bluuebunny/crossref_metadata_2025 huggingface dataset:
Elections and Democracy in the Caribbean
Authors: Barrow-Giles Cynthia , Joseph Tennyson S. D.
Published: August 2020

The works included in this compendium summary address themes relevant to the elections and democracy in the Caribbean region. The states that fall within the relevant “region” include the formerly English, French, and Dutch colonies in the Caribbean Sea and the South and Central American mainland, as well as the remaining English, French, Dutch, Danish, and Spanish colonies in the Caribbean. The aim of this bibliography is to provide readers and researchers with a broad overview of the kinds of theoretical, thematic, and empirical emphases that have framed the questions around which the electoral and democratic landscape of the Caribbean has been studied. For purposes of clarification, the collection does not address Caribbean democracy as a stand-alone isolated issue, but instead provides a survey of works on elections in the Caribbean through the lens of their interrelation with Caribbean democratic history, practice, culture, and constitutional development and institutional framework. (A survey of Caribbean democracy will require isolated treatment). Relatedly, while the article addresses the experience of the wider Caribbean, much of the emphasis on the intellectual output is on the works relevant to the English-speaking Caribbean. Where the experiences of the non-English countries have given rise to critical intellectual interventions, these are included to bring balance to the Caribbean story and to highlight commonalities and divergences, useful for researchers interested in comparative analyses. Following this introduction, the article is divided into eleven thematic sections, examining (1) seminal texts and works on Caribbean democracy and Caribbean elections, or works providing general data and analysis of large blocs of countries or works presenting pathbreaking theoretical treatment of critical issues in Caribbean democracy; (2) texts addressing the issue of the administration and governance of elections, inclusive of concerns with money and electoral financing; (3) texts concerned with constitutional development; (4) texts on electoral reform; (5) works addressing dysfunctionalities such as electoral corruption and electoral violence; (6) women and political participation; (7) public opinion and voting behavior; (8) works concerned with providing analyses of the results and outcomes of Caribbean elections in a largely statistical or data-capturing sense; and (9) works that have sought to offer analyses of Caribbean elections in relation to the broader political-economy of the region. Given the reality of ethnic division and the absence of racial and cultural uniformity in several countries of the Caribbean, one of the sections is devoted to (10) surveying some of the key works that have addressed the challenges of ethnicity, ethnic mobilization, and ethnic voting, and their implications for democratic development. The final section presents (11) the main works that have sought to address the very important question of election monitoring in the Caribbean.
Women and Politics in East and Southeast Asia
Authors: Tan Netina
Published: August 2020

Women’s descriptive representation in East and Southeast Asia remains lower than global average. Apart from Timor-Leste and Taiwan, no country has achieved the 30 percent “critical mass” of women parliamentarians—a number seen as the minimum proportion necessary to influence policies. East and Southeast Asia is a diverse region where, unlike in South Asia, the rise of powerful women leaders came about only in recent decades. With the rise of prominent women leaders, such as Corazon Aquino, Megawati Sukarnoputri, Yingluck Shinawatra, Park Geun-hye, and Aung San Suu Kyi, studies on dynastic or familial ties have become more prominent, and political science and area studies journals now publish frequently on gender and politics in Asia. Previously, qualitative, descriptive work based on historical archives, ethnography, or elite interviews has dominated. With more cross-country and public opinion data sets, however, quantitative studies have flourished. Similar to those dealing with the Global North, theories to explain the supply and demand of women in politics in Asia include: (1) international factors and diffusion theory, (2) women’s activism and mass movements, (3) institutional designs (e.g., quotas, electoral systems, candidate selection, party politics), and (4) culture and religion. Beyond the literature that theorizes how women engage in politics, another body of literature explores the experiences of women in politics. Who wins in elections? What are the experiences of women candidates and politicians? What are the barriers to substantively representing women? Findings demonstrate that highly educated, professional elite women win elections, while women in cabinet tend to hold “soft” and lower profile portfolios. Moreover, many prominent female state and party leaders come to power through their connection with prominent male leaders. The experiences of female politicians also differ depending on the level of politics, namely, local or national level. The status of women’s representation is further impacted by the regime type. A striking anomaly is the higher number of women politicians in authoritarian, one-party states than in established democracies in the region. Yet do authoritarian regimes with high numbers of female representatives better serve women’s interests? What is the relationship between women and democratic revolutions? In the Philippines, Taiwan, and South Korea, women’s activism and women leaders played key roles in democratic revolutions. More research is needed on assessing women’s substantive representation in both regimes. While it is important to examine politics through the lens of gender, it is equally important to understand how gender inequality intersects with ethnic minority and religious identities. Thus far, few researchers have adopted intersectional approaches in examining how women in politics can be disadvantaged by multiple sources of oppression.
POINCARÉ DUALITY, CAP PRODUCT AND BOREL–MOORE INTERSECTION HOMOLOGY
Authors: Saralegi-Aranguren Martintxo , Tanré Daniel
Published: August 2020

Using a cap product, we construct an explicit Poincaré duality isomorphism between the blown-up intersection cohomology and the Borel–Moore intersection homology, for any commutative ring of coefficients and second-countable, oriented pseudomanifolds.
The effect of competitive public funding on scientific output: A comparison between China and the EU
Authors: Wang Lili , Wang Xianwen , Piro Fredrik Niclas , Philipsen Niels J
Published: August 2020

Public funding is believed to play an important role in the development of science and technology. However, whether public funding and, in particular, competitive funding from public agencies actually helps to increase scientific output (i.e. publications) remains a matter of debate. By analysing a dataset of co-publications between China and the EU and a dataset of joint project collaborations in European Framework Programs for Research and Innovation [FP7 and Horizon 2020 (H2020)], we investigate whether different public funding agencies’ competitive assets have different impact on the volume of publication output. Our results support the hypotheses that competitively funded research output varies by funding sources, so that a high level of funding does not necessarily lead to high scientific output. Our results show that FP7/H2020 funded projects do not have a positive contribution to the output of joint publications between China and the EU. Interestingly, cooperation in the form of jointly writing proposals to these EU programmes, especially when they are not granted by the European Commission, can contribute significantly to joint scientific publications in a later stage. This applies in particular to cases where funding from China is involved. Our findings highlight the key role that funding agencies play in influencing research behaviour. Our results indicate that Chinese funding triggers a high number of publications, whereas research funded by the EU does so to a much lower extent, arguably due to the EU’s strong focus on social impact and its funding schemes as tools to promote European integration.
Informational Robustness in Intertemporal Pricing
Authors: Libgober Jonathan , Mu Xiaosheng
Published: August 2020

We introduce a robust approach to study dynamic monopoly pricing of a durable good in the face of buyer learning. A buyer receives information about her willingness-to-pay for the seller’s product over time, and decides when to make a one-time purchase. The seller does not know how the buyer learns but commits to a pricing strategy to maximize profits against the worst-case information arrival process. We show that a constant price path delivers the robustly optimal profit, with profit and price both lower than under known values. Thus, under the robust objective, intertemporal incentives do not arise at the optimum, despite the possibility for information arrival to influence the timing of purchases. We delineate whether constant prices remain optimal (or not) when the seller seeks robustness against a subset of information arrival processes. As part of the analysis, we develop new techniques to study dynamic Bayesian persuasion.
US rheumatologists’ beliefs and knowledge about biosimilars: a survey
Authors: Gibofsky Allan , McCabe Dorothy
Published: August 2020

Objectives

We sought to evaluate perceptions of biosimilar products among US rheumatologists who prescribe TNF-α inhibitors, given that 10 TNF-α inhibitor biosimilars and two rituximab biosimilars have Food and Drug Administration (FDA) approval.

Methods

A 19-question self-administered online survey was conducted from 6 May to 1 June 2019, and fielded by WebMD, LLC. Rheumatologists (n = 9050) who were members of Medscape.com and its partner panels were invited to participate. Likert and other rating scales were used to collect responses, which were summarized descriptively.

Results

Responses were obtained from 320 board-certified US rheumatologists, 85% of whom were fellows of the ACR. Nearly all respondents were familiar with the FDA definition of a biosimilar product and were aware that an infliximab biosimilar was FDA approved; fewer realized that adalimumab, etanercept and rituximab biosimilars were also FDA approved. Most respondents (84%) were aware that an approved biosimilar was not automatically deemed interchangeable by the FDA. Rheumatologists were more likely to initiate biosimilar treatment for a biologic treatment-naïve patient with RA (73%) than they were to switch to the biosimilar for a patient with RA doing well on the reference product (35%).

Conclusions

The results of this survey suggest that US rheumatologists have a good understanding and acceptance of biosimilar products, particularly for the initiation of treatment in biologic-naïve individuals. They were hesitant to switch from a reference product to a biosimilar for a patient doing well on the reference product. Additional education on biosimilars is required to help inform treatment decisions by rheumatologists.

A plain language summary of this article has been uploaded as supplementary material, available at Rheumatology online.
Cannabis use assessment and its impact on pain in rheumatologic diseases: a systematic review and meta-analysis
Authors: Guillouard M , Authier N , Pereira B , Soubrier M , Mathieu S
Published: August 2020

Objectives

Despite classic analgesic or effective treatments in rheumatic diseases, such as synthetic DMARDs in RA, patients remain in pain and often turn to non-prescribed pharmacological alternatives, such as cannabis self-therapeutic use. However, this medical use of cannabis has not been thoroughly studied.

Methods

We performed a systematic literature review up to June 2020. The incidence of cannabis consumption was calculated by metaproportion. Differences between cannabis users and non-users were expressed as standardized mean differences using the inverse-variance method. We also assessed the effects of cannabis on pain.

Results

A total of 2900 patients reported cannabis consumption in a sample of 10 873 patients [incidence 40.4% (95% confidence interval (CI): 0.28, 0.54)], and 15.3% (95% CI: 0.07, 0.27) specified that they were currently taking cannabis. Cannabis use was higher in the four fibromyalgia studies [68.2% (95% CI: 0.41, 0.90), n = 611] compared with seven articles concerning RA or lupus [26.0% (95% CI: 0.14, 0.41), n = 8168]. Cannabis consumption was associated with a decrease in pain intensity [VAS pain at baseline 8.2 (2.9) vs 5.6 (3.5) mm over time; pooled effect size −1.75 (95% CI: −2.75, −0.76)]. Cannabis users were younger [58.4 (11.4) vs 63.6 (12.1) years; P <0.001], more often smokers [OR 2.91 (95% CI: 1.84, 4.60)] or unemployed [OR 2.40 (95% CI: 1.31, 4.40)], and had higher pain intensity [5.0 (2.4) vs 4.1(2.6) mm; P <0.001] than non-users.

Conclusion

Nearly 20% of patients suffering from rheumatologic diseases actively consume cannabis, with an improvement in pain. The issue of cannabis use in the management of these patients should be addressed during medical consultation, essentially with cannabis-based standardized pharmaceutical products.
Morbidity and mortality in antiphospholipid syndrome based on cluster analysis: a 10-year longitudinal cohort study
Authors: Ogata Yusuke , Fujieda Yuichiro , Sugawara Masanari , Sato Taiki , Ohnishi Naoki , Kono Michihito , Kato Masaru , Oku Kenji , Amengual Olga , Atsumi Tatsuya
Published: August 2020

Objective

Using cluster analysis, to identify the subgroup of patients with APS with the poorest prognosis and clarify the characteristics of that subgroup.

Methods

This is a longitudinal retrospective cohort study of APS patients. Using clinical data and the profile of aPL, cluster analysis was performed to classify the patients into subgroups. Events were defined as thrombosis, severe bleeding, and mortality.

Results

A total of 168 patients with APS were included. Cluster analysis classified the patients into three subgroups; Cluster A (n = 61): secondary APS, Cluster B (n = 56): accumulation of cardiovascular risks and arterial thrombosis, Cluster C (n = 61): triple positivity of aPL and venous thrombosis. Cluster B showed significantly higher frequency of the events and higher mortality compared with the other clusters (P = 0.0112 for B vs A and P = 0.0471 for B vs C).

Conclusion

Using cluster analysis, we clarified the characteristics of the APS patients with the poorest prognosis. Risk factors for cardiovascular disease may further increase events in patients with APS.
ASSESSING RADIATION EXPOSURE INSIDE THE EARTH’S ATMOSPHERE
Authors: Tezari Anastasia , Paschalis Pavlos , Mavromichalaki Helen , Karaiskos Pantelis , Crosby Norma , Dierckxsens Mark
Published: August 2020

The study of the particle showers created inside the Earth’s atmosphere due to interactions of cosmic rays of solar and galactic origin is of great importance for the determination of the radiation impact on technological and biological systems. DYASTIMA is a Geant4-based software application that simulates the evolution of secondary particle cascades inside the atmosphere of Earth. DYASTIMA-R is a new feature especially created for assessing the exposure of flight-personnel and frequent flyers to cosmic radiation by performing calculations of radiobiological quantities, such as dose and equivalent dose rates for several air-flight scenarios. In this work, the validation of DYASTIMA/DYASTIMA-R, according to internationally accepted ICRP and ICRU standards, is discussed. Initial results for radiobiological quantities for several air-flight scenarios are also included. The results for specific scenarios calculated by DYASTIMA/DYASTIMA-R are provided as a federated product through the European Space Agency Space Situational Awareness Space Weather Service Centre Network.
Getting a Job, Again: New Evidence against Subjective Well-Being Scarring
Authors: Rauf Tamkinat
Published: August 2020

Previous research finds that unemployment leaves permanent “scars” on subjective well-being (SWB) that remain even after reemployment. However, this research systematically overweighs long-term unemployment, inaccurately measures employment transitions, often does not track individuals long enough to substantiate scarring, and does not always account for age-related changes in well-being. This paper uses event history calendars from the Panel Study of Income Dynamics to track complete monthly employment histories of prime working age Americans over a 17-year period, and accounts for the temporal relationships between SWB, age, and employment transitions using a novel fixed-effects formulation. The results suggest that there is some variation in patterns of recovery by employment stability after job loss, but no significant differences were observed by the duration of unemployment spells. Within 2 years of reemployment, average SWB levels reverted toward baseline trajectories across all groups, showing no evidence of scarring. This study brings unemployment literature into better alignment with research on resilience and adaptation. The findings also highlight some limitations of the construct of SWB for assessing the long-term costs of unemployment.
Threat and Emotions: Mobilizing and Attitudinal Outcomes of a Ballistic Missile Scare
Authors: Bergstrand Kelly , Robertson Christopher
Published: August 2020

This study examines the false ballistic missile alert that occurred in Hawaii in 2018, which presented a unique opportunity for assessing the civic and mobilizing outcomes of a threat. In the days that followed the scare, we conducted an online experiment to investigate its effects on willingness to engage in activism and concerns about broader issues. Our results show that emotions serve as an important mechanism for channeling threat experiences into concern about specific causes. Those most emotionally affected by the missile scare in Hawaii thought it more important to engage in activities to control the spread of nuclear weapons, protect the environment, and address climate change, relative to a control group on the mainland. Both the intensity and type of emotion play a role. These results shed light on the role of threats and grievances in shaping concern about social and environmental issues. They also suggest that emotions may serve as a bridge that can connect personal, concrete, lived-experiences to more abstract, complex, or future-oriented issues and grievances.
Development of an online tool for linking behavior change techniques and mechanisms of action based on triangulation of findings from literature synthesis and expert consensus
Authors: Johnston Marie , Carey Rachel N , Connell Bohlen Lauren E , Johnston Derek W , Rothman Alexander J , de Bruin Marijn , Kelly Michael P , Groarke Hilary , Michie Susan
Published: August 2020

Researchers, practitioners, and policymakers develop interventions to change behavior based on their understanding of how behavior change techniques (BCTs) impact the determinants of behavior. A transparent, systematic, and accessible method of linking BCTs with the processes through which they change behavior (i.e., their mechanisms of action [MoAs]) would advance the understanding of intervention effects and improve theory and intervention development. The purpose of this study is to triangulate evidence for hypothesized BCT–MoA links obtained in two previous studies and present the results in an interactive, online tool. Two previous studies generated evidence on links between 56 BCTs and 26 MoAs based on their frequency in literature synthesis and on expert consensus. Concordance between the findings of the two studies was examined using multilevel modeling. Uncertainties and differences between the two studies were reconciled by 16 behavior change experts using consensus development methods. The resulting evidence was used to generate an online tool. The two studies showed concordance for 25 of the 26 MoAs and agreement for 37 links and for 460 “nonlinks.” A further 55 links were resolved by consensus (total of 92 [37 + 55] hypothesized BCT–MoA links). Full data on 1,456 possible links was incorporated into the online interactive Theory and Technique Tool (https://theoryandtechniquetool.humanbehaviourchange.org/). This triangulation of two distinct sources of evidence provides guidance on how BCTs may affect the mechanisms that change behavior and is available as a resource for behavior change intervention designers, researchers and theorists, supporting intervention design, research synthesis, and collaborative research.
Draft Genome of Fusarium oxysporum f. sp. cubense Strain Tropical Race-4 Infecting Cavendish (AAA) Group of Banana in India
Authors: Thangavelu R. , Edwin Raj E. , Pushpakanth P. , Loganathan M. , Uma S.
Published: August 2020

Fusarium wilt, caused by the fungus Fusarium oxysporum f. sp. cubense, is the most serious pandemic disease of banana. In this study, we report the draft genome of F. oxysporum f. sp. cubense vegetative compatibility group (VCG) 01213/16 of strain tropical race 4 (TR4) that infects the Cavendish (AAA) group of banana collected from the subtropical region in India. The genome assembly of SFoc TR4 comprises 47,384,463 bp with 4,034 contigs and 15,508 protein-coding regions. Based on VCG analysis, the fungal isolate belongs to F. oxysporum f. sp. cubense TR4 but the genome sequence of SFoc TR4 shows differences in secreted-in-xylem (SIX) protein gene clusters (specifically, SIX8) in comparison with the reference genome of F. oxysporum f. sp. lycopersici and F. oxysporum f. sp. cubense TR4.
Foliar Chemical Protection Against Pantoea ananatis in Onion Is Negated by Thrips Feeding
Authors: Stumpf Spencer , Leach Leana , Srinivasan Rajagopalbabu , Coolong Timothy , Gitaitis Ron , Dutta Bhabesh
Published: August 2020

Center rot of onion, caused by Pantoea ananatis, is an economically important disease in onion production in Georgia and elsewhere in the United States. Growers rely on frequent foliar applications of bactericides and, in some cases, plant defense inducers to manage this disease. However, regular prophylactic application of these chemicals is not cost-effective and may not be environmentally friendly. Thrips (Thrips tabaci and Frankliniella fusca) are vectors of P. ananatis, and their feeding may compromise the effectiveness of foliar applications against P. ananatis. In this study, foliar treatments with acibenzolar-S-methyl (Actigard 50WG), cupric hydroxide (Kocide 3000), and Actigard plus Kocide were evaluated for their effectiveness in the presence and absence of thrips infestation at two critical onion growth stages: bulb initiation and bulb swelling. Onion growth stage had no impact on the effectiveness of either Kocide or Actigard. In the absence of thrips, Kocide application resulted in reduced center rot incidence compared with Actigard, regardless of the growth stage. However, when thrips were present, the efficacy of both Kocide and Actigard was reduced, with bulb incidence not significantly different from the nontreated control. In independent greenhouse studies in the presence or absence of thrips, it was observed that use of protective chemicals (Kocide, Actigard, and their combinations) at different rates also affected pathogen progression into internal neck tissue and incidence of bulb rot. These results suggest that thrips infestation can reduce the efficacy of protective chemical treatments against P. ananatis. Thrips feeding on onion foliage and resulting feeding scars could facilitate P. ananatis entry and subsequently compromise the efficacy of protective chemical treatments. Therefore, an effective center rot management strategy should likely include thrips management in addition to bactericides at susceptible growth stages of onion.
The Fungal Endophyte Epicoccum dendrobii as a Potential Biocontrol Agent Against Colletotrichum gloeosporioides
Authors: Bian Jin-Yue , Fang Yu-Lan , Song Qing , Sun Mei-Ling , Yang Ji-Yun , Ju Yun-Wei , Li De-Wei , Huang Lin
Published: August 2020

Anthracnose caused by Colletotrichum gloeosporioides is one of most serious fungal diseases on Chinese fir (Cunninghamia lanceolata). Eight fungal endophytes were isolated from a young heathy branch of Chinese fir and screened against the pathogen in vitro. One isolate, designated as SMEL1 and subsequently identified as Epicoccum dendrobii based on morphological and phylogenetic analyses, suppressed mycelial growth of Colletotrichum gloeosporioides on dual-culture plates. Additionally, E. dendrobii metabolites significantly decreased the biomass of Colletotrichum gloeosporioides. E. dendrobii was able to enter the internal tissues of the host plant via stomatal cells. Metabolites of E. dendrobii significantly inhibited conidial germination and appressorium formation, which at least partly explained why the endophyte significantly inhibited lesion development caused by Colletotrichum gloeosporioides on various host plants. We further confirmed that some components with antifungal activity could be extracted from E. dendrobii using ethyl acetate as an organic solvent. To our knowledge, this is the first report of E. dendrobii as a potential biocontrol agent against a fungal phytopathogen.
Clade-Specific Biosurveillance of Pseudoperonospora cubensis Using Spore Traps for Precision Disease Management of Cucurbit Downy Mildew
Authors: Rahman A. , Standish J. R. , D’Arcangelo K. N. , Quesada-Ocampo L. M.
Published: August 2020

Pseudoperonospora cubensis is an obligate oomycete and cause of cucurbit downy mildew (CDM), the most destructive foliar disease affecting cucurbit hosts. Annual epidemics develop throughout the United States as windborne sporangia travel great distances and survive prolonged exposure to solar radiation. Recent genomic evidence suggests that P. cubensis isolates display host adaptation based on their respective clade. Early detection is key for fungicide application timing, and identification of the host-adapted clade provides information on the risk of infection for specific cucurbit crops. In this study, a multiplex quantitative PCR assay was developed based on species- and clade-specific nuclear genomic markers. The assay detected as few as 10 sporangia or DNA at 100 fg/ml for both clades and was validated in the field by deploying rotorod spore samplers in cucurbit sentinel plots located at two research stations in North Carolina. Using this assay, sporangia DNA was detected in spore trap sampling rods before signs of P. cubensis or CDM symptoms were observed in the sentinel plots. Both clade 1 and clade 2 DNA were detected in late-season cucumber and watermelon plots but only clade 2 DNA was detected in the early-season cucumber plots. These results will significantly improve disease management of CDM by monitoring inoculum levels to determine the cucurbit crops at risk of infection throughout each growing season.
Peeling the Onion: Towards a Better Understanding of Botrytis Diseases of Onion
Authors: Steentjes Maikel B. F. , Scholten Olga E. , van Kan Jan A. L.
Published: August 2020

Onion is cultivated worldwide for its bulbs, but production is threatened by pathogens and pests. Three distinct diseases of onion are caused by species that belong to the fungal genus Botrytis. Leaf blight is a well-known foliar disease caused by B. squamosa that can cause serious yield losses. Neck rot is a postharvest disease that manifests in bulbs after storage and is associated with three species: B. aclada, B. allii, and B. byssoidea. The symptomless infection of onion plants in the field makes it difficult to predict the incidence of neck rot in storage, although progress on the detection of latent infection has been made. In onion cultivation for seed production, blighting of the inflorescence is caused by all four onion-specific Botrytis species plus the broad host range pathogen B. cinerea. Flower blight can reduce seed yield and contaminate seed. In this review, the long history of Botrytis diseases of onion is discussed, as well as recent and future approaches to acquire a better understanding of the biology and ecology of Botrytis spp. pathogenic on onion. New fundamental insights in the genetic, biochemical, and physiological aspects of Botrytis–onion interactions are essential to improve the breeding of Botrytis-resistant onion cultivars.

[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Automated Algorithm Analysis of Sublingual Microcirculation in an International Multicentral Database Identifies Alterations Associated With Disease and Mechanism of Resuscitation
Authors: Hilty Matthias Peter , Akin Sakir , Boerma Christiaan , Donati Abele , Erdem Özge , Giaccaglia Paolo , Guerci Philippe , Milstein Dan MJ , Montomoli Jonathan , Toraman Fevzi , Uz Zuhre , Veenstra Gerke , Ince Can
Published: August 2020

Objectives:

Reliable automated handheld vital microscopy image sequence analysis and the identification of disease states and effects of therapy are prerequisites for the routine use of quantitative sublingual microcirculation measurements at the point-of-care. The present study aimed to clinically validate the recently introduced MicroTools software in a large multicentral database of perioperative and critically ill patients and to use this automatic algorithm to data-mine and identify the sublingual microcirculatory variable changes in response to disease and therapy.

Design:

Retrospective algorithm-based image analysis and data-mining within a large international database of sublingual capillary microscopy. Algorithm-based analysis was compared with manual analysis for validation. Thereafter, MicroTools was used to identify the functional microcirculatory alterations associated with disease conditions and identify therapeutic options for recruiting functional microcirculatory variables.

Setting:

Ten perioperative/ICU/volunteer studies in six international teaching hospitals.

Patients:

The database encompass 267 adult and pediatric patients undergoing surgery, treatment for sepsis, and heart failure in the ICU and healthy volunteers.

Interventions:

Perioperative and ICU standard of care.

Measurements and Main Results:

One thousand five hundred twenty-five handheld vital microscopy image sequences containing 149,257 microscopy images were analyzed. 3.89 × 1012 RBC positions were tracked by the algorithm in real time, and offline manual analysis was performed. Good correlation and trending ability were found between manual and automatic total and functional capillary density (r = 0.6–0.8; p < 0.0001). RBC tracking within the database demonstrated changes in functional capillary density and/or RBC velocity in septic shock, heart failure, hypovolemia, obstructive shock, and hemodilution and thus detected the presence of a disease condition. Therapies recruiting the microcirculatory diffusion and convection capacity associated with systemic vasodilation and an increase in cardiac output were separately identified.

Conclusions:

Algorithm-based analysis of the sublingual microcirculation closely matched manual analysis across a broad spectrum of populations. It successfully identified a methodology to quantify microcirculatory alterations associated with disease and the success of capillary recruitment, improving point-of-care application of microcirculatory-targeted resuscitation procedures.
Evaluating Physical Functioning in Survivors of Critical Illness: Development of a New Continuum Measure for Acute Care*
Authors: Parry Selina M. , Knight Laura D. , Baldwin Claire E. , Sani Diana , Kayambu Geetha , Da Silva Vinicius Maldaner , Phongpagdi Pimsiri , Clarke Sandy , Puthucheary Zudin , Morris Peter , Denehy Linda , Granger Catherine L.
Published: August 2020

Objectives:

Evaluation of physical functioning is central to patient recovery from critical illness—it may enable the ability to determine recovery trajectories, evaluate rehabilitation efficacy, and predict individuals at highest risk of ongoing disability. The Physical Function in ICU Test-scored is one of four recommended physical functioning tools for use within the ICU; however, its utility outside the ICU is poorly understood. The De Morton Mobility Index is a common geriatric mobility tool, which has had limited evaluation in the ICU population. For the field to be able to track physical functioning recovery, we need a measurement tool that can be used in the ICU and post-ICU setting to accurately measure physical recovery. Therefore, this study sought to: 1) examine the clinimetric properties of two measures (Physical Function in ICU Test-scored and De Morton Mobility Index) and 2) transform these measures into a single measure for use across the acute care continuum.

Design:

Clinimetric analysis.

Setting:

Multicenter study across four hospitals in three countries (Australia, Singapore, and Brazil).

Patients:

One hundred fifty-one ICU patients.

Interventions:

None.

Measurements and Main Results:

Physical function tests (Physical Function in ICU Test-scored and De Morton Mobility Index) were assessed at ICU awakening, ICU, and hospital discharge. A significant floor effect was observed for the De Morton Mobility Index at awakening (23%) and minimal ceiling effects across all time points (5–12%). Minimal floor effects were observed for the Physical Function in ICU Test-scored across all time points (1–7%) and a significant ceiling effect for Physical Function in ICU Test-scored at hospital discharge (27%). Both measures had strong concurrent validity, responsiveness, and were predictive of home discharge. A new measure was developed using Rasch analytical principles, which involves 10 items (scored out of 19) with minimal floor/ceiling effects.

Conclusions:

Limitations exist for Physical Function in ICU Test-scored and De Morton Mobility Index when used in isolation. A new single measure was developed for use across the acute care continuum.
Mediators of the Impact of Hourly Net Ultrafiltration Rate on Mortality in Critically Ill Patients Receiving Continuous Renal Replacement Therapy
Authors: Naorungroj Thummaporn , Neto Ary Serpa , Zwakman-Hessels Lara , Fumitaka Yanase , Eastwood Glenn , Murugan Raghavan , Kellum John A. , Bellomo Rinaldo
Published: August 2020

Objectives:

During continuous renal replacement therapy, a high net ultrafiltration rate has been associated with increased mortality. However, it is unknown what might mediate its putative effect on mortality. In this study, we investigated whether the relationship between early (first 48 hr) net ultrafiltration and mortality is mediated by fluid balance, hemodynamic instability, or low potassium or phosphate blood levels using mediation analysis and the primary outcome was hospital mortality.

Design:

Retrospective, observational study.

Setting:

Mixed medical and surgical ICUs at Austin hospital, Melbourne, Australia.

Patients:

Critically ill patients treated with continuous renal replacement therapy within 14 days of ICU admission who survived greater than 48 hours.

Interventions:

None.

Measurements and Main Results:

We studied 347 patients (median [interquartile range] age: 64 yr [53–71 yr] and Acute Physiology and Chronic Health Evaluation III score: 73 (54–90)]. After adjustment for confounders, compared with a net ultrafiltration less than 1.01 mL/kg/hr, a net ultrafiltration rate greater than 1.75 mL/kg/hr was associated with significantly greater mortality (adjusted odds ratio, 1.15; 95% CI, 1.03–1.29; p = 0.011). Adjusted univariable mediation analysis found no suggestion of a causal mediation pathway for this effect by blood pressure, vasopressor therapy, or potassium levels, but identified a possible mediation effect for fluid balance (average causal mediation effect, 0.95; 95% CI, 0.89–1.00; p = 0.060) and percentage of phosphate measurements with hypophosphatemia (average causal mediation effect, 0.96; 95% CI, 0.92–1.00; p = 0.055). However, on multiple mediator analyses, these two variables showed no significant effect. In contrast, a high net ultrafiltration rate had an average direct effect of 1.24 (95% CI, 1.11–1.40; p < 0.001).

Conclusions:

An early net ultrafiltration greater than 1.75 mL/kg/hr was independently associated with increased hospital mortality. Its putative effect on mortality was direct and not mediated by a causal pathway that included fluid balance, low blood pressure, vasopressor use, hypokalemia, or hypophosphatemia.
Utilization of the Signature Method to Identify the Early Onset of Sepsis From Multivariate Physiological Time Series in Critical Care Monitoring
Authors: Morrill James H. , Kormilitzin Andrey , Nevado-Holgado Alejo J. , Swaminathan Sumanth , Howison Samuel D. , Lyons Terry J.
Published: August 2020

Objectives:

Patients in an ICU are particularly vulnerable to sepsis. It is therefore important to detect its onset as early as possible. This study focuses on the development and validation of a new signature-based regression model, augmented with a particular choice of the handcrafted features, to identify a patient’s risk of sepsis based on physiologic data streams. The model makes a positive or negative prediction of sepsis for every time interval since admission to the ICU.

Design:

The data were sourced from the PhysioNet/Computing in Cardiology Challenge 2019 on the “Early Prediction of Sepsis from Clinical Data.” It consisted of ICU patient data from three separate hospital systems. Algorithms were scored against a specially designed utility function that rewards early predictions in the most clinically relevant region around sepsis onset and penalizes late predictions and false positives.

Setting:

The work was completed as part of the PhysioNet 2019 Challenge alongside 104 other teams.

Patients:

PhysioNet sourced over 60,000 ICU patients with up to 40 clinical variables for each hour of a patient’s ICU stay. The Sepsis-3 criteria was used to define the onset of sepsis.

Interventions:

None.

Measurements and Main Results:

The algorithm yielded a utility function score which was the first placed entry in the official phase of the challenge.
Characteristics, Hospital Course, and Outcomes of Patients Requiring Prolonged Acute Versus Short-Term Mechanical Ventilation in the United States, 2014–2018*
Authors: Zilberberg Marya D. , Nathanson Brian H. , Ways Judy , Shorr Andrew F.
Published: August 2020

Objectives:

Most patients requiring mechanical ventilation only require it for a short term (< 4 d of mechanical ventilation). Those undergoing prolonged acute mechanical ventilation (≥ 4 d mechanical ventilation) represent a select cohort who face significant morbidity, mortality, and resource utilization. Using administrative codes, we identified prolonged acute mechanical ventilation and short-term mechanical ventilation patients and compared their baseline characteristics, hospital events, and hospital outcomes.

Design:

Retrospective cohort.

Setting:

Seven-hundred eighty-seven acute care hospitals, United States, contributing data to Premier database, 2014–2018.

Patients:

Patients on mechanical ventilation.

Interventions:

None.

Measurements and Main Results:

Among 691,961 patients meeting the enrollment criteria, 266,374 (38.5%) received prolonged acute mechanical ventilation. At baseline, patients on prolonged acute mechanical ventilation were similar to short-term mechanical ventilation in age (years: 62.0 ± 15.8 prolonged acute mechanical ventilation vs 61.7 ± 17.2 short-term mechanical ventilation), gender (males: 55.6% prolonged acute mechanical ventilation vs 53.9% short-term mechanical ventilation), and race (white: 69.1% prolonged acute mechanical ventilation vs 72.4% short-term mechanical ventilation). The prolonged acute mechanical ventilation group had a higher comorbidity burden than short-term mechanical ventilation (mean Charlson Score 3.5 ± 2.7 vs 3.1 ± 2.7). The prevalence of vasopressors (50.3% vs 36.9%), dialysis (19.4% vs 10.3%), severe sepsis (20.3% vs 10.3%), and septic shock (33.5% vs 15.9%) was higher in prolonged acute mechanical ventilation than short-term mechanical ventilation. Hospital mortality (29.75% vs 21.1%), combined mortality, or discharge to hospice (37.2% vs 25.3%), extubation failure (12.3% vs 6.1%), tracheostomy (21.6% vs 4.5%), development of Clostridium difficile (4.5% vs 1.7%), and incidence density of ventilator-associated pneumonia (2.4/1,000 patient-days vs 0.6/1,000 patient-days) were all higher in the setting of prolonged acute mechanical ventilation than short-term mechanical ventilation. Median (interquartile range) post mechanical ventilation onset length of stay (13 [8–20] vs 4 d [1–8 d]) and hospital costs ($55,014 [$35,051–$88,007] vs $20,120 [$12,071–$34,915] were higher in prolonged acute mechanical ventilation than short-term mechanical ventilation.

Conclusions:

Over one-third of all hospitalized patients on mechanical ventilation require it for greater than or equal to 4 days. Prolonged acute mechanical ventilation patients exhibit a higher burden of both chronic and acute illness and experience higher rates than those on short-term mechanical ventilation of hospital-acquired complications and worse clinical and economic outcomes.
Safety and Feasibility of Physical Rehabilitation and Active Mobilization in Patients Requiring Continuous Renal Replacement Therapy: A Systematic Review
Authors: Mayer Kirby P. , Joseph-Isang Ekaette , Robinson Lauren E. , Parry Selina M. , Morris Peter E. , Neyra Javier A.
Published: August 2020

Objectives:

To evaluate the safety and feasibility of physical rehabilitation and active mobilization in patients requiring continuous renal replacement therapy in the ICU.

Data Sources:

Medline, CINAHL, PubMed, Pedro, and Cochrane Library were used to extract articles focused on physical activity and mobility in this population.

Study Selection:

Research articles were included in this review if 1) included adult patients greater than or equal to 18 years old requiring continuous renal replacement therapy located in the ICU; 2) described physical rehabilitation, active mobilization, or physical activity deliverables; 3) reported data on patient safety and/or feasibility. The primary outcome was safety, defined as number of adverse events per total number of sessions.

Data Extraction:

Five-hundred seven articles were evaluated based on title and abstract with reviewers selecting 46 to assess by full text. Fifteen observational studies were included for final analysis with seven studies focused solely on physical activity in patients requiring continuous renal replacement therapy.

Data Synthesis:

Four-hundred thirty-seven adult ICU patients requiring continuous renal replacement therapy participated in some form of physical rehabilitation, physical activity, or active mobilization. Two major adverse events (hypotension event requiring vasopressor and continuous renal replacement therapy tube disconnection, pooled occurrence rate 0.24%) and 13 minor adverse events (pooled occurrence rate 1.55%) were reported during a total of 840 individual mobility or activity sessions. Intervention fidelity was limited by a low prevalence of higher mobility with only 15.5% of incidences occurring at or above level 5 of ICU Mobility Scale (transfer to chair, marching in place or ambulation away from bed, 122/715 reports). Feasibility in the provision of these interventions and/or continuous renal replacement therapy–specific deliverables was inconsistently reported.

Conclusions:

Early rehabilitation and mobilization, specifically activity in and near the hospital bed, appears safe and mostly feasible in ICU patients requiring continuous renal replacement therapy. A cautious interpretation of these data is necessary due to limited aggregate quality of included studies, heterogeneous reporting, and overall low achieved levels of mobility potentially precluding the occurrence or detection of adverse events.
Effects of adding a combined femoral and sciatic nerve block with levobupivacaine and clonidine to general anaesthesia in femoropopliteal bypass surgery
Authors: Charvin Martin , Longeras François , Jouve Philippe , Cherprenet Anne-Laure , Futier Emmanuel , Pereira Bruno , Dualé Christian
Published: August 2020

BACKGROUND

Adding a regional block to general anaesthesia can prevent postoperative pain and improve peripheral circulation.

OBJECTIVE

To seek improved postoperative analgesia and care due to a long-acting combined femoral and sciatic nerve block in patients undergoing femoropopliteal bypass surgery.

DESIGN

A randomised, double-blind, controlled trial.

SETTING

Vascular surgery unit of a French university hospital.

PATIENTS

Forty-four adults scheduled for bypass surgery under general anaesthesia.

INTERVENTION

Patients were allocated to receive either an active nerve block with 20 ml of 0.375% levobupivacaine and clonidine 0.5 μg kg–1, or a simulated (sham) block only, but with local anaesthesia of the skin, before general anaesthesia. General anaesthesia was standardised with propofol, then sevoflurane and sufentanil adjusted according to clinical need. Postoperative analgesia was standardised with paracetamol 1 g every 6 h, and intravenous morphine, initially titrated in the postanaesthesia care unit and then patient-controlled. Oral analgesics were repeated up to day 3.

MAIN OUTCOME MEASURES

The primary outcome was morphine consumption during the first 24 postoperative hours. In a subgroup of postoperative patients distal tissue oxygen saturation was recorded at the lateral side of the blocked calf.

RESULTS

Patients in the active group received less intra-operative sufentanil (median dose 25 vs. 41 μg), needed less morphine during the first 24 h (15 vs. 27 mg) and 72 (20 vs. 35 mg) postoperative hours, than in the control group. They also had less pain on movement, but pain at rest, the tissue oxygen saturation and other rehabilitation outcomes were unaffected by the treatment. Tolerance outcomes were also similar between groups.

CONCLUSION

Combining the two regional blocks improves the quality of postoperative care in this frail population, probably by reducing the amount of peri-operative opioid.

TRIAL REGISTRATION

ClinicalTrials.gov (ref. NCT01785693).
Pulmonary rehabilitation in interstitial lung diseases
Authors: Makhdami Nima , Farooqi Malik , Thom-Fernandes Cedel , Raghavan Natya G.
Published: August 2020

Purpose of review

This review will provide an overview of the components and current evidence to support pulmonary rehabilitation in patients with interstitial lung diseases (ILD), focusing on the latest findings in enhancing quality of life and functional capacity using exercise training and education.

Recent findings

Recent literature demonstrates a longer duration of pulmonary rehabilitation results in sustained improvements in functional capacity and quality of life in patients with ILD. Educational components tailored to ILD provide added value to supervised exercise training. Enhancing exercise training with hyperoxia merits further study and other modalities such as pursed-lip breathing have been shown to be counterproductive.

Recent evidence continues to support the use of tailored pulmonary rehabilitation programs in patients with ILD. Areas which require further investigation include identifying optimal exercise training regimens, educational topics, and breathing techniques that are specifically designed for ILD.