bluuebunny/crossref_metadata_2025 huggingface dataset:
The Challenge of Externally Generated Collaborative Governance: California’s Attempt at Regional Water Management
Authors: Cain Bruce E. , Gerber Elisabeth R. , Hui Iris
Published: February 2020

Creating successful collaborative governance regimes is difficult, but can be especially hard when collaborations are externally generated by higher levels of government as opposed to self-generated by local agencies and stakeholders due to the lack of spontaneity. We analyze this problem as it applies to California’s Integrated Regional Water Governance Program. Public administration theory indicates that a core element in a successful collaboration is empowering local leaders who share the collaboration’s intended goal. However, the political concessions to local autonomy necessary to enact an externally generated collaboration can undermine its success. The tensions between maintaining local autonomy and creating a regional approach are inherently strong in a “layered collaborative governance” approach that acknowledges and accommodates local boundaries. Drawing on the concept of role differentiation, we hypothesize that the roles participants play in layered collaborative governance will frequently derive from their preexisting issue areas, geographic orientations, and power relations, but that program design incentives can influence which groups participate in the effort and how they engage. We test these hypotheses in the context of California’s Integrated Regional Water Management (IRWM) program. We find evidence of role differentiation on grant leadership both with respect to the initial goal of regional collaboration as well as later efforts to address the water issues of disadvantaged communities.
How international are geography journals? Not international enough
Authors: Imhof Nadja , Müller Martin
Published: February 2020

As English is advancing to become the world’s academic lingua franca, English-language journals increasingly need to reflect knowledge production on a global scale. Our graphic shows how the majority of geography journals still remain strongly anchored in Anglophone countries. A few journals, however, lead the way in the decolonial imperative to decentre knowledge production.
Presence of Additional Safety Belt Enforcement Increases Safety Belt Use by Drivers
Authors: Acosta-Rodriguez Lusanni , Kwigizile Valerian , Oh Jun-Seok , Gates Timothy
Published: February 2020

The use of a safety belt is universally recognized as a primary means of reducing injuries and fatalities for motor vehicle occupants. There are several factors that contribute to safety belt utilization, including traffic enforcement, demographics, vehicle type, day of the week, and geographical location. These factors have been explored and found significant in relation to safety belt usage. Apart from these factors, the presence of additional traffic enforcement is generally believed to produce higher rates of safety belt use. However, the impacts provided by the presence/no-presence of additional traffic enforcement have been merely quantified on a disaggregated scale, broadly across an entire state while controlling for other influential factors. Thus, this paper presents an analysis that quantifies the impacts provided by the presence of additional safety belt enforcement on driver safety belt usage. Direct safety belt use observational surveys and traffic enforcement data were used for the analysis. Owing to the nature of the data, a binary logistic regression analysis was performed on the dataset from the state of Michigan. The results showed that for every location where additional traffic enforcement was present, safety belt usage increased by 6.4% per county compared with areas where no additional traffic enforcement was present. Finally, the results not only quantified the impact of traffic enforcement on safety belt use, but could help transportation safety agencies make more informed decisions about where additional safety belt enforcement may be needed to improve rates of safety belt use.
Simultaneously improving the fire performance and toughness of polylactic acid by reactive blending with castor oil-based polyurethane and ammonium polyphosphate
Authors: Zhang Sheng , Zhang Qingyu , Sun Jun , Gu Xiaoyu , Li Hongfei , Liu Xiaodong , Fei Bin
Published: February 2020

A new method has been presented to simultaneously enhance both the flame retardancy and toughness of polylactide acid composites by introducing castor oil-based polyurethane and ammonium polyphosphate via reactive blending. The in situ polymerization of castor oil and toluene diisocyanate in the polylactide acid matrix has been confirmed by the Fourier transform infrared spectroscopy. The flame retardant test results indicate that the introduction of 20% ammonium polyphosphate can increase the limiting oxygen index of polylactide acid composites from 19.3% to 27.2%, upgrade the UL-94 rating from no rating to V-0, and decrease the peak heat release rate from 505.5 to 337.0 kW/m2. Moreover, the toughness of polylactide acid is also improved significantly, with the elongation at break and notched impact strength increasing to 37.0% and 7.59 kJ/m2, respectively. The possible mechanisms for both flame retardancy and toughness are also discussed and proposed.
Gender Identity in Scripture: Indissoluble Marriage and Exceptional Eunuchs
Authors: Jones David Albert
Published: February 2020

There has been little considered reflection by Catholic theologians on the concepts of gender identity, gender dysphoria and gender transition. Seeking inspiration in the Scriptures, some Catholic thinkers have interpreted the first three chapters of Genesis and especially the text ‘male and female he created them’ (Gen. 1:27) as requiring all human beings to live in the gender role congruent with their biological sex, and have viewed the biology of sex as self-evident. This article argues that these chapters constitute an appropriate locus for reflection on theological anthropology but that they need to be taken together with other texts and especially with the explicit teaching of Jesus Christ. In the Gospel according to Matthew, the one occasion in which Jesus invokes this passage from Genesis is when he draws attention to exceptional examples in nature and, in a striking phrase, states that some ‘have made themselves eunuchs for the sake of the kingdom of heaven’ (Matt. 19:12). If the Genesis text is interpreted in the light of the words of Christ, the binary division of the sexes, while ordained by God and the basis for a vocation to marry and procreate, admits of exceptions both natural and supernatural.
End-of-Life Admission to the Emergency Department: Experience of Mexico’s National Cancer Institute of a Developing Country
Authors: Allende-Pérez Silvia , González Pamela , Peña-Nieves Adriana , Herrera-Gómez Ángel , Verástegui Emma
Published: February 2020

Background:

Admission to the emergency department (ED) of patients with advanced or end-of-life (EoL) cancer saturates the services that provide active medical attention to the complications of anticancer therapy, and the lack of specific protocol limits proper handling.

Objective:

The aim of this study was to describe the characteristics of patients with advanced cancer admitted to the ED at the EoL in a comprehensive cancer center in Mexico.

Patients and Methods:

We conducted a retrospective analysis of patients admitted to ED of the National Cancer Institute of Mexico City, with 3 or less days before they died, between January 2011 and December 2018. The data collected included clinical and demographic characteristics, reason for admission to the ED, number of admissions to ED in the last month of life, and cancer treatment received.

Results:

A total of 426 patients were included; 60.8% were female with a median age of 60 years; 71.6% patients were receiving some kind of disease-modifying treatment, although the oncologist had considered they could die within 6 months, and 16 of them were receiving concomitant PC. 8.9% of these patients had been admitted 3 or more times to the ED in the last month. The principal reasons for admission to ED were dyspnea, uncontrolled pain, 12 patients were admitted in active death and 94 died within hours of admission to ED.

Conclusions:

Palliative care approach in oncological patients admitted to ED is important to avoid unnecesary suffering at the EoL.
Improved Glycemic Control Outcomes Regardless of Mental Health Disorders in a Pharmacist-Endocrinologist Diabetes Intense Medical Management (DIMM) “Tune Up” Clinic
Authors: Morello Candis M. , Nguyen Tran , Tao Lillian , Hirsch Jan D.
Published: February 2020

Background: Previous studies show patients with type 2 diabetes (T2D) and a mental health (MH) disorder exhibit poorer glycemic control compared with those without. Objective: Compare mean change in glycosylated hemoglobin (A1C) after 6 months in the Diabetes Intense Medical Management (DIMM) “Tune Up” Clinic in patients with and without MH disorders. Methods: Retrospective cohort study in T2D patients, with A1C at baseline and 6 months, divided into subgroups of those with ≥1 MH diagnoses and without MH. Primary outcome was mean change in A1C from baseline to 6 months. Secondary outcomes were mean change in other metabolic parameters and proportion achieving A1C and related goals. Results: Of 155 patients meeting inclusion criteria, 66 (42.6%) had at least 1 MH disorder (MH group) and 89 (57.4%) did not (non-MH group). Mean A1C, fasting blood glucose (FBG), and triglycerides (TG) change (improvement) did not differ significantly between MH and non-MH groups at 6 months (eg, A1C reduction: −2.1% [SD = 2.0] vs −2.3% [SD = 2.1]; P = 0.61, respectively). Percentage at A1C goal did not differ significantly between groups, though a higher percentage of the non-MH group achieved FBG and TG goals than the MH group. Conclusion and Relevance: In 6 months, both groups in the DIMM clinic achieved a statistically significant mean A1C reduction (over 2%) with no statistical or clinical difference in the magnitude of change between groups. Patients with T2D benefitted from the DIMM model and personalized visits with a pharmacist regardless of having a MH disorder.
WJEC’s Paris Syndicate Program: Discussions Advance Global Journalism Education
Authors: Goodman Robyn S.
Published: February 2020

The World Journalism Education Congress (WJEC) holds global conferences every 3 years offering a unique opportunity for attendees: access to its Syndicate Program. The program gives participants the chance to meet in small groups with international counterparts to take part in research-based discussions focused on the most important journalism topics of the day. These discussions conclude with global recommendations to help advance journalism education pedagogy, practices, and research. This special section of Journalism & Mass Communication Educator features WJEC’s Paris (2019) syndicate results.
Evaluation of Health Literacy and Depression Literacy Among Korean Americans
Authors: Bernstein Kunsook , Han Shinhi , Park Chan Gi , Lee Young-Me , Hong OiSaeng
Published: February 2020

Low health literacy is closely related to a higher rate of hospitalization and of emergency services usage, leading to billions of dollars in avoidable health care costs and contributing to individuals’ poor physical and mental health. While Korean Americans (KAs) have a high prevalence of general health and mental health problems, relatively little is known about their health and mental health literacy, specifically their depression literacy. This study aims to evaluate KAs’ health literacy and depression literacy, as related to sociodemographic characteristics. An exploratory study was conducted with 681 community-residing adult KAs using the Center for Epidemiologic Studies Depression (CES-D) Scale, the Depression Literacy Questionnaire (D-Lit), and the One-Question Health Literacy Scale. Data analyses were performed using one-way analysis of variance and ordinal logistic regression of health literacy, a multiple linear regression model of depression literacy. Findings indicate a positive correlation between depression literacy and health literacy. Health literacy was also significantly related to religion, English language proficiency, income, education, and perceived physical health. Additionally, depression literacy was significantly related to age, Korean language preference over English, and education. Health literacy and depression literacy education are warranted to address low health literacy and depression literacy among KAs to reduce their health and mental health disparities.
Perceptions of regular and special education teachers of their own and their co-teacher’s instructional responsibilities in inclusive education: A case study
Authors: Lindacher Tanja
Published: February 2020

Co-teaching is fundamental to inclusive education. However, the way co-teaching is implemented, varies considerably, and establishing and allocating instructional responsibilities does not follow a standardized pattern. This study is based on four cases – two located at traditional secondary schools and two at newly created community schools – and includes semi-structured in-depth interviews with four regular teachers and four special education teachers. It aims at providing insight into how co-teaching partners in Germany perceive their own and their partner’s instructional responsibilities. Data are analyzed with a structuring technique of qualitative content analysis. It becomes evident that the partners in each case do not always follow identical instructional intents. Nonetheless, different types of teacher knowledge seem to complement each other effectively in co-teaching relationships. Although, of course provided primarily for pupils with special needs, special education expertise also seems to support pupils without such needs. The results indicate a need to secure and integrate co-teaching relationships structurally into a school’s development process. The article concludes with some options for development in practice.
Study of the environment factor from Fick’s and electrical resistivity models by simulation of chloride diffusivity prediction
Authors: Medeiros-Junior Ronaldo A , Bem Diogo H
Published: February 2020

The penetration of chlorides in concrete is the main reason for the beginning of corrosion in reinforced concrete structures exposed to a marine environment, reducing their service life. This article proposes correlations between the surface chloride content ( Cs) of Fick’s model and the ambient factor ( kCl) of a resistivity model. Literature data for three types of cement were used to simulate chloride diffusivity: (1) CEM I 52.5 R; (2) CEM II/A-P 42.5 R (with 6%–20% of pozzolans); and (3) CEM type II (with 12% of pozzolans and 8% of silica fume). Concretes containing these cements were analyzed for different environmental conditions: atmosphere zone, seawater immersion, and tidal/splash zones. The surface chloride contents were determined by a combination of Fick’s and resistivity models. In this article, it was noticed that the estimated Cs value varies with the exposure class from 0.484% to 0.644% (total chloride concentration by weight of cement). An equation has been proposed to correlate Cs with the ambient factor kCl of the resistivity model.
Mentoring the Next Generation of Women Candidates: A Field Experiment of State Legislators
Authors: Rhinehart Sarina
Published: February 2020

This experiment sent state legislators an email from an individual seeking advice on running for office, varying the gender and party of the sender. This project explores two inquiries—who the legislators choose to respond to and how the legislators’ own gender and partisan identities shape that decision. I theorize that women in politics is a salient issue for legislators; therefore, they will be more willing to advise politically ambitious women. Overall, I find that legislators are more willing to offer help when the aspirant is a woman and of the same party. When primed to further consider women in politics, legislators are more likely to offer gender-specific advice. Democrats rather than women legislators drive this heightened responsiveness to the woman aspirant. These findings highlight what role public officials can play in closing the candidate gender gap, and how legislators’ multiple identities intersect and frame their decisions to aid political aspirants.
Building a Thriving Lifestyle Medicine Practice Within a Primary Care Clinic: A Model for Aspiring Lifestyle Medicine Practitioners
Authors: Motley Elizabeth
Published: February 2020

The field of Lifestyle Medicine (LM) is growing rapidly as individuals and communities seek real solutions to the hardship of chronic disease. Providers across various medical specialties and allied health professions are gaining certification in this field, and yet are struggling with implementation. Time constraints, concern about reimbursement, and lack of clinical experience in counseling patients are often cited as obstacles. This article will address these issues and demonstrate how LM can be successfully practiced in a standard primary care setting. Active participation in the local community is essential. Office visits must be prepared for efficiently, and encounters should focus on teaching simple concepts to patients. At-home learning activities can then be used to build on these concepts. Referral to health coaches and outside programs are helpful options as well. Equipping providers with practice tools to promote lifestyle change will improve satisfaction for patients and providers alike and is an important step toward advancing the field of LM.
Coronary heart disease incidence still decreased between 2006 and 2014 in France, except in young age groups: Results from the French MONICA registries
Authors: Meirhaeghe Aline , Montaye Michèle , Biasch Katia , Huo Yung Kai Samantha , Moitry Marie , Amouyel Philippe , Ferrières Jean , Dallongeville Jean
Published: February 2020

Background

Over the past few decades decreases in coronary heart disease morbidity and mortality rates have been observed throughout the western world. We sought to determine whether the acute coronary event rates had decreased between 2006 and 2014 among French adults, and whether there were sex and age-specific differences.

Methods

We examined the French MONICA population-based registries monitoring the Lille urban area in northern France, the Bas-Rhin county in north-eastern France and the Haute Garonne county in south-western France. All acute coronary events among men and women aged 35–74 were collected.

Results

Over the study period, the age-standardised attack rates decreased in both men (annual percentage change −1.5%, P = 0.0006) and women (annual percentage change −2.1%, P = 0.002). Also, the age-standardised incidence rates decreased in both men (annual percentage change −0.9%, P = 0.03) and women (annual percentage change −1.8%, P = 0.002) due to decreases in the 65–74 year age group. In men, age-standardised mortality rates decreased by 3.5% per year ( P = 0.0004), especially in the 55–64 and 65–74 year age groups. In women, these rates decreased by 4.3% per year ( P = 0.0009), particularly in the 35–44 and 65–74 year age groups. We also observed significant decreases in case fatality among both men (annual percentage change −1.7%, P < 0.0001) and women (annual percentage change −1.9%, P = 0.009).

Conclusions

Downward trends in acute coronary event attack, incidence and mortality rates were observed between 2006 and 2014 in men and women. This effect was age dependent and was primarily due to decreases in the 65–74 year age group. There were no substantial declines in the younger age groups except for mortality in young women. Prevention measures still need to be strengthened, particularly in young adults.
Systematic Reviews and Meta-Analysis in Spine Surgery—How Good Are They in Methodological Quality? A Systematic Review
Authors: Sathish Muthu , Eswar Ramakrishnan
Published: February 2020

Study Design:

Systematic review.

Objectives:

To assess the methodological quality of systematic reviews and meta-analyses in spine surgery over the past 2 decades.

Materials and Methods:

We conducted independent and in duplicate systematic review of the published systematic reviews and meta-analyses between 2000 and 2019 from PubMed Central and Cochrane Database pertaining to spine surgery involving surgical intervention. We searched bibliographies to identify additional relevant studies. Methodological quality was evaluated with AMSTAR score and graded with AMSTAR 2 criteria.

Results:

A total of 96 reviews met the eligibility criteria, with mean AMSTAR score of 7.51 (SD = 1.98). Based on AMSTAR 2 criteria, 13.5% (n = 13) and 18.7% (n = 18) of the studies had high and moderate level of confidence of results, respectively, without any critical flaws. A total of 29.1% (n = 28) of the studies had at least 1 critical flaw and 38.5% (n = 37) of the studies had more than 1 critical flaw, so that their results have low and critically low confidence, respectively. Failure to analyze the conflict of interest of authors of primary studies included in review and lack of list of excluded studies with justification were the most common critical flaw. Regression analysis demonstrated that studies with funding and studies published in recent years were significantly associated with higher methodological quality.

Conclusion:

Despite improvement in methodological quality of systematic reviews and meta-analyses in spine surgery in current decade, a substantial proportion continue to show critical flaws. With increasing number of review articles in spine surgery, stringent measures must be taken to adhere to methodological quality by following PRISMA and AMSTAR guidelines to attain higher standards of evidence in published literature.
Roman Catholic Government and Mission to Tibet: A Historical and Theological Study
Authors: Beltramini Enrico
Published: February 2020

In this article I consider the administration of the Roman Catholic Church mission to Tibet in the seventeenth and eighteenth centuries. After summarizing the main events of this mission, I focus on the juridical-political aspects of the government (i.e., administration) of mission. I contribute to the understanding of the history of mission to Tibet by addressing administration in theological terms. I show that government in the history of mission to Tibet cannot be seen merely through the lens of politics (bureaucracy, etc.) but as an activity that is a significant element in the economy of salvation.
A Fast Multi-tasking Solution: NMF-Theoretic Co-clustering for Gear Fault Diagnosis under Variable Working Conditions
Authors: Shen Fei , Chen Chao , Xu Jiawen , Yan Ruqiang
Published: February 2020

Most gear fault diagnosis (GFD) approaches suffer from inefficiency when facing with multiple varying working conditions at the same time. In this paper, a non-negative matrix factorization (NMF)-theoretic co-clustering strategy is proposed specially to classify more than one task at the same time using the high dimension matrix, aiming to offer a fast multi-tasking solution. The short-time Fourier transform (STFT) is first used to obtain the time-frequency features from the gear vibration signal. Then, the optimal clustering numbers are estimated using the Bayesian information criterion (BIC) theory, which possesses the simultaneous assessment capability, compared with traditional validity indexes. Subsequently, the classical/modified NMF-based co-clustering methods are carried out to obtain the classification results in both row and column tasks. Finally, the parameters involved in BIC and NMF algorithms are determined using the gradient ascent (GA) strategy in order to achieve reliable diagnostic results. The Spectra Quest’s Drivetrain Dynamics Simulator gear data sets were analyzed to verify the effectiveness of the proposed approach.
Long-term expansion, genomic stability and in vivo safety of adult human pancreas organoids
Authors: Georgakopoulos Nikitas , Prior Nicole , Angres Brigitte , Mastrogiovanni Gianmarco , Cagan Alex , Harrison Daisy , Hindley Christopher J. , Arnes-Benito Robert , Liau Siong-Seng , Curd Abbie , Ivory Natasha , Simons Benjamin D. , Martincorena Inigo , Wurst Helmut , Saeb-Parsy Kourosh , Huch Meritxell
Published: February 2020

Background

Pancreatic organoid systems have recently been described for the in vitro culture of pancreatic ductal cells from mouse and human. Mouse pancreatic organoids exhibit unlimited expansion potential, while previously reported human pancreas organoid (hPO) cultures do not expand efficiently long-term in a chemically defined, serum-free medium. We sought to generate a 3D culture system for long-term expansion of human pancreas ductal cells as hPOs to serve as the basis for studies of human pancreas ductal epithelium, exocrine pancreatic diseases and the development of a genomically stable replacement cell therapy for diabetes mellitus.

Results

Our chemically defined, serum-free, human pancreas organoid culture medium supports the generation and expansion of hPOs with high efficiency from both fresh and cryopreserved primary tissue. hPOs can be expanded from a single cell, enabling their genetic manipulation and generation of clonal cultures. hPOs expanded for months in vitro maintain their ductal morphology, biomarker expression and chromosomal integrity. Xenografts of hPOs survive long-term in vivo when transplanted into the pancreas of immunodeficient mice. Notably, mouse orthotopic transplants show no signs of tumorigenicity. Crucially, our medium also supports the establishment and expansion of hPOs in a chemically defined, modifiable and scalable, biomimetic hydrogel.

Conclusions

hPOs can be expanded long-term, from both fresh and cryopreserved human pancreas tissue in a chemically defined, serum-free medium with no detectable tumorigenicity. hPOs can be clonally expanded, genetically manipulated and are amenable to culture in a chemically defined hydrogel. hPOs therefore represent an abundant source of pancreas ductal cells that retain the characteristics of the tissue-of-origin, which opens up avenues for modelling diseases of the ductal epithelium and increasing understanding of human pancreas exocrine biology as well as for potentially producing insulin-secreting cells for the treatment of diabetes.
A completeness-independent method for pre-selection of closely related genomes for species delineation in prokaryotes
Authors: Zhou Yizhuang , Zheng Jifang , Wu Yepeng , Zhang Wenting , Jin Junfei
Published: February 2020

Background

Whole-genome approaches are widely preferred for species delineation in prokaryotes. However, these methods require pairwise alignments and calculations at the whole-genome level and thus are computationally intensive. To address this problem, a strategy consisting of sieving (pre-selecting closely related genomes) followed by alignment and calculation has been proposed.

Results

Here, we initially test a published approach called “genome-wide tetranucleotide frequency correlation coefficient” (TETRA), which is specially tailored for sieving. Our results show that sieving by TETRA requires > 40% completeness for both genomes of a pair to yield > 95% sensitivity, indicating that TETRA is completeness-dependent. Accordingly, we develop a novel algorithm called “fragment tetranucleotide frequency correlation coefficient” (FRAGTE), which uses fragments rather than whole genomes for sieving. Our results show that FRAGTE achieves ~ 100% sensitivity and high specificity on simulated genomes, real genomes and metagenome-assembled genomes, demonstrating that FRAGTE is completeness-independent. Additionally, FRAGTE sieved a reduced number of total genomes for subsequent alignment and calculation to greatly improve computational efficiency for the process after sieving. Aside from this computational improvement, FRAGTE also reduces the computational cost for the sieving process. Consequently, FRAGTE extremely improves run efficiency for both the processes of sieving and after sieving (subsequent alignment and calculation) to together accelerate genome-wide species delineation.

Conclusions

FRAGTE is a completeness-independent algorithm for sieving. Due to its high sensitivity, high specificity, highly reduced number of sieved genomes and highly improved runtime, FRAGTE will be helpful for whole-genome approaches to facilitate taxonomic studies in prokaryotes.
A risk prediction tool for colorectal cancer screening: a qualitative study of patient and provider facilitators and barriers
Authors: Matthias Marianne S. , Imperiale Thomas F.
Published: February 2020

Background

Despite proven effectiveness of colorectal cancer (CRC) screening, at least 35% of screen-eligible adults are not current with screening. Decision aids and risk prediction tools may help increase uptake, adherence, and efficiency of CRC screening by presenting lower-risk patients with options less invasive than colonoscopy. The purpose of this qualitative study was to determine patient and provider perceptions of facilitators and barriers to use of a risk prediction tool for advanced colorectal neoplasia (CRC and advanced, precancerous polyps), to maximize its chances of successful clinical implementation.

Methods

We conducted qualitative, semi-structured interviews with patients aged 50–75 years who were not current with CRC screening, and primary care providers (PCPs) at an academic and a U.S. Department of Veterans Affairs Medical Center in the Midwest from October 2016 through March 2017. Participants were asked about their current experiences discussing CRC screening, then were shown the risk tool and asked about its acceptability, barriers, facilitators, and whether they would use it to guide their choice of a screening test. The constant comparative method guided analysis.

Results

Thirty patients and PCPs participated. Among facilitators were the tool’s potential to increase screening uptake, reduce patient risk, improve resource allocation, and facilitate discussion about CRC screening. PCP-identified barriers included concerns about the tool’s accuracy, consistency with guidelines, and time constraints.

Conclusions

Patients and PCPs found the risk prediction tool useful, with potential to increase uptake, safety, and efficiency of CRC screening, indicating potential acceptability and feasibility of implementation into clinical practice.
Disease characteristics and outcomes in patients with chronic kidney disease and type 2 diabetes: a matched cohort study of spironolactone users and non-users
Authors: Blankenburg Michael , Kovesdy Csaba P. , Fett Anne-Kathrin , Griner Raymond G. , Gay Alain
Published: February 2020

Background

Limited evidence has indicated that addition of a steroidal mineralocorticoid receptor antagonist (MRA) to the standard of care reduces proteinuria in patients with diabetic kidney disease (DKD); however, there are limited data regarding real-world MRA use in these patients. This study aimed to describe the characteristics of spironolactone users and non-users with DKD, and to explore their clinical outcomes.

Methods

This was a non-interventional, retrospective cohort study using demographic and clinical data from a US claims database (PharMetrics Plus) and the Experian consumer data asset during 2006–2015. Baseline characteristics (e.g. comorbidities) and post-inclusion clinical outcomes were described in matched cohorts of spironolactone users and non-users (n = 5465 per group).

Results

Although matching aligned key demographic and clinical characteristics of the cohorts, a significantly greater proportion of spironolactone users than non-users had oedema, proteinuria, and cardiovascular disease at baseline (P < 0.0001). During the post-inclusion period, disease progression and clinical events of interest such as acute kidney injury were more commonly observed in spironolactone users than non-users. Users also had higher healthcare resource utilization and costs than non-users; however, these differences diminished at later stages of disease.

Conclusions

In this study, spironolactone users had a greater comorbidity burden at baseline than matched non-users, suggesting that the presence of certain comorbidities may be contributing factors in the decision to prescribe spironolactone. High healthcare resource utilization and costs for patients at later stages of disease, irrespective of spironolactone use, highlight the need for new therapies for DKD.
Examination of corneal deposits in nephropathic cystinosis using in vivo confocal microscopy and anterior segment optical coherence tomography: an age-dependent cross sectional study
Authors: Csorba Anita , Maka Erika , Maneschg Otto Alexander , Szabó Attila , Szentmáry Nóra , Csidey Mária , Resch Miklós , Imre László , Knézy Krisztina , Nagy Zoltán Zsolt
Published: February 2020

Background

Presence of corneal cystine crystals is the main ocular manifestation of cystinosis, although controversial findings concerning the corneal layer with the highest density have been reported. The aim of this study was the analysis of the characteristics of crystal arrangement in different corneal layers and the assessment of corneal morphological changes with age.

Methods

A cross sectional study was carried out in three children and three adults who had nephropathic cystinosis and corneal cystine depositions. All patients underwent a comprehensive ophthalmological examination including best corrected distance visual acuity, slit-lamp examination, in vivo confocal microscopy and anterior segment optical coherence tomography. An evaluation of the depth of crystal deposits and crystal density in different corneal layers was also performed. Due to the low number of subjects no statistical comparison was performed.

Results

Anterior segment optical coherence tomography images revealed deposition of hyperreflective crystals from limbus to limbus in each patient. Crystals appeared as randomly oriented hyperreflective, elongated structures on in vivo confocal microscopy images in all corneal layers except the endothelium. In children the deposits occurred predominantly in the anterior stroma, while in adults, the crystals were mostly localized in the posterior corneal stroma with the depth of crystal deposition showing an increasing tendency with age (mean depth of crystal density was 353.17 ± 49.23 μm in children and it was 555.75 ± 25.27 μm in adults). Mean crystal density of the epithelium was 1.47 ± 1.17 (median: 1.5; interquartile range: 0.3–2.4). Mean crystal density of the anterior and posterior stroma of children and adults was 3.37 ± 0.34 (median: 3.4; interquartile range: 3.25–3.55) vs. 1.23 ± 0.23 (median: 1.2; interquartile range: 1.05–1.35) and 0.76 ± 0.49 (median: 0.7; interquartile range: 0.4–1.15) vs. 3.63 ± 0.29 (median: 3.7; interquartile range: 3.45–3.8), respectively. Endothelium had intact structure in all cases. Some hexagonal crystals were observed in two subjects.

Conclusions

In vivo confocal microscopy and anterior segment optical coherence tomography confirmed an age-related pattern of crystal deposition. In children, crystals tend to locate anteriorly, while in adults, deposits are found posteriorly in corneal stroma.
Muscle building supplement use in Australian adolescent boys: relationships with body image, weight lifting, and sports engagement
Authors: Yager Zali , McLean Siân
Published: February 2020

Background

The extent and implications of muscle building protein supplement use among adolescents is relatively unknown. This study aimed to describe the prevalence of protein powder, creatine, and anabolic steroid use in a sample of 14–16 year-old boys in Australia, and the predictors of actual use, and intentions to use protein powder.

Methods

Data were obtained from questionnaires with Australian adolescent boys aged 14–16 years from one independent boy’s school in Melbourne (N = 237). Hierarchical linear and logistic regressions were used to determine the predictors of intentions, and actual use of protein powder.

Results

49.8% of boys reported current use of, and 62% intended to use protein powder; 8.4% used creatine, and 4.2% used anabolic steroids. Higher levels of drive for muscularity, participation in weight training, and playing a greater number of sports were significant predictors of higher current use and intentions to use protein powder, but age, BMI, body esteem, and ethnicity were not.

Conclusions

Prevalence of muscle building supplement use was relatively high among this adolescent population. This research has implications for intervention and prevention programs to educate young boys about muscle building supplements to reduce negative physical and psychological health effects of their use.
The disequilibrium in the distribution of the primary health workforce among eight economic regions and between rural and urban areas in China
Authors: Wang Yueyue , Li Yuyang , Qin Shangren , Kong Yuanfeng , Yu Xiyang , Guo Keqiang , Meng Jiayu
Published: February 2020

Background

Equity is one of the major goals of China’s new medical reforms launched in 2009. This study aimed to analyze the disequilibrium in primary health care (PHC) workforce among various economic zones in China and to compare the fairness between urban and rural areas since the implementation of the new medical reforms.

Method

According to China’s 11th Five-Year Plan, China is divided into eight economic regions. The data of this study were obtained from China Statistical Yearbook 2009–2016. The Atkinson index was used to depict the trend of PHC workforce fairness; the Gini coefficient was used to compare the fairness of workforce distribution between urban and rural areas; the health resource agglomeration degree was used to analyze the distributional equity of the workforce in the eight regions; and the Theil Index was used to compare the fairness of urban and rural workforce distribution across eight regions.

Result

The Atkinson index indicated that the equity of the entire PHC workforce allocation had generally improved during the new medical reforms; the Gini coefficient indicated that the fairness of the entire workforce allocation had improved in cities, but only the nurse allocation became fairer in rural areas. The agglomeration degree and the Theil index indicated that the fairness gaps across the eight regions were still large. These analyses differed from previous studies where China was divided into western, central and eastern regions. In what was previously defined as eastern region, the northeast was under-resourced, while the eastern coastal areas were observing a resource surplus. In western region, we found that the fairness in the northwest was significantly worse than southwest.

Conclusion

In China, the distribution of healthcare workforce has been improved with continuous effort. The gaps in the distribution of PHC workforce across different economic regions and between urban and rural areas are still large, with different regions facing different problems. The government should consider the population and geographical factors in allocation of PHC workforce, especially nurses.
Manipulation of macrophage polarization by peptide-coated gold nanoparticles and its protective effects on acute lung injury
Authors: Wang Lu , Zhang Huasheng , Sun Liya , Gao Wei , Xiong Ye , Ma Aying , Liu Xiali , Shen Lei , Li Qiang , Yang Hong
Published: February 2020

Background

Macrophage polarization and reprogramming in the lung play a critical role in the initiation, development and progression of acute lung injury (ALI). Regulating the activation and differentiation of pulmonary macrophages may provide a potential therapeutic strategy to treat ALI. We previously developed a novel class of anti-inflammatory nanoparticles (P12) that can potently inhibit Toll-like receptor (TLR) signaling in macrophages. These bioactive nanodevices were made of gold nanoparticles (GNPs) coated with hexapeptides to not only ensure their physiological stability but also enable GNPs with TLR inhibitory activity.

Results

In this study, using a lipopolysaccharide (LPS) induced ALI mouse model, we showed that P12 was able to alleviate lung inflammation and damage through reducing the infiltration of inflammatory cells and increasing the anti-inflammatory cytokine (IL-10) in the lung. These results prompted us to investigate possible macrophage polarization by P12. We first confirmed that P12 primarily targeted macrophages in the lung to exert anti-inflammatory activity. We then showed that P12 could drive the polarization of mouse bone marrow-derived macrophages (BMDMs) toward anti-inflammatory M2 phenotype. Interestingly, in the ALI mouse model, P12 was able to increase the alveolar M2 macrophages and reduce both the alveolar and interstitial M1 macrophages in the bronchoalveolar lavage fluid (BALF) and lung tissues.

Conclusion

This study demonstrated that peptide-coated GNPs could induce M2 macrophage polarization in vitro and in vivo to effectively regulate lung inflammation, protect lung from injuries and promote inflammation resolution. The ability of regulating macrophage polarization together with TLR inhibition made such a bioactive nanodevice a new generation of potent therapeutics to treat ALI.
Autoresuscitation (Lazarus phenomenon) after termination of cardiopulmonary resuscitation - a scoping review
Authors: Gordon Les , Pasquier Mathieu , Brugger Hermann , Paal Peter
Published: February 2020

Background

Autoresuscitation describes the return of spontaneous circulation after termination of resuscitation (TOR) following cardiac arrest (CA). We aimed to identify phenomena that may lead to autoresuscitation and to provide guidance to reduce the likelihood of it occurring.

Materials and methods

We conducted a literature search (Google Scholar, MEDLINE, PubMed) and a scoping review according to PRISMA-ScR guidelines of autoresuscitation cases where patients undergoing CPR recovered circulation spontaneously after TOR with the following criteria: 1) CA from any cause; 2) CPR for any length of time; 3) A point was reached when it was felt that the patient had died; 4) Staff declared the patient dead and stood back. No further interventions took place; 5) Later, vital signs were observed. 6) Vital signs were sustained for more than a few seconds, such that staff had to resume active care.

Results

Sixty-five patients with ROSC after TOR were identified in 53 articles (1982–2018), 18 (28%) made a full recovery.

Conclusions

Almost a third made a full recovery after autoresuscitation. The following reasons for and recommendations to avoid autoresuscitation can be proposed: 1) In asystole with no reversible causes, resuscitation efforts should be continued for at least 20 min; 2) CPR should not be abandoned immediately after unsuccessful defibrillation, as transient asystole can occur after defibrillation; 3) Excessive ventilation during CPR may cause hyperinflation and should be avoided; 4) In refractory CA, resuscitation should not be terminated in the presence of any potentially-treatable cardiac rhythm; 5) After TOR, the casualty should be observed continuously and ECG monitored for at least 10 min.
Mapping molecular pathways for embryonic Sertoli cells derivation based on differentiation model of mouse embryonic stem cells
Authors: Xu Chenze , Dai Yichen , Mohsin Ali , Hang Haifeng , Zhuang Yingping , Guo Meijin
Published: February 2020

Background

Embryonic Sertoli cells (eSCs) have been known for playing important roles in male reproductive development system. In current studies, eSCs were mainly generated from induced intermediate mesoderm. The deriving mechanism of eSCs has been unclear so far. Therefore, this work was aimed to reveal the molecular pathways during derivation of eSCs.

Methods

In this scenario, a differentiation model from mouse embryonic stem cells (mESCs) to eSCs was established through spatiotemporal control of 5 key factors, Wilms tumor 1 homolog (Wt1), GATA binding protein 4 (Gata4), nuclear receptor subfamily 5, group A, member 1 (Nr5a1, i.e.,Sf1), SRY (sex determining region Y)-box 9 (Sox9), doublesex, and mab-3 related transcription factor 1 (Dmrt1). To investigate the molecular mechanism, these key factors were respectively manipulated through a light-switchable (light-on) system, tetracycline-switchable (Tet-on) system, and CRISPR/Cas9 knock out (KO) system.

Results

Via the established approach, some embryonic Sertoli-like cells (eSLCs) were induced from mESCs and formed ring-like or tubular-like structures. The key factors were respectively manipulated and revealed their roles in the derivation of these eSLCs. Based on these results, some molecular pathways were mapped during the development of coelomic epithelial somatic cells to eSCs.

Conclusions

This differentiation model provided a high controllability of some key factors and brought a novel insight into the deriving mechanism of Sertoli cells.
Statistical test for GNSS spoofing attack detection by using multiple receivers on a rigid body
Authors: Kalantari Ashkan , Larsson Erik G.
Published: February 2020

Global navigation satellite systems (GNSS) are being the target of various jamming, spoofing, and meaconing attacks. This paper proposes a new statistical test for the presence of multiple spoofers based on range measurements observed by a plurality of receivers located on a rigid body platform. The relative positions of the receivers are known, but the location and orientation of the platform are unknown. The test is based on the generalized likelihood ratio test (GLRT) paradigm and essentially performs a consistency check between the set of observed range measurements and known information about the satellite topology and the geometry of the receiver constellation. Optimal spoofing locations and optimal artificial time delays (as induced by the spoofers) are also determined.Exact evaluation of the GLRT requires the maximum-likelihood estimates of all parameters, which proves difficult. Instead, approximations based on iterative algorithms and the squared-range least squares algorithm are derived. The accuracy of these approximations is benchmarked against Cramér-Rao lower bounds.Numerical examples demonstrate the effectiveness of the proposed algorithm and show that increasing the number of GNSS receivers makes the attack easier to detect. We also show that using multiple GNSS receivers limits the availability of optimal attack positions.
Correction to: Inflammation of the choroid plexus in progressive multiple sclerosis: accumulation of granulocytes and T cells
Authors: Rodríguez-Lorenzo Sabela , Konings Julia , van der Pol Susanne , Kamermans Alwin , Amor Sandra , van Horssen Jack , Witte Maarten E. , Kooij Gijs , de Vries Helga E.
Published: February 2020

The original publication of this article [1] contained an incorrect author name. The correct and incorrect information is shown in this correction article. The original article has been updated.