bluuebunny/crossref_metadata_2025 huggingface dataset:
Manual acupuncture relieves microglia-mediated neuroinflammation in a rat model of traumatic brain injury by inhibiting the RhoA/ROCK2 pathway
Authors: Zhu Ming-min , Lin Ji-huan , Qing Peng , Pu Liu , Chen Shu-lian , Lin Shu-jun , Li Cheng-lu , Cao Lu-xi , Zhang Yi-min
Published: April 2020

Objective:

To investigate the regulatory mechanism of manual acupuncture (MA) on microglial polarization–mediated neuroinflammation after traumatic brain injury (TBI), focusing on the RhoA/Rho-associated coiled coil-forming protein kinase (ROCK2) pathway.

Methods:

Sprague Dawley (SD) rats were used to generate a TBI model using Feeney’s freefall epidural impact method. MA was performed on half of the TBI model rats, while the others remained untreated. Acupuncture was administered at GV15, GV16, GV20, GV26, and LI4. At the end of the intervention, rat brain tissue samples were collected, and the microglial M1 polarization status was observed by immunofluorescence labeling of CD86, an M1 microglia-specific protein. RhoA/ROCK2 signaling components were detected by quantitative real-time polymerase chain reaction (qRT-PCR) and Western blotting. An enzyme-linked immunosorbent assay (ELISA) was used to detect the expression levels of inflammatory factors.

Results:

Compared with normal rats, the CD86 expression density in the untreated TBI model rats was high and showed an aggregated expression pattern. The genes and proteins of the RhoA/ROCK2 signaling pathway were highly expressed, and inflammatory factors were significantly increased. The CD86 expression density in TBI rats after MA was reduced compared to that in untreated TBI rats and showed a scattered distribution. The expression of RhoA/ROCK2 signaling pathway genes and proteins was also significantly reduced, and inflammatory factors were decreased.

Conclusion:

These results show that MA may inhibit M1 polarization of microglia by regulating the RhoA/ROCK2 signaling pathway, thereby reducing neuroinflammation in TBI.
Development of a mismatch amplification mutation assay to correctly serotype isolates of Streptococcus suis serotypes 1, 2, 1/2, and 14
Authors: Lacouture Sonia , Okura Masatoshi , Takamatsu Daisuke , Corsaut Lorelei , Gottschalk Marcelo
Published: April 2020

Streptococcus suis is one of the most important bacterial swine pathogens worldwide and is an emerging pathogen in humans. There are 29 serotypes, and serotyping, which is based on the antigenicity of the capsular polysaccharide (CPS) or on its coding genes, is often part of routine identification and provides further information regarding S. suis virulence and zoonotic potential. Serotypes 2 and 14 possess high zoonotic potential, and serotype 1/2 is the serotype most frequently isolated from diseased pigs in North America. PCR has replaced antibody-based techniques to perform serotyping. However, traditional PCR is not able to differentiate serotype 2 from 1/2 and serotype 1 from 14, given that the only difference in the cps loci of those serotype pairs is a nonsynonymous single-nucleotide polymorphism. We developed a mismatch amplification mutation assay (MAMA)-PCR that was able to correctly serotype 148 isolates previously known to be serotypes 1, 2, 1/2, or 14. This technique will be highly useful in animal and human health laboratories performing PCR serotyping of S. suis isolates.
Access to Home and Community Health Services for Older Adults With Serious, Life-Limiting Illness: A Study Protocol
Authors: Hill Jacob D. , Cuthel Allison M. , Grudzen Corita R.
Published: April 2020

Objectives:

The objective of this study is to identify contextual access factors to home and community health services for end-of-life support for older adults with serious life-limiting illness, as well as determine if access to home and community services is associated with health-care utilization.

Design:

This study includes an environmental scan, grey literature review, qualitative interviews, and health-care utilization analysis. This study is a subproject of the Grudzen et al. Primary Palliative Care for Emergency Medicine (PRIM-ER) study.

Settings/Location:

Analysis will include data collection from 17 health systems implementing the PRIM-ER intervention.

Participants:

For the qualitative interviews, one emergency medicine (EM) physician and one EM nurse will be interviewed from each of the 17 participating health systems. For the health-care utilization analysis, we will use the Senior Care Services Scale (SCSS), American Hospital Association Annual Survey of Hospitals (AHA-ASH), and Medicare claims for all emergency department (ED) visits for serious illness who present at each participating health system.

Outcome Measures:

The contextual analysis will obtain data on home and community services, such as hospice, home health services, assisted living, integrative medicine services, etc., available around each health system’s highest volume ED, federal and state regulations influencing access to services, as well as EM provider perspectives on access to services. The health-care utilization analysis will determine if SCSS scores, which measure service availability, are associated with health-care usage. High or low SCSS scores are determined by comparing health system service availability on the AHA-ASH to the national median SCSS value.
Patient Decision Making Related to Maternal and Childhood Vaccines: Exploring the Role of Trust in Providers Through a Relational Theory of Power Approach
Authors: Limaye Rupali J. , Malik Fauzia , Frew Paula M. , Randall Laura A. , Ellingson Mallory K. , O’Leary Sean T. , Bednarczyk Robert A. , Oloko Oladeji , Salmon Daniel A. , Omer Saad B.
Published: April 2020

Immunization is one of the most effective ways to prevent infectious diseases. However, vaccination rates are suboptimal in the United States. Obstetric providers are critical in influencing vaccine decision making among pregnant women, as trust between a patient and provider may facilitate willingness to accept vaccination. Little is known about how power between a patient and provider affects vaccine acceptance. This study explored pregnant women’s trust in obstetric providers within the context of vaccines. Using concepts from the relational theory of power, we conducted 40 in-depth interviews with a purposive sample of pregnant women from four Ob-Gyn practices each in Georgia and Colorado. Results suggest that to enhance trust, providers could gain distributive power by conveying empathy. Designated power through medical experience was associated with both trust and distrust, as some women trusted their providers because of their authority and medical credentials, while others viewed authority and experience as reasons to distrust their provider. To increase acceptance, providers should acknowledge the underlying power dynamics within these interpersonal relationships and strengthen rapport with patients through empathy and dialogue.
Error Correction of Restrictive Measures: Appeals Made by Young People in Care
Authors: Kalliomaa-Puha Laura , Pösö Tarja , Toivonen Virve-Maria
Published: April 2020

The article examines appeals against restrictive measures in child protection submitted to and decided upon by administrative courts in Finland. Restrictive measures used in care restrict children’s and young people’s fundamental and human rights considerably, meaning ‘confinement in fractions’. Therefore, young people’s access to justice is an important issue in situations in which they consider an error to have been made. We study appeals as a form of legal safety and as a means of error correction.

Although young people, 12 years of age and older, have the right to appeal, the appeal system is mainly used by parents to appeal against restriction of contact. As such, the appeal system poorly protects young people’s individual access to justice, if at all. As only administrative courts can overturn the decision to apply restrictive measures, the adult-centeredness of the system and young people’s access to justice should be critically assessed and rethought.
Could mobile phone text messages be used for infant feeding education in Ethiopia? A formative qualitative study
Authors: Gebremariam Kidane Tadesse , Zelenko Oksana , Hadush Znabu , Mulugeta Afework , Gallegos Danielle
Published: April 2020

A majority of the world’s population now live in areas with a mobile telephone network. This expansion of the network enables people to use more mobile phone functionalities such as short message service, multimedia, and the Internet. Mobile phone–based health (mHealth) interventions have been considered to have benefits in low-income countries. The aim of this study was to explore the feasibility of a short message service for breastfeeding education in Ethiopia. Four focus groups—two with mothers and two with fathers—were conducted with a total of 41 participants. The focus group discussion recordings were transcribed in Tigrigna verbatim, and then translated to English. The data were analyzed using thematic analysis, underpinned by the technology acceptance model. The following four general themes emerged from the focus group discussions: (1) Mobile phones: integrated into everyday life; (2) SMS text messaging: anytime, anywhere, as long as there is a sound; (3) Marketing versus utility: a barrier to SMS; and (4) Scientific messages from credible experts are key to reading SMS-based messages. Parents in Ethiopia showed interest in receiving weekly infant feeding-related short messages. Short message service–based interventions could therefore be an option for improving knowledge and awareness of parents regarding infant feeding.
The aesthetics of reality media
Authors: Engberg Maria , Bolter Jay David
Published: April 2020

In this article, the authors examine the aesthetics of immersion in two emerging media forms: 360° video and 3D VR. Their goal is to move beyond addressing technical affordances, to consider the techniques and choices that producers of 360° video and 3D VR are making to exploit these affordances, and what resulting effects those viewing experiences have. They discuss the tension between transparency and reflectivity in two contrasting examples, in particular: the Danish company Makropol’s Anthropia (2017) and Arora and Unseld’s The Day the World Changed (2018). The authors argue that technical affordances are part of a complex process of mediation that includes both experimentation with the technology at hand and a reliance on earlier media forms. It is critical, they argue, to understand the creative tension between established forms and new ones that underscore new aesthetic and narrative experiences in VR and 360° formats.
Whole world within reach: Google Earth VR
Authors: Belisle Brooke
Published: April 2020

Google Earth VR (GEVR), released in 2017, claims to put the whole world within reach using virtual reality (VR). Relying on sensors that track a user’s position and gestures in actual space, GEVR suggests that users can experience its virtual Earth in the same way that they experience the real one: as a world they actively embody rather than a representation they examine from the outside. While GEVR conjures a dematerialized world, it also interrogates how what counts as a material world may always be suspended between embodied, technical, and aesthetic mediations. If ‘the whole world’ – which exceeds individual perception – can only be conceived through aesthetic logics, what do the particular aesthetics of GEVR tell us about the way our world is imaged and imagined today? What are the implications of the way it stages ‘worlding’ as a provisional, dimensional coordination? What does the disorienting experience it offers suggest about contemporary entanglements of perception and representation, body and world, the individual here-and-now and a global everywhere-at-once?
Public Office as a Stepping-Stone? Investigating the Careers of Ministerial Advisors
Authors: Askim Jostein , Karlsen Rune , Kolltveit Kristoffer
Published: April 2020

Ministerial advisors have become an essential aspect of executive branches worldwide, thus making the ministerial advisor office a potential route for young politicians aspiring to an expanding political class. The article studies which professions ministerial advisors migrate to following their ministerial careers, how ministerial advisors’ post-ministerial careers compare to their pre-ministerial careers, and if the variance in careers can be explained by the resources that ministerial advisors obtain while in government. Empirically, the article draws on a cohort of 139 ministerial advisors in Norwegian governments between 2001 and 2009; it covers positions in the political sphere and the public, private and voluntary occupational sectors over a period from each ministerial advisor’s youth to the end of 2017. The bibliographic data are combined with surveys and elite interviews. The results show that more than expanding the political class as a recruitment ground for future Members of the Parliament and ministers, ministerial advisor appointments serve as stepping-stones to careers outside of politics. Most ministerial advisors experience shifts between occupational sectors and upwards to higher positions. However, ministerial advisors’ attractiveness in the labour market is surprisingly unaffected by what they actually did in office; rather, it rests on resources such as insider knowledge and networks.
The Neglect of Left-Behind Children in China: A Meta-Analysis
Authors: Wen Yu-Jie , Hou Wen-Peng , Zheng Wei , Zhao Xi-Xi , Wang Xue-Qi , Bo Qi-Jing , Pao Christine , Tang Yi-Lang , Tan Tony , Li Xian-Bin , Wang Chuan-Yue
Published: April 2020

Objective:

To evaluate the neglect of left-behind children (LBC) in China.

Method:

Participants: Children separated from one or both parents for at least 6 months. Intervention: Trauma of separation. Comparison: Non-left-behind children (NLBC). Outcomes: Neglect rates and severity. Only case–control studies were included.

Results:

Thirteen studies were included; there were 18,688 LBC in a large sample ( N = 42,003) of children aged 0–18 years in China. The overall neglect rate was significantly higher in LBC compared to NLBC (odds ratio [ OR] = 1.58, 95% confidence interval [CI] = [1.50, 1.67], p < .01) based on the Chinese Rural Child Neglected Evaluation Model (CRCNEM) and the Parents–Child Conflict Tactics Scales ( OR = 1.44, 95% CI [1.35, 1.54], p < .01). The overall neglect severity in LBC was also significantly higher than NLBC ( SMD = 0.31, 95% CI [0.28, 0.33], p < .01). The same trends were observed in sex subgroups. With regard to subtypes, LBC were significantly more likely to have emotional neglect ( OR = 2.29, 95% CI [1.88, 2.78], p < .01), medical neglect ( OR = 1.79, 95% CI [1.62, 1.98], p < .01), physical neglect ( OR = 1.75, 95% CI [1.60, 1.91], p < .01), security neglect ( OR = 1.52, 95% CI [1.32, 1.75], p < .01), educational neglect ( OR = 1.50, 95% CI [1.31, 1.72], p < .01), and social neglect ( OR = 1.33, 95% CI [1.18, 1.51], p < .01). Furthermore, LBC had significantly higher severity in medical neglect ( SMD = 0.31, 95% CI [0.27, 0.35], p < .01), emotional neglect ( SMD = 0.28, 95% CI [0.24, 0.32], p < .01), physical neglect ( SMD = 0.24, 95% CI [0.18, 0.29], p < .01), security neglect ( SMD = 0.26, 95% CI [0.23, 0.29], p < .01), educational neglect ( SMD = 0.25, 95% CI [0.20, 0.31], p < .01), and social neglect ( SMD = 0.25, 95% CI [0.10, 0.40], p < .01).

Conclusion:

The neglect rates and severity in LBC in China were both significantly higher than those in NLBC. There was a strong association between neglect and LBC. Public policy changes are urgently needed to improve the dire situation and the well-being of the LBC.
The Value of Localizing Subclinical Seizures
Authors: King-Stephens David
Published: April 2020

[Box: see text]
East Austin Oaks: The Limits of Participatory Planning in the Space Age
Authors: Wilson Barbara Brown
Published: April 2020

In the fall of 1968, just after the passage of the Fair Housing Act and before astronauts would first orbit the moon, President Johnson launched a housing design competition meant to apply space-age technology to solve the housing crisis. The competition was judged not only by the performance of ten model homes in which a racially integrated community of first-time homebuyers would live but also via a larger participatory design study to identify cultural obstacles to racial integration. East Austin Oaks did not solve the housing crisis, but it did produce a humble cul-de-sac where several original homeowners still live.
Micro-scale numerical study of fiber/matrix debonding in steel fiber composites
Authors: Sabuncuoglu Baris , Lomov Stepan V
Published: April 2020

Fiber/matrix debonding behavior of steel fiber composites is analyzed using a parametric finite element modeling procedure and compared with conventional composites with carbon and glass fibers. Cohesive surfaces are applied to fiber–matrix interface to simulate the debonding behavior, while the interface strength properties of steel fiber are obtained with and without surface treatment. The effect of various parameters on the debonding behavior is investigated, including stress concentrations, fiber diameter, fiber shape, and fiber volume fraction, using the parametric model. The influence of stress concentrations is determined to be much lower than the debonding strength. Debonding damage is more evident in larger fibers compared to smaller ones. Earlier and sudden interface separation is observed with the polygonal steel fibers compared to the circular ones. Increase in the fiber volume ratio increases the debonding opening distance but does not affect the opening angle significantly. The results can be useful for assessing possibilities to use steel fibers to increase toughness of the composites in comparison with glass and carbon reinforcement.
Cellular Toxicity Study of Silicon Nanowires
Authors: Song Ziyan , Wu Fenglei , Zheng Yitong , Xu Xintang , Tang Qiang , Bian Baoxiang
Published: April 2020

The objective of this study was to achieve the practical bioapplications of silicon nanowires (SiNWs). In this study, the tumor and normal cell lines were used as models to systematically investigate the cytotoxicity of SiNWs synthesized by HF-assisted etching methods. Morphology observation, Cell Counting Kit 8, real-time polymerase chain reaction, and flow cytometry analysis were used to elucidate the cytotoxicity of SiNWs. The results showed that the cytotoxicity of SiNWs is greatly dependent on cell lines, SiNWs concentration, and incubation time. Particularly, SiNWs show better biocompatibility with tumor cell lines (eg, human epithelial cervical cancer [Hela] cells and human hepatocellular liver carcinoma [HepG2] cells) than normal cell lines (eg, human normal liver [HL-7702] cells and human embryonic kidney [HEK293T] cells). The reasons may be that SiNWs could tightly attach to the cell membrane in the cell medium, which obviously affects cell adhesion and inhibits their cell viability, especially for normal cell lines. From systematical analysis and comparison, we obtain the concentration limits of SiNWs, which may advance SiNWs applications and its toxicological study in vitro.
Teduglutide for the treatment of adults with intestinal failure associated with short bowel syndrome: pooled safety data from four clinical trials
Authors: Pape Ulrich-Frank , Iyer Kishore R. , Jeppesen Palle B. , Kunecki Marek , Pironi Loris , Schneider Stéphane M. , Seidner Douglas L. , Lee Hak-Myung , Caminis John
Published: April 2020

Background:

In multiple clinical studies, teduglutide reduced parenteral support (PS) with a consistent safety profile in adults with short bowel syndrome–associated intestinal failure (SBS–IF). The objective of this study was to assess adverse events (AEs) from a pooled data set.

Methods:

Safety data from four prospective clinical trials of teduglutide in patients with SBS–IF were assimilated. AEs were evaluated in patient groups based on treatment received in each study and in populations stratified to create distinct subgroups based on aetiology, bowel anatomy and baseline PS volume requirements.

Results:

Safety data are reported for up to 2.5 years, totalling 222 person-years exposure to teduglutide. In most patients, AEs were reported as mild or moderate in severity in all patient groups and occurred at comparable rates between patients who received teduglutide or placebo. Several common gastrointestinal AEs, including abdominal pain, nausea and abdominal distension, were reported more frequently earlier in the course of treatment, with their frequency declining over time. Fewer gastrointestinal AEs were reported in patients with vascular causes of SBS–IF and patients with most of their colon-in-continuity than in other patient subgroups. Across the patient stratification subgroups, the predominant treatment-emergent AEs for which patients receiving teduglutide had a significantly increased relative risk were abdominal distension and gastrointestinal stoma complication compared with patients receiving placebo.

Conclusions:

Teduglutide had a safety profile consistent with prior adult data and no new safety concerns were identified. The most frequently reported AEs were gastrointestinal in origin, consistent with the underlying disease condition and intestinotrophic actions of teduglutide.

Clinical Trial Registry information:

NCT00081458/EudraCT, 2004-000438-35; NCT00798967/EudraCT, 2008-006193-15; NCT00172185/EudraCT, 2004-000439-27; NCT00930644/EudraCT, 2009-011679-65
Migration: A European Question in Need of Urgent Answers
Authors: Koumoutsakos Giorgos
Published: April 2020

Migration is a major issue, not only for Europe but for the whole world, and it will remain so for years to come. It is a phenomenon caused by a number of factors and one that is beyond the capacities of a single state to tackle. Rather it requires solidarity and joint efforts to handle it. This article focuses on the migration/refugee issue in Europe, particularly from the perspective of Greece. It provides an overview of the efforts of Greece and the EU to address the challenge of irregular migration and the flow of refugees in the Eastern Mediterranean.
Stereoselective Synthesis of 1,6,9-Tri-oxaspiro[4.5]decanes From d-Glucose: Novel Structural Motifs of Spiroacetal Natural Products
Authors: Cuny Eckehard
Published: April 2020

Spiroacetals are the central structural core element of numerous natural products and are essential for their biological activity. A typical structural representative of a spiroacetal is the bicyclic 1,6-dioxaspiro[4.5]decane ring system. It represents the complete or partial structure of many biologically potent natural products such as the Paravespula pheromone 1, the antibiotic (+)-monensin A 2, the anticancer agent (−)-berkelic acid 3, the antimitotic ingredient spirastrellolide F, characterized after methylation as (+)-methyl ester 4, and the marine toxin (−)-calyculin A 5. In these compounds, the 1,6-dioxaspiro[4.5]decane ring system is found in either spiro ( R)-6 or ( S) - 6 configuration. The corresponding 1,6,9-trioxaspiro[4.5]decane framework ( S)-7 and ( R)-7 with opposite chirality at the spiro center due to an additional oxygen atom at position 9 in the pyran portion has so far not been found in living organisms or been synthesized. To close this gap and enable structure–activity relationship studies, potentially leading to novel antibiotics and selective anticancer agents, we have developed an efficient and stereocontrolled route to the ( R)- and ( S)-configurated 1,6,9-trioxaspiro[4.5]decane ring system leading to oxa analog motifs of the above natural products.
Extension Evaluation of Marine Ecological Carrying Capacity: An Empirical Study Based on the Development of Tropical Marine Island Free Trade Ports in Developing Countries
Authors: Luo Xiaochun , Wang Zilong , Yang Liguo , Lu Lin
Published: April 2020

Today, the global economy presents a leaping economic network centered on coastal areas. Relying on the ocean has become a very important economic development path for many countries and regions. To coordinate and solve the contradiction between the economic development of Hainan Island and the protection of marine ecological environment, this study, based on the matter-element extension evaluation model, examines the marine ecology of Hainan Island considering the construction of a free trade port. This study uses the extension set theory to describe the advantages of the intermediate state and dynamic trend of the transformation of the assessment object to a certain level, to improve the assessment accuracy of marine ecological carrying capacity. The results show that the marine ecological carrying capacity of Hainan Island in 2016 to 2018 is relatively stable, at the transformation grade of N3, indicating that the marine ecology of Hainan Island is in a medium bearing, sub health state. Focusing on protecting marine ecology, developing a modern service industry, and developing high-tech industry can be effective in improving the ecological carrying capacity of Hainan Island.
octanate®: over 20 years of clinical experience in overcoming challenges in haemophilia A treatment
Authors: Klukowska Anna , Komrska Vladimír , Vdovin Vladimír , Zozulya Nadezhda , Lissitchkov Toshko , Oldenburg Johannes , Ettingshausen Carmen Escuriola
Published: April 2020

Treatment of haemophilia A with FVIII replacement has evolved over the past decades to adapt to the needs of patients. octanate®, a plasma-derived, double virus-inactivated, von Willebrand factor (VWF)-containing FVIII concentrate, has been used in clinics worldwide for over 20 years. First licensed in 1998 in Germany, octanate® is approved in over 80 countries for the prevention and treatment of bleeding and for surgical prophylaxis in patients with haemophilia A, and in over 40 countries for immune tolerance induction (ITI). The manufacturing process for octanate® was developed to ensure high viral safety and effectively eliminates both enveloped and nonenveloped viruses. Over the past 20 years, the excellent safety and efficacy of octanate® have been demonstrated in pivotal clinical trials in adult and paediatric previously treated patients (PTPs) for on-demand treatment, prophylaxis and as surgical cover. Importantly, octanate® has displayed low immunogenicity in previously untreated patients (PUPs), with only 9.8% of PUPs developing FVIII inhibitors. octanate® has also shown to be highly effective in inhibitor elimination when used as ITI therapy. In a population of patients with high risk of ITI failure, success was achieved in 79.2% of patients (70.8% complete success), even when using exceptionally stringent success criteria. No relapses were observed. Here we present an overview of the clinical data with octanate® that support its use in a range of patient populations and clinical indications.
Low Hanging Fruit: How Sports Talk Radio Hosts Discuss Racism
Authors: Spearman Lequez
Published: April 2020

Talk radio has grown exponentially in the United States. The growth in talk radio was ignited by the Telecommunications Act of 1996, which allowed station owners to purchase more stations without antitrust scrutiny. One of the most popular formats on the radio is sports talk radio. Sports talk radio provides a unique entry point to understand how callers and hosts discuss racism in sport. The purpose of this study is to advance our understanding of race on the radio by examining how sports talk radio hosts discuss racism. The researcher interviewed 15 sports talk radio hosts over the phone to better understand how they discuss racism on the airwaves. After reviewing the transcripts and going through several rounds of data analysis, three themes were discovered: We can smell it, race is not always about race, and Black/White binary.
Urban–rural and socioeconomic status: Impact on multimorbidity prevalence in hospitalized patients
Authors: Robertson Lynn , Ayansina Dolapo , Johnston Marjorie , Marks Angharad , Black Corri
Published: April 2020

Objective:

The aim of this study was to describe multimorbidity prevalence in hospitalized adults, by urban–rural area of residence and socioeconomic status (SES).

Methods:

Linked hospital episode data were used. Adults (≥18 years) admitted to hospital as an inpatient during 2014 in Grampian, Scotland, were included. Conditions were identified from admissions during the 5 years prior to the first admission in 2014. Multimorbidity was defined as ≥2 conditions and measured using Tonelli et al. based on International Classification of Diseases-10 coding (preselected list of 30 conditions). We used proportions and 95% confidence intervals (CIs) to summarize the prevalence of multimorbidity by age group, sex, urban–rural category and deprivation. The association between multimorbidity and patient characteristics was assessed using the χ 2 test.

Results:

Forty one thousand five hundred and forty-five patients were included (median age 62, 52.6% female). Overall, 27.4% (95% CI 27.0, 27.8) of patients were multimorbid. Multimorbidity prevalence was 28.8% (95% CI 28.1, 29.5) in large urban versus 22.0% (95% CI 20.9, 23.3) in remote rural areas and 28.7% (95% CI 27.2, 30.3) in the most deprived versus 26.0% (95% CI 25.2, 26.9) in the least deprived areas. This effect was consistent in all age groups, but not statistically significant in the age group 18–29 years. Multimorbidity increased with age but was similar for males and females.

Conclusion:

Given the scarcity of research into the effect of urban–rural area and SES on multimorbidity prevalence among hospitalized patients, these findings should inform future research into new models of care, including the consideration of urban–rural area and SES.
High-Volume and Privately Owned Ambulatory Surgical Centers Reduce Costs in Achilles Tendon Repair
Authors: Li Lambert T. , Chuck Carlin , Bokshan Steven L. , O’Donnell Ryan , Hsu Raymond Y. , Blankenhorn Brad D. , Owens Brett D.
Published: April 2020

Background:

While Achilles tendon repairs are common, little data exist characterizing the cost drivers of this surgery.

Purpose:

To examine cases of primary Achilles tendon repair, primary repair with graft, and secondary repair to find patient characteristics and surgical variables that significantly drive costs.

Study Design:

Economic and decision analysis; Level of evidence, 3.

Methods:

A total of 5955 repairs from 6 states were pulled from the 2014 State Ambulatory Surgery and Services Database under the Current Procedural Terminology codes 27650, 27652, and 27654. Cases were analyzed under univariate analysis to select the key variables driving cost. Variables deemed close to significance ( P < .10) were then examined under generalized linear models (GLMs) and evaluated for statistical significance ( P < .05).

Results:

The average cost was $14,951 for primary repair, $23,861 for primary repair with graft, and $20,115 for secondary repair ( P < .001). In the GLMs, high-volume ambulatory surgical centers (ASCs) showed a cost savings of $16,987 and $2854 in both the primary with graft and secondary repair groups, respectively (both P < .001). However, for primary repairs, high-volume ASCs had $2264 more in costs than low-volume ASCs ( P < .001). In addition, privately owned ASCs showed cost savings compared with hospital-owned ASCs for both primary Achilles repair ($2450; P < .001) and primary repair with graft ($11,072; P = .019). Time in the operating room was also a significant cost, with each minute adding $36 of cost in primary repair and $31 in secondary repair (both P < .001).

Conclusion:

Private ASCs are associated with lower costs for patients undergoing primary Achilles repair, both with and without a graft. Patients undergoing the more complex secondary and primary with graft Achilles repairs had lower costs in facilities with greater caseload.
Impact of Telephone Follow-Up on Patient Satisfaction in a Pediatric Neurosurgery Clinic
Authors: Blanco Erica , Samuels Shenae , Kimball Rebekah , Patel Daxa , Citty Sandra , Spader Heather
Published: April 2020

Patient satisfaction is a key metric used to measure quality in health care. However, patient satisfaction measures in the pediatric population are less studied and understood than in the adult population. The purpose of this study was to evaluate the impact of telephone follow-up on patient satisfaction in an outpatient pediatric neurosurgery clinic. A standardized telephone follow-up call was performed within 1 week of a child’s clinic visit. Pearson’s χ2 or Fisher’s exact tests were used to assess changes in patient satisfaction measures after implementation of the telephone follow-up call initiative. The proportion of overall “top-box” physician rating significantly increased from 85.5% in 2017 to 95.6% in 2018 ( P = .04). There was also a nonsignificant upward trend in the proportion of respondents noting that they would recommend this provider, as well as in all measures of physician communication quality and office staff quality. A simple telephone call to new patients after an outpatient pediatric neurosurgery clinic visit resulted in statistically significant and clinically meaningful changes in patient satisfaction scores.
Effect of shape-memory alloy NiTi fiber on microstructure and mechanical properties of continuous ceramic Al2O3 fiber-reinforced Ti/Al3Ti metal–intermetallic laminated composite
Authors: Han Yuqiang , Zhu Junyi , Yan Haoran , Lin Chunfa , Zhao Zhilei , Pan Xuecong , Wang Siyu
Published: April 2020

Shape-memory alloy titanium nickel (NiTi) fiber was introduced into continuous ceramic aluminum oxide (Al2O3) fiber-reinforced titanium–titanium trialuminide metal–intermetallic laminated (CSMAFR-MIL) composite using vacuum hot pressing (HP) sintering method to improve the microstructure and mechanical properties of the composite. Scanning electron microscopy, energy-dispersive spectroscopy, and X-ray diffraction techniques were employed to characterize the microstructure of the novel CSMAFR-MIL composite. Besides, the tensile tests were carried out on continuous Al2O3 fiber-reinforced Ti-Al metal–intermetallic laminated (CFR-MIL) composite and the CSMAFR-MIL composite to explore the influence of NiTi fiber additive on mechanical behavior of the CFR-MIL composite. The experimental results showed that the intermetallic layer including Al3Ti, Al3Ti0.8V0.2, Al3Ni intermetallics but without residual NiTi fiber was generated via the reactions of liquid Al with NiTi fiber and Ti foil during preparation. Moreover, owing to the addition of NiTi fiber, intermetallic centerline was prevented effectively to form in the CSMAFR-MIL composite. Moreover, the elemental diffusion occurred between the Al2O3 fiber and the intermetallic, revealing that the metallurgical bonding was formed during the fabrication process. Furthermore, the CSMAFR-MIL composite possessed higher strength and superior ductility than those of CFR-MIL composite attributed to the microstructure optimization.
Correction to: The impact of driving homogeneity due to automation and cooperation of vehicles on uphill freeway sections
Authors: Makridis Michail , Leclercq Ludovic , Mattas Konstantinos , Ciuffo Biagio
Published: April 2020

In the original publication of this article [1], the whole Abstract section is revised as below. This is an error caused during the production stage.
DeSignate: detecting signature characters in gene sequence alignments for taxon diagnoses
Authors: Hütter Thomas , Ganser Maximilian H , Kocher Manuel , Halkic Merima , Agatha Sabine , Augsten Nikolaus
Published: April 2020

Background

Molecular characters have been added in integrative taxonomic approaches in recent years. Nevertheless, taxon diagnoses are still widely restricted to morphological characters. The inclusion of molecular characters into taxon diagnoses is not only hampered by problems, such as their definition and the designation of their positions in a reference alignment, but also by the technical effort.

Results

DeSignate is a tool for character-based taxon diagnoses that includes a novel ranking scheme. It detects and classifies individual and combined signature characters (diagnostic molecular characters) based on so-called character state vectors. An intuitive web application guides the user through the analysis process and provides the results at a glance. Further, formal definitions and a uniform terminology of characters are introduced.

Conclusions

DeSignate facilitates the inclusion of diagnostic molecular characters and their positions to complement taxon diagnoses. Compared to previous solutions, the tool simplifies the workflow and improves reproducibility and traceability of the results. The tool is freely available as a web application at (https://designate.dbresearch.uni-salzburg.at/) and is open source (https://github.com/DatabaseGroup/DeSignate/).
Genetic dissection of heat-responsive physiological traits to improve adaptation and increase yield potential in soft winter wheat
Authors: Pradhan Sumit , Babar Md Ali , Bai Guihua , Khan Jahangir , Shahi Dipendra , Avci Muhsin , Guo Jia , McBreen Jordan , Asseng Senthold , Gezan Salvador , Baik Byung-Kee , Blount Ann , Harrison Stephen , Sapkota Suraj , St. Amand Paul , Kunwar Sanju
Published: April 2020

Background

Climate change, including higher temperatures (HT) has a detrimental impact on wheat productivity and modeling studies predict more frequent heat waves in the future. Wheat growth can be impaired by high daytime and nighttime temperature at any developmental stage, especially during the grain filling stage. Leaf chlorophyll content, leaf greenness, cell membrane thermostability, and canopy temperature have been proposed as candidate traits to improve crop adaptation and yield potential of wheat under HT. Nonetheless, a significant gap exists in knowledge of genetic backgrounds associated with these physiological traits. Identifying genetic loci associated with these traits can facilitate physiological breeding for increased yield potential under high temperature stress condition in wheat.

Results

We conducted genome-wide association study (GWAS) on a 236 elite soft wheat association mapping panel using 27,466 high quality single nucleotide polymorphism markers. The panel was phenotyped for three years in two locations where heat shock was common. GWAS identified 500 significant marker-trait associations (MTAs) (p ≤ 9.99 × 10− 4). Ten MTAs with pleiotropic effects detected on chromosomes 1D, 2B, 3A, 3B, 6A, 7B, and 7D are potentially important targets for selection. Five MTAs associated with physiological traits had pleiotropic effects on grain yield and yield-related traits. Seventy-five MTAs were consistently expressed over several environments indicating stability and more than half of these stable MTAs were found in genes encoding different types of proteins associated with heat stress.

Conclusions

We identified 500 significant MTAs in soft winter wheat under HT stress. We found several stable loci across environments and pleiotropic markers controlling physiological and agronomic traits. After further validation, these MTAs can be used in marker-assisted selection and breeding to develop varieties with high stability for grain yield under high temperature.
MYB transcription factor PdMYB118 directly interacts with bHLH transcription factor PdTT8 to regulate wound-induced anthocyanin biosynthesis in poplar
Authors: Wang Haihai , Wang Xiaoqing , Yu Chunyan , Wang Cuiting , Jin Yanli , Zhang Hongxia
Published: April 2020

Background

R2R3-MYB transcription factors (TFs) play important roles in plant growth and development, and response to biotic and abiotic stresses. However, their regulatory mechanisms in wound-induced anthocyanin biosynthesis in woody plants are largely unknown.

Results

In this work, we report that expression of anthocyanin biosynthesis genes (ABGs) were activated by PdMYB118, a MYB TF encoding gene from Populus deltoids, and the activation of PdMYB118 was significantly enhanced by PdTT8, a bHLH protein, through its direct interaction with PdMYB118. PdMYB118 and some ABGs were evidently induced by wound induction and methyl jasmonate (MeJA) treatment. Overexpression of PdMYB118 promoted anthocyanin accumulation in transgenic poplar upon wound induction. Furthermore, a poplar JASMONATE ZIM-domain (JAZ) protein, PtrJAZ1, repressed the transcriptional function of PdMYB118/PdTT8 complex by binding to PdTT8, and wound stimulated the biosynthesis of jasmonic acid (JA) and the degradation of PtrJAZ1.

Conclusions

Based on these observations, we proposed that PtrJAZ1 degradation triggered the expression of ABGs, leading to increased biosynthesis of anthocyanins in the wounded leaves of transgenic poplar. Therefore, our findings not only illustrate the crucial role of PdMYB118 in wound-induced anthocyanin biosynthesis in poplar, but also provide a molecular basis for the genetic engineering of colorful tree species.
Interscalene brachial plexus block for surgical repair of clavicle fracture: a matched case-controlled study
Authors: Olofsson Magnus , Taffé Patrick , Kirkham Kyle Robert , Vauclair Frédéric , Morin Bénédict , Albrecht Eric
Published: April 2020

Background

Innervation of the clavicle is complex and debated, with scarce data on the analgesic and clinical impact of regional anaesthesia after surgical repair of clavicle fracture.

Methods

In order to assess the analgesic efficiency of an interscalene brachial plexus block (ISB) for surgical repair of clavicle fracture, 50 consecutive patients scheduled for surgical fixation of middle/lateral clavicle fracture under general anaesthesia with ISB were prospectively enrolled. This cohort was compared to a historical control of 76 retrospective patients without regional block. The primary outcome was total intravenous morphine equivalent consumption at 2 postoperative hours. To assess the ISB impact, both an overall cohort analysis and a case-matched analysis with each ISB-treated patient matched to a Non-ISB-treated patient was performed. Matching employed a 1-to-1, nearest-neighbour approach using the Mahalanobis metric.

Results

In the overall cohort, patients with ISB had significantly lower i.v. morphine equivalent consumption at 2 postoperative hours (0.7 mg (95% CI 0.1 to 1.2) versus controls 8.8 mg (95% CI 7.1 to 10.4); P <  0.0001). These results persisted after case-matching the cohorts (mean difference for the primary outcome: 8.3 mg (95% CI 6.5 to 10.0); P <  0.001).

Conclusions

ISB provides effective analgesia after surgical fixation of middle and lateral clavicle fracture. These results should help physicians in establishing an analgesic strategy for this type of surgery. Further research is needed to identify the optimal regional technique for medial third clavicle fractures and the clinically relevant contributions of the cervical and brachial plexus.

Trial registration

Clinicaltrials.gov – NCT02565342, October 1st 2015.
Understanding the spatio-temporal dynamics of meningitis epidemics outside the belt: the case of the Democratic Republic of Congo (DRC)
Authors: Mazamay Serge , Bompangue Didier , Guégan Jean-François , Muyembe Jean-Jacques , Raoul Francis , Broutin Hélène
Published: April 2020

Background

Bacterial meningitis remains a major threat for the population of the meningitis belt. Between 2004 and 2009, in the countries of this belt, more than 200,000 people were infected with a 10% mortality rate. However, for almost 20 years, important meningitis epidemics are also reported outside this belt. Research is still very poorly developed in this part of the word like in the Democratic Republic of Congo (DRC), which experiences recurrent epidemics. This article describes for the first time the spatio-temporal patterns of meningitis cases and epidemics in DRC, in order to provide new insights for surveillance and control measures.

Methods

Based on weekly suspected cases of meningitis (2000–2012), we used time-series analyses to explore the spatio-temporal dynamics of the disease. We also used both geographic information systems and geostatistics to identify spatial clusters of cases. Both using conventional statistics and the Cleveland’s algorithm for decomposition into general trend, seasonal and residuals, we searched for the existence of seasonality.

Results

We observed a low rate of biological confirmation of cases (11%) using soluble antigens search, culture and PCR. The main strains found are Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis (A and C) serogroups. We identified 8 distinct spatial clusters, located in the northeastern and southeastern part of DRC, and in the capital city province, Kinshasa. A low seasonal trend was observed with higher incidence and attack rate of meningitis during the dry season, with a high heterogeneity in seasonal patterns occurring across the different districts and regions of DRC.

Conclusion

Despite challenges related to completeness of data reporting, meningitis dynamics shows weak seasonality in DRC. This tends to suggest that climatic, environmental factors might be less preponderant in shaping seasonal patterns in central Africa. The characterization of 8 distinct clusters of meningitis could be used for a better sentinel meningitis surveillance and optimization of vaccine strategy in DRC. Improving biological monitoring of suspected cases should be a priority for future eco-epidemiological studies to better understand the emergence and spread of meningitis pathogens, and the potential ecological, environmental drivers of this disease.