bluuebunny/crossref_metadata_2025 huggingface dataset:
Swedish intensivists’ experiences and attitudes regarding end‐of‐life decisions
Authors: Nordenskjöld Syrous Alma , Ågård Anders , Kock Redfors Maria , Naredi Silvana , Block Linda
Published: January 2020

Background

To make end‐of‐life (EOL) decisions is a complex and challenging task for intensive care physicians and a substantial variability in this process has been previously reported. However, a deeper understanding of intensivists’ experiences and attitudes regarding the decision‐making process is still, to a large extent, lacking. The primary aim of this study was to address Swedish intensivists’ experiences, beliefs and attitudes regarding decision‐making pertaining to EOL decisions. Second, we aimed to identify underlying factors that may contribute to variability in the decision‐making process.

Method

This is a descriptive, qualitative study. Semi‐structured interviews with nineteen intensivists from five different Swedish hospitals, with different ICU levels, were performed from 1 February 2017 to 31 May 2017.

Results

Intensivists strive to make end‐of‐life decisions that are well‐grounded, based on sufficient information. Consensus with the patient, family and other physicians is important. Concurrently, decisions that are made with scarce information or uncertain medical prognosis, decisions made during on‐call hours and without support from senior consultants cause concern for many intensivists. Underlying factors that contribute to the variability in decision‐making are lack of continuity among senior intensivists, lack of needed support during on‐call hours and disagreements with physicians from other specialties. There is also an individual variability primarily depending on the intensivist's personality.

Conclusion

Swedish intensivists’ wish to make end‐of‐life decisions based on sufficient information, medically certain prognosis and consensus with the patient, family, staff and other physicians. Swedish intensivists’ experience a variability in end‐of‐life decisions, which is generally accepted and not questioned.
Preventing and reducing ‘coercion’ in mental health services: an international scoping review of English‐language studies
Authors: Gooding P. , McSherry B. , Roper C.
Published: January 2020

This article discusses initiatives aimed at preventing and reducing ‘coercive practices’ in mental health and community settings worldwide, including in hospitals in high‐income countries, and in family homes and rural communities in low‐ and middle‐income countries. The article provides a scoping review of the current state of English‐language empirical research. It identifies several promising opportunities for improving responses that promote support based on individuals’ rights, will and preferences. It also points out several gaps in research and practice (including, importantly, a gap in reviews of non‐English‐language studies). Overall, many studies suggest that efforts to prevent and reduce coercion appear to be effective. However, no jurisdiction appears to have combined the full suite of laws, policies and practices which are available, and which taken together might further the goal of eliminating coercion.
Risk of dementia in bipolar disorder and the interplay of lithium: a systematic review and meta‐analyses
Authors: Velosa J. , Delgado A. , Finger E. , Berk M. , Kapczinski F. , de Azevedo Cardoso T.
Published: January 2020

Objectives

To assess whether bipolar disorder (BD) increases the rate of dementia and whether lithium is related to a lower risk of dementia in BD.

Methods

A total of 10 studies (6859 BD; 487 966 controls) were included in the meta‐analysis to test whether BD is a risk factor for dementia. In addition, five studies (6483 lithium; 43 496 non‐lithium) were included in the meta‐analysis about the potential protective effect of lithium in BD.

Results

BD increases the risk of dementia (odds ratio (OR): 2.96 [95% CI: 2.09–4.18], P < 0.001), and treatment with lithium decreases the risk of dementia in BD (OR: 0.51 [95% CI: 0.36–0.72], P < 0.0001). In addition, secondary findings from our systematic review showed that the risk of progression to dementia is higher in BD than in major depressive disorder (MDD). Moreover, the number of mood episodes predicted the development of dementia in BD.

Conclusion

Individuals with BD are at higher risk of dementia than both the general population or those with MDD. Lithium appears to reduce the risk of developing dementia in BD.
Exercise‐induced allergic reactions on desensitization to wheat after rush oral immunotherapy
Authors: Furuta Tomoko , Tanaka Kajiyo , Tagami Kazunori , Matsui Teruaki , Sugiura Shiro , Kando Naoyuki , Kanie Yuuki , Naito Michihiro , Izumi Hidehiko , Tanaka Akira , Sjölander Sigrid , Yokooji Tomoharu , Matsuo Hiroaki , Ito Komei
Published: January 2020

Background

The effect of oral immunotherapy (OIT) on wheat allergy is promising in terms of the potential to obtain desensitization; however, the frequency of exercise‐induced allergic reactions on desensitization (EIARDs) and the associated risk factors remain to be determined.

Methods

Twenty‐five patients underwent rush OIT for wheat allergy, and 21 achieved the full‐dose intake of wheat products (5 g of wheat protein). Exercise‐provocation tests were repeatedly performed after the ingestion of a full‐dose wheat product. The time‐course of the levels of the specific IgEs (sIgE) to wheat extract, total gliadin, deamidated gliadin, recombinant gliadin components (α/β–, γ– and ω–5–), and glutenin (high and low molecular weight) components was analyzed using ImmunoCAP®, ELISA, or IgE immunoblotting.

Results

Fourteen patients (66.7%) were diagnosed as EIARD+, which remained 5 years after rush OIT in 11 patients (52.4%). There were no differences in the clinical backgrounds of the EIARD+ and EIARD− patients. However, EIARD+ patients showed significantly higher sIgE levels to all gliadin and glutenin components than EIARD‐ patients before OIT. The sIgE levels to each component decreased equally after 1 and 2 years of OIT. On IgE immunoblotting, sera from all patients reacted to the multiple gluten bands, and some reacted to the water‐soluble bands. The intensity of all IgE‐reactive bands also became equally lighter after OIT.

Conclusions

EIARDs were frequently observed and remained for a long period after successful OIT for wheat allergy. None of the specific wheat components were found to contribute to EIARDs.
Low‐dose‐aspirin usage among women with an increased preeclampsia risk: A prospective cohort study
Authors: van Montfort Pim , Scheepers Hubertina C. J. , van Dooren Ivo M. A. , Meertens Linda J. E. , Zelis Maartje , Zwaan Iris M. , Spaanderman Marc E. A. , Smits Luc J. M.
Published: January 2020

Introduction

Low‐dose aspirin (LDA) prophylaxis has been shown to reduce women’s preeclampsia risk. Evidence regarding LDA adherence rates of pregnant women is based almost exclusively on clinical trials, giving a potentially biased picture. Moreover, these studies do not report on determinants of adherence. Since 2017, obstetric healthcare professionals in a Dutch region have assessed women’s preeclampsia risk by means of a prediction tool and counseled those with an above‐population average risk on LDA as a prophylactic measure.

Material and methods

From 2017 to 2018, 865 women were recruited in multiple centers and prospectively followed using web‐based surveys (Expect Study II). Rates and determinants of LDA usage among women with an increased preeclampsia risk in daily practice were assessed. Results were compared with findings in a similar cohort from a care‐as‐usual setting lacking risk‐based counseling (Expect Study I, n = 2614). Netherlands Trial Register NTR4143.

Results

In total, 306 women had a predicted increased preeclampsia risk. LDA usage was higher for women receiving risk‐based care than care‐as‐usual (29.4% vs 1.5%, odds ratio 19.1, 95% confidence interval 11.2‐32.5). Daily LDA usage was positively correlated with both predicted risk and women’s concerns regarding preeclampsia. Most reported reasons for non‐ or incomplete use were unawareness of LDA as a preventive intervention, concerns about potential adverse effects and doubts regarding the benefits.

Conclusions

Risk‐based counseling was associated with a higher prevalence of LDA usage, but general usage rates were low. Future research regarding potential factors improving the usage of LDA during pregnancy is necessary.
CA‐125 reduction during neoadjuvant chemotherapy is associated with success of cytoreductive surgery and outcome of patients with advanced high‐grade ovarian cancer
Authors: Kessous Roy , Wissing Michel D. , Piedimonte Sabrina , Abitbol Jeremie , Kogan Liron , Laskov Ido , Yasmeen Amber , Salvador Shannon , Lau Susie , Gotlieb Walter H.
Published: January 2020

Introduction

The objective was to assess whether an early response to neoadjuvant chemotherapy in women with advanced ovarian cancer may predict short‐ and long‐term clinical outcome.

Material and methods

This is a retrospective study of all women with stage III‐IV tubo‐ovarian cancer treated with neoadjuvant chemotherapy at a single center in Montreal between 2003 and 2014. Logistic regression models were used to evaluate the association between cancer antigen 125 (CA‐125) levels during neoadjuvant chemotherapy and debulking success. Cox proportional hazard models were used to estimate hazard ratios and their respective 95% CI for death and recurrence. Harrell's concordance indices were calculated to evaluate which variables best predicted the chemotherapy‐free interval and overall survival in our population.

Results

In all, 105 women were included. Following the first, second, and third cycles of neoadjuvant chemotherapy, CA‐125 levels had a median reduction of 43.2%, 85.4%, and 92.9%, respectively, compared with CA‐125 levels at diagnosis. As early as the second cycle, CA‐125 was associated with overall survival (hazard ratio 1.03, 95% CI 1.01‐1.05, per 50 U/mL increment). By the third cycle, CA‐125 did not only predict overall survival (hazard ratio 1.04, 95% CI 1.01‐1.08), but it predicted overall survival better than the success of debulking surgery (Harrell's concordance index 0.646 vs 0.616). Both absolute CA‐125 levels and relative reduction in CA‐125 levels after 2 and 3 cycles predicted the chance to achieve complete debulking (P < .05).

Conclusions

Reduction of CA‐125 levels during neoadjuvant chemotherapy provides an early predictive tool that strongly correlates with successful cytoreductive surgery and long‐term clinical outcome in women with advanced high‐grade serous and endometrioid ovarian cancer.
Next‐generation sequencing through multi‐gene panel testing for diagnosis of hereditary ichthyosis in Chinese
Authors: Cheng Ruhong , Liang Jianying , Li Yue , Zhang Jia , Ni Cheng , Yu Hong , Kong Xiangsheng , Li Ming , Yao Zhirong
Published: January 2020

Inherited ichthyoses are a heterogeneous group of rare disorders related to over 40 genes. To identify underlying molecular causes in inherited ichthyosis among Chinese and to correlate genotype and phenotype, 35 probands clinically diagnosed inherited ichthyosis, except ichthyosis vulgaris and X‐linked ichthyosis, were included in our study. Molecular analysis was performed using next‐generation sequencing (NGS) through multi‐gene panel testing targeting all ichthyosis‐related genes. Genetic variants causative for the ichthyosis were identified in 32 of 35 investigated patients. In all, 43 causative mutations across 12 genes were disclosed, including 16 novel variants. Thirteen keratinopathic ichthyosis, fourteen autosomal recessive congenital ichthyosis (ARCI) including one caused by mutations in SDR9C7, and five syndromic ichthyoses were confirmed. Four probands, with presumptive ARCI, turned out to be keratinopathic ichthyosis (2), neutral lipid storage disease (1), and Sjogren‐Larsson syndrome (1), respectively. Next‐generation technology has been demonstrated to be an effective tool in diagnosing inherited ichthyosis constituting a diverse group of cornification disorders. Our study further expands mutation spectrum and clinical phenotype associated with inherited ichthyosis in Chinese.
The moral residue of conservation
Authors: Batavia Chelsea , Nelson Michael Paul , Wallach Arian D.
Published: January 2020

Should conservationists use lethal management to control introduced wildlife populations? Should they kill individual animals to protect endangered species? Are trade‐offs that prioritize some values at the expense of others morally appropriate? These sorts of ethical questions are common in conservation. In debating such questions, conservationists often seem to presume 1 of 2 possible answers: the act in question is right or it is wrong. But morality in conservation is considerably more complex than this simple binary suggests. A robust conservation ethic requires a vocabulary that gives voice to the uncertainty and unease that arise when what seems to be the best available course of action also seems to involve a measure of wrongdoing. The philosophical literature on moral residue and moral dilemmas supplies this vocabulary. Moral dilemmas arise when one must neglect certain moral requirements to fulfill others. Under such circumstances, even the best possible decision leaves a moral residue, which is experienced emotionally as some form of grief. Examples of conservation scenarios that leave a moral residue include management of introduced rabbits in Australia, trophy hunting in Africa, and forest management trade‐offs in the Pacific Northwest. Moral residue is integral to the moral experience of conservationists today, and grief is an appropriate response to many decisions conservationists must make.

Article impact statement: Defensible conservation decisions may neglect moral requirements, leaving a moral residue; conservationists should respond with grief.
Improved spotted hyena optimizer with space transformational search for training pi‐sigma higher order neural network
Authors: Panda Nibedan , Majhi Santosh Kumar
Published: January 2020

Spotted hyena optimizer (SHO) is a recently developed swarm‐based algorithm in the field of metaheuristic research, for solving realistic engineering design constraint and unconstrained difficulties. To resolve complicated nonlinear physical world tasks, at times, SHO reveals deprived performance concerning to explorative strength. So, to enhance the explorative strength along with exploitation in the search region, an attempt has been made by proposing the enhanced version of classical SHO. The suggested method is designated as space transformation search (STS)‐SHO. In STS‐SHO, a new evolutionary technique named as STS technique has been incorporated with original SHO. The suggested method has been assessed by IEEE CEC 2017 benchmark problems. The efficacy of the said method has been proven by using standard measures such as given performance metrics in CEC 2017, complexity analysis, convergence analysis, and statistical implications. Further as real‐world application, the said algorithm has been applied to train pi‐sigma neural network by means of 13 benchmark datasets considered from UCI depository. From the article it can be concluded that the suggested method STS‐SHO is an effective and trustworthy algorithm, which has the ability to resolve real‐life optimization complications.
The changing relation between alcohol and life expectancy in Russia in 1965–2017
Authors: Danilova Inna , Shkolnikov Vladimir M. , Andreev Evgeny , Leon David A.
Published: January 2020

Introduction and Aims

In the 1990s, a strong inverse relationship between life expectancy (LE) in Russia and mortality from alcohol poisoning was observed. This association is remarkable as this cause accounts for less than 2% of deaths each year. It can be explained by treating the alcohol poisoning mortality as the best available measure in Russia of the population prevalence of harmful drinking in any year which in turn associated with mortality from a wide range of causes. This study analyses the evolving relationship of LE with this mortality‐based measure of harmful drinking since 1965, and places it in a policy context.

Design and Methods

We examine three periods: 1965–1984, a period of gradual LE decline; 1984–2003, a period of massive LE fluctuations; and 2003–2017, a period of LE improvement. Pearson's correlation coefficients and a linear relationship between annual changes in LE and alcohol poisoning were estimated for each period.

Results

The strongest negative correlation between changes in LE and alcohol poisonings was found in 1984–2003. Over the period 2003–2017 a consistent positive LE trend emerged that was statistically independent of alcohol poisoning.

Discussion and Conclusions

These results suggest that in the period from the mid‐2000s a growth of LE in Russia was to a large extent independent of changes in the population prevalence of harmful drinking. While there has been a reduction in mortality at ages 15–64, at older ages mortality reduction unrelated to alcohol has become an increasingly important driver of overall mortality improvements.
Modified method of making a clip with ring‐thread for the traction of colorectal endoscopic submucosal dissection
Authors: Miyamoto Shuichi , Ito Jun , Ohya Tomohiko R.
Published: January 2020

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Stroke prevention in elderly patients with non‐valvular atrial fibrillation in the BALKAN‐AF survey
Authors: Potpara Tatjana S. , Simovic Stefan , Pavlovic Nikola , Nedeljkovic Milan , Paparisto Vilma , Music Ljilja , Goshev Evgenii , Loncar Daniela , Popescu Raluca , Manola Sime , Kusljugic Zumreta , Trendafilova Elina , Dan Gheorghe‐Andrei , Lip Gregory Y. H.
Published: January 2020

Background

Atrial fibrillation (AF) is common amongst the elderly, but this group tends to be suboptimally treated. Limited data are available on the stroke prevention strategies in the elderly, especially in the Balkan region.

Aim

We investigated the use of oral anticoagulant therapy (OAC) amongst elderly AF patients in clinical practice in the Balkan region.

Method

A 12‐week prospective snapshot survey (2014‐2015) of consecutive non‐valvular AF patients was conducted in Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Montenegro, Romania and Serbia. Data were collected via an electronic case report form.

Results

Of 2671 patients, 418 (15.6%) were ≥80 years old. Overall, OAC was used in 1965 patients (73.6%). Compared with younger patients, the elderly (age ≥ 80) had a higher mean CHA2DS2‐VASc score (3.22 ± 1.71 vs 4.89 ± 1.35, P < .001) and more often a HAS‐BLED score of ≥3 (n = 198 [47.0%] vs n = 625 [27.3%], P < .001), but were less likely to receive OAC (n = 269 [64.4%] vs n = 1696 [75.3%], odds ratio [OR] 0.91; 95%CI 0.86‐0.97, P = .003). There was no significant association between OAC use and mean CHA2DS2‐VASc (OR 0.86; 95%CI 0.75‐1.00, P = .053) or HAS‐BLED score (OR 1.21; 95%CI 0.81‐1.81, P = .349) in the elderly.

Conclusion

In the BALKAN‐AF Survey, elderly AF patients were less likely to receive the guideline‐adherent treatment despite their less favourable risk profile. Since OAC nonuse among the elderly was not associated with increased HAS‐BLED score, factors other than patients’ risk profile could influence the implementation of guideline‐adherent treatment for thromboprophylaxis in the elderly AF patients.
Differential induction of volatiles in rice plants by two stink bug species influence behaviour of conspecifics and their natural enemy Telenomus podisi
Authors: Ulhoa Lucas Adjuto , Barrigossi José Alexandre Freitas , Borges Miguel , Laumann Raúl Alberto , Blassioli‐Moraes Maria Carolina
Published: January 2020

Tritrophic interactions mediated by semiochemicals have been intensively studied from the viewpoint of ecological relationships with Nearctic tritrophic organisms. However, there are few studies involving interactions with different herbivores on the same host plant in Neotropical systems. The objective of the current study was to investigate the effects of herbivory by two species of stink bugs (Heteroptera: Pentatomidae) with the same feeding habit – Tibraca limbativentris Stål and Glyphepomis spinosa Campos & Grazia – on indirect and direct defence strategies of rice plants. The responses of each stink bug species (virgin and mated females) and of their main natural enemy, the egg parasitoid Telenomus podisi Ashmead (Hymenoptera: Platygastridae; mated females), to volatiles from undamaged and herbivore‐damaged rice plants were evaluated using a Y‐tube olfactometer. The results showed that rice plants responded differently to T. limbativentris or G. spinosa herbivory, enhancing the production of a different blend of volatile compounds, which reduced the attraction for conspecific stink bugs and elicited the foraging behaviour of T. podisi.
Effects of recreational fishing on zooplankton communities of drainage system reservoirs at an open‐pit mine
Authors: Goździejewska Anna Maria , Skrzypczak Andrzej Robert , Koszałka Jacek , Bowszys Magdalena
Published: January 2020

The use of artificial water bodies for angling is a popular practice, especially in industrial and urbanised areas where natural water bodies are lost. In this study, the zooplankton structure dynamics and water quality at three strip mine drainage system reservoirs were assessed with different types of recreational fishery exploitation: K1—intensive angling using the catch‐and‐release model, K2—lowest angling pressure and higher share of predatory fishes and K3—moderate fishing, that is limiting groundbait quantities and eliminating non‐predatory fishes by anglers. The null hypothesis tested was that recreational fishing does not affect the biotic and abiotic conditions of reservoirs. The significance of each environmental variable was tested using redundancy analysis (RDA). The highest nutrients and chlorophyll a concentration, turbidity level and organic matter content occurred in K1. Zooplankton diversity was the lowest under these conditions; protozoa and larval stages of copepods dominated. In reservoirs where sustainable fishing was implemented (K2, K3), trophic parameters of water were lower, on average, by 25%, turbidity by 30%, and productivity by 35–70%. Zooplankton diversity was significantly higher; rotifers and small cladocerans dominated. The choice of recreational fishing model determines the functionality and biological potential of the reservoir.
Policy preferences and ministerial structures: Immigrant integration governance in Western Europe, 1997–2017
Authors: Hernes Vilde
Published: January 2020

This article tests an often‐stated assumption in the “machinery of government” literature: that government parties’ issue and policy preferences affect the ministerial structure. Using a new Dataset on Immigrant Integration Governance (DIIG) that documents the ministerial structure of immigrant integration in 16 Western European countries during 1997–2017, the analysis finds that divergence and change characterize the ministerial structure. The analysis finds that right‐oriented governments are more inclined to couple integration with immigration and justice than are left‐oriented governments, indicating different policy preferences. However, it does not find that governments with radical parties are more inclined to signal “integration” in ministerial titles. The study's comparative approach challenges the generalizability of existing knowledge on drivers of ministerial changes. Additionally, it fills a gap in current immigrant integration literature: the study of the horizontal governance structure.
UNIQUE MARKOV EQUILIBRIUM UNDER LIMITED COMMITMENT
Authors: Bloise Gaetano
Published: January 2020

I develop a recursive method for the characterization of competitive equilibrium under limited commitment with not‐too‐tight solvency constraints. The reputational mechanism is fragile, as it sustains constrained efficiency as well as a large set of constrained inefficient equilibria. However, I establish that the only strongly ergodic Markov equilibrium with trade is constrained efficient. The method relies on a planning program along with the theory of monotone concave operators. It is suitable for other applications to macroeconomics and dynamic contracts.
INTERNATIONAL BUSINESS CYCLES IN EMERGING MARKETS
Authors: Rothert Jacek
Published: January 2020

I document cyclical behavior of real exchange rates (RERs) in emerging and developed economies: stronger RER procyclicality coincides with larger relative volatility of consumption and more countercyclical trade balance. I then reevaluate the sources of fluctuations in emerging economies using an international business cycle model estimated to match the behavior of the RERs. Interest rate shocks, without any frictions, account for most of output fluctuations. This result is driven by imperfect substitution between domestic and foreign goods, which dampens the impact of trend shocks and accentuates the impact of interest rate shocks on output and consumption.
Effects of CaCO3 additive on properties and microstructure of corundum‐ And mullite‐based ceramic proppants
Authors: Qin Mei , Tian Yuming , Hao Huilan , Li Guomin , Zhou Yi , Bai Pinbo
Published: January 2020

Corundum‐mullite ceramic proppants have been successfully synthesized using raw materials of natural bauxite and solid waste coal gangue, CaCO3, as additive. The influences of calcium carbonate additive on phase composition, microstructure, and mechanical performances were systematically investigated. The results indicate that the addition of CaCO3 promotes the formation of liquid phase at lower temperature during sintering process, which is beneficial to the densification of the samples and the reduction of sintering temperature. Moreover, the mullite grains become finer and finer with the content of CaCO3 additive increasing, which improves the toughness and strength of the samples via a grain refinement strengthening mechanism. The ceramic proppants exhibit optimal performances with additive of 5 wt.% at 1350°C, and the breakage ratio under 52 MPa closed pressure is the lowest. Additionally, the sintering temperature is dropped by 150°C compared with the samples without adding calcium carbonate.
Incongruous and Creative Grace: Reading Paul and the Gift with Martin Luther
Authors: Linebaugh Jonathan A.
Published: January 2020

Paul and the Gift by John Barclay advances an interpretation of Paul’s theology of grace that resonates with Martin Luther’s reading: God’s gift is God’s Son, Jesus Christ, given for and to the unworthy. To imagine Luther reading Paul and the Gift is thus to conjure images of deep and fundamental consensus. But questions remain. Is the law a cultural canon of worth that God’s gift of Christ ignores, or is it, as God’s law, a fixed judgement that God’s grace contravenes? Does God give only ‘without regard to worth’ and thus with a kind of divine indifference to cultural indices of value, or does the gift of Christ contradict the conditions of its receipts and thus come in a way that is actually incongruous? With these questions, Luther might push back against Barclay. With others he would ask Barclay to go further. Is not God’s incongruous grace also and characteristically creative? How is the gift of Christ that God gave present to and for recipients as the gift God now gives? In all these ways, Luther’s theology of the word poses questions to or invites expansions of Barclay’s theology of grace.
Thomas Aquinas and the Potential Catholic Integration of a Dynamic Occasionalist Understanding of Grace
Authors: Murray Paul D.
Published: January 2020

Starting out from John Barclay's Lutheran‐inclined, actualist reading of the in‐breaking quality of grace and the Spirit in Paul, this article asks how a Catholic theology of grace – typically more focused on identifying the relatively stable structures and effects of grace – might with integrity learn from the Barclayan‐Lutheran‐Pauline difference. By pursuing a close, four‐step reading of Thomas Aquinas' theology of grace, as that appears in the Summa Theologiæ and his lectures on the Pauline epistles, the article demonstrates that just such a Catholic appropriation of a more dynamic graced actualism is indeed possible; one which leads, with dynamic integrity, to a deepened understanding, articulation and practice of core Catholic instincts rather than to their reduction or distortion.
Configurations of Grace and Merit in Paul and His Interpreters
Authors: Eubank Nathan
Published: January 2020

One of the main findings of John Barclay’s Paul and the Gift is that divine grace was everywhere in ancient Judaism, but not everywhere the same. Though Barclay does not emphasize this point, something similar could be said about the worthiness or merit of the recipients of grace. Human worthiness is everywhere in Judaism and Christianity, but not everywhere the same. This article situates Barclay’s account of human worthiness relative to other possible configurations. According to Barclay’s Paul, the Christ‐gift is given without regard for the worth of the recipients, but this same gift remakes those to whom it is given, enabling them to become worthy of God. This account of human response places Barclay in surprisingly close proximity with non‐Protestant Augustinian streams of interpretation.
Ex Nihilo or Tabula Rasa? God's Grace between Freedom and Fidelity
Authors: Bertschmann D.H.
Published: January 2020

John Barclay’s magnum opus on grace genuinely moves the discussion forward by describing grace as unconditioned but not unconditional. This essay explores the notion of unconditioned grace as the gift given regardless of worth, disregarding any social and symbolic capital in the process. Taking Romans 9–11 as its case study, this essay argues that the deepest root of Paul’s confidence is God’s fidelity to the people God loved and chose, not God’s repeated movements of creative incongruous grace. Paul knows that in Israel’s case its symbolic capital is also spiritual in pointing towards Israel’s history with God. Far from disregarding this capital and its ethnic component, Paul professes God’s abiding faithfulness to the biological descendants of the patriarchs (Rom. 11:28). In his wrestling to hold God’s astonishing freedom and enduring fidelity together Paul sketches out his gospel of radical sin and grace, where both Jews and Gentiles are equally failing (Rom. 11:32) but met and restored precisely at the point of death and destruction.
Incongruous Grace as Pattern of Experience
Authors: Zahl Simeon
Published: January 2020

This article examines the relationship between the theological concept of grace and the effects of grace on human beings in bodies and in time, in critical engagement with John Barclay’s account of Paul’s theology of grace in Paul and the Gift. It begins by showing how one of the book’s most significant contributions is its ‘thick’ description of the effects of incongruous grace in the world in terms of its socially transformative power in the formation of communities. It then argues that Barclay’s account is substantially less successful at giving a compelling account of the more rapid and immediate changes that Paul also associates with encounter with divine grace in the lives of Christians. The article concludes by showing how Barclay’s picture can be expanded and improved by examining how the ‘incongruity’ of grace functions to pattern experience in relatively sudden, emotionally immediate ways rather than just through the long‐term formation of a Christian habitus.
Plant type dominates fine‐root C:N:P stoichiometry across China: A meta‐analysis
Authors: Wang Zhiqiang , Lv Shiqi , Song Hui , Wang Mingcheng , Zhao Qi , Huang Heng , Niklas Karl J.
Published: January 2020

Aim

Fine roots play an important role in biogeochemical cycling in terrestrial ecosystems. However, our understanding of large scale biogeographical patterns and drivers of fine‐root C:N:P stoichiometry is extremely limited.

Location

China.

Methods

We compiled data for fine‐root carbon (C), nitrogen (N) and phosphorus (P) concentrations at 165 sites across China to explore large‐scale biogeographical patterns and drivers of fine‐root C:N:P stoichiometry.

Results

The geometric means of fine‐root C, N, and P concentrations were 448.81, 10.73, and 0.9 mg/g, respectively, whereas C:N, C:P, and N:P ratios were 41.84, 508.32, and 11.73, respectively. The fine‐root elemental concentrations and their ratios varied widely among plant groups and biomes, and showed clear latitudinal and longitudinal trends, as a consequence of differences in climate, soil, and plant type. However, plant type was the largest contributor to the total variance in fine‐root C, N, and P and their ratios compared to climate factors or soil features.

Main conclusions

The data reveal the existence of broad biogeographical patterns of fine‐root C:N:P stoichiometry in China. These results advance our knowledge about the biogeochemical cycling of fine roots.
2‐mm surgical margins are adequate for most basal cell carcinomas in Japanese: a retrospective multicentre study on 1000 basal cell carcinomas
Authors: Nakamura Y. , Matsushita S. , Tanaka R. , Saito S. , Araki R. , Teramoto Y. , Aoki M. , Yamamura K. , Nakamura Y. , Fujisawa Y. , Brinker T.J. , Yamamoto A.
Published: January 2020

Background

Surgery is the gold standard for basal cell carcinomas (BCC). Current recommended surgical margins for BCCs are determined from studies in Caucasian populations. However, the appropriate surgical margins for BCCs in non‐white races are unclear.

Objectives

To investigate the accuracy of preoperative determination of clinical tumour borders and appropriate surgical margins in Japanese patients with BCC.

Methods

The maximum calculated differences in distance between the preoperatively determined surgical margins and the actual histologic tumour side margins were considered as ‘accuracy gaps’ of clinical tumour borders. Estimated side margin positivity rates (ESMPRs) with narrower (2 and 3 mm) surgical margins were calculated on the basis of the accuracy gaps.

Results

Overall, 1000 surgically excised BCCs from 980 Japanese patients were included. The most frequent histologic subtype was nodular BCC (67%). The median accuracy gap was 0.3 mm [interquartile range (IQR): −0.5 to +1 mm]. The ESMPRs with 2‐ and 3‐mm surgical margins were 3.8% and 1.4%, respectively. Only the ESMPRs between the well‐defined (n = 921) and poorly defined clinical tumour border groups (n = 79) showed statistical difference [2‐mm margin: 3.1% vs. 11.7%, OR: 3.89, 95% confidential interval (CI): 1.41–10.71, P <0.01; 3‐mm margin: 0.97% vs. 6.3%, OR: 6.58, 95% CI: 1.67–25.99, P <0.01]. No significant differences in ESMPRs were noted in other subgroups including risk classifications.

Conclusions

The determined clinical tumour border accuracy gaps in this Japanese cohort were negligible. Dermatologic surgeons may use narrower surgical margins with acceptable margin positivity rates. The clarity of clinical tumour borders could be an appropriate guide for selection of different surgical margins in the Japanese cohort.
Real‐world data from a single Greek centre on the use of secukinumab in plaque psoriasis: effectiveness, safety, drug survival, and identification of patients that sustain optimal response
Authors: Rompoti N. , Sidiropoulou P. , Panagakis P. , Stratigos A. , Papoutsaki M. , Stefanaki E. , Vavouli C. , Politou M. , Befon A. , Kostakis P. , Rigopoulos D. , Nicolaidou E.
Published: January 2020

Background

Few studies have investigated the long‐term outcomes of secukinumab in real‐life psoriasis treatment where diverse patient profiles require a personalized approach.

Objectives

To determine long‐term performance of secukinumab in moderate‐to‐severe plaque psoriasis, and identify potential clinical factors predictive of sustained optimal response under real‐world conditions.

Methods

In this 78‐week, single‐centre, retrospective study, effectiveness, safety and drug survival of secukinumab were evaluated. Effectiveness data are reported as observed. Co‐primary endpoints were absolute Psoriasis Area and Severity Index (PASI) ≤3 at week 4, 16, 52, 78, and clinical predictors of PASI ≤3 and PASI100 responses at week 52 and 78.

Results

A total of 85 patients (75.3% male; mean age 48.6 years) were included. Absolute PASI ≤3 was achieved in 73% and 83% of patients at week 52 and 78, respectively. PASI 75/90/100 responses at week 52 (71.6%, 50.8%, and 40.3%, respectively) were sustained at week 78 (73.6%, 64.2%, and 45.3%, respectively). Median absolute PASI remained low at week 52/78 (0.9/0.6, respectively), while mean absolute PGA also sustained low (0–1) values after 16–78 weeks. Investigator's Global Assessment 0/1 response rate was maintained by week 52/78 (72/83%, respectively). The drug survival rate of secukinumab at week 78 was 79.1%. Treatment was discontinued in 17.9% of patients after an average of 41.7 weeks, mainly due to loss of effectiveness (10.4%). A total of 27% experienced adverse events, without critical safety concerns. Based on multivariate analysis, advanced body mass index (BMI) and presence of ≥3 comorbidities decreased the chance of achieving PASI ≤3 at week 78 [OR (95% CI) 0.78 (0.64–0.97); P = 0.024, and OR (95% CI) 0.045 (0.002–0.83); P = 0.037, respectively].

Conclusions

Secukinumab showed consistently high effectiveness in this real‐life cohort, with an acceptable safety profile. Over time, persistence of PASI ≤3 response appears to be lower in patients with high BMI or multiple comorbidities.
Kaposi sarcoma among people living with HIV in the French DAT’AIDS cohort between 2010 and 2015
Authors: Poizot‐Martin I. , Obry‐Roguet V. , Duvivier C. , Lions C. , Huleux T. , Jacomet C. , Ferry T. , Cheret A. , Allavena C. , Bani‐Sadr F. , Palich R. , Cabié A. , Fresard A. , Pugliese P. , Delobel P. , Lamaury I. , Hustache‐Mathieu L. , Brégigeon S. , Makinson A. , Rey D. ,   The Dat'AIDS study group
Published: January 2020

Background

Although antiretroviral therapy (ART) has reduced the risk of Kaposi sarcoma (KS), KS cases still occur in HIV‐infected people.

Objective

To describe all KS cases observed between 2010 and 2015 in a country with high ART coverage.

Methods

Retrospective study using longitudinal data from 44 642 patients in the French Dat’AIDS multicenter cohort. Patients’ characteristics were described at KS diagnosis according to ART exposure and to HIV‐plasma viral load (HIV‐pVL) (≤50 or >50) copies/mL.

Results

Among the 209 KS cases diagnosed during the study period, 33.2% occurred in ART naïve patients, 17.3% in ART‐experienced patients and 49.5% in patients on ART, of whom 23% for more than 6 months. Among these patients, 24 (11.5%) had HIV‐pVL ≤50 cp/mL, and 16 (66%) were treated with a boosted‐PI‐based regimen. The distribution of KS localization did not differ by ART status nor by year of diagnosis.

Limitations

Data on human herpesvirus 8, treatment modalities for KS and response rate were not collected.

Conclusion

Half of KS cases observed in the study period occurred in patients not on ART, reflecting the persistence of late HIV diagnosis. Factors associated with KS in patients on ART with HIV‐pVL ≤50 cp/mL remain to be explored.
Drug survival in patients with psoriasis is associated with the availability of biologic medications
Authors: Shalom G. , Cohen A.D. , Feldhamer I. , Comaneshter D. , Freud T. , Pavlovsky L.
Published: January 2020

Background

Drug survival rates in patients with psoriasis had been described extensively. Different survival rates of TNF‐α inhibitors (TNFIs), ustekinumab and secukinumab were reported.

Objectives

To investigate drug survival rates of TNFIs, ustekinumab and secukinumab, with particular emphasis on the difference between ustekinumab and secukinumab.

Methods

Survival analysis was performed in patients with moderate‐to‐severe psoriasis who received adalimumab, infliximab, etanercept, ustekinumab and secukinumab treatment in 2002–2018, using the Clalit Health Services database. Stratified analysis was performed according to biologic treatment lines. Multivariate analysis was performed adjusting for demographic variables, calendar year, metabolic syndrome, psoriatic arthritis, biologic treatment line, biologic naivety, co‐administration of oral treatments and previous oral systemic treatment exposure.

Results

Among 1459 patients treated with 3070 biologic medication courses, ustekinumab had a significantly higher crude survival as compared with TNFIs and secukinumab. The mean drug survival of ustekinumab, adalimumab, etanercept, infliximab and secukinumab was 43.5 (CI: 39.7–47.2), 38.2 (CI: 34.8–41), 33.9 (CI: 30.8–37.1), 28.2 (CI: 22.5–33.8) and 17.1 (CI: 15.6–18.6) months, respectively, with significant statistical differences for all comparisons (P < 0.001). The differences between ustekinumab and secukinumab were not significant following adjustment to factors that included treatment line (hazard rate 1.16, CI: 0.93–1.43).

Conclusion

Different drug survival rates between ustekinumab and secukinumab are determined by the treatment line and calendar year, reflecting the availability of biologic medications, and not only by the biologic attributes of each medication.
Erosive pustular dermatosis of the scalp: a multicentre study
Authors: Starace M. , Iorizzo M. , Trüeb R.M. , Piccolo V. , Argenziano G. , Camacho F.M. , Gallyamova Y. , Rudnicka L. , Umbert I. , Lyakhovitsky A. , Vañó‐Galván S. , Goren A. , Alessandrini A. , Bruni F. , Piraccini B.M.
Published: January 2020

Background

Erosive pustular dermatosis of the scalp (EPDS) is characterized by crusted erosions or superficial ulcerations that lead to scarring alopecia.

Objectives and Methods

We performed a multicentre retrospective clinical study including 56 patients (29 females and 27 males, mean age 62.7) with a confirmed EPDS in order to describe epidemiology, clinical findings and therapeutic choices of this disease.

Results

Mechanical/chemical trauma was reported in 28.6%, a previous infection in 10.7%, a previous cryotherapy in 5.4% androgenetic alopecia in 48.2% and severe actinic damage in 25%. Trichoscopy showed absence of follicular ostia, tufted and broken hair, crusts, serous exudate, dilated vessels, pustules and hyperkeratosis. Histopathology revealed three different features, depending on the disease duration. The most prescribed therapy was topical steroids (62.5%), followed by the combination of topical steroids and topical tacrolimus (8.9%), systemic steroids (7.1%) and topical tacrolimus (5.4%). A reduction of inflammatory signs was observed in 28 patients (50%) treated with topical steroids and in all three patients treated with topical tacrolimus.

Conclusion

The relatively high number of patients collected allowed us to identify a better diagnostic approach, using trichoscopy and a more effective therapeutic strategy, with high‐potency steroids or tacrolimus, which should be considered as first‐line treatment.
Functional consequences of phenotypic variation between locally adapted populations: Swimming performance and ventilation in extremophile fish
Authors: Camarillo Henry , Arias Rodriguez Lenin , Tobler Michael
Published: January 2020

Natural selection drives the evolution of traits to optimize organismal performance, but optimization of one aspect of performance can influence other aspects of performance. Here, we asked how phenotypic variation between locally adapted fish populations affects locomotion and ventilation, testing for functional trade‐offs and trait–performance correlations. Specifically, we investigated two populations of livebearing fish (Poecilia mexicana) that inhabit distinct habitat types (hydrogen‐sulphide‐rich springs and adjacent nonsulphidic streams). For each individual, we quantified different metrics of burst swimming during simulated predator attacks, steady swimming and gill ventilation. Coinciding with predictions, we documented significant population differences in all aspects of performance, with fish from sulphidic habitats exhibiting higher steady swimming performance and higher ventilation capacity, but slower burst swimming. There was a significant functional trade‐off between steady and burst swimming, but not between different aspects of locomotion and ventilation. Although our findings about population differences in locomotion performance largely parallel the results from previous studies, we provide novel insights about how morphological variation might impact ventilation and ultimately oxygen acquisition. Overall, our analyses provided insights into the functional consequences of previously documented phenotypic variation, which will help to disentangle the effects of different sources of selection that may coincide along complex environmental gradients.
Usefulness of dynamic computed tomography for diagnosing and evaluating uterine artery pseudoaneurysms in women with late post‐partum hemorrhage not complicated by retained products of conception
Authors: Ogoyama Manabu , Nakamura Hiroyasu , Ugajin Atsushi , Nagayama Shiho , Suzuki Hirotada , Takahashi Hironori , Baba Yosuke , Usui Rie , Matsubara Shigeki , Ohkuchi Akihide
Published: January 2020

Aim

We examined whether critical conditions, which were defined as having hemoglobin (Hb) less than 7.0 g/dL, shock index ≥1.0, or need for transfusion, were associated with the presence of extravasation (EV) on dynamic computed tomography (CT) in women with late post‐partum hemorrhage (PPH).

Methods

Forty post‐partum women with late PPH without evident retained products of conception performed dynamic CT. Two radiologists retrospectively evaluated dynamic CT, and determined the presence or absence of EV and a sac‐like structure within the uterine cavity with enhancement.

Results

Ultrasound images were available in 34/40 patients. Color Doppler flow in uterine cavity was evaluated in 33/34 (97%), and all women showed abnormal flow. Of 40 patients, dynamic CT revealed EV in 8 (20%), and a sac‐like structure in 30 (75%). Thus, we diagnosed these 38 (95%) as having uterine artery pseudoaneurysm (UAP). Uterine artery embolization was performed in 36/38 diagnosed as having UAP, and in 2/2 patients with an unknown cause of hemorrhage. The incidence rates of critical conditions were significantly increased in PPH women with than without EV on dynamic CT: Hb <7.0 g/dL (62.5 vs 0%, [P < 0.001]), shock index ≥1.0 (50 vs 9.4% [P = 0.020]), and need for transfusion (37.5 vs 0% [P = 0.006]). Abnormal color Doppler flows were observed in all patients with either EV and sac on dynamic CT.

Conclusion

Dynamic CT was useful for diagnosing UAP, and for evaluating critical conditions, in women with late PPH not complicated by retained products of conception.