bluuebunny/crossref_metadata_2025 huggingface dataset:
HIPs and HIP-reactive T cells
Authors: Wiles T A , Delong T
Published: May 2019

Mounting evidence implicates hybrid insulin peptides (HIPs) as important autoantigens in the development of type 1 diabetes (T1D). These fusion peptides formed between insulin and other pancreatic beta cell-derived peptides contain non-genomically encoded amino acid sequences, making them plausible targets for autoreactive T cells in T1D. HIPs are detectable by mass spectrometry in human and murine islets and are targeted by diabetes-inducing T cells in non-obese diabetic mice as well as by T cells isolated from the residual pancreatic islets of human organ donors with T1D. The discovery of HIPs comes with numerous new challenges, as well as opportunities to study the pathogenesis of T1D. Here we review the original discovery of HIPs and describe recent studies investigating the role of HIP-reactive T cells in the development of diabetes. We also discuss potential mechanisms that may be responsible for the generation of HIPs in beta cells and describe challenges that need to be addressed in the field of mass spectrometry to enable the discovery of new HIPs. The identification of these potentially disease-driving antigens in T1D is of key interest to the field as it may provide new tools to predict, prevent and potentially reverse the disease.
Treatment of edentulous mandible with metal‐resin fixed complete dentures: A 15‐ to 20‐year retrospective study
Authors: McGlumphy Edwin A. , Hashemzadeh Shervin , Yilmaz Burak , Purcell Bradley A. , Leach Daniel , Larsen Peter E.
Published: May 2019

Objectives

The purpose of this retrospective study was to report the implant and prosthetic complications of mandibular metal‐resin fixed complete dentures (MRFCDs) opposing a maxillary complete removable dental prosthesis (CRDP) in a 15‐ to 20‐year post‐placement follow‐up period.

Material and methods

Dental records of 24 edentulous patients treated by a mandibular MRFCD and a maxillary CRDP were reviewed. Complications for the implants, MRFCDs, and CRDPs were recorded in four different recall periods: 0–5 years, 5–10 years, 10–15 years, and more than 15 years. The survival and failure times based on Kaplan–Meier statistics were analyzed using Lifetest procedures. Product‐limit survival estimates were used for cumulative survival rates (CSRs).

Results

The mean service time was 18.5 years. The CSR for the implants and MRFCDs was 91.8% at 16.9 years (confidence intervals: 85.2% and 95.5%) and 80% at 19.6 years (confidence intervals: 44.1% and 94.1%), respectively. The implant failures after 15 years occurred because of a tumor resection. Acrylic resin tooth fracture (45.8% of patients) and wear (75% of patients) were the most common complications with the MRFCD. Retaining screw complications [loosening (8.1% of retaining screws) and fracture (11.3% of retaining screws)] were also common.

Conclusions

The outcomes seen with MRFCD over the long term were favorable. After placement of prostheses, 1 implant loss was observed potentially due to prosthetic/hygiene/periodontal factors. However, potential maintenance complications such as acrylic resin tooth fracture and/or wear and retaining screw loosening and fracture may occur in the long term when a similar design is used for the mandible.
Impaired cardiac autonomic response in lung transplant patients: A retrospective cohort study
Authors: Martelli Vanessa , Mathur Sunita , Wickerson Lisa , Gottesman Chaya , Helm Denise , Singer Lianne G. , Rozenberg Dmitry
Published: May 2019

Background

Cardiac autonomic dysfunction (AD) is associated with adverse prognosis in lung disease; however, its implications in lung transplantation have not been previously described. This study evaluated the prevalence of AD in lung transplant (LTx) candidates, its determinants, prognostic implications, and prevalence post‐transplant.

Methods

Retrospective one‐year study of 103 LTx candidates with AD assessed using heart rate (HR) from the six‐minute walk test (6MWT). Impaired chronotropic response index (CRI) was defined as <80% age‐adjusted HR during 6MWT. Abnormal HR recovery (HRR) was categorized as reduction in HR ≤ 12 beats/minute after the first minute of 6MWT cessation.

Results

Abnormal CRI and HRR were observed in 94% and 76% of patients, respectively. A lower CRI was associated with obstructive lung disease and lower estimated aerobic capacity. CRI was independently associated with 6MW distance [12 m per 10% CRI, P = 0.03], but not with post‐transplant cardiovascular events, hospital stay, or one‐year mortality. At 3 months post‐transplant, no improvement was observed in CRI (99%, n = 66/67, P = 0.25) or HRR (88%, n = 36/41, P = 0.12).

Conclusion

Cardiac AD was prevalent in LTx candidates and recipients, with chronotropic incompetence a modest contributor to exercise intolerance pretransplant. Further study may help determine whether direct autonomic measures such as HR variability may be more prognostic of LTx outcomes.
Barriers to and facilitators of physical activity for children with cerebral palsy in special education
Authors: Cleary Stacey L , Taylor Nicholas F , Dodd Karen J , Shields Nora
Published: May 2019

Aim

To explore the barriers to and facilitators of physical activity for young people with cerebral palsy in specialist schools.

Method

Eleven focus groups involving 73 participants (10 young people with cerebral palsy, 13 parents of children with cerebral palsy, 27 teachers, 23 therapists) were held at two specialist schools. Focus groups were audio‐recorded and transcribed verbatim. Transcripts were analysed using inductive thematic analysis by two researchers, independently.

Results

Four main themes emerged from the focus groups: school priorities; student factors; staffing and environment; and roles and relationships. Physical activity was promoted when academic work and physical activity were seen as equally important school priorities. Student factors that reduced physical activity included fluctuating health, school absences, and protracted rehabilitation after surgery. The staffing and environment unique to specialist schools played a pivotal role in assisting students to be active, as was the importance of collaborative, relationship‐based care.

Interpretation

Physical activity programmes developed in specialist schools need to take into consideration complexities associated with the age, developmental stage, and academic requirements of young people with cerebral palsy. Particularly for adolescents, motivation was discussed as having a substantial influence on physical activity participation. These findings may assist school leadership teams, clinicians, and teachers in planning physical activity interventions.

What this paper adds

Specialist schools offer custom‐built environments that promote physical activity and inclusion for students with physical impairments.

Therapists and teaching staff work creatively and collaboratively to incorporate an ‘all‐day’ approach to providing physical activity opportunities.

Balancing time spent on physical activity versus academic work can cause tension.
Why we scratch: Function and dysfunction
Authors: Sanders Kristen M. , Fast Katharine , Yosipovitch Gil
Published: May 2019

Itch is a common sensation that drives an intense urge to scratch. Itch and scratching have persisted in humans and many other species, suggesting that they play an important role in survival. This commentary discusses the function of itch as a danger signal, why itch feels unpleasant and why we feel relief and pleasure when we scratch an itch. In addition, we explore the ways that this system becomes dysfunctional in conditions of chronic itch and important implications for treatment.
Pigments in surface sediments of South American shallow lakes as an integrative proxy for primary producers and their drivers
Authors: Buchaca Teresa , Kosten Sarian , Lacerot Gissell , Mazzeo Nestor , Kruk Carla , Huszar Vera L. M. , Lotter Andre F. , Jeppesen Erik
Published: May 2019

Pigments in lake surface sediments integrate both benthic and pelagic primary producer composition at the whole‐lake ecosystem level.

We gathered a comprehensive set of water chemistry, morphometric, physical and biological lake variables, catchment and climate characteristics, and geographical descriptors. We used multiple regressions to relate whole‐lake algal pigment concentration to environmental conditions and multivariate statistical analyses to assess the factors most associated with photoautotrophic algal and bacterial community composition. The relative influence of environmental factors and spatial distribution was assessed by variance partitioning analysis among three groups of variables: (1) in‐lake factors, (2) external factors, and (3) geographic descriptors.

Pigment concentration and community composition were most sensitive to in‐lake factors. Pigment‐inferred abundance of algae, including cyanobacteria, tended to be highest in shallower systems with high nutrient concentrations, independent of the latitudinal temperature or irradiance gradients. Pigment‐inferred community composition was best explained by nutrients and biotic composition (zooplankton and fish communities). Only in maritime temperate lakes did a link with regional location occur due to their low dissolved inorganic nitrogen to soluble reactive phosphorus ratios (1.5 atomic ratio), suggesting nitrogen limitation of phytoplankton growth; accordingly, the sediment pigments revealed cyanobacteria to be the dominant group, although this may also be a consequence of the overall high nutrient levels in these lakes.

Despite the large climate gradient covered, in‐lake rather than external factors were associated with the patterns observed in pigment concentration (from benthic and pelagic microorganisms) and inferred composition and abundance in these shallow lakes. Our results suggest that pigment assemblages in sediments, which integrate both benthic and pelagic microbial photoautotrophic community and processes, are valuable indicators of changes in shallow (0.75–12 m depth) lake ecosystems.
Can additive beta diversity be reliably partitioned into nestedness and turnover components?
Authors: Matthews Thomas J. , Aspin Thomas W. H. , Ulrich Werner , Baselga Andrés , Kubota Yasuhiro , Proios Konstantinos , Triantis Kostas A. , Whittaker Robert J. , Strona Giovanni
Published: May 2019

Aims

Quantifying β‐diversity (differences in the composition of communities) is central to many ecological studies. There are many β‐diversity metrics, falling mostly into two approaches: variance‐based (e.g., the Sørensen index), or diversity partitioning (e.g., additive β‐diversity). The former cannot be used when species–sites matrices are unavailable (which is often the case in island biogeography in particular) and only species richness data are provided. Recently, efforts have been made to partition additive β‐diversity, a metric calculated using only α‐diversity and γ‐diversity, into nestedness and turnover components (termed here “richness‐only β‐diversity partitioning”). We set out to test whether this form of β‐diversity partitioning generates interpretable results, comparable with metrics based on species incidence β‐diversity partitioning.

Location

Global.

Time period

Present day.

Major taxa studied

Multiple taxa.

Methods

We first provide a brief review of β‐diversity partitioning methods, with a particular focus on the development of richness‐only β‐diversity partitioning. Second, we use 254 empirical incidence matrices (provided with the paper) sourced from the literature to measure turnover and nestedness using incidence β‐diversity partitioning, comparing the resulting values with those calculated using richness‐only β‐diversity.

Results

We provide an account of the emergence of β‐diversity partitioning, with particular reference to the analysis of richness‐only datasets, and to the definition and usage of the relevant metrics. Analytically, we report weak correlations between turnover and nestedness calculated using the two different approaches. We show that this is because identical values of α‐diversity and γ‐diversity can correspond to incidence matrices with a range of different structures.

Main conclusions

Our results demonstrate that the use of richness‐only β‐diversity partitioning to measure turnover and nestedness is problematic and can produce patterns unrelated to conventional measures of turnover and nestedness. We therefore recommend that more accurate definitions are adopted for these terms in future studies.
Sustainable goat grazing for managing abandoned fields: Dynamics of vegetation quality, quantity and nutritional status of goats over five years
Authors: Doi Kazuya , Tamiya Sae , Nakajima Noriaki , Yayota Masato
Published: May 2019

Grazing goats have potential for use in managing abandoned fields. However, it is unclear how long‐term grazing affects goats as a result of vegetational changes in abandoned fields. This study aimed to assess the dynamics of vegetation quality and quantity and the nutritional status of goats for five years in an abandoned field at different stocking rates: high stocking rate (HS: 30–33 goats/ha) and low stocking rate (LS: 14 goats/ha). In five years, the dominant plant species changed from bamboo (Phyllostachys edulis) to tufted grass species at the HS, whereas dwarf bamboo (Pleioblastus argenteostriatus) dominated throughout the five years at the LS. The annual plant biomass at both stocking rates was similar and varied from year to year. Crude protein content in the goats' diet did not show any seasonal or annual trend regardless of the stocking rate. Neutral detergent fiber content in the HS diet did not show any seasonal or annual trend; however, that in the LS diet linearly increased with the grazing year. The dry matter (DM) intake for goats at the LS decreased linearly with the grazing year (p < 0.05), whereas that for goats at the HS did not show any trend. The DM digestibility was higher for goats at the HS than for goats at the LS (p < 0.05). Serum parameters did not show a negative nutritional status of the goats over the study years. Annual daily gain was positive throughout the grazing years regardless of the stocking rate. Consequently, within the stocking rate range studied here, long‐term goat grazing changes the quality of vegetation in an abandoned field; however, goats can maintain their nutritional status and body weight for five years. Thus, goat grazing is a feasible way to control abandoned vegetation over the long term.
Arsenic Release and Attenuation Processes in a Groundwater Aquifer During Anaerobic Remediation of TCE with Biostimulation
Authors: Smith Suzy , Dupont R. Ryan , McLean Joan E.
Published: May 2019

Arsenic in groundwater in excess of the drinking water limit is usually from natural sources. The release of As, however, can be amplified by anthropogenic inputs of carbon, including those associated with the remediation of chlorinated solvents such as trichloroethylene (TCE). Large laboratory columns (15.2 cm diameter, 183 cm long) packed with aquifer solids from a TCE contaminated site near Hill Air Force Base (Utah) were fed with groundwater containing TCE and were biostimulated, bioaugmented, and monitored for TCE dechlorination over 7.5 years. This is a basin‐fill aquifer with As bearing geologic features. The objective of this study was to evaluate the biogeochemical changes that affect As solubilization that occurred after 7.5 years of feeding the columns with either whey or two formulations of Newman Zone® emulsified oil, and a no carbon addition control. The columns were analyzed in 10.16 cm sections for pore water and sediment quality parameters, parameters descriptive of redox conditions, and As geochemistry. The whey treatment resulted in 52.9% (±1.36%) (average ± standard deviation) of the total As in the solids leaching from the columns. The oil treatments promoted loss of 20.9% (±6.40%) of the total As. Arsenic solubility was associated with strongly reducing conditions developed with whey addition, leading to dissolution of crystalline Fe oxides and release of As. Arsenic was attenuated within the oil treated columns with As associated with carbonates in the lower layers. A consequence of adding whey, resulting in the desired full dechlorination of TCE in this aquifer, is the mobilization of As in groundwater.
Physical activity and its related factors in Japanese people with haemophilia
Authors: Goto Miwa , Haga Nobuhiko , Takedani Hideyuki
Published: May 2019

Introduction

In the general population, benefits of physical activity (PA) include improvement of physical function, prevention of lifestyle diseases and improvement of bone mineral content and quality of life. PA is recommended for patients with haemophilia (PwH), especially for those receiving advanced haemostatic treatment. We hypothesised many PwH engage in insufficient PA.

Aim

This study aimed to clarify PA levels and the associated factors in Japanese PwH.

Methods

Physical activity was assessed using the International Physical Activity Questionnaire short version, and basic data, activities of daily living (ADLs) and self‐efficacy were also collected.

Results

A total of 106 questionnaires were completed. The average age of participant was 40.8 years. The median PA was 693.0 metabolic equivalent‐min/wk. More than half of the participants (59.4%) were classified into the low activity group. PA showed a significant inverse correlation with age (P = 0.022) and a positive correlation with self‐efficacy (P = 0.018). However, PA did not show a significant relationship with haemophilic severity, prophylactic treatment, annual intra‐articular bleeding frequency, body mass index and ADL. In PwH receiving guidance in sports, such as activities that are safe to participate in or performing prophylaxis prior to a physical activity, self‐efficacy was significantly higher (P = 0.033), ADL was better (P < 0.001), and mean age was younger (P = 0.01) than in those not receiving guidance in sports.

Conclusion

As for PA level, 60% of the subjects showed low activity. To promote PA in PwH, improvement of self‐efficacy and appropriate guidance may be necessary.
The role of patients and carers in diffusing a health‐care innovation: A case study of “My Medication Passport”
Authors: Barber Susan , French Catherine , Matthews Rachel , Lovett Derryn , Rollinson Tom , Husson Fran , Turley Margaret , Reed Julie
Published: May 2019

Background

Patients are increasingly recognized as playing important roles in improving health services. Little is known about the mechanisms by which patients develop and diffuse local innovations in a complex health‐care system.

Objective

To ascertain how diffusion of an innovation, My Medication Passport, occurred and roles played by patients in it.

Design

Case study: quantitative mapping of innovation's diffusion and analysis of the routes and occupations of those through whom the innovation spread; documentary analysis; reflective assessment of patient's roles.

Setting and participants

NHS Trusts, third sector organizations, patients and health‐care professionals.

Interventions studied

Co‐produced action to raise awareness and influence use of the innovation; order database which enabled ease of access to the innovation.

Main outcome measures

Geographical spread of innovation; occupations of individuals; types of organizations using the innovation.

Results

The innovation spread from initial development and use in Northwest London across the UK and beyond. Key roles played by patients were as follows: co‐producer; advocate; relationship builder; relationship broker; planner; presenter; awareness raiser; trainer; networker. Patients identified and introduced potential audiences and users to MMP, using social, organizational, sectoral, lay and professional networks to do so. They organized a range of awareness‐raising and communication activities, monitored feedback, evaluated the impact and responded to new interest.

Discussion and conclusions

The roles of patients in diffusing innovations are under‐recognized. Collaborative working between patients, carers and health‐care professionals in planning and progressing the use and supporting diffusion of the innovation was important. Principles described in this study are relevant to progressing other patient‐led ideas for innovative changes relating to health service development.
The evaluation of evidence‐informed changes to an internationally educated nurse registration process
Authors: Kwan J.A. , Wang M. , Cummings G.G. , Lemermeyer G. , Nordstrom P. , Blumer L. , Horne N. , Giblin C.
Published: May 2019

Aim

To evaluate effectiveness of specific policy and practice changes to the process of registration for internationally educated nurses.

Background

Little research exists to inform registration policy for internationally educated health professionals.

Introduction

Internationally educated nurse employment can help address nursing shortages. Regulators assess competencies for equivalency to Canadian‐educated nurses, but differences in health systems, education and practice create challenges.

Methods

The study setting was a Canadian province. We used a mixed methods approach, with a pre–post‐quasi‐experimental design and a qualitative evaluation. Previous analysis of relationships between applicant variables, registration outcomes and timelines informed changes to our registration process. Implementation of these changes composes the intervention. Comparisons between pre‐ and post‐implementation exemplar subgroups and timeline analyses were conducted using descriptive statistics, univariate analysis and non‐parametric tests. Data were collected from complete application files before (n = 426) and after (n = 287) implementation of the intervention. Interviews, focus groups and consultations were completed with various stakeholders.

Findings

The time between steps in the process was significantly reduced following implementation. Stakeholders reported an increase in perceived efficiency, transparency and use of evidence.

Discussion

Results indicated that initial impacts of the policy changes streamlined the process for applicants and staff.

Conclusion

Maintaining a consistent and systematic review of an organization's data coupled with implementation of findings to effect policy and practice change may have an important impact on regulatory policy.

Implications for Nursing Policy

These findings represent the beginning of an international policy conversation. Policy changes based on organizational data can underlie major process improvement initiatives. Ongoing nursing shortages across the globe and increasing mobility of nurses make it important to have efficient and transparent regulatory policy informed by evidence.
Decision‐making in civil litigation: Effects of attorney credibility, evidence strength, and juror cognitive processing
Authors: Wood Steve M. , DeVault Alicia , Miller Monica K. , Kemmelmeier Markus , Summers Alicia D.
Published: May 2019

The current study examined the relationship between juror cognitive processing (measured by need for cognition [NFC]), attorney credibility, evidence strength, and civil litigation verdicts (liability, likelihood of causation, and compensatory damages). Participants (N = 446) viewed a videotaped mock civil trial in which the credibility of the attorneys and the strength of the plaintiff's evidence were manipulated. Plaintiff attorney credibility, defense attorney credibility, and strength of evidence interacted with one another for liability verdicts. In the strong evidence condition, the likelihood of a liable verdict was higher for a credible plaintiff attorney than a non‐credible plaintiff attorney when facing a non‐credible defense attorney. In the ambiguous evidence condition, the likelihood of a liable verdict was higher for a credible plaintiff attorney than a non‐credible plaintiff attorney when facing a credible defense attorney. Plaintiff attorney credibility, however, was found to be more influential on jurors’ decision‐making than case evidence for likelihood of causation and compensatory damage award decisions. Participants’ NFC also interacted with plaintiff attorney credibility. High NFC jurors were more influenced by a credible plaintiff attorney than low NFC jurors. Although these findings are counter to common findings in the NFC literature, they conform to a body of literature that supports the notion that jurors view attorney credibility as a piece of case evidence and not a peripheral cue as is often assumed. Thus, the findings indicate that attorneys do matter to the outcomes of cases. Policy and practice implications for attorneys and the courts are discussed.
Updated hypertension prevalence, awareness, and control rates based on the 2017ACC/AHA high blood pressure guideline
Authors: Zhou Yaqing , Jia Limei , Lu Baojin , Gu Guoqiang , Hu Haijuan , Zhang Ziyuan , Bai Long , Cui Wei
Published: May 2019

In 2017, the American College of Cardiology/American Heart Association (ACC/AHA) updated the Guideline of Prevention, Detection, Evaluation and Management and Management of High Blood Pressure (HBP) in Adults. The purpose of the current study was to evaluate the potential impact of the 2017ACC/AHA HBP guideline on hypertension prevalence, awareness, and control rates. The data were collected from Physical Examination Center of the Second Hospital of Hebei Medical University from January 2012 to December 2017 (N = 66 977), including demographic information and risk factors of hypertension. The hypertension prevalence, awareness, and control rates of people were evaluated according to the new guideline. Additionally, the factors related to hypertension prevalence were also assessed. According to previous HBP guideline, hypertension prevalence, awareness, and control rate were 30.54%, 44.33%, and 13.04%, respectively. However, when the 2017 ACC/AHA HBP guideline was introduced, the population with hypertension increased from 20 453 to 34 460, the hypertension prevalence rate increased from 30.54% to 51.45%, the awareness rate decreased from 44.33% to 26.31%, and the control rate declined from 13.04% to 2.72%. The most newly diagnosed hypertension patients were from the low‐risk population with young age and without the above histories. The 2017ACC/AHA HBP guideline indicated that high hypertension prevalence rate still existed with a substantial increase, while the awareness and control rates were relatively lowered.
Clinical visible signs of disease activity in vitiligo: a systematic review and meta‐analysis
Authors: van Geel N. , Grine L. , De Wispelaere P. , Mertens D. , Prinsen C.A.C. , Speeckaert R.
Published: May 2019

Vitiligo is an unpredictable depigmenting disorder for which a static method to assess disease activity is lacking. Presence of certain skin manifestations may be indicative of disease activity. Here, we evaluated the current evidence for an association between clinical signs and reported disease activity in vitiligo. A systematic review and meta‐analysis was performed based on a search in PubMed, Embase and Cochrane Library. Literature reporting skin manifestations and disease activity was analysed based on descriptive analyses and, if applicable, odd ratios. Forty‐six observational studies were selected and analysed, including 28 case reports. Reported clinical signs in relation to active vitiligo were as follows: Koebner's phenomenon, confetti‐like depigmentations, tri‐ and hypochromic lesions (including poorly defined borders), inflammatory borders/areas, itch and leukotrichia. Based on this search, strong evidence was found for Koebner's phenomenon. Poorly defined borders and confetti lesions are potential markers, although more data are needed to confirm this. Evidence for other skin manifestations was inconclusive, whereas case reports on inflammatory borders were indicative of active disease. Limitations included the lack of randomized controlled trials, large‐scale prospective studies and heterogeneity due to inconsistent definitions. This systematic review urges the vitiligo community to come forward with consensus‐based definitions as well as a reliable scoring system to assess these clinical signs and to design optimal trials to investigate their true predictive value.
Perceptions and psychosocial impact of food, nutrition, eating and drinking in people with inflammatory bowel disease: a qualitative investigation of food‐related quality of life
Authors: Czuber‐Dochan W. , Morgan M. , Hughes L. D. , Lomer M. C. E. , Lindsay J. O. , Whelan K.
Published: May 2019

Introduction

Extensive research has provided an important understanding of the impact of inflammatory bowel disease (IBD) on nutrient intake, requirements and metabolism. By contrast, there has been limited research examining the psychosocial aspects of food, eating and drinking in IBD. The present study aimed to address this unmet need.

Methods

Qualitative semi‐structured interviews regarding the perceptions and psychosocial impact of food, eating and drinking were undertaken with 28 purposively selected people with IBD. Interviews were audio‐recorded and transcribed verbatim. Colaizzi's framework was used to structure the data analysis.

Results

Five major themes were identified. IBD symptoms and both surgical and medical treatments were described as having a direct impact on eating and drinking, with participants also using different food‐related strategies to control IBD symptoms. These included a process of experimentation to identify trigger foods, following a severely restricted and limited diet, eating small portions, and eating more frequently. However, their limited knowledge about if, and how, food affected their symptoms, often resulted in negative coping strategies that impacted on psychosocial functioning, including a lack of enjoyment of eating, being afraid to eat and finding social occasions stressful. Managing food and drinking also made food shopping and preparation more burdensome, creating problems with families, at work and for social life, as well as the need for careful preparation and advanced planning of activities.

Conclusions

Inflammatory bowel disease has a profound impact on psychosocial aspects of food and nutrition, which impacts on ‘food‐related quality of life’ (FRQoL). Further research is required to identify interventions that will improve FRQoL in patients with IBD.
Labor Market and Financial Shocks: A Time‐Varying Analysis
Authors: CORSELLO FRANCESCO , NISPI LANDI VALERIO
Published: May 2019

We estimate a time‐varying VAR model to analyze the effects of a financial shock on the U.S. labor market. We find that a tightening of financial conditions is highly detrimental to the labor market. We show that while negative financial shocks have been responsible for increases in unemployment, our model does not find significant contributions of financial shocks during periods of expansion. The source of this asymmetry is the time‐varying standard deviation of the identified shock, which is higher in times of financial distress; on the other hand, we find that the transmission mechanism does not significantly change over time.
A cohort study of the impact of epidural analgesia on maternal and neonatal outcomes
Authors: Yin Huifen , Hu Rong
Published: May 2019

Aim

To explore the impact of epidural analgesia on maternal and neonatal outcomes, especially the relation between epidural analgesia and intrapartum fever.

Methods

A retrospective cohort study was conducted in a tertiary hospital for all deliveries from November 2017 to December 2017. A total of 506 women were divided into epidural and non‐epidural group by whether to receive analgesia or not. Univariate and multivariate analyses were performed with P < 0.05 as significant.

Results

Epidural analgesia was associated with higher risk of maternal intrapartum fever (relative risk [RR] = 3.28, 95% confidence interval, 1.55–6.95), more intravenous use of antibiotics (36.66% vs 17.04%, P<0.001), longer time of second stage (58.55 ± 33.75 vs 47.39 ± 28.36 min，P = 0.001) and longer total duration of labor (790.32 ± 433.71 vs 461.33 ± 270.39 min，P<0.001), but had no influence on mode of delivery, the amount of post‐partum hemorrhage or hospital stay after delivery and all the neonatal outcomes we studied. Further time effect analysis found that epidural analgesia less than 6 h did not increase the risk of intrapartum fever (RR = 1.73, P = 0.15), however, when epidural analgesia lasted over 6 h, it significantly increased the risk of fever (RR = 5.23, P<0.001) but did not increase more adverse outcomes.

Conclusion

Having epidural anesthesia 6 h or more increases the risk of developing fever, but the prognosis of mothers and children is less affected.
An Evaluation of an Unstructured and Structured Approach to Increasing Recess Physical Activity
Authors: Behrens Timothy K. , Holeva‐Eklund Whitney M. , Luna Carmen , Carpenter Dick , Tucker Elizabeth , Field Julaine , Kelly Cheryl
Published: May 2019

BACKGROUND

The purpose of this study was to evaluate an unstructured and a structured program designed to increase physical activity (PA). The unstructured program increased the amount of equipment during recess, whereas the structured program introduced activities to students.

METHODS

PA was observed using the System for Observing Play and Leisure Activity in Youth (SOPLAY) in two school districts in Colorado. Researchers recorded baseline and follow‐up observations for sedentary activity, moderate PA, and vigorous PA, as well as for available equipment for the unstructured program. Observations from schools were aggregated for data analyses at the district level.

RESULTS

For the program increasing equipment, moderate PA and vigorous PA increased, while sedentary behavior decreased. For the structured program, moderate PA and vigorous PA did not increase, whereas sedentary behaviors increased following the program.

CONCLUSIONS

Other variables are likely influencing student PA during recess, such as teachers' interaction with students or the fidelity of the program. Results indicate that funding and implementing a program aimed at increasing PA will not necessarily accomplish that goal, and additional research should be performed to determine the best practice for increasing PA.
Transcriptome analysis of gingival tissues of enamel‐renal syndrome
Authors: Wang Yi‐Ping , Lin Hung‐Ying , Zhong Wen‐Lan , Simmer James P. , Wang Shih‐Kai
Published: May 2019

Background and objective

Biallelic loss‐of‐function mutations of human FAM20A have been known to cause enamel‐renal syndrome (ERS), featured by agenesis of dental enamel, nephrocalcinosis, and other orodental abnormalities, including gingival hyperplasia. However, while the histopathology of this gingival anomaly has been analyzed, its underlying molecular mechanism remains largely unknown. This study aimed to unravel the pathogenesis of gingival hyperplasia in ERS.

Methods

Whole‐exome sequencing was conducted for an ERS case. Transcriptome analyses, using RNA sequencing, of the patient's gingiva were performed to unravel dysregulated molecules and aberrant biological processes underlying the gingival pathology of ERS, which was further confirmed by histology and immunohistochemistry.

Results

Two novel frameshift FAM20A mutations in Exon 1 (g.5417delG; c.129delG; p.Cys44Alafs*101) and Exon 5 (g.62248_62249delAG; c.734_735delAG; p.Glu245Glyfs*11) were identified. Transcriptional profiling of patient's gingival tissue revealed a total of 1683 genes whose expression had increased (1129 genes) or decreased (554 genes) at least 2‐fold compared to control gingival tissues. There were 951 gene ontology (GO) terms of biological process being significantly over‐represented or under‐represented. While GOs involved in extracellular matrix organization, angiogenesis, biomineralization, and epithelial cell proliferation appeared to be activated in ERS gingiva, genes related to keratinocyte differentiation, epithelial development, and keratinization were of decreased expression. FAM20A immunohistochemistry revealed a strong reactivity at the suprabasal layers of epithelium in control gingiva but showed a significantly diminished and scattered signal in ERS tissues. For genes showing significant over‐expression in the transcriptome analyses, namely ALPL, SPARC, and ACTA2, an increased immunoreactivity was observed.

Conclusion

Our results unraveled a potential role for FAM20A in homeostasis of both gingival epithelium and connective tissues.
Interaction effect of obstructive sleep apnea and periodic limb movements during sleep on heart rate variability
Authors: Li Xiao , Covassin Naima , Zhou Junying , Zhang Ye , Ren Rong , Yang Linghui , Tan Lu , Li Taomei , Xue Pei , Tang Xiangdong
Published: May 2019

We aimed at assessing cardiac autonomic function by heart rate variability during sleep in patients with obstructive sleep apnea and periodic limb movements during sleep, and to compare it with that of patients with obstructive sleep apnea only, periodic limb movements during sleep only, and controls. We also aimed at investigating the interaction effect between apnea–hypopnea index and periodic limb movement index on heart rate variability. Four groups of patients (n = 42 each, total = 168) were identified based on the presence/absence of obstructive sleep apnea and periodic limb movements during sleep: + obstructive sleep apnea/− periodic limb movements during sleep (5 ≤ apnea–hypopnea index < 30 events per hr), − obstructive sleep apnea/+ periodic limb movements during sleep (periodic limb movement index > 15 events per hr), + obstructive sleep apnea/+ periodic limb movements during sleep, − obstructive sleep apnea/− periodic limb movements during sleep (controls). All groups were matched for age, sex and body mass index. Time‐ and frequency‐domain heart rate variability measures were calculated over 5‐min periods of stable stage 2 non‐rapid eye movement sleep. In patients with both obstructive sleep apnea and periodic limb movements during sleep, LFnu and LF/HF ratio were higher than in those with obstructive sleep apnea only, periodic limb movements during sleep only, and controls, while HFnu was the lowest among the four groups. LFnu, HFnu and LF/HF ratio were significantly and independently associated with minimal oxygen saturation in the + obstructive sleep apnea/+ periodic limb movements during sleep group. There was a significant interaction effect between apnea–hypopnea index and periodic limb movement index on LF/HF ratio (p = 0.038) in patients with obstructive sleep apnea. Patients with elevated apnea–hypopnea index and elevated periodic limb movement index exhibited higher sympathovagal balance compared with those with high apnea–hypopnea index and low periodic limb movement index, and compared with those with low apnea–hypopnea index (regardless of periodic limb movement index). Increased sympathetic activation and decreased parasympathetic control appear to be related to the severity of oxygen desaturation. Apnea–hypopnea index and periodic limb movement index had interactive effects on increased sympathovagal balance in patients with obstructive sleep apnea.
External validation of a data‐driven algorithm for muscular activity identification during sleep
Authors: Cesari Matteo , Christensen Julie A. E. , Sorensen Helge B. D. , Jennum Poul , Mollenhauer Brit , Muntean Maria‐Lucia , Trenkwalder Claudia , Sixel‐Döring Friederike
Published: May 2019

Several automated methods for scoring periodic limb movements during sleep (PLMS) and rapid eye movement (REM) sleep without atonia (RSWA) have been proposed, but most of them were developed and validated on data recorded in the same clinic, thus they may be biased. This work aims to validate our data‐driven algorithm for muscular activity detection during sleep, originally developed based on data recorded and manually scored at the Danish Center for Sleep Medicine. The validation was carried out on a cohort of 240 participants, including de novo Parkinson's disease (PD) patients and neurologically healthy controls, whose sleep data were recorded and manually evaluated at Paracelsus‐Elena Klinik, Kassel, Germany. In the German cohort, the algorithm showed generally good agreement between manual and automated PLMS indices, and identified with 88.75% accuracy participants with PLMS index above 15 PLMS per hour of sleep, and with 84.17% accuracy patients suffering from REM sleep behaviour disorder (RBD) showing RSWA. By comparing the algorithm performances in the Danish and German cohorts, we hypothesized that inter‐clinical differences may exist in the way limb movements are manually scored and how healthy controls are defined. Finally, the algorithm performed worse in PD patients, probably as a result of increased artefacts caused by abnormal motor events related to neurodegeneration. Our algorithm can identify, with reasonable performance, participants with RBD and increased PLMS index from data recorded in different centres, and its application may reveal inter clinical differences, which can be overcome in the future by applying automated methods.
The influence of batter formulation and predrying time on interparticle space fractions of a coated meat analog
Authors: Rahimi Jamshid , Adedeji Akinbode , Ngadi Michael
Published: May 2019

The purpose of the study was to understand the mechanism of microstructural changes in vegetable‐based meat analogs coated with different batter formulations. A meat analog (substrate) was developed by using vegetable proteins, coated with batters formulated from different combinations of wheat and rice flours, predried at various durations, and subsequently fried. The effect of batter formulation, predrying time, and frying time on spaces occupied by air (porosity, SOA), moisture (SOM), and fat (SOF) in the core region (the meat analog) was studied. The SOA, SOM, and SOF ranged between 8.28–32.72%, 16.73–58.31%, and 16.73–58.31%, respectively. All three fractions of pores in the meat analog were significantly influenced by predrying and frying times; however, batter formulation did not show any significant influence. Batter formulation did not show any significant influence on moisture and fat content within the meat analog. Fat content was not influenced by frying time; and only 90 min predrying made a difference.
Killer whale genomes reveal a complex history of recurrent admixture and vicariance
Authors: Foote Andrew D. , Martin Michael D. , Louis Marie , Pacheco George , Robertson Kelly M. , Sinding Mikkel‐Holger S. , Amaral Ana R. , Baird Robin W. , Baker Charles Scott , Ballance Lisa , Barlow Jay , Brownlow Andrew , Collins Tim , Constantine Rochelle , Dabin Willy , Dalla Rosa Luciano , Davison Nicholas J. , Durban John W. , Esteban Ruth , Ferguson Steven H. , Gerrodette Tim , Guinet Christophe , Hanson M. Bradley , Hoggard Wayne , Matthews Cory J. D. , Samarra Filipa I. P. , de Stephanis Renaud , Tavares Sara B. , Tixier Paul , Totterdell John A. , Wade Paul , Excoffier Laurent , Gilbert M. Thomas P. , Wolf Jochen B. W. , Morin Phillip A.
Published: May 2019

Reconstruction of the demographic and evolutionary history of populations assuming a consensus tree‐like relationship can mask more complex scenarios, which are prevalent in nature. An emerging genomic toolset, which has been most comprehensively harnessed in the reconstruction of human evolutionary history, enables molecular ecologists to elucidate complex population histories. Killer whales have limited extrinsic barriers to dispersal and have radiated globally, and are therefore a good candidate model for the application of such tools. Here, we analyse a global data set of killer whale genomes in a rare attempt to elucidate global population structure in a nonhuman species. We identify a pattern of genetic homogenisation at lower latitudes and the greatest differentiation at high latitudes, even between currently sympatric lineages. The processes underlying the major axis of structure include high drift at the edge of species' range, likely associated with founder effects and allelic surfing during postglacial range expansion. Divergence between Antarctic and non‐Antarctic lineages is further driven by ancestry segments with up to four‐fold older coalescence time than the genome‐wide average; relicts of a previous vicariance during an earlier glacial cycle. Our study further underpins that episodic gene flow is ubiquitous in natural populations, and can occur across great distances and after substantial periods of isolation between populations. Thus, understanding the evolutionary history of a species requires comprehensive geographic sampling and genome‐wide data to sample the variation in ancestry within individuals.
When I say … profession
Authors: Trimble Michael
Published: May 2019

Closely examining the definition of “profession”, Trimble argues that medical educators should seek to remind students that medicine is more than a job or career.
Microglia: Lifelong modulator of neural circuits
Authors: Ikegami Ako , Haruwaka Koichiro , Wake Hiroaki
Published: May 2019

Microglia, the sole immune cells in the brain, are the key player for synaptic regulation required for our brain function in both developing and adult brain. They have highly motile processes to detect synaptic functions. Recent accumulated studies have unveiled the mechanism underlying synapse detection and pruning / formation by microglia. In this review, we summarize the current knowledge of various microglial machinery recruited in synaptic modulation in the different life stages and contexts.
Pharyngeal contractile and regulatory characteristics are distinct during nutritive oral stimulus in preterm‐born infants: Implications for clinical and research applications
Authors: Prabhakar Varsha , Hasenstab Kathryn A. , Osborn Erika , Wei Lai , Jadcherla Sudarshan R.
Published: May 2019

Background

Maturation of pharyngeal swallowing during neonatal oral feeding is unknown. Our objective was to evaluate pharyngeal functioning using high‐resolution manometry (HRM) during nutritive oral stimulus and test the hypothesis that pharyngeal contractility and regulation are distinct in preterm‐born infants.

Methods

High‐resolution manometry data during oral milk feeding were analyzed for pharyngeal contractile (PhCI, mm Hg cm s) and regulatory (number and frequency of pharyngeal contractions and bursts, pharyngeal activity‐to‐quiescence ratio, upper esophageal sphincter nadir pressure) characteristics in 23 preterm (<38 weeks’ gestation) and 18 full‐term‐born infants at term maturation. Mixed linear models and stepwise regression methods were used.

Results

Despite more oral feeding experiences (P < 0.05), preterm infants (vs full‐term), consumed less milk volume (P < 0.001), had lesser pharyngeal contractions within bursts (P = 0.04), lower pharyngeal contraction frequency (P < 0.01), and lower pharyngeal activity (P = 0.03), but higher PhCI per individual contraction (P = 0.01). PhCI is higher for longer PMA (P < 0.05), higher UES nadir pressures (P < 0.05), and lower pharyngeal contraction frequency (P < 0.05).

Conclusions

Nutritive oral milk stimulus provoked pharyngeal contractility characteristics is distinct in preterm‐born. Despite more oral nutritive experiences, preterm infants had underdeveloped excitatory and inhibitory rhythmic activity. Cranial nerve IX and X effects on sensory‐motor responses and feedback (excitation‐inhibitory rhythm regulation) remain immature among preterm‐born even at full‐term maturational status. We speculate the relationship between PhCI and UES regulatory activity contributes to the observed differences in preterm and full‐term infants.