bluuebunny/crossref_metadata_2025 huggingface dataset:
Crosstalk between epigenetic silencing and infection by tobacco rattle virus in Arabidopsis
Authors: Diezma‐Navas Laura , Pérez‐González Ana , Artaza Haydeé , Alonso Lola , Caro Elena , Llave César , Ruiz‐Ferrer Virginia
Published: July 2019

DNA methylation is an important epigenetic mechanism for controlling innate immunity against microbial pathogens in plants. Little is known, however, about the manner in which viral infections interact with DNA methylation pathways. Here we investigate the crosstalk between epigenetic silencing and viral infections in Arabidopsis inflorescences. We found that tobacco rattle virus (TRV) causes changes in the expression of key transcriptional gene silencing factors with RNA‐directed DNA methylation activities that coincide with changes in methylation at the whole genome level. Viral susceptibility/resistance was altered in DNA (de)methylation‐deficient mutants, suggesting that DNA methylation is an important regulatory system controlling TRV proliferation. We further show that several transposable elements (TEs) underwent transcriptional activation during TRV infection, and that TE regulation likely involved both DNA methylation‐dependent and ‐independent mechanisms. We identified a cluster of disease resistance genes regulated by DNA methylation in infected plants that were enriched for TEs in their promoters. Interestingly, TEs and nearby resistance genes were co‐regulated in TRV‐infected DNA (de)methylation mutants. Our study shows that DNA methylation contributes to modulate the outcome of viral infections in Arabidopsis, and opens up new possibilities for exploring the role of TE regulation in antiviral defence.
Conifers depend on established roots during drought: results from a coupled model of carbon allocation and hydraulics
Authors: Mackay D. Scott , Savoy Philip R. , Grossiord Charlotte , Tai Xiaonan , Pleban Jonathan R. , Wang Diane R. , McDowell Nathan G. , Adams Henry D. , Sperry John S.
Published: July 2019

Trees may survive prolonged droughts by shifting water uptake to reliable water sources, but it is unknown if the dominant mechanism involves activating existing roots or growing new roots during drought, or some combination of the two.

To gain mechanistic insights on this unknown, a dynamic root‐hydraulic modeling framework was developed that set up a feedback between hydraulic controls over carbon allocation and the role of root growth on soil–plant hydraulics. The new model was tested using a 5 yr drought/heat field experiment on an established piñon‐juniper stand with root access to bedrock groundwater.

Owing to the high carbon cost per unit root area, modeled trees initialized without adequate bedrock groundwater access experienced potentially lethal declines in water potential, while all of the experimental trees maintained nonlethal water potentials. Simulated trees were unable to grow roots rapidly enough to mediate the hydraulic stress, particularly during warm droughts. Alternatively, modeled trees initiated with root access to bedrock groundwater matched the hydraulics of the experimental trees by increasing their water uptake from bedrock groundwater when soil layers dried out.

Therefore, the modeling framework identified a critical mechanism for drought response that required trees to shift water uptake among existing roots rather than growing new roots.
Evolving together, evolving apart: measuring the fitness of rhizobial bacteria in and out of symbiosis with leguminous plants
Authors: Burghardt Liana T.
Published: July 2019

Most plant–microbe interactions are facultative, with microbes experiencing temporally and spatially variable selection. How this variation affects microbial evolution is poorly understood. Given its tractability and ecological and agricultural importance, the legume–rhizobia nitrogen‐fixing symbiosis is a powerful model for identifying traits and genes underlying bacterial fitness. New technologies allow high‐throughput measurement of the relative fitness of bacterial mutants, strains and species in mixed inocula in the host, rhizosphere and soil environments. I consider how host genetic variation (G × G), other environmental factors (G × E), and host life‐cycle variation may contribute to the maintenance of genetic variation and adaptive trajectories of rhizobia – and, potentially, other facultative symbionts. Lastly, I place these findings in the context of developing beneficial inoculants in a changing climate.
Loneliness among older people living in care homes in Sri Lanka
Authors: Wijesiri H. S. Maliga S. K. , Samarasinghe Kerstin , Edberg Anna‐Karin
Published: July 2019

Aim and objectives

The aim of this study was to explore loneliness in older people (aged 65+) living in care homes in Colombo, Sri Lanka.

Background

Loneliness, defined as the subjective, unwelcome feeling of the lack or loss of companionship, is known to be associated with old age, especially among older people living in care homes. Although several studies have shown that loneliness is highly prevalent, we lack knowledge about older people's personal experience of loneliness when residing in a care home and the strategies that older people use by themselves on a day‐to‐day basis to alleviate loneliness.

Methods

The participants (n = 75) were randomly selected from three different types of care homes: governmental, non‐governmental and private, and loneliness was screened using the Revised University of California–Los Angeles (R‐UCLA) Loneliness Scale. The 15 participants with the highest score on the loneliness scale were purposively selected for individual interviews.

Results

The median loneliness score was 45 (range 20–80); no significant differences concerning loneliness were found between the care homes. No differences concerning loneliness were found for any demographic variable except marital status. Loneliness was experienced as coping with inner pain, which older people described as emotional suffering caused by feeling abandoned from the family network and fettered to the care home, anxious about their future and depressed. Participants managed their loneliness by accepting their loneliness, practising religion, staying in touch with family, engaging in daily activities and participating in social activities.

Conclusion

Reliable and socio‐culturally validated tools for screening loneliness and culturally applicable interventions targeting factors associated with loneliness are necessary in the care of older people residing in care homes. A person‐centred approach involving family or significant others is recommended in clinical practice, and an increase in the number of nurses with specialist education in geriatric nursing seems urgent.
BK viremia and nephropathy in pediatric renal transplant recipients
Authors: Hamasaki Yuko , Dolan Niamh M. , Cubitt David , Breuer Judith , Sebire Neil J. , Marks Stephen D.
Published: July 2019

The renal survival rate of pediatric renal transplant recipients (pRTR) has improved with the use of modern immunosuppressive agents; however, the incidence of post‐transplantation viral infection has increased. This study investigated the incidence of BK viremia and BK viral–associated nephropathy (BKVAN) in pRTR. One‐hundred‐and‐thirty‐four pRTR were divided into two groups: group 1 (n = 20, 14.9%) comprised those who were prospectively followed with longitudinal analyses after renal transplantation in the time period from May 2007 to June 2008, while group 2 (n = 114, 85.1%) cross‐sectional study of those who were transplanted from January 1994 to April 2007. The mean ages at transplantation in groups 1 and 2 were 10.6 ± 4.7 years and 7.8 ± 4.5 years, respectively. BK viremia was detected in four (20.0%) patients in group 1, and seven (6.1%) in group 2 (P = 0.04), with increased incidence associated with induction therapy. The median time to detection of BK viremia after transplantation was 44 days in group 1 and 142 days in group 2. BKVAN was diagnosed in three patients (two in group 1 and one in group 2). All three patients diagnosed with BKVAN were receiving tacrolimus, mycophenolate mofetil, and corticosteroids as maintenance immunosuppression. Reducing immunosuppression resulted in reduced BK viremia. Monitoring for BK viremia and BKVAN is important in pRTR being treated with the current immunosuppressive regimen. The first line of treatment for BK viremia remains careful reduction of immunosuppression and close monitoring of renal allograft function.
Empirical research on folk moral objectivism
Authors: Pölzler Thomas , Wright Jennifer Cole
Published: July 2019

Lay persons may have intuitions about morality's objectivity. What do these intuitions look like? And what are their causes and consequences? In recent years, an increasing number of scholars have begun to investigate these questions empirically. This article presents and assesses the resulting area of research as well as its potential philosophical implications. First, we introduce the methods of empirical research on folk moral objectivism. Second, we provide an overview of the findings that have so far been made. Third, we raise a number of methodological worries that cast doubt upon these findings. And fourth, we discuss ways in which lay persons' intuitions about moral objectivity may bear on philosophical claims.
Monetary feedback modulates performance and electrophysiological indices of belief updating in reward learning
Authors: Bennett Daniel , Sasmita Karen , Maloney Ryan T. , Murawski Carsten , Bode Stefan
Published: July 2019

Belief updating entails the incorporation of new information about the environment into internal models of the world. Bayesian inference is the statistically optimal strategy for performing belief updating in the presence of uncertainty. An important open question is whether the use of cognitive strategies that implement Bayesian inference is dependent upon motivational state and, if so, how this is reflected in electrophysiological signatures of belief updating in the brain. Here, we recorded the EEG of participants performing a simple reward learning task with both monetary and nonmonetary instructive feedback conditions. Our aim was to distinguish the influence of the rewarding properties of feedback on belief updating from the information content of the feedback itself. A Bayesian updating model allowed us to quantify different aspects of belief updating across trials, including the size of belief updates and the uncertainty of beliefs. Faster learning rates were observed in the monetary feedback condition compared to the instructive feedback condition, while belief updates were generally larger, and belief uncertainty smaller, with monetary compared to instructive feedback. Larger amplitudes in the monetary feedback condition were found for three ERP components: the P3a, the feedback‐related negativity, and the late positive potential. These findings suggest that motivational state influences inference strategies in reward learning, and this is reflected in the electrophysiological correlates of belief updating.
Management of COPD in Asia: A position statement of the Asian Pacific Society of Respirology
Authors: Rhee Chin Kook , Chau Ngo Quy , Yunus Faisal , Matsunaga Kazuto , Perng Diahn‐Warng ,   on behalf the COPD Assembly of the APSR
Published: July 2019

Chronic obstructive pulmonary disease (COPD) is a major disease in Asia. However, how to manage specifically Asian COPD patients has not been proposed. Awareness of COPD is very low and underdiagnosis/undertreatment is common in Asian countries. Low utilization of pulmonary function test and inhalers is also a problem. Moreover, high smoking prevalence and air pollution are barriers to managing Asian patients with COPD. The relatively low body mass index of Asian patients with COPD can increase their risk for experiencing adverse effects from COPD drugs. Physicians should consider the unique features of Asian populations with COPD such as the high prevalence rates of bronchiectasis and tuberculosis‐destroyed lungs, biomass smoke exposure and parasitic infection.
Land Distribution, Income Generation and Inequality in India's Agricultural Sector
Authors: Chakravorty Sanjoy , Chandrasekhar S. , Naraparaju Karthikeya
Published: July 2019

This paper is a contribution to understanding income generation and inequality in India's agricultural sector. We analyze the National Sample Surveys of agriculture in 2003 and 2013 using descriptive and regression based methods, and estimate income inequality in the agricultural sector at the scale of the nation and its 17 largest states. We show that: (a) there are significant state‐level differences in the structures/patterns of income generation from agriculture, (b) there is a negative relationship between the amount of land owned by the household and share of wages in total income, (c) income inequality in India's agricultural sector is very high (Gini Coefficient of around 0.6 during the period), and (d) about half of the income inequality is explained by the household‐level variance in income from cultivation, which in turn is primarily dependent on variance in landownership.
University–Industry Linkage Framework to Identify Opportunity Areas
Authors: Güemes‐Castorena David , Ponce‐Jaramillo Idalia E.
Published: July 2019

Although there are many studies of the collaboration between academia and industry in developed countries explaining the phenomenon and prescribing best practices, the findings cannot be extrapolated to developing countries. This article fills the gap by studying these interactions for the case of Mexico. To study these interactions, we performed a state‐of‐the‐art matrix analysis to obtain internal, structural, and environmental factors from literature. Then, an interpretative structural framework was built as a model to identify opportunities in the collaboration process. The results are presented in a map that describes how each element influences the others and highlights opportunities for improvement. The model shows that industry triggers collaboration and presents a highly complex internal organization for the academy. This study helps decision makers in government, the academy, and industry to understand the elements and how the system works to develop strategies that promote more effective collaboration.
Technology Innovation as a Response to Climate Change: The Case of the Climate Change Emissions Management Corporation of Alberta
Authors: Adkin Laurie E.
Published: July 2019

Innovation is the central element of climate change policy in many jurisdictions. Reduced to technology development and linked to market‐driven priorities, innovation accommodates the interests of large emitters in the energy sector and underpins a sustainable development discourse that denies ecological limits to economic growth. This study examines the use of innovation as a key component of climate change policy in the case of Alberta's Climate Change Emissions Management Corporation, utilizing a political economy approach to explain the drivers of government funding priorities. An analysis of this technology fund's investments over nine years, under two different governments, revealed that nearly half of the revenue has been used to subsidize R&D in the fossil fuels industry in the name of clean energy development, and that this priority has continued despite recent government commitments under the Paris CoP agreement. The carbon levy system that generates revenue for the fund has been unsuccessful in incentivizing facility reductions, pointing to the need for more stringent regulation. Innovation as a framework for transition to a post‐carbon economy is severely limited by its exclusion of the roles of social knowledge and citizen participation in envisaging and designing paths for change.
Sediment‐supply‐dominated stratal architectures in a regressively stacked succession of shoreline sand bodies, Campanian Desert Member to Lower Castlegate Sandstone interval, Book Cliffs, Utah–Colorado, USA
Authors: Pattison Simon A. J.
Published: July 2019

Strongly progradational regressive stacks of shallow marine sandstones are ubiquitous in modern and ancient coastal depositional systems. Many ancient examples form prolific hydrocarbon and freshwater reservoirs in the subsurface. One of the best areas in the world to study progradational shallow marine successions is the Campanian Book Cliffs of Utah and Colorado, where the Desert Member to Lower Castlegate Sandstone interval served as a foundational data set for early sequence stratigraphic models. A strongly progradational stack of 17 parasequences comprises the Desert–Castlegate interval. Parasequences are 6·5 to 20·7 m thick. Normally regressive coarsening‐upward successions are abundant, as are flat‐topped, rooted foreshore sandstones. Conformable facies contacts mark the transition between the laterally adjoining nearshore terrestrial and shallow marine deposits which are genetically, temporally and spatially linked. The width of the shoreface to inner shelf facies belts varies from 4·8 to 19·9 km per parasequence, with a mean of 12·6 km. Solitary tongue shoreline trajectories are all very low to low angle ascending regressive, varying from +0·0004° to +0·171°. Stacked shoreline system trajectories are also dominantly low angle ascending regressive, with only two descending regressive trajectories, one of which intersects the depositional slope. The predominance of ascending regressive shoreline trajectories and normal regression, rarity of high frequency sequence boundaries, regressive surfaces of marine erosion and descending regressive shoreline trajectories, and absence of third‐order sequence boundaries, incised valley fill deposits and no prolonged and regionally extensive sediment bypass, all point towards increasing sediment supply as the dominant driver of the Desert–Castlegate stratal architectures, while reduced accommodation (i.e. decreasing tectonic subsidence) played a secondary role.
Psychopathy in a forensic sample – the factor structure of the PCL:SV in a Danish forensic sample
Authors: Bo Sune , Pedersen Liselotte , Christensen Karl Bang , Rasmussen Kirsten
Published: July 2019

The research literature reveals an ongoing debate regarding the most appropriate conceptualization of psychopathic personality disorder. Specifically, it is discussed to what degree antisocial behavior is part of the conceptualization of the psychopathy construct and what constitutes the best factor model of the Psychopathy Checklist scales. The aim of the present study is to consider the underlying factor structure of the PCL:SV (Psychopathy Checklist Screening Version) in a Danish sample as well as considering the role of antisocial behavior in the psychopathy construct. Data from a Danish forensic patient sample (N = 225) was used and item response theory (IRT), aonfirmatory factor analyses (CFA) and structural equations model (SEM) analyses were carried out. Overall, the findings suggest appropriate item and model fit for the PCL:SV as well as superiority of the three‐factor model over the four‐factor model. The results are discussed in relation to the broader concept of personality disorder as well as clinical practice in regards to violence risk assessments and treatment of psychopathy.
When are infection risks of blood transfusion tolerable? Towards understanding the ethical views of stakeholders in the blood supply
Authors: Kramer Koen , Verweij Marcel F. , Zaaijer Hans L.
Published: July 2019

Background and objectives

The perception of transfusion‐transmitted infections (TTIs) is sensitive to various concerns besides the probability and impact of infection, and some of these concerns may be ethically relevant. This paper aims to advance thinking about blood safety policies by exploring and explaining stakeholders’ reasons to consider TTI risks tolerable or intolerable.

Materials and methods

Inspired by critical empirical ethics and phenomenological hermeneutics, we held interviews and focus group discussions to explore the moral experience of policymakers, hematologists, blood donors and recipients. Respondents were invited to discuss general concerns about the blood supply, to address the tolerability of TTI risks compared with other hazards and to comment on the costs of blood safety. Arguments for tolerance or intolerance towards TTI risks were analysed qualitatively.

Results

Stakeholders’ views could be clustered into seven categories: (1) clinical impact; (2) probability of infection; (3) avoidability of infection; (4) cost and health benefits; (5) other consequences of safety measures; (6) non‐consequentialist ethical arguments; and (7) stakeholders’ interests. Various arguments were offered that resonate with current ethical thinking about blood safety. Assuming that resources spent on inefficient blood safety measures could be applied more beneficially elsewhere, for example, responders typically expressed tolerance towards TTI risks. Some other arguments seem novel, for instance arguments for risk intolerance based on the low probability of infection and arguments for risk tolerance if patients have a poor prognosis.

Conclusion

Understanding the moral experience of stakeholders enriches ethical debate about blood safety and prepares developing more widely acceptable policies.
Developing in vitro assays to quantitatively evaluate the interactions of dressings with wounds
Authors: Ngo Qiaowei , Anand Padmaja , Wang Yingting , Ananthanarayanan Abhishek , Gong Peili , Newby Craig S. , Mcmillian Michael M.
Published: July 2019

Evaluating interactions between dressing and wound is important for understanding wound management. This study quantitatively compared four polyurethane foam‐based wound dressings for their absorption profile, cell penetration, and adherence using two novel in vitro assays. The dressing with uniform pore sizes varying from 25~75 μm showed the highest absorption of both culture media and serum. The same dressing showed a 1.2‐ to 3.6‐fold lower cell adherence (3 hours) than the other dressings, and ~20‐fold lower cell penetration (5 days) than dressings with pore sizes varying from 55 to 343 μm. Additionally, cell and dressing interactions using a 3‐dimensional wound healing assay showed that the dressings with the smallest pore size of 25~75 μm maintained the highest cell viability (76.3%) and promoted cell migration into the wound site. This data suggest that polyurethane foam dressing with smaller and evenly distributed pores promotes wound healing with less cellular adhesion and penetration.
Communicating Veganism: Evolving Theoretical Challenges to Mainstreaming Ideas
Authors: Wescombe Noah J.
Published: July 2019

Veganism, as both a philosophy and social movement, faces numerous challenges to the communication of its ideas across society. As a unique modern counterculture, it stands in contravention of prevailing anthropological discourses that dominate conceptual frameworks. This has led to difficulty in constructing updated virtue epistemologies that result in veganism as a logical moral conclusion. It is clear that new social discourses need developing, and that this is a primary concern for affirming moral agency. To explain this and identify key issues and features, vegan communications are evaluated herein from a philosophical, psychological, and informational perspective, with a view of both historical and modern social contexts. In doing so, a number of novel theoretical reflections are offered. This is done through a discussion separated into four sections dealing first with a view of veganism in evolution, secondly with the social complexity of media trends and social positioning, thirdly with achieving constructive dialogue given present-day challenges, and finally with a discussion of modern information systems. Overall, this broad systems view of veganism in society leads to the conclusion that an up-to-date vegan communication theory must necessarily incorporate such diversity considerations, and must also generate a new discourse that is in line with the complex nature of social dynamics and individual development. Done prudently, this could propel vegan ideas further into the mainstream of conversation and consciousness, fostering a new paradigm for consumption.
An approach for the identification of particulate matter in the clouds of Bogotá using satellite imagery analysis [Online First]
Authors: Aragón Moreno Juan Antonio , Espinosa Martínez Laura Isabel , Castañeda Garzón Paula Andrea
Published: July 2019

Objective: An analysis of the air quality of Bogotá by identifying clouds during the period from 2013-2017 and verifying patterns of behavior between cloud formation and the concentration of particulate matter is presented. Materials and methods: The study sample includes data provided by the Bogotá Air Quality Monitoring Network (RMCAB), taking into account the concentration of particulate matter, temperature, precipitation, wind direction and wind speed. The data are compared with Landsat 8 satellite images and different combinations of spectral bands through the use of the Geographic Information System (GIS) ArcGis. Results and discussion: A high model correlation is reflected in a percentage greater than 90%, presenting a greater coincidence with a periodicity of two years during the dry period; it is possible to observe that the concentration of pollutants follows the trend of the wind vector lines, and the concentration has a direct correlation with cloud formation, which is influenced by temperature, wind speed and wind direction. Conclusions: This paper provides an alternative for the measurement of particulate matter and contributes to the collection of information on this research topic.
Model for the prediction of noise generated by fixed sources [Online First]
Authors: Echeverri Londoño Carlos Alberto , Ortiz Pabón Héctor Jairo
Published: July 2019

Objective: This article proposes a prediction model applicable to the propagation of noise generated by fixed sources as the result of an analysis of phenomena related to the generation and propagation of sound levels and the subsequent correlation between the levels estimated with the data recorded in the field. Materials and methods: An experimental program was designed that included the measurement of sound pressure levels with a sound level meter to different weather conditions and distances from the noise emission source to compare them with the levels estimated by ISO 9613 Part 2. A statistical analysis of the data recorded in field was performed to observe the dependence with the meteorological variables recorded during the measurements. Results and discussion:  Standard error for the proposed prediction method is 11.4 dB, and absolute average error is 9.1 dB. The correlation coefficient of the proposed model is 0.87. A statistically significant relationship exists between the variables with a 95.0% confidence level. Conclusion: A propagation model was obtained that presented a better fit than the method of ISO 9613 Part 2 and a higher correlation coefficient.
Nanoparticle-laden droplets of liquid crystals: Interactive morphogenesis and dynamic assembly
Authors: Li Yunfeng , Khuu Nancy , Prince Elisabeth , Alizadehgiashi Moien , Galati Elizabeth , Lavrentovich Oleg D. , Kumacheva Eugenia
Published: July 2019

Interactive morphogenesis in nanoparticle-laden droplets of liquid crystals broadens the spectrum of structures of soft matter.
Charge localization and reentrant superconductivity in a quasi-ballistic InAs nanowire coupled to superconductors
Authors: Estrada Saldaña J. C. , Žitko R. , Cleuziou J. P. , Lee E. J. H. , Zannier V. , Ercolani D. , Sorba L. , Aguado R. , De Franceschi S.
Published: July 2019

Reentrant superconductivity, an attribute of topological superconductors, can result from a concealed localized charge.
Antisymmetric magnetoresistance in van der Waals Fe
3
GeTe
2
/graphite/Fe
3
GeTe
2
trilayer heterostructures
Authors: Albarakati Sultan , Tan Cheng , Chen Zhong-Jia , Partridge James G. , Zheng Guolin , Farrar Lawrence , Mayes Edwin L. H. , Field Matthew R. , Lee Changgu , Wang Yihao , Xiong Yiming , Tian Mingliang , Xiang Feixiang , Hamilton Alex R. , Tretiakov Oleg A. , Culcer Dimitrie , Zhao Yu-Jun , Wang Lan
Published: July 2019

The observation of an antisymmetric magnetoresistance in a trilayer van der Waals heterostructure Fe
3
GeTe
2
/graphite/Fe
3
GeTe
2
.
Bioresorbable optical sensor systems for monitoring of intracranial pressure and temperature
Authors: Shin Jiho , Liu Zhonghe , Bai Wubin , Liu Yonghao , Yan Ying , Xue Yeguang , Kandela Irawati , Pezhouh Maryam , MacEwan Matthew R. , Huang Yonggang , Ray Wilson Z. , Zhou Weidong , Rogers John A.
Published: July 2019

Bioresorbable optical sensor implants monitor brain pressure and temperature before naturally resorbing into the body.
A water lily–inspired hierarchical design for stable and efficient solar evaporation of high-salinity brine
Authors: Xu Ning , Li Jinlei , Wang Yang , Fang Chang , Li Xiuqiang , Wang Yuxi , Zhou Lin , Zhu Bin , Wu Zhen , Zhu Shining , Zhu Jia
Published: July 2019

A water lily–inspired hierarchical structure was designed for stable and efficient solar desalination and wastewater treatment.
A room-temperature ferroelectric semimetal
Authors: Sharma Pankaj , Xiang Fei-Xiang , Shao Ding-Fu , Zhang Dawei , Tsymbal Evgeny Y. , Hamilton Alex R. , Seidel Jan
Published: July 2019

WTe
2
, a layered crystalline material, displays both ferroelectricity and metallicity.
Sutureless superficial anterior lamellar keratoplasty for recurrent corneal haze after repeat excimer laser surface ablation
Authors: Myerscough James , Bovone Cristina , Thomas Peter Benjamin Michael , Mimouni Michael , Aljassar Faisal , Padroni Sara , Busin Massimo
Published: July 2019

Background/Aims

To evaluate the 5-year outcomes of sutureless superficial anterior lamellar keratoplasty (SALK) in the treatment of surface ablation-related corneal haze recurring after phototherapeutic keratectomy (PTK).

Methods

Prospective interventional study at a tertiary referral centre in Forli, Italy. Ten consecutive eyes with corneal haze following photorefractive keratectomy, recurring after treatment with PTK with or without mitomycin C, undergoing sutureless SALK. Sutureless SALK was performed using a microkeratome in donor and recipient. Main outcome measures: best spectacle-corrected visual acuity (BSCVA), surgically induced astigmatism (SIA), rate of recurrence and complications.

Results

There were no intraoperative complications and there was no recurrence of haze in any eye postoperatively. BSCVA showed significant improvement at all postoperative time points. Mean preoperative visual acuity improved from 0.46 logMAR units (SD=0.12) to 0.12 (SD=0.12, p=0.0001) at 5 years. At 6 months, SIA was 2.50±1.04 with no further significant change at 5 years (2.53±1.39, p=0.95). There was no significant change in mean spherical equivalent and no significant difference between preoperative and postoperative astigmatism vector values at 5 years.

Conclusions

Sutureless SALK provides a useful treatment option in patients with recurrent haze after excimer laser treatment. It can eliminate haze recurrence for at least a period of 5 years and can improve BSCVA, although there may be significant SIA.
Accuracy of the 2017 international recommendations for clinicians who interpret adolescent athletes’ ECGs: a cohort study of 11 168 British white and black soccer players
Authors: Malhotra Aneil , Dhutia Harshil , Yeo Tee-Joo , Finocchiaro Gherardo , Gati Sabiha , Bulleros Paulo , Fanton Zephyr , Papatheodorou Efstathios , Miles Chris , Keteepe-Arachi Tracey , Basu Joyee , Parry-Williams Gemma , Prakash Keerthi , Gray Belinda , D'Silva Andrew , Ensam Bode , Behr Elijah , Tome Maite , Papadakis Michael , Sharma Sanjay
Published: July 2019

Aim

To investigate the accuracy of the recently published international recommendations for ECG interpretation in young athletes in a large cohort of white and black adolescent soccer players.

Methods

11 168 soccer players (mean age 16.4±1.2 years) were evaluated with a health questionnaire, ECG and echocardiogram; 10 581 (95%) of the players were male and 10 163 (91%) were white. ECGs were retrospectively analysed according to (1) the 2010 European Society of Cardiology (ESC) recommendations, (2) Seattle criteria, (3) refined criteria and (4) the international recommendations for ECG interpretation in young athletes.

Results

The ESC recommendations resulted in a higher number of abnormal ECGs compared with the Seattle, refined and international criteria (13.2%, 4.3%, 2.9% and 1.8%, respectively). All four criteria were associated with a higher prevalence of abnormal ECGs in black athletes compared with white athletes (ESC: 16.2% vs 12.9%; Seattle: 5.9% vs 4.2%; refined: 3.8% vs 2.8%; international 3.6% vs 1.6%; p<0.001 each). Compared with ESC recommendations, the Seattle, refined and international criteria identified a lower number of abnormal ECGs—by 67%, 78% and 86%, respectively. All four criteria identified 36 (86%) of 42 athletes with serious cardiac pathology. Compared with ESC recommendations, the Seattle criteria improved specificity from 87% to 96% in white athletes and 84% to 94% in black athletes. The international recommendations demonstrated the highest specificity for white (99%) and black (97%) athletes and a sensitivity of 86%.

Conclusions

The 2017 international recommendations for ECG interpretation in young athletes can be applied to adolescent athletes to detect serious cardiac disease. These recommendations perform more effectively than previous ECG criteria in both white and black adolescent soccer players.
How context affects implementation of the Primary Health Care approach: an analysis of what happened to primary health centres in India
Authors: Ramani Sudha , Sivakami Muthusamy , Gilson Lucy
Published: July 2019

Introduction

In this paper, we elucidate challenges posed by contexts to the implementation of the Primary Health Care (PHC) approach, using the example of primary health centres (rural peripheral health units) in India. We first present a historical review of ‘written’ policies in India—to understand macro contextual influences on primary health centres. Then we highlight micro level issues at primary health centres using a contemporary case study.

Methods

To elucidate macro level factors, we reviewed seminal policy documents in India and some supporting literature. To examine the micro context, we worked with empirical qualitative data from a rural district in Maharashtra—collected through 12 community focus group discussions, 12 patient interviews and 34 interviews with health system staff. We interpret these findings using a combination of top–down and bottom–up lenses of the policy process.

Results

Primary health centres were originally envisaged as ‘social models’ of service delivery; front-line institutions that delivered integrated care close to people’s homes. However, macro issues of chronic underfunding and verticalisation have resulted in health centres with poor infrastructure, that mainly deliver vertical programmes. At micro levels, service provision at primary health centres is affected by doctors’ disinterest in primary care roles and an institutional context that promotes risk-averseness and disregard of outpatient care. Primary health centres do not meet community expectations in terms of services, drugs and attention provided; and hence, private practitioners are preferred. Thus, primary health centres today, despite having the structure of a primary-level care unit, no longer embody PHC ideals.

Conclusions

This paper highlights some contextual complexities of implementing PHC—considering macro (pertaining to ideologies and fiscal priorities) and micro (pertaining to everyday behaviours and practices of actors) level issues. As we recommit to Alma-Ata, we must be cautious of the ceremonial adoption of interventions, that look like PHC—but cannot deliver on its ideals.
Association between cardiometabolic risk factors and body mass index, waist circumferences and body fat in a Zanzibari cross-sectional study
Authors: Nyangasa Maria Adam , Buck Christoph , Kelm Soerge , Sheikh Mohammed Ali , Brackmann Kim Laura , Hebestreit Antje
Published: July 2019

Objectives

To determine the prevalence of obesity indices (body mass index (BMI), waist circumference (WC), body fat per cent (BF%)) and cardiometabolic risk factors. To investigate the association between obesity indices and cardiometabolic risk factors in a Zanzibari population.

Designs

Cross-sectional study.

Settings

Participants randomly selected from 80 Shehias (wards) in Unguja, Zanzibar in 2013.

Participants

A total of 470 participants between 5 and 95 years were examined. Data on socioeconomic status, area of residence, anthropometry and venous blood were collected. Associations between obesity indices and cardiometabolic risk factors were investigated using multilevel logistic regression analyses in two steps: first, each obesity indicator was tested independently; second, all indicators combined in one model were tested for their association with cardiometabolic risk factors.

Results

The proportion of overweight/obese individuals was 26.4%, high WC (24.9%) and high BF% (31.1%). Cardiometabolic risk factors with highest prevalence of abnormal values included hypertension (24.5%), low high-density lipoprotein cholesterol (HDL-C) (29.4%), high low-density lipoprotein cholesterol (LDL-C) (21.3%) and high glycated haemoglobin (HbA1c) (19.1%). Obesity and hypertension increased with age, and were most prevalent in participants aged 45 years and above. Low HDL-C was most prevalent among participants aged ≥18 to <45 years, while high LDL-C was more prevalent in those above 45 years. High WC and high BF% were associated with high levels of LDL-C (OR=2.52 (95% CI 1.24 to 5.13), OR=1.91 (95% CI 1.02 to 3.58), respectively). Additionally, BMI and WC were associated with high levels of HbA1c (OR=2.08 (95% CI 1.15 to 3.79), OR=3.01 (95% CI 1.51 to 6.03), respectively). In the combined regression model, WC was associated with higher chances for hypertension (OR=2.62 (95% CI 1.14 to 6.06)) and for high levels of HbA1c (OR=2.62 (95% CI 1.12 to 6.15)).

Conclusion

High BMI, WC and BF% were strongly associated with hypertension, with individuals with high WC being twice more likely to have hypertension; this calls for early and effective screening strategies for this study population.
Protocol for the evaluation of a pilot implementation of essential interventions for the prevention of cardiovascular diseases in primary healthcare in the Republic of Moldova
Authors: Collins Dylan , Ciobanu Angela , Laatikainen Tiina , Curocichin Ghenadie , Salaru Virginia , Zatic Tatiana , Anisei Angela , Farrington Jill
Published: July 2019

Introduction

Nearly 90% of all deaths in the Republic of Moldova are caused by non-communicable diseases, the majority of which (55%) are caused by cardiovascular diseases (CVD). In addition to reducing premature mortality from CVD, it is estimated that strengthening primary healthcare could cut the number of hypertension-related hospital admissions and diabetes-related hospitalisations in half. The aim of this evaluation is to determine the feasibility of implementing and evaluating essential interventions for the prevention of CVD in primary healthcare in the Republic of Moldova, with a view towards national scale-up.

Methods and analysis

A national steering group including international experts will be convened to adapt WHO Package of Essential NCD Intervention from Primary Healthcare in Low Resource Settings protocols 1 and 2 to the health system of the Republic of Moldova, develop and conduct training of primary healthcare workers and test a core set of indicators to monitor the quality of care and change in clinical practice. To evaluate the impact of this pilot implementation, a pragmatic, sequential mixed methods explanatory design, composed of quantitative and qualitative strands of equal weight, will be used. Twenty primary healthcare centres will be selected and randomised to the training and implementation arm (n=10) and the usual care arm (n=10). At baseline and 12 months follow-up, a standardised data collection form will be piloted to extract data directly from patient paper records in order to estimate the change in clinical practice. Semi-structured interviews and interclinic peer workshops will be conducted at 12 months follow-up, and qualitative data collected from these formats will be analysed thematically for explanatory themes that relate to the quantitative findings.

Ethics and dissemination

Ethical review and approval has been obtained. Findings of the evaluation will be shared in a project report to key stakeholders, presented back to participants and written into a manuscript for an open access peer-reviewed scientific journal.
Exercise duRing Active Surveillance for prostatE cancer—the ERASE trial: a study protocol of a phase II randomised controlled trial
Authors: Kang Dong-Woo , Fairey Adrian S , Boulé Normand G , Field Catherine J , Courneya Kerry S
Published: July 2019

Introduction

Active surveillance (AS) is the preferred primary treatment strategy for men with low-risk clinically localised prostate cancer (PCa); however, the majority of these men still receive radical treatment within 10 years due to disease progression and/or fear of cancer progression. Interventions designed to suppress tumour growth, mitigate fear of cancer progression and precondition men for impending radical treatments are an unmet clinical need. Exercise has been shown to delay the progression of prostate tumours in animal models, improve physical and functional health and manage psychological outcomes in cancer patients; however, these outcomes have not been demonstrated in PCa patients undergoing AS.

Methods and analysis

This phase II randomised controlled trial will randomise 66 men undergoing AS to either an exercise group or a usual care group. The exercise group will perform a 12-week, supervised, high-intensity interval training programme, consisting of 3 sessions/week for 28–40 min/session. The primary outcome will be cardiorespiratory fitness. Secondary outcomes will include immunosurveillance and cancer-related biomarkers, psychosocial outcomes including fear of cancer progression and quality of life and physical function. Exploratory outcomes will include clinical indicators of disease progression. The trial has 80% power to detect a significant between-group difference in VO2peakof 3.5 mL/kg/min with a two-tailed alpha level <0.05 and a 10% dropout rate.

Ethics and dissemination

The study has received full ethical approval from the Health Research Ethics Board of Alberta – Cancer Committee (Protocol Number: HREBA.CC-17–0248). The findings of the study will be disseminated through public and scientific channels.

Trial registration number

NCT03203460; Pre-results.
Association of fatty liver index with risk of incident type 2 diabetes by metabolic syndrome status in an Eastern Finland male cohort: a prospective study
Authors: Olubamwo Olubunmi Olujimisola , Virtanen Jyrki K , Pihlajamaki Jussi , Tuomainen Tomi-Pekka
Published: July 2019

Objective

Fatty liver disease (FLD) is increasingly recognised as a predictor of cardiometabolic risk. Our objective was to examine if metabolic syndrome (MS) status affects the association of FLD with incident type 2 diabetes (T2D) in middle-aged men.

Design

Prospective epidemiological study.

Setting

University affiliated research centre in Kuopio, Eastern Finland.

Participants

Our subjects were 1792 Finnish men without diabetes at baseline in the KuopioIschaemicHeart Disease Risk Factor Study cohort.

Outcome measure

Using fatty liver index (FLI), the association of baseline FLD with incident T2D was analysed in multivariable-adjusted Cox regression models, considering their MS statuses. The main models were adjusted for constitutional factors, lifestyle factors, biomarkers of inflammation and for high (FLI ≥60) versus low (FLI <30) FLI categories.

Results

During a mean follow-up of 19 years, 375 incident cases of T2D were recorded. In the full model, the HR (HR (95% CI)) for T2D was 3.68 (2.80 to 4.82). The association was attenuated, but maintained, with further adjustment for metabolic factors. When MS status was adjusted for in place of metabolic factors, the HRs (95% CIs) were 2.63 (1.92 to 3.59) for FLI ≥60 and 1.77 (1.35 to 2.31) for MS.

In MS-stratified analysis, FLI predicted T2D only among persons without MS. In unstratified analysis with subjects categorised by FLI-MS, persons with FLI ≥60 without MS had increased risk for T2D (HR=3.19 (2.26 to 4.52)) compared with persons with FLI <30 without MS. Persons with FLI <30 and MS had greater risk (HR=4.31 (2.15 to 8.61)) and persons with both FLI ≥60 and MS had the greatest risk (HR=4.66 (3.42 to 6.35)).

Conclusion

Generally, FLD (FLI ≥60) predicts T2D. It specifically predicted T2D among men without MS but not among men with MS, for whom MS alone already increases the risk. Both FLI and MS can complement each other in screening and surveillance for persons with increased T2D risk.
Association between serum vitamin B6concentration and risk of osteoporosis in the middle-aged and older people in China: a cross-sectional study
Authors: Wang Jing , Chen Lin , Zhang Yan , Li Chen-guang , Zhang Hao , Wang Qiang , Qi Xiaofeng , Qiao Liang , Da Wei-wei , Cui Xue-jun , Lu Sheng , Wang Yong-jun , Shu Bing
Published: July 2019

Objective

To determine the relationship between serum vitamin B6(Vit B6) concentration and the status of bone mineral density and identify the relationship between serum Vit B6 and bone metabolism parameters in middle-aged and older people in China.

Design

The present study was a cross-sectional study within the framework of an ongoing prospective population-based cohort study.

Setting and participants

A total of 1829 residents (men ≥50 years and women ≥45 years) from two subdistricts were recruited from July 2015 to February 2016 in Shanghai, China.

Measures

Recruited residents were grouped (control, osteopenia and osteoporosis) according to their lumbar spine bone mineral density, measured through dual-energy X-ray absorptiometry. Serum Vit B6concentrations, bone turnover marker concentrations and calcium and phosphorus metabolism parameters were assessed.

Results

No significant linear trend between serum Vit B6concentrations and lumbar bone mass was observed in the men. In the women, the average osteoporosis risk was 61% higher at serum Vit B6concentrations of <19.2 μg/L than at those of >26.9 μg/L (OR 1.61, 95% CI 1.00 to 2.58). However, there was no significance after controlling of serum 25-hydroxy-vitamin D concentration and parathyroid hormone concentration, respectively. In the osteoporotic women, the serum Vit B6concentration was significantly negatively correlated to concentrations of bone turnover marker including N-terminal propeptide of type I collagen, β-C-terminal telopeptide of type I collagen and osteocalcin. It was also positively related to the serum 25-hydroxy-vitamin D concentration and inversely related to the serum parathyroid hormone concentration.

Conclusions

A relatively low serum Vit B6concentration, even in the normal range, may be a risk factor for osteoporosis in postmenopausal women, which is dependent on serum 25-hydroxy-vitamin D concentration and parathyroid hormone concentration.

Trial registration number

NCT02958020; Post-results.