary benefits did not account for higher Namibian tolerance. Instead, only nonmonetary benefits explained the higher tolerance. We used crowding theory to explain this finding, proposing that CBNRM in Namibia and the monetary benefits from the program “crowd in” intrinsic motivation to appreciate and tolerate wildlife.
Tocilizumab use in Kidney Transplant Patients with COVID‐19
Authors: Trujillo Hernando , Caravaca‐Fontán Fernando , Sevillano Ángel , Gutiérrez Eduardo , Fernández‐Ruiz Mario , López‐Medrano Francisco , Hernández Ana , Aguado José María , Praga Manuel , Andrés Amado
Published: August 2020

A potential benefit of immunomodulatory agents such as tocilizumab (TCZ) has been reported in patients with coronavirus disease 2019 (COVID‐19) and severe pulmonary involvement. However, this therapy has been scarcely studied in kidney transplant (KT) recipients. Herein, we describe the clinical course and outcome of 10 KT patients with severe COVID‐19 that were treated with TCZ. Mean age of the study group was 54 ± 10 years (70% females), and 30% of the cases were within 6 months from transplant. Mycophenolate mofetil was discontinued in all cases upon admission, whereas baseline steroids were maintained and tacrolimus dose was reduced. Initial treatment included hydroxychloroquine, antibiotics, and prophylactic anticoagulation. Before treatment with TCZ, 3 patients were receiving high‐flow oxygen, 4 patients low‐flow oxygen and 1 case non‐invasive ventilation. All patients received a single dose of intravenous TCZ within a mean time of 7 ± 4 days since admission. During a median follow‐up of 16 days (IQR: 10‐29), 7 patients (70%) gradually improved and were finally discharged while three cases (30%) did not exhibited clinical improvement and ultimately died. In conclusion, although treatment with TCZ could be associated with improved clinical outcomes in a subset of KT recipients with COVID‐19, further studies are warranted before drawing firm conclusions.
Q&A #awareness #equity #respect
Authors: Goto Kelly
Published: August 2020

Two influential black designers share their insights about recent events as well as the importance of awareness, equity, and respect.
Design Education Reform: Modeling Equity and Inclusion in Teaching and Learning
Authors: Rittner Jennifer
Published: August 2020

Our design firms have been built on imperialist models that presume that those in power have the authority to determine who and what has value. Who and what are worthy of care, beauty, excellence, comfort, community, liberation, wholeness, and joy.

An educator discusses how design education can create change for the better. Developing new mental models is one of the building blocks to making it happen.
Designing Equitable Futures
Authors: Jacobs Jessica
Published: August 2020

Systemic racism has always been embedded in the structures and institutions of the United States, yet it often operates invisibly and unchallenged. At this moment, the infrastructures of inequality and inequity have been laid bare.

Individual designers and corporations have the opportunity to respond to systemic racism through their work. What are you doing? What more could you be doing?
Are COVID‐19 Layoffs a Red‐Flag on Innovation?
Authors: Cervantes Leticia
Published: August 2020

Over centuries we've seen that each economic and political hurdle we've encountered has kindled innovation and progress.

During tough times such as these, some companies lay off their creative staff—others view the situation as an opportunity for innovation.
The “New‐Normal” Life of a Sandwich Mom in a Sushi World
Authors: Goto Kelly
Published: August 2020

The term “sandwich generation” has been used by demographers to describe a group of Americans who are caring for children under 18 and older relatives at the same time. As a 52‐year old single mom living with two daughters and my just‐over‐80 mother, I squarely fit the bill.

One designer's account of the trials and joys of her “new normal” life in a three‐generational household during lockdown in the pandemic.
Tetralogy of Fallot with subaortic membrane: A rare association
Authors: Chimoriya Romila , Awasthy Neeraj , Kumar Gaurav , Chelawat Shubham
Published: August 2020

Tetralogy of Fallot is the most common cyanotic disease sharing a common anatomic basis but with varied presentation.There are very few described cases of TOF with left sided obstructive lesions. We describe a left ventricular outflow tract obstruction in a 3 year old child in association with TOF. Also we review the available literature for the association of left ventricular obstructive lesions in association with the same.
Transcriptomic similarities and differences between the limb bud AER and unique carapacial ridge of turtle embryos
Authors: Cordero Gerardo A.
Published: August 2020

Evolutionary innovation may arise via major departures from an ancestral condition. Turtle shell morphogenesis depends on a unique structure known as the carapacial ridge (CR). This lateral tissue protrusion in turtle embryos exhibits similar properties as the apical ectodermal ridge (AER)—a well‐known molecular signaling center involved in limb development. Still, how the CR influences shell morphogenesis is not entirely clear. The present study aimed to describe the CR transcriptome shortly before ribs were halted within its mesenchyme, as required for shell development. Analyses exposed that the mesenchymal marker VIM was one of the most highly co‐expressed genes and numerous appendage formation genes were situated within the core of CR and AER co‐expression networks. However, there were tissue‐specific differences in the activity of these genes. For instance, WNT5A was most frequently assigned to appendage‐related annotations of the CR network core, but not in the AER. Several homeobox transcription factors known to regulate limb bud patterning exhibited their highest expression levels in the AER, but were underexpressed in the CR. The results of this study corroborate that novel body plans often originate via alterations of pre‐existing genetic networks. Altogether, this exploratory study enhances the groundwork for future experiments on the molecular underpinnings of turtle shell development and evolution.
Language teacher multilingualism in Norway and Russia: Identity and beliefs
Authors: Calafato Raees
Published: August 2020

Multilingualism has witnessed growing interest as a subject of academic study and as a state to aspire to for many of the world's citizenry. In tandem with this growing interest, countries around the world have started to implement foreign language curricula at schools that seek to prepare the coming generations to thrive in an increasingly multilingual global environment. In this respect, language teachers are likely to play a pivotal role in promoting the learning of multiple languages among students, with their beliefs about multilingualism informing their practices. This study reports on the beliefs of 460 secondary school teachers of English, French, German, Spanish, Italian, and Chinese in Norway and Russia regarding the benefits of being or becoming multilingual, the affordances of multilingual teachers, and the promotion of multilingualism in their respective countries. The findings indicated statistically significant differences between the participants based on the number of languages they taught and, to some extent, their country of residence. The observed differences hold important implications for teacher education programs and initiatives promoting the use of multilingualism as a resource in language education.
Biomarkers of seizure response to vagus nerve stimulation: A scoping review
Authors: Workewych Adriana M. , Arski Olivia N. , Mithani Karim , Ibrahim George M.
Published: August 2020

Although vagus nerve stimulation (VNS) is a common procedure, seizure outcomes are heterogeneous, with few available means to preoperatively identify the ideal surgical candidate. Here, we perform a scoping review of the literature to identify biomarkers of VNS response in patients with drug‐resistant epilepsy. Several databases (Ovid MEDLINE, Ovid Embase, BIOSIS Previews, and Web of Science) were searched for all relevant articles that reported at least one biomarker of VNS response following implantation for intractable epilepsy. Patient demographics, seizure data, and details related to biomarkers were abstracted from all studies. From the 288 records screened, 28 articles reporting on 16 putative biomarkers were identified. These were grouped into four categories: network/connectomic‐based biomarkers, electrophysiological signatures, structural findings on neuroimaging, and systemic assays. Differences in brain network organization, connectivity, and electrophysiological synchronicity demonstrated the most robust ability to identify VNS responders. Structural findings on neuroimaging yielded inconsistent associations with VNS responsiveness. With regard to systemic biomarkers, heart rate variability was shown to be an independent marker of VNS response, whereas inflammatory markers were not useful. There is an unmet need to preoperatively identify candidates who are likely to benefit from VNS. Several biomarkers demonstrate promise in predicting seizure responsiveness to VNS, particularly measures of brain network connectivity. Further efforts are required to validate existing biomarkers to inform clinical decision‐making.
Protective effects of dexmedetomidine on small intestinal ischaemia‐reperfusion injury in horses
Authors: VanderBroek Ashley R. , Engiles Julie B. , Kästner Sabine B. R. , Kopp Veronika , Verhaar Nicole , Hopster Klaus
Published: August 2020

Background

Strangulating small intestinal lesions in the horse have increased morbidity and mortality compared to nonstrangulating obstructions due to mucosal barrier disruption and subsequent endotoxaemia.

Objectives

To investigate protective effects of dexmedetomidine on small intestinal ischaemia‐reperfusion injury in the horse.

Study design

Randomised, controlled, experimental study.

Methods

Eighteen systemically healthy horses were randomly assigned to three groups: control, preconditioning, and post‐conditioning. During isoflurane anaesthesia, complete ischaemia was induced in a 1‐m segment of jejunum for 90 minutes. Horses in the preconditioning and post‐conditioning groups received dexmedetomidine (3.5 µg/kg followed by 7 µg/kg/h) before (preconditioning) or after beginning ischaemia (post‐conditioning), and during reperfusion. Jejunal biopsies were collected before ischaemia (baseline‐1), at the end of the ischaemic period (ischaemia), and 30 minutes after reperfusion (reperfusion‐1). Additional biopsies were taken 24 hours after reperfusion from ischaemia‐reperfusion‐injured jejunum (reperfusion‐2). Epithelial injury was scored histologically, and morphometric analyses were used to calculate villus surface area (VSA) denuded of epithelium. Data were analysed using analysis of variance, Kruskal‐Wallis and Wilcoxon two‐sample tests.

Results

In the control group, epithelial injury scores and percentage of VSA denudation for ischaemia‐reperfusion‐injured jejunum were higher compared to baseline‐1 at all time points. The ischaemia and both reperfusion samples from the pre‐ and post‐conditioning groups had lower epithelial injury scores and percentage of VSA epithelial denudation compared to the control group, with no difference from baseline‐1 at any time point for the preconditioning group.

Main limitations

Preconditioning has limited application in the clinical setting with naturally occurring strangulating small intestinal lesions.

Conclusions

Dexmedetomidine was protective for small intestinal ischaemia‐reperfusion injury in the horse when administered before or during ischaemia.
Distribution of CYP2C19, ABCB1 and PON1 polymorphisms in Chinese Han, Hui, Uygur and Kazak patients with coronary atherosclerotic heart disease
Authors: Ma Lijuan , Yuan Yuan , Li Jing , Yu Changzhi , Zhao Jun
Published: August 2020

CYP2C19, ABCB1 and PON1 polymorphisms involve in the metabolism and absorption of clopidogrel, which may be associated with interethnic variability of clopidogrel response. In our study, we evaluated the prevalence of CYP2C19, ABCB1 and PON1 single nucleotide polymorphisms (SNP) in patients with coronary atherosclerotic heart disease (CHD) of Chinese Han, Hui, Uygur and Kazak ethnic groups. Five SNPs were detected [CYP2C19 ∗2 (rs4244285), CYP2C19 ∗3 (rs4986893), CYP2C19 ∗17 (rs12248560), ABCB1 (rs1045642) and PON1 (rs662)]. The analysis was performed in 1,337 patients with CHD, including 831 Han, 85 Hui, 352 Uygur and 69 Kazak. The results revealed the differential distribution of the five SNPs. Frequencies of CYP2C19 no function variants in Uygur and Kazak were lower than those in Han and Hui groups (P < .05). CYP2C19 variants with increased function were more common in Uygur (13.6%) and Kazak (10.9%) groups (P < .05). Compared with Han and Hui groups, distribution of ABCB1 allele T was more prevalent in Uygur and Kazak groups (53.8% and 50.7%, respectively, P < .05). PON1 allele A frequencies of 55.7% and 58.7% in Uygur and Kazak showed higher prevalence than in the Han (38.4%) and Hui (43.5%) groups (P < .05). In conclusion, CYP2C19 *2 and *3 alleles are prevalent in Chinese Han and Hui groups, whereas CYP2C19 *17, ABCB1 T and PON1 A variants are relatively frequent in Chinese Uygur and Kazak ethnic groups. Our findings may provide a theoretical basis for the explanation of ethnic differences in determining clinical therapy strategies and predicting adverse effects.
Giant otter Pteronura brasiliensis breeding programmes: challenges and current developments
Authors: Schikora T. F.
Published: August 2020

There is a history of over 130 years of Giant otters Pteronura brasiliensis in zoos. Thanks to the intensive work carried out at numerous holding institutions and huge progress in husbandry practices, especially over the past 20 years, significant success has been achieved in the breeding of this Endangered species. Initially kept for awareness and education purposes, the breeding programme for the Giant otter is gradually evolving into a global management programme capable of combining ex situ and in situ conservation. At the time of writing, zoos on four continents (South America, North America, Europe and Asia) work together with partners from research, conservation and the authorities to preserve this wonderful species, for which a reintroduction project is in the process of being established.
Highly efficient yellow‐orange emission and superior thermal stability of Ba2YAl3Si2O12:Ce3+ for high‐power solid lighting
Authors: Huang Dayu , Liu Zhiyuan , Wang Bo , Che Hailin , Zou Man , Zeng Qingguang , Lian Hongzhou , Lin Jun
Published: August 2020

With great economic benefits, white LEDs (w‐LEDs) have aroused worldwide attention. For phosphor‐converted w‐LED, highly efficient emission and good thermal stability of phosphor are significant parameters in practical application. Here, a yellow‐orange garnet‐structural phosphor, Ba2YAl3Si2O12:xCe3+ (x = 0‐0.1) (BYAS:xCe3+) was developed by solid solution design. The broad emission spectrum of the as‐synthesized phosphor could guarantee the effective increase of the color rendering index when it is combined with the InGaN blue chip. Benefiting from the garnet‐type highly rigid framework, BYAS:xCe3+ exhibits an excellent thermal stability (50%@673K of the initial integrated intensity at 280 K) as well as high absolute quantum efficiency (80.4%@460 nm excitation light). Utilizing the approach of “phosphor‐in‐glass” (PiG), a high‐power warm w‐LED is achieved based on a blue LED plus PiG and the illuminance of this w‐LED device can be as high as 4227 lx.
Fixed‐dose combination of amlodipine and atorvastatin improves clinical outcomes in patients with concomitant hypertension and dyslipidemia
Authors: Lin Chia‐Pin , Tung Ying‐Chang , Hsiao Fu‐Chih , Yang Chia‐Hung , Kao Yi‐Wei , Lin Yu‐Sheng , Chu You‐Chia , Chu Pao‐Hsien
Published: August 2020

Hypertension and dyslipidemia are important risk factors for cardiovascular disease. However, the clinical outcomes of fixed‐dose combination (FDC) versus free‐equivalent combination (FEC) of amlodipine and atorvastatin in the treatment of concurrent hypertension and dyslipidemia remain unknown. In this study, we included patients with newly diagnosed hypertension and dyslipidemia, without previously established cardiovascular disease, and treated with either FDC or FEC of amlodipine and atorvastatin were identified from the National Health Insurance Research Database of Taiwan and follow‐up for 5 years. By using 1:1 propensity score matching, a total of 1756 patients were enrolled in this study. The composite of major adverse cardiovascular events, including all‐cause mortality, myocardial infarction (MI), stroke, and coronary revascularization, occurred more frequently in the FEC group than in the FDC group (hazard ratio, 1.88; 95% confidence interval [CI], 1.42 to 2.5). Although the all‐cause mortality did not differ (hazard ratio, 0.46; 95% CI, 0.36 to 1.59), the FEC group developed increased MI, stroke, and coronary revascularization (hazard ratio, 2.87; 95% CI, 1.07 to 7.68; hazard ratio, 1.97; 95% CI, 1.41 to 2.74; and hazard ratio, 2.44; 95% CI, 1.26 to 4.69, respectively). Furthermore, as an unexpected result, a higher risk to develop new‐onset diabetes mellitus was observed with FEC regimens (hazard ratio, 2.19; 95% CI, 1.6 to 3.0). In conclusion, although the all‐cause mortality did not differ between the two groups, the FDC regimen of amlodipine and atorvastatin improved clinical outcomes when compared to FEC in patients with newly diagnosed hypertension and dyslipidemia.
Factors Related to the Clinical Competence of Registered Nurses: Systematic Review and Meta‐Analysis
Authors: Gunawan Joko , Aungsuroch Yupin , Fisher Mary L. , Marzilli Colleen , Liu Ying
Published: August 2020

Purpose

To determine the factors associated with the clinical competence of registered nurses.

Methods

Systematic review and meta‐analysis was used. The search strategy was limited to 10 years, ranging from January 2009 to December 2019, in Science Direct, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, ProQuest, and Google Scholar. A meta‐analysis was performed using R Studio with the metafor package (Boston, MA, USA; https://rstudio.com/products/rstudio/older‐versions/).

Results

A total of 22 studies were included, representing 33,961 nurses. There were 28 factors associated with clinical competence. Of those, 13 factors were significantly supported and included for meta‐analysis, grouped into (a) individual‐related factors, (b) job satisfaction, (c) bullying, (d) burnout, and (d) specific knowledge. The effect size of those factors ranged from ‐0.14 to 0.50.

Conclusions

Among individual‐related factors, salary has the largest effect size on competence and is considered important. Clinical competence is positively affected by job satisfaction, but negatively influenced by bullying and burnout. Although specific knowledge has a large effect size, it does not significantly affect the clinical competence of registered nurses.

Clinical Relevance

It is critical to understand factors related to the clinical competence of registered nurses to maintain quality care and patient outcomes in clinical settings. The findings serve as data to help nurse managers find effective ways to improve the knowledge, skill, attitudes, and performance of registered nurses.
Neuroimaging Characteristics of Nasopharyngeal Carcinoma in Children
Authors: Orman Gunes , Tran Brandon H. , Desai Nilesh , Meoded Avner , Kralik Stephen , Smith Valeria , Hicks John , Kirsch Claudia , Huisman Thierry A. G. M.
Published: August 2020

BACKGROUND AND PURPOSE

Pediatric nasopharyngeal carcinoma (NPC) is a rare epithelial origin tumor associated with undifferentiated histology, Epstein–Barr virus (EBV) infection, and genetic risk factors. Childhood NPC is usually clinically silent, often presenting with advanced locoregional compromise, including skull base invasion and cervical lymphadenopathy, and has a better prognosis than adult NPC. This article describes computed tomography (CT) and magnetic resonance imaging (MRI) features in a cohort of 28 pediatric NPC patients.

METHODS

A retrospective review was performed among children with histopathology proven NPC diagnoses between 1996 and 2019 for this study. The electronic medical records were reviewed to determine demographics, EBV serology, and World Health Organization (WHO) type. Nasopharyngeal CT and/or MRI at presentation for tumor spread as well as density and/or intensity, lymphadenopathy, postcontrast enhancement and diffusion characteristics before treatment were evaluated.

RESULTS

Twenty‐eight patients (21 males, 7 females) were included. The mean patient age at diagnosis was 13.3 (range 7 to 17) years. EBV was positive in 71.4% of patients. The majority of patients (78.6%) had a WHO type III tumor, unilateral fossa of Rosenmuller involvement (71.4%). Neuroimaging features were CT isodensity, T1‐isointensity, T2‐hyperintensity, and heterogeneous postcontrast enhancement for all patients (100%) and restricted diffusion (90%).

CONCLUSIONS

Although uncommon in pediatric patients, NPC should be in the differential diagnosis of adolescents presenting with a nasopharyngeal mass. Recognizing key imaging characteristics is helpful in the diagnosis of NPC.
High sugar content of European commercial baby foods and proposed updates to existing recommendations
Authors: Hutchinson Jayne , Rippin Holly , Threapleton Diane , Jewell Jo , Kanamäe Haidi , Salupuu Kristin , Caroli Margherita , Antignani Angelo , Pace Lucienne , Vassallo Charlene , Lande Britt , Hildonen Christina , Rito Ana Isabel , Santos Mariana , Gabrijelcic Blenkus Mojca , Sarkadi‐Nagy Eszter , Erdei Gergő , Cade Janet E. , Breda Joao
Published: August 2020

The aim was to determine whether commercial baby foods marketed within Europe (up to 36 months of age) have inappropriate formulation and high sugar content and to provide suggestions to update European regulations and recommendations as part of a nutrient profile model developed for this age group. The latter was produced following recommended World Health Organization (WHO) steps, including undertaking a rapid literature review. Packaging information from countries across the WHO European region was used to determine mean energy from total sugar by food category. The percentage of products containing added sugar and the percentage of savoury meal‐type products containing pureed fruit were also calculated. A total of 2,634 baby foods from 10 countries were summarised: 768 sold in the United Kingdom, over 200 each from Denmark (319), Spain (241), Italy (430) and Malta (243) and between 99–200 from Hungary, Norway, Portugal, Estonia and Slovenia. On average, approximately a third of energy in baby foods in these European countries came from total sugar, and for most food categories, energy from sugar was higher than 10%. Use of added sugars was widespread across product categories, with concentrated fruit juice most commonly used. Savoury meal‐type purees did not contain added sugars except in United Kingdom and Malta; however, fruit as an ingredient was found in 7% of savoury meals, most frequently seen in UK products. Clear proposals for reducing the high sugar content seen in commercial baby foods were produced. These suggestions, relating to both content and labelling, should be used to update regulations and promote product reformulation.
Losing confidence in luminosity
Authors: Goldstein Simon , Waxman Daniel
Published: August 2020

A mental state is luminous if, whenever an agent is in that state, they are in a position to know that they are. Following Timothy Williamson's Knowledge and Its Limits, a wave of recent work has explored whether there are any non‐trivial luminous mental states. A version of Williamson's anti‐luminosity appeals to a safety‐theoretic principle connecting knowledge and confidence: if an agent knows p, then p is true in any nearby scenario where she has a similar level of confidence in p. However, the relevant notion of confidence is relatively underexplored. This paper develops a precise theory of confidence: an agent's degree of confidence in p is the objective chance they will rely on p in practical reasoning. This theory of confidence is then used to critically evaluate the anti‐luminosity argument, leading to the surprising conclusion that although there are strong reasons for thinking that luminosity does not obtain, they are quite different from those the existing literature has considered. In particular, we show that once the notion of confidence is properly understood, the failure of luminosity follows from the assumption that knowledge requires high confidence, and does not require any kind of safety principle as a premise.
The search for invertebrate consciousness
Authors: Birch Jonathan
Published: August 2020

There is no agreement on whether any invertebrates are conscious and no agreement on a methodology that could settle the issue. How can the debate move forward? I distinguish three broad types of approach: theory‐heavy, theory‐neutral and theory‐light. Theory‐heavy and theory‐neutral approaches face serious problems, motivating a middle path: the theory‐light approach. At the core of the theory‐light approach is a minimal commitment about the relation between phenomenal consciousness and cognition that is compatible with many specific theories of consciousness: the hypothesis that phenomenally conscious perception of a stimulus facilitates, relative to unconscious perception, a cluster of cognitive abilities in relation to that stimulus. This “facilitation hypothesis” can productively guide inquiry into invertebrate consciousness. What is needed? At this stage, not more theory, and not more undirected data gathering. What is needed is a systematic search for consciousness‐linked cognitive abilities, their relationships to each other, and their sensitivity to masking.
Human immunodeficiency virus interaction with oral and genital mucosal epithelia may lead to epithelial–mesenchymal transition and sequestration of virions in the endosomal compartments
Authors: Tugizov Sharof M.
Published: August 2020

Oral and genital mucosal epithelia are multistratified epithelial barriers with well‐developed tight and adherens junctions. These barriers serve as the first line of defense against many pathogens, including human immunodeficiency virus (HIV). HIV interaction with the surface of mucosal epithelial cells, however, may activate transforming growth factor‐beta (TGF‐β) and mitogen‐activated protein kinase signaling pathways. When activated, these pathways may lead to the disruption of epithelial junctions and epithelial–mesenchymal transition (EMT). HIV‐induced impairment of the mucosal barrier may facilitate the spread of pathogenic viral, bacterial, fungal, and other infectious agents. HIV‐induced EMT promotes highly motile/migratory cells. In oral and genital mucosa, if EMT occurs within a human papillomavirus (HPV)‐infected premalignant or malignant cell environment, the HPV‐associated neoplastic process could be accelerated by promoting viral invasion of malignant cells. HIV also internalizes into oral and genital mucosal epithelial cells. The majority (90%) of internalized virions do not cross the epithelium, but are retained in endosomal compartments for several days. These sequestered virions are infectious. Upon interaction with activated peripheral blood mononuclear cells and CD4+ T lymphocytes, epithelial cells containing the virus can be transferred. The induction of HIV‐1 release and the cell‐to‐cell spread of virus from epithelial cells to lymphocytes is mediated by interaction of lymphocyte receptor function‐associated antigen‐1 with the epithelial cell receptor intercellular adhesion molecule‐1. Thus, mucosal epithelial cells may serve as a transient reservoir for HIV, which could play a critical role in viral transmission.
HIV testing in the dental setting: A global perspective of feasibility and acceptability
Authors: Santella Anthony J.
Published: August 2020

HIV is no longer a death sentence with early diagnosis and effective treatment contributing to a good prognosis. Surveillance data, however, suggest that one in four people globally living with HIV are unaware of their HIV infection and remains at risk of transmitting their infection if having unprotected sex. A wider array of testing opportunities and settings are thus needed to address this issue of public health significance. Evidence suggests there is a role for the dental team, particularly dentists, in offering chairside point‐of‐care HIV screening to patients during their dental appointments. Dentists, dental hygienists, and other members of the dental team may still have a role in helping to identify new cases of HIV with the goal of improving health outcomes, addressing health inequalities and improving the quality and quantity of life. This paper reviews the global epidemiology of HIV/AIDS, summarizes the point‐of‐care HIV testing process, highlights key findings of international studies (from high‐, middle‐, and low‐income countries) on the role of dental professionals in point‐of‐care HIV testing, and offers suggestions for what additional evidence is needed to make point‐of‐care HIV testing a routine part of dental care.
Oral health and HIV: What dental students need to know
Authors: Coulthard Paul , Tappuni Anwar R. , Ranauta Amitha
Published: August 2020

Introduction

Dentists have an important role in reducing new HIV infections by early diagnosis and need to know how to treat patients with HIV and understand universal cross‐infection control. In many parts of the world, healthcare professionals struggle to provide care because of barriers including stigma and cultural attitudes.

Aim

To investigate the effectiveness of a brief educational intervention in understanding/changing the views of dental school deans regarding the quality of the oral health and HIV/AIDS teaching and their willingness to undertake a curriculum review if appropriate.

Methods

Questionnaires before and after interactive presentation to the deans of 30 Indonesian dental schools and discussion.

Results

Only six of 30 dental school deans believed that their HIV undergraduate dental student teaching was inadequate before the intervention, but 29 of 30 deans recognised the need to review their curriculum after the intervention. Whilst the majority (24/30) felt that their HIV teaching was adequate, good or excellent, the majority also thought that their students would find it difficult to treat patients with HIV.

Conclusion

The brief educational intervention was effective in improving the understanding/changing the views of dental school deans regarding the quality of HIV/AIDS teaching and learning at their own institution and engaging a willingness to undertake curriculum review.
Innovations for prevention and care of oral candidiasis in HIV‐infected individuals: Are they available?—A workshop report
Authors: Ramírez‐Amador Velia , Patton Lauren L. , Naglik Julian R. , Nittayananta Wipawee
Published: August 2020

Oral candidiasis (OC) is the most prevalent HIV‐related oral lesion in patients on combined anti‐retroviral therapy (cART) or without cART. Management is challenged in some patients by development of resistance to azole drugs, such as fluconazole. Recent scientific knowledge about OC pathogenesis, the role of OC in the immune reconstitution inflammatory syndrome (IRIS), the relationship of OC with the microbiome, and novelties in OC treatment was discussed in an international workshop format. Literature searches were conducted to address five questions: (a) Considering the pathogenesis of Candida spp. infection, are there any potential therapeutic targets that could be considered, mainly in HIV‐infected individuals resistant to fluconazole? (b) Is oral candidiasis part of IRIS in HIV patients who receive cART? (c) Can management of the oral microbiome reduce occurrence of OC in patients with HIV infection? (d) What are the recent advances (since 2015) regarding plant‐based and alternative medicines in management of OC? and (e) Is there a role for photodynamic therapy in management of OC in HIV‐infected patients? A number of the key areas where further research is necessary were identified to allow a deeper insight into this oral condition that could help to understand its nature and recommend alternatives for care.
HIV testing: What, where and how?
Authors: Santella Anthony J. , Majam Mohammed , Van Ngo Huu , Luis Hendry
Published: August 2020

Globally, one in four people living with HIV are unaware of their status. Current HIV testing services’ strategies are falling short of reaching all, and thus, HIV testing should be offered in more decentralized and non‐traditional settings such as the dental and community settings. The workshop titled “HIV Testing: What, Where, and How?” provided an overview of concepts and advances in HIV point of care and self‐testing diagnostics and a discussion on the implementation of HIV self‐test interventions in different healthcare settings and its impact thereof. We also described how to build layperson capacity to deliver HIV testing in community settings. Additionally, we discussed what we have learned from expanding HIV testing beyond the specialist setting. We also noted considerations (i.e. provider willingness, test selection, training and preparing testing environment) dentists and other non‐specialist providers need to account for if they are planning to conduct HIV testing. Finally, we highlighted facilitators and barriers to implementing HIV testing in the dental setting on a global scale. These considerations are critical to meeting the UNAIDS 90–90–90 target to help end the HIV/AIDS epidemic.
Dentists experience influences knowledge and attitudes toward HIV patients in West Jakarta, Indonesia, and validation of a new questionnaire
Authors: Gunardi Indrayadi , Salsabila Nurina Nadia , Marcia  , Amtha Rahmi
Published: August 2020

Dentists’ knowledge and attitudes are two main components that may have a role in reducing and preventing the severity of HIV infection. No recent data on this are available in Jakarta.

Objective

To evaluate the dental profession's experience based on knowledge and attitude toward HIV patients in West Jakarta.

Subjects and Method

A cross‐sectional study was conducted on 218 private dentists. The knowledge and attitude were assessed by validated questionnaire under informed consent. Data were analyzed by the Rasch model to assess reliability and multiple logistic regression.

Result

Rasch test found person reliability was poor (0.60; 1.23) and item reliability was excellent (0.97; 5.32). Good knowledge was shown in 58.3% of respondents, and a good attitude was practiced in 56.9%. Only the duration of dental practice (p < .005) <1 year served as an independent risk factor for good knowledge and attitude (p < .05; p < .05), respectively. Age, gender, having a social history of interacting with HIV patients, or a history of having treated HIV patients were not associated (p > .05). The results suggest that newly graduated dentists (<1 year) have retained the knowledge which could impact on their attitude toward HIV patients in dental practice.

Conclusion

Newly qualified dentists had the best knowledge and attitude toward treating HIV patients in West Jakarta.
Management of third molar surgery in HIV‐positive patients
Authors: Zam Syarifah Nova Amiza , Sylvyana Melita , Sjamsudin Endang
Published: August 2020

Background

Third molar surgery is a common procedure performed by oral and maxillofacial surgeons. This kind of surgery is predictable, and complications are infrequent. Immune deficiency is one of the considerations for the prevention of complications. HIV patients may be immune deficient. Third molar surgical procedures are associated with bleeding and increased risk of infection. Improvement in oral hygiene must be encouraged, such as pre‐operative scaling. Prophylactic antibiotics and history of anti‐retroviral therapy should be considered.

Case report

7 cases of third molar surgery in HIV patients were handled at the oral and maxillofacial surgery department. Intraoral examination showed typical lesions of HIV patients such as oral candidiasis, hairy leucoplakia, necrotizing ulcerative periodontitis, oral ulcers and also pericoronitis of third molars. Radiological examination showed impacted teeth in the upper and lower the third molar region. Third molar treatment was carried out as elective surgery under general anaesthesia. Prophylactic antibiotics were given to the patients as standard of care.

Conclusion

Treatment planning for HIV‐positive patients follows the same sequence as with other patients, and the priorities are to remove local infection and prevent further dental disease. Third molar surgery in HIV‐positive patients can improve dental health which can affect the quality of life. Prophylactic antibiotic should be used to prevent infections. Bleeding control also needed to avoid complications.
The diagnostic accuracy of the HIV 1/2/subtype O Tri‐line rapid test compared with ELISA: A pilot study
Authors: Manenzhe Shumani Charlotte , Ngwenya Sizakele Pride , Shangase Sindisiwe Londiwe
Published: August 2020

Background

Accurate HIV diagnosis is essential for appropriate patient care. Rapid tests (RTs) are considered key to HIV screening and management. Some studies have found RTs to be comparable with the ELISA test whilst others have reported lower sensitivity.

Aim and study design

The aim of this retrospective, descriptive study was to evaluate the sensitivity and specificity of the HIV 1/2/O Tri‐line rapid test (HIV‐TRT) device compared with ELISA.

Method

The study sample comprised 45 records of patients who tested for HIV using the HIV‐TRT device and ELISA.

Results

As compared with ELISA as the 100% gold standard, the sensitivity of the HIV‐TRT was 80% (CI: 59%–93%) and specificity was 100% (CI: 83%–100%). ROC area of 0.9 at 95% CI was determined.

Conclusion

The low sensitivity of HIV‐TRT is a concern, since HIV screening in South Africa makes use of RTs.
Detection of Epstein–Barr virus DNA in saliva of HIV‐1‐infected individuals with oral hairy leukoplakia
Authors: Farisyi Muhammad Al , Sufiawati Irna
Published: August 2020

We present three cases of oral hairy leukoplakia (OHL) in whom the diagnosis was established by EBV DNA detection in whole saliva. Three HIV‐infected patients came to the Oral Medicine Clinic with similar chief complaints of asymptomatic white lesions on the tongue. All patients were diagnosed with suspected OHL and oral thrush also in the first patient. A multiplex PCR DNA microarray was performed to detect EBV DNA in saliva collected by spitting method. All saliva samples showed positive results for EBV DNA, and the definitive diagnosis of OHL was made. Resolution of lesions was found at 1‐ to 2‐month follow‐up after treatment with application of acyclovir 5% cream 5 times daily. Additionally, anti‐fungal treatment was given to the first patient and anti‐retroviral treatment to the first and second patients. EBV is mostly transmitted by asymptomatic shedding into saliva. Therefore, the detection of salivary EBV DNA is useful in establishing a definitive diagnosis of OHL allowing more effective treatment for both HIV‐infected patients receiving ART and treatment‐naïve patients at any CD4 + count.
HIV Teaching: A dental curriculum which fosters knowledge and attitude
Authors: Ranauta Amitha , Tappuni Anwar R. , Coulthard Paul
Published: August 2020

HIV Teaching

A dental curriculum which fosters knowledge and attitude.

Objectives

A pilot study to explore dental students views of current HIV related teaching and to assess the impact of this teaching on the students’ self‐perceived confidence in delivering dental care to HIV patients.

Methods

A short cross‐sectional survey was conducted to gather the views of students on both objectives. Data was collected using an online self‐administered questionnaire. Descriptive data analysis was conducted and used to present the data. Additionally, a one to one interview was performed with a past dental student for a thematic analysis.

Results

The HIV teaching at this dental school uses different learning approaches involving didactic, reflective, and participatory methods to address the knowledge, attitudinal and skills objectives. A didactic and experiential problem‐based approach using role‐play with simulated patients with feedback, and discussion is utilised. Preliminary results show dental students perceive the course to be valuable and there is a general improvement in confidence in their knowledge and ability to communicate with HIV‐positive patients.

Conclusions

This evaluation suggests the course format and content are appropriate in providing education and training for dental students and supports the value of teaching HIV to undergraduate students.
Viruses and oral diseases in HIV‐infected individuals on long‐term antiretroviral therapy: What are the risks and what are the mechanisms?
Authors: Johnson Newell W. , Anaya‐Saavedra Gabriela , Webster‐Cyriaque Jennifer
Published: August 2020

As a result of the extension of life span produced by increasing access to combined antiretroviral therapy, people living with HIV/AIDS (PLWH) face new challenges from comorbidities. Although advances in medical care for HIV infection have dramatically reduced opportunistic infections and AIDS‐defining cancers, some non‐AIDS‐defining cancers (NADC) and specific oral diseases such as periodontitis and salivary gland disease are now more prevalent. Cancer prevention is, therefore, a priority issue in care of PLWH, stressing both restoration of immune function and reduction of non‐HIV cancer risk factors (tobacco in all its forms; areca nut; heavy alcohol consumption; diets lacking antioxidant vitamins and minerals; and oncogenic virus infections) through specific interventions, especially tobacco and areca nut cessation and alcohol moderation. Detection of oral high‐risk human papillomaviruses (HR‐HPV) and the universal preventive HPV vaccination among PLWH should be promoted to reduce the malignancy burden, along with routine oral examinations which remain the cheapest, most reliable, most reproducible, and non‐invasive tool to identify suspicious lesions. Also, considerations of oral inflammation and periodontal health are important to replication and gene expression of viruses in the mouth. Considering that a key risk factor for this scenario is the presence of oncogenic virus infection such as several members of the human herpesvirus and human papillomavirus families, here we analyze the variables involved in the seeming increase in comorbidities in PLWH.
Interplay between oral immunity in HIV and the microbiome
Authors: Fidel Paul L. , Moyes David , Samaranayake Lakshman , Hagensee Michael E.
Published: August 2020

This Basic Science Workshop addressed the oral microbiome. At the 7th World Workshop on Oral Health & Disease in HIV/AIDS in India in 2014, some aspects of the human microbiome were discussed, and research questions formulated. Since that time, there have been major advances in technology, which have stimulated a number of publications on many aspects of the human microbiome, including the oral cavity. This workshop aimed to summarize current understanding of the “normal” microbiome of the oral cavity compared to that during HIV infection, and how oral immune factors and other clinical variables alter or control the oral microbiome. An important question is whether successful treatment with anti‐retroviral therapy, which leads to a significant drop in viral loads and immune reconstitution, is associated with any change or recovery of the oral microbiome. Additionally, the workshop addressed the issue of which parameters are most appropriate/correct to evaluate the oral microbiome and how clinically relevant are shifts/changes in the oral microbiome. The workshop evaluated current knowledge in five research areas related to five basic questions and identified further topics where further research is required.
Towards cost‐effective biofouling management in salmon aquaculture: a strategic outlook
Authors: Bloecher Nina , Floerl Oliver
Published: August 2020

Biofouling is an ongoing challenge for marine salmon aquaculture, impacting farming operations, fish health and welfare. Current mitigation strategies employed in Norway and Scotland rely mainly on the use of antifouling coatings and reactive removal of biofouling. These approaches are not only costly and of limited efficacy, but also pose active risks and likely contribute to mortality of fish during grow‐out at sea. Given the inefficiencies of current biofouling management approaches and the industry’s objectives for growth and sustainability, a strategic assessment of future avenues for biofouling management is needed. We here present such an assessment and outline three novel biofouling management strategies that, once implemented, could facilitate improved fish health and welfare, reduced environmental impacts and benefits to the public perception of fish farming. These strategies are based on: (i) efficient antifouling coatings; (ii) antifouling combined with intermittent cleaning; and (iii) grooming of nets. We discuss the advantages, challenges and research and development needs associated with the realisation of these strategies. Drawing on experiences from agricultural systems and invasive species management, we show how the costs involved in the implementation of new strategies will over time be offset by the direct and indirect benefits arising from a reduction in environmental and fish health impacts and an increase in the industry’s social licence to operate.