bluuebunny/crossref_metadata_2025 huggingface dataset:
Endoscopic radiofrequency biliary ablation treatment: A comprehensive review
Authors: Larghi Alberto , Rimbaș Mihai , Tringali Andrea , Boškoski Ivo , Rizzatti Gianenrico , Costamagna Guido
Published: November 2018

Radiofrequency ablation (RFA) functions by delivering thermal energy within tissue, the result of a high‐frequency alternating current released from an active electrode, leading to coagulative necrosis and cellular death. Recently, a biliary catheter working on a guidewire has been developed and a number of studies have so far been carried out. The present article provides a comprehensive review of the literature on the results of the use of RFA for the clinical management of patients with unresectable malignant biliary strictures, benign biliary strictures, and residual adenomatous tissue in the bile duct after endoscopic papillectomy. Available data show that biliary RFA treatment is a promising adjuvant therapy in patients with unresectable malignant biliary obstruction. The procedure is safe, well tolerated and improves stent patency and survival, even though more studies are warranted. In patients with residual endobiliary adenomatous tissue after endoscopic papillectomy, a significant rate of neoplasia eradication after a single RFA session has been reported, thus favoring this treatment over surgical intervention. In these patients, as well as in those with benign biliary strictures, dedicated probes with a short electrode able to focus the RF current on the short stenosis are needed to expand RFA treatment for these indications.
Missed outpatient appointments and unplanned healthcare: the real question is ‘why’?
Authors: Appleton Jane V
Published: November 2018

This commentary is on the original article by Jarvis et al. on pages 840–846 of this issue.
An intravenous insulin protocol designed for pregnancy reduces neonatal hypoglycaemia following betamethasone administration in women with gestational diabetes
Authors: Rowe C. W. , Putt E. , Brentnall O. , Gebuehr A. , Allabyrne J. , Woods A. , Wynne K.
Published: November 2018

Aims

Marked hyperglycaemia is common following betamethasone administration in women with gestational diabetes (GDM), and may contribute to neonatal hypoglycaemia. Validated protocols to deliver glycaemic stability following betamethasone are lacking. We hypothesized that an intravenous insulin (IVI) protocol for pregnancy‐specific glycaemic targets (Pregnancy‐IVI) would achieve greater at‐target glycaemic control than a generic adult intravenous insulin protocol (Adult‐IVI), and may reduce neonatal hypoglycaemia.

Methods

A retrospective cohort study of the performance Adult‐IVI and Pregnancy‐IVI following betamethasone in GDM, sequentially implemented at a tertiary hospital, without change in indication for IVI. Cases were identified by electronic record search. Primary outcome was percentage of on‐IVI time with at‐target glycaemia [blood glucose level (BGL) 3.8–7 mmol/l]. Secondary outcomes were time with critical hyperglycaemia (BGL > 10 mmol/l), occurrence of maternal hypoglycaemia (BGL < 3.8 mmol/l), and incidence of neonatal hypoglycaemia (BGL ≤ 2.5 mmol/l) if betamethasone was administered within 48 h of birth.

Results

The cohorts comprised 151 women (Adult‐IVI n = 86; Pregnancy‐IVI n = 65). The primary outcome was 68% time‐at‐target [95% confidence interval (CI) 64–71%) for Pregnancy‐IVI compared with 55% (95% CI 50–60%) for Adult‐IVI (P = 0.0002). Critical maternal hyperglycaemia (0% vs. 2%, P = 0.02) and hypoglycaemia (2% vs. 12%, P = 0.02) were both lower with Pregnancy‐IVI than Adult‐IVI. Neonatal hypoglycaemia was less common after Pregnancy‐IVI (29%) than after Adult‐IVI (54%, P = 0.03). A multiple logistic regression model adjusting for potential confounders gave an odds ratio for neonatal hypoglycaemia with Pregnancy‐IVI of 0.27 (95% CI 0.10–0.76, P = 0.01).

Conclusions

An IVI protocol designed for pregnancy effectively controlled maternal hyperglycaemia following betamethasone administration in GDM. This is the first intervention to show a reduction in betamethasone‐associated neonatal hypoglycaemia, linked with optimum maternal glycaemic control.
‘One tooth one child’: evaluating the effects of diet and fertility on the oral health of women from archaeological sites in South America
Authors: Carvalho Maria Rita G. , Pezo‐Lanfranco Luis , Eggers Sabine
Published: November 2018

Women from ancient societies have shown a higher prevalence of dental caries in comparison with men. Recent research has shown that the relationship between increased oestrogen production during pregnancy and decreased salivary flow is a possible cause for the higher levels of caries in women, which is in contrast to the traditional view of sexual division of labour resulting in unequal access to cariogenic food. In order to test these two hypotheses, individuals exhumed from 12 South American archaeological sites were examined for markers of oral health (caries, ante mortem tooth loss, deep caries, and enamel hypoplasia) and compared in terms of fertility (Crude Birth Rate) and subsistence systems. Our results suggest that diet and other cultural practices remain the most important factors affecting oral health and that the effects of hormones can be masked by them. Such findings add to the discussion regarding the availability of micronutrients in such societies affecting caries experience in pregnant women, because of their special nutritional requirements.
Comparing commercial, recreational and illegal coastal fishery catches and their economic values: A survey from the southern Mediterranean Sea
Authors: Ben Lamine Emna , Di Franco Antonio , Romdhane Mohamed Salah , Francour Patrice
Published: November 2018

Commercial small‐scale fishing in the Mediterranean Sea accounts for more than 80% of the commercial fishing fleet. Commercial small‐scale fishing competes with non‐professional fishing, such as recreational and illegal fishing. Fisheries statistics usually fail to report non‐professional fishing data. The aim of this study was to investigate the competition between fishing categories (commercial, recreational and illegal fishing) and their temporal variability in two future Marine Protected Areas in Tunisia. Over a 2‐year period, 213 small‐scale coastal fisheries landings were monitored. Additional socio‐economic information was collected using direct questionnaires. Results highlighted that: (a) at least 47.91% of non‐professional fishers admitted selling the catch (and so were classified as illegal fishers); (b) illegal and recreational fishing mean catch per fishers per day, represented, respectively, 40% and 20% of commercial fishing; (c) catch rates and species richness for illegal and commercial fishing followed the same temporal patterns at both locations; (d) all fishing categories fished high trophic levels and vulnerable species; and (e) potential economic values of illegal and recreational fishing catch were significantly higher than those of commercial fishing. These findings provide quantitative evidence of competition between illegal and legal (commercial and recreational) fishing in the Mediterranean Sea.
Food‐web structure and ecosystem function in the Laurentian Great Lakes—Toward a conceptual model
Authors: Ives Jessica T. , McMeans Bailey C. , McCann Kevin S. , Fisk Aaron T. , Johnson Timothy B. , Bunnell David B. , Frank Kenneth T. , Muir Andrew M.
Published: November 2018

The relationship between food‐web structure (i.e., trophic connections, including diet, trophic position, and habitat use, and the strength of these connections) and ecosystem functions (i.e., biological, geochemical, and physical processes in an ecosystem, including decomposition, production, nutrient cycling, and nutrient and energy flows among community members) determines how an ecosystem responds to perturbations, and thus is key to understanding the adaptive capacity of a system (i.e., ability to respond to perturbation without loss of essential functions). Given nearly ubiquitous changing environmental conditions and anthropogenic impacts on global lake ecosystems, understanding the adaptive capacity of food webs supporting important resources, such as commercial, recreational, and subsistence fisheries, is vital to ecological and economic stability.

Herein, we describe a conceptual framework that can be used to explore food‐web structure and associated ecosystem functions in large lakes. We define three previously recognised broad habitat compartments that constitute large lake food webs (nearshore, pelagic, and profundal). We then consider, at three levels, how energy and nutrients flow: (a) into each basal resource compartment; (b) within each compartment; and (c) among multiple compartments (coupling). Flexible shifts in food‐web structures (e.g., via consumers altering their diet or habitat) that sustain these flows in the face of perturbations provide evidence for adaptive capacity.

We demonstrate the conceptual framework through a synthesis of food‐web structure and ecosystem function in the Laurentian Great Lakes, with emphasis on the upper trophic levels (i.e., fishes). Our synthesis showed evidence of notable adaptive capacity. For example, fishes increased benthic coupling in response to invasion by mussels and round gobies. However, we also found evidence of loss of adaptive capacity through species extirpations (e.g., widespread collapse in the abundance and diversity of ciscoes,Coregonusspp., except in Lake Superior).

In large freshwater lakes, fishery managers have traditionally taken a top‐down approach, focusing on stocking and harvest policy. By contrast, water quality managers have focused on nutrient effects on chemical composition and lower trophic levels of the ecosystem. The synthesised conceptual model provides resource managers a tool to more systematically interpret how lower food‐web dynamics influence harvestable fish populations, and vice versa, and to act accordingly such that sustainable resource practices can be achieved.

We identify key gaps in knowledge that impede a fuller understanding of the adaptive capacities of large lakes. In general, we found a greater uncertainty in our understanding of processes influencing energy and nutrient flow within and among habitats than flows into the system.
Computing state average marginal income tax rates: An application to Missouri
Authors: Crader G. Dean , Haslag Joseph H.
Published: November 2018

Using filing‐level data, we compute the average marginal income tax rate for the State of Missouri. We have data from 2000 through 2015. We start with a simple experiment: consider the effect that a $10 change in federal adjusted gross income would have on each filer’s tax payment. We find that with deductions, exemptions, and credits, the average marginal income tax rate has been remarkably steady over the years, ranging from 3.50% to 3.66%. This rate is much lower than the top marginal income tax rate, which has been 6% for taxable income greater than $9,000 for the entire sample period. In addition, we compute the average marginal income tax rate for different types of income in order to compare directly with the NBER’s reported state rate.
Joint status in Spanish haemophilia B patients assessed using the Haemophilia Early Arthropathy Detection with Ultrasound (HEAD‐US) score
Authors: Jiménez‐Yuste Victor , Álvarez‐Román María Teresa , Martín‐Salces Mónica , De la Corte‐Rodríguez Hortensia , Altisent Carmen , Parra Rafael , Núñez Ramiro , Pérez Rosario , García‐Candel Faustino , Bonanad Santiago , Querol Felipe , Alonso Nieves , Fernández‐Mosteirín Nuria , López‐Ansoar Elsa , García‐Frade Luis Javier , Bermejo Nuria , Pérez‐González Noelia , Gutiérrez‐Pimentel María José , Martinoli Carlo , Fernández‐Arias Isabel , Kim Hae Kyung
Published: November 2018

Aim

The use of musculoskeletal ultrasound (MSK‐US) following protocols for haemophilic arthropathy and the Haemophilia Early Arthropathy Detection with Ultrasound (HEAD‐US) score can help standardize monitoring in haemophilia. This study evaluated the joint status (elbows, knees and ankles) of patients with haemophilia B (HB) in Spain using MSK‐US and the HEAD‐US score.

Methods

Haemophilia B patients ≥14 years old were included in this observational, multicentre, cross‐sectional study, regardless of their clinical condition, HB severity and treatment received. Two blinded observers were involved in image acquisition and scoring in each centre.

Results

Eighty‐two patients from 12 centres were enrolled: 27% mild HB, 23% moderate, 50% severe HB. Mean age was 38.9 ± 16.4 years, 60% were treated on demand (OD) and 40% were on prophylaxis. HEAD‐US was zero in all joints in 28.6% OD patients and 36.4% on prophylaxis. Mean scores significantly worsened with HB severity, except for the left knee. Patients on primary and secondary prophylaxis had significantly better joint health vs OD patients in all joints, except the right ankle. Among OD patients, those with severe disease presented significantly worse scores in all HEAD‐US items related to permanent damage.

Conclusion

Joint status of HB patients in Spain is influenced by severity and treatment modality, related to the development of arthropathy, which appears prevalent in OD patients with severe HB. Routine assessment with an imaging tool such as ultrasound and HEAD‐US system may help to improve joint health by personalizing and adjusting treatment in this population.
A novel prognostic model for tongue squamous cell carcinoma based on the characteristics of tumour and its microenvironment: iBD score
Authors: Yu Pei , Wang Weiwang , Zhuang Zehang , Xie Nan , Xu Jieyun , Wang Cheng , Hou Jingsong , Han Xiaozhe , Liu Xiqiang
Published: November 2018

Aims

Tumour budding and invasive depth can predict survival of patients with tongue squamous cell carcinoma (TSCC), while the prognostic value of tumour microenvironment (TME) remains unknown. Here, both characteristics of the tumour and its microenvironment were examined and a novel prognostic model has been proposed.

Methods and results

A total of 246 patients with TSCC were included. Using H&E‐stained sections, pathological parameters of tumour and the TME were assessed. Inflammatory response (i), tumour budding (B) and invasive depth (D) were combined as iBD score. The association between these variables and the patient survival was determined. Both tumour budding and inflammatory status were independent variables for predicting overall survival (OS) and disease‐free survival (DFS) of TSCC patients. Invasive depth was correlated with differentiation, T classification, lymph node metastasis, clinical stage and recurrence (P < 0.05). The novel iBD model was strongly correlated with T classification, lymph node metastasis, clinical stage and recurrence, and showed clear distinction of scores 0, 1 and 2. High iBD score had a strong association with reduced OS and DFS (P < 0.01).

Conclusions

The iBD scoring model is strongly associated with lymph node metastasis and recurrence in TSCC and could be a promising survival predictor for TSCC patients.
Measurement of torque generated during intracanal instrumentation in vivo
Authors: Gambarini G. , Seracchiani M. , Piasecki L. , Valenti Obino F. , Galli M. , Di Nardo D. , Testarelli L.
Published: November 2018

Aim

To compare two different clinical techniques when using endodontic rotary instruments by monitoring the torque in vivo.

Methodology

Ten single‐rooted maxillary anterior teeth were prepared by an endodontist using size 25, .06 taper TF rotary instruments (KerrEndo, Orange, CA, USA). All instruments were rotated at 500 rpm with maximum torque set at 2.5 N cm using an endodontic motor (Kavo, Biberach, Germany), which automatically recorded the torque values every 1/10 of a second. Instruments were used with two modi operandi: (i) Inward action: short‐length intermittent progression with slight apical pressure aiming to reach the working length (also known as pecking motion), followed by (ii) Outward action: lateral brushing action selectively directed to address the canal circumference whilst removing instruments in the coronal direction. The mean, maximum and accumulated torque values were recorded and analysed statistically (t‐test and Wilcoxon test) with a significance level set at 5%. None of the recorded values exceeded the selected torque limit.

Results

A significant difference between inward and outward actions was found regarding the evaluated parameters (P < 0.05). The outward action (brushing) was significantly safer (requiring less torque) compared to the inward action (pecking).

Conclusions

Torque measurements during in vivo instrumentation provided useful information regarding the techniques evaluated. Although the torque limit was not reached by any of the two actions, the technique impacted significantly on the torque applied to the instrument.
Richards's equation and nonlinear mixed models applied to avian growth: why use them?
Authors: Svagelj Walter S. , Laich Agustina Gómez , Quintana Flavio
Published: November 2018

Postnatal growth is an important life‐history trait that varies widely across avian species, and several equations with a sigmoidal shape have been used to model it. Classical three‐parameter models have an inflection point fixed at a percentage of the upper asymptote which could be an unrealistic assumption generating biased fits. The Richards model emerged as an interesting alternative because it includes an extra parameter that determines the location of the inflection point which can move freely along the growth curve. Recently, nonlinear mixed models (NLMM) have been used in modeling avian growth because these models can deal with a lack of independence among data as typically occurs with multiple measurements on the same individual or on groups of related individuals. Here, we evaluated the usefulness of von Bertalanffy, Gompertz, logistic, U4and Richards's equations modeling chick growth in the imperial shagPhalacrocorax atriceps. We modelled growth in commonly used morphological traits, including body mass, bill length, head length and tarsus length, and compared the performance of models by using NLMM. Estimated adult size, age at maximum growth and maximum growth rates markedly differed across models. Overall, the most consistent performance in estimated adult size was obtained by the Richards model that showed deviations from mean adult size within 5%. Based on AICc values, the Richards equation was the best model for all traits analyzed. For tarsus length, both Richards and U4models provided indistinguishable fits because the relative inflection value estimated from the Richards model was very close to that assumed by the U4model. Our results highlight the bias incurred by three‐parameter models when the assumed inflection placement deviates from that derived from data. Thus, the application of the Richards equation using the NLMM framework represents a flexible and powerful tool for the analysis of avian growth.
Wettability of juvenile plumage as a major cause of mortality threatens endangered Barau's petrel
Authors: Weimerskirch Henri , Pinet Patrick , Dubos Jérôme , Andres Sylvie , Tourmetz Julie , Caumes Christophe , Caceres Sarah , Riethmuller Martin , Corre Matthieu Le
Published: November 2018

Seabirds spend most of their life at sea and have to possess a waterproof plumage to be able to sit on water for extended periods. We tracked juvenile Barau's petrels for the first time, when they leave their birth colony and found that half of the transmitters stopped soon after they first landed on the water off Réunion Island. We suspected from observation at sea that birds may have problems with the waterproofness of their plumage. Therefore during the next season we set up a simple protocol to assess waterproofness of the plumage of the birds just before they fledge. This protocol is based on the calculation of a wettability index expressed as the mass of water logged in the plumage after simulating the bird sitting on the sea surface. We found that at least one third of chicks ready to fledge gained more than 4 g of water in 20 s, indicating that plumage was not waterproof. Within a sample of birds having fledged and before reaching the sea surface, a similar proportion of birds had their plumage not waterproof. For the birds tracked, only those with an index indicating a waterproof plumage successfully dispersed after their first touch on the sea surface. We provide evidence of a possible major cause of mortality of juvenile seabirds that has not been described previously in wild seabirds, but could exist in other species. This issue may be a major cause of threat to the endangered Barau's petrel.
Atrial fibrillation following heart transplantation: A systematic review and meta‐analysis of observational studies
Authors: Chokesuwattanaskul Ronpichai , Bathini Tarun , Thongprayoon Charat , Preechawat Somchai , O'Corragain Oisin A. , Pachariyanon Pavida , Ungprasert Patompong , Cheungpasitporn Wisit
Published: November 2018

Objective

Previous studies have suggested a high incidence of atrial fibrillation (AF) in heart transplant recipients. However, incidence trends of AF in heart transplant recipients remain unclear. The study's aims were (1) to investigate the pooled incidence/incidence trends of AF following heart transplantation and (2) to assess the mortality risk of heart transplant recipients with AF.

Methods

A literature search for studies that reported the incidence of AF following heart transplantation was conducted using MEDLINE, EMBASE, and The Cochrane Database from inception through March 2018. Pooled incidence and odds ratios (OR) with 95%CI were calculated using a random‐effects model.

Results

Eighteen studies (2 cohorts from clinical trials and 16 cohort studies) with 5393 heart transplant recipients were enrolled. The pooled estimated incidence of AF in heart transplant was 10.1% (95%CI: 7.6%‐13.2%). Meta‐analysis based on the type of anastomotic technique demonstrated a pooled estimated incidence of AF following heart transplantation of 18.7% (95%CI: 10.3%‐31.5%) and 11.1% (95%CI: 6.5%‐18.4%) by biatrial and bicaval techniques, respectively. There was a significant association between AF following a heart transplant and increased mortality risk with a pooled OR of 2.86 (95%CI: 2.08‐3.93). Meta‐regression analyses showed no significant correlations between the year of study and incidence of AF (P = 0.47) or mortality risk of AF after heart transplantation (P = 0.99).

Conclusions

The overall estimated incidence of AF following heart transplantation is 10.1%. There is a significant association between AF and increased mortality after transplantation. Furthermore, incidence and mortality risk of AF following heart transplant does not seem to decrease over time.
Spawning and emergence phenology of bull trout Salvelinus confluentus under differing thermal regimes
Authors: Austin Catherine S. , Essington Timothy E. , Quinn Thomas P.
Published: November 2018

Median bull trout Salvelinus confluentus breeding was 2 weeks earlier in a cool stream than in a proximate warmer stream, aligning with expectations for salmonids, followed by emergence timing calculated to be 6 weeks later in the cool stream than the warm stream. This pattern is consistent with both site‐specific adaptation and thermal spawning threshold hypotheses for life‐history event timing in this threatened species.
Use of an Evidence‐Based Guideline for Management of Side Effects from Long‐Acting Reversible Contraceptives: A Quality Improvement Report
Authors: Jacobson Julia , Nasso Jacqueline , Glantz J. Christopher
Published: November 2018

Introduction

Many health care providers believe that women who initiate long‐acting reversible contraceptives (LARC) discontinue the method because of side effects too soon for the method to be economical. The purpose of this quality improvement project was to implement and evaluate an evidence‐based telephone triage nursing guideline for management of side effects of LARC with an ultimate goal of reducing the number of early discontinuations.

Process

A telephone triage guideline was adapted from the Contraceptive Choice Project's Clinician Call Back System, supplemented with evidence‐based resources, and approved by clinicians at 2 community women's health and midwifery offices. Baseline retrospective data were collected on all women over the age of 18 who had LARC inserted at the 2 sites in the year prior to guideline implementation and in the 3 months after implementation. Rates of LARC removal at or before 3 months postinsertion, before and after guideline implementation, were evaluated.

Outcomes

Approximately 1 in 5 women called for help managing LARC side effects. Of the callers, 3 of 32 (9.4%) women receiving standard care discontinued their LARC prior to 3 months, whereas 0 of 24 women who were triaged using the guideline discontinued their LARC prior to 3 months (P = .12). Cramping, bleeding, and malposition or expulsion were the most common concerns and reasons for discontinuation.

Discussion

Fewer women than anticipated called to report side effects, and even fewer chose to discontinue their LARC early. There were fewer discontinuations with guideline use, but this was not a statistically significant difference. Most women did not discontinue their LARC early for any reason, including side effects.
Intradermal injection of Fluorouracil versus triamcinolone in localized vitiligo treatment
Authors: Zohdy Hatem Abo‐El‐Wafa , Hussein Mohamed Saber
Published: November 2018

Background

Vitiligo is an autoimmune disease with a prevalence of 1.22% in Egypt. Intralesional steroids use in localized vitiligo treatment still a matter of debate. Fluorouracil was tried in vitiligo treatment after lesion dermabrasion, ablative laser, or micro‐needling. The study aimed to compare the efficacy of intradermal fluorouracil and triamcinolone acetonide without any adjuvant therapy in localized vitiligo treatment.

Patients and methods

Sixty patients with localized non‐segmental stable vitiligo were assigned randomly and equally into groups. Patients subjected to intradermal injection of either fluorouracil (50 mg/mL), triamcinolone acetonide (3 mg/mL) or an equal mixture of both drugs. All patients had four treatment sessions every 2 weeks were followed up for 6 months.

Results

Intradermal fluorouracil showed the best overall improvement (median 52.27, IQR 36.25‐68.18) when compared with triamcinolone (median 13.86, IQR 3.83‐33.32) and the drug mixture (median 17.15, IQR 7.48‐41.67). During follow‐up, the vitiliginous patches continued to repigment for 6 months in fluorouracil and the drug mixture groups. The improvement stopped 1 month after the last session in the triamcinolone group.

Conclusion

The intradermal fluorouracil injection is an effective treatment of localized vitiligo. The intradermal steroid has a short‐acting therapeutic effect, but the mixture of drugs added no therapeutic effect.
Rapid and sensitive detection of Acidovorax citrulli in cucurbit seeds by visual loop‐mediated isothermal amplification assay
Authors: Yan Lichun , Zhao Yuqiang , Zhou Jiaju , Chen Shuo , Bai Sa , Tian Yanli , Gong Weirong , Hu Baishi
Published: November 2018

A rapid, sensitive and visual loop‐mediated isothermal amplification (LAMP) method for detecting Acidovorax citrulli in cucurbit seed was developed in this study. The LAMP primers were designed to recognize the non‐ribosomal peptide synthetase (NRPS) gene (locus tag: Aave_4658) from A. citrulli. The LAMP assay was conducted at 64°C in 1 hr with calcein as an indicator. The sensitivity and specificity of the LAMP assay were further compared with those of a conventional polymerase chain reaction (PCR). The LAMP assay is highly specific to A. citrulli, and no cross‐reaction was observed with other bacterial pathogen. The sensitivity of the LAMP assay was 100‐fold higher than that of conventional PCR with a detection limit of 1 pg of genomic DNA. Using the LAMP assay, 7 of 12 cantaloupe seedlots collected from Xinjiang province were determined to be positive for A. citrulli. In contrast, only 2 of 12 seedlots showed positive for the pathogen with conventional PCR. Moreover, A. citrulli was detected in 100% of artificially infested seedlots with 0.01% infestation or greater. Our results demonstrated that the LAMP assay was simple, visual and sensitive for detecting A. citrulli, especially in seed health testing. Hence, this method has great potential application in routine detecting seed‐borne pathogens and reducing the risk of epidemics.
Caries prevalence and associations with medications and medical comorbidities
Authors: Jurasic M. Marianne , Gibson Gretchen , Wehler Carolyn J. , Orner Michelle B. , Jones Judith A.
Published: November 2018

Objectives

To use extensive electronic dental, medical, and pharmacy databases to estimate the prevalence of dental caries in a cohort of new patients during a 5‐year period (FY2010–FY2015) and determine whether medication use and medical comorbidities are associated with caries prevalence.

Methods

This was a retrospective analysis of existing data from the Department of Veterans Affairs (VA). The number of teeth treated due to a caries‐related diagnosis was determined and outcomes were presented as number of teeth/person and proportion of patients receiving caries‐related treatment. Logistic and negative binomial regression modeled teeth/person with caries‐related treatment; covariates included age, gender, race, ethnicity, physical and mental comorbidities, and use of prescription medications and prescription drugs with strong anticholinergic properties.

Results

The study population included 95,850 dentate dental patients: 92.1 percent were male, mean age of 58.7 ± 12.6 years, 73.2 percent were White/Caucasian, and 21.3 percent were Black/African American. They were taking a mean of 10.6 ± 5.9 VA prescription drug classes, 0.6 ± 0.4 drugs with strong anticholinergic properties, and had 3.6 ± 2.2 physical and 1.4 ± 1.2 mental comorbidities. On average, 2.2 teeth/person received caries‐related treatment and 58 percent of the study population received any caries‐related treatment. An increase in the rate of caries‐related treatment in Veterans was statistically significantly associated with increased prescription medication use; one or more drugs with strong anticholinergic properties and with 1+ mental comorbidities. Increased physical comorbidity was not statistically significantly associated with caries‐related treatment.

Conclusions

This study demonstrates a high prevalence of caries among Veteran dental patients, with an increased prevalence in those taking higher numbers of prescription medications.
The ELCIDD Project: An Audit of End‐of‐Life Care in Persons with Intellectual Disabilities and Dementia
Authors: Tromans Samuel , Andrews Hayley , Wani Anu , Ganghadaran Satheesh
Published: November 2018

With a rise in the life expectancy of people with intellectual disabilities in recent decades, there has been a related increase in rates of dementia. As a chronic, progressive condition dementia presents opportunities for provision of pre‐planned end‐of‐life care. This audit focussed on the level of compliance with pre‐defined end‐of‐life care standards for a group of patients with intellectual disabilities and severe dementia. Compliance with pre‐defined end‐of‐life care standards was found to be highly variable. Areas of high compliance included all 32 patients having access to their primary care physician, 84% (n = 27) having regular review by their psychiatrist and 94% (n = 30) having had a review of their medication regime. In contrast, there was only clear evidence of patient involvement in advance planning for 25% (n = 8) of patients, with similarly few patients having agreement on the use of cardiopulmonary resuscitation (22%; n = 7) a plan for supporting their carers and/or family (13%; n = 4) or a documented preferred place of death (22%; n = 7). Possible reasons for variable compliance include limited awareness of end‐of‐life care standards among ID professionals and carers, difficulties in discerning when patients are approaching the end of their lives and limited involvement of both the patient and palliative care professionals in decision‐making approaches. There is a clear need for a more structured approach for the assessment and management of these patients, and recently published guidance may help support ID professionals in this regard.
Assessing student academic time use: assumptions, predictions and realities
Authors: Zeeman Jacqueline M , Kang Isabell , Angelo Thomas A
Published: November 2018

Context

In an era of medical education reform and increasing accountability at all levels of higher education, there is a need to understand how the time in which students engage in academic activities can inform evidence‐based quality improvement of the curriculum. Time logging provides an opportunity to quantify student use of academic time and guide data‐informed decision making in curriculum design.

Objectives

This study aimed to evaluate faculty staff and student predictions of students’ academic time use and to assess students’ reported academic time use.

Methods

Graduate‐level professional students engaged in a time use exercise during the first semester of Year 1 (autumn 2015) and second semester of Year 2 (spring 2017) of a redesigned curriculum launched in autumn 2015. This exercise involved three key activities: (i) prediction of time use; (ii) time logging, and (iii) reflection on time use. Key faculty staff predicted students’ weekday time use in both semesters.

Results

Students’ predictions of academic time use strongly correlated with their reported academic time use during both the first semester of Year 1 and second semester of Year 2 (r = 0.55 and r = 0.53, respectively). Faculty members’ predictions of academic time use did not correlate with student academic time use during either semester. Although 63.8% of Year‐1 students reported the time use exercise motivated them to change their time use, students reported spending similar amounts of time on academic activities during the first semester of Year 1 (7.8 ± 1.5 hours per weekday) and the second semester of Year 2 (7.9 ± 2.0 hours per weekday). Most students reported that the exercise had been useful and indicated that their logged time accurately reflected their actual time use.

Conclusions

Although curriculum reform efforts may always require that some assumptions be made, time logging can quantify students’ academic use of time. Although students predict their use of time more accurately than do faculty staff, negligible changes in students’ academic time use despite reported desires to make changes indicate that students’ academic time use may remain inelastic. Educators must consider these findings as they design curricula, identify academic rigour, and establish student expectations of academic time use.
Plant traits inform predictions of tundra responses to global change
Authors: Myers‐Smith Isla H. , Thomas Haydn J. D. , Bjorkman Anne D.
Published: November 2018

Contents

Summary
1742

I.
Introduction
1742

II.
The global context of tundra trait variation
1743

III.
The current state of knowledge on trait change in the tundra biome
1744

IV.
The links between traits and ecosystem functions
1744

V.
Future priorities for tundra trait research
1746

VI.
Conclusions
1746

References
1747

In the rapidly warming tundra biome, plant traits provide an essential link between ongoing vegetation change and feedbacks to key ecosystem functions. However, only recently have comprehensive trait data been compiled for tundra species and sites, allowing us to assess key elements of functional responses to global change. In this review, we summarize trait‐based research in tundra ecosystems, with a focus on three components: plant trait variation and how it compares with global patterns; shifts in community‐level traits in response to environmental change; and the use of traits to understand and predict ecosystem function. Quantifying patterns and trends in plant traits will allow us to better project the consequences of environmental change for the ecology and functioning of tundra ecosystems.
On the origins of osmotically driven stomatal movements
Authors: Sussmilch Frances C. , Roelfsema M. Rob G. , Hedrich Rainer
Published: November 2018

Contents

Summary
84

I.
Introduction
84

II.
Stomatal form and biomechanics
85

III.
Stomatal function
86

IV.
Evolution of guard cell ion channels
87

V.
Conclusions
88

Acknowledgements
88

Author contributions
88

References
88

Stomatal pores with apertures that can be adjusted by changes in guard cell turgor have facilitated plant success in dry environments. We explore their evolutionary origins, considering recent findings from bryophytes. Unlike vascular plant stomata, which close to prevent water loss, bryophyte stomata become locked open to promote spore desiccation. We find that the families of ion channels, known to control stomatal movements in angiosperms, are ancient and represented across extant land plants. However, although angiosperm guard cells express specific ion channel genes, none appear specifically expressed in stomata‐bearing moss tissues. Given the evolutionary shift in stomatal function from promotion to prevention of water loss, we postulate that ion channels adopted guard cell‐specific functions after the divergence of bryophytes.
Wood decomposition is more strongly controlled by temperature than by tree species and decomposer diversity in highly species rich subtropical forests
Authors: Pietsch Katherina A. , Eichenberg David , Nadrowski Karin , Bauhus Jürgen , Buscot François , Purahong Witoon , Wipfler Benjamin , Wubet Tesfaye , Yu Mingjian , Wirth Christian
Published: November 2018

While the number of studies on the role of biodiversity on ecosystem functioning is steadily increasing, a key component of biogeochemical cycling in forests, dead wood decay, has been largely neglected. It remains widely unknown whether and how dead wood decay is affected by diversity loss in forests. We studied the hierarchical effects of tree species diversity on wood decay rates in a subtropical forest landscape in southeast China via its influence on fungal OTU richness and invertebrate diversity using piecewise structural equation models. The experiment was conducted in natural forest plots that span a wide gradient of tree species diversity embedded in a heterogeneous topography. To account for interactions between macro‐invertebrates and fungi, that potentially modify the influence of tree biodiversity and climate on dead wood decay, we compared a macro‐invertebrate exclusion treatment with a control treatment that allowed access to all types of decomposers.

Diversity effects of trees on wood decay rates were mostly negative and mediated by the diversity of macro‐invertebrates. However, the effects of tree species diversity or fungal OTU richness and macro‐invertebrate diversity on wood decay rates were comparatively weak. Temperature affected decay rates positively and had the strongest influence in all treatments. While the exclusion of macro‐invertebrates did not lead to a reduction of wood decay rates, our results suggest that they may however have a mediating role in the process. In the presence of invertebrates the predictability of wood decay rates was higher and we observed a tendency of a stronger temperature control.

Our results suggest that there is evidence for diversity effects on wood decomposition, but the temperature control is still more important. Thus, an increase in mean annual temperature will increase carbon and nutrient turnover through wood decomposition in subtropical forest irrespective of biotic composition.
Pain relief in the palm of your hand: Harnessing mobile health to manage pediatric pain
Authors: Hunter John F. , Kain Zeev N. , Fortier Michelle A.
Published: November 2018

The development and implementation of mobile health (mHealth) interventions provide an opportunity for more optimal management of pediatric pain in the home setting. Leveraging the popularity, mobility, and technological capabilities of digital mobile devices may reduce pediatric pain. Several mHealth applications have already been developed that target the reduction of acute and chronic pediatric pain by digitally delivering intervention strategies in an engaging manner, accumulating pain assessment data, facilitating patient‐provider communication, and providing interactive training. Although several mHealth programs have begun to make strides in the management of pediatric pain, there are still many more possibilities for improvement as greater development and adoption of mHealth practices is on the horizon. Recommendations are provided that advocate for continued advancement of pediatric pain mHealth implementation with an emphasis on robust scientific evaluation, a structured approach to development and design elements that enhance engagement. Increased awareness about the positive influence of mHealth along with the encouragement of researchers and healthcare providers to promote and develop mHealth programs has the potential to transform pediatric pain management. This merger of evidence‐based pain management strategies and digital technology positions pediatric mHealth to have a profound impact by effectively augmenting standard of care and benefiting healthcare providers, parents, and especially children in need.
Reactionary Politics: Explaining the Psychological Roots of Anti Preferences in European Integration and Immigration Debates
Authors: Capelos Tereza , Katsanidou Alexia
Published: November 2018

The concurrent strong waves of anti‐EU integration and anti‐immigration preferences sweeping across Europe, capitalized on by populist discourses, reflect citizens’ economic anxieties brought about by the financial crisis, dormant cultural fears, widespread suspicion towards international institutions, and frustration with “politics as usual.” Extant electoral and public opinion research provide fragmented and conflicted accounts about the psychological origins of these anti preferences. In this article, (1) we articulate a novel overarching theoretical framework that focuses on reaction as a political orientation, and (2) we provide an empirical test of the propose theory using data from the 2004 and 2014 European Social Survey. Explication of political reaction as a driver of political preferences can move forward research on challenges to democratic representation, particularly political disengagement, violent protests, and populist and antiestablishment party vote in the context of the financial crisis.
Avoiding “A Chain Reaction of Disaster”: A Reappraisal of the Eisenhower White House’s Handling of the 1954–1955 Quemoy Crisis
Authors: Hartnett Stephen J.
Published: November 2018

The Quemoy crisis of 1954–1955 found the Eisenhower White House struggling to appear tough against Mao’s China and supportive of Chiang Kai‐shek’s Taiwan while not triggering World War III. When the initial rhetorical campaign of “fuzzing” failed, Eisenhower’s team switched to launching threats of imminent nuclear war—yet both strategies of deterrence were beside the point, for we now know that Mao had no intention of invading Quemoy or Taiwan. In this classic Cold War conundrum, what I call “the agony of sovereignty” left American leadership grasping at straws while misreading the trajectory of postcolonial nationalisms in Asia. Nonetheless, I demonstrate how, by the spring of 1955, Mao, Eisenhower, and Chiang all felt a sense of triumph, as they each evolved responses that left their main interests intact while avoiding what observers had feared might become “a chain reaction of disaster.”
Intensity expectation modifies gustatory evoked potentials to sweet taste: Evidence of bidirectional assimilation in early perceptual processing
Authors: Wilton Moon , Stancak Andrej , Giesbrecht Timo , Thomas Anna , Kirkham Tim
Published: November 2018

Expectations can affect subjective sensory and hedonic ratings of tastes, but it is unclear whether they also shape sensory experience at a perceptual level. The neural correlates of the taste‐expectancy relationship were explored through EEG analysis. Using a trial‐by‐trial cueing paradigm, lingual delivery of 0.05 M or 0.3 M sucrose solutions was preceded by congruent or incongruent visual cues designed to promote anticipation of either a low‐sweet or high‐sweet solution. When participants were cued to expect low‐sweet, but received high‐sweet (incongruent cue), intensity ratings for high‐sweet decreased. Likewise, expectation of high‐sweet increased intensity ratings of low‐sweet solutions. Taste‐dependent, right central‐parietal gustatory ERPs were detected, with greater P1 (associated with greater right insula activation) and P2 peak amplitudes for high‐sweet tastes. Valid cue‐taste pairings led to specific reduced right‐lateralized N400 responses (associated with an attenuation in right insula activation) compared with invalid cue‐taste pairings. Finally, P1 amplitudes following invalidly cued low‐sweet tastes closely matched those generated by expected high‐sweet tastes, and P1 amplitudes for invalidly cued high‐sweet tastes resembled those generated by low‐sweet tastes. We conclude that, as well as modifying subjective ratings toward the anticipated intensity level, expectations affect cortical activity in a top‐down manner to induce bidirectional assimilation in the early perceptual processing of sweet taste and modulate N400 ERP components not previously associated with gustatory stimulation.
Modulation theory solution for nonlinearly resonant, fifth‐order Korteweg–de Vries, nonclassical, traveling dispersive shock waves
Authors: Hoefer Mark A. , Smyth Noel F. , Sprenger Patrick
Published: November 2018

A new class of resonant dispersive shock waves was recently identified as solutions of the Kawahara equation— a Korteweg–de Vries (KdV) type nonlinear wave equation with third‐ and fifth‐order spatial derivatives— in the regime of nonconvex, linear dispersion. Linear resonance resulting from the third‐ and fifth‐order terms in the Kawahara equation was identified as the key ingredient for nonclassical dispersive shock wave solutions. Here, nonlinear wave (Whitham) modulation theory is used to construct approximate nonclassical traveling dispersive shock wave (TDSW) solutions of the fifth‐ order KdV equation without the third derivative term, hence without any linear resonance. A self‐similar, simple wave modulation solution of the fifth order, weakly nonlinear KdV–Whitham equations is obtained that matches a constant to a heteroclinic traveling wave via a partial dispersive shock wave so that the TDSW is interpreted as a nonlinear resonance. The modulation solution is compared with full numerical solutions, exhibiting excellent agreement. The TDSW is shown to be modulationally stable in the presence of sufficiently small third‐order dispersion. The Kawahara–Whitham modulation equations transition from hyperbolic to elliptic type for sufficiently large third‐order dispersion, which provides a possible route for the TDSW to exhibit modulational instability.