bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of HealthPathways: an appraisal of usage, experiences and opinions of healthcare professionals in Australia and New Zealand
Authors: Goddard-Nash Arran , Makate Marshall , Varhol Richard , Quirk Frances , Larsen Richard , McGeoch Graham , Shand Brett , Robinson Suzanne
Published: July 2020

Objectives HealthPathways, pioneered in Canterbury, New Zealand, in 2008, is a web-based tool designed to promote health care integration and patient management in primary care and to reduce fragmentation in the delivery of health services. This cross-sectional study evaluated the utilisation and perceptions of this tool among health professionals in Australia and New Zealand. Methods A cross-sectional survey was administered online through Research Electronic Data Capture (REDCap) to general practitioners (GPs), practice nurses and managers, nurse practitioners, specialist and community nurses, hospital clinicians, nurses, managers, and allied health professionals between April and September 2018. The frequency of HealthPathways use in the previous month was modelled as an ordered response using an ordered logistic regression model after adjusting for the possible effects of sex, age, years in clinical practice, location and time spent in practice. Results Health professionals perceived HealthPathways to be useful in primary care management and referral, as well as in the prereferral treatment of patients. GPs in New Zealand, New South Wales and Victoria were 73%, 47% and 27% more likely to have used HealthPathways ≥10 times in the previous month respectively. Conclusion The results suggest that HealthPathways is having a positive effect on healthcare systems in New Zealand and Australia. However, differences in uptake suggests the need for focused implementation, integration into eReferral software and expanding the tool to medical students, registrars, allied health professionals and potentially patients to encourage behavioural change. What is known about the topic? Early evaluations suggest that HealthPathways is a useful tool for health professionals, although uptake and utilisation may be limited. However, there is no comparative evidence regarding uptake and implementation of the tool. What does the paper add? This study is among the first to provide a comparative narrative of the literature assessing the implementation and uptake of HealthPathways across Australia and New Zealand. It is also among the first to compare the perceptions of allied health professionals in the use of HealthPathways across Australia and New Zealand. What are the implications for practitioners? The results of this study suggest the need for focused implementation, integration into eReferral software and expanding the tool to medical students, registrars, allied health professionals and potentially patients to encourage behavioural change.
PKM2 promotes Th17 cell differentiation and autoimmune inflammation by fine-tuning STAT3 activation
Authors: Damasceno Luis Eduardo Alves , Prado Douglas Silva , Veras Flavio Protasio , Fonseca Miriam M. , Toller-Kawahisa Juliana E. , Rosa Marcos Henrique , Públio Gabriel Azevedo , Martins Timna Varela , Ramalho Fernando S. , Waisman Ari , Cunha Fernando Queiroz , Cunha Thiago Mattar , Alves-Filho José Carlos
Published: July 2020

Th17 cell differentiation and pathogenicity depend on metabolic reprogramming inducing shifts toward glycolysis. Here, we show that the pyruvate kinase M2 (PKM2), a glycolytic enzyme required for cancer cell proliferation and tumor progression, is a key factor mediating Th17 cell differentiation and autoimmune inflammation. We found that PKM2 is highly expressed throughout the differentiation of Th17 cells in vitro and during experimental autoimmune encephalomyelitis (EAE) development. Strikingly, PKM2 is not required for the metabolic reprogramming and proliferative capacity of Th17 cells. However, T cell–specific PKM2 deletion impairs Th17 cell differentiation and ameliorates symptoms of EAE by decreasing Th17 cell–mediated inflammation and demyelination. Mechanistically, PKM2 translocates into the nucleus and interacts with STAT3, enhancing its activation and thereby increasing Th17 cell differentiation. Thus, PKM2 acts as a critical nonmetabolic regulator that fine-tunes Th17 cell differentiation and function in autoimmune-mediated inflammation.
Spherically symmetric loop quantum gravity: analysis of improved dynamics
Authors: Gambini Rodolfo , Olmedo Javier , Pullin Jorge
Published: July 2020

We study the ‘improved dynamics’ for the treatment of spherically symmetric space-times in loop quantum gravity introduced by Chiou et al in analogy with the one that has been constructed by Ashtekar, Pawlowski and Singh for the homogeneous space-times. In this dynamics the polymerization parameter is a well motivated function of the dynamical variables, reflecting the fact that the quantum of area depends on them. Contrary to the homogeneous case, its implementation does not trigger undesirable physical properties. We identify semiclassical physical states in the quantum theory and derive the corresponding effective semiclassical metrics. We then discuss some of their properties. Concretely, the space-time approaches sufficiently fast the Schwarzschild geometry at low curvatures. Besides, regions where the singularity is in the classical theory get replaced by a regular but discrete effective geometry with finite and Planck order curvature, regardless of the mass of the black hole. This circumvents trans-Planckian curvatures that appeared for astrophysical black holes in the quantization scheme without the improvement. It makes the resolution of the singularity more in line with the one observed in models that use the isometry of the interior of a Schwarzschild black hole with the Kantowski–Sachs loop quantum cosmologies. One can observe the emergence of effective violations of the null energy condition in the interior of the black hole as part of the mechanism of the elimination of the singularity.
Variable stiffness soft pneumatic grippers augmented with active vacuum adhesion
Authors: Chen Rui , Wu Li , Sun Yi , Chen Jin-Quan , Guo Jiang-Long
Published: July 2020

Soft pneumatic grippers (SPGs), made of highly stretchable elastomer materials with internal fluidic channels, are a popular soft robotic gripping technology, and have been configured as soft bending fingers for passively compliant grasping applications. It is challenging, however, for current SPGs to grip both flat, concave, and convex surfaces. Controllable adhesion augmented SPGs are promising solutions. We aim to develop a composite gripper structure that could enable SPGs with the capability to lift flat, concave, and convex surfaces using pneumatic inputs only. To this end, we present PneuIVAVS, a layer-jamming induced active vacuum adhesion (VA) augmented and variable stiffness (VS) fiber-reinforced SPG. This integrated PneuIVAVS design has enabled the gripper to generate a VA force without the requirement that all suction units should work. Also, a VA force analytical model and a shape-locking model of the PneuIVAVS design were developed and experimentally validated. In addition, the PneuIVAVS gripper presented good performance on gripping both flat, concave and convex objects with a range of contacting areas. According to the load capacity test, the gripper could grasp a maximum of approximately 470 g, 683 g, and 268 g when handling flat, concave, and convex surfaces respectively. Besides, the gripper could grasp curved surfaces with a minimum radius of curvature between 30 and 40 mm. The PneuIVAVS concept, design, and results in this work have potential to promote the applications of SPGs and VA grippers in various material handling and robotics tasks.
Designing green self-healing anticorrosion conductive smart coating for metal protection
Authors: Banerjee Debika , Guo Xiaohang , Benavides Jaime , Rameau Bruno , Cloutier Sylvain G
Published: July 2020

The development of an electrically-conductive anticorrosion coating with self-healing capability for metallic surface protection constitutes a priority concern for many key industrial applications. While current technologies largely rely on hazardous chromate-based corrosion inhibitors, this work proposes a simple polymer-based layer-by-layer (LBL) architecture, implemented using easy and fast fabrication techniques. Moreover, this smart coating architecture relies on three environmentally friendly polymers namely polyethylenimine (PEI), polystyrenesulfonate (PSS) and 8-hydroxyquinoline (8HQ) respectively serving as poly-cation, poly-anion and as corrosion inhibitor. Here, this protective coating is deposited and tested on the widely-used Aluminium 2024 alloy to achieve long term protection against corrosion. When structural damages to the coating occur, the inhibitor agents are released to passivate the surface. Raman micro-spectroscopy measurements confirm this effective self-healing capability. This chromate-free coating shows great promises for multiple aerospace, construction and automotive applications.
Nonlocality-controllable Kerr-nonlinearity in nonlocally nonlinear system with oscillatory responses
Authors: Liang Guo , Dang Dalong , Li Wei , Li Huagang , Guo Qi
Published: July 2020

We discuss the Kerr nonlinearities of the nonlocally nonlinear system with oscillatory responses by the variational approach. The self-focusing and self-defocusing states are found to dramatically depend on the degree of nonlocality. When the degree of nonlocality goes across a critical value, the nonlinearity can transit to its opposite counterpart, that is, focusing to defocusing or defocusing to focusing. The critical degree of nonlocality for the nonlinearities transition is given analytically, and confirmed by numerical simulations. As a versatile mathematical tool, we also employ the variational approach to analytically address the stabilities of solitons, and obtain the range of the degree of nonlocality for the stable solitons, which is confirmed by the linear stability analysis and the numerical simulation.
Galois groups and Cantor actions
Authors: Lukina Olga
Published: July 2020

In this paper, we study the actions of profinite groups on Cantor sets which arise from representations of Galois groups of certain fields of rational functions. Such representations are associated to polynomials, and they are called profinite iterated monodromy groups. We are interested in a topological invariant of such actions called the asymptotic discriminant. In particular, we give a complete classification by whether the asymptotic discriminant is stable or wild in the case when the polynomial generating the representation is quadratic. We also study different ways in which a wild asymptotic discriminant can arise.
Elimination of unknowns for systems of algebraic differential-difference equations
Authors: Li Wei , Ovchinnikov Alexey , Pogudin Gleb , Scanlon Thomas
Published: July 2020

We establish effective elimination theorems for ordinary differential-difference equations. Specifically, we find a computable function

B
(
r
,
s
)

B(r,s)

of the natural number parameters

r
r

and

s
s

so that for any system of algebraic ordinary differential-difference equations in the variables

x

=

x
1

,
…
,

x
q

\mathbfit {x} = x_1, \ldots , x_q

and

y

=

y
1

,
…
,

y
r

\mathbfit {y} = y_1, \ldots , y_r

, each of which has order and degree in

y

\mathbfit {y}

bounded by

s
s

over a differential-difference field, there is a nontrivial consequence of this system involving just the

x

\mathbfit {x}

variables if and only if such a consequence may be constructed algebraically by applying no more than

B
(
r
,
s
)

B(r,s)

iterations of the basic difference and derivation operators to the equations in the system. We relate this finiteness theorem to the problem of finding solutions to such systems of differential-difference equations in rings of functions showing that a system of differential-difference equations over

C

\mathbb {C}

is algebraically consistent if and only if it has solutions in a certain ring of germs of meromorphic functions.
Greatest common divisors with moving targets and consequences for linear recurrence sequences
Authors: Grieve Nathan , Wang Julie
Published: July 2020

We establish consequences of the moving form of Schmidt’s Subspace Theorem. Indeed, we obtain inequalities that bound the logarithmic greatest common divisor of moving multivariable polynomials evaluated at moving

S
S

-unit arguments. In doing so, we complement recent work of Levin. As an additional application, we obtain results that pertain to the greatest common divisor problem for algebraic linear recurrence sequences. These observations are motivated by previous related works of Corvaja-Zannier, Levin, and others.
Algebraic stability of meromorphic maps descended from Thurston’s pullback maps
Authors: Ramadas Rohini
Published: July 2020

Let

ϕ
:

S
2

→

S
2

\phi :S^2 \to S^2

be an orientation-preserving branched covering whose post-critical set has finite cardinality

n
n

. If

ϕ
\phi

has a fully ramified periodic point

p

∞

p_{\infty }

and satisfies certain additional conditions, then, by work of Koch,

ϕ
\phi

induces a meromorphic self-map

R

ϕ

R_{\phi }

on the moduli space

M

0
,
n

\mathcal {M}_{0,n}

;

R

ϕ

R_{\phi }

descends from Thurston’s pullback map on Teichmüller space. Here, we relate the dynamics of

R

ϕ

R_{\phi }

on

M

0
,
n

\mathcal {M}_{0,n}

to the dynamics of

ϕ
\phi

on

S
2

S^2

. Let

ℓ
\ell

be the length of the periodic cycle in which the fully ramified point

p

∞

p_{\infty }

lies; we show that

R

ϕ

R_{\phi }

is algebraically stable on the heavy-light Hassett space corresponding to

ℓ
\ell

heavy marked points and

(
n
−
ℓ
)

(n-\ell )

light points.
The conserved AAA-ATPase PCH-2TRIP13regulates spindle checkpoint strength
Authors: Défachelles Lénaïg , Russo Anna E. , Nelson Christian R. , Bhalla Needhi
Published: July 2020

The length of the cell cycle delay imposed by the spindle checkpoint, also referred to as the spindle checkpoint strength, is controlled by the number of unattached kinetochores, cell volume, and cell fate. We show that PCH-2, a highly conserved AAA-ATPase, controls checkpoint strength during early embryogenesis in C. elegans.
Exploring the reciprocal relationship between cognitive function and edentulism among middle-aged and older adults in China
Authors: Lu Nan , Wu Bei , Pei Yaolin
Published: July 2020

Objective

Previous longitudinal studies have found that cognitive function affected oral health, and vice versa. However, research is lacking on the reciprocal relationships between cognitive function and edentulism simultaneously, especially in developing countries. The present study aimed to examine the reciprocal relationship between cognitive function and edentulism among middle-aged and older adults in China.

Methods

Data were derived from the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study. The sample included 14,038 respondents aged 45 or older. A two-wave cross-lagged analysis was adopted to test the hypothesized model.

Results

Among respondents aged 45–59, baseline cognitive function was associated with subsequent edentulism [b = −0.017, standard deviation (SD) = 0.006, P < 0.01]. In contrast, baseline edentulism was not significantly associated with poorer cognitive function at the follow-up wave (b = −0.744, SD = 0.383, P > 0.05). However, among respondents aged 60 or older, baseline cognitive function was associated with subsequent edentulism (b = −0.017, SD = 0.005, P < 0.01), and baseline edentulism was also associated with follow-up lower levels of cognitive function (b = −0.419, SD = 0.143, P < 0.01).

Conclusions

These findings demonstrated the reciprocal relationships of cognitive function and edentulism. However, such relationships varied across age groups. This study demonstrates the importance of developing programs and services to promote both cognitive and oral health, especially for those in older age.
The association between loneliness and medication use in older adults
Authors: Vyas Manav V , Watt Jennifer A , Yu Amy Y X , Straus Sharon E , Kapral Moira K
Published: July 2020

Background

Loneliness is common in older adults, and it is associated with unhealthy behaviours, including substance use. We evaluated the association between loneliness and self-reported use of opioids and benzodiazepines in older adults.

Methods

We used data from the Canadian Community Health Survey’s ‘Healthy Aging’ sub-survey and included adults 65 years or older who administered their own medications. We classified individuals as lonely if they scored 6 or more on the three -item University of California, Los Angeles’s Loneliness Scale. We used multinomial logistic regression models, adjusting for demographics and self-reported comorbidities, to describe the association between loneliness and daily or occasional use of opioids, benzodiazepines and non-opioid analgesics. We also explored the association between loneliness and polypharmacy.

Results

Our cohort included 15,302 older adults, of whom 2,096 (13.7%) were classified as lonely. Daily use of opioids (4.1%) and benzodiazepines (1.7%) were less common than daily use of non-opioid analgesics (33.9%). Lonely older adults had higher daily use of opioids (odds ratio [OR] 1.61, 1.31-1.98) and benzodiazepines (OR 1.66, 1.21-2.28), but not non-opioid analgesics (OR 1.05, 0.92-1.19). Loneliness was not associated with occasional use of opioids, benzodiazepines or non-opioid analgesics in older adults, but was associated with polypharmacy (OR 1.27, 1.06-1.52).

Conclusions

Loneliness in older adults is associated with increased daily use of opioids and benzodiazepines. Further research should evaluate patient- and physician-level factors that mediate this association, and develop strategies to mitigate loneliness and its attendant adverse outcomes.
Edge effects alter the role of fungi and insects in mediating functional composition and diversity of seedling recruits in a fragmented tropical forest
Authors: Krishnadas Meghna , Agarwal Kavya , Comita Liza S
Published: July 2020

Background and Aims

In fragmented forests, proximity to forest edges can favour the establishment of resource-acquisitive species over more resource-conservative species. During seedling recruitment, resource-acquisitive species may benefit from either higher light availability or weaker top-down effects of natural enemies. The relative importance of light and enemies for recruitment has seldom been examined with respect to edge effects.

Methods

In a human-modified wet tropical forest in India, we first examined how functional traits indicative of resource-acquisitive vs. resource-conservative strategies, i.e. specific leaf area (SLA), leaf dry matter content, wood density and seed size, explained interspecific differences in densities of seedling recruits with distance to the forest edge. Then, we checked whether fungicide and insecticide treatments and canopy openness (proxy for light availability) explained edge effects on trait-mediated changes in seedling density. Finally, we examined whether light availability and natural enemy activity explained edge effects on functional diversity of seedling recruits.

Key Results

Up to 60 m from edges, recruit densities increased with decreasing seed size, but not at 90–100 m, where recruit densities increased with higher SLA. Trait-mediated variation in recruit densities changed with pesticides only at 90–100 m: compared with control plots, fungicide increased recruit densities for low SLA species and insecticide increased smaller seeded species. For SLA, wood density and seed size, functional diversity of recruits was higher at 90–100 m than at 0–5 m. At 90–100 m, fungicide decreased functional diversity for SLA and insecticide reduced seed size diversity compared with control plots. Canopy openness explained neither variation in recruit density in relation to traits nor functional diversity.

Conclusions

Altered biotic interactions can mediate local changes to trait composition and functional diversity during seedling recruitment in forest fragments, hinting at downstream effects on the structure and function of human-modified forests.
Quantifying the influence of water deficit on root and shoot growth in wheat using X-ray Computed Tomography
Authors: Khalil A M , Murchie E H , Mooney S J
Published: July 2020

The potential increased frequency and severity of drought associated with environmental change represents a significant obstacle to efforts aimed at enhancing food security due to its impact on crop development, and ultimately, yield. Our understanding of the impact of drought on crop growth in terms of plant aerial tissues is much more advanced than knowledge of the below-ground impacts. We undertook an experiment using X-ray Computed Tomography that aimed to support measurements of infrared gas exchange from plant shoots with quantification of 3D root architecture traits and the associated soil structural characteristics. Winter wheat (cv. Zebedee) was assessed at two early growth stages (14 and 21 days) under four water treatments (100, 75, 50 and 25 % of a notional field capacity (FC) and across two soil types (sandy loam and clay loam)). Plants generally grew better (to a larger size) in sandy loam soil as opposed to clay loam soil, most likely due to the soil structure and the associated pore network. All plants grew poorly under extreme water stress and displayed optimal growth at 75 % of FC, as opposed to 100 %, as the latter was most likely too wet. The optimal matric potential for root and shoot growth, inferred from the water release curve for each soil type, was higher than that for photosynthesis, stomatal conductance and transpiration suggesting root and shoot growth was more affected by soil water content than photosynthesis-related characteristics under water deficit conditions. With incidences of drought likely to increase, identification of wheat cultivars that are more tolerant of these conditions is important. Studies that consider the impact of water stress on both plant shoots and roots, and the role of the soil pore system such as this offer considerable potential in supporting these efforts.
Variance in lifetime reproductive success of male polar bears
Authors: Richardson Evan S , Davis Corey , Stirling Ian , Derocher Andrew E , Lunn Nicholas J , Malenfant René M
Published: July 2020

Despite the important role that population density plays in ecological and evolutionary processes, studies of solitary species that occur at low densities remain scarce. In the context of mating systems, density is expected to influence the ability of males to find and monopolize mates, in turn, influencing variance in lifetime mating/reproductive success and the opportunity for selection. Herein, we investigate variance in male lifetime mating success (LMS), lifetime reproductive success (LRS), and the mating system of a sexually dimorphic carnivore that occurs at low densities, the polar bear (Ursus maritimus). Across 17 cohorts, born from 1975 to 1991, male LMS ranged from 0 to10 mates and LRS from 0 to 14 cubs; 40% of known-age males were not known to have reproduced. The opportunity for sexual selection (Is = 1.66, range = 0.60–4.99) and selection (I = 1.76, range: 0.65–4.89) were low compared to species with similar levels of sexual size dimorphism. Skew in male LRS was also low but significant for most cohorts indicating nonrandom reproductive success. Age-specific reproductive success was biased toward males from 11 to 17 years of age, with variation in fecundity (54%) but not longevity (10%) playing an important role in male reproduction. Our results support a growing body of evidence that suggests that male-biased size dimorphism and polygynous mating systems need not be associated with high variance in male mating and/or reproductive success.
Cognitive Deficits and Clinical Symptoms with Hippocampal Subfields in First-Episode and Never-Treated Patients with Schizophrenia
Authors: Xiu Mei Hong , Lang XiaoE , Chen Da Chun , Cao Bo , Kosten Thomas R , Cho Raymond Y , Shi Hui , Wei Chang Wei , Wu An Shi , Zhang Xiang Yang
Published: July 2020

Memory dysfunction and associated hippocampal disturbances play crucial roles in cognitive impairment of schizophrenia. To examine the relationships between cognitive function and the hippocampal subfields (HSs) in first-episode never-treated (FENT) schizophrenia patients, the HSs were segmented in 39 FENT patients and 30 healthy controls using a state-of the-art automated algorithm. We found no significant differences in any HSs between the patients and controls. However, multivariate regression analysis showed that the left cornu ammonis 1 (CA1), left hippocampal tail, left presubiculum, and right molecular layer contributed 40% to the variance of the PANSS negative symptom score. After adjusting for sex, age, education, and intracranial volume, the partial correlation analysis showed that the volumes of left CA1, CA3, CA4, molecular layer, granule cell layer and both left and right subiculum were negatively correlated with the MATRICS consensus cognitive battery (MCCB) Hopkins Verbal Learning Test (HVLT). Multiple regression analysis showed that the left CA1 and CA3 hippocampal abnormalities contributed 66% to the variance of the HVLT. Our results suggest no detectable HS deficits were found in FENT schizophrenia patients. However, the HSs may be involved in the symptoms and cognitive deficits of schizophrenia patients in the early phase of their illness.
Timing of Antiretroviral Therapy Initiation and Risk of Cancer Among Persons Living With Human Immunodeficiency Virus
Authors: Silverberg Michael J , Leyden Wendy , Hernández-Ramírez Raúl U , Qin Li , Lin Haiqun , Justice Amy C , Hessol Nancy A , Achenbach Chad J , D’Souza Gypsyamber , Engels Eric A , Althoff Keri N , Mayor Angel M , Sterling Timothy R , Kitahata Mari M , Bosch Ronald J , Saag Michael S , Rabkin Charles S , Horberg Michael A , Gill M John , Grover Surbhi , Mathews W Christopher , Li Jun , Crane Heidi M , Gange Stephen J , Lau Bryan , Moore Richard D , Dubrow Robert , Neugebauer Romain S
Published: July 2020

Background

Persons living with human immunodeficiency virus (HIV; PLWH) experience a high burden of cancer. It remains unknown which cancer types are reduced in PLWH with earlier initiation of antiretroviral therapy (ART).

Methods

We evaluated AIDS-free, ART-naive PLWH during 1996–2014 from 22 cohorts participating in the North American AIDS Cohort Collaboration on Research and Design. PLWH were followed from first observed CD4 of 350–500 cells/µL (baseline) until incident cancer, death, lost-to-follow-up, or December 2014. Outcomes included 6 cancer groups and 5 individual cancers that were confirmed by chart review or cancer registry linkage. We evaluated the effect of earlier (in the first 6 months after baseline) versus deferred ART initiation on cancer risk. Marginal structural models were used with inverse probability weighting to account for time-dependent confounding and informative right-censoring, with weights informed by subject’s age, sex, cohort, baseline year, race/ethnicity, HIV transmission risk, smoking, viral hepatitis, CD4, and AIDS diagnoses.

Results

Protective results for earlier ART were found for any cancer (adjusted hazard ratio [HR] 0.57; 95% confidence interval [CI], .37–.86), AIDS-defining cancers (HR 0.23; 95% CI, .11–.49), any virus-related cancer (HR 0.30; 95% CI, .16–.54), Kaposi sarcoma (HR 0.25; 95% CI, .10–.61), and non-Hodgkin lymphoma (HR 0.22; 95% CI, .06–.73). By 15 years, there was also an observed reduced risk with earlier ART for virus-related NADCs (0.6% vs 2.3%; adjusted risk difference −1.6; 95% CI, −2.8, −.5).

Conclusions

Earlier ART initiation has potential to reduce the burden of virus-related cancers in PLWH but not non-AIDS-defining cancers (NADCs) without known or suspected viral etiology.
A Randomized Controlled Trial of an Electronic Clinical Decision Support Tool for Inpatient Antimicrobial Stewardship
Authors: Ridgway Jessica P , Robicsek Ari , Shah Nirav , Smith Becky A , Singh Kamaljit , Semel Jeffery , Acree Mary Ellen , Grant Jennifer , Ravichandran Urmila , Peterson Lance R
Published: July 2020

Background

The weighted incidence syndromic combination antibiogram (WISCA) is an antimicrobial stewardship tool that utilizes electronic medical record data to provide real-time clinical decision support regarding empiric antibiotic prescription in the hospital setting. The aim of this study was to determine the impact of WISCA utilization for empiric antibiotic prescription on hospital length of stay (LOS).

Methods

We performed a crossover randomized controlled trial of the WISCA tool at 4 hospitals. Study participants included adult inpatients receiving empiric antibiotics for urinary tract infection (UTI), abdominal-biliary infection (ABI), pneumonia, or nonpurulent cellulitis. Antimicrobial stewardship (ASP) physicians utilized WISCA and clinical guidelines to provide empiric antibiotic recommendations. The primary outcome was LOS. Secondary outcomes included 30-day mortality, 30-day readmission, Clostridioides difficile infection, acquisition of multidrug-resistant gram-negative organism (MDRO), and antibiotics costs.

Results

In total, 6849 participants enrolled in the study. There were no overall differences in outcomes among the intervention versus control groups. Participants with cellulitis in the intervention group had significantly shorter mean LOS compared to participants with cellulitis in the control group (coefficient estimate = 0.53 [−0.97, −0.09], P = .0186). For patients with community acquired pneumonia (CAP), the intervention group had significantly lower odds of 30-day mortality compared to the control group (adjusted odds ratio [aOR] .58, 95% confidence interval [CI], .396, .854, P = .02).

Conclusions

Use of WISCA was not associated with improved outcomes for UTI and ABI. Guidelines-based interventions were associated with decreased LOS for cellulitis and decreased mortality for CAP.
High Frequency of SARS-CoV-2 RNAemia and Association With Severe Disease
Authors: Hogan Catherine A , Stevens Bryan A , Sahoo Malaya K , Huang ChunHong , Garamani Natasha , Gombar Saurabh , Yamamoto Fumiko , Murugesan Kanagavel , Kurzer Jason , Zehnder James , Pinsky Benjamin A
Published: July 2020

Background

Detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in blood, also known as RNAemia, has been reported, but its prognostic implications are poorly understood. This study aimed to determine the frequency of SARS-CoV-2 RNA in plasma and its association with coronavirus disease 2019 (COVID-19) clinical severity.

Methods

An analytical cross-sectional study was performed in a single-center tertiary care institution and included consecutive inpatients and outpatients with confirmed COVID-19. The prevalence of SARS CoV-2 RNAemia and the strength of its association with clinical severity variables were examined and included intensive care unit (ICU) admission, invasive mechanical ventilation, and 30-day all-cause mortality.

Results

Paired nasopharyngeal and plasma samples were included from 85 patients. The median age was 55 years, and individuals with RNAemia were older than those with undetectable SARS-CoV-2 RNA in plasma (63 vs 50 years; P = .04). Comorbidities were frequent including obesity (37.6%), hypertension (30.6%), and diabetes mellitus (22.4%). RNAemia was detected in 28/85 (32.9%) of patients, including 22/28 (78.6%) who required hospitalization. In models adjusted for age, RNAemia was detected more frequently in individuals who developed severe disease including ICU admission (32.1 vs 14.0%; P = .04) and invasive mechanical ventilation (21.4% vs 3.5%; P = .02). All 4 deaths occurred in individuals with detectable RNAemia. An additional 121 plasma samples from 28 individuals with RNAemia were assessed longitudinally, and RNA was detected for a maximum duration of 10 days.

Conclusions

This study demonstrated a high proportion of SARS-CoV-2 RNAemia, and an association between RNAemia and clinical severity suggesting the potential utility of plasma viral testing as a prognostic indicator for COVID-19.
Cost-effectiveness of Frequent HIV Screening Among High-risk Young Men Who Have Sex With Men in the United States
Authors: Neilan Anne M , Bulteel Alexander J B , Hosek Sybil G , Foote Julia H A , Freedberg Kenneth A , Landovitz Raphael J , Walensky Rochelle P , Resch Stephen C , Kazemian Pooyan , Paltiel A David , Weinstein Milton C , Wilson Craig M , Ciaranello Andrea L
Published: July 2020

Background

Of new HIV infections in the US, 20% occur among young men who have sex with men (YMSM, ages 13–24), but >50% of YMSM with HIV are unaware of their status. Using Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) data, we projected the clinical benefit and cost-effectiveness of frequent HIV screening among high-risk YMSM from age 15.

Methods

Using a mathematical simulation, we examined 3 screening strategies: Yearly, 6-monthly, and 3-monthly, each in addition to the Status quo (SQ, 0.7–10.3% screened/year, stratified by age). We used published data (YMSM-specific when available) including: HIV incidences (0.91–6.41/100PY); screen acceptance (80%), linkage-to-care/antiretroviral therapy (ART) initiation (76%), HIV transmission (0.3–86.1/100PY, by HIV RNA), monthly ART costs ($2290-$3780), and HIV per-screen costs ($38). Projected outcomes included CD4 count at diagnosis, primary HIV transmissions from ages 15–30, quality-adjusted life expectancy, costs, and incremental cost-effectiveness ratios (ICERs, $/quality-adjusted life-year saved [QALY]; threshold ≤$100 000/QALY).

Results

Compared to SQ, all strategies increased projected CD4 at diagnosis (296 to 477–515 cells/µL) and quality-adjusted life expectancy from age 15 (44.4 to 48.3–48.7 years) among YMSM acquiring HIV. Compared to SQ, all strategies increased discounted lifetime cost for the entire population ($170 800 to $178 100-$185 000/person). Screening 3-monthly was cost-effective (ICER: $4500/QALY) compared to SQ and reduced primary transmissions through age 30 by 40%. Results were most sensitive to transmission rates; excluding the impact of transmissions, screening Yearly was ≤$100 000/QALY (ICER: $70 900/QALY).

Conclusions

For high-risk YMSM in the US, HIV screening 3-monthly compared to less frequent screening will improve clinical outcomes and be cost-effective.
The Rise of Screening Mechanisms in the Global North: Weaponizing the Law against China’s Weaponized Investments?
Authors: Carrai Maria Adele
Published: July 2020

Investment screening mechanisms are proliferating, especially in the global North, apparently in direct reaction to China’s global rise and what is perceived to be its ‘weaponized investments’. Given the lack of clear shared objectives and coordination between screening mechanisms, which remain a core prerogative of each sovereign State’s self-judgment on national security, and the possible negative repercussions on the international economy and cooperation, this article looks at the increase of screening mechanisms for foreign direct investments in Europe and the USA in relation to China’s global rise. What does it entail for Chinese outward foreign direct investments and for the international economic legal order more broadly? In discussing the strengths and limitations of screening mechanisms, this article argues that, while the concerns for Chinese commercial investments aimed at acquiring technology and critical assets are legitimate, at the same time, Western States can disproportionally discriminate against Chinese investments by creating an investment regime that is overly protectionist. The article, adopting the recent screening mechanism of the European Union as a model, proposes how screening mechanisms could be improved through harmonization and cooperation among States, alongside the setting of clear objectives to limit their discriminatory, unjustified, and overly discretionary use.
Baseline haematology, biochemistry, blood gas values and health status of the Galapagos swallow-tailed gull (Creagrus furcatus)
Authors: Valle Carlos A , Ulloa Catalina , Regalado Cristina , Muñoz-Pérez Juan-Pablo , Garcia Juan , Hardesty Britta Denise , Skehel Alice , Deresienski Diane , Passingham Ronald K , Lewbart Gregory A
Published: July 2020

The swallow-tailed gull, Creagrus furcatus, is a seabird endemic to the Galápagos archipelago. In general health, blood chemistry and haematology, parameters have not been published for this species. Blood analyses were run on samples drawn from 58 clinically healthy swallow-tailed gulls captured at Islote Pitt on San Cristóbal Island in July 2016 (28) and South Plaza Island in June 2017 (30). A point of care blood analyzer (iSTAT) was used in the field to obtain results for HCO3−, pH, pCO2, pO2, TCO2, anion gap, chloride, creatinine, glucose, haematocrit, haemoglobin, ionized calcium, potassium, sodium and urea nitrogen. A portable Lactate Plus™ analyzer was used to measure lactate. The baseline data reported is valuable for comparisons amongst different populations in the archipelago and to detect changes in health status of Galápagos swallow-tailed gulls.
Inflammation and adiposity: new frontiers in atrial fibrillation
Authors: Vyas Vishal , Hunter Ross J , Longhi M Paula , Finlay Malcolm C
Published: July 2020

The aetiology of atrial fibrillation (AF) remains poorly understood, despite its growing prevalence and associated morbidity, mortality, and healthcare costs. Obesity is implicated in myriad different disease processes and is now recognized a major risk factor in the pathogenesis of AF. Moreover, the role of distinct adipose tissue depots is a matter of intense scientific interest with the depot directly surrounding the heart—epicardial adipose tissue (EAT) appearing to have the greatest correlation with AF presence and severity. Similarly, inflammation is implicated in the pathophysiology of AF with EAT thought to act as a local depot of inflammatory mediators. These can easily diffuse into atrial tissue with the potential to alter its structural and electrical properties. Various meta-analyses have indicated that EAT size is an independent risk factor for AF with adipose tissue expansion being inevitably associated with a local inflammatory process. Here, we first briefly review adipose tissue anatomy and physiology then move on to the epidemiological data correlating EAT, inflammation, and AF. We focus particularly on discussing the mechanistic basis of how EAT inflammation may precipitate and maintain AF. Finally, we review how EAT can be utilized to help in the clinical management of AF patients and discuss future avenues for research.
Regional variations and socio-economic disparities in neonatal mortality in Angola: a cross-sectional study using demographic and health surveys
Authors: Yaya Sanni , Zegeye Betregiorgis , Ahinkorah Bright Opoku , Oladimeji Olanrewaju , Shibre Gebretsadik
Published: July 2020

Background

Inequalities in neonatal mortality rates (NMRs) in low- and middle-income countries show key disparities at the detriment of disadvantaged population subgroups. There is a lack of scholarly evidence on the extent and reasons for the inequalities in NMRs in Angola.

Objective

The aim of this study was to assess the socio-economic, place of residence, region and gender inequalities in the NMRs in Angola.

Methods

The World Health Organization Health Equity Assessment Toolkit software was used to analyse data from the 2015 Angola Demographic and Health Survey. Five equity stratifiers: subnational regions, education, wealth, residence and sex were used to disaggregate NMR inequality. Absolute and relative inequality measures, namely, difference, population attributable fraction (PAF), population attributable risk (PAR) and ratio, were calculated to provide a broader understanding of the inequalities in NMR. Statistical significance was calculated at corresponding 95% uncertainty intervals.

Findings

We found significant wealth-driven [PAR = −14.16, 95% corresponding interval (CI): −15.12, −13.19], education-related (PAF = −22.5%, 95% CI: −25.93, −19.23), urban–rural (PAF = −14.5%, 95% CI: −16.38, −12.74), sex-based (PAR = −5.6%, 95% CI: −6.17, −5.10) and subnational regional (PAF = −82.2%, 95% CI: −90.14, −74.41) disparities in NMRs, with higher burden among deprived population subgroups.

Conclusions

High NMRs were found among male neonates and those born to mothers with no formal education, poor mothers and those living in rural areas and the Benguela region. Interventions aimed at reducing NMRs, should be designed with specific focus on disadvantaged subpopulations.
Forging memory: the aftermath of the Saint Bartholomew’s Day massacre in Lyon
Authors: Mingous Gautier
Published: July 2020

In the aftermath of the Saint Bartholomew’s Day massacres, Catholics and Protestants often had to explain or justify the extreme violence that marked this bloody episode. A process of memory construction therefore took place in the days and weeks immediately following the killings. Taking the city of Lyon as a case study, this article analyses how Catholics and Protestants constructed a partisan memory of the massacres and studies the role of these memories in subsequent conflicts and in the interpretation of the massacres, both during and after the Wars of Religion. The article shows that whereas Protestants relied on the model of the martyrology to formulate a theological response to the violence, Lyon’s Catholic elites preferred to insist on the legality of their actions and their respect of the royal will. This dual memory was not only built up gradually, it was also rewritten and reconstructed over the years and in different contexts.
Multiplex melanoma families are enriched for polygenic risk
Authors: Law Matthew H , Aoude Lauren G , Duffy David L , Long Georgina V , Johansson Peter A , Pritchard Antonia L , Khosrotehrani Kiarash , Mann Graham J , Montgomery Grant W , Iles Mark M , Cust Anne E , Palmer Jane M ,   Melanoma GWAS Consortium, Baxter A , de Nooyer M , Gardner I , Statham D , Haddon B , Wright M J , Symmons J , Castellano B , Bowdler L , Smith S , Smyth D , Wallace L , Campbell M J , Caracella A , Kvaskoff M , Zheng O , Chapman B , Beeby H , Baxter A , de Nooyer M , Gardner I , Statham D , Haddon B , Wright M J , Symmons J , Castellano B , Bowdler L , Smith S , Smyth D , Wallace L , Campbell M J , Caracella A , Kvaskoff M , Zheng O , Chapman B , Beeby H , Shannon Kerwin F , Spillane Andrew J , Stretch Jonathan R , Thompson John F , Saw Robyn P M , Scolyer Richard A , Martin Nicholas G , Hayward Nicholas K , MacGregor Stuart
Published: July 2020

Cancers, including cutaneous melanoma, can cluster in families. In addition to environmental etiological factors such as ultraviolet radiation, cutaneous melanoma has a strong genetic component. Genetic risks for cutaneous melanoma range from rare, high-penetrance mutations to common, low-penetrance variants. Known high-penetrance mutations account for only about half of all densely affected cutaneous melanoma families, and the causes of familial clustering in the remainder are unknown. We hypothesize that some clustering is due to the cumulative effect of a large number of variants of individually small effect. Common, low-penetrance genetic risk variants can be combined into polygenic risk scores. We used a polygenic risk score for cutaneous melanoma to compare families without known high-penetrance mutations with unrelated melanoma cases and melanoma-free controls. Family members had significantly higher mean polygenic load for cutaneous melanoma than unrelated cases or melanoma-free healthy controls (Bonferroni-corrected t-test P = 1.5 × 10−5 and 6.3 × 10−45, respectively). Whole genome sequencing of germline DNA from 51 members of 21 families with low polygenic risk for melanoma identified a CDKN2A p.G101W mutation in a single family but no other candidate high-penetrance melanoma susceptibility genes. This work provides further evidence that melanoma, like many other common complex disorders, can arise from the joint action of multiple predisposing factors, including rare high-penetrance mutations, as well as via a combination of large numbers of alleles of small effect.
Mechanical and morphology properties of titanium oxide-epoxy nanocomposites
Authors: Gaaz Tayser Sumer , Hussein Emad Kamil , Subhi Kussay Ahmed , Al-Amiery Ahmed
Published: July 2020

In the current work, the influences of titanium oxide (TO) on nanocomposites using epoxy (EP) resin have been investigated. EP resin was added to various contents in terms of volume of TO (6%). Based on the casting method, the TO-EP nanocomposites were prepared. Mechanical properties in terms of tensile, impact and hardness properties exhibited improvements in the mechanical results of the TO-EP nanocomposites. The experimental results exhibited that the enhancement in the tensile strength, impact, and hardness was found to be 14 MPa, 40.1 J/mm2 and 228.9 HV, respectively. Moreover, the effect of the strength has decreased compared with pointing to brittleness that increased the TO-EP nanocomposites. Field emission scanning electron microscopy (FESEM) analysis was used to perform a microstructure analysis which in turn revealed how TO obstruction the cracks propagation in the nanocomposites. The interface between the TO and the EP nanocomposites was observed using the FESEM images. The results highlighted that the TO-EP nanocomposites can be used a wide range of industrial applications such as biomedical application.
Evidence-Based Guidelines and Secondary Meta-Analysis for the Use of Transcranial Direct Current Stimulation in Neurological and Psychiatric Disorders
Authors: Fregni Felipe , El-Hagrassy Mirret M , Pacheco-Barrios Kevin , Carvalho Sandra , Leite Jorge , Simis Marcel , Brunelin Jerome , Nakamura-Palacios Ester Miyuki , Marangolo Paola , Venkatasubramanian Ganesan , San-Juan Daniel , Caumo Wolnei , Bikson Marom , Brunoni André R ,   Neuromodulation Center Working Group, Cardenas-Rojas Alejandra , Giannoni-Luza Stefano , Leao Judah , Teixeira Leffa Douglas , Mejia-Pando Piero F , Alejandra Luna-Cuadros Maria , Gnoatto-Medeiros Marina , Balbuena-Pareja Ana , Machado Roberto M , Toyama Mayumi , Gianlorenco Anna C , Zeng Huiyan
Published: July 2020

Background

Transcranial direct current stimulation has shown promising clinical results, leading to increased demand for an evidence-based review on its clinical effects.

Objective

We convened a team of transcranial direct current stimulation experts to conduct a systematic review of clinical trials with more than 1 session of stimulation testing: pain, Parkinson’s disease motor function and cognition, stroke motor function and language, epilepsy, major depressive disorder, obsessive compulsive disorder, Tourette syndrome, schizophrenia, and drug addiction.

Methods

Experts were asked to conduct this systematic review according to the search methodology from PRISMA guidelines. Recommendations on efficacy were categorized into Levels A (definitely effective), B (probably effective), C (possibly effective), or no recommendation. We assessed risk of bias for all included studies to confirm whether results were driven by potentially biased studies.

Results

Although most of the clinical trials have been designed as proof-of-concept trials, some of the indications analyzed in this review can be considered as definitely effective (Level A), such as depression, and probably effective (Level B), such as neuropathic pain, fibromyalgia, migraine, post-operative patient-controlled analgesia and pain, Parkinson’s disease (motor and cognition), stroke (motor), epilepsy, schizophrenia, and alcohol addiction. Assessment of bias showed that most of the studies had low risk of biases, and sensitivity analysis for bias did not change these results. Effect sizes vary from 0.01 to 0.70 and were significant in about 8 conditions, with the largest effect size being in postoperative acute pain and smaller in stroke motor recovery (nonsignificant when combined with robotic therapy).

Conclusion

All recommendations listed here are based on current published PubMed-indexed data. Despite high levels of evidence in some conditions, it must be underscored that effect sizes and duration of effects are often limited; thus, real clinical impact needs to be further determined with different study designs.