Reliability of visual assessment of neonatal jaundice among neonates of black descent: a cross-sectional study from Tanzania.

BACKGROUND: Jaundice is common among neonates and if untreated can lead to kernicterus. Diagnosing neonatal jaundice (NJ) using Kramer's method (visual assessment) is considered user-friendly in resource-limited areas. However, there are conflicting findings on reliability of the Kramer's method in the diagnosis of NJ, particularly of black descent. Therefore, study aimed to determine the accuracy of Kramer's method in comparison to the total serum bilirubin (TSB) test in the diagnosis of NJ among neonates of black descent in Tanzania. METHODS: A cross-sectional study was conducted between June and July 2020 at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania. A total of 315 neonates were recruited consecutively. In each neonate, jaundice was assessed using Kramer's method and TSB test. NJ A total of 315 neonates were recruited i. A 2 X 2 table was created for the determination of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive and negative likelihood ratios (+LR/-LR), and diagnostic accuracy (effectiveness) of Kramer's method. Cohen kappa (κ) was used to analyze the agreement between Kramer's method and TSB. Association between independent variables and presence of jaundice were assessed using the chi-square test and the p < 0.05 was considered to be statistically significant. RESULTS: The prevalence of NJ was 49.8% by Kramer's method and 63.5% by TSB. The Sensitivity, Specificity, PPV, and NPV of Kramer's method were 70.5, 86.1, 89.8, and 62.6%, respectively. The +LR and -LR were 5.07 and 0.34, respectively. The diagnostic accuracy of Kramer's method was 76.1%. There was a moderate agreement between Kramer's method and TSB results (κ = 0.524, P<0.001). No significant relationship was observed between the independent variables and the presence of NJ. CONCLUSION: Kramer has a good positive predictive value. However, due to low sensitivity and NPV one cannot say that overall predictive ability is good. Also, clinical assessment by Kramer's method should not be used for screening of NJ. Further studies are needed to investigate the utility of other non-invasive techniques in detecting NJ among neonates of black descent.

Effect of single nanoparticle-nanopore interaction strength on ionic current modulation.

Solid-state nanopores are rapidly emerging as promising platforms for developing various single molecule sensing applications. The modulation of ionic current through the pore due to translocation of the target molecule has been the dominant measurement modality in nanopore sensors. Here, we focus on the dwell time, which is the duration taken by the target molecule or particle to traverse the pore and study its dependence on the strength of interaction of the target with the pore using single gold nanoparticles (NPs) as targets interacting with a silicon nitride (SiN) nanopore. The strength of interaction, which in our case is electrostatic in nature, can be controlled by coating the nanoparticles with charged polymers. We report on an operating regime of this nanopore sensor, characterized by attractive interactions between the nanoparticle and the pore, where the dwell time is exponentially sensitive to the target-pore interaction. We used negatively and positively charged gold nanoparticles to control the strength of their interaction with the Silicon Nitride pore which is negatively charged. Our experiments revealed how this modulation of the electrostatic force greatly affects the dwell time. Positively charged NPs with strong attractive interactions with the pore resulted in increase of dwell times by 2-3 orders of magnitude, from 0.4 ms to 75.3 ms. This extreme sensitivity of the dwell time on the strength of interaction between a target and nanopore can be exploited in emerging nanopore sensor applications.

Electron spin relaxation time of Ni(II) ion in hexapyrazole zinc(II) dinitrate at 300 K.

Understanding the electron spin relaxation properties of paramagnetic species is a fundamental requirement to use them as a probe to measure distances between sites in biomolecules by electron paramagnetic resonance (EPR) spectroscopy. Even though Ni(II) ion is an essential trace element for many species, relaxation properties are not well understood. Herein, the polycrystalline sample of Ni(II) ion magnetically diluted in Zn(Pyrazole)6 (NO3 )2 (Ni/ZPN) has been studied in detail by EPR spectroscopy to explore the electron spin relaxation time. Progressive continuous-wave (CW) EPR power saturation study on Ni/ZPN at 300 K yielded 907 mW as the P1/2 value. The cavity constant (KQ ) has been calculated using tempol in PVA-BA glass matrix and the product of electron spin-lattice relaxation time (T1 ) and spin-spin relaxation time (T2 ) for Ni/ZPN at 300 K has been reported for the first time.

Contemporary nursing graduates' transition to practice: A critical review of transition models.

AIM AND OBJECTIVE: To critically review contemporary transition theories to determine how they apply to the newly qualified graduate registered nurse programmes. BACKGROUND: Graduate nurse transition to employment is the time of significant change which has resulted in high attrition rates. Graduates are often challenged by their expectation of nursing practice and the reality of the role. The transition from hospital-based training to university-based training has resulted in the need for primary employment to commence with graduate/orientation/internship programmes to help support new graduates transition into clinical practice. One transition model, Duchscher's stages of transition theory, utilised three former theories to develop a final model. DESIGN: A narrative critical literature review. METHOD: The theories selected for the review were Kramer's reality shock theory, Benner's novice to expert theory, Bridges transition theory and Duchscher's stages of transition theory. CONCLUSION: Duchscher's stages of transition theory reflects the experiences of registered nursing transition into the workforce directly from university. The application of the theory is effective to guide understanding of the current challenges that new graduate nurse's experience today. There is a need for new graduates to complete their university degree as advanced beginners in order to decrease the experience of transition shock and keep pace with rapidly changing demands of the clinical environment. This may be achieved by increasing ward-based simulation in university education. A theoretical framework can provide a deep understanding of the various stages and processes of transition and enable development of successful programmes. RELEVANCE TO CLINICAL PRACTICE: Both universities and hospitals need to adapt their current practice to align with the needs of new graduates due to large student numbers and ongoing systematic advancements to decrease the attrition rate.

Clinical and radiographic outcomes of the Kramer osteotomy in the treatment of bunionette deformity.

BACKGROUND: Bunionette deformity is a painful bony prominence of the 5th metatarsal. We evaluated outcomes of using a Kramer osteotomy to treat this condition. METHODS: Retrospective study of patients treated with a Kramer osteotomy from 2003 and 2016. Outcome measures included Foot Functional Index (FFI) and radiographic measurements. RESULTS: 38 patients (43 feet) with an average follow-up of 55 months. Mean postoperative FFI1 was 19.4. Mean 4-5 IMA2 improved 3.9°, from 8.3° preoperatively to 4.4° on final postoperative films (p<0.01). Mean MTP-53 angle improved 13.2° from 13.6° preoperatively to 0.4° at final follow-up (p<0.01). There were 5 delayed unions (11.6%) and 1 non-union (2.3%). CONCLUSIONS: The Kramer osteotomy is an effective treatment option in patients with bunionette deformity, with significant correction of the 4-5 IM2 and MTP-53 angles and few complications.

An improved uniformly more powerful exact Fisher-Hayter pairwise comparisons procedure.

Pairwise comparison is a very common multiple comparison problem. It is known that Fisher's LSD test does not control the familywise error rate (FWER) when there are more than three groups to be compared. Improved testing strategies include the Tukey-Kramer (TK) test that eliminates the F-test step and the two-step Fisher-Hayter (FH) test which requires a significant F-test. We propose a modified FH-test that is uniformly more powerful than the original version and relies on exact size α test under the balanced model. We provide simulations to show that the new procedure is preferred to the FH-test and the TK-test.

Short- and long-term outcomes following hallux-valgus correction: a modified Kramer osteotomy.

BACKGROUND: Short- and long-term assessments were performed of a modification to the Kramer osteotomy that developed to stabilize the metatarsal head using an angular implant, the LINK(®) internal hallux fixator (Waldemar LINK GmbH & Co. KG, Hamburg, Germany). METHODS: For this retrospective study, radiological assessments were used to measure outcomes in 72 feet with hallux valgus treated from 2006 to 2011. The hallux-valgus angle, the intermetatarsal angle between the first and second intermetarsal shaft axes, and the distal metatarsal articular angle were measured at short- and long-term intervals. Long-term clinical assessments included results of the Foot Function Index and the American Orthopedic Foot and Ankle Society Forefoot Score. RESULTS: Of the 72 feet treated, 12 were done as bilateral operations. Fifty-five patients at a mean age of 52 years (±12; range 22-78) were included in short-term assessments. Significant improvements in angular measurements were made (p < 0.001) between baseline and 3 month assessments. Three postoperative complications occurred and 40 % (29/72) of the implants were eventually removed. Fifty-five of the 72 feet were available for long-term assessments at a median of 5 years postoperatively (IQR 5-7; range 3-9). No significant loss of correction was detected (p = 0.373). Clinical assessments indicated successful outcomes in 86 % (47/55) of the feet, with slightly better results in older patients (p = 0.033; OR 1.1, CI 95 % 1.01-1.15). CONCLUSION: This technique can achieve normal angular configuration, even with severe deformities, without significant long-term loss of correction. Patients should be informed of potential discomfort necessitating hardware removal, although the likelihood of complications is low. LEVEL OF EVIDENCE: Level III study.

Comparison of postoperative costs of two surgical techniques for hallux valgus (Kramer vs. scarf).

BACKGROUND: Most studies of hallux valgus surgery focus on the radiological findings or on medium-term clinical follow-up. The results obtained using various osteotomy techniques do not differ greatly. However, patient comfort and the need for postoperative care do appear to present differences. In the Kramer technique, the osteotomy is secured with a wire extruding from the skin of the foot. In this situation, patients may well experience problems (or at least discomfort) in the immediate postoperative period. Previous studies of the Kramer technique (also known as SERI, or percutaneous distal metatarsal osteotomy) do not report an increased number of complications. Early complications may not influence the outcome in the medium to long term, and patient discomfort during the postoperative period is rarely reflected in the analysis of one-year results obtained with standard scales such as AOFAS; in our experience, however, patient discomfort, the care burden (i.e., the number of visits and emergency service consultations) and the economic cost of immediate postoperative care are all aspects that should be borne in mind when assessing the merits of different surgical techniques. In this study we compare the care burden and economic cost of two surgical approaches to hallux valgus correction--the Kramer and the scarf techniques--during the first postoperative year. METHODS: Retrospective review of two independent patient cohorts. Sixty-nine feet underwent Kramer osteotomy and 133 the scarf technique. Care burden was assessed by the number of visits each patient required and the complications. The follow-up and costs of each were assessed and compared independently. RESULTS: Both techniques obtain satisfactory clinical results at one year. However, comparison of clinical progression showed AOFAS score increases of 34.7 points for Kramer and 41.1 points for the scarf technique (p-value<0.05). Patients in the Kramer group required a higher number of visits, especially postoperative emergency department visits (p<0.05), and had a significantly higher number of complications (27.5% vs. 6.7%, p<0.05). The mean cost of follow-up was significantly higher in the Kramer group (€ 218.97 vs. € 171.41, p<0.05). CONCLUSIONS: Kramer osteotomy presented significantly higher care burdens, complication rates and associated costs during the first year of follow-up. It is therefore a less cost-effective technique. Thus, even though according to the results of AOFAS we would not have changed our clinical practice, the analysis of these data has made us change our treatment strategy for hallux valgus and practically abandoned the use of the Kramer osteotomies.

Modified Kramer's versus Kramer's Method for Clinical Assessment of Jaundice in Term and Near-Term Neonates.

OBJECTIVES: To compare the performance of Modified Kramer's and Kramer's methods in terms of agreement with total serum bilirubin (TSB). METHODS: This cross-sectional study was done in Level-III neonatal unit in New Delhi. Visibly jaundiced neonates born at ≥35 wk of gestation were enrolled and examined by (i) conventional Kramer's, (ii) Modified Kramer's in artificial (MK-A) and (iii) natural daylight (MK-N), and finally sampled for estimation of TSB by point-of-care spectrophotometry. The primary outcomes were agreement of Kramer's and Modified Kramer's with TSB and accuracy in terms of proportion of bilirubin estimates lying within ±2 mg/dL of TSB; secondary outcome was agreement of MK-A and MK-N with TSB. RESULTS: A total of 144 neonates with median gestation of 37 wk and mean birth weight of 2788 g were enrolled. Bland Altman analysis between Kramer's and TSB yielded mean difference of 1.7 mg/dL, 95% limits of agreement (LOA) -3.1 to 6.6 mg/dL. For Modified Kramer's and TSB, mean difference was -0.02 mg/dL, 95% LOA -4.7 to 4.7 mg/dL under artificial light; 0.02 mg/dL, 95% LOA -4.2 to 4.2 mg/dL under natural daylight. MK-N had highest proportion of bilirubin estimates lying within ±2 mg/dL of TSB (68.7%) as compared to MK-A (59.7%) [OR, 1.77; 95% CI, 1.09 to 2.86] and Kramer's (45.8%) [OR, 1.65; 95% CI, 1.27 to 2.15]. CONCLUSIONS: Though all the three methods had poor agreement with TSB, Modified Kramer's method when performed in natural light had reasonable accuracy, however limited clinical utility, in evaluation of clinical jaundice.

Mini-invasive mitchell-kramer method in the operative treatment of hallux valgus deformity.

BACKGROUND: The mini-invasive Mitchell-Kramer procedure is a new method of operative correction of mild to moderate hallux valgus deformity. The aim of this study was to describe the technique and evaluate the results of the procedure. METHODS: We evaluated 54 patients who underwent mini-invasive distal metatarsal osteotomy of the first metatarsal with preservation of the lateral cortex of the distal fragment. We did percutaneous 2-mm K-wire stabilization of the osteotomy and did not use cast immobilization with postoperative offloading of the forefoot. We used anteroposterior and lateral foot standing X-rays, visual analog scale (VAS), and American Orthopaedic Foot and Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale for the clinical assessment at 18 months' follow-up. RESULTS: Preoperatively, mean hallux valgus angle was 33.9 degrees; intermetatarsal angle, 14.8 degrees; VAS, 8.9; and AOFAS, 37.0. At follow-up period, hallux valgus angle was 14.2; intermetatarsal angle, 9.7; VAS, 2.6; and AOFAS, 90.7. The average first metatarsal shortening was 2.7 mm. No transfer metatarsalgia was noted at 18 months' follow-up. We found 1 superficial infection, but all patients were satisfied. CONCLUSIONS: The mini-invasive Mitchell-Kramer method was indicated in mild to moderate hallux valgus deformity. Cast immobilization was unnecessary, and full weightbearing was allowed early. Using the minioscillating saw allowed for reduced surgical exposure. The technique of the osteotomy also allowed for rotational stability of the osteotomy. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Influence of Sous Vide Cooking on Ground Beef Patties.

With rising consumer demand for fast-food options, quick-service restaurants are constantly developing new menu items to attract consumers. Sous vide cookery has become popular for the in-home and fine dining consumer but has not been considered the first cooking option for quick service applications. Therefore, ground beef patties were manufactured to measure the influence of sous vide cooking time on the patty characteristics of moisture, color, and objective tenderness. Patties were randomly assigned a sous vide cooking time of 30, 60, or 90 min and then grilled to an internal temperature of 71.1 °C. Patties sous vide cooked for 30 min exhibited the greatest (p < 0.05) cook loss, Allo-Kramer Shear Force (AKSF) and were darker (L*) than patties sous vide cooked for 60 or 90 min. Additionally, neither internal redness, calculated spectral values of chroma, hue angle, or red-to-brown differed (p > 0.05) regardless of sous vide cooking time. Sous vide cooking duration prior to grilling the ground beef patties altered the moisture, color, and objective texture characteristics of ground beef patties.

Distal Metatarsal and Proximal Phalangeal Osteotomies without Soft Tissue Procedure for Hallux Valgus with 80° Hallux Valgus Angle: A Case Report.

Introduction: The commonly performed procedure for treating severe hallux valgus is proximal metatarsal osteotomy or first tarsometatarsal arthrodesis combined with a soft tissue procedure in which the severe intermetatarsal angle (IMA) is corrected using proximal metatarsal osteotomy or first tarsometatarsal arthrodesis; although a severe hallux valgus angle (HVA) can be corrected using the soft tissue procedure alone, the correction ability is low. Therefore, the more severe the hallux valgus is, the more difficult it is to correct. Case Report: A 52-year-old woman (height, 142 cm; weight, 47 kg) with severe hallux valgus with an HVA of 80° and an IMA of 22° was treated with a combination of the distal metatarsal and proximal phalangeal osteotomies fixated using K-wires, which was a modification of Kramer's and Akin's procedures, without a soft tissue procedure. The concept behind this technique is that distal metatarsal osteotomy primarily corrects the hallux valgus, and when the correction is insufficient, the proximal phalanx osteotomy complements it, which ensures that the first ray is approximately straight. After 4.1 years of follow-up, the HVA and IMA were 16° and 13°, respectively. Conclusion: Distal metatarsal and proximal phalangeal osteotomies without a soft tissue procedure were effective in treating a patient with severe hallux valgus with an HVA of 80°.

[Design of X-ray Images Based on Quantitative Analysis: Predictive Model of Image Quality and Physical Quantity Factors by Multiple Regression Equation of Visual Evaluation (Scheffé's) and Physical Quantities (Dose and Noise)].

PURPOSE: The Scheffé's method obtains the difference between pair comparisons with that of the interval scale and can judge the superiority or inferiority of the sample to be compared with no restriction in the observation image by the statistical significant difference. However, the Scheffé's method cannot be judged as a single image quality indicator. Therefore, I examined a method that can evaluate the association of average degree of preference of Scheffé's method and the physical quantities that make up the image. METHODS: This study focuses on the fact that the average degree of preference of the Scheffé's method is quantitative data on the interval scale and that multiple regression analysis is possible. In the multiple regression analysis, the average degree of preference by imaging simulated pulmonary adenocarcinoma with different exposure doses was used as the objective variable and the exposure doses and noise (standard deviation [SD]) were used as the explanatory variables. The Scheffé's method used the Nakaya's modified method. RESULTS: In the multiple regression analysis, SD was P=0.027. By substituting the threshold value of the intersection of the exposure doses and SD into the multiple regression equation (predictive model), the average degree of preference (Y) was calculated. Y(Scheffé;Gy,SD) was -0.147, which was about 1/2 of exposure doses (-0.150). CONCLUSION: The multiple regression analysis of Scheffé's (average degree of preference) and physical quantity factors (exposure doses and noise) has made it possible to design images that can reduce exposure doses while maintaining adequate image quality.

Kramer Score, an Evidence of Its Use in Accordance with Indonesian Hyperbilirubinemia Published Guideline.

Background: In some hospitals in low/middle-income countries, methods to determine the bilirubin level in newborn infants are unavailable and based on a clinical evaluation, namely a clinical score designed by Kramer. In this study, we evaluated if this score can be used to identify those infants that need phototherapy. Method: Infants admitted between November 2018 and June 2019 to three hospitals in Surabaya, Indonesia were included. The jaundice intensity was scored using the Kramer score. Blood was sampled for total serum bilirubin (TSB) measurement. The infants were categorized into Treatment Needed (TN) group when treatment with phototherapy was indicated and the No Treatment Needed (NTN) group when phototherapy was not indicated, based on the Indonesian Guideline for hyperbilirubinemia. Result: A total of 280 infants with a mean birth weight of 2744.6 ± 685.8 g and a gestational age of 37.3 ± 2.3 weeks were included. Twenty-seven of 113 (24%) infants with Kramer score 2 needed phototherapy, compared with 41 of 90 (46%) infants with score 3 and 20 of 28 (71%) of infants with score 4. The percentage of infants that needed phototherapy was higher with decreasing gestational age. Conclusion: The Kramer score is an invalid method to distinguish between those infants needing phototherapy and those infants where this treatment is not indicated.

Influence of Plant-Based Proteins on the Fresh and Cooked Characteristics of Ground Beef Patties.

Blended meat/plant products are capturing industry market space at the retail counter for value-added beef products. Plant protein ingredients can be added to meat formulations to create appealing and functional products. Ground beef was combined with one of three plant protein inclusion treatments: control, pea, oat, or rice, along with 5% textured vegetable protein (TVP) and 1.5% soy protein concentrate then formed into 226 g patties containing up to 10% plant-based proteins. Patties were analyzed for fresh and cooked characteristics throughout a 5- or 7-day retail display. The inclusion of plant-based proteins negatively affected the instrumental tenderness values which were greater (p < 0.01) in plant-inclusion patties compared to the control patties. The inclusion of plant proteins increased (p = 0.01) the cooking yield of patties compared to the control. Cooking time was longer (p = 0.04) for oat patties compared to the control patties. Cooked color values for vegetable inclusion patties did not affect (p = 0.12) lightness (CIE L*) values; however, redness (CIE a*) was greater (p < 0.01) for rice than all other treatments and yellowness (CIE b*) values were greater (p < 0.01) for all protein treatments compared to the control. Rice improved (p < 0.01) fresh a* values on day 5 of display compared to the control; whereas pea decreased (p = 0.04) values compared to the control. There was a treatment × day interaction (p < 0.01) on lipid oxidation values with a reduction in values on day 3 for all vegetable proteins compared to the control and on day 7 lipid oxidation was reduced (p ≤ 0.03) for oat patties.

Noninvasive methods for bilirubin measurements in newborns: A report.

New technologies have become available for noninvasive assessments of neonatal hyperbilirubinemia. Our objective is to review the noninvasive methods for measuring bilirubin in the newborn. We searched relevant literature from 1966 to January 1, 2020, which included cross-sectional studies to define the accuracy of any noninvasive methods for measuring or estimating total serum/plasma bilirubin (TB) levels in newborns. We identified and included 83 relevant studies of direct visual assessment, icterometry, mobile phone applications, and transcutaneous bilirubinometry (TcB). Compared with laboratory TB measurements, visual assessment was the least accurate and least reliable (r: 0.37 to 074), while TcB was the most accurate, but not always near-equivalent (r: 0.45 to 0.99). The sensitivity and specificity of TcB cut-off values to detect significant hyperbilirubinemia (TB>95th percentile for age in hours) ranged from 74% to 100% and 18% to 89%, respectively.

Assessment of the Miniature Kramer Shear Cell to Measure Both Solid Food and Bolus Mechanical Properties and Their Interplay with Oral Processing Behavior.

This study assessed the usefulness of the miniature Kramer shear cell to determine relevant instrumental parameters of solid foods and bolus counterparts, examining their relationships with oral processing behaviors to obtain greater knowledge about the texture perception process. Six solid foods with different textural properties were tested. Bolus mechanical properties were also determined by means of cone penetration tests and rheological measurements, and their particle size distributions by sieving. Oral processing behavior (chewing time, number of chews, chewing rate, eating rate) and food saliva uptake (SU) of a young volunteer and a panel of 39 untrained participants were analyzed. The Kramer mechanical properties were very suitable for detecting different levels of food and bolus textural hardness and fracturability and the associated degrees of fragmentation achieved during mastication. Chewing time and number of chews were highly correlated with Kramer food and bolus mechanical properties for the single subject and for the panel's oral processing behaviors. For the single subject, SU and eating rate also showed strong correlations with food and bolus mechanical properties, unlike chewing rate and food moisture content (FMC). In contrast, eating rate, FMC, and SU did not vary with the oral activities of the panel.

A novel pathophysiologic link between upper and lower airways in patients with chronic rhinosinusitis: Association of sputum periostin levels with upper airway inflammation and olfactory function.

BACKGROUND: Chronic rhinosinusitis (CRS) and asthma are collectively called unified airway diseases. Periostin has been implicated in the pathophysiologic link of these conditions but only by serum measurements. We sought to investigate sputum levels of periostin and their association with upper airway inflammation and olfactory function in CRS patients. METHODS: We prospectively recruited 56 CRS patients who underwent endoscopic sinus surgery (20 with and 36 without comorbid asthma), and 28 healthy controls between October 2015 and December 2017. Lower and upper airway indices such as sputum periostin levels and eosinophil and neutrophil counts, exhaled fractional nitric oxide (FeNO) levels, and olfactory function were evaluated in the three groups. Radiological severity of CT images and tissue eosinophilia of surgical specimens were also assessed in the CRS patients. RESULTS: Sputum periostin levels were highest, and olfactory function was most impaired, in the CRS patients with comorbid asthma, followed by those without asthma and controls in this order. CRS with asthma group showed higher sputum eosinophils and FeNO levels than the other two groups, while CRS patients without asthma showed significantly higher neutrophils in sputum than the other two groups. When confined to CRS patients, olfactory dysfunction was correlated with sputum eosinophil counts. Eosinophil counts of nasal polyps showed a significant positive correlation with sputum periostin and FeNO levels. Radiological severity of CRS was correlated with sputum eosinophil counts and FeNO levels. CONCLUSIONS: Periostin levels and inflammatory cells such as eosinophils and neutrophils in the lower airways are increased in patients with CRS, suggesting the presence of mutual interactions between upper and lower airways even if asthma does not coexist. Olfactory dysfunction and eosinophilic nasal polyps may be potential indicators of Th2-driven inflammation in the lower airways. TRIAL REGISTRATION: This study was registered on the UMIN Clinical Trials Registry (Registry ID UMIN000018672).

Understanding corporate surplus food donation in China: testing the roles of environmental concern, altruism, past experience, and perceived risk.

This paper investigates the motives behind corporate giving and determines whether perceived risk plays a major role in corporate surplus food donation intention. A conceptual model is developed from the perspectives of perceived risk, economic concern, past behavior, and moral motives. A questionnaire survey is conducted among food manufacturers and retailers in the Sichuan Province in China. A total of 143 valid observations are used to conduct structural equation modeling analysis. The results show that corporate reputation, legislation, and business risks are the main sub dimensions of risks that corporations perceive. Perceived risk, past behavior, environmental concern, and altruism affect corporate donation intention significantly. Implications of the findings for promoting surplus food donation are also discussed.

PLEKHA4/kramer Attenuates Dishevelled Ubiquitination to Modulate Wnt and Planar Cell Polarity Signaling.

Wnt signaling pathways direct key physiological decisions in development. Here, we establish a role for a pleckstrin homology domain-containing protein, PLEKHA4, as a modulator of signaling strength in Wnt-receiving cells. PLEKHA4 oligomerizes into clusters at PI(4,5)P2-rich regions of the plasma membrane and recruits the Cullin-3 (CUL3) E3 ubiquitin ligase substrate adaptor Kelch-like protein 12 (KLHL12) to these assemblies. This recruitment decreases CUL3-KLHL12-mediated polyubiquitination of Dishevelled, a central intermediate in canonical and non-canonical Wnt signaling. Knockdown of PLEKHA4 in mammalian cells demonstrates that PLEKHA4 positively regulates canonical and non-canonical Wnt signaling via these effects on the Dishevelled polyubiquitination machinery. In vivo knockout of the Drosophila melanogaster PLEKHA4 homolog, kramer, selectively affects the non-canonical, planar cell polarity (PCP) signaling pathway. We propose that PLEKHA4 tunes the sensitivities of cells toward the stimulation of Wnt or PCP signaling by sequestering a key E3 ligase adaptor controlling Dishevelled polyubiquitination within PI(4,5)P2-rich plasma membrane clusters.