bluuebunny/crossref_metadata_2025 huggingface dataset:
Ontario Brain Injury Association Peer Support Program: a mixed methods protocol for a pilot randomised controlled trial
Authors: Munce Sarah E P , Jaglal Susan , Kastner Monika , Nelson Michelle L A , Salbach Nancy M , Shepherd John , Sweet Shane N , Wilcock Ruth , Thoms Carla , Bayley Mark T
Published: March 2019

Introduction

The objective of this study is to conduct a pilot randomised controlled trial (RCT) of the Ontario Brain Injury Association (OBIA) Peer Support Program. The RCT is designed to evaluate the effectiveness and dose–response of the Peer Support Program in improving participation and mood for people with moderate-to-severe traumatic brain injury compared with a wait-list control group.

Methods and analysis

The proposed research is a three-phase, mixed methods pilot RCT. Consistent with an integrated knowledge translation approach, the study design has been informed in consultation with the knowledge user (ie, OBIA). It will include an initial qualitative examination of barriers and enablers to the trial implementation (phase 1), a pilot RCT (phase 2) and conclude with a qualitative component (phase 3). A qualitative descriptive approach will be adopted for both qualitative phases of the study (n=20–25) and thematic analysis will be used. The 6 months phase-2 trial will be conducted with 60 participants. These participants will be randomised to one of three groups: a twice a week programme (n=20), a once a week programme (n=20) or the wait-list control group (n=20). The feasibility of participant recruitment and retention, data collection, as well as participant adherence to the OBIA Peer Support Program will be evaluated. The primary outcome measure will be participation, as measured by the Participation Assessment with Recombined Tools–Objective. Other proposed outcomes of interest will include mood, health-related quality of life and self-efficacy.

Ethics and dissemination

Ethics approval will be obtained from the principal author’s institution (University Health Network Research Ethics Board). The results of this study will inform the development of a larger scale RCT and will inform future iterations of the OBIA Peer Support Program including a revised programme curriculum.

Trial registration number

NCT03450460; Pre-results.
Patient trade-offs between continuity and access in primary care interprofessional teaching clinics in Canada: a cross-sectional survey using discrete choice experiment
Authors: Oliver Doug , Deal Ken , Howard Michelle , Qian Helen , Agarwal Gina , Guenter Dale
Published: March 2019

Objective

Timely access to care and continuity with a specific provider are important determinants of patient satisfaction when booking appointments in primary care settings. Advanced access booking systems restrict the majority of providers’ appointment spots for same-day appointments and keep the number of prebooked appointments to a minimum. In the teaching clinic environment, continuity with the same provider can be a challenge. This study examines trade-offs that patients may consider during appointment bookings for six different clinical scenarios across a number of key access and continuity attributes using a discrete choice experiment (DCE) method.

Design

Cross-sectional survey.

Setting

Two urban family medicine teaching clinics in Canada.

Participants

Convenience sample of 430 patients of family medicine clinics aged 18 and older.

Intervention

Discrete choice conjoint experiment survey.

Primary outcome measures

Patient preferences on six attributes: appointment booking method, appointment wait time, time spent in the waiting room, appointment time convenience, familiarity with healthcare provider and position of healthcare provider. Data were analysed by hierarchical Bayes analysis to determine estimates of part-worth utilities for each respondent.

Results

Patients rated appointment wait time as the most highly valued attribute, followed by position of provider, then familiarity with the provider. Patients showed a significant preference (p<0.02) for their own physician for booking of routine annual check-ups and other logical preferences across attributes overall and by clinical scenario.

Conclusions

Patients preferred timely access to their primary care team over other attributes in the majority of health state scenarios tested, especially urgent issues, however they were willing to wait for a check-up. These results support the notion that advanced access booking systems which leave the majority of appointment spots for same day access and still leave a few for continuity (check-up) bookings, align well with trends in patient preferences.
Is knowledge retained by healthcare providers after training? A pragmatic evaluation of drug-resistant tuberculosis management in China
Authors: Wu Shishi , Li Renzhong , Su Wei , Ruan Yunzhou , Chen Mingting , Khan Mishal S
Published: March 2019

Objectives

Considering the urgent need of training to improve standardised management of drug-resistant infectious disease and the lack of evidence on the impact of training, this study evaluates whether training participants’ knowledge on multidrug-resistant tuberculosis (MDR-TB) is improved immediately and a year after training.

Setting and participants

The study involved 91 MDR-TB healthcare providers (HCPs), including clinical doctors, nurses and CDC staff, who attended a new MDR-TB HCP training programme in Liaoning and Jiangxi provinces, China.

Main outcome measures

A phone-based assessment of participants’ long-term retention of knowledge about MDR-TB management was conducted in July 2017, approximately 1 year after training. The proportion of correct responses in the long-term knowledge assessment was compared with a pretraining test and an immediate post-training test using a χ2test. Factors influencing participants’ performance in the long-term knowledge assessment were analysed using linear regression.

Results

Across both provinces, knowledge of definitions of drug-resistant TB, standardised MDR-TB case detection protocols and laboratory diagnosis was improved 1 year after the training by 14.5% (p=0.037), 32.4% (p<0.001) and 31% (p<0.001) relative to pretraining. However, compared with immediately after training, the knowledge of the three topics declined by 26.5% (p=0.003), 19.8% (p=0.018) and 52.7% (p<0.001) respectively in Jiangxi, while no significant decline was observed in Liaoning. Additionally, we found that obtaining a higher score in the long-term knowledge assessment was associated with longer years of clinical experience (coefficient=0.51; 95 CI% 0.02 to 0.99; p=0.041) and attending training in Liaoning (coefficient=0.50; 95% CI 0.14 to 0.85; p=0.007).

Conclusion

Our study, the first to assess knowledge retention of MDR-TB HCPs 1 year after training, showed an overall positive long-term impact of lecture-style group training on participants’ knowledge. Knowledge decline 1 year after training was observed in one province, Jiangxi, and this may be partly addressed by targeted support to HCPs with fewer years of clinical experience.
Comparison of medical comorbidity between patients with primary angle-closure glaucoma and a control cohort: a population-based study from Taiwan
Authors: Chen Hsin-Yi , Lin Cheng-Li
Published: March 2019

Objective

To determine the prevalence and risk of systemic comorbidities in primary angle-closure glaucoma in Taiwan population.

Methods

We included 3322 primary angle-closure glaucoma (PACG) subjects and randomly selected patients without PACG from the Taiwan National Health Insurance Research Database and frequency matched four of them (n=13 288) to each PACG patient, based on age and sex. The univariable and multivariable unconditional logistic regression models were used to estimate the effect of comorbidities on the risk of PACG as indicated by the OR with 95% CI.

Results

The mean age of the PACG group was 65.2±12.7 years, and 61.1% of the patients were female. The risk of PACG was greater for patients with the comorbidities of hyperlipidaemia (ORs: 1.11), headaches (ORs: 1.13), liver diseases (ORs: 1.14), peptic ulcers (ORs: 1.10) and cataract (ORs: 3.80). For the male group, diabetes (ORs: 1.19), liver diseases (ORs: 1.29) and cataract (ORs: 4.30) were significantly associated with increasing PACG risk. For the female group, hyperlipidaemia (ORs: 1.13), headaches (ORs: 1.15), peptic ulcers (ORs: 1.14) and cataract (ORs: 3.54) were significantly associated with increasing PACG risk. For the age group of 64 years and younger, patients with comorbidity of hyperlipidaemia (ORs: 1.20), peptic ulcers (ORs: 1.21) and cataract (ORs: 5.91) were significantly associated with increasing PACG risk. For the age group of 65 years and older, patients with cataract were significantly associated with increasing PACG risk (ORs: 5.07).

Conclusions

Clinicians should be aware of slightly increased PACG risk in the subjects with the medical comorbidities of hyperlipidaemia, headaches, liver diseases and peptic ulcers. However, cataract is the strongest risk factor of PACG.
Prophylactic epinephrine for the prevention of transbronchial lung biopsy-related bleeding in lung transplant recipients (PROPHET) study: a protocol for a multicentre randomised, double-blind, placebo-controlled trial
Authors: Kalchiem-Dekel Or , Iacono Aldo , Pickering Edward M , Sachdeva Ashutosh , Shah Nirav G , Sperry Mark , Tran Bich-Chieu , Reed Robert M
Published: March 2019

Introduction

Transbronchial lung biopsy (TBLB) is frequently performed in single-lung and double-lung transplant recipients for evaluation of clinical and radiological findings as well as routine surveillance for acute cellular rejection. While rates of clinically significant TBLB-related haemorrhage are <1% for all comers, the incidence in lung transplant recipients is reported to be higher, presumably due to persistent allograft inflammation and alterations in allograft blood flow. While routinely performed by some bronchoscopists, the efficacy and safety profile of prophylactic administration of topical intrabronchial diluted epinephrine for the prevention of TBLB-related haemorrhage has not been explored in a prospective manner.

Methods and analysis

In this randomised, double-blind, placebo-controlled multicentre trial (PROPHET Study), single-lung and double-lung transplant adult recipients from participating institutions who are scheduled for bronchoscopy with TBLB for clinical indications will be identified. Potential participants who meet inclusion and exclusion criteria and sign an informed consent will be randomised to receive either diluted epinephrine or placebo prior to performance of TBLB. The degree of TBLB-related haemorrhage will be graded by the performing bronchoscopist as well as independent observers. The primary analysis will compare the rates of severe and very severe bleeding in participants treated with epinephrine or placebo. The study will also evaluate the safety profile of prophylactic topical epinephrine including the occurrence of serious cardiovascular and haemodynamic adverse events. Additional secondary outcomes to be explored include rates of non-severe TBLB-related haemorrhage, overall yield of the bronchoscopic procedure and non-serious cardiovascular and haemodynamic adverse effects.

Ethics and dissemination

The study procedures were reviewed and approved by institutional review boards in participating institutions. This study is being externally monitored, and a data and safety monitoring committee has been assembled to monitor patient safety and to evaluate the efficacy of the intervention. The results of this study will be published in peer-reviewed scientific journals and presented at relevant academic conferences.

Trial registration number

NCT03126968; Pre-results.
Assessing societal and offender perspectives on the value of offender healthcare: a stated preference research protocol
Authors: Settumba Stella Nalukwago , Shanahan Marian , Chambers Georgina, M , Schofield Peter , Butler Tony
Published: March 2019

Introduction

The increasing burden that offenders place on justice and health budgets necessitates better methods to determine the benefits of and value society places on offender programmes to guide policy regarding resource allocation. The aim of this paper is to demonstrate how economic methods will be used to determine the strength of preferences and value of violent offender treatment programmes from the perspectives of offenders, their families and the general population.

Methods and analysis

Two stated preference economic methods, discrete choice experiment (DCE) and contingent valuation (CV), will be used to assess society’s and offenders' value of treatment programmes. The mixed methods process involves a literature review and qualitative methods to derive attributes and levels for the DCE and payment card values for the CV. Consensus building approaches of voting, ranking and the Delphi method will be used to further refine the findings from the qualitative phase. Attributes and their levels will be used in a D-efficient Bayesian experimental design to derive choice scenarios for the development of a questionnaire that will also include CV questions. Finally, quantitative surveys to assess societal preferences and value in terms of willingness to pay will be conducted.

Ethics and dissemination

Ethics approval for this study was obtained from the University of New South Wales (UNSW) Human Research Ethics Committee, Corrective Services New South Wales Ethics Committee and the Aboriginal Health and Medical Research Council ethics committee. The findings will be made available on the Kirby Institute UNSW website, published in peer-reviewed journals and presented at national and international conferences.
Progress and setbacks in socioeconomic inequalities in adolescent health-related behaviours in Brazil: results from three cross-sectional surveys 2009–2015
Authors: Azeredo Catarina Machado , de Rezende Leandro F M , Mallinson Poppy Alice Carson , Ricardo Camila Zancheta , Kinra Sanjay , Levy Renata B , Barros Aluisio J D
Published: March 2019

Objectives

Despite some progress, Brazil is still one of the most unequal countries, and the extent of socioeconomic inequalities in adolescent health is unclear. We assessed trends in socioeconomic inequalities in adolescent’s health-related behaviours in Brazil between 2009 and 2015.

Design

We used cross-sectional data from the Brazilian National Survey of School Health carried out in 2009, 2012 and 2015.

Setting

Brazilian state capitals.

Participants

Students attending ninth grade from public and private schools in Brazilian state capitals in 2009 (60 973 students), 2012 (61 145 students) and 2015 (51 192 students).

Main outcome measure

We assessed 12 health-related behaviours (irregular fruit, vegetables and bean consumption; regular soft drink consumption; irregular physical activity; alcohol, drug and tobacco use; unsafe sex; involvement in gun fights; bullying victimisation and domestic violence victimisation), under the broad domains of lifestyle risk behaviours, engagement in risky activities and exposure to violence. Socioeconomic status was assessed through an asset-based wealth index derived from principal component analysis. Absolute and relative inequalities in these health behaviours and inequalities trends were investigated.

Results

From 2009 to 2015, prevalence of certain harmful health-related behaviours increased, such as unsafe sex (21.5% to 33.9%), domestic violence (9.5% to 16.2%), bullying victimisation (14.2% to 21.7%) and irregular consumption of beans (37.5% to 43.7%). Other indicators decreased: alcohol use (27.1% to 23.2%), irregular physical activity (83.0% to 75.6%) and consumption of soft drinks (37.2% to 28.8%). Over the period, we found consistent evidence of decreasing health inequalities for lifestyle behaviours (fruit, bean and soft drink consumption) and alcohol use, set against increasing inequalities in violence (domestic violence, fights using guns and bullying victimisation).

Conclusion

Socioeconomic inequality increased in the violence domain and decreased for lifestyle behaviours among Brazilian adolescents. Widening gaps in violence domain urge immediately policy measures in Brazil.
Protocol for a quasi-experimental study of the effectiveness and cost-effectiveness of mother and baby units compared with general psychiatric inpatient wards and crisis resolution team services (The ESMI study) in the provision of care for women in the postpartum period
Authors: Trevillion Kylee , Shallcross Rebekah , Ryan Elizabeth , Heslin Margaret , Pickles Andrew , Byford Sarah , Jones Ian , Johnson Sonia , Pawlby Susan , Stanley Nicky , Rose Diana , Seneviratne Gertrude , Wieck Angelika , Jennings Stacey , Potts Laura , Abel Kathryn M , Howard Louise M
Published: March 2019

Introduction

Research into what constitutes the best and most effective care for women with an acute severe postpartum mental disorder is lacking. The effectiveness and cost-effectiveness of psychiatric mother and baby units (MBUs) has not been investigated systematically and there has been no direct comparison of the outcomes of mothers and infants admitted to these units, compared with those accessing generic acute psychiatric wards or crisis resolution teams (CRTs). Our primary hypothesis is that women with an acute psychiatric disorder, in the first year after giving birth, admitted to MBUs are significantly less likely to be readmitted to acute care (an MBU, CRTs or generic acute ward) in the year following discharge than women admitted to generic acute wards or cared for by CRTs.

Methods and analysis

Quasi-experimental study of women accessing different types of acute psychiatric services in the first year after childbirth. Analysis of the primary outcome will be compared across the three service types, at 1-year postdischarge. Cost-effectiveness will be compared across the three service types, at 1-month and 1-year postdischarge; explored in terms of quality-adjusted life years. Secondary outcomes include unmet needs, service satisfaction, maternal adjustment, quality of mother–infant interaction. Outcomes will be analysed using propensity scoring to account for systematic differences between MBU and non-MBU participants. Analyses will take place separately within strata, defined by the propensity score, and estimates pooled to produce an average treatment effect with weights to account for cohort attrition.

Ethics and dissemination

The study has National Health Service (NHS) Ethics Approval and NHS Trust Research and Development approvals. The study has produced protocols on safeguarding maternal/child welfare. With input from our lived experience group, we have developed a dissemination strategy for academics/policy-makers/public.
A qualitative study of cancer care professionals’ experiences of working with migrant patients from diverse cultural backgrounds
Authors: Broom Alex , Parker Rhiannon Bree , Kirby Emma , Kokanović Renata , Woodland Lisa , Lwin Zarnie , Koh Eng-Siew
Published: March 2019

Objectives

To improve the experiences of people from diverse cultural backgrounds, there has been an increased emphasis on strengthening cultural awareness and competence in healthcare contexts. The aim of this focus-group based study was to explore how professionals in cancer care experience their encounters with migrant cancer patients with a focus on how they work with cultural diversity in their everyday practice, and the personal, interpersonal and institutional dimensions therein.

Design

This paper draws on qualitative data from eight focus groups held in three local health districts in major metropolitan areas of Australia. Participants were health professionals (n=57) working with migrants in cancer care, including multicultural community workers, allied health workers, doctors and nurses. Focus group discussions were audio recorded and transcribed in full. Data were analysed using the framework approach and supported by NVivo V.11 qualitative data analysis software.

Results

Four findings were derived from the analysis: (1) culture as merely one aspect of complex personhood; (2) managing culture at the intersection of institutional, professional and personal values; (3) balancing professional values with patient values and beliefs, and building trust and respect; and (4) the importance of time and everyday relations for generating understanding and intimacy, and for achieving culturally competent care.

Conclusions

The findings reveal: how culture is often misconstrued as manageable in isolation; the importance of a renewed emphasis on culture as interpersonalandinstitutional in character; and the importance of prioritising the development of quality relationships requiring additional time and resource investments in migrant patients for enacting effective intercultural care.
Typical use effectiveness of Natural Cycles: postmarket surveillance study investigating the impact of previous contraceptive choice on the risk of unintended pregnancy
Authors: Bull Jonathan , Rowland Simon , Lundberg Olof , Berglund-Scherwitzl Elina , Gemzell-Danielsson Kristina , Trussell James , Scherwitzl Raoul
Published: March 2019

Objective

To investigate the association between contraceptive effectiveness of Natural Cycles and users’ previous choice of contraceptive, and to evaluate the impact of shifting from other methods to Natural Cycles on the risk of unintended pregnancy.

Setting

Natural Cycles mobile application.

Participants

16 331 Natural Cycles users in Sweden for the prevention of pregnancy.

Outcome measures

Risk of unintended pregnancy.

Study design

Real world evidence was collected from Natural Cycles users regarding contraceptive use prior to using Natural Cycles and sexual activity while using Natural Cycles. We calculated the typical use 1-year Pearl Index (PI) and 13-cycle failure rate of Natural Cycles for each cohort. The PI was compared with the population PI of their stated previous methods.

Results

For women who had used condoms before, the PI of Natural Cycles was the lowest at 3.5±0.5. For women who had used the pill before, the PI of Natural Cycles was the highest at 8.1±0.6. The frequency of unprotected sex on fertile days partially explained some of the observed variation in PI between cohorts. 89% of users switched to Natural Cycles from methods with higher or similar reported PIs.

Conclusion

The effectiveness of Natural Cycles is influenced by previous contraceptive choice and this should be considered when evaluating the suitability of the method for the individual. We estimate that Natural Cycles usage can reduce the overall likelihood of having an unintended pregnancy by shifting usage from less effective methods.
Multicentre, prospective, randomised, controlled, blinded-endpoint study to evaluate the efficacy and safety of pterygopalatine ganglion pulsed radiofrequency treatment for cluster headache: study protocol
Authors: Li Jin , Ren Hao , Wang Baoguo , Wu Dasheng , Luo Fang
Published: March 2019

Introduction

Single-centre reports on small groups of patients have shown that pterygopalatine ganglion pulsed radiofrequency treatment in patients with refractory cluster headache (CH) can quickly relieve pain without significant side effects. However, a randomised controlled trial is still necessary to evaluate whether pterygopalatine ganglion pulsed radiofrequency (PRF) treatment is a viable treatment option for patients with CH who are not responding to drug treatment.

Methods and analysis

This investigation is a multicentre, prospective, randomised, controlled, blinded-endpoint study. We will enrol 80 patients with CH who are not responding to medication. The enrolled patients will be randomly divided into two groups: the nerve block (NB) group and the PRF group. All patients will undergo CT-guided pterygopalatine ganglion puncture. A mixture containing steroids and local anaesthetics will be slowly injected into the patients in the NB group. The patients in the PRF group will be treated with PRF at 42°C for 360 s. After treatment, the duration of cluster periods; degree of pain during headache attacks; frequency of headache attacks; duration of each headache attack; dose of auxiliary analgesic drugs; duration of remission; degree of patient satisfaction; effectiveness rates at 1 day, 3 days, 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1 year after the procedure; and intraoperative and postoperative adverse events will be compared between the two groups.

Ethics and dissemination

This study was approved by the institutional ethics committee of the Beijing Tiantan Hospital (approval number: KY 2018-027-02). The results of the study will be published in peer-reviewed journals, and the findings will be presented at scientific meetings.

Trial registration number

NCT03567590; Pre-results.
Modified Delphi survey for the evidence summarisation of patient decision aids: Study protocol
Authors: Durand Marie-Anne , Dannenberg Michelle D , Saunders Catherine H , Giguere Anik M C , Alper Brian S , Hoffmann Tammy , Perestelo-Pérez Lily , Campbell Stephen T , Elwyn Glyn
Published: March 2019

Introduction

Information included in a patient decision aid (PDA) can significantly influence patients’ decisions and is, therefore, expected to be evidence-based and rigorously selected and summarised. PDA developers have not yet agreed on a standardised process for the selection and summarisation of the supporting evidence. We intend to generate consensus on a process (and related steps and criteria) for selecting and summarising evidence for PDAs using a modified Delphi survey.

Methods and analysis

We will develop an evidence summarisation process specific to PDA development by using a consensus-based Delphi approach, surveying international experts and stakeholders with two to three rounds. To increase generalisability and acceptability, we will distribute the survey to the following stakeholder groups: PDA developers, researchers with expertise in shared decision making, PDA development and evidence summarisation, members of the International Patient Decision Aids Standards (IPDAS) collaboration, policy makers with expertise in PDA certification and patient stakeholder groups. For each criterion, if at least 80% of survey participants rank the criterion as most important/least important, we will consider that consensus has been achieved.

Ethics and dissemination

It is critical for PDAs to have accurate and trustworthy evidence-based information about the risks and benefits of health treatments and tests, as these decision aids help patients make important choices. We want to generate consensus on an approach for selecting and summarising the evidence included in PDAs, which can be widely implemented by PDA developers. Dartmouth College’s Committee for the Protection of Human Subjects approved this protocol. We will publish our results in a peer reviewed journal.
INSoles To Ease Pressure (INSTEP) Study: a multicentre, randomised controlled feasibility study to compare the effectiveness of a novel instant optimised insole with a standard insole for people with diabetic neuropathy: a study protocol
Authors: Collings Richard , Freeman Jennifer A , Latour Jos , Vickery Patricia Jane , Glasser Sam , Lepesis Vasileios , Enki Doyo , Paton Joanne
Published: March 2019

Introduction

Foot ulceration is a multifactorial complication of diabetes. Therapeutic insoles and footwear are frequently used to reduce elevated tissue pressures associated with risk of foot ulceration. A novel protocol using in-shoe pressure measurement technology to provide an instant optimised insole and house shoe solution has been developed, with the aim of reducing foot ulceration.

Aim

This study aims to assess the feasibility of conducting a multicentre randomised controlled trial to compare the effectiveness of a novel instant optimised insole with a standard insole for people with diabetic neuropathy.

Methods and analysis

This study is a participant and assessor blinded, randomised, multicentre parallel group feasibility trial with embedded qualitative study. Seventy-six participants will be recruited from three podiatry clinics and randomised to an optimised insole plus usual care (intervention group) or standard insole plus usual care (control group) using a minimisation by randomisation procedure by study centre and previous ulcer status. Assessment visits and data collection will be at baseline, 3 months, 6 months and 12 months. Feasibility and acceptability of the trial procedures will be determined in terms of recruitment and retention rates, data completion rates, intervention adherence and effectiveness of the blinding.

Assessment of the appropriateness and performance of outcome measures will inform selection of the primary and secondary outcomes and sample size estimate for the anticipated definitive randomised controlled trial. Clinical outcomes include incidence of plantar foot ulceration and change in peak plantar pressure. Twelve participants (four from each centre) and three treating podiatrists (one from each centre) will be interviewed to explore their experiences of receiving and delivering the intervention.

Ethics and dissemination

The study was approved by the South-West Exeter Research Ethics Committee. Findings will be disseminated through conference presentations, public platforms and academic publications.

Trials registration number

ISRCTN16011830; Pre-results.
A new approach to the opening of the eastern Mediterranean Sea and the origin of the Hellenic subduction zone. Part 2: The Hellenic subduction zone
Authors: Le Pichon Xavier , Şengör A.M. Celâl , İmren Caner
Published: March 2019

We discuss the structure of the present Hellenic subduction zone. We show that the present Hellenic subduction zone was formed at about 15 Ma when it started to consume the Mediterranean lithosphere and to form the large accretionary wedge that covers a large part of the eastern Mediterranean. We establish that there is independent evidence that the very large Hellenic Trough that it created was formed simultaneously. Shortly before, an 8–10 km thick backstop that extends 200 km southward, where it presently abuts the African margin, was put into place. We reconstruct the northern margin of the eastern Mediterranean Sea prior to the Hellenic subduction in a new and independent way. The faults recently identified by Sachpazi et al. (2016a . Geophysical Research Letters, 43: 651–658) and Sachpazi et al. (2016b . Geophysical Research Letters, 43: 9619–9626) within the Hellenic seismic slab are a key element of our reconstruction. This is because the slab, which is part of the Nubia plate, is rigid and the faults within it coincide with the lines of slip congruent with the relative motion of the Aegean block over it. These faults demonstrate that about 400 to 500 kilometers of eastern Mediterranean lithosphere have been subducted with essentially the same southwestward direction of motion during the last 15 Myr. Our reconstruction shows that before the onset of the Hellenic subduction, the northern margin of the eastern Mediterranean Sea coincided with a major Jurassic transform fault that limited the eastern Mediterranean to the north during its formation in the Jurassic and Early Cretaceous as proposed in part 1. We discuss the implications of this reconstruction on the Neogene evolution of the Anatolia–Aegea block and its geodynamics.
Quasi-Transfer Continuity and Nash Equilibrium
Authors: Nessah Rabia , Tazdait Tarik
Published: March 2019

We introduce a new notion of continuity, called quasi-transfer continuity, and show that it is enough to guarantee the existence of Nash equilibria in compact, quasiconcave normal form games. This holds true in a large class of discontinuous games. We show that our result strictly generalizes the pure strategy existence theorem of Carmona [Carmona, G. [2009] An existence result for discontinuous games, J. Econ. Theory 144, 1333–1340]. We also show that our result is neither implied by nor does it imply the existence theorems of Reny [Reny, J. P. [1999] On the existence of pure and mixed strategy Nash equilibria in discontinuous games, Econometrica 67, 1029–1056] and Baye et al. [Baye, M. R., Tian, G. and Zhou, J. [1993] Characterizations of the existence of equilibria in games with discontinuous and nonquasiconcave payoffs, Rev. Econ. Studies 60, 935–948].
Nitrobenzene method: A keystone in meso-substituted halogenated porphyrin synthesis and applications
Authors: Pinto Sara M. A. , Vinagreiro Carolina S. , Tomé Vanessa A. , Piccirillo Giusi , Damas Liliana , Pereira Mariette M.
Published: March 2019

This review article briefly describes the available synthetic approaches for meso-arylporphyrins giving particular emphasis for one-pot nitrobenzene and nitrobenzene/NaY methods regarding the synthesis of meso-halogenated arylporphyrins. The review also describes the relevant applications of these halogenated porphyrins and their metalloporphyrin counterparts, prepared via nitrobenzene method, as photosensitizers for therapy (PDT and PDI), diagnostic (molecular contrast agents) and also for catalytic oxidation and CO2 cycloaddition reactions to epoxides.
Encounter rates and group sizes of diurnal primate species of Mole National Park, Ghana
Authors: Wiafe Edward Debrah
Published: March 2019

Primate species are not widely explored in Ghana’s savannah ecosystems.  We report data on encounter rates and group sizes of primates at the Mole National Park in Ghana.  Forty transects, each of 5km length, were randomly laid in the park for the study.  Four species of primates were visually recorded during field surveys: Olive Baboon Papio anubis, Patas Monkey Erythrocebus patas, Green Monkey Chlorocebus sabaeus and Colobus vellerosus.  The status of C. vellerosus is Critically Endangered, the status of the other species is Least Concern according to the IUCN Red List.  Encounter rates (groups/km) were 0.98, 0.65 and 0.45 for Olive Baboons, Patas Monkeys and Green Monkeys respectively.  The mean group sizes were: Olive Baboon 10.8 (SE=1.1, range=1-38), Patas Monkey 12.2 (SE=3.3, range=1-35), and Green Monkey 10.0 (SE=1.9, range=1-25).  Only one group of White-thighed Colobus with a group size of six was encountered.  Encounter rates and group sizes of the same species varied in different parts of the park, and factors such as resource distribution and security against secret hunting may have influenced this variation.  Authors recommend further studies to facilitate better understanding of these primates.
Usefulness of Blood Pressure Variability Indices Derived From 24‐Hour Ambulatory Blood Pressure Monitoring in Detecting Autonomic Failure
Authors: Lodhi Hamza A. , Peri‐Okonny Poghni A. , Schesing Kevin , Phelps Kamal , Ngo Christian , Evans Hillary , Arbique Debbie , Price Angela L. , Vernino Steven , Phillips Lauren , Mitchell Jere H. , Smith Scott A. , Yano Yuichiro , Das Sandeep R. , Wang Tao , Vongpatanasin Wanpen
Published: March 2019

Background

Increased blood pressure (
BP
) variability and nondipping status seen on 24‐hour ambulatory
BP
monitoring are often observed in autonomic failure (
ATF
).

Methods and Results

We assessed
BP
variability and nocturnal
BP
dipping in 273 patients undergoing ambulatory
BP
monitoring at Southwestern Medical Center between 2010 and 2017.
SD
, average real variability, and variation independent of mean were calculated from ambulatory
BP
monitoring. Patients were divided into a discovery cohort (n=201) and a validation cohort (n=72).
ATF
was confirmed by formal autonomic function test. In the discovery cohort, 24‐hour and nighttime average real variability,
SD
, and variation independent of mean did not differ significantly between
ATF
(n=25) and controls (n=176, all
P
>0.05). However, daytime SD, daytime coefficient of variation, and daytime variation independent of mean of systolic
BP
(
SBP
) were all significantly higher in patients with
ATF
than in controls in both discovery and validation cohorts. Nocturnal
BP
dipping was more blunted in
ATF
patients than controls in both cohorts (both
P
<0.01). Using the threshold of 16 mm Hg, daytime SD
SBP
yielded a sensitivity of 77% and specificity of 82% in detecting
ATF
in the validation cohort, whereas nondipping status had a sensitivity of 80% and specificity of 44%. The area under the receiver operator characteristic of daytime
SD SBP
was greater than the area under the receiver operator characteristic of nocturnal
SBP
dipping (0.79 [0.66‐0.91] versus 0.73 [0.58‐0.87], respectively).

Conclusions

Daytime
SD
of
SBP
is a better screening tool than nondipping status in detecting autonomic dysfunction.
Toll‐Like Receptor 9 Plays a Pivotal Role in Angiotensin II–Induced Atherosclerosis
Authors: Fukuda Daiju , Nishimoto Sachiko , Aini Kunduziayi , Tanaka Atsushi , Nishiguchi Tsuyoshi , Kim‐Kaneyama Joo‐ri , Lei Xiao‐Feng , Masuda Kiyoshi , Naruto Takuya , Tanaka Kimie , Higashikuni Yasutomi , Hirata Yoichiro , Yagi Shusuke , Kusunose Kenya , Yamada Hirotsugu , Soeki Takeshi , Imoto Issei , Akasaka Takashi , Shimabukuro Michio , Sata Masataka
Published: March 2019

Background

Toll‐like receptor (
TLR
) 9 recognizes bacterial
DNA
, activating innate immunity, whereas it also provokes inflammation in response to fragmented
DNA
released from mammalian cells. We investigated whether
TLR
9 contributes to the development of vascular inflammation and atherogenesis using apolipoprotein E–deficient (
Apoe

−/−

) mice.

Methods and Results

Tlr9
‐deficient
Apoe

−/−

(
Tlr9

−/−

Apoe

−/−

) mice and
Apoe

−/−

mice on a Western‐type diet received subcutaneous angiotensin
II
infusion (1000 ng/kg per minute) for 28 days. Angiotensin
II
increased the plasma level of double‐stranded DNA, an endogenous ligand of
TLR
9, in these mice. Genetic deletion or pharmacologic blockade of
TLR
9 in angiotensin II–infused
Apoe

−/−

mice attenuated atherogenesis in the aortic arch (
P
<0.05), reduced the accumulation of lipid and macrophages in atherosclerotic plaques, and decreased
RNA
expression of inflammatory molecules in the aorta with no alteration of metabolic parameters. On the other hand, restoration of
TLR
9 in bone marrow in
Tlr9

−/−

Apoe

−/−

mice promoted atherogenesis in the aortic arch (
P
<0.05). A
TLR
9 agonist markedly promoted proinflammatory activation of
Apoe

−/−

macrophages, partially through p38 mitogen‐activated protein kinase signaling. In addition, genomic
DNA
extracted from macrophages promoted inflammatory molecule expression more effectively in
Apoe

−/−

macrophages than in
Tlr9

−/−

Apoe

−/−

macrophages. Furthermore, in humans, circulating double‐stranded
DNA
in the coronary artery positively correlated with inflammatory features of coronary plaques determined by optical coherence tomography in patients with acute myocardial infarction (
P
<0.05).

Conclusions

TLR
9 plays a pivotal role in the development of vascular inflammation and atherogenesis through proinflammatory activation of macrophages.
TLR
9 may serve as a potential therapeutic target for atherosclerosis.
Global Brain Perfusion and the Risk of Transient Ischemic Attack and Ischemic Stroke: The Rotterdam Study
Authors: Fani Lana , Bos Daniel , Mutlu Unal , Portegies Marileen L.P. , Zonneveld Hazel I. , Koudstaal Peter J. , Vernooij Meike W. , Ikram M. Arfan , Ikram M. Kamran
Published: March 2019

Background

The role of subtle disturbances of brain perfusion in the risk of transient ischemic attack (
TIA)
or ischemic stroke remains unknown. We examined the association between global brain perfusion and risk of
TIA
and ischemic stroke in the general population.

Methods and Results

Between 2005 and 2015, 5289 stroke‐free participants (mean age, 64.3 years; 55.6% women) from the Rotterdam Study underwent phase‐contrast brain magnetic resonance imaging at baseline to assess global brain perfusion. These participants were followed for incident
TIA
or ischemic stroke until January 1, 2016. We investigated associations between global brain perfusion (mL of blood flow/100 mL of brain/min) and risk of
TIA
and ischemic stroke using Cox regression models with adjustment for age, sex, and cardiovascular risk factors. Additionally, we investigated whether associations were modified by retinal vessel calibers, small and large vessel disease, blood pressure, and heart rate. During a median follow‐up of 7.2 years (36 103 person‐years), 137 participants suffered a
TIA
and another 108 an ischemic stroke. We found that lower global brain perfusion was associated with a higher risk of
TIA
, but not with the risk of ischemic stroke (adjusted hazard ratio, 95% CI, per standard deviation decrease of global brain perfusion: 1.29, 1.07–1.55 for
TIA
and adjusted hazard ratio of 1.06, 0.87–1.30 for ischemic stroke). Across strata of wider arteriolar retinal calibers, lower brain perfusion was more prominently associated with
TIA
, but not with ischemic stroke.

Conclusions

In a community‐dwelling population, impaired global brain perfusion increased the risk of
TIA
, but not of ischemic stroke.
Acanthopagrus taiwanensis, a new sparid fish (Perciformes), with comparisons to Acanthopagrus berda (Forsskål, 1775) and other nominal species of Acanthopagrus
Authors: IWATSUKI YUKIO , CARPENTER KENT E.
Published: March 2019

A new sparid species, Acanthopagrus taiwanensis, is described on the basis of six specimens that were previously misidentified as A. berda (Forsskål, 1775), collected from Tung-kang, southwestern Taiwan. Acanthopagrus taiwanensis and A. berda are similar in overall appearance, both with deep bodies. However, A. taiwanensis differs from the latter in having a more rounded body, broadly rounded anteriormost head squamation with around 10 somewhat smaller scales anteriorly, 3 or 4 cheek scale rows, thin upper and lower lips, older individuals with a ridge on dorsal profile in front of eye and upper profile of head evenly convex, head and body black with sharply contrasting white area ventrally, a dark spot at upper base of pectoral fins, and flat molar teeth. In contrast, A. berda has a deeper body, broadly rounded anteriormost head squamation with around 20 small scales anteriorly, 5 or 6 cheek scale rows, thick upper and lower lips, larger individuals with a weak ridge in profile in front of eye and concave snout profile, head and body silvery gray, no black spot at upper base of pectoral fins and somewhat pointed molar teeth. Older individuals of A. berda also develop a strong concavity of the ventral edge of the first two infraorbitals above the posterior part of upper jaw, while the edge is relatively straight or weakly concave in A. taiwanensis. We discuss the nominal species that have been placed in synonymy with A. berda and contrast A. taiwanensis with similar congeners.
New Leptocheliidae (Crustacea: Tanaidacea: Tanaidomorpha) from Australian seagrass and macro-algal habitats, and a redescription of the poorly-known Leptochelia ignota from Sydney Harbour
Authors: EDGAR GRAHAM J.
Published: March 2019

Australia possesses a rich fauna of leptocheliid tanaidaceans (Crustacea: Tanaidacea: Leptocheliidae), including manyspecies that currently remain undescribed. As an addition to the 13 leptocheliid species known to date from Australianwaters, a new genus (Poorea n. gen.) and five new species collected from shallow macrophyte habitats are diagnosed(Parakonarus robertsoni n. sp., Leptochelia evansi n. sp., Leptochelia gadgeti n. sp., Poorea wrighti n. sp. and Pooreajohannesi n. sp.). Leptochelia nobbi is transferred to the genus Poorea, Leptochelia fairgo to Parakonarus, and a rede-scription provided for the enigmatic tanaidacean Leptochelia ignota on the basis of specimens collected near the Sydney type locality. A key is provided to Australian leptocheliid species.
Comparison of the morphology of the adult males of the rhizoecine, phenacoccine and pseudococcine mealybugs (Hemiptera: Sternorrhyncha: Coccoidea), with the recognition of the family Rhizoecidae Williams
Authors: HODGSON CHRIS
Published: March 2019

In the past, the morphology of adult males of Coccoidea has provided strong support for diagnosing the higher taxonstatus of scale insects (Coccoidea). In particular, studies on adult male morphology have produced some of the stron-gest evidence for considering the Putoidae and Eriococcidae (as then defined) as separate families from the Pseudo-coccidae. This paper uses adult male morphology to assess the relationships of the Pseudococcidae and the hypogaeicand myrmecophilous mealybugs. The latter most often are classified as a subfamily (Rhizoecinae) of the Pseudococ-cidae. In order to diagnose the latter taxa, the adult males of fifteen named species of hypogaeic rhizoecine mealybugs(Kissrhizoecus hungaricus Kozár & Konczné Benedicty, Rhizoecus cacticans (Hambleton), Rh. coffeae Laing, Rh.dianthi Green, Rh. falcifer Künckel d’Herculais, Rh. kazachstanus Matesova, Ripersiella cryphia (Williams), Ri.hibisci (Kawai & Takagi), Ri. kondonis (Kuwana), Ri. malschae (Williams), Ri. puhiensis (Hambleton), Capitisetellamigrans (Green) and Pseudorhizoecus proximus Green) plus two unidentified Ripersiella species are described. Inaddition, the adult males of a Xenococcus sp., three Eumyrmococcus spp. and two Neochavesia spp. are illustratedfrom previously published papers and the adult male of another Neochavesia sp. is described and illustrated. In orderto compare the diagnoses of the above taxa with that of adult males of Pseudococcidae (minus the Rhizoecinae), theadult males of two apterous pseudococcid mealybugs are described or redescribed: Asaphococcus agninus Cox andthe myrmecophilous Promyrmococcus dilli Williams, both belonging to the Pseudococcinae. In addition, threemacropterous Pseudococcidae, namely Phenacoccus solenopsis Tinsley (Phenacoccinae), Planococcus glaucus(Maskell) and Maconellicoccus hirsutus (Green) (Pseudococcinae) are also described and/or illustrated. Prior to thisstudy, the hypogaeic and myrmecophilous mealybugs generally were included in the subfamily Rhizoecinae of thePseudococcidae, with the hypogaeic mealybugs in tribe Rhizoecini and the myrmecophilous mealybugs in Xenococ-cini. Based on the present study and on phylogenetic data, it is concluded that the rhizoecine mealybugs form a sepa-rate family from the Pseudococcidae — Rhizoecidae Williams. This family is considered here to include twosubfamilies, Rhizoecinae Williams and Xenococcinae Tang. Based on adult male characters, there is little support forthe present generic divisions of the Rhizoecinae. Keys are given for separating the adult males of Rhizoecidae from those of Pseudococcidae, and for separating the known adult males within each subfamily.
Foreign ownership and intra-firm union density in Germany
Authors: Jirjahn Uwe
Published: March 2019

From a theoretical viewpoint the relationship between foreign ownership and unionization is ambiguous. On the one hand, foreign owners have better opportunities to undermine workers’ unionization. On the other hand, workers of foreign-owned firms have an increased demand for the protection provided by unions. Which of the two opposing influences dominates can vary according to moderating circumstances. This study shows that firm size and industry-level bargaining play a moderating role. The relationship between foreign ownership and unionization is negative in larger firms whereas it is positive in smaller firms. Coverage by industry-level collective bargaining makes a positive relationship both stronger and more likely.