bluuebunny/crossref_metadata_2025 huggingface dataset:
Commonly Used Screening Instruments to Identify Frailty Among Community-Dwelling Older People in a General Practice (Primary Care) Setting: A Study of Diagnostic Test Accuracy
Authors: Ambagtsheer Rachel C , Visvanathan Renuka , Dent Elsa , Yu Solomon , Schultz Timothy J , Beilby Justin
Published: November 2019

Background

Rapid frailty screening remains problematic in primary care. The diagnostic test accuracy (DTA) of several screening instruments has not been sufficiently established. We evaluated the DTA of several screening instruments against two reference standards: Fried’s Frailty Phenotype [FP] and the Adelaide Frailty Index [AFI]), a self-reported questionnaire.

Methods

DTA study within three general practices in South Australia. We randomly recruited 243 general practice patients aged 75+ years. Eligible participants were 75+ years, proficient in English and community-dwelling. We excluded those who were receiving palliative care, hospitalized or living in a residential care facility.

We calculated sensitivity, specificity, predictive values, likelihood ratios, Youden Index and area under the curve (AUC) for: Edmonton Frail Scale [EFS], FRAIL Scale Questionnaire [FQ], Gait Speed Test [GST], Groningen Frailty Indicator [GFI], Kihon Checklist [KC], Polypharmacy [POLY], PRISMA-7 [P7], Reported Edmonton Frail Scale [REFS], Self-Rated Health [SRH] and Timed Up and Go [TUG]) against FP [3+ criteria] and AFI [>0.21].

Results

We obtained valid data for 228 participants, with missing scores for index tests multiply imputed. Frailty prevalence was 17.5% frail, 56.6% prefrail [FP], and 48.7% frail, 29.0% prefrail [AFI]. Of the index tests KC (Se: 85.0% [70.2–94.3]; Sp: 73.4% [66.5–79.6]) and REFS (Se: 87.5% [73.2–95.8]; Sp: 75.5% [68.8–81.5]), both against FP, showed sufficient diagnostic accuracy according to our prespecified criteria.

Conclusions

Two screening instruments—the KC and REFS, show the most promise for wider implementation within general practice, enabling a personalized approach to care for older people with frailty.
Optimizing geophysical muon radiography using information theory
Authors: Benton C J , Mitchell C N , Coleman M , Paling S M , Lincoln D L , Thompson L , Clark S J , Gluyas J G
Published: November 2019

Cosmic ray muons are highly penetrating, with some reaching several kilometres into solid rock. Consequently, muon detectors have been used to probe the interiors of large geological structures, by observing how the muon flux varies with direction of arrival. There is an increasing need to discriminate between materials differing only slightly in bulk density. A particularly demanding application is in monitoring underground reservoirs used for CO2 capture and storage, where bulk density changes of approximately 1 per cent are anticipated. Muon arrival is a random process, and it is the underlying expectation values, not the actual muon counts, which provide information on the physical parameters of the system. It is therefore necessary to distinguish between differences in muon counts due to real geological features, and those arising from random error. This is crucial in the low-contrast case, where the method can reach the information theoretic limit of what a data source can reveal, even in principle. To this end, methods to analyse information availability in low-contrast muon radiography have been developed, as have means to optimally interpret the available data, both for radiography and for tomography. This includes a method for calculating expectation values of muon flux for a given geological model directly, complementing existing Monte Carlo techniques. A case study, using a model of carbon capture is presented. It is shown that the new data analysis techniques have the potential to approximately double the effective sensitivity of the detectors.
Technological leadership (de)concentration: causes in information and communication technology equipment
Authors: Ozcan Yasin , Greenstein Shane
Published: November 2019

Using patent data from 1976 to 2010 as indicators of inventive activity, we determine the concentration level of where inventive ideas originate and then examine how and why those concentrations change over time. The analysis finds pervasive deconcentration in every area related to the Information and Communication Technology equipment market. We find that booms and busts play an important role in deconcentration trends. In comparison, new entry explains surprisingly little and merger and acquisition activity does not revert the trend.
Image-based, unsupervised estimation of fish size from commercial landings using deep learning
Authors: Álvarez-Ellacuría Amaya , Palmer Miquel , Catalán Ignacio A , Lisani Jose-Luis
Published: November 2019

The dynamics of fish length distribution is a key input for understanding the fish population dynamics and taking informed management decisions on exploited stocks. Nevertheless, in most fisheries, the length of landed fish is still made by hand. As a result, length estimation is precise at fish level, but due to the inherent high costs of manual sampling, the sample size tends to be small. Accordingly, the precision of population-level estimates is often suboptimal and prone to bias when properly stratified sampling programmes are not affordable. Recent applications of artificial intelligence to fisheries science are opening a promising opportunity for the massive sampling of fish catches. Here, we present the results obtained using a deep convolutional network (Mask R-CNN) for unsupervised (i.e. fully automatic) European hake length estimation from images of fish boxes automatically collected at the auction centre. The estimated mean of fish lengths at the box level is accurate; for average lengths ranging 20–40 cm, the root-mean-square deviation was 1.9 cm, and maximum deviation between the estimated and the measured mean body length was 4.0 cm. We discuss the challenges and opportunities that arise with the use of this technology to improve data acquisition in fisheries.
Case-based surveillance of antimicrobial resistance with full susceptibility profiles
Authors: Ryu Sukhyun , Cowling Benjamin J , Wu Peng , Olesen Scott , Fraser Christophe , Sun Daphne S , Lipsitch Marc , Grad Yonatan H
Published: November 2019

Surveillance of antimicrobial resistance (AMR) is essential for clinical decision-making and for public health authorities to monitor patterns in resistance and evaluate the effectiveness of interventions and control measures. Existing AMR surveillance is typically based on reports from hospital laboratories and public health laboratories, comprising reports of pathogen frequencies and resistance frequencies among each species detected. Here we propose an improved framework for AMR surveillance, in which the unit of surveillance is patients with specific conditions, rather than biological samples of a particular type. In this ‘case-based’ surveillance, denominators as well as numerators will be clearly defined with clinical relevance and more comparable at the local, national and international level. In locations with sufficient resources, individual-based data on patient characteristics and full antibiotic susceptibility profiles would provide high-quality evidence for monitoring resistant pathogens of clinical importance, clinical treatment of infections and public health responses to outbreaks of infections with resistant bacteria.
Prognostic impact of pelvic and para-aortic lymphadenectomy on clinically-apparent stage I primary mucinous epithelial ovarian carcinoma: a multi-institutional study with propensity score-weighted analysis
Authors: Yoshihara Masato , Kajiyama Hiroaki , Tamauchi Satoshi , Iyoshi Shohei , Yokoi Akira , Suzuki Shiro , Kawai Michiyasu , Nagasaka Tetsuro , Takahashi Kunihiko , Matsui Shigeyuki , Kikkawa Fumitaka
Published: November 2019

Background

The exact impact of full-staging lymphadenectomy on patients with primary mucinous epithelial ovarian carcinoma confined to the ovary is still unclear. In this study, we investigated the prognostic impact of lymphadenectomy covering both pelvic and para-aortic lymph nodes in patients with clinically-apparent stage I mucinous epithelial ovarian carcinoma, using data from multi-institutions under a central pathological review system and analyses with a propensity score-based method.

Methods

We conducted a regional multi-institutional retrospective study between 1986 and 2017. Among 4730 patients with malignant ovarian tumors, a total of 186 women with mucinous epithelial ovarian carcinoma were eligible. We evaluated differences in survival outcomes between patients with both pelvic and para-aortic lymphadenectomy and those with only pelvic lymphadenectomy and/or clinical lymph node evaluation. To analyze the therapeutic effects, the baseline imbalance between patients with both pelvic and para-aortic lymphadenectomy and others was adjusted with an inverse probability of treatment weighting using propensity score involving independent clinical variables.

Results

Fifty-five patients received both pelvic and para-aortic lymphadenectomy. With PS-based adjustment, both pelvic and para-aortic lymphadenectomy did not have additive effects regarding overall survival (P = 0.696) and recurrence-free survival (P = 0.978). Multivariate analysis similarly showed no significant impact of both pelvic and para-aortic lymphadenectomy on their prognosis.

Conclusions

The effect of pelvic and para-aortic lymphadenectomy is limited for clinically-apparent stage I primary mucinous epithelial ovarian carcinoma as long as full peritoneal and clinical lymph node evaluations are conducted. The results of this study should be used as the basis for additional studies, including prospective trials.
Phase 1 Study of Molibresib (GSK525762), a Bromodomain and Extra-Terminal Domain Protein Inhibitor, in NUT Carcinoma and Other Solid Tumors
Authors: Piha-Paul Sarina A , Hann Christine L , French Christopher A , Cousin Sophie , Braña Irene , Cassier Phillippe A , Moreno Victor , de Bono Johann S , Harward Sara Duckworth , Ferron-Brady Geraldine , Barbash Olena , Wyce Anastasia , Wu Yuehui , Horner Thierry , Annan Meg , Parr Nigel J , Prinjha Rabinder K , Carpenter Christopher L , Hilton John , Hong David S , Haas Naomi B , Markowski Mark C , Dhar Arindam , O’Dwyer Peter J , Shapiro Geoffrey I
Published: November 2019

Background

Bromodomain and extra-terminal domain proteins are promising epigenetic anticancer drug targets. This first-in-human study evaluated the safety, recommended phase II dose, pharmacokinetics, pharmacodynamics, and preliminary antitumor activity of the bromodomain and extra-terminal domain inhibitor molibresib (GSK525762) in patients with nuclear protein in testis (NUT) carcinoma (NC) and other solid tumors.

Methods

This was a phase I and II, open-label, dose-escalation study. Molibresib was administered orally once daily. Single-patient dose escalation (from 2 mg/d) was conducted until the first instance of grade 2 or higher drug-related toxicity, followed by a 3 + 3 design. Pharmacokinetic parameters were obtained during weeks 1 and 3. Circulating monocyte chemoattractant protein-1 levels were measured as a pharmacodynamic biomarker.

Results

Sixty-five patients received molibresib. During dose escalation, 11% experienced dose-limiting toxicities, including six instances of grade 4 thrombocytopenia, all with molibresib 60–100 mg. The most frequent treatment-related adverse events of any grade were thrombocytopenia (51%) and gastrointestinal events, including nausea, vomiting, diarrhea, decreased appetite, and dysgeusia (22%–42%), anemia (22%), and fatigue (20%). Molibresib demonstrated an acceptable safety profile up to 100 mg; 80 mg once daily was selected as the recommended phase II dose. Following single and repeat dosing, molibresib showed rapid absorption and elimination (maximum plasma concentration: 2 hours; t1/2: 3–7 hours). Dose-dependent reductions in circulating monocyte chemoattractant protein-1 levels were observed. Among 19 patients with NC, four achieved either confirmed or unconfirmed partial response, eight had stable disease as best response, and four were progression-free for more than 6 months.

Conclusions

Once-daily molibresib was tolerated at doses demonstrating target engagement. Preliminary data indicate proof-of-concept in NC.
Supply to Deny: The Benefits of Nuclear Assistance for Nuclear Nonproliferation
Authors: Gibbons Rebecca Davis
Published: November 2019

Recent scholarship on nuclear proliferation finds that many forms of nuclear assistance increase the odds that recipient states pursue nuclear weapons programs. While these studies may help us understand select cases of proliferation, they overshadow the role of nuclear supply in bolstering global nonproliferation efforts. After the risks of nuclear assistance became well-known following India's nuclear explosion in 1974, most major suppliers conditioned their assistance on recipients joining nonproliferation agreements. Case studies of states’ decision-making regarding these agreements illustrate how the provision of nuclear technology has been an effective tool in persuading states to join such agreements, the most important of which is the Treaty on the Non-Proliferation of Nuclear Weapons (NPT). By joining the NPT, states strengthen the global nonproliferation regime and increase the costs of any potential future decision to proliferate. The offer of nuclear assistance has done far more to bolster global nuclear nonproliferation efforts than recent research suggests.
Polarimetry of relativistic tidal disruption event Swift J2058+0516
Authors: Wiersema K , Higgins A B , Levan A J , Eyles R A J , Starling R L C , Tanvir N R , Cenko S B , van der Horst A J , Gompertz B P , Greiner J , Pasham D R
Published: November 2019

A small fraction of candidate tidal disruption events (TDEs) show evidence of powerful relativistic jets, which are particularly pronounced at radio wavelengths, and likely contribute non-thermal emission at a wide range of wavelengths. A non-thermal emission component can be diagnosed using linear polarimetry, even when the total received light is dominated by emission from an accretion disc or disc outflow. In this paper, we present Very Large Telescope (VLT) measurements of the linear polarization of the optical light of jetted TDE Swift J2058+0516. This is the second jetted TDE studied in this manner, after Swift J1644+57. We find evidence of non-zero optical linear polarization, $P_{V}\sim 8{{\, \rm per\, cent}}$, a level very similar to the near-infrared polarimetry of Swift J1644+57. These detections provide an independent test of the emission mechanisms of the multiwavelength emission of jetted TDEs.
Mapping the Galactic disc with the LAMOST and Gaia red clump sample: II. 3D asymmetrical kinematics of mono-age populations in the disc between 6–14  kpc
Authors: Wang H-F , López-Corredoira M , Huang Y , Carlin J L , Chen B-Q , Wang C , Chang J , Zhang H-W , Xiang M-S , Yuan H-B , Sun W-X , Li X-Y , Yang Y , Deng L-C
Published: November 2019

We perform analysis of the 3D kinematics of Milky Way disc stars in mono-age populations. We focus on stars between Galactocentric distances of R = 6 and 14  kpc, selected from the combined LAMOST Data Release 4 (DR4) red clump giant stars and Gaia DR2 proper motion catalogue. We confirm the 3D asymmetrical motions of recent works and provide time tagging of the Galactic outer disc asymmetrical motions near the anticentre direction out to Galactocentric distances of 14 kpc. Radial Galactocentric motions reach values up to 10 km s−1, depending on the age of the population, and present a north–south asymmetry in the region corresponding to density and velocity substructures that were sensitive to the perturbations in the early 6  Gyr. After that time, the disc stars in this asymmetrical structure have become kinematically hotter, and are thus not sensitive to perturbations, and we find the structure is a relatively younger population. With quantitative analysis, we find stars both above and below the plane at R ≳ 9 kpc that exhibit bending mode motions of which the sensitive duration is around 8  Gyr. We speculate that the in-plane asymmetries might not be mainly caused by a fast rotating bar, intrinsically elliptical outer disc, secular expansion of the disc, or streams. Spiral arm dynamics, out-of-equilibrium models, minor mergers or others are important contributors. Vertical motions might be dominated by bending and breathing modes induced by complicated inner or external perturbers. It is likely that many of these mechanisms are coupled together.
Braginskii viscosity on an unstructured, moving mesh accelerated with super-time-stepping
Authors: Berlok Thomas , Pakmor Rüdiger , Pfrommer Christoph
Published: November 2019

We present a method for efficiently modelling Braginskii viscosity on an unstructured, moving mesh. Braginskii viscosity, i.e. anisotropic transport of momentum with respect to the direction of the magnetic field, is thought to be of prime importance for studies of the weakly collisional plasma that comprises the intracluster medium (ICM) of galaxy clusters. Here, anisotropic transport of heat and momentum has been shown to have profound consequences for the stability properties of the ICM. Our new method for modelling Braginskii viscosity has been implemented in the moving mesh code arepo. We present a number of examples that serve to test the implementation and illustrate the modified dynamics found when including Braginskii viscosity in simulations. These include (but are not limited to) damping of fast magnetosonic waves, interruption of linearly polarized Alfvén waves by the firehose instability, and the inhibition of the Kelvin–Helmholtz instability by Braginskii viscosity. An explicit update of Braginskii viscosity is associated with a severe time-step constraint that scales with (Δx)2, where Δx is the grid size. In our implementation, this restrictive time-step constraint is alleviated by employing second-order accurate Runge–Kutta–Legendre super-time-stepping. We envision including Braginskii viscosity in future large-scale simulations of Kelvin–Helmholtz unstable cold fronts in cluster mergers and AGN-generated bubbles in central cluster regions.
Exploring effects on magnifications due to line-of-sight galaxies in the Hubble Frontier Fields
Authors: Raney Catie A , Keeton Charles R , Brennan Sean
Published: November 2019

Cluster lensing has become an important tool in the search for high-redshift galaxies through its ability to magnify sources. In order to determine the intrinsic properties of these galaxies, lensing mass models must be constructed to determine the magnification of the images. These models are traditionally 2D, focusing on the mass within the cluster and either ignoring or approximating any contribution from line-of-sight galaxies. In this paper, we present the first full set of 3D mass models of the six Hubble Frontier Fields and use them to test for systematic biases in magnifications due to using the traditional 2D approach. We find that omitting foreground or background galaxies causes image position offsets between 0.1 and 0.4 arcsec, a non-negligible fraction of the typical 0.3–0.7 arcsec residuals of current state-of-the-art models. We also find that median image magnifications can shift by up to 6 per cent, though it is dependent on the field. This can be alleviated in some cases by approximating the mass in the lensing plane, but a 5 per cent magnification bias still exists in other cases; image position offsets are also improved, but are still present at 0.10 arcsec.
Warm dark matter model with a few keV mass is bad for the too-big-to-fail problem
Authors: Kang Xi
Published: November 2019

Theoretical studying of the very inner structure of faint satellite galaxy requires very high-resolution hydro-dynamical simulations with realistic model for star formation, which are beginning to emerge recently. In this work, we present an analytical description to model the inner kinematic of satellites in the Milky Way (MW). We use a Monte Carlo method to produce merger trees for MW mass halo and analytical models to produce stellar mass in the satellite galaxies. We consider two important processes which can significantly modify the inner mass distribution in satellite galaxy. The first is baryonic feedback which can induce a flat inner profile depending on the star formation efficiency in the galaxy. The second is the tidal stripping to reduce and re-distribute the mass inside satellite. We apply this model to MW satellite galaxies in both CDM and thermal relic WDM models. It is found that tidal heating must be effective to produce a relatively flat distribution of the satellite circular velocities, to agree with the data. The constraint on WDM mass depends on the host halo mass. For a MW halo with dark matter mass lower than $2\times 10^{12}\, \text{ M}_\odot$, a 2 keV WDM model can be safely excluded as the predicted satellite circular velocities are systematically lower than the data. For WDM with mass of 3.5 keV, it requires the MW halo mass to be larger than $1.5\times 10^{12}\, {\text{ M}}_{\odot }$.
A Correlation in the Waiting-time Distributions of Solar Flares
Authors: Hudson Hugh S
Published: November 2019

In a limited sample of isolated solar active regions, we find that the waiting times between flares may correlate well with flare magnitudes as determined by the GOES soft X-ray fluxes. A “build-up and release” scenario (BUR) for magnetic energy storage in the solar corona suggests the existence of such a relationship, relating the slowly varying subphotospheric energy sources to the sudden coronal energy releases of flares and CMEs. Substantial amounts of research effort had not previously found any obvious observational evidence for such a BUR process. This has posed a puzzle since coronal magnetic energy storage represents the consensus view of the basic flare mechanism. We have revisited the GOES soft X-ray flare statistics for any evidence of correlations, using two isolated active regions, and have found significant evidence for a “saturation” correlation. Rather than a “reset” form of this relaxation, in which the time before a flare correlates with its magnitude, the “saturation” relationship results in the time after the flare showing the correlation. The observed correlation competes with the “obscuration” effect of reduced GOES sensitivity following a strong event, by which weaker events can be under-reported systematically. This complicates the observed correlation, and we discuss several approaches to remedy this.
Short-Term Effect of Kinesiotaping on Chronic Nonspecific Low Back Pain and Disability: A Meta-Analysis of Randomized Controlled Trials
Authors: Lin Shanshan , Zhu Bo , Huang Guozhi , Wang Chuhuai , Zeng Qing , Zhang Shanshan
Published: November 2019

Background

Low back pain (LBP) is a very common and disabling disorder in modern society. The intervention strategies for LBP include drug therapy, surgery, and physical interventions. Recently, kinesiotaping, as a simple and noninvasive treatment, has been used to treat chronic nonspecific LBP, but its effectiveness and true merit remains unclear.

Purpose

The purpose of this study was to summarize the results of randomized controlled trials (RCTs) on the effectiveness of kinesiotaping (KT) for chronic nonspecific low back pain (CNLBP) and disability.

Data Sources

Medline, Cochrane Library, Google Scholar, Web of Science, and EmBase were searched from inception to September 1, 2018.

Study Selection

Studies were included in the review if they met the following criteria: RCTs published in English; patients (>18 years old) diagnosed with CNLBP (pain duration of > 12 weeks), with or without leg pain; KT as a single treatment or as a part of other forms of physical therapy; outcomes measured included pain intensity and disability.

Data Extraction

Three independent investigators completed data extraction. Methodological quality was appraised using the Cochrane tool for assessing the risk of bias. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) guidelines were applied to assess the confidence of the effect estimates.

Data Synthesis

Eleven RCT studies involving 785 patients were retained for the meta-analysis.

Standardized mean differences (SMDs) with 95% CIs were calculated using a random-effects model. Compared with the control group， the pooled SMD of pain intensity was significantly reduced (SMD = −0.73; 95% CI = −1.12 to −0.35; GRADE: low) and disability was improved (SMD = −0.51; 95% CI = −0.85 to −0.17; GRADE: low) in the KT group. Subgroup analyses showed that, compared with the control, the I strip of KT significantly reduced pain (SMD = −0.48; GRADE: low) but not disability (SMD = −0.26; GRADE: low). Compared with sham/placebo tape, KT provided significant pain reduction (SMD = −0.84; GRADE: low) and disability improvement (SMD = −0.56; GRADE: low). Moreover, compared with the no-tape group, the KT group also showed pain reduction (SMD = −0.74; GRADE: low) and disability improvement (SMD = −0.65; GRADE: low).

Limitations

Limitations of the review included a lack of homogeneity, different methodologies and treatment duration of KT application, and relatively small sample sizes.

Conclusions

There is low-quality evidence that KT has a beneficial role in pain reduction and disability improvement for patients with CNLBP. More high-quality studies are required to confirm the effects of KT on CNLBP.
Applying principles of injury and infectious disease control to the opioid mortality epidemic in North America: critical intervention gaps
Authors: Fischer Benedikt , Pang Michelle , Tyndall Mark
Published: November 2019

North America has been experiencing an acute and unprecedented public health crisis involving excessive and increasing levels of opioid-related overdose mortality. In the present commentary, we examine current interventions (as existent mainly in Canada) to date and compare them against established intervention frameworks and practices in other areas of public health, specifically injury and infectious disease control. We observe that current interventions focusing on opioid drug safety or exposure—specifically those that focus on distinctly potent and toxic opioid products driving major increases in overdose mortality—may be considered the equivalent of ‘agent-’ or ‘vector’-based interventions. Such interventions have been largely neglected in favor of ‘host’ (e.g., drug user-oriented) or ‘environmental’ measures among strategies to reduce opioid-related overdose, likely contributing to the limited efficacy of current measures. We explore potential reasons, implications and remedies for these gaps in the overall public health strategy employed towards improved interventions to reduce opioid-related health harms.
The effects of soybean hulls level, distillers dried grains with solubles, and net energy formulation on nursery pig performance1
Authors: Goehring Devin L , Wu Fangzhou , DeRouchey Joel M , Goodband Robert D , Tokach Mike D , Woodworth Jason C , Paulk Chad B , Dritz Steve S
Published: November 2019

Four experiments were conducted to investigate the effects of increasing dietary soybean hulls without or with distillers dried grains with solubles (DDGS) and net energy (NE) formulation on nursery pig performance. In experiment 1, a total of 210 nursery pigs (initially 6.6 ± 0.1 kg) were used in a 34-d study. Pigs were fed one of five diets that contained increasing soybean hulls (0%, 5%, 10%, 15%, and 20%). Diets were not balanced for NE. Increasing soybean hulls decreased (linear, P < 0.01) average daily gain (ADG) and gain:feed ratio(G:F), and tended to decrease average daily feed intake (ADFI; quadratic, P < 0.10). In experiment 2, 210 nursery pigs (initially 13.6 ± 0.1 kg) were used in a 20-d study to determine the effect of equal NE formulation in diets with soybean hulls. Pigs were fed one of five diets containing 0% (control), 10%, or 20% soybean hulls either balanced to contain equal NE to the control diet or not balanced for energy. Diets containing 10% and 20% soybean hulls with balanced NE contained 3.60% and 7.15% added soybean oil, respectively. Increasing soybean hulls decreased (linear, P < 0.01) ADG regardless of formulation method. Pigs fed increasing soybean hulls without added fat had decreased (linear, P < 0.01) G:F. Increasing soybean hulls in diets with balanced NE decreased (linear, P < 0.02) ADFI, but did not affect G:F. In experiment 3, 600 pigs (initially 6.8 ± 0.1 kg) were used in a 42-d study. Pigs were fed 1 of 10 diets containing 0%, 3%, 6%, 9%, or 12% soybean hulls without or with DDGS (15% from d 0 to 14, 30% from d 15 to 42). Feeding DDGS reduced (P < 0.04) ADG and ADFI, and tended to increase (P < 0.06) G:F. Increasing soybean hulls decreased G:F quadratically (P < 0.03) in diets without DDGS, but decreased G:F linearly (P < 0.01) in diets with DDGS (soybean hulls × DDGS interaction, P < 0.05). In experiment 4, 304 barrows (initially 11.7 ± 0.2 kg) were used in a 21-d study. Pigs were fed one of eight diets containing 0%, 5%, 10%, or 15% soybean hulls with or without 20% DDGS. No soybean hull × DDGS interactions were observed. Increasing soybean hulls tended to decrease (linear, P < 0.08) G:F. In conclusion, feeding low levels of soybean hulls did not affect nursery pig performance but more than 5% soybean hulls, with or without DDGS, decreased G:F. Formulating diets containing soybean hulls on an equal NE basis eliminated the negative effects on G:F, but the NE (1,003 kcal/kg) of soybean hulls used in this study was underestimated.
The Politics of Community Drama in Interwar England
Authors: Neima Anna
Published: November 2019

There was a wave of reform-oriented drama across England in the 1920s and 1930s, which extended from urban, socialist theatre to the ‘late modernist’ enthusiasm for rural pageantry and from adult education to Church revival. Most scholarship looks at drama in these various milieus separately, but this study of three plays that were put on in a corner of South West England—a nativity play, an innovative ‘dance-mime’, and a Workers’ Educational Association narrative piece—brings them together. These plays shared a connection to Dartington Hall, a social and cultural experiment set on a large estate in Devon in 1925 by an American heiress, Dorothy Elmhirst, and her Yorkshire-born husband, Leonard, which became a nexus for the various strands of community-seeking theatre evident in interwar England—as well as for social reform more generally. This article shows how dramatic performances formed part of the quest for communal unity that was a dominant strand in social thinking between the wars: driven by fears about class strife, the effects of democratization, the recurrence of war, and the fragmenting effects of secular modernity, elites, artists, and activists of diverse hues tried to reform the very idea of Englishness by putting on plays—fostering values of community and communality, while often taking inspiration from an idealized vision of the rural community of England’s pre-industrial past.
Macrophage migration inhibitory factor derived from spinal cord is involved in activation of macrophages following gecko tail amputation
Authors: Wang Yingjie , Wei Sumei , Song Honghua , Zhang Xuejie , Wang Wenjuan , Du Nan , Song Tiancheng , Liang Hao , Chen Xiaojun , Wang Yongjun
Published: November 2019

Macrophages and their initiation of acute inflammation have been defined to be functionally important in tissue repair and regeneration. In injury‐induced production of macrophage migration inhibitory factor (MIF), which has been described as a pleiotropic protein that participates in multiple cellular and biologic processes, it is unknown whether it is involved in the regulation of macrophage events during the epimorphic regeneration. In the model of gecko tail amputation, the protein levels of gecko MIF (gMIF) have been determined to be significantly increased in the nerve cells of the spinal cord in association with the recruitment of macrophages to the lesion site. gMIF has been shown to interact with the CD74 receptor to promote the migration of macrophages through activation of Ras homolog gene family member A and to trigger inflammatory responses through MAPK signaling pathways. The determination of microsphere phagocytosis also indicated that gMIF could enhance macrophage phagocytosis. gMIF‐mediated recruitment and activation of macrophages have been found to be necessary for gecko tail regeneration, as evidenced by the depletion of macrophages using clodronate liposomes. The results present a novel function of MIF during the epimorphic regeneration, which is beneficial for insights into its pleiotropic property.—Wang, Y., Wei, S., Song, H., Zhang, X., Wang, W., Du, N., Song, T., Liang, H., Chen, X., Wang, Y. Macrophage migration inhibitory factor derived from spinal cord is involved in activation of macrophages following gecko tail amputation. FASEB J. 33, 14798‐14810 (2019). www.fasebj.org
Escape the Sim! An Escape Room Innovation to Orient Learners to the Simulation Environment
Authors: Robertiello Gina , Genee Jordan , Marrera Amnerys
Published: November 2019

Orientation to the environment and equipment promotes psychological safety in simulation. Providing orientation activities also increases learner perceptions of simulation effectiveness, confidence, and learning overall. Escape rooms, used by educators from primary levels through graduate programs, promote skills in teamwork, creative problem-solving, and critical thinking ability. Creating an escape room-themed simulation experience with the objective of orienting learners to the simulation environment and equipment is an interactive way to prepare learners for simulation, while encouraging teamwork and group dynamics.
Indications and Clinical Results of Radial Head Replacement: Has Anything Changed?
Authors: Eyberg Blake A. , McKee Michael D.
Published: November 2019

Radial head fractures are common injuries comprising 1/3 of the fractures about the elbow. As a secondary valgus stabilizer of the elbow, radial head fractures can compromise elbow stability leading to long-term pain, dysfunction, and degenerative change. Furthermore, radial head fractures can be accompanied by associated injuries including ligamentous lesions that can further exacerbate elbow instability, leading to long-term sequelae. As fixation principles and technology have evolved, so has the ability to render surgical treatment for these fractures. In general, minimally displaced and some displaced fractures may be treated nonoperatively with early motion. Fractures with a block to rotation and displaced fragments with 3 or fewer fragments may be treated with open reduction and internal fixation. Comminuted fractures or those with greater than 3 fragments may be successfully treated with radial head replacement. Associated elbow instability will also influence treatment decisions.
Prevalence of depression and anxiety in women newly diagnosed with vulvovaginal atrophy and dyspareunia
Authors: Moyneur Erick , Dea Katherine , Derogatis Leonard R. , Vekeman Francis , Dury Alain Y. , Labrie Fernand
Published: November 2019

Objective:

To quantify the association between vulvovaginal atrophy and depression, major depressive disorder, and anxiety.

Methods:

Women with vulvovaginal atrophy from the Truven Health MarketScan Commercial and Medicare Supplemental Databases (01/2010-09/2016) with ≥365 days of continuous insurance coverage before and after the first vulvovaginal atrophy/dyspareunia diagnosis (index date) were selected. Women with vulvovaginal atrophy were matched 1:3 to women without (controls) according to age, calendar year, health plan, and region. The study period spanned from 12 months before to 12 months after index date. The ratios of diagnosed depression, major depressive disorder, and anxiety among women with vulvovaginal atrophy and the controls were calculated. Logistic regressions adjusting for proxies of menopause were used to compare prevalence.

Results:

In all, 125,889 women with vulvovaginal atrophy and 376,057 controls were included (mean age 60.7 [45-101]). The prevalence of depression, major depressive disorder, and anxiety was higher among women with vulvovaginal atrophy compared with controls (23.9% vs 18.9%, 6.3% vs 4.7%, 16.6% vs 11.3%), with prevalence ratios of 1.26, 1.33, and 1.47, respectively (all P 
< 0.0001). Highest prevalences and differences were observed in younger women. Findings were consistent when analyzing newly diagnosed conditions. When adjusting for proxies of menopause (insomnia, vasomotor symptoms, dysuria, and estrogen therapy), vulvovaginal atrophy remained significant (prevalence odds ratios; depression 1.23, major depressive disorder 1.22, anxiety 1.39; all P < 0.0001).

Conclusions:

Vulvovaginal atrophy is associated with a significantly higher prevalence/incidence of depression, major depressive disorder, and anxiety. The higher prevalence/incidence and greater differences in younger women highlight the need for a multidisciplinary approach and early diagnosis/management of vulvovaginal atrophy.
Pediatric Concussion: Managing Persistent Symptoms With an Interdisciplinary Approach
Authors: Scratch Shannon E. , Rumney Peter , Agnihotri Sabrina , Reed Nick
Published: November 2019

Objective:

We outline the development of a clinic that works directly with youth clients, their caregivers, and family members to help address symptoms that are persisting long after the youth sustained a concussion. Client referral characteristics are described, as well as general clinic flow and procedures. Particular emphasis is placed on a novel interdisciplinary team assessment pathway designed with input from clients and families to help provide consistent treatment plans, education, direction, and conclusions for those clients with complex psychosocial, cognitive, and physical presentations.

Setting and Participants:

The Persistent Concussion Clinic at Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.

Conclusions:

Youth with persistent concussion symptoms have limited access to interdisciplinary clinics and supports. This article outlines the practices of a large, hospital-based interdisciplinary clinic whose model can inform clinical care pathways and practices for this underserved population. Facilitators and barriers to access are discussed and future directions for the clinic and persistent concussion care in Ontario and internationally are reviewed.
Baseline Central Visual Field Defect as a Risk Factor For NTG Progression: A 5-Year Prospective Study
Authors: Raman Puspha , Suliman Nurull B. , Zahari Mimiwati , Mohamad Nor Fadhilah , Kook Michael S. , Ramli Norlina
Published: November 2019

Precis:

This 5-year follow-up study on normal-tension glaucoma (NTG) patients demonstrated that those with baseline central visual field (VF) defect progress at a more increased rate compared with those with peripheral field defect.

Purpose:

The purpose of this study was to investigate the clinical characteristics, including 24-hour ocular perfusion pressure and risk of progression in patients with baseline central VF defect, as compared with those with peripheral VF defect in NTG.

Design:

This was a prospective, longitudinal study.

Methods:

A total of 65 NTG patients who completed 5 years of follow-up were included in this study. All the enrolled patients underwent baseline 24-hour intraocular pressure and blood pressure monitoring via 2-hourly measurements in their habitual position and had ≥5 reliable VF tests during the 5-year follow-up. Patients were assigned to two groups on the basis of VF defect locations at baseline, the central 10 degrees, and the peripheral 10- to 24-degree area. Modified Anderson criteria were used to assess global VF progression over 5 years. Kaplan-Meier analyses were used to compare the elapsed time of confirmed VF progression in the two groups. Hazard ratios for the association between clinical risk factors and VF progression were obtained by using Cox proportional hazards models.

Results:

There were no significant differences between the patients with baseline central and peripheral VF defects in terms of demography, clinical, ocular and systemic hemodynamic factors. Eyes with baseline defects involving the central fields progressed faster (difference: βcentral=−0.78 dB/y, 95% confidence interval=−0.22 to −1.33, P=0.007) and have 3.56 times higher hazard of progressing (95% confidence interval=1.17-10.82, P=0.025) than those with only peripheral defects.

Conclusion:

NTG patients with baseline central VF involvement are at increased risk of progression compared with those with peripheral VF defect.
Prevalence and Outcomes of Balloon Atrial Septostomy in Neonates With Transposition of Great Arteries
Authors: Hamzah Mohammed , Othman Hasan F. , Peluso Allison M. , Sammour Ibrahim , Aly Hany
Published: November 2019

Objectives:

Transposition of the great arteries is the most common cyanotic congenital heart defect. Surgical correction usually occurs in the first week of life; presence of restrictive interatrial communication and severe hypoxemia warrants urgent intervention with balloon atrial septostomy and medical stabilization prior to surgery. The main objective of this study is to compare the characteristics, outcomes, and mortality risks in patients with transposition of the great arteries who underwent balloon atrial septostomy during their hospitalization versus transposition of the great arteries patients who have not undergone this procedure.

Design:

Retrospective analysis of administrative data.

Setting:

Data from Kids’ Inpatient Database complemented with the National Inpatient Sample dataset for the years 1998–2014, this includes data from participating hospitals in 47 U.S. States and the District of Columbia.

Patients:

Neonates admitted with transposition of the great arteries.

Interventions:

None.

Measurements and Main Results:

A total of 17,392 neonates with diagnosis of transposition of the great arteries were captured in the databases we used. Male-to-female ratio was 2:1. The rate of balloon atrial septostomy in patients with transposition of the great arteries was 27.7% without significant change over the years. There was no significant difference in mortality between balloon atrial septostomy and no balloon atrial septostomy (6.3% vs 6.7%; p = 0.29). Neonates with balloon atrial septostomy had a two-fold increase in their length of stay compared with no balloon atrial septostomy (16 d vs 7 d; p < 0.0001). Stroke was present in 1.1% of balloon atrial septostomy group versus 0.6% in those who did not have balloon atrial septostomy (odds ratio, 1.85; 95% CI, 1.29–2.65; p < 0.0001). Extracorporeal membrane oxygenation was used more in balloon atrial septostomy group (5.1% vs 3.1%; p < 0.0001).

Conclusions:

There was no difference in mortality rate between balloon atrial septostomy and no balloon atrial septostomy patients. The prevalence of the diagnosis of stroke in this study was higher in patients who underwent balloon atrial septostomy. Furthermore, comparison of in-hospital mortality in balloon atrial septostomy and no balloon atrial septostomy revealed increased mortality risk in no balloon atrial septostomy patients transferred from other institution, no balloon atrial septostomy patients supported with extracorporeal membrane oxygenation, and balloon atrial septostomy patients diagnosed with stroke. Finally, length of stay and charges were higher in balloon atrial septostomy patients.
Specialized Consultation for Suspected Recent-onset Schizophrenia: Diagnostic Clarity and the Distorting Impact of Anxiety and Reported Auditory Hallucinations
Authors: COULTER CHELSEY , BAKER KRISTA K. , MARGOLIS RUSSELL L.
Published: November 2019

Early detection of psychotic disorders is now recognized as vital in reducing dysfunction, morbidity, and mortality. However, making the diagnosis of a psychotic disorder, especially earlier in the course of disease, can be challenging, and an incorrect diagnosis of a psychotic disorder may also have significant consequences. We therefore, conducted a retroactive chart review of 78 patients referred to a specialty early psychosis consultation clinic to examine the role of specialty clinics in clarifying the diagnosis of early psychosis, especially potential schizophrenia. Of the 78 patients, 43 (55%) had a primary diagnosis at referral of a schizophrenia spectrum disorder. The primary diagnosis in the consultation clinic was different in 22 (51%) of these 43 cases, and 18 (42%) of these patients were not diagnosed with any form of primary psychotic disorder. These patients were more likely to report anxiety and less likely to report thought disorder than patients with a consultation diagnosis of schizophrenia or schizoaffective disorder. Clinicians may therefore overdiagnose schizophrenia, demonstrating the value of second opinions from clinics specializing in the diagnosis of recent-onset psychosis.
Aripiprazole and Delusional Disorder
Authors: IANNUZZI GREGORY L. , PATEL ANKITA A. , STEWART JONATHAN T.
Published: November 2019

Delusional disorder is a relatively rare psychotic illness characterized by delusions with contents that are theoretically possible but highly unlikely, and an absence of the disorganized thought and negative symptoms characteristic of schizophrenia. The illness is rarely studied systematically and most guidance with regard to the treatment derives from case reports and small case series. Antipsychotic medications are the mainstay of treatment, but it is not clear whether any particular agent is more effective than others. We report the case of a patient with delusional disorder who had failed to respond to risperidone but improved markedly with aripiprazole. Aripiprazole may show promise as a treatment for delusional disorder, possibly as a result of its effects on both dopaminergic and serotonergic receptors.
Effectiveness of a 5-Week Inpatient Dialectical Behavior Therapy for Borderline Personality Disorder
Authors: PROBST THOMAS , O’ROURKE TERESA , DECKER VERENA , KIEßLING EVA , MEYER SASCHA , BOFINGER CHRISTINE , NIKLEWSKI GÜNTER , MÜHLBERGER ANDREAS , PIEH CHRISTOPH
Published: November 2019

Objective:

The goal of this study was to evaluate whether symptoms are reduced and emotion regulation improves when patients with borderline personality disorder (BPD) receive a 5-week course of inpatient dialectical behavioral therapy (DBT) and if changes in emotion regulation are associated with changes in symptoms.

Methods:

Forty-four patients with BPD receiving a 5-week course of DBT in a German psychiatry clinic participated. The short version of the “Borderline Symptom List” (BSL-23) was the patient-reported outcome. To measure emotion regulation, the “Self-Report Measure for the Assessment of Emotion Regulation Skills” (SEK-27) was administered. Wilcoxon tests were performed to evaluate whether pre-post changes in the BSL-23 and SEK-27 reached statistical significance. Effect sizes (d) were calculated and correlations between the pre-post differences for both measures were computed to test associations between changes in emotion regulation and changes in symptoms. Completer (n=33) and intention-to-treat (n=43) analyses were performed.

Results:

Symptoms (BSL-23) were reduced and emotion regulation (SEK-27) improved during the 5-week inpatient DBT treatment (completer and intention-to-treat analysis: P<0.001). Effect sizes reached d=0.47 for the BSL-23 and d=0.84 for the SEK-27 in the completer analysis, and d=0.38 for the BSL-23 and d=0.68 for the SEK-27 in the intention-to-treat analysis. Improvements in emotion regulation (SEK-27) were correlated with reductions in symptoms (BSL-23) in both the completer (r=0.54; P=0.001) and the intention-to-treat (r=0.59; P<0.001) analyses.

Conclusions:

These findings indicate that a 5-week course of inpatient DBT can effectively reduce symptoms in patients with BPD and that the more patients’ emotion regulation improves, the more the patients benefit from the therapy.