bluuebunny/crossref_metadata_2025 huggingface dataset:
Can the school environment influence oral health–related behaviours? A multilevel analysis of the Brazilian National Adolescent School‐Based Health Survey 2015
Authors: Nery Newillames Gonçalves , Antunes José Leopoldo Ferreira , Jordão Lidia Moraes Ribeiro , Freire Maria do Carmo Matias
Published: August 2020

Objective

To investigate the association between the potential support of schools for oral health promotion and a set of oral health–related behaviours among adolescent students in Brazilian state capitals.

Methods

A cross‐sectional study using individual and school environment data from the 2015 Brazilian National Adolescent School‐Based Health Survey (PeNSE) was conducted. The sample consisted of 51 192 students from 1339 public and private schools in the 27 Brazilian State Capitals, aged 11‐19 years old. The outcomes were six oral health‐related behaviours: dental visits; toothbrushing frequency; soft drink and sweets consumption; smoking and alcohol consumption. The explanatory variable was the Oral Health Promotion School Environment index (OHPSE). Covariates were the adolescents' sociodemographic characteristics and organizational aspects of the schools. A two‐level multilevel mixed‐effects Poisson regression analysis with fixed slopes and random intercepts was performed, considering the complex sample design.

Results

The prevalence of risk behaviours was 28.0% for ‘low frequency of annual dental visits’, 6.9% for ‘low daily toothbrushing frequency’, 28.8% for ‘high weekly soft drink consumption’, 41.7% for ‘high weekly sweet consumption’, 18.9% for ‘cigarette experimentation’ and 52.6% for ‘alcoholic beverage experimentation’. The schools were classified as low (36.3%), intermediate (30.4%) and high (33.3%) OHPSE. In the adjusted model, schools with ‘high OHPSE’ had lower prevalence of ‘low frequency of annual dental visits’ (PR = 0.94 [95% CI 0.90; 0.99]), ‘high weekly frequency of soft drink consumption’ (PR = 0.94 [95% CI 0.89; 0.99]) and ‘sweet consumption’ (PR = 0.96 [95% CI 0.93; 1.00]) than those with ‘low OHPSE’. In addition, schools with ‘intermediate OHPSE’ had higher prevalence's of ‘low daily toothbrushing frequency’ (PR = 1.12 [95% CI 1.03; 1.23]) and ‘cigarette experimentation’ (PR = 1.08 [95% CI 1.01; 1.16]) than those with ‘low OHPSE’. ‘Alcoholic beverage experimentation’ was not associated with OHPSE.

Conclusions

The potential support of schools for oral health promotion was associated with most of the oral health–related behaviours among adolescent students. Those attending schools with higher OHPSE scores reported a higher annual frequency of dental visits and a lower weekly frequency of soft drink and sweet consumption, while those in schools with intermediate OHPSE had a lower daily toothbrushing frequency and a higher rate of cigarette experimentation.
The airway fungal microbiome in asthma
Authors: Rick Eva‐Maria , Woolnough Kerry F. , Seear Paul J. , Fairs Abbie , Satchwell Jack , Richardson Matthew , Monteiro William R. , Craner Michelle , Bourne Michelle , Wardlaw Andrew J. , Pashley Catherine H.
Published: August 2020

Background

Fungal involvement in asthma is associated with severe disease. The full spectrum of fungal species in asthma is not well described and is derived largely from insensitive culture techniques.

Objectives

To use high‐throughput sequencing to describe the airway mycobiota in asthmatics with and without fungal sensitization and healthy controls; to compare samples representing different airway compartments; to determine whether the mycobiota was influenced by the fungal composition of outdoor air; and to compare findings with clinically relevant outcomes.

Methods

We amplified the internal transcribed spacer region 2 of the nuclear ribosomal operon to identify the fungal species present. Ninety‐seven subjects were recruited and provided sputum (83 asthmatics; 14 healthy subjects), with 29 also undergoing a bronchoscopy. A subset of airway samples were compared with matched outdoor air and mouthwash samples.

Results

Two hundred and six taxa at the species level were identified in sputum, most at low relative abundance. Aspergillus fumigatus, Candida albicans and Mycosphaerella tassiana had the highest relative abundances and were the most prevalent species across all subjects. The airway mycobiota consisted of a complex community with high diversity between individuals. Notable shifts in the balance of fungi detected in the lung were associated with asthma status, asthma duration and biomarkers of inflammation. Aspergillus tubingensis, a member of the Aspergillus niger species complex, was most prevalent from bronchoscopic protected brush samples and significantly associated with a low sputum neutrophilia. Cryptococcus pseudolongus, from the Cryptococcus humicola species complex, was more abundant from bronchoscopy samples than sputum, and differentially more abundant in asthma than health.

Conclusions and Clinical Relevance

The airway mycobiota was dominated by a relatively small number of species, but was distinct from the oropharyngeal mycobiota and air samples. Members of the A. niger and C. humicola species complexes may play unexpected roles in the pathogenesis of asthma.
Health‐related quality of life and treatment strategies in myasthenia gravis
Authors: Utsugisawa Kimiaki , Nagane Yuriko , Uzawa Akiyuki , Murai Hiroyuki , Imai Tomihiro , Suzuki Shigeaki
Published: August 2020

Our multicenter studies have repeatedly shown that disease severity and oral steroid dose are major independent factors negatively impacting health‐related quality of life (QOL) in patients with myasthenia gravis (MG). Even if pharmacological remission is achieved, QOL is low in patients taking oral prednisolone >10 mg/day. Disease severity tends to affect QOL by decreasing personal activities, whereas insufficiently reduced steroids affects QOL by decreasing social activities. MG patients often experience unemployment and decreased income, and many patients report reduced social positivity. More effort is required to reduce both the severity and dose of oral steroids. QOL in patients with minimal manifestations (MM) or better status who are treated with prednisolone at ≤5 mg/day (MM‐or‐better‐5 mg) is almost identical to that in patients achieving complete stable remission. Early achievement of MM‐or‐better‐5 mg is now recommended as a target for MG treatment in Japan. However, our studies suggested that the percentage of patients achieving MM‐or‐better‐5 mg was not high in 2010 and 2012 (<40% of generalized MG patients), and was not considered to be increased by physician skill in steroid dosing. In Japan, treatment strategies are now being reconsidered to further increase treatment success, placing a focus on helping MG patients resume a normal lifestyle by achieving the target as soon as possible. An initial attempt to achieve early MM‐or‐better‐5 mg for some period through aggressive use of non‐oral fast‐acting therapies can be more important for patient QOL, even if long‐term stability cannot be provided.
Sustainable inspiratory pressure and incremental threshold loading for respiratory muscle endurance in chronic obstructive pulmonary disease: A pilot study
Authors: Gokcen Selda , Inal‐Ince Deniz , Saglam Melda , Vardar‐Yagli Naciye , Calik‐Kutukcu Ebru , Arikan Hulya , Coplu Lutfi
Published: August 2020

Introduction

A prolonged mismatch between the demand for respiratory muscle work and the capacity to meet that demand in chronic obstructive pulmonary disease (COPD) can result in symptoms of dyspnea and the development of muscle fatigue.

Objectives

The purpose of this study was to compare two different respiratory muscle endurance assessment methods of sustainable inspiratory pressure (SIP) and incremental threshold loading (ITL) in COPD.

Methods

Thirty‐four patients diagnosed with COPD were included in the study. Physical and demographic characteristics of the subjects were recorded. Pulmonary function testing (PFT), modified Medical Research Council (MMRC) dyspnea scale, COPD assessment test, inspiratory and expiratory muscle strength (MIP and MEP, respectively) measurement and six‐minute walk test (6MWT) were used to assess subjects. Two different respiratory muscle endurance tests (SIP and ITL) were performed within 48 hours apart, and each test was repeated two times on the same day.

Results

There was no correlation between the SIP and ITL tests (r = 0.069, P = .699). According to the test‐retest reliability analysis, both tests were reproducible (ICC = 0.843; P < .001 for SIP, ICC = 0.905; P < .001 for ITL). Finding no differences between repeated tests showed that tests are not affected by learning effect.

Conclusion

The SIP and ITL tests are used for the same purpose but have different characteristics. Regarding the relationship between the other parameters and tests, the ITL is well tolerated and reflects the differences in respiratory muscle endurance better.
Predictors of mediastinal staging and usefulness of pet in patients with stage IIIA (N2) or IIIB (N3) lung cancer
Authors: Gullón José Antonio , Villanueva Manuel A. , Sánchez‐Antuña Andrés A. , Rodríguez Manuel R. , Álvarez‐Navascues Fernando , Allende Jesús , Martínez‐Muñiz Manuel A. , García‐García José M.
Published: August 2020

Objective

To analyze which factors predict mediastinal N2/N3 lymph node staging and diagnostic accuracy of PET and CT to determine it.

Patients and Methods

We analyzed data collected prospectively in a database that included patients with non‐small cell lung cancer (NSCLC) who underwent EBUS‐TBNA. Prior to EBUS‐TBNA, CT and PET were used to define the radiographic N stage and lymph nodes with short axis ≥ 1 cm by CT or with ratio between maximum standardized uptake value (maxSUV), by PET, of lymph node and primary tumor greater than 0.56, were considered pathological. Definitive lymph node staging was established through EBUS‐TBNA, mediastinoscopy or surgical lymph node dissection.

Results

One hundred and thirty four patients were included, in 88 of whom (65.6%), definitive lymph node staging was N2 or N3. Primary tumor of central location, lymph node size, maxSUV of lymph node and radiographic N stage by CT or PET were associated with N2/N3 in univariate analysis, but in logistic regression model it was only independently related with N stage by CT or PET. Negative predictive value and positive predictive value of CT were 0.81 and 0.74, respectively, and for PET 0.78 and 0.68.

Conclusion

In NSCLC, in locoregional disease radiographic staging by CT or PET predict the existence of N2/N3 mediastinal disease, but negative and positive predictive values of both imaging techniques are not adequate, so EBUS‐TBNA samples should be taken in all lymph nodes with a diameter greater than 5 mm, regardless of PET findings.
Diagnosis of pancreatic solid pseudopapillary neoplasms using cell‐blocks and immunohistochemical evaluation of endoscopic ultrasound‐guided fine needle aspiration biopsy specimens
Authors: Ardengh José Celso , Lopes César Vivian , Venco Filadélfio Euclides , Machado Marcel Autran
Published: August 2020

Introduction

Preoperative diagnostic imaging of pancreatic solid pseudopapillary neoplasms (SPNs) is challenging. A few studies have investigated the role of endoscopic ultrasound‐guided fine needle aspiration (EUS‐FNA) for the diagnosis of SPN. We investigated the diagnostic yield of cell‐blocks and immunohistochemistry (IHC) for SPN using EUS‐FNA specimens without cytological evaluation.

Patients and methods

We retrospectively analysed the histopathology records of patients with suspected SPN, who underwent EUS‐FNA biopsy between January 1997 and January 2020. Diagnosis based on cell‐blocks (haematoxylin‐eosin staining with complementary IHC) was compared with the definitive surgical diagnosis.

Results

This study included 25 patients (24 were women). Patients' mean age was 33.7 years (range 12‐78 years). The most common symptom was abdominal pain. SPN was an incidental finding in 52% of the patients. The mean lesion size was 4.3 cm (range 1.2‐11.4 cm), and the most common endosonographic features included solid‐cystic (56%) or solid (40%) tumours. Final diagnoses included SPNs (n = 23) and non‐functioning neuroendocrine tumours (n = 2). The overall accuracy of EUS‐FNA was 80%. Tumour cells showed immunopositivity for β‐catenin, CD10, CD99 and progesterone receptor (PR) in 93.7%, 87.5%, 83.3% and 66.6% of patients, respectively. No SPN showed immunopositivity for chromogranin A.

Conclusions

Intention‐to‐diagnose analysis showed that the diagnostic accuracy of EUS‐FNA for SPNs using cell blocks and complementary IHC without cytological evaluation was fairly good. Evaluation of β‐catenin, CD 10, CD99 and PR expression must be included in the IHC panel for diagnostic confirmation of SPNs using EUS‐FNA biopsy specimens.
Combination therapy of oral propranolol and combined Nd:YAG/pulsed dye laser therapy in infantile hemangiomas: a retrospective analysis of 48 treated hemangiomas in 30 children
Authors: Hartmann Franziska , Lockmann Anike , Himpel Okko , Kühnle Ingrid , Hensen Janina , Schön Michael P. , Thoms Kai‐Martin
Published: August 2020

Background and aims

Infantile hemangiomas can be successfully treated by both systemic propranolol and neodymium:YAG (Nd:YAG)‐dye laser combination therapy. In this retrospective study, the efficacy and safety of sequential and parallel therapy of complicated hemangiomas treated with both methods were evaluated.

Patients and methods

30 children with 48 complicated hemangiomas were treated with propranolol and Nd:YAG‐dye laser combination therapy. Using photo comparison, the percentage remission rate was evaluated by three investigators on a four‐step scale (I: 0–25 %, II: 26–50 %, III: 51–75 % and IV: 76–100 %).

Results

Eleven children received propranolol and laser therapy in parallel (A), twelve children received laser therapy after propranolol (B) and seven children received propranolol after laser therapy (C). Due to emigration abroad, one child was lost to follow‐up. A strong improvement (IV) was observed in 23/29 (79.3 %) of all treated children (A: 90.9 %, B 75 %, C 66.7 %). The mean duration of propranolol therapy in all children was 8.6 months (A: 8.9 months, B: 8.2 months, C: 8.9 months). On average, 2.33 laser treatments were performed per hemangioma (A: 1.95, B: 3.2, C: 1.91). Serious side effects caused by propranolol and laser therapy were not observed.

Conclusions

Propranolol and Nd:YAG‐dye laser combination therapy can be used sequentially or in parallel safely and effectively. They complement each other in a meaningful manner.
Subcontracting New Product Development Projects: The Role of Competition and Commitment
Authors: Gernert Andreas , Heese H. Sebastian , Wuttke David A.
Published: August 2020

Should a firm, which seeks to subcontract a new product development project, leverage competition among potential suppliers and ask all of them to engage in research and development in parallel? Or should it first invite offers and commit to the supplier with the best offer, before only this supplier engages in development? Building on analytical literature on both formats, we apply game theory to answer these questions. We identify Bayesian Nash equilibrium strategies and characterize advantages of both formats. We find that having multiple suppliers engage in new product development in parallel is favored only if enough suppliers can be attracted, which is the case when development uncertainty and learning benefits are high. The participation decision also depends on the specific structure of the project's development costs. If administrative overhead and material costs are substantial, while engaging in development and exerting effort is relatively cheap but does not offer many learning opportunities, the number of suppliers who would be willing to engage in parallel development is limited. First inviting offers and selecting the best supplier to exclusively engage in new product development then becomes more attractive for the buyer. We discuss further implications and characterize environments that may foster more innovativeness in this context.
3D ultrasound to quantify lateral hip displacement in children with cerebral palsy: a validation study
Authors: Kay Rebecca H , Noble Jonathan J , Johnston Liam , Keevil Stephen F , Kokkinakis Michail , Reed Daniel , Gough Martin , Shortland Adam P
Published: August 2020

Aim

To assess the validity of a new index, lateral head coverage (LHC), for describing hip dysplasia in a population of children with cerebral palsy (CP).

Method

LHC is derived from 3D ultrasound assessment. Twenty‐two children (15 males, seven females; age 4–15y) with CP undergoing routine hip surveillance were recruited prospectively for the study. Each participant had both a planar radiograph acquired as part of their routine care and a 3D ultrasound assessment within 2 months. Reimer's migration percentage (RMP) and LHC were measured by the same assessor, and the correlation between them calculated using Pearson’s correlation coefficient. The repeatability of LHC was investigated with three assessors, analysing each of 10 images three times. Inter‐ and intra‐assessor variation was quantified using intraclass correlation coefficients.

Results

LHC was strongly correlated with RMP (Spearman's rank correlation coefficient=−0.86, p<0.001). LHC had similar inter‐assessor reliability to that reported for RMP (intraclass correlation coefficient=0.97 and intra‐assessor intraclass correlation coefficient=0.98).

Interpretation

This is an initial validation of the use of 3D ultrasound in monitoring hip development in children with CP. LHC is comparable with RMP in estimating hip dysplasia with similar levels of reliability that are reported for RMP.
Evaluation of the diagnostic performance of the creatinine‐based Chronic Kidney Disease Epidemiology Collaboration equation in people with diabetes: A systematic review
Authors: Zafari N. , Churilov L. , Wong L. Y.‐L. , Lotfaliany M. , Hachem M. , Kiburg K. V. , Kong L. , Torkamani N. , Baxter H. , MacIsaac R. J. , Ekinci E. I.
Published: August 2020

Aims

GFR estimated with the creatinine‐based Chronic Kidney Disease Epidemiology Collaboration (CKD‐EPICr) equation is used to screen for diabetic kidney disease and assess its severity. We systematically reviewed the process and outcome of evaluating CKD‐EPICr in estimating point GFR or GFR decline over time in adults with type 1 or type 2 diabetes.

Methods

In this systematic review, MEDLINE, Embase and Cochrane Central Register of Controlled Trials were searched up to August 2019. Observational studies comparing CKD‐EPICr with measured GFR (mGFR) in adults with diabetes were included. Studies on people with kidney transplant, non‐diabetes related kidney disease, pregnancy, potential kidney donors, and those with critical or other systematic illnesses were excluded. Two independent reviewers extracted data from published papers and disagreements were resolved by consensus. Risk‐of‐bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies‐2 tool. (PROSPERO registration number: CRD42018108776).

Results

From the 2820 records identified, 29 studies (14 704 participants) were included. All studies were at risk of bias. Bias (eight different forms) ranged from −26 to 35 ml min−1 1.73 m−2; precision (five different forms) ranged between 9 and 63 ml min−1 1.73 m−2; accuracy (five different forms) ranged between 16% and 96%; the correlation coefficient between CKD‐EPICr and mGFR (four different forms) ranged between 0.38 and 0.86; and the reduced major axis regression slope ranged between 0.8 and 1.8.

Conclusions

Qualitative synthesis of data suggested CKD‐EPICr was inaccurate in estimating point GFR or GFR decline over time. Furthermore, a lack of consistency in the methods and processes of evaluating the diagnostic performance of CKD‐EPICr limits reliable quantitative assessment. The equation needs to be improved in adults with diabetes.
Multimodality imaging of left ventricular apical pseudoaneurysm after apical approach transcatheter aortic valve replacement
Authors: Ansari‐Gilani Kianoush , Sareyyupoglu Basar
Published: August 2020

Left ventricular pseudoaneurysm formation is a rare complication of transapical approach transcatheter aortic valve replacement. It can cause chest pain and shortness of breath or remain asymptomatic. Mortality rate is high, and therefore, timely diagnosis and management are essential. Different imaging modalities can provide anatomic or functional information and are essential for the primary diagnosis or during follow‐up.
Right ventricular dysfunction in stress cardiomyopathy: The prognostic value of fractional area change
Authors: Subramanian Muthiah , Ahamed Hisham , Reddy Chirag , Mathew Navin , Chandrasekhar Rajiv
Published: August 2020

Background

There are limited data on the impact of right ventricular dysfunction (RVD) on the clinical outcomes in patients with stress cardiomyopathy (SC). The purpose of this study was to evaluate the impact of RVD on outcomes and to characterize the prognostic value of RV fractional area change (FAC).

Methods

This study retrospectively analyzed data from 111 consecutive patients with SC. The primary endpoint, major cardiac events (MCE), was a composite of 30‐day mortality, cardiogenic shock, life threatening arrhythmias, and stroke. Regression analysis was used to identify independent predictors of short (30 days)‐ and long‐term MCE.

Results

Among the 111 patients (80.2% females, mean age 45.8 ± 11.5 years), RVD was present in 17(15.3%) patients. MCE occurred in 18(16.2%) and 22(19.8%) patients at 30 days and during long‐term follow‐up, respectively. RVD was an independent predictor of short (HR 1.88(1.21–15.67), P = .036)‐ and long (HR 1.65(1.11–9.67), P = .016)‐term MCE. Compared with tricuspid annular plane systolic excursion < 15 mm (TAPSE) (sens 72.2%, spec 94.1%, AUC 0.75) and tricuspid annulus pulsed TDI‐derived peak systolic velocity (S′) < 9.5 cm/s (sens 67.2%, spec 94.5%, AUC 0.72), RV FAC < 30% (sens 89.1%, spec 100%, AUC 0.92) had the highest accuracy and discriminative ability to predict MCE. Furthermore, RV FAC < 30% was a significant predictor of recurrence (29.4% vs 2.1%, P = .002) and delayed recovery time (21.4 ± 6.8 vs 8.5 ± 4.3 days, P < .001).

Conclusions

The presence of RVD in stress cardiomyopathy identifies patients at higher risk of mortality, complications, delayed recovery, and recurrence. Compared with other indices, RV FAC has the highest prognostic ability to predict these outcomes.
Fragment reattachment after complicated crown‐root fractures of anterior teeth: A systematic review
Authors: Khandelwal Priyal , Srinivasan Siddharth , Arul Buvaneshwari , Natanasabapathy Velmurugan
Published: August 2020

Background/Aim

Fragment reattachment is a procedure that can immediately restore form and function in crown‐root fracture cases and is considered a minimally invasive and cost‐effective treatment option. The aim of this systematic review was to analyze the methods used and the outcome of fragment reattachment for complicated crown‐root fractures of anterior teeth.

Materials and Methods

Five electronic databases (PubMed, Web of Science, Embase, Scopus, and Google Scholar) were searched for English language articles regarding fragment reattachment after complicated crown‐root fractures of anterior teeth.

Results

Twelve case reports and two case series were selected for this review after applying the inclusion and exclusion criteria. In eleven articles, the fracture line was exposed prior to reattachment. Root canal treatment was performed in all cases except one, where conservative pulp treatment was done prior to reattachment. A post was used as part of the restoration in 85% of the cases. Additional fragment preparation was done in 42% of the cases in the form of beveling and groove formation. Adhesive strategies used to reattach the coronal fragments were total‐etch, self‐etch, or self‐cure adhesive. Intermediate materials used for reattachment were resin cement, glass‐ionomer cement, composite and self‐adhesive cement. Treatment outcomes were favorable in all the included articles and the follow‐up period ranged from three months to seven years.

Conclusion

Fragment reattachment after complicated crown‐root fractures of anterior teeth can be considered as a viable treatment option if the clinical conditions are favorable.
Human Resource Management and Organisational Performance: The Mediating Role of Social Exchange
Authors: Mohammad Tamara , Darwish Tamer K. , Singh Satwinder , Khassawneh Osama
Published: August 2020

This study seeks to explore the impact of specific set of HRM practice on organisational performance in a Middle Eastern emerging market. It aims to examine the mediating role of social exchange within the healthcare sector in Jordan, which is presently reeling under pressure from the refugee crisis from Syria and neighbouring countries. Both, HR and hospital managers were targeted in all private and public hospitals through two separate questionnaires. We find, as predicted, that recruitment, training, and internal promoting from within have a positive and significant effect on performance. However, contrary to expectations, we found performance appraisal and rewards and benefits not linked with performance. Notably, whilst researchers argue that a better theoretical understanding of the mechanisms describing the relationship between HRM and performance should be developed, the results indicate that social exchange can play an essential role in explaining the HRM‐performance indirect relationship – a result that partly unlocks the elements of so‐called ‘black box’ in HR research. The theoretical and applied implications of these findings are explored.
Song learning by prairie warblers: When, where, and from whom
Authors: Byers Bruce E. , Akresh Michael E. , King David I.
Published: August 2020

Songbirds of many species acquire their songs by imitating the songs of conspecific singers. Conclusive evidence of such imitation comes from controlled laboratory studies, but such studies do not reveal when and where songbirds learn their songs under natural conditions. To determine the timing and location of song learning in a population of prairie warblers, we compared the songs of yearling prairie warblers of known hatching location to the songs of other birds in the yearlings' natal and first breeding areas. The comparisons yielded a likely model song (and model singer) for each of the song types used by the focal yearlings. We supplemented our findings from the song comparisons with inferences drawn from an analysis of local geographic variation in songs. This analysis revealed that shared song types showed no tendency to be geographically clustered within the study area. Taken together, our data suggest that prairie warblers learn their songs during the hatch year, at locations somewhat distant (mean distance 1,437 m) from their natal site, most likely as birds wander about during the post‐fledging period.
Pathogenic postzygotic mosaicism in the tyrosine receptor kinase pathway: potential unidentified human disease hidden away in a few cells
Authors: Tiemann‐Boege Irene , Mair Theresa , Yasari Atena , Zurovec Michal
Published: August 2020

Mutations occurring during embryonic development affect only a subset of cells resulting in two or more distinct cell populations that are present at different levels, also known as postzygotic mosaicism (PZM). Although PZM is a common biological phenomenon, it is often overlooked as a source of disease due to the challenges associated with its detection and characterization, especially for very low‐frequency variants. Moreover, PZM can cause a different phenotype compared to constitutional mutations. Especially, lethal mutations in receptor tyrosine kinase (RTK) pathway genes, which exist only in a mosaic state, can have completely new clinical manifestations and can look very different from the associated monogenic disorder. However, some key questions are still not addressed, such as the level of mosaicism resulting in a pathogenic phenotype and how the clinical outcome changes with the development and age. Addressing these questions is not trivial as we require methods with the sensitivity to capture some of these variants hidden away in very few cells. Recent ultra‐accurate deep‐sequencing approaches can now identify these low‐level mosaics and will be central to understand systemic and local effects of mosaicism in the RTK pathway. The main focus of this review is to highlight the importance of low‐level mosaics and the need to include their detection in studies of genomic variation associated with disease.
Changing climate reallocates the carbon debt of frequent‐fire forests
Authors: Goodwin Marissa J. , North Malcolm P. , Zald Harold S. J. , Hurteau Matthew D.
Published: August 2020

Ongoing climate change will alter the carbon carrying capacity of forests as they adjust to climatic extremes and changing disturbance regimes. In frequent‐fire forests, increasing drought frequency and severity are already causing widespread tree mortality events, which can exacerbate the carbon debt that has developed as a result of fire exclusion. Forest management techniques that reduce tree density and surface fuels decrease the risk of high‐severity wildfire and may also limit drought‐induced mortality by reducing competition. We used a long‐term thinning and burning experiment in a mixed‐conifer forest to investigate the effects of the 2012–2015 California drought on forest carbon dynamics in each treatment, including the carbon emissions from a second‐entry prescribed fire that followed the drought. We assessed differences in carbon stability and tree survival across treatments, expecting that both carbon stability and survival probability would increase with increasing treatment intensity (decreasing basal area). Additionally, we analyzed the effects of drought‐ mortality on second‐entry burn emissions and compared emissions for the first‐ and second‐entry burns. We found a non‐linear relationship between treatment intensity and carbon stability, which was in part driven by varying relationships between individual tree growing space and survival across treatments. Drought mortality increased dead tree and surface fuel carbon in all treatments, which contributed to higher second‐entry burn emissions for two of the three burn treatments when compared to the first burn. Our findings suggest that restoration treatments will not serve as a panacea for ongoing climate change and that the carbon debt of these forests will become increasingly unstable as the carbon carrying capacity adjusts to severe drought events. Managing the carbon debt with prescribed fire will help reduce the risk of additional mortality from wildfire, but at an increasing carbon cost for forest management.
Longitudinal Impact of Parent Factors in Adolescents With Migraine and Tension‐Type Headache
Authors: Law Emily F. , Blume Heidi , Palermo Tonya M.
Published: August 2020

Objective

To examine longitudinal associations between parent factors (parent headache frequency and disability, protective parenting behaviors, parent catastrophizing) with adolescent headache‐related disability and headache frequency over 6 months.

Background

Theoretical models propose bidirectional, longitudinal relationships between parent factors and adolescent headache. Few studies have examined this using prospective study designs.

Design and Methods

Participants were a cohort of 239 youth ages 11‐17 years with recurrent migraine (with and without aura; chronic migraine) or tension‐type headache (episodic and chronic) and their parents recruited from a pediatric neurology clinic and the community who completed assessments at baseline and 6‐month follow‐up.

Results

After controlling for demographic and clinical covariates, we found that every point increase in baseline protective parenting behavior corresponded with a 2.19‐point increase in adolescent headache frequency at follow‐up (P = .026, 95% CI [0.27, 4.10]). Similarly, every point increase in baseline parent catastrophizing corresponded with a 0.93‐point increase in adolescent headache‐related disability (P = .029, 95% CI [0.09, 1.77]) and a .13‐point increase in adolescent headache frequency (P = .042, 95% CI [0.01, 0.25]) at follow‐up. We also found support for the reverse association, where every point increase in baseline adolescent headache‐related disability predicted a 0.03‐point increase in parent catastrophizing (P = .016, 95% CI [0.01, 0.05]) and a 0.02‐point increase in protective parenting behavior (P = .009, 95% CI [0.01, 0.03]) at follow‐up. The remaining bidirectional, longitudinal associations tested between parent factors and adolescent headache were not statistically significant.

Conclusion

Findings suggest that family‐based psychological interventions targeting modifiable adolescent and parent factors may lead to improvements in adolescent headache‐related disability and reductions in adolescent headache frequency.
Does workplace violence, empathy, and communication influence occupational stress among mental health nurses?
Authors: Yao Xiuyu , Shao Jing , Wang Lina , Zhang Jing , Zhang Chang , Lin Yujie
Published: August 2020

Workplace violence is a major cause of occupational stress among mental health nurses, particularly those working in acute care. This study investigated the occurrence of occupational stress among mental health nurses in psychiatric hospitals and explored whether workplace violence, empathy, and communication skills influenced occupational stress levels in this population. A socio‐demographic questionnaire and the Chinese Nursing Work Stress Scale, Workplace Violence Scale, Jefferson Scale of Empathy – Health Professions version, and Nurses’ Clinic Communication Competence Scale were administered to 539 mental health nurses from three top‐grade tertiary research hospitals in the Beijing–Tianjin–Hebei region. The analysis revealed a high level of job stress (3.06 ± 0.69) and a moderate prevalence of workplace violence (6.21 ± 2.94) existed among participants when compared with among other nurses. Meanwhile, participants’ empathy (114.78 ± 15.99) and communication (4.31 ± 0.60) abilities were similar to or higher than those of other nursing populations. Mental health nurses with varying years of practice experience distinct levels of job stress. A linear regression analysis revealed that, while practice years (β = 0.104;P < 0.05) and workplace violence (β = 0.264;P < 0.01) aggravated occupational stress levels, empathy (β = −0.147;P < 0.01) facilitated reductions in stress. Results suggest that reducing workplace violence and improving empathy in therapeutic relationships can limit the pervasiveness of occupational stress among mental health nurses. Having both psychological support and organizational support after a violent incident is essential, and the importance of professional education should be stressed.
Hormone Responses to Clomiphene Citrate in Young Chimpanzees
Authors: Nadler Ronald D. , Cooper Robert W. , Roth‐Meyer Christian , Bourreau Elaine , Affre Gerard
Published: August 2020

The responses of gonadotropin and gonadal steroids to the administration of clomiphene citrate were studied in male and female chimpanzees, aged 3.6 to 9.9 years. Follicle‐stimulating hormone (FSH) was significantly reduced after treatment in the prepubertal females (n = 4) and in early pubertal males (n = 2) but not in prepubertal males (n = 5). FSH was unchanged or increased in early pubertal females (n = 2) and late pubertal males (n = 2). There was no consistent response to treatment with clomiphene citrate by luteinizing hormone (LH) in either males or females, nor by 17β‐estradiol in the females. Testosterone levels were reduced in the early pubertal males only. These results support the hypothesis that negative feedback by gonadal steroids is operative in prepubertal chimpanzees and that puberty is accompanied by a reduction in the sensitivity to such feedback.
A Case of Acardiac Anomaly in the Cynomolgus Monkey (Macaca fascicularis): A Complication of Monozygotic Monochorial Twinning
Authors: Hein P.R. , van Groeninghen J.C. , Puts J.J.G.
Published: August 2020

A case of acardius acephalus in a Macaca fascicularis is reported. This congenital anomaly occurs only in multiple‐birth gestations (most commonly monozygotic twins). Artcry‐to‐artery and vein‐to‐vein anastomoses appear to be a constant feature. This condition is very rare in man and probably even more so in monkeys.

Classification and theories on etiology are discussed.
Fetal Blood Sampling Through Ultrasound‐Guided Puncture of the Umbilical Vein in Rhesus Monkeys
Authors: Lindgren P.‐G. , Lindberg Bo S.
Published: August 2020

Fetal blood was obtained through puncture of the umbilical vein in Rhesus monkeys. The puncture needle was introduced during direct visual control through ultrasound. This method offers a possibility to obtain fetal blood without opening the uterine cavity. Injection into the fetal circulation is also possible.
Breeding Vervet Monkeys in a Closed Environment
Authors: Seier Jürgen V.
Published: August 2020

A breeding group of vervet monkeys produced 95 offspring over five years. Fetal wastage for 114 pregnancies was 16.7%. Uterine sizes were recorded for 103 pregnancies in various stages of gestation. This enabled diagnosis of pregnancy, estimation of stage of gestation, and prediction of parturition to within two weeks. Detailed observations were made on dental eruption, pelage development, and growth of 57 infants.
CD16+ Lymphoblastic Cell Lines of Crab‐Eating Monkeys (Macaca fascicularis) Shared U‐5 Antigen and Expressed Natural Killer Activity
Authors: Murayama Yuichi , Fujisaki Masami , Noguchi Atsuo , Takenaka Osamu
Published: August 2020

The CD16+ lymphoblastic cell lines of crab‐eating monkeys shared the U‐5 antigen recognized by a monoclonal antibody. The CDI6 + U‐5+ cell lines expressed high natural killer activity to K562 cells, whereas the CD16−U‐5− control cell line had no significant natural killer activity. A possible involvement of the U‐5 antigen in natural killer function was also suggested by reduction of the natural killer activity in peripheral blood mononuclear cells of Japanese monkeys after treatment with U‐5 monoclonal antibody and complement.
Corneal Biometrics of the Rhesus Monkey (Macaca mulatta)
Authors: Zurawski Christine A. , McCarey Bernard E. , van Rij Gabriel , Fernandes Alcides
Published: August 2020

Keratometry, retinoscopy, horizontal diameter, and pachymetry were measured in adult and infant rhesus monkeys (Macaca mulatta). The adult monkeys had a mean corneal thickness of 0.47 ± 0.03 mm (± standard deviation), corneal diameters of 10.6 ± 0.5 mm, keratometry values of 51.90 ± 1.61 diopters, and subjective refractions of 0.48 ± 2.36 diopters. Female adult monkeys had smaller corneal diameters by 0.06 mm (P = .02) and steeper corneas by 0.77 diopters (P = .04). Infant female monkeys also had steeper corneas by 2.37 diopters (P = .05). No significant differences were found between right and left eyes in cither adult or infant monkeys.
Cellular Immune Response of SIV‐Infected Rhesus Macaques
Authors: McGraw Thomas P. , Vowels Benjamin R. , Gershwin M. Eric , Gardner Murray B.
Published: August 2020

Optimal conditions for the assessment of T cell proliferation and cytolytic T lymphocyte (CTL) responses specific for primate lentivirus were established. CTL and T cell proliferative responses were demonstrated as early as two weeks post‐infection. Although the majority of CTL were CD8+, MHC class I‐restricted, this study demonstrated CD4+, MHC class II‐restricted CTL. Experiments also demonstrated that CTL were CD 16 negative. Target cell generation could be blocked with CD4 mAb specific for the SIV binding site.
Maternal Transmission of Type D Simian Retrovirus (SRV‐2) in Pigtailed Macaques
Authors: Tsai C.‐C. , Follis K.E. , Snyder K. , Windsor S. , Thouless M.E. , Kuller L. , Morton W.R.
Published: August 2020

Pregnant macaques were used as a natural model for maternal‐infant transmission of SRV‐2 retrovirus. Fifty‐one pregnant females were placed into one of four virus/antibody groups. Nonviremic mothers produced 100% virus‐negative offspring at birth. In contrast, viremic mothers produced offspring which were 17% virus‐negative and 83% virus‐positive at birth. SRV‐2 infection occurred principally in utero by the transplacental route. Infants born to viremic mothers exhibited low birth weight, prematurity, high perinatal death, and increased incidence of SAIDS.
Use of Simian Immunodeficiency Virus for Vaccine Research
Authors: Daniel Muthiah D. , Sehgal Prabhat K. , Kodama Toshiaki , Wyand Michael S. , Ringler Douglas J. , King Norval W. , Schmidt Diane K. , Troup Cynthia D. , Desrosiers Ronald C.
Published: August 2020

Rhesus monkeys were immunized with purified, disrupted, noninfectious simian immunodeficiency virus (SIV) in adjuvant induced SIV neutralizing antibodies. Two of six previously vaccinated macaques were protected against infection when challenged with 200–1,000 animal infectious doses of uncloned, pathogenic SIV and both have remained free of signs of virus infection for 19 and 30 months. Prior vaccination appeared to be of benefit in decreasing the virus load and in delaying the onset of AIDS in animals that became infected. Nonetheless, two of four previously vaccinated monkeys that became infected following challenge eventually developed AIDS and died 505 and 538 days after infection. Thus, for a vaccine to be truly effective against AIDS, it may have to protect absolutely against initial infection.
Nef Genes of SIV
Authors: Kestler H.W. , Mori K. , Silva D.P. , Kodama T. , King N.W. , Daniel M.D. , Desrosiers R.C.
Published: August 2020

Molecular clones of SIVmac were constructed that differed only in sequences within the nef gene. DEAE‐transfection of viral DNA containing an open form of /ic/yiclded virus that replicated with similar kinetics and to a similar extent in macaque peripheral blood lymphocyte (PBL) cultures as virus with a deletion or stop codon within nef. Rhesus monkeys that received each kind of molecularly cloned virus became infected. Our results additionally suggest that mutant forms of virus are selected in vitro while open, functional forms are selected in vivo. In animals infected with virus containing a stop codon within nef, reversion of the stop codon to a coding codon was demonstrated in live of five clones analyzed. These results indicate that nef is playing some role crucial to the virus life cycle in vivo.
Intrauterine Insemination With Ultrasound Guidance in the Long‐Tailed Macaque (Macaca fascicularis)
Authors: Tarantal Alice F. , Vande Voort Catherine A. , Overstreet James W.
Published: August 2020

Techniques used for the artificial insemination of macaques have primarily involved instillation of the ejaculate into the vagina or cervical canal. Intrauterine insemination has been performed previously but only as a surgical procedure. The application of ultrasound‐guided techniques for this purpose provides a method for efficiently inseminating macaques in a relatively noninvasive fashion. This report describes the successful transabdominal ultrasound‐guided insemination of the long‐tailed macaque and the potential application of this procedure to a variety of nonhuman primate species.
Extraosseous Osteosarcoma in a Nonhuman Primate (Macaca mulatto)
Authors: Gliatto John M. , Bree Mark P. , Mello Nancy K.
Published: August 2020

A case of a very rare malignant bone‐forming sarcoma, which was located in the soft tissue but had no anatomic attachment to bone, is presented. This tumor originated in the subcuticular tissue over the right scapula and was histologically composed of sheets of anaplastic spindle cells that produced osteoid. The tumor recurred twice before the animal was killed. The recurrent masses produced less osteoid and were generally less differentiated histologically than the initial tumor.
Horseshoe Kidneys in Vervet Monkeys
Authors: Seier J.V. , Fincham J.E. , Taljaard J.J.F.
Published: August 2020

Two cases of horseshoe kidneys in vervet monkeys are described. Apart from the fusion, the rest of the urogenital system was anatomically normal and renal function was apparently not affected by this condition. The microanatomy was normal in both cases.
Diabetes Mellitus in Nonhuman Primates: Recent Research Advances and Current Husbandry Practices
Authors: Howard Charles F. , Yasuda Mitsuya
Published: August 2020

Primates can be utilized for a variety of studies to give insight into the mechanisms of the onset and progression of diabetes mellitus and obesity, and into the development of secondary manifestations. Results can be used to understand the etiologies and effects of diabetes in human beings. Investigators and animal care personnel should be continually aware of the potential for development of diabetes among primates and should seek to identify the earlier stages before the appearance of overt diabetes. In addition to updating recent research in which nonhuman primates have been used in studies on the different forms of diabetes, this review also furnishes some information about therapeutic management and husbandry of monkeys with predispositions toward diabetes or with overt diabetes.
Presence of antibody to Cyno‐EBV in domestically bred cynomolgus monkeys (Macaca fascicularis)
Authors: Fujimoto Koji , Honjo Shigeo
Published: August 2020

The presence of an antibody to the Cyno‐EBV was studied with Cyno‐EBV bearing cell line (Ts‐B‐9) as antigen in 186 domestically bred cynomolgus monkeys (Macaca fascicularis) ranging in age from birth to 18 yr as well as in 20 adult (older than 10 yr) cynomolgus monkeys of wild origin. The maternal antibody to Cyno‐EBV persisted for less than four mo after birth in infant monkeys. After one yr of age, all the domestically bred monkeys were consistently positive for Cyno‐EBV. In the monkeys of wild origin also, the anti‐Cyno‐EBV antibody was detected without exception. Antibody titers in adult monkeys varied from 1:80 to 1:640.
Technical note: A primatrail or an inexpensive cage expansion for group housing small primates
Authors: Salzen Eric A. , Marriott Bernadette M.
Published: August 2020

An inexpensive method for converting standard laboratory cages into colony units for housing small primate species is described.
Endogenous bilirubin excretion in Bolivian squirrel monkeys with a Gilbert's‐like syndrome
Authors: Myers Barbara A. , Bruss Michael L. , George Jeanne W. , Cornelius Charles E.
Published: August 2020

Fasted Bolivian squirrel monkeys (BoSM) exhibit a marked hyperbilirubinemia when compared to fed BoSM. This fasting hyperbilirubinemia (FH) is similar to that in human patients with Gilbert's syndrome. Endogenous bilirubin (BR) excretion (production) into bile was elevated two‐fold in BoSM upon fasting. The fraction of injected dose of 3 H‐aminolevulinic acid (ALA) incorporated into biliary BR in fasted monkeys was of less magnitude than in fed monkeys and was associated with lower specific activities of 3 H‐BR. Both the lower incorporation of ALA and lower specific activities of 3H‐BR in fasted BoSM suggest the increased BR excreted may have arisen from pre‐existing non‐labeled pools of either heme or BR.
Genetic polymorphism of the vitamin D‐binding protein (DBP) in crab‐eating macaques (Macaca fascicularis)
Authors: Tanaka Hiroyuki , Kawamoto Yoshi , Terao Keiji
Published: August 2020

Vitamin D‐binding protein (DBP) of crab‐eating macaques (Macaca fascicularis) was examined by means of three electrophoretic methods. DBP phenotypes were observed to be one or two bands in each method. All of DBP molecular variants could be detected by the simultaneous typing with these three methods. Family analysis suggested that DBP variants followed the mode of autosomal codominant inheritance. A total of 17 phenotypes governed by at least 11 alleles were observed in the populations of Malaysia, Indonesia, and the Philippines. The genetic variability was high in Malaysian and Indonesian populations but low in the Philippine population.