bluuebunny/crossref_metadata_2025 huggingface dataset:
Greek Religion in the LBA and EIA
Authors: Rutherford Ian
Published: October 2020

Chapter 3, which is aimed primary at those who are not experts in Greek religion, presents a survey of Greek and Aegean religion, covering Minoan religion, Mycenaean religion and Greek religion of the 1st millennium BC. Ione issue I address throughout is that continuity. The final section looks at the evidence for Greek religion in Anatolia in the 1st millennium BC
War-Rituals
Authors: Rutherford Ian
Published: October 2020

Chapter 10 compares Hittite military rituals with those of Greece, setting them in the context of other religious traditons of the Ancient Near East and the Mediterranean. The hypothesis that one culture might adopt another’s military rituals is plausible because we know that techniques of warfare and military technology themselves tended in some cases to migrate. Hittite military rituals and Greek military rituals of the 1st millennium do not seem particularly close, but Greek poets and writers seem to have knowledge of some rituals which resemble Hittite ones, so it seems there may be some memory of an historical reality here.
Anacondas’ Tales
Authors: Rivas Jesús A.
Published: October 2020

This chapter examines the lives and tribulations of anacondas. Anacondas, like humans, produce the same number of males and females because the sex ratio is determined by sexual chromosomes. If the sexes start out equally abundant, why would there be so many more males out there in the wild? In some vertebrates one sex or the other disperses away from the area they were born. However, the author does not believe migration plays a significant role with anacondas. For starters, males are the sex with the wanderlust, not females. As such, this would not account for the lower number of females. Moreover, migration should not be very high due to the fact that the study site is the only region that holds water, so animals might move out in the wet season, but they would likely come back in the dry season, when the author did most of the sampling. If migration is not the answer for the uneven sex ratio, one is left with mortality of females as the only explanation. If females suffered higher death rates, that could explain the male bias in the population that the model estimated. Looking further into the results of the population model, the author found that females have a lower estimated survival than males. The chapter then considers the reasons females have higher mortality. The large expenditure in reproduction females incur might result in death not only as a result of predation but also during or after feeding due to weakening.
The Largess of Motherhood
Authors: Rivas Jesús A.
Published: October 2020

This chapter assesses the reasons and limitations for large size in female anacondas. Considering how large females are—nearly five times the size of males—it is obvious that the evolutionary pressures for large size act more strongly on females than males. One aspect in which natural selection definitely favors large size in females has to do with reproductive output. The larger a female is, the more babies can develop in her body and the larger the reproductive output. Reproductive value, or lifetime reproductive success, is the number of potential offspring that an individual can leave in the population over its lifetime. There are costs animals must face when they make reproductive decisions. Some of these costs are dependent on fecundity and some of them are not, such as the risk of being preyed upon during mating or pregnancy. A young adult female that has just reached maturity is under two opposite pressures: one is to breed right away and secure a few babies into the next generation, and the other is to skip reproduction, grow larger, and make more babies in a later year. A female that is going to breed faces another decision: how to invest her breeding resources. She can produce a large number of neonates of small size or a few offspring of large size.
Black American Maternal Prenatal Choline, Offspring Gestational Age at Birth, and Developmental Predisposition to Mental Illness
Authors: Hunter Sharon K , Hoffman M Camille , McCarthy Lizbeth , D’Alessandro Angelo , Wyrwa Anna , Noonan Kathleen , Christians Uwe , Nakimuli-Mpungu Etheldreda , Zeisel Steven H , Law Amanda J , Freedman Robert
Published: October 2020

Black Americans have increased risk for schizophrenia and other mental illnesses with prenatal origins. Prenatal choline promotes infant brain development and behavioral outcomes, but choline has not been specifically assessed in Black Americans. Pregnant women (N = 183, N = 25 Black Americans) enrolled in a study of prenatal stressors and interactions with prenatal choline. Black American women had lower 16-week gestation plasma choline than Whites. Lower choline was not related to obesity, income, or metabolic genotypes. Pregnant women in rural Uganda have higher choline levels than Black American women. Black Americans’ lower choline was associated with higher hair cortisol, indicative of higher stress. Lower maternal choline was associated with offsprings’ lower gestational age at birth and with decreased auditory P50 inhibition, a marker of inhibitory neuron development. Behavioral development was assessed on the Infant Behavior Questionnaire-R-SF (IBQ-R) at 3 months. Lower Black American maternal gestational choline was associated with lower infant IBQ-R Orienting/Regulation, indicating decreased attention and relation to caregivers. Additional evidence for developmental effects of choline in Black Americans comes from a randomized clinical trial of gestational phosphatidylcholine supplementation versus placebo that included 15 Black Americans. Phosphatidylcholine increased gestational age at birth and newborn P50 inhibition and decreased Social Withdrawn and Attention problems at 40 months of age in Black Americans’ offspring compared to placebo. Inhibitory and behavioral deficits associated with lower prenatal choline in offspring of Black American women indicate potential developmental predispositions to later mental illnesses that might be ameliorated by prenatal choline or phosphatidylcholine supplementation.
High-Quality Genome Resource of the Pathogen of Diaporthe (Phomopsis) phragmitis Causing Kiwifruit Soft Rot
Authors: Wang Xiaojie , Dong Hongjie , Lan Jianbin , Liu Yuanyuan , Liang Kuan , Lu Qi , Fang Zemin , Liu Pu
Published: October 2020

Diaporthe spp. are critical plant pathogens that cause wood cankers, wilt, dieback, and fruit rot in a wide variety of economic plant hosts and are regarded as one of the most acute threats faced by the kiwifruit industry worldwide. Diaporthe phragmitis NJD1 is a highly pathogenic isolate of soft rot of kiwifruit. Here, we present a high-quality genome-wide sequence of D. phragmitis NJD1 that was assembled into 28 contigs containing a total size of 58.33 Mb and N50 length of 3.55 Mb. These results lay a solid foundation for understanding host-pathogen interaction and improving disease management strategies.

[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
The Total Population Size of ‘Candidatus Liberibacter asiaticus’ Inside the Phloem of Citrus Trees and the Corresponding Metabolic Burden Related to Huanglongbing Disease Development
Authors: Vasconcelos Fernanda N. C. , Li Jinuyn , Pang Zhiqian , Vincent Christopher , Wang Nian
Published: October 2020

‘Candidatus Liberibacter asiaticus’ (CLas) is the predominant causal agent of citrus huanglongbing, the most devastating citrus disease worldwide. CLas colonizes phloem tissue and causes phloem dysfunction. The pathogen population size in local tissues and in the whole plant is critical for the development of disease symptoms by determining the load of pathogenicity factors and metabolic burden to the host. However, the total population size of CLas in a whole plant and the ratio of CLas to citrus cells in local tissues have not been addressed previously. The total CLas population size for 2.5-year-old ‘Valencia’ sweet orange on ‘Kuharske’ citrange rootstock trees was quantified using quantitative PCR to be approximately 1.74 × 109 cells/tree, whereas 7- and 20-year-old sweet orange trees were estimated to be 4.3 × 1010 cells/tree, and 6.0 × 1010 cells/tree, respectively. The majority of CLas cells were distributed in leaf tissues (55.58%), followed by those in branch (36.78%), feeder root (4.75%), trunk (2.39%), and structural root (0.51%) tissues. The ratios of citrus cells to CLas cells for branch, leaf, trunk, feeder root, and structural root samples were within approximately 39 to 79, 44 to 124, 153 to 1,355, 191 to 1,054, and 561 to 3,760, respectively, representing the metabolic burden of CLas in different organs. It was estimated that the ratios of phloem cells to CLas cells for branch, leaf, trunk, feeder root, and structural root samples are approximately 0.39 to 0.79, 0.44 to 1.24, 1.53 to 13.55, 1.91 to 10.54, and 5.61 to 37.60, respectively. Approximately 0.01% of the total citrus phloem volume was estimated to be occupied by CLas, explaining the difficulty to observe CLas in most tissues under transmission electron microscopy. The CLas titer inside the leaf was estimated to be approximately 1.64 × 106 cells/leaf or 9.2 × 104 cells cm–2 in leaves, approximately 104 times less than that of typical apoplastic bacterial pathogens. This study provides quantitative estimates of phloem colonization by bacterial pathogens and furthers the understanding of the biology and virulence mechanisms of CLas.
Chondrosarcoma in the body of the C2 vertebral axis
Authors: Ozoner Baris , Kayhan Ahmet , Comunoglu Nil , Aydin Seckin , Sanus Galip Zihni , Tanriover Necmettin
Published: October 2020

Chondrosarcoma, a malignant bone tumor, is rarely encountered in the cervical spine. This article describes a patient whose neck pain and dysphagia were caused by an expansive, destructive lesion with calcification that was located in the body of the axis (C2 vertebra), the first time a chondrosarcoma has been reported in this location.
Poland and physician assistants
Authors: Bareja Sylwia
Published: October 2020

Historically, physician assistants (PAs) or their equivalent have been used to offset shortages of healthcare providers in many parts of the world. Poland, having been strongly influenced by Russia and the Soviet Union, revived the feldsher in the post-world war era. With a successful expansion of medical schools, the eventual surplus of physicians meant feldshers were no longer needed. In the early 2000s, Poland found itself in yet another medical provider crisis and turned toward the creation of the Polish PA profession.
The history and role of PAs in the US Coast Guard
Authors: Hooker Roderick S.
Published: October 2020

The US Coast Guard is a military service in the Department of Homeland Security charged with broad domestic and international missions. In 1971, the Coast Guard began recruiting physician assistants (PAs) in an effort to supplement physician staffing support. When first introduced, PAs were in the enlisted ranks. However, consistent with the other armed services, their entry ranks changed from enlisted to commissioned warrant officer and later to a commissioned officer status. As their numbers grew, PAs began augmenting and later replacing general medical officers assigned to treatment facilities and aboard ships. Their role is to keep the 43,000 men and women of the Coast Guard and their dependents healthy by providing medical care at 40 bases and stations. As of 2020, the Coast Guard has 47 commissioned PAs who work on shore postings, on polar-bound ice breakers, training ships, as faculty in the Interservice Physician Assistant Program, or as senior administrative officers. About one-third are female.
Volatile Isoflurane in Critically Ill Coronavirus Disease 2019 Patients—A Case Series and Systematic Review
Authors: Flinspach Armin Niklas , Zacharowski Kai , Ioanna Deligiannis , Adam Elisabeth Hannah
Published: October 2020

Objectives:

The ongoing coronavirus pandemic is challenging, especially in severely affected patients who require intubation and sedation. Although the potential benefits of sedation with volatile anesthetics in coronavirus disease 2019 patients are currently being discussed, the use of isoflurane in patients with coronavirus disease 2019–induced acute respiratory distress syndrome has not yet been reported.

Design:

We performed a retrospective analysis of critically ill patients with hypoxemic respiratory failure requiring mechanical ventilation.

Setting:

The study was conducted with patients admitted between April 4 and May 15, 2020 to our ICU.

Patients:

We included five patients who were previously diagnosed with severe acute respiratory syndrome coronavirus 2 infection.

Intervention:

Even with high doses of several IV sedatives, the targeted level of sedation could not be achieved. Therefore, the sedation regimen was switched to inhalational isoflurane. Clinical data were recorded using a patient data management system. We recorded demographical data, laboratory results, ventilation variables, sedative dosages, sedation level, prone positioning, duration of volatile sedation and outcomes.

Measurements & Main Results:

Mean age (four men, one women) was 53.0 (± 12.7) years. The mean duration of isoflurane sedation was 103.2 (± 66.2) hours. Our data demonstrate a substantial improvement in the oxygenation ratio when using isoflurane sedation. Deep sedation as assessed by the Richmond Agitation and Sedation Scale was rapidly and closely controlled in all patients, and the subsequent discontinuation of IV sedation was possible within the first 30 minutes. No adverse events were detected.

Conclusions:

Our findings demonstrate the feasibility of isoflurane sedation in five patients suffering from severe coronavirus disease 2019 infection. Volatile isoflurane was able to achieve the required deep sedation and reduced the need for IV sedation.
Almitrine Infusion in Severe Acute Respiratory Syndrome Coronavirus 2-Induced Acute Respiratory Distress Syndrome: A Single-Center Observational Study*
Authors: Caplan Morgan , Goutay Julien , Bignon Anne , Jaillette Emmanuelle , Favory Raphael , Mathieu Daniel , Parmentier-Decrucq Erika , Poissy Julien , Duburcq Thibault
Published: October 2020

Objectives:

Treating acute respiratory failure in patients with coronavirus disease 2019 is challenging due to the lack of knowledge of the underlying pathophysiology. Hypoxemia may be explained in part by the loss of hypoxic pulmonary vasoconstriction. The present study assessed the effect of almitrine, a selective pulmonary vasoconstrictor, on arterial oxygenation in severe acute respiratory syndrome coronavirus 2-induced acute respiratory distress syndrome.

Design:

Single-center retrospective observational study.

Setting:

ICU of Lille Teaching Hospital, France, from February 27, 2020, to April 14, 2020.

Patients:

Patients with coronavirus disease 2019 pneumonia confirmed by positive reverse transcriptase-polymerase chain reaction for severe acute respiratory syndrome-coronavirus 2 and acute respiratory distress syndrome according to Berlin definition. Data focused on clinicobiological features, ventilator settings, therapeutics, outcomes, and almitrine-related adverse events.

Interventions:

Almitrine was considered in patients with severe hypoxemia (Pao
2/Fio
2 ratio < 150 mm Hg) in addition to the recommended therapies, at an hourly IV delivery of 10 μg/kg/min. Comparative blood gases were done before starting almitrine trial and immediately after the end of the infusion. A positive response to almitrine was defined by an increase of Pao
2/Fio
2 ratio greater than or equal to 20% at the end of the infusion.

Measurements and Main Results:

A total of 169 patients were enrolled. Thirty-two patients with acute respiratory distress syndrome received an almitrine infusion trial. In most cases, almitrine was infused in combination with inhaled nitric oxide (75%). Twenty-one patients (66%) were responders. The median Pao
2/Fio
2 ratio improvement was 39% (9–93%) and differs significantly between the responders and nonresponders (67% [39–131%] vs 6% [9–16%], respectively; p < 0.0001). The 28-day mortality rates were 47.6% and 63.6% (p = 0.39) for the responders and nonresponders, respectively. Hemodynamic parameters remained similar before and after the trial, not suggesting acute cor pulmonale.

Conclusions:

Almitrine infusion improved oxygenation in severe acute respiratory syndrome coronavirus 2-induced acute respiratory distress syndrome without adverse effects. In a multistep clinical approach to manage severe hypoxemia in this population, almitrine could be an interesting therapeutic option to counteract the loss of hypoxic pulmonary vasoconstriction and redistribute blood flow away from shunting zones.
Is Cardiopulmonary Resuscitation Futile in Coronavirus Disease 2019 Patients Experiencing In-Hospital Cardiac Arrest?*
Authors: Shah Priyank , Smith Hallie , Olarewaju Ayodeji , Jani Yash , Cobb Abigail , Owens Jack , Moore Justin , Chenna Avantika , Hess David
Published: October 2020

Objectives:

There is limited data regarding outcomes after in-hospital cardiac arrest among coronavirus disease 2019 patients. None of the studies have reported the outcomes of in-hospital cardiac arrest in coronavirus disease 2019 patients in the United States. We describe the characteristics and outcomes of in-hospital cardiac arrest in coronavirus disease 2019 patients in rural Southwest Georgia.

Design:

Retrospective cohort study.

Setting:

Single-center, multihospital.

PATIENTS:

Consecutive coronavirus disease 2019 patients who experienced in-hospital cardiac arrest with attempted resuscitation.

Interventions:

Attempted resuscitation with advanced cardiac life support.

Measurement and Main Results:

Out of 1,094 patients hospitalized for coronavirus disease 2019 during the study period, 63 patients suffered from in-hospital cardiac arrest with attempted resuscitation and were included in this study. The median age was 66 years, and 49.2% were males. The majority of patients were African Americans (90.5%). The most common comorbidities were hypertension (88.9%), obesity (69.8%), diabetes (60.3%), and chronic kidney disease (33.3%). Eighteen patients (28.9%) had a Charlson Comorbidity Index of 0–2. The most common presenting symptoms were shortness of breath (63.5%), fever (52.4%), and cough (46%). The median duration of symptoms prior to admission was 14 days. During hospital course, 66.7% patients developed septic shock, and 84.1% had acute respiratory distress syndrome. Prior to in-hospital cardiac arrest, 81% were on ventilator, 60.3% were on vasopressors, and 39.7% were on dialysis. The majority of in-hospital cardiac arrest (84.1%) occurred in the ICU. Time to initiation of advanced cardiac life support protocol was less than 1 minute for all in-hospital cardiac arrest in the ICU and less than 2 minutes for the remaining patients. The most common initial rhythms were pulseless electrical activity (58.7%) and asystole (33.3%). Although return of spontaneous circulation was achieved in 29% patients, it was brief in all of them. The in-hospital mortality was 100%.

Conclusions:

In our study, coronavirus disease 2019 patients suffering from in-hospital cardiac arrest had 100% in-hospital mortality regardless of the baseline comorbidities, presenting illness severity, and location of arrest.
Patient-Centered Outcomes in an Interdisciplinary Clinic for Complex Children with Autism
Authors: Suen Catherine G. , Campbell Kathleen , Stoddard Gregory , Carbone Paul S.
Published: October 2020

Objective:

To compare the perspectives of caregivers of children with autism receiving care at the Neurobehavior Healthy Outcomes Medical Excellence (HOME) Program, an interdisciplinary clinic that provides primary care and behavioral/mental health services for patients with autism and other developmental disabilities, with those responding to the 2016 National Survey of Children's Health (NSCH). We focused on ratings related to shared decision-making, care coordination, family-centered care, and care within a medical home.

Methods:

We administered a subset of items from the 2016 NSCH to caregivers of children with autism enrolled in HOME and compared responses with the same items from a nationally representative group of caregivers of children with autism who completed the 2016 NSCH. We compared the proportions that reported receiving shared decision-making, care coordination, family-centered care, care within a medical home, and unmet needs among the 2 study groups using Poisson regression, controlling for age, sex, race/ethnicity, payor, autism severity, and intellectual disability (ID).

Results:

Compared with the NSCH cohort (n = 1151), children enrolled in HOME (n = 129) were older, more often female, had severe autism, and had co-occurring ID. Caregivers perceived that children receiving care within HOME more often received family-centered, coordinated care within a medical home compared with a national sample of children with autism. HOME enrollees also reported increased access to behavioral treatments and adult transition services with less financial burden compared with the national sample.

Conclusion:

An interdisciplinary clinic model may best serve children with autism, especially those with higher severity symptoms and co-occurring conditions.
CLINICAL OUTCOMES AND TREATMENT COURSE OF EYES WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION FOLLOWING THE DEVELOPMENT OF ENDOPHTHALMITIS
Authors: Koulisis Nicole , Moysidis Stavros N. , Govindaraju Viren K. , Dersch Anne Merrylees , Capone Antonio , Covert Douglas J. , Dadgostar Hajir , Dass A. Bawa , Drenser Kimberly A. , Engstrom Robert E. , Faia Lisa J. , Garretson Bruce R. , Guerami Amir H. , Hanscom Thomas A. , Mahmoud Tamer H. , Margherio Alan R. , Oh Kean T. , Randhawa Sandeep , Raphaelian Paul V. , Rhoades William R. , Ruby Alan J. , Sanfilippo Christian J. , Sneed Scott R. , Trese Michael T. , Wolfe Jeremy D. , Williams George A. , Yedavally Sunita , Hassan Tarek S.
Published: October 2020

Purpose:

To evaluate the clinical course of patients with neovascular age-related macular degeneration (nAMD) after developing endophthalmitis during their treatment with intravitreal injections.

Methods:

Multicenter, retrospective series.

Results:

From April 2013 to October 2018, 196,598 intravitreal anti–vascular endothelial growth factor (VEGF) injections were performed, with 75 cases of endophthalmitis (incidence 0.0381%). There was no association between intravitreal anti-VEGF drug (P = 0.29), anesthetic method (P = 0.26), povidone concentration (P = 0.22), or any intraprocedure variable and endophthalmitis incidence. Seventy-two patients (96%) were treated with intravitreal tap and inject , while 3 underwent immediate pars plana vitrectomy. After endophthalmitis resolution, 17 patients (22.7%) were not re-treated for nAMD (in 10 cases due to inactive disease; follow-up, 115 ± 8.4 weeks). Patients required less frequent anti-VEGF injections after infection (7.4 ± 0.61 weeks vs. 11.5 ± 1.8 weeks; P = 0.004). Preinfection logarithm of the minimum angle of resolution visual acuity was 0.585 ± 0.053 (∼20/77). It worsened with endophthalmitis (1.67 ± 0.08, ∼20/935; P < 0.001) and again on postendophthalmitis treatment day 1 (1.94 ± 0.064; count fingers; P < 0.001), but improved after reinitiating nAMD therapy (1.02 ± 0.11; ∼20/209; P < 0.001). Better visual acuity on postendophthalmitis week 1 (P = 0.002) and reinitiation of nAMD treatment (P = 0.008) were associated with better final visual acuity, and streptococcal culture with worse visual acuity (P = 0.028). The postendophthalmitis treatment interval was associated with the anti-VEGF drug used (aflibercept = ranibizumab > bevacizumab; P < 0.001).

Conclusion:

Patients with nAMD required fewer injections after endophthalmitis, suggesting a biological change in disease activity. Neovascular age-related macular degeneration became quiescent in 13.3% of eyes. Most achieved better outcomes with anti-VEGF reinitiation.
INTRAOPERATIVE AND POSTOPERATIVE MONITORING OF AUTOLOGOUS NEUROSENSORY RETINAL FLAP TRANSPLANTATION FOR A REFRACTORY MACULAR HOLE ASSOCIATED WITH HIGH MYOPIA
Authors: Takeuchi Jun , Kataoka Keiko , Shimizu Hideyuki , Tomita Ryo , Kominami Taro , Ushida Hiroaki , Kaneko Hiroki , Ito Yasuki , Terasaki Hiroko
Published: October 2020

Purpose:

To describe the intraoperative and postoperative morphological and functional outcomes after autologous neurosensory retinal flap transplantation (ART) for a high myopia–related refractory macular hole (MH).

Methods:

This prospective interventional study enrolled five eyes of five patients (age range 54–84 years) with highly myopic refractory MHs who underwent ART. All cases were evaluated with intraoperative optical coherence tomography and postoperative optical coherence tomography, optical coherence tomography angiography, and microperimetry for at least 6 months postoperatively.

Results:

Intraoperatively, the MH was covered by an ART flap with a persistent small subretinal space that was filled with the ART flap after 4 days to 6 days. Optical coherence tomography discriminated the original from the transplanted retina. The mean basal diameter of the original MH decreased from 1,504 ± 684 µm preoperatively to 1,111 ± 356 µm postoperatively. The best-corrected visual acuity improved in two cases, was stable in two cases, and deteriorated in one case. Microperimetry demonstrated no obvious postoperative changes in the fixation points and the absolute scotoma corresponding to the base of MHs with chorioretinal atrophy. In two eyes, choroidal neovascularization developed beneath the transplanted retinas.

Conclusion:

Transplanted tissue was in a fixed position by 1 week postoperatively with a decreased diameter of the original MH. Postoperative fixation points were on the original retina at the MH edge. Because choroidal neovascularization may develop, detailed monitoring is required.
Ethical and societal challenges in penis transplantation
Authors: van der Merwe André , Moosa Mogamat R. , Barsdorf Nicola
Published: October 2020

Purpose of review

To review the current understanding of the ethical and societal difficulties of penile transplantation.

Recent findings

Penile transplantation, as with other forms of vascularized composite allotransplantation, has increasing acceptance in society but is still not entirely accepted. Guidelines aiming to help guide future penile transplant programs in an ethical and scientific safe manner were created. Controversies regarding the economic impact, patient safety, and the rights of the patients choosing penile transplant remains.

Penile transplantation has excellent functional and cosmetic results in the short-term and medium-term. The penis, similar to the face in facial transplantation, carries emotional gravity that relates to visible body parts of another that live forth in a tangible manner contributing to psychological and ethical challenges for both the individual and society more broadly, healthcare administrators, and healthcare workers. In the context of these challenges, controversies emerge related to issues of judgment about what society can and wants to afford. Effects of toxic immunosuppression in a nonlife saving life-enhancing procedure, as well as costs, become arguments that have to be considered in the context of ethical and societal challenges.
Expedited placement to maximize utilization of marginal organs
Authors: Giorgakis Emmanouil , Mathur Amit K.
Published: October 2020

Purpose of review

Deceased donation represents the largest supply of organs for transplant in the United States. Organs with suboptimal characteristics related to donor disease or recovery-related issues are increasingly discarded at the time of recovery, prompting late allocation to candidates later in the match sequence. Late allocation contributes to organ injury by prolonging cold ischemia, which may further lead to the risk of organ discard, despite the potential to provide benefit to certain transplant candidates.

Recent findings

Expedited placement of marginal organs has emerged as a strategy to address the growing problem of organ discard of marginal organs that have been declined late after recovery. In this review, we describe the basis for expedited organ placement, and approaches to facilitating placement of these grafts, drawing examples from kidney and liver donation and transplantation globally.

There is significant global variation in practice related to late allocation. Multiple policy mechanisms exist to facilitate expedited placement, including simultaneous offers to multiple centers, predesignation of aggressive centers, and increasing organ procurement organization autonomy in late allocation. Optimizing late allocation of deceased donor organs holds significant promise to increase the number of transplants.
Health Information Exchange
Authors: Nahm Eun-Shim , Schoenbaum Anna , Behm Craig , Rowen Lisa
Published: October 2020

The US healthcare system is moving into a new era of value-based care, which focuses on delivering safer and higher quality care while reducing costs. Health information exchange (HIE) has been a vital component in this process; however, there has been a lack of awareness and use of HIE among nurse leaders, clinicians, and researchers. The purpose of this article is to provide nurses and administrators with a brief overview of HIE and its impact on care delivery, as well as practical applications using specific case examples.
Using Technology to Improve Capacity Management at a Pediatric Hospital
Authors: Foreman Cynthia , Stephens Kimberly , Swanson-Biearman Brenda , Acree Cynthia , Whiteman Kimberly
Published: October 2020

Bed flow decisions should be based on current information about capacity. The purpose of this project was to develop a real-time, enterprise-wide, capacity management dashboard. The dashboard successfully used information from the electronic medical record to create a comprehensive standardized data source, which was used to drive patient flow decisions optimizing bed space, allocating resources and maintaining safety.
Brief Report: Group Sex Among Men Who Have Sex With Men in the Era of PrEP: A Cross-Sectional Study
Authors: Phillips Tiffany R. , Fairley Christopher K. , Bradshaw Catriona S. , Hocking Jane S. , Choi Edmond P. H. , Ong Jason J. , Tabesh Marjan , Maddaford Kate , Chow Eric P. F.
Published: October 2020

Background:

Group sex has been commonly reported among gay and bisexual men who have sex with men (GBMSM); however, there are limited studies on the factors associated with participating in group sex.

Setting:

A cross-sectional study among GBMSM attending a sexual health clinic in Melbourne, Australia.

Methods:

Univariable and multivariable logistic regression were performed to examine the association between GBMSM participating in group sex in the previous 3 months and their demographic characteristics, including age, pre-exposure prophylaxis (PrEP) use, HIV status, any STI (gonorrhea, chlamydia, syphilis) diagnosis on the day, and method of seeking partners.

Results:

There were 357 GBMSM who participated in the survey and their mean age was 32.9 years (SD = 10.9). Almost a third (n = 115; 32.2%) had participated in group sex in the previous 3 months. GBMSM who sought sex partners at sex on premises venues (SOPVs) [aOR 5.83; 95% confidence interval (CI): 3.23 to 10.53] had the highest odds of group sex participation after adjusting for other potential confounders. Compared with GBMSM not living with HIV and not taking PrEP, GBMSM taking PrEP had higher odds of group sex participation (aOR 2.09; 95% CI: 1.05 to 4.15), but GBMSM living with HIV did not (aOR 0.93; 95% CI: 0.23 to 3.68).Recent group sex participation was not associated with being diagnosed with any STI (chlamydia, syphilis, or gonorrhea) on the day in the adjusted analyses.

Conclusion:

PrEP users and MSM attending SOPVs are more likely to participate in group sex. SOPV could be important venues for future public health campaigns.
The swine as a vehicle for research in trauma-induced coagulopathy: Introducing principal component analysis for viscoelastic coagulation tests
Authors: Brännström Andreas , von Oelreich Erik , Degerstedt Louise Elander , Dahlquist Albin , Hånell Anders , Gustavsson Jenny , Günther Mattias
Published: October 2020

BACKGROUND

Uncontrolled bleeding is the leading cause of potentially preventable deaths among trauma patients. Tissue injury and shock result in trauma-induced coagulopathy (TIC). There are still uncertainties regarding detection methods and best practice management for TIC, and a deeper understanding of the pathophysiology requires robust animal models. The applicability of swine in coagulation studies, particularly after trauma has not been sufficiently elucidated. We, therefore, evaluated the swine as a vehicle for TIC research in a selection of trauma modalities.

METHODS

Twenty-six landrace swine (3 females/23 males) (mean weight, 60.0 kg) were anesthetized and randomized to negative controls, receiving no manipulation (n = 5), positive controls by hemodilution (n = 5), pulmonary contusion without hemorrhage (n = 5), pulmonary contusion with hemorrhage (n = 5), and blast polytrauma with hypothermia, hypoperfusion, hypoventilation, and systemic inflammation (n = 6). A comprehensive coagulation panel was analyzed at baseline, 20 minutes and 120 minutes after trauma.

RESULTS

PT(INR), aPTT, thrombocytes, and fibrinogen did not change after trauma. D-dimer increased (p < 0.0001), prothrombin decreased (p < 0.05) and aPC decreased (p < 0.01) after polytrauma. PAI-1 decreased after pulmonary contusion with hemorrhage (p < 0.05). Positive controls displayed changes in PT(INR), thrombocytes, fibrinogen, prothrombin, aPC (p < 0.05). Principal Component Analysis of rotational thromboelastometry presented pathologic coagulation profiles in both polytrauma and positive control groups with vectors extending outside the 95% confidence interval, which were not detected in negative controls.

CONCLUSION

Coagulopathy was induced after severe porcine blast polytrauma, specifically detected in rotational thromboelastometry. A novel method for principal component analysis of viscoelastic tests was introduced which may increase the detection sensitivity and differentiation of TIC phenotypes and should be further investigated in trauma populations.
Antithrombin III ameliorates post–traumatic brain injury cerebral leukocyte mobilization enhancing recovery of blood brain barrier integrity
Authors: ElSaadani Mohamed , Ahmed Syed M. , Jacovides Christina , Lopez Alfonso , Johnson Victoria E. , Kaplan Lewis J. , Schwab C. William , Smith Douglas H. , Pascual Jose L.
Published: October 2020

BACKGROUND

Acute traumatic coagulopathy often accompanies traumatic brain injury (TBI) and may impair cognitive recovery. Antithrombin III (AT-III) reduces the hypercoagulability of TBI. Antithrombin III and heparinoids such as enoxaparin (ENX) demonstrate potent anti-inflammatory activity, reducing organ injury and modulating leukocyte (LEU) activation, independent of their anticoagulant effect. It is unknown what impact AT-III exerts on cerebral LEU activation and blood-brain barrier (BBB) permeability after TBI. We hypothesized that AT-III reduces live microcirculatory LEU–endothelial cell (EC) interactions and leakage at the BBB following TBI.

METHODS

CD1 mice (n = 71) underwent either severe TBI (controlled cortical impact (CCI), 6-m/s velocity, 1-mm depth, and 4-mm diameter) or sham craniotomy and then received either AT-III (250 IU/kg), ENX (1.5 mg/kg), or vehicle (saline) every 24 hours. Forty-eight hours post-TBI, cerebral intravital microscopy visualized in vivo penumbral microvascular LEU-EC interactions and microvascular leakage to assess BBB inflammation/permeability. Body weight loss and the Garcia neurological test (motor, sensory, reflex, balance) served as surrogates of clinical recovery.

RESULTS

Both AT-III and ENX similarly reduced in vivo penumbral LEU rolling and adhesion (p < 0.05). Antithrombin III also reduced live BBB leakage (p < 0.05). Antithrombin III animals demonstrated the least 48-hour body weight loss (8.4 ± 1%) versus controlled cortical impact and vehicle (11.4 ± 0.5%, p < 0.01). Garcia neurological test scores were similar among groups.

CONCLUSION

Antithrombin III reduces post-TBI penumbral LEU-EC interactions in the BBB leading to reduced neuromicrovascular permeability. Antithrombin III further reduced body weight loss compared with no therapy. Further study is needed to determine if these AT-III effects on neuroinflammation affect longer-term neurocognitive recovery after TBI.
Reporting and Handling of Missing Participant Data in Systematic Reviews of Kidney Transplant Studies
Authors: Budhiraja Pooja , Kalot Mohamad A. , Alayli Abdallah El , Dimassi Ahmad , Kaplan Bruce , Chakkera Harini A. , Mustafa Reem A.
Published: October 2020

Background.

Participant withdrawal from clinical trials occurs for various reasons, predominantly adverse effects or intervention inefficacy. Because these missing participant data can have implications for the validity, reproducibility, and generalizability of study results, when conducting a systematic review, it is important to collect and appropriately analyze missing data information to assess its effects on the robustness of the study results.

Methods.

In this methodologic survey of missing participant data reporting and handling in systematic reviews, we included meta-analyses that provided pooled estimates of at least 1 dichotomous intervention outcome of a randomized controlled trial performed in adult kidney transplant subjects.

Results.

Eighty-three systematic reviews (17 Cochrane and 66 non-Cochrane reviews) met the inclusion criteria. The most common intervention was drugs (80%), with the majority involving immunosuppressant drugs 55% (n = 46), followed by surgery in 14% (n = 12). The median follow-up duration was 12 months (maximum, 240 mo). Intention-to-treat or modified intention-to-treat analysis was reported in 24% (n = 20) of the reviews (76% of Cochrane and 10% of non-Cochrane). Overall, the majority of systematic reviews did not quantify (90% [n = 60] non-Cochrane and 29% [n = 5] Cochrane) or include the reasons for missing participant data (88% [n = 58] non-Cochrane and 24% [n = 4] Cochrane). Eleven percent (n = 9) handled missing participant data, 5% (n = 4) justified the analytical method(s) used to handle it, and 2% (n = 2) performed a sensitivity analysis for it.

Conclusions.

Systematic reviews of kidney transplantation provide inadequate information on missing participant data and usually do not handle or discuss the associated risk of bias with it.
Combination of a CD26 Inhibitor, G-CSF, and Short-term Immunosuppressants Modulates Allotransplant Survival and Immunoregulation in a Rodent Hindlimb Allotransplant Model
Authors: Chen Chien-Chang , Chen Rong-Fu , Wang Yu-Chi , Li Yun-Ting , Chuang Jiin-Haur , Kuo Yur-Ren
Published: October 2020

Background.

Recent studies have demonstrated that inhibition of CD26 potentiates stromal cell–derived factor-1α (SDF-1α), promotes tissue regeneration, and suppresses the rejection of organ transplants. This study investigated whether the combination of a CD26 inhibitor (CD26i) with granulocyte colony-stimulating factor (G-CSF) and short-term immunosuppressants modulates vascularized composite tissue allotransplant survival in a rodent orthotopic hindlimb allotransplant model.

Methods.

The hindlimb allotransplantation from Brown-Norway to Lewis rats was divided into 4 groups. Group 1 (controls) did not receive any treatment. Group 2 was treated with short-term antilymphocyte serum (ALS) and cyclosporine-A (CsA). Group 3 was administrated CD26i and G-CSF. Group 4 received a combination of CD26i/G-CSF/ALS/CsA. Each subgroup comprised 10 rats. Peripheral blood and sampling of transplanted tissues were collected for immunological and histological analysis.

Results.

The results revealed that allotransplant survival was found to be significantly prolonged in group 4 with CD26i/G-CSF/ALS/CsA treatment compared with those in the other groups. The interleukin-10 and transforming growth factor-βl levels, the percentage of CD4+/CD25+/FoxP3+ T cells, as well as the levels of SDF-1α expressions were significantly increased in group 4 compared with those in the other groups. Group 4 revealed a statistical increase in the percentage of donor cells (RT1n) expression in the recipient peripheral blood, and the mixed lymphocyte reaction showed hyporesponsiveness of the T cells to donor alloantigens.

Conclusion.

The combination of CD26i/G-CSF and short-term immunosuppressants prolongs allotransplant survival by inducing immunoregulatory effects and enhancing the percentage of SDF-1α expression. This immunomodulatory approach has great potential as a strategy to increase vascularized composite allotransplantation survival.
Neighborhood environment, social cohesion, and epigenetic aging
Authors: Martin Chantel L. , Ward-Caviness Cavin K. , Dhingra Radhika , Zikry Tarek M. , Galea Sandro , Wildman Derek E. , Koenen Karestan C. , Uddin Monica , Aiello Allison E
Published: October 2020

Living in adverse neighborhood environments have been linked to increased risk of aging-related diseases and mortality; however, the biological mechanisms explaining this observation remain poorly understood. DNA methylation (DNAm), a proposed biomarker of biological aging responsive to environmental stressors, offers promising insight into molecular pathways. We examined associations of three measures of neighborhood conditions (poverty, quality, and social cohesion) with three different epigenetic clocks (Horvath, Hannum, and Levine) using data from the Detroit Neighborhood Health Study (n=158). Using linear regression models, we evaluated associations in the total sample and stratified by gender and social cohesion. Differential effects by gender were found between men and women. Neighborhood poverty was associated with PhenoAge acceleration among women, but not among men (women: β = 1.4; 95% CI: −0.4, 3.3 vs. men: β = −0.3; 95% CI: −2.2, 1.5) in fully adjusted models. In models stratified on social cohesion, association of neighborhood poverty and quality with accelerated DNAm aging remained elevated for residents living in neighborhoods with lower social cohesion, but were null for those living in neighborhoods with higher social cohesion. Our study suggests that living in adverse neighborhood conditions can speed up epigenetic aging, while positive neighborhood characteristics may buffer effects.
HeartBioPortal2.0: new developments and updates for genetic ancestry and cardiometabolic quantitative traits in diverse human populations
Authors: Khomtchouk Bohdan B. , Vand Kasra A. , Nelson Christopher S. , Palmisano Salvator , Grossman Robert L.
Published: October 2020

Cardiovascular disease (CVD) is the leading cause of death worldwide for both genders and across most racial and ethnic groups. However, different races and ethnicities exhibit different rates of cardiovascular disease and its related cardiorenal and metabolic co-morbidities, suggesting differences in genetic predisposition and risk of onset, as well as socioeconomic and lifestyle factors (diet, exercise, etc.) that act upon an individual’s unique underlying genetic background. Here we present HeartBioPortal2.0, a major update to HeartBioPortal, the world’s largest CVD genetics data precision medicine platform for harmonized CVD-relevant genetic variants, which now enables search and analysis of human genetic information related to heart disease across ethnically diverse populations and cardiovascular/renal/metabolic quantitative traits pertinent to CVD pathophysiology. HeartBioPortal2.0 is structured as a cloud-based computing platform and knowledge portal that consolidates a multitude of CVD-relevant next-generation sequencing data modalities into a single powerful query and browsing interface between data and user via a user-friendly web application publicly available to the scientific research community. Since its initial release, HeartBioPortal2.0 has added new cardiovascular/renal/metabolic disease relevant gene expression data as well as genetic association data from numerous large-scale genome-wide association study (GWAS) consortiums such as CARDIoGRAMplusC4D, TOPMed, FinnGen, AFGen, MESA, MEGASTROKE, UK Biobank, CHARGE, Biobank Japan, MyCode, among other studies. In addition, HeartBioPortal2.0 now includes support for quantitative traits and ethnically diverse populations, allowing users to investigate the shared genetic architecture of any gene or its variants across the continuous cardiometabolic spectrum from health (e.g., blood pressure traits) to disease (hypertension), facilitating the understanding of CVD trait genetics that inform health-to-disease transitions and endophenotypes. Custom visualizations in the new and improved user interface (UI), including performance enhancements and new security features such as user authentication collectively re-imagine HeartBioPortal’s user experience and provide a data commons that co-locates data, storage and computing infrastructure in the context of studying the genetic basis behind the leading cause of global mortality.

Database URL

https://www.heartbioportal.com/
Sanitation and Diarrheal Morbidity: Evidence from Afghanistan
Authors: Malik Manzoor Ahmad , Akhtar Saddaf Naaz
Published: October 2020

Introduction

Lack of sanitation facilities and inadequate water is key to many diseases’ outcomes, mainly diarrhea. These factors not just affect the health status of a country and but also result in increased mortality and morbidity pattern, particularly among the vulnerable population like children and women. Thus, the study assesses the linkages between diarrheal diseases and sanitation in Afghanistan affected since long by political instability which has derailed the health system of the country.

Material and Methods

We used 2015 Afghanistan Demographic and Health Survey to assess the linkages between sanitation and diarrheal diseases among under-five children. Bivariate and multivariate analyses have used to carry out the study. The logistic model was used to evaluate the risk factors that lead to diarrheal outcomes.

Results

Our findings from the results showed that the prevalence of diarrhea among under-five children in Afghanistan was 29%. Pashai is the most affected, with 36% among ethnicities, whereas eastern Afghanistan is the most affected region with the prevalence of (38%). Open defecated Population (OR: 1.17, p<0.001), Tap water (OR: 1.31, p<0.001), Well water (OR: 1.24, p<0.001), and Sharing toilet (OR: 1.15, p<0.001) are significantly associated with childhood diarrhea.

Conclusions

A significant impact has found with factors like-inadequate sanitation, shared toilet facility, clean water and other elements with childhood diarrhea in Afghanistan. The region-wise difference has also found to be very high across the regions. Thus, it has found that a lack of such factors has a more significant impact on the health of children and needs a particular focus from a policy purpose.
Positive allosteric modulators of lecithin:cholesterol acyltransferase adjust the orientation of the membrane-binding domain and alter its spatial free energy profile
Authors: Niemelä Akseli , Koivuniemi Artturi
Published: October 2020

Lecithin:cholesterol acyltransferase protein (LCAT) promotes the esterification reaction between cholesterol and phospholipid derived acyl chains. Positive allosteric modulators have been developed to treat LCAT deficiencies and, plausibly, also cardiovascular diseases in the future. The mechanism of action of these compounds is poorly understood. Here computational docking and atomistic molecular dynamics simulations were utilized to study the interactions between LCAT and the activating compounds. Results indicate that all drugs bind to the allosteric binding pocket in the membrane-binding domain in a similar fashion. The presence of the compounds in the allosteric site results in a distinct spatial orientation and sampling of the membrane-binding domain (MBD). The MBD’s different spatial arrangement plausibly affects the lid’s movement from closed to open state andvice versa, as suggested by steered molecular dynamics simulations.