bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterization of acute kidney injury in critically ill patients with severe coronavirus disease 2019
Authors: Rubin Sébastien , Orieux Arthur , Prevel Renaud , Garric Antoine , Bats Marie-Lise , Dabernat Sandrine , Camou Fabrice , Guisset Olivier , Issa Nahema , Mourissoux Gaelle , Dewitte Antoine , Joannes-Boyau Olivier , Fleureau Catherine , Rozé Hadrien , Carrié Cédric , Petit Laurent , Clouzeau Benjamin , Sazio Charline , Bui Hoang-Nam , Pillet Odile , Rigothier Claire , Vargas Frederic , Combe Christian , Gruson Didier , Boyer Alexandre
Published: May 2020

Background

Coronavirus disease 2019 (COVID-19)-associated acute kidney injury (AKI) frequency, severity and characterization in critically ill patients has not been reported.

Methods

Single-centre cohort performed from 3 March 2020 to 14 April 2020 in four intensive care units in Bordeaux University Hospital, France. All patients with COVID-19 and pulmonary severity criteria were included. AKI was defined using Kidney Disease: Improving Global Outcomes (KDIGO) criteria. A systematic urinary analysis was performed. The incidence, severity, clinical presentation, biological characterization (transient versus persistent AKI; proteinuria, haematuria and glycosuria) and short-term outcomes were evaluated.

Results

Seventy-one patients were included, with basal serum creatinine (SCr) of 69 ± 21 µmol/L. At admission, AKI was present in 8/71 (11%) patients. Median [interquartile range (IQR)] follow-up was 17 (12–23) days. AKI developed in a total of 57/71 (80%) patients, with 35% Stage 1, 35% Stage 2 and 30% Stage 3 AKI; 10/57 (18%) required renal replacement therapy (RRT). Transient AKI was present in only 4/55 (7%) patients and persistent AKI was observed in 51/55 (93%). Patients with persistent AKI developed a median (IQR) urine protein/creatinine of 82 (54–140) (mg/mmol) with an albuminuria/proteinuria ratio of 0.23 ± 20, indicating predominant tubulointerstitial injury. Only two (4%) patients had glycosuria. At Day 7 after onset of AKI, six (11%) patients remained dependent on RRT, nine (16%) had SCr >200 µmol/L and four (7%) had died. Day 7 and Day 14 renal recovery occurred in 28% and 52%, respectively.

Conclusion

Severe COVID-19-associated AKI is frequent, persistent, severe and characterized by an almost exclusive tubulointerstitial injury without glycosuria.
Rapid Detection of SARS-CoV-2 by Low Volume Real-Time Single Tube Reverse Transcription Recombinase Polymerase Amplification Using an Exo Probe with an Internally Linked Quencher (Exo-IQ)
Authors: Behrmann Ole , Bachmann Iris , Spiegel Martin , Schramm Marina , Abd El Wahed Ahmed , Dobler Gerhard , Dame Gregory , Hufert Frank T
Published: May 2020

Background

The current outbreak of SARS-CoV-2 has spread to almost every country with more than 5 million confirmed cases and over 300,000 deaths as of May 26, 2020. Rapid first-line testing protocols are needed for outbreak control and surveillance.

Methods

We used computational and manual designs to generate a suitable set of reverse transcription recombinase polymerase amplification (RT-RPA) primer and exonuclease probe, internally quenched (exo-IQ), sequences targeting the SARS-CoV-2 N gene. RT-RPA sensitivity was determined by amplification of in vitro transcribed RNA standards. Assay selectivity was demonstrated with a selectivity panel of 32 nucleic acid samples derived from common respiratory viruses. To validate the assay against full-length SARS-CoV-2 RNA, total viral RNA derived from cell culture supernatant and 19 nasopharyngeal swab samples (8 positive and 11 negative for SARS-CoV-2) were screened. All results were compared to established RT-qPCR assays.

Results

The 95% detection probability of the RT-RPA assay was determined to be 7.74 (95% CI: 2.87–27.39) RNA copies per reaction. The assay showed no cross-reactivity to any other screened coronaviruses or respiratory viruses of clinical significance. The developed RT-RPA assay produced 100% diagnostic sensitivity and specificity when compared to RT-qPCR (n = 20).

Conclusions

With a run time of 15 to 20 minutes and first results being available in under 7 minutes for high RNA concentrations, the reported assay constitutes one of the fastest nucleic acid based detection methods for SARS-CoV-2 to date and may provide a simple-to-use alternative to RT-qPCR for first-line screening at the point of need.
Inhibition of xanthine oxidase in the acute phase of myocardial infarction prevents skeletal muscle abnormalities and exercise intolerance
Authors: Nambu Hideo , Takada Shingo , Maekawa Satoshi , Matsumoto Junichi , Kakutani Naoya , Furihata Takaaki , Shirakawa Ryosuke , Katayama Takashi , Nakajima Takayuki , Yamanashi Katsuma , Obata Yoshikuni , Nakano Ippei , Tsuda Masaya , Saito Akimichi , Fukushima Arata , Yokota Takashi , Nio-Kobayashi Junko , Yasui Hironobu , Higashikawa Kei , Kuge Yuji , Anzai Toshihisa , Sabe Hisataka , Kinugawa Shintaro
Published: May 2020

Aims

Exercise intolerance in patients with heart failure (HF) is partly attributed to skeletal muscle abnormalities. We have shown that reactive oxygen species (ROS) play a crucial role in skeletal muscle abnormalities, but the pathogenic mechanism remains unclear. Xanthine oxidase (XO) is reported to be an important mediator of ROS overproduction in ischaemic tissue. Here, we tested the hypothesis that skeletal muscle abnormalities in HF are initially caused by XO-derived ROS and are prevented by the inhibition of their production.

Methods and results

Myocardial infarction (MI) was induced in male C57BL/6J mice, which eventually led to HF, and a sham operation was performed in control mice. The time course of XO-derived ROS production in mouse skeletal muscle post-MI was first analysed. XO-derived ROS production was significantly increased in MI mice from Days 1 to 3 post-surgery (acute phase), whereas it did not differ between the MI and sham groups from 7 to 28 days (chronic phase). Second, mice were divided into three groups: sham + vehicle (Sham + Veh), MI + vehicle (MI + Veh), and MI + febuxostat (an XO inhibitor, 5 mg/kg body weight/day; MI + Feb). Febuxostat or vehicle was administered at 1 and 24 h before surgery, and once-daily on Days 1–7 post-surgery. On Day 28 post-surgery, exercise capacity and mitochondrial respiration in skeletal muscle fibres were significantly decreased in MI + Veh compared with Sham + Veh mice. An increase in damaged mitochondria in MI + Veh compared with Sham + Veh mice was also observed. The wet weight and cross-sectional area of slow muscle fibres (higher XO-derived ROS) was reduced via the down-regulation of protein synthesis-associated mTOR-p70S6K signalling in MI + Veh compared with Sham + Veh mice. These impairments were ameliorated in MI + Feb mice, in association with a reduction of XO-derived ROS production, without affecting cardiac function.

Conclusion

XO inhibition during the acute phase post-MI can prevent skeletal muscle abnormalities and exercise intolerance in mice with HF.
Applying machine learning to detect early stages of cardiac remodelling and dysfunction
Authors: Sabovčik František , Cauwenberghs Nicholas , Kouznetsov Dmitry , Haddad Francois , Alonso-Betanzos Amparo , Vens Celine , Kuznetsova Tatiana
Published: May 2020

Aims

Both left ventricular (LV) diastolic dysfunction (LVDD) and hypertrophy (LVH) as assessed by echocardiography are independent prognostic markers of future cardiovascular events in the community. However, selective screening strategies to identify individuals at risk who would benefit most from cardiac phenotyping are lacking. We, therefore, assessed the utility of several machine learning (ML) classifiers built on routinely measured clinical, biochemical, and electrocardiographic features for detecting subclinical LV abnormalities.

Methods and results

We included 1407 participants (mean age, 51 years, 51% women) randomly recruited from the general population. We used echocardiographic parameters reflecting LV diastolic function and structure to define LV abnormalities (LVDD, n = 252; LVH, n = 272). Next, four supervised ML algorithms (XGBoost, AdaBoost, Random Forest (RF), Support Vector Machines, and Logistic regression) were used to build classifiers based on clinical data (67 features) to categorize LVDD and LVH. We applied a nested 10-fold cross-validation set-up. XGBoost and RF classifiers exhibited a high area under the receiver operating characteristic curve with values between 86.2% and 88.1% for predicting LVDD and between 77.7% and 78.5% for predicting LVH. Age, body mass index, different components of blood pressure, history of hypertension, antihypertensive treatment, and various electrocardiographic variables were the top selected features for predicting LVDD and LVH.

Conclusion

XGBoost and RF classifiers combining routinely measured clinical, laboratory, and electrocardiographic data predicted LVDD and LVH with high accuracy. These ML classifiers might be useful to pre-select individuals in whom further echocardiographic examination, monitoring, and preventive measures are warranted.
Measuring and analysing social efficiency in the production of maternal health services in Mexico, 2008–15
Authors: Fene Fato , Serván-Mori Edson , Ángel Mendoza Miguel , Chivardi Carlos , Reyes-Morales Hortensia , Nigenda Gustavo
Published: May 2020

‘Social efficiency’ (SE) denotes the capacity of health systems to ensure equitable access to quality health services at no financial risk to users. Mexico and other low- and middle-income countries have rarely studied the performance of their health systems from an SE perspective. We propose a metric for assessing SE in the production of maternal health services in the public sector among populations without social security, analysing contextual correlates of the demand for these services. Analysis was based on administrative data collected from the 243 health jurisdictions (HJs) in Mexico for the period 2008–15. We defined production inputs as the availability of physical and human resources and social product as the unweighted sum of social sub-products, including an equitable distribution of maternal health resources, the provision of quality maternal health care and financial protection for users. We described the SE scores, the main contextual characteristics as well as those related to the demand for maternal health services. We then performed a variance decomposition analysis of the SE score by component and estimated the SE territorial concentration patterns. Finally, we identified the structural characteristics modelling SE by means of a spatial autoregressive panel data model with fixed effects by year. The SE score rose from 57.7% in 2008 to 71.9% in 2015 (P < 0.01), with its quality component accounting for the largest proportion of variance (30%). SE peaked in HJs with low social marginalization and rurality, and with service demand characterized by low parity and older populations. Different SE levels demonstrated territorial concentration patterns. Analysing SE as a metric for health system performance offers elements that contribute to the achievement of UHC as well as to the design and implementation of effective maternal health interventions intended particularly for the most socially vulnerable sectors of the population.
Glucocerebrosidase deficiency promotes release of α-synuclein fibrils from cultured neurons
Authors: Gegg Matthew E , Verona Guglielmo , Schapira Anthony H V
Published: May 2020

Mutations in the GBA gene, which encodes the lysosomal enzyme glucocerebrosidase (GCase), are the most important genetic risk factor for Parkinson disease (PD). GCase activity is also decreased in sporadic PD brains and with normal ageing. Loss of GCase activity impairs the autophagy lysosomal pathway resulting in increased α-synuclein (α-syn) levels. Furthermore, elevated α-syn results in decreased GCase activity. Although the role of α-syn in PD remains unclear, evidence indicates that aggregated α-syn fibrils are a pathogenic species in PD, passing between neurons and inducing endogenous native α-syn to aggregate; spreading pathology through the brain. We have investigated if preformed α-syn fibrils (PFFs) impair GCase activity in mouse cortical neurons and differentiated dopaminergic cells, and whether GCase deficiency in these models increased the transfer of α-syn pathology to naïve cells. Neurons treated with PFFs induced endogenous α-syn to become insoluble and phosphorylated at Ser129 to a greater extent than monomeric α-syn-treatment. PFFs, but not monomeric α-syn, inhibited lysosomal GCase activity in these cells and induced the unfolded protein response. Neurons in which GCase was inhibited by conduritol β-epoxide did not increase the amount of insoluble monomeric α-syn or its phosphorylation status. Instead the release of α-syn fibrils from GCase deficient cells was significantly increased. Co-culture studies showed that the transfer of α-syn pathology to naïve cells was greater from GCase deficient cells. This study suggests that GCase deficiency increases the spread of α-syn pathology and likely contributes to the earlier age of onset and increased cognitive decline associated with GBA-PD.
From past to future: understanding and accounting for recruitment variability of Australia’s redleg banana prawn (Penaeus indicus) fishery
Authors: Plagányi Éva , Deng Roy Aijun , Hutton Trevor , Kenyon Rob , Lawrence Emma , Upston Judy , Miller Margaret , Moeseneder Chris , Pascoe Sean , Blamey Laura , Eves Stephen
Published: May 2020

Understanding recruitment variability in marine fisheries has benefits for the stock management and dependent fishers’ ability to plan their income. Here, we overview past and new research on the complex recruitment dynamics of redleg banana prawns Penaeus indicus in Australia’s Joseph Bonaparte Gulf to assess themes dating back to the time of Hjort and identify new challenges. During 2015 and 2016, redleg prawn catches and catch per unit effort decreased to anomalously low levels, suggesting a substantial decrease in prawn biomass. We hypothesized that low catches could be explained by temporary drops in sea level and rainfall potentially reducing the ability of postlarvae to reach their nursery ground. We contend that very bad prawn catch years may be predicted using two variables that are possible drivers of recruitment—the January Southern Oscillation Index and the combined January to February cumulative rainfall. However, due to challenges in verifying and defining such environmental relationships for inclusion in a stock assessment, we propose development of a harvest strategy framework to support management recommendations. Our study highlights the increasing role of anthropogenic climate change in exaggerating the impacts of environmental drivers on recruitment processes and the need to also focus on multidisciplinary research.
Intravenous iron therapy for patients with preoperative iron deficiency or anaemia undergoing cardiac surgery reduces blood transfusions: a systematic review and meta-analysis
Authors: Gupta Saurabh , Panchal Puru , Gilotra Kevin , Wilfred Ann Mary , Hou Winston , Siegal Deborah , Whitlock Richard P , Belley-Cote Emilie P
Published: May 2020

OBJECTIVES

The benefits of preoperative intravenous (IV) iron treatment in cardiac surgery patients with preoperative anaemia or iron deficiency have not been well-established. We performed a systematic review and meta-analysis to determine the effects of treating preoperative anaemia or iron deficiency with IV iron in adult cardiac surgery patients.

METHODS

We searched Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval Systems Online and Excerpta Medica Database for randomized controlled trials (RCTs) and observational studies comparing IV iron to oral iron or no iron. We performed title and abstract, full-text screening, data extraction and risk of bias assessment independently and in duplicate. We pooled data using a random effects model and evaluated the overall quality of evidence.

RESULTS

We identified 4 RCTs and 7 observational studies. Pooled data from observational studies suggested a benefit of IV iron compared to no iron on mortality [relative risk 0.39, 95% confidence interval (CI) 0.23–0.65; P < 0.001, very low quality], units transfused per patient (mean difference −1.22, 95% CI −1.85 to −0.60; P < 0.001, very low quality), renal injury (relative risk 0.50, 95% CI 0.36–0.69; P < 0.001, very low quality) and hospital length of stay (mean difference −4.24 days, 95% CI −6.86 to −1.63; P = 0.001, very low quality). Pooled data from RCTs demonstrated a reduction in the number of patients transfused with IV iron compared to oral or no iron (relative risk 0.81, 95% CI 0.70–0.94; P = 0.005, moderate quality). The pooled estimates of effect from RCTs for mortality, hospital length of stay, units transfused per patient and renal injury were consistent in direction with observational studies.

CONCLUSIONS

This meta-analysis suggests that IV iron improves postoperative morbidity in adult cardiac surgery patients with preoperative anaemia or iron deficiency. A large, rigorous, placebo-controlled, double-blinded, multicentre trial is needed to clarify the role of IV iron in this patient population.

Clinical trial registration

International prospective register of systematic reviews ID Number CRD42019122844
Prevalence and Risk Factors of Moderate-to-Severe Hepatic Steatosis in Human Immunodeficiency Virus Infection: The Copenhagen Co-morbidity Liver Study
Authors: Kirkegaard-Klitbo Ditte Marie , Fuchs Andreas , Stender Stefan , Sigvardsen Per Ejlstrup , Kühl Jørgen Tobias , Kofoed Klaus Fuglsang , Køber Lars , Nordestgaard Børge G , Bendtsen Flemming , Mocroft Amanda , Lundgren Jens , Nielsen Susanne Dam , Benfield Thomas
Published: May 2020

Background

People with human immunodeficiency virus (PWH) may be at risk of nonalcoholic fatty liver disease. We compared the prevalence of moderate-to-severe hepatic steatosis (M-HS) in PWH with human immunodeficiency virus (HIV)-uninfected controls and determined risk factors for M-HS in PWH.

Methods

The Copenhagen Co-Morbidity in HIV Infection study included 453 participants, and the Copenhagen General Population Study included 765 participants. None had prior or current viral hepatitis or excessive alcohol intake. Moderate-to-severe hepatic steatosis was assessed by unenhanced computed tomography liver scan defined by liver attenuation ≤48 Hounsfield units. Adjusted odds ratios (aORs) were computed by adjusted logistic regression.

Results

The prevalence of M-HS was lower in PWH compared with uninfected controls (8.6% vs 14.2%, P < .01). In multivariable analyses, HIV (aOR, 0.44; P < .01), female sex (aOR, 0.08; P = .03), physical activity level (aOR, 0.09; very active vs inactive; P < .01), and alcohol (aOR, 0.89 per unit/week; P = .02) were protective factors, whereas body mass index (BMI) (aOR, 1.58 per 1 kg/m2; P < .01), alanine transaminase (ALT) (aOR, 1.76 per 10 U/L; P < .01), and exposure to integrase inhibitors (aOR, 1.28 per year; P = .02) were associated with higher odds of M-HS.

Conclusions

Moderate-to-severe hepatic steatosis is less common in PWH compared with demographically comparable uninfected controls. Besides BMI and ALT, integrase inhibitor exposure was associated with higher prevalence of steatosis in PWH.
Piloting a model-to-data approach to enable predictive analytics in health care through patient mortality prediction
Authors: Bergquist Timothy , Yan Yao , Schaffter Thomas , Yu Thomas , Pejaver Vikas , Hammarlund Noah , Prosser Justin , Guinney Justin , Mooney Sean
Published: May 2020

Objective

The development of predictive models for clinical application requires the availability of electronic health record (EHR) data, which is complicated by patient privacy concerns. We showcase the “Model to Data” (MTD) approach as a new mechanism to make private clinical data available for the development of predictive models. Under this framework, we eliminate researchers’ direct interaction with patient data by delivering containerized models to the EHR data.

Materials and Methods

We operationalize the MTD framework using the Synapse collaboration platform and an on-premises secure computing environment at the University of Washington hosting EHR data. Containerized mortality prediction models developed by a model developer, were delivered to the University of Washington via Synapse, where the models were trained and evaluated. Model performance metrics were returned to the model developer.

Results

The model developer was able to develop 3 mortality prediction models under the MTD framework using simple demographic features (area under the receiver-operating characteristic curve [AUROC], 0.693), demographics and 5 common chronic diseases (AUROC, 0.861), and the 1000 most common features from the EHR’s condition/procedure/drug domains (AUROC, 0.921).

Discussion

We demonstrate the feasibility of the MTD framework to facilitate the development of predictive models on private EHR data, enabled by common data models and containerization software. We identify challenges that both the model developer and the health system information technology group encountered and propose future efforts to improve implementation.

Conclusions

The MTD framework lowers the barrier of access to EHR data and can accelerate the development and evaluation of clinical prediction models.
Variation in electronic test results management and its implications for patient safety: A multisite investigation
Authors: Thomas Judith , Dahm Maria R , Li Julie , Smith Peter , Irvine Jacqui , Westbrook Johanna I , Georgiou Andrew
Published: May 2020

Objective

The management and follow-up of diagnostic test results is a major patient safety concern. The aim of this qualitative study was to explore how clinicians manage test results on an everyday basis (work-as-done) in a health information technology–enabled emergency department setting. The objectives were to identify (1) variations in work-as-done in test results management and (2) the strategies clinicians use to ensure optimal management of diagnostic test results.

Materials and Methods

Qualitative interviews (n = 26) and field observations were conducted across 3 Australian emergency departments. Interview data coded for results management (ie, tracking, acknowledgment, and follow-up), and artifacts, were reviewed to identify variations in descriptions of work-as-done. Thematic analysis was performed to identify common themes.

Results

Despite using the same test result management application, there were variations in how the system was used. We identified 5 themes relating to electronic test results management: (1) tracking test results, (2) use and understanding of system functionality, (3) visibility of result actions and acknowledgment, (4) results inbox use, and (5) challenges associated with the absence of an inbox for results notifications for advanced practice nurses.

Discussion

Our findings highlight that variations in work-as-done can function to overcome perceived impediments to managing test results in a HIT-enabled environment and thus identify potential risks in the process. By illuminating work-as-done, we identified strategies clinicians use to enhance test result management including paper-based manual processes, cognitive reminders, and adaptive use of electronic medical record functionality.

Conclusions

Test results tracking and follow-up is a priority area in need of health information technology development and training to improve team-based collaboration/communication of results follow-up and diagnostic safety.
Influence of Pain Killers on the Urinary Anabolic Steroid Profile
Authors: Stoll Anna , Iannone Michele , De Gregorio Giuseppina , de la Torre Xavier , Molaioni Francesco , Botrè Francesco , Kristina Parr Maria
Published: May 2020

Anabolic androgenic steroids (AAS) are prohibited as performance-enhancing drugs in sports. Among them, testosterone and its precursors are often referred to as “pseudoendogenous” AAS, that is, endogenous steroids that are prohibited when administered exogenously. To detect their misuse, among other methods, the World Anti-Doping Agency-accredited laboratories monitor the steroid profile (concentrations and concentration ratios of endogenous steroids, precursors and metabolites) in urine samples collected from athletes in and out of competition. Alterations in steroid profile markers are used as indicators for misuse of anabolic steroids in sports. Therefore, especially their metabolic pathways with possible interactions are crucial to elucidate. As steroid metabolism is very complex, and many enzymes are involved, certain non-prohibited drugs may influence steroid metabolite excretion. One important group of steroid-metabolizing enzymes is aldo–keto reductases (AKRs). An inhibition of them by non-steroidal anti-inflammatory drugs (NSAIDs), which are neither prohibited nor monitored, but frequently used drugs in sports, was demonstrated in vitro. Thus, this work aims to investigate the influence of NSAID intake on the urinary steroid profile. Kinetic and inhibitory studies were performed using 5α-dihydrotestosterone as substrate. The results obtained from in vitro experiments show that ibuprofen inhibits AKR1C2 and thus influences steroid biotransformation. For in vivo investigations, urine samples prior, during and postadministration of ibuprofen were analyzed using routine methods to monitor the steroid profile. Changes in markers of the steroid profile of volunteers were observed. The combination of in vitro and in vivo results suggests that monitoring of ibuprofen may be useful in doping control analysis. The presented work illustrates the importance to consider co-administration of (non-prohibited) drugs during antidoping analysis. Intake of multiple substances is likely leading to interfering effects. Divergent results in antidoping analysis may therefore be observed and misinterpretation of analytical data may occur. Similar considerations may be appropriate for other fields of forensic applications.
Vertical Mergers, The Coase Theorem, And The Burden of Proof
Authors: Brennan Timothy J
Published: May 2020

The challenge by the Department of Justice (DOJ) to AT&T’s acquisition of Time Warner, and a prior challenge by DOJ and Federal Communications Commission to Comcast’s acquisition of NBC-Universal, has increased attention on vertical mergers. The standard approach identifies a tactic that the merged firm would employ that is both profitable and harms consumers. This approach misses the target; a profitable but anticompetitive tactic may be necessary but is not sufficient. The “Coase theorem” implies that courts and enforcement agencies should instead focus on why vertical integration is necessary to achieve an outcome that would be profitable to the merging firms. The focus on the tactic rather than why ownership matters presumes that vertical merger is necessary, without supporting theory or evidence. The same proposition should hold for horizontal mergers, but the required strength of evidence is greater for vertical mergers because mergers between complement providers are first-order beneficial and the conduct facilitated by horizontal mergers but not vertical mergers is typically illegal.
The Mitigated Neighborhood: Exploring Homeowner Associations’ Role in Resident Wildfire-Mitigation Actions
Authors: Steffey Eric , Budruk Megha , Vogt Christine
Published: May 2020

Abstract Considerable research has explored homeowner wildfire-mitigation efforts identifying many salient factors that help predict acceptance and behaviors. A growing body of literature is unlocking the dynamics of formal associations’ roles in promoting fire adapted communities. This mixed-method study adds to the research by using a planned behavior theoretical lens, to explore homeowner associations’ (HOAs’) role in resident wildfire mitigation. Through HOA key informant interviews and a survey study of a Western midsized city, our results show that HOAs have a significant impact by providing important information linkages and reducing barriers to completing home mitigation. Most importantly, HOAs act as a neighborhood champion, taking on time-consuming tasks involved in becoming and maintaining a Firewise USA® community status. Many non-HOA neighborhoods lack the capacity to take on such tasks limiting their access to benefits provided by the designation. We take these results and propose avenues to engaging non-HOA neighborhoods.
Gastro-cholecysto-colic fistula. Case report of an idiopathic case, and management approach
Authors: Irwin Shane , Donlon Noel Edward , Mohan Helen , Reynolds John V
Published: May 2020

A 71-year-old lady presented with a 4-week-history of epigastric pain, feculent vomiting, diarrhoea and weight-loss. On subsequent investigations, she was found to have a complex gastro-cholecysto-colic fistula with no clear underlying aetiology. The only abnormality both macroscopically and microscopically was ulceration and inflammation in the colon. However, this was not pathognomonic of inflammatory bowel disease, and (gastric) acid-induced inflammation is an alternative explanation. Herein we present her case, her comprehensive evaluation, her successful surgical management and a review of the relevant literature.
Imaging flowers: a guide to current microscopy and tomography techniques to study flower development
Authors: Prunet Nathanaël , Duncan Keith
Published: May 2020

Developmental biology relies heavily on our ability to generate three-dimensional images of live biological specimens through time, and to map gene expression and hormone response in these specimens as they undergo development. The last two decades have seen an explosion of new bioimaging technologies that have pushed the limits of spatial and temporal resolution and provided biologists with invaluable new tools. However, plant tissues are difficult to image, and no single technology fits all purposes; choosing between many bioimaging techniques is not trivial. Here, we review modern light microscopy and computed projection tomography methods, their capabilities and limitations, and we discuss their current and potential applications to the study of flower development and fertilization.
The United Nations Commission on International Trade Law (UNCITRAL) Arbitration Rules
Authors: Castello James E
Published: May 2020

This chapter discusses the arbitration rules of the United Nations Commission on International Trade Law (UNCITRAL), an institution tasked with harmonizing national laws and international commercial legal practices on a wide range of trade-related issues, from dispute resolution to international contract practices, international payments, secured transactions, procurement, and sale of goods. The chapter first provides background on the history of UNCITRAL before describing the initial adoption of the UNCITRAL Arbitration Rules, the Rules’ subsequent revision, and finally the creation of rules on transparency designed to supplement the Arbitration Rules in treaty-based investor-state arbitrations. The chapter concludes with its principal section: a Commentary on Articles 1–43 of the 2010 UNCITRAL Arbitration Rules, which covers topics ranging from scope of application of the Rules to notice of arbitration; designation of appointment authorities; composition of the arbitral tribunal; arbitral proceedings, including the appointment of experts by the arbitral tribunal; and decisions with regard to arbitral awards.
Project Risks
Authors: Dewar John , Szczetnikowicz Suzanne , Roberts Jonathan
Published: May 2020

This chapter discusses various project risks (e.g. completion risk, operating risk, currency risk, political risk, etc.). The business of project financing is founded upon the identification, assessment, allocation, negotiation, and management of the risks associated with a particular project. Indeed, as project finance lenders look to the revenues generated by the operation of the financed project for the source of funds from which that financing will be repaid, the whole basis for project financing revolves around an understanding of the future project revenues and the impact of various risks upon them. Projects face a variety of risks, and not all of these risks can be easily identified, mitigated, or contracted away. However, such risks can be assessed, allocated, and managed so that a project is commercially reasonable. The first step is to identify the material risks and the second is to decide how they should be addressed.
Documentation of Project Bonds
Authors: Peterson Tim , Marques Rebecca
Published: May 2020

Project bonds are bonds issued in the international capital markets to raise financing for projects. Documenting a project bond involves a number of elements not found in more common forms of project finance. This difference is primarily due to the way bonds are marketed and the fact that, unlike loans, bonds are ‘securities’, making them subject to various legal regimes governing the offering and trading of securities, to which traditional loans are not subject. This chapter presents some key considerations for the use of project bonds as a source of financing and summarizes the legal framework for securities offerings, recognizing that various jurisdictions may impose different requirements. After describing the general legal context, the chapter explains the due diligence and underwriting processes for project bonds, followed by a discussion of the various project bond offering documents and how they relate to the legal framework. Finally, there is a brief discussion of bond listings.
Criminal Prosecutions by Regulators—Procedural Considerations
Authors: Russen Jonathan , Kingham Robin
Published: May 2020

This chapter examines the role of the FCA and the PRA as prosecuting authorities and their right to bring criminal proceedings in pursuit of their regulatory objectives as enshrined in the Financial Services and Markets Act 2000 (FSMA). The FCA and the PRA are not the only agencies responsible for the prosecution of criminal offences in the financial services sector; the jurisdiction of the Serious Fraud Office (SFO) in particular often overlaps with that of the FCA and the two agencies can work in tandem. Meanwhile, although a discrete area of criminal practice, the regulators’ powers to administer a caution to an offender should not be overlooked—particularly in the context of ongoing investigations. Acceptance of a caution can provide an offender with a way of avoiding conviction and sanction whilst offering the prosecutor an ‘easy win’ without the need for costly court proceedings. The chapter then considers key procedural issues as well as the importance of evidence collection and deployment in financial services prosecutions.
Redress
Authors: Russen Jonathan , Kingham Robin
Published: May 2020

This chapter explores alternative avenues that customers or investors may have for redress against firms. In the first instance, customers are expected to utilize firms’ internal complaints processes. If a customer is dissatisfied with the response he receives at the conclusion of the internal complaints process, the matter may be placed before the Financial Ombudsman Service (FOS). There are both advantages and disadvantages in pursuing a complaint to the FOS. The chapter then describes the Financial Services Compensation Scheme. The compensation scheme provides an important source of recovery for an ‘eligible claimant’ who has suffered loss through the act or omission of an authorised person who is unable to meet the resulting claim for compensation. The scheme therefore provides industry-funded insurance against the risk that a successful civil claim against an authorised person might otherwise prove to be worthless.
Independent Challenges to the Regulators
Authors: Russen Jonathan , Kingham Robin
Published: May 2020

This concluding chapter assesses the routes by which the regulators’ actions and decisions may be independently challenged by a person adversely affected. Through the passage into law of the Tribunals, Courts and Enforcement Act 2007 (TCEA), the Upper Tribunal (Tax and Chancery Chamber) replaced the Financial Services and Markets Tribunal (FSMT) as the forum for hearing appeals arising out of decisions made by the regulators. The Tribunal may uphold the regulator’s decision or direct the regulator (within certain limits) to take different action. It may also make recommendations about the regulator’s provisions and procedures. The chapter then considers other potential grounds of challenge and complaint. These comprise the possibility of challenging the regulator on an application to the High Court for judicial review and a complaint to the independent Financial Regulators Complaints Commissioner.
The Prospectus Regime and Brexit
Authors: Gleeson Simon
Published: May 2020

This chapter discusses the third country regime against the backdrop of Brexit. It explains that, post-Brexit, it will no longer be possible to use a UK prospectus for distribution of securities in the EU. However, since the majorities of securities offered on the UK markets are in fact sold to UK or international (non-EU) investors, it is difficult to know whether the consequence of this will be an increase in EU prospectus offerings or a decrease. The chapter notes that in reality the point is that there is a relatively well-established prospectus orthodoxy in the international securities markets, and as long as the EU regime remains closely aligned with that international orthodoxy, it is likely that the incremental cost of adding an EU limb to a global offering will remain acceptable. However if EU disclosure standards diverge from international standards, the issue will become more acute, and issuers may find themselves having to choose between a domestic EU offering and an international offering.
The Influence of the EU Prospectus Rules on Private Law
Authors: Busch Danny
Published: May 2020

This chapter examines the extent to which the civil courts are bound under EU law by the EU prospectus rules when judging issues of liability. It shows that that the influence of the new EU prospectus rules on private law is potentially considerable, but that the subject is unfortunately surrounded by much uncertainty. EU legislation on prospectus liability would be the best solution, not only for reasons of legal certainty but also for the sake of uniform investor protection and a truly level playing field in Europe. However, in the current political climate, that is likely to be a non-starter for the time being. The chapter concedes that our hopes must therefore be pinned on the Court of Justice of the European Union (CJEU), which will hopefully provide more clarity in the years ahead. But to achieve this the CJEU is dependent on the willingness of national civil courts to submit preliminary rulings with precisely formulated questions that give it sufficient insight into the facts of the case.
Prospectus Liability
Authors: Gargantini Matteo
Published: May 2020

This chapter addresses the European legal framework for cross-border disputes arising from alleged violations of prospectus rules. It deals with the identification of both jurisdiction and applicable law in cases where litigation involves transnational elements, so that a conflict may occur about who is the judge having jurisdiction and what law is this judge bound to apply. Crucial in both respects are, in the first place, the connecting factors to which EU law refers to and, in the second place, the rules concerning issuers' and investors' ability to deviate from such rules. The chapter asserts that the importance of these rules can hardly be overestimated. However, not all courts are equal, and neither are national laws, and the chapter shows these differences affect the topic at hand.
Germany
Authors: Mock Sebastian
Published: May 2020

This chapter discusses German law. In Germany, prospectus liability is a part of the general legal concept of capital market information liability. Although statutory prospectus liability is extensively regulated, prospectus liability is generally of minor importance since cases involving the direct liability of the issuer are rather rare for securities admitted to trading on organised markets. In contrast, the number of cases of prospectus liability for other securities is much higher probably due to the fact that in this part of the capital market more dubious issuers and offerors exist. The rather small number of cases involving securities admitted to trading on organised markets is also due to the fact that German statutory prospectus liability states some major limitations especially regarding the amount of damages the plaintiff can claim. This chapter thus focuses on the prospectus liability for securities traded on organised markets.
Spain
Authors: Campo Javier Redonet Sánchez del
Published: May 2020

This chapter considers the prospectus in Spain. Historically, and unlike other European Union jurisdictions, before the enactment of Directive 2003/71/EC of the European Parliament and of the Council of 4 November 2003 on the prospectus to be published when securities are offered to the public or admitted to trading and amending Directive 2001/34/EC (the ‘Prospectus Directive’), Spain lacked any explicit regulation on the civil liability arising from the defective content of prospectuses for securities offerings and listings in regulated markets. Nevertheless, legal authors having researched on the matter had expressed the view that liability attached to prospectuses on the basis of the general principles of tort liability. The legal regime of prospectus liability enshrined by the Securities Market Act and Royal Decree 1310/2005 is not fully comprehensive, however. In addition, it is completed with the general principles of civil liability contained in the Spanish Civil Code as construed by case law stemming from the Spanish Supreme Court.
United Kingdom
Authors: McMeel Gerard
Published: May 2020

This chapter provides an overview of the relevant UK law. The timing of the coming into force in EU Member States of the Prospectus Regulation posed some problems of exposition of the law in the United Kingdom of liability for information in prospectuses. The date of the Regulation coming into force was when it was originally intended that the UK would leave the European Union. When the date for ‘Brexit’ was extended, the Regulation automatically came into force in accordance with orthodox EU and UK arrangements. However, after changing prime ministers, the date for Brexit became uncertain. Furthermore, there were questions as to whether the UK would leave pursuant to the negotiated Withdrawal Agreement or some other withdrawal agreement, or with no agreement with the EU (the ‘no deal’ scenario) at all. The chapter tries to address the various possible scenarios arising from these complications introduced by Brexit.
Uniformed Services University Medical Student Mentorship Experiences and Gender From 2010 to 2017
Authors: Latham Kerry , Dong Ting , Schreiber Deanna , Torre Dario , Durning Steve , Battista Alexis
Published: May 2020

Introduction

Gender disparity in medicine has drawn increased attention in the form of root cause analysis and programmatic solutions with the goal of equity. Research indicates that mentoring, guidance, and support, which include the provision of social and academic guidance and support from more experienced practitioners, can mitigate challenges associated with gender disparity. The purpose of this study was to explore women medical students’ self-reports of mentorship during their time at Uniformed Services University (USU), if women report similar levels of mentorship as compared to men, and if levels of characteristics associated with mentoring (eg, social support, academic guidance) changed over time.

Materials and Method

Using data from the American Association of Medical College’s Graduate Questionnaire, a survey sent to all medical students prior to graduation, items were coded as related to mentorship, guidance, and support and analyzed to compare responses of female and male students from graduating USU classes of 2010–2017.

Results

No significant difference was found between experiences of female and male survey respondents. Equitable experiences were consistent across time for the 8 years of the study.

Conclusions

Although mentorship is cited as a key factor in mediating gender disparity in medicine, other STEM fields, and the military, the findings suggest that there is equity at the USU undergraduate medical education level. Further studies are needed to understand if disparities in mentorship experiences occur at other stages of a military physician’s career, such as graduate medical education, faculty and academic promotion levels.
A framework for designing and evaluating solar flare forecasting systems
Authors: Cinto T , Gradvohl A L S , Coelho G P , da Silva A E A
Published: May 2020

Disturbances in space weather can negatively affect several fields, including aviation and aerospace, satellites, oil and gas industries, and electrical systems, leading to economic and commercial losses. Solar flares are the most significant events that can affect the Earth’s atmosphere, thus leading researchers to drive efforts on their forecasting. The related literature is comprehensive and holds several systems proposed for flare forecasting. However, most techniques are tailor-made and designed for specific purposes, not allowing researchers to customize them in case of changes in data input or in the prediction algorithm. This paper proposes a framework to design, train, and evaluate flare prediction systems which present promising results. Our proposed framework involves model and feature selection, randomized hyperparameters optimization, data resampling, and evaluation under operational settings. Compared to baseline predictions, our framework generated some proof-of-concept models with positive recalls between 0.70 and 0.75 for forecasting ≥M class flares up to 96 h ahead while keeping the area under the ROC curve score at high levels.
Gravitational burst radiation from pulsars in the Galactic centre and stellar clusters
Authors: Kimpson Tom , Wu Kinwah , Zane Silvia
Published: May 2020

Pulsars (PSRs) orbiting intermediate or supermassive black holes at the centre of galaxies and globular clusters are known as Extreme Mass Ratio Binaries (EMRBs) and have been identified as precision probes of strong-field GR. For appropriate orbital parameters, some of these systems may also emit gravitational radiation in a ‘burst-like’ pattern. The observation of this burst radiation in conjunction with the electromagnetic radio timing signal would allow for multimessenger astronomy in strong-field gravitational regimes. In this work we investigate gravitational radiation from these PSR-EMRBs, calculating the waveforms and SNRs and explore the influence of this GW on the pulsar radio signal. We find that for typical PSR-EMRBs, gravitational burst radiation should be detectable from both the Galactic centre and the centre of stellar clusters, and that this radiation will not meaningfully affect the pulsar timing signal, allowing PSR-EMRB to remain ‘clean’ test-beds of strong-field GR.