bluuebunny/crossref_metadata_2025 huggingface dataset:
How One Company Drives Ownership Behavior to Innovate and Create Shareholder Value: The Case of Varian Medical Systems
Authors: Bruff J. Michael , Karame Marwaan
Published: June 2020

For the past 70 years, Varian Medical Systems has helped lead the fight against cancer by developing new and more effective cancer treatments and is today's market leader in radiation therapy, treating over four million cancer patients last year. From its founding in 1948, Varian's competitive advantage has been seen as deriving from its “culture of innovation“—a culture that has been fueled by significant investment in research and development. But after a long run of innovation that extended Varian's therapeutic reach and resulted in strong growth, the company's shareholder returns began to sag. And as a number of analysts noted, the stagnation of the share price appears to have been highly correlated with a slowdown in the company's release of new, innovative products.

To help steer the company back toward the success of its old ways, Varian's management put in place a new measure of periodic corporate operating performance that helped management gain more insight into the most promising areas for allocating resources and investment in different business lines and regions. The intent behind adopting this new measure, which also became the basis for the incentive pay of the company's executive team, was to restore and reinforce the company's high‐investment strategy while instilling strong discipline for earning market returns on those investments and, at the same time, meeting the short‐term demands of quarterly earnings (EPS) targets.

In this article, the company's CFO and one of the company's advisors describe the thinking behind, the actual implementation of, and the early returns derived from Varian's adoption of a new performance measurement and reward system. The effects go beyond those normally associated with adopting a “merely financial” measure, including a reinvigoration of ownership spirit and a much admired corporate culture of innovation and growth.
Increased expression of in situ IL‐31RA and circulating CXCL8 and CCL2 in pemphigus herpetiformis suggests participation of the IL‐31 family in the pathogenesis of the disease
Authors: Morais K.L. , Miyamoto D. , Orfali R.L. , Maruta C.W. , Santi C.G. , Sotto M.N. , da Silva L.F.F. , Branco A.C.C.C , Sato M.N. , Aoki V.
Published: June 2020

Background

Pemphigus herpetiformis (PH) is a rare clinical subtype of pemphigus with the presence of urticarial plaques, severe pruritus, rare acantholysis and eosinophilic spongiosis.

Objectives

The aim of this study was to investigate the influence of IL‐31 and pro‐inflammatory cytokines/chemokines in the pathogenesis of PH.

Methods

Twenty‐five patients with PH and three groups: pemphigus foliaceus (PF = 14), pemphigus vulgaris (PV = 15) and healthy controls (HC = 20) were selected for this study. The groups were analysed by immunohistochemistry utilizing IL‐31, IL‐31RA, IL‐4, IL‐17 and TNF‐α antibodies. Serum levels of IL‐4, IL‐13, TNF, CXCL8, CCL5 and CCL2 were evaluated by cytometric bead array.

Results

Analysis of IL‐31 family of PH patients revealed the following findings: (i) Enhanced in situ expression of IL‐31 in PH samples, compared to PF and to PV (epidermis); (ii) Cutaneous IL‐31RA expression in PH samples was higher than in PF, PV and HC groups (epidermis and dermis); (iii) PF patients that evolved to PH showed significant increased IL‐31RA epidermal expression during the PH phase. Profile of pro‐inflammatory cytokines (IL‐4, IL‐17 and TNF‐α) in PH patients’ skin exhibited: (i) Enhanced IL‐4 expression, when compared to patients with PF (epidermis and dermis) and with PV (epidermis); (ii) Augmented IL‐17 expression than PF and PV patients (epidermis); (iii) Augmented expression of TNF‐α when compared to PF at the epidermal level. Evaluation of circulating cytokines and chemokines showed higher levels of CXCL8 and CCL2 in PH sera compared to HC group.

Conclusions

IL‐31 and IL‐31RA, cytokines related to pruritus, and pro‐inflammatory chemokines (CXCL8 and CCL2) seem to exert a role in the pathogenesis of PH. These findings support future studies to clarify the role of IL‐31 pathway as a potential therapeutic target for patients with PH.
Minimally invasive procedures for deficient interdental papillae: A review
Authors: Zhang Yiding , Hong Guang , Zhang Yifan , Sasaki Keiichi , Wu Hongkun
Published: June 2020

Objective

Deficient interdental papillae cause a series of problems, including food impaction, phonetic difficulties, and esthetic concerns. The purpose of this article is to provide valid clinical recommendations for clinicians to address these problems in a predictable and less invasive way.

Overview

Numerous treatments are available for interdental papillae reconstruction, but most of them involve surgery and yield unpredictable outcomes. Minimally invasive treatments have the advantages of being effective, predictable, and involving only slight injury as compared to surgical treatments. We included 66 studies obtained after searching for relevant papers in PubMed and Web of Science. The etiology and classification of deficient interdental papillae are explained and minimally invasive procedures for deficient interdental papillae reconstruction are summarized.

Conclusions

Minimally invasive procedures are promising ways to reconstruct deficient interdental papillae, and have the advantages of slight pain and rapid recovery. It should be noticed that some of the minimally invasive treatments still require further long‐term observation to confirm their efficacy.

Clinical significance

Familiarity with etiology and classification of deficient interdental papillae can help clinicians to choose the appropriate minimally invasive approach as well as help with case collection to enhance esthetics status in patients with deficient interdental papillae.
First record of the opal chimaera, Chimaera opalescens (Holocephali: Chimaeridae) and revision of the occurrence of the rabbitfish Chimaera monstrosa in the Azores waters
Authors: Catarino Diana , Jakobsen Kirsten , Jakobsen Joachim , Giacomello Eva , Menezes Gui M. , Diogo Hugo , Canha Ângela , Porteiro Filipe M. , Melo Octávio , Stefanni Sergio
Published: June 2020

The presence of the opal chimaera, Chimaera opalescens, is reported for the first time in the deep waters of the Azores, with the capture of four specimens by fishermen and the video recording of an additional five individuals. Species identification was supported by the 646 bp sequenced fragment of the mitochondrial gene cytochrome oxidase subunit I. Because C. opalescens is a recently recognised species that had been recurrently misidentified as rabbitfish, Chimaera monstrosa, the historical data of C. monstrosa in the Azores were reviewed to assess the possible presence of both Chimaera species in the region. Although several authors have reported the occurrence of C. monstrosa in the Azorean waters since the 1800s, the majority of these are based on only three specimens caught during the late 1800s. The investigation performed using literature and examination of the museum specimens still available concluded that the most likely scenario is that C. monstrosa is absent from the Azores and past records of that species in the region are most likely misidentifications of C. opalescens.
Catching Air: Risk and Embodied Ocean Health among Dominican Diver Fishermen
Authors: Mallon Andrews Kyrstin
Published: June 2020

This article explores the connections between bodily health and environmental health among diver fishermen in the Dominican Republic, and how these relationships are excluded from broader conversations about marine conservation at the national and global levels. As changing ocean environments refigure marine ecosystems, making fish scarce in the shallows, diver fishermen must dive deeper and stay longer in risky conditions, using a compressor to pump an unlimited supply of air to the diver below. As a result, decompression sickness (the bends) has become a pervasive injury and a way that coastal communities experience changing ocean health. The article analyzes injury narratives from divers who “caught air,” the local term for the bends, arguing that decompression sickness is a symptom of failing ecologies and strained human relations with the sea, where environments at risk become embodied through parallel risky practices at sea.
Madness, sex, and risk: A poststructural analysis
Authors: Evans Alicia M. , Holmes Dave , Quinn Chris
Published: June 2020

The body of the one deemed mad often remains a sexual body with sexual needs. Mental health services respond to these demands of the body in various ways, including constructing rules around physical movement. In this context, we were interested in how mental health clinicians problematized the sexual needs and practices of residents of a long‐stay mental health rehabilitation facility and how solutions were constructed in relation to the residents’ sexual desires. This paper reports findings from mental health clinicians, as part of a case study where we addressed this question. Mental health clinicians responded to residents’ sexuality from a discourse of risk. The notion of the engagement with each resident as a sexual subject was subordinated to the paternalistic notion of protecting the patient from risk. The resident became an object to be monitored and protected rather than a subject with sexual desire and agency. This paternalism also showed itself in relation to a ‘no‐sex on‐site’ rule that allowed for a shift of risk from the organization to the resident. Residents, rather than having a relatively safe place to have sexual relations, were required to find a place elsewhere, potentially unsafe, outside the facility.
Notch activation leads to loss of myoepithelial differentiation and poor outcome in solid adenoid cystic carcinoma
Authors: Zhang Ye , Liu Xiaoxiao , Zhou Chuan‐Xiang , Li Tie‐Jun
Published: June 2020

Objective

We aimed to investigate Notch pathway dysregulation in solid adenoid cystic carcinoma (AdCC) and to define the association of Notch activation with cell differentiation and prognosis in AdCCs.

Materials and Methods

Notch1 mutations were detected from 125 AdCCs (62 cribriform‐tubular; 63 solid). RNA‐seq was performed in 16 AdCCs (6 Notch‐mutant; 10 wild type). Notch activation indicator NICD and myoepithelial marker p63 were detected using immunohistochemistry and double‐labelling immunofluorescence. The effect of exogenous NICD overexpression on p63 expression and cell proliferation was investigated using Western blotting and live‐cell imaging.

Results

We identified 33 Notch1 activating mutations in 27 AdCCs including 26 solid and 1 cribriform‐tubular subtypes. Six tumours harboured more than one Notch1 mutation, and 18 Notch1 mutations were novel. Most (47/63, 74.6%) solid AdCCs showed NICD overexpression, whereas 61 of 62 (98.4%) cribriform‐tubular tumours were negative. NICD and p63 exhibited mutually exclusive expression, and exogenous NICD overexpression promoted cell proliferation and decreased p63 expression. NICD overexpression and Notch mutations were poor indicators for overall survival and metastasis, especially bone metastasis.

Conclusions

Dysregulated Notch signalling plays a critical role in AdCC severity. Notch activation may contribute to loss of myoepithelial differentiation as well as high proliferation and metastasis rates in solid AdCC.
One‐Stage Repair of Posterior Oblique Ligament Avulsion Fracture Combined with Medial Collateral Ligament Injury
Authors: Zhang Min , Ma Ji , Zhang Run‐Jie , Xi Gang , Wang Hao‐hao , Zhao Bin
Published: June 2020

Objective

To evaluate the clinical effect of the one‐stage repair of a posterior oblique ligament avulsion fracture combined with a medial collateral ligament injury.

Methods

This study was a retrospective trial. From February 2007 to May 2017, five patients with posterior oblique ligament avulsion fracture combined with medial collateral ligament injury were included in this study. The patients were aged 37–58 years old with a mean of 45.2 years. All patients underwent the primary repair of a posterior oblique ligament avulsion fracture and medial collateral ligament injury. The main observational index included Lysholm score, International Knee Documentation Committee (IKDC) score, Visual Analogue Scale (VAS) score, and range of motion (ROM).

Results

The results showed that the average time of follow‐up was 53.6 months (range, 20–86 months). When compared to preoperative scores, the preoperative Lysholm score was significantly increased (47.8 ± 5.1 vs 95.0 ± 3.7, P < 0.05), the IKDC score was significantly increased (51.2 ± 5.6 vs 88.6 ± 4.2, P < 0.05), the VAS score was significantly decreased (7.0 ± 0.7 vs 0.4 ± 0.5, P < 0.05), and the ROM was significantly increased (91.6° ± 8.4° vs 129.9° ± 4.4°, P < 0.05).

Conclusion

Our study found that with the combination of the one‐stage repair of a posterior oblique ligament (POL) avulsion fracture and medial collateral ligament injury, the patient's postoperative function recovered well, their pain was relieved, and their knee joint stability was reliable.
CRT in a congenital heart disease patient with interventricular dyssynchrony due to an RV conduction delay
Authors: Miyazaki Aya , Matsutani Hayato , Nakano Yuta , Ikeda Tadashi , Uemura Hideki , Doi Hiraku
Published: June 2020

We encountered a unique pattern of cardiac dyssynchrony in a patient with complex congenital heart disease (heterotaxy syndrome) with a biventricular physiology and systemic left ventricle (LV). On speckle tracking echocardiography, dyssynchrony was not detected within the LV, but was noted in an interventricular fashion between the LV and right ventricle (RV). An electrophysiologic study revealed a conduction delay in the subpulmonary RV. Cardiac resynchronization therapy provided reverse cardiac remodeling and an excellent result in our patient by placing the pacing leads around the dyssynchronous lesion.
Pediatric allergic diseases in the Indian subcontinent—Epidemiology, risk factors and current challenges
Authors: Krishna Mamidipudi Thirumala , Mahesh Padukudru Anand , Vedanthan Pudupakkam K. , Mehta Vinay , Moitra Saibal , Christopher Devasahayam Jesudas
Published: June 2020

Introduction

India is low‐middle‐income country (LMIC) with a population of 1.3bn, comprising about 20% of the global population. While the high‐income Western countries faced an “allergy epidemic” during the last three decades, there has been a gradual rise in prevalence of allergic diseases in India.

Methods

Narrative review.

Results and Discussion

Allergic diseases occur as a consequence of a complex interplay between genetic and environmental factors. There are multiple contrasting determinants that are important to consider in India including high levels of air pollution, in particular PM2.5 due to burning of fossil fuels and biomass fuels, diverse aero‐biology, tropical climate, cultural and social diversity, religious beliefs/myths, linguistic diversity, literacy level, breastfeeding and weaning, diet (large proportion vegetarian), and high incidence rates of TB, HIV, malaria, filariasis, parasitic infestations, and others, that not only shape the immune system early in life, but also impact on biomarkers relevant to allergic diseases.

India has a relatively weak and heterogeneous healthcare framework, and allergology has not yet been recognized as an independent specialty. There are very few post‐graduate training programs, and allergic diseases are managed by primary care physicians, organ‐based specialists, and general pediatricians. Adrenaline auto‐injectors are not available, there is patient unaffordability for inhalers, nasal sprays, and biologics, and this is compounded by poor compliance leading to 40%‐50% of asthmatic children having uncontrolled disease and high rates of oral corticosteroid use. Standardized allergen extracts are not available for skin tests and desensitization.

This article provides a critical analysis of pediatric allergic diseases in India.
“Bypass the UN”: Diplomatic Practices and Change in Multilateral Settings
Authors: Bélanger‐Vincent Ariane
Published: June 2020

This article highlights diplomatic practices that contributed to the wide approval of the polemical issue of humanitarian intervention, reframed into the term Responsibility to Protect (R2P). The expression was coined in 2001. It is now reported that R2P was unanimously agreed upon by 155 heads of states and governments during the 2005 World Summit held at the United Nations (UN) General Assembly. The conditions under which such an issue can reach a swift consensus are complex and manifold. Here, I focus on a diplomatic strategy employed by a handful of actors who carefully bypassed UN headquarters rather than promote the idea within the organization, as the official narratives on R2P suggest. I show that this strategy was inspired by a previous experience that led to another important change in global politics—the entry into force of the Anti‐Personnel Mine Ban Convention in 1999. The actors involved contributed to a normative change on humanitarian intervention by creating new forums of negotiations and using new kinds of networks that avoid multilateral arenas such as the UN. This article exposes concealed and informal aspects of diplomatic practices.
Stäckel transform of Lax equations
Authors: Błaszak Maciej , Marciniak Krzysztof
Published: June 2020

We construct a map between Lax equations for pairs of Liouville integrable Hamiltonian systems related by a multiparameter Stäckel transform. Using this map, we construct Lax representation for a wide class of separable systems by applying the multiparameter Stäckel transform to Lax equations of suitably chosen systems from a seed class. For a given separable system, we obtain in this way a set of nonequivalent Lax equations parameterized by an arbitrary function of the spectral parameter, as it is in the case of a related seed system.
Combat Experience and the Foreign Policy Positions of Veterans
Authors: Endicott Travis W.
Published: June 2020

Objective

Prior work on the effect of combat on veterans typically measures combat experience as a dichotomous event. I extend work in this area by theorizing and empirically accounting for the number of unique combat experiences a veteran endures and how that associates with the veteran's outlook on foreign policy.

Methods

I utilize an original survey that asks for multiple types of military combat experience, as well as foreign policy positions.

Findings

Consistent with previous research, I find that veterans tend to be more hawkish than civilians. When I account for veterans’ number of unique combat experiences, however, I find that the more combat experiences that veterans endure, the less hawkish their foreign policy positions are. Moreover, consistent with literature from military psychology, this association only holds for veterans who express more regret about their time in the military.

Conclusions

The results should encourage public opinion scholars to consider the effects that the number of individual combat event experiences and regret have on veterans' issue positions more broadly.
Modified cranial closing wedge osteotomy to treat cranial cruciate ligament deficient stifles with excessive tibial plateau angles: Complications, owner satisfaction, and midterm to long‐term outcomes
Authors: Terreros Alex , Daye R. Mark
Published: June 2020

Objective

To report midterm to long‐term outcomes of dogs with cranial cruciate ligament (CCL) rupture and excessive tibial plateau angles (TPA) treated with a modified cranial closing wedge osteotomy (m‐CCWO).

Study design

Retrospective case series.

Study population

Dogs (n = 21) with CCL rupture and excessive TPA treated with m‐CCWO (n = 28).

Methods

Medical records, midterm and long‐term follow‐up radiographic examination records, Canine Orthopedic Index data, and owner surveys were reviewed to determine functional outcomes, owner satisfaction, and complications associated with the technique.

Results

Tibial plateau angle decreased from 42.3° ± 4.8° preoperatively to 4.8° ± 3.3° after m‐CCWO. No catastrophic complications occurred, while major and minor complications occurred in three of 28 and six of 28 stifles, respectively. Canine Orthopedic Index scores and owner surveys were available in 16 of 21 dogs at a median of 608 days postoperatively (range 279‐1225). Functional midterm or long‐term outcomes for these dogs treated with m‐CCWO were excellent in eight dogs, acceptable in seven dogs, and unacceptable in one dog. Progression of osteoarthritis was noted on all midterm and long‐term follow‐up radiographs. All owners but one were satisfied.

Conclusion

Modified cranial closing wedge osteotomy was associated with an acceptable morbidity and resulted in satisfactory functional outcomes in most dogs of this series.

Clinical significance

Modified cranial closing wedge osteotomy should be considered as an alternative to treat CCL rupture in dogs with excessive TPA.
Teachers of Future Teachers and Their Conception of Teaching
Authors: Kasíková Hana , Valenta Josef
Published: June 2020

The text presents a partial output from a broader research Teachers of Teachers: Careers and Teaching Conceptions (part of the research project “Life Paths, Lifestyles and Quality of Life from the perspective of individual adaptation and relationship of actors and institutions”, solved at the Faculty of Arts in Prague). The research focuses on the personal views of academics from faculties preparing teachers for their careers and on the profession itself and its key themes or issues. It also monitors the tendencies that appear in these statements. The fundamental question of this probe is: What is the conception of teaching for teachers teaching teachers? The theoretical part brings an overview of already known opinions and findings from Czech and foreign research. The survey shows that empirical research relating to university teachers who teach student teachers and their readiness for the profession is modest in our country. The presented survey is based on interviews with ten academics (deliberate selection) of different status, title and length of practice. They all teach pedagogical, respectively, psychological disciplines. The interview was partially structured by questions in five areas of inquiry. The method of thematic analysis was used to process the results. Since the aim of the research is not to create a new theory, and because of its qualitative nature, both the individual views and some summaries of accordant views are used in the conclusions. The conclusion that our respondents sensitively perceive the problem of the relationship between theory and practice in teaching future teachers at a university and strive to solve it in different ways is significant. The opinions on the relationship between research and teaching at faculties preparing teachers are interesting as well.
Buckling of Externally Pressurized Toroidal Shell With Stiffened Ribs
Authors: Zhu Yongmei , Zhao Bo , Chen Binbin , Zhao Xilu , Tang Wenxian , Wang Xiaorong
Published: June 2020

The buckling characteristics of toroidal shells with closed circular cross sections loaded with a static external pressure were investigated. Eight toroidal shell test models were developed: two ribless, two semicircular discrete ribs, two rectangular discrete ribs, and two rectangular continuous ribs. The geometry, toroidal shell thickness, buckling load, and failure of each model were measured and compared. The effects of different ribbing methods (discrete, continuous unidirectional single-wire, continuous unidirectional multiwire wound, and continuous bidirectional wound ribs) on the buckling behavior of a ribbed toroidal shell were investigated, and the results provide guidance for practical engineering.
Effects of Boot-Shaped Rib on Heat Transfer Characteristics of Internal Cooling Turbine Blades
Authors: Pham Ky-Quang , Nguyen Quang-Hai , Vu Tai-Duy , Dinh Cong-Truong
Published: June 2020

Gas turbine engine has been widely applied to many heavy industries, such as marine propulsion and aerospace fields. Increasing turbine inlet temperature is one of the major ways to improve the thermal efficiency of gas turbines. Internal cooling for gas turbine cooling system is one of the most commonly used approaches to reduce the temperature of blades by casting various kinds of ribs in serpentine passages to enhance the heat transfer between the coolant and hot surface of gas turbine blades. This paper presents an investigation of the boot-shaped rib design to increase the heat transfer performances in the internal cooling turbine blades for gas turbine engines. By varying the design parameter configuration, the airflow is taken with higher momentum, and the minor vortex being at the front rib is relatively removed. The object of this investigation is increasing the reattachment airflow to the heated wall and reducing the vortex occurring near the rib for improving the performances of heat transfer using three-dimensional (3D) Reynolds-averaged Navier–Stokes (RANS) with the SST model. A parametric study of the boot-shaped rib design was performed using various geometric parameters related to the heel-angle, toe-angle, slope-height, and rib-width to find their effect on the Nusselt number, temperature on the ribbed wall, friction factor ratio of the channel, and thermal performance factor. The numerical results showed that the heat transfer performances are significantly increased with the heel-angle, toe-angle, slope-height, while that remained relatively constant with the rib width.
Performance Factors and Strategies Favored by French Olympic Athletes
Authors: Joncheray Helene , Burlot Fabrice , Besombes Nicolas , Dalgalarrondo Sébastien , Desenfant Mathilde
Published: June 2020

This article presents the performance factors identified by Olympic athletes and analyzes how they were prioritized and implemented during the 2012–2016 Olympiad. To address this issue, 28 semistructured interviews were conducted with French athletes who participated in the Olympic Games in 2016. The analysis shows that to achieve performance, only two factors were implemented by all the athletes: training and physical preparation. The other factors, namely, mental preparation, nutrition, and recovery care, were not implemented by all athletes. In addition, two main types of configurations have been identified: a minority of athletes (n = 4) for whom the choice of performance factors and their implementation are controlled by the coach and a majority (n = 24) who adopts secondary adjustments by relying on a parallel network.
Enzyme-powered Janus platelet cell robots for active and targeted drug delivery
Authors: Tang Songsong , Zhang Fangyu , Gong Hua , Wei Fanan , Zhuang Jia , Karshalev Emil , Esteban-Fernández de Ávila Berta , Huang Chuying , Zhou Zhidong , Li Zhengxing , Yin Lu , Dong Haifeng , Fang Ronnie H. , Zhang Xueji , Zhang Liangfang , Wang Joseph
Published: June 2020

Drug-loaded urease-powered Janus cell robots enhance binding efficiency with biological targets and improve therapeutic efficacy.
The Ubiquitin-Modifying Enzyme A20 Terminates C-Type Lectin Receptor Signals and Is a Suppressor of Host Defense against Systemic Fungal Infection
Authors: Liang Jie , Zhang Junyi J. , Huang Hsin-I , Kanayama Masashi , Youssef Nourhan , Jin Yingai J. , Reyes Estefany Y. , Abram Clare L. , Yang Shigao , Lowell Clifford A. , Wang Donghai , Shao Ling , Shinohara Mari L. , Zhang Jennifer Y. , Hammer Gianna Elena
Published: June 2020

C-type lectin receptors (CLRs) play key roles in antifungal defense. CLR-induced NF-κB is central to CLR functions in immunity, and thus, molecules that control the amplitude of CLR-induced NF-κB could profoundly influence host defense against fungal pathogens. However, little is known about the mechanisms that negatively regulate CLR-induced NF-κB, and molecules which act on the CLR family broadly and which directly regulate acute CLR-signaling cascades remain unidentified.
Convergent Evolution of Neutralizing Antibodies to Staphylococcus aureus γ-Hemolysin C That Recognize an Immunodominant Primary Sequence-Dependent B-Cell Epitope
Authors: Hernandez David N. , Tam Kayan , Shopsin Bo , Radke Emily E. , Law Karen , Cardozo Timothy , Torres Victor J. , Silverman Gregg J.
Published: June 2020

Staphylococcus aureus
infection is a major public health threat in part due to the spread of antibiotic resistance and repeated failures to develop a protective vaccine. Infection is associated with production of virulence factors that include exotoxins that attack host barriers and cellular defenses, such as the leukocidin (Luk) family of bicomponent pore-forming toxins. To investigate the structural basis of antibody-mediated functional inactivation of Luk toxins, we generated a panel of murine monoclonal antibodies (MAbs) that neutralize host cell killing by the γ-hemolysin HlgCB.
Complete Genome Sequence of a Novel Coronavirus (SARS-CoV-2) Isolate from Bangladesh
Authors: Saha Senjuti , Malaker Roly , Sajib Mohammad Saiful Islam , Hasanuzzaman Md , Rahman Hafizur , Ahmed Zabed B. , Islam Mohammad Shahidul , Islam Maksuda , Hooda Yogesh , Ahyong Vida , Vanaerschot Manu , Batson Joshua , Hao Samantha , Kamm Jack , Kistler Amy , Tato Cristina M. , DeRisi Joseph L. , Saha Samir K.
Published: June 2020

The complete genome sequence of a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) isolate obtained from a nasopharyngeal swab from a patient with COVID-19 in Bangladesh is reported.
Cardiovascular risk in patients receiving ranibizumab for exudative
age-related macular degeneration: a nationwide self-controlled case-series
study
Authors: Jeon Ha-Lim , Byun Seong Jun , Pratt Nicole L , Sultana Janet , Park Sang Jun , Shin Ju-Young
Published: June 2020

Aims

To identify the association between ranibizumab and risk of stroke and
acute myocardial infarction (AMI) in patients with exudative age-related
macular degeneration (AMD).

Methods

We identified patients aged ≥45 years who received ranibizumab for
exudative AMD from the Korean National Health Insurance database. Of these, we
selected patients suffering stroke or AMI for the self-controlled case series.
We estimated incidence rate ratios (IRR) for stroke or AMI by comparing
incidence rates of ranibizumab-exposed periods to that of baseline using
conditional Poisson regression. The risks of haemorrhagic and ischaemic strokes
were also calculated separately.

Results

Among 33 134 patients receiving ranibizumab, 2397 patients had stroke or
AMI. The risk of stroke (IRR=0.83, 95% CI 0.75 to 0.91) was not increased
during the overall exposed period; however, there was a marginally elevated
risk in ≥57 days exposed period (IRR=1.14, 95% CI 1.001 to 1.31). When
analysing by the types of stroke, no increased risks of haemorrhagic (IRR=1.01,
95% CI 0.80 to 1.26) and ischaemic stroke (IRR=0.78, 95% CI 0.71 to 0.86) were
observed during the exposed period, although the risks of ischaemic and
haemorrhagic stroke were slightly elevated during ≥57 days exposed period. We
could not find an association between ranibizumab and AMI.

Conclusions

Ranibizumab intravitreal injections did not increase the overall risk of
stroke or AMI. Although the cardiovascular risk in patient receiving
ranibizumab seems to be low, continuous monthly use of ranibizumab for
high-risk patients should be judged carefully.
Interventions supporting long term adherence and decreasing cardiovascular events after myocardial infarction (ISLAND): pragmatic randomised controlled trial
Authors: Ivers Noah M , Schwalm Jon-David , Bouck Zachary , McCready Tara , Taljaard Monica , Grace Sherry L , Cunningham Jennifer , Bosiak Beth , Presseau Justin , Witteman Holly O , Suskin Neville , Wijeysundera Harindra C , Atzema Clare , Bhatia R Sacha , Natarajan Madhu , Grimshaw Jeremy M
Published: June 2020

Objective

To test a scalable health system intervention to improve long term adherence to secondary prevention treatments among patients who have had a recent myocardial infarction.

Design

Three arm, pragmatic randomised controlled trial with blinded outcome assessment.

Setting

Nine cardiac centres in Ontario, Canada.

Participants

2632 patients with obstructive coronary artery disease after a myocardial infarction, identified from a centralised cardiac registry.

Interventions

Participants were randomised 1:1:1 to receive usual care, five mail-outs developed through a user centred design process, or mail-outs plus phone calls. The phone calls were delivered first by an interactive automated system to screen for non-adherence to treatment. Trained lay health workers followed up as necessary. Interventions were coordinated centrally but delivered from each patient’s hospital site.

Main outcome measures

Co-primary outcomes were completion of cardiac rehabilitation and adherence to recommended medication. Data were collected by blinded assessors through patient report and from administrative health databases at 12 months.

Results

2632 patients (mean age 66, 71% male) were randomised: 878 to the full intervention (mail plus phone calls), 878 to mail only, and 876 to usual care. Of the respondents, 174 (27%) of 643 in the usual care group, 200 (32%) of 628 in the mail only group, and 196 (37%) of 531 allocated to the full intervention completed cardiac rehabilitation (adjusted odds ratio 1.55, 95% confidence interval 1.18 to 2.03). In the mail plus phone group, 11.7%, 6.0%, 14.4%, 32.9%, and 35.0% reported adherence to 0, 1, 2, 3, and 4 drug classes after one year, respectively, in comparison with 12.5%, 6.8%, 13.6%, 30.2%, and 36.8% in the mail only group, and 12.2%, 8.4%, 13.1%, 30.3%, and 36.1% in the usual care group, respectively (mail only
v
usual care, odds ratio 0.98, 95% confidence interval 0.81 to 1.19; full intervention
v
usual care, 0.99, 0.82 to 1.20).

Conclusions

Scalable interventions delivered by mail plus phone can increase completion of cardiac rehabilitation after myocardial infarction but not adherence to medication. More intensive interventions should be tested to improve adherence to medication and to evaluate the association between attendance at cardiac rehabilitation and adherence to medication.

Trial registration

ClinicalTrials.gov
NCT02382731
, registered 9 March 2015 before any patient enrolment.
A detailed analysis of patients included in the Summary Hospital-level Mortality Indicator (SHMI) for myocardial infarction (MI)—all is not what it seems?
Authors: Sharma Vinoda , Chowdhary Saqib , Abdul Fairoz , Džavík Vladimír , Varma Chetan
Published: June 2020

Background

The Summary Hospital-level Mortality Indicator (SHMI) for Myocardial Infarction (MI) is the ratio of the observed to the expected number of deaths due to MI. We aimed to assess (1) the accuracy of MI as a diagnosis in the SHMI for MI and (2) the healthcare received by patients with type 1 MI included in the SHMI for MI.

Methods

Retrospective review of patients included in SHMI for MI from April 2017 to March 2018. The diagnosis of MI was divided into type 1, type 2 and non-MI. For patients with type 1 MI who underwent intervention, we applied the prognostic Toronto Risk Score (TRS) and classified into group 0: score <13 (mortality risk 0%–4%, lowest risk), group 1: score 13–16 (mortality risk 6%–19.6%), group 2: score 17–19 (mortality risk 27.4%–47.6%) and group 3: score ≥20 (mortality risk 58%–92%). For patients with type 1 MI who underwent conservative management, we reviewed appropriateness of conservative management.

Results

SHMI for MI was 96 (41/42.83) falling to 65.4 with the inclusion of only type 1 MI (28 patients, 28/42.83). About 41.5% (n=17) underwent intervention of whom three were in the lowest risk TRS (group 0) and all received appropriate healthcare. Conservative management was appropriate for the 26.8% (n=11) treated medically, the most common reason was severe cognitive dysfunction.

Conclusions

We have demonstrated that SHMI for MI can be inaccurate due to the inclusion of type 2 MI or non-MI. Grouping patients into intervention versus conservative management helps in assessment of healthcare.
Improving access in a VA primary care clinic using an innovative Panel Retention Tool: a quality improvement report
Authors: Harris Andrew T , Hoover Catherine , Cmolik Brendan , Zaun Mariel , Falck-Ytter Corinna , Singh Mamta K
Published: June 2020

Background

Loss to follow-up is an under-recognised problem in primary care. Continuity with a primary care provider improves morbidity and mortality in the Veterans Health Administration. We sought to reduce the percentage of patients lost to follow-up at the Northeast Ohio Veterans Affairs Healthcare System from October 2017 to March 2019.

Methods

The Panel Retention Tool (PRT) was developed and tested with primary care teams using multiple Plan, Do, Study and Act cycles to identify and schedule lost to follow-up patients. Baseline data on loss to follow-up, defined as the percentage of panelled patients not seen in primary care in the past year, was collected over 6 months during tool development. Outcomes were tracked from implementation through spread and sustainment (12 months) across 14 primary care clinics.

Results

Of the 96 170 panelled patients at the beginning of the study period, 2715 (2.8%) were found to be inactive and removed from provider panels, improving panel reliability. Among the remaining, 1856 (1.9%) patients without scheduled follow-up were scheduled for future care, and 1239 (1.3%) without recent prior care completed encounters during the study period. The percentage of patients lost to follow-up decreased from 10.1% (lower control limit (LCL) 9.8%–upper control limit (UCL) 10.4%) at baseline to 6.4% (LCL 6.2%–UCL 6.7%) postintervention and patients without planned future care decreased from 21.7% (LCL 21.3%–UCL 22.1%) to 17.1% (LCL 16.7%–UCL 17.5%).

Conclusions

The PRT allowed primary care teams in an integrated health system to identify and schedule lost to follow-up patients. Ease of use, adaptability and encouraging outcomes facilitated spread. This has the potential to contribute to more appropriate utilisation of healthcare resources and improved access to primary care.
Consent in the time of COVID-19
Authors: Turnham Helen Lynne , Dunn Michael , Hill Elaine , Thornburn Guy T , Wilkinson Dominic
Published: June 2020

The COVID-19 pandemic crisis has necessitated widespread adaptation of revised treatment regimens for both urgent and routine medical problems in patients with and without COVID-19. Some of these alternative treatments maybe second-best. Treatments that are known to be superior might not be appropriate to deliver during a pandemic when consideration must be given to distributive justice and protection of patients and their medical teams as well the importance given to individual benefit and autonomy. What is required of the doctor discussing these alternative, potentially inferior treatments and seeking consent to proceed? Should doctors share information about unavailable but standard treatment alternatives when seeking consent? There are arguments in defence of non-disclosure; information about unavailable treatments may not aid a patient to weigh up options that are available to them. There might be justified concern about distress for patients who are informed that they are receiving second-best therapies. However, we argue that doctors should tailor information according to the needs of the individual patient. For most patients that will include a nuanced discussion about treatments that would be considered in other times but currently unavailable. That will sometimes be a difficult conversation, and require clinicians to be frank about limited resources and necessary rationing. However, transparency and honesty will usually be the best policy.
Managing hand and reconstructive microsurgery service during COVID-19 pandemic: Singapore experience
Authors: Omar Usama Farghaly , Pei Yein Tong , Rajaratnam Vaikunthan
Published: June 2020

Introduction

Managing healthcare service during pandemics and outbreaks is a challenging process. The aim is to keep patient safety as the priority, besides, continuing to provide essential healthcare services.

Methods

Situational audit was performed for the services rendered before and during COVID-19 pandemic and the elevation of the disease alert status, and a retrospective analysis of the attendance and procedures performed in the service.

Results

We present a methodology for performing a situational audit and generating service modification for hand and reconstructive microsurgery unit in a pandemic. There was no significant difference between the number of patients seen at outpatient clinics. However, there was a reduction in the numbers of total surgeries performed, with a 40% drop in the number of elective surgeries performed. There was also a reduction of cases seen in the emergency department hand clinic.

Discussion

COVID-19 pandemic is currently affecting not only the health service but also, other vital services all over the world. The pandemic puts significant challenges to acute surgical services in a hospital system involved in the management of the pandemic. Surgeons need to take proactive and a systematic approach in managing the available resources while maintaining essential surgical services. This paper provides the tools and methodology for doctors to plan their services in a pandemic situation.

Conclusions

It is possible to maintain essential surgical services in a pandemic situation through rapid situational audits and generating localised strategies while considering the constraints imposed during the pandemics while maintaining patient and staff safety.
Improvement of side resistance prediction for pile foundation using construction information
Authors: Otake Yu , Watanabe Shinya , Mizutani Taisaku
Published: June 2020

Problems such as the inclination and settlement of buildings after construction completion have been reported in recent years. Quality control during construction and mieruka (“visualizing” the work quality) are increasingly demanded. In light of this, the present study addresses execution with a “rotary penetration steel pipe pile (RPS-pile),” which is a system that is able to collect information in real time during the piling process. When an RPS-pile is placed, high push-in and pull-out bearing capacities are expected because the spiral blade at the pile tip resists at the bottom of the borehole against an external force. Additionally, continuous real-time data on the pile-head torque and the auger penetration depth per revolution are obtained, as these mechanical indicators are necessary for piling. This study aims at developing a method for the real-time confirmation of work quality at construction sites by utilizing construction information (information obtained during piling). Specifically, a method is proposed for the sequential updating of reliability in the estimation of the side friction acting on a drilled pile. In this method, real-time information on the pile-head torque and the auger penetration depth per revolution obtained during piling are used in addition to N-values that are observed in a standard penetration test conducted in advance as part of subsurface exploration.
Dark matter induced Brownian motion
Authors: Cheng Ting , Primulando Reinard , Spinrath Martin
Published: June 2020

We discuss a novel approach for directional, light dark matter searches inspired by the high precision position measurements achieved in gravitational wave detectors. If dark matter interacts with ordinary matter, movable masses are subject to an effect similar to Brownian motion induced by the scattering with dark matter particles which exhibits certain characteristics and could be observed. We provide estimates for the sensitivity of a hypothetical experiment looking for that motion. Interestingly, if successful, our approach would allow to constrain the local distribution of dark matter momentum.
1/N expansion for Horava–Lifshitz like four-fermion models
Authors: Gomes M. , Mariz T. , Nascimento J. R. , Petrov A. Yu. , da Silva A. J.
Published: June 2020

We study a class of four-fermion Gross–Neveu like models in four dimensions with critical exponents $$z=2$$

z
=
2

and $$z=3$$

z
=
3

. The models with $$z=2$$

z
=
2

are in general perturbatively nonrenormalizable but we show that there are in special cases renormalizable in the context of the 1/N expansion. We calculate explicitly the effective potential for these models.
Research and derivation for Wien’s displacement law by using catastrophe theory
Authors: Zhou Zhuo , Wu Jiu Hui , Liang Xiao , Yuan Xiao Yang , Wang Yun Lei
Published: June 2020

In this paper, Wien’s displacement law as one of the most important laws of thermal radiation, for which Wien has won the Nobel Prize in Physics, is studied and derived from the perspective of phase transition by using catastrophe theory. This paper describes in detail how the control variable causes the phase transition of the system potential function and the main indexes for judging whether the phase transition occurs. By extending the control variable in the catastrophe theory affecting the thermal radiation into multi-parameters form, the function equilibrium curve of the blackbody radiation is solved, and then the two expressions of Wien’s displacement law including wavelength-temperature and wavelength-temperature are derived theoretically. Furthermore, a phase transition method is proposed to study the thermal radiation of blackbody. This not only provides a new perspective for the research of thermal radiation, but also provides a new idea for the study of other phase transitions.
On almost valuation ring pairs
Authors: Jarboui Noômen , Dobbs David E.
Published: June 2020

If [Formula: see text] are (commutative) rings, [Formula: see text] denotes the set of intermediate rings and [Formula: see text] is called an almost valuation (AV)-ring pair if each element of [Formula: see text] is an AV-ring. Many results on AV-domains and their pairs are generalized to the ring-theoretic setting. Let [Formula: see text] be rings, with [Formula: see text] denoting the integral closure of [Formula: see text] in [Formula: see text]. Then [Formula: see text] is an AV-ring pair if and only if both [Formula: see text] and [Formula: see text] are AV-ring pairs. Characterizations are given for the AV-ring pairs arising from integrally closed (respectively, integral; respectively, minimal) ring extensions [Formula: see text]. If [Formula: see text] is an AV-ring pair, then [Formula: see text] is a P-extension. The AV-ring pairs [Formula: see text] arising from root extensions are studied extensively. Transfer results for the “AV-ring” property are obtained for pullbacks of [Formula: see text] type, with applications to pseudo-valuation domains, integral minimal ring extensions, and integrally closed maximal non-AV subrings. Several sufficient conditions are given for [Formula: see text] being an AV-ring pair to entail that [Formula: see text] is an overring of [Formula: see text], but there exist domain-theoretic counter-examples to such a conclusion in general. If [Formula: see text] is an AV-ring pair and [Formula: see text] satisfies FCP, then each intermediate ring either contains or is contained in [Formula: see text]. While all AV-rings are quasi-local going-down rings, examples in positive characteristic show that an AV-domain need not be a divided domain or a universally going-down domain.