bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding the focal points and sentiment of learners in MOOC reviews: A machine learning and SC‐LIWC‐based approach
Authors: Geng Shuang , Niu Ben , Feng Yuanyue , Huang Miaojia
Published: July 2020

Despite the popularity of massive open online courses (MOOCs), only a small portion of the course participants successfully complete the course. The low completion rate can be partially attributed to the mismatch between the participants' expectations and value delivered by the courses. Therefore, this study leverages MOOC reviews to investigate the focal point and sentiment of the learners by combining machine learning techniques and statistical analysis. Several text mining methods (ie, simplified Chinese‐linguistic inquiry and word count dictionary, word embeddings, and bidirectional long short‐term memory model) are combined to automatically extract the emotional and cognitive aspects, review focal point, and sentiment from the learner discourse. Multiple linear regression (MLR) analysis is performed to examine the relationships between the learner sentiment and the extracted content features. Using a set of real data from NetEase online open courses, our results reveal that the MOOC reviews mostly pertain to teaching and platform rather than the course content. Furthermore, the social process and personal concerns appear more frequently in the learner discourse. Overall, the learners exhibit positive attitudes towards teaching and platform and negative attitudes towards issues related to the course content. This study contributes to the literature regarding the MOOC research methodologies and provides a deeper understanding of the learner discourse behaviour in MOOCs.
Stimulus sampling and other recommendations for assessing domain‐general processes of attitude formation through exploration: Reply to Ruisch, Shook, and Fazio (2020)
Authors: Edem Fiagbenu Michael , Proch Jutta , Kessler Thomas
Published: July 2020

In response to Ruischet al., 2020,British Journal of Psychology, we propose that the assessment of domain‐general ideological differences requires systematic stimulus sampling. We argue that there is currently no evidence that the ‘neutral’ BeanFest assesses domain‐general ideological differences and that Ruischet al., 2020,British Journal of Psychologyfindings do not address the mechanism(s) underlying our findings.
Narrating personal experience of living with learning disabilities and mental health issues in institutional and community settings: A case study
Authors: Sutton Paul , Gates Bob
Published: July 2020

Accessible summary

This is a case study about a man with learning disabilities who has mental health issues.

The case study describes the way that he told a researcher about his life.

Thirty years of his earlier life were spent in a long‐stay hospital in England, UK and more recently he has lived in a community setting with five other people.

This research is important as it assists us to understand the experiences of people with learning disabilities who have mental health needs.

Background

Historically, the emotional lives and mental health needs of adults with learning disabilities received scant attention, especially when the policy of institutionalisation was at its zenith in the UK.

Materials and Methods

This case study employed biographical narrative interviews based on a psychosocial approach. The main sources of data production were two loosely structured, audio‐taped, interviews with a man with learning disabilities. This approach uses free association to elicit an individual's stories about his lived experiences. Additional information was acquired from consultations with key care staff and clinical records maintained by the man's service provider.

Results

Data revealed insights into the biography of this man who had a diagnosed mental health disorder. These data recall his personal journey through the care system which took place during an important historical period encompassing both long‐term institutionalisation in segregated settings, and the subsequent implementation of the policy of community care in the UK. He recalls positive and negative experiences while residing in a long‐stay hospital, and the related thoughts and feelings about his life in a community setting in more recent years.

Conclusion

This case study contributes to an increasing body of studies that perceive the use of in‐depth interviewing of individuals with learning disabilities as having high ecological validity in the development of authentic knowledge, not readily available through other methods used in the co‐production of data.
Switchover study of onabotulinumtoxinA to incobotulinumtoxinA for facial dystonia
Authors: Bladen John C. , Favor Maribel , Litwin Andre , Malhotra Raman
Published: July 2020

Importance

When making a cost‐saving it is important to ensure there is no loss of efficacy.

Background

Clinical effectiveness and efficiency of incobotulinumtoxinA compared to onabotulinumtoxinA in facial dystonia is unclear. Our aim is to evaluate switching from onabotulinumtoxinA to incobotulinumtoxinA in the treatment of essential blepharospasm (EB), hemifacial spasm (HFS) and aberrant facial nerve regeneration (AFR).

Design

A retrospective study of a prospective, single‐masked switchover audit from onabotulinumtoxinA to incobotulinumtoxinA.

Participants

Twenty essential EB, 12 HFS and six AFR patients.

Methods

A switchover from stable onabotulinumtoxinA to incobotulinumtoxinA using a 1:1 unit ratio and contemporaneous efficacy measures. Two nurse injectors performed the injections over a period of 6 years. Each masked patient received three onabotulinumtoxinA and three incobotulinumtoxinA over a minimum of 2 years.

Main Outcome methods

At each visit, a blepharospasm disability score (BDS), Jankovic score (JS), subjective improvement (SI), duration of maximum effect (DME) and complications were recorded. A cost comparison per unit dose was made.

Results

Twenty EB, 12 HFS and six AFR received 114 onabotulinumtoxinA and 114 incobotulinumtoxinA treatments. Both brands had similar efficacy, but SI (P < .01) and DME (P < .05) were higher in the HFS group with incobotulinumtoxinA. Complications included bruising (two onabotulinumtoxinA, one incobotulinumtoxinA) and ptosis (three onabotulinumtoxinA, zero incobotulinumtoxinA). OnabotulinumtoxinA was 33% pricier.

Conclusion and Relevance

Switching from onabotulinumtoxinA to incobotulinumtoxinA did not result in an inferior outcome for the treatment of facial dystonia and led to a cost‐saving for the department.
Evaluation of the use of psychometric scales in human–wildlife interaction research to determine attitudes and tolerance toward wildlife
Authors: Whitehouse‐Tedd K. , Abell J. , Dunn A. K.
Published: July 2020

Studies evaluating human–wildlife interactions (HWIs) in a conservation context often include psychometric scales to measure attitudes and tolerance toward wildlife. However, data quality is at risk when such scales are used without appropriate validation or reliability testing, potentially leading to erroneous interpretation or application of findings. We used 2 online databases (ProQuest Psych Info and Web of Science) to identify published HWI studies that included attitude and tolerance. We analyzed these studies to determine the methods used to measure attitudes or tolerance toward predators and other wildlife; determine the proportion of these methods applying psychometric scales; and evaluate the rigor with which the scales were used by examining whether the psychometric properties of validity and reliability were reported. From 2007 to 2017, 114 published studies were identified. Ninety‐four (82%) used questionnaires and many of these (53 [56%]) utilized a psychometric scale. Most scales (39 [74%]) had at least 1 test of reliability reported, but reliance on a single test was notable, contrary to recommended practice. Fewer studies (35 [66%]) reported a test of validity, but this was primarily restricted to structural validity rather than more comprehensive testing. Encouragingly, HWI investigators increasingly utilized the necessary psychometric tools for designing and analyzing questionnaire data, but failure to assess the validity or reliability of psychometric scales used in over one‐third of published HWI attitude research warrants attention. We advocate incorporation of more robust application of psychometric scales to advance understanding of stakeholder attitudes as they relate to HWI.
UNAUTHORIZED IMMIGRANTS' ACCESS TO DRIVER'S LICENSES AND AUTO INSURANCE COVERAGE
Authors: Churchill Brandyn F. , Mackay Taylor , Tan Bing Yang
Published: July 2020

Fourteen states and the District of Columbia allow unauthorized immigrants to obtain driver's licenses. Using variation in the timing and location of these policy changes, we show these Unauthorized Immigrant License Polices (UILPs) are associated with a 1% increase in both the number of licensed drivers and liability insurance coverage, although we do not document a statistically significant relationship with auto insurance claims. Nor do we detect a significant relationship between UILPs and the number of miles driven, vehicle registrations, air quality, or travel behaviors. Overall, our results are consistent with UILPs licensing unauthorized immigrants who were already driving. (JEL R48, G22, K37)
Common errors in inhalation therapy: Impact and solutions
Authors: Rodriguez‐Garcia Carlota , Barreiro Esther , Muñoz‐Gall Xavier , Bustamante‐Madariaga Victor , de‐Granda‐Orive Ignacio , Gonzalez‐Barcala Francisco‐Javier
Published: July 2020

Objective

Inhalation therapy is one of the key pillars in the treatment of chronic obstructive diseases, such as asthma and COPD (Chronic obstructive pulmonary disease); however, wide number of errors occur with high frequency in the inhalation manoeuvres among these patient. This review discuss the main errors made with inhalation devices, factors associated with poor IT (inhalation technique), their consequences and possible solutions.

Data sources

To do this, we performed a search of any publications available in PubMed between the years 2000 and 2019, using the key words: asthma, COPD, obstructive lung disease, inhalers, misuse and errors.

Study selections

After a review of the titles and abstracts by the working group, the articles chosen were considered the most relevant in providing evidence of the problems and establishing solutions in the inhalation treatment of asthma and COPD.

Results

There are several publications that associated the errors in the inhalation technique with a poor prognosis both of asthma and COPD. Most authors generally agree in that a poor IT is associated with poor control of the symptoms.

Conclusions

It is essential to review the IT in all our patients with asthma and COPD due to the high socio‐economic impact that it involves; an effort must be made to homogenise the evaluation of IT, so that it helps to transmit a clear message to the patients, as well as to the health professionals on what is and what is not a correct manoeuvre.
The Relationship Between the Level of Serum ESM‐1 and Lp‐PLA2 in Patients With Acute ST‐Segment Elevation Myocardial Infarction
Authors: Wei Peng , Zong Bin , Liu Xuekui , Zhang Miaomiao , Yang Cui , Wang Haibo , Fu Qiang , Wang Liansheng , Cao Bangming
Published: July 2020

Acute ST‐segment elevation myocardial infarction (STEMI) is the most lethal coronary heart disease with vascular endothelium dysfunction and inflammation in the disease development process. Endothelial cell‐specific molecule 1 (ESM‐1) and lipoprotein‐associated phospholipase A2 (Lp‐PLA2) are important for the diagnosis and characterization of STEMI. To date, no studies have reported the correlation between ESM‐1 and Lp‐PLA2 levels in patients with STEMI, which may be an important predictor of the fatal disease. To measure the level of serum ESM‐1 and Lp‐PLA2, and to evaluate the relationship and the clinical significance of these two biomarkers in patients with acute STEMI, 37 inpatients with acute STEMI were sequentially enrolled in the research group and 24 study objects with normal coronary artery function were included in the control group. The measurement of the relative parameters was done by enzyme‐linked immunosorbent assay using blood samples taken from the median cubital vein while the inpatients were enrolled. The levels of serum SEM‐1 and Lp‐PLA2 were significantly higher in patients with acute STEMI than in study objects with normal coronary artery function (P < 0.05). A significant correlation of serum SEM‐1 and Lp‐PLA2 was observed, leading to close linearity (r2 = 0.8131, P < 0.0001). In conclusion, the endothelium dysfunction factor ESM‐1 and inflammatory factor Lp‐PLA2 are significantly higher and correlated in patients with acute STEMI. These two factors could be novel and effective biomarkers for acute STEMI diagnosis and evaluation.
Pain in children with dyskinetic and mixed dyskinetic/spastic cerebral palsy
Authors: McKinnon Clare T , Morgan Prue E , Antolovich Giuliana C , Clancy Catherine H , Fahey Michael C , Harvey Adrienne R
Published: July 2020

Aim

To evaluate pain prevalence and characteristics in children and adolescents with predominant dyskinetic and mixed (dyskinetic/spastic) cerebral palsy (CP) motor types.

Method

Seventy‐five participants with a diagnosis of CP and confirmed dyskinetic or mixed (dyskinetic/spastic) motor type took part in a multisite cross‐sectional study. The primary outcome was carer‐reported pain prevalence (preceding 2wks) measured using the Health Utilities Index‐3. Secondary outcomes were chronicity, intensity, body locations, quality of life, and activity impact.

Results

Mean participant age was 10 years 11 months (SD 4y 2mo, range 5–18y). There were 44 males and 31 females and 37 (49%) had predominant dyskinetic CP. Pain was prevalent in 85% and it was chronic in 77% of participants. Fifty‐two per cent experienced moderate‐to‐high carer‐reported pain intensity, which was significantly associated with predominant dyskinetic motor types (p=0.008). Pain occurred at multiple body locations (5 out of 21), with significantly increased numbers of locations at higher Gross Motor Function Classification System levels (p=0.02). Face, jaw, and temple pain was significantly associated with predominant dyskinetic motor types (p=0.005). Poorer carer proxy‐reported quality of life was detected in those with chronic pain compared to those without (p=0.03); however, chronic pain did not affect quality of life for self‐reporting participants.

Interpretation

Pain was highly prevalent in children and adolescents with predominant dyskinetic and mixed (dyskinetic/spastic) motor types, highlighting a population in need of lifespan pain management.

What this paper adds

Chronic pain prevalence in children and adolescents with predominant dyskinetic and mixed (dyskinetic/spastic) motor types is high.

Pain occurs across multiple body locations in predominant dyskinetic and mixed (dyskinetic/spastic) motor types.

Less recognized locations of pain include the face, jaw, and temple for predominant dyskinetic motor types.
THE PERFORMANCE EFFECTS OF WISE AND UNWISE MANAGERIAL DISMISSALS
Authors: Flepp Raphael , Franck Egon
Published: July 2020

The decision to dismiss a coach is challenging because poor performance tends to coincide with both bad luck and low coaching ability. We differentiate between dismissals following actual poor performance on the pitch (wise dismissals) and dismissals following seemingly poor performance due to bad luck (unwise dismissals). To categorize dismissals, we use “expected goals,” which are less vulnerable to random variation in match outcomes. Using data from European football, we find that wise dismissals increase subsequent performance compared to a control group of nondismissals with similarly poor performance on the pitch. However, unwise dismissals do not improve subsequent performance compared to a control group with similar strings of bad luck. (JEL D81, J44, L83)
Autistic traits in first‐episode psychosis: Rates and association with 1‐year recovery outcomes
Authors: Zheng Shushan , Chua Yi Chian , Tang Charmaine , Tan Giles Ming‐Yee , Abdin Edimansyah , Lim Vicki Wei Qi , Koh Astelle Shiyun , Verma Swapna , Magiati Iliana
Published: July 2020

Aim

There is a growing appreciation that subthreshold but clinically elevated levels of autistic traits are clinically relevant. This study examined autistic traits in Singaporean patients with first‐episode psychosis and their association with 1‐year psychosis recovery.

Methods

The relationship between baseline patient characteristics, autistic traits (measured with autism screening questionnaires) and psychosis recovery outcomes at 1‐year were examined in 180 adults in the Early Intervention Psychosis Programme in Singapore.

Results

Out of 180 participants, 50 (27.8%) had clinically elevated above screening‐cut off levels of autistic traits on the self‐reported 10‐item Autism Spectrum Quotient and 8 (4.4%) on the staff‐rated Autism Spectrum Disorder in Adults Screening Questionnaire. At baseline, those with more autistic traits were more likely to be unemployed, economically inactive (ie, students or homemakers); and to have diagnoses of mood disorder with psychotic features, brief psychotic disorder or psychotic disorder not otherwise specified as compared to schizophrenia spectrum and delusional disorder diagnoses. Although most participants showed improvements in their clinical outcomes at 1‐year, those with higher autistic traits improved less in the Positive and Negative Syndrome Scale general psychopathology scale and in Global Assessment of Functioning symptomatology.

Conclusions

Autistic traits are common in those with first‐episode psychosis and may be associated with poorer clinical outcomes. Validated screening tools should be developed in this population to support earlier reporting.
Clinical course and risk factors for mortality from COVID‐19 in patients with haematological malignancies
Authors: Sanchez‐Pina José María , Rodríguez Rodriguez Mario , Castro Quismondo Nerea , Gil Manso Rodrigo , Colmenares Rafael , Gil Alos Daniel , Paciello Mari Liz , Zafra Denis , Garcia‐Sanchez Cristina , Villegas Carolina , Cuellar Clara , Carreño‐Tarragona Gonzalo , Zamanillo Irene , Poza María , Iñiguez Rodrigo , Gutierrez Xabier , Alonso Rafael , Rodríguez Antonia , Folgueira Maria Dolores , Delgado Rafael , Ferrari José Miguel , Lizasoain Manuel , Aguado José María , Ayala Rosa , Martinez‐Lopez Joaquín , Calbacho María
Published: July 2020

Background

The impact of coronavirus disease 2019 (COVID‐19) in haematological patients (HP) has not been comprehensively reported.

Methods

We analysed 39 patients with SARS‐CoV‐2 infection and haematological malignancies. Clinical characteristics and outcomes were compared to a matched control group of 53 non‐cancer patients with COVID‐19. Univariate and multivariate analyses were carried out to assess the risk factors associated with poor outcome.

Results

The most frequent haematological diseases were lymphoma (30%) and multiple myeloma (30%). Eighty‐seven % HP developed moderate or severe disease. Patients with haematological malignancies had a significantly higher mortality rate compared to non‐cancer patients (35.9% vs 13.2%; P = .003 (odds ratio 6.652). The worst outcome was observed in chronic lymphocytic leukaemia patients. Only age >70 years and C reactive protein >10 mg/dl at admission were associated with higher risk of death (odds ratio 34.86, P = .003 and 13.56,P = .03). Persistent viral sheddind was detected in 5 HP. Active chemotherapy, viral load at diagnosis and COVID‐19 therapy were not predictors of outcome.

Conclusion

Mortality of COVID‐19 is significantly higher in patients with haematological malignancies compared to non‐cancer patients. The impact of persistent viral shedding must be considered in order to re‐start therapies and maintain infectious control measures.
γδ T cells in malaria: a double‐edged sword
Authors: Pamplona Ana , Silva‐Santos Bruno
Published: July 2020

Malaria remains a devastating global health problem, resulting in many annual deaths due to the complications of severe malaria. However, in endemic regions, individuals can acquire ‘clinical immunity’ to malaria, characterized by a decrease in severe malaria episodes and an increase of asymptomatic Plasmodium falciparum infections. Recently, it has been reported that tolerance to ‘clinical malaria’ and reduced disease severity correlates with a decrease in the numbers of circulating Vγ9Vδ2 T cells, the major subset of γδ T cells in the human peripheral blood. This is particularly interesting as this population typically undergoes dramatic expansions during acute Plasmodium infections and was previously shown to play antiparasitic functions. Thus, regulated γδ T‐cell responses may be critical to balance immune protection with severe pathology, particularly as both seem to rely on the same pro‐inflammatory cytokines, most notably TNF and IFN‐γ. This has been clearly demonstrated in mouse models of experimental cerebral malaria (ECM) based on Plasmodium berghei ANKA infection. Furthermore, our recent studies suggest that the natural course of Plasmodium infection, mimicked in mice through mosquito bite or sporozoite inoculation, includes a major pathogenic component in ECM that depends on γδ T cells and IFN‐γ production in the asymptomatic liver stage, where parasite virulence is seemingly set and determines pathology in the subsequent blood stage. Here, we discuss these and other recent advances in our understanding of the complex—protective versus pathogenic—functions of γδ T cells in malaria.
Microbial tropicalization driven by a strengthening western ocean boundary current
Authors: Messer Lauren F. , Ostrowski Martin , Doblin Martina A. , Petrou Katherina , Baird Mark E. , Ingleton Timothy , Bissett Andrew , Van de Kamp Jodie , Nelson Tiffanie , Paulsen Ian , Bodrossy Levente , Fuhrman Jed A. , Seymour Justin R. , Brown Mark V.
Published: July 2020

Western boundary currents (WBCs) redistribute heat and oligotrophic seawater from the tropics to temperate latitudes, with several displaying substantial climate change‐driven intensification over the last century. Strengthening WBCs have been implicated in the poleward range expansion of marine macroflora and fauna, however, the impacts on the structure and function of temperate microbial communities are largely unknown. Here we show that the major subtropical WBC of the South Pacific Ocean, the East Australian Current (EAC), transports microbial assemblages that maintain tropical and oligotrophic (k‐strategist) signatures, to seasonally displace more copiotrophic (r‐strategist) temperate microbial populations within temperate latitudes of the Tasman Sea. We identified specific characteristics of EAC microbial assemblages compared with non‐EAC assemblages, including strain transitions within the SAR11 clade, enrichment of Prochlorococcus, predicted smaller genome sizes and shifts in the importance of several functional genes, including those associated with cyanobacterial photosynthesis, secondary metabolism and fatty acid and lipid transport. At a temperate time‐series site in the Tasman Sea, we observed significant reductions in standing stocks of total carbon and chlorophyll a, and a shift towards smaller phytoplankton and carnivorous copepods, associated with the seasonal impact of the EAC microbial assemblage. In light of the substantial shifts in microbial assemblage structure and function associated with the EAC, we conclude that climate‐driven expansions of WBCs will expand the range of tropical oligotrophic microbes, and potentially profoundly impact the trophic status of temperate waters.
Bus stops, triple wins and two steps: nurse migration in and out of Asia
Authors: WALTON‐ROBERTS MARGARET
Published: July 2020

The migration pathways in which nurses engage are increasingly heterogeneous. In this article, I contrast three types of nurse migration pathway from three country pairs – Vietnam to Germany ‘triple win’ bi‐lateral migration (direct migration); India to Canada two‐step study‐work (multistage) pathway; and ‘bus stop’ multinational migration from the Philippines to Singapore and onwards to other sites. Each pathway is not exclusive to the country pair selected; rather, this occupational and pathway specific analysis permits a comparison of the structures and processes involved – the different kinds of hierarchies that underpin mobility; the migration and border‐control infrastructure that channels mobility; and the differential incorporation of multi‐nationally mobile lives and their gendered/racialized implications. The migration trajectories analysed in this article reveal how multinational and multistage migrations are produced (through state and non‐state intermediaries and policy structures), and how they are productive of new subjectivities and imaginaries (shaped by what is possible and desirable).
City economic development, housing availability, and migrants' settlement intentions: Evidence from China
Authors: Chen Mengkai , Wu Yidong , Liu Guiwen , Wang Xianzhu
Published: July 2020

The slow growth of the permanently settled migrants in host cities poses new challenges for the sustainability of China's future urbanization. Given the growing importance of homeownership, this paper clarifies migrants' settlement intentions into three mutually exclusive patterns, including de facto permanent settlement intention through homeownership, long‐term temporary settlement intention and short‐term temporary settlement intention. Based on matched micro‐ and macro‐level data, this paper examines the influence of city economic development and housing prices on these three patterns. The results suggest that economic development exhibits an attractive effect on migrants' settlement intentions for both earning money and for making a life while housing price weakens rural migrants' de facto permanent settlement intention. We also highlight the effect of the Housing Provident Fund (HPF), the most important housing financial policy in China, on settlement intention, and the results suggest that the HPF serves as an option to help migrants achieve permanent settlement through housing availability. The findings can explain the mixed results of previous research and provide policy references for sustainable urbanization in China.
Do rural migrants benefit from labor market agglomeration economies? Evidence from Chinese cities
Authors: Yang Guangliang , Li Lixing , Fu Shihe
Published: July 2020

We combine the 2005 China Inter‐Census Population Survey data and the 2004 China Manufacturing Census to test whether workers, particularly rural migrants, benefit from labor market Marshallian externalities. We find that workers in general, and rural migrants in particular, benefit from labor market pooling effects (measured by total employment in a city‐industry cell) and human capital externalities (measured by share of workers with a college degree or above in a city‐industry cell). These findings are robust to various sorting bias tests. However, rural migrants benefit much less than do local or urban workers, possibly because rural migrants lack social networks and are discriminated doubly in terms of being both “rural” and “migrants.” Our findings have policy implications on how Chinese cities can become skilled during the rapid urbanization process coupled with global competition.
Chemistry of the Karst Sarabkalan Spring, Iran, and Controls of PDO and ENSO Climate Indices on It
Authors: Rezaei Abolfazl
Published: July 2020

The Sarabkalan Spring serves as a primary water supply to irrigation and domestic use in the Sirvan Region, Iran. As it has a highly variable discharge, understanding its teleconnections with large‐scale climate variability is crucial. In this study, we first characterize the springshed and its corresponding karst aquifer system using genetic algorithm analysis on the spring discharge, water balance calculations, temporal variations of physicochemical parameters, and stable isotopes along with considering its geological settings. Then, the large‐scale climate indices teleconnections with precipitation and spring discharge are studied using wavelet analysis. Results reveal that the springshed contains two karst subaquifers resulting from geological and morphological settings. Unlike most developed karst systems in Zagros, which show one peak, the spring has two principal flow peaks over most hydrological years where the second peak occurs over the dry season. It takes ∼99 d (from lag correlation over 2008‐2019) and ∼145 d (from δ18O measurements over 2018‐2019) for rain water to reach the Sarabkalan Spring. Moreover, intense precipitations would result in an increase in discharge and a decrease in electrical conductivity, Ca + Mg, HCO3, SO4, Cl, ionic strength, and δ18O of the spring because of the developed karst conduit(s). It is further found that a positive Pacific Decadal Oscillation phase coupled with El Niño causes an increase in both the precipitation and spring discharge, signifying the influence of the atmospheric circulations of the Pacific Ocean on the spring behavior.
Reflectance confocal microscopy and its role in the follow‐up of a topical treatment for lentigo maligna
Authors: Coco Valeria , Perino Francesca , Di Stefani Alessandro , Cappilli Simone , Peris Ketty
Published: July 2020

Background

In recent years, there has been an ongoing interest in topical treatment for lentigo maligna (LM) as imiquimod 5% cream owing to the localization of this tumor and the advanced age of patients; however, the efficacy of imiquimod 5% cream is controversial, and the rate of local relapses is about 25–53%. Reflectance confocal microscopy (RCM) is a noninvasive diagnostic tool useful not only for diagnostic purpose but also for monitoring the response to the local treatment of LM. Our aim was to demonstrate the role of RCM in the follow‐up of a topical treatment with imiquimod 5% cream in clinical practice.

Methods

We report three patients with histopathologically confirmed LM who were not candidates for surgery and were successfully treated with imiquimod 5% cream. In such patients, dermatoscopic images and reflectance confocal microscopy were useful to evaluate treatment response and to verify long‐term clinical benefits during the follow‐up visits.

Results

No relapses were observed in our patients 18 months after the end of treatment; although, continuous follow‐up visits are needed in these patients.

Conclusions

In the case series presented herein, we highlight the importance of RCM as a noninvasive tool to monitor the efficacy of imiquimod to treat LM during and after treatment. Detailed confocal images of two of our patients allowed us to establish the persistence of atypical cells and to continue treatment, although clinical and dermatoscopic examinations showed “apparent complete remission” after the first cycle of therapy.
Identifying and characterizing basal cell carcinomas in persons with albinism
Authors: Juhasz Margit L. W. , Levin Melissa K. , Sharp Andrew
Published: July 2020

Background

Historically, persons with albinism (PWA) were thought to develop squamous cell carcinoma (SCC) more frequently than basal cell carcinoma (BCC). Recent evidence suggests BCCs in PWA are more common than initially hypothesized.

Objective

To characterize the presentation of BCC in PWA.

Methods

Fifty‐four PWA with lesions suspicious for non‐melanoma skin cancer sought care at Tanzanian dermatologic clinics from 2017 to 2019. Demographic and clinical presentation data were recorded. Histologic analysis of each sample was completed.

Results

The majority of PWA were female (53.7%), with a mean age of 34.6 ± 14.9 years and a mean duration of disease of 0.70 ± 0.73 years. Physician description of histologically proven BCC included ulceration (41.7%), erythema (16.7%), and scale (16.7%). Lesions were most commonly located on the trunk (47.1%) and face (41.2%). Histologic analysis demonstrated 30.2% of lesions were BCC, 26.4% SCC, and 17% Bowen's disease.

Limitations

Patient population was limited to those visiting clinics, and data were limited by accuracy of the medical record.

Conclusions

Basal cell carcinoma occurs at a higher rate than SCC in our population, suggesting BCC in PWA is underdiagnosed. It is important to recognize BCC early in PWA to avoid large disease burden and high rates of morbidity and mortality.
Duration of smoking cessation is negatively associated with the magnitude of chronic prostatic inflammation and storage dysfunction in patients with benign prostatic hyperplasia
Authors: Inamura So , Ito Hideaki , Oe Hideki , Seki Masaya , Taga Minekatsu , Kobayashi Motohiro , Yokoyama Osamu
Published: July 2020

Objectives

To evaluate the impact of smoking and the benefit of smoking cessation on lower urinary tract function and prostatic inflammation in patients with benign prostatic hyperplasia.

Methods

The medical records of 118 benign prostatic hyperplasia patients who underwent transurethral prostatic surgery between 2006 and 2016 were analyzed. Their smoking history was confirmed. The relationship between smoking and main clinical parameters, International Prostate Symptom Scores, uroflowmetry, pressure flow study, magnitude of prostatic inflammation and the level of serum C‐reactive protein was investigated. Furthermore, the relationships between smoking cessation and these clinical parameters were assessed.

Results

The International Prostate Symptom Scores for straining among the non‐smokers were significantly lower than those of the smokers (1.71 vs 2.60, P = 0.029). In the pressure flow study, there were negative correlations between the duration of smoking and strong desire to void (correlation coefficient −0.314, P = 0.013), urgency (correlation coefficient −0.349, P = 0.008) and bladder volume at initial detrusor overactivity (correlation coefficient −0.417, P = 0.021). The duration of smoking cessation was negatively correlated with the magnitude of chronic prostatic inflammation (correlation coefficient −0.253, P = 0.027). In the pressure flow study, the duration of smoking cessation was positively correlated with urgency (correlation coefficient 0.286, P = 0.030) and maximum cystometric capacity (correlation coefficient 0.241, P = 0.050).

Conclusions

Smoking could be a risk factor for the exacerbation of storage dysfunction in benign prostatic hyperplasia patients. Smoking cessation is effective in improving chronic prostatic inflammation and storage dysfunction.
Is the membranous urethral length related to postoperative urinary incontinence after holmium laser enucleation of the prostate?
Authors: Ueki Hideto , Takahashi Kosuke , Yasufuku Tomihiko , Yuen Keiji , Yamashita Masuo
Published: July 2020

Objectives

To investigate the findings of preoperative magnetic resonance imaging associated with the occurrence of transient urinary incontinence after holmium laser enucleation of the prostate.

Methods

At a single institution, 360 patients underwent holmium laser enucleation of the prostate between January 2014 and December 2018. Of those, we retrospectively evaluated 237 who underwent preoperative magnetic resonance imaging and for whom postoperative evaluations were available for >3 months after holmium laser enucleation of the prostate. We carried out preoperative magnetic resonance imaging, and measured the periurethral sphincter complex, levator ani thickness, membranous urethral length and minimal residual membranous urethral length. Logistic regression analysis was carried out to assess the variables associated with incontinence.

Results

Transient urinary incontinence occurred after holmium laser enucleation of the prostate in 68 patients (28.7%); 46 (67.6%) of whom recovered within 3 months. Multivariate analysis showed that the membranous urethral length was independently associated with postoperative urinary incontinence at 1 and 3 months after surgery. The operative time was also independently associated with postoperative transient urinary incontinence at 1 month after surgery.

Conclusion

Preoperative membranous urethral length and operative time are independent predictors of transient urinary incontinence after holmium laser enucleation of the prostate. These findings should be considered by surgeons before surgery.
The use of acellular porcine dermis, hyaluronic acid and polynucleotides in the treatment of cutaneous ulcers: Single blind randomised clinical trial
Authors: Segreto Francesco , Carotti Simone , Marangi Giovanni Francesco , Francesconi Maria , Scaramuzzino Luca , Gratteri Marco , Caldaria Erika , Morini Sergio , Persichetti Paolo
Published: July 2020

Reconstruction of chronic ulcers is often hampered by lack of local tissues and poor general conditions. Conservative approaches with debridement and advanced medications, such as polyurethane foam, stand as mainstays. However, the healing process is often slow, thus increasing the risk for infection or other complications. In such cases, porcine dermis (PD) and polynucleotides‐added hyaluronic acid (PAHA) were previously reported to accelerate healing. The aim of the study was to compare the efficacy of PD, PAHA and polyurethane foam in chronic ulcers. Thirty patients were randomly divided into 3 groups: group 1 was treated with advanced medications, group 2 with PD, group 3 with PAHA. Standardised photographs and biopsies were taken before treatment and at 30‐day follow‐up. Photographs were processed to calculate the wound area. Specimens were stained with Haematoxylin/Eosin, Masson trichrome, and immunohistochemically for CD34, alpha‐Smooth Muscle Actin (α‐SMA), Collagen types I and III, Ki67. The re‐epithelialized area was larger in patients treated with PD and PAHA compared with those treated with polyurethane foam (P < .05 and P < .01, respectively). Specimens from patients treated with PD and PAHA showed a higher number of myofibroblasts (α‐SMA+, P < .01), neo‐angiogenesis (CD34+, P < .01), proliferating dermal cells (Ki67+, P < .01), proliferating keratinocytes (Ki67+, P < .01) and collagen type 1 deposition (P < .05). No difference was found between PD and PAHA. PD and PAHA proved to be more effective than polyurethane foam in the treatment of chronic ulcers. These approaches are a versatile and reliable option to address such cases.
Alcohol consumption does not increase the risk of surgical wound complications in breast cancer patients
Authors: de Menezes Raquel Ferreira , Bergmann Anke , Thuler Luiz Claudio Santos
Published: July 2020

Alcohol consumption, despite influencing several organic processes, has been scarcely studied regarding the risk of developing surgical wound complications after surgical breast cancer treatment. The aim of this study was to analyse the association between alcohol consumption and the development of surgical wound complications in women undergoing surgical treatment for breast cancer. A prospective cohort study was conducted, comprising 486 women between 40 and 69 years old, interviewed during the preoperative period and followed up for 30 days. The occurrence of seroma, necrosis, surgical site infection (SSI), dehiscence, ecchymosis, and hematoma were considered as outcomes. Alcohol consumption during the 30 days prior to surgery was reported by 20.8% of the patients, with 8.4% being occasional consumers and 12.4% regular consumers. Binge drinking was reported by 10.2% of the women. The presence of surgical wound complications was observed in 65.2%. The most frequent complications were seroma (54.3%), necrosis (17.7%), and SSI (7.8%). No statistically significant association between alcohol consumption and the development of cicatricial complications was observed.
Family network typologies of adults with intellectual disability: Associations with psychological outcomes
Authors: Tournier Tess , Hendriks Alexander H. C. , Jahoda Andrew , Hastings Richard P. , Giesbers Sanne A. H. , Vermulst Ad A. , Embregts Petri J. C. M.
Published: July 2020

Background

Based on self‐reported social capital, different typologies of family networks of people with intellectual disabilities were examined. Associations between behavioural and emotional problems or well‐being and typologies were investigated.

Method

137 participants with mild intellectual disability were interviewed using the Family Network Method‐Intellectual Disability to assess their emotionally supportive family relationships. Data on participants’ well‐being and behavioural and emotional problems were also gathered. Latent class analysis was used to identify family typologies based on social network measures.

Results

Four distinguishable typologies were identified, two supportive and two less supportive. A small association was found with behavioural and emotional problems and one of the supportive typologies. Associations with constructs of well‐being were found for both supportive and less supportive typologies.

Conclusions

A variety of family types were found, with implications for sensitive professional support.
Rationale, design, and baseline characteristics of the Salt Substitute in India Study (SSiIS): The protocol for a double‐blinded, randomized‐controlled trial
Authors: Thout Sudhir Raj , Yu Jie , Tian Maoyi , Huffman Mark D. , Arnott Clare , Li Qiang , Devarsetty Praveen , Johnson Claire , Pettigrew Simone , Neal Bruce , Wu Jason H. Y.
Published: July 2020

Reduced‐sodium, added‐potassium salt substitutes have favorable effects on blood pressure, but have not been tested in India. The Salt Substitute in India Study (SSiIS) is a double‐blinded, randomized‐controlled trial designed to investigate the effects of reduced‐sodium, added‐potassium salt substitution to replace usual cooking salt use and blood pressure (BP) among hypertensive patients in rural India. The primary objective is to assess effects on systolic blood pressure at 3 months. The secondary objectives are to determine effects on diastolic blood pressure, urinary sodium, and potassium levels, and to determine acceptability of the intervention. Eligible individuals received usual salt (100% sodium chloride) or salt substitute (70% sodium chloride and 30% potassium chloride) to replace all salt required for cooking and seasoning in the household. A total of 502 participants aged ≥18 years with a history of hypertension were successfully recruited and randomized in a 1:1 ratio to intervention or control, between November 2019 and January 2020. Mean blood pressure at baseline was 133.5/83.6 mm Hg and 96% were using one or more blood pressure‐lowering medications. The overall mean average 24‐hour urinary sodium excretion was 2825 (SD, 1166) mg/L, which corresponds to a urinary salt excretion of 10.4 g/d. Baseline findings suggest sodium intake in this population significantly exceeds World Health Organization recommendations. The SSiIS trial has successfully recruited participants and is well placed to determine whether salt substitution is an effective means of lowering blood pressure for rural Indian patients with hypertension.
Mental health of healthcare workers during the COVID‐19 pandemic in Italy
Authors: Di Tella Marialaura , Romeo Annunziata , Benfante Agata , Castelli Lorys
Published: July 2020

Background

The COVID‐19 pandemic represents one of the most stressful events of recent times. Among the population, healthcare professionals who treat COVID‐19 patients are most likely to develop psychological distress and posttraumatic stress symptoms (PTSS). The present study thus aimed to investigate the psychological impact of the COVID‐19 outbreak on Italian healthcare workers.

Methods

The responses of 145 healthcare workers (72 medical doctors and 73 nurses) were included in the final dataset. Participants were asked to provide sociodemographic and clinical information, and to complete: (a) quality of life and health‐related Visual Analogue Scales, (b) State‐Trait Anxiety Inventory‐Form Y1, (c) Beck Depression Inventory, and (d) PTSD Checklist for DSM‐5.

Results

A comparison between healthcare professionals working in COVID‐19 wards and other units revealed that the former reported higher levels of both depressive symptoms and PTSS. Moreover, the results of regression analyses showed that in healthcare professionals working with COVID‐19 patients, gender and marital status, and gender and age significantly predicted depressive symptoms and PTSS, respectively. Particularly, being female and not in a relationship were found to be associated with higher levels of depressive symptoms, whereas being female and older were found to be related to higher levels of PTSS.

Conclusions

The current findings suggest that specific predisposing factors could identify healthcare workers who are at high risk of developing mental health symptoms when faced with COVID‐19 patients.
First estimates of metabolic rate in Atlantic bluefin tuna larvae
Authors: Blanco Edurne , Reglero Patricia , Ortega Aurelio , Folkvord Arild , de la Gándara Fernando , Hernández de Rojas Alma , Moyano Marta
Published: July 2020

Atlantic bluefin tuna is an iconic scombrid species with a high commercial and ecological value. Despite their importance, many physiological aspects, especially during the larval stages, are still unknown. Metabolic rates are one of the understudied aspects in scombrid larvae, likely due to challenges associated to larval handling before and during respirometry trials. Gaining reliable estimates of metabolic rates is essential to understand how larvae balance their high growth needs and activity and other physiological functions, which can be very useful for fisheries ecology and aquaculture. This is the first study to (a) estimate the relationship between routine metabolic rate (RMR) and larval dry weight (DW) (mass scaling exponent) at a constant temperature of 26°C, (b) measure the RMR under light and darkness and (c) test whether the interindividual differences in the RMR are related to larval nutritional status (RNA/DNA and DNA/DW). The RMR scaled nearly isometrically with body size (b = 0.99, 0.60–31.56 mg DW) in contrast to the allometric relationship observed in most fish larvae (average b = 0.87). The results show no significant differences in larval RMR under light and darkness, suggesting similar larval activity levels in both conditions. The size explained most of the variability in RMR (97%), and nutritional condition was unrelated to the interindividual differences in routine metabolism. This is the first study to report the metabolic rates of Atlantic bluefin tuna larvae and discuss the challenges of performing bioenergetic studies with early life stages of scombrids.