bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative analysis of complete plastid genome reveals powerful barcode regions for identifying wood of Dalbergia odorifera and D. tonkinensis (Leguminosae)
Authors: Qin Ming , Zhu Cheng‐Jie , Yang Jun‐Bo , Vatanparast Mohammad , Schley Rowan , Lai Qiang , Zhang Dan‐Yan , Tu Tie‐Yao , Klitgård Bente B. , Li Shi‐Jin , Zhang Dian‐Xiang
Published: May 2020

Dalbergia odorifera T. C. Chen (Leguminosae), a rare and endangered tree species endemic to Hainan Island of China, produces the most expensive and rarest wood in China. The wood characteristics of D. odorifera are remarkably similar to those of D. tonkinensis (a much less sought‐after species from Vietnam), and the DNA from wood is often highly degraded, making it very difficult to identify the two species using anatomical features or DNA barcoding based on regular DNA markers. To solve the confusion of identifying wood reliably from the two species, we built and analyzed the plastome library of 26 samples from 18 Dalbergia species, of which 12 samples from eight closely related species of D. odorifera are newly sequenced in this study. Phylogenomic analysis suggested that the relationships among the 26 samples are mostly well resolved, and conspecific individuals from different populations of D. odorifera and D. tonkinensis clustered together. Between the plastid genomes of the two species, we identified 129 indels and 114 single nucleotide polymorphisms. By assessing a subset of 20 nucleotide polymorphisms and 10 indels using 37 population‐level samples (20 samples of D. odorifera and 17 samples of D. tonkinensis), we recovered eight species‐specific barcode regions that could be suitable for identifying the wood D. odorifera and D. tonkinensis. To examine their utility in wood identification, we amplified the eight DNA barcodes using six wood samples and recovered an amplification success rate of 83.3%, demonstrating a reliable method for precise wood identification of the two species.
Effects of chronic sleep deprivation on upper respiratory tract mucosal histology and mucociliary clearance on rats
Authors: Sazak Kundi Fatma Cemre , Murat Ozcan Kursat , Okudan Berna , Coskun Nazim , Inan Mehmet Arda , Ozcan Muge
Published: May 2020

In this study, we aimed to investigate the effects of chronic sleep deprivation on mucociliary clearance, which is the primary defence mechanism of the upper airway tract and nasal mucosal histology. Forty‐two Wistar Albino rats (250‐300 g), 8 or 12 weeks old, were randomly assigned into three groups as follows. The first sleep‐deprivation group consisted of 14 rats (A), another 14 of them were assigned to platform group (B), and the remaining 14 were included to the home cage control group (C). For the two deprivation groups (A and B), the modified multiple platform method (MMPM) was used to induce sleep deprivation for 21 days. Tc‐99m MAA rhinoscintigraphy was performed to assess mucociliary clearance and the nasal histopathological changes of the sacrificed rats were also examined. Mucociliary clearance was significantly higher in sleep deprivation (A) and deprivation control (B) groups than the control group (C) (p = .037). The ratio of columnar ciliary was significantly higher in group A and B than in the control group (p = .003). The transitional epithelial ratio in groups A and B was also significantly increased compared with group C (p = .04). The control group's squamous epithelial ratio was increased compared to the sleep‐deprived groups (p = .003). There was a significantly increased inflammatory response in the ciliated columnar epithelium in groups A and B compared to group C (p = .02). For the first time in the literature, we demonstrated that chronic sleep deprivation has caused a significant increase in mucociliary clearance speed and in the number of ciliary cells.
Effects of dietary shrimp extract on growth performance, muscle fatty acid composition, and lipid metabolism‐related genes of juvenile red tilapia
Authors: Yu Zhen‐Zhen , Wang Lan‐Mei , Song Fei‐Biao , Zhu Wen‐Bin , Miao Ling‐Hong , Fu Jian‐Jun , Dong Zai‐Jie
Published: May 2020

Shrimp extract (ShE) is one kind of aquatic animal attractant with abundant amino acids. In order to investigate the effects of dietary ShE supplementation on the growth and muscle fatty acid of juvenile red tilapia (initial weight: 12.02 ± 0.02 g), a 62‐day experiment was conducted. The fish were fed six diets containing graded levels of ShE (0%, 0.5%, 1%, 2%, and 3%) without fish meal (FM) and an FM diet in triplicate groups. At the end of the experiment, the final body weight, weight gain, specific growth rate, and feed intake of the red tilapia fed the 3% ShE diet and FM diet were significantly higher than those fed the other diets (p < .05). The total saturated fatty acid of fish muscle in the ShE diet groups was lower than that in the FM diet group (p < .05). The contents of erucic acid (C22:1), eicosapentaenoic acid (C20:5 n‐3; EPA), docosapentanoic acid (C22:5 n‐3; DPA), and docosahexaenoic acid (C22:6 n‐3; DHA) in the ShE diet groups were also lower than those in the FM diet group (p < .05). The expression level of the lpl gene in red tilapia liver of experimental group was significantly higher than that of the control group (p < .05). The liver mdh gene mRNA expression levels were higher in the red tilapia fed 0.5%, 2%, and 3% ShE diets than those of other groups (p < .05). Moreover, the respiratory burst activity had a positive effect in the 0.5%, 1%, and 2% ShE diet groups (p < .05). Our results suggest that dietary ShE has a significant effect on the growth and lipid metabolism‐related genes of fish, and 3% ShE was recommended to be supplemented in juvenile red tilapia diets.
Nurses' contribution to end‐of‐life family conferences in critical care: A Delphi study
Authors: Kawashima Tetsuharu , Tanaka Makoto , Kawakami Aki , Muranaka Saori
Published: May 2020

Background

Family conferences (FCs) in the intensive care unit play an important role in reducing the psychological burden of patients' families at the end of life. However, no studies have clarified the specific roles and contributions of nurses related to FCs for terminally ill patients in critical care and their families.

Aims and objectives

To clarify nurses' contribution to FCs for terminally ill patients in critical care and their families and examine the priority of each item.

Design

A modified Delphi method was used.

Methods

This study consisted of two phases. In phase 1, an initial list was developed based on a literature review, individual interviews, and a focus group interview. Phase 2 involved two rounds of the Delphi survey. Practitioners (N = 55) from hospitals across Japan were recruited to the Expert Panel for phase 2. They were asked to rate each nurse's contribution in terms of its importance using a 9‐point Likert scale (1 being “not important at all” to 9 being “very important”). Fifty participants responded to round 1 of the survey, and 46 participants completed round 2. If at least 80% of the panellists chose an importance level of 7 or higher, the item was considered “important”.

Results

The 65 items of the potential list were classified into three domains: preparation (16 items), discussion and facilitating meaning during a FC (32 items), and follow up after a FC (17 items). The expert panel determined that, of 65 items, 49 items on the proposed list of nurses' contribution were considered important.

Conclusions

This study clarified nurses' contribution to FCs, with consensus on their importance by expert nurses.

Relevance to clinical practice

This study could be useful for improving and ensuring the quality of nurses' contribution to FCs and promoting collaboration between nurses and other medical professionals.
Prophylactic oseltamivir during major seasonal influenza H1N1 outbreak might reduce both H1N1 and associated pulmonary aspergillosis in children undergoing haploidentical transplantation
Authors: Jaiswal Sarita Rani , Bhagwati Gitali , Soni Mayank , Thatai Atul , Aiyer Hemamalini , Chakrabarti Suparno
Published: May 2020

Following a major seasonal outbreak of H1N1 influenza in 2018 September, prophylactic oseltamivir for six months was initiated in children undergoing haploidentical HCT with regular monitoring for influenza and other respiratory virus infections. Influenza was not detected in 22 children undergoing prophylaxis, compared to 8 H1N1 infections in 21 adults without prophylaxis (P = .01). Four children on prophylaxis were detected to have other respiratory viruses, compared to 8 in those without prophylaxis. Invasive pulmonary aspergillosis (IPA) was observed only in association with H1N1 (4/8 with H1N1 vs 0/35 without H1N1, P = .001) and was thus lower in the prophylaxis group (P = .04). The overall incidence of episodes of respiratory illness and hospital stay were also lower in those on prophylaxis (P = .001). There were no untoward side effects associated with prophylactic oseltamivir. Prophylactic oseltamivir was safe and effective in prevention of H1N1 infection and subsequent IPA in children at‐risk, early after haploidentical HCT.
Expanding on Englishes: A symposium
Authors: Berns Margie
Published: May 2020

In this Symposium entitled ‘Expanding on Englishes’, four contributors discuss the sociolinguistic profiles of lesser‐known countries from a world Englishes perspective. The contributions for this symposium describe the Englishes of Iran, Nepal, Turkey, and Vietnam. These four accounts of the social and linguistic features of English in these countries highlight the challenges of identifying these (and other such) countries as either Inner or Outer Circle territories. This realization indicates that broadening our understanding of the complexities of the diffusion, status, and roles of English requires the importance of nuanced use and interpretation of long‐relied upon criteria.
English in Vietnam
Authors: Tran Phuong Minh , Tanemura Kenneth
Published: May 2020

Over the past few decades, English has emerged as a lingua franca and the dominant foreign language in the fast developing and populous society of Vietnam, placing the country in the center of the Expanding Circle. This paper presents a sociolinguistic profile of English in Vietnam following Berns’ framework. The profile begins with a demographic description and defines how Vietnam can be considered part of the Expanding Circle. We discuss the functional distributions of English in Vietnam by (i) chronicling its instrumental function from Chinese domination in Vietnam in 111 BC until recent years, (ii) detailing its administrative function before and after the country's Economic Reforms of the 1990s, (iii) revealing its interpersonal function in contemporary Vietnamese society; and (iv) illustrating how English borrowings and nativizations are used in the media. We conclude with a discussion of Vietnamese learners’ attitudes towards English learning and different English varieties.
Dynamics of a Viscous Droplet in Return Bends of Microfluidic Channels
Authors: Singh John-Luke , Wang Yechun , Zhang Yan , Melbye Julie A. , Brooks Amanda E. , Brooks Benjamin D.
Published: May 2020

Return bends are frequently encountered in microfluidic systems. In this study, a three-dimensional spectral boundary element method for interfacial dynamics in Stokes flow has been adopted to investigate the dynamics of viscous droplets in rectangular return bends. The droplet trajectory, deformation, and migration velocity are investigated under the influence of various fluid properties and operational conditions, which are depicted by the Capillary number, viscosity ratio, and droplet size, as well as the dimensions of the return bend. While the computational results provide information for the design of return bends in microfluidic systems in general, the computational framework shows potential to guide the design and operation of a droplet-based microfluidic delivery system for cell seeding.
Implementation of Optimized Artificial Neural Networks for Real-Time Estimation of Low Pressure Cooled Exhaust Gas Recirculation in a Turbocharged Gasoline Direct Injection Engine Using a Model-Based Design Approach
Authors: Jo Yuhyeok , Min Kyunghan , Sunwoo Myoungho , Han Manbae
Published: May 2020

Low pressure cooled exhaust gas recirculation (LP-EGR) system has been widely adopted to improve energy efficiency in turbocharged gasoline direct injection (GDI) engines. In order to utilize complete beneficial effects of the LP-EGR, a technique capable of accurately observing the LP-EGR flow into the cylinder in real-time is a prerequisite. To precisely estimate the LP-EGR rate in real-time, this paper proposes artificial neural network (ANN) models and its implementation on a real-time embedded system. As inputs for the ANN models, 12 combustion parameters physically correlated with the LP-EGR in the combustion process are selected and calculated from the in-cylinder pressure. The ANN models for the real-time LP-EGR estimation were trained with the steady-state data of 30,000 cycles and their hyper-parameters were searched by a hyper-parameter optimization method. Moreover, a model-based design procedure is introduced to implement the optimized ANN models on the real-time embedded system. Since the proposed implementation performs the validation procedure for each process, it provides a systematic and seamless process for creating ANN models for real-time embedded systems. In real-time experiments under eight steady-state engine operating points, the embedded ANN models show the estimation performance with R2 of above 0.9716. The operation time of each ANN was less than 1.285 ms meaning that the target system can operate in real-time sufficiently with a mass-produced 32 bit microprocessor up to 256 MHz.
New species and records of Trisetacus Keifer (Eriophyoidea, Nalepellidae) with an atypical shape of female internal genitalia collected from Chamaecyparis, Juniperus, and Thuja (Cupressaceae) in the USA

Authors: Chetverikov Philipp , Romanovich A. , Schubert M. , Sukhareva S.I. , Zukoff S. , Amrine Jr J.W.
Published: May 2020

Typically, females of eriophyoid mites of the large conifer-associated genus Trisetacus Keifer 1952 have long spermathecal tubes, which are at least twice as long as the spermathecae. In this paper, we report on four Trisetacus species collected in the USA from Cupressaceae that possess atypical short spermathecal tubes and demonstrate a distinct reduction trend in leg chaetotaxy when setae lʹ and/or bv II may be absent, and setae ftʹ II are very short. They are: 1) Trisetacus virginianus n. sp. and 2) T. thujae (Garman 1883, = T. thujivagrans Smith 1977a syn. nov.) from indigenous North American conifers Juniperus virginianus and Thuja occidentalis, respectively, and 3) Trisetacus maculatus n. sp. and 4) T. morgantownensis n. sp. from Japanese endemics, Chamaecyparis pisifera and C. obtusa, respectively, introduced to the USA. In these four Trisetacus species, the spermathecal apparatus consists of two drop-shaped segments, each about 2.5‒3 µm long and about 2‒2.5 µm wide, and resembles that of Boczekella, a nalepellid genus restricted to pinacean genera Larix and Pseudolarix. A new subgenus, Brevithecus n. subgen., is erected within the genus Trisetacus to accommodate the four Trisetacus species from Cupressaceae. Future molecular phylogenetic studies are needed to test whether Brevithecus is nested within Trisetacus or represents a separate genus, which may be a sister to either Trisetacus or Boczekella.
O·, H·, and ·OH radical etching probability of polystyrene obtained for a radio frequency driven atmospheric pressure plasma jet
Authors: Kondeti V. S. Santosh K. , Zheng Yashuang , Luan Pingshan , Oehrlein Gottlieb S. , Bruggeman Peter J.
Published: May 2020

Atmospheric pressure plasma jets have great potential for the surface modification of polymers. In this work, the authors report on polystyrene etching by a radio frequency driven atmospheric pressure plasma jet with a focus on the role of H⋅, O⋅, and ⋅OH radicals in this process. The absolute flux of H⋅, O⋅, and ⋅OH radicals reaching the surface of the polymer was determined by a comsol multiphysics reacting fluid dynamics model incorporating detailed transport phenomena in the boundary layer near the substrate. The simulated results of H⋅ and ⋅OH densities in the jet effluent were experimentally verified by two-photon absorption laser induced fluorescence and laser induced fluorescence, respectively. The carbon atom removal flux from the polystyrene surface was taken from previously reported measurements using the same plasma source. The authors show that the boundary layer effects in the interfacial region above the substrate can have a significant impact on the calculated etching probabilities. The reaction probability (β) has a significant uncertainty although a variation of 2 orders of magnitude in β leads to uncertainties of approximately 1 order of magnitude variation in the determined etching probability. The etching probability of polystyrene by ⋅OH radicals was confirmed to be at least an order of magnitude larger than the polystyrene etching probability by O⋅ radicals. The authors also confirmed the weak polystyrene etching probability by H⋅ radicals. The model suggests that the presence of a 30 ppm O2 impurity can lead to the production of ⋅OH radicals in the far effluent of the Ar+1%H2 plasma jet close to the substrate at sufficient densities to enable effective etching.
Comparing non-native and native speech: Are L2 productions more variable?
Authors: Xie Xin , Jaeger T. Florian
Published: May 2020

Foreign-accented speech of second language learners is often difficult to understand for native listeners of that language. Part of this difficulty has been hypothesized to be caused by increased within-category variability of non-native speech. However, until recently, there have been few direct tests for this hypothesis. The realization of vowels and word-final stops in productions of native-English L1 speakers and native-Mandarin speakers of L2 English is compared. With the largest sample size to date, it is shown that at least proficient non-native speakers exhibit little or no difference in category variability compared to native speakers. This is shown while correcting for the effects of phonetic context. The same non-native speakers show substantial deviations from native speech in the central tendencies (means) of categories, as well as in the correlations among cues they produce. This relativizes a common and a priori plausible assumption that competition between first and second language representations necessarily leads to increased variability—or, equivalently, decreased precision, consistency, and stability—of non-native speech. Instead, effects of non-nativeness on category variability are category- and cue-specific.
Programming PAM antennae for efficient CRISPR-Cas9 DNA editing
Authors: Wang Fei , Hao Yaya , Li Qian , Li Jiang , Zhang Honglu , Zhang Xueli , Wang Lihua , Bustamante Carlos , Fan Chunhai
Published: May 2020

We develop a DNA origami–based platform to program a PAM antenna microenvironment for CRISPR editing at the single-molecule level.
Three-dimensional self-assembly using dipolar interaction
Authors: Abelmann Leon , Hageman Tijmen A. G. , Löthman Per A. , Mastrangeli Massimo , Elwenspoek Miko C.
Published: May 2020

It is possible to grow three-dimensional crystals with dipolar magnetic forces.
3D printed Mg-NiTi interpenetrating-phase composites with high strength, damping capacity, and energy absorption efficiency
Authors: Zhang Mingyang , Yu Qin , Liu Zengqian , Zhang Jian , Tan Guoqi , Jiao Da , Zhu Wenjun , Li Shujun , Zhang Zhefeng , Yang Rui , Ritchie Robert O.
Published: May 2020

A 3D printed magnesium alloy with an interpenetrating NiTi phase shows remarkable strength, damping, and self-healing properties.
Microwave quantum illumination using a digital receiver
Authors: Barzanjeh S. , Pirandola S. , Vitali D. , Fink J. M.
Published: May 2020

A quantum radar prototype shows how quantum entanglement could help detect objects in noisy ambient conditions.
Antileishmanial Effects of Synthetic
Eh
PIb Analogs Derived from the Entamoeba histolytica Lipopeptidephosphoglycan
Authors: Fehling Helena , Choy Siew Ling , Ting Frederic , Landschulze Dirk , Bernin Hannah , Lender Sarah Corinna , Mühlenpfordt Melina , Bifeld Eugenia , Eick Julia , Marggraff Claudia , Kottmayr Nadine , Groneberg Marie , Hoenow Stefan , Sellau Julie , Clos Joachim , Meier Chris , Lotter Hannelore
Published: May 2020

With an estimated number of new cases annually of approximately 1.4 million, leishmaniasis belongs to the most important parasitic diseases in the world. Nevertheless, existing drugs against leishmaniasis in general have several drawbacks that urgently necessitate new drug development. A glycolipid molecule of the intestinal protozoan parasite
Entamoeba histolytica
and its synthetic analogs previously showed considerable immunotherapeutic effects against
Leishmania major
infection.
Understanding, Verifying, and Implementing Emergency Use Authorization Molecular Diagnostics for the Detection of SARS-CoV-2 RNA
Authors: Mitchell Stephanie L. , St. George Kirsten , Rhoads Daniel D. , Butler-Wu Susan M. , Dharmarha Vaishali , McNult Peggy , Miller Melissa B.
Published: May 2020

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has brought a new wave of challenges to health care, particularly in the area of rapid diagnostic test development and implementation. The diagnosis of acute coronavirus disease 2019 (COVID-19) is critically dependent on the detection of SARS-CoV-2 RNA from clinical specimens (e.g., nasopharyngeal swabs). While laboratory-developed testing for SARS-CoV-2 is an essential component of diagnostic testing for this virus, the majority of clinical microbiology laboratories are dependent on commercially available SARS-CoV-2 molecular assays.
Supplemental Material: Has Earth ever been ice-free? Implications for glacio-eustasy in the Cretaceous greenhouse age using high-resolution sequence stratigraphy
Authors: Lin Wen
Published: May 2020

Table S1 includes location information of measured sections and the supplemental Figure S1 includes detailed sequence stratigraphic correlation cross-section tied with measured sections.
Impact of expanding a paediatric OPAT programme with an antimicrobial stewardship intervention
Authors: Huynh Julie , Hodgson Kate A , Boyce Suzanne , Ibrahim Laila F , Bryant Penelope A
Published: May 2020

Background

As treatment out of hospital with outpatient parenteral antimicrobial therapy (OPAT) increases, so too does the risk for patients of being less visible, with potential for suboptimal care.

Objectives

We aimed to compare pre-expansion and post-expansion (1) successful completion, complications and (2) the impact of an OPAT-specific antimicrobial stewardship (AMS) intervention to mitigate inappropriate antibiotic prescribing.

Design

A prospective longitudinal study during two consecutive 12-month periods: period A (1 August 2012 to 31 July 2013) and period B (1 August 2013 to 31 July 2014).

Setting

The Hospital-in-the-Home (HITH) programme at The Royal Children’s Hospital Melbourne.

Participants

All patients who received OPAT during the study period.

Interventions

Between the two periods, the programme expanded from 16 to 32 patients/day. To coincide with this, a combined AMS intervention was introduced: (1) OPAT-specific guidelines and (2) active review of OPAT prescriptions and input by Paediatric Infectious Diseases.

Main outcomes

Successful completion of OPAT, OPAT-related complications, readmission, length of stay and antibiotic appropriateness.

Results

Over 2 years, 646 patients (47% female, median age 7 years) were treated via OPAT for 754 episodes. Patient episodes increased from 254 in period A to 500 in period B, with proportional increases in infants under 1 month and immunocompromised patients. OPAT was successfully completed in 245/251 (98%) versus 473/482 (98%) (OR 1.8, 95% CI 0.7 to 4.5, p=0.3). OPAT-related complications remained low: intravenous catheter-associated complications 16/138 (12%) versus 41/414 (10%), and antibiotic-associated complications 0/254 (0%) versus 2/500 (0.4%). Despite the increase in activity, with the AMS intervention, overall appropriate antibiotic prescribing remained high: 71% versus 76%. Inappropriately long durations reduced from 30/312 (10%) to 37/617 (6%) (OR 0.6, 95% CI 0.4 to 0.99, p=0.04), and median number of days on broad-spectrum antibiotics from 11 (IQR 8–24.5) to 8 (IQR 5–11).

Conclusion

During a period of substantial expansion, we maintained clinical outcomes. A modest AMS intervention reduced some but not all aspects of inappropriate antibiotic prescribing.
Uterine artery pseudoaneurysm and embolisation during pregnancy
Authors: Roeckner Jared T , Louis-Jacques Adetola F , Zwiebel Bruce R , Louis Judette M
Published: May 2020

Uterine artery pseudoaneurysm in pregnancy is a dangerous condition as rupture can be catastrophic due to the large volume of uterine blood flow. We present a case of a healthy, young woman with a desired pregnancy at 15 weeks of gestation incidentally discovered to have a pseudoaneurysm of the uterine artery during a routine prenatal ultrasound. She underwent initial thrombin injection followed by endovascular coil embolisation of the left uterine artery and carried the pregnancy to term without further complications.
Cluster randomised controlled trial of home cook intervention to reduce salt intake in China: a protocol study
Authors: Zhang Xiaochang , Hu Xiao , Ma Jixiang , Zhang Puhong , Li Yuan , Luo Rong , He Feng J , MacGregor Graham A , Wang Jinglei , Yin Zhaoxue
Published: May 2020

Introduction

Salt intake in China is twice the upper limit recommended by the WHO, and nearly 80% of salt is added during cooking. This study will develop a package of salt reduction interventions targeting home cooks and evaluate its effectiveness and feasibility for scale-up.

Methods and analysis

A cluster randomised controlled trial design is adopted in this study, which will be conducted in six provinces covering northern, central and southern China. For each province, 10 communities/villages (clusters) with 13 families (one cook and one adult family member) will be selected in each cluster for evaluation. In total, 780 home cooks and 780 adult family members will be recruited. The home cooks in the intervention group will be provided with the intervention package, including community-based standardised offline and online health education and salt intake monitoring. The duration of the intervention will be 1 year. The primary outcome is the difference between the intervention and control group in change in salt intake as measured by 24 hours urinary sodium from baseline to the end of the trial. The secondary outcome is the difference between the two groups in the change in salt-related knowledge, attitude and practice and blood pressure (BP).

Ethics and dissemination

The study has been approved by The Queen Mary Research Ethics Committee (QMERC2018/13) and Institutional Review Board of the Chinese Center for Disease Control and Prevention (No. 201801). The study findings will be disseminated widely through conference presentations and peer-reviewed publications and the general media.

Trial registration number

ChiCTR1800016804.
Adolescent follow-up in the Health Outcomes and Measures of the Environment (HOME) Study: cohort profile
Authors: Braun Joseph M , Buckley Jessie P , Cecil Kim M , Chen Aimin , Kalkwarf Heidi J , Lanphear Bruce P , Xu Yingying , Woeste Anastasia , Yolton Kimberly
Published: May 2020

Purpose

Environmental chemical exposures may adversely affect an array of adolescent health outcomes. Thus, we used the Health Outcomes and Measures of the Environment (HOME) study, a prospective cohort that recruited pregnant women and conducted longitudinal follow-up on children over the first 12 years of life, to determine if and when chemical exposures affect adolescent health.

Participants

We recruited 468 pregnant women (age range: 18–45 years) from the Cincinnati, Ohio region to participate in a cohort study between March 2003 and January 2006. Follow-up included two clinic and one home visits during pregnancy, a delivery hospital visit, and four home and six clinic visits when children were aged 4 weeks and 1, 2, 3, 4, 5 and 8 years. Of 441 children available for follow-up, 396 (90%) completed at least one follow-up and 256 (58%) completed the most recent follow-up at 12 years of age (range: 11–14).

Findings to date

Our new measures include maternal/child report of internalising symptoms, neuroimaging, dual-energy X-ray absorptiometry-derived estimates of lean/adipose tissue and bone mineral density, and cardiometabolic risk biomarkers. We assessed adolescent exposure to perfluoroalkyl substances, phenols, phthalates and flame retardants. Participants completing follow-up at 12 years of age were similar to the original cohort in terms of baseline factors. Most children had typical and expected values for this age on measures of internalising symptoms, body composition, bone density and cardiometabolic risk markers. Notably, 36% and 11% of children had scores indicative of potential anxiety and depressive disorders, respectively. Approximately 35% of children were overweight or obese, with higher prevalence among girls. Thirty-three per cent of children had borderline or high triglyceride concentrations (>90 mg/dL).

Future plans

We will examine associations of early life environmental chemical exposures with adolescent health measures while considering potential periods of heightened susceptibility and mixture effects.

Trial registration number

NCT00129324.
Evaluation of a continuous neonatal temperature monitor for low-resource settings: a device feasibility pilot study
Authors: Sosa Saenz Sonia E. , Hardy Mary Kate , Heenan Megan , Oden Z. Maria , Richards-Kortum Rebecca , Dube Queen , Kawaza Kondwani
Published: May 2020

Objective

Evaluate a novel continuous temperature monitor in a low-resource neonatal ward.

Design

We developed a low-cost continuous neonatal temperature monitor (NTM) for use in low-resource settings. Accuracy of NTM was initially assessed in the laboratory. Clinical evaluation then was performed in a neonatal ward in a central hospital in Malawi; eligible neonates (<1 week of age) were recruited for continuous temperature monitoring with NTM and a Philips Intellivue MP30 Patient Monitor.

Interventions and outcome measures

The temperature probes of NTM and the reference patient monitor were attached to the infant’s abdomen, and core temperature was continuously recorded for up to 3 hours. Axillary temperatures were taken every hour. We compared temperatures measured using NTM, the patient monitor and the axillary thermometer.

Results

Laboratory temperature measurements obtained with NTM were within 0.059°C (range: −0.035°C to 0.195°C) of a reference thermometer. A total of 39 patients were recruited to participate in the clinical evaluation of NTM; data from four patients were excluded due to faulty hardware connections. The mean difference in measured temperatures between the NTM and the Intellivue MP30 was −0.04°C (95% CI −0.52°C to 0.44°C).

Conclusion

NTM meets ISO 80601-2-56 standards for accuracy and is an appropriate, low-cost continuous temperature monitor for neonatal wards in low-resource settings.

Trial registration numbers

NCT03965312 and NCT03866122.
Evaluation of ‘care bundles’ for patients with chronic obstructive pulmonary disease (COPD): a multisite study in the UK
Authors: Morton Katherine , MacNeill Stephanie , Sanderson Emily , Dixon Padraig , King Anna , Jenkins Sue , Metcalfe Chris , Shaw Ali , Chalder Melanie , Benger Jonathan , Hollingworth William , Calvert James , Purdy Sarah
Published: May 2020

Background

Chronic obstructive pulmonary disease (COPD) accounts for 10% of emergency hospital admissions in the UK annually. Nearly 33% of patients are readmitted within 28 days of discharge. We evaluated the effectiveness of implementing standardised packages of care called ‘care bundles’ on COPD readmission, emergency department (ED) attendance, mortality, costs and process of care.

Methods

This is a mixed-methods, controlled before-and-after study with nested case studies. 31 acute hospitals in England and Wales which introduced COPD care bundles (implementation sites) or provided usual care (comparator sites) were recruited and provided monthly aggregate data. 14 sites provided additional individual patient data. Participants were adults admitted with an acute exacerbation of COPD.

Results

There was no evidence that care bundles reduced 28-day COPD readmission rates: OR=1.02 (95% CI 0.83 to 1.26). However, the rate of ED attendance was reduced in implementation sites over and above that in comparator sites (implementation: IRR=0.63 (95% CI 0.56 to 0.71); comparator: IRR=1.12 (95% CI 1.02 to 1.24); group–time interaction p<0.001). At implementation sites, delivery of all bundle elements was higher but was only achieved in 2.2% (admissions bundle) and 7.6% (discharge bundle) of cases. There was no evidence of cost-effectiveness. Staff viewed bundles positively, believing they help standardise practice and facilitate communication between clinicians. However, they lacked skills in change management, leading to inconsistent implementation.

Discussion

COPD care bundles were not effectively implemented in this study. They were associated with a reduced number of subsequent ED attendances, but not with change in readmissions, mortality or reduced costs. This is unsurprising given the low level of bundle uptake in implementation sites, and it remains to be determined if COPD care bundles affect patient care and outcomes when they are effectively implemented.

Trial registration number

ISRCTN13022442.
Positive predictive value of stroke identification by ambulance clinicians in North East England: a service evaluation
Authors: McClelland Graham , Flynn Darren , Rodgers Helen , Price Christopher
Published: May 2020

Introduction/background

Accurate prehospital identification of patients who had an acute stroke enables rapid conveyance to specialist units for time-dependent treatments such as thrombolysis and thrombectomy. Misidentification leads to patients who had a ‘stroke mimic’ (SM) being inappropriately triaged to specialist units. We evaluated the positive predictive value (PPV) of prehospital stroke identification by ambulance clinicians in the North East of England.

Methods

This service evaluation linked routinely collected records from a UK regional ambulance service identifying adults with any clinical impression of suspected stroke to diagnostic data from four National Health Service hospital trusts between 1 June 2013 and 31 May 2016. The reference standard for a confirmed stroke diagnosis was inclusion in Sentinel Stroke National Audit Programme data or a hospital diagnosis of stroke or transient ischaemic attack in Hospital Episode Statistics. PPV was calculated as a measure of diagnostic accuracy.

Results

Ambulance clinicians in North East England identified 5645 patients who had a suspected stroke (mean age 73.2 years, 48% male). At least one Face Arm Speech Test (FAST) symptom was documented for 93% of patients who had a suspected stroke but a positive FAST was only documented for 51%. Stroke, or transient ischaemic attack, was the final diagnosis for 3483 (62%) patients. SM (false positives) accounted for 38% of suspected strokes identified by ambulance clinicians and included a wide range of non-stroke diagnoses including infections, seizures and migraine.

Discussion

In this large multisite data set, identification of patients who had a stroke by ambulance clinicians had a PPV rate of 62% (95% CI 61 to 63). Most patients who had a suspected stroke had at least one FAST symptom, but failure to document a complete test was common. Training for stroke identification and SM rates need to be considered when planning service provision and capacity.
Combination therapy for non-alcoholic steatohepatitis: rationale, opportunities and challenges
Authors: Dufour Jean-François , Caussy Cyrielle , Loomba Rohit
Published: May 2020

Non-alcoholic steatohepatitis (NASH) is becoming a leading cause of cirrhosis with the burden of NASH-related complications projected to increase massively over the coming years. Several molecules with different mechanisms of action are currently in development to treat NASH, although reported efficacy to date has been limited. Given the complexity of the pathophysiology of NASH, it will take the engagement of several targets and pathways to improve the results of pharmacological intervention, which provides a rationale for combination therapies in the treatment of NASH. As the field is moving towards combination therapy, this article reviews the rationale for such combination therapies to treat NASH based on the current therapeutic landscape as well as the advantages and limitations of this approach.
Next-generation sequencing and histological response assessment in peritoneal metastasis from pancreatic cancer treated with PIPAC
Authors: Nielsen Malene , Graversen Martin , Ellebæk Signe Bremholm , Kristensen Thomas Kielsgaard , Fristrup Claus , Pfeiffer Per , Mortensen Michael Bau , Detlefsen Sönke
Published: May 2020

Background

Peritoneal metastasis from pancreatic cancer (PM-PC) may be treated with repeated pressurised intraperitoneal aerosol chemotherapy (PIPAC). Utility of next-generation sequencing (NGS) to detect cancer-related mutations in peritoneal quadrant biopsies (QBs) and peritoneal fluid (PF) after systemic and PIPAC treatment has not been evaluated. Around 90% of pancreatic cancers (PCs) harbour aKRASmutation, making PC ideal for the evaluation of this aspect.

Aims

Evaluation of PM-PC in terms of (1) histological response to PIPAC using Peritoneal Regression Grading Score (PRGS), (2) clinical characteristics and (3) frequency of mutations in QBs and PF before and after PIPAC.

Methods

Peritoneal QBs and PF were obtained prior to each PIPAC. NGS for 22 cancer-related genes was performed on primary tumours, QBs and PFs. Response was assessed by the four-tiered PRGS.

Results

Sixteen patients treated with a median of three PIPAC procedures were included. The mean PRGS was reduced from 1.91 to 1.58 (p=0.02). Fifty-seven specimens (13 primary tumours, 2 metastatic lymph nodes, 16 PFs and 26 QB sets) were analysed with NGS.KRASmutation was found in 14/16 patients (87.50%) and in QBs, primary tumours and PF in 8/12 (66.67%), 8/13 (61.53%) and 6/9 (66.67%). The median overall survival was 9.9 months (SE 1.5, 95% CI 4.9 to 13.9).

Conclusion

PIPAC induces histological response in the majority of patients with PM-PC.KRASmutation can be found in PM-PC after PIPAC at a frequency similar to the primaries. NGS may be used to detect predictive mutations in PM-PC of various origins, also when only post-PIPAC QBs or PFs are available.
The Society for Immunotherapy of Cancer perspective on regulation of interleukin-6 signaling in COVID-19-related systemic inflammatory response
Authors: Arnaldez Fernanda I , O"Day Steven J , Drake Charles G , Fox Bernard A , Fu Bingqing , Urba Walter J , Montesarchio Vincenzo , Weber Jeffrey S , Wei Haiming , Wigginton Jon M , Ascierto Paolo Antonio
Published: May 2020

The pandemic caused by the novel coronavirus SARS-CoV-2 has placed an unprecedented burden on healthcare systems around the world. In patients who experience severe disease, acute respiratory distress is often accompanied by a pathological immune reaction, sometimes referred to as ‘cytokine storm’. One hallmark feature of the profound inflammatory state seen in patients with COVID-19 who succumb to pneumonia and hypoxia is marked elevation of serum cytokines, especially interferon gamma, tumor necrosis factor alpha, interleukin 17 (IL-17), interleukin 8 (IL-8) and interleukin 6 (IL-6). Initial experience from the outbreaks in Italy, China and the USA has anecdotally demonstrated improved outcomes for critically ill patients with COVID-19 with the administration of cytokine-modulatory therapies, especially anti-IL-6 agents. Although ongoing trials are investigating anti-IL-6 therapies, access to these therapies is a concern, especially as the numbers of cases worldwide continue to climb. An immunology-informed approach may help identify alternative agents to modulate the pathological inflammation seen in patients with COVID-19. Drawing on extensive experience administering these and other immune-modulating therapies, the Society for Immunotherapy of Cancer offers this perspective on potential alternatives to anti-IL-6 that may also warrant consideration for management of the systemic inflammatory response and pulmonary compromise that can be seen in patients with severe COVID-19.
K-01 Agricultural exposures and health outcomes
Authors: Freeman Laura Beane
Published: May 2020

Pesticides, including herbicides, insecticides, fungicides, fumigants and rodenticides, represent a diverse set of chemicals. They provide important benefits in public health, food production and aesthetics. However, unlike most other chemicals, pesticides are designed to impact living systems. Consequently there has long been a concern about the consequences on both human health and the environment. Pesticide use increased dramatically in the last half of the 20th century, with use continuing to increase in low and middle income countries, reflecting changing agricultural practices. Over 1 billion people are estimated to be exposed to pesticides occupationally through production, mixing, application and other tasks, particularly in the agricultural sector. But, these exposures can also experienced by the general population through various pathways, including drift and contamination of water and food supplies. Not surprisingly, given their diverse properties, various pesticides have been linked to a number of adverse health outcomes, including cancer, respiratory and neurologic disease and reproductive outcomes. With hundreds of pesticide active ingredients and changing practices over time, exposure assessment for etiologic research is a challenge, particularly for chronic diseases with potentially long latency. The ubiquity of the exposure and the concern about health risks by the general population make it imperative to study these important chemicals.
O4E.2 Efficiency of autocoding programs for converting job descriptors into standard occupational classification codes
Authors: Dale Ann , Buckner-Petty Skye , Evanoff Bradley
Published: May 2020

Introduction

Standard Occupational Classification (SOC) codes can link work exposure data to individual health outcomes, but manually assigning job codes is laborious. We tested two recently developed automatic coding programs.

Methods

We entered self-reported job titles and industry from two existing cohorts into two publicly available autocoding programs, the NIOSH Industry and Occupation Computerized Coding System (NIOCCS) and the Standardized Occupation Coding for Computer-assisted Epidemiological Research (SOCcer), and assessed agreement between autocodes and manual coding. We also assessed agreement of several exposure values (from the Occupational Information Network, O*NET) linked by manual SOC codes versus those linked by autocodes, in order to examine how differences in coding might affect exposure assignments in general population cohort studies.

Results

NIOCCS produced SOC codes for the majority of subjects (Cohort 1: 85%; Cohort 2: 79%). The level of detail for these codes varied slightly; 6-digit SOC codes (detailed occupations) were available for 84% and 76% of cohorts A and B respectively. Comparison to manual codes showed strong agreement at the major group level (kappa=0.8 for both cohorts) and weaker agreement at the 6-digit level (kappa ≥0.4 and 0.6). SOCcer produced 6-digit SOC codes for all subjects with good agreement at the 2-digit level (kappa ≥0.6 and 0.7) and slightly lower at the 6-digit level (kappa ≥0.3 and 0.4). Agreement for O*NET exposures was very high for most comparisons within both cohorts for both programs (many ICCs>0.8).

Conclusion

Both autocoding programs can be reliable tools to aid in assigning SOC codes that represent broad industry levels, with less agreement at finer levels of job codes. Given the availability of large public datasets with job information but no other work exposure data, autocoding of jobs provides exciting opportunities for analyzing work-related health outcomes in future studies.
O4E.3 Utility of routinely recorded data on working hours for an epidemiological cohort study of 60,000 swedish health care employees
Authors: Gustavsson Per , Bigert Carolina , Bodin Theo , Selander Jenny , Härmä Mikko , Lindahl-Norberg Annika , Andersson Tomas , Gustavsson Annika , Albin Maria
Published: May 2020

Night and shift work is common in industry and service that must be functional 24 hour. Night work disrupts the circadian rhythm, and is potentially linked to an excess of cancer (especially breast cancer), cardiovascular disease, pregnancy complications, as well as to psychical effects. Large studies with detailed and objectively collected data on working hours are needed to confirm causal associations and develop practical advice on how shift schedules should be planned in order to minimize negative health effects.

Stockholm County Council employs a high number of health care workers of which many are working in shifts. We have formed a cohort of those employed from 2008 to 2016, 45 000 women and 15 000 men. The computerized employment register holds individual records on working hours day by day in retrospect since 2008, and information on night work since year 2000. Information on cancer incidence, hospital discharge diagnoses of cardiovascular disease, pregnancy outcome, and causes of sick-leave have been obtained from national central registers.

There were typically three work shifts: morning shifts (07–15), afternoon shifts (14–21), and night shifts (21–07). Non shift-workers typically worked (08–17). So far, we have investigated work shift patterns for those with a high percentage of night work: nurses, assistant nurses and midwives. Among these, 22% worked at least one night per month, and 15% worked at least 5 nights per month in 2009, which increased slightly to 23% and 16% respectively in 2016. It was common to work several nights in a row: in 2009 13.8% worked at least 3 consecutive nights or more per month, which increased to 15.5% in 2016. Only 0.6% worked 5 consecutive nights or more per month.

Analyses of cancer, pregnancy outcome, cardiovascular disease and psychical outcomes are planned for 2019.