bluuebunny/crossref_metadata_2025 huggingface dataset:
Recurrent attacks of acute hepatic porphyria: major role of the chronic inflammatory response in the liver
Authors: Schmitt C. , Lenglet H. , Yu A. , Delaby C. , Benecke A. , Lefebvre T. , Letteron P. , Paradis V. , Wahlin S. , Sandberg S. , Harper P. , Sardh E. , Sandvik A. K. , Hov J. R. , Aarsand A. K. , Chiche L. , Bazille C. , Scoazec J.‐Y. , To-Figueras J. , Carrascal M. , Abian J. , Mirmiran A. , Karim Z. , Deybach J.‐C. , Puy H. , Peoc'h K. , Manceau H. , Gouya L.
Published: March 2018

Background

Acute intermittent porphyria (AIP) is an inherited disorder of haem metabolism characterized by life‐threatening acute neurovisceral attacks due to the induction of hepatic δ‐aminolevulinic acid synthase 1 (ALAS1) associated with hydroxymethylbilane synthase (HMBS) deficiency. So far, the treatment of choice is hemin which represses ALAS1. The main issue in the medical care of AIP patients is the occurrence of debilitating recurrent attacks.

Objective

The aim of this study was to determine whether chronic hemin administration contributes to the recurrence of acute attacks.

Methods

A follow‐up study was conducted between 1974 and 2015 and included 602 French AIP patients, of whom 46 had recurrent AIP. Moreover, we studied the hepatic transcriptome, serum proteome, liver macrophage polarization and oxidative and inflammatory profiles of Hmbs−/− mice chronically treated by hemin and extended the investigations to five explanted livers from recurrent AIP patients.

Results

The introduction of hemin into the pharmacopeia has coincided with a 4.4‐fold increase in the prevalence of chronic patients. Moreover, we showed that both in animal model and in human liver, frequent hemin infusions generate a chronic inflammatory hepatic disease which induces HO1 remotely to hemin treatment and maintains a high ALAS1 level responsible for recurrence.

Conclusion

Altogether, this study has important impacts on AIP care underlying that hemin needs to be restricted to severe neurovisceral crisis and suggests that alternative treatment targeting the liver such as ALAS1 and HO1 inhibitors, and anti‐inflammatory therapies should be considered in patients with recurrent AIP.
Changes in School Competitive Food Environments after a Health Promotion Campaign
Authors: Green Sarah H. , Mallya Giridhar , Brensinger Colleen , Tierney Ann , Glanz Karen
Published: March 2018

BACKGROUND

Schools can reduce student access to competitive foods and influence healthy food choices by improving the school nutrition environment. This study describes changes in competitive nutrition environments in 100 K‐8 schools participating in the Philadelphia Campaign for Healthier Schools.

METHODS

Interviews with school staff were used to elicit information about policies, practices, and guidelines to restrict/limit competitive foods in schools, before and 1 year into the campaign. To increase the validity of responses, respondents provided documentation for reported policies and guidelines. Baseline interviews were conducted between April and June 2011 and follow‐up interviews were conducted between April and June 2012.

RESULTS

At follow‐up, significantly more schools reported having policies and/or guidelines in place to regulate food as a reward in the classroom, food served at parties and celebrations, outside foods allowed in school, and the availability of sodas and sugar‐sweetened beverages. There were no measurable effects on food available in school stores, fundraisers, or afterschool programs. Availability of concrete documentation of policies was limited, but when provided, it corroborated the interview responses.

CONCLUSIONS

In the context of a comprehensive school wellness policy, school wellness councils were associated with increases in school‐level policies and practices that improved the competitive nutrition environment.
Plasminogen binding and degradation by Treponema denticola: Identification of the plasminogen binding interface on the FhbB protein
Authors: Tegels B.K. , Oliver L.D. , Miller D.P. , Marconi R.T.
Published: March 2018

Treponema denticola is a proteolytic‐anaerobic spirochete whose abundance in the subgingival crevice correlates with periodontal disease severity. Treponema denticola evades serum‐mediated killing through the binding of factor H (FH), a negative regulator of the complement system. The T. denticolaFH receptor has been identified as FhbB, an 11.4kDa immunodominant lipoprotein. Three distinct subfamilies of FhbB proteins have been delineated and designated as FhbB1, FhbB2 and FhbB3. In this study we demonstrate that all FhbB variants bind human plasminogen (Plg). Competitive binding analyses revealed that FH and Plg do not compete for binding. Binding studies with FhbB135405 site‐directed amino acid substitution mutants demonstrated that the interaction domains for FH and Plg on FhbB are separable. Inhibition of Plg‐FhbB binding by ε‐aminocaproic acid (a lysine analog) indicates that binding is mediated by electrostatic interactions that presumably occur with Lys binding sites contained within Plg “Kringle” domains 1, 2, 4 or 5. Similar to that demonstrated for FH, Plg can also serve as a substrate for the T. denticola protease, dentilisin. The in vivo consequences of dentilisin‐mediated cleavage of Plg remained to be determined. The data presented demonstrate that FhbB is a multi‐functional protein that may contribute to virulence through several mechanisms including immune evasion, manipulation of the host immune response, adherence or tissue invasion.
Reid's Non‐Humean Theory of Moral Motives
Authors: Kroeker Esther Engels
Published: March 2018

Contrary to the widespread view that Reid and Hume agree that reason, alone, is inert, I argue that they disagree on this point. Both accept that reason plays a role in forming moral sentiments, and that affections are components of moral evaluations. However, I show that for Reid moral evaluations (comprised of moral judgments and moral affections) are different from moral motives (which are not comprised of affections). Moral motives for Reid are mind‐independent states of affairs that are grasped by reason and do not require affections to influence human beings. Reid hence holds a non‐Humean theory in which reason, alone, is not inert.
Adaptive responses of mature giant chloroplasts in the deep‐shade lycopod Selaginella erythropus to prolonged light and dark periods
Authors: Ghaffar Rabia , Weidinger Marieluise , Mähnert Barbara , Schagerl Michael , Lichtscheidl Irene
Published: March 2018

Deep‐shade plants have adapted to low‐light conditions by varying morphology and physiology of cells and chloroplasts, but it still remains unclear, if prolonged periods of high‐light or darkness induce additional modifications in chloroplasts' anatomy and pigment patterns. We studied giant chloroplasts (bizonoplasts) of the deep‐shade lycopod Selaginella erythropus in epidermal cells of mature fully developed microphylls and subjected them to prolonged darkness and high‐light conditions. Chloroplast size and ultrastructure were investigated by light and electron microscopy. Physiological traits were studied by pigment analyses, photosynthetic performance of photosystem II, and formation of reactive oxygen species. Results show that (a) thylakoid patterns and shape of mature bizonoplasts vary in response to light and dark conditions. (b) Prolonged darkness induces transitory formation of prolamellar bodies, which so far have not been described in mature chloroplasts. (c) Photosynthetic activity is linked to structural responses of chloroplasts. (d) Photosystem II is less active in the upper zone of bizonoplasts and more efficient in the grana region. (e) Formation of reactive oxygen species reflects the stress level caused by high‐light. We conclude that during prolonged darkness, chlorophyll persists and even increases; prolamellar bodies form de novo in mature chloroplasts; bizonoplasts have spatial heterogeneity of photosynthetic performance.
Interparental conflict, parental intrusiveness, and interpersonal functioning in emerging adulthood
Authors: KUMAR SHAINA A. , MATTANAH JONATHAN F.
Published: March 2018

The current study examined the effects of interparental conflict (IPC) on interpersonal functioning and psychopathology in emerging adulthood. In a sample of 188 emerging adult college students, IPC was associated significantly with greater symptoms of depression and loneliness. Furthermore, parental intrusiveness and romantic competence, as assessed by a novel interview methodology, mediated the links between IPC and depression symptomatology and loneliness. Links with prior research and implications for emerging adult functioning are discussed.
Significant correlation between peripheral blood CD34+ cell count in children prior to aphaeresis and CD34+ cell yield following aphaeresis: A single‐center experience
Authors: Rosenfeld‐Keidar Hila , Eshel Rinat , Pinhasov Aviva , Bitan Menachem , Edelman Sabina , Broitman Marcela , Dvir Rina , Sadot Efraim , Levin Dror , Manisterski Michal , Berger‐Achituv Sivan , Elhasid Ronit
Published: March 2018

Numerous adults’ studies demonstrated that preaphaeresis CD34+ cells significantly correlate with the number of CD34+ cells collected by the aphaeresis procedure. Equivalent studies in children are scarce. We studied retrospectively 92 aphaeresis procedures performed following chemotherapy (44) or in steady state (48) in 60 pediatric patients (40 males, 20 females), median age of 7.5 years. Aphaeresis procedures were performed using a SPECTRA Optica (TERUMOBCT) continuous flow cell separator. CD34+ cell concentrations were assessed using flow cytometry. A highly significant correlation between peripheral CD34 cell count on the day of aphaeresis and CD34 cell yield per kg (R2 = .824, P < .0001) was demonstrated. A higher preaphaeresis CD34 cell count was demonstrated in patients with higher preaphaeresis white blood cell count, in patients with brain tumors, and in patients who received chemotherapy as part of their mobilization protocol. A threshold number of 20 peripheral CD34+ cell/μL was found to predict harvesting of 3 × 106 stem cells/kg, and 30 peripheral CD34+ cell/μL for harvesting of 5 × 106 stem cells/kg. This significant correlation between peripheral CD34 cell count and CD34 cell yield, and the threshold number of peripheral CD34 found to predict adequate harvesting can be useful in planning the optimal time for aphaeresis in children.
PHOTOREACTIVATION OF CYCLOBUTANE DIMERS AND (6–4) PHOTOPRODUCTS IN THE EPIDERMIS OF THE MARSUPIAL, Monodelphis domestica
Authors: MITCHELL DAVID L. , APPLEGATE LEE A. , NAIRN RODNEY S. , LEY RONALD D.
Published: March 2018

Radioimmunoassays were used to investigate the repair of cyclobutane pyrimidine dimers and pyrimidine(6–4)pyrimidone photoproducts ([6–4] photoproducts) in the epidermis of the South American opossum, Monodelphis domestica. In the absence of photoreactivating light, both types of photodamage were excised with similar kinetics, 50% of the damage remaining 8 h after UV irradiation in vivo. Exposure of UV‐irradiated skin to photoreactivating light resulted in removal of most of the cyclobutane dimers and an enhanced rate of (6–4) photoproduct repair. Photoenhanced excision repair of non‐dimer damage increases the range of biologically effective lesions removed by in vivo photoreactivation.
PTERIN‐ AND FLAVIN‐LIKE FLUORESCENCE ASSOCIATED WITH ISOLATED FLAGELLA OF Euglena gracilis
Authors: GALLAND PAUL , KEINER PETRA , DÖRNEMANN DIETER , SENGER HORST , BRODHUN BONITA , HÄDER DONAT-P.
Published: March 2018

Fluorescence excitation‐ and emission spectra indicate the presence of pterin(s) and flavin(s) in isolated flagella of the phytoflagellate Euglena gracilis. These compounds appear to bind at least in part non‐covalently to the molecular framework of the paraflagellar body, which is the presumed photoreceptor organelle and which is attached to the isolated flagella. A compound with pterin‐like fluorescence excitation and emission spectrum could he extracted with methanol from isolated flagella and could he recovered on thin‐layer silica gels. Besides the previously assumed photoreceptor function of flavins, our results suggest also a role for pterins in the photosensory transduction chain of Euglena gracilis.
ACTION SPECTRA FOR PHOTOGRAVITROPISM OF Phycomyces WILD TYPE AND THREE BEHAVIORAL MUTANTS (L150, L152, AND L154)
Authors: ENSMINGER PETER A. , CHEN XIYIN , LIPSON EDWARD D.
Published: March 2018

We have measured fluence rate–response curves and action spectra for photogravitropism in Phycomyces wild type and in three recently isolated mutants with elevated phototropic thresholds. The action spectra were determined from least‐squares fits of a sigmoidal function to the fluence rate–response data for each wavelength. The action spectrum for wild type has maxima near 383, 413, 452, and 490 nm and minima near 397, 425, and 469 nm. This photogravitropism action spectrum is very similar to the Phycomyces phototropic balance action spectrum between 413 and 490 nm, but has significantly higher effectiveness below 400 nm and above 490 nm. These differences may be caused by dichroic effects of the oriented receptor pigment and/or by multiple receptor pigments. The action spectra of the three mutants differ significantly from one another and from that of wild type. Relative to the wild type spectrum, all three mutants exhibit a suppression in effectiveness near 425 nm, which is near the transmission peak of the broadband blue filter used to isolate the mutants.
FLAVIN TYPE ACTION SPECTRUM OF NITRATE UTILIZATION BY Monoraphidium braunii
Authors: QUIÑONES MIGUEL A. , APARICIO PEDRO J.
Published: March 2018

The light‐dependent utilization of nitrate by the green alga Monoraphidium braunii, coming from nocturnal dark periods, shows an action spectrum of flavin type with two main bands: one in the blue, peaking at 450 and 480 nm, and the other in the near‐UV region with a maximum at 365 nm. Other results indicate that cells growing on nitrate as the only nitrogen source resynthesize nitrate reductase daily, which implies the nocturnal loss of this enzyme. The biosynthesis of nitrate reductase at the beginning of the light periods can proceed under red light. In addition, blue or near‐UV light is required for the activation of the previously formed nitrate reductase.
EFFECTS INDUCED IN NEUTROPHILS BY A PRECURSOR OF TRIPLET ACETONE
Authors: ESCOBAR JORGE A. , CILENTO GIUSEPPE , NASCIMENTO ANA L. T. O.
Published: March 2018

The addition of a precursor of the enol form of isobutanal to neutrophils results in formation of triplet acetone, as attested to by emission from appropriate acceptors and cell damage (Nascimento et al., 1986 Biochim. Biophys. Acta 888, 337–342). The present study confirms the formation of triplet acetone by detection of the direct emission (λmax 430 nm) and differentiates between effects produced by triplet acetone and by the enol substrate itself. Thus, triplet acetone: (1) enhances the release of ribonucleic acid; (2) promotes lipid peroxidation (N3−‐inhibitable formation of thiobarbituric acid reactive products and concomitant light emission peaking at 480–500 nm); (3) increases myeloperoxidase activity, presumable as a result of damage and consequent increased exposure of the enzyme. On the other hand, the enol greatly enhances the release of protein(s) into the medium. These results confirm the utility of the neutrophil as a model system for the study of chemiexcitation processes induced at the cellular level. They also provide the first demonstration that an excited species formed at the cellular level may induce release of nucleic acids, thus reflecting the occurrence of deleterious processes in situ.
THE INTERACTION OF ACRYLAMIDE WITH GLYCERALDEHYDE‐3‐PHOSPHATE DEHYDROGENASE. STRUCTURAL MODIFICATIONS IN THE ENZYME STUDIED BY FLUORESCENCE TECHNIQUES
Authors: ÖRSTAN AYDIN , GAFNI ARI
Published: March 2018

The interaction of acrylamide with rabbit muscle glyceraldehyde‐3‐phosphate dehydrogenase (GPDH) has been investigated in Tris buffer, pH 7.5. When GPDH containing about 1 mol NAD per mol of tetramer is incubated with acrylamide (0.01–0.1 M), the tryptophan emission of GPDH, initially quenched by acrylamide, slowly increases to a value exceeding that recorded before the addition of acrylamide. This effect is not observed in apoenzyme solutions, indicating that the enhancement of fluorescence results from the dissociation of some NAD from the acrylamide treated GPDH. Acrylamide inactivates GPDH but 1 mM NAD protects the enzyme from inactivation. The addition of acrylamide to GPDH, labeled with fluorescein‐5‐isothiocyanate (GPDH‐FITC) increases the fluorescence and decreases the polarization of fluorescein. The fluorescent sulfhydryl reagent N‐iodoacetyl‐N′‐(5‐sulfo‐1‐naphthyl)ethylenediamine induces similar changes in the fluorescence properties of GPDH‐FITC. This reagent, however, fails to react with GPDH preincubated with acrylamide and the titration of acrylamide treated GPDH with the sulthydryl reagent 5,5’‐dithiobis(2‐nitrobenzoic acid) indicates the loss of up to 7 cysteine residues per tetramer. Acrylamide also decreases the heat stability of GPDH. Altogether, the data indicate that acrylamide covalently reacts with the active site cysteine residues of GPDH and subsequently induces a conformational change in the enzyme.
DIETARY β‐CAROTENE AND 13‐cis‐RETINOIC ACID ARE NOT EFFECTIVE IN PREVENTING SOME FEATURES OF UVB‐INDUCED DERMAL DAMAGE IN HAIRLESS MICE
Authors: KLIGMAN LORRAINE H. , MATHEWS-ROTH MICHELINE M.
Published: March 2018

Albino hairless mice were fed diets containing 10 g/kg feed of β‐carotene and 200 mg/kg feed of 13‐cis retinoic acid to assess the ability of these molecules to prevent UVB‐induced dermal damage. Diets were administered for 12 weeks prior to UVB exposure and were continued throughout the 20 week irradiation period. The UVB source was a bank of FS‐20 sunlamps (280–400 nm: peak 313 nm). Exposures were thrice weekly at 0.1 J/cm2 per exposure for the first 10 weeks and 0.2 J/cm2 per exposure for the second 10 weeks. Histologic evaluation of skin biopsies revealed no difference, between animals fed active or placebo diets, in UVB‐induced elastosis, collagen changes or amounts of glycosaminoglycans and proteoglycans of the ground substance.
Identification and molecular characterization of the Brachypodium distachyon NRT2 family, with a major role of BdNRT2.1
Authors: Wang Jiang , Hüner Norman , Tian Lining
Published: March 2018

The small monocot plant Brachypodium distachyon is rapidly emerging as a powerful model system to study questions unique to the monocot crops. An extensive BLAST search was carried to identify putative orthologues of the Arabidopsis NRT2 genes in the fully sequenced Brachypodium genome. Seven genes encoding putative high‐affinity nitrate transporters (BdNRT2) were identified. Transcriptional analysis of individual BdNRT2 gene under various nitrogen sources and levels in the wild‐type and a T‐DNA mutant of BdNRT2.1 were performed. A transgenic approach was taken to complement the bdnrt2.1 mutant. BdNRT2.1 and BdNRT2.2 were strongly induced by nitrate resupply to nitrogen‐starved plants and were classified as inducible genes. BdNRT2.5 was found to be repressed by nitrate resupply whereas other members were constitutively expressed in the root. Interestingly, higher ammonium concentrations also triggered similar gene expression regulation, suggesting BdNRT2 gene expression was also governed by internal nitrogen status, not just external nitrate concentrations. In bdnrt2.1 mutant, the high‐affinity transporter system (HATS) was reduced by 30% and BdNRT2.2 and BdNRT2.6 were differentially regulated. This pioneering research demonstrates that genes in the BdNRT2 family have diverse roles, differing from the Arabidopsis AtNRT2 family, in response to various nitrogen conditions. BdNRT2.1 serves as a key member of the family.
Topping Off and Bottoming Out: Setting Budget Priorities Through Executive Power
Authors: Breunig Christian , Koski Chris
Published: March 2018

This article examines the role of the institutional power of executives in public budgeting; specifically, how executives change spending on particular budget items. Leveraging extant theories of the policy process concerning preference expression, attention, and institutions, we argue that executives deepen large cuts and boost large increases in budgetary change. The strictures of the budgetary process force trade‐offs for executives in preference expression such that increases to preferred categories typically require decreases in other categories. Literatures in public policy and political representation suggest that all executives would like to express fiscal preferences, thereby contributing to categorical budget oscillations; however, not all executives are created equal. We employ quantile regression to examine whether the institutional strength of governors determine cuts, stasis, and expansion in spending across all budget functions in the American states between 1985 and 2009. Our model includes a host of political and economic variables found in the literature of fiscal policymaking, such as partisanship and divided government. The desire to change policy may be widely shared across executives, but we find that the ability to “top off” categorical increases and bottom out categorical decreases is a function of an executive's capacity to call attention to preferred categories via agenda‐setting power and to secure those changes via veto power. The findings show strong governors are well positioned to influence public policy through the budgetary process.
Acid‐base assessment of patients receiving hemodialysis. What are our management goals?
Authors: Gennari F. John
Published: March 2018

Acid‐base assessment of patients receiving conventional hemodialysis (HD) has been based solely on predialysis serum [total CO2], and treatment is currently driven by the KDOQI guideline from 2000. This guideline was directed solely at minimizing metabolic acidosis and thereby improving bone and muscle metabolism. In 2000, no data were available to assess the effects of acid‐base status on morbidity and mortality. Since then, new data have emerged from several large cohort studies about the association between variations in predialysis serum [total CO2], as well as blood pH, and morbidity and mortality risk. These studies have shown increased risk not only with very low predialysis [total CO2] values, but also with predialysis alkaline pH and very high predialysis serum [total CO2] values. At present, our major concern is not for patients with metabolic acidosis, but rather for the growing numbers of patients with metabolic alkalosis. This review discusses the controversies around assessing and treating acid‐base status in HD patients, and recommends a practical approach based on the results of these recent studies. The new approach provides recommendations for patients both with very low and very high predialysis serum [total CO2] values.
Diversifying but not Integrating: Entropic Measures of Local Segregation
Authors: Kramer Rory , Kramer Peter
Published: March 2018

Scholars of segregation have struggled to adapt indices designed to model two‐group segregation for cities with large populations drawn from more than two racial/ethnic groups. Considering segregation as a social form of entropy resolves that struggle and introduces a family of related measures that offer means of analysing segregation at both the local (neighbourhood) level and the greater (city/region) area. A case study of Philadelphia's level of segregation from 1990 to 2010 illustrates the benefits of the new measures. While Philadelphia has diversified, it remains racially segregated. Further, the new measures show the growing importance of Hispanic segregation and a shift from segregation being visited upon the city's Black residents to being driven by a White population that grows more segregated as its population share shrinks. Integrating measures of segregation and diversity into studies of residential racial patterns enhances our understanding of racial segregation patterns in a multiracial context.
WBC alloimmunization: effects on the laboratory and clinical endpoints of therapeutic granulocyte transfusions
Authors: Price Thomas H. , McCullough Jeffrey , Strauss Ronald G. , Ness Paul M. , Hamza Taye H. , Harrison Ryan W. , Assmann Susan F.
Published: March 2018

BACKGROUND

Although the subject of many previous studies, the importance of white blood cell (WBC) alloimmunization in granulocyte transfusion therapy has not been settled. In this study, we report the results of the effects of WBC antibodies in the RING (Resolving Infection in Neutropenia with Granulocytes) study, a randomized controlled trial comparing the efficacy of daily granulocyte transfusion therapy plus antimicrobials versus antimicrobials alone; the primary outcome results have been published previously.

STUDY DESIGN AND METHODS

One hundred fourteen subjects were enrolled in the study. Serum samples for WBC antibody determination were obtained from each subject at baseline and at 2 and 6 weeks. One hundred subjects had at least one antibody test result. Samples were tested for human leukocyte antigen (HLA) Class I and Class II antibodies as well as for granulocyte‐specific antibodies using granulocyte agglutination and immunofluorescence techniques. All testing was performed at a central laboratory.

RESULTS

Baseline WBC alloimmunization was modest, depending somewhat on the assay. Seroconversion during the study was slightly higher in the granulocyte transfusion arm, but the differences were not statistically significant. There was no demonstrable effect of the presence of alloimmunization on the primary outcome (survival and microbial response at 42 days), the occurrence of transfusion reactions (either overall or pulmonary), or posttransfusion neutrophil increments.

CONCLUSION

The presence or development of WBC antibodies had no demonstrable effect on any clinical aspect of granulocyte transfusion therapy. It appears that, at least in the patient population studied, there is no evidence suggesting need for concern about recipient WBC alloimmunization when prescribing granulocyte transfusions.
Amorphous gallium oxide grown by low-temperature PECVD
Authors: Kobayashi Eiji , Boccard Mathieu , Jeangros Quentin , Rodkey Nathan , Vresilovic Daniel , Hessler-Wyser Aïcha , Döbeli Max , Franta Daniel , De Wolf Stefaan , Morales-Masis Monica , Ballif Christophe
Published: March 2018

Owing to the wide application of metal oxides in energy conversion devices, the fabrication of these oxides using conventional, damage-free, and upscalable techniques is of critical importance in the optoelectronics community. Here, the authors demonstrate the growth of hydrogenated amorphous gallium oxide (a-GaOx:H) thin-films by plasma-enhanced chemical vapor deposition (PECVD) at temperatures below 200 °C. In this way, conformal films are deposited at high deposition rates, achieving high broadband transparency, wide band gap (3.5–4 eV), and low refractive index (1.6 at 500 nm). The authors link this low refractive index to the presence of nanoscale voids enclosing H2, as indicated by electron energy-loss spectroscopy. This work opens the path for further metal-oxide developments by low-temperature, scalable and damage-free PECVD processes.
Quantitative low energy depth profiling of SiGe laterally nonuniform structures
Authors: Merkulov Alexander , Peres Paula , Larson David James , Schuhmacher Michel
Published: March 2018

This work explored quantitative analyses of SiGe layers, either grown on bulk Si wafers or in a confined space of different dimensions within the N28 node technology. Dynamic secondary ion mass spectrometry (SIMS) measurements were performed with a magnetic sector CAMECA IMS Wf, using low impact energy O2+ sputtering and recording the Ge containing molecular ions. It was concluded that the molecular ions protocol, called “self-focusing” SIMS, is capable of providing an accurate characterization of SiGe composition with Ge content up to 90%.
‘So why didn’t you think this baby was ill?’ Decision-making in acute paediatrics
Authors: Roland Damian , Snelson Edward
Published: March 2018

Determining severity of illness and undertaking an adequate risk assessment is a fundamental part of acute paediatric practice. This review highlights physiology, communication, heuristics and external elements as factors which influence decision-making and discusses how incidence of disease and seniority of clinician impact might influence outcomes.
Realist evaluation of a complex integrated care programme: protocol for a mixed methods study
Authors: Nurjono Milawaty , Shrestha Pami , Lee Alice , Lim Xin Ya , Shiraz Farah , Tan Shermin , Wong Shing Hei , Foo Kah Mun , Wee Thomas , Toh Sue-Anne , Yoong Joanne , Maria Vrijhoef Hubertus Johannes
Published: March 2018

Introduction

The lack of understanding of how complex integrated care programmes achieve their outcomes due to the lack of acceptable methods leads to difficulties in the development, implementation, adaptation and scaling up of similar interventions. In this study, we evaluate an integrated care network, the National University Health System (NUHS) Regional Health System (RHS), consisting of acute hospitals, step down care, primary care providers, social services and community partners using a theory-driven realist evaluation approach. This study aims to examine how and for whom the NUHS-RHS works to improve healthcare utilisations, outcomes, care experiences and reduce healthcare costs. By using a realist approach that balances the needs of context-specific evaluation with international comparability, this study carries the potential to address current research gaps.

Methods and analysis

This evaluation will be conducted in three research phases: (1) development of initial programme theory (IPT) underlying the NUHS-RHS; (2) testing of programme theory using empirical data; and (3) refinement of IPT. IPT was elicited and developed through reviews of programme documents, informal discussions and in-depth interviews with relevant stakeholders. Then, a convergent parallel mixed method study will be conducted to assess context (C), mechanisms (M) and outcomes (O) to test the IPT. Findings will then be analysed according to the realist evaluation formula of CMO in which findings on the context, mechanisms will be used to explain the outcomes. Finally, based on findings gathered, IPT will be refined to highlight how to improve the NUHS-RHS by detailing what works (outcome), as well as how (mechanisms) and under what conditions (context).

Ethics and dissemination

The National Healthcare Group, Singapore, Domain Specific Review Board reviewed and approved this study protocol. Study results will be published in international peer-reviewed journals and presented at conferences and internally to NUHS-RHS and Ministry of Health, Singapore.
Dental caries and preterm birth: a systematic review and meta-analysis
Authors: Wagle Madhu , D’Antonio Francesco , Reierth Eirik , Basnet Purusotam , Trovik Tordis A , Orsini Giovanna , Manzoli Lamberto , Acharya Ganesh
Published: March 2018

Objectives

The primary objective of this systematic review was to evaluate the association between dental caries and preterm birth (PTB). The secondary objective was ascertaining the difference between women with dental caries who experienced PTB and those who did not with regard to decayed, missing and filled teeth (DMFT), and decayed, missing and filled surfaces (DMFS) indices.

Methods

MEDLINE, Embase, CINAHL and Cochrane databases were searched initially in November 2015 and repeated in December 2016. We included observational cohort and case–control studies. Only studies reporting the risk of PTB in women affected compared with those not affected by dental caries in pregnancy were included. Random-effect meta-analyses were used to compute the summary OR of PTB among women with caries versus women without caries, and the mean difference in either DMFT or DMFS indices between women experiencing PTB and those without PTB.

Results

Nine observational studies (4826 pregnancies) were included. Women affected by dental caries during pregnancy did not show a significantly higher risk of PTB (OR: 1.16, 95% CI 0.90 to 1.49, P=0.25, I2=35%). Also, the women with PTB did not show significantly higher DMFT or DMFS indices (summary mean differences: 1.56, P=0.10; I2=92% and −0.15, P=0.9, I2=89%, respectively).

Conclusion

Dental caries does not appear to be a substantial risk factor for PTB.

Trial registration number

NCT01675180; Pre-results.
Model-based recursive partitioning to identify risk clusters for metabolic syndrome and its components: findings from the International Mobility in Aging Study
Authors: Pirkle Catherine M , Wu Yan Yan , Zunzunegui Maria-Victoria , Gómez José Fernando
Published: March 2018

Objective

Conceptual models underpinning much epidemiological research on ageing acknowledge that environmental, social and biological systems interact to influence health outcomes. Recursive partitioning is a data-driven approach that allows for concurrent exploration of distinct mixtures, or clusters, of individuals that have a particular outcome. Our aim is to use recursive partitioning to examine risk clusters for metabolic syndrome (MetS) and its components, in order to identify vulnerable populations.

Study design

Cross-sectional analysis of baseline data from a prospective longitudinal cohort called the International Mobility in Aging Study (IMIAS).

Setting

IMIAS includes sites from three middle-income countries—Tirana (Albania), Natal (Brazil) and Manizales (Colombia)—and two from Canada—Kingston (Ontario) and Saint-Hyacinthe (Quebec).

Participants

Community-dwelling male and female adults, aged 64–75 years (n=2002).

Primary and secondary outcome measures

We apply recursive partitioning to investigate social and behavioural risk factors for MetS and its components. Model-based recursive partitioning (MOB) was used to cluster participants into age-adjusted risk groups based on variabilities in: study site, sex, education, living arrangements, childhood adversities, adult occupation, current employment status, income, perceived income sufficiency, smoking status and weekly minutes of physical activity.

Results

43% of participants had MetS. Using MOB, the primary partitioning variable was participant sex. Among women from middle-incomes sites, the predicted proportion with MetS ranged from 58% to 68%. Canadian women with limited physical activity had elevated predicted proportions of MetS (49%, 95% CI 39% to 58%). Among men, MetS ranged from 26% to 41% depending on childhood social adversity and education. Clustering for MetS components differed from the syndrome and across components. Study site was a primary partitioning variable for all components except HDL cholesterol. Sex was important for most components.

Conclusion

MOB is a promising technique for identifying disease risk clusters (eg, vulnerable populations) in modestly sized samples.
Development of an English-language version of a Japanese iPad application to facilitate collaborative goal setting in rehabilitation: a Delphi study and field test
Authors: Levack William , Tomori Kounosuke , Takahashi Kayoko , Sherrington Aidan J
Published: March 2018

Objective

This study aimed to investigate the content of an English-language version of a Japanese iPad application designed to facilitate shared decision-making around goal setting in rehabilitation: Aid for Decision-making in Occupational Choice—English (ADOC-E).

Design

Phase 1: Delphi methods to reach consensus with an international group of expert occupational therapists on the text and images in ADOC-E. Phase 2: Testing correct recognition (unprompted and prompted) of images in ADOC-E by health service users in inpatient rehabilitation and residential care.

Setting

Phase 1: International, online. Phase 2: Three healthcare services in New Zealand—(1) a residential rehabilitation service for traumatic brain injury, (2) a nursing home for frail older adults and (3) an inpatient rehabilitation ward in a public hospital.

Participants

Phase 1: Fourteen experienced occupational therapists from New Zealand (4), Australia (4), UK (2) and USA (4). Phase 2: Twenty-four rehabilitation and residential care service users (10 men, 14 women; 20–95 years; Mini-Mental State Exam scores 13–30).

Results

Four Delphi rounds were required to reach consensus with the experienced occupational therapists on the content of ADOC-E, ending with 100 items covering daily activities that people do and social roles they participate in. Ninety-five per cent (95/100) of ADOC-E items could each be correctly identified by over 80% of service user participants with either unprompted or prompted recognition.

Conclusion

While a few of the more abstract concepts in ADOC-E (related to complex social roles) were less likely to be correctly recognised by all participants, the text and images ADOC-E were deemed to be fit for purpose overall and ready for future clinical testing.
Interventions to encourage smoke-free homes in remote indigenous Australian communities: a study protocol to evaluate the effects of a community-inspired awareness-raising and motivational enhancement strategy
Authors: Clough Alan R , Grant Kristy , Robertson Jan , Wrigley Matthew , Nichols Nina , Fitzgibbon Tracey
Published: March 2018

Introduction

Rates of secondhand smoke exposure are currently significantly higher among remote indigenous communities in the top end of Australia. By implementing a ‘smoke-free home’ rule, secondhand smoke exposure can be reduced. Smoke-free homes encourage quit attempts and improve the health of children. The prevalence of indigenous smoking rates in remote, discrete communities in Australia is elevated compared with their non-indigenous counterparts. The primary aim of this project is to examine the feasibility of conducting a health-driven intervention to encourage community members to make their homes a smoke-free zone.

Methods and analysis

This study uses mixed-methods exploratory evaluation design to obtain data from key informants and community householders to assess their willingness to implement a ‘smoke-free’ rule in their homes. Initial focus groups will provide guidance on intervention content and deliver evaluation procedures and community requirements. A rapid survey will be conducted to ascertain interest from community members in having the project team visit to discuss study objectives further and to have a particle meter (with consent) placed in the house. Focus groups recordings will be transcribed and analysed thematically. Rapid surveys will be analysed using frequency distributions and tabulations of responses.

Ethics and dissemination

The National Health and Medical Research Council guidelines on ethical research approaches to indigenous studies will be adhered to. The James Cook University Human Research Ethics Committee has provided ethics approval.
Does physiological distribution of blood parameters in children depend on socioeconomic status? Results of a German cross-sectional study
Authors: Rieger Kristin , Vogel Mandy , Engel Christoph , Ceglarek Uta , Harms Kristian , Wurst Ulrike , Lengfeld Holger , Richter Matthias , Kiess Wieland
Published: March 2018

Objectives

In the present study, we examined the relation between socioeconomic status (SES) and the physiological distribution of iron-related blood parameters.

Design

This is a cross-sectional analysis of longitudinal population-based cohort study.

Setting

Based on a sample of healthy participants from a German research centre, various blood parameters and values of clinical examinations and questionnaires were collected.

Participants

A total of 1206 healthy volunteers aged 2.5 to 19 years, one child per family randomly selected, were included.

Primary and secondary outcome measures

Associations between the SES of children by Winkler-Stolzenberg Index (WSI) and its dimensions (income, education, occupation) and iron-related blood parameters (haemoglobin, ferritin and transferrin) were analysed by linear regression analyses. Gender and pubertal stage were included as covariables. Additionally, associations between SES of children by WSI and physical activity (side-to-side jumps, push-ups) as well as body mass index (BMI) were analysed by linear regression analyses.

Results

Children with high WSI or family income showed significantly increased z-scores for haemoglobin (P=0.046; P<0.001). Children with increased WSI or family income showed significantly lower z-scores for transferrin (P<0.001). There was a significant correlation between haemoglobin and gender (P<0.001) and between transferrin and pubertal stage (P=0.024). Furthermore, physical activity was positively correlated and BMI was negatively correlated with WSI (P<0.001).

Discussion

Our data show an association between SES and the distribution of iron-dependent parameters. Lower SES is correlated with lower values for haemoglobin and higher values for transferrin. Furthermore, we demonstrate that physical activity and BMI are associated with SES. Whereas higher SES is correlated with higher values for physical activity and lower BMI. Our parameters are standardised as z-scores with the advantages that the results are comparable across different age groups and present physiological courses.

Trial registration number

NCT02550236; Results.
Do non-inferiority trials of reduced intensity therapies show reduced effects? A descriptive analysis
Authors: Aberegg Scott K , Hersh Andrew M , Samore Matthew H
Published: March 2018

Objectives

To identify non-inferiority trials within a cohort where the experimental therapy is the same as the active control comparator but at a reduced intensity and determine if these non-inferiority trials of reduced intensity therapies have less favourable results than other non-inferiority trials in the cohort. Such a finding would provide suggestive evidence of biocreep in these trials.

Design

This metaresearch study used a cohort of non-inferiority trials published in the five highest impact general medical journals during a 5-year period. Data relating to the characteristics and results of the trials were abstracted.

Primary outcome measures

Proportions of trials with a declaration of superiority, non-inferiority and point estimates favouring the experimental therapy and mean absolute risk differences for trials with outcomes expressed as a proportion.

Results

Our search yielded 163 trials reporting 182 non-inferiority comparisons; 36 comparisons from 31 trials were between the same therapy at reduced and full intensity. Compared with trials not evaluating reduced intensity therapies, fewer comparisons of reduced intensity therapies demonstrated a favourable result (non-inferiority or superiority) (58.3%vs82.2%; P=0.002) and fewer demonstrated superiority (2.8%vs18.5%; P=0.019). Likewise, point estimates for reduced intensity therapies more often favoured active control than those for other trials (77.8%vs39.7%; P<0.001) as did mean absolute risk differences (+2.5% vs −0.7%; P=0.018).

Conclusions

Non-inferiority trials comparing a therapy at reduced intensity to the same therapy at full intensity showed reduced effects compared with other non-inferiority trials. This suggests these trials may have a high rate of type 1 errors and biocreep, with significant implications for the design and interpretation of future non-inferiority trials.
Cross-sectional and prospective associations of neighbourhood environmental attributes with screen time in Japanese middle-aged and older adults
Authors: Liao Yung , Shibata Ai , Ishii Kaori , Koohsari Mohammad Javad , Oka Koichiro
Published: March 2018

Objectives

This study examined cross-sectional and 2-year prospective associations of perceived and objectively measured environmental attributes with screen time among middle-aged Japanese adults.

Design

Prospective cohort study.

Setting

Nerima and Kanuma cities of Japan.

Participants

Data were collected from adults aged 40–69 years living in two cities of Japan in 2011 (baseline: n=1011; 55.3±8.4 years) and again in 2013 (follow-up: n=533; 52.7% of baseline sample).

Measures

The exposure variables were five geographic information system-based and perceived attributes of neighbourhood environments (residential density, access to shops and public transport, footpaths, street connectivity), respectively. The outcome variables were baseline screen time (television viewing time and leisure-time internet use) and its change over 2 years. Multilevel generalised linear modelling was used.

Results

On average, participants’ screen time was not statistically different over 2 years (2.3 hours/day at baseline and 2.2 hours/day at follow-up; P=0.24). There were cross-sectional associations of objective (exp(β): 1.11; 95% CI 1.01 to 1.22) and perceived (1.12; 1.02 to 1.23) good access to public transport, perceived good access to shop (1.18; 1.04 to 1.36) and perceived good street connectivity (1.11; 1.01 to 1.23) with higher time spent in screen time at baseline. No objective and perceived environmental attributes were significantly associated with change in screen time.

Conclusions

Activity-supportive neighbourhood environmental attributes appear to be related to higher levels of screen time cross-sectionally. Pattern of screen time might be maintained rather than changed over time under the same neighbourhood environments. Environmental interventions that promote physical activity may need to consider the potential negative health impact of screen time in Japan.
Temporal trends in severe maternal and neonatal trauma during childbirth: a population-based observational study
Authors: Wen Qi , Muraca Giulia M , Ting Joseph , Coad Sarah , Lim Kenneth I , Lisonkova Sarka
Published: March 2018

Objective

Instrumental vaginal delivery is associated with birth trauma to infant and obstetric trauma to mother. As caesarean delivery rates increased during the past decades, the rate of instrumental vaginal delivery declined. We examined concomitant temporal changes in the rates of severe birth trauma and maternal obstetric trauma.

Design

A retrospective observational study.

Settings and participants

All hospital singleton live births in Washington State, USA, 2004–2013, excluding breech delivery. Severe birth trauma (brain, nerve injury, fractures and other severe birth trauma) and obstetric trauma (third/fourth degree perineal lacerations, cervical/high vaginal lacerations) were identified from hospitalisation data. Pregnancy and delivery characteristics were obtained from birth certificates. Temporal trends were assessed by the Cochran-Armitage test. Logistic regression was used to obtain adjusted ORs (AORs) and 95% CI.

Results

Overall, 732 818 live births were included. The rate of severe birth trauma declined from 5.3 in 2004 to 4.5 per 1000 live births in 2013 (P<0.001). The decline was observed only in spontaneous vaginal delivery, the rates of fractures and other severe birth trauma declined by 5% and 4% per year, respectively (AOR: 0.95, 95% CI 0.94 to 0.97 and AOR: 0.96, 95% CI 0.93 to 0.99; respectively). The rate of third/fourth degree lacerations declined in spontaneous vaginal delivery from 3.5% to 2.3% (AOR: 0.95; 95% CI 0.94 to 0.95) and in vacuum delivery from 17.3% to 14.5% (AOR: 0.97, 95% CI 0.96 to 0.98). Among women with forceps delivery, these rates declined from 29.8% to 23.4% (AOR: 0.98, 95% CI 0.96 to 1.00).

Conclusion

While the rates of fractures and other birth trauma declined among infants delivered by spontaneous vaginal delivery, the rate of birth trauma remained unchanged in instrumental vaginal delivery and caesarean delivery. Among mothers, the rates of severe perineal lacerations declined, except for women with forceps delivery.