bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of barcode technology on medication preparation safety: a quasi-experimental study
Authors: Küng Kaspar , Aeschbacher Katrin , Rütsche Adrian , Goette Jeannette , Zürcher Simeon , Schmidli Jürg , Schwendimann René
Published: March 2021

Background

Medication errors are a common problem in hospitals and a major driver of adverse patient outcomes. Barcode verification technology is a promising strategy to help ensure safe medication preparation practices.

Objectives

The objectives of this study were (i) to assess the effects of a barcode-assisted medication preparation and administration system regarding the rate of medication preparation errors and (ii) to compare the time spent on medication preparation tasks by medical staff.

Methods

A quasi-experimental study with a pre–post design was conducted, from August 2017 to July 2018, in two mixed medical/surgical units of a tertiary teaching hospital. The primary aim was to assess the effects of a barcode-based electronically assisted medication preparation and administration system linked to the hospital’s electronic medication administration record regarding the rate of medication preparation errors and time-based staff performance. Data were collected using direct observation. Adjusted and unadjusted logistic models were used for error frequencies and linear regression models for time performance.

Results

5932 instances of medication selection and dosing during 79 medication preparation procedures were observed. The overall medication preparation error incidence decreased from 9.9% at baseline to 4.5% at post-intervention, corresponding to a relative risk reduction of 54.5% (P < 0.001). However, the adjusted effect by registered nurses (RNs) and nurses’ work experience of total medication preparation errors showed only borderline significance (odds ratio [OR] 0.64, P = 0.051). For adjusted error-specific analyses, significant error reductions were found in wrong medication errors (OR 0.38, P < 0.010) and wrong dosage errors (OR 0.12, P = 0.004). Wrong patient, wrong form and ambiguous dispenser errors did not occur at post-intervention. Errors of omission (OR 1.53, P = 0.17), additional doses (OR 0.63, P = 0.64) and wrong dispenser boxes (OR 0.51, P = 0.11) did not change significantly. The time necessary to prepare medications for a 24-h period also decreased significantly—from 30.2 min to 17.2 min (beta = −6.5, P = 0.047), while mean preparation time per individual medication dose fell from 24.3 s to 15.1 s (beta = −5.0, P = 0.002).

Conclusion

Use of the new barcode technology significantly reduced the rate of some medication preparation errors in our sample. Moreover, the time necessary for medication preparation, both per 24-h period and per single-medication dose, was significantly reduced.
A Survey of Sigma Metrics across Three Academic Medical Centers
Authors: Feldhammer Matthew , Brown Megan , Colby Jennifer , Bryksin Janetta , Milstid Bryan , Nichols James H
Published: March 2021

Background

Sigma metric calculations provide laboratories an objective means to assess analytical method performance. Methods with higher sigma values are desirable because they are more reliable and may use less frequent quality control in order to maintain optimal performance. Sigma metrics can also serve as a tool when comparing method performance across assay and manufacturer platforms.

Methods

Sigma values were calculated for 28 common chemistry and 24 immunoassay assays across 3 academic medical centers. Method imprecision and percent bias relative to peer group means was tabulated from Bio-Rad quality control (QC) data. Sigma values were calculated for each method using allowable total error (TEa) from either the CLIA evaluation limits or desirable biological variation. Average sigma values were generated for each site and graded as optimal: >6 sigma; good: 5–6 sigma; marginal: 3–5 sigma; or poor: <3 sigma. Analysis of NIST SRM1950 standards for a subset of analytes allowed an estimation of absolute bias.

Results

Clinical chemistry assays displayed similar method performance across all 3 study sites. Immunoassays showed significant differences between manufacturers, and a majority of assays failed to meet an optimal level of performance. Different TEa values produced different sigma metrics with more stringent TEa limits based on biological variation, resulting in poorer performance estimates than the wider CLIA limits. Analysis of NIST standards revealed similar performance.

Conclusions

Sigma metrics are comparable for chemistry but not immunoassay platforms. The selection of total allowable error goals led to differences in sigma metrics.
Informatics for public health and health system collaboration: Applications for the control of the current COVID-19 pandemic and the next one
Authors: Lenert Leslie A , Ding Wei , Jacobs Jeff
Published: March 2021

Public health faces unprecedented challenges in its efforts to control COVID-19 through a national vaccination campaign. Addressing these challenges will require fundamental changes to public health data systems. For example, of the core data systems for immunization campaigns is the immunization information system (IIS); however, IISs were designed for tracking the vaccinated, not finding the patients who are high risk and need to be vaccinated. Health systems have this data in their electronic health records (EHR) systems and often have a greater capacity for outreach. Clearly, a partnership is needed. However, successful collaborations will require public health to change from its historical hierarchical information supply chain model to an ecosystem model with a peer-to-peer exchange with population health providers. Examples of the types of informatics innovations necessary to support such an ecosystem include a national patient identifier, population-level data exchange for immunization data, and computable electronic quality measures. Rather than think of these components individually, a comprehensive approach to rapidly adaptable tools for collaboration is needed.
Alien woody plant invasions in natural forests across China
Authors: Wang Yupin , Fei Songlin , Tang Zhiyao , Sun Yuanfeng , Chen Guoping , Wang Xiangping , Wang Shaopeng , Fang Jingyun
Published: March 2021

Aims

Alien plant invasion has become a major global environmental issue, causing severe economic and ecological damages. Severe invasions have been reported in some regions of China. However, most studies have been conducted at local and provincial levels, and the overall degree of invasion in natural forests across China remains unclear. Here, we explored the biogeographic patterns and their environmental and socioeconomic controls of the invaded alien woody plants in natural forests across the country.

Methods

We compiled the data of 3573 natural forest plots across the mainland China and mapped spatial distribution of alien woody plant invasion. We also used logistic regression models to identify the key socioeconomic and environmental factors that were associated with the observed invasion patterns.

Important Findings

We found that only 271 plots among 3573 natural forest plots were invaded by alien woody plants, accounting for 7.58% of all plots. Among all 2825 woody plant species across all plots surveyed, only 5 alien species (0.177%) were found. Both human activities and climate factors were related to the observed invasion patterns. Since China’s natural forests are mostly located in remote mountainous areas with limited human disturbance, alien woody plant invasions are less than those reported in North America and Europe. However, with the development of transportation and increased economic activities in mountainous areas, more invasions by alien plants may be expected in the future. Therefore, proactive management and policy making are desired to prevent or slow down the invasion processes.
Clonal performance of Scirpus yagara in multiple levels of substrate heterogeneity and submergence
Authors: Wang Tong , Yang Liyu , Shao Runyu , Hu Jiangtao , Liu Chunhua , Yu Dan
Published: March 2021

Aims

Environmental heterogeneity affects the performance of clonal aquatic plants. Few researchers integrated two aspects of heterogeneity into the study of clonal plant ecology. The aims of the present study are to (i) test whether different substrate heterogeneity and submergence exert similar effects on plant performance and (ii) explore the foraging behaviour.

Methods

In this study, Scirpus yagara was subjected to multiple levels of substrate heterogeneity and submergence. Substrate treatments included one homogeneous substrate and three heterogeneous substrates (two-patch, four-patch and eight-patch). Water level treatments included 0, 10 and 30 cm. Traits including ramet number, generation number, leaf number, bulb number, ramet height, culm length, rhizome length, clonal radius, spacer length, spacer thickness, total biomass, biomass of bulbs and biomass per bulb were measured.

Important Findings

Deeper water levels significantly reduced variables associated with growth such as ramet number, generation number, leaf number and bulb number, while substrate patchiness induced significant variations in traits such as spacer length and spacer thickness. Significant interactive effects of the two factors were found for ramet number, leaf number and spacer length. Scirpus yagara showed colonization towards the lake sediment patch in two-patch and four-patch substrates, and more structures were placed in the lake sediment patch. Especially for the two-patch substrate, all structures occupied the lake sediment patch. Two-sided intrusion was observed in the eight-patch substrate, which induced an even allocation of structures in different patches. The foraging behaviour was correlated with the patch size.
Nitrogen addition amplified water effects on species composition shift and productivity increase
Authors: Zhang Xiaolin , Hasi Muqier , Li Ang , Tan Yulian , Daryanto Stefani , Wang Lixin , Zhang Xueyao , Chen Shiping , Huang Jianhui
Published: March 2021

Aims

Water and nitrogen (N) are two key resources in dryland ecosystems, but they may have complex interactive effects on the community structure and ecosystem functions. How future precipitation (rainfall vs snowfall) change will impact aboveground net primary production (ANPP) is far from clear, especially when combined with increasing N availability.

Methods

In this study, we investigated changes in community productivity, abundance and aboveground biomass of two dominant plant functional groups (PFGs), i.e. perennial rhizome grasses (PR) and perennial bunchgrasses (PB) under the impacts of increased precipitation (rainfall vs snowfall) combined with N addition in a semiarid temperate steppe.

Important Findings

Summer rainfall augmentation marginally increased community ANPP, whereas it significantly increased the abundance and aboveground biomass of PR, but not those of PB. Summer rainfall addition increased the fraction of PR biomass (fPR) while decreased that of PB (fPB). Spring snow addition had no effect on aboveground biomass of either compositional PFG although it marginally increased community ANPP. Nitrogen addition significantly increased community ANPP with greater increase in PR under summer rainfall addition, indicating strong interactive effects on community ANPP largely by enhancing PR biomass. We also found a nonlinear increase in the positive effect of nitrogen addition on productivity with the increased precipitation amount. These findings indicate an amplified impact of precipitation increase on grassland productivity under the accelerated atmospheric N deposition in the future.
Evaluation of novel X-ray protective eyewear in reducing the eye dose to interventional radiology physicians
Authors: Endo Mime , Haga Yoshihiro , Sota Masahiro , Tanaka Akiko , Otomo Kazuki , Murabayashi Yuuki , Abe Mitsuya , Kaga Yuji , Inaba Yohei , Suzuki Msatoshi , Meguro Taiichiro , Chida Koichi
Published: March 2021

The new recommendation of the International Commission on Radiological Protection for occupational eye dose is an equivalent dose limit to the eye of 20 mSv year–1, averaged over a 5-year period. This recommendation is a drastic reduction from the previous limit of 150 mSv year–1. Hence, it is important to protect physicians’ eyes from X-ray radiation. Particularly in interventional radiology (IVR) procedures, many physicians use protective lead (Pb) glasses to reduce their occupational exposure. This study assessed the shielding effects of novel 0.07 mm Pb glasses.

The novel glasses (XR-700) have Pb–acrylic lens molded in three dimensions. We studied the novel type of 0.07 mm Pb glasses over a period of seven consecutive months. The eye dose occupational radiation exposure of seven IVR physicians was evaluated during various procedures. All IVR physicians wore eye dosimeters (DOSIRIS™) close to the left side of the left eye. To calculate the shielding effects of the glasses, this same type of eye dosimeter was worn both inside and outside of the Pb lenses.

The average shielding effect of the novel glasses across the seven physicians was 61.4%. Our results suggest an improved shielding effect for IVR physicians that use these glasses. No physician complained that the new glasses were uncomfortable; therefore comfort is not a problem.

The lightweight glasses were acceptable to IVR physicians, who often must perform long procedures. Thus, the novel glasses are comfortable and reasonably protective. Based on the results of this study, we recommend that IVR physicians use these novel 0.07 mm Pb glasses to reduce their exposure.
An evaluation of DNA double strand break formation and excreted guanine species post whole body PET/CT procedure
Authors: Mondal Tanmoy , Nautiyal Amit , Ghosh Somiranjan , Loffredo Christopher A , Mitra Deepanjan , Saha Chabita , Dey Subrata Kumar
Published: March 2021

Ionizing radiation-induced oxidation and formation of deoxyribonucleic acid (DNA) double strand breaks (DSBs) are considered the exemplar of genetic lesions. Guanine bases are most prone to be oxidized when DNA and Ribonucleic acid (RNA) are damaged. The repair processes that are initiated to correct this damage release multiple oxidized guanine species into the urine. Hence, the excretion of guanine species can be related with the total repair process. Our study quantified the total DSBs formation and the amount of guanine species in urine to understand the DNA break and repair process after whole body (WB) exposure to 18F-FDG positron emission tomography/computed tomography (PET/CT). A total of 37 human participants were included with control and test groups and the average radiation dose was 27.50 ± 2.91 mSv. γ-H2AX foci assay in the collected blood samples was performed to assess the DSBs, and excreted guanine species in urine were analyzed by a competitive ELISA method. We observed a significant increase of DNA damage that correlated well with the increasing dose (p-value 0.009) and body weight (p-value 0.05). In the test group, excreted guanine species in urine sample significantly increased (from 24.29 ± 5.82 to 33.66 ± 7.20 mg/mmol creatinine). A minimum (r2 = 0.0488) correlation was observed between DSBs formation and excreted guanine species. A significant difference of DNA damage and 8-OHdG formation was seen in the test group compared to controls. Larger population studies are needed to confirm these observations, describe the fine-scale timing of changes in the biomarker levels after exposure, and further clarify any potential risks to patients from PET/CT procedures.
Endoscopic sleeve gastroplasty requiring conversion to partial gastrectomy with paraesophageal hernia repair
Authors: Grille Victoria J , You David , Kipnis Seth
Published: March 2021

Endoluminal bariatric surgery has lower costs and perceived risks compared to traditional surgery. Endoluminal procedures are a newer approach to weight loss but long-term outcomes and complications continue to emerge. This case report is an endoscopic sleeve gastroplasty that resulted in a paraesophageal hernia repair with removal of gastroplasty sutures and partial gastrectomy.
Prolonged Migraine Aura
Authors: LaHue Sara C. , Levin Morris
Published: March 2021

Most migraine auras are brief and in some ways provide an early warning for the migraine attack, but when the aura persists it should prompt attention.
Acute Generalized Weakness
Authors: LaHue Sara C. , Levin Morris
Published: March 2021

Subtle or severe, generalized weakness should come to attention promptly and has a wide range of potential causes.
Syncope
Authors: LaHue Sara C. , Levin Morris
Published: March 2021

Discovering the cause of syncope, whether cardiovascular, pulmonary, metabolic, or neurological, can be life-saving.
Thunderclap Headache
Authors: LaHue Sara C. , Levin Morris
Published: March 2021

This classic presentation suggests intracranial hemorrhage but a number of other conditions have been shown to cause sudden severe headache.
Febrile Dystonia
Authors: LaHue Sara C. , Levin Morris
Published: March 2021

Dystonia with fever presents an interesting differential diagnosis which must be navigated quickly. This chapter provides a path for doing that.
Acute Ataxia in a Child
Authors: LaHue Sara C. , Levin Morris
Published: March 2021

The differential diagnosis for acute ataxia is reviewed, including the most common explanation, a benign, self-limited postinfectious acute cerebellar ataxia.
An Effective Strategy to Combat Hospital Infections
Authors: Meddings Jennifer , Chopra Vineet , Saint Sanjay
Published: March 2021

Healthcare-associated infection takes a heavy toll on patients, and negatively affects hospitals themselves, both financially and psychologically. Proven technical approaches to prevent infection have often faltered because of the failure of hospital staff to adopt them. This book focuses on these adaptive problems, particularly as experienced during efforts to combat catheter-associated urinary tract infection (CAUTI), central line–associated bloodstream infection (CLABSI), and Clostridioides difficile infection (CDI). It provides a step-by-step description of a model quality improvement intervention, explaining why clinicians neglect or actively oppose such initiatives and how to change their minds. The focus is on preventing CAUTI, which has proven far more resistant to quality improvement efforts than CLABSI. The CAUTI intervention framework is also broadly applicable to a variety of other hospital issues, including preventing falls and CDI. The solutions presented grow out of the extensive research by the clinical authors and their colleagues at the University of Michigan and VA Ann Arbor Healthcare System.
Types of Interventions
Authors: Meddings Jennifer , Chopra Vineet , Saint Sanjay
Published: March 2021

Infection prevention programs were slow to develop—they were a rarity as recently as the 1950s—but they have become a staple of modern-day hospitals. Great strides have been made in identifying clinician activities that can control or prevent various healthcare-associated infections. This chapter describes the contents of an infection prevention bundle for catheter-associated urinary tract infection (CAUTI). In the case of CAUTI, the so-called bladder bundle sets forth appropriate and inappropriate use of indwelling catheters. A nursing checklist, on paper or as a template in the electronic medical record, is used to track patients’ daily urinary catheter status. Doctors and nurses are asked to rethink when a Foley is called for, what alternatives should be considered, what catheter equipment should be used, and how long the Foley should remain in place.
The Importance of Leadership and Followership
Authors: Meddings Jennifer , Chopra Vineet , Saint Sanjay
Published: March 2021

Leadership in a hospital setting differs substantially from that in a for-profit corporation, regarding both mission and practice; that is evident during a quality improvement initiative. Top administrative and clinical leaders need to continually communicate the value and scientific validity of the project to staff members by all available means—including personal cheerleading. Project managers and team champions have to energize the staff with their own enthusiasm for the initiative, capitalizing on the trust and respect they have earned. What is called for is transformational leadership and substantial emotional intelligence. Leaders on all levels need to devote themselves to helping colleagues become exemplary followers. The major characteristics of the leaders of successful infection prevention projects are described.
Common Problems, Realistic Solutions
Authors: Meddings Jennifer , Chopra Vineet , Saint Sanjay
Published: March 2021

A hospital-wide intervention is rolled out. There are changes in the team leadership and many operational adjustments: supplies ordered, procedures redesigned, nursing assignments altered. Three major types of troublemakers are described: the active resisters, the organizational constipators, and the time-servers. Motivations range from opposition to any kind of change to a personal animus toward the project champions to a determination to do as little extra work as possible. Requests by patients and their families may be used to try to get around bladder bundle items or a member of the project team may approach nurses with a patronizing attitude. The team cheers short-term progress to encourage staff compliance, solicits concrete criticism as a path to improvement, and adjusts the implementation process to allow for special circumstances. Efforts to use the electronic medical record to game the system must be squelched. Unfortunately, these challenges are all too common when implementing an infection prevention initiative—but there are solutions.
Toward Sustainability
Authors: Meddings Jennifer , Chopra Vineet , Saint Sanjay
Published: March 2021

After the formal initiative is finished, the project team continues working to secure and perpetuate the progress made in reducing Foley usage and institutionalizing the bladder bundle checklist. Members put into effect plans formulated during the initiative’s early days. The evaluation of catheter use and of infection rates goes on, though the data collection intervals are farther apart. Successes are promoted throughout the hospital, a reminder that the initiative continues. A major mission is to identify backsliders and realign them. Because of the possibility that champions will leave the hospital or be reassigned, current champions are urged to develop their replacements. The team makes sure that the orientation process for new arrivals to the hospital includes prevention information related to catheter-associated urinary tract infection and the hospital’s protocols concerning Foley insertion and removal.
The Future of Infection Prevention
Authors: Meddings Jennifer , Chopra Vineet , Saint Sanjay
Published: March 2021

The technical advances described in this chapter could markedly aid the struggle to prevent healthcare-associated infection. They range from nanomedicine to oral doses of probiotics and IBM’s Watson computer as diagnostician. The adaptive possibilities include further empowerment of the patient on the one hand and new approaches to bring hard-pressed clinicians emotional relief and improve their interactions with patients on the other hand. Studies have shown that large numbers of physicians have suffered burnout. Many doctors and nurses are not fully attentive in their encounters with patients. Growing numbers of clinicians have begun practicing mindfulness, and a model designed to show how a mindful focus can help clinicians in implementing infection prevention initiatives is presented.
Psychological and Psychiatric Issues in Patients with Chronic Pain
Authors: Doleys Daniel M.
Published: March 2021

This book presents a variety of real-life case studies encountered in the context of treating patients complaining of chronic pain. It highlights the complexity of chronic pain and its management. At times, progress can be slow and tedious, but achievable. Both clinician and patient must be clear and realistic about the therapeutic goal(s). Many of the interventions discussed are based on scientifically sound behavioral/psychological principles. However, many of these techniques can be successfully implement by the front-line clinician. Pain Psychology for the Clinician (Cinafrini et al, Oxford University Press, 2021) could be considered a companion volume, as it provides detailed illustrations of how to engage in meaningful clinician–patient interaction. Each case presented herein involves several sections: background information, how to approach assessment, and treatment recommendations; key points are provided for each case. The case studies are designed to be very succinct. The final three chapters provide a detailed discussion of topics including psychogenic pain, description of various psychological/behavioral therapies, and opioid tapering. These chapters can be read before or after the cases studies. They provided useful background information and context within which to understand the approach taken with each individual case.
Scope and Complexities of the Clinical Issues
Authors: Doleys Daniel M. , Doleys Nicholas D.
Published: March 2021

Individuals with chronic pain are a very diverse group of patients. The etiology of their pain may be very complex and difficult to identify using traditional diagnostic studies. Furthermore, many of these patients manifest very complicated and dynamic psychological/psychiatric issues. Patients present to a variety of settings, including pain clinics and the primary care office. No matter the level of training or experience, clinicians are confronted with all manner of diagnostic and therapeutic dilemmas. For some patients, their psychological/psychiatric issues dominate their presentation, requiring immediate, and often long-term, attention. Community resources may be limited, leaving the clinician feeling beleaguered. However, equipping oneself with some basic principles and strategies can contribute to developing meaningful and beneficial therapeutic relationships. The goals of treatment have to be considered very careful and may require some flexibility. Firm, yet compassionate, care and skillful communication offer the best opportunity for success.
A Broken Life
Authors: Doleys Daniel M. , Doleys Nicholas D.
Published: March 2021

This case represents an all too frequent, and tragic, example of the devastating effects of chronic pain following an injury. The problem impacts all aspects of the individual’s life, including the family. Repeated failure of various medical/surgical treatments, intending to be corrective, can result in despair, hopelessness, and anger. Even the most stoic are prone to depression. It is important to recognize and address these issues early. There are some simple strategies that can guide assessment and treatment. It can take years for such a person to “reinvent” themselves. The aware clinician can be a great source of solace and hope.
The Hand That Wouldn’t Move
Authors: Doleys Daniel M. , Doleys Nicholas D.
Published: March 2021

Symptoms that seem very uncharacteristic, if not exaggerated, and those appearing to be neurological in nature but without any apparent neurological explanation, have baffled clinicians and researchers for centuries. Patients often seems very sincere, but some are uncharacteristically indifferent. Somatic intervention can further complicate the problem of conversion disorder (CD). There is an unfortunate tendency to discount the patient with a CD. The assessment and the treatment can be complex. In most cases, referral to a specialist is indicated. A compassionate and understanding attitude will be more impactful than accusation of malingering (ie, willful deception).
Please, Find It and Fix It
Authors: Doleys Daniel M. , Doleys Nicholas D.
Published: March 2021

The setting appropriate treatment goals and expectations cannot be overemphasized when confronted with patients in this category. In some instances, the demand for a cure is a manipulative tactic. In other cases, it can a profound preoccupation ones symptoms, their cause, and eradication. Pain catastrophizing, repeated submission to, if not a request for, unproven and unconventional diagnostic testing and treatments is not uncommon. Reassurance, and diagnostic testing that fails to reveal a catastrophic cause are dismissed. Patients with some forms of somatization disorder suffer from an underlying psychiatric/psychological problem. Their willingness to undergo potential destructive procedures, such as surgery, in the search of a cure puts them at great peril for worsening of their condition.
There Are Not Enough Sheep
Authors: Doleys Daniel M. , Doleys Nicholas D.
Published: March 2021

It is difficult to overemphasize the potential impact of sleep and sleep disorders on chronic pain. Indeed, there are data indicating that sleep disturbance mat be a significant causal factor in the development and maintenance of chronic pain. One would think that daytime pain would predict degree of sleep. But, in fact, it is the opposite; sleep is better predictor of daytime pain intensity. The factor associated with poor sleep are many and varied. Ruling out sleep apnea should be a priority. The availability of in-home studies simplifies the assessment/screening, and may engender greater cooperation. Sleep apnea contributes to hypogonadism, which, in turn, impact a number of physical factor that influence mood, function, and pain. There is a number of approaches that can be implemented in the primary care and pain clinic setting to address the problem of sleep disorders in the patient with chronic pain.
No Way That’s My Drug Screen
Authors: Doleys Daniel M. , Doleys Nicholas D.
Published: March 2021

In the process of treating patients with for chronic pain with opioid type medications, the use of urine drug screens (UDS) is considered the standard of care. The frequency with which a UDS is obtained varies across different guidelines and states/medical boards. It is often associated with dosage, risk for aberrant drug behavior assessment, and ongoing compliance. Most clinicians will obtain a UDS two to four times per year, unless the circumstances require otherwise. In general, the point-of care UDS lacks the sensitivity and specificity of confirmatory testing. The prescribing clinician should (i) be familiar with various types of testing, (ii) create a relationship the testing lab performing the confirmatory testing, and (iii) acquire basic interpretation skills. Clinical decisions should be postponed pending the results of confirmatory testing. False positives, and false negatives, do occur. It behooves the clinician to have “all their ducks in row” before confronting the patient and to accurately document the consultation and decision-making process. In some instances, discontinuation of therapy may be necessary and appropriate. Other cases may be subject to remediation.
The Not-So-Perfect Remedy
Authors: Doleys Daniel M. , Doleys Nicholas D.
Published: March 2021

“But nobody ever died from an overdose of marijuana” has become one of the rallying cries of those who support legalization of marijuana for the treatment of chronic pain and a plethora of other disorders. There is little doubt that the Cannabis Sativa and Cannabis Indica plants produce substances that may well have medicinal value. However, much is yet to be learned. The endocannabinoid system, like the plants themselves, is very complex. Hemp oil and cannabidiol are flooding the market. Unregulated by any federal agencies, the claims and labeling are often unsupported and misleading, if not false. The issue of medical marijuana is here to stay. The clinician treating patients with chronic pain needs to become familiar with the nuances of these products and recognize that they are not without side effects and drug-drug interactions.
Fungal taxonomy and nomenclature
Authors: Borman Andrew M.
Published: March 2021

This chapter summarizes historical and modern approaches to fungal taxonomy, the current taxonomic standing of medically important fungi, and the implications for fungal nomenclature following the recent Amsterdam Declaration on Fungal Nomenclature, which prohibits dual nomenclature. Fungi comprise an entire kingdom, containing an estimated 1–10 million species. Traditionally, fungal identification was based on examination of morphological and phenotypic features, including the type of sexual spores they form and method of formation, and structural features of their asexual spores. Thus, many fungi have been described and named independently several times, based on either their sexual or asexual stages, resulting in a single genetic entity having multiple names. Recent molecular approaches to fungal identification have led to profound changes in fungal nomenclature and taxonomy. Certain phyla have now been disbanded, cryptic species have been identified via molecular approaches, and long-recognized species have been transferred to new genera, based on genotypic comparisons.
Enzymatic construction of metal-mediated nucleic acid base pairs
Authors: Flamme Marie , Figazzolo Chiara , Gasser Gilles , Hollenstein Marcel
Published: March 2021

Artificial metal base pairs have become increasingly important in nucleic acids chemistry due to their high thermal stability, water solubility, orthogonality to natural base pairs, and low cost of production. These interesting properties combined with ease of chemical and enzymatic synthesis have prompted their use in several practical applications, including the construction of nanomolecular devices, ions sensors, and metal nanowires. Chemical synthesis of metal base pairs is highly efficient and enables the rapid screening of novel metal base pair candidates. However, chemical synthesis is limited to rather short oligonucleotides and requires rather important synthetic efforts. Herein, we discuss recent progress made for the enzymatic construction of metal base pairs that can alleviate some of these limitations. First, we highlight the possibility of generating metal base pairs using canonical nucleotides and then describe how modified nucleotides can be used in this context. We also provide a description of the main analytical techniques used for the analysis of the nature and the formation of metal base pairs together with relevant examples of their applications.
Gratian and His Book: How a Medieval Teacher Changed European Law and Religion
Authors: Winroth Anders
Published: March 2021

Gratian of Bologna, later bishop of Chiusi (died c. 1145), was a remarkably influential lawyer, who is undeservedly little known today. He was a legal expert who specialized in the rules and regulations of the Western Christian church. In around 1140, he put together a law book known as the Decretum, which became a great success, remaining foundational for medieval and modern law. The article focuses on three legal areas: tithes, marriage, and natural law. It discusses how Gratian used scholastic methods and classroom exercises to come to grips with the many contradictions that existed in the more than ten centuries of law that he strove to collect and synthesize. It highlights how Gratian’s innovations in marriage law, natural law, and procedural law still influence modern law. Gratian left Bologna before he had finished the course, and the article reflects on the differences in his later fate and that of his book.
Interannual climate variation influences nest initiation date and nest productivity of the Red-cockaded Woodpecker at the northwestern edge of its range
Authors: Fullerton Matthew R , Walters Jeffrey R , Will Rodney E , Loss Scott R
Published: March 2021

Climate change, including directional shifts in weather averages and extremes and increased interannual weather variation, is influencing demography and distributions for many bird species. The Ouachita Mountains ecoregion in southeast Oklahoma and west-central Arkansas contains 2 populations of the Red-cockaded Woodpecker (Dryobates borealis, RCW), a federally endangered, cooperatively breeding species. Since this region is at the RCW’s northwestern range periphery, ecological thresholds likely are limiting for the species. Therefore, populations in this region may be more sensitive to climate change-associated weather variation and unpredictability. We used 26 years of nesting data (1991–2016) from the 2 RCW populations to determine if interannual weather variation has affected nesting phenology and productivity. For each population, we used daily temperature and precipitation data for 3 periods (30 and 60 days before nesting; 40 days overlapping the nesting period) to determine how weather influences median nesting date and average clutch size and numbers of fledglings. In a separate analysis, we used shorter time windows with individual nests as replicates to determine how discrete weather events (e.g., minimum and maximum temperatures and intense precipitation events) affect nest success and partial brood loss. For both Oklahoma and Arkansas populations, warmer early spring temperatures generally advanced nesting and increased clutch size and fledgling number. However, the effects of average precipitation varied depending on the amount and duration of precipitation in different time periods. At the nest level, most variables reflecting discrete temperature and precipitation events were unrelated to nest success and brood loss, suggesting that factors other than weather (e.g., habitat quality and predation) more strongly influenced the nesting output of individual RCW broods. Our results indicate RCWs are responding to interannual weather variation in complex and variable ways. However, warming trends may generally be having positive effects on the species at the northwestern edge of its range.
Climate variation drives dynamics and productivity of a subalpine breeding bird community
Authors: DeSante David F , Saracco James F
Published: March 2021

Effects of global climate change on local climate and dynamics of animal populations can be extreme at high latitudes and high elevation. Here, we investigated climate variation and its effects on the diversity and dynamics of a subalpine bird community in California’s Sierra Nevada over 32 years (1978–2009). For the first 16 years, we also assessed the effects of climate on fledging timing, fledging success, and fledgling numbers. We considered 4 climate variables: snowmelt timing, spring mean temperature, summer minimum temperature, and summer precipitation. Climate metrics were highly variable among years and exhibited evidence of temporal pattern. Cooler years with late-melting snowpack were less common in later years, and summer temperature increased, while summer precipitation tended to decrease, over the study period. Years of early snowmelt were associated with higher species richness, more breeding territories, population increases, earlier fledging, and fewer fledglings/successful breeding territory. After accounting for snowmelt timing, spring temperature was positively associated with population change and, although variable among species, negatively associated with fledging date and productivity metrics. Summers with higher minimum temperatures were associated with higher fledging success and (although variable among species) more fledglings. Three species showed evidence of population trend: Yellow-rumped Warbler (Setophaga coronata; increasing), Clark’s Nutcracker (Nucifraga columbiana; declining), and Chipping Sparrow (Spizella passerina; declining). We suggest that enhanced diversity and population growth in mild springs were driven primarily by the recruitment of young first-time breeders, which may also help explain lower productivity in those years. Spring and summer temperatures may have also affected productivity through effects on predator activity or on dynamics of moisture, vegetation, and food availability. Finally, summer precipitation was largely accumulated through summer storms, which were observed to cause occasional deaths to eggs and nestlings. Our results highlight the value of long-term single-site multispecies data in understanding population and community dynamics at an environmental extreme with high annual variability.
Rule 91: Interlocutory revision by the European Patent Office
Authors: Kuczera Markus
Published: March 2021

If, after the interlocutory revision, the EPO does not make a statement within the required time period, it is expressing that it deems the claimant’s application to be unfounded. This must at least be noted in the necessary documentation in order to prove that the interlocutory revision took place.
Article 280 TFEU
Authors: Schima Bernhard
Published: March 2021

Article 244 EC The judgments of the Court of Justice of the European Union shall be enforceable under the conditions laid down in Article 299.
Prevention And Settlement Of Conflicts Of Jurisdiction (Spanish System)
Authors: Ruano Miguel Carmona
Published: March 2021

Spanish law did not set up, until recently, any rules about either the prevention or the settlement of international conflicts of jurisdiction. These types of conflicts were not frequent at all in the context of Spain’s international relationships in the days of the codification of Spanish law, in the last decades of the nineteenth century, when the main legal bodies were established. Broadly speaking, in those days there was little or no cross-​border or transnational crime and, as a result, Spain saw little reason to legislate about concurrence of jurisdictions. The authors of the Ley de Enjuiciamiento Criminal (LECrim), the Criminal Procedure Law of 1882, which is still the principal legal text on the matter, would probably consider that the affirmation of the principle of territoriality would be sufficient. Therefore, in contrast to the detailed regulation of the conflicts of jurisdictions between the common and military courts or between secular and ecclesiastic courts, not a single word was devoted in the original text of this Law to possible international conflicts.
The Polarization of Legislative Party Votes: Comparative Illustrations from Denmark and Portugal
Authors: Christiansen Flemming Juul
Published: March 2021

This article introduces and demonstrate the use of a ‘legislative polarisation index’. This extends a current measure of party system polarisation, as developed by Dalton (2008), and makes it possible to include legislative behaviour in the form of roll call votes into the assessment of polarisation. The article selects Denmark and Portugal to illustrate how the index works. The cases show that increased fragmentation and increased polarisation of the party system may become more moderate when parties on the political extremes become included in the legislative process.
Secularism and American Political Behavior
Authors: Layman Geoffrey C , Campbell David E , Green John C , Sumaktoyo Nathanael Gratias
Published: March 2021

The recent growth of the secular population in the United States has implications for American politics. However, our understanding of these implications has been hindered by oversimplified concepts and measures that equate secularism with non-religion. We separate the two concepts, distinguishing “non-religiosity,” or the absence of religion, from “secularism,” or a positive embrace of secular beliefs and identities. Using original national-sample cross-sectional and panel surveys, we introduce new measures of secularism, evaluate their properties, and assess their connection to political attitudes and behavior. We find a clear distinction between secularism and non-religiosity in the American public and show that secularism is more closely related than non-religiosity to political attitudes, identifications, and engagement. In fact, while secularism is related to changes over time in political orientations, non-religiosity is not.
Years of life lost associated with COVID-19 deaths in the USA during the first year of the pandemic
Authors: Quast Troy , Andel Ross , Gregory Sean , Storch Eric A
Published: March 2021

Background

Years of Life Lost (YLLs) measure the shortfall in life expectancy due to a medical condition and have been used in multiple contexts. Previously it was estimated that there were 1.2 million YLLs associated with coronavirus disease 2019 (COVID-19) deaths in the USA through 11 July 2020. The aim of this study is to update YLL estimates for the first full year of the pandemic.

Methods

We employed data regarding COVID-19 deaths in the USA through 31 January 2021 by jurisdiction, gender and age group. We used actuarial life expectancy tables by gender and age to estimate YLLs.

Results

We estimated roughly 3.9 million YLLs due to COVID-19 deaths, which correspond to roughly 9.2 YLLs per death. We observed a large range across states in YLLs per 10 000 capita, with New York City at 298 and Vermont at 12. Nationally, the YLLs per 10 000 capita were greater for males than females (136.3 versus 102.3), but there was significant variation in the differences across states.

Conclusions

Our estimates provide further insight into the mortality effects of COVID-19. The observed differences across states and genders demonstrate the need for disaggregated analyses of the pandemic’s effects.
Infinite-Dimensional Degree Theory and Ramer’S Finite Co-Dimensional Differential Forms
Authors: Elworthy K. D.
Published: March 2021

Infinite-dimensional degree theory, especially for Fredholm maps with positive index as developed with Tromba, is combined with Ramer’s unpublished thesis work on finite co-dimensional differential forms. As an illustrative example, the approach of Nicolaescu and Savale to the Gauss–Bonnet–Chern theorem for vector bundles is reworked in this framework. Other examples mentioned are Kokarev and Kuksin’s approach to periodic differential equations and to forced harmonic maps. A discussion about how such forms and their constructions and cohomology relate to constructions for diffusion measures on path and loop spaces is also included.
How far does an emphasis on stakeholder engagement and co-production in research present a threat to academic identity and autonomy? A prospective study across five European countries
Authors: Boaz Annette , Borst Robert , Kok Maarten , O’Shea Alison
Published: March 2021

There is a growing recognition that needs more to be done to ensure that research contributes to better health services and patient outcomes. Stakeholder engagement in research, including co-production, has been identified as a promising mechanism for improving the value, relevance and utilization of research. This article presents findings from a prospective study which explored the impact of stakeholder engagement in a 3-year European tobacco control research project. That research project aimed to engage stakeholders in the development, testing and dissemination of a return-on-investment tool across five EU countries (the Netherlands, Spain, Hungary, Germany and the UK). The prospective study comprised interviews, observations and document review. The analysis focused on the extent to which the project team recognized, conceptualized and operationalized stakeholder engagement over the course of the research project. Stakeholder engagement in the European research project was conceptualized as a key feature of pre-designated spaces within their work programme. Over the course of the project, however, the tool development work and stakeholder engagement activities decoupled. While the modelling and tool development became more secluded, stakeholder engagement activities subtly transformed from co-production, to consultation, to something more recognizable as research participation. The contribution of this article is not to argue against the potential contribution of stakeholder engagement and co-production, but to show how even well-planned engagement activities can be diverted within the existing research funding and research production systems where non-research stakeholders remain at the margins and can even be seen as a threat to academic identify and autonomy.