Rationale: Conventional models of cultural humility - even those extending analysis beyond the dyad of healthcare provider-patient to include concentric social influences such as families, communities and institutions that make the clinical relationship possible - aren’t conceptually or methodologically calibrated to accommodate shifts occurring in contemporary biomedical cultures. More complex models are required that are attuned to how advances in biomedical, communications and information technologies are increasingly transforming the very cultural and material conditions of health care and its delivery structures, and thus how power manifests in clinical encounters. Methodological Intervention: In this paper, we offer a two-pronged intervention in the cultural humility literature. At a first level of analysis, we suggest the need to broaden understandings of culture and associated workings of power to accommodate the effects of biomedicine’s technologising turn. A second level of intervention invites experimentation to broaden the availability of methodological tools to analyse and assess the multidimensionality of technologies and their agentic effects in healthcare encounters. Drawing from new materialism theories, practices of care are approached “diffractively” as contingent and dynamic material-discursive events. Our neo-materialist framework for cultural humility expands analytical sight-lines beyond hierarchical relationships and dichotomies privileging humans (practitioner and/or patient) as sole actants in the clinical exchange. Attended to are the ongoing dynamics of practices entangling big-data driven knowledges and interventions, pharmacological technologies and material instruments and devices, diseases, and the bodies/subjectivities of health care providers and patients. We investigate the implications for clinical assessment if a cultural humility framework is methodologically attuned to the clinical encounter as a discontinuous, discursive-material process producing multiple, contextually emergent data moments and objects for analysis. Engaging evaluative inquiry diffractively allows for a different ethical practice of care, one that attends to the forms of patient and health provider accountability and responsibility emerging in the clinical encounter.

The search for mates and food is mediated by volatile chemicals. Insects sense food odorants and sex pheromones through odorant receptors (ORs) and pheromone receptors (PRs), which are expressed in olfactory sensory neurons. Investigating the receptive range of these receptors instructs the identification of behaviourally relevant chemicals. Studying orthologous receptors and their ligands across taxa affords insights into the role of chemical communication in reproductive isolation and phylogenetic divergence. The female sex pheromone of green budworm moth Hedya nubiferana (Lepidoptera, Totricidae) is a blend of two unsaturated acetates, only a blend of both elicits male attraction. Females also produce codlemone, which is the sex pheromone of another tortricid, codling moth Cydia pomonella. Codlemone also attracts green budworm moth males. Concomitantly, green budworm and codling moth males are attracted to the food plant volatile pear ester. A congruent behavioural response to the same pheromone and plant volatile in two tortricid species suggests co-occurrence of dedicated odorant receptors. In codling moth, one PR is tuned to both compounds, the sex pheromone codlemone and the plant volatile pear ester. Our phylogenetic analysis finds that green budworm moth expresses an orthologous PR gene. Shared ancestry, and high levels of amino acid identity and sequence similarity, in codling and green budworm moth PRs offers an explanation for parallel attraction of both species to the same compounds. A conserved olfactory channel for a sex pheromone and host plant volatile substantiates the alliance of social and habitat signals in insect chemical communication. Field attraction assays confirm that in silico investigations of odorant receptors afford powerful predictions for an efficient identification of behaviour-modifying semiochemicals, for an improved understanding of the mechanisms of host plant attraction in insect herbivores and for the further development of sustainable insect control.

The capacity of some yeasts to extract energy from single sugars, generating CO2 and ethanol (=fermentation), even in the presence of oxygen is known as the Crabtree effect. This phenomenon represents an important adaptation as it allowed the utilization of the ecological niche given by modern fruits, an abundant source of food that emerged in the terrestrial environment in the Cretaceous. However, identifying the evolutionary events that triggered fermentative capacity in Crabtree positive species is challenging, as microorganisms do not leave fossil evidence. Thus, key innovations should be inferred based only on traits measured under culture conditions. Here, we reanalyzed data form a common-garden experiment where several proxies of fermentative capacity were recorded in Crabtree positive and negative species, representing yeast’s phylogenetic diversity. In particular, we applied the “lasso-OU” algorithm which detects points of adaptive shifts, provided trait values representing a given performance measure. We tested whether multiple events or a single event explains the actual fermentative capacity of yeasts. According to the lasso-OU procedure, evolutionary changes in the three proxies of fermentative capacity that we considered (i.e., glycerol production, ethanol yield and respiratory quotient) are consistent with a single evolutionary episode (a whole-genomic duplication, WGD), instead of a series of small genomic rearrangements. Thus, the WGD appears as the key event behind the diversification of fermentative yeasts, which by increasing gene dosage and maximized their capacity of energy extraction for exploiting the new ecological niche provided by single sugars.

Mechanism of the oxidative nonpolar inversion reaction catalyzed by N-heterocyclic carbenes (NHCs) to achieve benzoxazoles was investigated in very details. The reaction was revealed to occur through five processes, and for oxidation in the second process, two successive tautomerizations followed by oxidation were demonstrated to be more energetically favorable than the other two pathways. The rate-determining step was disclosed to be the oxidation by 3,3’-5,5’-tetra-tert-butyl-4,4’-diphenoquinone (DQ). Afterwards, mechanism calculations to the non-catalyzed reaction was conducted and it was revealed that the excessive exothermic property of the initial step should be the main reason for the extremely high barrier in the following step. While with participation of NHC, this unfavorable transformation can be deftly prevented according to the specific sequence and amount of reagents addition, and therefore to enable the reaction to occur under mild conditions.

The turbulent characteristics of heat transfer and flow have been determined by applying the Van Driest model of the eddy diffusivity for water and ethylene glycol-based nanofluids. The properties of CuO, Al2O3 and SiO2 nanofluids in two base liquids viz., water and EG-water mixture with the ratio of 60:40 are considered for various concentrations and bulk temperature ranges. Based on the observations, it is concluded that numerical outcomes are validated with experimental measurements for heat transfer properties. It is monitored that SiO2 reaches a higher temperature gradient in comparison to CuO at a similar temperature and concentration in EG-water with the mixture of 60: 40. The gradients are greater for the EGW mixture compared to water-based nanofluids. However, the water-based nanofluids have higher heat transfer coefficients compared to EG-water nanofluid at identical flow velocities.

In the present paper we provide the conditions guaranteeing the generalization of so-called {\it diauxic} behaviour of solutions of ODEs. This behaviour was described by Monod in 1949 in the context of bacterial growth. Then a similar behaviour was observed and described referring to dynamic of CDK1 protein during cell cycle. The diauxic behaviour is described in terms of inflection points.

In this paper, we investigate a fractional p-Laplacian system with different critical Sobolev-Hardy exponents. By variational methods and the Mountain-Pass lemma, positive minimizers of the related best Sobolev constants and the existence of positive solutions of the system are found.

Euterpe edulis (Arecaceae) Mart has high ecological and economic importance providing food resources for more than 58 species of birds and 20 species of mammals, including humans. E. edulis is the second most explored non-timber product from Brazilian Atlantic Forest. Due to overexploitation and destruction of habitats, E. edulis is threatened by extinction. E. edulis populations have large morphological variations, with individuals having green, red or yellow leaf sheath. However, no study has related phenotypic distinctions between populations and their levels of genetic structure. Thus, this study aimed to evaluate the diversity and genetic structure of different E. edulis morphotypes. We sampled 250 adult individuals in eight populations with the different morphotypes. Using 14 microsatellite markers, we access genetic diversity through population genetic parameters calculated in the GenAlex program and the diveRsity package in R. We used the Wilcoxon test to verify population bottlenecks and the genetic distance of Nei and Bayesian analysis for genetic clusters. The eight populations showed low allele richness, low heterogeneity observed and high inbreeding values (f). In addition, six of the eight populations experienced genetic bottlenecks, which would partly explain the low genetic diversity in populations. Cluster analysis identified two clusters (K=2), with green morphotype genetically distinguishing from yellow and red morphotypes. Thus, we show, for the first time, a strong genetic structure among E. edulis morphotypes even for geographically close populations.

Multi-reference configuration interaction, MR-CI (including extensivity corrections, named +Q) calculations have been performed on S0 to S3 states of cyclohexa-2,4-diene-1-thione (thione 24) and cyclohexa-2,5-diene-1-thione (thione 25), which are thione isomers of thiophenol. Several types of uncontracted MR-CIS and MR-CISD wavefunctions have been employed, comprising MR-CI expansions as large as ~ 374 x 106 configuration state functions. The nature of the studied excited states has been characterized. Vertical excitation energies (ΔE) and oscillator strengths (f) have been computed. The most intense transitions (S0→S2 for 24 and S0→S3 for 25) do not change with the wavefunction, although a variation as large as ~ 1 eV has been obtained for the S3 state of 24. On the other hand, ΔE changes at most ~ 0.15 eV for 25, as the wavefunction changes. The S1 state of both thiones has nπ* character and is in the visible region. For 24 S2 and S3 are ππ* and nπ* states, respectively, while for 25 the reverse order has been obtained. S2 and S3 are in the range from ~ 3.5 to 5.2 eV, at the highest level (MR-CI+Q). It is the first time that the excited states of the title molecules are studied. The computed results agree with the experimental onsets of photoreactions of thiones 24 and 25 found by Reva et. al. (Phys. Chem. Chem. Phys. 2015, 17, 4888).

Quantitative analyses on the coefficient of friction of common coating waxes are necessary and essential for designing systems for coating, conveying, packaging operations, transporting and storing of papers and paperboards, while analyses on wear behavior can be helpful for predicting performance durability of the coating surface. In this study, we investigated the friction and wear behaviors of six waxes including four commercial waxes and two soybean oil-based wax developed in our lab for bulk coating on cardboard. The effect of normal load, sliding velocity, and environmental temperature was evaluated. The friction coefficient of different waxes varies with sliding conditions. Higher normal load, sliding velocity, and environmental temperature resulted in significantly greater wear loss. Crystalline morphology and crystallinity were affected by environmental temperature, and they correlate to the variations in friction coefficient and wear loss of these materials. Overall, the Estercoat developed in our lab had comparable frictional properties and much less wear than paraffin wax under tested conditions and can be a good substitute for paraffin wax.

We study the evaporation dynamics of multiple water droplets deposited in ordered arrays or randomly distributed (sprayed) on superhydrophobic substrates (SHP) and smooth silicone wafers (SW). The evaluation of mass of the droplets as a function of time shows a power-law behavior with exponent 3/2, and from the prefactor of the power-law an evaporation rate can be determined. We find that the evaporation rate on a SHP surface is slower than a normal surface for both single droplet and collection of droplets. By dividing a large droplet into more smaller ones, the evaporation rate increases and the difference between the evaporation rates on SHP and SW surfaces becomes higher. The evaporation rates depend also on the distance between the droplets and increase with increasing this distance.

Objective: To investigate the learning curve of robot-assisted laparoscopy in early stage cervical cancer and quantify impact on oncological outcomes. Design: Observational cohort study. Setting: Tertiary referral centre with one surgical team. Population: All early stage cervical cancer patients treated consecutively with robot-assisted laparoscopy between 2007 and 2017. Methods: With multivariate risk-adjusted cumulative sum analysis (RA-CUSUM), we assessed the learning curve of robot-assisted laparoscopy of a single surgical team based on cervical cancer recurrence. Subsequently, a survival analysis was conducted comparing oncological outcomes of patients treated during different phases of the learning curve. Main Outcome Measures: Surgical proficiency based on recurrence, survival rates in the different learning phases. Results: 165 cervical cancers patients were operated by robot-assisted laparoscopy, with a median follow-up of 57 months (range 3-132 months). The RA-CUSUM analysis demonstrated two phases of the learning curve: a learning phase of 61 procedures (group 1) and an experienced phase representing the 104 procedures thereafter (group 2). The 5-year disease free survival was 80.2% in group 1 and 91.1% in group 2 (P = 0.040). Both the 5-year disease-specific survival and overall survival significantly increased after the learning phase. Conclusion: The learning phase of robot-assisted laparoscopy in early stage cervical cancer in this institutional cohort is at least 61 procedures, with higher survival rates in the patients treated thereafter. The learning curve of robot-assisted laparoscopy affects oncological outcomes and warrants more attention in the design of future studies. Funding: None. Keywords: Cervical cancer, robot-assisted laparoscopy, learning curve, RA-CUSUM, recurrence, survival.

Letter to the Editor, BJOG Exchange

References1. Ravi, K.; Gunawardana, S.; Ravi, K.; Abeywickrema, M.; Davies, M.; Tough, E. et al. Why stillbirth deserves a place on the medical school curriculum: Stillbirth-related teaching in UK medical schools. BJOG. 2020;127(3):414.2. Frøen, J. E.; Heazell, A.E P.; Flenady, V.; de Bernis, L.; Kinney, M. V.; Blencowe, H. et al. The Lancet Ending Preventable Stillbirths Study Group. Ending preventable stillbirths: an executive summary for The Lancet’s series. Lancet [Internet]. 2016 18 May 2019. Available from: https://www.thelancet.com/pb/assets/raw/Lancet/stories/series/stillbirths2016-exec-summ.pdf.3. UK Foundation Programme Office. F2 Career Destinations Report. 2018.4. Burden, C.; Bradley, S.; Storey, C.; Ellis, A.; Heazell, A.E.P.; Downe, S. et al. From grief, guilt pain and stigma to hope and pride - a systematic review and meta-analysis of mixed-method research of the psychosocial impact of stillbirth. BMC Pregnancy Childbirth. 2016;16:9.—————————————————————————————————————————Funding Support: No specific funding received.—————————————————————————————————————————Statement of Contribution to Authorship: E.C. and D.S. conceived the idea for the Commentary. E.C. performed the literature review and wrote the initial version of the manuscript. D.S. supervised the writing of the manuscript and provided critical feedback prior to submission of the final version.—————————————————————————————————————————Disclosure of Interests: D.S. is an Executive Scientific Editor for BJOG. Otherwise the authors declare that they have no known competing interests or personal relationships that could have influenced the work reported in this paper.—————————————————————————————————————————

Microbial biomass (MB) production and turnover strongly affect soil organic carbon (SOC) accumulation. Microbial carbon use efficiency (CUE) and MB turnover in paddy soil were determined using a novel substrate-independent H218O labeling approach and the effect of long-term fertilization with mineral (NPK) or combined (NPK+OM (manure)) amendments in 0-10, 10-20, and 20-30 cm depths were investigated. Long-term fertilization increased microbial C uptake, CUE, and growth rates, and all indexes were the highest in the NPK+OM treatment. The CUE ranged between 0.07 and 0.23 and showed variable behavior with depth: it reduced in the control treatment, indicating that more C was allocated to energy production than biomass growth, and increased in fertilized soils, showing the shift of C usage for biomass growth. The highest CUE was observed at 20-30 cm in NPK and NPK+OM and indicated that microorganisms overcome the nutrient deficiency in deep soil layers by keeping high C uptake rates at a constant CUE. MBC turnover was more rapid in NPK (10-70 d) and NPK+OM (40-65 d) compared to control (80 d) and intensified with the depth. These findings highlight that under long-term fertilization MB turnover can be controlled by CUE. These shifts in the strategies of microorganisms functioning can explain the accumulation of SOC in heavily fertilized paddy soils.

Excessive salts in soil inhibit enzyme activity, decrease microbial growth and constrain biochemical functioning, which could be alleviated by soil management and fertilization. However, the effect of consecutive chemical fertilizer on soil bacterial community structure under saline environment is poorly understood. Here, a field randomized block design under four nitrogen fertilization rates (0, 150, 300, and 450 kg N hm-2 y-1) was conducted on coastal salt-affected Fluvo-aquic soil. Effect of nitrogen fertilization rates on soil properties and bacterial community was characterized using Illumina Miseq sequencing for 16S rRNA gene. Results indicated that consecutive chemical N fertilization accelerated the improvement of soil chemical and microbial properties under the paddy rice - winter wheat rotation. Soil bacterial community well responded to the nitrogen fertilization and community richness and diversity increased with the nitrogen rates. Predominant bacterial phyla belonged to Proteobacteria, Chloroflexi, Acidobacteria, Actinobacteria and Planctomycetes, whereas Deltaproteobacteria, Anaerolineae, Alphaproteobacteria, Betaproteobacteria, Gammaproteobacteria, Actinobacteria and Planctomycetia were dominant bacterial classes. Increasing nitrogen fertilization resulted in an elevation in the relative abundance of classes Alphaproteobacteria, Gammaproteobacteria, Planctomycetia and Nitrospira, and a decline in Anaerolineae, Acidobacteria_Gp6, Cytophagia, Bacilli and Acidobacteria_Gp10. Clear separations in the bacterial communities at class level were observed under different nitrogen fertilization rates. Community structure of classes Alphaproteobacteria, Planctomycetia and Nitrospira was significantly influenced by potential nitrification rate (PNR), and community structure of class Actinobacteria was significantly influenced by carbon mineralization rate (CMR). The results demonstrated that nitrogen fertilization improved nutrients and metabolic activities to more suitable bacterial microhabitats for saline soil.

Even though friction stir welding (FSW) has been shown to produce high performing butt-joints, stress concentration at the weld edges in overlap FSW significantly reduces the performance of these joints. By combining FSW and adhesive bonding into a friction stir (FS) weld-bonding, joint mechanical performance is greatly improved. Quasi-static and fatigue strength of the proposed FS weld-bonding joints was assessed and benchmarked against overlap FSW and adhesive bonding. The characterization of the structural adhesive is also presented, including differential scanning calorimetry (DSC) and thermogravimetric analysis (TGA), as well as mechanical characterization with curing temperature. A small process parameter study was made to select proper FSW parameters for AA6082-T6 overlap FSW and FS weld-bonded joints. The adhesive degradation temperature (357ºC) was found to be higher than reported temperatures in the adhesive during welding of FS weld-bonding joints. Higher curing temperatures were found to lead to increased strength while decreasing ductility of the adhesive. The addition of adhesive bonding to the overlap FSW to produce FS weld-bonding resulted in a significant increase in quasi-static and fatigue strength, achieving 79.9% of the fatigue strength of adhesive bonded joints at 106 cycles, while FSW had 41.6%.

Mini-commentary on BJOG-19-1615.R1: Pregnancy outcomes in women with primary biliary cholangitis and primary sclerosing cholangitis