bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk of selection bias due to non‐participation in a cohort study on pubertal timing
Authors: Brix Nis , Ernst Andreas , Lauridsen Lea Lykke Braskhøj , Parner Erik Thorlund , Arah Onyebuchi A. , Olsen Jørn , Henriksen Tine Brink , Ramlau‐Hansen Cecilia Høst
Published: April 2020

Background

Non‐participation in aetiologic studies of pubertal timing is frequent. However, little effort has been given to explore the risk and potential impact of selection bias in studies of pubertal timing.

Objective

We aimed to explore the risk of selection bias due to non‐participation in a newly established puberty cohort.

Methods

We evaluated whether three maternal exposures chosen a priori (pre‐pregnancy obesity, smoking, and alcohol drinking during pregnancy) were associated with participation, whether pubertal timing was associated with participation, and whether selection bias influenced the associations between these exposures and pubertal timing. In total, 22 439 children from the Danish National Birth Cohort born 2000–2003 were invited to the Puberty Cohort and 15 819 (70%) participated. Exposures were self‐reported during pregnancy. Pubertal timing was measured using a previously validated marker, “the height difference in standard deviations” (HD:SDS), which is the difference between pubertal height and adult height, both in standard deviations. For this study, pubertal height at around 13 years in sons and around 11 years in daughters was obtained from an external database, and adult height was predicted based on parental height reported by mothers.

Results

Participation was associated with most exposures but not with pubertal timing, measured by HD:SDS. The associations between exposures and HD:SDS were comparable for participants only and all invited for participation.

Conclusion

In conclusion, the risk of selection bias in aetiologic studies on pubertal timing in the Puberty Cohort appears minimal.
Reassessing the role of ion homeostasis for improving salinity tolerance in crop plants
Authors: Basu Sahana , Kumar Alok , Benazir Ibtesham , Kumar Gautam
Published: April 2020

Soil salinity is a constraint for major agricultural crops leading to severe yield loss, which may increase with the changing climatic conditions. Disruption in the cellular ionic homeostasis is one of the primary responses induced by elevated sodium ions (Na+). Therefore, unraveling the mechanism of Na+ uptake and transport in plants along with the characterization of the candidate genes facilitating ion homeostasis is obligatory for enhancing salinity tolerance in crops. This review summarizes the current advances in understanding the ion homeostasis mechanism in crop plants, emphasizing the role of transporters involved in the regulation of cytosolic Na+ level along with the conservation of K+/Na+ ratio. Furthermore, expression profiles of the candidate genes for ion homeostasis were also explored under various developmental stages and tissues of Oryza sativa based on the publicly available microarray data. The review also gives an up‐to‐date summary on the efforts to increase salinity tolerance in crops by manipulating selected stress‐associated genes. Overall, this review gives a combined view on both the ionomic and molecular background of salt stress tolerance in plants.
Are rigor and transparency enough? Review and future directions for case studies in technology and innovation Management
Authors: Elsahn Ziad , Callagher Lisa , Husted Kenneth , Korber Stefan , Siedlok Frank
Published: April 2020

It is crucial to assess how technology and innovation management (TIM) scholars use case‐based research. Our study provides a theoretical systematic review of qualitative case‐based articles published in 31 TIM journals from 2013 to 2018. Our analysis of 311 articles uncovers patterns regarding rigor (including case justification and selection), transparency (including data collection and analytical methods), and paradigmatic consistency and pluralism. Our findings show some evidence of emerging pluralism in how TIM researchers perform qualitative case studies, but also highlight some worrying trends: paradigmatic inconsistencies, lack of transparency, and over‐reliance on specific approaches, all of which affect the value of case study research. We provide methodological guidelines for improving the use of qualitative case research in TIM.
Calving date and its variability as a potential trait in the breeding objective to account for reproductive seasonality in alpacas
Authors: Cruz Alan , Gutiérrez Juan Pablo , Torres Richard , Formoso‐Rafferty Nora , Morante Renzo , Burgos Alonso , Cervantes Isabel
Published: April 2020

The low fertility and offspring survival indicators in alpacas can be partially due to their particularity seasonal reproduction that reduces the opportunities of the females to become pregnant within a season, with the survival of the offspring concerned by the availability of food and exposure to diseases that depends on the calving date. Optimizing the date of delivery and reducing its variability are shown as eligible criteria that could be used as selection criteria within the genetic improvement programmes in alpacas, the calving date being a much more appropriate trait to measure and optimize fertility unlike of age at first calving and the calving interval, this due to the reproductive seasonality in camelids. For this study, 6,533 birth date records were taken between 2001 and 2018 of Peruvian alpacas, to estimate the genetic parameters. Models assuming heterogeneity in the residuals were fitted besides classical homogeneous models to address, not only the possibility of forwarding or delaying the calving date, but also the trend to have parturitions in similar dates. The heritability and repeatability ranged from 0.07 to 0.20 for a homogeneity model and from 0.08 to 0.23 for a heterogeneity model, and suggest the possibility of advancing or delaying the calving date. It should be taken into account that the gestation length of camelids makes it difficult to adapt many reproductive traits, and trying to centre the calving date could delay it. It was concluded the feasibility to genetically select the calving date, also in the production of camels and dromedaries, which have the same reproductive characteristics as alpacas. This selection can be combined with other traits. The heterogeneity model was shown to provide a better fit.
Time trends in the effects of mindfulness‐based cognitive therapy for depression: A meta‐analysis
Authors: Thimm Jens C. , Johnsen Tom J.
Published: April 2020

Recent studies suggest that the effects of cognitive therapies for depression show systematic changes over time. A meta‐analysis was conducted to explore the temporal development of the effect of mindfulness‐based cognitive therapy (MBCT) for current depression in studies that used the Beck Depression Inventory (BDI) or the Hamilton Depression Rating Scale (HDRS) as outcome measures. A systematic search of research databases yielded 20 studies that were included in the analyses. The results showed that MBCT is effective in reducing depressive symptoms. The effect sizes of studies using the BDI or the HDRS as an outcome measure were not moderated by the time of publication. Funnel plots and the trim and fill method suggested that publication bias was low. However, the number of available studies was small, and the time period investigated relatively short. The results should therefore be considered preliminary.
How do I manage severe postpartum hemorrhage?
Authors: Butwick Alexander , Lyell Deirdre , Goodnough Lawrence
Published: April 2020

In the United States, postpartum hemorrhage (PPH) accounts for 4.6% of all maternal deaths and is responsible for major peripartum medical and surgical morbidity. Therefore, a national health priority is to ensure that women who experience severe PPH receive timely, appropriate, and effective treatment. In this article, we describe our system‐wide approach for the planning and delivery of women with suspected placenta accreta spectrum disorder, a condition associated with life‐threatening blood loss at the time of delivery. We also highlight current evidence related to transfusion decision making and hemostatic monitoring during active postpartum bleeding. Specifically, we describe how we activate and use the massive transfusion protocol to obtain sufficient volumes and types of blood products. We also describe how we use viscoelastic monitoring (thromboelastography) and standard laboratory tests to assess the maternal coagulation profile. Finally, we review the findings of recent studies examining the potential efficacy of tranexamic acid and fibrinogen concentrate as adjuncts for PPH prevention and treatment. We describe how we have incorporated these drugs into PPH treatment protocols at our institution.
Improved access to better HLA‐matched hematopoietic cells for allogeneic transplant: analysis of donors and cord blood units selected for Canadian patients in 2018
Authors: Greco‐Stewart Valerie , Elmoazzen Heidi , Morris Gail , Guo Yiming , Langdon Colleen , Mercer Dena , Dibdin Nicholas , Allan David S.
Published: April 2020

BACKGROUND

Patients undergoing hematopoietic cell transplantation (HCT) often require use of an unrelated donor or cord blood unit (CBU). An understanding of evolving practices in graft selection is needed for optimization of donor recruitment and cord blood collection.

STUDY DESIGN AND METHODS

Each donor workup (WU) requested in 2018 involving a Canadian (CDN) patient and unique donor product or CBU was reviewed (n = 598). Degree of HLA match; product origin (domestic or international [INT]); and non‐HLA factors including donor age, sex, cytomegalovirus (CMV), and ABO compatibility were analyzed for WUs that proceeded to transplant (n = 414). We also analyzed changes compared to a similar analysis performed in 2013.

RESULTS

The majority of transplants used matched unrelated donors (MUDs; n = 323; 78%) and were most often young (≤35 years), male, INT donors (n = 136). The proportion of transplants involving MUDs, as opposed to mismatched unrelated donors or CBUs, increased by 12.4% compared with 2013. When young, male, CDN MUDs were identified in patient search reports but not selected, CMV mismatching and ABO incompatibility were most likely to have influenced the decision to use an INT MUD. Consistent with global trends, CBU transplants decreased compared to 2013; however, the degree of HLA matching improved significantly, and 27% of transplanted CBUs were procured from the Canadian Blood Services Cord Blood Bank.

CONCLUSIONS

Access to MUDs and better HLA‐matched CBUs by CDN patients has increased since 2013. Ongoing recruitment of young registrants and cord blood donors with diverse HLA haplotypes will support selection of donors with optimal non‐HLA characteristics.
Removal of hexavalent chromium from wastewater using supported liquid membrane: synthesis of chromium‐iron complex through electrochemical reaction
Authors: Mondal Supriyo Kumar , Saha Prabirkumar
Published: April 2020

Treatment of wastewater containing hexavalent chromium is the issue in this research. Supported liquid membrane with in situ electrochemical reaction in stripping section helps to reduce hexavalent chromium to trivalent chromium by forming chromium‐iron complex. Iron plate acts as anode in stripping section. The chromium‐iron complex is an useful value added product that can be used for various purposes such as catalyst in water‐gas shift reaction. Aliquat 336 has been used as carrier for transport of hexavalent chromium. Various physico‐chemical parameters have been optimised to detect the condition of maximum transport and precipitation of chromium‐iron complex in stripping phase. The important physico‐chemical parameters such as strip phase concentration, strip phase pH and concentration of carrier (% v/v) in Liquid Membrane have been selected through response surface methodology to obtain optimum performance for %precipitation of chromium.
Invasiveness of agronomic weed species in wheat in Western Australia
Authors: Borger Catherine P. D. , Hashem Abul , van Burgel Andrew , Gill Gurjeet S.
Published: April 2020

Weed seeds are introduced to agronomic systems naturally or through human‐mediated seed dispersal, and introduced seeds have a high chance of being resistant to selective, in‐crop herbicides. However, colonisation (invasion) rates for a weed species are usually much lower than rates of seed dispersal. The current research investigated colonisation of a winter annual wheat cropping system in Western Australia by a range of winter or summer annual weed species. The weed seeds were sown (at 100 seeds/m2) directly before seeding the crop in 2016 and allowed to grow in the following 3 years of wheat. Selective herbicides were not applied, to simulate growth of weed populations if the initial seed had been resistant to herbicide. Bromus diandrus, Hordeum leporinum, Rumex hypogaeus, Sonchus oleraceus, Polygonum aviculare, Lolium rigidum, Citrullus amarus and Tribulus terrestris colonised the crop, while Dactyloctenium radulans, Chloris truncata and Salsola australis failed to establish over 3 years. The most successful weed was B. diandrus, with a plant density of 1,170/m2 by the third year and seed production of 67,740/m2. The high density of B. diandrus reduced wheat density by 76% in the third year and reduced average yield by 36%. Lolium rigidum reduced average yield by 11%, and the other weed species did not affect crop yield. Further research is required on the invasiveness of these species in other regions, but it is clear that the spread of B. diandrus to new areas or the introduction of resistant B. diandrus seeds via contaminated grain should be avoided.
Biotechnology Anticipates 4D Printing
Authors: Kosowatz John
Published: April 2020

Rapid advancements in 3D printing that have fueled the development of advanced manufacturing applications are well-known. New printing techniques and their ability to print objects from a growing variety of materials such as plastics, metals, ceramics, and more allow developers and manufacturers to speed prototyping, streamline supply chains, and produce complex designs not previously possible. Even so, there are limits to what can be done because the materials are rigid. This article explores if 4D printing, the layer-by-layer manufacturing of parts that can change over time, is the next step.
Recovery of Tractions Exerted by Single Cells in Three-Dimensional Nonlinear Matrices
Authors: Song Dawei , Dong Li , Gupta Mukund , Li Linqing , Klaas Ottmar , Loghin Adrian , Beall Mark , Chen Christopher S. , Oberai Assad A.
Published: April 2020

Cell-generated tractions play an important role in various physiological and pathological processes such as stem-cell differentiation, cell migration, wound healing, and cancer metastasis. Traction force microscopy (TFM) is a technique for quantifying cellular tractions during cell–matrix interactions. Most applications of this technique have heretofore assumed that the matrix surrounding the cells is linear elastic and undergoes infinitesimal strains, but recent experiments have shown that the traction-induced strains can be large (e.g., more than 50%). In this paper, we propose a novel three-dimensional (3D) TFM approach that consistently accounts for both the geometric nonlinearity introduced by large strains in the matrix, and the material nonlinearity due to strain-stiffening of the matrix. In particular, we pose the TFM problem as a nonlinear inverse hyperelasticity problem in the stressed configuration of the matrix, with the objective of determining the cellular tractions that are consistent with the measured displacement field in the matrix. We formulate the inverse problem as a constrained minimization problem and develop an efficient adjoint-based minimization procedure to solve it. We first validate our approach using simulated data, and quantify its sensitivity to noise. We then employ the new approach to recover tractions exerted by NIH 3T3 cells fully encapsulated in hydrogel matrices of varying stiffness. We find that neglecting nonlinear effects can induce significant errors in traction reconstructions. We also find that cellular tractions roughly increase with gel stiffness, while the strain energy appears to saturate.
Strain-Based CTOD and J-Integral Estimations for Pipelines With a Surface Crack Under Large Plastic Strain and Internal Pressure
Authors: Jang Youn-Young , Kang Ju-Yeon , Huh Nam-Su , Kim Ik-Joong , Kim Young-Pyo
Published: April 2020

Engineering solutions for crack-tip opening displacement (CTOD) and J-integral estimations for pipelines with a surface crack are proposed based on parametric finite element (FE) analyses for various geometries, material properties, and internal pressure conditions. Two kinds of CTOD definitions are considered in relation to strain-based estimation solutions for dealing with confusion regarding the definition of CTOD and to extend the applicability of tensile strain capacity (TSC) assessment. Moreover, influence functions of internal pressure are also suggested to take account of the effect of internal pressure on TSC. Using the proposed solutions, TSCs for cracked X65 and X70 pipes were assessed based on initiation and ductile instability. Curved wide plate tests were performed to obtain experimental TSCs, which were compared with those from the proposed solutions. Moreover, TSCs from the proposed solutions were also compared with those from other TSC-predicted models in order to assess their validity.
Fracture Behavior of Cracked Ring Specimen at Different Crack Positions
Authors: Alqahtani Abdulmohsen M. , Albulayhid Thamer K. , Alotaibi Mutlaq N. , Alarifi Ibrahim M. , EL-Bagory Tarek M. A. A.
Published: April 2020

The previous research review of piping systems revealed that the plastic pipe companies suffered from many problems in natural gas pipeline systems. One of the most significant problems that appeared in the piping systems are external cracks due to manufacturing processes, welding technique, and installation processes. The principal goal of the present experimental study is to predict the crack growth behavior and energy release rate of cracked ring specimens made from high-density polyethylene (HDPE) under different crack position angles and various crosshead speeds. The effect of loading rate on the external radial crack at different crack position angles plays an important role in the prediction of fracture behavior of plastic pipe materials. For this reason, it is necessary to conduct a study for the fracture analysis of pipe ring specimens under tension loading with double external cracks at constant radial crack length to width ratio equal a/W = 0.5. A precracking machine is designed especially in the present experimental study to simulate the actual radial cracks at outer surface of pipe ring specimens. The effects of crosshead speed and crack position angle revealed a significant effect on the energy release rate and maximum applied load under tensile load.
Effect of Morphology of Nano-Structured Surfaces on Anti-Icing Performance
Authors: Yang Siyan , Hao Tingting , Liu Mucan , Yu Xingtong , Ma Xuehu
Published: April 2020

Droplets bouncing off cold surfaces before being frozen is one way to achieve anti-icing, in which process superhydrophobic surfaces have been proven to play an important role. By using template-assisted method, three types of copper nanowired superhydrophobic surfaces (NSHSs) with mainly two morphologies (aggregated and upright) are fabricated. CuO nanograssed superhydrophobic surface (SHS) and copper smooth hydrophobic surface (HS) are also fabricated as a comparison. Compared with smooth HS and nanograssed SHS, all NSHSs exhibit better performance in repelling impacting droplet. In detail, on three types of NSHSs with temperatures ranging from 20 °C to −20 °C, impacting droplets can totally rebound. Among the three types, nanowires aggregated most exhibit the best water-repellency performance. The different performances among the five surfaces are due to surface temperature and surface morphology parameters, including micro/nano-size and surface roughness.
New species and records of Oppiidae (Acari, Oribatida) from the Montagne d'Ambre National Park (Madagascar)

Authors: Ermilov Sergey G. , Stary Josef
Published: April 2020

Two new species of oribatid mites of the family Oppiidae collected from leaf litter in Madagascar are described. Ramuselloppia indistincta sp. nov. differs from Ramuselloppia anomala by larger body size, the presence of epimeral tubercles  and comparatively long lamellar, interlamellar and notogastral setae and the absence of costulae and heads of bothridial setae. An identification key to known species of Ramuselloppia is provided. Lanceoppia (Baioppia) rugosa sp. nov. differs from all species of the subgenus by heavily rugose posterior part of the notogaster. The genus Ramuselloppia and subgenus Lanceoppia (Baioppia) are recorded in the Ethiopian region for the first time; the species Multioppia (Hammeroppia) wilsoni is recorded in Madagascar for the first time.
A Clinically Relevant Method of Quantifying the Mechanical Properties of RockTape® Kinesiology Tape at Different Elongation Lengths
Authors: Cheatham Scott W. , Baker Russell
Published: April 2020

Context: Kinesiology tape (KT) is a therapeutic intervention used to treat different musculoskeletal conditions and to enhance sports performance. The evidence is inconclusive, with researchers attributing the variable outcomes to different manufactured KT used in the research. Researchers have begun to measure and document the mechanical properties of different brands, using machines versus professionals. This prevents a clear translation to clinical practice, as it may be difficult to reproduce outcomes. There is a need to measure the mechanical properties of KT using more clinically relevant methodology. Objective: The purpose was to document a clinically relevant method of measuring the mechanical properties of 2 different types of precut RockTape® tape at common elongation lengths and to establish the methodology for future validation research on this testing method. Design: Controlled laboratory study. Setting: University laboratory. Participants: One researcher conducted all measurements. Procedures: Each tape was measured at 3 elongation lengths with a force gauge. Main Outcome Measures: Force, stress, and Young modulus. Results: The RockTape® 2 and RockTape® 3 elongation force were 25% = 2.27 (0.21) and 2.12 (0.26) N, 50% = 6.51 (0.27) and 5.93 (0.20) N, and 75% = 30.13 (0.63) and 21.23 (0.41) N. The stress values for the RockTape® 2 and RockTape® 3 were 25% = 0.88 (0.05) and 0.82 (0.03) kPa, 50% = 2.52 (0.03) and 2.29 (0.01) kPa, and 75% = 11.67 (0.04) and 8.23 (0.02) kPa. The Young modulus values for the RockTape® 2 and RockTape® 3 were 25% = 3.51 (0.00) and 3.29 (0.00) kPa, 50% = 5.04 (0.00) and 4.60 (0.00) kPa, and 75% = 15.57 (0.00) and 10.96 (0.00) kPa. Conclusion: This investigation documented a novel method of measuring the mechanical properties of 2 types of RockTape® KT. Future research should attempt to validate these testing methods.
Volleygate: A History of Scandal in the Largest International Sport Federation
Authors: Fabian Tom
Published: April 2020

Neither the history of volleyball nor of its governing body has received much scholarly attention. As such, the objective of this study is to highlight the institutional history of the Fédération Internationale de Volleyball (FIVB) through the organization’s response (or lack of response) to the corrupt practices known as “volleygate” that have embroiled the volleyball world since the mid 1980s. Through this sociohistorical study of the FIVB, many of the challenges facing modern international sport federations can be recognized and critiqued. Yet, despite its moral failings, the show must go on.
Linking indirect effects of cytomegalovirus in transplantation to modulation of monocyte innate immune function
Authors: Sen Pritha , Wilkie Adrian R. , Ji Fei , Yang Yiming , Taylor Ian J. , Velazquez-Palafox Miguel , Vanni Emilia A. H. , Pesola Jean M. , Fernandez Rosio , Chen Han , Morsett Liza M. , Abels Erik R. , Piper Mary , Lane Rebekah J. , Hickman Suzanne E. , Means Terry K. , Rosenberg Eric S. , Sadreyev Ruslan I. , Li Bo , Coen Donald M. , Fishman Jay A. , El Khoury Joseph
Published: April 2020

CMV-infected monocytes are unable to phagocytose fungal pathogens yet produce inflammation associated with rejection and GVHD.
Distinct roles of parvalbumin and somatostatin interneurons in gating the synchronization of spike times in the neocortex
Authors: Jang Hyun Jae , Chung Hyowon , Rowland James M. , Richards Blake A. , Kohl Michael M. , Kwag Jeehyun
Published: April 2020

Sensory information–driven spikes are synchronized across cortical layers by distinct subtypes of interneurons.
A facile technology for the high-throughput sequencing of the paired VH:VL and TCRβ:TCRα repertoires
Authors: Tanno Hidetaka , McDaniel Jonathan R. , Stevens Christopher A. , Voss William N. , Li Jie , Durrett Russell , Lee Jiwon , Gollihar Jimmy , Tanno Yuri , Delidakis George , Pothukuchy Arti , Ellefson Jared W. , Goronzy Jörg J. , Maynard Jennifer A. , Ellington Andrew D. , Ippolito Gregory C. , Georgiou George
Published: April 2020

We report a simple and low-cost one-step high-throughput technology for sequencing the paired antibody/TCR repertoire.
Rhodoxanthin synthase from honeysuckle; a membrane diiron enzyme catalyzes the multistep conversion of β-carotene to rhodoxanthin
Authors: Royer John , Shanklin John , Balch-Kenney Nathalie , Mayorga Maria , Houston Peter , de Jong René M. , McMahon Jenna , Laprade Lisa , Blomquist Paul , Berry Timothy , Cai Yuanheng , LoBuglio Katherine , Trueheart Joshua , Chevreux Bastien
Published: April 2020

A novel β-carotene hydroxylase catalyzes the formation of rhodoxanthin, an unusual carotenoid in red honeysuckle berries.
Actin modulates shape and mechanics of tubular membranes
Authors: Allard A. , Bouzid M. , Betz T. , Simon C. , Abou-Ghali M. , Lemière J. , Valentino F. , Manzi J. , Brochard-Wyart F. , Guevorkian K. , Plastino J. , Lenz M. , Campillo C. , Sykes C.
Published: April 2020

The stability of membrane tubes is fine-tuned by a hundred-nanometer-thick branched actin network.
Tropical cyclone motion in a changing climate
Authors: Zhang Gan , Murakami Hiroyuki , Knutson Thomas R. , Mizuta Ryo , Yoshida Kohei
Published: April 2020

Climate models suggest that future anthropogenic warming can slow hurricane motion, including near populated midlatitude regions.
An anti-inflammatory eicosanoid switch mediates the suppression of type-2 inflammation by helminth larval products
Authors: de los Reyes Jiménez Marta , Lechner Antonie , Alessandrini Francesca , Bohnacker Sina , Schindela Sonja , Trompette Aurélien , Haimerl Pascal , Thomas Dominique , Henkel Fiona , Mourão André , Geerlof Arie , da Costa Clarissa Prazeres , Chaker Adam M. , Brüne Bernhard , Nüsing Rolf , Jakobsson Per-Johan , Nockher Wolfgang A. , Feige Matthias J. , Haslbeck Martin , Ohnmacht Caspar , Marsland Benjamin J. , Voehringer David , Harris Nicola L. , Schmidt-Weber Carsten B. , Esser-von Bieren Julia
Published: April 2020

A helminth larval extract and its component
Hpb
glutamate dehydrogenase induce an anti-inflammatory mediator switch to suppress type-2 inflammation.
Glymphatics rapidly clear nanoparticles
Authors: Airan Raag
Published: April 2020

The glymphatics system of the brain rapidly clears organic nanoparticles commonly used for brain drug delivery.
Genome Sequence of Human Cytomegalovirus Ig-KG-H2, a Variant of Strain KG Propagated in the Presence of Neutralizing Antibodies
Authors: Al Qaffas Ahmed , Camiolo Salvatore , Nichols Jenna , Davison Andrew J. , Ourahmane Amine , Cui Xiaohong , Schleiss Mark R. , Hertel Laura , Dittmer Dirk P. , McVoy Michael A.
Published: April 2020

Human cytomegalovirus shed in infant urine was isolated and serially passaged in fibroblasts in the presence or absence of neutralizing antibodies. Comparison of the genome sequences of representative viruses Ig-KG-H2 (passed with antibody) and ϕ-KG-B5 (passed without antibody) revealed the presence of several mutations in each virus.
Hard routes of mental health in Portugal: what can we offer to an adolescent with serious mental illness and multiple social risk factors?
Authors: Goncalves Rita , Marques Mafalda , Cartaxo Teresa , Santos Vera
Published: April 2020

Worldwide, millions of children and adolescents are suffering due to a lack of efficient mental healthcare. Although some progress has been made to address the mental health problems in this age group, currently, even developed countries fail in providing psychiatric patients with the best practice care. We present a case of a Portuguese adolescent with a first episode of psychosis in whom multiple social and environmental risk factors were identified as triggers to his clinical presentation, as well as fundamental determinants of prognosis in the short and long term. In this case, we demonstrate how social determinants, including poverty, family dysfunction and difficulties in accessing appropriate mental healthcare, strongly influence the development, maintenance and prognosis in early psychosis during adolescence. Furthermore, we consider the implications of an absence of community-based mental healthcare and rehabilitation services and reasons for why this may complicate the management and limit opportunities to this patient population.
Coding and classifying GP data: the POLAR project
Authors: Pearce Christopher , McLeod Adam , Patrick Jon , Ferrigi Jason , Bainbridge Michael Michael , Rinehart Natalie , Fragkoudi Anna
Published: April 2020

Background

Data, particularly ‘big’ data are increasingly being used for research in health. Using data from electronic medical records optimally requires coded data, but not all systems produce coded data.

Objective

To design a suitable, accurate method for converting large volumes of narrative diagnoses from Australian general practice records to codify them into SNOMED-CT-AU. Such codification will make them clinically useful for aggregation for population health and research purposes.

Method

The developed method consisted of using natural language processing to automatically code the texts, followed by a manual process to correct codes and subsequent natural language processing re-computation. These steps were repeated for four iterations until 95% of the records were coded. The coded data were then aggregated into classes considered to be useful for population health analytics.

Results

Coding the data effectively covered 95% of the corpus. Problems with the use of SNOMED CT-AU were identified and protocols for creating consistent coding were created. These protocols can be used to guide further development of SNOMED CT-AU (SCT). The coded values will be immensely useful for the development of population health analytics for Australia, and the lessons learnt applicable elsewhere.
Two algorithms for the reorganisation of the problem list by organ system
Authors: Hier Daniel B , Pearson Joshua
Published: April 2020

Objective

Long problem lists can be challenging to use. Reorganisation of the problem list by organ system is a strategy for making long problem lists more manageable.

Methods

In a small-town primary care setting, we examined 4950 unique problem lists over 5 years (24 033 total problems and 2170 unique problems) from our electronic health record. All problems were mapped to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) and SNOMED CT codes. We developed two different algorithms for reorganising the problem list by organ system based on either the ICD-10-CM or the SNOMED CT code.

Results

The mean problem list length was 4.9±4.6 problems. The two reorganisation algorithms allocated problems to one of 15 different categories (12 aligning with organ systems). 26.2% of problems were assigned to a more general category of ‘signs and symptoms’ that did not correspond to a single organ system. The two algorithms were concordant in allocation by organ system for 90% of the unique problems. Since ICD-10-CM is a monohierarchic classification system, problems coded by ICD-10-CM were assigned to a single category. Since SNOMED CT is a polyhierarchical ontology, 19.4% of problems coded by SNOMED CT were assigned to multiple categories.

Conclusion

Reorganisation of the problem list by organ system is feasible using algorithms based on either ICD-10-CM or SNOMED CT codes, and the two algorithms are highly concordant.
Nurses’ perceptions of the clinical information system in primary healthcare centres in Qatar: a cross-sectional survey
Authors: Mansoori Monaa Hussain , Benjamin Kathleen , Ngwakongnwi Emmanuel , Al Abdulla Samya
Published: April 2020

Background

Qatar is one of the fastest growing countries in the Arabic region. Primary Health Care Corporation (PHCC) is the main provider of primary health services in Qatar and employs 1600 nurses. In 2014, PHCC started to migrate from paper to electronic documentation of patient records using a clinical information system (CIS). Since implementation, the use of CIS and perception of users have not been assessed.

Objective

This study measured nurses’ perceptions regarding the utilisation, quality and user satisfaction with the CIS in PHCC.

Methods

Using a pre-existing survey, a cross-section of nurses from six health centres in Qatar were systematically selected and invited to participate in the study. Eighty-nine surveys were completed (response rate: 98.8%) and descriptive analyses were performed.

Results

Nurses’ perceptions regarding the utilisation, quality and user satisfaction with the CIS were positive. Nurses indicated that the CIS is a resource for clear, accurate and up-to-date data and that their performance improved due to the CIS. Yet responses to an open-ended question in the survey revealed some concerns related to the CIS, such as patient confidentiality, system downtime and time constraints.

Conclusion

Ensuring that the CIS is facilitating nurses’ work is crucial to guarantee high-quality care to the community. The findings provide foundational data to help PHCC to understand nurses’ perceptions and to take steps to overcome challenges that nurses face related to the CIS in their daily practice. This work could also provide direction for future research.
International feasibility trial on the use of an interactive mobile health platform for cardiac rehabilitation: protocol of the Diversity 1 study
Authors: Gonzalez-Garcia Manuel Cruz , Fatehi Farhad , Scherrenberg Martijn , Henriksson Robin , Maciejewski Adrian , Salamanca Viloria Jorge , Cummins Paul , Frederix Ines , Rojas Gonzalez Antonio Manuel , Koltowski Lukasz , Bruining Nico , Mooe Thomas , Dendale Paul , Karunanithi Mohan , Varnfield Marlien
Published: April 2020

Introduction

The implementation of home-based cardiac rehabilitation has demonstrated potential to increase patient participation, but the content and the delivering of the programmes varies across countries. The objective of this study is to investigate whether an Australian-validated mobile health (mHealth) platform for cardiac rehabilitation will be accepted and adopted irrespectively from the existing organisational and contextual factors in five different European countries.

Methods and analysis

This international multicentre feasibility study will use surveys, preliminary observations and analysis to evaluate the use and the user’s perceptions (satisfaction) of a validated mHealth platform in different contextual settings.

Ethics and dissemination

This study protocol has been approved by the Australian research organisation CSIRO and the respective ethical committees of the European sites. The dissemination of this trial will serve as a ground for the further implementation of an international large randomised controlled trial which will contribute to an effective global introduction of mHealth into daily clinical practice.
Outcomes of a feasibility trial using an innovative mobile health programme to assist in insulin dose adjustment
Authors: Menon Anish , Fatehi Farhad , Ding Hang , Bird Dominique , Karunanithi Mohan , Gray Leonard , Russell Anthony
Published: April 2020

Objective

Intensification of diabetes therapy with insulin is often delayed for people with suboptimal glycaemic control. This paper reports on the feasibility of using an innovative mobile health (mHealth) programme to assist a diabetes insulin dose adjustment (IDA) service.

Methods

Twenty adults with diabetes referred to a tertiary hospital IDA service were recruited. They were provided with a cloud-based mobile remote monitoring system—the mobile diabetes management system (MDMS). The credentialled diabetes educator (CDE) recorded the time taken to perform IDA utilising the MDMS versus the conventional method—which is a weekly adjustment of insulin doses by a CDE through telephone contact based on three or more daily blood glucose readings. Participants and staff completed a feedback questionnaire.

Results

The CDE spent 55% less time performing IDA using MDMS than using the conventional method. The participants were satisfied with MDMS use and the CDEs reported improved efficiency.

Conclusion

Incorporating a mHealth programme for an IDA service has the potential to improve service delivery efficiencies while simultaneously improving the patient experience.
Evaluating the quality of voice assistants’ responses to consumer health questions about vaccines: an exploratory comparison of Alexa, Google Assistant and Siri
Authors: Alagha Emily Couvillon , Helbing Rachel Renee
Published: April 2020

Objective

To assess the quality and accuracy of the voice assistants (VAs), Amazon Alexa, Siri and Google Assistant, in answering consumer health questions about vaccine safety and use.

Methods

Responses of each VA to 54 questions related to vaccination were scored using a rubric designed to assess the accuracy of each answer provided through audio output and the quality of the source supporting each answer.

Results

Out of a total of 6 possible points, Siri averaged 5.16 points, Google Assistant averaged 5.10 points and Alexa averaged 0.98 points. Google Assistant and Siri understood voice queries accurately and provided users with links to authoritative sources about vaccination. Alexa understood fewer voice queries and did not draw answers from the same sources that were used by Google Assistant and Siri.

Conclusions

Those involved in patient education should be aware of the high variability of results between VAs. Developers and health technology experts should also push for greater usability and transparency about information partnerships as the health information delivery capabilities of these devices expand in the future.
Telehealth dashboard: leverage reporting functionality to increase awareness of high-acuity emergency department patients across an enterprise practice
Authors: Heaton Heather A , Russi Christopher S , Monroe Ryan J , Thompson Kristine M , Koch Karen A
Published: April 2020

Background

Emergency Medicine Telehealth (TeleEM) represents an opportunity to work directly with referral centres, rural facilities and underserved areas to mitigate unnecessary testing, optimise resource utilisation and facilitate patient transfers across health systems. To optimise the impact of a TeleEM programme, a tool is needed to remotely monitor patient activity in multiple emergency department facilities, concurrently.

Methods

After identifying data sources for activation criteria put forth by the TeleEM operations group, rules were constructed within the electronic health record to facilitate data checks and ultimately produce a yes/no response if the category’s conditions were met. Responses were organised into a table, with functionality allowing end users to drill into the different sites to see patient-specific information for patients meeting activation criteria.

Conclusions

The TeleEM dashboard allows for proactive engagement by the TeleEM physician and strengthens the team-based approach of critically ill.
Recording problems and diagnoses in clinical care: developing guidance for healthcare professionals and system designers
Authors: Shah Anoop Dinesh , Quinn Nicola J , Chaudhry Afzal , Sullivan Ralph , Costello Julian , O"Riordan Dermot , Hoogewerf Jan , Orton Martin , Foley Lorraine , Feger Helene , Williams John G
Published: April 2020

Background

Accurate recording of problems and diagnoses in health records is key to safe and effective patient care, yet it is often done poorly. Electronic health record systems vary in their functionality and ease of use, and are not optimally designed for easy recording and sharing of clinical information. There is a lack of professional consensus and guidance on how problems and diagnoses should be recorded.

Methods

The Professional Record Standards Body commissioned work led by the Royal College of Physicians Health Informatics Unit to carry out a literature review, draft guidance, carry out an online consultation and round table discussion, and produce a report including recommendations for systems. A patient workshop was held to explore patient preferences for mechanisms for sharing diagnosis information between primary and secondary care.

Results

Consensus was reached among medical specialties on key elements of diagnosis recording, and draft guidance was produced ready for piloting in a variety of care settings. Patients were keen for better ways for diagnosis information to be shared.

Discussion

Improving the recording of diagnoses and problems will require a major effort of which the new guidance is only a part. The guidance needs to be embedded in training, and clinical systems need to have improved, standardised functionality. Front-line clinicians, specialist societies, clinical informaticians and patients need to be engaged in developing information models for diagnoses to support care and research, accessible via user-friendly interfaces.
Methadone rotation for cancer pain: an observational study
Authors: Tan Christina , Wong Jade Fui , Yee Choon Meng , Hum Allyn
Published: April 2020

Context

Methadone is a useful option in the treatment of cancer pain. Despite its advantages, methadone use is complicated due to high interindividual variability in pharmacokinetics. Various rotation methods from other opioids have been proposed in mostly Caucasian populations.

Objectives

This study aims to describe our experience with opioid rotation to methadone for management of cancer pain in a predominantly Asian population.

Methods

A retrospective review of 52 inpatients initiated on methadone for cancer pain from June 2015 to June 2018 was conducted. Our institution protocol for methadone rotation involves either one of two methods (‘Stop-and-go’ or the Edmonton 3-day rotation) based on the morphine-equivalent daily dose (MEDD), using an equianalgesic ratio of 10:1 for MEDD <1000 mg. To account for incomplete cross-tolerance, we further reduce the calculated dose by 30%.

Results

The majority of patients had mixed nociceptive-neuropathic pain (83%) and the predominant reason for methadone rotation was ineffective analgesia with other opioids (75%). The median MEDD before rotation was 104 mg. Effective analgesia (defined as a decrease in numerical rating scale (NRS) of ≥1 or attainment of NRS ≤3) was achieved within 3 days after rotation in 89% of patients. Patients with an MEDD ≤100 mg/day required a greater degree of uptitration of methadone dose after rotation compared with those with an MEDD >100 mg/day.

Conclusion

Rotation to methadone according to our protocol is effective in achieving adequate analgesia in most patients experiencing nociceptive-neuropathic pain. Our results also suggest that a fixed equianalgesic ratio of 10:1 may be adequate for patients at low-to-moderate MEDD <400 mg/day.
Burns and Scalds Assessment Template: standardising clinical assessment of childhood burns in the emergency department
Authors: Hepburn Kirsty , Bennett Verity , Kemp Alison Mary , Hollen Linda Irene , Nuttall Diane , Roberts Zoe , Farrell David , Mullen Stephen
Published: April 2020

Objectives

The Burns and Scalds Assessment Template (BaSAT) is an evidence-based proforma coproduced by researchers and ED staff with the aim of (1) standardising the assessment of children attending ED with a burn, (2) improving documentation and (3) screening for child maltreatment. This study aimed to test whether the BaSAT improved documentation of clinical, contributory and causal factors of children’s burns.

Methods

A retrospective before-and-after study compared the extent to which information was recorded for 37 data fields after the BaSAT was introduced in one paediatric ED. Pre-BaSAT, a convenience sample of 50 patient records of children who had a burn was obtained from the hospital electronic database of 2007. The post-BaSAT sample included 50 randomly selected case notes from 2016/2017 that were part of another research project. Fisher's exact test and Mann-Whitney U tests were conducted to test for statistical significance.

Results

Pre-BaSAT, documentation of key data fields was poor. Post-BaSAT, this varied less between patients, and median completeness significantly (p<0.001) increased from 44% (IQR 4%–94%) to 96% (IQR 94%–100%). Information on ‘screening for maltreatment, referrals to social care and outcome’ was poorly recorded pre-BaSAT (median of 4% completed fields) and showed the greatest overall improvement (to 95%, p<0.001). Documentation of domestic violence at home and child’s ethnicity improved significantly (p<0.001) post-BaSAT; however, these were still not recorded in 36% and 56% of cases, respectively.

Conclusion

Introduction of the BaSAT significantly improved and standardised the key clinical data routinely recorded for children attending ED with a burn.
Dynamic adaptation to COVID-19 in a Singapore paediatric emergency department
Authors: Tan Ronald Ming Ren , Ong Gene Yong-Kwang , Chong Shu-Ling , Ganapathy Sashikumar , Tyebally Arif , Lee Khai Pin
Published: April 2020

Singapore was one of the earliest countries affected by the coronavirus disease 2019 (COVID-19) pandemic, with more laboratory-confirmed COVID-19 cases in early February 2020 than any other country outside China. This short report is a narrative review of our tertiary paediatric emergency department (ED) perspective and experience managing the evolving outbreak situation. Logistic considerations included the segregation of the ED into physically separate high-risk, intermediate-risk and low-risk areas, with risk-adapted use of personal protective equipment (PPE) for healthcare personnel in each ED area. Workflow considerations included the progressive introduction of outpatient COVID-19 testing in the ED for enhanced surveillance; adapting the admissions process particularly for high-risk and intermediate-risk cases; and the management of unwell accompanying adult caregivers. Manpower considerations included the reorganisation of medical manpower into modular teams to mitigate the risk of hospital transmission of COVID-19. Future plans for a tiered isolation facility should include structural modifications for the permanent isolation facility such as anterooms for PPE donning/doffing; replication of key ED functions in the tent facility such as a separate resuscitation room and portable X-ray room; and refresher PPE training. Dynamic reassessment of ED workflow processes, in conjunction with the hospital and national public health response, may help in managing this novel disease entity.