bluuebunny/crossref_metadata_2025 huggingface dataset:
Regulate or tolerate: Thermal strategy of a coral reef flat resident, the epaulette shark, Hemiscyllium ocellatum
Authors: Nay Tiffany J , Longbottom Rohan J , Gervais Connor R , Johansen Jacob L , Steffensen John F , Rummer Jodie L , Hoey Andrew S
Published: November 2020

Highly variable thermal environments, such as coral reef flats, are challenging for marine ectotherms and are thought to invoke the use of behavioural strategies to avoid extreme temperatures and seek out thermal environments close to their preferred temperatures. Common to coral reef flats, the epaulette shark (Hemiscyllium ocellatum) possesses physiological adaptations to hypoxic and hypercapnic conditions, such as those experienced on reef flats, but little is known regarding the thermal strategies used by these sharks. We investigated whether H. ocellatum uses behavioural thermoregulation (i.e., movement to occupy thermally favourable microhabitats) or tolerates the broad range of temperatures experienced on the reef flat. Using an automated shuttlebox system, we determined the preferred temperature of H. ocellatum under controlled laboratory conditions and then compared this preferred temperature to 6 months of in situ environmental and body temperatures of individual H. ocellatum across the Heron Island reef flat. The preferred temperature of H. ocellatum under controlled conditions was 20.7 ± 1.5°C, but the body temperatures of individual H. ocellatum on the Heron Island reef flat mirrored environmental temperatures regardless of season or month. Despite substantial temporal variation in temperature on the Heron Island reef flat (15–34°C during 2017), there was a lack of spatial variation in temperature across the reef flat between sites or microhabitats. This limited spatial variation in temperature creates a low‐quality thermal habitat limiting the ability of H. ocellatum to behaviourally thermoregulate. Behavioural thermoregulation is assumed in many shark species, but it appears that H. ocellatum may utilize other physiological strategies to cope with extreme temperature fluctuations on coral reef flats. While H. ocellatum appears to be able to tolerate acute exposure to temperatures well outside of their preferred temperature, it is unclear how this, and other, species will cope as temperatures continue to rise and approach their critical thermal limits. Understanding how species will respond to continued warming and the strategies they may use will be key to predicting future populations and assemblages.
Abscisic acid receptors maintain abscisic acid homeostasis by modulating UGT71C5 glycosylation activity
Authors: Ma Yanlin , Cao Jing , Chen Qiaoqiao , He Jiahan , Liu Zhibin , Wang Jianmei , Li Xufeng , Yang Yi
Published: November 2020

Uridine diphosphate‐glucosyltransferases (UGTs) maintain abscisic acid (ABA) homeostasis in Arabidopsis thaliana by converting ABA to abscisic acid‐glucose ester (ABA‐GE). UGT71C5 plays an important role in the generation of ABA‐GE. Abscisic acid receptors are crucial upstream components of the ABA signaling pathway, but how UGTs and ABA receptors function together to modulate ABA levels is unknown. Here, we demonstrated that the ABA receptors RCAR12/13 and UGT71C5 maintain ABA homeostasis in Arabidopsis following rehydration under drought stress. Biochemical analyses show that UGT71C5 directly interacted with RCAR8/12/13 in yeast cells, and the interactions between UGT71C5 and RCAR12/13 were enhanced by ABA treatment. Enzyme activity analysis showed that ABA‐GE contents were significantly elevated in the presence of RCAR12 or RCAR13, suggesting that these ABA receptors enhance the activity of UGT71C5. Determination of the content of ABA and ABA‐GE in Arabidopsis following rehydration under drought stress revealed that ABA‐GE contents were significantly higher in Arabidopsis plants overexpressing RCAR12 and RCAR13 than in non‐transformed plants and plants overexpressing RCAR11 following rehydration under drought stress. These observations suggest that RCAR12 and RCAR13 enhance the activity of UGT71C5 to glycosylate excess ABA into ABA‐GE following rehydration under drought stress, representing a rapid mechanism for regulating plant growth and development.
A recent retrotransposon insertion of J caused E6 locus facilitating soybean adaptation into low latitude
Authors: Fang Chao , Liu Jun , Zhang Ting , Su Tong , Li Shichen , Cheng Qun , Kong Lingping , Li Xiaoming , Bu Tiantian , Li Haiyang , Dong Lidong , Lu Sijia , Kong Fanjiang , Liu Baohui
Published: November 2020

Soybean (Glycine max) is an important legume crop that was domesticated in temperate regions. Soybean varieties from these regions generally mature early and exhibit extremely low yield when grown under inductive short‐day (SD) conditions at low latitudes. The long‐juvenile (LJ) trait, which is characterized by delayed flowering and maturity, and improved yield under SD conditions, allowed the cultivation of soybean to expand to lower latitudes. Two major loci control the LJ trait: J and E6. In the current study, positional cloning, sequence analysis, and transgenic complementation confirmed that E6 is a novel allele of J, the ortholog of Arabidopsis thaliana EARLY FLOWERING 3 (ELF3). The mutant allele e6PG, which carries a Ty1/Copia‐like retrotransposon insertion, does not suppress the legume‐specific flowering repressor E1, allowing E1 to inhibit Flowering Locus T (FT) expression and thus delaying flowering and increasing yields under SD conditions. The e6PG allele is a rare allele that has not been incorporated into modern breeding programs. The dysfunction of J might have greatly facilitated the adaptation of soybean to low latitudes. Our findings increase our understanding of the molecular mechanisms underlying the LJ trait and provide valuable resources for soybean breeding.
Retinoid stability and degradation kinetics in commercial cosmetic products
Authors: Temova Rakuša Žane , Škufca Petja , Kristl Albin , Roškar Robert
Published: November 2020

Background

Retinoids as dermatological agents are effective against acne, psoriasis, skin aging, and other skin conditions. However, their susceptibility to degradation is a limiting factor for their widespread use.

Objectives

Within this study, we aimed to provide comprehensive and evidence‐based information on retinoid stability and degradation kinetics in commercial cosmetics, focusing on different factors affecting their stability.

Methods

A validated HPLC‐UV methodology was utilized for determination of the most common retinoids in cosmetics (retinol, retinyl palmitate, β‐carotene) and a newer promising retinoid (hydroxypinacolone retinoate). The stability of 16 retinoid derivatives in 12 commercial cosmetics was evaluated within 6 months of long‐term and accelerated stability testing in addition to a one‐week photostability study. Retinoid degradation in the tested formulations followed first‐order kinetics, which was further applied to shelf‐life prediction.

Results

Long‐term and accelerated stability testing revealed retinoid instabilities in almost all products, resulting in a 0%‐80% decline after 6 months at 25°C and a 40%‐100% decline at 40°C, which were kinetically evaluated. Light degradation was more pronounced than temperature‐induced degradation. Among the studied retinoids, the stability of the newer hydroxypinacolone retinoate was the most prominent. This study also identifies correlations between retinoid concentrations, price, formulation, and their stability in cosmetics.

Conclusions

Retinoid instabilities were formulation‐dependent and associated with lower contents than declared in some cosmetics. Retinoid chemical stability and physical stability in topical formulations need to be evaluated by real‐time stability studies, instead of the more frequently used accelerated stability studies.
Early presence of Batrachochytrium dendrobatidis in Mexico with a contemporary dominance of the global panzootic lineage
Authors: Basanta M. Delia , Byrne Allison Q. , Rosenblum Erica Bree , Piovia‐Scott Jonah , Parra‐Olea Gabriela
Published: November 2020

Chytridiomycosis, caused by the fungus Batrachochytrium dendrobatidis (Bd), is a devastating infectious disease of amphibians. Retrospective studies using museum vouchers and genetic samples supported the hypothesis that Bd colonized Mexico from North America and then continued to spread into Central and South America, where it led to dramatic losses in tropical amphibian biodiversity (the epizootic wave hypothesis). While these studies suggest that Bd has been in Mexico since the 1970s, information regarding the historical and contemporary occurrence of different pathogen genetic lineages across the country is limited. In the current study, we investigated the historical and contemporary patterns of Bd in Mexico. We combined the swabbing of historical museum vouchers and sampling of wild amphibians with a custom Bd genotyping assay to assess the presence, prevalence, and genetic diversity of Bd over time in Mexico. We found Bd‐positive museum specimens from the late 1800s, far earlier than previous records and well before recent amphibian declines. With Bd genotypes from samples collected between 1975–2019, we observed a contemporary dominance of the global panzootic lineage in Mexico and report four genetic subpopulations and potential for admixture among these populations. The observed genetic variation did not have a clear geographic signature or provide clear support for the epizootic wave hypothesis. These results provide a framework for testing new questions regarding Bd invasions and their temporal relationship to observed amphibian declines in the Americas.
Environmental DNA metabarcoding of cow dung reveals taxonomic and functional diversity of invertebrate assemblages
Authors: Sigsgaard Eva Egelyng , Olsen Kent , Hansen Morten D. D. , Hansen Oskar Liset Pryds , Høye Toke Thomas , Svenning Jens‐Christian , Thomsen Philip Francis
Published: November 2020

Insects and other terrestrial invertebrates are declining in species richness and abundance. This includes the invertebrates associated with herbivore dung, which have been negatively affected by grazing abandonment and the progressive loss of large herbivores since the Late Pleistocene. Importantly, traditional monitoring of these invertebrates is time‐consuming and requires considerable taxonomic expertise, which is becoming increasingly scarce. In this study, we investigated the potential of environmental DNA (eDNA) metabarcoding of cow dung samples for biomonitoring of dung‐associated invertebrates. From eight cowpats we recovered eDNA from 12 orders, 29 families, and at least 54 species of invertebrates (mostly insects), representing several functional groups. Furthermore, species compositions differed between the three sampled habitats of dry grassland, meadow, and forest. These differences were in accordance with the species’ ecology; for instance, several species known to be associated with humid conditions or lower temperatures were found only in the forest habitat. We discuss potential caveats of the method, as well as directions for future study and perspectives for implementation in research and monitoring.
Demonstrating equivalence and non‐inferiority of medical education concepts
Authors: Klasen Martin , Sopka Saša
Published: November 2020

Context

In medical education, there are often several didactic methods for teaching and learning a specific medical skill. For educators, there are often pragmatic reasons to decide for one or another of them, such as costs, infrastructural requirements, time expenditure or qualification of the teacher. However, a central aspect to consider is the learning outcome: Does a new method achieve a similar learning success as an established standard method? To answer this question, we need an appropriate method to assess comparability of learning outcomes.

Methods

In this paper, we present two essential statistical concepts that can address the issue of comparability of learning outcomes: Equivalence and non‐inferiority testing. We explain the ideas behind these concepts and illustrate them with an example data set. To clarify several concepts, we use theoretical examples from one selected field: the teaching and assessment of Basic Life Support (BLS).

Conclusions

Equivalence and non‐inferiority tests can be powerful tools for comparing teaching and assessment methods. However, their correct application requires adequate knowledge about their strengths, pitfalls and application fields. The aim of this paper is to deliver this knowledge and to provide clinician researchers with a practical guidance to a successful application of these methods.
Debate as L2 Pedagogy: The Effects of Debating on Writing Development in Secondary Education
Authors: MAJIDI ABID EL , GRAAFF RICK DE , JANSSEN DANIEL
Published: November 2020

Research has painted a pessimistic picture of students’ second language (L2) writing skills in secondary education. One innovative tool that may help students foster their L2 proficiency, including writing ability, is in‐class debate. Debate is commonly associated with oral communication and argumentation skills. However, debate may also offer advantages as an effective vehicle for L2 writing instruction. This study evaluates the effect of a debate intervention on the writing competence of Dutch secondary‐school students. The intervention consisted of a number of speaking and writing activities, including case writing and note taking. The study, which employed a pretest–posttest design with a control group, involved 8 classes at 3 secondary schools in the Netherlands (N = 146). To measure the effect of the intervention, we analyzed 2 opinion writing tasks produced by the students: just prior to the first debate (pretest) and approximately 10 weeks later (posttest). We used a variety of measures, tapping into different aspects of writing performance, including fluency, syntactic and lexical complexity, accuracy, and cohesion. Multilevel analysis of the data revealed that the students in the intervention group significantly improved on a number of measures in comparison to the control group.
Two new species of Russula subgenus Compactae from Indian Himalaya based on morphology and molecular phylogenetic inferences
Authors: Das Kanad , Ghosh Aniket , Buyck Bart , Hembrom Manoj E.
Published: November 2020

The identity of blackening Russula (R. subg. Compactae) from Indian Himalaya has since long remained a mystery and they are often called after their European look‐alikes. Here, a combined approach including morphology and ITS phylogenetic inference resolved the identification of some of these taxa and revealed the discovery of two novel species. Thus, Russula ashihoi sp. nov., found under Abies in subalpine Himalaya, and R. indonigra sp. nov. occurring under Quercus in subtropical to temperate Himalaya are proposed herein with their morphological details, illustrations and ITS‐based phylogeny. Similarities with allied taxa are also discussed.
The seed germination spectrum of alpine plants: a global meta‐analysis
Authors: Fernández‐Pascual Eduardo , Carta Angelino , Mondoni Andrea , Cavieres Lohengrin A. , Rosbakh Sergey , Venn Susanna , Satyanti Annisa , Guja Lydia , Briceño Verónica F. , Vandelook Filip , Mattana Efisio , Saatkamp Arne , Bu Haiyan , Sommerville Karen , Poschlod Peter , Liu Kun , Nicotra Adrienne , Jiménez‐Alfaro Borja
Published: November 2020

Assumptions about the germination ecology of alpine plants are presently based on individual species and local studies. A current challenge is to synthesise, at the global level, the alpine seed ecological spectrum.

We performed a meta‐analysis of primary data from laboratory experiments conducted across four continents (excluding the tropics) and 661 species, to estimate the influence of six environmental cues on germination proportion, mean germination time and germination synchrony; accounting for seed morphology (mass, embryo : seed ratio) and phylogeny.

Most alpine plants show physiological seed dormancy, a strong need for cold stratification, warm‐cued germination and positive germination responses to light and alternating temperatures. Species restricted to the alpine belt have a higher preference for warm temperatures and a stronger response to cold stratification than species whose distribution extends also below the treeline. Seed mass, embryo size and phylogeny have strong constraining effects on germination responses to the environment.

Globally, overwintering and warm temperatures are key drivers of germination in alpine habitats. The interplay between germination physiology and seed morphological traits further reflects pressures to avoid frost or drought stress. Our results indicate the convergence, at the global level, of the seed germination patterns of alpine species.
Coumarin accumulation and trafficking in Arabidopsis thaliana: a complex and dynamic process
Authors: Robe Kevin , Conejero Geneviève , Gao Fei , Lefebvre‐Legendre Linnka , Sylvestre‐Gonon Elodie , Rofidal Valérie , Hem Sonia , Rouhier Nicolas , Barberon Marie , Hecker Arnaud , Gaymard Frédéric , Izquierdo Esther , Dubos Christian
Published: November 2020

Iron (Fe) is a major micronutrient and is required for plant growth and development. Nongrass species have evolved a reduction‐based strategy to solubilize and take up Fe. The secretion of Fe‐mobilizing coumarins (e.g. fraxetin, esculetin and sideretin) by plant roots plays an important role in this process. Although the biochemical mechanisms leading to their biosynthesis have been well described, very little is known about their cellular and subcellular localization or their mobility within plant tissues.

Spectral imaging was used to monitor, in Arabidopsis thaliana, the in planta localization of Fe‐mobilizing coumarins and scopolin. Molecular, genetic and biochemical approaches were also used to investigate the dynamics of coumarin accumulation in roots.

These approaches showed that root hairs play a major role in scopoletin secretion, whereas fraxetin and esculetin secretion occurs through all epidermis cells. The findings of this study also showed that the transport of coumarins from the cortex to the rhizosphere relies on the PDR9 transporter under Fe‐deficient conditions. Additional experiments support the idea that coumarins move throughout the plant body via the xylem sap and that several plant species can take up coumarins present in the surrounding media.

Altogether, the data presented here demonstrate that coumarin storage and accumulation in roots is a highly complex and dynamic process.
Evaluation of the health‐related quality of life in Turkish cystic fibrosis patients
Authors: Alishbayli Gulzar , Kilinc Ayse Ayzit , Cokugras Haluk
Published: November 2020

Background

Prolongation of life expectancy in cystic fibrosis (CF) to the fourth decade makes health‐related quality of life (HRQOL) an important issue in this population. This study aims to evaluate the effects of clinical and socio‐demographic characteristics of patients on different aspects of HRQOL in a pediatric CF population. We also intend to assess some measures of reliability and validity of the Turkish CF Questionnaire‐Revised (CFQ‐R) forms.

Methods

Fifty‐four CF patients and 46 parents / caregivers filled the appropriate CFQ‐R forms. Disease severity was evaluated via modified Shwachman–Kulczycki (SK) scores, and additional clinical information was obtained from patient records.

Results

Forty‐three percent (n = 23) of patients were female, the mean age of patients being 13.3 ± 3.96 years. Self‐ and proxy‐reported points showed a strong correlation (Spearman’s rho > 0.6) on more observable domains of HRQOL (e.g. physical functioning). No significant difference was found between sexes on any HRQOL domain. When compared between age groups, treatment burden appeared to worsen with age, while social functioning improved. All three forms of the CFQ‐R Turkish version showed acceptable internal consistency reliability and convergence with disease severity measures.

Conclusions

The CFQ‐R showed a fair correlation with the Shwachman–Kulczycki score and the FEV1% value, which makes its longitudinal use possible in clinical practice. It is important to use self‐reported evaluations as well as parent / caregiver‐reported HRQOL evaluations, especially in young children. More studies are needed to assess the psychometric properties of Turkish CFQ‐R forms.
Is tomosynthesis an ingenious scheme for bronchoscopic diagnosis of lung nodules?
Authors: Goto Taichiro
Published: November 2020

See related Reply
The European Elections 2019 in Greek – Cypriot print Media. The Positions of the Newspapers Alithia and Haravgi in May 2019
Authors: Antoniades Euripides
Published: November 2020

The role of the media during the European election is extremely important as it is the dominant form factor of news and public communication. In this context, both civil society and political actors are the two additional players in the triangle of shaping and influencing communication for social issues. The purpose of this paper is to investigate the agenda and the way in which the news of Greek Cypriot print media was framed. Specifically, this research examines the main topics identified in the printed media during the pre-election period of the European elections in Cyprus in May 2019. Also, this research focuses on how the issues of the news appeared. This research seeks to answer the above questions, thus enriching the research gap found in the existing literature. From a theoretical point of view, this article adopts the theories of the Agenda Setting and Framing, because as interrelated theories they can explain the research theme. In addition, for the purposes of the survey, a mixed methodological approach was applied, with the research adopting quantitative content analysis and framing. Our methodology was based on elements of content quality analysis and aims to analyse the content of the text message, discourse and form and involves five stages: 1. The procedure of compiling the empirical evidence. 2. The isolation of items (units recorded). 3. The classification of units into categories. 4. The quantity conversion and measurement of items (codification). 5. Analysis and interpretation of data. The findings showed that the Media Agenda during the pre-election period included a wide range of topics. The topics that had the highest frequency appearance in the media were the economy, society, and environment issues.
Ultrasound as a complementary diagnostic method for Dupuytren’s Contracture
Authors: Yildizgoren Mustafa Turgut
Published: November 2020

.
Developing and using a smartphone-app to support the teaching of technical basics for 3D/4D obstetrical ultrasound applications in medical education
Authors: Kollmann Christian , Santner Lukas , Yong-Ho Jo
Published: November 2020

.
Acknowledgements
Authors: Novero Cecilia
Published: November 2020

Acknowledgements
East Germany, March 1990: Eine Schubladenreportage
Authors: Barton Peter
Published: November 2020

Reportage
A Visit to Leipzig in the Cold War year of 1982
Authors: Grant Alyth F.
Published: November 2020

Story in German
Cultures Grow Exponentially: An Interview with Rainer Görß
Authors: Howes Seth
Published: November 2020

Interview with artist Goerss
Es ist Zeit, darüber zu sprechen. Stefan Heym über den 17. Juni 1953
Authors: Nelva Daniela
Published: November 2020

Essay on Heym on 1953 in the GDR
The Adaptation and Evaluation of a Pilot Mindfulness Intervention Promoting Mental Health in Student Athletes
Authors: Evers Audrey G. , Somogie Jessica A , Wong Ian L. , Allen Jennifer D. , Cuevas Adolfo G.
Published: November 2020

The objective of this study was to examine the effectiveness of a pilot mindfulness program for student athletes by assessing mental health, mindfulness ability, and perceived stress before and after the intervention. The mindfulness program was adapted from a program developed at the University of Southern California. The four-session intervention taught the basics of mindfulness, self-care skills, and guided meditations. Participants completed surveys before and after the intervention. Mindfulness ability was assessed with the Cognitive and Affective Mindfulness Scale, mental health was assessed with a modified Short Form Health Survey, and stress was assessed with the Perceived Stress Scale. After the intervention, participants reported improvement in mindfulness ability, t(28) = −2.61, p = .014, mental health, t(28)  = −2.87, p = .008, and a trending improvement in perceived stress, t(28)  = 1.86, p = .073. A short mindfulness program may be effective for improving mental health and mindfulness ability in collegiate student athletes.
“To Be, or Not to Be, That Is the Question”: Modeling and Differentiation Among Siblings Participating in Organized Youth Sport
Authors: Osai Keith V. , Dorsch Travis E. , Whiteman Shawn D.
Published: November 2020

Organized youth sport is a relatively common family context in which sibling dynamics are not well understood. The present study was designed to address two contrasting mechanisms of socialization—modeling and differentiation—in examining older siblings’ influence on younger siblings’ sport participation. American youth (N = 221) age 10–15 years (M = 12.38, SD = 1.01) who were active sport participants completed an online survey measuring individual and family demographics, sibling relationship qualities, and parent–child relationship dimensions. The participants reported on their most proximal older siblings, all of whom were within 4 years of age. The analyses suggest that sibling differentiation dynamics decreased the likelihood of playing the same primary sport as an older sibling for (a) the same biological sex, close in age to siblings; (b) the same biological sex, further in age from siblings; and (c) mixed biological sex, wide in age from siblings. The “Discussion” section highlights the practical value of understanding the impact of sibling influence processes on the individual, sibling dyad, and family system.
NF-κB activation persists into the remodeling phase of tendon healing and promotes myofibroblast survival
Authors: Best Katherine T. , Nichols Anne E. C. , Knapp Emma , Hammert Warren C. , Ketonis Constantinos , Jonason Jennifer H. , Awad Hani A. , Loiselle Alayna E.
Published: November 2020

NF-κB signaling promotes the survival of myofibroblasts during the late stages of tendon repair.
Draft Genome Sequence of Bifidobacterium longum subsp.
infantis
BI-G201, a Commercialization Strain
Authors: Song Jinan , Xu Yu , Han Di , Teng Qihui , Jiang Deyi , Liu Qing
Published: November 2020

Bifidobacterium longum
subsp.
infantis
has been widely used in many food products, such as solid beverages or dietary supplements. Here, a draft genome sequence of a commercialization strain,
Bifidobacterium longum
subsp.
infantis
BI-G201, was reported.
Draft Genome Sequences of Lactococcus lactis Strains MS22314, MS22333, MS22336, and MS22337, Isolated from Fermented Camel Milk in Ethiopia
Authors: Bragason Esben , Svendsen Christina Aaby , Guya Mitiku Eshetu , Berhe Tesfemariam , Hansen Egon Bech
Published: November 2020

The genome sequences of four
Lactococcus lactis
strains isolated from fermented camel milk were sequenced using paired-end Illumina MiSeq reads. The genome size of each strain was about 2.6 Mb, and three of the strains were annotated with
tet
(S) coding for tetracycline resistance.
Consulting with young people: informing guidelines for children’s palliative care
Authors: Taylor Johanna , Murphy Sarah , Chambers Lizzie , Aldridge Jan
Published: November 2020

Objective

Increasingly the views of young people are sought when improving healthcare; however, it is unclear how they shape policy or practice. This paper presents a consultation with young people commissioned by the National Institute for Health and Care Excellence (NICE) to inform clinical guidelines for paediatric palliative care (end-of-life care for infants, children and young people).

Methods

The consultation involved qualitative thematic analysis of data from 14 young people (aged 12–18 years) with a life-limiting or life-threatening condition who took part in focus groups or interviews. The topics explored were predefined by NICE: information and communication; care planning; place of care; and psychological care. Data collection consisted of discussion points and activities using visual cues and was informed by a pilot consultation group with five young adults (aged 19–24 years). Findings were shared with participants, and feedback helped to interpret the findings.

Results

Four overarching themes were identified, cutting across the predetermined topic areas: being treated as individuals with individual needs and preferences; quality of care more important than place; emotional well-being; and living as a young person. Importantly, care planning was viewed as a tool to support living well and facilitate good care, and the young people were concerned less about where care happens but who provides this.

Conclusion

Young people’s priorities differ from those of parents and other involved adults. Incorporating their priorities within policy and practice can help to ensure their needs and preferences are met and relevant research topics identified.
Unilateral leg swelling in a newborn
Authors: Cortellazzo Wiel Luisa , Berti Irene , Starc Meta , Murru Flora Maria , Barbi Egidio , Risso Francesco Maria
Published: November 2020

A female neonate was born with asymmetric lower limbs, the right leg appearing enlarged, with thickened, reddish-purple skin and ectasic superficial reticulum (figure 1A,B). Limb pulses were present and symmetrical. The girl’s family history and prenatal scans were unremarkable. Laboratory findings were within the normal range, except for a mild thrombocytopenia (90 000/μL), which spontaneously resolved during the next few days. A leg X-ray and the Doppler analysis ruled out the presence of calcifications and venous varices, respectively. Ultrasound showed significant skin thickening, with marked dermal hypertrophy and hyperechogenicity. Magnetic resonance showed circumferential thickening of the derma, with mild hypertrophy of some perforating vessels (figure 2). A biopsy of the right thigh showed capillary malformations on histology.

Figure 1

(A, B) Hypertrophy of the right lower limb, with large capillary malformation extending to the gluteus and the external genitalia.

Figure 2

Axial THRIVE magnetic resonance scan of the thighs’ proximal third, showing circumferential dermal thickening and inhomogeneity of the right leg’s subcutaneous tissue.

Questions

Based on the clinical picture and investigations results, which is the most likely diagnosis?

Beckwith-Wiedemann

CLOVES syndrome

Klippel-Trenaunay syndrome

Kaposiform hemangioendothelioma

How can the diagnosis be confirmed?

CT with PET

Lymphoscintigraphy

Genetic testing

None of the above, the diagnosis is clinical

What is the mainstay of management?

Conservative with follow-up

Pharmacotherapy

Sclerotherapy

Surgery

Which of the following complications can occur?

Scoliosis

Glaucoma

Urinary and gastrointestinal bleeding

All of the above

Answers can be found on page 02.
Durvalumab-associated vasculitis presenting as ‘the blue toe syndrome’
Authors: Gupta Shivangi , Xu Dan , Hadfield Jane , Prentice David
Published: November 2020

Durvalumab is a selective, high-affinity human immunoglobulin monoclonal antibody in a class called check point inhibitors, that blocks PD-L1 on tumour cells. Despite clinical success in increasing progression-free survival rates in patients with stage III non-small-cell lung cancer, durvalumab has been associated with immune-related side effects such as pneumonitis and colitis. We present a case of an 84-year-old woman with acral vasculitis presenting as blue toe syndrome, associated with prolonged use of durvalumab. After 1 year of fortnightly durvalumab therapy postchemoradiation therapy, the patient came in with a left blue big toe, and later developed bilateral livedo racemosa. The diagnosis of durvalumab-associated vasculitis was made and treatment with prednisolone was started with clinical improvement.
Machine learning to determine relative contribution of modifiable and non-modifiable risk factors of major eye diseases
Authors: Nusinovici Simon , Zhang Liang , Chai Xiaoran , Zhou Lei , Tham Yih Chung , Vasseneix Caroline , Majithia Shivani , Sabanayagam Charumathi , Wong Tien Yin , Cheng Ching Yu
Published: November 2020

Aims

To use machine learning (ML) to determine the relative contributions of modifiable and non-modifiable clinical, metabolic, genetic, lifestyle and socioeconomic factors on the risk of major eye diseases.

Methods

We conducted analyses in a cross-sectional multi-ethnic population-based study (n=10 033 participants) and determined a range of modifiable and non-modifiable risk factors of common eye diseases, including diabetic retinopathy (DR), non-diabetic-related retinopathy (NDR); early and late age-related macular degeneration (AMD); nuclear, cortical and posterior subcapsular (PSC) cataract; and primary open-angle (POAG) and primary angle-closure glaucoma (PACG). Risk factors included individual characteristics, metabolic profiles, genetic background, lifestyle patterns and socioeconomic status (n~100 risk factors). We used gradient boosting machine to estimate the relative influence (RI) of each risk factor.

Results

Among the range of risk factors studied, the highest contributions were duration of diabetes for DR (RI=22.1%), and alcohol consumption for NDR (RI=6.4%). For early and late AMD, genetic background (RI~20%) and age (RI~15%) contributed the most. Axial length was the main risk factor of PSC (RI=30.8%). For PACG, socioeconomic factor (mainly educational level) had the highest influence (20%). POAG was the disease with the highest contribution of modifiable risk factors (cumulative RI~35%), followed by PACG (cumulative RI ~30%), retinopathy (cumulative RI between 20% and 30%) and late AMD (cumulative RI ~20%).

Conclusion

This study illustrates the utility of ML in identifying factors with the highest contributions. Risk factors possibly amenable to interventions were intraocular pressure (IOP) and Body Mass Index (BMI) for glaucoma, alcohol consumption for NDR and levels of HbA1c for DR.
Perceived quality of surgical care in association with patient-related factors and correlation to reported postoperative complications in Finland: a cross-sectional study
Authors: Saarinen Ira Helena , Koivisto Jaana-Maija , Kaipia Antti , Haavisto Elina
Published: November 2020

Objective

To study if patient-related factors are associated with patient-evaluated quality of care in surgery. To examine if there is an association with postoperative complications and patient-evaluated low quality of care.

Design

A correlation cross-sectional study, in addition, a phone call interview at 30 days postoperatively to examine complications.

Setting

The data on patients admitted for non-cardiac general and orthopaedic surgery at a central hospital in Southwestern Finland were collected in two phases during an 8-month period.

Participants

436 consecutive consenting and eligible in-ward non-cardiac general surgery and orthopaedic surgery adult patients. Ambulatory, paediatric and memory disorder patients were excluded. 378 patients completed the questionnaire (Good Nursing Care Scale for Patients (GNCS-P)).

Methods

Perceived quality of care was examined by the GNCS-P questionnaire. Patient-related factors were obtained from electronic patient records and questionnaire. A telephone interview related to postdischarge complications was conducted 30 days after discharge.

Main outcome measures

Patient evaluation of quality of care at discharge, its association with patient-related factors and patient-reported postdischarge complications.

Results

The overall quality was evaluated high or very high by the patients. The lowest overall quality of care rate was assessed by surgical patients living alone (p=0.0088) and patients who evaluated their state of health moderate or poor (p=0.0047). Surgical patients reporting postoperative complications after discharge evaluated lower overall quality of care (p=0.0105) than patients with no complications.

Conclusion

Patient demographic factors do not seem to influence the perceptions of the quality of care. Instead, subjective state of health and living conditions (living alone) may have an influence on the patient experience of quality of care. The perceived quality of care in healthcare staff technical and communication skills may have an association with reported postoperative complications.
Biofortification of wheat with zinc for eliminating deficiency in Pakistan: study protocol for a cluster-randomised, double-blind, controlled effectiveness study (BIZIFED2)
Authors: Lowe Nicola M , Zaman Mukhtiar , Moran Victoria Hall , Ohly Heather , Sinclair Jonathan , Fatima Sadia , Broadley Martin R , Joy Edward J M , Mahboob Usman , Lark R Murray , Zia Munir H , Ander E Louise , Sharp Paul A , Bailey Elizabeth H , Young Scott D , Khan Muhammad Jaffar
Published: November 2020

Introduction

Micronutrient deficiencies, commonly referred to as ‘hidden hunger’, affect more than two billion people worldwide, with zinc and iron-deficiency frequently reported. The aim of this study is to examine the impact of consuming zinc biofortified flour (Zincol-2016) on biochemical and functional measures of status in adolescent girls and children living in a low-resource setting in Pakistan.

Methods and analysis

We are conducting a pragmatic, cluster-randomised, double-blind, controlled trial. A total of 482 households have been recruited from two catchment areas approximately 30–40 km distance from Peshawar. Household inclusion criteria are the presence of both an adolescent girl, aged 10–16 years, and a child aged 1–5 years. The study duration is 12 months, divided into two 6-month phases. During phase 1, all households will be provided with locally procured flour from standard varieties of wheat. During phase 2, clusters will be paired, and randomised to either the control or intervention arm of the study. The intervention arm will be provided with zinc biofortified wheat flour, with a target zinc concentration of 40 mg/kg. The control arm will be provided with locally procured wheat flour from standard varieties with an expected zinc concentration of 20 mg/kg. The primary outcome measure is plasma zinc concentration. Secondary outcomes include anthropometric measurements, biomarkers of iron and zinc status, and the presence and duration of respiratory tract infections and diarrhoea.

Ethics and dissemination

Ethical approval was granted from the University of Central Lancashire STEMH Ethics Committee (reference number: STEMH 1014) and Khyber Medical University Ethics Committee (DIR/KMU-EB/BZ/000683). The final study methods will be published in peer-reviewed journals, alongside the study outcomes. In addition, findings will be disseminated to the scientific community via conference presentations and abstracts and communicated to the study participants through the village elders at an appropriate community forum.

Trial registration number

ISRCTN17107812; Pre-results.
Health professionals’ perceptions of weight loss programmes and recommendations for future implementation: a qualitative study
Authors: Jessen-Winge Christina , Ilvig Pia Marie , Thilsing Trine , Lee Kim , Fritz Heather , Christensen Jeanette Reffstrup
Published: November 2020

Objective

Obesity is an increasing public health challenge and most weight loss programmes are still inadequate to support sustainable weight loss. One reason for the continued lack of success might be the dominant biomedical, individualised approach to weight loss. Holistic approaches that focus on overall health and well-being in addition to weight loss are increasingly recommended. In Denmark, health professionals in the municipalities are responsible for developing and conducting weight loss programmes. The objective of this study was to explore what health professional’s perceived as an ideal, holistic weight loss programme that could be feasibly implemented in the municipalities.

Design

A phenomenological-hermeneutical qualitative study was performed using semistructured interviews.

Setting

Thirty-two Danish municipalities were weight loss programmes are developed and conducted.

Participants

Thirty-five health professionals with experience conducting weight loss programmes.

Results

Three themes emerged from the analysis: Support from the social network are important both during and after a weight loss, Changing the self-belief by positive discussions and doing activities, Maintaining changes through daily life.

Conclusion

Future municipal weight loss programmes should emphasise overall health and well-being instead of weight loss and adopt a holistic approach including a focus on social relationships, meaningful activities and successes as part of a balanced daily life.
Prospective association between social engagement and cognitive impairment among middle-aged and older adults: evidence from the China Health and Retirement Longitudinal Study
Authors: Zhou Shuduo , Song Suhang , Jin Yinzi , Zheng Zhi-Jie
Published: November 2020

Objectives

Cognitive impairment is a precursor of dementia. This study aimed to examine the association of social engagement with cognitive decline during the process of normal ageing.

Methods

We used data from the China Health and Retirement Longitudinal Study. The cognitive functions were tested at baseline, and 2-year and 4-year follow-up visits. Social engagement was constructed as a comprehensive measure including the quantity and frequency of social activities. Activities of social engagement were classified into three types. Multilevel logistic model was fitted to evaluate the prospective association between social engagement and cognitive impairment.

Results

After 2-year follow-up, compared with participants with the lowest level of social engagement, those with level-2, level-3 and level-4 social engagement had a 12% (OR=0.88, 95% CI 0.71 to 1.09, p=0.242), 17% (OR=0.83, 95% CI 0.71 to 0.97, p=0.020) and 25% (OR=0.75, 95% CI 0.61 to 0.93, p=0.008) lower risk for developing cognitive impairment, respectively. A similar pattern of significantly protective association was found at 4-year follow-up. Combined effect analysis showed that participants who attended one type of social engagement had a lower risk of developing cognitive impairment and the protective effect was even larger with those who attended two or three types of social engagement.

Conclusions

Social engagement had a protective effect on cognitive impairment among middle-aged and older adults in China. Given the growing epidemic of dementia and rapid pace of ageing in low-income and middle-income countries, our study shed lights on comprehensive and tailored public health programmes for improving social engagement, to delay cognitive impairment at mid-age and later life.
Smoking cessation interventions for people living in rural and remote areas: a systematic review protocol
Authors: Lum Alistair , Skelton Eliza , McCarter Kristen Louise , Handley Tonelle , Judd Lucy , Bonevski Billie
Published: November 2020

Introduction

Smoking rates among people living in rural and remote areas are higher and quit rates are lower over the past 10 years compared with people living in suburban and urban areas. Higher smoking rates contribute to greater tobacco-related disease and morbidity in rural and remote areas. Physical and social isolation, greater exposure to pro-tobacco marketing, pro-tobacco social norms, and lower socioeconomic and educational levels are contributing to these higher smoking rates and lower quit rates. Smoking cessation interventions for people in rural and remote areas have been conducted, however little is known about their effectiveness or their mechanisms of action as well as the quality of such research. Behaviour change techniques (BCTs) are mechanisms of action derived from behaviour change theory, such as goal setting and reward. Improved understanding of the contribution of BCTs for smoking cessation in the rural and remote population will support future intervention development. We aim to review the literature on smoking cessation interventions for people living in rural and remote areas to inform evidence about intervention effectiveness and mechanisms of action.

Methods and analysis

We will conduct a systematic review using seven scientific databases (EMBASE, MedLine, PsycINFO, CINAHL, Cochrane, Informit Health and Scopus). We will include peer-reviewed journal articles published in English that examine a smoking cessation intervention delivered to people living in rural and remote areas in the USA, Canada and Australia. We will examine outcome data relating to intervention effectiveness (eg, point prevalence abstinence or continuous abstinence), as well as the BCTs used in included interventions and their relationship with intervention outcomes. We will also assess the feasibility, acceptability and quality of research interventions of included articles, and provide graded recommendations based on the review outcomes. Data will be synthesised using narrative approaches and interpreted using content analysis.

Ethics and dissemination

Ethics was not required for this systematic review. The results will be disseminated through peer-reviewed publication and at conferences by presentations.

PROSPERO registration number

177398.
Examining the effect of non-specialised clinical rotations upon medical students’ Thanatophobia and Self-efficacy in Palliative Care: a prospective observational study in two medical schools
Authors: Gryschek Guilherme , Cecilio-Fernandes Dario , Barros Guilherme Antonio Moreira de , Mason Stephen , de Carvalho-Filho Marco Antonio
Published: November 2020

Introduction

Including palliative care (PC) in overloaded medical curricula is a challenge, especially where there is a lack of PC specialists. We hypothesised that non-specialised rotations could provide meaningful PC learning when there are enough clinical experiences, with adequate feedback.

Objective

Observe the effects of including PC topics in non-specialised placements for undergraduate medical students in two different medical schools.

Design

Observational prospective study.

Setting

Medical schools in Brazil.

Participants

134 sixth-year medical students of two medical schools.

Methods

This was a longitudinal study that observed the development of Self-efficacy in Palliative Care (SEPC) and Thanatophobia (TS) in sixth-year medical students in different non-specialised clinical rotations in two Brazilian medical schools (MS1 and MS2). We enrolled 78 students in MS1 during the Emergency and Critical Care rotation and 56 students in MS2 during the rotation in Anaesthesiology. Both schools provide PC discussions with different learning environment and approaches.

Primary outcomes

SEPC and TS Scales were used to assess students at the beginning and the end of the rotations.

Results

In both schools’ students had an increase in SEPC and a decrease in TS scores.

Conclusion

Non-specialised rotations that consider PC competencies as core aspects of being a doctor can be effective to develop SEPC and decrease TS levels.