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In the17th and 18th centuries, just as English scholars were reading and writing about their heritage in the continental prestige language of Latin, so too were Japanese members of the Buddhist clergy researching and publishing about the Chinese language heritage of their own religious tradition, drawing both on new printed books, often imported from China, and on much earlier manuscripts and printed texts preserved in their own country. The importation and reprinting of the canon by Ōbaku monks and the subsequent flowering of Zen scholarship is already well-known, but we should consider the efforts of Shingon monks in commenting on the heritage they received from China eight centuries earlier, and even the activities of Nichiren monks, who took steps to promote the legacy of Chinese Tiantai Buddhism. Critical reflection on the Buddhist tradition may not have emerged in Japan until the 18th century, but it did so in the context of a world of scholarship concerning an imported classical language that certainly stood comparison with that of the contemporary Anglophone world.

Marine invaders, including the green crab ( Carcinus maenas ), cause widespread disruption in their invaded ranges. In a Marine Protected Area in Atlantic Canada, the concurrent collapse of a protected strain of Irish moss ( Chondrus crispus ) and establishment of green crabs prompted a removal program in 2016–2018. We evaluated the outcome of that program using surveys within and outside (control) the MPA that preceded (2015 and 2016) and ran parallel to the removal program. We used generalized linear models to assess effects on catch rates and demographics and then compared those results to the outcome of other removal programs using the framework of recruitment and growth overfishing. Green crab abundance increased between 2015 and 2017 despite removal efforts, but the increase of both males and females was suppressed compared to control sites, to 29% and 36% of expected numbers, respectively. Between 2017 and 2018, males became significantly smaller relative to control sites. Although green crab eradication is not achievable, benefits would accrue if recruitment overfishing could suppress populations to levels that could be maintained by modest harvesting. Comparing among studies showed that removal did not reduce populations or that supressed populations could rebound quickly. However, within-year population reductions and shifts to smaller sizes, which are consistent with growth overfishing, show that removal programs may achieve short-term/local benefits but seem unable to sustainably suppress populations. At larger scales, the green crab's status as one of the most resilient invaders is likely to remain.

Depensation (or an Allee effect) has recently been detected in stock–recruitment relationships (SRRs) in four Atlantic herring stocks and one Atlantic cod stock using a Bayesian statistical approach. In the present study, we define the Allee effect threshold (BAET) for these five stocks and propose BAET as a candidate limit reference point (LRP). We compare BAET to traditional LRPs based on proportions of equilibrium unfished biomass (B0) and biomass at maximum sustainable yield (BMSY) assuming a Beverton–Holt or Ricker SRR with and without depensation, and to the change point from a hockey stick SRR (BCP). The BAET for the case studies exceeded 0.2 B0 and 0.4 BMSY for three of the case study stocks and exceedances of 0.2 B0 were more common when the Ricker form of the SRR was assumed. The BAET estimates for all case studies were less than BCP. When there is depensation in the SRR, multiple equilibrium states can exist when fishing at a fixed fishing mortality rate (F) because the equilibrium recruits-per-spawner line at a given F can intersect the SRR more than once. The equilibrium biomass is determined by whether there is excess recruitment at the initial projected stock biomass. Estimates of equilibrium FMSY in the case studies were generally higher for SRRs that included the depensation parameter; however, the long-term F that would lead the stock to crash (Fcrash) in the depensation SRRs was often about half the Fcrash for SRRs without depensation. When warranted, this study recommends exploration of candidate LRPs from depensatory SRRs, especially if Allee effect thresholds exceed commonly used limits, and simulation testing of management strategies for robustness to depensatory effects.

This article provides an overview of the existing sociological literature relating to disabled masculinities, a field of enquiry that has undergone substantial development over the past two decades. I contend that previous studies have insightfully uncovered the social forces that have established a “dilemma of disabled masculinity” within contemporary Western societies, as well as the complex, contextualised and multiple ways in which disabled men negotiate this dilemma. To foster the further development of the field, I suggest three potentially productive lines for future enquiry. Specifically, I support greater attention to the issue of comparative diversity between impairment categories, a consideration of the generative role that disability may have in relation to masculinity, and more sustained enquiry into how changing constructions of masculinity inflect the lives of disabled men.

Objectives Compare the clinical and cost‐effectiveness of an established face to face (F2F) structured education program to a new remote (VIRTUAL) program teaching dynamic glucose management (DynamicGM) to children and young people with type 1 diabetes (CYPD) using continuous glucose monitoring (CGM). To ascertain the most effective DynamicGM strategies predicting time in range (TIR) (3.9–10.0 mmol/L) and incorporating these into a user‐friendly teaching aid. Design and methods Effectiveness of the F2F and VIRTUAL programs were ascertained by comparing the mean change (Δ) from baseline to 6 months in HbA1c, TIR and severe hypoglycemia. Delivery cost for the two programs were evaluated. Factors predicting TIR in the combined cohort were determined and incorporated into a user‐friendly infographic. Results First 50 graduates per group were evaluated. The mean difference in Δ HbA1c, Δ TIR and Δ episodes of severe hypoglycemia between VIRTUAL and F2F groups were 1.16 (p = 0.47), 0.76 (p = 0.78) and −0.06 (p = 0.61) respectively. Delivery cost per 50 CYPD for VIRTUAL and F2F were $5752 and $7020, respectively. The strongest predictors of TIR (n = 100) were short bursts of exercise (10–40 min) to lower hyperglycemia (p < 0.001), using trend arrow adjustment tools (p < 0.001) and adjusting pre‐meal bolus timing based on trend arrows (p < 0.01). These strategies were translated into a GAME (Stop highs), SET (Stay in target), MATCH (Prevent lows) mnemonic. Conclusion Teaching DynamicGM VIRTUALLY is just as effective as F2F delivery and cost saving. Short bursts of exercise and using CGM trend arrows to adjust insulin dose and timing improves TIR.

Alström Syndrome (ALMS) is an ultra-rare multisystem genetic disorder caused by autosomal recessive variants in the ALMS1 gene, which is located on chromosome 2p13. ALMS is a multisystem, progressive disease characterised by visual disturbance, hearing impairment, cardiomyopathy, childhood obesity, extreme insulin resistance, accelerated non-alcoholic fatty liver disease (NAFLD), renal dysfunction, respiratory disease, endocrine and urologic disorders. Clinical symptoms first appear in infancy with great variability in age of onset and severity. ALMS has an estimated incidence of 1 case per 1,000,000 live births and ethnically or geographically isolated populations have a higher-than-average frequency. The rarity and complexity of the syndrome and the lack of expertise can lead to delayed diagnosis, misdiagnosis and inadequate care. Multidisciplinary and multiprofessional teams of experts are essential for the management of patients with ALMS, as early diagnosis and intervention can slow the progression of multi-organ dysfunctions and improve patient quality of life. These guidelines are intended to define standard of care for patients suspected or diagnosed with ALMS of any age. All information contained in this document has originated from a systematic review of the literature and the experiences of the authors in their care of patients with ALMS. The Appraisal of Guidelines for Research & Evaluation (AGREE II) system was adopted for the development of the guidelines and for defining the related levels of evidence and strengths of recommendations. These guidelines are addressed to: a) specialist centres, other hospital-based medical teams and staffs involved with the care of ALMS patients, b) family physicians and other primary caregivers and c) patients and their families.

Objectives Create and evaluate the effectiveness of a structured education program in children and young people (CYP) with type 1 diabetes using continuous glucose monitoring (CGM). Design and methods Step 1: CGM devices were evaluated for predetermined criteria using a composite score. Step 2: The education program was developed following review of international structured education guidance, dynamic glucose management (DynamicGM) literature, award‐winning diabetes educators' websites, and CGM user feedback. Step 3: Program effectiveness was assessed at six months by change in time below range (TBR) (<3.9mmol/L), time in range (TIR) (3.9‐10.0mmol/L), time above range level 2 (TAR2) (>13.9mmol/L), severe hypoglycemia and HbA1c using a paired T‐test. A DynamicGM score was developed to assess proactive glucose management. Factors predicting TBR and TIR were assessed using regression analysis. Results Dexcom G6 was chosen for integrated CGM (iCGM) status and highest composite score (29/30). Progressive DynamicGM strategies were taught through five sessions delivered over two months. Fifty CYP (23 male) with a mean (±SD) age and diabetes duration of 10.2 (±4.8) and 5.2 (±3.7) years respectively, who completed the education program were prospectively evaluated. Evaluation at six months showed a significant reduction in TBR (10.4% to 2.1%, p<.001), TAR2 (14.1% to 7.3%, p<.001), HbA1c [7.4 to 7.1% (57.7 to 53.8 mmol/mol), p<.001] and severe hypoglycemic episodes (10 to 1, p<.05); TIR increased (47.4% to 57.0%, p<.001). Number of Dexcom followers (p<.05) predicted reduction in TBR and DynamicGM score (p<.001) predicted increased TIR. Conclusion Teaching DynamicGM strategies successfully improves TIR and reduces hypoglycemia.

OBJECTIVE:--To estimate the incidence of type 2 diabetes in children <17 years of age and to investigate the relationship of diabetes with increasing childhood obesity in the U.K. and the Republic of Ireland (ROI). RESEARCH DESIGN AND METHODS--Active monthly reporting of cases by consultant pediatricians occurred through the framework of the British Pediatric Surveillance Unit, with additional reports from specialist diabetes nurses. All children <17 years of age and diagnosed by their clinician as having non-type 1 diabetes from 1 October 2004 to 31 October 2005 were included. RESULTS:--A total of 168 confirmed cases of non-type 1 diabetes were reported, resulting in a national incidence (excluding the ROI) of 1.3 · 100,000⁻¹ · year⁻¹. Of these, 40% were diagnosed with type 2 diabetes giving a minimum incidence of 0.53 · 100,000⁻¹ · year⁻¹. Children of ethnic minorities were greatly overrepresented, with those of black and South-Asian origin (England data only) having an incidence of 3.9 and 1.25 · 100,000⁻¹ · year⁻¹, respectively, compared with 0.35 · 100,000⁻¹ · year⁻¹ in those defined as white. Of those diagnosed with type 2 diabetes, 95% were overweight and 83% obese according to International Obesity Task Force guidelines. Eighty-four percent had a family history of type 2 diabetes. CONCLUSIONS:--Type 2 diabetes is still less common than type 1 diabetes in U.K. children. However, compared with previous prevalence data, the frequency of type 2 diabetes appears to be increasing. Incidence among ethnic minorities is far higher than in whites, as previously described in the U.S. Increased adiposity and family history of type 2 diabetes were strongly associated with the diagnosis of type 2 diabetes in U.K. children.

Background. Serious infections with Salmonella species are often treated with fluoroquinolones or extended-spectrum β-lactams. Increasingly recognized in Enterobacteriaceae, plasmid-mediated quinolone resistance is encoded by qnr genes. Here, we report the presence of qnr variants in human isolates of non-Typhi serotypes of Salmonella enterica (hereafter referred to as non-Typhi Salmonella) from the United States National Antimicrobial Resistance Monitoring System for Enteric Bacteria. Methods. All non-Typhi Salmonella specimens from the United States National Antimicrobial Resistance Monitoring System for Enteric Bacteria collected from 1996 to 2003 with ciprofloxacin minimum inhibitory concentrations ⩾0.06 µg/mL (233 specimens) and a subset with minimum inhibitory concentrations ⩽0.03 µg/mL (102 specimens) were screened for all known qnr genes (A, B, and S) by polymerase chain reaction. For isolates with positive results, qnr and quinolone resistance—determining region sequences were determined. Plasmids containing qnr genes were characterized by conjugation or transformation. Results. Conjugative plasmids harboring qnrB variants were detected in 7 Salmonella enterica serotype Berta isolates and 1 Salmonella enterica serotype Mbandaka isolate. The S. Mbandaka plasmid also had an extended-spectrum β-lactamase. Variants of qnrS on nonconjugative plasmids were detected in isolates of Salmonella enterica serotype Anatum and Salmonella enterica serotype Bovismorbificans. Conclusions. Plasmid-mediated quinolone resistance appears to be widely distributed, though it is still uncommon in non-Typhi Salmonella isolates from the United States, including strains that are quinolone susceptible by the criteria of the Clinical and Laboratory Standards Institute (formerly the National Committee for Clinical Laboratory Standards). The presence of this gene in non-Typhi Salmonella that causes infection in humans suggests potential for spread through the food supply, which is a public health concern.