bluuebunny/crossref_metadata_2025 huggingface dataset:
No ordinary consultation – a qualitative inquiry of hospital palliative care consultation services
Authors: Böling Susanna , Berlin Johan M. , Berglund Helene , Öhlén Joakim
Published: August 2020

Purpose

Considering the great need for palliative care in hospitals, it is essential for hospital staff to have palliative care knowledge. Palliative consultations have been shown to have positive effects on in-hospital care. However, barriers to contact with and uptake of palliative consultation advice are reported, posing a need for further knowledge about the process of palliative consultations. The purpose of this study therefore was to examine how palliative consultations in hospitals are practised, as perceived by consultants and health care professionals on receiving wards.

Design/methodology/approach

Focus groups with palliative care consultation services, health care personnel from receiving wards and managers of consultation services. Interpretive description and constant comparative method guided the analysis.

Findings

Variations were seen in several aspects of practice, including approach to practice and represented professions. The palliative consultants were perceived to contribute by creating space for palliative care, adding palliative knowledge and approach, enhancing cooperation and creating opportunity to ameliorate transition. Based on a perception of carrying valuable perspectives and knowledge, a number of consultation services utilised proactive practices that took the initiative in relation to the receiving wards.

Originality/value

A lack of policy and divergent views on how to conceptualise palliative care appeared to be associated with variations in consultation practices, tentative approaches and a bottom-up driven development. This study adds knowledge, implying theoretical transferability as to how palliative care consultations can be practised, which is useful when designing and starting new consultation services.
Exploring the antecedents and outcomes of destination brand love
Authors: Amaro Suzanne , Barroco Cristina , Antunes Joaquim
Published: August 2020

Purpose

This study aims to apply the concept of brand love to a destination and investigate its antecedents and consequences. It also explores the moderating effects of time elapsed since the establishment of the destination brand love relationship on the outcomes of destination brand love.

Design/methodology/approach

A total of 5,511 valid responses were obtained from an online survey distributed among former international students from the Erasmus program of the European Union. Partial least squares structural equation modeling was conducted to assess the hypotheses.

Findings

Destination brand love was found to have a significant impact on electronic word of mouth (eWOM), WOM, WOM intensity, recommendation and revisit intention. Moderation analysis revealed that the amount of time elapsed since the establishment of the destination brand love relationship did not affect these outcomes. Moreover, destination image and the Erasmus experience had a positive effect on destination brand love.

Practical implications

Destination marketers should focus on enhancing the Erasmus experience and on improving destination image perception, as these factors help develop destination brand love. Marketers should also be aware that this relationship has long-lasting effects.

Originality/value

This study adds to the sparse literature on brand love in relation to a destination. This gives the first results for the importance of Erasmus students to the promotion of a host country. It also contributes to the question of how long the brand love relationship can last.
Insights into the reasons behind the limited implementation of ISO 9001 certification: empirical evidence from Yemen
Authors: Aamer Ammar Mohamed , Al-Awlaqi Mohammed Ali , Mandahawi Nabeel
Published: August 2020

Purpose

While ISO 9001 standard certification is approaching saturation in developed countries, other nations are still struggling with the implementation of ISO 9001. This study provides insights into countries with a very low number of registered certifications to understand the reasons behind the limited implementations, more particularly using evidence from Yemen. The objective of the study is to assess: the awareness, understanding, motivations, barriers and the benefits of implementing ISO 9001.

Design/methodology/approach

A survey was conducted to measure awareness levels, understanding, driving factors, barriers and the benefits of ISO 9001. Data collection was carried out through the classification of targeted firms into two separate categories, certified and noncertified organizations. The classification of firms was conducted to enrich the understanding from two different perspectives. A total of 72 responses, from companies ranging in size from large to small, and in both the private and public sectors, were analyzed using the descriptive and multiple correspondence analysis (MCA).

Findings

The data analysis showed that the limited implementation of ISO 9001 certifications could be due to several internal and external factors such as the relatively low awareness level of the certification and guidelines, and the inconsistency of understanding the certification purpose. The benefits focused solely on improving the quality of systems efficiency and increasing quality awareness, and not on internationalization.

Research limitations/implications

The findings of this work provide the groundwork for decision-makers to understand the drivers and challenges of ISO 9001 to plan corrective actions and contribute to promote and increase the number of certified organizations in similar countries and economies. While the data in this study were collected in the context of one country, the methodology and framework used in this study can be utilized by other researchers to collect data in similar countries with a low number of ISO 9001 certifications.

Originality/value

This research is one of the very few that addresses the limited implementation of ISO 9001 in the Middle East and North Africa region and Yemen in particular.
Plastic hinges mechano-reliability analysis in the beams of RC frames structures
Authors: Bouzid Leyla , Hamizi Mohand , Hannachi Naceur-Eddine , Nekmouche Aghiles , Akkouche Karim
Published: August 2020

Purpose

The purpose of this study is to establish a relationship between causes and effects, the respect of materials characteristics values [concrete compressive strength (fc) and steel yield stress (fy)] and the norms of the construction dispositions value (covers). This study is motivated by the post-seismic damages related to the plastification of the reinforced concrete (RC)/beams sections, named plastic hinges. The results are given by fragility curves representing the failure probability (Pf) of the plastic hinges versus covers value.

Design/methodology/approach

A mechanical-reliability coupling methodology is proposed and performed on three frames (three, six and nine storey). For each frame, seven covers the value of reinforcement steel bars has been taken into account in the beams. After definition of the limit state function G(x), a process of idea to twin-track; deterministic and probabilistic, is considered. Thus, numerical simulations are carried out under ETABS© software, to extract a soliciting moments Ms(x). Then, ultimate moments Mu(x), the result of reliability approach are calculated using Monte Carlo Simulations. In this step, two random variables; concrete compressive strength in 28 days of age (fc) and steel yield stress (fy), have been studied.

Findings

In the mechanical study, the results show that, the first plastic hinge appears at the beams for all frames. In the reliability study, the (fy) variation shows that all plastic hinges are in failure domain, nevertheless, the (fc) variation leads to have all sections in the safety domain, except A7 and B7 models. The failure probability (Pf) calculation according to (fc) and (fy) shows that an absolute error of 0.5 cm in the steel bars covers can switch the frame from the safety domain to the failure domain.

Originality/value

The plastic hinges reliability of the RC/ frame structures is independent on the high of the structure. The (fc) random variable according to the used distribution law does not affect the reliability (safety or failure). However, the impact of the steel yield stress variation (fy) is not negligible. The errors in covers affect considerably the strength of the elements.
Invasive crayfish alter the long‐term functional biodiversity of lotic macroinvertebrate communities
Authors: Mathers Kate L. , White James C. , Guareschi Simone , Hill Matthew J. , Heino Jani , Chadd Richard
Published: August 2020

Invasive species represent one of the primary threats to global biodiversity. Despite acknowledged implications for taxonomic properties of ecological communities following invasion, functional measures remain poorly understood.

We examined the long‐term implications of invasion by a crayfish species, Pacifastacus leniusculus, on functional alpha and beta diversity properties of lotic macroinvertebrate communities in three English regions. The dataset comprised 477 samples collected predominantly between 1990 and 2013. Unlike many invasion studies, we employed before and after invasion comparisons, in association with control rivers not invaded by crayfish.

Functional richness and divergence metrics displayed the strongest responses to invasion, highlighting that P. leniusculus may alter the range of functional niches and extreme trait values (likely reflecting resistance and resilience mechanisms) displayed by macroinvertebrate communities. Interestingly, in one region, biodiversity gains seen in control rivers were not mirrored in invaded rivers, potentially suggesting that invasion inhibited ecological improvements.

Invasion by signal crayfish resulted in functional compositional changes in two of the three English regions studied, with these rivers yielding greater ecological differences between pre‐ and post‐invasion periods relative to control rivers. This change was primarily driven by higher nestedness values in invaded rivers, with communities containing functional subsets relative to control rivers. The third region demonstrated no functional compositional changes or alterations in functional beta diversity associated with invasion.

Our findings indicated that in most instances, the functional properties of macroinvertebrate communities responded to crayfish invasion and may therefore represent a complementary means to monitor the ecological condition of lotic ecosystems. Given their spatial transferability, functional traits could provide a platform to guide regional management practices in the face of biological invasions.

A free Plain Language Summary can be found within the Supporting Information of this article.
How biological invasions affect animal behaviour: A global, cross‐taxonomic analysis
Authors: Ruland Florian , Jeschke Jonathan M.
Published: August 2020

In the Anthropocene, species are faced with drastic challenges due to rapid, human‐induced changes, such as habitat destruction, pollution and biological invasions. In the case of invasions, native species may change their behaviour to minimize the impacts they sustain from invasive species, and invaders may also adapt to the conditions in their new environment in order to survive and establish self‐sustaining populations.

We aimed at giving an overview of which changes in behaviour are studied in invasions, and what is known about the types of behaviour that change, the underlying mechanisms and the speed of behavioural changes.

Based on a review of the literature, we identified 191 studies and 360 records (some studies reported multiple records) documenting behavioural changes caused by biological invasions in native (236 records from 148 species) or invasive (124 records from 50 species) animal species. This global dataset, which we make openly available, is not restricted to particular taxonomic groups.

We found a mild taxonomic bias in the literature towards mammals, birds and insects. In line with the enemy release hypothesis, native species changed their anti‐predator behaviour more frequently than invasive species. Rates of behavioural change were evenly distributed across taxa, but not across the types of behaviour.

Our findings may help to better understand the role of behaviour in biological invasions as well as temporal changes in both population densities and traits of invasive species, and of native species affected by them.
Urbanization and plant invasion alter the structure of litter microarthropod communities
Authors: Malloch Bruce , Tatsumi Shinichi , Seibold Sebastian , Cadotte Marc W. , MacIvor J. Scott
Published: August 2020

Anthropogenic activity underpins the creation of urban ecosystems, often with introduced or invasive species playing a large role in structuring ecological communities. While the effects of urbanization on charismatic taxa such as birds, bees or butterflies have received much attention, the impacts on small and inconspicuous organisms remain poorly understood.

Here, we assess how the community structure of leaf litter‐inhabiting microarthropods in city parks varies along an urbanization gradient in Toronto, Canada. At each park, we established paired forest understorey plots which were either dominated by native vegetation or dog‐strangling vine Vincetoxicum rossicum, an invasive species that is spreading throughout northeastern North America and abundant in urban areas. We compared microarthropod richness, abundance and diversity in ecological traits between invaded and non‐invaded plots as well as compositional dissimilarities among plots across the urbanization gradient.

We recorded 123 genera and found (a) there was a negative effect of urbanization on microarthropod richness and abundance but only in invaded plots; (b) richness and abundance increased continuously with urbanization in non‐invaded plots, but peaked at intermediate urbanization levels in invaded plots and (c) there was significant turnover with increasing urbanization, with distinct communities represented in highly urbanized areas compared to less urbanized areas, regardless of whether invaded. We also found litter microarthropod richness and abundance increased with soil ammonium and decreased with nitrate. These trends were especially strong for fungivorous microarthropods; however, there was no relationship between soil nutrients and urbanization or invasion.

Urbanization and biological invasion drive biodiversity change, and there is a need to disentangle these effects on ecological communities and related ecosystem processes. We show microarthropod communities change with urbanization, with the effects of invasion most prominent in non‐urban areas. Here, there is high richness and abundance but low ecological trait diversity, possibly because certain feeding traits are excluded and others overrepresented.

Understanding of urban ecological systems must include knowledge of the microarthropods that interact widely across food webs, form distinct communities in highly urban areas and drive many of the important ecological functions upon which people in cities depend.
Inducing seed dispersal by generalist frugivores: A new technique to overcome dispersal limitation in restoration
Authors: Silva Wesley R. , Zaniratto Cristiane P. , Ferreira José O. V. , Rigacci Eduardo D. B. , Oliveira Jasmim F. , Morandi Maria E. F. , Killing Jéssica G. , Nemes Larissa G. , Abreu Laura B.
Published: August 2020

Dispersal limitation severely impairs the trajectory of restoration, mainly due to the lack of seed vectors bringing seeds from nearby habitats; a role played by many frugivorous vertebrates that can be absent or reduced in restored or degraded sites.

Here we propose a new technique named Induced Seed Dispersal, that amplifies the role that many generalist frugivores have in seed dispersal. It consists in the offering of seeds embedded in the pulp of commercial fruits or whole native fleshy fruits in feeders to generalist frugivores, which ingest the seeds and defecate them elsewhere. We set feeders in a restored site and monitored the visiting pattern of these frugivores with cameras‐traps. We also set seed traps to retrieve seeds dispersed by frugivores and offered around 1,500 seeds ofCecropia hololeuca(Urticaceae) per week for 1 year.

We recorded at least 24 generalist frugivore species of terrestrial mammals, bats and birds, which ingested/removed the seeds/fruits from the feeders. Seeds ofC. hololeucadispersed by marmosets were retrieved in the seed traps and germinated. We estimated a potential seed rain of more than 600C. hololeucaseeds ha−1 mo−1.

Synthesis and applications. Our study demonstrates that this new technique can make use of generalist frugivores to assist restoration or regeneration into sites where seed dispersal is compromised by the lack of dispersers or limited seed arrival. Inducing seed dispersal by generalist frugivores is a low‐cost and easy‐managed technique that can be applied year‐round in restoration and forest enrichments at all scales.
Meta‐omics highlights the diversity, activity and adaptations of fungi in deep oceanic crust
Authors: Quemener Maxence , Mara Paraskevi , Schubotz Florence , Beaudoin David , Li Wei , Pachiadaki Maria , Sehein Taylor R. , Sylvan Jason B. , Li Jiangtao , Barbier Georges , Edgcomb Virginia , Burgaud Gaëtan
Published: August 2020

The lithified oceanic crust, lower crust gabbros in particular, has remained largely unexplored by microbiologists. Recently, evidence for heterogeneously distributed viable and transcriptionally active autotrophic and heterotrophic microbial populations within low‐biomass communities was found down to 750 m below the seafloor at the Atlantis Bank Gabbro Massif, Indian Ocean. Here, we report on the diversity, activity and adaptations of fungal communities in the deep oceanic crust from ~10 to 780 mbsf by combining metabarcoding analyses with mid/high‐throughput culturing approaches. Metabarcoding along with culturing indicate a low diversity of viable fungi, mostly affiliated to ubiquitous (terrestrial and aquatic environments) taxa. Ecophysiological analyses coupled with metatranscriptomics point to viable and transcriptionally active fungal populations engaged in cell division, translation, protein modifications and other vital cellular processes. Transcript data suggest possible adaptations for surviving in the nutrient‐poor, lithified deep biosphere that include the recycling of organic matter. These active communities appear strongly influenced by the presence of cracks and veins in the rocks where fluids and resulting rock alteration create micro‐niches.
Feeding on fungi: genomic and proteomic analysis of the enzymatic machinery of bacteria decomposing fungal biomass
Authors: Starke Robert , Morais Daniel , Větrovský Tomáš , López Mondéjar Ruben , Baldrian Petr , Brabcová Vendula
Published: August 2020

Dead fungal biomass is an abundant source of nutrition in both litter and soil of temperate forests largely decomposed by bacteria. Here, we have examined the utilization of dead fungal biomass by the five dominant bacteria isolated from the in situ decomposition of fungal mycelia using a multiOMIC approach. The genomes of the isolates encoded a broad suite of carbohydrate‐active enzymes, peptidases and transporters. In the extracellular proteome, only Ewingella americana expressed chitinases while the two Pseudomonas isolates attacked chitin by lytic chitin monooxygenase, deacetylation and deamination. Variovorax sp. expressed enzymes acting on the side‐chains of various glucans and the chitin backbone. Surprisingly, despite its genomic potential, Pedobacter sp. did not produce extracellular proteins to decompose fungal mycelia but presumably feeds on simple substrates. The ecological roles of the five individual strains exhibited complementary features for a fast and efficient decomposition of dead fungal biomass by the entire bacterial community.
A Mona effect: How place discourse constitutes culture‐led change
Authors: Booth Kate , Ragaini Bruna Silva , Hardy Anne
Published: August 2020

The arrival of the Museum and Old and New Art (Mona) in the disadvantaged municipality of Glenorchy was heralded as the beginning of significant social change in Australia's island state of Tasmania. These expectations were premised on a local place discourse known as the “Tasmanian gothic,” and, in this article, our aim is to illustrate the importance of place specifications in culture‐led change, including in relation to how place discourse constitutes such change. To do this work, we illustrate a Mona effect that comprises a critical account of the Tasmanian gothic informed by an empiric of tourist movement to and from Mona. We demonstrate that tourist movements follow existing socio‐spatial patterns, with tourists from higher socio‐economic backgrounds bypassing Glenorchy and those from lower socio‐economic backgrounds more likely to stop in this disadvantaged municipality. This socio‐spatial account unsettles the characterisation of Tasmania and Tasmanians provided by the Tasmanian gothic and we conclude by observing (1) a lack of significant social change resulting from Mona, in part explained by well‐established socio‐economic patterns; (2) signs of more subtle change that warrant further investigation; and (3) how local place discourse can act to curtail culture‐led change by reinforcing existing socio‐economic patterns.
Characteristics and outcomes of adults with cytomegalovirus‐associated thrombocytopenia: a case series and literature review
Authors: Shragai Tamir , Lebel Eyal , Deshet Dana , Varon David , Avivi Irit , Kirgner Ilya , Sarid Nadav
Published: August 2020

Cytomegalovirus (CMV) is a ubiquitous virus that infects people worldwide. CMV is known to trigger thrombocytopenia, but this association is probably underdiagnosed since CMV infection in healthy adults is usually either asymptomatic or causes only mild symptoms. A systematic literature review was carried out and yielded 23 publications that reported 25 patients. All haematology centres in Israel were searched for adult immunocompetent patients with CMV‐associated thrombocytopenia, and five new cases were identified. The median age of the combined 30 patients was 33 years (range 18–80), 73% were men, 77% presented with CMV‐related symptoms, 48% had enlarged spleens, 95% had atypical lymphocytes in peripheral blood and 68% had elevated transaminase levels. The response rate to first‐line steroid‐containing regimens was only 31%, whereas 11 patients who were treated with an anti‐CMV agent had a response rate of 82%. Moreover, four patients received thrombopoietin receptor agonists (TPO‐RA) to which three (75%) responded. Taken together, these distinctive features of a case with thrombocytopenia should alert to CMV infection as the source. While steroids were effective in less than one‐third of the cases, both anti‐CMV therapy and TPO‐RA exhibited excellent efficacy, suggesting that those agents should be introduced earlier in the therapeutic course.
Artificial urinary sphincter significantly better than fixed sling for moderate post‐prostatectomy stress urinary incontinence: a propensity score‐matched study
Authors: Sacco Emilio , Gandi Carlo , Marino Filippo , Totaro Angelo , Di Gianfrancesco Luca , Palermo Giuseppe , Pierconti Francesco , Racioppi Marco , Bassi Pierfrancesco
Published: August 2020

Objective

To compare the efficacy of artificial urinary sphincter (AUS) vs retrourethral transobturator sling (RTS) in men with moderate post‐prostatectomy urinary incontinence (PPI) using propensity score‐matching analysis to enhance the validity of the comparison (Canadian Task Force classification II‐2).

Patients and methods

Consecutive men with moderate (3–5 pads/day) stress‐prevalent PPI were included if implanted with a RTS (TiLOOP® Male; pfm medical, Köln, Germany) or AUS (AMS800®; Boston Scientific, Boston, MA, USA) since July 2011 to December 2017 and with ≥12 months of follow‐up. Preoperative assessment included 24‐h pad usage, International Consultation on Incontinence Questionnaire‐Short Form (ICIQ‐SF), urethrocystoscopy, and urodynamics if indicated. Propensity score‐matching analysis was based on age, body mass index, Charlson Comorbidity Index, pad usage, previous radiotherapy, and urethrotomy. The primary outcome was at least ‘much improved’ response at 12‐months according to the Patient Global Impression of Improvement questionnaire, without additional PPI surgery or prosthesis explantation.

Results

Of 109 included patients, 70 patients were matched and the study groups were well balanced for the baseline matched variables. The median baseline 24‐h pad usage was four in both groups (P = 0.10), and median follow‐up was 51.2 months for AUS and 47.2 months (P = 0.5) for RTS patients. In the AUS and RTS cohorts, respectively, 33 (94.3%) and 24 (68.6%) patients achieved the primary outcome (P < 0.001), the 0–1 pad/day rates was 94.3% vs 68.6% (P = 0.012) at 12 months, and 91.4% vs 68.6% (P = 0.034) at last follow‐up. At the last follow‐up, the median 24‐h leakage volumes, median ICIQ‐SF scores and satisfaction rates were 0 vs 15 mL (P = 0.017), 4 vs 10 (P = 0.001), and 94.3% vs 68.6% (P = 0.012) in the AUS and RTS cohorts, respectively. There were no significant differences in overall rates of complications and re‐interventions, although Clavien–Dindo Grade III complications (n = 3) occurred only in the AUS group. At sensitivity analysis, the study was reasonably robust to hidden bias.

Conclusion

We found that AUS implantation significantly outperformed RTS in patients with moderate PPI for both subjective and objective outcomes.
Splicing factor PRPF6 upregulates oncogenic androgen receptor signaling pathway in hepatocellular carcinoma
Authors: Song Huijuan , Sun Ning , Lin Lin , Wei Shan , Zeng Kai , Liu Wei , Wang Chunyu , Zhong Xinping , Wang Manlin , Wang Shengli , Zhou Baosheng , Lv Chi , Liu Wensu , Zhao Yue
Published: August 2020

Androgen receptor (AR) signaling is considered to be crucial for the pathogenesis of hepatocellular carcinoma (HCC) with obvious sexual dimorphism. Pre‐mRNA processing factor 6 (PRPF6) was identified as a coactivator of AR. However, the molecular mechanism underlying the modulation function of PRPF6 on AR‐mediated transcriptional activity in HCC needs to be further clarified. In this study, we analyzed data from The Cancer Genome Atlas to show that PRPF6 is highly expressed in HCC. . Our data indicated that PRPF6 interacts with AR/AR splice variants (AR‐Vs) and upregulates AR/AR splice variant 7‐mediated transcriptional activity even without dihydrotestosterone treatment. We observed that AR is obviously induced by androgen treatment and is mainly expressed in the nucleus in HCC‐derived cell lines. Moreover, overexpression of PRPF6 enhances AR expression accompanied with the increase of AR‐Vs expression. We provided evidence that PRPF6 participates in upregulating AR self‐transcription. PRPF6 facilitates the recruitment of AR to the androgen responsive element region of the AR gene. Finally, PRPF6 depletion inhibits cell proliferation in HCC cells and mouse xenografts. Taken together, our results suggest that PRPF6 as a splicing factor enhances AR self‐transcription, thereby coactivating oncogenic AR/AR‐Vs actions in HCC.
Effectiveness of secondary prevention in metalworkers with work‐related skin diseases and comparison with participants of a tertiary prevention program: A prospective cohort study
Authors: Brans Richard , Wilke Annika , Rodríguez Elke , Boraczynski Nicole , Weidinger Stephan , Reich Anna , Geier Johannes , Schön Michael P. , Skudlik Christoph , John Swen M.
Published: August 2020

Background

In Germany, a multistep approach has been established to prevent work‐related skin diseases (WRSDs).

Objectives

To evaluate the effect of a secondary individual prevention program (SIP) in metalworkers with WRSD and to compare their characteristics with those of participants of a tertiary individual prevention program (TIP).

Patients and Methods

In a prospective cohort study, metalworkers with WRSD of the hands participating either in the SIP (n = 114) or in the TIP (n = 83) were recruited. At baseline and at the respective follow‐up 8–12 weeks after the SIP or at dismissal from the TIP (3–4 weeks later), questionnaires were completed and the severity of WRSD was assessed. Saliva samples were collected for assessment of filaggrin (FLG) mutations and an explorative genome‐wide association study (GWAS).

Results

Ninety‐three SIP patients (81.6%) attended the follow‐up. Disease severity was significantly reduced, and knowledge and protective behavior were significantly improved compared to baseline. Significant differences between SIP and TIP patients were found regarding duration and severity of symptoms, work absenteeism, tobacco smoking, and presence of atopic dermatitis, but not regarding FLG mutations and by GWAS.

Conclusions

The SIP was effective in metalworkers with WRSDs. Individual factors may influence the course of the disease and the need for the TIP.
Association of habits, triggers, glycaemic control, routines, stress and impulse control among emerging adults with type 1 diabetes
Authors: Hanna K. M. , Kupzyk K. A. , Hansen J. R. , Jones‐Ryan M. L. , Drincic A. T.
Published: August 2020

Aim

Glycaemic control is known to be poor among emerging adults with type 1 diabetes, but the reasons for this are poorly understood. Examination of diabetes self‐management‐related habits, triggers and daily routines within the context of impulse control and perceived daily stress may provide increased understanding of glycaemic control during this transitional period. This study examined associations among checking blood glucose (CBG) habits, eating a meal (EAM) habits and glycaemic control within the context of CBG triggers, daily routines, impulse control and perceived daily stress, in emerging adults with type 1 diabetes.

Methods

A cross‐sectional convenience sample of 100 emerging adults with type 1 diabetes was recruited from an outpatient diabetes care clinic for this age group. Participants self‐reported frequency of CBG and EAM habits, CBG triggers, daily routines, perceived daily stress and impulse control. Glycaemic control values were obtained from medical records. Path analysis was performed.

Results

Better glycaemic control was positively and significantly associated with greater frequency of CBG and EAM habits. CBG habits were positively and significantly associated with CBG triggers and EAM habits. EAM habits were positively and significantly associated with daily routines.

Conclusions

We suggest interventional research targeting CBG and EAM habits and daily routines to examine the impact on diabetes self‐management and glycaemic control.
Efficacy and safety of polyethylene glycol loxenatide as add‐on to metformin in patients with type 2 diabetes: A multicentre, randomized, double‐blind, placebo‐controlled, phase 3b trial
Authors: Gao Fei , Lv Xiaofeng , Mo Zhaohui , Ma Jianhua , Zhang Qiu , Yang Gangyi , Liu Weijuan , Li Quanmin , Zhou Jian , Bao Yuqian , Jia Weiping
Published: August 2020

Aim

To assess the efficacy and safety of polyethylene glycol loxenatide (PEX168), a new glucagon‐like peptide‐1 receptor agonist, as an add‐on to metformin therapy in Chinese patients with type 2 diabetes (T2D).

Materials and methods

This was a multicentre, randomized, double‐blind, placebo‐controlled phase 3b trial. After metformin monotherapy (≥1500 mg/day) for 8 weeks or more, patients with uncontrolled T2D (HbA1c of 7.0%‐10.5%) from 44 sites were randomized (1:1:1) to metformin + placebo, metformin + PEX168 100 μg, and metformin + PEX168 200 μg. The core treatment period lasted for 24 weeks, followed by a 28‐week extension period. The primary endpoint was the change in HbA1c levels at week 24. The main secondary endpoint was the proportion of patients with an HbA1c of less than 7.0% at week 24.

Results

The least‐square mean (standard error) change in HbA1c levels was significantly greater (P < .001 for superiority) in the PEX168 groups (−1.16% [0.08%] and −1.14% [0.08%] with 100 and 200 μg, respectively) than in the placebo group (0.35% [0.08%]). The proportion of patients with an HbA1c of less than 7.0% at week 24 was significantly higher in the PEX168 100 μg (37.4%) and PEX168 200 μg (40.6%) groups than in the placebo group (16.8%; both P < .001). The gastrointestinal reactions were mild; the risks of hypoglycaemia and weight gain did not increase. Anti‐PEX168 antibodies were noted in less than 2% of patients. No treatment‐emergent serious adverse events occurred.

Conclusion

The subcutaneous injection of PEX168 once a week can effectively, continuously and safely improve HbA1c levels in patients with T2D when combined with metformin.
Novel evidence for systemic induction of silicon defences in cucumber following attack by a global insect herbivore
Authors: Islam Tarikul , Moore Ben D. , Johnson Scott N.
Published: August 2020

1. Silicon (Si) is a beneficial nutrient that has been reported to ameliorate many abiotic and biotic stresses in plants, including insect herbivory. Insect herbivory has been shown to induce Si defences in plants, although the magnitude and nature of induction remain largely ambiguous. In particular, it is unclear whether herbivore induction of Si defences is confined to attacked tissues (local) or occurs elsewhere in the plant (systemic).

2. We grew cucumber, Cucumis sativus L. plants (var. Burpless F1 and Beit Alpha), an intermediate Si accumulator, hydroponically under Si‐supplemented or Si‐free conditions and measured the level of Si induction caused by a polyphagous chewing insect, the cotton bollworm, Helicoverpa armigera (Hübner) (Lepidoptera: Noctuidae). We also examined the impacts of Si on insect performance by conducting in vitro feeding assays on excised leaves (ex situ) and intact leaves on plants (in situ).

3. Herbivory significantly increased Si accumulation both locally in attacked leaves (21% increase in Beit Alpha and 17% in Burpless F1) and systemically in non‐attacked leaves (19% increase in Beit Alpha and 10% in Burpless F1). Si supplementation significantly increased % foliar Si and C:N ratio, while significantly decreasing larval relative consumption (RC) and relative growth rate (RGR) in the in situ assays. In ex situ assays, however, Si only reduced larval RGR when fed on Beit Alpha plants.

4. Our results confirm that Si‐based defences can also operate in moderate Si‐accumulating plants and, for the first time, that insect herbivory induces systemic Si accumulation equivalently between plant varieties.
Priority measures for publicly reporting primary care performance: Results of public engagement through deliberative dialogues in 3 Canadian provinces
Authors: Slater Morgan , Abelson Julia , Wong Sabrina T. , Langton Julia M. , Burge Fred , Hogg William , Hogel Matthew , Martin‐Misener Ruth , Johnston Sharon
Published: August 2020

Objective

While public reporting of hospital‐based performance measurement is commonplace, it has lagged in the primary care sector, especially in Canada. Despite the increasing recognition of patients as active partners in the health‐care system, little is known about what information about primary care performance is relevant to the Canadian public. We explored patient perspectives and priorities for the public reporting of primary care performance measures.

Methods

We conducted six deliberative dialogue sessions across three Canadian provinces (British Columbia, Ontario, Nova Scotia). Participants were asked to rank and discuss the importance of collecting and reporting on specific dimensions and indicators of primary care performance. We conducted a thematic analysis of the data.

Results

Fifty‐six patients participated in the dialogue sessions. Measures of access to primary care providers, communication with providers and continuity of information across all providers involved in a patient's care were identified as the highest priority indicators of primary care performance from a patient perspective. Several common measures of quality of care, such as rates of cancer screening, were viewed as too patient dependent to be used to evaluate the health system or primary care provider's performance.

Conclusions

Our findings suggest that public reporting aimed at patient audiences should focus on a nuanced measure of access, incorporation of context reported alongside measurement that is for public audiences, clear reporting on provider communication and a measure of information continuity. Participants highlighted the importance the public places on their providers staying up to date with advances in care.
Comparison of high‐flow and conventional nasal cannula oxygen in patients undergoing endobronchial ultrasonography
Authors: Yilmazel Ucar Elif , Araz Ömer , Kerget Bugra , Akgun Metin , Saglam Leyla
Published: August 2020

Background

Oxygen therapy is required to prevent hypoxaemia during the endobronchial ultrasonography (EBUS) procedure.

Aims

To compare the effectiveness of oxygen therapy delivered through high‐flow nasal cannula (HFNC) and conventional nasal cannula (CNC) in patients undergoing EBUS. The primary outcome was the proportion of patients who desaturated. Patient compliance and satisfaction were also evaluated.

Methods

This single‐centre prospective interventional study was conducted in a tertiary hospital among patients who presented to the EBUS unit in 2018 and 2019. Patients were randomly assigned to the HFNC group or the CNC group.

Results

The study included 170 patients (111 men and 59 women) with a mean age of 58 ± 14 years. The number of patients experiencing desaturation while receiving oxygen was statistically significantly lower (P < 0.001) in the HFNC group (n = 5) compared with the CNC group (n = 26). Oxygen therapy was adjusted in two patients in the CNC group due to desaturation. Saturation was significantly higher in the HFNC group (P < 0.0001) at the end of the EBUS procedure. Heart rate at the end of EBUS was lower in the HFNC group, but this difference was not statistically significant (96 ± 16 vs 101 ± 19, P = 0.13). Five patients in the HFNC group and 18 patients in the CNC group reported discomfort during the procedure (P = 0.006).

Conclusion

Oxygen therapy delivered by HFNC seems to be safer and more effective than by CNC in patients undergoing EBUS. Oxygen therapy with HFNC may be considered as an alternative to CNC because it may increase patient comfort and thereby improve compliance.
Statistical Implementations of Agent‐Based Demographic Models
Authors: Hooten Mevin , Wikle Christopher , Schwob Michael
Published: August 2020

A variety of demographic statistical models exist for studying population dynamics when individuals can be tracked over time. In cases where data are missing due to imperfect detection of individuals, the associated measurement error can be accommodated under certain study designs (e.g. those that involve multiple surveys or replication). However, the interaction of the measurement error and the underlying dynamic process can complicate the implementation of statistical agent‐based models (ABMs) for population demography. In a Bayesian setting, traditional computational algorithms for fitting hierarchical demographic models can be prohibitively cumbersome to construct. Thus, we discuss a variety of approaches for fitting statistical ABMs to data and demonstrate how to use multi‐stage recursive Bayesian computing and statistical emulators to fit models in such a way that alleviates the need to have analytical knowledge of the ABM likelihood. Using two examples, a demographic model for survival and a compartment model for COVID‐19, we illustrate statistical procedures for implementing ABMs. The approaches we describe are intuitive and accessible for practitioners and can be parallelised easily for additional computational efficiency.
A transitional care intervention for hypertension control for older people with diabetes: A cluster randomized controlled trial
Authors: Tu Qiang , Xiao Lily Dongxia , Ullah Shahid , Fuller Jeffrey , Du Huiyun
Published: August 2020

Aims

To evaluate the effect of a nurse‐coordinated hospital‐initiated transitional care programme on hypertension control for older people with diabetes in China.

Design

A cluster randomized controlled trial.

Methods

A total of 10 wards (clusters) of four acute care hospitals participated in the trial. They were randomly assigned to the intervention group or the control group. A total of 270 participants (135 in each group) were recruited from these wards. Data were collected between June 2016 ‐ June 2017. Participants in the intervention group received a 6‐month hospital to home transitional care programme coordinated by discharge nurses and community nurses. The programme comprised self‐management education, lifestyle changes, individualized medication treatment, structured telephone support, and primary care visits. Outcomes were measured at baseline, and 3 months and 6 months from the baseline.

Results

The mean age was 70.9 (SD 5.8) years and 55% of participants were men. The intervention group demonstrated a statistically significant decrease in mean systolic blood pressure of 10.7 mmHg and mean diastolic blood pressure of 4.1 mmHg compared with the control group. The findings also demonstrated significant improvements in HbA1c, hypertension knowledge, diabetes knowledge, treatment adherence, quality of life, hospital readmission, and emergency department visits in the intervention group compared with the control group. However, no significant differences in adverse events were observed between the two groups.

Conclusions

A hospital‐initiated and nurse‐coordinated transitional care intervention improves hypertension control and reduces hospital readmissions for older people with diabetes.

Impact

Lack hospital to home transitional care for hospitalized older people with hypertension and diabetes can result in high readmission rates and emergency department visits. A hospital‐initiated and nurse‐coordinated transitional care intervention built on collaboration between acute care hospitals and community health centres results in improved hypertension control and reduced readmissions for older people with diabetes and other chronic conditions. An integrated and well‐coordinated care services between acute care hospitals and community health centres can strengthen the primary care approach to supporting self‐management of hypertension, diabetes, and other ageing‐associated health conditions for community‐dwelling older people.

Trial registration

The trial was registered with the Australia New Zealand Clinical Trials Registry (ID: ACTRN12617001352392).
Decreased ANGPTL4 impairs endometrial angiogenesis during peri‐implantation period in patients with recurrent implantation failure
Authors: Li Mingyang , Hu Jingwen , Yao Lihua , Gao Minzhi
Published: August 2020

Insufficient endometrial angiogenesis during peri‐implantation impairs endometrial receptivity (ER), which contributes to recurrent implantation failure (RIF) during in vitro fertilization and embryo transfer (IVF‐ET). Angiopoietin‐like protein 4 (ANGPTL4) acts as a multifunctional secretory protein and is involved in the regulation of lipid metabolism and angiogenesis in various tissues including the endometrium. Herein, we found decreased ANGPTL4 expression in endometrial tissue and serum during peri‐implantation period in 18 RIF‐affected women with elevated uterine arterial impedance (UAI) compared with the pregnancy controls. ANGPTL4 and peroxisome proliferator‐activated receptor gamma (PPARγ) expression were up‐regulated upon decidualization on human endometrial stromal cells (HESCs). Rosiglitazone promoted the expression of ANGPTL4 in HESCs and human umbilical vein endothelial cells (HUVECs) via PPARγ. ANGPTL4 promoted the proliferation, migration and angiogenesis of HUVECs in vitro. Our results suggest that decreased abundance of ANGPTL4 in endometrial tissues impairs the endometrial receptivity via restraining endometrial angiogenesis during decidualization; while rosiglitazone‐induced ANGPTL4 up‐regulation in hESCs and HUVECs through PPARγ. Therefore, ANGPTL4 could be a potential therapeutic approach for some RIF‐affected women with elevated UAI.
Chemical peelings for the treatment of actinic keratosis: a systematic review and meta‐analysis
Authors: Steeb T. , Koch E.A.T. , Wessely A. , Wiest L.G. , Schmitz L. , Berking C. , Heppt M.V.
Published: August 2020

Background

Actinic keratosis (AK) is a common precancerous lesion of the skin that may be treated with chemical peelings. Despite their long‐standing usage and clinical experience, no evidence‐based recommendation regarding the efficacy and safety of chemical peelings for AK exists.

Objectives

To systematically review and synthesize the current knowledge on chemically exfoliative peelings as interventions for AK.

Methods

We performed a systematic literature research in Medline, Embase and CENTRAL and hand‐searched pertinent trial registers for eligible records until 5 August 2019. Results from individual studies were pooled using a random‐effects model or described in a qualitative synthesis. The risk of bias was estimated with the tools provided by the Cochrane Collaboration (randomized and non‐randomized trials) and the Evidence Project (single‐arm trials).

Results

Four randomized controlled trials, two non‐randomized controlled trials and two single‐arm studies with a total sample size of n = 170 patients were included. Trichloroacetic acid (TCA) plus Jessner’s solution showed significantly lower participant complete clearance (RR 0.36, 95% CI: 0.14–0.90, two studies, I2 = 0%, P = 0.03) and lower lesion clearance (RR 0.92, 95% CI: 0.85–0.99, one study, P = 0.03) compared to 5‐fluorouracil (5‐FU) 5% cream. TCA as monotherapy showed lower lesion complete clearance (RR 0.75, 95% CI: 0.69–0.82, two studies, I2 = 7%, P < 0.001) and lower mean lesion reduction per patient compared to conventional photodynamic therapy (cPDT) (MD −20.48, 95% CI: −31.55 to −9.41, two studies, I2 = 43%, P = 0.0003). Pain was more pronounced in patients treated with cPDT in comparison with TCA (MD −1.71 95% CI: −3.02 to −0.41, two studies, I2 = 55%, P = 0.01). In the single‐arm studies, 5‐FU plus glycolic acid showed 92% lesion clearance and phenol peeling 90.6% participant complete clearance. All studies showed a high risk for bias.

Conclusions

Future high‐quality studies and a standardization of peeling protocols are warranted to determine the value of chemical peelings in the treatment of AK.
Response to Tsai and colleagues
Authors: Gower B. A. , Adele Fowler L. , Fernandez J. R.
Published: August 2020

Click here to view the Review Symposium by Gower & Fowler