bluuebunny/crossref_metadata_2025 huggingface dataset:
Topical anaesthesia degree is reduced in temporomandibular disorders patients: A novel approach to assess underlying mechanisms of the somatosensory alterations
Authors: Costa Yuri Martins , Ferreira Dyna Mara A. O. , Conti Paulo César R. , Baad‐Hansen Lene , Svensson Peter , Bonjardim Leonardo R.
Published: August 2019

Background

Changes in quantitative sensory testing (QST) parameters following topical anaesthesia could contribute to better elucidate underlying mechanisms of somatosensory alterations in temporomandibular disorder (TMD) pain patients. This placebo‐controlled crossover investigation compared the somatosensory profile following topical anaesthesia between TMD patients (n = 20) and healthy participants (n = 20).

Methods

Cold detection threshold, warm detection threshold, cold pain threshold, heat pain threshold, mechanical detection threshold, mechanical pain threshold, wind‐up ratio and pressure pain threshold were assessed on the skin overlying the masseter at three consecutive days (baseline and immediately after lidocaine 4%/placebo cream). Mixed ANOVA and a coding system that accounts for the diversity of types of peripheral axons associated with the somatosensory parameters were applied for data analysis.

Results

The lidocaine application caused no changes in the somatosensory sensitivity in the masseter region in TMD patients (P > .050), but sensitivity to cold, cold pain, touch and pinprick stimuli were reduced after topical anaesthesia in healthy participants (P < .050). Also, the degree of topical anaesthesia was greater in healthy participants (P = .008). The coding system suggested that TMD patients presented only Aδ‐fibre block, whereas a combination of either Aβ‐ and/or C‐fibre block was observed in 35% of healthy participants in addition to Aδ‐fibre block following lidocaine application.

Conclusion

Quantitative sensory testing can be successfully applied to identify meaningful differences in the degree of hypoalgesia and hypoesthesia following short‐time topical anaesthesia.
Exemplarist Environmental Ethics
Authors: Balthrop‐Lewis Alda
Published: August 2019

This article argues that environmental ethics can deemphasize environmental problem‐solving in preference for a more exemplarist mode. This mode will renarrate what we admire in those we have long admired, in order to make them resonate with contemporary ethical needs. First, I outline a method problem that arose for me in ethnographic fieldwork, a problem that I call, far too reductively, “solution thinking.” Second, I relate that method problem to movements against “quandary ethics” in ethical theory more broadly. Third, I discuss some interpretive work I am engaged in about Henry David Thoreau and how it bears on the methodological issues my fieldwork raised. I argue that some of the most important icons of right relation to environment, especially Francis of Assisi and Thoreau, should be envisioned as far more politically invested than they usually are. They demonstrate to scholars of religious ethics that an exemplarist ethic focused on character need not neglect politics.
Navigating Moral Struggle: Toward a Social Model of Exemplarity
Authors: Hamilton Brian
Published: August 2019

Exemplars have the power to help people navigate various levels of moral struggle, from the relatively straightforward problem of lacking motivation to the much deeper problem of failing to see the moral realities that surround us. But there are also serious moral risks in the appeal to exemplars: we romanticize them, we make use of them in authoritarian ways, and we tend to forget how our choice of exemplars is conditioned by oppressive cultural formations. I argue that we need to develop a social model of exemplarity, attuned to social contexts of our exemplars themselves as well as the social processes of constructing and appealing to exemplars. More particularly, I argue that we need to develop space for thinking about exemplary groups, not just exemplary individuals, in order to develop the strengths and avoid the weaknesses in exemplarist moral theories.
Exemplarity Between Tradition and Critique
Authors: Herdt Jennifer A.
Published: August 2019

Moral exemplarism, which insists on the centrality of particular embodiments of exemplary virtue to the moral life, is currently receiving significant attention within moral philosophy as well as theological and religious ethics. This introductory essay situates the contributions made by this focus issue on moral exemplarity in relation to the history of attention to moral exemplars, the twentieth‐century turn to virtue, philosopher Linda Zagzebski’s exemplarist moral theory, Stanley Hauerwas’s particularist embrace of Christian discipleship, Foucauldian turns to critique and self‐cultivation, and the significance of exemplars in Jeffrey Stout’s democratic piety. Arguing for the critical importance of articulating the authority of exemplars, this essay points to the ways in which the present focus can assist us to navigate between the shoals of nostalgic deference to tradition and dismissive critiques of authoritarianism.
Loving the World We Are: Anthropology and Relationality in Laudato si’
Authors: Kohlhaas Jacob M. , McLaughlin Ryan Patrick
Published: August 2019

There is a tension between Laudato si's consistent emphasis on relationships and interconnectedness and its acceptance of anthropocentrism. While Laudato si’ does reject certain problematic forms of anthropocentrism, the encyclical does not assert an alternative to this traditional framework. This article contends that “relatiocentrism” provides the best avenue for developing the convictions expressed within Laudato si’ while moving beyond the limitations of the encyclical itself. In so doing, this essay explores the use of narrative as a means of shaping identity by mapping significant relationships and points of meaning. It examines the central anthropological claims of the encyclical and the tensions these create with anthropocentric narratives. And it examines relatiocentrism in light of the biblical creation accounts, the eschatological perspective of Laudato si’, and virtue ethics. The essay concludes by suggesting further theological and moral implications of this shift in perspective.
Mourning the Dead, Following the Living
Authors: Lambelet Kyle B. T.
Published: August 2019

In this paper I take up the ambivalence we rightly feel toward leaders by examining the relationship between charismatic authority and moral exemplarity. Drawing on the social theory of Max Weber, and in dialogue with a case study of an anti‐militarism movement called the SOA (School of Americas) Watch, I demonstrate that through a “politics of sacrifice” leaders synchronize their own stories with those of communally recognized exemplars and act in ways that evidence a solidarity in the suffering of those exemplars thereby generating their charismatic authority. While performing crucial strategic, motivational, and pedagogical roles, this charisma also introduces problematic temptations to authoritarianism that short‐circuit the practical reasoning that exemplars supposedly help to form. In the end this leaves our sense of ambivalence intact. What is needed, I argue, are practices of critique that reopen the distance between leader and follower and thus allow the possibility of practical reason.
From Environmental Stewardship To Environmental Holiness
Authors: Stephens Darryl W.
Published: August 2019

The descriptive moment in ethical reflection is helpfully informed by a careful consideration of what religious bodies have said about moral issues such as climate change. As a case study, this article identifies and interprets primary documents of The United Methodist Church (UMC) and its predecessor institutions, providing a detailed examination of the historical development of this denomination’s environmental witness statements. Methodism's long‐standing engagement with environmental ethics, out of which a concern for anthropogenic climate change incrementally emerged, includes significant institutional policies and practices. The history of Methodist environmental witness evidences a creative, faithful response by a religious denomination learning to grapple with the overwhelming problem of climate change. Describing and interpreting this history enables religious ethicists to engage Methodist environmental witness as they develop constructive models for addressing this problem.
Dental insurance, dental care utilization, and perceived unmet dental needs in women living with HIV: Results from the Women's Interagency HIV Study
Authors: Parish Carrigan Leigh , Feaster Daniel J. , Pereyra Margaret R. , Alcaide Maria , Cohen Mardge , Levin Susanna , Gustafson Deborah , Merenstein Daniel , Aouizerat Bradley , Donohue Jessica , Webster‐Cyriaque Jennifer , Wingood Gina , Kempf Mirjam , Metsch Lisa R.
Published: August 2019

Objectives

Dental care is the most commonly cited unmet health‐care service due to cost. Previous research has highlighted the unmet dental needs of people living with HIV (PLWH). Understanding associations among dental insurance availability, dental care utilization, and the presence of unmet dental needs among PLWH is a public health priority.

Methods

Oral health surveys were collected cross‐sectionally (April–October 2016) among 1,442 women living with HIV (WLWH) in the Women's Interagency HIV Study. Logistic regression models were used to analyze the association between having versus not having dental insurance by type (Ryan White, private, Medicaid/Medicare) and two primary outcomes: a) typical frequency of dental visits (at least annually, less than annually) and b) reporting an unmet dental need in the past 6 months.

Results

All dental insurance types were associated with higher odds of receiving annual dental care and, for those with either Medicare/Medicaid or private insurance, lower odds of having an unmet dental need. When WLWH were asked to describe their oral health, poor self‐reported condition was associated with both an unmet dental need (odds ratio [OR]: 4.52, 95 percent Confidence Interval [CI] [3.29–6.20]) and lower odds of annual dental care utilization (OR: 0.44, 95 percent CI [0.34–0.57]). Self‐reported depressive symptom burden was also linked to having an unmet dental need (OR: 2.10, 95 percent CI [1.46–3.01]).

Conclusions

Dental insurance coverage increases dental care utilization and is associated with better oral health among WLWH. In the era of health‐care reform, dental insurance coverage may be instrumental for enhancing treatment outcomes.
The Role of Hybrid Organizations in Scaling Social Innovations in Bottom‐of‐the‐Pyramid Markets: Insights from Microfinance in India
Authors: Vassallo Jarrod P. , Prabhu Jaideep C. , Banerjee Sourindra , Voola Ranjit
Published: August 2019

While social innovations that solve financial exclusion have gained increasing attention as a means of helping the poor in developing markets, little research has empirically investigated the types of organizations that drive these innovations to achieve scale. Hybrids, a type of organization that exist in between traditional organizational forms, are said to have rapidly gained prevalence, especially in bottom‐of‐the‐pyramid markets. Some scholars claim that hybrids are largely responsible for the spread of established social innovations, yet hybrids do not constitute a homogenous group; instead each hybrid form exists on a spectrum between pure for‐profit and not‐for‐profit organizational forms. It is important that empirical research investigates the role that various hybrid forms play in scaling established social innovations, especially under various bottom‐of‐the‐pyramid market conditions. To this end, using two market‐level outcome measures of scale achieved (prevalence and usage), the authors pursue two research objectives: to study (1) the extent to which, alternative hybrid forms (not‐for‐profit, quasi‐profit, and for‐profit hybrids) drive social innovation; and (2) the relative propensity of these hybrid forms to drive social innovation under varying bottom‐of‐the‐pyramid market conditions, specifically varying levels of development and social diversity. By theorizing how different organizational forms act given their degree of hybridity, the authors develop and test six hypotheses using data sets on microfinance organizations in India. Accordingly, they find that (1) compared with not‐for‐profit and for‐profit hybrids, quasi‐profit hybrids have a propensity to become more prevalent and achieve greater usage in bottom‐of‐the‐pyramid markets overall. Yet, within the spectrum of hybrid forms, (2) not‐for‐profit hybrids are more likely to become more prevalent and achieve greater usage in markets with lower development levels, whereas (3) for‐profit hybrids are more likely to become more prevalent and achieve greater usage in markets with lower social diversity when compared with other hybrid forms.
The effects of dietary nitrate on plasma glucose and insulin sensitivity in sheep
Authors: Villar Maria L. , Godwin Ian R. , Hegarty Roger S. , Dobos Robin C. , Smith Katherine A. , Clay Jonathon W. , Nolan John V.
Published: August 2019

Nitrate (NO3¯) is an effective non‐protein nitrogen source for gut microbes and reduces enteric methane (CH4) production in ruminants. Nitrate is reduced to ammonia by rumen bacteria with nitrite (NO2¯) produced as an intermediate. The absorption of NO2¯ can cause methaemoglobinaemia in ruminants. Metabolism of NO3¯ and NO2¯ in blood and animal tissues forms nitric oxide (NO) which has profound physiological effects in ruminants and has been shown to increase glucose uptake and insulin secretion in rodents and humans. We hypothesized that absorption of small quantities of NO2¯ resulting from a low‐risk dose of dietary NO3¯ will increase insulin sensitivity (SI) and glucose uptake in sheep. We evaluated the effect of feeding sheep with a diet supplemented with 18 g NO3¯/kg DM or urea (Ur) isonitrogenously to NO3¯, on insulin and glucose dynamics. A glucose tolerance test using an intravenous bolus of 1 ml/kg LW of 24% (w/v) glucose was conducted in twenty sheep, with 10 sheep receiving 1.8% supplementary NO3¯ and 10 receiving supplementary urea isonitrogenously to NO3¯. The MINMOD model used plasma glucose and insulin concentrations to estimate basal plasma insulin (Ib) and basal glucose concentration (Gb), insulin sensitivity (SI), glucose effectiveness (SG), acute insulin response (AIRg) and disposition index (DI). Nitrate supplementation had no effect on Ib (p > .05). The decrease in blood glucose occurred at the same rate in both dietary treatments (SG; p = .60), and there was no effect of NO3¯ on either Gb, SI, AIRg or DI. This experiment found that the insulin dynamics assessed using the MINMOD model were not affected by NO3¯ administered to fasted sheep at a low dose of 1.8% NO3¯ in the diet.
Hepatitis B core‐related antigen levels after HBeAg seroconversion is associated with the development of hepatocellular carcinoma
Authors: To Wai‐Pan , Mak Lung‐Yi , Wong Danny Ka‐Ho , Fung James , Liu Fen , Seto Wai‐Kay , Lai Ching‐Lung , Yuen Man‐Fung
Published: August 2019

Hepatitis B core‐related antigen (HBcrAg) is a novel serological marker for hepatitis B virus infection. Its clinical significance after HBeAg seroconversion has not been defined. We aimed to determine the relationship between HBcrAg levels after spontaneous HBeAg seroconversion and hepatocellular carcinoma (HCC). A total of 207 chronic hepatitis B patients with documented time of HBeAg seroconversion were enrolled. HBcrAg and HBsAg were checked within 3 years (as baseline), at 5 and 10 years after HBeAg seroconversion. HBV DNA was measured at the baseline. Multivariate Cox regression model was used to investigate the predictors for HCC development. The median follow‐up time was 13.1 (11.8‐15.5) years. Fourteen patients developed HCC (15‐year cumulative incidence: 7%). The median level of HBcrAg at baseline was significantly higher in patients who developed HCC when compared with patients without HCC (5.68 vs 4.78 log U/ml, respectively; P = .003). Cox proportional hazards model indicated that age of HBeAg seroconversion older than 40 years (hazard ratio (HR): 4.60; P = .049), presence of baseline cirrhosis (HR: 6.23; P = .003) and a higher baseline HBcrAg (HR: 1.75; P = .032) were independently associated with HCC development. A cut‐off value of baseline HBcrAg level ≥5.21 log U/mL yielded an AUROC of 0.74 with a negative predictive value of 97.7%. High HBcrAg levels within 3 years after HBeAg seroconversion were independently associated with the development of HCC in chronic hepatitis B patients.
Using species attributes to characterize late‐glacial and early‐Holocene environments at Kråkenes, western Norway
Authors: Felde Vivian Astrup , Birks Hilary Helen
Published: August 2019

Aim

We aim to use species attributes such as distributions and indicator values to reconstruct past biomes, environment, and temperatures from detailed plant‐macrofossil data covering the late glacial to the early Holocene (ca. 14–9 ka).

Location

Kråkenes, western Norway.

Methods

We applied attributes for present‐day geographical distribution, optimal July and January temperatures, and Ellenberg indicator values for plants in the macrofossil data‐set. We used assemblage weighted means (AWM) to reconstruct past biomes, changes in light (L), nitrogen (N), moisture (F), and soil reaction (R), and temperatures. We compared the temperature reconstructions with previous chironomid‐inferred temperatures.

Results

After the start of the Holocene around 11.5 ka, the Arctic‐montane biome, which was stable during the late‐glacial period, shifted successively into the Boreo‐arctic montane, Wide‐boreal, Boreo‐montane, Boreo‐temperate, and Wide‐temperate biomes by ca. 9.0 ka. Circumpolar and Eurasian floristic elements characteristic of the late‐glacial decreased and the Eurosiberian element became prominent. Light demand (L), soil moisture (F), nitrogen (N), and soil reaction (R) show different, but complementary responses. Light‐demanding plants decreased with time. Soil moisture was relatively stable until it increased during organic soil development during the early Holocene. Soil nitrogen increased during the early Holocene. Soil reaction (pH) decreased during the Allerød, but increased during the Younger Dryas. It decreased markedly after the start of the Holocene, reaching low but stable levels in the early Holocene. Mean July and January temperatures show similar patterns to the chironomid‐inferred mean July temperature trends at Kråkenes, but chironomids show larger fluctuations and interesting differences in timing.

Conclusion

Assigning attributes to macrofossil species is a useful new approach in palaeoecology. It can demonstrate changes in biomes, ecological conditions, and temperatures. The late‐glacial to early‐Holocene transition may form an analogue for changes observed in the modern arctic and in mountains, with melting glaciers, permafrost thaw, and shrub encroachment into tundra.
Procoagulant imbalance influences cardiovascular and liver damage in chronic hepatitis C independently of steatosis
Authors: Sigon Giordano , D'Ambrosio Roberta , Clerici Mariagrazia , Pisano Giuseppina , Chantarangkul Veena , Sollazzi Roberta , Lombardi Rosa , Peyvandi Flora , Lampertico Pietro , Fargion Silvia , Tripodi Armando , Fracanzani Anna Ludovica
Published: August 2019

Background & Aims

Patients with chronic HCV infection besides hepatitis often present cardiovascular damage, the pathogenesis of which is not defined. In chronic liver diseases, including NAFLD and cirrhosis, a procoagulant imbalance, potentially responsible for atherosclerosis has been reported. We aimed at evaluating whether a procoagulant imbalance is present also in non‐cirrhotic patients with HCV infection and whether the procoagulant imbalance correlates with cardiovascular damage. The correlation between the procoagulant imbalance, coexisting steatosis, and liver fibrosis was analysed.

Methods

From 2014 to 2018, 393 subjects (205 patients with chronic HCV infection from two liver units and 188 controls) were enrolled. Metabolic, cardiovascular, liver assessment and coagulation parameters—procoagulants (FII and FVIII) and anticoagulants (antithrombin and protein C [PC]), endogenous thrombin potential (ETP), peak‐thrombin and their ratios (with/without thrombomodulin)—were determined.

Results

The procoagulant imbalance (defined as high FVIII, FVIII/PC ratio, ETP‐ratio and peak‐thrombin‐ratio (with/without thrombomodulin)) was significantly higher in patients with chronic HCV than controls. Steatosis was detected in 87 patients (42%). No difference in coagulation imbalance, carotid and cardiac parameters and severity of liver fibrosis was observed in patients with or without steatosis, despite the latter had less severe metabolic alterations. The FVIII/PC ratio was independently associated with carotid intima‐media thickness (coefficient 0.04, 95% CI 0.002‐0.07, P = .04) and liver fibrosis (coefficient 0.64, 95% CI 0.37‐0.92, P < .0001).

Conclusion

Patients with HCV infection, even in the absence of cirrhosis have a procoagulant‐imbalance that possibly plays a role in increasing the risk of cardiovascular disease and progression of fibrosis.
HBV‐Pol is crucial for HBV‐mediated inhibition of inflammasome activation and IL‐1β production
Authors: Lei Qingsong , Li Tianju , Kong Lingna , Li Lin , Ding Xiaolin , Wang Xiaolin , Zhang Xiaomei , Qin Bo
Published: August 2019

Background & Aims

Hepatitis B virus (HBV) infection is the most critical factor underlying liver cirrhosis and hepatocellular carcinoma worldwide. IL‐1β and IL‐18, generated by activation of the inflammasome/caspase‐1 signaling pathway, play important roles in the control and clearance of HBV. However, the specific relationship between the inflammasome response and IFN‐α resistance or viral persistence is yet to be established.

Methods

Blood samples of patients and supernatant fractions of HBV cell lines were collected for analysis and the effects on inflammasome activation and IL‐1β production evaluated via enzyme‐linked immunosorbent assay (ELISA), western blot, quantitative RT‐PCR and immunofluorescence.

Results

IL‐1β and IL‐18 levels produced in sera of IFN‐α non‐responders were significantly lower than those of responders and normal donors. Additionally, expression of IL‐1β and inflammasome components was decreased in peripheral blood mononuclear cells (PBMC) of non‐responders, compared with those of responders. In vitro experiments on HepG2, HepG2.2.15 and HepAD38 cell lines showed that HBV induces a significant decrease in IL‐1β production through inhibiting activation of the NF‐κB signaling and inflammasome/caspase‐1 pathways. And hepatitis B virus polymerase (HBV‐Pol) appeared crucial for these inhibitory effects of HBV.

Conclusion

IL‐1β production is suppressed in HBV carriers and IFN‐α non‐responders. HBV induces a significant decrease in IL‐1β production through inhibiting the NF‐κB signaling and inflammasome pathways, for which HBV‐Pol is a crucial requirement.

Trial approval number: 20 173 402.
Identified Patient: Apartheid Syndrome, Political Therapeutics, and Generational Care in South Africa
Authors: McIsaac Stephen
Published: August 2019

In contemporary South Africa, racism, economic exclusion, and spatial segregation remain trenchant features of everyday life 25 years after the end of apartheid. In this article, I show how therapeutic practices by black South Africans in one of the country's largest townships address the ongoing legacies of this history. Rather than treat individual psyches, therapists’ practices are oriented toward the relational space between generations, a political therapeutic driven by the affective force of the therapists’ own history of struggle toward a different future for black youth, who continue to be marked by the legacies of colonialism and apartheid. In the process, I track how this political therapeutic confronts the normative demands of psychiatric knowledge. Overall, I argue that rather than solely focusing on the violence of care in clinical settings, we should interrogate political generation and embodied history as forms of expertise and their constitutive potentialities.
A gradient‐forming MipZ protein mediating the control of cell division in the magnetotactic bacterium Magnetospirillum gryphiswaldense
Authors: Toro‐Nahuelpan Mauricio , Corrales‐Guerrero Laura , Zwiener Theresa , Osorio‐Valeriano Manuel , Müller Frank‐Dietrich , Plitzko Jürgen M. , Bramkamp Marc , Thanbichler Martin , Schüler Dirk
Published: August 2019

Cell division needs to be tightly regulated and closely coordinated with other cellular processes to ensure the generation of fully viable offspring. Here, we investigate division site placement by the cell division regulator MipZ in the alphaproteobacterium Magnetospirillum gryphiswaldense, a species that forms linear chains of magnetosomes to navigate within the geomagnetic field. We show that M. gryphiswaldense contains two MipZ homologs, termed MipZ1 and MipZ2. MipZ2 localizes to the division site, but its absence does not cause any obvious phenotype. MipZ1, by contrast, forms a dynamic bipolar gradient, and its deletion or overproduction cause cell filamentation, suggesting an important role in cell division. The monomeric form of MipZ1 interacts with the chromosome partitioning protein ParB, whereas its ATP‐dependent dimeric form shows non‐specific DNA‐binding activity. Notably, both the dimeric and, to a lesser extent, the monomeric form inhibit FtsZ polymerization in vitro. MipZ1 thus represents a canonical gradient‐forming MipZ homolog that critically contributes to the spatiotemporal control of FtsZ ring formation. Collectively, our findings add to the view that the regulatory role of MipZ proteins in cell division is conserved among many alphaproteobacteria. However, their number and biochemical properties may have adapted to the specific needs of the host organism.
Stateless nation within a nationless state: The political past, present, and future of Hongkongers, 1949–2019
Authors: Fong Brian C H
Published: August 2019

Hongkonger identity has been a popular research topic for social scientists worldwide. Drawing upon contemporary theories of stateless nation, this article goes beyond the existing “local vis‐à‐vis national identity” paradigm and re‐articulates the political past, present, and future of the Hongkongers as a stateless nation. The article argues that political future of Hong Kong should be re‐thought within the framework of China's political trajectory as a nationless state.
Post‐traumatic stress symptoms and sense of coherence in proximity to intensive care unit discharge
Authors: Valsø Åse , Rustøen Tone , Skogstad Laila , Schou‐Bredal Ingerl , Ekeberg Øivind , Småstuen Milada C. , Myhren Hilde , Sunde Kjetil , Tøien Kirsti
Published: August 2019

Background

Post‐traumatic stress (PTS) symptoms following intensive care unit (ICU) treatment can lead to post‐traumatic stress disorder and represent a severe health burden. In trauma patients, a strong sense of coherence (SOC) is associated with fewer PTS symptoms. However, this association has not been investigated in a general ICU sample.

Aims and objectives

To examine the occurrence of PTS symptoms in general ICU patients early after ICU discharge and to assess possible associations between PTS symptoms and SOC, ICU memory, pain, and demographic and clinical characteristics.

Design

This was a cross‐sectional study.

Methods

Adult patients aged ≥18 years admitted for ≥24 hours to five ICUs between 2014 and 2016 were recruited. PTS symptoms and SOC were measured at the ward within the first week after discharge from the ICU using the Posttraumatic Stress Scale‐10 and Sense of Coherence Scale‐13. Multiple linear regression analysis was used to identify associations between PTS symptoms and SOC and the selected independent variables.

Results

A total of 523 patients were included (17.8% trauma patients; median age 57 years [range 18‐94]; 53.3% male). The prevalence of clinically significant PTS symptoms was 32%. After adjustments for gender and age, lower SOC (P < 0.001), more ICU delusional memories (P < 0.001), greater pain interference (P < 0.001), not being a trauma patient (P = 0.02), and younger age (P = 0.03) were significantly associated with more PTS symptoms.

Conclusions

One third of patients experienced clinically relevant PTS symptoms early after discharge from the ICU. In the present study, SOC, delusional memory, pain interference, younger age, and not being a trauma patient were factors associated with more PTS symptoms.

Relevance to clinical practice

Early individual follow up after ICU discharge focusing on pain relief and delusional memory may reduce PTS symptoms, with a potential of improving rehabilitation.
Shoot surface water uptake enables leaf hydraulic recovery in Avicennia marina
Authors: Fuenzalida Tomás I. , Bryant Callum J. , Ovington Leuwin I. , Yoon Hwan‐Jin , Oliveira Rafael S. , Sack Lawren , Ball Marilyn C.
Published: August 2019

The significance of shoot surface water uptake (SSWU) has been debated, and it would depend on the range of conditions under which it occurs. We hypothesized that the decline of leaf hydraulic conductance (Kleaf) in response to dehydration may be recovered through SSWU, and that the hydraulic conductance to SSWU (Ksurf) declines with dehydration.

We quantified effects of leaf dehydration on Ksurf and effects of SSWU on recovery of Kleaf in dehydrated leaves of Avicennia marina.

SSWU led to overnight recovery of Kleaf, with recovery retracing the same path as loss of Kleaf in response to dehydration. SSWU declined with dehydration. By contrast, Ksurf declined with rehydration time but not with dehydration.

Our results showed a role of SSWU in the recovery of leaf hydraulic conductance and revealed that SSWU is sensitive to leaf hydration status. The prevalence of SSWU in vegetation suggests an important role for atmospheric water sources in maintenance of leaf hydraulic function, with implications for plant responses to changing environments.
Nutrition‐related interventions targeting childhood overweight and obesity: A narrative review
Authors: Kerr Jessica A. , Loughman Amy , Knox Andrew , Koplin Jennifer J. , Allen Katrina J. , Wake Melissa
Published: August 2019

Systematic reviews of nutritional interventions indicate limited efficacy in reducing childhood obesity, but their blanket conclusions could obscure promising components. This narrative review sought more detail on effective components within nutrition‐related interventions involving children aged 2 to 11 years. In May 2016, the World Health Organization (WHO) searched the Cochrane Library and PubMed for relevant reviews. From 36 reviews, we screened 182 nutrition‐related randomized trials for inclusion. We then reviewed those that reported at least 1 statistically significant (P < 0.05) treatment benefit on body weight and/or composition outcomes at their longest follow‐up assessment. Fourteen trials met inclusion criteria (median n = 554; mean intervention duration = 10.8 mo; follow‐up = 4.4 mo). “Effective” approaches included environmental changes such as school water fountain installations and cafeteria menu changes and possibly less sustainable strategies such as health education lessons. However, effect sizes even of these selected significant treatment benefits were modest—significant body mass index z‐score effects range from −0.1 to −0.2. Each trial was associated with very small improvements in body composition. Because this is a “best‐case” scenario (reflecting our design), trialists should rigorously test these strategies alone and possibly together; be open to novel strategies; and ensure that each strategy is culturally relevant and self‐sustainable.
Severe hypersensitivity reactions to biological drugs in children with rheumatic diseases
Authors: Soyer Ozge , Demir Selcan , Bilginer Yelda , Batu Ezgi Deniz , Sonmez Hafize Emine , Arıcı Zehra Serap , Şahiner Ümit Murat , Sekerel Bulent Enis , Ozen Seza
Published: August 2019

Background

Hypersensitivity reactions (HSR) to biologic drugs (BD) may limit their use in children with rheumatic diseases. We aimed to analyze the incidence and clinical characteristics of immediate type I (IgE/non‐IgE) hypersensitivity reactions to BD and the risk factors for these reactions.

Methods

Children with rheumatic diseases using BD who were evaluated in the pediatric allergy department for possible drug hypersensitivity reaction (DHR) due to BD or any other drug were included in the study.

Results

One hundred and twenty‐eight children (49.2% boys; 14.6 years [9.9‐16.9 years] with juvenile idiopathic arthritis [58%], familial Mediterranean fever [14%], vasculitis [14%], and other diseases [14%]) had used eight different BD with 32 494 infusions/injections. Fifteen patients were evaluated for DHR [injection‐site reactions [n = 4], adverse events [n = 2], drug hypersensitivity other than BD [n = 3], and immediate BD hypersensitivity [n = 6]). The incidence of immediate BD HSR was 4.7%, with a clinical presentation of anaphylaxis in 3.9% (tocilizumab [n = 3], rituximab [n = 2], positive skin test with culprit BD [n = 3]). Among patients with BD HSR, the median follow‐up was longer (84.5 vs 54 months, P = .048), and renal (33.3% vs 4.1%, P = .002), hematologic involvement (16.7% vs 0, P < .001), and active disease (83.3% vs 13.9%, P < .001) were more common. Logistic regression analysis revealed that renal involvement, more than 14 hospitalizations per lifetime, and more than two different BD used were associated with BD hypersensitivity.

Conclusion

The frequency of severe immediate HSR due to BD was shown to be 3.9% in children with rheumatic diseases. Children with active rheumatic disease and who have exposure to multiple BD should be monitored for BD HSR, particularly during intravenous BD infusions.
A structured graduated protocol with heat denatured eggs in the treatment of egg allergy
Authors: Gotesdyner Leora , Zeldin Yuri , Machnes Maayan Diti , Efron Adi , Stauber Tali , Maoz Segal Ramit , Binson Inga , Dinkin Mira , Dinkowitz Larisa , Nevet Ayelet , Asher Ilan , Yakar Yael , Agmon‐Levin Nancy , Kenett Ron S. , Kidon Mona I.
Published: August 2019

Background

Most children with egg allergy (EA) can tolerate extensively heated and baked egg (EHBE). Consumption of EHBE may promote faster resolution of EA; however, no consensus exists as to the required amounts and treatment protocols.

Objective

To evaluate the efficacy and safety of a structured graduated exposure protocol (SGEP) with EHBE in promoting tolerance to eggs in EA children under 2 years of age.

Methods

In a case‐control study, EA children aged < 2 years who were treated with SGEP including EHBE were compared to children treated with strict avoidance. Data were collected from records and telephone questionnaires. Analysis was performed using non‐parametric Kaplan‐Meier and Cox proportional hazard regression models.

Results

Thirty‐nine egg‐allergic children with a median age at intervention of 16 months (interquartile range: 13‐19) were treated with SGEP and followed to a median age of 39 months (26.8‐50.0). The median age at resolution of EA was compared to a matched group of 80 children treated with strict avoidance at least until 2 years of age or earlier natural resolution and followed to a median age of 69 months (46‐104). The median estimated age at EA resolution in the SGEP group was 24 months (95% CI, 19.5‐28.5 months), compared to 78 months (95% CI, 53‐102) in the control group, P < .001. At last follow‐up, 82% of treated children were tolerant to lightly cooked eggs vs 54% of controls, P = .001.

Conclusion

A structured protocol with EHBE appears to promote faster resolution of EA.
Psychometric profile of the Ages and Stages Questionnaires, Japanese translation
Authors: Mezawa Hidetoshi , Aoki Sayaka , Nakayama Shoji F. , Nitta Hiroshi , Ikeda Natsuha , Kato Keiko , Tamai Satoshi , Takekoh Makoto , Sanefuji Masafumi , Ohga Shouichi , Oda Masako , Mitsubuchi Hiroshi , Senju Ayako , Kusuhara Koichi , Kuwajima Mari , Koeda Tatsuya , Ohya Yukihiro , Hashimoto Keiji
Published: August 2019

Background

This study assessed the psychometric profile of 10 questionnaires (every 6 months, from 6 to 60 months) from the Japanese translation of the Ages and Stages Questionnaires, third edition (J‐ASQ‐3).

Methods

Data from 439 children in a birth cohort were used to identify the J‐ASQ‐3 score distribution, establish cut‐off scores, and calculate the instrument's internal consistency. Data were also collected from 491 outpatients to examine J‐ASQ‐3 test–retest reliability and concurrent validity, which was examined using the Kyoto Scale of Psychological Development (KSPD) and the Japanese version of the Denver Developmental Screening Test II (J‐Denver II). Both the original and the alternative screening criteria of the ASQ‐3 were used (failure in at least one and at least two domains, respectively).

Results

Cronbach's alpha for each J‐ASQ‐3 subscale on each questionnaire ranged from 0.45 to 0.89. Test–retest reliability was >0.75 for the subscales on almost all questionnaires. Concurrent validity was also adequate. In comparison with the screening results of the KSPD, the overall sensitivity and specificity were 96.0% and 48.8%, respectively, when the ASQ‐3 original criterion was used, and 92.1% and 74.9%, respectively, when the alternative criterion was used. In comparison with the screening results of the J‐Denver II, the overall sensitivity and specificity were 75.6% and 74.7%, respectively, when the ASQ‐3 original criterion was used, and 56.3% and 93.0%, respectively, when the alternative criterion was used.

Conclusions

This study quantified the psychometric profiles of the Japanese translations of 10 ASQ‐3 questionnaires. We demonstrated the validity of the J‐ASQ‐3 and determined new cut‐off scores. Further studies with larger samples from a greater range of locations are required to clarify the suitability of this tool for all Japanese children.
Home‐based pulmonary rehabilitation for COPD using minimal resources: An economic analysis
Authors: Burge Angela T. , Holland Anne E. , McDonald Christine F. , Abramson Michael J. , Hill Catherine J. , Lee Annemarie L. , Cox Narelle S. , Moore Rosemary , Nicolson Caroline , O'Halloran Paul , Lahham Aroub , Gillies Rebecca , Mahal Ajay
Published: August 2019

Background and objective

This study aimed to compare the cost‐effectiveness and cost‐utility of home and centre‐based pulmonary rehabilitation for adults with stable chronic obstructive pulmonary disease (COPD).

Methods

Prospective economic analyses were undertaken from a health system perspective alongside a randomized controlled equivalence trial in which participants referred to pulmonary rehabilitation undertook a standard 8‐week outpatient centre‐based or a new home‐based programme. Participants underwent clinical assessment prior to programme commencement, immediately following completion and 12 months following programme completion. They provided data for utility (quality‐adjusted life years (QALY) determined using SF6D (utility scores for health states) calculated from 36‐Item Short Form Health Survey version 2) and effectiveness (change in distance walked on 6‐min walk test (Δ6MWD) following pulmonary rehabilitation ). Individual‐level cost data for the 12 months following programme completion was sourced from healthcare administration and government databases.

Results

Between‐group mean difference point estimates for cost (−$4497 (95% CI: −$12 250 to $3257), utility (0.025 (−0.038 to 0.086) QALY) and effectiveness (14 m (−11 to 39) Δ6MWD) favoured the home‐based group. Cost‐utility analyses demonstrated 63% of estimates falling in the dominant southeast quadrant and the probability that the new home‐based model was cost‐effective at a $0 threshold for willingness to pay was 78%. Results were robust to a range of sensitivity analyses. Programme completion was associated with significantly lower healthcare costs in the following 12 months.

Conclusion

Home‐based pulmonary rehabilitation provides a cost‐effective alternative model for people with COPD who cannot access traditional centre‐based programmes.
The prognostic value of tumour‐associated macrophages in Non‐Hodgkin's lymphoma: A systematic review and meta‐analysis
Authors: Xu Xuanxuan , Li Zhixia , Liu Jun , Zhu Fengfeng , Wang Zhitao , Wang Jiyu , Zhang Jiakui , Wang Huiping , Zhai Zhimin
Published: August 2019

Tumour‐associated macrophages (TAMs) play an important role in the tumour environment and were reported to be associated with poor prognosis in several tumours. However, the prognostic significance of TAMs in Non‐Hodgkin's Lymphoma (NHL) remains controversial. Consequently, we aimed to evaluate the relationship between subpopulations of TAMs and clinical outcomes in NHL patients. We did a comprehensive search of the PubMed, elsevier ScienceDirect, and Cochrane databases and extracted hazard ratio (HR) and their corresponding 95% confidence intervals (95% CIs) from eligible studies. Pooling total effect value by the stata statistical software and analysing correlation of TAMs with overall survival (OS) and progression‐free survival (PFS). Furthermore, subgroup analysis and sensitivity analysis were also conducted. We deemed eleven studies, including 1211 NHL patients. Our study demonstrated that high‐density CD68+ TAMs are associated with poor OS (HR: 1.17; 95% CI, 0.81‐1.54; P = .000) and poor PFS (HR: 1.15; 95% CI, 0.63‐1.67; P = .000) compared with low‐density CD68+ TAMs in the tumour microenvironment. Similarly, high‐density CD163+ TAMs can also predict poor OS (HR: 1.52; 95% CI, 1.11‐1.92; P = .000) and shorter PFS (HR: 1.52; 95% CI, 0.73‐2.30; P = .000). In addition, the high CD163+/CD68+ TAMs ratio is significantly correlated with poor OS (HR: 3.59; 95% CI, 0.77‐6.40; P = .013). However, in our subgroup analysis, high‐density CD68+ TAMs in the tumour microenvironment is associated with better OS (HR: 0.75; 95% CI, 0.41‐1.09; P = .000) in NHL patients treated with rituximab chemotherapy. Our results suggest that TAMs are a robust predictor of outcomes in NHL.
Demographic Transition and Fertility Rebound in Economic Development*
Authors: Ohinata Asako , Varvarigos Dimitrios
Published: August 2019

Recent evidence on the “fertility rebound” offers credence to the idea that, from the onset of early industrialization to the present day, the dynamics of fertility can be represented by an N‐shaped curve. An overlapping generations model with parental investment in human capital can account for these observed movements in fertility rates during the different stages of demographic change. A demographic transition with declining fertility emerges at the intermediate stage, when parents engage on a child quantity–quality trade‐off. At later stages, however, the process of economic growth generates sufficient resources so that households can rear more children while still providing the desirable amount of education investment per child.
Cox regression of clustered event times with covariates missing not at random
Authors: Liu Li , Liu Yanyan , Xiong Yi , Hu X. Joan
Published: August 2019

Motivated by a recent tuberculosis (TB) study, this paper is concerned with covariates missing not at random (MNAR) and models the potential intracluster correlation by a frailty. We consider the regression analysis of right‐censored event times from clustered subjects under a Cox proportional hazards frailty model and present the semiparametric maximum likelihood estimator (SPMLE) of the model parameters. An easy‐to‐implement pseudo‐SPMLE is then proposed to accommodate more realistic situations using readily available supplementary information on the missing covariates. Algorithms are provided to compute the estimators and their consistent variance estimators. We demonstrate that both the SPMLE and the pseudo‐SPMLE are consistent and asymptotically normal by the arguments based on the theory of modern empirical processes. The proposed approach is examined numerically via simulation and illustrated with an analysis of the motivating TB study data.
Evaluation of weight loss in canine cancer bearing patients undergoing radiation therapy
Authors: Callanan Gabrielle F. , Pfeiffer Isabella , Smith Kaitlin
Published: August 2019

Critical weight loss, as defined by ≥5% decrease in body weight, has been associated with increased morbidity and mortality in human patients with cancers of the head and neck. Weight loss has anecdotally been reported to occur frequently in veterinary patients undergoing radiation therapy and is hypothesized to be more severe in patients with cancers of the head and neck, along with those hospitalized during radiation therapy. The primary objective of this retrospective study was to evaluate the occurrence of critical weight loss in canine cancer bearing patients undergoing either definitive or palliative radiation protocols and to determine if weight changes were associated with radiation toxicity, tumour location or patient hospitalization status. Data from 47 dogs who underwent definitive and 43 dogs who underwent palliative radiation protocols at the University of Tennessee were included for analysis. Dogs were categorized based on tumour location (head/neck or other), hospitalization status (boarded or non‐boarded) and radiation toxicity score. Weight recorded at the start of treatment, midway through treatment and at the final treatment was used for analysis. No significant differences were found in regard to weight change over time, location or hospitalization status when evaluated for both protocols. Overall, 5/90 dogs (5.5%) lost 5% or more of their body weight during therapy, and 7/90 dogs (7.7%) gained 5% or more of their body weight. The results of the current study suggest that critical weight loss occurs in a small percentage of canine patients undergoing radiation therapy, contrary to what is often anecdotally reported.
Electrochemotherapy in treatment of canine oral non‐tonsillar squamous cell carcinoma. A case series report
Authors: Simčič Petra , Lowe Ron , Granziera Valentina , Pierini Alessio , Torrigiani Filippo , Lubas George
Published: August 2019

Non‐tonsillar squamous cell carcinoma (ntSCC) is a common and locally aggressive oral tumour in dogs. The treatments of choice are currently surgery and radiotherapy. Electrochemotherapy (ECT) is a local ablative anti‐tumour technique using electric pulses to enhance the intracellular diffusion of cytotoxic drugs. The aim was to retrospectively evaluate the outcome of patients with oral ntSCC treated with ECT. Twelve dogs with ntSCC were retrospectively enrolled. ECT was combined with IV bleomycin (15 000 UI/m2) alone in 11 cases and post‐surgery in 1. Parameters considered were: tumour site and size, electroporation parameters, response rate (complete remission [CR], partial remission [PR]), median survival time (MST), recurrence rate (RR), median disease‐free interval (DFI) and treatment toxicity (6‐point scale). Median tumour size was 1.65 cm (range 0.3‐8.0 cm) and the response rate was 90.9% (10/11; 8 CR and 2 PR). Two dogs underwent a second ECT. MST for dogs dead with tumour (n = 2) was 110 days and for dogs dead without tumour (n = 3) was 831 days. Among five surviving dogs, one experienced tumour recurrence and four were in CR. Results from two dogs were analysed separately. Overall RR was 27.3%. DFI and MST for dogs with recurrence were 50 and 115 days, respectively. Treatment toxicity was very low. We noticed that all dogs with tumours smaller than 1‐2 cm achieved CR without recurrence suggesting a favourable prognosis when using ECT. ECT for canine ntSCC could be considered a valid treatment option especially for smaller tumours, but a larger caseload would be needed to confirm this statement.