bluuebunny/crossref_metadata_2025 huggingface dataset:
A Practical Noncontact Model to Create Standardized Experimental Burn Wounds of Any Thickness: Blue Beam Laser Pointer for Burn Induction
Authors: Bingöl Uğur Anıl , Öksüz Sinan , Demiröz Anıl , Arslan Hakan
Published: June 2019

The objective of this study was to describe a predictable and easy-to-use model that can create standardized burn wounds. A 450-nm 1000-mW blue beam laser pointer was used to create burn wounds on the dorsal skin of 24 Sprague Dawley rats. Twelve distinct areas of dorsal skin were pulsed for 1, 3, 5, 7, 9, 11, 13, 15, 17, 19, 21, and 23 seconds with the help of a punched plastic card template. Three groups of 8 animals were killed immediately after on the third day and on the seventh day of the procedure and tissue samples were taken for histological evaluation and measurements. A second-degree burn was obtained in all animals with 3 and 5 seconds of laser application on the same day, third day, and seventh day measurements. Seven seconds of application resulted in a burn depth of 84.87% of dermis on the application day which deepened to involve the whole dermal layer on the third and seventh day. Nine seconds and longer application times resulted in third-degree burn wounds. Burn induction with blue beam laser pointer is an easy-to-use, predictable and safe model to create a standardized burn wound of desired thickness.
The EU’s Regulatory Commitment to a European Harmonized Pension Product (PEPP): The Portability of Pension Rights vis-à-vis the Free Movement of Capital
Authors: Borg Kyra , Minto Andrea , van Meerten Hans
Published: June 2019

European demographic structure and age composition are currently in a state of flux—life expectancy has increased, fertility rates have dropped, and baby-boomers have reached retirement age. The implications of these changes, coupled with the fragmented market for personal pension products throughout the EU are vast and call for close scrutiny of the relationship between financial and pension markets.

This article examines the current regulatory efforts aimed at creating a Pan-European Personal Pension Product (PEPP). In doing so, it pursues two primary objectives: firstly, it seeks to explain the relevance of a European harmonized pension product to the overall concept of the single market; and secondly, it aims to explore the looming regulatory challenges stemming from the portability of social and pension rights. This is done by elaborating upon established law and economics scholarship on capital markets, including the Legal Theory of Finance developed by Katharina Pistor. By assessing the costs faced by prospective pensioners against the benefits of legislative harmonization (and other policy-related alternatives), from both a normative perspective as well as a positive one, this article attempts to make a case for an effective and sustainable governance response.

The article ultimately seeks to provide a well-balanced, albeit modern outlook to the regulatory endeavours that have more recently been made applicable to the EU personal pension market in virtue of the creation of the PEPP and the wide-ranging effects of such reforms on law, finance, and society.
Self-reliance as a Concept and a Spatial Practice for Urban Refugees: Reflections from Delhi, India
Authors: Field Jessica , Tiwari Anubhav Dutt , Mookherjee Yamini
Published: June 2019

In India, urban refugees sit within a legal vacuum and often struggle to make ends meet in the socio-economic periphery. The United Nations High Commissioner for Refugees and its implementing partners have focused on supporting refugees to achieve a level of self-reliance, primarily through market-based livelihood interventions. However, refugee lives in India’s cities continue to be characterized by economic insecurity, exploitation and marginalization. This article explores the limitations of a market-orientated approach to fostering refugee self-reliance in the context of Delhi and departs from the burgeoning literature on refugee self-reliance by examining it from a spatial perspective. Building on recent work in political geography, the article highlights historic and ongoing practices of spatial exclusion of refugees and other poor migrant groups in India’s capital city, as well as a diverse range of (non-economic) social networks and activities that have emerged as safety nets. We argue that, in addition to livelihoods, humanitarian actors must also explore non-economic initiatives that might contribute to refugee self-reliance and, importantly, must pay more attention to how the urban environment both delimits and enables these activities.
Star-forming clumps in the Lyman Alpha Reference Sample of galaxies – I. Photometric analysis and clumpiness
Authors: Messa Matteo , Adamo Angela , Östlin Göran , Melinder Jens , Hayes Matthew , Bridge Johanna S , Cannon John
Published: June 2019

We study young star-forming clumps on physical scales of 10–500 pc in the Lyman-Alpha Reference Sample (LARS), a collection of low-redshift (z = 0.03–0.2) UV-selected star-forming galaxies. In each of the 14 galaxies of the sample, we detect clumps for which we derive sizes and magnitudes in five UV-optical filters. The final sample includes ∼1400 clumps, of which ∼600 have magnitude uncertainties below 0.3 in all filters. The UV luminosity function for the total sample of clumps is described by a power law with slope $\alpha =-2.03^{+0.11}_{-0.13}$. Clumps in the LARS galaxies have on average ΣSFR values higher than what is observed in H ii regions of local galaxies and comparable to typical star formation rate (SFR) densities of clumps in z = 1–3 galaxies. We derive the clumpiness as the relative contribution from clumps to the UV emission of each galaxy, and study it as a function of galactic-scale properties, i.e. ΣSFR and the ratio between rotational and dispersion velocities of the gas (vs/σ0). We find that in galaxies with higher ΣSFR or lower vs/σ0, clumps dominate the UV emission of their host systems. All LARS galaxies with Ly α escape fractions larger than 10% have more than 50% of the UV luminosity from clumps. We tested the robustness of these results against the effect of different physical resolutions. At low resolution, the measured clumpiness appears more elevated than if we could resolve clumps down to single clusters. This effect is small in the redshift range covered by LARS; thus, our results are not driven by the physical resolution.
The search for multiple populations in Magellanic Clouds clusters – V. Correlation between cluster age and abundance spreads
Authors: Martocchia S , Dalessandro E , Lardo C , Cabrera-Ziri I , Bastian N , Kozhurina-Platais V , Salaris M , Chantereau W , Geisler D , Hilker M , Kacharov N , Larsen S , Mucciarelli A , Niederhofer F , Platais I , Usher C
Published: June 2019

In our HST photometric survey, we have been searching for multiple stellar populations (MPs) in Magellanic Clouds (MCs) massive star clusters which span a significant range of ages (∼1.5–11 Gyr). In the previous papers of the series, we have shown that the age of the cluster represents one of the key factors in shaping the origin of the chemical anomalies. Here, we present the analysis of four additional clusters in the MCs, namely Lindsay 38, Lindsay 113, NGC 2121, and NGC 2155, for which we recently obtained new UV HST observations. These clusters are more massive than ∼104 M⊙ and have ages between ∼2.5 and ∼6 Gyr, i.e. located in a previously unexplored region of the cluster age/mass diagram. We found chemical anomalies, in the form of N spreads, in three out of four clusters in the sample, namely in NGC 2121, NGC 2155, and Lindsay 113. By combining data from our survey and HST photometry for three additional clusters in the Milky Way (namely 47 Tuc, M15, and NGC 2419), we show that the extent of the MPs in the form of N spread is a strong function of age, with older clusters having larger N spreads with respect to the younger ones. Hence, we confirm that cluster age plays a significant role in the onset of MPs.
Evolution of the hard X-ray photon index in black-hole X-ray binaries: hints for accretion physics
Authors: Liu Hao , Dong AiJun , Weng ShanShan , Wu Qingwen
Published: June 2019

Negative and positive correlations between the X-ray photon index and the Eddington-scaled X-ray luminosity were found in the decay phase of X-ray binary outbursts and a sample of active galactic nuclei in former works. We systematically investigate the evolution of the X-ray spectral index, along with the X-ray flux and Eddington ratio, in eight outbursts of four black-hole X-ray binaries, where all selected outbursts have observational data from the Rossi X-ray Timing Explorer in both rise and decay phases. In the initial rise phase, the X-ray spectral index is anticorrelated with the flux and the X-ray spectrum quickly softens when the X-ray flux is approaching the peak value. In the decay phase, the X-ray photon index and the flux follow two different positive correlations and they become anticorrelated again when the X-ray flux is below a critical value, where the anticorrelation part follows the same trend as found in the initial rise phase. Compared with other X-ray binaries, GRO J1655−40 has an evident lower critical Eddington ratio for the anticorrelation and positive transition, which suggests that its black-hole mass and distance are not well constrained, or its intrinsic physics is different.
Fundamental uncertainty levels of 21 cm power spectra from a delay analysis
Authors: Lanman Adam E , Pober Jonathan C
Published: June 2019

Several experimental efforts are underway to measure the power spectrum of 21 cm fluctuations from the epoch of reionization (EoR) using low-frequency radio interferometers. Experiments like the Hydrogen Epoch of Reionization Array (HERA) and Murchison Widefield Array Phase II (MWA) feature highly redundant antenna layouts, building sensitivity through redundant measurements of the same angular Fourier modes, at the expense of diminished UV coverage. This strategy limits the numbers of independent samples of each power spectrum mode, thereby increasing the effect of sample variance on the final power spectrum uncertainty. To better quantify this effect, we measure the sample variance of a delay-transform based power spectrum estimator, using both analytic calculations and simulations of flat-spectrum EoR-like signals. We find that for the shortest baselines in HERA, the sample variance can reach as high as 20 per cent, and up to 30 per cent for the wider fields of view of the MWA. Combining estimates from all the baselines in a HERA- or MWA-like 37 element redundant hexagonal array can lower the variance to 1−3 per cent for some Fourier modes. These results have important implications for observing and analysis strategies, and suggest that sample variance can be non-negligible when constraining EoR model parameters from upcoming 21 cm data.
The mass density profile and star formation history of Gaussian and non-Gaussian clusters
Authors: de Carvalho R R , Costa A P , Moura T C , Ribeiro A L B
Published: June 2019

This paper is the third of a series in which we investigate the discrimination between Gaussian (G) and Non-Gaussian (NG) clusters, based on the velocity distribution of the member galaxies. We study a sample of 177 groups from the Yang catalog in the redshift interval of 0.03 ≤ z ≤ 0.1 and masses ${\ge }10^{14}\, \rm M_{\odot }$. Examining the projected stellar mass density distributions of G and NG groups, we find strong evidence of a higher infall rate in the outskirts of NG groups over the G ones. There is a 61 per cent excess of faint galaxies in NGs when contrasted with G groups, when integrating $\rm from \, 0.8 \,to\, 2.0R/R_{200}$. The study of the star formation history (SFH) of ellipticals and spirals in the three main regions of the projected phase space reveals also that the star formation in faint spirals of NG groups is significantly different from their counterpart in the G groups. The assembled mass for faint spirals varies from 59 per cent at 12.7 Gyr to 75 per cent at 8.0 Gyr, while in G systems this variation is from 82 per cent to 91 per cent. This finding may also be interpreted as a higher infall rate of gas-rich systems in NG groups. This accretion process through the filaments, disturbing the velocity distribution and modifying not only the stellar population of the incoming galaxies but also their SFH, should be seriously considered in modelling galaxy evolution.
Variation in Recombination Rate Is Shaped by Domestication and Environmental Conditions in Barley
Authors: Dreissig Steven , Mascher Martin , Heckmann Stefan
Published: June 2019

Meiotic recombination generates genetic diversity upon which selection can act. Recombination rates are highly variable between species, populations, individuals, sexes, chromosomes, and chromosomal regions. The underlying mechanisms are controlled at the genetic and epigenetic level and show plasticity toward the environment. Environmental plasticity may be divided into short- and long-term responses. We estimated recombination rates in natural populations of wild barley and domesticated landraces using a population genetics approach. We analyzed recombination landscapes in wild barley and domesticated landraces at high resolution. In wild barley, high recombination rates are found in more interstitial chromosome regions in contrast to distal chromosome regions in domesticated barley. Among subpopulations of wild barley, natural variation in effective recombination rate is correlated with temperature, isothermality, and solar radiation in a nonlinear manner. A positive linear correlation was found between effective recombination rate and annual precipitation. We discuss our findings with respect to how the environment might shape effective recombination rates in natural populations. Higher recombination rates in wild barley populations subjected to specific environmental conditions could be a means to maintain fitness in a strictly inbreeding species.
Identifying Clusters of High Confidence Homologies in Multiple Sequence Alignments
Authors: Ali Raja Hashim , Bogusz Marcin , Whelan Simon
Published: June 2019

Multiple sequence alignment (MSA) is ubiquitous in evolution and bioinformatics. MSAs are usually taken to be a known and fixed quantity on which to perform downstream analysis despite extensive evidence that MSA accuracy and uncertainty affect results. These errors are known to cause a wide range of problems for downstream evolutionary inference, ranging from false inference of positive selection to long branch attraction artifacts. The most popular approach to dealing with this problem is to remove (filter) specific columns in the MSA that are thought to be prone to error. Although popular, this approach has had mixed success and several studies have even suggested that filtering might be detrimental to phylogenetic studies. We present a graph-based clustering method to address MSA uncertainty and error in the software Divvier (available at https://github.com/simonwhelan/Divvier), which uses a probabilistic model to identify clusters of characters that have strong statistical evidence of shared homology. These clusters can then be used to either filter characters from the MSA (partial filtering) or represent each of the clusters in a new column (divvying). We validate Divvier through its performance on real and simulated benchmarks, finding Divvier substantially outperforms existing filtering software by retaining more true pairwise homologies calls and removing more false positive pairwise homologies. We also find that Divvier, in contrast to other filtering tools, can alleviate long branch attraction artifacts induced by MSA and reduces the variation in tree estimates caused by MSA uncertainty.
Fierce Selection and Interference in B-Cell Repertoire Response to Chronic HIV-1
Authors: Nourmohammad Armita , Otwinowski Jakub , Łuksza Marta , Mora Thierry , Walczak Aleksandra M
Published: June 2019

During chronic infection, HIV-1 engages in a rapid coevolutionary arms race with the host’s adaptive immune system. While it is clear that HIV exerts strong selection on the adaptive immune system, the characteristics of the somatic evolution that shape the immune response are still unknown. Traditional population genetics methods fail to distinguish chronic immune response from healthy repertoire evolution. Here, we infer the evolutionary modes of B-cell repertoires and identify complex dynamics with a constant production of better B-cell receptor (BCR) mutants that compete, maintaining large clonal diversity and potentially slowing down adaptation. A substantial fraction of mutations that rise to high frequencies in pathogen-engaging CDRs of BCRs are beneficial, in contrast to many such changes in structurally relevant frameworks that are deleterious and circulate by hitchhiking. We identify a pattern where BCRs in patients who experience larger viral expansions undergo stronger selection with a rapid turnover of beneficial mutations due to clonal interference in their CDR3 regions. Using population genetics modeling, we show that the extinction of these beneficial mutations can be attributed to the rise of competing beneficial alleles and clonal interference. The picture is of a dynamic repertoire, where better clones may be outcompeted by new mutants before they fix.
The guanylate cyclase C agonist linaclotide ameliorates the gut–cardio–renal axis in an adenine-induced mouse model of chronic kidney disease
Authors: Nanto-Hara Fumika , Kanemitsu Yoshitomi , Fukuda Shinji , Kikuchi Koichi , Asaji Kei , Saigusa Daisuke , Iwasaki Tomoyuki , Ho Hsin-Jung , Mishima Eikan , Suzuki Takehiro , Suzuki Chitose , Tsukimi Tomoya , Matsuhashi Tetsuro , Oikawa Yoshitsugu , Akiyama Yukako , Kure Shigeo , Owada Yuji , Tomioka Yoshihisa , Soga Tomoyoshi , Ito Sadayoshi , Abe Takaaki
Published: June 2019

Background

Cardiorenal syndrome is a major cause of mortality in patients with chronic kidney disease (CKD). However, the involvement of detrimental humoral mediators in the pathogenesis of cardiorenal syndrome is still controversial. Trimethylamine-N-oxide (TMAO), a hepatic metabolic product of trimethylamine generated from dietary phosphatidylcholine or carnitine derived by the gut microbiota, has been linked directly with progression of cardiovascular disease and renal dysfunction. Thus, targeting TMAO may be a novel strategy for the prevention of cardiovascular disease and chronic kidney disease.

Methods

Linaclotide, a guanylate cyclase C agonist, was administered to adenine-induced renal failure (RF) mice and changes in renal function and levels of gut-derived uremic toxins, as well as the gut microbiota community, were analyzed using metabolomic and metagenomic methods to reveal its cardiorenal effect.

Results

Linaclotide decreased the plasma levels of TMAO at a clinically used low dose of 10 μg/kg in the adenine-induced RF mouse model. At a high concentration of 100 μg/kg, linaclotide clearly improved renal function and reduced the levels of various uremic toxins. A reduction in TMAO levels following linaclotide treatment was also observed in a choline-fed pro-atherosclerotic model. Linaclotide ameliorated renal inflammation and fibrosis and cardiac fibrosis, as well as decreased the expression of collagen I, transforming growth factor-β, galectin-3 (Gal-3) and ST2 genes. Plasma levels of Gal-3 and ST2 were also reduced. Because exposure of cardiomyocytes to TMAO increased fibronectin expression, these data suggest that linaclotide reduced the levels of TMAO and various uremic toxins and may result in not only renal, but also cardiac, fibrosis. F4/80-positive macrophages were abundant in small intestinal crypts in RF mice, and this increased expression was decreased by linaclotide. Reduced colonic claudin-1 levels were also restored by linaclotide, suggesting that linaclotide ameliorated the ‘leaky gut’ in RF mice. Metagenomic analysis revealed that the microbial order Clostridiales could be responsible for the change in TMAO levels.

Conclusion

Linaclotide reduced TMAO and uremic toxin levels and could be a powerful tool for the prevention and control of the cardiorenal syndrome by modification of the gut–cardio–renal axis.
Improved Oculomotor Physiology and Behavior After Unilateral Incremental Adaptation Training in a Person With Chronic Vestibular Hypofunction: A Case Report
Authors: Rinaudo Carlo N , Schubert Michael C , Cremer Phillip D , Figtree William V C , Todd Christopher J , Migliaccio Americo A
Published: June 2019

Background and Purpose

Traditional vestibular rehabilitation therapies are effective in reducing vestibular hypofunction symptoms, but changes to the vestibulo-ocular reflex (VOR) are minimal. This controlled case report describes an increase in VOR after 6 months of incremental VOR adaptation (IVA) training in a person with chronic unilateral vestibular hypofunction.

Case Description

The participant was a 58-year-old female with a confirmed (Neurologist P.D.C.) left vestibular lesion stable for 2 years prior to entering a clinical trial examining the effects of daily IVA training. She was evaluated monthly for self-reported symptoms (dizziness handicap inventory), VOR function (video head impulse test), and VOR behavior (Dynamic Visual Acuity test). Intervention consisted of 6 months of 15 minutes per day unassisted training using the IVA training regime with a device developed in our laboratory. The take-home device enables the VOR response to gradually normalize on the ipsilesional side via visual-vestibular mismatch training. The intervention was followed by a 6-month wash-out and 3-month control period. The control condition used the same training device set to function like standard VOR training indistinguishable to the participant.

Outcomes

After the intervention, ipsilesional VOR function improved substantially. The VOR adapted both via a 52% increase in slow-phase response and via 43% earlier onset compensatory saccades for passive head movements. In addition, the participant reported fewer symptoms and increased participation in sports and daily activities.

Discussion

Here, a participant with chronic vestibular hypofunction showing improved oculomotor performance atypical for traditional vestibular rehabilitation therapies, subsequent to using the newly developed IVA technique, is presented. It is the first time to our knowledge an improvement of this magnitude has been demonstrated as well as sustained over an extended period of time.
Health Competency Standards in Physical Therapist Practice
Authors: Dean Elizabeth , Skinner Margot , Myezwa Hellen , Mkumbuzi Vyvienne , Mostert Karien , Parra Diana C , Shirley Debra , Söderlund Anne , de Andrade Armele Dornelas , Abaraogu Ukachukwu Okoroafor , Bruno Selma , Clark Diane , Gylfadóttir Sif , Jones Alice , Veluswamy Sundar Kumar , Lomi Constantina , Moffat Marilyn , Morris David , Stensdotter Ann-Katrin , Wong Wai Pong ,   Global Health Working Group
Published: June 2019

Although the physical therapist profession is the leading established, largely nonpharmacological health profession in the world and is committed to health promotion and noncommunicable disease (NCD) prevention, these have yet to be designated as core physical therapist competencies. Based on findings of 3 Physical Therapy Summits on Global Health, addressing NCDs (heart disease, cancer, hypertension, stroke, diabetes, obesity, and chronic lung disease) has been declared an urgent professional priority. The Third Summit established the status of health competencies in physical therapist practice across the 5 World Confederation for Physical Therapy (WCPT) regions with a view to establish health competency standards, this article's focus. Three general principles related to health-focused practice emerged, along with 3 recommendations for its inclusion. Participants acknowledged that specific competencies are needed to ensure that health promotion and NCD prevention are practiced consistently by physical therapists within and across WCPT regions (ie, effective counseling for smoking cessation, basic nutrition, weight control, and reduced sitting and increased activity/exercise in patients and clients, irrespective of their presenting complaints/diagnoses). Minimum accreditable health competency standards within the profession, including use of the WCPT-supported Health Improvement Card, were recommended for inclusion into practice, entry-to-practice education, and research. Such standards are highly consistent with the mission of the WCPT and the World Health Organization. The physical therapist profession needs to assume a leadership role vis-à-vis eliminating the gap between what we know unequivocally about the causes of and contributors to NCDs and the long-term benefits of effective, sustained, nonpharmacological lifestyle behavior change, which no drug nor many surgical procedures have been reported to match.
Tibetan Refugee Journeys: Representations of Escape and Transit
Authors: Frilund Rebecca
Published: June 2019

This ethnographic study contributes to the scholarly call to increase studies on refugee journeys. It explores Tibetan journeys via Nepal to India and provides a novel case study about the Tibetan refugees who commonly cross the Himalayas at least partly on foot without passports and head to the Tibetan Reception Centre in Kathmandu, Nepal, from where they are assisted to India. Conceptually, the study argues that combining the studies of refugee journeys and transit migration increases understanding of the (Tibetan) refugee journeys. The findings reveal that the risky journey has a remarkable meaning both for those Tibetans who have done the journey and collectively for the diaspora Tibetans in India. As Tibetans, like refugees in general are still often victimised and their subjectivities overlooked, the study also contributes to a fuller understanding of the Tibetan refugee agency through the journey narratives of the interviewees of this study.
Neural correlates of theory-of-mind are associated with variation in children’s everyday social cognition
Authors: Mukerji Cora E , Lincoln Sarah Hope , Dodell-Feder David , Nelson Charles A , Hooker Christine I
Published: June 2019

Theory of mind (ToM), the capacity to reason about others’ mental states, is central to healthy social development. Neural mechanisms supporting ToM may contribute to individual differences in children’s social cognitive behavior. Employing a false belief functional magnetic resonance imaging paradigm, we identified patterns of neural activity and connectivity elicited by ToM reasoning in school-age children (N = 32, ages 9–13). Next, we tested relations between these neural ToM correlates and children’s everyday social cognition. Several key nodes of the neural ToM network showed greater activity when reasoning about false beliefs (ToM condition) vs non-mentalistic false content (control condition), including the bilateral temporoparietal junction (RTPJ and LTPJ), precuneus (PC) and right superior temporal sulcus. In addition, children demonstrated task-modulated changes in connectivity among these regions to support ToM relative to the control condition. ToM-related activity in the PC was negatively associated with variation in multiple aspects of children’s social cognitive behavior. Together, these findings elucidate how nodes of the ToM network act and interact to support false belief reasoning in school-age children and suggest that neural ToM mechanisms are linked to variation in everyday social cognition.
Effects of low- and high-intensity exercise on emotional face processing: an fMRI face-matching study
Authors: Schmitt Angelika , Martin Jason Anthony , Rojas Sandra , Vafa Ramin , Scheef Lukas , Strüder Heiko Klaus , Boecker Henning
Published: June 2019

Physical exercise has positive effects on mood and it reduces clinical depression and states of anxiety. While previous work mostly used subjective measures to study the effect of exercise upon emotions, this study for the first time employed blood oxygen level dependent functional magnetic resonance imaging (fMRI) to unravel associated neuronal changes of the emotional face-processing network in response to acute exercise. A total of 25 male athletes underwent fitness assessments to define two standardized 30 min exercise interventions (low and high intensity). The Positive and Negative Affect Schedule (PANAS) was completed pre- and post-exercise and neuronal responses to neutral, happy and fearful facial expressions were determined using an fMRI-based face-matching paradigm. Complete data sets were acquired in 21 participants (mean age, 27.2 ± 4.2 years). Both exercise interventions induced significant increases of the PANAS positive affect scale. Modulations of brain activation patterns following acute exercise were found only for fearful facial stimuli vs forms: reduced brain activation in posterior cingulate cortex/precuneus for the low condition and reduced activity in caudate nucleus and ventral anterior putamen for the high condition. In conclusion, this study provides first in vivo evidence that acute strenuous exercise interferes with emotional face-processing brain regions in an emotion type-specific manner.
Redistribution in a joint income–wealth perspective: A cross-country comparison
Authors: Kuypers Sarah , Figari Francesco , Verbist Gerlinde
Published: June 2019

Redistribution is usually understood in terms of income, as a resource used to rank individuals as well as determine tax liabilities or benefit entitlements. Yet, it is increasingly argued that more prominence should be given to the joint distribution of income and wealth and interest into the taxation of wealth for redistributive purposes has largely increased. By including income and wealth data from the Eurosystem Household Finance and Consumption Survey into the tax–benefit microsimulation model EUROMOD, we add two novel aspects to the literature. First, we include the analysis of taxes on wealth and wealth transfers. Second, we evaluate redistributive effects of tax–benefit systems against the joint income–wealth distribution instead of income only. We show that expressing living standards in terms of both income and wealth results in considerable reranking of individuals, which in turn leads to a lower redistributive impact of tax–benefit systems than is traditionally considered.
Fully exposed canopy tree and liana branches in a tropical forest differ in mechanical traits but are similar in hydraulic traits
Authors: Zhang Lan , Chen Yajun , Ma Keping , Bongers Frans , Sterck Frank J
Published: June 2019

Large lianas and trees in the forest canopy are challenged by hydraulic and mechanical failures and need to balance hydraulic conductivity, hydraulic safety and mechanical safety. Our study integrates these functions in canopy branches to understand the performance of canopy trees and lianas, and their difference. We sampled and measured branches from 22 species at a canopy crane in the tropical forest at Xishuangbanna, SW China. We quantified the hydraulic conductivity from the xylem-specific hydraulic conductivity (KS), hydraulic safety from the cavitation resistance (P50) and mechanical safety from the modulus of rupture (MOR) to evaluate trade-offs and differences between lianas and trees. We also measured a number of anatomical features that may influence these three functional traits. Our results suggest the following: trade-offs between hydraulic conductivity, hydraulic safety and mechanical safety are weak or absent; liana branches better resist external mechanical forces (higher MOR) than tree branches; and liana and tree branches were similar in hydraulic performance (KS and P50). The anatomical features underlying KS, P50 and MOR may differ between lianas and trees. We conclude that canopy branches of lianas and trees diverged in mechanical design due to fundamental differences in wood formation, but converged in hydraulic design.
Enhancement of ABA Sensitivity Through Conditional Expression of theARF10Gene inBrassica junceaReveals Fertile Plants with Tolerance AgainstAlternaria brassicicola
Authors: Mukherjee Amrita , Mazumder Mrinmoy , Jana Jagannath , Srivastava Archana Kumari , Mondal Banani , De Aishee , Ghosh Swagata , Saha Upala , Bose Rahul , Chatterjee Subhrangsu , Dey Nrisingha , Basu Debabrata
Published: June 2019

Concomitant increase of auxin-responsive factors ARF16 and ARF17, along with enhanced expression of ARF10 in resistant Sinapis alba compared with that in susceptible Brassica juncea upon challenge with Alternaria brassicicola, revealed that abscisic acid (ABA)-auxin crosstalk is a critical factor for resistance response. Here, we induced the ABA response through conditional expression of ARF10 in B. juncea using the A. brassicicola-inducible GH3.3 promoter. Induced ABA sensitivity caused by conditional expression of ARF10 in transgenic B. juncea resulted in tolerance against A. brassicicola and led to enhanced expression of several ABA-responsive genes without affecting the auxin biosynthetic gene expression. Compared with ABI3 and ABI4, ABI5 showed maximum upregulation in the most tolerant transgenic lines upon pathogen challenge. Moreover, elevated expression of ARF10 by different means revealed a direct correlation between ARF10 expression and the induction of ABI5 protein in B. juncea. Through in vitro DNA-protein experiments and chromosome immunoprecipitation using the ARF10 antibody, we demonstrated that ARF10 interacts with the auxin-responsive elements of the ABI5 promoter. This suggests that ARF10 may function as a modulator of ABI5 to induce ABA sensitivity and mediate the resistance response against A. brassicicola.
Set of Quality Indicators of Pediatric Intensive Care in Spain: Delphi Method Selection
Authors: Hernández-Borges Angel A. , Pérez-Estévez Elena , Jiménez-Sosa Alejandro , Concha-Torre Andrés , Ordóñez-Sáez Olga , Sánchez-Galindo Amelia C. , Murga-Herrera Vega , Balaguer-Gargallo Mónica , Nieto-Moro Montserrat , Pujol-Jover Montserrat , Aleo-Luján Esther
Published: June 2019

Introduction:

This study objective was to identify, select, and define a basic set of quality indicators for pediatric intensive care in Spain.

Methods:

(1) Review of the literature to identify quality indicators and their defining elements and (2) selection of indicators by consensus of a group of experts using basic Delphi methodology (2 rounds) and forms distributed by email among experts from the Spanish society of pediatric intensive care.

Results:

We selected quality indicators according to their relevance and feasibility and the experts’ agreement on their incorporation in the final set. We included only those indicators whose assessment was within the highest tertile and greater than or equal to 70% evaluator agreement in the final selection. Starting from an initially proposed set of 136 indicators, 31 experts first selected 43 indicators for inclusion in the second round. Twenty indicators were selected for the final set. This “top 20” set comprised 9 process indicators, 9 of results (especially treatment-associated adverse effects), and 2 indicators of structure. Several of them are classical indicators in intensive care medicine (rates of hospital-acquired infections, pressure ulcers, etc.), whereas others are specifically pediatric (eg, unrestricted parent visitation or training the parents of technology-dependent children).

Conclusions:

We reached a consensus on a set of 20 essential quality indicators for pediatric intensive care in Spain. A significant subset reflects the peculiarities of pediatric care. We consider this subset as a starting point for future projects of network collaboration between pediatric intensive care units in Spain.
Reduced Necrotizing Enterocolitis after an Initiative to Promote Breastfeeding and Early Human Milk Administration
Authors: Feinberg Michelle , Miller Lynn , Engers Barbara , Bigelow Kathy , Lewis Ann , Brinker Shannon , Kurland Fran , Potthoff Elizabeth , Wallin Melynda , Pantoja Alfonso , Britton John R.
Published: June 2019

Introduction:

We sought to reduce the incidence of necrotizing enterocolitis (NEC) in premature infants (PI) by fostering the postnatal establishment of protective intestinal bacteria through early administration of human milk (HM) and probiotics.

Methods:

A multidisciplinary team implemented an initiative to support breastfeeding (BF) and provide early postnatal supplemental donor human milk (DHM) and probiotics to PI. Interventions included process improvements in milk preparation, storage, and fortification. PI admitted to our NICU between 2006 and 2015 were monitored for feeding of HM, DHM, and preterm formula (PF), frequency of early feedings, and incidence of NEC.

Results:

Retrospective review of 2557 cases revealed post-initiative increases in the percentage of PI receiving HM (91.5% to 96.1%), HM within 48 hours of birth (75% to 90.6%), and DHM (17.7% to 71.9%). The percentage of infants receiving feedings on day one increased from 23.9% to 44.6% while the percentage receiving PF within the first 72 hours declined (31.2% to 10.3%). The NEC rate declined from 4.1% to 0.4%. Reduction in NEC occurred despite a simultaneous increase in perinatal antibiotic exposure and the universal but late administration of bovine HM fortifier. The improvement associated with the decrease in NEC included initiation of probiotic administration, a reduction in PF feeding, and improvements in milk preparation, storage, and fortification processes.

Conclusions:

Early exclusive feedings of HM and avoidance of PF together with probiotics and milkhygiene may decrease NEC in PI. Neither brief perinatal antibiotic exposure nor late introduction of bovine fortifiers appears detrimental in this context.
Pediatric Gastrostomy Tube Placement: Lessons Learned from High-performing Institutions through Structured Interviews
Authors: Berman Loren , Hronek Carla , Raval Mehul V. , Browne Marybeth L. , Snyder Charles L. , Heiss Kurt F. , Rangel Shawn J. , Goldin Adam B. , Rothstein David H.
Published: June 2019

Introduction:

Gastrostomy tube (GT) placement is one of the most common operations performed in children, and it is plagued by high complication rates. Previous studies have shown variation in readmission and emergency room visit rates across different children’s hospitals, with both low and high outliers. There is an opportunity to learn how to optimize outcomes by identifying practices at high-performing institutions.

Methods:

Surgeons and nurses routinely involved in GT care at 8 high-performing pediatric centers were identified. We conducted structured interviews focusing on the approach to GT education, technical aspects of GT placement, and postoperative management. Summary statistics were performed on quantitative data, and the open-ended responses were analyzed by 2 independent reviewers using content analysis.

Results:

Several common practices among high-performing centers were identified (standardized approach to education, availability by phone and in clinic to manage GT-related issues, and empowering families to feel confident with troubleshooting and dealing with GT problems). There was substantial variation in operative technique and postoperative care. The participants expressed that technical aspects of operative placement and postoperative management of feedings and common complications are not as important as education, availability, and empowerment in optimizing outcomes.

Conclusions:

We have identified common themes among pediatric centers with favorable outcomes after GT placement. Identifying which components of GT care are associated with optimal outcomes is critical to our understanding of current practice and may help identify opportunities to improve care quality.
Quality Improvement in Pediatric Head Trauma with PECARN Rules Implementation as Computerized Decision Support
Authors: Atabaki Shireen M. , Jacobs Brian R. , Brown Kathleen M. , Shahzeidi Samira , Heard-Garris Nia J. , Chamberlain Meghan B. , Grell Robert M. , Chamberlain James M.
Published: June 2019

Background:

For the 1.4 million emergency department (ED) visits for traumatic brain injury (TBI) annually in the United States, computed tomography (CT) may be over utilized. The Pediatric Emergency Care Applied Research Network developed 2 prediction rules to identify children at very low risk of clinically important TBI. We implemented these prediction rules as decision support within our electronic health record (EHR) to reduce CT.

Objective:

To test EHR decision support implementation in reducing CT rates for head trauma at 2 pediatric EDs.

Methods:

We compared monthly CT rates 1 year before [preimplementation (PRE)] and 1 year after [postimplementation (POST)] decision support implementation. The primary outcome was change in CT use rate over time, measured using statistical process control charts. Secondary analyses included multivariate comparisons of PRE to POST. Balancing measures included ED length of stay and returns within 7 days after ED release.

Results:

There were 2,878 patients with head trauma (1,329 PRE and 1,549 POST) included. Statistical process control charts confirmed decreased CT rates over time POST that was not present PRE. Secondary statistical analyses confirmed that CT scan utilization rates decreased from 26.8% to 18.9% (unadjusted Odds Ratio [OR], 0.64; 95% Confidence Interval [CI], 0.53 -0.76; adjusted OR, 0.71; 95% CI, 0.58 -0.86). Length of stay was unchanged. There was no increase in returns within 7 days and no significant missed diagnoses.

Conclusions:

Implementation of EHR-integrated decision support for children with head trauma presenting to the ED is associated with a decrease in CT utilization and no increase in significant safety events.
A Quality Improvement Intervention Reduces the Time to Administration of Stat Medications
Authors: Stephen Gigimol , Moran Dane , Broderick Joan , Shaikh Hanan A. , Tschudy Megan M. , Connors Cheryl , Williams Tammy , Pham Julius C.
Published: June 2019

Introduction:

The delivery of urgent (“stat”) medications to hospitalized children is important for safe quality care. The goal of this study was to evaluate the effect of a set of interventions on the percentage of stat medications administered within 30 minutes of ordering.

Methods:

A pre–post study in 2 pediatric units (36 beds) in a private hospital in Saudi Arabia between January 2015 and September 2016. Interventions included structured communication requirements, introduction of a dedicated electronic inbox for stat medication orders sent by nurses to the pharmacy, and the use of a pink envelope for the delivery of stat medications. A multivariate logistic regression model was used to model percentage of medications administered within goal.

Results:

Three hundred four stat orders met inclusion criteria. The proportion of orders meeting the 30-minute goal increased from a mean of 20% to a mean of 49% after the interventions (P < 0.001). In the final month of the study, compliance reached a peak of 67%. The mean turnaround time from ordering to the administration of the medication decreased from 59.7 to 40.7 minutes (P < 0.001). On multivariate analysis, medication type and unit-based availability of medications were statistically significant predictors of turnaround time. The odds of compliance being achieved was 0.3 times less if the medication was not available on the unit.

Conclusions:

A set of interventions significantly increased the percentage of stat medications delivered within 30 minutes.
A Retrospective Review to Determine If Children with Sickle Cell Disease Receive Hydroxyurea Monitoring
Authors: Creary Susan E. , O’Brien Sarah H. , Stanek Joseph , Hankins Jane S. , Garee Amy , Ball Kyle R. , Andrews Tina M. , Chisolm Deena J.
Published: June 2019

Introduction:

Sickle cell disease guidelines recommend that patients on hydroxyurea receive monitoring at least every 2–3 months, but it is unknown if this occurs in clinical practice. This study aimed to determine if patients with sickle cell disease at Nationwide Children’s Hospital had at least 4, in-person monitoring visits during a 12-month period and if frequent monitoring was associated with hydroxyurea adherence and clinical outcomes.

Methods:

We performed a retrospective analysis of children on hydroxyurea for at least 12 months during 2010–2015. Patients’ demographics, laboratory studies, prescriptions, and number of hydroxyurea and acute visits were recorded from their 12-month period that met eligibility criteria. Patients were considered frequently monitored if they had ≥ 4 hydroxyurea visits and adherent if they had prescriptions for hydroxyurea for ≥ 80% of the days in their 12-month period.

Results:

Seventy-four children met the eligibility criteria and 57 (77%) had frequent monitoring. The most common reason for not obtaining frequent monitoring was missing a scheduled appointment. A greater proportion of frequently monitored patients were adherent to hydroxyurea (66.7% versus 17.7%;P< 0.001), and they had significantly fewer acute visits (median 1 versus 2 visits;P= 0.032) compared with infrequently monitored patients.

Conclusions:

Our study shows that most children on hydroxyurea at Nationwide Children’s Hospital received frequent monitoring and that it was associated with improved adherence and outcomes. Our results suggest that frequent in-person monitoring could be an opportunity to identify poorly adherent patients. These data inform our next quality improvement initiative that will maximize adherence to these monitoring guidelines.
Long-Term Sustainability of Timely Emergency Department Analgesia for Fractures: A Time Series Study
Authors: Sterrett Emily C. , Murtagh Kurowski Eileen , Byczkowski Terri L.
Published: June 2019

Objectives:

To determine the long-term sustainability and unintended consequences of a quality improvement project to improve the timeliness of intravenous (IV) opioid administration to patients with long-bone extremity fractures within a dynamic pediatric emergency department.

Methods:

A retrospective study of patients with long-bone extremity fractures was conducted using electronic medical record data from 2007 to 2014. The primary outcome was the percentage of patients receiving timely IV opioids. Control charts and time series models were used to determine if changes in the clinical microenvironment were associated with shifts in the outcome measure. Unintended consequences included patients receiving potentially avoidable IVs and use of the quality improvement process for patients without long-bone extremity fractures.

Results:

Improved timeliness of IV opioids was sustained. The type of physician who staffed the process and optimization of faculty staffing hours were associated with a 9.6% decrease and 11.8% increase in timely IV opioids, respectively. Implementation of the IV opioid process was not associated with increased placement of potentially avoidable IVs. Of patients receiving the IV opioid process, 22% did not have a long-bone extremity fracture, of whom 91% were diagnosed with a different painful injury.

Conclusion:

Sustainability of IV opioid timeliness was robust, despite changes in the clinical microenvironment. Changes in physician staffing and responsibilities in a pediatric emergency department may be especially important to consider when planning future improvement initiatives. Our findings support the importance of higher reliability interventions, such as identification and utilization of existing patterns of behavior, as high yield for sustaining outcomes.