bluuebunny/crossref_metadata_2025 huggingface dataset:
Coherent Mortality Forecasting with Standards: Low Mortality Serves as a Guide
Authors: Booth Heather
Published: September 2020

Mortality forecasts are an important component of population forecasting and are central to the estimation of longevity risk in actuarial practice. Planning by the state for health and aged care services and by individuals for retirement and later life depends on accurate mortality forecasts. The overall accuracy or performance of mortality forecasting has improved since Lee and Carter (1992) introduced stochastic forecasting of mortality to the demographic community, and further improvements can undoubtedly be made.
European Mortality Forecasts: Are the Targets Still Moving?
Authors: Keilman Nico , Kristoffersen Sigve
Published: September 2020

Many statistical agencies routinely produce population forecasts, and revise these forecasts when new data become available, or when current demographic trends indicate that an update is necessary. When the forecaster strongly revises, from one forecast round to the next one, a forecast for a certain target year (for instance the life expectancy in 2050), this indicates large uncertainty connected to mortality predictions. The aim of this chapter is to shed more light on the uncertainty in mortality forecasts, by analysing the extent to which life expectancy predictions for 2030 and 2050 were revised in subsequent rounds of population forecasts published by statistical agencies in selected countries. It updates and extends earlier work that focused on United Nations and Eurostat forecasts published between 1994 and 2004 (Keilman et al. 2008). There the conclusion was that life expectancy forecasts for 18 European countries for the year 2050 had been revised upwards systematically, by around 2 years on average during the 10-year publication period. A recent analysis based on official population forecasts for Norway published in the period 1999–2018 led to the same conclusion (Keilman 2018). Here we will show that the period of upward revisions seems to have ended for some European countries.
On the Spectrum of the Local $${\mathbb {P}}^2$$ Mirror Curve
Authors: Kashaev Rinat , Sergeev Sergey
Published: September 2020

We address the spectral problem of the formally normal quantum mechanical operator associated with the quantised mirror curve of the toric (almost) del Pezzo Calabi–Yau threefold called local $${\mathbb {P}}^2$$

P

2

in the case of complex values of Planck’s constant. We show that the problem can be approached in terms of the Bethe ansatz-type highly transcendental equations.
A maltose-regulated large genomic region is activated by the transcriptional regulator MalT in Actinoplanes sp. SE50/110
Authors: Droste Julian , Kulisch Martin , Wolf Timo , Schaffert Lena , Schneiker-Bekel Susanne , Pühler Alfred , Kalinowski Jörn
Published: September 2020

Actinoplanes sp. SE50/110 is the industrially relevant producer of acarbose, which is used in the treatment of diabetes mellitus. Recent studies elucidated the expression dynamics in Actinoplanes sp. SE50/110 during growth. From these data, we obtained a large genomic region (ACSP50_3900 to ACSP50_3950) containing 51 genes, of which 39 are transcribed in the same manner. These co-regulated genes were found to be stronger transcribed on maltose compared with glucose as a carbon source. The transcriptional regulator MalT was identified as an activator of this maltose-regulated large genomic region (MRLGR). Since most of the genes are poorly annotated, the function of this region is farther unclear. However, comprehensive BLAST analyses indicate similarities to enzymes involved in amino acid metabolism. We determined a conserved binding motif of MalT overlapping the -35 promoter region of 17 transcription start sites inside the MRLGR. The corresponding sequence motif 5′-TCATCC-5nt-GGATGA-3′ displays high similarities to reported MalT binding sites in Escherichia coli and Klebsiella pneumoniae, in which MalT is the activator of mal genes. A malT deletion and an overexpression mutant were constructed. Differential transcriptome analyses revealed an activating effect of MalT on 40 of the 51 genes. Surprisingly, no gene of the maltose metabolism is affected. In contrast to many other bacteria, MalT is not the activator of mal genes in Actinoplanes sp. SE50/110. Finally, the MRLGR was found partly in other closely related bacteria of the family Micromonosporaceae. Even the conserved MalT binding site was found upstream of several genes inside of the corresponding regions.

Key points

• MalT is the maltose-dependent activator of a large genomic region in ACSP50_WT.

• The consensus binding motif is similar to MalT binding sites in other bacteria.

• MalT is not the regulator of genes involved in maltose metabolism in ACSP50_WT.
The Fun Factor: Does Serious Gaming Affect the Volume of Voluntary Laparoscopic Skills Training?
Authors: IJgosse Wouter Martijn , van Goor Harry , Rosman Camiel , Luursema Jan‐Maarten
Published: September 2020

Background

The availability of validated laparoscopic simulators has not resulted in sustainable high‐volume training. We investigated whether the validated laparoscopic serious game Underground would increase voluntary training by residents. We hypothesized that by removing intrinsic barriers and extrinsic barriers, residents would spend more time on voluntary training with Underground compared to voluntary training with traditional simulators.

Methods

After 1 year, we compared amount of voluntary time spent on playing Underground to time spent on all other laparoscopic training modalities and to time spent on performing laparoscopic procedures in the OR for all surgical residents. These data were compared to resident’ time spent on laparoscopic activities over the prior year before the introduction of Underground.

Results

From March 2016 until March 2017, 63 residents spent on average 20 min on voluntary serious gaming, 17 min on voluntary simulator training, 2 h and 44 min on mandatory laparoscopic training courses, and 14 h and 49 min on laparoscopic procedures in the OR. Voluntary activities represented 3% of laparoscopic training activities which was similar in the prior year wherein fifty residents spent on average 33 min on voluntary simulator training, 3 h and 28 min on mandatory laparoscopic training courses, and 11 h and 19 min on laparoscopic procedures.

Conclusion

Serious gaming has not increased total voluntary training volume. Underground did not mitigate intrinsic and extrinsic barriers to voluntary training. Mandatory, scheduled training courses remain needed. Serious gaming is flexible and affordable and could be an important part of such training courses.
Angewandtes Quantencomputing
Authors: Lässig Jörg
Published: September 2020

Quantencomputing ist als Konzept mittlerweile zwar mehrere Jahrzehnte alt und hat von der Idee bis zu den heutigen Noisy Intermediate-Scale Quantum Maschinen verschiedene Phasen stetiger Entwicklung durchlaufen, jedoch insbesondere in den letzten Jahren deutlich an Dynamik gewonnen. Im aktuellen Stadium stehen Quantenrechner zur Verfügung, die zwar noch immer stark limitiert sind, jedoch die Ausführung maßgeschneiderter Algorithmen unterstützen, die bestehende Schwächen dieser Maschinen mit ihrem speziellen Design zu umgehen versuchen. Diese Algorithmen adressieren dabei mit Maschinellem Lernen, kombinatorischer Optimierung und Simulationsanwendungen sowie weiteren potenziellen Anwendungsfeldern Problemstellungen, die praktisch vielfältig relevant und deshalb von breitem, allgemeinen Interesse sind. Das prinzipielle Potenzial des Quantencomputers, in bestimmten Anwendungsfeldern deutlich leistungsfähiger zu sein als klassische Rechner, ruft viel Aufmerksamkeit hervor. Außerdem stellt bereits eine ganze Reihe von prinzipiell für jedermann zugänglichen Softwareframeworks Implementierungen aktueller Quantenalgorithmen zum Test und zur Evaluierung bereit. Der Artikel stellt die bisherige Entwicklung, aktuelle Verfahren sowie weitere Perspektiven der Technologie in Grundzügen dar und informiert über mögliche Anwendungsgebiete aber auch bekannte Grenzen des Quantencomputing-Paradigmas.
The challenge of sustainability in healthcare systems: cost of radiotherapy in the last month of life in an Italian cancer center
Authors: Rossi Romina , Danesi Valentina , Massa Ilaria , Balzi William , Romeo Antonino , Foca Flavia , Nanni Oriana , Maltoni Marco , Altini Mattia
Published: September 2020

Purpose

Cost evaluation is becoming mandatory to support healthcare sustainability and optimize the decision-making process. This topic is a challenge, especially for complex and rapidly evolving treatment modalities such as radiotherapy (RT). The aim of the present study was to investigate the cost of RT in the last month of life of patients in an Italian cancer center.

Methods

This was a retrospective study on a cancer population (N= 160) who underwent RT or only an RT planning simulation in an end of life (EOL) setting. The cost of RT procedures performed on patients was collected according to treatment status, care setting, and RT technique used. Costs were valued according to the sum of reimbursements relating to all procedures performed and assessed from the perspective of the National Health System.

Results

The total cost of RT in the last month of life was €244,774, with an average cost per patient of €1530. Around 7.7% and 30.3% of the total cost was associated with patients who never started RT or who discontinued RT, respectively, while the remaining 62.0% referred to patients who completed treatment. Costs associated with outpatient and inpatient settings represented 54.3% and 38.6% of the total cost, respectively. The higher average cost per patient for the never-started and discontinued groups was correlated with patients who had a poor ECOG Performance Status.

Conclusion

Improved prognostic accuracy and a better integration between radiotherapy and palliative care units could be a key to a better use of resources and to a reduction in the cost of EOL RT.
On the Use of X-ray Computed Tomography in Assessment of 3D-Printed Components
Authors: Khosravani Mohammad Reza , Reinicke Tamara
Published: September 2020

Technical advantages of additive manufacturing (AM) have drawn great attention over the past few years. This cost-effective manufacturing process proved its potential applications in a wide range of fields. Although AM techniques (known as 3D printing) are able to fabricate geometrically complex components, it is necessary to evaluate internal and external dimensions of the printed parts. In this context, x-ray computed tomography (CT) as a nondestructive evaluation technique has been utilized. Indeed, CT can be used for geometric analysis, defects detection, quantitative comparison, structural quantification and porosity analysis. In the current study, we present a brief review of 3D printing processes and evolution of CT technology. Moreover, applications of CT in assessment of 3D-printed components are explained in detail. Although CT has been used in academic and industrial researches, abilities of this inspection method are not yet fully documented for precision engineering applications. In this work, usage of this technique in study of printed components are categorized in four subdomains and discussed. The documented data proved that CT is an appropriate non-contact technique for technical evaluation of various printed parts. As usage of CT in assessment of printed parts is still evolving, the limitations, challenges and future perspective are outlined.
Removal of Heavy Metal Ions from Water and Wastewaters by Sulfur-Containing Precipitation Agents
Authors: Pohl Alina
Published: September 2020

Restrictive requirements for maximum concentrations of metals introduced into the environment lead to search for effective methods of their removal. Chemical precipitation using hydroxides or sulfides is one of the most commonly used methods for removing metals from water and wastewater. The process is simple and inexpensive. However, during metal hydroxide precipitation, large amounts of solids are formed. As a result, metal hydroxide is getting amphoteric and it can go back into the solution. On the other hand, use of sulfides is characterized by lower solubility compared with that of metal hydroxides, so a higher degree of metal reduction can be achieved in a shorter time. Disadvantages of that process are very low solubility of metal sulfides, highly sensitive process to the dosing of the precipitation agent, and the risks of emission of toxic hydrogen sulfide. All these restrictions forced to search for new and effective precipitants. Potassium/sodium thiocarbonate (STC) and 2,4,6-trimercaptotiazine (TMT) are widely used. Dithiocarbamate (DTC) compounds are also used, e.g., sodium dimethyldithiocarbamate (SDTC), and ligands for permanent metal binding, e.g., 1,3-benzenediamidoethanethiol (BDETH2), 2,6-pyridinediamidoethanethiol (PyDET), a pyridine-based thiol ligand (DTPY) or ligands with open chains containing many sulfur atoms, using of a tetrahedral bonding arrangement around a central metal atom. The possibility of improving the efficiency of metal precipitation is obtained by using a higher dose of precipitating agent. However, toxic byproducts are often produced. It is required that the precipitation agents not only effectively remove metal ions from the solution but also effectively bind with dyes or metal complexes.
Living income benchmarking of rural households in low-income countries
Authors: van de Ven Gerrie W. J. , de Valença Anne , Marinus Wytze , de Jager Ilse , Descheemaeker Katrien K. E. , Hekman Willem , Mellisse Beyene Teklu , Baijukya Frederick , Omari Mwantumu , Giller Ken E.
Published: September 2020

The extreme poverty line is the most commonly used benchmark for poverty, set at US$ 1.90 by the World Bank. Another benchmark, based on the Anker living wage methodology, is the remuneration received for a standard work week necessary for a worker to meet his/her family’s basic needs in a particular place. The living wage concept has been used extensively to address incomes of plantation workers producing agricultural commodities for international markets. More recently intense discussion has emerged concerning the ‘living income’ of smallholder farmers who produce commodities for international supply chains on their own land. In this article we propose a simple method that can be used in all types of development projects to benchmark a rural ‘living income’. We launch the Living Income Methodology, as adapted from the Living Wage Methodology, to estimate the living income for rural households. In any given location this requires about one week of fieldwork. We express it per adult equivalent per day (AE/day) and data collection is focused on rural households and their immediate surroundings. Our three case studies showed that in 2017 in Lushoto District, rural Tanzania, the living income was US$ PPP 4.04/AE/day, in Isingiro District, rural Uganda, 3.82 and in Sidama Zone, rural Ethiopia, 3.60. In all cases, the extreme poverty line of US$ PPP 1.90 per capita per day is insufficient to meet the basic human rights for a decent living in low-income countries. The Living Income Methodology provides a transparent local benchmark that can be used to assess development opportunities of rural households, by employers in rural areas, including farmers hiring in labour, while respecting basic human rights on a decent living. It can be used to reflect on progress of rural households in low-income countries on their aspired path out of poverty. It further provides a meaningful benchmark to measure progress on Sustainable Development Goal 1, eliminating poverty, and 2, zero hunger and sustainable food systems, allowing for consideration of the local context.
Arbeitsbündnisse in der Migrationsgesellschaft
Authors: Vogler Jens
Published: September 2020

Die Zusammenarbeit von sozial arbeitenden Personen mit ihren Adressat*innen ist im Kontext Migration überwiegend durch ungleiche (Macht‑)Verhältnisse gekennzeichnet. Die bisher kaum untersuchten Ursachen dieser Asymmetrien und wie sie sich in den Begegnungen der Akteur*innen zeigen, bilden den Ausgangspunkt des Beitrags. Neben der theoretischen Rahmung werden eigene Forschungsergebnisse anhand von Audioaufzeichnungen von Interaktionen zivilgesellschaftlicher und professioneller Akteur*innen mit ihrer Zielgruppe in Handlungsfeldern Sozialer Arbeit gezeigt.
“Masculine” Describes Gender Expressions, Not Neurobiologies: Response to Dutton and Madison (2020)
Authors: Walsh Reubs J
Published: September 2020

This letter is a response to “Gender Dysphoria and Transgender Identity Is Associated with Physiological and Psychological Masculinization: a Theoretical Integration of Findings, Supported by Systematic Reviews” by Dutton and Madison (2020), which relies on theorisations for which substantial counter-evidence exists, fails to engage with these or other criticisms of the theories upon which it seeks to build, and reaches conclusions that contradict existing evidence. Furthermore, the original theorisations contained in Dutton and Madison (2020), and the conclusions drawn from those theorisations, risk causing serious harm to already-marginalised groups.
The upward tilt of honeycomb cells increases the carrying capacity of the comb and is not to prevent the outflow of honey
Authors: Oeder Robert , Schwabe Dietrich
Published: September 2020

The cells of the combs ofApis melliferaare tilted upwards by approximately 13°. The literature says that this tilt serves to prevent the outflow of honey. We checked this by hanging empty honeycombs upside down into beehives. Honey was stored in these inverted honeycombs in the same way as in the normally oriented combs, and inverted combs were also well accepted for rearing the brood. We thus show that the benefit for the bees of the upward tilt of the cells is not to prevent leakage of honey. Honey is obviously in a Wenzel state on the hydrophobic, micro-structured cell walls. The associated wetting of the cell wall causes adhesion that prevents leakage. We propose that the benefit of the inclination of the cells is to direct about 10% of the weight of cell contents onto the midwall, thus increasing the carrying capacity of the comb.
Resilience-Driven Road Network Retrofit Optimization Subject to Tropical Cyclones Induced Roadside Tree Blowdown
Authors: Hu Fuyu , Yang Saini , Thompson Russell G.
Published: September 2020

This article focuses on decision making for retrofit investment of road networks in order to alleviate severe consequences of roadside tree blowdown during tropical cyclones. The consequences include both the physical damage associated with roadside trees and the functional degradation associated with road networks. A trilevel, two-stage, and multiobjective stochastic mathematical model was developed to dispatch limited resources to retrofit the roadside trees of a road network. In the model, a new metric was designed to evaluate the performance of a road network; resilience was considered from robustness and recovery efficiency of a road network. The proposed model is at least a nondeterministic polynomial-time hardness (NP-hard) problem, which is unlikely to be solved by a polynomial time algorithm. Pareto-optimal solutions for this problem can be obtained by a proposed trilevel algorithm. The random forest method was employed to transform the trilevel algorithm into a single-level algorithm in order to decrease the computation burden. Roadside tree retrofit of a provincial highway network on Hainan Island, China was selected as a case area because it suffers severely from tropical cyclones every year, where there is an urgency to upgrade roadside trees against tropical cyclones. We found that roadside tree retrofit investment significantly alleviates the expected economic losses of roadside tree blowdown, at the same time that it promotes robustness and expected recovery efficiency of the road network.
Development of a 3D printed simulator for closed reduction of distal radius fractures
Authors: Dixon William , Miller Nathaniel , Toal Georgia G. , Sebok-Syer Stefanie S. , Gisondi Michael A.
Published: September 2020

Background The use of simulators in medical education is critical for developing procedural competence prior to treating patients. Current training of emergency physicians to perform distal radius fracture reduction is inconsistent and inadequate.

Approach We developed a 3D printed distal radius fracture simulation training model that is easy to assemble and relatively inexpensive. We present step-by-step instructions to reproduce the model.

Evaluation The model was found to have high fidelity for training by both instructors and participants in a simulation-based mastery learning course.

Reflection We successfully designed a low cost, easy to reproduce, high fidelity model for use in a simulation-based mastery learning course to teach distal radius fracture reduction.
Efficiency without Apology: Consideration of the Marginal Excess Tax Burden and Distributional Impacts in Benefit–Cost Analysis
Authors: Boardman Anthony E. , Greenberg David H. , Vining Aidan R. , Weimer David L.
Published: September 2020

Some issues in the application of benefit–cost analysis (BCA) remain contentious. Although a strong conceptual case can be made for taking account of the marginal excess tax burden (METB) in conducting BCAs, it is usually excluded. Although a strong conceptual case can be made that BCA should not include distributional values, some analysts continue to advocate doing so. We discuss the cases for inclusion of the METB and the exclusion of distributional weights from what we refer to as “core” BCA, which we argue should be preserved as a protocol for assessing allocative efficiency. These issues are topical because a recent article in this journal recommends ignoring the METB on the grounds that desirable distributional effects offset its cost. We challenge the logic of this article and explain why it may encourage inefficient policies.
Arithmeticity of discrete subgroups
Authors: BENOIST YVES
Published: September 2020

The topic of this course is the discrete subgroups of semisimple Lie groups. We discuss a criterion that ensures that such a subgroup is arithmetic. This criterion is a joint work with Sébastien Miquel, which extends previous work of Selberg and Hee Oh and solves an old conjecture of Margulis. We focus on concrete examples like the group

$\mathrm {SL}(d,{\mathbb {R}})$
and we explain how classical tools and new techniques enter the proof: the Auslander projection theorem, the Bruhat decomposition, the Mahler compactness criterion, the Borel density theorem, the Borel–Harish-Chandra finiteness theorem, the Howe–Moore mixing theorem, the Dani–Margulis recurrence theorem, the Raghunathan–Venkataramana finite-index subgroup theorem and so on.
Trilobite fauna (Wuliuan Stage, Miaolingian Series, Cambrian) of the lower Lakeview Limestone, Pend Oreille Lake, Idaho
Authors: Sundberg Frederick A.
Published: September 2020

The Lakeview Limestone is one of the westernmost Cambrian exposures in the northwestern United States and occurs on the western edge of the Montania paleotopographic high. These deposits occur between the deeper water deposits to the west and carbonate banks and intracratonic basins to the east and provide critical link between the regions. A re-investigation of the Cambrian trilobite faunas from the lower portion of the Lakeview Limestone, Pend Oreille Lake, Idaho, is undertaken due to the inadequate illustrations and descriptions provided by Resser (1938a). Resser's type specimens and additional material are figured and described. The trilobite assemblages represent thePtychagnostus praecurrensZone, Wuliuan Stage, Miaolingian Series and including two new taxa:Itagnostus idahoensisn. sp., andUtia debran. sp. Because of the similarity between some species ofAmecephalusfrom the Lakeview Limestone to specimens from the Chisholm Shale, Nevada, the type specimens ofAmecephalus piochensis(Walcott, 1886) andAm.packi(Resser, 1935), Walcott's and Resser's type specimens are re-illustrate and their taxonomic problems are discussed.Utia curioWalcott, 1924 from the Spence Shale, Utah, have never been re-illustrated since Walcott (1925), these type specimens are also re-illustrated and compared toUtia debran. sp.

UUID:http://zoobank.org/5ef6ee5e-bddc-4395-becf-9bcea54c679c
Conventional and unconventional participation in Latin America: a hierarchical latent class approach
Authors: Alvarez R. Michael , Katz Gabriel , Levin Ines , Núñez Lucas
Published: September 2020

Building on past research, we implement a hierarchical latent class model to analyze political participation from a comparative perspective. Our methodology allows simultaneously: (i) estimating citizens’ propensity to engage in conventional and unconventional modes of participation; (ii) classifying individuals into underlying “types” capturing within- and cross-country variations in participation; and (iii) assessing how this classification varies with micro- and macro-level factors. We apply our model to Latin American survey data. We show that our method outperforms alternative approaches used to study participation and derive typologies of political engagement. Substantively, we find that the distribution of participatory types is similar throughout the continent, and that it correlates strongly with respondents’ socio-demographic characteristics and crime victimization.
Artificial intelligence as an analytic approximation to evaluate associations between parental feeding behaviours and excess weight in Colombian preschoolers
Authors: Gamboa Edna M. , Amaya Claudia I. , Bahamonde Antonio
Published: September 2020

Parental practices can affect children’s weight and BMI and may even be related to a high prevalence of obesity. Therefore, the aim of this study was to evaluate the relationship between parents’ practices related to feeding their children and excess weight in preschoolers in Bucaramanga, Colombia, using artificial intelligence. A cross-sectional study was carried out between September and December 2017. The sample included preschoolers who attended child development institutions belonging to the Colombian Institute for Family Wellbeing in Bucaramanga and the metropolitan area (n 384). The outcome variable was excess weight and the main independent variable was parental feeding practices. Confounding variables analysed included sociodemographic characteristics, food consumption, and children’s physical activity. All equipment for the anthropometric measurements was calibrated. Logistic regression was used to predict the effect of parental practices on the excess weight of the children, and the AUC was used to measure performance. The parental practices with the greatest association with excess weight in the children involved using food to control their behaviour and restricting the amount of food they offered (use of food to control emotions (OR 1·77; 95 % CI 1·45, 1·83; P = 0·034) and encouraging children to eat less (OR 1·22; 95 % CI 1·14, 1·89; P = 0·045)). Childrearing practices related to feeding were found to be an important predictor of excess weight in children. The results of this study represent implications for public health considering this as a baseline for the design of nutrition education interventions focused on parents of preschoolers.
Vitamin C improves healing of foot ulcers: a randomised, double-blind, placebo-controlled trial
Authors: Gunton Jenny E. , Girgis Christian M. , Lau Timothea , Vicaretti Mauro , Begg Lindy , Flood Victoria
Published: September 2020

Chronic foot ulcers are associated with a high risk of osteomyelitis, poor quality of life, amputations and disability. Few strategies improve their healing, and amputation rates in high-risk foot services are usually over 30 %. We conducted a randomised, inactive-placebo controlled, double-blind trial of 500 mg of slow-release vitamin C in sixteen people with foot ulcers in the Foot Wound Clinic at Westmead Hospital. Nine were randomised to control and seven to vitamin C. When serum vitamin C results become available at 4 weeks, all people with deficiency were offered both vitamin C and glucosamine tablets for the next 4 weeks. Patients without baseline deficiency continued their original assigned treatment. The primary outcome was percentage ulcer healing (reduction in ulcer size) at 8 weeks. Fifty percentage of subjects had baseline vitamin C deficiency, half having undetectable levels. Healing at 8 weeks was significantly better in the vitamin C group (median 100 v. –14 %, P = 0·041). Healing without amputation occurred in all patients in the vitamin C group. In contrast, 44 % of controls had not healed their ulcer at the end of the study period. Vitamin C improved healing of foot ulcers. Further studies are needed to determine whether there is a threshold effect for serum vitamin C above which therapy is ineffective and whether there are better or lesser responding subgroups. Because of its low cost and ease of access and administration, we recommend offering vitamin C therapy to all people who have chronic foot ulcers and potentially suboptimal vitamin C intake. Trial registration number: ACTRN12617001142325.
Ethical implications of coronavirus disease 2019 for ENT surgeons – a discussion
Authors: Leonard C G
Published: September 2020

Background

Coronavirus disease 2019 has had a dramatic effect on society and healthcare. Preparations were based on predictive models of need, and with uncertainty regarding risk to patients and healthcare workers. Actions taken had both immediate and ongoing ethical impacts. The most obvious of these was the shift in duty of care from individual patients to public health centred ethics and decision making.

Relevance

In ENT, many procedures are aerosol-generating and so our capacity to provide care will remain significantly reduced. This reduction in capacity may result in difficult choices for patients when optimal care may be replaced by acceptable care. ENT surgeons may also be faced with unaccustomed paternalism when capacity prevents them from acting within the patients’ wishes.

Conclusion

Despite these challenges, the novel uses of technology highlight the desire to preserve and enhance the autonomy of our patients.
Impact of coronavirus disease 2019 on urgent referrals to secondary care otolaryngology: a prospective case series
Authors: Osborne M S , Bentley E , Farrow A , Chan J , Murphy J
Published: September 2020

Objective

As the novel coronavirus disease 2019 changed patient presentation, this study aimed to prospectively identify these changes in a single ENT centre.

Design

A seven-week prospective case series was conducted of urgently referred patients from primary care and accident and emergency department.

Results

There was a total of 133 referrals. Referral rates fell by 93 per cent over seven weeks, from a mean of 5.4 to 0.4 per day. Reductions were seen in referrals from both primary care (89 per cent) and the accident and emergency department (93 per cent). Presentations of otitis externa and epistaxis fell by 83 per cent, and presentations of glandular fever, tonsillitis and peritonsillar abscess fell by 67 per cent.

Conclusion

Coronavirus disease 2019 has greatly reduced the number of referrals into secondary care ENT. The cause for this reduction is likely to be due to patients’ increased perceived risk of the virus presence in a medical setting. The impact of this reduction is yet to be ascertained, but will likely result in a substantial increase in emergency pressures once the lockdown is lifted and the general public's perception of the coronavirus disease 2019 risk reduces.
Monitoring food digestion with magnetic resonance techniques
Authors: Smeets Paul A. M. , Deng Ruoxuan , van Eijnatten Elise J. M. , Mayar Morwarid
Published: September 2020

This review outlines the current use of magnetic resonance (MR) techniques to study digestion and highlights their potential for providing markers of digestive processes such as texture changes and nutrient breakdown. In vivo digestion research can be challenging due to practical constraints and biological complexity. Therefore, digestion is primarily studied using in vitro models. These would benefit from further in vivo validation. NMR is widely used to characterise food systems. MRI is a related technique that can be used to study both in vitro model systems and in vivo gastro-intestinal processes. MRI allows visualisation and quantification of gastric processes such as gastric emptying and coagulation. Both MRI and NMR scan sequences can be configured to be sensitive to different aspects of gastric or intestinal contents. For example, magnetisation transfer and chemical exchange saturation transfer can detect proton (1H) exchange between water and proteins. MRI techniques have the potential to provide molecular-level and quantitative information on in vivo gastric (protein) digestion. This requires careful validation in order to understand what these MR markers of digestion mean in a specific digestion context. Combined with other measures they can be used to validate and inform in vitro digestion models. This may bridge the gap between in vitro and in vivo digestion research and can aid the optimisation of food properties for different applications in health and disease.
Pathology of Angiostrongylus cantonensis infection in two model avian hosts
Authors: Fecková Barbora , Djoehana Priyanka , Putnová Barbora , Valašťanová Michaela , Petríková Michaela , Knotek Zdeněk , Modrý David
Published: September 2020

Angiostrongylus cantonensis causes severe neurological disorders in a wide range of warm-blooded animals, including several avian species. A laboratory isolate of A. cantonensis originating from French Polynesia, genotyped as clade 2, was used to assess the effect of experimental infection in chicken and Japanese quail. Low dose groups of birds were infected orally by 100 L3 larvae, high dose groups by 1500 L3 larvae and the birds in the third group were fed three infected snails, mimicking a natural infection. Clinical signs during the first week after infection, haematology, biochemistry, gross lesions and histology findings were used to assess the pathology of the infection. Some of the infected birds showed peripheral eosinophilia, while mild neurological signs were seen in others. No larvae were observed in serial sections of the central nervous system of infected birds 1 week after infection and no major gross lesions were observed during necropsy; histopathology did not reveal lesions directly attributable to A. cantonensis infection. Our results suggest that galliform birds are not highly susceptible to A. cantonensis infection and open a question of the importance of Galliformes in endemic areas as natural pest control, lowering the number of hosts carrying the infective larvae.
Context and contact: a comparison of patient and family engagement with early intervention services for psychosis in India and Canada
Authors: Iyer Srividya N. , Malla Ashok , Taksal Aarati , Maraj Anika , Mohan Greeshma , Ramachandran Padmavati , Margolese Howard C. , Schmitz Norbert , Joober Ridha , Rangaswamy Thara
Published: September 2020

Background

It is unknown whether patient disengagement from early intervention services for psychosis is as prevalent in low- and middle-income countries (LMICs) like India, as it is in high-income countries (HICs). Addressing this gap, we studied two first-episode psychosis programs in Montreal, Canada and Chennai, India. We hypothesized lower service disengagement among patients and higher engagement among families in Chennai, and that family engagement would mediate cross-site differences in patient disengagement.

Methods

Sites were compared on their 2-year patient disengagement and family engagement rates conducting time-to-event analyses and independent samples t tests on monthly contact data. Along with site and family involvement, Cox proportional hazards regression included known predictors of patient disengagement (e.g. gender).

Results

The study included data about 333 patients (165 in Montreal, 168 in Chennai) and their family members (156 in Montreal, 168 in Chennai). More Montreal patients (19%) disengaged before 24 months than Chennai patients (1%), χ2(1, N = 333) = 28.87, p < 0.001. Chennai families had more contact with clinicians throughout treatment (Cohen's d = −1.28). Family contact significantly predicted patient disengagement in Montreal (HR = 0.87, 95% CI 0.81–0.93). Unlike in Chennai, family contact declined over time in Montreal, with clinicians perceiving such contact as not necessary (Cohen's d = 1.73).

Conclusions

This is the first investigation of early psychosis service engagement across a HIC and an LMIC. Patient and family engagement was strikingly higher in Chennai. Maintaining family contact may benefit patient engagement, irrespective of context. Findings also suggest that differential service utilization may underpin cross-cultural variations in psychosis outcomes.
Les juridictions traditionnelles et la justice pénale internationale
Authors: Manirakiza Pacifique
Published: September 2020

Sommaire

L’ampleur de la criminalité internationale et de l’impunité qui en résulte exige que la communauté internationale développe de nouvelles stratégies afin de venir à about de ce phénomène. Bien que les juridictions pénales internationales soient souvent présentées comme une panacée, force est de constater que les juridictions étatiques interviennent pour leur prêter main forte dans la lutte contre l’impunité. Cet article se propose d’analyser l’opportunité de l’intervention des juridictions étatiques traditionnelles ou communautaires dans l’administration de la justice pénale internationale. Après avoir établi que leur intervention trouve des assises en droit international, l’auteur conclut que les juridictions traditionnelles ne sont pas juridiquement ni logistiquement outillées pour réprimer les crimes internationaux les plus graves. Néanmoins, dans les Etats où des violences massives ont eu lieu impliquant la participation de la population, l’auteur estime que celle-ci ainsi que les institutions populaires existantes peuvent être associées dans le règlement judiciaire de la crise afin de mieux définir de nouvelles bases de cohabitation sociale. L’implication judiciaire des institutions traditionnelles est envisageable à deux niveaux: la répression des infractions mineures, en l’occurrence celles contre les propriétés, qui sont commises à l’occasion de la perpétration des crimes odieux qui offensent la conscience de toute l’humanité d’une part, et, d’autrepart, l’implication des juges-citoyens comme jurés dans le cadre des procès pour crimes internationaux proprement dits. La population quant à elle peut être appelée à jouer un rôle de premier plan dans la recherche de la vérité historique et dans la manifestation de la vérité judiciaire.
Law and contestation in international negotiations
Authors: Rapp Kyle
Published: September 2020

What is the role of rhetoric and argumentation in international relations? Some argue that it is little more than ‘cheap talk’, while others say that it may play a role in persuasion or coordination. However, why states deploy certain arguments, and why these arguments succeed or fail, is less well understood. I argue that, in international negotiations, certain types of legal frames are particularly useful for creating winning arguments. When a state bases its arguments on constitutive legal claims, opponents are more likely to become trapped by the law: unable to develop sustainable rebuttals or advance their preferred policy. To evaluate this theory, I apply qualitative discourse analysis to the US arguments on the crime of aggression at the Kampala Review Conference of the International Criminal Court – where the US advanced numerous arguments intended to reshape the crime to align with US interests. The analysis supports the theoretical propositions – arguments framed on codified legal grounds had greater success, while arguments framed on more political grounds were less sustainable, failing to achieve the desired outcomes. These findings further develop our understanding of the use of international law in rhetoric, argumentation, and negotiation.
Universalizing and the we: endogenous game theoretic deontology
Authors: Studtmann Paul , Gouri Suresh Shyam
Published: September 2020

The Nash counterfactual considers the question: what would happen were I to change my behaviour assuming no one else does. By contrast, the Kantian counterfactual considers the question: what would happen were everyone to deviate from some behaviour. We present a model that endogenizes the decision to engage in this type of Kantian reasoning. Autonomous agents using this moral framework receive psychic payoffs equivalent to the cooperate-cooperate payoff in Prisoner’s Dilemma regardless of the other player’s action. Moreover, if both interacting agents play Prisoner’s Dilemma using this moral framework, their material outcomes are a Pareto improvement over the Nash equilibrium.
Assessing the capacity of Ghana to introduce health technology assessment: a systematic review of economic evaluations conducted in Ghana
Authors: Addo Rebecca , Goodall Stephen , Hall Jane , Haas Marion
Published: September 2020

Objectives

Ghana is in the process of formally introducing health technology assessment (HTA) for health decision making. Similar to other low- and middle-income countries, evidence suggests that the lack of data and human capacity is a major barrier to the conduct and use of HTA. This study assessed the current human and data capacity available in Ghana to undertake HTA.

Methods

As economic evaluation (EE) forms an integral part of HTA, a systematic review of EE studies undertaken in Ghana was conducted to identify the quality and number of studies available, methods and source of data used, and local persons involved. The literature search was undertaken in EMBASE (including MEDLINE), PUBMED, and Google Scholar. The quality of studies was evaluated using the Consolidated Health Economics Evaluation Reporting Standards. The number of local Ghanaians who contributed to authorship were used as a proxy for assessing human capacity for HTA.

Results

Thirty-one studies were included in the final review. Overall, studies were of good quality. Studies derived their effectiveness, resource utilization and cost data mainly from Ghana. The most common source of cost data was from the National Health Insurance Scheme pricing list for medicines and tariffs. Effectiveness data were mostly derived from either single study or intervention programs. Sixty out of 199 authors were Ghanaians (30 percent); these authors were mostly involved in data collection and study conceptualization.

Conclusions

Human capacity for HTA in Ghana is limited. To introduce HTA successfully in Ghana, policy makers would need to develop more local capacity to undertake Ghanaian-specific HTA.
Scoping Review of Clinical Practice Guidelines for Fall Risk Screening and Assessment in Older Adults across the Care Continuum
Authors: Williams-Roberts Hazel , Arnold Catherine , Kemp Daphne , Crizzle Alexander , Johnson Shanthi
Published: September 2020

Given the rising numbers of older adults in Canada experiencing falls, evidence-based identification of fall risks and plans for prevention across the continuum of care is a significant priority for health care providers. A scoping review was conducted to synthesize published international clinical practice guidelines (CPGs) and recommendations for fall risk screening and assessment in older adults (defined as 65 years of age and older). Of the 22 CPGs, 6 pertained to multiple settings, 9 pertained to community-dwelling older adults only, 2 each pertained to acute care and long-term care settings only, and 3 did not specify setting. Two criteria, prior fall history and gait and balance abnormalities, were applied either independently or sequentially in 19 CPG fall risk screening algorithms. Fall risk assessment components were more varied across CPGs but commonly included: detailed fall history; detailed evaluation of gait, balance, and/or mobility; medication review; vision; and environmental hazards assessment. Despite these similarities, more work is needed to streamline assessment approaches for heterogeneous and complex older adult populations across the care continuum. Support is also needed for sustainable implementation of CPGs in order to improve health outcomes.
Social Participation in Long-term Residential Care: Case Studies from Canada, Norway, and Germany
Authors: Lowndes Ruth , Struthers James , Ågotnes Gudmund
Published: September 2020

Meaningful social engagement in everyday activities can enhance resident quality of life in nursing homes. In this article, we draw on data collected in a multidisciplinary, international study exploring promising practices in long-term care homes across Canada, Norway, and Germany, to investigate conditions that either allow for or create barriers to residents’ social participation. Within a feminist political economy framework using a team-based rapid ethnography approach, observations and in-depth interviews were conducted with management, staff, volunteers, students, families, and residents. We argue that the conditions of work are the conditions of care. Such conditions as care home location, building layout, staffing levels, and work organization, as well as governing regulations, influence if and how residents can and do engage in meaningful everyday social life in/outside the nursing home. The presence of promising conditions that facilitate resident social participation, particularly those promoting flexibility and choice for residents, directly impacts their overall health and well-being.
Clinical presentation of asymptomatic and symptomatic women who tested positive for genital gonorrhoea at a sexual health service in Melbourne, Australia
Authors: Martín-Sánchez Mario , Fairley Christopher K. , Ong Jason J. , Maddaford Kate , Chen Marcus Y. , Williamson Deborah A. , Bradshaw Catriona S. , Chow Eric P.F.
Published: September 2020

Gonorrhoea cases in women have been rising in Australia in the 2010s but the cause of the increase is not well understood. This cross-sectional study aimed to describe the characteristics of genital gonorrhoea infection in women attending the Melbourne Sexual Health Centre, Australia. Gonorrhoea cases were diagnosed by nucleic acid amplification test (NAAT) and/or culture. Genitourinary specimens were obtained in 12 869 clinic visits in women aged 16 years or above between August 2017 and August 2018. Genital gonorrhoea was detected in 142 (1.1%) of the visits. Almost half of the cases were asymptomatic, 47.9% [95% confidence interval (CI) 39.8–56.1%]; yellow, green or pus-like vaginal discharge was present in 11.3% (95% CI 7.0–17.6%) and other genital symptoms in 40.8% (95% CI 33.1–49.1%) of the cases. The mean time between last sexual contact and onset of symptoms was 7.3 days and between the onset of symptoms to presentation to the clinic was 12.1 days. Half of the cases of genital gonorrhoea among women are asymptomatic and these cases would have been missed by testing of only symptomatic women. Further epidemiological and behavioural research is required to understand the temporal changes in sexual practices among women in Australia.