bluuebunny/crossref_metadata_2025 huggingface dataset:
Assistive technology for people with PIMD in challenging scenarios
Authors: Engelhardt Meike , Kosiedowski Michał , Duszyńska Irena
Published: May 2020

Purpose

The purpose of this study is to examine in what type of scenarios of daily life assistive technology such as the INSENSION system would provide considerable benefit for people with profound intellectual and multiple disabilities (PIMD).

Design/methodology/approach

A series of focus group workshops were held with relatives of people with PIMD and direct support professionals (DSPs), as well as experts in information and communications technology (ICT). They were oriented towards the design thinking approach and moderated as per the Disney method.

Findings

The participants identified transitions from known to unknown caregivers, provision of care during the night and the impact of external factors on a person’s mood as challenging situations within the PIMD context.

Practical implications

Solving these problems would lead to considerable benefits to the affected people. Based on the ideas gathered in workshops, three technological applications for the INSENSION system were derived, i.e. communication application, multimedia player and smart room devices, all of which will provide remedies in specific usage scenarios.

Originality/value

Methods drawing on the participant’s creativity in combination with the workshops’ multi-perspectivity facilitated a direct reference to the daily life of the target group. In this manner, the innovative ICT system INSENSION can be oriented towards the requirements of this vulnerable group.
Employee wellness on the frontline: an interactional psychology perspective
Authors: Solnet David , Subramony Mahesh , Golubovskaya Maria , Snyder Hannah , Gray Whitney , Liberman Olga , Verma Rohit
Published: May 2020

Purpose

Employee wellness is vital to creating high-quality employee–customer interactions, yet frontline service workers (FLSWs) do not typically engage in, or benefit from, wellness initiatives. This paper aims to conceptually model the interactive influences of organizational and employee factors in influencing FLSW involvement in wellness programs and provides suggestions on how service organizations can enhance wellness behaviors and outcomes.

Design/methodology/approach

This paper builds upon classical and contemporary management theories to identify important gaps in knowledge about how employees and firms engage with wellness. Interactive psychology, emphasizing multidirectional interaction between person (employee) and situation (organization) wellness orientation, is introduced.

Findings

The paper develops a model that can be used to assess organizational wellness program effectiveness by emphasizing the interaction of employee and organizational wellness orientation. The model illustrates that wellness effectiveness relies equally on employee agency through an active wellness orientation matched with the organizational wellness orientation.

Originality/value

This paper questions the dominant approaches to assessing the effectiveness of workplace wellness initiatives, arguing for a more humanistic and agentic perspective rather than traditional organizationally centered fiscal measures.
Feminist criminology in an era of misogyny†
Authors: Chesney‐Lind Meda
Published: May 2020

In this address I make the case for continuing to focus criminological research on gender, sexism, and racism within our lives and within our profession. I also provide a brief case study of a topic many would feel falls well outside our field: reproductive rights. Data are reviewed to reveal the impact of gender on the lives of women—notably the devaluation of work done by women, particularly if the work is deemed feminist. Afterward, recent data on the persistence of both sexism and racism in our field are reviewed. Despite gains made by women (notably in the membership of the field), the highest positions in our professional association are held by men, particularly by White men. Data on the importance of reproductive rights to women are then considered, notably the fact that nearly one third of women will need abortion services by the time they reach middle age. Finally, I review recent efforts by conservatives to recriminalize abortion, specifically through the passage of laws making abortion difficult to arrange, or even outlawing the provision of abortion services. These efforts directly involve the criminal justice system in the criminalization of women's bodies.
Pneumothorax triggered by EGFR‐tyrosine kinase inhibitors in three microwave ablation candidates: A review of the literature
Authors: Guo Runqi , LI Yuanming , Bie Zhixin , Li Bin , Li Xiaoguang
Published: May 2020

Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are widely used in patients with EGFR‐mutant lung cancer. Meanwhile, thermal ablation such as microwave ablation has been an option for selected patients. Herein, we describe three cases of pneumothorax that occurred in microwave ablation (MWA) candidates treated with EGFR‐TKIs. The three patients developed pneumothorax in different periods: case 1 developed pneumothorax two months after MWA and subsequent gefitnib therapy; case 2 took osimertinib for two years and developed pneumothorax before MWA; case 3 took gefitinb for 13 months and experienced bronchopleural fistula after MWA. Although a causal relationship is uncertain, the risk of pneumothorax for these MWA candidates should be considered.

Key points

Microwave ablation candidates treated with epidermal growth factor receptor tyrosine kinase inhibitors are more likely to suffer pneumothorax.

The risk of delayed pneumothorax or even bronchopleural fistula in patients pretreated with tyrosine kinase inhibitors should be taken into consideration when selecting patients and performing microwave ablations.
Cytoplasmic, but not nuclear Nrf2 expression, is associated with inferior survival and relapse rate and response to platinum‐based chemotherapy in non‐small cell lung cancer
Authors: Chen Ming‐Jenn , Lin Po‐Lin , Wang Lee , Cheng Ya‐Min , Chen Chih‐Yi , Lee Huei
Published: May 2020

Background

Several studies have previously indicated that nuclear factor erythroid 2‐related factor 2 (Nrf2) expression may promote tumor progression when the Keap1/Nrf2 pathway is activated, but few reports have demonstrated the role of cytoplasmic Nrf2 on tumorigenesis.

Methods

Immunohistochemistry was conducted to evaluate Nrf2 expression in 167 tumors from surgically‐resected patients with non‐small cell lung cancer (NSCLC). Univariate and multivariate analyses were performed to examine the association of Nrf2 expression with patients' prognosis. This study was conducted to examine the association of Nrf2 expression with tumor response to cisplatin‐based chemotherapy.

Results

Among these tumors, 56 and 32 of 167 tumors expressed Nrf2 in the cytoplasm (34% for C+/N‐) and in the cytoplasm/nucleus (19% for C+/N+), but not in the nucleus of tumor cells. Nrf2 was negatively expressed in the remainder of the tumor samples (C‐/N‐, 79 of 167, 47%). Univariate analysis indicated that patients with Nrf2 positive tumors (C+/N‐ plus C+/N+) had worse overall survival (OS), but not relapse‐free survival (RFS) than with Nrf2 negative tumors (C‐/N‐). However, patients with C+/N‐ tumors possessed worse OS and RFS than those with Nrf2 negative tumors (C‐/N‐). Multivariate analysis further confirmed the prognostic significance of patients with Nrf2 positive and C+/N‐ tumors on OS and RFS, but not on RFS for patients with Nrf2 positive tumors. Patients with Nrf2 positive and C+/N‐ tumors were determined to more frequently have an unfavorable response to cisplatin‐based chemotherapy than those with Nrf2 negative tumors.

Conclusions

Cytoplasmic Nrf2 expression might potentially be used to predict poor prognosis and unfavorable response to cisplatin‐based chemotherapy in patients with NSCLC.

Key points

The expression of cytoplasmic Nrf2 showed a significant relationship with patients' response to cisplatin‐based chemotherapy and influenced NSCLC prognosis.

A proteasomal inhibitor such as carfilzomib might be used to improve the outcomes and therapeutic response to cisplatin‐based chemotherapy in patients with tumors showing cytoplasmic Nrf2 expression.
HLA antibody repertoire in infants suggests selectivity in transplacental crossing
Authors: Savulescu Dana M. , Groome Michelle , Malfeld Susan C. K. , Madhi Shabir , Koen Anthonet , Jones Stephanie , Duxbury Vania , Scheuermaier Karine , De Assis Rosa Debbie , Suchard Melinda
Published: May 2020

Problem

Late in pregnancy, women produce and transfer high amounts of antibodies to the foetus. During gestation, women produce antibodies against human leukocyte antigens (HLA), including antibodies directed at foetal HLA. There is paucity of data on transplacental crossing, specificity and role of HLA antibodies in pregnancy and new‐borns.

Method of study

Using highly sensitive Luminex technology, we measured prevalence of IgG HLA antibodies in 30 mother‐infant pairs six weeks post‐partum. Additionally, in six pregnant women, we measured HLA antibodies longitudinally and HLA‐typed infant DNA to assess whether maternal HLA antibodies were directed at infant specificities.

Results

Overall, 68% of mothers and 44% of infants expressed HLA‐I antibodies and 56% of mothers and 52% of infants expressed HLA‐II antibodies. Infants shared up to 78% of antibodies with their mothers, suggesting that the remaining antibodies were self‐made. Less than 25% of maternal HLA antibodies were detected in infants, possibly due to selection in transplacental crossing. We detected complement‐fixing HLA antibodies in mothers and at low levels in infants. In a third of our pregnant subjects, we detected infant‐directed HLA antibodies.

Conclusion

Our findings raise the possibility of selection in transplacental crossing of HLA antibodies. As HLA antibodies may act as autoantibodies in the neonate, the mechanism of a selective transfer may give important insights into immune tolerance. Findings also suggest that infants start producing their own HLA antibodies in the first weeks of life, which, together with maternally derived antibodies may impact the infant's immune reaction to HLA proteins.
A randomised controlled trial comparing deep neuromuscular blockade reversed with sugammadex with moderate neuromuscular block reversed with neostigmine
Authors: Boggett S. , Chahal R. , Griffiths J. , Lin J. , Wang D. , Williams Z. , Riedel B. , Bowyer A. , Royse A. , Royse C.
Published: May 2020

Deep neuromuscular block aims to improve operative conditions during laparoscopic surgery with a lower intra‐abdominal pressure. Studies are conflicting on whether meaningful improvements in quality of recovery occur beyond emergence, and whether lower intra‐abdominal pressure is achieved. In this pragmatic randomised trial with 1:1 allocation, adults undergoing elective laparoscopic surgery were allocated to moderate neuromuscular block reversed with neostigmine, or deep neuromuscular block reversed with sugammadex. Allocation was revealed to the anaesthetist only. Primary outcome was cognitive recovery of the Postoperative Quality of Recovery Scale, 7 days after surgery. Secondary outcomes included recovery in other domains of the Postoperative Quality of Recovery Scale at 15 min and 40 min; days 1, 3, 7, 14; and 1 and 3 months after surgery. Chi‐square test was used for the primary outcome, and generalised linear mixed model for recovery over time between groups. Of 350 participants randomised, 140 (deep) and 144 (moderate) were analysed for the primary outcome. There was no difference in the Postoperative Quality of Recovery Scale cognitive domain at day 7 (deep 92.9% vs. moderate 91.8%, OR 1.164; 95%CI 0.486–2.788, p = 0.826), or at any other time‐point. No significant difference was observed for physiological, emotive, activities of daily living, nociception, or overall recovery. Length of stay in the recovery area (mean (SD) deep 108 (58) vs. moderate 109 (57) min, p = 0.78) and hospital (1.8 (1.9) vs. 2.6 (3.5) days, p = 0.019) was not different. Intra‐abdominal pressure and surgical operating conditions were not different between groups. Deep neuromuscular block did not improve quality of recovery compared with moderate neuromuscular block in operative laparoscopic surgery over a 1‐h duration.
Multidisciplinary guidance for safe tracheostomy care during the COVID‐19 pandemic: the NHS National Patient Safety Improvement Programme (NatPatSIP)
Authors: McGrath B. A. , Ashby N. , Birchall M. , Dean P. , Doherty C. , Ferguson K. , Gimblett J. , Grocott M. , Jacob T. , Kerawala C. , Macnaughton P. , Magennis P. , Moonesinghe R. , Twose P. , Wallace S. , Higgs A.
Published: May 2020

The COVID‐19 pandemic is causing a significant increase in the number of patients requiring relatively prolonged invasive mechanical ventilation and an associated surge in patients who need a tracheostomy to facilitate weaning from respiratory support. In parallel, there has been a global increase in guidance from professional bodies representing staff who care for patients with tracheostomies at different points in their acute hospital journey, rehabilitation and recovery. Of concern are the risks to healthcare staff of infection arising from tracheostomy insertion and caring for patients with a tracheostomy. Hospitals are also facing extraordinary demands on critical care services such that many patients who require a tracheostomy will be managed outside established intensive care or head and neck units and cared for by staff with little tracheostomy experience. These concerns led NHS England and NHS Improvement to expedite the National Patient Safety Improvement Programme’s ‘Safe Tracheostomy Care’ workstream as part of the NHS COVID‐19 response. Supporting this workstream, UK stakeholder organisations involved in tracheostomy care were invited to develop consensus guidance based on: expert opinion; the best available published literature; and existing multidisciplinary guidelines. Topics with direct relevance for frontline staff were identified. This consensus guidance includes: infectivity of patients with respect to tracheostomy indications and timing; aerosol‐generating procedures and risks to staff; insertion procedures; and management following tracheostomy.
Precipitation gradients, plant biogeography, and the incidence of drip‐tips in Cerrado plant species
Authors: Sullivan Megan K. , Queenborough Simon A.
Published: May 2020

Examining how both climate and species distribution patterns correlate with leaf morphology can give insights into the ecological and evolutionary patterns that drive adaptive selection of leaf form and function. Drip‐tips are a common feature of leaves in rain forest tree species; they are thought to be an adaptation that aids leaf drying and maximizes photosynthesis in areas with high‐rainfall climates. We tested whether this macroecological pattern holds true across the precipitation gradients in a non‐rain forest region—the woodland savannas of Brazil known as the Cerrado—and compared our results with previous studies from Amazonia. Drip‐tips were, as expected, less common overall in the drier Cerrado than in Amazonia. In addition, within the Cerrado, drip‐tips were more prevalent in areas with higher rainfall as well as in Cerrado sites that were closer to Amazonia. Moreover, species that occurred across both the Cerrado and Amazonia had drip‐tips more often than species that were found only in the Cerrado. These findings support the hypothesis that drip‐tips are adaptive and that either the cost of retaining drip‐tips is low or that in drier regions they have other benefits.

Abstract in Portuguese is available with online material.
For Anna: After critical GIS, what next?
Authors: Warren Stacy , Sauders Robert , Dvorak Anna
Published: May 2020

In honour of our lost colleague Anna K. Dvorak, we draw from elements of her last unfinished manuscript to explore new directions in critical GIS education and practice. Anna was a recent PhD in Geography hired into a critical GIS tenure‐track position. The ways in which she wove GIS practice through her research interests, teaching sensibilities, and community advocacy experiences defied easy categorization; we argue she represents a new generation of geography graduate student who is redefining where and how critical GIS education occurs. Anna's social and environmental justice work with the Pacoima Beautiful non‐profit organization in southern California formed the basis for an on‐going research initiative that gave her the opportunity to experiment with GIS as advocacy tool in the hands of local high school students. At the time of her death she had completed an initial draft of a manuscript situating this work in broader community activism issues. We remember Anna by presenting large sections of her work unaltered, interwoven with our commentary on the significance of her approach to critical GIS in a time of shifting academic and corporate commercial relationships to the technology.
Altered cortisol metabolism in individuals with HNF1A‐MODY
Authors: Juszczak Agata , Gilligan Lorna C. , Hughes Beverly A. , Hassan‐Smith Zaki K. , McCarthy Mark I. , Arlt Wiebke , Tomlinson Jeremy W. , Owen Katharine R.
Published: May 2020

Objective and context

Maturity onset diabetes of the young due to variants in HNF1A (HNF1A‐MODY) is the most common form of monogenic diabetes. Individuals with HNF1A‐MODY usually have a lean phenotype which contrasts with type 2 diabetes (T2DM). Data from hepatocytes derived from Hnf1a knock‐out mice demonstrated dysregulation of 11β‐hydroxysteroid dehydrogenase type 1 (11β‐HSD1), which regulates glucocorticoid availability and action in target tissues, together with 11β‐HSD2 and steroid A‐ring reductases, 5α‐ and 5β‐reductase. We proposed that altered glucocorticoid metabolism might underpin some of the phenotypic differences between patients with HNF1A‐MODY and those with T2DM.

Design

A retrospective matched cohort study.

Patients and measurements

24‐hours urine steroid metabolome profiling was carried out by gas chromatography‐mass spectrometry in 35 subjects with HNF1A‐MODY, 35 individuals with T2DM and 35 healthy controls matched for age, sex and BMI. The steroid metabolites were expressed as μg/L in all groups and measured in mid‐morning urine in diabetic subjects and 24‐hour urine collection in healthy controls. Hence, only ratios were compared not the individual steroids. Established ratios of glucocorticoid metabolites were used to estimate 11β‐HSD1/2 and 5α‐ and 5β‐reductase activities.

Results

While 11β‐HSD1 activity was similar in all groups, 11β‐HSD2 activity was significantly lower in subjects with HNF1A‐MODY and T2DM than in healthy controls. The ratio of 5β‐ to 5α‐metabolites of cortisol was higher in subjects with HNF1A‐MODY than in T2DM and healthy controls, probably due to increased activity of the 5β‐reductase (AKR1D1) in HNF1A‐MODY.

Conclusions

This is the first report of steroid metabolites in HNF1A‐MODY. We have identified distinct differences in steroid metabolism pathways in subjects with HNF1A‐MODY that have the potential to alter steroid hormone availability. Further studies are required to explore whether these changes link to phenotype.
Prognostic factors for the outcome of Bells' palsy: A cohort register‐based study
Authors: Urban Elisabeth , Volk Gerd Fabian , Geißler Katharina , Thielker Jovanna , Dittberner Andreas , Klingner Carsten , Witte Otto W. , Guntinas‐Lichius Orlando
Published: May 2020

Objectives

There is a lack of data on patients' and diagnostic factors for prognostication of complete recovery in patients with Bell's palsy.

Design and setting

Cohort register‐based study of 368 patients with Bell's palsy and uniform diagnostics and standardised treatment in a university hospital from 2007 to 2017 (49% female, median age: 51 years).

Main outcome measures

Clinical data, facial grading, electrodiagnostics, motor function tests, non‐motor function tests and onset of prednisolone therapy were assessed for their impact on the probability of complete recovery using univariable and multivariable statistics.

Results

Median onset of treatment was 1.5 days. 46% of patients had a House‐Brackmann scale at baseline of ≥ III. The median recovery time was 2.6 months (95% confidence interval [CI] = 2.1‐3.0). 54.9% achieved a complete recovery. If prednisolone therapy started later than 96 hours after onset, the recovery rate decreased significantly. Beyond less severe palsy, no abnormal electroneurography side difference, no pathological spontaneous activity in electromyography and normal stapedius reflex testing were the most powerful tool for prognostication of recovery after Bell's palsy.

Conclusion

Beyond severity of the palsy, facial electrodiagnostics and stapedius reflex testing are the most powerful tool for prognostication of recovery time after Bell's palsy. Prednisolone therapy should have started at best within a time window of 96 hours after onset to reach the highest probability of complete recovery.
Structure characterization within the vicinity of the fine granular area by synchrotron radiation nano‐CT
Authors: Liu Long , Hou Nan , Li Bochuan , Ma Bo , Hu Songqing , Ding Ning
Published: May 2020

The three‐dimensional (3D) microstructures within the vicinity of the fine granular area (FGA) were investigated with synchrotron radiation nano‐computed tomography (CT). In this investigation, the very high cycle fatigue test of a high‐strength steel was carried out with an ultrasonic fatigue testing machine. Then, focused ion beam cutting was used to cut a part near the surface of the FGA. Finally, the 3D structure of the sample was obtained with the nano‐CT imaging. The results indicated that the base material was composed of various subgrains that are tens to hundreds nanometres in size. Through analysis of the slices, small granular areas consist of several subgrains. The statistical analysis of the subgrain size indicated that the subgrain size near the surface of the FGA is similar to that far from the surface of the FGA and near the fracture surface except the FGA. It indicated that the refinement has not been found by nano‐CT.
Role of magnesium in the risk of intradialytic hypotension among maintenance hemodialysis patients
Authors: Geng Xuemei , Yu Jinbo , Xu Jiarui , Jin Shi , Shao Wenqi , Wang Yimei , Guo Man , Cao Xuesen , Zou Jianzhou , Xu Xialian , Ding Xiaoqiang
Published: May 2020

Introduction

Intradialytic hypotension (IDH) is a common complication in end‐stage renal disease patients on hemodialysis (HD). It has been documented that several factors contribute to IDH. However, the relationship between serum electrolytes and the occurrence of IDH remains unclear. Our study aims to investigate the role of serum magnesium (Mg) for the risk of IDH in maintenance HD patients.

Methods

The retrospective study included adults starting HD before January 2009 in the blood purification center, Zhongshan Hospital, Fudan University, and treated thrice weekly with standard bicarbonate dialysate by low‐flux HD. Patients' characteristics including age and sex, laboratory test results were collected. IDH was defined according to kidney disease outcomes quality initiative (K/DOQI) guidelines as a decrease in systolic blood pressure (SBP) by ≥20 mmHg or a decrease in mean arterial pressure (MAP) by ≥10 mmHg associated with clinical symptoms during HD. Multivariate logistic regression was employed to explore independent risk factors for IDH.

Findings

Among 423 patients recruited, 175 patients (41.4%) suffered from IDH. Compared with those with non‐IDH, patients with IDH presented higher predialysis serum Mg levels. Univariate correlation analysis showed that predialysis serum Mg level was negatively correlated with SBP at 3 hours, 4 hours after dialysis (3 hours SBP r = −0.134 P = 0.006, 4 hours SBP r = −0.142 P = 0.003) and was positively correlated with the differences of blood pressure (BP) (SBP and MAP) (△SBP r = 0.195 P < 0.001, △MAP r = 0.155, P = 0.001). After adjustment for predialysis blood urea nitrogen, platelet distribution width, cardiac troponin T, fasting blood glucose, β2‐microglobulin, and predialysis MAP, multivariate logistic regression analysis demonstrated that predialysis serum Mg level was one of the independent risk factors for IDH (odds ratio [95% confidence interval—CI]: 7.154 (1.568–32.637); P = 0.011). In addition, Mg levels of 1.15 mmol/L or higher were associated with a high incidence of IDH.

Discussion

Our findings suggested that higher predialysis serum Mg level was one of the independent risk factors for IDH among maintenance hemodialysis (MHD patients).
Improved stress measurement of YSZ by Raman spectroscopy: Effect of yttrium segregation‐dependent tetragonality
Authors: Cai Huangyue , Zhang Xing , Hu Li , Guo Fangwei , Wang Xin , Zhao Xiaofeng , Ni Na , Xiao Ping
Published: May 2020

The Raman peaks of metastable yttria‐stabilized zirconia changed with annealing at high temperatures even before the onset of transformation to any monoclinic phase, leading to ambiguous determination of stress‐free references. In this work, the evolution of the Raman bands of metastable YSZ with annealing for different times at different high temperatures were analyzed using the tetragonality variation, which was consequent on the cation redistribution activated by thermal diffusion. The Raman bands linearly varied with the volume weighted tetragonality over the range studied (1.009‐1.015). The cation diffusion changed the bonds length and the associated Raman modes frequencies. A semiempirical equation was established to amend the available calculation for residual stresses by Raman spectroscopy, based on the variation coefficients ratio of two Eg Raman modes (465 cm−1 and 640 cm−1).
Benchmarked Estimators for a Small Area Mean Under a Onefold Nested Regression Model
Authors: Stefan Marius , Hidiroglou Michael
Published: May 2020

In this paper, we modify small area estimators, based on the unit‐level model, so that they add up to reliable higher‐level estimates of population totals. These modifications result in benchmarked small area estimators. We consider two benchmarking procedures. One is based on augmenting the unit‐level model with a suitable variable. The other one uses the calibrated weights of the direct estimators that are reliable at the higher levels. These weights are used in estimators that are based on the aggregation of the unit‐level model for each small area. The mean squared error estimators of the proposed benchmarked estimators are obtained by suitably modifying those associated with the corresponding non benchmarked estimators. The properties of the estimators are evaluated via simulation.
Superimposed mosaicism in tuberous sclerosis complex: a key to understanding all of the manifold manifestations?
Authors: Happle R. , Torrelo A.
Published: May 2020

In patients with tuberous sclerosis, we can today distinguish between two different categories of segmental mosaicism. The well‐known simple segmental mosaicism is characterized by a unilateral or otherwise localized arrangement of the ordinary lesions of the disorder, reflecting heterozygosity for an early postzygotic new mutation. By contrast, superimposed mosaicism is defined by a pronounced segmental involvement in a patient with ordinary non‐segmental lesions of the same disorder, resulting in a heterozygous embryo from loss of the corresponding wild‐type allele that occurred at a very early developmental stage. So far, the second category has been called ‘type 2 segmental mosaicism’, but here we propose the short and unambiguous term ‘superimposed mosaicism’. In order to render physicians familiar with the manifold manifestations of this category as noted in tuberous sclerosis, we review the following clinical designations under which cases suggesting superimposed mosaicism have been published: forehead plaque; shagreen patch; fibrous cephalic plaque; fibromatous lesion of the scalp; folliculocystic and collagen hamartoma; segmental hypomelanosis; congenital segmental lymphedema; and segmental ‘diffuse’ lipomatosis. Molecular corroboration of this genetic concept has been provided in a case of forehead plaque and in a child with shagreen patch. – Extracutaneous manifestations suggesting superimposed mosaicism include columnar tuberous brain defects; ‘radial migration lines’ or ‘cerebral white matter migration lines’ as noted by brain imaging; linear hamartomatous lesions of the tongue; fibrous dysplasia of bones including macrodactyly; and unilateral overgrowth of an arm or leg. – Remarkably, superimposed mosaicism appears to occur in tuberous sclerosis far more frequently than simple segmental mosaicism.
Clinical Judgment Is Paramount When Performing Cognitive Screening during COVID‐19
Authors: Phillips Natalie A. , Andrew Melissa , Chertkow Howard , Pichora‐Fuller Margaret Kathleen , Rockwood Kenneth , Wittich Walter
Published: May 2020

This letter comments on the letter by Rudi Coetzer
First Impressions of Performing Bedside Cognitive Assessment of COVID‐19 Inpatients
Authors: Coetzer Rudi
Published: May 2020

See the Reply by Phillips et al.
Opioid Overdose and Addiction Treatment: A Collaborative Model of Compassion, Patience, and Respect
Authors: Burton William , Martin April
Published: May 2020

Purpose

The purpose of this article is to describe the creation and outcomes of a collaborative model and care facility for opioid overdose and addiction treatment based on compassion, patience, and respect: The Maryhaven Addiction Stabilization Center (MASC).

Approach

MASC was created with the vision to serve clients who have recently overdosed on opioids. In this article, the research, planning, building, and implementation of an opioid treatment center composed of an admission and triage unit, inpatient withdrawal management unit, and inpatient residential unit are described. A multi‐agency and multi‐disciplinary approach were used to immediately engage patients and connect them to treatment for opioid addiction.

Findings

Implementation of a collaborative model of care offers patients who overdose on opioids with immediate access to admission for treatment. This has resulted in significantly higher numbers of patients seeking and staying in treatment.

Conclusions

Through multi‐agency collaboration and a shared commitment to addressing the challenges of the opioid epidemic in innovative ways, more patients who are struggling with addiction have increased opportunities to engage in treatment and move towards recovery.

Clinical Relevance

Clinicians, first responders, and communities can employ MASC principles to guide their approaches to serve patients who have recently overdosed on opioids or who are in active addiction.
Sex differences in HEXACO personality characteristics across countries and ethnicities
Authors: Lee Kibeom , Ashton Michael C.
Published: May 2020

Objective

We examined sex differences in the HEXACO Personality Inventory—Revised (HEXACO‐PI‐R) factor‐ and facet‐level scales and the associations of national sex differences in those scales with national characteristics such as wealth and gender equality.

Method

HEXACO‐PI‐R self‐reports were collected online from persons in 48 countries (N = 347,192).

Results

(1) Women averaged substantially higher than men in Emotionality and in Honesty‐Humility, with (sample‐unweighted) mean differences across countries of d = 0.84 and d = 0.37, respectively; (2) the HEXACO‐PI‐R factor scales showed a rather large multivariate sex difference (D > 1 in most countries), about 19% larger than found in similar samples with the Big Five personality factors, (3) some facet scales belonging to the same factor showed widely varying sex differences, (4) national‐level sex differences in Emotionality were larger in wealthy and gender‐egalitarian countries, replicating previous counterintuitive findings, but such a tendency was not clearly observed for Honesty‐Humility, and (5) within several English‐speaking countries, sex differences in Emotionality showed comparatively little ethnic variation, suggesting that societal characteristics may influence the size of sex differences in Emotionality.

Conclusion

The HEXACO model of personality structure provides some new insights in understanding sex differences in personality at the individual and national levels.
The prevalence of excessive sleepiness is higher in shift workers than in patients with obstructive sleep apnea
Authors: Reis Cátia , Staats Richard , Pellegrino Pollyanna , Alvarenga Tathianna A. , Bárbara Cristina , Paiva Teresa
Published: May 2020

Excessive daytime sleepiness (EDS) is a common feature among shift workers as well as in obstructive sleep apnea (OSA) patients. There are several important accidents related to sleep disturbances causing EDS. The aim of this study was to evaluate EDS in a group of shift workers (regular rotating) from civil aviation and to compare them with OSA patients (n = 300) and with a group of regular workers (RW) (n = 140). Our sample was composed of 730 working‐age individuals (aged 18–67 years). The regular rotating shift workers (SW) sample was composed of 290 aeronautical mechanics. EDS was evaluated with the Epworth Sleepiness Scale (ESS) and defined as a score ≥ 11. The prevalence value obtained for the EDS of RW was 37.1%, for SW it was 60.7% and for OSA patients it was 40.7%. A logistic regression model for EDS in a subsample composed of men and matched for age and BMI, controlling for self‐reported sleep duration, showed an increased risk of EDS for SW (OR = 3.91, p = .001), with the RW group as reference. OSA patients did not differ from RW on EDS levels. This study emphasizes the presence of EDS in a shift work group of civil aviation professionals, which exceeded the EDS level of a positive control group of OSA patients. Sleep hygiene education for companies' workers and management is important and mitigation strategies should be implemented to reduce excessive sleepiness among workers.
Resistance‐associated substitutions in patients with chronic hepatitis C virus genotype 4 infection
Authors: Dietz Julia , Kalinina Olga V. , Vermehren Johannes , Peiffer Kai‐Henrik , Matschenz Katrin , Buggisch Peter , Niederau Claus , Schattenberg Jörn M. , Müllhaupt Beat , Yerly Sabine , Ringelhan Marc , Schmid Roland M. , Antoni Christoph , Müller Tobias , Schulze zur Wiesch Julian , Piecha Felix , Moradpour Darius , Deterding Katja , Wedemeyer Heiner , Moreno Christophe , Berg Thomas , Berg Christoph P. , Zeuzem Stefan , Welsch Christoph , Sarrazin Christoph ,   European HCV Resistance Study Group
Published: May 2020

Data on the prevalence of resistance‐associated substitutions (RASs) and their implications for treatment with direct‐acting antivirals (DAAs) are sparse in European patients with HCV genotype 4. This study investigated RASs before and after DAA failure in different genotype 4 subtypes and evaluated retreatment efficacies. Samples of 195 genotype 4‐infected patients were collected in the European Resistance Database and investigated for NS3, NS5A and NS5B RASs. Retreatment efficacies in DAA failure patients were analysed retrospectively. After NS5A inhibitor (NS5Ai) failure, subtype 4r was frequent (30%) compared to DAA‐naïve patients (5%) and the number of NS5A RASs was significantly higher in subtype 4r compared to 4a or 4d (median three RASs vs no or one RAS, respectively, P < .0001). RASsL28V, L30R and M31L pre‐existed in subtype 4r and were maintained after NS5Ai failure. Typical subtype 4r RASs were located in subdomain 1a of NS5A, close to membrane interaction and protein‐protein interaction sites that are responsible for multimerization and hence viral replication. Retreatment of 37 DAA failure patients was highly effective with 100% SVR in prior SOF/RBV, PI/SOF and PI/NS5Ai failures. Secondary virologic failures were rare (n = 2; subtype 4d and 4r) and only observed in prior NS5Ai/SOF failures (SVR 90%). In conclusion, subtype 4r harboured considerably more RASs compared to other subtypes. A resistance‐tailored retreatment using first‐ and second‐generation DAAs was highly effective with SVR rates ≥90% across all subtypes and first‐line treatment regimens.
Validation and preliminary data from a health‐related quality of life questionnaire for owners of dogs with cardiac disease
Authors: Freeman Lisa M. , Rush John E. , Clark Melissa A. , Bulmer Barret J.
Published: May 2020

Background

Cardiac disease in dogs impacts the quality of life (QoL) of their owners, but owners' QoL has not been comprehensively assessed in this population.

Objectives

To develop, validate, and provide preliminary data from a health‐related QoL (hrQoL) questionnaire for owners of dogs with cardiac disease.

Subjects

A total of 141 owners of dogs with cardiac disease were studied.

Methods

An owner hrQoL (O‐hrQoL) questionnaire containing 20 items related to areas of a person's life that could be impacted by caring for a dog with cardiac disease was developed and administered to owners of dogs with cardiac disease. The highest possible total score was 100, with higher scores indicating a worse hrQoL. Readability, internal consistency, face and construct validity, and item‐total correlations were assessed.

Results

Median O‐hrQoL score was 35 (range, 0‐87). The questionnaire had good internal consistency (Cronbach's α = 0.933), construct validity (Spearman'sr= 0.38‐0.53; Kendall's τ = 0.30‐0.43;P < .001), and item‐total correlation (Spearman'sr= 0.44‐0.79; Kendall's τ = 0.34‐0.66; allP < .001). Fifty percent of owners indicated a negative effect of dogs' cardiac disease on their own QoL, but all owners responded that caring for their dogs either had strengthened (n = 76; 53.9%) or had no effect on their relationship with their dog (n = 65; 46.1%).

Conclusions and clinical importance

The O‐hrQoL questionnaire had good validity, and results suggest that owners' QoL is significantly impacted by caring for dogs with cardiac disease. Additional research on effective approaches to minimizing the negative effects of a dog's cardiac disease on the owner is warranted.
Insularity effects on the morphological space and sexual dimorphism of a tropical tree lizard in western Mexico
Authors: Siliceo‐Cantero H. H. , Benítez‐Malvido J. , Suazo‐Ortuño I.
Published: May 2020

Ecological interactions of lizards on islands tend to differ from those on the mainland, with a decrease in predation and interspecific competition and an increase in intraspecific competition. This may drive morphological divergences from their mainland counterparts, presenting gigantism and frequently sexual dimorphism. The aim of this study was to determine morphological divergence (i.e. head and limbs) and sexual dimorphism in the arboreal lizard Urosaurus bicarinatus on San Agustin Island off the Mexican Pacific Coast. We measured several morphological structures of U. bicarinatus on San Agustin Island, as well as on the adjacent mainland in the state of Jalisco, Mexico. Additionally, we measured individuals from the state of Michoacán and from a preserved collection with individuals from Michoacán and Guerrero. Our results indicated a divergence and an expansion of the morphological space of the island population compared with the mainland. The divergence was accompanied by dwarfism (reduction of the head and limbs with respect to body size) and a lack of sexual dimorphism in morphology and size. Our study contributes to understanding the effect of insularity on lizards’ populations and enriches the knowledge concerning phrynosomatids such as U. bicarinatus.
Disentangling the effects of geographic peripherality and habitat suitability on neutral and adaptive genetic variation in Swiss stone pine
Authors: Dauphin Benjamin , Wüest Rafael O. , Brodbeck Sabine , Zoller Stefan , Fischer Martin C. , Holderegger Rolf , Gugerli Felix , Rellstab Christian
Published: May 2020

It is generally accepted that the spatial distribution of neutral genetic diversity within a species’ native range mostly depends on effective population size, demographic history, and geographic position. However, it is unclear how genetic diversity at adaptive loci correlates with geographic peripherality or with habitat suitability within the ecological niche. Using exome‐wide genomic data and distribution maps of the Alpine range, we first tested whether geographic peripherality correlates with four measures of population genetic diversity at > 17,000 SNP loci in 24 Alpine populations (480 individuals) of Swiss stone pine (Pinus cembra) from Switzerland. To distinguish between neutral and adaptive SNP sets, we used four approaches (two gene diversity estimates,FSToutlier test, and environmental association analysis) that search for signatures of selection. Second, we established ecological niche models forP. cembrain the study range and investigated how habitat suitability correlates with genetic diversity at neutral and adaptive loci. All estimates of neutral genetic diversity decreased with geographic peripherality, but were uncorrelated with habitat suitability. However, heterozygosity (He) at adaptive loci based on Tajima'sDdeclined significantly with increasingly suitable conditions. No other diversity estimates at adaptive loci were correlated with habitat suitability. Our findings suggest that populations at the edge of a species' geographic distribution harbour limited neutral genetic diversity due to demographic properties. Moreover, we argue that populations from suitable habitats went through strong selection processes, are thus well adapted to local conditions, and therefore exhibit reduced genetic diversity at adaptive loci compared to populations at niche margins.
BCR‐ABL tyrosine kinase inhibitors promote pathological changes in dilator phenotype in the human microvasculature
Authors: Durand Matthew J. , Hader Shelby N. , Derayunan Alexa , Zinkevich Natalya , McIntosh Jennifer J. , Beyer Andreas M.
Published: May 2020

Objective

Treatment with BCR‐ABL tyrosine kinase inhibitors (TKIs) is the standard of care for patients with chronic myeloid leukemia, however evidence indicates these compounds may have cardiovascular side‐effects. This study sought to determine if ex vivo exposure of human adipose arterioles to the BCR‐ABL TKIs imatinib and nilotinib causes endothelial dysfunction.

Methods

Human adipose arterioles were incubated overnight in cell culture media containing vehicle (PBS), imatinib (10 µmol/L) or nilotinib (100 µmol/L). Arterioles were cannulated onto glass pipettes and flow mediated dilation (FMD) was assessed via video microscopy. To determine the mechanism of vasodilation, FMD was re‐assessed in the presence of either the nitric oxide synthase inhibitor L‐NAME (100 µmol/L) or the H2O2 scavenger PEG‐Catalase (500 U/mL).

Results

Neither imatinib nor nilotinib affected the magnitude of FMD (max dilation = 78±17% vehicle, 80 ± 24% nilotinib, 73 ± 13% imatinib). FMD was decreased by L‐NAME in vehicle‐treated arterioles (max dilation = 47±29%). Conversely, L‐NAME had no effect on FMD in imatinib‐ or nilotinib‐treated vessels (max dilation = 79±14% and 80 ± 24%, respectively), rather FMD was inhibited by PEG‐Catalase (max dilation = 29±11% and 29 ± 14%, respectively).

Conclusion

Incubating human arterioles with imatinib or nilotinib switches the mediator of FMD from vasoprotective nitric oxide to pro‐inflammatory H2O2.
Anxiety‐related factors associated with symptom severity in irritable bowel syndrome
Authors: Black Christopher J. , Yiannakou Yan , Houghton Lesley A. , Shuweihdi Farag , West Robert , Guthrie Elspeth , Ford Alexander C.
Published: May 2020

Background

Gastrointestinal symptom‐specific anxiety and somatization have both been associated with higher symptom severity in patients with irritable bowel syndrome (IBS); however, this relationship has not been explored fully. Moreover, the performance of the visceral sensitivity index (VSI) for measuring gastrointestinal symptom‐specific anxiety has not been examined in a UK population. We conducted a cross‐sectional survey to examine these issues.

Methods

Gastrointestinal symptom‐specific anxiety was measured using the VSI, and somatization was measured via the patient health questionnaire‐12 (PHQ‐12) in adults from the UK community with Rome IV‐defined IBS. Exploratory factor analysis was performed on the VSI, prior to subsequent analyses, to establish its factor structure. Multiple regression analysis was used to determine the relationship between demographic features, different factors of the VSI, somatization, and IBS symptom severity.

Key Results

A total of 811 individuals with IBS provided complete data. Factor analysis of the VSI revealed a three‐factor structure, accounting for 47% of the variance. The first of these VSI factors and the PHQ‐12 were both strongly and independently associated with IBS symptom severity, for the group as a whole and for all four IBS subtypes. Most VSI items concerned with overt gastrointestinal symptom‐specific anxiety loaded onto the other two VSI factors that were not associated with symptom severity.

Conclusions and Inferences

The factor structure of the VSI requires further investigation. Our findings cast doubt on the central role of gastrointestinal symptom‐specific anxiety as a driver for symptom severity in IBS. Awareness of both gastrointestinal and extra‐intestinal symptoms, however, is strongly associated with symptom severity.
Policy instruments at work: A meta‐analysis of their applications
Authors: Acciai Claudia , Capano Giliberto
Published: May 2020

This article uses a systematic review of the main literature in the field to shed light on different operationalizations of the main classifications of policy instruments. Although the literature offers a large number of instrument taxonomies, many of them act as theoretical guidelines rather than operational concepts that can help to disentangle the different features of governing actions. This article provides a review of the most frequently used policy instrument typologies and, through a meta‐analysis, it analyses how instrument typologies have been differentially adopted to explain real‐world phenomena. The results are a high degree of heterogeneity in citation frequency, the polyhedral nature of the concept of policy instruments, a divide between typologies focused on governmental resources and those focused on drivers of expected behaviour, and ‘labellism’. Thus, what emerges is the urgency of a process of convergence towards a common framework.
Using public databases for genomic prediction of tropical maize lines
Authors: Pinho Morais Pedro Patric , Akdemir Deniz , Braatz de Andrade Luciano Rogério , Jannink Jean‐Luc , Fritsche‐Neto Roberto , Borém Aluízio , Couto Alves Filipe , Hottis Lyra Danilo , Granato Ítalo Stefanine Correia
Published: May 2020

In this paper, the aims were (a) to test the usefulness of using genomic and phenotypic information from public databases (open access) to predict genetic values for tropical maize inbred lines regarding plant and ear height; (b) to identify how the population structure, the use of optimized training sets (OTSs) and the amount of information originating from public databases affect the predictive ability. Thus, 29 training sets (TSs) were defined considering three diversity panels: the University of São Paulo (USP—validation set (VS)) and the ASSO and USDA North Central Regional Plant Introduction Station (NCRPIS) (external public panels—predictors), which were divided into four scenarios with different TS configurations. We showed that it is possible to use public datasets as a primary TS and that population structure can modify the predictive abilities of GS. In the four scenarios proposed, very large or very small sets did not provide predictive abilities over 0.53 for GS. However, OTSs composed of 250 individuals were sufficient to achieve predictive abilities over this limit.