bluuebunny/crossref_metadata_2025 huggingface dataset:
Cascading effects from plant to soil elucidate how the invasive Amorpha fruticosa L. impacts dry grasslands
Authors: Boscutti Francesco , Pellegrini Elisa , Casolo Valentino , de Nobili Maria , Buccheri Massimo , Alberti Giorgio
Published: March 2020

Questions

Understanding the mechanisms underlying the impacts of exotic plant invasions is a central issue in plant ecology. Considering the invasion process, any alteration of the nutrient cycle is of fundamental importance. We hypothesized that the woody N‐fixing invasive Amorpha fruticosa is indirectly depleting plant diversity by altering ecosystem functions of riverine grasslands, thus producing a conspicuous shift in species composition.

Location

Temperate lowland riparian areas of northeast Italy.

Methods

In 12 sites, we selected uninvaded, partially invaded, and invaded grasslands (36 plots). In each plot, we performed a vegetation relevé, measured main A. fruticosa growth traits, light transmittance and soil features. We studied the effects of the invasion of A. fruticosa on grassland properties and plant diversity, examining the interactions between soil nutrient cycles, light availability and plant diversity.

Results

Increased abundance of A. fruticosa affected main soil properties (i.e. increase in soil mineralization and nitrification) and light availability (i.e. decrease in light). The δ15N of soil organic matter was strongly related to A. fruticosa basal area, thus supporting the hypothesis of an increase in soil nitrogen (N) availability due to invasion by the N‐fixer. Plant taxonomical and functional diversity decreased significantly as A. fruticosa cover increased. Plant diversity was more related with N than light availability or soil organic carbon. Similarly, the shift in species composition (i.e. beta diversity) of invaded grasslands was related to increased soil nitrification rates.

Conclusions

Our findings show how a nitrogen‐fixing invasive plant such as A. fruticosa may influence the main ecosystem properties, causing cascading effects on soil functions, decreasing plant diversity. Alteration of the N cycle represents the key process involved in this plant invasion, suggesting that further studies should focus on potential solutions to mitigate the soil N supply, curb the invasion and restore plant diversity of these riverine grasslands.
Reading and writing: Narrative motifs of sexual and epistemic violence in Waiting for the Barbarians
Authors: Qassas Raed A.
Published: March 2020

This study examines J. M. Coetzee's deployment of reading and writing as dominant motifs in Waiting for the Barbarians. The narrative diffusion of the two motifs of reading and writing in the novel suggests that the colonial encounter is primarily an epistemic one. Moreover, these two motifs yield images of physical and sexual violence. Bodily torture is equated with writing and interrogation with reading. Even sexuality in the novel becomes interchangeable with textuality, and the body of the nameless native girl is transformed into a site for reading and writing violence and sex. History, which also involves writing and reading, is contested in the novel. In Waiting for the Barbarians, writing the history of the Empire and reading the history of the colonized Other are intractable, dialectic poles. The tension between the two is resolved by a third synthetic, unprejudiced form of writing outside history: Waiting for the Barbarians itself.
An autopsy case of GM1 gangliosidosis type II in a patient who survived a long duration with artificial respiratory support
Authors: Uchino Akiko , Nagai Makiko , Kanazawa Naomi , Ichinoe Masaaki , Yanagisawa Nobuyuki , Adachi Kaori , Nanba Eiji , Ishiura Hiroyuki , Mitsui Jun , Tsuji Shoji , Suzuki Kinuko , Murayama Shigeo , Nishiyama Kazutoshi
Published: March 2020

GM1 gangliosidosis is a storage disorder with autosomal recessive inheritance caused by deficiency of β‐galactosidase (GLB1), which is a lysosomal hydrolase, due to mutations in GLB1. We describe here an autopsy case of GM1 gangliosidosis in a female patient who survived for 38 years with a long period of artificial respiratory support (ARS). She was born after a normal pregnancy and delivery. Although development was normal until one year old, she was unable to walk at two years old and started having seizures by nine years old. At 21 years old, she became unable to communicate and was bed‐ridden. At 36 years old, she suffered from pneumonia and required ARS. She died of pneumonia at 40 years old. Neuropathological examination revealed severe atrophy, predominantly found in the frontal lobes. Microscopically, severe gliosis and neuronal loss were observed in the cerebral cortex, putamen, cerebellum, the latter including Purkinje cell and granule cell layers. The hippocampus was relatively preserved. Severe neuronal swelling was observed in the limbic regions and stored a material in these neurons negative for periodic acid‐Schiff (PAS). A PAS‐positive granular storage material in neurons and macrophages was mainly observed in the brainstem and limbic regions. Exome analysis showed a known c.152T>C (p.I51T) variant that has been described in type III patients and a novel c.1348‐2A>G variant in GLB1. Detailed analysis of reverse transcription‐polymerase chain reaction products of GLB1 mRNA revealed that these variants were present in a compound heterozygous state. In our case, clinical features and neuropathological findings were most consistent with type II, although the entire course was longer than any previously reported cases. This may be explained by the residual enzyme activity in this patient whose severity lay between types II and III. Our finding of relative preservation of the limbic regions suggests that neuronal loss in GM1 gangliosidosis has regional selectivity.
A new species of Hiptage (Malpighiaceae) from Nujiang Gorge, southwest China
Authors: Dong Shu‐Peng , Tan Ke , Ren Ming‐Xun
Published: March 2020

Hiptage lushuiensis, a new species from the Hengduan Mountains, northwestern Yunnan Province, China, is described and illustrated here. This species was found growing at the margin of an open forest in the Nujiang Gorge of Lushui City. Hiptage lushuiensis is distinctive for its pink petals, 2 or more calyx glands, and large and pink samara with white hairs. This species is isolated in the deep gorge (25°51′N, 98°51′E, altitude 917 m), at the northern edge distribution range of the genus. These distinctive morphological differences and the geographic isolation suggest a history of long‐distance dispersal and allopatric speciation. Hiptage lushuiensis has a shorter filament but larger herkogamy than related species, suggesting that H. lushuiensis may have adapted to other pollinators with short but fat body such as Amegilla or Bombus spp.
Two new endemic species of Ophiorrhiza L. (Rubiaceae: Ophiorrhizeae) from Davao Oriental, Philippines
Authors: Alfeche Niña Kathryn G. , Alejandro Grecebio Jonathan D. , Meve Ulrich , Liede‐Schumann Sigrid
Published: March 2020

Two new species of Ophiorrhiza collected from Mt Hamiguitan Range Wildlife Sanctuary in Davao Oriental, Philippines, are herein described and illustrated. Ophiorrhiza erythropilosa is the third Philippine species possessing involucral bracts and is further characterized by its predominantly villose stems that appear red due to strikingly red‐violet trichomes, subpersistent bifid stipules, linear involucral bracts without prominent midrib, and 4 mm long urceolate corolla that is villose outside and lightly puberulous inside. Ophiorrhiza hamiguitanensis is characterized by its coriaceous, lanceolate leaves with attenuate apex and base, brochidodromous venation, subpersistent bilobed stipules with slightly recurved acute tips, presence of 1.5–2.5 mm long linear ensiform bracts, heterostylous flowers, clavate calyces and broadly obcordate capsules.
Is it necessary to receive radiation for pT3‐4N0 oral cancer without other adverse risk features?
Authors: Li Bo , Wang Chong , Yuan Xiaohong , Wang Zhen , Kim Kyojin , Li Jinzhong , Cheng Aoming , Han Zhengxue , Feng Zhien
Published: March 2020

Objective

The purpose of this study was to explore the necessity of adjuvant radiotherapy for well‐differentiated pT3‐4aN0M0 OSCC without other negative features histologically.

Patients and Methods

This is a double‐center, ambispective cohort study enrolling 250 patients with well‐differentiated pT3‐4aN0M0 OSCC.

Results

A total of 250 patients were enrolled in the double‐center study, 155(62.0%) men and 95 (38.0%) women, and the mean age was 60.1 ± 11.1 years. T staging was classified as follows: T3 (n = 99, 39.6%) and T4a (n = 151, 60.4%). Kaplan–Meier analysis showed that there was no significant difference in the DSS between patients who received adjuvant radiotherapy (72.2%) and those who did not (77.4%) (p = .615). Specifically, no significant difference was found in the DSS of pT3N0M0 or pT4aN0M0 patients who received adjuvant radiotherapy compared with those who did not (pT3N0M0: 71.9% vs. 75.8%, p = .993; pT4aN0M0: 72.4% vs. 78.5%, p = .491). The Cox proportional hazards regression models showed that no factor was independent prognostic factor for pT3‐4aN0M0 patients, or pT3N0M0 subgroup or pT4aN0M0 subgroup in DSS. And no independent prognostic factor was found for the surgery‐alone subgroup and adjuvant radiotherapy subgroup.

Conclusions

The results showed that adjuvant radiotherapy did not obviously improve the prognosis of pT3‐4aN0M0 well‐differentiated OSCC without other negative features.
The moderating effects of economic development on innovation and shadow entrepreneurship: grey or pink?
Authors: Santos Eunice , Fernandes Cristina I. , Ferreira João J.
Published: March 2020

There is currently a renewed surge of interest in informal entrepreneurship around the world. One of the motives stems from how such entrepreneurship shapes and influences a substantial part of the global workforce. However, we may also verify how a major proportion of the research in this field focuses on developing economies and thus justifying the application of such analytical approaches to countries with different levels of economic development as is the case with Europe. Our research objectives, on the one hand, involve analysing the impact of R&D investment on informal entrepreneurship and, on the other hand, the moderating effect of the level of economic development on their innovative capacities and informal entrepreneurship results. To this end, and in accordance with Global Entrepreneurship Monitor, we divide the countries of Europe into two stages of development and may report that the higher the level of economic development, the greater the innovative capacity and, furthermore, the lower informal entrepreneurship becomes. The same holds for R&D investment with its increase being inversely proportionate to informal entrepreneurship. We, therefore, seek to contribute toward a better understanding of the problematic framework of informal entrepreneurship, in particular in the European context.
A world of possibilities: six restoration strategies to support the United Nation's Decade on Ecosystem Restoration
Authors: Aronson James , Goodwin Neva , Orlando Laura , Eisenberg Cristina , Cross Adam T.
Published: March 2020

Ecological restoration is practiced worldwide as a direct response to the degradation and destruction of ecosystems. In addition to its ecological impact it has enormous potential to improve population health, socioeconomic well‐being, and the integrity of diverse national and ethnic cultures. In recognition of the critical role of restoration in ecosystem health, the United Nations (UN) declared 2021–2030 as the Decade on Ecosystem Restoration. We propose six practical strategies to strengthen the effectiveness and amplify the work of ecological restoration to meet the aspirations of the Decade: (1) incorporate holistic actions, including working at effective scale; (2) include traditional ecological knowledge (TEK); (3) collaborate with allied movements and organizations; (4) advance and apply soil microbiome science and technology; (5) provide training and capacity‐building opportunities for communities and practitioners; and (6) study and show the relationships between ecosystem health and human health. We offer these in the hope of identifying possible leverage points and pathways for collaborative action among interdisciplinary groups already committed to act and support the UN Decade on Ecosystem Restoration. Collectively, these six strategies work synergistically to improve human health and also the health of the ecosystems on which we all depend, and can be the basis for a global restorative culture.
Achieving Adaptive Governance of Forest Wildfire Risk Using Competitive Grants: Insights From the Colorado Wildfire Risk Reduction Grant Program
Authors: Cheng Antony S. , Dale Lisa
Published: March 2020

Competitive grants are increasingly used to induce proactive collaborative action by a range of actors to reduce forest wildfire risks. Given the rigidity of past wildfire risk governance, it is important to assess the adaptability of competitive grants as a new governance approach. Adaptive governance theory is used as a lens to assess the adaptability of the Colorado Wildfire Risk Reduction Grant (WRRG) program, which awards funds to successful applicants to reduce fuel on non‐federal lands at a community scale. Four best practices from the theory were applied: participation of and collaboration among diverse actors; co‐production of knowledge and learning toward adaptive management; cross‐scale interactions and fit between the scale of governance and the scale of the ecological problem; and the capacity for innovation and re‐organization. Using data and information about the WRRG structure and processes, awarded grantees from the first five granting cycles from 2013 to 2016, our direct participation‐observation as part of the Advisory Committee, and results from the WRRG effectiveness monitoring report, we examine the extent to which the WRRG program exhibited adaptive governance attributes. For each adaptive governance attribute, we found evidence of factors facilitating and frustrating adaptiveness of the WRRG program. We situate our findings within the broader context of using competitive grants as a forest wildfire risk governance approach and address additional directions for adaptive governance research.
Tropical pyomyositis: an update
Authors: Shittu Adebayo , Deinhardt‐Emmer Stefanie , Vas Nunes Jonathan , Niemann Silke , Grobusch Martin P. , Schaumburg Frieder
Published: March 2020

Tropical pyomyositis (TP) is a life‐threatening bacterial infection of the skeletal muscle that occurs particularly among children, young adults and those with immunocompromised conditions. The appropriate diagnosis and treatment are often delayed due to its non‐specific signs, leading to fatal consequences. Staphylococcus aureus, especially methicillin‐susceptible S. aureus, is responsible for most TP cases. However, other bacteria (i.e. streptococci, Pseudomonas aeruginosa, Escherichia coli, Klebsiella spp., Candida spp., Mycobacterium spp.) have been reported. This narrative review provides an update on the epidemiology and clinical course of TP. A special focus is laid on the role of toxins (i.e. Panton‐Valentine Leucocidin and α‐toxin) in the pathogenesis of TP and their implication for the clinical management of infection.
Reviewer Acknowledgements
Authors: Oscar William
Published: March 2020

International Journal of Contemporary Education (IJCE) would like to acknowledge the following reviewers for their assistance with peer review of manuscripts for this issue. Many authors, regardless of whether IJCE publishes their work, appreciate the helpful feedback provided by the reviewers. Their comments and suggestions were of great help to the authors in improving the quality of their papers. Each of the reviewers listed below returned at least one review for this issue.Reviewers for Volume 3, Number 1Alexandra Ingram, University of Tennessee, USAÁlvaro Manzano Redondo, UCJC University, SpainAurora Q. Pestano, University of San Jose Recoletos, PhilippinesBlessing Dwumah Manu, Jiangsu University, GhanaBožić-Lenard Dragana, University of Osijek Croatia, CroatiaBruna Gabriela Augusto Marçal Vieira, CEFET-MG, BrazilDina Radeljas, Mohawk Valley Community College, USAEdward Bolden, Case Western Reserve University, USAFroilan Delute Mobo, Philippine Merchant Marine Academy, PhilippinesGraziano Serragiotto, Ca' Foscari University of Venice, ItalyIosif Fragkoulis, Hellenic Open University, GreeceLi Li, Bath Spa University, UKMatthew Schatt, University of Florida, USAMurat Tezer, Near East University, CyprusNesrin Ozturk, Ege University, TurkeyRaymond Aaron Younis, ACU Australia, AustraliaSuriadi Samsuri, Institute of Islamic Religion Sultan Muhammad Syafiuddin Sambas, IndonesiaTeresa Pozo-Rico, University of Alicante, SpainVassilios Papadimitriou, University of Thessaly, Greece William OscarEditorial AssistantInternational Journal of Contemporary Education---------------------------------------------------------Redfame Publishing9450 SW Gemini Dr. #99416Beaverton, OR 97008, USATel: 1-503-828-0536 ext. 509Fax: 1-503-828-0537E-mail 1: ijce@redfame.comE-mail 2: ijce@redfame.orgURL: http://ijce.redfame.com
Thermal Analysis and Optimization of Light-Emitting Diodes Filament Lamp
Authors: Liu Jie , Zou Jinglong , Liu Sheng
Published: March 2020

Due to the high efficiency, light-emitting diodes (LED) filament lamps have become more and more popular alternative to the incandescent lamp. However, the heat generated by the LED chips is traditionally dissipated by relying on the natural convection within lamps, resulting in poor heat dissipation performance for LED filament lamps. A numerical simulation model of the typical LED filament lamp was established to simulate and analyze the heat dissipation and airflow phenomenon of LED filament lamps in this study. In addition, increasing lamp sizes, increasing phosphor diameters, and using finned phosphor layers were considered as optimization measures to improve the heat dissipation performance of LED filament lamps. When these optimization measures are applied, chip junction temperatures are reduced. A reduction of 6.9 °C is seen when the lamp radius is increased from 25 mm to 31 mm. When the phosphor diameter is increased to 4 mm from 2 mm, the junction temperature is reduced by 17.2 °C. Integration of a finned phosphor layer where there are 12 fins at a height of 1 mm and thickness of 0.2 mm in the layer decreased the junction temperature by 10.9 °C. These optimization results provide technical support for the design and manufacture of LED filament lamps, and thermal analysis results provide theoretical support for the promotion of these optimization methods.
A Simplified Two-Phase Flow Model for Riser Gas Management With Non-Aqueous Drilling Fluids
Authors: Nwaka Nnamdi , Wei Chen , Chen Yuanhang
Published: March 2020

Gas-in-riser events can lead to rapid unloading if not timely controlled in a proper manner. When gas influx enters a wellbore with non-aqueous muds (NAMs), the ability of gas being dissolved in NAMs increases the difficulty in gas kick detection and significantly alters gas migration and unloading behavior from the predictions based on water-based muds (WBMs) assumptions.

In this study, a new mathematical model for riser gas management in NAMs is developed. In this model, the desorption of dissolved gas influx from NAMs is accounted for as an instantaneous process using a solubility-based mass transfer submodel. The effects of surface backpressures and circulation rates on the unloading behavior in both WBMs and NAMs were studied. This model was validated using data obtained from a drift-flux model (DFM) based simulator. Results show that with the same amount of free gas in the risers at the mudline level, the severity of unloading is significantly more severe in the cases of NAMs. Applied backpressure can effectively control the desorption of the gas influx from the mud, and the unloading occurs later and at shallower depth with higher backpressure. The behavior of unloading tends to be independent on the time when backpressures are applied but highly dependent on the magnitude of the backpressure and the circulation rates. The new two-phase model can accurately simulate riser gas kick events utilizing a simplified approach with improved numerical stability, making it more applicable for real-time riser gas management.
Experimental Study of Premixed-Charge Compression Ignition Mode in Low Load Fueled With Butanol Isomers and Diesel Binary Fuels in a Common-Rail Diesel Engine
Authors: Li Zilong , Huang Guan , Jiang Chenxu , Qian Yong , He Zhuoyao , Lu Xingcai
Published: March 2020

Low NOx and particulate matter (PM) emissions are simultaneously attempted to implement via an experimental study on diesel/butanol isomers binary fuels in premixed-charge compression ignition (PCCI) mode. N-butanol, iso-butanol, sec-butanol, and tert-butanol were blended with diesel in a certain volume ratio of 0.24:0.76, denoted as N24, I24, S24, and T24, respectively. The indicated thermal efficiency (ITE) of binary fuels in PCCI mode decreases slightly than that in direction injection (DI) mode. T24 obtains higher ITE than the other three test fuels with 50% exhaust gas recirculation (EGR). NOx formation is certainly inhibited more than 60% in PCCI mode, especially when the EGR rate is 50%. PCCI mode produces more CO, HC, and carbonyl emissions than DI mode to varying degrees; under these circumstances, T24 tends to have the lowest emissions among four test fuels, reflecting the potential of tert-butanol as a diesel alternative fuel. Butanol isomers have a vital contribution on particulate matter emissions inhibition for both PM total number and total mass. Tert-butanol tends to form accumulation mode particle, and n-butanol tends to form nucleation mode mainly caused by molecular structure diversity of isomers. The geometric mean diameter of diesel/butanol isomers increases in PCCI mode compared with that in DI mode.
Temporary hearing threshold shift in harbor seals (Phoca vitulina) due to a one-sixth-octave noise band centered at 40 kHz
Authors: Kastelein Ronald A. , Parlog Cosmin , Helder-Hoek Lean , Cornelisse Suzanne A. , Huijser Léonie A. E. , Terhune John M.
Published: March 2020

As part of a series of studies to determine frequency-dependent susceptibility to temporary hearing threshold shifts (TTS), two female harbor seals (F01 and F02) were exposed for 60 min to a one-sixth-octave noise band centered at 40 kHz at mean sound pressure levels ranging from 126 to 153 dB re 1 μPa [mean received sound exposure level (SEL) range: 162–189 dB re 1 μPa2s]. TTSs were quantified at 40, 50, and 63 kHz within 1–4 min of the exposure for F02 and within 12–16 min of the exposure for F01. In F02, significant TTS1–4 (1–4 min post exposure) occurred at 40 kHz with SELs of ≥183 dB re 1 μPa2s and at 50 kHz with SELs of ≥174 dB re 1 μPa2s. At 63 kHz, TTS1–4 occurred with SELs ≥186 dB re 1 μPa2s. In F01, significant TTS12–16 (12–16 min post exposure) occurred only at 50 kHz with SELs of ≥177 dB re 1 μPa2s. The highest TTSs (27.5 dB in F02, 29.8 dB in F01) occurred at 50 kHz, one-third of an octave above the fatiguing sound's center frequency (SEL = 189 dB re 1 μPa2s); recovery took 2 days in F02 and 4 days in F01. In most other cases, recovery was within 1 h. The seals have a similar susceptibility to TTS from 4 to 40 kHz.
The Effectiveness of Transdermal Iron Patches in Athletes With Suboptimal Iron Status (Part 1)
Authors: McCormick Rachel , Dawson Brian , Sim Marc , Lester Leanne , Goodman Carmel , Peeling Peter
Published: March 2020

The authors compared the effectiveness of two modes of daily iron supplementation in athletes with suboptimal iron stores: oral iron (PILL) versus transdermal iron (PATCH). Endurance-trained runners (nine males and 20 females), with serum ferritin concentrations <50 μg/L, supplemented with oral iron or iron patches for 8 weeks, in a parallel group study design. Serum ferritin was measured at baseline and fortnightly intervals. Hemoglobin mass and maximal oxygen consumption () were measured preintervention and postintervention in PATCH. A linear mixed effects model was used to assess the effectiveness of each mode of supplementation on sFer. A repeated-measures analysis of variance was used to assess hemoglobin mass and outcomes in PATCH. There was a significant time effect (p < .001), sex effect (p = .013), and Time × Group interaction (p = .009) for sFer. At Week 6, PILL had significantly greater sFer compared with PATCH (15.27 μg/L greater in PILL; p = .019). Serum ferritin was 15.53 μg/L greater overall in males compared with females (p = .013). There were no significant differences in hemoglobin mass (p = .727) or (p = .929) preintervention to postintervention in PATCH. Finally, there were six complaints of severe gastrointestinal side effects in PILL and none in PATCH. Therefore, this study concluded that PILL effectively increased sFer in athletes with suboptimal iron stores, whereas PATCH showed no beneficial effects.
Scaling, rotation, and channeling behavior of helical and skyrmion spin textures in thin films of Te-doped Cu
2
OSeO
3
Authors: Han M.-G. , Garlow J. A. , Kharkov Y. , Camacho L. , Rov R. , Sauceda J. , Vats G. , Kisslinger K. , Kato T. , Sushkov O. , Zhu Y. , Ulrich C. , Söhnel T. , Seidel J.
Published: March 2020

We report on scaling, rotation, and channeling behavior of helical and skyrmion spin textures in thin films of Te-doped Cu
2
OSeO
3
.
Generation of multiple ultrastable optical frequency combs from an all-fiber photonic platform
Authors: Kwon Dohyeon , Jeon Igju , Lee Won-Kyu , Heo Myoung-Sun , Kim Jungwon
Published: March 2020

A telecommunication optical fiber can stabilize the comb-line frequencies of ultrashort pulse lasers to the quadrillionth level.
High-frequency rectification via chiral Bloch electrons
Authors: Isobe Hiroki , Xu Su-Yang , Fu Liang
Published: March 2020

Engineering quantum crystals realizes high-frequency rectifiers by rational material design.
Three dimensions, two microscopes, one code: Automatic differentiation for x-ray nanotomography beyond the depth of focus limit
Authors: Du Ming , Nashed Youssef S. G. , Kandel Saugat , Gürsoy Doğa , Jacobsen Chris
Published: March 2020

We demonstrate the ability to reconstruct 3D objects beyond the depth of focus limit.
Soft crystal martensites: An in situ resonant soft x-ray scattering study of a liquid crystal martensitic transformation
Authors: Jin Hyeong Min , Li Xiao , Dolan James A. , Kline R. Joseph , Martínez-González José A. , Ren Jiaxing , Zhou Chun , de Pablo Juan J. , Nealey Paul F.
Published: March 2020

The martensitic nature of soft crystals is captured by soft x-ray scattering, broadening the analogy with atomic crystal systems.
Risk of colorectal cancer in a population-based study 20 years after diagnosis of ulcerative colitis: results from the IBSEN study
Authors: Klepp Pasquale , Brackmann Stephan , Cvancarova Milada , Hoivik Marte Lie , Hovde Øistein , Henriksen Magne , Huppertz-Hauss Gert , Bernklev Tomm , Hoie Ole , Kempski-Monstad Iril , Solberg Inger Camilla , Stray Njaal , Jahnsen Jorgen , Vatn Morten H , Moum Bjorn
Published: March 2020

Objective

The association between ulcerative colitis (UC) and colorectal cancer (CRC) is widely accepted, although attenuated risk has been reported in recent years. Colonoscopic surveillance is recommended with intervals based on established clinical risk factors. Nevertheless, a significant number of patients develop interval cancers, indicating the need of improved individualised assessment. In the present study, we evaluated clinical risk factors associated with CRC during a prescheduled follow-up 20 years after diagnosis, the IBSEN study.

Design

A population-based inception cohort of patients diagnosed with inflammatory bowel disease from 1 January 1990 until 31 December 1993, prospectively followed at 1, 5, 10 and 20 years after diagnosis. A total of 517 patients with UC were included; 264 (51 %) men; median age at inclusion 37.4 years (4–88).

Results

The overall incidence of CRC was 1.6% (8/517) at a 20-year follow-up. The total lifetime risk of CRC prior to or after UC diagnosis was 2.3%. (12/517). Patients older than 70 years at diagnosis had a 15-fold higher risk of CRC compared with those diagnosed when younger than 40 years, with HR 15.68 (95% CI: 1.31 to 187.92). Neither sex, first-degree relative with CRC, extent of colitis nor primary sclerosing cholangitis affected the risk of CRC.

Conclusion

The risk of CRC in UC was low and comparable with the risk of CRC in the background population of Norway.
Influence of observer preferences and auscultatory skill on the choice of terms to describe lung sounds: a survey of staff physicians, residents and medical students
Authors: Bohadana Abraham , Azulai Hava , Jarjoui Amir , Kalak George , Izbicki Gabriel
Published: March 2020

Background

In contrast with the technical progress of the stethoscope, lung sound terminology has remained confused, weakening the usefulness of auscultation. We examined how observer preferences regarding terminology and auscultatory skill influenced the choice of terms used to describe lung sounds.

Methods

Thirty-one staff physicians (SP), 65 residents (R) and 47 medical students (MS) spontaneously described the audio recordings of 5 lung sounds classified acoustically as: (1) normal breath sound; (2) wheezes; (3) crackles; (4) stridor and (5) pleural friction rub. A rating was considered correct if a correct term or synonym was used to describe it (term use ascribed to preference). The use of any incorrect terms was ascribed to deficient auscultatory skill.

Results

Rates of correct sound identification were: (i) normal breath sound: SP=21.4%; R=11.6%; MS=17.1%; (ii) wheezes: SP=82.8%; R=85.2%; MS=86.4%; (iii) crackles: SP=63%; R=68.5%; MS=70.7%; (iv) stridor: SP=92.8%; R=90%; MS=72.1% and (v) pleural friction rub: SP=35.7%; R=6.2%; MS=3.2%. The 3 groups used 66 descriptive terms: 17 were ascribed to preferences regarding terminology, and 49 to deficient auscultatory skill. Three-group agreement on use of a term occurred on 107 occasions: 70 involved correct terms (65.4%) and 37 (34.6%) incorrect ones. Rate of use of recommended terms, rather than accepted synonyms, was 100% for the wheezes and the stridor, 55% for the normal breath sound, 22% for the crackles and 14% for the pleural friction rub.

Conclusions

The observers’ ability to describe lung sounds was high for the wheezes and the stridor, fair for the crackles and poor for the normal breath sound and the pleural friction rub. Lack of auscultatory skill largely surpassed observer preference as a factor determining the choice of terminology. Wide dissemination of educational programs on lung auscultation (eg, self-learning via computer-assisted learning tools) is urgently needed to promote use of standardised lung sound terminology.
Alcohol and other drugs in suicide in Canada: opportunities to support prevention through enhanced monitoring
Authors: Orpana Heather , Giesbrecht Norman , Hajee Aliya , Kaplan Mark S
Published: March 2020

The use of alcohol and other drugs has been identified as a significant factor related to suicide through multiple pathways. This paper highlights current understanding of their contributions to suicide in Canada and identifies opportunities for enhancing monitoring and prevention initiatives. Publications from 1998 to 2018 about suicide in Canada and that referred to alcohol or other drugs were identified using PubMed and Google Scholar. A second literature search restricted to articles including results of toxicology testing was conducted by a librarian. We summarised the literature identified on ecological analyses, attributable fractions and deaths, and research including the results of toxicological analyses. Our literature search yielded 5230 publications, and 164 documents were identified for full-text screening. We summarised the findings from 30 articles. Ecological analyses support the association between alcohol sales, annual per capita alcohol consumption and suicide rates. Based on published estimates, approximately a quarter of suicide deaths in Canada are alcohol-attributable, while the estimated attributable fraction for illegal drugs is more variable. Finally, there is a dearth of literature examining the role of acute alcohol and/or drug consumption prior to suicide based on toxicological findings. The proportion of suicide decedents with drugs or alcohol present at the time of death varies widely. While there is evidence on the role of alcohol and drugs in suicide deaths, there is not a large body of research about the acute use of these substances at the time of death among suicide decedents in Canada. Our understanding of the role of alcohol and other drugs in suicide deaths could be enhanced through systematic documentation, which in turn could provide much needed guidance for clinical practice, prevention strategies and policy initiatives.
Abnormal expression of p-ATM/CHK2 in nasal extranodal NK/T cell lymphoma, nasal type, is correlated with poor prognosis
Authors: Ye Qiurong , Chen Huiling , Wen Zonghua , Guo Wenwen , Huang Yongta , Mo Xianglan
Published: March 2020

Aims

The aim of this study is to investigate the expression profiles of cell cycle related proteins in nasal extranodal NK/T cell lymphoma, nasal type (ENKTCL).

Methods

The expression profiles of cell cycle related proteins were assessed with a cell cycle antibody array and validated by immunohistochemistry. Correlations between the expression levels of proteins and clinical outcomes of patients with nasal ENKTCL were evaluated.

Results

The expression of full length ataxia telangiectasia mutated (ATM) in nasal ENKTCL significantly decreased compared with that in nasal benign lymphoid proliferative disease (NBLPD), but the expression levels of p-ATM, CHK2 and RAD51 significantly increased in nasal ENKTCL compared with that in NBLPD. Kaplan-Meier analysis showed that the expression levels of p-ATM and CHK2 in nasal ENKTCL were inversely related to overall survival (p=0.011 and p=0.025, respectively).

Conclusion

Abnormalities in the ATM pathway may play a crucial role in the oncogenesis and chemoradiotherapy resistance of nasal ENKTCL.
Review of pathology and cost benefit analysis of hernia sacs processed over a 19-year period
Authors: Kazerouni Arshia , Nowak Klaudia M , Serra Stefano , Vajpeyi Rajkumar , Chieu Kenny , Chetty Runjan
Published: March 2020

Aim

Hernia sacs with pathological evaluation over a 19-year period were analysed with regards to pathological diagnoses, full costing and the impact on patient management.

Materials and methods

The database of the Department of Pathology were searched over the study period (2001 to 2019 inclusive) for hernia sacs. The total cost of complete pathology examination was calculated on average numbers and rates of pay that existed over the study period.

Results

A total of 3619 hernia sacs from the abdominal, hiatus/diaphragmatic, inguinal and femoral hernias were retrieved. Of these 3592 cases (99.25%) had sections taken for histological evaluation. A total of 3437 cases representing 95.7% of all hernia sacs did not show any pathological abnormality. If non-neoplastic clinically insignificant lesions seen in hernia sacs is included, then 3552 of 3592 (98.9%) hernia sacs underwent full pathological evaluation for no patient benefit.

On average two blocks or tissue sections per case were processed incurring a technical cost of $53 175.00. The total pathologist cost in reporting the 3592 cases was approximately $39 870.00 and rose to $40 410.00 when interpretation of ancillary tests was factored in. $95 328.90 (average $26.90 per specimen with a yearly average total cost of $5 017.31) was spent over the 19-year period in full pathological examination of 3592 hernia sacs.

Conclusion

Given the low return on investment and the difficult to quantify time savings and reallocation, we do not advocate the routine sampling of hernia sacs. Gross examination will suffice in 99% of the cases. Selective cases may be sampled if clinically indicated.
Characterization of tumor mutation burden, PD-L1 and DNA repair genes to assess relationship to immune checkpoint inhibitors response in metastatic renal cell carcinoma
Authors: Labriola Matthew Kyle , Zhu Jason , Gupta Rajan , McCall Shannon , Jackson Jennifer , Kong Eric F , White James R , Cerqueira Gustavo , Gerding Kelly , Simmons John K , George Daniel , Zhang Tian
Published: March 2020

Background

Immune checkpoint inhibitors (ICIs) have expanded treatment options for metastatic renal cell carcinoma (mRCC); however, there are limited predictive biomarkers for response to ICIs in this indication, with programmed death-ligand 1 (PD-L1) status demonstrating little predictive utility in mRCC. While predictive of ICI response in other tumor types, the utility of tumor mutation burden (TMB) in mRCC is unclear. Here, we assess TMB, loss of antigen presentation genes and PD-L1 status correlated with outcomes to ICI treatment in mRCC.

Methods

Tumor samples from 34 patients with mRCC treated with ICI therapy at Duke Cancer Institute were retrospectively evaluated using Personal Genome Diagnostics elio tissue complete (RUO version), a tumor genomic profiling assay for somatic variants, TMB, microsatellite status and genomic status of antigen presentation genes. Tumor samples were also analyzed with the Dako 28-8 PD-L1 immunohistochemistry assay. Deidentified clinical information was extracted from the medical record, and tumor response was evaluated based on the Response Evaluation Criteria In Solid Tumors (RECIST) V.1.1 criteria.

Results

Patients were stratified by overall response following ICI therapy and designated as progressive disease (PD; n=18) or disease control groups (DC; n=16). TMB scores ranged from 0.36 to 12.24 mutations/Mb (mean 2.83 mutations/Mb) with no significant difference between the PD and DC groups (3.01 vs 2.63 mutations/Mb, respectively; p=0.7682). Interestingly, 33% of PD patients displayed loss of heterozygosity of major histocompatibility complex class I genes (LOH-MHC) vs 6% of DC patients. Nine of 34 samples were PD-L1-positive (4 in the PD group; 5 in the DC group), suggesting no correlation between PD-L1 expression and response to ICI therapy. Notably, the DC group displayed an enrichment of mutations in DNA repair genes (p=0.04), with 68.8% exhibiting at least one mutated homologous recombination repair (HRR)-related gene compared with only 38.9% of the PD group (p=0.03).

Conclusions

Overall, neither TMB nor PD-L1 correlated with ICI response and TMB was not significantly associated with PD-L1 expression. The higher incidence of LOH-MHC in PD group suggests that loss of antigen presentation may restrict response to ICIs. Separately, enrichment of HRR gene mutations in the DC group suggests potential utility in predicting ICI response and a potential therapeutic target, warranting future studies.
Unlocking medical leadership’s potential: a multilevel virtuous circle?
Authors: Keijser Wouter , Martin Graeme
Published: March 2020

Background and aimMedical leadership (ML) has been introduced in many countries, promising to support healthcare services improvement and help further system reform through effective leadership behaviours. Despite some evidence of its success, such lofty promises remain unfulfilled.

MethodCouched in extant international literature, this paper provides a conceptual framework to analyse ML’s potential in the context of healthcare’s complex, multifaceted setting.

ResultsWe identify four interrelated levels of analysis, or domains, that influence ML’s potential to transform healthcare delivery. These are the healthcare ecosystem domain, the professional domain, the organisational domain and the individual doctor domain. We discuss the tensions between the various actors working in and across these domains and argue that greater multilevel and multistakeholder collaborative working in healthcare is necessary to reprofessionalise and transform healthcare ecosystems.
Balancing professional obligations and risks to providers in learning healthcare systems
Authors: Piasecki Jan , Dranseika Vilius
Published: March 2020

Clinicians and administrators have a professional obligation to contribute (OTC) to improvement of healthcare quality. At the same time, participation in embedded research poses risks to healthcare institutions. Disclosure of an institution’s sensitive information could endanger relationships with patients and undermine its reputation. The existing ethical framework (EF) for learning healthcare systems (LHSs) does not address the conflict between the OTC and institutional interests. Ethical guidance and policy regulation are needed to create a safe environment for embedded research. In this article we analyse the EF for LHSs and the concept of professionalism. We suggest that the EF should be supplemented with an obligation to protect provider’s legitimate interests. We define legitimate interests as those that enable providers to discharge their primary duties. We argue that both the OTC and the obligation to protect legitimate interests are grounded in the concept of medical professionalism and can be understood as a matter of contract between a democratic society and medical professionals. The proposed supplemented EF can be implemented into a regulatory system in three different ways: theself-regulating: where providers decide themselves how to balance the ethical claims, the centralised: where a governmental institution decides the right balance between providers’ interests and interests of a health system; and themediating: where medical professionals, the state and patients negotiate their interests. Our article contributes to the discussion on ethical relevance of providers’ interests and the regulatory model for weighing opposite interests in LHSs.
Limits of trust in medical AI
Authors: Hatherley Joshua James
Published: March 2020

Artificial intelligence (AI) is expected to revolutionise the practice of medicine. Recent advancements in the field of deep learning have demonstrated success in variety of clinical tasks: detecting diabetic retinopathy from images, predicting hospital readmissions, aiding in the discovery of new drugs, etc. AI’s progress in medicine, however, has led to concerns regarding the potential effects of this technology on relationships of trust in clinical practice. In this paper, I will argue that there is merit to these concerns, since AI systems can be relied on, and are capable of reliability, but cannot be trusted, and are not capable of trustworthiness. Insofar as patients are required to rely on AI systems for their medical decision-making, there is potential for this to produce a deficit of trust in relationships in clinical practice.
Can bioethics be an honest way of making a living? A reflection on normativity, governance and expertise
Authors: Camporesi Silvia , Cavaliere Giulia
Published: March 2020

The authority of bioethics as a field of inquiry and of bioethicists as scholars with a distinctive expertise is being questioned on various fronts. Sarah Franklin’s 2019Naturecommentary ‘Ethical research – the long and bumpy road from shirked to shared’ is the latest example . In this paper, we respond to these challenges by focusing on two key issues. First, we discuss the theory and practice of bioethics. We argue that both of these endeavours are fundamental components of this field of inquiry and that bioethics cannot be reduced to the contribution that it makes to the production of biopolicy, as Franklin suggests. Second, we contend that bioethicists have distinctive skills and knowledge that place them at an epistemic advantage in discussing normative questions. Hence, we reject views that deny the specific contribution that bioethicists can bring to assessing the ethics and governance of science and technology. We conclude by arguing that—despite formal and substantive differences between disciplines—philosophers, social scientists and other scholars should join forces and engage in critical friendships rather than turf wars to move towards the just governance of science and technology.
Embracing slippery slope on physician-assisted suicide and euthanasia could have significant unintended consequences
Authors: Buturovic Zeljka
Published: March 2020

In a recent article Joshua James Hatherley argues that, if physician-assisted suicide (PAS) is morally permissible for patients suffering from somatic illnesses, it should be permissible for psychiatric patients as well. He argues that psychiatric disorders do not necessarily impair decision-making ability, that they are not necessarily treatable and that legalising PAS for psychiatric patients would not diminish research and therapeutic interest in psychiatric treatments or impair their recovery through loss of hope. However, by erasing distinction between somatic and psychiatric disorders on those grounds, he also erases distinction between healthy adults and patients (whether somatic or psychiatric) essentially implying that PAS should be available to all, for all reasons or, ultimately no reason. Furthermore, as psychiatric patients are much more likely to be a source of usable organs for transplantation, their broad inclusion would strengthen the link between PAS/euthanasia and organ donation, potentially undermining both as well as diminishing already declining general trust in medical authorities and professionals and public health authorities and activists.
Step-downs reduce workers’ compensation payments to encourage return to work: are they effective?
Authors: Lane Tyler J , Sheehan Luke , Gray Shannon E , Beck Dianne , Collie Alex
Published: March 2020

Objective

To determine whether step-downs, which cut the rate of compensation paid to injured workers after they have been on benefits for several months, are effective as a return to work incentive.

Methods

We aggregated administrative claims data from seven Australian workers’ compensation systems to calculate weekly scheme exit rates, a proxy for return to work. Jurisdictions were further subdivided into four injury subgroups: fractures, musculoskeletal, mental health and other trauma. The effect of step-downs on scheme exit was tested using a regression discontinuity design. Results were pooled into meta-analyses to calculate combined effects and the proportion of variance attributable to heterogeneity.

Results

The combined effect of step-downs was a 0.86 percentage point (95% CI −1.45 to −0.27) reduction in the exit rate, with significant heterogeneity between jurisdictions (I2=68%, p=0.003). Neither timing nor magnitude of step-downs was a significant moderator of effects. Within injury subgroups, only fractures had a significant combined effect (−0.84, 95% CI −1.61 to −0.07). Sensitivity analysis indicated potential effects within mental health and musculoskeletal conditions as well.

Conclusions

The results suggest some workers’ compensation recipients anticipate step-downs and exit the system early to avoid the reduction in income. However, the effects were small and suggest step-downs have marginal practical significance. We conclude that step-downs are generally ineffective as a return to work policy initiative.

Postprint link:https://www.medrxiv.org/content/10.1101/19012286