bluuebunny/crossref_metadata_2025 huggingface dataset:
Bone fractures from generalized convulsive seizures and status epilepticus—A systematic review
Authors: Grzonka Pascale , Rybitschka Anja , De Marchis Gian Marco , Marsch Stephan , Sutter Raoul
Published: April 2019

Objective

We present a systematic review of the literature regarding types and anatomic distribution of fractures in association with generalized convulsive status epilepticus (GCSE) and convulsive seizures in adult patients accompanied by an illustrative case of a patient with GCSE and diffuse postictal pain from underlying bone fractures.

Methods

The library search engines PubMed and EMBASE were screened systematically using predefined search terms. All identified articles written in English were screened for eligibility by two reviewers. The preferred reporting items for systematic reviews and meta‐analyses guidelines were followed.

Results

The screening of 3145 articles revealed 39 articles meeting the inclusion criteria. Among all fractures, bilateral posterior fracture‐dislocations of the shoulders were reported most frequently (33%), followed by thoracic and lumbar vertebral compression fractures (29%), skull and jaw fractures (8%), and bilateral femoral neck fractures (6%). Risk factors for seizure‐related fractures are seizure severity, duration of epilepsy, the use of antiseizure drugs known to decrease bone density, and a family history of fractures. Based on these findings, a three‐step screening procedure is proposed to uncover fractures in the postictal state. All studies were retrospective without standardized screening methods for seizure‐associated fractures resulting in a very low level of evidence and a high risk of bias.

Significance

Posterior fracture‐dislocations of the shoulders, thoracic and lumbar vertebral compression, fractures of the skull and jaw, and bilateral femoral neck fractures are most frequently reported. Preventive measures including bone densitometry, calcium/vitamin D supplementation, and bisphosphonate therapy should be reinforced in epilepsy patients at risk of osteoporosis. As long as the effect of standardized screening of fractures is not investigated, it is too early to integrate such a screening into treatment guidelines. In the meantime, clinicians are urged to heighten awareness regarding seizure‐associated fractures, especially in patients with postictal pain, as symptoms can be unspecific and misinterpretation may impede rehabilitation.
Pulling force deforms hair follicle root sheath nuclei and surrounding dermal collagen matrix differently at infundibulum, isthmus and suprabulbar regions
Authors: Johnson Simeon , Cowley Kevin , Hawkins Timothy J. , Määttä Arto
Published: April 2019

The biomechanical properties of the collagenous dermal matrix are well described but responses to mechanical force by the hair follicles have not been characterised so far. We applied a pulling force on hair follicles to visualise and quantify changes in the keratin‐14 and involucrin‐positive cell layers of the follicles using nuclear dimensions as an indicator of tissue deformation. Moreover, we used second‐harmonic generation imaging to visualise changes in the dermal collagen. We report how the anatomical regions of the follicle respond to the force. Nuclei of the isthmus region were most affected. The nuclei in both K14‐positive outer root sheath cells and in involucrin‐positive cells were significantly compressed, whereas the response in the infundibulum and suprabulbar regions was more variable. The deformation of the nuclei did not correlate with lamin A/C expression. The changes in the collagenous matrix were distinct at different depths of the dermis as collagen fibrils were compressed closer to each other in the region adjacent to upper suprabulbar follicle and pulled apart near the infundibulum. Thus, the responses to the force are locally defined and the cells in the permanent and cycling parts of the follicle behave differently.
Lactobacillus reuteri DSM 17938—A comparative study on the effect of probiotics and lysates on human skin
Authors: Khmaladze Ia , Butler Éile , Fabre Susanne , Gillbro Johanna M.
Published: April 2019

Human skin microbiota might play an important role in maintaining skin health and potentially prevent premature skin ageing. The use of probiotics in therapeutic skin applications is an attractive idea, as it could offer an alternative option for certain inflammatory skin disorders and dry or sensitive skin. Here, we investigated for the first time, a comparative study of live and the lysate products of probiotic strain Lactobacillus reuteri DSM 17938 in skin topical applications using ex vivo skin models focusing on anti‐inflammatory and skin barrier function and in vitro assays for antimicrobial activity. Our results in ultraviolet B radiation (UVB‐R)‐induced inflammation model demonstrated that both live bacteria and the lysate of L. reuteri DSM 17938 reduced proinflammatory IL‐6 and IL‐8, illustrated in both reconstructed human epidermis (RHE) and native skin models. Live L reuteri DSM 17938 significantly increased aquaporin 3 (AQP3) gene expression, while the lysate enhanced laminin A/B levels in a healthy (unstimulated) state of RHE, suggesting a positive impact on skin barrier. In addition, live L. reuteri DSM 17938 had antimicrobial action against pathogenic skin bacteria (Staphylococcus aureus, Streptococcus pyogenes M1, Cutibacterium acnes AS12, Pseudomonas aeruginosa), whereas the lysate did not have such an effect. Therefore, it is hypothesized that L. reuteri DSM 17938 could be beneficial for general skin health, to avoid the UVB‐R‐mediated inflammatory cascade and/or prevent photoageing, improve barrier function or in the management of unhealthy skin prone to inflammatory conditions due to its antimicrobial, anti‐inflammatory and skin barrier enhancing functions.
Measuring the depth of invasion in vulvar squamous cell carcinoma: interobserver agreement and pitfalls
Authors: Pouwer Anne‐Floor W , Bult Peter , Otte Irene , van der Brand Michiel , van der Horst Judith , Harterink Laurette J V , van de Vijver Koen K , Guerra Esther , Aliredjo Riena P , Bosch Steven L , M M Grefte Johanna , Zomer Saskia , Hollema Harry , de Heus Barry , Satumalaij Saphira , Ewing‐Graham Patricia C , IntHout Joanna , de Hullu Joanne A , Bulten Johan
Published: April 2019

Aims

The depth of invasion is an important prognostic factor for patients with vulvar squamous cell carcinoma (SCC). The threshold of 1 mm distinguishes between FIGO stages IA and ≥IB disease and guides the need for groin surgery. Therefore, high interobserver agreement is crucial. The conventional and the alternative method are described to measure the depth of invasion. The aims of this study were to assess interobserver agreement for classifying the depth of invasion using both methods and to identify pitfalls.

Methods and results

Fifty slides of vulvar SCC with a depth of invasion approximately 1 mm were selected, digitally scanned and independently assessed by 10 pathologists working in a referral or oncology centre and four pathologists in training. The depth of invasion was measured using both the conventional and alternative method in each slide and categorised into ≤1 and >1 mm. The percentage of agreement and Light’s kappa for multi‐rater agreement were calculated, and 95% confidence intervals were calculated by bootstrapping (1000 runs). The agreement using the conventional method was moderate (κ = 0.57, 95% confidence interval = 0.45–0.68). The percentage of agreement among the participating pathologists using the conventional method was 85.0% versus 89.4% using the alternative method. Six pitfalls were identified: disagreement concerning which invasive nest is deepest, recognition of invasive growth and where it starts, curved surface, carcinoma situated on the edge of the tissue block, ulceration and different measurement methods.

Conclusions

Pathologists reached only moderate agreement in determining the depth of invasion in vulvar SCC, without a notable difference between the two measurement methods.
A portfolio optimization approach to design of congested multi‐service networks with application in community healthcare: fractional 0‐1 programming
Authors: Ramshe Nasrin , Ahmadi‐Javid Amir
Published: April 2019

Multi‐service networks are broadly used in different service industries. Effective design of these networks has a considerable impact on customer satisfaction. Controlling congestion created at service facilities (SFs) is an important function for improving service quality. There are different studies on modeling multi‐service network design, but they mostly neglect incorporating service‐quality aspects such as congestion into their models. This paper considers the problem of simultaneous service portfolio selection, SF location, and capacity planning in a multi‐service network with M/M/1 servers where the total congestion at established facilities should be controlled. The problem is formulated as a fractional 0‐1 programming model, which is linearized in several different ways. The linear reformulations are enhanced by exploiting the special structure of the original model. A comprehensive numerical study is carried out to compare the linear models. Finally, a real case on a community healthcare network is studied to provide a set of managerial insights.
Financing decisions in supply chains with a capital‐constrained manufacturer: competition and risk
Authors: Shen Bin , Wang Xin , Cao Yifan , Li Qingying
Published: April 2019

Supply chain finance is a crucial topic. In this paper, we consider that a capital‐constrained manufacturer can borrow money from either a bank (bank credit financing) or a retailer (trade credit financing). Our analysis compares supply chain performance under these two financing schemes. Furthermore, we extend our model to evaluate the impacts of retail competition and supply chain member's risk aversion on supply chains, which consist of one capital‐constrained manufacturer and two competing retailers. We consider three financing schemes: only bank credit financing, dual trade credit financing, and bank and trade credit mix financing. We find that without retail competition, the retailer is always willing to use the trade credit financing; whereas with retail competition, if one retailer provides the trade credit but the other does not, the credit provider could receive the superior profit. Thus, providing an appropriate trade credit financing scheme is critically important for retailers. Moreover, we find that without retail competition, when a trade interest rate is relatively low, both the retailer and manufacturer could reach a win‐win situation in the trade credit financing. However, with retail competition, supply chain members (i.e., two retailers and one manufacturer) will not have an all‐win situation no matter which specific financing scheme is adopted and only a win‐win‐lose situation exists when using the credit mix financing scheme or the dual trade credit financing in supply chains. Last but not least, regardless of risk neutrality or aversion of supply chain members, their pricing decisions among three financing schemes are similar. This implies that the impacts of supply chain members’ risk aversion are limited in supply chain financing scheme selection. More managerial insights are discussed.
Microstructure, colossal permittivity, and humidity sensitivity of (Na, Nb) co‐doped rutile TiO2 ceramics
Authors: Li Tianyu , Si Renjun , Wang Jin , Wang Shuting , Sun Jie , Wang Chunchang
Published: April 2019

(Na0.25Nb0.75)xTi1−xO2 (NNTO) ceramics (x = 0, 0.005, 0.01, 0.02, and 0.05) were prepared by the conventional solid‐state reaction. The microstructure, dielectric, and humidity sensitivity of the ceramics were systematically investigated. Results showed that all ceramics exhibit pure rutile TiO2 phase with dense microstructures. Co‐doping of (Na, Nb) can effectively improve the microstructure homogeneity of the ceramics. When the doping level x ≥ 0.01, the co‐doped samples show colossal permittivity higher than 104 and dielectric loss tangent lower than 0.38. This dielectric behavior features the merit of both frequency and temperature stability in the range of 102‐106 Hz and 100‐300 K, respectively. The co‐doped ceramics were found to be sensitive to the environment moisture. The humidity sensitivity incurs a Maxwell‐Wagner relaxation near room temperature, which further enhances the dielectric permittivity. Excellent humidity sensitive properties of sensitivity to be 102.6 pF/%RH, response/recovery time to be 115/20 seconds, as well as good repeatability, were achieved in the sample with the doping level x = 0.05. This work underscores that the room temperature dielectric properties of doubly doped TiO2 system depends strongly on the environmental condition and suggests that the (Na + Nb) co‐doped TiO2 ceramics might be promising humidity sensing materials.
Recommended configuration for personal health records by standardized data item sets for diabetes mellitus and associated chronic diseases: A report from Collaborative Initiative by six Japanese Associations
Authors: Nakashima Naoki , Noda Mitsuhiko , Ueki Kohjiro , Koga Tatsuhiko , Hayashi Michio , Yamazaki Katsuya , Nakagami Tomoko , Ohara Makoto , Gochi Akira , Matsumura Yasushi , Kimura Michio , Ohe Kazuhiko , Kang Dongchon , Toya Yoshiyuki , Yamagata Kunihiro , Yokote Koutaro , Ikeda Shunya , Mitsutake Naohiro , Yamamoto Ryuichi , Tanizawa Yukio
Published: April 2019

It is expected that a large amount of data related to diabetes and other chronic diseases will be generated. However, databases constructed without standardized data item sets can be limited in their usefulness. To address this, the Collaborative Committee of Clinical Informatization in Diabetes Mellitus was established in 2011 by the Japan Diabetes Society and Japan Association for Medical Informatics. The committee has developed core item sets and self‐management item sets for diabetes mellitus, hypertension, dyslipidemia, and chronic kidney disease in collaboration with the Japanese Society of Hypertension, Japan Atherosclerosis Society, Japanese Society of Nephrology, and Japanese Society of Laboratory Medicine, as well as a mapping table that aligns the self‐management item sets with the Japanese standardized codes for laboratory testing. The committee also determined detailed specifications for implementing the four self‐management item sets in personal health record (PHR) applications to facilitate risk stratification, the generation of alerts using information and communications technology systems, the avoidance of data input errors, and the generation of reminders to input the self‐management item set data. The approach developed by the committee may be useful for combining databases for various purposes (such as for clinical studies, patient education, and electronic medical record systems) and for facilitating collaboration between PHR administrators.
Efficacy and tolerability of using platelet‐rich plasma versus chemical peeling in periorbital hyperpigmentation
Authors: Ellabban Noura F. , Eyada Moustafa , Nada Hesham , Kamel Noha
Published: April 2019

Background

Various therapeutic modalities for periorbital hyperpigmentation (POH) have been proposed.

Objective

This study was designed to compare the efficacy and tolerability of autologous platelet‐rich plasma (PRP) and chemical peeling in POH.

Subjects and methods

Forty‐two patients were enrolled in this study and randomly subdivided into two groups. Group A patients were assigned to receive four sessions of chemical peeling using trichloroacetic acid and lactic acid, while group B was assigned to patients who received four sessions of PRP injection with 2 weeks of intervals. Patients were assessed by digital photographs. The degree of improvement included four degrees from poor to excellent, and side effects were reported.

Results

Females constituted 38 out of 42 patients (mean age, 28.14 ± 3.47 years). There was a significant improvement in favor of chemical peeling over PRP. Good improvement occurred in 47.6% in the group A versus 4.8% in group B (P < 0.001). None of the PRP group had excellent improvement, while 38% of chemical peeling group did. Most of group A patients reported very pleased (47.6%) to excellent (38%) degree, in contrast to group B where 52.5% were just pleased (P < 0.001). Some of group A patients experienced itching (14.3%) and redness (14.3%), while in group B, they experienced pain (23.8%) and edema (14.3%) with nonsignificant difference between both groups (P = 0.07).

Conclusions

Both PRP and chemical peeling are effective for treatment of POH; however, chemical peeling is much more effective, tolerable, and satisfying procedure than PRP.
Carceral Kinship: Future Families of the Late Leviathan
Authors: Carter Jon Horne
Published: April 2019

This essay examines the monstrous first as a figure haunting Western legal history, stripped of rights and often merging with the animal, and second, as a divergent sociality borne of emergencies, crises, and faultlines of late liberal governmentality. In particular I ask how the figure of the pathological and violent gang member structures debates about the US‐Mexico border crosser, and the limits of humanity before the law. The essay moves from a genealogy of the gang member in Honduras, to the refugee asylum seeker of 2018, to ask what forms of difference‐making, in the form of new monstrosities, might inform new notions of kinship and solidarity amid anthropocenic futures.
Spatial segregation and urban structure
Authors: Mossay Pascal , Picard Pierre
Published: April 2019

In this paper, we develop a model of spatial segregation mediated by competitive land prices. Agents of two groups consume city land and benefit from social interactions. Because of cultural or ethnic differences, intragroup interactions are more frequent than intergroup ones. When group sizes differ, population groups sort into distinct neighborhoods. We characterize two‐ and three‐district urban structures. For high population ratios or strong intergroup interactions, only a three‐district city exists. In other cases, multiplicity of equilibria arises. Both groups generally rank these equilibria differently. However, when group sizes are similar, all individuals agree on which spatial equilibrium is best.
Rural‐Urban Trends in Opioid Overdose Discharges in Missouri Emergency Departments, 2012‐2016
Authors: Coffey Whitney , Hunter Andrew , Mobley Evan , Vivolo‐Kantor Alana
Published: April 2019

Purpose

Opioid overdose death rates rose 36% from 2015 to 2016 in Missouri, indicating a worsening of the opioid overdose epidemic. To better understand urban and rural differences in nonfatal opioid overdoses treated in Missouri emergency departments, this paper analyzed hospital billing data from emergency departments due to opioid overdose from 2012 to 2016.

Methods

Emergency department records meeting the opioid overdose case definition were aggregated into 6 progressively rural groups using the National Center for Health Statistics (NCHS) urban‐rural county classification from 2013. These data were analyzed to determine significant trends amongst and between the geographic groups.

Findings

Generally, the magnitude of opioid overdose morbidity decreased as levels of rurality increased, using annual percentage change as the metric of change. Over the study period, Missouri's most urban counties had significantly higher rates of opioid overdose and saw larger percentage increases in rates compared to more rural areas. Statewide, all rural‐urban classifications experienced increases in heroin overdose morbidity; however, there was extreme variation in the trajectory of those increases. Heroin overdose rates were much higher in urban areas than rural areas. Conversely, rural and urban areas saw relatively similar patterns for non‐heroin opioid overdoses, though overall magnitude of these increases was more modest across all geographic groups.

Conclusions

The results from this analysis can help inform prioritization of strategies and resources to implement activities addressing the opioid overdose epidemic. Using a rich hospital discharge database could allow for further analysis of subpopulations to enhance personalization and customization of care.
Effects of silymarin on growth performance, antioxidant capacity and immune response in turbot (Scophthalmus maximus L.)
Authors: Wang Jingyu , Zhou Huihui , Wang Xuan , Mai Kangsen , He Gen
Published: April 2019

A 9‐week feeding trial was conducted using triplicate groups of turbot (6.50 ± 0.01 g) to explore the potential effects of silymarin. Three concentrations of silymarin (100, 200, and 400 mg/kg) were added to the plant protein‐based diet. Fish were randomly distributed into fiberglass tanks (30 fish per tank). The results showed that adding 100 mg/kg silymarin significantly improved the growth performance, with no effects on feed utilization. The antioxidant capacity in the liver was significantly improved in the 100 mg/kg and 200 mg/kg silymarin groups by not only inducing the activities of superoxide dismutase (SOD) and catalase but also increasing the messager RNA (mRNA) expression levels of SOD, glutathione peroxidase, and peroxiredoxin 6. Meanwhile, supplying 100 and 200 mg/kg of silymarin enhanced the heights of villi and enterocytes. Silymarin supplementation reduced the mRNA expression of interleukin‐8 and tumor necrosis factor‐α but induced the expression of transforming growth factor‐β (TGF‐β) in the intestine. These results indicated that silymarin was a potential nutraceutical that could enhance the growth performance and health status of turbot fed in a high plant protein diet. Adding 100 mg/kg silymarin to the plant protein diet achieved optimal performance in turbot.
Risk of atrial fibrillation in patients with nonalcoholic steatohepatitis
Authors: Targher Giovanni
Published: April 2019

See Article on Page 933
Progressive ossification of the bone marrow vasculature with advancing age corresponds with reduced red blood cell count and percentage of circulating lymphocytes in male Fischer‐344 rats
Authors: Guderian Sophie , Lee Seungyong , McLane Mary Ann , Prisby Rhonda D.
Published: April 2019

Objective

Assess the link between bone marrow blood vessel ossification, Tb. and cortical bone, and hematological parameters across the lifespan in rats.

Methods

Right femora and whole blood samples were taken from male Fischer‐344 rats at 1, 6, 12, 18 and 24 months. Femora were scanned by micro‐computed tomography (MicroCT) to determine bone marrow blood vessel ossification (ie, ossified vessel volume [OsVV], ossified vessel thickness (OsV.Th), ossified vessel density (OsV density), and structural model index [SMI]). Bone microarchitecture (ie, bone volume [BV/TV], trabecular thickness, trabecular number, and trabecular separation), density and SMI, and cortical bone parameters (ie, cortical shell thickness, porosity, and density) were also determined by MicroCT. Complete blood counts with differentials were conducted.

Results

Ossified vessel volume increased throughout the lifespan, coinciding with reduced trabecular BV/TV and cortical shell thickness at 24 months. Many of the hematological parameters were unchanged (ie, white blood cells, lymphocyte number) or increased (monocyte number, percent monocyte, granulocyte number, percent granulocyte, hemoglobin, hematocrit, mean corpuscular hemoglobin concentration, red blood cell distribution width, platelet, mean platelet volume) with advancing age; however, red blood cells (RBC) and percent lymphocytes (LY%) were reduced at 24 months. In addition, OsV density was similar to trabecular bone density.

Conclusions

Declines in trabecular BV/TV, cortical shell thickness, RBC, and LY% with advanced age coincided with augmented ossification of bone marrow blood vessels.
Shaping smarter consumer food choices: The FoodSMART project
Authors: Hartwell H. , Appleton K. M. , Bray J. , Price S. , Mavridis I. , Giboreau A. , Perez‐Cueto F. J. A. , Ronge M.
Published: April 2019

Compared to meals prepared at home, meals eaten out of home tend to contain more energy, total fat and saturated fat and it is here where consumers can have very little knowledge of the nutrient profile of the dish they are eating. The aim of the European Union‐funded FoodSMART project (www.foodsmartproject.net) was to develop an innovative technical menu solution ‘app’ that enables informed consumer food choice, which takes into account individual preferences (such as dietary requirements) as well as food product specifications, in a workplace canteen setting. A best–worst scaling questionnaire was conducted to identify consumers’ functional app requirements and inform the development of personalised food choice messages. Proof of concept was tested using the System Usability Scale in consumers from four European countries (Denmark, France, Greece and the UK). Information on ingredients, nutrition, food ‘naturalness’ and value for money were those most valued by consumers, with this presented ideally in a personalised way and using a traffic light model. Field trials of the FoodSMART app indicated that consumers found it to be simple, easy to use and attractive for frequent use. By gaining insight into the needs of consumers, dietary information can be better tailored and provided in an appropriate format to enable informed food choice.
Towards understanding the Nordic paradox: A review of qualitative interview studies on intimate partner violence against women (IPVAW) in Sweden
Authors: Wemrell Maria , Stjernlöf Sara , Aenishänslin Justine , Lila Marisol , Gracia Enrique , Ivert Anna‐Karin
Published: April 2019

Intimate partner violence against women (IPVAW) is a major public health problem in countries around the world, including the Nordic region. Contrary to what would be expected, as the Nordic countries are rated among the most gender equal in the world, survey data suggests that the lifetime prevalence rates of IPVAW in Sweden and neighboring Nordic countries are among the highest in the EU. This phenomenon, which has been termed the Nordic paradox, requires elucidation. The aim of this review is to explore what previous qualitative studies, based on interviews with or field observations of victims, perpetrators, or professionals working in the area, primarily in Sweden, have to teach us about the nature of this paradox. Three interrelated themes are discussed. The first is how gender equality is perceived and addressed as linked, or not, to IPVAW in Swedish research and practice. The second is how violence tends to be othered, for example, through assumptions that violence is perpetrated by foreign rather than Swedish men. The third is how causal mechanisms of IPVAW have been described, typically with reference to norms and dynamics of masculinity, femininity, and heterosexual interaction.
Characteristics of the collaborative learning unit practice education model for undergraduate nursing students: a scoping review protocol
Authors: Marcellus Lenora , Jantzen Darlaine , Sawchuck Diane , Gordon Carol , Humble Robin
Published: April 2019

Review question:

What evidence on characteristics and processes of the collaborative learning unit practice education model for undergraduate nursing students is available?
Kinetics of Enzymatic Mercury Methylation at Nanomolar Concentrations Catalyzed by HgcAB
Authors: Date Swapneeta S. , Parks Jerry M. , Rush Katherine W. , Wall Judy D. , Ragsdale Stephen W. , Johs Alexander
Published: April 2019

The concentration of Hg in the biosphere has increased dramatically over the last century as a result of industrial activities. The microbial conversion of inorganic Hg to MeHg is a global public health concern due to bioaccumulation and biomagnification of MeHg in food webs. Exposure to neurotoxic MeHg through the consumption of fish represents a significant risk to human health and can result in neuropathies and developmental disorders. Anaerobic microbial communities in sediments and periphyton biofilms have been identified as sources of MeHg in aquatic systems, but the associated biomolecular mechanisms are not fully understood. In the present study, we investigate the biochemical mechanisms and kinetics of MeHg formation by HgcAB in sulfate-reducing bacteria. These findings advance our understanding of microbial MeHg production and may help inform strategies to limit the formation of MeHg in the environment.
Radiogenic isotope chemostratigraphy reveals marine and nonmarine depositional environments in the late Mesoproterozoic Borden Basin, Arctic Canada
Authors: Gibson Timothy M. , Wörndle Sarah , Crockford Peter W. , Bui T. Hao , Creaser Robert A. , Halverson Galen P.
Published: April 2019

The ca. 1050 Ma Bylot Supergroup in Arctic Canada is one of the best-preserved archives of late Mesoproterozoic geochemistry and biology and offers evidence that this period of Earth history may have been more biogeochemically dynamic than previously appreciated. The Bylot Supergroup was deposited in the Borden Basin and is the most thoroughly studied stratigraphic succession from a series of broadly contemporaneous late Mesoproterozoic intracratonic basins known as the Bylot basins. This ∼6-km-thick mixed carbonate-siliciclastic succession has undergone minimal postdepositional deformation and is now exposed on Baffin and Bylot Islands, Nunavut, Canada. Deep-water and tidally influenced carbonate facies, traditionally interpreted as marine, have yielded important insights into the evolution of Proterozoic seawater chemistry; however, more recent studies indicate that the Borden Basin was restricted marine or lacustrine for portions of its depositional history. Here, we present new multiproxy radiogenic isotope chemostratigraphic data spanning the Bylot Supergroup. A comparison of stratigraphic trends in radiogenic isotope data from hydrogenous (black shale 187Os/188Os and limestone 87Sr/86Sr) and detrital (whole-rock mudstone 143Nd/144Nd) sedimentary phases elucidates the complex hydrologic history of the Borden Basin and reconciles these disparate interpretations.

Episodic coupling and decoupling between the composition of basin waters (from Os and Sr isotopes) and the local weathering input to the basin (from Nd isotopes) indicate that depositional environments within the Borden Basin fluctuated between marine and nonmarine (i.e., lacustrine). Variations in basin hydrology controlled secular sedimentation patterns through changes in basin water chemistry. These interpretations help to characterize the environment in which the early red algal fossil Bangiomorpha pubescens evolved. Episodically restricted epeiric seaways, such as within the Borden Basin, were relatively widespread within Rodinia and may have exerted unique selective pressures on eukaryotic evolution in the Mesoproterozoic Era. Hydrogenous and detrital radiogenic isotope chemostratigraphy, as implemented in this study, may provide a useful paleoenvironmental framework for future paleontological studies aimed at testing the role of freshwater environments in eukaryotic evolution. In addition, 87Sr/86Sr compositions from 81 new middle Bylot Supergroup marine limestone samples, calibrated by recent Re-Os geochronology, contribute to the terminal Mesoproterozoic marine 87Sr/86Sr curve. These data display a rise from ∼0.705 to 0.706 that reflects weathering of the active Grenville orogenic belt and demonstrates a global increase in chemical weathering during the amalgamation of Rodinia.
Bone density in children: what are we measuring?
Authors: Shaw Nick , Crabtree Nicola
Published: April 2019

The measurement of bone density is a frequent request in the assessment of children with concerns about bone health due to chronic disease or recurrent fractures. Dual energy X-ray absorptiometry (DXA) remains the recommended modality and is widely available. However, the interpretation and reporting of results in growing individuals needs to be undertaken by individuals who are familiar with scanning children and the potential pitfalls.
RecalcitrantPaecilomyceskeratitis
Authors: Lakshmi Seetha , Garcia Cristina Vanessa
Published: April 2019

A 54-year-old Caucasian woman presented with corneal ulcer of the right eye of 4 weeks duration after scratching her cornea while removing her contact lens and artificial eye lashes. Her visual acuity was 20/32 (left eye) and finger counting (right eye). She had a 3x3 mm epithelial defect with underlying corneal oedema and hypopyon. Right eye cultures grewPaecilomycesspecies. Topical and systemic antifungal agents were initiated. Due to the sight-threatening disease, the patient underwent surgical intervention with intrastromal injection of amphotericin B and a large conjunctival flap covering 75% of the right eye corneal ulcer. After 3 months of therapy, she had near-complete resolution of the corneal ulcer. Unfortunately, recurrence of the corneal ulcer occurred within 3 weeks of cessation of therapy, prompting reinitiation of ophthalmic and systemic antifungal agents. The patient was advised to continue therapy for 6 months with regular follow-up.
Post-traumatic stress disorder (PTSD) and other trauma-related mental disorders in elite athletes: a narrative review
Authors: Aron Cindy Miller , Harvey Sydney , Hainline Brian , Hitchcock Mary E , Reardon Claudia L
Published: April 2019

This narrative review examines post-traumatic stress disorder (PTSD) and other trauma-related disorders—mental health conditions with complex diagnosis and treatment considerations—in elite athletes. Athletes may exhibit greater rates of PTSD (up to 13%–25% in some athlete populations) and other trauma-related disorders relative to the general population. We describe common inciting events leading to symptoms of PTSD in elite athletes, including trauma incurred in sports participation through direct physical injury, secondary/witnessed traumatic events, or abusive dynamics within sports teams. Symptoms of PTSD may significantly impact athletes’ psychosocial and sport-related function through avoidance, hypervigilance and dissociative behaviours, which, in turn, may delay recovery from musculoskeletal injury.

While PTSD may be common among elite athletes, recognition by providers who do not routinely screen for trauma-related disorders may be challenging because of the tendency of athletes to mask symptoms of PTSD and other trauma-related disorders. Early identification of athletes suffering from trauma-related symptoms, including those of acute stress disorder, may prevent progression to PTSD, while treatment of athletes already meeting criteria for PTSD may improve life functioning and sports performance outcomes. Current evidence supports increasing awareness of PTSD in athletes and use of screening tools to identify athletes who may benefit from trauma-informed medical or psychotherapeutic interventions.
Improving the diagnostics of tuberculosis and drug resistance with Xpert MTB/RIF in a district general hospital in Sierra Leone: a quality improvement project
Authors: Hamilton David Oliver , Vas Nunes Jonathan , Grobusch Martin Peter
Published: April 2019

Sierra Leone has a high tuberculosis (TB) burden with a prevalence of 441 cases per 100 000 population. As a result of the Global Fund, some facilities in the country have access to improved diagnostics, including Xpert MTB/RIF testing, of particular use in diagnosing those at risk of drug resistance, in the form of rifampicin-resistant (RR) TB. This quality improvement project describes how a small, rural district general hospital in Masanga village improved the diagnosis of TB and RR-TB by creating a formal link with the regional hospital in Makeni city. In an effort to improve diagnosis, all patients with a suspicion of TB and one of the following would have a sample sent for Xpert MTB/RIF testing: previous TB treatment (of any course length), HIV positive or known contact of a RR-TB case. The samples were transported by the logistics team, who already drove weekly from Masanga to Makeni for supplies, and the results were texted to the clinician in charge of the medical ward. Over the course of the first 4 months of this intervention, 34 samples had Xpert MTB/RIF testing performed compared with two samples in the previous 12 months since the machine had been installed. This yielded nine additional diagnoses of TB (in patients with negative or unavailable smear results) and five diagnoses of RR-TB with subsequent appropriate isolation and transfer to the central tertiary centre. This study shows that it is feasible to centralise Xpert MTB/RIF testing in low-resource settings using creative methods for sample transfer and results dissemination, leading to both improved diagnostics and infection control.
Effects of team-based quality improvement learning on two teams providing dementia care
Authors: Dixon Nancy , Wellsteed Lorna
Published: April 2019

Objective

To determine the effects of a structured team-based learning approach to quality improvement (QI) on the performance 12 months later of two teams caring for patients with dementia.

Design

Before and after prospective study.

Setting

Staff working in two inpatient services in National Health Service Trusts in England, one providing orthopaedic surgery (Team A) and one caring for elderly people with mental health conditions, including dementia (Team B). Team A consisted of nurses; Team B included doctors, nurses, therapists, mental health support workers and administrators.

Methods

QI training and support, assessment of the performance of teams and team coaching were provided to the two teams. QI training integrated tools for teamworking and a structured approach to QI. Team members completed the Aston Team Performance Inventory, a validated tool for assessing team performance, at the start of the QI work (time 1) and 1 year later (time 2).

Results

A year after the QI training and team QI project, Team A members perceived themselves as a high-performing team, reflected in improvement in 24 of 52 components measured in the Inventory; Team B was initially a poorly performing team and had improvements in 42 of 52 components a year later.

Conclusion

This study demonstrates that a structured team-based learning approach to QI has effects a year later on the performance of teams in clinical settings, as measured by a validated team performance tool.
Case for genome sequencing in infants and children with rare, undiagnosed or genetic diseases
Authors: Bick David , Jones Marilyn , Taylor Stacie L , Taft Ryan J , Belmont John
Published: April 2019

Up to 350 million people worldwide suffer from a rare disease, and while the individual diseases are rare, in aggregate they represent a substantial challenge to global health systems. The majority of rare disorders are genetic in origin, with children under the age of five disproportionately affected. As these conditions are difficult to identify clinically, genetic and genomic testing have become the backbone of diagnostic testing in this population. In the last 10 years, next-generation sequencing technologies have enabled testing of multiple disease genes simultaneously, ranging from targeted gene panels to exome sequencing (ES) and genome sequencing (GS). GS is quickly becoming a practical first-tier test, as cost decreases and performance improves. A growing number of studies demonstrate that GS can detect an unparalleled range of pathogenic abnormalities in a single laboratory workflow. GS has the potential to deliver unbiased, rapid and accurate molecular diagnoses to patients across diverse clinical indications and complex presentations. In this paper, we discuss clinical indications for testing and historical testing paradigms. Evidence supporting GS as a diagnostic tool is supported by superior genomic coverage, types of pathogenic variants detected, simpler laboratory workflow enabling shorter turnaround times, diagnostic and reanalysis yield, and impact on healthcare.
Why it is unethical to charge migrant women for pregnancy care in the National Health Service
Authors: Shahvisi Arianne , Finnerty Fionnuala
Published: April 2019

Pregnancy care is chargeable for migrants who do not have indefinite leave to remain in the UK. Women who are not ‘ordinarily resident’, including prospective asylum applicants, some refused asylum-seekers, unidentified victims of trafficking and undocumented people are required to pay substantial charges in order to access antenatal, intrapartum and postnatal services as well as abortion care within the National Health Service. In this paper, we consider the ethical issues generated by the exclusion of pregnancy care from the raft of services which are free to all. We argue that charging for pregnancy care amounts to sex discrimination, since without pregnancy care, sex may pose a barrier to good health. We also argue that charging for pregnancy care violates bodily autonomy, entrenches the sex asymmetry of sexual responsibility, centres the male body and produces health risks for women and neonates. We explore some of the ideological motivations for making maternity care chargeable, and suggest that its exclusion responds to xenophobic populism. We recommend that pregnancy care always be free regardless of citizenship or residence status, and briefly explore how these arguments bear on the broader moral case against chargeable healthcare for migrants.
Sources of work stress in veterinary practice in the UK
Authors: O'Connor Elinor
Published: April 2019

The veterinary profession recognises the importance of addressing work‐related stress for veterinary surgeons’ wellbeing. Identifying aspects of veterinarians’ work that are sources of stress is a key step in implementing appropriate stress management interventions for the profession. However, little systematic research on the causes of stress in veterinary work has been carried out. A qualitative interview study was conducted with 18 veterinarians practising in the UK to explore aspects of their work that are stressful. Thematic analysis revealed principal stressors to be poor work‐life balance, interaction with animal owners, specific aspects of euthanasia, dealing with poor animal welfare and staff management responsibilities. Injury risk, supervision arrangements for newly qualified veterinarians and lack of control over work were stressors for some. The practical implications of the findings for stress management in veterinary work are considered. Comments by several participants indicated a strong achievement focus and possible perfectionism. It is proposed that veterinarians with perfectionist traits might experience greater psychological distress in the face of some specific stressors in veterinary practice, and further investigation of possible interactive effects of work stressors and perfectionism on veterinarians’ wellbeing is merited.
Malignant Peripheral Nerve Sheath Tumors: From Epigenome to Bedside
Authors: Korfhage Justin , Lombard David B.
Published: April 2019

Malignant peripheral nerve sheath tumors (MPNST) are aggressive sarcomas typically developing in the context of neurofibromatosis type 1 (NF-1). With the exception of surgical resection, these tumors are resistant to all current therapies, and unresectable, recurrent, or metastatic tumors are considered incurable. Preclinical studies have identified several novel candidate molecular targets for therapeutic intervention, but, to date, targeted therapies have proven ineffective. Recent studies have identified recurrent mutations in polycomb repressive complex 2 (PRC2) core components, embryonic ectoderm development protein (EED) and suppressor of zeste 12 homolog (SUZ12), in MPNST. These mutations result in global loss of the histone H3 lysine 27 trimethylation epigenetic mark, normally deposited by PRC2, and subsequent gain in acetylation at this residue. This altered chromatin state has been shown to promote MPNST malignancy; however, acetylation at this residue sensitizes MPNSTs to BRD4 and bromodomain and extra-terminal domain inhibition. Interestingly, the catalytic component of PRC2, enhancer of zeste homolog 2 (EZH2), is not mutated in MPNST, hinting that a noncanonical, PRC2-independent function of EZH2 may play a role in this cancer. This review examines the pathobiology of MPNST, the contribution of PRC2 subunits to this process, and the prospects for PRC2-related therapies for this cancer.

Implications:

Identification of mutations in the PRC2 components EED and SUZ12 in the majority of MPNSTs may imply noncanonical oncogenic activities of the intact component, EZH2, and provide new opportunities for therapeutic intervention.
Placenta-Specific 8 Is Overexpressed and Regulates Cell Proliferation in Low-Grade Human Pancreatic Neuroendocrine Tumors
Authors: Tatura Marina , Schmidt Harald , Haijat Mikail , Stark Maren , Rinke Anja , Diels Ramona , Lawlor Rita T. , Scarpa Aldo , Schrader Joerg , Hackert Thilo , Schimmack Simon , Gress Thomas Matthias , Buchholz Malte
Published: April 2019

Background/Aims: Many aspects of the biology of pancreatic neuroendocrine tumors (PanNETs), including determinants of proliferative, invasive, and metastatic potential, remain poorly understood. Placenta-specific 8 (PLAC8), a gene with unknown molecular function, has been reported to have tumor-promoting roles in different human malignancies, including exocrine pancreatic cancer. Since preliminary data suggested deregulation of PLAC8 expression in PanNET, we have performed detailed analyses of PLAC8 expression and function in human PanNET. Methods: Primary tissue from PanNET patients was immunohistochemically stained for PLAC8, and expression was correlated with clinicopathological data. In vitro, PLAC8 expression was inhibited by siRNA transfection in PanNET cell lines and effects were analyzed by qRT-PCR, Western blot, and proliferation assays. Results: We report that PLAC8 is expressed in the majority of well-differentiated human PanNETs, predominantly in early-stage and low-grade tumors. SiRNA-mediated knockdown of PLAC8 in PanNET cells resulted in decreased proliferation and viability, while apoptosis was not induced. Mechanistically, these effects were mediated by attenuation of cell cycle progression, as Western blot analyses demonstrated upregulation of the tumor suppressor p21/CDKN2A and downregulation of the cell cycle regulator Cyclin D1 as well as reduced levels of phosphorylated ribosomal protein s6 and retinoblastoma protein. Conclusion: Our findings establish PLAC8 as a central mediator of cell growth in a subset of human PanNET, providing evidence for the existence of distinct molecular subtypes within this class of tumors.
Evidence-based decision making and promotion of physical activity among directors of local health departments
Authors: Becker Leonardo Augusto , Rech Cassiano Ricardo , Hino Adriano Akira Ferreira , Reis Rodrigo Siqueira
Published: April 2019

OBJECTIVE: To describe the steps involved in evidence-based decision making for the implementation of programs aimed at the promotion of physical activity. METHODS: It is a descriptive, cross-sectional study with quali-quantitative approach, held with municipal health secretaries chosen deliberately by regional health representatives of the state of Paraná. A total of 27 secretaries participated in a telephone interview consisting of 17 open questions. Content analysis was conducted according to the categories of an evidencebased decision-making model consisting of seven steps. RESULTS: None of the participants employed every step of the evidence-based decision-making model. The steps that were most often mentioned included: evaluation of the program (33.3%), use of evidence from the literature (22.2%) and identification of the problem (22.2%). The steps that were reported the least included: quantification of the problem (14.8%), development and prioritization of actions (14.8%), development of the plan of action (14.8%) and evaluation of the community (3.7%). CONCLUSIONS: The use of evidence-based decision making in the context of the promotion of physical activity was shown to be incipient among the health secretaries of the state of Paraná. We suggest widening dissemination and training on the use of evidence-based decision making among municipal administrators to increase the effectiveness of actions for promotion of physical activity.