bluuebunny/crossref_metadata_2025 huggingface dataset:
An Overview of Franchising Law: Why is it Important?
Authors: Bekhouche Imed Eddine , Kahlessenane Soheyb Salah
Published: June 2018

The main objective of this paper is to highlight the importance of specific franchising law, for that the armchair library approach employed. The obtained results have shown that there is no doubt of the role of franchising regulations to enhance the development of franchising around the globe.
Japan’s Introduction from the Sea of Sei Whale Meat: the Breaking Point of CITES?
Authors: Jayne Lyman Erica , Jamin Olivier
Published: June 2018

A cornerstone of the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) is the exertion of market control when a species’ biological status is put at risk by commercial demand. This is the crux of an Appendix I listing under CITES; once a species is listed on Appendix I it may not be imported or introduced from the sea in order to be used for primarily commercial purposes. As CITES has evolved and strengthened over its forty three-year history, the Parties have agreed specific compliance measures and policy initiatives targeted toward both building upon and supporting this cornerstone. And, yet, one decision at the upcoming Standing Committee puts at risk the reputation and integrity on which CITES stands.Since 2002 Japan has introduced from the sea sei whales and sold the meat, blubber, and other products commercially in order to raise money to support its whaling operations. Because Japan does not have a reservation for the North Pacific population of sei whale, which is listed on Appendix I, Japan’s actions are in clear contravention of the Convention. The question is whether the Standing Committee is willing to hold Japan accountable for nearly 20 years of non-compliance in a demonstration of the integrity and reputation of the Convention or whether politics and power triumph.
Case Studies in Exercise and Sport Sciences: A Powerful Tool to Bridge the Science–Practice Gap
Authors: Halperin Israel
Published: June 2018

Despite the progress made by the scientific exercise community in collaborating and communicating with nonscientist coaches, there is room for improvement. Coaches find research difficult to understand, feel that their interests are not being addressed by exercise research, and rely on peer discussion to further their coaching knowledge base while consuming few peer-reviewed articles. One useful strategy to bridge the science–practice gap is with case studies. In addition to furthering our understanding of the physiology, psychology, and training schedules of elite athletes, case studies can serve (1) as a useful communication channel with coaches if presented as narratives and (2) to establish and strengthen relationships between scientists and coaches, leading to fruitful research collaborations. The purpose of this invited commentary is to discuss these 2 less-recognized benefits of case studies and propose a way to incorporate case studies more frequently alongside group-based studies.
Excited state engineering for efficient reverse intersystem crossing
Authors: Noda Hiroki , Nakanotani Hajime , Adachi Chihaya
Published: June 2018

Excited state engineering in purely organic molecules provides highly efficient and stable TADF-OLEDs.
Direct metabolite detection with an n-type accumulation mode organic electrochemical transistor
Authors: Pappa Anna Maria , Ohayon David , Giovannitti Alexander , Maria Iuliana Petruta , Savva Achilleas , Uguz Ilke , Rivnay Jonathan , McCulloch Iain , Owens Róisín M. , Inal Sahika
Published: June 2018

This is the first ever demonstration of an accumulation mode OECT for biosensing and n-type polymer in electrocatalysis.
Self-consistent determination of spin Hall angle and spin diffusion length in Pt and Pd: The role of the interface spin loss
Authors: Tao Xinde , Liu Qi , Miao Bingfeng , Yu Rui , Feng Zheng , Sun Liang , You Biao , Du Jun , Chen Kai , Zhang Shufeng , Zhang Luo , Yuan Zhe , Wu Di , Ding Haifeng
Published: June 2018

Self-consistent determination of the key parameters in spin-charge conversion via spin pumping–induced inverse spin Hall effect.
Wavelength-tunable and shape-reconfigurable photonic capsule resonators containing cholesteric liquid crystals
Authors: Lee Sang Seok , Kim Jong Bin , Kim Yun Ho , Kim Shin-Hyun
Published: June 2018

Shape-reconfigurable photonic capsules are microfluidically designed to make wavelength- and intensity-tunable microlasers.
Mitochondria maintain controlled activation state of epithelial-resident T lymphocytes
Authors: Konjar Špela , Frising Ulrika C. , Ferreira Cristina , Hinterleitner Reinhard , Mayassi Toufic , Zhang Qifeng , Blankenhaus Birte , Haberman Nejc , Loo Yunhua , Guedes Joana , Baptista Marta , Innocentin Silvia , Stange Joerg , Strathdee Douglas , Jabri Bana , Veldhoen Marc
Published: June 2018

The semi-activation state of IELs is maintained by an altered cardiolipin makeup of their mitochondrial membranes.
Hygrobot: A self-locomotive ratcheted actuator powered by environmental humidity
Authors: Shin Beomjune , Ha Jonghyun , Lee Minhee , Park Keunhwan , Park Gee Ho , Choi Tae Hyun , Cho Kyu-Jin , Kim Ho-Young
Published: June 2018

A hygroresponsive actuation system crawls on a moist surface using aligned nanofibers that quickly swell and shrink.
An Engineered Aro1 Protein Degradation Approach for Increased
cis,cis
-Muconic Acid Biosynthesis in Saccharomyces cerevisiae
Authors: Pyne Michael E. , Narcross Lauren , Melgar Mindy , Kevvai Kaspar , Mookerjee Shoham , Leite Gustavo B. , Martin Vincent J. J.
Published: June 2018

Previous efforts to engineer a heterologous MA pathway in
Saccharomyces cerevisiae
have been hindered by a bottleneck at the PCA decarboxylation step and the creation of aromatic amino acid auxotrophy through deleterious manipulation of the pentafunctional Aro1 protein. In light of these studies, this work was undertaken with the central objective of preserving amino acid prototrophy, which we achieved by employing an Aro1 degradation strategy. Moreover, resolution of the key PCA decarboxylase bottleneck, as detailed herein, advances our understanding of yeast MA biosynthesis and will guide future strain engineering efforts. These strategies resulted in the highest titer reported to date for muconic acid produced in yeast. Overall, our study showcases the effectiveness of careful tuning of yeast Aro1 activity and the importance of host-pathway dynamics.
Arginine and Citrulline Catabolic Pathways Encoded by the
arc
Gene Cluster of Lactobacillus brevis ATCC 367
Authors: Majsnerowska Maria , Noens Elke E. E. , Lolkema Juke S.
Published: June 2018

High concentrations of
l
-arginine or
l
-citrulline in the growth medium provided the wine bacterium
Lactobacillus brevis
with a significant growth advantage. The arginine deiminase pathway (ADI)
arc
gene cluster of
Lactobacillus brevis
contains three genes—
arcD
,
arcE1
, and
arcE2
—encoding putative
l
-arginine/
l
-ornithine exchangers. Uptake experiments with
Lactococcus lactis
cells expressing the genes showed that all three transported
l
-ornithine with affinities in the micromolar range. Similarly, ArcD and ArcE2 transported
l
-arginine, while ArcE1 transported
l
-citrulline, an intermediate of the ADI pathway. Chase experiments showed very efficient exchange of
l
-arginine and
l
-ornithine by ArcD and ArcE2 and of
l
-citrulline and
l
-ornithine by ArcE1. Low affinities (millimolar range) combined with low translocation rates were found for ArcD and ArcE2 with
l
-citrulline and for ArcE1 with
l
-arginine. Resting cells of
Lactobacillus brevis
grown in the presence of
l
-arginine and
l
-citrulline rapidly consumed
l
-arginine and
l
-citrulline, respectively, while producing ammonia and
l
-ornithine. About 10% of
l
-arginine degraded was excreted by the cells as
l
-citrulline. Degradation of
l
-arginine and
l
-citrulline was not subject to carbon catabolite repression by glucose in the medium. At a high medium pH,
l
-citrulline in the medium was required for induction of the
l
-citrulline degradation pathway. Pathways are proposed for the catabolic breakdown of
l
-arginine and
l
-citrulline that merge at the level of ornithine transcarbamylase in the ADI pathway.
l
-Arginine uptake is catalyzed by ArcD and/or ArcE2,
l
-citrulline by ArcE1.
l
-Citrulline excretion during
l
-arginine breakdown is proposed to be catalyzed by ArcD and/or ArcE2 through
l
-arginine/
l
-citrulline exchange.

IMPORTANCE
Lactobacillus brevis
, a bacterium isolated from wine, as well as other food environments, expresses a catabolic pathway for the breakdown of
l
-citrulline in the medium that consists of the
l
-citrulline
/l
-ornithine exchanger ArcE1 and part of the catabolic arginine deiminase (ADI) pathway enzymes. The proposed pathways for
l
-arginine and
l
-citrulline breakdown provide a mechanism for
l
-citrulline accumulation in fermented food products that is the precursor of the carcinogen ethyl carbamate.
Synthetic Biology of Small RNAs and Riboswitches
Authors: Villa* Jordan K. , Su* Yichi , Contreras Lydia M. , Hammond Ming C.
Published: June 2018

In bacteria and archaea, small RNAs (sRNAs) regulate complex networks through antisense interactions with target mRNAs in trans, and riboswitches regulate gene expression in
cis
based on the ability to bind small-molecule ligands. Although our understanding and characterization of these two important regulatory RNA classes is far from complete, these RNA-based mechanisms have proven useful for a wide variety of synthetic biology applications. Besides classic and contemporary applications in the realm of metabolic engineering and orthogonal gene control, this review also covers newer applications of regulatory RNAs as biosensors, logic gates, and tools to determine RNA-RNA interactions. A separate section focuses on critical insights gained and challenges posed by fundamental studies of sRNAs and riboswitches that should aid future development of synthetic regulatory RNAs.
Using facilitator–receiver peer dyads matched according to socioeconomic status to promote behaviour change in overweight adolescents: a feasibility study
Authors: Saez Laura , Legrand Karine , Alleyrat Camille , Ramisasoa Serge , Langlois Johanne , Muller Laurent , Omorou Abdou Yacoubou , De Lavenne Rozenn , Kivits Joëlle , Lecomte Edith , Briançon Serge
Published: June 2018

Objective

To evaluate the feasibility of an innovative peer intervention promoting healthy eating and physical activity, which purposefully selected peer facilitators according to socioeconomic status to target less-advantaged overweight receivers.

Setting

Nine high schools, two middle schools.

Participants

One hundred and fifty-six adolescents were approached to become facilitators, of whom 18 were trained. Thirty-two of 56 potential receivers agreed to participate.

Intervention

The peer intervention was carried out in 2013–2014 and embedded in a larger trial: PRALIMAP-INÈS (Promotion de l’ALIMentation et l’Activité Physique-INEgalité de Santé). Facilitanoators were selected and trained to organise weight-control activities with specific peer receivers participating in the programme.

Primary and secondary outcome measures

Different types of data were collected to assess demand, acceptability, implementation and practicality of the intervention. For the facilitators, this included 6 training sessions, 11 mid-programme interviews, 4 end-of-programme sessions, telephone notes and text message exchanges. All six potential receivers in one school were also interviewed. Sociodemographic and health characteristics were also analysed.

Results

Agreeing to participate was more likely when asked by a peer compared with a professional (51.2% discordant pairs; p<0.02). Twelve activities, mostly based on physical activity and implemented during weekends or holidays, were carried out. The mean age of active receivers was 16 and their body mass index was higher than other participants. For both facilitators and active receivers, there were more participating girls. Qualitative analysis reveals key implementation challenges for facilitators. Interviews with the receivers highlight social difficulties, with most feeling bad about their appearance and wanting to lose weight. Those who participated in peer activities were very positive about the experience especially social support.

Conclusions

The present study suggests the peer intervention is feasible provided organisational difficulties are addressed. Good practice recommendations are formulated, including a longer training session, organising a joint meeting with the facilitators and receivers, matching dyads on place of residence and multiplying modes of contact.

Trial registration number

NCT01688453.
Pattern and spectrum of tornado injury and its geographical information system distribution in Yancheng, China: a cross-sectional study
Authors: Deng Qiangyu , Lv Yipeng , Xue Chen , Kang Peng , Dong Junqiang , Zhang Lulu
Published: June 2018

Objectives

Few studies of tornado injuries have considered differences related to damage levels and Enhanced-Fujita (EF) scale ratings. This study aimed to evaluate the pattern, spectrum and geographical distribution of injuries related to the Yancheng tornado and provide guidelines for effective emergency medical strategies.

Setting

The study was conducted at three hospitals which treated patients with injuries related to the tornado in Yancheng, China.

Participants

We obtained the records of 451 patients with tornado-related injuries. Of these, 401 valid trauma medical records were included; 50 other records were excluded for insufficient information. Informed consent was obtained from all patients by telephone.

Main outcome measures

We analysed patients’ injury sites and types and used the abbreviated injury scale (AIS) to standardise injury severity. Geographical information system and non-parametric tests were used to analyse the effects of geographical factors on casualties.

Results

Women, middle-aged/elderly individuals (age>45 years) and children/adolescents (<18 years) accounted for 51.62%, 77.30% and 12.47% of injured patients, respectively. This caused a dumbbell-shaped age distribution. Head (46.63%), body surface (39.90%) and lower-limb (29.43%) injuries were common, as were soft-tissue injuries (90.77%), fractures (38.90%) and organ damage (19.70%). Minor injuries (AIS=1) were common (60.85%), whereas critical/fatal injuries (AIS≥5) were very rare (2.50%). Although the densities of injury varied among damage levels and EF ratings for different areas, area-wise differences in injury severity (AIS scores) were not significant (p>0.05).

Conclusion

We recommend the use of helmets to prevent head injuries caused by tornadoes and suggest prioritising the treatment of high-risk head and multiple-organ injuries. Additionally, medical rescuers should follow the ‘same quality and different quantity’ principle: the injured in all affected areas should receive equal attention, but numbers of medical personnel should be allocated based on the level of effects from the tornado.
Full-text publication rate of abstracts presented at the Japan Primary Care Association Annual Meetings (2010–2012): a retrospective observational study
Authors: Komagamine Junpei , Yabuki Taku
Published: June 2018

Objective

To determine the publication rate of abstracts presented at the Japan Primary Care Association Annual Meetings and the factors associated with publication.

Design

A retrospective observational study.

Participants

All abstracts presented at the Japan Primary Care Association Annual Meetings (2010–2012).

Main outcome measures

Publication rates were determined by searching the MEDLINE database for full-text articles published by September 2017. Data on presentation format (oral vs poster), affiliation of the first author, number of authors, number of involved institutions, journal of publication and publication date were abstracted.

Results

Of the 1003 abstracts evaluated, 38 (3.8%, 95% CI 2.6% to 5.0%) were subsequently published in peer-reviewed journals indexed in the MEDLINE database. The median time to publication was 15.5 months (IQR, 9.3–29.3 months). More than 95% of published abstracts were published within 4 years. The publications appeared in 23 different journals (21 English-language journals and two Japanese-language journals). Based on univariate analysis using binary logistic regression, publication was more frequent for oral presentations (7.3%vs2.0% for poster presentations; OR 3.91,95% CI 1.98 to 7.75), and for first authors affiliated with university-associated institutions (6.4%vs2.4% for first authors affiliated with non-university-associated institutions; OR 2.75,95% CI 1.42 to 5.30). Based on multivariate analysis, oral presentation and first author affiliation with a university-associated institution were still the only independent predictive factors for publication (adjusted OR 3.50(95% CI 1.72 to 7.12) and adjusted OR 2.35(95% CI 1.19 to 4.63), respectively). Even among 151 abstracts presented orally by first authors affiliated with a university-associated institution, only 18 abstracts (11.9%) were subsequently published in peer-reviewed journals.

Conclusions

The publication rate of abstracts presented at the Japan Primary Care Association Annual Meetings was extremely low. Further studies are warranted to investigate the barriers to publication among investigators who participate in conferences where the publication rate is extremely low.
Cardiovascular disease risk marker responses to breaking up prolonged sedentary time in individuals with paraplegia: the Spinal Cord Injury Move More (SCIMM) randomised crossover laboratory trial protocol
Authors: Withers Thomas M , Croft Louise , Goosey-Tolfrey Victoria L , Dunstan David W , Leicht Christof A , Bailey Daniel P
Published: June 2018

Introduction

Sedentary behaviour is a distinct risk factor for cardiovascular disease (CVD) and could partly explain the increased prevalence of CVD in people with spinal cord injury (SCI). Interrupting prolonged sitting periods with regular short bouts of walking acutely suppresses postprandial glucose and lipids in able-bodied individuals. However, the acute CVD risk marker response to breaking up prolonged sedentary time in people with SCI has not been investigated.

Methods and analysis

A randomised two-condition laboratory crossover trial will compare: (1) breaking up prolonged sedentary time with 2 min moderate-intensity arm-crank activity every 20 min, with (2) uninterrupted prolonged sedentary time (control) in people with SCI. Outcomes will include acute effects on postprandial glucose, insulin, lipids and blood pressure. Blood samples will be collected and blood pressure measured at regular intervals during each 5½-hour condition.

Ethics and dissemination

This study was approved by the Cambridge South National Health Service Research Ethics Committee. This research will help determine if breaking up prolonged sedentary time could be effective in lowering CVD risk in people with SCI. The findings of the research will be published in a peer-reviewed journal and disseminated to relevant user groups.

Trial registration number

ISRCTN51868437; Pre-results.
Satisfactory Analgesia with Minimal Emesis in Day Surgeries (SAME DayS): a protocol for a randomised controlled trial of morphine versus hydromorphone
Authors: Shanthanna Harsha , Paul James , Lovrics Peter , Devereaux P J , Bhandari Mohit , Thabane Lehana
Published: June 2018

Introduction

There has been an exponential increase in the number of ambulatory surgeries (AS). Pain and postoperative nausea vomiting (PONV) affects the recovery, discharge and overall satisfaction of patients having AS. Opioids remain the primary modality for moderate to severe pain. Since there is no perfect opioid, physicians should ideally use the opioid that optimally balances benefits and risks. Present decisions on the choice between morphine (M) and hydromorphone (HM) are based on individual experience and observation. Our primary objective is to compare the proportion of patients having AS achieving satisfactory analgesia without significant PONV when using M compared with HM. Secondarily we will compare the proportion of patients with adverse events, analgesic used, patient satisfaction, time to discharge and postdischarge symptoms.

Methods and analysis

This is a two-arm, multicentre, parallel group, randomised controlled trial of 400 patients having AS. Eligible patients undergoing AS of the abdominal and pelvic regions with a potential to cause moderate to severe pain will be recruited in the preoperative clinic. Using a computer-generated randomization, with a 1:1 allocation ratio, patients will be randomised to M or HM. Patients, healthcare providers and research personnel will be blinded. Study interventions will be administered in the recovery using equianalgesic doses of M or HM in concealed syringes. Patients will be followed in hospital and up to 3 months. Intention-to-treat approach will be used for analysis.

Ethics and dissemination

This study has been approved by the Hamilton integrated research ethics board. We plan to publish our trial findings and present our findings at scientific meetings.

Trail registration number

NCT02223377; Pre-results.
Medical expenditure clustering and determinants of the annual medical expenditures of residents: a population-based retrospective study from rural China
Authors: Zhang Yan , Lu Shan , Niu Yadong , Zhang Liang
Published: June 2018

Objective

To identify the characteristics of high-cost (HC) patients and the determinants of the annual medical expenditures of Chinese rural residents.

Methods

Medical expenditure clustering was performed by Lorentz curve and Gini index. T and X2tests were performed to identify the characteristics of the respondents, and a multilevel regression model examined the determinants of their annual medical expenditures.

Design

A cluster sampling study was performed to identify those residents who availed healthcare services and to assign them to HC (top 5%), moderate-cost (top 30%) and low-cost (others) groups based on their annual medical expenditures.

Setting

The annual healthcare utilisation was calculated by using data from the population-based database of the 2014 New Rural Cooperative Medical System.

Participants

A total of 478 051 residents who availed healthcare services were recruited for the retrospective study in 2014. The annual medical expenditures of these residents were used as the research object.

Results

The total medical expenditures of Macheng city residents for the year 2014 have a Gini index of 0.81 and around 68.01% of these expenditures can be attributed to HC patients. Female residents (51.5%) and persons aged over 60 years (34.48%) who are suffering from diseases that are difficult to diagnose have a high tendency to accumulate high medical costs. The annual medical expenditures of people living in the same village or town tend to be approximated. Age, disease category, inpatient status, healthcare utilisation and utilisation level are identified as the determinants of annual medical expenditures.

Conclusions

The medical expenditures of rural residents are clustered at a remarkably high level, and HC patients are suffering from high economic burden. Therefore, policy-makers must guide these patients in seeking appropriate healthcare services and improve their management of healthcare quality to reduce the unnecessary healthcare utilisation of these patients.

Trial registration number

ChiCTR-OOR-14005563.
The first 6 months: developing a user-informed anticipatory counselling video about the levonorgestrel intrauterine system
Authors: Gilmore Kelly , Ojanen-Goldsmith Alison , Callegari Lisa S , Godfrey Emily M
Published: June 2018

Background

The levonorgestrel intrauterine system (LNG-IUS) is a contraceptive method that can cause irregular bleeding and cramping during the first 6 months of use. Expected side effects are common reasons given for LNG-IUS device discontinuation within 12 months of use. Anticipatory counselling regarding expected LNG-IUS side effects may reduce method discontinuation and improve patient satisfaction. Educational videos could improve anticipatory counselling for LNG-IUS users; however, none have been developed. This article describes the process of developing an anticipatory counselling video with input from women in the first 6 months of LNG-IUS use and from family planning (FP) experts.

Methods

We used a participatory, iterative process to develop an anticipatory counselling video about the first 6 months of LNG-IUS use. We developed a preliminary draft using evidence from the published literature. We sought feedback from 11 FP experts and 49 LNG-IUS users to revise the script before creating the final video.

Results

FP experts suggested balancing negative with positive information and using colloquial language. LNG-IUS users requested more detailed information on the LNG-IUS mechanism of action and expected side effects in the form of statistics, infographic animations, testimonials from LNG-IUS users, and technical as opposed to colloquial language. The final video is 6 min in length and features seven LNG-IUS users, three physicians, and infographic animations.

Conclusion

Including input from FP experts and LNG-IUS users in the development process resulted in a 6-min anticipatory counselling video that will be piloted among patients on the day of their LNG-IUS insertion.
Effective resource management using machine learning in medicine: an applied example
Authors: Williams Alan , Mekhail Ann-Marie , Williams James , McCord Johanna , Buchan Vanessa
Published: June 2018

Background

The field of medicine is rapidly becoming digitised, and in the process passively amassing large volumes of healthcare data. Machine learning and data analytics are advancing rapidly, but these have been slow to be taken up in the day-to-day delivery of healthcare. We present an application of machine learning to optimise a laboratory testing programme as an example of benefiting from these tools.

Methods

Canterbury District Health Board has recently implemented a system for urgent lab sample processing in the community, reducing unnecessary emergency presentations to hospital. Samples are transported from primary care facilities to a central laboratory. To improve the efficiency of this service, our team built a prototype transport scheduling platform using machine learning techniques and simulated the efficiency and cost impact of the platform using historical data.

Results

Our simulation demonstrated procedural efficiency and potential for annual savings between 5% and 14% from implementing a real-time lab sample transport scheduling platform. Advantages included providing a forward job list to the laboratory, an expected time to result and a streamlined transport request process.

Conclusion

There are a range of opportunities in healthcare to use large datasets for improved delivery of care. We have described an applied example of using machine learning techniques to improve the efficiency of community patient lab sample processing at scale. This is with a view to demonstrating practical avenues for collaboration between clinicians and machine learning engineers.
Facility-level association of preoperative stress testing and postoperative adverse cardiac events
Authors: Valle Javier A , Graham Laura , Thiruvoipati Thejasvi , Grunwald Gary , Armstrong Ehrin J , Maddox Thomas M , Hawn Mary T , Bradley Steven M
Published: June 2018

Background

Despite limited indications, preoperative stress testing is often used prior to non-cardiac surgery. Patient-level analyses of stress testing and outcomes are limited by case mix and selection bias. Therefore, we sought to describe facility-level rates of preoperative stress testing for non-cardiac surgery, and to determine the association between facility-level preoperative stress testing and postoperative major adverse cardiac events (MACE).

Methods

We identified patients undergoing non-cardiac surgery within 2 years of percutaneous coronary intervention in the Veterans Affairs (VA) Health Care System, from 2004 to 2011, facility-level rates of preoperative stress testing and postoperative MACE (death, myocardial infarction (MI) or revascularisation within 30 days). We determined risk-standardised facility-level rates of stress testing and postoperative MACE, and the relationship between facility-level preoperative stress testing and postoperative MACE.

Results

Among 29 937 patients undergoing non-cardiac surgery at 131 VA facilities, the median facility rate of preoperative stress testing was 13.2% (IQR 9.7%–15.9%; range 6.0%–21.5%), and 30-day postoperative MACE was 4.0% (IQR 2.4%–5.4%). After risk standardisation, the median facility-level rate of stress testing was 12.7% (IQR 8.4%–17.4%) and postoperative MACE was 3.8% (IQR 2.3%–5.6%). There was no correlation between risk-standardised stress testing and composite MACE at the facility level (r=0.022, p=0.81), or with individual outcomes of death, MI or revascularisation.

Conclusions

In a national cohort of veterans undergoing non-cardiac surgery, we observed substantial variation in facility-level rates of preoperative stress testing. Facilities with higher rates of preoperative stress testing were not associated with better postoperative outcomes. These findings suggest an opportunity to reduce variation in preoperative stress testing without sacrificing patient outcomes
Phantom menace: novel psychoactive substances and the UK Armed Forces
Authors: Hunter Alys H , Ayres T , Moreland N , Cox A
Published: June 2018

Novel psychoactive substances (NPS) encompass a large group of synthesised compounds specifically designed to mimic traditional recreational drugs. Current UK Armed Forces compulsory drug testing does not screen for these substances, making them tempting to the small proportion of UK Armed Forces personnel who indulge in recreational drug use. The acute and chronic sequelae of NPS misuse are widely variable and associated with high morbidity. In this paper, we discuss NPS pharmacology and clinical presentation. We describe toxidromes and management of patients who have misused NPS.Finally, we reflect on the legal, ethical and military consequences of NPS misuse for both the service person misusing NPS and the Military Physician providing their care.
Denis Richard Lane
Authors:   Charles and Athene Lane
Published: June 2018

A small animal practitioner and author who gained a lifelong interest in animal charities through his work with Guide Dogs. Travel and broadening his knowledge were his main interests in retirement.
Severity of obstructive sleep apnea (OSA) in 382 Han and Uyghur patients with sleep disorders
Authors: Gul Aman , Memtily Nassirhadjy , Aihemaiti Aikeranmu , Abdukadir Amir , Wushuer Palidan
Published: June 2018

Objective: Race and ethnicity may impact the prevalence and severity of Obstructive Sleep Apnea (OSA) in adults and children. In this study, we aim to investigate the ethnologic influence on OSA severity between Han and Uyghur OSA patients in Xinjiang, China.

Methods: We enrolled total of 382 (205 Han and 177 Uyghur) patients diagnosed with OSA with apnea/hypopnea index (AHI) or respiratory disturbance index (RDI) [Formula: see text] 5. During admission, the severity of OSA was evaluated by polysomnography (PSG).

Results: From demographic characteristics of enrolled patients, we found that there was no significant difference in sex, age, BMI, and neck circumference between two study populations. Uyghur OSA patients had longer sleep latency, longer REM sleep and N3 stage, but shorter N1 phase than Han OSA patients. AHI and apnea RDI level, but not hypopnea RDI, were evidently higher in Han patients compared with Uyghur patients. There was no distinctive difference between two ethnic populations in average and minimum peripheral capillary oxygen saturation (SaO2) level.

Conclusion: Better understanding of impact factors encompassing ethnicity may help improve OSA diagnosis accuracy, management and treatment for patients in Xinjiang.
Combination Forecasting Reversion Strategy for Online Portfolio Selection
Authors: Huang Dingjiang , Yu Shunchang , Li Bin , Hoi Steven C. H. , Zhou Shuigeng
Published: June 2018

Machine learning and artificial intelligence techniques have been applied to construct online portfolio selection strategies recently. A popular and state-of-the-art family of strategies is to explore the reversion phenomenon through online learning algorithms and statistical prediction models. Despite gaining promising results on some benchmark datasets, these strategies often adopt a single model based on a selection criterion (e.g., breakdown point) for predicting future price. However, such model selection is often unstable and may cause unnecessarily high variability in the final estimation, leading to poor prediction performance in real datasets and thus non-optimal portfolios. To overcome the drawbacks, in this article, we propose to exploit the reversion phenomenon by using combination forecasting estimators and design a novel online portfolio selection strategy, named
Combination Forecasting Reversion
 (CFR), which outputs optimal portfolios based on the improved reversion estimator. We further present two efficient CFR implementations based on online Newton step (ONS) and online gradient descent (OGD) algorithms, respectively, and theoretically analyze their regret bounds, which guarantee that the online CFR model performs as well as the best CFR model in hindsight. We evaluate the proposed algorithms on various real markets with extensive experiments. Empirical results show that CFR can effectively overcome the drawbacks of existing reversion strategies and achieve the state-of-the-art performance.
The Epigenome, Cell Cycle, and Development in Toxoplasma
Authors: Kim Kami
Published: June 2018

Toxoplasma gondii is a common veterinary and human pathogen that persists as latent bradyzoite forms within infected hosts. The ability of the parasite to interconvert between tachyzoite and bradyzoite is key for pathogenesis of toxoplasmosis, particularly in immunocompromised individuals. The transition between tachyzoites and bradyzoites is epigenetically regulated and coupled to the cell cycle. Recent epigenomic studies have begun to elucidate the chromatin states associated with developmental switches in T. gondii. Evidence is also emerging that AP2 transcription factors both activate and repress the bradyzoite developmental program. Further studies are needed to understand the mechanisms by which T. gondii transduces environmental signals to coordinate the epigenetic and transcriptional machinery that are responsible for tachyzoite-bradyzoite interconversion.
Cochlear Nerve Aplasia with Detectable Olivocochlear Efferent Function: A Distinct Presentation of Auditory Neuropathy Spectrum Disorder
Authors: James Adrian L. , Dixon Peter R. , Harrison Robert V.
Published: June 2018

Background: Cochlear nerve aplasia (CNA) may present with features of auditory neuropathy spectrum disorder (ANSD), having detectable otoacoustic emissions (OAE) but profound hearing loss. We propose that some children with CNA have a distinct form of afferent ANSD in which efferent cochlear nerve function can be detected using contralateral suppression of OAE. Methods: Children were prospectively enrolled with MRI and auditory brainstem response evidence of unilateral CNA, a normal contralateral ear, and detectable OAE bilaterally. Distortion product OAE (DPOAE) levels were recorded in real time with default primary tone settings: frequency (f)2 = 4.5 kHz and f2/f1 = 1.22 kHz, with level (L)1 = 65 dB SPL and L2 = 55 dB SPL. Recordings were made over 2 min with simultaneous application of an intermittent contralateral broadband noise (CBBN) stimulus at 60 dB SPL. Results: Three girls, aged 4.5, 7, and 8 years, participated. Suppression of DPOAE of 0.15–1.3 dB was detected in all 3 ears with CNA in response to CBBN stimulation. No response was detected in the normal ears. Conclusions: Children with unilateral ANSD can have normal efferent cochlear nerve function despite MRI evidence of ipsilateral CNA. The importance of these findings for newborn hearing screening and cochlear implantation is discussed.
Refractory Septic Shock due to Underlying Immunocompromised Disease: A Case of Fatal Peripheral T-Cell Lymphoma Not Otherwise Specified in a Young Hispanic Woman
Authors: Kumar Kishore , Saad Muhammad , Chime Chukwunonso , Badipatla Kanthi , Tariq Hassan , Nayudu Sureshkumar , Niazi Masooma , Chilimuri Sridhar
Published: June 2018

Peripheral T-cell lymphoma not otherwise specified (PTCL-NOS) is known as an unclassified group of non-Hodgkin lymphomas. PTCL-NOS is a subtype of peripheral T-cell lymphoma that accounts for 3% of all lymphomas in the United States. PTCL-NOS commonly presents as a disseminated disease, B symptoms (fever, night sweats, and weight loss), generalized lymphadenopathy, bone marrow infiltration, and extranodal involvement. Other rare and possible manifestations include peripheral eosinophilia, pruritus, or hemophagocytic syndrome. This type of lymphoma is aggressive in nature and carries a high mortality rate. There is no established standard-of-care treatment protocol for PTCL-NOS, several chemotherapy drug combinations are frequently used as a frontline treatment with an overall 5-year survival rate of 25%. We present a case of a 35-year old Hispanic woman who initially presented with a chief complaint of bilateral lower extremity swelling due to hypoalbuminemia and new-onset hyperkeratotic skin of the palms and soles.
Transoral Robotic Surgery for Obstructive Sleep Apnoea-Hypopnoea Syndrome
Authors: Vauterin Tom , Garas George , Arora  Asit
Published: June 2018

Obstructive sleep apnoea-hypopnoea (OSAH) syndrome constitutes a major health care problem. Surgical modalities for the treatment of OSAH are regaining momentum in view of the increasing prevalence of OSAH and the low compliance rates associated with continuous positive airway pressure. There are several investigations to complement clinical examination in accurately determining the level of airway collapse to ensure correct patient selection and a targeted surgical approach. The most commonly employed include drug-induced sleep endoscopy and imaging with the tongue base and epiglottis often revealed as the major sites of airway narrowing during sleep. In the continuing search for the optimal approach to address these areas, transoral robotic surgery (TORS) has been successfully used for tongue base reduction and epiglottoplasty. With sufficient experience, this technique is safe and well tolerated. Meticulous work-up and careful patient selection are crucial. Multiple studies have demonstrated very good short-term results of TORS for OSAH, with significant reduction in both the Apnoea-Hypopnea Index (AHI) and Epworth Sleepiness Score (ESS). With the appropriate infrastructure, proctoring, and access to robotic surgical technology, it is possible for these results to be reproduced more widely. Further prospective long-term clinical evaluation will ultimately determine the exact role of TORS in the treatment of OSAH.
Predictors of Daytime Consequences of Insomnia: The Roles of Quantitative Criteria and Nonrestorative Sleep
Authors: Chung Ka-Fai , Yeung Wing-Fai , Ho Fiona Yan-Yee , Ho Lai-Ming , Yung Kam-Ping , Yu Branda Yee-Man , Kwok Chi-Wa
Published: June 2018

Background: The implications of removing nonrestorative sleep (NRS) and adding quantitative criteria in the most recent diagnostic criteria of insomnia disorder remain unresolved. The study was aimed to investigate how nighttime quantitative measures of sleep quality and NRS relate to daytime functioning in a general population sample. Sampling and Methods: Data of 905 subjects (mean age = 47.0 years; 64.5% females) in a population-based survey who had insomnia symptoms or NRS at least 1 night in a typical week were analyzed to evaluate their relationship with “functional impairment,” “concerns/distress,” and “interference with daily activities” over the past 30 days. Receiver-operating characteristic curve analysis was performed, while controlling for age and gender. Results: Moderate to severe NRS was the first-level predictor of all 3 daytime variables. Insomnia frequency ≥3 times per week and sleep onset latency ≥10–20 min were second-level predictors. Conclusions: We found that NRS was more important than insomnia symptoms in determining daytime consequences of insomnia. On the basis of our findings we express concerns whether the removal of NRS from the most recent diagnostic criteria may lead to its underrecognition, but support the quantitative criteria on insomnia frequency of at least 3 nights per week.
Involving Individuals with Disorders of Sex Development and Their Parents in Exploring New Models of Shared Learning: Proceedings from a DSDnet COST Action Workshop
Authors: Sanders Caroline , Hall Joanne , Sanders Caroline , Dessens Arianne , Bryce Jillian , Callens Nina , Cools Martine , Kourime Mariam , Kyriakou Andreas , Springer Alexander , Audi Laura , Balsamo Antonio , Iotova Violeta , Mladenov Vilhelm , Krawczynski Maciej , Nordenskjöld Agneta , Rozas Marta , Claahsen-van der Grinten Hedi , Hiort Olaf , Riedl Stefan , Ahmed S. Faisal
Published: June 2018

The level of connection between health care professionals and people who experience a condition that affects sex development is variable. These people and associated support groups need to be included in discussions about research and healthcare delivery. The aim of this study was to understand the experiences of individuals with disorders of sexual development (DSD), their parents, health care providers, and support groups. Workshop planning, preparation, delivery, and evaluation involved members of working groups from the COST Action DSDnet. A coordinator, in collaboration with a support group representative, led the workshop design and delivery. Our successful, facilitated workshop involved 33 attendees from 8 EU countries. The workshop provided individuals with DSD, parents, advisory groups, and professionals with an opportunity for shared learning. Outputs focused on 7 key areas, including diagnosis, childhood, and transition to adult care as well as fostering discussion around registries, future research topics, consent processes, and information needs across the life course. The importance of trustworthy and knowledgeable providers, time to understand such rare conditions, and the place support groups have in a life course approach were valuable learning points for all attendees. In conclusion, workshops can be designed and delivered in meaningful ways for all those involved in care of individuals with rare conditions.
Sleep Apnea, the Risk of Developing Heart Failure, and Potential Benefits of Continuous Positive Airway Pressure (CPAP) Therapy
Authors: Holt Anders , Bjerre Jenny , Zareini Bochra , Koch Henning , Tønnesen Philip , Gislason Gunnar H. , Nielsen Olav W. , Schou Morten , Lamberts Morten
Published: June 2018

Background

Whether there is an association between sleep apnea (
SA
) and the risk of developing heart failure (
HF
) is unclear. Furthermore, it has never been established whether continuous positive airway pressure (
CPAP
) therapy can prevent development of
HF
. We aimed to investigate
SA
patients’ risk of developing
HF
and the association of
CPAP
therapy.

Methods and Results

Using nationwide databases, the entire Danish population was followed from 2000 until 2012. patients with
SA
receiving and not receiving
CPAP
therapy were identified and compared with the background population. The primary end point was first‐time hospital contact for
HF
and adjusted incidence rate ratios of
HF
were calculated using Poisson regression models. Among 4.9 million individuals included, 40 485 developed
SA
during the study period (median age: 53.4 years, 78.5% men) of whom 45.2% received
CPAP
therapy. Crude rates of
HF
were increased in all patients with
SA
relative to the background population. In the adjusted model, the incidence rate ratios of
HF
were increased in the untreated
SA
patients of all ages, compared with the background population. Comparing the
CPAP
‐treated patients with
SA
with the untreated patients with
SA
showed significantly lower incidence rate ratios of
HF
among older patients.

Conclusions

In this nationwide cohort study,
SA
not treated with
CPAP
was associated with an increased risk of
HF
in patients of all ages. Use of
CPAP
therapy was associated with a lower risk of incident
HF
in patients >60 years of age, suggesting a protective effect of
CPAP
therapy in the elderly.
The Returns to Education at Community Colleges: New Evidence from the Education Longitudinal Survey
Authors: Marcotte Dave E.
Published: June 2018

I use nationally representative data from the Education Longitudinal Survey (ELS) to update the literature on returns to community college education. I compare the experiences of the ELS cohort that graduated high school in 2004 with those of the National Education Longitudinal Survey (NELS) cohort that graduated high school more than a decade earlier, in 1992. I estimate that community college students from the ELS cohort were more likely to be employed, and that those who were earned about 21 percent more than comparable peers with only a high school education. This estimate is at least as large as that observed for the NELS cohort, though I find some evidence that the value of an associate's degree is smaller for the more recent cohort. I compare these results with those from the burgeoning body of research using state administrative data to answer similar questions.
Introduction to ‘Strategy and Politics’
Authors: Roso Darren
Published: June 2018

In the following article, I situate Daniel Bensaïd’s ‘Strategy and Politics’ within the different phases of his thinking about strategy as well as his own general theoretical background that informs parts of the text.
Making genealogical language classifications available for phylogenetic analysis
Authors: Dediu Dan
Published: June 2018

One of the best-known types of non-independence between languages is caused by genealogical relationships due to descent from a common ancestor. These can be represented by (more or less resolved and controversial) language family trees. In theory, one can argue that language families should be built through the strict application of the comparative method of historical linguistics, but in practice this is not always the case, and there are several proposed classifications of languages into language families, each with its own advantages and disadvantages. A major stumbling block shared by most of them is that they are relatively difficult to use with computational methods, and in particular with phylogenetics. This is due to their lack of standardization, coupled with the general non-availability of branch length information, which encapsulates the amount of evolution taking place on the family tree. In this paper I introduce a method (and its implementation in R) that converts the language classifications provided by four widely-used databases (Ethnologue, WALS, AUTOTYP and Glottolog) into the de facto Newick standard generally used in phylogenetics, aligns the four most used conventions for unique identifiers of linguistic entities (ISO 639-3, WALS, AUTOTYP and Glottocode), and adds branch length information from a variety of sources (the tree’s own topology, an externally given numeric constant, or a distance matrix). The R scripts, input data and resulting Newick trees are available under liberal open-source licenses in a GitHub repository (https://github.com/ddediu/lgfam-newick), to encourage and promote the use of phylogenetic methods to investigate linguistic diversity and its temporal dynamics.