bluuebunny/crossref_metadata_2025 huggingface dataset:
Fluctuation of arc plasma in arc plasma torch with multiple cathodes*
Authors: Zhang Zelong , Wang Cheng , Sun Qiang , Xia Weidong
Published: July 2019

Fluctuation phenomena commonly exist in arc plasmas, limiting the application of this technology. In this paper, we report an investigation of fluctuations of arc plasmas in an arc plasma torch with multiple cathodes. Time-resolved images of the plasma column and anode arc roots are captured. Variations of the arc voltage, plasma column diameter, and pressure are also revealed. The results indicate that two well-separated fluctuations exist in the arc plasma torch. One is the high-frequency fluctuation (of several thousand Hz), which arises from transferring of the anode arc root. The other is the low-frequency fluctuation (of several hundred Hz), which may come from the pressure variation in the arc plasma torch. Initial analysis reveals that as the gas flow rate changes, the low-frequency fluctuation shows a similar variation trend with the Helmholtz oscillation. This oscillation leads to the shrinking and expanding of the plasma column. As a result, the arc voltage shows a sinusoidal fluctuation.
A note on minimal models for pmp actions
Authors: Zucker Andy
Published: July 2019

Given a countable group

G
G

, we say that a metrizable flow

Y
Y

is model-universal if by considering the various invariant measures on

Y
Y

, we can recover every free measure-preserving

G
G

-system up to isomorphism. Weiss in[Dynamical systems and group actions, American Mathematical Society, Providence, RI, 2012, pp. 249–264] constructs a minimal model-universal flow. In this note, we provide a new, streamlined construction, allowing us to show that a minimal model-universal flow is far from unique.
A note on the eightfold way
Authors: Gilton Thomas , Krueger John
Published: July 2019

Assuming the existence of a Mahlo cardinal, we construct a model in which there exists an

ω
2

\omega _2

-Aronszajn tree, the

ω
1

\omega _1

-approachability property fails, and every stationary subset of

ω
2

∩
cof
(
ω
)

\omega _2 \cap \text {cof}(\omega )

reflects. This solves an open problem of Cummings et al. [J. Symb. Log. 83 (2018), no. 1, pp. 349–371]
Eating Insects Athens Conference 2018 and the North American Coalition for Insect Agriculture
Authors: Butner Justin , Shockley Marianne
Published: July 2019

In August 2018, the North American Coalition for Insect Agriculture (NACIA) organized a 3-d conference, Eating Insects Athens, in Athens, GA. The conference built on the success of the 2016 event, Eating Insects Detroit, and highlighted progress in both research and industry linked to insect agriculture. NACIA was created as a platform to strengthen an industry currently in its infancy. Goals of NACIA include, but are not limited to, promoting discussion about insect agriculture, educating, and streamlining efforts aimed at developing quality products for consumption by humans, livestock, poultry, or aquaculture. The 3-d Eating Insects Athens conference consisted of presentations, outreach events, and small group sessions to further develop the mission of NACIA. This overview article highlights some of the topics discussed at the conference, including optimizing production systems, developing standard operating procedures related to quality assurance, and investigating key issues such as palatability and bioavailability of insect nutrients, allergenicity, animal welfare, and ethics. Such research has the potential to improve the environmental impacts, resource efficiency, public acceptance, and regulatory approval of insect agriculture. Though the field and study of insect agriculture is young, the increased interest in research indicates a promising future.
Night-Shift Work and Risk of Prostate Cancer: Results From a Canadian Case-Control Study, the Prostate Cancer and Environment Study
Authors: Barul Christine , Richard Hugues , Parent Marie-Elise
Published: July 2019

Night-shift work involving disruption of circadian rhythms has been associated with breast cancer risk. A role in prostate cancer is also suspected, but evidence is limited. We investigated the association between night-shift work and prostate cancer incidence in the Prostate Cancer and Environment Study (PROtEuS), a population-based case-control study conducted in 2005–2012 in Montreal, Quebec, Canada. Participants were 1,904 prostate cancer cases (432 high-grade cancers) and 1,965 population controls. Detailed work schedules for each job held for at least 2 years (n = 15,724) were elicited in face-to-face interviews. Night-shift work was defined as having ever worked ≥3 hours between midnight and 5:00 am ≥3 nights/month for ≥1 year. Unconditional logistic regression was used to estimate odds ratios and 95% confidence intervals for the association between night-shift work and prostate cancer, adjusting for age, ancestry, and education. No association was found between overall prostate cancer and night-shift work metrics, including ever exposure, duration, intensity, cumulative exposure, rotating shifts, and early-morning shifts. For none of the exposure indices was there evidence of heterogeneity in odds ratios between low- and high-grade cancers. Sensitivity analyses restricting exposures to ≥7 nights/month or considering screening history yielded similar results. Our findings lend no support for a major role of night-shift work in prostate cancer development.
Revisiting the functional response in habitat selection for large herbivores: a matter of spatial variation in resource distribution?
Authors: Duparc Antoine , Garel Mathieu , Marchand Pascal , Dubray Dominique , Maillard Daniel , Loison Anne
Published: July 2019

Most habitats are distributed heterogeneously in space, forcing animals to move according to both habitat characteristics and their needs for energy and safety. Animal space use should therefore vary according to habitat characteristics, a process known as the “functional response” in habitat selection. This response has often been tested vis-à-vis the proportion of a habitat category within areas available to individuals. Measuring sought-after resources in landscape where they are continuously distributed is a challenge and we posit here that both the mean availability of a resource and its spatial variation should be measured. Accordingly, we tested for a functional response in habitat selection according to these two descriptors of the resource available for a mountain herbivore. We hypothesized that selection should decrease with mean value of resources available and increase with its spatial variation. Based on GPS data from 50 chamois females and data on the actual foodscape (i.e., distribution of edible-only biomass in the landscape), we estimated individual selection ratio (during summer months) for biomass at the home range level, comparing edible biomass in individual home ranges and the mean and standard deviation of edible biomass in their available range. Chamois being a group-living species, available accessible ranges were shared by several individuals that formed socio-spatial groups (clusters) in the population. As expected, selection ratios increased with the standard deviation of edible resources in each cluster, but unlike our prediction, was unrelated to its mean. Selection of areas richer in resources hence did not fade away when more resources were available on average, a result that may be explained by the need for this capital breeder species to accumulate fat-reserve at a high rate during summer months. Low spatial variation could limit the selection of chamois, which highlights the importance of resource distribution in the process of habitat selection.
DEEPCON: protein contact prediction using dilated convolutional neural networks with dropout
Authors: Adhikari Badri
Published: July 2019

Motivation

Exciting new opportunities have arisen to solve the protein contact prediction problem from the progress in neural networks and the availability of a large number of homologous sequences through high-throughput sequencing. In this work, we study how deep convolutional neural networks (ConvNets) may be best designed and developed to solve this long-standing problem.

Results

With publicly available datasets, we designed and trained various ConvNet architectures. We tested several recent deep learning techniques including wide residual networks, dropouts and dilated convolutions. We studied the improvements in the precision of medium-range and long-range contacts, and compared the performance of our best architectures with the ones used in existing state-of-the-art methods. The proposed ConvNet architectures predict contacts with significantly more precision than the architectures used in several state-of-the-art methods. When trained using the DeepCov dataset consisting of 3456 proteins and tested on PSICOV dataset of 150 proteins, our architectures achieve up to 15% higher precision when L/2 long-range contacts are evaluated. Similarly, when trained using the DNCON2 dataset consisting of 1426 proteins and tested on 84 protein domains in the CASP12 dataset, our single network achieves 4.8% higher precision than the ensembled DNCON2 method when top L long-range contacts are evaluated.

Availability and implementation

DEEPCON is available at https://github.com/badriadhikari/DEEPCON/.
Towards an Integrative, Eco-Evolutionary Understanding of Ecological Novelty: Studying and Communicating Interlinked Effects of Global Change
Authors: Heger Tina , Bernard-Verdier Maud , Gessler Arthur , Greenwood Alex D , Grossart Hans-Peter , Hilker Monika , Keinath Silvia , Kowarik Ingo , Kueffer Christoph , Marquard Elisabeth , Müller Johannes , Niemeier Stephanie , Onandia Gabriela , Petermann Jana S , Rillig Matthias C , Rödel Mark-Oliver , Saul Wolf-Christian , Schittko Conrad , Tockner Klement , Joshi Jasmin , Jeschke Jonathan M
Published: July 2019

Global change has complex eco-evolutionary consequences for organisms and ecosystems, but related concepts (e.g., novel ecosystems) do not cover their full range. Here we propose an umbrella concept of “ecological novelty” comprising (1) a site-specific and (2) an organism-centered, eco-evolutionary perspective. Under this umbrella, complementary options for studying and communicating effects of global change on organisms, ecosystems, and landscapes can be included in a toolbox. This allows researchers to address ecological novelty from different perspectives, e.g., by defining it based on (a) categorical or continuous measures, (b) reference conditions related to sites or organisms, and (c) types of human activities. We suggest striving for a descriptive, non-normative usage of the term “ecological novelty” in science. Normative evaluations and decisions about conservation policies or management are important, but require additional societal processes and engagement with multiple stakeholders.
Projected Population Benefit of Increased Effectiveness and Coverage of Influenza Vaccination on Influenza Burden in the United States
Authors: Hughes Michelle M , Reed Carrie , Flannery Brendan , Garg Shikha , Singleton James A , Fry Alicia M , Rolfes Melissa A
Published: July 2019

Background

Vaccination is the best way to prevent influenza; however, greater benefits could be achieved. To help guide research and policy agendas, we aimed to quantify the magnitude of influenza disease that would be prevented through targeted increases in vaccine effectiveness (VE) or vaccine coverage (VC).

Methods

For 3 influenza seasons (2011–12, 2015–16, and 2017–18), we used a mathematical model to estimate the number of prevented influenza-associated illnesses, medically attended illnesses, and hospitalizations across 5 age groups. Compared with estimates of prevented illness during each season, given observed VE and VC, we explored the number of additional outcomes that would have been prevented from a 5% absolute increase in VE or VC or from achieving 60% VE or 70% VC.

Results

During the 2017–18 season, compared with the burden already prevented by influenza vaccination, a 5% absolute VE increase would have prevented an additional 1 050 000 illnesses and 25 000 hospitalizations (76% among those aged ≥65 years), while achieving 60% VE would have prevented an additional 190 000 hospitalizations. A 5% VC increase would have resulted in 785 000 fewer illnesses (56% among those aged 18–64 years) and 11 000 fewer hospitalizations; reaching 70% would have prevented an additional 39 000 hospitalizations.

Conclusions

Small, attainable improvements in effectiveness or VC of the influenza vaccine could lead to substantial additional reductions in the influenza burden in the United States. Improvements in VE would have the greatest impact in reducing hospitalizations in adults aged ≥65 years, and VC improvements would have the largest benefit in reducing illnesses in adults aged 18–49 years.
Each Additional Day of Antibiotics Is Associated With Lower Gut Anaerobes in Neonatal Intensive Care Unit Patients
Authors: Rooney Ashley M , Timberlake Kathryn , Brown Kevin A , Bansal Saumya , Tomlinson Christopher , Lee Kyong-Soon , Science Michelle , Coburn Bryan
Published: July 2019

Background

Discontinuation of inappropriate antimicrobial therapy is an important target for stewardship intervention. The drug and duration-dependent effects of antibiotics on the developing neonatal gut microbiota needs to be precisely quantified.

Methods

In this retrospective, cross-sectional study, we performed 16S rRNA sequencing on stool swab samples collected from neonatal intensive care unit patients within 7 days of discontinuation of therapy who received ampicillin and tobramycin (AT), ampicillin and cefotaxime (AC), or ampicillin, tobramycin, and metronidazole (ATM). We compared taxonomic composition within term and preterm infant groups between treatment regimens. We calculated adjusted effect estimates for antibiotic type and duration of therapy on the richness of obligate anaerobes and known butyrate-producers in all infants.

Results

A total of 72 infants were included in the study. Term infants received AT (20/28; 71%) or AC (8/28; 29%) with median durations of 3 and 3.5 days, respectively. Preterm infants received AT (32/44; 73%) or ATM (12/44; 27%) with median durations of 4 and 7 days, respectively. Compositional analyses of 67 stool swab samples demonstrated low diversity and dominance by potential pathogens. Within 1 week of discontinuation of therapy, each additional day of antibiotics was associated with lower richness of obligate anaerobes (adjusted risk ratio [aRR], 0.84; 95% confidence interval [CI], .73–.95) and butyrate-producers (aRR, 0.82; 95% CI, .67–.97).

Conclusions

Each additional day of antibiotics was associated with lower richness of anaerobes and butyrate-producers within 1 week after therapy. A longitudinally sampled cohort with preexposure sampling is needed to validate our results.
Depletion-of-susceptibles Bias in Analyses of Intra-season Waning of Influenza Vaccine Effectiveness
Authors: Ray G Thomas , Lewis Ned , Klein Nicola P , Daley Matthew F , Lipsitch Marc , Fireman Bruce
Published: July 2019

Bias arises in studies of waning vaccine effectiveness when higher-risk individuals are depleted from the at-risk population at different rates between study groups. We examined how this bias arises and how to avoid it. A reanalysis of data from California confirmed a finding of intra-season waning of influenza vaccine effectiveness.
Antithrombotic therapy in the early phase of non-ST-elevation acute coronary syndromes: a systematic review and meta-analysis
Authors: Galli Mattia , Andreotti Felicita , D’Amario Domenico , Vergallo Rocco , Vescovo Giovanni Maria , Giraldi Luca , Migliaro Stefano , Ameri Pietro , Porto Italo , Crea Filippo
Published: July 2019

Aims

Despite the increasing use of early invasive strategies in non-ST-elevation acute coronary syndromes (NSTE-ACS), optimal initial antithrombotic therapy (ATT) based on the safety/efficacy profile of all guideline-recommended combinations remains crucial for the early management of both medically and invasively treated NSTE-ACS patients.

Methods and results

Randomized controlled trials on ATT in NSTE-ACS/unstable angina reporting early (within 14 days) major adverse cardiovascular events (MACE) and major bleeding were selected. Overall, 3799 studies were screened, 117 clinical trials were assessed as potentially eligible, 20 trials were included in the study. According to treatment and type of intervention, nine different meta-analyses were performed including a total of 88 748 patients. A significant reduction of trial-defined MACE was found for aspirin vs. placebo [odds ratio (OR), 0.57; 95% confidence interval (CI), 0.34–0.96], heparin vs. placebo (OR, 0.38; 95% CI, 0.15–0.97), aspirin + heparin vs. placebo (OR, 0.32; 95% CI, 0.18–0.59), aspirin + heparin vs. aspirin (OR, 0.57; 95% CI, 0.42–0.79), aspirin + low molecular weight heparin (LMWH) vs. aspirin + unfractionated heparin (UFH; OR, 0.81; 95% CI, 0.69–0.95) and aspirin + ticagrelor/prasugrel + heparins vs. aspirin + clopidogrel + heparins (OR, 0.76; 95% CI, 0.62–0.94). A significant decrease in major bleeding was found only for fondaparinux vs. LMWH on the background of aspirin + clopidogrel (OR, 0.52; 95% CI, 0.44–0.62) despite a clear trend towards increased bleeding for heparin compared to aspirin, aspirin + heparin compared to placebo, aspirin + heparin compared to aspirin, aspirin + P2Y12inhibitors + UFH/LMWH compared to aspirin + UFH/LMWH, and aspirin + ticagrelor/prasugrel + heparins compared to aspirin + clopidogrel + heparins.

Conclusion

To our knowledge, these findings are the first to report the safety and efficacy of all the various combinations of currently recommended ATT for the early management of NSTE-ACS, providing a comprehensive evidence-base to guide decisions depending on the patients’ bleeding risk and treatment strategy.
Mortality reduction with physical activity in patients with and without cardiovascular disease
Authors: Jeong Sang-Woo , Kim Sun-Hwa , Kang Si-Hyuck , Kim Hee-Jun , Yoon Chang-Hwan , Youn Tae-Jin , Chae In-Ho
Published: July 2019

Aims

Physical activity has been shown to reduce mortality in a dose-response fashion. Current guidelines recommend 500–1000 metabolic equivalent task (MET)-min per week of regular physical activity. This study aimed to compare the impact of leisure-time physical activity on mortality in primary versus secondary cardiovascular prevention.

Methods and results

This study included a total of 131 558 and 310 240 subjects with and without cardiovascular disease (CVD), respectively, from a population-based cohort. Leisure-time physical activity was measured by self-report questionnaires. The study subjects were followed-up for a median of 5.9 years, and the main study outcome was all-cause mortality. There was an inverse relationship between the physical activity level and the mortality risk in both groups. The benefit in the secondary prevention group was shown to be greater than that in the primary prevention group: every 500 MET-min/week increase in physical activity resulted in a 14% and 7% risk reduction in mortality in the secondary and primary prevention groups, respectively (interaction P < 0.001). In addition, while individuals without CVD benefited the most between 1 and 500 MET-min/week of physical activity, the benefit in those with CVD continued above 500 − 1000 MET-min/week. The adjusted mortality risk of individuals with CVD who performed a high level of physical activity (≥1000 MET-min/week) was shown to be comparable to or lower than that of their counterparts without CVD.

Conclusion

Individuals with CVD may benefit from physical activity to a greater extent than do healthy subjects without CVD.
Impact of monitoring on detection of arrhythmia recurrences in the ESC-EHRA EORP atrial fibrillation ablation long-term registry
Authors: Balabanski Tosho , Brugada Josep , Arbelo Elena , Laroche Cécile , Maggioni Aldo , Blomström-Lundqvist Carina , Kautzner Josef , Tavazzi Luigi , Tritto Massimo , Kulakowski Piotr , Kalejs Oskars , Forster Tamas , Villalobos Federico Segura , Dagres Nikolaos ,   on behalf of the ESC-EHRA Atrial Fibrillation Ablation Long-Term Registry investigators Group
Published: July 2019

Aims

Monitoring of patients after ablation had wide variations in the ESC-EHRA atrial fibrillation ablation long-term (AFA-LT) registry. We aimed to compare four different monitoring strategies after catheter AF ablation.

Methods and results

The ESC-EHRA AFA-LT registry included 3593 patients who underwent ablation. Arrhythmia monitoring during follow-up was performed by 12-lead electrocardiogram (ECG), Holter ECG, trans-telephonic ECG monitoring (TTMON), or an implanted cardiac monitoring (ICM) system. Patients were selected to a given monitoring group according to the most extensive ECG tool used in each of them. Comparison of the probability of freedom from recurrences was performed by censored log-rank test and presented by Kaplan–Meier curves. The rhythm monitoring methods were used among 2658 patients: ECG (N = 578), Holter ECG (N = 1874), TTMON (N = 101), and ICM (N = 105). A total of 767 of 2658 patients (28.9%) had AF recurrences during follow-up. Censored log-rank test discovered a lower probability of freedom from relapses, which was detected with ICM compared to TTMON, ECG, and Holter ECG (P < 0.001). The rate of freedom from AF recurrences was 50.5% among patients using the ICM while it was 65.4%, 70.6%, and 72.8% using the TTMON, ECG, and Holter ECG, respectively.

Conclusion

Comparing all main electrocardiographic monitoring methods in a large patient sample, our results suggest that post-ablation recurrences of AF are significantly underreported by TTMON, ECG, and Holter ECG. The ICM estimates AF ablation recurrences most reliably and should be a preferred mode of monitoring for trials evaluating novel AF ablation techniques.
No impact of sports practice before or after atrial fibrillation ablation on procedure efficacy in athletes: a case–control study
Authors: Decroocq Marie , Ninni Sandro , Klein Cédric , Machuron François , Verbrugge Eric , Klug Didier , Brigadeau François , Lacroix Dominique
Published: July 2019

Aims

Limited data exist on the efficacy of catheter ablation (CA) for sport-related atrial fibrillation (AF). Impact of sports practice resumption post-CA remains unknown. We aimed to determine AF CA efficacy in athletes vs. non-athletes, and to assess the impact of sport practice resumption.

Methods and results

From 1153 first-time AF CA performed between 2009 and 2017, 73 athletes were matched with 73 sedentary patients based on age, sex, and closest CA procedure date. Athletes were defined as performing ≥6 h/week of vigorous sports to achieve ≥2000 h accumulated lifetime sports activity. They were mostly males (93.2%) with a mean age of 55 ± 9.8 years. Before CA, athletes practiced 10.2 ± 3.9 h/week of vigorous exercise vs. 4.6 ± 3.4 after CA. Within first year after CA, physical activity was stopped in 12 (16.4%) athletes, lowered in 45 (61.9%), and resumed at same intensity in 16 (21.9%). Athletes and non-athletes suffered from same AF recurrence rates during 5-year follow-up after CA: 38 (52.0%) vs. 35 (47.9%), respectively [adjusted hazard ratio (HR) on age, body mass index (BMI), obstructive sleep apnoea (OSA), and reduced left ventricular ejection fraction (LVEF), 1.17 (0.70–1.97, P = 0.54)]. No significant impact of physical activity resumption status was found regarding AF recurrence rates at 1-year and beyond (P = 0.60). Procedure effectiveness was significantly lower in athletes with non-paroxysmal AF [adjusted on age, BMI, reduced LVEF, and OSA HR 2.36 (confidence interval 1.19–4.70), P = 0.01].

Conclusion

Sports practice before and after CA has no significant impact on AF recurrence rates in athletes within 5-year after AF CA.
Investigating the Effects of Spacing on Working Memory Training Outcome: A Randomized, Controlled, Multisite Trial in Older Adults
Authors: Jaeggi Susanne M , Buschkuehl Martin , Parlett-Pelleriti Chelsea M , Moon Seung Min , Evans Michelle , Kritzmacher Alexandra , Reuter-Lorenz Patricia A , Shah Priti , Jonides John
Published: July 2019

Objective

The majority of the population will experience some cognitive decline with age. Therefore, the development of effective interventions to mitigate age-related decline is critical for older adults’ cognitive functioning and their quality of life.

Methods

In our randomized controlled multisite trial, we target participants’ working memory (WM) skills, and in addition, we focus on the intervention’s optimal scheduling in order to test whether and how the distribution of training sessions might affect task learning, and ultimately, transfer. Healthy older adults completed an intervention targeting either WM or general knowledge twice per day, once per day, or once every-other-day. Before and after the intervention and 3 months after training completion, participants were tested in a variety of cognitive domains, including those representing functioning in everyday life.

Results

In contrast to our hypotheses, spacing seems to affect learning only minimally. We did observe some transfer effects, especially within the targeted cognitive domain (WM and inhibition/interference), which remained stable at the 3-month follow-up.

Discussion

Our findings have practical implications by showing that the variation in training schedule, at least within the range used here, does not seem to be a crucial element for training benefits.
“Who’s Been Putting Socks in My Drawer?” Narrative Case Study of an Elder Role Model
Authors: Kivnick Helen Q , Driessen Molly C , Santavasy Chittaphone , Wardwell Clair , Duncan Davis Linda
Published: July 2019

Background and Objectives

This article presents a narrative-based case study about vital involvement in an elder role model, exploring the dimensions of this man’s current vital involvement and identifying its lifelong expressions that appear, in older adulthood, to have enabled him to become such an exemplar. This case was chosen from a larger study of “Elder Roles Models”, that explores: (i) What about these particular older adults (identified by colleagues, friends, program directors, and service providers) constitutes their “elder role model-hood”; and (ii) How, developmentally, they got to be this way in older adulthood. This case study addresses the first of these questions by identifying five dimensions of vital involvement.

Research Design and Methods

Case study data were collected through five, semi-structured life-history interviews conducted over the 3 months. Interviews (90–120 minutes, each) were transcribed and analyzed using a thematic analysis approach.

Findings

Five dimensions emerged as constituting this man’s vital involvement in older adulthood: (i) enacting personal values and strengths; (ii) person–environment reciprocity; (iii) using environmental supports; (iv) enriching the environment; and (v) experience-based perspective.

Discussion and Implications

Dimensions are contextualized in terms of gerontological and life-cycle research, theory, and practice. A fundamental principle of Erikson’s theory of lifelong psychosocial development, the vital involvement dynamic, is suggested as an “umbrella concept” for integrating disparate gerontological practices, theories, and research, and for conceptualizing older adulthood in the context of the life cycle as a whole.
Communicative Competence: Responding to Residents’ Health Changes in Assisted Living
Authors: Kemp Candace L , Ball Mary M , Jason Kendra , Appel Joy Anna Dillard , Fitzroy Andrea F
Published: July 2019

Background and Objectives

Frail and disabled individuals, including assisted living (AL) residents, are embedded in care convoys composed of dynamic networks of formal and informal care partners. Yet, little is known about how care convoys operate over time, especially when health changes occur. Thus, our aim was to provide an in-depth understanding of care convoy communication during times of residents’ health changes in AL.

Research Design and Methods

Data for this analysis come from a Grounded Theory study that involved 50 residents and their care convoy members (n = 169) from 8 diverse AL communities followed over 2 years. Researchers conducted formal and informal interviewing, participant observation, and record review.

Results

We identified “communicative competence” as an explanatory framework in reference to a resident’s or care partner’s ability, knowledge, and action pertaining to communication and health change. Individual and collective competencies were consequential to timely and appropriate care. Communication involved: identifying; assessing significance; informing, consulting or collaborating with others; and responding to the change. Variability in communication process and properties (e.g., pace and timing; sequencing, timing, content, and mode of communication) depended on multiple factors, including the nature of the change and resident, informal and formal caregiver, convoy, AL community, and regulatory influences.

Discussion and Implications

Formal and informal care partners need support to establish, enhance, and maintain communicative competence in response to health changes. Findings reinforce the need for timely communication, effective systems, and well-documented accessible health care directives and have implications that are applicable to AL and other care settings.
Investigating the seismic structure and visibility of dynamic plume models with seismic array methods
Authors: Stockmann Fabienne , Cobden Laura , Deschamps Frédéric , Fichtner Andreas , Thomas Christine
Published: July 2019

Mantle plumes may play a major role in the transport of heat and mass through the Earth, but establishing their existence and structure using seismology has proven challenging and controversial. Previous studies have mainly focused on imaging plumes using waveform modelling and inversion (i.e. tomography). In this study we investigate the potential visibility of mantle plumes using array methods, and in particular whether we can detect seismic scattering from the plumes. By combining geodynamic modelling with mineral physics data we compute ‘seismic’ plumes whose shape and structure correspond to dynamically plausible thermochemical plumes. We use these seismic models to perform a full-waveform simulation, sending seismic waves through the plumes, in order to generate synthetic seismograms. Using velocity spectral analysis and slowness-backazimuth plots, we are unable to detect scattering. However at longer dominant periods (25 s) we see several arrivals from outside the plane of the great circle path, that are consistent with an apparent bending of the wave front around the plume conduit. At shorter periods (15 s), these arrivals are less obvious and less strong, consistent with the expected changes in the waves' behaviour at higher frequencies. We also detect reflections off the iron-rich chemical pile which serves as the plume source in the D″ region, indicating that D″ reflections may not always be due to a phase transformation. We suggest that slowness-backazimuth analysis may be a useful tool to locate mantle plumes in real array data sets. However, it is important to analyse the data at different dominant periods since, depending on the width of the plume, there is probably an optimum frequency band at which the plume is most visible. Our results also show the importance of studying the incoming energy in all directions, so that any apparently out-of-plane arrivals can be correctly interpreted.
Intravenous infusion of iPSC-derived neural precursor cells increases acid β-glucosidase function in the brain and lessens the neuronopathic phenotype in a mouse model of Gaucher disease
Authors: Peng Yanyan , Liou Benjamin , Inskeep Venette , Blackwood Rachel , Mayhew Christopher N , Grabowski Gregory A , Sun Ying
Published: July 2019

Gaucher disease (GD) is caused by GBA1 mutations leading to functional deficiency of acid-β-glucosidase (GCase). No effective treatment is available for neuronopathic GD (nGD). A subclass of neural stem and precursor cells (NPCs) expresses VLA4 (integrin α4β1, very late antigen-4) that facilitates NPC entry into the brain following intravenous (IV) infusion. Here, the therapeutic potential of IV VLA4+NPCs was assessed for nGD using wild-type mouse green fluorescent protein (GFP)-positive multipotent induced pluripotent stem cell (iPSC)-derived VLA4+NPCs. VLA4+NPCs successfully engrafted in the nGD (4L;C*) mouse brain. GFP-positive cells differentiated into neurons, astrocytes and oligodendrocytes in the brainstem, midbrain and thalamus of the transplanted mice and significantly improved sensorimotor function and prolonged life span compared to vehicle-treated 4L;C* mice. VLA4+NPC transplantation significantly decreased levels of CD68 and glial fibrillary acidic protein, as well as TNFα mRNA levels in the brain, indicating reduced neuroinflammation. Furthermore, decreased Fluoro-Jade C and NeuroSilver staining suggested inhibition of neurodegeneration. VLA4+NPC-engrafted 4L;C* midbrains showed 35% increased GCase activity, reduced substrate [glucosylceramide (GC, −34%) and glucosylsphingosine (GS, −11%)] levels and improved mitochondrial oxygen consumption rates in comparison to vehicle-4L;C* mice. VLA4+NPC engraftment in 4L;C* brain also led to enhanced expression of neurotrophic factors that have roles in neuronal survival and the promotion of neurogenesis. This study provides evidence that iPSC-derived NPC transplantation has efficacy in an nGD mouse model and provides proof of concept for autologous NPC therapy in nGD.
Quality of life can be good after slide tracheoplasty for long-segment tracheal stenosis
Authors: Wray Jo , Ryde Matthew , Butler Colin R , Hewitt Richard J
Published: July 2019

OBJECTIVES

The objectives of this study were to measure ‘health-related quality of life’ (HRQoL) in children following slide tracheoplasty for long-segment tracheal stenosis (LSTS) and to explore the relationship of comorbidities and parental mental health with HRQoL outcomes.

METHODS

A cross-sectional study was undertaken with children who had undergone slide tracheoplasty. Participants included parents and children (age 5–15 years) recruited over a 13-month period, who were asked to complete validated measures of HRQoL, development and behaviour. Scores were compared to published norms.

RESULTS

Forty-two children (male 69%; n = 29) were included; mean age was 5.3 (standard deviation 3.5) years and mean follow-up was 45 (range 4–179) months. Mean total HRQoL scores for children with repaired LSTS did not differ from those of healthy norms other than for children aged 13–23 months, but 10 children (24%) had scores >2 SD below the mean for healthy children. HRQoL was poorer in children with non-cardiac congenital comorbidities than in those with isolated LSTS (mean scores 60.34 ± 17.19 and 85.52 ± 12.19, respectively, P = 0.01). There was good agreement between children’s and parents’ scores, although children rated their HRQoL as better than their parents did. Anxious parents rated their children’s HRQoL as significantly worse than non-anxious parents (P<0.001).

CONCLUSIONS

Older children with isolated LSTS can have excellent HRQoL after surgery. Younger children, at an earlier time point postoperatively, and those with non-cardiac congenital comorbidities have poorer HRQoL. Further longitudinal evaluation is required to identify psycho-social (including parental) predictors of outcome which may inform, or be amenable to, intervention.
A Concordance Analogue of the 4D Light Bulb Theorem
Authors: Miller Maggie
Published: July 2019

We prove a concordance analogue of Gabai’s $4$D light bulb theorem. That is, we show that when $R$ and $R^{\prime}$ are homotopic, embedded $2$-spheres in a $4$-manifold $X^4,$ where $\pi _1(X^4)$ has no $2$-torsion and one of $R$ or $R^{\prime}$ has a transverse sphere, then $R$ and $R^{\prime}$ are concordant. When $\pi _1(X^4)$ has $2$-torsion, we give a similar statement with extra hypotheses as in the $4$D light bulb theorem. We also give similar statements when $R$ and $R^{\prime}$ are orientable positive-genus surfaces.
Extremal Domains and Pólya-type Inequalities for the Robin Laplacian on Rectangles and Unions of Rectangles
Authors: Freitas Pedro , Kennedy James B
Published: July 2019

We investigate the question of whether the eigenvalues of the Laplacian with Robin boundary conditions can satisfy inequalities of the same type as those in Pólya’s conjecture for the Dirichlet and Neumann Laplacians and, if so, what form these inequalities should take. Motivated in part by Pólya’s original approach and in part by recent analogous works treating the Dirichlet and Neumann Laplacians, we consider rectangles and unions of rectangles and show that for these two families of domains, for any fixed positive value $\alpha$ of the boundary parameter, Pólya-type inequalities do indeed hold, albeit with an exponent smaller than that of the corresponding Weyl asympotics for a fixed domain. We determine the optimal exponents in both cases, showing that they are different in the two situations. Our approach to proving these results includes a characterization of the corresponding extremal domains for the $k^{\textrm{}}$th eigenvalue in regions of the $(k,\alpha )$-plane, which in turn supports recent conjectures on the nature of the extrema among all bounded domains.
Epidemiology of Bacterial Meningitis in the Nine Years Since Meningococcal Serogroup A Conjugate Vaccine Introduction, Niger, 2010–2018
Authors: Sidikou Fati , Potts Caelin C , Zaneidou Maman , Mbaeyi Sarah , Kadadé Goumbi , Paye Marietou F , Ousmane Sani , Issaka Bassira , Chen Alexander , Chang How-Yi , Issifou Djibo , Lingani Clement , Sakande Souleymane , Bienvenu Baruani , Mahamane Ali Elhadji , Diallo Alpha Oumar , Moussa Amadou , Seidou Issaka , Abdou Moussa , Sidiki Ali , Garba Omar , Haladou Sani , Testa Jean , Obama Nse Ricardo , Mainassara Halima Boubacar , Wang Xin
Published: July 2019

Background

In 2010, Niger and other meningitis belt countries introduced a meningococcal serogroup A conjugate vaccine (MACV). We describe the epidemiology of bacterial meningitis in Niger from 2010 to 2018.

Methods

Suspected and confirmed meningitis cases from January 1, 2010 to July 15, 2018 were obtained from national aggregate and laboratory surveillance. Cerebrospinal fluid specimens were analyzed by culture and/or polymerase chain reaction. Annual incidence was calculated as cases per 100 000 population. Selected isolates obtained during 2016–2017 were characterized by whole-genome sequencing.

Results

Of the 21 142 suspected cases of meningitis, 5590 were confirmed: Neisseria meningitidis ([Nm] 85%), Streptococcus pneumoniae ([Sp] 13%), and Haemophilus influenzae ([Hi] 2%). No NmA cases occurred after 2011. Annual incidence per 100 000 population was more dynamic for Nm (0.06–7.71) than for Sp (0.18–0.70) and Hi (0.01–0.23). The predominant Nm serogroups varied over time (NmW in 2010–2011, NmC in 2015–2018, and both NmC and NmX in 2017–2018). Meningococcal meningitis incidence was highest in the regions of Niamey, Tillabery, Dosso, Tahoua, and Maradi. The NmW isolates were clonal complex (CC)11, NmX were CC181, and NmC were CC10217.

Conclusions

After MACV introduction, we observed an absence of NmA, the emergence and continuing burden of NmC, and an increase in NmX. Niger’s dynamic Nm serogroup distribution highlights the need for strong surveillance programs to inform vaccine policy.
Efficient Transmission of Mixed Plasmodium falciparum/vivax Infections From Humans to Mosquitoes
Authors: Balasubramanian Sujata , Rahman Rifat S , Lon Chanthap , Parobek Christian , Ubalee Ratawan , Hathaway Nicholas , Kuntawunginn Worachet , My Mok , Vy Dav , Saxe Jeremy , Lanteri Charlotte , Lin Feng-Chang , Spring Michele , Meshnick Steven R , Juliano Jonathan J , Saunders David L , Lin Jessica T
Published: July 2019

Background

In Southeast Asia, people are often coinfected with different species of malaria (Plasmodium falciparum [Pf] and Plasmodium vivax [Pv]) as well as with multiple clones of the same species. Whether particular species or clones within mixed infections are more readily transmitted to mosquitoes remains unknown.

Methods

Laboratory-reared Anopheles dirus were fed on blood from 119 Pf-infected Cambodian adults, with 5950 dissected to evaluate for transmitted infection. Among 12 persons who infected mosquitoes, polymerase chain reaction and amplicon deep sequencing were used to track species and clone-specific transmission to mosquitoes.

Results

Seven of 12 persons that infected mosquitoes harbored mixed Pf/Pv infection. Among these 7 persons, all transmitted Pv with 2 transmitting both Pf and Pv, leading to Pf/Pv coinfection in 21% of infected mosquitoes. Up to 4 clones of each species were detected within persons. Shifts in clone frequency were detected during transmission. However, in general, all parasite clones in humans were transmitted to mosquitoes, with individual mosquitoes frequently carrying multiple transmitted clones.

Conclusions

Malaria diversity in human hosts was maintained in the parasite populations recovered from mosquitoes fed on their blood. However, in persons with mixed Pf/Pv malaria, Pv appears to be transmitted more readily, in association with more prevalent patent gametocytemia.
Intervention planning for Antibiotic Review Kit (ARK): a digital and behavioural intervention to safely review and reduce antibiotic prescriptions in acute and general medicine
Authors: Santillo M , Sivyer K , Krusche A , Mowbray F , Jones N , Peto T E A , Walker A S , Llewelyn M J , Yardley L ,   ARK-Hospital, Lee Amy , Sargent Catherine , Butler Chris , Roseveare Chris , Agranoff Daniel , Lockwood Debbie , Lyon Donald , Cross Elizabeth , Darwin Elizabeth , Barlow Gavin , Setchfield Ian , Islam Jasmin , Wright Juliet , Hand Kieran , Vaughan Louella , Wilcox Mark , Wiselka Martin , Sharland Mike , Jones Nicola , Fawcett Nicola , Wade Paul , Martin Dachsel R , Sierra Rachaeol , Bellamy Richard , Pires Sacha , Curtis Sally , Lippett Samantha , Crossland Sue , Hopkins Susan , Garcia-Arias Veronica , Gudka Vikesh , Hamilton Will , Gorton Clifford
Published: July 2019

Background

Hospital antimicrobial stewardship strategies, such as ‘Start Smart, Then Focus’ in the UK, balance the need for prompt, effective antibiotic treatment with the need to limit antibiotic overuse using ‘review and revise’. However, only a minority of review decisions are to stop antibiotics. Research suggests that this is due to both behavioural and organizational factors.

Objectives

To develop and optimize the Antibiotic Review Kit (ARK) intervention. ARK is a complex digital, organizational and behavioural intervention that supports implementation of ‘review and revise’ to help healthcare professionals safely stop unnecessary antibiotics.

Methods

A theory-, evidence- and person-based approach was used to develop and optimize ARK and its implementation. This was done through iterative stakeholder consultation and in-depth qualitative research with doctors, nurses and pharmacists in UK hospitals. Barriers to and facilitators of the intervention and its implementation, and ways to address them, were identified and then used to inform the intervention’s development.

Results

A key barrier to stopping antibiotics was reportedly a lack of information about the original prescriber’s rationale for and their degree of certainty about the need for antibiotics. An integral component of ARK was the development and optimization of a Decision Aid and its implementation to increase transparency around initial prescribing decisions.

Conclusions

The key output of this research is a digital and behavioural intervention targeting important barriers to stopping antibiotics at review (see http://bsac-vle.com/ark-the-antibiotic-review-kit/ and http://antibioticreviewkit.org.uk/). ARK will be evaluated in a feasibility study and, if successful, a stepped-wedge cluster-randomized controlled trial at acute hospitals across the NHS.
Outpatient parenteral antimicrobial therapy: updated recommendations from the UK
Authors: Chapman Ann L N , Patel Sanjay , Horner Carolyne , Gilchrist Mark , Seaton R Andrew
Published: July 2019

Outpatient parenteral antimicrobial therapy (OPAT) offers safe, effective and patient-centred care for adults and children. The OPAT UK good practice recommendations for adults and children have recently been updated through a process of literature review, expert consensus and extensive stakeholder consultation. Here we discuss the key changes in the updated recommendations in the context of recent developments, including novel antimicrobial agents and delivery devices, the place of oral antimicrobials as an alternative to intravenous therapy, new OPAT service models and the broader antimicrobial stewardship agenda.
A mobile app identifies momentary psychosocial and contextual factors related to mealtime self-management in adolescents with type 1 diabetes
Authors: Mulvaney Shelagh A , Vaala Sarah E , Carroll Rachel B , Williams Laura K , Lybarger Cindy K , Schmidt Douglas C , Dietrich Mary S , Laffel Lori M , Hood Korey K
Published: July 2019

Effective diabetes problem solving requires identification of risk factors for inadequate mealtime self-management. Ecological momentary assessment was used to enhance identification of factors hypothesized to impact self-management. Adolescents with type 1 diabetes participated in a feasibility trial for a mobile app called MyDay. Meals, mealtime insulin, self-monitored blood glucose, and psychosocial and contextual data were obtained for 30 days. Using 1472 assessments, mixed-effects between-subjects analyses showed that social context, location, and mealtime were associated with missed self-monitored blood glucose. Stress, energy, mood, and fatigue were associated with missed insulin. Within-subjects analyses indicated that all factors were associated with both self-management tasks. Intraclass correlations showed within-subjects accounted for the majority of variance. The ecological momentary assessment method provided specific targets for improving self-management problem solving, phenotyping, or integration within just-in-time adaptive interventions.
How and when informative visit processes can bias inference when using electronic health records data for clinical research
Authors: Goldstein Benjamin A , Phelan Matthew , Pagidipati Neha J , Peskoe Sarah B
Published: July 2019

Objective

Electronic health records (EHR) data have become a central data source for clinical research. One concern for using EHR data is that the process through which individuals engage with the health system, and find themselves within EHR data, can be informative. We have termed this process informed presence. In this study we use simulation and real data to assess how the informed presence can impact inference.

Materials and Methods

We first simulated a visit process where a series of biomarkers were observed informatively and uninformatively over time. We further compared inference derived from a randomized control trial (ie, uninformative visits) and EHR data (ie, potentially informative visits).

Results

We find that only when there is both a strong association between the biomarker and the outcome as well as the biomarker and the visit process is there bias. Moreover, once there are some uninformative visits this bias is mitigated. In the data example we find, that when the “true” associations are null, there is no observed bias.

Discussion

These results suggest that an informative visit process can exaggerate an association but cannot induce one. Furthermore, careful study design can, mitigate the potential bias when some noninformative visits are included.

Conclusions

While there are legitimate concerns regarding biases that “messy” EHR data may induce, the conditions for such biases are extreme and can be accounted for.