bluuebunny/crossref_metadata_2025 huggingface dataset:
Disability Insurance: Theoretical Trade‐Offs and Empirical Evidence*
Authors: Low Hamish , Pistaferri Luigi
Published: May 2020

Disability insurance provides protection against health shocks that limit the ability to work. In most countries, these programmes are large and growing, both in expenditure and in number of recipients. We discuss the traditional trade‐off between insurance and incentives in providing this insurance, with a focus on the US and UK experiences. There is substantial evidence on the extent of the labour supply incentive costs of disability insurance, but there has been a lack of evidence on the insurance value until very recently. Further, evidence on errors in the disability insurance process suggests false rejections of genuine claimants is a substantial problem, and these are more serious than false acceptances of healthy applicants. We provide a life‐cycle framework for understanding the trade‐offs and to evaluate the welfare implications of policy reforms. We argue that reforms should be focused on reducing false rejections and supporting labour market attachment. The difficulty in considering reform is that the design of disability insurance has many aspects that interact and impact on outcomes.
Cognitive and Non‐Cognitive Impacts of High‐Ability Peers in Early Years*
Authors: Belfield Christopher , Rasul Imran
Published: May 2020

The sorting of students into ability groups is one of the most common, controversial and long‐examined educational practices. Ability grouping also mechanically changes peer groups. We provide novel evidence on the cognitive and non‐cognitive impacts in early years, of being exposed to higher‐ability classroom peers through being assigned to the top within‐class ability group. We exploit panel data from the UK Millennium Cohort Study, which allows us to construct trajectories of the cognitive and non‐cognitive development of children from birth to entry into primary school. The data also record school grouping policies and the specific within‐class group assignment of each child, by subject. We combine these rich data with an instrumental variable design using child‐level variation in group assignment due to month of birth, in order to measure the local average treatment effect (LATE) of being assigned to the highest‐ability peer group. We find that if a marginal student is assigned higher‐ability peers, this significantly reduces their cognitive achievement in mathematics, and has no impact on literacy. There are countervailing impacts on non‐cognitive outcomes for the marginal student assigned higher‐ability peers: although they are more motivated to study and parents respond with an improved home learning environment, these children have more study‐related difficulties and their relations with their peers significantly worsen. These findings have important policy implications for the use and design of within‐class ability grouping in early years.
Balloon‐occluded retrograde transvenous obliteration (BRTO) of gastric varices using foam sclerosant and a reduced balloon inflation time: Feasibility and efficacy
Authors: Clements Warren , Barrett Rebecca , Roberts Stuart K , Majeed Ammar , Kemp William , Moriarty Heather K
Published: May 2020

Introduction

Balloon‐occluded retrograde transvenous obliteration (BRTO) is recommended for secondary prevention of gastric variceal bleeding in the American Association for the Study of Liver Disease (AASLD) guidelines, as an alternative to Transjugular intrahepatic portosystemic shunt (TIPS). However, there is significant heterogeneity in how BRTO is performed, including how and how long to occlude the outflow venous shunt amongst other variables such as variceal size, flow rate, agent used, and preparation technique. We propose a method using foam sclerotherapy and reducing balloon occlusion to as little as 30 min, with assessment of the efficacy of this shorter balloon inflation time.

Methods

Retrospective single‐centre analysis of BRTO procedures between July 2015 and February 2019 for isolated gastric varices in a non‐acute setting, where inflation time was 2 h or less.

Results

Six patients underwent BRTO with a short inflation time, with a mean age of 66 years. The median balloon inflation and thus 3% athoxysclerol foam contact time was 30 min (range 30–60 min). Four of the 6 patients showed complete resolution of varices, while 2 of the 6 showed a partial response. Mean follow‐up was 27 months. There were no patients who did not show a response to treatment and no episodes of clinically significant upper gastrointestinal bleeding.

Conclusions

This technique using a shortened balloon occlusion time resulted in complete or partial clinical and technical success in all patients and suggests that the threshold for initiation of gastric variceal thrombosis may be below 30 min. This timepoint may provide a balance between adequate balloon inflation, angiography room efficiency and hospital resource allocation with resultant procedural cost implications.
Adult mesentero‐axial gastric volvulus: Case report
Authors: Mistry Vijay , Gamble Erin Lee , Chang Jennifer
Published: May 2020

Acute gastric volvulus is a rare surgical emergency which can lead to severe complications such as gastric ischaemia and perforation. Gastric volvulus is classified by the axis upon which the stomach rotates into organo‐axial and mesentero‐axial subtypes, with the former more common in adults. We present an uncommon case of recurrent adult mesentero‐axial gastric volvulus and describe the associated radiological findings.
Relationship Between Pain, Opioid Treatment, and Delirium in Older Emergency Department Patients
Authors: Daoust Raoul , Paquet Jean , Boucher Valérie , Pelletier Mathieu , Gouin Émilie , Émond Marcel
Published: May 2020

Objectives

Emergency department (ED) stay and its associated conditions (immobility, inadequate hydration and nutrition, lack of stimulation) increase the risk of delirium in older patients. Poorly controlled pain and paradoxically opioid pain treatment have also been identified as triggers for delirium. The aim of this study was to assess the relationship between pain, opioid treatment, and delirium in older ED patients.

Methods

A multicenter prospective cohort study was conducted in four hospitals across the province of Québec (Canada). Patients aged ≥ 65 years old, waiting for hospital admission between March and July 2015, who were nondelirious upon ED arrival, who were independent or semi‐independent in their daily living activities, and who had an ED stay of at least 8 hours were included. Delirium assessments were conducted twice a day during the patient’s entire ED stay and their first 24 hours on the hospital ward using the Confusion Assessment Method. Pain intensity was evaluated using a visual analog scale (VAS = 0–100) during the initial interview, and all opioid treatments were documented.

Results

A total of 338 patients were included; 51% were female, and mean (±SD) age was 77 (±8) years. Forty‐one patients (12%) experienced delirium during their hospital stay occurring within a mean (±SD) delay of 47 (±19) hours after ED admission. Among patients with pain intensity ≥ 65 from VAS (0–100), 26% experienced delirium compared to 11% for patients with pain < 65 (p < 0.01), and no significant association was found between opioid consumption and delirium (p = 0.31). Logistic regression controlling for confounding factors showed that patients with pain intensity ≥ 65 are 3.3 (95% confidence interval = 1.4 to 7.9) times more likely to develop delirium than patients who had pain intensity of <65.

Conclusions

Severe pain, not opioids, is associated with the development of delirium during ED stay. Adequate pain control during the hospital stay may contribute to a decrease in delirium episodes.
The Dialyzer Identification Code (DIC): A filter characteristics codification for dialyzer choice in renal replacement therapy
Authors: Nalesso Federico , Cattarin Leda , Calò Lorenzo Arcangelo , Garzotto Francesco
Published: May 2020

The dialyzer is the core element of extracorporeal blood purification therapies where several processes take place depending on specific membrane characteristics. To date, the filter choice requires preliminary knowledge of all its characteristics as they cannot be easily deduced from the commercial trade name, hence the difficulty in identifying easily equivalent dialyzers and clearly comparing single‐filter characteristics. The choice of improper dialyzers for a specific treatment can determine a less‐effective blood purification and potentially harmful treatments. We aimed to propose a univocal and standardized alphanumeric string to summarize essential filter properties in the Dialyzer Identification Code (DIC). DIC clearly describes device characteristics and allows to compare different dialyzer performances without resorting to the technical data sheets. Therefore, the presence of the DIC on every device facilitates information retrieval on the dialyzer, its intended use, and can facilitate matching the dialysis modality to correct dialyzers achieving a personalized renal replacement therapy. The standard filter characteristics codification by the DIC may further optimize correct extracorporeal blood purification prescriptions and the use of equivalent filters from different providers avoiding treatment inefficiency, clinical complications, and improving patient safety.
Prenatal histomorphological development of the reticulum in fallow deer (Dama dama)
Authors: Redondo Eloy , García Ángela , Ortega Cristina , Peña Fernando J. , Gázquez Antonio , Masot Javier
Published: May 2020

The histomorphological changes occurring in theDama damareticulum during prenatal development have been investigated. Twenty‐fiveDama damaembryos were used, from the first stages of prenatal life until birth. Differentiation of the reticulum was observed at 23% gestation. By 25% gestation the reticular wall comprised three layers: an internal epithelial layer, a middle layer of pluripotential blastemic tissue and an external layer or serosa. Primary reticular crests were visible at 38% gestation. Secondary reticular crests were observed at 61% gestation. Neuroendocrine cells were detected by synaptophysin (SYP) at 35% gestation, in the lamina propria‐submucosa, tunica muscularis, and serosa. Epithelial Cytokeratin‐18 (CK‐18) cells were observed at 35% gestation extended throughout the epithelial layers. The glial cells (vimentin –VIM‐ and glial fibrillary acidic protein‐GFAP‐markers) were discerned at 25% and 43% gestation, respectively, in myenteric and submucosal plexuses, lamina propria, muscularis mucosae, tunica muscularis, and perivascular connective tissue. The neuropeptide Y (NPY) and vasoactive intestinal polypeptide (VIP) markers were immunodetected at 75% and 80 gestation, respectively, in the lamina propria‐submucosa, muscularis mucosae, tunica muscularis, serosa, and myenteric plexuses. The prenatal development of the fallow deer reticular mucosa evidenced a considerable precocity similar to that previously reported in goat and red deer.
Analysis of factors related to prognosis and death of fish bile poisoning in China: A retrospective study
Authors: Yan Weitao , Wang Zhen , Lu Shuang , Li Jingyu , Chen Qianqian , Wang Lan , Chen Siqi , Wang Xiao , Xiong Kun , Yan Jie
Published: May 2020

Fish bile has long been considered to have therapeutic benefits in folk medicine in some Asian countries. However, poisoning incidents and even death sporadically occurred when people consumed fish bile. Herein, we summarize the main characteristics of fish bile poisoning in China including clinical symptoms, treatment strategies and factors being associated with death and affecting prognosis, hoping to provide a reference for the diagnosis and treatment of fish bile poisoning, as well as forensic identification of death cases induced by fish bile poisoning. We suggest that the health authorities should make an effort to enhance people's awareness of the safety of traditional medicine like fish bile so as to reduce the incidence of adverse events.
Astaxanthin attenuates hepatic damage and mitochondrial dysfunction in non‐alcoholic fatty liver disease by up‐regulating the FGF21/PGC‐1α pathway
Authors: Wu Liwei , Mo Wenhui , Feng Jiao , Li Jingjing , Yu Qiang , Li Sainan , Zhang Jie , Chen Kan , Ji Jie , Dai Weiqi , Wu Jianye , Xu Xuanfu , Mao Yuqing , Guo Chuanyong
Published: May 2020

Background and Purpose

Non‐alcoholic fatty liver disease (NAFLD) is considered to be one of the most common chronic liver diseases across worldwide. Astaxanthin (Ax) is a carotenoid, and beneficial effects of astaxanthin, including anti‐oxidative, anti‐inflammatory, and anti‐tumour activity, have been identified. The present study aimed to elucidate the protective effect of astaxanthin against NAFLD and its underlying mechanism.

Experimental Approach

Mice were fed either a high fat or chow diet, with or without astaxanthin, for up to 12 weeks. L02 cells were treated with free fatty acids combined with different doses of astaxanthin for 48 h. Histopathology, expression of lipid metabolism, inflammation, apoptosis, and fibrosis‐related gene expression were assessed. And the function of mitochondria was also evaluated.

Key Results

The results indicated that astaxanthin attenuated HFD‐ and FFA‐induced lipid accumulation and its associated oxidative stress, cell apoptosis, inflammation, and fibrosis both in vivo and in vitro. Astaxanthin up‐regulated FGF21 and PGC‐1α expression in damaged hepatocytes, which suggested an unrecognized mechanism of astaxanthin on ameliorating NAFLD.

Conclusion and Implications

Astaxanthin attenuated hepatocyte damage and mitochondrial dysfunction in NAFLD by up‐regulating FGF21/PGC‐1α pathway. Our results suggest that astaxanthin may become a promising drug to treat or relieve NAFLD.
Statins use and its impact in EGFR‐TKIs resistance to prolong the survival of lung cancer patients: A Cancer registry cohort study in Taiwan
Authors: Nguyen Phung‐Anh , Chang Chih‐Cheng , Galvin Cooper J. , Wang Yao‐Chin , An Soo Yeon , Huang Chih‐Wei , Wang Yu‐Hsiang , Hsu Min‐Huei , Li Yu‐Chuan (Jack) , Yang Hsuan‐Chia
Published: May 2020

Statins have been shown to be a beneficial treatment as chemotherapy and target therapy for lung cancer. This study aimed to investigate the effectiveness of statins in combination with epidermal growth factor receptor‐tyrosine kinase inhibitor therapy for the resistance and mortality of lung cancer patients. A population‐based cohort study was conducted using the Taiwan Cancer Registry database. From January 1, 2007, to December 31, 2012, in total 792 non‐statins and 41 statins users who had undergone EGFR‐TKIs treatment were included in this study. All patients were monitored until the event of death or when changed to another therapy. Kaplan‐Meier estimators and Cox proportional hazards regression models were used to calculate overall survival. We found that the mortality was significantly lower in patients in the statins group compared with patients in the non‐statins group (4‐y cumulative mortality, 77.3%; 95% confidence interval (CI), 36.6%‐81.4% vs. 85.5%; 95% CI, 78.5%‐98%; P = .004). Statin use was associated with a reduced risk of death in patients the group who had tumor sizes <3 cm (hazard ratio [HR], 0.51, 95% CI, 0.29‐0.89) and for patients in the group who had CCI scores <3 (HR, 0.6; 95% CI, 0.41‐0.88; P = .009). In our study, statins were found to be associated with prolonged survival time in patients with lung cancer who were treated with EGFR‐TKIs and played a synergistic anticancer role.
Is the timing of food intake a potential indicator of low weight loss responders? A secondary analysis of three weight loss studies
Authors: Jacob Raphaëlle , Tremblay Angelo , Panahi Shirin , Provencher Véronique , Drapeau Vicky
Published: May 2020

Individual variability in weight loss in response to a weight loss intervention is commonly observed. Recently, the timing of food intake has been identified as one possible factor implicated in obesity and weight loss. The objective of this study was to further characterize low weight loss responders by assessing the pre‐diet distribution of daily energy and macronutrient intakes. A pooled cohort of men and women (n = 122; aged 39.1 ± 8.2 years; body mass index [BMI] 33.1 ± 3.8 kg/m2) who participated in a 12 to 15 week energy‐restricted intervention (−500 to −700 kcal/d) were included in this study. Participants were categorized into two weight loss groups (ie, low [−1.3 ± 2.3 kg] and high [−6.1 ± 2.1 kg] weight loss). Food intake and distribution of energy and macronutrient intakes were assessed using a 3‐day food record at baseline. The daily distribution of energy intake (% of total energy intake) was similar in the two weight loss groups with the exception of the low weight loss group who consumed a slightly lower proportion of their total energy intake before 9:00 am compared with the high weight loss group (12.5% ± 5.8% vs 15.0% ± 6.6%, respectively, P = .03). In the low weight loss group, the percentage of energy intake consumed after 8:00 pm was positively associated with total energy intake (r = 0.27, P = .04). The results of this study suggest that the timing of food intake measured prior to a weight loss intervention does not permit the characterization of low weight loss responders.
International expert consensus guidance on indications, implementation and quality measures for transanal total mesorectal excision
Authors:   The TaTME Guidance Group representing the ESCP (European Society of Coloproctology), in collaboration with the ASCRS (American Society of Colon and Rectal Surgeons), ACPGBI (Association of Coloproctology of Great Britain and Ireland), ECCO (European Crohn’s and Colitis Organisation), EAES (European Association of Endoscopic Surgeons), ESSO (European Society of Surgical Oncology), CSCRS (Canadian Society of Colorectal Surgery), CNSCRS (Chinese Society of Colorectal Surgery), CSLES (Chinese Society of Laparo
Published: May 2020

Aim

To provide dynamic guidance from a rigorous and up‐to‐date consensus on the safe implementation and application of transanal total mesorectal excision (TaTME) from an international panel of expert surgeons and educationalists supported by 14 international surgical societies.

Method

An adapted Delphi method and focus group discussion approach was implemented for this consensus process, with expert advice from a guidelines methodologist. Statements were generated focusing on three main topics relating to the safe implementation of TaTME: (1) indications, (2) quality and outcome measures, (3) training and implementation of TaTME.

Results

Five rounds of the Delphi consensus process were completed over a 13‐month period. A total of 56 surgeons experienced in TaTME and surgical education participated in this project. By Delphi round four, 80.0% or greater agreement was reached for all statements except for two, which were further reviewed during a fifth round. More complex cases that are likely to benefit from TaTME were identified, with the recommendation that they should be referred to TaTME expert centres. The most agreed upon definition of expert centres is outlined.

Conclusion

We have provided a current framework of best practice related to implementation of TaTME. The statements are not indefinite and will continue to be ‘dynamic’ and updated as new evidence emerges.
Postoperative vasoactive inotropic score is predictive of outcomes in pediatric heart transplantation
Authors: Tadros Hanna J. , Lopez‐Colon Dalia , Bleiweis Mark S. , Fricker Fredrick J. , Pietra Biagio A. , Gupta Dipankar
Published: May 2020

Vasoactive inotrope score (VIS) is scarcely studied in pediatric orthotopic heart transplantation (pOHT). We conducted a retrospective review of pOHT (<21 years) recipients. Max VIS and mean VIS were calculated at 0‐24 and 24‐48 hours post‐pOHT. Patients were divided into groups based on ISHLT guidelines: high (>10) and low (≤10). In our group (n = 104), patients with high max and mean VIS groups at 0‐24 and 24‐48 hours had longer bypass times (high: >130 minutes; low: <108 minutes; P < .05) and high max and mean VIS groups at 0‐24 hours had longer ischemic times (high: >215 minutes; low: <192 minutes; P < .05). Patients with high max and mean VIS at 0‐24 and 24‐48 hours had longer hospital stay, ventilation, inotrope duration, more cardiac events, and acute kidney injury postoperatively (P < .05). High max VIS at 24‐48 hours and high mean VIS at 24‐48 hours had higher 3‐year mortality (P = .04; P = .02). Multivariate analysis confirmed the association of VIS with short‐term outcomes. However, VIS was not identified as an independent predictor of mortality. The ROC curve exhibits 10 as the ideal cutoff with area under the curve >0.8 for primary graft dysfunction (PGD).
The effect of pulsatile pump perfusion on hepatitis C transmission in kidney transplantation: A prospective pilot study
Authors: Forbes Rachel C. , Concepcion Beatrice P. , Clapper Deana , DuBray Bernard J. , Shawar Saed , Schaefer Heidi M. , Langone Anthony , Shaffer David , Johnson Keith
Published: May 2020

With increasing utilization of hepatitis C (HCV) viremic donor organs, there may be a role for kidney pump perfusion to reduce viral load and prevent HCV transmission. We performed a prospective pilot study of HCV viremic donors; one kidney from each donor pair was pumped with perfusate exchanges and viral load testing at least every 4 hours. Donor, recipient, and transplant characteristics were obtained with clinical outcomes. Linear regression was performed to quantify the association between pump time and perfusate viral load. Six HCV viremic donors for six pairs of aviremic recipients were included. Perfusate of the pumped kidneys showed detectable virus throughout the pump cycles. Although perfusate viral levels decreased with increasing pump times, this was not statistically significant (β = −.48, P = .36). All recipients had detectable HCV RNA postoperatively. The pumped cohort had an insignificantly reduced mean viral load compared to pumped recipients (1352 ± 2006 vs 26 170 ± 61 211, P = .09). Time to initiation of direct‐acting antiviral was 32 ± 12 vs 26 ± 7 days (P = .17) and to undetectable levels was 66 ± 27 vs 55 ± 22 days (P = .82) for the pumped and unpumped cohorts, respectively. Pulsatile perfusion alone does not appear adequate to decrease HCV transmission. Future studies will need to explore additional ex vivo interventions to pumping.
Alcohol consumption in Iran: A systematic review and meta‐analysis of the literature
Authors: Chegeni Maryam , Kamel Khodabandeh Atiyeh , Karamouzian Mohammad , Shokoohi Mostafa , Abedi Leili , Khalili Malahat , Rajaei Leila , Ardalan Gelayol , Sharifi Hamid
Published: May 2020

Issues

Alcohol production, marketing and consumption are illegal in Iran. This systematic review examines the lifetime and last 12‐month prevalence of alcohol consumption among the general and young population in Iran.

Approach

We searched Web of Science, PubMed, Embase, Scopus and Iranian scientific databases (i.e. Scientific Information Database and Magiran) for relevant publications in English and Persian from inception to 12 May 2019. Following a random‐effects meta‐analysis, we estimated the pooled prevalence of alcohol consumption among the general population and young people (<30 years old). Meta‐regression was used to identify potential sources of heterogeneity.

Key Findings

Of the 2400 identified records, 62 met the inclusion criteria. The overall pooled prevalence of lifetime alcohol consumption among the general population and young people was 13.0% [95% confidence intervals (CI) 10.0, 16.0]. The overall pooled prevalence of last 12‐month alcohol consumption was 12.0% (95% CI 7.0, 18.0) for the general population and 15.0% (95% CI 9.0, 22.0) for young people. The prevalence of alcohol consumption varied from 0.03% to 68.0% in different regions, 0.3% to 66.6% among males and 0.2% to 21.0% among females.

Implications

Our findings highlight the need for public health surveillance of alcohol use in Iran.

Conclusion

These estimates show that, on average, one in eight people in the general population have ever consumed alcohol in Iran, indicating that alcohol consumption is not an uncommon practice in the country.
Why humility is vital to effective humanitarian aid leadership: a review of the literature
Authors: Wang David C. , Hall M. Elizabeth Lewis , Shannonhouse Laura R. , Mize Mary Chase Breedlove , Aten Jamie D. , Davis Edward B. , Van Tongeren Daryl R. , Annan Kent
Published: May 2020

Organisational scientists are paying increasing attention to humility, following a larger trend in scholarship highlighting the relational and interdependent nature of leadership and business. A growing body of evidence identifies humility as vital to effective organisational leadership, facilitating positive organisational outcomes, such as lower voluntary turnover and greater follower job satisfaction. To date, research on the subject has focused on certain specific organisational contexts, including businesses, hospitals, and schools. This paper reviews the existing literature and explores why humility may be an especially important leader trait in international humanitarian aid organisations and relief work—a context that is not only uniquely challenging, but also one that would seemingly stand to benefit keenly from the quality. It argues that humility is essential for effective leadership because it is normative of good character, it is predictive of positive outcomes, and it corresponds to a genuine representation of the nature of humanitarian aid.
Left ventricular cavity obliteration: Mechanism of the intracavitary gradient and differentiation from hypertrophic obstructive cardiomyopathy
Authors: Pollick Charles , Shmueli Hezzy , Maalouf Nicolas , Zadikany Ronit H.
Published: May 2020

Background

Controversy surrounds the cause of the pressure gradient in patients with hypertrophic obstructive cardiomyopathy (HOCM). Left ventricular cavity obliteration (LVCO) was first described as the cause of the gradient but subsequently systolic anterior motion (SAM) of the mitral valve has been established as the cause. Nevertheless, the two gradients, though different in origin and significance, share similar characteristics. They both have a similar “dagger” profile, are obtained from the cardiac apex, are associated with a hyperdynamic left ventricle, and the gradients are worsened by Valsalva. The distinction has clinical relevance, because treating the intracavitary gradient (ICG) of LVCO as if it were a SAM‐associated gradient associated with HOCM would be inappropriate and possibly harmful.

Materials and Methods

To clarify the cause and characteristics of the ICG in patients with LVCO in patients without HOCM, we assessed the extent and duration of cavity obliteration, and for differentiation, we compared the spectral profiles with patients with HOCM and severe aortic stenosis (AS).

Results

Higher ICG is associated with a greater extent and more prolonged apposition of LV walls, and smaller left ventricular cavity size.

The spectral profile of patients with AS, HOCM, and LVCO is differentiated by the peak/mean gradient ratios of 2 or less, 2–3, and 3 or greater, respectively, in >90% of patients. Most patients with LVCO without HOCM or severe LVH have an ICG < 36 mm Hg.

Conclusion

The magnitude of ICG is quantitatively associated with the extent and duration of LVCO. Spectral profiles of severe AS, HOCM, and LVCO can be differentiated by the peak/mean gradient ratio.
Soil pore system evaluated from gas measurements and CT images: A conceptual study using artificial, natural and 3D‐printed soil cores
Authors: Lamandé Mathieu , Schjønning Per , Dal Ferro Nicola , Morari Francesco
Published: May 2020

Combining digital imaging, physical models and laboratory measurements is a step further towards a better understanding of the complex relationships between the soil pore system and soil functions. Eight natural 100‐cm3 soil cores were sampled in a cultivated Stagnic Luvisol from the topsoil and subsoil, which we assumed had contrasting pore systems. Artificial 100‐cm3 cores were produced from plastic or from autoclaved aerated concrete (AAC). Eight vertical holes of each diameter (1.5 and 3 mm) were drilled for the plastic cylinder and for one of the two AAC cylinders. All natural and artificial cores were scanned in an X‐ray CT scanner and printed in 3D. Effective air‐filled porosity, true Darcian air permeability, apparent air permeability at a pressure gradient of 5 hPa and oxygen diffusion were measured on all cores. The active pore system characteristics differed between topsoil (sponge‐like, network of macropores of similar size) and subsoil (dominated by large vertical macropores). Active soil pore characteristics measured on a simplified pore network, that is, from artificial and printed soil cores, supported the fundamental differences in air transport by convection and diffusion observed between top‐ and subsoil. The results confirm the suitability of using the conceptual model that partitions the pore system into arterial, marginal and remote pores to describe effects of soil structure on gas transport. This study showed the high potential of using 3D‐printed soil cores to reconstruct the soil macropore network for a better understanding of soil pore functions.
Integrating data mining and transmission theory in the ecology of infectious diseases
Authors: Han Barbara A. , O’Regan Suzanne M. , Paul Schmidt John , Drake John M.
Published: May 2020

Our understanding of ecological processes is built on patterns inferred from data. Applying modern analytical tools such as machine learning to increasingly high dimensional data offers the potential to expand our perspectives on these processes, shedding new light on complex ecological phenomena such as pathogen transmission in wild populations. Here, we propose a novel approach that combines data mining with theoretical models of disease dynamics. Using rodents as an example, we incorporate statistical differences in the life history features of zoonotic reservoir hosts into pathogen transmission models, enabling us to bound the range of dynamical phenomena associated with hosts, based on their traits. We then test for associations between equilibrium prevalence, a key epidemiological metric and data on human outbreaks of rodent‐borne zoonoses, identifying matches between empirical evidence and theoretical predictions of transmission dynamics. We show how this framework can be generalized to other systems through a rubric of disease models and parameters that can be derived from empirical data. By linking life history components directly to their effects on disease dynamics, our mining‐modelling approach integrates machine learning and theoretical models to explore mechanisms in the macroecology of pathogen transmission and their consequences for spillover infection to humans.
Active case finding of dementia in ambulatory care settings: a comparison of three strategies
Authors: Liew T. M.
Published: May 2020

Background and purpose

To reduce the diagnostic gap of dementia, three strategies can be employed for case finding of cognitive impairment in ambulatory care settings, namely using informant report, brief cognitive test or a combination of informant report and brief cognitive test. The right strategy to adopt across different healthcare settings remains unclear. This diagnostic study compared the performance of the three strategies for detecting dementia (primary aim), as well as for detecting both mild cognitive impairment (MCI) and dementia (secondary aim).

Methods

Participants aged ≥65 years (n = 11 057) were recruited from Alzheimer’s Disease Centers across the USA. Participants provided data on an informant report (Functional Activities Questionnaire), brief cognitive test (four‐item short variant of Montreal Cognitive Assessment) and a combined measure with informant report and brief cognitive test (sum of Functional Activities Questionnaire and Montreal Cognitive Assessment short variant). They also received standardized assessments (clinical history, physical examination and neuropsychological testing) to diagnose MCI and dementia. Areas under the receiver operating characteristic curve (AUCs) of the three strategies were compared using the DeLong method, with AUC > 90% indicating excellent performance.

Results

All three strategies had excellent performance in detecting dementia, although informant report [AUC, 95.9%; 95% confidence intervals (CI), 95.4–96.3%] was significantly better than brief cognitive test (AUC, 93.0%; 95% CI, 92.4–93.6%) and the combined measure had the best performance (AUC, 97.0%; 95% CI, 96.7–97.4%). However, to detect both MCI and dementia, only the combined measure had excellent performance (AUC, 93.0%; 95% CI, 92.5–93.4%), whereas stand‐alone informant report or brief cognitive test performed suboptimally (AUC < 90%). Performance of the three strategies was not affected by participants’ age, educational attainment or underlying prevalence of MCI and dementia.

Conclusions

For case finding of dementia in ambulatory care settings, informant reports would suffice as first‐line measures and brief cognitive tests may optionally be added on, in services with available resources, to further improve the accuracy of detection. For case finding of both MCI and dementia, a combination of informant reports and brief cognitive tests remains the most appropriate strategy.
Dose–response relationship between physical exercise and risk of physician‐diagnosed dementia in 206 073 Thai community‐dwelling men and women: HCUR study
Authors: Boongird P. , Chamnan P. , Laptikultham S. , Krittayapoositpot P. , Nitiyanant W. , Aekplakorn W. , Mangklabruks A. ,   HCUR investigators
Published: May 2020

Background and purpose

Little evidence exists to describe the incidence and risk factors for dementia in developing countries. This study aimed to examine the incidence and factors associated with the risk of developing dementia in a Thai general population.

Methods

Data on 206 073 men and women aged ≥50 years participating in the Health Check Ubon Ratchathani Project in 2006 were merged with diagnostic information from the hospital’s electronic medical records in the following 6 years (2006–2012). The incidence of physician‐diagnosed dementia over 6 years was examined. Factors associated with the risk of developing dementia were examined using multivariate Cox proportional hazard regression.

Results

Over a total time at risk of 1 196 433 person‐years, 480 individuals developed dementia; the incidence rate was 0.40 [95% confidence interval (CI) 0.37–0.44] per 1000 person‐years. Dementia incidence rose exponentially with increasing age to 1.37 (95% CI 1.07–1.75) per 1000 person‐years in those aged 80–84 years and dropped after the age of 85 years. Factors independently associated with the risk of developing dementia included increasing age, diabetes and lack of physical exercise. The risk of dementia rose by 7% for every 1 year of age older [adjusted hazard ratio (aHR) 1.07, 95% CI 1.06–1.08]. Diabetes increased the risk of dementia by 51% (aHR 1.51, 95% CI 1.12–2.03). Compared to no physical exercise, having 3–5 days/week and> 5 days/week of physical exercise reduced the risk of dementia by 37% and 59% (aHR 0.63, 95% CI 0.50–0.79, and 0.41, 95% CI 0.26–0.66, respectively).

Conclusions

Dementia incidence in a Thai population was lower than Western populations and its independent risk factors included increasing age, diabetes and a lack of physical exercise. Adequate physical exercise may counterbalance the ageing process, the main drive of dementia.
Recent CO2 rise has modified the sensitivity of tropical tree growth to rainfall and temperature
Authors: Zuidema Pieter A. , Heinrich Ingo , Rahman Mizanur , Vlam Mart , Zwartsenberg Sophie A. , van der Sleen Peter
Published: May 2020

Atmospheric CO2 (ca) rise changes the physiology and possibly growth of tropical trees, but these effects are likely modified by climate. Such ca × climate interactions importantly drive CO2 fertilization effects of tropical forests predicted by global vegetation models, but have not been tested empirically. Here we use tree‐ring analyses to quantify how ca rise has shifted the sensitivity of tree stem growth to annual fluctuations in rainfall and temperature. We hypothesized that ca rise reduces drought sensitivity and increases temperature sensitivity of growth, by reducing transpiration and increasing leaf temperature. These responses were expected for cooler sites. At warmer sites, ca rise may cause leaf temperatures to frequently exceed the optimum for photosynthesis, and thus induce increased drought sensitivity and stronger negative effects of temperature. We tested these hypotheses using measurements of 5,318 annual rings from 129 trees of the widely distributed (sub‐)tropical tree species, Toona ciliata. We studied growth responses during 1950–2014, a period during which ca rose by 28%. Tree‐ring data were obtained from two cooler (mean annual temperature: 20.5–20.7°C) and two warmer (23.5–24.8°C) sites. We tested ca × climate interactions, using mixed‐effect models of ring‐width measurements. Our statistical models revealed several significant and robust ca × climate interactions. At cooler sites (and seasons), ca × climate interactions showed good agreement with hypothesized growth responses of reduced drought sensitivity and increased temperature sensitivity. At warmer sites, drought sensitivity increased with increasing ca, as predicted, and hot years caused stronger growth reduction at high ca. Overall, ca rise has significantly modified sensitivity of Toona stem growth to climatic variation, but these changes depended on mean climate. Our study suggests that effects of ca rise on tropical tree growth may be more complex and less stimulatory than commonly assumed and require a better representation in global vegetation models.
Use of ultrasound for assessment of musculoskeletal disease in persons with haemophilia: Results of an International Prophylaxis Study Group global survey
Authors: Ignas Danial M. , Doria Andrea S. , von Drygalski Annette , Blanchette Victor S. , Chang Eric Y. , Dover Saunya , Fischer Kathelijn , Gibikote Sridhar , Keshava Shyamkumar N. , Querol Felipe , Abad Audrey , Babyn Paul
Published: May 2020

Aim

The objective of this survey was to understand the global trends of imaging assessments in persons with haemophilia, focusing on point‐of‐care ultrasound (POCUS). Insights into the barriers impeding its widespread proliferation as a frontline imaging modality were obtained.

Methods

The survey opened in September of 2017 and closed in May of 2018. Haemophilia Treatment Centres (HTCs) treating both paediatric/adult patients were the population of interest. A REDCap survey of 25 questions was disseminated to 232 clinical staff in 26 countries.

Results

The majority of respondents (88.3%, 91/103) reported that POCUS is most useful to confirm or rule out a presumed acute joint bleed. European HTCs reported the highest routine use of POCUS at 59.5% (22/37) followed by HTCs in the “Other” countries of the world at 46.7% (7/15) and North American HTCs at 43.9% (25/57). At the time of the survey, physiotherapists were identified as the clinical staff who perform POCUS 52.8% (28/53) of the time, in contrast with nurses/nurse practitioners who represent only 5.7% (3/53) of users. The greatest perceived barriers to the implementation of POCUS are the lack of trained healthcare professionals who can perform POCUS at 69.2% (74/107) and the overall time commitment required at 68.2% (73/107).

Conclusion

Despite POCUS being used in 49.5% (54/109) of sampled HTCs, it is still utilized almost 30% less globally than full diagnostic ultrasound. A list of barriers has been identified to inform HTCs which challenges they will likely need to overcome should they choose to incorporate this imaging modality into their practice.
Falling into a deep dark hole: Tongan people’s perceptions of being at risk of developing type 2 diabetes
Authors: Faletau Julienne , Nosa Vili , Dobson Rosie , Heather Maryann , McCool Judith
Published: May 2020

Background

Prediabetes is a precursor for type 2 diabetes. Compared to the New Zealand/European and other population groups (24.6%), the prevalence of prediabetes is higher within Pacific groups (29.8%). The diagnosis of prediabetes presents a potential opportunity to intervene to prevent progression to type 2 diabetes.

Objective

To develop an understanding of how being ‘at risk’ of developing type 2 diabetes is perceived by Tongan people with prediabetes living in Auckland, New Zealand.

Methods

The Kakala and Talanga Tongan methodologies underpinned this study. Twelve one‐on‐one, semi‐structured interviews with Tongan patients who had prediabetes from a primary health‐care clinic in Auckland, New Zealand, were conducted. Thematic analysis was used to identify recurrent themes from the data.

Results

Participants were not aware of their prediabetes diagnosis, emotions associated with the diagnosis reflected fear and disbelief and a perception of imminent danger. Family history informed perceptions of the risk of developing type 2 diabetes. Participants could not differentiate prediabetes from type 2 diabetes, and recollections of being ‘back in the Islands’ of Tonga were consistent with healthy lifestyles.

Conclusions

Prediabetes appeared to be poorly understood and was believed to be irreversible, which could discourage behaviour change, social and physical improvements in health. Appropriate culturally tailored messages to accompany a prediabetes diagnosis, including cause and management, would be beneficial for Pacific peoples.
Non‐invasive papillary urothelial carcinoma with ‘micropapillary’ architecture: clinicopathological study of 18 patients emphasising clinical outcomes
Authors: Sangoi Ankur R , Cox Roni M , Higgins John P , Quick Charles M , McKenney Jesse K
Published: May 2020

Aims

Invasive micropapillary carcinoma is a recognised aggressive urothelial carcinoma variant. One prior study focusing on non‐invasive (pTa) high‐grade papillary urothelial carcinoma with micropapillary architecture has been reported.

Methods and results

We collected bladder transurethral resection specimens showing non‐invasive high‐grade papillary urothelial carcinoma with non‐hierarchical secondary papillae lacking fibrovascular cores (i.e. micropapillary architecture). Cases with any invasive component or any prior history of invasive urothelial carcinoma were excluded. Twenty cases were identified from 16 male and two female patients (aged 55–86 years). Micropapillary architecture comprised from 10 to 95% (mean = 31%), but non‐invasive cribriform (15 cases, comprising 5–60%, mean = 19%) and villoglandular patterns (nine cases, comprising 5–60%, mean = 24%) were commonly admixed. Treatment data were available for 16 patients: surveillance (n = 13), cystoprostatectomy (n = 1), BCG plus mitomycin (n = 1) and BCG (n = 1). Follow‐up data were available from 16 patients (range = 1–128 months, mean = 50 months): 13 patients had no new occurrences to date (81%), two had stage progression to pT1 papillary urothelial carcinoma (13%) with one dying of other causes, and one died of other causes with no evidence of disease (6%).

Conclusion

Non‐invasive urothelial carcinomas with micropapillary architecture are often admixed with non‐invasive cribriform and villoglandular patterns. Stage progression to lamina propria invasion in only two of 16 patients (13%) is not higher than expected for otherwise typical pTa high‐grade urothelial carcinomas and no progression to invasive micropapillary carcinoma was identified, adding further support to the current World Health Organisation recommendation excluding use of the term ‘micropapillary’ for pTa urothelial carcinoma.
The optimal time to test for sero‐reversion in HIV‐exposed uninfected infants: the later the better?
Authors: Hindocha A , Randell P , Seery P , Rahimi T , Kirkhope N , Raghunanan S , Foster C , Tudor‐Williams G , Lyall H
Published: May 2020

Objectives

HIV‐exposed uninfected (HEU) infants are tested for loss of maternal antibody (sero‐reversion) at 18 months of age. Highly sensitive fourth‐generation antigen/antibody assays can detect very low levels of antibody, leading to retesting. We audited serological screening outcomes in HEU infants at two National Health Service (NHS) Trusts.

Methods

HEU infants born between January 2013 and August 2016 were identified via case records. Data collected included gestation; age at testing; test results and assay type.

Results

One hundred and forty‐two infants were identified, of whom 21 were excluded from analysis. One hundred and one (83%) were born at term and 20 (17%) preterm (< 37/40 weeks of gestation), and the median age at first serology was 19.1 [interquartile range (IQR) 18.1; 21.4] months. Initial serology was positive in 10 of 121 infants (8.3%), and the median age of these 10 infants was 18.3 (IQR 18.1; 18.8) months, whereas those with negative serology (n = 111) had a median age of 19.2 (IQR 18.1; 21.5) months (P = 0.12). All infants with positive HIV serology were born at term. Seven of 10 infants had reactive serology on two fourth‐generation assays. Subsequent serology was available for eight of 10 infants, with a median age of 21.3 months. Five of the eight (63%) were negative. One was reactive but HIV RNA polymerase chain reaction (PCR) was negative, and one was reactive on screening but negative on confirmatory testing. The remaining child was still seropositive at 24.7 months but had a non‐reactive result at 29.4 months.

Conclusions

Overall, 8.3% of HEU infants required repeat testing to confirm loss of antibody. Delaying testing until 22 months of age reduces retesting to < 2%, with associated resource and emotional implications. Positive serology at 22 months should prompt an HIV RNA PCR to exclude infection.