bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of maternal risk factors with the recent rise of neural tube defects in Canada
Authors: Liu Shiliang , Evans Jane , MacFarlane Amanda J. , Ananth Cande V. , Little Julian , Kramer Michael S. , Joseph K. S.
Published: March 2019

Background

We sought to assess the recent trend in NTD prevalence at birth in the post‐folic acid food fortification era and to identify the maternal risk factors associated with that trend.

Methods

We carried out a population‐based study of all livebirths and stillbirths (including late pregnancy terminations) delivered in hospitals in Canada (excluding Quebec) from 2004 to 2015 (n = 3 439 330). We examined NTD birth prevalence by year, multiple pregnancy, maternal age, parity, pregestational diabetes, chronic illness, and problematic substance use. Poisson regression was used to quantify the association between spina bifida and cranial defects and maternal characteristics and other risk factors.

Results

We identified 1517 non‐chromosomal NTDs, yielding a birth prevalence of 4.4 per 10 000 total births. NTD prevalence rose from 3.6 in 2004 to 4.6 per 10 000 in 2015 (Ptrend = 0.03). Among NTD subtypes, only spina bifida showed a temporal increase (Ptrend = 0.03). Birth prevalence of spina bifida was higher among younger mothers, those with type 2 diabetes (rate ratio (RR) 3.74, 95% confidence interval (CI) 2.21, 6.35), chronic illness (RR 3.16, 95% CI 1.97, 5.07), and problematic substance use (RR 1.88, 95% CI 1.31, 2.71). Adjusting for risk factors attenuated the significant temporal trend in spina bifida (unadjusted average annual prevalence ratio (aAAPR) 1.016, 95% CI 1.001, 1.032; adjusted AAPR 1.014, 95% CI 0.998, 1.029).

Conclusions

Increases in the frequency of maternal risk factors such as pregestational diabetes mellitus, substance use, and chronic illness may be partly responsible for the recent rise in NTDs, particularly spina bifida.
New tools for engineering tomorrow's forests
Authors: Law Simon R.
Published: March 2019

It is difficult to overstate the role of wood in the story of humanity. In times that predate recorded history it provided shelter from the elements, light and warmth when burned, and a supple material with which early humans could craft their first tools. Today, it is still one of our chief building materials and an emerging industry is extending its applications through the development of novel biomaterials, such as cellulose fiber‐derived nanocomposites. An article in this issue of Physiologia Plantarum (Johnsson et al. 2019) describes the influence the phytohormones auxin and gibberellic acid (GA) have on the process of wood formation, and reveals possible targets for optimizing cell wall properties in fiber cells.
Association between longitudinal clinical outcomes in patients with hip fracture and their pre‐fracture place of residence
Authors: Balzer‐Geldsetzer Monika , Buecking Benjamin , Ruchholtz Steffen , Kis Bernhard , Dodel Richard , Hessmann Philipp
Published: March 2019

Background

Clinical outcomes of patients with proximal femoral fracture within 1 year after hospitalization are presented. In particular, associations between the patients' clinical status and their pre‐fracture residence were evaluated (community‐dwelling vs nursing home).

Methods

Patients aged ≥60 years with proximal femoral fractures were included in a prospective, single‐centre observational study and followed for 12 months. Patients' clinical status at baseline was compared to their health status at follow‐up 12 months later. Several standardized questionnaires were used to evaluate the patients' functional and cognitive capacity (e.g. Lawton Instrumental Activities of Daily Living Scale, Barthel Index, and Mini‐Mental State Examination), mobility (timed up‐and‐go test, Tinetti Test, and Harris Hip Score), quality of life (EuroQol‐5 Dimensions index and EuroQol Visual Analogue Scale), and psychological status (Geriatric Depression Scale).

Results

This study included 402 patients (mean age: 81.3 ± 8.2 years, 72% women). Patients stayed in hospital for 13.7 ± 6.1 days on average. The comparison of patients' clinical status at baseline and at 12‐month follow‐up revealed that the Mini‐Mental State Examination and Charlson Comorbidity Index remained unchanged (P = 0.527 and P = 0.705), the level of depression (Geriatric Depression Scale) significantly decreased (P < 0.001), and quality of life (EuroQol‐5 Dimensions index) diminished (P < 0.001). Although patients' mobility increased after 12 months (P < 0.001 for timed up‐and‐go test and Harris Hip Score), their functional capacity was significantly reduced (P < 0.001 for Barthel Index and Lawton Instrumental Activities of Daily Living Scale). Nursing home residents showed a significantly higher impairment at baseline than community‐dwelling individuals and less improvement in functional and cognitive tests at 12‐month follow‐up.

Conclusions

Clinical outcomes after hip fracture are significantly associated with patients' pre‐fracture residence status. Place of residence as well as functional and cognitive status on admission may lead to differences in functional recovery and affect therapeutic and rehabilitative decision‐making.
A review of fish identification methods applied on small fish
Authors: Sandford Marade , Castillo Gonzalo , Hung Tien‐Chieh
Published: March 2019

Most of the research on marking of aquatic organisms has been done using large organisms since they tend to have better retention rates, their swimming behaviour is less affected by the size of the tag, they have less trauma due to injectable tags or from the injector itself and they are easier to handle and able to withstand the stress of tagging and recapture. The development of small tags has grown from a necessity to study smaller fish species, earlier life stages of fish and to study other small aquatic organisms. As an endangered species, delta smelt (Hypomesus transpacificus) are being intensively studied in the upper San Francisco Estuary (CA, USA). A crucial part of many of these studies is tracking delta smelt, which requires a distinctive mark on each individual or group of fish. Unfortunately, many of the experimental fish suffer inadvertent mortality, as delta smelt are very sensitive to environmental and handling stress. The purpose of this review was to synthesize the different tagging and marking studies on small fish and aquatic organisms and to evaluate the advantages and disadvantages of each method for applications on sensitive species such as delta smelt. This review suggests the most effective methods for tracking delta smelt are visible implant alphanumeric (VIA) tagging and adipose fin clips for subadult to adult fish and calcein marks for young life stages. Among these methods, only VIA tagging currently provides individual organism identification.
Transmission of bacteria in bronchiectasis and chronic obstructive pulmonary disease: Low burden of cough aerosols
Authors: Stockwell Rebecca E. , Chin Melanie , Johnson Graham R. , Wood Michelle E. , Sherrard Laura J. , Ballard Emma , O'Rourke Peter , Ramsay Kay A. , Kidd Timothy J. , Jabbour Nassib , Thomson Rachel M. , Knibbs Luke D. , Morawska Lidia , Bell Scott C.
Published: March 2019

Background and objective

Aerosol transmission of Pseudomonas aeruginosa has been suggested as a possible mode of respiratory infection spread in patients with cystic fibrosis (CF); however, whether this occurs in other suppurative lung diseases is unknown. Therefore, we aimed to determine if (i) patients with bronchiectasis (unrelated to CF) or chronic obstructive pulmonary disease (COPD) can aerosolize P. aeruginosa during coughing and (ii) if genetically indistinguishable (shared) P. aeruginosa strains are present in these disease cohorts.

Methods

People with bronchiectasis or COPD and P. aeruginosa respiratory infection were recruited for two studies. Aerosol study: Participants (n = 20) underwent cough testing using validated cough rigs to determine the survival of P. aeruginosa aerosols in the air over distance and duration. Genotyping study: P. aeruginosa sputum isolates (n = 95) were genotyped using the iPLEX20SNP platform, with a subset subjected to the enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC‐PCR) assay to ascertain their genetic relatedness.

Results

Aerosol study: Overall, 7 of 20 (35%) participants released P. aeruginosa cough aerosols during at least one of the cough aerosol tests. These cough aerosols remained viable for 4 m from the source and for 15 min after coughing. The mean total aerosol count of P. aeruginosa at 2 m was two colony‐forming units. Typing study: No shared P. aeruginosa strains were identified.

Conclusion

Low viable count of P. aeruginosa cough aerosols and a lack of shared P. aeruginosa strains observed suggest that aerosol transmission of P. aeruginosa is an unlikely mode of respiratory infection spread in patients with bronchiectasis and COPD.
Azithromycin and ABBA in the chest clinic: ‘The winner takes it all...’
Authors: Gibson Peter G.
Published: March 2019

See related Article
Scheduled to Gain: Short‐ and Longer‐Run Educational Effects of Examination Scheduling*
Authors: Bensnes Simon Søbstad
Published: March 2019

In this paper, I present findings concerning the effect of examination scheduling on high‐stakes exam scores and longer‐run outcomes. I show that random variations in examination schedules, which increase the time students have to prepare, have positive effects on exam scores. The effect is highly concave, and stronger for females and in quantitative subjects. I trace the effects of preparation time into tertiary education outcomes, finding significant effects for female students on the extensive and intensive margins. I show how easily exam scores and, consequently, longer‐run outcomes are affected by a random institutional factor unrelated to student ability.
Immigration Status, Immigrant Family Ties, and Support for the Democratic Party
Authors: Hawley George
Published: March 2019

Objective

I test the hypothesis that immigration status itself is a predictor of Democratic Party affiliation and vote choice, even controlling for other attributes. I further test whether having immigrant parents and grandparents has a similar effect.

Method

To examine these questions, I created single‐ and multilevel models of party affiliation and vote choice using the 2016 Cooperative Congressional Election Study.

Results

Even after controlling for a myriad of individual and contextual attributes, immigration status was a statistically significant and substantively important predictor of Democratic affiliation. This was also true of the children and grandchildren of immigrants, but this effect weakened over multiple generations.

Conclusion

Immigration status itself appears to be an important determinant of voting patterns, which is highly consequential, given the large and growing foreign‐born population in the United States.
Outcomes of patients lost to follow‐up after antiretroviral therapy initiation in rural north‐eastern South Africa
Authors: Ambia Julie , Kabudula Chodziwadziwa , Risher Kathryn , Xavier Gómez‐Olivé Francesc , Rice Brian D. , Etoori David , Reniers Georges
Published: March 2019

Objective

The vital status of patients lost to follow‐up often remains unknown in antiretroviral therapy (ART) programmes in sub‐Saharan Africa because medical records are no longer updated once the patient disengages from care. Thus, we aimed to assess the outcomes of patients lost to follow‐up after ART initiation in north‐eastern South Africa.

Methods

Using data from a rural area in north‐eastern South Africa, we estimated the cumulative incidence of patient outcomes (i) after treatment initiation using clinical records, and (ii) after loss to follow‐up (LTFU) using data from clients that have been individually linked to Agincourt Health and Demographic Surveillance System (AHDSS) database. Aside from LTFU, we considered mortality, re‐engagement and migration out of the study site. Cox proportional hazards regression was used to identify covariates of these patient outcomes.

Results

Between April 2014 and July 2017, 3700 patients initiated ART and contributed a total of 6818 person‐years of follow‐up time. Three years after ART initiation, clinical record‐based estimates of LTFU, mortality and documented transfers were 41.0% (95% CI: 38.5–43.4%), 1.9% (95% CI 1.0–3.2%) and 0.1% (95% CI 0.0–0.9%), respectively. Among those who were LTFU, the cumulative incidence of re‐engagement, out‐migration and mortality at 3 years were 38.1% (95% CI 33.1–43.0%), 49.4% (95% CI 43.1–55.3%) and 4.7% (95% CI 3.5–6.2%), respectively. Pregnant or breastfeeding women, foreigners and those who initiated ART most recently were at an increased risk of LTFU.

Conclusion

LTFU among patients starting ART in north‐eastern South Africa is relatively high and has increased in recent years as more asymptomatic patients have initiated treatment. Even though this tendency is of concern in light of the prevention of onwards transmission, we also found that re‐engagement in care is common and mortality among persons LTFU relatively low.
Diurnal changes in concerted plant protein phosphorylation and acetylation in Arabidopsis organs and seedlings
Authors: Uhrig R. Glen , Schläpfer Pascal , Roschitzki Bernd , Hirsch‐Hoffmann Matthias , Gruissem Wilhelm
Published: March 2019

Protein phosphorylation and acetylation are the two most abundant post‐translational modifications (PTMs) that regulate protein functions in eukaryotes. In plants, these PTMs have been investigated individually; however, their co‐occurrence and dynamics on proteins is currently unknown. Using Arabidopsis thaliana, we quantified changes in protein phosphorylation, acetylation and protein abundance in leaf rosettes, roots, flowers, siliques and seedlings at the end of day (ED) and at the end of night (EN). This identified 2549 phosphorylated and 909 acetylated proteins, of which 1724 phosphorylated and 536 acetylated proteins were also quantified for changes in PTM abundance between ED and EN. Using a sequential dual‐PTM workflow, we identified significant PTM changes and intersections in these organs and plant developmental stages. In particular, cellular process‐, pathway‐ and protein‐level analyses reveal that the phosphoproteome and acetylome predominantly intersect at the pathway‐ and cellular process‐level at ED versus EN. We found 134 proteins involved in core plant cell processes, such as light harvesting and photosynthesis, translation, metabolism and cellular transport, that were both phosphorylated and acetylated. Our results establish connections between PTM motifs, PTM catalyzing enzymes and putative substrate networks. We also identified PTM motifs for further characterization of the regulatory mechanisms that control cellular processes during the diurnal cycle in different Arabidopsis organs and seedlings. The sequential dual‐PTM analysis expands our understanding of diurnal plant cell regulation by PTMs and provides a useful resource for future analyses, while emphasizing the importance of analyzing multiple PTMs simultaneously to elucidate when, where and how they are involved in plant cell regulation.
OsBZR1 turnover mediated by OsSK22‐regulated U‐box E3 ligase OsPUB24 in rice BR response
Authors: Min Hye Jo , Cui Li Hua , Oh Tae Rin , Kim Jong Hum , Kim Tae‐Wuk , Kim Woo Taek
Published: March 2019

Oryza sativa BRASSINAZOLE RESISTANT 1 (OsBZR1) is the closest rice homolog of the Arabidopsis BZR1 and bri1‐EMS‐SUPPRESSOR 1 (BES1)/BZR2 transcription factors. OsBZR1 plays a central role in the rice brassinosteroid signaling pathway. Despite its functional importance, the control mechanism by which the cellular stability of OsBZR1 is regulated has not yet been fully elucidated. Here, we report that a rice U‐box E3 ubiquitin (Ub) ligase OsPUB24 acts as a negative regulator in the BR signaling pathway via the 26S proteasome‐dependent degradation of OsBZR1. The ospub24 T‐DNA knock‐out mutant and Ubi:RNAi‐OsPUB24 knock‐down rice plants displayed enhanced seedling growth, increased lamina joint bending, and hypersensitivity to brassinolide (BL). The expressions of the BR biosynthetic genes suppressed by BR in a negative feedback loop were lower in the mutant progeny than in the wild‐type rice plants, which indicated increased BR responses in the mutant line. OsPUB24 ubiquitinated OsBZR1, resulting in the proteasomal degradation of OsBZR1. In addition, the stability of OsPUB24 was downregulated by BL and bikinin, an inhibitor of Oryza sativa Shaggy/GSK3‐like kinase 22 (OsSK22). OsSK22, the homolog of Arabidopsis BRASSINOSTEROID INSENSITIVE 2 (BIN2) protein kinase, phosphorylated OsPUB24 and elevated the cellular stability of OsPUB24. Our findings suggest that OsPUB24 participates in OsBZR1 turnover, and that the regulatory networks of OsPUB24, OsSK22 and OsBZR1 are crucial for fine‐tuning the BR response in rice.
Reappraising David Livingstone'sThe Geographical Tradition: A quarter of a century on
Authors: Boyle Mark , Hall Tim , Sidaway James D.
Published: March 2019

The quarter of a century since the publication of David Livingstone'sThe Geographical Traditionin 1992 provides an apt moment to reflect on the book's theses, lacunae, and legacies, and to take stock of the ways in which its provocations and reception might instruct the wider project of rendering the discipline's history. In framing this themed intervention, we engage the assertion that contextualisers need contextualising; there exists scope to heighten awareness of the location within time, space and culture from which contextualist historiographies of geography are written. We call attention to the meaning and implications of the particular and situated contextualist methodology mobilised and executed inThe Geographical Tradition.
Theorising cohortness: (Mis)Fitting into student geographies
Authors: Brown Gavin , Kraftl Peter
Published: March 2019

This paper advances a theory of “cohortness” for understanding the experience and articulation of identities. Using a case study focusing on higher education students, we argue that thinking in terms of cohorts enables an alternative way to examine how people perform, feel, and express their subjectivities collectively, especially within institutional spaces. Our analysis is based on an ongoing research‐education project, which ran over five years and involved over 250 undergraduate students at a post‐1992 UK university. The project involved large groups of students engaging in an exercise on “mis/fitting,” which encouraged them to articulate (as individuals and groups) which identities it was “easy” to perform/hold/display as students, and which it was not. The project also involved a range of subsequent reflective discussions with each group. Our data provide striking insights into how year groups produce “cohortness” in different ways and across intersecting scales. In this paper, we focus on three key themes, which are underpinned by an often ambivalent articulation of contemporary neoliberal ideals: mixtures of deliberation and chance in the production of in‐class, micro‐spatial, intertextual dialogues; the intersection of norms and commonalities in the naming of some identity groups (such as sporting interests) and hiding of others (such as fandom); and the significance of personality, performative, and/or bodily traits compared with other aspects of identity.
Between roots and rhizomes: Towards a post‐phenomenology of home
Authors: Gibas Petr
Published: March 2019

Humanistic and phenomenological scholarship has long tended to regard home as a fundamental place of existential and experiential stability. In recent times, the notion of home has been critically re‐examined, however, and home is now regarded as a more complex and multi‐faceted phenomenon. Drawing on interviews with prospective buyers in two cities of the Czech Republic, I explore the complexity of home and pay particular attention to the internal tensions and paradoxes of home as imagined by people buying a flat in which to make their home. I specifically attempt at opening home as a theme and field for post‐phenomenological inquiry which has so far relatively neglected it despite the rich phenomenological tradition. In analysing the complex and seemingly contradictory imaginary home‐to‐be expressed in the interviews, I employ a Deleuzian notion of territorialisation and argue that it can be used to productively account for the inner paradox of home as both a stable and secure place to put down roots and a rhizomatic place of temporary and transplantable instance of being at home. The paper proposes to infuse phenomenological understanding of home with Deleuzian insights and as such represents an answer to the calls for instilling post‐phenomenological geography with post‐structuralist contributions. This I argue may help geographers to develop post‐phenomenological geography of home while overcoming the limitations of a phenomenological approach. At the same time, it can allow for bringing the emerging post‐phenomenology of home closer to the more established critical geographies of home on both a thematic and theoretical level and open up a space for potential cross‐fertilisation of concepts and ideas.
Fibroblast growth factor 21: an endocrine inhibitor of sugar and alcohol appetite
Authors: von Holstein‐Rathlou Stephanie , Gillum Matthew P.
Published: March 2019

Fibroblast growth factor 21 (FGF21) is a liver‐derived hormone with pleiotropic metabolic effects. Its production is induced by various dietary imbalances in mice (including low‐protein and ketogenic diets, fructose feeding and ethanol), hinting that it might influence food preference given the role of the liver in maintaining homeostatic levels of circulating nutrients. In 2016, it was shown that FGF21 selectively inhibits consumption of sugars and the primary product of their fermentation, ethanol, but not intake of fat, protein or complex carbohydrates. Since then, studies have sought to unravel this selectivity, its physiological purpose and translational relevance, as well as delineate the neural mechanisms involved. Initially found to impact ingestive behaviours in mice and non‐human primates, FGF21 is also induced in humans by sugars and, far more dramatically, by acute alcohol intake. Genetic studies have revealed that patterns of weekly candy and alcohol consumption are associated with genetic variants in FGF21 and its co‐receptor β‐klotho (KLB), suggesting that liking for sugar, and fermented sugar, may be influenced by natural variation in FGF21 signal strength in humans. Herein, we discuss our nascent understanding of FGF21 as a selective negative regulator of sugar and alcohol appetite as well as reasons why such a peculiar system may have evolved in mammals. Uncovering the regulatory network governing sugar, and fermented sugar, intake could provide new opportunities to improve dietary choices in a population suffering from Western diet‐induced diseases fuelled in part by a runaway sweet – and alcohol – tooth.

image
Protein composition of the muscle mitochondrial reticulum during postnatal development
Authors: Kim Yuho , Yang Daniel S. , Katti Prasanna , Glancy Brian
Published: March 2019

Key points

Muscle mitochondrial networks changed from a longitudinal, fibre parallel orientation to a perpendicular configuration during postnatal development.

Mitochondrial dynamics, mitophagy and calcium uptake proteins were abundant during early postnatal development.

Mitochondrial biogenesis and oxidative phosphorylation proteins were upregulated throughout muscle development.

Postnatal muscle mitochondrial network formation is accompanied by a change in protein expression profile from mitochondria designed for co‐ordinated cellular assembly to mitochondria highly specialized for cellular energy metabolism.

Striated muscle mitochondria form connected networks capable of rapid cellular energy distribution. However, the mitochondrial reticulum is not formed at birth and the mechanisms driving network development remain unclear. In the present study, we aimed to establish the network formation timecourse and protein expression profile during postnatal development of the murine muscle mitochondrial reticulum. Two‐photon microscopy was used to observe mitochondrial network orientation in tibialis anterior (TA) muscles of live mice at postnatal days (P) 1, 7, 14, 21 and 42, respectively. All muscle fibres maintained a longitudinal, fibre parallel mitochondrial network orientation early in development (P1–7). Mixed networks were most common at P14 but, by P21, almost all fibres had developed the perpendicular mitochondrial orientation observed in mature, glycolytic fibres. Tandem mass tag proteomics were then applied to examine changes in 6869 protein abundances in developing TA muscles. Mitochondrial proteins increased by 32% from P1 to P42. In addition, both nuclear‐ and mitochondrial‐DNA encoded oxidative phosphorylation (OxPhos) components were increased during development, whereas OxPhos assembly factors decreased. Although mitochondrial dynamics and mitophagy were induced at P1–7, mitochondrial biogenesis was enhanced after P14. Moreover, calcium signalling proteins and the mitochondrial calcium uniporter had the highest expression early in postnatal development. In conclusion, mitochondrial networks transform from a fibre parallel to perpendicular orientation during the second and third weeks after birth in murine glycolytic skeletal muscle. This structural transition is accompanied by a change in protein expression profile from mitochondria designed for co‐ordinated cellular assembly to mitochondria highly specialized for cellular energy metabolism.
Diferencias individuales y burnout en médicos oncólogos venezolanos
Authors: Torres Blanca , Guarino Leticia Rosaria
Published: March 2019

El presente estudio explora la influencia de ciertas diferencias individuales como la sensibilidad emocional, los estilos de afrontamiento y los estilos de comunicación sobre el burnout de médicos oncólogos venezolanos. Participaron en el estudio 93 médicos oncólogos de diversos hospitales oncológicos públicos de Caracas (Venezuela), quienes completaron los cuestionarios que evaluaban las variables mencionadas. Los resultados indicaron niveles medios de burnout en los médicos estudiados, una mayor sensibilidad emocional positiva, adopción de funcionales estilos de afrontamiento y estilos de comunicación más centrados en sí mismos. Por su parte, el análisis de regresión reveló que una mayor sensibilidad egocéntrica negativa y una menor sensibilidad interpersonal positiva determinan mayores niveles de burnout en los oncólogos.
Toward the Development of Knee Prostheses: Review of Current Active Devices
Authors: Torrealba Rafael R. , Fonseca-Rojas Edgar D.
Published: March 2019

This paper presents a thorough review of the initiatives carried out in the last 10 years toward the development of active knee prostheses (AKP) for transfemoral amputees. Three selection criteria were employed to filter the works to be considered in the review: (1) a prototype of the prosthesis is available; (2) the mechanical design, instrumentation, and control strategy of such a prototype have been presented in a scientific disclosure media; and (3) the prototype has been subjected to clinical assessment at least in a preliminary way. After applying such criteria, 16 projects were selected and further reviewed through a total of 31 scientific papers, considering the following six aspects: (1) actuators, (2) instrumentation, (3) control, (4) testing trials, (5) performance metrics, and (6) limitations. Then, in addition, the chronological appearance of the aforesaid papers is also shown and quantified regarding each of the previously mentioned issues, to initiate discussion on the related topics. Thus, the present review results in a specialized summary of all these developments in a structured format, offering additional understanding of the recent advances achieved in this field.
Numerical Approaches for Modeling Gas–Solid Fluidized Bed Reactors: Comparison of Models and Application to Different Technical Problems
Authors: Ostermeier Peter , Vandersickel Annelies , Gleis Stephan , Spliethoff Hartmut
Published: March 2019

Gas–solid fluidized bed reactors play an important role in many industrial applications. Nevertheless, there is a lack of knowledge of the processes occurring inside the bed, which impedes proper design and upscaling. In this work, numerical approaches in the Eulerian and the Lagrangian framework are compared and applied in order to investigate internal fluidized bed phenomena. The considered system uses steam/air/nitrogen as fluidization gas, entering the three-dimensional geometry through a Tuyere nozzle distributor, and calcium oxide/corundum/calcium carbonate as solid bed material. In the two-fluid model (TFM) and the multifluid model (MFM), both gas and powder are modeled as Eulerian phases. The size distribution of the particles is approximated by one or more granular phases with corresponding mean diameters and a sphericity factor accounting for their nonspherical shape. The solid–solid and fluid–solid interactions are considered by incorporating the kinetic theory of granular flow (KTGF) and a drag model, which is modified by the aforementioned sphericity factor. The dense discrete phase model (DDPM) can be interpreted as a hybrid model, where the interactions are also modeled using the KTGF; however, the particles are clustered to parcels and tracked in a Lagrangian way, resulting in a more accurate and computational affordable resolution of the size distribution. In the computational fluid dynamics–discrete element method (CFD–DEM) approach, particle collisions are calculated using the DEM. Thereby, more detailed interparticulate phenomena (e.g., cohesion) can be assessed. The three approaches (TFM, DDPM, CFD–DEM) are evaluated in terms of grid- and time-independency as well as computational demand. The TFM and CFD–DEM models show qualitative accordance and are therefore applied for further investigations. The MFM (as a variation of the TFM) is applied in order to simulate hydrodynamics and heat transfer to immersed objects in a small-scale experimental test rig because the MFM can handle the required small computational cells. Corundum is used as a nearly monodisperse powder, being more suitable for Eulerian models, and air is used as fluidization gas. Simulation results are compared to experimental data in order to validate the approach. The CFD–DEM model is applied in order to predict mixing behavior and cohesion effects of a polydisperse calcium carbonate powder in a larger scale energy storage reactor.
Israeli lander demonstrates a cut-rate route to the moon
Authors: Clery Daniel
Published: March 2019

Other private missions spawned by Lunar XPrize competition are not far behind.
University fights restrictive law on fetal tissue research
Authors: Wadman Meredith
Published: March 2019

Indiana law upheld by federal court faces new appeal.
Cancer immunotherapy may have a dark side
Authors: Kaiser Jocelyn
Published: March 2019

In some patients, checkpoint inhibitors seem to fuel tumor "hyperprogression."
Saving fossil hill
Authors: Finkel Elizabeth
Published: March 2019

An Australian farmer safeguards a time capsule of the world's first complex life.
Cross-boundary human impacts compromise the Serengeti-Mara ecosystem
Authors: Veldhuis Michiel P. , Ritchie Mark E. , Ogutu Joseph O. , Morrison Thomas A. , Beale Colin M. , Estes Anna B. , Mwakilema William , Ojwang Gordon O. , Parr Catherine L. , Probert James , Wargute Patrick W. , Hopcraft J. Grant C. , Olff Han
Published: March 2019

Threats to the Serengeti

Protected areas are an important tool for conserving biodiversity and ecosystem functioning. But how well do these areas withstand pressure from human activity in surrounding landscapes? Veldhuis
et al.
studied long-term data from the Serengeti-Mara ecosystem in East Africa. Human activities at boundary regions cause animals to concentrate in the core of the protected area, which eventually reduces soil carbon storage and nitrogen fixation rates and increases vulnerability to extreme droughts. Similar patterns are likely for many, if not all, large protected areas.

Science
, this issue p.
1424
Photocatalytic decarboxylative alkylations mediated by triphenylphosphine and sodium iodide
Authors: Fu Ming-Chen , Shang Rui , Zhao Bin , Wang Bing , Fu Yao
Published: March 2019

Crowdsourcing a chromophore

Photoredox catalysis is widely used to accelerate chemical reactions by channeling the energy in visible light. However, most implementations rely on expensive chromophores to absorb light. Fu
et al.
now show that a pair of cheap components acting in concert can induce these reactions, despite not being strong visible absorbers individually. The combination of sodium iodide and triphenylphosphine allowed photoinduced electron transfer to catalyze a variety of alkylations.

Science
, this issue p.
1429
A deadly amphibian disease goes global
Authors: Greenberg Dan A. , Palen Wendy J.
Published: March 2019

Chytrid infection is linked to the decline of more than 500 amphibian species
Integron-Derived Aminoglycoside-Sensing Riboswitches Control Aminoglycoside Acetyltransferase Resistance Gene Expression
Authors: Wang Shasha , He Weizhi , Sun Wenxia , Zhang Jun , Chang Yaowen , Chen Dongrong , Murchie Alastair I. H.
Published: March 2019

Class 1 integrons accumulate antibiotic resistance genes by site-specific recombination at
aatI-1
sites. Captured genes are transcribed from a promoter located within the integron; for class 1 integrons, the first gene to be transcribed and translated normally encodes an aminoglycoside antibiotic resistance protein (either an acetyltransferase [AAC] or adenyltransferase [AAD]).
Tridecaptin M, a New Variant Discovered in Mud Bacterium, Shows Activity against Colistin- and Extremely Drug-Resistant
Enterobacteriaceae
Authors: Jangra Manoj , Kaur Manpreet , Tambat Rushikesh , Rana Rohit , Maurya Sushil K. , Khatri Neeraj , Ghafur Abdul , Nandanwar Hemraj
Published: March 2019

The World Health Organization has categorized the Gram-negative superbugs, which are inherently impervious to many antibiotics, as critical priority pathogens due to the lack of effective treatments. The breach in our last-resort antibiotic (i.e., colistin) by extensively drug-resistant and pan-drug-resistant
Enterobacteriaceae
strains demands the immediate development of new therapies.
Risk factors and outcomes of management of delayed suprachoroidal haemorrhage following Ahmed glaucoma valve implantation in children
Authors: Balekudaru Shantha , Basu Tamonash , Sen Parveen , Bhende Pramod , Lingam Vijaya , George Ronnie
Published: March 2019

Aims

To assess the incidence, risk factors and outcomes of management of delayed suprachoroidal haemorrhage (DSCH) in children who had undergone Ahmed glaucoma valve implantation.

Methods

A retrospective case-control study of eyes which developed DSCH in children <18 years of age who underwent surgery between January 2009 and December 2017 with a follow-up of at least 2 months was performed. Nine cases were compared with 27 age, gender and surgeon matched controls who had undergone surgery during this period.

Results

The incidence of DSCH was 4.7% (95% CL 1.5% to 7.7%, 9 eyes of 191 children). There were no significant differences between cases and controls in baseline details except for the number of intraocular pressure (IOP) lowering medications (p=0.01) and follow-up period (p=0.001). Risk factors identified on univariate analysis (p≤0.1) were axial length (p=0.02), diagnosis of primary congenital glaucoma (p=0.05), postoperative hypotony (p=0.07) and aphakia (p=0.1). None of them were found to be significant on multivariate analysis. Five eyes, three with retinal apposition and two with retinal detachment, underwent surgical drainage. There were no significant differences in the outcomes of eyes which underwent drainage compared with those which did not. Failures, defined as IOP>18 mm Hg despite use of medications, loss of light perception, phthisis or removal of the implant were more frequent in cases (three eyes, 33.3%) compared with controls (four eyes, 14.8%) (p=0.002).

Conclusions

None of the risk factors analysed in our series proved to be significant. Failures were more common in eyes with choroidal haemorrhage, despite surgical intervention.
Contribution of specific diseases and injuries to changes in health adjusted life expectancy in 187 countries from 1990 to 2013: retrospective observational study
Authors: Chen He , Chen Gong , Zheng Xiaoying , Guo Yan
Published: March 2019

Objective

To quantify and compare the contribution of 306 diseases and injuries to the changes in health adjusted life expectancy at birth (HALE
0
) between 1990 and 2013.

Design

Retrospective demographic analysis based on aggregated data and using life table technique, Sullivan method, and decomposition method for differences in health expectancy.

Setting

The globe, 21 regions, and 187 countries, covered in the Global Burden of Disease Study (GBD) 2013.

Main outcome measures

Cause specific contribution to changes in HALE
0
between 1990 and 2013 in terms of mortality effect, disability effect, and total effect.

Results

Between 1990 and 2013, global HALE
0
increased by 5.31 years for males and 5.73 years for females. The cross national Gini coefficient of HALE
0
for both sexes combined decreased by 15.22% from 0.0736 to 0.0624. HALE
0
declined in 11 countries during the period, predominantly owing to HIV/AIDS except in Belize, Belarus, and Paraguay. Controlling communicable, maternal, neonatal, and nutritional diseases accounted for 56.47% (3.10 years) of changes in HALE
0
for both sexes combined, followed by non-communicable diseases (30.05%; 1.65 years) and injuries (13.67%; 0.75 years). Globally, HIV/AIDS caused the biggest reduction in HALE
0
(–0.28 years) and mainly afflicted residents in southern (–7.86 years), western (–1.53 years), and eastern (–1.38 years) sub-Saharan Africa. Diabetes had the second biggest negative total effect on changes in HALE
0
(–0.12 years), which was quite widespread across regions. Despite their positive total effect in high income regions, such non-communicable diseases as ischaemic heart disease, cerebrovascular disease, and hypertensive heart disease had a negative total effect in many low and middle income regions. Mortality reduction was the predominant driver (93.62%; 5.14 years) for improvement in HALE
0
, accompanied by an increase of 0.80 years in life expectancy lived with disability at birth. Only 44 (27%) of 163 causes at level 3 in the GBD cause hierarchy influenced changes in HALE
0
, mainly or only through disability.

Conclusions

Between 1990 and 2013, the globe made achievements in not only promoting population health as a whole but reducing health inequality between countries. This study pinpoints the priority diseases and injuries for altering the declining health trend in 11 countries, for curbing the epidemic of non-communicable diseases in low and middle income countries, and for promoting compression of morbidity worldwide. The detailed country specific decomposition results of effects of diseases and injuries on change in population health will further facilitate the development of national health policies.
Caregiver’s readiness for change as a predictor of outcome and attendance in an intervention programme for children and adolescents with obesity: a secondary data analysis
Authors: Anderson Yvonne C , Dolan Gerard M S , Wynter Lisa E , Treves Katharine F , Wouldes Trecia A , Grant Cameron C , Cave Tami L , Smiley Anna J , Derraik José G B , Cutfield Wayne S , Hofman Paul L
Published: March 2019

Objective/design

It remains unclear as to the efficacy of readiness for change measurements in child and adolescent obesity intervention programmes. This observational study aimed to determine whether the caregiver’s stage of change could predict outcome and adherence to treatment in an intensive intervention programme for children and adolescents with obesity.

Setting

Participants were from the Whānau Pakari randomised clinical trial, a community based multi-disciplinary intervention programme for obesity in Taranaki, New Zealand.

Participants

Eligible participants (recruited January 2012 to August 2014) were aged 5–16 years and had a body mass index (BMI) ≥98th centile or BMI >91st centile with weight-related comorbidities.

Interventions

This study only assessed participants randomised to the high-intensity intervention programme (6-month assessments with weekly group sessions for 12 months) given attendance data were required (n=96).

Primary and secondary outcome measures

Primary trial outcome was BMI SD score (SDS). Secondary outcome measures included indices such as fruit and vegetable intake, 550-m run/walk time and quality of life scores. At baseline assessment, participants (if >11 years old) and their accompanying adult were assessed for readiness to make healthy lifestyle change.

Results

A quantitative measure of stage of change in caregivers was not a predictor of primary or secondary outcomes (change in BMI SDS pre-contemplation/contemplation −0.08, 95% CI −0.18 to 0.03, action −0.16, 95% CI −0.27 to –0.05, p=0.27), or overall attendance in the weekly activity sessions (40.0% vs 37.1%, respectively, p=0.54) in the child or adolescent.

Conclusions

Caregiver’s stage of change was not a predictor of success in this multi-disciplinary assessment and intervention programme for children and adolescents with obesity. Future research needs to determine participants’ factors for success.

Trial registration number

ANZCTR12611000862943; Post-results.
Hospital nurse staffing and staff–patient interactions: an observational study
Authors: Bridges Jackie , Griffiths Peter , Oliver Emily , Pickering Ruth M
Published: March 2019

Background

Existing evidence indicates that reducing nurse staffing and/or skill mix adversely affects care quality. Nursing shortages may lead managers to dilute nursing team skill mix, substituting assistant personnel for registered nurses (RNs). However, no previous studies have described the relationship between nurse staffing and staff–patient interactions.

Setting

Six wards at two English National Health Service hospitals.

Methods

We observed 238 hours of care (n=270 patients). Staff–patient interactions were rated using the Quality of Interactions Schedule. RN, healthcare assistant (HCA) and patient numbers were used to calculate patient-to-staff ratios. Multilevel regression models explored the association between staffing levels, skill mix and the chance of an interaction being rated as ‘negative’ quality, rate at which patients experienced interactions and total amount of time patients spent interacting with staff per observed hour.

Results

10% of the 3076 observed interactions were rated as negative. The odds of a negative interaction increased significantly as the number of patients per RN increased (p=0.035, OR of 2.82 for ≥8 patients/RN compared with >6 to <8 patients/RN). A similar pattern was observed for HCA staffing but the relationship was not significant (p=0.056). When RN staffing was low, the odds of a negative interaction increased with higher HCA staffing. Rate of interactions per patient hour, but not total amount of interaction time, was related to RN and HCA staffing levels.

Conclusion

Low RN staffing levels are associated with changes in quality and quantity of staff–patient interactions. When RN staffing is low, increases in assistant staff levels are not associated with improved quality of staff–patient interactions. Beneficial effects from adding assistant staff are likely to be dependent on having sufficient RNs to supervise, limiting the scope for substitution.
The singular patient in patient-centred care: physiotherapists’ accounts of treatment of patients with chronic muscle pain
Authors: Ahlsen Birgitte , Engebretsen Eivind , Nicholls David , Mengshoel Anne Marit
Published: March 2019

A patient-centred approach has gained increasing interest in medicine and other health sciences. Whereas there are discussions about the meaning of a patient-centred approach and what the concept entails, little is known about how the patient as a person is understood in patient-centred care. This article investigates understandings of the patient as a self in patient-centred care through physiotherapy of patients with chronic muscle pain. The material consists of interviews with five Norwegian physiotherapists working in a rehabilitation clinic. Drawing on Kristeva’s discussion of subjectivity in medical discourse, the study highlights two different treatment storylines that were closely entwined. One storyline focuses on open singular healing processes in which the treatment was based on openness to a search for meaning and sharing. In this storyline, the “person“ at the centre of care was not essentialised in terms of biological mechanisms, but rather considered as a vulnerable, irrational and moving self. By contrast, the second storyline focused on goal-oriented interventions aimed at restoring the patient to health. Here, the person in the centre of the treatment was shaped according to model narratives about “the successful patient”; the empowered, rational, choosing and self-managing individual. As such, the findings revealed two conflicting concepts of the individual patient inherent in patient-centred care. On the one hand, the patient is seen as being a person in constant movement, and on the other, they are captured by more standardised terms designed to focus on a more stable notion of outcome of illness. Therefore, our study suggests that the therapists’ will to recognise the individual in patient-centred care had a counterpart involving a marginalisation of the singular.
Comparing two posterior quadratus lumborum block approaches with low thoracic erector spinae plane block: an anatomic study
Authors: Elsharkawy Hesham , Bajracharya Gausan Ratna , El-Boghdadly Kariem , Drake Richard L. , Mariano Edward R.
Published: March 2019

Background and objectives

Both posterior quadratus lumborum (QL) and erector spinae plane (ESP) blocks have been described as new truncal interfascial plane blocks. Distribution of injectate is influenced by fascial anatomy; therefore, different injection sites may produce similar spread. This anatomic study was designed to test the hypothesis that a posteromedial QL block at L2 level will more closely resemble a low thoracic ESP block when compared with the posterolateral approach at L2 level.

Methods

Left-sided ESP blocks were performed in six cadavers at T10–11. Three of these cadavers received right-sided posteromedial QL block at L2, while the other three received right-sided posterolateral QL block at L2. All injections were composed of 20 mL methylcellulose 0.5 % mixed with India ink and 10 mL of Omnipaque (Iohexol) 240 mg/mL. CT 24 hours after injection and cadaver dissection were used to evaluate injectate spread.

Results

Cephalocaudal spread of injectate by CT and cadaveric dissection was highly correlated (
r
=0.85 [95% CI 0.51 to 0.95]). Cadaver dissection showed ESP injectate spread deep to the muscle (mean [SD]) 11.7 (2.3) levels compared with 7.3 (1.2) levels for posterolateral QL and 9.7 (1.5) for posteromedial QL (p=0.04 overall, with a statistically significant pairwise difference between ESP and posterolateral QL only). The subcostal nerve and dorsal rami were commonly involved in most blocks, but the paravertebral space and ventral rami had inconsistent involvement. The lumbocostal ligament limited cranial spread from the posterlateral QL block approach.

Conclusions

The posteromedial QL block at L2 produces more cranial spread beyond the lumbocostal ligament than the posterolateral QL block, and this spread is comparable with a low thoracic ESP block. Both posterior QL and ESP blocks show unreliable spread of injectate to the paravertebral space and ventral rami, but the dorsal rami were frequently covered.