bluuebunny/crossref_metadata_2025 huggingface dataset:
Position statement for the diagnosis and management of anogenital warts
Authors: O'Mahony C. , Gomberg M. , Skerlev M. , Alraddadi A. , de las Heras‐Alonso M.E. , Majewski S. , Nicolaidou E. , Serdaroğlu S. , Kutlubay Z. , Tawara M. , Stary A. , Al Hammadi A. , Cusini M.
Published: April 2019

Background

Anogenital warts (AGW) can cause economic burden on healthcare systems and are associated with emotional, psychological and physical issues.

Objective

To provide guidance to physicians on the diagnosis and management of AGW.

Methods

Fourteen global experts on AGW developed guidance on the diagnosis and management of AGW in an effort to unify international recommendations. Guidance was developed based on published international and national AGW guidelines and an evaluation of relevant literature published up to August 2016. Authors provided expert opinion based on their clinical experiences.

Results

A checklist for a patient's initial consultation is provided to help physicians when diagnosing AGW to get the relevant information from the patient in order to manage and treat the AGW effectively. A number of frequently asked questions are also provided to aid physicians when communicating with patients about AGW. Treatment of AGW should be individualized and selected based on the number, size, morphology, location, and keratinization of warts, and whether they are new or recurrent. Different techniques can be used to treat AGW including ablation, immunotherapy and other topical therapies. Combinations of these techniques are thought to be more effective at reducing AGW recurrence than monotherapy. A simplified algorithm was created suggesting patients with 1–5 warts should be treated with ablation followed by immunotherapy. Patients with >5 warts should use immunotherapy for 2 months followed by ablation and a second 2‐month course of immunotherapy. Guidance for daily practice situations and the subsequent action that can be taken, as well as an algorithm for treatment of large warts, were also created.

Conclusion

The guidance provided will help physicians with the diagnosis and management of AGW in order to improve the health and quality of life of patients with AGW.
How stabilizing selection and nongenetic inheritance combine to shape the evolution of phenotypic plasticity
Authors: Levis Nicholas A. , Pfennig David W.
Published: April 2019

Relatively little is known about whether and how nongenetic inheritance interacts with selection to impact the evolution of phenotypic plasticity. Here, we empirically evaluated how stabilizing selection and a common form of nongenetic inheritance—maternal environmental effects—jointly influence the evolution of phenotypic plasticity in natural populations of spadefoot toads. We compared populations that previous fieldwork has shown to have evolved conspicuous plasticity in resource‐use phenotypes (“resource polyphenism”) with those that, owing to stabilizing selection favouring a narrower range of such phenotypes, appear to have lost this plasticity. We show that: (a) this apparent loss of plasticity in nature reflects a condition‐dependent maternal effect and not a genetic loss of plasticity, that is “genetic assimilation,” and (b) this plasticity is not costly. By shielding noncostly plasticity from selection, nongenetic inheritance generally, and maternal effects specifically, can preclude genetic assimilation from occurring and consequently impede adaptive (genetic) evolution.
Detecting the macroevolutionary signal of species interactions
Authors: Harmon Luke J. , Andreazzi Cecilia S. , Débarre Florence , Drury Jonathan , Goldberg Emma E. , Martins Ayana B. , Melián Carlos J. , Narwani Anita , Nuismer Scott L. , Pennell Matthew W. , Rudman Seth M. , Seehausen Ole , Silvestro Daniele , Weber Marjorie , Matthews Blake
Published: April 2019

Species interactions lie at the heart of many theories of macroevolution, from adaptive radiation to the Red Queen. Although some theories describe the imprint that interactions will have over long timescales, we are still missing a comprehensive understanding of the effects of interactions on macroevolution. Current research shows strong evidence for the impact of interactions on macroevolutionary patterns of trait evolution and diversification, yet many macroevolutionary studies have only a tenuous relationship to ecological studies of interactions over shorter timescales. We review current research in this area, highlighting approaches that explicitly model species interactions and connect them to broad‐scale macroevolutionary patterns. We also suggest that progress has been made by taking an integrative interdisciplinary look at individual clades. We focus on African cichlids as a case study of how this approach can be fruitful. Overall, although the evidence for species interactions shaping macroevolution is strong, further work using integrative and model‐based approaches is needed to spur progress towards understanding the complex dynamics that structure communities over time and space.
Evaluation of extraction technologies and optimization of microwave and ultrasonic assisted consecutive extraction of phenolic antioxidants from winery byproducts
Authors: Wang Jun , Zhang Yuxiu , Wang Hongli , Huo Sufang
Published: April 2019

Acid, enzyme, ultrasonic, and microwave were used to assist extraction of polyphenols in grape pomace, skins, and seeds. The relationship among extraction technologies, polyphenolic content and antioxidant capacities was analyzed by principal component analysis (PCA), and the effective extraction condition for specific target was optimized by response surface methodology. Polyphenolic content could be mostly enhanced by microwave‐assisted processing, while PCA showed that ultrasound‐assisted processing had a more positive effect on the antioxidant activity of extracts. Microwave and ultrasonic assisted consecutive extraction on Merlot seed showed the superiority and the numerical optimization for the highest global desirability value of antioxidants extraction was obtained at the condition of 1:24.50 (liquid–solid ratio), 68.00% EtOH, 3.24 min (microwave time) and 60.00 min (sonication time) with desirability of 0.973. The predicted extraction condition of total phenolics, total flavonoids, and proanthocyanidins were 19.51 mg GAE/g DW, 29.06 mg RE/g DW, and 24.47 mg CE/g DW, respectively; while the values for antioxidant activity were 87.25% hydroxyl radicals‐scavenging activity, 83.39% superoxide radical‐scavenging activity, and 1.86 (at 700 nm) reducing power.

Practical applications

Polyphenols present an important antioxidant activity and health‐beneficial properties. Sustainable and relatively cheap raw material should be utilized in the production, such as winery byproducts. However, microwave‐assisted processing may affect the antioxidant activity of extracts despite that the polyphenolic content could be enhanced. This research provides information about optimization of novel extraction technique (microwave and ultrasonic assisted consecutive extraction), which could be successfully used for polyphenols extraction due to increased yield of target compounds and improved quality of the liquid extracts in terms of antioxidant activity. These findings are a useful tool for producers of winery byproducts to achieve an effective and economically viable extraction process as well as optimal composition and bioactivity in terms of antioxidant capacity.
Aggressive Care near the End of Life for Cancer Patients in Medicare Accountable Care Organizations
Authors: Kim Hyosin , Keating Nancy L. , Perloff Jennifer N. , Hodgkin Dominic , Liu Xiaodong , Bishop Christine E.
Published: April 2019

OBJECTIVES

To compare aggressiveness of end‐of‐life (EoL) care for older cancer patients attributed to Medicare Shared Savings Programs with that for similar fee for service (FFS) beneficiaries not in an accountable care organization (ACO) and examine whether observed differences in EoL care utilization vary across markets that differ in ACO penetration.

DESIGN

Cross‐sectional observational study comparing ACO‐attributed beneficiaries with propensity score–matched beneficiaries not attributed to an ACO.

SETTING

A total of 21 hospital referral regions (HRRs) in the United States.

PARTICIPANTS

Medicare FFS beneficiaries with a cancer diagnosis who were 66 years or older and died in 2013‐2014.

MEASUREMENTS

Outcome measures were claims‐based quality measures of aggressive EoL care: (1) one or more intensive care unit (ICU) admissions in the last month of life, (2) two or more hospitalizations in the last month of life, (3) two or more emergency department visits in the last month of life, (4) chemotherapy 2 weeks or less before death, and (5) no hospice enrollment or hospice enrollment within 3 days of death. Analyses were adjusted for demographic and clinical characteristics of beneficiaries and practice characteristics.

RESULTS

Compared with beneficiaries not in an ACO, ACO‐attributed beneficiaries had a higher rate of ICU admission during the last month of life (37.7% vs 34.0%; adjusted difference = +2.8 percentage points; 95% confidence interval (CI) = 1.0‐4.6) but fewer repeated hospitalizations (14.5% vs 15.2%; adjusted difference = −1.7 percentage points; CI = −3.1 to −.3). Other measures did not differ for the two groups. Although the ICU admission rates tended to decrease as ACO‐penetration rates increased (P < .01), ACO patients had higher rates of ICU admission than non‐ACO patients in both medium and high ACO‐penetration HRRs.

CONCLUSION

Cancer patients attributed to ACOs had fewer repeated hospitalizations but more ICU admissions in the last month of life than non‐ACO patients; they had similar rates of other measures of aggressive care at the EoL. This suggests opportunities for ACOs to improve EoL care for cancer patients. J Am Geriatr Soc 67:961–968, 2019.
Integration of End‐of‐Life Care into Accountable Care Organization's Quality Measures
Authors: Subbiah Ishwaria M.
Published: April 2019

This editorial comments on the Clinical Investigation by Kim et al. in this issue.
What's Mine Is Ours? Income Pooling in American Families
Authors: Eickmeyer Kasey J. , Manning Wendy D. , Brown Susan L.
Published: April 2019

Objective: The objective of this study is to determine whether income‐pooling strategies differ between married and cohabiting individuals without children, only biological children, or any stepchildren.

Background: Americans are forming families in new ways via cohabitation and stepfamilies, which may have implications for resource pooling. Although a majority of married and cohabiting couples pool their incomes, little is known about the role of children in couple's income‐pooling behaviors.

Method: The authors use recently collected, nationally representative data from the Families and Relationships Study (n = 4,362). Controlling for sociodemographic, household, and relationship characteristics, the authors use logistic regression to predict the odds of income pooling among married and cohabiting individuals without children, only biological children, or any stepchildren.

Results: The likelihood of income pooling remained similar among cohabitors regardless of the configuration of children in the household. Among married families, however, the likelihood of income pooling differed by the presence of resident stepchildren. Married families with resident stepchildren had a lower probability of pooling their income when compared with married families with only resident biological children.

Conclusion: The ways economic resources are shared differs across family types. The findings from this study are consistent with an incomplete institutionalization perspective and demonstrate that individuals in cohabiting‐couple families and married‐couple families with resident stepchildren are less likely to pool their incomes.
Identity Management Strategies for Workers with Concealable Disabilities: Antecedents and Consequences
Authors: Santuzzi Alecia M. , Keating Robert T. , Martinez Jesus J. , Finkelstein Lisa M. , Rupp Deborah E. , Strah Nicole
Published: April 2019

Twenty‐eight currently or recently employed adults with concealable impairments from a community in the United States completed semi‐structured interviews to capture workers’ perceptions of their internal and social experiences that contribute to their identity management decisions. Disability identity management strategies included effortful behaviors, such as avoiding relevant situations and using specific language to describe impairments. Participants suggested intraindividual factors (disability salience, disability strain) and environmental factors (disability stigma, ineffective social support) as primary reasons for their identity management decisions. The findings align with existing research on stigmatized identity management and consequences for well‐being, together informing a proposed theoretical model. Conclusions invite policy change at national and organizational levels to account for intraindividual and environmental factors that may introduce barriers to disability disclosure and effective accommodation practices.
The effects of zolpidem in obstructive sleep apnea – An open‐label pilot study
Authors: Carberry Jayne C. , Grunstein Ronald R. , Eckert Danny J.
Published: April 2019

New knowledge on hypnotics and their effects on the phenotypic causes of obstructive sleep apnea indicate that zolpidem has therapeutic potential for certain patients. Specifically, zolpidem increases the threshold for arousal threshold and pharyngeal dilator muscle responsiveness. However, the effects of a standard dose of zolpidem (10 mg) on obstructive sleep apnea severity and symptoms have not been investigated. In an open‐label pilot study, 12 unselected people with obstructive sleep apnea were recruited following a diagnostic in‐laboratory sleep study. Participants then returned for a single‐night sleep study in which 10 mg of zolpidem was given just prior to sleep. Tolerability, next‐day sleepiness and the effects of zolpidem on polysomnography variables were assessed. Zolpidem was well tolerated and significantly improved the sleep efficiency compared with the no‐drug night (77 ± 12% versus 84 ± 9%, p = 0.005). Individual responses on obstructive sleep apnea severity to zolpidem in this unselected obstructive sleep apnea patient population were variable with no overall systematic difference in apnea–hypopnea index (29 ± 18.2 events per hr versus 33 ± 28 events per hr, p = 0.45) or other key respiratory parameters (e.g. event duration or hypoxemia). Next‐day sleepiness assessed via the Karolinska Sleepiness Scale was not different between visits (4 ± 1 versus 4 ± 2, p = 0.85). These findings provide the first insight into the effects of a standard dose of zolpidem in obstructive sleep apnea, and highlight its tolerability and potential to improve sleep quality. The variable effects on obstructive sleep apnea severity observed in this pilot also underscore the need for larger trials that incorporate phenotypic characterisation (e.g. arousal threshold, Pcrit and muscle responsiveness) to understand inter‐individual heterogeneity and the therapeutic potential of zolpidem for certain people with obstructive sleep apnea.
Embryonic development in corkwing wrasse, Symphodus melops
Authors: Blanco Gonzalez Enrique , Torstensnes Ingrid , Naito Mana
Published: April 2019

Corkwing wrasse, Symphodus melops, is one of the main species used as cleaner fish to combat sea lice infestation in salmon aquaculture; however, there is little knowledge about its biology. Here, we describe the embryonic development of this species and examine the viability of the eggs under three temperature regimes. The experiments were conducted at three water temperature regimes, 12, 15, and 18°C, which resemble common sea water temperatures registered during the spawning season of corkwing wrasse at different latitudes along the Norwegian coast. Corkwing wrasse spawn small spherical eggs of 0.75–0.80 mm in diameter (mean 0.78, CV = 3.6%) with several oil droplets and go through eight developmental stages until hatching. The shortest hatching time was registered after 144 hr at 18°C and after 222 and 372 hr at 15 and 12°C, respectively. These observations provide important baseline biological information to advance the establishment of commercial rearing techniques and sustainable fishing management practices for this heavily exploited species.
Importance of plant‐ and microbe‐driven metabolic pathways for plant defence
Authors: O'Brien Anna M.
Published: April 2019

Expression of plant phenotypes can depend on both plant genomes and interactions between plants and the microbes living in, on and near their roots. We understand a growing number of the mechanistic links between plant genotypes and phenotypes, such as defence against herbivory (see brief review in Hubbard et al., 2019), yet the links between root microbiomes and the comprehensive swathe of plant phenotypes they affect (Friesen et al., 2011) remain less clear. In this issue of Molecular Ecology, Hubbard et al. (2019) follow microbe‐ and plant‐driven changes in plant defence against hervibory from molecular underpinnings to ecological consequences, contrasting both the metabolites affected and the magnitude of defensive impact. Naively, we might expect plant genomes to drive more variation in phenotype than the root microbiome, but Hubbard et al. (2019) find the opposite, implying profound consequences for plant trait evolution and ecological interactions.
The portion size effect and overconsumption – towards downsizing solutions for children and adolescents – An update
Authors: Hetherington M. M.
Published: April 2019

The portion size effect (PSE), where more is eaten when large amounts are offered, is robust, reliable and enduring. Although it is not known what drives the PSE, amount served may act as a guide to how much should be eaten. Over time, consumers become accustomed to particular amounts of food as the ‘social norm’ and so large portion sizes are treated as typical. For children and adolescents who are forming eating habits, long‐term exposure to large portion sizes of snacks and meal items may encourage overconsumption. Therefore, offering smaller portions to suit the age and stage of children and young people should offer a potential solution to the PSE. We have developed a series of downsizing strategies to test the effect of providing smaller portions of snacks and meal items in pre‐school children, adolescents and families. One potential consequence of downsizing is that compensation may occur, in which smaller portion sizes drive intake of other foods. Therefore, in examining downsizing strategies, measures of compensation elsewhere in the meal or across the overall diet are important. Our studies indicate that it is both feasible and desirable to offer ‘me‐sized’, smaller portions for children to facilitate portion control as food preferences and eating habits are developed. However, strategies for young adults and adolescents are more challenging and require further investigation.
Cardiovascular nurses' adherence to practice standards in in‐hospital telemetry monitoring
Authors: Fålun Nina , Oterhals Kjersti , Pettersen Trond , Brørs Gunhild , Olsen Siv S. , Norekvål Tone M. ,   On behalf of the TELMON‐NOR investigators
Published: April 2019

Background

Correct electrode placement and proper skin preparation for cardiac telemetry monitoring of patients at risk for arrhythmias increase the quality of the arrhythmic surveillance. Inconsistent arrhythmia surveillance can compromise patient safety and care outcomes. An inspection of international literature demonstrates that nurses generally do not adhere to cardiac monitoring standards.

Aim

The aims of this study were to determine cardiovascular nurses' knowledge of and adherence to practice standards for cardiac surveillance and whether their knowledge and practice improves over time.

Study design

A comparative study design was applied, and data were obtained by survey methodology.

Methods

Nurse delegates at the Annual National Congress on Cardiovascular Nursing in Norway completed surveys in 2011 and 2017 (delegates from 44 and 38 hospitals, respectively).

Results

In total, 363 cardiac nurses (70%) responded to the questionnaires. Of these, 95% were female, with a mean age of 41 years. In 2011, 97% of participants were unaware of international practice standards. However, by 2017 unawareness decreased to 78% (P < .001). Despite their lack of knowledge of practice standards, 94% of participants often or always prepared patients' skin for telemetry; this improved from 2011 to 2017 (P = .001). Overall, 73% of nurses never or seldom scrubbed or washed the patients' skin before electrode placement, and 38% of the electrodes were misplaced. In 2011, 49% of nurses used protective telemetry covers; this increased to 80% in 2017 (P < .001). Overall, 64% always informed patients of the purpose of cardiac monitoring.

Conclusion

A significant percentage of nurses fail to adhere to recommendations for electrode placement, skin preparation and providing patients with telemetry information. In order to raise the quality of arrhythmic surveillance, investment in educational programmes in cardiac telemetry monitoring is required.

Relevance to Clinical Practice

Improved in‐hospital telemetry practice is required to ensure patient safety and better care outcomes.
Hoya tengchongensissp. nov. (Apocynaceae, Asclepiadoideae) from Yunnan, China
Authors: Zhang Jing‐Feng , Xia Nian‐He , Kuang Yan‐Feng
Published: April 2019

Hoya tengchongensis, a new species of Apocynaceae, subfamily Asclepiadoideae from Yunnan, China, is described and illustrated. The new species is morphologically similar toHoya serpensin its creeping habit, bearing small and suborbicular leaves, and adaxially tomentose corolla. However,H. tengchongensisdiffers fromH. serpensin corolla size (ca 7 mm versus ca 12 mm in diam) and corona morphology (corona lobes slightly ascending versus erect).
Analysis of procedural data of pulmonary vein isolation for atrial fibrillation with the second‐generation laser balloon
Authors: Nagase Takahiko , Bordignon Stefano , Perrotta Laura , Bologna Fabrizio , Tsianakas Nikolaos , Chen Shaojie , Konstantinou Athanasios , Chun Julian K.R. , Schmidt Boris
Published: April 2019

Background

The procedural data of pulmonary vein (PV) isolation (PVI) for patients with atrial fibrillation using the second‐generation laser balloon (LB2), which became available recently, remains unclear and were evaluated.

Methods

Thirty consecutive patients (116 PVs) underwent PVI using LB2 (LB2 group) and were matched to 30 patients (116 PVs) treated with the first‐generation laser balloon (LB1 group). The left atrial isolated surface area (ISA) (ratio of the total isolated antral surface area excluding PV to the total isolated antral surface area including the posterior wall) was also measured after LB2 PVI.

Results

PVI was achieved in 103/116 (89%) PVs and 108/116 (93%) PVs in the LB2 and LB1 groups, respectively, after the initial circular ablation (P = 0.360) and in 115/116 (99%) PVs and 116/116 (100%) PVs in the LB2 and LB1 groups, respectively, at the end of the procedure (P = 1.000). PV occlusion grade, categorized by the degree of PV occlusion, was significantly better in the LB2 group than in the LB1 group (P < 0.001). Zero rotational maneuver was applicable in 23/116 (20%) PVs and 8/116 (7%) in the LB2 and LB1 groups, respectively (P = 0.007). There was no significant difference in the procedural time, fluoroscopic time, or complications. The mean ISA after LB2 PVI was 53 ± 14%. The application number was the only independent predictor of successful PVI after initial circular LB2 ablation (adjusted odds ratio 0.860; 95% confidence interval 0.764–0.968; P = 0.013).

Conclusion

LB2 displays favorable PV occlusion characteristics and enables more zero rotational maneuvers.
A randomized trial of human C1 inhibitor prophylaxis in children with hereditary angioedema
Authors: Aygören‐Pürsün Emel , Soteres Daniel F. , Nieto‐Martinez Sandra A. , Christensen Jim , Jacobson Kraig W. , Moldovan Dumitru , Van Leerberghe Arthur , Tang Yongqiang , Lu Peng , Vardi Moshe , Schranz Jennifer , Martinez‐Saguer Inmaculada
Published: April 2019

Background

Patients with hereditary angioedema with C1 inhibitor deficiency or dysfunction have burdensome recurrent angioedema attacks. The safety, efficacy, and health‐related quality of life (HRQoL) outcomes of C1 inhibitor (C1‐INH) prophylaxis (intravenously administered) in patients aged 6‐11 years were investigated.

Methods

Eligible patients were enrolled in a randomized, single‐blind, crossover, phase 3 trial. After a 12‐week baseline observation period (BOP), patients received 500 or 1000 U C1‐INH, twice weekly, for 12 weeks before crossing over to the alternate dose for 12 weeks. The primary efficacy end‐point was the monthly normalized number of angioedema attacks (NNA). HRQoL was assessed using the EuroQoL 5‐dimensional descriptive system youth version and visual analog scale (EQ‐VAS).

Results

Twelve randomized patients had a median (range) age of 10.0 (7‐11) years. Mean (SD) percentage reduction in monthly NNA from BOP was 71.1% (27.1%) with 500 U and 84.5% (20.0%) with 1000 U C1‐INH. Mean (SD) within‐patient difference (−0.4 [0.58]) for monthly NNA with both doses was significant (P = 0.035 [90% CI, −0.706 to −0.102]). Cumulative attack severity, cumulative daily severity, and number of acute attacks treated were reduced. No serious adverse events or discontinuations occurred. Mean EQ‐VAS change from BOP to week 9 of treatment (500 U C1‐INH, 10.4; 1000 U C1‐INH, 21.6) was greater than the minimal important difference, indicating a meaningful HRQoL change.

Conclusions

C1‐INH prophylaxis was effective, safe, and well tolerated in children aged 6‐11 years experiencing recurrent angioedema attacks. A post hoc analysis indicated a meaningful improvement in HRQoL with C1‐INH.

Trial registration

ClinicalTrials.gov identifier NCT02052141.
Negative gravitropic response of roots directs auxin flow to control root gravitropism
Authors: Ge Liangfa , Chen Rujin
Published: April 2019

Root tip is capable of sensing and adjusting its growth direction in response to gravity, a phenomenon known as root gravitropism. Previously, we have shown that negative gravitropic response of roots (NGR) is essential for the positive gravitropic response of roots. Here, we show that NGR, a plasma membrane protein specifically expressed in root columella and lateral root cap cells, controls the positive root gravitropic response by regulating auxin efflux carrier localization in columella cells and the direction of lateral auxin flow in response to gravity. Pharmacological and genetic studies show that the negative root gravitropic response of the ngr mutants depends on polar auxin transport in the root elongation zone. Cell biology studies further demonstrate that polar localization of the auxin efflux carrier PIN3 in root columella cells and asymmetric lateral auxin flow in the root tip in response to gravistimulation is reversed in the atngr1;2;3 triple mutant. Furthermore, simultaneous mutations of three PIN genes expressed in root columella cells impaired the negative root gravitropic response of the atngr1;2;3 triple mutant. Our work revealed a critical role of NGR in root gravitropic response and provided an insight of the early events and molecular basis of the positive root gravitropism.
Topical timolol as adjunct therapy to shorten oral propranolol therapy for infantile hemangiomas
Authors: Mannschreck Diana B. , Huang Amy H. , Lie Erina , Psoter Kevin , Puttgen Katherine
Published: April 2019

Background/Objectives

First‐line therapy for infantile hemangiomas (IH) is oral propranolol, a systemic beta‐blocker with the risk of rare but serious adverse effects. Topical timolol presents an attractive off‐label alternative with good tolerability, but sequential therapy with propranolol followed by timolol is not well studied. Here, we report effects of topical timolol preceding or following oral propranolol as adjunct therapy for IH.

Methods

A retrospective chart review of 559 patients with IH seen at the pediatric dermatology clinic of a tertiary care center between December 2008 and January 2018. Children were grouped by treatment received: propranolol only, timolol only, propranolol to timolol, timolol to propranolol to timolol, and timolol to propranolol. Patient demographics, clinical/treatment characteristics, and pairwise differences were explored between groups.

Results

Among all patients treated with propranolol, those who received propranolol followed by timolol received the shortest duration of oral propranolol and were the youngest at the time of propranolol completion. These patients received propranolol for a median of 2.2 months duration (P = 0.006) and were a median of 1.7 months younger (P = 0.007) compared with patients who received oral propranolol only. None had treatment failure defined as requiring propranolol reinitiation, compared with 13% of patients in the propranolol only group (P = 0.036).

Conclusions

Sequential therapy with oral propranolol followed by topical timolol for IH may help minimize potential adverse effects of systemic beta‐blockers by reducing the duration of propranolol therapy and facilitating successful taper at a younger age without an increase in treatment failures.
Policy analysis of access to and reimbursement for nonpharmacologic therapies for cancer‐related fatigue
Authors: Djalilova Dilorom , Mandolfo Natalie , Berger Ann M. , Cramer Mary E.
Published: April 2019

Cancer‐related fatigue (CRF) is an important public health issue that involves millions of community‐dwelling cancer survivors. CRF is the most debilitating patient reported symptom related to cancer therapies and exacts a significant economic and social toll. It adversely impacts patients' work, social relationships, and overall quality of life. CRF prevalence ranges from 30% to 90% during therapy and often persists months and years afterwards. This policy analysis examines the problem of lack of patient access to evidence‐based nonpharmacologic CRF therapies. The authors use a five‐step process described by Teitelbaum & Wilenski (2017) to address the problem statement, identify key stakeholders, explore problem landscape, describe two viable policy options, and make a recommendation. The two policy options considered were: (a) insurer reimbursements modeled after existing cardiac rehabilitation programs and (b) health care provider incentives that incorporate the oncology care model (OCM) quality measure. Advantages and disadvantages of both options are presented. Public health nurses are uniquely positioned in their communities to advocate for these changes to improve population health.
Different Photosynthetic Responses of Pyropia yezoensis to Ultraviolet Radiation Under Changing Temperature and Photosynthetic Active Radiation Regimes
Authors: Bao Menglin , Hu Lili , Fu Qianqian , Gao Guang , Li Xinshu , Xu Juntian
Published: April 2019

Macroalgae play a crucial role in coastal marine ecosystems, but they are also subject to multiple challenges due to tidal and seasonal alterations. In this work, we investigated the photosynthetic response of Pyropia yezoensis to ultraviolet radiation (PAR: 400–700 nm; PAB: 280–700 nm) under changing temperatures (5, 10 and 15°C) and light intensities (200, 500 and 800 μmol photons m−2 s−1). Under low light intensity (200 μmol photons m−2 s−1), P. yezoensis showed the lowest sensitivity to ultraviolet radiation, regardless of temperature. However, higher temperatures inhibited the repair rates (r) and damage rates (k) of photosystem II (PSII) in P. yezoensis. However, under higher light intensities (500 and 800 μmol photons m−2 s−1), P. yezoensis showed higher sensitivity to UV radiation. Both r and the ratio of repair rate to damage rate (r:k) were significantly inhibited in P. yezoensis by PAB, regardless of temperature. In addition, higher temperatures significantly decreased the relative UV‐inhibition rates, while an increased carbon fixation rate was found. Our study suggested that higher light intensities enhanced the sensitivity to UV radiation, while higher temperatures could relieve the stress caused by high light intensity and UV radiation.
The Two Faces of Mental Imagery
Authors: Arcangeli Margherita
Published: April 2019

Mental imagery has often been taken to be equivalent to “sensory imagination”, the perception‐like type of imagination at play when, for example, one visually imagines a flower when none is there, or auditorily imagines a music passage while wearing earplugs. I contend that the equation of mental imagery with sensory imagination stems from a confusion between two senses of mental imagery. In the first sense, mental imagery is used to refer to a psychological attitude, which is perception‐like in nature. In the second sense, mental imagery refers to a mental content, which can be grasped via different attitudes. I will show that failure to acknowledge the distinction between these senses of mental imagery has muddled philosophical discussion. This distinction brings much needed clarity to debates where sensory imagination and mental imagery are invoked, shedding light on issues such as the nature of imagistic mental states, and the representational powers and limits of mental imagery. I will conclude by sketching a general attitudinal account of imagination that does justice to both senses of mental imagery, outlining a promising framework for understanding imagination.
Ethics by Design: The Impact of Form of Government on Municipal Corruption
Authors: Nelson Kimberly L. , Afonso Whitney B.
Published: April 2019

While trust in government at all levels is at an all‐time low, actual corruption at the municipal level has been declining. One factor often credited with this decline is the introduction of the council‐manager form of government. One of the key reasons the council‐manager form was created in the early 1900s was to act as an antidote to the corruption prevalent in the big‐city machine politics of the era. Despite this, no one has tested whether the council‐manager form has in fact influenced the decline in corruption rates. This article uses a rare events logit model to analyze corruption convictions in municipalities between 1990 and 2010 to determine which factors, including form of government, affect the probability that a corrupt act will occur. The findings indicate that municipalities with the council‐manager form are 57 percent less likely to have corruption convictions than municipalities with the mayor‐council form.
Non‐R&D innovation and firms’ new product performance: the joint moderating effect of R&D intensity and network embeddedness
Authors: Xie Xuemei , Wang Hongwei , Jiao Hao
Published: April 2019

Non‐R&D innovation increasingly plays a critical role in explaining firms’ new product performance. Yet, there has been little research on the consequences and contingent mechanisms of non‐R&D innovation for firms embedded in collaborative network environments. To address this research gap, we investigated a conceptual framework of non‐R&D innovation using data drawn from Chinese manufacturing firms. First, we found that non‐R&D innovation positively affects firms’ new product performance. Second, we discovered that high R&D intensity positively strengthens the impact of firms’ non‐R&D innovation on new product performance. Third, we provided critical analysis of the role of non‐R&D innovation in promoting new product performance, accomplished by enhancing R&D investment while simultaneously improving the degree of network embeddedness. Our findings extend both the non‐R&D innovation literature and open innovation literature while providing managers with several key recommendations.
Cultural Theory's Contributions to Risk Analysis: A Thematic Review with Directions and Resources for Further Research
Authors: Johnson Branden B. , Swedlow Brendon
Published: April 2019

Cultural theory (CT) developed from grid/group analysis, which posits that different patterns of social relations—hierarchist, individualist, egalitarian, and fatalist—produce compatible cultural biases influencing assessment of which hazards pose high or low risk and how to manage them. Introduced to risk analysis (RA) in 1982 by Douglas and Wildavsky's Risk and Culture, this institutional approach to social construction of risk surprised a field hitherto focused on psychological influences on risk perceptions and behavior. We explain what CT is and how it developed; describe and evaluate its contributions to the study of risk perception and management, and its prescriptions for risk assessment and management; and identify opportunities and resources to develop its contributions to RA. We suggest how the diverse, fruitful, but scattered efforts to develop CT both inside and outside the formal discipline of RA (as exemplified by the Society for Risk Analysis) might be leveraged for greater theoretical, methodological, and applied progress in the field.
A Comprehensive Approach to Problems of Performance Measurement
Authors: Fisher N. I.
Published: April 2019

The paper describes a comprehensive approach to problems of performance measurement that can be used to tackle a wide range of situations, including designing monthly board and leadership reports in enterprises, assessing research quality and monitoring the efficiency and effectiveness of government programmes. It provides a review of various methods for tackling these problems and outlines some current areas of research. Although technical statistical issues are buried somewhat below the surface, statistical thinking is very much part of the main line of argument, meaning that performance measurement should be an area attracting serious attention from statisticians.
Achieving a person‐centered approach to dialysis discontinuation: An historical perspective
Authors: O'Hare Ann M. , Murphy Emma , Butler Catherine R. , Richards Claire A.
Published: April 2019

In this essay, we describe the evolution of attitudes toward dialysis discontinuation in historical context, beginning with the birth of outpatient dialysis in the 1960s and continuing through the present. From the start, attitudes toward dialysis discontinuation have reflected the clinical context in which dialysis is initiated. In the 1960s and 1970s, dialysis was only available to select patients and concerns about distributive justice weighed heavily. Because there was strong enthusiasm for new technology and dialysis was regarded as a precious resource not to be wasted, stopping treatment had negative moral connotations and was generally viewed as something to be discouraged. More recently, dialysis has become the default treatment for advanced kidney disease in the United States, leading to concerns about overtreatment and whether patients' values, goals, and preferences are sufficiently integrated into treatment decisions. Despite the developments in palliative nephrology over the past 20 years, dialysis discontinuation remains a conundrum for patients, families, and professionals. While contemporary clinical practice guidelines support a person‐centered approach toward stopping dialysis treatments, this often occurs in a crisis when all treatment options have been exhausted. Relatively little is known about the impact of dialysis discontinuation on the experiences of patients and families and there is a paucity of high‐quality person‐centered evidence to guide practice in this area. Clinicians need better insights into decision‐making, symptom burden, and other palliative outcomes that patients might expect when they discontinue dialysis treatments to better support decision‐making in this area.
Being a poor farmer in a wealthy country: A Swiss case study
Authors: Contzen Sandra , Crettaz Eric
Published: April 2019

Many Swiss farming families face socioeconomic disadvantage despite Switzerland being a wealthy country with instruments of agricultural policy financially supporting almost all farmers. However, official poverty statistics exclude Swiss farmers and scientific knowledge is rare about how such situations are experienced. This article scrutinises the situation of Swiss farming families living in poverty or material deprivation by intertwining qualitative and quantitative methods to enrich both types of data and interpretations. By statistically comparing farmers with the self‐employed in other economic sectors, it uses a novel way of comparing the farming with the non‐farming population. The article shows that the poverty among farmers resembles that of the self‐employed with no or few employees in other economic sectors and describes the lived experiences of poverty and material deprivation. It concludes that adaptive preferences make farming families resilient to socioeconomic disadvantage, while possibly leading to a loss of their livelihood in the long run.
Discrepancies between self‐reported tick bites and evidence of tick‐borne disease exposure among nomadic Mongolian herders
Authors: Lkhagvatseren Sukhbaatar , Hogan Kathryn M. , Boldbaatar Bazartseren , von Fricken Michael E. , Anderson Benjamin D. , Pulscher Laura A. , Caddell Luke , Nymadawa Pagbajabyn , Gray Gregory C.
Published: April 2019

Twenty‐six per cent of Mongolians live pastoral lifestyles, increasing their likelihood of exposure to ticks and placing them at a higher risk for contracting tick‐borne diseases (TBDs). Anaplasma spp. and Rickettsia spp. have been identified in ticks, livestock and humans in Mongolia, but no known qualitative research has been conducted investigating the association between nomadic herder characteristics, tick bite history and exposure to TBDs. To better understand the association between self‐reported tick bites and symptoms versus actual exposure to TBDs, this study paired serological data with 335 surveys administered to Mongolian herders, ages 12–69, from 2014 to 2015. Logistic regression results identified no significant associations between reported tick bites or symptoms with serological evidence of Anaplasma spp. and Rickettsia spp. controlling for age, gender and aimag. Among the 335 respondents who were seropositive to either Anaplasma spp. or Rickettsia spp., 32.9% self‐reported experiencing abnormal symptoms such as redness, inflammation, headache, arthritis or fever after being bitten. Alternatively, 17.3% (58/335) of individuals reported experiencing symptoms following a tick bite in instances where serological results indicated no exposure to Anaplasma spp. or Rickettsia spp. Results also identified inconsistencies in reporting and seroprevalence among different age groups, with children having the highest reporting and treatment seeking rates but low levels of exposure in comparison with other groups. While survey results showed that individuals were aware of peak tick seasons and tick species that inhabit specific areas, 58% of heads of households (49/84) were unaware that ticks can cause disease in livestock or dogs. This study suggests that herders are an at‐risk population in Mongolia with gaps in awareness of TBD risk. Increased surveillance paired with focused outreach to prevent TBDs targeted to the herder population is encouraged.
Intercellular calcium waves integrate hormonal control of glucose output in the intact liver
Authors: Gaspers Lawrence D. , Pierobon Nicola , Thomas Andrew P.
Published: April 2019

Key points

Sympathetic outflow and circulating glucogenic hormones both regulate liver function by increasing cytosolic calcium, although how these calcium signals are integrated at the tissue level is currently unknown.

We show that stimulation of hepatic nerve fibres or perfusing the liver with physiological concentrations of vasopressin only will evoke localized cytosolic calcium oscillations and modest increases in hepatic glucose production.

The combination of these stimuli acted synergistically to convert localized and asynchronous calcium responses into co‐ordinated intercellular calcium waves that spread throughout the liver lobule and elicited a synergistic increase in hepatic glucose production.

The results obtained in the present study demonstrate that subthreshold levels of one hormone can create an excitable medium across the liver lobule, which allows global propagation of calcium signals in response to local sympathetic innervation and integration of metabolic regulation by multiple hormones. This enables the liver lobules to respond as functional units to produce full‐strength metabolic output at physiological levels of hormone.

Glucogenic hormones, including catecholamines and vasopressin, induce frequency‐modulated cytosolic Ca2+ oscillations in hepatocytes, and these propagate as intercellular Ca2+ waves via gap junctions in the intact liver. We investigated the role of co‐ordinated Ca2+ waves as a mechanism for integrating multiple endocrine and neuroendocrine inputs to control hepatic glucose production in perfused rat liver. Sympathetic nerve stimulation elicited localized Ca2+ increases that were restricted to hepatocytes in the periportal zone. During perfusion with subthreshold vasopressin, sympathetic stimulation converted asynchronous Ca2+ signals in a limited number of hepatocytes into co‐ordinated intercellular Ca2+ waves that propagated across entire lobules. A similar synergism was observed between physiological concentrations of glucagon and vasopressin, where glucagon also facilitated the recruitment of hepatocytes into a Ca2+ wave. Hepatic glucose production was significantly higher with intralobular Ca2+ waves. We propose that inositol 1,4,5‐trisphosphate (IP3)‐dependent Ca2+ signalling gives rise to an excitable medium across the functional syncytium of the hepatic lobule, co‐ordinating and amplifying the metabolic responses to multiple hormonal inputs.
Performance Comparison of a Single Cylinder and a Dual Cylinder Free Piston Engine
Authors: Bade Mehar , Clark Nigel. N. , Famouri Parviz , Guggilapu PriyaankaDevi
Published: April 2019

Free piston linear engine alternators (FPLEA) may be designed following several different baseline configurations. Common designs include a translator that carries permanent magnets, with either one piston attached to one end of the translator, or a piston at each end of the translator. The single cylinder engine requires a reversing force from a spring so that it can operate, whereas, the dual cylinder version can operate without a spring. However, inclusion of stiff springs would serve to raise the operating frequency and reduces the cycle-to-cycle variations in a dual cylinder version. A matlab/simulink numerical model with translator rod dynamics and in-cylinder thermodynamics was employed to predict the overall performance and efficiency of a FPLEA. This numerical model allowed comparison of different FPLEA configurations for a variety of design variables. First, a dual cylinder FPLEA design was considered where the spring constant was varied, changing the frequency of operation and the motion of the translator. The simulation results showed that without springs the motion was far from sinusoidal, and low in frequency and power, whereas the presence of stiff springs in the system strongly dictated nearly sinusoidal motion and high power at high frequency. Effects of other parameters such as stroke and bore were also examined. Finally, the same tests were carried out for a single cylinder FPLEA design. The simulation results showed that the dual cylinder engine produced twice the electrical power output with higher efficiency than the single cylinder engine for the same cylinder geometry.