bluuebunny/crossref_metadata_2025 huggingface dataset:
Significant Regional Differences in Antibiotic Use Across 576 US Hospitals and 11 701 326 Adult Admissions, 2016–2017
Authors: Goodman Katherine E , Cosgrove Sara E , Pineles Lisa , Magder Laurence S , Anderson Deverick J , Dodds Ashley Elizabeth , Polk Ronald E , Quan Hude , Trick William E , Woeltje Keith F , Leekha Surbhi , Harris Anthony D
Published: May 2020

Background

Quantifying the amount and diversity of antibiotic use in United States hospitals assists antibiotic stewardship efforts but is hampered by limited national surveillance. Our study aimed to address this knowledge gap by examining adult antibiotic use across 576 hospitals and nearly 12 million encounters in 2016–2017.

Methods

We conducted a retrospective study of patients aged ≥ 18 years discharged from hospitals in the Premier Healthcare Database between 1 January 2016 and 31 December 2017. Using daily antibiotic charge data, we mapped antibiotics to mutually exclusive classes and to spectrum of activity categories. We evaluated relationships between facility and case-mix characteristics and antibiotic use in negative binomial regression models.

Results

The study included 11 701 326 admissions, totaling 64 064 632 patient-days, across 576 hospitals. Overall, patients received antibiotics in 65% of hospitalizations, at a crude rate of 870 days of therapy (DOT) per 1000 patient-days. By class, use was highest among β-lactam/β-lactamase inhibitor combinations, third- and fourth-generation cephalosporins, and glycopeptides. Teaching hospitals averaged lower rates of total antibiotic use than nonteaching hospitals (834 vs 957 DOT per 1000 patient-days; P < .001). In adjusted models, teaching hospitals remained associated with lower use of third- and fourth-generation cephalosporins and antipseudomonal agents (adjusted incidence rate ratio [95% confidence interval], 0.92 [.86–.97] and 0.91 [.85–.98], respectively). Significant regional differences in total and class-specific antibiotic use also persisted in adjusted models.

Conclusions

Adult inpatient antibiotic use remains high, driven predominantly by broad-spectrum agents. Better understanding reasons for interhospital usage differences, including by region and teaching status, may inform efforts to reduce inappropriate antibiotic prescribing.
Cell-free DNA as a marker for the outcome of end-stage renal disease patients on haemodialysis
Authors: Coimbra Susana , Rocha Susana , Nascimento Henrique , Valente Maria João , Catarino Cristina , Rocha-Pereira Petronila , Sameiro-Faria Maria , Oliveira José Gerardo , Madureira José , Fernandes João Carlos , Miranda Vasco , Belo Luís , Bronze-da-Rocha Elsa , Santos-Silva Alice
Published: May 2020

Background

DNA damage and inflammation are common in end-stage renal disease (ESRD). Our aim was to evaluate the levels of circulating cell-free DNA (cfDNA) and the relationship with inflammation, anaemia, oxidative stress and haemostatic disturbances in ESRD patients on dialysis. By performing a 1-year follow-up study, we also aimed to evaluate the predictive value of cfDNA for the outcome of ESRD patients.

Methods

A total of 289 ESRD patients on dialysis were enrolled in the study: we evaluated cfDNA, haemogram, serum iron, hepcidin, inflammatory and oxidative stress markers, and haemostasis. Events and causes of deaths were recorded throughout the follow-up period.

Results

ESRD patients, as compared with controls, presented significantly higher levels of cfDNA, hepcidin, and inflammatory and oxidative stress markers, and significantly lower values of iron and anaemia-related haemogram parameters. The all-cause mortality rate was 9.7%; compared with alive patients, deceased patients (n = 28) were older and presented significantly higher values of inflammatory markers and of cfDNA, which was almost 2-fold higher. Furthermore, cfDNA was the best predictor of all-cause mortality and cardiovascular mortality in ESRD patients, in both unadjusted and adjusted models for basic confounding factors in dialysis.

Conclusions

Our data show cfDNA to be a valuable predictive marker of prognosis in ESRD patients on dialysis treatment; high levels of cfDNA were associated with a poor outcome.
Seasonal Population Dynamics of Potato Psyllid (Hemiptera: Triozidae) in the Columbia River Basin
Authors: Cohen Abigail L , Wohleb Carrie H , Rondon Silvia I , Swisher Grimm Kylie D , Cueva Isabel , Munyaneza Joseph E , Jones Vincent P , Crowder David W
Published: May 2020

Understanding factors that affect the population dynamics of insect pest species is key for developing integrated pest management strategies in agroecosystems. Most insect pest populations are strongly regulated by abiotic factors such as temperature and precipitation, and assessing relationships between abiotic conditions and pest dynamics can aid decision-making. However, many pests are also managed with insecticides, which can confound relationships between abiotic factors and pest dynamics. Here we used data from a regional monitoring network in the Pacific Northwest United States to explore effects of abiotic factors on populations of an intensively managed potato pest, the potato psyllid (Bactericera cockerelli Šulc), which can vector Candidatus Liberibacter psyllaurus, a bacterial pathogen of potatoes. We assessed effects of temperature on psyllid populations, and show psyllid population growth followed predictable patterns within each year, but there was considerable variation across years in psyllid abundance. Examination of seasonal weather patterns suggested that in 2017, when psyllid populations were less abundant by several orders of magnitude than other years, a particularly long and cold period of winter weather may have harmed overwintering populations and limited population growth. The rate of degree-day accumulation over time, as well as total degree-day accumulation also affected trap catch abundance, likely by mediating the number of psyllid generations per season. Our findings indicate that growers can reliably infer the potential magnitude of risk from potato psyllids using monitoring data, date of first detection, seasonal weather patterns, and population size early in the growing season.
Delayed Mating with Multiple Partners Decreases Indexes of Mating in Female and Male Spodoptera litura (Lepidoptera: Noctuidae)
Authors: Di Xueyuan , Liu Jianfeng , Wu Chengxu , Yan Bin , Yu Xiaofei , Yang Maofa
Published: May 2020

Delayed mating is an effective strategy that can decrease the fecundity of a pest by reducing the time that females have to mate. This disruption does not completely inhibit mating and may lead to multiple matings. The effects of delayed mating with multiple partners on different indexes of mating in female and male Spodoptera litura (Fabricius) (Lepidoptera: Noctuidae) were determined in this study. The delay in mating significantly decreased the number of matings and the mating success of both sexes and the male contribution to reproduction. Compared with the effect on female fecundity, the delayed mating with multiple partners had a greater effect on the male mate contribution to fecundity. The longevity of females and males increased significantly with a 72 h delay in mating. Linear regression analysis showed negative relationships between delayed mating and fecundity and number of matings in both sexes. Thus, delayed mating with multiple partners can disrupt the mating and reproductive potential of S. litura.
The use of echo density to quantify pulmonary right-to-left shunt in transthoracic contrast echocardiography
Authors: Kroon Steven , Van Thor Mitch C J , Vorselaars Veerle M M , Hosman Anna E , Swaans Martin J , Snijder Repke J , Mager Hans-Jurgen , Post Marco C
Published: May 2020

Aims

Transthoracic contrast echocardiography (TTCE) is the recommended screening tool to detect pulmonary right-to-left shunt (RLS) caused by pulmonary arteriovenous malformations (PAVMs). We assessed a novel method to quantify the RLS using the change in echo density (ED) following contrast injection.

Methods and results

An analysis of 437 consecutive patients [58% female, 47 years, interquartile range (IQR) 33–60] who underwent TTCE for the detection of a pulmonary RLS. Using ImageJ (National Institutes of Health), the change in ED was measured for each patient. This method was strongly correlated (Spearman’s ρ = 0.89; P < 0.0001) with our standard method based on a four-point grading scale (no, mild, moderate, and severe RLS). In patients without a history of embolotherapy (n = 334), a PAVM was detected with chest computed tomography (CT) in 66 and embolotherapy was judged possible in 35 of these patients. The median increase in ED was higher in the latter: +20.1% (IQR 12.3–34.0) compared to non-treatable PAVM +0.2% (IQR −0.2 to 1.1). The specificity to detect treatable PAVMs increased from 87% to 90% when using the novel method without affecting the sensitivity (of 100%). Using the optimal cut-off value of +4.5% increase in ED, 8/74 (11%) needed chest CT-scans—individuals with a moderate or severe RLS—were no longer required without missing any treatable PAVM.

Conclusions

The use of ED quantification for pulmonary RLS is promising; resulting in a substantial decrease in the number of chest CT scans needed. However, this method and the threshold should be validated in an independent study population.
Incremental prognostic value of global myocardial work over ejection fraction and global longitudinal strain in patients with heart failure and reduced ejection fraction
Authors: Wang Chun-Li , Chan Yi-Hsin , Wu Victor Chien-Chia , Lee Hsin-Fu , Hsiao Fu-Chih , Chu Pao-Hsien
Published: May 2020

Aims 

Left ventricular (LV) ejection fraction (EF) and global longitudinal strain (GLS) help identify heart failure (HF) patients who are at risk for adverse outcomes. This study aimed to determine whether global myocardial work (GMW), derived from non-invasive LV pressure-strain loops, can provide incremental prognostic information over EF and GLS in patients with HF and reduced EF (HFrEF).

Methods and results 

We retrospectively analysed 508 patients (age 62.9 ± 15.8 years, 29.1% female) with LVEF ≤40%. The study endpoint was a composite of all-cause death and HF hospitalization. The incremental value of GMW over clinical and echocardiographic variables including EF and GLS for the association with the composite endpoint was assessed using Cox regression analyses. Over a 1-year follow-up, 183 patients reached the endpoint. Baseline variables associated with the endpoint were age, haemoglobin, LV end-systolic volume, New York Heart Association Class III or IV, E/e′ ratio, pulmonary artery systolic pressure, EF, and GLS. Cox regression analysis revealed that GMW [hazard ratio (HR) 1.15, 95% confidence interval (CI) 1.05–1.25, per 100-mmHg% decrease] added incremental prognostic value over these variables. Both EF and GLS were not independent variables when GMW was included in the model. Patients with GMW <750 mmHg% were associated with a significantly higher risk of all-cause death and HF hospitalization (HR 3.33, 95% CI 2.31–4.80) than patients with GMW ≥750 mmHg%.

Conclusion 

In patients with HFrEF, GMW provides incremental prognostic information over EF and GLS regarding risk of all-cause death and HF hospitalization.
Strategic Transmission of Correlated Information
Authors: Currarini Sergio , Ursino Giovanni , Chand A K S
Published: May 2020

We consider a situation in which a decision-maker gathers information from imperfectly informed experts, receiving coarse signals about a uniform state of the world. Private information is (conditionally) correlated across players, and communication is cheap talk. We show that with two experts correlation unambiguously tightens the conditions on preferences for a truth-telling equilibrium. However, with multiple experts the effect of correlation on the incentives to report information truthfully can be non-monotonic: while little and large levels of correlation hinder truth-telling, intermediate levels may discipline experts’ equilibrium behaviour and foster truthful communication. We discuss the implications of our results for the political discussion in the presence of ‘selective exposure' to media, where similarity in preferences comes with higher correlation, and a trade-off between truth-telling incentives and informational content arises.
Oral and maxillofacial outcomes in children with microcephaly associated with the congenital Zika syndrome
Authors: Ribeiro Renato Araújo , Mattos Adriana , Meneghim Marcelo de C , Vedovello Silvia A S , Borges Técia Mendes Daltro , Santamaria Milton
Published: May 2020

Introduction

The objective of this study is to assess the oral and maxillofacial characteristics of microcephalic children associated with congenital Zika syndrome (CZS).

Methods

A cross-sectional, observational study was carried out with 61 patients with microcephaly/CZS born between June 2015 and September 2017 (29 boys and 32 girls, average age of 22.8 months) and a control group with 58 non-CZS children born in the same period (25 boys and 33 girls, average age of 23.8 months). The functional clinical analysis considered the labial and lingual frena, tongue anterior projection, oral escape, palate form, and first tooth eruption. For the craniofacial analysis, facial anthropometric points and the cephalic perimeter at the time were measured. Demographic data were collected from medical records, and a clinical exam was performed in order to register the intrabuccal characteristics and craniofacial measures. The chi-square test and Student’s t-test were used with a significance level of 0.05.

Results

The narrow palate form, tongue anterior projection, oral escape, and late first tooth eruption were significantly more present in the group with microcephaly/CZS. As for the craniofacial analysis, face width (Bi-Zi), mandible width (Go-Go), height of face upper third (Tr-G), and monthly growth of cephalic perimeter were significantly smaller, whereas height of face lower third (Sn-Gn) was significantly bigger in the group with microcephaly/CZS (P < 0.05).

Conclusion

Children with microcephaly resulting from a congenital Zika infection showed functional, oral, and maxillofacial changes and smaller facial development in comparison with non-CZS children in the same age group.
Potential Role of Oral Rinses Targeting the Viral Lipid Envelope in SARS-CoV-2 Infection
Authors: O’Donnell Valerie B , Thomas David , Stanton Richard , Maillard Jean-Yves , Murphy Robert C , Jones Simon A , Humphreys Ian , Wakelam Michael J O , Fegan Christopher , Wise Matt P , Bosch Albert , Sattar Syed A
Published: May 2020

Emerging studies increasingly demonstrate the importance of the throat and salivary glands as sites of virus replication and transmission in early COVID-19 disease. SARS-CoV-2 is an enveloped virus, characterized by an outer lipid membrane derived from the host cell from which it buds. While it is highly sensitive to agents that disrupt lipid biomembranes, there has been no discussion about the potential role of oral rinsing in preventing transmission. Here, we review known mechanisms of viral lipid membrane disruption by widely available dental mouthwash components that include ethanol, chlorhexidine, cetylpyridinium chloride, hydrogen peroxide, and povidone-iodine. We also assess existing formulations for their potential ability to disrupt the SARS-CoV-2 lipid envelope, based on their concentrations of these agents, and conclude that several deserve clinical evaluation. We highlight that already published research on other enveloped viruses, including coronaviruses, directly supports the idea that oral rinsing should be considered as a potential way to reduce transmission of SARS-CoV-2. Research to test this could include evaluating existing or specifically tailored new formulations in well-designed viral inactivation assays, then in clinical trials. Population-based interventions could be undertaken with available mouthwashes, with active monitoring of outcome to determine efficacy. This is an under-researched area of major clinical need.
Guppy Y Chromosome Integrity Maintained by Incomplete Recombination Suppression
Authors: Darolti Iulia , Wright Alison E , Mank Judith E
Published: May 2020

The loss of recombination triggers divergence between the sex chromosomes and promotes degeneration of the sex-limited chromosome. Several livebearers within the genus Poecilia share a male-heterogametic sex chromosome system that is roughly 20 Myr old, with extreme variation in the degree of Y chromosome divergence. In Poecilia picta, the Y is highly degenerate and associated with complete X chromosome dosage compensation. In contrast, although recombination is restricted across almost the entire length of the sex chromosomes in Poecilia reticulata and Poecilia wingei, divergence between the X chromosome and the Y chromosome is very low. This clade therefore offers a unique opportunity to study the forces that accelerate or hinder sex chromosome divergence. We used RNA-seq data from multiple families of both P. reticulata and P. wingei, the species with low levels of sex chromosome divergence, to differentiate X and Y coding sequences based on sex-limited SNP inheritance. Phylogenetic tree analyses reveal that occasional recombination has persisted between the sex chromosomes for much of their length, as X- and Y-linked sequences cluster by species instead of by gametolog. This incomplete recombination suppression maintains the extensive homomorphy observed in these systems. In addition, we see differences between the previously identified strata in the phylogenetic clustering of X–Y orthologs, with those that cluster by chromosome located in the older stratum, the region previously associated with the sex-determining locus. However, recombination arrest appears to have expanded throughout the sex chromosomes more gradually instead of through a stepwise process associated with inversions.
The crustal structure of the Eastern Subbasin of the South China Sea: constraints from receiver functions
Authors: Liu Yanan , Liu Baohua , Liu Chenguang , Hua Qingfeng
Published: May 2020

The crustal structure is a window to understand the tectonic evolution of an area. Through the first large-scale passive-source ocean bottom seismometer (OBS) array observation experiment in the Eastern Subbasin of the South China Sea (ESSCS), we calculated and obtained the respective receiver functions of these stations. As OBS works on the seafloor, where the working environment is different from that for its land-based counterpart, the effects of the sea-water layer and the oceanic low-velocity sediment layer on the seismic signals must be evaluated. Receiver functions’ synthetic test demonstrates the following: the presence of the sea-water layer produces a strong negative-amplitude phase (Pwp) in the receiver function, and the arrival time of this phase is delayed as the thickness of the sea-water layer increases; the presence of the low-velocity sediment layer produces a strong positive-amplitude phase (Pseds) which causes a delay in the arrival time of the Moho-related phases of the receiver function and makes them difficult to distinguish. On the basis of phase identification and synthetic tests, we estimate crustal thickness beneath each of the stations using two approaches. The first approach utilizes the observed arrival time of Moho phases, and the second approach finds the optimal crustal thickness by comparing the synthetic and observed receiver functions, which leads to more reliable results. The results of the second method show that the thickness of the sediment in the study area is mainly controlled by seafloor topography, the thickness of the crust in the seamount area is affected by the magma supply during the expansion stage and the post-spreading magmatism, and the crust in the flat basin is only affected by the magma supply during the expansion period. Moreover, the crust in the area affected by magmatic activity after the expansion stage is thicker than that in the area not affected.
The Relational Turbulence Model: A Meta-Analytic Review
Authors: Goodboy Alan K , Bolkan San , Sharabi Liesel L , Myers Scott A , Baker James P
Published: May 2020

A series of 27 meta-analyses was conducted to synthesize theoretical predictions, to date, of the relational turbulence model (RTM), which has informed relational turbulence theory (RTT). In line with theorized predictions, 12 random-effects meta-analyses (k = 9–15; n = 1,395–5,493) confirmed that RTM variables (i.e., self uncertainty, partner uncertainty, relationship uncertainty, and partner interference), on average, correlated with topic avoidance, depressive symptoms, and relationship satisfaction. An additional 15 random-effects meta-analyses (k = 4–41; n = 930–8,975) were conducted to pool an average correlation matrix among self uncertainty, partner uncertainty, relationship uncertainty, partner interference, partner facilitation, and relational turbulence. This pooled correlation matrix was used to test a meta-analytic structural equation model of the RTM commonly specified in the literature. Global and local fit statistics indicated the meta-analytic data fit the RTM well. Collectively, these results offer empirical and theoretical evidence for the RTM across nearly 2 decades of research and provide insights for future scholarship guided by the axioms and propositions of RTT.
Black and White Patients With Inflammatory Bowel Disease Show Similar Biologic Use Patterns With Medicaid Insurance
Authors: Barnes Edward L , Bauer Christina M , Sandler Robert S , Kappelman Michael D , Long Millie D
Published: May 2020

Background

Prior studies have identified racial disparities in the treatment and outcomes of inflammatory bowel disease (IBD). These disparities could be secondary to differences in biology, care delivery, or access to appropriate therapy. The primary aim of this study was to compare medication use among Medicaid-insured black and white patients with IBD, given uniform access to gastroenterologists and therapies.

Methods

We analyzed Medicaid Analytic eXtract data from 4 states (California, Georgia, North Carolina, and Texas) between 2006 and 2011. We compared the use of IBD-specific therapies, including analyses of postoperative therapy among patients with Crohn disease (CD). We performed bivariate analyses and multivariable logistic regression, adjusting for potential confounders.

Results

We identified 14,735 patients with IBD (4672 black [32%], 8277 with CD [58%]). In multivariable analysis, there was no significant difference in the odds of anti-tumor necrosis factor use by race for CD (adjusted odds ratio [aOR] = 1.13; 95% confidence interval [CI], 0.99-1.28] or ulcerative colitis (aOR = 1.12; 95% CI, 0.96-1.32). Black patients with CD were more likely than white patients to receive combination therapy (aOR = 1.50; 95% CI, 1.15-1.96), and black patients were more likely than white patients to receive immunomodulator monotherapy after surgery for CD (31% vs 18%; P = 0.004).

Conclusions

In patients with Medicaid insurance, where access to IBD-specific therapy should be similar for all individuals, there was no significant disparity by race in the utilization of IBD-specific therapies. Disparities in IBD treatment discussed in prior literature seem to be driven by socioeconomic or other issues affecting access to care.
Limited effect of red blood cell transfusion on long-term mortality among anaemic cardiac surgery patients
Authors: Tran Long , Greiff Guri , Wahba Alexander , Pleym Hilde , Videm Vibeke
Published: May 2020

OBJECTIVES

Our goal was to investigate long-term mortality associated with red blood cell (RBC) transfusion among patients with anaemia undergoing cardiac surgery when adjusting for known risk factors.

METHODS

Adults with preoperative anaemia as defined by World Health Organization criteria undergoing open-heart surgery from 2000 through 2017 were included. Cox regression was performed for long-term mortality (30 days–5 years), comparing patients who received ≥1 unit of RBC with those who did not. Unadjusted and multivariable analyses adjusted for risk factors were performed.

RESULTS

The study included 1859 patients, 1525 (82%) of whom received RBC transfusion. A total of 370 (19.9%) deaths were registered between 30 days and 5 years; 88 patients (23.8%) died between 30 days and 1 year. The unadjusted hazard ratio (HR) associated with RBC transfusion was 2.09 (1.49–2.93, P < 0.001) from 30 days to 5 years postoperatively. The HR for RBC transfusion were 4.70 (1.72–12.81, P = 0.002) and 1.77 (1.23–2.55, P = 0.002) for 30 days–1 year and 1–5 years, respectively. Adjusting for perioperative risk factors, which included postoperative complications, the HR decreased to 1.16 (0.80–1.68, P = 0.43), 1.79 (0.63–5.12, P = 0.28) and 1.11 (0.75–1.65, P = 0.61) for observation time from 30 days to 5 years, 30 days to 1 year and 1 to 5 years, respectively. Results were similar when postoperative complications were excluded from the adjustment variables.

CONCLUSIONS

No statistically significant association between RBC transfusion and long-term mortality was found when we adjusted for known risk factors. This study suggests that the observed difference in mortality in this patient group is largely due to patient-related risk factors.
Providing Hospitalized Ulcerative Colitis Patients With Practice Guidelines Improves Patient-Reported Outcomes
Authors: Weizman Adam V , Bressler Brian , Seow Cynthia H , Afif Waqqas , Afzal Nooran M , Targownik Laura , Nguyen Derek M , Jones Jennifer L , Huang Vivian , Murthy Sanjay K , Nguyen Geoffrey C
Published: May 2020

Background and aims

Variation in care has been demonstrated among hospitalized patients with ulcerative colitis. Guidelines aim to reduce variation; however, it is known that the uptake of guidelines by physicians is variable. Providing patients with guidelines is a strategy that has not been extensively studied in inflammatory bowel disease (IBD). Our aim was to evaluate the impact of a patient-directed educational intervention that included treatment guidelines among hospitalized ulcerative colitis patients.

Methods

We performed a quality improvement, cluster-randomized trial at seven tertiary IBD centres. Sites were randomized to implement an educational intervention or standard care for a 6-month period between January 2017 and January 2018. The educational intervention consisted of a patient-directed video that provided a summary of inpatient management guidelines for ulcerative colitis. Primary outcome measures included the length of stay and colectomy at discharge and 6 months. Patient-reported outcomes included trust in physician and patient satisfaction at discharge and at 6 months.

Results

Ninety-one patients were enrolled. No statistically significant differences in length of stay or colectomy were noted. Patients who received the intervention had higher trust in physician as measured by Trust in Physician Score at discharge (69.5 vs. 62.6, P = 0.028) and at 6 months (77.7 vs. 68, P = 0.008). Patient satisfaction as measured by the CACHE questionnaire in the intervention group was higher at discharge (72.8 vs. 67.1, P = 0.04); however, this difference was not sustained.

Conclusion

Empowering patients with guidelines through an educational intervention resulted in differences in trust in physician and patient satisfaction. Further studies are needed for evaluating a strategy of engaging IBD patients to take a more active role in their care. (clinicaltrials.gov, NCT02569333).
Innovation policy and the market for vaccines*
Authors: Xue Qiwei Claire , Ouellette Lisa Larrimore
Published: May 2020

Vaccines play a crucial role in improving global public health, with the ability to stem the spread of infectious diseases and the potential to eradicate them completely. Compared with pharmaceuticals that treat disease, however, preventative vaccines have received less attention from both biomedical researchers and innovation scholars. This neglect has substantial human and financial costs, as vividly illustrated by the COVID-19 pandemic. In this article, we argue that the large number of ``missing'' vaccines is likely due to more than lack of scientific opportunities. Two key aspects of vaccines help account for their anemic development pipeline: (1) they are preventatives rather than treatments; and (2) they are generally durable goods with long-term effects rather than products purchased repeatedly. We explain how both aspects make vaccines less profitable than repeat-purchase treatments, even given comparable IP protection. We conclude by arguing that innovation policy should address these market distortions by experimenting with larger government-set rewards for vaccine production and use. Most modestly, policymakers should increase direct funding—including no grants and public-private partnerships—and insurance-based market subsidies for vaccine development. We also make the case for a large cash prize for any new vaccine made available at low or zero cost.
Laparoscopic approach for diaphragmatic hernia repair in adult: our experience of four cases
Authors: Kumar Abhijeet , Karn Ratish , Khanal Bhawani , Sah Suresh Prasad , Gupta Rakesh
Published: May 2020

Diaphragmatic hernia can be congenital or acquired. Usual clinical presentation may range from asymptomatic cases to serious respiratory/gastrointestinal symptoms and occasionally atypical presentation as lumbar hernia also. The diagnosis of diaphragmatic hernia is based on clinical investigation and is confirmed by plain X-ray film and computed tomography scan. Various treatment approaches, open, laparoscopic and combination, are available for this condition. However, laparoscopic approach has recently gained in popularity. Surgical repair typically involves primary or patch closure of the diaphragm through an open or endoscopic abdominal or thoracic approach. This paper reflects our experience of repair of diaphragmatic hernias to evaluate its safety, efficacy and outcomes.
Expression of a fungal exo-β-1,3-galactanase in Arabidopsis reveals a role of type II arabinogalactans in the regulation of cell shape
Authors: Yoshimi Yoshihisa , Hara Katsuya , Yoshimura Mami , Tanaka Nobukazu , Higaki Takumi , Tsumuraya Yoichi , Kotake Toshihisa
Published: May 2020

Arabinogalactan-proteins (AGPs) are a family of plant extracellular proteoglycans implicated in many physiological events. AGP is decorated with type II arabinogalactans (AGs) consisting of a β-1,3-galactan backbone and β-1,6-galactan side chains, to which other sugars are attached. Based on the fact that a type II AG-specific inhibitor, β-Yariv reagent, perturbs growth and development, it has been proposed that type II AGs participate in the regulation of cell shape and tissue organization. However, the mechanisms by which type II AGs participate have not yet been established. Here, we describe a novel system that causes specific degradation of type II AGs in Arabidopsis, by which a gene encoding a fungal exo-β-1,3-galactanase that specifically hydrolyzes β-1,3-galactan backbones of type II AGs is expressed under the control of a dexamethasone-inducible promoter. Dexamethasone treatment increased the galactanase activity, leading to a decrease in Yariv reagent-reactive AGPs in transgenic Arabidopsis. We detected the typical oligosaccharides released from type II AGs by Il3GAL in the soluble fraction, demonstrating that Il3GAL acted on type II AG in the transgenic plants. Additionally, this resulted in severe tissue disorganization in the hypocotyl and cotyledons, suggesting that the degradation of type II AGs affected the regulation of cell shape.
Comorbidity of Bipolar Disorder and Medical Disorders
Authors: Chowdhury Awad , Goldstein Benjamin I.
Published: May 2020

Much of the excess mortality in bipolar disorder can be attributed to medical comorbidities, particularly cardiometabolic disorders. This observation has been noted for more than a century. The proportion of excess mortality attributable to cardiovascular disease has increased in recent years. In addition to mortality, there are increased cardiovascular risk factors in bipolar disorder across the life span. The prevalence of these comorbidities is thought to be elevated by aberrations in particular biological pathways, including inflammation, oxidative stress, and neurotrophic factors. Medical comorbidities significantly affect the lives of patients with bipolar disorder in the form of decreased treatment response, increased symptom severity, and increased mortality risk. To successfully ameliorate the negative impacts of medical comorbidities on patients with bipolar disorder, an integrated emphasis on cardiometabolic health alongside mental health is warranted, including behavioral, pharmacological, and systems-related approaches.
Neurobiology of Bipolar Disorder
Authors: Romo-Nava Francisco , McElroy Susan L.
Published: May 2020

As frequently occurs in science, progress made on the neurobiology of bipolar disorder has followed a nonlinear course that often revisits deserted concepts. The neurobiological blueprint of bipolar disorder continues to unfold from a neurotransmitter-based hypothesis to include peptides and intracellular signaling pathways, and into a broader neuronal network perspective that involves cortical and subcortical regions in the brain. Moreover, new evidence makes it increasingly clear that the mechanisms of disease in bipolar disorder extend beyond the brain, providing plausible “missing links” between psychopathology and the elevated medical comorbidities. This is illustrated by the expanding role of the circadian system in bipolar disorder and the emerging evidence on the contribution of spinal afferents to the construct of mood, portraying that brain–body communication pathways are relevant to the pathophysiology of bipolar disorder. This chapter provides an overview of the current and emerging neurobiological frameworks for bipolar disorder.
Current State of Evidence-Based Psychotherapies for Bipolar Disorder
Authors: O’Donnell Lisa , Miklowitz David
Published: May 2020

Bipolar disorder is characterized by recurrent mood episodes and severe functional impairments. Earlier onsets of bipolar disorder are associated with a more severe course of the illness. Treatment guidelines across age groups include pharmacotherapy plus bipolar disorder–specific psychotherapies. Evidence supporting the use of adjunctive psychotherapies is strongest for long-term maintenance of bipolar disorder, including relapse prevention and restoring function and quality of life, for youths and adults with bipolar disorder. When given in combination with pharmacotherapy, family-focused treatment (FFT) and group psychoeducation (including functional remediation methods) have the strongest support among adults. Individual psychotherapies (interpersonal and social rhythm therapy [IPSRT] and cognitive-behavioral therapy [CBT]) are associated with improvements in clinical functioning similar to intensive psychoeducational or supportive therapies. For adolescent bipolar patients there is evidence for FFT and dialectical behavior therapy in stabilizing symptoms and enhancing quality of life, whereas in younger-age patients (i.e., ages 7–14), there is evidence for multifamily group formats that combine psychoeducation with CBT strategies. Finally, there is preliminary evidence that FFT, multifamily psychoeducation, and IPSRT have effects on symptom control in youths at high risk for bipolar disorder. Future research directions include identifying mechanisms of change in current psychotherapies, establishing best-practice treatments for more severe forms of bipolar disorder, examining clinically significant outcomes (e.g., suicidal behaviors, school dropout, unemployment), and developing technology-driven treatment strategies.
Enhancing independent community access and participation Services, technologies, and policies
Authors: Noreau Luc , Boucher Normand , Edwards Geoffrey , Fougeyrollas Patrick , Morales Ernesto , Routhier Francois , Vincent Claude , Gascon Hubert
Published: May 2020

Despite regulations and major efforts aimed at protecting the rights of people with disabilities, there are still huge challenges to ensure community access and full participation of persons with disabilities in society, in a context where the prevalence of disability will increase over the next decades. In this chapter, we examine three aspects of the community access issue—access to services, the value of both existing and emerging technologies, and social and economic policymaking. In addition to an efficient rehabilitation process focusing on physical and mental capabilities, enhancing community access and social participation will require the optimization of access to services such as primary healthcare, family support, the home environment, and job training, which currently are highly variable between jurisdictions. Key concepts in this regard include the notion of resiliency—support for both individuals and their families as well as their communities should aim to enhance the ability of these to rebound from challenging situations and create new ways of functioning. Technologies that enhance mobility, communication, and home adaptation also play an increasingly important role in favouring community access and participation. While these are essential to compensate various forms of disabilities, the current rapid evolution of technologies does not allow adequate efficacy testing, limiting the establishment of best practices or recommendations regarding these products and often overestimating their benefits. Finally, better community access and participation, supported by an enabling environment should not be based on a culture of disability but a culture of ‘ability’ that impacts all citizens regardless of their life situation.
What is diabetes?
Authors: Wright Alexander D.
Published: May 2020

The definition of diabetes, its causes, complications, and basic treatments are outlined. Diabetes mellitus is characterized by increased concentrations of glucose in the blood. The basic defect is a relative or absolute lack of insulin, the pancreatic hormone promoting the transfer of glucose into tissues for storage as glycogen or fat. Type 1 diabetes is due to autoimmune destruction of insulin-producing cells and insulin therapy is essential. Type 2 diabetes is due to a relative lack of insulin, often with tissue insulin resistance. It is a slowly progressive condition so that, although diet and lifestyle changes are often effective initially, oral therapy and insulin may be required eventually. Diabetes is associated with long-term vascular complications affecting both small and large arteries.
Public Bioethics
Authors: Childress James F.
Published: May 2020

Doing public bioethics involves analyzing and assessing actual and proposed public policies regarding biomedicine, healthcare, and public health. “Public bioethics” also refers to commissions, councils, task forces, and the like, that are governmentally established, sponsored, or funded for the purpose of deliberating collectively about bioethical issues, again with a primary goal of recommending public policies. Most chapters in this book grow out of, some reflect on, and all are profoundly shaped by the author’s experiences as a participant in several public bioethics bodies, especially at the national level in the United States. The processes of publicly deliberating in such bodies about bioethical issues and appropriate policies and of publicly justifying collective recommendations have profoundly shaped this book. After examining respect for autonomy—both thin and thick conceptions—and paternalistic policies and practices, as well as the tensions between particular case judgments and general principles and rules, this book next examines the appropriate role of religious convictions in public bioethics and in public policy and in conscientious claims to exemptions from expectations to provide certain health-related services. The third section of the book focuses on public policies and practices in organ transplantation, particularly difficulties in determining death, in obtaining first-person consent for deceased organ donation, and in fairly allocating donated organs. The final section maps the terrain of public health ethics, argues for a presumptivist approach to justifying public health interventions that infringe civil liberties, proposes a framework of triage for public health crises, and recasts John Stuart Mill’s misunderstood legacy for public health ethics.
Anticipating Issues with Capacitous Pregnant Women: United Lincolnshire NHS Hospitals Trust v CD [2019] EWCOP 24 and Guys and St Thomas’ NHS Foundation Trust (GSTT) and South London and Maudsley NHS Foundation Trust (SLAM) v R [2020] EWCOP 4
Authors: Fovargue Sara
Published: May 2020

In United Lincolnshire NHS Hospitals Trust v CD and Guys and St Thomas’ NHS Foundation Trust (GSTT) and South London and Maudsley NHS Foundation Trust (SLAM) v R, the Court of Protection was asked to make anticipatory and contingent declarations relating to the obstetric care and mode of delivery for currently capacitous women who were near to their due date but not yet in labour. In this case note I explore the judges’ reasoning on the legal basis for these declarations. In so doing, I consider the wider implications of employing this seemingly new addition to the Court of Protection’s armoury.
Low rate of azole resistance in cases of avian aspergillosis in Germany
Authors: Barber Amelia E , Scheufen Sandra , Walther Grit , Kurzai Oliver , Schmidt Volker
Published: May 2020

Aspergillosis is the most common fungal disease of the avian respiratory tract. Due to delayed diagnosis and treatment failure, the outcome of these infections is often poor. We investigate 159 cases of avian aspergillosis among captive birds in Germany to define clinical features as well as the frequency of in vitro triazole resistance. Adult birds were more likely to present with clinical signs compared to juvenile birds, and dyspnoea was the most common clinical sign, present in 53% of birds. Molecular species identification indicated that all infections were caused by Aspergillus fumigatus. Only one of 159 independent isolates was azole resistant.
H i scale height in dwarf galaxies
Authors: Patra Narendra Nath
Published: May 2020

Assuming a vertical hydrostatic equilibrium in the baryonic discs, joint Poisson–Boltzmann equation was set up and solved numerically in a sample of 23 nearby dwarf galaxies from the LITTLE-THINGS survey. This is the largest sample to date for which detailed hydrostatic modelling is performed. The solutions of the Poisson–Boltzmann equation provide a complete three-dimensional distribution of the atomic hydrogen (H i) in these galaxies. Using these solutions, we estimate the vertical scale height (defined as the half width at half maxima of the density distribution) of the H i as a function of radius. We find that the scale height in our sample galaxies varies between a few hundred parsec at the centre to a few kiloparsec at the edge. These values are significantly higher than what is observed in spiral galaxies. We further estimate the axial ratios to investigate the thickness of the H i discs in dwarf galaxies. For our sample galaxies, we find a median axial ratio to be 0.40, which is much higher than the same observed in the Milky Way. This indicates that the vertical hydrostatic equilibrium results in thicker H i discs in dwarf galaxies naturally.
Systematically asymmetric: a comparison of H i profile asymmetries in real and simulated galaxies
Authors: Deg N , Blyth S-L , Hank N , Kruger S , Carignan C
Published: May 2020

We examine different measures of asymmetry for galaxy H i velocity profiles. We introduce the channel-by-channel asymmetry and the velocity-of-equality statistics to quantify profile asymmetries. Using a sample of simulated galaxies, we examine how these and the standard lopsidedness morphometric statistic depend on a variety of observational effects, including the viewing angle and inclination. We find that our newly introduced channel-by-channel asymmetry is less sensitive to the effects of viewing angle and inclination than other morphometrics. Applying our statistics to the WHISP (Westerbork H i survey of Irregular and SPiral galaxies) H i galaxy sample, we also find that the channel-by-channel asymmetry is a better indicator of visually classified asymmetric profiles. In addition, we find that the lopsidedness–velocity of equality space can be used to identify profiles with deep central dips without visual inspection.
Correlations between mass, stellar kinematics, and gas metallicity in eagle galaxies
Authors: Zenocratti L J , De Rossi M E , Lara-López M A , Theuns T
Published: May 2020

The metallicity of star-forming gas in galaxies from the eagle (Evolution and Assembly of GaLaxies and their Environments) simulations increases with stellar mass. Here, we investigate whether the scatter around this relation correlates with morphology and/or stellar kinematics. At redshift z = 0, galaxies with more rotational support have lower metallicities on average when the stellar mass is below M⋆ ≈ 1010 M⊙. This trend inverts at higher values of M⋆, when prolate galaxies show typically lower metallicity. At increasing redshifts, the trend between rotational support and metallicity becomes weaker at low stellar mass but more pronounced at high stellar mass. We argue that the secondary dependence of metallicity on stellar kinematics is another manifestation of the observed anticorrelation between metallicity and star formation rate at a given stellar mass. At low masses, such trends seem to be driven by the different star formation histories of galaxies and stellar feedback. At high masses, feedback from active galactic nuclei and galaxy mergers plays a dominant role.
Deep learning for intensity mapping observations: component extraction
Authors: Moriwaki Kana , Filippova Nina , Shirasaki Masato , Yoshida Naoki
Published: May 2020

Line intensity mapping (LIM) is an emerging observational method to study the large-scale structure of the Universe and its evolution. LIM does not resolve individual sources but probes the fluctuations of integrated line emissions. A serious limitation with LIM is that contributions of different emission lines from sources at different redshifts are all confused at an observed wavelength. We propose a deep learning application to solve this problem. We use conditional generative adversarial networks to extract designated information from LIM. We consider a simple case with two populations of emission-line galaxies; H $\rm \alpha$ emitting galaxies at $z$ = 1.3 are confused with [O iii] emitters at $z$ = 2.0 in a single observed waveband at 1.5 $\mu{\textrm m}$. Our networks trained with 30 000 mock observation maps are able to extract the total intensity and the spatial distribution of H $\rm \alpha$ emitting galaxies at $z$ = 1.3. The intensity peaks are successfully located with 74 per cent precision. The precision increases to 91 per cent when we combine five networks. The mean intensity and the power spectrum are reconstructed with an accuracy of ∼10 per cent. The extracted galaxy distributions at a wider range of redshift can be used for studies on cosmology and on galaxy formation and evolution.