bluuebunny/crossref_metadata_2025 huggingface dataset:
Admission sodium levels and hospital outcomes
Authors: Chi Cecilia , Patel Shivani , Cheung N. Wah
Published: February 2020

Background

Previous studies have found an increase in mortality among patients with worsening degrees of hyponatraemia. There is limited evidence on the impact of dysnatraemia on outcomes such as length of stay (LOS) and intensive care unit (ICU) admission.

Aims

To investigate the relationship between admission sodium levels at a quaternary referral hospital and outcomes, including mortality, LOS and admission to ICU.

Methods

All patients admitted to hospital over a period of 1 year who had a blood sodium level measured on admission were included. Admission sodium levels and related blood results were obtained. Data linkage was performed. Analyses for associations between admission sodium level and primary hospital outcomes (in‐hospital mortality) and secondary hospital outcomes (LOS and admission to ICU) were performed.

Case notes of patients with severe hyponatraemia were also reviewed, with a focus on the use of hypertonic saline.

Results

A total of 6447 patient admissions had an admission blood sodium level performed. Mean age was 55.8 ± 20.8 years. 49.3% were male. Serum sodium ranged from 110 mmol/L to 175 mmol/L.

The primary outcome of in‐hospital mortality occurred in 190 patients. An abnormal sodium level (Na <135 mmol/L or >145 mmol/L) was an independent predictor of in‐hospital mortality, and an independent predictor of the combined outcome of in‐hospital mortality and admission to ICU.

Hypertonic saline was infrequently used in patients with severe hyponatraemia. Its use did not worsen outcomes.

Conclusions

An abnormal serum sodium level is a strong marker of poor outcome in acute hospital illness.
Pliocene colonization of the Mediterranean by Great White Shark inferred from fossil records, historical jaws, phylogeographic and divergence time analyses
Authors: Leone Agostino , Puncher Gregory N. , Ferretti Francesco , Sperone Emilio , Tripepi Sandro , Micarelli Primo , Gambarelli Andrea , Sarà Maurizio , Arculeo Marco , Doria Giuliano , Garibaldi Fulvio , Bressi Nicola , Dall'Asta Andrea , Minelli Daniela , Cilli Elisabetta , Vanni Stefano , Serena Fabrizio , Díaz‐Jaimes Píndaro , Baele Guy , Cariani Alessia , Tinti Fausto
Published: February 2020

Aim

Determine the evolutionary origin of the heretofore poorly characterized contemporary Great White Shark (GWS; Carcharodon carcharias) of the Mediterranean Sea, using phylogenetic and dispersal vicariance analyses to trace back its global palaeo‐migration pattern.

Location

Mediterranean Sea.

Taxon

Carcharodon carcharias.

Methods

We have built the largest mitochondrial DNA control region (CR) sequence dataset for the Mediterranean GWS from referenced historical jaws spanning the 19th and 20th centuries. Mediterranean and global GWS CR sequences were analysed for genetic diversity, phylogenetic relationships and divergence time. A Bayes factor approach was used to assess two scenarios of GWS lineage divergence and emergence of the Mediterranean GWS line using fossil records and palaeo‐geographical events for calibration of the molecular clock.

Results

The results confirmed a closer evolutionary relationship between Mediterranean GWS and populations from Australia–New Zealand and the North‐eastern Pacific coast rather than populations from South African and North‐western Atlantic. The Mediterranean GWS lineage showed the lowest genetic diversity at the global level, indicating its recent evolutionary origin. An evaluation of various divergence scenarios determined the Mediterranean GWS lineage most likely appeared some 3.23 million years ago by way dispersal/vicariance from Australian/Pacific palaeo‐populations.

Main conclusion

Based on the fossil records, phylogeographic patterns and divergence time, we revealed that the Mediterranean GWS population originated in the Pliocene following the Messinian Salinity Crisis. Colonization of the Mediterranean by GWS likely occurred via an eastward palaeo‐migration of Australian/eastern Pacific elements through the Central American Seaway, before the complete closure of the Isthmus of Panama. This Pliocene origin scenario contrasts with a previously proposed scenario in which Australian GWS colonized the Mediterranean via antipodean northward migration resulting from navigational errors from South Africa during Quaternary climatic oscillations.
Contests over joint production on networks
Authors: Doğan Serhat , Keskin Kerim , Sağlam Çağrı
Published: February 2020

We consider a network of heterogeneous agents where each edge represents a two‐player contest between the respective nodes. In these bilateral contests, agents compete over an endogenous prize jointly produced using their own contest efforts. We provide a necessary and sufficient condition for the existence of Nash equilibrium and characterize the equilibrium total effort for every agent. Our model has insightful results regarding the network type, that is, depending on whether the network is bipartite or nonbipartite. Finally, considering the sum of all expected utilities as an efficiency notion, we investigate the optimal network structure.
Is sharing really caring? Viewpoints on shared decision‐making in paediatrics
Authors: Jordan Zachary , Tremblay Claire , Lipstein Ellen , Jordan Isabel , Boland Laura
Published: February 2020

Shared decision‐making (SDM), the cornerstone of family‐centred care and the gold standard in health decision‐making, occurs when the patient, family members and the health‐care team members partner to make health decisions about the child. This partnership involves an exchange of medical information and information about patient/family preferences and values. Together, the health‐care team, parent and patient deliberate to determine the best course of action for the child. Despite high‐quality evidence supporting its positive impact on outcomes, SDM has not been widely adopted in paediatric clinical practice. Greater understanding of the impact of SDM on all members of the decision triad (parent, patient and health‐care provider) may increase the likelihood of SDM adoption. Therefore, we present the viewpoints of a paediatric patient, parent and paediatrician about the use of SDM. A youth living with a rare chronic disease discusses the impacts of being involved and excluded from health decisions. A mother of a son living with a rare nephrotic condition discusses working with a health‐care team who are committed and skilled in SDM and the positive impacts SDM has had for her son's care. A general paediatrician with research expertise in SDM discusses the individual and system level challenges and rewards of using SDM in her clinical practice. Based on the viewpoints presented, we offer pragmatic recommendations for using SDM in paediatric clinical practice.
Associations of objectively measured sleep characteristics and incident hypertension among police officers: The role of obesity
Authors: Ma Claudia C. , Gu Ja Kook , Bhandari Ruchi , Charles Luenda E. , Violanti John M. , Fekedulegn Desta , Andrew Michael E.
Published: February 2020

This study investigated the associations of baseline sleep onset latency, wake after sleep onset, longest wake episode, number of awakenings, sleep efficiency and sleep duration with incident hypertension during a 7‐year follow‐up (n = 161, 68% men) and the joint effect of insufficient sleep and obesity on incident hypertension. Sleep parameters were derived from 15‐day actigraphy data. Relative risks and 95% confidence intervals were estimated using a robust Poisson regression model. Each 10‐min increase in sleep onset latency was associated with an 89% higher risk of hypertension (95% confidence interval [CI] = 1.12–3.20). Each 10‐min increase in longest wake episode was associated with a 23% higher risk of hypertension (95% CI = 1.01–1.50) and each 10% decrease in sleep efficiency was associated with a 50% higher risk of hypertension (95% CI = 1.02–2.22). These associations were independent of demographic and lifestyle characteristics, depressive symptoms, shift work, sleep duration and body mass index. Having <6 hr of sleep and a body mass index ≥30 kg/m2 increased the risk of hypertension (relative risk = 2.81; 95% CI = 1.26–6.25) compared with having ≥6 hr of sleep and a body mass index <30 after controlling for confounders. Relative excess risk due to interaction was 3.49 (95% CI = −1.69–8.68) and ratio of relative risk was 3.21 (95% CI = 0.72–14.26). These results suggest that poor sleep quality is a risk factor for hypertension. Longitudinal studies with larger sample sizes are warranted to examine the joint effect of insufficient sleep and obesity on development of hypertension.
The Impact of Partisan Gerrymandering on Political Parties
Authors: Stephanopoulos Nicholas O. , Warshaw Christopher
Published: February 2020

The relationship between votes and seats in the legislature lies at the heart of democratic governance. However, there has been little previous work on the downstream effects of partisan gerrymandering on the health of political parties. In this study, we conduct a comprehensive examination of the impact of partisan advantage in the districting process on an array of downstream outcomes. We find that districting bias impedes numerous party functions at both the congressional and state house levels. Candidates are less likely to contest districts when their party is disadvantaged by a districting plan. Candidates that do choose to run are more likely to have weak resumes. Donors are less willing to contribute money. And ordinary voters are less apt to support the targeted party. These results suggest that gerrymandering has long‐term effects on the health of the democratic process beyond simply costing or gaining parties seats in the legislature.
Environmental catastrophes, climate change, and attribution
Authors: Lloyd Elisabeth A. , Shepherd Theodore G.
Published: February 2020

In our discussion of environmental and ecological catastrophes or disasters resulting from extreme weather events, we unite disparate literatures, the biological and the physical. Our goal is to tie together biological understandings of extreme environmental events with physical understandings of extreme weather events into joint causal accounts. This requires fine‐grained descriptions, in both space and time, of the ecological, evolutionary, and biological moving parts of a system together with fine‐grained descriptions, also in both space and time, of the extreme weather events. We find that both the “storyline” approach to extreme event attribution and the probabilistic “risk‐based” approach have uses in such descriptions. However, the storyline approach is more readily aligned with the forensic approach to evidence that is prevalent in the ecological literature, which cultivates expert‐based rules of thumb, that is, heuristics, and detailed methods for analyzing causes and mechanisms. We introduce below a number of preliminary examples of such studies as instances of what could be pursued in the future in much more detail.
Skin and nails abnormalities in a patient with ZTTK syndrome and a de novo mutation in SON
Authors: Quintana Castanedo Lucía , Sánchez Orta Alba , Maseda Pedrero Rocío , Santos Simarro Fernando , Palomares Bralo María , Feito Rodríguez Marta , de Lucas Laguna Raúl
Published: February 2020

Zhu‐Tokita‐Takenouchi‐Kim (ZTTK) syndrome is a rare, severe, and recently described multisystem developmental disorder characterized by delayed psychomotor development and intellectual disability, characteristic facial features, hypotonia, poor overall growth, and visual abnormalities. Mucocutaneous manifestations have not been reported so far among individuals with ZTTK syndrome. Herein, we present a patient with ZTTK syndrome due to a de novo mutation in SON gene, who has dental abnormalities and retronychia of the toenails. We suggest that mucocutaneous features may be a part of the phenotype.
Using the Multiple Streams Framework to Connect Policy Adoption to Implementation
Authors: Fowler Luke
Published: February 2020

The author furthers research on the multiple streams framework (MSF) by testing hypotheses related to the conditional nature of politics, policy, and problems streams in affecting policy outputs from both policymaking and policy implementation. The author articulates a theoretical model of the policy process where policymaking and policy implementation are separate, but interdependent processes, and generates three hypotheses related to policymaking, policy implementation, and the interdependence of those processes. Then, the author tests hypotheses with state‐level implementation of federal environmental policy over a 20 year period. Using seemingly unrelated regression (SUR), the author makes joint estimations of policymaking and policy implementation as separate, correlated processes. Findings indicate how politics affects policymaking and policy implementation is conditional on existing policies and problems, and that these two processes are not independent from each other. Conclusions connect this MSF to the broader literature and how it may address current criticisms.
Driving processes and recognition criteria for complex subaerial unconformities in a non‐marine succession: Implications for basin margin shaping during forced regressions
Authors: Olivo Mariana S. , Schwarz Ernesto , Veiga Gonzalo D.
Published: February 2020

A regional sedimentological and sequence stratigraphic analysis is presented in this paper to provide new insights into the morphological complexity and sedimentary mechanisms of unconformities giving shape to basin margins. Although the development of unconformities entails significant sediment delivery to be considered when analysing ‘source to sink’ systems, as well as large palaeogeographical changes related to basin reconfiguration episodes, the complexity that unconformities can reveal towards basin margins has been scarcely explored. A sedimentological and architectural analysis combining outcrop and subsurface datasets shows five palaeoenvironmental evolutionary stages and four key stratigraphic surfaces in a constrainedca2 Ma Valanginian interval on the southern margin of the Neuquén back‐arc basin (Argentina). A complex‐type subaerial unconformity was identified, composed in turn of two subaerial unconformities exhibiting both single and composite motifs, different morphologies and facies shifts representative of large palaeogeographical changes. In the studied stratigraphic interval, two erosional stages occur linked to combinations of exclusively non‐marine‐driven processes involved in unconformities developing. The two subaerial unconformities differ in nature and distribution, representing a novel case of complex unconformities and stratigraphic architectures in non‐marine lowstand wedges. The Valanginian complex subaerial unconformity entails a high diachroneity along strike and depositional dip, implying that the hiatus created in landward settings occurred during relative sea‐level fall and rise stages during a period longer than in basinward areas. Disagreeing with classical sequential models, two third‐order sequence components of a complex lowstand wedge are preserved in proximal settings. Subsidence‐controlled accommodation and interplay between second‐order and third‐order cycles were combined, increasing the prospects of sediment storage and preservation potential of composite sequences towards landward areas. This work improves current comprehension about complex subaerial unconformities formation and related lowstand architectures in proximal settings, providing criteria to understand and revaluate lowstand wedge geometries, particularly for more complex examples, such as the case reported in this contribution.
Reexamine regional models of China's economic growth: Toward an integrated analytical framework
Authors: Zhang Changdong
Published: February 2020

Based on a selective review of studies of regional development models in China, this article develops an integrated analytical framework, which includes two dimensions. First, a static dimension that integrates national institutions with regional specific structural and informal institutional factors, specifically historical legacies, how they interact with each other to shape local actors' incentives, constraints and strategies of survival, therefore explain different regional models. Second, it includes a dynamic dimension that explores the historical evolution of regional models, with a focus on the coevolution or mutual transformation of different institutions with feedback effects.
Overcoming Ungrievability: Transgender Expectations for Identity after Death
Authors: Whitestone Stephenson Brooks , Giles Howard , Linz Daniel
Published: February 2020

Butler (Precarious Life: The Powers of Mourning and Violence. London, UK: Versa; 2004) observed cultural shifts immediately after 9/11 and suggested that, with regard to grievable and ungrievable lives, societal power structures “produce and maintain certain exclusionary conceptions of who is normatively human” (p. xiv–xv). The current study brings new understanding to the concept of grievability by exploring the symbolically violent de‐transitioning of trans people after their deaths. The aim of this exploratory study was to examine the thoughts and attitudes of older trans people (40 y. o. plus) with regard to the phenomenon of nonconsensual de‐transitioning after death and the expectations they have regarding the expression of their own identity after death. The wishes of the participants were grouped into four outcome categories: hoping to be memorialized only as their lived identity (25%); only as their identity‐assigned‐at‐birth (6%); as both identities combined (44%); and those who claimed that they did not care how their identity was memorialized (25%). Our findings serve to emphasize the importance of open and honest end‐of‐life communication as well as to underscore the diverse nature of the transgender population and the complexity of the transgender identity.
Analyses of Gas Stratification Erosion by a Vertical Jet in Presence of an Obstacle Using the GOTHIC Code
Authors: Andreani Michele , Kapulla Ralf , Kelm Stephan , Paladino Domenico , Paranjape Sidharth
Published: February 2020

The GOTHIC code was validated using three experiments carried out in the PANDA facility in the framework of the OECD/NEA HYMERES project. These tests addressed the mixing of an initially stratified atmosphere by means of a vertical jet in the presence of on obstacle (circular plate). This paper reports on the simulations of three experiments, and complementary, quasi-steady-state tests without stratification, where the flow structure above the impingement plate could be observed by means of particle image velocimetry (PIV) velocity measurements in a region larger than that considered in the transient experiments. Moreover, simulations of similar tests without obstacle conducted during the OECD/SETH-2 project are also discussed. The reference, best-estimate model used for the analyses of the three experiments with different flowrates and initial and pressure boundary conditions was built on the base of a multistep approach. This was based on mesh and modeling sensitivity studies mostly performed for the complementary tests, to assess the capability to represent the flow structure produced by the jet–plate interaction with different meshes around the plate. Generally, the results show that the use of a coarse mesh and the standard k–ε turbulence model permits a reasonable representation of the erosion process, but with a systematic over prediction of the mixing time. The results with the reference model were more accurate for two experiments with two flowrates and same initial conditions and all complementary tests. For the third test with different initial and boundary conditions, however, poor results were obtained with the reference model, which could only be improved by further refining the mesh. These results indicate that a model “qualified” for certain conditions could be inadequate for other cases, and sensitivity studies are necessary for the specific conditions considered in the analyses.
Geometric perspective on quantum parameter estimation
Authors: Sidhu Jasminder S. , Kok Pieter
Published: February 2020

Quantum metrology holds the promise of an early practical application of quantum technologies, in which measurements of physical quantities can be made with much greater precision than what is achievable with classical technologies. In this Review, the authors collect some of the key theoretical results in quantum parameter estimation by presenting the theory for the quantum estimation of a single parameter, multiple parameters, and optical estimation using Gaussian states. The authors give an overview of results in areas of current research interest, such as Bayesian quantum estimation, noisy quantum metrology, and distributed quantum sensing. The authors address the question of how minimum measurement errors can be achieved using entanglement as well as more general quantum states. This review is presented from a geometric perspective. This has the advantage that it unifies a wide variety of estimation procedures and strategies, thus providing a more intuitive big picture of quantum parameter estimation.
Improvement of characteristics of flexible Al-doped ZnO/Ag/Al-doped ZnO transparent conductive film using silver
Authors: Manzen Issei , Yoshimura Yukio , Matsubara Kazuki , Nitta Atsushi
Published: February 2020

In recent years, transparent conductive oxide (TCO) films that can be applied to flexible devices have attracted considerable attention. Among TCOs, indium tin oxide (ITO) is frequently used, but ITO contains the rare metal In and is inflexible. Therefore, the authors focused on an Al-doped ZnO (AZO) transparent conductive film as an alternative material for ITO. The authors prepared films on polyethylene naphthalate (PEN) substrates to prepare flexible electrodes. PEN substrates are sensitive to heat and must be deposited at low temperatures. However, there is a limit to improving the conductivity of AZO film formation at low temperatures. Therefore, the authors focused on the AZO/Ag/AZO multilayer transparent conductive films. The AZO layer was deposited by RF magnetron sputtering, and the Ag layer was deposited by electron beam evaporation. The electrical and optical characteristics were evaluated by changing the deposition conditions during the AZO and Ag deposition. Thus, when the thickness of the Ag layer was changed, the maximum transmittance was obtained at a thickness of 10 nm. Next, the upper AZO film was divided into room temperature/50 °C. When the upper AZO is formed at 50 °C, the already deposited Ag is affected by thermal oxidation. Ag was protected from thermal oxidation by first depositing the upper AZO at room temperature and then applying 50 °C, resulting in improved transmittance and resistivity. Furthermore, the resistivity and transmittance were improved by increasing the deposition rate of the Ag layer due to a decrease in the oxygen content in the Ag layer. Among the formed thin films, the best obtained characteristics were the resistivity of 1.24 × 10−4 Ω cm and the transmittance of 84.8%.
Elastic softening of sandstone due to a wideband acoustic pulse
Authors: Muir Thomas G. , Cormack John M. , Slack Charles M. , Hamilton Mark F.
Published: February 2020

Elastic wave propagation experiments were performed on a thin bar sample composed of Texas “moss” sandstone in order to study nonlinear elastic effects in the time domain. The present experiments utilized a pendulous hammer to produce axially propagating transient signals with strain amplitude between 15 and 130 microstrain in the mid-audio band. Particle velocity along the bar axis was measured with a laser Doppler vibrometer, focused at various locations along the bar. Nonequilibrium dynamics and nonlinear elasticity effects were observed on the propagating pulse as it reflected between the ends of the bar. The same effects were also observed at a single location along the mid-length of the bar using a continuous-wave 1 MHz probe signal, propagating transverse to the bar axis. The results demonstrate larger strain amplitudes and greater reduction in the Young's modulus than in previously reported measurements that employed narrowband excitation. Nonlinear attenuation of the axial pulse is also observed, which increases with excitation amplitude. The present results indicate significant conditioning of the sandstone, particularly “softening” of the Young's modulus of up to 20%, primarily during the tensile phase of propagation, with a “slow dynamic” memory that is similar to that reported in previous investigations.
Broadband low frequency sound absorption using a monostable acoustic metamaterial
Authors: Li Xianhui , Xing Tuo , Zhao Junjuan , Gai Xiaoling
Published: February 2020

This Letter presents a monostable acoustic metamaterial that has the potential to implement broadband sound absorption in low frequencies. The proposed metamaterial is realized by placing a flexible panel with a magnetic proof mass in a symmetric magnetic field. A theoretical model of the metamaterial is established and experimentally validated. Predictions and measurements demonstrate that the sound absorption peak frequency significantly shifts downwards with the increasing magnetic field. The relative bandwidth of the metamaterial is also broadened with the increasing magnetic field due to its inverse proportionality to the absorption peak frequency.
Scope and Predictive Genetic/Phenotypic Signatures of Bicarbonate (NaHCO
3
) Responsiveness and β-Lactam Sensitization in Methicillin-Resistant Staphylococcus aureus
Authors: Ersoy Selvi C. , Otmishi Mariam , Milan Vanessa T. , Li Liang , Pak Youngju , Mediavilla Jose , Chen Liang , Kreiswirth Barry , Chambers Henry F. , Proctor Richard A. , Xiong Yan Q. , Fowler Vance G. , Bayer Arnold S.
Published: February 2020

Addition of sodium bicarbonate (NaHCO
3
) to standard antimicrobial susceptibility testing medium reveals certain methicillin-resistant
Staphylococcus aureus
(MRSA) strains to be highly susceptible to β-lactams. We investigated the prevalence of this phenotype (NaHCO
3
responsiveness) to two β-lactams among 58 clinical MRSA bloodstream isolates. Of note, ∼75% and ∼36% of isolates displayed the NaHCO
3
responsiveness phenotype to cefazolin (CFZ) and oxacillin (OXA), respectively.
An unusually impressive atorvastatin-induced elevation of serum alkaline phosphatase
Authors: Chapman George , Tanner Stephanie
Published: February 2020

A 90-year-old woman is referred six months after a transient ischaemic attack (TIA) with asymptomatic cholestatic liver function test (LFT) derangement. Following the TIA, atorvastatin and clopidogrel therapy are initiated. This is added to pre-existent once daily nifedipine for hypertension. Nifedipine (a weak inhibitor of CYP3A4 and competing substrate) and clopidogrel (a competitive inhibitor of CYP3A4) may have affected the metabolism of atorvastatin, resulting in the elevation of serum alkaline phosphatase levels to over six times the upper limit of normal. More often, statin therapy elevates serum alanine aminotransferase levels. Drug-induced liver injury (DILI) was deemed ‘probable’ as judged by the Roussel Uclaf Causality Assessment Method score. Statin therapy remains overwhelmingly safe, with benefits outweighing risks in the vast majority. The UK recommended LFT monitoring regime facilitates early recognition of DILI. Case reports are examined where similar drug combinations resulted in severe morbidity and mortality.
Curious case of submandibular swelling
Authors: Sivadas Naveen , Ramachandran Riju , Pillai Anoop V , Krishnakumar Sivasankar
Published: February 2020

A 35-year-old woman presented with a progressively increasing swelling over the left side of the upper part of the neck for the past 8 months with no associated pain over the swelling. On examination, a non-tender, firm, well-defined, oval swelling of size 3×2 cm was palpable in the left submandibular region that was mobile, non-pulsatile and free from the overlying skin and the underlying muscle. Ultrasonography revealed a bilobed heteroechoic lesion in the left submandibular region with internal vascularity and multiple macrocalcification within it. During the procedure for surgically excising the swelling, we found that it was separate from the gland and vascular structures, had a sinus tracking over and around the left submandibular gland extending beyond the angle of mandible up to the root of a decayed left lower second molar tooth.
Concurrent Guillain-Barré syndrome and myositis complicating dengue fever
Authors: Gulia Manisha , Dalal Preeti , Gupta Monica , Kaur Daljinderjit
Published: February 2020

Dengue is an arboviral infection that classically presents with fever, headache, joint pain, skin flush and morbilliform rashes. Neurological manifestations are well recognised but their exact incidence is unknown. Though myalgias are common in dengue virus infection, myositis and/or elevated serum creatine kinase is an uncommon complication. Guillain-Barré syndrome is another rare neurological manifestation associated with dengue fever. Here, we report the case of a 21-year-old man with serologically confirmed dengue fever presenting with severe myalgia, bilateral lower and upper limb weakness with raised creatine kinase, MRI suggestive of myositis and myonecrosis and nerve conduction velocity showing bilateral lower limb and axillary sensory motor neuropathy. He was managed conservatively and made an uneventful recovery.
Primary cutaneous mucormycosis of the abdomen at the site of repeated insulin injections
Authors: Perz Allison , Makar Gabriel , Fernandez Edward , Weinstock Joshua , Rafferty William
Published: February 2020

A 71-year-old woman with metastatic squamous cell carcinoma of the lung and insulin-dependent type 2 diabetes mellitus presented with a necrotic lesion on her lower abdomen. Further history revealed that this was the site of repeat insulin injections with reuse of the same needles. On investigation, biopsy of the site was positive for broad, aseptate, right-angle branching fungal hyphae consistent with mucormycosis. Studies have shown that insulin needle reuse is a common practice among diabetics for several reasons, including cost and convenience. While the current American Diabetes Association guidelines suggest that this is an acceptable practice among the general population of diabetics, they advise against it in patients who are actively ill or immunocompromised. Discussion about insulin needle reuse should be of utmost importance among providers and their diabetic patients, especially for patients who are immunocompromised.
Spontaneous regression of hepatocellular carcinoma: myth or reality?
Authors: Costa-Santos Maria Pia , Gonçalves Afonso , Ferreira Alexandre Oliveira , Nunes Joana
Published: February 2020

We present a case of a 68-year-old man with chronic hepatitis C infection, with no evidence of chronic liver disease during the first years of follow-up, diagnosed with a hepatocellular carcinoma (HCC) with 40 mm (α-fetoprotein (AFP) 205 ng/mL). He underwent segmental liver resection and pathology analysis was consistent with HCC and cirrhosis in the adjacent liver. Four months after surgery, AFP raised up to 126 661 ng/mL and abdominal MRI revealed a multinodular HCC. Patient rejected treatment with sorafenib and started megestrol and an herbal medicine, soursop (Annona muricata). Six months later, AFP markedly decreased (28 ng/mL) and abdominal MRI showed decreasing size and number of lesions. At 5 years of follow-up, he has no evidence of HCC. Spontaneous regression of HCC is a rare condition and the underlying mechanism is unclear. In this case there is a temporal relation between the start of megestrol andAnnona muricataand HCC regression.
Case of primary hepatic leiomyosarcoma successfully treated with laparoscopic right hepatectomy
Authors: Vella Stephanie , Cortis Kelvin , Pisani David , Pocock James , Aldrighetti Luca
Published: February 2020

We describe the case of a 77-year-old woman, presenting with non-specific epigastric pain. Physical examination and subsequent imaging revealed the presence of a large mass in the right liver lobe. This was shown to be a leiomyosarcoma on biopsy histology. Further investigation confirmed this to be a primary hepatic leiomyosarcoma with no evidence of metastases. The patient underwent successful surgical resection. She is currently under imaging follow-up, with no evidence of disease recurrence.
Short term association between ozone and mortality: global two stage time series study in 406 locations in 20 countries
Authors: Vicedo-Cabrera Ana M , Sera Francesco , Liu Cong , Armstrong Ben , Milojevic Ai , Guo Yuming , Tong Shilu , Lavigne Eric , Kyselý Jan , Urban Aleš , Orru Hans , Indermitte Ene , Pascal Mathilde , Huber Veronika , Schneider Alexandra , Katsouyanni Klea , Samoli Evangelia , Stafoggia Massimo , Scortichini Matteo , Hashizume Masahiro , Honda Yasushi , Ng Chris Fook Sheng , Hurtado-Diaz Magali , Cruz Julio , Silva Susana , Madureira Joana , Scovronick Noah , Garland Rebecca M. , Kim Ho , Tobias Aurelio , Íñiguez Carmen , Forsberg Bertil , Åström Christofer , Ragettli Martina S , Röösli Martin , Guo Yue-Liang Leon , Chen Bing-Yu , Zanobetti Antonella , Schwartz Joel , Bell Michelle L , Kan Haidong , Gasparrini Antonio
Published: February 2020

Objective

To assess short term mortality risks and excess mortality associated with exposure to ozone in several cities worldwide.

Design

Two stage time series analysis.

Setting

406 cities in 20 countries, with overlapping periods between 1985 and 2015, collected from the database of Multi-City Multi-Country Collaborative Research Network.

Population

Deaths for all causes or for external causes only registered in each city within the study period
.

Main outcome measures

Daily total mortality (all or non-external causes only).

Results

A total of 45 165 171 deaths were analysed in the 406 cities. On average, a 10 µg/m
3
increase in ozone during the current and previous day was associated with an overall relative risk of mortality of 1.0018 (95% confidence interval 1.0012 to 1.0024). Some heterogeneity was found across countries, with estimates ranging from greater than 1.0020 in the United Kingdom, South Africa, Estonia, and Canada to less than 1.0008 in Mexico and Spain. Short term excess mortality in association with exposure to ozone higher than maximum background levels (70 µg/m
3
) was 0.26% (95% confidence interval 0.24% to 0.28%), corresponding to 8203 annual excess deaths (95% confidence interval 3525 to 12 840) across the 406 cities studied. The excess remained at 0.20% (0.18% to 0.22%) when restricting to days above the WHO guideline (100 µg/m
3
), corresponding to 6262 annual excess deaths (1413 to 11 065). Above more lenient thresholds for air quality standards in Europe, America, and China, excess mortality was 0.14%, 0.09%, and 0.05%, respectively.

Conclusions

Results suggest that ozone related mortality could be potentially reduced under stricter air quality standards. These findings have relevance for the implementation of efficient clean air interventions and mitigation strategies designed within national and international climate policies.
TULIP: a randomised controlled trial of surgical versus non-surgical treatment of lateral compression injuries of the pelvis with complete sacral fractures (LC1) in the non-fragility fracture patient—a feasibility study protocol
Authors: Barnfield Steven , Ingram Jenny , Halliday Ruth , Griffin Xavier , Greenwood Rosemary , Kandiyali Rebecca , Thompson Julian , Glynn Joel , Beasant Lucy , McArthur John , Bates Peter , Acharya Mehool
Published: February 2020

Introduction

Lateral compression type 1 (LC1) pelvic fractures are the most common type of pelvic fracture. The majority of LC1 fractures are considered stable. Fractures where a complete sacral fracture is present increases the degree of potential instability and have the potential to displace over time. Non-operative management of these unstable fractures may involve restricted weight bearing and significant rehabilitation. Frequent monitoring with X-rays is also necessary for displacement of the fracture. Operative stabilisation of these fractures may be appropriate to prevent displacement of the fracture. This may allow patients to mobilise pain-free, quicker.

Methods and analysis

The study is a feasibility study to inform the design of a full definitive randomised controlled trial to guide the most appropriate management of these injuries. Participants will be recruited from major trauma centres and randomly allocated to either operative or non-operative management of their injuries. A variety of outcome instruments, measuring health-related quality of life, functional outcome and pain, will be completed at several time points up to 12 months post injury. Qualitative interviews will be undertaken with participants to explore their views of the treatments under investigation and trial processes.

Eligibility and recruitment to the study will be analysed to inform the feasibility of a definitive trial. Completion rates of the measurement instruments will be assessed, as well as their sensitivity to change and the presence of floor or ceiling effects in this population, to inform the choice of the primary outcome for a definitive trial.

Ethics and dissemination

Ethical approval for the study was given by the South West—Central Bristol NHS Research Ethics Committee on 2nd July 2018 (Ref; 18/SW/0135). The study will be reported in relevant specialist journals and through presentation at specialist conferences.

Trial registration number

ISRCTN10649958
Validity and characteristics of patient-evaluated adherence to medication via smartphones in patients with bipolar disorder: exploratory reanalyses on pooled data from the MONARCA I and II trials
Authors: Faurholt-Jepsen Maria , Frost Mads , Christensen Ellen Margrethe , Bardram Jakob Eyvind , Vinberg Maj , Kessing Lars Vedel
Published: February 2020

Background

Non-adherence to medication is associated with increased risk of relapse in patients with bipolar disorder (BD).

Objectives

To (1) validate patient-evaluated adherence to medication measured via smartphones against validated adherence questionnaire; and (2) investigate characteristics for adherence to medication measured via smartphones.

Methods

Patients with BD (n=117) evaluated adherence to medication daily for 6–9 months via smartphones. The Medication Adherence Rating Scale (MARS) and the Rogers’ Empowerment questionnaires were filled out. The 17-item Hamilton Depression Rating Scale, the Young Mania Rating Scale and the Functional Assessment Short Test were clinically rated. Data were collected multiple times per patient. The present study represents exploratory pooled reanalyses of data collected as part of two randomised controlled trials.

Findings

During the study 90.50% of the days were evaluated as ‘medication taken’, 6.91% as ‘medication taken with changes’ and 2.59% as ‘medication not taken’. Adherence to medication measured via smartphones was valid compared with the MARS (B: −0.049, 95% CI −0.095 to −0.003, p=0.033). Younger age and longer illness duration were significant predictors for non-adherence to medication (model concerning age: B: 0.0039, 95% CI 0.00019 to 0.0076, p=0.040). Decreased affective symptoms measured with smartphone-based patient-reported mood and clinical ratings as well as decreased empowerment were associated with non-adherence.

Conclusions

Smartphone-based monitoring of adherence to medication was valid compared with validated adherence questionnaire. Younger age and longer illness duration were predictors for non-adherence. Increased empowerment was associated with adherence.

Clinical implications

Using smartphones for empowerment of adherence using patient-reported measures may be helpful in everyday clinical settings.

Trial registration number

NCT01446406andNCT02221336.
Mental health disorders research in Europe, 2001–2018
Authors: Begum Mursheda , Lewison Grant , Wölbert Eva , Berg Brigham Karen , Darlington Meryl , Durand-Zaleski Isabelle , Sullivan Richard
Published: February 2020

Background

The burden of mental health disorders in Europe is well above the world average and has increased from 11.5% to 13.9% of the total disease burden in 2000 and 2015. That from dementia has increased rapidly, and overtaken that from depression as the leading component. There have been no analyses of the research activity in Europe to combat this burden.

Methodology

We identified research papers in the Web of Science (WoS) with a complex mental health disorders filter based on title words and journal names in the years 2001-18, and downloaded their details for analysis.

Results

European mental health disorders research represented less than 6% of the total biomedical research. We estimate that research expenditure in Europe on mental health disorders amounted to about €5.4 billion in 2018. The Scandinavian countries, with Croatia and Estonia, published the most relative to their wealth, but the outputs of France and Romania were less than half the amounts expected.

Discussion and conclusions

The burden from mental health disorders is increasing rapidly in Europe, but research was only half what would have been proportional. Suicide & self-harm, and alcohol misuse, were also neglected by researchers, particularly since the latter also causes many physical burdens, such as foetal alcohol syndrome, interpersonal violence, and road traffic accidents. Other relatively neglected subjects are sexual disorders, obsessive compulsive disorder, post-traumatic stress disorder, attention-deficit hyperactivity and sleep disorders. There is an increasing volume of research on alternative (non-drug) therapies, particularly for post-traumatic stress and eating disorders, notably in Germany.
Price smoking participation elasticity in Colombia: estimates by age and socioeconomic level
Authors: Gallego Juan Miguel , Otálvaro-Ramírez Susana , Rodriguez-Lesmes Paul Andres
Published: February 2020

Background

Tobacco prevalence in Colombia is small compared with other Latin America despite the nation’s tobacco taxes being among the lowest in the region. However, tobacco taxes have increased several times during the last decade, and large increases in 2010 and 2016 impacted consumer prices.

Objective

This paper aims to estimate the price smoking participation elasticity (PPE) in Colombia, with specific reference to regional increases in consumer prices after 2010 tax policy changes.

Methods

The PPE is computed using logistic regression based on individual-level data from the National Psychoactive Substances Consumption Survey for 2008 and 2013. Our specific focus is state-level variation in Colombian cigarette prices between 2008 and 2013 induced by the tax hike in 2010.

Results

The estimated PPE in Colombia is around −0.66 (p value=0.046). We find almost no differences across socioeconomic level, but price sensitivity was greater for women than men, and for relatively older individuals (ages 51–64).

Conclusions

PPE for Colombia is above estimates for comparable middle-income countries such as Mexico. As a result, current estimates for health gains of tax policies are likely to be underestimated. Moreover, in contrast with the literature, we find that the PPE for the youth (≤25 years) is lower than older age groups, and there is no evidence of a prominent socio-economic status (SES) gradient.
Effectiveness of static and dynamic backcalculation approaches for asphalt pavement
Authors: Cao Dandan , Zhou Changjun , Zhao Yanqing , Fu Guozhi , Liu Wanqiu
Published: February 2020

In this study, the field falling weight deflectometer (FWD) data for asphalt pavement with various base types were backcalculated through dynamic and static backcalculation approaches, and the effectiveness of backcalculation approaches was studied. Asphalt concrete (AC) was treated as a viscoelastic material and the complex modulus was obtained using the dynamic approach. The dynamic modulus at a fixed frequency was computed for comparison purposes. The coefficient of variance and the compensating layer effect were assumed as two characteristics for the effectiveness of backcalculation approaches. The results show that the layer property from the dynamic backcalculation approach for different stations were more consistent and showed smaller coefficient of variance, which were more appropriate for the characterization pavement behavior. The elastic moduli from the static approach were more variable and exhibited a compensating layer effect in which a portion of the modulus of one layer was backcalculated into other layers. The dynamic approach is more effective than static approaches in backcalculation of layer properties.
Phase space analysis and singularity classification for linearly interacting dark energy models
Authors: Aljaf Muhsin , Gregoris Daniele , Khurshudyan Martiros
Published: February 2020

In this paper, applying the Hartman–Grobman theorem we carry out a qualitative late-time analysis of some unified dark energy-matter Friedmann cosmological models, where the two interact through linear energy exchanges, and the dark energy fluid obeys to the dynamical equation of state of Redlich–Kwong, Modified Berthelot, and Dieterici respectively. The identification of appropriate late-time attractors allows to restrict the range of validity of the free parameters of the models under investigation. In particular, we prove that the late-time attractors which support a negative deceleration parameter correspond to a de Sitter universe. We show that the strength of deviation from an ideal fluid for the dark energy does not influence the stability of the late-time attractors, as well as the values of all the cosmological parameters at equilibrium, but for the Hubble function (which represents the age of the universe). Our analysis also shows that a singularity in the effective equation of state parameter for the dark energy fluid is not possible within this class of models.
Wilsonian renormalization group in the functional non-perturbative approach
Authors: Vacca Gian Paolo
Published: February 2020

We consider a functional relation between a given Wilsonian renormalization group (RG) flow, which has to be related to a specific coarse-graining procedure, and an infinite family of (UV cutoff) scale-dependent field redefinitions. Within this framework, one can define a family of Wilsonian proper-time (PT) exact RG equations associated to an arbitrary regulator function. New applications of these RG flow schemes to the Ising Universality class in three dimensions in the derivative expansion are shortly illustrated.
A Baker–Campbell–Hausdorff formula for the logarithm of permutations
Authors: Elze Hans-Thomas
Published: February 2020

The dynamics-from-permutations of classical Ising spins are studied for a chain of four spins. We obtain the Hamiltonian operator which is equivalent to the unitary permutation matrix that encodes assumed pairwise exchange interactions. It is shown how this can be summarized by an exact terminating Baker–Campbell–Hausdorff formula, which relates the Hamiltonian to a product of exponentiated two-spin exchange permutations. We briefly comment upon physical motivation and implications of this study.