bluuebunny/crossref_metadata_2025 huggingface dataset:
Problems of Data Availability and Quality for COVID-19 and Older People in Low- and Middle-Income Countries
Authors: Lloyd-Sherlock Peter , Sempe Lucas , McKee Martin , Guntupalli Aravinda
Published: October 2020

For all health conditions, reliable age-disaggregated data are vital for both epidemiological analysis and monitoring the relative prioritization of different age groups in policy responses. This is especially essential in the case of Coronavirus Disease-2019 (COVID-19), given the strong association between age and case fatality. This paper assesses the availability and quality of age-based data on reported COVID-19 cases and deaths for low- and middle-income countries. It finds that the availability of reliable data which permit specific analyses of older people is largely absent. The paper explores the potential of excess mortality estimates as an alternative metric of the pandemic’s effects on older populations. Notwithstanding some technical challenges, this may offer a better approach, especially in countries where cause of death data are unreliable.
Performance of an Abbreviated Lubben Social Network Scale (LSNS-6) in Three Ethnic Groups of Older Asian Americans
Authors: Jang Yuri , Powers Daniel A , Park Nan Sook , Chiriboga David A , Chi Iris , Lubben James
Published: October 2020

Background and Objectives

The present study examined the measurement quality and performance of an abbreviated Lubben Social Network Scale (LSNS-6) in three ethnic groups (Chinese, Koreans, and Vietnamese) of older Asian Americans, addressing both within- and cross-group validations.

Research Design and Methods

We selected 605 participants aged 50 or older (242 Chinese, 150 Koreans, and 213 Vietnamese) from the 2015 Asian American Quality of Life survey, conducted with self-identified Asian Americans aged 18 or above living in central Texas. We analyzed LSNS-6 data on measurement qualities (internal consistency and corrected item-total correlation), dimensionality (exploratory and confirmatory factor analyses), and correlations with other indicators.

Results

LSNS-6 showed very good internal consistency in each ethnic group, and the two-factor structure of family and friends were invariant across the groups. The items on friends demonstrated greater homogeneity than those on family and emerged as a first factor. Both subscale and total scores of LSNS-6 were associated in expected directions with the social and health indicators considered.

Discussion and Implications

The findings confirm the measurement qualities of LSNS-6 within each group and provide support for measurement invariance across the groups. While the observed difference in family and friend networks warrants further investigation, LSNS-6 serves as a viable option for the assessment of social networks. When using LSNS-6 with older Asian Americans, it is highly recommended to use the family/friend subscales in consideration of cultural and immigration contexts.
Harmonic tremor model during the 2011 Shinmoe-dake eruption, Japan
Authors: Takeo Minoru
Published: October 2020

The Shinmoe-dake volcano started with three sub-Plinian eruptions from 26 to 27 January 2011, followed by a magma effusive stage from 28 to 31 January 2011, and Vulcanian eruptions occurred frequently during 1 to 10 February 2011. During the magma effusive and Vulcanian stages, multiple episodes of harmonic tremors were observed at stations near the summit crater. Although harmonic tremors have been observed at various volcanoes worldwide, the source mechanism remains poorly understood. This paper proposes a source model for harmonic tremors, which is composed of a nonlinear viscous fluid flow in a flexible channel. A simple lumped parameter model is used to consider the process. The dynamics are described by a third-order system of ordinary differential equations using model variables for a cross-sectional area of the constricted segment and the fluid velocities in the upstream and downstream tubes. This model produces various kinds of trajectories for self-sustained oscillations that change the reservoir pressure connected on the upstream channel of the model. Linearization analysis around the stationary point and global analysis employing nullcline planes reveal the mechanism of self-sustained oscillations of the system qualitatively. To consider both the frequency peaks of the harmonic tremor and the characteristics of observed phase spectra, the qualitative characteristics of an observed phase portrait are compared to those of a simulated one. This tremor model simulates the frequency peaks and the phase portraits of typical harmonic tremors observed during the 2011 Shinmoe-dake eruption. Because this model involves several geometrical configuration parameters, it has the potential to reveal the source mechanism of various kinds of harmonic tremors.
Anatomical circumstances and aortic cross-clamp time in minimally invasive aortic valve replacement
Authors: Jug Jure , Štor Zdravko , Geršak Borut
Published: October 2020

OBJECTIVES

Prolonged operative times, potentially leading to increased morbidity, are a possible drawback of minimally invasive aortic valve replacement. The aim of this study was to assess the impact of anatomical circumstances in the chest on aortic cross-clamp time.

METHODS

This retrospective study included 68 patients who underwent minimally invasive aortic valve replacement with the Perceval sutureless valve via right-anterior thoracotomy or with ministernotomy. Anatomical variables were measured during preoperative computer tomography scans.

RESULTS

Aortic cross-clamp time was shorter in those having ministernotomy than in the right-anterior thoracotomy group (41.1 vs 52.3 min; P < 0.001). Cardiopulmonary bypass (CPB) time was not significantly different between groups (P = 0.09). A multivariable linear-regression model (P = 0.018) showed the aortic dextroposition variable to be a significant predictor of the aortic cross-clamp method and CPB times (P = 0.005 and P = 0.003) independent of other anatomical variables in the right thoracotomy group (10 mm deviation from optimal position prolonged the times for 240 and 600 s). For the whole cohort, a correlation between aortic valve dimensions and operative times was found (P = 0.046, P = 0.009). A linear-regression model (P = 0.046) predicted 90 s longer aortic cross-clamp time and 231 s longer CPB time for every 1 mm smaller aortic valve diameter.

CONCLUSIONS

The anatomical variables are associated with the operative times in minimally invasive aortic valve replacement with sutureless valves. Considering this association, preplanning the procedure is recommended.
Impact of design features on natural ventilation of open-air malls in Thailand
Authors: Tantasavasdi Chalermwat , Inprom Natthaumporn
Published: October 2020

In recent times, retail buildings in tropical areas have started to evolve from fully enclosed air-conditioned designs towards designs featuring open-air naturally ventilated malls. This paper discusses influential factors that can be used to help achieve thermal comfort conditions in the semi-outdoor spaces of open-air malls within the Bangkok Metropolitan Area in Thailand. The researchers surveyed 23 buildings and categorised them into three groups according to their configurations. Six representative projects were selected and assessed using a computational fluid dynamics program. The results revealed that the percentages of thermal comfort hours varied from 34.7% to 80.8% of the annual occupation time and were highly dependent on the design decisions taken for individual projects. The study found that among five important design factors, which are position of openings in accordance to the prevailing wind, distribution of openings, window-to-wall ratio, building shape, and openings that encourage cross-ventilation, the first factor was the most influential. Buildings that have their position of openings in good accordance to the prevailing winds can achieve the number of hours 2.0 times greater than those that do not.
Bovine β-lactoglobulin-induced passive systemic anaphylaxis model using humanized NOG hIL-3/hGM-CSF transgenic mice
Authors: Ito Ryoji , Katano Ikumi , Otsuka Iyo , Takahashi Takeshi , Suemizu Hiroshi , Ito Mamoru , Simons Peter J
Published: October 2020

Food allergy is a common disease caused by intake of allergen-containing foods, such as milk, eggs, peanuts and wheat. Systemic anaphylaxis is a severe hypersensitive allergic reaction resulting from degranulation of mast cells or basophils after cross-linking of surface high-affinity IgE receptors (Fcε-RI) with allergen-specific IgE and allergens. In this study, we developed a novel human mast cell/basophil-engrafted mouse model that recapitulates systemic anaphylaxis triggered by β-lactoglobulin (BLG), a major allergen found in cow’s milk. Human CD34+ hematopoietic stem cells were transferred into NOG (non-Tg) or NOG hIL-3/hGM-CSF transgenic (Tg) mice. After 14–16 weeks, bovine BLG-specific human IgE was intravenously injected into humanized mice, followed by intravenous or oral bovine BLG exposure 1 day later. Body temperature in Tg, but not in non-Tg, mice gradually decreased within 10 min, and 80% of Tg mice died within 1 h by intravenous BLG exposure. Serum histamine levels and anaphylaxis scores in Tg mice were markedly increased compared to non-Tg mice. Furthermore, these allergic symptoms were significantly inhibited by epinephrine treatment of the Tg mice. Therefore, the current NOG hIL-3/hGM-CSF Tg mouse model may be useful for development of novel anaphylaxis drugs for treatment of food allergies and for safety assessment of low-allergenicity extensively hydrolyzed cow’s milk whey protein-based infant formulas.
A Lotus Blooms in the End Times: Cosmological Topography and the Tibetan State
Authors: MacCormack Ian
Published: October 2020

The ruler of the central Tibetan state, the Desi Sangyé Gyatso (1653–1705), recognized its capital city of Lhasa as having the radial form of an eight-petaled flower or eight-spoked wheel. This article examines the Desi’s writings to reflect on the relationship between symbolically ordered space and cosmology. Scholars have often explained such spaces as representing a cosmological model, assigning that model the role of a static foundation and distancing it from human activity. This Tibetan case is read as evidence for another way of thinking about cosmological topography, namely as a creative process in a self-consciously critical relationship with its encompassing world. At stake is the general question of how humans both inhabit the cosmos and actively participate in ordering it.
Within-host evolution of a Klebsiella pneumoniae clone: selected mutations associated with the alteration of outer membrane protein expression conferred multidrug resistance
Authors: Aihara Masamune , Nishida Ruriko , Akimoto Masaru , Gotoh Yasuhiro , Kiyosuke Makiko , Uchiumi Takeshi , Nishioka Mitsuaki , Matsushima Yuichi , Hayashi Tetsuya , Kang Dongchon
Published: October 2020

Background

A patient repeatedly developed bacteraemia despite the continuous use of antibiotics. We obtained two Klebsiella pneumoniae isolates from the patient’s blood on Days 72 and 105 after hospitalization. Each of the two isolates belonged to ST45, but while the first isolate was susceptible to most antibiotics, the second one was resistant to multiple drugs including carbapenems.

Objectives

To identify the genetic differences between the two isolates and uncover alterations formed by the within-host bacterial evolution leading to the antimicrobial resistance.

Methods

Whole-genome comparison of the two isolates was carried out to identify their genetic differences. We then profiled their outer membrane proteins related to membrane permeability to drugs. To characterize a ramR gene mutation found in the MDR isolate, its WT and mutant genes were cloned and expressed in the MDR isolate.

Results

The two isolates showed only three genomic differences, located in mdoH, ramR and upstream of ompK36. In the MDR isolate, a single nucleotide substitution in the ompK36 upstream region attenuated OmpK36 expression. A single amino acid residue insertion in RamR in the MDR isolate impaired its function, leading to the down-regulation of OmpK35 and the subsequent up-regulation of the AcrAB-TolC transporter, which may contribute to the MDR.

Conclusions

We identified very limited genomic changes in the second K. pneumoniae clone during within-host evolution, but two of the three identified mutations conferred the MDR phenotype on the clone by modulating drug permeability.
Assessing automated product selection success rates in transmissions between electronic prescribing and community pharmacy platforms
Authors: Panich Jennifer , Larson Natalee , Sojka Luanne , Wallace Zach , Lokken James
Published: October 2020

Objective

Wrong drug product errors occurring in community pharmacies often originate at the transcription stage. Electronic prescribing and automated product selection are strategies to reduce product selection errors. However, it is unclear how often automated product selection succeeds in outpatient pharmacy platforms.

Materials and Methods

The intake of over 800 e-prescriptions was observed at baseline and after intervention to assess the rate of automated product selection success. A dispensing accuracy audit was performed at baseline and postintervention to determine whether enhanced automated product selection would result in greater accuracy; data for both analyses were compared by 2x2 Chi square tests. In addition, an anonymous survey was sent to a convenience sample of 60 area community pharmacy managers.

Results

At baseline, 79.8% of 888 e-prescriptions achieved automated product selection. After the intervention period, 84.5% of 903 e-prescriptions achieved automated product selection (P = .008). Analysis of dispensing accuracy audits detected a slight but not statistically significant improvement in accuracy rate (99.3% versus 98.9%, P = .359). Fourteen surveys were returned, revealing that other community pharmacies experience similar automated product selection failure rates.

Discussion

Our results suggest that manual product selection by pharmacy personnel is required for a higher than anticipated proportion of e-prescriptions received and filled by community pharmacies, which may pose risks to both medication safety and efficiency.

Conclusion

The question of how to increase automated product selection rates and enhance interoperability between prescriber and community pharmacy platforms warrants further investigation.
The Influence of the Paris Agreement on Climate Litigation: Legal Obligations and Norms (Part I)∗
Authors: Preston Brian J
Published: September 2020

The Paris Agreement is the first universal climate change agreement requiring all parties to communicate ambitious greenhouse gas (GHG) reduction targets to achieve a long-term global temperature goal. The Paris Agreement is a game-changer at the international level, but has it been at the national (and sub-national) level? What has been the influence of the Paris Agreement on litigation to improve mitigation of, and adaptation to, climate change? This question is addressed in two articles. Both articles seek to look at a familiar topic—the Paris Agreement and climate litigation—in new and fresh ways. This first article examines how the Paris Agreement is directly implemented through incorporation into the domestic laws of the signatories as well as indirectly implemented through judicial decision-making in accordance with norms under the Paris Agreement. First, the article examines the international obligations created by the Paris Agreement, noting the flexible nature of the agreement and wide margin of discretion left to parties. Secondly, it explores how the Paris Agreement is incorporated in domestic laws and policies. The potential for litigation based on these international and domestic obligations will be considered. Thirdly, it discusses the courts’ application of norms under the Paris Agreement.
The secret social lives of African crested rats, Lophiomys imhausi
Authors: Weinstein Sara B , Malanga Katrina Nyawira , Agwanda Bernard , Maldonado Jesús E , Dearing M Denise
Published: October 2020

The crested rat, Lophiomys imhausi, is the only mammal known to sequester plant toxins. Found in eastern Africa, this large rodent is thought to defend against predation by coating specialized hairs along its sides with cardenolide toxins from the poison arrow tree, Acokanthera schimperi. To better understand the ecology of this unusual poisonous mammal, we used camera traps, livetrapping, and captive behavioral observations, to study L. imhausi in central Kenya. Although crested rats were rarely detected with camera traps, 25 individuals were caught in live traps, with estimated densities of up to 15 rats/km2 at one of nine trapping sites. Trapping records and behavioral observations suggest that L. imhausi live in male–female pairs, with juveniles that might exhibit delayed dispersal. We observed chewing of A. schimperi and/or anointing in 10 of 22 individuals, confirming the previous poison sequestration observation. We monitored crested rat activity using cameras and found that chewing on A. schimperi and cardenolide exposure had no effect on feeding, movement, or total activity. One crested rat also fed on milkweed (Gomphocarpus physocarpus; Gentaniales: Apocynaceae), but did not anoint with this cardenolide containing plant. This observation, combined with L. imhausi’s selective use of A. schimperi, suggests the potential for use of alternative poison sources. This research provides novel insight into the ecology of L. imhausi, while also suggesting that more field observations, feeding trials, and chemical analyses are needed to understand their behavior and physiology. Furthermore, their complex social interactions, slow life history, and fragmented populations suggest that L. imhausi could be at risk of decline.
Red tape and psychological capital: a counterbalancing act for professionals in street-level bureaucracies
Authors: Dudau A , Kominis G , Brunetto Y
Published: October 2020

Assuming that red tape is inevitable in institutions, and drawing on positive organizational behavior, we compare the impact of individual psychological capital on the ability of street-level bureaucrats (SLBs) with different professional backgrounds to work within the confines of red tape. The two SLB professions investigated here are nurses and local government employees; and the work outcomes of interest to this study are well-being and engagement. The findings show that red tape has a different impact on each professional group but, encouragingly, they also indicate that psychological capital has a compensatory effect. Implications include nurses requiring more psychological resources than local government employees to counteract the negative impact of red tape. A practical implication for managers is that, if perception of red tape in organizations is set to increase or to stay constant, enhancing the psychological capital of professionals in SLB roles, through specific interventions, may be beneficial to professionals and organizations alike.
Using American Community Survey Data to Improve Estimates from Smaller U.S. Surveys Through Bivariate Small Area Estimation Models
Authors: Franco Carolina , Bell William R
Published: September 2020

We demonstrate the potential for borrowing strength from estimates from the American Community Survey (ACS), the largest US household survey, to improve estimates from smaller US household surveys. We do this using simple bivariate area-level models to exploit strong relationships between population characteristics estimated by the smaller surveys and ACS estimates of the same, or closely related, quantities. We illustrate this idea with two applications. The first shows impressive variance reductions for state estimates of health insurance coverage from the National Health Interview Survey when modeling these jointly with corresponding ACS estimates. The second application shows impressive variance reductions in ACS one-year county estimates of poverty of school-aged children from modeling these jointly with previous ACS five-year county estimates of school-age poverty. Simple theoretical calculations show how the amount of variance reduction depends on characteristics of the underlying data. In our applications, we examine three alternative bivariate models, starting with a simple bivariate Gaussian model. Since our applications involve modeling proportions, we also examine a bivariate binomial logit normal model, and an unmatched model that combines the Gaussian sampling model with the bivariate logit normal model for the population proportions. Given the strong relationships between the population characteristics estimated by the smaller surveys and the corresponding ACS estimates, and the low levels of sampling error in the ACS estimates, the models achieve large variance reductions even without using regression covariates drawn from auxiliary data sources.
Module 2: Special Time and Pleasant Activities Scheduling
Authors: Chronis-Tuscano Andrea , O’Brien Kelly , Danko Christina M.
Published: September 2020

During Module 2, parents increase pleasant activities with their child and on their own. Parents of children with attention-deficit/hyperactivity disorder (ADHD) often get caught in the cycle of giving more corrective/negative feedback than positive feedback. This negative feedback loop can impact the parent–child relationship, the child’s behavior, and the parent’s mood. By the time they seek treatment, parents often say that they find it hard to enjoy time with their child. You will instill hope that, by using “Special Time,” the parent can begin to enjoy time with their child again and ultimately improve their relationship. In addition, parent participation in scheduled pleasant activities (away from their child and work/family demands) is emphasized as necessary to effectively parent a challenging child. Over the course of the program, one overarching goal is to help parents prioritize their self-care, for the sake of their own mental health and their family’s well-being.
Module 3: Maintaining a Consistent Schedule and Time Management
Authors: Chronis-Tuscano Andrea , O’Brien Kelly , Danko Christina M.
Published: September 2020

In Module 3, parents learn to develop and maintain a consistent household schedule and daily routines for their child and themselves. All children benefit from consistency, but children with attention-deficit/hyperactivity disorder (ADHD) can be especially reactive when their environment is unpredictable or chaotic. External structure can scaffold the child with ADHD’s own sense of organization. In many families, parents of children with ADHD struggle with executive function or attention difficulties themselves. Teaching parents to implement a consistent daily schedule and to more effectively manage their time can reduce the parental stress that can contribute to harsh or negative parenting and poor parent–child relationship. In this module, you will work with parents on the basics of scheduling and time management, with the goal of creating a more organized and harmonious household.
Module 4: Praise and Changing Your Thinking to Feel Better
Authors: Chronis-Tuscano Andrea , O’Brien Kelly , Danko Christina M.
Published: September 2020

During Module 4, parents learn to praise their child to increase appropriate and desirable behaviors. They also learn that their own automatic thoughts about their child, parenting, and self can influence how they feel and behave. By learning common thinking errors and how to challenge them, parents develop an important skill that can help them with emotion regulation and improved mood, which can in turn affect their parenting. Parents will also be able to increase their sense of control by learning the thoughts-feelings-behaviors connection. Although parents cannot always control a situation, they can learn to respond in new ways. Toward this end, specific strategies for increasing helpful and constructive thinking and decreasing negative or unhelpful thinking (particularly in relation to their parenting and child) will be taught in this module. As parents establish new ways of thinking, different feelings and actions will follow.
Module 5: Planned Ignoring and Relaxation Skills
Authors: Chronis-Tuscano Andrea , O’Brien Kelly , Danko Christina M.
Published: September 2020

During Module 5, parents learn differential attention skills for handling minor misbehaviors. They learn the benefits of active ignoring to reduce negative attention and to improve interactions with their child by focusing attention relatively more on positive versus negative child behavior. This will help parents to develop a proactive (rather than reactive) plan for those behaviors they will actively ignore and a clear understanding of why ignoring is the most effective strategy for those behaviors. However, some parents may be particularly reactive and have difficulty managing their own emotions when their child is behaving in a way the parent finds annoying or otherwise upsetting. Thus, in Module 5, parents also learn relaxation and mindfulness skills to help them be less reactive to child misbehavior and more successful with active ignoring.
Module 6: Assertiveness, Effective Commands, and House Rules
Authors: Chronis-Tuscano Andrea , O’Brien Kelly , Danko Christina M.
Published: September 2020

In Module 6, parents learn about assertiveness and how to apply assertiveness skills to improve communication with others. An assertive (or authoritative) parenting style, characterized by giving effective commands and setting house rules, provides both nurturance and structure. The assertive parent follows through with healthy boundaries in a calm and effective manner. Parents also need to use assertiveness skills when they communicate with their child’s school, their partner/co-parent, and extended family members. In addition, parents’ success with self-care requires asserting their own needs (e.g., saying “no” to additional obligations), following through with needed changes, and challenging the beliefs (thoughts) about holding others accountable or asking for help. Given the large influence of social interactions on mood, assertiveness skills can have significant benefits for a parent’s overall interpersonal functioning across domains of family and work.
Epidemiology of Cannabis Use Disorder
Authors: Keen II Larry D. , Ma Liangsuo , Abbate Antonio
Published: September 2020

Cannabis use continues to be a public health concern and has become a major clinical and nonclinical research construct in numerous fields for numerous reasons. First, the slight alterations in the criteria for cannabis use disorder (CUD) diagnosis required validation and prevalence statistics. Second, the shift in social perceptions of cannabis use and its legalization by various states have led to significant increases in cannabis use, abuse, and individuals meeting the criteria for CUD. Additionally, understanding the psychological and neural mechanisms associated with CUD will allow for innovative and tailored intervention and treatment methods for those suffering from the condition. This chapter provides a brief overview of the central, peripheral, and autonomic processes associated with CUD. It then considers the current treatments for CUD that are informed by pharmacological and epidemiological information. Finally, the authors contrast CUD with cardiovascular dysfunction, providing inferences for CUD as a potential contributor to the leading cause of death: cardiovascular disease.
Use of Buprenorphine for the Treatment of Opioid Use Disorder
Authors: Fudala Paul J. , Andorn Anne Cramer
Published: September 2020

Buprenorphine is a mu-opioid partial agonist that was first developed as a parenteral analgesic and subsequently as a treatment for opioid dependence. In the United States, the first two products approved by the US Food and Drug Administration (in 2002) for the latter indication were buprenorphine (Subutex) and buprenorphine/naloxone (Suboxone) tablet formulations for sublingual administration. Since that time, additional products for both sublingual and buccal administration have also been approved, as well as a subcutaneous injection for once-monthly administration for the treatment of moderate or severe opioid use disorder (OUD) and a subdermal implant for the maintenance treatment of opioid dependence that delivers buprenorphine over a 6-month period. Under the Drug Addiction Treatment Act of 2000 (DATA 2000), qualified practitioners may apply for waivers to treat opioid dependence/OUD with approved buprenorphine products in any setting in which they are qualified to practice. Like other opioids, buprenorphine has the potential for being misused and abused.
Turn the Next Page
Authors: Cunningham Kathryn A. , Price Amanda E. , Gerard Moeller F. , Anastasio Noelle C.
Published: September 2020

Contemporary research has enriched our knowledge of mechanisms involved in the generation and persistence of the debilitating disorders characterized by an “addictive dimensionality,” such as substance use disorders and binge eating disorder. Personalized treatment strategies for addictive disorders might include one or a combination of medications at important stages in detoxification and recovery to reduce craving, assist in establishing a substance-free state, and open the optimal window to allow cognitive restructuring and enhanced inhibitory control of substance-seeking. The overlapping neural systems and brain circuitry involved across addictive disorders have elevated interest in the metabolic and neural regulators serotonin (5-hydroxytryptamine; 5-HT) and ghrelin. This chapter focuses on these systems as examples of how we can broaden our horizons for advancing future therapeutic and biomarker initiatives.
Interprofessional team building and case management
Authors: Flaherty Ellen , Halnon Michaela , Fulmer Terry
Published: October 2020

Interprofessional team care (ITC) and case management are essential to achieve the best patient-centred outcomes for complicated older adults with multiple comorbidities. Case management in geriatrics refers to a process of care coordination. Caring for complex geriatric patients with multiple chronic conditions requires the development and implementation of individualized, coordinated plans of care. Such plans of care often call for further evaluation, treatment, referrals, and patient or caregiver education, or both. Typically, this care coordination occurs in an interprofessional team of geriatric healthcare providers—which may include physicians, geriatric nurses, pharmacists, psychiatrists, therapists, and social workers. The components of good team care include effective communication, conflict resolution, understanding and respecting team member’s and responsibilities, and team governance. Formal training is necessary to achieve these skills. Providing efficient and effective team care is both challenging and critical in an environment of accountable care with a burgeoning over-85 population.
The first steps on long marches: The costs of active observation
Authors: Dayan Peter , Roiser Jonathan P. , Viding Essi
Published: September 2020

That we shape our environment, and our environment shapes us, are truisms with deep and complicated consequences. The resulting feedback interaction leads to a substantial form of what is known as path dependency. This is that small initial variations, stemming from individual differences or even just the vicissitudes of chance, can potentially result in large and persistent divergence in outcomes. This has implications for the nature and interpretation of adaptive and maladaptive choice. This chapter offers a simple formulation in terms of active observers—a formalization of decision-making problems in which actors have the choice of whether and how to gather information to improve what happens. The chapter notes that, according to Bayesian decision theory, it is often optimal for active observers to remain incorrectly calibrated with their surroundings; it explores consequences of this in non-interactive environments, and environments containing other people who might compete or cooperate. The chapter draws loose parallels with the literature on active and evocative gene–environment correlations.
Conventional disease-modifying drugs
Authors: Scott David L.
Published: September 2020

Conventional disease-modifying antirheumatic drugs (DMARDs) are a diverse range of drugs used to treat rheumatoid arthritis. They are currently a dominant therapeutic group. They both improve the symptoms of rheumatoid arthritis and modify its course. Currently, only four DMARDs are used to any great extent. Methotrexate is the main DMARD; the others are sulfasalazine, leflunomide, and hydroxychloroquine. Successful treatment with DMARDs reduces the number of tender joints and swollen joints, patients’ and clinicians’ overall assessments improve and there are reductions in acute phase reactants with falls in the erythrocyte sedimentation rate and C-reactive protein levels. Improvements in synovitis are mirrored by reductions in the levels of disability and increases in health-related quality of life. Finally, the progression of joint damage is slowed by most DMARDs, and this impact is the main reason they are considered ‘disease-modifying’ treatments.
Antenatal assessment and pain management
Authors: Collis Rachel , De Lloyd Lucy , Hill David
Published: September 2020

Successive confidential enquiry reports have emphasized that planned and timely antenatal anaesthetic assessment plays a vital role in the successful management of women with complex medical problems, or in women whose delivery is considered high risk. Women who benefit from referral to a high risk obstetric anaesthetic clinic, usually at 32–34 weeks gestation, are outlined. Particular emphasis is given to antenatal assessment of the woman with cardiac disease, who should be meticulously managed in a combined multi-disciplinary clinic with a cardiologist, obstetrician, anaesthetist, echocardiography technician, and specialist midwife all present. Antenatal pain is commonly reported and can be due to a variety of causes. It may follow an acute presentation, or chronic pain which becomes difficult to manage due to restrictions in drug treatments because of concerns for the developing fetus. A generic pathway for pain management is described, with non-pharmacological and safe pharmacological options for ongoing analgesia management.
Ultrasound in obstetric practice
Authors: Baraz Rafal
Published: September 2020

The use of ultrasound to aid location of the spinal and epidural space is not a new concept but has gained increasing popularity, particularly in woman who are obese, have abnormal spinal anatomy, or where regional placement has or is proving difficult. The benefits and challenges of spinal ultrasound imaging are discussed, with the methods to scan and obtain the right views or planes with the supporting images for spinal and epidural techniques. The use of ultrasound to perform a transversus abdominis plane (TAP) block is also illustrated. The chapter concludes with a section on the additional applications of ultrasound for vascular access and gastric volume estimation.
Anaesthesia for Caesarean section: Basic principles
Authors: Collis Rachel
Published: September 2020

Management of the woman for caesarean delivery requires meticulous planning and skill from the anaesthetist. The time available to plan and communicate with the woman will depend on the degree of urgency to deliver the baby. However, this chapter sets out the important basic principles which need to be adhered to, regardless of the time available. Information and consent for the planned technique is discussed, with a review of antacid prophylaxis and monitoring requirements for the woman and fetus prior to delivery. Enhanced recovery in obstetric surgery is considered the gold standard for elective caesarean delivery, with attention to the details of each aspect described. Caesarean section confers considerable cardio-vascular instability, therefore attention to maternal positioning to minimize aorto-caval compression, intravenous pre-loading, and current evidence to support the practice of differing vasopressor use is highlighted.
Anaesthesia and analgesia for specific obstetric indications
Authors: Harries Sarah
Published: September 2020

Abstract: Specific obstetric conditions and complications require careful consideration by the obstetric anaesthetist before embarking on the required analgesia and anaesthesia management plan. This chapter covers the breadth of obstetric problems which may present on any labour ward, with their definition, the key issues to consider, and a proposed management plan. The following indications are covered in each sub-section; feticide, intrauterine death, abnormal presentation, multiple pregnancies, vaginal delivery after CS, preterm fetus, placenta previa and accreta, controlled rupture of membranes, fetal distress, cord prolapse, placental abruption, instrumental delivery, uterine inversion, EXIT (ex utero intrapartum treatment) procedure, retained placenta, and perineal suturing.
Hypertensive disease
Authors: Lewis Eleanor , Davies Stuart
Published: September 2020

Hypertension affects ~1 in 10 pregnant women in the UK, whilst pre-eclampsia (PET) complicates 2–8% of pregnancies. Hypertensive disease is the 4th leading cause of direct deaths, with recent triennium deaths due to intracerebral causes. This chapter explores the pathophysiology of hypertensive disease and its current management in pregnancy, including the treatment of eclampsia on labour ward. PET is a multi-system disease, which may present across a wide spectrum of organs. Therefore, the anaesthetic plan of management is greatly influenced by the extent of the disease process and which systems may be involved. This chapter provides detailed recommendations for the anaesthetic plan of care, whichever mode of delivery is indicated, and the peripartum critical care management required.
Post-transcriptional control of cellular differentiation by the RNA exosome complex
Authors: Fraga de Andrade Isabela , Mehta Charu , Bresnick Emery H
Published: October 2020

Given the complexity of intracellular RNA ensembles and vast phenotypic remodeling intrinsic to cellular differentiation, it is instructive to consider the role of RNA regulatory machinery in controlling differentiation. Dynamic post-transcriptional regulation of protein-coding and non-coding transcripts is vital for establishing and maintaining proteomes that enable or oppose differentiation. By contrast to extensively studied transcriptional mechanisms governing differentiation, many questions remain unanswered regarding the involvement of post-transcriptional mechanisms. Through its catalytic activity to selectively process or degrade RNAs, the RNA exosome complex dictates the levels of RNAs comprising multiple RNA classes, thereby regulating chromatin structure, gene expression and differentiation. Although the RNA exosome would be expected to control diverse biological processes, studies to elucidate its biological functions and how it integrates into, or functions in parallel with, cell type-specific transcriptional mechanisms are in their infancy. Mechanistic analyses have demonstrated that the RNA exosome confers expression of a differentiation regulatory receptor tyrosine kinase, downregulates the telomerase RNA component TERC, confers genomic stability and promotes DNA repair, which have considerable physiological and pathological implications. In this review, we address how a broadly operational RNA regulatory complex interfaces with cell type-specific machinery to control cellular differentiation.
Flexizyme-aminoacylated shortened tRNAs demonstrate that only the aminoacylated acceptor arms of the two tRNA substrates are required for cyclodipeptide synthase activity
Authors: Canu Nicolas , Tellier Carine , Babin Morgan , Thai Robert , Ajel Inès , Seguin Jérôme , Cinquin Olivier , Vinck Robin , Moutiez Mireille , Belin Pascal , Cintrat Jean-Christophe , Gondry Muriel
Published: October 2020

Cyclodipeptide synthases (CDPSs) use two aminoacyl-tRNAs (AA-tRNAs) to catalyse cyclodipeptide formation in a ping-pong mechanism. Despite intense studies of these enzymes in past years, the tRNA regions of the two substrates required for CDPS activity are poorly documented, mainly because of two limitations. First, previously studied CDPSs use two identical AA-tRNAs to produce homocyclodipeptides, thus preventing the discriminative study of the binding of the two substrates. Second, the range of tRNA analogues that can be aminoacylated by aminoacyl-tRNA synthetases is limited. To overcome the limitations, we studied a new model CDPS that uses two different AA-tRNAs to produce an heterocyclodipeptide. We also developed a production pipeline for the production of purified shortened AA-tRNA analogues (AA-minitRNAs). This method combines the use of flexizymes to aminoacylate a diversity of minitRNAs and their subsequent purifications by anion-exchange chromatography. Finally, we were able to show that aminoacylated molecules mimicking the entire acceptor arms of tRNAs were as effective a substrate as entire AA-tRNAs, thereby demonstrating that the acceptor arms of the two substrates are the only parts of the tRNAs required for CDPS activity. The method developed in this study should greatly facilitate future investigations of the specificity of CDPSs and of other AA-tRNAs-utilizing enzymes.
Peginterferon and Entecavir Combination Therapy Improves Outcome of Non–Early Response Hepatitis B e Antigen–Positive Patients
Authors: Chen Lu , Lin Lanyi , Zhou Huijuan , Tang Weiliang , Wang Hui , Cai Wei , Bao Shisan , Guo Simin , Xie Qing
Published: September 2020

Background

The efficacy of nucleot(s)ide analogs (NAs) and pegylated interferon (PegIFN) combination therapy for hepatitis B e antigen–positive (HBeAg+) patients is still controversial. Whether PegIFN and entecavir (ETV) combination therapy could provide a greater benefit for HBeAg+ patients was assessed.

Methods

Treatment-naïve HBeAg+ patients initiated on PegIFN alfa-2a (PegIFNα-2a) for 24 weeks without early response (early response: HBsAg <1500 IU/mL and hepatitis B virus [HBV] DNA <105 copies/mL) were recruited in the current study. Among total of 94 patients, 51 were continued on PegIFNα-2a monotherapy, and 43 were offered PegIFNα-2a and ETV combined therapy.

Results

Better outcomes in response to the combined therapy, compared with that of the monotherapy, were demonstrated, including more HBsAg decline and loss and HBV DNA decline and HBeAg clearance. Importantly, the patients with HBsAg levels between 1500 and 20 000 IU/mL initially or between 5000 and 20 000 IU/mL after 24 weeks of PegIFNα-2a benefitted more from the combined therapy, compared with those on monotherapy.

Conclusions

Combined therapy of PegIFNα-2a and ETV is more efficacious for HBeAg+ patients without early response to PegIFN monotherapy, and HBsAg levels are a good predictor of treatment outcomes.
Buying Time: The AMR Action Fund and the State of Antibiotic Development in the United States 2020
Authors: Clancy Cornelius J , Nguyen M Hong
Published: September 2020

Antimicrobial resistance is a pressing global threat, but companies developing antibiotics are failing. Large pharmaceutical companies recently created the AMR Action Fund, which will invest $1 billion in small antibiotic development companies. To understand the state of antibiotic development in the United States, we conducted a case study of new agents against carbapenem-resistant Gram-negative bacteria. Factors contributing to market failures were slow clinical uptake of drugs despite their effectiveness and safety, relatively small numbers of target infections that are insufficient to support existing drugs economically, and an excess of recently approved and pipeline agents with redundant spectra of activity. The AMR Action Fund will provide an immediate lifeline to companies in danger of failing due to an inability to secure investment, but it will not address issues identified in the case study or fix the antibiotic development model or marketplace. The Fund buys time for reforms to salvage antibiotic development.
Staphylococcus intermedius Brain Abscess as a Complication of Pulmonary Arteriovenous Malformation in a Patient With Hereditary Hemorrhagic Telangiectasia
Authors: Moskatel Leon S , Vo Joslyn N , Nayak Keshav R , Crum-Cianflone Nancy F
Published: September 2020

Staphylococcus intermedius is a rare cause of human infections ranging from skin and soft tissue infections to bacteremia. It is particularly known for its association with exposure to dogs. We report an unusual case of a 73-year-old female with a brain abscess caused by S intermedius who was recently diagnosed with hereditary hemorrhagic telangiectasia and a pulmonary arteriovenous malformation. The patient underwent debridement of the brain abscess followed by a 6-week course of vancomycin and rifampin, after which she made a near complete recovery. This is the first case of a brain abscess in an adult due to S intermedius in the published literature, and we provide a comprehensive review of the literature of all human infections caused by this pathogen and summarize its clinical manifestations, treatment recommendations, and outcomes.
Phenology of alpine zooplankton populations and the importance of lake ice-out
Authors: Loria Kelly A , Christianson Kyle R , Johnson Pieter T J
Published: October 2020

The prolonged ice cover inherent to alpine lakes incurs unique challenges for aquatic life, which are compounded by recent shifts in the timing and duration of ice cover. To understand the responses of alpine zooplankton, we analyzed a decade (2009–2019) of open-water samples of Daphnia pulicaria and Hesperodiaptomus shoshone for growth, reproduction and ultraviolet radiation tolerance. Due to reproductive differences between taxa, we expected clonal cladocerans to exhibit a more rapid response to ice-cover changes relative to copepods dependent on sexual reproduction. For D. pulicaria, biomass and melanization were lowest after ice clearance and increased through summer, whereas fecundity was highest shortly after ice-off. For H. shoshone, biomass and fecundity peaked later but were generally less variable through time. Among years, ice clearance date varied by 49 days; years with earlier ice-out and a longer growing season supported higher D. pulicaria biomass and clutch sizes along with greater H. shoshone fecundity. While these large-bodied, stress tolerant zooplankton taxa were relatively resilient to phenological shifts during the observation period, continued losses of ice cover may create unfavorably warm conditions and facilitate invasion by montane species, emphasizing the value of long-term data in assessing future changes to these sensitive ecosystems.