bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding the Effects of ‘Behind‐the‐Scenes’ Tours on Visitor Understanding of Collections and Research
Authors: Gallimore Emily‐Jane , Wilkinson Clare
Published: April 2019

Collections can be a ‘mystery’ to many museum visitors, which makes investing in behind‐the‐scenes tours an opportunity for increasing awareness of the role museums play in scientific research. Drawing on the theories of contextual learning, situated learning, and legitimate peripheral participation, we offer insights from an exploratory study that investigated the potential effectiveness and practicalities of using behind‐the‐scenes tours to improve visitor understandings of museum research. This forum paper reports on emerging results from visitor questionnaires and staff interviews across six museums where we explored the experience offered by behind‐the‐scenes tours as an effective learning environment. These results suggest that behind the scenes tours remain under‐researched and highlight the need for further investigation into the value of this visitor experience.
Risk factors and outcomes for neonatal hypoglycaemia and neonatal hyperbilirubinaemia in pregnancies complicated by gestational diabetes mellitus: a single centre retrospective 3‐year review
Authors: Thevarajah A. , Simmons D.
Published: April 2019

Aim

To determine risk factors associated with neonatal hypoglycaemia and hyperbilirubinaemia, and assess their impact on neonatal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM).

Methods

Retrospective review investigating all pregnancies complicated by GDM at Campbelltown Hospital (Sydney, Australia) between 1 January 2013 and 31 December 2015. Main outcomes measured were neonatal hypoglycaemia (capillary glucose levels < 1.8 mmol/l) and hyperbilirubinaemia (total serum bilirubin levels greater than age‐appropriate thresholds for phototherapy). Adjusted odds ratios [95% confidence interval (CI)] are shown, calculated by multivariable logistic regression.

Results

Some 60 (7.8%) infants developed hypoglycaemia, 58 (7.5%) developed hyperbilirubinaemia and 13 (1.7%) developed both. Risk of developing hypoglycaemia increased 1.8‐fold (95% CI 1.3–2.6, P < 0.001) per gestational week at GDM diagnosis, 1.1‐fold (95% CI 1.0–1.3, P = 0.04) per mmol/l maternal fasting glucose, 6.2‐fold (95% CI 2.6–16.2, P < 0.001) with maternal history of macrosomia, 10.8‐fold (95% CI 4.1–27.6, P < 0.001) with multiple pregnancy and 1.1‐fold (95% CI 1.0–1.3, P = 0.04) per gestational week at birth. Risk of hyperbilirubinaemia increased with multiple pregnancy (26.4; 95% CI 11.7–59.7, P < 0.001), and 1.5‐fold (95% CI 1.1–2.1, P = 0.01) per gestational week at GDM diagnosis. Hypoglycaemia was associated with a 2.8‐fold (95% CI 1.1–7.1, P = 0.03) increased risk of macrosomia, a 5.4‐fold (95% CI 1.1–27.3, P = 0.04) excess risk of shoulder dystocia and a 6.4‐fold increased risk of 5‐min APGAR ≤ 7 (95% CI 1.2–1.7, P < 0.001). Hyperbilirubinaemia was associated with an excess risk of polycythaemia (packed cell volume > 0.6; 97.1, 95% CI 38.9–241.5, P < 0.001).

Conclusions

Neonatal hypoglycaemia and hyperbilirubinaemia largely occur in different pregnancies. Both are associated with earlier GDM diagnosis; however, hypoglycaemia is more associated with maternal glycaemia and its sequelae, and hyperbilirubinaemia is associated with polycythaemia.
Lipid profile is associated with treatment regimen in a large cohort of children and adolescents with Type 1 diabetes mellitus: a study from the international SWEET database
Authors: Kosteria I. , Schwandt A. , Davis E. , Jali S. , Prieto M. , Rottembourg D. ,   the SWEET study group
Published: April 2019

Aims

To examine the effect of pump vs injection therapy on the lipid profile of children with Type 1 diabetes mellitus.

Methods

A cross‐sectional analysis of the lipid profile of children aged ≤ 18 years with Type 1 diabetes mellitus from SWEET, an international diabetes registry, was conducted with a focus on the effect of treatment regimen. Dyslipidaemia was defined as LDL cholesterol ≥2.6 mmol/l or non‐HDL cholesterol ≥3.1 mmol/l. LDL and non‐HDL cholesterol values among 14 290 children (52% boys, 51% receiving pump therapy) from 60 SWEET centres were analysed by linear and logistic regression analysis adjusted for sex, age, diabetes duration, HbA1c and BMI‐standard deviation score group, region, and common interactions between age, sex, HbA1c and BMI.

Results

This study confirmed the established associations of increased lipids with female sex, age, diabetes duration, HbA1c and BMI. LDL and non‐HDL cholesterol levels were lower in the pump therapy group compared to the injection therapy group [LDL cholesterol: injection therapy 2.44 mmol/l (95% CI 2.42 to 2.46) vs pump therapy 2.39 mmol/l (95% CI 2.37–2.41), P<0.001; non‐HDL cholesterol: injection therapy 2.88 mmol/l (95% CI 2.86 to 2.90) vs pump therapy 2.80 mmol/l (95% CI 2.78–2.82), both P<0.0001]. Similarly, the odds ratios for LDL cholesterol ≥2.6 mmol/l [0.89 (95% CI 0.82–0.97)] and non‐HDL cholesterol ≥3.1 mmol/l [0.85 (0.78 to 0.93)] were significantly lower in the pump therapy group, even after all adjustments.

Conclusions

Our results indicate that pump therapy is associated with a better lipid profile.
Role of apolipoprotein C‐III overproduction in diabetic dyslipidaemia
Authors: Adiels Martin , Taskinen Marja‐Riitta , Björnson Elias , Andersson Linda , Matikainen Niina , Söderlund Sanni , Kahri Juhani , Hakkarainen Antti , Lundbom Nina , Sihlbom Carina , Thorsell Annika , Zhou Haihong , Pietiläinen Kirsi H. , Packard Chris , Borén Jan
Published: April 2019

Aims

To investigate how apolipoprotein C‐III (apoC‐III) metabolism is altered in subjects with type 2 diabetes, whether the perturbed plasma triglyceride concentrations in this condition are determined primarily by the secretion rate or the removal rate of apoC‐III, and whether improvement of glycaemic control using the glucagon‐like peptide‐1 analogue liraglutide for 16 weeks modifies apoC‐III dynamics.

Materials and Methods

Postprandial apoC‐III kinetics were assessed after a bolus injection of [5,5,5‐2H3]leucine using ultrasensitive mass spectrometry techniques. We compared apoC‐III kinetics in two situations: in subjects with type 2 diabetes before and after liraglutide therapy, and in type 2 diabetic subjects with matched body mass index (BMI) non‐diabetic subjects. Liver fat content, subcutaneous abdominal and intra‐abdominal fat were determined using proton magnetic resonance spectroscopy.

Results

Improved glycaemic control by liraglutide therapy for 16 weeks significantly reduced apoC‐III secretion rate (561 ± 198 vs. 652 ± 196 mg/d, P = 0.03) and apoC‐III levels (10.0 ± 3.8 vs. 11.7 ± 4.3 mg/dL, P = 0.035) in subjects with type 2 diabetes. Change in apoC‐III secretion rate was significantly associated with the improvement in indices of glucose control (r = 0.67; P = 0.009) and change in triglyceride area under the curve (r = 0.59; P = 0.025). In line with this, the apoC‐III secretion rate was higher in subjects with type 2 diabetes compared with BMI‐matched non‐diabetic subjects (676 ± 208 vs. 505 ± 174 mg/d, P = 0.042).

Conclusions

The results reveal that the secretion rate of apoC‐III is associated with elevation of triglyceride‐rich lipoproteins in subjects with type 2 diabetes, potentially through the influence of glucose homeostasis on the production of apoC‐III.
Genome‐wide association and genomic prediction for biomass yield in a genetically diverse Miscanthus sinensis germplasm panel phenotyped at five locations in Asia and North America
Authors: Clark Lindsay V. , Dwiyanti Maria S. , Anzoua Kossonou G. , Brummer Joe E. , Ghimire Bimal Kumar , Głowacka Katarzyna , Hall Megan , Heo Kweon , Jin Xiaoli , Lipka Alexander E. , Peng Junhua , Yamada Toshihiko , Yoo Ji Hye , Yu Chang Yeon , Zhao Hua , Long Stephen P. , Sacks Erik J.
Published: April 2019

To improve the efficiency of breeding of Miscanthus for biomass yield, there is a need to develop genomics‐assisted selection for this long‐lived perennial crop by relating genotype to phenotype and breeding value across a broad range of environments. We present the first genome‐wide association (GWA) and genomic prediction study of Miscanthus that utilizes multilocation phenotypic data. A panel of 568 Miscanthus sinensis accessions was genotyped with 46,177 single nucleotide polymorphisms (SNPs) and evaluated at one subtropical and five temperate locations over 3 years for biomass yield and 14 yield‐component traits. GWA and genomic prediction were performed separately for different years of data in order to assess reproducibility. The analyses were also performed for individual field trial locations, as well as combined phenotypic data across groups of locations. GWA analyses identified 27 significant SNPs for yield, and a total of 504 associations across 298 unique SNPs across all traits, sites, and years. For yield, the greatest number of significant SNPs was identified by combining phenotypic data across all six locations. For some of the other yield‐component traits, greater numbers of significant SNPs were obtained from single site data, although the number of significant SNPs varied greatly from site to site. Candidate genes were identified. Accounting for population structure, genomic prediction accuracies for biomass yield ranged from 0.31 to 0.35 across five northern sites and from 0.13 to 0.18 for the subtropical location, depending on the estimation method. Genomic prediction accuracies of all traits were similar for single‐location and multilocation data, suggesting that genomic selection will be useful for breeding broadly adapted M. sinensis as well as M. sinensis optimized for specific climates. All of our data, including DNA sequences flanking each SNP, are publicly available. By facilitating genomic selection in M. sinensis and Miscanthus × giganteus, our results will accelerate the breeding of these species for biomass in diverse environments.
The influence of exopolysaccharide‐producing lactic acid bacteria on reconstructed ham
Authors: Hilbig Jonas , Loeffler Myriam , Herrmann Kurt , Weiss Jochen
Published: April 2019

The influence of in‐situ‐formed exopolysaccharides (EPS) by lactic acid bacteria (LAB; Lactobacillus sakeiTMW 1.411 and Lactobacillus plantarumTMW 1.1478) on the yield and texture of reconstructed ham was investigated. No differences in yield (P > 0.05) were observed but weight loss during storage was significantly higher (P < 0.05) for hams produced with L. sakei 1.411. Furthermore, the produced EPS decreased the hardness (P < 0.05; 50.22 N for control compared to 44.81 N) but did not influence the cohesiveness (P > 0.05) of hams. Products with L. plantarum 1.1478 showed no significant differences in comparison to the control. This could be attributed to the lower amount of EPS formed during ripening. L. sakei 1.411 produced 194.49 ± 5.34 mg kg−1 EPS, whereas L. plantarum 1.1478 formed 60.26 ± 2.96 mg kg−1 EPS. Thus, the use of the examined LAB is not recommended in reconstructed ham, since they have no or even a negative influence on the product quality.
Melanized focal changes in skeletal muscle in farmed Atlantic salmon after natural infection with Piscine orthoreovirus (PRV)
Authors: Bjørgen Håvard , Haldorsen Randi , Oaland Øyvind , Kvellestad Agnar , Kannimuthu Dhamotharan , Rimstad Espen , Koppang Erling Olaf
Published: April 2019

Melanized focal changes in skeletal muscle of farmed Atlantic salmon (Salmo salar) are a major quality problem. The aetiology is unknown, but infection with Piscine orthoreovirus (PRV) has been associated with the condition. Here, we addressed the pathogenesis of red and melanized focal changes and their association with PRV. First, a population of farmed fish (PRV‐negative prior to sea transfer) was sequentially investigated throughout the seawater period. The fish were autopsied and tested for PRV infection. Muscular changes were described by macroscopy and histology, and a classification system was established. Second, in an experimental infection trial, PRV was injected intramuscularly to induce changes. The farmed fish was gradually infected with PRV. Red focal changes occurred throughout the observation period with a low prevalence regardless of PRV status. Melanized changes were highly diverse and their prevalence increased during the trial. Changes of low macroscopic grade and histological category were more prevalent in PRV‐negative fish. Diffuse granulomatous melanized changes only occurred after PRV infection. No muscular changes were observed in the experimentally challenged fish. Our studies do not indicate that PRV infection causes red focal changes, but seems important in the development of granulomatous melanized changes.
Tacticians, Stewards, and Professionals: The Politics of Publishing Select Committee Legal Advice
Authors: Yong Ben , Davies Greg , Leston‐Bandeira Cristina
Published: April 2019

At Westminster, there are increasing pressures on select committees to publish in‐house legal advice. We suggest that examining the process of deciding to publish provides useful insights into the provision, reception, and use of legal advice, and the dynamics of select committees generally. We argue that the autonomy of select committees to decide what use they make of evidence and advice they receive is, in practice, constrained by the intra‐institutional dynamics and practices of select committees. Committee actors – parliamentarians, clerks, and parliamentary lawyers – each have overlapping, sometimes competing, roles. Most of the time, these roles and the responsibilities they encompass coincide, but the prospect of publication reveals clear tensions between the different actors. This is the politics of publication: the tactical approach of politicians is in tension with the stewardship of clerks and the professional norms of parliamentary lawyers. We suggest this tension will only increase in the near future.
Successful treatment of hepatitis C virus infection with direct‐acting antivirals during hematopoietic cell transplant
Authors: Cunningham Hayley E. , Shea Thomas C. , Grgic Tatjana , Lachiewicz Anne M.
Published: April 2019

Current guidelines recommend that hepatitis C virus (HCV) infection be treated completely prior to hematopoietic cell transplantation or delayed until immune reconstitution after transplantation to avoid drug‐drug interactions and treatment interruption. However, these recommendations were informed by outcomes using treatment with ribavirin and pegylated interferon. We report the first case of successful treatment of HCV using direct‐acting antivirals during hematopoietic cell transplantation. This case study suggests that treatment of HCV concurrent with hematopoietic cell transplantation for malignancy may be the best option for some patients in whom it is unsafe to delay treatment for either disease.
Is there a risk of transfusion‐transmissible infections after percutaneous needle treatments in blood donors? A systematic review and meta‐analysis
Authors: Van Remoortel Hans , Moorkens Dorien , Avau Bert , Compernolle Veerle , Vandekerckhove Philippe , De Buck Emmy
Published: April 2019

Background and objectives

The donor medical questionnaire identifies a blood donor's history of known blood safety risks. Current Australian, Canadian, European and USA legislation temporarily defers blood donors who received different percutaneous needle treatments (i.e. tattooing, acupuncture and piercing) from blood donation. This systematic review aimed to scientifically underpin these deferrals by identifying the best available evidence on the association between percutaneous needle treatments and the risk of transfusion‐transmissible infections (TTIs).

Materials and methods

Studies from three databases investigating the link between percutaneous needle treatments and TTIs (HBV, HCV and HIV infection) in blood donors were retained and assessed on eligibility by two reviewers independently. The association between percutaneous needle treatments and TTIs was expressed by conducting meta‐analyses and calculating pooled effect measures (odds ratios (ORs) and 95% CIs). The GRADE methodology (Grades of Recommendation, Assessment, Development and Evaluation) was used to assess the quality of evidence.

Results

We identified 1242 references and finally included 21 observational studies. Twenty studies assessed the link between percutaneous needle treatments and HCV infection and found that blood donors receiving these treatments had an increased risk of HCV infection (tattooing: pooled OR 5·28, 95% CI [4·33, 6·44], P < 0·00001 (low‐quality evidence); acupuncture: pooled OR 1·56, 95% CI [1·17, 2·08], P = 0·03 (very low‐quality evidence); and piercing: pooled OR 3·25, 95% CI [1·68, 6·30], P = 0·0005 (low‐quality evidence)).

Conclusion

Percutaneous needle treatments may be associated with an increased HCV infection risk. Further high‐quality studies are required to formulate stronger evidence‐based recommendations on percutaneous needle treatments as a blood donor deferral criterion.
Postoperative pain management in a surgical unit in a Basque Country hospital: a best practice implementation project
Authors: Tíscar-González Verónica , Uriarte-Diaz Ana , Morales-Boiza Noelia , Linaza-Arriola Miren Bittore , García-Guevara Nieves , Izquierdo-García María Jesús
Published: April 2019

Objectives:

The objective of this project was to implement evidence-based recommendations for post-surgical pain management and improve quality of care for patients.

Introduction:

Inadequate approaches to postoperative pain can lead to the pain becoming chronic, which has an impact on the patient's quality of life. The focus of this project was to implement evidence-based recommendations to improve the effect or outcome of post-surgical pain management strategies and improve quality of care.

Methods:

This implementation project was undertaken in a surgical unit of a tertiary hospital. The clinical audit was developed in three phases using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tools for promoting change in healthcare practices and improving quality of care. A baseline audit was conducted with 27 patients that identified the barriers and strategies needed to improve the assessment and management of postoperative pain. Two follow-up audits audits were conducted, each comprising 40 patients.

Results:

The baseline audit revealed the need to increase health education for patients and, or, their families on managing postoperative pain, with a special emphasis on non-pharmacological measures. This education was not recorded in the patients’ medical histories at baseline and the aim was to rectify this.

In follow-up audits, 100% of patients received individually tailored education about postoperative pain and its management.

Conclusions:

The aims and main objectives of the present project were achieved, including improvements in the quality of health education related to pain and the recording of pain data. In addition, variations in the clinical practice related to the management of post-surgical pain decreased.
La memoria y la forma política: una lectura de Carl Schmitt sobre la soberanía y el estado de excepción.
Authors: Vega Díaz Luis Felipe , Avella de Martínez Dora Inés
Published: April 2019

El objetivo de este artículo es  hacer una presentación sobre la relación existente entre la forma política de la soberanía y la forma de la memoria en el marco de  la posguerra de la segunda guerra mundial, adelantado por Carl Schmitt. En efecto, las discusiones sobre la influencia de la memoria colectiva sobre la esfera de la toma de decisiones políticas, supone el resurgimiento de lo sentimientos nacionales a partir de la comprensión de las amenazas globales, por lo que estos sentimientos logran agregarse bajo la figura de un  “dictador benévolo” y particularmente del “Estado de Excepción (Ausnahmezustand)” como forma política más que como forma política. En efecto, el resurgimiento de los nacionalismos y de liderazgos políticos que rebasan las formas del populismo por sus componentes teológicos en la composición supra-histórica de los caudillos como decisores sobre la vida de la población,  y aunado a esto como factor de catalización de los procesos políticos internos y de política exterior del concepto binario amigo-enemigo, desplaza la comprensión de la política al reencuentro con la memoria de la guerra, a través de la que Carl Schmitt avizoraba desde los procesos de Nürnberg de 1948 una suerte de guerra civil mundial, debido a la imagen de triunfo de una suerte de democracia  liberal anglosajona.
Paradiplomacia: Definiciones y trayectorias.
Authors: ARENAS ARIAS GERMÁN JAIR
Published: April 2019

El activismo internacional por parte de los gobiernos locales y regionales es cada vez mayor en el planeta globalizado de hoy. Para explicar este fenómeno, la disciplina de las relaciones internacionales ha adoptado el término “Paradiplomacia”. Sin embargo, en el derecho constitucional, este neologismo no obtiene todavía la cobertura científica exhaustiva que se requiere para abordarlo con suficiencia. Este trabajo se enfrenta al desafío de retomar el debate conceptual acerca de la paradiplomacia, abordando un problema fundamental. La implicación en los asuntos exteriores por parte de gobiernos no centrales de un modo paralelo al Estado puede expresar convergencia pero también enfrentamiento de cara a la construcción y proyección de una sola política exterior: única y uniforme. A partir de un análisis casuístico basado en la infraestructura constitucional de Alemania, Colombia y España, se considerarán cuatro factores que permiten aproximarse al funcionamiento estatal interno, dentro del cual la paradiplomacia puede encontrar sitio y acomodo legal, político e institucional. El modelo de organización territorial, las relaciones intergubernamentales, la representatividad e identidad con el órgano legislativo por parte de las unidades constitutivas del Estado y la acción de los partidos políticos resultarán claves para proponer tres escenarios de orden, desorden y antiorden.
Data-Driven Model for the Dynamic Characteristics of O-Rings for Gas Bearing Supported Rotors
Authors: Bättig Philipp , Schiffmann Jürg
Published: April 2019

The measurement results of various nitrile butadiene rubber (NBR) O-Ring sizes are presented, and reduced-order models are developed in order to predict the stiffness and damping coefficient as a function of O-Ring geometry, Shore hardness, squeeze, and excitation frequency. The results show that the curvature ratio d/D needs to be considered in the reduced-order models. The assessment of the model suggests a maximum deviation of 30% in predicted stiffness compared to the measurement data. However, taking into account the typical Shore hardness tolerance given by O-Ring manufacturers and other measurement uncertainties, the proposed model enables the prediction of various O-Rings with a good accuracy in the frequency range of 1.5–3.75 kHz, which corresponds to typical gas bearing supported rotor applications.
Nanomechanical and microtribological properties of yttrium thin films for photocathode engineering
Authors: Broitman Esteban , Lorusso Antonella , Perrone Alessio , Karoutsos Vagelis , Vainos Nikolaos A. , Gontad Francisco
Published: April 2019

The authors study the nanomechanical and microtribological properties of yttrium (Y) thin films deposited by pulsed laser deposition on Cu polycrystalline substrates. Nanoindentation tests reveal that such films have a high hardness of H = 2.3 GPa and a reduced elastic modulus of 71.7 GPa with respect to the Cu substrates. The friction coefficient between a diamond tip and the Y film reaches a steady state value of μ ∼ 0.34, lower than that for the Cu (μ ∼ 0.38). Moreover, nanoscratch experiments show that Y films are more scratch-resistant than the Cu substrates, probably due to their greater hardness, higher elastic recovery, and lower friction coefficient. Their results confirm that the mechanical and tribological properties of the Y films are suitable for designing and fabricating scratch-resistant hybrid photocathodes and can reduce instabilities and unwanted discharges in the cavity of the radio-frequency gun. Furthermore, the low surface roughness and the low work function of the material are important characteristics for a photocathode based on the Y thin film for the production of high-brightness electron beams.
Strategy for simultaneously increasing both hardness and toughness in ZrB2-rich Zr1−xTaxBy thin films
Authors: Bakhit Babak , Engberg David L. J. , Lu Jun , Rosen Johanna , Högberg Hans , Hultman Lars , Petrov Ivan , Greene J. E. , Greczynski Grzegorz
Published: April 2019

Refractory transition-metal diborides exhibit inherent hardness. However, this is not always sufficient to prevent failure in applications involving high mechanical and thermal stress, since hardness is typically accompanied by brittleness leading to crack formation and propagation. Toughness, the combination of hardness and ductility, is required to avoid brittle fracture. Here, the authors demonstrate a strategy for simultaneously enhancing both hardness and ductility of ZrB2-rich thin films grown in pure Ar on Al2O3(0001) and Si(001) substrates at 475 °C. ZrB2.4 layers are deposited by dc magnetron sputtering (DCMS) from a ZrB2 target, while Zr1−xTaxBy alloy films are grown, thus varying the B/metal ratio as a function of x, by adding pulsed high-power impulse magnetron sputtering (HiPIMS) from a Ta target to deposit Zr1−xTaxBy alloy films using hybrid Ta-HiPIMS/ZrB2-DCMS sputtering with a substrate bias synchronized to the metal-rich portion of each HiPIMS pulse. The average power PTa (and pulse frequency) applied to the HiPIMS Ta target is varied from 0 to 1800 W (0 to 300 Hz) in increments of 600 W (100 Hz). The resulting boron-to-metal ratio, y = B/(Zr+Ta), in as-deposited Zr1−xTaxBy films decreases from 2.4 to 1.5 as PTa is increased from 0 to 1800 W, while x increases from 0 to 0.3. A combination of x-ray diffraction (XRD), glancing-angle XRD, transmission electron microscopy (TEM), analytical Z-contrast scanning TEM, electron energy-loss spectroscopy, energy-dispersive x-ray spectroscopy, x-ray photoelectron spectroscopy, and atom-probe tomography reveals that all films have the hexagonal AlB2 crystal structure with a columnar nanostructure, in which the column boundaries of layers with 0 ≤ x < 0.2 are B-rich, whereas those with x ≥ 0.2 are Ta-rich. The nanostructural transition, combined with changes in average column widths, results in an ∼20% increase in hardness, from 35 to 42 GPa, with a simultaneous increase of ∼30% in nanoindentation toughness, from 4.0 to 5.2 MPa√m.
Concerted proton-electron transfer reactions in the Marcus inverted region
Authors: Parada Giovanny A. , Goldsmith Zachary K. , Kolmar Scott , Pettersson Rimgard Belinda , Mercado Brandon Q. , Hammarström Leif , Hammes-Schiffer Sharon , Mayer James M.
Published: April 2019

Protons venture into the inverted region

One of the most counterintuitive features of electron transfer kinetics is the inverted region. As Marcus theory predicts and experiments have borne out, electron transfer slows down once the driving force for it becomes especially favorable. Parada
et al.
now offer evidence for such inverted behavior in proton-coupled electron transfer (see the Perspective by Dempsey). Specifically, they examined a series of compounds with phenol bridging anthracene (electron acceptor) and pyridine (proton acceptor) derivatives. Time-resolved spectroscopy and accompanying theory revealed slower rates at higher driving forces in the back reaction that follows light-induced intramolecular proton and electron transfer.

Science
, this issue p.
471
; see also p.
436
Mechanism of 5ʹ splice site transfer for human spliceosome activation
Authors: Charenton Clément , Wilkinson Max E. , Nagai Kiyoshi
Published: April 2019

Creation of the splicing catalytic center

The catalytic center of the fully assembled, precatalytic pre–B spliceosome is not yet formed, even though all the pieces are present in this complex. Charenton
et al.
solved the structures of the human pre–B complex, providing detailed mechanistic insights into how the helicase Prp28 transfers the 5′ splice site of the messenger RNA precursor from U1 small nuclear ribonucleoprotein (snRNP) to U6 snRNA. The pairing of the 5′ splice site with U6 induces a series of conformational changes that triggers the relocation of Brr2 helicase and loading of U4 snRNA to the helicase active site. This leads to unwinding of the U4/U6 snRNA duplex and allows U6 to fold and pair with U2 to create the spliceosome active site.

Science
, this issue p.
362
Maternal immunization confers protection against neonatal herpes simplex mortality and behavioral morbidity
Authors: Patel Chaya D. , Backes Iara M. , Taylor Sean A. , Jiang Yike , Marchant Arnaud , Pesola Jean M. , Coen Donald M. , Knipe David M. , Ackerman Margaret E. , Leib David A.
Published: April 2019

Maternal immunization confers antibody-mediated protection against neonatal HSV, preventing mortality and long-term behavioral sequelae in a mouse model.
“I am not delusional!” Sensory dysaesthesia secondary to degenerative cervical myelopathy
Authors: Mowforth Oliver Daniel , Davies Benjamin Marshall , Kotter Mark Reinhard
Published: April 2019

Degenerative cervical myelopathy (DCM) is the most common cause of adult spinal cord dysfunction, most classically presenting with a broad-based gait and clumsy hands. Limb sensory loss and paraesthesia are considered common symptoms of DCM. However, we report an unusual case of a patient presenting with prominent and atypical sensory symptoms. The patient repeatedly presented to accident and emergency complaining of her body resembling a wet gel-like substance that she attributed to the use of olive oil moisturising cream. The patient was found to have myelopathic signs on examination and MRI consistent with severe cervical myelopathy. She subsequently underwent successful decompressive anterior cervical discectomy, as recommended by international guidelines. This case serves to remind health professionals of uncommon presentations of common disease and the importance of maintaining a wide initial differential diagnosis.
Stress related disorders and risk of cardiovascular disease: population based, sibling controlled cohort study
Authors: Song Huan , Fang Fang , Arnberg Filip K , Mataix-Cols David , Fernández de la Cruz Lorena , Almqvist Catarina , Fall Katja , Lichtenstein Paul , Thorgeirsson Gudmundur , Valdimarsdóttir Unnur A
Published: April 2019

Objective

To assess the association between stress related disorders and subsequent risk of cardiovascular disease.

Design

Population based, sibling controlled cohort study.

Setting

Population of Sweden.

Participants

136 637 patients in the Swedish National Patient Register with stress related disorders, including post-traumatic stress disorder (PTSD), acute stress reaction, adjustment disorder, and other stress reactions, from 1987 to 2013; 171 314 unaffected full siblings of these patients; and 1 366 370 matched unexposed people from the general population.

Main outcome measures

Primary diagnosis of incident cardiovascular disease—any or specific subtypes (ischaemic heart disease, cerebrovascular disease, emboli/thrombosis, hypertensive diseases, heart failure, arrhythmia/conduction disorder, and fatal cardiovascular disease)—and 16 individual diagnoses of cardiovascular disease. Hazard ratios for cardiovascular disease were derived from Cox models, after controlling for multiple confounders.

Results

During up to 27 years of follow-up, the crude incidence rate of any cardiovascular disease was 10.5, 8.4, and 6.9 per 1000 person years among exposed patients, their unaffected full siblings, and the matched unexposed individuals, respectively. In sibling based comparisons, the hazard ratio for any cardiovascular disease was 1.64 (95% confidence interval 1.45 to 1.84), with the highest subtype specific hazard ratio observed for heart failure (6.95, 1.88 to 25.68), during the first year after the diagnosis of any stress related disorder. Beyond one year, the hazard ratios became lower (overall 1.29, 1.24 to 1.34), ranging from 1.12 (1.04 to 1.21) for arrhythmia to 2.02 (1.45 to 2.82) for artery thrombosis/embolus. Stress related disorders were more strongly associated with early onset cardiovascular diseases (hazard ratio 1.40 (1.32 to 1.49) for attained age <50) than later onset ones (1.24 (1.18 to 1.30) for attained age ≥50; P for difference=0.002). Except for fatal cardiovascular diseases, these associations were not modified by the presence of psychiatric comorbidity. Analyses within the population matched cohort yielded similar results (hazard ratio 1.71 (1.59 to 1.83) for any cardiovascular disease during the first year of follow-up and 1.36 (1.33 to 1.39) thereafter).

Conclusion

Stress related disorders are robustly associated with multiple types of cardiovascular disease, independently of familial background, history of somatic/psychiatric diseases, and psychiatric comorbidity.
Telemedical coaching for weight loss in overweight employees: a three-armed randomised controlled trial
Authors: Kempf Kerstin , Röhling Martin , Martin Stephan , Schneider Michael
Published: April 2019

Objectives

We examined the effect of a telemedical coaching (TMC) programme accompanied with or without telemonitoring on weight loss in an occupational healthcare setting with a three-armed randomised controlled trial (NCT01837134’Pre-results').

Methods

Overweight employees (n=104, body mass index [BMI] ≥25 kg/m2) were invited by their medical corporate department and randomised into either a TMC group (n=34) or in one of the two control groups (C1, n=34; C2, n=36). TMC and C1 were equipped with telemonitoring devices (scales and pedometers) at baseline, and C2 after 6 months. Telemonitoring devices automatically transferred data into a personalised online portal. TMC was coached with weekly care calls in months 3–6 and monthly calls from months 7 to 12. C2 had a short coaching phase in months 6–9. C1 received no further support. After the 12-month intervention phase, participants could take advantage of further company health promotion offers. Follow-up data were determined after 12 months of intervention and per-protocol (PP) and intention-to-treat (ITT) analyses were performed. Weight change was followed up after 36 months. Estimated treatment difference (ETD) was calculated for weight reduction.

Results

ETD from TMC to C1 (−3.6 kg 95% CI −7.40 to −0.1, p=0.047) and to C2 (−4.2 kg [−7.90 to −0.5], p=0.026) was significantly different at the 12 months follow-up in the PP-analysis, but lost significance in the ITT analysis. All groups reduced weight after 12 months (−3.3 to −8.4 kg [5.5–10.3 kg], all p<0.01) and sustained it during the 36 months follow-up (−4.8 to −7.8 kg [5.6–12.8 kg], all p<0.01). ETD analyses revealed no difference between all groups neither in the PP nor in the ITT analysis at the 3 years follow-up. All groups reduced BMI, systolic and diastolic blood pressure and improved eating behaviour in the PP or ITT analyses.

Conclusions

TMC and/or telemonitoring support long-term weight reduction in overweight employees. The combination of both interventions points towards an additional effect.

Trial registration number

NCT01837134.
The impact of general practitioners working in or alongside emergency departments: a rapid realist review
Authors: Cooper Alison , Davies Freya , Edwards Michelle , Anderson Pippa , Carson-Stevens Andrew , Cooke Matthew W , Donaldson Liam , Dale Jeremy , Evans Bridie Angela , Hibbert Peter D , Hughes Thomas C , Porter Alison , Rainer Tim , Siriwardena Aloysius , Snooks Helen , Edwards Adrian
Published: April 2019

Objectives

Worldwide, emergency healthcare systems are under intense pressure from ever-increasing demand and evidence is urgently needed to understand how this can be safely managed. An estimated 10%–43% of emergency department patients could be treated by primary care services. In England, this has led to a policy proposal and £100 million of funding (US$130 million), for emergency departments to stream appropriate patients to a co-located primary care facility so they are ‘free to care for the sickest patients’. However, the research evidence to support this initiative is weak.

Design

Rapid realist literature review.

Setting

Emergency departments.

Inclusion criteria

Articles describing general practitioners working in or alongside emergency departments.

Aim

To develop context-specific theories that explain how and why general practitioners working in or alongside emergency departments affect: patient flow; patient experience; patient safety and the wider healthcare system.

Results

Ninety-six articles contributed data to theory development sourced from earlier systematic reviews, updated database searches (Medline, Embase, CINAHL, Cochrane DSR & CRCT, DARE, HTA Database, BSC, PsycINFO and SCOPUS) and citation tracking. We developed theories to explain: how staff interpret the streaming system; different roles general practitioners adopt in the emergency department setting (traditional, extended, gatekeeper or emergency clinician) and how these factors influence patient (experience and safety) and organisational (demand and cost-effectiveness) outcomes.

Conclusions

Multiple factors influence the effectiveness of emergency department streaming to general practitioners; caution is needed in embedding the policy until further research and evaluation are available. Service models that encourage the traditional general practitioner approach may have shorter process times for non-urgent patients; however, there is little evidence that this frees up emergency department staff to care for the sickest patients. Distinct primary care services offering increased patient choice may result in provider-induced demand. Economic evaluation and safety requires further research.

PROSPERO registration number

CRD42017069741.
Partial versus complete prostatectomy specimen sampling: prospective non-inferiority study for pT3a tumours and surgical margin involvement
Authors: Collette Eelco R P , den Bakker Michael A , Klaver Sjoerd O , Vis André N , Kliffen Mike
Published: April 2019

Aims

The importance of additional information gained by complete versus partial sampling or prostatectomy specimens is uncertain. There is sparse data on the value of complete versus partial sampling and numbers of inclusions in studies are small and retrospective. We present the results of a prospective non-inferiority study to examine if partial sampling is inferior to complete sampling in terms of pathology outcomes and clinical relevance.

Methods

564 robot-assisted prostatectomy (RARP) specimens with prospective registration and analysis were collected over a 2-year period. All patients underwent RARP between January 2014 and February 2016 in our hospital after a diagnosis of clinically localised prostate cancer. For each patient, tumour stage and surgical margin status was recorded after partial and after complete sampling. Upstaging from pT2 to pT3a and upgrading from a negative-to-positive surgical margin was analysed.

Results

In 12 of 564 patients (2.1%), complete sampling yielded new information. In eight patients (1.4%), the surgical margin converted to positive after complete sampling. Upstaging from initial pT2 tumour in partial sampling to pT3a tumour after complete sampling was documented in five patients (0.9%). In the follow-up period (mean 35 months), a biochemical recurrence occurred in one patient.

Conclusions

Complete sampling provides new information in only 2.1% of cases, compared with partial sampling. We conclude that the additional information gained by complete sampling in terms of stage and surgical margin detection is statistically insignificant compared with partial sampling. Furthermore, partial sampling compared with complete sampling does not change postoperative clinical management.
Patient factors driving overuse of cardiac catheterisation: a qualitative study with 25 participants from two German teaching practices
Authors: Herwig Anna , Dehnen Dorothea , Weltermann Birgitta
Published: April 2019

Objectives

Percutaneous coronary interventions do not provide a benefit over medical therapy for stable patients. However, an overuse of cardiac catheterisation (CC) for stable coronary artery disease (CAD) is documented in Germany and other countries. In this study, we aim to understand patient factors that foster this overuse.

Design

Our study is an exploratory qualitative interview study with narrative, structured interviews. The interviews were analysed using qualitative content analysis by Mayring.

Setting

The interviews were conducted in two German teaching practices.

Participants

24 interviews with 25 patients were conducted; 17 (68%) patients were male, the average age was 73.9 years (range 53–88 years). All patients suffered from CAD and had undergone at least one CC. Patients with known anxiety disorders were excluded from the study.

Results

The analysis identified six patient factors which contributed to or prevented the overuse of CC: (1) unquestioned acceptance of prescheduled appointments for procedures/convenience; (2) disinterest in and/or lack of disease-specific knowledge; (3) helplessness in situations with varying opinions on the required care; (4) fear of another cardiac event, (5) patient–physician relationship and (6) the patient’s experience that repeat interventions did not result in a change of health status or care.

Conclusions

Conducted in a country with documented overuse of CC, we showed that most patients trusted their physicians’ recommendations for repeat coronary angiographies even if they were asymptomatic. Strategies to align physician adherence with guidelines and corresponding patient information are needed to prevent overuse.
What factors are associated with resilient outcomes in children exposed to social adversity? A systematic review
Authors: Gartland Deirdre , Riggs Elisha , Muyeen Sumaiya , Giallo Rebecca , Afifi Tracie O , MacMillan Harriet , Herrman Helen , Bulford Eleanor , Brown Stephanie J
Published: April 2019

Objectives

Children exposed to social adversity—hardship as a result of social circumstances such as poverty or intergenerational trauma—are at increased risk of poor outcomes across the life course. Understanding what promotes resilient outcomes is essential for the development of evidence informed intervention strategies. We conducted a systematic review to identify how child resilience is measured and what factors are associated with resilient outcomes.

Design

Systematic search conducted in CINAHL, MEDLINE and PsychInfo from January 2004 to October 2018 using the keywords ‘resilien* and child* in the title or abstract. Eligible studies: (1) described children aged 5–12 years; (2) identified exposure to social adversity; (3) identified resilience; and (4) investigated factors associated with resilience.

Outcome measures

(1) approaches to identifying resilience and (2) factors associated with resilient outcomes.

Results

From 1979 studies retrieved, 30 studies met the inclusion criteria. Most studies were moderate to high quality, with low cultural competency. Social adversity exposures included poverty, parent loss, maltreatment and war. Only two studies used a measure of child resilience; neither was psychometrically validated. Remaining studies classified children as resilient if they showed positive outcomes (eg, mental health or academic achievement) despite adversity. A range of child, family, school and community factors were associated with resilient outcomes, with individual factors most commonly investigated. The best available evidence was for cognitive skills, emotion regulation, relationships with caregivers and academic engagement.

Conclusions

While there is huge variation in the type and severity of adversity that children experience, there is some evidence that specific individual, relational and school factors are associated with resilient outcomes across a range of contexts. Such factors provide an important starting point for effective public health interventions to promote resilience and to prevent or ameliorate the immediate and long-term impacts of social adversity on children.
Gut-directed hypnotherapy versus standard medical treatment for nausea in children with functional nausea or functional dyspepsia: protocol of a multicentre randomised trial
Authors: Browne Pamela D , den Hollander Bibiche , Speksnijder Esther M , van Wering Herbert M , Tjon a Ten Walther , George Elvira K , Groeneweg Michael , Bevers Nanja , Wessels Margaretha M S , van den Berg Maartje M , Goede Joery , Teklenburg-Roord Sarah T A , Frankenhuis Carla , Benninga Marc A , Vlieger Arine M
Published: April 2019

Introduction

The treatment of chronic functional nausea or nausea due to functional dyspepsia in children is generally symptomatic. Moreover, these disorders pose a risk for worse psychosocial and health outcomes in children. Hypnotherapy (HT), by its ability to positively influence gastrointestinal and psychosocial functioning, may be an effective treatment for chronic nausea.

Methods and analysis

To test efficacy, this multicentre, parallel, randomised controlled, open label trial evaluates whether gut-directed HT is superior to standard medical treatment (SMT) for reducing nausea. The study will be conducted at eleven academic and non-academic hospitals across the Netherlands. A total of 100 children (8–18 years), fulfilling the Rome IV criteria for chronic idiopathic nausea or functional dyspepsia with prominent nausea, will be randomly allocated (1:1) to receive HT or SMT. Children allocated to the HT group will receive six sessions of HT during 3 months, while children allocated to the SMT group will receive six sessions of SMT+supportive therapy during the same period. The primary outcome will be the difference in the proportion of children with at least 50% reduction of nausea, compared with baseline at 12 months’ follow-up. Secondary outcomes include the changes in abdominal pain, dyspeptic symptoms, quality of life, anxiety, depression, school absences, parental absence of work, healthcare costs and adequate relief of symptoms, measured directly after treatment, 6 and 12 months’ follow-up. If HT proves effective for reducing nausea, it may become a new treatment strategy to treat children with chronic functional nausea or functional dyspepsia with prominent nausea.

Ethics and dissemination

Results of the study will be publicly disclosed to the public, without any restrictions, in peer-reviewed journal and international conferences. The study is approved by the Medical Research Ethics Committees United (MEC-U) in the Netherlands.

Trial registration number

NTR5814.