bluuebunny/crossref_metadata_2025 huggingface dataset:
Staff resourcing, guideline implementation and models of care for gestational diabetes mellitus management
Authors: Meloncelli Nina , Barnett Adrian , de Jersey Susan
Published: July 2019

Background

In 2014, updated screening and diagnostic criteria for gestational diabetes (GDM) were introduced across Australia. Many states including Queensland introduced clinical guidelines to include these changes and other recommendations for GDM management. While it is understood that GDM diagnosis has increased, it is unknown whether resources or service delivery have changed, or whether health services have implemented the guidelines.

Aims

To understand the staff resourcing, models of care, level of guideline implementation and barriers and enablers to implementing the guideline across Queensland Health GDM services.

Materials and Methods

A 22‐item electronic survey containing multiple choice and open‐ended questions was disseminated to healthcare professionals involved in GDM care across 14 Hospital and Health Services (HHS) in Queensland between August and October 2017.

Results

Fifty‐three surveys were included for analysis. Between 2014 and 2016, Queensland GDM diagnosis increased by an average of 33%, yet only eight out of 14 HHS reported increases to staff resourcing. Full implementation of the GDM guideline was reported by 41% of metropolitan compared with 29% for regional and 25% for rural/remote services. Guideline recommendations were inconsistently delivered for physical activity advice, minimum schedule of dietetics appointments and psychosocial support. The most common barrier to guideline implementation was staff resourcing (85%), whereas enablers included staff/teamwork (42%), staff resourcing (21%), local protocols (21%) and staff education/knowledge (15%).

Conclusions

Increased staff funding as well as an implementation science‐driven process for guideline implementation is required to ensure that the increasing number of women with GDM can receive evidence‐based care.
Development of evidence‐based recommendations for procedure‐specific pain management: PROSPECT methodology
Authors: Joshi G. P. , Van de Velde M. , Kehlet H. ,   the PROSPECT Working Group Collaborators
Published: July 2019

Effective peri‐operative pain management is a prerequisite for optimal recovery after surgery. Despite published evidence‐based guidelines from several professional groups, postoperative pain management remains inadequate. The procedure‐specific pain management (PROSPECT) collaboration consists of anaesthetists and surgeons with broad international representation that provide healthcare professionals with practical and evidence‐based recommendations formulated in a way that facilitates clinical decision‐making across all stages of the peri‐operative period on a procedure‐specific basis. The aim of this manuscript is to provide a detailed description of the current PROSPECT methodology with the intention of providing the rigour and transparency in which procedure‐specific pain management recommendations are developed. The high methodological standards of the recommendations should improve the quality of clinical practice.
Biological sex influences antibody responses to routine vaccinations in the first year of life
Authors: Zimmermann Petra , Perrett Kirsten P. , Ritz Nicole , Flanagan Katie L. , Robins‐Browne Roy , van der Klis Fiona R. M. , Curtis Nigel ,   the MIS BAIR group
Published: July 2019

Aim

We investigated the effect of early‐life factors, namely sex, delivery mode, feeding method and antibiotic exposure, on antibody responses to routine vaccinations administered during the first year of life.

Methods

One and seven months after the primary course of routine vaccines and 1 month after routine vaccines at 12 months of age, antibodies against 26 vaccine antigens were measured in 398 healthy infants. The geometric mean concentration (GMC) of antibodies (adjusted for effect modifiers with multiple linear regression) and the seroprotection rate for each vaccine were compared for each early‐life factor.

Results

Sex had an influence on GMCs. Antibody concentrations were significantly lower at 7 months of age in females for tetanus and filamentous haemagglutinin and at 13 months of age for pertactin. In contrast, at 13 months of age, antibody concentrations were significantly higher in females for polio type 3, pneumococcal serotype 6A and measles. Sex did not have an influence on seroprotection rates. Delivery mode, feeding method and antibiotic exposure did not exert a substantial influence on vaccine antibody concentrations.

Conclusion

There is a difference between males and females in the humoral response to routine vaccinations in the first year of life.
The package barrier to user adherence: Comparative analysis of various types of opening instructions on the ease of opening comprising effectiveness, efficiency and user satisfaction
Authors: Braun‐Münker Myriam , Kahriman Bakiye , Ecker Felix
Published: July 2019

Aims

Adequate user access to drug therapy can only be ensured when the drug can be removed from its package. The aim of this study was to investigate the influence of a variety of opening instructions on the ease of opening a user package and user satisfaction.

Methods

This experiment was conducted according to CEN/TS 15945. Ease of opening was defined as the ability to open a package within a defined time frame (effectiveness) and the learning effect by repeated opening (efficiency). (Dis)satisfaction ranged from −2 to +2. Empty bottles with left threat screw caps (rather than the standard right) were studied following 4 different types of instructions: none, arrow in the screw cap, package leaflet, video. Each instruction was studied in a group of 20 different healthy older adult volunteers (65–80 years). No opening aid was permitted. Data were captured in forms and on video.

Results

Nine (45%) participants could open the package without any instruction, 19 (95%) with an arrow marked bottle and 20 (100%) with a package leaflet or video. No notable differences were observed in median times for first and repeated opening. Participants were most often (n = 11) dissatisfied (score −2) without any instruction and neutral to most satisfied (0–2) with a video (n = 17).

Conclusion

The effectiveness, efficiency and user satisfaction to open a package is strongly influenced by the type of opening instruction. This conclusion requires further consideration in drug product packaging and labelling.
Metacognition and emotional regulation in children from 8 to 12 years old
Authors: Pennequin Valérie , Questel Floriane , Delaville Emeline , Delugre Marie , Maintenant Célia
Published: July 2019

Background

The Metacognitive Affective Model ofSRL(MASRL) considers the relationships between metacognition, motivation, and affect. Notably, it provides a theoretical framework to understand how subjective experiences (metacognition and affect) change self‐regulation from a top‐down to a bottom‐up process andvice versa.

Aims

The study examines the link between metacognition and emotional regulation in the everyday problem‐solving performance of children in elementary school. Emotional regulation is studied from the angle of coping strategies.

Sample(s)

Participants were 269 children aged 8.17–11.66 years old (Mean = 9.8,SD = 0.88).

Methods

They completed a French version of the ‘The Metacognitive Experiences Questionnaire’ developed by Efklides and Petkaki (2005,Learning and Instruction, 15, 415) and the Kidcope (Spirito et al., 1988,Journal of Pediatric Psychology, 13, 555) to measure the coping strategies before and after solving the everyday problem taken from ‘The Everyday Cognition Battery’ (Allaire & Marsiske, 1999,Psychology and Aging, 14, 261).

Results

The results indicate that several metacognitive experiences are significantly linked to solving everyday problems, in particular thefeeling of difficulty. The other results of our study show that no single coping strategy was linked to problem‐solving performance but that the three coping strategies (i.e.,emotional outburst,blaming others,andmagical thinking)are linked to metacognitive experiences.

Conclusions

The results highlight the importance of emotional regulation on cognitive performance, both before and after solving the problem. These findings have important implications for teachers, who should be aware of the effect that afeeling of difficultymay have on solving a given problem.
Designing for situated learning: Understanding the relations between material properties, designed form and emergent learning activity
Authors: Yeoman Pippa , Wilson Stephanie
Published: July 2019

Situative theories of learning challenge the notion of learning as a singular cognitive pursuit. However, the relations between the designed environment and situated learning activity are not well theorised, and this increases the difficulty of designing future learning spaces to accommodate learning communities supported by a range of digital technologies. In this paper, we use the ACAD framework and insights from the ecology of resources model to explore the role of materials in the enactment of situative theories of learning in a refurbished seminar room, in the University of Sydney Business School. Conducted as ethnography, this case study draws on observations, interviews and document analysis, which reveal a qualitative shift in learning activity facilitated by improved eye‐contact and increased fluidity of movement that supports instructor‐student and student‐student interaction. This paper offers a theoretical contribution in its exploration of the materiality of learning, methodological innovation in the use of images to examine spatial pedagogies and practical innovation through a reconceptualisation of spatial provisions for learning—all of which has implications for the design and use of future learning spaces intended to accommodate learning communities supported by complex webs of material and digital infrastructure.

Practitioner Notes

What is already known about this topic

The role of the designed environment in learning is poorly theorised.

As a result, educational research tends to frame material and digital infrastructure for learning as deterministic (causing change) or instrumental (improving efficiency).

This makes enacting valued learning theory challenging at any scale.

What this paper adds

A case study using a theoretical framework capable of addressing the relations between designed form and learning activity—contributing to the integration of theory and practice.

Methodological innovation using visual methods to examine spatial pedagogies.

Practice‐based design innovation in the reconceptualisation of spatial provisions for learning.

Implications for practice and/or policy

The consequences of failing to understand how the materiality of space for learning indirectly influences situated learning activity.

Impetus for thinking about how a richer understanding of space supports decision making around the use of digital technologies for learning.

The need to rethink spatial allocations for learning to accommodate increasingly active, collaborative and digitally mediated learning activity both in person and online.
Partnering against Insecurity? A Comparison of Markets, Institutions and Worker Risk in Canadian and Swedish Retail
Authors: O'Brady Sean
Published: July 2019

This article provides insights on how union power influences the outcomes of labour‐management partnerships, with a focus on insecurity. It examines matched pairs of food retailers in Canada and Sweden. Trends in wages, scheduling and union coverage from 1980 to 2016 are compared. Actors in both contexts adopted partnering strategies in response to intensified price competition. However, the Swedish partnerships produced stable work arrangements, while working conditions eroded considerably in Canada. Bargaining structures, union security and identity are examined to explain the variations. As market competition intensified, the Swedish union gained leverage by using partnerships to fight unfair competition and promote sectoral well‐being in the process. Meanwhile, the Canadian union lost leverage, instead using partnerships to align employment practices with those of low‐cost market entrants and enhancing store‐level performance at all costs. The argument is that markets can be a resource for unions, even in low‐skilled service sectors, but only under inclusive institutions.
Guideline adherence for the surgical treatment of T1 renal tumours correlates with hospital volume: an analysis from the British Association of Urological Surgeons Nephrectomy Audit
Authors: Tran Maxine G.B. , Aben Katja K.H. , Werkhoven Erik , Neves Joana B. , Fowler Sarah , Sullivan Mark , Stewart Grant D. , Challacombe Ben , Mahrous Ahmed , Patki Prasad , Mumtaz Faiz , Barod Ravi , Bex Axel ,   the British Association of Urological Surgeons
Published: July 2019

Objective

To assess European Association of Urology guideline adherence on the surgical management of patients with T1 renal tumours and the effects of centralisation of care.

Patients and methods

Retrospective data from all kidney tumours that underwent radical nephrectomy (RN) or partial nephrectomy (PN) in the period 2012–2016 from the British Association of Urological Surgeons Nephrectomy Audit were retrieved and analysed. We assessed total surgical hospital volume (HV; RN and PN performed) per centre, PN rates, complication rates, and completeness of data. Descriptive analyses were performed, and confidence intervals were used to illustrate the association between hospital volume and proportion of PN. Chi‐ squared and Cochran–Armitage trend tests were used to evaluate differences and trends.

Results

In total, 13 045 surgically treated T1 tumours were included in the analyses. Over time, there was an increase in PN use (39.7% in 2012 to 44.9% in 2016). Registration of the Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) complexity score was included in March 2016 and documented in 39% of cases. Missing information on postoperative complications appeared constant over the years (8.5–9%). 

A clear association was found between annual HV and the proportion of T1 tumours treated with PN rather than RN (from 18.1% in centres performing <25 cases/year [lowest volume] to 61.8% in centres performing ≥100 cases/year [high volume]), which persisted after adjustment for PADUA complexity. Overall and major (Clavien–Dindo grade ≥III) complication rate decreased with increasing HV (from 12.2% and 2.9% in low‐volume centres to 10.7% and 2.2% in high‐volume centres, respectively), for all patients including those treated with PN.

Conclusion

Closer guideline adherence was exhibited by higher surgical volume centres. Treatment of T1 tumours using PN increased with increasing HV, and was accompanied by an inverse association of HV with complication rate. These results support the centralisation of kidney cancer specialist cancer surgical services to improve patient outcomes.
Subtle differences in chemical pattern between human toll‐like receptor 8 agonists and antagonists: Emerging chemical patterns analysis
Authors: Huang Shuheng , Mei Hu , Zhang Duo , Shi Tingting , Chen Linxin , Kuang Zuyin , Heng Yu , Pan Xianchao , Lu Laichun
Published: July 2019

Due to the potencies in the treatments of cancer, infectious diseases, and autoimmune diseases, the developments of human TLR8 (hTLR8) agonists and antagonists have attracted widespread attentions. The hTLR8 agonists and antagonists have similar structures but with completely opposite biological effects. Up to date, the subtle differences in the structures between the hTLR8 agonists and antagonists are still unknown. In this work, emerging chemical pattern (ECP) was successfully used to extract the key chemical patterns of the hTLR8 agonists and antagonists. By using CAEP classifier, an optimal ECP model with only 3 descriptors was established with the overall prediction accuracy larger than 90%. Further hierarchical cluster analysis and molecular docking showed that the H‐bond and hydrophobic properties are the key features distinguishing the hTLR8 agonists from antagonists. Comparing with the antagonists, the agonists show stronger specific H‐bond properties, while antagonists have stronger non‐specific hydrophobic properties. The significant differences in the structural properties may be closely related to the activation/inhibition mechanism of hTLR8.
Better survival for patients with colon cancer operated on by specialized colorectal surgeons – a nationwide population‐based study in Sweden 2007–2010
Authors: Bergvall M. , Skullman S. , Kodeda K. , Larsson P.‐A.
Published: July 2019

Aim

Mortality and complication rates after surgery for colon cancer are high, especially after emergency procedures. The aim of the present study was to evaluate the importance of the formal competence of surgeons for survival and morbidity.

Method

The Swedish Colorectal Cancer Registry prospectively records data on patients diagnosed with cancer within the colon and rectum. A cohort of patients operated on for colon cancer between 2007 and 2010 were followed 5 years after surgery. Data on postoperative morbidity, mortality and long‐term survival were compared with regard to formal competency of the most senior surgeon attending the procedure.

Results

This analysis includes 13 365 patients operated on for colon cancer, including 10 434 elective procedures and 2931 emergency cases. The overall 5‐year survival was higher for those operated on by subspecialist colorectal surgeons compared with general surgeons (60% vs 48%; P < 0.001). Five‐year survival after elective surgery was 63% vs 55% (P < 0.001) and 35% vs 31% (P < 0.05) after emergency procedures when performed by colorectal surgeons compared with general surgeons. Postoperative 30‐day mortality was 3% after surgery performed by colorectal surgeons compared with 7% when performed by general surgeons. Mortality at 90 days was 6% after surgery performed by colorectal surgeons compared with 11% for patients operated on by general surgeons (P < 0.001).

Conclusion

Subspecialization in colorectal surgery is associated with better outcome for patients operated on for colon cancer, and effort should be made to increase the availability of colorectal surgeons for both acute and elective colon cancer surgery.
Parameter derivation of a proton exchange membrane fuel cell based on coevolutionary ribonucleic acid genetic algorithm
Authors: Erlin Tian , Ebadi Abdol Ghaffar , Mavaluru Dinesh , Alshehri Mohammed , Mohamed Ahmed Abo‐Bakr , Sobhani Behnam
Published: July 2019

Precise modeling of a polymer electrolyte membrane fuel cell (PEMFC) is a crucial issue in analyzing and controlling electrical energy production. In this paper, a novel semiexperimental model is proposed for forecasting of PEMFC output voltage. As well, the coevolution ribonucleic acid genetic algorithm (coRNA‐GA) is presented as a novel estimation approach for determination of proposed model coefficients. This optimization method is motivated by the biological RNA, encodes the chromosomes by RNA nucleotide basics, and accepts a few RNA operations. This paper proposed several genetic operators to preserve the diversity of particles, and two sets from particles are chosen using various validation functions. In these two subpopulations, different evolutionary methods have been employed for balancing of seeking and extraction. Input pressure of cathode is chosen in this paper as a further parameter for modifying the depiction of concentration overvoltage (Vcon) in the case of conventional Amphlett's PEMFC system. Finally, the performance of the coRNA‐GA algorithm, as well as the precision of the obtained model, is authenticated via empirical results. Also, the obtained results are compared with some other methods, and the superiority of the proposed model is demonstrated in voltage prediction accuracy.
Identification of two independent clones underlying the co‐existence of myelodysplastic syndrome with excess of blasts type 2 and isolated 5q‐ and smouldering multiple myeloma
Authors: Quintini Martina , Arniani Silvia , Ascani Stefano , Camerini Chiara , Crescenzi Barbara , Di Battista Valeria , Moretti Martina , Pellanera Fabrizia , Pierini Valentina , Mecucci Cristina
Published: July 2019

This report is dealing with simultaneous diagnosis of Myelodysplastic Syndrome with Excess of Blasts 2 (MDS‐EB2) with isolated 5q deletion and Smoldering Multiple Myeloma (SMM) with typical changes, namely t(4;14) and monosomy 13. I‐FISH and FICTION techniques showed distinct specific clones underlie the two hematological malignancies.
Waiting for the flood: technocratic time and impending disaster in the Himalayas
Authors: Gagné Karine
Published: July 2019

A landslide occurred in the region of Zanskar in the Indian Himalayas in 2015, damming the Tsarap River, creating a lake that effectively became a ticking time bomb, threatening villagers downstream. During the period between the discovery of the natural dam and the bursting of the lake, the state's approach to disaster management plunged the local population into a situation where ‘technocratic time’ ruled, as government experts handled the impending disaster at a rhythm dictated by the production of studies and reports. Analysis of the temporality of disaster mitigation and preparedness measures during this anticipated flood, as well as of the factors that surrounded the events, reveals how attitudes towards the state shaped people's perceptions of these interventions. In Zanskar, the technocratic pace and the state's lack of transparency were seen as a form of oppression that further marginalised the region, in particular by subjecting its population to the process of waiting.
Recommended pre‐analytical plasma glucose sampling methodology may distort gestational diabetes mellitus prevalence: implications for diagnostic thresholds
Authors: Song D. , Lia M. , Hurley J. C.
Published: July 2019

Aim

Current International Association of the Diabetes and Pregnancy Study Groups/World Health Organization gestational diabetes mellitus (GDM) diagnostic thresholds are based on a landmark study in which the pre‐analytical plasma glucose sampling methodology is unclear. Worldwide, plasma glucose pre‐analytical sampling methodology practices are divergent. We considered the effects of pre‐analytical plasma glucose sampling methodology on GDM prevalence and gestational outcomes.

Methods

This is a retrospective observational cohort study of 1178 pregnant women undergoing an oral glucose tolerance test (OGTT). Of the 1178 pregnant women, a subset of 892 non‐GDM women with singleton births undergoing OGTT between 24 and 28 weeks’ gestation were investigated for large for gestation age (LGA) outcomes. OGTT were determined using traditional methods (sodium fluoride tubes batched at roomed temperature). We modelled the potential effects of using a recommended pre‐analytical plasma glucose methodology (lyophilized citrate tubes) on GDM prevalence.

Results

The GDM prevalence in our cohort was 13.5%. The incidence of LGA showed a linear association with maternal plasma glucose that was similar to the association observed in the Hyperglycemia and Adverse Pregnancy Outcome study. Frequency of LGA exceeded 10% at HAPO glucose category 4 (fasting, 4.8 to 4.9 mmol/l; 1‐h, 8.7 to 9.5 mmol/l) for fasting and 1‐h plasma glucose. The use of a recommended pre‐analytical method is projected to increase the prevalence of GDM to 39.2%.

Conclusion

We challenge the consensus that recommended pre‐analytical plasma glucose methodologies are optimal for the accurate diagnosis of GDM. Recommended pre‐analytical plasma glucose methods may profoundly over‐diagnose GDM. Centres using recommended pre‐analytical plasma glucose methodologies may need to reappraise their diagnostic thresholds.
Cost‐effectiveness analysis of empagliflozin treatment in people with Type 2 diabetes and established cardiovascular disease in the EMPA‐REG OUTCOME trial
Authors: Kansal A. , Reifsnider O. S. , Proskorovsky I. , Zheng Y. , Pfarr E. , George J. T. , Kandaswamy P. , Ruffolo A.
Published: July 2019

Aim

In the EMPA‐REG OUTCOME trial, empagliflozin therapy reduced cardiovascular death by 38% compared with placebo when added to standard of care. Using the trial results, we created a discrete‐event simulation model to assess lifetime health economic outcomes in people with Type 2 diabetes and established cardiovascular disease.

Methods

Time‐dependent survival regression analysis was performed on data from EMPA‐REG OUTCOME for 10 cardiovascular and renal events (e.g. stroke, heart failure hospitalization, macroalbuminuria, cardiovascular mortality) to capture event rates over time, and interaction between events. Model performance was assessed by comparing predicted and observed outcomes at 3 years. Costs in the United Kingdom (UK) and health utilities were obtained from published literature. Outcomes included cumulative event rates, life‐years, costs and quality‐adjusted life‐years (QALYs).

Results

The model predicted an 18% relative increase (by 2.1 life‐years) in survival for empagliflozin (14.0 life‐years) vs. standard of care (11.9 life‐years), attributable to direct treatment effect on cardiovascular mortality, and to indirect effect via reductions in other events. Participants treated with empagliflozin may experience improved quality of life (1.0 QALY) and higher costs (£3737/participant), yielding an incremental cost‐effectiveness ratio (ICER) of £4083/QALY. Sensitivity analyses confirmed the robustness of these results to changes in input parameters.

Conclusions

Based on extrapolation of EMPA‐REG OUTCOME trial data using a participant‐level simulation model, empagliflozin in addition to standard of care is projected to be highly cost‐effective using UK healthcare costs. The impact in other countries will vary due to differences in drug pricing and accrual of other costs. (Clinical Trial Registry No: NCT01131676)
Uric acid level, gout and bone mineral density: A Mendelian randomization study
Authors: Lee Young Ho , Song Gwan Gyu
Published: July 2019

Objective

This study aimed to examine whether the uric acid level or gout is causally associated with bone mineral density (BMD).

Method

We performed a two‐sample Mendelian randomization (MR) analysis. The statistics dataset, we used was from a meta‐analysis of genome‐wide association studies (GWASs) on uric acid levels from 14 studies with a total of 28 141 participants of European descent, and the dataset for gout from the United Kingdom (UK) Biobank (4807 cases and 3 32 352 controls). We further used the summary statistics dataset of a GWAS on lumbar spine and femur neck (FN) BMDs of individuals of European ancestry (up to 32 735).

Results

The instrumental variables (IVs) selected were six single nucleotide polymorphisms (SNPs) from the uric acid level GWAS data and 19 SNPs from the gout GWAS data. The inverse‐variance weighted (IVW) method yielded no evidence to support a causal association between the uric acid level or gout and lumbar spine BMD (β = −.002, standard error (SE) = 0.035, P = .951; β = –.700, SE = 0.672, P = .297). MR‐Egger regression revealed no causality between uric acid level, gout and lumbar spine. Similarly, the weighted median approach provided no evidence of causality between uric acid level, gout and lumbar spine BMD. The MR results on FN BMD showed similar patterns with those of the lumbar spine BMD.

Conclusions

Mendelian randomization analysis did not support a causal association between uric acid level, gout and lumbar spine or FN BMD.
Neuronal chemo‐architecture of the entorhinal cortex: A comparative review
Authors: Kobro‐Flatmoen Asgeir , Witter Menno P.
Published: July 2019

The identification of neuronal markers, that is, molecules selectively present in subsets of neurons, contributes to our understanding of brain areas and the networks within them. Specifically, recognizing the distribution of different neuronal markers facilitates the identification of borders between functionally distinct brain areas. Detailed knowledge about the localization and physiological significance of neuronal markers may also provide clues to generate new hypotheses concerning aspects of normal and abnormal brain functioning. Here, we provide a comprehensive review on the distribution within the entorhinal cortex of neuronal markers and the morphology of the neurons they reveal. Emphasis is on the comparative distribution of several markers, with a focus on, but not restricted to rodent, monkey and human data, allowing to infer connectional features, across species, associated with these markers, based on what is revealed by mainly rodent data. The overall conclusion from this review is that there is an emerging pattern in the distribution of neuronal markers in the entorhinal cortex when aligning data along a comparable coordinate system in various species.
The value of cerebrospinal fluid α‐synuclein and the tau/α‐synuclein ratio for diagnosis of neurodegenerative disorders with Lewy pathology
Authors: Førland M. G. , Tysnes O.‐B. , Aarsland D. , Maple‐Grødem J. , Pedersen K. F. , Alves G. , Lange J.
Published: July 2019

Background and purpose

Parkinson's disease (PD), dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) are three of the most common neurodegenerative disorders. Up to 20% of these patients have the wrong diagnosis, due to overlapping symptoms and shared pathologies. A cerebrospinal fluid (CSF) biomarker panel for AD is making its way into the clinic, but an equivalent panel for PD and DLB and for improved differential diagnoses is still lacking. Using well‐defined, community‐based cohorts and validated analytical methods, the diagnostic value of CSF total‐α‐synuclein (t‐α‐syn) alone and in combination with total tau (t‐tau) in newly diagnosed patients with PD, DLB and AD was determined.

Methods

Cerebrospinal fluid concentrations of t‐α‐syn were assessed using our validated in‐house enzyme‐linked immunosorbent assay in 78 PD patients, 20 AD patients, 19 DLB patients and 32 controls. t‐tau was measured using a commercial assay. Diagnostic performance was assessed by receiver operating characteristic curve analysis.

Results

Compared to controls (mean 517 pg/ml), significantly lower levels of CSF t‐α‐syn in patients with PD (434 pg/ml, 16% reduction, P = 0.036), DLB (398 pg/ml, 23% reduction, P = 0.009) and AD (383 pg/ml, 26% reduction, P = 0.014) were found. t‐α‐syn levels did not differ significantly between PD, DLB and AD. The t‐tau/t‐α‐syn ratio showed an improved performance compared to the single markers.

Conclusion

This is the first study to compare patients with PD, DLB and AD at the time of diagnosis. It was found that t‐α‐syn can contribute as a teammate with tau in a CSF biomarker panel for PD and DLB, and strengthen the existing biomarker panel for AD.
Fracture load and chewing simulation of zirconia and stainless‐steel crowns for primary molars
Authors: Kist Stefan , Stawarczyk Bogna , Kollmuss Maximilian , Hickel Reinhard , Huth Karin C.
Published: July 2019

Aesthetic alternatives to stainless‐steel crowns for restoring primary molars attain growing interest. We studied the mechanical properties of prefabricated zirconia crowns and conventional crowns. Three brands of prefabricated zirconia crowns were compared with computer‐aided design/computer‐aided manufacturing (CAD/CAM) zirconia crowns, preveneered stainless‐steel crowns, and conventional stainless‐steel crowns regarding: (i) fracture load under each of three conditions [no pretreatment, artificial aging in saliva for 12 wk, and after chewing simulation/thermocycling (1.68 × 106 cycles/5–55°C)]; and (ii) survival rate during chewing simulation, considering decementation, fracture, chipping, fatigue cracks, and occlusal holes. Without pretreatment, the prefabricated zirconia crowns showed mean fracture load values between 893 N and 1,582 N, while the corresponding values for CAD/CAM zirconia crowns and preveneered stainless‐steel crowns were 2,444 N and 6,251 N. Preveneered stainless‐steel crowns showed significantly lower fracture loads after artificial aging (5,348 N after saliva aging; 3,778 N after chewing simulation) than without artificial aging, whereas the fracture load of zirconia crowns was not influenced negatively. The survival rate of the different groups of zirconia crowns and preveneered stainless‐steel crowns during chewing simulation was 100%, but only 41.7% for the stainless‐steel crowns. These in‐vitro data suggest that prefabricated zirconia crowns are aesthetically and durable alternatives to stainless‐steel crowns for primary molars.
Implications of existing local (mal)adaptations for ecological forecasting under environmental change
Authors: Walters Richard J. , Berger David
Published: July 2019

Standing genetic variation represents a genetic load on population fitness but can also support a rapid response to short‐term environmental change, and the greatest potential source of such standing genetic variation typically exists among locally adapted populations living along an environmental gradient. Here, we develop a spatially explicit simulation model to quantify the contribution of existing genetic variation arising from migration–mutation–selection–drift balance to time to extinction under environmental change. Simulations reveal that local adaptation across a species range associated with an underlying environmental gradient could extend time to extinction by nearly threefold irrespective of the rate of environmental change. The potential for preadapted alleles to increase the rate of adaptation changes the relative importance of established extinction risk factors; in particular, it reduced the importance of the breadth of environmental tolerance and it increased the relative importance of fecundity. Although migration of preadapted alleles generally increased persistence time, it decreased it at rates of environmental change close to the critical rate of change by creating a population bottleneck, which ultimately limited the rate at which de novo mutations could arise. An analysis of the extinction dynamics further revealed that one consequence of gene flow is the potential to maximize population growth rate in at least part of the species range, which is likely to have consequences for forecasting the consequences of ecological interactions. Our study shows that predictions of persistence time change fundamentally when existing local adaptations are explicitly taken into account, underscoring the need to preserve and manage genetic diversity.
Increasing antimicrobial resistance to clarithromycin and metronidazole in pediatric Helicobacter pylori infection in southern Taiwan: A comparison between two decades
Authors: Lu Hsiao‐Han , Lai Fu‐Ping , Lo Hsiao‐Yu , Sheu Bor‐Shyang , Yang Yao‐Jong
Published: July 2019

Background

Antimicrobial resistance of Helicobacter pylori reduces the eradication rate. This study aimed to investigate changes in antimicrobial susceptibility of H pylori isolated from children in Taiwan in the past two decades.

Methods

This study enrolled children receiving esophagogastroduodenoscopy for upper gastrointestinal diseases in a national tertiary referring hospital from 1998 to 2018. H pylori infection was diagnosed by culture. The minimal inhibitory concentrations (MICs) of antibiotics were tested using the E test. The antibiotic resistance rates and MICs of amoxicillin, clarithromycin, metronidazole, levofloxacin, and tetracycline were compared between 1998‐2008 and 2009‐2018.

Results

A total of 70 Helicobacter pylori isolates (29 from 1998 to 2008 and 41 from 2009 to 2018) were identified. The esophagogastroduodenoscopy findings included duodenal ulcers (n = 31), gastric ulcers (n = 9), and gastritis (n = 30). The overall antimicrobial resistance rates of clarithromycin and metronidazole were 22.9% and 21.4%, respectively. The dual resistance rate of clarithromycin and metronidazole was 10%. Resistance rates of levofloxacin and amoxicillin were 8.3% and 2.9%, respectively. None of the isolates were resistant to tetracycline. Compared with the isolates from 1998 to 2008, those from 2009 to 2018 had higher MICs and resistance rates of clarithromycin (26.8% vs 17.2%, P = 0.35) and metronidazole (26.8% vs 13.8%, P = 0.19), but not levofloxacin (9.8% vs 5.3%, P = 1.0) or coresistance to clarithromycin and metronidazole (12.2% vs 6.9%, P = 0.69).

Conclusions

The antimicrobial resistance rates of pediatric H pylori isolates to clarithromycin and metronidazole increased during the past decade. The selection of antimicrobial agents other than clarithromycin and metronidazole is crucial to increase pediatric H pylori eradication rates.
Losing Herself to Save Herself: Perspectives on Conservatism and Concepts of Self for Black Women Aspiring to the HBCU Presidency
Authors: Commodore Felecia
Published: July 2019

Historically Black Colleges and Universities (HBCUs) often come under criticism for being havens of conservatism (Harper and Gasman 2008). This conservatism can be found intertwined in some HBCUs’ presidential hiring processes. Focusing on the lack of gender parity in the HBCU presidency, through a Black Feminist Theory lens, I argue that HBCUs using these practices for the selection of Black women presidents create a conflict of self for aspirants who do not authentically subscribe to or perform conservatism. The philosophical ideas of authenticity, self‐esteem, and self‐respect are explored to explain how these expectations create barriers to aspirants achieving their goals and their authentic selves. Subjecting Black women leaders to these practices oppresses aspirants’ need for authenticity and leads to the replication of these conservative ideologies. I conclude that these barriers, in turn, narrow the HBCU presidential pipeline and perpetuate a lack of gender parity in HBCU leadership.
Antigone, Empire, and the Legacy of Oedipus: Thinking African Decolonization through the Rearticulation of Kinship Rules
Authors: Coetzee Azille
Published: July 2019

In her book Antigone's Claim: Kinship between Life and Death, Judith Butler reads the figure of Antigone, who exists as an impossible aberration of kinship, as a challenge to the very terms of livability that are established by the reigning symbolic rules of Western thought (Butler 2000). In this article I extend Butler's argument to reach beyond gender. I argue that African feminist scholarship shows that the kinship norms shaping the reigning symbolic rules of Western thought not only render certain gendered lives unlivable, but through the gendered working thereof also become key to the colonial process of the racial dehumanization of the colonized and the violent expansion of Eurocentric capitalism. I show how Oyèrónké Oyĕwùmí, in her work on the Yorùbá people of Nigeria, provides, in a way analogous to Antigone, a glimpse of an order structured by kinship formations that are remarkably different from, and thereby bring into crisis, the normative versions of kinship that are posited as timeless truths. Through a reimagining or reconstruction of precolonial Yorùbá kinship formations, Oyĕwùmí articulates a different scheme of intelligibility, which enables radically different ways of being human and existing in the world.
Trabajar o no trabajar: evolución del compromiso no económico con el empleo y sus determinantes
Authors: SHARABI Moshe , HARPAZ Itzhak
Published: July 2019

A partir de datos transversales relativos a Israel de 1981, 1993 y 2006, basados en respuestas a la pregunta de si se seguiría trabajando tras ganar la lotería, se investiga el compromiso no económico con el trabajo (NFEC), tratando de identificar las variables demográficas y las dimensiones del «significado del trabajo» que funcionan como predictores, sobre la base de estudios previos en todo el mundo. Se observa un marcado descenso del NFEC y un cambio en sus determinantes en el nuevo milenio. Los autores lo relacionan con la evolución económica y social reciente, tendiente a un mayor individualismo.
Migrants’ Descendants and New Mobilities between China and Spain
Authors: Masdeu Torruella Irene
Published: July 2019

The economic rise of China and the financial crises in Spain have transformed transnational practices between the two countries and have boosted new strategies of mobility among Spanish of Chinese descent. This article examines the relationship that migrants’ descendants establish with their parents’ country of origin from their childhood, and analyses emerging new mobilities towards China undertaken by migrants’ descendants who have attained high degrees of formal education and are looking for a better professional future. The article argues that migrants’ descendants are reshaping the transnational space between the two countries and re‐evaluating their transnational training in order to apply their Spanish and Chinese socio‐cultural skills in their professional careers. The research reveals how migrants’ descendants undertake a migration journey to secure upward social mobility, just as their parents did when migrating to Europe. Hence, social and geographical mobility intersect in opposite directions over time and across generations.
Electronic informed consent: the need to redesign the consent process for the digital age
Authors: Lunt Helen , Connor Saxon , Skinner Helen , Brogden Greg
Published: July 2019

The delivery of healthcare, which includes the informed consent process, is moving to a digital environment. This change in informed consent delivery will be associated with opportunities, risks and also unintentional consequences. Physicians are well placed to contribute to the ongoing dialogue about what is needed to make the informed consent process fit for purpose, in the digital age.
Anomalies of the 1919 influenza pandemic remain unexplained after 100 years
Authors: Shanks G. Dennis
Published: July 2019

The modern world's most lethal single event, the 1918–1921 influenza pandemic, remains an anomaly which is still unexplained. The pandemic's unprecedented mortality was very unevenly distributed with young adults and isolated populations worst affected. Australia was the last continent involved with about 12 000 influenza deaths in 1919. Most cases were clinically unremarkable and recovered quickly, but a small minority developed severe tracheobronchitis compromising oxygenation and immune defences usually dying in the second week of illness. Histopathology showed massive destruction of the respiratory epithelium with evidence of secondary bacterial invasion. No simple explanation (e.g. hypervirulent virus) is consistent with these observations.
Giving and receiving: Exploring the predictive causality between oil prices and exchange rates
Authors: Gomez‐Gonzalez Jose E. , Hirs‐Garzon Jorge , Uribe Jorge M.
Published: July 2019

We study the dynamic connectedness and predictive causality between oil prices and exchange rates. Our sample includes six important oil‐producing and six net importing countries. Our results show that for the first set of countries, oil prices are net spillover receivers from exchange rate markets. Similarly, there is evidence of bidirectional Granger causality, which is detected for longer time periods from these countries’ exchange rates to oil prices. In contrast, for the second set of countries, oil prices are net spillover transmitters, and the causality is stronger from oil prices to exchange rates, mainly in the aftermath of the Global Financial Crisis. However, even for this group of countries, there are long periods of time for which exchange‐rate markets transmit spillovers to oil markets. Overall, oil markets are net receivers of shocks during most of the sample period, thus providing evidence in favor of the oil‐financialization hypothesis.
Into the deep: science, politics and law in conflicts over marine dumping of mine waste
Authors: Coumans Catherine
Published: July 2019

National and international deliberations about whether the global mining industry should be permitted to use the earth's seas as mine waste dumps are not decided on the basis of independent scientific data from past or existing sites. Nor is a critical lack of scientific knowledge about the deep sea environment and about the long‐term consequences of marine dumping triggering the precautionary principle for proposed projects. Rather, governments make decisions on submarine tailings disposal (STD) on a mine‐by‐mine basis, in a context of contested scientific claims, considerable political and economic pressure, and, sometimes, contravening or amending existing legislation to allow a project to proceed. These decisions provoke complex social processes that commonly involve: local opposition; political conflict; regulatory and legal challenges; powerful industry lobbies; international financial institutions, and resource‐hungry states. STD projects engender controversy in developing countries, such as Papua New Guinea (Divecha 2002; Shearman 2002a), Indonesia (Edinger 2012; Glynn 2002) and the Philippines (Coumans et al. 2002; Coumans and MaCEC 2002), but also in Canada (Cultural Survival 1982) and Norway (Kvassness et al. 2009). This paper examines cases drawn from the Philippines, Canada and Papua New Guinea to illustrate common themes that arise in conflicts surrounding STD mine projects.
Phase and microstructural evolution in lithium silicate glass‐ceramics with externally added nucleating agent
Authors: Kolay Santa , Bhargava Parag
Published: July 2019

Development of lithium disilicate‐based glass‐ceramics critically depends on use of nucleating agent in the glass matrix. The present study reports the effect of externally added nucleating agent Li3PO4 in Li2O–K2O–MgO–ZnO–ZrO2–Al2O3–SiO2 system which is compared with a reference composition (GC1) (SiO2:Li2O = 2.16:1) prepared with in situ formed Li3PO4. For externally added Li3PO4, two compositions were studied. In one case (GC2) before addition of Li3PO4, SiO2:Li2O ratio in glass was maintained as 2.87:1 and in another case (GC3) SiO2:Li2O ratio in glass was maintained same as reference GC1 that is, 2.16:1. The glasses were characterized by using MAS‐NMR spectroscopy. Sintering and crystallization behavior of the glass‐ceramics was characterized by using XRD, SEM, DTA. Due to in situ formation of Li3PO4, GC1 resulted in a dense sample with finer crystals of lithium disilicate. In GC2 and GC3, externally added lithium phosphate, which was in the form of ultrafine aggregated particles, formed flower‐like colonies of radially outward crystals. Higher SiO2:Li2O ratio in GC2 resulted in lithium disilicate crystals and high viscous glass causing large air entrapment and so less densification. GC3 with higher lithia in glass showed higher densification than GC2 but only lithium metasilicate crystals were formed.