bluuebunny/crossref_metadata_2025 huggingface dataset:
Phenology of farmland floral resources reveals seasonal gaps in nectar availability for bumblebees
Authors: Timberlake Thomas P. , Vaughan Ian P. , Memmott Jane
Published: April 2019

Floral resources are known to be important in regulating wild pollinator populations and are therefore an important component of agri‐environment and restoration schemes which aim to support pollinators and their associated services. However, the phenology of floral resources is often overlooked in these schemes — a factor which may be limiting their success.

Our study characterizes and quantifies the phenology of nectar resources at the whole‐farm scale on replicate farms in Southwestern UK throughout the flowering season. We quantify the corresponding nectar demands of a subset of common wild pollinators (bumblebees) to compare nectar supply and pollinator demand throughout the year, thereby identifying periods of supply‐demand deficit.

We record strong seasonal fluctuations in farmland nectar supplies, with two main peaks of nectar production (May and July) and a considerable “June Gap” in between. March and August/September are also periods of low nectar availability.

Comparing the phenology of nectar supply with the phenology of bumblebee nectar demand reveals “hunger gaps” during March and much of August/September when supply is unlikely to meet demand.

Permanent pasture and woodland produced the greatest share of farmland nectar because of their large area; however, linear features such as hedgerows and field margins provided the greatest nectar per unit area. Fifty percent of total nectar was supplied by just three species (Allium ursinum, Cirsium arvense and Trifolium repens), but some less productive species (e.g. Hedera helix and Taraxacum agg.) were important in ensuring phenological continuity of nectar supply.

Synthesis and applications. By comparing the phenology of farmland nectar supply with the phenology of pollinator demand, we demonstrate that the timing of nectar supply may be as important as total nectar production in limiting farmland pollinator populations. Considering phenology in the design of agri‐environment or restoration schemes is therefore likely to improve their suitability for pollinators. Plant species which flower during periods of resource deficit (early spring and late summer) should be prioritized in schemes which aim to conserve or restore pollinator populations. Maintaining a range of semi‐natural habitats with complementary flowering phenologies (e.g. woodland, hedgerows and field margins) will ensure a more continuous supply of nectar on farmland, thereby supporting pollinators for their entire flight season.
Temperature and phosphorus interacts in controlling the picoplankton carbon flux in the Adriatic Sea: an experimental versus field study
Authors: Šolić Mladen , Šantić Danijela , Šestanović Stefanija , Bojanić Natalia , Jozić Slaven , Vrdoljak Ana , Ordulj Marin , Kušpilić Grozdan
Published: April 2019

Temperature and phosphorus positively interacted in controlling picoplankton biomass production and its transfer towards higher trophic levels. Two complementary approaches (experimental and field study) indicated several coherent patterns: (1) the impact of temperature on heterotrophic bacteria was high at temperatures lower than 16°C and levelled off at higher temperatures, whereas this impact on autotrophic picoplankton was linear along the entire range of the investigated temperatures; (2) the addition of phosphorus increased the values of picoplankton production and grazing, but did not change the nature of their relationships with temperature substantially; (3) the picoplankton carbon flux towards higher trophic levels was larger during the warmer months (grazing by HNF dominated during the warmer period and by ciliates during the colder period) and also strengthened in conditions without phosphorus limitation; (4) the hypothesis that the available phosphorus can be better utilized at higher temperatures was confirmed for both autotrophic and heterotrophic picoplankton; (5) the hypothesis that the rise in temperature stimulates growth only in conditions of sufficient phosphorus was confirmed only for heterotrophic bacteria. Therefore, in the global warming scenario, an increase of the picoplankton carbon flux towards higher trophic levels can be expected in the Adriatic Sea, particularly under unlimited phosphorus conditions.
Shock index thresholds to predict adverse outcomes in maternal hemorrhage and sepsis: A prospective cohort study
Authors: Nathan Hannah L. , Seed Paul T. , Hezelgrave Natasha L. , De Greeff Annemarie , Lawley Elodie , Anthony John , Steyn Wilhelm , Hall David R. , Chappell Lucy C. , Shennan Andrew H.
Published: April 2019

Introduction

Shock index (SI) is a predictor of hemodynamic compromise in obstetric patients. The SI threshold for action is not well understood. We aimed to evaluate SI thresholds as predictors of outcomes in obstetric patients.

Material and methods

We undertook a prospective cohort study at three South African hospitals of women with postpartum hemorrhage (n = 283) or maternal sepsis (n = 126). The “first” and “worst” SI following diagnosis were recorded. SI was compared with conventional vital signs as predictors of outcomes. The performance of SI <.9, SI .9‐1.69 and SI ≥1.7 to predict outcomes (maternal death; Critical Care Unit admission; major procedure; hysterectomy) and hemorrhage‐specific outcomes (lowest hemoglobin <70 g/l; blood transfusion ≥4 IU) were evaluated.

Results

“First” SI was one of two best performing vital signs for every outcome in postpartum hemorrhage and sepsis. In hemorrhage, risk of all outcomes increased with increasing “first” SI; for blood transfusion ≥4 IU odds ratio was 4.24 (95% confidence interval 1.25‐14.36) for SI ≥1.7 vs SI .9‐1.69. In sepsis, risk of all outcomes increased with increasing “worst” SI. Sensitivity, specificity, positive and negative predictive values of “first” SI <.9 vs SI ≥.9 for maternal death were 100.0%, 55.2%, 4.6% and 100.0%, respectively, in hemorrhage and 80.0%, 50.4%, 12.3% and 96.7%, respectively, in sepsis.

Conclusions

The shock index was a consistent predictor of outcomes compared with conventional vital signs in postpartum hemorrhage and sepsis. SI <.9 performed well as a rule‐out test and SI .9‐1.69 and SI ≥1.7 indicated increased risk of all outcomes in both cohorts. These thresholds may alert to the need for urgent intervention and prevent maternal deaths.
Evaluation of in vitro hemolysis and platelet activation of a newly developed maglev LVAD and two clinically used LVADs with human blood
Authors: Berk Zachary B. K. , Zhang Jiafeng , Chen Zengsheng , Tran Douglas , Griffith Bartley P. , Wu Zhongjun J.
Published: April 2019

In vitro hemolysis testing remains one of the most important performance measures to judge the hemocompatibility of a left ventricular assist device (LVAD). Clinically relevant operating conditions and appropriate testing blood are essential to infer in vitro data for potential clinical use. This in vitro study was carried out to evaluate and compare the hemolytic performance of a newly developed magnetically levitated (maglev) LVAD (CH‐VAD) with two clinically used LVADs (HVAD and HeartMate II (HMII)) using fresh human blood. A small volume (~300 mL) in vitro circulating flow loop was constructed with a LVAD generated flow of 4.5 L/min at the nominal or reported clinical operating speed for each LVAD. The blood was circulated in the loop for 4 hours with samples drawn at baseline and hourly. Plasma‐free hemoglobin (PFH) concentrations in the hourly blood samples were determined with spectrophotometry. Normalized index of hemolysis (NIH) was calculated to compare the hemolytic performance of the CH‐VAD and the two reference LVADs. Platelet activation was measured with flow cytometry. The experimental test for each device was repeated at least 7 times. The data from this study showed that all the three LVADs generated very low hemolysis (NIH <0.01 g/100 L). The CH‐VAD was found to have a significantly lower NIH value (0.00135 ± 0.00032 g/100 L) compared to the HVAD (0.00525 ± 0.00183 g/100 L) and the HMII (0.00583 ± 0.00182 g/100 L). No statistically significant difference in device‐generated hemolysis was found between the HVAD and the HMII. The level of platelet activation induced by the CH‐VAD is significantly lower than those by the HVAD and the HMII. The data suggest that the shear‐induced hemolysis and platelet activation of the CH‐VAD are acceptable relative to the two LVADs currently in clinical use.
Cohort study showed that growth rate increment has not been enough to prevent growth retardation of preterm infants and raised concerns about unbalanced growth
Authors: Zozaya Carlos , Avila‐Alvarez Alejandro , Couce María L. , García‐Muñoz Rodrigo Fermín , Arruza Luis , Fernandez‐Perez Cristina , Castro Abdón , Cuesta María Teresa , Vacas Beatriz , Vento Máximo , Saenz de Pipaón Miguel
Published: April 2019

Aim

We describe the postnatal weight gain, linear and head growth trends of surviving preterm infants from 2005 to 2017.

Methods

Multicentre cohort study, including surviving preterm infants <32 weeks (n = 21 084), from the Spanish Neonatal Network database, without major congenital malformations who were less than 50 weeks postmenstrual age at discharge. Outcomes were weight gain (g/kg/day), linear and head growth (cm/week) and changes in weight, length and head circumference z‐scores from birth to discharge. The study period was divided into 2005–8, 2009–11, 2012–14 and 2015–17.

Results

Weight gain, linear growth and head growth were slightly higher in 2015–2017 than in 2005–2008: 12.2 ± 2.6 to 13.1 ± 2.5 g/kg/day, 0.98 ± 0.6 to 1.03 ± 0.6 cm/week and 0.76 ± 0.2 to 0.77 ± 0.3 cm/week, respectively. It was associated with a decreased fall in weigh, length and head circumference z‐scores from birth to discharge (−1.32 ± 0.9 to −1.01 ± 0.84, −1.38 ± 1.2 to −1.18 ± 1.2 and −0.41 ± 1.2 to −0.33 ± 1.3, respectively).

Conclusion

Postnatal growth restriction remained a common complication of prematurity despite some increment over the last years. Growth disproportionality seemed to be worsening as weight gain was increased more than linear growth.
Systematic review: long‐term cognitive and behavioural outcomes of neonatal hypoxic–ischaemic encephalopathy in children without cerebral palsy
Authors: Schreglmann Magdalena , Ground Amy , Vollmer Brigitte , Johnson Mark J.
Published: April 2019

Aim

To evaluate long‐term cognitive and behavioural outcomes of children with neonatal hypoxic–ischaemic encephalopathy (HIE) in the absence of cerebral palsy (CP).

Methods

A systematic search was performed on five databases (EMBASE, Medline, PubMed, Web of Science, PsycInfo). Randomised controlled trials, non‐randomised controlled trials, or observational studies, published between 1990 and 2017, that reported long‐term (age greater than or equal to four years) cognitive and/or behavioural outcomes of neonatal HIE without CP were included.

Results

Seven articles met the inclusion criteria (n = 352 total participants, n = 53 treated with therapeutic hypothermia). Studies reporting cognitive outcome demonstrate impairment of general cognitive abilities in 25–63% of participants with HIE without CP. Specific cognitive difficulties were reported in two studies for attention, executive functioning, memory function and language. Results regarding behavioural outcome possibly indicate a higher risk of difficulties.

Conclusion

A substantial proportion of children with neonatal HIE who survive without CP are at increased risk of general and/or specific cognitive impairments. Behavioural problems may be more common, but evidence is limited. Results highlight the importance of comprehensive long‐term follow‐up to identity difficulties and enable intervention to optimise educational achievement and behavioural adjustment.
GLUT12 and adipose tissue: Expression, regulation and its relation with obesity in mice
Authors: Gil‐Iturbe Eva , Arbones‐Mainar José Miguel , Moreno‐Aliaga María J. , Lostao María Pilar
Published: April 2019

Aim

The facilitative glucose transporter GLUT12 was isolated from the breast cancer cell line MCF‐7 by its homology with GLUT4. GLUT12 is expressed in insulin‐sensitive tissues such as adipose tissue. The aim of this work was to investigate GLUT12 expression and hormonal regulation in 3T3‐L1 adipocytes and in adipose tissue of lean and diet‐induced obese mice.

Methods

Uptake studies were performed using radio‐labelled sugars; α‐methyl‐d‐glucose (αMG) was used as specific substrate of GLUT12. Expression and localization of GLUT12 in adipocytes were investigated by western blot and immunohistochemical methods.

Results

GLUT12 is expressed in the peri‐nuclear region of mouse adipocytes. Insulin, by AKT activation, and TNF‐α, by AMPK activation, increase αMG uptake by inducing GLUT12 translocation to the membrane. In contrast, leptin and adiponectin decrease GLUT12 activity through its internalization. Under hypoxia conditions GLUT12 expression is upregulated. The response of GLUT12 to TNF‐α, leptin, adiponectin and hypoxia is the opposite to that of GLUT4. In diet‐induced obese mice and obese subjects, GLUT12 protein is decreased. Intraperitoneal injection of insulin increases AKT phosphorylation and GLUT12 expression, but this effect is lost in obese animals.

Conclusion

We hypothesize that GLUT12 would contribute to modulate sugar absorption in physiological and pathophysiological situations such as obesity.
Cyclicity in ridge patterns on the prograding coasts of Estonia
Authors: Suursaar Ülo , Kall Tarmo , Steffen Holger , Tõnisson Hannes
Published: April 2019

Recent LiDAR surveys have revealed that on postglacially uplifting coasts of Estonia rhythmic coastal landforms (beach ridge sequences and foredune plains) occur to a considerable extent. We studied four of them to reveal age and periodicity in these multiple ridge systems and discussed their genesis in the Subatlantic (semi‐continental) conditions of the Baltic Sea area. Using recent models of Fennoscandian uplift due to glacial isostatic adjustment (GIA), we constructed Holocene apparent sea level curves for the study sites at Õngu, Mänspe, Haldi and Keibu; converted distance–height shore profiles into time series (including corrections on shore profile non‐linearity and variations in GIA‐eustasy balance); and analysed the patterns using spectral analysis. It was suggested that due to non‐tidal conditions, relatively low‐energy hydrodynamic forcing and small aeolian contribution, the ridges mark ancient shorelines. They are relatively modest in height (mostly 0.2–1 m), form regular and extensive (up to 150 ridges) patterns, and date back to ~9000 years before present. We studied <5‐ka‐old sections. The mean ridge spacing varied, depending also on coastal slope, between 21 and 39 m. Both simple counting and spectral analysis involved some specific limitations, yet the estimates for typical spacing were alike, at 32 (±5) years. The regular nature of the low‐ridge patterns originated from relative sea level lowering and gradual sediment accretion/erosion. However, the progradation was rather uplift‐ than accretion‐driven and the stepwise process in ridge formation was probably not autocyclic. It was governed or modulated by quasi‐periodic 25–40 year cyclicity in local wave forcing, relative sea level variations and wind conditions. Being most likely connected to the North Atlantic Oscillation, the quasi‐regular, decadal‐scale, similarly phased variations may magnify each other's effect on the westerly exposed coasts of Estonia. Additionally, some other (e.g. event‐driven) mechanisms may also be present.
Adrenal morphology and associated comorbidities in congenital adrenal hyperplasia
Authors: El‐Maouche Diala , Hannah‐Shmouni Fady , Mallappa Ashwini , Hargreaves Courtney J. , Avila Nilo A. , Merke Deborah P.
Published: April 2019

Objective

Adrenonodular hyperplasia and tumour formation are potential long‐term complications of congenital adrenal hyperplasia (CAH) with little known regarding the clinical implications. Our aim was to describe volumetric adrenal morphology and determine the association between radiological findings and comorbidities in adults with classic CAH.

Design

This was a cross‐sectional study of 88 patients (mean age 29.2 ± 13 years, 47 females) with classic CAH seen in a tertiary referral centre.

Methods

CT imaging, performed at study entry or when reaching adulthood, was used to create 3‐dimensional volumetric models. Clinical, genetic and hormonal evaluations were collected and correlated with adrenal morphology and tumour formation.

Results

Over one‐third of the cohort was obese. 53% had elevated 17‐OH‐progesterone or androstenedione; and 60% had adrenal hyperplasia. Tumours included 11 myelolipomas, 8 benign adrenocortical adenomas, 1 pheochromocytoma and 50% of men had testicular adrenal rest tissue. CAH patients with adrenal hyperplasia had significantly higher number of comorbidities than those with morphologically normal adrenals (P = 0.03). Variables that positively correlated with adrenal volume included hypogonadal/oligomenorrhoeic status, hypertension, androstenedione, aldosterone, and triglyceride levels, and in women, low HDL and insulin resistance. Elevated aldosterone was observed in a subset of patients with simple virilizing CAH.

Conclusions

Adrenocortical hyperplasia is associated with a number of comorbidities, especially hypogonadism. Aldosterone production associated with adrenal enlargement may play a role in the development of metabolic risk factors. Further studies are needed to assess the long‐term impact of the excess adrenal steroid milieu associated with adrenal enlargement to develop improved management strategies for CAH.
The clinical presentation caused by truncating CHD8 variants
Authors: Douzgou Sofia , Liang Hui Wen , Metcalfe Kay , Somarathi Suresh , Tischkowitz Marc , Mohamed Wafik , Kini Usha , McKee Shane , Yates Laura , Bertoli Marta , Lynch Sally Ann , Holder Susan ,   the Deciphering Developmental Disorders Study, Banka Siddharth
Published: April 2019

Variants in the chromodomain helicase DNA‐binding protein 8 (CHD8) have been associated with intellectual disability (ID), autism spectrum disorders (ASDs) and overgrowth and CHD8 is one of the causative genes for OGID (overgrowth and ID). We investigated 25 individuals with CHD8 protein truncating variants (PTVs), including 10 previously unreported patients and found a male to female ratio of 2.7:1 (19:7) and a pattern of common features: macrocephaly (62.5%), tall stature (47%), developmental delay and/or intellectual disability (81%), ASDs (84%), sleep difficulties (50%), gastrointestinal problems (40%), and distinct facial features. Most of the individuals in this cohort had moderate‐to‐severe ID, some had regression of speech (37%), seizures (27%) and hypotonia (27%) and two individuals were non‐ambulant. Our study shows that haploinsufficiency of CHD8 is associated with a distinctive OGID syndrome with pronounced autistic traits and supports a sex‐dependent penetrance of CHD8 PTVs in humans.
An overview of the genetic basis of epidermolysis bullosa in Brazil: discovery of novel and recurrent disease‐causing variants
Authors: Mariath Luiza M. , Santin Juliana T. , Frantz Jeanine A. , Doriqui Maria J.R. , Kiszewski Ana E. , Schuler‐Faccini Lavínia
Published: April 2019

Epidermolysis bullosa (EB) is a genodermatosis that encompasses a group of clinically and genetically heterogeneous disorders classified in four major types: EB simplex (EBS), junctional EB (JEB), dystrophic EB (DEB) and Kindler syndrome. Our aim was to characterize recurrent and novel mutations associated to EB in a sample of Brazilian patients. Eighty‐seven patients (25 EBS, 4 JEB and 58 DEB) were studied. We performed a next‐generation sequencing‐based multigene panel through ion torrent technology including 11 genes: KRT5, KRT14, PLEC, TGM5, LAMA3, LAMB3, LAMC2, COL17A1, ITGB4, COL7A1, and FERMT1. A total of 72 different pathogenic or likely pathogenic variants were identified, 32 of them are novel. The causal variant was detected in 82 patients (efficiency of 94.3%). Pathogenic variants in the residue 125 of KRT14 were identified in 32% of all EBS patients. In DEB patients, four COL7A1 variants were quite frequent, some of them clustered in specific Brazilian regions. Our study extends the spectrum of known mutations in EB and describes, for the first time, the genetic profile of EB patients from Brazil.
Caucasian Mediterranean patients seeking rhinoplasty—Anthropometric measurements and prevalence of major deformities
Authors: Santos Mariline , Monteiro Daniel , Coutinho Miguel , e Sousa Cecília Almeida , Ferreira Miguel Gonçalves
Published: April 2019

Objective

To describe the average values of the nasal anthropometric measurements of Caucasian Mediterranean patients seeking rhinoplasty and evaluate the major nasal deformities.

Design

Prospective, observational and cross‐sectional study.

Setting

Centro Hospitalar do Porto.

Participants

A 100 Caucasian Mediterranean patients seeking rhinoplasty.

Outcomes

Standardized photography was used to obtain nasal anthropometric measurements and to evaluate the major nasal defects. Data regarding age, gender, skin type and Fitzpatrick scale were also collected.

Results

There was a statistically significant difference in the means values of palpebral fissure, intercanthal width, upper lip height, nasal root width, morphological nose width, nose height, nasal tip projection and nasofrontal–hump and nasofrontal–supratip angles between females and males. The major nasal deformity was dorsal hump (78.0%), followed by rinomegalia (53.0%) and boxy bulbous tip (47.0%).

Conclusion

The present study shows statistically significant gender differences between anthropometric nasal measurements and the mean values are greater than standard values obtained on general population. This might be one of the reasons why Caucasian Mediterranean patients seek aesthetical rhinoplasty. On both genders, dorsal hump, rinomegalia and boxy bulbous tip were the major nasal defects. This emphasize the importance of rhinoplasty techniques designed to reconstruct nasal dorsum and nasal tip on Caucasian Mediterranean patients. To the best of our knowledge, our study is the first study of digital anthropometric nasal analysis and evaluation of major nasal defects specifically in Caucasian Mediterranean patients who applied for rhinoplasty. With this results, we provide a reference material for the evaluation of the Caucasian and Mediterranean patient when planning a cosmetic nasal surgery.
Perceptions of a curriculum vitae clinic for conservation science students
Authors: Januchowski‐Hartley Stephanie R. , Mantel Sukhmani K. , Barber‐James Helen M. , Celi Jorge , Olden Julian D. , Piccolo John J. , Hermoso Virgilio
Published: April 2019

We led a curriculum vitae (CV) clinic aimed at student participants attending the 28th International Congress for Conservation Biology (ICCB 2017) in Cartagena, Colombia. The CV Clinic was a pilot program consisting of resources to assist with developing an effective CV and involving preconference and at‐conference reviews of student attendees' CVs. Here, we explore our experiences in organizing the CV Clinic as well as nonparticipant and participant perceptions of the clinic. We used an online standardized interview form to gather qualitative data on nonparticipant and participant perceptions of the CV Clinic, and to explore how such a CV Clinic program could best align with student needs. Most respondents who submitted their CV for review ahead of ICCB 2017 (n = 9) found the template and guidance useful. Half of the respondents who did not participate in the CV Clinic perceived the clinic as duplicating services provided by their academic institutions. Both participant and nonparticipant respondents perceived value in such a CV Clinic, but also believed that adjustments could be made to make the CV review part of a broader professional development program lead by Society for Conservation Biology (SCB). Key lessons learned from the CV Clinic include the need to: (a) document and evaluate professional development initiatives within SCB; (b) better understand and account for the diversity of student needs before program creation; and (c) pilot and evaluate appropriateness of different locations, frequency, and duration of professional development programs.
Vaccination of solid organ transplant candidates and recipients: Guidelines from the American society of transplantation infectious diseases community of practice
Authors: Danziger‐Isakov Lara , Kumar Deepali ,   The AST ID Community of Practice
Published: April 2019

These updated guidelines of the AST IDCOP review vaccination of solid organ transplant candidates and recipients. General principles of vaccination as well as the use of specific vaccines in this population are discussed. Vaccination should be reviewed in the pre‐transplant setting and appropriate vaccines updated. Both inactivated and live vaccines can be given pre‐transplant. The timing of vaccination post‐transplant should be taken into account. In the post‐transplant setting, inactivated vaccines can be administered starting at 3 months post‐transplant with the exception of influenza which can be given as early as one month. Inactivated vaccines can be safely administered post‐transplant. There is accumulating data that live‐attenuated vaccines can also be given to select post‐transplant patients. Close contacts of transplant patients can receive most routine live vaccines. Specific vaccines including pneumococcal, influenza, hepatitis B, HPV, and meningococcal vaccines are discussed. Newer vaccines for seasonal influenza vaccine and herpes zoster are highlighted. Live‐attenuated vaccines such as measles, mumps, rubella, and varicella are also discussed. Emerging data on live‐attenuated vaccines post‐transplant are highlighted.
Obstructive sleep apnoea in Type 2 diabetes mellitus: increased risk for overweight as well as obese people included in a national primary care database analysis
Authors: Feher M. , Hinton W. , Munro N. , de Lusignan S.
Published: April 2019

Aims

To determine obstructive sleep apnoea prevalence in people with Type 2 or Type 1 diabetes in a national primary care setting, stratified by BMI category, and to explore the relationship between patient characteristics and obstructive sleep apnoea.

Methods

Using the Royal College of General Practitioners Research and Surveillance Centre database, a cross‐sectional analysis was conducted. Diabetes type was identified using a seven‐step algorithm and was grouped by Type 2 diabetes, Type 1 diabetes and no diabetes. The clinical characteristics of these groups were analysed, BMI‐stratified obstructive sleep apnoea prevalence rates were calculated, and a multilevel logistic regression analysis was completed on the Type 2 diabetes group.

Results

Analysis of 1 275 461 adult records in the Royal College of General Practitioners Research and Surveillance Centre network showed that obstructive sleep apnoea was prevalent in 0.7%. In people with Type 2 diabetes, obstructive sleep apnoea prevalence increased with each increasing BMI category, from 0.5% in those of normal weight to 9.6% in those in the highest obesity class. By comparison, obstructive sleep apnoea prevalence rates for these BMI categories in Type 1 diabetes were 0.3% and 4.3%, and in those without diabetes 1.2% and 3.9%, respectively. Obstructive sleep apnoea was more prevalent in men than women in both diabetes types. When known risk factors were adjusted for, there were increased odds ratios for obstructive sleep apnoea in people with Type 2 diabetes in the overweight and higher BMI categories.

Conclusions

Obstructive sleep apnoea was reported in people with both types of diabetes across the range of overweight categories and not simply in the highest obesity class.
Preferences of people with Type 2 diabetes for diabetes care: a discrete choice experiment
Authors: Hertroijs D. F. L. , Elissen A. M. J. , Brouwers M. C. G. J. , Hiligsmann M. , Schaper N. C. , Ruwaard D.
Published: April 2019

Aims

Limited knowledge exists on the preferences of people with Type 2 diabetes towards diabetes care. Consequently, these care preferences cannot yet be considered in the development of tailored diabetes care approaches. Therefore, this study aimed to assess care preferences and their determinants in people with Type 2 diabetes.

Methods

A discrete choice experiment was conducted to elicit people's preferences. People with Type 2 diabetes, treated in 30 Dutch primary care practices, were asked to choose repeatedly between two hypothetical diabetes care packages, which differed in six attributes: role division in daily diabetes care planning, lifestyle education method, type of medication management support, consultation frequency, emotional support and time spend on self‐management. A mixed‐logit model was used to estimate the relative importance of the included attributes. Preference heterogeneity among people with different person‐ and disease‐related characteristics was investigated.

Results

In total, 288 participants completed the experiment. They preferred to plan their daily diabetes care together with a healthcare provider, to receive individual lifestyle education, medication and emotional support from a healthcare provider, one consultation visit every 3 months and to spend less time on self‐management. Participants did not prefer to receive emotional support from a psychologist. Heterogeneity in preferences could partly be explained by differences in sex, education level and glucose‐lowering drug use.

Conclusion

People with Type 2 diabetes show a preference for traditional care models. Emotional support was identified by participants as the most important attribute. It is therefore important to adequately guide them when changes in diabetes care organization are implemented.
A heterozygous protein‐truncating RFX6 variant in a family with childhood‐onset, pregnancy‐associated and adult‐onset diabetes
Authors: Akiba K. , Ushijima K. , Fukami M. , Hasegawa Y.
Published: April 2019

Background

Recently, heterozygous RFX6 mutations including p.Arg377Ter were identified in individuals with maturity‐onset diabetes of the young (MODY). Clinical analysis of 36 individuals suggested that RFX6 mutation‐induced MODY is characterized by low penetrance and relatively late onset. However, given the small number of previous reports and the limited clinical information of each case, further studies are necessary to clarify the phenotypic characteristics of RFX6 mutations.

Case report

We identified a previously reported p.Arg377Ter variant of RFX6 in a three‐generation family with diabetes. The variant was detected through mutation screening for 30 diabetes‐associated genes. The variant was not found in public databases and was predicted to encode a truncated protein or undergo nonsense‐mediated mRNA decay. The proband showed glycosuria from 8 years of age and was diagnosed with MODY at 10 years of age, before the onset of puberty. She received basal and bolus insulin injection as initial therapy. The proband's mother exhibited glycosuria at 26 years of age when she conceived the first child. The mother was treated with insulin, oral hypoglycaemic drugs and diet. The proband and her mother were negative for islet cell autoantibodies. The maternal grandmother showed glycosuria around 50 years of age and was treated with oral hypoglycaemic drugs alone.

Conclusion

This study provides supporting evidence for the causal relationship between heterozygous RFX6 mutations and MODY. Furthermore, our results indicate that phenotypic consequences of RFX6 mutations are highly variable even within a single family, and possibly include childhood‐onset and pregnancy‐associated non‐autoimmune diabetes.
The extent to which statins have improved cardiovascular outcomes: Lessons from randomized trials and observational studies of “real world” practice in people with diabetes
Authors: Bengaluru Jayanna Manju , Robinson Jennifer G.
Published: April 2019

Statins are the mainstay of therapy for cardiovascular risk reduction in patients with diabetes mellitus. It is estimated that there are more than half a billion patients with diabetes mellitus worldwide and the numbers of prevalent cases of diabetes are expected to increase in both developed and developing countries in the next decade. Statins reduce risk of mortality and morbidity mainly by reducing blood low density cholesterol. Statins, along with other medical treatments, are responsible for about half of the decrease in cardiovascular mortality over the past several decades.

Multiple clinical trials have found evidence for statin use in patients with diabetes, for both primary prevention and secondary prevention. The benefit of statins in patients with coronary heart disease and diabetes in terms of absolute risk reduction is twice as much as compared to the risk in patients with coronary heart disease but no diabetes. The proportion of patients with diabetes treated with statins has increased steadily over the past few decades with concurrent decrease in cardiovascular deaths in this high‐risk population. However, there are significant unmet needs in cardiovascular risk reduction, due to underutilization of statins and due to residual cardiovascular risk despite maximal statin therapy. Future strategies in population risk reduction in diabetics should include maximal statin therapy, additional treatment with nonstatin therapy and new paradigms of prevention with early intervention with shorter, more intensive therapy to potentially “reverse” atherosclerosis with goals of reducing clinical cardiovascular disease later in life.
The Issue of Citizenship for the Bidun Minority in Kuwait after the Arab Spring
Authors: Cohen Ronen A. , Keinan‐Cohen Yael
Published: April 2019

Kuwait is a country in which there are many tribes but it is the al‐U'zam tribe which is very dominant and influential in local politics and the economy, in contrast to the other tribes in Kuwait who are recognized by the state as being equal, but have little influence in these things. The Bedouin tribes, such as the Bidun society in Kuwait, who have been excluded from nationality and citizenship and thus have no influence, are an exception. The Kuwaiti government claims that the Bidun themselves gave up these rights so as not to be part of the Kuwaiti state and this has resulted in the Kuwaiti government not granting them any formal economic, political, or social rights. Because of this, the Bidun have had to fight for their rights for decades since the formal establishment of an independent Kuwait in 1961. This article wishes to discuss whether the question of the Kuwaiti refusal to recognize the Bidun as citizens is because of geostrategic reasons, because of the fear of creating a precedent that might lead to the inclusion of other tribes into the Kuwaiti state, or because this is a traditional political strategy for dealing with politically weak tribes.
Relationship between presence of spontaneous echo contrast and platelet‐to‐lymphocyte ratio in patients with mitral stenosis
Authors: Sahin Omer , Savas Goktug
Published: April 2019

Background

Left atrial spontaneous echo contrast (SEC) is an existence of smoke‐like echoes with a typical swirling motion of blood in left atrial cavity or appendage, and it is known to be a marker of prothrombotic state. Previous studies have revealed that there is an association between prothrombotic state and the platelet‐to‐lymphocyte ratio (PLR). Thus, we aimed to investigate the association between the presence of SEC and PLR in patients with mitral stenosis (MS).

Methods

A total of 306 consecutive patients with MS were enrolled in the study. Transoesophageal echocardiography was made to assess the SEC for all patients. Recruited patients were divided into two groups according to the formation of SEC in the left atrium. Complete blood counting parameters, biochemical tests and high‐sensitive C‐reactive protein (Hs‐CRP) levels were measured.

Results

There were 182 patients (mean age 42.7 ± 11.9 and 78% female) in the SEC (−) group, and 124 patients (mean age 45.3 ± 10.5 and 68% female) in the SEC (+) group. Hs‐CRP levels (3.9 ± 1.9 vs 5.1 ± 3.6, P < 0.001) were significantly different between the two groups. PLR (143.4 ± 77.7 vs 180.6 ± 108.7, P < 0.001) was significantly higher in the SEC (+) group. ROC curve analysis, PRL ≥123 had 71% sensitivity and 52% specificity in predicting SEC in patients with MS.

Conclusion

Platelet‐to‐lymphocyte ratio is an inexpensive and easily calculated biomarker, which is useful to predict left atrial SEC in patients with mitral stenosis.
PET imaging during hypoglycaemia to study adipose tissue metabolism
Authors: Boss Marti , Rooijackers Hanne M. M. , Buitinga Mijke , Janssen Marcel J. R. , Arens Anne I. J. , de Geus‐Oei Lioe‐Fee , Salm Liesbeth P. , de Galan Bastiaan E. , Gotthardt Martin
Published: April 2019

Background

Disturbances in adipose tissue glucose uptake may play a role in the pathogenesis of type 2 diabetes, yet its examination by 2‐deoxy‐2‐[18F]fluorodeoxyglucose ([18F]FDG) PET/CT is challenged by relatively low uptake kinetics. We tested the hypothesis that performing [18F]FDG PET/CT during a hypoglycaemic clamp would improve adipose tissue tracer uptake to allow specific comparison of adipose tissue glucose handling between people with or without type 2 diabetes.

Design

We enrolled participants with or without diabetes who were at least overweight, to undergo a hyperinsulinaemic hypoglycaemic clamp or a hyperinsulinaemic euglycaemic clamp (n = 5 per group). Tracer uptake was quantified using [18F]FDG PET/CT.

Results

Hypoglycaemic clamping increased [18F]FDG uptake in visceral adipose tissue of healthy participants (P = 0.002). During hypoglycaemia, glucose uptake in visceral adipose tissue of type 2 diabetic participants was lower as compared to healthy participants (P < 0.0005). No significant differences were observed in skeletal muscle, liver or pancreas.

Conclusions

The present findings indicate that [18F]FDG PET/CT during a hypoglycaemic clamp provides a promising new research tool to evaluate adipose tissue glucose metabolism. Using this method, we observed a specific impairment in visceral adipose tissue [18F]FDG uptake in type 2 diabetes, suggesting a previously underestimated role for adipose tissue glucose handling in type 2 diabetes.
Labor and behavior determinants of remittances in Saudi Arabia
Authors: Snudden Stephen
Published: April 2019

Saudi Arabia is the second largest sender of international remittances. These remittances constitute large foreign capital inflows to labor‐exporting remittee economies. This study is the first to structurally decompose remittance dynamics into behavioral and labor market outcomes of migrants. Remittance outflows are decomposed into migrant labor supply, unemployment and participation rates, wage earnings, and the marginal propensity to remit (MPR) out of migrant earnings. The estimates suggest that migrant labor supply is highly elastic. The important driver of remittance dynamics is the MPR, migrant wages, and the labor supply of migrants. The MPR is found to respond counter‐cyclically to foreign gross domestic product.
Association between excessive supraventricular ectopy and subclinical cerebrovascular disease: a population‐based study
Authors: Hisamatsu T. , Miura K. , Fujiyoshi A. , Kunimura A. , Ito T. , Miyazawa I. , Torii S. , Shiino A. , Nozaki K. , Kanda H. , Arima H. , Ohkubo T. , Ueshima H. ,   on behalf of the Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA) Research Group
Published: April 2019

Background and purpose

The association between an increased supraventricular ectopic beat (SVEB) and subclinical cerebrovascular disease remains unclear. Given the emerging concept that an increased SVEB is a marker of atrial cardiomyopathy or atherosclerosis burden, we sought to determine whether excessive supraventricular ectopic activity (ESVEA) is associated with a higher burden of subclinical cerebrovascular disease in the middle‐aged to older cohort with neither apparent stroke nor atrial fibrillation.

Methods

We conducted a cross‐sectional population‐based study of 462 men (mean age, 68.1 years) who underwent 24‐h Holter electrocardiography and brain magnetic resonance imaging. ESVEA was defined as the presence of >10 SVEBs/h. Subclinical cerebrovascular diseases were defined as silent brain infarct (SBI), white matter hyperintensity (WMH) and intracranial atherosclerotic stenosis (ICAS). The association of ESVEA with the presence of subclinical cerebrovascular diseases was adjusted for potential confounding covariates.

Results

A total of 88 (19.0%) participants had ESVEA and 81 (17.5%), 91 (19.7%) and 109 (23.6%) had SBI, WMH and ICAS, respectively. In multivariable‐adjusted Poisson regression with robust error variance, ESVEA was associated with the presence of WMH (relative risk, 1.58; 95% confidence interval, 1.06–2.36) and ICAS (relative risk, 1.49; 95% confidence interval, 1.02–2.18), but not with that of SBI (relative risk, 1.32; 95% confidence interval, 0.86–2.01). These associations were consistent when the graded distributions of subclinical cerebrovascular diseases were applied as outcomes in ordinal logistic regression.

Conclusions

The ESVEA was independently associated with higher burdens of WMH and ICAS. This suggests that increased SVEBs might improve risk stratification of individuals at high risk of subclinical cerebrovascular disease and consequently apparent ischaemic stroke.
Molecular imaging of neuroinflammation in patients after mild traumatic brain injury: a longitudinal 123I‐CLINDE single photon emission computed tomography study
Authors: Ebert S. E. , Jensen P. , Ozenne B. , Armand S. , Svarer C. , Stenbaek D. S. , Moeller K. , Dyssegaard A. , Thomsen G. , Steinmetz J. , Forchhammer B. H. , Knudsen G. M. , Pinborg L. H.
Published: April 2019

Background and purpose

Neuroinflammation has been proposed as part of the pathogenesis of post‐concussion symptoms (PCS), but the inflammatory response of the human brain to mild traumatic brain injury (mTBI) remains unknown. We hypothesized that a neuroinflammatory response is present in mTBI at 1–2 weeks post‐injury and persists in patients with PCS.

Methods

We scanned 14 patients with mTBI without signs of structural damage at 1–2 weeks and 3–4 months post‐injury and 22 healthy controls once using the single photon emission computed tomography tracer 123I‐CLINDE, which visualizes translocator protein (TSPO), a protein upregulated in active immune cells. PCS was defined as three or more persisting symptoms from the Rivermead Post Concussion Symptoms Questionnaire at 3 months post‐injury.

Results

Across brain regions, patients had significantly higher 123I‐CLINDE binding to TSPO than healthy controls, both at 1–2 weeks after the injury in all patients (P = 0.011) and at 3–4 months in the seven patients with PCS (P = 0.006) and in the six patients with good recovery (P = 0.018). When the nine brain regions were tested separately and results were corrected for multiple comparisons, no individual region differed significantly, but all estimated parameters indicated increased 123I‐CLINDE binding to TSPO, ranging from 2% to 19% in all patients at 1–2 weeks, 13% to 27% in patients with PCS at 3–4 months and −9% to 17% in patients with good recovery at 3–4 months.

Conclusions

Neuroinflammation was present in mTBI at 1–2 weeks post‐injury and persisted at 3–4 months post‐injury with a tendency to be most pronounced in patients with PCS.
Effect of interface surface design on the fracture behavior of bilayered composites
Authors: Omran Tarek A. , Garoushi Sufyan , Lassila Lippo V. , Vallittu Pekka K.
Published: April 2019

This study aimed to evaluate the effect of different interface designs on the load‐bearing capacity of bilayered composite structures (BLS). Cylindrical specimens of BLS were prepared from base composite of 3.5 mm thickness and surface composite of 1.5 mm thickness (n = 80). Two different base composites – flowable bulk‐fill (FBF) [smart dentin replacement (SDR)] and short fiber‐reinforced (FRC) (everX Posterior) – were evaluated, and conventional composite (G‐ænial Posterior) was used as the surface layer. Four different interface designs were used: (i) pyramidal; (ii) mesh; (iii) linear grooves; and (iv) flat surface (control). Three‐dimensional printed molds were fabricated to standardize the interface design between the surface and the base composites. The specimens were then statically loaded with a steel ball until fracture using a universal testing machine. Fracture types were classified into catastrophic, complete, and partial bulk. ANOVA revealed that both the material and the interface design had a statistically significant effect on the load‐bearing capacity. Flowable bulk‐fill showed lower mean load‐bearing capacity than FRC in all the interface designs tested, except for the flat surface design. Fracture analysis showed that FRC demonstrated up to 100% partial bulk fractures with the pyramid interface design, but no incidence of catastrophic bulk fracture. By contrast, FBF demonstrated up to 84.6% and 40% catastrophic bulk fractures with the flat interface design but no incidence of partial bulk fracture. Consequently, the interface designs studied enhanced the fracture behavior of BLS.
The Oomen bee brood feeding test – revision of the method to current needs and developments
Authors: Lückmann J. , Schmitzer S.
Published: April 2019

The Oomen bee brood feeding test is a long‐standing, frequently used test for investigating potentially adverse effects of plant protection products on honey bee brood. Based on new methods, new regulatory requirements, technical improvements as well as current experience and results from the evaluation of acute (single) and chronic (multiple) honey bee brood feeding tests, a revision of the method is advised. This paper describes recent approaches suited to current needs and developments and fulfils new risk assessment requirements.
Test validation for the detection of Tilletia indica Mitra by multiplex real‐time PCR
Authors: Valente M. T. , Bragaloni M. , Di Giambattista G. , Riccioni L.
Published: April 2019

Tilletia indica Mitra is a fungal pathogen causing Karnal bunt of wheat. Tilletia indica is a quarantine pest in many countries worldwide. In the European Union, imported wheat grain from countries where the fungus is present must be checked for the presence of T. indica teliospores. The inspection services at the borders need rapid, sensitive and reliable detection tests to identify T. indica spores on wheat grain. In this work, validation was carried out according to EPPO Standard PM 7/98 to evaluate the multiplex real‐time PCR test described in ISPM 27 Diagnostic Protocol for regulated pests (Annex 4 Tilletia indica Mitra) by means of a test performance study with nine participating laboratories, and the performance characteristics of the test were established. The original protocol was modified with regard to the extraction of DNA from the pellet obtained from the ‘washing test’ and the enrichment PCR step in order to increase the amount of template DNA for the real‐time PCR. The optimized test still has five teliospores as the limit of detection for the contaminated pellet but has an increased analytical sensitivity and had positive results with three teliospores in 93% of cases instead of 43% for the original test. The two closest Tilletia species, Tilletia horrida and Tilletia walkeri, were used to evaluate analytical specificity (exclusivity) and no cross‐reactions were obtained. Diagnostic sensitivity, diagnostic specificity, accordance and concordance were also evaluated.
Eulachnus tuberculostemmatus (Lachninae: Eulachnini) sur pin d'Alep: premier signalement en Tunisie
Authors: Ben Halima Kamel M. , Zouari S. , Mdellel L. , Rekik A.
Published: April 2019

Lors de l'étude de la dynamique de populations de pucerons du pin d'Alep, Pinus halepensis, dans la région de Chott Mariem, Eulachnus tuberculostemmatus Theobald a été collecté. Il s'agit du premier signalement de cette espèce en Tunisie.