bluuebunny/crossref_metadata_2025 huggingface dataset:
The Productivity and Efficiency of Vietnamese Securities Firms, 2009 to 2017
Authors: Tran My , Abbott Malcolm
Published: June 2020

This paper provides an examination of the impact of size, regulation and ownership structure on the productivity and efficiency of 53 securities firms in Vietnam in the years 2009 to 2017. The results show that the size of the firms and regulation has an impact on the performance of the firms. Foreign ownership also has a significant negative correlation with the firms’ efficiency, while majority ownership by domestic Vietnamese, individual shareholders (as opposed to ownership by institutional shareholders) has a positive impact. In contrast, there is no significant correlation between ownership by banks and the productive efficiency of the firms.
Alternative Core Inflation Measures in Nigeria: An Examination
Authors: Bala-Keffi Ladi R. , Mbaka Donald G. , Usman Nuruddeen
Published: June 2020

Core inflation measures have played an important role in the conduct of monetary policy at various central banks around the world. We examine core inflation in Nigeria using non-traditional measures and assess their persistence, to determine whether the Central Bank of Nigeria (CBN) should pay attention to one or other of these measures when assessing inflation developments. We find that the two new measures outperform the official core rate in tracking the persistence of headline inflation. The findings of this study will aid policy making within the Central bank of Nigeria (CBN) particularly where inflation targeting is adopted as the monetary policy framework. These core inflation measures provide a useful guide to central bankers both for monetary policy decisions and as a communication tool. They are a better predictor of future inflation depicting the more persistent influences on underlying inflation, which are of interest to policymakers (e.g. Clark, 2001; Blinder and Reis, 2005; Smith, 2004 and Dolmas &Wynne, 2008).
La acción del Estado en la producción de conjuntos habitacionales para obreros del carbón en el centro-sur de Chile entre 1940 y 1973
Authors: Hoyos Giraldo Robert
Published: June 2020

Este artículo tiene como ámbito de estudio la producción habitacional para obreros del carbón en el centro-sur de Chile. A mediados del siglo XIX, los empresarios industriales eran los principales promotores de la vivienda para obreros, más tarde, entre principios y mediados del siglo XX, la producción habitacional tuvo un mayor auge, que además incluyó la participación de diferentes agencias estatales. Definiendo como estudio de caso la ciudad minera de Lota, esta investigación tiene como objetivo analizar la influencia de dichas agencias en la construcción de vivienda colectiva en este período de tiempo. El método de investigación consiste en el análisis comparativo de los conjuntos habitacionales construidos en el territorio, a partir de las publicaciones que realizó la compañía carbonífera a través del diario La Opinión de Lota, entre 1940 y 1973. Los resultados demuestran la importancia de la participación del Estado en el desarrollo de un estándar de vivienda cada vez mayor para los obreros del carbón.
Fez: entre la cultura de la ciudad y el festival de música sagrada del mundo
Authors: Selkani Ikrame
Published: June 2020

Desde su creación en 1994, el éxito del Festival de la Música Sagrada del Mundo, promovido por la Fundación Espíritu de Fez, ha traspasado las fronteras de Marruecos. Este acontecimiento ofrece un amplio abanico de cantos y música espirituales, y pretende transmitir el espíritu de Fez, capital cultural que valoriza el intercambio entre las civilizaciones.

Este festival se ha consolidado como uno de los más importantes de las músicas del mundo, y fue reconocido en 2001 por la ONU por el importante papel que desempeña en la promoción del diálogo de las culturas y de las religiones.

Los encuentros de Fez reúnen a intelectuales, científicos y humanistas en torno a un tema determinado. Abiertos a un amplio público, son objeto de intercambios, diálogos y debates a la sombra de un majestuoso roble del museo Batha.
Numerical Modeling of Subcooled Flow Boiling and Heat Transfer Enhancement: Validation and Applicability to Fusion Reactor Target Design
Authors: Young Graeme , Karimi Nader , Mackenzie Ross
Published: June 2020

Boiling flows are an extremely efficient mechanism for the transfer of ultrahigh heat fluxes and used in numerous industrial applications. In this paper, the accuracy of computational fluid dynamics in predicting the temperature distributions and heat transfer performance is examined within a nuclear fusion reactor divertor. The aim is to establish the role of computational fluid dynamics (CFD) within the design of complicated high heat flux components using a semi-mechanistic approach to flow boiling that is independent of geometry and flow conditions. An Eulerian–Eulerian two-fluid method is developed and a conjugate heat transfer model is validated against the existing experimental data where available. Overall, a satisfactory accuracy is achieved in the prediction of several important quantities. Temperature distribution throughout the divertor is found to be highly accurate and aligns with the physical testing across two expected operating regimes. Additionally, the system heat transfer coefficients and coolant temperatures are close to the assumptions already established within the literature. Heat transfer enhancement is a critical component of the divertor design, and a twisted-tape insert appears to be necessary for the system to withstand ultrahigh heat fluxes encountered within the fusion reactor. The results show that the inclusion of a twisted tape improved the heat transfer coefficient of the system by almost 45% allowing the divertor to withstand the required heat fluxes of 10 MW/m2 and 20 MW/m2.
A Six-Year Review of the Biomedical Engineering in Simulations, Imaging, and Modeling Undergraduate Research Experience
Authors: George Stephanie M. , Domire Zachary J.
Published: June 2020

Undergraduate research continues to serve as an effective strategy for mitigating the effects of a leaky pipeline. Significant funding from institutions and government agencies has increased the number of students participating in undergraduate research. In this paper, we report on the six-year experience of a National Science Foundation funded Research Experiences for Undergraduates (REU) Site: Biomedical Engineering in Simulations, Imaging, and Modeling (BME-SIM). The operation and evaluation of the program are both described. We report on the results from 55 students over six summers from 2014 to 2019. Our program was successful in attracting a diverse group of participants including 46% under-represented minority students and 53% women. Based on evaluation results, students reported significant gains in technical skills, communication skills, and knowledge of graduate school. Our findings indicate baseline gender differences for several learning outcomes, where women and nonbinary students report lower levels of mastery. These gaps are closed by the end of the program except for confidence in skills, which is still significantly lower than those reported by male counterparts. The impact of the experience on ultimate career path is difficult to determine due to underlying biases and other motivating factors; however, 67.6% of graduates have entered graduate programs. Finally, we have provided lessons learned for those who are interested in building a summer research program. In conclusion, we have described the successful implementation of an REU site and the positive learning outcomes of the student participants.
Geometric-acoustics analysis of singly scattered, nonlinearly evolving waves by circular cylinders
Authors: Muhlestein Michael B. , Hart Carl R.
Published: June 2020

Geometric acoustics, or acoustic ray theory, is used to analyze the scattering of high-amplitude acoustic waves incident upon rigid circular cylinders. Theoretical predictions of the nonlinear evolution of the scattered wave field are provided, as well as measures of the importance of accounting for nonlinearity. An analysis of scattering by many cylinders is also provided, though the effects of multiple scattering are not considered. Provided the characteristic nonlinear distortion length is much larger than a cylinder radius, the nonlinear evolution of the incident wave is shown to be of much greater importance to the overall evolution than the nonlinear evolution of the individual scattered waves.
Anisotropic and hierarchical SiC@SiO
2
nanowire aerogel with exceptional stiffness and stability for thermal superinsulation
Authors: Su Lei , Wang Hongjie , Niu Min , Dai Sheng , Cai Zhixin , Yang Biguo , Huyan Huaixun , Pan Xiaoqing
Published: June 2020

Anisotropic and hierarchical microstructure is designed to realize thermal superinsulation and high stiffness of ceramic aerogels.
Carbon nanocarriers deliver siRNA to intact plant cells for efficient gene knockdown
Authors: Demirer Gozde S. , Zhang Huan , Goh Natalie S. , Pinals Rebecca L. , Chang Roger , Landry Markita P.
Published: June 2020

Carbon nanoparticles, carrying small interfering RNA, enter plant cells to silence genes in plants.
Impact of mRNA chemistry and manufacturing process on innate immune activation
Authors: Nelson Jennifer , Sorensen Elizabeth W. , Mintri Shrutika , Rabideau Amy E. , Zheng Wei , Besin Gilles , Khatwani Nikhil , Su Stephen V. , Miracco Edward J. , Issa William J. , Hoge Stephen , Stanton Matthew G. , Joyal John L.
Published: June 2020

A combination of uridine modification and process optimization minimizes innate immune response to therapeutic mRNA.
Chronic alcohol consumption alters extracellular space geometry and transmitter diffusion in the brain
Authors: De Santis Silvia , Cosa-Linan Alejandro , Garcia-Hernandez Raquel , Dmytrenko Lesia , Vargova Lydia , Vorisek Ivan , Stopponi Serena , Bach Patrick , Kirsch Peter , Kiefer Falk , Ciccocioppo Roberto , Sykova Eva , Moratal David , Sommer Wolfgang H. , Canals Santiago
Published: June 2020

The alcohol-induced inflammatory response increases the diffusion range of small molecules in the extracellular brain parenchyma.
XAF1 as a modifier of p53 function and cancer susceptibility
Authors: Pinto Emilia M. , Figueiredo Bonald C. , Chen Wenan , Galvao Henrique C.R. , Formiga Maria Nirvana , Fragoso Maria Candida B.V. , Ashton-Prolla Patricia , Ribeiro Enilze M.S.F. , Felix Gabriela , Costa Tatiana E.B. , Savage Sharon A. , Yeager Meredith , Palmero Edenir I. , Volc Sahlua , Salvador Hector , Fuster-Soler Jose Luis , Lavarino Cinzia , Chantada Guillermo , Vaur Dominique , Odone-Filho Vicente , Brugières Laurence , Else Tobias , Stoffel Elena M. , Maxwell Kara N. , Achatz Maria Isabel , Kowalski Luis , de Andrade Kelvin C. , Pappo Alberto , Letouze Eric , Latronico Ana Claudia , Mendonca Berenice B. , Almeida Madson Q. , Brondani Vania B. , Bittar Camila M. , Soares Emerson W.S. , Mathias Carolina , Ramos Cintia R.N. , Machado Moara , Zhou Weiyin , Jones Kristine , Vogt Aurelie , Klincha Payal P. , Santiago Karina M. , Komechen Heloisa , Paraizo Mariana M. , Parise Ivy Z.S. , Hamilton Kayla V. , Wang Jinling , Rampersaud Evadnie , Clay Michael R. , Murphy Andrew J. , Lalli Enzo , Nichols Kim E. , Ribeiro Raul C. , Rodriguez-Galindo Carlos , Korbonits Marta , Zhang Jinghui , Thomas Mark G. , Connelly Jon P. , Pruett-Miller Shondra , Diekmann Yoan , Neale Geoffrey , Wu Gang , Zambetti Gerard P.
Published: June 2020

The
XAF1
-E134* variant increases the cancer risk for carriers of the
TP53
-R337H allele.
A dopamine-induced gene expression signature regulates neuronal function and cocaine response
Authors: Savell Katherine E. , Tuscher Jennifer J. , Zipperly Morgan E. , Duke Corey G. , Phillips Robert A. , Bauman Allison J. , Thukral Saakshi , Sultan Faraz A. , Goska Nicholas A. , Ianov Lara , Day Jeremy J.
Published: June 2020

Single-nucleus RNA-seq reveals a dynamic and cell-specific gene program in striatal neurons that contributes to cocaine response.
Sequential deconstruction of composite drug transport in metastatic breast cancer
Authors: Goel Shreya , Zhang Guodong , Dogra Prashant , Nizzero Sara , Cristini Vittorio , Wang Zhihui , Hu Zhenhua , Li Zheng , Liu Xuewu , Shen Haifa , Ferrari Mauro
Published: June 2020

We report a translational toolbox of multiscale imaging and mathematical modeling exploring nanoscale drug transport in metastases.
Emergent quantum Hall effects below 50 mT in a two-dimensional topological insulator
Authors: Shamim Saquib , Beugeling Wouter , Böttcher Jan , Shekhar Pragya , Budewitz Andreas , Leubner Philipp , Lunczer Lukas , Hankiewicz Ewelina M. , Buhmann Hartmut , Molenkamp Laurens W.
Published: June 2020

Quantum Hall effects emerge at very low magnetic fields from helical edge channels in topological HgTe quantum wells.
Foraging behavior links sea ice to breeding success in Antarctic penguins
Authors: Watanabe Yuuki Y. , Ito Kentaro , Kokubun Nobuo , Takahashi Akinori
Published: June 2020

In ice-free summer, Antarctic penguins enjoy easy access to food and increase body weight and breeding success.
Gate-tunable van der Waals heterostructure for reconfigurable neural network vision sensor
Authors: Wang Chen-Yu , Liang Shi-Jun , Wang Shuang , Wang Pengfei , Li Zhu’an , Wang Zhongrui , Gao Anyuan , Pan Chen , Liu Chuan , Liu Jian , Yang Huafeng , Liu Xiaowei , Song Wenhao , Wang Cong , Cheng Bin , Wang Xiaomu , Chen Kunji , Wang Zhenlin , Watanabe Kenji , Taniguchi Takashi , Yang J. Joshua , Miao Feng
Published: June 2020

A reconfigurable neural network vision sensor is proposed by using gate-tunable photoresponse of van der Waals heterostructures.
4D physiologically adaptable cardiac patch: A 4-month in vivo study for the treatment of myocardial infarction
Authors: Cui Haitao , Liu Chengyu , Esworthy Timothy , Huang Yimin , Yu Zu-xi , Zhou Xuan , San Hong , Lee Se-jun , Hann Sung Yun , Boehm Manfred , Mohiuddin Muhammad , Fisher John P. , Zhang Lijie Grace
Published: June 2020

A 4D cardiac patch with physiological adaptability may improve iPSC cell therapy for the treatment of myocardial infarction.
Structure-based drug designing and immunoinformatics approach for SARS-CoV-2
Authors: Panda Pritam Kumar , Arul Murugan Natarajan , Patel Paritosh , Verma Suresh K. , Luo Wei , Rubahn Horst-Günter , Mishra Yogendra Kumar , Suar Mrutyunjay , Ahuja Rajeev
Published: June 2020

We report development of in-silico approaches for the identification of anti-coronaviral drugs against SARS-CoV-2.
Evaluating the cardiovascular safety of sclerostin inhibition using evidence from meta-analysis of clinical trials and human genetics
Authors: Bovijn Jonas , Krebs Kristi , Chen Chia-Yen , Boxall Ruth , Censin Jenny C. , Ferreira Teresa , Pulit Sara L. , Glastonbury Craig A. , Laber Samantha , Millwood Iona Y. , Lin Kuang , Li Liming , Chen Zhengming , Milani Lili , Smith George Davey , Walters Robin G. , Mägi Reedik , Neale Benjamin M. , Lindgren Cecilia M. , Holmes Michael V.
Published: June 2020

SOST
variants that mimic therapeutic inhibition of sclerostin for osteoporosis are associated with higher risk of cardiovascular disease.
cGAS-STING–mediated DNA sensing maintains CD8
+
T cell stemness and promotes antitumor T cell therapy
Authors: Li Wenwen , Lu Lu , Lu Juanjuan , Wang Xinran , Yang Chao , Jin Jingsi , Wu Lingling , Hong Xiaochuan , Li Fanlin , Cao Dongqing , Yang Yuanqin , Wu Meng , Su Bing , Cheng Jinke , Yang Xuanming , Di Wen , Deng Liufu
Published: June 2020

Cell-intrinsic cGAS-STING–mediated DNA sensing promotes the formation of stem cell–like CD8
+
T cells for effective cancer T cell therapy.
Personalized dietary advice on the horizon
Authors: Nadkarni Girish N.
Published: June 2020

Multimodal measurements and machine learning provide evidence for personalized dietary advice.
Fungal Signature of Moisture Damage in Buildings: Identification by Targeted and Untargeted Approaches with Mycobiome Data
Authors: Adams Rachel I. , Sylvain Iman , Spilak Michal P. , Taylor John W. , Waring Michael S. , Mendell Mark J.
Published: June 2020

Living or working in damp or moldy buildings increases the risk of many adverse health effects, including asthma and other respiratory diseases. To date, however, the particular environmental exposure(s) from water-damaged buildings that causes the health effects have not been identified. Likewise, a consistent quantitative measurement that would indicate whether a building is water damaged or poses a health risk to occupants has not been found. In this work, we tried to develop analytical tools that would find a microbial signal of moisture damage amid the noisy background of microorganisms in buildings. The most successful approach taken here focused on particular groups of fungi—those considered likely to grow in damp indoor environments—and their associations with observed moisture damage. With further replication and refinement, this hypothesis-based strategy may be effective in finding still-elusive relationships between building damage and microbiomes.
Clinical and Analytical Performance of an Automated Serological Test That Identifies S1/S2-Neutralizing IgG in COVID-19 Patients Semiquantitatively
Authors: Bonelli Fabrizio , Sarasini Antonella , Zierold Claudia , Calleri Mariella , Bonetti Alice , Vismara Chiara , Blocki Frank A. , Pallavicini Luca , Chinali Alberto , Campisi Daniela , Percivalle Elena , DiNapoli Anna Pia , Perno Carlo Federico , Baldanti Fausto
Published: June 2020

In the coronavirus (CoV) disease 2019 (COVID-19) pandemic, highly selective serological testing is essential to define exposure to severe acute respiratory syndrome CoV 2 (SARS-CoV-2). Many tests have been developed, yet with variable speeds to first results, and are of unknown quality, particularly when considering the prediction of neutralizing capacity. The LIAISON SARS-CoV-2 S1/S2 IgG assay was designed to measure antibodies against the SARS-CoV-2 native S1/S2 proteins in a standardized automated chemiluminescence assay.
Genome Sequence of a Pathogenic Vibrio cholerae O1 El Tor Strain Defective for the Entire
Vibrio
Pathogenicity Island 1, Isolated in Eastern Democratic Republic of the Congo
Authors: Irenge Leonid M. , Durant Jean-François , Ambroise Jérôme , Mitangala Prudence N. , Bearzatto Bertrand , Gala Jean-Luc
Published: June 2020

We report here a complete genome sequence of a
Vibrio cholerae
O1 El Tor (Inaba; sequence type 515 [ST515]) strain isolated from a cholera patient in North Kivu Province, Democratic Republic of the Congo (DRC), which showed a complete deletion (∼80 kb) of the
Vibrio
pathogenicity island 1.
Genome Sequence of a CHeRI Orbivirus 3 Strain Isolated from a Dead White-Tailed Deer (Odocoileus virginianus) in Florida, USA
Authors: Rodrigues Thais C. S. , Lednicky John A. , Loeb Julia C. , Campos Krauer Juan M. , Wisely Samantha M. , Waltzek Thomas B. , Subramaniam Kuttichantran
Published: June 2020

We report the genome sequence of an orbivirus isolated from a dead farmed white-tailed deer in Florida. The deer was coinfected with epizootic hemorrhagic disease virus type 2. Phylogenetic and genetic analyses supported the virus as the fourth strain of the CHeRI orbivirus 3 species.
Genome Sequence of SARS-CoV-2 Isolate Cali-01, from Colombia, Obtained Using Oxford Nanopore MinION Sequencing
Authors: Lopez-Alvarez Diana , Parra Beatriz , Cuellar Wilmer J.
Published: June 2020

We report the genome sequence of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) isolate obtained from a patient with symptoms of coronavirus disease 2019 (COVID-19) who was infected in Cali, Colombia. The patient had no recent travel record and did not require hospitalization. The virus genome was obtained using Oxford Nanopore MinION sequencing.
High-Quality Draft Genome Sequences of Three Cyanobacteria Isolated from the Limestone Walls of the Old Cathedral of Coimbra, Portugal
Authors: Soares Fabiana , Trovão João , Coelho Catarina , Costa Inês , Mesquita Nuno , Gil Francisco , Catarino Lídia , Cardoso Susana M. , Portugal António , Tiago Igor
Published: June 2020

The recently described species
Myxacorys almedinensis
and two other cyanobacteria were isolated from the limestone walls of the Old Cathedral of Coimbra, Portugal (UNESCO World Heritage Site). The high-quality genome sequences presented here will be essential for characterization purposes and description of the novel taxa.
Secretion of Recombinant Interleukin-22 by Engineered Lactobacillus reuteri Reduces Fatty Liver Disease in a Mouse Model of Diet-Induced Obesity
Authors: Oh Jee-Hwan , Schueler Kathryn L. , Stapleton Donnie S. , Alexander Laura M. , Yen Chi-Liang Eric , Keller Mark P. , Attie Alan D. , van Pijkeren Jan-Peter
Published: June 2020

In humans, nonalcoholic fatty liver disease (NAFLD) is the most prevalent liver disease due to the increased prevalence of obesity. While treatment of NAFLD is often geared toward lifestyle changes, such as diet and exercise, the use of dietary supplements such as probiotics is underinvestigated. Here, we report that probioticLactobacillus reuterireduces fatty liver in a mouse model of diet-induced obesity. This phenotype was further enhanced upon delivery of recombinant interleukin-22 by engineeredLactobacillus reuteri. These observations pave the road to a better understanding of probiotic mechanisms driving the reduction of diet-induced steatosis and to development of next-generation probiotics for use in the clinic. Ultimately, these studies may lead to rational selection of (engineered) probiotics to ameliorate fatty liver disease.
Dihydrofolate Reductase Is a Valid Target for Antifungal Development in the Human Pathogen
Candida albicans
Authors: DeJarnette Christian , Luna-Tapia Arturo , Estredge Leanna R. , Palmer Glen E.
Published: June 2020

The folate biosynthetic pathway is a promising and understudied source for novel antifungals. Even dihydrofolate reductase (DHFR), a well-characterized and historically important drug target, has not been conclusively validated as an antifungal target. Here, we demonstrate that repression of DHFR inhibits growth of
Candida albicans
, a major human fungal pathogen. Methotrexate, an antifolate, also inhibits growth but through pH-dependent activity. In addition, we show that
C. albicans
has a limited ability to take up or utilize exogenous folates as only the addition of high concentrations of folinic acid restored growth in the presence of methotrexate. Finally, we show that repression of DHFR in a mouse model of infection was sufficient to eliminate host mortality. Our work conclusively establishes DHFR as a valid antifungal target in
C. albicans
.
Effect of treatment with exenatide and pioglitazone or basal-bolus insulin on diabetic neuropathy: a substudy of the Qatar Study
Authors: Ponirakis Georgios , Abdul-Ghani Muhammad A , Jayyousi Amin , Almuhannadi Hamad , Petropoulos Ioannis N , Khan Adnan , Gad Hoda , Migahid Osama , Megahed Ayman , DeFronzo Ralph , Mahfoud Ziyad , Hassan Mona , Al Hamad Hanadi , Ramadan Marwan , Alam Uazman , Malik Rayaz A
Published: June 2020

Introduction

To assess the effect of exenatide and pioglitazone or basal-bolus insulin on diabetic peripheral neuropathy (DPN) in patients with poorly controlled type 2 diabetes (T2D).

Research design and methods

This is a substudy of the Qatar Study, an open-label, randomized controlled trial. 38 subjects with poorly controlled T2D were studied at baseline and 1-year follow-up and 18 control subjects were assessed at baseline only. A combination of exenatide (2 mg/week) and pioglitazone (30 mg/day) or glargine with aspart insulin were randomly assigned to patients to achieve an HbA1c <53 mmol/mol (<7%). DPN was assessed with corneal confocal microscopy (CCM), DN4, vibration perception and sudomotor function.

Results

Subjects with T2D had reduced corneal nerves, but other DPN measures were comparable with the control group. In the combination treatment arm (n=21), HbA1c decreased by 35.2 mmol/mol (3.8 %) (p<0.0001), body weight increased by 5.6 kg (p<0.0001), corneal nerve branch density increased (p<0.05), vibration perception worsened (p<0.05), and DN4 and sudomotor function showed no change. In the insulin treatment arm, HbA1c decreased by 28.7 mmol/mol (2.7 %) (p<0.0001), body weight increased by 4.6 kg (p<0.01), corneal nerve branch density and fiber length increased (p≤0.01), vibration perception improved (p<0.01), and DN4 and sudomotor function showed no change. There was no association between the change in CCM measures with change in HbA1c, weight or lipids.

Conclusions

Treatment with exenatide and pioglitazone or basal-bolus insulin results in corneal nerve regeneration, but no change in neuropathic symptoms or sudomotor function over 1 year.
Effectiveness of a comprehensive care protocol in patients with new diagnoses of type 2 diabetes mellitus and associated comorbidities in primary care: study protocol of a quasi-experimental trial
Authors: Lapena Carolina , Borràs Enriqueta , Digon Clarisa , Aznar Rosa , del Val Garcia Jose Luis , Castelblanco Esmeralda , Garaikoetxea Ana , Laguna Vicencia
Published: June 2020

Introduction

Type 2 diabetes mellitus (T2DM) is a highly prevalent chronic disease in the Spanish population. Typically, T2DM is associated with other chronic conditions. Intensive medication at the time of diagnosis has proven effective in reducing cardiovascular risk, improving glycaemic control and preventing T2DM complications. However, it has not yet been demonstrated that a comprehensive and intensive health education protocol at the time of diagnosis has the benefits described previously. Currently, there is great variability in the practices of primary care nurses regarding health education at the time of disease diagnosis.

We aimed to evaluate the effectiveness of a systematic protocol with a comprehensive care programme in people with newly diagnosed T2DM with associated comorbidities.

Methods and analysis

A multicentre quasi-experimental design comparing a group of individuals taking part in the intervention (intervention group (IG)) with a similar group receiving standard diabetes care (comparison group (CG)) is planned. The intervention will take place during the 3 months after study enrolment. Data will be collected at baseline and at 3, 6 and 12 months. Ten primary care centres in Barcelona city will be selected for participation: 5 for the IG and 5 for the CG. The IG will include five structured individual visits postdiagnosis with the primary care nurse, during which aspects of diabetes education will be discussed with the patient and his/her family. The results will be measured in terms of health-related quality of life and the change in main outcomes (glycated haemoglobin and weight).

Ethics and dissemination

The study fully met the requirements of the Ethical Committee of Clinical Investigation of the IDIAP Jordi Gol (approval code: P13/118). Patients will be informed that their data are confidential, and they have the right to withdraw at any time without penalty. Dissemination will include publishing the findings in peer-reviewed journals and sharing our findings at scientific conferences.

Trial registration number

NCT03990857; Pre-results.
Development of an implementation and evaluation strategy for the Australian ‘Zero Childhood Cancer’ (Zero) Program: a study protocol
Authors: Rapport Frances , Smith James , O’Brien Tracey A , Tyrrell Vanessa J , Mould Emily VA , Long Janet C , Gul Hossai , Braithwaite Jeffrey
Published: June 2020

Introduction

Effective implementation of a research Program requires an actionable plan to guide execution. To assess the actionability and success of that plan, both scientific and implementation elements must be taken into account. The aim of this study is to assess the ‘Zero Childhood Cancer Personalised Medicine Program’ (the Zero Program), an Australian first-ever and most comprehensive personalised medicine programme for children with high-risk or relapsed cancer, in terms of its structure, process and implementational effect.

Methods and analysis

We will assess Program delivery mechanisms. The development of the implementation and evaluation strategy will concentrate on the work of the Zero Program as a complex whole. This includes the structure of collaborative links across stakeholder groups involved in Program development and delivery, changes to collaborative relationships over time and the impact of group working on Program outcomes. We are applying a mixed-methods design including: a rapid ethnography (observations of stakeholder interactions and informal conversations), Program professionals’ completion of a rapid health implementation proforma and a social network analysis. Formative evaluations of the implementation science effects, applying feedback techniques, for example, Formative Evaluation Feedback Loops and the Zero Program professionals’ feedback, will determine where Program tailoring may be needed. A repeat of the social network analysis downstream will examine network changes over time, followed by an expert panel using the expert recommendations for implementing change to assess the integration of implementation strategies into the Program structure. A summative evaluation of the Program will bring the research elements together, leading to comprehensive data triangulation and determining the sustainability and implementational effects of Program delivery.

Ethics and dissemination

Ethical approval for this study has been granted by Hunter New England Research Ethics Committee, New South Wales, Australia (approval ref: 2019/ETH12025). Knowledge translation will be achieved through publications, reports and conference presentations to healthcare professionals, patients, families and researchers.

Trial Registration

NCT03336931; Pre-results.
Lessons from the failure of implementing the ‘Better Care Better Value’ prescribing indicator for renin–angiotensin system drugs in England: a qualitative study of general practitioners’ perceptions using behavioural change framework
Authors: Kurdi Amanj , Elliott Rachel Ann , Chen Li-Chia
Published: June 2020

Objectives

To explore reasons for the lack of uptake of ‘Better Care Better Value (BCBV)’ prescribing indicators for renin–angiotensin–aldosterone system (RAAS) inhibitors and identify learning lessons to inform the implementation of future prescribing policies.

Design

In-depth, semistructured interviews to explore: general practitioners’ (GPs) experiences in prescribing RAAS, perceptions of the BCBV policy and potential barriers to policy implementation and suggestions for improving future policy implementation. Interviews were audio recorded, transcribed verbatim and analysed thematically, then mapped onto behavioural change frameworks (the Capability, Opportunity, Motivation and Behaviour) model and Behaviour Change Wheel (BCW)).

Setting

Primary care setting in England

Participants

Interviews were conducted with 16 GPs recruited from a purposive sample of 91 GP practices in three English counties.

Results

Four factors/barriers, related mainly to GPs’ psychological capability and reflective motivation, emerged as the possible barriers for the BCBV’s lack of uptake, including: lack of the policy awareness, negative attitude to the policy, lack of incentives and GPs’ reluctance to switch patients from angiotensin receptor blockers (ARBs) to ACE inhibitors (ACEIs). The participating GPs proposed interventions to improve future BCBV implementation and they were related to six intervention/policy functions of the BCW, addressing the four identified barriers: education/communication (increase GPs’ awareness) and environmental restructuring/regulations (provide GPs with reminding alerts); incentivisation/fiscal (provide GPs with financial incentives); enablement/guidelines-regulations (provide GPs with benchmarking against peers) and enablement/regulations and education/guidelines (facilitate switching from ARBs to ACEIs).

Conclusions

The main reason underpinning the low uptake of the BCBV indicator appears to be lack of a proactive implementation strategy. This case study demonstrated that passively disseminating policy without an effective implementation strategy results in low uptake. Furthermore, multifaceted implementation strategies are necessary to influence complex clinical decision making in a time-limited environment, such as prescribing behaviours. These findings suggest that effective policy implementation requires the application of a systematic comprehensive behaviours change framework.
Midodrine in end-stage heart failure
Authors: Gonzalez-Cordero Ariel , Ortiz-Troche Stephanie , Nieves-Rivera Juan , Mesa-Pabón Marcel , Franqui-Rivera Hilton
Published: June 2020

It is estimated that 5% of patients with heart failure (HF) will progress to end-stage disease refractory to medical therapy and might require prolonged hospitalisation with inotropic support. We present the case of a patient with end-stage HF who was admitted with cardiogenic shock. During his hospitalisation, he required prolonged intravenous vasopressor therapy due to refractory hypotension. He did not qualify for heart transplantation or left ventricular-assist device strategies. Midodrine was started as a last resort attempt to wean off vasopressors. After 5 days of therapy, the patient was weaned entirely off vasopressors and was discharged home for hospice care. By the time of discharge, he was tolerating low-dose carvedilol along with midodrine. We propose midodrine as a reasonable alternative for patients with end-stage HF with reduced ejection fraction and refractory hypotension, who are dependent on intravenous vasoactive drugs and are not candidates for advanced HF therapies.
Mindful breathing for suffering
Authors: Tung Yu Zhen , Tan Seng Beng
Published: June 2020

We present a case of a 64-year-old woman with stage 1 breast cancer. She underwent a modified radical mastectomy, followed by chemotherapy. She reported physical and psychosocial suffering due to her disease and treatment. Four weekly sessions of guided 30-min mindful breathing were delivered by the palliative care team to ease her suffering. The patient reported feelings of calmness, peace and relaxation after each session, with decrease in suffering, negative emotions and physical discomfort. This is the first report on the use of guided 30-min mindful breathing in palliating suffering of a patient with cancer.
Patient-level and system-level barriers associated with treatment delays for ST elevation myocardial infarction in China
Authors: Yin Xuejun , He Yibo , Zhang Jing , Song Feier , Liu Jin , Sun Guoli , Liang Yan , Ye Jianfeng , Hu Yunzhao , Song Mingcai , Chen Cong , Xu Qingbo , Tan Ning , Chen Jiyan , Liu Yong , Liu Hueiming , Tian Maoyi
Published: June 2020

Objective

This study aims to understand the current ST elevated myocardial infarction (STEMI) treatment process in Guangdong Province and explore patient-level and system-level barriers associated with delay in STEMI treatment, so as to provide recommendations for improvement.

Methods

This is a qualitative study. Data were collected using semistructured, face-to-face individual interviews from April 2018 to January 2019. Participants included patients with STEMI, cardiologists and nurses from hospitals, emergency department doctors, primary healthcare providers, local health governors, and coordinators at the emergency medical system (EMS). An inductive thematic analysis was adopted to generate overarching themes and subthemes for potential causes of STEMI treatment delay. The WHO framework for people-centred integrated health services was used to frame recommendations for improving the health system.

Results

Thirty-two participants were interviewed. Patient-level barriers included poor knowledge in recognising STEMI symptoms and not calling EMS when symptoms occurred. Limited capacity of health professionals in hospitals below the tertiary level and lack of coordination between hospitals of different levels were identified as the main system-level barriers. Five recommendations were provided: (1) enhance public health education; (2) strengthen primary healthcare workforce; (3) increase EMS capacity; (4) establish an integrated care model; and (5) harness government’s responsibilities.

Conclusions

Barriers associated with delay in STEMI treatment were identified at both patient and system levels. The results of this study provide a useful evidence base for future intervention development to improve the quality of STEMI treatment and patient outcomes in China and other countries in a similar situation.
Understanding the cumulative risk of maternal prenatal biopsychosocial factors on birth weight: a DynaHEALTH study on two birth cohorts
Authors: Parmar Priyanka , Lowry Estelle , Vehmeijer Florianne , El Marroun Hanan , Lewin Alex , Tolvanen Mimmi , Tzala Evangelia , Ala-Mursula Leena , Herzig Karl-Heinz , Miettunen Jouko , Prokopenko Inga , Rautio Nina , Jaddoe Vincent WV , Järvelin Marjo-Riitta , Felix Janine , Sebert Sylvain
Published: June 2020

Background

There are various maternal prenatal biopsychosocial (BPS) predictors of birth weight, making it difficult to quantify their cumulative relationship.

Methods

We studied two birth cohorts: Northern Finland Birth Cohort 1986 (NFBC1986) born in 1985–1986 and the Generation R Study (from the Netherlands) born in 2002–2006. In NFBC1986, we selected variables depicting BPS exposure in association with birth weight and performed factor analysis to derive latent constructs representing the relationship between these variables. In Generation R, the same factors were generated weighted by loadings of NFBC1986. Factor scores from each factor were then allocated into tertiles and added together to calculate a cumulative BPS score. In all cases, we used regression analyses to explore the relationship with birth weight corrected for sex and gestational age and additionally adjusted for other factors.

Results

Factor analysis supported a four-factor structure, labelled closely to represent their characteristics as ‘Factor1-BMI’ (body mass index), ‘Factor2-DBP’ (diastolic blood pressure), ‘Factor3-Socioeconomic-Obstetric-Profile’ and ‘Factor4-Parental-Lifestyle’. In both cohorts, ‘Factor1-BMI’ was positively associated with birth weight, whereas other factors showed negative association. ‘Factor3-Socioeconomic-Obstetric-Profile’ and ‘Factor4-Parental-Lifestyle’ had the greatest effect size, explaining 30% of the variation in birth weight. Associations of the factors with birth weight were largely driven by ‘Factor1-BMI’. Graded decrease in birth weight was observed with increasing cumulative BPS score, jointly evaluating four factors in both cohorts.

Conclusion

Our study is a proof of concept for maternal prenatal BPS hypothesis, highlighting the components snowball effect on birth weight in two different European birth cohorts.
Does urbanicity modify the relationship between a polygenic risk score for depression and mental health symptoms? Cross-sectional evidence from the observational HUNT Study in Norway
Authors: Sund Erik Reidar , van Lenthe Frank J , Avendano Mauricio , Raina Parminder , Krokstad Steinar
Published: June 2020

Background

Research suggests that genetic predisposition for common mental disorders may be moderated by the environment. This study examines whether a polygenic risk score (PRS) for depression is moderated by the level of residential area urbanicity using five symptoms of poor mental health as outcomes.

Methods

The study sample consisted of 41 198 participants from the 2006–2008 wave of the Norwegian HUNT study. We created a weighted PRS for depression based on 99 variants identified in a recent genome -wide association study. Participants were classified into urban or rural place of residence based on wards that correspond to neighbourhoods. Mixed effects logistic regression models with participants nested in 477 neighbourhoods were specified.

Results

A SD increase in PRS for depression was associated with a small but statistically significant increase in the odds of anxiety, comorbid anxiety and depression and mental distress. Associations for depression were weaker and not statistically significant. Compared with urban residents, rural resident had higher odds for reporting poor mental health. Genetic propensity for depression was higher for residents of urban than rural areas, suggesting gene–environment correlation. There was no sign of effect modification between genetic propensity and urbanicity for depression, anxiety, comorbid anxiety and depression, or mental distress.

Conclusion

The PRS predicted small but significant odds of anxiety, comorbid anxiety and depression and mental distress, but we found no support for a differential effect of genetic propensity in urban and rural neighbourhoods for any of the outcomes.
MRI of tumor T cell infiltration in response to checkpoint inhibitor therapy
Authors: Jiang Xiaoyu , Dudzinski Stephanie , Beckermann Kathryn E , Young Kirsten , McKinley Eliot , McIntyre J Oliver , Rathmell Jeffrey C , Xu Junzhong , Gore John C
Published: June 2020

Background

Immune checkpoint inhibitors, the most widespread class of immunotherapies, have demonstrated unique response patterns that are not always adequately captured by traditional response criteria such as the Response Evaluation Criteria in Solid Tumors or even immune-specific response criteria. These response metrics rely on monitoring tumor growth, but an increase in tumor size and/or appearance after starting immunotherapy does not always represent tumor progression, but also can be a result of T cell infiltration and thus positive treatment response. Therefore, non-invasive and longitudinal monitoring of T cell infiltration are needed to assess the effects of immunotherapies such as checkpoint inhibitors. Here, we proposed an innovative concept that a sufficiently large influx of tumor infiltrating T cells, which have a smaller diameter than cancer cells, will change the diameter distribution and decrease the average size of cells within a volume to a degree that can be quantified by non-invasive MRI.

Methods

We validated our hypothesis by studying tumor response to combination immune-checkpoint blockade (ICB) of anti-PD-1 and anti-CTLA4 in a mouse model of colon adenocarcinoma (MC38). The response was monitored longitudinally using Imaging Microstructural Parameters Using Limited Spectrally Edited Diffusion (IMPULSED), a diffusion MRI-based method which has been previously shown to non-invasively map changes in intracellular structure and cell sizes with the spatial resolution of MRI, in cell cultures and in animal models. Tumors were collected for immunohistochemical and flow cytometry analyzes immediately after the last imaging session.

Results

Immunohistochemical analysis revealed that increased T cell infiltration of the tumors results in a decrease in mean cell size (eg, a 10% increase of CD3+T cell fraction results a ~1 µm decrease in the mean cell size). IMPULSED showed that the ICB responders, mice with tumor volumes were less than 250 mm3or had tumors with stable or decreased volumes, had significantly smaller mean cell sizes than both Control IgG-treated tumors and ICB non-responder tumors.

Conclusions

IMPULSED-derived cell size could potentially serve as an imaging marker for differentiating responsive and non-responsive tumors after checkpoint inhibitor therapies, a current clinical challenge that is not solved by simply monitoring tumor growth.
Influence of gut microbiome on multiple myeloma: friend or foe?
Authors: Ahmed Nausheen , Ghannoum Mahmoud , Gallogly Molly , de Lima Marcos , Malek Ehsan
Published: June 2020

Multiple myeloma (MM) is a malignancy of terminally differentiated plasma cells, which typically evolves over time from its precursor, monoclonal gammopathy of undetermined significance. While the underlying mechanisms of this evolution remain elusive, immunomodulatory factors affecting the bone marrow (BM) microenvironment are suspected to play a role. There is an increasing evidence that the gut microbiome exerts an influence on its host’s adaptive and innate immune systems, inflammatory pathways and the BM microenvironment. Dysbiosis, therefore, may impact tumorigenesis in MM. This article gives an overview of potential mechanisms by which the microbiome may influence the pathogenesis of MM, MM patients’ responses to treatment and toxicities experienced by MM patients undergoing autologous transplant. It also discusses the potential role of the mycobiome in MM, a less studied component of the microbiome.
More than just filler: an empirically informed ethical analysis of non-surgical cosmetic procedures in body dysmorphic disorder
Authors: Lane Natalie M
Published: June 2020

Objectives

To identify and analyse ethical considerations raised when individuals with body dysmorphic disorder (BDD) consult for non-surgical cosmetic procedures.

Methods

Ethical analysis was conducted addressing the issues of best interests and capacity to consent for non-surgical cosmetic procedures in individuals with BDD. Analysis was informed by the findings of semistructured interviews with non-surgical cosmetic practitioners and mental health professionals.

Findings

Non-surgical cosmetic interventions were viewed not to be in the best interests of individuals with BDD, as they fail to address core psychological issues, result in dissatisfaction post-procedure, and risk harm. Referral to mental health services was advocated, however numerous obstacles to this were perceived. The issue of capacity to consent to non-surgical cosmetic procedures raised questions regarding whether standard capacity assessment is sensitive to the manner in which BDD may influence decision-making processes. In addition, concerns were voiced that decisions made by individuals with BDD in this context may be judged foolish, and thus wrongly equated with lack of capacity.

Discussion/conclusions

Ethical analysis, informed by the available evidence base, suggests that it is generally not in the best interests of individuals with BDD to undergo non-surgical cosmetic intervention, and referral to mental health services is indicated. Analysis of capacity draws parallels between BDD and anorexia nervosa, as decision-making capacity in both conditions can be impaired by pathological values derived from the disorder. Means of differentiating clinical assessment of pathological values from inappropriate value judgements are advocated, in order to safeguard against the latter encroaching into capacity assessment.
Perception of consultants, feedlot owners, and packers regarding management and marketing decisions on feedlots: a national survey in Brazil (Part II)
Authors: de Andrade Thiago Sérgio , Albertini Tiago Zanett , Barioni Luís Gustavo , de Medeiros Sérgio Raposo , Millen Danilo Domingues , dos Santos Antônio Carlos Ramos , Goulart Rodrigo Silva , Lanna Dante Pazzanese Duarte
Published: June 2020

Research interviews with agribusiness professionals are carried out in several countries for updating and developing technologies. This study aimed to investigate the perception of Brazilian feeders regarding management and marketing tools used in the feedlot industry. Interviews were conducted with groups: nutritionist-consultants (n = 23), feedlot owners (n = 21), and packer-owned feedlots (n = 8). Roughly 58% of the interviewees worked with two cycles of animals per year. Roughly 80% of animals on feedlots were males, with 73% of the respondents having fed only intact males and 75% of the animals were Nellore breed. Among the criteria used for pen formation, weight was the most common (75%). The use of computational tools for feedlot management (71%) and diet formulation (69%) were found to be common, although interviewees did not use any software to characterize feeder animals. In 44% of the respondent feedlots, animals that reached the desired weight and degree of finish were removed for slaughter, whereas the unfinished animals remained in the same pen. We found that a need, therefore, exists to develop efficient strategies for forming homogeneous pens upon animal entry onto feedlots, and maintaining homogenous pens upon the exit of animals for slaughter.