bluuebunny/crossref_metadata_2025 huggingface dataset:
Ambulatory blood pressure monitoring using telemedicine: proof-of-concept cohort and failure modes and effects analyses
Authors: Armitage Laura C. , Lawson Beth K. , Roman Cristian , Thompson Beth , Biggs Christopher , Rutter Heather , Lewis-Jones Martin , Ede Jody , Tarassenko Lionel , Farmer Andrew , Watkinson Peter
Published: February 2022

Background: The COVID-19 pandemic has accelerated adoption of remote consulting in healthcare. Despite opportunities posed by telemedicine, most hypertension services in Europe have suspended ambulatory blood pressure monitoring (ABPM).

Methods: We examined the process and performance of remotely delivered ABPM using two methodologies: firstly, a Failure Modes and Effects Analysis (FMEA) and secondly, a quantitative analysis comparing ABPM data from a subgroup of 65 participants of the Screening for Hypertension in the INpatient Environment (SHINE) diagnostic accuracy study. The FMEA was performed over seven sessions from February to March 2021, with a multidisciplinary team comprising a patient representative, a research coordinator with technical expertise and four research clinicians.

Results: The FMEA identified a single high-risk step in the remote ABPM process. This was cleaning of monitoring equipment in the context of the COVID-19 pandemic, unrelated to the remote setting.

A total of 14 participants were scheduled for face-to-face ABPM appointments, before the UK March 2020 COVID-19 lockdown; 62 were scheduled for remote ABPM appointments since emergence of the COVID-19 pandemic between November 2020 and August 2021. A total of 65 (88%) participants completed ABPMs; all obtained sufficient successful measurements for interpretation. For the 10 participants who completed face-to-face ABPM, there were 402 attempted ABPM measurements and 361 (89%) were successful. For the 55 participants who completed remote ABPM, there were 2516 attempted measurements and 2114 (88%) were successful. There was no significant difference in the mean per-participant error rate between face-to-face (0.100, SD 0.009) and remote (0.143, SD 0.132) cohorts (95% CI for the difference -0.125 to 0.045 and two-tailed P-value 0.353).

Conclusions: We have demonstrated that ABPM can be safely and appropriately provided in the community remotely and without face-to-face contact, using video technology for remote fitting appointments, alongside courier services for delivery of equipment to participants.
Age-related low skeletal muscle mass correlates with joint space narrowing in knee osteoarthritis in a South Korean population: a cross-sectional, case-control study
Authors: Kim Hyun-Je , Hong Young-Hoon
Published: February 2022

Background: This study was conducted to analyze the effects of low skeletal muscle mass index (SMI) and obesity on aging-related osteoarthritis (OA) in the Korean population.Methods: A total of 16,601 participants who underwent a dual-energy X-ray absorptiometry and 3,976 subjects with knee X-rays according to the modified Kellgren-Lawrence (KL) system were enrolled. Knees of ≥KL grade 2 were classified as radiologic OA. The severity of joint space narrowing (JSN) was classified by X-rays as normal, mild-to-moderate, and severe JSN in radiologic OA. The subjects were grouped as normal SMI (SMI of ≥–1 standard deviation [SD] of the mean), low SMI class I (SMI of ≥–2 SDs and <–1 SD), and low SMI class II (SMI of <–2 SDs). Obesity was defined as a body mass index (BMI) of ≥27.5 kg/m2.Results: The modified KL grade and JSN severity were negatively correlated with the SMI and positively correlated with BMI and age. The SMI was negatively correlated with age. JSN severity was significantly associated with a low SMI class compared to a normal SMI, which was more prominent in low SMI class II than class I. Obesity was significantly associated with more severe JSN, only for obesity with a low SMI class. Furthermore, patients with a low SMI class, regardless of obesity, were prone to having more severe JSN.Conclusion: This study suggested that a low SMI class was associated with aging and that an age-related low SMI was more critically related to the severity of JSN in OA.
Murciélagos importantes aliados como bioindicadores de calidad de hábitats
Authors: Racero Casarrubia Javier
Published: February 2022

Los murciélagos se pueden convertir en nuestros aliados y héroes al convertirse en batindicadores y batimonitores de contaminantes como metales pesados y plaguicidas en los ecosistemas y nos ayudan a entender cabalmente el fenómeno de la bioacumulación.
Un desierto megadiverso
Authors: Cab Sulub Leticia
Published: February 2022

Muchas veces asociamos la palabra desierto con algo inhóspito, solitario, despoblado y casi sin vida. Sin embargo, algunos ecosistemas desérticos suelen albergar gran diversidad de flora y fauna que los hacen regiones con relevancia biológica.
Investigating active versus expectant management of third stage labour in a midwife-led unit
Authors: Baker Karen Clare , Stephenson John
Published: February 2022

Little is known regarding third stage management approaches and the incidence of and treatment of postpartum haemorrhage in women giving birth solely in midwife-led units. This systematic literature review identified nine studies of varying quality that investigated active versus expectant management of the third stage of labour and any related blood loss in women, who had a normal physiological birth and gave birth or intended to give birth in a midwife-led unit. The results identified a need for further research studies into this area of practice, as birth settings are becoming increasingly more important. This is because of research studies that have reported many beneficial outcomes for healthy women at low risk of obstetric complications, who plan to give birth in midwife-led units.
Working in an urgent dental care hub during the Covid-19 pandemic from a dental nurses' perspective
Authors: Plessas Anastasios , Paisi Martha , Baines Rebecca , Wheat Hannah , Delgado Maria Bernardes , Mills Ian , Witton Robert
Published: February 2022

A qualitative study
Employment law myths—who are you gonna call?
Authors: Bernstein Adam
Published: February 2022

Adam Bernstein speaks to Lucy Gordon and Chloe Themistocleous to bust some widespread employment law myths
Validating Student’s Green Character Instrument Using Factor and Rasch Model
Authors: Sukri Akhmad , Rizka Muhammad Arief , Purwanti Elly , Ramdiah Siti , Lukitasari Marheny
Published: February 2022

Many researchers have separately developed instruments to measure environmental characteristics such as attitudes, values, and knowledge. However, there is no instrument used to measure all these aspects in one comprehensive instrument. This study is meant to develop and validate a green character instrument which reveals student behavior and awareness of the environment. The instrument consists of 40 statement items consisting of 5 aspects, namely private pro-environmental behavior, public pro-environmental behavior, environmental knowledge, environmental values, and environmental attitudes. It was implemented on 1,398 students from 15 universities in Indonesia. The instrument content validation was analyzed by three experts using content validity index (CVI). The construct validity was analyzed using exploratory factor analysis, confirmatory factor analysis, and RASCH analysis. The content validity results obtained CVI scores ranging between 0.8 and 0.9 with a good category, while item reliability was in a fairly good category with a high level of separation index. Construct validation resulted in 34 items (4 items were eliminated after Exploratory and Confirmatory Factor Analysis, and 2 items were eliminated after RASCH analysis) spread over five constructs, namely environmental behavior, environmental knowledge, environmental values, environmental attitudes, and environmental habits. The resulting instrument has a good level of item difficulty, with a well understood response set which can be understood easily by respondents, and without bias. Therefore, it can be used to measure the students’ green character on both male and female.
New Trends in Ultrasound-Guided Musculoskeletal Injuries Approaches
Authors: Pedro Bernáldez Domínguez , Ignacio Dallo Lazzarini
Published: February 2022

The ultrasound not only allows us to diagnose musculoskeletal injuries but is also a fantastic tool to assist us when performing different therapies on the tissues. Multiple studies compare the classic blind versus ultrasound-guided infiltrations, with a significant difference in the results. In this article, we present the different indications for ultrasound-guided therapies, including ultrasound-guided local infiltration, percutaneous needle tenotomy, intracapsular hydrodilatation, hydrodissection, high-volume injection, percutaneous needle scraping and ultrasound-guided surgery (EAS). We describe the techniques, their advantages, and disadvantages, as well as possible complications. These procedures require a good learning curve, but once achieved, it will allow us to use them to obtain good clinical results, and in many cases avoiding the operating room. We have included these therapies in the so-called “SUBA Protocol” that includes the application of the concepts of modern Sports trauma, the use of musculoskeletal Ultrasounds, consider Biological therapies as one more tool in the therapeutic arsenal, and finally, the use of Arthroscopic surgeries, minimally invasive procedures with minor tissue damage. Keywords: Musculoskeletal ultrasound, Ultrasound-guided therapies, Percutaneous needle tenotomy, Intracapsular hydrodilatation, Hydrodissection, Percutaneous needle scraping, Ultrasound-guided surgery, SUBA protocol.
Bionic orientation method based on polarization imaging in HDR scenes
Authors: Wu Xuesong , Fan Chen , He Xiaofeng , Zhang Lilian , Hu Xiaoping , Fan Ying , Han Guoliang , Zhou Wenzhou , Shang Hang
Published: February 2022

An increasing number of bio-inspired navigation approaches have been designed based on polarization cameras. However, digital cameras can sense a much narrower field of vision than the vision of insects or human beings. In this study, we propose an adaptive skylight polarized orientation method for high dynamic range (HDR) scenes. Initially, we built a model of the image acquisition pipeline that can recover HDR irradiance maps from polarization images. Subsequently, the orientation method was designed based on a combination of the irradiance maps and the least squares methods. Some preprocessing steps were utilized to eliminate occlusion interference. In addition, an autoexposure adjustment method was proposed using information entropy and heuristic segmentation. Finally, the experimental results show that the proposed method can improve the accuracy of bionic orientation and adaption to skylight with occlusions and interference in natural conditions.
Optical fiber tip integrated photoelectrochemical sensors
Authors: Wang Haoshang , Xiong Yifeng , Wu Chenhui , Zhu Hengtian , Chen Ye , Xu Fei
Published: February 2022

In this work, we design and fabricate a compact photoelectrochemical (PEC) sensor by integrating a graphene-MoS2 heterostructure on an optical fiber tip. The graphene serves as a transparent carrier transport layer, and the MoS2 presents a photoelectrical transducer that generates photocarriers and interacts with ascorbic acid (AA) in solution. This device is used to demonstrate a self-powered detection of AA with a concentration range between 1 mM and 50 mM, and a time response of ∼ 6 ms. The device downsizes traditional PEC systems to the micrometer scale, benefiting the real-time monitoring of biochemical changes in small areas and opening the pathway for miniaturized PEC sensing applications.
Rainbow trapping based on higher-order topological corner modes
Authors: Liang Li , Zhou Xiaoxi , Hu Jun-Hui , Wang Hai-Xiao , Jiang Jian-Hua , Hou Bo
Published: February 2022

The recent advancements in higher-order topology have provided unprecedented opportunities in optical device designs and applications. Here, we propose a new, to the best of our knowledge, method to realize rainbow trapping based on higher-order topological corner modes (HOTCMs), which are constructed by two configurations of breathing kagome photonic crystals with distinct topological phases. Interestingly, the HOTCMs localized at corners with different geometric configurations are found to be frequency dispersive and thus initiate the possible application in realizing rainbow trapping. By designing a polygon structure containing several configurations of corners, we demonstrate that the HOTCMs can be excited with the frequency sequence locked to the corner order (clockwise/anticlockwise direction) in the polygon. The reported HOTCMs provide a new mechanism to realize multiple-frequency trapping, which may find potential applications in future integrated photonics.
Halide Perovskites for Photonics and Optoelectronics feature issue: publisher’s note
Authors: Dou Letian , Gong Xiwen , Makarov Sergey , Rand Barry , Zhao Yongsheng
Published: February 2022

This publisher's note amends the titles of [Opt. Mater. Express 12, 772 (2022)10.1364/OME.450214] and [Opt. Mater. Express 12, 823 (2022)10.1364/OME.445927].
Understanding factors influencing utilization of HIV prevention and treatment services among patients and providers in a heterogeneous setting: A qualitative study from South Africa
Authors: Chimoyi Lucy , Chikovore Jeremiah , Musenge Eustasius , Mabuto Tonderai , Chetty-Makkan Candice. M. , Munyai Reuben , Nchachi Tshegang , Charalambous Salome , Setswe Geoffrey
Published: February 2022

Despite advances made in HIV prevention and treatment interventions in South Africa, barriers to their utilization continue to exist. Understanding perspectives from patients and providers of healthcare can shed light on the necessary strategies to enhance uptake of HIV services. A cross-sectional qualitative study was conducted in July 2020 in Ekurhuleni District. Based on HIV prevalence estimates from a national survey, male condom use coverage and antiretroviral treatment (ART) initiation rates from routinely collected clinical data for 2012, we selected facilities from geographical areas with varying HIV prevalence and uptake of HIV services. In-depth interviews were conducted with adult (≥18 years) patients and healthcare workers in selected primary healthcare facilities. Thematic analysis was performed following a framework built around the social cognitive theory to describe behavioural, personal, and social/environmental factors influencing utilization of HIV services. Behavioural factors facilitating uptake of HIV services included awareness of the protective value of condoms, and the benefits of ART in suppressing viral load and preventing mother-to-child HIV transmission which was evident across geographical areas. Barriers in high prevalence areas included suboptimal condom use, fears of a positive HIV result, and anticipated HIV-related stigma while seeking healthcare services. Across the geographical areas, personal factors included ability to correctly use available services enhanced by knowledge acquired during counselling sessions and community-based health promotion activities. Further, social support from family reinforced engagement in care. Compared to low uptake areas, clinics in high uptake areas used care-facilitators, outreach teams and decanting programs to address the environmental barriers including staff shortages and long queues. Barriers at multiple levels prevent optimal utilization of HIV services, calling for strategies that target and address the different levels and tailored to needs of specific settings. Overall, improved delivery of HIV prevention or treatment interventions can be achieved through strengthening training of healthcare providers in facilities and communities and addressing negative sequelae from utilising services in low uptake areas.
Sex- and age- dependent effect of pre-gestational chronic stress and mirtazapine treatment on neurobehavioral development of Wistar rat offspring
Authors: Viñas-Noguera Mireia , Csatlósová Kristína , Šimončičová Eva , Bögi Ezster , Ujházy Eduard , Dubovický Michal , Belovičová Kristína
Published: February 2022

Hormonal fluctuations, such as the perinatal period, may increase susceptibility of women to depression, which in turn exert a negative impact on child’s neurodevelopment, becoming a risk factor in development of neuropsychiatric disorders. Moreover, the use of antidepressants during this critical period presents a serious health concern for both the mother and the child, due to the consequences of treatment in terms of the reliability and safety for the proper neurodevelopment of the organism being not well known. Atypical antidepressants, such as mirtazapine, that targets both serotonergic and noradrenergic systems in the central nervous system (CNS), represent a novel focus of research due to its unique pharmacological profile. The aim of this work was to study the effects of maternal depression and/or perinatal antidepressant mirtazapine treatment on the neurobehavioral development of the offspring. Pre-gestationally chronically stressed or non-stressed Wistar rat dams were treated with either mirtazapine (10 mg/kg/day) or vehicle during pregnancy and lactation followed by analysis of offspring’s behavior at juvenile and adolescent age. We found mirtazapine induced significant alterations of nursing behavior. In offspring, pregestational stress (PS) had an anxiogenic effect on adolescent males (p≤0.05) and increased their active behavior in forced swim test (p≤0.01). Interaction between pregestational stress and mirtazapine treatment variously induced anxiolytic changes of juvenile (p≤0.05) and adolescent (p≤0.05) females and impairment of spatial memory (p≤0.01) in adolescent females as well. Hippocampal density of synaptophysin, pre-synaptic protein marker, was decreased mainly by mirtazapine treatment. In conclusion, our results show mirtazapine induced significant alterations in maternal behavior and several sex- and age-dependent changes in neurobehavioral development of offspring caused by both prenatal mirtazapine treatment and/or chronic pregestational stress.
Spatial variations in the biochemical potential of okra [Abelmoschus esculentus L. (Moench)] leaf and fruit under field conditions
Authors: Sarwar Samreen , Akram Nudrat Aisha , Saleem Muhammad Hamzah , Zafar Sadia , Alghanem Suliman Mohammed , Abualreesh Muyassar H. , Alatawi Aishah , Ali Shafaqat
Published: February 2022

Okra (Abelmoschus esculentus L. (Moench) plays a significant role in humans nutrition because its fresh leaves, stems, flowers, pods and seeds, are used for multiple purposes. The present study attempted to determine the spatial variations in biochemical attributes of osmoprotectants and the oxidative defense system of okra plants. Samples of soil and okra plants (leaves and fruits) were collected from three different locations: Faisalabad region-1 (7 JB-I), Faisalabad region-2 (7 JB-II) and Pindi Bhattian. Chlorophyll contents, glycine betaine (GB), ascorbic acid (AsA), total phenolics, hydrogen peroxide (H2O2), proline, and malondialdehyde (MDA) contents were analyzed in the leaves and fruits of okra plants. Soil analyses showed that pH, electrical conductivity (EC), phosphorus (P), potassium (K), iron (Fe), and saturation of soil were higher in Faisalabad region 2, while organic matter, sand, Zn, and Cu were higher in the Pindi Bhattian region. The results from okra leaves showed that Pindi Bhattian had higher chlorophyll a, GB and H2O2 contents, while Faisalabad region 1 had a higher ratio of chlorophyll a/b compared to the other regions. However, Faisalabad regions 2 and 1 had higher leaf phenolic contents, Faisalabad regions 1 and 2 showed higher leaf proline contents, and Faisalabad region 2 possessed higher AsA and MDA contents. Analyses of okra fruits showed that Faisalabad region 2 had higher chlorophyll a and total chlorophyll contents, while Faisalabad region 1 had higher chlorophyll b contents. Faisalabad region 2 and Pindi Bhattian had higher ratios of chlorophyll a/b, and Faisalabad region 1 showed higher phenolic, AsA, H2O2, and MDA contents of okra fruit, whereas the Faisalabad regions exhibited higher proline and GB contents than the Pindi Bhattian region. Overall, okra leaves and fruits showed better responses in the Faisalabad regions, and these results may be used to screen for okra cultivars with better tolerance under different environmental conditions.
A callosal biomarker of behavioral intervention outcomes for autism spectrum disorder? A case-control feasibility study with diffusion tensor imaging
Authors: Virues-Ortega Javier , McKay Nicole S. , McCormack Jessica C. , Lopez Nerea , Liu Rosalie , Kirk Ian
Published: February 2022

Tentative results from feasibility analyses are critical for planning future randomized control trials (RCTs) in the emerging field of neural biomarkers of behavioral interventions. The current feasibility study used MRI-derived diffusion imaging data to investigate whether it would be possible to identify neural biomarkers of a behavioral intervention among people diagnosed with autism spectrum disorder (ASD). The corpus callosum has been linked to cognitive processing and callosal abnormalities have been previously found in people diagnosed with ASD. We used a case-control design to evaluate the association between the type of intervention people diagnosed with ASD had previously received and their current white matter integrity in the corpus callosum. Twenty-six children and adolescents with ASD, with and without a history of parent-managed behavioral intervention, underwent an MRI scan with a diffusion data acquisition sequence. We conducted tract-based spatial statistics and a region of interest analysis. The fractional anisotropy values (believed to indicate white matter integrity) in the posterior corpus callosum was significantly different across cases (exposed to parent-managed behavioral intervention) and controls (not exposed to parent-managed behavioral intervention). The effect was modulated by the intensity of the behavioral intervention according to a dose-response relationship. The current feasibility case-control study provides the basis for estimating the statistical power required for future RCTs in this field. In addition, the study demonstrated the effectiveness of purposely-developed motion control protocols and helped to identify regions of interest candidates. Potential clinical applications of diffusion tensor imaging in the evaluation of treatment outcomes in ASD are discussed.
The role of the common agricultural policy in contributing to jobs and growth in EU’s rural areas and the impact of employment on shaping rural development: Evidence from the Baltic States
Authors: Grodzicki Tomasz , Jankiewicz Mateusz
Published: February 2022

Agriculture is a very important sector of the economy that has a great influence on rural areas. Almost sixty years of the Common Agricultural Policy (CAP) in the European Union (EU) may impose a question on the impact of this policy on job creation and economic growth in rural areas. By analyzing key indicators, one should note that although there are still many problems to tackle, the CAP has been successful to some extend in increasing employment rate and Gross Domestic Product (GDP) per capita as well as decreasing poverty rate in the EU rural areas. There are also more and more households connected to the next-generation broadband network and there is still a significant number of bed places in the EU rural areas. Although, the situation in specific EU Member States and their rural regions may be different, the overall performance of the EU is satisfactory and shows positive prognostics for the current EU financial perspective of 2021–2027. This paper also provides an empirical approach which checks whether there is a connection between the employment rate and the rural development measured in GDP per capita based on the data from the Baltic States: Estonia, Latvia and Lithuania in the period of 2000–2020. This research confirms that when increasing the level of rural employment, the economic growth rises in rural areas.
DriverFuse: An R package for analysis of next-generation sequencing datasets to identify cancer driver fusion genes
Authors: Roy Shikha , Gupta Dinesh
Published: February 2022

We developed the DriverFuse package to integrate orthogonal data types such as Structural Variants (SV) and Copy Number Variations (CNV) to characterize fusion genes in cancer datasets. A fusion gene is reported as a driver or passenger fusion gene, based on mapping SV and CNV profiles. DriverFuse generates a fusion plot of fusion genes with their mapping SV, CNV profile, domain architecture and classification of its role in cancer. The analysis facilitates discrimination of driver fusions from passenger fusions. To demonstrate the utility of DriverFuse, we analyzed two datasets, one each for CCLE (Cancer Cell Line Encyclopedia) for lung cancer and HCC1395BL for breast cancer. The analysis validates the driver fusion genes that are already reported for the datasets. Thus, DriverFuse is a valuable tool for studying the driver fusion genes in cancers, enabling the identification of recurrent complex rearrangements that provide intuitive insights into disease driver events.
Cardiorespiratory response to early rehabilitation in critically ill adults: A secondary analysis of a randomised controlled trial
Authors: Eggmann Sabrina , Irincheeva Irina , Luder Gere , Verra Martin L. , Moser André , Bastiaenen Caroline H. G. , Jakob Stephan M.
Published: February 2022

Introduction

Early rehabilitation is indicated in critically ill adults to counter functional complications. However, the physiological response to rehabilitation is poorly understood. This study aimed to determine the cardiorespiratory response to rehabilitation and to investigate the effect of explanatory variables on physiological changes during rehabilitation and recovery.

Methods

In a prospectively planned, secondary analysis of a randomised controlled trial conducted in a tertiary, mixed intensive care unit (ICU), we analysed the 716 physiotherapy-led, pragmatic rehabilitation sessions (including exercise, cycling and mobilisation). Participants were previously functionally independent, mechanically ventilated, critically ill adults (n = 108). Physiological data (2-minute medians) were collected with standard ICU monitoring and indirect calorimetry, and their medians calculated for baseline (30min before), training (during physiotherapy) and recovery (15min after). We visualised physiological trajectories and investigated explanatory variables on their estimated effect with mixed-effects models.

Results

This study found a large range of variation within and across participants’ sessions with clinically relevant variations (>10%) occurring in more than 1 out of 4 sessions in mean arterial pressure, minute ventilation (MV) and oxygen consumption (VO2), although early rehabilitation did not generally affect physiological values from baseline to training or recovery. Active patient participation increased MV (mean difference 0.7l/min [0.4–1.0, p<0.001]) and VO2 (23ml/min [95%CI: 13–34, p<0.001]) during training when compared to passive participation. Similarly, session type ‘mobilisation’ increased heart rate (6.6bpm [2.1–11.2, p = 0.006]) during recovery when compared to ‘exercise’. Other modifiable explanatory variables included session duration, mobilisation level and daily medication, while non-modifiable variables were age, gender, body mass index and the daily Sequential Organ Failure Assessment.

Conclusions

A large range of variation during rehabilitation and recovery mirrors the heterogenous interventions and patient reactions. This warrants close monitoring and individual tailoring, whereby the best option to stimulate a cardiorespiratory response seems to be active patient participation, shorter session durations and mobilisation.

Trial registration

German Clinical Trials Register (DRKS) identification number: DRKS00004347, registered on 10 September 2012.
A novel bat pollination system involving obligate flower corolla removal has implications for global Dillenia conservation
Authors: Petit Sophie , Scanlon Annette T. , Naikatini Alivereti , Pukala Tara , Schumann Russell
Published: February 2022

The Dilleniaceae is known to produce nectarless flowers pollinated by bees, but the fact that bats ingest Dillenia biflora pollen led us to question pollination assumptions for these trees. We aimed to identify the pollinators of D. biflora, check for nectar presence, and investigate potential for cleistogamy and global prevalence of this pollination system. We examined aspects of the pollination of D. biflora on two Fijian islands using video recordings, direct observations, hand pollination, measurements (flowers, bite marks, nectar), and monitoring. The flowers, receptive for one night, contained copious nectar and had permanently closed globose corollas that required removal by bats for pollination. All the 101 flowers that retained their corolla died and did not produce seeds by cleistogamy. The bat Notopteris macdonaldi was well adapted to corolla removal. Keeping corollas closed until bats manipulate the nectar-rich flowers is a beneficial strategy in high-rainfall environments with many flower parasites. We propose to name a pollination system reliant exclusively on bats “chiropteropisteusis.” From clues in the literature, other species in the geographical range of Dillenia are probably chiropteropisunous. Chiropteropisteusis should be investigated in the Old-World range of Dillenia, many species of which are threatened. The remarkable “fall” of the entire corolla observed by an earlier botanist for several species in the genus is most likely attributable to bats. This discovery has important implications for the conservation of bat-dependent trees and their associated fauna, particularly considering the high level of threat faced by flying-foxes globally.
Effects of a group-based weight management programme on anxiety and depression: A randomised controlled trial (RCT)
Authors: Heath Laura , Jebb Susan , Stevens Richard , Wheeler Graham , Ahern Amy , Boyland Emma , Halford Jason , Aveyard Paul
Published: February 2022

Objectives

The aim was to investigate the impact of a group-based weight management programme on symptoms of depression and anxiety compared with self-help in a randomised controlled trial (RCT).

Method

People with overweight (Body Mass Index [BMI]≥28kg/m2) were randomly allocated self-help (n = 211) or a group-based weight management programme for 12 weeks (n = 528) or 52 weeks (n = 528) between 18/10/2012 and 10/02/2014. Symptoms were assessed using the Hospital Anxiety and Depression Scale, at baseline, 3, 12 and 24 months. Linear regression modelling examined changes in Hospital Anxiety and Depression Scale between trial arms.

Results

At 3 months, there was a -0.6 point difference (95% confidence interval [CI], -1.1, -0.1) in depression score and -0.1 difference (95% CI, -0.7, 0.4) in anxiety score between group-based weight management programme and self-help. At subsequent time points there was no consistent evidence of a difference in depression or anxiety scores between trial arms. There was no evidence that depression or anxiety worsened at any time point.

Conclusions

There was no evidence of harm to depression or anxiety symptoms as a result of attending a group-based weight loss programme. There was a transient reduction in symptoms of depression, but not anxiety, compared to self-help. This effect equates to less than 1 point out of 21 on the Hospital Anxiety and Depression Scale and is not clinically significant.
Nursing care recommendation for pediatric COVID-19 patients in the hospital setting: A brief scoping review
Authors: Efendi Defi , Hasan Faizul , Natalia Regina , Utami Ayuni Rizka , Sonko Ismaila , Asmarini Titik Ambar , Yuningsih Risna , Wanda Dessie , Sari Dian
Published: February 2022

Background

The hospitalization of children during the COVID-19 pandemic has affected their physical and mental health. Pediatric nurses have faced challenges in providing high-quality nursing care for children and their families. However, the pediatric nursing care recommendations for COVID-19 patients in the hospital setting remain unclear. The current scoping review provides recommendations for nursing interventions for pediatric COVID-19 patients in the hospital setting.

Methods and findings

The selected articles containing management and nursing recommendations for COVID-19 that have occurred in pediatric patients ages 0–19 years old. A search strategy was developed and implemented in seven databases. We included peer-reviewed articles that reported observational or interventional studies, as well as policy papers, guides or guidelines, letters and editorials, and web articles. A total of 134 articles and other documents relevant to this review were included. We categorized the results based on The Nursing Intervention Classification (NIC) taxonomy which consists of six domains (e.g., Physiological: Basic); eleven classes (e.g., Nutrition Support); and eighteen intervention themes (e.g., Positioning, Family Presence Facilitation, Family Support, and Discharge Planning).

Conclusion

Apart from the intervention of physical problems, there is a need to promote patient- and family-centered care, play therapy, and discharge planning to help children and families cope with their new situation.
Carbapenem-resistant Enterobacteriaceae in sink drains of 40 healthcare facilities in Sindh, Pakistan: A cross-sectional study
Authors: Apanga Paschal A. , Ahmed Jamil , Tanner Windy , Starcevich Katherine , VanDerslice James A. , Rehman Ubed , Channa Najeebullah , Benson Scott , Garn Joshua V.
Published: February 2022

In Pakistan, antimicrobial resistance (AMR) is expected to greatly increase the already high mortality and morbidity rates attributed to infections, making AMR surveillance and prevention a priority in the country. The aims of the project were to characterize the prevalence of carbapenem-resistant Enterobacteriaceae (CRE) in healthcare facility sink drains in Pakistan and to characterize how physical characteristics of sinks and healthcare facility rooms were associated with CRE in those sinks. The study took place in 40 healthcare facilities in Jamshoro Pakistan. Swabs were collected from sink drains in each facility that had a sink, and structured observations of sinks and facilities were performed at each facility. Swabs were plated on CHROMagar KPC to screen for carbapenem-resistant Enterobacteriaceae, which were then isolated on Mueller-Hinton agar plates. Antibiotic susceptibility was determined using the disk diffusion method to assess resistance to carbapenems, cephalosporins, and fluoroquinolones. Thirty-seven of the healthcare facilities had at least one sink, and thirty-nine total sinks were present and sampled from those healthcare facilities. Sinks in these facilities varied in quality; at the time of sampling 68% had water available, 51% had soap/alcohol cleanser at the sink, 28% appeared clean, and 64% drained completely. Twenty-five (64%) of the sink samples grew Enterobacteriaceae on CHROMagar KPC, sixteen (41%) of which were clinically non-susceptible to ertapenem. Seven of the 39 sampled sinks (18%) produced Enterobacteriaceae that were resistant to all three antibiotic classes tested. Several facilities and sink characteristics were associated with CRE. Sinks and drains can serve as undetected reservoirs for carbapenem-resistant Enterobacteriaceae. Control and remediation of such environments will require both systemic strategies and physical improvements to clinical environments.
A protocol for the VISION study: An indiVidual patient data meta-analysis of randomised trials comparing MRI-targeted biopsy to standard transrectal ultraSound guided bIopsy in the detection of prOstate cancer
Authors: Kasivisvanathan Veeru , Chan Vinson Wai-Shun , Clement Keiran D. , Levis Brooke , Haider Masoom , Agarwal Ridhi , Emberton Mark , Pond Gregory R. , Takwoingi Yemisi , Klotz Laurence , Moore Caroline M. ,   VISION study collaborators
Published: February 2022

Background

Transrectal ultrasound (TRUS) guided biopsy for prostate cancer is prone to random and systemic error and has been shown to have a negative predictive value of 70%. PRECISION and PRECISE are among the first randomised studies to evaluate the new MRI-targeted biopsy (MRI-TB) pathway with a non-paired design to detect clinically significant prostate cancer and avoid unnecessary treatment. The trials’ results individually demonstrated non-inferiority of MRI-TB compared to TRUS biopsy. An individual patient data (IPD) meta-analysis was planned from the outset of the two trials in parallel and this IPD meta-analysis aims to further elucidate the utility of MRI-TB as the optimal diagnostic pathway for prostate cancer.

Methods and materials

This study is registered on PROSPERO (CRD42021249263). A search of Medline, Embase, Cochrane Central Register of Registered Trials (CENTRAL), Web of Science, and ClinicalTrials.gov was performed up until 4th February 2021. Only randomised controlled trials (PRECISE, PRECISION and other eligible trials) comparing the MRI-targeted biopsy pathway and traditional TRUS biopsy pathway will be included. The primary outcome of the review is the proportion of men diagnosed with clinically significant prostate cancer in each arm (Gleason ≥ 3+4 = 7). IPD and study-level data and characteristics will be sought from eligible studies. Analyses will be done primarily using an intention-to-treat approach, and a one-step IPD meta-analysis will be performed using generalised linear mixed models. A non-inferiority margin of 5 percentage points will be used. Heterogeneity will be quantified using the variance parameters from the mixed model. If there is sufficient data, we will investigate heterogeneity by exploring the effect of the different conducts of MRIs, learning curves of MRI reporting and MRI targeted biopsies.

Trial registration

This systematic review is registered on PROSPERO (CRD42021249263)
Effects of combined training on metabolic profile, lung function, stress and quality of life in sedentary adults: A study protocol for a randomized controlled trial
Authors: Ferreira José Pedro , Duarte-Mendes Pedro , Teixeira Ana M. , Silva Fernanda M.
Published: February 2022

Background

Both physical inactivity and sedentary behavior are considered modifiable risk factors for chronic diseases and all-cause mortality. Adult office-workers spend most of their working day in sedentary behaviors, so they are particularly at high risk of developed chronic diseases (e.g., cardiovascular diseases, metabolic disorders like diabetes mellitus, …). It seems important to promote behavioral changes that could prevent or delay metabolic disease development. Evidence supports the use of exercise programs, however, to date there are several knowledge gaps and inconsistencies in the literature regarding the effects of Combined Training (i.e., aerobic plus resistance training) in sedentary healthy adults. This paper outlines an RCT designed to evaluate the effects of a 16-week combined training program on biochemical and immune markers of metabolic disease, lung function, salivary stress hormones and subjective quality of life (primary outcomes), as well as on body composition and physical fitness (secondary outcomes) in sedentary middle-aged office-workers. Furthermore, we aimed to assess the associations between the changes promoted by the exercise program and the different variables studied.

Methods and design

This is a single-blinded two-arm RCT with parallel groups. A minimum of healthy 40 office-workers aged 40–64 years will be recruited to engage in a 16-week intervention study. After baseline assessments, participants will be randomized to one of the two groups: (1) combined training group or (2) control group. Baseline assessments will be repeated after 8 weeks of intervention (mid-testing) and upon completion of the intervention (post-testing).

Discussion

This RCT involves a multi-disciplinary approach and seems to be a relevant contribution to understanding the potential role of combined training in improving the metabolic profile, lung function, stress, and quality of life in adults. The results can provide important insights for clinical recommendations and for the optimization of strategies to prevent metabolic disorders in adults with sedentary jobs.

Trial registration

This trial is registered with ClinicalTrials.gov (registration number: NCT04868240; date of registration April 30, 2021).
Predictors of mortality among hospitalized COVID-19 patients and risk score formulation for prioritizing tertiary care—An experience from South India
Authors: Gopalan Narendran , Senthil Sumathi , Prabakar Narmadha Lakshmi , Senguttuvan Thirumaran , Bhaskar Adhin , Jagannathan Muthukumaran , Sivaraman Ravi , Ramasamy Jayalakshmi , Chinnaiyan Ponnuraja , Arumugam Vijayalakshmi , Getrude Banumathy , Sakthivel Gautham , Srinivasalu Vignes Anand , Rajendran Dhanalakshmi , Nadukkandiyil Arunjith , Ravi Vaishnavi , Hifzour Rahamane Sadiqa Nasreen , Athur Paramasivam Nirmal , Manoharan Tamizhselvan , Theyagarajan Maheshwari , Chadha Vineet Kumar , Natrajan Mohan , Dhanaraj Baskaran , Murhekar Manoj Vasant , Ramalingam Shanthi Malar , Chandrasekaran Padmapriyadarsini
Published: February 2022

Background

We retrospectively data-mined the case records of Reverse Transcription Polymerase Chain Reaction (RT-PCR) confirmed COVID-19 patients hospitalized to a tertiary care centre to derive mortality predictors and formulate a risk score, for prioritizing admission.

Methods and findings

Data on clinical manifestations, comorbidities, vital signs, and basic lab investigations collected as part of routine medical management at admission to a COVID-19 tertiary care centre in Chengalpattu, South India between May and November 2020 were retrospectively analysed to ascertain predictors of mortality in the univariate analysis using their relative difference in distribution among ‘survivors’ and ‘non-survivors’. The regression coefficients of those factors remaining significant in the multivariable logistic regression were utilised for risk score formulation and validated in 1000 bootstrap datasets.

Among 746 COVID-19 patients hospitalised [487 “survivors” and 259 “non-survivors” (deaths)], there was a slight male predilection [62.5%, (466/746)], with a higher mortality rate observed among 40–70 years age group [59.1%, (441/746)] and highest among diabetic patients with elevated urea levels [65.4% (68/104)]. The adjusted odds ratios of factors [OR (95% CI)] significant in the multivariable logistic regression were SaO2<95%; 2.96 (1.71–5.18), Urea ≥50 mg/dl: 4.51 (2.59–7.97), Neutrophil-lymphocytic ratio (NLR) >3; 3.01 (1.61–5.83), Age ≥50 years;2.52 (1.45–4.43), Pulse Rate ≥100/min: 2.02 (1.19–3.47) and coexisting Diabetes Mellitus; 1.73 (1.02–2.95) with hypertension and gender not retaining their significance. The individual risk scores for SaO2<95–11, Urea ≥50 mg/dl-15, NLR >3–11, Age ≥50 years-9, Pulse Rate ≥100/min-7 and coexisting diabetes mellitus-6, acronymed collectively as ‘OUR-ARDs score’ showed that the sum of scores ≥ 25 predicted mortality with a sensitivity-90%, specificity-64% and AUC of 0.85.

Conclusions

The ‘OUR ARDs’ risk score, derived from easily assessable factors predicting mortality, offered a tangible solution for prioritizing admission to COVID-19 tertiary care centre, that enhanced patient care but without unduly straining the health system.
Biología y metafísica en los albores de la modernidad: mecanicismo y vitalismo en Leibniz
Authors: Rodero Cilleros Sergio
Published: February 2022

El objetivo principal de esta tesis doctoral consiste en mostrar la influencia que el desarrollo de la biología tuvo sobre la filosofía en los albores de la Modernidad, y muy especialmente en G. W. Leibniz. Sostengo que no se puede alcanzar una comprensión correcta de su pensamiento filosófico sin tomar en consideración el influjo que recibió de las ciencias de la vida. Trato, además, de ensayar esta clave interpretativa con algunos de los conceptos centrales del pensamiento leibniziano. La tesis trata sobre biología y metafísica en los albores de la Modernidad. Creo que la biología marcó profundamente en los inicios de la Modernidad el desarrollo de la metafísica. Así fue en muchos autores, por ejemplo, en los Van Helmont o Diderot, pero el caso más evidente e influyente fue el de Leibniz, de quien trataremos con más detalle a lo largo del trabajo. Si bien Leibniz ha de ser interpretado en el contexto de una época, la suya, en la que se dio esta influencia de la biología sobre la metafísica de modo generalizado, no podemos dejar de contemplar y ocuparnos de la posición dominante en los siglos XVII-XVIII: el mecanicismo cartesiano. Hemos querido hacer en este trabajo de investigación una resignificación y reinterpretación de Leibniz desde un enfoque vitalista, recogiendo a ese otro Leibniz biólogo y médico, en constante debate con numerosos filósofos del momento, seguidores de posturas más mecanicistas. El tema de la presente disertación doctoral se basa en el trabajo desarrollado en la Tesina doctoral acerca también de esta temática y que titulé: G. W. Leibniz: de la biología a la metafísica.
Clinical Features, Treatments, and Prognosis of Intramedullary Spinal Cord Metastases From Lung Cancer: A Case Series and Systematic Review
Authors: Wu Liang , Wang Li'ao , Yang Jun , Jia Wenqing , Xu Yulun
Published: February 2022

Objective: Intramedullary spinal cord metastasis from lung cancer (ISCM-LC) are increasing in prevalence. We aim to investigate its clinical features, treatments and prognosis.Methods: We reported 6 ISCM-LC cases and conducted a systematic review. Descriptive summarization, survival analysis, and multivariate Cox regression analysis were performed to comprehensively study the disease.Results: All 6 patients had surgery. One used chemotherapy and the other had targeted drugs. Two patients died of ISCM-LC, 1 died of pulmonary embolism, 1 was alive, and 2 were lost to follow-up. We identified 197 ISCM-LC cases in literature with a mean age of 58 years and male preponderance. Small cell lung cancer accounted for 39.1%. The median interval from lung cancer to ISCM-LC was 7 months. Limb weakness was the most common symptom, and 45% cases progressed rapidly. Concomitant brain, leptomeningeal, and vertebral metastasis occurred to 55.8%, 20%, and 19.5%, respectively. Peritumoral edema appeared in 83.3%. Through survival analysis, we found sex, extraspinal metastasis, pathology, and improved symptoms affected the overall survival. Additionally, gross total resection (GTR) shared similar effectiveness with non-GTR, and other treatments following surgery hardly added extra effect. Surgery, improved symptoms, and sex were 3 independent prognostic factors after adjusting for confounding. The estimated median survival time was 5 months.Conclusion: The overall survival of ISCM-LC remains poor. Surgery is an independent protective factor for survival. Surgery should be considered once tolerated, and GTR might not be necessary. In addition, female patients with improved symptoms after intervention might have better overall survival.