Shifting medical guidelines: Compliance and spillover effects for revised antibiotic recommendations

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this recordData sharing statement: All data and analysis scripts, along with materials and analysis plan, are permanently available at the site of the trial registration. https://doi.org/10.17605/OSF.IO/8NFWCRationale: Experts have recently argued that guidelines to take the full course of antibiotics are due for revision, instead recommending that patients stop when they feel better. It is unknown how communicating revised guidelines from medical experts about how long to take a course of antibiotics will affect beliefs, behavior, and trust in guidelines more generally. Objective. This study seeks to understand how revisions to long standing advice impacts the beliefs, behavior, and trust toward such guidelines from medical experts. Method: In a pre-registered experiment, we use a national sample of UK participants (N = 1,263) to test the effects of a message that reverses the prior full-course guideline (versus a status quo message to take the full course). We also test a secondary intervention that emphasizes that medical guidance and evidence may change over time. Results: Early stoppage messages significantly shifted personal beliefs and perceived expert consensus about early stoppage (a shift of 16%, 95% CI: 13.8% to 17.9%, p <.001) and behavioral intent (a shift of 19%, 95% CI: 15.3 to 21.8%, p < .001) in the intended direction. Yet, the new guideline also slightly decreased acceptance of uncertainty about future guidelines (a decrease of 2%, 95% CI: 0.2% to 3.1%, p = .022) and general intention to comply with other guidelines in the future (a decrease of 6%, 95% CI: 2.6% to 8.4%, p < .001); it did not affect perceptions of medical researchers’ or doctors’ credibility or respondents’ epistemic efficacy. Prior belief about early stoppage did not moderate receptivity to messages. Notably, though, we also find receptivity to early stoppage messages was contingent on deference to experts. We find no effect of a secondary intervention that emphasizes that medical guidance and evidence may change over time. Conclusions. Overall, our findings suggest the (U.K.) public is likely to accept new guidelines that change long standing advice to take a full course of antibiotics. While respondents show wariness about further future revisions, these data do not show that changing guidelines undermines trust in the experts that produce them

Integrable semi-discretization of the coupled nonlinear Schr\"{o}dinger equations

A system of semi-discrete coupled nonlinear Schr\"{o}dinger equations is studied. To show the complete integrability of the model with multiple components, we extend the discrete version of the inverse scattering method for the single-component discrete nonlinear Schr\"{o}dinger equation proposed by Ablowitz and Ladik. By means of the extension, the initial-value problem of the model is solved. Further, the integrals of motion and the soliton solutions are constructed within the framework of the extension of the inverse scattering method.Comment: 27 pages, LaTeX2e (IOP style

Design and characterization of a minimally invasive bipolar electrode for electroporation

Objective: To test a new bipolar electrode for electroporation consisting of a single minimally invasive needle. Methods: A theoretical study was performed by using Comsol Multiphysics® software. The prototypes of electrode have been tested on potatoes and pigs, adopting an irreversible electroporation protocol. Different applied voltages and different geometries of bipolar electrode prototype have been evaluated. Results: Simulations and pre-clinical tests have shown that the volume of ablated area is mainly influenced by applied voltage, while the diameter of the electrode had a lesser impact, making the goal of minimal-invasiveness possible. The conductive pole’s length determined an increase of electroporated volume, while the insulated pole length inversely affects the electroporated volume size and shape; when the insulated pole length decreases, a more regular shape of the electric field is obtained. Moreover, the geometry of the electrode determined a different shape of the electroporated volume. A parenchymal damage in the liver of pigs due to irreversible electroporation protocol was observed. Conclusion: The minimally invasive bipolar electrode is able to treat an electroporated volume of about 10 mm in diameter by using a single-needle electrode. Moreover, the geometry and the electric characteristics can be selected to produce ellipsoidal ablation volumes

A Novel Hierarchy of Integrable Lattices

In the framework of the reduction technique for Poisson-Nijenhuis structures, we derive a new hierarchy of integrable lattice, whose continuum limit is the AKNS hierarchy. In contrast with other differential-difference versions of the AKNS system, our hierarchy is endowed with a canonical Poisson structure and, moreover, it admits a vector generalisation. We also solve the associated spectral problem and explicity contruct action-angle variables through the r-matrix approach.Comment: Latex fil

How Politics Shape Views Toward Fact-Checking: Evidence from Six European Countries

This is the author accepted manuscript. The final version is available from SAGE Publications via the DOI in this recordFact-checking has spread internationally, in part to confront the rise of digital disinformation campaigns. American studies suggests ideological asymmetry in attitudes towards factchecking, as well as greater acceptance of the practice among those more interested in and knowledgeable about politics. We examine attitudes toward fact-checking across 6 European counties to put these findings in a broader context (N = 6,067). We find greater familiarity with and acceptance of fact-checking in Northern Europe (Sweden, Germany) than elsewhere (Italy, Spain, France, Poland). We further find two dimensions of political antipathy: a left-right dimension and an “anti-elite” dimension (including dissatisfaction with democracy and negative feelings toward the E.U.), the latter of which more consistently predicts negative feelings toward fact-checkers in the countries examined. Our findings demonstrate that despite general acceptance of the movement, significant political divides remain. Those less likely to trust factcheckers could be more vulnerable to disinformation targeting these divides, leading to a spiral of cynicism.European Commissio

Integrable discretizations of derivative nonlinear Schroedinger equations

We propose integrable discretizations of derivative nonlinear Schroedinger (DNLS) equations such as the Kaup-Newell equation, the Chen-Lee-Liu equation and the Gerdjikov-Ivanov equation by constructing Lax pairs. The discrete DNLS systems admit the reduction of complex conjugation between two dependent variables and possess bi-Hamiltonian structure. Through transformations of variables and reductions, we obtain novel integrable discretizations of the nonlinear Schroedinger (NLS), modified KdV (mKdV), mixed NLS, matrix NLS, matrix KdV, matrix mKdV, coupled NLS, coupled Hirota, coupled Sasa-Satsuma and Burgers equations. We also discuss integrable discretizations of the sine-Gordon equation, the massive Thirring model and their generalizations.Comment: 24 pages, LaTeX2e (IOP style), final versio

Smoke Evacuation During Laparoscopic Surgery: A Problem Beyond the COVID-19 Period. A Quantitative Analysis of CO2 Environmental Dispersion Using Different Devices

Background. The COVID-19 pandemic leads to several debates regarding the possible risk for healthcare professionals during surgery. SAGES and EAES raised the issue of the transmission of infection through the surgical smoke during laparoscopy. They recommended the use of smoke evacuation devices (SEDs) with CO2 filtering systems. The aim of the present study is to compare the efficacy of different SEDs evaluating the CO2 environmental dispersion in the operating theater. Methods. We prospectively evaluated the data of 4 group of patients on which we used different SEDs or standard trocars: AIRSEAL system (S1 group), a homemade device (S2 group), an AIRSEAL system + homemade device (S3 group), and with standard trocars and without SED (S4 group). Quantitative analysis of CO2 environmental dispersion was carried out associated to the following data in order to evaluate the pneumoperitoneum variations: a preset insufflation pressure, real intraoperative pneumoperitoneum pressure, operative time, total volume of insufflated CO2, and flow rate index. Results. 16 patients were prospectively enrolled. The [CO2] mean value was 711 ppm, 641 ppm, 593 ppm, and 761 ppm in S1, S2, S3, and S4 groups, respectively. The comparison between data of all groups showed statistically significant differences in the measured ambient CO2 concentration. Conclusion. All tested SEDs seem to be useful to reduce the CO2 environmental dispersion respect to the use of standard trocars. The association of AIRSEAL system and a homemade device seems to be the best solution combining an adequate smoke evacuation and a stable pneumoperitoneum during laparoscopic surgery

Inflammatory bowel disease: New insights into the interplay between environmental factors and pparγ

The pathophysiological processes of inflammatory bowel diseases (IBDs), i.e., Crohn’s disease (CD) and ulcerative colitis (UC), are still not completely understood. The exact etiology re-mains unknown, but it is well established that the pathogenesis of the inflammatory lesions is due to a dysregulation of the gut immune system resulting in over-production of pro-inflammatory cy-tokines. Increasing evidence underlines the involvement of both environmental and genetic factors. Regarding the environment, the microbiota seems to play a crucial role. Peroxisome proliferator-activated receptors (PPARs) are nuclear receptors that exert pleiotropic effects on glucose homeo-stasis, lipid metabolism, inflammatory/immune processes, cell proliferation, and fibrosis. Further-more, PPARs modulate interactions with several environmental factors, including microbiota. A significantly impaired PPARγ expression was observed in UC patients’ colonic epithelial cells, suggesting that the disruption of PPARγ signaling may represent a critical step of the IBD pathogenesis. This paper will focus on the role of PPARγ in the interaction between environmental factors and IBD, and it will analyze the most suitable in vitro and in vivo models available to better study these relationships