bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of the analgesic effect of an adductor canal block using a new suture‐method catheter vs. standard perineural catheter vs. single‐injection: a randomised, blinded, controlled study
Authors: Lyngeraa T. S. , Jæger P. , Gottschau B. , Graungaard B. , Rossen‐Jørgensen A. M. , Toftegaard I. , Grevstad U.
Published: August 2019

We performed a randomised, blinded, controlled study with adult patients scheduled for primary total knee arthroplasty under spinal anaesthesia. The aim was to investigate the analgesic effects of adductor canal block using catheter‐based repeated boluses, either through a new suture‐method catheter or a standard perineural catheter, compared with a single‐injection technique. All patients received an adductor canal block after surgery with an initial bolus of 20 ml ropivacaine 0.75%, followed by 20 ml of ropivacaine 0.2% every 8 h in the standard and suture‐method catheter groups, and sham boluses for the single‐injection group. The primary outcome measure was total opioid consumption (intravenous morphine equivalents) from the end of surgery until 12:00 on postoperative day 2. Secondary outcomes were pain, muscle strength and ambulation. We randomly assigned (1:1:1) and analysed 153 patients. Total opioid consumption was median (IQR [range]) 24 (11–37 [0–148]) mg in the suture‐method group, 38 (17–51 [0–123]) mg in the standard catheter group and 37 (14–57 [0–158]) mg in the single‐injection group (p = 0.049). Differences were not statistically significant after Bonferroni correction (α = 0.05/3). There were no differences between groups on postoperative day 1. On postoperative day 2, there were no differences between catheter groups, but muscle strength and ambulation were improved compared with the single‐injection group. We conclude that providing repeated boluses via a catheter did not decrease opioid consumption or pain compared with a single injection, but improved muscle strength and ambulation on postoperative day 2. The two types of catheters were similar.
Parsing metabolic heterogeneity in mood disorders: A hypothesis‐driven cluster analysis of glucose and insulin abnormalities
Authors: Mansur Rodrigo B. , Lee Yena , Subramaniapillai Mehala , Cha Danielle S. , Brietzke Elisa , McIntyre Roger S.
Published: August 2019

Objectives

Metabolically based distinctions for disturbances in glucose and insulin may provide meaningful insights both clinically and mechanistically.

Methods

Data were derived from 352 subjects of previously completed clinical studies with a mood disorder (MD) (bipolar disorder: n = 179, major depressive disorder: n = 173) and 218 healthy controls from the Comprehensive Assessment of Long‐Term Effects of Reducing Intake of Energy. We conducted a factor analysis to replicate a priori dissociable factors informed by glucose and insulin levels and indices of insulin resistance and beta‐cell function: elevated insulin and insulin resistance (“insulin‐IR”), and increased fasting glucose and reduced insulin secretion (“glucotoxicity”). Cluster analyses were conducted, separately in men and women, to evaluate the clinical relevance of subtyping individuals with MDs using insulin‐IR and glucotoxicity (GT) factor scores.

Results

Factors insulin‐IR and GT explained 92.64% and 92.09% of the variance in men and women respectively. Three clusters were replicated in men and women separately: metabolically healthy (MH), high GT, and insulin‐resistant (IR). After adjusting for age, gender, study cohort, MD diagnosis, and antipsychotics use, body mass index (BMI) and mean arterial pressure were higher in IR‐ vs GT‐ or MH‐clustered individuals; GT‐clustered individuals had more metabolic syndrome components and higher C‐reactive protein. Glucotoxic‐clustered subjects reported greater impairments in cognitive function and global functioning when compared to MH‐ or IR‐clustered subjects.

Conclusions

Using simple, cost‐effective, and accessible measures, we identified stable, gender‐convergent, subgroups of individuals that significantly diverged on measures of cognitive dysfunction, self‐reported anhedonia, functional disability, BMI, and blood pressure.
Machine learning and big data analytics in bipolar disorder: A position paper from the International Society for Bipolar Disorders Big Data Task Force
Authors: Passos Ives C. , Ballester Pedro L. , Barros Rodrigo C. , Librenza‐Garcia Diego , Mwangi Benson , Birmaher Boris , Brietzke Elisa , Hajek Tomas , Lopez Jaramillo Carlos , Mansur Rodrigo B. , Alda Martin , Haarman Bartholomeus C. M. , Isometsa Erkki , Lam Raymond W. , McIntyre Roger S. , Minuzzi Luciano , Kessing Lars V. , Yatham Lakshmi N. , Duffy Anne , Kapczinski Flavio
Published: August 2019

Objectives

The International Society for Bipolar Disorders Big Data Task Force assembled leading researchers in the field of bipolar disorder (BD), machine learning, and big data with extensive experience to evaluate the rationale of machine learning and big data analytics strategies for BD.

Method

A task force was convened to examine and integrate findings from the scientific literature related to machine learning and big data based studies to clarify terminology and to describe challenges and potential applications in the field of BD. We also systematically searched PubMed, Embase, and Web of Science for articles published up to January 2019 that used machine learning in BD.

Results

The results suggested that big data analytics has the potential to provide risk calculators to aid in treatment decisions and predict clinical prognosis, including suicidality, for individual patients. This approach can advance diagnosis by enabling discovery of more relevant data‐driven phenotypes, as well as by predicting transition to the disorder in high‐risk unaffected subjects. We also discuss the most frequent challenges that big data analytics applications can face, such as heterogeneity, lack of external validation and replication of some studies, cost and non‐stationary distribution of the data, and lack of appropriate funding.

Conclusion

Machine learning‐based studies, including atheoretical data‐driven big data approaches, provide an opportunity to more accurately detect those who are at risk, parse‐relevant phenotypes as well as inform treatment selection and prognosis. However, several methodological challenges need to be addressed in order to translate research findings to clinical settings.
Consent’s dominion: Dementia and prior consent to sexual relations
Authors: Director Samuel
Published: August 2019

In this paper, I answer the following question: suppose that two individuals, C and D, have been in a long‐term committed relationship, and D now has dementia, while C is competent; if D agrees to have sex with C, is it permissible for C to have sex with D? Ultimately, I defend the view that, under certain conditions, D can give valid consent to sex with C, rendering sex between them permissible. Specifically, I argue that there is compelling reason to endorse the Prior Consent Thesis, which states the following: D, when competent, can give valid prior consent to sex with her competent partner (C) that will take place after she has dementia, assuming that D is the same person as she was when she gave prior consent, meaning that, if D, when competent, gave prior consent to sex with C, then C may permissibly have sex with D. In Section 2, I explain both the background and the existing literature on this issue. In Section 3, I outline relevant stipulations about the kinds of cases I will be examining. In Section 4, I defend the Prior Consent Thesis. And, in Section 5, I address objections to the Prior Consent Thesis.
Element interactivity as a factor influencing the effectiveness of worked example–problem solving and problem solving–worked example sequences
Authors: Chen Ouhao , Retnowati Endah , Kalyuga Slava
Published: August 2019

Background

The worked example effect in cognitive load theory suggests that providing worked examples first followed by solving similar problems would facilitate students’ learning. Using problem solving–worked example sequence is another way of implementing example‐based instruction. Although research has demonstrated the superiority of worked example–problem solving sequence on learning materials that presumably are high in element interactivity for novices, none of the previous studies have compared the two sequences with levels of element interactivity experimentally manipulated in a strictly controlled manner.

Aim

The reported study aimed to investigate the effects of levels of element interactivity of the learning tasks and levels of learner prior knowledge on the effectiveness of two alternative example‐based sequences, worked example–problem solving versus problem solving–worked example.

Sample

Fifty‐two Year five students, around 10 to 11 years old, from a primary school in Indonesia participated in Experiment 1, and 96 Year eight students, around 13 to 14 years old, from a secondary school in Indonesia participated in Experiment 2.

Methods

2 (sequences: worked example–problem solving vs. problem solving–worked example) × 2 (levels of element interactivity: low vs. high) experimental design, with the second factor repeatedly measured, was used in the two experiments conducted with learners at different levels of prior knowledge.

Result

The results showed the advantage of using worked example–problem solving sequence for learning materials high in element interactivity, especially for novice learners, whereas there were no differences between the worked example–problem solving and problem solving–worked example sequences for learning materials low in element interactivity for more knowledgeable learners.

Conclusion

This study not only replicated the results of previous studies, but also extended their findings by experimentally manipulating levels of element interactivity of learning materials.
Retrospective markers of paediatric atopic dermatitis persistence after hospital diagnosis: A nationwide cohort study
Authors: Thyssen Jacob P. , Corn Giulia , Wohlfahrt Jan , Melbye Mads , Bager Peter
Published: August 2019

Background

Atopic dermatitis (AD) normally onsets in childhood and mostly resolves before adolescences. Disease persistence is known to be difficult to study properly, and current predictors are insufficient to identify more than a small fraction of patients at risk.

Objective

To study personal AD medicine history as a retrospective marker of persistent AD.

Methods

The study population included all Danish first hospital contacts with a diagnosis of AD (ICD‐10, L20) between 1995 and 2012. National register data following the diagnosis were used to define persistent AD activity until 2017 according to personal AD medicine history before diagnosis. Activity was defined as filled prescriptions for topical corticosteroids (TCS) or calcineurin inhibitors (TCI), dermatologist contacts or hospital re‐contacts for AD. Risk ratios (RR) for persistent activity (defined as activity >4 of the most recent 5 years) were estimated according to AD medicine history (prescriptions filled prior to diagnosis) adjusted for age at onset, parental AD and basic covariates.

Results

A total of 13 628 patients were diagnosed at ages 0‐16 years and had up to 21 years of follow‐up. 10 years after diagnosis, 67% showed activity (9.5% persistent). Among prior TCS users (69%), the RR10y of persistent activity increased 1‐ to 6‐fold with increasing strength of strongest TCS/TCI ever, and with number of TCS courses. Prior use of antibiotics (RR10y 1.32, 95% CI 1.09‐1.59) and antihistamines (RR10y 1.65, 95% CI 1.42‐1.91) increased the RR10y in a dose‐dependent manner. In >90% of patients, prior medication use occurred <4 years before diagnosis.

Conclusions and clinical relevance

The strength and type of AD medication used in the previous 4 years may predict 10‐year persistence of AD. Since children may be misjudged as having milder disease when seen between flares of skin lesions, this information may improve physicians' ability to determine the correct prognosis independently of current AD severity.
The implanted glucose monitoring system Eversense: An alternative for diabetes patients with isobornyl acrylate allergy
Authors: Oppel Eva , Kamann Stefanie , Heinemann Lutz , Reichl Franz‐Xaver , Högg Christof
Published: August 2019

Background

Some patients with diabetes develop skin reactions when using systems for continuous glucose monitoring (CGM) or insulin pumps. Regular usage and long wearing periods lead not only to skin irritation, but also to allergic contact dermatitis. It has been shown that allergens such as isobornyl acrylate (IBOA) are present in the plastic housing and also in the adhesives of medical devices used for diabetes treatment.

Objectives

To evaluate the IBOA content of all parts of a newly introduced, implanted CGM system (Eversense) to check whether this can be an alternative for IBOA‐sensitized patients.

Methods

The IBOA content of the implanted sensor itself (n = 3), the transmitter (n = 3), and two different types of adhesive (white adhesive [n = 4] and clear adhesive [n = 4]) was measured by gas chromatography/mass spectrometry.

Results

No IBOA was found in any part of this CGM system.

Conclusions

Patients with an IBOA allergy may be able to use this implanted CGM system.
Factors affecting FiO2 and PEEP during high‐flow nasal cannula oxygen therapy: A bench study
Authors: Sun Yu‐Han , Dai Bing , Peng Yun , Tan Wei , Zhao Hong‐Wen
Published: August 2019

Introduction

It is unknown if set‐flow, peak inspiratory flow (PIF), tidal volume and set fraction of inspired O2 (FiO2) affect actual‐FiO2 and positive end‐expiratory pressure (PEEP) during high‐flow nasal cannula (HFNC) oxygen therapy. In addition, the extent of their influence is also unknown.

Objectives

To investigate the effects of set‐FiO2, set‐flow, PIF and tidal volume on the actual‐FiO2 and PEEP during HFNC oxygen therapy.

Methods

A lung simulation model was used to study the factors that might affect FiO2 and PEEP during HFNC therapy in vitro. These factors included set‐flow (20, 40, 60, 80 and 120 L/min), PIF (40, 80 and 120 L/min), tidal volume (400 and 600 mL), and set‐FiO2 (30%, 50% and 70%). Actual‐FiO2 and PEEP were recorded for 10 consecutive breaths. Actual‐FiO2 and PEEP were compared under different conditions. Multivariate linear regressions were performed to investigate the effects of these factors on actual‐FiO2 and PEEP.

Results and conclusion

Regression formula were: (a) actual‐FiO2 as the dependent variable: actual FiO2 = 2.71 + 0.78 × set‐FiO2 + 0.17 × set‐flow − 0.09 × PIF (F test, F = 3866.62, P < 0.001, R2 = 0.94), (b) PEEP as the dependent variable: PEEP = 1.35 + 0.15 × set‐flow − 0.02 × PIF + 0.01 × tidal volume (F test, F = 4082.39, P < 0.001, R2 = 0.95). The following factors were found to affect actual‐FiO2 (in descending order): set‐FiO2, set‐flow and PIF. Tidal volume had little effect on actual‐FiO2. Factors which affected PEEP were (in descending order): set‐flow, peak inspiratory flow and tidal volume.
Episodic and chronic migraine in children
Authors: Youssef Paul E , Mack Kenneth J
Published: August 2019

Migraine is the most common acute and recurrent headache syndrome in children. This condition has unique clinical characteristics in the pediatric population, that can evolve with age, and significantly impact a child's quality of life, affecting their education, socialization, and family life. The purpose of this review is to describe the varied clinical features of migraine seen in children, and discuss potential treatment options for pediatric migraine, including chronic migraine. In many patients a multifaceted approach involving lifestyle changes, treatment of comorbid conditions, and pharmacological treatments are needed for optimal headache control.

What this paper adds

Migraine presents as various phenotypes in children, sometimes evolving as the child ages.

An expanded range of treatment options exists for the challenging chronic migraine patient.
Loss of incretin effect contributes to postprandial hyperglycaemia in cystic fibrosis‐related diabetes
Authors: Frost F. , Jones G. H. , Dyce P. , Jackson V. , Nazareth D. , Walshaw M. J.
Published: August 2019

Aim

To investigate the incretin axis in people with cystic fibrosis.

Methods

Adults with cystic fibrosis‐related diabetes, cystic fibrosis without diabetes, and controls (adults without cystic fibrosis and without diabetes) underwent an oral glucose tolerance test and then a closely matched isoglycaemic i.v. glucose infusion. On each occasion, glucose, insulin, C‐peptide, total and active glucagon‐like peptide‐1 and gastric inhibitory polypeptide responses were recorded and incremental areas under curves were calculated for 60 and 240 min.

Results

Five adults with cystic fibrosis‐related diabetes, six with cystic fibrosis without diabetes and six controls, matched for age and BMI, completed the study. Glucose during oral glucose tolerance test closely matched those during isoglycaemic i.v. glucose infusion. The calculated incretin effect was similar in the control group and the cystic fibrosis without diabetes group (28% and 29%, respectively), but was lost in the cystic fibrosis‐related diabetes group (cystic fibrosis‐related diabetes vs control group: –6% vs 28%; p=0.03). No hyposecretion of glucagon‐like peptide‐1 or gastric inhibitory polypeptide was observed; conversely, 60‐min incremental area under the curve for total glucagon‐like peptide‐1 was significantly higher in the cystic fibrosis‐related diabetes group than in the control group [1070.4 (254.7) vs 694.97 (308.1); p=0.03]

Conclusions

The incretin effect was lost in cystic fibrosis‐related diabetes despite adequate secretion of the incretin hormones. These data support the concept that reduced incretin hormone insulinotropic activity contributes significantly to postprandial hyperglycaemia in cystic fibrosis‐related diabetes.
A population‐based epidemiological study of neuromyelitis optica spectrum disorder in Hungary
Authors: Papp V. , Iljicsov A. , Rajda C. , Magyari M. , Koch‐Henriksen N. , Petersen T. , Jakab G. , Deme I. , Nagy F. , Imre P. , Lohner Z. , Kovács K. , Birkás A. J. , Köves Á. , Rum G. , Nagy Z. , Kerényi L. , Vécsei L. , Bencsik K. , Jobbágy Z. , Diószeghy P. , Horváth L. , Galántai G. , Kasza J. , Molnár G. , Simó M. , Sátori M. , Rózsa C. , Ács P. , Berki T. , Lovas G. , Komoly S. , Illes Z.
Published: August 2019

Background and purpose

The goal of this study was to determine the prevalence and incidence of neuromyelitis optica spectrum disorder (NMOSD) in Hungary based on the 2015 International Panel of NMO Diagnosis (IPND) criteria.

Methods

A retrospective population‐based cohort study was conducted of 6.4 million Hungarians (age ≥ 16 years) between 1 January 2006 and 31 December 2016. Possible NMOSD patients were selected via multistage re‐evaluation from multiple sources. Crude and sex‐ and serostatus‐specific prevalence (per 100 000 persons) and incidence rates (per 1 000 000 person‐years) from 2006 to 2015 were estimated and age‐adjusted rates were determined.

Results

Of 2262 study candidates, 154 NMOSD patients (age ≥ 16 years) with onset until 31 December 2016 were identified based on 2015 IPND criteria. The prevalence analysis on 1 January 2016 included 123 NMOSD living cases, resulting in a prevalence of 1.91 [95% confidence interval (CI) 1.52–2.28] per 100 000 persons. The 101 incident cases emerging from the observed 76 394 288 person‐years provided an incidence rate of 1.32 (95% CI 1.08–1.61) per 1 000 000 person‐years. Age‐adjusted prevalence was 1.87 (95% CI 1.56–2.23) per 100 000 persons and incidence was 1.20 (95% CI 0.98–1.46) per 1 000 000 person‐years.

Conclusions

In this first report of a large population‐based epidemiological study from an Eastern European Caucasian population using robust case validation, a greater prevalence and incidence of NMOSD was found compared to previous large studies in Caucasian populations.
Fifth International Biannual Evolution and Ecology of Cancer Conference (Cooperation, Conflict and Parasitism) meeting report—Wellcome Genome Campus, Hinxton, UK
Authors: Raven Nynke , Bramwell Georgina , Hamede Rodrigo , Thomas Frédéric , Ujvari Beata
Published: August 2019

The fifth biannual conference of the International Society of Evolution and Ecology of Cancer (ISEEC) was held between the 17th and 19th of July 2019 in Hinxton (UK) at the Wellcome Genome Campus. The main theme of the conference: cooperation, conflict and parasitism reflected our growing understanding of the role cancer has played in the evolution of multicellular organisms, as well as the urgent need of translating these Darwinian processes to treatment strategies. Below we provide a brief summary of each plenary sessions and other oral presentations, to bring the conference to the broader audience of evolutionary biology and applications.
An efficient hybrid similarity measure based on user interests for recommender systems
Authors: Hawashin Bilal , Lafi Mohammad , Kanan Tarek , Mansour Ayman
Published: August 2019

Recommender systems are used to suggest items to users based on their interests. They have been used widely in various domains, including online stores, web advertisements, and social networks. As part of their process, recommender systems use a set of similarity measurements that would assist in finding interesting items. Although many similarity measurements have been proposed in the literature, they have not concentrated on actual user interests. This paper proposes a new efficient hybrid similarity measure for recommender systems based on user interests. This similarity measure is a combination of two novel base similarity measurements: the user interest–user interest similarity measure and the user interest–item similarity measure. This hybrid similarity measure improves the existing work in three aspects. First, it improves the current recommender systems by using actual user interests. Second, it provides a comprehensive evaluation of an efficient solution to the cold start problem. Third, this similarity measure works well even when no corated items exist between two users. Our experiments show that our proposed similarity measure is efficient in terms of accuracy, execution time, and applicability. Specifically, our proposed similarity measure achieves a mean absolute error (MAE) as low as 0.42, with 64% applicability and an execution time as low as 0.03 s, whereas the existing similarity measures from the literature achieve an MAE of 0.88 at their best; these results demonstrate the superiority of our proposed similarity measure in terms of accuracy, as well as having a high applicability percentage and a very short execution time.
High genetic variation and phylogeographic relations among Palearctic fairy shrimp populations reflect persistence in multiple southern refugia during Pleistocene ice ages and postglacial colonisation
Authors: Lukić Dunja , Waterkeyn Aline , Rabet Nicolas , Mioduchowska Monika , Geudens Bernard , Vanschoenwinkel Bram , Brendonck Luc , Pinceel Tom
Published: August 2019

Intense anthropogenic disturbance threatens temporary pond ecosystems and their associated fauna across the Palearctic. Since fairy shrimps (Crustacea, Branchiopoda) are endemic to temporary ponds, populations are declining due to habitat loss and it is important to define adequate units for conservation.

Phylogeographic reconstructions, based on genetic variation, provide valuable information for defining evolutionary and conservation units, especially for organisms with high levels of cryptic diversity like many fairy shrimps. We studied a total of 152 individuals of the fairy shrimpBranchipus schaefferifrom 79 populations across the Palearctic and used mitochondrial (CO1) and nuclear (ITS1)DNAdata to reconstruct the phylogeography of the species.

Our results show thatB. schaeffericomprises four highly diverged (10.3–16.5%) evolutionary clades. The present‐day haplotypes within each of the clades probably diverged from lineages that were maintained in separate refugia during the Pleistocene ice ages. While two clades represent distinct geographic regions, the two remaining clades have more wide and overlapping ranges. In addition, the limited number of shared haplotypes among populations from geographically distant regions within three of the clades suggest recent long‐distance dispersal events.

Overall, the studiedB. schaefferidataset comprises high levels of genetic differentiation, without a clear morphological signal. Phylogenetic searches and pairwise genetic distances suggest that the studied lineages belong to a complex of four morphologically cryptic species. Since these four evolutionary old clades persist (±2 million years), despite overlapping geographic ranges and since they span a variety of ecological conditions, they should be considered as separate evolutionary significant units for conservation.
Forest streams are important sources for nitrous oxide emissions
Authors: Audet Joachim , Bastviken David , Bundschuh Mirco , Buffam Ishi , Feckler Alexander , Klemedtsson Leif , Laudon Hjalmar , Löfgren Stefan , Natchimuthu Sivakiruthika , Öquist Mats , Peacock Mike , Wallin Marcus B.
Published: August 2019

Streams and river networks are increasingly recognized as significant sources for the greenhouse gas nitrous oxide (N2O). N2O is a transformation product of nitrogenous compounds in soil, sediment and water. Agricultural areas are considered a particular hotspot for emissions because of the large input of nitrogen (N) fertilizers applied on arable land. However, there is little information on N2O emissions from forest streams although they constitute a major part of the total stream network globally. Here, we compiled N2O concentration data from low‐order streams (~1,000 observations from 172 stream sites) covering a large geographical gradient in Sweden from the temperate to the boreal zone and representing catchments with various degrees of agriculture and forest coverage. Our results showed that agricultural and forest streams had comparable N2O concentrations of 1.6 ± 2.1 and 1.3 ± 1.8 µg N/L, respectively (mean ± SD) despite higher total N (TN) concentrations in agricultural streams (1,520 ± 1,640 vs. 780 ± 600 µg N/L). Although clear patterns linking N2O concentrations and environmental variables were difficult to discern, the percent saturation of N2O in the streams was positively correlated with stream concentration of TN and negatively correlated with pH. We speculate that the apparent contradiction between lower TN concentration but similar N2O concentrations in forest streams than in agricultural streams is due to the low pH (<6) in forest soils and streams which affects denitrification and yields higher N2O emissions. An estimate of the N2O emission from low‐order streams at the national scale revealed that ~1.8 × 109 g N2O‐N are emitted annually in Sweden, with forest streams contributing about 80% of the total stream emission. Hence, our results provide evidence that forest streams can act as substantial N2O sources in the landscape with 800 × 109 g CO2‐eq emitted annually in Sweden, equivalent to 25% of the total N2O emissions from the Swedish agricultural sector.
Non‐native mangroves support carbon storage, sediment carbon burial, and accretion of coastal ecosystems
Authors: Soper Fiona M. , MacKenzie Richard A. , Sharma Sahadev , Cole Thomas G. , Litton Creighton M. , Sparks Jed P.
Published: August 2019

Mangrove forests play an important role in climate change adaptation and mitigation by maintaining coastline elevations relative to sea level rise, protecting coastal infrastructure from storm damage, and storing substantial quantities of carbon (C) in live and detrital pools. Determining the efficacy of mangroves in achieving climate goals can be complicated by difficulty in quantifying C inputs (i.e., differentiating newer inputs from younger trees from older residual C pools), and mitigation assessments rarely consider potential offsets to CO2 storage by methane (CH4) production in mangrove sediments. The establishment of non‐native Rhizophora mangle along Hawaiian coastlines over the last century offers an opportunity to examine the role mangroves play in climate mitigation and adaptation both globally and locally as novel ecosystems. We quantified total ecosystem C storage, sedimentation, accretion, sediment organic C burial and CH4 emissions from ~70 year old R. mangle stands and adjacent uninvaded mudflats. Ecosystem C stocks of mangrove stands exceeded mudflats by 434 ± 33 Mg C/ha, and mangrove establishment increased average coastal accretion by 460%. Sediment organic C burial increased 10‐fold (to 4.5 Mg C ha−1 year−1), double the global mean for old growth mangrove forests, suggesting that C accumulation from younger trees may occur faster than previously thought, with implications for mangrove restoration. Simulations indicate that increased CH4 emissions from sediments offset ecosystem CO2 storage by only 2%–4%, equivalent to 30–60 Mg CO2‐eq/ha over mangrove lifetime (100 year sustained global warming potential). Results highlight the importance of mangroves as novel systems that can rapidly accumulate C, have a net positive atmospheric greenhouse gas removal effect, and support shoreline accretion rates that outpace current sea level rise. Sequestration potential of novel mangrove forests should be taken into account when considering their removal or management, especially in the context of climate mitigation goals.
Exemptions, Sincerity and Pastafarianism
Authors: Martin Nick
Published: August 2019

Because Pastafarianism – or the Church of the Flying Spaghetti Monster – is a parodic religion, common sense suggests its ‘adherents’ should not receive exemptions. However, the prima facie case for excluding Pastafarians is complicated by the fact that many assert their religion is as legitimate as any other religion and that their beliefs are genuine. Indeed, Pastafarians have already obtained exemptions in various countries. Taking the dominant liberal egalitarian, integrity‐based approach to exemptions, this article investigates whether there is a principled, objective basis for excluding Pastafarians that accounts for their assertions. To that end, I examine four tests: a religion, seriousness, obligation, and sincerity test. I assess whether each test can actually exclude Pastafarians, and if it could, can it do so in a way that is consistent with liberal egalitarian commitments. I argue that only a sincerity test – based on consistent behaviour and a willingness to bear the costs of one's beliefs – satisfies both of these conditions, but, on a weak and contingent basis.
Long non‐coding RNA cardiac hypertrophy‐associated regulator governs cardiac hypertrophy via regulating miR‐20b and the downstream PTEN/AKT pathway
Authors: Zhang Mingyu , Jiang Yuan , Guo Xiaofei , Zhang Bowen , Wu Jiangjiao , Sun Jiabin , Liang Haihai , Shan Hongli , Zhang Yong , Liu Jiaqi , Wang Ying , Wang Lu , Zhang Rong , Yang Baofeng , Xu Chaoqian
Published: August 2019

Pathological cardiac hypertrophy (CH) is a key factor leading to heart failure and ultimately sudden death. Long non‐coding RNAs (lncRNAs) are emerging as a new player in gene regulation relevant to a wide spectrum of human disease including cardiac disorders. Here, we characterize the role of a specific lncRNA named cardiac hypertrophy‐associated regulator (CHAR) in CH and delineate the underlying signalling pathway. CHAR was found markedly down‐regulated in both in vivo mouse model of cardiac hypertrophy induced by pressure overload and in vitro cellular model of cardiomyocyte hypertrophy induced by angiotensin II (AngII) insult. CHAR down‐regulation alone was sufficient to induce hypertrophic phenotypes in healthy mice and neonatal rat ventricular cells (NRVCs). Overexpression of CHAR reduced the hypertrophic responses. CHAR was found to act as a competitive endogenous RNA (ceRNA) to down‐regulate miR‐20b that we established as a pro‐hypertrophic miRNA. We experimentally established phosphatase and tensin homolog (PTEN), an anti‐hypertrophic signalling molecule, as a target gene for miR‐20b. We found that miR‐20b induced CH by directly repressing PTEN expression and indirectly increasing AKT activity. Moreover, CHAR overexpression mitigated the repression of PTEN and activation of AKT by miR‐20b, and as such, it abrogated the deleterious effects of miR‐20b on CH. Collectively, this study characterized a new lncRNA CHAR and unravelled a new pro‐hypertrophic signalling pathway: lncRNA‐CHAR/miR‐20b/PTEN/AKT. The findings therefore should improve our understanding of the cellular functionality and pathophysiological role of lncRNAs in the heart.
Legislative Control over Executive Law‐making: Delegation of Quasi‐legislative Powers to the European Commission
Authors: Yordanova Nikoleta , Zhelyazkova Asya
Published: August 2019

Most EU legislation consists of executive acts of the European Commission. The Lisbon Treaty introduced a new type of EU executive legislation – delegated acts, which give the European Parliament formal powers of legislative scrutiny equal to those of the EU Council. Thus, the use of delegated acts could reinforce the institutional balance of power and help reduce the EU's democratic deficit. We studied the situations when the Parliament and the Council agreed to grant the Commission the right to adopt delegated acts, considering the preference constellations of legislative and executive actors and legislative complexity. Using a novel dataset on post‐Lisbon legislation, we found that delegated acts are more likely in cases of high legislative complexity and when the Council sees the Parliament as an ally vis‐à‐vis the Commission. However, the European Parliament gets no say over executive measures when doing so could shift policy outcomes away from the Council's preferences, raising doubts about the effectiveness of parliamentary control.
Explaining the European Union's Security Role in Practice
Authors: Ekengren Magnus , Hollis Simon
Published: August 2019

European states may no longer expect inter‐state violence, but they do expect complex threats emanating from storms, epidemics, terror attacks and earthquakes. The EU has answered these threats through the rapid and far‐reaching institutionalization of European security cooperation. However, member states hesitate to use their common capacities. While both intergovernmental and constructivist approaches treat this pattern as evidence of weak integration and as unimportant to the European security community, we examine this cooperation through the lens of practice theory and reveal how the growth of EU capacities is fully compatible with a critical and cautious approach to activating these resources in the everyday work of national officials. Using unique empirical data retrieved through participant observation in the first multisectoral crisis management exercise held by the EU, the findings of this analysis sketch the contours of a new type of security community.
Consistency of plasma glucagon levels in patients with type 1 diabetes after a 1‐year period
Authors: Kawamori Dan , Katakami Naoto , Takahara Mitsuyoshi , Miyashita Kazuyuki , Takebe Satomi , Yasuda Tetsuyuki , Matsuoka Taka‐aki , Shimomura Iichiro
Published: August 2019

Recent progress in research on glucagon and α‐cells highlights their pathophysiological roles in diabetes. We previously showed that plasma glucagon levels measured by newly developed enzyme‐linked immunosorbent assay were dysregulated in patients with type 1 diabetes with respect to plasma glucose levels, suggesting dysregulated secretion. In the current study, the annual change in plasma glucagon levels was assessed in these same patients. We found that the plasma glucagon levels in the 66 Japanese patients involved in the study were significantly correlated between both years. In addition, they were significantly associated with serum blood urea nitrogen levels in a multivariate linear regression analysis, as reported in our previous study. The statistical correlation in glucagon levels between annual checkups and the sustained significant correlation between glucagon and blood urea nitrogen suggest a constant dysregulation of glucagon in association with altered amino acid metabolism in patients with type 1 diabetes.
Ablative fractional laser‐assisted photodynamic therapy for lentigo maligna: a prospective pilot study
Authors: Räsänen J.E. , Neittaanmäki N. , Jeskanen L. , Pölönen I. , Snellman E. , Grönroos M.
Published: August 2019

Background

Lentigo maligna (LM) is an in situ form of melanoma carrying a risk of progression to invasive lentigo maligna melanoma (LMM). LM poses a clinical challenge, with subclinical extension and high recurrence rates after incomplete surgery. Alternative treatment methods have been investigated with varying results. Photodynamic therapy (PDT) with methylaminolaevulinate (MAL) has already proved promising in this respect.

Objectives

To investigate the efficacy of ablative fractional laser (AFL)‐assisted PDT with 5‐aminolaevulinic acid nanoemulsion (BF‐200 ALA) for treating LM.

Methods

In this non‐sponsored prospective pilot study, ten histologically verified LMs were treated with AFL‐assisted PDT three times at 2‐week intervals using a light dose of 90 J/cm2 per treatment session. Local anaesthesia with ropivacaine was used. Four weeks after the last PDT treatment the lesions were treated surgically with a wide excision and sent for histopathological examination. The primary outcome was complete histopathological clearance of the LM from the surgical specimen. Patient‐reported pain during illumination and the severity of the skin reaction after the PDT treatments were monitored as secondary outcomes.

Results

The complete histopathological clearance rate was 7 out of 10 LMs (70%). The pain during illumination was tolerable, with the mean pain scores for the PDT sessions on a visual assessment scale ranging from 2.9 to 3.8. Some severe skin reactions occurred during the treatment period, however.

Conclusions

Ablative fractional laser‐assisted PDT showed moderate efficacy in terms of histological clearance. It could constitute an alternative treatment for LM but due to the side effects it should only be considered in inoperable cases.
Examining the Dual Purpose Use of Student Learning Objectives for Classroom Assessment and Teacher Evaluation
Authors: Briggs Derek C. , Chattergoon Rajendra , Burkhardt Amy
Published: August 2019

The process of setting and evaluating student learning objectives (SLOs) has become increasingly popular as an example where classroom assessment is intended to fulfill the dual purpose use of informing instruction and holding teachers accountable. A concern is that the high‐stakes purpose may lead to distortions in the inferences about students and teachers that SLOs can support. This concern is explored in the present study by contrasting student SLO scores in a large urban school district to performance on a common objective external criterion. This external criterion is used to evaluate the extent to which student growth scores appear to be inflated. Using 2 years of data, growth comparisons are also made at the teacher level for teachers who submit SLOs and have students that take the state‐administered large‐scale assessment. Although they do show similar relationships with demographic covariates and have the same degree of stability across years, the two different measures of growth are weakly correlated.
Decisional Guidance Tool for Antibiotic Prescribing in the Skilled Nursing Facility
Authors: Davenport Claire , Brodeur Michael , Wolff Michael , Meek Patrick D. , Crnich Christopher J.
Published: August 2019

OBJECTIVES

To derive weighted‐incidence syndromic combination antibiograms (WISCAs) in the skilled nursing facility (SNF). To compare burden of resistance between SNFs in a region and those with and without protocols designed to reduce inappropriate antibiotic use.

DESIGN

Retrospective analysis of microbial data from a regional laboratory.

SETTING

We analyzed 2484 isolates collected at a regional laboratory from a large mixed urban and suburban area from January 1, 2015, to December 31, 2015.

PARTICIPANTS

A total of 28 regional SNFs (rSNFs) and 7 in‐network SNFs (iSNFs).

MEASUREMENTS

WISCAs were derived combining Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, and reports restricted to fluoroquinolones, cefazolin, amoxicillin clavulanate, and trimethoprim/sulfamethoxazole.

RESULTS

Pooling the target isolates into WISCAs resulted in an average of 28 of 37 achieving a number greater than 30 with an average of 50 isolates (range = 11‐113; >97% urinary). Significant differences were found in antibiotic susceptibility between grouped rSNF data and iSNF data of 75% vs 65% (2.76‐11.77; P = .002). The susceptibilities were higher in iSNFs with active antibiotic reduction protocols compared with iSNFs without protocols and rSNFs (effect size = .79 vs .67 and .65, respectively) (I2 = 93.33; P < .01). Susceptibilities to cefazolin (95% vs 76%; P < .001) and fluoroquinolones (72% vs 64%; P = .048) were significantly higher in iSNFs with active urinary tract infection protocols as compared with iSNFs without antibiotic reduction protocols.

CONCLUSION

These results suggest that WISCAs can be developed in most SNFs, and their results can serve as indicators of successful antibiotic stewardship programs. J Am Geriatr Soc 68:55–61, 2019
Facilitators and Barriers to Adoption of a Healthy Diet in Survivors of Colorectal Cancer
Authors: Lee Myung Kyung , Park Soo Yeun , Choi Gyu‐Seog
Published: August 2019

Purpose

Adherence to dietary guidelines and consumption of a high‐quality diet are essential to rebuild strength and to decrease tumor recurrence and mortality in patients with colorectal cancer. We examined the associations of the diet quality of patients who have colorectal cancer with the characteristics of the patients and their families, the patient's perceived barriers to following the diet, and the family's attempts to change the diet.

Design

A cross‐sectional study design was employed. Patients with colorectal cancer were recruited from National University Hospitals in South Korea. Enrolled patients were over 19 years old. Enrolled relatives served as the primary caregivers of the patients.

Methods

A total of 216 patients who had colorectal cancer and their family caregivers were enrolled. We assessed patients’ diet quality, their perceived barriers to following the dietary plan, and family caregivers’ attempts to improve diet quality.

Findings

Patients with colorectal cancer were less likely to have healthy eating habits if they perceived barriers to the recommended dietary plan, and more likely to have healthy eating habits if they had family caregivers who attempted to change their own dietary habits.

Conclusions

Strategies that target patients’ perceived barriers to following a healthy diet and that encourage family members to facilitate the adoption of a healthy diet can be integrated into the treatment plan of patients with colorectal cancer.

Clinical Relevance

The results can be used as evidence for promoting the notion that diet interventions for patients with colorectal cancer focus on the patient–family dyad, which support overall quality of care in oncology care hospitals.
Urinary placental growth factor in preeclampsia and fetal growth restriction: An alternative to circulating biomarkers?
Authors: Zhang Kewei , Zen Monica , Popovic Nicole L. , Lee Vincent W. , Alahakoon Thushari I.
Published: August 2019

Aim

To correlate plasma and urinary soluble fms‐like tyrosine kinase 1 (sFlt‐1) and placental growth factor (PIGF) in preeclampsia (PE) and fetal growth restriction (FGR) and assess the performance in detecting established disease.

Methods

A cross‐sectional case–control study recruited 26–40 weeks gestation pregnancies into four clinical groups: normal pregnancy, PE, PE + FGR, and FGR. enzyme‐linked immunosorbent assay (ELISA) measurements of urinary and plasma sFlt‐1 and PlGF levels were performed. Urinary levels of sFlt‐1 and PIGF were normalized to creatinine. Spearman's rank correlation was used to assess the association between plasma and urinary levels of sFlt‐1 and PIGF, and receiver operating characteristic graphs were used to quantify the performance of each individual marker and their ratios in predicting normal versus pathological pregnancies affected by preeclampsia and/or FGR.

Results

There was a significant correlation between plasma PlGF and urinary PlGF (r = 0.718, P < 0.001) in all groups. In the pathological groups, plasma sFlt‐1 and urinary sFlt‐1 as well as plasma sFlt‐1: PIGF ratio and urinary sFlt‐1: PlGF ratio were higher, but plasma PIGF and urinary PlGF were lower when compared to normal pregnancy. Plasma PIGF and plasma sFlt‐1: PlGF ratio was comparable in performance to urinary PlGF and urinary sFlt‐1: PIGF ratio for the diagnosis of preeclampsia and/or FGR.

Conclusion

Urinary PIGF can be used as an alternative to circulating biomarkers in preeclampsia and FGR. Plasma sFlt‐1, PlGF and sFlt‐1: PlGF ratio as well as urinary PIGF and sFlt‐1: PlGF ratio can be used to differentiate between normal pregnancy and pregnancies complicated by preeclampsia and FGR.
Cesarean section under general anesthesia for antepartum reversible cerebral vasoconstriction syndrome: A case report
Authors: Descamps Richard , Envain François , Kuchcinski Grégory , Clouqueur Elodie , Henon Hilde , Gonzalez‐Estevez Max
Published: August 2019

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by acute and usually severe headache related to multifocal vasoconstriction of cerebral arteries, reversible within 3 months. About 10% of RCVS are pregnancy‐related, but only three cases of antepartum RCVS have been described. We report the case of a 26‐year‐old pregnant woman who presented at 36 weeks gestation with antepartum RCVS. Delivery was managed by cesarean section under general anesthesia. Though she developed focal neurologic deficits on the first postoperative day, these resolved at hospital discharge. This case highlights pre‐ and post‐partum multidisciplinary management including cesarean section under general anesthesia.