bluuebunny/crossref_metadata_2025 huggingface dataset:
Biofortified crops for tackling micronutrient deficiencies – what impact are these having in developing countries and could they be of relevance within Europe?
Authors: Lockyer S. , White A. , Buttriss J. L.
Published: November 2018

The development of crops that by harvest have accumulated higher amounts of a particular micronutrient than standard crops is known as biofortification. Biofortified staple crops such as provitamin A‐biofortified sweet potato (‘orange sweet potato’), zinc‐biofortified rice (‘zinc rice’) and iron‐biofortified beans (‘iron beans’), developed by selective breeding, have been introduced into developing countries with the goal of reducing micronutrient deficiencies. In these settings, micronutrient deficiencies caused by low dietary intakes and exacerbated by inflammation and infection result in considerable morbidity and mortality worldwide. The aim of this review is twofold: (1) to describe the impact of biofortified crops on micronutrient intake, nutritional status and other biological endpoints in developing countries and (2) to consider the relevance of these nutritional effects in other parts of the world such as Europe. Regular consumption of biofortified crops in developing countries where micronutrient deficiency is common has been shown to increase micronutrient intakes and thus help meet the World Health Organization's dietary recommendations. In terms of micronutrient status, most research has been conducted using provitamin A‐biofortified crops (particularly orange sweet potato), with large 2‐ to 3‐year studies indicating increases in plasma retinol, though additional studies measuring change in body stores would provide more definitive evidence. There is some evidence to suggest that iron‐biofortified crops can increase iron status (measured by serum ferritin and total body iron), but further studies are required to demonstrate the efficacy of zinc‐biofortified foods. Intakes of some micronutrients are low in someUKpopulation subgroups (in particular adolescents and young adult women), with sizeable proportions having intakes below the lower reference nutrient intake. There is also evidence of low status for some nutrients (e.g. iron and in particular vitamin D), although the prevalence of iron deficiency is much less, and therefore the consequences less severe, than seen in the developing world. The final part of the paper describes strategies used to improve micronutrient intake in Europe, such as fortification of bread flour post‐harvest and supplementation with vitamin D and folic acid, and discusses whether there is a role for biofortified crops in theUK.
Cultivating self‐regulatory eating behaviours during childhood: The evidence and opportunities
Authors: McCrickerd K.
Published: November 2018

Global high levels of obesity and metabolic disease have called for a reformulation of the food environment to reduce portion sizes and food energy density, particularly from added sugars, highlighting the importance of the food environment in energy intake and adiposity. Young children are often assumed to have the ability to self‐regulate eating behaviours in a way that protects against overconsumption. Therefore, a complementary approach to changing the food environment is to identify and cultivate ‘protective’ eating behaviours from an early age. But what is the evidence for children's capacity to self‐regulate food intake? And could cultivating self‐regulatory eating behaviours complement broader environmental approaches aimed at reducing unhealthy weight gain during childhood? This review considers these questions with a focus on three aspects of eating behaviour that challenge energy intake regulation and healthy growth: large portion sizes, eating speed and energy compensation abilities. As children get older and gain more experience in the food environment, individual self‐regulatory skills can be compromised by factors such as sustained exposure to large portion sizes and feeding practices that fail to take into account children's appetite cues. More research is required to understand the developmental trajectories of children's eating behaviours, but parents and caregivers have the opportunity to promote self‐regulatory eating from a young age. The success of individualised interventions that aim to empower children to recognise and respond to their own appetite signals will be contingent on broader improvements to the wider food environment.
Target of rapamycin, a master regulator of multiple signalling pathways and a potential candidate gene for crop improvement
Authors: Bakshi A. , Moin M. , Madhav M. S. , Kirti P. B.
Published: November 2018

The target of rapamycin (TOR) protein regulates growth and development in photosynthetic and non‐photosynthetic eukaryotes. Although the TOR regulatory networks are involved in nutrient and energy signalling, and transcriptional and translational control of multiple signalling pathways, the molecular mechanism of TOR regulation of plant abiotic stress responses is still unclear. The TOR‐mediated transcriptional regulation of genes encoding ribosomal proteins (RP) is a necessity under stress conditions for balanced growth and productivity in plants. The activation of SnRKs (sucrose non‐fermenting‐related kinases) and the inactivation of TOR signalling in abiotic stresses is in line with the accumulation of ABA and transcriptional activation of stress responsive genes. Autophagy is induced under abiotic stress conditions, which results in degradation of proteins and the release of amino acids, which might possibly induce phosphorylation of TOR and, hence, its activation. TOR signalling also has a role in regulating ABA biosynthesis for transcriptional regulation of stress‐related genes. The switch between activation and inactivation of TOR by its phosphorylation and de‐phosphorylation maintains balanced growth in response to stresses. In the present review, we discuss the important signalling pathways that are regulated by TOR and try to assess the relationship between TOR signalling and tolerance to abiotic stresses in plants. The review also discusses possible cross‐talk between TOR and RP genes in response to abiotic stresses.
Cryopreservation of spermatozoa on grouper species: a review
Authors: Che‐Zulkifli Che Ismail , Koh Ivan Chong Chu , Shahreza Md Sheriff , Ikhwanuddin Mhd
Published: November 2018

Cryopreservation of spermatozoa of grouper species supporting artificial insemination in production of fry has contributed to the grouper aquaculture industry. Grouper is a high‐value species in marine cage finfish culture and a major business for the aquaculture industry in South East Asia. The species contributes a significant value to the income of South East Asian countries such as Indonesia, Malaysia, Philippines and Thailand. Hybrid grouper is a new candidate for marine finfish culture, and cryopreservation of grouper and giant grouper spermatozoa is important to support development of its production. This review article discusses the cryopreservation of the spermatozoa of grouper species specifically. Emphasis is placed on the protocols for implementation and implications of the cryopreservation of grouper spermatozoa in the marine finfish aquaculture industry.
The role of shrimp microRNAs in immune response and beyond
Authors: González‐Duarte Ramiro J. , García‐Carreño Fernando L.
Published: November 2018

MicroRNAs are a class of small non‐coding RNAs that regulate gene expression at post‐transcriptional level. Regulatory RNAs were discovered in the nematode Caenorhabditis elegans, since then, their biological functions have been studied on different animals, including marine organisms. Several species of penaeid shrimp are important in ecology and fishing, including aquaculture. Overcrowding in aquaculture calls for infectious diseases, which threaten the development of shrimp aquaculture worldwide. Given that microRNAs play crucial regulatory roles in a wide variety of biological processes, there is a scientific interest to understand their contribution on shrimp physiology and pathology, specifically during immune and stress response. Increasing evidence has shown that the expression of microRNAs is affected during virus or bacterial infection and upon stress in shrimp. This information provides valuable insights for a better understanding of shrimp biology by means of microRNA regulation to bacterial and viral diseases.
Clumped planting arrangements improve seed production in a revegetated eucalypt woodland
Authors: McCallum Kimberly P. , Breed Martin F. , Paton David C. , Lowe Andrew J.
Published: November 2018

The arrangement of plants within revegetated sites is rarely considered an important characteristic of these communities. However, in natural systems, plant spatial arrangements can influence a range of ecological processes, including pollination and seed set. Pollinators tend to preferentially visit larger and/or more closely spaced populations, with plants in these populations generally receiving more outcrossed pollen, resulting in increased seed set and better quality seed. Similar trends may occur in revegetated populations, but little is known about the influence of planting arrangement on seed production in restored systems. Here, we quantified the effect of plant abundance (number of conspecifics within 100 m) and distance to nearest reproductive conspecific on the level of seed set for six eucalypt species (n = 422 trees in total) in 1 year and for one of these species (Eucalyptus leucoxylon), across three additional years. Seed number per fruit was highly variable both between individuals and within individuals across years. Despite this variability, there was a consistent trend of higher seed production (seed number per fruit) when another reproductive conspecific was within 20 m. In contrast, plant abundance had little influence on seed production. Further investigation of nearest neighbor arrangements found the distance to either the first, second, third, or fourth reproductive neighbors were the key predictors of seed production. Therefore, revegetation designs that consider plant spacing and aggregation, rather than only planting to overall density criteria (i.e. trees/ha), at least for the eucalypts studied here, has the potential to improve seed production in revegetated populations.
Discharge from hospital – a national survey of transition to out‐patient care
Authors: Åhsberg Elizabeth
Published: November 2018

Introduction

Despite a generally decreased length of stay in Swedish hospitals, an increasing delay of discharge has been observed among patients with long‐term care need.

Aim

Identify challenges and opportunities in the transition of patients between hospitals and out‐patient care.

Method

Data were obtained from national registers on patients discharged from hospitals in 2014, interviews with public care authorities, and a systematic literature review.

Results

A total of 1 121 823 persons were discharged from Swedish hospitals in 2014. Of all discharged patients, 334 420 (30%) was in need of further out‐patient medical care while 221 221 (20%) needed social services. Among these discharged patients, 53 763 (5%) needed both medical care and social services. In this group of frail persons (primarily females 80 years or older), 25 760 (48%) were readmitted to hospital within 30 days from the discharge. Main reported challenges in the transition were as follows: a decreasing number of beds in hospitals and nursing homes, lack of staff with proper education, and problems in transfer of information between caregivers. To solve these problems, respondents reported some new approaches: extensive initial home services after discharge, out‐patient care organised by both municipalities and county councils, local follow‐up of patient data as well as an emphasis on collaboration between caregivers. The literature reported ambiguous results about effects of single interventions at discharge. However, evidence suggests that the number of readmissions to hospital may be reduced by combining several interventions before discharge (individual planning, geriatric assessment, and patient education) with follow‐up after discharge.

Conclusion

Since many frail patients are readmitted to hospital within 30 days after discharge, Swedish out‐patient care may need new working methods in order to promote a coherent care. Further, multi‐component interventions at discharge, including follow‐up after discharge, may prevent unintended readmissions.
Tolerance of Ambiguity and the Linguistic Intervention Program
Authors: Stranovská Eva , Hvozdíková Silvia
Published: November 2018

The study examines the process of foreign language learning. The aim was to investigate dynamics and stability of the variable tolerance of ambiguity in the process of learning a foreign language through the means of specifically designed linguistic intervention program. The investigation aimed to find out the impact of the intervention called The Linguistic Intervention Program in the process of foreign language learning and tolerance of ambiguity in the foreign language performance. Moreover, the purpose was to investigate long-lasting changes in the selected periods, after one year. The focus was put on the ability to create a cognitive structure, especially the ability to achieve cognitive structuration. The linguistic intervention program represented a method of active social learning, and autonomous learning.The approaches we used were the following: relaxation, cooperative techniques, communication techniques, and the techniques aimed at social perception and intercultural communication in a foreign language. The linguistic intervention program was based on the natural approach of foreign language acquisition. The research method called the scale of the ability to achieve cognitive structure AACS was used on the sample of 256 college students enrolled for the foreign languages teaching programs. The results showed unique findings in the process of dynamics and stability of the examined variable, tolerance of ambiguity through the means of the linguistic intervention. They showed statistically significant higher score in AACS and statistically significant score in long-lasting changes in time. AACS appeared to be a stabile characteristic in the foreign language learning.
Effects of Water Intake on Biochemical Parameters and Performance During Resistance Exercise
Authors: Kasap Murat , Erdemir İbrahim , Kayhan Recep Fatih
Published: November 2018

The study aims to determine whether water intake during resistance training impacts the amounts of potassium (K+), sodium (Na+), magnesium (Mg), and calcium (Ca) and to identify the effects of the reactions of these minerals on performance. Ten male university students aged between 20 and 23 participated in the study. The participants did five different previously-determined resistance exercises (3 sets of 8RM). During the training program, the participants did the resistance exercises by not consuming water in the first week and consuming water in the second week. (Pre-exercise and exercise days routine food and fluid intake was maintained, fluid intake restriction was applied only during exercise) The participants’ weight, body mass index (BMI), percent body fat, systolic and diastolic pressure, lactate, Borg scale ratings, and K+, Na+, Mg, and Ca were determined before and after the exercises. Training volume was recorded. Performing the exercises without water intake produced a significant increase in K+. During the exercises done with water intake, there was a significant increase in Na+. No statistical differences were determined in the volume of exercise done with and without water intake. The study shows that water intake during high-intensity resistance training does not have any effect on the volume of exercise. In addition, the changes in Na+ and K+ parameters do not affect the volume of exercise. Although loss of minerals is statistically significant in exercise without water, it is understood that the total amount of minerals lost is not enough to induce a physiological change or a performance change in the total resistance training volume. Water, regardless of the volume and intensity of exercise, promotes balance of metabolism and prevents performance degradation that can occur during sport events (Murray et al., 1991). For this reason, water should be consumed not only in sports activities but also in daily activities.
Exendin‐4 overcomes cytokine‐induced decreases in gap junction coupling via protein kinase A and Epac2 in mouse and human islets
Authors: Farnsworth Nikki L. , Walter Rachelle , Piscopio Robert A. , Schleicher Wolfgang E. , Benninger Richard K. P.
Published: November 2018

Key points

The pancreatic islets of Langerhans maintain glucose homeostasis through insulin secretion, where insulin secretion dynamics are regulated by intracellular Ca2+ signalling and electrical coupling of the insulin producing β‐cells in the islet.

We have previously shown that cytokines decrease β‐cell coupling and that compounds which increase cAMP can increase coupling.

In both mouse and human islets exendin‐4, which increases cAMP, protected against cytokine‐induced decreases in coupling and in mouse islets preserved glucose‐stimulated calcium signalling by increasing connexin36 gap junction levels on the plasma membrane.

Our data indicate that protein kinase A regulates β‐cell coupling through a fast mechanism, such as channel gating or membrane organization, while Epac2 regulates slower mechanisms of regulation, such as gap junction turnover.

Increases in β‐cell coupling with exendin‐4 may protect against cytokine‐mediated β‐cell death as well as preserve insulin secretion dynamics during the development of diabetes.

The pancreatic islets of Langerhans maintain glucose homeostasis. Insulin secretion from islet β‐cells is driven by glucose metabolism, depolarization of the cell membrane and an influx of calcium, which initiates the release of insulin. Gap junctions composed of connexin36 (Cx36) electrically couple β‐cells, regulating calcium signalling and insulin secretion dynamics. Cx36 coupling is decreased in pre‐diabetic mice, suggesting a role for altered coupling in diabetes. Our previous work has shown that pro‐inflammatory cytokines decrease Cx36 coupling and that compounds which increase cAMP can increase Cx36 coupling. The goal of this study was to determine if exendin‐4, which increases cAMP, can protect against cytokine‐induced decreases in Cx36 coupling and altered islet function. In both mouse and human islets, exendin‐4 protected against cytokine‐induced decreases in coupling and preserved glucose‐stimulated calcium signalling. Exendin‐4 also protected against protein kinase Cδ‐mediated decreases in Cx36 coupling. Exendin‐4 preserved coupling in mouse islets by preserving Cx36 levels on the plasma membrane. Exendin‐4 regulated Cx36 coupling via both protein kinase A (PKA)‐ and Epac2‐mediated mechanisms in cytokine‐treated islets. In mouse islets, modulating Epac2 had a greater impact in mediating Cx36 coupling, while in human islets modulating PKA had a greater impact on Cx36 coupling. Our data indicate that PKA regulates Cx36 coupling through a fast mechanism, such as channel gating, while Epac2 regulates slower mechanisms of regulation, such as Cx36 turnover in the membrane. Increases in Cx36 coupling with exendin‐4 may protect against cytokine‐mediated β‐cell dysfunction to insulin secretion dynamics during the development of diabetes.
New flat mite species of the genus Tenuipalpus (Acari: Tenuipalpidae) from Iran
Authors: Mahdavi Sayed Mosayeb , Asadi Mahdieh
Published: November 2018

New species of the genus Tenuipalpus Donnadieu, 1875 (Acari: Trombidiformes: Tenuipalpidae), namely Tenuipalpus tamarixi sp. nov. from Tamarix sp. (Tamaricaceae) is described from Iran (Kerman Province). This species belongs to the proteae species group. A key to all known species of subgroup keiensis is also provided.
Future prospects of fluoride based upconversion nanoparticles for emerging applications in biomedical and energy harvesting
Authors: Tiwari Surya P. , Maurya Sachin K. , Yadav Ram S. , Kumar Abhishek , Kumar Vinod , Joubert Marie-France , Swart Hendrik C.
Published: November 2018

Rare earth doped/codoped phosphors have been extensively studied for different types of applications based on their intense luminescence features. For this, researchers have tried to choose the inorganic host matrices having both a low phonon cut-off frequency and a high refractive index. Many articles have been published on oxide based phosphor materials, but due to their high cut-off phonon frequency, use of these materials is restricted for optical based applications. This is why additional research has been carried out on fluoride based host materials because of their low phonon frequencies, low composition degradation, and high quantum efficiency. In this paper, the authors review the rare earth fluoride based host nano- and micromaterials for different applications and discuss possible mechanisms.
Coalescence-induced jumping of droplets on superomniphobic surfaces with macrotexture
Authors: Vahabi Hamed , Wang Wei , Mabry Joseph M. , Kota Arun K.
Published: November 2018

Superomniphobic surfaces with macrotextures allow coalescence-induced jumping of droplets at Ohnesorge number >1.
Inhibition of Protein Secretion in
Escherichia coli
and Sub-MIC Effects of Arylomycin Antibiotics
Authors: Walsh Shawn I. , Peters David S. , Smith Peter A. , Craney Arryn , Dix Melissa M. , Cravatt Benjamin F. , Romesberg Floyd E.
Published: November 2018

At sufficient concentrations, antibiotics effectively eradicate many bacterial infections. However, during therapy, bacteria are unavoidably exposed to lower antibiotic concentrations, and sub-MIC exposure can result in a wide variety of other effects, including the induction of virulence, which can complicate therapy, or horizontal gene transfer (HGT), which can accelerate the spread of resistance genes.
Rootstocks Shape the Rhizobiome: Rhizosphere and Endosphere Bacterial Communities in the Grafted Tomato System
Authors: Poudel Ravin , Jumpponen Ari , Kennelly Megan M. , Rivard Cary L. , Gomez-Montano Lorena , Garrett Karen A.
Published: November 2018

Understanding factors that control microbial communities is essential for designing and supporting microbiome-based agriculture. In this study, we used a grafted tomato system to study the effect of rootstock genotypes and grafting on bacterial communities colonizing the endosphere and rhizosphere. To compare the bacterial communities in control treatments (nongrafted and self-grafted plants) with the hybrid rootstocks used by farmers, we evaluated the effect of rootstocks on overall bacterial diversity and composition. These findings indicate the potential for using plant genotype to indirectly select bacterial taxa. In addition, we identify taxa responsive to each rootstock treatment, which may represent candidate taxa useful for biocontrol and in biofertilizers.
Early warning scores in paediatrics: an overview
Authors: Chapman Susan M , Maconochie Ian K
Published: November 2018

Paediatric Early Warning Scores (PEWS)are used in hospitalised patients to detect physiological deterioration and is being used increasingly throughout healthcare systems with a limited evidence based. There are two versions in general use that can lead to a clinical response, either by triggering an action or by reaching a ‘threshold’ when graduated responses may occur depending on the value of the score. Most evidence has come from research based on paediatric inpatients in specialist children’s hospitals, although the range of research is expanding, taking into account other clinical areas such as paediatric intensive care unit, emergency department and the prehospital setting. Currrently, it is uncertain whether a unified system does deliver benefits in terms of outcomes or financial savings, but it may inform and improve patient communication. PEWS may be an additional tool in context of a patient’s specific condition, and future work will include its validation for different conditions, different clinical settings, patient populations and organisational structure. The incorporation of PEWS within the electronic health records may form a keystone of the safe system framework and allow the development of consistent PEWS system to standardise practice.
Cerebral palsy: not always what it seems
Authors: Appleton Richard E , Gupta Rajat
Published: November 2018

Cerebral palsy (CP) is not a disease, but a neurological syndrome, a combination of signs and symptoms, some of which may occur in neurodegenerative or metabolic disorders, particularly those with an onset in the first 2 years of life. There are many different causes of the syndrome. All children with CP should undergo brain MRI, even with an identified antenatal or perinatal insult. Children with CP should be referred to a paediatric neurologist or a clinical geneticist, or both, if appropriate and particularly in the absence of a known perinatal cerebral insult, with brain MRI that is reported to be normal, a progression in, or new, signs or where there is a reported ‘family history of CP’. Finally, a few of the CP syndromes may be readily treatable and potentially prevent irreversible neurological and cognitive impairment.
Splenic granulomas: a rare manifestation of Mycobacterium avium complex in an immunocompetent host
Authors: Acharya Nupoor , Chattopadhyay Arghya , Sharma Kusum , Sharma Aman
Published: November 2018

Infections caused by Mycobacteriumavium complex (MAC) are commonly seen in immunocompromised individuals. Though disseminated MAC infections with splenic granulomas are seen in some patients, MAC infection clinically manifesting as only splenic granulomas is rare. This presentation is even less common in immunocompetent individuals. We report a case of a young adult who presented with fever of unknown origin and was found to have multiple splenic granulomas. Fine needle aspiration cytology and PCR for Mycobacterium tuberculosis of the granulomas revealed a diagnosis of MAC infection. The patient was not found to have any immunodeficiency on investigations. This case is perhaps the first case of MAC clinically presenting as splenic granulomas in an immunocompetent individual.
Large anterior urethral calculus masquerading as periurethral abscess
Authors: Aggarwal Ajay , Singh Vishwajeet , Sinha Rahul Janak , Pandey Siddharth
Published: November 2018

Urethral calculus causes variety of symptoms from simple dysuria to acute urinary retention. The diagnosis is many times not easy. A plain X-ray of the pelvis may aid in diagnosis. Due to variety of symptomatic presentations sometimes it is not the first diagnosis that comes to one’s mind. Management is by removal of the calculus via various methods ranging from endoscopic to open surgery. We present the case of an adult male, who was initially thought to have periurethral abscess due to stricture urethra but during investigations was found to have urethral calculus as the cause for his symptoms.
Primary hydatid cyst of the urinary bladder
Authors: Arif Sardar Hassan , Mohammed Ayad Ahmad
Published: November 2018

A 35-year-old man presented with poorly localised lower abdominal pain for 3 months. Abdominal examination revealed lower abdominal tenderness, with normal other parts of examination. CT scan of the abdomen showed irregular multiloculated mass related to the upper part of the urinary bladder with mild rim enhancement in the postcontrast study with no areas of calcifications. During laparotomy, we found a mass attached to the superior part of the urinary bladder and arising from its wall. Complete excision was done without opening the cavity of the bladder. The mass was opened and was a hydatid cyst of the bladder containing multiple daughter cysts.
Polyglandular endocrine emergency: lessons from a patient, which a book cannot teach
Authors: Ahmad Sajjad , Giannopoulou Angeliki , Owen Penelope , Kalhan Atul
Published: November 2018

A 30-year-old woman with polyglandular autoimmune type 2 syndrome was found collapsed at home with a cardiac arrest, which required direct current cardioversion. On admission, she was hypothermic, hypotensive and bradycardic. Initial biochemical investigations were consistent with a pre-renal acute kidney injury, metabolic acidosis and a possible sepsis. She had significantly elevated thyroid-stimulating hormone levels on admission with the clinical profile consistent with dual Addisonian and myxoedema crisis. She received intravenous liothyronine and hydrocortisone along with supportive therapy. Echo showed severe left ventricular impairment with apical ballooning although coronary angiogram disclosed nothing abnormal. She made a gradual recovery and was discharged home after 2 weeks. She was diagnosed to have primary autoimmune hypothyroidism, Addison’s diseaseand type 1 diabetes and coeliac disease in October 2006, July 2007, May 2010 and September 2016, respectively. Her inability to stick to gluten-free diet at her workplace was considered a significant contributory factor for out-of-hospital cardiac arrest.
Prevalence and causes of blindness and vision impairment: magnitude, temporal trends and projections in South and Central Asia
Authors: Nangia Vinay , Jonas Jost B , George Ronnie , Lingam Vijaya , Ellwein Leon , Cicinelli Maria Vittoria , Das Aditi , Flaxman Seth R , Keeffe Jill E , Kempen John H , Leasher Janet , Limburg Hans , Naidoo Kovin , Pesudovs Konrad , Resnikoff Serge , Silvester Alexander J , Tahhan Nina , Taylor Hugh R , Wong Tien Y , Bourne Rupert R A
Published: November 2018

Background

To assess prevalence and causes of vision loss in Central and South Asia.

Methods

A systematic review of medical literature assessed the prevalence of blindness (presenting visual acuity<3/60 in the better eye), moderate and severe vision impairment (MSVI; presenting visual acuity <6/18 but ≥3/60) and mild vision impairment (MVI; presenting visual acuity <6/12 and ≥6/18) in Central and South Asia for 1990, 2010, 2015 and 2020.

Results

In Central and South Asia combined, age-standardised prevalences of blindness, MSVI and MVI in 2015 were for men and women aged 50+years, 3.72% (80% uncertainty interval (UI): 1.39–6.75) and 4.00% (80% UI: 1.41–7.39), 16.33% (80% UI: 8.55–25.47) and 17.65% (80% UI: 9.00–27.62), 11.70% (80% UI: 4.70–20.32) and 12.25% (80% UI:4.86–21.30), respectively, with a significant decrease in the study period for both gender. In South Asia in 2015, 11.76 million individuals (32.65% of the global blindness figure) were blind and 61.19 million individuals (28.3% of the global total) had MSVI. From 1990 to 2015, cataract (accounting for 36.58% of all cases with blindness in 2015) was the most common cause of blindness, followed by undercorrected refractive error (36.43%), glaucoma (5.81%), age-related macular degeneration (2.44%), corneal diseases (2.43%), diabetic retinopathy (0.16%) and trachoma (0.04%). For MSVI in South Asia 2015, most common causes were undercorrected refractive error (accounting for 66.39% of all cases with MSVI), followed by cataract (23.62%), age-related macular degeneration (1.31%) and glaucoma (1.09%).

Conclusions

One-third of the global blind resided in South Asia in 2015, although the age-standardised prevalence of blindness and MSVI decreased significantly between 1990 and 2015.
Prerace medical screening and education reduce medical encounters in distance road races: SAFER VIII study in 153 208 race starters
Authors: Schwellnus Martin , Swanevelder Sonja , Derman Wayne , Borjesson Mats , Schwabe Karen , Jordaan Esme
Published: November 2018

Objectives

To examine the efficacy and feasibility of an online prerace medical screening and educational intervention programme for reducing medical complications in long-distance races.

Methods

This was an 8-year observational study of medical encounter rates among 153 208 Two Oceans race starters (21.1 and 56 km) in South Africa. After the first 4-year control (CON) period, we introduced an online prerace medical screening (based on European pre-exercise screening guidelines) and an automated educational intervention programme. We compared the incidence of medical encounters (per 1000 starters; all and serious life threatening) in the CON versus the 4-year intervention (INT) period.

Results

In comparison to the CON period (2008–2011: 65 865 starters), the INT period (2012–2015: 87 343 starters) had a significantly lower incidence (adjusted for age group, sex, race distance) of all medical encounters by 29% (CON=8.6 (7.9–9.4); INT=6.1 (5.6–6.7), p<0.0001), in the 21.1 km race by 19% (CON=5.1 (4.4–5.9); INT=4.1 (3.6–4.8), p=0.0356) and in the 56 km race by 39% (CON=14.6 (13.1–16.3); INT=9.0 (7.9–10.1), p<0.0001). Serious life-threatening encounters were significantly reduced by 64% (CON=0.6 (0.5–0.9); INT=0.2 (0.1–0.4); p=0.0003) (adjusted for age group and sex). Registration numbers increased in the INT period (CON=81 345; INT=106 743) and overall % race starters were similar in the CON versus INT period. Wet-bulb globe temperature was similar in the CON and INT periods.

Conclusion

All medical encounters and serious life-threatening encounters were significantly lower after the introduction of a prescreening and educational intervention programme, and the programme was feasible.
Task-shifting for cardiovascular risk factor management: lessons from the Global Alliance for Chronic Diseases
Authors: Joshi Rohina , Thrift Amanda G , Smith Carter , Praveen Devarsetty , Vedanthan Rajesh , Gyamfi Joyce , Schwalm Jon-David , Limbani Felix , Rubinstein Adolfo , Parker Gary , Ogedegbe Olugbenga , Plange-Rhule Jacob , Riddell Michaela A , Thankappan Kavumpurathu R , Thorogood Margaret , Goudge Jane , Yeates Karen E
Published: November 2018

Task-shifting to non-physician health workers (NPHWs) has been an effective model for managing infectious diseases and improving maternal and child health. There is inadequate evidence to show the effectiveness of NPHWs to manage cardiovascular diseases (CVDs). In 2012, the Global Alliance for Chronic Diseases funded eight studies which focused on task-shifting to NPHWs for the management of hypertension. We report the lessons learnt from the field. From each of the studies, we obtained information on the types of tasks shifted, the professional level from which the task was shifted, the training provided and the challenges faced. Additionally, we collected more granular data on ‘lessons learnt ’ throughout the implementation process and ‘design to implementation’ changes that emerged in each project. The tasks shifted to NPHWs included screening of individuals, referral to physicians for diagnosis and management, patient education for lifestyle improvement, follow-up and reminders for medication adherence and appointments. In four studies, tasks were shifted from physicians to NPHWs and in four studies tasks were shared between two different levels of NPHWs. Training programmes ranged between 3 and 7 days with regular refresher training. Two studies used clinical decision support tools and mobile health components. Challenges faced included system level barriers such as inability to prescribe medicines, varying skill sets of NPHWs, high workload and staff turnover. With the acute shortage of the health workforce in low-income and middle-income countries (LMICs), achieving better health outcomes for the prevention and control of CVD is a major challenge. Task-shifting or sharing provides a practical model for the management of CVD in LMICs.
Healthy Foundations Study: a randomised controlled trial to evaluate biological embedding of early-life experiences
Authors: Gonzalez Andrea , Catherine Nicole , Boyle Michael , Jack Susan M , Atkinson Leslie , Kobor Michael , Sheehan Debbie , Tonmyr Lil , Waddell Charlotte , MacMillan Harriet L
Published: November 2018

Introduction

Adverse early experiences are associated with long-lasting disruptions in physiology, development and health. These experiences may be ‘biologically embedded’ into molecular and genomic systems that determine later expressions of vulnerability. Most studies to date have not examined whether preventive interventions can potentially reverse biological embedding. The Nurse-Family Partnership (NFP) is an evidence-based intervention with demonstrated efficacy in improving prenatal health, parenting and child functioning. The Healthy Foundations Study is an innovative birth cohort which will evaluate the impact of the NFP on biological outcomes of mothers and their infants.

Methods and analysis

Starting in 2013, up to 400 pregnant mothers and their newborns were recruited from the British Columbia Healthy Connections Project—a randomised controlled trial of the NFP, and will be followed to child aged 2 years. Women were recruited prior to 28 weeks’ gestation and then individually randomised to receive existing services (comparison group) or NFP plus existing services (intervention group). Hair samples are collected from mothers at baseline and 2 months post partum to measure physiological stress. Saliva samples are collected from infants during all visits for analyses of stress and immune function. Buccal swabs are collected from infants at 2 and 24 months to assess DNA methylation. Biological samples will be related to child outcome measures at age 2 years.

Ethics and dissemination

The study received ethical approval from seven research ethics boards. Findings from this study will be shared broadly with the research community through peer-reviewed publications, and conference presentations, as well as seminars with our policy partners and relevant healthcare providers. The outcomes of this study will provide all stakeholders with important information regarding how early adversity may lead to health and behavioural disparities and how these may be altered through early interventions.

Trial registration number

NCT01672060; Pre-results.
Perceived barriers to maternal and newborn health services delivery: a qualitative study of health workers and community members in low and middle-income settings
Authors: Sumankuuro Joshua , Crockett Judith , Wang Shaoyu
Published: November 2018

Objectives

In considering explanations for poor maternal and newborn health outcomes, many investigations have focused on the decision-making patterns and actions of expectant mothers and families, as opposed to exploring the ‘supply side’ (health service provider) barriers. Thus, we examined the health system factors impacting on access to and delivery of quality maternal and newborn healthcare in rural settings.

Design

A semistructured qualitative study using face-to-face in-depth interviews with health professionals, and focus group sessions with community members, in eight project sites in two districts of Upper West Region, Ghana, was employed. Participants were purposively selected to generate relevant data to help address the study objective. The survey was guided by WHO standard procedures and Ghana Health Ministry’s operational work plan for maternal and newborn care.

Setting

Nadowli–Kaleo and Daffiama–Bussie–Issa districts in Upper West Region, Ghana.

Participants

Two hundred and fifty-three participants were engaged in the study through convenient and purposive sampling: healthcare professionals (pharmacist, medical doctor, two district directors of health services, midwives, community health and enrolled nurses) (n=13) and community members comprising opinion leaders, youth leaders and adult non-pregnant women (n=240 in 24 units of focus groups).

Results

Results show significant barriers affecting the quality and appropriateness of maternal and neonatal health services in the rural communities and the Nadowli District Hospital. The obstacles were inadequate medical equipment and essential medicines, infrastructural challenges, shortage of skilled staff, high informal costs of essential medicines and general limited capacities to provide care.

Conclusion

Implementation of the birth preparedness and complication readiness strategy is in its infancy at the health facility level in the study areas. Increasing the resources at the health provider level is essential to achieving international targets for maternal and neonatal health outcomes and for bridging inequities in access to essential maternal and newborn healthcare.
Sex differences in the prevalence of neural tube defects and preventive effects of folic acid (FA) supplementation among five counties in northern China: results from a population-based birth defect surveillance programme
Authors: Liu Jufen , Xie Jing , Li Zhiwen , Greene Nicholas D E , Ren Aiguo
Published: November 2018

Objectives

Sex differences in prevalence of neural tube defects (NTDs) have previously been recognised; however, the different susceptibility of men and women have not been examined in relation to the effects of folic acid (FA) supplementation. We hypothesised that FA may have a disproportionate effect that alters the sex-specific prevalence of NTDs.

Setting

Data from two time points, before (2003–2004) and after (2011–2016) the start of the supplementation programme, were obtained from a population-based birth defect surveillance programme among five counties in northern China. All live births (28 or more complete gestational weeks), all stillbirths of at least 20 weeks’ gestational age and pregnancy terminations at any gestational age following the prenatal diagnosis of NTDs were included.

Participants

A total of 25 249 and 83 996 births before and after the programme were included respectively.

Primary and secondary outcome measures

The prevalence of NTDs by sex and subtype, Male:female rate ratios and their 95% CI were calculated.

Results

Overall, NTDs were less prevalent among men than among women (rate ratio (RR) 0.92; 95% CI 0.90 to 0.94), so was anencephaly (RR 0.77; 95% CI 0.73 to 0.81) and encephalocele (RR 0.75; 95% CI 0.61 to 0.92), while spina bifida showed a male predominance (RR 1.10; 95% CI 1.05 to 1.15). The overall prevalence of NTDs decreased by 78/10 000 in men and 108.7/10 000 in women from 2003 to 2004 to 2011 to 2016. There was a significant sex difference in the magnitude of reduction, being greater in women than men, particularly for anencephaly.

Conclusions

The prevalence of NTDs decreased in both sexes after the implementation of a massive FA supplementation programme. While female predominance was observed in open NTDs and total NTDs, they also had a greater rate of decrease in NTDs after the supplementation programme.
Conflict of interest disclosure slides at the European Society of Cardiology Congress 2016 in Rome: are they displayed long enough to assess their content? A cross-sectional study
Authors: van Lieshout Christianne T , Tijdink Joeri K , Smulders Yvo M
Published: November 2018

Objectives

To assess the duration of display of conflict of interest (COI) disclosure slides of presentations at the European Society of Cardiology (ESC) Congress 2016, and to identify factors associated with the duration of display of the disclosure slide.

Design

Cross-sectional observational study.

Outcome measures

Display duration of the COI disclosure slide and display duration per disclosure.

Results

Analysis of official video recordings of all oral presentations, viewed on the ESC website. 1673 oral presentations were analysed. In 706 presentations (42.2%), COIs were present on the disclosure slide. The median display duration of the disclosure slide was 2.49 s (minimum value: 0.16 s; IQR 1.47–4.08). In multivariable analysis, time spent on COI disclosures was positively related to the number of COIs (+0.11 s per extra COI), older estimated age of the speaker (+3.92 s for 75–85 years compared with <25 years), verbally commenting on disclosures (up to +8.25 s) and disclosures being of a non-commercial nature (+2.83 s). In addition, speakers from Eastern, Southern and Western Europe, Africa+East Asia and Asia showed their disclosures significantly shorter than the reference group (Northern Europe).

Conclusion

COI disclosure slides are often displayed too briefly to reasonably assess their content. Several factors appear to influence the duration of display of the COI disclosure slides, but none do so to the degree that the display duration becomes sufficiently long.
Tumour heterogeneity in triplet-paired metastatic tumour tissues in metastatic renal cell carcinoma: concordance analysis of target gene sequencing data
Authors: Kim Sung Han , Park Weon Seo , Chung Jinsoo
Published: November 2018

Aims

The aim of the present study was to determine the concordant correlation in the expression of 88 target genes from triple-paired metastatic tissues in individual patients with metastatic renal carcinoma (mRCC) using a target gene sequencing (TGS) approach.

Methods

Between 2002 and 2017, a total of 350 triple-paired metastatic tissue samples from 262 patients with mRCC obtained from either nephrectomy or metastasectomy were used for TGS of 88 candidate genes. After quality check, 243 tissue samples from 81 patients were finally applied to TGS. The concordance of triple-paired tissues was analysed with the 88 TGS panels using bioinformatics tools.

Results

Among 81 patients, alterations were observed in 42 (51.9%) for any of the 88 mRCC panel genes; however, no pathogenic gene was detected in 38 (39.5%) . Concordance >95% for altered gene expression among the three tissues was reported in 12 (28.6%) patients, while concordance >95% within two tissues was reported in 30 (71.4%); concordance <50% was reported in the remaining eight patients. Considering several types of genetic alterations, including deletions, insertions, missense and nonsense mutations, and splice variants, genes most frequently detected with genetic alterations in the patients with mRCC werePTENloss, followed byFLCN,BCR,SMARCA2,AKAP9,MLH1,MYH11,APCandTP53.

Conclusions

The study provides reference information on the genetic alterations at various organ sites and the multi-heterogeneity of mRCC tissues. The concordance of pathogenic gene alterations within tissues was not high, and approximately half of the patients showed no pathogenic gene alterations at all.
Apocrine lesions of the breast: part 1 of a two-part review: benign, atypical and in situ apocrine proliferations of the breast
Authors: D'Arcy Clare , Quinn Cecily
Published: November 2018

Apocrine morphology is a common phenomenon encountered in everyday breast pathology practice, and is defined as cuboidal or columnar cells exhibiting abundant eosinophilic granular cytoplasm, prominent apical granules, a low nuclear-cytoplasmic ratio, and round nuclei with pale chromatin and prominent nucleoli. Apocrine morphology is recognised in benign, atypical and malignant lesions of the breast. The morphology of apocrine atypia and non-high-grade apocrine ductal carcinoma in situ (DCIS) is less well defined due to the relative rarity of these lesions. In part 1 of this two-part review, we focus on the morphological characteristics of benign, atypical and in situ apocrine lesions of the breast, summarise the available data to date regarding distinction of atypical apocrine proliferations from non-high-grade apocrine DCIS and the biological significance of apocrine atypia, and provide practical guidance on handling these difficult lesions. Part 2 of this review will focus on the concept of pure apocrine carcinoma with emphasis on its definition and molecular data, including the current understanding of the molecular apocrine signature in breast carcinoma. We complete the review with a synopsis on the utility of immunohistochemistry in the diagnosis of apocrine lesions of the breast.