bluuebunny/crossref_metadata_2025 huggingface dataset:
Utility of double arterial cannulation for surgical repair of acute type A dissection
Authors: Kusadokoro Sho , Kimura Naoyuki , Hori Daijiro , Hattori Masahiro , Matsunaga Wataru , Itagaki Ryo , Yuri Koichi , Mieno Makiko , Nakamura Masanori , Yamaguchi Atsushi
Published: January 2020

OBJECTIVES

Outcomes of planned and unplanned (rescue) double arterial cannulation (DAC) in surgery for acute type A aortic dissection were investigated retrospectively.

METHODS

The study involved 805 patients who were divided into 4 groups according to the cannulation strategy: single cannulation of the femoral artery (n = 338), axillary artery (n = 256), left ventricular apex (n = 52) or ascending aorta (n = 5) (total, n = 57), and DAC (n = 154). Patients who underwent DAC were divided between planned (n = 132) and rescue (n = 22) usage. Characteristics and outcomes were compared between groups. Both unmatched and propensity score-matched analyses were performed.

RESULTS

Shock (39%, 19%, 33% and 14%, in the femoral artery, axillary artery, left ventricular apex/ascending aorta and DAC, respectively) and leg malperfusion (5%, 16%, 16% and 26%, respectively) differed significantly (P < 0.001), but in-hospital mortality did not (9%, 8%, 18% and 7%, respectively; P = 0.096). The 5-year survival rates were 79.4%, 79.7%, 78.6% and 82.2%, respectively. Propensity score-matched analysis showed no statistically significant differences in in-hospital mortality rates (10%, 12%, 14% and 9%, respectively; P = 0.78) and 5-year survival rates (78.4%, 72.3%, 82.3% and 78.0%, respectively). The leading vessel combination and indications for planned and rescue DAC were the femoral and axillary arteries (98%) and true lumen narrowing and/or leg malperfusion (34%), and the axillary followed by femoral (77%) artery and low cardiopulmonary bypass flow (36%). In-hospital mortality in the planned and rescue DAC groups was 7% and 9%, respectively.

CONCLUSIONS

DAC seems effective for both prevention and management of intraoperative malperfusion.
Prognostic factors of oligometastatic non-small-cell lung cancer following radical therapy: a multicentre analysis
Authors: Opitz Isabelle , Patella Miriam , Payrard Loic , Perentes Jean Yannis , Inderbitzi Rolf , Gelpke Hans , Schulte Sandra , Diezi Maja , Gonzalez Michel , Krueger Thorsten , Weder Walter
Published: January 2020

OBJECTIVES

Patients with oligometastatic non-small-cell lung cancer (NSCLC) may benefit from therapy with curative intent. Our goal was to identify prognostic factors related to better prognosis in a multicentre analysis of patients who underwent surgery of primary tumours in combination with radical treatment of all metastatic sites.

METHODS

We retrospectively reviewed the records of oligometastatic patients who underwent resection of primary tumours at 4 centres (August 2001–February 2018). Oligometastasis was defined as ≤5 synchronous metastases in ≤2 organs. Radical metastatic treatment was surgery, radiotherapy or a combination. The Cox proportional hazards model was used for identification of prognostic factors on overall survival.

RESULTS

We treated 124 patients; 72 (58%) were men, mean age 60 ± 9.8 years, with 87 (70%) adenocarcinoma. Sixty-seven (54%) patients had positive pathologic-N stage (pN). Brain metastases were most common (n = 76; 61%) followed by adrenal (n = 13; 10%) and bone (n = 12; 10%). Systemic therapy was administered in 101 (82%) patients. Median follow-up was 60 months [95% confidence interval (CI) 41–86]. Thirty- and 90-day mortality rates were 0 and 2.4%, respectively. One-, 2-, and 5-year overall survival were 80%, 58% and 36%, respectively. Cox regression analysis showed that patients ≤60 years [hazard ratio (HR) 0.41, 95% CI 0.24, 0.69; P = 0.001] and patients with pN0 (HR 0.38, 95% CI 0.21–0.69; P = 0.002) had a significant survival benefit. The presence of bone metastases negatively affected survival (HR 2.53, 95% CI 1.05–6.09; P = 0.04).

CONCLUSIONS

Treatment with curative intent of selected oligometastatic NSCLC, including resection of the primary tumour, can be performed safely and with excellent 5-year survival rates, especially in younger patients with pN0 disease.
Inflamm-ageing: the role of inflammation in age-dependent cardiovascular disease
Authors: Liberale Luca , Montecucco Fabrizio , Tardif Jean-Claude , Libby Peter , Camici Giovanni G
Published: January 2020

The ongoing worldwide increase in life expectancy portends a rising prevalence of age-related cardiovascular (CV) diseases in the coming decades that demands a deeper understanding of their molecular mechanisms. Inflammation has recently emerged as an important contributor for CV disease development. Indeed, a state of chronic sterile low-grade inflammation characterizes older organisms (also known as inflamm-ageing) and participates pivotally in the development of frailty, disability, and most chronic degenerative diseases including age-related CV and cerebrovascular afflictions. Due to chronic activation of inflammasomes and to reduced endogenous anti-inflammatory mechanisms, inflamm-ageing contributes to the activation of leucocytes, endothelial, and vascular smooth muscle cells, thus accelerating vascular ageing and atherosclerosis. Furthermore, inflamm-ageing promotes the development of catastrophic athero-thrombotic complications by enhancing platelet reactivity and predisposing to plaque rupture and erosion. Thus, inflamm-ageing and its contributors or molecular mediators might furnish targets for novel therapeutic strategies that could promote healthy ageing and conserve resources for health care systems worldwide. Here, we discuss recent findings in the pathophysiology of inflamm-ageing, the impact of these processes on the development of age-related CV diseases, results from clinical trials targeting its components and the potential implementation of these advances into daily clinical practice.
Social inequalities in the provision of obstetric services in Norway 1967–2009: a population-based cohort study
Authors: Eriksen Helene Sofie , Høy Susanne , Irgens Lorentz M , Rasmussen Svein , Haug Kjell
Published: January 2020

Background

Socioeconomic (SE) inequalities have been observed in a number of adverse outcomes of pregnancy and many of the risk factors for such outcomes are associated with a low SE level. However, SE inequalities persist even after adjustment for these risk factors. Less well-off women are more vulnerable, but may also get less adequate health services. The objective of the present study was to assess possible associations between SE conditions in terms of maternal education as well as ethnic background and obstetric care.

Methods

A population-based national cohort study from the Medical Birth Registry of Norway. The study population comprised 2 305 780 births from the observation period 1967–2009. Multilevel analysis was used because of the hierarchical structure of the data. Outcome variables included induction of labour, epidural analgesia, caesarean section, neonatal intensive care and perinatal death.

Results

While medical interventions in the 1970s were employed less frequently in women of short education and non-western immigrants, this difference was eliminated or even reversed towards the end of the observation period. However, an excess perinatal mortality in both the short-educated [adjusted relative risk (aRR) = 2.49] and the non-western immigrant groups (aRR = 1.75) remained and may indicate increasing health problems in these groups.

Conclusion

Even though our study suggests a fair and favourable development during the last decades in the distribution across SE groups of obstetric health services, the results suggest that the needs for obstetric care have increased in vulnerable groups, requiring a closer follow-up.
Antibiotic resistome and microbial community structure during anaerobic co-digestion of food waste, paper and cardboard
Authors: Kanger Kärt , Guilford Nigel G H , Lee HyunWoo , Nesbø Camilla L , Truu Jaak , Edwards Elizabeth A
Published: January 2020

Solid organic waste is a significant source of antibiotic resistance genes (ARGs) and effective treatment strategies are urgently required to limit the spread of antimicrobial resistance. Here, we studied ARG diversity and abundance as well as the relationship between antibiotic resistome and microbial community structure within a lab-scale solid-state anaerobic digester treating a mixture of food waste, paper and cardboard. A total of 10 samples from digester feed and digestion products were collected for microbial community analysis including small subunit rRNA gene sequencing, total community metagenome sequencing and high-throughput quantitative PCR. We observed a significant shift in microbial community composition and a reduction in ARG diversity and abundance after 6 weeks of digestion. ARGs were identified in all samples with multidrug resistance being the most abundant ARG type. Thirty-two per cent of ARGs detected in digester feed were located on plasmids indicating potential for horizontal gene transfer. Using metagenomic assembly and binning, we detected potential bacterial hosts of ARGs in digester feed, which included Erwinia, Bifidobacteriaceae, Lactococcus lactis and Lactobacillus. Our results indicate that the process of sequential solid-state anaerobic digestion of food waste, paper and cardboard tested herein provides a significant reduction in the relative abundance of ARGs per 16S rRNA gene.
TheShewanellagenus: ubiquitous organisms sustaining and preserving aquatic ecosystems
Authors: Lemaire Olivier N , Méjean Vincent , Iobbi-Nivol Chantal
Published: January 2020

The Gram-negative Shewanella bacterial genus currently includes about 70 species of mostly aquatic γ­-proteobacteria, which were isolated around the globe in a multitude of environments such as surface freshwater and the deepest marine trenches. Their survival in such a wide range of ecological niches is due to their impressive physiological and respiratory versatility. Some strains are among the organisms with the highest number of respiratory systems, depending on a complex and rich metabolic network. Implicated in the recycling of organic and inorganic matter, they are important components of organism-rich oxic/anoxic interfaces, but they also belong to the microflora of a broad group of eukaryotes from metazoans to green algae. Examples of long-term biological interactions like mutualism or pathogeny have been described, although molecular determinants of such symbioses are still poorly understood. Some of these bacteria are key organisms for various biotechnological applications, especially the bioremediation of hydrocarbons and metallic pollutants. The natural ability of these prokaryotes to thrive and detoxify deleterious compounds explains their use in wastewater treatment, their use in energy generation by microbial fuel cells and their importance for resilience of aquatic ecosystems.
Heterogeneous oceanic mass distribution in GRACE observations and its leakage effect
Authors: Yi Shuang , Heki Kosuke
Published: January 2020

Signal leakage between the land and ocean is a challenge in using Gravity Recovery and Climate Experiment (GRACE) observation data to study global mass redistributions. Although the leakage occurs in both directions, more attention has been paid to the land-to-ocean leakage and less to the ocean-to-land leakage. Here, we show that the ocean-to-land leakage is non-uniform and non-negligible and propose a new forward modelling method to fully consider bi-directional leakages with the help of the global Ocean ReAnalysis System ORAS5. This observation-driven model could significantly reduce the variations in ocean grids and thus decrease the ocean-to-land leakage. The results with different treatment of the ocean signal leakage are compared. We find that failing to consider the ocean-to-land leakage will cause an underestimation of ∼20 per cent in the seasonal variation and will introduce a bias of several giga-tons in the secular trend. Although the uniform and non-uniform model have similar results in the global average of seasonal mass variations, the non-uniform ocean model is necessary in most places, especially near the Arctic Ocean, the Sea of Japan and the Gulf of Carpentaria. Despite these achievements, we also point out that there is still much room for improvement in ocean mass models, particularly in long-term trends. Our results indicate the importance of the ocean-to-land leakage correction in the mass estimation in coastal land areas using the GRACE data.
Intraoperative identification of major blood supply to Adamkiewicz artery after multistep surgeries in thoraco-abdominal aortic aneurysm repair
Authors: Sakatsume Ko , Kawatsu Satoshi , Adachi Osamu , Saiki Yoshikatsu
Published: January 2020

Herein, we report a case of thoraco-abdominal aortic repair in a 55-year-old man with a multiple treatment history for aortic aneurysm and aortic dissection. A computed tomography scan revealed that the Adamkiewicz artery was connected to an occluded intercostal artery, suggesting that the left inferior epigastric artery was the key artery supplying the Adamkiewicz artery; the key artery was identified through direct monitoring of cerebrospinal fluid temperature and selective hypothermic perfusion. No spinal cord injury was detected during the postoperative period.
GLU: a software package for analysing continuously measured glucose levels in epidemiology
Authors: Millard Louise A C , Patel Nashita , Tilling Kate , Lewcock Melanie , Flach Peter A , Lawlor Debbie A
Published: January 2020

Continuous glucose monitors (CGM) record interstitial glucose levels ‘continuously’, producing a sequence of measurements for each participant (e.g. the average glucose level every 5 min over several days, both day and night). To analyse these data, researchers tend to derive summary variables such as the area under the curve (AUC), to then use in subsequent analyses. To date, a lack of consistency and transparency of precise definitions used for these summary variables has hindered interpretation, replication and comparison of results across studies. We present GLU, an open-source software package for deriving a consistent set of summary variables from CGM data. GLU performs quality control of each CGM sample (e.g. addressing missing data), derives a diverse set of summary variables (e.g. AUC and proportion of time spent in hypo-, normo- and hyper- glycaemic levels) covering six broad domains, and outputs these (with quality control information) to the user. GLU is implemented in R and is available on GitHub at https://github.com/MRCIEU/GLU. Git tag v0.2 corresponds to the version presented here.
Interpretation and Implications of Lognormal Linear Regression Used for Bacterial Enumeration
Authors: Gao Anli , Fischer-Jenssen Jennifer , Wroblewski Charles , Martos Perry
Published: January 2020

Background

Bacterial enumeration data are typically log transformed to realize a more normal distribution and stabilize the variance. Unfortunately, statistical results from log transformed data are often misinterpreted as data within the arithmetic domain.

Objective

To explore the implication of slope and intercept from an unweighted linear regression and compare it to the results of the regression of log transformed data.

Method

Mathematical formulae inferencing explained using real dataset.

Results

For y=Ax+B+ε, where y is the recovery (CFU/g) and x is the target concentration (CFU/g) with error ε homogeneous across x. When B=0, slope A estimates percent recovery R. In the regression of log transformed data, logy=αlogx+β+εz (equivalent to equation y=Axα·ω), it is the intercept β=logyx=logA that estimates the percent recovery in logarithm when slope α=1, which means that R doesn’t vary over x. Error term ω is multiplicative to x, while εz or log(ω) is additive to log(x). Whether the data should be transformed or not is not a choice, but a decision based on the distribution of the data. Significant difference was not found between the five models (the linear regression of log transformed data, three generalized linear models and a nonlinear model) regarding their predicted percent recovery when applied to our data. An acceptable regression model should result in approximately the best normal distribution of residuals.

Conclusions

Statistical procedures making use of log transformed data should be studied separately and documented as such, not collectively reported and interpreted with results studied in arithmetic domain.

Highlights

The way to interpret statistical results developed from arithmetic domain does not apply to that of the log transformed data.
Characterization of metabolic and inflammatory profiles of transition dairy cows fed an energy-restricted diet
Authors: Esposito Giulia , Raffrenato Emiliano , Lukamba Somwe D , Adnane Mounir , Irons Pete C , Cormican Paul , Tasara Taurai , Chapwanya Aspinas
Published: January 2020

Periparturient diseases of dairy cows are caused by disproportionate energy metabolism, mineral imbalance, and perturbed immune function. The aim of the present study was to characterize metabolism, innate immune endometrial gene expression, and uterine microbial populations of transition animals receiving normal or restricted energy diets. Pregnant multiparous Holstein cows (n = 14) were randomly assigned to one of the two dietary treatments from 20 d prepartum until 35 d postpartum (DPP). One group was fed a diet providing 100% energy requirements (NE), whereas the other received an energy-restricted diet providing 80% energy requirements (RE). Feed intake, milk yield, body weight, body condition score, temperature, respiratory, and pulse rate were recorded. After calving, blood was collected weekly to analyze nonesterified fatty acids (NEFAs), β-hydroxybutyrate (BHB), and total cholesterol (TC). Endometrial cytobrushes were collected for gene expression analysis of inflammatory markers, microbial populations determination, and cytological evaluation. The restricted energy diet did not alter feed intake or milk yield but changed energy balance and metabolites levels (P < 0.05). In fact, RE animals had high NEFA and BHB levels, and low TC concentrations (P < 0.05). Moreover, RE animals had upregulated gene expression of serum amyloid A3 (SAA3) at 35 DPP (P < 0.05) and CXC chemokine receptor 2 (CXCR2) at 14 DPP (P < 0.01). Interleukin (IL) 1 and IL8 genes were downregulated 14 DPP but upregulated 35 DPP in RE animals, whereas IL6 and lipopolysaccharide-binding protein (LBP) genes were upregulated at 14 DPP (P ≤ 0.05). The most abundant phyla in RE animals (n = 3) were Bacteroidetes and Fusobacteria, whereas Proteobacteria was the least abundant at both 14 and 35 DPP. In conclusion, it can be speculated that energy balance is one of the main drivers for uterine inflammation by affecting metabolism, immune function, and uterine microbiota. However, these findings should be validated in a larger sample size.
Peppermint Essential Oil Toxicity to the Pear Psylla (Hemiptera: Psyllidae) and Potential Applications in the Field
Authors: Li Jianyi , Tian Baoliang
Published: January 2020

Chinese pear psylla (Cacopsylla chinensis Yang et Li) is a serious orchard pest that causes declines in fruit quality through feeding damage and the spread of pathogens. The rapid development of chemical pesticide resistance has become a severe problem in controlling pear psylla. Thus, the development of natural pesticides to replace conventional chemical pesticides is urgently needed. Here, we found that the essential oil of peppermint (Mentha haplocalyx Briq. [Lamiales: Labiatae]) is an ideal agent for controlling pear psylla based on experiments in the laboratory and the field. The major constituents of peppermint essential oil were found including menthol (49.73%), menthone (30.52%), α-pinene (3.60%), and α-terpineol (3.81%). This oil and chemicals in it performed serious contact toxicity against the winter-form adults and nymphs of pear psylla, yielding LD50 values of 2.54, 10.71, 2.77, 5.85, and 12.58 μg/adult and 1.91, 9.56, 2.18, 4.98, and 12.07 μg/nymph, respectively. Furthermore, the essential oil strongly repelled the adults of pear psylla with 78% repellence at the highest concentration tested in a Y-tube olfactometer in the laboratory. The combined effect of the two factors made peppermint essential oil a natural pesticide, which achieved a maximum reduction of round to 80.9% in winter-form adult population and round to 67.0% in nymph population at the concentration of 4.0 ml/L in the field. Additionally, it had no effect on the natural enemies of pear psylla in the field. Therefore, peppermint essential oil has potential as an alternative to chemical pesticides for pest control in integrated pest management programs in pear orchards.
AN EMPIRICAL ANALYSIS OF MERGERS: EFFICIENCY GAINS AND IMPACT ON CONSUMER PRICES
Authors: Bonnet Céline , Philip Schain Jan
Published: January 2020

In this article, we extend the literature on merger simulation models by incorporating its potential synergy gains into structural econometric analysis. We present an integrated approach. We estimate a structural demand and supply model dealing with two-part tariff contracts between manufacturers and retailers as in Bonnet and Dubois (2010). This model allows us to recover the marginal cost of each differentiated product. Then we estimate potential efficiency gains using the data envelopment analysis approach of Bogetoft and Wang (2005), and some assumptions about exogenous cost shifters. In the last step, we simulate the new price equilibrium post-merger by taking into account synergy gains, and derive price and welfare effects. We use a home scan data set of dairy dessert purchases in France, and show that synergy gains could offset the upward pressure on prices post. Moreover, in this market, the increase in industry profit due to the merger is more driven by its induced synergy gains than by the market power increase.
No magic dust: The relationship between the national and local assessments in Sainsbury’s/Asda
Authors: Haydock Jenny , Smith Tom
Published: January 2020

We consider the Competition and Markets Authority (CMA) investigation into the proposed merger of UK grocery and fuel retailers Sainsbury’s and Asda. The CMA prohibited the merger in April 2019, based on a finding of widespread competition concerns. In this article we examine in particular the CMA’s assessments of the proposed merger’s effects on the merging parties’ unilateral incentives to worsen their offering across their businesses—for example, by raising supermarket product prices nationwide.

We note that the CMA’s concerns on a national basis arose exclusively from the aggregation of the competitive impacts in individual local areas. We consider to what extent this is likely to be the case in other mergers with somewhat similar features. We also consider under what circumstances an assessment of national-level concerns is necessary when the relevant geographic markets have been defined as local. We address the relationship between the CMA’s national-level analysis and its assessments of the merging parties’ incentives to worsen their offerings at specific stores. Finally, we discuss the ways in which the CMA’s national-level concerns affected its analysis of possible remedies.
Paraduodenal mass as initial presentation of burned-out testicular tumour: case report and literature review
Authors: Almeida Miguel , Amaral Luís , Viveiros Duarte , Carneiro Victor , Sebastião Carlos , Medeiros Armando
Published: January 2020

Testicular germ cell tumours (TGCTs) are relatively rare overall and are mainly encountered in young adults and teenagers. The ‘burned-out’ phenomenon refers to the spontaneous regression of the primary testicular lesion, generally with the presence of a metastatic germ cell tumour. Regressed tumours with retroperitoneal metastasis, as the first manifestation, represent difficult cases prone to misdiagnosis. Burned-out TGCT is a rare but well-recognized entity, with defined clinical features and diagnostic criteria; however, its etiopathogenesis is still not well defined.

We present a case of 37-year-old man with a retroperitoneal mass adjacent to the duodenum identified on CT scan. After surgical excision, histopathologic findings evidenced metastatic non-seminomatous GCT. Testicular examination was normal, but a right testis suspicious lesion was found on ultrasound study. Radical right orchidectomy was performed, and histological examination showed complete regression of TGCT. He underwent first-line chemotherapy with complete response and no evidence of recurrence.
High CO2/hypoxia-induced softening of persimmon fruit is modulated by DkERF8/16 and DkNAC9 complexes
Authors: Wu Wei , Wang Miao-miao , Gong Hui , Liu Xiao-fen , Guo Da-long , Sun Ning-jing , Huang Jing-wen , Zhu Qing-gang , Chen Kun-song , Yin Xue-ren
Published: January 2020

Most persimmon (Diospyros kaki) cultivars are astringent and require post-harvest deastringency treatments such as 95% CO2 (high-CO2 treatment) to make them acceptable to consumers. High-CO2 treatment can, however, also induce excessive softening, which can be reduced by adding 1-methylcyclopropene (1-MCP). Previous studies have shown that genes encoding the ETHYLENE RESPONSE FACTORS (ERFs) DkERF8/16/19 can trans-activate xyloglucan endotransglycosylase/hydrolase (DkXTH9), which encodes the cell wall-degrading enzyme associated with persimmon fruit softening. In this study, RNA-seq data between three treatments were compared, namely high-CO2, high-CO2+1-MCP, and controls. A total of 227 differentially expressed genes, including 17 transcription factors, were predicted to be related to persimmon post-deastringency softening. Dual-luciferase assays indicated that DkNAC9 activated the DkEGase1 promoter 2.64-fold. Synergistic effects on transcription of DkEGase1 that involved DkNAC9 and the previously reported DkERF8/16 were identified. Electrophoretic mobility shift assay indicated that DkNAC9 could physically bind to the DkEGase1 promoter. Bimolecular fluorescence complementation and firefly luciferase complementation imaging assays indicated protein–protein interactions between DkNAC9 and DkERF8/16. Based on these findings, we conclude that DkNAC9 is a direct transcriptional activator of DkEGase1 that can co-operate with DkERF8/16 to enhance fruit post-deastringency softening.
Clinical Usefulness of Hematologic Indices as Predictive Parameters for Systemic Lupus Erythematosus
Authors: Peirovy Amirhossein , Malek Mahdavi Aida , Khabbazi Alireza , Hajialilo Mehrzad , Sakhinia Ebrahim , Rashtchizadeh Nadereh
Published: January 2020

Objective

This study assessed the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume, platelet distribution width, and red cell distribution width (RDW) in systemic lupus erythematosus (SLE) patients and their correlation with disease activity.

Methods

Two hundred eight SLE patients and 205 age- and sex-matched healthy controls were included. Disease activity was assessed using the systemic lupus erythematosus disease activity index 2000, and hematological indices were determined.

Results

Lymphocyte and platelet counts were significantly lower in SLE patients than in the controls, while the NLR, PLR, and RDW were significantly higher (P < .05). In patients with active disease, the neutrophil counts, NLR, and PLR were significantly higher than in those with inactive disease (P < .05), while the lymphocyte count was significantly lower (P < .05). Based on receiver operating characteristic curve analyses, only for lymphocyte count and PLR. The area under curve was significantly higher (P = .001 and P = .053, respectively).

Conclusion

PLR can serve as a biomarker for indicating SLE disease activity.
Embeddings of Bishop spaces
Authors: Petrakis Iosif
Published: January 2020

We develop the basic constructive theory of embeddings of Bishop spaces in parallel to the basic classical theory of embeddings of topological spaces. The theory of Bishop spaces is a constructive approach to point-function topology and a natural constructive alternative to the classical theory of the rings of continuous functions. Our most significant result is the translation of the classical Urysohn extension theorem within the theory of Bishop spaces. The related theory of the zero sets of a Bishop topology is also included. We work within $\textrm{BISH}^{\ast }$, Bishop’s informal system of constructive mathematics $\textrm{BISH}$ equipped with inductive definitions with rules of countably many premises.
Dementia and Neurocognitive Disability
Authors: Büla Christophe J.
Published: January 2020

Dementia can be broadly defined as a decline in cognitive abilities in comparison with a previous level of performance. It is a clinical syndrome most often characterized by progressive deficits in several cognitive domains such as memory, language, and impairments in a person’s behavior and daily functional abilities. Dementia places considerable strain on patients and their relatives, who provide a large share of the required care and support. As the global population is aging, the burden of dementia has become a worldwide concern and will be further increasing over the next two decades. New pharmacological and nonpharmacological interventions are urgently needed to address this huge challenge.
The Predestined Nature of Assistive Technologies for Dementia
Authors: Sugihara Taro , Fujinami Tsutomu , Moriyama Osamu
Published: January 2020

Assistive technologies for dementia care will be a fruitful way to enhance resources in care facilities, especially in the era of global super-aging. While assistive technologies have been deployed across national boundaries, their users—people who are cared for and their caregivers—are bound by policies in their respective countries or regions. Therefore, technology developers have to pay attention to local policies and related rules. This chapter examines this issue using a case study approach from care homes in Japan. We describe the opportunities and challenges of implementing these technologies from the micro, meso, and macro perspectives. Finally, this chapter attempts to delineate possible solutions from the author’s perspective.
Personal Identity, Neuroprosthetics, and Alzheimer’s Disease
Authors: Jotterand Fabrice
Published: January 2020

This chapter examines the implications of the use of neuroprosthetics such as artificial hippocampi or neurostimulation techniques for the understanding of personal identity in patients with Alzheimer’s disease (AD): first, regarding a conceptualization of personal identity based on psychological continuity (memory), and second, according to a conceptualization of personal identity based on psychological continuity (memory) and embodiment. This chapter provides an overview of the various stages of AD, including how the disorder impacts people’s memory capabilities and personality and generates behavioral changes. It focuses on neuroprosthetics as a technique to help patients in the early stages of AD to compensate for lost neural functionality and cognitive abilities. It also critically examines the concept of personal identity through the work of John Locke and Derek Parfit and provide an alternative account called bio-psycho-somatic unity. Finally, the chapter offers an ethical framework for the care of patients with AD who experience identity loss that includes the preservation or restoration of psychological continuity, the acknowledgment of an embodied identity, and the necessity of a relational narrative.
Privacy and Security Issues in Assistive Technologies for Dementia
Authors: Ienca Marcello , Villaronga Eduard Fosch
Published: January 2020

The collection of a large volume and variety of physiological and behavioral data is critical for the effective development, deployment, and implementation of intelligent assistive technologies (IATs) and for the subsequent effective support of older adults with dementia. Yet it raises privacy and security issues. This chapter reviews the major privacy and security implications associated with the use of three major families of IATs for dementia: ambient assisted living systems, wearable devices, and service robotics, especially telepresence robots. After exploring a number of both category-specific and cross-categorical ethical and legal implications, the chapter proposes a list of policy recommendations with the purpose of maximizing the uptake of IATs while minimizing possible adverse effects on the privacy and security of end-users.
Developing Ethical Web- and Mobile-Based Technologies for Dementia
Authors: Robillard Julie M. , Feng Tanya L.
Published: January 2020

The availability of web- and mobile-based technologies (WMBTs) for dementia prevention and care has grown exponentially over the last decade. These include computer-based resources such as online self-diagnostic tools, mobile-based resources such as applications (“apps”) that track lifestyle metrics or provide interactive platforms for cognitive engagement, and cross-platform resources such as websites providing health information. Despite their potential benefits, key ethical challenges have been identified in WMBTs for dementia both at the individual and societal levels, including issues of privacy, quality, and accessibility. This chapter explores the ethical challenges surrounding the use of WMBTs for dementia and highlights recent evidence on the positive and negative impacts of WMBT solutions. The chapter reviews development and design recommendations that have been put forward to maximize the benefits and minimize the harms of using WMBTs for dementia. It closes by looking to the future and proposing development considerations for future WMBT development.
Dementia and the Regulation of Gerontechnology
Authors: Beauregard James
Published: January 2020

The federal regulation of gerontechnology in the United States is a complex issue spread across multiple agencies. In addition, gerontechnology is not a unified area, but covers multiple types of technology that can help with medical care, safety monitoring, communication, and mobility, most recently through advances in robotics. This chapter reviews the nature of federal regulation as it impacts the development, safety, efficacy, monitoring, and use of gerontechnology for dementia care through an examination of the different types of dementia and specific care needs that arise within them, followed by consideration of the specific federal agencies that regulate a multifaceted gerontechnology field. The chapter concludes with recommendations for creating a common core of knowledge across the many disciplines contained in the field of gerontechnology.
Anaesthetic equipment
Authors: Craig Richard
Published: January 2020

This chapter presents anaesthetic equipment used in paediatric anaesthesia. Airway equipment is described in detail with specific examples. This includes a description of the variety of supraglottic airway devices, endotracheal tubes, laryngoscopes for direct and indirect visualization of the larynx, breathing systems, ventilators, and modes of ventilation. Equipment for perioperative monitoring of the paediatric patient is reviewed. Practical advice regarding monitoring neonates and small babies is given particular attention. The use of the bispectral index (BIS) monitor and near-infrared spectroscopy (NIRS) are discussed. New advances in pulse oximetry that enable better monitoring with low perfusion states and motion are included.
Advanced airway management
Authors: Craig Richard
Published: January 2020

Management of the difficult paediatric airway is described in this chapter. Airway assessment and a structured approach to planning for the anticipated difficult airway are the essence of the chapter. This includes a plan for induction of anaesthesia, a plan for laryngoscopy and intubation, and a plan for safe extubation. Detailed, step-by-step guides describing the techniques for intubation using a flexible bronchoscope, Macintosh-style video laryngoscope, and rigid optical stylet are provided. The conditions commonly associated with the difficult paediatric airway are classified according to the mechanism by which they cause difficulty.
Neonatal anaesthesia
Authors: Arnold Phil
Published: January 2020

Paediatric anaesthetists often place emphasis on the differences between children and adults. These differences will be greatest when considering neonates, whose physiology will also differ substantially from that of older children. This chapter focuses on general issues around anaesthesia in neonates, including airway management, fluids, and vascular access. Specific sections discuss the cardiovascular changes around birth and anaesthesia for premature infants. The effect of anaesthetic agents, and anaesthesia, on bran development is controversial, and key aspects of this debate are summarized.
Day-case surgery
Authors: Roberts Steve
Published: January 2020

Day surgery is an immensely important aspect of any hospital’s workload, with innovations in both surgery and anaesthesia allowing a greater array of procedures to be delivered in this manner. The benefits to children and families is huge, particularly in avoiding the psychological upset of an overnight admission. This chapter describes the facilities and resources required to safely deliver day surgery for children, as well as the general principles of patient selection and anaesthetic practice.
Cardiothoracic surgery
Authors: Arnold Phil
Published: January 2020

Congenital heart disease occurs in around 1% of live births and will be more common in children presenting for surgical correction of other congenital anomalies. Whilst the anaesthetic care of children undergoing cardiac surgery is a highly specialized area of practice, any anaesthetist looking after children and young adults will encounter patients with congenital heart disease and therefore requires an understanding of optimal anaesthetic management of these children. The objects of this chapter are first to describe different congenital heart lesions and their implications with respect to anaesthesia and to provide advice for anaesthetic care of these patients. More specialist areas of anaesthetic care are also discussed, including anaesthesia for cardiac surgery in children, anaesthesia in the cardiac catheter laboratory, and use of mechanical support of the circulation. The second part of the chapter concerns surgery on thoracic structures other than the heart. Indications for thoracic surgery, general conduct of anaesthesia, analgesic techniques, and techniques for one-lung ventilation in children are described. Mediastinal surgery and surgery on the chest wall are also discussed.
Dental and oral surgery
Authors: Carver Ed
Published: January 2020

Dental and oral surgery is one of the commonest reasons for providing anaesthesia to children in the UK. Other than simple extractions for caries, patients may present for restorative work and to facilitate orthodontic treatment. A familiarity with the techniques involved is essential, including that of airway maintenance with a nasal mask, which is still used in some centres.
Orthopaedic surgery
Authors: Raj Naveen
Published: January 2020

This chapter covers the perioperative management of both elective (e.g. scoliosis surgery) and emergency (e.g. fractured limb) orthopaedic procedures. For each pathology, the patient population and the surgical management are described. Thereafter, the perioperative care is described in a concise but thorough manner, explaining everything from preoperative assessment to the analgesic regimes employed to manage these often-challenging patients.
Radiology
Authors: Bowes Laura
Published: January 2020

This chapter covers both diagnostic and interventional radiology. Unlike adults, many children require general anaesthesia or sedation to be able to cooperate with diagnostic radiology, e.g. a breath hold during CT chest, or keeping still for a long MRI scan. Commonly, general anaesthesia is delivered in the radiology department. This can mean the anaesthetist is working remotely from colleagues and therefore must be experienced and aware of the potential hazards in this environment (e.g. radiation). Increasingly, interventional procedures are being performed in children (e.g. venous access), with large numbers of personnel and equipment often involved; therefore, organisation and planning are imperative. This chapter helps highlight the issues involved.
AGN feedback in the FR II galaxy 3C 220.1
Authors: Liu Wenhao , Sun Ming , Nulsen Paul E J , Worrall Diana M , Birkinshaw Mark , Sarazin Craig , Forman William R , Jones Christine , Ge Chong
Published: January 2020

We present results from a deep (174 ks) Chandra observation of the FR-II radio galaxy 3C 220.1, the central brightest cluster galaxy (BCG) of a kT ∼ 4 keV cluster at z = 0.61. The temperature of the hot cluster medium drops from ∼5.9 to ∼3.9 keV at ∼35 kpc radius, while the temperature at smaller radii may be substantially lower. The central active galactic nucleus (AGN) outshines the whole cluster in X-rays, with a bolometric luminosity of 2.0 × 1046 erg s−1 (∼10 per cent of the Eddington rate). The system shows a pair of potential X-ray cavities ∼35 kpc east and west of the nucleus. The cavity power is estimated within the range of 1.0 × 1044 and 1.7 × 1045 erg s−1, from different methods. The X-ray enhancements in the radio lobes could be due to inverse Compton emission, with a total 2–10 keV luminosity of ∼8.0 × 1042 erg s−1. We compare 3C 220.1 with other cluster BCGs, including Cygnus A, as there are few BCGs in rich clusters hosting an FR-II galaxy. We also summarize the jet power of FR-II galaxies from different methods. The comparison suggests that the cavity power of FR-II galaxies likely underestimates the jet power. The properties of 3C 220.1 suggest that it is at the transition stage from quasar-mode feedback to radio-mode feedback.
tRNA 2′-O-methylation by a duo of TRM7/FTSJ1 proteins modulates small RNA silencing in Drosophila
Authors: Angelova Margarita T , Dimitrova Dilyana G , Da Silva Bruno , Marchand Virginie , Jacquier Caroline , Achour Cyrinne , Brazane Mira , Goyenvalle Catherine , Bourguignon-Igel Valérie , Shehzada Salman , Khouider Souraya , Lence Tina , Guerineau Vincent , Roignant Jean-Yves , Antoniewski Christophe , Teysset Laure , Bregeon Damien , Motorin Yuri , Schaefer Matthias R , Carré Clément
Published: January 2020

2′-O-Methylation (Nm) represents one of the most common RNA modifications. Nm affects RNA structure and function with crucial roles in various RNA-mediated processes ranging from RNA silencing, translation, self versus non-self recognition to viral defense mechanisms. Here, we identify two Nm methyltransferases (Nm-MTases) in Drosophila melanogaster (CG7009 and CG5220) as functional orthologs of yeast TRM7 and human FTSJ1. Genetic knockout studies together with MALDI-TOF mass spectrometry and RiboMethSeq mapping revealed that CG7009 is responsible for methylating the wobble position in tRNAPhe, tRNATrp and tRNALeu, while CG5220 methylates position C32 in the same tRNAs and also targets additional tRNAs. CG7009 or CG5220 mutant animals were viable and fertile but exhibited various phenotypes such as lifespan reduction, small RNA pathways dysfunction and increased sensitivity to RNA virus infections. Our results provide the first detailed characterization of two TRM7 family members in Drosophila and uncover a molecular link between enzymes catalyzing Nm at specific tRNAs and small RNA-induced gene silencing pathways.
Public Safety Personnel’s interpretations of potentially traumatic events
Authors: Ricciardelli R , Czarnuch S , Afifi T O , Taillieu T , Carleton R N
Published: January 2020

Background

Many public safety personnel (PSP) experience trauma directly or indirectly in their occupational role, yet there remain barriers to accessing care or seeking help.

Aims

To understand how PSP interpret different potentially traumatic events and how perceived eligibility for being traumatized is determined among PSP.

Methods

We analysed open-ended comments provided by over 800 PSP in a survey designed to assess the prevalence of post-traumatic stress injuries and other mental disorders.

Results

We found evidence that a trauma hierarchy may exist among PSP. Certain experiences may be interpreted as more traumatic, based on both the event and the PSP role in the actual event. For example, involvement in a shooting may be interpreted as more traumatic than arriving on the scene later. Similarly, a single event may be deemed more traumatic than an accumulation of events. The role of the individual and social context in shaping experiences and interpretations of trauma may be largely ignored in line with confirmation biases.

Conclusions

The role that individuals and social contexts play in shaping experiences and interpretations of trauma appear suppressed by perceptions of a trauma hierarchy, facilitating systematic discrediting or valuation of some experiences, therein evidencing that trauma is subjective and reinforcing barriers to care seeking. A trauma hierarchy may also propagate stigma and legitimize discrimination regarding mental health. We argue that recognizing, engaging with, and dismantling the perception of a trauma hierarchy may help create a respectful and open occupational culture supportive of mental health needs.
Two definitions of presenteeism: sickness presenteeism and impaired work function
Authors: Ishimaru T , Mine Y , Fujino Y
Published: January 2020

Background

Two major definitions exist for presenteeism: sickness presenteeism and impaired work function. The evidence for comparing previous studies on presenteeism is insufficient because of the different definitions of presenteeism used.

Aims

To assess the relationship between the two major definitions of presenteeism.

Methods

This cross-sectional study analysed secondary data on 5334 respondents to an employee survey administered in a construction company in Japan. Impaired work function was measured using the Work Functioning Impairment Scale (WFun). Multiple logistic regression was performed.

Results

A strong linear association was observed between the number of days of sickness presenteeism and impaired work function (all P < 0.001). In contrast, the number of days of sickness absence was only partially positively associated with impaired work function. All choices for most frequent health problem were positively associated with impaired work function, beginning with mental problems (adjusted odds ratio [OR] = 20.45, 95% confidence interval [CI]: 14.94–28.01), followed by malaise (adjusted OR = 11.91, 95% CI: 9.08–15.62) and sleeping problems (adjusted OR = 8.62, 95% CI: 6.57–11.33).

Conclusions

A strong relationship was observed between the two major definitions of presenteeism, even after adjusting for a variety of chronic health conditions. Although a consensus on the definition of presenteeism is yet to be reached, this study provides insight on comparing existing studies on presenteeism.
Refusal of animal-derived medical products in a paediatric setting: Ethical issues
Authors: Hassanein Maram , Anderson James A
Published: January 2020

Many medical products that are widely available and commonly used are of animal origin, which can be problematic for those who identify as followers of a particular religion, or have moral commitments or dietary preferences that prohibit or restrict the ingestion of animal products. Given that people are becoming more conscious of the products they ingest, however, we suspect this might be an issue in the foreseeable future, particularly in a multicultural and diverse community like Toronto, Canada. Failure to provide services sensitive to these beliefs and preferences may result in a refusal of medical treatment. In this paper, we aim to identify and explore issues relating to the refusal of animal-derived medical products in paediatric settings by exploring three clinical cases.