bluuebunny/crossref_metadata_2025 huggingface dataset:
Early findings of a nurse‐led youth activist program in mind caring
Authors: Aekwarangkoon Saifon , LeClair Jessica , Oakley Linda Denise
Published: April 2022

Background

: School‐based youth activist programs in mind caring have been shown to support the mental health and learning needs of adolescent students.

Methods

: We used collaborative action research methods to implement a nurse‐led mind caring youth activist program for a rural, extended opportunity school in Thailand. The participants (N = 67) were the public health nurse assigned to the school, students willing to become youth activists (n = 42), school teachers and staff (n = 7), university psychiatric mental health nursing faculty (n = 2), and volunteer nursing students (n = 16). Qualitative thematic analyses methods were used to explore the transcripts of the participant's reflection circles and confirmatory interviews for evidence of effective program implementation.

Results

: Major themes of change and growth were identified. Youth activists students said mind caring improved their mental health. Teachers described having a more positive attitude towards students’ mental health and learning needs. Nursing students found optimistic confidence and self‐awareness in the hands‐on experience with the complex role responsibilities in public health nursing.

Conclusion

: These results provide early evidence of stakeholder satisfaction with the implementation of a school‐based youth activist program as collaborative action for organizational change.
Intercropping of Pennisetum sinese with Lolium perenne improved phytoextraction of heavy metal from soil
Authors: Zou Wentong , Cao Zhi , Wang Yanjun , Jin Meifang , Lin Maozi
Published: April 2022

In order to find the optimum planting pattern for phytoremediation of metal‐accumulating plants in heavy metal‐contaminated soils, Pennisetum sinese and Lolium perenne were intercropped or monocultured, and the plant leaf physiological indexes as well as the heavy metal contents and accumulation of the two plants were determined. The contents, accumulation, and bioconcentration of Pb, Cd, Cu, and Zn in different parts of the two plants under the intercropping method were significantly (p < 0.05) higher than those under the monoculture method. The average accumulation amounts of Pb, Cd, Cu, and Zn in P. sinese under the intercropping method are 29.51, 19.60, 182.8, and 178.2 μg/plant in leaves; 8.89, 17.99, 61.68, and 205.4 μg/plant in stems; and 8.45, 2.18, 36.35, and 47.94 μg/plant in roots, respectively. The average accumulation amounts of Pb, Cd, Cu, and Zn in L. perenne under the intercropping method are 2.30, 1.40, 23.29, and 33.34 μg/plant in shoots and 1.43, 0.42, 3.21, and 6.98 μg/plant in roots, respectively. Thus, P. sinese has higher heavy metal accumulation. Compared with the monocultured plants, the average accumulation amounts of Pb, Cd, Cu, and Zn increased in both two plants. Therefore, intercropping P. sinese and L. perenne was the optimum planting pattern for heavy metal‐contaminated soil phytoremediation, and P. sinese was more suitable for heavy metal phytoextraction from soil.
Plains rough fescue grassland restoration using natural regeneration after pipeline disturbances
Authors: Elsinger Mae E. , Dhar Amalesh , Naeth M. Anne
Published: April 2022

Plains rough fescue (Festuca hallii), once a dominant grassland in the Northern Great Plains, has been reduced to a fraction of its original extent by agricultural intensification and energy sector disturbances and has become a threatened community type. Despite thousands of kilometers of pipelines in grasslands, little is documented about long‐term restoration outcomes. This research assessed recovery of rough fescue grassland 6–21 years after pipeline construction with topsoil stripping and natural regeneration relative to undisturbed reference sites in south‐central Canada. Soil properties varied between pipelines and undisturbed prairie, although most were within theoretical values to support plant growth and development. Vegetation cover, species richness and Shannon diversity and evenness did not differ significantly between pipelines and undisturbed prairie. Multivariate analysis (multi‐response permutation procedure) showed plant community composition, and its dominant species differed significantly between pipelines and undisturbed prairie. Bray–Curtis dissimilarity indices showed dominant species and functional species groups on pipelines were more similar to undisturbed prairie than the undesirable species group. Presence of early‐ to late‐successional species and increasing F. hallii with pipeline age indicate restoration was possible with topsoil salvage and replacement, using natural regeneration as a revegetation method, but requires time to develop and restore a typical rough fescue grassland ecosystem.
GA3‐mediated reforestation pioneering mechanism of actinorhizal Elaeagnus conferta Roxb. in the slashed and burnt shifting cultivation lands in India's megadiversity hotspot
Authors: Shaikh Maroof , Bahulikar Rahul , Chitnis Akhilesh , Pandit Sagar
Published: April 2022

Forest slashing and burning is a key characteristic of shifting cultivation. Its intensification is a major anthropogenic cause of deforestation, as it reduces forest resilience. We analyzed the reforestation process in the regenerating shifting cultivation lands in India's Western Ghats, a megadiversity hotspot. An actinorhizal shrub, Elaeagnus conferta, was associated with the regenerating thickets' higher density and higher species diversity. Its presence increased the thicket density by >2.8‐fold and the species diversity by >2.5‐fold; these thickets showed >1.5‐fold higher Shannon's diversity index than those without it. Moreover, the thickets containing E. conferta showed >7‐fold more multi‐species seedlings. Liquid chromatography‐mass spectrometry analysis showed that rhizosphere soils of E. conferta containing thickets had >10‐fold higher gibberellic acid (GA3) concentrations than the E. conferta‐deplete thickets. When E. conferta was potted separately, its root nodules, roots, and rhizosphere soil showed about 3.6, 2.0, and 0.4 μg/g GA3, respectively. These E. conferta root and rhizosphere soil GA3 concentrations were >10‐fold higher than those shown by other co‐occurring species. These elevated GA3 levels were likely due to E. conferta's association with the rhizosymbiont Frankia elaeagni. Frankia elaeagni's GA3 synthesis may promote plant recruitment by stimulating seed germination and explain why we measured higher seedling density and plant diversity in E. conferta containing thickets. We hypothesize that E. conferta plays a two‐stage pioneering role in the reforestation process by providing GA3 to facilitate seed germination and providing nitrogen for the developing plantlets. We recommend the inclusion of E. conferta in Western Ghats' reforestation programs.
Advances and applications of single‐cell omics technologies in plant research
Authors: Mo Yajin , Jiao Yuling
Published: April 2022

Single‐cell sequencing approaches reveal the intracellular dynamics of individual cells and answer biological questions with high‐dimensional catalogs of millions of cells, including genomics, transcriptomics, chromatin accessibility, epigenomics, and proteomics data across species. These emerging yet thriving technologies have been fully embraced by the field of plant biology, with a constantly expanding portfolio of applications. Here, we introduce the current technical advances used for single‐cell omics, especially single‐cell genome and transcriptome sequencing. Firstly, we overview methods for protoplast and nucleus isolation and genome and transcriptome amplification. Subsequently, we use well‐executed benchmarking studies to highlight advances made through the application of single‐cell omics techniques. Looking forward, we offer a glimpse of additional hurdles and future opportunities that will introduce broad adoption of single‐cell sequencing with revolutionary perspectives in plant biology.
Melanocore uptake by keratinocytes occurs through phagocytosis and involves protease‐activated receptor‐2 internalization
Authors: Moreiras Hugo , Bento‐Lopes Liliana , Neto Matilde V. , Escrevente Cristina , Cabaço Luís C. , Hall Michael J. , Ramalho José S. , Seabra Miguel C. , Barral Duarte C.
Published: April 2022

In the skin epidermis, melanin is produced and stored within melanosomes in melanocytes, and then transferred to keratinocytes. Different models have been proposed to explain the melanin transfer mechanism, which differ essentially in how melanin is transferred—either in a membrane‐bound melanosome or as a melanosome core, that is, melanocore. Here, we investigated the endocytic route followed by melanocores and melanosomes during internalization by keratinocytes, by comparing the uptake of melanocores isolated from the supernatant of melanocyte cultures, with melanosomes isolated from melanocytes. We show that inhibition of actin dynamics impairs the uptake of both melanocores and melanosomes. Moreover, depletion of critical proteins involved in actin‐dependent uptake mechanisms, namely Rac1, CtBP1/BARS, Cdc42 or RhoA, together with inhibition of Rac1‐dependent signaling pathways or macropinocytosis suggest that melanocores are internalized by phagocytosis, whereas melanosomes are internalized by macropinocytosis. Interestingly, we found that Rac1, Cdc42 and RhoA are differently activated by melanocore or melanosome stimulation, supporting the existence of two distinct routes of melanin internalization. Furthermore, we show that melanocore uptake induces protease‐activated receptor‐2 (PAR‐2) internalization by keratinocytes to a higher extent than melanosomes. Because skin pigmentation was shown to be regulated by PAR‐2 activation, our results further support the melanocore‐based mechanism of melanin transfer and further refine this model, which can now be described as coupled melanocore exo/phagocytosis.
Transmission of SARS‐CoV‐2 Delta variant (B.1.617.2) from a fully vaccinated human to a canine in Georgia, July 2021
Authors: Wendling Natalie M. , Carpenter Ann , Liew Amanda , Ghai Ria R. , Gallardo‐Romero Nadia , Stoddard Robyn A. , Tao Ying , Zhang Jing , Retchless Adam C. , Ahmad Ausaf , Bunkley Paige , Godino Claire , Mauldin Matthew R. , Varela Kate , Ritter Jana M. , Hennebelle Janemarie , Feldpausch Amanda , Gabel Julie , Kainulainen Markus H. , Herzegh Owen , Tong Suxiang , Spengler Jessica R. , Barton Behravesh Casey
Published: April 2022

SARS‐CoV‐2 infection has been described in a wide range of species, including domestic animals such as dogs and cats. Illness in dogs is usually self‐limiting, and further diagnostics may not be pursued if clinical signs resolve or they respond to empirical treatment. As new variants emerge, the clinical presentation and role in transmission may vary in animals. This report highlights different clinical presentations and immunological responses in two SARS‐CoV‐2 Delta‐variant‐positive dogs with similar exposure to the same fully vaccinated human with a SARS‐CoV‐2 infection and emphasizes the need for active surveillance and additional One Health research on SARS‐CoV‐2 variant infections in companion animals and other species.
Interactions Between Solid Electrolyte Interphase and Lithium Dendrite
Authors: Wang Yunxiang , Hao Feng
Published: April 2022

Li metal batteries (LMBs) are one of the most promising high-energy-density batteries. However, solid electrolyte interphase (SEI) and Li dendrite substantially form in LMBs. Due to low ionic conductivity, inhomogeneity, and poor mechanical and electrochemical stability of native SEI, dendritic Li nucleates and grows, which in turn induces the fracture of SEI and promotes the formation of new SEI, causing the loss of active materials and safety issues for LMBs. Understanding the SEI–dendrite interactions could play a critical role in developing LMBs. For instance, modified SEI has been demonstrated to suppress dendrite growth and improve battery performance. In this short review, we discuss the underlying mechanisms of SEI–dendrite interactions and strategies for improving battery cycling performance.
Lithium-Ion Battery Strain Gauge Monitoring and Depth of Discharge Estimation
Authors: Hendricks Christopher , Sood Bhanu , Pecht Michael
Published: April 2022

Lithium-ion battery diagnostics and prognostics rely on measurements of electrical impedance, capacity, and voltage to infer the internal state of the battery. Mechanical changes to the cell structure represent an additional measure of the battery’s state because these changes are related to the overall battery health. As lithium-ion batteries are charged and discharged, lithium ions are inserted or removed from the anode and cathode, a process called intercalation and deintercalation. As lithium ions intercalate and de-intercalate, they can cause changes to the lattice of the electrode particles, resulting in volumetric changes. These volumetric changes cause mechanical stresses and strains on the lithium-ion battery electrodes, and subsequently, the whole cell’s thickness varies as it is charged and discharged. This paper presents a study on the use of surface-mounted strain gauges for in-situ measurement of structural changes to lithium-ion batteries, along with a characterization of the unit-to-unit differences in strain response. A neural network modeling structure is then used to predict the battery’s depth of discharge under dynamic discharge conditions.
Design of Type 3 High-Pressure Vessel Liner (Al 6061) for Hydrogen Vehicles
Authors: Lee Changhwan , Park Gunyoung , Kim Chul
Published: April 2022

The liner of type 3 high-pressure vessel is manufactured by a D.D.I. (Deep drawing and ironing) process for the cylinder part, which is a continuous process that includes a drawing process to reduce the diameter of the billet and a subsequent ironing process to reduce the thickness of the billet. But the wall thickness of type 3 pressure vessel liners used in vehicles and ships is required to be 5 mm. Excessive wall thickness not only increases the weight of hydrogen vehicles and ships equipped with type 3 high-pressure vessels but also deteriorates their transportation efficiency. But the forming process of the cylinder part of the high-pressure vessel liner (Al6061) has a total of three stages (first deep drawing with blank holder, second redrawing, third redrawing + ironing) through which the wall thickness is manufactured up to 6.8 mm in the actual field. In this study, the maximum drawing ratio and die inflow angle in the first-stage deep drawing process by using the shape factor formula of the tractrix die and combined process (redrawing + ironing) in the third stage were determined in order to manufacture a liner with a wall thickness of 5 mm within the existing three stages, including saving of die costs. Using damage value verified through finite element analysis and experiment and based on the above results, design of the D.D.I. process (three stages) was performed, and its results were verified.
Tracing brain genotoxic stress in Parkinson’s disease with a novel single-cell genetic sensor
Authors: El-Saadi Madison Wynne , Tian Xinli , Grames Mychal , Ren Michael , Keys Kelsea , Li Hanna , Knott Erika , Yin Hong , Huang Shile , Lu Xiao-Hong
Published: April 2022

To develop an in vivo tool to probe brain genotoxic stress, we designed a viral proxy as a single-cell genetic sensor termed PRISM that harnesses the instability of recombinant adeno-associated virus genome processing and a hypermutable repeat sequence–dependent reporter. PRISM exploits the virus-host interaction to probe persistent neuronal DNA damage and overactive DNA damage response. A Parkinson’s disease (PD)–associated environmental toxicant, paraquat (PQ), inflicted neuronal genotoxic stress sensitively detected by PRISM. The most affected cell type in PD, dopaminergic (DA) neurons in substantia nigra, was distinguished by a high level of genotoxic stress following PQ exposure. Human alpha-synuclein proteotoxicity and propagation also triggered genotoxic stress in nigral DA neurons in a transgenic mouse model. Genotoxic stress is a prominent feature in PD patient brains. Our results reveal that PD-associated etiological factors precipitated brain genotoxic stress and detail a useful tool for probing the pathogenic significance in aging and neurodegenerative disorders.
Northern Hemisphere vegetation change drives a Holocene thermal maximum
Authors: Thompson Alexander J. , Zhu Jiang , Poulsen Christopher J. , Tierney Jessica E. , Skinner Christopher B.
Published: April 2022

The Holocene thermal maximum, a period of global warmth evident in early to mid-Holocene proxy reconstructions, is controversial. Most model simulations of the Holocene have not reproduced this warming, leading to a disagreement known as the Holocene Temperature Conundrum. Pollen records document the expansion of vegetation in the early and mid-Holocene African Sahara and Northern Hemisphere mid- and high latitudes, which has been overlooked in previous modeling studies. Here, we use time slice simulations of the Community Earth System Model to assess the impact of Northern Hemisphere vegetation change on Holocene annual mean temperatures. Our simulations indicate that expansion of Northern Hemisphere vegetation 9000 and 6000 years ago warms Earth’s surface by ~0.8° and 0.7°C, respectively, producing a better match with proxy-based reconstructions. Our results suggest that vegetation change is critical for modeling Holocene temperature evolution and highlight its role in driving a mid-Holocene temperature maximum.
Cln5 represents a new type of cysteine-based
S
-depalmitoylase linked to neurodegeneration
Authors: Luebben Anna V. , Bender Daniel , Becker Stefan , Crowther Lisa M. , Erven Ilka , Hofmann Kay , Söding Johannes , Klemp Henry , Bellotti Cristina , Stäuble Andreas , Qiu Tian , Kathayat Rahul S. , Dickinson Bryan C. , Gärtner Jutta , Sheldrick George M. , Krätzner Ralph , Steinfeld Robert
Published: April 2022

Genetic
CLN5
variants are associated with childhood neurodegeneration and Alzheimer’s disease; however, the molecular function of ceroid lipofuscinosis neuronal protein 5 (Cln5) is unknown. We solved the Cln5 crystal structure and identified a region homologous to the catalytic domain of members of the N1pC/P60 superfamily of papain-like enzymes. However, we observed no protease activity for Cln5; and instead, we discovered that Cln5 and structurally related PPPDE1 and PPPDE2 have efficient cysteine palmitoyl thioesterase (
S
-depalmitoylation) activity using fluorescent substrates. Mutational analysis revealed that the predicted catalytic residues histidine-166 and cysteine-280 are critical for Cln5 thioesterase activity, uncovering a new cysteine-based catalytic mechanism for
S
-depalmitoylation enzymes. Last, we found that Cln5-deficient neuronal progenitor cells showed reduced thioesterase activity, confirming live cell function of Cln5 in setting
S
-depalmitoylation levels. Our results provide new insight into the function of Cln5, emphasize the importance of
S
-depalmitoylation in neuronal homeostasis, and disclose a new, unexpected enzymatic function for the N1pC/P60 superfamily of proteins.
Piezoelectric ultrasound energy–harvesting device for deep brain stimulation and analgesia applications
Authors: Zhang Tao , Liang Huageng , Wang Zhen , Qiu Chaorui , Peng Yuan Bo , Zhu Xinyu , Li Jiapu , Ge Xu , Xu Jianbo , Huang Xian , Tong Junwei , Ou-Yang Jun , Yang Xiaofei , Li Fei , Zhu Benpeng
Published: April 2022

Supplying wireless power is a challenging technical problem of great importance for implantable biomedical devices. Here, we introduce a novel implantable piezoelectric ultrasound energy–harvesting device based on Sm-doped Pb(Mg
1/3
Nb
2/3
)O
3
-PbTiO
3
(Sm-PMN-PT) single crystal. The output power density of this device can reach up to 1.1 W/cm
2
in vitro, which is 18 times higher than the previous record (60 mW/cm
2
). After being implanted in the rat brain, under 1-MHz ultrasound with a safe intensity of 212 mW/cm
2
, the as-developed device can produce an instantaneous effective output power of 280 μW, which can immediately activate the periaqueductal gray brain area. The rat electrophysiological experiments under anesthesia and behavioral experiments demonstrate that our wireless-powered device is well qualified for deep brain stimulation and analgesia applications. These encouraging results provide new insights into the development of implantable devices in the future.
On-demand modulating afterglow color of water-soluble polymers through phosphorescence FRET for multicolor security printing
Authors: Peng Hao , Xie Gaozhan , Cao Yang , Zhang Longyan , Yan Xi , Zhang Xiao , Miao Shihao , Tao Ye , Li Huanhuan , Zheng Chao , Huang Wei , Chen Runfeng
Published: April 2022

Developing full-color organic ultralong room temperature phosphorescence (OURTP) materials with continuously variable afterglow emission is of considerable practical importance in diverse optoelectronic applications but remains a formidable challenge. Here, we present an effective strategy for on-demand engineering of afterglow color in water-soluble polymeric systems via efficient phosphorescence Förster resonance energy transfer. Using a blue afterglow emitting water-soluble polymer as host and a series of fluorescent emitters with varied emissive colors as guests, afterglow emission is rationally modulated, conferring the full-color afterglow emission ranging from blue to red and even white with ultralong lifetimes up to 4.2 s and photoluminescence quantum yields of 36%.These water-soluble multicolor-emitting polymeric afterglow systems can function as OURTP security inks, and multilevel information encryption was successfully established by RGB-based multicolor security printing. These results present important guidance in developing high-performance afterglow polymers with on-demand color tuning ability for remarkable optoelectronic applications.
Observation of topological Hall torque exerted on a domain wall in the ferromagnetic oxide SrRuO
3
Authors: Yamanouchi Michihiko , Araki Yasufumi , Sakai Takaki , Uemura Tetsuya , Ohta Hiromichi , Ieda Jun’ichi
Published: April 2022

In a ferromagnetic Weyl metal SrRuO
3
, a large effective magnetic field
H
eff
exerted on a magnetic domain wall (DW) by current has been reported. We show that the ratio of
H
eff
to current density exhibits nonmonotonic temperature dependence and surpasses those of conventional spin-transfer torques and spin-orbit torques. This enhancement is described well by topological Hall torque (THT), which is exerted on a DW by Weyl electrons emerging around Weyl points when an electric field is applied across the DW. The ratio of the
H
eff
arising from the THT to current density is over one order of magnitude higher than that originating from spin-transfer torques and spin-orbit torques reported in metallic systems, showing that the THT may provide a better way for energy-efficient manipulation of magnetization in spintronics devices.
Pressure and stiffness sensing together regulate vascular smooth muscle cell phenotype switching
Authors: Swiatlowska Pamela , Sit Brian , Feng Zhen , Marhuenda Emilie , Xanthis Ioannis , Zingaro Simona , Ward Matthew , Zhou Xinmiao , Xiao Qingzhong , Shanahan Cathy , Jones Gareth E. , Yu Cheng-han , Iskratsch Thomas
Published: April 2022

Vascular smooth muscle cells (VSMCs) play a central role in the progression of atherosclerosis, where they switch from a contractile to a synthetic phenotype. Because of their role as risk factors for atherosclerosis, we sought here to systematically study the impact of matrix stiffness and (hemodynamic) pressure on VSMCs. Thereby, we find that pressure and stiffness individually affect the VSMC phenotype. However, only the combination of hypertensive pressure and matrix compliance, and as such mechanical stimuli that are prevalent during atherosclerosis, leads to a full phenotypic switch including the formation of matrix-degrading podosomes. We further analyze the molecular mechanism in stiffness and pressure sensing and identify a regulation through different but overlapping pathways culminating in the regulation of the actin cytoskeleton through cofilin. Together, our data show how different pathological mechanical signals combined but through distinct pathways accelerate a phenotypic switch that will ultimately contribute to atherosclerotic disease progression.
Elucidation of master allostery essential for circadian clock oscillation in cyanobacteria
Authors: Furuike Yoshihiko , Mukaiyama Atsushi , Ouyang Dongyan , Ito-Miwa Kumiko , Simon Damien , Yamashita Eiki , Kondo Takao , Akiyama Shuji
Published: April 2022

Spatiotemporal allostery is the source of complex but ordered biological phenomena. To identify the structural basis for allostery that drives the cyanobacterial circadian clock, we crystallized the clock protein KaiC in four distinct states, which cover a whole cycle of phosphor-transfer events at Ser
431
and Thr
432
. The minimal set of allosteric events required for oscillatory nature is a bidirectional coupling between the coil-to-helix transition of the Ser
431
-dependent phospho-switch in the C-terminal domain of KaiC and adenosine 5′-diphosphate release from its N-terminal domain during adenosine triphosphatase cycle. An engineered KaiC protein oscillator consisting of a minimal set of the identified master allosteric events exhibited a monophosphorylation cycle of Ser
431
with a temperature-compensated circadian period, providing design principles for simple posttranslational biochemical circadian oscillators.
Combinatorial wound healing therapy using adhesive nanofibrous membrane equipped with wearable LED patches for photobiomodulation
Authors: Lee So Yun , Jeon Sangheon , Kwon Young Woo , Kwon Mina , Kang Moon Sung , Seong Keum-Yong , Park Tae-Eon , Yang Seung Yun , Han Dong-Wook , Hong Suck Won , Kim Ki Su
Published: April 2022

Wound healing is the dynamic tissue regeneration process replacing devitalized and missing tissue layers. With the development of photomedicine techniques in wound healing, safe and noninvasive photobiomodulation therapy is receiving attention. Effective wound management in photobiomodulation is challenged, however, by limited control of the geometrical mismatches on the injured skin surface. Here, adhesive hyaluronic acid–based gelatin nanofibrous membranes integrated with multiple light-emitting diode (LED) arrays are developed as a skin-attachable patch. The nanofibrous wound dressing is expected to mimic the three-dimensional structure of the extracellular matrix, and its adhesiveness allows tight coupling between the wound sites and the flexible LED patch. Experimental results demonstrate that our medical device accelerates the initial wound healing process by the synergetic effects of the wound dressing and LED irradiation. Our proposed technology promises progress for wound healing management and other biomedical applications.
Fatal overdose ofTaxus baccataplant matter treated in a rural district general hospital
Authors: Vallis-Booth Emma , Moore Sophie
Published: April 2022

A 25-year-old woman presented with cardiogenic shock following intentional overdose of Common Yew (Taxus baccata). The pharmacological mechanisms underlying yew toxicity resulted in failure of multiple treatment modalities including inotropes, vasopressors and attempted pacing. Resuscitation was ultimately unsuccessful. The limited literature available on this kind of overdose suggests that early extracorporeal membrane oxygenation (ECMO) is the mainstay of treatment in severe cases presenting with hypotension and arrhythmias. However, there may be a role for digoxin antibody fragments in maintaining patients presenting to remote sites, to allow transfer to a specialist centre.
Subclinical phaeochromocytoma: a diagnostic and management challenge
Authors: Chee Ying Jie , Teo Clarence Hai Yi , Au Rebecca Tian Mei , Kon Yin Chian
Published: April 2022

There is a paradigm shift in the detection of phaeochromocytomas with more being identified as adrenal ‘incidentalomas’. While majority of these individuals are asymptomatic, they are nevertheless at risk of subtle cardiovascular dysfunction and phaeochromocytoma crises. Therefore, early resection of phaeochromocytomas, even if subclinical, is recommended. However, the perioperative management can be challenging as the normotension can limit the initiation and titration of alpha-blockade. We present a man in his 60s with a subclinical phaeochromocytoma, discuss the evaluation of an incidentally discovered adrenal nodule, as well as the practical considerations in the perioperative management.
Scoping review with textual narrative synthesis of the literature reporting stress and burn-out in specialist nurses: making the case for inflammatory bowel disease nurse specialists
Authors: Kemp Karen , Duncan Julie , Mason Isobel , Younge Lisa , Dibley Lesley
Published: April 2022

Objective

Inflammatory bowel disease clinical nurse specialists (IBD-CNSs) face increasing pressures due to rising clinical and patient demands, advanced complexity of work role, and minimal specialist management training and support. Stress and burn-out could undermine the stability of this workforce, disrupting clinical provision. We reviewed the literature on stress and burn-out to demonstrate the lack of evidence pertinent to IBD-CNSs and make the case for further research.

Design

Following Levacet al’s scoping review framework, relevant databases were searched for publications reporting work-related stress and burn-out among specialist nurses. Following screening and consensus on selection of the final articles for review, all authors contributed to data charting. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review extension guided reporting of the review.

Results

Of 194 retrieved articles, eight were eligible for review. None focused on IBD-CNSs, were qualitative, or UK-based. Three core themes were identified: Rates of Burn-out, Mitigating and Alleviating Factors, and Preventing and Resolving Burn-out. Risk of burn-out is greatest in novice and mid-career CNSs. Age and duration in role appear protective. Personal achievement is also protective and can mitigate earlier episodes of burn-out; opportunities for career progression are limited. Promoting personal well-being is beneficial. Senior managers have poor understanding of the role and provide inadequate support. Commitment to patients remains high.

Conclusion

Burn-out arises in CNSs across clinical specialisms in the international literature and has a significant negative effect on the workforce. Further research is needed to address the dearth of evidence on burn-out in IBD-CNSs in the UK.
Derivation and validation of a novel risk assessment tool to identify children aged 2–59 months at risk of hospitalised pneumonia-related mortality in 20 countries
Authors: Rees Chris A , Colbourn Tim , Hooli Shubhada , King Carina , Lufesi Norman , McCollum Eric D , Mwansambo Charles , Cutland Clare , Madhi Shabir Ahmed , Nunes Marta , Mathew Joseph L , Addo-Yobo Emmanuel , Chisaka Noel , Hassan Mumtaz , Hibberd Patricia L , Jeena Prakash M , Lozano Juan M , MacLeod William B , Patel Archana , Thea Donald M , Nguyen Ngoc Tuong Vy , Kartasasmita Cissy B , Lucero Marilla , Awasthi Shally , Bavdekar Ashish , Chou Monidarin , Nymadawa Pagbajabyn , Pape Jean-William , Paranhos-Baccala Glaucia , Picot Valentina S , Rakoto-Andrianarivelo Mala , Rouzier Vanessa , Russomando Graciela , Sylla Mariam , Vanhems Philippe , Wang Jianwei , Asghar Rai , Banajeh Salem , Iqbal Imran , Maulen-Radovan Irene , Mino-Leon Greta , Saha Samir K , Santosham Mathuram , Singhi Sunit , Basnet Sudha , Strand Tor A , Bhatnagar Shinjini , Wadhwa Nitya , Lodha Rakesh , Aneja Satinder , Clara Alexey W , Campbell Harry , Nair Harish , Falconer Jennifer , Qazi Shamim A , Nisar Yasir B , Neuman Mark I
Published: April 2022

Introduction

Existing risk assessment tools to identify children at risk of hospitalised pneumonia-related mortality have shown suboptimal discriminatory value during external validation. Our objective was to derive and validate a novel risk assessment tool to identify children aged 2–59 months at risk of hospitalised pneumonia-related mortality across various settings.

Methods

We used primary, baseline, patient-level data from 11 studies, including children evaluated for pneumonia in 20 low-income and middle-income countries. Patients with complete data were included in a logistic regression model to assess the association of candidate variables with the outcome hospitalised pneumonia-related mortality. Adjusted log coefficients were calculated for each candidate variable and assigned weighted points to derive the Pneumonia Research Partnership to Assess WHO Recommendations (PREPARE) risk assessment tool. We used bootstrapped selection with 200 repetitions to internally validate the PREPARE risk assessment tool.

Results

A total of 27 388 children were included in the analysis (mean age 14.0 months, pneumonia-related case fatality ratio 3.1%). The PREPARE risk assessment tool included patient age, sex, weight-for-age z-score, body temperature, respiratory rate, unconsciousness or decreased level of consciousness, convulsions, cyanosis and hypoxaemia at baseline. The PREPARE risk assessment tool had good discriminatory value when internally validated (area under the curve 0.83, 95% CI 0.81 to 0.84).

Conclusions

The PREPARE risk assessment tool had good discriminatory ability for identifying children at risk of hospitalised pneumonia-related mortality in a large, geographically diverse dataset. After external validation, this tool may be implemented in various settings to identify children at risk of hospitalised pneumonia-related mortality.
Immigrant child health in Canada: a scoping review
Authors: Salami Bukola , Olukotun Mary , Vastani Muneerah , Amodu Oluwakemi , Tetreault Brittany , Obegu Pamela Ofoedu , Plaquin Jennifer , Sanni Omolara
Published: April 2022

Introduction

Understanding the health of immigrant children from birth to 18 years of age is important given the significance of the early childhood years and complexity of factors that may influence the health status of immigrant populations. Thus, the purpose of this review was to understand the extent and nature of the literature on the health of immigrant children in Canada.

Methods

We conducted a scoping review of the literature. The review was focused on studies of first-generation and second-generation immigrant children aged 0–18 years. We completed standardised data extraction of immigration status, immigration route, age of children, data source, health or clinical focus, country of origin and major findings.

Results

In total, 250 published papers representing data from 237 studies met the inclusion criteria for this study. A total of 178 articles used quantitative methodologies (mostly survey and cross-sectional study designs), 54 used qualitative methodologies and 18 used mixed methodologies. The articles considered in this review included 147 (59%) focusing on physical health, 76 (30%) focusing on mental health and 37 (15%) focusing on the social aspects of health for refugee and first-generation and second-generation immigrant children across the provinces and territories of Canada.

Conclusions

Several literature gaps exist with respect to child immigrant health in Canada. For instance, there are no exclusive studies on immigrant boys and limited studies on children of international students.
Implementation and evaluation of a rural general practice assessment pathway for possible cardiac chest pain using point-of-care troponin testing: a pilot study
Authors: Norman Tim , Young Joanna , Scott Jones Jo , Egan Gishani , Pickering John , Du Toit Stephen , Hamilton Fraser , Miller Rory , Frampton Chris , Devlin Gerard , George Peter , Than Martin
Published: April 2022

Objectives

To assess the feasibility and acceptability, and additionally to preliminarily evaluate, the effectiveness and safety of an accelerated diagnostic chest pain pathway in rural general practice using point-of-care troponin to identify patients at low risk of acute myocardial infarction, avoiding unnecessary patient transfer to hospital and enabling early discharge home.

Design

A prospective observational pilot evaluation.

Setting

Twelve rural general (family) practices in the Midlands region of New Zealand.

Participants

Patients aged ≥18 years who presented acutely to rural general practice with suspected ischaemic chest pain for whom the doctor intended transfer to hospital for serial troponin measurement.

Outcome measures

The proportion of patients managed using the low-risk pathway without transfer to hospital and without 30-day major adverse cardiac event (MACE); pathway adherence; rate of 30-day MACE; patient satisfaction with care; and agreement between point-of-care and laboratory measured troponin concentrations.

Results

A total of 180 patients were assessed by the pathway. The pathway classified 111 patients (61.7%) as low-risk and all were managed in rural general practice with no 30-day MACE (0%, 95% CI 0.0% to 3.3%). Adherence to the low-risk pathway was 95.5% (106 out of 111). Of the 56 patients classified as non-low-risk and referred to hospital, 9 (16.1%) had a 30-day MACE. A further 13 non-low-risk patients were not transferred to hospital, with no events. The sensitivity of the pathway for 30-day MACE was 100.0% (95% CI 70.1% to 100%). Of low-risk patients, 94% reported good to excellent satisfaction with care. Good concordance was observed between point-of-care and duplicate laboratory measured troponin concentrations.

Conclusions

The use of an accelerated diagnostic chest pain pathway incorporating point-of-care troponin in a rural general practice setting was feasible and acceptable, with preliminary results suggesting that it may safely and effectively reduce the urgent transfer of low-risk patients to hospital.
Lessons learned from the COVID-19 pandemic about sample access for research in the UK
Authors: Sims Jessica M , Lawrence Emma , Glazer Katy , Gander Amir , Fuller Barry , Davidson Brian R , Garibaldi Jonathan , Quinlan Philip R
Published: April 2022

Objective

Annotated clinical samples taken from patients are a foundation of translational medical research and give mechanistic insight into drug trials. Prior research by the Tissue Directory and Coordination Centre (TDCC) indicated that researchers, particularly those in industry, face many barriers in accessing patient samples. The arrival of the COVID-19 pandemic to the UK produced an immediate and extreme shockwave, which impacted on the ability to undertake all crucial translational research. As a national coordination centre, the TDCC is tasked with improving efficiency in the biobanking sector. Thus, we took responsibility to identify and coordinate UK tissue sample collection organisations (biobanks) able to collect COVID-19-related samples for researchers between March and September 2020.

Findings

Almost a third of UK biobanks were closed during the first wave of the UK COVID-19 pandemic. Of the remainder, 43% had limited capabilities while 26% maintained normal activity. Of the nationally prioritised COVID-19 interventional studies, just three of the five that responded to questioning were collecting human samples. Of the 41 requests for COVID-19 samples received by the TDCC, only four could be fulfilled due to a lack of UK coordinated strategy. Meanwhile, in the background there are numerous reports that sample collections in the UK remain largely underutilised.

Conclusion

The response to a pandemic demands high level co-ordinated research responses to reduce mortality. Our study highlights the lack of efficiency and coordination between human sample collections and clinical trials across the UK. UK sample access is not working for researchers, clinicians or patients. A radical change is required in the strategy for sample collection and distribution to maximise this valuable resource of human-donated samples.
Evaluation of medication risk at the transition of care: a cross-sectional study of patients from the ICU to the non-ICU setting
Authors: Wang Yao , Zhang Xueting , Hu Xu , Sun Xuqun , Wang Yuanyuan , Huang Kaiyu , Sun Sijia , Lv Xiongwen , Xie Xuefeng
Published: April 2022

Objectives

To describe the incidence and types of medication errors occurring during the transfer of patients from the intensive care unit (ICU) to the non-ICU setting and explore the key factors affecting medication safety in transfer care.

Design

Multicentre, retrospective, epidemiological study.

Participants

Patients transferred from the ICU to a non-ICU setting between 1 July 2019 and 30 June 2020.

Main outcome measures

Incidence and types of medication errors.

Results

Of the 1546 patients transferred during the study period, 899 (58.15%) had at least one medication error. Most errors (83.00%) were National Coordinating Council (NCC) for Medication Error Reporting and Prevention (MERP) category C. A small number of errors (17.00%) were category D. Among patients with medication errors, there was an average of 1.68 (SD, 0.90; range, 1–5) errors per patient. The most common types of errors were route of administration 570 (37.85%), dosage 271 (17.99%) and frequency 139 (9.23%). Eighty-three per cent of medication errors reached patients but did not cause harm. Daytime ICU transfer (07:00–14:59) and an admission diagnosis of severe kidney disease were found to be factors associated with the occurrence of medication errors as compared with the reference category (OR, 1.40; 95% CI 1.01 to 1.95; OR, 6.78; 95% CI 1.46 to 31.60, respectively).Orders for bronchorespiratory (OR, 5.92; 95% CI 4.2 to 8.32), cardiovascular (OR, 1.91; 95% CI 1.34 to 2.73), hepatic (OR, 1.95; 95% CI 1.30 to 2.91), endocrine (OR, 1.99; 95% CI 1.37 to 2.91), haematologic (OR, 2.58; 95% CI 1.84 to 3.64), anti-inflammatory/pain (OR, 2.80; 95% CI 1.90 to 4.12) and vitamin (OR, 1.73; 95% CI 1.26 to 2.37) medications at transition of care were associated with an increased odds of medication error.

Conclusions

More than half of ICU patients experienced medication errors during the transition of care. The vast majority of medication errors reached the patient but did not cause harm.
Adverse childhood experiences and implications of perceived stress, anxiety and cortisol among women in Pakistan: a cross-sectional study
Authors: Ikram Naira , Frost Allison , LeMasters Katherine , Hagaman Ashley , Baranov Victoria , Gallis John , Sikander Siham , Scherer Elissa , Maselko Joanna
Published: April 2022

Objectives

Adverse childhood experiences (ACEs) are linked to poor maternal mental health. The goal of this study is to examine the associations between ACEs and multiple manifestations of stress (including perceived stress, anxiety and cortisol) among mothers in rural Pakistan.

Design

This study used a cross-sectional design. Mothers were originally recruited during their third trimester of pregnancy and followed until 36 months post partum. Cortisol was collected at 12 months post partum, and self-report data were collected at 36 months post partum.

Setting

All participants reside in rural villages in Rawalpindi, Pakistan. The measures were administered at home visits by field interviewers.

Participants

Data were collected from 889 mothers. All mothers in the sample provided data on ACEs and perceived stress, 623 provided data on anxiety and 90 provided hair cortisol.

Primary and secondary outcomes measures

ACEs were captured retrospectively using an adapted version of the ACE International Questionnaire, and represented as a continuous variable and subdomains (neglect, home violence, family psychological distress, community violence). Primary outcomes included perceived stress measured with the Cohen Perceived Stress Scale (PSS) and anxiety measured with the Generalised Anxiety Disorder-7 scale (GAD-7). Hair-derived cortisol was included as a secondary outcome. Generalised linear models with cluster-robust SEs were used to estimate associations between ACEs and the outcome variables.

Results

All models featured positive associations between ACE items and PSS. The continuous total ACE score (B=0.4; 95% CI 0.0 to 0.8) was associated with higher anxiety symptoms on the GAD-7. Home violence (B=6.7; 95% CI 2.7 to 10.8) and community violence (B=7.5; 95% CI 1.4 to 13.6) were associated with increased hair cortisol production.

Conclusions

All four ACE domains were associated with elevated levels of perceived stress, anxiety and cortisol, with varying precision and strength of estimates, indicating that the type of ACE has a differential impact. This study informed our understanding of the differential impact of specific ACEs on perceived stress, anxiety and hypothalamic pituitary adrenal-axis functioning, providing implications for future clinical intervention and research development.
Individualised non-contrast MRI-based risk estimation and shared decision-making in men with a suspicion of prostate cancer: protocol for multicentre randomised controlled trial (multi-IMPROD V.2.0)
Authors: Ettala Otto , Jambor Ivan , Montoya Perez Ileana , Seppänen Marjo , Kaipia Antti , Seikkula Heikki , Syvänen Kari T , Taimen Pekka , Verho Janne , Steiner Aida , Saunavaara Jani , Saukko Ekaterina , Löyttyniemi Eliisa , Sjoberg Daniel D , Vickers Andrew , Aronen Hannu , Boström Peter
Published: April 2022

Introduction

European Association of Urology and UK National Institute for Health and Care Excellence guidelines recommend that all men with suspicions of prostate cancer should undergo prebiopsy contrast enhanced, that is, multiparametric prostate MRI. Subsequent prostate biopsies should also be performed if MRI is positive, that is, Prostate Imaging–Reporting and Data System (PI-RADS) scores 3–5. However, several retrospective post hoc analyses have shown that this approach still leads to many unnecessary biopsy procedures. For example, 88%–96% of men with PI-RADS, three findings are still diagnosed with clinically non-significant prostate cancer or no cancer at all.

Methods and analysis

This is a prospective, randomised, controlled, multicentre trial, being conducted in Finland, to demonstrate non-inferiority in clinically significant cancer detection rates among men undergoing prostate biopsies post-MRI and men undergoing prostate biopsies post-MRI only after a shared decision based on individualised risk estimation. Men without previous diagnosis of prostate cancer and with abnormal digital rectal examination findings and/or prostate-specific antigen between 2.5 ug/L and 20.0 ug/L are included. We aim to recruit 830 men who are randomised at a 1:1 ratio into control (all undergo biopsies after MRI) and intervention arms (the decision to perform biopsies is based on risk estimation and shared decision-making). The primary outcome of the study is the proportion of men with clinically significant prostate cancer (Gleason 4+3 prostate cancer or higher). We will also compare the overall biopsy rate, benign biopsy rate and the detection of non-significant prostate cancer between the two study groups.

Ethics and dissemination

The study (protocol V.2.0, 4 January 2021) was approved by the Ethics Committee of the Hospital District of Southwest Finland (IORG number: 0001744, IBR number: 00002216; trial number: 99/1801/2019). Participants are required to provide written informed consent. Full reports of this study will be submitted to peer-reviewed journals, mainly urology and radiology.

Trial registration number

NCT04287088; the study is registered at ClinicalTrials.gov.