bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing the ease of conversation in multi-group conversation spaces: Effect of background music volume on acoustic comfort in a café
Authors: Maruyama Naoya , Hiraguri Yasuhiro , Kawai Keiji , Ueda Mari
Published: January 2020

A “multi-group conversation space” refers to a space, such as restaurant or café, where more than one group of people share a space and make conversation within their respective group. From a field experiment in an actual café, we investigated the acoustic comfort in a multi-group conversation space considering speech intelligibility and speech privacy as major factors. In the experiment, noise measurements and a questionnaire survey taken by customers were conducted for 4 days. We were able to change the volume of the background music during operating hours, setting the level on each of the 4 days to low, mid, high, and none. Indoor noise levels were measured at six representative points with six sound level meters hung from the ceiling. The questionnaire consisted of eight items for subjective evaluation, including ease of conversation, comfort, and room atmosphere. After having their meal or drinks, the customers were asked to fill in the questionnaire at their table. The occupancy of neighboring tables and the number of customers in the café were also recorded. Results show that (1) overall, the respondents evaluated the café space positively; (2) high background music volume levels together with occupied neighboring tables tended to elicit negative evaluations; and (3) customer clustering analysis identified certain influences of distance from loudspeakers, neighboring table occupancy, and personal characteristics.
Heterogeneous effects of visa exemption policy on international tourist arrivals: Evidence from Indonesia
Authors: Yudhistira Muhammad Halley , Sofiyandi Yusuf , Indriyani Witri , Pratama Andhika Putra
Published: January 2020

We examined the potential heterogeneous impact of implementing a series of visa exemption policies on foreign tourist arrivals in Indonesia by exploiting a rich data set of monthly series of foreign tourist arrivals, by country and by port of entry between January 2014 and December 2018. This is the first study in providing empirical evidence of the heterogeneous impact of a country’s visa exemption policy across tourist’s origins and within-country destinations. Using a panel data approach, our estimates showed that while the policy increased monthly foreign tourist arrivals by 5% on average, the effect was evident for less-traditional destinations only. The policy also potentially provided a diversion effect between destinations, such that it created an adverse effect on the traditional destinations of Indonesia. Our estimates also suggest a heterogeneous impact between origins at the continent level, and an 8% higher impact per year after the policy’s introduction, which was relatively lower than has been found in other studies. The findings imply that the visa exemption policy is not a one-size-fits-all policy in attracting international tourist arrivals.
Happy Christmases are All Alike; Each Unhappy Christmas is Unhappy in its Own Way
Authors: Blanchet Vivien
Published: January 2020

The French postal service has been opening a bureau for Father Christmas every winter since 1962. Sixty employees are responsible for responding to letters to Father Christmas. In 2018, more than one million children corresponded with him. But what would happen if someone were to write to Father Christmas, developing a close epistolary relationship with him? This short story explores such a scenario. Pierre M. and Father Christmas have during many years maintained regular and personal correspondence. Yet Father Christmas’s attitude seems to have changed. Pierre M. reveals the evolution of their secret relationship to his mysterious friend. On substance, the short story offers an original perspective on modern marketplace mythologies. Previous studies depict myths as liminal spaces in which people negotiate contradictory meanings, practices and realities. The myth of Father Christmas thus involves compromises between ignorance and knowledge, life and death, the sacred and the profane. The short story tells how they evolve to define the identity of the protagonists and the world they live in. It highlights how they are embodied in hybrid artefacts like letters to Father Christmas and extraordinary servicescape. The short story also questions the performative force of the myth. It shows that it results from the interpretative work and ritual practices of the protagonists involved in an unstable actantial system structured around an enlightened person, an ignorant person and a mythical character. This is constantly negotiated throughout sociotechnical interactions, which, as in the case of witchcraft, may or may not realize the myth. On form, the short story adopts the principle of the eternal return inherent to the myth: it is plotted as a series of small variations on recurring themes and structural repetitions. Intertextual references to academic publications, literary tradition and popular culture enrich the narrative by extending it beyond its textual boundaries.
Separation characterized by responsibility and guilt: Family caregivers’ experiences with palliative care for a close family member with severe dementia in long-term care facilities
Authors: Midtbust May H , Alnes Rigmor E , Gjengedal Eva , Lykkeslet Else
Published: January 2020

Aim and objectives

The aim of this study was to explore family caregivers’ experiences with palliative care for a close family member with severe dementia in long-term care facilities.

Background

Dementia not only affects individuals but also affects and changes the lives of close family members. An increasing number of dementia-related deaths occur in long-term care facilities; therefore, it is critical to understand how healthcare professionals support and care for residents with dementia and their families at the end of life.

Design

A qualitative design with a phenomenological approach was adopted.

Methods

In-depth interviews were performed with 10 family caregivers of residents in 3 Norwegian long-term care facilities.

Results

The family caregivers’ experiences with palliative care for a close family member with severe dementia in long-term care facilities were characterized by responsibility and guilt. Admission to a long-term care facility became a painful relief for the family caregivers due to their experiences with the poor quality of palliative care provided. The lack of meaningful activities and unsatisfactory pain relief enhanced the feelings of responsibility and guilt among the family caregivers. Despite the feelings of insecurity regarding the treatment and care given during the early phase of the stay, the family caregivers observed that their close family member received high-quality palliative care during the terminal phase. The family caregivers wanted to be involved in the care and treatment, but some felt that it became a heavy responsibility to participate in ethical decision-making concerning life-prolonging treatment.

Conclusions

The family caregivers experienced ongoing responsibility for their close family members due to painful experiences with the poor quality of the palliative care provided. When their expectations regarding the quality of care were not met, the palliative care that was offered increased their feeling of guilt in an already high-pressure situation characterized by mistrust.
An empirical approach to the study of legal socialization in adolescence
Authors: Baz Cores Olalla , Fernández-Molina Esther
Published: January 2020

Considering research on juvenile delinquency more broadly, few studies have examined the legal socialization process whereby adolescents come to accept legal authority and comply with the law as a result of the interaction with informal and formal socializing agents. Police legitimacy is an important dimension of legal socialization, because the police are the visible face of the legal system and contribute to the internalization of norms and values in society. Therefore, this article aims to analyse police legitimacy perceptions as an element of the legal socialization process in Spain among a subsample of 2041 youths aged from 13 to 18 from the Third International Self-Report Delinquency Study (ISRD-3). The results using structural equation modelling reveal that adolescents who perceive the police as a legitimate institution commit fewer criminal offences. Additionally, police legitimacy perceptions mediate the association of parental monitoring, school attachment and procedural justice of the police with juvenile delinquency. Other explanations for juvenile delinquency are discussed from a legal socialization perspective.
Identifying Core Variables Associated With Health Literacy in Kidney Transplant Recipients
Authors: Dahl Kari Gire , Andersen Marit Helen , Urstad Kristin Hjorthaug , Falk Ragnhild S. , Engebretsen Eivind , Wahl Astrid Klopstad
Published: January 2020

Background:

A kidney transplantation requires complex self-care skills and adequate follow-up from health-care providers. Identifying strengths and limitations in different aspects of health literacy (HL) and associated variables are central to being able to improve health care. The objective of this study was to identify core variables associated with independent domains of HL 8 weeks following a kidney transplantation.

Methods:

A single-center cross-sectional study was conducted, wherein 159 kidney transplant recipients answered the Health Literacy Questionnaire (HLQ). Multivariable linear regression with backward elimination was used to investigate variables possibly associated with the 9 domains of HL.

Results:

The transplant recipients had the lowest scores in “appraisal of health information” and “navigating the healthcare system.” The highest scores were found in “feeling understood and supported by health-care providers” and “ability to actively engage with health-care provider.” General perceived self-efficacy, transplant-specific knowledge, and general health were the driving variables in several of the HL domains.

Conclusions:

The HLQ provides a more complex picture of strengths and limitations related to HL, as well as important knowledge about vulnerable groups following a kidney transplantation. The study offers an important supplement to the field of HL in kidney transplant care.
Mobile terminal identity authentication system based on behavioral characteristics
Authors: Liang Xiaoshi , Zou Futai , Li Linsen , Yi Ping
Published: January 2020

We propose a new type of authentication system based on behavioral characteristics for smartphone users. With the sensor and touch screen data in the smartphone, the combination of the motion state detection mode and the authentication mode can effectively distinguish between legitimate smartphone users and other users. The system deploys software on the smartphone to collect data from sensors and touch screens, and upload the data to the cloud. We apply random forest algorithm on the data to extract features and achieve motion state detection. Multilayer perceptron algorithm is used for user authentication in corresponding motion state. The system effectively implements an implicit and continuous authentication mode, which can achieve user identity authentication without users’ being aware of it. The system proposed in this article can achieve 95.96% accuracy with false rejection rate of 2.55% and false acceptance rate of 6.94%.
“Whose Liability Is It Anyway?” Cultivating an Inclusive College Climate for Autistic LGBTQ Students
Authors: Nachman Brett Ranon , Miller Ryan A. , Vallejo Peña Edlyn
Published: January 2020

With one in 59 children diagnosed with autism, higher education institutions are experiencing increasing enrollments of autistic students. Furthermore, autistic students are disproportionately more likely to identify as gay and lesbian in their sexual orientation and as transgender or genderqueer in their gender identity compared with nondisabled peers. This case study challenges readers to consider the role that educational leaders can play in addressing the complexities of supporting a student named Erik, a gay, autistic student who is considering “coming out.” Readers are also challenged to consider implications about addressing campus climate issues for students with multiple, intersecting identities.
Indigenizing the Doctoral Experience to Build Indigenous Community Leaders in Educational Leadership
Authors: Minthorn Robin Starr Zape-tah-hol-ah
Published: January 2020

In this case, readers will learn how the University of New Mexico educational leadership program intentionally created a doctoral cohort that is Indigenous based and focused that included Indigenous and tribal community narrative and feedback in its development. The NALE doctoral cohort program included these same communities as sites for reciprocation and centering community in many of the courses offered. Instead of community being an afterthought, there was intentional inclusion in all aspects of honoring and including Indigenous community as the center to build Indigenous educational leaders who are also community leaders and advocates.
Offering Payment in Clinical Research: Enrolling Individuals With or at Risk for Opioid Use Disorder
Authors: Wickliffe Candace , Lynch Holly Fernandez , Largent Emily A.
Published: January 2020

Offering payment is an important means of facilitating research participation. Yet, offers of payment raise ethical challenges that may be heightened when prospective participants suffer from or are at risk for opioid use disorder (OUD). We surveyed principal investigators (PIs) conducting research in this population to characterize the relative importance they assign to various ethical and practical factors when designing offers of payment and also analyzed descriptions of payment in both their study advertisements and consent forms. Overall, we found that, despite literature suggesting heightened ethical concerns for this population, practical factors related to payment were more influential for PIs than either ethical factors or factors unique to individuals with or at risk for OUD. Our findings can help inform the development of ethical, effective recruitment and retention strategies for research in this population.
Egyptian journalists and the struggle for change following the 2011 uprising: The ambiguous journalistic agency between change and conformity
Authors: Issawi Fatima el
Published: January 2020

The Egyptian media displayed a high level of content diversity in the final years of the Mubarak regime, prior to the 2011 uprising. This diversity expanded considerably after the uprising when national media embodied expressions of dissent with unprecedented openness, in defiance of the entrenched identity of the journalist as the regime’s guard. This article investigates the dynamics of journalistic agency in Egyptian newsrooms in search for a new identity, investigating the challenges, hopes and trade-offs of a painful process of change. It looks at the complex interplay between these agentic dynamics and inherited structures within an uncertain and highly contested transition to democracy, which finally collapsed into a new chapter of authoritarianism. The article argues that while journalistic agency helped support trends towards democratization in media and politics in the immediate aftermath of the uprising, it also acted as powerful platform in ‘othering’ opponents preparing the ground for the return of autocratic practices and ultimately the fall of the democratic experiment.
Determining the Correlation Between Lateral Radiograph Morphology and the Outcome Following Surgically Treated Intra-Articular Calcaneal Fractures
Authors: Nooijen Lynn E. , Spierings Kimberley E. , Sanders Fay R. K. , Dingemans Siem A. , Halm Jens A. , Schepers Tim
Published: January 2020

Purpose. It is currently still common practice to obtain conventional radiographs in the follow-up of surgically treated displaced intra-articular calcaneal fractures at regular intervals. There is, however, insufficient evidence that these radiographs can be used to predict functional outcome. The aim of the current study was to evaluate the correlation between the most commonly used angles on lateral radiographs and disease-specific patient-reported outcome measures (PROMs). Methods. Two available databases, containing a total of 233 patients, were used in this study. Eleven angles on the lateral images of the preoperative and at 1-year follow-up radiographs were measured. The 6 most commonly used angles were also measured immediately postoperatively. These 6 most commonly used angles were correlated with PROMs (American Orthopaedic Foot and Ankle Society hindfoot score, Foot Function Index) by a Spearman’s rho analysis. After a Bonferroni correction was applied, a P value of <.0042 was considered to be statistically significant. Results. After exclusion of bilateral fractures, primary arthrodesis, open fractures, wound infections, other wound complications, nonavailable radiographs, and nonresponders, 86 patients remained. No significant correlations were found between the measured angles on the preoperative and at 1-year follow-up radiographs and the PROMs. Conclusion. No apparent correlation between lateral radiograph morphology and outcome was detected. Therefore, long-term follow-up radiographs after confirmed healing may be restricted to patients with persistent complaints on indication.

Levels of Evidence: Prognostic, Level IV: Retrospective
Hyponatremia in the Neurologically Ill Patient: A Review
Authors: Lerner David P. , Shepherd Starane A. , Batra Ayush
Published: January 2020

Hyponatremia is a well-known disorder commonly faced by clinicians managing neurologically ill patients. Neurological disorders are often associated with hyponatremia during their acute presentation and can be associated with specific neurologic etiologies and symptoms. Patients may present with hyponatremia with traumatic brain injury, develop hyponatremia subacutely following aneurysmal subarachnoid hemorrhage, or may manifest with seizures due to hyponatremia itself. Clinicians caring for the neurologically ill patient should be well versed in identifying these early signs, symptoms, and etiologies of hyponatremia. Early diagnosis and treatment can potentially avoid neurologic and systemic complications in these patients and improve outcomes. This review focuses on the causes and findings of hyponatremia in the neurologically ill patient and discusses the pathophysiology, diagnoses, and treatment strategies for commonly encountered etiologies.
Bring School Nursing Out of the Shadows: Advocacy for the Future of Nursing 2030
Authors: Johnson Kathleen
Published: January 2020

School nursing is part of America’s hidden healthcare system. Recently, the Institute of Medicine commissioned the Robert Wood Johnson Foundation and the AARP (formerly the American Association of Retired Persons) to review progress on its Future of Nursing 2010 study. Additionally, the AARP and the Future of Nursing Campaign for Action held town halls that focused on school nursing. This article is a summary of the testimony offered to the Future of Nursing and Campaign for Action leaders about the value that school nursing brings to the health of our nation and the recommendations for action.
Lack of long‐term follow‐up after paediatric‐adult transition in coeliac disease is not associated with complications, ongoing symptoms or dietary adherence
Authors: Kivelä Laura , Hekkala Sointu , Huhtala Heini , Kaukinen Katri , Kurppa Kalle
Published: January 2020

Background

Follow‐up of coeliac disease is recommended to prevent complications associated with unsuccessful treatment.

Objective

The objective of this article is to evaluate the implementation and significance of long‐term follow‐up.

Methods

Medical data were collected from 585 and follow‐up questionnaires sent to 559 current adult coeliac disease patients diagnosed in childhood. Diagnostic features and adulthood health outcomes were compared between those with and without adulthood follow‐up.

Results

Of paediatric patients, 92% were followed up 6–24 months after diagnosis. A total of 235 adults responded to the questionnaires a median of 18 years after diagnosis, and 25% of them reported regular follow‐up. They were diagnosed more recently than those without follow‐up (median year 2001 vs 1995, p  = 0.001), being otherwise comparable at diagnosis. Those with follow‐up were less often smokers (5% vs 16%, p  = 0.042) and relatives of coeliac patients (48% vs 66%, p  = 0.018), and more often students (48% vs 28%, p  = 0.005) and type 1 diabetics (19% vs 4%, p  = 0.001). Lack of follow‐up was not associated with complications, ongoing symptoms, poorer general health or dietary adherence. All completely non‐adherent patients were without follow‐up.

Conclusions

Most coeliac disease patients diagnosed in childhood were not followed up according to recommendations in adulthood. The individual effect of this on long‐term treatment outcomes varied markedly.
Toxocara infection in the differential diagnosis of multiple sclerosis in the Middle East
Authors: Baalbaki Marwa , El Najjar Mayssam , Atweh Samir , El Ayoubi Nabil K.
Published: January 2020

A critical step in the diagnosis of multiple sclerosis is to rule out a heterogeneous variety of multiple sclerosis mimickers, which is crucial in the era of powerful immune-modulator treatments. In this review, we discuss the background of toxocariasis in general, present central nervous system Toxocara infection as one of the multiple sclerosis mimickers in the Middle East, and share our experience about the diagnosis and management of this condition. This entity seems very relevant in a region such as the Middle East, where displacement of populations and conflict can result in non-hygienic food and water management bundles. The diagnosis should be entertained, especially when assessing patients with myelopathy. The presence of a single lesion in the spinal cord with inflammatory features should prompt serological testing for Toxocara IgG and IgM in serum and the cerebrospinal fluid. This infection is treatable, with the regimen of high-dose albendazole being one of the most accepted treatments. Although most cases exhibit a good prognosis, some have residual deficits localized to the affected spinal cord level.
Multiple sclerosis and human leukocyte antigen genotypes: Focus on the Middle East and North Africa region
Authors: Maghbooli Zhila , Sahraian Mohammad Ali , Naser Moghadasi Abdorreza
Published: January 2020

Recent reports have demonstrated that the prevalence of multiple sclerosis (MS) is increasing in the Middle East and North Africa region. There is also emerging evidence regarding the genetic components of MS risk. This review provides an overview of the role of genetic factors in MS susceptibility by examining human leukocyte antigen loci in patients within the Middle East and North Africa region. Most of the genetic studies conducted in the Middle East and North Africa region have been based on case–control designs, which cannot confirm direct causality of genetic variants on MS susceptibility. Moreover, there are very limited and inconsistent studies on human leukocyte antigen class I and II (DQA and DQB) in MS patients of the Middle East and North Africa region. To identify common risk haplotypes in the Middle East and North Africa region or its sub-populations, further longitudinal studies will be required.
Diaper Dermatitis: Prevalence and Associated Factors in 2 University Daycare Centers
Authors: Suebsarakam Porntipa , Chaiyarit Jitjira , Techasatian Leelawadee
Published: January 2020

Purpose: Diaper dermatitis is uncommon in children older than 2 years because the majority of these children are diaper independent. However, diaper dermatitis still occurs, especially in children in daycare settings. This study attempted to determine the prevalence of diaper dermatitis and its associated factors among children aged 2 to 4 years attending daycare centers. Cross-sectional analysis and tests for correlation were conducted to determine the factors associated with diaper dermatitis among the study population. Results: The prevalence of diaper dermatitis during the study period was 17.2%. Factors significantly correlated with the occurrence of diaper dermatitis were beginning toilet training later than 2 years of age (odds ratio [OR] = 2.84, 95% CI = 1.17-6.86, P = .02) and the use of oral antibiotics (OR = 15.92, 95%CI = 3.57-70.94, P < .001). Conclusion: Two major adjustable factors for preventing diaper dermatitis in the study population were toilet training before 2 years of age and avoiding the use of unnecessary oral antibiotics. These results may help in devising a preventive protocol for diaper dermatitis among this age group in the future.
Is Urbanization Good for the Climate? A Cross-County Analysis of Impervious Surface, Affluence, and the Carbon Intensity of Well-Being
Authors: Greiner Patrick Trent , Shtob Daniel A. , Besek Jordan Fox
Published: January 2020

We contribute to literature exploring the socioecological impact of urban development as a multidimensional project, one in which changes to landscape features complement changes in demographic and administrative measures to co-constitute the socioecological impact of urbanity. We use a random coefficients modeling approach to examine U.S. relationships between the intensity of impervious surface within a county, population density in impervious areas, and carbon intensity of well-being (CIWB)—here constructed using industrial emissions. We then explore the moderating association that another component of social settlement patterns, household median income, has on the impervious surface–population density–CIWB nexus. Findings suggest that landscapes featuring greater development of impervious surface are associated with increased CIWB. Further exploration indicates that income acts to attenuate the association of urban space and CIWB. Ultimately, we argue that such attenuation indicates that more affluent areas are able to shift production-based processes associated with urban forms to less affluent areas.
Dual Embeddedness and Entrepreneurial Activities of Second-Generation Ethnic Entrepreneurs: Multiple Case Studies with Vietnamese Entrepreneurs in Germany
Authors: Dang Cat-My , Harima Aki
Published: January 2020

This article explores mutual relationships between embeddedness and second-generation ethnic entrepreneurs. We apply an exploratory and inductive qualitative research design to investigate how a dual embeddedness of second-generation immigrants in the ethnic community and in mainstream society influence their entrepreneurial activities and vice versa. Based on multiple cases studies of Vietnamese second-generation ethnic entrepreneurs, we identify four causal relations between embeddedness and entrepreneurial activities: (a) resource mobilisation; (b) formation of entrepreneurial motivation; (c) feedback effect on embeddedness and (d) re-formation of dual identity. This research contributes to the research on ethnic entrepreneurship by showing novel causalities between socio-psychological factors and entrepreneurial activities of second-generation entrepreneurs.
Shortest paths, travel costs, and traffic
Authors: Cui Mengying , Levinson David
Published: January 2020

This study examines path flows for road networks. Path flows sum individual route choices from individual travelers, associated with specific path objective. We estimate these flows for each cost factor of auto travel: time, safety, emission, and monetary costs, as well as their composite, internal and full cost of travel. For each factor, we find the route with the minimum cumulative cost. We further explore the extent to which each cost factor contributes to explaining the observed link traffic flows given an estimated home-to-work demand pattern. The results of the Minneapolis – St. Paul metropolitan area indicate that flows from multiple path types, associated with different internal cost components, along with distance, provide the best fit.
Quantitative analysis of optical coherence tomography angiography metrics in diabetic retinopathy
Authors: Safi Hamid , Anvari Pasha , Naseri Dariush , Shenazandi Hamideh , Kazemi Pegah , Farsi Pirouzeh , Jafari Sanaz , Sedaghat Ahad , Yaseri Mehdi , Ghasemi Falavarjani Khalil
Published: January 2020

Purpose:

To evaluate the correlation of the visual acuity and diabetic retinopathy stage using optical coherence tomography and optical coherence tomography angiography metrics.

Methods:

In this prospective study, optical coherence tomography and optical coherence tomography angiography images of patients with different stages of diabetic retinopathy were obtained. In optical coherence tomography angiography images, the size of foveal avascular zone, central macular thickness, and vessel density at superficial and deep capillary layers of the macula were measured. In optical coherence tomography images, the presence of intraretinal cyst, disorganization of retinal inner layer, and ellipsoid zone and external limiting membrane disruption were evaluated. The associations between the variables with visual acuity and diabetic retinopathy stage were analyzed.

Results:

In total, 68 eyes of 38 patients with a mean age of 58.96 ± 10.59 years were included. In total, 34 eyes were categorized as non-proliferative diabetic retinopathy, 14 as active, and 20 as regressed proliferative diabetic retinopathy. Univariate analysis showed deep parafoveal vessel density, central macular thickness, ellipsoid zone disruption, disorganization of retinal inner layer, and external limiting membrane disruption had a significant relationship with visual acuity. However, in multivariate analysis, only central macular thickness and ellipsoid zone disruption had significant association with visual acuity ( p = 0.02 and p = 0.01, respectively). There was a significant difference in deep parafoveal vessel density ( p = 0.04), but not in foveal avascular zone area, between different stages of diabetic retinopathy.

Conclusion:

In this study, the foveal avascular zone area did not correlate with visual acuity and different stages of diabetic retinopathy. Structural abnormalities on optical coherence tomography images with especial focus on outer retinal disruption provided more reliable predictors for visual acuity outcomes in patients with diabetic retinopathy.
The pan-genome of Treponema pallidum reveals differences in genome plasticity between subspecies related to venereal and non-venereal syphilis
Authors: Jaiswal Arun Kumar , Tiwari Sandeep , Jamal Syed Babar , de Castro Oliveira Letícia , Alves Leandro Gomes , Azevedo Vasco , Ghosh Preetam , Oliveira Carlo Jose Freira , Soares Siomar C.
Published: January 2020

Background

Spirochetal organisms of the Treponema genus are responsible for causing Treponematoses. Pathogenic treponemes is a Gram-negative, motile, spirochete pathogen that causes syphilis in human. Treponema pallidum subsp. endemicum (TEN) causes endemic syphilis (bejel); T. pallidum subsp. pallidum (TPA) causes venereal syphilis; T. pallidum subsp. pertenue (TPE) causes yaws; and T. pallidum subsp. Ccarateum causes pinta. Out of these four high morbidity diseases, venereal syphilis is mediated by sexual contact; the other three diseases are transmitted by close personal contact. The global distribution of syphilis is alarming and there is an increasing need of proper treatment and preventive measures. Unfortunately, effective measures are limited.

Results

Here, the genome sequences of 53 T. pallidum strains isolated from different parts of the world and a diverse range of hosts were comparatively analysed using pan-genomic strategy. Phylogenomic, pan-genomic, core genomic and singleton analysis disclosed the close connection among all strains of the pathogen T. pallidum, its clonal behaviour and showed increases in the sizes of the pan-genome. Based on the genome plasticity analysis of the subsets containing the subspecies T pallidum subsp. pallidum, T. pallidum subsp. endemicum and T. pallidum subsp. pertenue, we found differences in the presence/absence of pathogenicity islands (PAIs) and genomic islands (GIs) on subsp.-based study.

Conclusions

In summary, we identified four pathogenicity islands (PAIs), eight genomic islands (GIs) in subsp. pallidum, whereas subsp. endemicum has three PAIs and seven GIs and subsp. pertenue harbours three PAIs and eight GIs. Concerning the presence of genes in PAIs and GIs, we found some genes related to lipid and amino acid biosynthesis that were only present in the subsp. of T. pallidum, compared to T. pallidum subsp. endemicum and T. pallidum subsp. pertenue.
Validity and bias on the online active Australia survey: activity level and participant factors associated with self-report bias
Authors: Curtis Rachel G. , Olds Timothy , Plotnikoff Ronald , Vandelanotte Corneel , Edney Sarah , Ryan Jillian , Maher Carol
Published: January 2020

Background

This study examined the criterion validity of the online Active Australia Survey, using accelerometry as the criterion, and whether self-report bias was related to level of activity, age, sex, education, body mass index and health-related quality of life.

Methods

The online Active Australia Survey was validated against the GENEActiv accelerometer as a direct measure of activity. Participants (n = 344) wore an accelerometer for 7 days, completed the Active Australia Survey, and reported their health and demographic characteristics. A Spearman’s rank coefficient examined the association between minutes of moderate-to-vigorous physical activity recorded on the Active Australia Survey and GENEActiv accelerometer. A Bland-Altman plot illustrated self-report bias (the difference between methods). Linear mixed effects modelling was used to examine whether participant factors predicted self-report bias.

Results

The association between moderate-to-vigorous physical activity reported on the online Active Australia Survey and accelerometer was significant (rs = .27, p < .001). Participants reported 4 fewer minutes per day on the Active Australia Survey than was recorded by accelerometry (95% limits of agreement −104 – 96 min) but the difference was not significant (t(343) = −1.40, p = .16). Self-report bias was negatively associated with minutes of accelerometer-recorded moderate-to-vigorous physical activity and positively associated with mental health-related quality of life.

Conclusions

The online Active Australia Survey showed limited criterion validity against accelerometry. Self-report bias was related to activity level and mental health-related quality of life. Caution is recommended when interpreting studies using the online Active Australia Survey.
Treatment outcomes of patients with chronic hepatitis C receiving sofosbuvir-based combination therapy within national hepatitis C elimination program in the country of Georgia
Authors: Tsertsvadze Tengiz , Gamkrelidze Amiran , Nasrullah Muazzam , Sharvadze Lali , Morgan Juliette , Shadaker Shaun , Gvinjilia Lia , Butsashvili Maia , Metreveli David , Kerashvili Vakhtang , Ezugbaia Marina , Chkhartishvili Nikoloz , Abutidze Akaki , Kvaratskhelia Valeri , Averhoff Francisco
Published: January 2020

Background

Georgia has one of the highest HCV prevalence in the world and launched the world’s first national HCV elimination programs in 2015. Georgia set the ambitious target of diagnosing 90% of people living with HCV, treating 95% of those diagnosed and curing 95% of treated patients by 2020. We report outcomes of Sofosbuvir (SOF) based treatment regimens in patients with chronic HCV infection in Georgia.

Methods

Patients with cirrhosis, advanced liver fibrosis and severe extrahepatic manifestations were enrolled in the treatment program. Initial treatment consisted of SOF plus ribavirin (RBV) with or without pegylated interferon (INF). Sustained virologic response (SVR) was defined as undetectable HCV RNA at least 12 weeks after the end of treatment. SVR were calculated using both per-protocol and modified intent-to-treat (mITT) analysis. Results for patients who completed treatment through 31 October 2018 were analyzed.

Results

Of the 7342 patients who initiated treatment with SOF-based regimens, 5079 patients were tested for SVR. Total SVR rate was 82.1% in per-protocol analysis and 74.5% in mITT analysis. The lowest response rate was observed among genotype 1 patients (69.5%), intermediate response rate was achieved in genotype 2 patients (81.4%), while the highest response rate was among genotype 3 patients (91.8%). Overall, SOF/RBV regimens achieved lower response rates than IFN/SOF/RBV regimen (72.1% vs 91.3%, P < 0.0001).

In multivariate analysis being infected with HCV genotype 2 (RR =1.10, CI [1.05–1.15]) and genotype 3 (RR = 1.14, CI [1.11–1.18]) were associated with higher SVR. Patients with cirrhosis (RR = 0.95, CI [0.93–0.98]), receiving treatment regimens of SOF/RBV 12 weeks, SOF/RBV 20 weeks, SOF/RBV 24 weeks and SOF/RBV 48 weeks (RR = 0.85, CI [0.81–0.91]; RR = 0.86, CI [0.82–0.92]; RR = 0.88, CI [0.85–0.91] and RR = 0.92, CI [0.87–0.98], respectively) were less likely to achieve SVR.

Conclusions

Georgia’s real world experience resulted in high overall response rates given that most patients had severe liver damage. Our results provide clear evidence that SOF plus IFN and RBV for 12 weeks can be considered a treatment option for eligible patients with all three HCV genotypes. With introduction of next generation DAAs, significantly improved response rates are expected, paving the way for Georgia to achieve HCV elimination goals.
Changes in pneumococcal carriage prevalence and factors associated with carriage in Norwegian children, four years after introduction of PCV13
Authors: Løvlie A. , Vestrheim D. F. , Aaberge I. S. , Steens A.
Published: January 2020

Background

Streptococcus pneumoniae carriage is often asymptomatic but can cause invasive pneumococcal disease. Pneumococcal carriage is a prerequisite for disease, with children as main reservoir and transmitters. Childhood carriage can therefore be used to determine which serotypes circulate in the population and which may cause disease in the non-vaccinated population. In 2006, a pneumococcal conjugate vaccine (PCV7) was introduced into the Norwegian Childhood Immunisation Programme, which was replaced by the more valent PCV13 in 2011. We investigated changes in pneumococcal carriage prevalence 4 years after switching to PCV13 compared to three previous surveys, and analysed factors associated with carriage in children.

Methods

We conducted a cross-sectional study in Norway, autumn 2015, among children attending day-care centres. We collected questionnaire data and nasopharyngeal swabs to identify pneumococcal serotypes. We compared the carriage prevalence in 2015 with surveys conducted in the same setting performed before widespread vaccination (2006; n = 610), 2 years after PCV7 introduction (2008; n = 600), and 2 years after switching to PCV13 (2013; n = 874). Using multilevel logistic regression we determined the association between pneumococcal carriage and previously associated factors.

Results

In 2015, 896 children participated, with age ranging from 8 to 80 months. The overall carriage prevalence was 48/100 children [95%CI 44–53] in 2015, 38% [29–46] lower than in 2006 pre-PCV7, and 23% [12–32] lower than in 2013, 2 years after switching to PCV13. The PCV13 carriage prevalence was 2.8/100 children [1.9–4.2] in 2015. Increasing age (p < 0.001), recent antimicrobial use (odds ratio = 0.42 [0.21–0.57]) and being vaccinated (odds ratio = 0.37 [0.29–0.47]) were negatively associated with carriage.

Conclusions

Our study showed a continued decrease in overall pneumococcal carriage, mainly fuelled by the decline in vaccine serotypes after vaccine introduction. Childhood vaccination with PCV13 should be continued to keep low PCV13 carriage, transmission and disease. Furthermore, the low prevalence of PCV13-type carriage in children endorse the choice of not recommending PCV13 in addition to the 23-valent pneumococcal polysaccharide vaccine to most medical risk groups in Norway, as little disease caused by these serotypes can be expected.
Do virtual renal clinics improve access to kidney care? A preliminary impact evaluation of a virtual clinic in East London
Authors: Hull S. A. , Rajabzadeh V. , Thomas N. , Hoong S. , Dreyer G. , Rainey H. , Ashman N.
Published: January 2020

Background

Early identification of people with CKD in primary care, particularly those with risk factors such as diabetes and hypertension, enables proactive management and referral to specialist services for progressive disease.

The 2019 NHS Long Term Plan endorses the development of digitally-enabled services to replace the ‘unsustainable’ growth of the traditional out-patient model of care.Shared views of the complete health data available in the primary care electronic health record (EHR) can bridge the divide between primary and secondary care, and offers a practical solution to widen timely access to specialist advice.

Methods

We describe an innovative community kidney service based in the renal department at Barts Health NHS Trust and four local clinical commissioning groups (CCGs) in east London. An impact evaluation of the changes in service delivery used quantitative data from the virtual CKD clinic and from the primary care electronic health records (EHR) of 166 participating practices. Survey and interview data from health professionals were used to explore changes to working practices.

Results

Prior to the start of the service the general nephrology referral rate was 0.8/1000 GP registered population, this rose to 2.5/1000 registered patients by the second year of the service. The majority (> 80%) did not require a traditional outpatient appointment, but could be managed with written advice for the referring clinician. The wait for specialist advice fell from 64 to 6 days. General practitioners (GPs) had positive views of the service, valuing the rapid response to clinical questions and improved access for patients unable to travel to clinic. They also reported improved confidence in managing CKD, and high levels of patient satisfaction. Nephrologists valued seeing the entire primary care record but reported concerns about the volume of referrals and changes to working practices.

Conclusions

‘Virtual’ specialist services using shared access to the complete primary care EHR are feasible and can expand capacity to deliver timely advice. To use both specialist and generalist expertise efficiently these services require support from community interventions which engage primary care clinicians in a data driven programme of service improvement.
Kidney function and nephrotoxic drug use among older home-dwelling persons with or without diabetes in Finland
Authors: Heinjoki Marjo , Karjalainen Merja , Saltevo Juha , Tiihonen Miia , Haanpää Maija , Kautiainen Hannu , Mäntyselkä Pekka
Published: January 2020

Background

Due to these changes in kidney function, aging kidneys are more prone to drug-induced impairments in renal properties. Diabetes has been associated with the declined kidney function and an elevated risk of renal failure. The aim of this study is to compare kidney function and potentially nephrotoxic drug use among home-dwelling older persons with or without diabetes.

Methods

A total of 259 persons with and 259 persons without diabetes and aged ≥65 years were randomly selected to participate in a health examination with complete data gathered from 363 individuals (187 with diabetes and 176 without diabetes). The estimated glomerular filtration rate (eGFR) was calculated using CKD-EPI equation. Each participant was categorized based on the nephrotoxic profile of their medications.

Results

There were no differences in mean eGFR values (77.5 ± 18.8 vs. 80.5 ± 14.8 ml/min/1.73m2,p = 0.089) or in the proportion of participants with eGFR < 60 ml/min/1.73m2among persons with diabetes (16% vs. 10%,p = 0.070), compared to persons without diabetes. Potentially nephrotoxic drug use was similar between the groups. The mean number of potentially nephrotoxic drugs was 1.06 ± 0.88 in those with and 0.97 ± 1.05 in those without diabetes (p = 0.39).

Conclusions

The kidney function of older persons with diabetes does not differ from that of older persons without diabetes and furthermore potentially nephrotoxic drug use seem to play only a minor role in the decline in kidney function among home-dwelling persons in the Inner-Savo district.
Men’s grief following pregnancy loss and neonatal loss: a systematic review and emerging theoretical model
Authors: Obst Kate Louise , Due Clemence , Oxlad Melissa , Middleton Philippa
Published: January 2020

Background

Emotional distress following pregnancy loss and neonatal loss is common, with enduring grief occurring for many parents. However, little is known about men’s grief, since the majority of existing literature and subsequent bereavement care guidelines have focused on women. To develop a comprehensive understanding of men’s grief, this systematic review sought to summarise and appraise the literature focusing on men’s grief following pregnancy loss and neonatal loss.

Methods

A systematic review was undertaken with searches completed across four databases (PubMed, PsycINFO, Embase, and CINAHL). These were guided by two research questions: 1) what are men’s experiences of grief following pregnancy/neonatal loss; and 2) what are the predictors of men’s grief following pregnancy/neonatal loss? Eligible articles were qualitative, quantitative or mixed methods empirical studies including primary data on men’s grief, published between 1998 and October 2018. Eligibility for loss type included miscarriage or stillbirth (by any definition), termination of pregnancy for nonviable foetal anomaly, and neonatal death up to 28 days after a live birth.

Results

A final sample of 46 articles were identified, including 26 qualitative, 19 quantitative, and one mixed methods paper. Findings indicate that men’s grief experiences are highly varied, and current grief measures may not capture all of the complexities of grief for men. Qualitative studies identified that in comparison to women, men may face different challenges including expectations to support female partners, and a lack of social recognition for their grief and subsequent needs. Men may face double-disenfranchised grief in relation to the pregnancy/neonatal loss experience.

Conclusion

There is a need to increase the accessibility of support services for men following pregnancy/neonatal loss, and to provide recognition and validation of their experiences of grief. Cohort studies are required among varied groups of bereaved men to confirm grief-predictor relationships, and to refine an emerging socio-ecological model of men’s grief.

Trials registration

PROSPERO registration number:CRD42018103981