bluuebunny/crossref_metadata_2025 huggingface dataset:
Does maternal attachment to her infant mediate the link between perceptions of infant crying at 6 months and parenting stress at 24 months? A structural equation modelling approach
Authors: Bailhache Marion , Doyle Orla , Salmi Louis‐Rachid , McDonnell Therese
Published: April 2019

Background

Parenting stress is influenced by many factors including maternal attachment and excessive infant crying, yet the nature of these relationships is not well understood. For example, excessive infant crying despite maternal soothing may impact maternal attachment to the child, leading to higher stress. This paper explored whether maternal perception of excessive infant crying at 6 months was associated with higher maternal parenting stress at 24 months, and whether maternal attachment mediated this relationship.

Methods

All families, present at 24 months in a randomized controlled trial of a 5‐year early intervention programme targeting school readiness skills in disadvantaged area of Ireland, were included. At 6 months, infant crying was assessed using a maternal reported measure of duration of infant crying, and maternal attachment to the infant was assessed using the Condon Maternal Attachment Scale. Parenting stress was assessed at 24 months using the childrearing stress subscale from the Parenting Stress Index. Structural equation modelling was used to explore the direct and indirect effects of maternal perceptions of excessive infant crying on parenting stress, controlling for infant, maternal, and environmental characteristics, and focusing on the mediating role of maternal attachment.

Results

Reporting excessive infant crying at 6 months was associated with lower maternal attachment at 6 months, which led to higher parenting stress at 24 months. In addition, vulnerable adult attachment style, previous maternal mental health difficulties, low paternal education, paternal involvement with the child, and not being married were associated with higher parenting stress.

Conclusion

Findings suggest that the association between maternal perceptions of excessive crying at 6 months and later parenting stress may be mediated through maternal attachment to the infant. Interventions based on improving maternal attachment could be investigated to determine the effectiveness of supporting mothers with low attachment.
Nepal's civil war and the changing sources of income: The role of sectoral shifts and remittances in mitigation and recovery
Authors: Bansak Cynthia , Chezum Brian
Published: April 2019

Given the increased worldwide unrest and a large number of displaced individuals, understanding the economic impacts of civil war has been the subject of growing attention by academics and policymakers. The 10‐year civil war in Nepal from 1996 to 2006 provides an opportunity to assess the impact of civil unrest on income sources and remittance patterns. In this study, we examine the changes in household income generating processes over the period of the Nepali civilwar. Using survey data from the Nepal Living Standards Survey (NLSS) in 1995/1996 and 2010/2011, we observe household income and remittance patterns before and after the civil war. Specifically, we employ a difference‐in‐difference estimator that focuses on the heterogeneity in civil unrest within Nepal to examine how the civil war impacted the sources of household income. Within the context of a slower growth rate of income after the revolution for those in the hardest hit districts, we find that there was also a change in the composition of income sources. In particular, our results suggest that there was a shift from a reliance on wages in the nonagricultural sector to wages in the agricultural sector; that there was a shift from external remittances to internal remittances; and finally that home production—the market value of items produced and consumed within the household—may be taking the place of income in regions hit by unrest. “People living in zones of war are maimed, killed, and see their property destroyed. They may be displaced or prevented from attending school or earning a living. To the extent that these costs are borne unequally across groups, the conflict could intensify economic inequality as well as poverty. The destruction (and deferred accumulation) of both human and physical capital also hinder macroeconomic performance, combining with any effects of war on institutions and technology to impact national income growth. Understanding the economic legacies of conflict is important to the design of post‐conflict recovery” (Blattman & Miguel, 2010).
Neonatal amygdalae and hippocampi are influenced by genotype and prenatal environment, and reflected in the neonatal DNA methylome
Authors: Ong Mei‐Lyn , Tuan Ta A. , Poh Joann , Teh Ai L. , Chen Li , Pan Hong , MacIsaac Julia L. , Kobor Michael S. , Chong Yap S. , Kwek Kenneth , Saw Seang M. , Godfrey Keith M. , Gluckman Peter D. , Fortier Marielle V. , Karnani Neerja , Meaney Michael J. , Qiu Anqi , Holbrook Joanna D.
Published: April 2019

The amygdala and hippocampus undergo rapid development in early life. The relative contribution of genetic and environmental factors to the establishment of their developmental trajectories has yet to be examined. We performed imaging on neonates and examined how the observed variation in volume and microstructure of the amygdala and hippocampus varied by genotype, and compared with prenatal maternal mental health and socioeconomic status. Gene × Environment models outcompeted models containing genotype or environment only to best explain the majority of measures but some, especially of the amygdaloid microstructure, were best explained by genotype only. Models including DNA methylation measured in the neonate umbilical cords outcompeted the Gene and Gene × Environment models for the majority of amygdaloid measures and minority of hippocampal measures. This study identified brain region‐specific gene networks associated with individual differences in fetal brain development. In particular, genetic and epigenetic variation within CUX1 was highlighted.
Immunohistochemical expression of HIK1083 and MUC6 in endometrial carcinomas
Authors: Hodgson Anjelica , Parra‐Herran Carlos , Mirkovic Jelena
Published: April 2019

Aims

Gastric‐type endocervical adenocarcinoma (EA) is characterised by aggressive behaviour and pathogenesis independent of human papillomavirus infection. Because of its morphology and frequent mutation‐pattern expression of p53, gastric‐type EA may be confused with several types of endometrial carcinoma, particularly in biopsy and curettage specimens. HIK1083 and MUC6 are immunohistochemical markers used to support a diagnosis of gastric‐type EA; however, the rates of expression of these markers in endometrial tumours are largely unknown. We therefore aimed to assess the expression of HIK1083 and MUC6 in a cohort of different types of endometrial carcinoma.

Methods and results

Ninety‐one endometrial carcinomas (56 endometrioid, 16 clear cell, and 19 serous) from 91 patients treated with hysterectomy were included. A representative tumour block from each case was used for immunohistochemical staining with HIK1083 and MUC6. The percentage of stained cells (0–100%) and average staining intensity (weak, moderate, and strong) were recorded for both markers. None of 91 cases expressed HIK1083. In contrast, 66% (60/91) of cases showed at least focal expression of MUC6; importantly, 54 of 60 (90%) positive cases showed moderate or strong staining. Five of 60 (8%) cases showed MUC6 staining in ≥50% of tumour cells. Endometrioid tumours (49/56, 88%) were more likely to express MUC6 than cases of clear cell (1/16, 6%) or serous (10/19, 53%) carcinoma.

Discussion

Endometrial carcinoma often expresses MUC6. In contrast, HIK1083 is consistently negative, and thus, when positive, is a more reliable marker for distinguishing gastric‐type EA from some of its endometrial mimics.
Social disorganisation theory and suicide
Authors: Moore Matthew D.
Published: April 2019

Early examinations of homicide and suicide by sociologists believed that the two forms of deviance were similar. However, the investigation into the exact association between homicide and suicide has been unexplored in more recent years. Yet studies examining homicide and suicide independently often illustrate that similar structural factors predict increases in both forms of deviance. At the same time, studies of homicide and suicide have shown an inverse relationship. Using data from the Center for Disease Control and Prevention and the US Census Bureau, the current analysis explores if factors predicting homicide can be applied to suicide, using social disorganisation theory as a guide. Multivariate regression analysis reveals that some of the same factors theorised by social disorganisation theory do predict increased levels of suicide. The current analysis demonstrates that theories of crime may be applied to suicide to gain a fuller understanding of the deviant act.
Dermatoscopic evaluation of melanocytic nevi under laser therapy
Authors: Stolz W.
Published: April 2019

Linked article: Guicciardi et al. J Eur Acad Dermatol Venereol 2019; 33: 954 –958. https://doi.org/10.1111/jdv.15388.
Changes in the quality of sliced mortadella sausages prepared using chitosan
Authors: Martins Aline P. , de Abreu Martins Heloísa H. , Isidoro Silas R. , Alcântara João P. , Ramos Eduardo M. , Piccoli Roberta H.
Published: April 2019

This study aimed to evaluate the changes in the quality of mortadella sausages with different concentrations of chitosan during the cold storage period. The mortadella was prepared using 0, 1, 2, and 3% chitosan. It was then sliced, vacuum packed and stored at 4°C for a period of 60 days. During the storage period pH, water activity, oxy‐reduction potential, residual nitrite, and degree of oxidation were evaluated. In addition, the development of coagulase‐positive staphylococci, Salmonella spp., Clostridium reducing sulfite, coliforms, psychrotrophic microorganisms, mold, and yeast as well as lactic acid bacteria were analyzed. Sensorial analyzes to characterize mortadella were performed using the check‐all‐that‐apply (CATA) method. Mortadella prepared with chitosan presented technological feasibility, an antimicrobial and antioxidant activity, sensory acceptance, and in addition it is a source of fibers.

Practical Applications

Mortadella is a meat product consumed in many countries, however, it is food that needs to improve its image for the consumer, mainly because it is rich in fat, salt, and synthetic additives. Chitosan is a natural polysaccharide that has been studied as a functional ingredient in foods, possessing antioxidant, and antimicrobial characteristics. The addition of chitosan to mortadella can improve the quality of the product and provide the consumer a meat product with nutritional benefits and greater stability and shelf life.
Adults with autism are less proficient in identifying biological motion actions portrayed with point‐light displays
Authors: Hsiung E.‐Y. , Chien S. H.‐L. , Chu Y.‐H. , Ho M. W.‐R.
Published: April 2019

Background

Whether individuals with autism spectrum disorder (ASD) have impairments with biological motion perception has been debated. The present study examined the ability to identify point‐light‐displayed (PLD) human actions in neurotypical (NT) adults and adults with ASD.

Method

Twenty‐seven adults with ASD (mean age = 28.36) and 30 NT adults (mean age = 22.45) were tested. Both groups viewed 10 different biological motion actions contacting an object/tool and 10 without making contact. Each action was presented twice, and participant's naming responses and reaction times were recorded.

Results

The ASD group had a significantly lower total number of correct items (M = 29.30 ± 5.08 out of 40) and longer response time (M = 4550 ± 1442 ms) than NT group (M = 32.77 ± 2.78; M = 3556 ± 1148 ms). Both groups were better at naming the actions without objects (ASD group: 17.33 ± 2.30, NT group: 18.67 ± 1.30) than those with objects (ASD group: 11.96 ± 3.57, NT group: 14.10 ± 1.97). Correlation analyses showed that individuals with higher Autism‐spectrum Quotient scale scores tended to make more errors and responded more slowly.

Conclusion

Adults with ASD were able to identify human point‐light display biological motion actions much better than chance; however, they were less proficient compared with NT adults in terms of accuracy and speed, regardless of action type.
Proteomics; applications in familial Parkinson's disease
Authors: Li Yan , Cookson Mark R.
Published: April 2019

Our understanding of the biological basis of Parkinson's disease (PD) has been greatly improved in recent years by the identification of mutations that lead to inheritedPD. One of the strengths of using genetics to try to understand disease biology is that it is inherently unbiased and can be applied at a genome‐wide scale. More recently, many studies have used another set of unbiased approaches, proteomics, to query the function of familialPDgenes in a variety of contexts. We will discuss some specific examples, including; elucidation of protein‐protein interaction networks for two dominantly inherited genes, α‐synuclein and leucine rich‐repeat kinase 2 (LRRK2); the identification of substrates for three genes for familialPDthat are also enzymes, namelyLRRK2, pink1, and parkin; and changes in protein abundance that arise downstream to introduction of mutations associated with familialPD. We will also discuss those situations where we can integrate multiple proteomics approaches to nominate deeper networks of inter‐related events that outline pathways relevant to inheritedPD.

image

This article is part of the Special Issue "Proteomics".
Temporal sweetness profile of the emerging sweetener MNEI in stirred yogurt
Authors: Miele Nicoletta A. , Leone Serena , Cabisidan Erliza K. , Picone Delia , Di Monaco Rossella , Cavella Silvana
Published: April 2019

Yogurt is widely consumed by people under‐controlled dietary regimes. The addition of hypocaloric sweeteners to the yogurt is typically used to make them more palatable, but this may affect the fermentation phase and/or its physical and sensory characteristics. The aim of this work was to test the possible application of an emerging sweetener, MNEI, a variant of a sweet protein, monellin. In particular, its sweetness profile was compared with that of other natural sweeteners, sucrose, xylitol, and sorbitol, in yogurt. First, determinations of iso‐sweet concentration of MNEI and of those sweeteners were performed, both for set and stirred yogurts. Then, the sweetness temporal profiles of all the sweeteners were evaluated as the mean of time–intensity data (t–I). In set yogurt, the iso‐sweet concentrations of xylitol and sorbitol, but not of MNEI, were found, whereas, in stirred yogurts, the concentrations were determined for all the sweeteners. t–I results showed that sweeteners had similar behaviors, except for the end time of sweetness perception: in particular, in stirred yogurt, MNEI resulted in a more lingering sweet aftertaste. These results suggest new applications of the sweet protein MNEI in food preparations, although the combination with other natural sweeteners could be explored.

Practical applications

Yogurts are ideal products to develop potential applications of MNEI, a protein that has been demonstrated stable to acidic environments, and to our knowledge, this is the first report of the use of a sweet protein to sweeten viscous food preparations. Preliminary experimental results suggest new possible applications of sweet protein MNEI in food samples. In particular, it could be used to sweeten‐stirred yogurt.
Utility of viral kinetics in HCV therapy – It is not over until it is over?
Authors: Sandmann Lisa , Manns Michael P. , Maasoumy Benjamin
Published: April 2019

See Article on Page 826
Human activity can influence the gut microbiota of Darwin's finches in the Galapagos Islands
Authors: Knutie Sarah A. , Chaves Jaime A. , Gotanda Kiyoko M.
Published: April 2019

The gut microbiota of animal hosts can be influenced by environmental factors, such as unnatural food items that are introduced by humans. Over the past 30 years, human presence has grown exponentially in the Galapagos Islands, which are home to endemic Darwin's finches. Consequently, humans have changed the environment and diet of Darwin's finches, which in turn, could affect their gut microbiota. In this study, we compared the gut microbiota of two species of Darwin's finches, small ground finches (Geospiza fuliginosa) and medium ground finches (Geospiza fortis), across sites with and without human presence, where finches prefer human‐processed and natural food, respectively. We predicted that: (a) finch microbiota would differ between sites with and without humans due to differences in diet, and (b) gut microbiota of each finch species would be most similar where finches have the highest niche overlap (areas with humans) compared to the lowest niche overlap (areas without humans). We found that gut bacterial community structure differed across sites and host species. Gut bacterial diversity was most distinct between the two species at the site with human presence compared to the site without human presence, which contradicted our predictions. Within host species, medium ground finches had lower bacterial diversity at the site with human presence compared to the site without human presence and bacterial diversity of small ground finches did not differ between sites. Our results show that the gut microbiota of Darwin's finches is affected differently across sites with varying human presence.
The development of the Compassion Focused Therapy Therapist Competence Rating Scale
Authors: Horwood Victoria , Allan Steven , Goss Kenneth , Gilbert Paul
Published: April 2019

Objectives

Compassion‐focused therapy (CFT) has shown promise as a treatment for a number of clinical presentations; however, existing studies have not adequately addressed issues of treatment fidelity. The aims of the present study were to identify initial candidate items that may be included in a CFT therapist competence rating scale and to develop the behavioural indicators to anchor these items.

Design

The Delphi method was used to develop and operationalize the competencies required for inclusion in a CFT therapist competence rating scale over five rounds.

Methods

Face‐to‐face meetings with two CFT experts were conducted in rounds one, two, and five, and these were used to define and operationalize the competencies. Nine other CFT experts were invited to complete online surveys in rounds two and four. An 80% consensus level was applied to the online surveys.

Results

The resulting Compassion Focused Therapy Therapist Competence Rating Scale (CFT‐TCRS) consisted of 23 competencies which were separated into 14 ‘CFT unique competencies’ and nine ‘Microskills’. There was high agreement about the included ‘CFT unique competencies’ and ‘Microskills’; however, there were some differences in opinion about the specific content of some items.

Conclusions

This is the first study that has attempted to reach consensus regarding the competencies and behavioural anchors for a CFT therapist competence rating scale. The next stage of development for the CFT‐TCRS is to establish whether the scale can be reliably and validly used to evaluate CFT practice.

Practitioner points

The Compassion Focused Therapy Therapist Competence Rating Scale (CFT‐TCRS) is the first scale to operationalize the unique and generic competencies required to deliver compassion‐focused therapy (CFT).

The CFT‐TCRS can be used as a learning guide for delivering CFT training and with further development could be used to assess therapist competence for CFT training courses, clinical practice, and treatment fidelity in research trials.
Evaluating where and how habitat restoration is undertaken for animals
Authors: Hale Robin , Mac Nally Ralph , Blumstein Daniel T. , Swearer Stephen E.
Published: April 2019

Habitat restoration is vital to ameliorate the effects of anthropogenic disturbances on animal habitats. We reviewed the peer‐reviewed literature to examine where and how habitat restoration is undertaken. Our aim was to identify key knowledge gaps as well as research and monitoring needs that can inform future restoration actions. We found: (1) marine and terrestrial actions focus most commonly on restoring vegetation, and freshwater actions focus on restoring the in‐channel habitat; (2) arthropods are the most common focal group; (3) there is often no collection of pre‐restoration data, so certainty in attributing environmental changes to restoration actions is limited; and (4) population and community measures are most commonly used in monitoring programs, which only show if animals are present at restored sites and not whether they are able to grow, survive, and reproduce. We highlight three important considerations for future restoration actions. First, more integration of knowledge among freshwater, marine, and terrestrial systems will help us to understand how, and why, restoration outcomes might vary in different contexts. Second, where possible, restoration projects should be assessed using before‐after‐control‐impact designs, which will provide the strongest evidence if desired restoration responses occur. Third, if the goal of restoration is to develop self‐sustaining breeding populations of target animals, then measures of fitness (i.e. breeding, survival) should be collected. These recommendations will hopefully help guide more effective restoration practices and monitoring in the future.
Normalcy, Understanding and the Problem of Statistical Evidence
Authors: Belkoniene Miloud
Published: April 2019

This article examines Smith's recent treatment of the problem of statistical evidence and the conception of epistemic justification that he puts forward. Two possible solutions to the problem of statistical evidence that result from his analysis of cases involving a contrast between statistical and individual evidence are considered. The solution resulting from Smith's conception of epistemic justification is shown to be inferior to the solution calling for an explanationist conception of epistemic justification. As a result, Smith's analysis of cases illustrating the problem of statistical evidence, given his own standards of theory choice, is shown to support an explanationist conception of epistemic justification as an alternative to the probabilistic conception that he urges us to reject.
One‐pot sample preparation approach for profiling spatial distribution of gibberellins in a single shoot of germinating cereal seeds
Authors: Liu Cuimei , Li Dongmei , Li Jincheng , Guo Zhenpeng , Chen Yi
Published: April 2019

Sample preparation remains a bottleneck in the rapid and reliable quantification of gibberellins (GAs) for obtaining an insight into the physiological processes mediated by GAs. The challenges arise from not only the extremely low content of GAs in complex plant matrices, but the poor detectability of GAs by mass spectrometry (MS) in negative ion mode. In an effort to solve these urgent difficulties, we present a spatial‐resolved analysis method to investigate the distribution of GAs in tiny plant tissues based on a simplified one‐pot sample preparation approach coupled with ultrahigh‐performance liquid chromatography‐tandem MS. By integrating extraction and derivatization into one step, target GAs were effectively extracted from plant materials and simultaneously reacted with N‐(3‐dimethylaminopropyl)‐N′‐ethylcarbodiimide, the sample preparation time was largely shortened, the probability of sample loss was minimized and the detection sensitivity of MS was also greatly improved compared with underivatized GAs. Under optimal conditions, the method was validated from the quantification linearity, limits of detection and limits of quantification in the presence of plant matrices, recoveries, and precision. With the proposed method, 15 endogenous GAs were detected and, among these, 11 GAs could be quantified in 0.50 mg fresh weight (FW) wheat shoot samples, and five GAs were quantified in only 0.15 mg FW developing seed samples of Arabidopsis thaliana. The distribution patterns of GAs along both the non‐13‐hydroxylation pathway and the early 13‐hydroxylation pathway in a single shoot of germinating wheat, rice and maize seeds were finally profiled with a spatial resolution down to approximately 1 mm2.
Evaluation of D2 Attention Levels of Orienteering National Team Athletes Who Are in Education Age
Authors: Bektaş Fatih
Published: April 2019

The aim of this study was to determine the levels of attention in the rest state and post-performance status of the national orienteering team athletes who are in education age with the d2 attention test. For this purpose, this study was designed with relational screening model from quantitative research approaches. 40 volunteer athletes, 14 of which were female and 26 of them were male, were included in this study group. It was analyzed by Paired Samples t test whether the pre-test and post-test scores which the athletes participating in the study got from the d2 attention test were different. There was a significant difference among the applications in all scores of the d2 test (p <0.05). When the averages of the scores were examined, it was found by performing test repetitions that selective attention ability, sustainability of attention, high motivation and psychomotor speed (TN) most marked material) didn’t decrease the stability of psychomotor speed and quality of work performed CP (number of correctly marked d2)] d2 numbers [TN- (E1) + (E2)] that were marked incorrectly or weren’t marked. As a result; it was observed with d2 test which is one of the tests used in the field of applied sports psychology to evaluate the visual focusing attention performance of the athletes that the reason of positive differentiation in the attention performances which was obtained after the intensive exercise was intense concentration and the attention levels were high due to the concentration.
Muscle-Tendon Unit Parameter Estimation of a Hill-Type Musculoskeletal Model Based on Experimentally Obtained Subject-Specific Torque Profiles
Authors: Heinen Frederik , Sørensen Søren N. , King Mark , Lewis Martin , Lund Morten Enemark , Rasmussen John , de Zee Mark
Published: April 2019

The aim of this study was to generate a subject-specific musculoskeletal muscle model, based on isometric and isovelocity measurements of the whole lower extremity. A two-step optimization procedure is presented for optimizing the muscle-tendon parameters (MTPs) for isometric and isovelocity joint torque profiles. A significant improvement in the prediction of joint torque profiles for both the solely isometric and a combined isometric and dynamic method of optimization when compared to the standard scaling method of the AnyBody Modeling System (AMS) was observed. Depending on the specific purpose of the model, it may be worth considering whether the isometric-only would be sufficient, or the additional dynamic data are required for the combined approach.
Clarity Index Analysis and Modeling Using Probability Distribution Functions in Campo Grande-MS, Brazil
Authors: de Souza Amaury , Ihaddadene Razika , Ihaddadene Nabila , E. Oguntunde Pelumi
Published: April 2019

The importance of statistical analysis in the field of energy for environmental engineering is shown in this research paper, in which the adequacy of the data sets of clarity index with the model of “best” probability (based on the criteria used) was studied. In Campo Grande which is the capital of the Brazilian state of Mato Grosso do Sul, located in the Center-West region of the country, there is a predominance of the atmospheric conditions of low cloudiness, with a high frequency of days with a clear sky and in consequence a low-frequency of days with cloudy sky. The aerosols resulting from the burning of sugarcane influence the sky conditions in Campo Grande thus reducing the frequency of the clear sky.
Methylphosphonate Oxidation in
Prochlorococcus
Strain MIT9301 Supports Phosphate Acquisition, Formate Excretion, and Carbon Assimilation into Purines
Authors: Sosa Oscar A. , Casey John R. , Karl David M.
Published: April 2019

Until recently, MPn was only known to be degraded in the environment by the bacterial carbon-phosphorus (CP) lyase pathway, a reaction that releases the greenhouse gas methane. The identification of a formate-yielding MPn oxidative pathway in the marine planctomycete
Gimesia maris
(S. R. Gama, M. Vogt, T. Kalina, K. Hupp, et al., ACS Chem Biol 14:735–741, 2019,
https://doi.org/10.1021/acschembio.9b00024
) and the presence of this pathway in
Prochlorococcus
indicate that this compound can follow an alternative fate in the environment while providing a valuable source of P to organisms. In the ocean, where MPn is a major component of dissolved organic matter, the oxidation of MPn to formate by
Prochlorococcus
may direct the flow of this one-carbon compound to carbon dioxide or assimilation into biomass, thus limiting the production of methane.
Potentiation of Cytokine-Mediated Restriction of
Legionella
Intracellular Replication by a Dot/Icm-Translocated Effector
Authors: Ngwaga Tshegofatso , Hydock Alex J. , Ganesan Sandhya , Shames Stephanie R.
Published: April 2019

Legionella
spp. are natural pathogens of protozoa and accidental pathogens of humans. Innate immunity in healthy individuals effectively controls
Legionella
infection due in part to rapid and robust production of proinflammatory cytokines resulting from detection of Dot/Icm-translocated substrates, including effectors. Here, we demonstrate that the effector LegC4 enhances proinflammatory host restriction of
Legionella
by macrophages. These data suggest that LegC4 may augment proinflammatory signaling or antimicrobial activity of macrophages, a function that has not previously been observed for another bacterial effector. Further insight into LegC4 function will likely reveal novel mechanisms to enhance immunity against pathogens.
Granulomatosis with polyangiitis: potentially lethal gingival lesions presenting to the dentist
Authors: Patrick Amy , Altman Keith
Published: April 2019

Gingival pathology is a daily presentation, however a small number of systemic conditions can manifest similar to a common gingival condition and have fatal results. Dentist referred 56-year-old woman to Oral and Maxillofacial Surgery department with a 2-week medical history of gingival bleeding not responding to local measures. Biopsy showed eosinophilic infiltrate and vasculitis, and blood tests showed positive markers including cytoplasmic antineutrophil cytoplasmatic antibodies. Granulomatosis with polyangiitis is a rare disease affecting the respiratory tract, blood vessels and kidneys. Oral lesions are rarely the primary presenting feature. When left untreated, most cases are fatal within a year of diagnosis. The diagnosis can only be made when certain criteria are found, including granular oral lesions exhibiting an eosinophilic inflammatory infiltrate on biopsy. With 5% of cases showing intraoral lesions as the primary feature, it is essential that dentists have the knowledge of this rare disease to refer and not to treat as a common gingival condition.
Investing in non-communicable disease risk factor control among adolescents worldwide: a modelling study
Authors: Watkins David , Hale Jessica , Hutchinson Brian , Kataria Ishu , Kontis Vasilis , Nugent Rachel
Published: April 2019

Introduction

Exposure to non-communicable disease (NCD) risk factors is increasing among adolescents in most countries due to demographic, economic and epidemiological forces. We sought to analyse the potential health impact and costs of implementing NCD risk reduction interventions among adolescents worldwide.

Methods

We identified six interventions targeted at adolescent tobacco smoking, heavy episodic drinking and obesity and supported by effectiveness and cost-effectiveness evidence. Based on a population-level cohort of adolescents in 70 representative countries, we assessed the global mortality consequences of fully implementing these interventions over 2020–2070 using the potential impact fraction approach. We calculated the economic benefits of reduced mortality and estimated the required financial costs, discounting both at 3% annually. We also conducted best-case and worst-case scenario analyses.

Results

Full implementation of these interventions worldwide could avert nearly 10% of premature deaths among this cohort, translating to about US$400 billion in cumulative economic benefits. Cumulatively, the required costs would be about US$85 billion, suggesting that every US$1 of public money invested would generate US$5 in increased human capital. Tobacco taxes generally conferred the highest economic returns; however, an in-depth analysis of three countries illustrated the potential for different priorities, such as alcohol control, to emerge.

Conclusion

From a life course perspective, implementation of a package of interventions to reduce NCD risk among adolescents worldwide would substantially reduce premature mortality at reasonable costs. Our analysis illustrates the importance of integrating NCD prevention policies into the emerging global agenda for adolescent health and well-being.
Individually tailored whole-body vibration training to reduce symptoms of chemotherapy-induced peripheral neuropathy: study protocol of a randomised controlled trial—VANISH
Authors: Streckmann Fiona , Hess Viviane , Bloch Wilhelm , Décard Bernhard F , Ritzmann Ramona , Lehmann Helmar C , Balke Maryam , Koliamitra Christina , Oschwald Vanessa , Elter Thomas , Zahner Lukas , Donath Lars , Roth Ralf , Faude Oliver
Published: April 2019

Introduction

Chemotherapy-induced peripheral neuropathy (CIPN) is a prevalent and clinically meaningful side effect of cancer treatment. CIPN is induced by neurotoxic agents, causing severe sensory and/or motor deficits, resulting in disability and poor recovery, reducing patients’ quality of life and limiting medical therapy. To date, effective treatment options are lacking. Whole-body vibration (WBV) training can attenuate motor and sensory deficits. We are conducting a two-armed, multicentre, assessor-blinded, randomised controlled trial, to investigate the effects of WBV on relevant symptoms of CIPN and determine the training characteristics.

Methods and analysis

In this ongoing study, 44 patients who have completed therapy in the past 3 months, with a neurologically confirmed CIPN are assessed before and after a 12-week intervention and follow-up. The intervention group receives WBV twice a week. Exercises are individually tailored according to the initially determined optimal neuromuscular response. The control group receives care as usual.

Primary endpoint is the patient reported reduction of CIPN-related symptoms (Functional Assessment of Cancer Therapy/Gynaecology Oncology Group—Neurotoxicity). Secondary endpoints are compound muscle action potentials, distal motor latency, conduction velocity, F-waves from the tibial and peroneal nerve, antidromic sensory nerve conduction studies of the sural nerve, normalised electromyographic activity, peripheral deep sensitivity, proprioception, balance, pain, the feasibility of training settings, quality of life and the level of physical activity.

Aim, ethics and dissemination

The study was approved by both responsible ethics committees. (1) Our results may contribute to a better understanding of the effects of WBV on motor and sensory functions and (2) may provide information whether WBV at the most effective setting, is feasible for neuropathic patients. (3) Our results may also contribute to improve supportive care in oncology, thereby enhancing quality of life and enabling the optimal medical therapy. All results will be published in international peer-reviewed journals as well as a manual for clinical practice.

Trial registration number

NCT03032718
How do financial (dis)incentives influence health behaviour and costs? Protocol for a systematic literature review of randomised controlled trials
Authors: Humphries Brittany , Irwin Andrew , Zoratti Michael , Xie Feng
Published: April 2019

Introduction

In this era of rising healthcare costs, there is a growing interest in understanding how funding policies can be used to improve health and healthcare efficiency. Financial incentives (eg, vouchers or access to health insurance) or disincentives (eg, fines or out-of-pocket costs) affect behaviours. To date, reviews have explored the effects of financial (dis)incentives on patient health and behaviour by focusing on specific behaviours or geographical areas. The objective of this systematic review is to provide a comprehensive overview on the use of financial (dis)incentives as a means of influencing health-related behaviour and costs in randomised trials.

Methods and analysis

We will search electronic databases, clinical trial registries and websites of health economic organisations for randomised controlled trials. The initial searches, which were conducted on 13 January 2018, will be updated every 12 months until the completion of data analysis. The reference lists of included studies will be manually screened to identify additional eligible studies. Two researchers will independently review titles, abstracts and full texts to determine eligibility according to a set of predetermined inclusion criteria. Data will be extracted from included studies using a form developed and piloted by the research team. Discrepancies will be resolved through discussion with a third reviewer. Risk of bias will be assessed using the Cochrane Collaboration tool.

Ethics and dissemination

Ethics approval is not required since this is a review of published data. Results will be disseminated through publication in peer-reviewed journals and presentations at relevant conferences.

PROSPERO registration number

CRD42018097140
Association between the level of municipality healthcare services and outcome among acutely older patients in the emergency department: a Danish population-based cohort study
Authors: Tanderup Anette , Ryg Jesper , Rosholm Jens-Ulrik , Lassen Annmarie Touborg
Published: April 2019

Objectives

This study aims to describe the association between use of municipality healthcare services before an emergency department (ED) contact and mortality, hospital reattendance and institutionalisation.

Design

Population-based prospective cohort study.

Setting

ED of a large university hospital.

Participants

All medical patients ≥65 years of age from a single municipality with a first attendance to the ED during a 1-year period (November 2013 to November 2014).

Primary and secondary outcome measures

Patients were categorised as independent of home care, dependent of home care or in residential care depending on municipality healthcare before ED contact. Patients were followed 360 days after discharge. Outcomes were postdischarge mortality, hospital reattendance and institutionalisation.

Results

A total of 3775 patients were included (55% women), aged (median (IQR) 78 years (71–85)). At baseline, 48.9% were independent, 34.9% received home care and 16.2% were in residential care. Receiving home care or being in residential care was a strong predictor of mortality, hospital reattendance and institutionalisation. Among patients who were independent, 64.3% continued being independent up to 360 days after discharge. Even among patients ≥85 years, 35.4% lived independently in their own house 1 year after ED contact.

Conclusion

Prehospital information on municipality healthcare is closely related to patient outcome in older ED patients. It might have the potential to be used in risk stratification and planning of needs of older acute medical patients attending the ED.
Effects of esmolol on QTc interval changes during tracheal intubation: a systematic review
Authors: Thiruvenkatarajan Venkatesan , Lee Jenn Yuan , Sembu Manesha , Watts Richard , Van Wijk Roelof Markus
Published: April 2019

Introduction and aims

Esmolol is an ultra-short-acting β1antagonist that has been shown to attenuate the corrected QT (QTc) interval prolongation associated with laryngoscopy and endotracheal intubation (LTI). Prolongation of the QTc interval can precipitate arrhythmias, the most serious of which is torsades de pointes . The aim of this systematic review was to compare esmolol and placebo on QTc changes occurring during LTI.

Materials and methods

PubMed, EMBASE, Cochrane Registry of Clinical Trials and CINAHL databases (up to August 2018) were screened for randomised controlled trials comparing esmolol and placebo on QTc changes during LTI in cardiac and non-cardiac surgeries. The primary outcome was QTc changes during LTI and secondary outcome was related to adverse effects from esmolol such as bradycardia and hypotension.

Results

Seven trials were identified involving 320 patients, 160 patients receiving esmolol or placebo apiece. A shortening of the QTc post-LTI was evident in the esmolol group compared with the placebo in four studies. Compared with the baseline, the QTc was reduced post-LTI in the esmolol group. In the placebo group, the QTc was prolonged compared with the baseline post LTI. Nonetheless, esmolol did not prevent QTc prolongation in the remaining three studies, and much of this was attributed to employing QTc prolonging agents for premedication and anaesthetic induction. No significant adverse events were noted.

Conclusion

Compared with placebo, esmolol reduced the LTI-induced QTc prolongation when current non-QTc prolonging agents were chosen for tracheal intubation. Future studies should explore whether transmural dispersion (a marker of torsadogenicity) is also affected during LTI by analysing parameters such as the Tp-e interval (interval between the peak to the end of the T-wave) and Tp-e/QTc (rate corrected Tp-e interval).

Trial registration number

CRD42018090282.
Appropriate utilisation of cardiac telemetry monitoring: a quality improvement project
Authors: Stoltzfus Ky B , Bhakta Maharshi , Shankweiler Caylin , Mount Rebecca R , Gibson Cheryl
Published: April 2019

For hospitals located in the United States, appropriate use of cardiac telemetry monitoring can be achieved resulting in cost savings to healthcare systems. Our institution has a limited number of telemetry beds, increasing the need for appropriate use of telemetry monitoring to minimise delays in patient care, reduce alarm fatigue, and decrease interruptions in patient care.

This quality improvement project was conducted in a single academic medical centre in Kansas City, Kansas. The aim of the project was to reduce inappropriate cardiac telemetry monitoring on intermediate care units. Using the 2004 American Heart Association guidelines to guide appropriate telemetry utilisation, this project team sought to investigate the effects of two distinct interventions to reduce inappropriate telemetry monitoring, huddle intervention and mandatory order entry. Telemetry utilisation was followed prospectively for 2 years.

During our initial intervention, we achieved a sharp decline in the number of patients on telemetry monitoring. However, over time the efficacy of the huddle intervention subsided, resulting in a need for a more sustained approach. By requiring physicians to input indication for telemetry monitoring, the second intervention increased adherence to practice guidelines and sustained reductions in inappropriate telemetry use.
Syndromic surveillance by veterinary practitioners: a pilot study in the pig sector
Authors: Correia‐Gomes Carla , Henry Madeleine Kate , Williamson Susanna , Irvine Richard M , Gunn George J , Woolfenden Nigel , White Mark E. C. , Tongue Sue C
Published: April 2019

Traditional indicator‐based livestock surveillance has been focused on case definitions, definitive diagnoses and laboratory confirmation. The use of syndromic disease surveillance would increase the population base from which animal health data are captured and facilitate earlier detection of new and re‐emerging threats to animal health. Veterinary practitioners could potentially play a vital role in such activities. In a pilot study, specialist private veterinary practitioners (PVP) working in the English pig industry were asked to collect and transfer background data and disease incident reports for pig farms visited during the study period. Baseline data from 110 pig farms were received, along with 68 disease incident reports. Reports took an average of approximately 25 minutes to complete. Feedback from the PVPs indicated that they saw value in syndromic surveillance. Maintenance of anonymity in the outputs would be essential, as would timely access for the PVPs to relevant information on syndromic trends. Further guidance and standardisation would also be required. Syndromic surveillance by PVPs is possible for the pig industry. It has potential to fill current gaps in the collection of animal health data, as long as the engagement and participation of data providers can be obtained and maintained.
Potential role of wildlife in the USA in the event of a foot‐and‐mouth disease virus incursion
Authors: Brown Vienna R , Bevins Sarah N
Published: April 2019

Foot‐and‐mouth disease (FMD) is caused by foot‐and‐mouth disease virus (FMDV) which affects domestic and wild cloven‐hoofed species. The FMD‐free status of the USA and the tremendous economic impact of a virus incursion motivated the development of this evaluation of the potential role of wildlife in the event of a virus introduction. Additionally, this manuscript contains a summary of US vulnerabilities for viral incursion and persistence which focuses specifically on the possible role of wildlife. The legal movement of susceptible live animals, animal products, by‐products and animal feed containing animal products pose a risk of virus introduction and spread. Additionally, the illegal movement of FMD‐susceptible animals and their products and an act of bioterrorism present additional routes where FMDV could be introduced to the USA. Therefore, robust surveillance and rapid diagnostics in the face of a possible introduction are essential for detecting and controlling FMD as quickly as possible. Wildlife species and feral pigs present an added complexity in the case of FMDV introduction as they are typically not closely monitored or managed and there are significant logistical concerns pertaining to disease surveillance and control in these populations. Recommendations highlight the need to address existing knowledge gaps relative to the potential role of wildlife in FMDV introduction events.
The modern UK veterinary profession: photo‐elicitation interviewing reveals that small animal and surgical images dominate
Authors: Ward Abbie , May Stephen A
Published: April 2019

More than 80 per cent of vets are employed in clinical practice but other veterinary roles are vital for society. However, even clinical practice does not seem to fulfil some modern graduates, and an increasing number of veterinarians are leaving the profession to pursue other careers. Research suggests that less than 50 per cent of veterinarians would choose to undertake their career path again, so the profession faces a ‘workforce crisis’. Through semi‐structured photo‐elicitation interviewing, this study has explored the image that students embarking on veterinary education have of the profession. The students’ dominant image of the profession, and their perception of the public image, was small animal practice. A large proportion (n=16, 80 per cent) of participants saw themselves working in clinical practice, with many (n=8, 40 per cent) aspiring to focus on surgery. The image of the veterinary profession has changed since the 1970s when the James Herriot mixed practice model was well known to the public. The dominant small animal and surgical image emerging demonstrates a need for members of the profession to work together to educate public and entrant perception, emphasising the diversity of veterinary careers and their value to society, to allow aspiring veterinary entrants to develop a range of career goals.
Allan Christie Annat
Authors: MacPherson Fiona ,   colleagues from Kirkton Vet Centre
Published: April 2019

A dedicated, accomplished and compassionate vet, who made a difference. He had boundless energy and endless jokes, and enjoyed sharing his enthusiasm about being a vet with students.