bluuebunny/crossref_metadata_2025 huggingface dataset:
Organizational Factors Associated with Sepsis Bundle Compliance: A Nationwide Study
Authors: Peach B.C. , Ng B.P.
Published: August 2020

Sepsis is one of the leading causes of mortality in the United States (U.S.), accounting for over 220 000 deaths annually. To address the issue of mortality, the Centers for Medicare and Medicaid Services (CMS) launched a core measure with an associated clinical bundle. This measure requires completion of time‐sensitive bundled interventions (eg, fluid resuscitation, antibiotics). Completion of these interventions is known to improve the odds of survival. CMS reimbursement is not currently tied to a certain compliance level; however, it is under consideration. Hospitals’ compliance with the bundle is publicly reported as the SEP‐1 measure. The objective of this study was to examine which hospital organizational factors were associated with high and low compliance with the SEP‐1 measure.

This study used a cross‐sectional design with 2017 hospital‐level data from the CMS Timely and Effective Care dataset, and the American Hospital Association (AHA)’s Annual Survey. A multivariate logistic regression with outcome variable of hospital compliance (high/low) with the SEP‐1 measure (0 = less than overall average on SEP‐1 score; 1 = greater than overall average) was performed. Control variables included: number of beds (<100, 100‐250, >250), teaching status (teaching, nonteaching), technology level (high, low), intensive care unit (ICU) beds (none, 1‐4, 5‐14, 15‐29, 30 or more), ownership (government, non‐for‐profit, for‐profit), sepsis case volume (0‐100, 101‐200, 201 or more), nurse hours per patient day, and Magnet certification status (yes/no).

The study included 2429 acute care, nonspecialty adult U.S. hospitals. Hospitals were excluded if they did not complete the AHA survey.

The overall average SEP1 score was 48.9% on a 0‐100 scale. Of 2429 hospitals, 49% were high compliance hospitals, and 51% were low compliance. Factors associated with increased odds of compliance included: for‐profit ownership (OR = 2.48; 95% CI = 1.78‐3.44; P < .01), higher sepsis case volume (OR 1.18, 95% CI 1.08‐1.28, P < .01), smaller numbers (5‐14) of ICU beds (OR 1.76, 95% CI 1.17‐2.63, P = .01), and more nursing hours (OR 1.01, 95% CI 1.00‐1.02, P < .01). Factors associated with decreased odds of compliance included: more than 250 hospital beds (OR 0.68, 95% CI 0.47‐0.99, P = .02), and teaching status (OR 0.58, 95% CI 0.41‐0.81, P < .01).

For‐profit ownership, higher sepsis case volumes, a smaller number of ICU beds, and more nursing hours per patient day were positively associated with SEP‐1 bundle compliance. A higher number of total hospital beds (>250) and having a residency program (teaching hospital) were negatively associated with compliance.

Sepsis is the most expensive condition treated in U.S. hospitals, and hospitals must consider how they can improve their outcomes. Two strategies hospitals could consider are restricting the size of their ICUs to allow for closer monitoring, and increasing their nurse staffing.

Florida Nurses Foundation and Sigma Theta Tau International Theta Epsilon Chapter.
Improving the Value of Care for Veterans: Impacts of VA Payment Reform for Community‐Based Dialysis
Authors: Wang V. , Swaminathan S. , Corneau E. , Maciejewski M. , Trivedi A. , O'Hare A. , Mor V.
Published: August 2020

End‐stage kidney disease (ESKD) is common among Veterans. VA’s limited capacity to deliver dialysis treatment means that VA relies heavily on community providers, making chronic dialysis the single largest VA expenditure for outpatient community care. In the past, VA paid for non‐VA dialysis on a local, ad hoc basis, with some payments greatly exceeding Medicare’s reimbursement rates. In 2009‐2011, the VA began implementing payment policies to standardize the process of pricing non‐VA dialysis care, beginning with the use of the Medicare fee schedule and national dialysis contracts with non‐VA dialysis facilities. This study examined the effect of VA’s standardized pricing policies on VA costs, access to non‐VA dialysis care, and patient outcomes.

We used an interrupted time series design and 2006‐2016 data from VA, Medicare, and the US Renal Data System to identify Veterans receiving VA‐financed dialysis in the community from non‐VA providers. Changes over time in prices for non‐VA dialysis treatments and associated ancillary services were ascertained from >7 million VA‐paid community dialysis claims. We performed multivariable regression analyses using differential trend/intercept shift models to examine the effects of VA national contract pricing on (a) VA treatment prices for non‐VA dialysis, (b) access to non‐VA dialysis care defined as the number of non‐VA dialysis providers, and non‐VA dialysis providers’ publicly reported quality hospitalization and mortality rates, patient distance to non‐VA dialysis care, and (c) Veterans’ one‐year mortality, controlling for patient and facility fixed effects.

National cohort of 24,130 VA‐enrolled Veterans who received ≥1 community‐based chronic dialysis treatment financed by VA in 2006‐2016.

Before implementation of national contracts, treatment prices for non‐VA dialysis care varied widely across VA facilities from as little as $61 to as much as $1,575 per treatment. After implementation of national contracts, there was significantly reduced variation in the cost of treatment across individuals ($73.40 to $663.37) and the average price per dialysis session dropped by 40% (P < .001). Over the same time period, the average number of non‐VA dialysis facilities providing VA‐paid dialysis care increased from 19 to 37 and there were no changes in community dialysis facility quality (P ≥ .44) or 1‐year mortality (12% vs. 11%, P = .98).

VA’s policy to standardize national dialysis contracts resulted in a substantial increase in the value of VA‐financed community dialysis care by reducing spending with no adverse effect on Veterans’ access to care nor on mortality.

Our findings suggest it is possible to simultaneously lower costs while improving VA partnerships with community providers. National price setting may be a feasible approach for VA to improve the value of other community care services.

Department of Veterans Affairs.
Progress of California's Effort to Improve Outcomes of Care for Homeless Medicaid Patients Under a Section 1115 Medicaid Waiver Program
Authors: Pourat N. , Yue D. , Chen X. , O'Masta B. , Huynh M. , Chau B.
Published: August 2020

Research Objective

The current Section 1115 Medicaid Waiver in California includes the Whole Person Care (WPC) pilot program, designed to improve care coordination for high‐cost, high‐utilizing populations, with special emphasis on the homeless. Pilots link homeless and other patients to housing, food, benefits, and similar services with the goals of improving health outcomes. We examined the impact of WPC in the first two years of the program on health care utilization of homeless enrollees.

Study Design

We conducted difference‐in‐difference (DD) analyses using a generalized mixed‐effect model to compare the 2‐year change in the pre‐ and postperiod among key outcome measures using an intervention‐control methodology. We developed a model for identifying homeless Medicaid patients in a control sample that matched the characteristics of WPC enrollees. We examined the (1) likelihood of hospitalization, (2) likelihood of emergency department (ED) visits, (3) number of ED visits, outpatient follow‐up after hospitalization for mental illness in (4) 7 days and (5) 30 days, and (6) initiation and (7) engagement of alcohol and other drug dependence treatment.

Population Studied

The DD model included 133 998 person‐years among the WPC homeless enrollees and 201 523 person‐years among the control group.

Principal Findings

The analyses (table below) showed that the predicted probability of hospitalization and ED visits and predicted number of ED visits declined for WPC homeless enrollees from before to after WPC enrollment, with a greater reduction for WPC enrollees than the control group in the same time period. Changes in other outcomes were not significant.

Conclusions

Early analyses indicated reductions in ED visits and hospitalizations among homeless WPC enrollees compared to the control group but not the other outcomes examined. Improvements in outcomes were likely due to pilot's effort to assess homeless patients' needs and linkages to housing and other needed social services.

Implications for Policy or Practice

Reductions in ED visits and hospitalizations are likely indicators of better outcomes and have significant implications for cost reduction under the Medicaid program. Our findings provide the needed evidence that provision of housing support and other social services may improve health outcomes among homelessness patients who frequently have higher level of need for care.

Primary Funding Source

California Department of Health Care Services.
Earnings Co‐movements and the Informativeness of Earnings
Authors: Jackson Andrew B. , Li Chao , Morris Richard D.
Published: August 2020

We examine the informativeness of earnings in the presence of earnings co‐movements. Many theoretical studies infer that the more a firm's earnings move with the market the less weight investors need to place on those earnings, thus rendering them less informative. On the other hand, managers have less opportunity to bias the earnings signal the more earnings co‐move, making them more reliable. We measure earnings co‐movement using an industry–firm pairing correlational technique. Overall our results show both the degree of co‐movement and the ordering of earnings announcements impacts on the informativeness of earnings as indicated by earnings response coefficients. Earnings responses are larger for firms that report earnings before their most highly correlated industry peer, but the responses are reduced as earnings co‐movement increases. We interpret our results to indicate that the more earnings co‐move with an industry peer the less informative earnings become, but only when the peer firm is able to obtain information at a later date.
Trainee surgeons and patient outcomes in carotid endarterectomy: a retrospective cohort study
Authors: Johnson Nicholas W. , Smoll Nicholas R. , Tan Christianne , Brooks Christopher E.
Published: August 2020

Background

In Australia and New Zealand, more than 2000 carotid endarterectomies are performed annually. The major morbidities arising from this procedure are post‐operative stroke, cranial nerve injury and death. Carotid endarterectomy surgery is a key component of the vascular surgical training programme. We assessed the impact of having a surgical trainee perform a major component of this procedure on the post‐operative rates of stroke, cranial nerve injury and mortality.

Methods

We performed a retrospective cohort study of vascular surgical patients undergoing carotid endarterectomy, with data obtained from the Australasian Vascular Audit database between January 2010 and December 2014. The dataset comprised of 6528 carotid endarterectomies performed during this time. The collected data were stratified into two categories – consultant‐led cases, and those in which trainee surgeons performed at least a major component of the surgery under consultant supervision. The results were analysed for differences in post‐operative stroke, cranial nerve injury and inpatient mortality. Differences between groups were assessed using multivariate analysis, adjusting for potentially confounding covariables.

Results

On multivariate analysis, there was no statistically significant difference in the rates of post‐operative stroke (odds ratio (OR) 0.88, 95% confidence interval (CI) 0.57–1.36, P = 0.55), cranial nerve injury (OR 0.68, 95% CI 0.39–1.21, P = 0.19) or inpatient mortality (OR 0.78, 95% CI 0.29–2.13, P = 0.63) between the two cohorts.

Conclusion

Having surgical trainees perform components of carotid endarterectomies under supervision is not associated with an increased rate of post‐operative stroke, cranial nerve injury or mortality.
Central venous catheters are an important factor in paediatric thrombosis
Authors: Biswas Mouri , Ryan Paul M. , Nakrani Rima , Bhatt Mihir , Chan Anthony K. C. , Mondal Tapas
Published: August 2020

Aim

To establish the incidence and characteristics of paediatric thrombosis (PT) in a Canadian tertiary care centre during the era of low molecular weight heparin (LMWH).

Methods

A retrospective observational case study of all patients <18 years of age evaluated for arterial and venous thrombosis from May 2008 to July 2018 at McMaster Children’s Hospital was conducted through the electronic medical record.

Results

The incidence of PT was 52.2 per 10 000 hospital admissions (n = 477/91 462). Provoked thrombosis was more prevalent (88.9%, n = 424/477) than unprovoked (2.9%, n = 14/477) or idiopathic thrombosis (4%, n = 19/477). Half of PT were in children <2 years (51.2%, n = 244/477). Central vascular catheterisation was a contributory factor in more than half of thrombotic events (56.2%, n = 268/477), while trauma (1.1%, n = 5/477), oral contraceptives (4%, n = 19/477), infection (4%, n = 19/477), surgery (6.9%, n = 33/477) and malignancy (8.4%, n = 40/477) were also risk factors. Arterial ischaemic stroke was diagnosed in 11.1% of cases (n = 53/477), while pulmonary embolism was identified in 7.1% (n = 34/477) and 1.7% of cases were fatal (n = 8/477). LMWH was the first‐line therapeutic of choice (47.8%, n = 228/477), with 28.1% (n = 134/477) requiring no intervention.

Conclusion

These data reiterate the elevated thrombosis risk to which infants and children with central vascular access are exposed.
PSMB8 inhibition decreases tumor angiogenesis in glioblastoma through vascular endothelial growth factor A reduction
Authors: Chang Hsin‐Han , Cheng Yu‐Chen , Tsai Wen‐Chiuan , Chen Ying
Published: August 2020

Glioblastoma, also known as glioblastoma multiforme (GBM), is a fast‐growing tumor and the most aggressive brain malignancy. Proteasome subunit beta type‐8 (PSMB8) is one of the 17 essential subunits for the complete assembly of the 20S proteasome complex. The aim of the present study was to evaluate the role of PSMB8 expression in GBM progression and angiogenesis. PSMB8 expression in glioblastoma LN229 and U87MG was knocked down by siRNA or inducible shRNA both in vitro and in vivo. After PSMB8 reduction, cell survival, migration, invasion, angiogenesis, and the related signaling cascades were evaluated. An orthotopic mouse tumor model was also provided to examine the angiogenesis within tumors. A GEO profile analysis indicated that high expression of PSMB8 mRNA in GBM patients was correlated with a low survival rate. In immunohistochemistry analysis, PSMB8 expression was higher in high‐grade than in low‐grade brain tumors. The proliferation, migration, and angiogenesis of human GBM cells were decreased by PSMB8 knockdown in vitro. Furthermore, phosphorylated focal adhesion kinase (p‐FAK), p‐paxillin, MMP2, MMP9, and cathepsin B were significantly reduced in LN229 cells. Integrin β1 and β3 were reduced in HUVEC after incubation with LN229‐conditioned medium. In an orthotopic mouse tumor model, inducible knockdown of PSMB8 reduced the expression of vascular endothelial growth factor (VEGF), VEGF receptor, and CD31 as well as the progression of human glioblastoma. In this article, we demonstrated the role of PSMB8 in glioblastoma progression, especially neovascularization in vitro and in vivo. These results may provide a target for the anti–angiogenic effect of PSMB8 in glioblastoma therapy in the future.
Patterns of niche contraction identify vital refuge areas for declining mammals
Authors: von Takach Brenton , Scheele Ben C. , Moore Harry , Murphy Brett P. , Banks Sam C.
Published: August 2020

Aim

Investigation of realized niche contraction in declining species can help us understand how and where threats are being either mediated or tolerated across landscapes. It also provides insights into species' sensitivity to environmental change that are unable to be identified through analysis of declines in range size or abundance alone. Here, we apply the recently proposed "niche reduction hypothesis" to investigate relationships between trends in niche breadth and geographic distribution of declining species.

Location

Northern Australia.

Methods

We compare and contrast contemporary and historical data sets to examine the relationship between extent of occurrence (EOO) and realized niche hypervolume, and investigate changes in species' utilization of environmental space through time via generalized linear modelling and bootstrapping of historical values. We also use the "Maxent" algorithm to create and stack contemporary and historical ecological niche models (ENMs) and identify regions where resilience to threatening processes is maximized.

Results

We found larger mean reductions in niche hypervolume (39%) than EOO (30.5%), with little correlation (r = 0.07) between the two measures, suggesting that contraction of realized niche breadth can be largely independent of reduction in EOO. We also identified a general set of environmental conditions towards which species' realized niches contracted. Comparison of stacked ENMs allowed us to identify regions of natural refuge where environmental conditions are associated with increased species resilience to threats, and conversely, regions where habitat suitability has declined.

Main conclusions

Examining species declines from an ecological niche perspective provides a powerful tool for understanding how environmental conditions, biotic interactions and species traits shape responses to local and global environmental changes. Quantifying reductions in niche breadth is crucial as contraction to a narrower subset of environmental space can reduce a species' ability to tolerate other threats and potentially lower adaptive capacity and genetic diversity, increasing extinction risk.
Carbon benefits from Forest Transitions promoting biomass expansions and thickening
Authors: Kauppi Pekka E. , Ciais Philippe , Högberg Peter , Nordin Annika , Lappi Juha , Lundmark Tomas , Wernick Iddo K.
Published: August 2020

The growth of the global terrestrial sink of carbon dioxide has puzzled scientists for decades. We propose that the role of land management practices—from intensive forestry to allowing passive afforestation of abandoned lands—have played a major role in the growth of the terrestrial carbon sink in the decades since the mid twentieth century. The Forest Transition, a historic transition from shrinking to expanding forests, and from sparser to denser forests, has seen an increase of biomass and carbon across large regions of the globe. We propose that the contribution of Forest Transitions to the terrestrial carbon sink has been underestimated. Because forest growth is slow and incremental, changes in the carbon density in forest biomass and soils often elude detection. Measurement technologies that rely on changes in two‐dimensional ground cover can miss changes in forest density. In contrast, changes from abrupt and total losses of biomass in land clearing, forest fires and clear cuts are easy to measure. Land management improves over time providing important present contributions and future potential to climate change mitigation. Appreciating the contributions of Forest Transitions to the sequestering of atmospheric carbon will enable its potential to aid in climate change mitigation.
Bridging the geospatial gap: Data about space and indigenous knowledge of place
Authors: Briggs Carolyn , Burfurd Ingrid , Duckham Matt , Guntarik Olivia , Kerr Di , McMillan Mark , San Martin Saldias Daisy
Published: August 2020

Indigenous knowledge of place is not well‐served by today's digital geospatial technologies, such as spatial data, maps, spatial databases, and GIS. This paper aims to identify and explore new connections between Indigenous knowledge of place and digital geospatial technologies. Our analysis is structured around three key gaps in past work: (a) the overrepresentation of digital data about space, rather than knowledge of place; (b) a lack of facility to differentiate access to knowledge and enable Indigenous data sovereignty; (c) a lack of facility to support and sustain relationships between Indigenous and non‐Indigenous peoples. The paper further identifies and explores recent research topics in the field of geographic information science (GI science) with relevance to addressing these gaps. This includes identifying new serendipitous synergies with previously unconnected research areas, such as research into location privacy, uncertainty, qualitative spatial reasoning, or distributed spatial computing. The conclusions acknowledge that our retrospective approach is unlikely to lead to radical reformulation of geospatial technologies. Nevertheless, we argue that identifying technological opportunities could offer a pragmatic pathway to more rapidly bootstrap new approaches, beyond simply technological “fixes.”
Arbuscular mycorrhizal fungi promote plant growth of Leymus chinensis (Trin.) Tzvelev by increasing the metabolomics activity under nitrogen addition
Authors: Khan Yaseen , Yang Xue , Zhang Xinlei , Yaseen Tabassum , Shi Lianxuan , Zhang Tao
Published: August 2020

Nitrogen (N) deposition has been influencing ecological process, for instance N addition can affect plant growth and then alter plant community composition. Arbuscular mycorrhizal fungi (AMF) is one of the important soil microbiota, which play a key role in plant growth, especially under harsh environmental conditions. However, the effects of AMF on plant growth under N addition are still not well understood. To investigate the mechanism how AMF affect plant growth under N addition, a microcosm experiment was conducted with four N addition levels. The results showed that AMF increased aboveground biomass of Leymus chinensis by 21.5% and 4.8% under with and without N addition, respectively. AMF expressively improved the net photosynthetic rate by 44% and 29%, soluble protein by 65% and 40% under with and without N additions, respectively. The chlorophyll a, chlorophyll b, chlorophyll a + b and carotenoids content in leaves treated by AMF were greater than those without AMF treatment. AMF also significantly increased the metabolomics enzymes glutamate dehydrogenase, glutamine oxoglutarate aminotransferase, alanine transaminase and nitrogen reductase activity under N addition. However, the level of glutamine synthetase and soluble carbohydrates increased significantly under N addition in non‐inoculated AMF plants. The result showed that the response of AMF to L. chinensis was stronger than nitrogen deposition, which indicates that AMF could increase plant growth by improving photosynthetic characters and affecting metabolomics enzymes of L. chinensis under N addition.
Experiences of intensive home treatment for a mental health crisis during the perinatal period: A UK qualitative study
Authors: Rubio Luisa , Lever Taylor Billie , Morant Nicola , Johnson Sonia
Published: August 2020

Some women with severe perinatal mental health difficulties in England are cared for by acute home treatment services, known as Crisis Resolution Teams (CRTs), which provide short‐term home‐based treatment for adults experiencing a mental health crisis. Intensive home treatment has been trialed in a number of countries, but it is not known how well suited it is to the needs of perinatal women. This qualitative study aimed to explore how women and practitioners experience the provision of intensive home treatment for perinatal mental health problems. Semi‐structured interviews were conducted with women who had received intensive home treatment in the perinatal period (n = 15), and focus groups were held with practitioners working in CRTs or in specialist perinatal mental health services (3 groups, n = 25). Data were analysed thematically. Women commonly found intensive home treatment problematic, experiencing it as intrusive and heavily risk‐focused, with poor staff continuity and little tailoring to the perinatal context. However, women valued emotional support when provided, particularly when it had a perinatal focus, sometimes based on practitioners sharing their own experiences. Some women also appreciated avoiding hospital admission, but choice was often limited. Practitioners reported a lack of perinatal training among CRT staff and described difficulties tailoring treatment to perinatal women’s needs. Currently, intensive home treatment, as offered by CRTs, may not be well suited to women with perinatal mental health difficulties. Findings suggest a need to develop community crisis responses that are better tailored to the needs of this population.
A Tale of Leadership in Value Creation
Authors: Milano Greg
Published: August 2020

In this prologue to his new book, Curing Corporate Short‐Termism, the founder and CEO of Fortuna Advisors presents a fictional account of a corporate turnaround—a “composite” reflection of the author's many years of consulting experience that dramatizes the pressure to meet near‐term earnings targets and other kinds of “agency” problems facing a public company called Blue Dynamics Corp. The tale begins with the puzzlement of the incoming CEO, Betty Manning, at finding the company's highest‐return business unit starved for investment, even as the low‐return units continue to receive and spend capital with little success. At the core of the company's capital allocation and “underinvestment” problems, she finds a corporate‐wide performance measurement and reward system focused on setting and beating budgets and growth in EPS and ROE.

Manning's solution is to divorce the performance and reward system entirely from the budgeting process and implement new annual incentives and target‐setting practices that result in both more reliable budgeting and forecasting and a longer‐term view of value creation. The new measure of economic profit, called BDVA (short for Blue Dynamics Value Added), is based on a customized measure of EBITDA less a capital charge. The adoption of the new measure has the effect of encouraging her team to take a number of decisive steps: make an objective, “fact‐based” case for a strategic acquisition whose price appears to be too high (at least using conventional measures like EPS accretion); pull the trigger on a divestment that appears to have been adding value, but is more valuable outside the firm; and, more generally and most important, guide operating managers toward an ideal balance of overall growth and return on capital.
Rising above: Investigating employee exemplification as a response to the experience of shame induced by abusive supervision
Authors: Kim Joseph K. , Holtz Brian C. , Hu Biyun
Published: August 2020

Scholars have clearly demonstrated that abusive supervision can precipitate a variety of destructive reactions from employees. Employees, however, do not universally reciprocate mistreatment with their own destructive behaviour and yet our current understanding of how victims of abusive supervision might choose to react less destructively, or potentially constructively, is still limited. Further, we lack a sufficient understanding of the psychological mechanisms that help explain why employees may react less destructively to abusive supervision. Drawing from appraisal theories of emotions, this research investigates whether the emotion of shame helps to explain why employees might engage in exemplification as a relatively constructive coping strategy in response to abusive supervision. An experimental (Study 1) and a field study (Study 2) found that shame mediated the effect of abusive supervision on employee exemplification. We further examined locus of control as a moderator of the indirect relationship between abusive supervision and exemplification and found individuals with internal (compared to external) locus of control were more likely to experience shame from abusive supervision and cope with shame by engaging in exemplification. In turn, the positive relationship between abusive supervision and exemplification, via shame, was strengthened for individuals with internal locus of control.

Practitioner points

Practicing managers should help guide employees to make more informed judgements about how to react to abuse in ways that are most suitable for their well‐being and career. Common reactions such as leaving the organization or retaliating against the abusive supervisor may not be a good personal and professional choice for employees. As such, employees should know that there are other viable avenues, such as engaging in exemplification, that can help cope with shame induced by abusive supervision.

Organizations should identify formal procedures and practices that reward and celebrate employees that go above and beyond. If employees perceive that their exemplification has gone unnoticed, they may feel that their self‐concept is not being restored at their desired rate, consequently driving employees to cope with the feeling of shame through withdrawal (e.g., turnover).
Characteristics of paediatric frequent presenters at emergency departments: A whole‐of‐population study
Authors: Procter Alexandra M , Gialamas Angela , Pilkington Rhiannon M , Montgomerie Alicia , Chittleborough Catherine R , Smithers Lisa G , Lynch John W
Published: August 2020

Aim

To quantify the frequency of emergency department (ED) presentations and profile the socio‐demographic, health and presentation characteristics of paediatric ED frequent presenters.

Methods

A population‐based data linkage study of 55 921 children in the South Australian Early Childhood Data Project aged 0–12 years with 100 976 presentations to public hospital EDs in South Australia. For each child, the total number of recurrent ED presentations during a 364‐day period post‐index presentation was calculated. Frequent presenters were children who experienced ≥4 recurrent ED presentations. We determined the socio‐demographic, health and presentation characteristics by number of recurrent presentations.

Results

Children with ≥4 recurrent presentations (4.4%) accounted for 15.4% of all paediatric ED presentations and 22.5% of subsequent admissions to hospital during the 12‐month study period. Compared to children with no recurrent ED presentation, frequent presenters had higher proportions of socio‐economic and health disadvantage at birth. One in two (49.3%) frequent presenters had at least one injury presentation and one (21.3%) in five had at least one presentation related to a chronic condition.

Conclusions

Children with ≥4 presentations do not represent the majority of ED users. Nevertheless, they represent a disproportionate burden accounting for 15% of all paediatric ED presentations in a 12‐month period. Frequent presenters were characterised by early socio‐economic and health disadvantage, and childhood injury. Strategies targeting social disadvantage and childhood injury may reduce the burden of ED presentations.
How does cessation of work affect sleep? Prospective analyses of sleep duration, timing and efficiency from the Swedish Retirement Study
Authors: Garefelt Johanna , Gershagen Sara , Kecklund Göran , Westerlund Hugo , Platts Loretta G.
Published: August 2020

Several strands of research indicate that work competes for time with sleep, but to what extent the timing and duration of sleep is affected by work is not known. Retirement offers a quasi‐experimental life transition to study this in a within‐individual study design. The few existing studies report that people sleep longer and later after retirement but mainly rely on self‐reported data or between‐individual analyses. We recruited 100 participants aged 61–72 years who were in paid work but would soon retire and measured them in a baseline week with accelerometers, diaries and questionnaires. After 1 and 2 years, the measurements were repeated for the now retired participants. Changes in sleep duration, timing, efficiency, chronotype and social jetlag were analysed using multilevel modelling. Gender, chronotype at baseline and partner's working status were analysed as potential effect modifiers. Sleep duration increased by 21 min, whereas sleep efficiency remained similar. Time of sleep onset and final awakening were postponed by 26 and 52 min, respectively, pushing midsleep forward from 03:17 to 03:37 hours. Changes in duration and timing of sleep were driven by weekday sleep, whereas weekend sleep stayed about the same. Social jetlag decreased but still occurred after retirement. Changes at retirement in sleep duration and timing were smaller for participants with a later chronotype and who had full‐time working partners. These findings indicate that paid work generates sleep loss and hinders people from sleeping in line with their biological time.
MRI‐defined sarcopenia predicts mortality in patients with chronic liver disease
Authors: Beer Lucian , Bastati Nina , Ba‐Ssalamah Ahmed , Pötter‐Lang Sarah , Lampichler Katharina , Bican Yesim , Lauber David , Hodge Jacqueline , Binter Teresa , Pomej Katharina , Simbrunner Benedikt , Semmler Georg , Trauner Michael , Mandorfer Mattias , Reiberger Thomas
Published: August 2020

Background & Aims

To explore whether sarcopenia, diagnosed by an abbreviated magnetic resonance imaging (MRI) protocol is a risk factor for hepatic decompensation and mortality in patients with chronic liver disease (CLD).

Methods

In this retrospective single‐centre study we included 265 patients (164 men, mean age 54 ± 16 years) with CLD who had undergone MRI of the liver between 2010 and 2015. Transverse psoas muscle thickness (TPMT) was measured on unenhanced and contrast‐enhanced T1‐weighted and T2‐weighted axial images. Sarcopenia was defined by height‐adjusted and gender‐specific cut‐offs in women as TPMT < 8 mm/m and in men as TPMT < 12 mm/m respectively. Patients were further stratified into three prognostic stages according to the absence of advanced fibrosis (FIB‐4 < 1.45, non‐advanced CLD), compensated‐advanced CLD (cACLD) and decompensated‐advanced CLD (dACLD).

Results

The inter‐observer agreement for the TPMT measurements (κ = 0.98; 95% confidence interval [95% CI]:0.96‐0.98), as well as the intra‐observer agreement between the three image sequences (κ = 0.99; 95% CI: 0.99‐1.00) were excellent. Sarcopenia was not predictive of first or further hepatic decompensation. In patients with cACLD and dACLD, sarcopenia was a risk factor for mortality (cACLD: hazard ratio (HR):3.13, 95% CI: 1.33‐7.41, P = .009; dACLD:HR:2.45, 95% CI: 1.32‐4.57, P = .005) on univariate analysis. After adjusting for the model of end‐stage liver disease (MELD) score, albumin and evidence of clinical significant portal hypertension, sarcopenia (adjusted HR: 2.76, 95% CI: 1.02‐7.42, P = .045) remained an independent risk factor for mortality in patients with cACLD.

Conclusion

Sarcopenia can be easily evaluated by a short MRI exam without the need for contrast injection. Sarcopenia is a risk factor for mortality, especially in patients with cACLD.
Abundant extraterrestrial amino acids in the primitive CM carbonaceous chondrite Asuka 12236
Authors: Glavin Daniel P. , McLain Hannah L. , Dworkin Jason P. , Parker Eric T. , Elsila Jamie E. , Aponte José C. , Simkus Danielle N. , Pozarycki Chad I. , Graham Heather V. , Nittler Larry R. , Alexander Conel M.O’D.
Published: August 2020

The Asuka (A)‐12236 meteorite has recently been classified as a CM carbonaceous chondrite of petrologic type 3.0/2.9 and is among the most primitive CM meteorites studied to date. Here, we report the concentrations, relative distributions, and enantiomeric ratios of amino acids in water extracts of the A‐12236 meteorite and another primitive CM chondrite Elephant Moraine (EET) 96029 (CM2.7) determined by ultra‐high‐performance liquid chromatography time‐of‐flight mass spectrometry. EET 96029 was highly depleted in amino acids and dominated by glycine, while a wide diversity of two‐ to six‐carbon aliphatic primary amino acids were identified in A‐12236, which had a total amino acid abundance of 360 ± 18 nmol g−1, with most amino acids present without hydrolysis (free). The amino acid concentrations of A‐12236 were double those previously measured in the CM2.7 Paris meteorite, consistent with A‐12236 being a highly primitive and unheated CM chondrite. The high relative abundance of α‐amino acids in A‐12236 is consistent with formation by a Strecker‐cyanohydrin dominated synthesis during a limited early aqueous alteration phase on the CM meteorite parent body. The presence of predominantly free glycine, a near racemic mixture of alanine (d/l ~0.93–0.96), and elevated abundances of several terrestrially rare non‐protein amino acids including α‐aminoisobutyric acid (α‐AIB) and racemic isovaline indicate that these amino acids in A‐12236 are extraterrestrial in origin. Given a lack of evidence for biological amino acid contamination in A‐12236, it is possible that some of the l‐enantiomeric excesses (lee ~34–64%) of the protein amino acids, aspartic and glutamic acids and serine, are indigenous to the meteorite; however, isotopic measurements are needed for confirmation. In contrast to more aqueously altered CMs of petrologic types ≤2.5, no l‐isovaline excesses were detected in A‐12236. This observation strengthens the hypothesis that extensive parent body aqueous activity is required to produce or amplify the large l‐isovaline excesses that cannot be explained solely by exposure to circularly polarized radiation or other chiral symmetry breaking mechanisms prior to incorporation into the asteroid parent body.
Close arrangement of CARK3 and PMEIL affects ABA‐mediated pollen sterility in Arabidopsis thaliana
Authors: Wang Hsi‐Hua , Qiu Yao , Yu Qin , Zhang Qian , Li Xiaoyi , Wang Jianmei , Li Xufeng , Zhang Yang , Yang Yi
Published: August 2020

Abscisic acid (ABA) signaling is a vital plant signaling pathway for plant responses to stress conditions. ABA treatment can alter global gene expression patterns and cause significant phenotypic changes. We investigated the responses to ABA treatment during flowering in Arabidopsis thaliana. Dipping the flowers of CARK3 T‐DNA mutants in ABA solution, led to less reduction of pollen fertility than in the wild type plants (Col‐0). We demonstrated that PMEIL, a gene located downstream of CARK3, directly affects pollen fertility. Due to the close arrangement of CARK3 and PMEIL, CARK3 expression represses transcription of PMEIL in an ABA‐dependent manner through transcriptional interference. Our study uncovers a molecular mechanism underlying ABA‐mediated pollen sterility and provides an example of how transcriptional interference caused by close arrangement of genes may mediate stress responses during plant reproduction.
On the Systematicity of Academic Philosophy
Authors: Alvargonzález David
Published: August 2020

In this paper, I will discuss the significance of the idea of system as applied to academic philosophy. Firstly, I will distinguish systems from other types of totalities, such as sets, aggregates and structures, and then present a definition of system and analyse the basic constituent components of any system. I will subsequently apply the proposed idea of system and its internal modulations to philosophical systems to account for the different ways of understanding academic philosophy as systematic philosophy. To end, I will argue that the systematicity of academic philosophy does not necessarily imply any dogmatism, doctrinarism or metaphysical monism.
Loss of variable fascicle gearing during voluntary isometric contractions of paretic medial gastrocnemius muscles in male chronic stroke survivors
Authors: Son Jongsang , Rymer William Zev
Published: August 2020

Key points

Maximum fascicle shortening/rotation was significantly decreased in paretic medial gastrocnemius (MG) muscles compared to non‐paretic MG muscles.

The fascicle gear ratio on both sides decreased as the ankle became dorsiflexed, but the slope of the fascicle gear ratio over ankle joint angle was significantly lower on the paretic side.

The side‐to‐side slope difference was strongly correlated with the relative maximum joint torque and with the relative shear wave speed, suggesting that variable gearing may explain muscle weakness after stroke.

The present study aimed to understand variable fascicle gearing during voluntary isometric contractions of the medial gastrocnemius (MG) muscle in chronic stroke survivors. Using ultrasonography, we characterized fascicle behaviour on both paretic and non‐paretic sides during plantarflexion contractions at different intensities and at different ankle joint angles. Shear wave speed was also recorded from the MG muscle belly under passive conditions. Fascicle gear ratios were then calculated as the ratio of muscle belly shortening velocity to fascicle shortening velocity, and variable fascicle gearing was quantified from the slope of gear ratio vs. joint angle relations. This slope was used to establish associations with maximum joint torques and with shear wave speeds. At all measured angles, we found a significant reduction in both maximum fascicle shortening and maximum fascicle rotation on the paretic side compared to the non‐paretic side on our stroke survivor cohort. The fascicle rotation per fascicle shortening on the paretic side was also significantly smaller than on the non‐paretic side, especially at plantarflexed positions. Furthermore, the fascicle gear ratio on both sides decreased as the ankle became dorsiflexed, but the change in the fascicle gear ratio was significantly lower on the paretic side. The side‐to‐side difference in the gear ratio slope was also strongly correlated with the relative maximum joint torque and with the relative shear wave speed, suggesting that variable gearing may explain muscle weakness after stroke. Further studies are needed to investigate how muscular changes after stroke may impede variable gearing and adversely impact muscle performance.
Myosin dynamics during relaxation in mouse soleus muscle and modulation by 2′‐deoxy‐ATP
Authors: Ma Weikang , Childers Matthew , Murray Jason , Moussavi‐Harami Farid , Gong Henry , Weiss Robert , Daggett Valerie , Irving Thomas , Regnier Michael
Published: August 2020

Key points

Skeletal muscle relaxation has been primarily studied by assessing the kinetics of force decay. Little is known about the resultant dynamics of structural changes in myosin heads during relaxation.

The naturally occurring nucleotide 2‐deoxy‐ATP (dATP) is a myosin activator that enhances cross‐bridge binding and kinetics.

X‐ray diffraction data indicate that with elevated dATP, myosin heads were extended closer to actin in relaxed muscle and myosin heads return to an ordered, resting state after contraction more quickly.

Molecular dynamics simulations of post‐powerstroke myosin suggest that dATP induces structural changes in myosin heads that increase the surface area of the actin‐binding regions promoting myosin interaction with actin, which could explain the observed delays in the onset of relaxation.

This study of the dATP‐induced changes in myosin may be instructive for determining the structural changes desired for other potential myosin‐targeted molecular compounds to treat muscle diseases.

Here we used time‐resolved small‐angle X‐ray diffraction coupled with force measurements to study the structural changes in FVB mouse skeletal muscle sarcomeres during relaxation after tetanus contraction. To estimate the rate of myosin deactivation, we followed the rate of the intensity recovery of the first‐order myosin layer line (MLL1) and restoration of the resting spacing of the third and sixth order of meridional reflection (SM3 and SM6) following tetanic contraction. A transgenic mouse model with elevated skeletal muscle 2‐deoxy‐ATP (dATP) was used to study how myosin activators may affect soleus muscle relaxation. X‐ray diffraction evidence indicates that with elevated dATP, myosin heads were extended closer to actin in resting muscle. Following contraction, there is a slight but significant delay in the decay of force relative to WT muscle while the return of myosin heads to an ordered resting state was initially slower, then became more rapid than in WT muscle. Molecular dynamics simulations of post‐powerstroke myosin suggest that dATP induces structural changes in myosin that increase the surface area of the actin‐binding regions, promoting myosin interaction with actin. With dATP, myosin heads may remain in an activated state near the thin filaments following relaxation, accounting for the delay in force decay and the initial delay in recovery of resting head configuration, and this could facilitate subsequent contractions.
Y(OH)3 powder characterized by XPS
Authors: Cole Kevin M. , Kirk Donald W. , Thorpe Steven J.
Published: August 2020

X-ray photoelectron spectroscopy was performed on as-received analytical grade Y(OH)3 powder. This report provides a detailed photoelectron spectroscopy investigation such that Y(OH)3 can be properly identified in a non-destructive manner from Y2O3. In addition to the survey scan, detailed charge corrected scans for Y 3s, Y 3p, Y 4s, Y 4p, O 1s, O 2s, and C 1s surface photoelectron signals are reported.
Cross-generational acoustic comparisons of tonal Kyungsang Korean stops
Authors: Lee Hyunjung
Published: August 2020

Under sound change of stops in Kyungsang Korean, this study examined how the voice onset time (VOT) and F0 cues to the aspirated-lenis stop contrast were used in the productions of children, teenagers, young adults, and elderly speakers. Results showed that the three younger groups were more innovative in using VOT than the elderly speakers, but the use of F0 was not as innovative as the use of VOT. This study suggests that although there is some difference between Seoul and Kyungsang Korean, the sound change in Kyungsang Korean stops is incrementally similar to the change in Seoul Korean stops.
A multi-task learning convolutional neural network for source localization in deep ocean
Authors: Liu Yining , Niu Haiqiang , Li Zhenglin
Published: August 2020

A multi-task learning (MTL) method with adaptively weighted losses applied to a convolutional neural network (CNN) is proposed to estimate the range and depth of an acoustic source in deep ocean. The network input is the normalized sample covariance matrices of the broadband data received by a vertical line array. To handle the environmental uncertainty, both the training and validation data are generated by an acoustic propagation model based on multiple possible sets of environmental parameters. The sensitivity analysis is investigated to examine the effect of mismatched environmental parameters on the localization performance in the South China Sea environment. Among the environmental parameters, the array tilt is found to be the most important factor on the localization. Simulation results demonstrate that, compared with the conventional matched field processing (MFP), the CNN with MTL performs better and is more robust to array tilt in the deep-ocean environment. Tests on real data from the South China Sea also validate the method. In the specific ranges where the MFP fails, the method reliably estimates the ranges and depths of the underwater acoustic source.