bluuebunny/crossref_metadata_2025 huggingface dataset:
The Net Landscape Carbon Balance—Integrating terrestrial and aquatic carbon fluxes in a managed boreal forest landscape in Sweden
Authors: Chi Jinshu , Nilsson Mats B. , Laudon Hjalmar , Lindroth Anders , Wallerman Jörgen , Fransson Johan E. S. , Kljun Natascha , Lundmark Tomas , Ottosson Löfvenius Mikaell , Peichl Matthias
Published: January 2020

The boreal biome exchanges large amounts of carbon (C) and greenhouse gases (GHGs) with the atmosphere and thus significantly affects the global climate. A managed boreal landscape consists of various sinks and sources of carbon dioxide (CO2), methane (CH4), and dissolved organic and inorganic carbon (DOC and DIC) across forests, mires, lakes, and streams. Due to the spatial heterogeneity, large uncertainties exist regarding the net landscape carbon balance (NLCB). In this study, we compiled terrestrial and aquatic fluxes of CO2, CH4, DOC, DIC, and harvested C obtained from tall‐tower eddy covariance measurements, stream monitoring, and remote sensing of biomass stocks for an entire boreal catchment (~68 km2) in Sweden to estimate the NLCB across the land–water–atmosphere continuum. Our results showed that this managed boreal forest landscape was a net C sink (NLCB = 39 g C m−2 year−1) with the landscape–atmosphere CO2 exchange being the dominant component, followed by the C export via harvest and streams. Accounting for the global warming potential of CH4, the landscape was a GHG sink of 237 g CO2‐eq m−2 year−1, thus providing a climate‐cooling effect. The CH4 flux contribution to the annual GHG budget increased from 0.6% during spring to 3.2% during winter. The aquatic C loss was most significant during spring contributing 8% to the annual NLCB. We further found that abiotic controls (e.g., air temperature and incoming radiation) regulated the temporal variability of the NLCB whereas land cover types (e.g., mire vs. forest) and management practices (e.g., clear‐cutting) determined their spatial variability. Our study advocates the need for integrating terrestrial and aquatic fluxes at the landscape scale based on tall‐tower eddy covariance measurements combined with biomass stock and stream monitoring to develop a holistic understanding of the NLCB of managed boreal forest landscapes and to better evaluate their potential for mitigating climate change.
Phase diagram of the Li2SO4–Na2SO4 system
Authors: Fedorov Pavel P. , Proydakova Vera Y. , Kuznetsov Sergey V. , Voronov Valery V. , Pynenkov Alexandr A. , Nishchev Konstantin N.
Published: January 2020

The thermal analysis and X‐ray powder diffraction studies of the Li2SO4–Na2SO4 system, including the high‐temperature X‐ray diffraction technique, have elucidated four phases of variable composition: three solid solutions based on the α‐Li2SO4, α‐Na2SO4, and α‐LiNaSO4 high‐temperature polymorphs, and a low‐temperature β‐LiNaSO4 phase. α‐Na2SO4‐Base solid solution disintegrates into two phases via a monotectoid phase transformation. It is quite probable that the monotectoid process is related to the conversion of the second‐order phase transition to the first‐order phase transition.
Co‐doping effects of (Al, Ti, Mg) on the microstructure and electrical behavior of ZnO‐based ceramics
Authors: Sun Qianying , Li Guorong , Tian Tian , Zeng Jiangtao , Zhao Kunyu , Zheng Liaoying , Barré Maud , Dittmer Jens , Gouttenoire Francois , Rousseau Anthony , Kassiba Abdel Hadi
Published: January 2020

Co‐doped ZnO‐based ceramics using Al, Ti, and Mg ions in different ratios were synthesized with the objective to investigate the doping effects on the crystalline features, microstructure and the electrical behavior. For Al and Ti doping, a coexistence of crystalline phases was shown with a major wurtzite ZnO structure and secondary spinel phases (ZnAl2O4, Zn2TiO4, or ZnaTibAlcOd), while Mg doping did not alter significantly the structural features of the wurtzite ZnO phase. The electrical behavior induced by Al, Ti, and Mg co‐doping in different ratios was investigated using Raman, electron paramagnetic resonance (EPR) and 27Al and 67Zn solid‐state nuclear magnetic resonance (NMR). Al doping induces a high electrical conductivity compared to other doping elements. In particular, shallow donors from Zni‐AlZn defect structures are inferred from the characteristic NMR signal at about 185 ppm; that is, quite far from the usual oxygen coordinated Al. The Knight shift effect emanating from a highly conducting Al‐doped ZnO ceramics was considered as the origin of this observation. Oppositely, as Ti doping leads to the formation of secondary spinel phases, EPR analysis shows a high concentration of Ti3+ ions which limit the electrical conductivity. The correlation between the structural features at the local order, the involved defects and the electrical behavior as function of the doping process are discussed.
High energy storage efficiency and thermal stability of A‐site‐deficient and 110‐textured BaTiO3–BiScO3 thin films
Authors: Abbas Waseem , Ho Derek , Pramanick Abhijit
Published: January 2020

The development of thin film dielectrics having both high energy density and energy conversion efficiency, as well as good thermal stability, is necessary for practical application in high‐temperature power electronics. In addition, there is a demand for the development of new Pb‐free high‐energy density dielectric materials due to environmental concerns. In this regard, thin films of weakly coupled relaxors based on solid solutions of BaTiO3–BiMeO3 have shown good promise, because they exhibit a remarkably large polarization over a wide temperature range. Nevertheless, the performance of Pb‐free thin films has lagged behind that of their Pb‐based counterparts in terms of thermal stability and energy conversion efficiency. Toward this end, most recent studies on BaTiO3–BiMeO3 systems have focused on the optimization of material composition, while relatively less attention has been paid to other aspects such as defect chemistry and crystallographic texture. In this study, we examine the effects of A‐site vacancy and crystallographic texture on the energy storage performance of BaTiO3–BiScO3 thin films synthesized using pulsed laser deposition (PLD). It is shown that a high energy storage density (Wr) of ~28.8 J/cm3 and a high efficiency of η >90% are achieved through a combination of moderate A‐site vacancy concentration and (110) crystallographic texture. Furthermore, Wr remains nearly temperature independent while a high efficiency of η >80% is maintained for temperatures up to 200°C, which constitutes one of the best performances for Pb‐free ferroelectric films for high‐temperature capacitor applications.
Estimation of additive and non‐additive genetic effects for fertility and reproduction traits in North American Holstein cattle using genomic information
Authors: Alves Kristen , Brito Luiz F. , Baes Christine F. , Sargolzaei Mehdi , Robinson John Andrew B. , Schenkel Flavio S.
Published: January 2020

Non‐additive genetic effects are usually ignored in animal breeding programs due to data structure (e.g., incomplete pedigree), computational limitations and over‐parameterization of the models. However, non‐additive genetic effects may play an important role in the expression of complex traits in livestock species, such as fertility and reproduction traits. In this study, components of genetic variance for additive and non‐additive genetic effects were estimated for a variety of fertility and reproduction traits in Holstein cattle using pedigree and genomic relationship matrices. Four linear models were used: (a) an additive genetic model; (b) a model including both additive and epistatic (additive by additive) genetic effects; (c) a model including both additive and dominance effects; and (d) a full model including additive, epistatic and dominance genetic effects. Nine fertility and reproduction traits were analysed, and models were run separately for heifers (N = 5,825) and cows (N = 6,090). For some traits, a larger proportion of phenotypic variance was explained by non‐additive genetic effects compared with additive effects, indicating that epistasis, dominance or a combination thereof is of great importance. Epistatic genetic effects contributed more to the total phenotypic variance than dominance genetic effects. Although these models varied considerably in the partitioning of the components of genetic variance, the models including a non‐additive genetic effect did not show a clear advantage over the additive model based on the Akaike information criterion. The partitioning of variance components resulted in a re‐ranking of cows based solely on the cows’ additive genetic effects between models, indicating that adjusting for non‐additive genetic effects could affect selection decisions made in dairy cattle breeding programs. These results suggest that non‐additive genetic effects play an important role in some fertility and reproduction traits in Holstein cattle.
Global biogeographic synthesis and priority conservation regions of the relict tree family Juglandaceae
Authors: Song Yi‐Gang , Fragnière Yann , Meng Hong‐Hu , Li Ying , Bétrisey Sébastien , Corrales Adriana , Manchester Steven , Deng Min , Jasińska Anna K. , Văn Sâm Hoàng , Kozlowski Gregor
Published: January 2020

Aim

To establish a complete database of Juglandaceae at a spatiotemporal scale and develop a phylogeographic framework with which to elucidate the distributional patterns, diversity patterns, origins, evolution, and conservation priority regions of this family.

Location

Worldwide.

Taxon

Walnut family (Juglandaceae).

Methods

Data on the distribution of all the extant and fossil species of Juglandaceae were collected, followed by analyses of its latitudinal distribution, elevational distribution, and species and generic diversity. Furthermore, based on all genera and 87% of the species, we reconstructed phylogenetic relationships, estimated divergence times, calculated phylogenetic diversity and inferred ancestral distributions.

Results

Extant Juglandaceae (10 genera and 60 species) are mainly distributed in eastern Asia and North America (principally between 20 and 40°N). Tropical Juglandaceae mainly inhabit mountainous areas higher than 1,000 m, especially in the New World. Southwest China and northern Vietnam are characterized by high species, generic and phylogenetic diversity. The United States of America has only high species diversity. The area of origin of Juglandaceae was North America and Europe in the early Eocene, and its widespread dispersal mainly occurred between 13 and 26 Ma.

Main conclusions

The members of Juglandaceae inhabit areas with temperate climatic conditions. The diversification centre has shifted intercontinentally from North America and Europe to Southwest China and northern Vietnam, which are identified as conservation priority regions. The high‐latitude cooling during the Oligocene followed by a long‐term stable warmer climate in the early and middle Miocene drove the southward translocation of the family.
Resective surgery for the treatment of furcation involvement: A systematic review
Authors: Dommisch Henrik , Walter Clemens , Dannewitz Bettina , Eickholz Peter
Published: January 2020

Objective

To evaluate the benefit of resective surgical periodontal therapy (root amputation or resection, root separation, tunnelling) in periodontitis patients exhibiting class II and III furcation involvement (FI) compared with non‐surgical treatment (SRP) or open flap debridement (OFD).

Material

Outcomes were tooth survival (primary), vertical probing attachment gain, and reduction in probing pocket depth (secondary) evidenced by randomized clinical trials, prospective and retrospective cohort studies and case series with ≥ 12 months of follow‐up. Search was performed on 3 electronic databases from January 1998 to December 2018.

Results

From a total of 683 articles, 66 studies were identified for full‐text analysis and 7 studies finally included. Six hundred sixty‐seven patients contributed 2,021 teeth with class II or III FI. Data were very heterogeneous regarding follow‐up and distribution of FI. A total of 1,515 teeth survived 4 to 30.8 years after therapy. Survival ranged from 38%–94.4% (root amputation or resection, root separation), 62%–67% (tunnelling), 63%–85% (OFD) and 68%–80% (SRP). Overall, treatment provided better results for class II FI than class III.

Conclusion

Within their limits, the data indicate that in class II and III FI, SRP and OFD may result in similar survival rates as root amputation/resection, root separation or tunnelling.
The efficacy of pocket elimination/reduction compared to access flap surgery: A systematic review and meta‐analysis
Authors: Polak David , Wilensky Asaf , Antonoglou Georgios N. , Shapira Lior , Goldstein Moshe , Martin Conchita
Published: January 2020

Aim

To assess the efficacy and adverse effects of resective surgery compared to access flap in patients with periodontitis.

Methods

Randomized controlled trials with a follow‐up ≥6 months were identified in ten databases. Screening, data extraction, and quality assessment were conducted by two reviewers. The primary outcome was probing pocket depth, and the main secondary outcome was clinical attachment level. Data on adverse events were collected. Meta‐analysis was used to synthesize the findings of trials.

Results

A total of 880 publications were identified. Fourteen publications from nine clinical trials met the inclusion criteria and were included for analysis. Meta‐analysis was carried out using all available results. The results indicated superior pocket depth reduction following resective surgery compared to access flap after 6–12 months of follow‐up (weighted mean difference 0.47 mm; confidence interval 0.7–0.24; p = .010). After 36–60 months of follow‐up, no differences were found between the two treatments in pocket depth and attachment level. The prevalence of adverse effects was not different between the groups. Post‐operative recession tended to be more severe for the resective approaches.

Conclusion

Resective surgical approach was superior to access flap in reducing pocket depth 6–12 months post‐surgery, while no differences between the two modalities were found at 36–60 months of follow‐up.
Association of prosthetic features and peri‐implantitis: A cross‐sectional study
Authors: Yi Yuseung , Koo Ki‐Tae , Schwarz Frank , Ben Amara Heithem , Heo Seong‐Joo
Published: January 2020

Objective

To identify the influence of prosthetic features through a comprehensive analysis with other known risk factors.

Materials and methods

A total of 169 patients (n = implants: 349) was retrospectively included in the present study. Peri‐implantitis was diagnosed based on peri‐implant bone loss and probing depth. Using radiographs taken 1 and 5 years following prosthesis insertion, the following features were determined: peri‐implant marginal bone loss (MBL), emergence angle (EA), emergence profile (EP) and crown/implant ratio (CIR). The splinted position of prosthesis was also recorded. Multivariable generalized estimating equation was used to analyse the influence of each feature on the prevalence of peri‐implantitis. The final prediction model was constructed by Cox proportional hazard regression analysis.

Results

The EA showed a significant correlation with MBL. A statistically greater prevalence of peri‐implantitis was observed if EA ≥ 30 degrees, when EP is convex and in middle implant splinted with both mesial and distal adjacent implants in bone‐level implant. A similar correlation was not observed in tissue‐level implants. CIR had no significant effect on the prevalence of peri‐implantitis.

Conclusion

Over‐contoured implant prosthesis is a critical local confounder for peri‐implantitis. The implant splinted to both mesial and distal adjacent implant has a higher risk of peri‐implantitis.
Analysing flash flood risk perception through a geostatistical approach in the village of Navaluenga, Central Spain
Authors: Guardiola‐Albert Carolina , Díez‐Herrero Andrés , Amerigo Cuervo‐Arango María , Bodoque Jose María , García Juan A. , Naranjo‐Fernández Nuria , Aroca‐Jiménez Estefanía
Published: January 2020

Flash floods are unexpected events, which evolve rapidly and affect relatively small areas. The short time available for minimising risks requires preparedness and active response. In this context of risk management, the flood risk perception of the local population is the first step towards achieving resilience of people and communities. Although flood risk perception has intrinsic spatial variability, few previous studies take this into account. This paper explores the spatial variability of flash flood risk perception in the village of Navaluenga in Central Spain, using nonparametric and multivariate geostatistical tools. How local people perceived the flash flood risk to their homes was assessed interviewing a representative sample. Results show that considering these flash flood risk related spatial variables enhances people's psychological interpretation of risk perception: the perception of flash flood risk in a short time event is congruent with those spatial variables. These findings determine priority areas for future risk communication plans. They could also be extrapolated to other urban areas with a similar hydrographic configuration, when there is a flood hazard from a main river and potentially flooded minor water courses, which are even closer to houses but are not considered dangerous by the local population.
Colonization of endophyte Acremonium sp. D212 in Panax notoginseng and rice mediated by auxin and jasmonic acid
Authors: Han Li , Zhou Xuan , Zhao Yiting , Zhu Shusheng , Wu Lixia , He Yunlu , Ping Xiangrui , Lu Xinqi , Huang Wuying , Qian Jie , Zhang Lina , Jiang Xi , Zhu Dan , Luo Chongyu , Li Saijie , Dong Qian , Fu Qijing , Deng Kaiyuan , Wang Xin , Wang Lei , Peng Sheng , Wu Jinsong , Li Weimin , Friml Jiří , Zhu Youyong , He Xiahong , Du Yunlong
Published: January 2020

Endophytic fungi can be beneficial to plant growth. However, the molecular mechanisms underlying colonization of Acremonium spp. remain unclear. In this study, a novel endophytic Acremonium strain was isolated from the buds of Panax notoginseng and named Acremonium sp. D212. The Acremonium sp. D212 could colonize the roots of P. notoginseng, enhance the resistance of P. notoginseng to root rot disease, and promote root growth and saponin biosynthesis in P. notoginseng. Acremonium sp. D212 could secrete indole‐3‐acetic acid (IAA) and jasmonic acid (JA), and inoculation with the fungus increased the endogenous levels of IAA and JA in P. notoginseng. Colonization of the Acremonium sp. D212 in the roots of the rice line Nipponbare was dependent on the concentration of methyl jasmonate (MeJA) (2–15 μmol/L) and 1‐naphthalenacetic acid (NAA) (10–20 μmol/L). Moreover, the roots of the JA signaling‐defective coi1‐18 mutant were colonized by Acremonium sp. D212 to a lesser degree than those of the wild‐type Nipponbare and miR393b‐overexpressing lines, and the colonization was rescued by MeJA but not by NAA. It suggests that the cross‐talk between JA signaling and the auxin biosynthetic pathway plays a crucial role in the colonization of Acremonium sp. D212 in host plants.
The “Mula Ring”: Material Networks of Circulation Through the Cuban World
Authors: Cearns Jennifer
Published: January 2020

Este artículo está basado en quince meses de trabajo de campo etnográfico en Cuba, los EE. UU., México, Panamá y Guyana para describir una red transnacional emergente de circulación de materiales que llamo el “circuito mula.” Muestro cómo los cubanos movilizan vastas redes transnacionales para realizar sus sistemas de circulación de materiales en la actualidad. Estas redes equivalen a una economía en sí misma que está redefiniendo lo que significa ser cubano dentro y fuera de la isla. Muestro cómo esta economía informal se basa en esferas de circulación e intercambio de género preexistentes, así como en nuevas modalidades de poder, cuyos efectos se pueden sentir lejos de la propia isla. De hecho, esta red, que surge de una escasez material histórica desde el socialismo, está conduciendo a la reificación de nuevas estructuras de clase, que la Revolución se había propuesto inicialmente desmantelar.
Efficacy of Diabetes Education in Adults With Diabetes Mellitus Type 2 in Primary Care: A Systematic Review
Authors: Cruz‐Cobo Celia , Santi‐Cano M José
Published: January 2020

Purpose

To analyze the effect of different diabetes education methods on metabolic control, body mass index (BMI), and blood pressure.

Design

A systematic review was carried out.

Data Sources

PubMed, Medline, Embase, Cochrane, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), CUIDEN, Ibecs, and Scopus databases were consulted. The search was done in May 2018. Studies included controlled clinical trials on diabetes education in primary care that were published in English and Spanish during the years 2011 to 2018.

Results

The post‐intervention results were as follows: glycosylated hemoglobin concentration (HbA1c) ranged between ‐1.6% (individual education [IE]) and + 0.05% (mixed education [ME]). The values of BMI varied from ‐0.7% (group education [GE]) to ‐0.3% (GE). Systolic blood pressure (SBP) and diastolic blood pressure (DBP) fluctuated. SBP varied from ‐8.5 mmHg (GE) to +2.9 mmHg (GE); DBP varied from ‐3.1 mmHg (GE) to ‐0.9 mmHg (GE). Total cholesterol ranged from ‐15.9/dL (GE) to +2 mg/dL (GE). LDL cholesterol ranged from ‐18.3 mg/dL (GE) to ‐7 mg/dL (ME). HDL cholesterol ranged from +0.8 mg/dL (IE) to +8.12 mg/dL (GE). Triglycerides varied from ‐21.1 mg/dL (GE) to +11.0 (GE).

Conclusions

The most profound decrease in HbA1c was achieved using individual education. However, to decrease BMI, SBP, DBP, total cholesterol, LDL cholesterol, and triglycerides, group education was the most effective intervention.

Clinical Relevance

To obtain good metabolic control, it is necessary to address both clinical and psychological aspects, including modifying nutritional and dietary habits, monitoring medication, increasing knowledge of diabetes, and combining theoretical content with physical exercise programs. Reinforcement strategies are very important to achieve the objectives of educational programs.
“There is anointing everywhere”: An interpretative phenomenological analysis of the role of religion in the recovery of Black African service users in England
Authors: Tuffour Isaac
Published: January 2020

Accessible summary

What is known on the subject?

Religion plays important role in recovery from mental illness.

Religion can have both positive and negative effects on recovery.

What does this paper add to existing knowledge?

It is conceivable for Black African service users (BASUs) to engage with the mainstream mental health services at the onset of their symptoms.

BASUs see mental illness and recovery through the lens of religion. They mostly use Pentecostalism and traditional African healing systems to aid their recovery.

The mainstream mental health system and the traditional African healing system exist in harmony for BASUs who are open to simultaneously access both services.

What are the implications for practice?

There is a need to recognize that most Black Africans have unique ways of practising their Christianity. Thus, broad changes are needed in the services to support religious coping tailored to the individual persons in their recovery journey.

There is a need for service providers and healthcare professionals to integrate Pentecostalism and traditional African healing systems into the recovery processes. It should equally be recognized that such changes could trigger confusion, dilemmas and paradoxes.

Service providers and healthcare professionals must build partnership and collaborative working with cultural practitioners and the clergy from the Black African communities to facilitate recovery and address any misunderstandings.

Introduction

Religion is an important impetus for recovery. However, there has been little work examining the role of religion in recovery for Black African service users (BASUs) in England.

Aim

The aim of this study was to explore how religion influences recovery from mental illness for BASUs in England.

Method

Twelve Black African service users were purposively selected and interviewed using face‐to‐face semi‐structured interviews. Data were analysed using interpretative phenomenological analysis (IPA).

Results

The study generates fascinating insights that BASUs views about mental illness and recovery are influenced by Pentecostalism and traditional African healing systems.

Discussion

The participants' perceptions of their mental illness experiences and recovery which are characterized by the pragmatism of Pentecostalism and cultural beliefs are consistent with what is reported in the literature.

Implications for practice

The findings of the study show that broad changes are needed to accommodate the religious coping of BASUs in their recovery journey.
Prevalence and correlates of sleep apnea among US Veterans with chronic kidney disease
Authors: Canales Muna T. , Bozorgmehri Shahab , Ishani Areef , Weiner I. David , Berry Richard , Beyth Rebecca
Published: January 2020

The prevalence and correlates of sleep apnea (SA) among Veterans with chronic kidney disease (CKD), a population at high risk of both SA and CKD, are unknown. We performed a cross‐sectional analysis of 248 Veterans (18–89 years) selected only for presence of moderate to severe CKD. All participants underwent full, unattended polysomnography, measurement of renal function and a sleepiness questionnaire. Logistic regression with backward selection was used to identify predictors of prevalent SA (apnea–hypopnea index [AHI, ≥15 events/hr] and prevalent nocturnal hypoxia [NH, % of total sleep time spent at <90% oxygen saturation]). The mean age of our cohort was 73.2 ± 9.6 years, 95% were male, 78% were Caucasian and the mean body mass index (BMI) was 30.3 ± 4.8 kg/m2. The prevalence of SA was 39%. There was no difference in daytime sleepiness among those with and without SA. In the final model, older age, higher BMI and diabetes mellitus (DM) were associated with higher odds of SA, after controlling for age, BMI, race and sex. Higher BMI, DM, unemployed/retired status, current smoking and higher serum bicarbonate level were associated with prevalent NH. To sum, SA was common among Veterans with moderate to severe CKD. Although some traditional risk factors for SA were associated with SA in this population, sleepiness did not correlate with SA. Further study is needed to validate our findings and understand how best to address the high burden of SA among Veterans with CKD.
‘Being international is always a good thing’: A multicentre interview study on ethics in international medical education
Authors: Brouwer Emmaline , Frambach Janneke , Somodi Klara , Nadarajah Vishna Devi , Driessen Erik
Published: January 2020

Context

Internationalisation in medical education raises ethical concerns over, for instance, its for‐profit orientation, the potential erosion of cultural diversity and the possibility that standardised education may not meet the needs of patients everywhere. These concerns fit into a broader debate on social responsibility in higher education. This study aims to explore how academic staff in international medical education experience and act upon the ethical concerns that pertain to their programmes. By adding their perspectives to the debate, this study helps us understand how theory‐based ethical concerns are reflected in practice.

Methods

We conducted a multicentre instrumental case study across three international medical programmes, all of which were characterised by an international student intake, an internationalised curriculum and international partnerships, and all of which used English as the medium of instruction. We conducted 24 semi‐structured interviews with purposively sampled curriculum directors and teaching staff. Participants shared their personal experiences and responded to ethical concerns expressed in the literature. Our multidisciplinary team performed a template analysis of the data based on theoretical frameworks of ethics and social responsibility.

Results

Participants primarily experienced the internationalisation of their institutions and programmes as having a positive impact on students, the university and the future global society. However, they did face several ethical dilemmas. The first of these involved the possibility that marketisation through international recruitment and the application of substantial tuition fees might widen access to medical education, but might allow weaker students to enter medical schools. The second concern referred to the homogenisation of education methods and content, which offers opportunities to expose students to best practices, but may also pose a risk to education quality. The third issue referred to the experience that although student diversity helped to promote intercultural learning, it also jeopardised student well‐being.

Conclusions

In the eyes of teaching staff in international medical education, internationalisation can benefit education quality and society, but poses ethical dilemmas through the forces of marketisation, homogenisation and diversification. The findings reflect a tension between the views of scholars and those of practitioners. The critical perspective found in academic debates is largely missing in practice, and theoretical frameworks on ethics possibly overlook the benefits of international education. To facilitate ethical decision making, we propose that scholars and practitioners globally try to learn from each other.
The cognitive process of test takers when using the script concordance test rating scale
Authors: Gawad Nada , Wood Timothy J. , Cowley Lindsay , Raiche Isabelle
Published: January 2020

Context

Clinical decision making (CDM) skills are important to learn and assess in order to establish competence in trainees. A common tool for assessing CDM is the script concordance test (SCT), which asks test takers to indicate how a new clinical finding influences a proposed plan using a Likert‐type scale. Most criticisms of the SCT relate to its rating scale but are largely theoretical. The cognitive process of test takers when selecting their responses using the SCT rating scale remains understudied, but is essential to gathering validity evidence for use of the SCT in CDM assessment.

Methods

Cases from an SCT used in a national validation study were administered to 29 residents and 14 staff surgeons. Semi‐structured cognitive interviews were then conducted with 10 residents and five staff surgeons based on the SCT results. Cognitive interview data were independently coded by two data analysts, who specifically sought to elucidate how participants mapped their internally generated responses to any of the rating scale options.

Results

Five major issues were identified with the response matching cognitive process: (a) the meaning of the ‘0' response option; (b) which response corresponds to agreement with the planned management; (c) the rationale for picking ‘±1' versus ‘±2'; (d) which response indicates the desire to undertake the planned management plus an additional procedure, and (e) the influence of time on response selection.

Conclusions

Studying how test takers (experts and trainees) interpret the SCT rating scale has revealed several issues related to inconsistent and unintended use. Revising the scale to address the variety of interpretations could help to improve the response process validity of the SCT and therefore improve the SCT's ability to be used in CDM skills assessments.
Students as patients: A systematic review of peer simulation in health care professional education
Authors: Dalwood Narelle , Bowles Kelly‐Ann , Williams Cylie , Morgan Prue , Pritchard Shane , Blackstock Felicity
Published: January 2020

Context

Evidence supports the substitution of both clinical placement time and traditional educational activities with simulation‐based education (SBE). However, lack of resources can be a barrier to SBE implementation. Peer simulation provides an alternative to simulated patient (SP)‐based SBE by educating students to portray patient roles. This diversifies learning experiences for students using SBE and may decrease costs.

Objectives

This study aimed to determine the impact of students portraying the roles of patients in a simulation‐based learning environment (peer simulation) on learning outcomes in entry‐level health care professional students.

Methods

Seven databases were searched (from inception to 8 May 2019) using terms including ‘peer simulation,’ ‘role‐play’ and ‘simulated/standardised patient.’ The studies included described a health care professional student SBE interaction involving peer simulation. Data were extracted by two independent investigators. Study quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI) and Critical Appraisal Skills Programme (CASP). A descriptive analysis was completed and meta‐analysis conducted in instances in which outcomes could be pooled.

Results

A total of 12 studies met the inclusion criteria. Constructs measured by the studies included communication, empathy, self‐efficacy and confidence. Five randomised controlled trials compared peer simulation with the use of SPs and demonstrated greater or equivalent patient empathy gains in peer simulation. Meta‐analysis determined no difference in communication capabilities between the two groups. Students perceived peer simulation as comparably valuable and frequently superior to other forms of learning. This review was unable to determine effective design features of peer simulation initiatives.

Conclusions

Students were positive about peer simulation, but there has been limited evaluation of learning outcome attainment. Significant heterogeneity was observed; studies were diverse in design, outcome measures and the training provided for peer patients. Peer simulation positively influences student communication and development of patient empathy and offers an alternative to learning with SPs. Further rigorous research is required to understand the impact of peer simulation for a broader range of learning outcomes and to confirm the impact of this developing educational approach.
Healthy lifestyle score and irritable bowel syndrome: A cross‐sectional study in adults
Authors: Hajishafiee Maryam , Keshteli Ammar H. , Saneei Parvane , Feinle‐Bisset Christine , Esmaillzadeh Ahmad , Adibi Peyman
Published: January 2020

Background

Lifestyle modifications play an important role in the management of irritable bowel syndrome (IBS), but there is limited information on any associations of combined lifestyle‐related factors with IBS in Middle Eastern populations. We, therefore, assessed the associations of a “lifestyle score,” in analogy to lifestyle scores applied in studies of other disorders, with IBS in adults.

Methods

In a cross‐sectional study on 3363 Iranian adults, a healthy lifestyle score (HLS) was constructed using information about dietary habits, dietary intake, physical activity, smoking status, and psychological distress, which was collected using validated questionnaires. A modified version of the Rome III questionnaire (in Persian) was used to diagnose IBS and its subtypes.

Key Results

Individuals with the highest HLS had a 65% lower odds of having IBS compared with those in the lowest category (OR: 0.35; 95% CI: 0.26‐0.48). Participants with healthy dietary habits, including regular meal pattern, slow/moderate eating rate, moderate intra‐meal fluid consumption, moderate/long meal‐to‐sleep interval, and low/moderate consumption of fatty foods, had significantly lower odds of having IBS compared with those with unhealthy dietary habits (OR: 0.81; 95% CI: 0.69‐0.96). Moreover, individuals with lower levels of psychological distress, compared with those with higher levels of distress, had significantly lower odds of IBS (OR: 0.49; 95% CI: 0.40‐0.60).

Conclusions and Inferences

Our data suggest that having an overall “healthy lifestyle” is related to substantially reduced odds of IBS, suggesting that adhering to a healthy lifestyle pattern, including dietary habits, diet quality, physical activity, smoking, and psychological distress, can be considered as a key management strategy for IBS.
An evaluation of the impact of lifestyle interventions on body weight in postpartum women: A systematic review and meta‐analysis
Authors: Lim Siew , Hill Briony , Teede Helena J. , Moran Lisa J. , O'Reilly Sharleen
Published: January 2020

The established efficacy in postpartum lifestyle interventions has not been translated into better outcomes. This systematic review and meta‐analysis assess the penetration (the proportion of women invited within the target population), implementation (fidelity), participation (the proportion of those invited who enrolled), and effect (weight loss compared to controls) (PIPE) of randomized controlled trials of lifestyle interventions in postpartum women (within two years after birth). MEDLINE, EMBASE, Pubmed, and other databases and clinical trial registries were searched up to the 3rd of May 2019. Data was extracted from published reports and missing data was obtained from study authors. The quality of the studies was appraised using the Cochrane Risk of Bias tool (2·0). Main outcomes were the PIPE impact metrics and changes in body weight. Thirty‐six trials (49 publications) were included (n=5,315 women). One study provided sufficient information to calculate the population penetration rate (2·5%). All studies provided implementation (fidelity) information, but over half had low program fidelity. The participation rate was calculated for nine studies (0·94% to 86%). There was significant change in body weight (mean difference (MD) (95% confidence interval, CI) of ‐2·33 (‐3·10 to ‐1·56). This highlights the inadequacy of conventional RCTs to inform implementation. Future research should broaden methods to pragmatic trials.
THE FINDSPOTS OF BRONZE AGE METALWORK IN LOWLAND ENGLAND: A NEW FIELD STUDY
Authors: Dunkin David , Yates David , Bradley Richard
Published: January 2020

This paper is concerned with the deposition of Middle and Late Bronze Age metalwork in three study areas extending from the coast of south‐east England to the edge of the Fenland. It considers where hoards and single finds have been discovered and is based on inspection of over 300 findspots on the ground. It investigates regions in which tools and ornaments are common, but also extends to those with a stronger representation of weapons. While rapiers, swords and spears are found in rivers, terrestrial finds often come from sites close to springs, aquifers and confluences and favour areas with fresh water rather than salt water. Others are from more prominent locations on high ground or in low‐lying positions like dry valleys. We suggest that such places played a role in a tiered cosmology. Metalwork was deposited where the underworld or the sky came into contact with the landscapes inhabited in daily life.
Survey of analgesia and sedation in pediatric intensive care units in Japan
Authors: Koizumi Taku , Kurosawa Hiroshi
Published: January 2020

Background

High‐quality evidence of analgesia and sedation management in pediatric intensive care units (PICUs) is lacking.

Methods

An online survey concerning the institutional management of pain, sedation, delirium, and withdrawal syndrome, as well as non‐pharmacological interventions to reduce pain and / or to provide comfort, was conducted with the medical directors of 31 PICUs in Japan. The survey was conducted from September to November 2016.

Results

The response rate was 77% (24/31). Pain was routinely assessed in nine (38%) PICUs. Self‐report pain scales were used in 14 (58%) PICUs. Observational pain scales for children who were unable to self‐report were used in only one PICU. Physician‐driven analgesia protocols were used in two (8%) PICUs. Although sedation scales for intubated patients were used in 15 (63%) PICUs, they were used for the goal‐directed sedation management in nine (38%). Nurse‐driven sedation protocols were used in two (8%) PICUs. Five (21%) PICUs used delirium assessment tools, and delirium screening was not routinely done in any PICU. Five (21%) PICUs regularly used withdrawal assessment tools for a high‐risk group of patients with withdrawal syndrome. Non‐pharmacological interventions for analgesia and comfort were frequently practiced for mechanically ventilated patients.

Conclusions

This study is the first survey conducted by physicians regarding pain and agitation management in PICUs in Japan, and the results revealed great diversity in practice. The implementation strategies to assess pain, delirium, and withdrawal syndrome, as well as to set goals regarding sedation level, are lacking. Protocols for analgesia and sedation management are uncommon.
Experimental and Theoretical Study of the Stability of the Complex Fisetin–Cu(II) and A Comparative Study of Free Ligand and Complex Interaction with Molecular Singlet Oxygen
Authors: Muñoz Vanesa A. , Dimarco Palencia Frida C. D. , Sancho Matias I. , Miskoski Sandra , García Norman A. , Ferrari Gabriela V. , Montaña María Paulina
Published: January 2020

In this work, the flavonol fisetin was selected in order to study its reactivity against Cu(II), a metal ion of interest in biological media and industry. The stoichiometry and apparent formation constant of the complex in ethanolic medium at 25°C were evaluated using spectrophotometric techniques. The resulting stoichiometry was a 1:1 ligand:metal complex, and a log K = 5.17 ± 0.12 was determined. Since two possible chelation sites can be proposed for the complex formation, quantum chemistry calculations were performed on these structures. Calculations suggest that the hydroxyl‐keto site is more stable for the complex formation than the catechol site. Flavonoids could exert protection against oxidative damage caused by reactive oxygen species, and this biological activity could be affected by chelation with metal ions. This led us to perform a study on the interaction of both, free flavonoid and complex, with reactive oxygen species. Our results showed both compounds quench molecular singlet oxygen photogenerated with visible light, mainly in a physical fashion. In order to analyze a possible protective effect of flavonoid and its complex against oxidative damage in biological environments, the amino acid tryptophan was selected as a model oxidation system. Free flavonoid does not have a marked protective effect, whereas its complex showed a relevant protective effect.
Granulosa cells in three‐dimensional culture: A follicle‐like structure for domestic cat vitrified oocytes
Authors: Colombo Martina , Morselli Maria Giorgia , Apparicio Maricy , Luvoni Gaia Cecilia
Published: January 2020

Follicle‐like structures are three‐dimensional matrices joint with living cells that allow the in vitro development of female gametes in more physiological conditions. They have been shown to be beneficial to fresh oocytes in different species, and in this study, domestic cat (Felis silvestris catus) granulosa cells were used to create a functional follicle‐like structure aimed at supporting the in vitro maturation of conspecific vitrified oocytes, key players of fertility preservation programmes that usually struggle to acquire their full developmental competence after warming. Cat granulosa cells were cultured for up to 6 days in three‐dimensional barium alginate microcapsules (i.e. follicle‐like structures) or in two‐dimensional monolayers, and their steroidogenic ability (estradiol and progesterone secretion) was assessed to confirm their functionality. The same systems were used (on day 2 or 6 of granulosa cells culture) for the in vitro maturation (IVM) of Cryotop® vitrified immature cat oocytes and compared with microdrops of IVM medium without cells (control). Granulosa cells were able to maintain their functionality in vitro in both the conditions, even if with a different extent of hormonal secretion along culture (p = .02). Vitrified oocytes resumed meiosis at higher rates when cultured with 2 days old granulosa cells (p = .03), but full maturation rates slightly raised when granulosa cells were cultured longer, albeit without differences with the control group. This study paved the road for the creation of enriched culture systems in the domestic cat, but innovations are strongly needed for vitrified oocytes that deserve better chances to develop in vitro.
Model Misspecification in Approximate Bayesian Computation: Consequences and Diagnostics
Authors: Frazier David T. , Robert Christian P. , Rousseau Judith
Published: January 2020

We analyse the behaviour of approximate Bayesian computation (ABC) when the model generating the simulated data differs from the actual data-generating process, i.e. when the data simulator in ABC is misspecified. We demonstrate both theoretically and in simple, but practically relevant, examples that when the model is misspecified different versions of ABC can yield substantially different results. Our theoretical results demonstrate that even though the model is misspecified, under regularity conditions, the accept–reject ABC approach concentrates posterior mass on an appropriately defined pseudotrue parameter value. However, under model misspecification the ABC posterior does not yield credible sets with valid frequentist coverage and has non-standard asymptotic behaviour. In addition, we examine the theoretical behaviour of the popular local regression adjustment to ABC under model misspecification and demonstrate that this approach concentrates posterior mass on a pseudotrue value that is completely different from accept–reject ABC. Using our theoretical results, we suggest two approaches to diagnose model misspecification in ABC. All theoretical results and diagnostics are illustrated in a simple running example.
Current risk factors for HIV infection among blood donors in seven Chinese regions
Authors: Zeng Peibin , Liu Jing , Zhang Chunhong , Zhang Bowei , Liu Wei , Huang Mei , Ma Hongli , Zhao Yuwei , Guo Rong , He Miao , Liu Yu , Liao Dan , Sullivan Marian , Wang Jingxing , Cai Wei , Ness Paul , Shan Hua ,   for the International Component of the NHLBI Recipient Epidemiology and Donor Evaluation Study‐III (REDS‐III)
Published: January 2020

BACKGROUND

In China, there is a rising concern on the increasing trends of HIV infections in high‐risk groups, who make blood donations that might potentially challenge the blood safety. Analyses on current risk factors for HIV infection among Chinese blood donors are urgently needed for developing effective strategies to defer high‐risk donors and to warrant the safety of the blood supply.

STUDY DESIGN AND METHODS

We recruited 313 HIV‐positive and 762 HIV‐negative donors from seven study sites in China and evaluated donor demographic characteristics, current medical and behavioral risk factors associated with HIV infection in a case–control survey. Univariable analyses examined the relationship between HIV infection and donor and donation characteristics, medical and behavioral risks, living conditions, and lifestyles. Multivariable logistic regression analyses evaluated the association between selected individual risks and HIV infection. Regression tree analysis was used to select covariates correlated with both HIV infection and individual risks and thus need to be controlled for in logistic regression models.

RESULTS

Being a man who has sex with men was associated with the highest odds of HIV infection. Not using a condom, having sex with HIV‐infected individuals, having sex partners with sexually transmitted diseases (STDs), having more than two concurrent sex partners, or having an STD were all associated with more than five times higher odds of having HIV. Having remunerated sex was associated with a 2.4 increased odds of having HIV infection.

CONCLUSION

High‐risk sexual behaviors were among the major risks for HIV infection among Chinese blood donors.