bluuebunny/crossref_metadata_2025 huggingface dataset:
Fishing for euros: how mapping applications can assist in maintaining revenues under the Landing Obligation
Authors: Calderwood Julia , Plet-Hansen Kristian Schreiber , Ulrich Clara , Reid David G
Published: June 2020

With the introduction of the Landing Obligation (LO) in EU fisheries, there is an increasing need for fishers to avoid unwanted catches while maximizing revenues. Improving understanding of the spatio-temporal dynamics of unwanted catches could assist the fishing industry optimize catches by altering where they fish. How following such advice relates to revenues and fishery dynamics requires more consideration. We take an existing hotspot mapping methodology and examine how it could be used to identify fishing opportunities under the LO in Irish (Celtic Sea) and Danish (North Sea and Skagerrak) demersal fisheries. We consider if fishing effort can be relocated to avoid unwanted catches while maintaining revenues. The value per unit effort of fishing activity in both areas was often linked to high catch rates of key demersal species (cod, haddock, hake, and whiting). Our analyses indicated, however, that there are options to fish in areas that could provide higher revenues while avoiding below minimum conservation reference size catches and choke species. This was evident across both case study areas demonstrating that hotspot mapping tools could have wide applicability. There does, however, remain a need to explore how the displacement of vessels may further alter species distributions and fleet economics.
Double Jump Phase Transition in a Soliton Cellular Automaton
Authors: Levine Lionel , Lyu Hanbaek , Pike John
Published: June 2020

In this paper, we consider the soliton cellular automaton introduced in [ 26] with a random initial configuration. We give multiple constructions of a Young diagram describing various statistics of the system in terms of familiar objects like birth-and-death chains and Galton–Watson forests. Using these ideas, we establish limit theorems showing that if the 1st $n$ boxes are occupied independently with probability $p\in (0,1)$, then the number of solitons is of order $n$ for all $p$ and the length of the longest soliton is of order $\log n$ for $p<1/2$, order $\sqrt{n}$ for $p=1/2$, and order $n$ for $p>1/2$. Additionally, we uncover a condensation phenomenon in the supercritical regime: for each fixed $j\geq 1$, the top $j$ soliton lengths have the same order as the longest for $p\leq 1/2$, whereas all but the longest have order $\log n$ for $p>1/2$. As an application, we obtain scaling limits for the lengths of the $k^{\textrm{th}}$ longest increasing and decreasing subsequences in a random stack-sortable permutation of length $n$ in terms of random walks and Brownian excursions.
Slow Progress on UN Rapid Deployment: The Pitfalls of Policy Paradigms in International Organizations
Authors: Coleman Katharina P , Lundgren Magnus , Oksamytna Kseniya
Published: June 2020

When reform negotiations in international organizations (IOs) produce limited substantive progress, the diagnosis is typically a lack of political will. We identify a different dynamic: in protracted negotiations, international policy paradigms can emerge that enshrine a politically realistic but incomplete issue definition and thereby focus the debate on a subset of policy instruments that do not fully address the underlying problem. We draw on the multilateral negotiations literature to show how policy paradigms—which are widely explored in Comparative Politics, but largely neglected in International Relations—can emerge even in heterogenous IOs, where deep cognitive cohesion is unlikely. The risk of negotiation failure incentivizes negotiators to adopt and maintain “achievable” issue and goal definitions, which over time are accepted as axiomatic by diplomats, IO officials, and policy experts. The resulting international policy paradigms help avoid institutional paralysis, but can also impede more ambitious reforms. To establish the empirical plausibility of this argument, we highlight the contemporary international policy paradigm of rapid deployment in UN peacekeeping, which focuses more on establishing an initial brigade-sized presence than on rapid deployment of the full peacekeeping force. Drawing on primary documents and interviews, we identify the roots of this First Brigade policy paradigm in reactions to the UN's failure to respond to the 1994 Rwandan genocide and trace its consolidation during UN reform negotiations in the 2000s and early 2010s. We also demonstrate that an alternative explanation of the paradigm as reflecting operational lessons-learned does not hold: a brigade-sized initial presence is rarely sufficient for mandate implementation, does not reliably speed up full deployment, and creates risks for peacekeepers. By highlighting the existence and impact of international policy paradigms, our study adds to scholarship on the role of ideas in International Relations and provides a novel perspective on reform negotiations in IOs.
Cannula complications using elastomeric infusers in Hospital in the Home
Authors: Ryan Damian , Miller Jennifer , Campbell Joanne
Published: June 2020

Objectives

Comparison of the short peripheral cannula (SPC) complication rate of patients with cellulitis receiving IV cefazolin via an elastomeric infuser with those receiving twice-daily bolus treatment (control group) in the Hospital in the Home service.

Methods

A randomized controlled study using elastomeric infuser versus bolus delivery of IV cefazolin via an SPC of patients referred to the Hospital in the Home service in the Northern Illawarra for treatment of cellulitis. A total of 104 patients were enrolled during the time period of May 2018 to January 2019. Primary outcome measures were SPC complications including phlebitis with a secondary outcome of patient satisfaction.

Results

A total of 104 patients enrolled. After randomization there were 60 in the infuser group and 44 in the bolus group. Patient characteristics of age, gender, weight and mobility were similar for the two groups. There was no statistically significant difference between the groups for the endpoint of cannula complication rates. Patient satisfaction scores showed patient acceptance of both forms of treatment.

Conclusions

This study suggests that using elastomeric infusers to deliver cefazolin via a short peripheral IV catheter has similar complication rates to traditional bolus delivery. Patients surveyed showed high levels of satisfaction with both forms of antibiotic delivery.
A new genus and species of pilumnid crab (Decapoda: Brachyura: Pilumnidae) symbiotic with the spongeCallyspongiaDuchassaing & Michelotti, 1864 (Porifera: Demospongiae: Callyspongiidae) from Lombok, Indonesia; the identity ofPseudactumnus pestaeBalss, 1933; and a review of symbiosis in the Pilumnidae
Authors: Ng Peter K L , Rahayu Dwi Listyo
Published: June 2020

A new genus and new species of pilumnid crab, Ericiolumnus symbioticus (Decapoda: Brachyura), is described from the sponge Callyspongia Duchassaing & Michelotti, 1864 (Porifera: Callyspongiidae) in reefs in Lombok, Indonesia. The new taxon is characterized, among several characters, by the unusual shape of the carapace, which possesses sharp anterolateral teeth armed with secondary spinules, and prominently spinulous ambulatory legs. Another pilumnid, Pseudactumnus pestaeBalss, 1933, is shown to be a junior synonym of Actumnus asper (Rüppell, 1830). The pilumnid genus PseudactumnusBalss, 1933 is additionally synonymised with ActumnusDana, 1851. A review of symbiosis in Pilumnidae is also presented.
Patient comprehension of hip arthroscopy: an investigation of health literacy
Authors: Waryasz Gregory R , Gil Joseph A , Kosinski Lindsay R , Chiou Daniel , Schiller Jonathan R
Published: June 2020

Several studies have demonstrated that patients have significant impairments in understanding their injury and appropriate course of management in orthopedic surgery. The purpose of this investigation is to determine if patients are able to obtain a fundamental understanding of the requisite care associated with hip arthroscopy. Any patient who elected to have hip arthroscopy was prospectively recruited to participate in the study. All patients were told they would be asked to complete a questionnaire about their surgery and post-operative instructions. The answers to each question of the questionnaire they would receive at the first post-operative visit were verbally given to each patient during the pre-operative visit. They were also given a post-operative instruction sheet on the day of surgery that contained answers to the questionnaire. At the first post-operative visit, all patients were then asked to complete a multiple-choice questionnaire prior to seeing the surgeon. A total of 56 patients (14 males, 42 females) were enrolled. All patients reported they had read the post-operative instruction sheet. The average number of correct answers was 6.5 ± 0.6 (95% CI 6 − 7) out of 11 questions (59% correct response rate ±18% [95% CI 52 − 66%]). Although we made significant pre-operative oral and written efforts to help patients achieve an elementary level of health literacy regarding their forthcoming hip arthroscopy, many patients did not achieve satisfactory comprehension. Even with instruction and information given verbally and physically (via post-operative instruction sheet) patients did not obtain satisfactory comprehension of their surgical procedure. New ways (through video, simplified cartoons or verbal explanations) must be considered in educating patients concerning surgical procedures to increase comprehension and health literacy.
New Light on the Emergence of Māturīdism: Abū Shakūr al-Sālimī (fifth/eleventh century) and his Kitāb al-Tamhīd fī bayān al-tawḥīd
Authors: Brodersen Angelika
Published: June 2020

The present paper focuses on the Arabic theological work al-Tamhīd fī bayān al-tawḥīd (‘Introduction to the Explanation of Monotheism’), authored by the Transoxanian scholar, Abū Shakūr al-Sālimī (fifth/eleventh century). A jurist and theologian, he belonged to the kalām-school in the succession of Abū Manṣūr al-Māturīdī (d. 333/944), and which, based on Ḥanafī tradition, forms the second pillar of the Sunni confession alongside the doctrines of Abū l-Ḥasan al-Ashʿarī (d. 324/935) and his followers. Despite increasing activities in the field of editions during the last few decades, details of Māturīdī speculative theology (kalām) still remain insufficiently studied. This deficiency applies, on the one hand, to the utilization of texts, partially or not yet available in text-critical and analytically focused editions. On the other hand, a profound and pressing need for systematic research remains, particularly with regards to the relationship between Māturīdism and Ashʿarism, given that the latter has been studied in much greater detail. Against this background, al-Sālimī is presented in his historical and intellectual milieu. It is shown that his treatise is in the Ḥanafī–Māturīdī tradition, but his doctrines sometimes differ from other Māturīdī teachings. Subsequently, some key topics of the Tamhīd are addressed. A special focus is on the beginning of the dispute between Māturīdī theologians and the Ashʿariyya, where issues of epistemology, prophecy, the doctrine of God’s names and attributes, and the conception of faith that serve as typical examples of Ḥanafī jurisprudence and theology are also treated. Finally, a case study illuminates important issues at the heart of Māturīdī theology, as well as the integration of juridical topics into kalām. Through this approach, this paper intends to introduce the text as a valuable source for the study of Sunni theology in a more comprehensive sense than has previously been considered.
Does latitudinal migration represent an advantage in the decrease of ectoparasitic loads in Leptonycteris yerbabuenae (Chiroptera)?
Authors: Zamora-Mejías Daniel , Morales-Malacara Juan B , Rodríguez-Herrera Bernal , Ojeda Margarita , Medellín Rodrigo A
Published: June 2020

Latitudinal migration increases fitness of migrants by allowing them to exploit favorable conditions in nonadjacent geographic regions. Other consequences also may follow, such as interactions with parasites. Migrants may have lower parasite prevalence and abundance than resident individuals because of their ability to abandon infested areas or due to mortality of highly infested hosts. To further understand whether variation in ectoparasite loads is influenced by migration, we investigated whether prevalence and abundance of two species of obligate ectoparasites, the wing mite Periglischrus paracaligus (Mesostigmata: Spinturnicidae) and the bat fly Nycterophilia coxata (Diptera: Streblidae, Nycterophiliinae), of the lesser long-nosed bat, Leptonycteris yerbabuenae, varied between migratory and resident populations throughout their range in Mexico. We examined the presence or absence of migratory behavior, as well as sex and reproductive status of the host because ectoparasitism differentially affects the sexes. Our results showed that the prevalence of both ectoparasites did not vary between migrant and resident females or males, but abundance of the wing mite P. paracaligus was lower in migrant females compared with resident females, with an important influence from the reproductive status of the host. A partial negative relationship between ectoparasite loads and latitudinal migration therefore was demonstrated.
Organizational and Individual Innovation Decisions in an Interorganizational System: Social Influence and Decision-Making Authority
Authors: Fu Jiawei Sophia , Shumate Michelle , Contractor Noshir
Published: June 2020

This study examines the processes of complex innovation adoption in an interorganizational system. It distinguishes the innovation adoption mechanisms of organizational-decision-makers (ODMs), who make authority adoption decisions on behalf of an organization, from individual-decision-makers (IDMs), who make optional innovation decisions in their own work practice. Drawing on the Theory of Reasoned Action and Social Information Processing Theory, we propose and test a theoretical model of interorganizational social influence. We surveyed government health-care workers, whose advice networks mostly span organizational boundaries, across 1,849 state health agencies in Bihar, India. The collective attitudes of coworkers and advice network members influence health-care workers’ attitudes and perceptions of social norms toward four types of innovations. However, individuals’ decision-making authority moderates these relationships; advisors’ attitudes have a greater influence on ODMs, while perceptions of social norms only influence IDMs. Notably, heterogeneity of advisors’ and coworkers’ attitudes negatively influence IDMs’ evaluations of innovations but not ODMs’.
Severe Acute Respiratory Syndrome Coronavirus 2 Infections in Children: Multicenter Surveillance, United States, January–March 2020
Authors: Rha Brian , Lively Joana Y , Englund Janet A , Staat Mary A , Weinberg Geoffrey A , Selvarangan Rangaraj , Halasa Natasha B , Williams John V , Boom Julie A , Sahni Leila C , Michaels Marian G , Stewart Laura S , Harrison Christopher J , Szilagyi Peter G , McNeal Monica M , Klein Eileen J , Strelitz Bonnie , Lacombe Kirsten , Schlaudecker Elizabeth , Moffatt Mary E , Schuster Jennifer E , Pahud Barbara A , Weddle Gina , Hickey Robert W , Avadhanula Vasanthi , Wikswo Mary E , Hall Aron J , Curns Aaron T , Gerber Susan I , Langley Gayle
Published: June 2020

Previous reports of coronavirus disease 2019 among children in the United States have been based on health jurisdiction reporting. We performed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing on children enrolled in active, prospective, multicenter surveillance during January–March 2020. Among 3187 children, only 4 (0.1%) SARS-CoV-2–positive cases were identified March 20–31 despite evidence of rising community circulation.
Multiple peritoneal dissemination of T2 colorectal cancer without lymph node metastases: a case report
Authors: Namba Yosuke , Hirata Yuzo , Mukai Shoichiro , Nishida Toshihiro , Ishikawa Syo , Kai Azusa , Kohata Akihiro , Okimoto Syo , Fujisaki Seiji , Fukuda Saburo , Takahashi Mamoru , Fukuda Toshikatsu
Published: June 2020

Most cases of peritoneal dissemination of colorectal cancers are from T3 or T4 tumors. A 61-year-old woman was admitted for examination of a positive fecal occult blood test. Colonoscopy showed an ascending colon tumor that was diagnosed as an adenocarcinoma with massive submucosal invasion. Imaging modality revealed numerous nodules throughout the abdominal cavity. Peritoneal dissemination of the ascending colon or ovarian cancer and pseudomyxoma peritonei were considered in the preoperative differential diagnoses, and laparoscopic ileocecal resection was performed. Intraperitoneal observation revealed numerous white nodules in the peritoneum, omentum and Douglas fossa. Both the nodules and tumor were diagnosed as mucinous carcinoma based on a pathology report. The tumor invasion depth was limited to muscularis propria, and no regional lymph node metastasis was detected. Peritoneal dissemination of the ascending colon cancer was considered. We report a rare case of multiple peritoneal dissemination of T2 colorectal cancer without lymph node metastases.
Galaxy mass profiles from strong lensing II: The elliptical power-law model
Authors: O’Riordan C M , Warren S J , Mortlock D J
Published: June 2020

We present a systematic analysis of the constraints σγ on the mass profile slope γ obtainable when fitting a singular power-law ellipsoid model to a typical strong lensing observation of an extended source. These results extend our previous analysis of circular systems, Paper I. We draw our results from 676 mock observations covering a range of image configurations, each created with a fixed signal to noise ratio S = 100 in the images. We analyse the results using a combination of theory and a simplified model which identifies the contribution to the constraints of the individual fluxes and positions in each of the lensed images. The main results are: 1. For any lens ellipticity, the constraints σγ for two image systems are well described by the results of Paper I, transformed to elliptical coordinates; 2. We derive an analytical expression for σγ for systems with the source aligned with the axis of the lens; 3. For both two-image systems and aligned systems, σγ is limited by the flux uncertainties; 4. The constraints for off-axis four-image systems are a factor of two to eight better, depending on source size, than for two-image systems, and improve with increasing lens ellipticity. We show that the constraints on γ in these systems derive from the complementary positional information of the images alone, without using flux. The complementarity improves as the offset of the source from the axis increases, such that the best constraints σγ < 0.01, for S = 100, occur when the source approaches the caustic.
Study of the departures from LTE in the unevolved stars infrared spectra
Authors: Korotin S A , Andrievsky S M , Caffau E , Bonifacio P , Oliva E
Published: June 2020

We present a study of departures from Local Thermodynamic Equilibrium (LTE) in the formation of infrared (IR) lines of Na i, Mg i, Al i, S i, K i, and Sr ii in unevolved stars of spectral types F, G, K and metallicities around the solar metallicity. The purpose of this investigation is to identify lines of these species that can be safely treated with the LTE approximation in the IR spectra of these types of stars. We employ a set of 40 stars observed with the GIANO spectrograph at the 3.5 m Telescopio Nazionale Galileo and previously investigated by Caffau et al. We were able to identify many lines that can be treated in LTE for all the above-mentioned species, except for Sr ii. The latter species can only be studied using three lines in the J band, but all three of them display significant departures from LTE. With our small-size, but high-quality sample, we can determine robustly the trends of the abundance ratios with metallicity, confirming the trends apparent from a sample that is larger by several orders of magnitude, but of lower quality in terms of resolution and S/N ratio.
Environments of dwarf galaxies with optical AGN characteristics
Authors: Kristensen Mikkel T , Pimbblet Kevin , Penny Samantha
Published: June 2020

This study aims to explore the relation between dwarf galaxies (M* ≤ 5 × 109 M⊙) with active galactic nuclei (AGNs) and their environment by comparing neighbourhood parameters of AGN and non-AGN samples. Using the NASA-Sloan Atlas, both the local environment and the immediate environment of dwarf galaxies with z ≤ 0.055 are analysed. Of the 145 155 galaxies in the catalogue, 62 258 of them are classified as dwarf galaxies, and by employing two AGN selection methods based on emission-line fluxes (BPT and WHAN), 4476 are found to have AGN characteristics in their optical spectra. Regardless of selection method, this study finds no discernible differences in environment between AGN and non-AGN host dwarf galaxies and these results indicate that environment is not an important factor in triggering AGN activity in dwarf galaxies. This is in line with existing literature on environments of regular galaxies with AGNs and suggests universality in terms of reaction to environment across the mass regime. The biases of AGN selection in low-mass galaxies, and the biases of different measures of environment are also considered. It is found that there are several mass trends in emission-line ratios and that the SDSS fibre covers galaxies non-uniformly with redshift. These biases should be accounted for in future work by possibly including other wavelength regimes or mass weighting of emission-line ratios. Lastly, a discussion of the environment estimation methods is included since they may not gauge the desired properties due to factors such as time delay or using loosely constrained proxy parameters.
Multiwavelength classification of X-ray selected galaxy cluster candidates using convolutional neural networks
Authors: Kosiba Matej , Lieu Maggie , Altieri Bruno , Clerc Nicolas , Faccioli Lorenzo , Kendrew Sarah , Valtchanov Ivan , Sadibekova Tatyana , Pierre Marguerite , Hroch Filip , Werner Norbert , Burget Lukáš , Garrel Christian , Koulouridis Elias , Gaynullina Evelina , Molham Mona , Ramos-Ceja Miriam E , Khalikova Alina
Published: June 2020

Galaxy clusters appear as extended sources in XMM–Newton images, but not all extended sources are clusters. So, their proper classification requires visual inspection with optical images, which is a slow process with biases that are almost impossible to model. We tackle this problem with a novel approach, using convolutional neural networks (CNNs), a state-of-the-art image classification tool, for automatic classification of galaxy cluster candidates. We train the networks on combined XMM–Newton X-ray observations with their optical counterparts from the all-sky Digitized Sky Survey. Our data set originates from the XMM CLuster Archive Super Survey (X-CLASS) survey sample of galaxy cluster candidates, selected by a specially developed pipeline, the XAmin, tailored for extended source detection and characterization. Our data set contains 1707 galaxy cluster candidates classified by experts. Additionally, we create an official Zooniverse citizen science project, The Hunt for Galaxy Clusters, to probe whether citizen volunteers could help in a challenging task of galaxy cluster visual confirmation. The project contained 1600 galaxy cluster candidates in total of which 404 overlap with the expert’s sample. The networks were trained on expert and Zooniverse data separately. The CNN test sample contains 85 spectroscopically confirmed clusters and 85 non-clusters that appear in both data sets. Our custom network achieved the best performance in the binary classification of clusters and non-clusters, acquiring accuracy of 90 per cent, averaged after 10 runs. The results of using CNNs on combined X-ray and optical data for galaxy cluster candidate classification are encouraging, and there is a lot of potential for future usage and improvements.
Activation of transcription factor circuity in 2i-induced ground state pluripotency is independent of repressive global epigenetic landscapes
Authors: Shukla Ruchi , Mjoseng Heidi K , Thomson John P , Kling Simon , Sproul Duncan , Dunican Donncha S , Ramsahoye Bernard , Wongtawan Tuempong , Treindl Fridolin , Templin Markus F , Adams Ian R , Pennings Sari , Meehan Richard R
Published: June 2020

Mouse embryonic stem cells (mESCs) cultured with MEK/ERK and GSK3β (2i) inhibitors transition to ground state pluripotency. Gene expression changes, redistribution of histone H3K27me3 profiles and global DNA hypomethylation are hallmarks of 2i exposure, but it is unclear whether epigenetic alterations are required to achieve and maintain ground state or occur as an outcome of 2i signal induced changes. Here we show that ESCs with three epitypes, WT, constitutively methylated, or hypomethylated, all undergo comparable morphological, protein expression and transcriptome changes independently of global alterations of DNA methylation levels or changes in H3K27me3 profiles. Dazl and Fkbp6 expression are induced by 2i in all three epitypes, despite exhibiting hypermethylated promoters in constitutively methylated ESCs. We identify a number of activated gene promoters that undergo 2i dependent loss of H3K27me3 in all three epitypes, however genetic and pharmaceutical inhibition experiments show that H3K27me3 is not required for their silencing in non-2i conditions. By separating and defining their contributions, our data suggest that repressive epigenetic systems play minor roles in mESC self-renewal and naïve ground state establishment by core sets of dominant pluripotency associated transcription factor networks, which operate independently from these epigenetic processes.
Inactivation of the dimeric RappLS20 anti-repressor of the conjugation operon is mediated by peptide-induced tetramerization
Authors: Crespo Isidro , Bernardo Nerea , Miguel-Arribas Andrés , Singh Praveen K , Luque-Ortega Juan R , Alfonso Carlos , Malfois Marc , Meijer Wilfried J J , Boer Dirk Roeland
Published: June 2020

Quorum sensing allows bacterial cells to communicate through the release of soluble signaling molecules into the surrounding medium. It plays a pivotal role in controlling bacterial conjugation in Gram-positive cells, a process that has tremendous impact on health. Intracellular regulatory proteins of the RRNPP family are common targets of these signaling molecules. The RRNPP family of gene regulators bind signaling molecules at their C-terminal domain (CTD), but have highly divergent functionalities at their N-terminal effector domains (NTD). This divergence is also reflected in the functional states of the proteins, and is highly interesting from an evolutionary perspective. RappLS20 is an RRNPP encoded on the Bacillus subtilis plasmid pLS20. It relieves the gene repression effectuated by RcopLS20 in the absence of the mature pLS20 signaling peptide Phr*pLS20. We report here an in-depth structural study of apo and Phr*pLS20-bound states of RappLS20 at various levels of atomic detail. We show that apo-RappLS20 is dimeric and that Phr*pLS20-bound Rap forms NTD-mediated tetramers. In addition, we show that RappLS20 binds RcopLS20 directly in the absence of Phr*pLS20 and that addition of Phr*pLS20 releases RcopLS20 from RappLS20. This allows RcopLS20 to bind the promotor region of crucial conjugation genes blocking their expression.
Differential metabolomic signatures of declining renal function in Types 1 and 2 diabetes
Authors: Manca Maria Laura , Solini Anna , Haukka Jani K , Sandholm Niina , Forsblom Carol , Groop Per-Henrik , Ferrannini Ele
Published: June 2020

Background

Chronic kidney disease (CKD) shows different clinical features in Types1 (T1D) and 2 diabetes (T2D). Metabolomics have recently provided useful contribution to the identification of biomarkers of CKD progression in either form of the disease. However, no studies have so far compared plasma metabolomics between T1D and T2D in order to identify differential signatures of progression of estimated glomerular filtration rate (eGFR) decline.

Methods

We used two large cohorts of T1D (from Finland) and T2D (from Italy) patients followed up to 7 and 3 years, respectively. In both groups, progression was defined as the top quartile of yearly decline in eGFR. Pooled data from the two groups were analysed by univariate and bivariate random forest (RF), and confirmed by bivariate partial least squares (PLS) analysis, the response variables being type of diabetes and eGFR progression.

Results

In progressors, yearly eGFR loss was significantly larger in T2D [−5.3 (3.0), median (interquartile range)mL/min/1.73 m2/year] than T1D [−3.7 (3.1) mL/min/1.73 m2/year ; P = 0.018]. Out of several hundreds, bivariate RF extracted 22 metabolites associated with diabetes type (all higher in T1D than T2D except for 5-methylthioadenosine, pyruvate and β-hydroxypyruvate) and 13 molecules associated with eGFR progression (all higher in progressors than non-progressors except for sphyngomyelin). Three of the selected metabolites (histidylphenylalanine, leucylphenylalanine, tryptophylasparagine) showed a significant interaction between disease type and progression. Only eight metabolites were common to both bivariate RF and PLS.

Conclusions

Identification of metabolomic signatures of CKD progression is partially dependent on the statistical model. Dual analysis identified molecules specifically associated with progressive renal impairment in both T1D and T2D.
Reactions to Standardized Cigarette Packs With Varying Structural Designs, and the Association With Smoking Susceptibility: A Postimplementation Cross-Sectional Survey With Never-Smoking Adolescents in Scotland
Authors: Mitchell Danielle , Critchlow Nathan , Moodie Crawford , Bauld Linda
Published: June 2020

Introduction

From May 20, 2017, cigarettes in the United Kingdom must be sold in standardized (plain) packaging. We explore postimplementation reactions to standardized cigarette packaging among never-smokers in Scotland, whether reactions vary in relation to permitted variations in pack structure, and whether reactions are associated with susceptibility.

Aims and Methods

A cross-sectional survey with 12–17-year-old never-smokers (n = 507) in Scotland, conducted November 2017–November 2018. Participants were shown one “regular” standardized cigarette pack (flip-top lid and straight-edged pack, similar to designs in Australia) and three standardized packs with varied pack structures (beveled-edges, slim pack, and shoulder box), which are permitted postimplementation in the United Kingdom. Participants rated each pack on eight five-point reaction measures (eg, attractiveness). Participants also indicated which pack, if any, they would choose. Smoking susceptibility was the outcome.

Results

The mean reaction scores for all four packs were mostly negative, however the shoulder box was consistently rated less negatively than the regular, slim, or beveled-edge packs. Most participants (87%) said they would not select any of the four packs, although susceptible participants were more likely to select one than nonsusceptible participants (25% vs. 7%; χ 2 = 29.70; p < .001). For all four packs, not finding them off-putting was associated with susceptibility (Adjusted Odds Ratio range: 2.73–3.69), albeit only a minority of adolescents did not find each pack off-putting.

Conclusions

Adolescents have negative reactions to the standardized cigarette packs implemented in the United Kingdom, albeit permitted variations in structure can reduce the extent of negativity. Most reactions to standardized packaging had no association with susceptibility.

Implications

We provide the first empirical evidence that adolescents find the standardized cigarette packs implemented in the United Kingdom unappealing and that most pack reactions have no association with susceptibility among never-smokers, with the exception of the minority who did not think that they would put them off smoking. This suggests that the legislation is achieving one of its primary aims, to reduce the appeal of packaging. That permitted variations in pack structure (eg, shoulder boxes) somewhat reduce negative reactions suggests that the United Kingdom, and other countries introducing similar legislation, should ensure that all aspects of pack design are fully standardized.
Perspectives of Physician and Pharmacist Stewards on Successful Antibiotic Stewardship Program Implementation: A Qualitative Study
Authors: Barlam Tamar F , Childs Ellen , Zieminski Sarah A , Meshesha Tsega M , Jones Kathryn E , Butler Jorie M , Damschroder Laura J , Goetz Matthew Bidwell , Madaras-Kelly Karl , Reardon Caitlin M , Samore Matthew H , Shen Jincheng , Stenehjem Edward , Zhang Yue , Drainoni Mari-Lynn
Published: June 2020

Background

Antibiotic stewardship programs (ASPs) are required at every hospital regardless of size. We conducted a qualitative study across different hospital settings to examine perspectives of physician and pharmacist stewards about the dynamics within their team and contextual factors that facilitate the success of their programs.

Methods

Semistructured interviews were conducted in March–November 2018 with 46 ASP stewards, 30 pharmacists, and 16 physicians, from 39 hospitals within 2 large hospital systems.

Results

We identified 5 major themes: antibiotic stewards were enthusiastic about their role, committed to the goals of stewardship for their patients and as a public-health imperative, and energized by successful interventions; responsibilities of pharmacist and physician stewards are markedly different, and pharmacy stewards performed the majority of the day-to-day stewardship work; collaborative teamwork is important to improving care, the pharmacists and physicians supported each other, and pharmacists believed that having a strong physician leader was essential; provider engagement strategies are a critical component of stewardship, and recommendations must be communicated in a collegial manner that did not judge the provider competence, preferably through face-to-face interactions; and hospital leadership support for ASP goals and for protected time for ASP activities is critical for success.

Conclusions

The physician-pharmacist team is essential for ASPs; most have pharmacists leading and performing day-to-day activities with physician support. Collaborative, persuasive approaches for ASP interventions were the norm. Stewards were careful not to criticize or judge inappropriate antibiotic prescribing. Further research should examine whether this persuasive approach undercuts provider appreciation of stewardship as a public health mandate.
Tentorial Peeling: Surgical Extradural Navigation to Protect the Temporal Lobe in the Focused Combined Transpetrosal Approach
Authors: Vidal Claudio H F , Nicácio Joab A , Hahn Yoav , Caldas Neto Silvio S , Coimbra Caetano J
Published: June 2020

BACKGROUND

Transpetrosal approaches have been used for treatment of tumors in the petroclival region for many years. Injury to the temporal lobe, however, has been a potential drawback of the techniques described to date.

OBJECTIVE

To describe modifications of the transpetrosal surgical technique, which allows extradural manipulation of the temporal lobe during the focused combined transpetrosal approach. This extra layer of protection avoids mechanical brain retraction, direct trauma to the temporal lobe and disruption of the local venous structures.

METHODS

The present manuscript describes an innovative technical nuance based on the combination of the focused combined transpetrosal approach, the peeling of the dural layers of the tentorium, and the reverse peeling of the middle fossa dura mater. Ample illustrative material is provided and illustrative cases are presented.

CONCLUSION

Peeling of the dural layers of the tentorium is a promising modification of the transpetrosal approach to increase the safety of the temporal lobe manipulation.
Comprehensive photometric investigation of an active early K-type contact system—IL Cancri
Authors: Liu Nian-Ping , Sarotsakulchai Thawicharat , Rattanasoon Somsawat , Zhang Bin
Published: June 2020

Comprehensive photometric investigation of the early K-type contact binary IL Cnc was carried out. A few light curves from both ground-based telescopes and the Kepler space telescope were obtained (or downloaded) and then analyzed in detail. They are mostly found to be asymmetric and there are even continuously changing O’Connell effects in the light curves from Kepler K2 data, suggesting the system to be highly active. Using the Wilson–Devinney code (version 2013), photometric solutions were derived and then compared. It is found that the calculation of the mass ratio is easily affected by the spot settings. Combining the radial velocities determined from LAMOST median resolution spectral data, the mass ratio of the binary components is found to be M2/M1 = 1.76 ± 0.05. The components are in shallow contact ($f\sim 9\%$) and have a temperature difference about T2 − T1 = −280 ± 20 K. The system is demonstrated to be W-subtype, which may be a common feature of K-type contact binaries. The masses of the binary components were estimated to be $M_1\sim 0.51\, M_{\odot }$ and $M_2\sim 0.90\, M_{\odot }$. The values are in good agreement with that deduced from the parallax data of Gaia. The results suggest that the primary component lacks luminosity compared with the zero main sequence. The Hα spectral line of the primary component is found to be peculiar. Combining newly determined minimum light times with those collected from literature, the orbital period of IL Cnc is studied. It is found that the (O − C) values of the primary minima show sinusoidal variation while those of the secondary do not. The oscillation is more likely to be caused by the starspot activities, yet this assumption needs more data to support.
Assessing the current state of medical education on cannabis in Canada: Preliminary findings from Quebec
Authors: Elkrief Laurent , Belliveau Julien , D’Ignazio Tara , Simard Philippe , Jutras-Aswad Didier
Published: June 2020

The legalization of recreational cannabis across Canada has revealed the importance of medical education on cannabis-related topics. A recent study has indicated that Canadian physicians report a significant gap in current versus desired knowledge regarding the therapeutic use of cannabis. However, the state of education on cannabis has never been studied in Canadian medical schools. This article presents the preliminary findings of a survey conducted to understand the perceptions of Quebec’s medical students regarding cannabis-related teachings in their current curriculum. Overall, students reported very low to low levels of exposure to, knowledge of, and comfort levels with cannabis-related subjects. The majority of students reported that they felt that their medical curricula did not prepare them to face cannabis-related issues in their future practices. Strategies need to be developed for improving medical school curriculum regarding cannabis-related issues. These findings provide potential key strategies to improve curricula.
Cannabis and breastfeeding
Authors: Graves Lisa
Published: June 2020

Cannabis is one of the most commonly used substances in Canada with 15% of Canadians reporting use in 2019. There is emerging evidence that cannabis is linked to an impact on the developing brain in utero and adverse outcomes in infants, children, and adolescents. The impact of cannabis during breastfeeding has been limited by studies with small sample sizes, follow-up limited to 1 year and the challenge of separating prenatal exposure from that during breastfeeding. In the absence of high-quality evidence, health care providers need to continue to engage women in conversation about the potential concerns related to breastfeeding and cannabis use.
Le counseling auprès des adolescents et des parents au sujet du cannabis : une introduction pour les professionnels de la santé
Authors: Bélanger Richard E , Grant Christina N
Published: June 2020

L’usage de cannabis est fréquent chez les adolescents du Canada, mais les jeunes en reconnaissent les dangers potentiels et s’attendent de plus en plus à ce que des dispensateurs de soins bien informés leur parlent d’usage de substances psychoactives dans leur pratique quotidienne. Le présent point de pratique propose de solides outils fondés sur des données probantes pour aider les professionnels de la santé à parler d’usage de cannabis à des fins non médicales (récréatives) et des risques qui s’y associent. Les auteurs expliquent comment rendre le milieu clinique sécuritaire pour parler de substances psychoactives avec les jeunes et suggèrent des stratégies précises pour leur parler d’usage de cannabis de manière efficace et adaptée à leur développement. Conformément aux publications scientifiques récentes, ils recommandent des questionnaires de dépistage pour contribuer à structurer les échanges et déterminer quels adolescents pourraient profiter d’interventions plus spécialisées. Puisqu’un adolescent sur six qui expérimente le cannabis finit par en faire un usage abusif, l’évaluation de la volonté des adolescents à modifier leurs comportements à risque représente un aspect essentiel des soins, conjointement avec l’établissement d’objectifs complémentaires et l’aide aux familles. Enfin, des ressources pour les praticiens et les parents sont recommandées.

Tant les parents que les adolescents se préoccupent des effets et des dommages potentiels du cannabis et des autres substances psychoactives (1,2). De nombreux adolescents considèrent les professionnels de la santé comme des sources d’information fiables sur les substances psychoactives et s’attendent à ce qu’ils abordent l’usage ou les risques qui s’y associent lors des rendez-vous de santé (3). Dans le rôle de facilitateurs et de courtiers du savoir, les dispensateurs de soins (DdS) peuvent entretenir un dialogue efficace avec les jeunes et leur famille.
AAAPT Diagnostic Criteria for Acute Low Back Pain with and Without Lower Extremity Pain
Authors: Nicol Andrea L , Adams Meredith C B , Gordon Debra B , Mirza Sohail , Dickerson David , Mackey Sean , Edwards David , Hurley Robert W
Published: June 2020

Objective

Low back pain is one of the most common reasons for which people visit their doctor. Between 12% and 15% of the US population seek care for spine pain each year, with associated costs exceeding $200 billion. Up to 80% of adults will experience acute low back pain at some point in their lives. This staggering prevalence supports the need for increased research to support tailored clinical care of low back pain. This work proposes a multidimensional conceptual taxonomy.

Methods

A multidisciplinary task force of the ACTTION-APS-AAPM Pain Taxonomy (AAAPT) with clinical and research expertise performed a focused review and analysis, applying the AAAPT five-dimensional framework to acute low back pain.

Results

Application of the AAAPT framework yielded the following: 1) Core Criteria: location, timing, and severity of acute low back pain were defined; 2) Common Features: character and expected trajectories were established in relevant subgroups, and common pain assessment tools were identified; 3) Modulating Factors: biological, psychological, and social factors that modulate interindividual variability were delineated; 4) Impact/Functional Consequences: domains of impact were outlined and defined; 5) Neurobiological Mechanisms: putative mechanisms were specified including nerve injury, inflammation, peripheral and central sensitization, and affective and social processing of acute low back pain.

Conclusions

The goal of applying the AAAPT taxonomy to acute low back pain is to improve its assessment through a defined evidence and consensus-driven structure. The criteria proposed will enable more rigorous meta-analyses and promote more generalizable studies of interindividual variation in acute low back pain and its potential underlying mechanisms.
Hemogram-based decision tree for predicting the metabolic syndrome and cardiovascular diseases in the elderly
Authors: Hsu C -H , Chen Y -L , Hsieh C -H , Liang Y -J , Liu S -H , Pei D
Published: June 2020

Background

This study aimed to build a hemogram-based decision tree to evaluate the association between current probability of metabolic syndrome (MetS) and prediction of future hypertension, type 2 diabetes and cardiovascular diseases (CVD) risk.

Methods

A total of 40 395 elder participants (≥60 years) were enrolled in a standard health examination program in Taiwan from January 1999 to December 2014. A decision tree classification of the presence or absence of MetS at baseline, using age, sex and hemogram (white blood cell, hemoglobin and platelet) as independent variables, was conducted for the randomly assigned training (70%) and validation (30%) groups. Participants without MetS at baseline (n = 25 643) were followed up to observe whether they developed MetS, hypertension, type 2 diabetes or CVD in the future.

Results

Modest accuracy of the decision tree in the training and validation groups with area under the curves of 0.653 and 0.652, respectively, indicated an acceptable generalizability of results. The predicted probability of baseline MetS was obtained from decision tree analysis. Participants without MetS at baseline were categorized into three equally sized groups according to the predicted probability. Participants in the third tertile had significantly higher risks of future MetS (hazard ratio 1.40, 95% confidence interval 1.25–1.58); type 2 diabetes (1.46, 1.17–1.83); hypertension (1.14, 1.01–1.28); and CVD (1.21, 1.01–1.44), compared with those in the first tertile.

Conclusions

Execution of hemogram-based decision tree analysis can assist in early identification and prompt management of elderly patients at a high risk of future hypertension, type 2 diabetes and CVD.
A patient-initiated DMARD self-monitoring service for people with rheumatoid or psoriatic arthritis: a cost-effectiveness analysis
Authors: McBain Hayley , Flood Chris , Shipley Michael , Olaleye Abigail , Moore Samantha , Newman Stanton
Published: June 2020

Objective

To determine whether a patient-initiated DMARD self-monitoring service for people on MTX is a cost-effective model of care for patients with RA or PsA.

Methods

An economic evaluation was undertaken alongside a randomized controlled trial involving 100 patients. Outcome measures were quality of life and ESR assessed at baseline and post-intervention. Costs were calculated for healthcare usage using a United Kingdom National Health Service economic perspective. Sensitivity analysis was performed to explore the impact of nurse-led telephone helplines. Uncertainty around the cost-effectiveness ratios was estimated by bootstrapping and analysing the cost-effectiveness planes.

Results

Fifty-two patients received the intervention and 48 usual care. The difference in mean cost per case indicated that the intervention was £263 more expensive (P < 0.001; 95% CI: £149.14, £375.86) when the helpline costs were accounted for and £94 cheaper (P = 0.08; 95% CI: –£199.26, £10.41) when these costs were absorbed by the usual service. There were, however, statistically significant savings for the patient (P = 0.02; 95% CI: −£28.98, £3.00). When costs and effectiveness measures of ESR and quality of life measured, using the Short Form-12v1, were combined this did not show the patient-initiated service to be cost-effective at a statistically significant level.

Conclusion

This patient-initiated service led to reductions in primary and secondary healthcare services that translated into reduced costs, in comparison with usual care, but were not cost-effective. Further work is needed to establish how nurse-led telephone triage services are integrated into rheumatology services and the associated costs of setting up and delivering them.

Trial registration

ClinicalTrials.gov, http://clinicaltrials.gov, ISRCTN21613721