bluuebunny/crossref_metadata_2025 huggingface dataset:
Lower risk of invasive meningococcal disease during pregnancy: national prospective surveillance in England, 2011–2014
Authors: Parikh SR , Borrow R , Ramsay ME , Ladhani SN
Published: April 2019

Objective

To describe cases of invasive meningococcal disease (IMD) in women of childbearing age and to estimate the disease incidence and relative risk of IMD in pregnant compared with non‐pregnant women.

Design

Prospective enhanced national surveillance for IMD.

Setting

England.

Population

Women of reproductive age (15–44 years) with laboratory‐confirmed IMD.

Methods

Public Health England conducts enhanced national surveillance for IMD in England. Laboratory‐confirmed cases are followed up with postal questionnaires to general practitioners. All cases confirmed in women of reproductive age from 1 January 2011 to 31 December 2014 were included.

Main outcome measures

Annual IMD incidence and relative risk of IMD in pregnant compared with non‐pregnant women of reproductive age.

Results

During the 4‐year surveillance period, there were 1502 cases of IMD in females across England; of these, 310 (20.6%) cases were in women of reproductive age, including four women who were pregnant at the time of IMD confirmation (1.3%). Serogroup distribution of IMD cases in women of childbearing age was similar to the overall distribution. The four cases in otherwise healthy pregnant women were confirmed across all trimesters and all survived; one case in the first trimester had a septic miscarriage. The incidence of IMD was lower in pregnant than in non‐pregnant women (0.16 compared with 0.76 per 100 000 pregnant and non‐pregnant years, respectively), giving a lower risk of IMD in pregnant women (incidence rate ratio, IRR, 0.21; 95% confidence interval, 0.06–0.54).

Conclusions

Pregnant women are nearly five times less likely to develop IMD compared with non‐pregnant women, but the infection can be severe.

Tweetable abstract

The risk of meningococcal disease is lower in pregnant women compared with non‐pregnant women; the infection can occur across all trimesters and can be severe.
Nutraceutical Potential of Seaweed Polysaccharides: Structure, Bioactivity, Safety, and Toxicity
Authors: Tanna Bhakti , Mishra Avinash
Published: April 2019

In recent years, marine organisms including seaweeds have been highlighted as potential sources of useful metabolites and bioactive compounds, with vast biological and physiological activities. Seaweeds have long been used as a food source, for medicinal purposes, and as dietary supplements in various Asian countries, and their potential benefits have recently attracted the attention of many Western and European countries. Their commercial value depends on their applications in the food, nutraceutical, and pharmaceutical industries. Seaweeds are considered a potential source of nutraceuticals or functional foods, and analysis of taste‐oriented motives has revealed that seaweeds are preferentially selected over other types of marine foods by seafood consumers and people with high levels of health, education, and living status. It is a general perception that health conscious people prefer environmentally friendly food sources, and present an opportunity to focus on seaweed‐based foods, which have significant nutritional benefits to humans. Among the various bioactive constituents, seaweed polysaccharides have been proven to possess various beneficial properties including anticoagulant, anti‐inflammatory, antioxidant, anticarcinogenic, and antiviral activities. The diversity and composition of seaweed polysaccharides play vital roles in these biological activities. Seaweeds are a rich source of sulfated polysaccharides, which are responsible for much of the bioactivity, as they can interact with various textures and cellular proteins. A number of toxicological assays and clinical trials suggest that the ingestion of seaweeds as functional foods should be considered worldwide to improve immune responses. In this review, different polysaccharides from seaweeds and their compositions and potential nutraceutical applications are discussed.
A retrospective 4D‐MRI based on 2D diaphragm profiles for lung cancer patients
Authors: Lee Danny , Kim Siyong , Palta Jatinder , Lewis Benjamin , Keall Paul , Kim Taeho
Published: April 2019

Introduction

4D‐MRI, compared to 4D‐CT, provides better soft‐tissue contrast for target delineation. However, motion artefacts are often observed due to residual breathing variations. This study is to present a retrospective 4D‐MRI reconstruction method based on 2D diaphragm profiles to improve the quality of 4D‐MR images in the presence of significant breathing variations.

Methods

The proposed 4D‐MRI reconstruction method utilized diaphragm profiles (2D cine images on a single sagittal plan at the peak diaphragm) in conjunction with 4D‐MR scans (2D‐cine images on multiple pre‐determined coronal planes along the anterior‐posterior direction over a volume of interest). The diaphragm profile images were exploited to sort the 4D‐MR scans by matching respiratory amplitude of diaphragm on the 4D‐MR scans to the diaphragm profiles. To evaluate reconstructed 4D‐MR images (ten 3D‐MR images), sagittal images on ten 3D‐MR images under free breathing (FB) and respiratory guidance (GB) were compared with diaphragm profile images (reference) from 13 healthy volunteers.

Results

Forty‐four 4D‐MR scan datasets were successfully reconstructed without distinct respiratory‐related motion artefacts even with the presence of breathing variation. The differences in diaphragm profiles between the reference and corresponding reconstructed images in the mean of root mean square were similar between FB (3.5 mm) and GB (3.0 mm), confirming that the 4D‐MRI reconstruction method was effective even with significant breathing variation.

Conclusions

The diaphragm profiles were utilized to reconstruct 4D‐MR images with spatial reliability and a fixed scan time under FB and GB. Our method can provide reliable 4D information of thoracic and abdominal regions for MRI‐guided radiotherapy.
Sticking points: common‐agency problems and contracting in the US healthcare system
Authors: Frandsen Brigham , Powell Michael , Rebitzer James B.
Published: April 2019

We propose a “common‐agency” model for explaining inefficient contracting in the US healthcare system. Common‐agency problems arise when multiple payers seek to motivate a provider to invest in improved care coordination. We highlight the possibility of “sticking points,” that is, Pareto‐dominated equilibria in which payers coordinate around contracts which give weak incentives to the provider. Sticking points rationalize three hard‐to‐explain features of the US healthcare system: widespread fee‐for‐service arrangements; problematic care coordination; and the historical reliance on single‐specialty practices to deliver care. The model also analyzes the effects of policies promoting more efficient contracting between payers and providers.
The association between platelet dysfunction and adverse outcomes in cardiac surgical patients
Authors: Ho L. T. S. , Lenihan M. , McVey M. J. , Karkouti K. ,   the transfusion avoidance in cardiac surgery study investigators
Published: April 2019

Haemostatic activation during cardiopulmonary bypass is associated with prothrombotic complications. Although it is not possible to detect and quantify haemostatic activation directly, platelet dysfunction, as measured with point‐of‐care‐assays, may be a useful surrogate. In this study, we assessed the association between cardiopulmonary bypass‐associated platelet dysfunction and adverse outcomes in 3010 cardiac surgical patients. Platelet dysfunction, as measured near the end of the rewarming phase of cardiopulmonary bypass, was calculated as the proportion of non‐functional platelets after activation with collagen. Logistic regression and multivariable analyses were applied to assess the relationship between platelet dysfunction and a composite of in‐hospital death; myocardial infarction; stroke; deep vein thrombosis or pulmonary embolism; and acute kidney injury (greater than a two‐fold increase in creatinine). The outcome occurred in 251 (8%) of 3010 patients. The median (IQR [range]) percentage platelet dysfunction was less for those without the outcome as compared with those with the outcome; 14% (8–28% [1–99%]) vs. 19% (11–45% [2–98%]), p < 0.001. After risk adjustment, platelet dysfunction was independently associated with the composite outcome (p < 0.001), such that for each 1% increase in platelet dysfunction there was an approximately 1% increase in the composite outcome (OR 1.012; 95%CI 1.006–1.018). This exploratory study suggests that cardiopulmonary bypass‐associated platelet dysfunction has prognostic value and may be a useful clinical measure of haemostatic activation in cardiac surgery.
Children with dyskinetic cerebral palsy are severely affected as compared to bilateral spastic cerebral palsy
Authors: Préel Marie , Rackauskaite Gija , Larsen Mads L. , Laursen Bjarne , Lorentzen Jakob , Born Alfred Peter , Langhoff‐Roos Jens , Uldall Peter , Hoei‐Hansen Christina E.
Published: April 2019

Aim

We aimed at describing clinical findings in children with dyskinetic as compared to bilateral spastic cerebral palsy (CP).

Methods

Data were extracted from the Danish nationwideCPregister. Participants were born in 1999–2007 and were 5–6 years at ascertainment.

Results

The total number ofCPcases was 1165 of which 92 had dyskinetic and 540 bilateral spasticCP. Prevalence of dyskineticCPwas 0.16 per 1000 live births. In participants with dyskinetic compared to bilateral spasticCP, there was more frequently an Apgar level less than five at five minutes (22.7% vs. 11.2%) and neonatal seizures (43.5% vs. 28.5%), but less respiratory deficiency, hyperbilirubinaemia and sepsis. Impairment based on gross motor function classification was more severe in dyskineticCP(levelIII–V 90.0% vs. 66.0%). In dyskineticCP, there was a high rate of reduced developmental quotient (68.1%), visual impairment (39.3%) and epilepsy (51.6%). Basal ganglia lesions were more prevalent in dyskinetic compared to bilateral spasticCP(27.7% vs. 12.8%).

Conclusion

Cases of dyskineticCPhad overlapping clinical features with cases of bilateral spasticCP, but differed significantly in several perinatal risk factors. The children with dyskineticCPhad experienced more peri‐ or neonatal adverse events, and neurodevelopmental impairment was severe.
Postoperative bleeding complications after endoscopic inguinal hernia repair in patients receiving anticoagulation agents, antiplatelet agents, or both
Authors: Mita Kazuhito , Fujino Keiichi , Asakawa Hideki , Matsuyama Tomokazu , Hayashi Takashi , Ito Hideto
Published: April 2019

Introduction

In patients receiving chronic anticoagulation agents, antiplatelet agents, or both, perioperative antithrombotic therapy for inguinal hernia repair requires an understanding of potential side‐effects—specifically, the postoperative bleeding risks. In the present study, we evaluated postoperative bleeding complications after transabdominal preperitoneal patch plasty (TAPP) in patients undergoing antithrombotic therapy.

Methods

We retrospectively reviewed 413 patients who had undergone TAPP between February 2013 and June 2017. Individuals in the antithrombotic group received one of three regimens of perioperative antithrombotic therapy. The clinical indications for chronic anticoagulation agents (ie bridging therapy with unfractionated heparin), antiplatelet agents (ie continuation of aspirin), or both were followed. The antithrombotic group was compared to the control group in terms of surgical outcomes. We primarily focused on the incidence of postoperative bleeding complications.

Results

A total of 83 patients received antithrombotic therapy. We observed significant differences between the groups in terms of mean age, ASA physical status, and length of postoperative stay. In contrast, postoperative complications were not significantly different between the antithrombotic and control groups (4.8% vs 5.5%, P = 0.818). In addition, a significantly greater postoperative bleeding rate was not observed in the antithrombotic group than in the control group (1.2% vs 0.6%, P = 0.566). Likewise, other complications were similar in both groups.

Conclusions

Antithrombotic therapy is not a risk factor for postoperative bleeding complications in patients who have undergone TAPP, suggesting its safety and efficacy in this patient population. Indeed, this group has the same incidence rates of morbidity and postoperative bleeding complications as patients who have not undergone antithrombotic therapy.
Laparoscopic high anterior resection for rectal cancer with rare variations of the left renal vessels: A case report
Authors: Saito Kentaro , Hino Hitoshi , Shiomi Akio , Kagawa Hiroyasu , Yamakawa Yushi , Manabe Shoichi , Yamaoka Yusuke
Published: April 2019

We present a case of rectal cancer with rare variations of the left renal vessels. A man in his 60s underwent endoscopic mucosal resection for an Ip‐type lesion in the upper rectum. Histologically, the lesion was a well‐differentiated adenocarcinoma that had invaded the deep submucosal layer. Therefore, additional resection of the rectum with regional lymph node dissection was recommended. Preoperative CT revealed rare variations of the left renal vessels. There were two left renal arteries and veins; the caudal left renal artery and vein were located between the inferior mesenteric artery and the abdominal aorta. During the operation, these renal vessels were confirmed, and laparoscopic high anterior resection was performed safely without any injury to these renal vessels. To avoid the risk of unexpected intraoperative injuries, it is important to preoperatively check whether there are any variations in the renal vessels, even before colorectal surgery.
Assessing the impact of the addition of dendritic cell vaccination to neoadjuvant chemotherapy in breast cancer patients: A model‐based characterization approach
Authors: Solans Belén P. , López‐Díaz de Cerio Ascensión , Elizalde Arlette , Pina Luis Javier , Inogés Susana , Espinós Jaime , Salgado Esteban , Mejías Luis Daniel , Trocóniz Iñaki F. , Santisteban Marta
Published: April 2019

Aims

Immunotherapy is a rising alternative to traditional treatment in breast cancer (BC) patients in order to transform cold into hot immune enriched tumours and improve responses and outcome. A computational modelling approach was applied to quantify modulation effects of immunotherapy and chemotherapy response on tumour shrinkage and progression‐free survival (PFS) in naïve BC patients.

Methods

Eighty‐three Her2‐negative BC patients were recruited for neoadjuvant chemotherapy with or without immunotherapy based on dendritic cell vaccination. Sequential tumour size measurements were modelled using nonlinear mixed effects modelling and linked to PFS. Data from another set of patients (n = 111) were used to validate the model.

Results

Tumour size profiles over time were linked to biomarker dynamics and PFS. The immunotherapy effect was related to tumour shrinkage (P < .05), with the shrinkage 17% (95% confidence interval: 2–23%) being higher in vaccinated patients, confirmed by the finding that pathological complete response rates in the breast were higher in the vaccinated compared to the control group (25.6% vs 13.6%; P = .04). The whole tumour shrinkage time profile was the major prognostic factor associated to PFS (P < .05), and therefore, immunotherapy influences indirectly on PFS, showing a trend in decreasing the probability of progression with increased vaccine effects. Tumour subtype was also associated with PFS (P < .05), showing that luminal A BC patients have better prognosis.

Conclusions

Dendritic cell‐based immunotherapy is effective in decreasing tumour size. The semi‐mechanistic validated model presented allows the quantification of the immunotherapy treatment effects on tumour shrinkage and establishes the relationship between the dynamics of tumour size and PFS.
Minor structural modifications to Pracinostat produce big changes in its biological responses
Authors: Jia Rong , Sun Pengju , Zhang Yan , Ge Youjin , Yu Niefang
Published: April 2019

A series of compounds similar to Pracinostat that contained benzimidazole ring and N‐hydroxyacrylamide attached at 5‐ or 6‐position were designed, synthesized, and evaluated as HDAC inhibitors. It was interesting to find that the corresponding derivative 1 with N‐hydroxyacrylamide attached at 5‐position was a potent HDAC inhibitor while the others at 6‐position were not. This is the first time to demonstrate the position difference plays important role in the HDAC inhibitory activities of the cinnamic hydroxamates.
Deviant Peer Factors During Early Adolescence: Cause or Consequence of Physical Aggression?
Authors: Thompson Erin L. , Mehari Krista R. , Farrell Albert D.
Published: April 2019

This study investigated reciprocal relations between adolescents' physical aggression and their perceptions of peers' deviant behaviors and attitudes. Analyses were conducted on four waves of data from 2,290 adolescents (ages 10–16) from three urban middle schools. Autoregression models revealed reciprocal relations between peer factors (i.e., friends' problem behavior, peer pressure for fighting, friends' support for fighting) and adolescents' reporting of their aggressive behavior. Bidirectional relations were also found between peer pressure for fighting and adolescents' frequency of physical aggression based on teacher ratings. Findings were consistent across sex, grade, and time. Findings suggest that multiple dimensions of peers' behaviors uniquely play a role in the development of adolescents' aggression and have important implications for interventions to reduce problem behaviors.
Diffusion‐weighted imaging (DWI) highlights SDHB‐related tumours: A pilot study
Authors: Tufton Nicola , White Gemma , Drake William M. , Sahdev Anju , Akker Scott A.
Published: April 2019

Objective

There is consensus that asymptomatic carriers of SDHB mutations should undergo periodic surveillance imaging. MRI has the advantage of avoiding radiation exposure but its sensitivity and specificity for detecting phaeochromocytoma and paraganglioma (PPGL) are dependent on sequences performed and expertise of reporting radiologists. We aim to highlight the additional value of diffusion‐weighted imaging (DWI) for MR based surveillance, demonstrating DWI's ability to identify small PPGLs at all body sites.

Design

We presented DWI sequences taken as part of SDHB surveillance to a radiologist, expert in reporting PPGL screening scans. Areas of high signal on DWI were interrogated using other standard MRI sequences.

Patients

We reviewed the MRI scans for 18 SDHB mutation carriers with a total of 18 histologically proven SDHB‐related tumours and 12 presumed PGLs/metastatic deposits.

Results

The DWI sequences identified all 30 lesions. False‐positive lesions were excluded by standard sequences. The tumours detected by DWI ranged in size from 5 to 52 mm. PPGLs were identified on DWI in the abdomen (n = 14), adrenal gland (n = 1), thorax (n = 3), neck (n = 2) and bladder (n = 2). Additionally, other SDHB‐related tumours (GIST, RCC) were also highlighted by DWI, as were metastatic deposits in the liver and bone.

Conclusions

These preliminary data suggest that DWI has high sensitivity and can identify even small SDHB‐related tumours. If these findings are confirmed in larger series, for all SDH subunits, it will provide reassurance about identifying small SDH‐related tumours, without exposing patients to the consequences of radiation‐based imaging and will secure the role of MRI for surveillance imaging.
Risk factors for abdominal wall defects
Authors: Kapapa Melanie , Rieg Teresa , Henne‐Bruns Doris , Serra Alexandre
Published: April 2019

In the last decades, the prevalence of gastroschisis (GS) has increased worldwide. The purpose of this study was to identify maternal risk factors explaining the described gain and to identify differences between GS and omphalocele (OC). A case‐control design was used to compare GS (n = 36) and OC (n = 18) mothers to control group (CG; n = 30) matched for maternal age. Specialized questionnaires and mothers' prenatal records were used, and participants completed a structured interview. Focus was on medical history, changing nutrition, drug consumption, and external risk factors. The local ethics committee approved this study. GS mothers were significantly younger (mean 23.00; median 24; SD ±5) than OC (P = 0.007; mean 28.61; median 28, 19‐41; SD ±5.1) and CG (P = 0.001; mean 30.77; median 31, SD ±6.2). Mothers with abdominal wall defects (AWD) ingested antibiotics more often (P = 0.008) than CG. Socioeconomic characteristics, for example, level of profession, of GS mothers was significantly lower than OC (P = 0.039) and CG (P = 0.05) mothers, and their cohabitation time was shorter (P < 0.05; mean 35 month/median 24 month, SD ±35.8). Incidence of OC significantly increased after hormonal treatment (P = 0.022) and invasive prenatal diagnostics (P < 0.05) compared to GS. GS mothers took folic acid prophylaxis less often than OC (P = 0.02). Smoking, illicit drugs, and external risks like herbicides showed no influence, but GS mothers drink significantly more often alcohol (P = 0.05). We confirmed an increased risk for GS if several factors such as young maternal age, short cohabitation time, and usage of antibiotics coincide with alcohol consumption and associated immune diseases. OC increased after hormonal treatment and invasive prenatal diagnostics.
Malignant transformation of tailgut cysts is significantly higher than previously reported: systematic review of cases in the literature
Authors: Nicoll K. , Bartrop C. , Walsh S. , Foster R. , Duncan G. , Payne C. , Carden C.
Published: April 2019

Aim

The best treatment for tailgut cysts has not been firmly established. We report a systematic review of the cases in the available literature in order to provide an evidence base for treatment.

Method

A systematic search of articles wholly or partly in English was made of PubMed, Embase and Google Scholar; additional studies were discovered by searching reference lists and contacting authors directly. Search terms ‘tailgut cyst’, ‘tail gut cyst’, ‘retrorectal hamartoma’ and ‘retrorectal tumour’ were used for case reports or case series; no publication date restrictions were imposed. Only studies with histological confirmation of diagnosis and reporting the age and gender of patients were included. Papers were excluded by consensus between the first two authors.

Results

A total of 196 individual cases were analysed in detail including 51 cases of neoplasia. The overall rate of neoplastic transformation was 26.6%. Although the male:female cyst incidence ratio was 1:4, men over 18 had a significantly greater relative risk of neoplasm at 1.94 (P = 0.0055). Radiological evidence of nodular thickening of the cyst wall significantly increased the relative risk of the presence of cancer (P = 0.0023).

Conclusions

Current orthodoxy that these are not dangerous embryological remnants is unfounded and may be false. The available data suggest the risk of malignant transformation is high and will apply to any residual tissue after excision. The same rationale behind total mesorectal excision in rectal cancer applies to tailgut cysts. Consequently they should be resected with similar oncological margins.
Clarice Beckett and Mood
Authors: Freeland Cynthia
Published: April 2019

This essay discusses the role of mood in Clarice Beckett's painting “Evening, St. Kilda Road,” 1930. To begin I briefly discuss the difference between moods and emotions. Then I examine various philosophical treatments of how artworks are expressive, including views of Tolstoy (direct communication), Carroll (audience arousal), and Robinson (use of a ‘persona’ in the work or in its composition). I apply these to Beckett's work by examining some of its distinctive features in comparison to somewhat similar paintings by Childe Hassam and J.M.W. Turner. Finally, I describe some recent treatments of mood in film theory, by Sinnerbrink and Plantinga, who define mood as a holistic sort of creation of a “world” in film. Painting has different resources from film, but it is still possible to describe the kind of world Beckett presents in her work: one that is detached but serene and not melancholy.
Identifying neurodisability research priorities in resource poor regions
Authors: Seal Arnab
Published: April 2019

This commentary is on the scoping review by Jindal et al. on pages 1050–1060 of this issue.
Evaluation of the potential predictors of embolism in patients with left atrial myxoma
Authors: Kalçık Macit , Bayam Emrah , Güner Ahmet , Küp Ayhan , Kalkan Semih , Yesin Mahmut , Gürsoy Mustafa O. , Gündüz Sabahattin , Karakoyun Süleyman , Özkan Mehmet
Published: April 2019

Introduction

Cardiac myxomas are the most common primary intracardiac tumors. Although myxomas are histologically benign, they are potentially dangerous due to potential risk of systemic and cerebral embolism. In this study, we aimed to investigate the potential predictors of embolism in patients with left atrial myxoma.

Methods

This single‐center retrospective study enrolled 93 patients (mean age: 52.9 ± 15.3 years, female: 70 [75.3%]) with left atrial myxomas between 2014 and 2018. The patients were classified into two groups (embolic vs nonembolic) to investigate possible predictors of embolism. Demographic, laboratory, and echocardiographic parameters were recorded into a dataset and compared between patients with and without embolism.

Results

The study population was composed of 13 (14%) patients in embolic (11 cerebrovascular and 2 peripheral) and 80 (86%) patients in nonembolic group. Demographic and laboratory parameters were similar between the groups. Tumor sizes were significantly higher in the embolic group than in the nonembolic group (5.59 ± 1.08 vs 4.29 ± 0.61; P = 0.001). By multivariate analysis, increased tumor size, increased left atrial diameter, and the presence of atrial fibrillation and irregular tumor surface were identified as independent predictors of embolism. In ROC curve analyses, tumor size above 4.6 cm predicted embolism with a sensitivity of 77% and a specificity of 73% (AUC: 0.858; 95% CI: 0.752–0.964; P < 0.001).

Conclusion

The presence of atrial fibrillation, irregular tumor surface, increased tumor size, and increased left atrial diameter is associated with increased risk of embolism in patients with left atrial myxoma. Early surgery should be scheduled for such patients due to increased potential for embolism.
Biotic and abiotic determinants of the formation of ant mosaics in primary Neotropical rainforests
Authors: Dejean Alain , Compin Arthur , Delabie Jacques H. C. , Azémar Frédéric , Corbara Bruno , Leponce Maurice
Published: April 2019

1. Ants are widespread in tropical rainforests, including in the canopy where territorially dominant arboreal species represent the main part of the arthropod biomass.

2. By mapping the territories of dominant arboreal ant species and using a null model analysis and a pairwise approach this study was able to show the presence of an ant mosaic on the upper canopy of a primary Neotropical rainforest (c. 1 ha sampled; 157 tall trees from 28 families). Although Neotropical rainforest canopies are frequently irregular, with tree crowns at different heights breaking the continuity of the territories of dominant ants, the latter are preserved via underground galleries or trails laid on the ground.

3. The distribution of the trees influences the structure of the ant mosaic, something related to the attractiveness of tree taxa for certain arboreal ant species rather than others.

4. Small‐scale natural disturbances, most likely strong winds in the area studied (presence of canopy gaps), play a role by favouring the presence of two ant species typical of secondary formations: Camponotus femoratus and Crematogaster levior, which live in parabiosis (i.e. share territories and nests but lodge in different cavities) and build conspicuous ant gardens. In addition, pioneer Cecropia myrmecophytic trees were recorded.
First report that the wasp Gronotoma guamensis (Hymenoptera: Figitidae: Eucoilinae) parasitizes the orchid‐feeding fly Japanagromyza tokunagai in Japan
Authors: Suetsugu Kenji , Mita Toshiharu
Published: April 2019

Compared with mycorrhizal relationships, the relationships between mycoheterotrophic plants and insects have rarely been studied. Here we report a previously unknown tripartite interaction among an endangered mycoheterotrophic orchid, an orchid‐feeding fly, and a parasitoid wasp. The flowers and stems of Eulophia zollingeri were heavily attacked by Japanagromyza tokunagai (Sasakawa) (Diptera: Agromyzidae), and the parasitoid wasp Gronotoma guamensis (Yoshimoto) (Hymenoptera: Figitidae) was reared from these J. tokunagai individuals. Considering the high infestation rate of J. tokunagai, G. guamensis could be important in suppressing the J. tokunagai population, and positively affect the reproductive success of E. zollingeri.
The influence of abiotic incubation conditions on the winter mortality of wild salmonid embryos
Authors: Lavery J. Michelle , Cunjak Richard A.
Published: April 2019

Embryos of many valued salmonid species incubate in the hyporheic zone of boreal streams over winter. Influence of individual winter‐related environmental variables on salmonid embryo success has been previously investigated. However, how multiple variables act together to influence embryo incubation remains poorly understood.

Using a naturally spawning population of Atlantic salmon (Salmo salar) in the Miramichi River basin (New Brunswick, Canada), we related variation in the abiotic embryo incubation habitat in different streams (spatial) and over the course of two winters (temporal) to embryo mortality between fertilisation and hatch. Over two years (2013–2014 and 2014–2015), we introduced fertilised eggs to six simulated salmon redds in each of three riffles in each of five active spawning reaches (nredds = 90) with a range of hyporheic conditions. Embryo mortality was quantified at an early sampling event (March; pre‐freshet and during late embryonic development) and a late sampling event (May; post‐freshet and post‐hatch). We extracted 22 abiotic predictor variables for statistical analyses from continuous records of hyporheic environmental conditions, collected for the duration of the incubation period in each study reach.

Through partial least squares regression analyses, 37.6% of the total variation in mortality was explained by the predictor variables. Each group of predictor variables explained similar proportions of variation (water temperature: 8.4%, water level: 7.4%, dissolved oxygen: 7.1%, ice conditions: 7.2%, and substrate characteristics: 7.5%), which suggests that mortality is influenced by multiple interacting abiotic conditions, rather than a single variable in isolation, and that the factors contributing to ideal salmonid incubation habitats are complex and interconnected.

Our research highlights the value of a multi‐faceted research perspective and provides a baseline from which future changes in threatened salmonid populations can be measured and compared in an effort to identify relevant species‐ or population‐specific differences.
Observed and modelled historical trends in the water‐use efficiency of plants and ecosystems
Authors: Lavergne Aliénor , Graven Heather , De Kauwe Martin G. , Keenan Trevor F. , Medlyn Belinda E. , Prentice Iain Colin
Published: April 2019

Plant water‐use efficiency (WUE, the carbon gained through photosynthesis per unit of water lost through transpiration) is a tracer of the plant physiological controls on the exchange of water and carbon dioxide between terrestrial ecosystems and the atmosphere. At the leaf level, rising CO2 concentrations tend to increase carbon uptake (in the absence of other limitations) and to reduce stomatal conductance, both effects leading to an increase in leaf WUE. At the ecosystem level, indirect effects (e.g. increased leaf area index, soil water savings) may amplify or dampen the direct effect of CO2. Thus, the extent to which changes in leaf WUE translate to changes at the ecosystem scale remains unclear. The differences in the magnitude of increase in leaf versus ecosystem WUE as reported by several studies are much larger than would be expected with current understanding of tree physiology and scaling, indicating unresolved issues. Moreover, current vegetation models produce inconsistent and often unrealistic magnitudes and patterns of variability in leaf and ecosystem WUE, calling for a better assessment of the underlying approaches. Here, we review the causes of variations in observed and modelled historical trends in WUE over the continuum of scales from leaf to ecosystem, including methodological issues, with the aim of elucidating the reasons for discrepancies observed within and across spatial scales. We emphasize that even though physiological responses to changing environmental drivers should be interpreted differently depending on the observational scale, there are large uncertainties in each data set which are often underestimated. Assumptions made by the vegetation models about the main processes influencing WUE strongly impact the modelled historical trends. We provide recommendations for improving long‐term observation‐based estimates of WUE that will better inform the representation of WUE in vegetation models.
European Union financial integration, a geography perspective
Authors: van Meeteren Michiel
Published: April 2019

During the last 30 years, the financial sectors of the different European Union member states have gradually coalesced toward operating in a single, integrated, European financial space. This paper analyses financial integration by chronicling the process from Jacques Delors' single market project until the recent capital markets union. Drawing on geographical theories of space and scale, the paper collates the large interdisciplinary literature on financial integration with an emphasis on the work of financial geographers. The result is a distinctive geographical perspective on European financial integration intended to inform new rounds of empirical research.
IMF flexibility or neoliberal adaptation: A discursive content analysis of Article IV policy biases in Argentina
Authors: Hernandez Christian
Published: April 2019

At the turn of the century, the consensus among scholars was that the International Monetary Fund's (IMF) policy preferences, which centered on deflation via austerity, privatization, and deregulation, were indicative of its neoliberal bias. However, a subsequent wave of literature has challenged this view by suggesting that the IMF has demonstrated flexibility. While these accounts arrive at their conclusion via different analytical and empirical focuses, this article posits that the flexibility or breath of ideas found within the discourse itself is key to gauging policy biases (previous study). Herein, this article contributes to the question of whether the IMF can be considered a “flexible” institution via its analysis on Argentina (1989–2006; 2016–2017). Extending a previous study's methods, this one provides a “discursive content analysis,” on the IMF–Argentine Article IV consultations. Ultimately, the findings show that policy discourse remained neoliberal throughout.
An examination of the incidence and nature of chemical restraint on adult acute psychiatric inpatient units in Adelaide, South Australia
Authors: Hu Feyan , Muir‐Cochrane Eimear , Oster Candice , Gerace Adam
Published: April 2019

Reducing and/or eliminating the use of coercive measures in psychiatric services is a priority worldwide. Chemical restraint is one such measure, yet to date has been poorly defined and poorly investigated. The aim of this study was to examine chemical restraint use in 12 adult acute inpatient psychiatric units in Adelaide, South Australia. Methods involved the analysis of all reported chemical restraint events occurring over a 12‐month period analysed using a descriptive quantitative design. There were 166 chemical restraint events involving 110 consumers. The highest prevalence rate in an individual unit was 28.78 events per 1000 occupied bed days, with the lowest being 0.12 events per 1000 occupied bed days. More males (n = 69, 57.5%) were involved in chemical restraint than females. Schizophrenia, schizotypal, and delusional disorders were the predominant diagnoses among consumers who were chemically restrained. The most events occurred during three time blocks: 14.00–14.59 pm, 16.00–16.59 pm, and 21.00–21.59 pm. The two most common medications used were olanzapine and clonazepam. The study presents a general picture of the practice of chemical restraint in Adelaide and identifies areas of concern in relation to the need for monitoring of side effects and completion of systematic processes of documentation regarding chemical restraint events. Findings highlight the need for sustained focus on reducing the need for chemical restraint and exploring less restrictive measures with those most likely to receive medication against their will.
Acute surgical wound‐dressing procedure: Description of the steps involved in the development and validation of an observational metric
Authors: Hegarty Josephine , Howson Victoria , Wills Teresa , Creedon Sile A. , Mc Cluskey Pat , Lane Aoife , Connolly Aine , Walshe Nuala , Noonan Brendan , Guidera Fiona , Gallagher Anthony G , Murphy Siobhan
Published: April 2019

The aim of this study was to develop an observational metric that could be used to assess the performance of a practitioner in completing an acute surgical wound‐dressing procedure using aseptic non‐touch technique (ANTT). A team of clinicians, academics, and researchers came together to develop an observational metric using an iterative six‐stage process, culminating in a Delphi panel meeting. A scoping review of the literature provided a background empirical perspective relating to wound‐dressing procedure performance. Video recordings of acute surgical wound‐dressing procedures performed by nurses in clinical (n = 11) and simulated (n = 3) settings were viewed repeatedly and were iteratively deconstructed by the metric development group. This facilitated the identification of the discrete component steps, potential errors, and sentinel (serious) errors, which characterise a wound dressing procedure and formed part of the observational metric. The ANTT wound‐dressing observational metric was stress tested for clarity, the ability to be scored, and interrater reliability, calculated during a further phase of video analysis. The metric was then subjected to a process of cyclical evaluation by a Delphi panel (n = 21) to obtain face and content validity of the metric. The Delphi panel deliberation verified the face and content validity of the metric. The final metric has three phases, 31 individual steps, 18 errors, and 27 sentinel errors. The metric is a tool that identifies the standard to be attained in the performance of acute surgical wound dressings. It can be used as both an adjunct to an educational programme and as a tool to assess a practitioner's performance of a wound‐dressing procedure in both simulated and clinical practice contexts.
The Limits of Forensic Evidence
Authors: Tarran Brian
Published: April 2019

Ten years ago, the US National Academy of Sciences published a report that was critical of the scientific foundations of many forms of forensic evidence. It called for “more and better research”. Ten years on, Significance is publishing a special collection of articles that reflect on the report's impact, the progress that has been made, and the challenges that remain for evaluating and interpreting evidence. First, Brian Tarran highlights the critical role played by statisticians in supporting the development of forensic science
R Guides to Statistics and Graphics
Authors: Reese R. Allan
Published: April 2019

R. Allan Reese reviews three textbooks for users of the statistical programming language, R
Bond characteristics, mechanical properties, and high‐temperature thermal conductivity of (Hf1−xTax)C composites
Authors: Kim Jiwoong , Kim Myungjae , Roh Ki-Min , Kang Ilmo
Published: April 2019

Bond characteristics, mechanical properties, and high‐temperature thermal conductivity of ultrahigh‐temperature ceramics (UHTCs), hafnium carbide (HfC), tantalum carbide (TaC), and their solid solution composites, were investigated using first‐principles calculations. Mulliken analyses revealed that Ta formed stronger covalent bonds with C than did Hf. Bond overlap analyses indicated that the Hf–C bond possessed mixed covalent and ionic bond characteristics, compared with the more covalent character of the Ta–C bond. Consequently, the overall elastic properties were enhanced with increasing number of Ta–C bonds in the composites. The overall metallicity of the composites also increased with increasing TaC content; thus, the mechanical properties did not improve monotonically. Our results indicate that adding a small amount of TaC to HfC or vice versa to produce a composite would create a new UHTC with greatly improved elastic and mechanical properties as well as high‐temperature thermal conductivity.
Effect of particle size distribution of metakaolin on hydration kinetics of tricalcium silicate
Authors: Lapeyre Jonathan , Ma Hongyan , Kumar Aditya
Published: April 2019

The focus of this study is to elucidate the role of particle size distribution (PSD) of metakaolin (MK) on hydration kinetics of tricalcium silicate (C3S–T1) pastes. Investigations were carried out utilizing both physical experiments and phase boundary nucleation and growth (pBNG) simulations. [C3S + MK] pastes, prepared using 8%mass or 30%mass MK, were investigated. Three different PSDs of MK were used: fine MK, with particulate sizes <20 µm; intermediate MK, with particulate sizes between 20 and 32 µm; and coarse MK, with particulate sizes >32 µm. Results show that the correlation between specific surface area (SSA) of MK's particulates and the consequent alteration in hydration behavior of C3S in first 72 hours is nonlinear and nonmonotonic. At low replacement of C3S (ie, at 8% mass), fine MK, and, to some extent, coarse MK act as fillers, and facilitate additional nucleation and growth of calcium silicate hydrate (C–S–H). When C3S replacement increases to 30% mass, the filler effects of both fine and coarse MK are reversed, leading to suppression of C–S–H nucleation and growth. Such reversal of filler effect is also observed in the case of intermediate MK; but unlike the other PSDs, the intermediate MK shows reversal at both low and high replacement levels. This is due to the ability of intermediate MK to dissolve rapidly—with faster kinetics compared to both coarse and fine MK—which results in faster release of aluminate [Al(OH)4−] ions in the solution. The aluminate ions adsorb onto C3S and MK particulates and suppress C3S hydration by blocking C3S dissolution sites and C–S–H nucleation sites on the substrates’ surfaces and suppressing the post‐nucleation growth of C–S–H. Overall, the results suggest that grinding‐based enhancement in SSA of MK particulates does not necessarily enhance early‐age hydration of C3S.
A new substage classification strategy for Barcelona Clinic Liver Cancer stage B patients with hepatocellular carcinoma
Authors: Hu Ke‐Shu , Tang Bei , Yuan Jia , Lu Shen‐Xin , Li Miao , Chen Rong‐Xin , Zhang Lan , Ren Zheng‐Gang , Yin Xin
Published: April 2019

Background and Aim

Patients with Barcelona Clinic Liver Cancer stage B hepatocellular carcinoma are a heterogeneous population, and the classifications available could not predict the prognosis accurately. Herein, we proposed a new substage classification method, Scoring Method for Intermediate Stage, for precise classification and clinical guidance in hepatocellular carcinoma patients within Barcelona Clinic Liver Cancer stage B.

Methods

A total of 1026 stage B patients of hepatocellular carcinoma who underwent transcatheter arterial chemoembolization as a first‐line treatment in Liver Cancer Institute, Zhongshan Hospital, Fudan University were retrospectively enrolled. The prognostic evaluation ability of the new substage classification criteria was analyzed, in comparison with the existing substage classification criteria.

Results

Using Scoring Method for Intermediate Stage, 1026 stage B patients were subclassified into three subgroups, based on Child–Pugh score and up‐to‐7 grade, as B1 (scoring 2), B2 (scoring 3 or 4), and B3 (scoring 5 or 6). The median survival time of the three substages was 29 (95% confidence interval [CI]: 25–36), 19 (95% CI: 16–21), and 10 (95% CI: 8–12) months, respectively. More favorable discrimination efficacy was identified by the new criteria in comparison with the existing substage classification criteria, including Bolondi, Kinki, MICAN, and Kim's criteria. Moreover, multivariate analyses indicated that the novel classification was highly associated with prognosis (Hazard ratio(s) = 1.63, 95% CI: 1.43–1.86, P < 0.001).

Conclusions

Scoring Method for Intermediate Stage demonstrates satisfying capacity in classifying patients with stage B hepatocellular carcinoma and predicting prognosis.
Epidemiology, characteristics, and survival of post‐colonoscopy colorectal cancer in Asia: A population‐based study
Authors: Cheung Ka Shing , Chen Lijia , Seto Wai Kay , Leung Wai K
Published: April 2019

Background and Aim

Population‐based studies on post‐colonoscopy colorectal cancer (CRC) from Asia are sparse. We aimed to determine the characteristics and predictive factors and survival of post‐colonoscopy CRC in Hong Kong.

Methods

This is a territory‐wide retrospective cohort study. Patients aged ≥ 40 years with colonoscopies performed between 2005 and 2013 without history of CRCs, inflammatory bowel disease, and prior colectomy were included. Post‐colonoscopy colorectal cancer for an interval of 3 years (PCCRC‐3y) was defined as CRC diagnosed between 6 and 36 months after index colonoscopy, whereas CRC diagnosed within 6 months of index colonoscopy was regarded as “detected CRC.” We used multivariable logistic regression to derive adjusted odds ratio (aOR) of PCCRC‐3y and Cox model for adjusted hazard ratio (aHR) of cancer‐specific mortality after CRC diagnosis.

Results

Of the 197 902 eligible patients, 10 005 (92.1%) were detected CRC and 854 (7.9%) PCCRC‐3y. The median age at PCCRC‐3y diagnosis was 75.9 years (interquartile range: 65.5–83.8)—a delay of 1.2 years (interquartile range: 0.8–1.9) from index colonoscopy—and 60.1% were male. Predictive factors for PCCRC‐3y included older age (aOR: 1.07), male sex (aOR: 1.45), history of colonic polyps (aOR: 1.31), polypectomy/biopsy at index colonoscopy (aOR: 3.97), surgical endoscopists (aOR: 1.53), and a higher center annual endoscopy volume. Independent predictive factors for cancer‐specific mortality after CRC diagnosis included PCCRC‐3y (aHR: 1.32), proximal cancer location (aHR: 1.80), and certain patient factors.

Conclusion

The PCCRC‐3y rate was 7.9% in Hong Kong, with a high proportion (> 80%) of distal cancers and a higher cancer‐specific mortality compared with detected CRC.