bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of moisture content and additives on the ensiling quality and vitamins changes of alfalfa silage with or without rain damage
Authors: Wang Bing , Yu Zhu
Published: May 2020

We investigated the effects of moisture, rain damage, and additives on fermentation quality and vitamins change in alfalfa (Medicago sativa L.) silage. Two moisture content alfalfa (53 and 72% moisture content) were received artificial rain damage. Then, the formic acid and L. plantarum (LP) + sucrose were added. After 30 days, silos were opened. The significant interaction between rain damage and moisture content were found for nutrients and fermentation characteristics in alfalfa silage, which showed more rain damage effects occurred in 53% moisture content rather than in 72% moisture content material. Treatment with LP + sucrose had lower pH value, ammonia‐N/total N, and higher lactic acid content compared to the other additives. The concentrations of α‐tocopherol and phylloquinone increased, but thiamine, riboflavin, and ascorbic acid decreased in alfalfa silage treated with LP + sucrose, especially when the alfalfa was subjected to rain damage. The highly significant correlations were found between pantothenic acid (VB5) and pH, and between VB5 and lactic acid. The improvements in fermentation quality by adding of LP + sucrose was observed after rain damage for either 53% or 72% moisture alfalfa, which can be a guideline for forage processor who ensiles alfalfa after rain damage.
Highways are a threat for giant armadillos that underpasses can mitigate
Authors: Banhos Aureo , Fontes Bruno L. , Yogui Débora Regina , Alves Mario Henrique , Ardente Natália Carneiro , Valls Renata , Barreto Lucas Mendes , Damásio Lucas , Ferreguetti Átilla Colombo , Carvalho Andréa Siqueira , Schettino Vitor Roberto , Santos Alexandre Rosa dos , Bergallo Helena Godoy , Srbek‐Araujo Ana Carolina , Medici Emilia Patrícia , Canena Ariel , Desbiez Arnaud L.J.
Published: May 2020

We report 24 records of giant armadillo roadkill on Brazilian highways in the Cerrado, Pantanal and Amazon biomes illustrating that highways are a threat to this species. However, we also documented the species using underpasses, demonstrating that these structures could help to reduce the risk of roadkill for giant armadillos.

Abstract in Portuguese is available with online material
Future burden of vision loss in Australia: Projections from the National Eye Health Survey
Authors: Foreman Joshua , Keel Stuart , McGuiness Myra , Liew Danny , van Wijngaarden Peter , Taylor Hugh R. , Dirani Mohamed
Published: May 2020

Importance

Projections of Australia's future burden of vision loss will inform eye health service delivery.

Background

This study aimed to forecast bilateral vision loss in Australia from 2020 to 2050.

Design

Population‐based survey.

Participants

Indigenous and non‐indigenous Australians (n = 4253) aged ≥50 years from the National Eye Health Survey (NEHS, 2015‐2016).

Methods

Using the age‐and‐sex‐stratified prevalence of vision loss (better eye visual acuity <6/12) from the NEHS, the prevalence of, and number of people aged ≥50 years with, vision loss were forecast to 2050 using Australian census projections.

Main outcome measure

Prevalence of, and number of Australians with, vision loss from 2020 to 2050.

Results

The prevalence of vision loss is predicted to increase from 6.7% to 7.5% by 2050. Owing to population dynamics, the estimated number of Australians ≥50 years old with vision loss will nearly double from 532 386 in 2016 to 1 015 021 in 2050. The greatest increase in vision loss is expected to occur in those aged ≥80 years (2.6‐fold, 2016 = 144 240; 2050 = 376 296). The number of people with uncorrected refractive error is projected to increase 1.7‐fold, from 331 914 in 2016 to 578 969 in 2050.

Conclusions and relevance

Due to population growth and ageing, the future burden of vision loss in Australia is likely to increase, but the magnitude of this change is uncertain due to a lack of available data on some relevant input variables. Nonetheless, efforts are required to ensure early detection and treatment of major eye conditions, particularly treatable conditions such as uncorrected refractive error and cataract.
Wolves are back: Sociopolitical identity and opinions on management of Canis lupus
Authors: Hamilton Lawrence C. , Lambert Joanna E. , Lawhon Lydia Anne , Salerno Jonathan , Hartter Joel
Published: May 2020

Gray wolves (Canis lupus) were eliminated from the state of Oregon in the middle of the 20th century. By the early 21st century, wolves had returned to the northeast corner of the state, dispersing from populations reintroduced in Idaho and Wyoming. On a series of random‐sample telephone surveys (2011–2018), we asked more than 3,000 northeast Oregon residents about their preferences concerning wolf management strategies. One‐third of the respondents said that wolves should be eliminated from this region. Sociopolitical identity dominated other individual characteristics including age, education, years resident, and forestland ownership in predicting wolf‐management views. Political effects appear even stronger when our indicator distinguishes the most conservative, and further intensify when most of the respondent's friends belong to the same party. This strong influence of sociopolitical identity echoes findings from the broader literature on environmental concern, but adds a new and policy‐relevant element to wolf‐attitude research. As wolves expand throughout the west, and new states consider reintroduction, state and federal wildlife managers face deeply rooted opposition. Managers must consider a range of strategies to manage wolves while working with community leaders in wolf‐occupied areas to determine management options.
Heart failure and chronic kidney disease manifestation and mortality risk associations in type 2 diabetes: A large multinational cohort study
Authors: Birkeland Kåre I. , Bodegard Johan , Eriksson Jan W. , Norhammar Anna , Haller Hermann , Linssen Gerard C.M. , Banerjee Amitava , Thuresson Marcus , Okami Suguru , Garal‐Pantaler Elena , Overbeek Jetty , Mamza Jil Billy , Zhang Ruiqi , Yajima Toshitaka , Komuro Issei , Kadowaki Takashi
Published: May 2020

Aims

To examine the manifestation of cardiovascular or renal disease (CVRD) in patients with type 2 diabetes (T2D) initially free from CVRD as well as the mortality risks associated with these diseases.

Methods

Patients free from CVRD were identified from healthcare records in England, Germany, Japan, the Netherlands, Norway and Sweden at a fixed date. CVRD manifestation was defined by first diagnosis of cardiorenal disease, or a stroke, myocardial infarction (MI) or peripheral artery disease (PAD) event. The mortality risk associated with single CVRD history of heart failure (HF), chronic kidney disease (CKD), MI, stroke or PAD was compared with that associated with CVRD‐free status.

Results

Of 1 177 896 patients with T2D, 772 336 (66%) were CVRD‐free and followed for a mean of 4.5 years. A total of 137 081 patients (18%) developed a first CVRD manifestation, represented by CKD (36%), HF (24%), stroke (16%), MI (14%) and PAD (10%). HF or CKD was associated with increased cardiovascular and all‐cause mortality risk: hazard ratio (HR) 2.02 (95% confidence interval [CI] 1.75–2.33) and HR 2.05 (95% CI 1.82–2.32), respectively. HF and CKD were separately associated with significantly increased mortality risks, and the combination was associated with the highest cardiovascular and all‐cause mortality risk: HRs 3.91 (95% CI 3.02–5.07) and 3.14 (95% CI 2.90–3.40), respectively.

Conclusion

In a large multinational study of >750 000 CVRD‐free patients with T2D, HF and CKD were consistently the most frequent first cardiovascular disease manifestations and were also associated with increased mortality risks. These novel findings show these cardiorenal diseases to be important and serious complications requiring improved preventive strategies.
Sodium‐glucose co‐transporter‐2 inhibitors and the risk of diabetic ketoacidosis in patients with type 2 diabetes: A systematic review and meta‐analysis of randomized controlled trials
Authors: Liu Jiali , Li Ling , Li Sheyu , Wang Yuning , Qin Xuan , Deng Ke , Liu Yanmei , Zou Kang , Sun Xin
Published: May 2020

Aim

To assess the effects of sodium‐glucoseco‐transporter‐2 (SGLT2) inhibitors on diabetic ketoacidosis (DKA) in patients with type 2 diabetes.

Materials and Methods

We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov from inception to 13 June 2019 for randomized controlled trials (RCTs) that compared SGLT2 inhibitors with control in patients with type 2 diabetes. Paired reviewers independently screened citations, assessed the risk of bias and extracted data. Peto's method was used as the primary approach to pool the effect of SGLT2 inhibitors on DKA. Sensitivity analyses with the alternative effect measure (risk ratio) or pooling method (Mantel–Haenszel), the use of continuity correction of 0.5 for zero‐event trials or a generalized linear mixed model were conducted. Six preplanned subgroup analyses were performed to explore heterogeneity. The grading of recommendations assessment, development and evaluation (GRADE) approach was used to rate the quality of evidence.

Results

A total of 39 RCTs were included, involving 60 580 patients and 85 DKA events. SGLT2 inhibitors were statistically associated with an increased risk of DKA versus control (SGLT2 inhibitors: 62/34 961 [0.18%] vs. control: 23/25 211 [0.09%], Peto odds ratio [OR] 2.13, 95% confidence interval [CI] 1.38 to 3.27, I2 = 8%; RD 1.7 more events, 95% CI 0.6 more to 3.4 more events per 1000 over 5 years; high‐quality evidence). Sensitivity analyses showed similar results. The subgroup analyses by mean age (interaction P = 0 .02) and length of follow‐up (interaction P = 0 .03) showed a larger relative effect among older patients (aged ≥60 years) and those with longer use of SGLT2 inhibitors (>52 weeks).

Conclusions

High‐quality evidence suggests that SGLT2 inhibitors may increase the risk of DKA in patients with type 2 diabetes. The apparent differences in treatment effects among patients of a different age or follow‐up were probable, suggesting the advisability of caution in patients with long‐term use of SGLT2 inhibitors or in older patients.
Neonatal vitamin D status and risk of childhood epilepsy
Authors: Specht Ina O. , Thorsteinsdottir Fanney , Walker Karen Christina , Olsen Jørn , Heitmann Berit L
Published: May 2020

Objective

Epilepsy is a nervous system abnormality that may be caused by unknown exposures during fetal development. Studies have shown neuroprotective effects of early exposure to vitamin D in other neurological disorders, and seasonal variation in birth of children with epilepsy. We aimed to investigate if neonatal 25(OH)D3was associated with risk of childhood epilepsy.

Methods

This case‐cohort study compared neonatal 25(OH)D3levels from children with epilepsy (n = 403) and a random selected cohort of controls (n = 1163), assessing the hazard of first epilepsy diagnosis between 1 and 4 years of age from a weighted Cox proportional hazard model. Analyses were adjusted for parental education, maternal age, maternal epilepsy, maternal ethnicity, and gestational age, and additionally for season of birth and smoking during pregnancy.

Results

The mean (standard deviation [SD]) of neonatal 25(OH)D3levels were 30.8(19.6) nmol/L among cases and 28.5(19.4) nmol/L among the cohort. The hazard ratio (HR) of epilepsy was in a dose‐response patternhigheramong children from the highest neonatal 25(OH)D3quintiles (P‐trend = .004). Results were unchanged after including season of birth in the analysis, where a significantly higher HR of epilepsy was observed among children in the two highest quintiles compared to children in the lowest quintile (Q4: HRadj 1.62, 95% CI 1.07‐2.47 and Q5: HRadj 1.86, 95% CI 1.21‐2.86).

Significance

In this study, the risk of childhood epilepsy increased with neonatal 25(OH)D3categories in a dose‐response pattern, suggesting an association between a high neonatal 25(OH)D3and the risk of childhood epilepsy. Considering that adjusting for season of birth strengthened the results, we conclude that maternal intake of vitamin D, and not vitamin D from sun exposure, was the vitamin D source associated with epilepsy. Although we cannot, in the present study, control for compounds in the diet like pollutants or heavy metals, which may correlate with dietary vitamin D, future studies investigating fetal origin of epilepsy should focus on compounds correlating with vitamin D.
Cognitive phenotypes in temporal lobe epilepsy utilizing data‐ and clinically driven approaches: Moving toward a new taxonomy
Authors: Reyes Anny , Kaestner Erik , Ferguson Lisa , Jones Jana E. , Seidenberg Michael , Barr William B. , Busch Robyn M. , Hermann Bruce P. , McDonald Carrie R.
Published: May 2020

Objective

To identify cognitive phenotypes in temporal lobe epilepsy (TLE) and test their reproducibility in a large, multi‐site cohort of patients using both data‐driven and clinically driven approaches.

Method

Four‐hundred seven patients with TLE who underwent a comprehensive neuropsychological evaluation at one of four epilepsy centers were included. Scores on tests of verbal memory, naming, fluency, executive function, and psychomotor speed were converted into z‐scores based on 151 healthy controls (HCs). For the data‐driven method, cluster analysis (k‐means) was used to determine the optimal number of clusters. For the clinically driven method, impairment was defined as >1.5 standard deviations below the mean of the HC, and patients were classified into groups based on the pattern of impairment.

Results

Cluster analysis revealed a three‐cluster solution characterized by (a) generalized impairment (29%), (b) language and memory impairment (28%), and (c) no impairment (43%). Based on the clinical criteria, the same broad categories were identified, but with a different distribution: (a) generalized impairment (37%), (b) language and memory impairment (30%), and (c) no impairment (33%). There was a 82.6% concordance rate with good agreement (κ = .716) between the methods. Forty‐eight patients classified as having a normal profile based on cluster analysis were classified as having generalized impairment (n = 16) or an isolated language/memory impairment (n = 32) based on the clinical criteria. Patients with generalized impairment had a longer disease duration and patients with no impairment had more years of education. However, patients demonstrating the classic TLE profile (ie, language and memory impairment) were not more likely to have an earlier age at onset or mesial temporal sclerosis.

Significance

We validate previous findings from single‐site studies that have identified three unique cognitive phenotypes in TLE and offer a means of translating the patterns into a clinical diagnostic criteria, representing a novel taxonomy of neuropsychological status in TLE.
Using asexual vertebrates to study genome evolution and animal physiology: Banded (Fundulus diaphanus) x Common Killifish (F. heteroclitus) hybrid lineages as a model system
Authors: Dalziel Anne C. , Tirbhowan Svetlana , Drapeau Hayley F. , Power Claude , Jonah Lauren S. , Gbotsyo Yayra A. , Dion‐Côté Anne‐Marie
Published: May 2020

Wild, asexual, vertebrate hybrids have many characteristics that make them good model systems for studying how genomes evolve and epigenetic modifications influence animal physiology. In particular, the formation of asexual hybrid lineages is a form of reproductive incompatibility, but we know little about the genetic and genomic mechanisms by which this mode of reproductive isolation proceeds in animals. Asexual lineages also provide researchers with the ability to produce genetically identical individuals, enabling the study of autonomous epigenetic modifications without the confounds of genetic variation. Here, we briefly review the cellular and molecular mechanisms leading to asexual reproduction in vertebrates and the known genetic and epigenetic consequences of the loss of sex. We then specifically discuss what is known about asexual lineages ofFundulus diaphanus x F. heteroclitusto highlight gaps in our knowledge of the biology of these clones. Our preliminary studies ofF. diaphanusandF. heteroclituskaryotypes from Porter's Lake (Nova Scotia, Canada) agree with data from other populations, suggesting a conserved interspecific chromosomal arrangement. In addition, genetic analyses suggest that: (a) the same major clonal lineage (Clone A) ofF. diaphanus x F. heteroclitushas remained dominant over the past decade, (b) some minor clones have also persisted, (c) new clones may have recently formed, and iv) wild clones still mainly descend fromF. diaphanus♀ x F. heteroclitus♂crosses (96% in 2017–2018). These data suggest that clone formation may be a relatively rare, but continuous process, and there are persistent environmental or genetic factors causing a bias in cross direction. We end by describing our current research on the genomic causes and consequences of a transition to asexuality and the potential physiological consequences of epigenetic variation.
Multi‐seasonal modelling of plant‐nematode interactions reveals efficient plant resistance deployment strategies
Authors: Nilusmas Samuel , Mercat Mathilde , Perrot Thomas , Djian‐Caporalino Caroline , Castagnone‐Sereno Philippe , Touzeau Suzanne , Calcagno Vincent , Mailleret Ludovic
Published: May 2020

Root‐knot nematodes, Meloidogyne spp., are soil‐borne polyphagous pests with major impact on crop yield worldwide. Resistant crops efficiently control avirulent root‐knot nematodes, but favour the emergence of virulent forms. Since virulence is associated with fitness costs, susceptible crops counter‐select virulent root‐knot nematodes. In this study, we identify optimal rotation strategies between susceptible and resistant crops to control root‐knot nematodes and maximize crop yield. We developed an epidemiological model describing the within‐season dynamics of avirulent and virulent root‐knot nematodes on susceptible or resistant plant root‐systems, and their between‐season survival. The model was fitted to experimental data and used to predict yield‐maximizing rotation strategies, with special attention to the impact of epidemic severity and genetic parameters. Crop rotations were found to be efficient under realistic parameter ranges. They were characterized by low ratios of resistant plants and were robust to parameter uncertainty. Rotations provide significant gain over resistant‐only strategies, especially under intermediate fitness costs and severe epidemic contexts. Switching from the current general deployment of resistant crops to custom rotation strategies could not only maintain or increase crop yield, but also preserve the few and valuable R‐genes available.
Differential thermal tolerance between algae and corals may trigger the proliferation of algae in coral reefs
Authors: Anton Andrea , Randle Janna L. , Garcia Francisca C. , Rossbach Susann , Ellis Joanne I. , Weinzierl Michael , Duarte Carlos M.
Published: May 2020

Marine heatwaves can lead to rapid changes in entire communities, including in the case of shallow coral reefs the potential overgrowth of algae. Here we tested experimentally the differential thermal tolerance between algae and coral species from the Red Sea through the measurement of thermal performance curves and the assessment of thermal limits. Differences across functional groups (algae vs. corals) were apparent for two key thermal performance metrics. First, two reef‐associated algae species (Halimeda tuna and Turbinaria ornata) had higher lethal thermal limits than two coral species (Pocillopora verrucosa and Stylophora pistillata) conferring those species of algae with a clear advantage during heatwaves by surpassing the thermal threshold of coral survival. Second, the coral species had generally greater deactivation energies for net and gross primary production rates compared to the algae species, indicating greater thermal sensitivity in corals once the optimum temperature is exceeded. Our field surveys in the Red Sea reefs before and after the marine heatwave of 2015 show a change in benthic cover mainly in the southern reefs, where there was a decrease in coral cover and a concomitant increase in algae abundance, mainly turf algae. Our laboratory and field observations indicate that a proliferation of algae might be expected on Red Sea coral reefs with future ocean warming.
COVID‐19 and older people in Asia: Asian Working Group for Sarcopenia calls to action
Authors: Lim Wee‐Shiong , Liang Chih‐Kuang , Assantachai Prasert , Auyeung Tung W , Kang Lin , Lee Wei‐Ju , Lim Jae‐Young , Sugimoto Ken , Akishita Masahiro , Chia Shu‐Lih , Chou Ming‐Yueh , Ding Yew‐Yoong , Iijima Katsuya , Jang Hak C , Kawashima Shuji , Kim Miji , Kojima Taro , Kuzuya Masafumi , Lee Jenny , Lee Sang Y , Lee Yunhwan , Peng Li‐Ning , Wang Ninie Y , Wang Yin‐Wei , Won Chang W , Woo Jean , Chen Liang‐Kung , Arai Hidenori
Published: May 2020

The coronavirus disease 2019 (COVID‐19) pandemic has casted a huge impact on global public health and the economy. In this challenging situation, older people are vulnerable to the infection and the secondary effects of the pandemic and need special attention. To evaluate the impacts of COVID‐19 on older people, it is important to balance the successful pandemic control and active management of secondary consequences. These considerations are particularly salient in the Asian context, with its diversity among countries in terms of sociocultural heritage, healthcare setup and availability of resources. Thus, the Asian Working Group for Sarcopenia summarized the considerations of Asian countries focusing on responses and difficulties in each country, impacts of health inequity related to the COVID‐19 pandemic and proposed recommendations for older people, which are germane to the Asian context. More innovative services should be developed to address the increasing demands for new approaches to deliver healthcare in these difficult times and to establish resilient healthcare systems for older people. Geriatr Gerontol Int 2020; 20: 547–558.
Mössbauer study of the temperature dependence of electron delocalization in mixed valence freudenbergite
Authors: Cashion John D. , Vance Eric R. , Ryan Dominic H.
Published: May 2020

The evolution of the electron delocalization in the ferrous subspectra in a sample of mixed valence ferrous‐ferric freudenbergite has been followed by Mössbauer spectroscopy from 6 K to 650 K. The spectral changes do not involve the ferric component, leading to the conclusion that it is due to a thermally driven delocalization of the sixth d‐electron on the ferrous ions. The phenomenon does not occur in samples of pure ferrous freudenbergite.
Effects of timing of formative feedback in computer‐assisted learning environments
Authors: Candel Carmen , Vidal‐Abarca Eduardo , Cerdán Raquel , Lippmann Marie , Narciss Susanne
Published: May 2020

This study examines the effects of timing of corrective formative feedback on processing text information on question‐answering. Undergraduate students read an expository text and answered questions in two attempts. Students were randomly assigned to a no feedback, immediate feedback and delayed feedback conditions. Students in the feedback conditions received feedback on the correctness of their answer after the first attempt and were informed about the right answer after the second attempt. Students were prompted to restudy the text after failing in their first attempt. However, students in the no feedback condition were just prompted to search the text. All students were tested on question‐answering, corrective probability and a post‐test cued‐recall test. Results showed that: (a) feedback reduced the initial time reading the text; (b) feedback increased performance on question answering and cued‐recall; (c) delayed feedback produced no advantages over immediate feedback. Theoretical and practical implications of these results are discussed.
Monotherapy and combination therapy with acitretin for mycosis fungoides: results of a retrospective, multicentre study
Authors: Nikolaou V. , Patsatsi A. , Sidiropoulou P. , Chlouverakis G. , Kavvalou E. , Koletsa T. , Economidi A. , Georgiou E. , Papadavid E. , Rigopoulos D. , Stratigos A.J. , Kruger‐Krasagakis S.E.
Published: May 2020

Background

Retinoids have long been used in the treatment of cutaneous T‐cell lymphomas. However, data on acitretin use for mycosis fungoides (MF) are very limited.

Objectives

To evaluate treatment outcomes of acitretin in patients with MF attending three academic referral centres in different regions of Greece.

Methods

Data on effectiveness, safety and drug survival of acitretin as monotherapy or as adjuvant regimen were collected in a multicentre, register‐based, retrospective study.

Results

Overall, 128 patients (64.8% male; mean age at MF diagnosis 59.7 years) were included. Folliculotropic MF was present in 24 (18.8%) cases. Most patients (n = 118; 92.2%) had early‐stage disease (≤IIA) at acitretin initiation. In all, 28 (21.9%) patients received acitretin monotherapy, while 100 (78.1%) subjects on acitretin concomitantly received phototherapy (n = 65; 50.8%) or topical steroids (n = 27; 21.1%). Acitretin was given as a first‐line agent in 73 (57%) cases. A 77.3% overall response rate was noted: 44.5% and 32.8% for complete and partial responses, respectively. Acitretin was more effective as first‐line than as a subsequent agent (P = 0.008). A trend towards better response was observed in the combination arm compared to patients receiving acitretin alone (P = 0.056). Median time to best response was 6.9 months (IQR 4.4–9.4); median duration of response was 23.7 months (IQR 11.9–35.4). Overall, the mean length of all treatment patterns was 569 days (SD 718.8). Therapy was discontinued in 5 (3.9%) cases due to drug intolerance. Adverse effects were recorded in 62 (48.4%) cases with dyslipidaemia (n = 31; 24.2%), xerosis (n = 24; 18.6%) and hair loss (n = 10; 7.8%) being the most commonly recorded.

Conclusions

Acitretin, either alone or as adjuvant, showed a stable long‐term effectiveness in this cohort, especially when used in the first‐line setting. This RAR‐selective agonist may serve as an attractive option for treatment of MF and should be further evaluated.
Variation amongst hierarchies of evidence
Authors: Vere Joseph , Gibson Barry
Published: May 2020

Evidence‐based standards are fundamental to the practice, funding, and governance of modern medicine. These standards are developed using hierarchies of evidence yet it is often not appreciated that different hierarchies exist and there is a risk that inconsistent standards may be developed depending upon the hierarchy that is used. In this paper, we present four factors, independent of study design, that have led to differences amongst hierarchies. These factors are: establishment of professional jurisdiction, practical concerns, methodological quality, and the importance of different questions within medicine. We demonstrate that each of these factors has led to the upgrading of expert opinion and/or the downgrading of randomized controlled trials and meta‐analyses within different hierarchies. Our aim is to raise awareness of factors that have influenced the development of hierarchies. This may make the reader more critical of the processes that are used to develop evidence based standards.
Less Really Is More in Inappropriate Medication Use in Older Adults: How Can We Improve Prescribing and Deprescribing in Older Adults?
Authors: Fick Donna M.
Published: May 2020

See related article by Weir et al. in this issue
Motor chronic inflammatory demyelinating polyneuropathy (CIDP) in 17 patients: Clinical characteristics, electrophysiological study, and response to treatment
Authors: Pegat Antoine , Boisseau William , Maisonobe Thierry , Debs Rabab , Lenglet Timothée , Psimaras Dimitri , Azoulay‐Cayla Arièle , Fournier Emmanuel , Viala Karine
Published: May 2020

Motor chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare and poorly described subtype of CIDP. We aimed to study their clinical and electrophysiological characteristics and response to treatment. From a prospective database of CIDP patients, we included patients with definite or probable CIDP with motor signs and without sensory signs/symptoms at diagnosis. Patients were considered to have pure motor CIDP (PM‐CIDP) if sensory conductions were normal or to have motor predominant CIDP (MPred‐CIDP) if ≥2 sensory nerve action potential amplitudes were abnormal. Among the 700 patients with CIDP, 17 (2%) were included (PM‐CIDP n = 7, MPred‐CIDP n = 10); 71% were male, median age at onset was 48 years (range: 13‐76 years), 47% had an associated inflammatory or infectious disease or neoplasia. At the more severe disease stage, 94% of patients had upper and lower limb weakness, with distal and proximal weakness in 4 limbs for 56% of them. Three‐quarters (75%) responded to intravenous immunoglobulins (IVIg) and four of five patients to corticosteroids including three of three patients with MPred‐CIDP. The most frequent conduction abnormalities were conduction blocks (CB, 82%) and F‐wave abnormalities (88%). During follow up, 4 of 10 MPred‐CIDP patients developed mild sensory symptoms; none with PM‐CIDP did so. Patients with PM‐CIDP had poorer outcome (median ONLS: 4; range: 22‐5) compared to MPred‐CIDP (2, range: 0‐4; P = .03) at last follow up. This study found a progressive clinical course in the majority of patients with motor CIDP as well as frequent associated diseases, CB, and F‐wave abnormalities. Corticosteroids might be considered as a therapeutic option in resistant IVIg patients with MPred‐CIDP.
Do we need a 200 μg misoprostol vaginal insert? A retrospective cohort study comparing the misoprostol vaginal insert to oral misoprostol
Authors: Wegener Silke , Koenigbauer Josefine T. , Laesser Claudia , Metz Melanie , Pech Luisa , Kummer Julia , Daut Julia , Jarchau Ute , Wegener Viktor , Hellmeyer Lars
Published: May 2020

Aim

The misoprostol vaginal insert (MVI) was reported to be more effective than dinoprostone but discussed critically because of high rates of fetal heart rate changes due to uterine tachysystole. The aim of this study was to investigate the outcome of induced labor using the MVI compared to off‐label orally‐administered misoprostol (OM).

Methods

Retrospective study including a total of 401 patients with singleton pregnancies in whom labor was induced at ≥36 0/7 gestational weeks with MVI (203) or OM (198). Primary outcomes were the time from induction to delivery, vaginal delivery in 24 h and the mode of delivery and the neonatal outcome.

Results

Median time until any delivery was 833 min (645–1278) for MVI and 1076.5 min (698–1686.3) for OM group; 83.7% of the patients in the MVI group gave birth within 24 h versus 63.6% in the OM group. The MVI group needed significantly less pre‐delivery oxytocin (29%). Tachysystole (6.4%) and pathological CTG (30.5%) occurred at a significantly higher frequency in the MVI group. The cesarean section rate was significantly higher in the MVI group amounting to 21.7% versus 14.6% in the OM group (P < 0.05). Neonatal outcome did not differ between the groups.

Conclusion

The MVI might be an option if you are in need for an approved and faster method to induce labor. Although we observed a significantly higher rate of fetal heart rate changes and cesarean sections in the MVI group this did not affect the neonatal outcome.
Complete rupture of unscarred uterus with delayed symptoms: Case report and possible mechanism
Authors: Nishikawa Shigeki , Shibata Takashi , Kato Hiroki , Kotsuji Fumikazu , Nakago Satoshi
Published: May 2020

Uterine ruptures typically occur suddenly, have obvious symptoms, and may require urgent treatment. We experienced a case of complete rupture of an unscarred uterus that was undetected for 9 days. We report the clinical course and possible factors that led to it. Nine days after delivery, complete rupture of the posterior uterine wall was diagnosed by magnetic resonance imaging. The colon and ovaries were tightly adhered to the posterior uterine body. When this adhesive lesion was detached, 7 cm horizontal defects of the muscular layer were revealed. The ruptured wound was repaired. Magnetic resonance imaging 1 year postoperatively showed no thinning of the repaired lesion and suggested successful reperfusion. Mild clinical course despite complete uterine rupture was presumably because of adhesion of the ovaries and intestines to the rupture site.
Epigenetic regulation of insulin action and secretion – role in the pathogenesis of type 2 diabetes
Authors: Ling C.
Published: May 2020

The prevalence of type 2 diabetes (T2D) is rapidly increasing worldwide. Obesity, physical inactivity and ageing increase the risk of T2D. Epigenetic modifications can change due to environmental exposures and may thereby predispose to disease. This review aims at summarizing recent advances in epigenetics related to T2D, with a special focus on impaired insulin action and secretion in humans. There will be an emphasis on analyses in human tissues; both from T2D case‐control cohorts and intervention studies. Current data support an important role for epigenetics in the pathogenesis of T2D. Numerous studies have found differential DNA methylation and gene expression in skeletal muscle, adipose tissue, the liver and pancreatic islets from subjects with T2D compared with nondiabetic controls. For example, PDX1 has increased DNA methylation and decreased expression in pancreatic islets from patients with T2D compared with nondiabetic controls. Nongenetic risk factors for T2D such as ageing, unhealthy diets and physical activity do also impact the epigenome in human tissues. Interestingly, physical activity altered DNA methylation of candidate genes for T2D such as THADA in muscle and FTO, KCNQ1 and TCF7L2 in adipose tissue. There is also a strong interaction between genetic and epigenetic factors that together seem to affect T2D. mQTL studies in human adipose tissue and pancreatic islets showed that SNPs associated with DNA methylation levels in numerous sites. Several of these SNPs are also associated with T2D. Recent data also support that DNA methylation of some sites in blood may be developed into biomarkers that predict T2D since methylation of, for example TXNIP, ABCG1 and SREBF1 associated with future T2D. Future studies should use this information for development of new therapies and biomarkers and thereby improve prediction, prevention and treatment of T2D and its complications.
Joint impact of common risk factors on incident dementia: A cohort study of the Swedish Twin Registry
Authors: Tomata Y. , Li X. , Karlsson I. K. , Mosing M. A. , Pedersen N. L. , Hägg S.
Published: May 2020

Background

As common risk factors of dementia, nine factors (low education, hearing loss, obesity, hypertension, smoking, depression, physical inactivity, diabetes and social isolation) were proposed. However, the joint impact of these factors on incident dementia is still uncertain; hence, we aimed to examine this impact.

Methods

We conducted a cohort study of 9017 cognitively intact individuals aged ≥ 65 years in the Swedish Twin Registry. The main exposure was the total number of reported risk factors (ranging from 0 to 9). Data on dementia diagnoses were based on clinical workup and national health registers. After estimating the adjusted hazard ratios of incident dementia, the population attributable fraction (PAF) was calculated. We then conducted additional analyses, including APOE ε4 status in a genotyped subsample (n = 2810) to check the relative impact of the main exposure and discordant twin pair (n = 1158) analysis to consider confounding by familial effects (shared genetic or familial environmental factors).

Results

The number of dementia cases was 1950 (21.6%). A dose‐response relationship between the number of risk factors and incident dementia was observed; hazard ratio (95% confidence interval) per one‐unit increment in number of risk factors was 1.07 (1.03 to 1.11). The PAF for the combination of the nine risk factors was 10.4%. The PAF of all nine risk factors was smaller than that of APOE ε4 genotype (20.8%) in the subsample. Discordant pair analysis suggested that the observed association was not likely explained by familial effects.

Conclusion

The nine risk factors may have considerable impact as modifiable factors on incident dementia.
Copper, heart disease and homocysteine thiolactone
Authors: Jakubowski H.
Published: May 2020

Click here to view the Letter to the Editor by Klevay
Serious psychological distress: A national study of Middle Eastern immigrants
Authors: Alkaid Albqoor Maha , Chen Jyu‐Lin , Weiss Sandra , Waters Catherine , Choi Ji‐Won
Published: May 2020

What is known on the subject?

There is very limited literature on the health of Middle Eastern immigrants in the United States, and the available studies were mostly conducted on small convenient samples in local communities.

There is also a need to understand changes in the rates of serious psychological distress (SPD) during the 15 years after 2001, as there were negative effects on Arabs’ health since the September 2001 aftermath.

What does this paper add to existing knowledge?

The study examined the rates of SPD, the risk of SPD and its associated factors in a national sample of Middle Eastern immigrants in the United States from 2001 to 2015.

The study found that serious psychological distress rate was high among Middle Eastern immigrants. Being a female and having obesity were associated with a higher risk of reporting serious psychological distress among this population.

What are the implications for practice?

These outcomes necessitate mental health nursing interventions that provide culturally sensitive mental health care to immigrants

For example, developing community‐based prevention programmes is required to address risk factors of psychological distress and to increase awareness about psychological distress among Middle Eastern immigrants.

Introduction

While Middle Eastern immigrants are a fast‐growing population in the United States, there is very limited literature on their mental health. Most of the available studies were conducted on small convenient samples in local communities.

Aims

To examine rates of serious psychological distress (SPD) and its associated factors among Middle Eastern immigrants in the United States, compared with US‐born, non‐Hispanic Whites.

Methods

Data from the National Health Interview Survey (NHIS) from 2001 to 2015 were analysed. The survey included 1,246 Middle Eastern immigrants and 232,392 US‐born, non‐Hispanic Whites. SPD was measured by the Kessler‐6 psychological distress scale. Survey analysis procedures, sampling weights and variance estimates were conducted. Descriptive statistics and regression analyses were employed to examine differences and factors associated with SPD.

Results

SPD rate was the highest among Middle Eastern immigrants (5.99%) between 2006 and 2010. Among Middle Eastern immigrants, being female and obese were significantly associated with a higher risk of SPD.

Discussion

Middle Eastern immigrants in the United States suffered high rates of SPD. Gender and obesity were factors associated with SPD risk.

Implications

These outcomes indicate the need for mental health nursing interventions that provide culturally sensitive mental health care to immigrants, such as developing community‐based prevention programmes.
Prevalence and clinical features of patients with concurrent HBsAg and anti‐HBs: Evaluation of the hepatitis B research network cohort
Authors: Lee William M. , King Wendy C. , Schwarz Kathleen B. , Rule Jody , Lok Anna S. F. ,   the HBRN Investigators
Published: May 2020

The prevalence of concurrent HBsAg and anti‐HBs in plasma of persons with chronic hepatitis B virus (HBV) infection is variable and its clinical significance enigmatic. We examined the prevalence and clinical and virological features of concurrent HBsAg and anti‐HBs in children and adults with chronic HBV infection living in North America. A total of 1462 HBsAg positive participants in the Hepatitis B Research Network paediatric and adult cohorts were included (median age 41 (range 4‐80) years, 48% female, 11% white, 13% black, 73% Asians). Only 18 (1.2%) were found to be anti‐HBs positive (≥10 mIU/mL) at initial study evaluation. Distributions of sex, race, HBV genotype and ALT were similar between participants with and without concurrent anti‐HBs. Those who were anti‐HBs positive appeared to be older (median age 50 vs 41 years, P = .06), have lower platelet counts (median 197 vs 222 × 103/mm3, P = .07) and have higher prevalence of HBeAg (44% vs 26%, P = .10). They also had lower HBsAg levels (median 2.0 vs 3.5 log10 IU/mL, P = .02). Testing of follow‐up samples after a median of 4 years (range 1‐6) in 12 of the 18 participants with initial concurrent anti‐HBs showed anti‐HBs became undetectable in 6, decreased to <10 mIU/mL in 1 and remained positive in 5 participants. Two patients lost HBsAg during follow‐up. In conclusion, prevalence of concurrent HBsAg and anti‐HBs was low at 1.2%, with anti‐HBs disappearing in some during follow‐up, in this large cohort of racially diverse children and adults with chronic HBV infection living in North America. Presence of concurrent HBsAg and anti‐HBs did not identify a specific phenotype of chronic hepatitis B, nor did it appear to affect clinical outcomes.
The effects of secondary processing in the unique carbonaceous chondrite Miller Range 07687
Authors: Haenecour Pierre , Floss Christine , Brearley Adrian J. , Zega Thomas J.
Published: May 2020

Our detailed mineralogical, elemental, and isotopic study of the Miller Range (MIL) 07687 meteorite showed that, although this meteorite has affinities to CO chondrites, it also exhibits sufficient differences to warrant classification as an ungrouped carbonaceous chondrite. The most notable feature of MIL 07687 is the presence of two distinct matrix lithologies that result from highly localized aqueous alteration. One of these lithologies is Fe‐rich and exhibits evidence for interaction with water, including the presence of fibrous (dendritic) ferrihydrite. The other lithology, which is Fe‐poor, appears to represent relatively unaltered protolith material. MIL 07687 has presolar grain abundances consistent with those observed in other modestly altered carbonaceous chondrites: the overall abundance of O‐rich presolar grains is 137 ± 3 ppm and the overall abundance of SiC grains is 71 ± 11 ppm. However, there is a large difference in the observed O‐rich and SiC grain number densities between altered and unaltered areas, reflecting partial destruction of presolar grains (both O‐ and C‐rich grains) due to the aqueous alteration experienced by MIL 07687 under highly oxidizing conditions. Detailed coordinated NanoSIMS‐TEM analysis of a large hotspot composed of an isotopically normal core surrounded by a rim composed of 17O‐rich grains is consistent with either original condensation of the core and surrounding grains in the same parent AGB star, or with grain accretion in the ISM or solar nebula.
Reproducibility of carotid sinus massage
Authors: Brignole Michele , Croci Francesco , Solano Alberto , Donateo Paolo , Maggi Roberto , Solari Diana , Bertolone Cristina , Fontana Daniele , Oddone Daniele
Published: May 2020

Aims

The reproducibility of carotid sinus massage (CSM) is debated. The aim of this study was to assess the reproducibility according to the methodology and diagnostic criteria defined by the guidelines on syncope of the European Society of Cardiology.

Method

Among 2800 patients with syncope who underwent CSM in the years 2005‐2019, 109 patients (62 males; mean age 76 ± 10 years) had performed a second CSM after a median of 28 months. Carotid sinus hypersensitivity (CSH) was diagnosed when CSM elicited a pause of >3 s and/or a fall in systolic blood pressure >50 mm Hg without reproduction of spontaneous symptoms. Carotid sinus syndrome (CSS) was established when spontaneous symptoms were reproduced in the presence of bradycardia and/or hypotension.

Results

The reproducibility of CSM was 78% for 18 CSS patients, 41% for 29 CSH patients, and 77% for 62 negative patients. The corresponding interrater agreement was good for CSS (kappa = 0.66), moderate for negative CSM (kappa = 0.42), and poor for CSH (kappa = 0.30). Combining CSH and negative tests, their reproducibility rose to 90% with kappa = 0.66.

Conclusion

CSS but not CSH has a good reproducibility. About half of patients with CSH had a negative response at the second test, thus suggesting a great overlap between them.
The effect of intraoperative methadone during pediatric cardiac surgery on postoperative opioid requirements
Authors: Barnett Annika M. , Machovec Kelly A. , Ames Warwick A. , Homi Hercilia M. , Turi Jennifer L. , Koo Jeannie , Fuller Matthew , Jooste Edmund H.
Published: May 2020

Background

Pain control in pediatric patients undergoing cardiac surgery presents a unique challenge. Postoperatively, many of these patients require long‐term opioid infusions and sedation leading to need for prolonged weaning from opioids and longer hospital stays. We hypothesized that intravenous methadone as the sole opioid in children having cardiac surgery with cardiopulmonary bypass would improve perioperative pain control and decrease overall perioperative use of opioid analgesics and sedatives.

Methods

We instituted a practice change involving pediatric patients aged <18 years who underwent cardiac surgery with cardiopulmonary bypass over a 14‐month period, comparing the patient population who had surgery prior to the institution of intraoperative methadone usage to patients who had surgery in the months following. We then separated patients into two groups: neonatal (aged < 30 days) and non‐neonatal (aged > 30 days to 18 years). Our primary outcome was intraoperative and postoperative opioid requirements measured in morphine equivalents intraoperatively, during the first 24 hours postoperatively, and up to postoperative day 7. Secondary outcomes included extubation rates in the OR, pain and sedation scores, sedation requirements, and time to start of oxycodone.

Results

Patients in both groups had similar demographics. In neonatal patients, the postintervention group required significantly lower doses of intraoperative opioids. There was no statistically significant difference in postoperative opioid use. In non‐neonatal patients, the postintervention group required significantly less intraoperative opioids. Postoperatively, those in the postintervention group required significantly less opioids in the first 24 hours.

Conclusion

The use of intraoperative methadone appears to be a reasonable alternative to the use of fentanyl with potential other benefits both intra‐ and postoperatively of decreased total dose of opioids and other sedatives. Future studies will assess for any improvement in total postoperative opioid requirements during the total hospital stay, and potential use of methadone by the ICU team.
Return Window Decision in A Distribution Channel
Authors: Ma Buqing , Di Chenchen , Hsiao Lu
Published: May 2020

This study investigates a firm's return window decision in a distribution channel. Conventional wisdom posits that compared to a centralized channel, a decentralized channel induces worse services (e.g., a shorter return window) because of double marginalization. We build a model consisting of one manufacturer, one retailer, and consumers who are heterogeneous in their willingness‐to‐pay (WTP) for product quality. Counterintuitively, we find that the return window can be longer in a decentralized channel than in a centralized channel. Furthermore, the return window can decrease along with product quality, which means that high‐quality products can be offered shorter return windows than low‐quality products. When endogenizing product quality, we reveal, contrary to previous findings, that the product quality in a decentralized channel may be higher, even when consumer heterogeneity in product quality follows a uniform distribution. This higher product quality induces a decentralized channel to generate a consumer surplus higher than that of a centralized channel.