bluuebunny/crossref_metadata_2025 huggingface dataset:
Microneedling and PRP for acne scars: A new tool in our arsenal
Authors: Schoenberg Elizabeth , O’Connor Mackenzie , Wang Jordan V , Yang Sherry , Saedi Nazanin
Published: May 2019

A common complication of acne vulgaris is clinically significant scarring, which can greatly impact patient quality of life. While treatment options have included microneedling, the recent addition of platelet‐rich plasma (PRP) to this regimen has led to an increased popularity of combination treatment. Here, we offer backgrounds on microneedling and PRP therapies and review the literature on combination treatment for acne scars.
The Enduring Effects of Mother–Child Interactions on Episodic Memory in Adulthood
Authors: Sharifian Neika , Zahodne Laura B.
Published: May 2019

Objective: The objective of this study was to examine the enduring effects of retrospective reports of early‐life mother–child interactions on psychosocial and cognitive functioning later in life.

Background: Mother–child interactions have been linked to cognitive outcomes in childhood, however, little work has examined whether early‐life mother–child interactions have far‐reaching effects on episodic memory in adulthood. Early‐life mother–child interactions may also influence cognitive functioning in adulthood indirectly through the development of academic competence (education attainment), social competence (marital satisfaction, social support, contact frequency) or depressive symptoms.

Methods: Using longitudinal data from the Wisconsin Longitudinal Study sibling respondents (T1: 1993–1994, T2: 2004–2007, T3: 2011; baseline 29–79 years), we examined how retrospective positive mother–child interactions (PMCI) and negative mother–child interactions (NMCI) were independently associated with episodic memory. Structural equation modeling was used to model direct and indirect pathways from PMCI and NMCI to episodic memory and latent change in episodic memory.

Results: More PMCI retrospectively reported at T1 were associated with higher T2 memory and less memory decline from T2 to T3 via higher education. In addition, more PMCI were associated with higher T2 memory through greater marital satisfaction. Independent of these indirect effects, more PMCI and NMCI were each associated with higher T2 memory, but not memory change.

Conclusion: Mother–child interactions appeared to have an enduring effect on episodic memory in adulthood. These findings highlight the importance of taking an integrative and lifespan approach to assessing how early‐life experiences affect socioemotional and cognitive development.
Amphibians in Eurasian otterLutra lutradiet: osteological identification unveils hidden prey richness and male‐biased predation on anurans
Authors: Smiroldo Giorgio , Villa Andrea , Tremolada Paolo , Gariano Pasquale , Balestrieri Alessandro , Delfino Massimo
Published: May 2019

Amphibians form a major component of the diet of the otterLutra lutrain several areas of its wide geographic range. Yet, amphibian remains are rarely identified to species level and therefore information on the diversity of this food resource is generally scarce.

The aims of this study were: 1) to assess the overall pattern and trends in the use of amphibians as a resource by otters at the range scale, and 2) to highlight current knowledge on the diversity of amphibians taken as prey by otters. Additionally, we carried out osteological identification of amphibian remains in otter spraints (faeces) from southern Italy, with the aim of demonstrating how this method may improve our knowledge on predator–prey relationships.

The frequency of occurrence of amphibians in 64 dietary studies averaged 12%. Predation of amphibians by otters increased with longitude and was the highest in the Alpine biogeographical region. Predation by otters was reported on 28 amphibian species (35% of European species). Peaks in their frequency of use were reported for all seasons, mostly in winter and spring. In southern Italy, we identified 355 individuals belonging to at least seven amphibian taxa (64% of available species;Rana italica,Rana dalmatina/italica, Pelophylaxkl.bergeri/hispanicus, Hyla intermedia, Bufo bufo, Bufotes balearicus, andLissotriton italicus), and pointed out male‐biased predation within the Order Anura (frogs).

We conclude that the contribution of amphibians to the richness of the otter's prey community is far higher than commonly perceived, and that osteological analyses allow the detailed investigation of the feeding behaviour of this top predator of freshwater habitats.
The chlorine isotope composition of iron meteorites: Evidence for the Cl isotope composition of the solar nebula and implications for extensive devolatilization during planet formation
Authors: Gargano Anthony , Sharp Zachary
Published: May 2019

The bulk chlorine concentrations and isotopic compositions of a suite of non‐carbonaceous (NC) and carbonaceous (CC) iron meteorites were measured using gas source mass spectrometry. The δ37Cl values of magmatic irons range from −7.2 to 18.0‰ versus standard mean ocean chloride and are unrelated to their chlorine concentrations, which range from 0.3 to 161 ppm. Nonmagmatic IAB irons are comparatively Cl‐rich containing >161 ppm with δ37Cl values ranging from −6.1 to −3.2‰. The anomalously high and low δ37Cl values are inconsistent with a terrestrial source, and as Cl contents in magmatic irons are largely consistent with derivation from a chondrite‐like silicate complement, we suggest that Cl is indigenous to iron meteorites. Two NC irons, Cape York and Gibeon, have high cooling rates with anomalously high δ37Cl values of 13.4 and 18.0‰. We interpret these high isotopic compositions to result from Cl degassing during the disruption of their parent bodies, consistent with their low volatile contents (Ga, Ge, Ag). As no relevant mechanisms in iron meteorite parent bodies are expected to decrease δ37Cl values, whereas volatilization is known to increase δ37Cl values by the preferential loss of light isotopes, we interpret the low isotope values of <−5‰ and down to −7.2‰ to most closely represent the primordial isotopic composition of Cl in the solar nebula. Similar conclusions have been derived from low δ37Cl values down to −6, and −3.8‰ measured in Martian and Vestan meteorites, respectively. These low δ37Cl values are in contrast to those of chondrites which average around 0‰ previously explained by the incorporation of isotopically heavy HCl clathrate into chondrite parent bodies. The poor retention of low δ37Cl values in many differentiated planetary materials suggest that extensive devolatilization occurred during planet formation, which can explain Earth's high δ37Cl value by the loss of approximately 60% of the initial Cl content.
A convolutional neural‐network‐based pedestrian counting model for various crowded scenes
Authors: Shen Jie , Xiong Xin , Xue Zhiyuan , Bian Yinglong
Published: May 2019

Pedestrian counting from unconstrained images is an important task in various applications such as resource management, transportation engineering, urban design, and advertising, but it is greatly challenged by some factors such as interocclusion, cross‐scene, scale, and scene perspective distortion. Traditional image‐based methods suffer from them, and the performance of conventional sensor‐based methods such as Kinect and LASER degrades gradually with the increase in pedestrian count and distance from the device to pedestrians. Based on these challenges, this paper proposes a new network model making use of stacked multicolumn convolutional neural networks (CNNs) for pedestrian counting. The human's head features are used to replace the whole body for solving the problem of serious occlusion and choose multicolumn CNNs for dealing with scale and scene perspective distortion. Also, pretrained VGG‐16 is used to generate deeper detailed features and expand the receptive field of the model. Extensive analysis and experiments on current major pedestrian counting datasets show that the proposed network model has considerable advantages in pedestrian counting tasks compared to other state‐of‐the‐art models, and the proposed network model has an improvement effect for the training process. Moreover, the visual differences between the generated density map and ground‐truth density map are visualized and analyzed quantitatively to demonstrate the feasibility of the model.
Quality improvement project to reduce pediatric clear liquid fasting times prior to anesthesia
Authors: Isserman Rebecca , Elliott Elizabeth , Subramanyam Rajeev , Kraus Blair , Sutherland Tori , Madu Chinonyerem , Stricker Paul A.
Published: May 2019

Background

Unnecessarily long preprocedural fasting can cause suffering and distress for children and their families. Institutional fasting policies are designed to consistently achieve minimum fasting times, often without regard to the extent to which actual fasting times exceed these minimums. Children at our hospital frequently experienced clear liquid fasting times far in excess of required minimums.

Aims

The aim of this study was to utilize quality improvement methodology to reduce excess fasting times, with a goal of achieving experienced clear liquid fasting times ≤4 hours for 60% of our patients.

Methods

This quality improvement project was conducted between July 2017 and August 2018. A multidisciplinary team performed a series of Plan‐Do‐Study‐Act cycles focused on children undergoing elective procedures at a large children's hospital. Key drivers for clear liquid fasting times and relevant balancing measures were identified. Data were analyzed using control charts and statistical process control methods.

Results

Approximately 16 000 children were involved in this project. Over the course of the project, the percentage of children with goal clear liquid fasting times improved from the baseline of 20%‐63%, with a change in the mean fasting time from 9 hours to 6 hours. There were no significant effects on balancing measures (case delays/cancellations and clinically significant aspiration events).

Conclusion

Using quality improvement methodology, we safely improved the duration of preoperative fasting experienced by our patients. Our results provide additional data supporting the safety of more permissive 1‐hour clear liquid fasting minimums. We suggest other institutions pursue similar efforts to improve patient and family experience.
Novel Experiencer‐Object Verbs and Clitic Doubling
Authors: Alexiadou Artemis , Anagnostopoulou Elena
Published: May 2019

This article discusses novel experiencer‐object verbs (NEOs) and proposes to align their syntax as well as the syntax of nonagentive experiencer‐object verbs to the syntax of verbs undergoing the causative alternation under similar restrictions. We provide support for the view that (i) volitional agents do not occupy the same structural position as nonvolitional causers; (ii) VoiceP creates a phase, that is, a domain of compositional interpretation, and coercion into a psychological reading takes place in the absence of this layer; (iii) clitic doubling can be sensitive to animacy in a structure that lacks Voice and in which the clitic is the reflex of movement; and (iv) the accusative case morphology of experiencers both in eventive experiencer‐object constructions and our NEO constructions is straightforwardly explained as the result of dependent‐case assignment.
Characterization of the novel HLA‐A*03:350 allele by sequencing‐based typing
Authors: Cargou Marine , Elsermans Vincent , Top Isabelle , Guidicelli Gwendaline , Visentin Jonathan
Published: May 2019

HLA‐A*03:350 differs from HLA‐A*03:01:01:01 by one nucleotide substitution in codon 1 in exon 1.
Characterization of the novel HLA‐DRB1*01:100 allele by sequencing‐based typing
Authors: Cargou Marine , Elsermans Vincent , Top Isabelle , Guidicelli Gwendaline , Visentin Jonathan
Published: May 2019

HLA‐DRB1*01:100 differs from HLA‐DRB1*01:01:01 by one nucleotide substitution in codon 228 in exon 5.
Characterization of the novel HLA‐DPA1*02:15 allele by sequencing‐based typing
Authors: Blouin Laura , Andreani Marco , Locatelli Franco , Guidicelli Gwendaline , Visentin Jonathan
Published: May 2019

HLA‐DPA1*02:15 differs from HLA‐DPA1*02:06 by one nucleotide substitution in codon 218 in exon 4.
Identification of the novel KIR2DL4*036 allele in a Chinese Hani individual
Authors: Su Pincan , Yang Tonghua , Yao Fuzhu , Cai Siqi , Deng Zhi‐hui
Published: May 2019

The novel KIR2DL4*036 allele differs from the closest allele KIR2DL4*00102 by a single missense mutation.
Geospatial preparedness: Empirical study of the joint effort to provide geospatial support to disaster response
Authors: San Martin Roberto , Painho Marco
Published: May 2019

In a disaster aftermath in places lacking geospatial preparedness, the United Nations Office for the Coordination of Humanitarian Affairs creates a framework for cooperation with the Coordinated Data Scramble initiative, where Information Management Officers (IMOs) from different organizations work together in supporting the coordination of humanitarian aid. The perspective of these IMOs has been considered to identify the factors influencing the use of GIS in this context. The results show the requirement for a geodata management strategy, including geodata gathering, maintenance, and decision‐making processes based on those geodata. Geodata should be reliable and up‐to‐date. It requires consistent and useful metadata and the possibility of contacting the geodata source. Security and political issues limit information sharing. In this context, OpenStreetMap is often used as a source of information. Therefore, improving OpenStreetMap improves geospatial preparedness. Nevertheless, the use of this open platform highlights issues related to information privacy.
Dasatinib inhibition of cSRC prevents the migration and metastasis of canine mammary cancer cells with enhanced Wnt and HER signalling
Authors: Timmermans‐Sprang Elpetra P. M. , Mestemaker Helena M. , Steenlage Renske R. , Mol Jan A.
Published: May 2019

Human epidermal growth factor 2 (HER2) overexpression leads to aggressive mammary tumour growth. Although the prognosis of HER2+ tumours in humans is greatly improved using biologicals, therapy resistance, which may be caused by increased phosphatidyl‐3‐kinase (PI3K), rous sarcoma proto‐oncogene (cSRC) or wingless‐type MMTV integration site family (Wnt) activity, is a major concern. A recent analysis of 12 canine mammary cell lines showed an association between HER2/3 overexpression and phosphatase and tensin homologue (PTEN) deletion with elevated Wnt‐signalling. Wnt‐activity appeared to be insensitive to phosphatidyl‐3‐kinase (PI3K) inhibitors but sensitive to Src‐I1. We hypothesized that Wnt activation, was caused by HER2/3‐activated cSRC activation. The role of HER2/3 on Wnt signalling was investigated by silencing HER2/3 expression using specific small interfering RNA (siRNAs). Next, the effect of an epidermal growth factor receptor (EGFR)/HER2 tyrosine kinase inhibitor on Wnt activity and migration was investigated and compared to other tyrosine kinase inhibitors (TKIs) of related signalling pathways. Finally, two TKIs, a cSRC and a PI3K inhibitor, were investigated in a zebrafish xenograft model. Silencing of HER1‐3 did not inhibit the intrinsic high Wnt activity, whereas the HER kinase inhibitor afatinib showed enhanced Wnt activity. The strongest inhibition of Wnt activity and cell viability and migration was shown by cSRC inhibitors, which also showed strong inhibition of cell viability and metastasis in a zebrafish xenograft model. HER2/3 overexpression or HER2/3‐induced cSRC activation is not the cause of enhanced Wnt activity. However, inhibition of cSRC resulted in a strong inhibition of Wnt activity and cell migration and metastasis. Further studies are needed to unravel the mechanism of cSRC activation and cSRC inhibition to restore sensitivity to HER‐inhibitors in HER2/3‐positive breast cancer.
Veterinary ocular microbiome: Lessons learned beyond the culture
Authors: Banks Kayla C. , Ericsson Aaron C. , Reinero Carol R. , Giuliano Elizabeth A.
Published: May 2019

Ocular pathogens cause many painful and vision‐threatening diseases such as infectious keratitis, uveitis, and endophthalmitis. While virulent pathogens and pathobionts play important roles in disease pathogenesis, the scientific community has long assumed disruption of the ocular surface occurs prior to microbial colonization and subsequent infection. While nonpathogenic bacteria are often detected in corneal and conjunctival cultures from healthy eyes, cultures also frequently fail to yield growth of common ocular pathogens or nonpathogenic bacteria. This prompts the following question: Is the ocular surface populated by a stable microbial population that cannot be detected using standard culture techniques? The study of the microbiome has recently become a widespread focus in physician and veterinary medicine. Research suggests a pivotal symbiotic relationship with these microbes to maintain healthy host tissues, and when altered is associated with various disease states (“dysbiosis”). The microbiota that lives within and on mammalian bodies have long been known to influence health and susceptibility to infection. However, limitations of traditional culture methods have resulted in an incomplete understanding of what many now call the “forgotten organ,” that is, the microbiome. With the introduction of high‐throughput sequencing, physician ophthalmology has recognized an ocular surface with much more diverse microbial communities than suspected based on traditional culture. This article reviews the salient features of the ocular surface microbiome and highlights important future applications following the advent of molecular techniques for microbial identification, including characterizing ocular surface microbiomes in our veterinary species and their potential role in management of infectious and inflammatory ocular diseases.
Experimental Analysis of Continuous Vibrations in Dielectric Elastomer Membrane Actuators via Three-Dimensional Laser Vibrometry
Authors: Nalbach Sophie , Rizzello Gianluca , Seelecke Stefan
Published: May 2019

Dielectric elastomer (DE) membrane transducers are well known for exhibiting large deformations when subject to high voltage. Furthermore, DEs are characterized by an actuation bandwidth of several kilohertz, which allows their use in high-frequency applications, e.g., acoustic ones. The frequency response of DE membranes depends on many parameters such as geometry, pre-stress, and electrode pattern. By properly designing such parameters, it is possible to control vibration modes and resonance frequencies of the membrane, opening up a number of application scenarios. Motivated by this fact, this work presents the first experimental study of continuous vibrations generated in DE membranes via high-voltage excitation. The system under investigation consists of a squared DE membrane with a circular electrode, preloaded out of plane with a linear spring. Vibrations are generated by applying a broadband high-voltage signal to the DE membrane. A 3D laser vibrometer is used to reconstruct the three-dimensional oscillations of scanning points on the membrane surface. Experimental investigations are performed to study the effects of DE geometry and pre-stress on the membrane motion, in terms of resulting frequency spectrum and vibration modes.
Jeepers, creatures, where'd you get those peepers?
Authors: Pennisi Elizabeth
Published: May 2019

Photoreceptor genes have diversified in deep-living fish to capture every possible photon.
Ready to
pounce
Authors: Grimm David
Published: May 2019

After years of favoring dogs, researchers are finally probing the secrets of the feline mind.
Molecular basis for high-affinity agonist binding in GPCRs
Authors: Warne Tony , Edwards Patricia C. , Doré Andrew S. , Leslie Andrew G. W. , Tate Christopher G.
Published: May 2019

A GPCR seen in the active state

G protein–coupled receptors (GPCRs) are exceptionally good targets for drug development. Warne
et al.
describe four crystal structures of complexes of a GPCR—the β1-adrenergic receptor—in its active state. They used nanobodies (recombinant variable domains of heavy-chain antibodies) and engineered G protein to stabilize the β1-adrenergic receptor bound to a full agonist, two partial agonists, and a weak partial agonist. Comparison of these structures to the inactive state elucidates how agonist binding is altered in the active conformation.

Science
, this issue p.
775
Temporal patterning of apical progenitors and their daughter neurons in the developing neocortex
Authors: Telley L. , Agirman G. , Prados J. , Amberg N. , Fièvre S. , Oberst P. , Bartolini G. , Vitali I. , Cadilhac C. , Hippenmeyer S. , Nguyen L. , Dayer A. , Jabaudon D.
Published: May 2019

Origins of neuronal diversity

Although the main task of a neuroprogenitor is to produce more cells, it may not always produce the same cells. Some progenitors produce different daughter neurons as an embryo develops. Concurrently, these daughter neurons are also transitioning through states toward maturation. Telley
et al.
used single-cell RNA sequencing to survey the transcriptional identity of cells early in mouse brain development. As a neuroprogenitor transitioned to new states, it produced daughter neurons that reflect those new states. The neuron's own postmitotic differentiation program is apparently overlaid onto these parentally supplied programs, driving emergence of specialized neuronal cell types in the neocortex.

Science
, this issue p.
eaav2522
Vision using multiple distinct rod opsins in deep-sea fishes
Authors: Musilova Zuzana , Cortesi Fabio , Matschiner Michael , Davies Wayne I. L. , Patel Jagdish Suresh , Stieb Sara M. , de Busserolles Fanny , Malmstrøm Martin , Tørresen Ole K. , Brown Celeste J. , Mountford Jessica K. , Hanel Reinhold , Stenkamp Deborah L. , Jakobsen Kjetill S. , Carleton Karen L. , Jentoft Sissel , Marshall Justin , Salzburger Walter
Published: May 2019

Fish catch color with rods

Vertebrates are typically thought to have a consistent system for processing light, in which multiple cone opsins permit color vision during the day, but a single rod opsin provides only monochrome vision in the dark. Musilova
et al.
analyzed more than 100 deep-sea fish genomes and found a previously unknown proliferation of rod opsin genes that generate rod opsin photopigments that are tuned to different wavelengths of light. These receptors may allow the fish to perceive bioluminescent signals that pervade their deep-sea environment. These results reveal a previously undescribed visual system that allows for color vision in the dark.

Science
, this issue p.
588
The fight for clean air
Choked: Life and Breath in the Age of Air Pollution
Beth Gardiner
University of Chicago Press, 2019. 237 pp.
Authors: Pope C. Arden
Published: May 2019

Efforts to reduce air pollution around the world have yielded tangible but tenuous gains
Remote control with engineered enzymes
Authors: Hepworth Lorna J. , Flitsch Sabine L.
Published: May 2019

Directed evolution yields catalysts for remote functionalization to form a range of lactams
Science support for Belt and Road
Authors: Horvat Manfred , Gong Peng
Published: May 2019

Last month, at the Second Belt and Road Forum for International Cooperation in Beijing, President Xi Jinping gave an update on China's $US1.3 trillion Belt and Road Initiative (BRI). This massive land, sea, and digital enterprise aims to create improved economic, social, and environmental conditions between China and 126 cooperating countries from Asia, Europe, and Africa through strengthened connectivity by constructing roads, railways, IT networks, power stations, pipelines, airports, and ports. President Xi acknowledged growing international concerns about environmental damage along the BRI. Now, China must commit to addressing these issues. China's use of science and technology (S&T) as an instrument to build BRI relationships should likewise be used to examine and minimize the environmental impacts of BRI projects.
Wood Modification by Furfuryl Alcohol Resulted in a Delayed Decomposition Response in
Rhodonia
(
Postia
)
placenta
Authors: Skrede Inger , Solbakken Monica Hongrø , Hess Jaqueline , Fossdal Carl Gunnar , Hegnar Olav , Alfredsen Gry
Published: May 2019

Fungi are important decomposers of woody biomass in natural habitats. Investigation of the mechanisms employed by decay fungi in their attempt to degrade wood is important for both the basic scientific understanding of ecology and carbon cycling in nature and for applied uses of woody materials. For wooden building materials, long service life and carbon storage are essential, but decay fungi are responsible for massive losses of wood in service. Thus, the optimization of durable wood products for the future is of major importance. In this study, we have investigated the fungal genetic response to furfurylated wood, a commercial environmentally benign wood modification approach that improves the service life of wood in outdoor applications. Our results show that there is a delayed wood decay by the fungus as a response to furfurylated wood, and new knowledge about the mechanisms behind the delay is provided.
Development, Characterization, and Standardization of a Nose-Only Inhalation Exposure System for Exposure of Rabbits to Small-Particle Aerosols Containing Francisella tularensis
Authors: O’Malley Katherine J. , Bowling Jennifer D. , Barry Eileen M. , Hazlett Karsten R. O. , Reed Douglas S.
Published: May 2019

Inhalation of
Francisella tularensis
causes pneumonic tularemia in humans, a severe disease with a 30 to 60% mortality rate. The reproducible delivery of aerosolized virulent bacteria in relevant animal models is essential for evaluating medical countermeasures. Here we developed optimized protocols for infecting New Zealand White (NZW) rabbits with aerosols containing
F. tularensis
.
Please reconcile, not wait a while
Authors: Trivedi Ashifa , Sharma Sadhna , Ajitsaria Richa , Davey Nicola J
Published: May 2019

A quality improvement project to increase the rate of paediatric medicines reconciliation was carried out in a district general hospital between April and July 2018. Baseline data collected from our paediatric ward shows that medicines reconciliation by doctors is only accurately completed 50% of the time. Evidence shows that medicines-related patient safety incidents are more likely when medicines reconciliation happens more than 24 hours after a person is admitted to an acute setting. The aim of this quality improvement project was therefore to ensure that 100% of paediatric patients have their regular medications prescribed by mid-day the day after admission. The paediatric pharmacy team reviewed all paediatric inpatient drug charts from Monday to Friday for 12 weeks. The number of regular medications and the number of medicines reconciled was recorded each day. The effectiveness of various interventions were reviewed using Plan–Do–Study–Act cycles. On average, 40 patients were reviewed each week. The mean reconciliation rate was 79%, and the worst rate was 0%. 100% reconciliation was achieved on 34 occasions and was achieved continuously for the last 3 weeks of data collection. A repeat audit carried out in September 2018 found the reconciliation rate was maintained at 100%. Multiple interventions occurred during this quality improvement project: teaching sessions for doctors, posters to raise awareness and questionnaires for parents/children to complete about their regular medications. The main factor for success in this project has been involving all members of the paediatric department including children and their parents.
Postpartum use of oxytocin and volume of placental transfusion: a randomised controlled trial
Authors: Vain Nestor E , Satragno Daniela S , Gordillo Juan Esteban , Fernandez Ariel L , Carrolli Guillermo , Romero Norma P , Prudent Luis M
Published: May 2019

Objective

To assess whether oxytocin administered before clamping the umbilical cord modifies the volume of placental transfusion.

Design

Randomised controlled trial.

Methods

Mothers of term infants born vigorous by vaginal delivery with informed consent provided in early labour were randomly assigned to oxytocin (10 IU) given intravenously within 15 s of birth (group 1) or after clamping the umbilical cord 3 min after delivery (group 2). Soon after birth, all infants were weighed using a 1 g precision scale and subsequently placed on the mother’s abdomen or chest. At 3 min, in both groups, the cord was clamped and cut, and the weight was again obtained. The primary outcome (volume of placental transfusion) was estimated by the difference in weights.

Results

144 patients were included. There were no differences in the primary outcome: infants in group 1 (n=70) gained a mean weight of 85.9 g (SD 48.3), and in group 2 (n=74) 86.7 g (SD 49.6) (p=0.92). No differences were found in secondary outcomes, including newborns’ haematocrit and bilirubin concentrations and severe maternal postpartum haemorrhage. On the advice of the Data and Safety Monitoring Committee, the trial was stopped due to futility at 25% of the planned sample size.

Conclusions

When umbilical cord clamping is delayed for 3 min, term newborn infants born vigorous receive a clinically significant placental transfusion which is not modified by the administration of intravenous oxytocin immediately after birth.

Trial registration number

NCT02618499.
Knee osteoarthritis risk is increased 4-6 fold after knee injury – a systematic review and meta-analysis
Authors: Poulsen Erik , Goncalves Glaucia H , Bricca Alessio , Roos Ewa M , Thorlund Jonas B , Juhl Carsten B
Published: May 2019

Objective

To estimate knee osteoarthritis (OA) risk following anterior cruciate ligament (ACL), meniscus or combined ACL and meniscus injury.

Design

Systematic review and meta-analysis.

Data sources

MEDLINE, Embase, SPORTDiscus, CINAHL and Web of Science until November 2018.

Eligibility criteria for selecting studies

Prospective or retrospective studies with at least 2-year follow-up including adults with ACL injury, meniscal injury or combined injuries. Knee OA was defined by radiographs or clinical diagnosis and compared with the contralateral knee or non-injured controls.

Study appraisal and synthesis

Risk of bias was assessed using the SIGN50 checklist. ORs for developing knee OA were estimated using random effects meta-analysis.

Results

53 studies totalling ∼1 million participants were included: 185 219 participants with ACL injury, mean age 28 years, 35% females, 98% surgically reconstructed; 83 267 participants with meniscal injury, mean age 38 years, 36% females, 22% confirmed meniscectomy and 73% unknown; 725 362 participants with combined injury, mean age 31 years, 26% females, 80% treated surgically. The OR of developing knee OA were 4.2 (95% CI 2.2 to 8.0; I2=92%), 6.3 (95% CI 3.8 to 10.5; I2=95%) and 6.4 (95% CI 4.9 to 8.3; I2=62%) for patients with ACL injury, meniscal injury and combined injuries, respectively.

Conclusion

The odds of developing knee OA following ACL injury are approximately four times higher compared with a non-injured knee. A meniscal injury and a combined injury affecting both the ACL and meniscus are associated with six times higher odds compared with a non-injured knee. Large inconsistency (eg, study design, follow-up period and comparator) and few high-quality studies suggest that future studies may change these estimates.

Clinical relevance

Patients sustaining a major knee injury have a substantially increased risk of developing knee OA, highlighting the importance of knee injury prevention programmes and secondary prevention strategies to prevent or delay knee OA development.

PROSPERO registration number CRD42015016900
Understanding patient preference for physician attire in ambulatory clinics: a cross-sectional observational study
Authors: Zollinger Marc , Houchens Nathan , Chopra Vineet , Clack Lauren , Schreiber Peter Werner , Kuhn Latoya , Snyder Ashley , Saint Sanjay , Petrilli Christopher M , Sax Hugo
Published: May 2019

Objectives

We explored patient perceptions regarding physician attire in different clinical contexts and resultant effects on the physician–patient relationship.

Setting

The 900-bed University Hospital Zurich, Switzerland.

Participants

A convenience sample of patients receiving care in dermatology, infectious diseases and neurology ambulatory clinics of the University Hospital Zurich participated in a paper-based survey.

Primary and secondary outcome measures

The survey instrument was randomised and showed photographs of male or female physicians wearing various forms of attire. On the basis of the respondents’ ratings of how the physician’s attire affected perceptions across five domains (knowledgeable, trustworthy, caring, approachable and comfort with the physician), a composite preference score for attire was calculated as the primary outcome. Secondary outcomes included variation in preferences by respondent characteristics and context in which care was provided.

Results

Of 834 patient respondents (140 in dermatology, 422 in infectious diseases and 272 in neurology), 298 (36%) agreed that physician attire was important. When compared with all available choices, the combination of white scrubs with white coat was rated highest while a business suit ranked lowest. Variation in preferences and opinions for attire were noted relative to respondent demographics and the clinical setting in which the survey was administered. For example, compared with younger patients, respondents ≥65 years of age more often reported that physician dress was both important to them and influenced how happy they were with their care (p=0.047 and p=0.001, respectively).

Conclusions

Outpatients at a large Swiss University hospital prefer their physicians to be dressed in white scrubs with white coat. Substantial variation among respondents based on demographics, type of physician and clinical setting were observed. Healthcare systems should consider context of care when defining policies related to dress code.
Assessing testing rates for viral hepatitis B and C by general practitioners in Flanders, Belgium: a registry-based study
Authors: Bielen Rob , Koc Özgür M , Busschots Dana , Robaeys Geert , Aertgeerts Bert , Vaes Bert , Mamouris Pavlos , Mathei Catharina , Goderis Geert , Nevens Frederik
Published: May 2019

Objectives

Chronic infections with hepatitis B virus (HBV) and hepatitis C virus (HCV) have a major impact on mortality worldwide. Although effective treatments are available for both HBV and HCV infection, <50% of the patients are even diagnosed in Belgium. This study assessed the real-life testing—and diagnosis rate by general practitioners (GPs) in Flanders, Belgium.

Setting

We assessed the testing rate for HBV and HCV in 48 primary care practices with electronic medical records linked into one central registry in Flanders, Belgium.

Participants

The registry contains data of 440 140 patients over 20 years, which corresponds to 2.2% of the total Flemish population yearly. The primary care practices are distributed across Flanders and the patient population is representative for the distribution of age, gender and socioeconomic status at the community level.

Results

Of 440 140 patients included in the registry, 7892 (1.8%) patients were screened for hepatitis B surface antigen (HBsAg) and 7206 (1.6%) for hepatitis C antibody (HCV Ab) of whom 369 (4.7%) and 163 (2.3%) tested positive, respectively. Of 14 059 patients with chronic liver enzyme elevation, 1112 (7.9%) and 1395 (9.9%) were tested for HBsAg and HCV Ab, respectively. There was no improvement in testing rates over time.

Conclusions

This study demonstrates that real-life testing uptake for viral hepatitis B and C is suboptimal in the general practices in Flanders, even in patients with chronically elevated liver enzymes. As GPs play a crucial role in prevention, diagnosis and linkage to care, efforts and strategies to increase the testing uptake for HBV and HCV are urgently needed.
Parental experiences of end of life care decision-making for children with life-limiting conditions in the paediatric intensive care unit: a qualitative interview study
Authors: Mitchell Sarah , Spry Jenna L , Hill Emma , Coad Jane , Dale Jeremy , Plunkett Adrian
Published: May 2019

Objectives

To provide an in-depth insight into the experience and perceptions of bereaved parents who have experienced end of life care decision-making for children with life-limiting or life-threatening conditions in the paediatric intensive care unit (PICU).

Design

An in-depth qualitative interview study with a sample of parents of children with life-limiting or life-threatening conditions who had died in PICU within the previous 12 months. A thematic analysis was conducted on the interview transcripts.

Setting

A PICU in a large National Health Service (NHS) tertiary children’s hospital in the West Midlands, UK.

Participants

17 parents of 11 children who had died in the PICU.

Results

Five interconnected themes were identified related to end of life care decision-making:(1) parents have significant knowledge and experiences that influence the decision-making process.(2) Trusted relationships with healthcare professionals are key to supporting parents making end of life decisions.(3) Verbal and non-verbal communication with healthcare professionals impacts on the family experience.(4) Engaging with end of life care decision-making can be emotionally overwhelming, but becomes possible if parents reach a ‘place of acceptance’.(5) Families perceive benefits to receiving end of life care for their child in a PICU.

Conclusions and implications

The death of a child is an intensely emotional experience for all involved. This study adds to the limited evidence base related to parental experiences of end of life care decision-making and provides findings that have international relevance, particularly related to place of care and introduction of end of life care discussions. The expertise and previous experience of parents is highly relevant and should be acknowledged. End of life care decision-making is a complex and nuanced process; the information needs and preferences of each family are individual and need to be understood by the professionals involved in their care.
Out-of-hours primary care end of life prescribing: a data linkage study
Authors: Brettell Rachel , Fisher Rebecca , Hunt Helen , Garland Sophie , Lasserson Daniel , Hayward Gail
Published: May 2019

Objectives

Out-of-hours (OOH) primary care services are contacted in the last 4 weeks of life by nearly 30% of all patients who die, but OOH palliative prescribing remains poorly understood. Our understanding of prescribing demand has previously been limited by difficulties identifying palliative patients seen OOH. This study examines the volume and type of prescriptions issued by OOH services at the end of life.

Methods

A retrospective cohort study was performed by linking a database of Oxfordshire OOH service contacts over a year with national mortality data, identifying patients who died within 30 days of OOH contact. Demographic, service and prescribing data were analysed.

Results

A prescription is issued at 14.2% of contacts in the 30 days prior to death, compared with 29.9% of other contacts. The most common prescriptions were antibiotics (22.2%) and strong opioids (19%). 41.8% of prescriptions are for subcutaneously administered medication. Patients who were prescribed a syringe driver medication made twice as many OOH contacts in the 30 days prior to death compared with those who were not.

Conclusion

Absolute and relative prescribing rates are low in the 30 days prior to death. Further research is required to understand what occurs at these non-prescribing end of life contacts to inform how OOH provision can best meet the needs of dying patients. Overall, relatively few patients are prescribed strong opioids or syringe drivers. When a syringe driver medication is prescribed this may help identify patients likely to be in need of further support from the service.
Testing algorithm for identification of patients with TRK fusion cancer
Authors: Penault-Llorca Frédérique , Rudzinski Erin R , Sepulveda Antonia R
Published: May 2019

The neurotrophic tyrosine receptor kinase (NTRK) gene family encodes three tropomyosin receptor kinases (TRKA, TRKB, TRKC) that contribute to central and peripheral nervous system development and function.NTRKgene fusions are oncogenic drivers of various adult and paediatric tumours. Several methods have been used to detectNTRKgene fusions including immunohistochemistry, fluorescence in situ hybridisation, reverse transcriptase polymerase chain reaction, and DNA- or RNA-based next-generation sequencing. For patients with TRK fusion cancer, TRK inhibition is an important therapeutic target. Following the FDA approval of the selective TRK inhibitor, larotrectinib, as well as the ongoing development of multi-kinase inhibitors with activity in TRK fusion cancer, testing forNTRKgene fusions should become part of the standard diagnostic process. In this review we discuss the biology ofNTRKgene fusions, and we present a testing algorithm to aid detection of these gene fusions in clinical practice and guide treatment decisions.
Effects of school environments on student risk-behaviours: evidence from a longitudinal study of secondary schools in England
Authors: Bonell Chris , Beaumont Emma , Dodd Matthew , Elbourne Diana Ruth , Bevilacqua Leonardo , Mathiot Anne , McGowan Jennifer , Sturgess Joanna , Warren Emily , Viner Russell M , Allen Elizabeth
Published: May 2019

Background

The theory of human functioning and school organisation proposes that schools with rigid ‘boundaries’ (weaker relationships), for example, between staff and students, or learning and broader development, engender weaker student school commitment and sense of belonging, particularly among disadvantaged students, leading to greater involvement in risk-behaviours. Existing studies provide some support but rely on a proxy exposure of ‘value-added education’ and have not explored effects by disadvantage.

Methods

We used longitudinal data from English secondary schools from the control arm of a trial, assessing school-level measures of rigid boundaries, and student commitment and belonging at age 11/12, and student risk-behaviours at age 14/15.

Results

Our direct measures were more strongly associated with risk-behaviours than was value-added education. School-level rigid boundaries were associated with increased alcohol use and bullying. Student belonging was more consistently associated with reduced risk-behaviours than was student commitment. Some school effects were greater for students from disadvantaged subgroups defined in terms of poverty, ethnicity and family structure.

Conclusion

Our results provide direct support for the theory of human functioning and school organisation and suggest a sense of belonging in school might be particularly protective factor among secondary school students. School effects on risk are generally stronger among disadvantaged students as theorised.

Trial registration number

ISRCTN10751359
Therapeutic non-invasive brain stimulation in amyotrophic lateral sclerosis: rationale, methods and experience
Authors: Edmond Evan C , Stagg Charlotte J , Turner Martin R
Published: May 2019

The neurodegenerative syndrome amyotrophic lateral sclerosis (ALS) is characterised by increased cortical excitability, thought to reflect pathological changes in the balance of local excitatory and inhibitory neuronal influences. Non-invasive brain stimulation (NIBS) has been shown to modulate cortical activity, with some protocols showing effects that outlast the stimulation by months. NIBS has been suggested as a potential therapeutic approach for disorders associated with changes in cortical neurophysiology, including ALS. This article reviews NIBS methodology, rationale for its application to ALS and progress to date.
Intraventricular flow patterns during right ventricular apical pacing
Authors: Bianco Francesco , Cicchitti Vincenzo , Bucciarelli Valentina , Chandra Alvin , Di Girolamo Enrico , Pedrizzetti Gianni , Tonti Gianni , Romano Silvio , De Caterina Raffaele , Gallina Sabina
Published: May 2019

Objectives

To assess differences in blood flow momentum (BFM) and kinetic energy (KE) dissipation in a model of cardiac dyssynchrony induced by electrical right ventricular apical (RVA) stimulation compared with spontaneous sinus rhythm.

Methods

We cross-sectionally enrolled 12 consecutive patients (mean age 74±8 years, 60% male, mean left ventricular ejection fraction 58%±6 %), within 48 hours from pacemaker (PMK) implantation. Inclusion criteria were: age>18 years, no PMK-dependency, sinus rhythm with a spontaneous narrow QRS at the ECG, preserved ejection fraction (>50%) and a low percentage of PMK-stimulation (<20%). All the participants underwent a complete echocardiographic evaluation, including left ventricular strain analysis and particle image velocimetry.

Results

Compared with sinus rhythm, BFM shifted from 27±3.3 to 34±7.6° (p=0.016), while RVA-pacing was characterised by a 35% of increment in KE dissipation, during diastole (p=0.043) and 32% during systole (p=0.016). In the same conditions, left ventricle global longitudinal strain (LV GLS) significantly decreased from 17±3.3 to 11%±2.8% (p=0.004) during RVA-stimulation. At the multivariable analysis, BFM and diastolic KE dissipation were significantly associated with LV GLS deterioration (Beta Coeff.=0.54, 95% CI 0.07 to 1.00, p=0.034 and Beta Coeff.=0.29, 95% CI 0.02 to 0.57, p=0.049, respectively).

Conclusions

In RVA-stimulation, BFM impairment and KE dissipation were found to be significantly associated with LV GLS deterioration, when controlling for potential confounders. Such changes may favour the onset of cardiac remodelling and sustain heart failure.
Coping with confidence
Authors: Escalona Ebony
Published: May 2019

Confidence can be a fickle friend, waxing and waning as your career changes and life evolves. Here Ebony Escalona describes how best to deal with the periods when it deserts you.
Computational study of the structures and photoelectron spectra of 12 azabenzenes
Authors: Chong Delano P.
Published: May 2019

The molecular structures of 12 azabenzenes have been optimized with the Gaussian09 package at the level of coupled cluster singles and doubles with the basis set cc-pVTZ. The optimized geometry of each is used in the ADF13 program for the calculation of the vertical ionization energies of all the electrons. For both outer-shell and inner-shell valence electrons, the 2009 method of ΔPBE0(SAOP) is used, whereas the 1999 method of ΔPW86PW91 + Crel is employed for the core electrons. For degenerate orbitals, the alternative method chosen is to use localized orbitals, keeping the integer number of electrons, while giving up proper symmetry, rather than to keep symmetry with fractional electrons. The success of the computed results of valence ionization potentials of pyridine and the diazabenzenes gives confidence for the predicted values for the higher azabenzenes. The calculated results for core-electron binding energies provide incentive to experimentalists to measure them with X-ray photoelectron spectrometers and (or) synchrotron facilities.