bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysing tree–neighbourhood interactions in ecotones of montane evergreen and deciduous forests in China
Authors: Wang Qinggang , Chi Xiulian , Tang Zhiyao , Jiang Mingxi
Published: February 2019

Questions

Do neighbourhood interactions in trees result in discernible spatial and phylogenetic signals among their nearest neighbours in a montane evergreen and deciduous forest? Are neighbourhood patterns of different species associated with their abundances and traits?

Location

Badagongshan National Nature Reserve, Hunan, China.

Methods

We used four nearest‐neighbour indices: average spatial distance to the nearest conspecific cohort‐mate (SNCC), average spatial distance to the nearest conspecific adult (SNCA), average phylogenetic distance to the nearest heterospecific cohort‐mate (PNHC), and average phylogenetic distance to the nearest heterospecific adult (PNHA). We focused on 77 abundant species in a 25‐ha plot. We evaluated whether the changes in SNCC, PNHC, SNCA and PNHA deviated significantly from expected values of spatially random mortality during two life stage transitions.

Results

For more than one‐fourth of the tested species, the changes in SNCC and PNHC deviated significantly from the expectations of random mortality. Nearly one‐third of the tested species showed greater SNCC at the juvenile stage than expected of random mortality, which may be mainly explained by conspecific tree competition for space and resources. Approximately 60% and 40% of the tested species showed significantly smaller SNCA and PNHA than expected by random mortality, respectively, which suggests the effects of facilitation and habitat filtering. In addition, abundant and taller species were suppressed by conspecific cohorts to a greater degree than locally rarer and shorter species. Deciduous species were more negatively influenced by conspecifics and closely related heterospecifics than evergreen species.

Conclusions

Our study focused on long‐term responses of individual species to their conspecific and phylogenetic neighbourhoods and revealed the associations between species traits and neighbourhood patterns. Such trait–neighbourhood interactions provide support for stabilizing mechanisms driving species coexistence in this species‐rich subtropical forest.
Possible records of space weathering on Vesta: Case study in a brecciated eucrite Northwest Africa 1109
Authors: Wang Shu‐Zhou , Zhang Ai‐Cheng , Pang Run‐Lian , Li Yang , Chen Jia‐Ni
Published: February 2019

Records of space weathering are important for understanding the formation and evolution of surface regolith on airless celestial bodies. Current understanding of space weathering processes on asteroids including asteroid‐4 Vesta, the source of the howardite–eucrite–diogenite (HED) meteorites, lags behind what is known for the Moon. In this study, we studied agglutinates, a vesicular glass‐coating lithic clast, and a fine‐grained sulfide replacement texture in the polymict breccia Northwest Africa (NWA) 1109 with electron microscopy. In agglutinates, nanophase grains of FeNi and FeS were observed, whereas npFe0 was absent. We suggested that the agglutinates in NWA 1109 formed from fine‐grained surface materials of Vesta during meteorite/micrometeorite bombardment. The fine‐grained sulfide replacement texture (troilite + hedenbergite + silica) should be a result of reaction between S‐rich vapors and pyroxferroite. The unique Fe/Mn values of relict pyroxferroite indicate a different source from normal HED pyroxenes, arguing that the reaction took place on or near the surface of Vesta. The fine‐grained sulfide replacement texture could be a product of nontypical space weathering on airless celestial bodies. We should pay attention to this texture in future returned samples by asteroid exploration missions.
Experts’ responses in script concordance tests: a response process validity investigation
Authors: Lineberry Matthew , Hornos Eduardo , Pleguezuelos Eduardo , Mella Jose , Brailovsky Carlos , Bordage Georges
Published: February 2019

Context

The script concordance test (SCT), designed to measure clinical reasoning in complex cases, has recently been the subject of several critical research studies. Amongst other issues, response process validity evidence remains lacking. We explored the response processes of experts on an SCT scoring panel to better understand their seemingly divergent beliefs about how new clinical data alter the suitability of proposed actions within simulated patient cases.

Methods

A total of 10 Argentine gastroenterologists who served as the expert panel on an existing SCT re‐answered 15 cases 9 months after their original panel participation. They then answered questions probing their reasoning and reactions to other experts’ perspectives.

Results

The experts sometimes noted they would not ordinarily consider the actions proposed for the cases at all (30/150 instances [20%]) or would collect additional data first (54/150 instances [36%]). Even when groups of experts agreed about how new clinical data in a case affected the suitability of a proposed action, there was often disagreement (118/133 instances [89%]) about the suitability of the proposed action before the new clinical data had been introduced. Experts reported confidence in their responses, but showed limited consistency with the responses they had given 9 months earlier (linear weighted kappa = 0.33). Qualitative analyses showed nuanced and complex reasons behind experts’ responses, revealing, for example, that experts often considered the unique affordances and constraints of their varying local practice environments when responding. Experts generally found other experts’ alternative responses moderately compelling (mean ± standard deviation 2.93 ± 0.80 on a 5‐point scale, where 3 = moderately compelling). Experts switched their own preferred responses after seeing others’ reasoning in 30 of 150 (20%) instances.

Conclusions

Expert response processes were not consistent with the classical interpretation and use of SCT scores. However, several fruitful and justifiable alternatives for the use of SCT‐like methods are proposed, such as to guide assessments for learning.
To be a Bosniak or to be a citizen? Bosnia and Herzegovina's 2013 census as an election
Authors: Cooley Laurence
Published: February 2019

Bosnia and Herzegovina's first post‐war population census, held in 2013, was accompanied by campaigns associated with each of the country's three main ethnic groups, which sought to maximise their share of the recorded population. These campaigns were challenged by a rival ‘civic’ campaign that instead stressed the right to freedom of self‐identification, however. This article compares the aims, methods and framings used by this civic campaign with those of the most prominent of the ‘ethnic’ campaigns – that of Bosniak ethnic entrepreneurs. It demonstrates that the two campaigns were each motivated by a combination of symbolic motives, centred on recognition and highlighting discrimination, and instrumental motives relating to the country's power‐sharing institutions. The limited success of the civic campaign in countering the messages of its rival ethnic campaigns demonstrates the difficulties that civic movements face in mobilising citizens in consociational democracies such as BiH.
Effects of heat shock and ambient temperature on female soldier production in a polyembryonic parasitic wasp
Authors: Takano Yumi , Ono Hitomi , Sakamoto Takuma , Yoshimura Jin , Iwabuchi Kikuo
Published: February 2019

Larval castes are well known in both sexes of polyembryonic parasitic wasps, in which sterile soldier larvae are clonally produced from a single egg and thousands of reproductive larvae develop into adults. The proportion of soldier larvae in Copidosoma floridanum is first determined genetically in both sexes but subsequently increases in females as a result of environmental disturbances, such as the presence of competitive parasitoids. Because temperature is the most influential environmental factor affecting ectotherms, we hypothesize that an increase in ambient temperature also affects the production of female soldier larvae. Conversely, we hypothesize that there would be no effect of temperature on the production of male soldier larvae. In the present study, we show that heat stress experienced by C. floridanum at an early stage in host development increases the number of female soldier larvae produced during the last instar stage of the host. We also show that rearing at extreme (high and low) temperatures induces an increase in the number of female soldiers produced. The effect of heat stress and ambient temperature on soldier production is found only in females, as is the response to heterospecific competitors. By contrast, no responses are detected in males for either heat stress or ambient temperature. The adaptive effect of these phenomena is not known, although the results of the present study imply the existence of a common physiological cascade that causes an increase in the number of soldier larvae in females.
A case of spheroid‐type localized lactoferrin amyloidosis in the bronchus
Authors: Ichimata Shojiro , Aoyagi Daiju , Yoshinaga Tsuneaki , Katoh Nagaaki , Kametani Fuyuki , Yazaki Masahide , Uehara Takeshi , Shiozawa Satoshi
Published: February 2019

We report a case of localized bronchial lactoferrin amyloidosis. A 47‐year‐old man presented with a complaint of persistent dry cough for two months. Chest computed‐tomography revealed a calcification shadow of the right main bronchus; hence, a biopsy was performed, showing layered spheroid‐type eosinophilic deposits in the bronchial wall. These deposits were positive for Congo red staining, exhibiting apple‐green birefringence under polarized light. In addition, an electron microscopic examination demonstrated that this layered structure was formed by very thin cord‐like amyloid deposits. By proteomics analysis using liquid chromatography–tandem mass spectrometry and immunohistochemistry, we confirmed that the deposited amyloid was composed of lactoferrin. While lactoferrin is known to be a precursor protein of localized corneal and seminal vesicle amyloidosis, localized lactoferrin amyloidosis of the bronchus has not been reported in the English literature. Our pathological findings suggested that localized lactoferrin amyloidosis may be caused by long‐term tissue damage, and the characteristic spheroid‐type appearance is thought to be associated with unique, thin cord‐like amyloid deposits.
How policies constrain native seed supply for restoration in Brazil
Authors: de Urzedo Danilo I. , Fisher Robert , Piña‐Rodrigues Fatima C. M. , Freire Juliana M. , Junqueira Rodrigo G. P.
Published: February 2019

Large‐scale ecological restoration programs across the world involve a voluminous demand for native seeds of diverse native plant species. In this article, we explore how institutional systems have operated and impacted native seed supply in Brazil. Native seed supply for restoration is essentially a community‐based activity which faces broad barriers to operating within regulations because of requirements for excessive and costly technical documentation, scarcity of seed laboratories, and lack of instructions for native seed quality testing. Although decentralized seed networks have stimulated arrangements for local organizations to promote seed supply, policies constrain the development of local capacities and the ongoing sustainability of these organizations. These conditions have resulted in a vast network of informal collectors and producers who are largely “invisible” and unknown to the regulatory authorities. Policies have decentralized responsibilities from the state without devolving decision‐making power to the multiple stakeholders engaged in policy elaboration. The policies maintain the centralized regulation of native seed supply. After examining Brazilian seed networks' experiences and conducting discussions with stakeholders and experts, we suggest adapting the current regulations to more local level contexts, encompassing the following strategies: (1) ensuring native seed origin and identity; (2) relaxation of the laboratory accreditation process for native seed quality assurance; (3) fostering seed markets for restoration; (4) research to provide technological innovation; (5) supporting local, diverse, and small seed‐based businesses.
Paediatric and adult bronchiectasis: Diagnosis, disease burden and prognosis
Authors: Quint Jennifer K. , Smith Maeve P.
Published: February 2019

Bronchiectasis is a chronic, debilitating disease with increasing worldwide prevalence and burden. Accurate and early diagnosis is essential for both its management and prognosis. This review will discuss the diagnosis of bronchiectasis, the international burden of the disease and its current prognosis.
Central limit theorems for functionals of large sample covariance matrix and mean vector in matrix‐variate location mixture of normal distributions
Authors: Bodnar Taras , Mazur Stepan , Parolya Nestor
Published: February 2019

In this paper, we consider the asymptotic distributions of functionals of the sample covariance matrix and the sample mean vector obtained under the assumption that the matrix of observations has a matrix‐variate location mixture of normal distributions. The central limit theorem is derived for the product of the sample covariance matrix and the sample mean vector. Moreover, we consider the product of the inverse sample covariance matrix and the mean vector for which the central limit theorem is established as well. All results are obtained under the large‐dimensional asymptotic regime, where the dimension p and the sample size n approach infinity such that p/n→c ∈ [0, + ∞) when the sample covariance matrix does not need to be invertible and p/n→c ∈ [0,1) otherwise.
Etching of fission tracks in monazite: An experimental study
Authors: Jones Sean , Gleadow Andy , Kohn Barry , Reddy Steven M.
Published: February 2019

This study reports a range of etching and annealing experiments to establish the optimum conditions for the etching of fission tracks in monazite. The previously reported concentrated (12 M) HCl etchant at 90°C was found to cause grain loss from epoxy mounts and high degrees of grain corrosion, as did much longer etching times at lower temperatures. Using implanted 252Cf semi‐tracks, a series of experiments were performed on internal prismatic faces of monazite‐(Ce) crystals from the Palaeozoic Harcourt Granodiorite (Victoria, Australia) using an alternative 6 M HCl etchant, also at 90°C. Step‐etch results show optimal etching at 60–90 min. Further, an isothermal annealing experiment illustrated that the degree of annealing that can be expected during etching at 90°C under laboratory time scales is negligible. The etching rate between grains is not uniform, with a correlation demonstrated between over‐etched grains and high U and Th concentrations.
Pulmonary functions in Egyptian children with transfusion‐dependent β‐thalassemia
Authors: Abd El Hakeem A. A. , Mousa S. M. O. , AbdelFattah M. T. , AbdelAziz A. O. , Abd El Azeim S. S.
Published: February 2019

Background

In β‐thalassemia, there are varying degrees of ineffective haematopoiesis, intermittent haemolysis and iron overload. Excess iron is deposited in organs such as the heart, the liver, the endocrine glands and the lungs.

Objectives

To evaluate the pulmonary functions in asymptomatic beta thalassemic children on regular transfusion therapy and their relation to iron overload.

Methods

The study included 50 transfusion‐dependent β‐thalassemic children and 50 apparently healthy children as control. All children had undergone pulmonary function tests (spirometry, lung volumes and diffusion capacities). In addition, test to determine the mean serum ferritin of the last 2 years and pre‐transfusion haemoglobin and chest radiograph and echocardiography were performed for the thalassemic children only.

Results

A total of 70% of the thalassemic children had diffusion impairment, whereas 34% of them had associated restrictive abnormality. Thalassemic children with serum ferritin >2500 ng mL−1 had significantly lower values of forced vital capacity (FVC), forced expiratory volume at one second (FEV1), peak expiratory flow (PEFR), total lung capacity (TLC) and diffusing capacity of carbon monoxide (DLCO) (P < 0·05). Only diffusion impairment had a significant positive correlation with serum ferritin level. Restrictive impairment had significant positive correlations with age, duration of blood transfusion and serum ferritin level and a significant negative correlation with duration of chelation (P < 0·05). Having a serum ferritin >2500 ng mL−1 was the only predicting factor for diffusion impairment and the strongest predicting factor for restrictive dysfunction.

Conclusion

Despite being asymptomatic, the majority of thalassemic children in this study suffered from diffusion impairment either alone or in combination with restrictive dysfunction. These pulmonary dysfunctions correlated significantly with body iron stores measured by serum ferritin.
How does import processing time impact export patterns?
Authors: Hayakawa Kazunobu , Laksanapanyakul Nuttawut , Yoshimi Taiyo
Published: February 2019

We examine how import processing time, which is one of the major obstacles in international trade, affects export patterns at the establishment level. Investigating the effect of suchtime costson export patterns reveals how smoothness or sluggishness in operations at one stage affects all stages in an international production network. We first discuss the effects of import processing time on exports, export shipment frequency and exports per shipment from a theoretical standpoint. We employ highly detailed customs data for Thailand from 2007 to 2011 to empirically investigate our theoretical predictions. Import processing time is measured using the difference between the dates on which import shipments arrive in ports and when they were released from the container yard. Results suggest that longer import processing times reduce total exports, particularly as a result of decreasing export frequency; this testifies to the importance of time costs in international trade. It is also revealed that negative effects of import processing time on exports per shipment appear in some specific instances, such as in the case of sea transportation. These results imply that the time spent in one stage has significant effects on both upstream and downstream stages in international production networks.
EFFECT OF MYOCARDIAL INFARCTION ON SPLEEN AND KIDNEY OF ISOPRENALINE-INDUCED MYOCARDIAL INJURY RAT MODEL
Authors: Shaukat Ali Shafreena , Rozalei Nur Hafiqah , Mohamed Siti Fatimah Azaharah , Wei Boon Yap , Zainalabidin Satirah
Published: February 2019

Myocardial infarction (MI)-associated inflammation is crucial for post-infarct healing. However, unregulated inflammation may lead to unnecessary systemic inflammation, and affect other organs. This study investigated the effects of MI on spleen and kidneys over early time-points (2 and 7 days) in isoprenaline-induced MI rat model. MI was evident by elevated levels of cardiac injury marker, troponin T, and lactate dehydrogenase (LDH). MI rats showed significant upregulation of myeloperoxidase (MPO) activity at day-2 post infarct while kidney MPO activity remained unaffected. Kidney function test revealed only slightly increased plasma urea at day-2 post MI with no changes in plasma creatine at both time-points. Histological observation on the spleen showed disorganization of spleen structure at day-2 post MI while the kidney structures were preserved at both time-points. In conclusion, although MI-associated damages in the spleen were seen at day-2 post infarct, it had no impact on the kidney structures at both time-points.
A Comparative Study of English and Chinese Proverbs Using Natural Semantic Metalanguage Approach
Authors: Wu Qiling
Published: February 2019

The current study investigates the similarities and differences between ‘equivalent’ proverbs in English and Chinese. It integrates natural semantic metalanguage (NSM) into a semantic and pragmatic analysis to explain differences in proverbs as cultural linguistic artifacts. In this study, NSM has enabled the cultural meanings behind the artifacts to be brought into stark contrast for careful qualitative discourse analysis. The findings of the study indicate that it is not only worthwhile but also practical to carefully examine English and Chinese proverb pairs, as their respective meanings may differ, offering unique insight into certain cultural factors. There is much potential for further research on linguistic cultural indicators such as proverbs, song lyrics, and idioms.
Analyzing occupational risks of pharmaceutical industry under uncertainty using a Bow-Tie analysis
Authors: Seker Sukran
Published: February 2019

Risk analysis is a systematic and widespread methodology to analyze and evaluate risks which are exposed in many working areas. One of the Quantitative Risk Analysis (QRA) methods for risk assessment is Bow-Tie analysis which combines features of fault-tree analysis and event-tree analysis to identify the top event; its causes and consequences (outcomes); and possible preventive and protective control measures or barriers. This study proposes an occupational risk assessment approach, which is known as Fuzzy Bow-Tie analysis, for pharmaceutical industry processes and work units. The aim is to evaluate critical risks and risky pharmaceutical work units and take safety precautions against accidents which caused by risky conditions. Thus, this methodology combines the concept of uncertainty which comes from different (Decision Maker) DM’s evaluations and the whole performance of the Bow-Tie analysis for hazard identification and risk assessment.  To apply and validate the proposed method, a case study is performed for pharmaceutical industry processes and work units. Based on the computed risk score, which is calculated by multiplying probability ranking and impact ranking of criterion, the risks are prioritized and some measures are suggested for management to prevent accidents occur in the industry.
A Two-Stage Local Positioning Method With Misalignment Calibration for Robotic Structural Monitoring of Buildings
Authors: Wang Rong , Xiong Zhi , Chen Yulu Luke , Manjunatha Preetham , Masri Sami F.
Published: February 2019

In structural health monitoring (SHM) applications carried out by mobile robots, the precise locating of the SHM robot is essential for accurate detection and quantification of defects. The traditional dead reckoning (DR) approach can only provide local position in the horizon, which is not enough for SHM applications in three dimensions in large buildings. In this paper, a new robot positioning algorithm for active building structural defect detection and localization is proposed. The two-stage robot positioning scheme is designed through the self-misalignment calibration and the positioning during SHM task stages, fusing the absolute and relative measurements. In order to overcome the drawback of the DR algorithm, in the full analysis of existing localization mode that can be applied to mobile robots, this paper adopted the inertial navigation system (INS) approach to measure the absolute motion information of a moving robot. On this basis, through the transformation between the absolute positioning coordinates and the local positioning coordinates of buildings, the mobile robot's optimal trajectory on building surface was designed for self-calibration of coordinate misalignments. The proposed method could effectively achieve the robot local positioning in building coordinate frame by fusing the external relative assistant measurements with absolute measurement. By using the designed strategies, the coordinate misalignment can also be self-calibrated effectively, improving local positioning accuracy.
Visualization of Rotating Cavitation Oscillation Mechanism in a Turbopump Inducer
Authors: Kim Junho , Song Seung Jin
Published: February 2019

An experimental investigation has been conducted on rotating cavitation in a turbopump inducer. Previous research suggested that incidence angle variation leads to rotating cavitation. This study, using particle image velocimetry (PIV) method, provides the first measurement of the incidence angle distribution near the tip region of an inducer blade's leading edge with and without rotating cavitation. Without rotating cavitation, the incidence angle near the leading edge of the following blade is positive. Under rotating cavitation, the tip leakage vortex cavitation regions on the blades become uneven, forming large and small tip leakage vortex cavitation regions. A large tip leakage vortex cavitation on the leading blade increases the axial and absolute tangential velocities near the following blade's leading edge. Thus, the incidence angle on the following blade becomes negative, suppressing tip leakage vortex cavitation. Conversely, a small tip leakage vortex cavitation on the leading blade increases the incidence angle and promotes tip leakage vortex cavitation on the following blade. Due to such suppression and promotion mechanisms, the tip leakage vortex cavitation region on each blade oscillates in sequence, seemingly but not actually propagating in the forward direction. High-speed camera flow visualization has been used to confirm the same oscillation mechanism of rotating cavitation.
Calculation of Friction Factors and Nusselt Numbers for Twisted Elliptical Tube Heat Exchangers Using Nek5000
Authors: Shaver Dillon R. , Carasik Lane B. , Merzari Elia , Salpeter Nate , Blandford Edward
Published: February 2019

Twisted elliptical tube geometries for heat exchanger design are expected to offer significant enhancement in heat transfer with a marginal increase in frictional losses. The presented work focuses on computational fluid dynamics (CFD) simulations of heated molten salt flows through twisted elliptical tube geometries at low modified Froude numbers. The objectives of this work are to evaluate the available correlations at low Froude numbers and to determine the impact of using a small gap to resolve contact points. The spectral element CFD code Nek5000 was used for all simulations, which were performed in periodic domains of triangular and square unit cells surrounding a single tube through a complete twist using an explicit filtering large eddy simulation (LES) method. The simulation methodology was validated by comparing to the experimental data of Tan et al. Excellent agreement was observed for this comparison. The Dzyubenko correlation for transitional flow was evaluated for a range of Froude numbers. This correlation demonstrated good agreement with LES results at high modified Froude number. As Froude number was decreased toward the bounds of the correlation, the agreement worsened. Cases were then simulated at low Froude number, testing the effects of tube spacing. It was determined that the laminar case for the square unit cell is the most affected by increasing gap size, which should be minimized to mitigate the effect. In the triangular unit cell, the laminar flow regime is also more significantly impacted by increasing gap size compared to the turbulent flow regime which was only marginally impacted.
Model Predictive Control of a Feedback-Linearized Hybrid Neuroprosthetic System With a Barrier Penalty
Authors: Bao Xuefeng , Kirsch Nicholas , Dodson Albert , Sharma Nitin
Published: February 2019

Functional electrical stimulation (FES) is prescribed as a treatment to restore motor function in individuals with neurological impairments. However, the rapid onset of FES-induced muscle fatigue significantly limits its duration of use and limb movement quality. In this paper, an electric motor-assist is proposed to alleviate the fatigue effects by sharing work load with FES. A model predictive control (MPC) method is used to allocate control inputs to FES and the electric motor. To reduce the computational load, the dynamics is feedback linearized so that the nominal model inside the MPC method becomes linear. The state variables: the angular position and the muscle fatigue are still preserved in the transformed state space to keep the optimization meaningful. Because after feedback linearization the original linear input constraints may become nonlinear and state-dependent, a barrier cost function is used to overcome this issue. The simulation results show a satisfactory control performance and a reduction in the computation due to the linearization.
Attenuation of low-frequency sound in water containing dense bubble clouds
Authors: Raveau Maria P.
Published: February 2019

Recently, the attenuation of sound propagating through a bubble cloud has been a subject of investigation due to its ability to mitigate low-frequency underwater noise from anthropogenic sources. The primary purpose of this work was to explore the use of bubbles to attenuate low-frequency underwater sound in a laboratory tank, when multiple scattering between bubbles is significant and the classic theory cannot be used. Bubbles of 1 mm radius were generated using a commercial fish tank air pump and air diffusers. The transfer function was measured at frequencies between 400 and 800 Hz. The insertion loss and extinction cross section were obtained through this experiment, and the results were compared with those from an existing predictive model [Feuillade, Nero, and Love, J. Acoust. Soc. Am. 99, 196–208 (1996)], which incorporates multiple scattering effects between bubbles. The effects of the enclosure on the sound propagation are incorporated through specular surface reflections. The comparison with theoretical models yielded satisfactory results in the forward field, with a normalized root mean squared error between 0.13 and 0.17. Computational modeling, experimental details, and a data/model comparison are presented.
MAP Kinase Regulation of the
Candida albicans
Pheromone Pathway
Authors: Rastghalam Golnaz , Omran Raha Parvizi , Alizadeh Masoumeh , Fulton Debrah , Mallick Jaideep , Whiteway Malcolm
Published: February 2019

MAP kinases and their regulators are critical components of eukaryotic signaling pathways implicated in normal cell behavior as well as abnormal behaviors linked to diseases such as cancer. The mating pathway of the yeast
Saccharomyces
cerevisiae
was central in establishing the MAP kinase paradigm. Here we investigate the mating pathway in a different ascomycete, the fungal pathogen
C. albicans
. In this dimorphic fungus MAP kinases are also implicated in the mating response, with two MAP kinases apparently playing redundant roles in the mating process. This work establishes that while some level of mating can occur in the presence of a single kinase, the Cek1 kinase is most important for mating, while the Cek2 kinase is involved in adaptation to signaling. While both kinases appear to be themselves regulated by dephosphorylation through the action of the Cpp1 phosphatase, this process appears important for mating only in the case of Cek1.
Identification of barriers, facilitators and system-based implementation strategies to increase teleophthalmology use for diabetic eye screening in a rural US primary care clinic: a qualitative study
Authors: Liu Yao , Zupan Nicholas J , Swearingen Rebecca , Jacobson Nora , Carlson Julia N , Mahoney Jane E , Klein Ronald , Bjelland Timothy D , Smith Maureen A
Published: February 2019

Objective

Teleophthalmology for diabetic eye screening is an evidence-based intervention substantially underused in US multipayer primary care clinics, even when equipment and trained personnel are readily available. We sought to identify patient and primary care provider (PCP) barriers, facilitators, as well as strategies to increase teleophthalmology use.

Design

We conducted standardised open-ended, individual interviews and analysed the transcripts using both inductive and directed content analysis to identify barriers and facilitators to teleophthalmology use. The Chronic Care Model was used as a framework for the development of the interview guide and for categorising implementation strategies to increase teleophthalmology use.

Setting

A rural, US multipayer primary care clinic with an established teleophthalmology programme for diabetic eye screening.

Participants

We conducted interviews with 29 participants (20 patients with diabetes and 9 PCPs).

Results

Major patient barriers to teleophthalmology use included being unfamiliar with teleophthalmology, misconceptions about diabetic eye screening and logistical challenges. Major patient facilitators included a recommendation from the patient’s PCP and factors related to convenience. Major PCP barriers to referring patients for teleophthalmology included difficulty identifying when patients are due for diabetic eye screening and being unfamiliar with teleophthalmology. Major PCP facilitators included the ease of the referral process and the communication of screening results. Based on our results, we developed a model that maps where these key patient and PCP barriers occur in the teleophthalmology referral process. Patients and PCPs also identified implementation strategies to directly address barriers and facilitators to teleophthalmology use.

Conclusions

Patients and PCPs have limited familiarity with teleophthalmology for diabetic eye screening. PCPs were expected to initiate teleophthalmology referrals, but reported significant difficulty identifying when patients are due for diabetic eye screening. System-based implementation strategies primarily targeting PCP barriers in conjunction with improved patient and provider education may increase teleophthalmology use in rural, US multipayer primary care clinics.
Place-specific factors associated with adverse maternal and perinatal outcomes in Southern Mozambique: a retrospective cohort study
Authors: Makanga Prestige Tatenda , Sacoor Charfudin , Schuurman Nadine , Lee Tang , Vilanculo Faustino Carlos , Munguambe Khatia , Boene Helena , Ukah Ugochinyere Vivian , Vidler Marianne , Magee Laura A , Sevene Esperanca , von Dadelszen Peter , Firoz Tabassum
Published: February 2019

Objectives

To identify and measure the place-specific determinants that are associated with adverse maternal and perinatal outcomes in the southern region of Mozambique.

Design

Retrospective cohort study. Choice of variables informed by literature and Delphi consensus.

Setting

Study conducted during the baseline phase of a community level intervention for pre-eclampsia that was led by community health workers.

Participants

A household census identified 50 493 households that were home to 80 483 women of reproductive age (age 12–49 years). Of these women, 14 617 had been pregnant in the 12 months prior to the census, of which 9172 (61.6%) had completed their pregnancies.

Primary and secondary outcome measures

A combined fetal, maternal and neonatal outcome was calculated for all women with completed pregnancies.

Results

A total of six variables were statistically significant (p≤0.05) in explaining the combined outcome. These included: geographic isolation, flood proneness, access to an improved latrine, average age of reproductive age woman, family support and fertility rates. The performance of the ordinary least squares model was an adjusted R2=0.69. Three of the variables (isolation, latrine score and family support) showed significant geographic variability in their effect on rates of adverse outcome. Accounting for this modest non-stationary effect through geographically weighted regression increased the adjusted R2 to 0.71.

Conclusions

The community exploration was successful in identifying context-specific determinants of maternal health. The results highlight the need for designing targeted interventions that address the place-specific social determinants of maternal health in the study area. The geographic process of identifying and measuring these determinants, therefore, has implications for multisectoral collaboration.

Trial registration number

NCT01911494.
The association between having a coordinator and return to work: the rapid-return-to-work cohort study
Authors: Skarpaas Lisebet Skeie , Haveraaen Lise Aasen , Småstuen Milada Cvancarova , Shaw William S , Aas Randi Wågø
Published: February 2019

Objectives

The aim of this study was to assess if the reported provision of a coordinator was associated with time to first return to work (RTW) and first full RTW among sick-listed employees who participated in different rapid-RTW programmes in Norway.

Design

The study was designed as a cohort study.

Setting

Rapid-RTW programmes financed by the regional health authority in hospitals and Norwegian Labour and Welfare Administration in Norway.

Participants

The sample included employees on full-time sick leave (n=326) who participated in rapid-RTW programmes (n=43), who provided information about the coordination of the services they received. The median age was 46 years (minimum–maximum 21–67) and 71% were female. The most common reported diagnoses were musculoskeletal (57%) and mental health disorders (14%).

Interventions

The employees received different types of individually tailored RTW programmes all aimed at a rapid RTW; occupational rehabilitation (64%), treatment for medical or psychological issues, including assessment, and surgery (26%), and follow-up and work clarification services (10%). It was common to be provided with a coordinator (73%).

Primary and secondary outcome measures

Outcomes were measured as time to first RTW (graded and 100%) and first full RTW (100%).

Results

Employees provided with a coordinator returned to work later than employees who did not have a coordinator; a median (95% CI) of 128 (80 to 176) days vs 61 (43 to 79) days for first RTW, respectively. This difference did not remain statistically significant in the adjusted regression analysis. For full RTW, there was no statistically significant difference between employees provided with a coordinator versus those who were not.

Conclusions

The model of coordination, provided in the Norwegian rapid-RTW programmes was not associated with a more rapid RTW for sick-listed employees. Rethinking how RTW coordination should be organised could be wise in future programme development.
Microsimulation model for the health economic evaluation of osteoporosis interventions: study protocol
Authors: Si Lei , Eisman John A , Winzenberg Tania , Sanders Kerrie M , Center Jacqueline R , Nguyen Tuan V , Palmer Andrew J
Published: February 2019

Introduction

Osteoporosis is a systemic skeletal disease that is characterised by reduced bone strength and increased fracture risk. Osteoporosis-related fractures impose enormous disease and economic burden to the society. Although many treatments and health interventions are proven effective to prevent fractures, health economic evaluation adds evidence to their economic merits. Computer simulation modelling is a useful approach to extrapolate clinical and economic outcomes from clinical trials and it is increasingly used in health economic evaluation. Many osteoporosis health economic models have been developed in the past decades; however, they are limited to academic use and there are no publicly accessible health economic models of osteoporosis.

Methods and analysis

We will develop the Australian osteoporosis health economic model based on our previously published microsimulation model of osteoporosis in the Chinese population. The development of the model will follow the recommendations for the conduct of economic evaluations in osteoporosis by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases and the US branch of the International Osteoporosis Foundation. The model will be a state-transition semi-Markov model with memory. Clinical parameters in the model will be mainly obtained from the Dubbo Osteoporosis Epidemiology Study and the health economic parameters will be collected from the Australian arm of the International Costs and Utilities Related to Osteoporotic Fractures Study. Model transparency and validates will be tested using the recommendations from Good Research Practices in Modelling Task Forces. The model will be used in economic evaluations of osteoporosis interventions including pharmaceutical treatments and primary care interventions. A user-friendly graphical user interface will be developed, which will connect the user to the calculation engine and the results will be generated. The user interface will facilitate the use of our model by people in different sectors.

Ethics and dissemination

No ethical approval is needed for this study. Results of the model validation and future economic evaluation studies will be submitted to journals. The user interface of the health economic model will be publicly available online accompanied with a user manual.
Use, utility and methods of telehealth for patients with COPD in England and Wales: a healthcare provider survey
Authors: Al Rajeh Ahmed , Steiner Michael C , Aldabayan Yousef , Aldhahir Abdulelah , Pickett Elisha , Quaderi Shumonta , Hurst John R
Published: February 2019

Introduction

Although the effectiveness of domiciliary monitoring (telehealth) to improve outcomes in chronic obstructive pulmonary disease (COPD) is controversial, it is being used in the National Health Service (NHS).

Aim

To explore the use of teleheath for COPD across England and Wales, to assess the perceptions of clinicians employing telehealth in COPD and to summarise the techniques that have been used by healthcare providers to personalise alarm limits for patients with COPD enrolled in telehealth programmes.

Methods

A cross-sectional survey consisting of 14 questions was sent to 230 COPD community services in England and Wales. Questions were designed to cover five aspects of telehealth in COPD: purpose of use, equipment type, clinician perceptions, variables monitored and personalisation of alarm limits.

Results

65 participants completed the survey from 52 different NHS Trusts. 46% of Trusts had used telehealth for COPD, and currently, 31% still provided telehealth services to patients with COPD. Telehealth is most commonly used for baseline monitoring and to allow early detection of exacerbations, with 54% believing it to be effective. The three most commonly monitored variables were oxygen saturation, heart rate and breathlessness. A variety of methods were used to set alarm limits with the majority of respondents believing that at least 40% of alarms were false.

Conclusion

Around one-third of responded community COPD services are using telehealth, believing it to be effective without robust evidence, with a variety of variables monitored, a variety of hardware and varying techniques to set alarm limits with high false alarm frequencies.
First patient-centred set of outcomes for pulmonary sarcoidosis: a multicentre initiative
Authors: Kampstra Nynke A , Grutters Jan C , van Beek Frouke T , Culver Daniel A , Baughman Robert P , Renzoni Elisabetta A , Wuyts Wim , Kouranos Vaslis , Wijsenbeek Marlies S , Biesma Douwe H , van der Wees Philip J , van der Nat Paul B
Published: February 2019

Introduction

Routine and international comparison of clinical outcomes enabling identification of best practices for patients with pulmonary sarcoidosis is lacking. The aim of this study was to develop a standard set of outcome measures for pulmonary sarcoidosis, using the value-based healthcare principles.

Methods

Six expert clinics for interstitial lung diseases in four countries participated in a consensus-driven RAND-modified Delphi study. A mixed-method approach was applied for the identification of an outcome measures set and initial conditions for patients with pulmonary sarcoidosis. The expert team consisted of multidisciplinary professionals (n=14) from Cleveland Clinic, Cincinnati MC, Erasmus MC, Leuven UZ, Royal Brompton and St. Antonius Hospital. During a ranking process, participants were instructed to rank variables on a scale from 1 to 10 based on whether it has (1) impact of the outcome on quality of life, (2) impact of quality of care on the outcome and (3) the number of patients negatively affected by the outcome.

Results

An outcome measures set was defined consisting of seven outcome measures: mortality, pulmonary function, soluble interleukin-2 receptor change as an activity biomarker, weight gain, quality of life, osteoporosis and clinical outcome status.

Discussion

Collecting outcomes in pulmonary sarcoidosis internationally and the use of a broadly accepted set can enable international comparison. Differences in outcomes can potentially be used as a starting point for quality improvement initiatives.
Psychological processes of suffering of palliative care patients in Malaysia: a thematic analysis
Authors: Tan Seng Beng , Loh Ee Chin , Lam Chee Loong , Ng Chong Guan , Lim Ee Jane , Boey Christopher Chiong Meng
Published: February 2019

Although suffering in palliative care has received increasing attention over the past decade, the psychological processes that underpin suffering remain relatively unexplored.

Objective

To understand the psychological processes involved in the experiencing of suffering at the end phase of life.

Methods

Semistructured interviews were conducted with 20 palliative care inpatients from an academic medical centre in Kuala Lumpur, Malaysia. The transcripts were thematically analysed with NVIVO9.

Results

5 themes of psychological processes of suffering were generated: (1) perceptions, (2) cognitive appraisals, (3) hope and the struggles with acceptance, (4) emotions and (5) clinging. A model of suffering formation was constructed.

Conclusion

The findings may inform the development of mechanism-based interventions in the palliation of suffering.
Impact of instructor professional background and interim retesting on knowledge and self-confidence of schoolchildren after basic life support training: a cluster randomised longitudinal study
Authors: Haseneder Rainer , Skrzypczak Matthias , Haller Bernhard , Beckers Stefan K , Holch Julia , Wank Christina , Kochs Eberhard , Schulz Christian M
Published: February 2019

Introduction

To increase the rate of bystander resuscitation, basic life support (BLS) training for schoolchildren is now recommended on a broad level. However, debate continues about the optimal teaching methods. In this study, we investigated the effects of a 90 min BLS training on female pupils’ BLS knowledge and self-confidence and whether learning outcomes were influenced by the instructors’ professional backgrounds or test-enhanced learning.

Methods

We conducted a cluster randomised, longitudinal trial in a girls’ grammar school in Germany from 2013 to 2014. Pupils aged 10–17 years were randomised to receive BLS training conducted by either emergency physicians or medical students. Using a multiple-choice questionnaire and a Likert-type scale, BLS knowledge and self-confidence were investigated before training (t0), 1 week (t1) and 9 months after training (t2). To investigate whether test-enhanced learning influenced learning outcomes, the questionnaire was administered 6 months after the training in half of the classrooms. The data were analysed using linear mixed-effects models.

Results

The study included 460 schoolchildren. BLS knowledge (mean number of correct answers) increased from 5.86 at t0to 9.24 at t1(p<0.001) and self-confidence (mean score on the Likert-type scale) increased from 8.70 at t0to 11.29 at t1(p<0.001). After 9 months, knowledge retention was good (8.94 at t2; p=0.080 vs t1), but self-confidence significantly declined from t1to 9.73 at t2(p<0.001). Pupils trained by medical students showed a slight but statistically significant greater increase in the knowledge at both t1and t2, whereas instructors’ background did not influence gain or retention of self-confidence. Retesting resulted in a marginally, non-significantly better retention of knowledge.

Conclusions

BLS training led to short-term gains in knowledge and self-confidence. Although knowledge was retained at 9 months after the training session, self-confidence significantly decreased. Interim testing did not appear to impact retention of knowledge or self-confidence. Medical students should be considered as instructors for these courses given their favourable learning outcomes and greater availability.