bluuebunny/crossref_metadata_2025 huggingface dataset:
Combined histopathological risk score using TP53 protein expression, CD8+ T cell density and intratumoral budding is an independent predictor of neoadjuvant therapy response in rectal adenocarcinoma
Authors: Chen Wei , Farchoukh Lama , Seigh Lindsey , Hartman Douglas J , Pai Reetesh K
Published: June 2021

Aims

Neoadjuvant therapy is the recommended treatment for locally advanced rectal adenocarcinoma; however, there remains significant variability in response to therapy. Tumour protein 53 (TP53) has been associated with therapy response and prognosis with conflicting data. Recently, we demonstrated that immune cell density and intratumoral budding (ITB) are predictive factors in rectal cancer. We investigated the predictive value of TP53 immunohistochemistry with CD8+ T cell density and ITB on pretreatment biopsies of rectal adenocarcinoma for response to neoadjuvant therapy.

Methods and results

Pretreatment biopsies of rectal adenocarcinoma from 117 patients with neoadjuvant therapy were analysed for TP53 expression by immunohistochemistry, ITB, CD8+ T cell density and mismatch repair protein (MMR) status. Most rectal adenocarcinomas displayed aberrant TP53 expression (86 of 117, 74%). Compared to wild‐type TP53, aberrant TP53 expression was associated with proficient MMR status (P = 0.003) and low CD8+ T cell density (P = 0.001). Aberrant TP53 was significantly associated with a partial to poor response to neoadjuvant therapy [odds ratio (OR) = 2.42, 95% confidence interval (CI) = 1.04–5.62, P = 0.04]. A combined histopathological risk score (HRS) was created using CD8+ T cell density, ITB and TP53 expression. Patients were separated into low (none to one factor) and high (two to three factors) HRS categories. In the multivariable model, patients with a high HRS were 3.25‐fold more likely to have a partial or poor response to neoadjuvant therapy (95% CI = 1.48–7.11, P = 0.003).

Conclusions

Our study demonstrates that aberrant TP53 expression, high ITB and low CD8+ T cell density in pretreatment biopsies can help predict response to neoadjuvant therapy. These biomarkers may be helpful in identifying patients at risk for therapy resistance.
Racial/ethnic differences in dietary intake among a diverse sample of adolescents: An experimental study
Authors: Zurita Tomas , Kazmierski Kelly F. M. , Wong Larissa , Faulkner Megan , Kuo Sabrina , Huszti Heather , Rao Uma
Published: June 2021

Background

African‐American (AA) and Hispanic/Latina (HL) females have higher obesity prevalence than do non‐Hispanic Whites (NHW); this may be due to AA and HL consuming more energy‐dense foods in response to stressors.

Objectives

This study examined racial/ethnic differences in dietary intake under controlled conditions (relaxation and stress) in a diverse sample of adolescent females.

Methods

Participants included 120 adolescent females (30% AA, 37% HL and 33% NHW) who participated in a laboratory food intake study. Using a randomized cross‐over design, ad libitum food consumption was measured following control/relaxation and social‐evaluative stress conditions. Food intake was indexed as consumed calories, added sugars and solid fats.

Results

The effect of laboratory conditions on food intake varied by race/ethnicity, such that AA consumed more energy following relaxation than following stress. For NHW and HL, food intake did not differ between conditions.

Conclusions

To the best of our knowledge, these findings are the first to directly observe racial/ethnic differences in food intake in response to acute stress, which may contribute to obesity‐related health disparities.
A shift to libertarian paternalism in old‐age income security: Discourses on pension privatization reforms in Lithuania 2016–2018
Authors: Juska Arunas
Published: June 2021

This study uses news media discourse analysis to investigate the highly contentious process of pension privatization retrenchment in Lithuania. In 2016, Lithuania began debating reforms on restructuring its poorly performing “second pillar” pension scheme – statutory funded individually defined contribution plans managed by the private sector. Pension reform is here conceptualized as a process of discursive contestation of the orthodox neoliberal consensus that prevailed in designing and introducing a private pension system in the early 2000s. By 2018, when a new Law on Pensions institutionalized a subsidized “nudge‐type” private retirement saving scheme, this process was legitimized by a newly prominent libertarian paternalistic ideology. Impacts of the discursive framing of pension reforms on their outcomes are discussed.
The impact of the Lesotho Child Grant Programme in the lives of children and adults with disabilities: Disaggregated analysis of a community randomized controlled trial
Authors: de Groot Richard , Palermo Tia , Banks Lena Morgon , Kuper Hannah
Published: June 2021

Globally, people with disabilities are disproportionally affected by poverty. Social protection policies, including cash transfers, are key strategies to address poverty “in all its forms”, but it is currently unclear how such programmes affect people with disabilities. This study examines differences in the impact of the Lesotho Child Grant Programme (CGP) on food security, health, education and livelihoods between people with and without disabilities using data from a community randomized control trial. Overall, this study finds the CGP had significant and differential impacts for people with disabilities across multiple health indicators (e.g. increased health expenditures, self‐rated health, likelihood of seeking healthcare). The CGP also had an impact on food security, decreasing the number of months households with and without members with disabilities faced extreme food shortages. There was also a modest but significant and differential impact of the CGP on the engagement of people with disabilities in paid work. The CGP only had an impact on school enrolment for children without disabilities, however the difference in impact was non‐significant and likely due to underpowered sample sizes. Overall, people with disabilities receiving the CGP still experienced high levels of absolute deprivation, and were generally still worse off compared to people without disabilities, indicating a need for adapted or complementary social protection and other poverty alleviation programmes.
Attitudes of nursing staff towards pressure ulcer prevention in primary and specialised health care: A correlational cross‐sectional study
Authors: Parisod Heidi , Holopainen Arja , Kielo‐Viljamaa Emilia , Puukka Pauli , Beeckman Dimitri , Haavisto Elina
Published: June 2021

The aim of this correlational, cross‐sectional study was to assess the pressure ulcer prevention attitudes of the nursing staff and to identify factors associated with it both in primary and special health care. The study was conducted with nursing staff (N = 554) working in primary and special health care units in two hospital districts in Finlandin 2018 to 2019. Attitude towards Pressure ulcer Prevention instrument was used for data collection. Demographic data, Pressure Ulcer Prevention Knowledge test, and Pressure Ulcer Prevention Practice instrument were used as background variables. Data were analysed with statistical tests. Nursing staff working in primary care (n = 327) had more positive attitudes towards pressure ulcer prevention than those in specialised care (n = 209;P = .047). Working as a wound care nurse (P = .0005), working experience after graduation (P = .0017), self‐reported pressure ulcer prevention and early detection skills (P < .0001), pressure ulcer prevention knowledge (P = .0002), and views about the realisation of their unit's pressure ulcer prevention practices (P < .0001) independently explained variation in participants' attitudes. Attention should be placed on the pressure ulcer prevention attitudes of nurses who are less experienced or less skilled and who have lower pressure ulcer prevention knowledge. Positive organisational culture towards evidence‐based pressure ulcer prevention practices should be promoted.
Clinical validation of amachine‐learning‐based handheld3‐dimensionalinfrared wound imaging device in venous leg ulcers
Authors: Chan Kai Siang , Liang Shanying , Cho Yuan Teng , Chan Yam Meng , Tan Audrey Hui Min , Muthuveerappa Sivakami , Lai Tina Peiting , Goh Cheng Cheng , Joseph Annie , Hong Qiantai , Yong Enming , Zhang Li , Chong Lester Rhan Chaen , Tan Glenn Wei Leong , Chandrasekar Sadhana , Lo Zhiwen Joseph
Published: June 2021

Chronic venous insufficiency is a chronic disease of the venous system with a prevalence of 25% to 40% in females and 10% to 20% in males. Venous leg ulcers (VLUs) result from venous insufficiency. VLUs have a prevalence of 0.18% to 1% with a 1‐year recurrence of 25% to 50%, bearing significant socioeconomic burden. It is therefore important for regular assessment and monitoring of VLUs to prevent worsening. Our study aims to assess the intra‐ and inter‐rater reliability of a machine learning‐based handheld 3‐dimensional infrared wound imaging device (WoundAide [WA] imaging system, Konica Minolta Inc, Tokyo, Japan) compared with traditional measurements by trained wound nurse. This is a prospective cross‐sectional study on 52 patients with VLUs from September 2019 to January 2021 using three WA imaging systems. Baseline patient profile and clinical demographics were collected. Basic wound parameters (length, width and area) were collected for both traditional measurements and measurements taken by the WA imaging systems. Intra‐ and inter‐rater reliability was analysed using intra‐class correlation statistics. A total of 222 wound images from 52 patients were assessed. There is excellent intra‐rater reliability of the WA imaging system on three different image captures of the same wound (intra‐rater reliability ranging 0.978‐0.992). In addition, there is excellent inter‐rater reliability between the three WA imaging systems for length (0.987), width (0.990) and area (0.995). Good inter‐rater reliability for length and width (range 0.875‐0.900) and excellent inter‐rater reliability (range 0.932‐0.950) were obtained between wound nurse measurement and each of the WA imaging system. In conclusion, high intra‐ and inter‐rater reliability was obtained for the WA imaging systems. We also obtained high inter‐rater reliability of WA measurements against traditional wound measurement. The WA imaging system is a useful clinical adjunct in the monitoring of VLU wound documentation.
A Computationally Simple Method for Estimating Decision Consistency
Authors: Wolkowitz Amanda A.
Published: June 2021

Decision consistency (DC) is the reliability of a classification decision based on a test score. In professional credentialing, the decision is often a high‐stakes pass/fail decision. The current methods for estimating DC are computationally complex. The purpose of this research is to provide a computationally and conceptually simple method for estimating DC that produces results comparable to, and at times potentially better than, the widely used Livingston‐Lewis method.
“This is not negotiable. You need to do this…”: A directed content analysis of decision making in rehabilitation after knee arthroplasty
Authors: Graber Jeremy , Lockhart Steven , Matlock Daniel D. , Stevens‐Lapsley Jennifer , Kittelson Andrew J.
Published: June 2021

Purpose

To understand patients' and physical therapists' perspectives related to decision making during outpatient rehabilitation after total knee arthroplasty (TKA), and to describe potential barriers and opportunities for shared decision making (SDM) in this setting.

Methods

A qualitative study examined the beliefs, thoughts, and experiences of patients and physical therapists regarding decision making in outpatient rehabilitation after TKA. Semi‐structured interviews were conducted and analysed using directed content analysis.

Results

Thirty‐five participants were interviewed (20 patients, 15 physical therapists). Three main themes emerged from the data: (1) there is variability among physical therapists in how patients are involved in care decisions, (2) several features of the outpatient care paradigm are not supportive of SDM, and (3) preoperative patient‐clinician interactions may facilitate SDM in postoperative rehabilitation, but these interactions are not typically utilized.

Conclusion

Physical therapists described using decision‐making strategies with varying levels of patient involvement. Both patients and physical therapists described barriers to routine use of SDM in the outpatient setting. Several actionable strategies for overcoming these barriers were identified for providers and organizations seeking to consistently use SDM in outpatient TKA rehabilitation.
Diagnostic accuracy of narrow‐band imaging endoscopy with targeted biopsies compared with standard endoscopy with random biopsies in patients with Barrett's esophagus: A systematic review and meta‐analysis
Authors: Hajelssedig Omer Eljyli , Zorron Cheng Tao Pu Leonardo , Thompson Jacqueline Y , Lord Anton , El Sayed Iman , Meyer Chase , Shaukat Ali Faisal , Abdulazeem Hebatullah M , Kheir Ammar O , Siepmann Timo , Singh Rajvinder
Published: June 2021

Background and Aim

Endoscopic surveillance for dysplasia in Barrett's esophagus (BE) with random biopsies is the primary diagnostic tool for monitoring clinical progression into esophageal adenocarcinoma. As an alternative, narrow‐band imaging (NBI) endoscopy offers targeted biopsies that can improve dysplasia detection. This study aimed to evaluate NBI‐guided targeted biopsies' diagnostic accuracy for detecting dysplasia in patients undergoing endoscopic BE surveillance compared with the widely used Seattle protocol.

Methods

Cochrane DTA Register, MEDLINE/PubMed, EMBASE, OpenGrey, and bibliographies of identified papers were searched until 2018. Two independent investigators resolved discrepancies by consensus, study selection, data extraction, and quality assessment. Data on sensitivity, specificity, and predictive values were pooled and analyzed using a random‐effects model.

Results

Of 9528 identified articles, six studies comprising 493 participants were eligible for quantitative synthesis. NBI‐targeted biopsy showed high diagnostic accuracy in detection of dysplasia in BE with a sensitivity of 76% (95% confidence interval [CI]: 0.61–0.91), specificity of 99% (95% CI: 0.99–1.00), positive predictive value of 97% (95% CI: 0.96–0.99), and negative predictive value of 84% (95% CI: 0.69–0.99) for detection of all grades of dysplasia. The receiver‐operating characteristic curve for NBI model performance was 0.8550 for detecting all dysplasia.

Conclusion

Narrow‐band imaging‐guided biopsy demonstrated high diagnostic accuracy and might constitute a valid substitute for random biopsies during endoscopic surveillance for dysplasia in BE.
Trends in telehealth and in‐person transitional care management visits during the COVID‐19 pandemic
Authors: Anderson Timothy S. , O'Donoghue Ashley L. , Dechen Tenzin , Herzig Shoshana J. , Stevens Jennifer P.
Published: June 2021

Background/Objectives

Transitional care management (TCM) visits delivered following hospitalization have been associated with reductions in mortality, readmissions, and total costs; however, uptake remains low. We sought to describe trends in TCM visit delivery during the COVID‐19 pandemic.

Design

Cross‐sectional study of ambulatory electronic health records from December 30, 2019 and January 3, 2021.

Setting

United States.

Participants

Forty four thousand six hundred and eighty‐one patients receiving transitional care management services.

Measurements

Weekly rates of in‐person and telehealth TCM visits before COVID‐19 was declared a national emergency (December 30, 2019 to March 15, 2020), during the initial pandemic period (March 16, 2020 to April 12, 2020) and later period (April 12, 2020 to January 3, 2021). Characteristics of patients receiving in‐person and telehealth TCM visits were compared.

Results

A total of 44,681 TCM visits occurred during the study period with the majority of patients receiving TCM visits age 65 years and older (68.0%) and female (55.0%) Prior to the COVID‐19 pandemic, nearly all TCM visits were conducted in‐person. In the initial pandemic, there was an immediate decline in overall TCM visits and a rise in telehealth TCM visits, accounting for 15.4% of TCM visits during this period. In the later pandemic, the average weekly number of TCM visits was 841 and 14.0% were telehealth. During the initial and later pandemic periods, 73.3% and 33.6% of COVID‐19‐related TCM visits were conducted by telehealth, respectively. Across periods, patterns of telehealth use for TCM visits were similar for younger and older adults.

Conclusion

The study findings highlight a novel and sustained shift to providing TCM services via telehealth during the COVID‐19 pandemic, which may reduce barriers to accessing a high‐value service for older adults during a vulnerable transition period. Further investigations comparing outcomes of in‐person and telehealth TCM visits are needed to inform innovation in ambulatory post‐discharge care.
Virgin coconut oil as prophylactic therapy against alcohol damage on skin in COVID times
Authors: Saraogi Punit , Kaushik Vaibhav , Chogale Ritesh , Chavan Sneha , Gode Vaishali , Mhaskar Sudhakar
Published: June 2021

Background

Increased frequency of using alcohol‐based hand sanitizers (ABHS) by consumers during COVID times have resulted in increased incidences of skin issues on palms.

Objective

(1) To quantify skin damage with increased usage frequency of ABHS by consumers and (2) To evaluate Virgin Coconut Oil (VCO) as natural prophylactic agent to counter the adverse effects.

Methods

In‐home usage study was carried out with 60 volunteers for a 15‐day intervention—Control Group: 6 applications per day of ABHS and Test Group: Overnight VCO use (6–8 drops) followed by 6× usage per day of ABHS. This leg included dermatological evaluation and WHO Self‐Assessment Scale for skin health. Another leg of measurement included non‐invasive instrumental study (Moisture & TEWL Probes, Tape Strip for protein content and IR spectroscopy for protein & lipid content) on forearm of 12 subjects (25–60 years age) with and without VCO application and repeated alcohol exposure.

Results

In‐home usage study established consumer experiencing skin protective effect of VCO in the context of ABHS onslaught. 25% increase in perceived moisture content was recorded for VCO users, using WHO Self‐Assessment Scale. Instrumental studies confirmed an increase in TEWL and decrease in lipids & protein content. Overnight VCO application resists the extraction which builds up with repeated application.

Conclusions

Current work provides evidence of compromised hand skin barrier with ABHS daily usage. Overnight VCO application helps prepare the skin for next day alcohol use. Based on the findings, a regimen of overnight VCO application on hands as a natural prophylactic is recommended.
Caregiver contribution to self‐care and its associated variables among caregivers of ostomy patients: Results of a cross‐sectional study
Authors: Giordano Vittoria , Iovino Paolo , Corvese Francesco , Vellone Ercole , Alvaro Rosaria , Villa Giulia
Published: June 2021

Aims and objectives

To describe caregiver contribution (CC) to ostomy self‐care and identify its associated variables among caregivers of ostomy patients.

Background

Self‐care is essential for ostomy patients, but it can be difficult to perform. In these cases, caregivers play a key role in promoting self‐care behaviours. So far, the CC to ostomy self‐care has not been investigated thoroughly.

Design

This is a cross‐sectional and multicentre study conducted at seven outpatient clinics of two Italian regions.

Methods

We recruited 252 caregivers between February 2017–May 2018. The Caregiver Contribution to Ostomy Self‐Care Index (CC‐OSCI) was used to measure CC to ostomy self‐care. Three multivariable linear regression models were fitted to identify variables associated with CC dimensions (maintenance, monitoring and management). The STROBE checklist was used to report the present study.

Results

The sample (mean age = 58.73, SD = 13.98) was mostly female (80.60%), unemployed (58.70%) and resided with the patient (81.00%). Caregivers being employed and those declaring more hours of contribution per week were associated with a significantly lower contribution to self‐care maintenance. Caregivers with lower levels of education and those residing with the patient were less likely to contribute to CC to self‐care monitoring. Spousal caregivers and those with higher preparedness contributed significantly lower to CC to self‐care management.

Conclusions

We found a variety of sociodemographic factors associated with CC to ostomy self‐care.

Relevance to clinical practice

Sociodemographic variables associated with CC to ostomy self‐care can help clinicians develop more tailored educational interventions for caregivers who find their contribution challenging.
Conundrums in teaching decolonial critical community psychology within the context of neo‐liberal market pressures
Authors: Canham Hugo , Bowman Brett , Graham Tanya , Stevens Garth , Langa Malose , Jithoo Vinitha , Alexander Daleen
Published: June 2021

In this paper, we provide empirically informed reflections on the difficulty of undertaking critically inflected, decolonial praxis in community psychology within the overdetermined global order of neo‐liberalism. Using interviews with 10 alumni of the Masters in Community‐Based Counselling (MACC) psychology program at the University of the Witwatersrand (Wits) in South Africa, we extend what have hitherto been largely theoretical debates about the fundamental constraints on teaching decolonial theory as an important touchstone of criticality in the context of the constraining forces of the free‐market economy. We focus on our participants’ attempts to navigate the inevitable tensions between the tenets of decolonial critical community psychology and neo‐liberal market pressures on employability. We analyze accounts of job‐seeking and employment experiences of the program alumni to ask whether we may have to contemplate the imminent evacuation of critical community epistemologies within the context of a market‐structured and professionally regulated psychology. We suggest that while the death knell of critical pedagogies and epistemologies has not yet quite arrived, more nuanced approaches to criticality may have to be adopted by the training programs that embrace them. We reveal that decoloniality's emergent traction within the academy is not mirrored by the world of professional psychology. We contend that our apparently ideologically bifurcated curriculum together with fundamental constraints on practice opportunities in the world of work, do not support an easy leap into the decolonial breach.
Adolescents’ preference for later school start times
Authors: Werner Helene , Albrecht Joëlle N. , Widmer Natacha , Janisch Daniel , Huber Reto , Jenni Oskar G.
Published: June 2021

As the chronotype delays progressively throughout puberty, early morning school start times (SSTs) contradict the sleep biology of adolescents. Various studies have demonstrated beneficial effects of later SSTs on sleep and health; however, adolescents’ preferences for SSTs have to date never been investigated in detail. The present online survey study aimed to fill this gap and explored influencing factors. A total of 17 high schools in the Canton of Zurich, Switzerland, circulated the survey among their students. Participants were included if they reported their sex, age, and school (n = 5,308). Students indicated whether they preferred later SSTs. Additionally, five predictor blocks were assessed: sociodemographic, school‐related, sleep, leisure‐time, and health‐related characteristics. We applied multivariate logistic regression models with fixed and random effects to predict the preference. The mean (SD) age of the students was 16.09 (1.76) years (65.1% female). The majority (63.2%) endorsed later SSTs with a preferred delay of 55 min (interquartile range 25–75 min). In the multilevel analysis (n = 2,627), sex, mother tongue, sleep characteristics, mobile device use at bedtime, caffeine consumption, and health‐related quality of life were significant predictors for the preference. Hence, the majority of adolescents preferred later SSTs, and especially those with sleep or health‐related problems. These characteristics have been consistently shown to improve after delaying SSTs. Thus, also from adolescents’ view, later SSTs should be considered to improve the adolescents’ health.
Body condition indices are better surrogates for lean mass and water content than for body fat content in an insect
Authors: Stahlschmidt Z. R. , Chang E.
Published: June 2021

Ecologists and evolutionary biologists often use body condition indices (BCIs) to approximate an animal’s energetic state, which is important because energy (typically, lipid) reserves influence an animal’s investment into fitness‐related traits. A BCI’s utility is typically assessed by examining its ability to predict standardized fat content (fat mass in fresh mass after correcting for body size) across a population. Less frequently, a BCI is assessed as a response variable by comparing its sensitivity to a particular treatment or factor (e.g. food availability or age) relative to that of standardized fat content. We assessed five common BCIs (or equivalent) with these two approaches in the wing‐dimorphic sand field cricket (Gryllus firmus Scudder 1902). All of the BCI methods significantly predicted standardized fat content in both sexes and wing morphs where the scaled mass index and Que ́telet’s index explained the most and least amount of variation, respectively. The BCIs and fat content were also similarly affected by adult age. However, BCIs were universally better proxies for lean mass and water content than for fat content. The relationships between BCIs and standardized lean mass and water content were stronger than those between BCIs and standardized fat content, and the effect sizes of age on BCIs were closer to that of lean mass relative to that of fat content. Thus, although BCIs reasonably predicted energy (fat) stores in G. firmus, they may be more indicative of lean mass or water content in insects. If BCIs are surrogates for protein and water storage, they may still approximate the storage of resources that fuel fitness‐related traits. Yet, future work is required to understand which body components (e.g. fat, protein or water) are most tightly linked to fitness, and whether traditional BCIs explain variation in fitness‐related body components across animal taxa.
Kinetics of CagA type IV secretion by Helicobacter pylori and the requirement for substrate unfolding
Authors: Lettl Clara , Haas Rainer , Fischer Wolfgang
Published: June 2021

Type IV secretion of effector proteins is an important principle for interaction of human pathogens with their target cells. The corresponding secretion systems may transport a multitude of effector proteins that have to be deployed in the respective spatiotemporal context, or only a single translocated protein, as in the case of the CagA effector protein produced by the human gastric pathogen Helicobacter pylori. For a more detailed analysis of the kinetics and mode of action of CagA type IV secretion by H. pylori, we describe here, a novel, highly sensitive split luciferase‐based translocation reporter which can be easily adapted to different end‐point or real‐time measurements. Using this reporter, we showed that H. pylori cells are able to rapidly inject a limited amount of their CagA supply into cultured gastric epithelial cells. We have further employed the reporter system to address the question whether CagA has to be unfolded prior to translocation by the type IV secretion system. We showed that protein domains co‐translocated with CagA as protein fusions are more readily tolerated as substrates than in other secretion systems, but also provide evidence that unfolding of effector proteins is a prerequisite for their transport.
An autopsy case of PARK2 due to a homozygous exon 2 deletion of parkin and associated with α‐synucleinopathy
Authors: Sakuwa Mayuko , Adachi Tadashi , Yoshida Kentaro , Adachi Yoshiki , Nakano Toshiya , Hanajima Ritsuko
Published: June 2021

Lewy bodies (LBs) are usually detected in patients with idiopathic Parkinson's disease (PD), but there have been few reports of LBs in a familial form of early‐onset PD associated with several mutations in parkin, a gene that encodes a ubiquitin E3 ligase involved in mitochondrial homeostasis, being also known as PARK2. Here, we report a case of PD with a PARK2 mutation characterized by a homozygous deletion of exon 2 and incidental LB pathology. A 60‐year‐old man developed tremor in the upper limbs. Although levodopa was initially effective, his symptoms slowly progressed. His cardiac uptake of 123I‐metaiodobenzylguanidine, as assessed by myocardial scintigraphy, decreased from an early stage after the onset. At the age of 81 years, he developed Legionella pneumonia and died of respiratory failure. Histopathological examination revealed a moderate loss of pigmented neurons, as well as gliosis in the substantia nigra and the locus coeruleus. Little LB‐related pathology was found in the locus coeruleus, dorsal nucleus of vagal nerve, and basal nucleus of Meynert. The cardiac sympathetic nerve in the epicardium showed a reduction in the numbers of fibers immunoreactive for tyrosine hydroxylase and phosphorylated neurofilament protein. Genetic analysis of frozen brain materials revealed a homozygous deletion of exon 2 of parkin. To our knowledge, this is the first autopsy case with a homozygous deletion of exon 2 of parkin. The number of LBs was small, the age of disease onset was later than that in typical PARK2‐associated PD patients, and cardiac sympathetic denervation was also present. Thus, we considered the LBs in our case as incidental and preclinical α‐synucleinopathy.
Why are you talking to yourself? The epistemic role of inner speech in reasoning
Authors: Munroe Wade
Published: June 2021

People frequently report that, at times, their thought has a vocal character. Thinking commonly appears to be accompanied or constituted by silently ‘talking’ to oneself in inner speech. In this paper, we explore the specifically epistemic role of inner speech in conscious reasoning. A plausible position—but one I argue is ultimately wrong—is that inner speech plays asolelyfacilitative role that is exhausted by (i) serving as the vehicle of representation for conscious reasoning, and/or (ii) allowing one to focus on certain types of objects or relations, e.g., causal relations, abstracta, counterfactuals, etc., or to consciously entertain structured propositional contents that it would be hard (or impossible) to focus on or entertain with representations in other (e.g., imagistic) formats. According to this position, inner speech doesn't figure as a justificatory element in our reasoning or as the partial epistemic basis of our conclusions—it merely facilitates reasoning through (i) and/or (ii). In contrast to the view that inner speech is amerefacilitator, I establish that (outside of potentially playing roles (i) and/or (ii)) the language we use itself serves as a crucial source of information in reasoning. In other words, we reason from propositions about the language we use in inner speech as opposed to exclusively reasoning from the semantic contents of the speech. My conclusion follows from how we use language as a cognitive tool to keep track of information, e.g., the contents of premises, lemmas, previous reasoning results, etc., in reasoning.
Humility in health care: A model
Authors: Zinan Nora
Published: June 2021

This paper presents the author's model of humility structures that can be operationalized as behaviours and incorporated into healthcare practice, the Humility in Health Care Model. The Humility in Health Care Model expands and combines the concepts of cultural humility, holistic nursing, servant leadership and the Chinese concept ‘QIAN’. The paper identifies ways to create a regular practice of humility behaviours on the personal/interpersonal, leadership, systems and policy levels. The paper discusses the benefits of operationalizing humility, forces that favour humility and barriers to practicing its behaviours. Suggestions for future research on humility in the healthcare professions are offered.
Salivary IgA antibody to malondialdehyde–acetaldehyde associates with mild periodontal pocket depth
Authors: Akhi Ramin , Nissinen Antti E. , Wang Chunguang , Kyrklund Mikael , Paju Susanna , Mäntylä Päivi , Buhlin Kåre , Sinisalo Juha , Pussinen Pirkko J. , Hörkkö Sohvi
Published: June 2021

Objective

Oxidized epitopes such as malondialdehyde–acetaldehyde (MAA) play a crucial role in the progression of atherosclerosis through activation of the humoral immune response. The exact mechanism of the association between atherosclerosis and periodontal diseases is not fully understood. The aim of the current study is to evaluate the association of oral humoral immune response to oxidized epitopes with parameters of periodontal disease.

Materials and methods

The Parogene cohort consist of patients who have undergone coronary angiography due to cardiac symptoms. In this study, 423 patients were randomly selected for an extensive oral examination. Salivary Immunoglobulin A to oxidized epitopes and bacterial antigens was determined by chemiluminescence immunoassay.

Results

In a binary logistic regression model adjusted with periodontal disease confounders, periodontal pocket depth (PPD) 4–5 mm associated with salivary IgA antibodies to MAA‐LDL (p = 0.034), heat shock protein 60 of Aggregatibacter actinomycetemcomitans (p = 0.045), Porphyromonas gingivalis (p = 0.045), A. actinomycetemcomitans (p = 0.005), P. intermedia (p = 0.020), and total IgA (p = 0.003).

Conclusions

The current study shows the association of salivary IgA to MAA‐LDL with PPD 4–5 mm in a cohort of patients with chronic coronary artery disease. Humoral immune cross‐reactivation to oxidized epitopes such MAA‐LDL could partly explain the link of periodontitis with systemic diseases.
Stability of rocky intertidal communities, in response to species removal, varies across spatial scales
Authors: Valdivia Nelson , López Daniela N. , Fica‐Rojas Eliseo , Catalán Alexis M. , Aguilera Moisés A. , Araya Marjorie , Betancourtt Claudia , Burgos‐Andrade Katherine , Carvajal‐Baldeon Thais , Escares Valentina , Gartenstein Simon , Grossmann Mariana , Gutiérrez Bárbara , Kotta Jonne , Morales‐Torres Diego F. , Riedemann‐Saldivia Bárbara , Rodríguez Sara M. , Velasco‐Charpentier Catalina , Villalobos Vicente I. , Broitman Bernardo R.
Published: June 2021

Improving our understanding of stability across spatial scales is crucial in the current scenario of biodiversity loss. Still, most empirical studies of stability target small scales. We experimentally removed the local space‐dominant species (macroalgae, barnacles, or mussels) at eight sites spanning more than 1000 km of coastline in north‐ and south‐central Chile, and quantified the relationship between area (the number of aggregated sites) and stability in aggregate community variables (total cover) and taxonomic composition. Resistance, recovery, and invariability increased nonlinearly with area in both functional and compositional domains. Yet, the functioning of larger areas achieved a better, albeit still incomplete, recovery than composition. Compared with controls, smaller disturbed areas tended to overcompensate in terms of total cover. These effects were related to enhanced available space for recruitment (resulting from the removal of the dominant species), and to increasing beta diversity and decaying community‐level spatial synchrony (resulting from increasing area). This study provides experimental evidence for the pivotal role of spatial scale in the ability of ecosystems to resist and recover from chronic disturbances. This knowledge can inform further ecosystem restoration and conservation policies.
Feasibility study for echocardiography‐guided lead insertion for permanent cardiac implantable electronic devices
Authors: Sogade Omolade O. , Aben Rieta N. , Eyituoyo Harry , Arinze Nkechi C. , Sogade Felix O.
Published: June 2021

Background

Permanent cardiac implantable electronic devices (CIEDs) are traditionally implanted with the assistance of fluoroscopy. While clinically effective, this technique exposes both patients and providers to radiation which is associated with adverse health effects and represents an occupational hazard. In this study, we investigate the safety and feasibility of permanent CIED placement under the guidance of transthoracic echocardiography (TTE). There is also increasing interest in use of non‐fluoroscopic options for noninvasive cardiac electrophysiologic procedures.

Methods

Fifteen patients consecutively consented for initial implant of CIEDs, specifically dual chamber pacemakers (DCPM) and dual chamber implantable cardioverter defibrillators (DCICDs). Patients were excluded if they had previous implants, abandoned leads, or anatomic anomalies including congenital and known persistent left superior vena cava (PLSVC). We used TTE to guide and implant atrial and ventricular leads.

Results

Eleven patients received DCPMs and four patients received DCICDs. The procedure duration was 49.3 min for DCICD and 52.3 min for DCPM, p = .807. The average number of right atrial lead attempts was 1.6 for DCPMs and 1.8 for DCICD, p = .860. The average number of right ventricular lead attempts for DCPMs was 2.2 and 1.0 attempt for DCICDs, p = .044. There were no complications at 90‐day follow‐up.

Conclusion

We demonstrate the feasibility of TTE‐guided DCPM/DCICD implantation without use of fluoroscopy. We present this method as a safe alternative for permanent CIED placement that may reduce risk of radiation exposure and cost while maintaining safety and efficacy. No operators wore lead aprons during the procedure.
Everyday Authoritarianism: Class and Coercion on Housing Estates in Neoliberal Britain
Authors: Davey Ryan , Koch Insa Lee
Published: June 2021

In Britain, especially in the 2010s, neoliberal reform involved an extension of legal coercion into the domestic and community lives of marginalized citizens. On two postindustrial housing estates in Britain, working‐class residents experience this “everyday authoritarianism” in areas that the liberal state typically constructs as private and purports to leave alone: the home and the intimate relations that frame it. Residents engage this legal coercion by adopting responses that range from defensive avoidance to co‐opting officials to acts of vigilantism. By doing so, they negotiate the presence of an authority that is often out of sync with their own expectations for protection, and in some cases actively undermines their efforts to remain safe. Their pluralism can be framed neither in terms of an acceptance of state authority nor as a straightforward refusal to be governed. Rather, it reveals the contradictory ways in which marginalized citizens define their relationship to the state under contemporary conditions of class fragmentation. By adding detail on everyday life to meta‐narratives of an authoritarian turn, this article theorizes the political potential and limits of people's daily engagements with the state for contesting the latter's authority.[class, coercion, liberal governance]
On Sharing Part Dimensions Information and Its Impact on Design Tolerances In Fixed‐Bin Selective Assembly
Authors: Clottey Toyin , Benton W. C.
Published: June 2021

Fixed‐bin selective assembly (FBSA) is a method for producing high‐tolerance specification assembly from lower precision components. This study investigates the design tolerance implications of an external supplier sharing dimensional information about shipped parts to be used for FBSA. An approach for reducing surplus components in FBSA is to predictively adjust the assembler's manufacturing process so that components produced internally better match those of incoming parts. However, it is unclear how the assembler's use of timely dimensions information—that is fully shared or is shared for a limited period, about the mean, variance, or both—of an externally sourced mating part would influence procedures for setting tolerances in an FBSA context. We develop and evaluate a Bayesian prediction‐based model with estimated parameters from a US assembler of bearings. Our results indicate that adjustments made using predictions from solely historical data produced comparable assembly efficiency to those made with shared information about only the dimensional variance of incoming parts. Prediction‐based adjustments, when only information about the dimensional mean was shared, yielded comparable matchable degrees to that when the mean and variance were both known. Furthermore, contrary to convention, looser tolerances were required to increase selective assembly efficiency. The shared information had a larger effect on the matchable degree than the modification of design tolerances in the absence of such information sharing. The insights have implications for coordinated component design and quality control.
Risk Assessment of Norovirus Illness from Consumption of Raw Oysters in the United States and in Canada
Authors: Pouillot Régis , Smith Mark , Van Doren Jane M. , Catford Angela , Holtzman Jennifer , Calci Kevin R. , Edwards Robyn , Goblick Gregory , Roberts Christopher , Stobo Jeffrey , White John , Woods Jacquelina , DePaola Angelo , Buenaventura Enrico , Burkhardt William
Published: June 2021

Human norovirus (NoV) is the leading cause of foodborne illness in the United States and Canada. Bivalve molluscan shellfish is one commodity commonly identified as being a vector of NoV. Bivalve molluscan shellfish are grown in waters that may be affected by contamination events, tend to bioaccumulate viruses, and are frequently eaten raw. In an effort to better assess the elements that contribute to potential risk of NoV infection and illness from consumption of bivalve molluscan shellfish, the U.S. Department of Health and Human Services/Food and Drug Administration (FDA), Health Canada (HC), the Canadian Food Inspection Agency (CFIA), and Environment and Climate Change Canada (ECCC) collaborated to conduct a quantitative risk assessment for NoV in bivalve molluscan shellfish, notably oysters. This study describes the model and scenarios developed and results obtained to assess the risk of NoV infection and illness from consumption of raw oysters harvested from a quasi‐steady‐state situation. Among the many factors that influence the risk of NoV illness for raw oyster consumers, the concentrations of NoV in the influent (raw, untreated) and effluent (treated) of wastewater treatment plants (WWTP) were identified to be the most important. Thus, mitigation and control strategies that limit the influence from human waste (WWTP outfalls) in oyster growing areas have a major influence on the risk of illness from consumption of those oysters.
D‐‐phenotype due to RHD‐RHCE hybrid transcript in a case of severe haemolytic disease of newborn with anti‐Rh 17(Hrₒ) antibodies
Authors: Mani Anila , Mishra Garima , Kulkarni Swati , Gupta Debasish
Published: June 2021

Background

D antigen is one among the most immunogenic antigens and is the most common cause of Haemolytic Disease of Fetus and Newborn (HDFN). The D‐phenotype is a rare Rh variant in which none of the RhCE antigens are expressed on the red cell surface. Individuals having D‐phenotype are capable of producing a rare alloantibody named as anti‐Rh17(Hr°) in response to pregnancy or transfusion and has the potential to react with C/c and E/e antigens causing severe haemolytic transfusion reaction (HTR) and haemolytic disease of fetus and newborn (HDFN).

Case report

We have encountered a case of severe HDFN with an accidental discovery of D‐ phenotype of the mother with anti‐Rh‐17 antibodies. D‐ phenotype has been confirmed with molecular typing along with genotyping of all family members.

Conclusion

Rare phenotypes like D‐ individuals especially if allo‐immunised are of great concern at times of transfusion requirements. Hence, proper identification of these individuals are important to contribute them to the rare donor pool and to adopt adequate patient blood management strategies.
The Development of Learning, Performing, and Controlling Repeated Sequential Actions in Young Children
Authors: Yanaoka Kaichi , Saito Satoru
Published: June 2021

Our daily lives are composed of several sequential actions that we perform routinely, such as making breakfast, taking a train, and changing clothes. Previous research has demonstrated that a routine system plays a role in performing and controlling repeated sequential actions in familiar situations, and a top‐down control system involves the control of the routine system in novel situations. Specifically, most developmental studies have focused on the top‐down control system (e.g., executive functions) as a factor enabling the control of goal‐directed actions in novel situations. Yet, it has not been thoroughly examined how young children learn, perform, and control repeated sequential actions in familiar contexts. In this review, based on recent computational accounts for adults, we highlight two critical aspects of the routine system from a developmental perspective: (1) automatic flexible changes of contextual representations, which enables humans to select context‐dependent actions appropriately; and (2) detection of deviant situations, which signals the need for control to avoid errors. In addition, we propose the developmental mechanism underlying the routine system and its potential driving factors such as statistical regularities and executive functions. Finally, we suggest that an investigation into the interplay between routine and executive functions can form foundations for understanding learning, performing, and controlling repeated sequential actions in young children and discuss future directions in this area.
Antigen matching for transfusion support in Brazilian female patients with sickle cell disease to reduce RBC alloimmunization
Authors: Muniz Janaína Guilhem , Arnoni Carine , Medeiros Rosangela , Vendrame Tatiane , Cortez Afonso , S Afonso José , Latini Flavia , Castilho Lilian , Girão Manoel
Published: June 2021

Background

Red blood cell (RBC) alloimmunization is a complication of patients with sickle cell disease (SCD) and it has a greater impact on pregnancy, leading to a risk of hemolytic disease of the newborn and reducing blood availability for pregnant women. This study proposed to evaluate antigen matching transfusion protocols, aiming to reduce RBC alloimmunization in Brazilian female patients with SCD.

Methods

Samples from female patients with SCD (153) and self‐declared Afro‐Brazilian donors (307) were genotyped for RBC antigens and RH variants were investigated. The transfusion needs of patients during 1‐year period and the number of compatible donors were assessed using three antigen‐matching transfusion protocols: prophylactic CEK antigen‐matched RBCs, prophylactic extended antigen‐matched RBCs, and extended‐matched red blood cells (RBCs) only for alloimmunized patients. In addition, RH molecular matching has been proposed for patients carrying variant RHCE.

Results

Provision of CEK antigen‐matched donors would have been possible in 92.4% of transfusion events while provision of prophylactic extended antigen‐matched RBCs would cover 88.7% of the transfusion events. Extended antigen matching for alloimmunized patients would be efficient in 99% of the cases. The presence of partial D in 10 patients increased the need of D‐negative donors. Compatible donors could be enough for four of the five patients with altered RHCE genotypes in both alleles.

Conclusion

In Brazilians, screening African descent donors allows the implementation of prophylactic CEK and extended antigen‐matching transfusion protocols to female patients with SCD to reduce RBC alloimmunization; however, the supply of compatible blood can be impaired for patients with Rh variants.