bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of coupling agents on the transport properties of sulfonated poly (ether ether ketone) based composite membrane
Authors: Yan Chia Min , San Thiam Hui , Kong Leong Loong , Hoon Koo Chai , Huat Saw Lip
Published: July 2019

Development of low cost proton exchange membrane surges as a main research topic in order to replace expensive Nafion in the fuel cell industry. In this study, sulfonated poly (ether ether ketone) (SPEEK) was used as the base polymer for the purpose. Silicotungstic acid supported on silica (SiWA-SiO2) was incorporated into SPEEK polymer matrix to improve the performance of composite membrane. 3-aminopropyltriethoxysilane (APTES) and carbonyldiimidazole (CDI) were used as coupling agents to increase the compatibility of the organic and inorganic phases in the composite membrane. The reaction mechanisms involve the interaction between imidazole group of CDI with sulfonic acid group of SPEEK polymer followed by substitution using APTES. Finally, inorganic silica will attach to the inorganic functionalities of APTES and complete the organic-inorganic bridge between the two phases. Stabilisation of SiWA-SiO2 additives in the polymer matrix was greatly improved when APTES and CDI are added. It was found that SPEEK/SiO2-SiWA exhibited smooth, homogenous and compact membrane structure. This could reduce the permeability of the membrane to methanol. Although the composite membrane had low water uptake, presence of ample amount of SiWA within the polymer matrix helped to enhance the proton conductivity of SPEEK composite membrane. It was reported that the overall selectivity is increased to 10.6 × 104 S.s/cm3.
Carbon Deposition Properties of Ni0.5M0.5/10Sc1CeSZ (M = Cu, Co and Fe) Cermet Anode for Dry Reforming Methane-Fuelled Solid Oxide Fuel Cells
Authors: Jais A A , Somalu M R , Muchtar A , Isahak W N R W
Published: July 2019

Nickel-based cermet anode can be operated in hydrogen and hydrocarbon-fuelled intermediate temperature solid oxide fuel cells (SOFCs). Nickel/zirconia co-doped with 10 mol% scandia and 1 mol% ceria (Ni/10Sc1CeSZ) has better electrochemical performance compared with the state-of-the art SOFC anode, Ni/yttria-stabilised-zirconia. In this study, nickel-metal/10 mol% scandia-1 mol% ceria-stabilised zirconia (Ni0.5M0.5/10Sc1CeSZ, M = Co, Cu and Fe) composite anode powders were synthesised via a single-step microwave-assisted glycine nitrate process. The phase identification and morphology of the prepared powder were investigated by X-ray diffraction and field-emission scanning electron microscopy, respectively. The carbon deposition properties of Ni/10Sc1CeSZ and Ni0.5M0.5/10Sc1CeSZ (M = Co, Cu and Fe) cermet anode in dry methane fuel were evaluated. Cermet anode powder was reduced under a mixture of hydrogen (10%) and nitrogen (90%) at 800 °C for 2 h prior to the carbon deposition test. In the carbon deposition test, the reduced cermet powder was exposed in dry methane atmosphere at 800 °C for 3 h. Overall, Ni0.5Cu0.5/10Sc1CeSZ cermet anode exhibits the highest intensity ratio of G/D (2.64) in Raman analysis, resulting in less amorphous carbon deposits. This study shows that copper metal substitution could suppress carbon deposition onto Ni/10Sc1CeSZ cermet, and this material can be used as an anode material for SOFCs that operate on dry methane fuel.
A Study to Retrofit Parabolic Trough Collector on Jimah Coal-Fired Power Plant
Authors: Ashraf Asmuni Iman , Kumar Venkiteswaran Vinod , Abdulrahman Alkaff Saqaff Ahmed
Published: July 2019

In Malaysia, coal-fired power plant makes up 40% out of the total installed capacity as of the year 2016. This preference is set to continue despite the global push to reduce carbon emissions. Solar Aided Coal-Fired Power Generation (SACPG) may be a viable option to be considered to help reduce carbon emissions while maintaining the capability to meet the country’s growing electricity demand. This study looks into the possibility and potential of retrofitting Parabolic Trough Collectors (PTC) at Jimah Power Plant (JPP) to substitute the existing steam extraction feedwater heating with solar heating. The main focuses are the potential solar energy that can be harvested and the best feedwater preheating retrofitting scheme. The study found that an area of 59,340.06 m2 can be utilised and a maximum solar heating rate of 69,427,870.20 kJ/hr can be harvested. Meanwhile, the lowest feedwater heating was at Feedwater Heater (FWH) A with a heating rate of 153,317,018.40 kJ/hr. Full replacement of any feedwater heater is found to be impossible and the only suitable retrofit scheme is to have 0.45 solar fraction heating at Feedwater Heater A. This retrofit scheme can help to increase 0.59% of JPP efficiency and reduce 8.18 ton/hr of coal consumption
The insight investigation on the performance affecting parameters of Micro wind turbines
Authors: Natarajan Karthikeyan , Anand RB , Charan Jirra , Kanungo Tanay
Published: July 2019

The large to small wind turbines have been investigated for past few decades, but only a few have conducted the investigation on micro wind turbines, whose power rating and rotor diameters are less than 1 kW and 1.5 m respectively. The growing utilization of power electronic devices creates space for the development of micropower harvesting that could be used for standalone charging applications. The theoretical investigation is conducted on rotor diameter of 30 cm and which is targeted to operate at the cut in, rated and cut out wind speed of 4 ms
−1
, 7 ms
−1
and 11 ms
−1
respectively with the rated tip speed ratio ranging from 2.5 to 4. The airfoils SD7037, E193, RG15, SG6041, SG6051 and S7012 are shortlisted on the basis of the prior aerodynamic investigation, and this study aims to improve the performance of MWT rotor at 7 ms
−1
. The different chord and twist equations are used to determine the optimum blade geometry with trade-offs between the better starting and maximum performance. The turbines with RG15 and SD7037 attains the maximum power of 2.3 W at a wind speed of 7 ms
−1
of wind speed and design TSR of 2.5 leading to better annual energy production.
The Ineffectiveness of Water Splash on Paddlewheel Aerator
Authors: Bahri Samsul , Jufriadi  , Anwar Hamdani
Published: July 2019

The successful of intensive aquaculture is strongly influenced by the ability of the farmers to overcome the deterioration of water quality. The problem is low dissolved oxygen through aeration process. The aerator device which widely used in pond farming is paddle wheel aerator because it is the best aerator in aeration mechanism and usable driven power. However, the paddlewheel has a slow aeration rate resulting in low aeration efficiency. The problem is caused by the backward water splash ineffectively. The backward water of the paddlewheel that is already aerated, but it is splashed again so it wastes the power. However, only the forward splash is effectively. The aim of this study was to determine the ineffectiveness of paddlewheel aerator based on the backward water splash. The paddlewheel used an 1 phase motor, 1 hp power, 1400 rpm motor speed, and 2 pieces of wheels. The treatment was carried out by varying the blade of 65, 85, and 105 mm submerged. The test was done by collecting the forward and backward water splash and calculating its volume. The normal position of the float on the blade submerged by 85 mm was obtained that the forward and backward splash volume of water was 17.99 and 13.74 m3/hour. Only 56.70% the effectiveness of the water splash compared to 43.30% the backward water splash. In fact, the forward splash coverage volume of water was 47.83% compared to the forward was 52.17%. This result shown that the water splash of paddlewheel aerator was not effective, so the backward water splash need to optimize to the effectiveness of water splash.
Direct oral anticoagulants in patients with cancer
Authors: Bossaer John B , Covert Kelly L
Published: July 2019

Purpose

This review summarizes the available evidence concerning direct oral anticoagulant (DOAC) use to treat venous thromboembolism (VTE) in patients with cancer as well as pertinent safety data on the use of DOACs in patients with both cancer and atrial fibrillation.

The introduction of DOACs into clinical practice changed the way thrombotic complications are managed and prevented in diverse patient populations, including VTE and atrial fibrillation. Low-molecular-weight heparins have been the standard of care for treating VTE in cancer patients due to superiority over vitamin K antagonists in preventing recurrent VTE. Therefore, widespread DOAC use for VTE in patients with active cancer has not been adopted.

Conclusion

Recent randomized clinical trials (SELECT-D, Hokusai VTE Cancer) have provided evidence that DOACs may have a role in treating VTE in cancer patients.
Heterogeneous information network and its application to human health and disease
Authors: Ding Pingjian , Ouyang Wenjue , Luo Jiawei , Kwoh Chee-Keong
Published: July 2019

The molecular components with the functional interdependencies in human cell form complicated biological network. Diseases are mostly caused by the perturbations of the composite of the interaction multi-biomolecules, rather than an abnormality of a single biomolecule. Furthermore, new biological functions and processes could be revealed by discovering novel biological entity relationships. Hence, more and more biologists focus on studying the complex biological system instead of the individual biological components. The emergence of heterogeneous information network (HIN) offers a promising way to systematically explore complicated and heterogeneous relationships between various molecules for apparently distinct phenotypes. In this review, we first present the basic definition of HIN and the biological system considered as a complex HIN. Then, we discuss the topological properties of HIN and how these can be applied to detect network motif and functional module. Afterwards, methodologies of discovering relationships between disease and biomolecule are presented. Useful insights on how HIN aids in drug development and explores human interactome are provided. Finally, we analyze the challenges and opportunities for uncovering combinatorial patterns among pharmacogenomics and cell-type detection based on single-cell genomic data.
Reduced PAX2 expression in murine fallopian tube cells enhances estrogen receptor signaling
Authors: Colina Jose A , Varughese Peter , Karthikeyan Subbulakshmi , Salvi Amrita , Modi Dimple A , Burdette Joanna E
Published: July 2019

High-grade serous ovarian cancer (HGSOC) is thought to progress from a series of precursor lesions in the fallopian tube epithelium (FTE). One of the preneoplastic lesions found in the FTE is called a secretory cell outgrowth (SCOUT), which is partially defined by a loss of paired box 2 (PAX2). In the present study, we developed PAX2-deficient murine cell lines in order to model a SCOUT and to explore the role of PAX2 loss in the etiology of HGSOC. Loss of PAX2 alone in the murine oviductal epithelium (MOE) did not induce changes in proliferation, migration and survival in hypoxia or contribute to resistance to first line therapies, such as cisplatin or paclitaxel. RNA sequencing of MOE PAX2shRNA cells revealed significant alterations in the transcriptome. Silencing of PAX2 in MOE cells produced a messenger RNA expression pattern that recapitulated several aspects of the transcriptome of previously characterized human SCOUTs. RNA-seq analysis and subsequent qPCR validation of this SCOUT model revealed an enrichment of genes involved in estrogen signaling and an increase in expression of estrogen receptor α. MOE PAX2shRNA cells had higher estrogen signaling activity and higher expression of putative estrogen responsive genes both in the presence and absence of exogenous estrogen. In summary, loss of PAX2 in MOE cells is sufficient to transcriptionally recapitulate a human SCOUT, and this model revealed an enrichment of estrogen signaling as a possible route for tumor progression of precursor lesions in the fallopian tube.
Isolation and Purification of Pyrazines Produced by Reaction of Cellulosic-Derived Sugars with NH4OH and Selected Amino Acids
Authors: Ashraf-Khorassani M , Coleman III W M , Dube M F , Taylor L T
Published: July 2019

Various pyrazines have been synthesized via reaction of selected cellulosic-derived sugars, ammonium hydroxide and amino acids at 110°C for 2 hours. Different methods of sample cleanup such as liquid–liquid extraction (LLE), liquid–solid extraction, column chromatography and distillation were employed to isolate pyrazines from the reaction mixture. Effective LLE of pyrazines from aqueous solution using either hexane, methyl-t-butyl ether (MTBE) or ethyl acetate required multiple extraction steps with fresh solvent each time. When hexane was used as the extraction solvent, no imidazole derivatives were extracted with the pyrazines. However, when MTBE or ethyl acetate was employed, 4-methyl imidazole was co-extracted and further cleanup was required. Passing the organic solvent extracts through a column of silica revealed that the silica retained the undesirable imidazoles, such as 4-methyl imidazole. A mixture of 90/10 hexane/ethyl acetate as eluting solvent provided the desirable pyrazines, but it also provided a desirable separation of pyrazines as a function of total alkyl substituent content. Distillation of the aqueous reaction mixture was also used to isolate the pyrazines, leaving the undesirable imidazoles in the undistilled portion of the reaction. Additional chromatographic methods were used to isolate pyrazines from the aqueous distillate including a column packed with C18-bonded silica.
TAILoR (TelmisArtan and InsuLin Resistance in Human Immunodeficiency Virus [HIV]): An Adaptive-design, Dose-ranging Phase IIb Randomized Trial of Telmisartan for the Reduction of Insulin Resistance in HIV-positive Individuals on Combination Antiretroviral Therapy
Authors: Pushpakom Sudeep , Kolamunnage-Dona Ruwanthi , Taylor Claire , Foster Terry , Spowart Cath , García-Fiñana Marta , Kemp Graham J , Jaki Thomas , Khoo Saye , Williamson Paula , Pirmohamed Munir ,   for the TAILoR Study Group, Ainsworth Jonathan , Chadwick David , Chaponda Mas , Chauhan Mayur , Churchill Duncan , Das Satyajit , Gompels Mark , Hereika Elbushra , Johnson Margaret , Leen Clifford , Loay David , Martin Fabiola , Minton Jane , Peters Barry , Post Frank , Schembri Gabriel , Vora Jiten , Whitehead John
Published: July 2019

Background

Combination antiretroviral therapy results in metabolic abnormalities which increase cardiovascular disease risk. We evaluated whether telmisartan reduces insulin resistance in human immunodeficiency virus (HIV)–positive individuals on antiretrovirals.

Methods

We conducted a multicenter, randomized, open-label, dose-ranging controlled trial of telmisartan. Participants with HIV infection receiving combination antiretroviral therapy were randomized equally to either no intervention (control) or 20, 40, or 80 mg telmisartan once daily. The adaptive design allowed testing of all dose(s) of telmisartan in stage I, with the promising dose(s) being taken into stage II. The primary outcome measure was reduction in homeostasis model assessment of insulin resistance (HOMA-IR) at 24 weeks.

Results

A total of 377 patients were recruited. In stage I, 48, 49, 47, and 45 patients were randomized to control and 20, 40, and 80 mg telmisartan, respectively (total n = 189). At the interim analysis, 80 mg telmisartan was taken forward into stage II. At the end of stage II (n = 105, control; 106, 80-mg arm), there were no differences in HOMA-IR (estimated effect, 0.007; SE, 0.106) at 24 weeks between the telmisartan (80 mg) and nonintervention arms. Longitudinal analysis over 48 weeks showed no change in HOMA-IR, lipid or adipokine levels. There were significant (P ≤ .05), but marginal, improvements in revised Quantitative Insulin Sensitivity Check Index (QUICKI) (0.004) and plasma hs-CRP (−0.222 mg/L) and reduction in liver fat content (1.714 mean reduction; P = .005).

Conclusions

No significant effect of telmisartan was demonstrated on the primary outcome (HOMA-IR), but there were marginal improvements with some secondary outcome measures. Further studies in this population are warranted to identify novel strategies for preventing cardiovascular morbidity and mortality.

Clinical Trial Registration

ISRCTN registry (51069819).
Rational trust in resilient health systems
Authors: Kittelsen Sonja Kristine , Keating Vincent Charles
Published: July 2019

The 2014–15 Ebola epidemic in West Africa highlighted the significance of trust between the public and public health authorities in the mitigation of health crises. Since the end of the epidemic, there has been a focus amongst scholars and practitioners on building resilient health systems, which many see as an important precondition for successfully combatting future outbreaks. While trust has been acknowledged as a relevant component of health system resilience, we argue for a more sustained theoretical engagement with underlying models of trust in the literature. This article takes a first step in showing the importance of theoretical engagement by focusing on the appeal to rational models of trust in particular in the health system resilience literature, and how currently unconsidered assumptions in this model cast doubt on the effectiveness of strategies to generate trust, and therein resilience, during acute public health emergencies.
Loss of FLCN inhibits canonical WNT signaling via TFE3
Authors: Kennedy John C , Khabibullin Damir , Hougard Thomas , Nijmeh Julie , Shi Wei , Henske Elizabeth P
Published: July 2019

Lower lobe predominant pulmonary cysts occur in up to 90% of patients with Birt–Hogg–Dubé (BHD) syndrome, but the key pathologic cell type and signaling events driving this distinct phenotype remain elusive. Through examination of the LungMAP database, we found that folliculin (FLCN) is highly expressed in neonatal lung mesenchymal cells. Using RNA-Seq, we found that inactivation of Flcn in mouse embryonic fibroblasts leads to changes in multiple Wnt ligands, including a 2.8-fold decrease in Wnt2. This was associated with decreased TCF/LEF activity, a readout of canonical WNT activity, after treatment with a GSK3-α/β inhibitor. Similarly, FLCN deficiency in HEK293T cells decreased WNT pathway activity by 76% post-GSK3-α/β inhibition. Inactivation of FLCN in human fetal lung fibroblasts (MRC-5) led to ~ 100-fold decrease in Wnt2 expression and a 33-fold decrease in Wnt7b expression—two ligands known to be necessary for lung development. Furthermore, canonical WNT activity was decreased by 60%. Classic WNT targets such as AXIN2 and BMP4, and WNT enhanceosome members including TCF4, LEF1 and BCL9 were also decreased after GSK3-α/β inhibition. FLCN-deficient MRC-5 cells failed to upregulate LEF1 in response to GSK3-α/β inhibition. Finally, we found that a constitutively active β-catenin could only partially rescue the decreased WNT activity phenotype seen in FLCN-deficient cells, whereas silencing the transcription factor TFE3 completely reversed this phenotype. In summary, our data establish FLCN as a critical regulator of the WNT pathway via TFE3 and suggest that FLCN-dependent defects in WNT pathway developmental cues may contribute to lung cyst pathogenesis in BHD.
Gender Differences and Other Factors Associated with Weight Gain Following Initiation of Infliximab: A Post Hoc Analysis of Clinical Trials
Authors: Christian Kaci E , Russman Katharine M , Rajan Dhyan P , Barr Erik A , Cross Raymond K
Published: July 2019

Background

In our clinical practice, women often report excess weight gain with infliximab (IFX) use. There are currently no studies investigating weight gain after antitumor necrosis factor therapy in patients with inflammatory bowel disease. The objective of this study was to evaluate the association of clinical factors, with a particular focus on sex and weight gain in patients with moderate to severe Crohn’s disease (CD) or ulcerative colitis (UC) initiating IFX.

Methods

Data was extracted from ACCENT I, ACCENT II, ACT 1, and SONIC; included patients received IFX for induction or maintenance of remission of CD or UC. Patients treated with azathioprine (IFX 0 mg/kg) were included as controls. Baseline demographics, clinical characteristics, and weight at each follow-up for the study duration were collected. In addition to descriptive statistics, adjusted mixed effects models were used to test the association between clinical variables and weight gain.

Results

There were 1273 patients included for analysis; the majority was white (91%), with CD (81%), and half of patients (50%) were women. Upon univariate analysis, IFX dose, African American race, diagnosis of CD, elevated C-reactive protein, and low hematocrit and albumin were associated with weight gain (P < 0.001). Upon adjusted analysis, sex was significantly associated with weight gain (P = 0.009), with women experiencing a lower percentage increase from baseline weight than men (3.9% increase vs 4.3% increase).

Conclusions

When starting IFX, those with markers of severe disease and with a diagnosis of CD are likely to gain more weight. Adjusting for confounding variables, women actually gain less weight than men after IFX treatment, although this difference is not clinically relevant.
The morality of foreign law
Authors: Tripkovic Bosko
Published: July 2019

The article explains the normative foundations of the use of foreign law in constitutional reasoning. It pursues four claims. First, it argues that a normative explanation of the use of foreign law must elucidate the connection between foreign legal facts and moral values. Second, it distinguishes between the deductive model of the use of foreign law, which ascribes value to foreign legal facts directly, and the reflective model, which ascribes value to the outcomes of the reflective process facilitated by foreign legal facts. Third, it shows how the deductive model fails to explain the value of foreign law for constitutional judgment. Fourth, the article demonstrates how the reflective model can be justified with reference to a set of virtues of good moral judgment, but argues that this model poses important limits to the use of foreign law.
Finite element method for a stationary Stokes hemivariational inequality with slip boundary condition
Authors: Fang Changjie , Czuprynski Kenneth , Han Weimin , Cheng Xiaoliang , Dai Xiaoxia
Published: July 2019

This paper is devoted to the study of a hemivariational inequality problem for the stationary Stokes equations with a nonlinear slip boundary condition. The hemivariational inequality is formulated with the use of the generalized directional derivative and generalized gradient in the sense of Clarke. We provide an existence and uniqueness result for the hemivariational inequality. Then we apply the finite element method to solve the hemivariational inequality. The incompressibility constraint is treated through a mixed formulation. Error estimates are derived for numerical solutions. Numerical simulation results are reported to illustrate the theoretically predicted convergence orders.
Cycle-Complete Ramsey Numbers
Authors: Keevash Peter , Long Eoin , Skokan Jozef
Published: July 2019

The Ramsey number $r(C_{\ell },K_n)$ is the smallest natural number $N$ such that every red/blue edge colouring of a clique of order $N$ contains a red cycle of length $\ell $ or a blue clique of order $n$. In 1978, Erd̋s, Faudree, Rousseau, and Schelp conjectured that $r(C_{\ell },K_n) = (\ell -1)(n-1)+1$ for $\ell \geq n\geq 3$ provided $(\ell ,n) \neq (3,3)$. We prove that, for some absolute constant $C\ge 1$, we have $r(C_{\ell },K_n) = (\ell -1)(n-1)+1$ provided $\ell \geq C\frac{\log n}{\log \log n}$. Up to the value of $C$ this is tight since we also show that, for any $\varepsilon>0$ and $n> n_0(\varepsilon )$, we have $r(C_{\ell }, K_n) \gg (\ell -1)(n-1)+1$ for all $3 \leq \ell \leq (1-\varepsilon )\frac{\log n}{\log \log n}$. This proves the conjecture of Erd̋s, Faudree, Rousseau, and Schelp for large $\ell $, a stronger form of the conjecture due to Nikiforov, and answers (up to multiplicative constants) two further questions of Erd̋s, Faudree, Rousseau, and Schelp.
Do Self-Reporting Regimes Matter? Evidence from the Convention Against Torture
Authors: Creamer Cosette D , Simmons Beth A
Published: July 2019

International regulatory agreements depend largely on self-reporting for implementation, yet we know almost nothing about whether or how such mechanisms work. We theorize that self-reporting processes provide information for domestic constituencies, with the potential to create pressure for better compliance. Using original data on state reports submitted to the Committee Against Torture, we demonstrate the influence of this process on the pervasiveness of torture and inhumane treatment. We illustrate the power of self-reporting regimes to mobilize domestic politics through evidence of civil society participation in shadow reporting, media attention, and legislative activity around antitorture law and practice. This is the first study to evaluate systematically the effects of self-reporting in the context of a treaty regime on human rights outcomes. Since many international agreements rely predominantly on self-reporting, the results have broad significance for compliance with international regulatory regimes globally.
Longitudinal Study on Retrospective Assessment of Perceived Usability: A New Method and Perspectives
Authors: Yuhui Wang , Chunfu Li , Tian Lei , Qin Huang
Published: July 2019

This paper reports a longitudinal study on the retrospective evaluation of perceived usability. We propose a retest method based on SUS questionnaires to reduce the multiple-observation effects typically present in longitudinal research. We designed different forms of the SUS questionnaire to eliminate memory effects and distributed duplicate SUS copies to subjects. We first measured the alternative-form reliability of duplicate in Experiment I ($\textbf{r =0.814}$). We then found that the duplicates we designed significantly reduce memory effects compared to the standard SUS questionnaire. Experiment II involved tests on the retrospective evaluation of perceived usability at five measurement points after initial use. The retrospective evaluation of perceived usability changes over time. After 5 min (at point ${\mathrm{T}}_2$), we found that each subject’s retrospective evaluation changed significantly regardless of whether the task had higher or lower usability levels. Moreover, the `directions’of this change tended to differ. This indicates that time is an important factor in perceived usability evaluation. Our results altogether indicate that time affects the retrospective evaluation of perceived usability as well as the accuracy of perceived usability evaluation, which suggests that the process of perceived usability assessment requires strict time constraints.
Characterization of carbapenem-resistant and XDR Pseudomonas aeruginosa in Canada: results of the CANWARD 2007–16 study
Authors: McCracken Melissa G , Adam Heather J , Blondeau Joseph M , Walkty Andrew J , Karlowsky James A , Hoban Daryl J , Zhanel George G , Mulvey Michael R ,   Canadian Antimicrobial Resistance Alliance (CARA) and CANWARD, Zhanel George G , Hoban Daryl J , Adam Heather J , Baxter Melanie R , Nichol Kimberly A , Lagacé-Wiens Philippe R S , Walkty Andrew , Karlowsky James A , Blondeau J , Slinger R , Davidson R , Zhanel G , Hoban D , Delport J , Ellis C , Laverdière M , Loo V , Poutanen S , Fuller J , Roscoe D , Desjardins M , Matukas L , Goyette M , Lee C , Carignan A , Bergevin M , Pelletier R
Published: July 2019

Objectives

Carbapenem-resistant Pseudomonas aeruginosa are emerging worldwide with increasing reports of carbapenemase-producing isolates. Carbapenem-resistant isolates may also be XDR. This study characterized carbapenem-resistant and XDR P. aeruginosa isolated from patients receiving care at Canadian hospitals from 2007 to 2016.

Methods

Antimicrobial susceptibility testing was performed using CLSI broth microdilution methods. PCR was used to detect carbapenemases (GES, KPC, NDM, IMP, VIM, OXA-48) and other resistance markers; specific carbapenemase gene variants were identified by DNA sequencing. Genetic relatedness was assessed by MLST and PFGE.

Results

From 2007 to 2016, 3864 isolates of P. aeruginosa were collected; 466 (12.1%) isolates were carbapenem resistant. The prevalence of carbapenem-resistant P. aeruginosa reached a peak of 17.3% in 2014. Colistin (94% susceptible) and ceftolozane/tazobactam (92.5%) were the most active agents against carbapenem-resistant P. aeruginosa. XDR P. aeruginosa comprised 4.5% of isolates; they were found to be genetically diverse and remained susceptible to colistin and ceftolozane/tazobactam. Only 4.3% (n = 20) of carbapenem-resistant P. aeruginosa harboured a carbapenemase; most were blaGES-5 (35%, n = 7). Wide genetic diversity was observed among carbapenem-resistant P. aeruginosa with >200 different sequence types identified.

Conclusions

Although the prevalence of carbapenem-resistant P. aeruginosa in Canada spiked in 2014 and 2015, carbapenemase-producing P. aeruginosa remain rare with only 20 (4.3%) isolates identified over a 10 year period. Broad genetic diversity was observed among both carbapenem-resistant and XDR phenotypes of P. aeruginosa. Pan-drug-resistant P. aeruginosa have not yet been identified in Canada.
Time trend of prevalence and susceptibility to nitrofurantoin of urinary MDR Escherichia coli from outpatients
Authors: Bruyndonckx Robin , Latour Katrien , Atud Glory Abong , Dubovy Patrick , Jaspers Stijn , Hens Niel , Catry Boudewijn , Goossens Herman , Coenen Samuel
Published: July 2019

Objectives

To assess the time trend of the prevalence of urinary MDR Escherichia coli in Belgian outpatients (2005 versus 2011–12), the antibiotic susceptibility of urinary MDR E. coli, and the time trend of non-susceptibility to nitrofurantoin, i.e. first-line treatment for uncomplicated urinary tract infections (UTIs), of urinary MDR E. coli (2005 versus 2011–12).

Methods

In this secondary analysis of a multicentre study, which collected a convenience sample of voluntary participating laboratories (15 and 8 in 2005 and 2011–12, respectively), we analysed antimicrobial susceptibilities (ampicillin, amoxicillin/clavulanate, cefalotin, ciprofloxacin, nitrofurantoin and trimethoprim/sulfamethoxazole) of urinary E. coli. MDR was defined as resistance to three or more of these agents. The prevalence of MDR E. coli and its non-susceptibility to nitrofurantoin was compared between 2005 and 2011–12 using a generalized estimating equation model.

Results

MDR status could be determined for 9704 and 12512 urinary E. coli isolates from 7911 and 9441 patients in 2005 and 2011–12, respectively, with most patients being women (79% in both study periods). The prevalence of MDR increased from 28.4% (2758/9704) in 2005 to 34.3% (4286/12512) in 2011–12 (adjusted OR 1.305; 95% CI 1.220–1.397). Within the MDR isolates, the prevalence of nitrofurantoin non-susceptibility decreased from 23.2% (623/2684) in 2005 to 10.7% (455/4253) in 2011–12 (adjusted OR 0.424; 95% CI 0.363–0.494).

Conclusions

Despite a high prevalence of MDR E. coli in urinary samples from Belgian outpatients, nitrofurantoin could still be recommended as first-line empirical treatment in uncomplicated UTIs.
Physicians’ gender and their use of electronic health records: findings from a mixed-methods usability study
Authors: Khairat Saif , Coleman Cameron , Ottmar Paige , Bice Thomas , Koppel Ross , Carson Shannon S
Published: July 2019

Objective

Physician burnout associated with EHRs is a major concern in health care. A comprehensive assessment of differences among physicians in the areas of EHR performance, efficiency, and satisfaction has not been conducted. The study sought to study relationships among physicians’ performance, efficiency, perceived workload, satisfaction, and usability in using the electronic health record (EHR) with comparisons by age, gender, professional role, and years of experience with the EHR.

Materials and Methods

Mixed-methods assessments of the medical intensivists' EHR use and perceptions. Using simulated cases, we employed standardized scales, performance measures, and extensive interviews. NASA Task Load Index (TLX), System Usability Scale (SUS), and Questionnaire on User Interface Satisfaction surveys were deployed.

Results

The study enrolled 25 intensive care unit (ICU) physicians (11 residents, 9 fellows, 5 attendings); 12 (48%) were men, with a mean age of 33 (range, 28-55) years and a mean of 4 (interquartile range, 2.0-5.5) years of Epic experience. Overall task performance scores were similar for men (90% ± 9.3%) and women (92% ± 4.4%), with no statistically significant differences (P = .374). However, female physicians demonstrated higher efficiency in completion time (difference = 7.1 minutes; P = .207) and mouse clicks (difference = 54; P = .13). Overall, men reported significantly higher perceived EHR workload stress compared with women (difference = 17.5; P < .001). Men reported significantly higher levels of frustration with the EHR compared with women (difference = 33.15; P < .001). Women reported significantly higher satisfaction with the ease of use of the EHR interface than men (difference = 0.66; P =.03). The women’s perceived overall usability of the EHR is marginally higher than that of the men (difference = 10.31; P =.06).

Conclusions

Among ICU physicians, we measured significant gender-based differences in perceived EHR workload stress, satisfaction, and usability—corresponding to objective patterns in EHR efficiency. Understanding the reasons for these differences may help reduce burnout and guide improvements to physician performance, efficiency, and satisfaction with EHR use.

Design

Mixed-methods assessments of the medical intensivists’ EHR use and perceptions. Using simulated cases, we employed standardized scales, performance measures, and extensive interviews.
‘Better Than A Great Many Good Works’: Jenny Erpenbeck’s Go, Went, Gone and the Primacy of Attention in Human Rights Practice
Authors: Phillips Brian
Published: July 2019

Beginning with Simone Weil’s writing on the subject of attention, this article reflects on the place of attention in contemporary human rights practice—specifically in relation to the challenges posed by the multiple patterns of migration that have so defined our era. Through the lens of Jenny Erpenbeck’s remarkable novel, Go, Went, Gone, the article explores what attentiveness may mean today with regard to research and advocacy concerning migration issues. The article also asks how we secure and maintain the interest of the general public in the so-called global migration ‘crisis’ at a historical moment characterized by mass distraction?
Revised staging system for malignant lymphoma based on the Lugano classification
Authors: Munakata Wataru , Terauchi Takashi , Maruyama Dai , Nagai Hirokazu
Published: July 2019

The Lugano classification was published in 2014 to form the basis for revising the recommendations regarding anatomic staging and evaluation of disease before and after therapy. This staging system was adopted by the eighth edition of the Cancer Staging Manual of the American Joint Committee on Cancer. In this review, we aimed to discuss this updated staging system for malignant lymphomas. The most important change was that fluorodeoxyglucose positron emission tomography/computed tomography became the new standard imaging technique for staging of all fluorodeoxyglucose-avid histologies. Due to the introduction of fluorodeoxyglucose positron emission tomography/computed tomography for staging, the evaluation of not only lymph node involvement but also organ involvement, including liver or spleen, has become simplified. Furthermore, it is possible to eliminate bone marrow biopsies in patients with Hodgkin lymphoma and diffuse large B-cell lymphoma. Although patients were grouped according to the absence (A) or presence (B) of disease-related symptoms based on the previous classification, only the patients with Hodgkin lymphoma need to be assigned the designations A or B in this revision. Hopefully, these revised recommendations will improve patient management and the conduct of clinical trials.
LYK4 is a component of a tripartite chitin receptor complex in Arabidopsis thaliana
Authors: Xue De-Xing , Li Chun-Lian , Xie Zhi-Ping , Staehelin Christian
Published: July 2019

LYK1, LYK4, and LYK5 form a tripartite receptor complex in Arabidopsis to perceive chitin, with constitutive LYK4–LYK5 and chitin-induced LYK1–LYK5 ectodomain interactions, and LYK4 functioning as a LYK5-associated co-receptor or scaffold protein.
Nanotechnology as a new sustainable approach for controlling crop diseases and increasing agricultural production
Authors: Fu Lin , Wang Zhenyu , Dhankher Om Parkash , Xing Baoshan
Published: July 2019

This review summarizes the potential of nanomaterials as antimicrobial agents, biostimulants, and carriers for active ingredients in plant disease management.
Is triose phosphate utilization involved in the feedback inhibition of photosynthesis in rice under conditions of sink limitation?
Authors: Fabre Denis , Yin Xinyou , Dingkuhn Michael , Clément-Vidal Anne , Roques Sandrine , Rouan Lauriane , Soutiras Armelle , Luquet Delphine
Published: July 2019

Triose phosphate utilization is involved in the regulation of photosynthesis under elevated CO2 conditions, and it should be considered in photosynthesis studies under severe source–sink imbalance at elevated CO2.
Giant cacti: isotopic recorders of climate variation in warm deserts of the Americas
Authors: Hultine Kevin R , Dettman David L , English Nathan B , Williams David G
Published: July 2019

Stable isotope ratios captured in spine tissues potentially reflect temporal and spatial patterns of stomatal conductance, internal to atmospheric CO2 partial pressures, and subsequent patterns of photosynthetic gas exchange.
The Choice of a Treaty
Authors: Boyle Alan
Published: July 2019

From a lawmaking perspective “soft law” is simply a convenient description for a variety of non-binding normatively worded instruments used in contemporary international relations by states and international organizations. Examples include UN conference declarations, appropriately worded resolutions and declarations adopted by the UN General Assembly or one of its subsidiary organs or specialized agencies, or codes of conduct, guidelines, and principles adopted by any of these UN organs. The main advantage of adopting rules and principles in soft-law form is that the process is simpler, faster, and potentially more inclusive than a multilateral treaty. The UN has pioneered the use of soft law, most obviously through the adoption of General Assembly resolutions that, inter alia, interpret and amplify the UN Charter, codify and progressively develop international law, provide evidence of opinio juris on new norms and general principles, or legitimize state practice. The functions of soft law in the international legal system—and in UN practice—are diverse, but it would be wrong to see the choice of instrument—treaty or soft law—in either/or terms. Non-binding soft law sometimes presents alternatives to lawmaking by treaty; at other times it complements and amplifies treaties while also providing different ways of understanding the legal effect of different kinds of treaties. But it is inconceivable that modern treaty regimes or international organizations such as the UN could function successfully without resort to soft law.
United Nations Weapons Control Treaties
Authors: Kellman Barry
Published: July 2019

Weapons control was born of necessity to reduce the existential threats of weapons technologies following the last century’s world wars. In a dangerous and anarchic world, security can be enhanced by substituting multilateral agreements for unconstrained procurement, deployment, and transfer of weapons. This chapter focuses on four aspects of weapons control treaties: (1) nonproliferation of nuclear weapons, (2) eradication of chemical and biological weapons, (3) prohibition of unique inhumane weapons, and (4) restriction of the trade in conventional weapons. Cumulatively, these treaties serve to lower the risk of war, reduce war’s devastation should it begin, and curtail the enormous financial drain of procuring and stockpiling weapons. Methodologies have developed with established institutions and stipulated procedures that influence virtually every state’s military choices, significantly enhancing global security. These treaties have enabled humanity to stanch the inherent tendency of employing advancing technologies to make and use more powerful weapons. By significantly contributing to capping centuries of accelerating violence and by restraining how escalating fears of an adversary’s weapons can accelerate political friction into armed conflict, these treaties have contributed to building a more secure world order, thereby enabling diplomacy and other processes to help address more deep-rooted social conditions. It is perhaps the greatest achievement of these treaties to have fostered trust among the vast majority of states and their populations with regard to lethal weapons, enabling maturation of innumerable initiatives for promoting peace.
Creating from Chaos
Authors: Prins Daniël
Published: July 2019

In practice, negotiations leading to a United Nations treaty are often untidy and anarchic. The ambition to adopt a strong treaty covering the whole UN membership is habitually at odds with the overriding significance of national sovereignty. Unwilling countries, knowing that proponents aspire consensus, can block progress where they deem fit. And that same sovereignty principle plays out in the limited options a chairperson of a conference has for firm process management. The disarray has other origins as well. At treaty conferences, delegates need to develop pockets of informality in which they can build the trust needed for recognition of their most pressing priorities. The abundance of informal exchanges outside the meeting room adds to making process management a challenge. Also, a lack of national resources, and patronage in recruitment, often negatively impact on consistent, knowledgeable engagement by delegations. Last, unavoidable time restrictions prevent the process from playing out in a well-planned, methodical way. Bringing order to this process is only limitedly possible. Multilateral treaty-making seems inherently messy and deeply improvisational. Such a setting tends to reward those countries that can field skilled, creative, resourceful diplomats who can be trusted to make the most from only generic instructions.
Terrorism
Authors: Klein Pierre
Published: July 2019

Treaties are among the main tools used by states in their attempts to combat terrorism on the international scene. Under the impetus of the General Assembly, the UN has adopted five of the most significant conventions aimed at combating terrorism at the universal level and is currently pursuing work on a draft comprehensive convention against terrorism. These treaties are classical instruments of international criminal law, providing for the criminalization of specific acts or activities under the domestic law of states parties and maximizing the possibilities of prosecution for these crimes, based in particular on the principle aut dedere, aut judicare. While the adoption of these treaties proved to be generally uncontroversial, the difficulties encountered in the elaboration of the draft comprehensive convention (particularly in respect of acts of national liberation movements and of acts of members of armed forces in situations other than armed conflicts) are evidence of persistent divisions within the international society, even in an area that has been identified as one of its most important priorities for the last two decades.
Terrorism
Authors: Perera Amrith Rohan
Published: July 2019

A consensus still eludes the negotiation process of the Draft Comprehensive Convention on International Terrorism. Given this backdrop, this article traces the history and evolution of the UN treaty-making practice on terrorism, and examines the attempts to define and address the phenomenon of terrorism through international Conventions, which provide for the establishment of the core legal regime of “extradite or prosecute.” It explores the challenges encountered in the negotiation processes, including “definitional issues,” which consider issues such as the “political offences exception”; whether carve-outs should be made for military forces of States/national liberation movements; and the notions of “individual criminal responsibility” and “state responsibility,” the latter particularly in the context of acts of nuclear terrorism. The article follows the evolution of negotiations on these considerations, which later moves to discuss the issue not in the context of a generic definition of the term “terrorism,” but in the delineation of the precise scope of application of the Convention, by “carving out” the other applicable legal regimes. The article concludes that the Draft Comprehensive Convention on International Terrorism is a carefully nuanced and delicately balanced package fraught with both legal and political complexities, and strategic concerns for groups of States, and underlines the need for a compromise approach and political accommodation.
The Peaceful Uses of Outer Space
Authors: Masson-Zwaan Tanja , Cassar Roberto
Published: July 2019

The creation of space law is rooted in the aftermath of the Cold War. The two world powers of the time—the United States and the USSR—joined forces in the UNCOPUOS (UN Committee on the Peaceful Uses of Outer Space) to introduce law to outer space and ensure that the use and exploration of this domain was conducted for peaceful purposes. Against this backdrop, the negotiations underlying the drafting of the Magna Carta of outer space—the Outer Space Treaty—demonstrate how these two world powers set aside various political differences in order to reach a legal compromise for the benefit of the world as a whole. Today, half a century after this milestone, the landscape of the use and exploration of outer space has changed dramatically, particularly in terms of the technology involved. As a result, the question is whether international space law and UNCOPUOS are still able to provide a relevant framework within which the peaceful use and exploration of outer space can progress.
The ILO’s Standard-Setting
Authors: Politakis George P.
Published: July 2019

Established 100 years ago as a normative institution to promote social justice, the International Labour Organization (ILO) fulfills its mission principally through the adoption of international labor standards. To date, those standards have taken the form of 189 international labor Conventions, six Protocols, and 205 international labor Recommendations. ILO standard-setting follows special techniques and practices, mainly because of the Organization’s unique tripartite structure, that have given shape to specificities such as the inadmissibility of reservations, the frequent recourse to built-in flexibility, and the limited possibility for denunciation. The interpretation of international labor Conventions is, pursuant to a specific constitutional provision, entrusted to the International Court of Justice, while the application of international labor standards is monitored by an elaborate supervisory system that combines standing bodies responsible for the regular examination of reports and special adversarial procedures activated by different complaint mechanisms. Today, the abrogation of outdated instruments and the consolidation of up-to-date standards into framework Conventions are among the key challenges for enhancing the relevance and impact of standards. Standard-setting has distinctively marked the Organization’s 100-year-long history and has in many respects broken new ground in the field of international treaty law.