bluuebunny/crossref_metadata_2025 huggingface dataset:
History and photographic memory
Authors: Zaatari Akram
Published: August 2019

In this interview, artist Akram Zaatari reflects on his longstanding work with photographic heritage in the Middle East, North Africa and the Arab diaspora, and considers the different ways in which he has used photographs to illuminate and unfold historical truths. Charting divergencies and disagreements around issues of preservation that have arisen over the years within the Arab Image Foundation (of which he is one of the founders), Zaatari points out radical gestures of preservation that return photographs to the ‘living tissue’, the ‘larger ecosystem’ and a set of affective relations from which they had become detached. The far-ranging metaphor of archaeology that the artist employs to illuminate his practice also lends itself to describe the destructive nature of certain acts of collecting premised on ‘excessive accumulation’, of which the pillage of the archaeological heritage in the Middle East and North Africa in the late 18th and early 19th centuries is an emblematic example. Collecting, however, is also a tool for writing history and the displacement of photographs serves as a crucial step to reconfigure them within new narratives. Attentive to the changing nature of photographic archives, Zaatari frees photographs from fixed and prescribed readings, bringing new perspectives to bear on them without necessarily denying those former interpretations. Additional layers of historical information can be found nestling in details accidentally captured by the camera's lens, in signs of material damage or ‘worthy’ defects. In Zaatari’s hands, digital technologies are used to emphasize, not to occlude the traces of these material histories. In the folds of the archives, hidden narratives wait to be revealed and unfolded under the loving gaze of the artist, collector and historian.
Differentiation in the International Baccalaureate Diploma Programme
Authors: Dulfer Nicky
Published: August 2019

There is now widespread acceptance of the importance of differentiated instruction in today’s classrooms. However, much of the research regarding differentiated instruction takes place in primary and middle years environments, with very little focussed on the senior secondary years. This article explores differentiated instruction practices in senior secondary high stakes environments. Specifically focussed on the experiences of teachers in the International Baccalaureate Diploma Programme (IBDP) in Hong Kong and Australia, where the IB is predominately taught in high-fee-paying institutions, the article explores some of the current practices and concerns of teachers involved in the programme. In exploring differentiated instruction in the IBDP it asks the questions 1) How do teachers employ differentiation in their approaches to teaching in IBDP environments?, and 2) What factors inhibit or enable differentiation in their classrooms?

Results from the study indicate that teachers of the IBDP provide several differentiation opportunities within the content and product areas. However, the areas of process and environment were more problematic, with the amount of content that needed to be covered impacting on the approach to teaching and learning adopted by both the teachers and the students. The IB prides itself on its Learner Profile attributes which support the students to become “inquiring, knowledgeable and caring young people who help to create a better and more peaceful world through intercultural understanding and respect.” (IB, 2019a). However, in this study questions were raised regarding the amount of time students are given to think, reflect, or inquire. This is something that all senior secondary years programmes will need to consider as we move through the twenty-first century.
Developing and institutionalising the ‘Internationally-Minded School’: The role of the ‘Numerous Fs’
Authors: Bunnell Tristan
Published: August 2019

The concept and theory of ‘international-mindedness’ has been much discussed and debated in recent years. The conceptualising of the character of ‘international-mindedness’ as practised by schools has begun to attract some scholarly attention, but one especially under-theorised aspect involves the often-derided ‘Several Fs’, or sometimes ‘Five Fs’ (flags, festivals, food etc.). This paper aims to give credibility and importance to the day-to-day aspects of the ‘Several Fs’, and draws attention to the broader range of activity, identifying upwards of 15 ‘Fs’ in practice. The broader framework of these ‘Numerous Fs’ is then placed at the centre of identifying the nature and form of the school, as a deliverer of ‘international mindedness’. In a ‘low-culture context’, where collective identity is undermined by transient and relatively distanced stakeholders, the ‘Numerous Fs’ can be viewed as acting as significant ‘purveyors of organisational identity’. At another level, the ‘Numerous Fs’ give considerable legitimacy to a school’s claim to be ‘internationally-minded’, acting as ‘carriers of institutionalisation’. Put simply, they give the school a distinct set of norms, activities, artefacts and routines, characterising it as a specific type of educational institution. As well as acting as practical everyday tools for developing the ‘internationally-minded school’, they arguably help to give the school a considerable degree of legitimacy both as an organisation, and as an institution.
Treatable traits in acute exacerbations of chronic airway diseases
Authors: McDonald Vanessa M , Osadnik Christian R , Gibson Peter G
Published: August 2019

Acute exacerbations of chronic airway disease are common occurrences that cause a major burden of illness. Acute exacerbations are associated with impaired health status, increased lung function decline, hospitalization and increased risk of death. Exacerbation avoidance is a major priority. Despite this goal, exacerbations continue to occur and the need for effective models of care that optimize patient outcomes are urgently needed. ‘Treatable Traits’ is an approach to personalized medicine that has been proposed for the management of airway diseases. The treatable traits approach allows for the recognition of clinically important, identifiable and treatable disease characteristics, followed by targeted and individualized treatment interventions to address each trait. We review the literature relating to treatable traits in airway diseases; in particular, those traits that can predict exacerbations and approaches to management that aim to prevent exacerbations by using a treatable traits model of care. We propose this approach as a potentially useful model of care to both prevent and manage acute exacerbations.
Capacity Development and Evaluation of a Parent Advisory Team Engaged in Childhood Obesity Research
Authors: Alexander Ramine , Estabrooks Paul , Brock Donna-Jean P. , Hill Jennie L. , Whitt-Glover Melicia C. , Zoellner Jamie
Published: August 2019

Guided by community-based participatory research principles, this mixed-methods process evaluation explored the experience and capacity of a newly formed Parental Advisory Team (PAT) engaged in childhood obesity research in a medically underserved region. Following the successful completion of a 3-month evidence-based childhood obesity treatment program (iChoose), 13 parents/caregivers who completed iChoose consented to participate in the PAT. Between June 2015 and March 2016, the PAT had nine monthly meetings and completed mixed-methods capacity assessments. They engaged in activities related to understanding iChoose outcomes, defining their role and purpose as a partnership, initiating content development, and pilot testing maintenance intervention components for future iChoose efforts. Assessments included a quantitative survey administered at baseline and 9 months, and a qualitative interview completed at 9 months. Results indicated that PAT members’ perceptions of the identified capacity dimensions were positive at baseline (3.8-4.3 on a 5-point scale) and remained positive at follow-up (3.9-4.4 on a 5-point scale); changes were not statistically significant. Qualitative data revealed that PAT members were satisfied with group participation and desired to enhance their role in subsequent iChoose research. Understanding and promoting parental engagement in the research process fills an important gap in childhood obesity literature.
Metformin Prolongs Survival in Type 2 Diabetes Lung Cancer Patients With EGFR-TKIs
Authors: Hung Ming-Szu , Chuang Min-Chun , Chen Yi-Chuan , Lee Chuan-Pin , Yang Tsung-Ming , Chen Pau-Chung , Tsai Ying-Huang , Yang Yao-Hsu
Published: August 2019

Background: Metformin use reportedly reduces cancer risk and improves survival in lung cancer patients. This study aimed to investigate the effect of metformin use in patients with diabetes mellitus (DM) and lung cancer receiving epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) therapy. Methods: A nationwide, population-based cohort study was conducted using the Taiwan National Health Insurance Research Database. From January 1, 2004, to December 31, 2012, a total of 373 metformin and 1260 non-metformin lung cancer cohorts with type 2 DM and EGFR-TKI treatment were studied. Results: Metformin use was significantly associated with a reduced risk of death (hazard ratio: 0.73, 95% confidence interval [CI]: 0.62-0.85, P < .001), as well as a significantly longer median progression-free survival (9.2 months, 95% CI: 8.6-11.7, vs 6.4 months, 95% CI: 5.9-7.2 months, P < .001) and median overall survival (33.4 months, 95% CI: 29.4-40.2, vs 25.4 months, 95% CI: 23.7-27.2 months, P < 0.001). Conclusions: In conclusion, metformin may potentially enhance the therapeutic effect and increase survival in type 2 DM patients with lung cancer receiving EGFR-TKI therapy.
Are adolescent sports fans more physically active than the sports indifferent? A self-reported questionnaire study
Authors: Yargic MP , Kurklu GB
Published: August 2019

Aims:

Physical inactivity in adolescents is a global health problem. Eighty percent of adolescents worldwide do not meet the minimum recommended physical activity. Although many adolescents define themselves as a ‘sports fan’, the relationships between sports spectatorship and sport participation in adolescents have not yet been investigated. Here, we determine whether there is a relationship between the levels of sports spectatorship and physical activity among adolescents.

Methods:

The Physical Activity Questionnaire for Adolescents (PAQ-A), Sport Spectator Identification Scale (SSIS) and three questions regarding total screen time spent watching a sports game and other sports-related screen time on weekdays and weekends were given to high school students in two cities in Turkey (Konya and Ankara).

Results:

After excluding 21 invalid questionnaires, a total of 1100 full and valid questionnaires were returned from the participants (578 females, 522 males). Participants were aged between 13 and 19 (median = 15) years. Female students had lower PAQ-A (median = 2.38, interquartile range (IQR) = 0.99) and SSIS scores (median = 19, IQR = 24) and less total screen time on weekends compared to male students (median PAQ-A = 2.64, IQR = 1.05; median SSIS = 29, IQR = 30) ( p < .05). The physical activity level of the students was significantly lower among those at higher grades. A weak positive correlation was found between SSIS scores and PAQ-A scores ( r = .28, p < .01). Multiple linear regression analysis revealed that sex, age and SSIS scores were all significant predictors of PAQ-A scores ( p < .001).

Conclusions:

When comparing female and male adolescents, we found that females scored significantly less in mean physical activity levels, screen time on weekends and sports spectator identification. A positive correlation was observed between sports spectator identification and physical activity levels, both in males and in females. Higher sports spectator identification, being younger and being male were all significant predictors of higher levels of physical activity.
Genetic Diversity of the Endangered Mekong Giant Catfish, Striped Catfish, and Their Hybrids From Thailand
Authors: Phadphon Poompat , Amontailak Thitapa , Kotchantuek Napatsakorn , Srithawong Suparat , Kutanan Wibhu , Suwannapoom Chatmongkon
Published: August 2019

Previous genetic investigations of the Mekong giant catfish ( Pangasianodon gigas Chevey, 1913) and striped catfish ( Pangasianodon hypophthalmus Sauvage, 1878) provided discordant results. Here, we sequenced mitochondrial (mt) DNA of the cytochrome B region, and a control region, to characterize the genetic variation of P. gigas, P. hypophthalmus, and hybrids of these two species. Among the three groups, P. hypophthalmus had the greatest diversity in both regions, yet all three studied groups showed lower genetic diversity compared to the results of previous studies. The Bayesian Skyline Plots showed a reduction in effective population sizes of the parental species. The hybrids were found to have a constant population size with a recent divergence time. As expected, the network and neighbor joining tree showed a close maternal genetic relationship between the hybrid and P. hypophthalmus, a reflection of the breeding between male P. gigas and female P. hypophthalmus. Our results provide genetic information on these endangered fish that will be useful for both conservation and commercial breeding programs.
Physical activity is associated with a large number of cardiovascular-specific proteins: Cross-sectional analyses in two independent cohorts
Authors: Stattin Karl , Lind Lars , Elmståhl Sölve , Wolk Alicja , Lemming Eva Warensjö , Melhus Håkan , Michaëlsson Karl , Byberg Liisa
Published: August 2019

Aims

We aimed to discover and replicate associations between leisure-time physical activity and cardiovascular candidate plasma protein biomarkers and to examine whether the associations were independent of body fat.

Methods

We used cross-sectional data from two population-based cohorts, the EpiHealth (discovery cohort; n = 2239) and the Swedish Mammography Cohort – Clinical (SMCC; replication cohort; n = 4320). Physical activity during leisure time was assessed using questionnaires, and plasma concentrations of 184 proteins were assayed using the Olink Proseek Multiplex Cardiovascular 2 and 3 kits. We applied adjusted linear regression models using the False Discovery Rate to control for multiple testing in discovery.

Results

In EpiHealth, physical activity was associated with 75 cardiovascular plasma biomarkers, of which 28 associations were verified (replicated) in SMCC. Findings include seven novel associations in human: paraoxonase 3, cystatin B, cathepsin Z, alpha-L-iduronidase, prostasin, growth differentiation factor 2 and tumour necrosis factor alpha receptor superfamily member 11A. Estimates for associations were similar across tertiles of body fat and physical activity was associated with four biomarkers independent of body fat percentage: paraoxonase 3, cystatin B, fatty acid-binding protein 4 and interleukin-1 receptor antagonist.

Conclusion

Leisure-time physical activity was associated with 28 cardiovascular-specific proteins; four associations were independent of body fat. Biomarkers in novel associations are involved in several atherosclerotic processes including regulation of low-density lipoprotein oxidation, protein degradation and immune cell adhesion and migration. Further research into these pathways may yield new insights into how physical activity affects cardiovascular health.
“Oh, She’s a Tumblr Feminist”: Exploring the Platform Vernacular of Girls’ Social Media Feminisms
Authors: Keller Jessalynn
Published: August 2019

As avid social media users, it is perhaps unsurprising that feminist teenage girls use their favorite platforms to engage in various forms of feminist activism. Yet, existing research has not explored how a growing number of social media platforms and their technological affordances uniquely shape how girls engage in online activism. I address this oversight by asking the following: Why are girls using particular platforms for feminist activism? How do certain platforms facilitate distinctive opportunities for youth engagement with feminist politics? and How might this shape the types of feminist issues and politics both made possible and foreclosed by some social media platforms? To answer these questions, I draw on ethnographic data gathered from a group of American, Canadian, and British teenage girls involved in various forms of online feminist activism on Twitter, Facebook, and Tumblr. These data were collected as part of two UK-based team research projects. Using the concept of “platform vernacular,” I analyze how these girls do feminism across these different platforms, based on discursive textual analysis of their social media postings and interview reflections. I argue that teenage girls strategically choose how to engage with feminist politics online, carefully weighing issues like privacy, community, and peer support as determining factors in which platform they choose to engage. These decisions are often related to distinctive platform vernaculars, in which the girls have a keen understanding. Nonetheless, these strategic choices shape the kinds of feminisms we see across various social media platforms, a result that necessitates some attention and critical reflection from social media scholars.
The combination of Astragalus membranaceus extract and ligustrazine to improve the inflammation in rats with thrombolytic cerebral ischemia
Authors: Pan Ruihuan , Zhou Mingchao , Zhong Yiping , Xie Jingping , Ling Shanshan , Tang Xialin , Huang Yan , Chen Hongxia
Published: August 2019

The purpose of the study was to evaluate the effect of Astragalus membranaceus extract and ligustrazine combination on ameliorating inflammation in cerebral ischemic rats that have undergone thrombolysis. Astragalus membranaceus and ligustrazine per se, or a combination of A. membranaceus and ligustrazine was administered by intraperitoneal injection immediately after surgery and sham surgery. After the induction of thrombolysis, the neurological function was measured and cerebral lesion volume was determined. The regulatory T cells in the spleen were measured by flow cytometry. To explore the protective effects of the combination drug on the neurological function and inflammation, the expression of transcription factor Foxp3 and cytokines, including transforming growth factor beta 1, interleukin 10, interleukin 4, interleukin 1 beta, interferon gamma, interleukin 17, in damaged brain was examined using reverse transcription polymerase chain reaction, Western blot, and enzyme-linked immunosorbent assay. The cerebral lesion volume was markedly reduced in the combination drug–treated rats compared to the rats treated with either A. membranaceus or ligustrazine alone ( P < 0.05). The neurological function, regulatory T cells, transcription factor Foxp3, transforming growth factor beta 1, interleukin 10, and interleukin 4 were markedly elevated in the rats treated with combination drugs ( P < 0.05). The expression of interleukin 1 beta, interferon gamma, and interleukin 17 was reduced in the rats treated with combination drug therapy ( P < 0.05). Treatment with a combination of A. membranaceus and ligustrazine can ameliorate inflammation after thrombolysis and regulate the related cytokines by elevating the expression of endogenous regulatory T cells.
The role of education, participation in departmental decisions, and burnout in social support and consulting networks in juvenile probation departments
Authors: Holloway Evan D , Mootoo Candace , Kırbıyık Uzay , Aalsma Matthew C
Published: August 2019

Juvenile probation officers (JPOs) play an important role as decisionmakers for adolescents under their supervision in the community. While some research has examined how individual and organizational characteristics may affect their decision-making, this is the first study to examine the role of social networks that naturally occur within the juvenile probation department workplace. Specifically, demographics, attitudes about participation in the workplace, and burnout were examined as predictors of social support and consultation networks within the workplace. The current study was exploratory in nature. Participants were JPOs who supervised adolescents in the United States within one state. JPOs who felt more involved in workplace decision-making processes reported receiving more social support from their colleagues. JPOs with some graduate education or a Master’s degree were less likely to provide consultation to others on tough cases or to be rated by others as providing social support. Implications are discussed.
“I Wouldn’t Bring in Anything that Could Be Challenged”: Educators as Moral Educators
Authors: Walther Carol S. , Wickens Corrine M. , Koss Melanie D.
Published: August 2019

Rooted in protectionist discourses, would-be censors regularly frame censorship and book challenges as defenses against portrayals of deviance and social ills. Such concerns often feed into social control of community values and moral panics around the degradation of children’s presumed innate innocence. In this study, we investigated perceptions of public K-12 educators regarding the inclusion or exclusion of controversial materials in schools. We found that the “parent phone call” both served to define what constituted controversial materials and constrain educators’ professional decision making. Although the rare teacher used parent phone calls as opportunities to educate parents about curriculum, the majority of educators avoided instructional practices that might elicit such a phone call, thus engaging in self-censorship and moral entrepreneurship as rule enforcers.
Mothers’ Perceived Barriers to and Recommendations for Health Care Appointment Keeping for Children Who Have Cerebral Palsy
Authors: Ballantyne Marilyn , Liscumb Laurie , Brandon Erin , Jaffar Janice , Macdonald Andrea , Beaune Laura
Published: August 2019

Children with cerebral palsy (CP) require ongoing rehabilitation services to address complex health care needs. Attendance at appointments ensures continuity of care and improves health and well-being. The study’s aim was to gain insight into mothers’ perspectives of the factors associated with nonattendance. A qualitative descriptive design was conducted to identify barriers and recommendations for appointment keeping. Semi-structured interviews were conducted with 15 mothers of children with CP. Data underwent inductive qualitative analysis. Mothers provided rich context regarding barriers confronted for appointment keeping—transportation and travel, competing priorities for the child and family, and health services. Mothers’ recommendations for improving the experience of attending appointments included virtual care services, transportation support, multimethod scheduling and appointment reminders, extended service hours, and increased awareness among staff of family barriers to attendance. The results inform services/policy strategies to facilitate appointment keeping, thereby promoting access to ongoing rehabilitation services for children with CP.
Do Readers Judge Books by Author Gender? Results from a Randomized Experiment
Authors: Kapelner Adam , Weinberg Dana
Published: August 2019

We run a randomized experiment to examine gender discrimination in book purchasing with 2,544 subjects on Amazon’s Mechanical Turk. We manipulate author gender and book genre in a factorial design to study consumer preferences for male versus female versus androgynous authorship. Despite previous findings in the literature showing gender discrimination in book publishing and in evaluations of work, respondents expressed no gender preference across a variety of measures, including quality, interest, and the amount they were willing to pay to purchase the book. This nonfinding, if it holds up to additional research, suggests that book consumers may not express the same discriminatory tendencies observed among indie and traditional publishers.
Engaging Possibilities: Reinvigorating the Call for Research on Reading
Authors: Ivey Gay
Published: August 2019

Can we teach children and young adults about reading while simultaneously and inseparably teaching them how to take control of their own lives and relationships, a possibility that has been just barely touched by research and even less so by educational policies and practice? This address highlights research findings that suggest the promise of literacy engagement for clarifying and expanding how we think about reading assessment, achievement, comprehension, socio-emotional growth, and equity in literacy instruction. Using my own evolution as a researcher studying, primarily, the classroom-based reading experiences of middle school students, I show how my own questions and theoretical perspectives shifted based on what the children taught me as I studied their experiences and how that led me to champion engagement as a promising way forward. I rely heavily on what students themselves have shared with me, as their perspectives have fueled the shifts in my thinking and in the research questions I have pursued. I then share what I believe is the potential of an engagement-focused perspective on our field’s knowledge about reading development and practices. Finally, I comment on what we might need to do to make this line of research influence real classrooms and policies in positive ways. I argue that in order to influence, through an engagement perspective, the transformation of reading-related policies—and more importantly the agentive transformation of individuals and communities—we must renew our commitment to research conducted in classrooms and in partnership with teachers and families.
Towards an affective politics of hope: Learning from land struggles in the Philippines
Authors: Wright Sarah L
Published: August 2019

Acts of resistance recognize the world’s becoming. In this article, I attend to hope and resistance through the experiences of land-based social movements in the Philippines. Many of the stories shared by those involved do not immediately appear to be hopeful, infused as they are with loss. For, despite decades of struggle, many participants have lost, or never gained access to, their land. Yet, hope weaves its way through, binds and even underpins, the experiences shared. In this paper, I consider some of the contradictions and issues associated with land reform in the Philippines and some of the complexities of hope and being hopeful for these participants. I find hope to be a way of being and becoming now that insists on contingency and openness in ways often radically different from a simple optimism. Hope helped those involved remain in the struggle, bound the participants to each other and to land, nurtured their belief in their organizing efforts, and encouraged them to understand themselves, and their lives, differently. Hope became a way of being, relationally, in the world. I conclude by considering the possibilities for building an affective politics based on a recognition that the emotional and the political, feeling and action, are entirely entwined.
Re-wilding Parkdale? Environmental gentrification, settler colonialism, and the reconfiguration of nature in 21st century Toronto
Authors: Parish Jessica
Published: August 2019

In 21st century Toronto, the labour of caring for urban trees is entangled with both gentrification processes and the social reproduction of settler colonial space. This paper contributes to the study of environmental gentrification through a study of the social reproduction of settler colonial relations to land in the Parkdale–High Park area of Toronto. Specifically, I take up the hyper-visibility of some forms of social reproduction, in order to shed light on how the mundane, quotidian ‘non-work’ of living in/with/for capitalism becomes a site of privilege and a luxury pursuit for more affluent residents. The paper highlights the processes and practices whereby settler colonial urban subjects seek out ‘nature’ as a temporary outside where they can escape from widely accepted downsides of capitalist urbanism, including a diverse array of social and physical ills, from stress, to obesity, to ecological degradation. The paper asks: whose social reproduction does the presence of urban trees serve? In the context of 21st century financialized gentrification, cities are increasingly normalized as spaces of wealth and luxury. It is therefore crucial to pay attention to the raced, gendered, and colonial micro-politics through which urban ecologies are transformed in the service of an anti-democratic vision of the city as a space of leisure and luxury.
Hiding in Plain Sight: Epigenetic Plasticity in Drug-Induced Tumor Evolution
Authors: Sharma Ankur
Published: August 2019

Cancer is a heterogeneous disease with key differences at the cellular and molecular levels. Acquisition of these differences during the course of tumor development manifests into functional and phenotypic heterogeneity leading to tumor diversity, also referred to as intra-tumor heterogeneity (ITH). Within a tumor, there are subpopulations of cells capable of tumor initiation and maintenance. These cells often exhibit resistance to standard-of-care anti-cancer drugs. However, the role of various subpopulations (clones) in drug resistance remains to be investigated. Moreover, the jury is still out about whether drug resistance is a result of clonal selection of preexisting cells, or the cells acquire resistance by dynamic re-wiring of their epigenome. Therefore, we investigated the drug-induced tumor evolution in patient-derived primary cells of head and neck squamous cell carcinoma. Our data demonstrated the role of a preexisting poised epigenetic state in drug-induced adaptive evolution of tumor cells. Importantly, the combination of chemotherapy and epigenetic inhibitors can prevent/delay drug-induced tumor evolution.
Synergistic effects of ADAMTS13 deficiency and complement activation in pathogenesis of thrombotic microangiopathy
Authors: Zheng Liang , Zhang Di , Cao Wenjing , Song Wen-Chao , Zheng X. Long
Published: August 2019

This study in mice suggests a synergistic role of ADAMTS13 deficiency and complement “hyperactivatability” in the pathogenesis of thrombotic microangiopathy.
Effects of the SGLT2 inhibitor dapagliflozin on cardiac function evaluated by impedance cardiography in patients with type 2 diabetes. Secondary analysis of a randomized placebo-controlled trial
Authors: Bonora Benedetta Maria , Vigili de Kreutzenberg Saula , Avogaro Angelo , Fadini Gian Paolo
Published: August 2019

Background and aims

Cardiovascular outcome trials have documented a strong benefit of sodium glucose cotransporter-2 inhibitors (SGLT2i) on the risk of hospitalization for heart failure (HF) in patients with type 2 diabetes (T2D) with or without established cardiovascular disease or prior history of HF. The mechanisms, however, are not entirely clear. We aimed to evaluate whether treatment with SGLT2i affected cardiac function using impedance cardiography (ICG) in a randomized placebo-controlled trial.

Materials and methods

Thirty-three patients with T2D were randomized to receive blind dapagliflozin 10 mg or matching placebo for 12-week on top of their ongoing glucose lowering medication regimen. Cardiac function was evaluated by resting ICG at baseline and at the end of the 12-week treatment period. ICG is a non-invasive technology based on the continuous measurement of thoracic electrical conductivity to process a cardiodynamic parameters related to fluid content, blood flow, cardiac function, and circulatory function. We also evaluated changes in glycaemic control, blood pressure, and body weight.

Results

Thirty-one patients completed the study, 1 was excluded because ICG data was missing. Patients included in the final analysis were on average 63.4-year-old, with a known diabetes duration of 14.1 years and a baseline HbA1c of 8.2% (66 mmol/mol). 63.3% of patients had established cardiovascular disease (symptomatic or asymptomatic) and 36.7% had microangiopathy, but none had a prior history of HF. After 12 weeks, patients randomized to dapagliflozin, as compared to those randomized to placebo, showed improvements in HbA1c (− 1.2%; 13 mmol/mol), systolic blood pressure (− 3.7 mmHg), and body weight (− 3.3 kg). Based on ICG, in both groups, we detected no significant change in parameters of blood flow (stroke volume, cardiac output, cardiac index), systolic function (ejection fraction, acceleration and velocity indexes, systolic time ratio), circulatory function (systemic vascular resistance index), and fluid status (thoracic fluid content) after treatment.

Conclusion

This is the first study exploring cardiac effects of SGLT2i using ICG in T2D. We observed no change in cardiac function parameters estimated by ICG in T2D patients who received dapagliflozin versus placebo for 12 weeks.

Trial registration ClinicalTrial.gov NCT02327039. Registered 30 December 2014
Information conveyed by electrical diaphragmatic activity during unstressed, stressed and assisted spontaneous breathing: a physiological study
Authors: Piquilloud Lise , Beloncle François , Richard Jean-Christophe M. , Mancebo Jordi , Mercat Alain , Brochard Laurent
Published: August 2019

Background

The electrical activity of the crural diaphragm (Eadi), a surrogate of respiratory drive, can now be measured at the bedside in mechanically ventilated patients with a specific catheter. The expected range of Eadi values under stressed or assisted spontaneous breathing is unknown. This study explored Eadi values in healthy subjects during unstressed (baseline), stressed (with a resistance) and assisted spontaneous breathing. The relation between Eadi and inspiratory effort was analyzed.

Methods

Thirteen healthy male volunteers were included in this randomized crossover study. Eadi and esophageal pressure (Peso) were recorded during unstressed and stressed spontaneous breathing and under assisted ventilation delivered in pressure support (PS) at low and high assist levels and in neurally adjusted ventilatory assist (NAVA). Overall eight different situations were assessed in each participant (randomized order). Peak, mean and integral of Eadi, breathing pattern, esophageal pressure–time product (PTPeso) and work of breathing (WOB) were calculated offline.

Results

Median [interquartile range] peak Eadi at baseline was 17 [13–22] μV and was above 10 μV in 92% of the cases. Eadimax defined as Eadi measured at maximal inspiratory capacity reached 90 [63 to 99] μV. Median peak Eadi/Eadimax ratio was 16.8 [15.6–27.9]%. Compared to baseline, respiratory rate and minute ventilation were decreased during stressed non-assisted breathing, whereas peak Eadi and PTPeso were increased. During unstressed assisted breathing, peak Eadi decreased during high-level PS compared to unstressed non-assisted breathing and to NAVA (p = 0.047). During stressed breathing, peak Eadi was lower during all assisted ventilation modalities compared to stressed non-assisted breathing. During assisted ventilation, across the different conditions, peak Eadi changed significantly, whereas PTPeso and WOB/min were not significantly modified. Finally, Eadi signal was still present even when Peso signal was suppressed due to high assist levels.

Conclusion

Eadi analysis provides complementary information compared to respiratory pattern and to Peso monitoring, particularly in the presence of high assist levels.

Trial registration The study was registered as NCT01818219 in clinicaltrial.gov. Registered 28 February 2013
The UK Government should withdraw from the Convention on the Rights of Persons with Disabilities
Authors: Gosney Paul , Bartlett Peter
Published: August 2019

Many psychiatrists in the UK may be surprised to find that the Government ratified a convention ten years ago that suggests compulsory mental health treatment be prohibited. The Convention on the Rights of Persons with Disabilities is arguably the most important legal instrument that no one in psychiatry ever discusses, but if moved from ratification to enforcement it would have enormous effect on day-to-day practice. Here, Dr Paul Gosney argues that the convention if enforced would be damaging for the people it aims to protect, whereas Professor Peter Bartlett defends it as a necessary challenge to the inequalities in our current system.
PTH Immunoassay Interference Due to Human Anti-Mouse Antibodies in a Subject With Obesity With Normal Parathyroid Function
Authors: Laudes Matthias , Frohnert Janosch , Ivanova Kamelia , Wandinger Klaus-Peter
Published: August 2019

Context

Immunoassay interference has been most often found with prolactin measurement. However, only few data exist on immunoassay interference for other hormones.

Case Description

A 36-year-old woman with obesity (body mass index, 31 kg/m2) had regularly attended our endocrine unit for type 2 diabetes therapy. When she was included as a control subject in a study for obesity management, detailed laboratory testing was performed, including PTH. In the absence of clinical symptoms, she presented with normal calcium, phosphate, and vitamin D levels. However, the PTH levels were >5000 ng/L. These results were obtained using the Roche Elecsys electrochemiluminescence assay. Repeated measurements with this assay (mouse antibody) led to the same findings. However, using an Euroimmun assay (goat antibody), the exact PTH values were measured at 18.0 ng/L. After pretreatment with a heterophilic antibody blocking reagent, the results of the Roche assay had decreased to a normal level. This phenomenon was explained by the detection of human anti-mouse antibodies in the proband’s serum.

Conclusions

In cases of prolactin immunoassay interference, endogenous antibodies will bind to the hormone in vivo, resulting in complexes of a high molecular weight that are less efficiently cleared by the kidneys and, thus, accumulate in the blood. In contrast, the PTH values >5000 ng/L detected in our subject most likely had resulted from the specific interference of the human anti-mouse antibodies present in the proband’s serum with the assay antibody, resulting in artificial stimulation of the Roche assay detection system ex vivo.
Keeping Candida commensal: how lactobacilli antagonize pathogenicity of Candida albicans in an in vitro gut model
Authors: Graf Katja , Last Antonia , Gratz Rena , Allert Stefanie , Linde Susanne , Westermann Martin , Gröger Marko , Mosig Alexander S. , Gresnigt Mark S. , Hube Bernhard
Published: August 2019

The intestine is the primary reservoir of Candida albicans that can cause systemic infections in immunocompromised patients. In this reservoir, the fungus exists as a harmless commensal. However, antibiotic treatment can disturb the bacterial microbiota, facilitating fungal overgrowth and favoring pathogenicity. The current in vitro gut models that are used to study the pathogenesis of C. albicans investigate the state in which C. albicans behaves as a pathogen rather than as a commensal. We present a novel in vitro gut model in which the fungal pathogenicity is reduced to a minimum by increasing the biological complexity. In this model, enterocytes represent the epithelial barrier and goblet cells limit C. albicans adhesion and invasion. Significant protection against C. albicans-induced necrotic damage was achieved by the introduction of a microbiota of antagonistic lactobacilli. We demonstrated a time-, dose- and species-dependent protective effect against C. albicans-induced cytotoxicity. This required bacterial growth, which relied on the presence of host cells, but was not dependent on the competition for adhesion sites. Lactobacillus rhamnosus reduced hyphal elongation, a key virulence attribute. Furthermore, bacterial-driven shedding of hyphae from the epithelial surface, associated with apoptotic epithelial cells, was identified as a main and novel mechanism of damage protection. However, host cell apoptosis was not the driving mechanism behind shedding. Collectively, we established an in vitro gut model that can be used to experimentally dissect commensal-like interactions of C. albicans with a bacterial microbiota and the host epithelial barrier. We also discovered fungal shedding as a novel mechanism by which bacteria contribute to the protection of epithelial surfaces.

This article has an associated First Person interview with the joint first authors of the paper.
The effect of environmental enrichment on behavioral variability depends on genotype, behavior, and type of enrichment
Authors: Akhund-Zade Jamilla , Ho Sandra , O'Leary Chelsea , de Bivort Benjamin
Published: August 2019

Non-genetic individuality in behavior, also termed intragenotypic variability, has been observed across many different organisms. A potential cause of intragenotypic variability is sensitivity to minute environmental differences during development, even as major environmental parameters are kept constant. Animal enrichment paradigms often include the addition of environmental diversity, whether in the form of social interaction, novel objects, or exploratory opportunities. Enrichment could plausibly affect intragenotypic variability in opposing ways: it could cause an increase in variability due to the increase in microenvironmental variation, or a decrease in variability due to elimination of aberrant behavior as animals are taken out of impoverished laboratory conditions. In order to test our hypothesis, we assayed five isogenic Drosophila melanogaster lines raised in control and mild enrichment conditions, and one isogenic line under both mild and intense enrichment conditions. We compared the mean and variability of six behavioral metrics between our enriched fly populations and the laboratory housing control. We found that enrichment often caused a small increase in variability across most of our behaviors, but that the ultimate effect of enrichment on both behavioral means and variabilities was highly dependent on genotype and its interaction with the particular enrichment treatment. Our results support previous work on enrichment that presents a highly variable picture of its effects on both behavior and physiology.
Derivation and internal validation of a data-driven prediction model to guide frontline health workers in triaging children under-five in Nairobi, Kenya
Authors: Mawji Alishah , Akech Samuel , Mwaniki Paul , Dunsmuir Dustin , Bone Jeffrey , Wiens Matthew O. , Görges Matthias , Kimutai David , Kissoon Niranjan , English Mike , Ansermino Mark J.
Published: August 2019

Background: Many hospitalized children in developing countries die from infectious diseases. Early recognition of those who are critically ill coupled with timely treatment can prevent many deaths. A data-driven, electronic triage system to assist frontline health workers in categorizing illness severity is lacking. This study aimed to develop a data-driven parsimonious triage algorithm for children under five years of age.

Methods: This was a prospective observational study of children under-five years of age presenting to the outpatient department of Mbagathi Hospital in Nairobi, Kenya between January and June 2018. A study nurse examined participants and recorded history and clinical signs and symptoms using a mobile device with an attached low-cost pulse oximeter sensor. The need for hospital admission was determined independently by the facility clinician and used as the primary outcome in a logistic predictive model. We focused on the selection of variables that could be quickly and easily assessed by low skilled health workers.

Results: The admission rate (for more than 24 hours) was 12% (N=138/1,132). We identified an eight-predictor logistic regression model including continuous variables of weight, mid-upper arm circumference, temperature, pulse rate, and transformed oxygen saturation, combined with dichotomous signs of difficulty breathing, lethargy, and inability to drink or breastfeed. This model predicts overnight hospital admission with an area under the receiver operating characteristic curve of 0.88 (95% CI 0.82 to 0.94). Low- and high-risk thresholds of 5% and 25%, respectively were selected to categorize participants into three triage groups for implementation. 

Conclusion: A logistic regression model comprised of eight easily understood variables may be useful for triage of children under the age of five based on the probability of need for admission. This model could be used by frontline workers with limited skills in assessing children. External validation is needed before adoption in clinical practice.
The Problem of Labor Productivity Factors in the Regions of Modern Russia
Authors: Басовский Леонид , Basovskiy Leonid , Басовская Елена , Basovskaya Elena
Published: August 2019

The transition to a post-industrial — informational, digital economy, which occurs in modern Russia, is capable of providing a multiple increase in labor productivity. In the course of numerous studies of the conditions for the transition to the development of a post-industrial, information economy, certain features of the resource support for the growth of the post-industrial economy have established. However, far, it is not possible to establish with delivery completeness a complex of factors that ensure economic growth and increase in labor productivity in the process of forming a postindustrial economy. The results of research are often controversial. To assess the factors determining labor productivity, it is proposed to investigate the impact of capital, human and intellectual capital, infrastructural, institutional, social, innovative factors, factors associated with inflation and foreign economic activity. At the preliminary stage of the research, the positive impact of the spread of computers with Internet access on 100 workers and the negative impact of electronic document management on labor productivity in the regions of Russia found.
Statistical Study of Demographic Indicators of Tula region
Authors: Авдеева А. , Avdeeva A. , Кальянов Александр , Kalyanov Aleksandr
Published: August 2019

The article assesses the dynamics of the main demographic indicators of the Tula region: birth rate, mortality, natural increase and decrease for 2000–2018, presents the age pyramid of the population, estimates the coefficient of demographic load, and analyzes the main reasons for the increase in the burden on the working-age population. It is established that the demographic situation in the Tula region, as in most other regions of Russia, remains quite tense, and is characterized by complex processes in the development of the population, which is associated with high mortality and low fertility. Methods of analysis, synthesis, deduction and induction, methods of graphical analysis were used in the preparation of the article. The methodological basis was the data of the Federal state statistics service and normative documents. The authors based on the analysis of the main normative documents regulating the activities of the authorities and management in the field of demographic situation management at the municipal level, and statistical data, justified the need to introduce measures to improve the demographic situation in the Tula region, the introduction of additional mechanisms to encourage families to give birth to children by increasing guaranteed social benefits to families.