bluuebunny/crossref_metadata_2025 huggingface dataset:
Rural Food Retailing and Independent Grocery Retailer Exits
Authors: Çakır Metin , Kong Xiangwen , Cho Clare , Stevens Alexander
Published: August 2020

We investigate the food retailing landscape and the exit of independent grocery stores in rural America using U.S. NETS data. Our paper makes several contributions that could potentially help the agenda for future research and public policy. We begin by documenting local concentration trends in food retailing and how they change across rural and urban markets from 1990 to 2015. Then, we conduct two event studies to examine how entry by a large chain is associated with the local market concentration and independent grocery retailer (IGR) exits. Last, we document the IGR exit rate in rural markets for a period of twenty‐five years and investigate its determinants in a regression framework. Our results show that market concentration in food retailing has increased since 1990, but the increasing trend after the Great Recession of 2008 is particularly noticeable. The local concentration differs substantially by the urban status of markets. Focusing on rural markets, we show that entry by a large food retailer is associated with higher market concentration and the decreasing number of IGRs. We also find that the annual average IGR exit rate is around 6.6% during the study period. The IGRs that are younger that operate in relatively more competitive markets, and that face entry by a large chain, are more likely to exit. Also, IGR rates are higher in markets with lower median income and higher poverty rates. We discuss how our results can potentially inform policies on sustainable rural development, food access, and food insecurity in rural communities.
Delayed referral increases the need for surgery and intervention in patients with acute pancreatitis
Authors: Muktesh Gaurav , Samanta Jayanta , Kumar Singh Anupam , Gupta Pankaj , Sinha Saroj K. , Kumar Hemant , Gupta Vikas , Yadav Thakur D. , Kochhar Rakesh
Published: August 2020

Background

The aim was to study the outcomes of acute pancreatitis (AP) patients who were referred from other facilities to a tertiary care centre.

Methods

Patients with AP were who were referred from other hospitals to a tertiary care centre between April 2013 and September 2019 were studied and their outcomes were analysed. Comparison was made between patients referred early (≤7 days) versus those referred late (>7 days).

Results

Of the 838 patients seen by us, 650 patients (77.6%) were referred from other centres. Median (interquartile range) onset to admission interval was 5 (4–7) days for those who were referred ≤7 days and was 16 (11–30) for those who were referred >7 days. Patients referred beyond 7 days of pain onset had higher rates of development of organ failure (P = 0.007), including acute lung injury (P = 0.008) and acute kidney injury (P = 0.026), infected necrosis (P < 0.0001), requirement of endoscopic/percutaneous drainage (P < 0.001) and need for surgery (P < 0.02) compared to patients who were referred ≤7 days of pain onset. Mortality was however similar in the two groups.

Conclusion

Patients with AP referred to a specialized centre with AP early (≤7 days) have better outcomes than those referred late (>7 days) from other facilities.
The characterization of cycad palm toxicosis and treatment effects in 130 dogs
Authors: Lake BB , Edwards T , Atiee G , Stone R , Scott L
Published: August 2020

The purpose of this retrospective study is to characterize the clinical signs, laboratory values, treatment modalities and mortality outcomes related to cycad palm toxicosis in dogs and to identify medical interventions that potentially correlate with mortality. Dogs with confirmed cycad palm ingestion were identified by reviewing medical records from two private veterinary referral centres for key terms and phrases indicative of cycad palm toxicosis. Of 130 dogs included, 107 (82.3%) presented with clinical signs. A total of 2 (1.5%) died and 14 (10.8%) were euthanized. Diarrhea, lethargy and mortality were all associated with an elevated initial alanine transaminase (ALT) concentration. Overall mortality was 12.3%, with a significantly higher proportion of dogs with an ALT concentration <125 U/L surviving compared to dogs with an elevated ALT concentration. Treatment with activated charcoal reduced the odds of death among all dogs by 82% and was even more protective among dogs with an elevated initial ALT concentration. Among dogs that had an initial platelet count performed, the presence of thrombocytopenia (<200,000/μL) was a negative prognostic indicator and was associated with a significant increase in mortality. Given the high mortality rates reported for cycad palm toxicosis, it is imperative to identify early clinical indicators of mortality as well as treatments that reduce mortality.
Faecal PCR panel results and clinical findings in Western Australian dogs with diarrhoea
Authors: Kim MW , Sharp CR , Boyd CJ , Twomey LN
Published: August 2020

Aim

To describe faecal PCR (fPCR) results and clinical findings of dogs seen at a university teaching hospital for diarrhoea.

Design

Retrospective case series (April 2015 to July 2018).

Procedure

Data were collected from the hospital electronic medical records. Data extracted included signalment, history, clinical signs, treatment, fPCR panel results, other faecal diagnostic test results and antimicrobial use.

Results

One hundred and sixty‐eight dogs with diarrhoea had a fPCR panel submitted. Most dogs (115, 68.5%) had diarrhoea of 3 days or less duration. Clostridium perfringens alpha toxin gene was most frequently detected (156, 92.9%) by fPCR, followed by Campylobacter spp. (55, 32.7%), canine parvovirus (CPV) (29, 17.3%), Salmonella spp. (14, 8.3%) and Giardia spp. (9, 5.4%). For the 45 dogs that had a negative point‐of‐care CPV test, 13 were CPV fPCR positive; some of which were adult dogs with current vaccination status. A total of 94/168 (56%) dogs received antimicrobials at some time during the treatment of diarrhoea.

Conclusion

Faecal PCR panels can identify dogs with enteric organisms in their faeces that traditional faecal diagnostics may miss, thus contributing additional information to the diagnostic process. Nonetheless, fPCR results should be interpreted in light of the clinical findings, and particular consideration given to avoiding inappropriate use of antimicrobials. This study highlights that testing for C. perfringens alpha toxin gene is not likely to be diagnostically helpful, and that adult dogs with diarrhoea might be identified as CPV positive with PCR testing, despite a negative point‐of‐care CPV test result and a current vaccination status.
The burden of alcohol on health care during COVID‐19
Authors: Stockwell Tim , Andreasson Sven , Cherpitel Cheryl , Chikritzhs Tanya , Dangardt Frida , Holder Harold , Naimi Timothy , Sherk Adam
Published: August 2020

Alcohol's impact on global health is substantial and of a similar order of magnitude to that from COVID‐19. Alcohol now also poses specific concerns, such as increased risk of severe lung infections, domestic violence, child abuse, depression and suicide. Its use is unlikely to aid physical distancing or other preventative behavioural measures. Globally, alcohol contributes to 20% of injury and 11.5% of non‐injury emergency room presentations. We provide some broad comparisons between alcohol‐attributable and COVID‐19‐related hospitalisations and deaths in North America using most recent data. For example, for Canada in 2017 it was recently estimated there were 105 065 alcohol‐attributable hospitalisations which represent a substantially higher rate over time than the 10 521 COVID‐19 hospitalisations reported during the first 5 months of the pandemic. Despite the current importance of protecting health‐care services, most governments have deemed alcohol sales to be as essential as food, fuel and pharmaceuticals. In many countries, alcohol is now more readily available and affordable than ever before, a situation global alcohol producers benefit from and have helped engineer. We argue that to protect frontline health‐care services and public health more generally, it is essential that modest, evidence‐based restrictions on alcohol prices, availability and marketing are introduced. In particular, we recommend increases in excise taxation coupled with minimum unit pricing to both reduce impacts on health‐care services and provide much‐needed revenues for governments at this critical time.
Self‐perception of assisting with future injection drug initiation: The influence of relationships in the process of drug injecting initiation
Authors: Bloom Brittnie E. , Jain Sonia , Sun Xiaoying , Garfein Richard S. , Strathdee Steffanie A. , Milloy M‐J , Hayashi Kanna , DeBeck Kora , Bluthenthal Ricky , Werb Dan , Rafful Claudia
Published: August 2020

Introduction and Aims

People who inject drugs (PWID) play critical roles in assisting others into injection drug use (IDU) initiation. Understanding perceptions of PWID's risk of initiating others is needed to inform interventions for prevention. The objective was to examine factors associated with self‐perception of assisting with future IDU initiation events. The primary variables of interest are the relationships of PWID with the person(s) they assisted and their reasons for previously providing initiation assistance.

Design and Methods

Data from Preventing Injecting by Modifying Existing Responses, a multi‐site prospective community‐recruited cohort study, were analysed. Analyses were restricted to PWID who reported ever providing IDU initiation assistance. Site‐specific (Vancouver, Canada [n = 746]; San Diego, USA [n = 95] and Tijuana, Mexico [n = 92]) multivariable logistic regression analyses were performed to determine factors associated with self‐perception of assisting with future IDU initiation.

Results

Having provided IDU initiation assistance to a family member or intimate partner decreased the odds of self‐perception of assisting with future IDU initiation in Vancouver (AOR = 0.4; 95% CI 0.2–0.8); however, previous IDU initiation assistance to an ‘other’ increased the odds of self‐perception of assisting with future IDU in Tijuana (AOR = 12.0; 95% CI 2.1–70.3). Daily IDU (Vancouver: AOR = 3.7; 95% CI 2.1–6.4) and less than daily IDU (San Diego: AOR = 5.9; 95% CI 1.3–27.1) (Vancouver: AOR = 2.6; 95% CI 1.4–2.9) were associated with increased self‐perception of assisting with future IDU compared to current non‐injectors.

Discussion and Conclusions

Relationship to past initiates and IDU frequency might increase PWID's self‐perception of assisting with future IDU. Interventions focused on social support and reducing IDU frequency may decrease occurrences of IDU initiation assistance.
Effect of corrosion on the fatigue behaviour of butt welds of G20Mn5QT cast steel and Q345D hot rolled steel in 3.5‐wt% NaCl solution
Authors: Han Qinghua , Wang Xin , Lu Yan
Published: August 2020

Corrosion fatigue experiments are carried out on butt welds of G20Mn5QT cast steel and Q345D hot rolled steel in simulated seawater. The cyclic stress versus number of cycles to failure (S‐N) curve was fitted. The mechanism of crack nucleation at different fracture locations and at different stress levels is analysed. The results show that compared with the S‐N curve of laboratory air, for the S‐N curve of simulated seawater, the number of fatigue failure cycles is significantly reduced when the maximum cyclic stress is less than 190 MPa. At higher stress levels, stress concentrations caused by internal defects near the surface of the weld zone and the heat‐affected zone of G20Mn5QT cast steel cause crack nucleation. At lower stress levels, the main reason for crack nucleation is the stress concentration caused by corrosion pitting. However, there are no obvious internal defects in the heat‐affected zone of the Q345D steel, and corrosion pitting is the main cause of crack nucleation. The stress concentrations caused by pitting lead to crack nucleation.
Unravelling material/digital shopping space: An assemblage approach
Authors: Rao Fujie
Published: August 2020

In this paper, I propose a new retail typology to explore emerging shopping space through the lens of assemblage thinking. The recent rise of online retailing has stimulated substantial net‐closures of brick‐and‐mortar shops—what some call the “retail apocalypse". While being widely covered by the news media, the impact of online retailing on shopping space receives little attention in existing research. There is, in particular, a lack of a retail typology that regards online retailing as a form of shopping space. The current four primary typologies of scale, retail offer, control, and morphology are biased towards material shopping centres (agglomeration of shops). In an attempt to tackle this issue, I introduce Deleuzian assemblage theory. Assemblage prioritises interrelation, transformation, and difference, and suggests that both the virtual and actual are real and they can morph into a whole. In light of assemblage, I redefine a retail type as a “diagram” depicting how some shopping spaces work in general while still being geared to the particularity of each instance, and I focus on the “interface” between people and shops. This diagrammatic typology of interface could thus be adapted to emergent and diversified material, digital, and material/digital shopping spaces.
Geographies of purpose built student accommodation: Exclusivity, precarity and (im)mobility
Authors: Reynolds Alice
Published: August 2020

Purpose Built Student Accommodation is increasingly dominating the urban landscapes of university locations. Yet a focus on student accommodation beyond “studentification” remains under‐researched and under‐analysed in geography and housing studies. Drawing upon pre‐existing studies and new insights from the United Kingdom and Republic of Ireland, this paper provides an analysis of the contemporary student accommodation sector and the distinct geographies this creates. The paper argues that the neoliberalisation of the student accommodation sector has (re)produced three distinct outcomes: exclusivity, precarity, and (im)mobility, themes of increasing attention within geography and beyond. In concluding, the paper argues that student accommodation is a key vector in which inequalities produced by neoliberalism are articulated and displayed, reflective of a wider global trend.
Evidence‐practice gaps in P2Y12 inhibitor use after hospitalisation for acute myocardial infarction: findings from a new population‐level data linkage in Australia
Authors: Falster Michael O. , Schaffer Andrea L. , Wilson Andrew , Nasis Arthur , Jorm Louisa R. , Hay Melanie , Leeb Kira , Pearson Sallie‐Anne , Brieger David
Published: August 2020

Background

P2Y12 inhibitor therapy is recommended for 12 months in patients hospitalised for acute myocardial infarction (AMI) unless the bleeding risk is high.

Aims

To describe real‐world use of P2Y12 inhibitor therapy following AMI hospitalisation.

Methods

We used population‐level linked hospital data to identify all patients discharged from a public hospital with a primary diagnosis of AMI between July 2011 and June 2013 in New South Wales and Victoria, Australia. We used dispensing claims to examine dispensing of a P2Y12 inhibitor (clopidogrel, prasugrel or ticagrelor) within 30 days of discharge and multilevel models to identify predictors of post‐discharge dispensing and persistence of therapy to 1 year.

Results

We identified 31 848 patients hospitalised for AMI, of whom 56.8% were dispensed a P2Y12 inhibitor within 30 days of discharge. The proportion of patients with post‐discharge dispensing varied between hospitals (interquartile range: 25.0–56.5%), and significant between‐hospital variation remained after adjusting for patient characteristics. Patient factors associated with the lowest likelihood of post‐discharge dispensing were: having undergone coronary artery bypass grafting (odds ratio (OR): 0.17; 95% confidence intervals (CI): 0.15–0.20); having oral anticoagulants dispensed 180 days before or 30 days after discharge (OR: 0.39, 95% CI: 0.35–0.44); major bleeding (OR: 0.68, 95% CI: 0.61–0.76); or being aged ≥85 years (OR: 0.68, 95% CI: 0.62–0.75). A total of 26.8% of patients who were dispensed a P2Y12 inhibitor post‐discharge discontinued therapy within 1 year.

Conclusion

Post‐hospitalisation use of P2Y12 inhibitor therapy in AMI patients is low and varies substantially by hospital of discharge. Our findings suggest strategies addressing both health system (hospital and physician) and patient factors are needed to close this evidence‐practice gap.
Incidence and risk factors of surgical site infection after intertrochanteric fracture surgery: A prospective cohort study
Authors: Zhao Kuo , Zhang Junzhe , Li Junyong , Meng Hongyu , Wang Zhongzheng , Zhu Yanbin , Hou Zhiyong , Zhang Yingze
Published: August 2020

Surgical site infection (SSI) is a challenging complication after intertrochanteric fracture surgery but without a large‐sample size study to investigate the incidence and risk factors of it. The present study was to investigate the incidence and risk factors of SSI after intertrochanteric fracture surgery. A total of 1941 patients underwent intertrochanteric fracture surgery between October 2014 and December 2018 were included. Demographic data, surgical variables, and preoperative laboratory indexes were obtained from a prospective database and reviewed by hospital records. The optimum cut‐off value for quantitative data was detected by receiver operating characteristic analysis. The univariate analysis and multivariable analysis were conducted to analyse the risk factors. In total, 25 patients (1.3%) developed SSI, including 22(1.1%) superficial infection and 3(0.2%) deep infection. After adjustment of multiple variables, gender (odds ratio[OR] 2.64, P = .024), time to surgery>4 days (OR 2.41, P = .046), implant (intramedullary or extramedullary devices) (OR 2.96, P = .036), ALB<35 g/L (OR 2.88, P = .031) remained significant factors. In conclusion, the incidence of SSI after intertrochanteric fractures surgery was 1.3%, with 1.1% for superficial and 0.2% for deep infection. Gender, time to surgery>4 days, the implant (intramedullary or extramedullary devices), and ALB<35 g/L were independent risk factors for the rate of SSI.
The effect of continuous diffusion of oxygen treatment on cytokines, perfusion, bacterial load, and healing in patients with diabetic foot ulcers
Authors: Lavery Lawrence A. , Killeen Amanda L. , Farrar David , Akgul Yucel , Crisologo Peter A. , Malone Matthew , Davis Kathryn E.
Published: August 2020

To evaluate continuous diffusion of oxygen therapy (CDO) on cytokines, perfusion, and bacterial load in diabetic foot ulcers we evaluated 23 patients for 3 weeks. Tissues biopsies were obtained at each visit to evaluate cytokines and quantitative bacterial cultures. Perfusion was measured with hyperspectral imaging and transcutaneous oxygen. We used paired T tests to compare continuous variables and independent T tests to compare healers and nonhealers. There was an increase from baseline to week 1 in TGF‐β (P = .008), TNF‐α (P = .014), VEGF (P = .008), PDGF (P = .087), and IGF‐1 (P = .058); baseline to week 2 in TGF‐β (P = .010), VEGF (P = .051), and IL‐6 (P = .031); and baseline to week 3 with TGF‐β (P = .055) and IL‐6 (P = .054). There was a significant increase in transcutaneous oxygen after 1 week of treatment on both medial and lateral foot (P = .086 and .025). Fifty‐three percent of the patients had at least a 50% wound area reduction (healers). At baseline, there were no differences in cytokines between healers and nonhealers. However, there was an increase in CXCL8 after 1 week of treatment (P = .080) and IL‐6 after 3 weeks of treatment in nonhealers (P = .099). There were no differences in quantitative cultures in healers and nonhealers.
Heal or no heel: Outcomes of ischaemic heel ulcers following lower limb revascularization from a multi‐ethnic Asian Cohort in Singapore
Authors: Linn Yun Le , Chan Sze Ling , Soon Shereen Xue Yun , Yap Charyl Jia Qi , Lim Mervin Nathan Han Hui , Lee Qing Wei Shaun , Chong Tze Tec , Tang Tjun Yip
Published: August 2020

Ischaemic diabetic heel ulcers are difficult to treat and prognosis is often guarded. The aim was to document our outcome of treating heel ulcers following revascularization in a predominantly diabetic Asian cohort presenting with chronic limb threatening ischaemia from Singapore. Retrospective cohort study (n = 66, 66 limbs) over a 5‐year period. Data were collected from hospital electronic health records. Outcomes included time to healing, amputation free survival (AFS), and mortality. Minimum follow‐up period was 6 months. Multivariate regression analysis was performed to look for factors associated with poor outcome. Mean age was 67.4 ± 8.8 years. 62/66 (93.9%) were diabetics. Mean wound size at presentation was 3.6 ± 2.3 cm. Mean Wound, Ischaemia, Foot Infection (WIFI) score was 5 ± 1.6. 12/66 (18%) patients had a patent posterior tibial artery pre‐operatively. Straight line flow was restored in only 31/66 (46.9) patients but 47/66 (71.2%) had successful limb salvage. Median time to wound healing was 90.0 (IQR 60‐180) days. A median of 1 (IQR 0‐2) wound debridement was required. Patients who underwent negative pressure dressing (23/66; 34.8%) required a median of 26 (IQR 13‐33) cycles to achieve healing. Amputation free survival (AFS) was 72% and 68% at 6‐ and 12‐months, respectively. Mortality rate was 16.7% and 19.7% at 6‐ and 12‐months, respectively. Low albumin level and initial Rutherford class were independent predictors of worse 6‐month AFS. Outcomes of heel ulcers post revascularisation may not be as poor as previously described. Persistent attention to wound care with multidisciplinary effort is needed for optimal healing.
Physiological response and earliness of soybean genotypes to soil base saturation conditions
Authors: Alves de Andrade Cristiane , Ramsdorf Gomes Patinni Isabela , de Andrea Pantaleão Ariane , Pereira Ribeiro Teodoro Larissa , Naudi Silva Campos Cid , Pereira de Souza Jonas , de Mello Prado Renato , Antonio da Silva Junior Carlos , Eduardo Teodoro Paulo
Published: August 2020

Low base saturation (V) is one of the major abiotic stresses in the Brazilian Cerrado. Given this scenario, it is important to evaluate different physiological responses of genotypes in environments with and without liming aiming at select both liming responsive and low‐saturation tolerant genotypes. The hypothesis of this study is that contrasting V conditions provide changes in physiological performance of soybean genotypes. Thus, our objective was to select soybean genotypes in environments with recommended and low V. Two field experiments were carried in randomized block design with three replicates and 10 F3 soybean genotypes (P1, P2, P3, P4, P5, P6, P7, P8, P9 and P10). In the first experiment, genotypes were evaluated without V correction (V = 30%), while in the second experiment, a liming was performed three months before to raise V to 60%. The traits evaluated were as follows: calcium and magnesium contents, days for maturation, transpiration, net photosynthesis, stomatal conductance and internal CO2 concentration. Our findings indicate that the physiological performance of soybean genotypes depends on the saturation condition. The P9 genotype obtained the best physiological performance under recommended V and can be used to obtain F3:4 lines physiologically responsive to soil correction. The P5 genotype obtained the best physiological performance at low V and can be used to obtain F3:4 lines aiming at a higher tolerance to low saturation. Considering that the Brazilian soils, especially in the Cerrado, are mostly poorly fertile, our study provide crucial information for soybean breeding programmes aiming at selecting genotypes tolerant to limiting environmental conditions.
Environmental factors associated with biological use and surgery in inflammatory bowel disease
Authors: van der Sloot Kimberley W J , Geertsema Paul , Rijkmans Hanneke C , Voskuil Michiel D , van Dullemen Hendrik M , Visschedijk Marijn C , Festen Eleonora A M , Weersma Rinse K , Alizadeh Behrooz Z , Dijkstra Gerard
Published: August 2020

Background and Aim

While major efforts were made studying the complex etiology of inflammatory bowel disease (IBD) including environmental factors, less is known about underlying causes leading to the heterogeneous and highly variable course of disease. As cigarette smoking cessation is the best‐known environmental factor with beneficial effect in Crohn's disease (CD), more exposome factors are likely involved. Further insights into the role of the exposome in heterogeneity of disease might not only further knowledge of underlying pathways, but also allow for better risk stratification.

Methods

Seven hundred twenty‐eight IBD patients completed the validated Groningen IBD Environmental Questionnaire, collecting exposome data for 93 exposome factors. Associations with disease course, that is, for need for surgery or biological therapy, were evaluated using univariate and multivariate‐adjusted logistic regression modeling.

Results

No significant associations were seen after Bonferroni correction. However, 11 novel exposome factors were identified with P < 0.05. Two factors were associated with course of CD and ulcerative colitis (UC): beer (CD OR0.3/UC OR0.3) and cannabis (0.5/2.2). While in CD, carpet flooring (0.5) was associated with biological use, and four factors were associated with surgery: working shifts (1.8), appendectomy (2.4), frequent tooth brushing (2.8), and large household size (0.1). For UC, migrants more often required biologicals (10.2). Childhood underweight (3.4), amphetamine use (6.2), and cocaine use (4.8) were associated with surgery. Five factors were replicated.

Conclusions

We identified 16 environmental factors nominally associated with biological use and surgery in established IBD. These new insights form an important stepping stone to guide research on biological pathways involved, risk stratification, tailor‐made interventions, and preventive strategies in IBD.
Vitamin D receptor is overexpressed in the duodenum of patients with irritable bowel syndrome
Authors: Miura Ko , Oshima Tadayuki , Ito Chiyomi , Horikawa Tomoki , Yamada Mayumi , Tomita Toshihiko , Fukui Hirokazu , Miwa Hiroto
Published: August 2020

Background and Aim

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders, and bile acids are thought to be associated with the pathogenesis of IBS. Bile acid receptors are expressed on intestinal epithelial cells. However, no study has assessed bile acid receptor proteins in IBS. Therefore, we examined the intestinal mucosal expression of bile acid receptors in patients with IBS.

Methods

Intestinal biopsies were performed in patients with IBS and controls. Mast cells, vitamin D receptor (VDR), and somatostatin were stained with specific antibodies. Levels of VDR, farnesoid X receptor (FXR), takeda‐G‐protein‐receptor‐5 (TGR5), claudins, and transient‐receptor‐potential‐cation‐channel‐subfamily‐V‐member 6 (TRPV6) were assessed by western blotting.

Results

Mast cell counts in the second part of the duodenum were significantly higher in patients with IBS than in controls. VDR protein levels were significantly elevated in the duodenum and terminal ileum of patients with IBS compared with controls, although this difference was not seen in the cecum or rectum. FXR and TGR5 protein levels did not differ in any part of the intestine. VDR‐positive cryptal epithelia in IBS were distributed not only at basal crypt but also along the upper part of the basal crypt epithelial cells. In contrast, the pattern of gut somatostatin‐positive cells, claudins, and TRPV6 levels did not differ.

Conclusions

The number of mast cells in the duodenum was significantly increased, and the protein expression levels of VDR, but not those of FXR or TGR5, were elevated in the duodenal epithelial crypt in patients with IBS.
The Health Care Provider's Role in Securing Work Accommodations for Pregnant and Postpartum Patients
Authors: Franco Juliana , Morris Liz , Lee Jessica , Williams Joan C.
Published: August 2020

Most women today are the primary, sole, or cobreadwinners for their families; their continued ability to work during and after pregnancy is crucial for their families’ well‐being. Midwives and other health care providers are regularly asked to provide work notes for patients who need adjustments to how, when, or where their job is done to continue working while maintaining a healthy pregnancy or breastfeeding. Whereas an improperly written work note can result in the patient being forced out on leave or losing their job, an effectively written work note from a health care provider can ensure the patient will receive the adjustments they need to stay safe and healthy on the job. Health care providers can also play an important role by incorporating discussions about workplace issues into care conversations. This article provides an overview of pregnancy‐related employment rights, guidelines for writing effective work notes, and a discussion of common workplace issues patients face and how health care providers can respond.
Epidemiology of pregnancy‐associated pulmonary embolism in South Asian multi‐ethnic country: Mortality trends over the last four decades
Authors: Tan Thiam Chye , Goh Cheryl Ming Ying , Tan Sophie Seine Xuan , Tan Lay Kok , Yang Yong , Lee Lai Heng
Published: August 2020

Objective

To determine the cumulative incidence, time of occurrence and risk factors of pregnancy‐associated pulmonary embolism (PE) in Singapore, and to review the maternal mortality ratio of PE over the last four decades.

Study design and setting

In this retrospective epidemiology review, women with pregnancy‐associated PE were identified via International Classification of Diseases codes and included if they had been objectively diagnosed on imaging with PE during pregnancy or within 6 weeks postpartum from 2004 to 2016 at KK Women's and Children's Hospital (KKH) and Singapore General Hospital (SGH) in Singapore. The medical records were reviewed and the time of occurrence of confirmed PE cases and risk factors for PE were noted.

Results

There were 18 PE cases out of 174 708 deliveries, of which two were fatal, giving a cumulative incidence of PE at 1.03 per 10 000 deliveries and a mortality rate of 11.1%. The maternal mortality ratio is 1.14 per 100 000 deliveries, the lowest compared to that of the previous three decades (2.5–4.9 per 100 000 deliveries). Majority of PE (66.7%) occurred during the first 2 weeks postpartum. Cumulative incidence of postpartum PE was four times more in caesarean section compared to vaginal delivery at 1.58 per 10 000 deliveries and 0.40 per 10 000 deliveries, respectively.

Conclusion

Although the cumulative incidence of pregnancy‐associated PE in Singapore is low, it is comparable to the United Kingdom (UK) and United States (US). Risk assessment and thromboprophylaxis have decreased PE mortality significantly during this period.
Supplementation of citric acid in plant protein‐based diets for juvenile tambaqui, Colossoma macropomum
Authors: Nascimento Marcelo dos S. , de Mattos Bruno O. , Bussons Márcia R. F. M. , de Oliveira Adriano T. , Liebl Ariany R. da S. , Carvalho Thaís B.
Published: August 2020

We evaluated citric acid supplementation (0, 10, 20, and 30 g/kg) in plant protein‐based diets for juvenile tambaqui, Colossoma macropomum. In Experiment 1, fish (n = 160; 27.56 ± 2.73 g) were distributed in 310 L tanks (n = 16) for 80 days. Zootechnical performance, hematological parameters, and mineral composition (muscle and bones) did not differ significantly (p > .05). The inclusion of citric acid‐reduced pH of diets (p = .001) and stomach (p = .035). In Experiment 2, fish (n = 60; 48.00 ± 1.98 g) were distributed in fecal collection aquaria (200 L) for 21 days. The following were observed: a linear effect for the crude protein (p = .0004) and crude fat (p = .0037) digestibility coefficients; a quadratic effect for crude energy (p = .0037) and dry matter (p = .0004); an optimal supplementation level of 18.5 g/kg. Calcium (p = .0060) and magnesium (p = .0222) showed a linear effect, while phosphorus (p = .0001) had a quadratic effect with the 20 g/kg optimum supplementation level. To conclude, the supplementation of this organic acid in diets does not negatively affect fish nutritional status, health or welfare, and increases nutrient and mineral availability.
Water quality for young children in Cambodia—High contamination at collection and consumption level
Authors: Poirot Etienne , Som Somphos Vicheth , Wieringa Frank T. , Treglown Sam , Berger Jacques , Laillou Arnaud
Published: August 2020

Unsafe drinking water is a leading cause of child morbidity, especially among young children in low‐income settings. Safe water consumption requires high‐quality water available at its source and at point of use. We examined the quality of drinking water at point of collection and point of use in 796 households in three provinces, in Cambodia. Microbiological testing for coliform andEscherichia colicontamination was conducted for samples collected. Bivariable analysis and multivariable logistic regression were used to examine associations between various factors and the deterioration in water quality (increase in the risk according coliform orE. coliconcentration) between point of collection and point of use. Contamination with both coliforms andE. coliwas higher at point of use than at point of collection, with contamination at point of collection to account for 76.6% (coliforms) and 46.3% (E. coli). Results suggest that child drinking water represents a considerable pathway for the ingestion of pathogens, in Cambodia. Area of residence, seasonality, type of water source, and water chlorination were associated with coliform concentration between the point of collection and point of use, whereas only seasonality was associated withE. colicontamination (OR = 1.46; 95% CI [1.05, 2.02]). Children living in rural settings were two times more likely to drink water with a deteriorating coliform concentration between the two‐time points than children living in urban settings (OR = 2.00; 95% CI [1.22, 3.30]). The increase in coliform andE. coliconcentrations between point of collection and point of use indicates that water contamination mostly occurs within the household. Strengthening national legislation on water quality standards and promoting safe water management at the household are needed.
High double burden of child stunting and maternal overweight in the Republic of the Marshall Islands
Authors: Blankenship Jessica L. , Gwavuya Stanley , Palaniappan Uma , Alfred Julia , deBrum Frederick , Erasmus Wendy
Published: August 2020

Many low‐ and middle‐income countries are faced with a double burden of malnutrition characterized by a stagnating burden of undernutrition and an increasing prevalence of overweight and obesity often observed both at population and household levels. We used data from the 2017 National Integrated Child Health and Nutrition Survey in the Republic of the Marshall Islands to explore the prevalence of overweight mother‐stunted child pairs (mother–child double burden, MCDB). We used bivariate analysis, multivariate logistic regression, and multinomial logistic regression analysis to explore associations between child‐, maternal‐, and household‐level variables and both stunting and MCDB and other types of maternal–child pairs. Our results indicate that nearly three out of four mothers were overweight or obese and one in four households is home to an overweight mother with a stunted child. The risk of child stunting and of MCDB were largely associated with maternal characteristics of lower maternal height, maternal age at birth, years of education, and marital status and household economic status as measured by wealth index and number of household members. These findings support the growing body of evidence showing that the coexistence of high maternal overweight and child stunting (MCDB) has linked root causes to early life undernutrition that are exacerbated by the nutrition transition.
Complementary feeding practices and associated factors among Mongolian children 6–23 months of age
Authors: Janmohamed Amynah , Luvsanjamba Munkhjargal , Norov Bolormaa , Batsaikhan Enkhtungalag , Jamiyan Batjargal , Blankenship Jessica L.
Published: August 2020

Little is known about factors influencing children's dietary intake in Mongolia, a country undergoing rapid nutrition transition. Using nationally representative data from the 2017 Mongolia National Nutrition Survey, we assessed the nutritional status of children aged <2 years and examined household, maternal, and child factors associated with feeding practices among children aged 6–23 months (n = 938). Multivariable logistic regression models were used to identify predictors of minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD). The prevalence of child stunting (length/height‐for‐age Z‐score < −2 SD) was 6.3%, and the prevalence of overweight (weight‐for‐height Z‐score > +2 SD) was 16.8%. The prevalence of anaemia and iron deficiency was 39.0% and 32.2%, respectively, and 73.5% and 85.5% of children had inadequate vitamin A and vitamin D status, respectively. Of children aged 6‐23 months, 92.1% (n = 864) had MMF, 49.6% (n = 465) had MDD, and 43.8% (n = 411) achieved MAD. Increased household wealth was positively associated with all three indicators, whereas severe food insecurity was not associated with MMF, MDD, or MAD. Older child age (odds ratio, 95% CI: 1.09 [1.06, 1.12]; p < .001) and maternal dietary diversity (odds ratio, 95% CI: 2.36 [1.67, 3.34]; p < .001) were positively associated with child MDD. Nutrition‐specific and nutrition‐sensitive efforts are needed to improve the dietary quality of infants and young children in Mongolia and reduce the high burdens of child micronutrient deficiency and overweight in the country.
Characterization of putative interneurons in the myenteric plexus of human colon
Authors: Humenick Adam , Chen Bao Nan , Wattchow David A. , Zagorodnyuk Vladimir P. , Dinning Phil G. , Spencer Nick J. , Costa Marcello , Brookes Simon J. H.
Published: August 2020

Background

The enteric nervous system contains multiple classes of neurons, distinguishable by morphology, immunohistochemical markers, and projections; however, specific combinations differ between species. Here, types of enteric neurons in human colon were characterized immunohistochemically, using retrograde tracing combined with multiple labeling immunohistochemistry, focussing on non‐motor neurons.

Methods

The fluorescent carbocyanine tracer, DiI, was applied to the myenteric plexus in ex vivo preparations, filling neurons projecting within the plexus. Limits of projection lengths of motor neurons were established, allowing them to be excluded from the analysis. Long ascending and descending interneurons were then distinguished by labeling for discriminating immunohistochemical markers: calbindin, calretinin, enkephalin, 5‐hydroxytryptamine, nitric oxide synthase, and substance P. These results were combined with a previous published study in which nitric oxide synthase and choline acetyltransferase immunoreactivities were established.

Key Results

Long ascending neurons (with projections longer than 8 mm, which excludes more than 95% motor neurons) formed four types, in descending order of abundance, defined by immunoreactivity for: (a) ChAT+/ENK+, (b) ChAT+/ENK+/SP+, (c) ChAT+/Calb+, and (d) ChAT+/ENK+/Calb+. Long descending neurons, up to 70 mm long also formed at least four types, distinguished by immunoreactivity for (a) NOS + cells (without ChAT), (b) ChAT+/NOS+, (c) ChAT+/Calret+, and (d) ChAT+/5HT + cells (with or without NOS).

Conclusions and Inferences

Long interneurons, which do not innervate muscularis externa, are likely to coordinate neural activity over distances of many centimeters along the colon. Characterizing their neurochemical coding provides a basis for understanding their roles, investigating their connectivity, and building a comprehensive account of human colonic enteric neurons.
Association of pericardial effusion after pulmonary vein isolation and outcomes in patients with paroxysmal atrial fibrillation
Authors: Do Ungjeong , Kim Jun , Kim Minsoo , Cho Min Soo , Nam Gi‐Byoung , Choi Kee‐Joon , Kim You‐Ho
Published: August 2020

Background

The clinical implications of pericardial effusion (PE) after catheter ablation for atrial fibrillation (AF) are not well understood. We evaluated the association between newly developed PE after pulmonary vein isolation (PVI) for paroxysmal AF and arrhythmic recurrence.

Methods

From a prospective AF ablation registry, 184 patients (mean age 59 ± 10 years, 65% male) who underwent first‐time PV isolation using a smart touch surround flow catheter (Biosense Webster, Diamond Bar, CA) were analyzed. Postablation transthoracic echocardiography (TTE) was performed within 1‐3 days after ablation, and the occurrence of PE was assessed.

Results

PE developed in 91 patients (49.5%), and most were of minimal severity (minimal, 93.4%; mild, 6.6%). Patients with PE had significantly lower body mass index and underwent cavotricuspid isthmus ablation more frequently. Early arrhythmic recurrence (EAR) (within 3 months) was observed in 28.8% of patients and was not different according to the PE development (PE [+]: 29.7% vs PE [−]: 28.0%; P = .80). During a median follow‐up of 696 days, the cumulative rate of the late arrhythmic recurrence (LAR) (after 3 months) was 36.4%, and there was no difference between groups (PE [+]: 36.7% vs PE [−]: 35.1%; P = .988). The only predictor of LAR was EAR, and no echocardiographic parameters showed a significant correlation with LAR.

Conclusions

Minimal or mild PE after PVI for paroxysmal AF is a frequent echocardiographic finding, and it had no significant association with AF recurrence. Routine TTE after AF ablation has no clinical implication.
Glyphosate and nickel differently affect photosynthesis and ethylene in glyphosate‐resistant soybean plants infected by Phakopsora pachyrhizi
Authors: Einhardt Andersom Milech , Ferreira Sandro , Oliveira Lillian Mathias , Ribeiro Dimas Mendes , Rodrigues Fabrício Ávila
Published: August 2020

Nickel (Ni) and glyphosate (Gl) are able to reduce the symptoms of Asian soybean rust (ASR), caused by Phakopsora pachyrhizi, in soybean. However, their combined effects on the energy balance and ethylene metabolism of soybean plants infected with this fungus has not been elucidated. Therefore, the effects of Ni, Gl, and the combination of Ni + Gl on ASR development, photosynthetic capacity, sugar concentrations, and ethylene concentrations in plants of a Gl‐resistant cultivar, uninfected or infected with P. pachyrhizi, were investigated. Inoculated plants supplied with Ni had the highest foliar Ni concentration in all the treatments. Gl had a negative effect on the foliar Ni concentration in Ni‐sprayed plants. The ASR severity was reduced in plants sprayed with Ni and Gl. Carotenoid and chlorophyll concentrations were higher in inoculated Ni, Gl, and Ni + Gl plants than in control plants. Based on the chlorophyll a fluorescence parameters, the photosynthetic apparatus of the control inoculated plants was damaged, and the least amount of energy was directed to the photochemistry process in these plants. The reduced capacity of the photosynthetic mechanism to capture light and use the energy absorbed by photosystem II in inoculated plants was reflected in their reduced capacity to process CO2, as indicated by the high internal CO2 concentrations and low rates of net carbon assimilation. The low sugar concentrations in inoculated plants from the control treatment were linked to their reduced photosynthetic capacity due to the high ASR severity. In uninfected plants, the ethylene concentration was not affected by Ni or Gl, while the ethylene concentration decreased in inoculated plants; this decrease was more pronounced in plants from the control treatment than in treated inoculated plants. In conclusion, this study sheds light on the role played by both Ni and Gl in ASR control from a physiological perspective. Soybean plants exposed to Ni and Gl were able to maintain high ethylene concentrations and photosynthetic capacity during the P. pachyrhizi infection process; as a result, these plants consumed less of their reserves than inoculated plants not treated with Ni or Gl.
Changes in polyamine pattern mediates sex differentiation and unisexual flower development in monoecious cucumber (Cucumis sativus L.)
Authors: Kiełkowska Agnieszka , Dziurka Michał
Published: August 2020

Changes in the levels of polyamines are associated with fundamental physiological processes such as embryogenesis, induction of flowering, fruit development and ripening, senescence, and responses to environmental stresses, but the role of polyamines in sex differentiation and unisexual flower development has not been deeply studied. To extend the knowledge on the regulatory mechanisms of flowering in monoecious plant (producing unisexual flowers), we investigated the morphogenesis and free polyamine levels in Cucumis sativus during sex differentiation and unisexual flower development in vitro using histocytological and biochemical methods. As shown in our study, floral development in vitro was undisturbed and flowers of both sexes were produced. Sex differentiation relied on preventing the development of generative organs of the opposite sex, as we observed carpel repression in male flowers and stamen repression in female flowers. Pollen viability was negatively correlated with female flower development on the same node. Biochemical analysis revealed increased accumulation of aliphatic amines (tri, tetra‐amines) in generative (flower buds and flowers) compare to vegetative (axillary buds and leaves) organs. Undifferentiated floral buds contained elevated levels of agmatine, cadaverine, spermidine and spermine. Sex differentiation was associated with significantly decreased levels of agmatine and cadaverine. Our results showed that female flowers contained higher levels of total polyamine than male flowers. The increased level of cadaverine was associated with macrogametogenesis and female flower maturation. Putrescine was important for male flower development. Such results support the hypothesis that aliphatic amines are involved in unisexual flower development.
Unequally Adrift: How Social Class and College Context Shape Students’ Mentorship Experiences
Authors: Scherer Mary L.
Published: August 2020

Faculty mentorship is a highly advantageous yet under‐explored form of social capital which can grant access to co‐curriculars (e.g., research assistantships), ensure strong letters of recommendation, and more. It is also typically informal and dependent on student initiative, requiring that students be skilled at engaging educational authority figures. Privileged students are most likely to have such skills as part of their dominant cultural capital, making faculty mentorship a site of social reproduction. To explore variations in this process, I compare two institution types: a small, teaching/undergraduate‐focused regional university and a large, research‐intensive flagship. In interviews with 68 working‐ and upper‐middle‐class students, I find that college context mediates the relationship of class background and faculty mentorship. Upper‐middle‐class students fostered advantageous faculty relationships at both universities, but working‐class students diverged: at the flagship, they rarely approached professors in search of mentorship, while those at the regional university described close, beneficial connections with professors. I discuss working‐class students’ dissimilar experiences in terms of each university’s structural and cultural characteristics (organizational habitus), particularly their institutional focus and size. I argue that through their particular organizational features, colleges can both reproduce and reduce inequalities, challenging the determinacy of precollege socialization in education.