bluuebunny/crossref_metadata_2025 huggingface dataset:
Three‐year outcomes of macular buckling for macular holes and foveoschisis in highly myopic eyes
Authors: Zhao Xiujuan , Ma Wei , Lian Ping , Tanumiharjo Silvia , Lin Ying , Ding Xiaoyan , Stewart Jay M. , Liu Bingqian , Lu Lin
Published: November 2019

Background

To assess the functional and structural outcomes of macular buckling using a silicone sponge‐titanium exoplant for the treatment of foveoschisis (FS) and full‐thickness macular holes (FTMHs) in highly myopic eyes.

Methods

Forty‐nine consecutive patients with high myopia who underwent macular buckling for the treatment of FS and FTMHs were included. The outcomes measured included the anatomical success rate with FS resolution, retinal reattachment, MH closure, best corrected visual acuity (BCVA), axial length (AL) and complications of surgery. Moreover, the correlations between the BCVA at year three and series of factors, including age, duration of symptoms, baseline BCVA, AL, surgical type, preoperative macular status and severity of myopic maculopathy, were analysed.

Results

This study involved 28 patients (28 eyes) with FS and 21 patients (21 eyes) with FTMHs with macular detachment. Retinal reattachment was achieved in 100% of cases, while MH closure was achieved in 76.19% of cases. The BCVA significantly improved one year after macular buckling in the FS cases and two years after macular buckling in the FTMH cases, and it remained stable throughout the rest of the follow‐up period. The mean AL decreased by 2.09 mm postoperatively. No major perioperative complications were observed, although one patient needed to explant the buckling device due to intolerable diplopia.

Conclusion

Macular buckling with a silicone sponge‐titanium exoplant may represent a safe and effective surgical option for the treatment of FS and FTMH in highly myopic eyes. Macular buckling showed a high closure rate and virtually no tendency to recur.
Serum pro‐inflammatory factors as predictors of persistent diabetic macular oedema with limited anatomic response to anti‐VEGF: association with intravitreal injection treatment profiles in real‐world setting
Authors: Brito Pedro , Costa Jorge , Gomes Nuno , Costa Sandra , Correia‐Pinto Jorge , Silva Rufino
Published: November 2019

Purpose

To study the role of serum levels of pro‐inflammatory factors in the identification of persistent diabetic macular oedema (DME) cases with limited anatomic response to anti‐VEGF. Additionally, possible predictive associations between serum factors and intravitreal treatment profiles were analysed.

Methods

Cases with DME were treated with monthly bevacizumab (BVZ). After the sixth month of follow‐up, if the change in central foveal thickness (CFT) was <20% of baseline, combination treatment with triamcinolone was initiated. All cases underwent a baseline laboratory workup including inflammatory, metabolic and prothrombotic factors. The following outcome parameters were evaluated: percentage of CFT change from baseline, occurrence of persistent DME with <20% change in CFT, achieving CFT <330 μm with ≤6 BVZ injections, total number of intravitreal injections (IVI), number of IVI after the 6th month and number of triamcinolone acetonide (TCA) injections.

Results

A total of 58 cases were included receiving a mean of 7.23 ± 1.55 IVI in 12 months, resulting in a significant improvement of visual acuity (VA) and CFT. No significant differences were found for baseline CFT, baseline LogMAR VA, diabetic retinopathy grade, age or duration of DM2 between cases initiating TCA and those treated only with anti‐VEGF. Significant correlations were found between total number of IVI and the following serum factors: high‐sensitivity C‐reactive protein (hsCRP) (p = 0.004, r = 0.395), creatinine (p = 0.023, r = 0.338) and homocysteine (p = 0.037, r = 0.309). Regression analysis revealed that hsCRP was a significant predictor of TCA treatment (p = 0.028, r2 = 0.350). Cases requiring ≤6 IVI had significantly lower values of hsCRP (1.33 ± 1.07 versus 2.46 ± 2.18 mg/l, p = 0.016) and creatinine (0.71 ± 0.28 versus 0.94 ± 0.19 mg/dl, p = 0.003).

Conclusions

Serum markers of microvascular damage (hsCRP, homocysteine and creatinine) were associated with a higher frequency of IVI due to persistent DME, suggesting a role for such biomarkers in the identification of limited responders to anti‐VEGF monotherapy.
Paradoxical Leader Behaviors: Leader Personality and Follower Outcomes
Authors: Ishaq Erum , Bashir Sajid , Khan Abdul Karim
Published: November 2019

We examined leaders’ Big Five personality traits as the antecedents and followers’ in‐role and innovative performance behaviors as outcomes of paradoxical leader behavior (PLB) in people management. We also examined the moderating effect of followers’ psychological capital on PLB and its relationship with followers’ outcomes. We drew on the trait theory of leadership, social learning theory, and the conservation of resources theory to derive our hypotheses. We tested our predictions with a sample of 131 managers and 609 followers. By and large, we found support for our predictions. More specifically, leaders’ traits of extraversion and openness to experience were positively related to followers’ PLB ratings. Conversely, agreeableness, conscientiousness, and neuroticism among leaders were negatively related to followers’ PLB ratings. PLB in turn was positively related to followers’ in‐role and innovative performance behaviors. Followers’ psychological capital was found to moderate the relationship between PLB and followers’ in‐role performance such that the relationship was stronger when followers’ psychological capital was high than when it was low. The implications of these findings were discussed.
Prevalence of positive reactions in intradermal and IgE serological allergy tests in dogs from South Australia, and the subsequent outcome of allergen‐specific immunotherapy
Authors: Han C , Chan WY , Hill PB
Published: November 2019

Objective

To determine the prevalence of positive allergen reactions in intradermal and IgE serological tests in dogs presenting to a dermatology referral centre in South Australia and the clinical efficacy of subsequent allergen‐specific immunotherapy.

Design

Retrospective study.

Methods

Results from 108 intradermal allergy tests, 25 IgE serological assays and immunotherapy outcomes in 37 dogs were retrospectively analysed. Immunotherapy outcomes were determined as excellent, good, modest or failure using a global assessment of efficacy matrix which incorporated pruritus scores, lesion severity, medication requirements, and owner and clinician opinion.

Results

The most common positive reactions in intradermal allergy tests were Red clover (59%), Dermatophagoides farinae (29%), Tyrophagus putrescentiae (28%), Yellow dock (25%) and Malassezia pachydermatis (24%). In the IgE serological tests, Yorkshire fog grass (40%), Yellow dock (36%), Kentucky bluegrass (36%) and T. putrescentiae (36%) were the most commonly reported positive results. The outcome of allergen‐specific immunotherapy was judged to be excellent in 20% of dogs, good in 15%, modest in 18% and a failure in 47%.

Conclusion

As has been reported in other geographical areas, environmental mites and plant pollens frequently gave positive reactions in allergy tests in South Australia. However, the prevalence of individual allergen reactions differed between intradermal and IgE serological tests, with M. pachydermatis being identified as a common cause of hypersensitivity in intradermal tests but not in IgE serological assays. Immunotherapy was judged to be a beneficial treatment in 35% of dogs but was essentially unsuccessful in 65%.
Severe poisoning with naproxen causing coagulopathy
Authors: Lelièvre Bénédicte , Drouillard Isabelle , Thill Chloé , Le Roux Gaël , Bruneau Chloé , Mahé Julien , Deguigne Marie , Boels David
Published: November 2019

Non‐steroidal anti‐inflammatory drugs (NSAIDs) are well known for their most frequent side effects (digestive, renal and metabolic disorders) but are lesser known for other effects, such as coagulation disturbances. In this issue, we report the case of a 58‐year‐old woman who ingested 26 g of naproxen in a suicidal attempt and developed cardiovascular shock, hypocoagulability and thrombopenia. Her outcome was positive (extubation 3 days after admission [D3], correction of haemostatic disruptions on D5 and of thrombopenia on D6). Naproxen plasma concentration was at a toxic concentration of 1320 mg/L at 6 hours after drug ingestion. Only few cases of hypocoagulopathy are reported with the NSAIDs, and this is the first case that can be attributed to naproxen. A possible explanation of this phenomenon following naproxen ingestion is an inhibition of thromboxane A2, usually attributed to NSAIDs, combined with an inhibition of activation of downstream the cascade.
A prospective study of fatigue trajectories among in‐centre haemodialysis patients
Authors: Picariello Federica , Norton Sam , Moss‐Morris Rona , Macdougall Iain C , Chilcot Joseph
Published: November 2019

Objectives

Fatigue is common and debilitating among dialysis patients. The aim of this study was to understand the longitudinal trajectory of fatigue and consider sociodemographic, clinical, and psychological factors that are related to variation in fatigue levels over time.

Design

A prospective study of fatigue with yearly assessments over 3 years among prevalent in‐centre haemodialysis (HD) patients.

Methods

Fatigue severity was measured using the Chalder Fatigue Questionnaire and fatigue‐related functional impairment using the Work and Social Adjustment Scale. The trajectories of fatigue outcomes were examined using piecewise growth models, using length of time on dialysis as time. Sociodemographic, clinical, and psychological predictors of fatigue were assessed using linear growth models, using follow‐up time.

Results

One hundred and seventy‐four prevalent HD patients completed baseline measures, 118 at 12 months, 84 at 24 months, and 66 at 36 months. Fatigue severity scores decreased by 0.15 each year. Fatigue‐related functional impairment increased by 1.17 each year. In adjusted linear growth models, non‐white ethnicity was a significant predictor of lower initial fatigue severity (B = −2.95, 95% CI −5.51 to −0.40) and a greater reduction in fatigue severity of 1.60 each year (95% CI 0.35–2.36). A one‐point increase in damage beliefs was associated with a 0.36 increase in fatigue‐related functional impairment each year (95% CI −0.61 to −0.01).

Conclusion

Damage beliefs predicted an increase in fatigue‐related functional impairment over time. However, the data strongly suggested that fatigue outcomes vary by length of time on dialysis.

Statement of contribution

What is already known on this subject?

At least 1 in 2 haemodialysis (HD) patients are clinically fatigued.

Growing evidence is available on the important role of psychological factors in fatigue across chronic conditions.

The contribution of psychological factors, beyond distress, to fatigue in HD has not been examined to date.

What does this study add?

Ethnicity played a role in the initial level of fatigue severity and over time.

Damage beliefs predicted an increase in fatigue‐related impairment over time.

Data strongly suggested that fatigue outcomes vary by length of time on dialysis.
The potential for malignancy from atopic disorders and allergic inflammation: A systematic review and meta‐analysis
Authors: Muir Amanda B. , Whelan Kelly A. , Dougherty Michael K. , Aaron Bailey , Navarre Brianna , Aceves Seema S. , Dellon Evan S. , Jensen Elizabeth T.
Published: November 2019

Objective

While chronic inflammation is a well‐established risk factor for malignancy, studies evaluating the relationship between allergic inflammation and cancer have revealed conflicting results. Here, we aimed to assess the association between allergic inflammation in the lung (asthma), skin (eczema) or oesophagus (eosinophilic oesophagitis; EoE) and cancer at the organ site.

Design

We conducted a systematic review of the literature to identify observational studies (case‐control, cohort and cross‐sectional) evaluating the association between asthma and lung cancer, eczema and skin cancer, or EoE and oesophageal cancer. Random‐effects meta‐analysis was performed to define pooled estimates of effects.

Data sources

PubMed, EMBASE and Web of Science.

Eligibility criteria for selection

Included studies evaluated the incidence of cancer.

Results

Thirty‐two studies met the inclusion criteria, 27 in the lung, four in the skin and one in the oesophagus. Meta‐analysis of the three studies with prospective data collection of asthma diagnosis revealed a positive association with incident lung cancer (OR 1.27, 95% CI 1.09‐1.44); however, this result was not consistently supported by the larger dataset of retrospective studies (OR 1.37, 95% CI 0.90‐1.83). Overall, studies in the lung displayed significant heterogeneity (I2 98%, P < .0001), but no significant effect modification on the association between asthma and lung cancer was identified for the variables of sex, smoking or study design. Meta‐analysis could not be applied to the four papers reviewed in the skin, but three suggested an association between eczema and non‐melanoma skin cancer, while the remaining study failed to identify an association between melanoma and eczema. A single study meeting inclusion criteria showed no association between EoE and oesophageal malignancy.

Conclusions

The current data cannot exclude the possibility of an association between atopy and malignancy the lung, skin and oesophagus. The relationship between allergy and cancer should be explored further in prospective studies that any association identified between these conditions has the potential for significant public health implications.
Amniotic fluid levels of selected trace elements and heavy metals in pregnancies complicated with neural tube defects
Authors: Ovayolu Ali , Ovayolu Gamze , Karaman Erbil , Yuce Tuncay , Ozek Murat A. , Turksoy Vugar A.
Published: November 2019

The aims of this study were to determine the levels of trace elements and heavy metals, namely aluminum (Al), chromium (Cr), manganese (Mn), cobalt (Co), nickel (Ni), copper (Cu), zinc (Zn), arsenic (As), molybdenum (Mo), cadmium (Cd), tin (Sn), antimony (Sb), mercury (Hg), and lead (Pb), in the amniotic fluid of pregnant women, and to investigate their relationship with neural tube defects (NTDs). The study included 36 pregnant women whose fetuses were complicated with NTDs (study group) and 39 pregnant women with unaffected healthy fetuses (control group), who were matched for body mass index and gestational weeks. The amniotic fluid levels of trace elements and heavy metals were measured using inductively coupled plasma‐mass spectrometry and compared between the two groups. Significantly lower mean levels of Zn and Mo and significantly higher levels of Al, Sn, Sb, and Hg in the study group than in the healthy control group were observed, which implied that these elements are possibly correlated with risk factors for the occurrence of NTDs. In contrast, there were no significant differences in the levels of Cr, Mn, Co, Ni, Cu, As, Cd, and Pb between the groups (P ≥ .05).
Proportional data modeling via selection and estimation of a finite mixture of scaled Dirichlet distributions
Authors: Zamzami Nuha , Alsuroji Rua , Eromonsele Oboh , Bouguila Nizar
Published: November 2019

This paper proposes an unsupervised algorithm for learning a finite mixture of scaled Dirichlet distributions. Parameters estimation is based on the maximum likelihood approach, and the minimum message length (MML) criterion is proposed for selecting the optimal number of components. This research work is motivated by the flexibility issues of the Dirichlet distribution, the widely used model for multivariate proportional data, which has prompted a number of scholars to search for generalizations of the Dirichlet. By introducing the extra parameters of the scaled Dirichlet, several useful statistical models could be obtained. Experimental results are presented using both synthetic and real datasets. Moreover, challenging real‐world applications are empirically investigated to evaluate the efficiency of our proposed statistical framework.
Assessment of the impact of isolated coronary artery ectasia on left ventricular functions with 3D speckle‐tracking echocardiography
Authors: Dogdus Mustafa , Kucukosmanoglu Mehmet , Kilic Salih
Published: November 2019

Background

Coronary artery ectasia (CAE) is an angiographic definition of coronary artery pathology in which the diameter of the ectatic segment measures more than 1.5 times the diameter of an adjacent healthy reference segment. No previous study has reported on the use of 3D‐STE for assessing the left ventricular (LV) functions in patients with isolated CAE. As a result of this, we aimed to evaluate the effects of isolated CAE on LV functions using 3D‐STE in the present study.

Methods

Ninety‐one patients with isolated CAE and 90 controls who proved to have normal coronary angiograms were enrolled to the study. 3D‐STE was performed and GLS, GCS, GAS, and GRS were obtained for every subject after coronary angiography.

Results

The mean age of the patients was 61.75 ± 10.02 years, and 71.8% were male. GLS, GCS, GAS, and GRS were significantly depressed in the isolated CAE group than in the control group (P < .001; P < .001; P = .001; and P = .001, respectively). ROC analyses were performed to find out the ideal strain cut off values to predict the presence of isolated CAE. A GLS value of >‐16 has 92.1 % sensitivity, 88.5 % specificity; and a GCS value of >‐20 has 86.7 % sensitivity, 89.2 % specificity to detect the presence of isolated CAE.

Conclusion

Isolated CAE has a considerable negative effect on LV functions as evaluated by 3D‐strain parameters, and 3D‐STE could be an effective method to detect early stage myocardial impairment in patients with isolated CAE.
Effect of desiccation on mosquito oviposition site selection in Mediterranean temporary habitats
Authors: Duchet Claire , Mukherjee Shomen , Stein Meital , Spencer Matthew , Blaustein Leon
Published: November 2019

1. Hydroperiod duration has been identified as the main factor determining the faunal composition and structure of aquatic communities in temporary habitats. It is hypothesised that desiccation will positively affect mosquito oviposition habitat selection during the post‐drought period due to the lack of antagonists.

2. An experiment was carried out in outdoor mesocosms to assess whether desiccation events have post‐drought effects on community richness and mosquito oviposition.

Three different treatments were randomly assigned to the mesocosms: (i) eight mesocosms were left dried for a week and then reflooded; (ii) eight mesocosms stayed dry for 4 weeks before they were reflooded; (iii) eight mesocosms were maintained at a constant water volume of 30 litres during the entire experiment as controls. Mosquito oviposition and invertebrate community richness were monitored in every mesocosm, along with environmental parameters [water temperature, pH, conductivity, dissolved oxygen, total suspended solids (TSS) and chlorophyll a concentration].

3. Post‐drought mosquito oviposition and larval abundance were higher in the short‐drought and long‐drought pools than in the control. Desiccation negatively affected the biomass of the filter feeder invertebrates in both desiccation treatments. Chlorophyll a concentrations were higher in the long‐drought pools than in controls. The negative impact of desiccation on zooplankton led to a post‐drought increase in algae, associated with an increase in mosquito oviposition.

4. Despite immediate negative effect on mosquitoes, pulsed disturbances can benefit mosquitoes as they favour oviposition during the post‐disturbance recovery period due to a lower abundance of mosquito antagonists and higher food resources for their offspring.
Transitioning to age inclusive early intervention for psychosis
Authors: O'Driscoll Ciarán , Free Katherine , Attard Angelica , Carter Peter , Mason Jemma , Shaikh Madiha
Published: November 2019

Aim

Early Intervention in psychosis Services (EIS) have previously restricted access based on age. However, there is now a move to age inclusive service. We aimed to examine differences between early and late onset (>35 years) psychosis to see if a threshold was valid. We also investigated the potential of a statistical modelling method to identify group characteristics which may be missed using a descriptive approach.

Methods

Routine clinical data (n = 343), from an EIS, comprising socio‐demographic, clinical, physical and treatment variables, were examined using descriptive and classification and regression tree (CART) analysis.

Results

The findings suggest that age differences were best explained by social factors. There was no emerging evidence that the differences exhibited had a fundamental impact on the clinical outcomes of the clients in terms of support beyond EIS (ie, hospitalization and home treatment team involvement) and pharmacological and psychological interventions. CART analysis revealed distinct service user characteristics associated with the clinical outcomes.

Conclusion

There was no evidence to support a clinical cut off based on age providing support for age inclusive services. However, in the transition to age inclusive service delivery, EIS need to consider social/life stage variables, adapting provision where service delivery may operate a youth focused model. Routine analysis of clinical data should employ methods to identify groups of service users who may require adjusted service provision.
Responses of ammonia‐oxidizing archaea and bacteria to nitrogen and phosphorus amendments in an alpine steppe
Authors: Dong Junfu , Che Rongxiao , Jia Shugang , Wang Fang , Zhang Biao , Cui Xiaoyong , Wang Shiping , Wang Shuping
Published: November 2019

With the increasing demands of livestock production, grasslands are under pressure from over‐intensified grazing. Phosphorus (P) and nitrogen (N) fertilization is widely employed to meet the nutrient demands of heavy grazing. Although soil ammonia‐oxidizers play a critical role in determining N dynamics after fertilizer application, their responses to fertilization are still not well understood in steppe grassland systems. Here, the individual and combined effects of N (0, 7.5 and 15 g N m−2year−1) and P (0, 3.27, 6.55 and 13.09 g P m−2year−1) applications on soil ammonia‐oxidizers were explored in the Tibetan alpine steppe. Ammonia‐oxidizing archaea (AOA) and bacteria (AOB) abundance and community composition were examined using qPCR, terminal restriction fragment length polymorphism and clone libraries. Results showed that AOB diversity was significantly increased by N fertilization and decreased by P fertilization. The abundance of AOB was significantly increased by N fertilization and its interactive effects with P application. In contrast, AOA community diversity and abundance remained unaffected by either N or P application. The AOB abundance and diversity were affected by the direct effects of N fertilization, as well as its indirect effects of N application through available N and ammonium (NH4+), and further analysis showed that NH4+and pH were the main factors. The changes to the ammonia‐oxidizing community altered the total N content of plants and the N:P ratio ofGramineae. Plant P properties were influenced by P addition, which also interacted with soil pH and available N to indirectly affect AOB. Overall, AOB exhibited stronger responses to N and P fertilization of alpine steppe grassland than AOA, and appear to play a critical role in plant nutrient absorption under fertilization management.

Highlights

Effects of N and P application on AOA and AOB communities were evaluated.

AOB, not AOA, responded to N or P, and their interaction, and NH4+and pH were regulators of AOB.

N application affected AOB community, resulting in changes to plant nutrient absorption.

P addition affected plant tissue stoichiometry, and thus affected AOB community.
Experiences of Family Belonging among Two Generations of Sexually Diverse Australians
Authors: Newman Christy E. , Persson Asha , Prankumar Sujith , Lea Toby , Aggleton Peter
Published: November 2019

Objective

To extend knowledge about how lesbian, gay, bisexual, trans+, and queer (LGBTQ+) people relate to their families of origin by paying particular attention to their experiences of belonging within this context.

Background

Although the impact of family rejection on young LGBTQ+ people is well established, circumstances and expressions of family belonging are less well understood.

Method

Taking a qualitative, social generational approach, we asked two groups of Australians, born in the 1970s (n = 14) and 1990s (n = 18), about their experiences of family relationships when they were growing up sexually and/or gender diverse.

Results

A subset of participants described feeling accepted by families of origin, although very few were gender diverse. The 1970s cohort described these experiences as culturally exceptional, and the 1990s cohort as a birthright. Examples from both demonstrate how family belonging can remain conditional.

Conclusion

Experiences of family belonging reveal both the importance of family to the well‐being and flourishing of LGBTQ+ people, and the entanglement between individual and social understandings of what family acceptance comprises.

Implications

Scholars and support service providers may benefit from recognizing that some sexual minorities experience belonging in their families of origin, but work remains in understanding and challenging the conditions that some families continue to impose.
Cardiac regeneration and remodelling of the cardiomyocyte cytoarchitecture
Authors: Ali Hashim , Braga Luca , Giacca Mauro
Published: November 2019

Adult mammals are unable to regenerate their hearts after cardiac injury, largely due to the incapacity of cardiomyocytes (CMs) to undergo cell division. However, mammalian embryonic and fetal CMs, similar to CMs from fish and amphibians during their entire life, exhibit robust replicative activity, which stops abruptly after birth and never significantly resumes. Converging evidence indicates that formation of the highly ordered and stable cytoarchitecture of mammalian mature CMs is coupled with loss of their proliferative potential. Here, we review the available information on the role of the cardiac cytoskeleton and sarcomere in the regulation of CM proliferation. The actin cytoskeleton, the intercalated disc, the microtubular network and the dystrophin–glycoprotein complex each sense mechanical cues from the surrounding environment. Furthermore, they participate in the regulation of CM proliferation by impinging on the yes‐associated protein/transcriptional co‐activator with PDZ‐binding motif, β‐catenin and myocardin‐related transcription factor transcriptional co‐activators. Mastering the molecular mechanisms regulating CM proliferation would permit the development of innovative strategies to stimulate cardiac regeneration in adult individuals, a hitherto unachieved yet fundamental therapeutic goal.
The potential and pitfalls of narrative elicitation in person‐centred care
Authors: Naldemirci Öncel , Britten Nicky , Lloyd Helen , Wolf Axel
Published: November 2019

Background

Revitalized interest in narrative has informed some recent models of patient and person‐centred care. Yet, scarce attention has been paid to how narrative elicitation is actually used in person‐centred care practice and in which ways it is incorporated into clinical routine.

Aim

We aimed to identify facilitators and barriers for narrative elicitation and setting goals in a particular example of person‐centred care practice (University of Gothenburg Centre for Person‐centred Care, GPCC) where narrative elicitation is considered as a method of setting goals for the patient.

Methods

Observation of 14 admission interviews including narrative elicitation on an internal medicine ward in Sweden where person‐centred care was implemented. Five focus group vignette‐based interviews with nurses (n = 53) were conducted to assess confirmation of the emerging themes.

Results

The inductive analysis resulted in three themes about the strategies to elicit patients' narratives: (a) Preparing for narrative elicitation, (b) Lingering in the patient's narrative, and (c) Co‐creating, that is, the practitioner's and third parties' engagement in the patient's narration. Even though there were obstacles to eliciting narratives and setting lifeworld goals in a medical setting, narrative elicitation was often useful to turn general and medical goals into more specific and personal goals.

Conclusions

Narrative elicitation is neither a simple transition from traditional medical history taking nor a type of structured interview. It entails skills and strategies to be practiced. On the one hand, it revitalizes ethical considerations about clinical relationship building. On the other hand, it can help patients articulate lifeworld goals that are meaningful and important for themselves.
Immigration Detention under the Global Compacts in the Light of Refugee and Human Rights Law Standards
Authors: Majcher Izabella
Published: November 2019

The article explores how immigration detention is addressed in the Global Compact on Refugees (GCR) and Global Compact for Safe, Orderly and Regular Migration (GCM) and investigates the potential implications of the compacts on the existing legal framework regulating the use of immigration detention. While Objective 13 of the GCM largely reflects detention‐related standards under international human rights law, the GCR makes only scarce references to detention in §60. Overall, the compacts risk inhibiting gradual endorsement of the norm of non‐detention of children. On the other hand, they rightly restate the priority for alternatives to detention for adults. States should implement the provisions of the compacts in line with their obligations under international human rights and refugee law. The compacts cannot be used as a pretext to lower domestic detention‐related standards or to diminish the validity of the existing framework governing immigration detention.
Thermal niche traits of high alpine plant species and communities across the tropical Andes and their vulnerability to global warming
Authors: Cuesta Francisco , Tovar Carolina , Llambí Luis D. , Gosling William D. , Halloy Stephan , Carilla Julieta , Muriel Priscilla , Meneses Rosa I. , Beck Stephan , Ulloa Ulloa Carmen , Yager Karina , Aguirre Nikolay , Viñas Paul , Jácome Jorge , Suárez‐Duque David , Buytaert Wouter , Pauli Harald
Published: November 2019

Aim

The climate variability hypothesis (CVH) predicts that locations with reduced seasonal temperature variation select for species with narrower thermal ranges. Here we (a) test the CVH by assessing the effect of latitude and elevation on the thermal ranges of Andean vascular plant species and communities, and (b) assess tropical alpine plants vulnerability to warming based on their thermal traits.

Location

High tropical Andes.

Taxon

Vascular plants.

Methods

Temperature data for 505 vascular plant species from alpine communities on 49 summits, were extracted from 29,627 georeferenced occurrences. Species thermal niche traits (TNTs) were estimated using bootstrapping for: minimum temperature, optimum (mean) temperature and breadth (maximum‐minimum). Plant community‐weighted scores were estimated using the TNTs of their constituent species. CVH was tested for species, biogeographical species groups and communities. Vulnerability to global warming was assessed for species, biogeographical species groups and communities.

Results

Species restricted to the equator showed narrower thermal niche breadth than species whose ranges stretch far from the equator, however, no difference in niche breadth was found across summits’ elevation. Biogeographical species groups distributed close to the equator and restricted to alpine regions showed narrower niche breadth than those with broader ranges. Community‐weighted scores of thermal niche breadth were positively related to distance from equator but not to elevation. Based on their TNTs, species restricted to equatorial latitudes and plant communities dominated by these species were identified as the most vulnerable to the projected 1.5°C warming, due to a potentially higher risk of losing thermal niche space.

Main conclusions

Our study confirms that the CVH applies to high tropical Andean plant species and communities, where latitude has a strong effect on the thermal niche breadth. TNTs are identified as suitable indicators of species’ vulnerability to warming and are suggested to be included in long‐term biodiversity monitoring in the Andes.
Effects of the ARCS‐V‐based motivational strategies on online learners' academic performance, motivation, volition, and course interest
Authors: Ucar Hasan , Kumtepe Alper Tolga
Published: November 2019

This exploratory experimental study investigates the impact of motivational strategies based on the Attention, Relevance, Confidence, Satisfaction, and Volition (ARCS‐V) model on online learners' academic performance, motivation, volition, and course interest. The research was conducted over an 11‐week semester with 122 undergraduate online learners within two groups. One group received a traditional e‐course, while the other group was offered the course with extra motivational strategies derived from the ARCS‐V model. The results revealed that the group who used motivational strategies showed significantly higher gains in motivation, academic performance, and course interest scores. However, there were no significant differences between the groups regarding the volition. Furthermore, the motivation and interest variables were measured with Attention, Relevance, Confidence, and Satisfaction subscales of the ARCS‐V model. In terms of interest variable, there was only a statistically significant difference on the Attention subscale. Regarding motivation variable, the results also showed a statistically significant difference on the attention, confidence, and satisfaction subsections of the ARCS‐V model. The findings of the present study offer insights into ARCSV model‐based research by examining the effects of the model as a valid and reliable framework for online learning environments. The implications and directions for future research are then discussed.
TPD7 inhibits the growth of cutaneous T cell lymphoma H9 cell through regulating IL‐2R signalling pathway
Authors: Zhu Man , Yang Liu , Shi Xianpeng , Gong Zhengyan , Yu Runze , Zhang Dongdong , Zhang Yanmin , Ma Weina
Published: November 2019

IL‐2R pathway is a key regulator in the development of immune cells and has emerged as a promising drug target in cancer treatment, but there is a scarcity of related inhibitors. TPD7 is a novel biphenyl urea taspine derivate, which has been shown anti‐cancer effect. Here, we demonstrated the anti‐cancer activity of TPD7 in cutaneous T cell lymphoma and investigated the underlying mechanism of TPD7 through IL‐2R signalling. The inhibitory effect of TPD7 on cell viability exhibited a strong correlation with the expression level of IL‐2R, and cutaneous T cell lymphoma H9 and HUT78 cells were most sensitive to TPD7. TPD7 was nicely bound to IL‐2R and down‐regulated the mRNA and protein levels of IL‐2R. Furthermore, TPD7 suppressed the downstream cascades of IL‐2R including JAK/STAT, PI3K/AKT/mTOR and PLCγ/Raf/MAPK signalling, resulting in Bcl‐2 mitochondrial apoptosis pathway and cell cycle proteins CDK/Cyclins regulation. And, these were verified by flow cytometry analysis that TPD7 facilitated cell apoptosis in H9 cells via mitochondrial pathway and impeded cell cycle progression at G2/M phase. TPD7 is a novel anti‐cancer agent and may be a potential candidate for cutaneous T cell lymphoma treatment by regulating IL‐2R signalling pathway.
Long‐term (52‐week) efficacy and safety of ipragliflozin add‐on therapy to insulin in Japanese patients with type 1 diabetes mellitus: An uncontrolled, open‐label extension of a phase III study
Authors: Kaku Kohei , Isaka Hiroyuki , Sakatani Taishi , Toyoshima Junko
Published: November 2019

Introduction

The aim of the present study was to assess the long‐term (52‐week) efficacy and safety of ipragliflozin in insulin‐treated Japanese patients with type 1 diabetes mellitus and inadequate glycemic control.

Materials and Methods

In this 28‐week, open‐label extension of a multicenter, randomized, placebo‐controlled, 24‐week phase III study, ipragliflozin recipients continued treatment (50 mg, once daily), and placebo recipients were switched to once‐daily 50 mg ipragliflozin at the start of the extension period. The ipragliflozin dose could be increased to 100 mg if warranted. The primary end‐point was change in glycated hemoglobin; secondary end‐points were change in insulin dose and bodyweight. Safety outcomes were monitored as treatment‐emergent adverse events.

Results

A total of 53 (placebo switched to ipragliflozin) and 108 (ipragliflozin) patients completed the open‐label extension (treatment period 2), with 24 and 44 patients, respectively, receiving dose increases. From baseline to end of treatment, the overall mean change (standard deviation [SD]) in glycated hemoglobin was −0.33% (0.72; −3.7 mmol/mol [7.9]), with changes in basal, bolus and total insulin doses of −3.76 IU (SD 3.85 IU), −2.51 IU (SD 7.08 IU) and −6.27 IU (SD 8.16 IU), respectively. No serious drug‐related treatment‐emergent adverse events or deaths were reported. Treatment‐emergent adverse events leading to study discontinuation occurred in zero and three (2.6%) patients in the placebo switched to ipragliflozin and ipragliflozin groups, respectively; all were considered drug‐related. There were no cases of severe hypoglycemia or diabetic ketoacidosis, and no safety concerns related to dose increase.

Conclusions

The efficacy and safety of 50 mg, once‐daily ipragliflozin in insulin‐treated type 1 diabetes mellitus patients were confirmed in this long‐term, open‐label extension study. No safety concerns were attributed to a dose increase to 100 mg.
Safe and effective use of alitretinoin in children with recalcitrant hand eczema and other dermatoses – a retrospective analysis
Authors: Luchsinger I. , Vogler T. , Schwieger‐Briel A. , Knöpfel N. , Wälchli R. , Weibel L. , Theiler M.
Published: November 2019

Background

Alitretinoin is a systemic retinoid licensed for use in adult patients suffering from chronic hand eczema recalcitrant to potent topical steroids. Experience with its use in childhood is lacking.

Objectives

To report on the efficacy and safety of alitretinoin treatment in a cohort of children and adolescents with chronic hand eczema (CHE) and other inflammatory skin diseases.

Methods

We performed a retrospective chart review of all consecutive patients under the age of 18 years treated with alitretinoin at our paediatric skin centre. Physician's Global Assessment (PGA) was used as the primary outcome measure.

Results

Thirteen children (9 girls and 4 boys) were enrolled in this study. The median age at start of treatment with alitretinoin was 11.5 years (range 5.8–15.8 years). Nine children were diagnosed with CHE, two with severe atopic dermatitis (AD), and two with inherited ichthyosis [netherton syndrome (NS), autosomal recessive congenital ichthyosis (ARCI)]. Moderate to excellent response (PGA decrease of ≥1 point) was observed in 7 (78%) of the nine patients with CHE, one of the two patients with extensive AD and in the one patient with ARCI. In the remaining four subjects, no convincing effect was documented. Tolerability was overall very good. The most common adverse event was headache in 10 patients (77%) during the initiation of treatment, leading to interruption of therapy in one subject.

Conclusions

Alitretinoin seems to be highly effective and safe for the treatment of paediatric CHE and should thus be considered in children with refractory disease under topical therapy. Larger studies are required to corroborate these findings.
Pressurized hot water extraction of phenolic compounds from leaves of Stevia rebaudiana: An UPLC‐ESI‐MSMS study
Authors: Sandra Pedisić , Zorić Zoran , Bursać Kovačević Danijela , Elez Garofulić Ivona , Dragović‐Uzelac Verica
Published: November 2019

Bioactive polyphenolic compounds are present in Stevia rebaudiana leaves and pressurized hot water was applied for their extraction. The extraction was carried out at a constant pressure of 10.34 MPa and the effects of extraction parameters, temperature (100–160°C), time (5 and 10 min), and cycles (1–3) on the polyphenolic composition and content were determined [Correction added on 6 January 2020, after first online publication: the preceding sentence has been updated to reflect the correct temperature from “(10–160°C)” to “(100–160°C)”.]. A total of 33 polyphenolic compounds of four major categories namely phenolic acids, flavonols, flavones, and flavanols were determined in stevia extracts using UPLC‐ESI‐MS2, but the main polyphenolics were mono‐ and diacyl caffeoylquinic acids and quercetin glycosides. The observed pressurized hot water extraction parameters had a statistically significant effect on extraction yield of all analyzed stevia polyphenol subclasses. Cumulative effects of temperature and cycle number did not cause a significant difference in the extraction yield of flavan‐3‐ols. There was no difference in phenolic acids and flavonols with prolonged static extraction time at the highest temperature. Increasing the cycle number minimizes the effect of static time prolongation. The most suitable extraction conditions of stevia phenolic acids and flavanols were found to be at the 130°C and for flavonols and flavones at 160°C at the same extraction time of 10 min and 3 cycles.

Practical Applications

The major application of stevia extracts and stevioside is their use as a sweetener and dietary supplement. Apart from the sweet content, Stevia rebaudiana has numerous compounds with bioactive potential such as flavonoids and phenolic acids, sterols, triterpenoids, chlorophylls, alkaloids, lipids, essential oils, and trace elements. Past few years, stevia has attracted significant scientific interest as a natural antioxidant agent. Therefore, in this study, pressurized hot water extraction was optimized using water as generally recognized as safe solvent in order to establish an effective method for the production of stevia leaf extract rich in polyphenols. UPLC‐MS/MS analysis showed 33 different phenolic compounds belonging to the classes of phenolic acids, flavonols, flavones, and flavanols with mono‐ and diacyl caffeoylquinic acids and quercetin glycosides in the highest concentrations, indicating high potential of stevia leaves' extract for use in food and pharmaceutical industries.
Antipsychotics and the Risk of Mortality or Cardiopulmonary Arrest in Hospitalized Adults
Authors: Basciotta Matthew , Zhou Wenxiao , Ngo Long , Donnino Michael , Marcantonio Edward R. , Herzig Shoshana J.
Published: November 2019

OBJECTIVES

Prior studies in outpatient and long‐term care settings demonstrated increased risk for sudden death with typical and atypical antipsychotics. To date, no studies have investigated this association in a general hospitalized population. We sought to evaluate the risk of death or nonfatal cardiopulmonary arrest in hospitalized adults exposed to antipsychotics.

DESIGN

Retrospective cohort study.

SETTING

Large academic medical center in Boston, Massachusetts.

PARTICIPANTS

All hospitalizations between 2010 and 2016 were eligible for inclusion. We excluded those admitted directly to the intensive care unit (ICU), obstetric and gynecologic or psychiatric services, or with a diagnosis of a psychotic disorder.

INTERVENTION

Typical and atypical antipsychotic administration, defined by pharmacy charges.

MEASUREMENTS

The primary outcome was death or nonfatal cardiopulmonary arrest during hospitalization (composite).

RESULTS

Of 150 948 hospitalizations in our cohort, there were 691 total events (515 deaths, 176 cardiopulmonary arrests). After controlling for comorbidities, ICU time, demographics, admission type, and other medication exposures, typical antipsychotics were associated with the primary outcome (hazard ratio [HR] = 1.6; 95% confidence interval [CI] = 1.1‐2.4; P = .02), whereas atypical antipsychotics were not (HR = 1.1; 95% CI = .8‐1.4; P = .5). When focusing on adults age 65 years and older, however, both typical and atypical antipsychotics were associated with increased risk of death or cardiopulmonary arrest (HR = 1.8; 95% CI = 1.1‐2.9; and HR = 1.4; 95% CI = 1.1‐2.0, respectively). Sensitivity analyses using a propensity score approach and a cohort of only patients with delirium both yielded similar results.

CONCLUSION

In hospitalized adults, typical antipsychotics were associated with increased mortality or cardiopulmonary arrest, whereas atypical antipsychotics were only associated with increased risk among adults age 65 years and older. Providers should be thoughtful when prescribing antipsychotic medications, especially to older adults in settings where data regarding benefit are lacking. J Am Geriatr Soc 68:544–550, 2020
The anatomical basis for transcutaneous auricular vagus nerve stimulation
Authors: Butt Mohsin F. , Albusoda Ahmed , Farmer Adam D. , Aziz Qasim
Published: November 2019

The array of end organ innervations of the vagus nerve, coupled with increased basic science evidence, has led to vagus nerve stimulation (VNS) being explored as a management option in a number of clinical disorders, such as heart failure, migraine and inflammatory bowel disease. Both invasive (surgically implanted) and non‐invasive (transcutaneous) techniques of VNS exist. Transcutaneous VNS (tVNS) delivery systems rely on the cutaneous distribution of vagal afferents, either at the external ear (auricular branch of the vagus nerve) or at the neck (cervical branch of the vagus nerve), thus obviating the need for surgical implantation of a VNS delivery device and facilitating further investigations across a wide range of uses. The concept of electrically stimulating the auricular branch of the vagus nerve (ABVN), which provides somatosensory innervation to several aspects of the external ear, is relatively more recent compared with cervical VNS; thus, there is a relative paucity of literature surrounding its operation and functionality. Despite the increasing body of research exploring the therapeutic uses of auricular transcutaneous VNS (tVNS), a comprehensive review of the cutaneous, intracranial and central distribution of ABVN fibres has not been conducted to date. A review of the literature exploring the neuroanatomical basis of this neuromodulatory therapy is therefore timely. Our review article explores the neuroanatomy of the ABVN with reference to (1) clinical surveys examining Arnold’s reflex, (2) cadaveric studies, (3) fMRI studies, (4) electrophysiological studies, (5) acupuncture studies, (6) retrograde tracing studies and (7) studies measuring changes in autonomic (cardiovascular) parameters in response to auricular tVNS. We also provide an overview of the fibre composition of the ABVN and the effects of auricular tVNS on the central nervous system. Cadaveric studies, of which a limited number exist in the literature, would be the ‘gold‐standard’ approach to studying the cutaneous map of the ABVN; thus, there is a need for more such studies to be conducted. Functional magnetic resonance imaging (fMRI) represents a useful surrogate modality for discerning the auricular sites most likely innervated by the ABVN and the most promising locations for auricular tVNS. However, given the heterogeneity in the results of such investigations and the various limitations of using fMRI, the current literature lacks a clear consensus on the auricular sites that are most densely innervated by the ABVN and whether the brain regions secondarily activated by electrical auricular tVNS depend on specific parameters. At present, it is reasonable to surmise that the concha and inner tragus are suitable locations for vagal modulation. Given the therapeutic potential of auricular tVNS, there remains a need for the cutaneous map of the ABVN to be further refined and the effects of various stimulation parameters and stimulation sites to be determined.