bluuebunny/crossref_metadata_2025 huggingface dataset:
Sustainable tourism development in Kepulauan Seribu
Authors: Mira  , Marrou L , Muawanah U
Published: December 2019

This paper aims to analyze sustainable tourism development in the Kepulauan Seribu. The methodology employed three indicators for sustainable tourism namely development strategies, visitor behavior, and general concepts. The results show that tourism development driven by a private company has a lack of the principles of sustainability. Tourism development is oriented to non-local business players. On the contrary, the island that is managed by the community and the government implements the principles of sustainable tourism development. The owner of hotels and homestays use local labors. Based on visitor behavior indicator, those islands managed by private companies, only apply one out of 6 sustainable indicators, namely trip preparation. For the other 4 sustainable tourism development indicators, private islands do not implement them. For example, when tourists do not learn the local language, they have no desire to visit the private island again. Based on development strategies indicators, the island being managed by the community and government does implement the sustainable tourism development principles. This is because the island implements the most determined sustainable tourism indicators such as using local developers, local labors, and local architectures.
Production and carrying capacity of super-1 sorghum given different levels of chicken manure
Authors: Rumambi A , B. Kaunang W , Pontoh C J , Tangkere E S
Published: December 2019

An experiment was conducted in order to determine the level of chicken manure which best for the production and carrying capacity of Super-1 sorghum. Completely Randomized Design (CRD) was used in this experiment with four treatments as follow P0 = without chicken manure; P1 = 3,500 kg manure/ha; P2 = 4,500 kg manure/ha; P3 = 5,500 kg manure/ha, 5 repetitions each treatment, as a result it was obtained total of 20 experimental unit. There were 36 sorghum plants on each 6 m2 plot sized. Measurements taken were plants height (cm/plant), leaf number (leaves/plant), leaf length (cm/leaf/plant), fresh weight (gr/plant), dry weight (gr/plant) and carrying capacity (ha/AU/year). Sorghums were harvested on the day 110th. It was found in this experiment that the application of chicken manure gave a significant effect (P<0.05) on all measurements taken compared to that of all measurements taken in control. Application of chicken manure at level 5,500 kg per hectare gave the best results on all growth parameters and forage yields of Super 1 sorghum as well as its carrying capacity.
Sustainable markets development in Bogor District
Authors: Mansyur U , Priatna D
Published: December 2019

Bogor District consists 40 sub-districts and 483 villages, with development policy in the development of Metropolitan Jabodetabekpunjur, which makes the potential to grow rapidly. The increase of GRDP value is indirectly affected by the condition of economic activity, including the existence of economic facilities and infrastructures and its sustainability. The objectives of this research are to identify market development location (environmental aspect), to identify market development feasibility (economic aspect), and to draw up the concept of distributed market development (social aspect). This research uses the methodology of agency and field surveys, observations and interviews using descriptive analysis technique, scoring system, descriptive statistics and strategic decision making. The results obtained from this research: there are 26 sub-district traditional markets and 47 village traditional markets by lacks of 450 markets, under the category of 12 most feasible markets, 16 feasible markets, and 12 unfeasible markets; the first optimization model is achieved by Kemang sub-district while the second position is achieved by Dramaga sub-district and the third position is achieved by Ciawi sub-district; and the development in 2018-2038 by the highest population in Gunungputri and the lowest population in Cariu, under total needs of 280 markets and still lacks of 202 markets.
Determinants of household food waste value in Indonesia: a study case on high education level parents
Authors: Pamela  , Nugraha A , Aritonang M , Hutajulu J P
Published: December 2019

In the world, amounting to about 1.3 billion tons is lost or wasted every year. This study used a quantitative method and descriptive analysis to find the determinants of consumer household food waste behavior in Indonesia. The study used multiple linear regression to found the significant factors that determined household food waste. The results were (1) knowledge of the parent, (2) recording of the shopping list, and (3) waste size become the factors that have a significant impact on waste value. The findings suggest that public advertisement about food waste could be generated knowledge of the parent, and the practice of management principle could be used on the food waste management on consumer behavior.
Utilization of liquid waste from freshwater fish cultivation in bioreactors batch culture system and biochar to increase lettuce plant production (Lactuca sativa L.)
Authors: Zaitun  , Halim A , Rahya S
Published: December 2019

The utilization of freshwater fish cultivation and agricultural wastes can be an alternative in increasing vegetable production. Freshwater fish waste can be used as liquid organic fertilizer, while agricultural waste in the form of rice husk can be used as biochar which has the potential to improve soil fertility. the The purpose of this study was to evaluate the treatment of watering freshwater fish waste as a liquid organic fertilizer that affects the production of lettuce plants, as well as to evaluate the rice husk biochar treatment that can affect the production of lettuce plants. This study used a factorial randomized block design with 3 replications. The factors used in this studied were Factor I: watering frequency of freshwater aquaculture wastewater, consisting of without watering wastewater (L0); watering twice a week (L1); and watering 4 times a week (L2); and Factor II: dosage of rice husk biochar, consisting of without rice husk biochar (B0); 10 g of rice husk biochar per polybag (B1); 20 g of rice husk biochar per polybag (B2). The result showed that:(1) liquid waste from freshwater fish cultivation in bioreactor batch culture system can be used as liquid organic fertilizer in lettuce cultivation, and (2) watering frequency of liquid organic fertilizer from freshwater aquaculture wastewater 4 times a week and rice husk biochar 20 g per polybag were the best treatment for lettuce yield.
The importance of ecocentrism to the level of environmental awareness for sustainable natural resources
Authors: Humaida N
Published: December 2019

Environmental ethics is a reflection of the moral principle between human beings and the natural environment. Ecocentrism, one of the environmental ethics, supports long-term environmental sustainability. This study aimed to determine the roles of ecocentrism toward the level of environmental awareness for sustainable use of natural resources. This descriptive research is to determine the association between the level of environmental awareness and environmental ethics. The study involved 30 students in Biology Education Department. Data were primarily collected using researcher-developed questionnaires. The level of environmental awareness was measured by using the Likert scale (1-5), based on the students’ positive contribution to their local environment in daily life. The problem-based interview was also added to determine which environmental ethics the students stood for (Ecocentrism or Anthropocentrism). The result showed 19 out of 30 students were dominated by anthropocentrism rather than ecocentrism toward the environment. Chi-Square analysis showed that there is no significant association between the level of environmental awareness and environmental ethics. People can have the same level of environmental awareness, but different environmental ethics. Ecocentrism needs to be promoted more in academics for sustainable use of natural resources not only for the present generation but also for the future generation.
Effects of single vacancy on electronic properties of blue-phosphorene nanotubes
Authors: Vergara J M , Flórez E , Mora-Ramos M E , Correa J D
Published: December 2019

We investigate the electronic properties of blue-phosphorene nanotubes using density functional theory first-principle calculations, taking into account, in particular, the presence of atom vacancies in the structure. The study considers both zigzag and armchair achiral configurations and reports on the structure and the electron energy states of the nanostructure. Compared to pristine blue-phosphorene nanotubes, which exhibit values of the fundamental bandgap between one and two electron-volts. For atomic single vacancies, the incorporation of spin-polarization helps to identify the induction of localized mid-gap states in the blue phosphorene nanotubes. The difference of energy between the highest near-valence and lower near-conduction localized states is, approximately, of 0.5 eV. Also the increase of the single vacancies concentration leads to the formation of additional bands that change the energy gap of the system.
MatchMixeR: a cross-platform normalization method for gene expression data integration
Authors: Zhang Serin , Shao Jiang , Yu Disa , Qiu Xing , Zhang Jinfeng
Published: December 2019

Motivation

Combining gene expression (GE) profiles generated from different platforms enables previously infeasible studies due to sample size limitations. Several cross-platform normalization methods have been developed to remove the systematic differences between platforms, but they may also remove meaningful biological differences among datasets. In this work, we propose a novel approach that removes the platform, not the biological differences. Dubbed as ‘MatchMixeR’, we model platform differences by a linear mixed effects regression (LMER) model, and estimate them from matched GE profiles of the same cell line or tissue measured on different platforms. The resulting model can then be used to remove platform differences in other datasets. By using LMER, we achieve better bias-variance trade-off in parameter estimation. We also design a computationally efficient algorithm based on the moment method, which is ideal for ultra-high-dimensional LMER analysis.

Results

Compared with several prominent competing methods, MatchMixeR achieved the highest after-normalization concordance. Subsequent differential expression analyses based on datasets integrated from different platforms showed that using MatchMixeR achieved the best trade-off between true and false discoveries, and this advantage is more apparent in datasets with limited samples or unbalanced group proportions.

Availability and implementation

Our method is implemented in a R-package, ‘MatchMixeR’, freely available at: https://github.com/dy16b/Cross-Platform-Normalization.

Supplementary information

Supplementary data are available at Bioinformatics online.
The Elephant in the Room: Race and STEM Diversity
Authors: Miriti Maria N
Published: December 2019

Despite considerable efforts to enhance participation of underrepresented demographics, participation of scholars of color in STEM remains stagnant. In contrast to other academic disciplines, the experiences of STEM scholars of color are relatively unvoiced, which hinders examination of the factors that reduce participation and retention. Social science and education research reveal the importance of intersectional strategies to address institutional and cultural practices that reduce diverse participation. Institutional change requires the support of the STEM workforce. I summarize important issues that influence recruitment and retention and offer strategies that can improve recruitment and retention of faculty of color. Broad awareness among STEM practitioners of the relationship between race and the biases that reduce recruitment and retention of underrepresented scholars can support STEM diversity initiatives.
Combined centrality measures for an improved characterization of influence spread in social networks
Authors: Şimşek Mehmet , Meyerhenke Henning
Published: December 2019

Influence Maximization (IM) aims at finding the most influential users in a social network, that is, users who maximize the spread of an opinion within a certain propagation model. Previous work investigated the correlation between influence spread and nodal centrality measures to bypass more expensive IM simulations. The results were promising but incomplete, since these studies investigated the performance (i.e. the ability to identify influential users) of centrality measures only in restricted settings, for example, in undirected/unweighted networks and/or within a propagation model less common for IM. In this article, we first show that good results within the Susceptible-Infected-Removed propagation model for unweighted and undirected networks do not necessarily transfer to directed or weighted networks under the popular Independent Cascade (IC) propagation model. Then, we identify a set of centrality measures with good performance for weighted and directed networks within the IC model. Our main contribution is a new way to combine the centrality measures in a closed formula to yield even better results. Additionally, we also extend gravitational centrality (GC) with the proposed combined centrality measures. Our experiments on 50 real-world data sets show that our proposed centrality measures outperform well-known centrality measures and the state-of-the art GC measure significantly.
Plant hydraulic traits reveal islands as refugia from worsening drought
Authors: Ramirez Aaron R , De Guzman Mark E , Dawson Todd E , Ackerly David D
Published: December 2019

Relatively mesic environments within arid regions may be important conservation targets as ‘climate change refugia’ for species persistence in the face of worsening drought conditions. Semi-arid southern California and the relatively mesic environments of California’s Channel Islands provide a model system for examining drought responses of plants in potential climate change refugia. Most methods for detecting refugia are focused on ‘exposure’ of organisms to certain abiotic conditions, which fail to assess how local adaptation or acclimation of plant traits (i.e. ‘sensitivity’) contribute to or offset the benefits of reduced exposure. Here, we use a comparative plant hydraulics approach to characterize the vulnerability of plants to drought, providing a framework for identifying the locations and trait patterns that underlie functioning climate change refugia. Seasonal water relations, xylem hydraulic traits and remotely sensed vegetation indices of matched island and mainland field sites were used to compare the response of native plants from contrasting island and mainland sites to hotter droughts in the early 21st century. Island plants experienced more favorable water relations and resilience to recent drought. However, island plants displayed low plasticity/adaptation of hydraulic traits to local conditions, which indicates that relatively conserved traits of island plants underlie greater hydraulic safety and localized buffering from regional drought conditions. Our results provide an explanation for how California’s Channel Islands function as a regional climate refugia during past and current climate change and demonstrate a physiology-based approach for detecting potential climate change refugia in other systems.
Left ventricular function monitoring in heart failure
Authors: Čelutkienė Jelena , Spoletini Ilaria , Coats Andrew J S , Chioncel Ovidiu
Published: December 2019

Imaging modalities are used for screening, risk stratification and monitoring of heart failure (HF). In particular, echocardiography represents the cornerstone in the assessment of left ventricular (LV) dysfunction. Despite the well-known limitations of LV ejection fraction, this parameter, repeated assessment of LV function is recommended for the diagnosis and care of patients with HF and provides prognostic information. Left ventricular ejection fraction (LVEF) has an essential role in phenotyping and appropriate guiding of the therapy of patients with chronic HF. This document reflects the key points concerning monitoring LV function discussed at a consensus meeting on physiological monitoring in the complex multi-morbid HF patient under the auspices of the Heart Failure Association of the ESC.
Who approves/pays for additional monitoring?
Authors: Rosano Giuseppe M C , Spoletini Ilaria , Vitale Cristiana
Published: December 2019

Major considerations in the provision of healthcare are availability, affordability, accessibility, and appropriateness, especially in the setting of heart failure where disease burden is growing, developments have been rapid and newer biomarkers, diagnostic and imaging techniques, monitoring systems, devices, procedures, and drugs have all been developed in a relatively short period of time. Many monitoring and diagnostic systems have been developed but the disproportionate cost of conducting trials of their effectiveness has limited their uptake. There are added complexities, in that the utilization of doctors for the supervision of the monitoring results may be optimal in one setting and not in another because of differences in the characteristics of organization of healthcare provision, making even interpretation of the trials we have had, still difficult to interpret. New technologies are continuously changing the approach to healthcare and will reshape the structure of the healthcare systems in the future. Mobile technologies can empower patients and carers by giving them more control over their health and social care needs and reducing their dependence on healthcare professionals for monitoring their health, but a significant problem is the integration of the multitude of monitored parameters with clinical data and the recognition of intervention thresholds. Digital technology can help, but we need to prove its cost/efficacy and how it will be paid for. Governments in many European countries and worldwide are trying to establish frameworks that promote the convergence of standards and regulations for telemedicine solutions and yet simultaneously health authorities are closely scrutinizing healthcare spending, with the objective of reducing and optimizing expenditure in the provision of health services. There are multiple factors to be considered for the reimbursement models associated with the implementation of physiological monitoring yet it remains a challenge in cash-strapped health systems.
Loneliness Following Widowhood: The Role of the Military and Social Support
Authors: King Brittany M , Carr Dawn C , Taylor Miles G
Published: December 2019

Objectives

Increased loneliness is a common consequence of widowhood in later life. However, individuals with high levels of perceived social support from friends tend to cope more effectively following major social losses like widowhood. Military service is associated with cultivation of strong social support structures. This effect may not only influence those who serve, but also their spouses. Roughly half of older women today are married to veterans, which could shape how they cope with widowhood. We tested two hypotheses: (a) widows of veterans will be less lonely following widowhood compared to their nonveteran counterparts, and (b) this effect will be explained by perceived social support from friends.

Methods

We used the Health and Retirement Study (HRS) to examine changes in loneliness following widowhood among wives of veterans and nonveterans. We used Ordinary Least Squares regression and mediation tests to address our hypotheses.

Results

Net of baseline differences, widows of veterans reported statistically lower levels of loneliness (p < .05) following widowhood compared to widows of nonveterans. Widows of veterans retained the same level of perceived social support from friends pre- and postwidowhood, whereas nonveteran wives experienced a loss. Perceived social support from friends mediated the association between veteran status of the deceased spouse and loneliness.

Discussion

Our findings suggest wives of veterans may have more resilient social support structures than nonveteran spouses, helping them cope at widowhood. Future research should explore whether these effects persist in association with other major stressful events in later life.
Technology Adaptivity Mediates the Effect of Technology Biography on Internet Use Variability
Authors: Seifert Alexander , Kamin Stefan T , Lang Frieder R
Published: December 2019

Background and Objectives

Increasing numbers of older adults use the internet, but relatively little is known about the range and determinants of different online activities among older internet users. This study explores the interplay between technology-related biographical experiences and subjective technology adaptivity to explain the variability of internet use. Older adults who report having had more biographical experiences with technologies were expected to use a greater range of online activities. In addition, subjective technology adaptivity was expected to serve as a mediator of this relationship.

Research Design and Methods

The analyses are based on a sample of 707 community-dwelling older participants of the University of the Third Age between 60 and 95 years of age (mean age = 72.49 years; 48% female) who use the internet. The measures include self-reports of online activities, technology-related biographical experiences, subjective technology adaptivity, and personal characteristics (age, gender, education, income, living-together status, and subjective health). Correlations and a path model with mediator effects were used to explore the research hypothesis.

Results

The bivariate effects on the variability of internet use showed that study subjects participated in a greater range of online activities when they lived together with other people and were male, younger, and had higher levels of subjective technology adaptivity, technology-related biographical experiences, and educational level. The direct effects on the mediator show higher levels of subjective technology adaptivity for people who reported greater technology-related biographical experiences and for those who reported higher levels of subjective health.

Discussion and Implications

The results show that the positive association between people’s past experiences with and stances toward technology in their own lifetimes and their range of diverse internet activities is mediated by subjective technology adaptivity. The findings also help to illustrate which biographical factors and which current individual factors explain differences in actual online behavior.
The birth of a baby with mosaicism resulting from a known mosaic embryo transfer: a case report
Authors: Kahraman Semra , Cetinkaya Murat , Yuksel Beril , Yesil Mesut , Pirkevi Cetinkaya Caroline
Published: December 2019

Mosaic embryos have the potential to implant and develop into healthy babies. The transfer of mosaic embryos is now considered to be a possible option for women undergoing ART with preimplantation genetic testing for aneuploidies and in the absence of euploid embryos, particularly those with diminished ovarian reserve and/or advanced maternal age. It can aid in avoiding the discard of potentially viable embryos, which might otherwise result in healthy babies. In over 500 studies on mosaicism, there have been no reports of mosaicism in babies born following the transfer of mosaic embryos. Here, we present a case report of a 39-year-old woman with diminished ovarian reserve with only one blastocyst available for trophectoderm biopsy. The transfer of the embryo, which showed 35% mosaicism of monosomy 2, resulted in pregnancy. Amniocentesis revealed a mosaic trisomic mos46,XX(98)/47,XX,+2(2) karyotype. There were no pathological findings in detailed ultrasonography, and the fetus showed a normal fetal growth with no evidence of intrauterine growth retardation. A healthy female baby was born at Week 37. The peripheral blood chromosome analysis validated with fluorescence in situ hybridization showed 2% mosaic monosomy 2 [mos45,XX,-2(2)/46,XX(98)]. This is the first reported case of true fetal mosaicism resulting in a live birth following the transfer of a known mosaic embryo. Worldwide, prenatal diagnosis has shown the depletion of mosaicism in embryos transferred after they have been reported as mosaics. Our case demonstrates the need for close prenatal monitoring and diagnosis by early amniocentesis, preferably at >14 weeks gestation.
Mediastinal teratoma presenting with respiratory distress and cardiogenic shock in a neonate
Authors: Stajevic Mila , Dizdarevic Ivan , Krunic Igor , Topic Vesna
Published: December 2019

Mediastinal teratomas are uncommon, fast-growing thoracic tumours, which are usually diagnosed in childhood or adolescence. Neonatal forms are the rarest and often present with life-threatening respiratory distress syndrome. In our case, respiratory failure in a neonate was aggravated by severe cardiogenic shock due to aortic and systemic venous compression, extreme heart displacement and rotation, necessitating an emergency operation on the first day of life.
Physician understanding, explainability, and trust in a hypothetical machine learning risk calculator
Authors: Diprose William K , Buist Nicholas , Hua Ning , Thurier Quentin , Shand George , Robinson Reece
Published: December 2019

Objective

Implementation of machine learning (ML) may be limited by patients’ right to “meaningful information about the logic involved” when ML influences healthcare decisions. Given the complexity of healthcare decisions, it is likely that ML outputs will need to be understood and trusted by physicians, and then explained to patients. We therefore investigated the association between physician understanding of ML outputs, their ability to explain these to patients, and their willingness to trust the ML outputs, using various ML explainability methods.

Materials and Methods

We designed a survey for physicians with a diagnostic dilemma that could be resolved by an ML risk calculator. Physicians were asked to rate their understanding, explainability, and trust in response to 3 different ML outputs. One ML output had no explanation of its logic (the control) and 2 ML outputs used different model-agnostic explainability methods. The relationships among understanding, explainability, and trust were assessed using Cochran-Mantel-Haenszel tests of association.

Results

The survey was sent to 1315 physicians, and 170 (13%) provided completed surveys. There were significant associations between physician understanding and explainability (P < .001), between physician understanding and trust (P < .001), and between explainability and trust (P < .001). ML outputs that used model-agnostic explainability methods were preferred by 88% of physicians when compared with the control condition; however, no particular ML explainability method had a greater influence on intended physician behavior.

Conclusions

Physician understanding, explainability, and trust in ML risk calculators are related. Physicians preferred ML outputs accompanied by model-agnostic explanations but the explainability method did not alter intended physician behavior.
Evaluative Discourse and Affective States of Mind
Authors: Franzén Nils
Published: December 2019

It is widely held within contemporary metaethics that there is a lack of linguistic support for evaluative expressivism. On the contrary, it seems that the predictions that expressivists make about evaluative discourse are not borne out. An instance of this is the so-called problem of missing Moorean infelicity. Expressivists maintain that evaluative statements express non-cognitive states of mind in a similar manner to how ordinary descriptive language expresses beliefs. Conjoining an ordinary assertion that p with the denial of being in the corresponding belief state famously gives rise to Moorean infelicity:

(i) ?? It’s raining but I don’t believe that it’s raining.

If expressivists are right, then conjoining evaluative statements with the denial of being in the relevant non-cognitive state of mind should give rise to similar infelicity. However, as several theorists have pointed out, this does not seem to be the case. Statements like the following are not infelicitous:

(ii) Murder is wrong but I don’t disapprove of it.

In this paper, I argue that evaluative statements express the kind of states that are attributed by ‘find’-constructions in English and that these states are non-cognitive in nature. This addresses the problem of missing Moorean infelicity and, more generally, goes to show that there are linguistic facts which support expressivism about evaluative discourse.
Loneliness among veterans in the Netherlands
Authors: Reijnen A , Duel J
Published: December 2019

Background

Loneliness among military veterans may have unique features because of deployment-related experiences. Consequently, loneliness is increasingly recognized as an issue that may affect the health of veterans, even years after military deployment.

Aims

To examine the prevalence of loneliness in Dutch veterans and to assess the extent to which their loneliness is associated with deployment-related factors.

Methods

We invited 6000 veterans who have left the Armed Forces to fill out a questionnaire. Hierarchical regression analysis was used to assess the association between loneliness and deployment-related factors in addition to demographic information, social support and needs of care.

Results

We received the responses of 2643 veterans (44%). Of them, 27% experienced at least some loneliness and 13% experienced severe loneliness. Social support, perceived comradeship during deployment and a perceived positive effect of one’s deployment on life at present are negatively related to loneliness. Younger age, living alone (with or without children), unemployment or work disability, needs of care in general or deployment-related, perceived frustration related to the deployment and longing back to the time of the deployment were positively associated with loneliness.

Conclusions

Feelings of loneliness are prevalent among Dutch veterans who have left the Armed Forces. Veterans’ loneliness is associated with several deployment-related factors. To reduce veterans’ loneliness, attention for deployment-related experiences and its consequences is recommended.
One dose of immunotherapy leading to an exceptional and durable response in a patient with metastatic renal cell carcinoma
Authors: Wade Louise , Hilman Serena
Published: December 2019

A 72-year-old man with metastatic clear cell renal carcinoma, who had progressed after previous treatment with Sunitinib and Axitinib, was given one dose of immunotherapy. He was initially unwell after treatment with fever, shortness of breath, chest pain and raised inflammatory markers. Following this he elected not to have any further immunotherapy. Before the treatment he had multiple pulmonary metastases and hilar and mediastinal lymph nodes on chest X-ray and suffered with a persistent cough. Chest X-ray 10 months after treatment showed normal appearances and his cough had largely resolved. The patient initially declined repeat computed tomography imaging but agreed to it 2 years after the immunotherapy, the results showed a maintained response. Some patients with renal cell carcinoma show a durable response to immunotherapy but we are not aware of other published cases where a patient has shown such a dramatic and sustained response to one dose.
Smart watch-detected tachycardia: a case of atrial flutter
Authors: Goldstein Lara N , Wells Mike
Published: December 2019

The use of smart watches like the Apple watch and other wearable electronic devices by the general public has been increasing dramatically. Until their accuracy for detecting dysrhythmias has been well-established, however, it would not be appropriate to rely on them solely to rule-in or rule-out pathology. Nonetheless, unusual findings from these devices should be followed up with more conventional investigations, and this approach may prove highly beneficial to patients and treating clinicians alike. This case demonstrates a diagnosis of atrial flutter that was suspected based on the Apple watch and iPhone Health app findings.
A blend of essential oils improved feed efficiency and affected ruminal and systemic variables of dairy cows
Authors: Silva Rayana Brito da , Pereira Marcos Neves , Araujo Rafael Canonenco de , Silva Wesley de Rezende , Pereira Renata Apocalypse Nogueira
Published: December 2019

This experiment evaluated the effect of a blend of essential oils (BEO) on intake, lactation performance, diet digestibility, ruminal fermentation profile, eating behavior, body thermoregulation, blood acid–base balance, and milk fatty acid profile of lactating cows. Twenty-eight Holstein cows were individually fed a standard diet for 14 d and treatments control or BEO (a microencapsulated blend of pepper extract containing capsaicin and pure forms of carvacrol, cinnamaldehyde, and eugenol; 150 mg/kg of diet dry matter) for 56 d. Significance was declared at P ≤ 0.05 and trends at 0.05 < P ≤ 0.10. Dry matter intake (DMI) was reduced (19.5 vs. 20.1 kg/d) and milk yield was increased (30.1 vs. 30.8 kg/d) by BEO, inducing improved milk to DMI ratio (1.53 vs. 1.62). Milk fat concentration tended to be increased by BEO, but total solids yield did not differ. There was a trend for increased total tract non-neutral detergent fiber organic matter digestibility with BEO. The molar proportion of acetate in ruminal fluid was reduced (51.4 vs. 57.8%) and that of propionate was increased (26.1 vs. 31.3%) by BEO. Ruminal microbial yield and total protozoa count in ruminal fluid did not differ. Cows fed BEO ingested a greater proportion of the daily intake in the morning (30.6 vs. 36.6%) and tended to ingest a lower proportion at night, tended to have longer meals, and had fewer meals per day (11.9 vs. 13.7) and larger meal size (1.5 vs. 1.7 kg of dry matter per meal). Blood urea-N and glucose concentrations did not differ. The BEO increased jugular blood oxygenation. The sweating rate on a hot and dry day was increased (160 vs. 221 g/m2/h) by BEO. The mean rectal and skin temperatures and respiration rate did not differ, but the proportion of rectal temperature measurements ≥39.2 °C was reduced by BEO at 1400 h (17.8 vs. 28.5%) and 2000 h (23.2 vs. 34.8%). The BEO increased the secretion (g/d) of 18:2 trans-10, cis-12 and the concentration of 18:0 iso fatty acids in milk fat. When one sample of milk from BEO cows was offered with two samples of milk from control, 59% of regular consumers of milk (n = 63) identified the odd sample correctly. The gain in feed efficiency induced by BEO was associated with reduced acetate-to-propionate ratio in ruminal fluid, altered eating behavior, lower frequency of high rectal temperature, and increased blood oxygenation. Essential oils had positive effects on ruminal fermentation and systemic variables of dairy cows.
Vitamin D: can the sun stop the atopic epidemic?
Authors: Hawrylowicz Catherine M. , Santos Alexandra F.
Published: December 2019

Purpose of review

To review recent evidence on the capacity of vitamin D to prevent atopic disease, focussing on food allergy and asthma, and potential underlying mechanisms.

Recent findings

The incidence of allergic disease continues to increase worldwide. Vitamin D status is influenced by sun exposure and dietary intake. Vitamin D deficiency is linked to an increased incidence of allergic disease and asthma. These associations are generally strongest in early life. The capacity of vitamin D to enhance antimicrobial pathways, promote peripheral immunological tolerance and maintain mucosal barrier integrity may underlie these associations. Interventional studies have addressed the capacity of vitamin D supplementation in utero and early life to reduce the incidence of disease. Ancillary studies have provided insights into potential biological mechanisms linked to these effects.

Observational studies show an inverse association between vitamin D levels and development of food allergy and asthma. Secondary analyses of two recent interventional studies suggest that achieving vitamin D sufficiency throughout pregnancy reduces the incidence of asthma/recurrent wheeze at 3 years. Longitudinal studies of vitamin D requirements in utero and postnatally, better understanding of factors that influence bioavailability of vitamin D and mechanistic insights into vitamin D effects on neonatal-specific immune pathways are awaited.
Organ donation: from diagnosis to transplant
Authors: Robba Chiara , Fossi Francesca , Citerio Giuseppe
Published: December 2019

Purpose of review

Organ transplantation has largely expanded over the last decades and despite several improvements have been made in the complex process occurring between the identification of organ donors and organ transplant, there is still a chronic inability to meet the needs of patients. Consequently, the optimization of the transplant process through its different steps is crucial, and the role of the intensivists is fundamental as it requires clinical, managerial and communication skills to avoid the loss of potential donors. The purpose of this review is to provide an update on the transplant process from the early identification of the donor, to transplant. The two main pathways of organ donation will be discussed: donation after death by neurologic criteria and the donation after cardiac death (DCD).

Recent findings

Recent evidence demonstrates that appropriate intensive care management is fundamental to increase organ availability for transplantation. The expansion of pool donation requires a strong legal framework supporting ethical and organizational considerations in each country, together with the implementation of physicians’ technical expertise and communication skills for family involvement and satisfaction. New evidence is available regarding organ donor's management and pathway. The importance of checklists is gaining particular interest according to recent literature. Recent clinical trials including the use of naloxone, simvastatin and goal directed hemodynamic therapies were not able to demonstrate a clear benefit in improving quality and number of transplanted organs. Ethical concerns about DCD are recently being raised, and these will be discussed focusing on the differences of outcome between controlled and uncontrolled procedure.

The major change in the process of organ donation has been to implement parallel DCD and donation after brain death pathways. However, more research is needed for improving quality and number of transplanted organs.
A Mini-Open, Dorsal Approach for Scaphoid Fracture Fixation With a Ligament Sparing Arthrotomy
Authors: Dodds Seth D. , Rush Augustus J. , Staggers Jackson R.
Published: December 2019

There are several surgical approaches that are currently used to address nondisplaced scaphoid waist fractures, including percutaneous fixation, limited exposure fixation, and traditional open techniques through a volar or dorsal approach. Although percutaneous fixation has some theoretical advantages, it is much more difficult to achieve an accurate starting point for a headless compression screw. The purpose of this paper is to describe a simple, dorsal, mini-open approach to the scaphoid that minimizes incision size, extensor tendon dissection, capsular trauma, and vascular disruption, while still allowing for direct visualization of the proximal pole and optimal exposure for accurate screw placement. As a case report, we retrospectively evaluated 80 consecutive patients with closed scaphoid fractures. There were 2 groups, with 44 patients (age: 24±10 y) receiving a percutaneous dorsal approach and 36 patients (age: 30±16 y) treated with a mini-open approach. All scaphoid fractures were acute or fibrous nonunions (<6 mo from injury, except for one) treated with cannulated headless compression screws. Intraoperative and postoperative complications were measured and evaluated for each group to assess for differences between the percutaneous approach and the mini-open technique. We found no significant difference in complication rate with the mini-open dorsal technique compared with the dorsal percutaneous approach (8.3% vs. 4.5%, respectively). Therefore, we suggest consideration of this mini-open dorsal approach for scaphoid fracture fixation as a useful and safe technique.
Rhombic Flap: A Useful Flap for Small-to-Medium Defects of the Medial Canthus
Authors: Cressey Brienne D. , Jellinek Nathaniel J.
Published: December 2019

BACKGROUND

Medial canthal defects are frequently encountered yet present specific challenges for the reconstructive surgeon. Surgical repair in this area may inadvertently lead to canthal webbing, ectropion, and/or epiphora. The rhombic flap is a versatile workhorse in the reconstructive armamentarium for canthal defects.

OBJECTIVE

To describe the use of the inferiorly based rhombic flap for reconstructing defects on the medial canthus.

METHODS

A retrospective analysis of the Mohs micrographic surgery cases was performed. All cases in which an inferiorly based rhombic flap was used for canthal reconstruction between 2012 and 2017 were identified. Defect size, location, and any postoperative complications were noted. Surgical scars were scored using the Vancouver Scar Scale.

RESULTS

There were 34 cases (17 men and 17 women). Age ranged from 38 to 86 (mean 69). Defect size varied from 0.6 to 2.1 cm in diameter. Postoperative complications were uncommon and minor.

CONCLUSION

The rhombic flap is a versatile and useful option for reconstructing surgical defects of the medial canthus.
Quality over quantity: skeletal loading intensity plays a key role in understanding the relationship between physical activity and bone density in postmenopausal women
Authors: Madansingh Stefan I. , Ngufor Che G. , Fortune Emma
Published: December 2019

Objective:

Increasing physical activity (PA) is regularly cited as a modifiable target to improve health outcomes and quality of life in the aging population, especially postmenopausal women who exhibit low bone mineral density (BMD) and high fracture risk. In this cross-sectional study, we aimed to quantify real-world PA and its association with BMD in postmenopausal women.

Methods:

Seventy postmenopausal women, aged 46 to 79 years, received a dual-energy X-ray absorptiometry scan measuring total hip BMD and wore bilateral triaxial accelerometers on the ankles for 7 days to measure PA in their free-living environment. Custom step detection and peak vertical ground reaction force estimation algorithms, sensitive to both quantity and intensity of PA, were used to calculate a daily bone density index (BDI) for each participant. Multiple regression was used to quantify the relationship between total hip BMD, age, step counts, and mean BDI over the span of 7 days of data collection.

Results:

All participants completed the full 7 days of PA monitoring, totaling more than 7 million detected steps. Participants averaged 14,485 ± 4,334 steps daily with mean peak vertical ground reaction force stepping loads of 675 ± 121 N during daily living. Across the population, total hip BMD was found to be significantly correlated with objective estimates of mean BDI (r = 0.44), as well as participant age (r = 0.285).

Conclusion:

Despite having higher-than-expected PA, the low stepping loads observed in this cohort, along with half of the participants having low BMD measures, underscores the need for PA intensity to be considered in the management of postmenopausal bone health.
Variability in Transitional Care Outcomes Across Hospitals Discharging Veterans to Skilled Nursing Facilities
Authors: Burke Robert E. , Canamucio Anne , Glorioso Thomas J. , Barón Anna E. , Ryskina Kira L.
Published: December 2019

Background:

The period after transition from hospital to skilled nursing facility (SNF) is high-risk, but variability in outcomes related to transitions across hospitals is not well-known.

Objectives:

Evaluate variability in transitional care outcomes across Veterans Health Administration (VHA) and non-VHA hospitals for Veterans, and identify characteristics of high-performing and low-performing hospitals.

Research Design:

Retrospective observational study using the 2012–2014 Residential History File, which concatenates VHA, Medicare, and Medicaid data into longitudinal episodes of care for Veterans.

Subjects:

Veterans aged 65 or older who were acutely hospitalized in a VHA or non-VHA hospital and discharged to SNF; 1 transition was randomly selected per patient.

Measures:

Adverse “transitional care” outcomes were a composite of hospital readmission, emergency department visit, or mortality within 7 days of hospital discharge.

Results:

Among the 365,942 Veteran transitions from hospital to SNF across 1310 hospitals, the composite outcome rate ranged from 3.3% to 23.2%. In multivariable analysis adjusting for patient characteristics, hospital discharge diagnosis and SNF category, no single hospital characteristic was significantly associated with the 7-day adverse outcomes in either VHA or non-VHA hospitals. Very few high or low-performing hospitals remained in this category across all 3 years. The increased odds of having a 7-day event due to being treated in a low versus high-performing hospital was similar to the odds carried by having an intensive care unit stay during the index admission.

Conclusions:

While variability in hospital outcomes is significant, unmeasured care processes may play a larger role than currently measured hospital characteristics in explaining outcomes.
Review on the role of socioeconomic status in child health and development
Authors: Poulain Tanja , Vogel Mandy , Kiess Wieland
Published: December 2019

Purpose of review

This review presents findings from recent studies investigating the role of socioeconomic status (SES) in child development. Studies on associations between SES and different parameters of physical and psychological health, on interventions and possible resilience factors are reviewed.

Recent findings

Several cross-sectional and longitudinal studies demonstrate social disparities in child behavior and health. They underline the detrimental effects of low SES on child development. Some studies also highlight the potentially adverse effects of early diseases or vulnerabilities on later career and social position. Whereas most studies applied parent-based measures of SES, some studies emphasize the significance of child-based (e.g. perceived social position) and area-level indicators of SES (e.g. area deprivation). With respect to intervention, study findings suggest positive effects of programs aiming to improve specific neighborhood characteristics and psychosocial functioning of individuals.

The relation between SES and health is bidirectional and stable, and the effects of interventions aiming at changing behaviors of children and families with low SES are small. There is a need for further center-based and area-level interventions and studies evaluating the effects of these interventions.