bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparing Longitudinal Sarcopenia Trends by Definitions Across Men and Women After Hip Fracture
Authors: Chiles Shaffer Nancy , Huang Yi , Abraham Danielle S. , Cheng Yun‐Ju , Lu Wenxin , Gruber‐Baldini Ann L. , Hochberg Marc C. , Guralnik Jack , Magaziner Jay , Orwig Denise
Published: April 2020

OBJECTIVES

While sarcopenia is prevalent after hip fracture in the acute postfracture period, little is known about the prevalence after discharge. This study assessed longitudinal trends in sarcopenia prevalence over 12 months after hip fracture using three different operational definitions.

DESIGN

Prospective observational study.

SETTING

Baltimore Hip Studies seventh cohort.

PARTICIPANTS

A total of 82 men and 78 women, aged 65 years and older, with surgical repair of a nonpathological hip fracture.

MEASUREMENTS

Baseline assessment included a dual‐energy X‐ray absorptiometry scan and interview. Follow‐up assessments, which additionally included performance measures, occurred 2, 6, and 12 months after admission. Using these measures, three sarcopenia definitions were assessed over the year following hip fracture: European Working Group on Sarcopenia in Older Persons (EWGSOP), International Working Group on Sarcopenia (IWGS), and Foundation for the National Institutes of Health (FNIH).

RESULTS

EWGSOP and IWGS provided the highest prevalence of sarcopenia (62%‐69% in men, 42%‐62% in women), while prevalence by FNIH was much lower for men (15%‐19%) and women (5%‐12%). For both men and women, the agreement between EWGSOP and IWGS definitions was excellent, and FNIH showed poor agreement with them, supported by various statistical measures across first‐year follow‐up. Prevalence was stable over time in men by all definitions, while the prevalence in women by FNIH was lowest at 2 months, significantly increased at 6 months (P = .03), and remained higher at 12 months. Whether sarcopenia prevalence differed significantly by sex varied by time point and definition; however, when different, men had a higher prevalence than women (P < .05). While some participants recovered from sarcopenia over time, some also became newly sarcopenic.

CONCLUSION

The prevalence of sarcopenia after fracture differed greatly for EWGSOP and IWGS compared to FNIH. Overall, there appeared to be no reduction in sarcopenia over the year after hip fracture, regardless of definition. Future research should examine the relationship between sarcopenia prevalence and functional recovery. J Am Geriatr Soc 68:1537‐1544, 2020.
An optimized hepatocellular carcinoma prediction model for chronic hepatitis B with well‐controlled viremia
Authors: Lee Hye W. , Park Soo Y. , Lee Myeongjee , Lee Eun J. , Lee Jinae , Kim Seung U. , Park Jun Y. , Kim Do Y. , Ahn Sang H. , Kim Beom K.
Published: April 2020

Background and Aims

Hepatocellular carcinoma (HCC) risk in chronic hepatitis B (CHB) substantially decreased in the era of potent antiviral therapy. We developed an optimized HCC risk prediction model for CHB with well‐controlled viremia by nucelos(t)ide analogs (NUCs).

Method

We analysed those who achieved virological response (VR; serum HBV‐DNA < 2000 IU/mL on two consecutive assessments) by NUCs. Liver stiffness by transient elastography, ultrasonography and laboratory tests was performed at the time of confirmed VR. Patients with decompensated cirrhosis or HCC at baseline were excluded. Multivariate Cox‐regression analysis was used to determine key variables to construct a novel risk‐scoring model.

Results

Among 1511 patients, 9.5% developed HCC. Cirrhosis on ultrasonography (adjusted HR [aHR] 2.47), age (aHR 1.04), male (aHR 1.90), platelet count <135 000/uL (aHR 1.57), albumin <4.5 g/dL (aHR 1.77) and liver stiffness ≥11 kPa (aHR 6.09) were independently associated with HCC. Using these, CAMPAS model was developed with c‐index of 0.874. The predicted and observed HCC probabilities were calibrated with a reliable agreement. Such results were reproduced from internal validation and external validation among the independent cohort (n = 252). The intermediate‐risk (CAMPAS model score 75 ~ 161) and high‐risk (score >161) groups were more likely to develop HCC compared with the low‐risk group (score ≤75) with statistical significances (HRs; 4.43 and 47.693 respectively; both P < .001).

Conclusion

CAMPAS model derived through comprehensive clinical evaluation of liver disease allowed the more delicate HCC prediction for CHB patients with well‐controlled viremia by NUCs.
Liver impairment in COVID‐19 patients: A retrospective analysis of 115 cases from a single centre in Wuhan city, China
Authors: Zhang Yafei , Zheng Liang , Liu Lan , Zhao Mengya , Xiao Jun , Zhao Qiu
Published: April 2020

Background

The SARS‐CoV‐2 pandemic is an ongoing global health emergency. The aim of our study was to investigate the changes of liver function and its clinical significance in COVID‐19 patients.

Method

This retrospective, single‐centre study was conducted on 115 confirmed cases of COVID‐19 in Zhongnan hospital of Wuhan University from 18 January 2020 to 22 February 2020. Liver function and related indexes were analysed to evaluate its relationship with disease progression in COVID‐19 patients.

Results

Part of the COVID‐19 patients presented with varying degrees of abnormality in liver function indexes. However, the levels of ALT, AST, TBIL, GGT and LDH in COVID‐19 patients were not significantly different when compared with hospitalised community‐acquired pneumonia patients, and the levels of albumin is even significantly higher. The levels of ALT, AST, TBIL, LDH and INR showed statistically significant elevation in severe COVID‐19 cases compared with that in mild cases. However, the clinical significance of the elevation is unremarkable. Majority of severe COVID‐19 patients showed significantly decreasing in albumin level and continuously decreasing in the progress of illness. Most of the liver function indexes in COVID‐19 patients were correlated with CRP and NLR, the markers of inflammation. Logistic regression analysis further identified NLR as the independent risk factor for severe COVID‐19, as well as age.

Conclusions

Although abnormalities of liver function indexes are common in COVID‐19 patients, the impairment of liver function is not a prominent feature of COVID‐19, and also may not have serious clinical consequences.
Ecotype and geographical variation in carbon and nitrogen stable isotope values in western North Pacific killer whales (Orcinus orca)
Authors: Borisova Ekaterina A. , Filatova Olga A. , Fedutin Ivan D. , Tiunov Alexei V. , Shpak Olga V. , Hoyt Erich
Published: April 2020

Killer whales are top predators in marine trophic chains, and therefore their feeding preferences can substantially affect the abundance of species on the lower trophic levels. Killer whales are known to feed on many different types of prey from small fish to large whales, but a given killer whale population usually focuses on a specific type of prey. Stable isotope analysis is widely used to study whale diets, because direct observations are often impossible. Killer whale feeding habits in the western North Pacific are poorly studied, and the large‐scale stable isotope analysis provides a unique opportunity to gain insights into the trophic links of this top predator. In this study, we compare the δ13C and δ15N stable isotope values from killer whale skin samples obtained in different areas of the western North Pacific from fish‐eating (R‐type) and mammal‐eating (T‐type) killer whale ecotypes. The effect of ecotype was highly significant: both carbon and nitrogen stable isotope values were lower in R‐type whales than in T‐type whales. The geographical variation also affected killer whale stable isotope values due to both the differences in killer whale diet and the variation in baseline stable isotope values across the study areas.
Utility of enzyme immunoassays for diagnosis of subacute sclerosing panencephalitis
Authors: Maeda Hajime , Hashimoto Koichi , Miyazaki Kyohei , Kanno Shuto , Go Hayato , Suyama Kazuhide , Sato Masatoki , Kawasaki Yukihiko , Hosoya Mitsuaki
Published: April 2020

Background

Subacute sclerosing panencephalitis (SSPE) is a progressive neurologic disorder caused by the measles virus (MV) and is identified by positive MV‐specific antibody titers, detected mainly by hemagglutination inhibition (HI) tests in the cerebrospinal fluid (CSF). However, an alternative method, the enzyme immunoassay (EIA), has increasingly become a preferred method for detecting MV antibodies. To establish the index for SSPE diagnosis using EIA, we investigated the correlation between HI and EIA titers of MV antibodies in SSPE patients.

Methods

Data on MV antibody titers and measurement methods at the time of diagnosis in 89 Japanese SSPE cases diagnosed between 1979 and 2006 were obtained by a survey. We also assessed the serum and CSF MV antibody titers in three patients with SSPE and serum MV antibody titers in 38 healthy adults using immunoglobulin G (IgG)‐EIA and HI.

Results

In all cases diagnosed as SSPE, IgG‐EIA titers in the CSF were ≥0.49 IU/mL. There was a positive correlation between serum antibody values in the controls measured by IgG‐EIA and HI. In patients with SSPE, both serum and CSF antibody values, measured by IgG‐EIA, and HI, were positively correlated, and a positive correlation was found between the serum and CSF MV antibody titers as measured by IgG‐EIA. The serum/CSF MV antibody titer ratios determined by IgG‐EIA were <20 in most SSPE patients.

Conclusions

Immunoglobulin G‐EIA may be a suitable alternative method for SSPE diagnosis; however, its potential utility and the cut‐off point of ≥0.49 IU/mL should be tested with additional patient cohorts.
The Security Apparatus, Federal Magistrate Courts, and Detention Centers as Simulacra: The Effects of Trump's Zero Tolerance Policy on Migrants and Refugees in the Rio Grande Valley
Authors: Garrett Terence Michael
Published: April 2020

Trump's Department of Homeland Security implemented the Zero Tolerance policy from April 6 to June 24, 2018. Refugees, prevented from crossing the midpoints of bridges by Customs and Border Protection agents, crossed the Rio Grande to ask for asylum, were denied, and forced to cross at places deemed illegal by law. This resulted in misdemeanor violations for unlawful entry and fleeing immigration checkpoints. The policy initiative centered on the separation of children from their migrant parents—refugees fleeing from the northern triangle countries: El Salvador, Honduras, and Guatemala. Adult migrants were sent to prisons and holding facilities, brought before a magistrate to plead guilty, and were deported while their children were placed in government‐funded privately‐owned detention centers. Migrants contend with a security apparatus comprised of border walls, zones of surveillance, agents, and paramilitary troops. This article analyzes the United States (in)security system using Baudrillard's concept of simulacrum supplemented by Foucault's dispositif and Agamben's apparatuses.

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Duman, Yoav H. 2014. “Reducing the Fog? Immigrant Regularization and the State.” Politics & Policy 42 (2): 187‐220. https://doi.org/10.1111/polp.12065

Silverman, Stephanie J. 2012. “‘Regrettable but Necessary?’ A Historical and Theoretical Study of the Rise of the U.K. Immigration Detention Estate and its Opposition.” Politics & Policy 40 (6): 1131‐1157. https://doi.org/10.1111/j.1747-1346.2012.00393.x
The better sleep better well‐being programme: Educating and training community healthcare nurses in developing interventions for families of infants with moderate sleep problems: a pilot study
Authors: Skuladottir Arna , Sigurdardottir Anna Olafia , Svavarsdottir Erla Kolbrun
Published: April 2020

The main aim of this pilot study was to evaluate the benefit of the Better Sleep Better Well‐being (BSBW) educational and training intervention programme regarding infants sleep problems for Community Health Care (CHC) nurses, on their perceptions on their family nursing practice skills and on their job demand, control and support. There were 6 CHC nurses who participated in the BSBW programme, and 26 nurses in the comparison group. The programme consisted of 4 sessions (8 hours per session) of lectures on the aetiology of infants sleep problems as well as on evidence‐based and family relational practices and on 20 sessions of clinical cases, scenarios, discussions and reflections. The main finding indicated that the nurses in the intervention group reported significantly higher family nursing practices skills compared to the nurses in the comparison group. The findings are promising, since they offered additional resources to the CHC nurses, in their clinical practices.
Presidential Communication During the Legislative Process
Authors: Ostrander Ian , Sievert Joel
Published: April 2020

Objective

Presidents routinely employ public statements to inform Congress about their position on pending legislation. Position‐taking is strategic, with presidents choosing whether, how, how often, and when to intervene. We move beyond the traditional dichotomies of issuance and position to explore the timing and frequency of presidential position‐taking during the lawmaking process.

Method

We use Statements of Administration Policy (SAPs)–bill‐specific messages addressed to Congress–to analyze presidential communications. Our regression analyses examine both the frequency of SAPs usage on bills and when in the process presidents communicate their position.

Results

We find that presidents take positions sparingly and most often at the early stages of the lawmaking process.

Conclusion

Presidential communications during the lawmaking process are more about winnowing options and bargaining over bill text than influencing pivotal votes.
Influence of an Additional Indexing Rotary Axis on Wire Electrical Discharge Machining Performance for the Automated Manufacture of Fir Tree Slots
Authors: Bergs Thomas , Tombul Ugur , Herrig Tim , Klink Andreas , Welling David
Published: April 2020

The demand for higher efficiency in aircraft propulsion engines leads to materials with increasing thermomechanical strengths and new designs inducing filigree geometries of blisks and disks. Because of new designs which induce tighter tolerances, the high mechanical process forces in conventional cutting processes like broaching cause inacceptable geometrical deviations and high tooling costs. Due to the electro-thermal material removal mechanism, electrical discharge machining (EDM) ensures a force free and thus precise machining. The manufacture of fir tree slots in nickel-based alloys by wire EDM has been investigated in the last few years and the process was verified as an alternative technology for broaching. To get a better competitive position, the productivity can be prospectively increased by using an additional indexing rotary axis which ensures a precise and automated production of rotationally symmetric components and reduce production times, e.g., for the manufacture of fir tree slots on a disk. Nevertheless, the application of these axes cause changed flushing conditions and can also affect the electrical contacting as well. Both influence the process performance and demand a technology development or adjustment of standard machining technologies. The influence of these changed machining conditions has not been investigated scientifically to date. In this paper, the surface integrity and process performance of fir tree slots machined by wire EDM on the machine table are compared with the manufacture by using an additional indexing rotary axis.
A Novel Assessment of Delayed Neutron Detector Data in CANDU Reactors
Authors: Aylward Will , Wallace Christopher , West Graeme , McEwan Curtis
Published: April 2020

A common opportunity for nuclear power plant operators is ensuring that routinely collected data are fully leveraged. Exploiting data analytics can enable improvements in anomaly detection and condition monitoring by identifying previously unseen data trends and correlations without major financial investment. One such opportunity is in facilitating the detection of fuel defects by augmenting the delayed neutron (DN) monitoring system deployed in the majority of Canada deuterium uranium (CANDU) reactors. In this paper, we demonstrate using archive data that the detection of fuel defects can be accelerated using this system in combination with the use of a deeper historical dataset and the introduction of a smoothing algorithm. The current defect identification process relies on the analysis of data of high variance and is subject to the judgment of a domain expert, resulting in variable defect identification periods. The proposed approaches seek to mitigate this and alleviate the variable identification time. Initial results presented here show that for an initial batch of 30 defects, identification periods can be meaningfully reduced compared to the current process, with defects potentially visible on an average of 11.4 days earlier. By shortening this identification period, fuel containing defects can be scheduled for earlier removal, reducing the risk of statutory shutdown obligations, protecting personnel, and promoting industry best practice. Exploring a historical dataset identifies previously undocumented trends and we discuss the potential to produce correlations with other reactor parameters. The application of this knowledge can lead to opportunities in the use of machine learning algorithms and, ultimately, more accurate predictions.
Growth-induced temperature changes during transition metal nitride epitaxy on transparent SiC substrates
Authors: Scott Katzer Douglas , Hardy Matthew T. , Nepal Neeraj , Downey Brian P. , Jin Eric N. , Meyer David J.
Published: April 2020

Noncontact band edge thermometry based on diffuse reflectance was used to monitor and control the substrate temperature rise during the MBE growth of niobium nitride transition metal nitrides on transparent, wide-bandgap silicon carbide substrates. Temperature transients as large as 135 °C are induced by changing the main substrate shutter state. The growth of niobium nitride films as thin as ∼5 nm leads to temperature increases as large as 240 °C. In addition, a temperature decrease during the growth of ultrawide-bandgap AlN films on niobium nitride was observed and characterized. The causes of the observed temperature excursions are explained by considering the Stefan–Boltzmann law, and ways to better control the substrate temperature are discussed.
Low temperature platinum chemical vapor deposition on functionalized self-assembled monolayers
Authors: Salazar Bryan G. , Liu Hanwen , Walker Amy V. , McElwee-White Lisa
Published: April 2020

The reaction pathways of Pt CVD using (COD)PtMe2 – xClx (x = 0, 1, 2) have been investigated on functionalized self-assembled monolayers (SAMs) as models for organic substrates. Residual gas analysis for (COD)PtMe2 and (COD)PtMeCl is consistent with the loss of methyl radicals as the initial step in deposition, while for (COD)PtCl2, the first step is the loss of a chlorine radical. It is further shown using x-ray photoelectron spectroscopy and time-of-flight secondary ion mass spectrometry that the deposition process leads to chemical damage of the SAM layer and little Pt deposition. Using this understanding, it is demonstrated that the Pt CVD rate can be controlled using a radical trap. In the presence of 1,4-cyclohexadiene, a well-known alkyl radical trap, Pt deposition was increased by 5× to 10×, creating a room-temperature effective Pt CVD process.
Infect volunteers to speed a coronavirus vaccine?
Authors: Cohen Jon
Published: April 2020

Human challenge studies can accelerate vaccine development, but raise dicey ethical issues.
Lead pollution tracks the rise and fall of medieval kings
Authors: Gibbons Ann
Published: April 2020

Ice core preserves precise record of lead dust from English mines.
Where are the women?
Authors: Wadman Meredith
Published: April 2020

Female scientists allege discrimination and neglect of research on women at NIH's child health institute.
Extreme tensile strain states in La
0.7
Ca
0.3
MnO
3
membranes
Authors: Hong Seung Sae , Gu Mingqiang , Verma Manish , Harbola Varun , Wang Bai Yang , Lu Di , Vailionis Arturas , Hikita Yasuyuki , Pentcheva Rossitza , Rondinelli James M. , Hwang Harold Y.
Published: April 2020

Straining an oxide membrane

Perovskite manganites, such as La
0.7
Ca
0.3
MnO
3
, have complex phase diagrams with many competing states. Among the knobs that can be used to control their properties are magnetic field and strain. Hong
et al.
placed membranes of La
0.7
Ca
0.3
MnO
3
on a flexible polymer layer (see the Perspective by Beekman). Stretching the flexible layer resulted in large strains of up to 8% on the membrane. By varying the magnitude and direction of the strain, the researchers were able to explore the phase diagram of the system and influence its magnetic and transport properties.

Science
, this issue p.
71
; see also p.
32
De novo design of protein logic gates
Authors: Chen Zibo , Kibler Ryan D. , Hunt Andrew , Busch Florian , Pearl Jocelynn , Jia Mengxuan , VanAernum Zachary L. , Wicky Basile I. M. , Dods Galen , Liao Hanna , Wilken Matthew S. , Ciarlo Christie , Green Shon , El-Samad Hana , Stamatoyannopoulos John , Wysocki Vicki H. , Jewett Michael C. , Boyken Scott E. , Baker David
Published: April 2020

Designer gates

Signaling in cells can occur through protein-protein interactions. Chen
et al.
describe the design of logic gates that can regulate protein association. The gates were built from small, designed proteins that all have a similar structure but where one module can be designed to interact specifically with another module. Using monomers and covalently connected monomers as inputs and encoding specificity through designed hydrogen-bond networks allowed the construction of two-input or three-input gates based on competitive binding. The modular control elements were used to regulate the association of elements of transcription machinery and split enzymes in vitro and in yeast cells.

Science
, this issue p.
78
Temporal integration of mitogen history in mother cells controls proliferation of daughter cells
Authors: Min Mingwei , Rong Yao , Tian Chengzhe , Spencer Sabrina L.
Published: April 2020

How cells monitor mitogen availability

Classical experiments indicated that cells sense the mitogens or growth factors that control cell division within a limited window during the cell cycle. Min
et al.
reexamined this issue with high-throughput live-cell imaging and temporally controlled perturbations to more closely monitor dynamic signal processing. Human epithelial cells in culture integrated the mitogenic signals sensed throughout the cell cycle. One important factor was the control of translation rates, which influenced the amount of cyclin D, thus regulating proliferation. The results may also help to explain how cells maintain a uniform size.

Science
, this issue p.
1261
A slip law for glaciers on deformable beds
Authors: Zoet Lucas K. , Iverson Neal R.
Published: April 2020

Slipping on till

How do glaciers flow over the ground underlying them? We know that friction, ice stream velocity, and water pressure at the ice bed all matter, but we still do not know how to represent the process over both hard beds (which are solid rock) and soft ones (composed of unconsolidated erosion products called till). Zoet and Iverson present experimental results describing how glacial ice moves over watersaturated till (see the Perspective by Minchew and Joughin). These observations should help to solve the long-standing problem of constructing a generalized slip law that combines the processes of hard-bedded sliding and bed deformation.

Science, this issue p.76; see also p.29
Facial expressions of emotion states and their neuronal correlates in mice
Authors: Dolensek Nate , Gehrlach Daniel A. , Klein Alexandra S. , Gogolla Nadine
Published: April 2020

How to read the face of a mouse

The neuroscientific investigation of emotions is hindered by a lack of rapid and precise readouts of emotion states in model organisms. Dolensek
et al.
identified facial expressions as innate and sensitive reflections of the internal emotion state in mice (see the Perspective by Girard and Bellone). Mouse facial expressions evoked by diverse stimuli could be classified into emotionlike categories, similar to basic emotions in humans. Machine-learning algorithms categorized mouse facial expressions objectively and quantitatively at millisecond time scales. Intensity, value, and persistence of subjective emotion states could thus be decoded in individual animals. Combining facial expression analysis with two-photon calcium imaging allowed the identification of single neurons whose activity closely correlated with specific facial expressions in the insular cortex, a brain region implicated in affective experiences in humans.

Science
, this issue p.
89
; see also p.
33
Maintenance of neural stem cell positional identity by
mixed-lineage leukemia 1
Authors: Delgado Ryan N. , Mansky Benjamin , Ahanger Sajad Hamid , Lu Changqing , Andersen Rebecca E. , Dou Yali , Alvarez-Buylla Arturo , Lim Daniel A.
Published: April 2020

Sustaining stem cell identity

Stem cells in the developing brain acquire identities according to their locations and the types of neurons they will generate. As the brain grows larger and more complex, these identities must be maintained. Delgado
et al.
found this positional identity to be sustained by an epigenetic memory system. A morphogen sets the stem cell's identity early in development, but the identity is sustained by epigenetics.

Science
, this issue p.
48
Tuning drug binding
Authors: Slade Dea , Eustermann Sebastian
Published: April 2020

Understanding anticancer drug binding to its target could improve drug discovery and efficacy
Population Pharmacokinetics and Dosage Optimization of Linezolid in Patients with Liver Dysfunction
Authors: Zhang Su-hua , Zhu Zhen-yu , Chen Zi , Li Ying , Zou Yang , Yan Miao , Xu Yun , Wang Feng , Liu Mou-ze , Zhang Min , Zhang Bi-kui
Published: April 2020

Linezolid is the first synthetic oxazolidone agent to treat infections caused by Gram-positive pathogens. Infected patients with liver dysfunction (LD) are more likely to suffer from adverse reactions, such as thrombocytopenia, when standard-dose linezolid is used than patients with LD who did not use linezolid. Currently, pharmacokinetics data of linezolid in patients with LD are limited. This study aimed to characterize pharmacokinetics parameters of linezolid in patients with LD, identify the factors influencing the pharmacokinetics, and propose an optimal dosage regimen.
Novel Peptide from Commensal Staphylococcus simulans Blocks Methicillin-Resistant Staphylococcus aureus Quorum Sensing and Protects Host Skin from Damage
Authors: Brown Morgan M. , Kwiecinski Jakub M. , Cruz Luis Mejia , Shahbandi Ali , Todd Daniel A. , Cech Nadja B. , Horswill Alexander R.
Published: April 2020

Recent studies highlight the abundance of commensal
co
agulase-
n
egative
s
taphylococci (CoNS) on healthy skin. Evidence suggests that CoNS actively shape the skin immunological and microbial milieu to resist colonization or infection by opportunistic pathogens, including methicillin-resistant
Staphylococcus aureus
(MRSA), in a variety of mechanisms collectively termed colonization resistance. One potential colonization resistance mechanism is the application of quorum sensing, also called the
a
ccessory
g
ene
r
egulator (
agr
) system, which is ubiquitous among staphylococci.
Improving interpretability of individual Diabetes Symptom Checklist-Revised (DSC-R) scores: the role of patient characteristics
Authors: Wieringa Thomas H , de Wit Maartje , Twisk Jos W R , Snoek Frank J
Published: April 2020

Introduction

The Diabetes Symptom Checklist-Revised (DSC-R) is a well-validated patient-reported outcome designed to assess symptom burden in persons with type 2 diabetes mellitus (T2DM) across eight domains. The DSC-R has so far primarily been used in research settings. With the aim to make the DSC-R applicable in clinical practice by improving its interpretability, we sought to identify patient characteristics associated with DSC-R (domain) scores as a first initiative toward reference values.

Research design and methods

We used baseline data from two large observational studies to select patient characteristics significantly associated with DSC-R domain and total scores. Multivariable Tobit analyses with the backward procedure per (domain) score were performed.

Results

Data from 1531 participants with T2DM were included. On a 0–100 scale, the median DSC-R total score was 15.88 (7.06–29.41), with domain scores ranging from 5.00 (0.00–22.50) (pain) to 35.00 (10.00–60.00) (fatigue). Low well-being status was most profoundly associated with higher scores across all domains. Persons with one or more complication, as well as one or more symptomatic hypoglycemic episode during the past 3 months, scored higher on (almost) all domains and the total scale.

Conclusions

Complications, symptomatic hypoglycemia, and low well-being are important characteristics to take into account when using the DSC-R in individual patients. Further validation of our findings is warranted in diverse patient populations.
Intended and unintended effects: community perspectives on a performance-based financing programme in Malawi
Authors: Petross Chisomo , McMahon Shannon , Lohmann Julia , Chase Rachel P , Muula Adamson S. , De Allegri Manuela
Published: April 2020

Background

Several performance-based financing (PBF) evaluations have been undertaken in low-income countries, yet few have examined community perspectives of care amid PBF programme implementation. We assessed community members’ perspectives of Support for Service Delivery Integration - Performance-Based Incentives (‘SSDI-PBI’), a PBF intervention in Malawi, and explored some of the unintended effects that emerged amid implementation.

Methods

We conducted 30 focus group discussions: 17 with community leaders and 13 with mothers within catchment areas of SSDI-PBI implementing facilities. We analysed data using the framework approach.

Results

Community leaders and women had mixed impressions regarding the effect of SSDI-PBI on service delivery in facilities. They highlighted several improvements (including improved dialogue between staff and community, and cleaner, better-equipped facilities with enhanced privacy), but also persisting challenges (including inadequate and overworked staff, overcrowded facilities and long distances to facilities) related to services in SSDI-PBI-implementing facilities. Further, respondents described how four targeted service indicators related to maternal risk factor management, antenatal care (ANC) in the first trimester, skilled birth attendance and couple’s HIV testing sparked unintended negative effects as experienced by women and communities. The unintended effects included women returning home for delivery, women feeling uncertain about their pregnancy status, women feeling betrayed or frustrated by the quality of care provided and partnerless women being denied ANC.

Conclusion

PBF programmes such as SSDI-PBI may improve some aspects of service delivery. However, to achieve system improvement, not only should necessary tools (such as medicines, equipment and human resources) be in place, but also programme priorities must be congruent with cultural expectations. Finally, facilities must be better supported to expect and then address increases in client load and heightened expectations in relation to services.
How primary healthcare workers obtain information during consultations to aid safe prescribing in low-income and lower middle-income countries: a systematic review
Authors: Smith Chris , van Velthoven Michelle Helena , Truong Nguyen Duc , Nam Nguyen Hai , Anh Vũ Phan , AL-Ahdal Tareq Mohammed Ali , Hassan Osama Gamal , Kouz Basel , Huy Nguyen Tien , Brewster Malcolm , Pakenham-Walsh Neil
Published: April 2020

Background

We systematically reviewed the evidence on how primary healthcare workers obtain information during consultations to support decision-making for prescribing in low and lower middle-income countries.

Methods

We searched electronic databases, consulted the Healthcare Information For All network, hand searched reference lists, ran citation searches of included studies and emailed authors of identified papers. Two reviewers extracted data and appraised quality with relevant tools.

Results

Of 60 497 records found, 23 studies met our inclusion criteria. Fourteen studies were observational and nine were interventional. Frequently mentioned sources of information were books, leaflets, guidelines, aids and the internet. These sources were sometimes out of date and health workers reported being confused which to use. Internet access varied and even when it was available, use was limited by technical issues. Of the five electronic tools that were assessed, four had positive outcomes. Tools assisted prescribers with medicine selection and dosage calculations, which increased prescribing accuracy. The quality of reporting varied but was overall low.

Discussion

Studies indicated a lack of up-to-date and relevant medicine information in low and lower middle-income settings. Internet-based sources appeared to be useful when it is possible to download content for offline use and to update when there is internet access. Electronic tools showed promise, but their accuracy needs to be validated and they should focus on giving actionable advice to guide prescribers.

PROSPERO registration number

CRD42018091088.
Considerations for the development of extreme heat policies in sport and exercise
Authors: Chalmers Samuel , Anderson Glenda , Jay Ollie
Published: April 2020

We detail key considerations for the development of extreme heat policies in sport and exercise. Policies should account for the four environmental parameters (ambient temperature, humidity, air velocity, and mean radiant temperature) and two personal (activity and clothing) parameters that determine the prevailing thermoregulatory strain during exercise in the heat. Considerations for how to measure environmental stress and convey the level of risk are discussed. Finally, we highlight the need to include feasible cooling strategies that are relevant for the prevailing environmental conditions.
Awareness of oral and genital human papillomavirus (HPV) infection in young adolescents prior to gender-neutral vaccination
Authors: Knight Gillian , Roberts Ben
Published: April 2020

Introduction

Oral human papillomavirus (HPV) and oropharyngeal cancer prevalence are increasing, particularly in men. Raising greater awareness of male HPV disease is perceived as an important intervention strategy. This study investigated the effectiveness of HPV education on adolescents’ perception of HPV disease and the impact of HPV vaccination on their sexual health.

Methods

An HPV questionnaire was completed by 357 UK-based adolescents, aged 12–13 years.

Results

Most adolescents knew HPV causes cervical cancer and HPV vaccination prevents this. A minority acknowledged HPV causes other genital cancers, with under one-fifth knowing HPV causes genital warts. Adolescents’ awareness of HPV transmission activities were limited. There was very poor awareness of oral HPV infection or HPV-induced oropharyngeal cancer. Half of the participants stated HPV vaccination reduced their concerns about sexually transmitted infection contraction. Over half the males said they may take more sexual risks following vaccination, while a similar proportion of females did not expect their partner to take more risks.

Conclusions

Adolescents had little awareness of male HPV infection and the role HPV vaccination can play in preventing these diseases. With variable rates of HPV vaccination uptake in males reported worldwide, this study indicates that in the UK greater emphasis on male HPV disease within educational information is required, to raise better awareness of how HPV affects both genders. As both genders preferred to receive education via healthcare professionals, educating a wider range of healthcare professionals on oral HPV could help facilitate awareness of HPV’s role in head and neck cancer.
Normalising abortion: what role can health professionals play?
Authors: Maxwell Karen J , Hoggart Lesley , Bloomer Fiona , Rowlands Sam , Purcell Carrie
Published: April 2020

Background

Despite being a common gynaecological procedure, abortion continues to be widely stigmatised. The research and medical communities are increasingly considering ways of reducing stigma, and health professionals have a role to play in normalising abortion as part of routine sexual and reproductive healthcare (SRH). We sought to investigate how health professionals may normalise abortion and challenge prevailing negative sociocultural narratives.

Methods

As part of the Sexuality and Abortion Stigma Study (SASS), qualitative secondary analysis was conducted on two datasets containing health professionals’ accounts of providing abortion in Scotland and England. A subsample of 20 interviews were subjected to in-depth, thematic analysis.

Results

Four key themes were identified in heath professionals’ accounts: (1) encountering resistance to abortion from others working in SRH; (2) contending with prevailing negative sociocultural narratives of abortion; (3) enacting overt positivity towards abortion provision; and (4) presenting abortion as part of normal, routine healthcare.

Conclusions

It is clear that negative attitudes toward abortion persist both inside and outside of healthcare systems, and need to be challenged in order to destigmatise those accessing and providing services. Health professionals can play a key role in normalising abortion, through the ways in which they frame their work and present abortion to women they treat, and others more widely. Our analysis suggests a key way to achieve this is by presenting abortion as part of normal, routine SRH, but that appropriate support and structural change are essential for normalisation to become embedded.
Cell death induced by cytotoxic CD8+T cells is immunogenic and primes caspase-3–dependent spread immunity against endogenous tumor antigens
Authors: Jaime-Sanchez Paula , Uranga-Murillo Iratxe , Aguilo Nacho , Khouili Sofia C , Arias Maykel A , Sancho David , Pardo Julian
Published: April 2020

Background

Elimination of cancer cells by some stimuli like chemotherapy and radiotherapy activates anticancer immunity after the generation of damage‐associated molecular patterns, a process recently named immunogenic cell death (ICD). Despite the recent advances in cancer immunotherapy, very little is known about the immunological consequences of cell death activated by cytotoxic CD8+T (Tc) cells on cancer cells, that is, if Tc cells induce ICD on cancer cells and the molecular mechanisms involved.

Methods

ICD induced by Tc cells on EL4 cells was analyzed in tumor by vaccinating mice with EL4 cells killedin vitroorin vivoby Ag-specific Tc cells. EL4 cells and mutants thereof overexpressing Bcl-XLor a dominant negative mutant of caspase-3 and wild-type mice, as well as mice depleted of Tc cells and mice deficient in perforin, TLR4 and BATF3 were used.Ex vivocytotoxicity of spleen cells from immunized mice was analyzed by flow cytometry. Expression of ICD signals (calreticulin, HMGB1 and interleukin (IL)-1β) was analyzed by flow cytometry and ELISA.

Results

Mice immunized with EL4.gp33 cells killed in vitro or in vivo by gp33-specific Tc cells were protected from parental EL4 tumor development. This result was confirmed in vivo by using ovalbumin (OVA) as another surrogate antigen. Perforin and TLR4 and BATF3-dependent type 1 conventional dendritic cells (cDC1s) were required for protection against tumor development, indicating cross-priming of Tc cells against endogenous EL4 tumor antigens. Tc cells induced ICD signals in EL4 cells. Notably, ICD of EL4 cells was dependent on caspase-3 activity, with reduced antitumor immunity generated by caspase-3–deficient EL4 cells. In contrast, overexpression of Bcl-XLin EL4 cells had no effect on induction of Tc cell antitumor response and protection.

Conclusions

Elimination of tumor cells by Ag-specific Tc cells is immunogenic and protects against tumor development by generating new Tc cells against EL4 endogenous antigens. This finding helps to explain the enhanced efficacy of T cell-dependent immunotherapy and provide a molecular basis to explain the epitope spread phenomenon observed during vaccination and chimeric antigen receptor (CAR)-T cell therapy. In addition, they suggest that caspase-3 activity in the tumor may be used as a biomarker to predict cancer recurrence during T cell-dependent immunotherapies.
Call to action for health systems integration of point-of-care testing to mitigate the transmission and burden of sexually transmitted infections
Authors: Toskin Igor , Govender Veloshnee , Blondeel Karel , Murtagh Maurine , Unemo Magnus , Zemouri Charifa , Peeling Rosanna W , Kiarie James
Published: April 2020

Objectives

In 2016, WHO estimated 376 million new cases of the four main curable STIs: gonorrhoea, chlamydia, trichomoniasis and syphilis. Further, an estimated 290 million women are infected with human papillomavirus. STIs may lead to severe reproductive health sequelae. Low-income and middle-income countries carry the highest global burden of STIs. A large proportion of urogenital and the vast majority of extragenital non-viral STI cases are asymptomatic. Screening key populations and early and accurate diagnosis are important to provide correct treatment and to control the spread of STIs. This article paints a picture of the state of technology of STI point-of-care testing (POCT) and its implications for health system integration.

Methods

The material for the STI POCT landscape was gathered from publicly available information, published and unpublished reports and prospectuses, and interviews with developers and manufacturers.

Results

The development of STI POCT is moving rapidly, and there are much more tests in the pipeline than in 2014, when the first STI POCT landscape analysis was published on the website of WHO. Several of the available tests need to be evaluated independently both in the laboratory and, of particular importance, in different points of care.

Conclusion

This article reiterates the importance of accurate, rapid and affordable POCT to reach universal health coverage. While highlighting the rapid technical advances in this area, we argue that insufficient attention is being paid to health systems capacity and conditions to ensure the swift and rapid integration of current and future STI POCT. Unless the complexity of health systems, including context, institutions, adoption systems and problem perception, are recognised and mapped, simplistic approaches to policy design and programme implementation will result in poor realisation of intended outcomes and impact.
Chemical- and light-induced isomerization of the P=C bond of a 1-phosphabutadiene
Authors: Walsgrove Henry T.G. , Dabringhaus Philipp , Patrick Brian O. , Gates Derek P.
Published: April 2020

Treatment of Mes*P=C(Si(CH3)3)Br with CH2=CHMgBr in the presence of Pd(0) affords 1-phosphabutadiene Mes*P=C(Si(CH3)3)–CH=CH2 (1) selectively as the Z isomer. Remarkably, treatment of Z-1 with n-BuLi (0.1 equiv.) resulted in quantitative formation of E-1. The exact role of the n-BuLi is unknown; however, it appears to be required to promote the isomerization in the absence of light. The isomerization of Z-1 to E-1 was also mediated by sunlight with the reaction mixture consisting of a ca. 1:9 ratio of Z-1 to E-1. DFT calculations were consistent with the thermodynamic favorability of the isomerization of Z-1 to E-1.
Subliminal aspects concerning the Lounesto’s classification
Authors: Rogerio R. J. Bueno
Published: April 2020

In the present communication we employ a split programme applied to spinors belonging to the regular and singular sectors of the Lounesto’s classification (Clifford algebras and spinors, Cambridge University Press, Cambridge), looking towards unveil how it can be built (or defined) upon two spinors arrangement. We separate the spinors into two distinct parts and investigate to which class within the Lounesto’s classification each part belong. The machinery here developed open up the possibility to better understand how spinors behave under such classification. As we shall see, the resulting spinor from the arrangement of other spinors (belonging to a distinct class or not) does not necessarily inherit the characteristics of the spinors that compose them, as example, such characteristics stands for the class, dynamic or the encoded physical information.
A Facile Segregation Process and Restoration of LiMn2O4Cathode Material From Spent Lithium-Ion Batteries
Authors: Palaniyandy Nithyadharseni , Rambau Khavharendwe , Musyoka Nicholas , Ren Jianwei
Published: April 2020

Due to its three-dimensional tunnel structure, the spinel LiMn2O4(LMO) cathode material is highly favourable for the migration of lithium ions. Thus, LMO has been used as a commercial cathode material for the electronic devices such as mobile phones and electric vehicles, owing to its special characteristics of low-cost, eco-friendly and non-toxic. However, the scarcity of lithium resources makes the system expensive. On the other hand, the tremendous and increasing usage of lithium ion batteries (LIBs) has undoubtedly generated a significant amount of spent LIBs, resulting in resource waste and environmental pollution. Therefore, in this work, we report on the recycling process of LMO from the spent LIBs and mainly devote to re-examine the electrochemical performances of the regenerated LMO cathode material, for the first time. It is noticed that, the renovated spinel LMO exhibits a better cycling stability up to 500 cycles, with the discharge capacity of 56 mAh g−1and retained almost 100% of its initial capacity cycled at 1.0 C.
The unfortunately long life of some retracted biomedical research publications
Authors: Hagberg James M.
Published: April 2020

The scientific misconduct and fraud case of a noted exercise physiology researcher was concluded ~15 yr ago, and one the of the results was the retraction of 10 published manuscripts. However, based on a number of comparisons to that same author's and another investigator's citation histories for similar articles, the citation histories for these retracted articles appear to not have been affected whatsoever in the subsequent 15 yr.
Central AT1 receptor signaling by circulating angiotensin II is permissive to acute intermittent hypoxia-induced sympathetic neuroplasticity
Authors: Shimoura Caroline G. , Andrade Mary Ann , Toney Glenn M.
Published: April 2020

Acute intermittent hypoxia (AIH) triggers sympathetic long-term facilitation (sLTF) that relies on peripheral renin-angiotensin system (RAS) activation. Here, increasing AIH cycles from 5 to 10 proportionally increased RAS activity, but not the magnitude of post-AIH sLTF. Brain angiotensin II (ANG II) receptor blockade and nephrectomy each largely prevented sLTF, whereas central ANG II rescued it following nephrectomy. Peripheral RAS activation by AIH induces time-dependent neuroplasticity at an apparent central ANG II signaling threshold, triggering a stereotyped sLTF response.
Aging reduces cerebral blood flow regulation following an acute hypertensive stimulus
Authors: Rosenberg Alexander J. , Schroeder Elizabeth C. , Grigoriadis Georgios , Wee Sang Ouk , Bunsawat Kanokwan , Heffernan Kevin S. , Fernhall Bo , Baynard Tracy
Published: April 2020

Reductions in cerebral blood flow and increases in flow pulsatility with aging are associated to cerebrovascular disease; however, little is known about how an acute hypertensive stimulus effects cerebral blood flow regulation in an aged population. Following the hypertensive stimulus, older adults elicit an attenuated increase in cerebral blood velocity and greater transmission of pulsatile velocity to the brain compared with young adults, demonstrating reduced cerebral blood flow regulation to elevated blood pressure responses with aging.