bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving community health worker performance through supportive supervision: a randomised controlled implementation trial in Pakistan
Authors: Aftab Wafa , Rabbani Fauziah , Sangrasi Kashif , Perveen Shagufta , Zahidie Aysha , Qazi Shamim Ahmed
Published: December 2018

Aim

To assess the effect of enhanced supportive supervision of lady health workers (LHWs) by lady health supervisors on integrated community case management of childhood pneumonia and diarrhoea.

Methods

A total of thirty‐four supervisors were randomly assigned to intervention and comparison arms. The intervention included enhanced training of supervisors on supervisory skills and written feedback to LHWs by supervisors. The performance of both cadres was assessed three times. Household surveys judged caregiver practices.

Results

Intervention arm LHWs performed better than those in the comparison arm in assessing dehydration (92% [n = 25] vs 64% [n = 25]) and in classifying diarrhoea correctly (68% [n = 25] vs 40% [n = 25]). The two arms differed little in correct disease classification for pneumonia (44% [n = 25] vs 40% [n = 25]). Supervisory performance of intervention arm supervisors was better than that in the comparison arm in correcting the workers’ clinical examination skills (64% [n = 25] vs 40% [n = 25]) and more frequent feedback. In the household survey, only 18% (n = 2182) intervention and 23% (n = 2197) comparison arm caregivers considered LHWs capable of providing diarrhoea and pneumonia care. Commodities for integrated community case management were not regularly available to workers.

Conclusion

Supportive supervision can improve community case management performance. Support through refresher training, logistics and commodities is essential.
Clan‐involved approaches to increasing antenatal care use in a rural minority area of China: implementation research
Authors: Ma Wei , Liu Bo , Nan Lei , Portela Anayda , Yin Bibo , Wei Chongyi , Rollins Nigel , Wang Shumei , Emu Aga , Zhou Haiqun
Published: December 2018

Aim

This study aimed to test a model which involved clans and health providers to increase antenatal care attendance in rural minority areas of China with high HIV prevalence.

Methods

Formative research was conducted to determine barriers and facilitators to antenatal care use. A strategy involving clans in addressing the barriers identified was developed. Implementation of the new strategy was done through three plan‐do‐study‐act (PDSA) cycles, lasting four months each.

Results

Awareness and uptake of antenatal care increased significantly after the intervention. The proportion of post‐partum women who used any antenatal care increased from 21.3% to 64.5% (p < 0.001), and the proportion who knew that antenatal care is necessary increased from 77.8% to 89.8% (p < 0.001). The proportion of pregnant women who attended antenatal care (p < 0.001) and the proportion of pregnant women who went for a first antenatal care visit in early pregnancy (p < 0.001) all showed increasing trends during the study period.

Conclusion

Involving clans in antenatal care programmes in rural minority areas of China had an impact on antenatal care use. A quality improvement approach incorporating PDSA cycles can help local health authorities make context‐specific, evidence‐informed decisions to improve uptake of health services.
Implementation research to assess a health workers performance‐based management system in Nepal
Authors: Baral S , Subedi HN , Paudel P , Chand PB , Shrestha MP , McCullough A , Raven J , Theobald S , Martineau T , Elsey H
Published: December 2018

Aim

To test and refine a performance‐based management system to improve health worker performance in Nepal.

Methods

A mixed‐methods implementation research in three districts. The study assessed health workers’ job satisfaction at the start and end of the study. Qualitative techniques were used to document processes, and routine health service data were analysed to measure outcomes.

Results

Job satisfaction significantly increased in six of nine key areas, and the proportion of staff absenteeism significantly declined in the study districts. It demonstrated an increase in immunisation coverage, the proportion of women who had a first antenatal check‐up also having a fourth check‐up and the proportion of childbirth in a health facility. The greatest perceived strengths of the system were its robust approach to performance planning and evaluation, supportive supervision, outcome‐based job descriptions and a transparent reward system. A functional health facility environment, leadership and community engagement support successful implementation.

Conclusion

The performance‐based management system has the potential to increase health workers’ job satisfaction, and it offers a tool to link facility‐wide human resource management. A collaborative approach, ownership and commitment of the health system are critical to success. Considering the Nepal context, a management system that demonstrates a positive improvement has potential for improved health care delivery.
Operationalising integrated community case management of childhood illnesses by community health workers in rural Haryana
Authors: Taneja Sunita , Dalpath Suresh , Bhandari Nita , Kaur Jasmine , Mazumder Sarmila , Chowdhury Ranadip , Mundra Sudarshan , Bhan Maharaj Kishan
Published: December 2018

Aim

To conduct implementation research in integrated community case management (ICCM) of childhood pneumonia, diarrhoea and fever by promoting accredited social health activists as treatment providers and generate lessons for upscaling this approach.

Methods

In this one‐sample study, 49 Accredited Social Health Activists were trained in ICCM. Community awareness and demand generation activities undertaken included announcements, pamphlets and posters. Supplies of medicines and supervision of activists were maintained throughout the 10‐month implementation period. Three cross‐sectional surveys were conducted in households with children aged 2–59 months for documenting two‐week prevalence of illnesses and care‐seeking practices. Focus group discussions and in‐depth interviews were carried out with mothers/grandmothers and activists for documenting perceptions about health activists as treatment providers.

Results

One third of pneumonia (113/334) and one quarter of diarrhoea (102/408) cases at end‐line were treated by Accredited Social Health Activists. Proportion of households seeking care from private providers (mostly unqualified) reduced significantly from baseline to endline (81–56% for diarrhoea, p < 0.01; 78–48% for pneumonia, p < 0.01). At endline, activists were considered an acceptable and attractive source for treatment near home.

Conclusion

Trained Accredited Social Health Activists can treat uncomplicated childhood illnesses and are accepted by the community in this role.
Identification of dehydroxy isoquine and isotebuquine as promising anticancer agents targeting K+ channel
Authors: Romero Angel H. , López Simón E. , Arvelo Francisco , Sojo Felipe , Calderon Christian , Morales Alvaro
Published: December 2018

Traditional antimalarial drugs based on 4‐aminoquinolines have exhibited good antiproliferative activities against human tumor cells; however, their low relative efficacy has limited their corresponding clinical uses. In order to identify new potent anticancer agents based on 4‐aminoquinoline, we evaluated the antiproliferative activity of a series of dehydroxy isoquines and isotebuquines against five human cancer lines. HeLa and SKBr3 were significantly more sensitive to the action of tested quinolines than the A549, MCF‐7, and PC‐3 cancer lines. Compound 2h was by far the most potent derivative against four of the tested lines (except to PC3 line), exhibiting low micromolar or nanomolar IC50 values superior to adriamycin reference, low toxicities on dermis human fibroblasts (LD50 > 250 μM), and excellent selectivity indexes against the mentioned cancer cells. A structure–activity relationship analysis put in evidence that a pyrrolidine or morpholine moiety as N‐alkyl terminal substitution and the incorporation of the extra phenyl attached to aniline ring are pharmacophore essentials for improvement the anticancer activity of the studied dehydroxy isoquines and isotebuquines. From the results, compound 2h emerged as a promising anticancer candidate for further in vitro assays against resistant‐strain and in vivo studies as well as pharmacokinetic and genotoxicity studies. Mechanistic assays suggested that the most active quinoline 2h act as calcium‐activated potassium channel activator.
Pathways of socioeconomic inequalities in gingival bleeding among adolescents
Authors: Sfreddo Camila S. , Moreira Carlos Heitor C. , Celeste Roger K. , Nicolau Belinda , Ardenghi Thiago M.
Published: December 2018

Objectives

To explore the pathways through which the socioeconomic inequalities may influence gingival bleeding in adolescents, assessing the direct and indirect effects of material and psychosocial variables.

Methods

This cohort study followed a multistage, random sample of 1134 12‐year‐old adolescents from 20 public schools of Santa Maria, a city in southern Brazil. The percentage of teeth with gingival bleeding was recorded according to the Community Periodontal Index criteria (scored as healthy or bleeding) at baseline and at 2‐year follow‐up. Biological (dental plaque, caries, and dental crowding), material (socioeconomic position [SEP] operationalized as family income and parents’ education), psychosocial (parents’ religiosity, self‐rated health, and happiness) and behavioural (use of dental service by adolescents) factors were collected at baseline. Structural equation modelling (SEM) was guided by the adapted Commission on the Social Determinants of Health model linking material, psychosocial, biological, and behaviour variables to health. The SEM was employed to estimate standardized direct, indirect, and total effects of material and psychosocial factors on gingival bleeding at follow‐up.

Results

A total of 770 14‐year‐old adolescents were reassessed (follow‐up rate of 68%). The lower SEP at baseline had a higher direct effect (standard coefficient [SC] = −0.17, P < 0.01) than a mediated effect on percentage of teeth with gingival bleeding at 2‐year follow‐up. The lower indirect effect (SC = −0.06, P < 0.01) from SEP to gingival bleeding at follow‐up ran through biological factors—dental plaque (baseline and follow‐up) and gingival bleeding at baseline. The lower religiosity of the parents as a psychosocial aspect had only a small direct effect (SC = −0.10, P = 0.03) on gingival bleeding at follow‐up.

Conclusions

Material factors such as SEP contributed most to explanations on inequalities in adolescents’ periodontal health because of their higher direct effect and additional shared (indirect) effect (through biological factors) on gingival bleeding. Religious practice as a psychosocial factor only explained part of percentage of teeth with gingival bleeding at follow‐up.
When the Marae Moves into the City: Being Māori in Urban Palmerston North
Authors: King Pita , Hodgetts Darrin , Rua Mohi , Morgan Mandy
Published: December 2018

Through processes of colonization, many indigenous peoples have become absorbed into settler societies and new ways of existing within urban environments. Settler society economic, legal, and social structures have facilitated this absorption by recasting indigenous selves in ways that reflect the cultural values of settler populations. Urban enclaves populated and textured by indigenous groups such as Māori (indigenous people of New Zealand) can be approached as sites of existential resistance to the imposition of colonial ways of seeing and understanding the self. In maintaining everyday social practices and ways–of–being that traverse rural and urban locales, Māori preserve and reproduce cultural selves in ways that make aspects of cityscapes more homely for Māori ways–of–being. This article brings issues of place and being to the fore by investigating Māori reassemblage of cultural selves within a low SES urban environment as an ongoing resistance to colonial absorption.
A rule of thumb for widths of conservation corridors
Authors: Beier Paul
Published: December 2018

Article impact statement: A rule of thumb is that a conservation corridor should be at least 2 km wide to provide long‐term gene flow and recolonization.
Climate readiness of recovery plans for threatened Australian species
Authors: Hoeppner Johanne Malin , Hughes Lesley
Published: December 2018

The rapidly changing climate is posing growing threats for all species, but particularly for those already considered threatened. We reviewed 100 recovery plans for Australian terrestrial threatened species (50 fauna and 50 flora plans) written from 1997 to 2017. We recorded the number of plans that acknowledged climate change as a threat and of these how many proposed specific actions to ameliorate the threat. We classified these actions along a continuum from passive or incremental to active or interventionist. Overall, just under 60% of the sampled recovery plans listed climate change as a current or potential threat to the threatened taxa, and the likelihood of this acknowledgment increased over time. A far smaller proportion of the plans, however, identified specific actions associated with ameliorating climate risk (22%) and even fewer (9%) recommended any interventionist action in response to a climate‐change‐associated threat. Our results point to a disconnect between the knowledge generated on climate‐change‐related risk and potential adaptation strategies and the extent to which this knowledge has been incorporated into an important instrument of conservation action.
On Bauer's How to Do things with Pornography
Authors: Watson Lori
Published: December 2018

This article is a response to Nancy Bauer's How To Do Things with Pornography. The main argument of the book is presented and evaluated. In particular, Bauer's criticisms of Catharine MacKinnon's work on pornography are considered and a defense of MacKinnon's views offered.
Interspecific aggression declines seasonally in breeding great tits Parus major
Authors: Samplonius Jelmer M.
Published: December 2018

During the breeding season, great tits show aggression to protect their nest from intra‐ and interspecific intruders. Aggression is a labile trait that can be plastically expressed as a result of individual differences (e.g., personality), seasonal gradients in the costs and benefits of aggression, or other environmental components (e.g., number of competitors). Competitors may try to take over great tit nests, because the number of suitable nesting sites is limited, and great tits may guard high quality territories. Taking over a great tit nest may be especially fruitful in early phenological stages (egg laying) when great tits frequent their nests less often. However, great tits may compensate for this vulnerability by being more aggressive toward intruders during early nesting stages, a pattern that has already been established in an intraspecific context. Previous studies have shown that interspecific intruders were most likely to die from great tit aggression during great tit egg laying, suggesting great tits may also be more aggressive during this phase in an interspecific context. Here, I tested this hypothesis with simulated territorial intrusions in great tit territories using taxidermized blue tits Cyanistes caeruleus (hereafter called blue tit models). Great tit aggression (number of calls and approach distance toward blue tit model) was assayed during egg laying, incubation, and chick rearing in the breeding season of 2014. Although sample size was low due to a high fraction of non‐responders (n = 44 out of 89 assays across 26 out of 35 individuals), I found that great tits showed a seasonal decline in aggressiveness, which is congruent with intraspecific results on this study species. I discuss my findings in the context of differential adjustment to climate change between interspecific competitors.
Four decades of functional community change reveals gradual trends and low interlinkage across trophic groups in a large marine ecosystem
Authors: Törnroos Anna , Pecuchet Laurene , Olsson Jens , Gårdmark Anna , Blomqvist Mats , Lindegren Martin , Bonsdorff Erik
Published: December 2018

The rate at which biological diversity is altered on both land and in the sea, makes temporal community development a critical and fundamental part of understanding global change. With advancements in trait‐based approaches, the focus on the impact of temporal change has shifted towards its potential effects on the functioning of the ecosystems. Our mechanistic understanding of and ability to predict community change is still impeded by the lack of knowledge in long‐term functional dynamics that span several trophic levels. To address this, we assessed species richness and multiple dimensions of functional diversity and dynamics of two interacting key organism groups in the marine food web: fish and zoobenthos. We utilized unique time series‐data spanning four decades, from three environmentally distinct coastal areas in the Baltic Sea, and assembled trait information on six traits per organism group covering aspects of feeding, living habit, reproduction and life history. We identified gradual long‐term trends, rather than abrupt changes in functional diversity (trait richness, evenness, dispersion) trait turnover, and overall multi‐trait community composition. The linkage between fish and zoobenthic functional community change, in terms of correlation in long‐term trends, was weak, with timing of changes being area and trophic group specific. Developments of fish and zoobenthos traits, particularly size (increase in small size for both groups) and feeding habits (e.g. increase in generalist feeding for fish and scavenging or predation for zoobenthos), suggest changes in trophic pathways. We summarize our findings by highlighting three key aspects for understanding functional change across trophic groups: (a) decoupling of species from trait richness, (b) decoupling of richness from density and (c) determining of turnover and multi‐trait dynamics. We therefore argue for quantifying change in multiple functional measures to help assessments of biodiversity change move beyond taxonomy and single trophic groups.
Extramammary Paget's disease: a review of the literature
Authors: Simonds Robert M. , Segal Robert J. , Sharma Amit
Published: December 2018

Extramammary Paget's disease (EMPD) is a rare cutaneous malignancy. The disease typically affects older individuals aged 60–80 years and is seen most frequently in postmenopausal Caucasian women and Asian men. EMPD exhibits a predilection for the genital and perianal regions and may be associated with an underlying carcinoma in adjacent organs. EMPD presents a challenge in both diagnosis and management. Often treated empirically as various dermatitides, the correct diagnosis is frequently delayed by many years. Following diagnosis, an extensive search for an associated malignancy should be initiated. If invasive disease is present on biopsy, a sentinel lymph node biopsy may guide further treatment. Mohs micrographic surgery appears to be superior to wide local excision when considering tissue sparing ability and disease recurrence. Nonsurgical interventions have also been investigated with varied results. Regardless of treatment method, long‐term follow‐up is recommended to monitor for local disease recurrence, development of internal malignancy, regional lymphadenopathy, or distant metastasis.
Evaluación de la eficacia de las disposiciones laborales de los acuerdos comerciales: marco analítico y metodológico
Authors: AISSI Jonas , PEELS Rafael , SAMAAN Daniel
Published: December 2018

Este artículo propone un marco analítico y metodológico para examinar la eficacia de las disposiciones laborales de los acuerdos comerciales, ilustrándolo con estudios de casos. Los autores desarrollan la noción de capacidad en tres niveles (jurídico, institucional y político) y diferencian entre resultados inmediatos (jurídicos, institucionales y políticos) y resultados socioeconómicos ulteriores (mejora de los derechos y las condiciones laborales). Analizan las disposiciones laborales de dichos acuerdos como una «combinación de políticas» que ha de evaluarse con métodos cualitativos y/o cuantitativos, dependiendo del aspecto de la capacidad de que se trate y de los datos disponibles. Asimismo, ofrecen algunas recomendaciones de política.
Conserved and variable natural killer cell receptors: diverse approaches to viral infections
Authors: Bastidas‐Legarda Leidy Y. , Khakoo Salim I.
Published: December 2018

Natural killer (NK) cells are lymphocytes of the innate immune system with essential roles during viral infections. NK cell functions are mediated through a repertoire of non‐rearranging inhibitory and activating receptors that interact with major histocompatibility complex (MHC)–peptide complexes on the surface of infected cells. Recent work studying the conserved CD94–NKG2A and variable killer cell immunoglobulin‐like receptor–MHC systems suggest that these two receptor families may have subtly different properties in terms of interactions with MHC class I bound peptides, and in recognition of down‐regulation of MHC class I. In this review, we discuss how these properties generate diversity in the NK cell response to viruses.
Sex‐specific relationship between adult height and the risk of stroke: A dose‐response meta‐analysis of prospective studies
Authors: Zhou Wen , Li Yuqian , Liu Xuejiao , Zhang Lulu , Shi Yuanyuan , Wang Chongjian , Zhang Dongdong , Mao Zhenxing , Li Linlin
Published: December 2018

Conflicting evidence exists regarding the magnitude of the association between adult height and risk of stroke, and it is unclear whether this association is different between men and women. The authors carried out a meta‐analysis to assess the sex‐specific effect of adult height on the risk of stroke and its subtypes. Prospective cohort studies reporting sex‐specific risk estimates of height with stroke or reported in a certain sex were included. Summary relative risks for 5‐unit increments in height were calculated using random‐effects, and dose‐response relationships were performed using a restricted cubic spline model. Subgroup analyses, sensitivity analyses, and tests for publication bias were also performed. In all, 20 prospective studies were identified in this study. The summary of relative risks (95% CIs) of stroke for a 5 cm increase in adult height were 0.93 (0.90‐0.95) for men and 0.88 (0.83‐0.93) for women. There was no significant difference in the effect of height on future stroke risk between men and women (Pinteraction = 0.085). There was evidence of a nonlinear association between adult height and stroke risk, with steeper inverse associations at lower level of height, but further reductions in risk were observed at greater heights. Subgroup and sensitivity analyses showed that the significant associations were consistent in most stratifications and with various inclusion criteria. In conclusion, higher adult height was significantly associated with lower risk of stroke in both men and women.
Stage‐specific probabilistic phenology model of Cydia pomonella (Lepidoptera: Tortricidae) using laboratory maximum likelihood parameter estimates
Authors: Damos Petros , Soulopoulou Polyxeni
Published: December 2018

In this study, a probabilistic degree‐day phenology model has been developed for the codling moth, Cydia pomonella, and calibrated using data from laboratory growth studies. The model is further used to predict the succession and overlapping of certain biological events of C. pomonella in probabilistic‐physiological time scale in northern Greece fruit orchards. The model satisfactorily predicts the stage‐specific pest population dynamics, including egg laying and hatching, the occurrence of larvae and pupae stages and the emergence of adults. According to the model projections for the adult flights, there is a very high probability, p = 0.999, of observing adults of the first flight generation until 333 degree‐days (DD), but a very low probability of finding adults of the second flight generation. Moreover, at 575 DD, the probability of finding an individual to lay eggs is p = 0.15. However, there is nearly the same probability of egg hatch, p = 0.36, and larval completion p = 0.313, while at the same time, the probability of pupal completion is very low, p = 0.001. The above model predictions were validated using field data for the adult stage emergence as well as for the percentage of larval damage providing satisfactory results considering that larval emergence prediction was close to actual fruit damage observed in field. This information is very important considering that IPM programs rely on the use of biorational compounds, such as IGRs and bio‐toxins which are stage selective and often have a shorter residual activity than the preceding broad‐spectrum insecticides.
Response of two parasitoid species (Hymenoptera: Braconidae, Figitidae) to tephritid host and host food substrate cues
Authors: Buonocore Biancheri María Josefina , Suárez Lorena C. , Bezdjian Laura Patricia , Van Nieuwenhove Guido Alejandro , Rull Juan , Ovruski Sergio Marcelo
Published: December 2018

The Neotropical‐native figitid Aganaspis pelleranoi (Brèthes) and the Asian braconid Diachasmimorpha longicaudata (Ashmead) are two parasitoids of Tephritidae fruit flies with long and recent, respectively, evolutionary histories in the Neotropics. Both species experienced a recent range of overlap. In Argentina, A. pelleranoi is a potential species in biological control programs against the pestiferous tephritid species, Anastrepha fraterculus (Wiedemann) and Ceratitis capitata (Wiedemann), whereas D. longicaudata is already used in open‐field releases against Medfly in central‐western Argentina. To characterize the host‐foraging strategies of A. pelleranoi and D. longicaudata, olfactometer experiments were conducted comparing responses to C. capitata and A. fraterculus larvae, in two kinds of food substrate: fruit and artificial larval medium. To control the possible influence of host larvae used for parasitoid rearing on olfactory response, two strains of both parasitoid species, reared on both tephrtid species, were studied. Volatiles directly emanating either from A. fraterculus or C. capitata larvae may be detected by both A. pelleranoi and D. longicaudata, although chemical stimuli originating from the combination of host larvae and the habitat of the host were preferred. However, olfactory cues associated with host larvae probably play a relevant role in host searching behaviour of A. pelleranoi, whereas for D. longicaudata, the host‐habitat olfactory stimuli would be highly essential in short‐range host location. The strain of the parasitoids did not affect host search ability on the two tephritid species evaluated. These evidences are relevant for mass production of both parasitoids and their impact following open‐field augmentative releases.
Quantitative Easing in the 1930s
Authors: HANES CHRISTOPHER
Published: December 2018

During the 1934–39 recovery from the U.S. Great Depression, overnight interest rates were usually at a lower bound. Meanwhile, American monetary authorities followed policies related to today's debates on quantitative easing: they tried to stabilize yields on Treasury bonds with open market operations; they created rapid growth in high‐powered money; and they allowed transitory factors to affect high‐powered money. Effects of these policies on bond yields reveal a portfolio effect of short‐duration asset supply on term premiums. This portfolio effect helps explain why high‐powered money growth was associated with recovery of real activity over 1934–39.
G protein‐coupled estrogen receptor activates cell type‐specific signaling pathways in cortical cultures: relevance to the selective loss of astrocytes
Authors: Roque Cláudio , Mendes‐Oliveira Julieta , Baltazar Graça
Published: December 2018

Selective activation of the G protein‐coupled estrogen receptor has been proposed to avoid some of the side effects elicited by the activation of classical estrogen receptors α and β. Although its contribution to neuroprotection triggered by estradiol in brain disorders has been explored, the results regarding ischemic stroke are contradictory, and currently, there is no consensus on the role that this receptor may play. The present study aimed to investigate the role of GPER in the ischemic insult. For that, primary cortical cultures exposed to oxygen and glucose deprivation (OGD) were used as a model. Our results demonstrate that neuronal survival was strongly affected by the ischemic insult and concurrent GPER activation with G1 had no further impact. In contrast, OGD had a smaller impact on astrocytes survival but G1, alone or combined with OGD, promoted their apoptosis. This effect was prevented by the GPER antagonist G15. The results also show that ischemia did not change the expression levels of GPER in neurons and astrocytes. In this study, we also demonstrate that selective activation of GPER induced astrocyte apoptosis via the phospholipase C pathway and subsequent intracellular calcium rise, whereas in neurons, this effect was not observed. Taken together, this evidence supports a direct impact of GPER activity on the viability of astrocytes, which seems to be associated with the regulation of different signaling pathways in astrocytes and neurons.

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Small‐fiber neuropathy: Expanding the clinical pain universe
Authors: Sopacua Maurice , Hoeijmakers Janneke G. J. , Merkies Ingemar S. J. , Lauria Giuseppe , Waxman Stephen G. , Faber Catharina G.
Published: December 2018

Small‐fiber neuropathy (SFN) is a disorder of thinly myelinated Aδ and unmyelinated C fibers. SFN is clinically dominated by neuropathic pain and autonomic complaints, leading to a significant reduction in quality of life. According to international criteria, the diagnosis is established by the assessment of intraepidermal nerve fiber density and/or quantitative sensory testing. SFN is mainly associated with autoimmune diseases, sodium channel gene variants, diabetes mellitus, and vitamin B12 deficiencies, although in more than one half of patients no etiology can be identified. Recently, gain‐of‐function variants in the genes encoding for the Nav1.7, Nav1.8 and Nav1.9 sodium channel subunits have been discovered in SFN patients, enlarging the spectrum of underlying conditions. Sodium channel gene variants associated with SFN can lead to a diversity of phenotypes, including different pain distributions and presence or absence of autonomic symptoms. This suggests that SFN is part of a clinical continuum. New assessments might contribute to a better understanding of the cellular and molecular substrates of SFN and might provide improved diagnostic methods and trial designs in the future. Identification of the underlying mechanisms may inform the development of drugs that more effectively address neuropathic pain and autonomic symptoms of SFN.
Non‐urgent paediatric emergency department presentation: A systematic review
Authors: Alele Faith O , Emeto Theophilus I , Callander Emily J , Watt Kerrianne
Published: December 2018

There has been an increase in the use of the emergency department (ED) for non‐urgent presentations. The aim of this systematic review was to identify the proportion, criteria and predictors of non‐urgent ED presentations in paediatric populations. A search of multiple databases was conducted for articles published from inception of the databases to 20 August 2018, which reported the proportion, criteria and predictors of non‐urgent ED presentation in paediatric populations. Thirty‐one articles met the inclusion criteria. The mean proportion of non‐urgent paediatric ED presentations was 41.06 ± 15.16%. There appears to be a weak association between predisposing, enabling and needs factors and non‐urgent ED use in paediatric populations. The findings of this review suggest that non‐urgent ED use in paediatric populations is high. However, non‐urgent ED use and the reasons for the visits in paediatric populations remain understudied.
Genetic and morphological differentiation of Porphyra and Pyropia species (Bangiales, Rhodophyta) coexisting in a rocky intertidal in Central Chile
Authors: Meynard Andrés , Zapata Javier , Salas Nicolás , Betancourtt Claudia , Pérez‐Lara Gabriel , Castañeda Francisco , Ramírez María Eliana , Bulboa Contador Cristian , Guillemin Marie‐Laure , Contreras‐Porcia Loretto
Published: December 2018

A recent molecular taxonomic study along the Chilean coast (18° S–53° S) described 18 candidate species of bladed Bangiales of which only two were formally described. Few studies focused on local genetic and morphological diversity of bladed Bangiales and attempted to determine their intertidal distribution in contrasting habitats, and none were performed in Chile. To delimit intertidal distributions of genetic species, 66 samples of bladed Bangiales were collected at Maitencillo (32° S) in four zones: a rocky platform, a rocky wall, and two boulders zones surrounded by sandy and rocky bottoms, respectively. These samples were identified based on sequences of the mitochondrial COI and chloroplast rbcL markers. We also collected 87 specimens for morphological characterization of the most common species, rapidly assessing their putative species identity using newly developed species‐diagnostic (PCR‐RFLP) markers. Eight microscopic and two macroscopic morphological traits were measured. We described and named three of four species that predominate in Maitencillo (including Pyropia orbicularis): Pyropia variabilis Zapata, Meynard, Ramírez, Contreras‐Porcia, sp. nov., Porphyra luchea Meynard, Ramírez, Contreras‐Porcia sp. nov., and Porphyra longissima Meynard, Ramírez, Contreras‐Porcia, sp. nov. With the exception of Po. longissima restricted to boulders surrounded by sandy bottom, and a morphotype of Py. variabilis restricted to rocky walls, the other species/morphotypes have overlapping intertidal distributions. Except for Po. longissima, which is clearly differentiated morphologically (longest and thinnest blades), we conclude that morphology is not sufficient to differentiate bladed Bangiales. Our findings underscore the importance of refining our knowledge of intrinsic and environmental determinants on the distribution of bladed Bangiales.
The Moral Community Divide: Underage Marijuana Use Across Religious Contexts
Authors: Nie Fanhao , Yang Xiaozhao Y.
Published: December 2018

Compared to individual‐level research on religion and marijuana use, much less research has been conducted to investigate how the overall religious context of a geographic location may influence marijuana use during adolescence and early adulthood. Using multilevel analyses on two waves of the National Study of Youth and Religion (NSYR) merged with county‐level variables from the U.S. Census and the Religious Congregations and Membership Study (RCMS), this study finds that a county's higher Catholic population share is negatively associated with underage marijuana use frequency even after controlling for a wide range of individual and county‐level variables. Besides being robust, the Catholic contextual effect on marijuana use is also diffusive, influencing both Catholic and non‐Catholic youth who live in the same county. This study highlights the importance of viewing religious influence on substance use as a contextual, cultural force across different kinds of religious moral communities.
Isavuconazole and voriconazole for the treatment of chronic pulmonary aspergillosis: A retrospective comparison of rates of adverse events
Authors: Bongomin Felix , Maguire Niamh , Moore Caroline B. , Felton Timothy , Rautemaa‐Richardson Riina
Published: December 2018

Background

Long‐term oral triazole antifungal therapy is the cornerstone of management for patients with chronic pulmonary aspergillosis (CPA). Itraconazole is the first‐line choice of treatment. Voriconazole, posaconazole or isavuconazole can be used as alternative treatments in case of resistance or intolerance. All of these can cause significant adverse drug reactions.

Objectives

To evaluate how CPA patients tolerate voriconazole and isavuconazole after prior triazole therapy.

Methods

We performed a retrospective observational study at the UK National Aspergillosis Centre. Medical records for all consecutive CPA patients started on isavuconazole and voriconazole during an observation period of 12 and 6 months respectively were analysed.

Results

During this study period, 20 patients were started on isavuconazole and 21 patients on voriconazole. Adverse events were seen in 18 of 21 (86%) the patients in the voriconazole group and 12 of 20 (60%) in the isavuconazole group (P = 0.02). For those who developed adverse events to these agents, the rates of discontinuation of therapy were comparable (ie 10/18 [56%], voriconazole vs 8/12 [67%], isavuconazole; P = 0.54). Five (25%) patients in the isavuconazole group who were intolerant to other triazoles tolerated the standard dose of isavuconazole.

Conclusions

Compared with isavuconazole, adverse events were significantly higher in CPA patients commenced on voriconazole. Isavuconazole may be an option for those patients who are intolerant to other triazoles.
Two sides to every leaf: water and CO2 transport in hypostomatous and amphistomatous leaves
Authors: Drake Paul L. , de Boer Hugo J. , Schymanski Stanislaus J. , Veneklaas Erik J.
Published: December 2018

Leaves with stomata on both upper and lower surfaces, termed amphistomatous, are relatively rare compared with hypostomatous leaves with stomata only on the lower surface. Amphistomaty occurs predominantly in fast‐growing herbaceous annuals and in slow‐growing perennial shrubs and trees. In this paper, we present the current understanding and hypotheses on the costs and benefits of amphistomaty related to water and CO2 transport in contrasting leaf morphologies. First, there is no evidence that amphistomatous species achieve higher stomatal densities on a projected leaf area basis than hypostomatous species, but two‐sided gas exchange is less limited by boundary layer effects. Second, amphistomaty may provide a specific advantage in thick leaves by shortening the pathway for CO2 transport between the atmosphere and the chloroplasts. In thin leaves of fast‐growing herbaceous annuals, in which both the adaxial and abaxial pathways are already short, amphistomaty enhances leaf–atmosphere gas‐exchange capacity. Third, amphistomaty may help to optimise the leaf‐interior water status for CO2 transport by reducing temperature gradients and so preventing the condensation of water that could limit CO2 diffusion. Fourth, a potential cost of amphistomaty is the need for additional investments in leaf water transport tissue to balance the water loss through the adaxial surface.
Macroevolutionary dynamics of nectar spurs, a key evolutionary innovation
Authors: Fernández‐Mazuecos Mario , Blanco‐Pastor José Luis , Juan Ana , Carnicero Pau , Forrest Alan , Alarcón Marisa , Vargas Pablo , Glover Beverley J.
Published: December 2018

Floral nectar spurs are widely considered a key innovation promoting diversification in angiosperms by means of pollinator shifts. We investigated the macroevolutionary dynamics of nectar spurs in the tribe Antirrhineae (Plantaginaceae), which contains 29 genera and 300–400 species (70–80% spurred). The effect of nectar spurs on diversification was tested, with special focus onLinaria, the genus with the highest number of species.

We generated the most comprehensive phylogeny of Antirrhineae to date and reconstructed the evolution of nectar spurs. Diversification rate heterogeneity was investigated using trait‐dependent and trait‐independent methods, and accounting for taxonomic uncertainty. The association between changes in spur length and speciation was examined withinLinariausing model testing and ancestral state reconstructions.

We inferred four independent acquisitions of nectar spurs. Diversification analyses revealed that nectar spurs are loosely associated with increased diversification rates. Detected rate shifts were delayed by 5–15 Myr with respect to the acquisition of the trait. Active evolution of spur length, fitting a speciational model, was inferred inLinaria, which is consistent with a scenario of pollinator shifts driving diversification.

Nectar spurs played a role in diversification of the Antirrhineae, but diversification dynamics can only be fully explained by the complex interaction of multiple biotic and abiotic factors.
Stable and unstable equilibrium states in a fishery–aquaculture model
Authors: Bergland Harald , Pedersen Pål Andreas , Wyller John
Published: December 2018

We study interactions between fishery and aquaculture using a 3D generalized Lotka–Volterra model, where we assume that the aquaculture production may affect the growth rate in the fish stock and the productivity in harvesting. In addition, input demands from both marine industries may result in effort competition. We identify conditions for the coexistence of a unique equilibrium state inside the first octant of the phase space and equilibrium states on its boundary. Conditions for stability and instability of these states are also given, thus showing the possibility of having bistability. The equilibrium point inside the first octant is stable if the growth impact on fishery from sea farming is below the potential productivity in harvesting. In the complementary case, we have an unstable interior equilibrium, and we may then end up in stable equilibrium states on the boundary, where either the fishery or the aquaculture is wiped out.

Recommendations for Resource Managers

More empirical and theoretical research is needed to reveal types of interrelations between fisheries and aquaculture, and their importance for long run stability between the sectors.

When designing policies for the aquaculture industries, managers should in particular be aware of possible long‐term harmful effects from aquaculture to fisheries.

Increased areas for sea farming reduce the relative profitability of the fishery, and if the area increases above a certain level, this could wipe out the fishery.
Bullous pemphigoid in adolescence
Authors: Patsatsi Aikaterini , Kyriakou Aikaterini , Werth Victoria P.
Published: December 2018

Bullous pemphigoid (BP) is the most common autoimmune blistering disease affecting the elderly but is quite rare in childhood. The majority of pediatric cases have been reported during early childhood. Adolescence is divided into three phases: early (10‐13 years), middle (14‐17), and late (18‐21). This review aimed to identify BP cases in adolescence and demonstrate their clinical features and course. Our literature search was performed in Medline with the terms “bullous pemphigoid in childhood and adolescence,” “childhood bullous pemphigoid,” “juvenile bullous pemphigoid,” and “autoimmune blistering and autoimmune bullous diseases in childhood.” The data extraction for late adolescence was limited by the fact that this age group is included in adult BP registries. We identified nine cases in early adolescence. Mucosa were affected in 5 of 9 cases. Treatment consisted of systemic prednisone (8/9), in combination with dapsone (2/9), azathioprine (2/9), or erythromycin/nicotinamide (1/9). Relapses were reported in 3 of 9 cases. We identified five cases occuring in middle adolescence. Mucosa were not affected. Treatment consisted of systemic prednisone (5/5), in combination with dapsone (3/5), azathioprine (2/5), doxycycline/nicotinamide (1/5), or mycophenolate mofetil (1/5). Relapses were reported in two of five cases. No case of BP in the late adolescence was included in the results, as only one case met the search criteria, and overlapped with pemphigus vulgaris. With only 14 cases found in our review, BP in adolescence appears even rarer than in earlier childhood. Despite its low prevalence, BP should be included in the differential diagnosis of autoimmune blistering diseases in adolescents.
Improving the curriculum for a community nursing training program in Guangzhou City, China
Authors: Wang Siyun , Chen Weiju , Du Yun
Published: December 2018

In China, community nurses do not have systematic training, and the nursing education curriculum focuses on clinical nursing both in vocational school and high school. Most nurses work at a hospital, and almost all community nurses lack systematic knowledge about community nursing. A training program for community nurses in Guangzhou City has been conducted since 2003. The training curriculum has evolved over the years, but is not standardized. This article describes research on improving community nurses’ basic knowledge and practice skills. We modified the curriculum with a questionnaire and a modified Delphi method. First, 318 participating nurses and instructors were queried in December 2012. Then 22 experts modified the training program based on the results of the questionnaire and implementation since 2013. After 4 years, we followed up with the new participating nurses to evaluate the curriculum.
High vegetative compatibility diversity of Cryphonectria parasitica infecting sweet chestnut (Castanea sativa) in Britain indicates multiple pathogen introductions
Authors: Pérez‐Sierra A. , Romón‐Ochoa P. , Gorton C. , Lewis A. , Rees H. , Van Der Linde S. , Webber J.
Published: December 2018

Chestnut blight, caused by Cryphonectria parasitica, was identified in Devon, UK, in December 2016. Intensive surveys detected the disease at further sites in Devon (seven), Berkshire (one), Dorset (one), Derbyshire (four) and a cluster of eight sites in southeast London. Over 570 survey samples were tested, and 227 were positive for C. parasitica by isolation and real‐time PCR. A total of 227 isolates were tested for mating type, and 197 screened for vegetative compatibility group (VCG) and compared with VCGs known from mainland Europe. The same isolates were also screened for the presence of Cryphonectria hypovirus 1 (CHV‐1). Eleven VCGs were identified within the UK population. Five corresponded to already known European VCGs but six were unique. The European VCGs mainly came from the Devon, Dorset, Berkshire and Derbyshire disease outbreaks, whilst unique VCGs were almost exclusively from the southeast London cluster. Both mating types were detected, but only one mating type was present at each site, with the exception of a single Devon site. Perithecia of C. parasitica were never observed at any site. CHV‐1 was found in seven isolates from three different locations and was always subtype‐I, which has limited hypovirulence. Therefore, although CHV‐1 is associated with C. parasitica at some outbreaks, it probably has limited impact on virulence. The diversity of VCGs and their distribution at outbreak sites, together with findings of CHV‐1, suggests C. parasitica has been introduced to the UK multiple times over at least two decades through international plant trade.
Waiving Goodbye to Congressional Constraints: Presidents and Subnational Policy Making
Authors: Levesque Elizabeth Mann
Published: December 2018

Presidents often find themselves frustrated by the legislative process and in need of an alternative policy‐making route. While most scholarship on the presidency focuses on unilateral action as the preferred alternative, I propose that subnational policy making can be an equally viable option. Specifically, evidence suggests that presidents have used a waiver strategy to pursue their agendas at the subnational level. I develop and test a proposition about the conditions under which presidents use waivers with an original data set of approved Section 1115 waivers in welfare and Medicaid from 1986 through 2012. I find that presidents approve waivers contingent not only on their ideological distance from Congress, as we might expect, but also on the share of the nation's governors in the president's party. While the president can use a waiver strategy to circumvent Congress, the division of authority in the federal system constrains the president's use of this strategy, as participation from governors is critical for success.