bluuebunny/crossref_metadata_2025_split huggingface dataset:
Species‐specific effects of phosphorus addition on tropical tree seedling response to elevated CO2
Authors: Thompson Jennifer B. , Slot Martijn , Dalling James W. , Winter Klaus , Turner Benjamin L. , Zalamea Paul‐Camilo 
Published: July 2019

Abstract

Tropical forest productivity is often thought to be limited by soil phosphorus (P) availability. Phosphorus availability might therefore constrain potential increases in growth as the atmospheric CO2 concentration increases, yet there is little experimental evidence with which to evaluate this hypothesis. We hypothesized that while all species would respond more strongly to elevated CO2 when supplied with extra P, the responses of individual species would also depend on their habitat associations with either high‐ or low‐P soils. We further hypothesized that this effect would be exacerbated by a reduction in transpiration rate under elevated CO2, as transpiration may aid in P acquisition.

We used a pot experiment to test the effects of P addition on the physiological and growth response to elevated CO2 of eight tropical tree species with contrasting distributions across a soil P gradient in Panamanian lowland forests. Seedlings were grown in an ambient (400 ppm) or elevated (800 ppm) CO2‐controlled glasshouse in either a high‐ or low‐P treatment to quantify the effects of P limitation on relative growth rate (RGR), transpiration, maximum photosynthetic rate and foliar nutrients.

We found evidence of limitation by P and CO2 on growth, photosynthesis, foliar nutrients and transpiration. However, the affinity of a species for P, defined as the species distribution relative to P availability, was not correlated with RGR or transpiration responses to elevated CO2 in either the low‐P or high‐P treatments.

Transpiration rates decreased under elevated CO2, but foliar P was greater for some species under elevated CO2, suggesting a greater capacity for upregulation of P acquisition in species associated with low‐P soils.

Our results show that tropical forest responses to elevated CO2 will be species‐specific and not necessarily explained by P affinities based on distribution, which poses challenges for predictions of community‐wide responses.

A free Plain Language Summary can be found within the Supporting Information of this article.
Agents intervening against delirium in the intensive care unit (AID‐ICU) – Protocol for a randomised placebo‐controlled trial of haloperidol in patients with delirium in the ICU
Authors: Andersen‐Ranberg Nina C. , Poulsen Lone M. , Perner Anders , Wetterslev Jørn , Estrup Stine , Lange Theis , Ebdrup Bjørn H. , Hästbacka Johanna , Morgan Matthew P.G. , Citerio Giuseppe , Zafrani Lara , Caballero Jesús , Oxenbøll-Collet Marie , Weber Sven‐Olaf , Andreasen Anne S. , Bestle Morten , Pedersen Helle B. S. , Hildebrandt Thomas , Thee Carsten , Jensen Troels B. , Dey Nilanjan , Nielsen Louise G. , Mathiesen Ole 
Published: July 2019

BackgroundDelirium among patients in the intensive care unit (ICU) is a common condition associated with increased morbidity and mortality. Haloperidol is the most frequently used pharmacologic intervention, but its use is not supported by firm evidence. Therefore, we are conducting Agents Intervening against Delirium in the Intensive Care Unit (AID‐ICU) trial to assess the benefits and harms of haloperidol for the treatment of ICU‐acquired delirium.MethodsAID‐ICU is an investigator‐initiated, pragmatic, international, randomised, blinded, parallel‐group, trial allocating adult ICU patients with manifest delirium 1:1 to haloperidol or placebo. Trial participants will receive intravenous 2.5 mg haloperidol three times daily or matching placebo (isotonic saline 0.9%) if they are delirious. If needed, a maximum of 20 mg/daily haloperidol/placebo is given. An escape protocol, not including haloperidol, is part of the trial protocol. The primary outcome is days alive out of the hospital within 90 days post‐randomisation. Secondary outcomes are number of days without delirium or coma, serious adverse reactions to haloperidol, usage of escape medication, number of days alive without mechanical ventilation; mortality, health‐related quality‐of‐life and cognitive function at 1‐year follow‐up. A sample size of 1000 patients is required to detect a 7‐day improvement or worsening of the mean days alive out of the hospital, type 1 error risk of 5% and power 90%.PerspectiveThe AID‐ICU trial is based on gold standard methodology applied to a large sample of clinically representative patients and will provide pivotal high‐quality data on the benefits and harms of haloperidol for the treatment ICU‐acquired delirium.
Elevated maternal and child mortality among women with multiple DUI convictions compared with socio‐demographically matched controls
Authors: McCutcheon Vivia V. , Bucholz Kathleen K. , Houston‐Ludlam Alexandra N. , Heath Andrew C. 
Published: July 2019

AbstractAimsTo assess whether having multiple convictions for driving while under the influence of alcohol (MDUI) in women is a risk factor for maternal, infant and child mortality.DesignRetrospective cohort design using record linkage, comparing women with MDUI convictions with propensity‐matched women without alcohol‐related driving offences ascertained through state records, on rates of maternal, infant and child mortality.SettingMissouri, United States.ParticipantsMDUI women (n = 1658) and women with no alcohol‐related driving convictions (control, n = 184 252) who gave birth from 2000 to 2004.MeasurementsData were obtained from state administrative records and US Census data. The outcomes were maternal, infant and child mortality. The input variable was presence or absence of MDUI convictions. Propensity‐matching variables were maternal (smoking during pregnancy, delayed prenatal care, previous child deaths, age at birth, mother Missouri‐born, education, pre‐pregnancy obesity, marital status), reproductive partner (un‐named partner, race/ethnicity, education, DUI status) and census tract (socio‐economic advantage, urbanicity) characteristics.FindingsWomen with MDUI convictions had higher odds of maternal, infant and child mortality than propensity‐matched controls [odds ratio (OR) = 2.65, 95% confidence interval (CI) = 2.07–3.40 and OR = 1.75, 95% CI = 1.17–2.61, respectively].ConclusionsHaving multiple convictions for driving under the influence of alcohol in women appears to be a risk factor for increased maternal, infant and child mortality.
Inadequate community engagement hamstrings sustainable wildlife resource management in Zambia
Authors: Milupi Inonge D. , Somers Michael J. , Ferguson Willem 
Published: July 2019

AbstractWe propose improvements for addressing the inadequate sustainable use of wildlife resources in the community‐based natural resource management (CBNRM) programme in game management areas (GMAs) using case study data from Mumbwa and Lupande GMAs in Zambia. Firstly, we assess the sustainability of wildlife resources in these GMAs using design principles for enduring common pool institutions. Secondly, we propose the steps required to address the lack of sustainability of wildlife resources in the CBNRM programme in the two GMAs by building on indicators suggested by Ostrom's principles. The resource use patterns in the two GMAs were assessed according to their socio‐economic and institutional factors. Comparisons were made between the two GMAs in relation to Ostrom's design principles. Accordingly, the combination of socio‐economic and institutional factors restrains the sustainable use of wildlife resources in the two GMAs. Unless the Zambian government provides local communities with meaningful decision‐making powers and benefits for the utilisation and management of wildlife, this resource is likely to disappear outside national parks.
The Safer Anaesthesia from Education (SAFE)® paediatric anaesthesia course: educational impact in five countries in East and Central Africa
Authors: Boyd N. , Sharkey E. , Nabukenya M. , Tumukunde J. , Sipuka N. , Zyambo M. , Walker I. , Hart J. , Byrne‐Davis L. 
Published: July 2019

SummaryThere is an urgent need to improve access to safe surgical and anaesthetic care for children living in many low‐ and middle‐income countries. Providing quality training for healthcare workers is a key component of achieving this. The 3‐day Safer Anaesthesia from Education (SAFE)® paediatric anaesthesia course was developed to address the specific skills and knowledge required in this field. We undertook a project to expand this course across five East and Central African countries (Ethiopia, Kenya, Malawi, Uganda and Zambia) and train local faculty. This study reports the outcomes from course evaluation data, exploring the impact on knowledge, skills and behaviour change in participants. Eleven courses were conducted in a 15‐month period, with 381 participants attending. Fifty‐nine new faculty members were trained. Knowledge scores (0–50 scale) increased significantly from mean (SD) 37.5 (4.7) pre‐course to 43.2 (3.5) post‐course (p < 0.0001). Skills scores (0–10 scale) increased significantly from 5.7 (2.0) pre‐course to 8.0 (1.5) post‐course (p < 0.0001). One hundred and twenty‐six participants in Malawi, Uganda and Zambia were visited in their workplace 3–6 months later. Knowledge and skills were maintained at follow‐up, with scores of 41.5 (5.0) and 8.3 (1.4), respectively (p < 0.0001 compared with pre‐course scores). Content analysis from interviews with these participants highlighted positive behaviour changes in the areas of preparation, peri‐operative care, resuscitation, management of the sick child, communication and teaching. This study indicates that the SAFE paediatric anaesthesia course is an effective way to deliver training, and could be used to help strengthen emergency and essential surgical care for children as a component of universal health coverage.
The first‐generation phosphodiesterase 5 inhibitors and their pharmacokinetic issue
Authors: Zucchi A. , Costantini E. , Scroppo F. I. , Silvani M. , Kopa Z. , Illiano E. , Petrillo M. G. , Cari L. , Nocentini G. 
Published: July 2019

AbstractBackgroundErectile dysfunction (ED) is a relatively frequent disease that negatively impacts the overall quality of life, well‐being, and relationships. Although the use of phosphodiesterase 5 inhibitors (PDE5is) has revolutionized the treatment of ED, a high percentage of ED patients discontinue PDE5i treatment.Objectives(i) To analyze the reasons for patient dissatisfaction leading to PDE5i discontinuation; (ii) analyze the pharmacokinetics of new formulations focusing on the time needed to reach an effective plasma concentration of PDE5is (Tonset) following drug intake; and (iii) summarize the physicochemical properties of sildenafil to understand which excipients may increase the absorption rate.Material and methodsAn online PubMed literature search was conducted to identify English language publications from inception to January 2019.ResultsThe main reasons for patient dissatisfaction when using PDE5is on demand are the relatively long Tonset after taking vardenafil and sildenafil, including formulations such as film‐coated tablets, fine granules, orally disintegrating tablets (ODTs), and oral thin films (ODFs). The relatively long Tonset, further worsened when accompanied by eating, highlights the following: (i) the need for planning intercourse, determining partner‐related issues; (ii) issues when having sex before the maximum effect of the drug; and (iii) lower drug‐related placebo effects. Some data suggest that sildenafil is a ‘difficult’ molecule, but Tonset can be improved following absorption by buccal mucosa using appropriate excipients.ConclusionsWe conclude that several ODT and ODF formulations can improve the ‘discretion’ issue because they are taken without water, but they have similar pharmacokinetics to corresponding film‐coated tablet formulations. One ODF formulation of sildenafil was characterized by a shorter Tonset and could potentially increase patient satisfaction following treatment. However, more clinical studies are needed to confirm the findings. Surfactants and ascorbic acid appear to be crucial excipients for achieving a high absorption rate, but more studies are needed.
Diagnostic accuracy of a single‐lead portable ECG device for measuring QTc prolongation
Authors: Bekker Charlotte L. , Noordergraaf Fauve , Teerenstra Steven , Pop Gheorghe , van den Bemt Bart J. F. 
Published: July 2019

AbstractBackgroundTo assess the diagnostic accuracy of a single‐lead portable ECG device for measuring QTc‐intervals in comparison with a standard 12‐lead ECG.MethodsAdult patients visiting the cardiology outpatient clinic for a 12‐lead recording were also measured with a portable single‐lead ECG recorder (HeartcheckTM). QTc‐intervals were determined by two cardiologists. Perfect agreement was defined as a limit of ≤10 ms between the two measurement methods.ResultsHundred one ECGs were recorded. QTc‐interval mean differences between the two measurement methods was substantially outside our definition of perfect agreement (‐31.9 [SD±41.3] ms).ConclusionIn conclusion, the Heartcheck single‐lead ECG device is not accurate for measuring QTc‐intervals.
Facilities for presence and provision of support to parents and significant others in neonatal units
Authors: Flacking Renée , Breili Christine , Eriksson Mats 
Published: July 2019

AbstractAimTo describe parental facilities for staying in neonatal units, visiting policies and access to emotional support during hospitalisation.MethodsA cross‐sectional design was used in which a survey was presented to all neonatal units in Sweden; 34 out of 38 units participated (89%).ResultsThe findings showed that in 50% of the units, parents could stay 24/7 for the infant's entire hospital stay. In 32% of the units, siblings could stay the night with their parents. Units had policies on restrictions for visits by siblings (80%), grandparents (59%), friends and relatives (71%). All units offered counselling to parents, and some units offered peer‐to‐peer groups (24%), diaries (35%), relaxation techniques (6%) or Internet parental forums (6%). All units enabled parents to be at home with their infant and to visit the unit for check‐ups (35%) or to have staff visits at home (65%).ConclusionFacilities for parents to stay with their infant during hospitalisation and to have significant others visit are good, but there is room for improvement. During the transitional phase to being at home, parents are facilitated in being at home before the infant is discharged and are supported by the unit, which must be considered beneficial for parents.
Robust inference on the average treatment effect using the outcome highly adaptive lasso
Authors: Ju Cheng , Benkeser David , van der Laan Mark J. 
Published: July 2019

AbstractMany estimators of the average effect of a treatment on an outcome require estimation of the propensity score, the outcome regression, or both. It is often beneficial to utilize flexible techniques, such as semiparametric regression or machine learning, to estimate these quantities. However, optimal estimation of these regressions does not necessarily lead to optimal estimation of the average treatment effect, particularly in settings with strong instrumental variables. A recent proposal addressed these issues via the outcome‐adaptive lasso, a penalized regression technique for estimating the propensity score that seeks to minimize the impact of instrumental variables on treatment effect estimators. However, a notable limitation of this approach is that its application is restricted to parametric models. We propose a more flexible alternative that we call the outcome highly adaptive lasso. We discuss the large sample theory for this estimator and propose closed‐form confidence intervals based on the proposed estimator. We show via simulation that our method offers benefits over several popular approaches.
Building generalized linear models with ultrahigh dimensional features: A sequentially conditional approach
Authors: Zheng Qi , Hong Hyokyoung G. , Li Yi 
Published: July 2019

AbstractConditional screening approaches have emerged as a powerful alternative to the commonly used marginal screening, as they can identify marginally weak but conditionally important variables. However, most existing conditional screening methods need to fix the initial conditioning set, which may determine the ultimately selected variables. If the conditioning set is not properly chosen, the methods may produce false negatives and positives. Moreover, screening approaches typically need to involve tuning parameters and extra modeling steps in order to reach a final model. We propose a sequential conditioning approach by dynamically updating the conditioning set with an iterative selection process. We provide its theoretical properties under the framework of generalized linear models. Powered by an extended Bayesian information criterion as the stopping rule, the method will lead to a final model without the need to choose tuning parameters or threshold parameters. The practical utility of the proposed method is examined via extensive simulations and analysis of a real clinical study on predicting multiple myeloma patients’ response to treatment based on their genomic profiles.
Distance‐based analysis of variance for brain connectivity
Authors: Shinohara Russell T. , Shou Haochang , Carone Marco , Schultz Robert , Tunc Birkan , Parker Drew , Martin Melissa Lynne , Verma Ragini 
Published: July 2019

AbstractThe field of neuroimaging dedicated to mapping connections in the brain is increasingly being recognized as key for understanding neurodevelopment and pathology. Networks of these connections are quantitatively represented using complex structures, including matrices, functions, and graphs, which require specialized statistical techniques for estimation and inference about developmental and disorder‐related changes. Unfortunately, classical statistical testing procedures are not well suited to high‐dimensional testing problems. In the context of global or regional tests for differences in neuroimaging data, traditional analysis of variance (ANOVA) is not directly applicable without first summarizing the data into univariate or low‐dimensional features, a process that might mask the salient features of high‐dimensional distributions. In this work, we consider a general framework for two‐sample testing of complex structures by studying generalized within‐group and between‐group variances based on distances between complex and potentially high‐dimensional observations. We derive an asymptotic approximation to the null distribution of the ANOVA test statistic, and conduct simulation studies with scalar and graph outcomes to study finite sample properties of the test. Finally, we apply our test to our motivating study of structural connectivity in autism spectrum disorder.
Penile urethroplasty using Orandi's dorsal skin flap: a new technique
Authors: Barbagli Guido , Joshi Pankaj M. , Kulkarni Sanjay B. , Butnaru Denis , Sansalone Savatore , Lazzeri Massimo 
Published: July 2019

ObjectivesTo describe, step by step, a new one‐stage dorsal skin flap urethroplasty for penile stricture repair.Materials and MethodsThe surgery was accomplished through a midline incision on the ventral penile surface, the urethra was fully dissected from the corpora cavernosa and longitudinally opened along its dorsal surface. A penile skin island, based on the dartos fascia flap, was dissected and moved over the corpora cavernosa, and the urethra was moved and sutured over the penile skin flap.ResultsOut of the 12 cases, 10 were classified successful and there were two failures. The operating time was 60 min. There was no postoperative fistula or urethral diverticulum.ConclusionOur modified Orandi's technique was easy and feasible, and avoided fistula and diverticulum formation after repair.
Working with Signs of Safety: Parents' perception of change
Authors: Baginsky Mary , Hickman Ben , Moriarty Jo , Manthorpe Jill 
Published: July 2019

AbstractSigns of Safety (SoS) is an approach used to work with families involved with children's services that was developed in Australia during the 1990s. Despite the fact that it has been adopted by countries across the globe, the evidence for its effectiveness in relation to improved outcomes for children has not been established. This study attempted to take an initial step in measuring the impact of SoS on families. In the course of evaluating SoS in 10 areas across England, the authors collected data from social workers using the approach and from families with whom they were working who also gave permission for their case records to be examined. Where social workers were more confident about using SoS and had consistently applied its elements, more families reported improvements in their lives. Families with social workers who had higher confidence in using SoS were also more likely to say that they had achieved more than expected against their earlier stated goals and were more likely to report positively against self‐defined goals.
The inclusive family support model: Facilitating openness for post‐adoptive families
Authors: Kim JaeRan , Tucker Angela 
Published: July 2019

AbstractOpen adoptions have increased over the past few decades, and although guidance for considering and creating open adoption agreements exist, one area of needed post‐adoption support is helping adoptive birth/first families navigate open‐adoption relationships after finalization. Adoption agencies have a responsibility to assist adoptive parents, who may have fears and concerns about openness, see the potential benefits rather than only the challenges. This article describes a practice model designed by one agency to help families navigate post‐adoption openness. The Inclusive Family Support model is conceptualized through the theoretical perspectives of family systems theory, ambiguous loss and disenfranchised grief, and the transtheoretical model of change. We highlight the major dimensions of the model, how it will be implemented and evaluated at one agency, and discuss implications for practice and policy.
Reimagining child welfare outcomes: Learning from Family Group Conferencing
Authors: Mitchell Mary 
Published: July 2019

AbstractThis article reports on a qualitative study, which sought to retrospectively understand the contribution family group conferencing (FGC) makes to longer‐term outcomes for children at risk of entering State care and their families. Eleven case examples of FGC were studied from five local government areas across Scotland. Each example included the perspectives of different stakeholders in the process: children, their parents/carers and extended family (n = 32), and professionals (n = 28) involved with them. The study found a number of interconnecting issues in relation to FGC outcome contribution. First, the personal experience of process matters to the service user and his/her opinion of the outcomes they achieve. Second, what professionals do and how they do it can impact the outcomes of people requiring support. Thus, the relationship between professionals and service users is central to understanding why and how families achieve longer‐term outcomes. Finally, who defines outcomes and to what purpose is significant when understanding outcomes. This article reports on two sets of FGC outcomes identified within the study: personal and professional. Arguing for a more nuanced understanding of outcomes in child welfare this article begins to explore, and challenge, the manner in which outcomes are identified and valued in child welfare.