Differences in code status practice patterns among emergency clinicians working in Japan and the United States

ObjectiveThis study aimed to examine self-reported code-status practice patterns among emergency clinicians from Japan and the U.S.MethodsA cross-sectional questionnaire was distributed to emergency clinicians from one academic medical center and four general hospitals in Japan and two academic medical centers in the U.S. The questionnaire was based on a hypothetical case involving a critically ill patient with end-stage lung cancer. The questionnaire items assessed whether respondent clinicians would be likely to pose questions to patients about their preferences for medical procedures and their values and goals.ResultsA total of 176 emergency clinicians from Japan and the U.S participated. After adjusting for participants' backgrounds, emergency clinicians in Japan were less likely to pose procedure-based questions than those in the U.S. Conversely, emergency clinicians in Japan showed a statistically higher likelihood of asking 10 out of 12 value-based questions.ConclusionSignificant differences were found between emergency clinicians in Japan and the U.S. in their reported practices on posing procedure-based and patient value-based questions.Practice implicationsSerious illness communication training based in the U.S. must be adapted to the Japanese context, considering the cultural characteristics and practical responsibilities of Japanese emergency clinicians

Synergistic Activation of Dopamine D1 and TrkB Receptors Mediate Gain Control of Synaptic Plasticity in the Basolateral Amygdala

Fear memory formation is thought to require dopamine, brain-derived neurotrophic factor (BDNF) and zinc release in the basolateral amygdala (BLA), as well as the induction of long term potentiation (LTP) in BLA principal neurons. However, no study to date has shown any relationship between these processes in the BLA. Here, we have used in vitro whole-cell patch clamp recording from BLA principal neurons to investigate how dopamine, BDNF, and zinc release may interact to modulate the LTP induction in the BLA. LTP was induced by either theta burst stimulation (TBS) protocol or spaced 5 times high frequency stimulation (5xHFS). Significantly, both TBS and 5xHFS induced LTP was fully blocked by the dopamine D1 receptor antagonist, SCH23390. LTP induction was also blocked by the BDNF scavenger, TrkB-FC, the zinc chelator, DETC, as well as by an inhibitor of matrix metalloproteinases (MMPs), gallardin. Conversely, prior application of the dopamine reuptake inhibitor, GBR12783, or the D1 receptor agonist, SKF39393, induced robust and stable LTP in response to a sub-threshold HFS protocol (2xHFS), which does not normally induce LTP. Similarly, prior activation of TrkB receptors with either a TrkB receptor agonist, or BDNF, also reduced the threshold for LTP-induction, an effect that was blocked by the MEK inhibitor, but not by zinc chelation. Intriguingly, the TrkB receptor agonist-induced reduction of LTP threshold was fully blocked by prior application of SCH23390, and the reduction of LTP threshold induced by GBR12783 was blocked by prior application of TrkB-FC. Together, our results suggest a cellular mechanism whereby the threshold for LTP induction in BLA principal neurons is critically dependent on the level of dopamine in the extracellular milieu and the synergistic activation of postsynaptic D1 and TrkB receptors. Moreover, activation of TrkB receptors appears to be dependent on concurrent release of zinc and activation of MMPs

Genomic insights into rapid speciation within the world's largest tree genus Syzygium

Acknowledgements Y.W.L. was supported by a postgraduate scholarship research grant from the Ministry of National Development, Singapore awarded through the National Parks Board, Singapore (NParks; NParks’ Garden City Fund). Principal research funding from NParks and the School of Biological Sciences (SBS), Nanyang Technological University (NTU), Singapore, is acknowledged. We thank Peter Preiser, Associate Vice President for Biomedical and Life Sciences, for facilitating NTU support, and Kenneth Er, CEO of NParks, for facilitating research funding through that organisation. V.A.A. and C.L. were funded by SBS, NTU for a one-year research leave. V.A.A. and C.L. also acknowledge support from the United States National Science Foundation (grants 2030871 and 1854550, respectively). S.R. was supported by a postdoctoral research fellowship under the NTU Strategic Plant Programme. S.R. and N.R.W.C. acknowledge funding from NTU start-up and the Academy of Finland (decisions 318288, 319947) grants to J.S. Fieldwork conducted by Y.W.L. was supported by an Indonesian Government RISTEK research permit (Application ID: 1517217008) and an Access License from the Sabah State government [JKM/MBS.1000-2/2JLD.7(84)]. T.N.C.V. is grateful to the Assemblée de la Province Nord and Assemblée de la Province Sud (New Caledonia) for facilitating relevant collection permits. A.N. was partly supported by the Research Project Promotion Grant (Strategic Research Grant No. 17SP01302) from the University of the Ryukyus, and partly by the Environment Research and Technology Development Fund (JPMEERF20204003) from the Environmental Restoration and Conservation Agency of Japan. Fieldwork in Fiji conducted by R.B. was hosted and facilitated by Elina Nabubuniyaka-Young (The Pacific Community’s Centre for Pacific Crops and Trees, Fiji). We thank the NTU-Smithsonian Partnership for tree data obtained for the Bukit Timah Nature Reserve (BTNR) long-term forest dynamics plots. Administrative support provided by Mui Hwang Khoo-Woon and Peter Ang at the molecular laboratory of the Singapore Botanic Gardens (SBG) is acknowledged. Rosie Woods and Imalka Kahandawala (DNA and Tissue Bank, Royal Botanic Gardens, Kew) facilitated additional DNA samples. Daniel Thomas (SBG) and Yan Yu (Sichuan University) commented on biogeographical analyses. NovogeneAIT in Singapore is acknowledged for personalised sequencing service.Peer reviewedPublisher PD

Genomic insights into rapid speciation within the world's largest tree genus Syzygium

The relative importance of the mechanisms underlying species radiation remains unclear. Here, the authors combine reference genome assembly and population genetics analyses to show that neutral forces have contributed to the radiation of the most species-rich tree genus Syzygium. Species radiations, despite immense phenotypic variation, can be difficult to resolve phylogenetically when genetic change poorly matches the rapidity of diversification. Genomic potential furnished by palaeopolyploidy, and relative roles for adaptation, random drift and hybridisation in the apportionment of genetic variation, remain poorly understood factors. Here, we study these aspects in a model radiation, Syzygium, the most species-rich tree genus worldwide. Genomes of 182 distinct species and 58 unidentified taxa are compared against a chromosome-level reference genome of the sea apple, Syzygium grande. We show that while Syzygium shares an ancient genome doubling event with other Myrtales, little evidence exists for recent polyploidy events. Phylogenomics confirms that Syzygium originated in Australia-New Guinea and diversified in multiple migrations, eastward to the Pacific and westward to India and Africa, in bursts of speciation visible as poorly resolved branches on phylogenies. Furthermore, some sublineages demonstrate genomic clines that recapitulate cladogenetic events, suggesting that stepwise geographic speciation, a neutral process, has been important in Syzygium diversification.Peer reviewe

Factors Affecting Profit Distribution Management in Sharia Banks in Indonesia

This study aims to determine the effect of Capital Adequacy Ratio, Effectiveness of Third Party Funds and Risk of Financing on Distribution Management Profit in Islamic Banks in Indonesia in 2013-2017. The strategy used is associative causal. This type of research is quantitative. The data of this study are secondary. The population of this study is Islamic banks in Indonesia that have been officially registered in the Financial Services Authority (OJK) from 2013 to 2017. The research sample is determined by purposive sampling method, so that the number of samples, there are 10 Islamic banks. The data collection technique used is the documentation obtained through the from each bank sample. The research method used is multiple regression analysis, descriptive statistical analysis, classic assumption test and hypothesis test. The data processing tool used is Eviews 9.0 software with panel data regression method. The results of this study are (1) Capital Adequacy Ratio has an effect on Profit Distribution Management, (2) Effectiveness of Third Party Funds does not affect the Distribution ManagementProfit,(3)FinancingRiskhasaneffectonProfitDistributionManagement

Risks of seasonal extreme rainfall events in Bangladesh under 1.5 and 2.0 °C warmer worlds – how anthropogenic aerosols change the story

Anthropogenic climate change is likely to increase the risk (probability of occurrence of a hazard) of extreme weather events in the future. Previous studies have robustly shown how and where climate change has already changed the risks of weather extremes. However, developing countries have been somewhat underrepresented in these studies, despite high vulnerability and limited capacities to adapt. How additional global warming would affect the future risks of extreme rainfall events in Bangladesh needs to be addressed to limit adverse impacts. Our study focuses on understanding and quantifying the relative risks of extreme rainfall events in Bangladesh under the Paris Agreement temperature goals of 1.5 and 2.0°C warming above pre-industrial levels. In particular, we investigate the influence of anthropogenic aerosols on these risks given their likely future reduction and resulting amplification of global warming. Using large ensemble regional climate model simulations from weather@home under different forcing scenarios, we compare the risks of rainfall events under pre-industrial (natural; NAT), current (actual; ACT), 1.5 and 2.0°C warmer, and greenhouse gas (GHG)-only (with pre-industrial levels of anthropogenic aerosols) conditions. Both GHGs and anthropogenic aerosols have an impact on seasonal mean rainfall over this region. In general, higher global mean temperature levels lead to higher rainfall and higher aerosol concentrations to lower rainfall, however the relative importance of the two factors varies between the regions. For extreme rainfall events, we find that the risk of a 1 in 100 year rainfall episode has already increased significantly compared with pre- industrial levels across parts of Bangladesh, with additional increases likely for 1.5 and 2.0°C warming. Climate change impacts on the probabilities of extreme rainfall episodes are found during both pre-monsoon and monsoon seasons. Results show that reduction in anthropogenic aerosols will exacerbate the effects of GHG-induced warming and thereby increasing the rainfall intensity, which has otherwise attenuated the impacts. We highlight that the net aerosol effect varies from region to region within Bangladesh, which leads to different outcomes of aerosol reduction on extreme rainfall statistics and must therefore be considered in future risk assessments. While there is a substantial reduction in risk at 1.5°C warming when compared to 2°C warming, the difference is spatially and temporally variable too, specifically with respect to seasonal extreme rainfall events

Integrated infrastructure for CO2 transport and storage in the west Mediterranean

COMET–Integrated infrastructure for CO2 transport and storage in the west Mediterranean–is a join research Project co-financed by the European Seventh Framework Programme (FP7), which started on January 2010. Carbon dioxide Capture and Storage (CCS) is a CO2 abatement option that can contribute substantially to the ambitious targets needed for climate stabilization. The significant role foreseen for CCS is based on several conditions, like the availability of a CO2 transport infrastructure or construction of such an infrastructure within the near future. The need to have a suitable transport infrastructure, its implications over time and its related costs have only more recently attracting the attention and getting priority in the R&D agenda of the European Countries. This is partly because research on CO2 transport and storage needs to be realized at the local-regional level, unlike the technological research on CO2 capture which is not country dependent. In this context, COMET focuses on assessing CO2 transport and storage in a geographical area that until now has received little attention: The West Mediterranean area, specifically, the Iberian Peninsula and Morocco

Attributing the 2017 Bangladesh floods from meteorological and hydrological perspectives

In August 2017 Bangladesh faced one of its worst river flooding events in recent history. This paper presents, for the first time, an attribution of this precipitation-induced flooding to anthropogenic climate change from a combined meteorological and hydrological perspective. Experiments were conducted with three observational datasets and two climate models to estimate changes in the extreme 10-day precipitation event frequency over the Brahmaputra basin up to the present and, additionally, an outlook to 2 ∘C warming since pre-industrial times. The precipitation fields were then used as meteorological input for four different hydrological models to estimate the corresponding changes in river discharge, allowing for comparison between approaches and for the robustness of the attribution results to be assessed. In all three observational precipitation datasets the climate change trends for extreme precipitation similar to that observed in August 2017 are not significant, however in two out of three series, the sign of this insignificant trend is positive. One climate model ensemble shows a significant positive influence of anthropogenic climate change, whereas the other large ensemble model simulates a cancellation between the increase due to greenhouse gases (GHGs) and a decrease due to sulfate aerosols. Considering discharge rather than precipitation, the hydrological models show that attribution of the change in discharge towards higher values is somewhat less uncertain than in precipitation, but the 95 % confidence intervals still encompass no change in risk. Extending the analysis to the future, all models project an increase in probability of extreme events at 2 ∘C global heating since pre-industrial times, becoming more than 1.7 times more likely for high 10-day precipitation and being more likely by a factor of about 1.5 for discharge. Our best estimate on the trend in flooding events similar to the Brahmaputra event of August 2017 is derived by synthesizing the observational and model results: we find the change in risk to be greater than 1 and of a similar order of magnitude (between 1 and 2) for both the meteorological and hydrological approach. This study shows that, for precipitation-induced flooding events, investigating changes in precipitation is useful, either as an alternative when hydrological models are not available or as an additional measure to confirm qualitative conclusions. Besides this, it highlights the importance of using multiple models in attribution studies, particularly where the climate change signal is not strong relative to natural variability or is confounded by other factors such as aerosols.</p