Go west: Population genomics reveals unexpected population fluctuations and little gene flow in Western hemisphere populations of the predatory lady beetle, Hippodamia convergens

Hippodamia convergens-the convergent lady beetle, has been used extensively in augmentative biological control of aphids, thrips, and whiteflies across its native range in North America, and was introduced into South America in the 1950s. Overwintering H. convergens populations from its native western range in the United States are commercially collected and released across its current range in the eastern USA, with little knowledge of the effectiveness of its augmentative biological control. Here we use a novel ddRADseq-based SNP/haplotype discovery approach to estimate its range-wide population diversity, differentiation, and recent evolutionary history. Our results indicate (1) significant population differentiation among eastern USA, western USA, and South American populations of H. convergens, with (2) little to no detectable recent admixture between them, despite repeated population augmentation, and (3) continued recent population size expansion across its range. These results contradict previous findings using microsatellite markers. In light of these new findings, the implications for the effectiveness of augmentative biological control using H. convergens are discussed. Additionally, because quantifying the non-target effects of augmentative biological control is a difficult problem in migratory beetles, our results could serve as a cornerstone in improving and predicting the efficacy of future releases of H. convergens across its range.

Neuroadaptive LBS: towards human-, context-, and task-adaptive mobile geographic information displays to support spatial learning for pedestrian navigation

Well-designed, neuroadaptive mobile geographic information displays (namGIDs) could improve the lives of millions of mobile citizens of the mostly urban information society who daily need to make time critical and societally relevant decisions while navigating. What are the basic perceptual and neurocognitive processes with which individuals make movement decisions when guided by human- and context-adaptive namGIDs? How can we study this in an ecologically valid way, also outside of the highly controlled laboratory? We report first ideas and results from our unique neuroadaptive research agenda that brings us closer to answering this fundamental empirical question. We present our first implemented methodological solutions of novel ambulatory evaluation methods to study and improve Location-based System (LBS) displays, by critical examination of how perceptual, neurocognitive, psychophysiological, and display design factors might influence decision-making and spatial learning in pedestrian mobility across broad ranges of users and mobility contexts.

Initial antibiotic therapy for postoperative moderate or severe diabetic foot infections: Broad versus narrow spectrum, empirical versus targeted

AIM

To retrospectively evaluate clinical and microbiological outcomes after combined surgical and medical therapy for diabetic foot infections (DFIs), stratifying between the empirical versus the targeted nature, and between an empirical broad versus a narrow-spectrum, antibiotic therapy.

METHODS

We retrospectively assessed the rate of ultimate therapeutic failures for each of three types of initial postoperative antibiotic therapy: adequate empirical therapy; culture-guided therapy; and empirical inadequate therapy with a switch to targeted treatment based on available microbiological results.

RESULTS

We included data from 332 patients who underwent 716 DFI episodes of surgical debridement, including partial amputations. Clinical failure occurred in 40 of 194 (20.6%) episodes where adequate empirical therapy was given, in 77 of 291 (26.5%) episodes using culture-guided (and correct) therapy from the start, and in 73 of 231 (31.6%) episodes with switching from empirical inadequate therapy to culture-targeted therapy. Equally, a broad-spectrum antibiotic choice could not alter this failure risk. Group comparisons, Kaplan-Meier curves and Cox regression analyses failed to show either statistical superiority or inferiority of any of the initial antibiotic strategies.

CONCLUSIONS

In this study, the microbiological adequacy of the initial antibiotic regimen after (surgical) debridement for DFI did not alter therapeutic outcomes. We recommend that clinicians follow the stewardship approach of avoiding antibiotic de-escalation and start with a narrow-spectrum regimen based on the local epidemiology.

Empirical versus tailored therapy based on genotypic resistance detection for Helicobacter pylori eradication: a systematic review and meta-analysis

Background

The eradication rate of Helicobacter pylori infection with empirical therapy has decreased due to increased drug resistance. The latest guidelines recommend genotypic resistance-guided therapy, but its clinical efficacy remains unclear.

Objectives

The purpose of our study was to evaluate whether tailored therapy based on genotypic resistance is superior to empirical therapy for H. pylori infection.

Design

A systematic review and meta-analysis of randomized controlled trials (RCTs) comparing tailored therapy based on genotypic resistance with empirical therapy was performed.

Sources and methods

We retrieved relevant studies from PubMed, Embase, and the Cochrane Library. The primary outcome was H. pylori eradication rate and the adverse events (AEs) was the secondary outcome. A random-effect model was applied to compare pooled risk ratios (RRs) with related 95% confidence intervals (CIs).

Results

A total of 12 qualified RCTs containing 3940 patients were identified in our systematic review and meta-analysis. The pooled eradication rates of tailored therapy based on the detection of genotypic resistance were consistently higher than those in the empirical treatment group, with no statistical significance. In triple therapy, the eradication rate was significantly higher in the tailored group than in the empirical group by intention-to-treat analysis (ITT) and per-protocol analysis (PP) analysis (p < 0.0001, RR: 1.20; 95% CI: 1.12-1.29; p < 0.0001, RR: 1.20; 95% CI: 1.15-1.25). In quadruple therapy, the eradication rate was higher in the empirical group (p = 0.001, RR: 0.93; 95% CI: 0.89-0.97; p = 0.009, RR: 0.95; 95% CI: 0.92-0.99). And this result was true for both bismuth quadruple therapy (BQT) and non-BQT. Regarding total AEs, the pooled rate was 34% in the tailored group and 37% in the empirical group, and no difference between the two groups was found (p = 0.17, RR: 0.88; 95% CI: 0.74-1.06).

Conclusion

In conclusion, tailored therapy based on molecular methods may offer better efficacy than empirical triple therapy, but it may not be superior to empirical quadruple therapy in eradicating H. pylori infection. Larger and more individualized RCTs are needed to aid clinical decision-making.

Registration PROSPERO

CRD42023408688.

Control of release in active packaging/coating for food products; approaches, mechanisms, profiles, and modeling

Antimicrobial or antioxidant active packaging (AP) is an emerging technology in which a bioactive antimicrobial or antioxidant agent is incorporated into the packaging material to protect the contained product during its shelf life from deterioration. The important issue in AP is making a balance between the deterioration rate of the food product and the controlled release of the bioactive agent. So, the AP fabrication should be designed in such a way that fulfills this goal. Modeling the controlled release is an effective way to avoid trial and error and time-consuming experimental runs and predict the release behavior of bioactive agents in different polymeric matrices and food/food simulants. To review the release of bioactive compounds from AP, in the first part of this review we present an introductory explanation regarding the release controlling approaches in AP. Then the release mechanisms are explained which are very important in defining the appropriate modeling approach and also the interpretation of the modeling results. Different release profiles that might be observed in different packaging systems are also introduced. Finally, different modeling approaches including empirical and mechanistic techniques are covered and the recent literature regarding the utilization of such approaches to help design new AP is thoroughly studied.

Safety of megadose meropenem in the empirical treatment of nosocomial sepsis: a pilot randomized clinical trial

Objective: To evaluate the safety of megadose meropenem as empirical treatment of nosocomial sepsis. Materials & methods: Critically ill patients diagnosed with sepsis received either high-dose (2 g every 8 h) or megadose (4 g every 8 h) meropenem as an intravenous infusion over 3 h. Results: A total of 23 patients with nosocomial sepsis were eligible and included in the megadose (n = 11) or high-dose (n = 12) group. No treatment-related adverse events were observed during a 14-day follow-up. Clinical response was also comparable between the groups. Conclusion: Megadose meropenem may be considered for empirical treatment of nosocomial sepsis without serious concern regarding its safety.

Demand response with heat pumps: Practical implementation of three different control options

The electrification of heating and transport and decarbonisation of supply creates a need for demand side flexibility to balance the grid. Heat pumps are expected to form a major part of heat delivery, and many modelling studies have investigated the technical potential of heat pump demand response. However, little empirical work has been reported on the practical implementation of such demand response in occupied homes. This paper presents a cross-case comparison of three early adopters of heat pump demand response in the UK. The aim was to reduce heat pump electricity consumption during the same peak period, but each employed a different control strategy: lowered air temperature setpoints, lowered flow temperature and blocked heat pump compressor. A 56-90% electricity reduction during the peak period was observed; the success of the demand response depended on how the control strategy affected the heat pump and the rest of the heating system. However, no one stakeholder is responsible for all these system components. The fabric, heating distribution and control system and heat pumps installed are highly heterogeneous across the stock, highlighting that flexibility mechanisms must be developed that can be tailored to or work across their range.

PRACTICAL APPLICATION

Three case studies of different heat pump demand response control strategies in real homes are presented. All three households reduced their electricity consumption during a peak period but delivered unintended consequences where the heat pump's logic did not correspond to the demand response requirements. This study highlights that the implementation of heat pump demand response to support electricity system operation requires a clear definition of electricity system need as well as practical demand response mechanisms to be integrated into heating system design.

Improving power in functional magnetic resonance imaging by moving beyond cluster-level inference

Inference in neuroimaging typically occurs at the level of focal brain areas or circuits. Yet, increasingly, well-powered studies paint a much richer picture of broad-scale effects distributed throughout the brain, suggesting that many focal reports may only reflect the tip of the iceberg of underlying effects. How focal versus broad-scale perspectives influence the inferences we make has not yet been comprehensively evaluated using real data. Here, we compare sensitivity and specificity across procedures representing multiple levels of inference using an empirical benchmarking procedure that resamples task-based connectomes from the Human Connectome Project dataset (∼1,000 subjects, 7 tasks, 3 resampling group sizes, 7 inferential procedures). Only broad-scale (network and whole brain) procedures obtained the traditional 80% statistical power level to detect an average effect, reflecting >20% more statistical power than focal (edge and cluster) procedures. Power also increased substantially for false discovery rate- compared with familywise error rate-controlling procedures. The downsides are fairly limited; the loss in specificity for broad-scale and FDR procedures was relatively modest compared to the gains in power. Furthermore, the broad-scale methods we introduce are simple, fast, and easy to use, providing a straightforward starting point for researchers. This also points to the promise of more sophisticated broad-scale methods for not only functional connectivity but also related fields, including task-based activation. Altogether, this work demonstrates that shifting the scale of inference and choosing FDR control are both immediately attainable and can help remedy the issues with statistical power plaguing typical studies in the field.

Prognostic Effects of Delayed Administration of Appropriate Antimicrobials in Bacteraemic Adults Initially Presenting with Various Body Temperatures

Purpose

To investigate the different impact of delayed administration of appropriate antimicrobial therapy (AAT) on short-term mortality of bacteraemia patients initially presenting with various body temperatures (BTs).

Materials and Methods

A six-year, two-center cohort consisting of adults with community-onset bacteraemia in emergency departments (EDs) was retrospectively collected. Through the multivariable analyses, clinical impacts of delayed AAT, assessed by the time gap between the first dose of AAT and ED arrival, on 30-day mortality (primary outcomes) were respectively examined in the different groups of initial BTs (iBTs).

Results

Of the 3171 adults, despite the similarities of delayed AAT in six iBT categories, hourly AAT delay was associated with an average increase in 30-day mortality rates of 0.24% in the group of iBT <36.0℃, 0.40% in the 36.0℃–36.9℃ group, 0.48% in the 37.0℃–37.9℃ group, 0.59% in the 38.0℃–38.9℃ group, 0.58% in the 39.0℃–39.9℃ group, and 0.71% in the ≥40.0℃ group, after respective adjusting independent predictors of mortality. Furthermore, for 589 patients who inappropriately received empirical antimicrobial treatment (ie, delayed AAT ≥ 24 hours), with a cutoff of 34.0℃, each 1℃ increase in iBTs was independently associated with an average increase in 30-day mortality rates of 42%.

Conclusion

For adults with community-onset bacteraemia, the iBT-related differences in the prognostic impacts of delayed administration of appropriate antimicrobials might be evident.

Susceptibility-Guided Treatment of Helicobacter pylori Infection: A Systematic Review and Meta-Analysis

Background

Treating Helicobacter pylori infection according to antibiotic resistance has been frequently recommended. However, information on its real effectiveness is scarce.

Aim

The aim of this study is to perform a meta-analysis comparing empirical vs. susceptibility-guided treatment of H. pylori.

Methods

Selection of studies: Studies comparing empirical versus susceptibility-guided treatment were selected. Search strategy: electronic and manual up to August 2021. Data synthesis: by intention-to-treat (random-effects model).

Results

Overall, 54 studies were included (6,705 patients in the susceptibility-guided group and 7,895 in the empirical group). H. pylori eradication rate was 86 vs. 76%, respectively (RR: 1.12; 95% CI: 1.08-1.17; I 2: 83%). Similar results were found when only RCTs were evaluated (24 studies; RR: 1.16; 95% CI: 1.11-1.22; I 2: 71%) and when susceptibility testing was assessed by culture (RR: 1.12; 95% CI: 1.06-1.18) or PCR (RR: 1.14; 95% CI: 1.05-1.23). For first-line treatments (naïve patients; 30 studies), better efficacy results were obtained with the susceptibility-guided strategy (RR: 1.15; 95% CI: 1.11-1.20; I 2: 79%). However, for empirical first-line quadruple regimens, in particular (both with and without bismuth, excluding the suboptimal triple therapies), not based on CYP2C19 gene polymorphism, no differences in efficacy were found compared with the susceptibility-guided group (RR: 1.04; 95% CI: 0.99-1.09); this lack of difference was confirmed in RCTs (RR: 1.05; 95% CI: 0.99-1.12). For rescue therapies (13 studies, most 2nd-line), similar results were demonstrated for both strategies, including all studies (RR: 1.09; 95% CI: 0.97-1.22; I 2: 82%) and when only RCTs were considered (RR: 1.15; 95% CI: 0.97-1.36).

Conclusion

The benefit of susceptibility-guided treatment over empirical treatment of H. pylori infection could not be demonstrated, either in first-line (if the most updated quadruple regimens are prescribed) or in rescue therapies.

Statistical upscaling of ecosystem CO2 fluxes across the terrestrial tundra and boreal domain: Regional patterns and uncertainties

The regional variability in tundra and boreal carbon dioxide (CO₂ ) fluxes can be high, complicating efforts to quantify sink-source patterns across the entire region. Statistical models are increasingly used to predict (i.e., upscale) CO₂ fluxes across large spatial domains, but the reliability of different modeling techniques, each with different specifications and assumptions, has not been assessed in detail. Here, we compile eddy covariance and chamber measurements of annual and growing season CO₂ fluxes of gross primary productivity (GPP), ecosystem respiration (ER), and net ecosystem exchange (NEE) during 1990-2015 from 148 terrestrial high-latitude (i.e., tundra and boreal) sites to analyze the spatial patterns and drivers of CO₂ fluxes and test the accuracy and uncertainty of different statistical models. CO₂ fluxes were upscaled at relatively high spatial resolution (1 km² ) across the high-latitude region using five commonly used statistical models and their ensemble, that is, the median of all five models, using climatic, vegetation, and soil predictors. We found the performance of machine learning and ensemble predictions to outperform traditional regression methods. We also found the predictive performance of NEE-focused models to be low, relative to models predicting GPP and ER. Our data compilation and ensemble predictions showed that CO₂ sink strength was larger in the boreal biome (observed and predicted average annual NEE -46 and -29 g C m^-2  yr^-1 , respectively) compared to tundra (average annual NEE +10 and -2 g C m^-2  yr^-1 ). This pattern was associated with large spatial variability, reflecting local heterogeneity in soil organic carbon stocks, climate, and vegetation productivity. The terrestrial ecosystem CO₂ budget, estimated using the annual NEE ensemble prediction, suggests the high-latitude region was on average an annual CO₂ sink during 1990-2015, although uncertainty remains high.

Application of augmented reality in museums - Factors influencing the learning motivation and effectiveness

Technology advancement has led to the successful and broad application of augmented reality approach in museums. Several literature works have supported the influence of augmented reality in education. However, relatively few studies have been carried out on augmented reality in museum and relevant educational influence. Thus, this study aims to identify educational effectiveness by employing augmented reality in museum and conducting research and analysis on related theories and empirical evidence. In this context, the research is based on the theoretical and conceptual frameworks of relevant literature. Further, integrate them into a functional research prototype and framework to acknowledge the positive influence between the visitors' acceptance, employ augmented reality in museum, and increase learning motivation. Also, the mutual positive relationship between learning motivation and learning effectiveness will be realized. The consequences of mutual effect among all the variables in this study have convinced the relationship of intermediary influence between augmented reality in museum and learning effectiveness.

Cost-Effectiveness, Efficacy, and Safety Analysis of Tailored Therapy in Patients with Helicobacter pylori Infection

Recently in Korea, where triple therapy is accepted as the first-line Helicobacter pylori (H. pylori) eradication treatment, antibiotic resistance to clarithromycin has increased considerably, resulting in eradication rates of less than 80%. We investigated the efficacy of tailored therapy after a clarithromycin resistance test compared with empirical therapy for H. pylori eradication. The cost-effectiveness of H. pylori eradication success was evaluated according to the average medical cost per patient. A total of 364 patients were enrolled in the study. The first-line H. pylori eradication rate was significantly higher in patients who received tailored therapy than in those who received empirical therapy. The total medical costs for the tailored and empirical groups were 46,374 Won and 53,528 Won. The total treatment period for each ultimately successful eradication in the tailored group was 79.8 ± 2.8 days, which is shorter than that of the empirical group (99.2 ± 7.4 days). The rate of eradication-related adverse events for the tailored group and empirical group was 12.9% and 14.8%, respectively. Tailored therapy could be a useful option to achieve a higher successful eradication rate, shorter treatment periods, and lower medical costs than empirical therapy in the era of increasing antibiotic resistance.

The Role of Transparency, Trust, and Social Influence on Uncertainty Reduction in Times of Pandemics: Empirical Study on the Adoption of COVID-19 Tracing Apps

Background

Contact tracing apps are an essential component of an effective COVID-19 testing strategy to counteract the spread of the pandemic and thereby avoid overburdening the health care system. As the adoption rates in several regions are undesirable, governments must increase the acceptance of COVID-19 tracing apps in these times of uncertainty.

Objective

Building on the Uncertainty Reduction Theory (URT), this study aims to investigate how uncertainty reduction measures foster the adoption of COVID-19 tracing apps and how their use affects the perception of different risks.

Methods

Representative survey data were gathered at two measurement points (before and after the app’s release) and analyzed by performing covariance-based structural equation modeling (n=1003).

Results

We found that uncertainty reduction measures in the form of the transparency dimensions disclosure and accuracy, as well as social influence and trust in government, foster the adoption process. The use of the COVID-19 tracing app in turn reduced the perceived privacy and performance risks but did not reduce social risks and health-related COVID-19 concerns.

Conclusions

This study contributes to the mass adoption of health care technology and URT research by integrating interactive communication measures and transparency as a multidimensional concept to reduce different types of uncertainty over time. Furthermore, our results help to derive communication strategies to promote the mass adoption of COVID-19 tracing apps, thus detecting infection chains and allowing intelligent COVID-19 testing.

A Review of Natural Therapies Potentially Relevant in Triple Negative Breast Cancer Aimed at Targeting Cancer Cell Vulnerabilities

We reviewed the research into the mechanisms of growth of triple negative breast cancer (TNBC) based on laboratory pre-clinical studies that have shaped understanding of the disease over the past decade. In response to these findings, we propose an approach to potentially prevent cancer metabolic adaptation and recurrence. This paper collates pre-clinical results, first to determine the tumor’s mechanisms of growth and then to source natural substances that could potentially suppress those mechanisms. The results from in vivo and in vitro studies of TNBC were combined first to select 10 primary mechanisms (Hypoxia-inducible factor 1α, Hedgehog, MAPK, MTAP, NF-κ B, Notch, P13K, STAT3, and Wnt signaling pathways plus p53 and POL2A gene expression) that promote TNBC growth, and second to propose a treatment array of 21 natural compounds that suppress laboratory models of TNBC via these mechanisms. We included BRCA mutations in the review process, but only pathways with the most preclinical studies utilizing natural products were included. Then we outlined potential biomarkers to assess the changes in the micro-environment and monitor biochemical pathway suppression. This suppression-centric aim targets these mechanisms of growth with the goal of potentially halting tumor growth and preventing cancer cell metabolic adaptation. We chose TNBC to demonstrate this 5-step strategy of supplementary therapy, which may be replicated for other tumor types.

LoRaWAN for Smart Campus: Deployment and Long-Term Operation Analysis

The recent years have gradually increased the value of wireless connectivity, making it the de facto commodity for both human users and the machines. In this paper, we summarize our experiences of deploying and managing for over two years the extensive indoor sensor network composed of more than three hundred devices connected over LoRaWAN low power wide area network (LPWAN) technology. We start by detailing the background and methodology of our deployment and then present the results of analyzing the network's operation over a period of two years, focusing specifically on identifying the reasons after the packet losses. Our results reveal that despite the common assumptions, in a real-life network, the packets are lost not only during the on-air transmission but also within the backbone. Among the other interesting findings are the observed nonuniform distribution of the packet transmissions by the nodes in the networks, the seasonal effects on the packet delivery, and the observed effects of the interferences on network performance. The empirical results presented in the paper provide valuable insight into the performance of a real-life extensive LoRaWAN network deployed in an indoor environment and thus may be of interest both to the practitioners and academics.

Empirical or susceptibility-guided treatment for Helicobacter pylori infection? A comprehensive review

Although susceptibility-guided therapy is frequently recommended for Helicobacter pylori infection, the evidence available to date supporting this strategy is limited. The aim of the present article is to review the advantages and limitations of the susceptibility-guided and the empirical strategies to treat this infection. We performed a bibliographic search to identify studies investigating H. pylori susceptibility-guided therapy. Culture is not the only way to assess antibiotic resistance, as different polymerase chain reaction-based approaches have been developed as alternative methods. For detecting H. pylori antimicrobial resistance, a molecular approach based on a stool sample might enable more convenient, time-saving methods. Unfortunately, the antimicrobial susceptibility cannot be obtained in all cases. Furthermore, antibiotic susceptibility testing in clinical practice yields useful information only for a few antibiotics: clarithromycin, metronidazole, and quinolones. In addition, susceptibility towards clarithromycin and metronidazole in vitro does not necessarily lead to eradication in vivo. In the case of H. pylori therapy failure, we should not re-administer any of the antibiotics against which H. pylori has probably become resistant. Our updated meta-analysis showed that susceptibility-guided treatment is not better than empirical treatment of H. pylori infection in first-line therapy if the most updated quadruple regimens are empirically prescribed, and similar efficacy results were also demonstrated with the two strategies for second-line therapy. Cumulative H. pylori eradication rate with several successive rescue therapies empirically prescribed reaches almost 100%. Finally, the studies that have evaluated the cost-effectiveness of the susceptibility-guided treatment have achieved contradictory results. In summary, we can conclude that the evidence is too limited to support the generalized use of susceptibility-guided therapy for H. pylori treatment in routine clinical practice, either as first-line or as rescue treatment. Nevertheless, it would be recommended that susceptibility tests are performed routinely, even before prescribing first-line treatment, in specialized centers with an interest in H. pylori management.

An empirical study on the construct of "God" in the Twelve Step process

Background: The term God, included in 5 of the 12 Steps of Narcotics Anonymous (NA) and Alcoholics Anonymous (AA), self-designated spiritual fellowships, has not been studied empirically relative to members' experiences. A greater understanding of this can be clinically useful and can shed light on the 12 Step process of recovery. Objectives: To determine how NA members understand the 12-step concept "God as we understood Him" and the relationship between their understanding of God and the intensity of their craving and depressive symptoms." Methods: 450 (59% male) NA members completed a survey related to their experiences relative to their relationship with "God." The relationship among these variables and comparisons to the general population was analyzed. Craving and depressive symptoms were assessed by self-report. Results: 98% of the NA participants believe in God explicitly or some other higher power (vs 89% of a probability sample of the US population), 67% believe that God determines what happens to them some or all of the time (vs 48%), 78% (vs 28%) report hearing God talking to them "in their mind"; and 37% report that God talks to them "out loud." Acceptance of 12 Step God-related variables inversely predicted a significant portion of the variance of scores on craving (7.5%) and depression (13.5%). Conclusions: Respondents' understanding of God in NA varied considerably and was predictive of their depressive symptoms and craving intensity. These findings can serve as a basis for research into mechanisms underlying NA/AA recovery experiences and can also aid clinicians in how to employ these programs.

Modeling the release of food bioactive ingredients from carriers/nanocarriers by the empirical, semiempirical, and mechanistic models

The encapsulation process has been utilized in the field of food technology to enhance the technofunctional properties of food products and the delivery of nutraceutical ingredients via food into the human body. The latter application is very similar to drug delivery systems. The inherent sophisticated nature of release mechanisms requires the utilization of mathematical equations and statistics to predict the release behavior during the time. The science of mathematical modeling of controlled release has gained a tremendous advancement in drug delivery in recent years. Many of these modeling methods could be transferred to food. In order to develop and design enhanced food controlled/targeted bioactive release systems, understanding of the underlying physiological and chemical processes, mechanisms, and principles of release and applying the knowledge gained in the pharmaceutical field to food products is a big challenge. Ideally, by using an appropriate mathematical model, the formulation parameters could be predicted to achieve a specific release behavior. So, designing new products could be optimized. Many papers are dealing with encapsulation approaches and evaluation of the impact of process and the utilized system on release characteristics of encapsulated food bioactives, but still, there is no deep insight into the mathematical release modeling of encapsulated food materials. In this study, information gained from the pharmaceutical field is collected and discussed to investigate the probable application in the food industry.

Comparison of empirical and dynamic models for HIV viral load rebound after treatment interruption

OBJECTIVE

To compare empirical and mechanistic modeling approaches for describing HIV-1 RNA viral load trajectories after antiretroviral treatment interruption and for identifying factors that predict features of viral rebound process.

METHODS

We apply and compare two modeling approaches in analysis of data from 346 participants in six AIDS Clinical Trial Group studies. From each separate analysis, we identify predictors for viral set points and delay in rebound. Our empirical model postulates a parametric functional form whose parameters represent different features of the viral rebound process, such as rate of rise and viral load set point. The viral dynamics model augments standard HIV dynamics models-a class of mathematical models based on differential equations describing biological mechanisms-by including reactivation of latently infected cells and adaptive immune response. We use Monolix, which makes use of a Stochastic Approximation of the Expectation-Maximization algorithm, to fit non-linear mixed effects models incorporating observations that were below the assay limit of quantification.

RESULTS

Among the 346 participants, the median age at treatment interruption was 42. Ninety-three percent of participants were male and sixty-five percent, white non-Hispanic. Both models provided a reasonable fit to the data and can accommodate atypical viral load trajectories. The median set points obtained from two approaches were similar: 4.44 log10 copies/mL from the empirical model and 4.59 log10 copies/mL from the viral dynamics model. Both models revealed that higher nadir CD4 cell counts and ART initiation during acute/recent phase were associated with lower viral set points and identified receiving a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based pre-ATI regimen as a predictor for a delay in rebound.

CONCLUSION

Although based on different sets of assumptions, both models lead to similar conclusions regarding features of viral rebound process.

The Hypotension Period after Initiation of Appropriate Antimicrobial Administration Is Crucial for Survival of Bacteremia Patients Initially Experiencing Severe Sepsis and Septic Shock

Bacteremia is linked to substantial morbidity and medical costs. However, the association between the timing of achieving hemodynamic stability and clinical outcomes remains undetermined. Of the multicenter cohort consisted of 888 adults with community-onset bacteremia initially complicated with severe sepsis and septic shock in the emergency department (ED), a positive linear-by-linear association (γ = 0.839, p < 0.001) of the time-to-appropriate antibiotic (TtAa) and the hypotension period after appropriate antimicrobial therapy (AAT) was exhibited, and a positive trend of the hypotension period after AAT administration in the 15-day (γ = 0.957, p = 0.003) or 30-day crude (γ = 0.975, p = 0.001) mortality rate was evidenced. Moreover, for every hour delay of the TtAa, 30-day survival dropped an average of 0.8% (adjusted odds ratio [AOR], 1.008; p < 0.001); and each additional hour of the hypotension period following AAT initiation notably resulted in with an average 1.1% increase (AOR, 1.011; p < 0.001) in the 30-day crude mortality rate, after adjusting all independent determinants of 30-day mortality recognized by the multivariate regression model. Conclusively, for bacteremia patients initially experiencing severe sepsis and septic shock, prompt AAT administration might shorten the hypotension period to achieve favourable prognoses.

Recent advances in phenotypic drug discovery

There is a great need for innovative new medicines to treat unmet medical needs. The discovery and development of innovative new medicines is extremely difficult, costly, and inefficient. In the last decade, phenotypic drug discovery (PDD) was reintroduced as a strategy to provide first-in-class medicines. PDD uses empirical, target-agnostic lead generation to identify pharmacologically active molecules and novel therapeutics which work through unprecedented drug mechanisms. The economic and scientific value of PDD is exemplified through game-changing medicines for hepatitis C virus, spinal muscular atrophy, and cystic fibrosis. In this short review, recent advances are noted for the implementation and de-risking of PDD (for compound library selection, biomarker development, mechanism identification, and safety studies) and the potential for artificial intelligence. A significant barrier in the decision to implement PDD is balancing the potential impact of a novel mechanism of drug action with an under-defined scientific path forward, with the desire to provide infrastructure and metrics to optimize return on investment, which a known mechanism provides. A means to address this knowledge gap in the future is to empower precompetitive research utilizing the empirical concepts of PDD to identify new mechanisms and pharmacologically active compounds.

Establishment and Characterization of an Empirical Biomarker SS/PV-ROC Plot Using Results of the UBC® Rapid Test in Bladder Cancer

BACKGROUND

This investigation included both a study of potential non-invasive diagnostic approaches for the bladder cancer biomarker UBC^® Rapid Test and a study including comparative methods about sensitivity-specificity characteristic (SS-ROC) and predictive receiver operating characteristic (PV-ROC) curves that used bladder cancer as a useful example.

METHODS

The study included 289 urine samples from patients with tumors of the urinary bladder, patients with non-evidence of disease (NED) and healthy controls. The UBC^® Rapid Test is a qualitative point of care assay. Using a photometric reader, quantitative data can also be obtained. Data for pairs of sensitivity/specificity as well as positive/negative predictive values were created by variation of threshold values for the whole patient cohort, as well as for the tumor-free control group. Based on these data, sensitivity-specificity and predictive value threshold distribution curves were constructed and transformed into SS-ROC and PV-ROC curves, which were included in a single SS/PV-ROC plot.

RESULTS

The curves revealed TPP-asymmetric improper curves which cross the diagonal from above. Evaluation of the PV-ROC curve showed that two or more distinct positive predictive values (PPV) can correspond to the same value of a negative predictive value (NPV) and vice versa, indicating a complexity in PV-ROC curves which did not exist in SS-ROC curves. In contrast to the SS-ROC curve, the PV-ROC curve had neither an area under the curve (AUC) nor a range from 0% to 100%. Sensitivity of the qualitative assay was 58.5% and specificity 88.2%, PPV was 75.6% and NPV 77.3%, at a threshold value of approximately 12.5 µg/L.

CONCLUSIONS

The SS/PV-ROC plot is a new diagnostic approach which can be used for direct judgement of gain and loss of predictive values, sensitivity and specificity according to varied threshold value changes, enabling characterization, comparison and evaluation of qualitative and quantitative bioassays.

FOODLIT-PRO: conceptual and empirical development of the food literacy wheel

Pursuing food systems' sustainability is crucial. Given the risk constituted by unhealthy diets, scarce research on food-related adjacent fields, and inconsistency across food literacy conceptualizations, this study aims to explore the constructs' definition and develop a conceptual and empirical framework of food literacy. A quantitative approach was taken on previously obtained qualitative outcomes from 30 interviews with experts from food-related fields. Food literacy was defined by a four-dimension model: Cooking Skills, Preserve and Analyse, Choice and Acquisition, Search and Plan. The framework Food Literacy Wheel integrates the construct definition, food literacy determinants (Internal, External) and influential factors (Nutritional, Psychological, Health, Learning Contexts, Policy, Industry, Sustainability, Social and Cultural). Allowing a broader perspective of food literacy within major food systems, this study contributes with new insights for future instruments and interventions, paving the way to develop/implement food literacy-related multi-sectorial and multilevel actions.

Rethinking Social Interaction: Empirical Model Development

Background

Social media is an integral part of human social life. More than 90% of young people use social media daily. Current theories, models, and measures are primarily based on face-to-face conceptions, leaving research out of sync with current social trends. This may lead to imprecise diagnoses and predictions.

Objective

To develop a theoretically based empirical model of current social interfaces to inform relevant measures.

Methods

A three-stage, qualitative, data-collection approach included anonymous individual Post-it notes, three full-class discussions, and 10 focus groups to explore 82 adolescents’ relational practices. Data analysis followed a meaning-condensation procedure and a field-correspondence technique.

Results

We developed an empirical model that categorizes adolescents’ social interactions into five experiential positions. Four positions result from trajectories relating to social media and face-to-face social interaction. Positions are described by match or mismatch dynamics between preferred and actual social platforms used. In matched positions, individuals prefer and use both face-to-face and social media platforms (position 1), prefer and use face-to-face platforms (position 2), or prefer and use social media platforms (position 3). In mismatched positions, individuals prefer face-to-face interactions but use social media platforms (position 4) or prefer social media but use face-to-face platforms (position 5). We propose that matched positions indicate good social functioning while mismatched positions indicate serious social challenges.

Conclusions

We propose a model that will expand previous unidimensional social interaction constructs, and we hypothesize that the described match and mismatch analyses provide conceptual clarity for research and practical application. We discuss prediction value, implications, and model validation procedures.

Is empirical treatment a reasonable strategy for laryngopharyngeal reflux? A contemporary review

BACKGROUND

Diagnosis and treatment of presumed laryngopharyngeal reflux (LPR) remain controversial. Empiric medication trials remain widespread for suspected LPR despite emerging evidence against proton pump inhibitor (PPI) safety and for pepsin as a mediator of LPR symptoms. Ongoing concerns exist related to inaccurate diagnosis, the cost and morbidity of potentially unnecessary PPI prescriptions, and availability and interpretation of objective reflux testing.

OBJECTIVES

To review contemporary evidence that does and does not support empiric medication trials for presumed LPR.

METHODS

PubMed, Scopus and Cochrane Library were searched for literature about benefits, limitations and alternatives to empiric medication trial for LPR, in order to present both sides of this debate and identify best practices.

RESULTS

The majority of physicians perform prolonged empiric medication trial with PPIs for patients with suspected LPR. Because symptoms and signs of LPR are non-specific, empiric medication trials require exclusion of other conditions that can mimic LPR. Following a PPI empiric medication trial, over one-third of patients remain non-responders. The use of hypopharyngeal-oesophageal multichannel intraluminal impedance-pH monitoring (HEMII-pH) has benefits and limitations in objective diagnosis of LPR.

CONCLUSIONS

Use of PPIs for single-agent empiric medication trial does not account for possible non-responders with non-acid or mixed LPR. If LPR diagnosis remains uncertain, alginates can be added to PPI trials. HEMII-pH testing upfront is ideal for patients with suspected LPR, but not always practical; it is indicated when PPI and alginate empiric medication trials have failed or when comorbidities confuse the diagnosis. A more comprehensive, combination therapy empiric medication trial regimen may be needed.

Types of Privacy Expectations

Understanding user privacy expectations is important and challenging. General Data Protection Regulation (GDPR) for instance requires companies to assess user privacy expectations. Existing privacy literature has largely considered privacy expectation as a single-level construct. We show that it is a multi-level construct and people have distinct types of privacy expectations. Furthermore, the types represent distinct levels of user privacy, and, hence, there can be an ordering among the types. Inspired by expectations-related theory in non-privacy literature, we propose a conceptual model of privacy expectation with four distinct types - Desired, Predicted, Deserved and Minimum. We validate our proposed model using an empirical within-subjects study that examines the effect of privacy expectation types on participant ratings of privacy expectation in a scenario involving collection of health-related browsing activity by a bank. Results from a stratified random sample (N = 1,249), representative of United States online population (±2.8%), confirm that people have distinct types of privacy expectations. About one third of the population rates the Predicted and Minimum expectation types differently, and differences are more pronounced between younger (18-29 years) and older (60+ years) population. Therefore, studies measuring privacy expectations must explicitly account for different types of privacy expectations.

A prospective randomized comparative study of targeted versus empirical prophylactic antibiotics in the prevention of infective complications following transrectal ultrasound-guided prostate biopsy

Background:

It is established that antibiotic prophylaxis prevents infection following transrectal ultrasound-guided prostate biopsy. This study compares the infective complications in transrectal prostate biopsy (TRPB) in empirical versus targeted prophylactic antibiotics.

Patients and Methods:

Urine and rectal swabs were obtained prior to TRPB. They were randomized into targeted antibiotic (TA) and empirical antibiotic (EA) groups. TA had prophylactic antibiotics according to rectal swab culture, whereas EA had the standard parenteral ciprofloxacin. They were followed up weekly for 4 weeks. Chi-square or Fisher's exact tests were used to compare categorical variables, Student's “t”-test was used to compare means of numerical variables, and P < 0.05 was considered statistically significant.

Results:

One hundred patients were studied, fifty in each group. The mean age was 66 years, with men aged 60–69 years accounting for 50% of the study population. Providencia stuartii, Escherichia coli, andCitrobacter freundii were the most predominant bacteria identified in the prebiopsy rectal swab culture, with resistance to ciprofloxacin (57%) being much more common than that to levofloxacin (21%). Postbiopsy infection occurred in one (2%) patient in the TA group and five (10%) patients in the EA group. Difference in the infection rate between the two groups was statistically significant (P = 0.042). Three of the patients with postbiopsy infection in the EA group had urosepsis and required hospitalization. Fluoroquinolone-resistant bacteria were responsible for infection in all the six patients. TA reduced the risk of postbiopsy infection by 5.6 folds.

Conclusion:

TA was associated with a decreased risk of infection in TRPB.

Psychiatric genetics researchers' views on offering return of results to individual participants

In the middle of growing consensus that genomics researchers should offer to return clinically valid, medically relevant, and medically actionable findings identified in the course of research, psychiatric genetics researchers face new challenges. As they uncover the genetic architecture of psychiatric disorders through genome-wide association studies and integrate whole genome and whole exome sequencing to their research, there is a pressing need for examining these researchers' views regarding the return of results (RoR) and the unique challenges for offering RoR from psychiatric genetics research. Based on qualitative interviews with 39 psychiatric genetics researchers from different countries operating at the forefront of their field, we provide an insider's view of researchers' practices regarding RoR and the most contentious issues in psychiatry researchers' decision-making around RoR, including what are the strongest ethical, scientific, and practical arguments for and against offering RoR from this research. Notably, findings suggest that psychiatric genetics researchers (85%) overwhelmingly favor offering RoR of at least some findings, but only 22% of researchers are returning results. Researchers identified a number of scientific and practical concerns about RoR, and about how to return results in a responsible way to patients diagnosed with a severe psychiatric disorder. Furthermore, findings help highlight areas for further discussion and resolution of conflicts in the practice of RoR in psychiatric genetics research. As the pace of discovery in psychiatric genetics continues to surge, resolution of these uncertainties gains greater urgency to avoid ethical pitfalls and to maximize the positive impact of RoR.

Recognizing the Role of Research Assistants in the Protection of Participants in Vulnerable Circumstances

Little is known about how research assistants (RAs) protect participants in vulnerable circumstances. Using a critical qualitative method informed by feminist ethics, we ran five focus groups with experienced RAs. We identified two themes: (a) expressing moral competencies (subthemes: recognizing power, privilege, and vulnerability; adapting processes and providing support; understanding the sources of moral competencies) and (b) negotiating and making transparent roles and responsibilities (subthemes: separating responsibilities as a clinician from those of an RA; critically reflecting on the shared responsibilities of principal investigators and RAs; and identifying the role of the Research Ethics Committee). Although RAs possess a variety of moral competencies and have an important role in protecting research participants in vulnerable circumstances, that role is largely unrecognized.

Small- and large-scale heterogeneity in genetic variation across the collard flycatcher genome: implications for estimating genetic diversity in nonmodel organisms

Population genetic studies in nonmodel organisms are often hampered by a lack of reference genomes that are essential for whole-genome resequencing. In the light of this, genotyping methods have been developed to effectively eliminate the need for a reference genome, such as genotyping by sequencing or restriction site-associated DNA sequencing (RAD-seq). However, what remains relatively poorly studied is how accurately these methods capture both average and variation in genetic diversity across an organism's genome. In this issue of Molecular Ecology Resources, Dutoit et al. (2016) use whole-genome resequencing data from the collard flycatcher to assess what factors drive heterogeneity in nucleotide diversity across the genome. Using these data, they then simulate how well different sequencing designs, including RAD sequencing, could capture most of the variation in genetic diversity. They conclude that for evolutionary and conservation-related studies focused on the estimating genomic diversity, researchers should emphasize the number of loci analysed over the number of individuals sequenced.

Arms races with mitochondrial genome soft sweeps in a gynodioecious plant, Plantago lanceolata

Biological situations involving conflict can create arms race situations with repeated fixations of different functional variants, producing selective sweeps and lowering neutral diversity in genome regions linked to the functional locus. However, they can sometimes lead to balancing selection, potentially creating long coalescent times for sites with functionally different variants, and, if recombination occurs rarely, for extended haplotypes carrying such variants. We tested between these possibilities in a gynodioecious plant, Plantago lanceolata, in which cytoplasmic male-sterility factors conflict with nuclear restorers of male fertility. We find low mitochondrial diversity, which does not support very long-term coexistence of highly diverged mitochondrial haplotypes. Interestingly, however, we found a derived haplotype that is associated with male fertility in a restricted geographic region, and that has fixed differences from the ancestral sequence in several genes, suggesting that it did not arise very recently. Taken together, the results suggest arms race events that involved "soft" selective sweeps involving a moderately old-established haplotype, consistent with the frequency fluctuations predicted by theoretical models of gynodioecy.

A comparative study of the efficacy of intravenous benzylpenicillin and intravenous augmentin in the empirical management of Ludwig's angina

Background:

Ludwig's angina is a potentially life-threatening condition characterized by bilateral cellulitis of the submandibular, submental, and sublingual spaces. Intravenous (I.V) penicillin G or amoxicillin-clavulanate (Augmentin) has been recommended for use as empirical management before obtaining culture and sensitivity results.

Aim:

The aim of this study was to compare the therapeutic efficacies and clinical outcomes of I.V benzylpenicillin with I.V Augmentin in the empirical management of Ludwig's angina.

Methods:

This was a prospective randomized clinical study carried out to measure the rate of swelling reduction (using the lobar rate, Adam's rate, and interincisal distance) and other clinical parameters among the two drug groups (I.V penicillin G and Augmentin). Descriptive summaries of variables were generated, and Student's t-test was used to compare the mean outcomes of the two groups.

Results:

A total of 26 individuals participated in the study, consisting of 46% (12) males and 54% (14) females. The participants ranged from 13 to 61 years with mean and median of 34.4 (±12.7) and 35 years, respectively. Only 8% of the cases of Ludwig's angina were not attributable to odontogenic factors, compared to 92% resulting from odontogenic causes. There was no significant difference in the efficacy of the two antibiotics used in this study.

Conclusion:

The efficacies and the clinical outcomes of the two antibiotics were similar. Benzylpenicillin is probably a suitable empirical alternative where Augmentin cannot be afforded, to reduce the mortality associated with the condition.

A more principled use of the p-value? Not so fast: a critique of Colquhoun's argument

The usefulness of the statistic known as the p-value, as a means of quantifying the strength of evidence for the presence of an effect from empirical data has long been questioned in the statistical community. In recent years, there has been a notable increase in the awareness of both fundamental and practical limitations of the statistic within the target research fields and especially biomedicine. In this article, I analyse the recently published article (Colquhoun 2017 R. Soc. open sci. 4, 171085 (doi:10.1098/rsos.171085)) which, in summary, argues that with a better understanding and thus more appropriate use of the statistic, many of the aforementioned limitations can be addressed. In particular, I demonstrate that the (often implicit) premises of this counterargument are questionable, in some cases arguably inconsistent, and that therefore the counterargument provides little if any justification for the continued use of the p-value. Additionally, my analysis should help researchers seeking to interpret their empirical data by illustrating the nuanced nature and the multiplicity of statistical, methodological and epistemological issues which must be considered in this process.

Empirical and Heuristic Phenomenological Case Study of the HeartMath Global Coherence Initiative

Along with the creativity of vast technological advances, humanity’s endemic destructiveness continues. Planetary healing needs motivated this research. The aim was an empirical and heuristic phenomenological investigation into and an evaluation of the theoretical and technological implications of the HeartMath Global Coherence Initiative. The single case study, and limited amount of data, indicated the null hypothesis. Methodology included HeartMath Inner Balance tool and newly developed Global Coherence application (app). Data collection involved linked empirical measures and experiential journaling. Quantitative data analysis, which consisted of statistical analysis of correlations between six existing Global Coherence magnetometers and empirical measures of meditation records, from Inner Balance and Global coherence apps, respectively, yielded unexpected findings, both significant and insignificant, in the form of trends towards global and local group coherence, respectively. Qualitative findings essentially revealed variations on the, interrelated, consciousness themes of wholeness, holistic healing, energy healing and meditation. In addition to various limitations and implications, interpretation of integrative findings indicated theoretical and practical support for the HeartMath mission and vision of developing and promoting personal, social and global coherence.

The Impact of E-Visits on Visit Frequencies and Patient Health: Evidence from Primary Care

Secure messaging, or "e-visits," between patients and providers has sharply increased in recent years, and many hope they will help improve healthcare quality, while increasing provider capacity. Using a panel data set from a large healthcare system in the United States, we find that e-visits trigger about 6% more office visits, with mixed results on phone visits and patient health. These additional visits come at the sacrifice of new patients: physicians accept 15% fewer new patients each month following e-visit adoption. Our data set on nearly 100,000 patients spans from 2008 to 2013, which includes the rollout and diffusion of e-visits in the health system we study. Identification comes from difference-in-differences estimates leveraging variation in the timing of e-visit adoption by both patients and providers. We conduct several robustness checks, including matching analyses and an instrumental variable analysis to account for possible time-varying characteristics among patient e-visit adopters.

Inappropriate Empirical Treatment of Uncomplicated Cystitis in Thai Women: Lessons Learned

A prospective study conducted in a Thai general practice clinic demonstrated a high prevalence (91.3%) of inappropriate empirical antibiotic use in women with uncomplicated cystitis and 42.6% Escherichia coli fluoroquinolone resistance. An annual update of antimicrobial resistance surveillance data of uropathogens may permit targeted treatment of patients in hospital care.

Empirical estimation of intravoxel structure with persistent angular structure and Q-ball models of diffusion weighted MRI

The diffusion tensor model is nonspecific in regions where micrometer structural patterns are inconsistent at the millimeter scale (i.e., brain regions with pathways that cross, bend, branch, fan, etc.). Numerous models have been proposed to represent crossing fibers and complex intravoxel structure from in vivo diffusion weighted magnetic resonance imaging (e.g., high angular resolution diffusion imaging-HARDI). Here, we present an empirical comparison of two HARDI approaches-persistent angular structure MRI (PAS-MRI) and Q-ball-using a newly acquired reproducibility dataset. Briefly, a single subject was scanned 11 times with 96 diffusion weighted directions and 10 reference volumes for each of two [Formula: see text] values (1000 and [Formula: see text] for a total of 2144 volumes). Empirical reproducibility of intravoxel fiber fractions (number/strength of peaks), angular orientation, and fractional anisotropy was compared with metrics from a traditional tensor analysis approach, focusing on [Formula: see text] values of 1000 and [Formula: see text]. PAS-MRI is shown to be more reproducible than Q-ball and offers advantages at low [Formula: see text] values. However, there are substantial and biologically meaningful differences between the intravoxel structures estimated both in terms of analysis method as well as by [Formula: see text] value. The two methods suggest a fundamentally different microarchitecture of the human brain; therefore, it is premature to perform meta-analysis or combine results across HARDI studies using a different analysis model or acquisition sequences.

Beyond demarcation: Care ethics as an interdisciplinary field of inquiry

BACKGROUND:

For many years the body of literature known as 'care ethics' or 'ethics of care' has been discussed as regards its status and nature. There is much confusion and little structured discussion. The paper of Klaver et al. (2014) was written as a discussion article to which we respond.

OBJECTIVES:

We aim to contribute to the ongoing discussion about the status and nature of care ethics.

RESEARCH DESIGN:

Responding to 'Demarcation of the ethics of care as a discipline' by Klaver et al. (2014) and 'Three versions of an ethics of care' by Edwards (2009), we identified shared concerns and formulated criticisms of both texts in order to develop an alternative view.

PARTICIPANTS AND RESEARCH CONTEXT:

This paper has been written from the academic context of a master in care ethics an policy.

ETHICAL CONSIDERATIONS:

We have tried to be fair and respectful to the authors discussed.

FINDINGS:

Both Klaver et al. (2014) and Edwards (2009) raise important concerns about the question if care ethics can be considered an academic discipline, and to what extend it can be seen as a moral theory. Despite shared concerns, their arguments fail to convince us in all respects.

DISCUSSION AND CONCLUSION:

We propose to conceive care ethics as an interdisciplinary field of inquiry, incorporating a dialectical relation between empirical research and theoretical reflection. Departing from the notion of caring as a practice of contributing to a life-sustaining web, we argue that care ethics can only profit from a loosely organized academic profile that allows for flexibility and critical attitude that brings us close to the good emerging in specific practices. This asks for ways of searching for a common focus and interest that is inherently democratic and dialogical and thus beyond demarcation.

Recognizing Risk and Vulnerability in Research Ethics: Imagining the "What Ifs?"

Research ethics committees (RECs) may misunderstand the vulnerability of participants, given their distance from the field. What RECs identify as the vulnerabilities that were not adequately recognized in protocols and how they attempt to protect the perceived vulnerability of participants and mitigate risks were examined using the response letters sent to researchers by three university-based RECs. Using a critical qualitative method informed by feminist ethics, we identified an overarching theme of recognizing and responding to cascading vulnerabilities and four subthemes: identifying vulnerable groups, recognizing potentially risky research, imagining the "what ifs," and mitigating perceived risks. An ethics approach that is up-close, as opposed to distant, is needed to foster closer relationships among participants, researchers, and RECs and to understand participant vulnerability and strength better.

Alpha synchronization as a brain model for unconscious defense: An overview of the work of Howard Shevrin and his team

Howard Shevrin and his team have developed a stringent subliminal priming methodology, which experimentally approximates a situation of an internal, mental triggering of unconscious defense. Through a series of four studies they thus are able to bring evidence for this type of unconscious defense. With event-related potentials, three clinical studies show how synchronization of a specific brain wave, the alpha wave, known for its inhibitory function, is also induced by subliminally presented conflictual subject-specific stimuli. Therefore, alpha synchronization could serve as the brain mechanism of unconscious defense. The results only make sense if we suppose the existence of a dynamic unconscious, which has inherited childhood conflicts, and with privileged connections to neurotic symptom characteristics. Moreover, by showing that the unconscious conflict phrases, inferred by clinicians from clinical interviews, have a similar brain behavior, Shevrin and his team provide evidence that these inferences are not simply clinician-dependent subjective interpretations but also imply some form of independent mental reality. Finally, interpretation of the results has led us to propose two distinct physiological mechanisms for defense: one, unconscious defense, by alpha synchronization in connection with the drive derivatives, and another, repression, based on the indications of reality in connection with the ego.

Challenges of Empirical Antibiotic Therapy for Community-Acquired Pneumonia in Children

Background

Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality globally, responsible for more than 14% of deaths in children younger than 5 years of age. Due to difficulties with pathogen identification and diagnostics of CAP in children, targeted antimicrobial therapy is not possible, hence the widespread use of empirical antibiotics, in particular penicillins, cephalosporin, and macrolides.

Objectives

This review aimed to address medical, societal, and political issues associated with the widespread use of empirical antibiotics for CAP in the United Kingdom, India, and Nigeria.

Methods

A literature review was performed identifying the challenges pertaining to the use of widespread empirical antibiotics for CAP in children. A qualitative analysis of included studies identified relevant themes. Empirical guidance was based on guidelines from the World Health Organization, British Thoracic Society, and Infectious Diseases Society of America, used in both industrialized and resource-poor settings.

Results

In the United Kingdom there was poor adherence to antibiotics guidelines. There was developing antibiotic resistance to penicillins and macrolides in both developing and industrialized regions. There were difficulties accessing the care and treatment when needed in Nigeria. Prevention strategies with vaccination against Streptococcus pneumonia, Haemophilus influenza, and measles are particularly important in these regions.

Conclusions

Effective and timely treatment is required for CAP and empirical antibiotics are evidence-based and appropriate in most settings. However, better diagnostics and education to target treatment may help to prevent antibiotic resistance. Ensuring the secure financing of clean food and water, sanitation, and public health infrastructure are also required to reduce the burden of disease in children in developing countries.

Apologies in a Legal Setting: Insights from Research into Injured Parties' Experiences of Apologies after an Adverse Event

There is scholarly support for the use of apologies in the settlement of legal disputes and anecdotal evidence of their effectiveness in mediation and other dispute resolution processes. There is also a growing body of empirical psychological research regarding the use and effectiveness of apologies available to inform and guide the practice of lawyers, mediators and other professionals, and judicial officers when apologies arise in legal proceedings. This article critically reviews the research literature concerning the experience of apology recipients and offers a framework for understanding the circumstances in which an apology may contribute to the resolution of a legal dispute.

Compassion in Health Care: An Empirical Model

CONTEXT

Compassion is frequently referenced as a hallmark of quality care by patients, health care providers, health care administrators, and policy makers. Despite its putative centrality, including its institution in recent health care reform, an empirical understanding based on the perspectives of patients, the recipients of compassion, is lacking-making compassion one of the most referenced yet poorly understood elements of quality care.

OBJECTIVES

The objective of this study was to investigate palliative cancer patients' understanding and experiences of compassion to provide a critical perspective on the nature and importance of compassion.

METHODS

This grounded theory study used semi-structured interviews to investigate how patients understand and experience compassion in clinical care. Using convenience and theoretical sampling, 53 advanced cancer inpatients were recruited over a seven-month period from a specialized palliative care unit and hospital-wide palliative care service within a Canadian urban setting. Data were analyzed by four members of the research team through the three stages of Straussian grounded theory.

RESULTS

Qualitative analysis yielded seven categories, each containing distinct themes and subthemes. Together, they constitute components of the compassion model-the first empirically based clinical model of compassion. The model defines compassion as a virtuous response that seeks to address the suffering and needs of a person through relational understanding and action.

CONCLUSION

The components of the compassion model provide insight into how patients understand and experience compassion, providing the necessary empirical foundation to develop future research, measures, training, and clinical care based on this vital feature of quality care.

Empirical versus Etiological Approaches in Oriental Medical Research

Although Oriental medicine, by nature, may be considered an etiology-based approach to healing, its role in modern research is primarily empirical. The absolute dependence on symptomatic presentation to establish acupuncture point selection goes against the grain of traditional Oriental methods, which emphasize pulse, tongue, and other diagnostic tools to determine the overall biological and psychological conditions of the patient. Recently introduced diagnostic methods in Oriental medical research indicate a potential shift from empirically to etiologically centered designs. This article reviews current mainstream approaches to efficacy trial designs and proceeds with the analysis of newer research models, such as a constitutional approach spearheaded in Korea by the field of four-constitutional medicine.

Novel bayes factors that capture expert uncertainty in prior density specification in genetic association studies

Bayes factors (BFs) are becoming increasingly important tools in genetic association studies, partly because they provide a natural framework for including prior information. The Wakefield BF (WBF) approximation is easy to calculate and assumes a normal prior on the log odds ratio (logOR) with a mean of zero. However, the prior variance (W) must be specified. Because of the potentially high sensitivity of the WBF to the choice of W, we propose several new BF approximations with logOR ∼N(0,W), but allow W to take a probability distribution rather than a fixed value. We provide several prior distributions for W which lead to BFs that can be calculated easily in freely available software packages. These priors allow a wide range of densities for W and provide considerable flexibility. We examine some properties of the priors and BFs and show how to determine the most appropriate prior based on elicited quantiles of the prior odds ratio (OR). We show by simulation that our novel BFs have superior true-positive rates at low false-positive rates compared to those from both P-value and WBF analyses across a range of sample sizes and ORs. We give an example of utilizing our BFs to fine-map the CASP8 region using genotype data on approximately 46,000 breast cancer case and 43,000 healthy control samples from the Collaborative Oncological Gene-environment Study (COGS) Consortium, and compare the single-nucleotide polymorphism ranks to those obtained using WBFs and P-values from univariate logistic regression.

From international health to global health: how to foster a better dialogue between empirical and normative disciplines

BACKGROUND

Public health recommendations are usually based on a mixture of empirical evidence and normative arguments: to argue that authorities ought to implement an intervention that has proven effective in improving people's health requires a normative position confirming that the authorities are responsible for improving people's health. While public health (at the national level) is based on a widely accepted normative starting point - namely, that it is the responsibility of the state to improve people's health - there is no widely accepted normative starting point for international health or global health. As global health recommendations may vary depending on the normative starting point one uses, global health research requires a better dialogue between researchers who are trained in empirical disciplines and researchers who are trained in normative disciplines.

DISCUSSION

Global health researchers with a background in empirical disciplines seem reluctant to clarify the normative starting point they use, perhaps because normative statements cannot be derived directly from empirical evidence, or because there is a wide gap between present policies and the normative starting point they personally support. Global health researchers with a background in normative disciplines usually do not present their work in ways that help their colleagues with a background in empirical disciplines to distinguish between what is merely personal opinion and professional opinion based on rigorous normative research. If global health researchers with a background in empirical disciplines clarified their normative starting point, their recommendations would become more useful for their colleagues with a background in normative disciplines. If global health researchers who focus on normative issues used adapted qualitative research guidelines to present their results, their findings would be more useful for their colleagues with a background in empirical disciplines. Although a single common paradigm for all scientific disciplines that contribute to global health research may not be possible or desirable, global health researchers with a background in empirical disciplines and global health researchers with a background in normative disciplines could present their 'truths' in ways that would improve dialogue. This paper calls for an exchange of views between global health researchers and editors of medical journals.

Projected climate impacts to South African maize and wheat production in 2055: a comparison of empirical and mechanistic modeling approaches

Crop model-specific biases are a key uncertainty affecting our understanding of climate change impacts to agriculture. There is increasing research focus on intermodel variation, but comparisons between mechanistic (MMs) and empirical models (EMs) are rare despite both being used widely in this field. We combined MMs and EMs to project future (2055) changes in the potential distribution (suitability) and productivity of maize and spring wheat in South Africa under 18 downscaled climate scenarios (9 models run under 2 emissions scenarios). EMs projected larger yield losses or smaller gains than MMs. The EMs' median-projected maize and wheat yield changes were -3.6% and 6.2%, respectively, compared to 6.5% and 15.2% for the MM. The EM projected a 10% reduction in the potential maize growing area, where the MM projected a 9% gain. Both models showed increases in the potential spring wheat production region (EM = 48%, MM = 20%), but these results were more equivocal because both models (particularly the EM) substantially overestimated the extent of current suitability. The substantial water-use efficiency gains simulated by the MMs under elevated CO2 accounted for much of the EM-MM difference, but EMs may have more accurately represented crop temperature sensitivities. Our results align with earlier studies showing that EMs may show larger climate change losses than MMs. Crop forecasting efforts should expand to include EM-MM comparisons to provide a fuller picture of crop-climate response uncertainties.

Concordance of resistance profiles in households of patients with multidrug-resistant tuberculosis

We estimated the proportion of household contacts whose drug-susceptibility test results matched those of the purported source patient with multidrug-resistant tuberculosis. Ninety-nine (88.4%) contacts had isolates resistant to isoniazid and rifampin, and 41 (36.6%) contacts had isolates with results that also matched the purported source for ethambutol, streptomycin, and pyrazinamide.