bluuebunny/crossref_metadata_2025 huggingface dataset:
Can nutrient‐utilization efficiency be improved by reduced fertilizer supply to maize plants treated with the plant growth regulator paclobutrazol?
Authors: Hütsch Birgit W. , Schubert Sven
Published: June 2021

In previous investigations of several maize cultivars, an improvement of the harvest index was obtained by paclobutrazol (PAC) application combined with an increase in water‐use efficiency. However, so far nutrient‐utilization efficiencies could not be enhanced when control and PAC‐treated maize plants received the same amount of fertilizers. With adjusted fertilizer supply according to the lower requirement of the smaller, PAC‐treated plants, an improvement of nutrient‐utilization efficiencies may be expected. Thus, in the present study, PAC was applied at growth stage V5 to two maize cultivars (Zea mays L. cvs. Galactus and Fabregas) grown in a container experiment. Shortly after PAC application, differential NPK fertilization was introduced in order to obtain a nutrient supply according to the requirement of control plants (100% NPK), the requirement of PAC‐treated plants (85% NPK) and a further slight decrease (78% NPK). Plant height and transpiration rates were significantly reduced due to PAC treatment with stronger effects on Galactus than on Fabregas. Pollen shed, silking and the anthesis‐silking interval (ASI) were unaffected by PAC application and fertilizer supply. Senescence of PAC‐treated plants was delayed, whereas it was accelerated with reduced fertilizer supply. The grain yield of cultivar Galactus was significantly decreased due to PAC application by 13% to 20%, and this effect was strengthened due to reduction in NPK supply. These grain yield reductions were solely caused by decreases in kernel number, which were closely linked to reductions in cob length. On the contrary, PAC treatment did not affect grain yield of Fabregas and reductions due to less NPK supply were small. Harvest index and water‐use efficiency were enhanced by PAC treatment. Plant nutrient contents were similar for control and PAC‐treated plants, but strongly related to fertilizer supply with significant decreases due to reductions in NPK application. The N‐, P‐ and K‐utilization efficiencies of both cultivars were either decreased or unaffected by PAC treatments. The key constraint for improvements of nutrient‐utilization efficiencies is grain yield reduction due to PAC. This problem should be addressed in further studies with avoidance of grain yield decreases by delayed application time combined with fine‐tuning of cultivar‐specific PAC application rates.
Widely targeted metabolomics reveals the different metabolic changes in leaves and roots of two cotton varieties under drought stress
Authors: Zhang Xiaomeng , Chen Jing , Feng Keyun , Wang Ning , Zhang Siping , Ma Huijuan , Ge Changwei , Shen Qian , Liu Ruihua , Zhao Xinhua , Liu Shaodong , Du Xiongming , Pang Chaoyou
Published: June 2021

Cotton yield is affected by drought stress. We performed widely targeted metabolomics to explore metabolic changes under drought stress in the roots and leaves of two cotton varieties differing in drought tolerance—XLZ8 as sensitive and G95079 as tolerant variety. A total of 537 metabolites were detected at different stages of drought stress. Abscisic acid (ABA) was significantly enriched in all stages of drought stress in both roots and leaves of XLZ8. Amino acids showed enrichment in leaves of G95079 in the early stage of drought stress. Flavonoids were significantly enriched in the leaves of the two varieties in the late stage of drought stress. In roots, nucleotides and their derivatives were highly enriched in XLZ8 in the late stage of drought stress. The biosynthetic pathways of kynurenine and polyamine and glycerophospholipid metabolism may play an important role in cotton drought tolerance by scavenging reactive oxygen species (ROS) and reconstructing cell membranes. Spraying appropriate concentrations of proline, kynurenine, S‐adenosylmethionine, glucose and 1‐oleoyl‐2‐hydroxy‐sn‐glycero‐3‐phosphocholine (lyso PC18:1) significantly increased the survival rate of cotton seedlings under drought stress. We speculated that ABA‐dependent and ABA‐independent metabolic changes may lead to differences in drought tolerance among cotton varieties.
Effect of conscious sedation and deep sedation on the vagal response characteristics during ganglionated plexus ablation
Authors: Aksu Tolga , Yalin Kivanc , John Leah , Osorio Jose , Winterfield Jeffrey , Aras Dursun , Gopinathannair Rakesh
Published: June 2021

Introduction: We aimed to determine the effects of conscious and deep sedation on vagal response (VR) characteristics during ganglionated plexus (GP) ablation. Methods: Forty consecutive patients undergoing GP ablation for vasovagal syncope were divided to receive conscious sedation with midazolam (Group 1, n = 29) or deep sedation with the midazolam–propofol combination (Group 2, n = 11). VR was defined on three levels. R–R interval increase of >50% (Level 1); R–R interval increase of 20%–50% (Level 2); and R–R interval increase of <20% (Level 3). Results: The ratio of Level 1 VR during ablation on left superior and inferior GPs was significantly lower in Group 2 (p < .0001 and p = .034, respectively). Once the cut‐off for VR was decreased to Level 2, the ratio of (+) VR was similar between groups during ablation of left‐sided GPs. Positive VR in any level was lower than 20% during ablation of right‐sided GPs. Conclusions: The autonomic tone might be affected in different ways by the level or type of intravenous sedation. Awareness of anesthesia‐related differences may be important if GP ablation will be performed by using VR characteristics during ablation.
Laser‐assisted lead extraction of a retained lead remnant in the femoral and iliac veins
Authors: Gianni Carola , Canby Robert C. , Della Rocca Domenico G. , Natale Andrea , Al‐Ahmad Amin
Published: June 2021

Herein, we present a case of laser‐assisted extraction of a retained lead remnant following incomplete removal of an implantable cardiac defibrillator system implanted via a left femoral approach.
Cytokeratin 5 and cytokeratin 20 inversely correlate with tumour grading in Ta non‐muscle‐invasive bladder cancer
Authors: Muilwijk Tim , Akand Murat , Van der Aa Frank , De Coninck Vincent , Claessens Marc , Hente Robert , Eckstein Markus , Allory Yves , Libbrecht Louis , Joniau Steven , Gevaert Thomas
Published: June 2021

Cytokeratin 5 is a marker of basal molecular subtypes of muscle‐invasive bladder cancer (MIBC), which correlates with worse overall survival compared to luminal subtypes. Our observations have not confirmed CK5 as a marker of high‐grade (HG) disease in Ta non‐muscle‐invasive bladder cancer (NMIBC). Therefore, to understand the basal‐luminal immunohistochemistry profile in Ta NMIBC, we performed immunohistochemistry for CK5, P40, P63 (basal), GATA3 and CK20 (luminal) and studied the correlation with HG and clinical outcome in 109 patients with Ta NMIBC. HG and low‐grade (LG) diseases were scored in each patient. Four different CK5 patterns were evaluated: absent (median 41.3%), normal (72.5%), rising (84.4%) and full thickness (23.9%). The median percentage of GATA3 was 100%. HG disease and CK5 expression and rising CK5 pattern had a significant inverse correlation, whereas HG disease and CK20 expression had a significant positive correlation. We also found a significant inverse correlation between CK5 expression and CK20 expression. Quantitative PCR confirmed that the presence of CK5 correlated with up‐regulation of CK5 RNA. None of the markers could differentiate patients with regard to clinical outcome. Our results suggest a role for CK5 and CK20 in differentiating between LG and HG disease in Ta NMIBC.
Mobile Internet usage and usage‐based pricing
Authors: Prince Jeffrey , Greenstein Shane
Published: June 2021

Using data on mobile Internet usage of thousands of individuals, we provide some of the first analyses linking mobile usage to key demographics such as income. We find a reverse‐U relationship between mobile Internet usage and income—notably different than the monotonically declining relationship found on home devices. This pattern suggests that data caps are particularly binding on low‐income users. We then construct a simple model of mobile Internet usage that incorporates demand features suggested by our empirical finding and prior empirical findings on device adoption and usage. After abstracting away from cost and two‐sided market considerations, we solve the model, and through comparative statics, identify demand conditions for which usage‐based pricing (via a data cap) is, or is not, revenue enhancing. Key insights from this analysis are: (1) the tendency toward demand‐driven price discrimination is hill‐shaped (increasing then decreasing) in the number of low‐income users and eventually declining in high‐income users, and (2) a relatively high (low) proportion of total value attained from relatively low usage levels by low‐income (high‐income) users increases the tendency toward demand‐driven price discrimination. Hence, to the extent that a market has a large number of low‐income users and/or high‐income users attain a higher proportion of their total value at the cap than low‐income users, the use of caps by providers is more likely driven by cost (or other non‐demand‐side) considerations than by revenue enhancement. Lastly, additional analysis shows a largely monotonically increasing relationship between income and usage intensity (measured as page views in a session), suggesting that, ceteris paribus, price discrimination strategies may be more effective if tied to usage intensity rather than duration.
A new species of viviparous brotula genusPseudogilbia(Ophidiiformes: Dinematichthyidae)fromBrazilianreefs, with an updated diagnosis of the genus
Authors: Bauer Arthur B. , Schwarzhans Werner W. , Moura Rodrigo L. , Nunes José Anchieta C. C. , Mincarone Michael M.
Published: June 2021

In this study, a new species ofPseudogilbiaMøller, Schwarzhans & Nielsen 2004 is described based on two male specimens (40–44 mmLS) from shallow reefs of Bahia, Brazil.Pseudogilbia australissp. nov. is distinguished from its only congener,Pseudogilbia sanblasensisMøller, Schwarzhans & Nielsen 2004 from Caribbean Panama, by having: two lower preopercular pores (vs. one); dorsal‐fin rays 65–67 (vs. 69); anal‐fin rays 51–53 (vs. 56); pectoral‐fin rays 18 (vs. 20); caudal vertebrae 27–28 (vs. 30); pectoral‐fin length 15.0%–15.9%LS(vs. 14.3); pelvic‐fin length 13.5%LS(vs. 16.4) and a different morphology of the male copulatory organ.Pseudogilbia australissp. nov. is the only dinematichthyid so far recorded in the South Atlantic. An updated diagnosis for the genus is also provided.
Perioperative cardiovascular outcomes among older adults undergoing in‐hospital noncardiac surgery
Authors: Banco Darcy , Dodson John A. , Berger Jeffrey S. , Smilowitz Nathaniel R.
Published: June 2021

Background

Older adults undergoing noncardiac surgery have a high risk of major adverse cardiovascular events (MACE). This study aims to estimate the magnitude of increased perioperative risk, and examine national trends in perioperative MACE following in‐hospital noncardiac surgery in older adults compared to middle‐aged adults.

Design

Time‐series analysis of retrospective longitudinal data.

Setting

The United States Agency for Healthcare Research and Quality National Inpatient Sample (NIS).

Participants

Hospitalizations for major noncardiac surgery among adults age ≥45 years between January 2004 and December 2014.

Measurements

Inpatient perioperative MACE was defined as a composite of in‐hospital death, myocardial infarction (MI), and ischemic stroke. In hospital death was determined from the NIS discharge disposition. MI and ischemic stroke were defined by International Classification of Diseases, Ninth Revision codes.

Results

Of an estimated 55,349,978 surgical hospitalizations, 26,423,039 (47.7%) were for adults age 45–64, 14,231,386 (25.7%) age 65–74, 10,621,029 (19.2%) age 75–84 years, and 4,074,523 (7.4%) age ≥85 years. MACE occurred in 1,601,022 surgical hospitalizations (2.9%). Adults 65–74 (2.8%; aOR 1.16, 95% CI 1.14–1.17), 75–84 years (4.5%; aOR 1.30, 95% CI 1.28–1.32), and ≥85 years (6.9%; aOR 1.55, 95% CI 1.52–1.57) had greater risk of MACE than those 45–64 years (1.7%). From 2004 to 2014, MACE declined among adults 65–74 (3.1–2.5%, p < 0.001), 75–85 years (4.9–3.9%, p < 0.001), and ≥85 years (7.7–6.1%, p < 0.001), but was unchanged for adults age 45–64. Declines in MACE were driven by decreased MI and mortality despite increased stroke.

Conclusion

Older adults accounted for half of hospitalizations, but experienced the majority of MACE. Older adults had greater adjusted odds of MACE than younger individuals. The proportion of perioperative MACE declined over time, despite increases in ischemic stroke. These data highlight risks of noncardiac surgery in older adults that warrant increased attention to improve perioperative outcomes.
Reply to: Comment on: Geriatric co‐management for cardiology patients in the hospital: A quasi‐experimental study
Authors: Van Grootven Bastiaan , Milisen Koen , Flamaing Johan , Deschodt Mieke ,   The G‐COACH Consortium
Published: June 2021

This letter comments on the letter by Issei Kameda in this issue.
Comment on: Geriatric co‐management for cardiology patients in the hospital: A quasi‐experimental study
Authors: Kameda Issei , Ito Toshikazu , Tsuge Syota , Hori Shinsuke , Ushida Kenta , Momosaki Ryo
Published: June 2021

See the Reply by Van Grootven et al. in this issue.
Cyclical Part‐Time Employment in an Estimated New Keynesian Model with Search Frictions
Authors: MUKOYAMA TOSHIHIKO , SHINTANI MOTOTSUGU , TERAMOTO KAZUHIRO
Published: June 2021

This paper analyzes the dynamics of full‐time and part‐time employment over the business cycle. We first document basic macroeconomic facts on these employment stocks using the U.S. data and decompose their cyclical dynamics into the contributions of different flows into and out of these stocks. Second, we develop and estimate a New Keynesian search‐and‐matching model with a segmented labor market to uncover the fundamental driving forces of the cyclical dynamics of employment stocks. We find the countercyclicality of the (net) flow from full‐time to part‐time employment is essential in accounting for countercyclical patterns of part‐time employment.
Braincase anatomy of extant Crocodylia, with new insights into the development and evolution of the neurocranium in crocodylomorphs
Authors: Kuzmin Ivan T. , Boitsova Elizaveta A. , Gombolevskiy Victor A. , Mazur Evgeniia V. , Morozov Sergey P. , Sennikov Andrey G. , Skutschas Pavel P. , Sues Hans‐Dieter
Published: June 2021

Present‐day crocodylians exhibit a remarkably akinetic skull with a highly modified braincase. We present a comprehensive description of the neurocranial osteology of extant crocodylians, with notes on the development of individual skeletal elements and a discussion of the terminology used for this project. The quadrate is rigidly fixed by multiple contacts with most braincase elements. The parabasisphenoid is sutured to the pterygoids (palate) and the quadrate (suspensorium); as a result, the basipterygoid joint is completely immobilized. The prootic is reduced and externally concealed by the quadrate. It has a verticalized buttress that participates in the canal for the temporal vasculature. The ventrolateral processes of the otoccipitals completely cover the posteroventral region of the braincase, enclose the occipital nerves and blood vessels in narrow bony canals and also provide additional sutural contacts between the braincase elements and further consolidate the posterior portion of the crocodylian skull. The otic capsule of crocodylians has a characteristic cochlear prominence that corresponds to the lateral route of the perilymphatic sac. Complex internal structures of the otoccipital (extracapsular buttress) additionally arrange the neurovascular structures of the periotic space of the cranium. Most of the braincase elements of crocodylians are excavated by the paratympanic pneumatic sinuses. The braincase in various extant crocodylians has an overall similar structure with some consistent variation between taxa. Several newly observed features of the braincase are present in Gavialis gangeticus and extant members of Crocodylidae to the exclusion of alligatorids: the reduced exposure of the prootic buttress on the floor of the temporal canal, the sagittal nuchal crest of the supraoccipital projecting posteriorly beyond the postoccipital processes and the reduced paratympanic pneumaticity. The most distinctive features of the crocodylian braincase (fixed quadrate and basipterygoid joint, consolidated occiput) evolved relatively rapidly at the base of Crocodylomorpha and accompanied the initial diversification of this clade during the Late Triassic and Early Jurassic. We hypothesize that profound rearrangements in the individual development of the braincases of basal crocodylomorphs underlie these rapid evolutionary modifications. These rearrangements are likely reflected in the embryonic development of extant crocodylians and include the involvement of neomorphic dermal anlagen in different portions of the developing chondrocranium, the extensive ossification of the palatoquadrate cartilage as a single expanded quadrate and the anteromedial inclination of the quadrate.
Localization of nerve entry points and the center of intramuscular nerve‐dense regions in the adult pectoralis major and pectoralis minor and its significance in blocking muscle spasticity
Authors: Li Yanrong , Wang Meng , Tang Shaohua , Zhu Xiankun , Yang Shengbo
Published: June 2021

The aims of this study were to localize the body surface position and depth of nerve entry points, and the center of the intramuscular nerve‐dense regions of the pectoralis major and pectoralis minor in order to provide guidance for blocking muscle spasticity. Formalin‐fixed adult cadavers (66.3 ± 5.2 years) were used. The curved line on the skin from the acromion to the most inferior point of the jugular notch was defined as the horizontal reference line (H). The line from the most inferior point of the jugular notch to the xiphisternal joint was defined as the longitudinal reference line (L). The nerve entry points was anatomically exposed. Sihler's staining, barium sulfate labeling, and computed tomography were employed to determine the projection points (P) on the body surface. The intersection of the longitudinal line through the P point and the H line and the horizontal line through the P point and the L line were recorded as PH and PL, respectively. The projection of the nerve entry points or the center of the intramuscular nerve‐dense regions were in the opposite direction across the transverse plane and were recorded as P'. The percentage positions of PH and PL on the H and L lines, as well as the nerve entry points and the center of the intramuscular nerve‐dense regions depths, were determined using the Syngo system. The pectoralis major had two nerve entry points, while the pectoralis minor had only one. In addition, two intramuscular nerve‐dense regions were found in the pectoralis major, while only one region was found in the pectoralis minor. The PH of the nerve entry points were located at 47.83%, 32.31%, and 34.31%, while the PH of the center of the intramuscular nerve‐dense regions were at 41.95%, 55.88%, and 32.58% of line H, respectively. The PL of the nerve entry points were at −9.84%, 36.16%, and 2.44%, while the PL for each of three center of the intramuscular nerve‐dense regions was at −3.87%, 25.29%, and −7.13% of line L, respectively. The depth for each of the nerve entry points was at 17.76%, 17.53%, and 25.51% of line P‐P′’, respectively, and the depth of the center of the intramuscular nerve‐dense regions was at 5.23%, 6.75%, and 13.73% of line P‐P′, respectively. These percentage values are all means. The definition of the surface position and depth of these nerve entry points and center of the intramuscular nerve‐dense regions can improve the localization efficiency and efficacy of target blocking for pectoralis major and minor spasticity.
A model of consumer life‐satisfaction amidst the COVID‐19 pandemic: Evidence and policy implications
Authors: Ekici Ahmet , Watson Forrest
Published: June 2021

The COVID‐19 pandemic has dramatically impacted the lives of consumers across the globe. What guidance can consumer researchers and policymakers provide consumers to elicit adaptive responses that contribute to their life‐satisfaction under these adverse conditions? To this end, we develop and test an adaptive response model and demonstrate its impact on the life‐satisfaction of the consumers experiencing the pandemic in Turkey. Our model suggests that amidst COVID‐19, seeking emotional help triggers the positivity in people, which in turn increases life‐satisfaction. Moreover, turning to religion to deal with the challenges of the pandemic leads to positivity and hope, which in turn positively affect life‐satisfaction. Importantly, “escape” behaviors (such as excessive work or time spent in online shows/games) reduce positivity and hope in consumers, thus negatively impacting life‐satisfaction. The paper discusses the conceptual and public policy implications of the results and offers recommendations for future research.
One‐sided bargaining over a finite set of alternatives
Authors: Groseclose Tim
Published: June 2021

I consider a bargaining game in which only one player can make proposals and the space of proposals is finite. Thus, the game is like a situation where: (i) a CEO suggests a possible hire, who must be okayed by a board of directors, or (ii) the US president nominates a potential judge, who must be okayed by the Senate. My main result is an algorithm that finds the unique subgame‐perfect equilibrium. The number of steps in the algorithm is on the order of , the number of possibilities (e.g., applicants to a job) that the bargainers may consider. By contrast, if one uses backwards induction to solve the game, then the number of steps is on the order of . A corollary of the main result, similar to some results of previous bargaining models, is that the wait costs of only one player, the non‐proposer, is relevant to the outcome. The wait costs of the proposer are irrelevant, provided that they are positive. Applied to the nomination process specified by the US Constitution, the corollary suggests that only the Senate's wait costs are relevant to the outcome—the president's wait costs are irrelevant. As I argue, this result may explain a little‐noticed regularity of American politics. This is that the Senate seems to have much influence in the selection of lower‐court judges but relatively little influence in the selection of Supreme Court justices.
The impact of medical complications on optimal hospital payment
Authors: Maréchal François , Thomas Lionel
Published: June 2021

This paper studies the optimal payment policy offered by a regulator to a partially altruistic hospital when the latter privately observes the severity of illness of patients and chooses a hidden quality that influences the probability of medical complications occurring. We analyze how the level of altruism of the hospital affects the conditions under which the payment, for a given diagnosis‐related group, should be refined according to the severity of illness and the occurrence of complications.
On the Neutrality of  Profit Taxation in a Mixed Oligopoly
Authors: Kuo Horn‐In , Peng Cheng‐Hau , Glen Ueng K. L.
Published: June 2021

This paper investigates the neutrality of profit taxation in a mixed oligopoly where one (partially) public firm competes with private firms. We find that the neutrality of a profit tax is robust under a general cost and a general demand function as long as the degree of privatization is endogenously determined. This result is also true when product heterogeneity is considered under both Cournot and Bertrand competition. By contrast, if the degree of privatization is exogenously given, the profit tax neutrality holds only in the cases where the public firm is fully privatized or fully state‐owned; otherwise, the neutrality breaks down.
The microbiome of the habitat‐forming brown alga Fucus vesiculosus (Phaeophyceae) has similar cross‐Atlantic structure that reflects past and present drivers1
Authors: Capistrant‐Fossa Kyle A. , Morrison Hilary G. , Engelen Aschwin H. , Quigley Charlotte T.C. , Morozov Aleksey , Serrão Ester A. , Brodie Juliet , Gachon Claire M.M. , Badis Yacine , Johnson Ladd E. , Hoarau Galice , Abreu Maria Helena , Tester Patricia A. , Stearns Leigh A. , Brawley Susan H.
Published: June 2021

Latitudinal diversity gradients have provided many insights into species differentiation and community processes. In the well‐studied intertidal zone, however, little is known about latitudinal diversity in microbiomes associated with habitat‐forming hosts. We investigated microbiomes of Fucus vesiculosus because of deep understanding of this model system and its latitudinally large, cross‐Atlantic range. Given multiple effects of photoperiod, we predicted that cross‐Atlantic microbiomes of the Fucus microbiome would be similar at similar latitudes and correlate with environmental factors. We found that community structure and individual amplicon sequencing variants (ASVs) showed distinctive latitudinal distributions, but alpha diversity did not. Latitudinal differentiation was mostly driven by ASVs that were more abundant in cold temperate to subarctic (e.g., Granulosicoccus_t3260, Burkholderia/Caballeronia/Paraburkholderia_t8371) or warm temperate (Pleurocapsa_t10392) latitudes. Their latitudinal distributions correlated with different humidity, tidal heights, and air/sea temperatures, but rarely with irradiance or photoperiod. Many ASVs in potentially symbiotic genera displayed novel phylogenetic biodiversity with differential distributions among tissues and regions, including closely related ASVs with differing north‐south distributions that correlated with Fucus phylogeography. An apparent southern range contraction of F. vesiculosus in the NW Atlantic on the North Carolina coast mimics that recently observed in the NE Atlantic. We suggest cross‐Atlantic microbial structure of F. vesiculosus is related to a combination of past (glacial‐cycle) and contemporary environmental drivers.
Bidirectional learning opportunities: How GP‐supervisors and trainees exchange knowledge
Authors: Welink Lisanne S. , van Charldorp Tessa C. , Di Colandrea Laura , Bartelink Marie‐Louise L. , Pype Peter , Damoiseaux Roger A.M.J. , de Groot Esther
Published: June 2021

Introduction

Workplace‐based learning conversations can be a good opportunity for supervisors and trainees to learn from each other. When both professionals discuss their specific knowledge openly with each other, learning conversations may be a useful educational tool, for instance for learning how to apply evidence‐based medicine (EBM) in the workplace. We do, however, need a better understanding of how the exchange of knowledge provides opportunities for such bidirectional learning. The aim of this study was therefore to analyse how trainees and supervisors currently handle bidirectional learning opportunities by describing in detail how supervisors respond to knowledge expressed by trainees during a learning conversation.

Method

We video‐recorded learning conversations between supervisors and trainees in general practice (GP). Within these learning conversations, EBM discussions on medical topics were selected and transcribed. We then identified, analysed using Conversation Analysis (CA) and categorised each expression of knowledge by the trainee and the supervisor's subsequent response.

Results

We found that when a trainee expresses knowledge during the learning conversation, supervisors either (a) refute the expressed knowledge, (b) immediately suggest an alternative or (c) pose (additional) questions. These responses have consequences for the learning opportunities of both trainee and supervisor: it is only when supervisors pose further questions that trainees are encouraged to elaborate on their knowledge, leading to a bidirectional learning opportunity.

Discussion

Improving EBM learning opportunities for both supervisors and trainees requires more than simply instructing trainees to express knowledge‐based—for instance—on recent evidence more often. Inflexible institutional roles related to historical claims of supervisors’ epistemic authority hamper bidirectional learning. Posing open questions during learning conversations enhances the flexibility of institutional roles while also creating bidirectional learning opportunities.
Confidence‐competence alignment and the role of self‐confidence in medical education: A conceptual review
Authors: Gottlieb Michael , Chan Teresa M. , Zaver Fareen , Ellaway Rachel
Published: June 2021

Context

There have been significant advances in competency‐based medical education (CBME) within health professions education. While most of the efforts have focused on competency, less attention has been paid to the role of confidence as a factor in preparing for practice. This paper seeks to address this deficit by exploring the role of confidence and the calibration of confidence with regard to competence.

Methods

This paper presents a conceptual review of confidence and the calibration of confidence in different medical education contexts. Building from an initial literature review, the authors engaged in iterative discussions exploring divergent and convergent perspectives, which were then supplemented with targeted literature reviews. Finally, a stakeholder consultation was conducted to situate and validate the provisional findings.

Results

A series of axioms were developed to guide perceptions and responses to different states of confidence in health professionals: (a) confidence can shape how we act and is optimised when it closely corresponds to reality; (b) self‐confidence is task‐specific, but also inextricably influenced by the individual self‐conceptualisation, the surrounding system and society; (c) confidence is shaped by many external factors and the context of the situation; (d) confidence must be considered in conjunction with competence and (e) the confidence‐competence ratio (CCR) changes over time. It is important to track learners’ CCRs and work with them to maintain balance.

Conclusion

Confidence is expressed in different ways and is shaped by a variety of modifiers. While CBME primarily focuses on competency, proportional confidence is an integral component in ensuring safe and professional practice. As such, it is important to consider both confidence and competence, as well as their relationship in CBME. The CCR can serve as a key construct in developing mindful and capable health professionals. Future research should evaluate strategies for assessing CCR, identify best practices for teaching confidence and guiding self‐calibration of CCR and explore the role of CCR in continuing professional development for individuals and teams.
The kinetic estimated glomerular filtration rate ratio predicts acute kidney injury
Authors: Christiadi Daniel , Erlich Jonathan , Levy Melissa , Herath Sanjeeva , Qian Jennifer , Boardman Sally , Campbell Craig , Kotwal Sradha , Horvath Andrea R. , Endre Zoltán
Published: June 2021

Aim

Kinetic estimated Glomerular Filtration Rate (KeGFR) approximates GFR under non‐steady‐state conditions. We investigated whether the ratio of KeGFR difference to baseline eGFR could predict acute kidney injury (AKI) earlier than a creatinine‐based algorithm that triggered an AKI electronic Alert (eAlert).

Methods

This retrospective, single‐centre, proof‐of‐concept cohort study assessed all patients diagnosed with AKI by an automated serum creatinine‐based eAlert. The kinetic eGFR, the kinetic eGFR difference from baseline and the ratio of difference to baseline was calculated in subjects with at least two serum creatinine (sCr) measurements within 72 h of AKI.

Results

Patients in the AKI cohort (n = 140) had a significant decline in KeGFR ratio (AKI: 17% IQR 7% to 29%, Non‐AKI: 0 IQR −12% to 9%; P‐value <.0001). A decrease of the ratio greater than 10% predicted AKI with a sensitivity of 66%, a specificity of 77%, a positive predictive value of 63%, and negative predictive value of 80%. The median lead time between KeGFR ratio decrease and AKI was 24 h (IQR: 19–27 h).

Conclusions

KeGFR ratio is a cheap, simple method that predicted AKI 24 h before laboratory detection. KeGFR may facilitate triaging patients to increased monitoring or intervention.
Hydraulic‐stomatal coordination in tree seedlings: tight correlation across environments and ontogeny in Acer pseudoplatanus
Authors: Beikircher Barbara , Sack Lawren , Ganthaler Andrea , Losso Adriano , Mayr Stefan
Published: June 2021

Hydraulic conductance is recognized as a major determinant of gas exchange and productivity. However, whether this also applies to seedlings, a critically important stage for vegetation regeneration, has been largely unknown.

We analyzed the hydraulic and stomatal conductance of leaves and shoots for 6‐wk‐old Acer pseudoplatanus seedlings emerging in different lowland and treeline habitats and under glasshouse conditions, respectively, as well as on 9‐, 15‐ and 18‐wk‐old plants, and related findings to leaf and xylem anatomical traits.

Treeline seedlings had higher leaf area‐specific shoot hydraulic conductance (Kshoot‐L), and stomatal conductance (gs), associated with wider xylem conduits, lower leaf area and higher stomatal density than lowland and glasshouse‐grown plants. Across the first 18 wk of development, seedlings increased four‐fold in absolute shoot hydraulic conductance (Kshoot) and declined by half in Kshoot‐L, with correlated shifts in xylem and leaf anatomy. Distal leaves had higher leaf hydraulic conductance (Kleaf) and gs compared to basal leaves.

Seedlings show strong variation across growth environments and ontogenetic shifts in hydraulic and anatomical parameters. Across growth sites, ontogenetic stages and leaf orders, gs was tightly correlated with Kshoot‐L and Kleaf, balancing hydraulic supply with demand for the earliest stages of seedling establishment.
Prioritizing actions: spatial action maps for conservation
Authors: Tallis Heather , Fargione Joe , Game Edward , McDonald Rob , Baumgarten Leandro , Bhagabati Nirmal , Cortez Rane , Griscom Bronson , Higgins Jonathan , Kennedy Christina M. , Kiesecker Joe , Kroeger Timm , Leberer Trina , McGowan Jennifer , Mandle Lisa , Masuda Yuta J. , Morrison Scott A. , Palmer Sally , Shirer Rebecca , Shyamsundar Priya , Wolff Nicholas H. , Possingham Hugh P.
Published: June 2021

Spatial prioritization is a critical step in conservation planning, a process designed to ensure that limited resources are applied in ways that deliver the highest possible returns for biodiversity and human wellbeing. In practice, many spatial prioritizations fall short of their potential by focusing on places rather than actions, and by using data of snapshots of assets or threats rather than estimated impacts. We introduce spatial action mapping as an approach that overcomes these shortfalls. This approach produces a spatially explicit view of where and how much a given conservation action is likely to contribute to achieving stated conservation goals. Through seven case examples, we demonstrate simple to complex versions of how this method can be applied across local to global scales to inform decisions about a wide range of conservation actions and benefits. Spatial action mapping can support major improvements in efficient use of conservation resources and will reach its full potential as the quality of environmental, social, and economic datasets converge and conservation impact evaluations improve.
Use of complementary medicines and lifestyle approaches by people living with dementia: Exploring experiences, motivations and attitudes
Authors: Steiner Genevieve Z. , George Emma S. , Metri Najwa‐Joelle , MacMillan Freya , Dubois Shamieka , Moyle Wendy , Hohenberg Mark I. , Singh Kawaljit , Townsend Camilla , Chang Dennis , Bensoussan Alan , McBride Kate A.
Published: June 2021

Background

Lack of effective treatments for chronic conditions is associated with high rates of complementary medicine (CM) use. However, little is known about CM use for dementia.

Aims and Objectives

The aim of this study was to explore the experiences, motivations, and attitudes towards CM use by people living with dementia in an Australian setting.

Design

This study had a qualitative research design; quantitative demographic information was also collected.

Methods

In‐depth interviews were conducted with people living with dementia and their caregivers (N = 18). A thematic (inductive) analysis approach was taken to interpret data.

Results

Three in four participants used CM for dementia, spending ~AUD$100/month (USD$70/month). Within three overarching themes, a range of sub‐themes was identified: (1) CM knowledge and use: people living with dementia and caregivers understanding of CM, types of CM used, and CM usage patterns; (2) Self‐determined reasons for use/non‐use: maintain or improve quality of life, hope, management of dementia symptoms, level of awareness, willingness and evidence, perceptions on efficacy and safety of CM, experiences of conventional medicine, and holistic approach to wellness; (3) External determinants of use: information on CM, relationship influences on CM use, and experiences with General Practitioners (GPs) and CM.

Conclusion

Findings highlight that CM use is widespread and positively viewed by people living with dementia and their caregivers. Decisions regarding CM use were based on personal opinions. Findings have important implications for conversations with health professionals regarding CM use by people living with dementia to improve communication, health literacy, and reduce the risk of adverse effects through polypharmacy.

Implications for Practice

This study showed that CM is a valued approach for dementia management by people living with dementia, their families, and healthcare providers. Future international research is required to evaluate the efficacy and safety of these approaches and promote accurate advice in nursing care.
ABA regulation of root growth during soil drying and recovery can involve auxin response
Authors: Zhang Qian , Yuan Wei , Wang Qianwen , Cao Yiying , Xu Feiyun , Dodd Ian C. , Xu Weifeng
Published: June 2021

Abscisic acid (ABA) plays an important role in plant adaptation to water deficits, but its role in regulating root growth (primary root elongation and lateral root number) during different drought‐phases remains unclear. Here, we exposed wild‐type (WT) and ABA‐deficient (not) tomato plants to three continuous drought‐phases (moderate drying: day 0–21; severe drying: day 22–47 and re‐watering: day 48–51). It was found that WT increased primary root growth during moderate drying; maintained more lateral roots, and greater primary root and total root length under severe drying; and produced more roots after re‐watering. After RNA‐Seq analysis, we found that the auxin‐related genes in root showed different expression patterns between WT and not under drying or re‐watering. Further, exogenous supply of IAA partially recovered the root growth of ABA‐deficient not plants under three continuous drought‐phases. Our results suggested that ABA regulation of tomato root growth during soil drying and recovery can involve auxin response.
On the Capacity of a Process with Batch Processing and Setup Times
Authors: Feng Zhichao , Dawande Milind , Janakiraman Ganesh
Published: June 2021

While batch processes are ubiquitous across industries, there is little understanding of the determination of the capacity (i.e., the maximum long‐term output rate) of such processes. In this study, we consider processes with collaboration (activities may require multiple resources simultaneously) and multitasking (the same resource may be needed for multiple activities), and characterize the capacity of an arbitrary deterministic, single‐product process with batch processing and (activity) setup times. Such a process can be viewed as an “intermittent” process in which production occurs in discrete quantities; specifically, in multiples of the batch size. To obtain a corresponding “smooth” process, we use the most natural transformation that eliminates batching and setups, and simply prorates the processing and setup time per flow unit. The main result of our analysis is that capacity remains unaffected in this transformation. Then, using recent developments in the literature on process capacity, the capacity of the transformed process can be obtained by computing the fractional chromatic number of an associated graph—this latter problem can be formulated as a linear program.
Emergence of Informal Safety Leadership: A Social–Cognitive Process for Accident Prevention
Authors: Wu Chunlin , Yao Han , Ning Xin , Wang Lei
Published: June 2021

As an important domain of disaster management, accident prevention is an urgent and crucial subject because of the high frequency and severe consequences of industrial accidents in recent times. Current researchers focus on organization‐level safety antecedents, among which leadership receives the highest attention. However, formal leadership of senior managers is limited by the level‐by‐level effect attenuation, such that frontline accidents cannot be controlled substantially. Thus, this study proposes the construct of informal safety leadership (ISL), which emerges among frontline workers through socially cognitive interactions. We develop a moderated mediating conceptual model to explore the ISL emergence mechanism from the social‐cognitive perspective. Across two studies, that is, a three‐wave field study and an agent‐based modeling simulation experiment, we find that three social‐cognitive elements are positively associated with ISL emergence, which in turn predicts safety organizational citizenship behavior and perceived followership. Moreover, this relationship is conditional on formal leadership support. We contribute to disaster management literature by articulating how informal leaders emerge from the operational frontline to possess safety leadership traits. We also give insight into leadership emergence by clearly indicating that who becomes a leader is an inherently social process, dependent on peers who bestow influence to a person engaging in leader‐like behaviors. We thus provide a unique perspective on practical efforts to leverage benefits of the closest and most immediate leadership in frontline accident prevention.
Depositional patterns of slowly plugging neck cutoffs from core analysis and estimates of bedload transport, White River, Arkansas
Authors: Richards Derek , Konsoer Kory , Langendoen Eddy , Ursic Mick , Constantine JosÉ
Published: June 2021

Meander cutoffs and oxbow lakes are very common features of fluvial landscapes that add complexity and diversity to floodplain alluvial architecture and riverine habitats. Following initial cutoff, sediment accumulates within the entrance and exit of the original bend forming plugs that eventually disconnect the abandoned bend from the main channel. While studies have examined the sedimentology of these plugs once they have fully disconnected from the abandoned bend, fewer studies have detailed the sedimentological processes occurring during the early stages following cutoff initiation. Furthermore, recent studies have highlighted the importance that planform geometry plays in the evolution of neck cutoffs. This study examines the spatial depositional patterns of two neck cutoffs on the White River in central Arkansas, USA, that remain hydrologically connected to the main channel, providing a unique opportunity to research sedimentological processes before disconnection of the abandoned bend. Sediment cores were collected in key locations of each cutoff, including the entrance and exit of the abandoned bends, abandoned bend apices, and newly developed cutoff bars in the downstream channel. The cores were logged and interpreted and grain‐size analyses were performed. In addition to sediment cores, repeat high‐resolution multibeam echo sounding surveys were conducted roughly four hours apart to estimate bedload transport rates and patterns of bedload routing through each cutoff. Results from this research are different from previous studies. Sediment core results show a pattern of deposition typically associated with lower diversion angle chute cutoffs instead of higher diversion angle neck cutoffs. Previous research has indicated that plugging of abandoned bends drives disconnection from the active channel; however, this research shows that disconnection is more associated with the prevention of sediment from being delivered to the abandoned bends due to flow being pulled away from the abandoned bends and the evolving channel morphology.
Robust prediction of domain compositions from uncertain data using isometric logratio transformations in a penalized multivariate Fay–Herriot model
Authors: Krause Joscha , Burgard Jan Pablo , Morales Domingo
Published: June 2021

Assessing regional population compositions is an important task in many research fields. Small area estimation with generalized linear mixed models marks a powerful tool for this purpose. However, the method has limitations in practice. When the data are subject to measurement errors, small area models produce inefficient or biased results since they cannot account for data uncertainty. This is particularly problematic for composition prediction, since generalized linear mixed models often rely on approximate likelihood inference. Obtained predictions are not reliable. We propose a robust multivariate Fay–Herriot model to solve these issues. It combines compositional data analysis with robust optimization theory. The nonlinear estimation of compositions is restated as a linear problem through isometric logratio transformations. Robust model parameter estimation is performed via penalized maximum likelihood. A robust best predictor is derived. Simulations are conducted to demonstrate the effectiveness of the approach. An application to alcohol consumption in Germany is provided.
Intestinal mucormycosis initially identified by next‐generation sequencing of cell‐free DNA
Authors: Martin‐Blais Rachel , Pathak Saumya , Fitzwater Sean , Dawson David W. , Sisk Anthony E. , Farmer Douglas G. , Venick Robert , Yeganeh Nava
Published: June 2021

Mucormycosis is a rare fungal infection that typically affects severely immunocompromised individuals, often resulting in significant morbidity and mortality. Although early and aggressive intervention is necessary to prevent poor outcomes, diagnosis of this infection remains difficult. We report the first case, to our knowledge, of invasive gastrointestinal mucormycosis initially identified by next‐generation sequencing of cfDNA from the blood, and discuss the various benefits and challenges which come with new molecular diagnostic techniques.