bluuebunny/crossref_metadata_2025 huggingface dataset:
From conventional to unconventional monetary policies: The failure of the market‐maker of last resort
Authors: Giménez Roche Gabriel A. , Janson Nathalie
Published: April 2018

This paper analyses the new role of market‐maker of last resort openly assumed by central banks since the 2008 financial crisis revealed the increasing impact of noninterest‐income activities on banks' balance sheets. A brief review of the distinction between conventional and unconventional monetary policies shows that the inflexion point from lender of last resort to market‐maker of last resort is given by the extension of central bank intervention to other markets than the bank reserves markets. Herein, it is explained how the market‐maker of last resort role is as counterproductive as its predecessor in putting the economy back on track. We show that the main problem of both conventional and unconventional monetary policies is that they distort price signals, particularly asset prices, in their attempt to reignite economic growth. Instead of correcting cyclical fluctuations, the policies of the market‐maker of last resort prevent the cyclical divergences between financial and goods sectors from readjusting.
Afferent neural feedback overrides the modulating effects of arousal, hypercapnia and hypoxaemia on neonatal cardiorespiratory control
Authors: Lumb Kathleen J. , Schneider Jennifer M. , Ibrahim Thowfique , Rigaux Anita , Hasan Shabih U.
Published: April 2018

Key points

Evidence obtained at whole animal, organ‐system, and cellular and molecular levels suggests that afferent volume feedback is critical for the establishment of adequate ventilation at birth.

As a result of the irreversible nature of the vagal ablation studies performed to date, it was difficult to quantify the roles of afferent volume input, arousal and changes in blood gas tensions on neonatal respiratory control.

During reversible perineural vagal block, profound apnoeas and hypoxaemia and hypercarbia were observed, necessitating the termination of perineural blockade.

Respiratory depression and apnoeas were independent of sleep state. We demonstrate that profound apnoeas and life‐threatening respiratory failure in vagally denervated animals do not result from a lack of arousal or hypoxaemia.

A change in sleep state and concomitant respiratory depression result from a lack of afferent volume feedback, which appears to be critical for the maintenance of normal breathing patterns and adequate gas exchange during the early postnatal period.

Afferent volume feedback plays a vital role in neonatal respiratory control. Mechanisms for the profound respiratory depression and life‐threatening apnoeas observed in vagally denervated neonatal animals remain unclear. We investigated the roles of sleep states, hypoxic‐hypercapnia and afferent volume feedback on respiratory depression using reversible perineural vagal block during the early postnatal period. Seven lambs were instrumented during the first 48 h of life to record/analyse sleep states, diaphragmatic electromyograph, arterial blood gas tensions, systemic arterial blood pressure and rectal temperature. Perineural cuffs were placed around the vagi to attain reversible blockade. Postoperatively, during the awake state, both vagi were blocked using 2% xylocaine for up to 30 min. Compared to baseline values, pHa, and decreased and increased during perineural blockade (P < 0.05). Four of seven animals exhibited apnoeas of ≥20 s requiring the immediate termination of perineural blockade. Breathing rates decreased from the baseline value of 53 ± 12 to 24 ± 20 breaths min–1 during blockade despite an increased (P < 0.001). Following blockade, breathing patterns returned to baseline values despite marked hypocapnia ( 33 ± 3 torr; P = 0.03). Respiratory depression and apnoeas were independent of sleep states. The present study provides the much needed physiological evidence indicating that profound apnoeas and life‐threatening respiratory failure in vagally denervated animals do not result from a lack of arousal or hypoxaemia. Rather, a change in sleep state and concomitant respiratory depression result from a lack of afferent volume feedback, which appears to be critical for the maintenance of normal breathing patterns and adequate gas exchange during the early postnatal period.
A Repeating Sulfated Galactan Motif Resuscitates Dormant Micrococcus luteus Bacteria
Authors: Böttcher Thomas , Szamosvári Dávid , Clardy Jon
Published: April 2018

Only a small fraction of bacteria can autonomously initiate growth on agar plates. Nongrowing bacteria typically enter a metabolically inactive dormant state and require specific chemical trigger factors or signals to exit this state and to resume growth.
Micrococcus luteus
has become a model organism for this important yet poorly understood phenomenon. Only a few resuscitation signals have been described to date, and all of them are produced endogenously by bacterial species. We report the discovery of a novel type of resuscitation signal that allows
M. luteus
to grow on agar but not agarose plates. Fractionation of the agar polysaccharide complex and sulfation of agarose allowed us to identify the signal as highly sulfated saccharides found in agar or carrageenans. Purification of hydrolyzed κ-carrageenan ultimately led to the identification of the signal as a small fragment of a large linear polysaccharide, i.e., an oligosaccharide of five or more sugars with a repeating disaccharide motif containing
d
-galactose-4-sulfate (G4S) 1,4-linked to 3,6-anhydro-α-
d
-galactose (DA), G4S-(DA-G4S)

n
≥2

.

IMPORTANCE
Most environmental bacteria cannot initiate growth on agar plates, but they can flourish on the same plates once growth is initiated. While there are a number of names for and manifestations of this phenomenon, the underlying cause appears to be the requirement for a molecular signal indicating safe growing conditions.
Micrococcus luteus
has become a model organism for studying this growth initiation process, often called resuscitation, because of its apparent connection with the persistent or dormant form of
Mycobacterium tuberculosis
, an important human pathogen. In this report, we identify a highly sulfated saccharide from agar or carrageenans that robustly resuscitates dormant
M. luteus
on agarose plates. We identified and characterized the signal as a small repeating disaccharide motif. Our results indicate that signals inherent in or absent from the polysaccharide composition of solid growth media can have major effects on bacterial growth.
Forecasted impacts of a sofosbuvir-based national hepatitis C treatment programme on Egypt’s hepatocellular cancer epidemic: simulation of alternatives
Authors: Ma Wenkang , Soliman Amr S , Anwar Wagida A , Hablas Ahmed , El Din Tamer B , Ramadan Mohamed , Seifeldin Ibrahim A , Wilson Mark L
Published: April 2018

Background

Egypt is experiencing a hepatocellular cancer (HCC) epidemic due to widespread hepatitis C virus (HCV) transmission. The use of sofosbuvir-related therapies producing improved treatment success has permitted an updated, nationwide, HCV treatment programme with expanded coverage. This study simulated the multidecade impacts of the new treatment programme on hepatitis and HCC.

Methods

A Markov model of HCV infection and treatment analysed the HCV-related HCC epidemic between 2009 and 2050, using parameters based on peer-reviewed studies and expert opinion. Comparing the ‘new’ and ‘old’ scenarios, and with the old treatment programme being replaced or not by the new programme in 2015, the annual number, prevalence and incidence of HCC were simulated for representative Egypt populations including HCV-infected patients aged 15–59 years in 2008, healthy people aged 5–59 years in 2008 and 5-year-old children cohorts entering the population each year beginning in 2009. Averted HCC cases were calculated, and sensitivity analyses were performed.

Results

Compared with the old scenario, the estimated number, prevalence and incidence of future HCC cases in the new scenario would peak earlier and at lower levels in 2025 (~29 000), 2023 (~28/100 000) and 2022 (~14/100 000), respectively. The new treatment programme is estimated to avert ~956 000 HCC cases between 2015 and 2050.

Discussion

By reducing cancer cases and shortening the peak epidemic period, the new programme should substantially diminish the HCC epidemic across Egypt. Our timeline forecast for Egypt’s HCC epidemic, and evaluation of various disease and programme components, should be useful to other countries that are developing policies to address HCV-related liver cancer prevention.
Involving the public in epidemiological public health research: a qualitative study of public and stakeholder involvement in evaluation of a population-wide natural policy experiment
Authors: Anderson de Cuevas Rachel , Nylén Lotta , Burström Bo , Whitehead Margaret
Published: April 2018

Background

Public involvement in research is considered good practice by European funders; however, evidence of its research impact is sparse, particularly in relation to large-scale epidemiological research.

Objectives

To explore what difference public and stakeholder involvement made to the interpretation of findings from an evaluation of a natural policy experiment to influence the wider social determinants of health: ‘Flexicurity’.

Setting

Stockholm County, Sweden.

Participants

Members of the public from different occupational groups represented by blue-collar and white-collar trade union representatives. Also, members of three stakeholder groups: the Swedish national employment agency; an employers’ association and politicians sitting on a national labour market committee. Total: 17 participants.

Methods

Qualitative study of process and outcomes of public and stakeholder participation in four focused workshops on the interpretation of initial findings from the flexicurity evaluation.

Outcome measures

New insights from participants benefiting the interpretation of our research findings or conceptualisation of future research.

Results

Participants sensed more drastic and nuanced change in the Swedish welfare system over recent decades than was evident from our literature reviews and policy analysis. They also elaborated hidden developments in the Swedish labour market that were increasingly leading to ‘insiders’ and ‘outsiders’, with differing experiences and consequences for financial and job security. Their explanation of the differential effects of the various collective agreements for different occupational groups was new and raised further potential research questions. Their first-hand experience provided new insights into how changes to the social protection system were contributing to the increasing trends in poverty among unemployed people with limiting long-standing illness. The politicians provided further reasoning behind some of the policy changes and their intended and unintended consequences. These insights fed into subsequent reporting of the flexicurity evaluation results, as well as the conceptualisation of new research that could be pursued in a future programme.
Incidence of superficial venous thrombosis in primary care and risk of subsequent venous thromboembolic sequelae: a retrospective cohort study performed with routine healthcare data from the Netherlands
Authors: Geersing Geert-Jan , Cazemier Selma , Rutten Frans , Fitzmaurice David A , Hoes Arno W
Published: April 2018

Objectives

Recent studies in referred populations of patients with superficial venous thrombosis (SVT) report risks of venous thromboembolic (VTE) sequelae (deep vein thrombosis or pulmonary embolism) as high as 25%. Likely, these estimates are lower in non-referred patients, but large-scale population-based studies are lacking. We aimed to estimate the incidence rate of SVT in primary care and quantify its risk of VTE sequelae.

Design

A retrospective cohort study, using International Classification of Primary Care coding (K94.02) combined with free text searching (synonyms for SVT) to capture all SVT events. All patients were followed up for 3 months using manual free text searching.

Setting

Primary care.

Participants

All patients enlisted with general practitioners within the Utrecht General Practitioner Network between 2010 and 2016 (1 534 845 person-years follow-up).

Main outcome measures

The incidence rate of SVT was expressed as the number of SVT events per 1000 person-years of follow-up and the 3-month cumulative incidence of VTE events was calculated. Logistic regression analysis was used to compare patients with SVT with and without VTE sequelae.

Results

A total of 2008 SVT cases were identified, that is, an SVT incidence rate of 1.31 (95% CI 1.25 to 1.37) per 1000 person-years follow-up, with higher rates notably with increasing age. VTE sequelae occurred in 83 patients; 51 at the time of SVT diagnosis and 32 patients during follow-up (total cumulative incidence of 4.1%; 95% CI 3.3% to 5.1%), and were more frequent in those with an active malignancy (OR 2.19; 95% 0.97 to 4.95) and less frequent in those with varicose veins at baseline (OR 0.57, 95% CI 0.34 to 0.94).

Conclusion

We found an incidence rate of SVT in primary care of 1.31 per 1000 person-years. The risks of VTE sequelae was relatively low at 4.1%, with the highest risk in patients with cancer and in those who experience an SVT in the absence of varicose veins.
Fostering active living and healthy eating through understanding physical activity and dietary behaviours of Arabic-speaking adults: a cross-sectional study from the Middle East
Authors: Donnelly Tam Truong , Fung Tak Shing , Al-Thani Al-Anoud bint Mohammad
Published: April 2018

Objectives

Physical inactivity and unhealthy diets increase the risk for diabetes, cardiovascular diseases and cancer. Many people in Qatar are sedentary and consume diets high in fats, salt and sugar. The purpose of this study was to determine physical activity levels, food habits and understand the variables that might predict physical activity and healthy eating behaviours among Arabic-speaking adults living in the State of Qatar.

Setting

A cross-sectional community-based survey was conducted with 1606 Arab adults ≥18 years of age from March 2013 to June 2015. Using a non-probability sampling technique, participants were recruited from three universities and five primary healthcare centres in Qatar. Participants were interviewed using a structured survey questionnaire. The survey included questions regarding demography, clinical characteristics and the participant’s daily dietary practice. Physical activity level was assessed by the Arabic version of the International Physical Activity Questionnaire. Statistical analysis was performed using SPSS V.22.0.

Results

Of 1606 participants, 50.1% were men and 49.9% were women. The participants’ mean (SD) body mass index was 28.03 (5.85) Kg/m2. Two-thirds of the participants were either overweight (36.4%) or obese (33.6%). Within the 7 days prior to completing the questionnaire, 64% and 39.9% of study participants did not engage in vigorous or moderate physical activity, respectively. Within the 7 days prior to completing the questionnaire, the mean (SD) time for vigorous physical activity was 31.12 (59.28) min, 46.87 (63.01) min for moderate physical activity, and 42.01 (47.04) min for walking. One-third of the participants consumed fresh fruits and vegetables once or more daily, and fish, beef or chicken 2–4 times weekly. One quarter of the participants ate pasta, cakes or pastries 2–4 times weekly, and 40.6% of them ate white bread daily.

Conclusions

Participants exhibited insufficient physical activity and poor dietary habits. There is a need for a nationwide health promotion programme to promote a healthier lifestyle. The information from this study can inform public health policies, programmes and services in Qatar and other Middle Eastern countries.
Health-related quality of life in Asian patients with breast cancer: a systematic review
Authors: Ho Peh Joo , Gernaat Sofie A M , Hartman Mikael , Verkooijen Helena M
Published: April 2018

Objective

To summarise the evidence on determinants of health-related quality of life (HRQL) in Asian patients with breast cancer.

Design

Systematic review conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations and registered with PROSPERO (CRD42015032468).

Methods

According to the PRISMA guidelines, databases of MEDLINE (PubMed), Embase and PsycINFO were systematically searched using the following terms and synonyms: breast cancer, quality of life and Asia. Articles reporting on HRQL using EORTC-QLQ-C30, EORTC-QLQ-BR23, FACT-G and FACT-B questionnaires in Asian patients with breast cancer were eligible for inclusion. The methodological quality of each article was assessed using the quality assessment scale for cross-sectional studies or the Newcastle-Ottawa Quality Assessment Scale for cohort studies.

Results

Fifty-seven articles were selected for this qualitative synthesis, of which 43 (75%) were cross-sectional and 14 (25%) were longitudinal studies. Over 75 different determinants of HRQL were studied with either the EORTC or FACT questionnaires. Patients with comorbidities, treated with chemotherapy, with less social support and with more unmet needs have poorer HRQL. HRQL improves over time. Discordant results in studies were found in the association of age, marital status, household income, type of surgery, radiotherapy and hormone therapy and unmet sexuality needs with poor global health status or overall well-being.

Conclusions

In Asia, patients with breast cancer, in particular those with other comorbidities and those treated with chemotherapy, with less social support and with more unmet needs, have poorer HRQL. Appropriate social support and meeting the needs of patients may improve patients’ HRQL.
Cohort profile: the Italian Network of Longitudinal Metropolitan Studies (IN-LiMeS), a multicentre cohort for socioeconomic inequalities in health monitoring
Authors: Caranci Nicola , Di Girolamo Chiara , Giorgi Rossi Paolo , Spadea Teresa , Pacelli Barbara , Broccoli Serena , Ballotari Paola , Costa Giuseppe , Zengarini Nicolás , Agabiti Nera , Bargagli Anna Maria , Cacciani Laura , Canova Cristina , Cestari Laura , Biggeri Annibale , Grisotto Laura , Terni Gianna , Costanzo Gianfranco , Mirisola Concetta , Petrelli Alessio
Published: April 2018

Purpose

The Italian Network of Longitudinal Metropolitan Studies (IN-LiMeS) is a system of integrated data on health outcomes, demographic and socioeconomic information, and represents a powerful tool to study health inequalities.

Participants

IN-LiMeS is a multicentre and multipurpose pool of metropolitan population cohorts enrolled in nine Italian cities: Turin, Venice, Reggio Emilia, Modena, Bologna, Florence, Leghorn, Prato and Rome. Data come from record linkage of municipal population registries, the 2001 population census, mortality registers and hospital discharge archives. Depending on the source of enrolment, cohorts can be closed or open. The census-based closed cohort design includes subjects resident in any of the nine cities at the 2001 census day; 4 466 655 individuals were enrolled in 2001 in the nine closed cohorts. The open cohort design includes subjects resident in 2001 or subsequently registered by birth or immigration until the latest available follow-up (currently 31 December 2013). The open cohort design is available for Turin, Venice, Reggio Emilia, Modena, Bologna, Prato and Rome. Detailed socioeconomic data are available for subjects enrolled in the census-based cohorts; information on demographic characteristics, education and citizenship is available from population registries.

Findings to date

The first IN-LiMeS application was the study of differentials in mortality between immigrants and Italians. Either using a closed cohort design (nine cities) or an open one (Turin and Reggio Emilia), individuals from high migration pressure countries generally showed a lower mortality risk. However, a certain heterogeneity between the nine cities was noted, especially among men, and an excess mortality risk was reported for some macroareas of origin and specific causes of death.

Future plans

We are currently working on the linkage of the 2011 population census data, the expansion of geographical coverage and the implementation of the open design in all the participating cohorts.
Older patients’ perception of deprescribing in resource-limited settings: a cross-sectional study in an Ethiopia university hospital
Authors: Tegegn Henok Getachew , Tefera Yonas Getaye , Erku Daniel Asfaw , Haile Kaleab Taye , Abebe Tamrat Befekadu , Chekol Fasil , Azanaw Yonas , Ayele Asnakew Achaw
Published: April 2018

Objective

To assess older patients’ attitude towards deprescribing of inappropriate medications.

Design

This was an institutional-based, quantitative, cross-sectional survey.

Setting

Outpatient clinics of the University of Gondar Referral and Teaching Hospital in Ethiopia.

Participants

Patients aged 65 or older with at least one medication were enrolled in the study from 1 March to 30 June 2017. Excluded patients were those who had severe physical or psychological problems and who refused to participate.

Main outcome measures

Older patients’ attitude towards deprescribing was measured using a validated instrument, ‘the revised Patients’ Attitudes towards Deprescribing’ (rPATD) tool for older patients. Data were collected on sociodemographic characteristics and clinical data such as comorbidity and polypharmacy, and the main outcome was older patients’ willingness to deprescribe inappropriate medications.

Results

Of the 351 eligible participants, 316 patients completed the survey. Of the 316 patients, 54.7% were men and were taking a median of 3 (IQR: 2–4) medications daily. Overall, most of the participants (92.1%; 95% CI 89% to 95%) were satisfied with the medications they were taking; however, still a significant number of participants (81.6%; 95% CI 77% to 86%) were willing to stop one or more of their medications if possible and agreed by their doctors. This willingness was correlated with seven items of the rPATD, including a strong correlation with the overall satisfaction of patients with the medications taken.

Conclusion

Many older patients have shown their willingness to reduce one or more of their medications if their doctors said it was possible. Healthcare providers should be proactive in discussing and evaluating potentially inappropriate medications for better clinical decision making.
Prescribing and deprescribing antihypertensive medication in older people by Dutch general practitioners: a qualitative study
Authors: van Middelaar Tessa , Ivens Sophie D , van Peet Petra G , Poortvliet Rosalinde K E , Richard Edo , Pols A Jeannette , Moll van Charante Eric P.
Published: April 2018

Objectives

To explore general practitioners’ (GPs) routines and considerations on (de)prescribing antihypertensive medication (AHM) in older patients, their judgement on usability of the current guideline and needs for future support.

Design

Semistructured interviews.

Setting

Dutch general practice.

Participants

Fifteen GPs were purposively sampled based on level of experience and practice characteristics until saturation was reached.

Results

GPs appeared reluctant to start AHM, especially in patient >80 years. High systolic blood pressure and history of cardiovascular disease or diabetes were enablers to start or intensify treatment. Reasons to refrain from this were frailty and patient preference. GPs described a tendency to continue AHM regimens unchanged, influenced by daily time constraints, automated prescription routines and anticipating discomfort when disturbing patients’ delicate balance. GPs were only inclined to deprescribe AHM in terminally ill patients or after prolonged achievement of target levels in combination with side effects or patient preference. Deprescription was facilitated when GPs had experience with patients showing increased quality of life after deprescription and was withheld by anticipated regret (ie, GPs’ fear of a stroke after deprescribing). GPs felt insufficient guidance from current guidelines, especially on deprescription.

Conclusions

GPs are reluctant to start or deprescribe AHM in older people and have a propensity to continue AHM within a daily routine that insufficiently supports critical medication review. (De)prescription is influenced by patient preferences and anticipated regret and current guidelines provide insufficient guidance.
Clinicians’ and researchers’ perspectives on establishing and implementing core outcomes in haemodialysis: semistructured interview study
Authors: Tong Allison , Crowe Sally , Gill John S , Harris Tess , Hemmelgarn Brenda R , Manns Braden , Pecoits-Filho Roberto , Tugwell Peter , van Biesen Wim , Wang Angela Yee Moon , Wheeler David C , Winkelmayer Wolfgang C , Gutman Talia , Ju Angela , O’Lone Emma , Sautenet Benedicte , Viecelli Andrea , Craig Jonathan C
Published: April 2018

Objectives

To describe the perspectives of clinicians and researchers on identifying, establishing and implementing core outcomes in haemodialysis and their expected impact.

Design

Face-to-face, semistructured interviews; thematic analysis.

Stetting

Twenty-seven centres across nine countries.

Participants

Fifty-eight nephrologists (42 (72%) who were also triallists).

Results

We identified six themes:reflecting direct patient relevance and impact(survival as the primary goal of dialysis, enabling well-being and functioning, severe consequences of comorbidities and complications, indicators of treatment success, universal relevance, stakeholder consensus);amenable and responsive to interventions(realistic and possible to intervene on, differentiating between treatments);reflective of economic burden on healthcare; feasibility of implementation(clarity and consistency in definition, easily measurable, requiring minimal resources, creating a cultural shift, aversion to intensifying bureaucracy, allowing justifiable exceptions);authoritative inducement and directive(endorsement for legitimacy, necessity of buy-in from dialysis providers, incentivising uptake);instituting patient-centredness(explicitly addressing patient-important outcomes, reciprocating trial participation, improving comparability of interventions for decision-making, driving quality improvement and compelling a focus on quality of life).

Conclusions

Nephrologists emphasised that core outcomes should be relevant to patients, amenable to change, feasible to implement and supported by stakeholder organisations. They expected core outcomes would improve patient-centred care and outcomes.
Can exercise delay transition to active therapy in men with low-grade prostate cancer? A multicentre randomised controlled trial
Authors: Galvão Daniel A , Hayne Dickon , Frydenberg Mark , Chambers Suzanne K , Taaffe Dennis R , Spry Nigel , Scuffham Paul A , Ware Robert S , Hart Nicolas H , Newton Robert U
Published: April 2018

Introduction

Active surveillance is a strategy for managing low-risk, localised prostate cancer, where men are observed with serial prostate-specific antigen assessments to identify signs of disease progression. Currently, there are no strategies to support active surveillance compliance nor are there interventions that can prevent or slow disease progression, ultimately delaying transition to active treatment before it is clinically required. Recently, we proposed that exercise may have a therapeutic potential in delaying the need for active treatment in men on active surveillance.

Methods and analysis

A single-blinded, two arm, multicentre randomised controlled trial will be undertaken with 168 patients randomly allocated in a ratio of 1:1 to exercise or usual care. Exercise will consist of supervised resistance and aerobic exercise performed three times per week for the first 6 months in an exercise clinical setting, and during months 7–12, a progressive stepped down approach will be used with men transitioning to once a week supervised training. Thereafter, for months 13 to 36, the men will self-manage their exercise programme. The primary endpoint will be the time until the patients begin active therapy. Secondary endpoints include disease progression (prostate specific antigen), body composition and muscle density, quality of life, distress and anxiety and an economic analysis will be performed. Measurements will be undertaken at 6 and 12 months (postintervention) and at 24 and 36 months follow-up. The primary outcome (time to initiation of curative therapy) will be analysed using Cox proportional hazards regression. Outcomes measured repeatedly will be analysed using mixed effects models to examine between-group differences. Data will be analysed using an intention-to-treat approach.

Ethics and dissemination

Outcomes from the study will be published in peer-reviewed academic journals and presented in scientific, consumer and clinical meetings.

Trial registration number

ACTRN12618000225213.
Using videos in a smartphone app logbook to aid obstetricians and gynaecologists with reflection following critical events
Authors: Gray Thomas G , Li Weiguang , Farrell Tom
Published: April 2018

Introduction

Reflection is essential for continuous professional development. Many opportunities to reflect during training in obstetrics and gynaecology are not utilised. A Smartphone App (Healthcare Supervision Logbook), allows doctors training in obstetrics and gynaecology to view videos to aid reflection. The App incorporates a comprehensive logbook of practical skills. A self-facilitated reflective process, prompted by offering the viewing of a video when logging an event such as a shoulder dystocia, has been integrated into the logbook. The objective of this study was to evaluate how this function aids reflection.

Methods

Forty doctors training in obstetrics and gynaecology undertook a shoulder dystocia drill as part of a mock examination. After completing the drill, participants scored their performance on a proforma, before watching a video of simulated standard management for shoulder dystocia on a Smartphone. Participants then re-scored themselves before completing a survey. This assessed their agreement with three statements on a five-point Likert scale.

Results

50% of participants marked themselves lower after watching the video. 100% agreed or strongly agreed that watching the video helped them reflect on the shoulder dystocia drill. 80% agreed or strongly agreed that they would feel more prepared to deal with shoulder dystocia as a result of using the video to reflect. 93% agreed or strongly agreed that they would be willing to use a Smartphone App with videos to aid reflection following critical events. Student’s t test showed that viewing the standardised video clip on the App resulted in a significant down-marking (P<0.0005).

Conclusions

Many emergency scenarios in obstetrics and gynaecology unfold quickly and are rapidly resolved, doctors-in-training need to use opportunities for self-directed reflection. Using the video self-reflection function integrated into Healthcare Supervision Logbook Smartphone App could help to prompt this process, which could be utilised in other specialities and disciplines.
The burden of neurothrombectomy call: a multicenter prospective study
Authors: Williams Michelle M , Wilson Taylor A , Leslie-Mazwi Thabele , Hirsch Joshua A , Kellogg Ryan T , Spiotta Alejandro M , De Leacy Reade , Mocco J , Albuquerque Felipe C , Ducruet Andrew F , Arthur Adam , Srinivasan Visish M , Kan Peter , Mokin Maxim , Dumont Travis M , Reeves Alan , Singh Jasmeet , Wolfe Stacey Q , Fargen Kyle M
Published: April 2018

Introduction

Neurothrombectomy frequency is increasing, and a better understanding of the neurothrombectomy call burden is needed.

Methods

Neurointerventional physicians at nine participating stroke centers prospectively recorded time requirements for all neurothrombectomy (NT) consultations over 30 consecutive 24 hour call periods.

Results

Data were collected from a total of 270 days of call. 214 NT consultations were reported (mean 0.79 per day), including 130 ‘false positive’ consultations that ultimately did not lead to thrombectomy (mean 0.48 per day). 84 NT procedures were performed at the nine centers (0.32 per day, or 1 every 3 days). Most (59.8%) consultations occurred between 5pm and 7am. 30% of thrombectomy procedures resulted in delays in scheduled cases; treating physicians had to emergently travel to the hospital for 51.2% of these cases. A median of 27 min was spent on each false positive consultation and 171 min on each thrombectomy. Overall, the median physician time spent on NT responsibilities per 24 hour call period was 69 min (mean 85 min; IQR 16–135 min).

Conclusions

NT consultations are frequent and often disrupt physician schedules, requiring physicians to commute in from home after hours in the majority of cases. As procedural and consultation volumes increase, it is crucial to understand the significant burden of call on neurointerventional physicians and develop strategies that reduce the potential for burnout. Importantly, this study was performed prior to the completion of the DAWN and DEFUSE3 trials; NT consultations are expected to continue to increase in the future.
Assessing components of the model-based mean square error estimator for remote sensing assisted forest applications
Authors: McRoberts Ronald E. , Næsset Erik , Gobakken Terje , Chirici Gherardo , Condés Sonia , Hou Zhengyang , Saarela Svetlana , Chen Qi , Ståhl Göran , Walters Brian F.
Published: April 2018

Model-based inference is an alternative to probability-based inference for small areas or remote areas for which probability sampling is difficult. Model-based mean square error estimators incorporate three components: prediction covariance, residual variance, and residual covariance. The latter two components are often considered negligible, particularly for large areas, but no thresholds that justify ignoring them have been reported. The objectives of the study were threefold: (i) to compare analytical and bootstrap estimators of model parameter covariances as the primary factors affecting prediction covariance; (ii) to estimate the contribution of residual variance to overall variance; and (iii) to estimate thresholds for residual spatial correlation that justify ignoring this component. Five datasets were used, three from Europe, one from Africa, and one from North America. The dependent variable was either forest volume or biomass and the independent variables were either Landsat satellite image bands or airborne laser scanning metrics. Three conclusions were noteworthy: (i) analytical estimators of the model parameter covariances tended to be biased; (ii) the effects of residual variance were mostly negligible; and (iii) the effects of spatial correlation on residual covariance vary by multiple factors but decrease with increasing study area size. For study areas greater than 75 km2 in size, residual covariance could generally be ignored.
Combined but not single administration of vitamin C andl-carnitine ameliorates cisplatin-induced gastric mucosa damage in male rats
Authors: Adefisayo Modinat Adebukola , Adeyemi Wale Johnson , Alabi Quadri Kunle
Published: April 2018

Although cisplatin is a potent anticancer drug, it instigates oxidative and pro-inflammatory reactions that pose significant and distressing clinical symptoms. Therefore, this study investigated the effects of vitamin C and (or) l-carnitine on cisplatin-induced gastric mucosa damage in rat. The rats were allocated into 6 groups (n = 5). The control group received distilled water, while the treatment groups received cisplatin alone (CIP), or cisplatin with vitamin C, l-carnitine, or their combination. Cisplatin caused disruption of the gastric mucosa histoarchitecture and altered the mucus barrier function. Moreover, the stomach tissue of the CIP-treated group showed increased levels of oxidative stress markers (malondialdehyde and H2O2) and decreased activities of antioxidant (superoxide dismutase, glutathione peroxidase, catalase, glutathione S-transferase) and non-antioxidant (reduced glutathione) enzymes. These deleterious events were accompanied with significant increases in pro-inflammatory cytokines and inflammatory infiltration markers, myeloperoxidase and inducible nitric oxide synthase. However, the administration of both vitamin C and l-carnitine, and not either of the two showed additive effects in attenuating the adverse effects of cisplatin. The histological results agreed with the biochemical assays. The study concluded that the combined administration of vitamin C and l-carnitine, but not the single therapy, could prevent the adverse effects of cisplatin on gastric tissue.
On the Strategic Considerations and Paths Selection of Integrating Ecological Civilization into Economic Construction
Authors: HUANG Chengliang
Published: April 2018

Since the 18th National Congress of the Communist Party of China, the integration of ecological civilization construction with the development of economy, politics, culture, and society has not only been an established strategy of deepening and consolidating the “five-sphere integrated plan” of socialism with Chinese characteristics, but it has also been an important approach to achieve ecological civilization. In order to realize it, “integration” is the living soul. Integration means that on one hand, ecological civilization construction should be in step with economic and social development; on the other hand, it is inherent with the strategic thinking that priority should be given to ecology and environmental protection. This paper explains how ecological civilization construction is integrated with economic development and also discusses its strategies and paths. The findings are as follows: The first is to cling to the bottom line that no major ecological disasters should happen. This requires adherence to the basic state policy of environmental protection, restructuring of conventional industries and transformation of development patterns. The second is to adhere to the philosophy that industrialization, urbanization, informatization, agricultural modernization and greenization be promoted simultaneously, so that they can complement with the “five-sphere integrated plan”. This requires that a green, low carbon, and recyclable path should be pursued. The third is to stay open and forward-looking. In the new era of ecological civilization with new fashion and trends, active measures should be taken to build a modern ecological and industrial development system in order to lay a solid foundation for ecological civilization construction.
Translating Immunology into Therapeutic Concepts for Inflammatory Bowel Disease
Authors: Uhlig Holm H. , Powrie Fiona
Published: April 2018

Inflammatory bowel disease (IBD) defines a spectrum of complex disorders. Understanding how environmental risk factors, alterations of the intestinal microbiota, and polygenetic and epigenetic susceptibility impact on immune pathways is key for developing targeted therapies. Mechanistic understanding of polygenic IBD is complemented by Mendelian disorders that present with IBD, pharmacological interventions that cause colitis, autoimmunity, and multiple animal models. Collectively, this multifactorial pathogenesis supports a concept of immune checkpoints that control microbial-host interactions in the gut by modulating innate and adaptive immunity, as well as epithelial and mesenchymal cell responses. In addition to classical immunosuppressive strategies, we discuss how resetting the microbiota and restoring innate immune responses, in particular autophagy and epithelial barrier function, might be key for maintaining remission or preventing IBD. Targeting checkpoints in genetically stratified subgroups of patients with Mendelian disorder–associated IBD increasingly directs treatment strategies as part of personalized medicine.
Laboratory practical to study the differential innervation pathways of urinary tract smooth muscle
Authors: Rembetski Benjamin E. , Cobine Caroline A. , Drumm Bernard T.
Published: April 2018

In the mammalian lower urinary tract, there is a reciprocal relationship between the contractile state of the bladder and urethra. As the bladder fills with urine, it remains relaxed to accommodate increases in volume, while the urethra remains contracted to prevent leakage of urine from the bladder to the exterior. Disruptions to the normal contractile state of the bladder and urethra can lead to abnormal micturition patterns and urinary incontinence. While both the bladder and urethra are smooth-muscle organs, they are differentially contracted by input from cholinergic and sympathetic nerves, respectively. The laboratory practical described here provides an experiential approach to understanding the anatomy of the lower urinary tract. Several key factors in urinary tract physiology are outlined, e.g., the bladder is contracted by activation of the parasympathetic pathway via cholinergic stimulation on muscarinic receptors, whereas the urethra is contracted by activation of the sympathetic pathway via adrenergic stimulation on α1-adrenoceptors. This is achieved by measuring the force generated by bladder and urethra smooth muscle to demonstrate that acetylcholine contracts the smooth muscle of the bladder, whereas adrenergic agonists contract the urethral smooth muscle. An inhibition of these effects is also demonstrated by application of the muscarinic receptor antagonist atropine and the α1-adrenergic receptor blocker phentolamine. A list of suggested techniques and exam questions to evaluate student understanding on this topic is also provided.
Generation of life in a test tube: Albert Szent-Gyorgyi, Bruno Straub, and the discovery of actin
Authors: Rall Jack A.
Published: April 2018

This is a story about a great scientist, luck, great discovery that changed the future direction of muscle research, war, a clandestine war mission, postwar politics, and an attempt to rewrite scientific history. Albert Szent-Gyorgyi, at 44 yr of age, won the Nobel Prize in 1937 for his work on vitamin C and the establishment of the groundwork of the citric acid cycle. He now wanted to investigate one of the fundamental aspects of life and settled on the study of muscle contraction. The Szent-Gyorgyi laboratory in Hungary during World War II demonstrated that contraction could be reproduced in vitro by threads consisting of just two proteins, myosin and the newly discovered protein by Bruno Straub that they called actin. Szent-Gyorgyi called seeing the contraction of these threads, which occurred in the presence of ATP and ions, “the most thrilling moment” of his scientific life. This major discovery of the generation of “life” in a test tube was totally unknown for years by the rest of the world because of the war. When the discovery was finally communicated to the world, it was not immediately accepted by all as being relevant to the physiology of muscle contraction. Nonetheless, this discovery opened up the modern phase of muscle research. Serendipity played an important role in the great discovery, and much later politics would lead to a shocking controversy around the true discoverer of actin.
Sourcebook update: intestinal smooth muscle contractility and autonomic control
Authors: Langton Philip D.
Published: April 2018

This laboratory practical requires first-year students to anticipate the effects of drugs active at cholinergic and adrenergic receptors on gut motility in order to design experiments during an authentic inquiry exercise. Rather than specifying a strict sequence of drug additions that aim to provide ideal demonstrations of pharmacological and physiological antagonism, I have instead designed switches into the drugs provided and set students, working in small teams, the task of identifying the switched drugs, an inquiry activity. To extend the teamwork aspect, laboratory reports were submitted by the student teams rather than individual students. Staff observed that discussions within the teams were stimulated by the inquiry-led nature of the practical. The quality of the laboratory reports submitted by teams were substantially improved over the individual reports submitted in previous years. (Students previously worked in teams, but simply followed a list of prescribed experiments and wrote individual reports.) Although, in conversation, teams of students had an improved understanding of the regulation of gut motility by the parasympathetic and sympathetic divisions of the autonomic nervous system and could readily distinguish between pharmacological and functional antagonism, no attempt was made to evaluate learning because the revision was triggered by the observed effect of a technical error and was not otherwise planned. It is likely that laboratory practicals, in general, would benefit from inclusion of inquiry.
Mitochondrial genome modulates myocardial Akt/Glut/HK salvage pathway in spontaneously hypertensive rats adapted to chronic hypoxia
Authors: Nedvedova Iveta , Kolar David , Elsnicova Barbara , Hornikova Daniela , Novotny Jiri , Kalous Martin , Pravenec Michal , Neckar Jan , Kolar Frantisek , Zurmanova Jitka M.
Published: April 2018

Recently we have shown that adaptation to continuous normobaric hypoxia (CNH) decreases myocardial ischemia/reperfusion injury in spontaneously hypertensive rats (SHR) and in a conplastic strain (SHR-mtBN). The protective effect was stronger in the latter group characterized by a selective replacement of the SHR mitochondrial genome with that of a more ischemia-resistant Brown Norway strain. The aim of the present study was to examine the possible involvement of the hypoxia inducible factor (HIF)-dependent pathway of the protein kinase B/glucose transporters/hexokinase (Akt/GLUT/HK) in this mitochondrial genome-related difference of the cardioprotective phenotype. Adult male rats were exposed for 3 wk to CNH ([Formula: see text] 0.1). The expression of dominant isoforms of Akt, GLUT, and HK in left ventricular myocardium was determined by real-time RT-PCR and Western blotting. Subcellular localization of GLUTs was assessed by quantitative immunofluorescence. Whereas adaptation to hypoxia markedly upregulated protein expression of HK2, GLUT1, and GLUT4 in both rat strains, Akt2 protein level was significantly increased in SHR-mtBNonly. Interestingly, a higher content of HK2 was revealed in the sarcoplasmic reticulum-enriched fraction in SHR-mtBNafter CNH. The increased activity of HK determined in the mitochondrial fraction after CNH in both strains suggested an increase of HK association with mitochondria. Interestingly, HIF1a mRNA increased and HIF2a mRNA decreased after CNH, the former effect being more pronounced in SHR-mtBNthan in SHR. Pleiotropic effects of upregulated Akt2 along with HK translocation to mitochondria and mitochondria-associated membranes can potentially contribute to a stronger CNH-afforded cardioprotection in SHR-mtBNcompared with progenitor SHR.