bluuebunny/crossref_metadata_2025 huggingface dataset:
Procedural learning and retention of audio‐verbal temporal sequence is altered in children with developmental coordination disorder but cortical thickness matters
Authors: Lê Margaux , Blais Mélody , Jucla Mélanie , Chauveau Nicolas , Maziero Stéphanie , Biotteau Maëlle , Albaret Jean‐Michel , Péran Patrice , Chaix Yves , Tallet Jessica
Published: June 2020

Rhythmic abilities are impaired in developmental coordination disorder (DCD) but learning deficit of procedural skills implying temporal sequence is still unclear. Current contradictory results suggest that procedural learning deficits in DCD highly depend on learning conditions. The present study proposes to test the role of sensory modality of stimulations (visual or auditory) on synchronization, learning, and retention of temporal verbal sequences in children with and without DCD. We postulated a deficit in learning particularly with auditory stimulations, in association with atypical cortical thickness of three regions of interesting: sensorimotor, frontal and parietal regions. Thirty children with and without DCD (a) performed a synchronization task to a regular temporal sequence and (b) practiced and recalled a novel non‐regular temporal sequences with auditory and visual modalities. They also had a magnetic resonance imaging to measure their cortical thickness. Results suggested that children with DCD presented a general deficit in synchronization of a regular temporal verbal sequence irrespective of the sensory modality, but a specific deficit in learning and retention of auditory non‐regular verbal temporal sequence. Stability of audio‐verbal synchronization during practice correlated with cortical thickness of the sensorimotor cortex. For the first time, our results suggest that synchronization deficits in DCD are not limited to manual tasks. This deficit persists despite repeated exposition and practice of an auditory temporal sequence, which suggests a possible alteration in audio‐verbal coupling in DCD. On the contrary, control of temporal parameters with visual stimuli seems to be less affected, which opens perspectives for clinical practice.
Prevalence of co‐morbidities and their association with mortality in patients with COVID‐19: A systematic review and meta‐analysis
Authors: Singh Awadhesh K. , Gillies Clare L. , Singh Ritu , Singh Akriti , Chudasama Yogini , Coles Briana , Seidu Sam , Zaccardi Francesco , Davies Melanie J. , Khunti Kamlesh
Published: June 2020

Aim

To estimate the prevalence of both cardiometabolic and other co‐morbidities in patients with COVID‐19, and to estimate the increased risk of severity of disease and mortality in people with co‐morbidities.

Materials and Methods

Medline, Scopus and the World Health Organization website were searched for global research on COVID‐19 conducted from January 2019 up to 23 April 2020. Study inclusion was restricted to English language publications, original articles that reported the prevalence of co‐morbidities in individuals with COVID‐19, and case series including more than 10 patients. Eighteen studies were selected for inclusion. Data were analysed using random effects meta‐analysis models.

Results

Eighteen studies with a total of 14 558 individuals were identified. The pooled prevalence for co‐morbidities in patients with COVID‐19 disease was 22.9% (95% CI: 15.8 to 29.9) for hypertension, 11.5% (9.7 to 13.4) for diabetes, and 9.7% (6.8 to 12.6) for cardiovascular disease (CVD). For chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), cerebrovascular disease and cancer, the pooled prevalences were all less than 4%. With the exception of cerebrovascular disease, all the other co‐morbidities presented a significantly increased risk for having severe COVID‐19. In addition, the risk of mortality was significantly increased in individuals with CVD, COPD, CKD, cerebrovascular disease and cancer.

Conclusions

In individuals with COVID‐19, the presence of co‐morbidities (both cardiometabolic and other) is associated with a higher risk of severe COVID‐19 and mortality. These findings have important implications for public health with regard to risk stratification and future planning.
Historical legacies and ecological determinants of grass naturalizations worldwide
Authors: Monnet Anne‐Christine , Vorontsova Maria S. , Govaerts Rafaël H. A. , Svenning Jens‐Christian , Sandel Brody
Published: June 2020

The global distribution of exotic species is the result of abiotic, biotic and dispersal filtering processes that shape the movement and success of species outside their native range. In this study we aim to understand how these filtering processes drive the fluxes of grass species among regions, the factors that influence which species establish outside of their native range, and where they do so.

We used national and subnational checklists of native and introduced grass species to determine the extent to which each region was a source or recipient of exotic grass species. We asked how species traits may distinguish those grass species that have naturalized outside their native range from those that have not, and how environmental conditions are related to the distribution of exotic grass species.

We found that exotic grass establishment is shaped by an array of factors including characteristics of regions, traits of species and their interactions. Regions with a longer history of human occupation and larger numbers of native grass species were generally the most important sources of exotic species. Global flows of species were mostly driven by a climate match between the native and exotic ranges, but were also highly asymmetric, with regions with recent human arrival being the major hosts of exotic grass species. Tall, annual and C4 grass species exhibited particularly high probabilities of establishment outside their native range.

Despite the idiosyncrasy and stochasticity characteristic of exotic species establishment, this biogeographical analysis revealed important generalities across this large plant group. Our results suggest that grass species that have co‐occurred with humans for a longer time may be better adapted to living in anthropogenic landscapes, explaining the global asymmetry in species introductions.
Information seeking behaviour of dental trauma patients and their parents
Authors: Bamashmous Nada , Cunningham Susan J. , Parekh Susan
Published: June 2020

Background and Aim

Dental trauma is a common public health issue that can be associated with high costs and lifelong treatment. Children and parents should have the correct information regarding its management to reduce the potential long‐term sequelae. Understanding their information seeking behaviour is therefore important to ensure that they are able to access, understand and retain the relevant information. The aim of this study was to investigate (a) the different ways that patients undertaking treatment for dental trauma, and their parents, look for relevant information, (b) their information needs, and (c) their preferred format of information.

Material and Methods

This was a two‐phase study: Phase I involved in‐depth interviews with 10 patients who were currently undergoing treatment for dental trauma, and 11 parents. In phase II, the themes and sub‐themes identified from the interviews were used to develop patient and parent questionnaires, which were distributed to all trauma patients and parents who fulfilled the inclusion criteria and who were attending the dental clinics from March to May 2014.

Results

Patients and parents had different concerns immediately following the trauma, during treatment and in the long term, and they wanted different forms of information to answer their concerns. Reliability was the main issue about trusting the information available in the Internet, social media and other online sources. Therefore, patients preferred to obtain information verbally from their dentist, while parents preferred written information.

Conclusion

Patients and parents have different information needs, and these also vary at different stages of treatment. It is therefore important to customize the way information is provided for each group accordingly.
Youth Experience Tracker Instrument: A self‐report measure of developmental antecedents to severe mental illness
Authors: Patterson Victoria C. , Pencer Alissa , Pavlova Barbara , Awadia Alim , MacKenzie Lynn E. , Zwicker Alyson , Drobinin Vladislav , Howes Vallis Emily , Uher Rudolf
Published: June 2020

Aim

We sought to examine the structure, internal consistency, convergent and criterion validity of the Youth Experience Tracker Instrument (YETI), a new brief self‐report measure designed to facilitate early identification of risk for severe forms of mental illness, including major depressive disorder, bipolar disorder, and schizophrenia.

Methods

We collected 716 YETIs from 315 individuals aged 8 to 27 with and without familial risk of severe mental illness. The YETI measures six developmental antecedents that precede and predict serious forms of mental illness: affective lability, anxiety, basic symptoms, depressive symptoms, psychotic‐like experiences, and sleep. A battery of concurrent questionnaires and interviews measured the same constructs.

Results

The best‐fitting bifactor model supported the validity of both total score and antecedent‐specific subscales. Internal consistency was high for the total score (ω = 0.94) and subscales (ω = 0.80‐0.92; ρ = 0.72). The total score captured the majority of information from the 26 YETI items (hierarchical omega ωh = 0.74). Correlations of YETI subscales with established measures of the same constructs (r = 0.45‐0.80) suggested adequate convergent validity. We propose cut‐offs with high negative predictive values to facilitate efficient risk screening.

Conclusion

The YETI, a brief self‐report measure of antecedents, provides an alternative to using multiple longer instruments. Future research may examine the predictive validity of the YETI for the onset of major mood and psychotic disorders.
Associations between schizotypal personality features, mentalizing difficulties and thought problems in a sample of community adolescents
Authors: Salaminios George , Morosan Larisa , Toffel Elodie , Tanzer Michal , Eliez Stephan , Badoud Deborah , Armando Marco , Debbané Martin
Published: June 2020

Aim

Schizotypal trait expression and mentalizing impairments represent key factors associated with increased vulnerability for schizophrenia. In the current study, we analysed the nature of associations linking specific schizotypal personality features to mentalizing difficulties during adolescence. Furthermore, we examined the extent to which mentalizing difficulties mediate the relationship between schizotypal trait features and self‐reported thought problems.

Methods

One hundred and five community adolescents (Mage = 15.72; SD = 1.91) completed a recently developed self‐report measure of mentalizing (Reflective Functioning Questionnaire [RFQ]), evaluating the degree of certainty (RFQc‐scale) and uncertainty (RFQu‐scale) with which individuals utilize mental state information to understand their own and others' behaviour. High scores on the RFQu‐scale reflect poor usage of mental state information, while high scores on the RFQc‐scale capture adaptive levels of certainty about mental states. Self‐report questionnaires were also used to assess schizotypal trait expression, thought problems and symptoms of anxiety/depression.

Results

Linear regression models indicated that schizotypal features of social anxiety and odd speech accounted for increased RFQu scores, while odd speech also accounted for reduced RFQc scores. RFQu partially mediated the effects of social anxiety and odd speech on the level of thought problems in the sample.

Conclusions

Present findings suggest that schizotypal features that impede interpersonal communication during adolescence are linked to difficulties in mental state understanding. Our study also provides original data suggesting that the effects of social anxiety and odd speech on psychosis‐risk may partially depend upon the level of mentalizing uncertainty. Mentalizing difficulties may constitute important clinical assessment and early prevention treatment targets in adolescents who demonstrate schizotypal features.
Intracisternal IGF‐1 gene therapy abrogates kainic acid‐induced excitotoxic damage of the rat spinal cord
Authors: Nishida Fabián , Zanuzzi Carolina N. , Sisti María S. , Falomir Lockhart Eugenia , Camiña Agustina E. , Hereñú Claudia B. , Bellini María J. , Portiansky Enrique L.
Published: June 2020

Development of alternative therapies for treating functional deficits after different neurological damages is a challenge in neuroscience. Insulin‐like growth factor‐1 (IGF‐1) is a potent neurotrophic factor exerting neuroprotective actions in brain and spinal cord. It is used to prevent or treat injuries of the central nervous system using different administration routes in different animal models. In this study, we evaluated whether intracisternal (IC) route for IGF‐1 gene therapy may abrogate or at least reduce the structural and behavioral damages induced by the intraparenchymal injection of kainic acid (KA) into the rat spinal cord. Experimental (Rad‐IGF‐1) and control (Rad‐DsRed‐KA) rats were evaluated using a battery of motor and sensory tests before the injection of the recombinant adenovector (day −3), before KA injection (day 0) and at every post‐injection (pi) time point (days 1, 2, 3 and 7 pi). Histopathological changes and neuronal and glial counting were assessed. Pretreatment using IC delivery of RAd‐IGF‐1 improved animal's general condition and motor and sensory functions as compared to Rad‐DsRed‐KA‐injected rats. Besides, IC Rad‐IGF‐1 therapy abrogated later spinal cord damage and reduced the glial response induced by KA as observed in Rad‐DsRed‐KA rats. We conclude that the IC route for delivering RAd‐IGF‐1 prevents KA‐induced excitotoxicity in the spinal cord.
Financial constraints and the growth and survival of innovative start‐ups: An analysis of Italian firms
Authors: Ferrucci Edoardo , Guida Roberto , Meliciani Valentina
Published: June 2020

We study the impact of measures devoted to relieving financial constraints for the growth and survival of Italian innovative start‐ups. Using balance sheet data on innovative start‐ups and information on the use of the Italian Central Guarantee Fund for small and medium‐sized enterprises, we evaluate whether access to the fund, relieving financial constraints, helps innovative start‐ups survive and grow. We find innovative start‐ups benefit significantly more than similar control firms. We shed light on the relevance of policies aimed at reducing financial constraints for the growth and survival of innovative start‐ups, an issue receiving increasing attention at the European level.
Storytelling for the foreign language classroom
Authors: Sauro Shannon , Buendgens‐Kosten Judith , Cornillie Frederik
Published: June 2020

At a time when many language teachers are looking for research‐based teaching materials that can be modified to support their students in online or digital learning, existing teaching and assessment materials developed through European grant‐funded projects can provide valuable and ready‐to‐use resources. This paper reports on the published and forthcoming teaching materials developed by the FanTALES group for teaching multilingual interactive digital storytelling to low‐to‐high intermediate level learners, more specifically, the B1 level according to the Common European Framework of Reference for Languages: Learning, teaching, assessment.
Trends and change points in surface and bottom thermal environments of the US Northeast Continental Shelf Ecosystem
Authors: Friedland Kevin D. , Morse Ryan E. , Manning James P. , Melrose Donald Christopher , Miles Travis , Goode Andrew G. , Brady Damian C. , Kohut Josh T. , Powell Eric N.
Published: June 2020

Temperature is an important factor in defining the habitats of marine resource species. While satellite sensors operationally measure ocean surface temperatures, we depend on in situ measurements to characterize benthic habitats. Ship‐based measurements were interpolated to develop a time series of gridded spring and fall, surface and bottom temperature fields for the US Northeast Shelf. Surface and bottom temperatures have increased over the study period (1968–2018) at rates between 0.18–0.31°C per decade and over a shorter time period (2004–2018) at rates between 0.26–1.49°C per decade. A change point analysis suggests that a warming regime began in the surface waters in 2011 centered on Georges Bank and the Nantucket Shoals; in following years, most of the Northeast Shelf had experienced a shift in surface temperature. A similar analysis of bottom temperature suggests a warming regime began in 2008 in the eastern Gulf of Maine; in following years, change points in temperature occurred further to the west in the Gulf of Maine, finally reaching the Middle Atlantic Bight by 2010. The spatial pattern in bottom water warming is consistent with well‐known oceanographic patterns that advect warming North Atlantic waters into the Gulf of Maine. The varying spatial and temporal progression of warming in the two layers suggests they were actuated by different sets of forcing factors. We then compared these trends and change points to responses of lower and higher trophic level organisms and identified a number of coincident shifts in distribution and biomass of key forage and fisheries species.
Fracture incidence of WaveOne Gold files: a prospective clinical study
Authors: Bueno C. S. P. , Oliveira D. P. , Pelegrine R. A. , Fontana C. E. , Rocha D. G. P. , Gutmann J. L. , Bueno C. E. S.
Published: June 2020

Aim

This prospective clinical study evaluated the incidence of instrument fracture observed after single‐file root canal treatment of molars using WaveOne Gold instruments.

Methodology

Three standardized, experienced and calibrated specialists treated 750 maxillary and mandibular molars with curvatures less than 45° (2691 root canals) over a 12‐month period. All the treatments were performed in a single session. A total of 1104 WaveOne Gold instruments were used, including 38 small, 750 primary, 228 medium and 88 large instruments. Intracanal procedures were performed according to the manufacturer's recommendations, and each instrument was used in a single clinical case. The instruments were examined after their removal from the canal, under an operating microscope at 8× magnification.

Results

No fractures were observed in any of the 1104 instruments used.

Conclusions

No fractures of WaveOne Gold reciprocating instruments occurred during root canal preparations performed in maxillary and mandibular molars with curvatures less than 45° when used strictly according to the manufacturer's recommendations and applied in a single clinical case.
The effects of preparation and cooking processes on vitamins and antioxidant capacity of sour and spicy potato silk
Authors: Ren Xue , Tang Tiantian , Xie Xinfang , Wang Wenjun , Tang Xuanming , Brennan Charles S. , Zhang Jie , Wang Zhidong
Published: June 2020

The effect of a traditional dish sour and spicy potato silk preparation and cooking process on B vitamins, phenolic profiles and antioxidant activities was investigated. Results showed that cutting of potato caused an increase in VB1, VB2, nicotinic acid, nicotinamide, VB7 and VB9. Soaking decreased the content of B vitamins and vitamin C. Blanching and rinsing caused the contents of B vitamins and vitamin C decrease compared to the control. The content of VB1, VB5 and VB6 after rinsing increased compared to soaking and blanching processes. However, VB1, nicotinamide, VB5, VB6 and VC decreased sharply after the stir‐frying process. The content of VB1, nicotinic acid, nicotinamide, VB7 and VC retained the most after five steps compared to the control. In addition, there was no difference in VB9 contents among different cooking processes compared to the control. Superoxide dismutase (SOD) exhibited a reduction rate of 95.32% and peroxidase (POD) 97.13% after the stir‐frying process.
Optimal channel strategies in a supply chain under green manufacturer financial distress with advance payment discount
Authors: Zhang Chong , Wang Yaxian , Ma Peng
Published: June 2020

Green manufacturers are always faced with capital constraints in reality, while the previous literature has shown that internal financing is more effective than external financing. Given manufacturers' financial constraints, this paper studies and compares the optimal green decisions and profits under single‐channel or dual‐channel strategies with and without green investment. Therefore, the main contribution of the paper is determining the optimal channel strategy of supply chains under advance payment financing. The results indicate that the retailer's optimal channel strategy is to provide advance payment financing to the manufacturer who introduces online channel and produces green products, which are beneficial to the economic and environmental performance. Besides, green investment can facilitate a win‐win scenario if the price elasticity of the demand for the retail channel is smaller than a threshold. Furthermore, green investment increases the retailer's acceptance of online channel. The results of our research can provide decision support for decision makers under the advance payment financing.
Limb salvage procedure in immunocompromised patients with therapy‐resistant leg ulcers—The value of ultra‐radical debridement and instillation negative‐pressure wound therapy
Authors: Geierlehner Alexander , Horch Raymund E. , Müller‐Seubert Wibke , Arkudas Andreas , Ludolph Ingo
Published: June 2020

The purpose of this study was to analyse the outcome of our established triple treatment strategy in therapy‐resistant deep‐thickness chronic lower leg ulcers. This limb salvage approach consists of ultra‐radical surgical debridement, negative‐pressure wound therapy (NPWT) with or without instillation, and split‐thickness skin grafting. Between March 2003 and December 2019, a total of 16 patients and 24 severe cases of lower leg ulcers were eligible for inclusion in this highly selective population. A total of seven patients received immunosuppressive medication. Complete wound closure was achieved in 25% and almost 90% of included lower leg ulcer cases after 3 and 24 months of our triple treatment strategy, respectively. The overall limb salvage rate was 100%. Bacterial colonisation of these wounds was significantly reduced after multiple surgical debridements and NPWT. Fasciotomy and radical removal of devitalised tissue such as deep fascia, tendons, and muscles combined with NPWT showed promising results in terms of the overall graft take rate. This treatment strategy was considered as last resort for limb salvage in such a critically ill and immunocompromised patient population. Surgeons should be aware of its efficacy and consider the triple treatment strategy especially if no other limb salvage option remains.
Measuring causality between collaborative and individual gaze metrics for collaborative problem‐solving with intelligent tutoring systems
Authors: Sharma Kshitij , Olsen Jennifer K. , Aleven Vincent , Rummel Nikol
Published: June 2020

When students are working collaboratively and communicating verbally in a technology‐enhanced environment, the system cannot track what collaboration is happening outside of the technology, making it difficult to fully assess the collaboration of the students and adapt accordingly. In this article, we propose using gaze measures as a proxy for cognitive processes to achieve collaboration awareness. Specifically, we use Granger causality to analyse the causal relationships between collaborative and individual gaze measures from students working on a fractions intelligent tutoring system and the influence that the students' dialogue, prior knowledge, or success has on these relationships. We found that collaborative gaze patterns drive the individual focus in the pairs with high posttest scores and when they are engaged in problem‐solving dialogues but the opposite with low performing students. Our work adds to the literature by extending the correlational relationships between individual and collaborative gaze measures to causal relationships and suggests indicators that can be used within an adaptive system.
Suicide assessment and treatment in pediatric primary care settings
Authors: Sisler Shawna M. , Schapiro Naomi A. , Nakaishi Michelle , Steinbuchel Petra
Published: June 2020

Topic

This article will briefly review screening for depression and suicidal ideation in primary care and school‐based clinics, with a focus on in‐depth screening for imminent suicide risk, developing a safety plan, and incorporating handoffs to urgent and emergency mental health care personnel. The article will cover current definitions of levels of suicidal risk and clinic‐based protocols for a team approach to adolescents in crisis.

Purpose

To provide primary care and behavioral health nurses with evidence‐based suicide risk screening and assessment tools and best practices for using them in patient‐centered encounters with adolescents with suicidal thinking or behavior.

Sources Used

Journal articles, books, and reports.

Conclusion

Past studies have shown that many individuals who died by suicide had seen a primary care provider in 30 days before their deaths. Nurses in primary care settings should develop clinic‐based protocols for screening all adolescents for suicide risk, developing safety plans, and providing suicidal youth and families with monitoring, appropriate referrals, follow‐up, and support.
The role of stretch, tachycardia and sodium‐calcium exchanger in induction of early cardiac remodelling
Authors: Djalinac Natasa , Ljubojevic‐Holzer Senka , Matzer Ingrid , Kolesnik Ewald , Jandl Katharina , Lohberger Birgit , Rainer Peter , Heinemann Akos , Sedej Simon , von Lewinski Dirk , Bisping Egbert
Published: June 2020

Stretch and tachycardia are common triggers for cardiac remodelling in various conditions, but a comparative characterization of their role in the excitation‐transcription coupling (ETC) and early regulation of gene expression and structural changes is lacking. Here, we show that stretch and tachycardia directly induced hypertrophy of neonatal rat cardiac myocytes and also of non‐myocytes. Both triggers induced similar patterns of hypertrophy but had largely distinct gene expression profiles. ACTA1 served as good hypertrophy marker upon stretch, while RCAN1 was found increased in response to tachycardia in a rate‐dependent fashion. Mechanistically, several calcium‐handling proteins, including the sodium‐calcium exchanger (NCX), contributed to ETC. Phosphorylation of the calcium/calmodulin‐dependent protein kinase II (CaMKII) was elevated and occurred downstream of NCX activation upon tachycardia, but not stretch. Microarray profiling revealed that stretch and tachycardia regulated around 33% and 20% genes in a NCX‐dependent manner, respectively. In conclusion, our data show that hypertrophy induction by stretch and tachycardia is associated with different gene expression profiles with a significant contribution of the NCX.
Practitioner review: Co‐design of digital mental health technologies with children and young people
Authors: Bevan Jones Rhys , Stallard Paul , Agha Sharifah Shameem , Rice Simon , Werner‐Seidler Aliza , Stasiak Karolina , Kahn Jason , Simpson Sharon A. , Alvarez‐Jimenez Mario , Rice Frances , Evans Rhiannon , Merry Sally
Published: June 2020

Background

There is increasing interest in digital technologies to help improve children and young people’s mental health, and the evidence for the effectiveness for these approaches is rising. However, there is concern regarding levels of user engagement, uptake and adherence. Key guidance regarding digital health interventions stress the importance of early user input in the development, evaluation and implementation of technologies to help ensure they are engaging, feasible, acceptable and potentially effective. Co‐design is a process of active involvement of stakeholders, requiring a change from the traditional approaches to intervention development. However, there is a lack of literature to inform the co‐design of digital technologies to help child and adolescent mental health.

Methods

We reviewed the literature and practice in the co‐design of digital mental health technologies with children and young people. We searched Medline, PsycInfo and Web of Science databases, guidelines, reviews and reference lists, contacted key authors for relevant studies, and extracted key themes on aspects of co‐design relevant to practice. We supplemented this with case studies and methods reported by researchers working in the field.

Results

We identified 25 original articles and 30 digital mental health technologies that were designed/developed with children and young people. The themes identified were as follows: principles of co‐design (including potential stakeholders and stages of involvement), methods of involving and engaging the range of users, co‐designing the prototype and the challenges of co‐design.

Conclusions

Co‐design involves all relevant stakeholders throughout the life and research cycle of the programme. This review helps to inform practitioners and researchers interested in the development of digital health technologies for children and young people. Future work in this field will need to consider the changing face of technology, methods of engaging with the diversity in the user group, and the evaluation of the co‐design process and its impact on the technology.
Post‐glacial establishment of locally adapted fish populations over a steep salinity gradient
Authors: Leder Erica H. , André Carl , Le Moan Alan , Töpel Mats , Blomberg Anders , Havenhand Jonathan N. , Lindström Kai , Volckaert Filip A. M. , Kvarnemo Charlotta , Johannesson Kerstin , Svensson Ola
Published: June 2020

Studies of colonization of new habitats that appear from rapidly changing environments are interesting and highly relevant to our understanding of divergence and speciation. Here, we analyse phenotypic and genetic variation involved in the successful establishment of a marine fish (sand goby, Pomatoschistus minutus) over a steep salinity drop from 35 PSU in the North Sea (NE Atlantic) to two PSU in the inner parts of the post‐glacial Baltic Sea. We first show that populations are adapted to local salinity in a key reproductive trait, the proportion of motile sperm. Thereafter, we show that genome variation at 22,190 single nucleotide polymorphisms (SNPs) shows strong differentiation among populations along the gradient. Sequences containing outlier SNPs and transcriptome sequences, mapped to a draft genome, reveal associations with genes with relevant functions for adaptation in this environment but without overall evidence of functional enrichment. The many contigs involved suggest polygenic differentiation. We trace the origin of this differentiation using demographic modelling and find the most likely scenario is that at least part of the genetic differentiation is older than the Baltic Sea and is a result of isolation of two lineages prior to the current contact over the North Sea–Baltic Sea transition zone.
Unravelling the polyphony in clinical reasoning research in medical education
Authors: Koufidis Charilaos , Manninen Katri , Nieminen Juha , Wohlin Martin , Silén Charlotte
Published: June 2020

Rationale

Clinical reasoning lies at the heart of medical practice and has a long research tradition. Nevertheless, research is scattered across diverse academic disciplines with different research traditions in a wide range of scientific journals. This polyphony is a source of conceptual confusion.

Aims and objectives

We sought to explore the underlying theoretical assumptions of clinical reasoning aiming to promote a comprehensive conceptual and theoretical understanding of the subject area. In particular, we asked how clinical reasoning is defined and researched and what conceptualizations are relevant to such uses.

Methods

A scoping review of the clinical reasoning literature was undertaken. Using a “snowball” search strategy, the wider scientific literature on clinical reasoning was reviewed in order to clarify the different underlying conceptual assumptions underlying research in clinical reasoning, particularly to the field of medical education. This literature included both medical education, as well as reasoning research in other academic disciplines outside medical education, that is relevant to clinical reasoning. A total of 124 publications were included in the review.

Results

A detailed account of the research traditions in clinical reasoning research is presented. In reviewing this research, we identified three main conceptualisations of clinical reasoning: “reasoning as cognitive activity,” “reasoning as contextually situated activity,” and “reasoning as socially mediated activity.” These conceptualisations reflected different theoretical understandings of clinical reasoning. Each conceptualisation was defined by its own set of epistemological assumptions, which we have identified and described.

Conclusions

Our work seeks to bring into awareness implicit assumptions of the ongoing clinical reasoning research and to hopefully open much needed channels of communication between the different research communities involved in clinical reasoning research in the field.
Clinical effects of dehydration on tooth color: How much and how long?
Authors: Hatırlı Hüseyin , Karaarslan Emine Şirin , Yaşa Bilal , Kılıç Enes , Yaylacı Ayla
Published: June 2020

Objective

To evaluate effects of dehydration on tooth color determine whether color returns to baseline after 30 min or 24 h.

Materials and methods

Thirty participants with intact maxillary central and lateral incisors were recruited for the study. Color measurements were performed with a spectrophotometer (SpectroShade Micro) at baseline and at 10, 20, and 30 min of dehydration, as well as 30 min and 24 h of rehydration. CIEDE2000 color parameters were used to calculate color difference. The data were analyzed for color changes over time by repeated‐measures analysis of variance (ANOVA), and the Bonferroni‐Tukey test was used for post‐ANOVA comparisons (P < .05).

Results

After 30 min of dehydration, all the tested teeth were above the perceptibility threshold (ΔE00 = 0.8), and 85% of the teeth were above the acceptability threshold (ΔE00 = 1.8). After 30 min of rehydration, 78.3% of the tested teeth were above the perceptibility threshold, and 31.6% of the teeth were above the acceptability threshold. After 24 h of rehydration, 99.2% of the teeth were below the acceptability threshold, and 90% of the values were below the perceptibility threshold.

Conclusions

Thirty‐minute tooth dehydration can result in a clinically significant color change. After a 24‐h rehydration period, reliable color assessment can be performed.

Clinical significance

Tooth dehydration causes significant color change, thus assessment of final color or clinical success should be considered after tooth rehydration for esthetic restorations and tooth bleaching.
Clinical course of duodenal mucosa‐associated lymphoid tissue lymphoma: Comparison with gastric mucosa‐associated lymphoid tissue lymphoma
Authors: Na Hee Kyong , Won Sung Hyun , Ahn Ji Yong , Kim Ga Hee , Jung Kee Wook , Lee Jeong Hoon , Kim Do Hoon , Choi Kee Don , Song Ho June , Lee Gin Hyug , Jung Hwoon‐Yong , Kim Hwa Jung
Published: June 2020

Background and Aim

There are few cases of duodenal mucosa‐associated lymphoid tissue (MALT) lymphoma reported in the literature, and little is known about the clinical course of this disease. Here, we aimed to characterize the clinical features of duodenal MALT lymphoma by comparison with gastric MALT lymphoma.

Methods

Thirteen patients diagnosed with duodenal MALT lymphoma at Asan Medical Center from March 1997 to February 2017 were included in this retrospective study, along with patients with gastric MALT lymphoma, matched by age and sex at a 1:10 ratio.

Results

Median age of patients with duodenal MALT lymphoma was 49 (range 20–72) years, and 53.8% (7/13) were male. Comparison of patient characteristics indicated that Helicobacter pylori infection (46.2% vs 90.8%, P < 0.001) and lymph node metastasis (23.1% vs 5.4%, P = 0.049) rates differed between patients with duodenal and gastric MALT lymphoma. Overall complete remission (61.5% vs 86.2%, P = 0.021) and complete remission after initial H. pylori eradication therapy (50% vs 87.7%, P = 0.037) were significantly lower in patients with duodenal than gastric MALT lymphoma. Complications including bleeding, stricture, and transformation to high‐grade lymphoma occurred in a total of seven patients (4.9%), with a higher incidence in patients with duodenal than gastric MALT lymphoma (38.5% vs 1.5%, P < 0.001).

Conclusions

Duodenal MALT lymphoma is very rare, and treatment outcomes appear to be inferior to those of gastric MALT lymphoma.
Safer Prescribing for Hospitalized Older Adults with an Electronic Health Records‐Based Prescribing Context
Authors: Drago Kathleen , Sharpe Jackie , De Lima Bryanna , Alhomod Abdulaziz , Eckstrom Elizabeth
Published: June 2020

BACKGROUND/OBJECTIVES

Hospitalized older adults are at risk of receiving potentially inappropriate medication (PIM) doses, driven in part by age‐independent dose defaults used by electronic health records (EHRs), leading providers to prescribe for older adults as they do for younger adults. We studied whether an automated EHR‐based medication support tool would reduce PIM dosing for hospitalized older adults.

DESIGN

Pre‐post study design.

SETTING

Tertiary care, level 1 trauma, academic medical center in Oregon.

PARTICIPANTS

Hospitalized adults 75 years and older in the inpatient, nonemergency setting prescribed medications with geriatric‐specific dose considerations.

INTERVENTION

An EHR‐based, automated set of evidence‐based, age‐specific dose and frequency defaults called the Geriatric Prescribing Context (GPC).

MEASUREMENTS

The process measure is percentage of orders consistent with geriatric dose recommendations, and outcome measures are average dose (AD) in milligrams and total daily dose (TDD) in milligrams in the 12 months before and after implementation.

RESULTS

Use of recommended geriatric doses with the context improved for all 10 of the most commonly ordered medications. In the year after implementation, there was a trend toward decreasing TDD and AD across all drug classes.

CONCLUSION

The GPC is a simple, elegant, and effective means to align prescribing practices with safety standards for older adults, improving prescribing safety for all. It works within the current prescriber workflow without triggering alert fatigue and requires minimal resources for development and maintenance.
The Effects of Dementia Care Co‐Management on Acute Care, Hospice, and Long‐Term Care Utilization
Authors: Jennings Lee A. , Hollands Simon , Keeler Emmett , Wenger Neil S. , Reuben David B.
Published: June 2020

BACKGROUND/OBJECTIVES

Although nurse practitioner dementia care co‐management has been shown to reduce total cost of care for fee‐for‐service (FFS) Medicare beneficiaries, the reasons for cost savings are unknown. To further understand the impact of dementia co‐management on costs, we examined acute care utilization, long‐term care admissions, and hospice use of program enrollees as compared with persons with dementia not in the program using FFS and managed Medicare claims data.

DESIGN

Quasi‐experimental controlled before‐and‐after comparison.

SETTING

Urban academic medical center.

PARTICIPANTS

A total of 856 University of California, Los Angeles (UCLA) Alzheimer's and Dementia Care program patients were enrolled between July 1, 2012, and December 31, 2015, and 3,139 similar UCLA patients with dementia not in the program. Comparison patients were identified as having dementia using International Classification of Diseases‐9 codes and natural language processing of clinical notes. Coarsened exact matching was used to reduce covariate imbalance between intervention and comparison patients.

INTERVENTION

Dementia co‐management model using nurse practitioners partnered with primary care providers and community organizations.

MEASUREMENTS

Average difference‐in‐differences per quarter over the 2.5‐year intervention period for all‐cause hospitalization, emergency department (ED) visits, intensive care unit (ICU) stays, and number of inpatient hospitalization days; admissions to long‐term care facilities; and hospice use in the last 6 months of life.

RESULTS

Intervention patients had fewer ED visits (odds ratio [OR] = .80; 95% confidence interval [CI] = .66–.97) and shorter hospital length of stay (incident rate ratio = .74; 95% CI = .55–.99). There were no significant differences between groups for hospitalizations or ICU stays. Program participants were less likely to be admitted to a long‐term care facility (hazard ratio = .65; 95% CI = .47–.89) and more likely to receive hospice services in the last 6 months of life (adjusted OR = 1.64; 95% CI = 1.13–2.37).

CONCLUSION

Comprehensive nurse practitioner dementia care co‐management reduced ED visits, shortened hospital length of stay, increased hospice use, and delayed admission to long‐term care.
Feasibility and reliability of the Assessing Levels of Physical Activity health‐related fitness test battery in adults with intellectual disabilities
Authors: Cabeza‐Ruiz R. , Sánchez‐López A. M. , Trigo M. E. , Gómez‐Píriz P. T.
Published: June 2020

Background

People with intellectual disabilities (IDs) seem to have a lower physical fitness (PF) than their peers without disabilities, which coincides with reduced autonomy, life expectancy and quality of life. To assess PF in these individuals, it is necessary to use appropriate tools that permit the assessment of their physical capacities taking into account their specific characteristics. The aim of this work is to study the feasibility and reliability of the Assessing Levels of Physical Activity (ALPHA)‐Fit test battery for adults in a group of men and women with mild to moderate ID.

Methods

Forty‐one adults with ID of both sexes, ranging in age from 20 to 60 years old, participated in the study. To identify the feasibility and reliability of the ALPHA‐Fit test battery for adults, two complete assessments were done for each one of the tests included in the battery. The assessments were performed for a period of no more than 2 weeks (test–retest). An intraclass correlation coefficient was used to determinate test–retest reliability, and a mixed analysis of variance factorial was used for each of the dependent variables. Bland–Altman plots were also used to assess consistency between the two measurements. Feasibility was calculated as the percentage of people who were able to perform the tests correctly (not feasible <50%, fairly feasible 50%–75% and feasible >75%). In order to determine other psychometric properties, minimal detectable change and standard error of measurement (SEM) were also calculated.

Results

Of the 10 tests in the ALPHA‐Fit test battery, eight were shown to be feasible. High reliability was obtained (>0.90) for the variables related to body composition. In the hand‐grip test, reliability was high in the men's group but low in the women's group. Good reliability results were also found (0.80–0.89) in the dynamic sit‐up test for women, but not for men. Fair reliability (0.70–0.79) was found in jump‐and‐reach and neck‐shoulder mobility tests. The variables in the 2‐km walk and agility tests indicated poor reliability. All tests showed SEM values related to high variability. However, Bland–Altman plots showed results related to lack of consistency.

Conclusions

The feasibility and reliability calculations, as well as the SEM values, confirm that not all the tests of the ALPHA‐Fit Test Battery for Adults are suitable for the assessment of PF in adults with ID, probably because of the complexity of the motor fitness tests. The authors emphasise the necessity of making adaptations to the protocols used or of using other tests more appropriate to the characteristics of people with mild to moderate ID.
H63D variant of the homeostatic iron regulator (HFE) gene alters α‐synuclein expression, aggregation, and toxicity
Authors: Kim Yunsung , Stahl Mark C. , Huang Xuemei , Connor James R.
Published: June 2020

Pathological features of Parkinson's disease include the formation of Lewy bodies containing α‐synuclein and the accumulation of iron in the substantia nigra. Previous studies have suggested that iron accumulation contributes to the Parkinson's disease pathology through reactive oxygen species production and accelerated α‐synuclein aggregation. This study examines the effects of commonly occurring H63D variant of the homeostatic iron regulatory (HFE) gene on α‐synuclein pathology in cell culture and animal models. H63D HFE expression in SH‐SY5Y cells lowered endogenous α‐synuclein levels and significantly decreased pre‐formed fibril‐induced α‐synuclein aggregation. H63D HFE cells were also protected from pre‐formed fibril‐induced apoptosis. Autophagic flux, a major pathway for α‐synuclein clearance, was increased in H63D HFE cells. Expression of REDD1 was elevated and rapamycin treatment was unable to further induce autophagy, indicating mTORC1 inhibition as the main mechanism of autophagy induction. Moreover, siRNA knockdown of REDD1 in H63D HFE cells decreased autophagic flux and increased the sensitivity to PFF‐mediated toxicity. While iron chelator (deferiprone) treatment rescued WT HFE cells from pre‐formed fibril toxicity, it exacerbated or was unable to rescue H63D HFE cells. In the in vivo pre‐formed fibril intracranial injection model, H67D Hfe (mouse homolog of the human H63D HFE variant) C57BL/6J × 129 mice showed less α‐synuclein aggregation and less decline in motor function compared to WT Hfe. Collectively, this study suggests that H63D HFE variant modifies α‐synuclein pathology through the induction of autophagy and has the potential to impact the pathogenesis and treatment response in Parkinson's disease.

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Ultraviolet and COVID‐19 pandemic
Authors: Türsen Ümit , Türsen Belma , Lotti Torello
Published: June 2020

Background

COVID‐19 virus causes coronavirus disease.

Aims

It is a highly contagious viral infection.

Patients/Methods/Results/Conclusion

In this article, we will discuss the potential phototherapy problems and also alternative options for dermatologists, ultraviolet treatment against COVID‐19 virus, and vitamin D–associated problems in these coronavirus days.