bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Uncertainty Parameter Distribution on Robust Decision Making Outcomes for Climate Change Adaptation under Deep Uncertainty
Authors: Reis Julia , Shortridge Julie
Published: October 2019

Deep uncertainty in future climatic and economic conditions complicates developing infrastructure designed to last several generations, such as water reservoirs. In response, analysts have developed multiple robust decision frameworks to help identify investments and policies that can withstand a wide range of future states. Although these frameworks are adept at supporting decisions where uncertainty cannot be represented probabilistically, analysts necessarily choose probabilistic bounds and distributions for uncertain variables to support exploratory modeling. The implications of these assumptions on the analytical outcomes of robust decision frameworks are rarely evaluated, and little guidance exists in terms of how to select uncertain variable distributions. Here, we evaluate the impact of these choices by following the robust decision‐making procedure, using four different assumptions about the probabilistic distribution of exogenous uncertainties in future climatic and economic states. We take a water reservoir system in Ethiopia as our case study, and sample climatic parameters from uniform, normal, extended uniform, and extended normal distributions; we similarly sample two economic parameters. We compute regret and satisficing robustness decision criteria for two performance measures, agricultural water demand coverage and net present value, and perform scenario discovery on the most robust reservoir alternative. We find lower robustness scores resulting from extended parameter distributions and demonstrate that parameter distributions can impact vulnerabilities identified through scenario discovery. Our results suggest that exploratory modeling within robust decision frameworks should sample from extended, uniform parameters distributions.
Empirically supporting school STEM culture—The creation and validation of the STEM Culture Assessment Tool (STEM‐CAT)
Authors: White Chris , Marshall Jeff C. , Alston Danny
Published: October 2019

School STEM Culture—an aspect of culture within a school community—is defined as the beliefs, values, practices, and resources in STEM fields as perceived by students, parents, teachers, and administrators and counselors within a school. This study validates the STEM Culture Assessment Tool (STEM‐CAT), an instrument intended to advance the use of the School STEM Culture construct within the research community. Internal consistency was determined through the use of Cronbach's alpha and factor analyses, and the instrument was found to be a reliable measure of School STEM Culture. The instrument can be used in future research to quantify School STEM Culture to determine if interventions change the culture of a school to further STEM education.
Measuring the structural similarity of network time prisms using temporal signatures with graph indices
Authors: Jaegal Young , Miller Harvey J.
Published: October 2019

The network‐time prism (NTP) is an extension of the space‐time prism that provides a realistic model of the potential pattern of moving objects in transportation networks. Measuring the similarity among NTPs can be useful for clustering, aggregating, and querying potential mobility patterns. Despite its practical importance, however, there has been little attention given to similarity measures for NTPs. In this research, we develop and evaluate a methodology for measuring the structural similarity between NTPs using the temporal signature approach. The approach extracts the one‐dimensional temporal signature of a selected property of NTPs and applies existing path similarity measures to the signatures. Graph‐theoretic indices play an essential role in summarizing the structural properties of NTPs at each moment. Two extensive simulation experiments demonstrate the feasibility of the approach and compare the performance of graph indices for measuring NTP similarity. An empirical application using bike‐share system data shows that the method is useful for detecting different usage patterns of two heterogenous user groups.
Laurent phenomenon and simple modules of quiver Hecke algebras
Authors: Kashiwara Masaki , Kim Myungho
Published: October 2019

In this paper we study consequences of the results of Kang et al. [Monoidal categorification of cluster algebras, J. Amer. Math. Soc.31(2018), 349–426] on a monoidal categorification of the unipotent quantum coordinate ring$A_{q}(\mathfrak{n}(w))$together with the Laurent phenomenon of cluster algebras. We show that if a simple module$S$in the category${\mathcal{C}}_{w}$strongly commutes with all the cluster variables in a cluster$[\mathscr{C}]$, then$[S]$is a cluster monomial in$[\mathscr{C}]$. If$S$strongly commutes with cluster variables except for exactly one cluster variable$[M_{k}]$, then$[S]$is either a cluster monomial in$[\mathscr{C}]$or a cluster monomial in$\unicode[STIX]{x1D707}_{k}([\mathscr{C}])$. We give a new proof of the fact that the upper global basis is a common triangular basis (in the sense of Qin [Triangular bases in quantum cluster algebras and monoidal categorification conjectures, Duke Math.166(2017), 2337–2442]) of the localization$\widetilde{A}_{q}(\mathfrak{n}(w))$of$A_{q}(\mathfrak{n}(w))$at the frozen variables. A characterization on the commutativity of a simple module$S$with cluster variables in a cluster$[\mathscr{C}]$is given in terms of the denominator vector of$[S]$with respect to the cluster $[\mathscr{C}]$.
Nurse-initiated spontaneous breathing trials in adult intensive care unit patients: a scoping review
Authors: Starnes Elizabeth , Palokas Michelle , Hinton Elizabeth
Published: October 2019

Objective:

The objective of this scoping review was to explore existing literature on protocols initiated by nurses for a spontaneous breathing trial in adult intensive care unit (ICU) patients in order to examine and conceptually map the evidence, and identify gaps in the literature.

Introduction:

Nurses are vital in the care of the critically ill mechanically ventilated patient. By involving the nurse in the weaning process through implementing the final stage of the weaning process, the spontaneous breathing trial, patients may liberate from mechanical ventilation more readily, thereby reducing the cost of care and number of complications associated with prolonged ventilation.

Inclusion criteria:

This review considered experimental and quasi-experimental study designs, analytical observational studies, case-control studies, analytical cross-sectional studies, descriptive observational studies, qualitative studies, and text and opinion papers. Adult ICU patients, aged 18 and over who were mechanically ventilated and candidates for weaning to spontaneous breathing trials, were included in the review. Adult ICUs included but were not limited to burn ICUs, cardiovascular ICUs, medical ICUs, neurological ICUs, surgical ICUs and trauma ICUs in all geographic locations. This scoping review considered studies that examined the use of nurse-initiated protocols for a spontaneous breathing trial.

Methods:

The Joanna Briggs Institute scoping review methodology was used. Key information sources searched were Cochrane Database of Systematic Reviews, PubMed, PROSPERO, DARE, CINAHL, Embase, Scopus, Academic Search Premier, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, MedNar, ProQuest Dissertations and Theses, Papers First and societal websites with information relevant to the scoping review. Only studies published in English were included, and no date limits were applied. The data extraction tool was developed by the authors to examine information retrieved from the studies.

Results:

Four studies, with 430 participants, were included in this review. One study was a non-randomized controlled trial, two were randomized controlled studies, and one was a text and opinion paper. The four studies included in the review identified both eligibility criteria for spontaneous breathing trial initiation, detailed elements of a spontaneous breathing trial, and criteria for success. Three of the four studies reported outcomes with the use of protocols for spontaneous breathing trials initiated by nurses.

Conclusions:

All included studies support the utilization of protocols and allowing the nurse to initiate the protocol, however variations in the eligibility criteria, details of the spontaneous breathing trial and success criteria create ambiguity in practice.
Positional effects of premature termination codons on the biochemical and biophysical properties of CFTR
Authors: Yeh Jiunn‐Tyng , Hwang Tzyh‐Chang
Published: October 2019

Key points

Biochemical and biophysical characterizations of three nonsense mutations of cystic fibrosis transmembrane conductance regulator (CFTR) associated with a severe form of cystic fibrosis (CF) reveal the importance and heterogenous effects of the position of the premature termination codon (PTC) on the CFTR protein function.

Electrophysiological studies of W1282X‐CFTR, whose PTC is closer to the C‐terminus of CFTR, suggest the presence of both C‐terminus truncated CFTR proteins that are poorly functional and read‐through, full‐length products.

For G542X‐ and E60X‐CFTR, the only mechanism capable of generating functional proteins is the read‐through, but the outcome of read‐through products is highly variable depending on the interplay between the missense mutation caused by the read‐through and the structural context of the protein.

Pharmacological studies of these three PTCs with various CFTR modulators suggest position‐dependent therapeutic strategies for these disease‐inflicting mutations.

About one‐third of genetic diseases and cancers are caused by the introduction of premature termination codons (PTCs). In theory, the location of the PTC in a gene determines the alternative mechanisms of translation, including premature cessation or reinitiation of translation, and read‐through, resulting in differential effects on protein integrity. In this study, we used CFTR as a model system to investigate the positional effect of the PTC because of its well‐understood structure‐function relationship and pathophysiology. The characterization of three PTC mutations, E60X‐, G542X‐ and W1282X‐CFTR revealed heterogenous effects of these PTCs on CFTR function. The W1282X mutation results in both C‐terminus truncated and read‐through proteins that are partially or fully functional. In contrast, only the read‐through protein is functional with E60X‐ and G542X‐CFTR, although abundant N‐terminus truncated proteins due to reinitiation of translation were detected in E60X‐CFTR. Single‐channel studies of the read‐through proteins of E60X‐ and G542X‐CFTR demonstrated that both mutations have a single‐channel amplitude similar to wild type (WT), and good responses to high‐affinity ATP analogues, suggesting intact ion permeation pathways and nucleotide binding domains (NBDs), albeit with reduced open probability (Po). The comparison of the Po of these mutations with the proposed missense mutations revealed potential identities of the read‐through products. Importantly, a majority of the functional protein studied responds to CFTR modulators like GLPG1837 and Lumacaftor. These results not only expand current understanding of the molecular (patho)physiology of CFTR, but also infer therapeutic strategies for different PTC mutations at large.
Future Prospects of Smallholder Dairy Production: Pragmatic Evidence from Crop-Livestock Farming Systems of an Economically Transforming State in India
Authors: D Thirunavukkarasu , N Narmatha , K.A. Doraisamy , V. RAMESH SARAVANAKUMAR , K.M. SAKTHIVEL
Published: October 2019

In the context of structural transformation of Indian economy, we examined the patterns of income, migration, milk marketing, dairy trends and future plans at the household level in Tamil Nadu state in south India. The study finds that majority of the dairy households in various farming systems have poor landholdings; belong to low or middle income classes; have one migrant in their families, and diversified sources of income. Given this backdrop, continuing dairy activity in the near future differed based on farming system and market opportunities. The majority were not willing to motivate the next generation to take up dairying as a profession.
La problemática de las definiciones en el análisis del nacionalismo y la nación desde el paradigma del modernismo
Authors: Reyes Pascual Guillermo
Published: October 2019

Aunque el estudio académico del nacionalismo ha tenido un profundo desarrollo desde la década de los 60, todavía se suelen atisbar ciertas dificultades teóricas para concretar los términos que se emplean. Una de las razones puede ser la utilización de conceptos capitales, como nacionalismo y nación, de forma poco rigurosa y precisa. Se podría decir que, hasta cierto punto, hay tantas definiciones para estos dos conceptos como actores. El objetivo de este artículo de reflexión es proponer, de forma concisa, una serie de definiciones de los términos nacionalismo y nación desde el paradigma modernista del nacionalismo. Se pretende aportar claridad a los debates que teorizan sobre el nacionalismo desde una perspectiva analítica profunda y consolidada entre gran parte de los autores que deliberan sobre este fenómeno social. Primero, se hace un breve resumen del modernismo como paradigma del nacionalismo. Esto viene seguido de un análisis de los diferentes fundamentos teóricos de ambos conceptos que tienen cierta aceptación dentro del modernismo. Finalmente, se da una posible definición para cada uno de estos dos términos desde este punto de vista modernista. La principal conclusión es que se deben repensar estos conceptos teóricos clave para analizar las formas complejas de las sociedades contemporáneas.
Against the Tide
Authors: Bridget Mintz Testa
Published: October 2019

Many of the world’s largest cities are near the ocean, and more than 600 million people live within 10 meters of sea level. A lot of hard-to-replace infrastructure—ports, power plants, transmission lines, oil refineries, sewage treatment facilities, telecommunications cables, and highways—have been built close to the water. As glaciers melt and warmed waters expand in volume, that infrastructure will be threatened. In the face of this relentless tide, engineers are looking at what can be done.
Modeling the noise mitigation of a bubble curtain
Authors: Bohne Tobias , Grießmann Tanja , Rolfes Raimund
Published: October 2019

The bubble curtain is one of the most used measures to reduce underwater pile driving noise. A model of the local distribution of the effective wavenumber was developed. The bubble size distribution was derived from tank measurements. The local distribution of the air fraction was determined by means of an integral method. In a preliminary step, the transfer characteristics of a bubble curtain were studied. The results show a decrease of the transmission coefficient for higher frequencies and additionally for lower water depths. For lower frequencies, λ/2-transmission can be observed. Examining the noise mitigation of a bubble curtain under offshore conditions, a model of the acoustical scenario was developed. Two different offshore measurement sites are described in detail and compared to the modeling results. The distance between bubble curtain and the pile was identified as an important parameter affecting the noise mitigation. The presented approach shows an appropriate representation of the noise mitigation and allows, due to its generic definition, for future investigations of various aspects, e.g., the influence of the soil or the effect of an extra pile near system on the noise mitigation.
Muscle Mass and Muscle Strength Relationships to Balance: The Role of Age and Physical Activity
Authors: Gouveia Élvio R. , Ihle Andreas , Gouveia Bruna R. , Kliegel Matthias , Marques Adilson , Freitas Duarte L.
Published: October 2019

Objective:To investigate the relations of balance to muscle mass (MM) and muscle strength (MS), depending on age and physical activity, which is of particular importance to functional independence in older people.Methods:This cross-sectional study included 802 volunteers (69.82 ± 5.60 years). The Fullerton Advanced Balance scale was used to assess balance and a composite score, including arm curl and chair stand tests for assessing MS. MM was estimated by dual-energy X-ray absorptiometry and physical activity by questionnaire.Results:Greater MM (r = .26,p < .001) and MS (r = .53,p < .001) were positively correlated to balance. The old-old adults and less active individuals attained lower balance. Notably, moderation and subsequent simple slope analyses revealed that the relations of balance, MM, and MS were larger in less active and the old-old adults.Conclusions:The old-old and less active adults were more prone to muscle weakness and balance impairments. Tailored interventions should particularly consider these vulnerable groups.
Lessons From the Experts: The Effect of a Cognitive Processing Intervention During Deliberate Practice of a Complex Task
Authors: Coughlan Edward K. , Williams A. Mark , Ford Paul R.
Published: October 2019

Deliberate practice is defined as an activity that is highly relevant to improving performance. It is effortful, challenging, not inherently enjoyable, or immediately rewarding and underpinned by advanced cognitive processing. The authors examine the effect of increasing cognitive processing during deliberate practice on skill learning in intermediate-level performers using a novel approach and quasi-experimental design. Two matched groups of intermediate-level Gaelic football players practiced a kick they identified as being most relevant to improving performance during an acquisition phase and pre-, post-, and retention tests. During acquisition, participants rated practice for cognitive effort and enjoyment. An intervention group engaged in structured cognitive processing before, during, and after the kicking practice sessions, whereas a control group did not. Both groups improved kicking accuracy across pre-, post-, and retention tests; however, the intervention group improved accuracy significantly more than the control group. The intervention group rated practice greater for mental effort compared with the control group, while both groups rated practice low for enjoyment. The intervention group increased reflection and evaluation to a greater degree following practice compared with the control group. Findings highlight the value of applying the principles of deliberate practice and increasing cognitive processing to expedite learning in intermediate-level performers, with implications for skill learning across many professional domains.
Gas flow and accretion via spiral streamers and circumstellar disks in a young binary protostar
Authors: Alves F. O. , Caselli P. , Girart J. M. , Segura-Cox D. , Franco G. A. P. , Schmiedeke A. , Zhao B.
Published: October 2019

Gas flows and disks in a young binary

Many stars are in binary systems, pairs of stars gravitationally bound to each other, often with the two components having similar masses. It remains unclear how these systems assemble and accrete material. Alves
et al.
made high-resolution observations of a young binary star that is still in the process of forming. A large disk surrounds both stars, and each component also has its own smaller circumstellar disk. Spiral filaments of dust and gas connect the small disks to the larger one. Material is accreting preferentially onto the star that currently has a lower mass, driving the masses toward similar values.

Science
, this issue p.
90
Gas filaments of the cosmic web located around active galaxies in a protocluster
Authors: Umehata H. , Fumagalli M. , Smail I. , Matsuda Y. , Swinbank A. M. , Cantalupo S. , Sykes C. , Ivison R. J. , Steidel C. C. , Shapley A. E. , Vernet J. , Yamada T. , Tamura Y. , Kubo M. , Nakanishi K. , Kajisawa M. , Hatsukade B. , Kohno K.
Published: October 2019

Glowing filaments of the cosmic web

Most gas in the Universe lies in the intergalactic medium, where it forms into sheets and filaments of the cosmic web. Clusters of galaxies form at the intersection of these filaments, fed by gas pulled along them by gravity. Although this picture is well established by cosmological simulations, it has been difficult to demonstrate observationally. Umehata
et al.
mapped emission from the intergalactic medium in an area around galaxies that are starting to form a cluster (see the Perspective by Hamden). They found that the gas is arranged into filaments, whose position and velocity correlate with star-forming galaxies, supporting the theoretical picture.

Science
, this issue p.
97
; see also p.
31
Evolution of vocal learning and spoken language
Authors: Jarvis Erich D.
Published: October 2019

Although language, and therefore spoken language or speech, is often considered unique to humans, the past several decades have seen a surge in nonhuman animal studies that inform us about human spoken language. Here, I present a modern, evolution-based synthesis of these studies, from behavioral to molecular levels of analyses. Among the key concepts drawn are that components of spoken language are continuous between species, and that the vocal learning component is the most specialized and rarest and evolved by brain pathway duplication from an ancient motor learning pathway. These concepts have important implications for understanding brain mechanisms and disorders of spoken language.
The neurobiology of language beyond single-word processing
Authors: Hagoort Peter
Published: October 2019

In this Review, I propose a multiple-network view for the neurobiological basis of distinctly human language skills. A much more complex picture of interacting brain areas emerges than in the classical neurobiological model of language. This is because using language is more than single-word processing, and much goes on beyond the information given in the acoustic or orthographic tokens that enter primary sensory cortices. This requires the involvement of multiple networks with functionally nonoverlapping contributions.
Remodeling the genome with DNA twists
Authors: Bowman Gregory D. , Deindl Sebastian
Published: October 2019

Intricate protein machines repackage DNA to turn genes on and off
Justice and genes
Altered Inheritance
Françoise Baylis
Harvard University Press, 2019. 297 pp.
Authors: Hayden Adam
Published: October 2019

A new book offers an introduction to the ethical dimensions of germline gene editing
They Mite B GCs
Authors: Lowe Margaret M. , Rosenblum Michael D.
Published: October 2019

T follicular regulatory cells restrain and refine germinal center responses in vivo.
Comparative
In Vivo
Antibacterial Activity of Human-Simulated Exposures of Cefiderocol and Ceftazidime against
Stenotrophomonas maltophilia
in the Murine Thigh Model
Authors: Chen Iris H. , Kidd James M. , Abdelraouf Kamilia , Nicolau David P.
Published: October 2019

Cefiderocol is a novel siderophore cephalosporin that utilizes bacterial ferric iron transports to cross the outer membrane. Cefiderocol shows high stability against all classes of β-lactamases, rendering it extremely potent against carbapenem- and multidrug-resistant Gram-negative organisms.
Metagenomic Signatures of Gut Infections Caused by Different
Escherichia coli
Pathotypes
Authors: Peña-Gonzalez Angela , Soto-Girón Maria J. , Smith Shanon , Sistrunk Jeticia , Montero Lorena , Páez Maritza , Ortega Estefanía , Hatt Janet K. , Cevallos William , Trueba Gabriel , Levy Karen , Konstantinidis Konstantinos T.
Published: October 2019

E. coli
infectious diarrhea is an important contributor to child mortality worldwide. However, diagnosing and thus treating
E. coli
infections remain challenging due to technical and other reasons associated with the limitations of the traditional culture-based techniques and the requirement to apply Koch’s postulates. In this study, we integrated traditional microbiology techniques with metagenomics and epidemiological data in order to identify cases of diarrhea where
E. coli
was most likely the causative disease agent and evaluate specific signatures in the disease-state gut microbiome that distinguish between diffuse adherent, enterotoxigenic, and enteropathogenic
E. coli
pathotypes. Therefore, our methodology and results should be highly relevant for diagnosing and treating diarrheal infections and have important applications in public health.
Implications of Mobile Genetic Elements for
Salmonella enterica
Single-Nucleotide Polymorphism Subtyping and Source Tracking Investigations
Authors: Li Shaoting , Zhang Shaokang , Baert Leen , Jagadeesan Balamurugan , Ngom-Bru Catherine , Griswold Taylor , Katz Lee S. , Carleton Heather A. , Deng Xiangyu
Published: October 2019

Despite increasingly routine use of WGS and SNP subtyping in outbreak and source tracking investigations, whether and how MGEs affect SNP subtyping has not been thoroughly investigated. Besides chromosomal MGEs, plasmids are frequently entangled in draft genome assemblies and yet to be assessed for their impact on SNP subtyping. This study provides evidence-based guidance on the treatment of MGEs in SNP analysis for
Salmonella
to infer phylogenetic relationship and SNP distance between isolates.
Construction and Characterization of the Mycobacterium tuberculosis
sigE fadD26
Unmarked Double Mutant as a Vaccine Candidate
Authors: Hernandez-Pando Rogelio , Shin Sung Jae , Clark Simon , Casonato Stefano , Becerril-Zambrano Martin , Kim Hongmin , Boldrin Francesca , Mata-Espinoza Dulce , Provvedi Roberta , Arbues Ainhoa , Marquina-Castillo Brenda , Cioetto Mazzabò Laura , Barrios-Payan Jorge , Martin Carlos , Cho Sang-Nae , Williams Ann , Manganelli Riccardo
Published: October 2019

Despite the great increase in the understanding of the biology and pathogenesis of
Mycobacterium tuberculosis
achieved by the scientific community in recent decades, tuberculosis (TB) still represents one of the major threats to global human health.
B Cell-Intrinsic SHP1 Expression Promotes the Gammaherpesvirus-Driven Germinal Center Response and the Establishment of Chronic Infection
Authors: Johnson K. E. , Lange P. T. , Jondle C. N. , Volberding P. J. , Lorenz U. M. , Cui W. , Dittel B. N. , Tarakanova V. L.
Published: October 2019

Gammaherpesviruses establish lifelong infection in a majority of adults worldwide and are associated with a number of malignancies, including B cell lymphomas. These viruses infect naive B cells and manipulate B cell differentiation to achieve a lifelong infection of memory B cells. The germinal center stage of B cell differentiation is important as both an amplifier of the viral latent reservoir and the target of malignant transformation. In this study, we demonstrate that expression of tyrosine phosphatase SHP1, a negative regulator that normally limits the activation and proliferation of hematopoietic cells, enhances the gammaherpesvirus-driven germinal center response and the establishment of chronic infection. The results of this study uncover an intriguing beneficial interaction between gammaherpesviruses that are presumed to profit from B cell activation and a cellular phosphatase that is traditionally perceived to be a negative regulator of the same processes.
Rare basal cell metastasis of a basal-squamous skin collision tumour to the lung and axillary lymph node
Authors: Li Rui , Lee Gina , Huang Min , El-Sherief Ahmed
Published: October 2019

We report a case of a 60-year-old man who was a former cigar smoker with a slow-growing, large exophytic left shoulder mass (15 cm in diameter) and later found to have left axillary lymphadenopathy. Fine needle aspirate biopsy of the left shoulder mass revealed squamous cell carcinoma (SCC). However, pathology of the enlarged left axillary lymph node was reported as metastatic adenocarcinoma. The patient underwent surgical resection of the shoulder mass which comprised of SCC (>95%) and adenoid basal cell carcinoma (BCC) as a second component of the tumour. The BCC had identical histology as the metastatic carcinoma in the left axillary lymph node. Therefore, diagnosis was revised as cutaneous collision tumour with metastatic BCC. Six months later following adjuvant radiation therapy, the patient was diagnosed with metastatic BCC in the right lung. Stereotactic body radiation therapy (SBRT) and a selective hedgehog pathway inhibitor vismodegib were given with only limited efficacy. Clinical trial registration numberNCT03132636.
Histopathology and selective biomarker expression in human meibomian glands
Authors: Reneker Lixing W , Irlmeier Rebecca T , Shui Ying-Bo , Liu Ying , Huang Andrew J W
Published: October 2019

Background/aims

Meibomian gland dysfunction (MGD) is the most common form of evaporative dry eye disease, but its pathogenesis is poorly understood. This study examined the histopathological features of meibomian gland (MG) tissue from cadaver donors to identify potential pathogenic processes that underlie MGD in humans.

Methods

Histological analyses was performed on the MGs in the tarsal plates dissected from four cadaver donors, two young and two old adults, including a 36-year-old female (36F) and three males aged 30, 63 and 64 years (30M, 63M and 64M).

Results

The MGs of 36F displayed normal anatomy and structure, whereas the MGs of 30M showed severe ductal obstruction with mild distortion. The obstruction was caused by increased cytokeratin levels in association with hyperproliferation, but not hyperkeratinisation. In two older males, moderate to severe MG atrophy was noted. Cell proliferation was significantly reduced in the MG acini of the two older donors as measured by Ki67 labelling index (6.0%±3.4% and 7.9%±2.8% in 63M and 64M, respectively) when compared with that of the two younger donors (23.2%±5.5% and 16.9%±4.8% in 30M and 36F, respectively) (p<0.001). The expression patterns of meibocyte differentiation biomarkers were similar in the older and younger donors.

Conclusion

Our histopathological study, based on a small sample size, suggests potentially distinct pathogenic mechanisms in MGD. In the young male adult, hyperproliferation and aberrant differentiation of the central ductal epithelia may lead to the obstruction by overproduced cytokeratins. In contrast, in older adults, decreased cell proliferation in acinar basal epithelia could be a contributing factor leading to MG glandular atrophy.
Comparison of a commercial spectral-domain OCT and swept-source OCT based on an angiography scan for measuring circumpapillary retinal nerve fibre layer thickness
Authors: Tan Bingyao , Chua Jacqueline , Harish Thiyagrajan , Lau Amanda , Gan Alfred Tau Liang , Tan Yar Li , Wong Damon W K , Chong Rachel Shujuan , Ang Marcus , Husain Rahat , Schmetterer Leopold
Published: October 2019

Background/aims

To assess the agreement in measuring retinal nerve fibre layer (RNFL) thickness between spectral-domain (SD; Cirrus HD, Carl Zeiss Meditec, USA) optical coherence tomography (OCT) and swept-source (SS; Plex Elite 9000, Carl Zeiss Meditec) OCT using an OCT angiography (OCTA) scanning protocol.

Methods

57 participants (12 glaucomatous, 8 ocular hypertensive and 74 normal eyes) were scanned with two OCT instruments by a single experienced operator on the same day. Circumpapillary RNFL thicknesses were automatically segmented for SD-OCT and manually segmented for SS-OCTA scans. Agreement of global RNFL thickness, as well as average thickness in four quadrants was assessed using intraclass correlation coefficients (ICCs).

Results

There was excellent agreement in the inferior and superior quadrants and the global (all ICC >0.90), followed by good agreement in the temporal (ICC=0.79) and nasal (ICC=0.73) quadrants. The ICC values were similar in the subgroups except within the ocular hypertension group, where the nasal quadrant was less agreeable (ICC=0.31). SS-OCTA-derived RNFL thickness was on average 3 µm thicker than SD-OCT, particularly in the nasal (69.7±11.5 µm vs 66.3±9.3 µm; p<0.001) and temporal (75.6±13.7 µm vs 67.9±12.3 µm; p<0.001) quadrants.

Conclusions

RNFL measurements taken with SS-OCTA have good-to-excellent agreement with SD-OCT, which suggests that the RNFL thickness can be sufficiently extracted from wide-field OCTA scans.
Optical coherence tomography angiography for the assessment of choroidal vasculature in high myopia
Authors: Devarajan Kavya , Sim Ralene , Chua Jacqueline , Wong Chee Wai , Matsumura Saiko , Htoon Hla M , Schmetterer Leopold , Saw Seang Mei , Ang Marcus
Published: October 2019

Aims

To assess specific layers of the choroid in highly myopic young adults and to examine their associations with levels of myopia.

Methods

We recruited 51 young myopes (n=91 eyes) from the Singapore Cohort of Risk Factors for Myopia cohort. We performed standardised optical coherence tomography (OCT) and OCT angiography imaging and developed a novel segmentation technique assessing choroidal layers’ thickness (overall choroidal thickness (CT), medium-vessel choroidal layer (MVCL) thickness, large-vessel choroidal layer (LVCL)) and vasculature (choroidal vessel density (%), choroidal branch area (CBA, %) and mean choroidal vessel width (MCVW, mm)).

Results

We found that eyes with extreme myopia (EM) had thinner vascular layers compared with high myopia (HM), that is, LVCL (36.0±1.5 vs 39.2±1.2 µm, p=0.002) and MVCL (185.5±5.7 vs 198.2±4.6 µm, p=0.014). Overall CT was thinnest in the nasal and inferior quadrants in EM (nasal: 157.1±9.6 vs 187.2±8.3 µm, p<0.001; superior: 236.6±11.1 vs 257.0±9.5 µm, p=0.02; temporal: 228.0±10.6 vs 254.3±8.8 µm, p=0.012; and inferior quadrant: 198.7±10.0 vs 239.8±8.3 µm, p=<0.001) when compared with HM. We also observed significantly more vessel branching in eyes with EM as compared with eyes with HM (CBA, 10.2%±0.7% vs 9.95%±0.8%, p=0.018).

Conclusions

The novel segmentation technique and introduced choroidal parameters may serve as new biomarkers to study disease conditions in myopia.
Where is the ‘global’ in the European Union’s Health Research and Innovation Agenda?
Authors: Berner-Rodoreda Astrid , Rehfuess Eva Annette , Klipstein-Grobusch Kerstin , Cobelens Frank , Raviglione Mario , Flahault Antoine , Casamitjana Núria , Fröschl Günter , Skordis-Worral Jolene , Abubakar Ibrahim , Ashrafian Hutan , Agardh Anette , Visser Leo , Schultsz Constance , Plasència Antoni , Jahn Albrecht , Norton Robyn , van Leeuwen Remko , Hagander Lars , Bärnighausen Till
Published: October 2019

Global Health has not featured as prominently in the European Union (EU) research agenda in recent years as it did in the first decade of the new millennium, and participation of low-income and middle-income countries (LMICs) in EU health research has declined substantially. The Horizon Europe Research and Innovation Framework adopted by the European Parliament in April 2019 for the period 2021–2027 will serve as an important funding instrument for health research, yet the proposed health research budget to be finalised towards the end of 2019 was reduced from 10% in the current framework, Horizon 2020, to 8% in Horizon Europe. Our analysis takes the evolvement of Horizon Europe from the initial framework of June 2018 to the framework agreed on in April 2019 into account. It shows that despite some improvements in terms of Global Health and reference to the Sustainable Development Goals, European industrial competitiveness continues to play a paramount role, with Global Health research needs and relevant health research for LMICs being only partially addressed. We argue that the globally interconnected nature of health and the transdisciplinary nature of health research need to be fully taken into account and acted on in the new European Research and Innovation Framework. A facilitated global research collaboration through Horizon Europe could ensure that Global Health innovations and solutions benefit all parts of the world including EU countries.
Can a smartphone-delivered tool facilitate the assessment of surgical site infection and result in earlier treatment? Tracking wound infection with smartphone technology (TWIST): protocol for a randomised controlled trial in emergency surgery patients
Authors: McLean Kenneth A , Mountain Katie E , Shaw Catherine A , Drake Thomas M , Ots Riinu , Knight Stephen R , Fairfield Cameron J , Sgrò Alessandro , Skipworth Richard J E , Wigmore Stephen J , Potter Mark A , Harrison Ewen M
Published: October 2019

Introduction

National data suggest that surgical site infection (SSI) complicates 2%–10% of general surgery cases, although the patient-reported incidence is much higher. SSIs cause significant patient morbidity and represent a significant burden on acute healthcare services, in a cohort predominantly suitable for outpatient management. Over three-quarters of UK adults now own smartphones, which could be harnessed to improve access to care. We aim to investigate if a smartphone-delivered wound assessment tool results in earlier treatment.

Methods and analysis

This is a randomised controlled trial aiming to recruit 500 patients across National Health Service (NHS) hospitals. All emergency abdominal surgery patients over the age of 16 who own smartphones will be considered eligible, with the exclusion of those with significant visual impairment. Participants will be randomised in a 1:1 ratio between standard postoperative care and the intervention – use of the smartphone tool in addition to standard postoperative care. The main outcome measure will be time-to-diagnosis of SSI with secondary outcome measures considering use of emergency department and general practitioner services and patient experience. Follow-up will be conducted by clinicians blinded to group allocation. Analysis of time-to-diagnosis will be by comparison of means using an independent two sample t-test.

Ethics and dissemination

This is the first randomised controlled trial on the use of a smartphone-delivered wound assessment tool to facilitate the assessment of SSI and the impact on time-to-diagnosis. The intervention is being used in addition to standard postoperative care. The study design and protocol were reviewed and approved by Southeast Scotland Research and Ethics Committee (REC Ref: 16/SS/0072 24/05/2016). Study findings will be presented at academic conferences, published in peer-reviewed journals and are expected in 2020. A written lay summary will be available to study participants on request.

Trial registration number

NCT02704897; Pre-results.
Questionnaire survey on women’s views after a first caesarean delivery in two tertiary centres in Ireland and their preference for involvement in a future randomised trial on mode of birth
Authors: Ryan Gillian , O Doherty Kate C , Devane Declan , McAuliffe Fionnuala , Morrison John
Published: October 2019

Objective

To assess the views of women after a first caesarean section (CS) on their birth experience, preference for future mode of birth and willingness to participate in a randomised controlled trial on mode of birth in a future pregnancy.

Design

Questionnaire survey.

Setting

Two tertiary maternity centres Ireland, Galway University Hospital, Galwayand the National Maternity Hospital, Dublin.

Participants

Women with one previous CS.

Methods

Eligible women consented to participate, and postal surveys were forwarded. Results were collected and analysed. Results were compared between women who had elective operations and women who had emergency operations.

Primary outcome measures

The satisfaction levels of women after a first caesarean, their preference for mode of birth in a future pregnancy and their willingness to participate in a randomised trial on mode of birth.

Results

There were 347 completed surveys of 633 women who consented to participate (54.8%), of whom 285 and 62 had emergency and elective caesarean deliveries, respectively. In general, satisfaction ratings with the delivery were greater than 90%, with similar levels of satisfaction with the care received from doctors and midwives. Women who an emergency procedure expressed lower satisfaction levels with the information about the caesarean and the debriefing received afterwards than women who had a planned operation (p<0.05). For future mode of birth, 39.5% expressed a preference for vaginal birth after caesarean (VBAC) in a subsequent pregnancy, and 80% said they would consider involvement in a randomised trial in a future pregnancy.

Conclusion

Debriefing and counselling women after a CS is an important part of pregnancy care and can significantly impact on a woman’s overall birth experience. A significant proportion of this cohort considered VBAC as a future birth option. These data indicate that a randomised trial on mode of birth after caesarean would be viewed positively by women in our population.
Feasibility of a 6-month pilot randomised controlled trial of resistance training on cognition and brain health in Canadian older adults at-risk for diabetes: study protocol
Authors: Furlano Joyla A , Nagamatsu Lindsay S
Published: October 2019

Introduction

Type 2 diabetes (T2D) is associated with cognitive deficits and increased risk of dementia, and thus individuals at high risk for T2D (ie, those who are overweight or prediabetic) are also at greater risk for cognitive decline. Aerobic exercise is known to preserve and improve cognitive function, but the effects of resistance training (RT) are much less known in older adults. Moreover, research on the effects of RT on cognition and brain health (structure and function) in older adults at-risk for diabetes is limited. To address this question, a 6-month RT intervention is needed. Importantly, before conducting a full-scale randomised controlled trial (RCT), we are conducting a feasibility pilot study to assess potential recruitment rates, adherence and retention in this specific population.

Methods and analysis

We are conducting a 6-month, thrice-weekly RT RCT. Participants (aged 60–80; sedentary; fasting plasma glucose of 6.1–7.0 mmol/L or body mass index ≥25) are randomised into one of two groups: (1) RT or (2) balance and tone (control). Based on other exercise trials using a similar population, we will consider our trial feasible if we have adherence and retention at 70%. Recruitment rate will be measured as time it takes to enrol 20 participants. To assess behavioural and MRI data, we will report descriptive statistics and estimation using a 95% CI.

Ethics and dissemination

Our study has received ethics approval from the Health Sciences Research Ethics Board at Western University. As this is a small pilot study, data will only be made available to other researchers on request. Results from this study will be disseminated via academic publication.

Trial registration number

NCT03254381
Patient-reported outcome measures in the management of neovascular age-related macular degeneration: a 1-year prospective study
Authors: Jelin Elma , Wisløff Torbjørn , Jørstad Øystein Kalsnes , Heiberg Turid , Moe Morten Carstens
Published: October 2019

Objective

To prospectively explore the following patient-reported outcome measures (PROMs) in the management of neovascular age-related macular degeneration (nAMD): (1) self-reported visual function, (2) symptom-state, (3) general-health and (4) satisfaction of treatment.

Methods and analysis

Corresponding to the four PROMs, participants responded to the following questionnaires: (1) National Eye Institute Visual-Functioning-Questionnaire (NEI-VFQ-25), (2) Patient-Acceptable-Symptom-Status (PASS 5), (3) EuroQol-Group-Questionnaire (EQ-5D-3L) and (4) Dimensions of Importance in Treatment of nAMD (DITAMD). Data were collected at baseline and after 3, 6 and 12 months of intravitreal antivascular endothelial growth factor treatment. Results were evaluated with t-tests and mixed linear regression analyses.

Results

The study included 197 patients. At baseline NEI-VFQ-25 (79.53±14.52) and EQ-5D (0.74±0.28) had relatively high scores, whereas PASS 5 was below ‘acceptable’ (3.30±0.80). At 12 months NEI-VFQ-25 and PASS 5 showed significant improvement, whereas EQ-5D and DITAMD remained unchanged. At baseline patients receiving treatment of the better-seeing eye (BSE) (n=52) reported significantly worse NEI-VFQ-25 and PASS 5 than patients for whom treatment only involved the worse-seeing eye (WSE), (n=145). In contrast to BSE patients, there was no improvement of NEI-VFQ-25 for WSE patients at 12 months, despite a significant improvement in best-corrected visual acuity (BCVA). Two independent variables, treatment including the BSE and BCVA for the treated eye, were found to predict both NEI-VFQ-25 and PASS 5.

Conclusion

After 12 months of nAMD treatment, there was a significant improvement in PASS 5 and NEI-VFQ-25, the latter depending on whether therapy included BSE. EQ-5D and DITAMD remained unaltered.
Patient experience of COPD care: outcomes from the British Lung Foundation Patient Passport
Authors: Philip Keir , Gaduzo Stephen , Rogers Judith , Laffan Michael , Hopkinson Nicholas S
Published: October 2019

Introduction

The British Lung Foundation (BLF) COPD Patient Passport (www.blf.org.uk/passport) was developed as a resource to help people with chronic obstructive pulmonary disease (COPD) and clinicians to consider the care received and identify essential omissions. We used the online data collected to evaluate the delivery of COPD care in the UK from a patient perspective.

Methods

The patient passport consists of 13 questions relating to key aspects of COPD care including: spirometry confirmation of diagnosis, understanding their diagnosis, support and a written management plan, vaccinations, smoking cessation, physical activity, exercise, eating well, pulmonary rehabilitation, exacerbations, medications and yearly reviews. Data were presented as proportions with an answer corresponding to good care, and plotted over time to identify trends.

Results

After removing identifiable duplicates, data from 41 769 entries, completed online between November 2014 and April 2019, remained (table 1). Twenty-four per cent reported getting support to manage their care and a written action plan; 53% could spot the signs of an acute exacerbation; 34% had discussed pulmonary rehabilitation and 41% stated they understood their COPD, and their doctor or nurse had explained where to find information, advice and emotional support. A quarter reported not receiving influenza vaccination and a third of those who smoke were not offered support to quit smoking. Even the strongest areas including spirometry-confirmed diagnosis, and knowing the importance of being active and eating well, achieved only around 80%. Response patterns remained stable or worsened over time.

Discussion

Responses to the BLF COPD Patient Passport identify substantial gaps in patients’ experience of care, which did not appear to improve during the 5 years covered. These data provide a unique yet commonly overlooked perspective on care quality, and highlight that new approaches will be needed to meet the ambitions to improve respiratory care set out in the NHS Long Term Plan.
Managing cancer pain in dogs and cats
Authors: Elliott James , Alderson Briony
Published: October 2019

Background: Cancer is a frequent diagnosis in modern veterinary medicine, and one of the most common causes of mortality.

Aim of the article: This article reviews the types of pain commonly associated with cancer and the analgesics and other treatments that can be used to manage this pain.
Reducing antimicrobial use on dairy farms using a herd health approach
Authors: Hyde Robert , Tisdall David , Gordon Paddy , Remnant John
Published: October 2019

Background: There has been much scrutiny of antimicrobial use in the livestock sector, since the O’Neill report, a 2015 government ‐commissioned review of antimicrobial resistance, called for the agriculture industry to reduce its use of antimicrobials.

Aim of the article: This article outlines key herd health approaches to common diseases on dairy farms that will result in a decrease in antimicrobial use, with a focus on those interventions that are most likely to result in the biggest reductions.