bluuebunny/crossref_metadata_2025 huggingface dataset:
Combined changes in albuminuria and kidney function and subsequent risk for kidney failure in type 2 diabetes
Authors: Oshima Megumi , Toyama Tadashi , Hara Akinori , Shimizu Miho , Kitajima Shinji , Iwata Yasunori , Sakai Norihiko , Furuichi Kengo , Haneda Masakazu , Babazono Tetsuya , Yokoyama Hiroki , Iseki Kunitoshi , Araki Shin-ichi , Ninomiya Toshiharu , Hara Shigeko , Suzuki Yoshiki , Iwano Masayuki , Kusano Eiji , Moriya Tatsumi , Satoh Hiroaki , Nakamura Hiroyuki , Makino Hirofumi , Wada Takashi
Published: June 2021

Introduction

Changes in albuminuria or estimated glomerular filtration rate (eGFR) can be used as a surrogate endpoint of end-stage kidney disease (ESKD) in people with type 2 diabetes. We investigated whether the combined changes in albuminuria and eGFR are more strongly associated with future risk of ESKD.

Research design and methods

Using data from a multicenter observational cohort study of people with type 2 diabetes, we evaluated the association of percentage change in urine albumin to creatinine ratio (UACR) and/or annual change in eGFR over 2 years with subsequent ESKD risk.

Results

Among 1417 patients with repeated albuminuria and eGFR over 2 years, 129 (9.1%) developed ESKD. Patients with >30% UACR decline had lower ESKD risk (HR 0.47; 95% CI 0.29 to 0.77), whereas those with >30% UACR increase had higher ESKD risk (HR 2.31; 95% CI 1.52 to 3.51), compared with those with minor UACR change. Patients with greater eGFR decline had an increased ESKD risk than those with minor eGFR change (a decline of <2.5 mL/min/1.73 m2/year): HR 4.19 (95% CI 1.87 to 9.38) and 2.89 (95% CI 1.32 to 6.33) for those with a decline of >5 and 2.5–5 mL/min/1.73 m2/year, respectively. When the combined changes in UACR and eGFR were used, the highest ESKD risk (HR 5.60; 95% CI 2.08 to 15.09) was observed among patients with >30% UACR increase and an eGFR decline of >5 mL/min/1.73 m2/year compared with those with a minor change in UACR and eGFR.

Conclusions

Combined changes in albuminuria and eGFR over 2 years were strongly associated with future risk of kidney failure in patients with type 2 diabetes.
Empowering the patient? Medication communication during hospital discharge: a qualitative study at an internal medicines ward in Norway
Authors: Rognan Stine Eidhammer , Kälvemark-Sporrong Sofia , Bengtsson Kajsa Rebecka , Lie Helene Berg , Andersson Yvonne , Mowé Morten , Mathiesen Liv
Published: June 2021

Objective

Effective communication and patient empowerment before hospital discharge are important steps to ensure medication safety. Patients discharged from hospitals are often expected to assume self-management, frequently without healthcare personnel (HCP) having ensured patients’ knowledge, motivation and/or skills. In this substudy of a larger study, we explore how patients experience medication communication during encounters with HCPs and how they are empowered at hospital discharge.

Design

This is a qualitative case study. Data collection was done through qualitative observations of patient–HCP encounters, semistructured interviews with patients and drug reconciliation. Data were analysed using content analysis.

Setting

An internal medicines ward at a university hospital in Norway.

Participants

Nine patients aged 49–90 years were included close to the day of discharge.

Results

The analysis revealed the following themes: (1) patient-centred care (PCC), which included ‘understanding and involvement in the patient-as-person’, ‘establishment of a therapeutic alliance’, and ‘sharing power and responsibility’; and (2) biomedical (conventional) care, including the subthemes ‘HCPs in power and control’ and ‘optimising medical outcomes, following guidelines’. Even though the elements of PCC were observed in several encounters, overall communication was not sufficiently fostering patient empowerment. Spending time with patients and building relations based on mutual trust seemed undervalued.

Conclusions

The results provide a broader understanding of how patients experience medication communication at hospital discharge. Both the patients and the HCPs appear to be inculcated with biomedical traditions and are uncertain about the roles and opportunities associated with PCC. Attention should be paid to patient preferences and to the core elements of the PCC model from admission to discharge to empower patients in medication self-management.
Association between early child development trajectories and adult cognitive function in a 50-year longitudinal study in Guatemala
Authors: Gonzalez Casanova Ines , DiGirolamo Ann , Kroker-Lobos Maria F , Ochaeta Laura , Ramirez-Zea Manuel , Martorell Reynaldo , Stein Aryeh D
Published: June 2021

Objectives

Few studies have used longitudinal data to study the development of cognition over the life course in low-income and middle-income countries. The objectives of this study were to assess predictors of cognitive development trajectories from 6 months through 7 years, and if these trajectories predicted adult cognitive function in a birth cohort from Guatemala.

Design

We analysed data from the INCAP Nutrition Supplementation Trial Longitudinal Study in Guatemala. Cognition was assessed at eight different time points between 6 months and 7 years. We derived childhood development trajectories using latent class growth analysis. We assessed predictors of the trajectories using ordinal logistic regression, and associations between childhood trajectories and adult non-verbal intelligence and literacy at age 18–52 years (mean±SD =42.7±6.4 years) using mixed models.

Setting

The study was conducted in four Guatemalan villages.

Participants

The study included 927 participants from Guatemala with repeated measurements of cognitive function during the first 7 years of life.

Results

We identified three trajectories of cognitive development (high: n=214, average: n=583, low: n=130). Participants whose mothers were taller (proportional log odds (PO)=0.03, 95% CI=0.01 to 0.06), had more years of schooling (PO=0.15, 95% CI=0.06 to 0.25), or lived in households with higher socioeconomic scores (PO=0.19, 95% CI=0.09 to 0.29) were more likely to follow higher trajectories. Childhood trajectories predicted adult non-verbal intelligence (high=18.4±0.3, average=14.6±0.53, low=11.4±0.9) and literacy (high=63.8±2.0, average=48.6±1.2, low=33.9± 2.6) scores.

Conclusions

In this sample from Guatemala, cognitive development trajectories from 6 months through 7 years were associated with adult non-verbal intelligence and literacy. These findings provide evidence of tracking of cognition over time in a transitioning low-income setting.
Value of stakeholder engagement in improving newborn care in Kenya: a qualitative description of perspectives and lessons learned
Authors: Nzinga Jacinta , Jones Caroline , Gathara David , English Mike
Published: June 2021

Objective

Embedding researchers within health systems results in more socially relevant research and more effective uptake of evidence into policy and practice. However, the practice of embedded health service research remains poorly understood. We explored and assessed the development of embedded participatory approaches to health service research by a health research team in Kenya highlighting the different ways multiple stakeholders were engaged in a neonatal research study.

Methods

We conducted semistructured qualitative interviews with key stakeholders. Data were analysed thematically using both inductive and deductive approaches.

Setting

Over recent years, the Health Services Unit within the Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme in Nairobi Kenya, has been working closely with organisations and technical stakeholders including, but not limited to, medical and nursing schools, frontline health workers, senior paediatricians, policymakers and county officials, in developing and conducting embedded health research. This involves researchers embedding themselves in the contexts in which they carry out their research (mainly in county hospitals, local universities and other training institutions), creating and sustaining social networks. Researchers collaboratively worked with stakeholders to identify clinical, operational and behavioural issues related to routine service delivery, formulating and exploring research questions to bring change in practice

Participants

We purposively selected 14 relevant stakeholders spanning policy, training institutions, healthcare workers, regulatory councils and professional associations.

Results

The value of embeddedness is highlighted through the description of a recently completed project, Health Services that Deliver for Newborns (HSD-N). We describe how the HSD-N research process contributed to and further strengthened a collaborative research platform and illustrating this project’s role in identifying and generating ideas about how to tackle health service delivery problems

Conclusions

We conclude with a discussion about the experiences, challenges and lessons learned regarding engaging stakeholders in the coproduction of research.
Air quality, Environment and Respiratory Outcomes in Bronchopulmonary Dysplasia, the AERO-BPD cohort study: design and adaptation during the SARS-CoV-2 pandemic
Authors: Ruran Hana B , Adamkiewicz Gary , Cunningham Amparito , Petty Carter R , Greco Kimberly F , Gunnlaugsson Sigfus , Stamatiadis Natalie , Sierra Gabriella , Vallarino Jose , Alvarez Marty , Hayden Lystra P , Sheils Catherine A , Weller Edie , Phipatanakul Wanda , Gaffin Jonathan M
Published: June 2021

Introduction

Almost half of all school-age children with bronchopulmonary dysplasia (BPD) have asthma-like symptoms and more suffer from lung function deficits. While air pollution and indoor respiratory irritants are known to affect high-risk populations of children, few studies have objectively evaluated environmental contributions to long-term respiratory morbidity in this population. This study aimed to examine the role of indoor environmental exposures on respiratory morbidity in children with BPD.

Methods and analysis

The Air quality, Environment and Respiratory Ouctomes in BPD (AERO-BPD) study is a prospective, single-centre observational study that will enrol a unique cohort of 240 children with BPD and carefully characterise participants and their indoor home environmental exposures. Measures of indoor air quality constituents will assess the relationship of nitrogen dioxide (NO2), particulate matter (PM2.5), nitric oxide (NO), temperature and humidity, as well as dust concentrations of allergens, with concurrently measured respiratory symptoms and lung function.

Adaptations to the research protocol due to the SARS-CoV-2 pandemic included remote home environment and participant assessments.

Ethics and dissemination

Study protocol was approved by the Boston Children’s Hospital Committee on Clinical Investigation. Dissemination will be in the form of peer-reviewed publications and participant information products.

Trial registration number

NCT04107701.
Randomised trial of a serious illness decision aid (Plan Well Guide) for patients and their substitute decision-makers to improve engagement in advance care planning
Authors: Howard Michelle , Elston Dawn , Borhan Sayem , Hafid Abe , Arora Neha , Forbes Ruth , Bernard Carrie , Heyland Daren K
Published: June 2021

Objective

To evaluate the feasibility and efficacy of a serious illness decision aid (Plan Well Guide) in increasing the engagement of substitute decision-makers (SDM) in advance care planning (ACP).

Methods

This trial was conducted (2017–2019) in outpatient settings in Ontario, Canada, aiming to recruit 90 dyads of patients aged 65 years and older at high risk of needing future medical decisions and their SDM. Participants were randomised to receive the intervention immediately or to a 3-month wait period. The Plan Well Guide was administered to the patient and SDM by a facilitator. Outcomes were change on the validated 17-item SDM ACP Engagement Survey (primary) and 15-item patient ACP Engagement Survey (secondary).

Results

Of 136 dyads approached, 58 consented and were randomised and 45 completed the study (28 immediate intervention, 17 delayed intervention). The trial was stopped early because of difficulties with enrolling and following up participants. The mean changes on the SDM ACP Engagement Survey and the patient ACP Engagement Survey favoured the first group but were not statistically significant (mean difference (MD)=+0.2 (95% CI: −0.3 to 0.6) and MD=+0.4 (95% CI: −0.1 to 0.8), respectively). In a post-hoc subgroup analysis, significant treatment effects were seen in SDMs with a lower-than-median baseline score compared with those at or above the median.

Conclusions

In this statistically underpowered randomised trial, differences in SDM ACP engagement between groups were small. Further information is needed to overcome recruitment challenges and to identify people most likely to benefit from the Plan Well Guide.

Trial registration numberNCT03239639
Auxiliary diagnostic value of D2-40 in early lung adenocarcinoma and precursor lesions
Authors: Hongxia Wang , Qingqing Yi , Chunfang Zhang , Jun Chen , Jing Li , Guofeng Lu , Rong Yang
Published: June 2021

Aims

Objective to investigate whether D2-40 can be used as a marker of early lung adenocarcinoma and precursor lesions.

Methods

In order to explore the value of D2-40, a monoclonal antibody that recognises the podoplanin, as an auxiliary diagnostic marker to aid the diagnosis of these conditions, we performed the immunohistochemical (IHC) staining using early lung adenocarcinoma, infiltrating adenocarcinoma, benign lung lesions and relevant peritumour normal tissues. The microscopic examination was performed to analyse the D2-40 IHC staining.

Results

We found that there was no D2-40 staining in 47 cases of early stage lung adenocarcinoma and precursor lesions; only 1 of the 32 cases (3.13%) of infiltrating adenocarcinoma stained positive. There was 100% D2-40 staining in 30 cases of benign lung lesions and 79 cases of peritumour normal tissues. The positivity rate in carcinoma group was 1.27% and the normal tissue group was 100%, (p<0.01). Based on our findings, we concluded that D2-40 IHC staining in lung adenocarcinoma and precursor lesions compared with normal alveolar epithelia displayed the ‘none or all’ phenomenon.

Conclusions

The results from our study suggested that D2-40 can be sued as auxiliary diagnostic tool in early lung adenocarcinoma and its precursor lesions.
Effect of annual road safety publicity and enforcement campaign on road fatalities in Japan: a time series study from 1949 to 2019
Authors: Inada Haruhiko , Tomio Jun , Nakahara Shinji , Ichikawa Masao
Published: June 2021

Background

In 1948, Japan started a short-term publicity and enforcement campaign for traffic safety nationwide, and since 1952, the campaign has been conducted twice a year for 10 days. We aimed to quantify the short-term effect of the spring sessions of the campaign, which were conducted in different months in different years, on road fatalities in Japan using data from 1949 to 2019.

Methods

We obtained national police data on the monthly number of road deaths and conducted a time series regression analysis with three steps: smoothing the long-term patterns with the natural cubic spline function, calculating the ratio of the monthly number of deaths to the corresponding smoothed value, and regressing the ratio on the number of months from January 1949 and the binary variable for the conduct of spring sessions. We repeated the analysis for four subperiods (1949–1964, 1965–1989, 1990–2004 and 2005–2019).

Results

During the study period, there were 632577 road deaths. Our analysis revealed that the spring sessions changed the number of deaths per day by −2.5% (95% CI −4.1% to −0.9%) in the months when they were conducted. In the four subperiods, the estimated changes were −4.5% (95% CI −8.9% to −0.1%), −2.6% (95% CI −5.0% to −0.1%), −0.1% (95% CI −2.9 to 2.7) and −3.5% (95% CI −7.9 to 0.9).

Conclusions

Road fatalities were reduced in the months when the spring sessions of the campaign were conducted, but the reduction was modest. The effect might have been somewhat larger until 1964, when Japan was a middle-income country.
TGM4: an immunogenic prostate-restricted antigen
Authors: Lopez-Bujanda Zoila A , Obradovic Aleksandar , Nirschl Thomas R , Crowley Laura , Macedo Rodney , Papachristodoulou Alexandros , O’Donnell Timothy , Laserson Uri , Zarif Jelani C , Reshef Ran , Yuan Tiezheng , Soni Mithil K , Antonarakis Emmanuel S , Haffner Michael C , Larman H Benjamin , Shen Michael M , Muranski Pawel , Drake Charles G
Published: June 2021

Background

Prostate cancer is the second leading cause of cancer-related death in men in the USA; death occurs when patients progress to metastatic castration-resistant prostate cancer (CRPC). Although immunotherapy with the Food and Drug Administration‐approved vaccine sipuleucel‐T, which targets prostatic acid phosphatase (PAP), extends survival for 2–4 months, the identification of new immunogenic tumor-associated antigens (TAAs) continues to be an unmet need.

Methods

We evaluated the differential expression profile of castration-resistant prostate epithelial cells that give rise to CRPC from mice following an androgen deprivation/repletion cycle. The expression levels of a set of androgen-responsive genes were further evaluated in prostate, brain, colon, liver, lung, skin, kidney, and salivary gland from murine and human databases. The expression of a novel prostate-restricted TAA was then validated by immunostaining of mouse tissues and analyzed in primary tumors across all human cancer types in The Cancer Genome Atlas. Finally, the immunogenicity of this TAA was evaluated in vitro and in vivo using autologous coculture assays with cells from healthy donors as well as by measuring antigen-specific antibodies in sera from patients with prostate cancer (PCa) from a neoadjuvant clinical trial.

Results

We identified a set of androgen-responsive genes that could serve as potential TAAs for PCa. In particular, we found transglutaminase 4 (Tgm4) to be highly expressed in prostate tumors that originate from luminal epithelial cells and only expressed at low levels in most extraprostatic tissues evaluated. Furthermore, elevated levels ofTGM4expression in primary PCa tumors correlated with unfavorable prognosis in patients. In vitro and in vivo assays confirmed the immunogenicity of TGM4. We found that activated proinflammatory effector memory CD8 and CD4 T cells were expanded by monocyte-derived dendritic cell (moDCs) pulsed with TGM4 to a greater extent than moDCs pulsed with either PAP or prostate-specific antigen (PSA), and T cells primed with TGM4-pulsed moDCs produce functional cytokines following a prime/boost regiment or in vitro stimulation. An IgG antibody response to TGM4 was detected in 30% of vaccinated patients, while fewer than 8% of vaccinated patients developed antibody responses to PSA or prostate-specific membrane antigen (PSMA).

Conclusions

These results suggest that TGM4 is an immunogenic, prostate-restricted antigen with the potential for further development as an immunotherapy target.
Hypermobile Ehlers-Danlos syndrome (hEDS) phenotype in fragile X premutation carriers: case series
Authors: Tassanakijpanich Nattaporn , McKenzie Forrest J , McLennan Yingratana A , Makhoul Elisabeth , Tassone Flora , Jasoliya Mittal J , Romney Christopher , Petrasic Ignacio Cortina , Napalinga Kaye , Buchanan Caroline B , Hagerman Paul , Hagerman Randi , Casanova Emily L
Published: June 2021

Background

While an association between full mutation CGG-repeat expansions of the Fragile X Mental Retardation 1 (FMR1) gene and connective tissue problems are clearly described, problems in fragile X premutation carriers (fXPCs) CGG-repeat range (55–200 repeats) of the FMR1 gene may be overlooked.

Objective

To report five FMR1 fXPCs cases with the hypermobile Ehlers-Danlos syndrome (hEDS) phenotype.

Methods

We collected medical histories and FMR1 molecular measures from five cases who presented with joint hypermobility and loose connective tissue and met inclusion criteria for hEDS.

Results

Five cases were female and ranged between 16 and 49 years. The range of CGG-repeat allele sizes ranged from 66 to 150 repeats. All had symptoms of hEDS since early childhood. Commonalities in molecular pathogenesis and coexisting conditions between the fXPCs and hEDS are also presented. The premutation can lead to a reduction of fragile X mental retardation protein, which is crucial in maintaining functions of the extracellular matrix-related proteins, particularly matrix metallopeptidase 9 and elastin. Moreover, elevated FMR1 messenger RNA causes sequestration of proteins, which results in RNA toxicity.

Conclusion

Both hEDS phenotype and premutation involvement may co-occur because of related commonalities in pathogenesis.
Prevalence of SARS-CoV-2 antibodies among workers of the public higher education institutions of Porto, Portugal: a cross-sectional study
Authors: Meireles Paula , Amaro Joana , Pinto da Costa Joana , Lopes Mariana Mendes , Varandas Tatiana , Norton Pedro , Guimarães João Tiago , Severo Milton , Barros Henrique
Published: June 2021

Objectives

To assess the prevalence of SARS-CoV-2-specific IgM and IgG antibodies among workers of the three public higher education institutions of Porto, Portugal, up to July 2020.

Methods

A rapid point-of-care test for specific IgM and IgG antibodies of SARS-CoV-2 was offered to all workers (SD Biosensor STANDARD Q COVID-19 IgM/IgG Duo and STANDARD Q COVID-19 IgM/IgG Combo). Testing was performed and a questionnaire was completed by 4592 workers on a voluntary basis from 21 May to 31 July 2020. We computed the apparent IgM, IgG, and combined IgM or IgG prevalence, along with the true prevalence and 95% credible intervals (95% CrI) using Bayesian inference.

Results

We found an apparent prevalence of 3.1% for IgM, 1.0% for IgG and 3.9% for either. The estimated true prevalence was 2.0% (95% CrI 0.1% to 4.3%) for IgM, 0.6% (95% CrI 0.0% to 1.3%) for IgG, and 2.5% (95% CrI 0.1% to 5.3%) for IgM or IgG. A SARS-CoV-2 molecular diagnosis was reported by 21 (0.5%) workers; and of these, 90.5% had a reactive IgG result. Seroprevalence was higher among those reporting contacts with confirmed cases, having been quarantined, having a previous molecular negative test or having had symptoms.

Conclusions

The seroprevalence among workers from the three public higher education institutions of Porto after the first wave of the SARS-CoV-2 infection was similar to national estimates for the same age working population. However, the estimated true seroprevalence was approximately five times higher than the reported SARS-CoV-2 infection based on a molecular test.
Maternal occupation as a nail technician or hairdresser during pregnancy and birth defects, National Birth Defects Prevention Study, 1997–2011
Authors: Siegel Miriam R , Rocheleau Carissa M , Broadwater Kendra , Santiago-Colón Albeliz , Johnson Candice Y , Herdt Michele L , Chen I-Chen , Lawson Christina C
Published: June 2021

Objective

Nail technicians and hairdressers may be exposed to chemicals with potential reproductive effects. While studies have examined birth defects in children of hairdressers, those in children of nail technicians have not been evaluated. We investigated associations between selected birth defects and maternal occupation as a nail technician or hairdresser versus a non-cosmetology occupation during pregnancy.

Methods

We analysed population-based case–control data from the multisite National Birth Defects Prevention Study, 1997–2011. Cases were fetuses or infants with major structural birth defects; controls were live-born infants without major birth defects. Expert raters classified self-reported maternal jobs as nail technician, combination nail technician-hairdresser, hairdresser, other cosmetology work or non-cosmetology work. We used logistic regression to calculate adjusted ORs and 95% CIs for associations between occupation during pregnancy and birth defects, controlling for age, smoking, education and race/ethnicity.

Results

Sixty-one mothers worked as nail technicians, 196 as hairdressers, 39 as combination nail technician-hairdressers and 42 810 as non-cosmetologists. The strongest associations among nail technicians included seven congenital heart defect (CHD) groups (ORs ranging from 2.7 to 3.5) and neural tube defects (OR=2.6, CI=0.8 to 8.4). Birth defects most strongly associated with hairdressing included anotia/microtia (OR=2.1, CI=0.6 to 6.9) and cleft lip with cleft palate (OR=2.0, CI=1.1 to 3.7). All oral cleft groups were associated with combination nail technician-hairdresser work (ORs ranging from 4.2 to 5.3).

Conclusions

Small samples resulted in wide CIs. Still, results suggest associations between maternal nail technician work during pregnancy and CHDs and between hairdressing work and oral clefts.
Pain and its management: Dante’s Divine Comedy
Authors: Bianucci Raffaella , Lanini Iacopo , Donell Simon , Lippi Donatella
Published: June 2021

Dante Alighieri died in 1321; therefore, 2021 is the 700th anniversary of his death. His best known work is the Divine Comedy, which explores Dante’s journey through the three realms of the underworld. Each realm is associated with three different sensations: Inferno, bodily (pain); Purgatorio, acoustic (music); and Paradiso, visual (light). The progression of the painful experiences and the resolution through music and light mirror the modern understanding of pain and its management. Music has both direct and indirect benefits and can help with coping. Sunlight promotes well-being and self-awareness.
Development and implementation of a postgraduate medical education-wide initiative in quality improvement and patient safety
Authors: Bowes David , Shearer Cindy , Daigle-Maloney Trisha , Dornan John , Lynk Andrew , Parker Jennie , Romao Rodrigo L P , Stevens Sarah , Allen Stefan , Warren Andrew , Ackroyd-Stolarz Stacy
Published: June 2021

Background

Quality improvement and patient safety (QIPS) have been assigned a higher profile in CanMEDS 2015, CanMEDS–Family Medicine 2017 and new accreditation standards, prompting an initiative at Dalhousie University to create a vision for integrating QIPS into postgraduate medical education.

Objective

The purpose of this study is to describe the implementation of a QIPS strategy across residency education at Dalhousie University.

Methods

A QIPS task force was formed, and a literature review and needs assessment survey were completed. A needs assessment survey was distributed to all Dalhousie residency programme directors. 12 programme directors were interviewed individually to collect additional feedback. The results were used to develop a ‘road map’ of recommendations with a graduated timeline.

Results

A task force report was released in February 2018. 46 recommendations were developed with a timeframe and responsible party identified for each. Implementation of the QIPS strategy is underway, and evaluation and challenges faced will be described.

Conclusions

We have developed a multiyear strategy that is available to provide guidance and support to all programmes in QIPS. The development and implementation of this QIPS framework may serve as a template for other institutions who seek to integrate these competencies into residency training.
Changing face of medical education during a pandemic: tragedy or opportunity?
Authors: Leong Jean Mei Ching , Lam Wee Leon , Tan Shi Zhuan , Ng Chye Yew
Published: June 2021

The COVID-19 pandemic has changed forever the way we do certain things. Although the race for a cure and vaccine has taken centre stage, traditional face-to-face medical education has slowly metamorphosised in the background to a virtual world with innumerable webinars, virtual tutorials and lectures in the World Wide Web. Despite this seemingly ‘perfect’ solution, there remains a hidden cost. Educators are forced to learn new skills to engage students as well as manipulate the electronic platform. Impact on learning for students, both undergraduate and postgraduate from a lack of social interactions, remains unknown. In this article, the authors share their experiences from different specialities about the pros and cons of virtual learning and teaching. Suggestions and practical tips are offered to enhance the learning experience. More emphasis may need to be placed on the creation of learning communities rather than lecture-based curricula. Hybrid curricula or conferences may become the future norm. As we slowly move out of lockdown into a changed world and new ways of doing things, lessons learnt can be harnessed for future hybrid models that can combine the best of technology and physical teaching to reduce worldwide inequalities.
Statin and mortality in COVID-19: a systematic review and meta-analysis of pooled adjusted effect estimates from propensity-matched cohorts
Authors: Zein Ahmad Fariz Malvi Zamzam , Sulistiyana Catur Setiya , Khasanah Uswatun , Wibowo Arief , Lim Michael Anthonius , Pranata Raymond
Published: June 2021

Purpose

Statin potentially improved outcome in patients with COVID-19. Patients who receive statin generally have a higher proportion of comorbidities than those who did not, which may introduce bias. In this meta-analysis, we aimed to investigate the association between statin use and mortality in patients with COVID-19 by pooling the adjusted effect estimates from propensity-score matching (PSM) matched studies or randomised controlled trials to reduce bias.

Methods

A systematic literature search using the PubMed, Scopus and Embase databases were performed up until 1 March 2021. Studies that were designed the study to assess statin and mortality using PSM with the addition of Inverse Probability Treatment Weighting or multivariable regression analysis on top of PSM-matched cohorts were included. The effect estimate was reported in term of relative risk (RR).

Results

14 446 patients were included in the eight PSM-matched studies. Statin was associated with decreased mortality in patients with COVID-19 (RR 0.72 (0.55, 0.95), p=0.018; I2: 84.3%, p<0.001). Subgroup analysis in patients receiving statin in-hospital showed that it was associated with lower mortality (RR 0.71 (0.54, 0.94), p=0.030; I2: 64.1%, p<0.025). The association of statin and mortality was not significantly affected by age (coefficient: −0.04, p=0.382), male gender (RR 0.96 (0.95, 1.02), p=0.456), diabetes (RR 1.02 (0.99, 1.04), p=0.271) and hypertension (RR 1.01 (0.97, 1.04), p=0.732) in this pooled analysis.

Conclusion

In this meta-analysis of PSM-matched cohorts with adjusted analysis, statin was shown to decrease the risk of mortality in patients with COVID-19.

PROSPERO registration number

CRD42021240137.
Predictors of first pass success without hypoxemia in trauma patients requiring emergent rapid sequence intubation
Authors: West Jason Randall , O'Keefe Brandon P , Russell James T
Published: June 2021

Objective

The predictors of first pass success (FPS) without hypoxemia among trauma patients requiring rapid sequence intubation (RSI) in the emergent setting are unknown.

Methods

Retrospective study of adult trauma patients requiring RSI during a 5-year period comparing the trauma patients achieving FPS without hypoxemia to those who did not. The primary outcome was FPS without hypoxemia evaluated by multivariate logistic regression adjusting for the neuromuscular blocking agent used (succinylcholine or rocuronium), hypoxemia prior to RSI, Glasgow Coma Scale (GCS) scores, the presence of head or facial trauma, and intubating operator level of training.

Results

246 patients met our inclusion criteria. The overall FPS rate was 89%, and there was no statistical difference between those receiving either paralytic agent. 167 (69%) patients achieved FPS without hypoxemia. The two groups (those achieving FPS without hypoxemia and those who did not) had similar mean GCS, mean Injury Severity Scores, presence of head or facial trauma, the presence of penetrating trauma, intubating operator-level training, use of direct laryngoscopy, hypoxemia prior to RSI, heart rate per minute, mean systolic blood pressure, and respiratory rate. In the multivariate regression analysis, the use of succinylcholine and GCS score of 13–15 were found to have adjusted ORs of 2.1 (95% CI 1.2 to 3.8) and 2.0 (95% CI 1.0 to 3.3) for FPS without hypoxemia, respectively.

Conclusion

Trauma patients requiring emergency department RSI with high GCS score and those who received succinylcholine had higher odds of achieving FPS without hypoxemia, a patient safety goal requiring more study.

Level of evidence

IV.

Study type

Prognostic.
Hybrid treatment system to remove micromolecular SMPs from fruit wastewater treated with an MBR
Authors: Jamal-Uddin A.T. , Zytner P.R. , Zytner R.G.
Published: June 2021

Fruit processors want to reduce their environmental footprint by implementing the recycling of treated wastewater. Observations of a membrane bioreactor (MBR) and reverse osmosis (RO) system showed that the RO quickly fouled due to elevated levels of soluble microbial products (SMPs), an inert micromolecular composition in the form of dissolved organic matter (DOM) in the MBR effluent. Bench-scale experiments were performed using enhanced coagulation and granular activated (GAC) carbon sorption. Results showed that enhanced coagulation removed only 20% of the DOM, which was insufficient to protect the RO membrane. However, sorption studies with GAC showed that 98% of the dissolved SMP-DOM could be removed, the fraction of DOM from microbial activities. Results also showed that when enhanced coagulation preceded the sorption stage, GAC column run time could be extended by approximately 15%. The resulting best management practice (BMP) minimizes RO membrane fouling in the agri-food sector and opens further water recycling opportunities.
Ideal free eagles: Bald Eagle (Haliaeetus leucocephalus) distribution in relation to Pacific salmon (Oncorhynchus spp.) availability on four spawning rivers
Authors: Walters K.E. , Reynolds J.D. , Ydenberg R.C.
Published: June 2021

The movement of individuals according to the availability of resources has a fundamental effect on animal distributions. In the Pacific Northwest, Bald Eagles (Haliaeetus leucocephalus (Linnaeus, 1766)) rely heavily on scavenging opportunities during the non-breeding period, and their distribution and movements are thought to be strongly influenced by the availability of post-spawning Pacific salmon (genus Oncorhynchus Suckley, 1861) carcasses. We surveyed the abundance of eagles and salmon on four adjacent rivers on Vancouver Island, British Columbia, Canada, during the 2017 fall spawning season. Salmon began to arrive in late September, peaked in abundance in mid-November, and were absent after early December. The seasonal progression of Bald Eagle abundance matched that of salmon carcass availability. The slope of proportional eagle–salmon relationship was significantly positive, though lower than the 1:1 match predicted by Ideal Free Distribution theory. The numerical response of Bald Eagles to salmon abundance was elevated on one of the rivers, potentially due to physical features such as sandbars and mudflats that increased the availability of carcasses and provided access points for eagles.
Ten bridges on the road to recovering Canada’s endangered species
Authors: Kraus Daniel , Murphy Stephen , Armitage Derek
Published: June 2021

Wildlife is declining around the world. Many developed nations have enacted legislation on endangered species protection and provide funding for wildlife recovery. Protecting endangered species is also supported by the public and judiciary. Yet, despite what appear as enabling conditions, wild species continue to decline. Our paper explores pathways to endangered species recovery by analyzing the barriers that have been identified in Canada, the United States, and Australia. We summarize these findings based on Canada’s Species at Risk Conservation Cycle (assessment, protection, recovery planning, implementation, and monitoring and evaluation) and then identify 10 “bridges” that could help overcome these barriers and bend our current trajectory of wildlife loss to recovery. These bridges include ecosystem approaches to recovery, building capacity for community co-governance, linking wildlife recovery to ecosystem services, and improving our storytelling about the loss and recovery of wildlife. The focus of our conclusions is the Canadian setting, but our findings can be applied in other national and subnational settings to reverse the decline of wildlife and halt extinction.
Introgressed DNA within a Zea mays near-isogenic line displays lower levels of 24nt sRNA expression than the homologous region from the recurrent parent
Authors: Minow Mark A.A. , Ávila Luis M. , Lukens Lewis , Rossi Vincenzo , Colasanti Joseph
Published: June 2021

Near-isogenic lines (NILs) are classical genetic tools used to dissect the actions of an allele when placed in a uniform genetic background. Although the goal of NIL creation is to examine the effects of a single allele in isolation, DNA linked to the allele is invariably retained and can confound any allele-specific effects. In addition to genetic variation, highly polymorphic species such as Zea mays will contain introgressed polymorphisms encompassing transposable elements (TEs) and the cis-acting small RNA (sRNA) that represses them. Through transcriptomics, we described the differences in sRNA and TE transcriptional expression between a W22-derived introgression and its homologous B73 region. As anticipated, many differences in sRNA expression were observed. Unexpectedly, however, 24nt sRNA expression over the introgressed region was low overall compared to both the homologous B73 region and the rest of the genome. Across the introgression, low sRNA expression was accompanied by increased TE transcription. Possible explanations for the observed trends in sRNA and TE expression across the introgression region are discussed. These findings support the notion that any introgressed allele is in an epigenetic environment distinct from that found at the allele from the recurrent parent. Additionally, these results suggest that further study of sRNA expression levels during the introgression process is warranted.
Low lying particle-hole states in $$^\mathbf{206 }$$Pb and $$^\mathbf{208 }$$Pb and the shell model
Authors: Heusler A.
Published: June 2021

The nucleus $$^{206}\mathrm{Pb}$$

206

Pb

differs from the doubly magic nucleus $$^{208}\mathrm{Pb}$$

208

Pb

by two missing neutrons. In $$^{208}\mathrm{Pb}$$

208

Pb

most states at $$E_x< 7.4$$

E
x

<
7.4

 MeV are described by one-particle one-hole configurations. The lowest configurations with a g$$_{{ 9}/{2}}$$

9
/
2

particle and dominant p$$_{{ 1}/{2}}$$

1
/
2

, f$$_{{ 5}/{2}}$$

5
/
2

, p$$_{{ 3}/{2}}$$

3
/
2

holes and admixtures from f$$_{{ 7}/{2}}$$

7
/
2

and a few more configurations build an ensemble of two dozen states at 3.2$$<E_x< 4.9$$

<

E
x

<
4.9

MeV. They are described by rather complete orthonormal transformation matrices of two dozen states with spins from 2$$^-$$

-

to 8$$^-$$

-

to configurations. In $$^{206}\mathrm{Pb}$$

206

Pb

a similar ensemble of states is deduced from the analysis of angular distributions measured in 1969 for the $$^{206}\mathrm{Pb}$$

206

Pb

$$({{{\textit{p}}}, {{\textit{p}}}' })$$

(

p
,

p

′

)

reaction via the g$$_{{ 9}/{2}}$$

9
/
2

IAR in $$^{207}\mathrm{Bi}$$

207

Bi

. An equivalent $$^{208}\mathrm{Pb}$$

208

Pb

$$({{{\textit{p}}}, {{\textit{p}}}' })$$

(

p
,

p

′

)

experiment was performed in 1968 at the Max–Planck–Institut für Kernphysik at Heidelberg (Germany). New spins are determined for 32 states and 22 levels in $$^{206}\mathrm{Pb}$$

206

Pb

. The comparison to corresponding states in $$^{208}\mathrm{Pb}$$

208

Pb

studied especially in 1982 yields both remarkable similarities and clear differences. Sizeable g$$_{{ 9}/{2}}$$

9
/
2

p$$_{{ 1}/{2}}$$

1
/
2

strength found in 4$$^-$$

-

and 5$$^-$$

-

states is interpreted as admixtures of $${{\textit{p}}}{_{{ 3}/{2}}}^{-2}$$

p

3
/
2

-
2

and $${{\textit{f}}}{_{{ 5}/{2}}}^{-2}$$

f

5
/
2

-
2

components to the ground state of $$^{206}\mathrm{Pb}$$

206

Pb

with dominant $${{\textit{p}}}{_{{ 1}/{2}}}^{-2}$$

p

1
/
2

-
2

character. The description of nuclear states by shell model particle-hole configurations in the lead region needs the inclusion of collective excitations at already very low excitation energies. For the two isotopes $$^{206}\mathrm{Pb}$$

206

Pb

and $$^{208}\mathrm{Pb}$$

208

Pb

a rather good agreement of excitation energies and configuration mixing is observed for states at 3.7$$<E_x< 4.7$$

<

E
x

<
4.7

MeV.
The half-life of $$^{212}$$Po
Authors: Belli P. , Bernabei R. , Boiko R. S. , Cappella F. , Caracciolo V. , Cerulli R. , Danevich F. A. , Incicchitti A. , Kasperovych D. V. , Kobychev V. V. , Polischuk O. G. , Sokur N. V. , Tretyak V. I.
Published: June 2021

The half-life of $$^{212}$$

212

Po was measured with the highest up-to-date accuracy as $$T_{1/2}=295.1(4)$$

T

1
/
2

=
295.1

(
4
)

ns by using thorium-loaded liquid scintillator.
Intermediate class of warm pseudoscalar inflation
Authors: Ebrahimi Saeid , Kamali Vahid , Alaei Asma
Published: June 2021

High dissipative regime of warm pseudoscalar inflation model (Kamali in Phys Rev D 100:043520, arXiv:1901.01897 [gr-qc], 2019) with an approximately constant value of dissipation parameter Q is studied. Intermediate solution of the scale-factor related to the accelerated expansion of the Universe which is rolled out by observational data in the context of standard (cold) model of inflation is used. There is a region of free parameters phase-space of the model which is interestingly compatible with recent observational data. It is discussed that the model is also compatible with the swampland criteria in a broad range of parameters phase-space and TCC in a limited area of parameters.
Criticality-based Varying Step-number Algorithm for Reinforcement Learning
Authors: Spielberg Yitzhak , Azaria Amos
Published: June 2021

In the context of reinforcement learning we introduce the concept of criticality of a state, which indicates the extent to which the choice of action in that particular state influences the expected return. That is, a state in which the choice of action is more likely to influence the final outcome is considered as more critical than a state in which it is less likely to influence the final outcome.

We formulate a criticality-based varying step number algorithm (CVS) — a flexible step number algorithm that utilizes the criticality function provided by a human, or learned directly from the environment. We test it in three different domains including the Atari Pong environment, Road-Tree environment, and Shooter environment. We demonstrate that CVS is able to outperform popular learning algorithms such as Deep Q-Learning and Monte Carlo.
A spin-independent three-body force potential: Applications to hadron-deuteron elastic scattering at high energy
Authors: Hassan M. A. , Salama T. N. E.
Published: June 2021

In this paper, a new version of spin-independent three-body force potential is suggested. Using the suggested potential, the hadron-deuteron elastic scattering differential cross-section is calculated at high energies. A good agreement is obtained.
Quantum holonomy based in a Kaluza–Klein description for defects in C60 fullerenes
Authors: Cavalcante Everton , Furtado Claudio
Published: June 2021

In this paper, we discuss a new way to get a quantum holonomy around topological defects in [Formula: see text] fullerenes. For this, we use a Kaluza–Klein extra dimension approach. Furthermore, we discuss how an extra dimension could promote the formation of new freedom degrees which would open a discussion about a possible qubits computation.
Structural, Electronic, Magnetic Properties and Elastic Anisotropy of New Ferromagnetic Cu2CrZ (Z=Si and Ge) Full Heusler Alloys
Authors: Halis L. , Mazouz H. M. A. , Negadi K. , Menad A. , Hiadsi S. , Baghdad R. , Ferhat M.
Published: June 2021

In this paper, we have performed a first-principles study to investigate the electronic structure, magnetic, mechanic and anisotropic elastic properties of Cu2CrZ (Z=Si and Ge) Full Heusler alloys. The study of these characteristics shows thermodynamic and mechanical stability with cubic symmetry in our compounds and they also have an anisotropic character. The ground-state parameters, i.e., lattice constant, the bulk modulus and the electronic structure are calculated using the full-potential linearized augmented plane wave (FP-LAPW) approach to the density functional theory (DFT) within the generalized gradient approximation (GGA+WC) for the exchange and correlation potential. The objective is to seek stable metallic ferromagnet materials.
Attack Mitigation of Hardware Trojans for Thermal Sensing via Micro-ring Resonator in Optical NoCs
Authors: Zhou Jun , Li Mengquan , Guo Pengxing , Liu Weichen
Published: June 2021

As an emerging role in new-generation on-chip communication, optical networks-on-chip (ONoCs) provide ultra-high bandwidth, low latency, and low power dissipation for data transfers. However, the thermo-optic effects of the photonic devices have a great impact on the operating performance and reliability of ONoCs, where the thermal-aware control with accurate measurements, e.g., thermal sensing, is typically applied to alleviate it. Besides, the temperature-sensitive ONoCs are prone to be attacked by the hardware Trojans (HTs) covertly embedded in the counterfeit integrated circuits (ICs) from the malicious third-party vendors, leading to performance degradation, denial-of-service (DoS), or even permanent damages. In this article, we focus on the tampering and snooping attacks during the thermal sensing via micro-ring resonator (MR) in ONoCs. Based on the provided workflow and attack model, a new structure of the anti-HT module is proposed to verify and protect the obtained data from the thermal sensor for attacks in its optical sampling and electronic transmission processes. In addition, we present the detection scheme based on the spiking neural networks (SNNs) to implement an accurate classification of the network security statuses for further high-level control. Evaluation results indicate that, with less than 1% extra area of a tile, our approach can significantly enhance the hardware security of thermal sensing for ONoC with trivial costs of up to 8.73%, 5.32%, and 6.14% in average latency, execution time, and energy consumption, respectively.
Multi-Objective Heuristic Decision Making and Benchmarking for Mobile Applications in English Language Learning
Authors: Zhao Chunhe , Muthu Balaanand , Shakeel P. Mohamed
Published: June 2021

This research proposes to evaluate and analyze the decision matrix for learner's English mobile applications (EMAs) based on multi-objective heuristic decision making with a view to listening, speaking, reading, and writing. Because of the number of criteria, the significance of parameters, and variance in results, EMAs are difficult. Decision making has built on the combination of listening, speaking, reading, and writing and EMA evaluation criteria for students. The requirements are adapted from a framework of pre-school education. Six alternatives and 17 skills as a requirement are included in decision-making results. The six EMA are then assessed, with six English learning experts distributing a review form. The application subsequently is evaluated using the best-worst method and preference-order technique (TOPSIS) using multi-objective heuristic decision making methods. The best-worst method is used to measure requirements, whereas TOPSIS is used to test and assess the applications. In two cases, namely person and group, TOPSIS is used. Internal and external aggregations are used throughout the group context. In effect, the aim of evaluating the proposed study and comparing it to six relative studies with scenarios and benchmarking checklists is to develop an objectives validation framework for e-apps.