bluuebunny/crossref_metadata_2025 huggingface dataset:
Relation of Photochemical Internalization to Heat, pH and Ca2+ Ions
Authors: Soe Tet Htut , Nanjo Tomotaka , Watanabe Kazunori , Ohtsuki Takashi
Published: July 2019

The inefficient endosomal escape of drugs or macromolecules is a major obstacle to achieving successful delivery to therapeutic targets. An efficient approach to circumvent this barrier is photochemical internalization (PCI), which uses light and photosensitizers for endosomal escape of the delivered macromolecules. The PCI mechanism is related to photogenerated singlet oxygen, but the mechanism is still unclear. In this study, we examined the relation of PCI to heat, pH and Ca2+ ions using cell penetrating peptide (CPP)‐cargo‐photosensitizer (Alexa546 or Alexa633) conjugates. A cell temperature changing experiment demonstrated that heat (thermal mechanism) does not significantly contribute to the photoinduced endosomal escape. Inhibition of V‐ATPase proton pump activity and endosomal pH upregulation indicated that PCI‐mediated endosomal escape needs endosomal acidification prior to photoirradiation. Imaging of the CPP‐cargo‐photosensitizer and Ca2+ ions during photostimulation showed that intracellular calcium increase is not the cause of the endosomal escape of the complex. The increment is mainly due to Ca2+ influx. These findings show the importance of extra‐ and intracellular milieu conditions in the PCI mechanism and enrich our understanding of PCI‐related changes in cell.
Biochemical characteristics support the recently described species Karlodinium zhouanum (Gymnodiniales, Dinophyceae)
Authors: Zhu Xiaojuan , Zhou Chengxu , Meng Ran , Li Shuang , Fang Keyi , Luo Zhaohe , Xu Jilin , He Shan , Luo Qijun , Yan Xiaojun
Published: July 2019

The small athecate dinoflagellate Karlodinium zhouanum is a species recently described in the coastal waters of China. K. zhouanum is morphologically similar to Karlodinium veneficum, a typical ichthyotoxic blooming karlotoxin‐producing species, and it is impossible to distinguish between these two species based on light microscopy. In this study, strains of K. zhouanum isolated from the East China Sea were studied. By analyzing toxins, toxicity, lipid characteristics and typical molecular and physiological traits of this species, K. zhouanum was shown to be nontoxic to brine shrimp and widely spread over the coastal waters of China. No karlotoxin‐like toxin was detected by liquid chromatography‐mass spectrometry (LC–MS). Instead of gymnodinosterol, the critical sterol in toxic K. veneficum, 27(nor)‐24S‐4α‐Methyl‐5α‐ergosta‐8(14)‐en‐3β‐ol (NEE) was dominant in K. zhouanum, while gymnodinosterol was absent. These sterol characteristics may provide not only support for the species separation between toxic and nontoxic species of Karlodinium but also environmental survey tools to differentiate the contribution of nontoxic Karlodinium strains, which has been unclear until now.
Patterns of protein glycosylation in bovine placentomes as a function of gestational age and in retained versus non‐retained placenta
Authors: Wawrzykowski Jacek , Franczyk Monika , Kankofer Marta
Published: July 2019

The formation of placenta at the beginning of pregnancy and its separation at parturition require not only deep remodelling of extracellular matrix, which mainly consists of proteins conjugated with sugar moieties, but also the cooperation with cells from both maternal and foetal parts of placenta. The aim of the study was to compare the patterns of selected conjugated proteins with sugar moieties between pregnant and term placenta as well as between released and retained placenta in cows. Placental samples from healthy pregnant cows (3–5 months of pregnancy) were collected at a slaughterhouse (n = 6), and parturient samples were collected during caesarean section at term and retrospectively divided into retained (n = 6) and released (n = 6). The pattern of selected sugar moieties conjugated with proteins was detected by use of lectin blotting with Phaseolus Vulgaris leucoagglutinin, Maackia Amurensis and Sambucus Nigra (Elderberry). The comparison and analysis of obtained band patterns showed differences between their number, molecular weight and abundance related to the intensity of staining. Samples from 3 to 4 months showed similarities, while at the 5th month, clear differences were visible in all 3 lectins, which were used in this study. Samples from retained/released placenta expressed significant differences in PHA‐L and SNA pattern in the foetal part. Obtained results indicate that the development of placenta related to extracellular matrix and accompanying cells from both sides of placenta shows dynamic changes during pregnancy. Moreover, in the case of animals with the retention of foetal membranes the patterns of proteins conjugated with sugar moieties are altered, suggesting that the changes in extracellular matrix metabolism can be involved in the attachment and detachment of the placenta in cows.
Loss/Gain Framing, Dose, and Reactance: A Message Experiment
Authors: Ratcliff Chelsea L. , Jensen Jakob D. , Scherr Courtney L. , Krakow Melinda , Crossley Kaylee
Published: July 2019

Whether a loss or gain frame has a persuasive advantage in communicating health risks is a matter of ongoing debate. Findings reported in the literature are mixed, suggesting that framing effects are likely complex and may be influenced by a combination of factors. This study examined reactance as a mediator and dose as a moderator of loss/gain framing effects. Adults (N = 1,039) read framed messages about the health consequences of physical (in)activity in varying message doses (i.e., number of framed statements). Compared to loss frames, gain frames generated more threat to freedom and reactance. Dosage exerted significant influence at the extremes; the one‐dose messages invoked less intentions to exercise compared to the four‐dose messages. Planned contrasts revealed significant frame × dose interactions. Notably, the one‐dose gain‐framed messages triggered significantly more freedom threat and less intentions to engage in physical activity—a situation that changed when the information was loss‐framed or when the dosage was increased.
DETERMINING MINIMUM WAGES IN CHINA: DO ECONOMIC FACTORS DOMINATE?
Authors: Dreger Christian , Kosfeld Reinhold , Zhang Yanqun
Published: July 2019

We analyze the determinants of minimum wages in China at the regional level. We include a broad set of economic variables and consider the role of spatial spillovers, which reflect the geographical pattern of regions and can arise for several reasons, including competition between local policymakers. The analysis primarily reveals the existence of strong regional ties in the development of minimum wages. Once these spatial effects are considered, the role of economic variables in the determination of minimum wages declines, and their impact is lower than initially thought. Whereas consumption per capita and consumer prices remain significant, regular wages lose their importance when controlling for reverse causation. Although minimum wage regulation stresses the relevance of economic factors in the determination of appropriate levels, actual development is largely driven by regional dependencies. As minimum wage standards set by local officials do not fully reflect regional economic conditions, further reform should be on the agenda.
Group life shapes the psychology and biology of health: The case for a sociopsychobio model
Authors: Haslam S. Alexander , Haslam Catherine , Jetten Jolanda , Cruwys Tegan , Bentley Sarah
Published: July 2019

Engel presented a compelling case for a biopsychosocial model of health. This challenged a biomedical model that he saw as reductionistic, physicalistic, and exclusionist. Yet despite its laudable goals and popularity, the biopsychosocial model can be faulted for being incremental, imprecise, and individualistic. Ultimately, this means it is no less reductionist than the biomedical model which it sought to supplant. In this paper, we present a reformulation of this model that foregrounds the capacity for social groups—and the social contexts in which those groups are embedded—to structure psychology and, through this, biology and health. This sociopsychobio model argues that the three elements of Engel's framework are not fixed and immutable but rather dynamic and interdependent. The model is consistent with a range of recent approaches to health that have focused on the important role that social class, social inequality, social structure, and social networks play in shaping health outcomes. In this paper, though, the concrete value of this reformulation is illustrated through a discussion of recent research that focuses on the role of group memberships and associated social identities in shaping the psychology and biology of stress. This review underlines two key points that are central to the general case for a sociopsychobio model of health. First, that groups are a force in the world that shape the psychology and biology of their members (as well as members of other groups) in ways that cannot be reduced to those group members' functioning as individuals. Second, that groups provide their members with a basis for seeking to change the world rather than simply accepting it. In this, group life is not merely an appendage to psychology and biology but is instead a basis for collective experiences that have the potential to unleash new expressions of both.
Resolving subcellular plant metabolism
Authors: Fürtauer Lisa , Küstner Lisa , Weckwerth Wolfram , Heyer Arnd G. , Nägele Thomas
Published: July 2019

Plant cells are characterized by a high degree of compartmentalization and a diverse proteome and metabolome. Only a very limited number of studies has addressed combined subcellular proteomics and metabolomics which strongly limits biochemical and physiological interpretation of large‐scale ’omics data. Our study presents a methodological combination of nonaqueous fractionation, shotgun proteomics, enzyme activities and metabolomics to reveal subcellular diurnal dynamics of plant metabolism. Subcellular marker protein sets were identified and enzymatically validated to resolve metabolism in a four‐compartment model comprising chloroplasts, cytosol, vacuole and mitochondria. These marker sets are now available for future studies that aim to monitor subcellular metabolome and proteome dynamics. Comparing subcellular dynamics in wild type plants and HXK1‐deficient gin2‐1 mutants revealed a strong impact of HXK1 activity on metabolome dynamics in multiple compartments. Glucose accumulation in the cytosol of gin2‐1 was accompanied by diminished vacuolar glucose levels. Subcellular dynamics of pyruvate, succinate and fumarate amounts were significantly affected in gin2‐1 and coincided with differential mitochondrial proteome dynamics. Lowered mitochondrial glycine and serine amounts in gin2‐1 together with reduced abundance of photorespiratory proteins indicated an effect of the gin2‐1 mutation on photorespiratory capacity. Our findings highlight the necessity to resolve plant metabolism to a subcellular level to provide a causal relationship between metabolites, proteins and metabolic pathway regulation.
Equine odontogenic tumors: Clinical presentation, CT findings, and outcome in 11 horses
Authors: Morgan Rhiannon E. , Fiske‐Jackson Andrew R. , Hellige Maren , Gerhauser Ingo , Wohlsein Peter , Biggi Marianna
Published: July 2019

Odontogenic tumors present as locally invasive, slow growing, firm swellings on the face. They are rare in all species and are characterized histologically by the degree of differentiation and dental tissue of origin. Radiographic appearance is not pathognomonic for these lesions. Computed tomographic (CT) examination allows exact determination of tumor extension and aggressiveness. The objectives of this retrospective, case series study were to describe the clinical presentation, CT characteristics, and outcome in horses with histologically confirmed odontogenic tumors, and to identify imaging features suggestive of individual types of tumors. Four ameloblastomas, two ameloblastic carcinomas, three ameloblastic fibromas, and two complex odontomas were included. All but one complex odontoma presented as a single mass. All tumors were associated with maxillary or mandibular bone expansion, alveolar and cortical bone lysis, and cortical bone thinning. The majority also had cortical bone thickening and periosteal proliferation. All tumors contained some degree of mineral attenuation, although only the complex odontomas contained enamel attenuation allowing differentiation from other types of odontogenic tumors in this study. Ameloblastomas were found to have variable CT characteristics likely due to the sub‐groups of ameloblastomas. Both ameloblastic carcinomas contained a mixture of mineralized and soft tissue attenuating material whereas ameloblastic fibromas were mainly composed of soft tissue attenuating material. Computed tomographic characteristics of odontogenic tumors generally indicate that they are expansile, aggressive tumors and can occur in a wide range of ages. Further investigation is needed to elucidate differences between each type of equine odontogenic tumor.
Automorphisms of graph products of groups from a geometric perspective
Authors: Genevois Anthony , Martin Alexandre
Published: July 2019

This article studies the structure of the automorphism groups of general graph products of groups. We give a complete characterisation of the automorphisms that preserve the set of conjugacy classes of vertex groups for arbitrary graph products. Under mild conditions on the underlying graph, this allows us to provide a simple set of generators for the automorphism groups of graph products of arbitrary groups. We also obtain information about the geometry of the automorphism groups of such graph products: lack of property (T) and acylindrical hyperbolicity.

The approach in this article is geometric and relies on the action of graph products of groups on certain complexes with a particularly rich combinatorial geometry. The first such complex is a particular Cayley graph of the graph product that has a quasi‐median geometry, a combinatorial geometry reminiscent of (but more general than) CAT(0) cube complexes. The second (strongly related) complex used is the Davis complex of the graph product, a CAT(0) cube complex that also has a structure of right‐angled building.
Competencias genéricas de los estudiantes de Auditoría requeridas por las Big Four en Chile
Authors: Araya Pizarro Sebastián Cristóbal  
Published: July 2019

Este artículo analiza las competencias genéricas más valoradas por las cuatro firmas líderes en el sector de la consultoría y auditoría del mundo: las Big Four, con el fin de evidenciar aquellas que deben ser potenciadas en los planes de formación de los estudiantes de contabilidad y auditoría en Chile. Para la recolección de datos se realizaron entrevistas personales a representantes de las empresas, además de la aplicación de cuestionarios a estudiantes que trabajaron en ellas y que fueron seleccionados mediante un muestreo no probabilístico intencional. Los resultados destacan las competencias sistémicas (capacidad de aplicar conocimientos en la práctica, capacidad de motivar, habilidad para trabajar de forma autónoma, capacidad de aprender y actualizarse continuamente), seguidas de competencias interpersonales (trabajo en equipo y habilidades interpersonales), y competencias instrumentales (conocimientos sobre la profesión y capacidad de resolver problemas). Se concluye la necesidad de configurar programas de formación que estimulen el desarrollo de las competencias genéricas deficitarias del estudiante en pro de su mejor inserción y desempeño profesional, bajo un contexto global, dinámico, competitivo y de mayor preocupación social.
Elementos de la confidencialidad en el ejercicio profesional del auditor
Authors: Ruza Wuilliam , Valderrama Yosman , Leal Enderson
Published: July 2019

La auditoría permite aumentar la confiabilidad de los estados financieros a través de la expresión de una opinión sobre si estos fueron preparados conforme al marco de referencia aplicable, para lo cual, el profesional debe actuar bajo principios éticos que garanticen la confidencialidad como relación cliente-auditor. En este artículo se describen los elementos de la confidencialidad presentes en el ejercicio profesional del auditor. Metodológicamente, el estudio se enmarcó en un enfoque cualitativo con un paradigma interpretativo, aplicando la entrevista estructurada como técnica y la guía de entrevista como instrumento de recolección de datos. La confidencialidad debe ser ejercida por el auditor bajo criterios de autonomía, respeto por los demás y confianza, apegándose a leyes y normativas que regulan la profesión, lo cual incidirá directamente en la percepción que pueda tener el entorno sobre el auditor como profesional que atiende el interés público.
Surface Quality and Contamination on Si Wafer Surfaces Sliced Using Wire-Electrical Discharge Machining
Authors: Joshi Kamlesh , Padhamnath Pradeep , Bhandarkar Upendra , Joshi Suhas S.
Published: July 2019

In the past, studies on wire-electrical discharge machining (EDM) of Si wafers have often focused on the effect of energy-related parameters on various wafer characteristics. However, comprehensive treatment on analyzing the effect of non-energy parameters of the Si wafer slicing process is not available thus far. This work, therefore, presents an extensive experimental work considering the parameters like wire tension (WT), wire feed rate (WF), and dielectric flushing pressure (WaP) on crucial wafer characteristics such as wafer-thickness and its uniformity, thermal damage, wire material contamination on wafer surfaces, and surface quality. A total of 72 experiments were performed at low and high servo voltage (SV) conditions. The sliced wafers were characterized by SEM, EDAX, and ICP-AES techniques. Ultrathin wafers with a uniform thickness of ∼107 µm were sliced at high SV conditions, while a lower thermal damage (∼10 µm) with low wire contamination was observed during low SV conditions. The percentage of contamination was further found to decrease with an increase in WT, WF, and WaP during low SV conditions. The wafer surface etching showed the diffusion of contaminates like Cu/Zn up to a depth of 25–30 µm. The wafer surface roughness in the middle section has always been observed to be poor due to short-circuiting and arcing within that zone.
Soft-Elastohydrodynamic Lubrication Line Contact Analysis on a Strip of Bio-Materials
Authors: Chen Qie-Da , Li Wang-Long
Published: July 2019

The characteristics of anisotropic material, finite deformation, and lubrication in biological system diminish the friction and wear between soft tissues with relative motion. In this research, the lubrication between pleura surfaces in relative motion is analyzed by soft elastohydrodynamic lubrication (soft-EHL) line contact with an equivalent model. The model is a soft, transversely isotropic (TI) elastic strip with finite thickness sliding under a rigid sinusoidal surface, which is used to simulate the surface irregularities, with lubricant in between. The material nonlinearity and the curvature effects due to finite deformation, which are significant in soft-EHL, are considered in the present study. The pressure distribution, film thickness, von Mises stress, and material deformation are analyzed and discussed under various combinations of elastic moduli and Poisson's ratios for the transversely isotropic models. The simulation results reveal that the soft-EHL modeling fit actual result better than the traditional EHL (t-EHL) modeling. The Poisson's ratio νp = 0.1 and νpz = 0.49 situation will have more gentle stress distribution. The present soft-EHL solver can be used to realize some desired stress distributions and to identify the mechanical properties bio-materials under the aids of experiments.
ACOUSTICAL STANDARDS NEWS
Authors: Mennigke Caryn , Struck Christopher J.
Published: July 2019

American National Standards (ANSI Standards) developed by Accredited Standards Committees S1, S2, S3, S3/SC 1, and S12 in the areas of acoustics, mechanical vibration and shock, bioacoustics, animal bioacoustics, and noise, respectively, are published by the Acoustical Society of America (ASA). In addition to these standards, ASA publishes a catalog of Acoustical American National Standards. To receive a copy of the latest Standards catalog, please contact Neil Stremmel.

Comments are welcomed on all material in Acoustical Standards News.

This Acoustical Standards News section in JASA, as well as the national catalog of Acoustical Standards and other information on the Standards Program of the Acoustical Society of America, are available via the ASA home page: http://acousticalsociety.org.
Slow growth determines nonheritable antibiotic resistance in
Salmonella enterica
Authors: Pontes Mauricio H. , Groisman Eduardo A.
Published: July 2019

Slow growth alone determines the persistence of
Salmonella
after antibiotic treatment.
TBAJ-876 Retains Bedaquiline’s Activity against Subunits c and ε of
Mycobacterium tuberculosis
F-ATP Synthase
Authors: Sarathy Jickky Palmae , Ragunathan Priya , Shin Joon , Cooper Christopher B. , Upton Anna M. , Grüber Gerhard , Dick Thomas
Published: July 2019

The antituberculosis drug bedaquiline (BDQ) inhibits
Mycobacterium tuberculosis
F-ATP synthase by interfering with two subunits. Drug binding to the c subunit stalls the rotation of the c ring, while binding to the ε subunit blocks coupling of c ring rotation to ATP synthesis at the catalytic α
3
:β
3
headpiece. BDQ is used for the treatment of drug-resistant tuberculosis.
Exebacase in Addition to Daptomycin Is More Active than Daptomycin or Exebacase Alone in Methicillin-Resistant Staphylococcus aureus Osteomyelitis in Rats
Authors: Karau Melissa J. , Schmidt-Malan Suzannah M. , Yan Qun , Greenwood-Quaintance Kerryl E. , Mandrekar Jayawant , Lehoux Dario , Schuch Raymond , Cassino Cara , Patel Robin
Published: July 2019

Bacteriophage-derived lysins are being developed as anti-infective agents. In an acute osteomyelitis methicillin-resistant
Staphylococcus aureus
(MRSA) model, rats receiving no treatment or treatment with daptomycin, exebacase (CF-301), or daptomycin plus exebacase had means of 5.13, 4.09, 4.65, and 3.57 log
10
CFU/gram of bone, respectively.
Efficacy and Safety of Pyronaridine-Artesunate plus Single-Dose Primaquine for the Treatment of Malaria in Western Cambodia
Authors: Leang Rithea , Khim Nimol , Chea Huch , Huy Rekol , Mairet-Khedim Melissa , Mey Bouth Denis , Dorina Bustos Maria , Ringwald Pascal , Witkowski Benoit
Published: July 2019

This single-arm trial (
n
 = 104) in western Cambodia showed high efficacy for 3-day treatment with pyronaridine-artesunate plus single-dose primaquine in
Plasmodium falciparum
malaria.
8-Aminoquinoline Therapy for Latent Malaria
Authors: Baird J. Kevin
Published: July 2019

The technical genesis and practice of 8-aminoquinoline therapy of latent malaria offer singular scientific, clinical, and public health insights. The 8-aminoquinolines brought revolutionary scientific discoveries, dogmatic practices, benign neglect, and, finally, enduring promise against endemic malaria.
Cracking a complex problem
Authors: Gough Joy
Published: July 2019

This is the second instalment in a four-part series documenting my journey to better understand, and improve the care of, complex paediatric patients.
Relationship between novel intraocular pressure measurement from Corvis ST and central corneal thickness and corneal hysteresis
Authors: Matsuura Masato , Murata Hiroshi , Fujino Yuri , Yanagisawa Mieko , Nakao Yoshitaka , Tokumo Kana , Nakakura Shunsuke , Kiuchi Yoshiaki , Asaoka Ryo
Published: July 2019

Aims

Corvis ST (CST) yields biomechanical corrected IOP (bIOP) which is purported to be less dependent on biomechanical properties. In our accompanied paper, it was suggested that the repeatability of bIOP is high. The purpose of the current study was to assess the relationship between intraocular pressure (IOP) measured with CST and central corneal thickness (CCT) and corneal hysteresis (CH), in comparison with IOP measured with Goldmann applanation tonometry (GAT) and the ocular response analyzer (ORA).

Methods

A total of 141 eyes from 141 subjects (35 healthy eyes and 106 glaucomatous eyes) underwent IOP measurements with GAT, CST and ORA. The relationships between IOP measurements (ORA-IOPg, ORA-IOPcc, CST-bIOP and GAT IOP) and biomechanical properties (CCT, CH and corneal resistance factor (CRF)) were analysed using the linear regression analysis.

Results

IOPg, IOPcc and GAT IOP were significantly associated with CCT (p<0.001), whereas bIOP was not significantly associated with CCT (p=0.19). IOPg, bIOP and GAT IOP were significantly associated with CH (IOPg: p<0.001; bIOP: p<0.001; GAT IOP: p=0.0054), whereas IOPcc was not significantly associated with CH (p=0.18). All of IOP records were associated with CRF (p<0.001).

Conclusion

The bIOP measurement from CST is independent from CCT, but dependent on CH and CRF.
False-negative malaria rapid diagnostic test results and their impact on community-based malaria surveys in sub-Saharan Africa
Authors: Watson Oliver J , Sumner Kelsey Marie , Janko Mark , Goel Varun , Winskill Peter , Slater Hannah C , Ghani Azra , Meshnick Steven R , Parr Jonathan B
Published: July 2019

Surveillance and diagnosis ofPlasmodium falciparummalaria relies predominantly on rapid diagnostic tests (RDT). However, false-negative (FN) RDT results are known to occur for a variety of reasons, including operator error, poor storage conditions,pfhrp2/3gene deletions, poor performance of specific RDT brands and lots, and low-parasite density infections. We used RDT and microscopy results from 85 000 children enrolled in Demographic Health Surveys and Malaria Indicator Surveys from 2009 to 2015 across 19 countries to explore the distribution of and risk factors for FN-RDTs in sub-Saharan Africa, where malaria’s impact is greatest. We sought to (1) identify spatial and demographic patterns of FN-RDT results, defined as a negative RDT but positive gold standard microscopy test, and (2) estimate the percentage of infections missed within community-based malaria surveys due to FN-RDT results. Across all studies, 19.9% (95% CI 19.0% to 20.9%) of microscopy-positive subjects were negative by RDT. The distribution of FN-RDT results was spatially heterogeneous. The variance in FN-RDT results was best explained by the prevalence of malaria, with an increase in FN-RDT results observed at lower transmission intensities, among younger subjects, and in urban areas. The observed proportion of FN-RDT results was not predicted by differences in RDT brand or lot performance alone. These findings characterise how the probability of detection by RDTs varies in different transmission settings and emphasise the need for careful interpretation of prevalence estimates based on surveys employing RDTs alone. Further studies are needed to characterise the cost-effectiveness of improved malaria diagnostics (eg, PCR or highly sensitive RDTs) in community-based surveys, especially in regions of low transmission intensity or high urbanicity.
Protocol for a prospective observational study on the association of variables obtained by contrast-enhanced ultrasonography and sepsis-associated acute kidney injury
Authors: Liu Ning , Zhang Zhongheng , Hong Yucai , Li Bing , Cai Huabo , Zhao Hui , Dai Junru , Liu Lian , Qian Xin , Jin Qicheng
Published: July 2019

Introduction

Sepsis commonly results in acute kidney injury (AKI), whereas about 50% of AKI cases are due to sepsis. Sepsis-associated acute kidney injury (SA-AKI) increases morbidity and mortality especially among critically ill patients. This study aims to monitor renal microcirculation perfusion during sepsis using contrast-enhanced ultrasonography (CEUS), and to explore whether CEUS is useful for predicting the development of SA-AKI.

Methods and analysis

This prospective observational study will enrol patients who were diagnosed with sepsis-3 definition. The total of septic or septic shock patients were stratified into AKI (including stages 1, 2 and 3) and non-AKI groups according to Kidney Disease Improving Global Outcomes criteria on days 0, 1, 2 and 7 after admission to the emergency intensive care unit, meanwhile, the CEUS technique will be performed to monitor renal microcirculation perfusion. A multivariable model including all CEUS variables were expected to create for predicting the development of AKI during sepsis. Ultrasonography results, demographic information, therapeutic interventions, survival outcomes, laboratory and other clinical datas will also be collected for further analysis.

Ethics and dissemination

The study protocol was approved on 2 August 2017 by the Ethics Committee of Sir Run Run Shaw Hospital (Zhejiang University Medical College) (approval number: 2016C91401). The results will be published in a peer-reviewed journal and shared with the worldwide medical community within 2 years after the start of the recruitment.

Trial registration number

ISRCTN14728986
Is there a relationship between female genital mutilation/cutting and fistula? A statistical analysis using cross-sectional data from Demographic and Health Surveys in 10 sub-Saharan Africa countries
Authors: Matanda Dennis Juma , Sripad Pooja , Ndwiga Charity
Published: July 2019

Objectives

Literature on associations between female genital mutilation/cutting (FGM/C) and fistula points to a common belief that FGM/C predisposes women to developing fistula. This study explores this association using nationally representative survey data.

Design

A secondary statistical analysis of cross-sectional data from Demographic and Health Surveys was conducted to explore the association between FGM/C and fistula.

Setting

Sub-Saharan Africa.

Participants

Women aged 15–49 years in Burkina Faso (n=17 087), Chad (n=17 719), Côte d’Ivoire (n=10 060), Ethiopia (n=14 070), Guinea (n=9142), Kenya (n=31 079), Mali (n=10 424), Nigeria (n=33 385), Senegal (n=15 688) and Sierra Leone (n=16 658).

Main outcome measures

Fistula symptoms.

Results

Multivariate logit modelling using pooled data from 10 countries showed that the odds of reporting fistula symptoms were 1.5 times (CI 1.06 to 2.21) higher for women whose genitals were cut and sewn closed than those who had undergone other types of FGM/C. Women who attended antenatal care (ANC) (adjusted odds ratio (AOR) 0.51, CI 0.36 to 0.71) and those who lived in urban areas (AOR 0.62, CI 0.44 to 0.89) were less likely to report fistula symptoms than those who did not attend ANC or lived in rural areas.

Conclusions

Severe forms of FGM/C (infibulation) may predispose women to fistula. Contextual and socioeconomic factors may increase the likelihood of fistula. Multisectoral interventions that concurrently address harmful traditional practices such as FGM/C and other contextual factors that drive the occurrence of fistula are warranted. Promotion of ANC utilisation could be a starting point in the prevention of fistulas.
Are socioeconomic inequalities in the incidence of small-for-gestational-age birth narrowing? Findings from a population-based cohort in the South of England
Authors: Wilding Sam , Ziauddeen Nida , Roderick Paul , Smith Dianna , Chase Debbie , Macklon Nick , McGrath Nuala , Hanson Mark , Alwan Nisreen A
Published: July 2019

Objectives

To investigate socioeconomic inequalities, using maternal educational attainment, maternal and partner employment status, and lone motherhood indicators, in the risk of small-for-gestational-age (SGA) births, their time trend, potential mediation by maternal smoking and body mass index, and effect modification by parity.

Design

Population-based birth cohort using routine antenatal healthcare data.

Setting

Babies born at University Hospital Southampton, UK, between 2004 and 2016.

Participants

65 909 singleton live births born to mothers aged ≥18 years between 24-week and 42-week gestation.

Main outcome measures

SGA (birth weight <10th percentile for others born at the same number of completed weeks compared with 2013/2014 within England and Wales).

Results

Babies born to mothers educated up to secondary school level (adjusted OR (aOR) 1.32, 99% CI 1.19 to 1.47), who were unemployed (aOR 1.27, 99% CI 1.16 to 1.38) or with unemployed partners (aOR 1.27, 99% CI 1.13 to 1.43), were at greater risk of being SGA. There was no statistically significant change in the magnitude of this risk difference by these indicators over time between 2004 and 2016, as estimated by linear interactions with year of birth. Babies born to lone mothers were not at higher risk compared with partnered mothers after adjusting for maternal smoking (aOR 1.05, 99% CI 0.93 to 1.20). The inverse association between maternal educational attainment and SGA risk appeared greater in multiparous (aOR 1.40, 99% CI 1.10 to 1.77) compared with primiparous women (aOR 1.28, 99% CI 1.12 to 1.47), and the reverse was true for maternal and partner’s unemployment where the association was stronger in primiparous women.

Conclusions

Socioeconomic inequalities in SGA risk by educational attainment and employment status are not narrowing over time, with differences in association strength by parity. The greater SGA risk in lone mothers was potentially explained by maternal smoking. Preventive interventions should target socially disadvantaged women, including preconception and postpartum smoking cessation to reduce SGA risk.
Readiness of public health facilities to provide quality maternal and newborn care across the state of Bihar, India: a cross-sectional study of district hospitals and primary health centres
Authors: Kaur Japneet , Franzen Samuel Richard Piers , Newton-Lewis Tom , Murphy Georgina
Published: July 2019

Introduction

Poor access to quality healthcare is one of the most important reasons of high maternal and neonatal mortality in India, particularly in poorer states like Bihar. India has implemented initiatives to promote institutional maternal deliveries. It is important to ensure that health facilities are adequately equipped and staffed to provide quality care for mothers and newborns.

Methods

We conducted a cross-sectional study of 190 primary health centres (PHCs) and 36 district hospitals (DHs) across all districts in Bihar to assess the readiness of facilities to provide quality maternal and neonatal care. Infrastructure, equipment and supplies and staffing were assessed using the WHO service availability and readiness assessment and Indian public health standard guidelines. Additionally, we used household survey data to assess the quality of care reported by mothers delivering at study facilities.

Results

PHCs and DHs were found to have 61% and 67% of the mandated structural components to provide maternal and neonatal care, on average, respectively. DHs were, on average, slightly better equipped in terms of infrastructure, equipment and supplies by comparison to PHCs. DHs were found to be inadequately prepared to provide neonatal care. Lack of recommended handwashing stations and bins at both DHs and PHCs suggested low levels of hygiene. Only half of the essential drugs were available in both DHs and PHCs. While no association was revealed between structural capacity and patient-reported quality of care, adequacy of staffing was positively associated with the quality of care in DHs.

Conclusion

Examining all DHs and a representative sample of PHCs in Bihar, this study revealed the gaps in structural components that need to be filled to provide quality care to mothers and newborns. Access to quality care is essential if progress in reducing maternal and neonatal mortality is to be achieved in this high-burden state.
Eye care delivery models to improve access to eye care for Indigenous people in high-income countries: protocol for a scoping review
Authors: Burn Helen , Black Joanna , Harwood Matire , Gordon Iris , Burnett Anthea M , Hamm Lisa Marie , Evans Jennifer , Ramke Jacqueline
Published: July 2019

Introduction

Globally, there are an estimated 370 million Indigenous people across 90 countries. Indigenous people experience worse health compared with non-Indigenous people, including higher rates of avoidable visual impairment. Countries such as Australia and Canada have service delivery models aimed at improving access to eye care for Indigenous people. We will conduct a scoping review to identify and summarise these service delivery models to improve access to eye care for Indigenous people in high-income countries.

Methods and analysis

An information specialist will conduct searches on MEDLINE, Embase and Global Health. All databases will be searched from their inception date with no language limits used. We will search the grey literature via websites of relevant government and service provider agencies. Field experts will be contacted to identify additional articles, and reference lists of relevant articles will be searched. All quantitative and qualitative study designs will be eligible if they describe a model of eye care service delivery aimed at Indigenous populations. Two reviewers will independently screen titles, abstracts and full-text articles; and complete data extraction. For each service delivery model, we will extract data on the context, inputs, outputs, Indigenous engagement and enabling health system functions. Where models were evaluated, we will extract details. We will summarise findings using descriptive statistics and thematic analysis.

Ethics and dissemination

Ethical approval is not required, as our review will include published and publicly accessible data. This review is part of a project to improve access to eye care services for Māori in Aotearoa New Zealand. The findings will be useful to policymakers, health service managers and clinicians responsible for eye care services in New Zealand, and other high-income countries with Indigenous populations. We will publish our findings in a peer-reviewed journal and develop an accessible summary of results for website posting and stakeholder meetings.
In primary care, is measuring free-thyroxine plus thyroid-stimulating hormone to detect hypopituitarism cost-effective? A cost utility analysis using Markov chain models
Authors: Shine Brian , James Tim , Adler Amanda
Published: July 2019

Objective

We examined whether it is cost-effective to measure free thyroxine (FT4) in addition to thyrotropin (thyroid-stimulating hormone (TSH)) on all requests for thyroid function tests from primary care on adult patients.

Background

Hypopituitarism occurs in about 4 people per 100 000 per year. Loss of thyrotropin (TSH) secretion may lead to secondary hypothyroidism with a low TSH and low FT4, and this pattern may help to diagnose hypopituitarism that might otherwise be missed.

Design

Markov model simulation.

Primary outcome measure

Incremental cost-effectiveness ratio (ICER), the ratio of cost in pounds to benefit in quality-adjusted life years of this strategy.

Results

The ICER for this strategy was £71 437. Factors with a large influence on the ICER were the utilities of the treated hypopituitary state, the likelihood of going to the general practitioner (GP) and of the GP recognising a hypopituitary patient. The ICER would be below £20 000 at a cost to the user of an FT4 measurement of £0.61.

Conclusion

With FT4 measurements at their present cost to the user, routine inclusion of FT4 in a thyroid hormone profile is not cost-effective.
Educational impact of assessment on medical students’ learning at Tehran University of Medical Sciences: a qualitative study
Authors: Kordestani Moghaddam Azadeh , Khankeh Hamid Reza , Shariati Mohammad , Norcini John , Jalili Mohammad
Published: July 2019

Objectives

It has been shown that assessment strongly affects students’ performance. A deeper insight needs to be gained into the interplay of assessment and learning. The aim of the current study was to develop a model to explain the educational impact of assessments on students’ learning, before, during and after the test.

Design

This study used semistructured interviews, focus group discussions and observation and collection of field notes. A qualitative methodology using the grounded theory data analysis approach was then used to generate an explanation of the process of how assessment impacts students’ learning.

Setting

School of Medicine, Tehran University of Medical Sciences.

Participants

Participants were medical students and teachers with first-hand experience or expertise in assessment as well as their willingness to participate in the study. Fifteen people (eight medical students, seven faculty members) were interviewed. One focus group discussion (with five students) was held.

Results

The extracted concepts from our study were classified into four main categories. These categories include elements of the assessment programme which affect learning, the mechanism through which they exert their effects, contextual factors and the impact they have on learning. These elements and their interplay occur within an environment with its antecedent characteristics.

Conclusions

This study suggested a model for understanding the elements of the assessment which, within the context, affect learning, the mechanisms through which they impart their effects and the final outcomes obtained.
The ageing surgeon: a qualitative study of expert opinions on assuring performance and supporting safe career transitions among older surgeons
Authors: Sherwood Rupert , Bismark Marie
Published: July 2019

Background

Unlike some other safety critical professions, there is no mandatory age of retirement for doctors, including surgeons. Medical regulators in Australia are implementing additional checks on doctors from the age of 70. We describe expert opinions on assuring performance and supporting career transitions among older surgeons.

Methods

In this qualitative study, experts in four countries were purposively selected for their expertise in surgical governance. Experts responded to interviews (Australia, New Zealand and UK) or a survey (Canada). A tiered framework of interventions was developed by integrating findings with previous literature and responsive regulation theory.

Results

52 experts participated. Participants valued the contribution of senior surgeons, while acknowledging that age-related changes can affect performance. Participants perceived that identity, relationships and finances influence retirement decisions. Experts were divided on the need for age-specific testing, with some favouring whole-of-career approaches to assuring safe care. A lack of validated tools for assessing performance of older surgeons was highlighted. Participants identified three options for addressing performance concerns—remediate, restrict or retire—and emphasised the need for co-ordinated and timely responses.

Conclusion

Experts perceive the need for a staged approach to assessing the performance of older surgeons and tailoring interventions. Most older surgeons are seen to make decisions around career transitions with self-awareness and concern for patient safety. Some older surgeons may benefit from additional guidance and support from employers and professional colleges. A few poorly performing older surgeons, who are recalcitrant or lack insight, require regulatory action to protect patient safety. Developing robust processes to assess performance, remediate deficits and adjust scopes of practice could help to support safe career transitions at any age.
An exploratory study considering the potential impacts of high-fidelity simulation based education on self-evaluated confidence of non-respiratory physiotherapists providing an on-call respiratory physiotherapy service: a mixed methods study
Authors: Mansell Stephanie K , Harvey Alex , Thomas Amanda
Published: July 2019

Introduction

Physiotherapists working on-call to provide emergency respiratory services report stress and lack of confidence in on-call scenarios. Simulation-based education (SBE) is a potential solution to improve confidence and reduce stress of on-call physiotherapists. In physiotherapy, use of SBE is sporadic. The aim of this study was to evaluate the addition of SBE to an on-call training programme on non-respiratory physiotherapists’ self-evaluated confidence. Additionally, the study aimed to evaluate if SBE facilitates identification of learning needs.

Methods

This cohort study took a mixed methods approach. Participants were recruited from staff providing on-call respiratory physiotherapy services at a UK hospital. Participants received traditional on-call training over 1 year, with SBE added the subsequent year, in a pre-post analysis design. Self-evaluated confidence was assessed with the Association of Chartered Physiotherapists in Respiratory Care Acute Respiratory/On-call Physiotherapy Self-evaluation of Competence (ACPRC) questionnaire. Two focus groups were conducted post-SBE.

Results

There were 10 participants. Thematic analysis of focus groups indicated participants found SBE provided coping strategies for on-call working. Using coping strategies taught in SBE reduced stress levels and increased confidence of non-specialist on-call physiotherapists. ACPRC questionnaire scores significantly improved following the addition of SBE (median change 5.5%, p=0.034, r=0.57). SBE assisted in identification of learning needs through recognition of unconscious incompetence and reinforcement of conscious and unconscious competence.

Conclusions

SBE may improve self-evaluated confidence of non-specialist on-call physiotherapists. SBE assists in learning needs identification. SBE could enhance training of physiotherapists providing on-call respiratory services. Further larger trials investigating optimal methods of on-call physiotherapy postgraduate education are warranted.
Estranged relations: coercion and care in narratives of supported decision-making in mental healthcare
Authors: Stone Meredith , Kokanovic Renata , Callard Felicity , Broom Alex F
Published: July 2019

Supported decision-making has become popular among policymakers and mental health advocates as a means of reducing coercion in mental healthcare. Nevertheless, users of psychiatric services often seem equivocal about the value of supported decision-making initiatives. In this paper we explore why such initiatives might be rejected or ignored by the would-be beneficiaries, and we reflect on broader implications for care and coercion. We take a critical medical humanities approach, particularly through the lens of entanglement. We analyse the narratives of 29 people diagnosed with mental illness, and 29 self-identified carers speaking of their experiences of an Australian mental healthcare system and of their views of supported decision-making. As a scaffolding for our critique we consider two supported decision-making instruments in the 2014 Victorian Mental Health Act: the advance statement and the nominated person. These instruments presuppose that patients and carers endorse a particular set of relationships between the agentic self and illness, as well as between patient, carer and the healthcare system. Our participant narratives instead conveyed ‘entangled’ relations, which we explore in three sections. In the first we show how ideas about fault and illness often coexisted, which corresponded with shifting views on the need for more versuslessagency for patients. In the second section, we illustrate how family carers struggled to embody the supported decision-making ideal of the independent yet altruistic nominated person, and in the final section we suggest that both care and coercion were narrated as existing across informal/formal care divisions. We conclude by reflecting on how these dynamic relations complicate supported decision-making projects, and prompt a rethink of how care and coercion unfold in contemporary mental healthcare.