bluuebunny/crossref_metadata_2025 huggingface dataset:
Rectal Surgery Evaluation Trial: protocol for a parallel cohort trial of outcomes using surgical techniques for total mesorectal excision with low anterior resection in high‐risk rectal cancer patients
Authors: Rouanet P. , Gourgou S. , Gogenur I. , Jayne D. , Ulrich A. , Rautio T. , Spinoglio G. , Bouazza N. , Moussion A. , Gomez Ruiz M.
Published: February 2019

Aim

Total mesorectal excision (TME) is the standard of care for rectal cancer, which can be combined with low anterior resection (LAR) in patients with mid‐to‐low rectal cancer. The narrow pelvic space and difficulties in obtaining adequate exposure make surgery technically challenging. Four techniques are used to perform the surgery: open laparotomy, laparoscopy, robot‐assisted surgery and transanal surgery. Comparative data for these techniques are required to provide clinical data on the surgical management of rectal cancers.

Methods

The Rectal Surgery Evaluation Trial will be a prospective, observational, case‐matched, four‐cohort, multicentre trial designed to study TME with LAR using open laparotomy, laparoscopy, robot‐assisted surgery or transanal surgery in high‐surgical‐risk patients with mid‐to‐low non‐metastatic rectal cancer. All surgeries will be performed by surgeons experienced in at least one of the techniques. Oncological, morbidity and functional outcomes will be assessed in a composite primary outcome, with success defined as circumferential resection margin ≥ 1 mm, TME Grade III and minimal postoperative morbidity (absence of Clavien–Dindo Grade III–IV complications within 30 days after surgery). Secondary end‐points will include the co‐primary end‐points over the long term (2 years), quality of surgery, quality of life, length of hospital stay, operative time and rate of unplanned conversions.

Discussion

This will be the first trial to study all four surgical techniques currently used for TME with LAR in a specific group of high‐risk patients. The knowledge obtained will contribute towards helping physicians determine the advantages of each technique and which may be the most appropriate for their patients.
Evolution of the wealth gap in child development and mediating pathways: Evidence from a longitudinal study in Bogota, Colombia
Authors: Rubio‐Codina Marta , Grantham‐McGregor Sally
Published: February 2019

Large gaps in cognition and language on the Bayley‐III between the top and bottom household wealth quartiles in 1,330 children aged 6–42 months in a representative sample of low‐ and middle‐income families in Bogota were previously shown. Maternal education and the home environment mediated these wealth effects, whereas height‐for‐age mediated a small amount of the language deficit only. At ages 6–8 years, we relocated 72% of the children and assessed their IQ on the WISC‐V, school achievement, and behavior to investigate the evolution of the wealth gaps and potential mediators. The wealth gap in IQ at 6–8 years was significantly larger than that in a factor combining Bayley‐III language and cognition at 6–42 months; whereas the gap in achievement was larger but not significantly. Moreover, in cross‐sectional analysis, the IQ gap increased from 6 to 8 years reaching over 1 SD. In contrast, the gap in behavior was not significant in either childhood stage. Parental education and early home environment remained major mediators of the wealth gap in IQ and achievement at 6–8 years; later home environment and attending private education also had an effect; and early height‐for‐age was no longer significant. The home environment partly mediated the effect of parental education on wealth. All mediators combined explained most of the variance in the wealth gap; the remaining gaps being not significant. Results highlight the importance of the early home environment and suggest that interventions focusing on that should have long‐term benefits. Also, continued intervention through to 8 years may be desirable.

A video abstract of this article can be viewed at https://youtu.be/_U53iXNww3I.
The neural correlates of orienting to walking direction in 6‐month‐old infants: An ERP study
Authors: Lunghi Marco , Piccardi Elena Serena , Richards John E. , Simion Francesca
Published: February 2019

The ability to detect social signals represents a first step to enter our social world. Behavioral evidence has demonstrated that 6‐month‐old infants are able to orient their attention toward the position indicated by walking direction, showing faster orienting responses toward stimuli cued by the direction of motion than toward uncued stimuli. The present study investigated the neural mechanisms underpinning this attentional priming effect by using a spatial cueing paradigm and recording EEG (Geodesic System 128 channels) from 6‐month‐old infants. Infants were presented with a central point‐light walker followed by a single peripheral target. The target appeared randomly at a position either congruent or incongruent with the walking direction of the cue. We examined infants' target‐locked event‐related potential (ERP) responses and we used cortical source analysis to explore which brain regions gave rise to the ERP responses. The P1 component and saccade latencies toward the peripheral target were modulated by the congruency between the walking direction of the cue and the position of the target. Infants' saccade latencies were faster in response to targets appearing at congruent spatial locations. The P1 component was larger in response to congruent than to incongruent targets and a similar congruency effect was found with cortical source analysis in the parahippocampal gyrus and the anterior fusiform gyrus. Overall, these findings suggest that a type of biological motion like the one of a vertebrate walking on the legs can trigger covert orienting of attention in 6‐month‐old infants, enabling enhancement of neural activity related to visual processing of potentially relevant information as well as a facilitation of oculomotor responses to stimuli appearing at the attended location.
Reliability of the Motor Learning Strategies Rating Instrument in physiotherapy intervention for children with cerebral palsy
Authors: Ryan Jennifer L , Levac Danielle E , Wright F Virginia
Published: February 2019

Aim

To evaluate the reliability of the Motor Learning Strategies Rating Instrument (MLSRI‐20) in gait‐based, video‐recorded physiotherapy interventions for children with cerebral palsy (CP).

Method

Thirty videos of 18 children with CP, aged 6 to 17 years, participating in either traditional or Lokomat‐based physiotherapy interventions were rated using the MLSRI‐20. Physiotherapist raters provided general and item‐specific feedback after rating each video, which was used when interpreting reliability results.

Results

Both interrater and intrarater reliability of the MLSRI‐20 total score was good. The interrater reliability intraclass correlation coefficient (ICC) was 0.78 with a 95% confidence interval (CI) of 0.53–0.89 and a coefficient of variation (CV) of 11.8%. The intrarater reliability ICC was 0.89 with a 95% CI of 0.76–0.95 and CV of 7.8%. Rater feedback identified task delineation and interpretation of therapist verbalizations as sources of interrater reliability‐related scoring challenges.

Interpretation

The MLSRI‐20 is a reliable tool for measuring the extent to which a physiotherapist uses motor learning strategies during a video‐recorded intervention. These results have clinical and research implications for documenting and analyzing the motor learning content of physiotherapy interventions for children with CP.

What this paper adds

The Motor Learning Strategies Rating Instrument (MLSRI‐20) is reliable for use by trained physiotherapist raters.

Measuring motor learning strategies can identify active ‘ingredients’ in physiotherapy interventions for children with cerebral palsy.

The MLSRI‐20 promotes a common language in motor learning.
The Hand Assessment for Infants at risk for cerebral palsy
Authors: Wallen Margaret
Published: February 2019

This commentary is on the original article by Ek et al. on pages 1087–1092 of this issue.
Applying economic models to estimate local economic benefits of improved coverage of early intervention for psychosis
Authors: Campion Jonathan , Taylor Matthew J. , McDaid David , Park A‐La , Shiers David
Published: February 2019

Aim

Early Intervention Psychosis Services (EIPS) for people experiencing First Episode Psychosis (FEP) offer important clinical and non‐clinical benefits over standard care. Similarly, intervention for Clinical High Risk for Psychosis state (CHR‐P) can prevent psychosis, ameliorate symptoms and have non‐clinical benefits. This study aimed to estimate associated local economic benefits of FEP and CHR‐P services compared with standard care.

Methods

Across four south London boroughs, proportion of annual number of new cases of FEP and CHR‐P seen by early intervention services was estimated. Economic modelling conducted for England's mental health strategy was applied to estimate local economic impacts of current and improved service provision.

Results

Across four London boroughs during 2011/2012, proportion of 15‐34 year olds with FEP seen by EIPS was 100.2% assuming 80/100 000 annual incidence whereas proportion with CHR‐P seen by CHR‐P services was 4.1% assuming 200/100 000 annual incidence. Application of economic modelling suggests that provision of EIPS to reach all new FEP cases each year would free up resources of £13.1m over 10 years including £2.0m to National Health Service (NHS) after the first year. Scaling up to reach all new CHR‐P cases each year would free up resources of £19.7m over 10 years with an estimated 10‐year cost of implementation gap for each 1 year cohort of £18.9m. An earlier related briefing resulted in increased funding for EIPS and new CHR‐P services despite overall cuts to mental health services.

Conclusions

Estimation of local economic impacts of FEP and CHR‐P services was associated with improved investment in such services.
Association between remote diffusion‐weighted imaging lesions and cerebral small vessel disease in primary intracerebral hemorrhage
Authors: Xu X.‐h. , Ye X.‐h. , Li J.‐w. , Cai J.‐s. , Gao T. , Zhang W.‐j. , Zhao G.‐h. , Tong L.‐s. , Gao F.
Published: February 2019

Background and purpose

The aim of this study was to examine the association amongst remote diffusion‐weighted imaging lesions (R‐DWILs), imaging markers of cerebral small vessel disease (cSVD) and total cSVD burden in patients with primary intracerebral haemorrhage (ICH).

Methods

In total, 344 consecutive primary ICH patients were enrolled prospectively. R‐DWILs on magnetic resonance imaging as well as four imaging markers of cSVD, including cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), lacunes and enlarged perivascular spaces, were rated with validated scales. The total cSVD score was calculated by adding up these four markers. Univariate and multivariate analyses were performed.

Results

Remote DWI lesions were detected in 57 (16.6%) primary ICH patients. On multivariate logistic regression analysis, the presence of CMBs [odds ratio (OR) 5.26, 95% confidence interval (CI) 1.72–16.12], of high‐grade WMHs (OR 4.68, 95% CI 2.01–10.90), the presence of lacunes (OR 2.69, 95% CI 1.20–6.06), mixed CMBs (OR 2.93, 95% CI 1.35–6.36), mixed lacunes (OR 3.60, 95% CI 1.25–10.37), periventricular WMHs (OR 2.19, 95% CI 1.40–3.44), deep WMHs (OR 1.92, 95% CI 1.24–2.97) and total WMHs (OR 1.52, 95% CI 1.20–1.94) were associated with the presence of R‐DWILs. A significant association was also found between high‐grade total cSVD score and R‐DWILs (OR 1.97, 95% CI 1.36–2.84). This association remained significant in patients stratified by an age of 60 years or more than 60 years.

Conclusions

Remote DWI lesions are correlated with the severity of each imaging marker of cSVD and with the total burden of cSVD.
Development of information sharing in language neocortex in childhood‐onset drug‐resistant epilepsy
Authors: Arya Ravindra , Ervin Brian , Wilson J. Adam , Byars Anna W. , Rozhkov Leonid , Buroker Jason , Horn Paul S. , Scholle Craig , Fujiwara Hisako , Greiner Hansel M. , Leach James L. , Rose Douglas F. , Mangano Francesco T. , Glauser Tracy A. , Holland Katherine D.
Published: February 2019

Objective

We studied age‐related dynamics of information sharing among cortical language regions with electrocorticographic high‐gamma modulation during picture‐naming and story‐listening tasks.

Methods

Seventeen epilepsy patients aged 4‐19 years, undergoing extraoperative monitoring with left‐hemispheric subdural electrodes, were included. Mutual information (MI), a nondirectional measure of shared information, between 16 pairs of cortical regions of interest, was computed from trial‐averaged 70–150 Hz power modulations during language tasks. Impact of age on pairwise MI between language regions and their determinants were ascertained with regression analysis.

Results

During picture naming, significant increase in MI with age was seen between pairwise combinations of Broca's area, inferior precentral gyrus (iPreC), and frontal association cortex (FAC); Wernicke's area and posterior association cortex (PAC); and Broca's and Wernicke's areas. During story listening, significant age‐related increase in MI was seen between Wernicke's area and either Broca's area, FAC, or PAC; and between Broca's area and FAC. Significant impact of baseline intelligence quotient was seen on the relationship between age and MI for all pairs, except between Broca's area and iPreC. The mean MI was higher during naming compared to listening for pairs including iPreC with Broca's area, FAC, or PAC and was lower for pairs of Wernicke's area or PAC with anterior language regions.

Significance

Information sharing matures with age “within” frontal and temporoparietal language cortices, and “between” Broca's and Wernicke's areas. This study provides evidence for distinct patterns of developmental plasticity within perisylvian language cortex and has implications for planning epilepsy surgery.
Reconciling Independence and accountability at the European Central Bank: The false promise of Proceduralism
Authors: Dawson Mark , Maricut‐Akbik Adina , Bobić Ana
Published: February 2019

This article revisits the balancing act between independence and accountability at the European Central Bank (ECB). It contrasts procedural and substantive concepts of accountability, and challenges the mainstream idea that independence and accountability can be reconciled through narrow mandates, the indiscriminate increase of transparency, the creation of multiple channels of accountability, and the active use of judicial review. These assumptions form the pillars of a procedural type of accountability that promises to resolve the independence/accountability dilemma but fails to do so in practice. The article brings evidence to show how ECB accountability has become a complex administrative exercise that focuses on the procedural steps leading up to monetary and supervisory decisions while simultaneously limiting substantive accountability. The failure to acknowledge the trade‐off between independence and accountability (said to be ‘two sides of the same coin’) has resulted in a tendency to privilege the former over the latter.
An online‐offline prognosis model for fatigue life prediction under biaxial cyclic loading with overloads
Authors: Li Guoyi , Datta Siddhant , Chattopadhyay Aditi , Iyyer Nagaraja , Phan Nam
Published: February 2019

This paper presents a robust online‐offline model for the prediction of crack propagation under complex in‐phase biaxial fatigue loading in the presence of overloads of different magnitudes. The online prognosis model comprises a combination of finite element analysis and data‐driven regression to predict the crack propagation under constant loading, while the offline model is trained using experimental data to inform the post‐overload crack growth retardation behavior to the online model. The developed methodology is validated by conducting biaxial fatigue experiments using aluminum AA7075‐T651 alloy cruciform specimens. A close correlation is observed between the experimental results and model predictions. The results show that the model successfully predicts the crack retardation behavior under the influence of overloads with different magnitudes occurring at different stages of fatigue crack growth. Error analysis is conducted to investigate the sensitivities of the number of training points and crack increments to the prediction accuracy. In addition, the error propagation with respect to the crack length is studied, which provides constructive suggestions for further model improvement.
A Fictionalized Representation of Scientific Counter‐Discourse: Jo Lendle's Historical Science NovelAlles Land(2011)
Authors: Schaffeld Norbert
Published: February 2019

This paper explores a fictionalized series of past events in which a process of scientific discovery clearly contradicts the dominant academic discourse and is therefore bound to meet with powerful opposition. Based on an analysis of Jo Lendle's novelAlles Land(2011), the literary representation of the life of Alfred Wegener (1880–1930) and his theory of continental drift is studied against the backdrop of Thomas S. Kuhn's conceptualization of the processual character of science, as well as a modified reading of Foucault's discursive formations. The novel identifies Wegener's scientific plight as the fatal outcome of a nexus between modalities that predefine the object of research and those that regulate the institutional right to speak. In Lendle's context‐dependent narrativization, which provides the reader with a clear epistemic advantage, these two modalities fatefully converge in order to effectively, if falsely, claim that as a young astronomer and atmospheric physicist, Wegener allegedly lacks authority to speak on geological subject matters.
Off‐track thoughts: Intentional and unintentional mind wandering in Alzheimer's disease
Authors: El Haj Mohamad , Antoine Pascal , Moustafa Ahmed A , Roche Jean , Quaglino Véronique , Gallouj Karim
Published: February 2019

Aim

Despite the recent upsurge of interest in mind wandering (i.e. the occurrence of task‐unrelated and stimulus‐independent thoughts), little research has attempted to evaluate mind wandering in Alzheimer's disease (AD). We addressed this issue by evaluating intentional and unintentional mind wandering, as well as the relationship between both mind‐wandering domains. We also investigated the relationship between mind wandering and depression and working memory.

Methods

A total of 30 participants with AD and 33 control participants participated in the study.

Results

The results showed higher intentional and unintentional mind wandering in AD participants than in controls. In AD participants and controls, both mind wandering domains were significantly correlated with depression, but not with working memory.

Conclusions

The present findings show a tendency of AD patients to shift from external stimuli to task‐unrelated thoughts and concerns, a tendency that seems to be related with depression. Geriatr Gerontol Int 2019; 19: 342–346.
Same job, different rewards: The gender pay gap among physicians in Italy
Authors: Gaiaschi Camilla
Published: February 2019

Women have made significant progress in the medical profession, but despite this trend towards equality, the gender pay gap persists. This study investigates the determinants of earning differentials among physicians in Italy. This analysis is based on a dataset of more than 1000 doctors working in five hospitals in the Lombardy region. Data were collected through an online survey with a response rate of 48.7 per cent. Women's concentration in the lower ranks of the career ladder, their lower propensity to work as private practitioners and their lower concentration in surgical specialties contribute to the gender income gap. Having children and a spouse or a cohabiting partner entails a premium on income for men, but no penalty for women, which suggests that positive discrimination towards fathers and husbands is stronger than negative discrimination towards mothers and wives. On the other hand, the gender gap associated with marital and parental status is stronger in public hospitals than in private hospitals, at least up to the second child. Once differences in characteristics are controlled, women earn 18 per cent less than men. This penalty should be ascribed to employer's discrimination and/or unobserved characteristics. These findings challenge the human capital perspective by calling for attention into the role of structural mechanisms in producing inequalities.
New modes of continuous renal replacement therapy using a refiltering technique to reduce micronutrient loss
Authors: Wu Buyun , Ji Daxi , Xu Bin , Fan Rong , Gong Dehua
Published: February 2019

Introduction: Micronutrient depletion is a major drawback of high‐dose continuous renal replacement therapy (CRRT). We tested two novel CRRT modes, double‐filtration hemofiltration (DHF) and dialysate‐recycling hemodiafiltration (DHDF), aimed at reducing micronutrient loss while maintaining a high clearance rate of midsized solutes comparable to that of high‐volume hemofiltration (HVHF).

Methods: Forty patients with renal failure requiring CRRT were randomly assigned to receive predilutional standard‐volume hemofiltration (SVHF, effluent rate 35 mL/kg/h), predilutional HVHF (100 mL/kg/h), DHF (35 mL/kg/h), and DHDF (30 mL/kg/h). In the two novel modes of CRRT, part of the high‐volume primary effluent fluid produced by a high‐flux filter (AV600S) was refiltered by two low‐flux filters (15 L) for recycling as replacement fluid in DHF and dialysate in DHDF, while the remainder was discarded as final effluent fluid. Specimens were collected for measurement of trace elements, folic acid, amino acids (AAs), β2‐microglobulin, cystatin C, and creatinine and for calculation of solute clearance.

Findings: The clearance of 17 AAs, phosphorus, folic acid, copper, and zinc by DHF and DHDF was much lower than that by HVHF and comparable to that by SVHF. The estimated amount of AA loss by SVHF, HVHF, DHF, and DHDF was 10.3 (7.2–13.4) g/d, 22.1 (17.8–24.0) g/d, 10.6 (8.6–14.0) g/d, and 10.0 (8.6–11.4) g/d, respectively. Clearance of cystatin C and β2‐microglobulin by DHF and DHDF was much greater than that by SVHF and equal to that by HVHF.

Discussion: Compared to HVHF, DHF, and DHDF have an equal capacity for removal of large solutes but show substantially reduced micronutrient loss.
“Integration Constellations” – The Interaction between Destination and Origin Countries and Civil Society Organizations in Migrant Integration
Authors: Salamońska Justyna , Unterreiner Anne
Published: February 2019

Mainstream migration research examines migrant integration mainly as a function of integration policies in the country of destination, paying relatively little attention to policy frameworks in the country of origin. In this article we introduce the concept of “integration constellations” in order to describe multiple actors and actions involved in migrant integration in Europe. The analysis of such constellations includes policies frameworks produced by countries of destination and by countries of origin along with activities by civil society organizations. Our study encompasses all these actors in examining three empirical cases: Chinese student migration to the UK, Iranian refugees in Sweden, and Ukrainian labour migrants in Poland. These examples illustrate how actions by the states of origin and of destination can either complement or oppose each other. Although we concentrate on just three dimensions of integration (education, labour market and political participation), we point out the multidimensional reality of migrant integration.
Reducing carbon emissions through employee participation: evidence from Australia
Authors: Markey Raymond , McIvor Joseph , O'Brien Martin , Wright Chris F.
Published: February 2019

Based on a survey of 682 Australian organisations, we find that employee participation influences organisations' behaviours to reduce carbon emissions. Representative forms of participation and mechanisms dedicated specifically to environmental management are particularly important. Utilisation of a range of forms of participation is also associated with a broader suite of emission reduction activities.
Pilot trial of a STOMA psychosocial intervention programme for colorectal cancer patients with stomas
Authors: Lim Siew Hoon , Chan Sally Wai Chi , Chow Aloysius , Zhu Lixia , Lai Jiunn Herng , He Hong‐Gu
Published: February 2019

Aims

To evaluate preliminary effects of a newly developed STOMA psychosocial intervention programme that was delivered via a multi‐modal and multi‐dimensional approach on the improvement of outcomes of colorectal cancer patients with stoma.

Background

With a distorted body image and the loss of an essential body function, stoma patients face difficulties in everyday life in terms of physical, psychological, and social aspects. Few studies have explored effects of psychosocial interventions on improving stoma‐related health outcomes.

Design

This was a two‐group pre‐test‐post‐test pilot randomized controlled trial.

Methods

Fifty‐three participants were recruited from July 2015–November 2016 in a tertiary public hospital in Singapore. They were randomized into either intervention group (N = 29) or control group (N = 24). Stoma care self‐efficacy, acceptance of stoma, stoma proficiency, length of hospital stay, anxiety and depression and quality of life were measured. IBM SPSS 24.0 was used to analyse the data.

Results

There was an improvement in acceptance of stoma in the intervention group (p < 0.05). Significant effects on stoma care self‐efficacy, stoma proficiency, length of hospital stay, anxiety and depression level and quality of life were not shown.

Conclusion

This study developed a feasible and applicable psychosocial intervention programme and generated preliminary evidence in the positive outcomes of colorectal cancer patients with stoma. Future studies can explore technology‐based interventions to provide a more sustainable support for patients with stoma.
Identification and typing of Vagococcus salmoninarum using genomic and proteomic techniques
Authors: Torres‐Corral Yolanda , Santos Ysabel
Published: February 2019

This study reports on the characterization of Vagococcus salmoninarum using phenotypic, serological, antigenic, genetic and proteomic methods. All strains of V. salmoninarum were resistant to most of the antimicrobials tested, and only 10% of strains were sensitive to florfenicol. Serological analysis demonstrated a high antigenic homogeneity within the species. No cross‐reaction was detected with other fish pathogenic species causing streptococcosis (Lactococcus garvieae, Streptococcus parauberis, Streptococcus iniae, Streptococcus agalactiae, Carnobacterium maltaromaticum) using serum against V. salmoninarum CECT 5810. Electrophoretic analysis of cell surface proteins and immunoblot supported the antigenic homogeneity within V. salmoninarum strains. Moreover, limited diversity was detected using genomic (RAPD, ERIC‐PCR and REP‐PCR) and MALDI‐TOF‐MS analyses. The phenotypic, genomic and proteomic methods tested allowed the rapid differentiation of V. salmoninarum from the other species causing streptococcosis. However, MALDI‐TOF‐MS is the most promising method for typing and characterization of V. salmoninarum.
Bioengineering the microanatomy of human skin
Authors: Roger Mathilde , Fullard Nicola , Costello Lydia , Bradbury Steven , Markiewicz Ewa , O'Reilly Steven , Darling Nicole , Ritchie Pamela , Määttä Arto , Karakesisoglou Iakowos , Nelson Glyn , von Zglinicki Thomas , Dicolandrea Teresa , Isfort Robert , Bascom Charles , Przyborski Stefan
Published: February 2019

Recreating the structure of human tissues in the laboratory is valuable for fundamental research, testing interventions, and reducing the use of animals. Critical to the use of such technology is the ability to produce tissue models that accurately reproduce the microanatomy of the native tissue. Current artificial cell‐based skin systems lack thorough characterisation, are not representative of human skin, and can show variation. In this study, we have developed a novel full thickness model of human skin comprised of epidermal and dermal compartments. Using an inert porous scaffold, we created a dermal construct using human fibroblasts that secrete their own extracellular matrix proteins, which avoids the use of animal‐derived materials. The dermal construct acts as a foundation upon which epidermal keratinocytes were seeded and differentiated into a stratified keratinised epithelium. In‐depth morphological analyses of the model demonstrated very close similarities with native human skin. Extensive immunostaining and electron microscopy analysis revealed ultrastructural details such as keratohyalin granules and lamellar bodies within the stratum granulosum, specialised junctional complexes, and the presence of a basal lamina. These features reflect the functional characteristics and barrier properties of the skin equivalent. Robustness and reproducibility of in vitro models are important attributes in experimental practice, and we demonstrate the consistency of the skin construct between different users. In summary, a new model of full thickness human skin has been developed that possesses microanatomical features reminiscent of native tissue. This skin model platform will be of significant interest to scientists researching the structure and function of human skin.
The bizarre skull of Xenotyphlops sheds light on synapomorphies of Typhlopoidea
Authors: Chretien Johann , Wang‐Claypool Cynthia Y. , Glaw Frank , Scherz Mark D.
Published: February 2019

The emerging picture of non‐monophyly of scolecophidian snakes is increasingly indicative that fossorial lifestyle, myrmecophagous diet, and miniaturisation are powerful drivers of morphological evolution in squamate skulls. We provide a detailed description of the skull of Xenotyphlops grandidieri, with reference to the skulls of other scolecophidian snakes. The skull, which shows dramatic ventral inflection of the snout complex, is remarkably bizarre, and the mouth opening is more ventrally oriented than in other typhlopoids. The eyes are strongly reduced, and the enlarged and rather flat anterior head shield is covered in numerous sensillae. We put forward several potential explanations for the evolution of these unusual modifications. On the other hand, Xenotyphlops shares numerous synapomorphies with other typhlopoid snakes, including the highly specialized jaw mechanism. We argue that the key differences between the jaw mechanisms of Leptotyphlopidae, Anomalepididae, and Typhlopoidea provide compelling evidence for a strong role of convergence in the evolution of the scolecophidian bauplan, and these clades therefore cannot be interpreted as representative of ancestral anatomy or ecology among snakes.
Do Family Relationships Buffer the Impact of Disability on Older Adults' Daily Mood? An Exploration of Gender and Marital Status Differences
Authors: Carr Deborah , Cornman Jennifer C. , Freedman Vicki A.
Published: February 2019

Objective

We evaluate whether non‐spousal family support and strain moderate the effect of disability on older adults' daily frustration and happiness, and whether these patterns differ by gender and marital status.

Background

Stress buffering perspectives predict that harmful effects of stress on well‐being are buffered by family support, whereas stress proliferation models suggest effects are intensified by family strain. The extent to which family relationships moderate these associations may vary on the basis of gender and marital status, as non‐spousal family ties are considered especially salient for women and unpartnered persons.

Method

Data are from the 2013 Disability and Use of Time supplement to the Panel Study of Income Dynamics (n = 1,474), a national sample of adults ages 60+. Multivariate regression models are estimated for married/partnered men and women, and formerly married women.

Results

Neither family support nor strain moderated the effect of severe impairment on married men's emotions. Family support buffered the effect of impairment on frustration among divorced and widowed women, but not their married counterparts. Counterintuitively, family arguments reduced frustration and increased happiness among married women with severe impairment.

Conclusion

Consistent with stress buffering perspectives, family support was most protective for the vulnerable population of formerly married older women with severe impairment.

Implications

This study underscores the importance of family support for formerly married women managing health‐related challenges in later life.
Oral health status of adults in North Carolina assisted living facilities
Authors: Stephens Rhonda , White Benjamin Alex
Published: February 2019

Objectives

The specific aims of this study were to describe the baseline oral health status of persons residing in North Carolina assisted living facilities and determine how identified oral health problems vary according to resident and facility demographic variables.

Methods

This cross‐sectional descriptive epidemiologic study used a statewide random sample of 40 assisted living facilities and a convenience sample of 854 assisted living residents. Dental hygienists and dentists conducted oral screenings on residents using the Association of State and Territorial Dental Director's Basic Screening Survey for Older Adults tool.

Results

Nearly one‐third of participants were younger than 65. Overall, poorer oral health was noted for non‐Hispanic black residents, Medicaid recipients, residents of small facilities (20–60 beds), and residents of facilities located in the Coastal Plains region of the state. Oral health also worsened with increasing length of residence yet seemed to improve with age. The overall rate of edentulism was 29 percent, half of whom did not have complete dentures. Nearly half (48.6 percent) of residents had untreated decay.

Conclusions

There is a need for policy and public health programming that addresses the broad racial and socioeconomic factors that contribute to disparities among the institutionalized. Furthermore, the oral health disparities between institutionalized and community‐dwelling older adults reflect the need for policy that requires and ensures access to a minimum level of oral health care throughout the duration of a resident's stay. Programming to support such policy should include development of an oral health workforce that is competent in geriatric oral health care.
Projecting the economic impact of silver diamine fluoride on caries treatment expenditures and outcomes in young U.S. children
Authors: Johhnson Ben , Serban Nicoleta , Griffin Paul M. , Tomar Scott L.
Published: February 2019

Objective

To quantify the economic impact of using silver diamine fluoride (SDF) to arrest the progression of dental caries in Medicaid‐enrolled children (aged 1–5 years) relative to the standard restorative treatment from the Medicaid programs’ perspective.

Methods

We used Monte Carlo simulation to estimate averted restorative visits and associated expenditures for varying SDF effectiveness and intervention penetration levels. We compared the current standard of care for treating caries to applying SDF. We estimated expenditures from the 2010–2012 Medicaid Analytic Extract files for seven US states and the incremental cost effectiveness ratio for SDF application on averted restorative visits.

Results

Across the seven states, averted restorative visits ranged from 2,049 (Vermont) to 60,542 (North Carolina), assuming an SDF penetration level of 50%. Averted per‐restorative visit costs ranged from $100 to $350 per‐visit. There were higher averted per‐restorative visit costs in nonmetropolitan counties than metropolitan counties.

Conclusions

Providing SDF as a caries management strategy can reduce Medicaid program dental care expenditures by averting expensive caries treatment options. It could also prevent stressful restorative procedures. State Medicaid programs should consider reimbursing for SDF to arrest the progression of dental caries in young children.
Isolation by instability: Historical climate change shapes population structure and genomic divergence of treefrogs in the Neotropical Cerrado savanna
Authors: Vasconcellos Mariana M. , Colli Guarino R. , Weber Jesse N. , Ortiz Edgardo M. , Rodrigues Miguel T. , Cannatella David C.
Published: February 2019

Although the impact of Pleistocene glacial cycles on the diversification of the tropical biota was once dismissed, increasing evidence suggests that Pleistocene climatic fluctuations greatly affected the distribution and population divergence of tropical organisms. Landscape genomic analyses coupled with paleoclimatic distribution models provide a powerful way to understand the consequences of past climate changes on the present‐day tropical biota. Using genome‐wide SNP data and mitochondrial DNA, combined with projections of the species distribution across the late Quaternary until the present, we evaluate the effect of paleoclimatic shifts on the genetic structure and population differentiation of Hypsiboas lundii, a treefrog endemic to the South American Cerrado savanna. Our results show a recent and strong genetic divergence in H. lundii across the Cerrado landscape, yielding four genetic clusters that do not seem congruent with any current physical barrier to gene flow. Isolation by distance (IBD) explains some of the population differentiation, but we also find strong support for past climate changes promoting range shifts and structuring populations even in the presence of IBD. Post‐Pleistocene population persistence in four main areas of historical stable climate in the Cerrado seems to have played a major role establishing the present genetic structure of this treefrog. This pattern is consistent with a model of reduced gene flow in areas with high climatic instability promoting isolation of populations, defined here as “isolation by instability,” highlighting the effects of Pleistocene climatic fluctuations structuring populations in tropical savannas.
Tic22 from Anabaena sp. PCC 7120 with holdase function involved in outer membrane protein biogenesis shuttles between plasma membrane and Omp85
Authors: Brouwer Eva‐Maria , Ngo Giang , Yadav Shivam , Ladig Roman , Schleiff Enrico
Published: February 2019

β‐barrel‐shaped outer membrane proteins (OMPs) ensure regulated exchange of molecules across the cell‐wall of Gram‐negative bacteria. They are synthesized in the cytoplasm and translocated across the plasma membrane via the SEC translocon. In the periplasm, several proteins participate in the transfer of OMPs to the outer membrane‐localized complex catalyzing their insertion. This process has been described in detail for proteobacteria and some molecular components are conserved in cyanobacteria. For example, Omp85 proteins that catalyze the insertion of OMPs into the outer membrane exist in cyanobacteria as well. In turn, SurA and Skp involved in OMP transfer from plasma membrane to Omp85 in E. coli are likely replaced by Tic22 in cyanobacteria. We describe that anaTic22 functions as periplasmic holdase for OMPs in Anabaena sp. PCC 7120 and provide evidence for the process of substrate delivery to anaOmp85. AnaTic22 binds to the plasma membrane with specificity for phosphatidylglycerol and monogalactosyldiacylglycerol. Substrate recognition induces membrane dissociation and interaction with the N‐terminal POTRA domain of Omp85. This leads to substrate release by the interaction with a proline‐rich domain and the first POTRA domain of Omp85. The order of events during OMP transfer from plasma membrane to Omp85 in cyanobacteria is discussed.
Variations and angulation of the coronary sinus tributaries: Implications for left ventricular pacing
Authors: Mazur Małgorzata , Żabówka Anna , Bolechała Filip , Kopacz Paweł , Klimek‐Piotrowska Wiesława , Hołda Mateusz K.
Published: February 2019

Background

Variations of the coronary sinus tributaries might result in difficulties in left ventricle electrode insertion during cardiac resynchronizing therapy. Morphometric features of tributaries, especially angulation of the coronary sinus tributaries, are crucial for coronary sinus procedures.

Methods

This study was carried out on 200 formaldehyde‐fixed human hearts (22.0% females, mean age of 48.7 ± 15.6 years).

Results

The inferolateral aspect of the left ventricle was accessible from the coronary venous tree in 77.0% (in 35% from one, 29% from two, and 13.0% from three tributaries). The middle cardiac vein was present in all cases, with a diameter of 1.8 ± 0.5 mm, cannulation distance of 5.3 ± 3.2 mm, and angle of 82.0 ± 12.8°. The inferolateral vein of the left ventricle varied greatly in number: single in 63.5%, multiple in 30.5%. The ostium diameter for a single vein was 1.3 ± 0.5 mm, cannulation distance was 21.1 ± 9.8 mm, and the angle was 98.1 ± 13.5°. The left marginal vein was present in 39.5% with an ostium diameter of 0.9 ± 0.5 mm, cannulation distance of 46.0 ± 12.0 mm, and angle of 92.0 ± 13.4°. Finally, the oblique vein of the left atrium was present in 71.0% with a diameter of 1.3 ± 0.8 mm, cannulation distance of 27.2 ± 9.4 mm, and angle of 136.8 ± 16.6°.

Conclusions

This study shows the clinically relevant morphometric characteristic of coronary sinus tributaries. The middle cardiac vein is the most constant among coronary veins. However, it is usually not suitable for left ventricular pacing. The inferolateral vein of the left ventricle is highly variable in number, but its morphology makes it a suitable target for left ventricular lead placement.
Electroanatomic mapping‐guided catheter ablation of atrial tachycardia in children with limited/zero fluoroscopy
Authors: Elkiran Ozlem , Akdeniz Celal , Karacan Mehmet , Tuzcu Volkan
Published: February 2019

Introduction

Atrial tachycardia (AT) is an uncommon cause of supraventricular tachycardia in children and it is often resistant to medical therapy. Catheter ablation can be curative in children with AT. However, experience of ablation of pediatric AT is still very limited. The aim of this study, which is the largest series from a single center, was to assess the efficacy and safety of ablation of AT using an electroanatomical‐mapping system.

Methods

It was a retrospective review of 39 children with AT who underwent catheter ablation procedure using the EnSite Velocity system (St. Jude Medical, St. Paul, MN, USA) between July 2012 and April 2017.

Results

The mean patient age was 13.32 ± 6.82 years. The location of AT was right sided in 25 and left sided in 13, and both sides in one patient. The mean procedure time was 184.23 ± 60.19 min. Fluoroscopy was not used in 25 of 39 patients. The mean fluoroscopy time in the remaining patients was 5.53 ± 5.22 min. Radiofrequency (RF) ablation was used in 22, cryoablation was used in 10, and both RF and cryoablation were used in seven. Acute success was achieved in 34 patients (87.2%). During a mean follow‐up of 51.35 ± 12.62 months, AT recurred in five patients. These patients underwent second ablation procedures and four of them were successful. Final success was achieved in 33 out of 39 patients (84.6%). There were no complications except for one patient who had an uneventful pericardial needle injury during transseptal puncture without effusion.

Conclusions

Catheter ablation of AT in children can be performed safely and effectively with a limited fluoroscopy using electroanatomical mapping systems.
Use of psychologic strategies to reduce pain and anxiety related to dermatology procedures
Authors: Armenta Andrew M. , Jaquez Sasha D. , Levy Moise L. , Diaz Lucia Z.
Published: February 2019

The fear of painful procedures is at an increased incidence within the pediatric population. This can be an extremely challenging obstacle in dermatology where injections, blood draws, and cryotherapy are often required during the care of patients. Psychologic techniques based on cognitive behavioral therapy (CBT) can be implemented leading up to and while performing these procedures to help reduce patient anxiety.
Laser ablation of embryonic veins in children
Authors: Bittles Mark , Jodeh Diana S. , Mayer Jennifer L. R. , Gallant Michael , Rottgers S. Alex
Published: February 2019

Background

Klippel–Trenaunay syndrome (KTS) and related overgrowth syndromes are rare conditions that often present to academic pediatric units and multidisciplinary vascular anomaly clinics. These conditions are commonly associated with abnormalities of the superficial and deep venous structures and carry an increased risk of venous thromboembolism.

Methods

A retrospective chart review was completed of all patients treated at Johns Hopkins All Children's Hospital with endovenous laser ablation therapy (EVLT) for management of dilated embryonic veins in the setting of limb overgrowth.

Results

Three patients with limb overgrowth underwent EVLT between 2015 and 2017. All patients had successful occlusion of the targeted veins on post‐procedure imaging. One patient developed a cellulitis successfully treated with oral antibiotics.

Conclusions

Endovenous laser ablation therapy is a well‐tolerated and safe procedure for prophylactic closure of abnormal superficial embryonic veins. This study supports the use of this technique in managing increased thromboembolic risk in this unique patient population and recognizes the need for a long‐term study to determine its efficacy.
Tissue‐specific organic acid metabolism in reproductive and non‐reproductive parts of the fig fruit is partially induced by pollination
Authors: Lama Kumar , Peer Reut , Shlizerman Lyudmila , Meir Sagit , Doron‐Faigenboim Adi , Sadka Avi , Aharoni Asaph , Flaishman Moshe A.
Published: February 2019

Organic acids are important components of overall fruit quality through flavor, taste, nutritional and medicinal values. Pollinated fig (Ficus carica L.) fruit quality is enhanced by increased acidity. We quantified the major organic acids and characterized the expression pattern of organic acid metabolic pathway‐related genes in the reproductive part – inflorescence and non‐reproductive part – receptacle of parthenocarpic and pollinated fig fruit during ripening. Essentially, pollinated fruit contains seeds in the inflorescence, as opposed to no seeds in the parthenocarpic inflorescence. The major organic acids – citrate and malate – were found in relatively high quantities in the inflorescence compared to the receptacle of both parthenocarpic and pollinated fig fruit. Notably, pollination increased citric acid content significantly in both inflorescence and receptacle. Genes related to the phosphoenolpyruvate carboxylase (PEPC) cycle, tricarboxylic acid cycle, citrate catabolism and glyoxylate cycle were identified in fig fruit. Expression levels of most of these genes were higher in inflorescences than in receptacles. In particular, FcPEPC and FcFUM (encoding fumarase) had significantly higher expression in the inflorescence of pollinated fruit. Most importantly, expression of the glyoxylate cycle genes FcMLS and FcICL (encoding malate synthase and isocitrate lyase, respectively) was induced to strikingly high levels in the inflorescence by pollination, and their expression level was highly positively correlated with the contents of all organic acids. Therefore, the glyoxylate cycle may be responsible for altering the accumulation of organic acids to upgrade the fruit taste during ripening, especially in the pollinated, seeded inflorescence.