bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding the Potential for Patient Engagement in Electronic Consultation and Referral Systems: Lessons From One Safety Net System
Authors: Olayiwola Jacqueline Nwando , Knox Margae , Dubé Kate , Lu Emily Chen‐Yuan , Woldeyesus Tem , James Iguehi E. , Willard‐Grace Rachel , Tuot Delphine
Published: September 2017

Objective

To understand patient, primary care clinician (PCC), and subspecialist perspectives on potential, unexplored roles for patients in electronic consultation and referral (eCR) systems.

Data Sources

Primary focus group and survey data collected April–November 2015. Zuckerberg San Francisco General Hospital (ZSFG) is part of an integrated public health delivery system. Its mature eCR system was first implemented in 2005.

Study Design

This mixed‐methods study synthesizes patient, subspecialist, and PCC perspectives through two patient focus groups in English, Spanish, and Cantonese (n = 6); subspecialist focus groups (n = 2); and an electronic survey of all PCCs (n = 222/634, 35 percent response).

Data Collection/Extraction Methods

Focus groups were audio‐recorded and transcribed. Two researchers coded the transcripts to identify recurrent themes. Survey data were analyzed using summary and bivariate statistics.

Principal Findings

Patients expressed minimal desire to directly engage in eCR, instead of emphasizing their PCC's role in advocating, informing, and finding health solutions. Subspecialists requested more consistent communication to patients about the electronic consultation process. Most PCCs (52 percent) supported patient engagement in the eCR process, particularly patient ability to track consult status and securely message with subspecialists.

Conclusions

Results suggest a continuum of opportunities for patients and their caregivers to engage in eCR systems.
Patient perspectives on priorities for emergency medicine research: The PERSPEX study
Authors: McLay Stuart VB , McCutcheon David , Arendts Glenn , Macdonald Stephen PJ , Fatovich Daniel M
Published: September 2017

Objectives

To determine the priorities for emergency medicine research of patients currently in an ED and to compare their priorities with those of ACEM researchers.

Methods

A survey of current patients in the EDs of Royal Perth Hospital and Armadale Health Service. Patients gave their reason for presentation, suggested three important research priorities for emergency medicine and ranked their top 5 choices from a pre‐specified list published by the ACEM researchers. Results were analysed using qualitative and quantitative research methods.

Results

A total of 430 patients completed the survey, of which 218 were men (50.7%), with median age 44 years (interquartile range [IQR] 30–61 years, range 18–92 years). The top 5 priorities suggested by patients were cardiology, trauma, ED processes, mental health and haematology/oncology. The top 5 patient rankings of the ACEM researcher list were resuscitation, trauma, cardiology, infectious diseases and paediatrics. Older age groups tended to rank cardiology high, while trauma and resuscitation were ranked high among all age groups. There was moderate agreement between patients and ACEM researchers (ρ = 0.51, P = 0.03).

Conclusions

The top 5 emergency medicine research priorities nominated by patients in ED were cardiology, trauma, ED processes, mental health and haematology/oncology, although many ‘system priorities’ were identified as well. These priorities were generally consistent with ACEM researchers, but patients also suggested alternative directions for future research.
Grafting to manage infections of top stunting and necrogenic strains of cucumber mosaic virus in tomato
Authors: Spanò R. , Gallitelli D. , Mascia T.
Published: September 2017

Cucumber mosaic virus (CMV) lists among the most important etiological agents of tomato diseases. Some isolates of CMV function as helper virus for replication, encapsidation and transmission of satellite RNAs (satRNA), which may exacerbate symptoms induced by CMV in certain hosts. Outbreaks of CMV strains supporting hypervirulent variants of satRNAs are recurrent in tomato with devastating effects on crop production and efficient control measures are still unavailable. In this study, we examined the dynamics of infection of the CMV strains tomato top stunting (TTS) and 77 supporting replication of satRNA variants that codetermine top stunting (TTS‐satRNA) and necrotic (77‐satRNA) phenotypes in two tomato cultivars denoted Solanum lycopersicum Manduria (Sl‐Ma) and S. lycopersicum UC82 (Sl‐UC). Sl‐Ma but not Sl‐UC recovered from disease symptoms induced by CMV‐TTS while both the cultivars succumbed to the infection of CMV‐77 and its necrogenic satRNA. Ability to recover of the Sl‐Ma plants was transmitted by grafting to the susceptible genotype Sl‐UC. More interestingly, recovery was observed also against the challenge inoculation of CMV plus 77‐satRNA in plants grafted on Sl‐Ma and in self‐grafted plants of both the Sl‐Ma and Sl‐UC cultivars. Analysis of small RNAs and genes of the defence plant response based on RNA interference (RNAi) suggested that RNAi is involved in the recovery of Sl‐Ma against CMV with hypervirulent satRNAs and in scions grafted on this rootstock. The response of Sl‐Ma to the inoculation of CMV‐77 plus 77‐satRNA was compared with that of the transgenic tomato line S. lycopersicum transgenic line UCTC5.9.2 that expresses constitutively the benign variant of the satRNA denoted Tfn‐satRNA. Comparative analysis suggested that the response may operate via similar mechanisms, which involve RNAi, the graft and the presence of the satRNA.
Arthroscopic, open and mini‐open approach for rotator cuff repair: no difference in pain or function at 24 months
Authors: Bond Elizabeth C. , Hunt Lynette , Brick Matthew J. , Leigh Warren B. , Maher Anthony , Young Simon W. , Caughey Michael A.
Published: September 2017

Background

The New Zealand Rotator Cuff Registry was established in 2009 to collect prospective functional, pain and outcome data on patients undergoing rotator cuff repair (RCR).

Methods

Information collected included an operation day technical questionnaire completed by the surgeon and Flex Shoulder Function (SF) functional and pain scores preoperatively, immediately post‐operatively and at 6, 12 and 24 months. A multivariate analysis was performed analysing the three surgical approaches to determine if there was a difference in pain or functional outcome scores.

Results

A total of 2418 RCRs were included in this paper. There were 418 (17.3%) arthroscopic, 956 (39.5%) mini‐open and 1044 (43.2%) open procedures. Twenty‐four‐month follow‐up data were obtained for pain and Flex SF in 71% of patients. At 24 months, there was no difference in the average Flex SF score for the arthroscopic, mini‐open and open groups. There was no difference in improvement in Flex SF score at 24 months. At 24 months, there was no difference in mean pain scores. There was no difference in improvement in pain score from preoperation to 24 months. Most patients returned to work within 3 months of surgery, with no difference between the three surgical approaches.

Conclusion

RCR has good to excellent outcomes in terms of improvement in pain and function at 2‐year follow‐up. We found no difference in pain or functional outcome at 24 months between arthroscopic, open and mini‐open approaches for RCR.
Declining trend in the incidence of biopsy‐verified coeliac disease in the adult population of Finland, 2005‐2014
Authors: Virta L. J. , Saarinen M. M. , Kolho K.‐L.
Published: September 2017

Background

The frequency of coeliac disease (CD) has been on the rise over the past decades, especially in Western Europe, but current trends are unclear.

Aim

To research the recent temporal changes in the incidence of adult, biopsy‐verified coeliac disease and dermatitis herpetiformis (DH) in Finland, a country with a high frequency of coeliac disease.

Methods

All coeliac disease and DH cases diagnosed at age 20‐79 years during 2005‐2014 were retrieved from a nationwide database documenting all applicants for monthly compensation to cover the extra cost of maintaining a gluten‐free diet. This benefit is granted on the basis of histology, not socioeconomic status. Temporal trends in the annual incidences were estimated using Poisson regression analyses.

Results

The total incidence of coeliac disease decreased from 33/100 000 during the years 2005‐2006 to 29/100 000 during 2013‐2014. The mean annual incidence of coeliac disease was nearly twice as high among women as among men, 42 vs 22 per 100 000, respectively. For middle‐ and old‐aged women, the average rate of decrease in incidence was 4.8% (95% CI 3.9‐5.7) per year and for men 3.0% (1.8‐4.1) (P for linear trend <.001, for both). Similarly, the annual incidence of DH declined. For young adults, the rate of change remained low and nonsignificant throughout the period 2005‐2014.

Conclusions

Although the awareness of coeliac disease has increased during the past decades, the incidence of biopsy‐verified diagnoses is not increasing, which suggests that exposure to yet unidentified triggering factors for coeliac disease has plateaued among the Finnish adult population.
A randomized controlled trial of a brief online intervention to reduce alcohol consumption in new university students: Combining self‐affirmation, theory of planned behaviour messages, and implementation intentions
Authors: Norman Paul , Cameron David , Epton Tracy , Webb Thomas L. , Harris Peter R. , Millings Abigail , Sheeran Paschal
Published: September 2017

Objectives

Excessive alcohol consumption increases when students enter university. This study tests whether combining (1) messages that target key beliefs from the theory of planned behaviour (TPB) that underlie binge drinking, (2) a self‐affirmation manipulation to reduce defensive processing, and (3) implementation intentions (if‐then plans to avoid binge drinking) reduces alcohol consumption in the first 6 months at university.

Design

A 2 (self‐affirmation) × 2 (TPB messages) × 2 (implementation intention) between‐participants randomized controlled trial with 6‐month follow‐up.

Methods

Before starting university, students (N = 2,951) completed measures of alcohol consumption and were randomly assigned to condition in a full‐factorial design. TPB cognitions about binge drinking were assessed immediately post‐intervention (n = 2,682). Alcohol consumption was assessed after 1 week (n = 1,885), 1 month (n = 1,389), and 6 months (n = 892) at university. TPB cognitions were assessed again at 1 and 6 months.

Results

Participants who received the TPB messages had significantly less favourable cognitions about binge drinking (except perceived control), consumed fewer units of alcohol, engaged in binge drinking less frequently, and had less harmful patterns of alcohol consumption during their first 6 months at university. The other main effects were non‐significant.

Conclusions

The findings support the use of TPB‐based interventions to reduce students’ alcohol consumption, but question the use of self‐affirmation and implementation intentions before starting university when the messages may not represent a threat to self‐identity and when students may have limited knowledge and experience of the pressures to drink alcohol at university.

Statement of contribution

What is already known on this subject?

Alcohol consumption increases when young people enter university.

Significant life transitions represent potential teachable moments to change behaviour.

Interventions with a strong theoretical basis have been found to be more effective.

What does this study add?

A brief online intervention delivered to students before they start university can reduce alcohol consumption.

The theory of planned behaviour can be used to inform the design of interventions to change health behaviour.
Role of oestrogen receptor‐α and ‐β in bladder tissue of patients with a clinical diagnosis of benign prostatic hyperplasia
Authors: Bhattar Rohit , Yadav Sher Singh , Tomar Vinay , Mittal Alka , Gangkak Goto , Mehta Jayanti
Published: September 2017

Objectives

To study the differential expression of oestrogen receptor (ER) subtypes in human urinary bladder tissue using immunohistochemistry (IHC) methods and to explore their correlation with various measures of lower urinary tract symptoms (LUTS).

Methods

In this prospective case–control study, the case group comprised 34 patients with bothersome LUTS who underwent transurethral resection of prostate (TURP), while the control group comprised 19 age‐matched, otherwise healthy patients who underwent cystoscopy to investigate microscopic haematuria. Cystoscopy and bladder biopsy were performed in both groups. IHC evaluation of biopsy specimens was carried out for ER subtypes (ER‐α and ER‐β) and for Ki 67 in semi‐quantitative fashion. Correlations of receptors with various measures of benign prostatic hyperplasia (BPH)/LUTS were also assessed.

Results

Expression of ER‐α (in both epithelial and stromas cells) was statistically significantly greater in the case group than in the control group, but ER‐β expression was not significantly different between the groups. Ki 67 expression was also significantly greater in the case group. Comparison of clinical variables according to receptor status showed that International Prostate Symptom Score (IPSS), post‐void residual urine volume (PVR) and prostate volume were significantly associated with epithelial and stromal ER‐α; however, ER‐β was associated only with PVR.

Conclusion

We found significant correlation between bladder ER levels (specifically ER‐α) and various clinical measures of BPH. We conclude that ER‐α is the key mediator that could be responsible for various clinical measures of BPH/LUTS.
Site function and lithic technology in the Acheulean technocomplex: a case study from Thiongo Korongo (TK), BedII, Olduvai Gorge, Tanzania
Authors: Rubio‐Jara Susana , Panera Joaquín , Santonja Manuel , Pérez‐González Alfredo , Yravedra José , Domínguez‐Rodrigo  Manuel , Bello Patricia , Rojas Raquel , Mabulla Audax , Baquedano Enrique
Published: September 2017

The most recent excavations carried out at the Thiongo Korongo (TK) site, in the upper part of Olduvai BedIIand dating from about 1.353±0.035 Ma, have made it possible to identify a hitherto unknown Acheulean floor. Between 2010 and 2015, we excavated nearly 175 m2in several areas immediately adjacent to M. Leakey's trenches. Our findings led us to reinterpretTK's general stratigraphy and to identify a hitherto unpublished floor situated between levelsTKLFandTKUF(the ones recognized by M. Leakey), which we have calledTKSF. The differences we note between these two floors are very significant and concern production techniques and systems, which were aimed at obtaining different types of tools. These differences are especially marked in bifaces. InTKLF, bifacial tools consist of large, very specialized items characterized by a functional point opposite a thick basal area that makes the tool easy to grasp. InTKSF, handaxes are lighter and their cutting edges extend all around their perimeter, and can thus withstand long and varied uses. Considering the stratigraphical proximity and the accumulation rate of the sedimentary processes involved, the differences we observed cannot be correlated with evolutionary developments, which would require long periods of time. The differences observed in the tools seem to be related to the different activities carried out on each of these floors, and show thatTKwas a complex site with a heuristic capacity that is particularly significant in the context of Olduvai and of the study of behaviour patterns in the Lower Pleistocene.
Competitive response of savanna tree seedlings to C4 grasses is negatively related to photosynthesis rate
Authors: Campbell Tracy A. , Holdo Ricardo M.
Published: September 2017

Savanna tree species vary in the magnitude of their response to grass competition, but the functional traits that explain this variation remain largely unknown. To address this gap, we grew seedlings of 10 savanna tree species with and without grasses in a controlled greenhouse experiment. We found strong interspecific differences in tree competitive response, which was positively related to photosynthesis rates, suggesting a trade‐off between the ability to grow well under conditions of low and high grass biomass across tree species. We also found no competitive effect of tree seedlings on grass, suggesting strong tree‐grass competitive asymmetry. Our results identify a potentially important trade‐off that enhances our ability to predict how savanna tree communities might respond to variation in grass competition.
Rural‐urban disparity in oral health‐related quality of life
Authors: Gaber Amal , Galarneau Chantal , Feine Jocelyne S. , Emami Elham
Published: September 2017

Objectives

The objective of this population‐based cross‐sectional study was to estimate rural‐urban disparity in the oral health‐related quality of life (OHRQoL) of the Quebec adult population.

Methods

A 2‐stage sampling design was used to collect data from the 1788 parents/caregivers of schoolchildren living in the 8 regions of the province of Quebec in Canada. Andersen's behavioural model for health services utilization was used as a conceptual framework. Place of residency was defined according to the Statistics Canada Census Metropolitan Area and Census Agglomeration Influenced Zone classification. The outcome of interest was OHRQoL measured using the Oral Health Impact Profile (OHIP)‐14 validated questionnaire. Data weighting was applied, and the prevalence, extent and severity of negative oral health impacts were calculated. Statistical analyses included descriptive statistics, bivariate analyses and binary logistic regression.

Results

The prevalence of poor oral health‐related quality life (OHRQoL) was statistically higher in rural areas than in urban zones (P = .02). Rural residents reported a significantly higher prevalence of negative daily‐life impacts in pain, psychological discomfort and social disability OHIP domains (P < .05). Additionally, the rural population showed a greater number of negative oral health impacts (P = .03). There was no significant rural‐urban difference in the severity of poor oral health. Logistic regression indicated that the prevalence of poor OHRQoL was significantly related to place of residency (OR = 1.6; 95% CI = 1.1‐2.5; P = .022), perceived oral health (OR = 9.4; 95% CI = 5.7‐15.5; P < .001), dental treatment needs factors (perceived need for dental treatment, pain, dental care seeking) (OR = 8.7; 95% CI = 4.8‐15.6; P < .001) and education (OR = 2.7; 95% CI = 1.8‐3.9; P < .001).

Conclusion

The results of this study suggest a potential difference in OHRQoL of Quebec rural and urban populations, and a need to develop strategies to promote oral health outcomes, specifically for rural residents. Further studies are needed to confirm these results.
Small airway involvement in the late allergic response in asthma
Authors: Stenberg H. , Diamant Z. , Ankerst J. , Bjermer L. , Tufvesson E.
Published: September 2017

Background

Allergy and asthma are closely linked. Inhalation of allergen induces an early allergic response (EAR) within the airways of allergic asthmatic subjects, which is followed by a late allergic response (LAR) in approximately 50% of the subjects. The LAR is defined as a drop in forced expiratory volume in 1 second (FEV1) from baseline usually occurring 4‐8 hours after exposure and is believed to affect small airways. However, FEV1 is insensitive to changes in small airway physiology.

Objective

Our aim was to investigate and compare the pathophysiological processes in large and small airways during the EAR and the LAR and to characterize subjects with both an EAR and a LAR (dual responders) versus those with an EAR only (single responders).

Methods

Thirty‐four subjects with allergic asthma underwent an inhaled allergen challenge. Lung physiology was assessed by spirometry, impulse oscillometry (IOS), body plethysmography, inert gas washout, single breath methane dilution carbon monoxide diffusion and exhaled breath temperature (EBT), at baseline and repeatedly for 23 hours post‐allergen challenge.

Results

Peripheral airway resistance, air trapping and ventilation heterogeneity were significantly increased in dual responders (n = 15) compared to single responders (n = 19) 6‐8 hours post‐challenge. Parameters of peripheral airway resistance and ventilation heterogeneity, measured with IOS and inert gas washout, respectively, correlated at baseline and during the allergic airway response in all subjects.

Conclusion

The LAR involves increased resistance and ventilation defects within the peripheral airways. Alternative definitions of the LAR including small airways pathophysiology could be considered.

Clinical relevance

Small airway dysfunction during the LAR suggests that dual responders may have more extensive airway pathology and underscores the relevance of small airways assessment in asthma.
How to use the new 2017 Japanese guidelines for multiple sclerosis and neuromyelitis optica
Authors: Matsui Makoto
Published: September 2017

New guidelines for the management of multiple sclerosis and neuromyelitis optica were published in Japan in 2017 for doctors and nurses, as well as patients and their family members. They consist of three major parts. The first includes a general discussion regarding the diseases, including brief reviews of seven inflammatory demyelinating diseases of the central nervous system, along with recent advances shown in epidemiological and etiological studies of multiple sclerosis and neuromyelitis optica. That is followed by part I of the detailed discussion section, which describes symptoms, measurements of disability, tests for diagnosis, diagnostic criteria, clinical course and prognosis, and information regarding medical economics and social resources. Finally, part II of the detailed discussion focuses on general treatment strategies, acute stage treatment, disease‐modifying therapy and symptomatic treatment for sequelae after relapse. There are 110 clinical questions covered. Physicians and patients are advised to first read chapter 1 in order to understand the current situation regarding related diseases. For treatment of acute stage patients, a common algorithm is proposed. In order to prevent relapse and suppress progression of disability, proper disease‐modifying therapy must be chosen for individual patients. Physicians are advised to not jump to the portion where a specific drug is discussed, but rather should first read chapter 13 for unbiased facts regarding the whole body of evidence for disease‐modifying therapy. In chapter 11, an escalation therapy strategy starting with baseline drugs is proposed, while induction therapy is mentioned as a possibility for patients with highly active disease.
“The Dirt Came Up”: Domestic Service and Women's Agency in Oaxaca City, Mexico
Authors: HOWELL JAYNE
Published: September 2017

More than two million Mexican women, including over 60,000 in the southeastern state of Oaxaca (population 3.8 million), generate income through paid domestic labour. Within the local political economy, this low‐paid, low‐status job commodifies the unpaid household chores that local gender role norms ascribe to women. Although the potential economic, social, and physical exploitation of uneducated, poor women domestic workers in a “dead end job” is well documented across the globe (see Hoerder, 2015), less is known about the goals and experiences of women who work in service as a way to “get ahead” through and after schooling. Through ethnographic analysis of the lives of Oaxacan domestics who possess high education levels, this paper explores ways that local socioeconomic and geographic conditions and patterns coincide and contrast with broader debates regarding the gendering of urbanization and employment in underdeveloped regions. This issue is especially compelling in an impoverished state that is notorious for low schooling levels, high rates of international migration, and the nation's highest percentage (80 percent) of workers in the informal sector (CONEVAL 2013). This study contributes to our understanding of the importance of informal sector employment for urban women—both with and without advanced schooling—whose agency has led them to work in domestic service while negotiating precarious economic circumstances.
Clinical and patient‐reported outcomes of zirconia‐based implant fixed dental prostheses: Results of a prospective case series 5 years after implant placement
Authors: Spies Benedikt Christopher , Witkowski Siegbert , Vach Kirstin , Kohal Ralf‐Joachim
Published: September 2017

Objective

To evaluate the clinical and patient‐reported outcome of all‐ceramic zirconia implant supported fixed dental prostheses (FDPs) 5 years after implant installation.

Materials and methods

Thirteen patients were treated with two terminally placed one‐piece zirconia implants for a three‐unit FDP each. The FDPs consisted of a CAD/CAM‐fabricated zirconia framework over‐pressed with a fluor‐apatite veneering ceramic and were adhesively cemented. Survival and success were assessed by applying modified US Public Health Service (USPHS) criteria and preparation of Kaplan–Meier (KM) plots. Alpha and Bravo ratings were accepted for success (among others including small area veneer chippings and occlusal roughness), whereas Charlie ratings allowing for intra‐oral correction (e.g., polishing) were accepted for survival. Furthermore, patient‐reported outcome measures (PROMs) were analyzed with the help of visual analogue scales (VAS). Wilcoxon matched‐pairs signed‐rank test (USPHS criteria) and linear mixed models (PROMs) were used to evaluate time effects on response variables.

Results

All patients were available 61.8 ± 1.1 months after implant installation (53.6 ± 3.1 months after final prosthesis insertion). FDP survival was 100%. Significant incidence of veneer chipping (p = .0096) and occlusal roughness (p = .0019) was observed. Charlie rated extent of both phenomena resulted in a KM success estimate of 38.5% (95% CI: 14.1%–62.8%; seven FDPs with obvious roughness, three of them with extended veneer chipping). Compared with the pre‐treatment assessments (30%–81% of satisfaction), all surveys at prosthetic delivery showed significantly improved VAS scores (66%–93%; p ≤ .038), except for speech (p = .341). Concerning function, esthetics and self‐esteem, no decrease in satisfaction could be observed until the end of follow‐up (90%–96%; p ≥ .057), whereas perception of sense (92%) and speech (95%) increased over time (p ≤ .030). Occurrence of technical complications did not correlate with patient satisfaction.

Conclusions

Bi‐layered FDPs made from zirconia/fluor‐apatite highly satisfied patients but showed significant incidence of technical complications.
Androgen alleviates neurotoxicity of β‐amyloid peptide (Aβ) by promoting microglial clearance of Aβ and inhibiting microglial inflammatory response to Aβ
Authors: Yao Peng‐Le , Zhuo Shu , Mei Hong , Chen Xiao‐Fang , Li Na , Zhu Teng‐Fei , Chen Shi‐Ting , Wang Ji‐Ming , Hou Rui‐Xing , Le Ying‐Ying
Published: September 2017

Aims

Lower androgen level in elderly men is a risk factor of Alzheimer's disease (AD). It has been reported that androgen reduces amyloid peptides (Aβ) production and increases Aβ degradation by neurons. Activated microglia are involved in AD by either clearing Aβ deposits through uptake of Aβ or releasing cytotoxic substances and pro‐inflammatory cytokines. Here, we investigated the effect of androgen on Aβ uptake and clearance and Aβ‐induced inflammatory response in microglia, on neuronal death induced by Aβ‐activated microglia, and explored underlying mechanisms.

Methods

Intracellular and extracellular Aβ were examined by immunofluorescence staining and Western blot. Amyloid peptides (Aβ) receptors, Aβ degrading enzymes, and pro‐inflammatory cytokines were detected by RT‐PCR, real‐time PCR, and ELISA. Phosphorylation of MAP kinases and NF‐κB was examined by Western blot.

Results

We found that physiological concentrations of androgen enhanced Aβ42 uptake and clearance, suppressed Aβ42‐induced IL‐1β and TNFα expression by murine microglia cell line N9 and primary microglia, and alleviated neuronal death induced by Aβ42‐activated microglia. Androgen administration also reduced Aβ42‐induced IL‐1β expression and neuronal death in murine hippocampus. Mechanistic studies revealed that androgen promoted microglia to phagocytose and degrade Aβ42 through upregulating formyl peptide receptor 2 and endothelin‐converting enzyme 1c expression, and inhibited Aβ42‐induced pro‐inflammatory cytokines expression via suppressing MAPK p38 and NF‐κB activation by Aβ42, in an androgen receptor independent manner.

Conclusion

Our study demonstrates that androgen promotes microglia to phagocytose and clear Aβ42 and inhibits Aβ42‐induced inflammatory response, which may play an important role in reducing the neurotoxicity of Aβ.
Methods for delivering the UK's multi‐centre prison‐based naloxone‐on‐release pilot randomised trial (N‐ALIVE): Europe's largest prison‐based randomised controlled trial
Authors: Meade Angela Mary , Bird Sheila Macdonald , Strang John , Pepple Tracey , Nichols Laura Lea , Mascarenhas Monica , Choo Louise , Parmar Mahesh Kumar Bhikhubhai
Published: September 2017

Introduction and Aims

Naloxone is an opioid antagonist used for emergency resuscitation following opioid overdose. Prisoners with a history of heroin use by injection have a high risk of drug‐related death in the first weeks after prison‐release. The N‐ALIVE trial was planned as a large prison‐based randomised controlled trial (RCT) to test the effectiveness of naloxone‐on‐release in the prevention of fatal opiate overdoses soon after release. The N‐ALIVE pilot trial was conducted to test the main trial's assumptions on recruitment of prisons and prisoners, and the logistics for ensuring that participants received their N‐ALIVE pack on release.

Design and Methods

Adult prisoners who had ever injected heroin, were incarcerated for ≥7 days and were expected to be released within 3 months were eligible. Participants were randomised to receive, on liberation, a pack containing a single ‘rescue’ injection of naloxone or a control pack with no naloxone syringe. The trial was double‐blind prior to prison‐release.

Results

We randomised 1685 prisoners (842 naloxone; 843 control) across 16 prisons in England. We stopped randomisation on 8 December 2014 because only one‐third of administrations of naloxone‐on‐release were to the randomised ex‐prisoner; two‐thirds were to others whom we were not tracing.

Discussion and Conclusions

Prevention RCTs are seldom conducted within prisons; we demonstrated the feasibility of conducting a multi‐prison RCT to prevent fatality from opioid overdose in the outside community. We terminated the N‐ALIVE trial due to the infeasibility of individualised randomisation to naloxone‐on‐release. Large RCTs are feasible within prisons.
Alien plants have greater impact than habitat fragmentation on native insect flower visitation networks
Authors: Hansen Simone , Roets Francois , Seymour Colleen L. , Thébault Elisa , van Veen F.J. Frank , Pryke James S.
Published: September 2017

Aim

Habitat fragmentation and alien species are among the leading causes of biodiversity loss. In an attempt to reduce the impact of forestry on natural systems, networks of natural corridors and patches of natural habitat are often maintained within the afforested matrix, yet these can be subject to degradation by invasion of non‐native species. Both habitat fragmentation and alien invasive species disrupt the complex interaction networks typical of native communities. This study examines whether an invasive plant and/or the fragmented nature of the forestry landscape influences natural flower visitation networks (FVNs), flower–visitor abundance and richness or flower/visitor species composition.

Location

The species rich and diverse grasslands in the KwaZulu‐Natal Midlands, South Africa is under threat from transformation, particularly by commercial forestry plantations, restricting much of the remaining untransformed grasslands into remnant grassland patches (RGPs). Remaining patches are under additional threat from the invasive Rubus cuneifolius Pursh (bramble). Sites were established in RGPs and in a nearby protected area (PA), with and without brambles present for both areas.

Results

Flower abundance and flower area of native plant species were greater within RGP than in PA, but only in the absence of R. cuneifolius. Flower–visitor assemblages differed between invaded and uninvaded sites and also differed between PA and RGP sites. Both areas lost specialist flower–visitor species in the presence of brambles. Network modularity was greatly reduced by the presence of bramble, indicating a reduction in complexity and organization. The structure of FVNs was otherwise unaffected by presence of bramble or being located in RGPs or the PA.

Main conclusions

The RPGs contribute to regional biodiversity conservation through additional compositional diversity and intact FVNs. Rubus cuneifolius reduces ecological complexity of both RGPs and PAs, however, and its removal must be prioritized to conserve FVNs.
Therapy access among children with autism spectrum disorder, cerebral palsy, and attention‐deficit–hyperactivity disorder: a population‐based study
Authors: Benevides Teal W , Carretta Henry J , Ivey Carole K , Lane Shelly J
Published: September 2017

Aim

This study examined cross‐sectional population‐based rates in reported need and unmet need for occupational, physical, and speech therapy services in children with autism spectrum disorder (ASD) compared with children with attention‐deficit–hyperactivity disorder (ADHD) and cerebral palsy (CP).

Method

The 2005–2006 and 2009–2010 (USA) National Survey of Children with Special Health Care data sets were used to compare therapy need and unmet need among children younger than 18 years with ASD (n=5178), ADHD (n=20 566), and CP (n=1183). Bivariate approaches and multivariate logistic regression using imputed data were used to identify associations between child and family characteristics, and access to therapy services.

Results

After adjusting for other variables, children with ASD had a significantly greater likelihood of having an unmet therapy need compared with children with ADHD (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.36–2.03), but a similar unmet need as children with CP (OR 1.30, 95% CI 0.97–1.74). Factors associated with unmet need included survey year, younger child age, no health insurance, and increased functional and behavioral difficulties.

Interpretation

Children in our sample had greater unmet therapy needs in 2009 than in 2005. Caregiver‐reported reasons for unmet need included cost and school resources. Research examining future trends in therapy access are warranted for children with ASD and CP.

What this paper adds

Children with complex diagnoses of autism spectrum disorder and cerebral palsy had reported unmet need for therapy services.

High costs of therapy were the primary reported reason contributing to reduced access among children.
DISAPPOINTMENT AVERSION AND SOCIAL COMPARISONS IN A REAL‐EFFORT COMPETITION
Authors: Gächter Simon , Huang Lingbo , Sefton Martin
Published: September 2017

We present an experiment to investigate the source of disappointment aversion in a sequential real‐effort competition. Specifically, we study the contribution of social comparison effects to the disappointment aversion previously identified in a two‐person real‐effort competition (Gill, D., and V. Prowse. “A Structural Analysis of Disappointment Aversion in a Real Effort Competition.” American Economic Review, 102, 2012, 469–503). To do this we compare “social” and “asocial” versions of the Gill and Prowse experiment, where the latter treatment removes the scope for social comparisons. If disappointment aversion simply reflects an asymmetric evaluation of losses and gains we would expect it to survive in our asocial treatment. Alternatively, if losing to or winning against another person affects the evaluation of losses/gains, as we show would be theoretically the case under asymmetric inequality aversion, we would expect treatment differences. We find behavior in social and asocial treatments to be similar, suggesting that social comparisons have little impact in this setting. Unlike in Gill and Prowse we do not find evidence of disappointment aversion. (JEL C91, D12, D81, D84)
Ecological constraints from incumbent clades drive trait evolution across the tree‐of‐life of freshwater macroinvertebrates
Authors: Múrria Cesc , Dolédec Sylvain , Papadopoulou Anna , Vogler Alfried P. , Bonada Núria
Published: September 2017

The rates of species and trait diversification vary across the Tree‐of‐Life and over time. Whereas species richness and clade age generally are decoupled, the correlation of accumulated trait diversity of clades (trait disparity) with clade age remains poorly explored. Total trait disparity may be coupled with clade age if the growth of disparity (disparification) within and across clades is continuous with time in an additive niche expansion process (linear‐cumulative model), or alternatively if the rate of trait disparification varies over time and decreases as ecological space becomes gradually saturated (disparity‐dependent model). Using a clock‐calibrated phylogenetic tree for 143 freshwater macroinvertebrate families and richness and trait databases covering > 6400 species, we measured trait disparity in 18 independent clades that successively transitioned to freshwater ecosystems and analyzed its relation with clade age. We found a positive correlation between clade age and total disparity within clades, but no relationship for most individual traits. Traits unique to freshwater lifestyle were highly variable within older clades, while disparity in younger clades shifted towards partially terrestrial lifestyles and saline tolerance to occupy habitats previously inaccessible or underutilized. These results argue that constraints from incumbent lineages limit trait disparity in younger clades that evolved for filling unoccupied regions of the trait space, which suggests that trait disparification may follow a disparity‐dependent model. Overall, we provide an empirical pattern that reveals the potential of the disparity‐dependent model for understanding fundamental processes shaping trait dynamics across the Tree‐of‐Life.
Investigation of thickness effects on the bending singularities of a notched plate
Authors: Chen C.‐D.
Published: September 2017

In this paper, the bending singularities of a notched plate are investigated through the finite element method. The computed singular parameters, including the singularity orders and associated corner functions, are compared with those of classical plate theory and first‐order shear deformation plate theory (FSDPT); the comparisons demonstrate the inaccuracy of the boundary conditions in classical plate theory. The thickness effects are then investigated through the finite element method. The results show that although the singularity parameters computed by finite element agree with those of the FSDPT in the interior of the plate, the FSDPT is not applicable at the notch tip on the top or bottom surface because of substantial free surface effects. For a very thin plate, the inconsistence in the comparison slightly increases because of the free surface effects.
Language games: University responses to ranking metrics
Authors: Heffernan Troy A. , Heffernan Amanda
Published: September 2017

League tables of universities that measure performance in various ways are now commonplace, with numerous bodies providing their own rankings of how institutions throughout the world are seen to be performing on a range of metrics. This paper uses Lyotard's notion of language games to theorise that universities are regaining some power over being placed on league tables by creating narratives that manipulate their rankings to promote their own strengths. This paper examines the findings of a study involving university responses to global rankings throughout 2016 produced by two major ranking bodies, Times Higher Education and QS Top Universities. The existing literature has established that ranking tables can be used as a vehicle for humiliation and can produce terrors for all those involved. Thus, the significance of this study's findings is in new ways of theorising university responses to appearing on league tables at a time when academia is a high‐stakes activity where institutions’ abilities are measured and reported on at a global scale.
Mobile phone text messaging improves antihypertensive drug adherence in the community
Authors: Varleta Paola , Acevedo Mónica , Akel Carlos , Salinas Claudia , Navarrete Carlos , García Ana , Echegoyen Carolina , Rodriguez Daniel , Gramusset Lissette , Leon Sandra , Cofré Pedro , Retamal Raquel , Romero Katerine
Published: September 2017

Antihypertensive drug adherence (ADA) is a mainstay in blood pressure control. Education through mobile phone short message system (SMS) text messaging could improve ADA. The authors conducted a randomized study involving 314 patients with hypertension with <6 months of antihypertensive treatment from the Preventive Health Program of 12 different primary care centers in Santiago, Chile. Patients were randomly assigned to receive or not receive SMS related to ADA and healthy lifestyle. Adherence was assessed by the self‐reported four‐item scale Morisky‐Green‐Levine questionnaire at baseline and after 6 months of follow‐up, with four of four positive questions classified as good adherence. Group comparison for adherence was performed by means of a logistic regression model, adjusting by baseline adherence, age older than 60 years, and sex. A total of 163 patients were randomized to receive and 151 to not receive SMS. After 6 months of follow‐up, ADA in the non‐SMS group decreased from 59.3% to 51.4% (P=.1). By contrast, adherence increased from 49% to 62.3% (P=.01) in the SMS group. Text messaging intervention improved ADA (risk ratio, 1.3; 95% confidence interval, 1.0–1.6 [P<.05]). At 6‐month follow‐up, text messaging resulted in an increase in reporting ADA in this hypertensive Latino population. This approach could become an effective tool to overcome poor medication adherence in the community.
Low and high body mass index in hidradenitis suppurativa patients—different subtypes?
Authors: Theut Riis P. , Saunte D.M. , Benhadou F. , del Marmol V. , Guillem P. , El‐Domyati M. , Abdel‐Wahab H. , Antoniou C. , Dessinioti C. , Gürer M.A. , Beksaç B. , Szepietowski J.C. , Matusiak L. , Emtestam L. , Lapins J. , Riad H. , Doss N. , Massa A.F. , Hamzavi I. , Nicholson C. , Dolenc‐Voljc M. , Kim K.H. , Ohn J. , Zouboulis C.C. , Karagiannidis I. , Mokos Z.B. , Durinec P. , Jemec G.B.E.
Published: September 2017

Introduction

Overweight is a well‐established risk factor for hidradenitis suppurativa (HS). In this cross‐sectional study, we compare HS patients with a high body mass index (BMI) with HS patients with a low BMI to investigate differences in disease characteristics.

Materials and method

Patients were recruited from 17 dermatological centres from four continents. A total of 246 patients with a BMI below 25 were compared to 205 patients with a BMI of above 35.

Results

Patients with a high BMI suffered more severe disease (Hurley, physician global assessment, number of areas affected and patient‐reported severity (PRS), P < 0.001 for all). There was no difference in smoking (P = 0.783) nor in family history (P = 0.088). In both low and high BMI patients, early onset of HS was a predictor of positive family history (P < 0.001, for each). For low BMI patients, an increase in BMI significantly increased PRS (P < 0.001). For patients with a high BMI, number of pack‐years significantly increased PRS (P = 0.001). Cluster analysis of eruption patterns was location specific for low BMI patients but severity specific for high BMI patients.

Discussion

Patients with a low and high BMI could represent two clinically different subtypes. We suggest a non‐linear relationship between BMI and impact of HS. As patients go from a low BMI patient to a high BMI patient (or from high to low), eruption patterns and risk factors may change.
Physical factors influencing the oviposition behaviour of European grapevine moths Lobesia botrana and Eupoecilia ambiguella
Authors: Markheiser A. , Rid M. , Biancu S. , Gross J. , Hoffmann C.
Published: September 2017

Uncovering the entire process of oviposition could enable the development of innovative pest control strategies. The European grapevine moth Lobesia botrana as well as the European grape berry moth Eupoecilia ambiguella are serious insect pests, which still threaten viticulture in many parts of the world. By creating an artificial semiochemical emitting surface, in form of a card, we tried to develop an egg‐monitoring tool for the oviposition of these two species in vineyards. The idea was to create a decision support system that facilitates timing and necessity of insecticide treatments. This article deals exclusively with the initial step towards the development of this tool: the influence of physical factors (colour, shape or texture) of a surface on the oviposition behaviour of L. botrana and E. ambiguella under laboratory conditions. The acceptance of different artificial substrates as oviposition site was analysed exclusive of volatile organic compounds emitted by a host plant. We investigated particular colours of the surface, which could be a visual stimulus to trigger the oviposition of both species. Apparently, the colour green, the texture of the material and the light conditions turned out to be highly important stimuli for oviposition.
Atypical Clinical Presentations of Acute Phase Chikungunya Virus Infection in Older Adults
Authors: Godaert Lidvine , Najioullah Fatiha , Bartholet Seendy , Colas Sébastien , Yactayo Sergio , Cabié André , Fanon Jean‐Luc , Césaire Raymond , Dramé Moustapha
Published: September 2017

Objectives

We aimed to determine whether the presentation of Chikungunya virus (CHIKV) infection differs between older and younger adults with regard to clinical form during the acute phase defined by the World Health Organization: acute clinical, atypical, and severe acute.

Design

Cross‐sectional, retrospective.

Setting

University Hospital of Martinique.

Participants

Individuals aged 65 and older (n = 267, mean age 80.4 ± 87.9) who attended the emergency department with a positive biological diagnosis of CHIKV (reverse transcriptase polymerase chain reaction) between January and December 2014 and a randomly selected sample of individuals younger than 65 (n = 109, mean age 46.2 ± 12.7).

Results

Typical presentation was present in 8.2% of older adults and 59.6% of younger individuals (P < .001), atypical presentation in 29.6% of older adults and 5.6% of younger individuals (P < .001), and severe presentation in 19.5% of older adults and 17.4% of younger individuals (P = .65). One hundred fourteen (42.7%) of the older group and 19 (17.4%) of the younger group could not be classified in any category (absence of fever, absence of joint pain, or both) (P < .001).

Conclusion

Only 8.2% of the older adults presenting in the acute phase of CHIKV have typical forms, suggesting that the most‐frequent clinical presentation of CHIKV in older adults differs from that in younger individuals.