bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding How High‐Protein Bar Formulations Impact Their Mechanical and Wear Behaviors Using Response Surface Analysis
Authors: Sparkman Kristen , Joyner Helen S. , Smith Brennan
Published: July 2019

High‐protein bars are popular snack items that can have significant processing issues like sticking, clogging, and cold flow. These issues are primarily problematic during formulation development because current predictive testing is reliant on highly empirical bench tests or pilot plant testing, which is expensive and time‐consuming. Wear testing, which has been used in the medical field to evaluate the lifetime of soft materials used in joint replacements, may have promise in evaluating food processing ability. Wear and rheological testing were used to better understand high‐protein bar processing ability. The objective of this study was to determine bench‐level instrumental tests that would be able to predict processing ability for a given formulation. Two response surface designs were used for formulations of model bar systems comprising whey protein isolate (WPI), high fructose corn syrup (HFCS), and either canola oil or vegetable shortening. Ingredient formulation affected processing ability, wear behaviors, and rheological behaviors. Formulations with high ratios of WPI to HFCS and either shortening or oil exhibited good processing ability, lower wear rates, and increased elastic‐type behavior, indicating that processing ability is related to formulation. The results of this study indicated that material mechanical and wear behaviors were related to processing ability; both were controlled by formulation. Because it was shown to be a good indicator of high‐protein bar processing ability, wear testing of food has potential significance in benchtop testing.

Practical Application

Understanding of how high‐protein bar formulations impact their mechanical behaviors can help streamline their formulation development and scaling from bench to industrial production. Processing ability may be predicted with a quick wear test, providing a rapid testing method that requires little sample for evaluating bar formulations.
Effect of Genistein on Cholesterol Metabolism‐Related Genes in HepG2 Cell
Authors: Lu Rongrong , Zheng Zicong , Yin Yimin , Jiang Zhuoqin
Published: July 2019

It has been reported that genistein could improve metabolic syndromes. Our study aimed to investigate the effects and potential mechanisms of genistein on improving cholesterol metabolism in HepG2 cell. HepG2 cells were cultured with 0, 0.01, 1.00, 10.00, and 50.00 µM genistein for 24 hr. The current results showed a dose‐dependent manner between genistein and intracellular contents of total cholesterol (TC), high‐density lipoprotein‐cholesterol (HDL‐C), and cellular apolipoprotein A1 (Apo‐A1) secretion. TC was increased by 25.69%, meanwhile HDL‐C and Apo‐A1 were decreased by 56.00% and 25.93%, respectively, when the dosage of genistein was 1.00 µM. Genistein dose‐dependently upregulated the protein and mRNA levels of sterol regulatory element binding proteins‐2 (SREBP‐2), as well as the mRNA levels of low‐density lipoprotein receptor (LDLR) and 3‐hydroxy‐3‐methyl glutaryl coenzyme A reductase (HMGCR), by 145.91%, 72.29%, 310.23%, and 123.08%, respectively, when we gave 1.00 µM genistein, indicating that intracellular cholesterol synthesis and absorption of exogenous cholesterol were increased. In addition, the mRNA levels of peroxisome proliferator‐activated receptor‐γ (PPARγ) and liver X receptor (LXRα), lowered by 58.23% and 34.86% at 0.01 µM genistein, were reduced in a dose‐dependent manner. LXRα and ATP‐binding cassette transporter A1 (ABCA1) protein levels were significantly (P < 0.05) decreased by 50.35% and 11.60% at 1.00 µM genistein, which indicated that cellular cholesterol efflux was inhibited. Taken together, our results suggested that genistein at dosage of more than 1.00 µM was able to increase the intracellular cholesterol levels by up regulating SREBP‐2/LDLR/HMGCR pathway and suppressing PPARγ/LXRα/ABCA1 pathway.

Practical Application

In this study, genistein appeared to be effective in reducing plasma cholesterol levels due to increase the intracellular cholesterol levels by upregulating cholesterol absorption through SREBP‐2/LDLR/HMGCR pathway, and also downregulating cholesterol efflux via PPARγ/LXRα/ABCA1 pathway in vitro. In addition, plasma cholesterol is regarded as the key indicator of atherosclerosis; therefore, we believe that our findings could be used for further exploration on a possible therapeutic application of genistein for atherosclerosis.
Concert Diplomacy: Past, Present, Prospects
Authors: Meerts Paul W.
Published: July 2019

This article analyzes the evolution of concert diplomacy in the past 370 years. It argues that negotiations bridging gaps are vulnerable unless parties have some control over each other. As modern technology makes war more costly, concerted negotiations are becoming increasingly important. This study raises questions about the future role of concert diplomacy in a globalizing world in which states and diplomats are losing their age old hegemony in international relations while some politicians do not shy away from deleting agreements that have already been signed and ratified. Pacta servanda sunt seems to lose some of its significance. This contribution concludes with recommendations for enhancing the effectiveness of working together through negotiation processes in concerto, even if the concert becomes unharmonious.
Phase II study of nedaplatin and amrubicin as first‐line treatment for advanced squamous cell lung cancer
Authors: Taniguchi Hirokazu , Yamaguchi Hiroyuki , Dotsu Yosuke , Shimada Midori , Gyotoku Hiroshi , Senju Hiroaki , Takemoto Shinnosuke , Kitazaki Takeshi , Fukuda Masaaki , Ogawara Daiki , Soda Hiroshi , Nakatomi Katsumi , Sugasaki Nanae , Kinoshita Akitoshi , Nagashima Seiji , Ikeda Takaya , Nakamura Yoichi , Sakamoto Noriho , Obase Yasushi , Fukuda Minoru , Mukae Hiroshi
Published: July 2019

Background

The first‐line treatment for squamous cell lung cancer (SCC) has not necessarily been established; however, our previous exploratory study suggested that the combination of nedaplatin and amrubicin would be a promising treatment approach for patients with SCC. Therefore, a phase II study of this chemotherapeutic combination was designed to evaluate its efficacy and safety for treatment‐naïve patients with advanced SCC.

Methods

A total of 21 treatment‐naïve patients with stage IIIB/IV or postoperative recurrent SCC were enrolled from six institutions. Nedaplatin (100 mg/m2) on day 1 and amrubicin (25 mg/m2) on days 1–3 were administered intravenously every 4 weeks. The primary endpoint was overall response rate (ORR), while the secondary endpoints included overall survival (OS), progression‐free survival (PFS), and drug toxicities.

Results

Partial response was observed in seven of 21 cases (ORR, 33.3%; 95% confidence interval [CI], 14.5–52.2). Disease control rate, which includes stable disease, was 71.4%. Median OS and PFS was 14.6 and 4.1 months, respectively. This regimen did not cause any treatment‐related deaths. Grade 3/4 neutropenia developed in 8 of 21 cases (38.1%); however, febrile neutropenia developed in only 9.5% of the cases. Grade 3/4 gastrointestinal or neuromuscular toxicities were not observed.

Conclusion

The efficacy of the combination of nedaplatin and amrubicin was comparable to that of other conventional chemotherapeutic regimens for treatment‐naïve patients with advanced SCC, and no severe gastrointestinal or neuromuscular toxicities were observed. This combination therapy may be an alternative treatment approach, particularly in patients who cannot tolerate gastrointestinal or neuromuscular toxicities.
Supervised consumption sites: a nuanced assessment of the causal evidence
Authors: Caulkins Jonathan P. , Pardo Bryce , Kilmer Beau
Published: July 2019

Background and Aims

Supervised consumption sites (SCS) operate in more than 10 countries. SCS have mostly emerged as a bottom‐up response to crises, first to HIV/AIDS and now overdose deaths, in ways that make rigorous evaluation difficult. Opinions vary about how much favorable evidence must accumulate before implementation. Our aim was to assess the nature and quality of evidence on the consequences of implementing SCS.

Methods

We reviewed the higher‐quality SCS literature, focusing on articles evaluating natural experiments and mathematical modeling studies that estimate costs and benefits. We discuss the evidence through the lens of three types of decision‐makers and from three intellectual perspectives.

Results

Millions of drug use episodes have been supervised at SCS with no reported overdose deaths; however, uncertainties remain concerning the magnitude of the population‐level effects. The published literature on SCS is large and almost unanimous in its support, but limited in nature and the number of sites evaluated. It can also overlook four key distinctions: (1) between outcomes that occur within the facility and possible spillover effects on behavior outside the SCS; (2) between effects of supervising consumption and the effects of other services offered, such as syringe or naloxone distribution; (3) between association and causation; and (4) between effectiveness and the cost‐effectiveness of SCS compared to other interventions.

Conclusions

The causal evidence for favorable outcomes of supervised consumption sites is minimal, but there appears to be little basis for concern about adverse effects. This raises the question of how context and priors can affect how high the bar is set when deciding whether to endorse supervised consumption sites. The literature also understates distinctions and nuances that need to be appreciated to gain a rich understanding of how a range of stakeholders should interpret and apply that evidence to a variety of decisions.
Oral manifestations of illicit drug use
Authors: Teoh L , Moses G , McCullough MJ
Published: July 2019

The use of illicit and misuse of licit drugs is a global public health problem, with illicit drug use being responsible for 1.8% of the total disease burden in Australia in 2011. Oral adverse effects associated with illicit drug use are well‐established, with aggressive caries, periodontitis, bruxism, poor oral hygiene and general neglect documented. Other factors such as a high cariogenic diet and lifestyle, social and psychological factors compound the poorer oral health in illicit drug users. Literature has shown that the oral health‐related quality of life among injecting drug users is poorer compared with the Australian general population and the overall quality of life of addicted people correlates with caries experience. Thus, the role of the dentist is imperative in managing the oral health of these individuals. Given their widespread recreational use, it is likely that dental practitioners will encounter patients who are regular or past users of illicit drugs. The aim of this article is to describe the prevalence and mechanism of action of commonly used illicit drugs in Australia, including cannabis, methamphetamine, cocaine and heroin and to inform dentists about the common orofacial presentations of their side effects to help with patient management.
Viable versus nonviable positive margins in Ewing sarcoma and associated recurrence rates: A systematic review
Authors: El Demellawy Dina , Menzies‐Toman Danielle , Murphy Michelle , Kabir Nooh , Shaw Ashley , Chernetsova Elizavita , Serlo Joni A. , de Nanassy Joseph
Published: July 2019

Residual tumor after curative intent therapy in patients with Ewing's sarcoma is of great clinical significance. Surgeons use the resection margin to indicate the completeness of a surgical excision. However, this margin may be either nonviable/necrotic or viable. This systematic review examines the 5‐year event‐free survival rate and local recurrence as a function of positive resection margins that are nonviable/necrotic versus those that are viable. Multiple databases were searched using the Ovid interface. After full text screening, 45 articles that reported either margin or postchemotherapy histology and one or more outcomes of interest were identified, and two articles reported on margin and histology simultaneously. An attempt was made to contact the remaining authors and one author was able to provide additional data. The data from the three studies suggest that prognosis in ES depends on both margin involvement and the postchemotherapy histological response simultaneously. However, radiation therapy likely improves local control in patients with inadequate surgical margins, regardless of histological response. This is an area where there is a paucity of evidence that needs to be rectified to ensure that ES patients are provided the highest quality of evidence‐based care.
External‐beam radiation therapy versus surgery in the treatment of hepatocellular carcinoma with inferior vena cava/right atrium tumor thrombi
Authors: Li Yong , Liu Fenghua , Yang Liang , Meng Yan , Li Aijun , Pan Mianshun
Published: July 2019

Background

Both surgery and external‐beam radiotherapy are effective treatments for hepatocellular carcinoma (HCC) patients with inferior vena cava/right atrium (IVC/RA) tumor thrombi. At present, it is not clear which modality is more suitable. We therefore compared outcomes between surgery and radiotherapy for these patients.

Methods

We retrospectively reviewed 108 HCC patients with IVC/RA tumor thrombi who were referred for surgery (n = 51) and external‐beam radiotherapy (n = 57) at three institutions. Different surgical methods were selected according to the classification of the tumor thrombus. Radiotherapy was designed to focus on primary intrahepatic tumors and tumor thrombi. Predictors of time to progression (TTP) were identified by using univariate and multivariate analyses.

Results

The median TTP was significantly longer in the radiotherapy group than in the surgery group (5.0 months vs 4.2 months; P = 0.010). The multivariate analysis revealed that independent factors predicting shorter TTP were treatment with surgery (HR = 0.577; 95% CI, 0.385–0.865; P = 0.008) and intrahepatic tumor size larger than 10 cm (HR = 0.561; 95% CI, 0.342–0.919; P = 0.022). The median survival times for the radiotherapy and surgery groups were 12.8 and 14.5 months, respectively; the two groups did not have a significant difference in survival (P = 0.466).

Conclusions

For HCC patients with IVC/RA tumor thrombi, treatment with external‐beam radiotherapy and intrahepatic tumor size smaller than 10 cm may predict longer TTP. Compared with complicated surgery, radiotherapy, as a noninvasive treatment modality, may be more likely to be accepted.
Trend analysis and regional tumor incidence in Germany for testicular cancer between 2003 and 2014
Authors: Brandt M. P. , Gust K. M. , Bon D. , Tsaur I. , Thomas C. , Neisius A. , Haferkamp A. , Herrmann E. , Bartsch G.
Published: July 2019

Background

Testicular germ cell tumor (TGCT) is one the most common solid tumors in men between the age of 15 and 35 with an overall incidence rate of 1–1.5 %. Epidemiologic studies have demonstrated different incidence patterns in western civilized countries with overall rising incidence trends.

Objective

To analyze differences in regional tumor incidence rates for TGCT and perform a trend analysis for TGCT between 2003 and 2014 in Germany.

Material and methods

TGCT cases in Germany which were diagnosed between 2003 and 2014 were provided by the Robert‐Koch‐Institute, Berlin. For statistical analysis, cluster and spatial scan tests according to Kulldorff were used for cases with seminoma and non‐seminoma. Results are presented in administrative districts and graphically illustrated. We performed a trend‐analysis in order to evaluate age‐adjusted incidence trends in Germany. Tests were two‐sided with a level of significance of α=0.05.

Results

In total we included 35,066 patients. Overall, 22,634 cases had newly diagnosed seminoma and 12,432 were diagnosed as non‐seminoma. Maximum incidence of seminoma and non‐seminoma was observed for age‐group 38–40 years and 26–28 years, respectively. No second peak for the incidences of seminoma and non‐seminoma with respect to age were observed. Cluster analysis revealed areas with high and low incidence rates as well as slightly different spatial distribution in Germany between seminoma and nonseminoma. Furthermore, there was no significant increase in age‐adjusted incidence rates over the reviewed time period in both cohorts.

Discussion

In this study differences in reginal tumor incidence rates for seminoma and non‐seminoma are reported with both tumor entities revealing distinct clusters. Furthermore, tumor incidence trends for seminoma and nonseminoma between 2003 and 2014 were stable which might indicate the beginning of a plateau phase for TGCT incidence rates in Germany.

Conclusion

In this analysis we were able to identify regions with significantly higher tumor incidence rates for both seminoma and non‐seminoma which were specific for these two subtypes. Furthermore, trend analysis revealed a steady incidence rate for testicular cancer in Germany.
Earlier discontinuation of TNF‐α inhibitor therapy in female patients with inflammatory bowel disease is related to a greater risk of side effects
Authors: Schultheiss Johannes P.D. , Brand Eelco C. , Lamers Evert , van den Berg Willemijn C.M. , van Schaik Fiona D.M. , Oldenburg Bas , Fidder Herma H.
Published: July 2019

Background

In rheumatoid arthritis and psoriasis female sex has been shown to be associated with discontinuation of anti‐tumour necrosis factor‐α (TNF‐α) therapy.

Aim

To retrospectively assess the association between sex and TNF‐α drug persistence in patients with inflammatory bowel disease (IBD).

Methods

All IBD patients on anti‐TNF‐α therapy with a minimum follow‐up of 12 months in a single tertiary centre were identified. Patient and treatment characteristics and reasons for anti‐TNF‐α discontinuation were recorded. Overall and cause‐specific drug persistence was analysed with Kaplan‐Meier followed by Cox proportional hazards regression models.

Results

We included 529 patients (49.9% male) with 631 treatment episodes (2280 anti‐TNF‐α treatment years) and 289 discontinuations of therapy. Female sex (adjusted hazard ratio [aHR] 1.42, 95% confidence interval [CI] 1.16‐1.74), greater age at start of therapy per decade (aHR 1.15, 95% CI 1.04‐1.27] and dose escalation (aHR 3.74, 95% CI 2.78‐5.02) were associated with TNF‐α inhibitor discontinuation. Total cohort cause‐specific analysis identified female sex to be associated with side effects (aHR 4.05, 95% CI 2.36‐6.98) but not to other discontinuation reasons. Adalimumab (aHR 1.70, 95% CI 1.11‐2.60) and golimumab (aHR 4.97, 95% CI 2.30‐10.74) use and dose‐escalation (aHR 7.71, 95% CI 5.28‐11.26) were associated with secondary loss of response.

Conclusion

Drug persistence of anti‐TNF‐α therapy is lower in females as compared to males, mainly because of higher rates of side effects in females. Understanding the sex specific differences in effectiveness and safety of anti‐TNF‐α compounds can aid physicians in clinical decision‐making.
Letter: psoriasiform eruption during vedolizumab therapy
Authors: Garbo Giuseppe Maria , Renna Sara , Caputo Valentina , Orlando Elisabetta , Macaluso Fabio Salvatore , Orlando Rosalba , Bongiorno Maria Rita , Orlando Ambrogio
Published: July 2019

Linked Content

This article is linked to Chaparro et al paper. To view these articles, visit https://doi.org/10.1111/apt.15930.
Upsetting the balance on sex selection
Authors: Saunders Ben
Published: July 2019

It is widely assumed that the strongest case for permitting non‐medical sex selection is where parents aim at family balance. This piece criticizes one representative attempt to justify sex selection for family balance. Kluge (2007) assumes that some couples may seek sex selection because they hold discriminatory values, but this need not impugn those who merely have preferences, without evaluative commitments, for a particular sex. This is disputed by those who see any sex selection as inherently sexist because it upholds stereotypes about the sexes. This article takes an alternative approach. I argue that, even if we accept that preference‐based selection is unobjectionable, a policy permitting selection for family balancing does a poor job of distinguishing between value‐based and preference‐based selection. If we wish to permit only preference‐based sex selection we should seek to identify parents’ motives. If we wish to justify a family balancing policy, other arguments are needed.
Investigating subtle kidney injury in primary hyperparathyroidism by means of sensitive and specific biomarkers
Authors: Cipriani Cristiana , Pepe Jessica , Colangelo Luciano , Fassino Valeria , Occhiuto Marco , Biondi Piergianni , Nieddu Luciano , Minisola Salvatore
Published: July 2019

Objective

Kidney involvement is a common complication in primary hyperparathyroidism (PHPT). No study so far has assessed the prevalence of kidney injury developing before the reduction in glomerular filtration rate (GFR) in PHPT. The study was aimed at establishing the potential role of biomarkers of kidney injury in detecting subtle renal damage in patients with PHPT.

Design

Cross‐sectional study.

Patients

A total of 69 postmenopausal patients with PHPT and 41 healthy age‐ and sex‐matched subjects were studied. Exclusion criteria were as follows: GFR < 30 mL/min, chronic inflammatory disease, nephrotic syndrome, infection, malignancy, heart failure, recent exposure to iodinated contrast media or nonsteroidal anti‐inflammatory drugs.

Measurements

We measured a panel of sensitive biomarkers of kidney injury in PHPT vs controls.

Results

Mean FGF23 and Klotho were higher in PHPT (72 ± 48 and 811 ± 366 pg/mL, respectively) than controls (53 ± 23.5 and 668.6 ± 17; P < .02 and P < .05). Urine KIM‐1/uCr was significantly higher in PHPT (1.4−6 ± 1.3−6) than controls (9.2−7 ± 7−7; P < .05); this was particularly evident in the CrCl 60‐89 mL/min category (1.36 ± 97 vs 8.2−7 ± 3.6−7; P < .02). Mean values of urine NGAL/uCr were higher in PHPT with (n = 28) compared to those without kidney stones (n = 35; 1.8−5 ± 1.4−5 and 1−5 ± 8−6; P < .0001). We found significant positive associations between urine NGAL/uCr and Ca (R = .292, P < .02) and urine KIM1/uCr and PTH (R = .329, P < .01).

Conclusions

We propose the utilization of these molecules, particularly urine KIM‐1/uCr and urine NGAL/uCr ratios for the assessment of subtle kidney injury in patients with PHPT. These molecules are elevated in tubular necrosis and have potential role in the development of kidney damage in PHPT, according to the severity of the disease.
Is Death Taboo for Children? Developing Death Ambivalence as a Theoretical Framework to Understand Children’s Relationship with Death, Dying and Bereavement
Authors: Paul Sally
Published: July 2019

Children’s voices are missing from debates related to the idea that death is a taboo subject and this limits understandings of how children encounter death. Drawing on data from focus groups with children aged 9–12, this paper aimed to explore if and how children experience death as a taboo, but discovered that the death‐taboo thesis lacks nuance, confining and misrepresenting children’s experiences. Death ambivalence is thus proposed as a conceptual tool to illuminate children’s relationship with death. It identifies policy and practice implications concerned with developing death literacy and brings a new theorisation to death and childhood studies.
Unveiling the role of multiple blockholders: Evidence from closely held firms
Authors: Russino Annalisa , Picone Pasquale Massimo , Dagnino Giovanni Battista
Published: July 2019

Research Question/Issue

This paper disentangles how the modes of ownership distribution among multiple blockholders and their heterogeneity shape principal–principal conflicts and, in turn, affect firm performance. The paper offers empirical evidence from a panel of Italian closely held firms over the period 2009–2014.

Research Findings/Insights

We explore the principal–principal conflicts among blockholders across two distinct control structures. When a single blockholder controls the firm, principal–principal conflicts are shaped by the trade‐off between the alignment effect and the monitoring effect. In this scenario, we find that the relationship between the two largest blockholders' ownership concentration and firm performance is U‐shaped. Furthermore, we show that heterogeneity across the two largest blockholder types has a negative effect on performance. In the absence of a controlling blockholder, firm control is usually obtained by forming coalitions, and principal–principal conflicts involve the blockholders inside the controlling coalition and the other shareholders. We find that the ownership distribution and heterogeneity across blockholder types are negatively related to the size of controlling coalitions, and in turn, the size of controlling coalitions is positively correlated with firm performance.

Theoretical/Academic Implications

We contribute to principal–principal segment of agency theory by showing that the presence of a controlling blockholder is a key variable that alters the relationship between blockholders' ownership concentration and corporate performance, as well as the relationship between heterogeneity across the largest blockholders and firm performance.

Practitioner/Policy Implications

Our findings across control structures in which multiple blockholders are present suggest that blockholders take different roles depending on the control structure in which they are involved. The implications of these findings relate to the design of the ownership structure of a firm.
Ductile cast irons: Microstructure influence on the fatigue initiation mechanisms
Authors: Bellini Costanzo , Di Cocco Vittorio , Favaro Gregory , Iacoviello Francesco , Sorrentino Luca
Published: July 2019

In the last decades, the combination of high mechanical performances and low production costs increased the industrial interest on ductile cast irons. These grades are often used for applications where the fatigue resistance can be a critical issue (eg, machine frames for the wind‐power industry or crankshaft used in trucks) and the investigation of the main damaging mechanisms during both the crack initiation and the crack propagation stage could offer new perspectives about these alloys.

Ductile cast irons can be considered as a natural composite, being characterized by graphite elements (nodules) embedded in a more or less ductile matrix (ranging from fully ferritic to pearlitic, from martensitic to austempered). In this work, the fatigue crack initiation mechanisms were investigated considering different matrix microstructure and the presence of a mechanical properties gradient in the graphite nodules.
Largely underestimated carbon emission from land use and land cover change in the conterminous United States
Authors: Yu Zhen , Lu Chaoqun , Tian Hanqin , Canadell Josep G.
Published: July 2019

Carbon (C) emission and uptake due to land use and land cover change (LULCC) are the most uncertain term in the global carbon budget primarily due to limited LULCC data and inadequate model capability (e.g., underrepresented agricultural managements). We take the commonly used FAOSTAT‐based global Land Use Harmonization data (LUH2) and a new high‐resolution multisource harmonized national LULCC database (YLmap) to drive a land ecosystem model (DLEM) in the conterminous United States. We found that recent cropland abandonment and forest recovery may have been overestimated in the LUH2 data derived from national statistics, causing previously reported C emissions from land use have been underestimated due to the definition of cropland and aggregated LULCC signals at coarse resolution. This overestimation leads to a strong C sink (30.3 ± 2.5 Tg C/year) in model simulations driven by LUH2 in the United States during the 1980–2016 period, while we find a moderate C source (13.6 ± 3.5 Tg C/year) when using YLmap. This divergence implies that previous C budget analyses based on the global LUH2 dataset have underestimated C emission in the United States owing to the delineation of suitable cropland and aggregated land conversion signals at coarse resolution which YLmap overcomes. Thus, to obtain more accurate quantification of LULCC‐induced C emission and better serve global C budget accounting, it is urgently needed to develop fine‐scale country‐specific LULCC data to characterize the details of land conversion.
Comparison of three frailty models and a sarcopenia model in elderly patients with chronic obstructive pulmonary disease
Authors: Hirai Kuniaki , Tanaka Akihiko , Homma Tetsuya , Kaneko Keisuke , Uno Tomoki , Sato Haruna , Manabe Ryo , Ohta Shin , Kusumoto Sojiro , Yamaguchi Fumihiro , Suzuki Shintaro , Sagara Hironori
Published: July 2019

Aim

Frailty and sarcopenia affect the prognosis and quality of life of patients with chronic obstructive pulmonary disease (COPD). However, it remains uncertain which model is the most suitable for evaluating vulnerability in patients with COPD. We evaluated the validity of three frailty models – the Kihon Checklist (KCL), the Japanese version of the Cardiovascular Health Study and the Study of Osteoporotic Fractures – and one sarcopenia model for older patients with COPD.

Methods

This cross‐sectional study included 201 older (aged ≥65 years) outpatients with COPD. We used three frailty models and one sarcopenia model to identify their correlation with various indices that can evaluate the status of COPD and determine the most ideal model for evaluating vulnerability in patients with COPD.

Results

The highest prevalence of frailty (38%) and lowest prevalence of robustness (26%) were observed using the KCL. Although all models reflected the characteristics of COPD, the KCL yielded the strongest correlations with clinically important physical, psychological and prognostic indices. The KCL yielded statistically significant differences in almost all indices among the three intergroup comparisons (robust, pre‐frailty and frailty). The KCL was superior in extracting mood disorders to the other models.

Conclusion

Although all investigated models were useful, the KCL was the most suitable for evaluating the frailty status and might enable interventions in patients with COPD. Geriatr Gerontol Int 2019; 19: 896–901.
Architectural tradition and modernity as crypto‐colonial ways of seeing: A comparison of Kathmandu's 1934 and 2015 post‐quake reconstructions
Authors: Nelson Andrew
Published: July 2019

This essay compares the architectural responses to Kathmandu's 1934 and 2015 earthquakes through a postcolonial framework. While rulers and elites used post‐1934 reconstruction to impose their notion of modernity upon the city, in post‐2015 reconstruction, conservationists see an opportunity to remake the traditional city. Instead of framing modernity and tradition as opposing forces, however, this essay reconsiders references to both as markers of class distinction that obscure Nepal's enduring crypto‐colonial position.
Gender Bias in Medical Implant Design and Use: A Type of Moral Aggregation Problem?
Authors: Hutchison Katrina
Published: July 2019

In this article, I describe how gender bias can affect the design, testing, clinical trials, regulatory approval, and clinical use of implantable devices. I argue that bad outcomes experienced by women patients are a cumulative consequence of small biases and inattention at various points of the design, testing, and regulatory process. However, specific instances of inattention and bias can be difficult to identify, and risks are difficult to predict. This means that even if systematic gender bias in implant design is an ethical issue, it is one with no clearly blameworthy player. From a practical perspective, there is no single obvious point at which to intervene. Philosophers working in other areas have explored structurally similar moral problems—sometimes referred to as “moral aggregation problems”—such as the type of environmental harm caused by small actions of many players. I describe key features of these type of problems and strategies to address them. I then draw on these to suggest an approach to gender bias in medical implant design and use.
Synchronized in vivo measurements of skin hydration and trans‐epidermal water loss. Exploring their mutual influences
Authors: Caberlotto E. , Cornillon C. , Njikeu S. , Monot M. , Vicic M. , Flament F.
Published: July 2019

Objective

To explore the relationship between skin surface hydration and Trans‐Epidermal Water Loss (TEWL) when simultaneously measured.

Methods

Six circular skin areas of the forearms (3 per forearm, 3 cm in diameter) of 12 Caucasian women were used as models. 4 prototypes of formulae of different compositions containing glycerol at different concentrations 7%, 10% and 40% were used as models of hydrating products. One formula (glycerol‐free) was used as control vehicle. Standardized applications of formulae (2 mg/cm2) were performed on 5 skin sites chosen at random, the other being left as bare/control. A recently marketed instrumental device that records the skin surface hydration and TEWL on a small skin area in a simultaneous manner was used. Measurements were carried out at T0 (pre‐application), at 1 h (T1) and 5 h (T5) post applications on two close sites within the 6 defined areas of both forearms.

Results

The new instrumental device allowed to clearly differentiate the 5 formulae (i.e. 7% vs. 10%) with regard the dose effect brought by glycerol (7%, 10%, 40%) and to record their lingering effects at T1 and T5. Both parameters were found significantly and negatively correlated, i.e. the higher the skin hydration, the lower the TEWL. The 40% concentration of glycerol, that leads to the highest skin hydration, brings a drop in the TEWL by about a two‐fold factor. Skin hydration of bare skin and control/vehicle sites showed minor and non‐significant changes along 5 h. Instead, the control/ vehicle slowed down the TEWL to a slight extent.

Conclusion

The use of this new instrumental device shed a new light on the mutual and inverse relationships between skin hydration and TEWL. Results suggest that, at high concentration, glycerol leads to largely increase the water content of both epidermal and dermal compartments, possibly leading to structural changes in the skin relief.
Clinical and in vitro evaluation of new anti‐redness cosmetic products in subjects with winter xerosis and sensitive skin
Authors: Nisbet S. J. , Targett D. , Rawlings A. V. , Qian K. , Wang X. , Lin C. B. , Thompson M. A. , Bulsara P. A. , Moore D. J.
Published: July 2019

Objective

To demonstrate the in vitro activities of panthenol, palmitoylethanolamide (PEA), and niacinamide (NAM) and determine the biophysical properties, clinical safety, tolerability together with efficacy of two developmental anti‐redness (AR) formulations containing these ingredients, in alleviating facial redness associated with winter xerosis in healthy volunteers with sensitive skin.

Methods

The anti‐inflammatory and skin protective properties of panthenol, PEA and NAM were evaluated in vitro. The physical properties of the AR formulations were analysed using measurement of water vapour transport rate (WVTR) and infrared spectroscopy. Clinical studies were performed between the months of December and April (2014–2015) with efficacy assessed during the winter. Facial redness, irritation, sensitization potential, photo‐irritation, and photo‐sensitization were evaluated. Self‐assessed adverse reactions were reported in diaries of use.

Results

Panthenol and PEA reduced prostaglandin E2, interleukin‐6, and thymic stromal lymphopoietin levels in vitro, while NAM induced nicotinamide adenine dinucleotide (NAD) levels and the keratinocyte differentiation markers: filaggrin (2‐fold increase, P < 0.001), loricrin (2‐fold increase, P < 0.05), involucrin (2 fold increase, P < 0.001) & peroxisomal proliferator activated receptor‐alpha (1.5 fold increase, P < 0.05). The two AR products exhibited low WVTR vs. no treatment (P < 0.001) and displayed an ordered lipid structure. The day cream formulation protected against ultraviolet B radiation in vitro. A total of 382 participants were included in clinical studies which showed the AR formulations significantly improved facial redness associated with winter xerosis (Day 29 mean change from baseline: AR day cream 0.77 (P < 0.001); AR serum 0.67 (P < 0.001)). No irritation, sensitization, photo‐irritation, photo‐sensitization or product‐related adverse reactions were observed or reported in the clinical studies.

Conclusion

The new products significantly improved skin redness associated with winter xerosis in participants with self‐perceived sensitive skin. Both products were well tolerated with a suitable safety profile for topical use in subjects with sensitive skin.
Complementary medicine use and its cost in Australians with type 2 diabetes: the Fremantle Diabetes Study Phase II
Authors: Yarash Tatsiana , Sharif Imrana , Masood Farhat , Clifford Rhonda M. , Davis Wendy A. , Davis Timothy M. E.
Published: July 2019

Background

Few studies have examined complementary medicine (CM) use in diabetes. Australian data are inconsistent, limited in scope and have not considered cost.

Aims

To evaluate the prevalence, associates and costs of CM in a contemporary Australian urban, community‐based cohort of people with type 2 diabetes.

Methods

Baseline CM use was determined as part of a detailed assessment in 1543 of 1551 Fremantle Diabetes Study Phase II (FDS2) participants with type 2 diabetes (mean age 65.7 years, 51.8% males, median diabetes duration 9.0 years) recruited to the FDS2 between 2008 and 2011 who self‐reported medication use including CM defined as non‐prescription medicinal products.

Results

A total of 672 FDS2 type 2 participants (43.6%) used at least one type of CM, 92% of which were nutritional supplements (omega‐3 fatty acids/fish oil in 24% of CM users followed by calcium in 11%, glucosamine in 10% and others in <10%). Independent associates of CM use included older age, female sex, any mobility problem, and, inversely, Southern European or Indigenous Australian background, lack of English fluency, ex/current smoking status, taking oral glucose‐lowering medications and higher HbA1c. The total annual estimated cost of CM used by FDS2 participants with type 2 diabetes was A$121 640 or A$79 ± 208 per person (range A$0–2993). Extrapolating these data, the 1 million Australians with type 2 diabetes spend A$79 million/year on CM.

Conclusions

CM use in type 2 diabetes is both common and costly. Healthcare professionals should consider discussing safe and cost‐effective use of CM with their patients with type 2 diabetes.
New sources of housing market risk: Asset pricing for the US state‐level housing markets
Authors: Huang MeiChi
Published: July 2019

This study develops three novel housing risk factors to explore the sources of risk in US state‐level housing markets. The asset‐pricing models enrich our investigations into housing markets from three perspectives: housing boom–bust, volatile–calm, and factors’ time‐varying impact regimes. The findings indicate that state‐level housing returns all show significant exposure to systemic risk of housing markets, but the demographic and economic factors’ explanatory powers for housing returns differ across markets. Although the liquidity factor is significant under all three frameworks, the inventory and credit factors show significant impacts only in the impact‐switching specification. There are differences in the responses of housing returns to various risk factors and shifts in housing regimes across state housing markets, depending on whether the states exhibited housing bubbles. The results suggest that an effective housing stabilization mechanism must be capable of tracking shifts in the relations between housing markets and risk factors.
Experiences of implementing hand hygiene for Malawian schoolchildren: a qualitative study
Authors: Mbakaya B.C. , Lee R.L.T.
Published: July 2019

Aim

To explore the experiences of schoolchildren, school personnel and parents who participated in a school‐based hand hygiene programme implemented by nurses in Malawi.

Background

There is low uptake of hand hygiene practice in developing countries due to limited resources available and no standardized hand hygiene policy.

Introduction

Current health policies acknowledge the advantage of investing in disease prevention and health promotion among young children in Malawi. School nurses should adopt good evidence‐based practice in promoting school‐based hand hygiene programmes which remain a challenge in Malawi.

Methods

In this descriptive qualitative study, 10 focus group discussions were conducted with 23 females and 14 males including schoolchildren, school personnel and parents participating in a school‐based hand hygiene programme. The programme was implemented by nurses in three primary schools between May and July 2017 in Malawi. Data from these discussions were coded and analysed using thematic analysis.

Findings

The school‐based hand hygiene programme was well received by participants. Four themes illustrated effective strategies in implementing the hand hygiene programme from the participants’ view, including ‘Being committed’, ‘Sharing responsibilities’, ‘Disseminating good practice’ and ‘Appreciating assets’. These are essential resources and strategies that school nurses need to mobilize and integrate when they advocate handwashing policy by delivering hygiene promotion activities.

Discussion

School nurses play a significant role in helping to achieve United Nation’s Sustainable Development Goal 3 through promoting hand hygiene to minimize transmission of diseases and reduce mortality rate.

Conclusion and implications for nursing and health policy

An evidence‐based protocol based on study findings is beneficial for school nurses in formulating handwashing policies. It is important for developing countries to formulate the much‐need policies for primary care practices.
Targeting the PI3K/STAT3 axis modulates age‐related differences in macrophage phenotype in rats with myocardial infarction
Authors: Lin Chih‐Chan , Chen Syue‐yi , Lien Hsiao‐Yin , Lin Shinn‐Zong , Lee Tsung‐Ming
Published: July 2019

Ageing is associated with impaired repair mechanisms in cardiovascular diseases. Macrophages contribute to cardiac fibrosis after myocardial infarction (MI). The phosphatidyl‐inositol‐3‐kinase (PI3K) pathway has been shown to play a role in cardiac remodelling after MI. It remained unclear whether n‐butylidenephthalide, a major component of Angelica sinensis, can attenuate cardiac fibrosis by regulating the PI3K/signal transducer and activator of transcription 3 (STAT3)‐mediated macrophage phenotypes in ageing rats after MI. Twenty‐four hours after ligation of the left anterior descending artery, young (2‐month‐old) and ageing (18‐month‐old) male Wistar rats were treated with either vehicle or n‐butylidenephthalide for 4 weeks. There were similar infarct sizes in both age groups. Compared with young rats, ageing rats exhibited significant increased cardiac fibrosis after MI, which can be attenuated after administering n‐butylidenephthalide. MI was associated with decreased activities of PI3K and STAT3 in ageing rats compared with young rats. In both age groups, n‐butylidenephthalide effectively provided a significant increase of STAT3 phosphorylation, STAT3 activity, STAT3 nuclear translocation, myocardial IL‐10 levels and the percentage of M2c macrophage and a decrease of myofibroblast infiltration. The effects of n‐butylidenephthalide on increased IL‐10 levels were reversed by LY294002 or S3I‐201. Furthermore, LY294002 abolished the STAT3 phosphorylation, whereas PI3K activity was not affected following the inhibition of STAT3. In conclusions, the host environment is responsible for ageing‐related myofibroblast dysregulation in response to MI which can be improved by administering n‐butylidenephthalide via macrophage differentiation towards M2 phenotype by targeting the PI3K/STAT3 axis.
Commentary: I thought I was going to die and the world is not safe—how to help children recover after trauma? Reflections on Meiser‐Stedman et al. (2019)
Authors: Jensen Tine K.
Published: July 2019

Children all over the world experience exposure to trauma. Why do only some young people have significant traumatic stress symptoms in the days and weeks immediately post‐trauma while others do not, and why do some youth then recover without treatment while others go on to suffer from persistent PTSD? This important question is examined in a comprehensive study by Meiser‐Stedman et al., (2019). In a sample of single‐event trauma exposed youth, they investigate the role cognitive processes may have in shaping early reactions and in maintaining post‐traumatic stress symptoms (PTSS) over time. For the onset of PTSS, perceived threat and feeling overwhelmed and confused during the traumatic event was associated with significant PTSS. For the maintenance of PTSS, poorly elaborated, sensory‐based memories, dissociation, rumination, and negative appraisals were associated with higher PTSS. The newly revised International Society for Traumatic Stress Studies’ guidelines for the prevention and treatment of PTSS found no strong evidence to recommend any of the evaluated preventive or early intervention programs. This commentary highlights how understanding different trajectories for the onset and maintenance of post‐traumatic stress may inform our development of prevention and early intervention strategies. Cognitive processes seem to play an important role in the development of PTSS but these may play out differently in youth exposed to single events and youth with interpersonal trauma experiences. Knowledge on memory processing, meaning making, the role of social support and maladaptive cognitions need to be implemented in systems of trauma‐informed care.
GlycA, a composite low‐grade inflammatory marker, predicts mortality: prime time for utilization?
Authors: Duprez D. A. , Jacobs D. R.
Published: July 2019

Click to view the Original Article by Gruppen et al.
Different Nutritional Histories Affect the Susceptibility of Algae to Grazing
Authors: Venuleo Marianna , Giordano Mario
Published: July 2019

We hypothesize that algae with different cell compositions are differently perceived by their predators and consequently subjected to selective grazing. Five populations of the diatom Phaeodactylum tricornutum that differed in organic and elemental composition, but were otherwise identical, were generated by acclimation to distinct growth regimes. The different populations were then mixed in pairs and subjected to predation by either the rotifer Brachionus plicatilis or the copepod Acartia tonsa. The presence of rotifers had no impact on the ratio between any two algal populations. The presence of copepods, however, affected the ratio between algae previously acclimated to a medium containing 1 mM NH4+ and algae acclimated to 0.5 mM NO3−, and to either a lower irradiance or a higher CO2 concentration. We discuss the possible reason for the influence of different nutritional histories on the vulnerability of algae to predators. The differential impact of grazers on the growth of algae with different nutritional histories may result from direct selective grazing (i.e., grazers can detect algae with the most palatable cell composition), alone or combined to an asymmetric utilization of the nutrients regenerated after predation by co‐existing algal populations. Our results strongly suggest that the nutritional history of algae can influence the relationships between phytoplankton and grazers and hint at the possibility that algal cell composition is potentially subject to natural selection, because it influences the probability that algae survive predation.