bluuebunny/crossref_metadata_2025 huggingface dataset:
Measuring the benefits of the integration of health and social care: qualitative interviews with professional stakeholders and patient representatives
Authors: Crocker Helen , Kelly Laura , Harlock Jenny , Fitzpatrick Ray , Peters Michele
Published: June 2020

Background

Integrated care has the potential to ease the increasing pressures faced by health and social care systems, however, challenges around measuring the benefits for providers, patients, and service users remain. This paper explores stakeholders’ views on the benefits of integrated care and approaches to measuring the integration of health and social care.

Methods

Twenty-five semi-structured qualitative interviews were conducted with professional stakeholders (n = 19) and patient representatives (n = 6). Interviews focused on the benefits of integrated care and how it should be evaluated. Data was analysed using framework analysis.

Results

Three overarching themes emerged from the data: (1) integrated care and its benefits, with stakeholders defining it primarily from the patient’s perspective; (2) potential measures for assessing the benefits of integration in terms of system effects, patient experiences, and patient outcomes; and (3) broader considerations around the assessment of integrated care, including the use of qualitative methods.

Conclusions

There was consensus among stakeholders that patient experiences and outcomes are the best measures of integration, and that the main measures currently used to assess integration do not directly assess patient benefits. Validated health status measures are readily available, however, a substantial shift in practices is required before their use becomes commonplace.
Saccharomyces cerevisiae nutrient signaling pathways show an unexpected early activation pattern during winemaking
Authors: Vallejo Beatriz , Matallana Emilia , Aranda Agustín
Published: June 2020

Background

Saccharomyces cerevisiae wine strains can develop stuck or sluggish fermentations when nutrients are scarce or suboptimal. Nutrient sensing and signaling pathways, such as PKA, TORC1 and Snf1, work coordinately to adapt growth and metabolism to the amount and balance of the different nutrients in the medium. This has been exhaustively studied in laboratory strains of S. cerevisiae and laboratory media, but much less under industrial conditions.

Results

Inhibitors of such pathways, like rapamycin or 2-deoxyglucose, failed to discriminate between commercial wine yeast strains with different nutritional requirements, but evidenced genetic variability among industrial isolates, and between laboratory and commercial strains. Most signaling pathways involve events of protein phosphorylation that can be followed as markers of their activity. The main pathway to promote growth in the presence of nitrogen, the TORC1 pathway, measured by the phosphorylation of Rps6 and Par32, proved active at the very start of fermentation, mainly on day 1, and ceased soon afterward, even before cellular growth stopped. Transcription factor Gln3, which activates genes subject to nitrogen catabolite repression, was also active for the first hours, even when ammonium and amino acids were still present in media. Snf1 kinase was activated only when glucose was exhausted under laboratory conditions, but was active from early fermentation stages. The same results were generally obtained when nitrogen was limiting, which indicates a unique pathway activation pattern in winemaking. As PKA remained active throughout fermentation, it could be the central pathway that controls others, provided sugars are present.

Conclusions

Wine fermentation is a distinct environmental situation from growth in laboratory media in molecular terms. The mechanisms involved in glucose and nitrogen repression respond differently under winemaking conditions.
Oleic acid and derivatives affect human endothelial cell mitochondrial function and vasoactive mediator production
Authors: Bass Virginia L. , Soukup Joleen M. , Ghio Andrew J. , Madden Michael C.
Published: June 2020

Background

Inhalation of common air pollutants such as diesel and biodiesel combustion products can induce vascular changes in humans which may contribute to increased mortality and morbidity associated with fine particulate matter exposures. Diesel, biodiesel, and other combustion byproducts contain fatty acid components capable of entering the body through particulate matter inhalation. Fatty acids can also be endogenously released into circulation following a systemic stress response to some inhaled pollutants such as ozone. When in the circulation, bioactive fatty acids may interact with cells lining the blood vessels, potentially inducing endothelial dysfunction. To examine whether fatty acids could potentially be involved in human vascular responses to air pollutants, we determined the effects of fatty acids and derivatives on important vascular cell functions.

Methods

Human umbilical vein endothelial cells (HUVEC) were exposed in vitro to oleic acid (OA) or OA metabolites for 4-48 h. Cytotoxicity, vasodilator production (by ELISA measurement), mitochondrial function (using Sea Horse assays), and iron metabolism (inferred by ICP-OES measurements) were examined, with standard statistical testing (ANOVA, t-tests) employed.

Results

Dose-dependent cytotoxicity was noted at 24 h, with 12-hydroxy OA more potent than OA. Mitochondrial stress testing showed that 12-hydroxy OA and OA induce mitochondrial dysfunction. Analysis of soluble mediator release from HUVEC showed a dose-dependent increase in prostaglandin F2α, a lipid involved in control of vascular tone, at 24 h (85% above controls) after OA-BSA exposure. RT-PCR analysis revealed OA did not induce changes in gene expression at noncytotoxic concentrations in exposed HUVEC, but 12-OH OA did alter ICAM and COX2 gene expression.

Conclusions

Together, these data demonstrate that FA may be capable of inducing cytotoxic effects and altering expression of mediators of vascular function following inhalation exposure, and may be implicated in air pollutant-induced deaths and hospitalizations. (267 of max 350 words).
Comparison common equations for LDL-C calculation with direct assay and developing a novel formula in Iranian children and adolescents: the CASPIAN V study
Authors: Molavi Fatemeh , Namazi Nazli , Asadi Mojgan , Sanjari Mahnaz , Motlagh Mohammad Esmaeil , Shafiee Gita , Qorbani Mostafa , Heshmat Ramin , Kelishadi Roya
Published: June 2020

Background

Hypercholesterolemia is a common dyslipidemia that leads to atherosclerosis. It is proved that early stages of atherosclerosis begins in early stages of life. In several studies, widespread prevalence of dyslipidemia in children is reported. So, assessment of lipid profile in children and adolescence is necessary for early diagnosis of dyslipidemia. Laboratory methods for measuring LDL are not available and economical. So, in some laboratories Friedwald method is used to determine LDL level. But, the preciseness of this method is not acceptable. Further, the preciseness of this method was not assayed in children and adolescence. So, it seems that assaying the preciseness of different methods is necessary.

Methods

The methodology of this work is on the basis of findings of the Caspian V study. This study was conducted in 30 provinces of Iran during 2015. The population of this work was rural and urban students aged 7–18 years old. The level of total cholesterol (TC), HDL, LDL, and TG were measured using laboratory methods. The average and variances values were determined for each group of data using SPSS. Further, LDL values were calculated with a new formula introduced in this work. A comparison was made between the new formula and the other methods.

Results

In the present study, we found that compare to four common formulas, Friedwald was the best equation to estimate LDL-C concentrations in Iranian children and adolescents and the new formula was the next accurate equation. The strongest correlation between Friedwald and the new equation was found for those with 15–18 years old.

Conclusion

Considering the cut-off points of TG (100 mg/dL), we observed the strongest correlation between Friedwald equation and direct assay and the weakest one was for Ahmadi formula in subjects with either greater or lower TG concentrations. Furthermore, we found that Anandraja equation had the most sensitivity (89.5%), while the most specificity was dedicated to the new formula (98.9%).
FTY720 ameliorates GvHD by blocking T lymphocyte migration to target organs and by skin fibrosis inhibition
Authors: Ryu Jaeyoon , Jhun Jooyeon , Park Min-Jung , Baek Jin-ah , Kim Se-Young , Cho Keun-Hyung , Choi Jeong-Won , Park Sung-Hwan , Choi Jong Young , Cho Mi-La
Published: June 2020

Background

Fibrosis is the formation of excess connective tissue in an organ or tissue during a reparative or reactive process. Graft-versus-host disease (GvHD) is a medical complication of allogeneic tissue transplantation with transplanted donor T cell-mediated inflammatory response; it is characterized by a severe immune response with fibrosis in the final stage of the inflammatory process. T helper 17 cells play a critical role in the pathogenesis of GvHD. Fingolimod (FTY720), an analogue of sphingosine-1-phosphate (S1P), is an effective immunosuppressive agent in experimental transplantation models.

Methods

In this study, we evaluated the effects of FTY720 as a treatment for an animal GvHD model with inflammation and fibrosis. The splenocytes, lymph nodes, blood, tissues from Syngeneic mice and GvHD-induced mice treated vehicle or FTY720 were compared using flow cytometry, hematological analyses, histologic analyses.

Results

FTY720 reduced clinical scores based on the following five clinical parameters: weight loss, posture, activity, fur texture, and skin integrity. FACS data showed that T lymphocyte numbers increased in mesenteric lymph nodes and decreased in splenocytes of FTY720-treated mice. Tissue analysis showed that FTY720 reduced skin, intestinal inflammation, and fibrotic markers. FTY720 dramatically decreased α-smooth muscle actin, connective tissue growth factor, and fibronectin protein levels in keloid skin fibroblasts.

Conclusions

Thus, FTY720 suppressed migration of pathogenic T cells to target organs, reducing inflammation. FTY720 also inhibited fibrogenesis marker expression in vitro and in vivo. Together, these results suggest that FTY720 prevents GvHD progression via immunosuppression of TH17 and simultaneously acts an anti-fibrotic agent.
Kynurenine pathway modulation reverses the experimental autoimmune encephalomyelitis mouse disease progression
Authors: Sundaram Gayathri , Lim Chai K. , Brew Bruce J. , Guillemin Gilles J.
Published: June 2020

Background

Multiple sclerosis (MS) is a chronic immune-mediated disorder of the central nervous system characterized by demyelination, neuroinflammation, and neurodegeneration. Activation of the kynurenine pathway (KP) results from acute and chronic neuroinflammation leading to both immune suppression and neurotoxicity. However, the exact effects of KP metabolites and changes in neurodegenerative diseases over time are not fully understood. Studies, including those in MS models, have reported that short-term KP activation is beneficial through immune tolerance. However, the effects of long-term KP activation are poorly understood. We hypothesized that such chronic activation is responsible for the neurodegeneration in MS, and further, modulating the KP in EAE-induced mice could significantly decrease the EAE disease severity.

Methods

We biochemically altered the KP at different stages of the disease in experimental allergic encephalomyelitis (EAE) mouse model of MS and at two different enzymatic levels of the KP (IDO-1 (indoleamine 2,3 dioxygenase)) and KMO (kynurenine monooxygenase). CNS tissue and blood samples were analyzed longitudinally using GCMS, HPLC, IHC, and RT-PCR.

Results

We showed that the KP was steadily upregulated correlating with disease severity and associated with a shift towards increasing concentrations of the KP metabolite quinolinic acid, a neuro- and gliotoxin. KP modulation by inhibition of IDO-1 with 1-methyl tryptophan (1-MT) was dependent on the timing of treatment at various stages of EAE. IDO-1 inhibition at EAE score 2 led to significantly higher numbers of FoxP3 cells (p< 0.001) in the spleen than earlier IDO-1 inhibition (prophylactic 1-MT treatment group (p< 0.001)), 1-MT treatment after EAE induction (EAE score 0;p< 0.001), and 1-MT treatment at EAE score of 1 (p< 0.05). Significant improvement of disease severity was observed in EAE mice treated with 1-MT at EAE score 2 compared to the untreated group (p< 0.05). KP modulation by KMO inhibition with Ro 61-8048 led to significantly greater numbers of Foxp3 cells (p< 0.05) in Ro 61-8048 treated mice and even more significant amelioration of EAE disease compared to the 1-MT treatment groups.

Conclusions

These results provide a new mechanistic link between neuroinflammation and neurodegeneration and point to KP modulation at the KMO level to preserve immune tolerance and limit neurodegeneration in EAE. They provide the foundation for new clinical trials for MS.
Rottlerin, a natural polyphenol compound, inhibits upregulation of matrix metalloproteinase-9 and brain astrocytic migration by reducing PKC-δ-dependent ROS signal
Authors: Lee Tsong-Hai , Chen Jiun-Liang , Liu Pei-Shan , Tsai Ming-Ming , Wang Su-Jane , Hsieh Hsi-Lung
Published: June 2020

Background

Upregulation of matrix metalloproteinase-9 (MMP-9) has been indicated as one of the inflammatory biomarkers. In the central nervous system (CNS), the MMP-9 is induced by several proinflammatory mediators and participates in the CNS disorders, including inflammation and neurodegeneration. In addition, protein kinase Cs (PKCs) has been shown to be involved in regulation of various inflammatory factors like MMP-9 by several stimuli in many cell types. Several phytochemicals are believed to reduce the risk of several inflammatory disorders including the CNS diseases. The rottlerin, a principal phenolic compound of the Kamala plant Mallotus philippinensis, has been shown to possess an array of medicinal properties, including anti-PKC-δ, antitumor, anti-oxidative, and anti-inflammatory activities.

Methods

Herein, we used rat brain astrocytes (RBA) to demonstrate the signaling mechanisms of phorbol 12-myristate 13-acetate (PMA)-induced MMP-9 expression by zymographic, RT-PCR, subcellular isolation, Western blot, ROS detection, and promoter reporter analyses. Then, we evaluate the effects of rottlerin on PMA-induced MMP-9 expression in RBA and its influencing mechanism.

Results

We first demonstrated that PMA stimulated activation of various types of PKC, including PKC-δ in RBA. Subsequently, PMA induced MMP-9 expression via PKCδ-mediated reactive oxygen species (ROS) generation, extracellular signal-regulated kinase 1/2 (ERK1/2) activation, and then induced c-Fos/AP-1 signaling pathway. Finally, upregulation of MMP-9 by PMA via the pathway may promote astrocytic migration, and the event could be attenuated by rottlerin.

Conclusions

These data indicated that rottlerin may have anti-inflammatory activity by reducing these related pathways of PKC-δ-dependent ROS-mediated MMP-9 expression in brain astrocytes.
Exercise training alone or in combination with high-protein diet in patients with late onset Pompe disease: results of a cross over study
Authors: Sechi Annalisa , Zuccarelli Lucrezia , Grassi Bruno , Frangiamore Rita , De Amicis Ramona , Marzorati Mauro , Porcelli Simone , Tullio Annarita , Bacco Anna , Bertoli Simona , Dardis Andrea , Biasutti Lea , Pasanisi Maria Barbara , Devigili Grazia , Bembi Bruno
Published: June 2020

Background

Late onset Pompe disease (LOPD) is a lysosomal neuromuscular disorder which can progressively impair the patients’ exercise tolerance, motor and respiratory functions, and quality of life. The available enzyme replacement therapy (ERT) does not completely counteract disease progression. We investigated the effect of exercise training alone, or associated with a high-protein diet, on the exercise tolerance, muscle and pulmonary functions, and quality of life of LOPD patients on long term ERT.

Methods

The patients were asked to participate to a crossover randomized study comprehending a control period (free diet, no exercise) followed by 2 intervention periods: exercise or exercise + diet, each lasting 26 weeks and separated by 13 weeks washout periods. Exercise training included moderate-intensity aerobic exercise on a cycle ergometer, stretching and balance exercises, strength training. The diet was composed by 25–30% protein, 30–35% carbohydrate and 35–40% fat. Before and after each period patients were assessed for: exercise tolerance test on a cycle-ergometer, serum muscle enzymes, pulmonary function tests and SF36 questionnaire for quality of life. Compliance was evaluated by training and dietary diaries. Patients were contacted weekly by researchers to optimize adherence to treatments.

Results

Thirteen LOPD patients, median age 49 ± 11 years, under chronic ERT (median 6.0 ± 4.0 years) were recruited. Peak aerobic power (peak pulmonary O2 uptake) decreased after control, whereas it increased after exercise, and more markedlyafter exercise + diet. Serum levels of lactate dehydrogenase (LDH) significantly decreased after exercise + diet; both creatine kinase (CK) and LDH levels were significantly reduced after exercise + diet compared to exercise. Pulmonary function showed no changes after control and exercise, whereas a significant improvement of forced expiratory volume in 1 sec (FEV1) was observed after exercise + diet. SF36 showed a slight improvement in the “mental component” scale after exercise, and a significant improvement in “general health” and “vitality” after exercise + diet. The compliance to prescriptions was higher than 70% for both diet and exercise.

Conclusions

Exercise tolerance (as evaluated by peak aerobic power) showed a tendency to decrease in LOPD patients on long term ERT. Exercise training, particularly if combined with high-protein diet, could reverse this decrease and result in an improvement, which was accompanied by improved quality of life. The association of the two lifestyle interventions resulted also in a reduction of muscle enzyme levels and improved pulmonary function.
Thyroid cancer among patients with thyroid nodules in Yemen: a three-year retrospective study in a tertiary center and a specialty clinic
Authors: Al-Sharafi Butheinah A. , AlSanabani Jamila A. , Alboany Ibraheem M. , Shamsher Amani M.
Published: June 2020

Background

The prevalence of thyroid cancer is increasing worldwide. No previous data are available on the prevalence of thyroid cancer in Yemen. We performed this study to determine the prevalence of thyroid cancer among patients with thyroid nodules in Yemen.

Methods

A retrospective chart review was performed for 550 patients with thyroid nodules who underwent fine needle aspiration and/or thyroid surgery at a private endocrine clinic and at an endocrine clinic in a tertiary hospital in Yemen over a 3 -year period from October 2016–2019. The prevalence of thyroid cancer; the sonographic findings, Bethesda classification, age, sex, thyroid stimulating hormone (TSH) levels of the patients; and the nodule size and number were reviewed.

Results

A total of 550 charts were reviewed [501 females (91.1%) and 49 males (8.9%)]. The thyroid cancer prevalence among the patients was 13.8% (CI = 10.9–16.7), and the mean age of the patients was 38.5 years (SD = 12.2). The TSH level and the rate of cancer were significantly related (P = 0.01), but no significant difference in the prevalence of thyroid cancer was found between females (13.4%) and males (18.4%) (P = 0.334). When correlating the rate of cancer with the ultrasound guided fine needle aspiration (UG-FNA) result, those with Bethesda system category III and IV, V and VI had malignancy rates of 20.8, 27.2, 52.4 and 69.2%, respectively. Thyroid nodules highly suspicious for malignancy on ultrasound had a 70% cancer diagnosis rate. The most common thyroid cancer was papillary cancer (71%), followed by follicular cancer (23.7%). Among those undergoing surgery, 44.2% had thyroid cancer, and 5.2% had a premalignant diagnosis.

Conclusion

Thyroid cancer has a higher prevalence in Yemen than in other middle eastern countries. Our study also reports a higher rate of follicular thyroid cancer than that in other published data, which has to be confirmed by further studies. The malignancy and premalignant diagnosis rate was ~ 50% in our patients who underwent surgery. Many centers in Yemen still do not perform FNA before thyroid surgery. It is important that other centers in the country start emphasizing the need for FNA before surgery. This will decrease the number of unnecessary surgeries and associated complications.
A randomized, open-label, Phase III study of obinutuzumab or rituximab plus CHOP in patients with previously untreated diffuse large B-Cell lymphoma: final analysis of GOYA
Authors: Sehn Laurie H. , Martelli Maurizio , Trněný Marek , Liu Wenxin , Bolen Christopher R. , Knapp Andrea , Sahin Deniz , Sellam Gila , Vitolo Umberto
Published: June 2020

Background

Rituximab (R) plus cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) is the current standard therapy for diffuse large B cell lymphoma (DLBCL). Obinutuzumab (G), a glycoengineered, type II anti-CD20 monoclonal antibody, has shown activity and an acceptable safety profile when combined with CHOP (G-CHOP) in patients with advanced DLBCL. We present the final analysis results of the Phase III GOYA study (NCT01287741), which compared the efficacy and safety of G-CHOP versus R-CHOP in patients with previously untreated DLBCL.

Methods

Patients aged ≥ 18 years with previously untreated advanced DLBCL were randomly assigned to receive eight 21-day cycles of R or G, plus six or eight cycles of CHOP. The primary endpoint was investigator-assessed progression-free survival (PFS). Secondary endpoints included overall survival, other time-to-event endpoints, and safety; investigator-assessed PFS by cell of origin subgroup was an exploratory endpoint.

Results

A total of 1418 patients were randomized, with 1414 included in this final analysis (G-CHOP, N = 704; R-CHOP, N = 710). Five-year PFS rates were 63.8% and 62.6% for G-CHOP and R-CHOP, respectively (stratified hazard ratio 0.94, 95% CI 0.78–1.12; p = 0.48). The results of the secondary efficacy endpoints did not show a benefit of G-CHOP over R-CHOP. In the exploratory analysis, a trend towards benefit with G-CHOP over R-CHOP was apparent in the patients with germinal center B cell DLBCL. The safety profile of G-CHOP was as expected, and no new safety signals were observed. More grade 3–5 (75.1% vs 65.8%), serious (44.4% vs 38.4%), and fatal (6.1% vs 4.4%) adverse events (AEs) were observed in the G-CHOP arm compared with the R-CHOP arm, respectively, with the most common fatal AEs being infections. A higher incidence of late-onset neutropenia occurred in the G-CHOP arm (8.7%) versus the R-CHOP arm (4.9%).

Conclusions

The final analysis, similar to the primary analysis, did not show a PFS benefit of G-CHOP over R-CHOP in previously untreated patients with DLBCL. The results of the secondary endpoints were consistent with the primary endpoint. Further exploratory analyses and investigation of biomarkers are ongoing.
Adherence to National Comprehensive Cancer Network Guidelines for BRCA testing among high risk breast Cancer patients: a retrospective chart review study
Authors: Bobbili Priyanka , Olufade Temitope , DerSarkissian Maral , Shenolikar Rahul , Yu Hong , Duh Mei Sheng , Tung Nadine
Published: June 2020

Background

Testing for BRCA variants can impact treatment decisions for breast cancer patients and affect surveillance and prevention strategies for both patients and their relatives. National Comprehensive Cancer Network (NCCN) guidelines recommend testing for patients at heightened risk of BRCA pathogenic variant. We examined the BRCA testing rate among high risk breast cancer patients treated in community oncology practices.

Methods

We conducted a retrospective medical chart review among community-based US oncologists using a physician panel approach. High risk breast cancer patients with a known family history of cancer and diagnosis with breast cancer at age ≥ 18 years between January 2013–October 2017 were included. We assessed the proportions of patients tested for BRCA variants in accordance with NCCN guidelines.

Results

Charts from 63 physicians, averaging 16 years of practice, were included; 97% were medical oncologists and 66.7% had a genetic counselor in their practice. We analyzed data for 410 randomly-selected patients with mean age of 52 years; 95% were female, 74% were White, and 19% had Ashkenazi Jewish ancestry. Among all patients, 94% were tested for BRCA variants. The testing rate ranged from 78 to 100% in various high risk groups; lower rates were observed among Black patients (91%), men (92%), and patients meeting NCCN criteria based on family history of male breast cancer (78%) and prostate cancer (87%). We observed a higher testing rate in patients treated by physicians with a genetic counselor in their practice (95% versus 91%).

Conclusions

Adherence to NCCN BRCA testing guidelines is high in this group of predominantly medical oncologists with extensive experience, with a high proportion having a genetic counselor in practice. Testing rates can be improved in patients with risk factors related to male relatives. High level of compliance to guidelines in a community setting is possible with a delivery model for genetic counseling and testing.
ECMO use in COVID-19: lessons from past respiratory virus outbreaks—a narrative review
Authors: Cho Hwa Jin , Heinsar Silver , Jeong In Seok , Shekar Kiran , Li Bassi Gianluigi , Jung Jae Seung , Suen Jacky Y. , Fraser John F.
Published: June 2020

The spread of coronavirus disease 2019 (COVID-19) continues to grow exponentially in most countries, posing an unprecedented burden on the healthcare sector and the world economy. Previous respiratory virus outbreaks, such as severe acute respiratory syndrome (SARS), pandemic H1N1 and Middle East respiratory syndrome (MERS), have provided significant insights into preparation and provision of intensive care support including extracorporeal membrane oxygenation (ECMO). Many patients have already been supported with ECMO during the current COVID-19 pandemic, and it is likely that many more may receive ECMO support, although, at this point, the role of ECMO in COVID-19-related cardiopulmonary failure is unclear. Here, we review the experience with the use of ECMO in the past respiratory virus outbreaks and discuss potential role for ECMO in COVID-19.
The effectiveness of peer and community health worker-led self-management support programs for improving diabetes health-related outcomes in adults in low- and-middle-income countries: a systematic review
Authors: Werfalli Mahmoud , Raubenheimer Peter J. , Engel Mark , Musekiwa Alfred , Bobrow Kirsten , Peer Nasheeta , Hoegfeldt Cecilia , Kalula Sebastiana , Kengne Andre Pascal , Levitt Naomi S.
Published: June 2020

Objective

Community-based peer and community health worker-led diabetes self-management programs (COMP-DSMP) can benefit diabetes care, but the supporting evidence has been inadequately assessed. This systematic review explores the nature of COMP-DSMP in low- and middle-income countries’ (LMIC) primary care settings and evaluates implementation strategies and diabetes-related health outcomes.

Methods

We searched the Cochrane Library, PubMed-MEDLINE, SCOPUS, CINAHL PsycINFO Database, International Clinical Trials Registry Platform, Clinicaltrials.gov, Pan African Clinical Trials Registry (PACTR), and HINARI (Health InterNetwork Access to Research Initiative) for studies that evaluated a COMP-DSMP in adults with either type 1 or type 2 diabetes in World Bank-defined LMIC from January 2000 to December 2019. Randomised and non-randomised controlled trials with at least 3 months follow-up and reporting on a behavioural, a primary psychological, and/or a clinical outcome were included. Implementation strategies were analysed using the standardised implementation framework by Proctor et al. Heterogeneity in study designs, outcomes, the scale of measurements, and measurement times precluded meta-analysis; thus, a narrative description of studies is provided.

Results

Of the 702 records identified, eleven studies with 6090 participants were included. COMP-DSMPs were inconsistently associated with improvements in clinical, behavioural, and psychological outcomes. Many of the included studies were evaluated as being of low quality, most had a substantial risk of bias, and there was a significant heterogeneity of the intervention characteristics (for example, peer definition, selection, recruitment, training and type, dose, and duration of delivered intervention), such that generalisation was not possible.

Conclusions

The level of evidence of this systematic review was considered low according to the GRADE criteria. The existing evidence however does show some improvements in outcomes. We recommend ongoing, but well-designed studies using a framework such as the MRC framework for the development and evaluation of complex interventions to inform the evidence base on the contribution of COMP-DSMP in LMIC.
A possible case of sporadic aurora observed at Rio de Janeiro
Authors: Oliveira Denny M. , Hayakawa Hisashi , Bhaskar Ankush , Zesta Eftyhia , Vichare Geeta
Published: June 2020

Being footprints of major magnetic storms and hence major solar eruptions, mid- to low-latitude aurorae have been one of the pathways to understand solar–terrestrial environments. However, it has been reported that aurorae are also occasionally observed at low latitudes under low or even quiet magnetic conditions. Such phenomena are known as “sporadic aurorae”. We report on a historical event observed by a scientist of the Brazilian Empire in Rio de Janeiro on 15 February 1875. We analyze this event on the basis of its spectroscopic observations, along with its visual structure and coloration, to suggest this event was a possible case of sporadic aurorae. Given the absence of worldwide aurora observations on that day as a consequence of low magnetic activity recorded on the days preceding the observation, in addition to a detailed description, the event observed can most likely be classified as a sporadic aurora. We discuss the geographic and magnetic conditions of that event. Thus, we add a possible case of sporadic aurora in the South American sector.
A pilot open-label feasibility trial examining an adjunctive mindfulness intervention for adolescents with obesity
Authors: Cotter Elizabeth W. , Hornack Sarah E. , Fotang Jenny P. , Pettit Elizabeth , Mirza Nazrat M.
Published: June 2020

Background

Obesity in adolescence is predictive of obesity in adulthood and risk for chronic disease. Traditional behavioral approaches to addressing obesity in adolescence rarely yield meaningful changes in body mass index (BMI), suggesting that adjunctive treatments are necessary. Herein, we describe a study examining whether it is feasible to integrate a brief mindfulness intervention with the usual recommended care for adolescent obesity in a pediatric weight management clinic.

Methods

We conducted a single arm open-label trial with 11 adolescent patients with obesity. Participants received the recommended standard of medical management of obesity (usual care) plus a six-week mindfulness intervention. To assess our primary aim of feasibility, we examined recruitment, retention, and satisfaction rates. Participants also completed measures of mindfulness, emotion regulation, disordered eating, quality of life, and executive functioning, and had their BMI and blood pressure measured.

Results

We recruited 11 adolescents to participate in the intervention, with 8 (73%) completing the entire program. Attendance rates (85%) and satisfaction rates (100%) were promising for a larger trial. While preliminary analyses of changes in health outcomes should be examined with caution, effect sizes ranged from small to large with some promising trends in eating behaviors.

Discussion

It might be feasible to augment existing behavioral interventions for adolescents with obesity with brief mindfulness; however, some adaptations are needed to enhance recruitment and retention. The lessons learned in this feasibility study can inform an adequately powered efficacy trial.

Trial registration

This research is registered on ClinicalTrials.gov (NCT03874377).
The impact of active research involvement of young children in the design of a new stereotest
Authors: Casanova Therese , Black Carla , Rafiq Sheima , Hugill-Jones Jessica , Read Jenny C. A. , Vancleef Kathleen
Published: June 2020

Background

Although considered important, the direct involvement of young children in research design is scarce and to our knowledge its impact has never been measured. We aim to demonstrate impact of young children’s involvement in improving the understanding of a new 3D eye test or stereotest.

Methods

After a pre-measure of understanding was taken, we explored issues with the test instructions in patient and public involvement (PPI) sessions where children acted as advisers in the test design. Feedback was collected via observations, rating scales and verbal comments. An interdisciplinary panel reviewed the feedback, discussed potential changes to the test design, and decided on the implementation. Subsequently, a post-measure of understanding (Study 1–2) and engagement (Study 3) was collected in a pre-post study design. Six hundred fifty children (2–11.8 years old) took part in the pre-measure, 111 children (1–12 years old) in the subsequent PPI sessions, and 52 children (4–6 years old) in the first post-measure. One hundred twenty-two children (1–12 years old) and unrelated adults took then part in a second series of PPI sessions, and 53 people (2–39 years old) in the final post-measure. Adults were involved to obtain verbal descriptions of the target that could be used to explain the task to children.

Results

Following feedback in Study 1, we added a frame cue and included a shuffle animation. This increased the percentage of correct practice trials from 76 to 97% (t (231) = 14.29, p < .001), but more encouragements like ‘Keep going!’ were needed (t (64) = 8.25, p < .001). After adding a cardboard demo in Study 2, the percentage of correct trials remained stable but the number of additional instructions given decreased (t (103) = 3.72, p < .001) as did the number of encouragements (t (103) = 8.32, p < .001). Therefore, changes in test design following children’s feedback significantly improved task understanding.

Conclusions

Our study demonstrates measurable impact of involvement of very young children in research design through accessible activities. The changes implemented following their feedback significantly improved the understanding of our test. Our approach can inform researchers on how to involve young children in research design and can contribute to developing guidelines for involvement of young children in research.
Anesthetic management of laparoscopy-assisted total proctocolectomy in a cardiac sarcoidosis patient with a cardiac resynchronization therapy-defibrillator: a case report
Authors: Kammura Yutaro , Fujita Ai , Karashima Yuji , Nakayama Shoko , Shirozu Kazuhiro , Kandabashi Tadashi , Yamaura Ken
Published: June 2020

Background

Cardiac sarcoidosis (CS) causes severe conduction abnormalities and arrhythmias. CS patients are increasingly being treated with cardiac resynchronization therapy-defibrillators (CRT-Ds). For the first time, we report the anesthetic management of a CS patient with a CRT-D.

Case presentation

A 65-year-old male with an implanted CRT-D due to CS was scheduled for a laparoscopy-assisted total proctocolectomy for his transverse colon cancer. His left ventricular ejection fraction was 32.0%, and his physical status was a New York Heart Association class III. General and epidural anesthesia were performed while using standard monitors and a FloTracTMsystem. The dual-chamber pacing (DDD) modality of the CRT-D was unchanged, and its defibrillation function was deactivated before surgery. The surgery was successfully performed, and the patient was discharged without worsening of his cardiac condition.

Conclusions

A detailed understanding of this patient’s condition, as well as sarcoidosis, helped to facilitate successful anesthetic management of this patient.
Mineral Intake and Clinical Symptoms in Adult Patients with Hypophosphatasia
Authors: Kuehn Katinka , Hahn Andreas , Seefried Lothar
Published: June 2020

Background

Hypophosphatasia (HPP) is a rare inherited metabolic disorder characterized by deficient activity of the tissue-nonspecific alkaline phosphatase entailing impaired turnover of phosphorus metabolites. Dietary mineral intake is suspected to influence clinical symptoms of HPP, but scientific evidence is missing.

Methods

Cross-sectional matched-pairs study collecting comprehensive data on nutrient intake in 20 HPP patients and 20 unaffected, age- and gender-matched controls. Dietary information and clinical symptoms were documented in detail over 7 consecutive days using structured diaries.

Results

Baseline data and type of energy-supplying nutrients were balanced between both groups. Median nutritional intake of phosphorus and calcium were significantly lower in HPP patients versus controls, which is partially attributable to lower energy consumption in HPP patients. Differences regarding phosphorus and calcium (Ca/P) ratio and uptake of magnesium, zinc, and vitamin B6 were not statistically significant. Both high (≥ 1375 mg/d) and low intakes (< 1100 mg/d) of phosphorus were significantly associated with an increased frequency of neuropsychiatric symptoms (P = 0.02). Similarly, very high and very low intake of calcium was significantly associated with musculoskeletal (P < 0.01), gastrointestinal (P = 0.02), and neuropsychiatric (P < 0.001) symptoms. An increased Ca/P ratio was associated with increased tiredness/fatigue (P < 0.01), whereas a decreased Ca/P was associated with gastrointestinal issues (P = 0.01).

Conclusion

Phosphorus and calcium intake seem reduced in HPP patients along with reduced total energy consumption. Particularly high as well as very low absolute or unbalanced phosphorus and calcium intake are associated with an increased frequency of clinical symptoms.
From Finance to Bodies
Authors: Cavallero Lucía
Published: June 2020

Since the organization of the first international feminist strikes, Argentina’s feminist movement has used the method of the assembly to produce analyses of the relationship and interconnection between sexist violence and economic violence. As part of that political process, in May 2017, the feminist movement convened a mobilization, with the slogan “We Want Ourselves Alive, Free, and Debt Free” in the doorways of the Central Bank to denounce the process of massive indebtedness of domestic economies that occurred in parallel to the taking out of debt by the state. From that moment on, a form of fighting back against financialization and the invasion of finance into increasingly more areas of the reproduction of life emerged. Today the feminist movement is questioning access to rights through debt in the struggle against the end of social security extensions (which provided important benefits to housewives and other informally employed women) and in the processes of compulsory urbanization in the peripheries of Buenos Aires. This article seeks to account for the fabric of this political process and its innovative forms of weaving together resistance against the government of finance.
Making Reasonable Adjustment to Enable and Support People With Intellectual Disability Engage in Objective Health Measures in a Research Study—The Health Fair in the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing
Authors: Burke Éilish A. , Walsh J. Bernard , McCallion Philip , McCarron Mary
Published: June 2020

This observational cross-sectional study presents methods employed in designing and undertaking a suite of eight health assessments, purposely named The Health Fair, as part of Wave 2 (2014) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA) study. Overall, 604 persons of all levels of intellectual disability, aged 40 years and above and in different living circumstances, participated. The Health Fair process was mobile and overcame barriers such as communication challenges or access that people with intellectual disability face. This protocol could support researchers and practitioners in clinical practice to guide and improve the health assessment of people with intellectual disability to facilitate a better understanding of their health pathways and improve health care delivery and services.
The Usefulness of Offering 24/7 Online Support Within a Wider Mix of Professional Services for People With Intellectual and Developmental Disabilities Living Independently: A Qualitative, Multiple Case Study
Authors: Zaagsma Miriam , Volkers Karin M. , Koning Mark H. M. , van Hove Geert , Schippers Alice P.
Published: June 2020

Service organizations for people with intellectual and developmental disabilities (IDD) increasingly use telecare applications to improve their services. This study explored the usefulness of offering the 24/7 online support service DigiContact within a broader mix of professional services for people with IDD living independently. We employed a qualitative multiple case study, in which the cases of nine online support users were reconstructed through semistructured interviews with both support users and their case workers. Thematic analysis showed that online support was used as an addition to regular onsite support to enable a more tailor-made delivery of professional supports. Online support can be valuable for its users by increasing the accessibility of professional support and creating opportunities for more self-direction in support.
At Last—Empirical Proof That the “R-Word” Really Must Go: The Influence of Terminology on Tolerance
Authors: Garcia Gayle L. , Granello Darcy H. , Boehm Karly D.
Published: June 2020

College undergraduate students (N = 259), were given a measure of tolerance toward people with intellectual disability. Half of the sample was given a version that used the term mentally retarded, and half was given a version that used person with intellectual disability. Individuals receiving the version with mentally retarded had lower levels of tolerance on all four subscales of the instrument. They scored significantly higher on the subscales of Exclusion and Sheltering and significantly lower on the subscales of Empowerment and Similarities than their peers who received the version using the term person with intellectual disability.
Efficient all-optical router and beam splitter for light with orbital angular momentum
Authors: Qiu T. H. , Li H. , Xie M. , Liu Q. , Ma H. Y. , Xu R.
Published: June 2020

We propose an efficient scheme for realizing all-optical router or beam splitter (BS) by employing a double tripod-type atomic system, where the ground levels are coupled by two additional intensity-dependent weak microwave fields. We show that the high-dimensional probe field encoded in a degree of freedom of orbital angular momentum can be stored, retrieved, and manipulated. Due to the constructive or destructive interference between the introduced microwave fields and the atomic spin coherence, the generated stationary light pulses and the retrieved probe fields can be increased or decreased with high efficiency and fidelity in a controllable manner. On the basis of the results and a general extension, a tunable all-optical router or BS, which can split a high-dimensional probe field into two or more ones, can be achieved by actively operating the controlling fields and the microwave fields. The current scheme, integrating multiple functions and showing excellent performance, could greatly enhance the tunability and capacity for the all-optical information processing.
Transparent ultrawideband absorber based on simple patterned resistive metasurface with three resonant modes
Authors: Min Pingping , Song Zicheng , Yang Lei , Dai Bing , Zhu Jiaqi
Published: June 2020

A transparent low-profile polarization-insensitive metamaterial absorber with ultrawideband microwave absorption is presented. A fractional bandwidth of 125.2% (4.3–18.7 GHz, absorptance > 90%) is achieved using a simple patterned resistive metasurface. The thickness of the absorber is only ∼0.086 times the upper-cutoff wavelength. The experimental results agree with full-wave simulation results. A Cu-metal-mesh ground plane enhances the shielding efficiency and visible transparency. Radar cross-sections (RCS) are reduced across all reflection angles, over frequencies spanning the C, X, and Ku bands. With its visible-wavelength transparency, low profile, polarization insensitivity, excellent absorption, and wideband RCS reduction, the proposed absorber has wide applicability.
Dressing Disney's children in the twenty-first century
Authors: Harvey Kate
Published: June 2020

This article is concerned with the clothing and costuming of children in the Disney Princess transmedial universe. This extends to the fictional children who grow into their 'princesshood' within the film, as well as the nonfictional children who are the implied audience both for the films and for their associated merchandise. Since Disney acquired Pixar in 2006 and John Lasseter was made creative director of both companies, there has been an increased focus on childhood in Disney's output, and this is particularly notable in the 'princess' films produced under Lasseter: The Princess and the Frog (), Tangled (), Brave (), Frozen () and Moana (). This article first explores the films' use of costume simultaneously to establish the childness of the characters and visually foreshadow the 'princesses' they will become. It then turns to the implied child audience of these films, considering the Disney Princess line of merchandise and the role of clothing and costume within it.
“Arte em defesa da vida”
Authors: Paula Cacia Regia de , Pelazza Bruno Bordin , Paranaíba Juliana Flávia Ferreira e Silva , Silva Juliana Freitas , Mendonca Guilherme Silva
Published: June 2020

Este relato de experiência versa sobre o projeto de extensão e cultura, intitulado “Arte em Defesa da Vida”, desenvolvido com alunos de escolas municipais e de um colégio estadual de ensino fundamental  I e II de um município do sudoeste goiano. O objetivo foi promover a saúde na escola e na comunidade em geral, permitindo disseminar conhecimentos sobre o Aedes aegypti e as doenças ocasionadas por esse vetor. Participaram 30 escolas públicas e conveniadas com o ensino público, com 2.576 alunos, com média de 12 anos de idade, nas duas edições. Constituiu-se em dois concursos de cartazes, realizado em duas edições: 2014 e 2016. Para o desenvolvimento dos cartazes, a comunidade escolar participou de rodas de conversa sobre o Aedes aegypti e as doenças transmitidas por ele, elucidando as causas, transmissão, sintomas, prevenção, formas de combate ao vetor. Premiações foram utilizadas como forma de incentivo aos alunos a participarem do concurso. A experiência contribuiu para o avanço do ensino e conscientização socioambiental dos alunos.