bluuebunny/crossref_metadata_2025 huggingface dataset:
Automatic detection and classification of bearded seal vocalizations in the northeastern Chukchi Sea using convolutional neural networks
Authors: Escobar-Amado Christian. D. , Badiey Mohsen. , Pecknold Sean.
Published: January 2022

Bearded seals vocalizations are often analyzed manually or by using automatic detections that are manually validated. In this work, an automatic detection and classification system (DCS) based on convolutional neural networks (CNNs) is proposed. Bearded seal sounds were year-round recorded by four spatially separated receivers on the Chukchi Continental Slope in Alaska in 2016–2017. The DCS is divided in two sections. First, regions of interest (ROI) containing possible bearded seal vocalizations are found by using the two-dimensional normalized cross correlation of the measured spectrogram and a representative template of two main calls of interest. Second, CNNs are used to validate and classify the ROIs among several possible classes. The CNNs are trained on 80% of the ROIs manually labeled from one of the four spatially separated recorders. When validating on the remaining 20%, the CNNs show an accuracy above 95.5%. To assess the generalization performance of the networks, the CNNs are tested on the remaining recorders, located at different positions, with a precision above 89.2% for the main class of the two types of calls. The proposed technique reduces the laborious task of manual inspection prone to inconstant bias and possible errors in detections.
Physical Activity, Glycemic Variability, and Parental Hypoglycemia Fear in Preschoolers With Type 1 Diabetes
Authors: Patton Susana R. , Monzon Alexandra D. , Noser Amy E. , Clements Mark A.
Published: January 2022

Purpose: The authors examined associations between preschoolers’ daily glycemic variability, parents’ report of hypoglycemia fear, and preschoolers’ daily moderate to vigorous physical activity (MVPA) and sedentary behavior (SB) in 25 families of preschoolers with type 1 diabetes. Methods: Parents completed a valid measure of hypoglycemia fear, and their child wore an accelerometer for up to 7 days. Parents provided glucose data from their child’s devices. The authors used multiple regression and multilevel modeling to analyze their data. Results: Preschoolers (mean age 4.2 [1.7] y; 50% boys) engaged in a mean of 154.5 (59.6) and 339.2 (85.1) minutes of MVPA and SB per day, respectively, and parents reported relatively low levels of hypoglycemia worry and avoidance behaviors. Preschoolers’ SB (r = .19, P = .02) and MVPA (r = −.20, P = .01) levels were significantly correlated with parental hypoglycemia worry scores but not with parents’ hypoglycemia behavior scores (P = .15 and P = .92, respectively). While multilevel models did not show an association between MVPA and preschoolers’ glycemic variability, preschoolers who engaged in more daily SB experienced higher glycemic variability (P = .04). Conclusions: Research exploring MVPA, SB, and parental hypoglycemia fear in preschoolers with type 1 diabetes could have important clinical implications because it may reveal modifiable treatment targets that can impact preschoolers’ health and activity patterns.
Trade-off between sex and growth in diatoms: Molecular mechanisms and demographic implications
Authors: Annunziata Rossella , Mele Bruno Hay , Marotta Pina , Volpe Massimiliano , Entrambasaguas Laura , Mager Svenja , Stec Krzysztof , d’Alcalà Maurizio Ribera , Sanges Remo , Finazzi Giovanni , Iudicone Daniele , Montresor Marina , Ferrante Maria Immacolata
Published: January 2022

Diatoms are fast-growing and winning competitors in aquatic environments, possibly due to optimized growth performance. However, their life cycles are complex, heteromorphic, and not fully understood. Here, we report on the fine control of cell growth and physiology during the sexual phase of the marine diatom
Pseudo-nitzschia multistriata
. We found that mating, under nutrient replete conditions, induces a prolonged growth arrest in parental cells. Transcriptomic analyses revealed down-regulation of genes related to major metabolic functions from the early phases of mating. Single-cell photophysiology also pinpointed an inhibition of photosynthesis and storage lipids accumulated in the arrested population, especially in gametes and zygotes. Numerical simulations revealed that growth arrest affects the balance between parental cells and their siblings, possibly favoring the new generation. Thus, in addition to resources availability, life cycle traits contribute to shaping the species ecological niches and must be considered to describe and understand the structure of plankton communities.
How is a turbidite actually deposited?
Authors: Ge Zhiyuan , Nemec Wojciech , Vellinga Age J. , Gawthorpe Rob L.
Published: January 2022

The deposition of a classic turbidite by a surge-type turbidity current, as envisaged by conceptual models, is widely considered a discrete event of continuous sediment accumulation at a falling rate by the gradually waning density flow. Here, we demonstrate, on the basis of a high-resolution advanced numerical CFD (computational fluid dynamics) simulation and rock-record examples, that the depositional event in reality involves many brief episodes of nondeposition. The reason is inherent hydraulic fluctuations of turbidity current energy driven by interfacial Kelvin-Helmholtz waves. The experimental turbidity current, with realistic grain-size composition of a natural turbidite, used only 26 to 33% of its in-place flow time for deposition, while the remaining time went to the numerous episodes of sediment bypass and transient erosion. The general stratigraphic notion of a gross incompleteness of sedimentary record may then extend down to the deposition time scale of a single turbidite.
A 2-year locomotive exploration and scientific investigation of the lunar farside by the Yutu-2 rover
Authors: Ding L. , Zhou R. , Yuan Y. , Yang H. , Li J. , Yu T. , Liu C. , Wang J. , Li S. , Gao H. , Deng Z. , Li N. , Wang Z. , Gong Z. , Liu G. , Xie J. , Wang S. , Rong Z. , Deng D. , Wang X. , Han S. , Wan W. , Richter L. , Huang L. , Gou S. , Liu Z. , Yu H. , Jia Y. , Chen B. , Dang Z. , Zhang K. , Li L. , He X. , Liu S. , Di K.
Published: January 2022

The lunar nearside has been investigated by many uncrewed and crewed missions, but the farside of the Moon remains poorly known. Lunar farside exploration is challenging because maneuvering rovers with efficient locomotion in harsh extraterrestrial environment is necessary to explore geological characteristics of scientific interest. Chang’E-4 mission successfully targeted the Moon’s farside and deployed a teleoperated rover (Yutu-2) to explore inside the Von Kármán crater, conveying rich information regarding regolith, craters, and rocks. Here, we report mobile exploration on the lunar farside with Yutu-2 over the initial 2 years. During its journey, Yutu-2 has experienced varying degrees of mild slip and skid, indicating that the terrain is relatively flat at large scales but scattered with local gentle slopes. Cloddy soil sticking on its wheels implies a greater cohesion of the lunar soil than encountered at other lunar landing sites. Further identification results indicate that the regolith resembles dry sand and sandy loam on Earth in bearing properties, demonstrating greater bearing strength than that identified during the Apollo missions. In sharp contrast to the sparsity of rocks along the traverse route, small fresh craters with unilateral moldable ejecta are abundant, and some of them contain high-reflectance materials at the bottom, suggestive of secondary impact events. These findings hint at notable differences in the surface geology between the lunar farside and nearside. Experience gained with Yutu-2 improves the understanding of the farside of the Moon, which, in return, may lead to locomotion with improved efficiency and larger range.
Quadruped robots venture into the wild with open eyes
Authors: Kim Donghyun
Published: January 2022

Perception-based locomotion learning accelerates the real-world deployment of quadruped robots.
Loss of TDP-43 function and rimmed vacuoles persist after T cell depletion in a xenograft model of sporadic inclusion body myositis
Authors: Britson Kyla A. , Ling Jonathan P. , Braunstein Kerstin E. , Montagne Janelle M. , Kastenschmidt Jenna M. , Wilson Andrew , Ikenaga Chiseko , Tsao William , Pinal-Fernandez Iago , Russell Katelyn A. , Reed Nicole , Mozaffar Tahseen , Wagner Kathryn R. , Ostrow Lyle W. , Corse Andrea M. , Mammen Andrew L. , Villalta S. Armando , Larman H. Benjamin , Wong Philip C. , Lloyd Thomas E.
Published: January 2022

Sporadic inclusion body myositis (IBM) is the most common acquired muscle disease in adults over age 50, yet it remains unclear whether the disease is primarily driven by T cell–mediated autoimmunity. IBM muscle biopsies display nuclear clearance and cytoplasmic aggregation of TDP-43 in muscle cells, a pathologic finding observed initially in neurodegenerative diseases, where nuclear loss of TDP-43 in neurons causes aberrant RNA splicing. Here, we show that loss of TDP-43–mediated splicing repression, as determined by inclusion of cryptic exons, occurs in skeletal muscle of subjects with IBM. Of 119 muscle biopsies tested, RT-PCR–mediated detection of cryptic exon inclusion was able to diagnose IBM with 84% sensitivity and 99% specificity. To determine the role of T cells in pathogenesis, we generated a xenograft model by transplanting human IBM muscle into the hindlimb of immunodeficient mice. Xenografts from subjects with IBM displayed robust regeneration of human myofibers and recapitulated both inflammatory and degenerative features of the disease. Myofibers in IBM xenografts showed invasion by human, oligoclonal CD8
+
T cells and exhibited MHC-I up-regulation, rimmed vacuoles, mitochondrial pathology, p62-positive inclusions, and nuclear clearance and cytoplasmic aggregation of TDP-43, associated with cryptic exon inclusion. Reduction of human T cells within IBM xenografts by treating mice intraperitoneally with anti-CD3 (OKT3) suppressed MHC-I up-regulation. However, rimmed vacuoles and loss of TDP-43 function persisted. These data suggest that T cell depletion does not alter muscle degenerative pathology in IBM.
Increased Microbial Diversity and Decreased Prevalence of Common Pathogens in the Gut Microbiomes of Wild Turkeys Compared to Domestic Turkeys
Authors: Craft Julia , Eddington Hyrum , Christman Nicholas D. , Pryor Weston , Chaston John M. , Erickson David L. , Wilson Eric
Published: January 2022

Due to the increasingly recognized problems associated with antibiotic use in agricultural settings, poultry producers need alternative methods to control common bacterial pathogens. In this study, we compare the microbiota of wild and domestic turkeys.
Blocking Mitophagy Does Not Significantly Improve Fuel Ethanol Production in Bioethanol Yeast Saccharomyces cerevisiae
Authors: Eliodório Kevy Pontes , de Gois e Cunha Gabriel Caetano , White Brianna A. , Patel Demisha H. M. , Zhang Fangyi , Hettema Ewald H. , Basso Thiago Olitta , Gombert Andreas Karoly , Raghavendran Vijayendran
Published: January 2022

Bioethanol is the largest (per volume) ever biobased bulk chemical produced globally. The fermentation process is well established, and industries regularly attain nearly 85% of maximum theoretical yields.
Noncognate Signals Drive Enhanced Effector CD8
+
T Cell Responses through an IFNAR1-Dependent Pathway after Infection with the Prototypic Vaccine, 0ΔNLS, against Herpes Simplex Virus 1
Authors: Gmyrek Grzegorz B. , Predki Paul , Gershburg Edward , Carr Daniel J. J.
Published: January 2022

Cytotoxic T lymphocytes (CTLs) play a critical role in the clearance for many viral pathogens including herpes simplex virus 1 (HSV-1). Here, we compared the cellular innate and adaptive immune response in mice infected with an attenuated HSV-1 (0ΔNLS) found to be a highly successful experimental prophylactic vaccine to parental HSV-1 virus.
The Immune-Specific E3 Ubiquitin Ligase MARCH1 Is Upregulated during Human Cytomegalovirus Infection to Regulate Iron Levels
Authors: Martin Madison , Sandhu Praneet , Kumar Rinki , Buchkovich Nicholas J.
Published: January 2022

Iron is essential for cells, playing important roles in energy generation, DNA replication, and gene expression. During infection, HCMV alters many cellular processes to aid its replication.
An ESCRT/VPS4 Envelopment Trap To Examine the Mechanism of Alphaherpesvirus Assembly and Transport in Neurons
Authors: Barnes Jenna , Jordan Bryen A. , Wilson Duncan W.
Published: January 2022

Alphaherpesviruses, including herpes simplex virus 1 (HSV-1) and pseudorabies virus (PRV), are pathogens of the nervous system. They replicate in the nerve cell body and then travel great distances along axons to reach nerve termini and spread to adjacent epithelial cells; however, key aspects of how these viruses travel along axons remain controversial.
ARF1 with Sec7 Domain-Dependent GBF1 Activates Coatomer Protein I To Support Classical Swine Fever Virus Entry
Authors: Zhang Liang , Wang Tao , Yi Yanyan , Song Mengzhao , Jin Mingxing , Guo Kangkang , Zhang Yanming
Published: January 2022

Classical swine fever (CSF), a highly contact-infectious disease caused by classical swine fever virus (CSFV) infecting domestic pigs or wild boars, has caused huge economic losses to the pig industry. Our previous studies have revealed that GBF1 and class I and II ARFs are required for CSFV proliferation.
Spotted Fever Group
Rickettsia
Trigger Species-Specific Alterations in Macrophage Proteome Signatures with Different Impacts in Host Innate Inflammatory Responses
Authors: Curto Pedro , Santa Cátia , Cortes Luísa , Manadas Bruno , Simões Isaura
Published: January 2022

The incidence of diseases caused by
Rickettsia
has been increasing over the years. It has long been known that rickettsioses comprise diseases with a continuous spectrum of severity.
Insights into the Complexity of a Dormant
Mycobacterium tuberculosis
Cluster Once Transmission Is Resumed
Authors: Acosta Fermin , Martínez-Lirola Miguel , Sola-Campoy Pedro J. , Sicilia Jon , Guerra-Galán Teresa , Maus Sandra R. , Muñoz Patricia , Pérez-Lago Laura , García de Viedma Darío
Published: January 2022

The precise study of the dynamics of tuberculosis transmission in socio-epidemiologically complex scenarios may require more thorough analysis than the standard molecular epidemiology strategies. Our study illustrates the epidemiological and bacteriological complexity present in a transmission cluster in a challenging epidemiological setting with a high proportion of migrant cases.
Microbial Communities in Retail Draft Beers and the Biofilms They Produce
Authors: Bose Nikhil , Auvil Daniel P. , Moore Erica L. , Moore Sean D.
Published: January 2022

Beer production, packaging, and service are each vulnerable to contamination by microbes that metabolize beer chemicals and impart undesirable flavors, which can result in the disposal of entire batches. Therefore, great effort is taken by brewmasters to reduce and monitor contamination during production and packaging.
ECF Sigma Factor HxuI Is Critical for
In Vivo
Fitness of
Pseudomonas aeruginosa
during Infection
Authors: Cai Zeqiong , Yang Fan , Shao Xiaolong , Yue Zhuo , Li Zhenpeng , Song Yuqin , Pan Xiaolei , Jin Yongxin , Cheng Zhihui , Ha Un-Hwan , Feng Jie , Yang Liang , Deng Xin , Wu Weihui , Bai Fang
Published: January 2022

P. aeruginosa
has a strong ability to adapt to diverse environments, making it capable of causing recurrent and multisite infections in clinics. Understanding host adaptive mechanisms plays an important guiding role in the development of new anti-infective agents.
The Evolutionary Trend and Genomic Features of an Emerging Lineage of Elizabethkingia anophelis Strains in Taiwan
Authors: Lee Yu-Lin , Liu Kuan-Ming , Chang Hui-Lan , Liao Yi-Ci , Lin Jen-Shiou , Kung Fang-Yen , Ho Cheng-Mao , Lin Kai-Hsiang , Chen Ying-Tsong
Published: January 2022

Elizabethkingia anophelis
is an emerging multidrug resistant pathogen caused several global outbreaks recently.
E. anophelis
was frequently misidentified as
E. meningoseptica
in the past by conventional culture methods; therefore, the prevalence was often underestimated. Through revised identification, an increasing trend of
E. anophelis
infection was noted in a tertiary hospital and a dominant lineage of strains was recognized by genotyping.
The Role of RelA and SpoT on ppGpp Production, Stress Response, Growth Regulation, and Pathogenicity in Xanthomonas campestris pv.
campestris
Authors: Bai Kaihong , Yan Huayu , Chen Xing , Lyu Qingyang , Jiang Na , Li Jianqiang , Luo Laixin
Published: January 2022

Xanthomonas campestris
pv.
campestris
(Xcc) is a typical seedborne phytopathogenic bacterium that causes large economic losses worldwide, and this is the first original research article to investigate the role of ppGpp in this important species. Here, we revealed the function of RelA and SpoT in ppGpp production, physiology, pathogenicity, and stress resistance in Xcc.
KPNA6 is a Cofactor of ANP32A/B in Supporting Influenza Virus Polymerase Activity
Authors: Yu Mengmeng , Sun Liuke , Zhang Zhenyu , Zhang Yuan , Zhang Haili , Na Lei , Wang Xiaojun
Published: January 2022

Host factor ANP32 plays a fundamental role in supporting the polymerase activity of influenza viruses, but the underlying mechanism is largely unknown. Here, we propose that KPNA6 is involved in the function of ANP32A/B to support influenza virus polymerase by interacting with both vRNP and ANP32A/B.
Supplemental Material: Mesozoic intracontinental ductile shearing along the Paleozoic Shangdan suture in the Qinling Orogen: Constraints from deformation fabrics and geochronology
Authors: Sun Shengsi , al. et
Published: January 2022

Table S1: Zircon LA-ICPMS U-Pb data for samples SG13, SG25 and SG26 from the Shagou shear zone. Table S2: Amphibole 40Ar/39Ar analytical data for sample SG13 from the Shagou shear zone.
Retinal age gap as a predictive biomarker for mortality risk
Authors: Zhu Zhuoting , Shi Danli , Guankai Peng , Tan Zachary , Shang Xianwen , Hu Wenyi , Liao Huan , Zhang Xueli , Huang Yu , Yu Honghua , Meng Wei , Wang Wei , Ge Zongyuan , Yang Xiaohong , He Mingguang
Published: January 2022

Aim

To develop a deep learning (DL) model that predicts age from fundus images (retinal age) and to investigate the association between retinal age gap (retinal age predicted by DL model minus chronological age) and mortality risk.

Methods

A total of 80 169 fundus images taken from 46 969 participants in the UK Biobank with reasonable quality were included in this study. Of these, 19 200 fundus images from 11 052 participants without prior medical history at the baseline examination were used to train and validate the DL model for age prediction using fivefold cross-validation. A total of 35 913 of the remaining 35 917 participants had available mortality data and were used to investigate the association between retinal age gap and mortality.

Results

The DL model achieved a strong correlation of 0.81 (p<0·001) between retinal age and chronological age, and an overall mean absolute error of 3.55 years. Cox regression models showed that each 1 year increase in the retinal age gap was associated with a 2% increase in risk of all-cause mortality (hazard ratio (HR)=1.02, 95% CI 1.00 to 1.03, p=0.020) and a 3% increase in risk of cause-specific mortality attributable to non-cardiovascular and non-cancer disease (HR=1.03, 95% CI 1.00 to 1.05, p=0.041) after multivariable adjustments. No significant association was identified between retinal age gap and cardiovascular- or cancer-related mortality.

Conclusions

Our findings indicate that retinal age gap might be a potential biomarker of ageing that is closely related to risk of mortality, implying the potential of retinal image as a screening tool for risk stratification and delivery of tailored interventions.
Diagnostic accuracy of rapid point-of-care tests for diagnosis of current SARS-CoV-2 infections in children: a systematic review and meta-analysis
Authors: Fujita-Rohwerder Naomi , Beckmann Lars , Zens Yvonne , Verma Arpana
Published: January 2022

Objective

To systematically assess the diagnostic accuracy of rapid point-of-care tests for diagnosis of current SARS-CoV-2 infections in children under real-life conditions.

Design

Systematic review and meta-analysis.

Data sources

MEDLINE, Embase, Cochrane Database for Systematic Reviews, INAHTA HTA database, preprint servers (via Europe PMC), ClinicalTrials.gov, WHO ICTRP from 1 January 2020 to 7 May 2021; NICE Evidence Search, NICE Guidance, FIND Website from 1 January 2020 to 24 May 2021.

Review methods

Diagnostic cross-sectional or cohort studies were eligible for inclusion if they had paediatric study participants and compared rapid point-of care tests for diagnosing current SARS-CoV-2 infections with reverse transcription polymerase chain reaction (RT-PCR) as the reference standard. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was used to assess the risk of bias and the applicability of the included studies. Bivariate meta-analyses with random effects were performed. Variability was assessed by subgroup analyses.

Results

17 studies with a total of 6355 paediatric study participants were included. All studies compared antigen tests against RT-PCR. Overall, studies evaluated eight antigen tests from six different brands. Only one study was at low risk of bias. The pooled overall diagnostic sensitivity and specificity in paediatric populations was 64.2% (95% CI 57.4% to 70.5%) and 99.1% (95% CI 98.2% to 99.5%), respectively. In symptomatic children, the pooled diagnostic sensitivity was 71.8% (95% CI 63.6% to 78.8%) and the pooled diagnostic specificity was 98.7% (95% CI 96.6% to 99.5%). The pooled diagnostic sensitivity in asymptomatic children was 56.2% (95% CI 47.6% to 64.4%) and the pooled diagnostic specificity was 98.6% (95% CI 97.3% to 99.3%).

Conclusions

The performance of current antigen tests in paediatric populations under real-life conditions varies broadly. Relevant data were only identified for very few antigen tests on the market, and the risk of bias was mostly unclear due to poor reporting. Additionally, the most common uses of these tests in children (eg, self-testing in schools or parents testing their toddlers before kindergarten) have not been addressed in clinical performance studies yet. The observed low diagnostic sensitivity may impact the planned purpose of the broad implementation of testing programmes.

PROSPERO registration number

CRD42021236313.
Crohn’s disease therapeutic dietary intervention (CD-TDI): study protocol for a randomised controlled trial
Authors: Raman Maitreyi , Ma Christopher , Taylor Lorian M , Dieleman Levinus A , Gkoutos Georgios V , Vallance Jeff K , McCoy Kathy D , Lewis Ian , Jijon Humberto , McKay Derek M , Mutch David M , Barkema Herman W , Gibson Deanna , Rauch Marcus , Ghosh Subrata
Published: January 2022

Introduction

Dietary patterns that might induce remission in patients with active Crohn’s disease (CD) are of interest to patients, but studies are limited in the published literature. We aim to explore the efficacy of the CD therapeutic dietary intervention (CD-TDI), a novel dietary approach developed from best practices and current evidence, to induce clinical and biomarker remission in adult patients with active CD.

Methods and analysis

This study is a 13-week, multicentre, randomised controlled trial in patients with mild-to-moderate active CD at baseline. One hundred and two patients will be block randomised, by sex, 2:1 to the intervention (CD-TDI) or conventional management. Coprimary outcomes are clinical and biomarker remission, defined as a Harvey Bradshaw Index of <5 and a faecal calprotectin of <250 µg/g, respectively.

Secondary outcomes include gut microbiota diversity and composition, faecal short-chain fatty acids, regulatory macrophage function, serum and faecal metabolomics, C reactive protein, peripheral blood mononuclear cell gene expression profiles, quality of life, sedentary time and physical activity at 7 and/or 13 weeks. Predictive models of clinical response to a CD-TDI will be investigated.

Ethics and dissemination

The research protocol was approved by the Conjoint Health Research Ethics Board at the University of Calgary (REB19-0402) and the Health Research Ethics Board—Biomedical Panel at the University of Alberta (Pro00090772). Study findings will be presented at national and international conferences, submitted for publication in abstracts and manuscripts, shared on social media and disseminated through patient-education materials.

Trial registration number

NCT04596566.
Provision of end-of-life care in primary care: a survey of issues and outcomes in the Australian context
Authors: Ding Jinfeng , Johnson Claire E , Saunders Christobel , Licqurish Sharon , Chua David , Mitchell Geoffrey , Cook Angus
Published: January 2022

Objectives

To describe general practitioners’ (GPs) involvement in end-of-life care, continuity and outcomes of care, and reported management challenges in the Australian context.

Methods

Sixty-three GPs across three Australian states participated in a follow-up survey to report on care provided for decedents in the last year life using a clinic-based data collection process. The study was conducted between September 2018 and August 2019.

Results

Approximately one-third of GPs had received formal palliative care training. Practitioners considered themselves as either the primary care coordinator (53.2% of reported patients) or part of the management team (40.4% of reported patients) in the final year of care. In the last week of life, patients frequently experienced reduced appetite (80.6%), fatigue (77.9%) and psychological problems (44.9%), with GPs reporting that the alleviation of these symptoms were less than optimal. Practitioners were highly involved in end-of-life care (eg, home visits, consultations via telephone and family meetings), and perceived higher levels of satisfaction with communication with palliative care services than other external services. For one-third of patients, GPs reported that the last year of care could potentially have been improved.

Conclusion

There are continuing needs for integration of palliative care training into medical education and reforms of healthcare systems to further support GPs’ involvement in end-of-life care. Further, more extensive collection of clinical data is needed to evaluate and support primary care management of end-of-life patients in general practice.
Associations of state-level and county-level hate crimes with individual-level cardiovascular risk factors in a prospective cohort study of middle-aged Americans: the National Longitudinal Survey of Youths 1979
Authors: Gero Krisztina , Noubary Farzad , Kawachi Ichiro , Baum Christopher F , Wallace Robert B , Briesacher Becky A , Kim Daniel
Published: January 2022

Background

There have been long-standing debates about the potential health consequences of hate crimes over and above other types of crimes. Besides the direct consequences for victims, less is known about whether hate crimes have spillover effects onto the health of local residents.

Methods

We drew data on cardiovascular disease risk factors from middle-aged Americans in the National Longitudinal Survey of Youths 1979 and on hate crimes from the FBI’s Uniform Crime Reports. Employing multivariable logistic regression, we estimated the associations between changes in state/county-level all and group-specific hate crime rates from 2000 to 2006 and incident individual-level diabetes, hypertension, obesity and depressive symptoms from 2008 to 2016. All models controlled for individual-level sociodemographic factors and financial strain, county-level and state-level changes in the total crime rate, the percentage of non-Hispanic Black and Hispanic/Latino residents, and median household income, as well as state-level changes in the percentage of residents aged 65 years or older and the unemployment rate.

Results

1-SD increases in state-level all and race/ethnicity-based hate crime rates were associated with 20% (OR 1.20, 95% CI 1.05 to 1.35) and 15% higher odds (OR 1.15, 95% CI 1.01 to 1.31) of incident diabetes, respectively. At the county level, a 1-SD increase in the all hate crime rate was linked to 8% higher odds (OR 1.08, 95% CI 1.00 to 1.16) of obesity, while a 1-SD increase in the race/ethnicity-based hate crime rate was associated with 8% higher odds (OR 1.08, 95% CI 1.01 to 1.15) of obesity and 9% higher odds (OR 1.09, 95% CI 1.02 to 1.17) of hypertension. We found no significant associations for depressive symptoms, and no interactions between race/ethnicity-based hate crime rates and individual-level race/ethnicity.

Conclusion

Living in areas with higher hate crime rates may confer higher odds of hypertension, diabetes and obesity.
Non-operative treatment for lumbar spinal stenosis with neurogenic claudication: an updated systematic review
Authors: Ammendolia Carlo , Hofkirchner Corey , Plener Joshua , Bussières André , Schneider Michael J , Young James J , Furlan Andrea D , Stuber Kent , Ahmed Aksa , Cancelliere Carol , Adeboyejo Aleisha , Ornelas Joseph
Published: January 2022

Objectives

Neurogenic claudication due to lumbar spinal stenosis (LSS) is a growing health problem in older adults. We updated our previous Cochrane review (2013) to determine the effectiveness of non-operative treatment of LSS with neurogenic claudication.

Design

A systematic review.

Data sources

CENTRAL, MEDLINE, EMBASE, CINAHL and Index to Chiropractic Literature databases were searched and updated up to 22 July 2020.

Eligibility criteria

We only included randomised controlled trials published in English where at least one arm provided data on non-operative treatment and included participants diagnosed with neurogenic claudication with imaging confirmed LSS.

Data extraction and synthesis

Two independent reviewers extracted data and assessed risk of bias using the Cochrane Risk of Bias Tool 1. Grading of Recommendations Assessment, Development and Evaluation was used for evidence synthesis.

Results

Of 15 200 citations screened, 156 were assessed and 23 new trials were identified. There is moderate-quality evidence from three trials that: Manual therapy and exercise provides superior and clinically important short-term improvement in symptoms and function compared with medical care or community-based group exercise; manual therapy, education and exercise delivered using a cognitive-behavioural approach demonstrates superior and clinically important improvements in walking distance in the immediate to long term compared with self-directed home exercises and glucocorticoid plus lidocaine injection is more effective than lidocaine alone in improving statistical, but not clinically important improvements in pain and function in the short term. The remaining 20 new trials demonstrated low-quality or very low-quality evidence for all comparisons and outcomes, like the findings of our original review.

Conclusions

There is moderate-quality evidence that a multimodal approach which includes manual therapy and exercise, with or without education, is an effective treatment and that epidural steroids are not effective for the management of LSS with neurogenic claudication. All other non-operative interventions provided insufficient quality evidence to make conclusions on their effectiveness.

PROSPERO registration number

CRD42020191860.
Asthma, atopy and lung function in young adults after hospitalisation for bronchiolitis in infancy: impact of virus and sex
Authors: Sørensen Karen Galta , Øymar Knut , Dalen Ingvild , Halvorsen Thomas , Mikalsen Ingvild Bruun
Published: January 2022

Background

Hospitalisation for bronchiolitis is a risk factor for asthma and impaired lung function during childhood, but outcomes in young adults are poorly described. Our primary aim was to study the prevalence of asthma and atopy, and lung function at 17–20 years of age after bronchiolitis in infancy and, secondarily, the impact of viral aetiology (respiratory syncytial virus (RSV) vs non-RSV) and sex on these outcomes.

Methods

This Norwegian cohort study enrolled 225 young adults hospitalised for bronchiolitis in infancy during 1996–2001 and 167 matched control subjects. The follow-up included questionnaires for asthma and examinations of lung function and atopy. Outcomes were analysed by mixed effects regressions.

Results

Current asthma was more frequent in the postbronchiolitis group versus the control group: 25.1% (95% CI 19.0% to 31.2%) vs 13.1% (95% CI 7.9% to 18.2%), but not atopy: 44.3% (95% CI 37.1% to 51.5%) vs 48.2% (95% CI 40.5% to 55.8%), adjusted predicted proportions (95% CIs). Asthma prevalence did not differ between the RSV group and the non-RSV group: 24.0% (95% CI 16.1% to 32.0%) vs 23.8% (95% CI 12.8% to 34.7%) nor between sexes. Forced expiratory volume in 1 s (FEV1), the ratio FEV1/forced vital capacity (FVC), and forced expiratory flow between 25% and 75% of FVC, were lower in the postbronchiolitis group.

Conclusion

Young adults hospitalised for bronchiolitis had higher prevalence of asthma, but not atopy, and a more obstructive lung function pattern than control subjects. The asthma prevalence was high after both RSV bronchiolitis and non-RSV bronchiolitis, and there was no difference between sexes. Bronchiolitis in infancy is associated with respiratory morbidity persisting into young adulthood.
Association between delays to patient admission from the emergency department and all-cause 30-day mortality
Authors: Jones Simon , Moulton Chris , Swift Simon , Molyneux Paul , Black Steve , Mason Neil , Oakley Richard , Mann Clifford
Published: January 2022

Background

Delays to timely admission from emergency departments (EDs) are known to harm patients.

Objective

To assess and quantify the increased risk of death resulting from delays to inpatient admission from EDs, using Hospital Episode Statistics and Office of National Statistics data in England.

Methods

A cross-sectional, retrospective observational study was carried out of patients admitted from every type 1 (major) ED in England between April 2016 and March 2018. The primary outcome was death from all causes within 30 days of admission. Observed mortality was compared with expected mortality, as calculated using a logistic regression model to adjust for sex, age, deprivation, comorbidities, hour of day, month, previous ED attendances/emergency admissions and crowding in the department at the time of the attendance.

Results

Between April 2016 and March 2018, 26 738 514 people attended an ED, with 7 472 480 patients admitted relating to 5 249 891 individual patients, who constituted the study’s dataset. A total of 433 962 deaths occurred within 30 days. The overall crude 30-day mortality rate was 8.71% (95% CI 8.69% to 8.74%). A statistically significant linear increase in mortality was found from 5 hours after time of arrival at the ED up to 12 hours (when accurate data collection ceased) (p<0.001). The greatest change in the 30-day standardised mortality ratio was an 8% increase, occurring in the patient cohort that waited in the ED for more than 6 to 8 hours from the time of arrival.

Conclusions

Delays to hospital inpatient admission for patients in excess of 5 hours from time of arrival at the ED are associated with an increase in all-cause 30-day mortality. Between 5 and 12 hours, delays cause a predictable dose–response effect. For every 82 admitted patients whose time to inpatient bed transfer is delayed beyond 6 to 8 hours from time of arrival at the ED, there is one extra death.
Outcomes of catecholamine and/or mechanical support in Takotsubo syndrome
Authors: Terasaki Satoshi , Kanaoka Koshiro , Nakai Michikazu , Sumita Yoko , Onoue Kenji , Soeda Tsunenari , Watanabe Makoto , Miyamoto Yoshihiro , Saito Yoshihiko
Published: January 2022

Objective

This study aimed to reveal the clinical characteristics of patients with severe Takotsubo syndrome (TTS) who needed catecholamine support (CS) or mechanical support (MS) and to identify factors associated with serious illness and in-hospital mortality.

Methods

This was a nationwide retrospective study that used claims data from the Japanese registry of all cardiac and vascular diseases and the diagnosis procedure combination registry, from April 2012 to March 2016. The patients with TTS were divided into severe TTS and mild TTS groups. The severe group was defined as patients who needed CS and/or MS.

Results

Among 6169 patients with TTS, 1148 (18.6%) had severe TTS. No significant difference in age was found between the two groups; however, the number of female patients was significantly lower in the severe group than in the mild group. Among 130 patients who underwent MS, 22 and 108 patients required MS alone and both MS and CS, respectively. The 30-day mortality rate was significantly higher in the severe group than in the mild group (11.4% vs 2.6%, p<0.01) and increased with age. Of the patients with severe TTS, 65.6% died within 7 days. Multivariable analysis showed that male sex (OR 1.22, p=0.03), higher Charlson scores (OR 1.11, p<0.01), comorbid pneumonia (OR 1.68, p<0.01), comorbid sepsis (OR 6.02, p<0.01) and ambulance use (OR 2.01, p<0.01) were associated with severe TTS.

Conclusions

The rate of severe TTS was 18.6% among 6169 patients registered in the Japanese nationwide database, and the 30-day mortality was higher in patients with severe TTS than in those with mild TTS (11.4% vs 2.6%).
Health trends, inequalities and opportunities in South Africa’s provinces, 1990–2019: findings from the Global Burden of Disease 2019 Study
Authors: Achoki Tom , Sartorius Benn , Watkins David , Glenn Scott D , Kengne Andre Pascal , Oni Tolu , Wiysonge Charles Shey , Walker Alexandra , Adetokunboh Olatunji O , Babalola Tesleem Kayode , Bolarinwa Obasanjo Afolabi , Claassens Mareli M , Cowden Richard G , Day Candy T , Ezekannagha Oluchi , Ginindza Themba G , Iwu Chidozie C D , Iwu Chinwe Juliana , Karangwa Innocent , Katoto Patrick DMC , Kugbey Nuworza , Kuupiel Desmond , Mahasha Phetole Walter , Mashamba-Thompson Tivani Phosa , Mensah George A , Ndwandwe Duduzile Edith , Nnaji Chukwudi A , Ntsekhe Mpiko , Nyirenda Thomas Elliot , Odhiambo Julius Nyerere , Oppong Asante Kwaku , Parry Charles D H , Pillay Julian David , Schutte Aletta Elisabeth , Seedat Soraya , Sliwa Karen , Stein Dan J , Tanser Frank C , Useh Ushotanefe , Zar Heather J , Zühlke Liesl J , Mayosi Bongani M , Hay Simon I , Murray Christopher J L , Naghavi Mohsen
Published: January 2022

Background

Over the last 30 years, South Africa has experienced four ‘colliding epidemics’ of HIV and tuberculosis, chronic illness and mental health, injury and violence, and maternal, neonatal, and child mortality, which have had substantial effects on health and well-being. Using data from the 2019 Global Burden of Diseases, Injuries and Risk Factors Study (GBD 2019), we evaluated national and provincial health trends and progress towards important Sustainable Development Goal targets from 1990 to 2019.

Methods

We analysed GBD 2019 estimates of mortality, non-fatal health loss, summary health measures and risk factor burden, comparing trends over 1990–2007 and 2007–2019. Additionally, we decomposed changes in life expectancy by cause of death and assessed healthcare system performance.

Results

Across the nine provinces, inequalities in mortality and life expectancy increased over 1990–2007, largely due to differences in HIV/AIDS, then decreased over 2007–2019. Demographic change and increases in non-communicable diseases nearly doubled the number of years lived with disability between 1990 and 2019. From 1990 to 2019, risk factor burdens generally shifted from communicable and nutritional disease risks to non-communicable disease and injury risks; unsafe sex remained the top risk factor. Despite widespread improvements in healthcare system performance, the greatest gains were generally in economically advantaged provinces.

Conclusions

Reductions in HIV/AIDS and related conditions have led to improved health since 2007, though most provinces still lag in key areas. To achieve health targets, provincial governments should enhance health investments and exchange of knowledge, resources and best practices alongside populations that have been left behind, especially following the COVID-19 pandemic.
Diagnosis of Coronary Artery Rethrombosis after Effective Systemic Thrombolytic Therapy in Patients with ST-Segment Elevation Myocardial Infarction
Authors: Oleynikov Valentin E , Matskeplishvili Simon , Shigotarova Ekaterina , Kulyutsin Alexey , Burko Nadezhda
Published: January 2022

The aim of the study was to evaluate the diagnostic significance of ST-segment re-elevation episodes registered with telemetric ECG monitoring in patients with ST-segment elevation myocardial infarction (STEMI) treated with thrombolytic therapy (TLT). The study included 117 patients with STEMI following effective TLT. The elective coronary angiography followed by percutaneous coronary interventions was performed in the interval from 3 to 24 hours after a successful systemic TLT. Before and after cardiac catheterization, the telemetric ECG monitoring was performed using AstroCard Telemetry system (Meditec, Russia). During the study, two groups of patients were formed. Group 1 included 85 patients (72.6%) without new ST-segment deviations on telemetry. 77 patients (90.6%) had no recurrent coronary artery thrombosis at angiography. Eight patients (9.4%) from group 1 were diagnosed with thrombosis of the infarct-related coronary artery. Group 2 included 32 patients (27.4%) who underwent TLT and then had ST-segment re-elevation episodes of 1 mV or more in the infarct-related leads, lasting for at least 1 minute. In group 2, in 27 of 32 patients (84.4%), thrombosis of the infarct-related coronary artery was confirmed (p<0.01 compared with group 1). In 71.9% cases, the recurrent ischemic episodes were asymptomatic (‘painless myocardial ischemia’) (p<0.01). Thus, in patients with STEMI and successful TLT, re-elevation of ST-segment during remote ECG monitoring is strongly related to angiographically documented coronary artery thrombotic reocclusion. The absence of chest pain during recurrent myocardial ischemia requires continuous ECG telemetry to select patients for the rescue percutaneous coronary interventions at an earlier stage.
Reconsenting paediatric research participants for use of identifying data
Authors: Murdoch Blake , Jandura Allison , Caulfield Timothy
Published: January 2022

When a minor research participant reaches the age of majority or the level of maturity necessary to be granted legal decision-making capacity, reconsent can be required for ongoing participation in research or use of health information and banked biological materials. Despite potential logistical concerns with implementation and ethical questions about the trade-offs between maximising respect for participant agency and facilitating research that may generate benefits, reconsent is the approach most consistent with both law and research ethics.

Canadian common law consent requirements are expansive and likely compel reconsent on obtaining capacity. Common law doctrine recognises that children are entitled to decision-making authority that reflects their evolving intelligence and understanding. Health consent legislation varies by province but generally either compels reconsent on obtaining capacity or delegates the ability to determine reconsent to research ethics boards. These boards largely rely on the Canada’s national ethics policy, the Tri-Council Policy Statement, which states that, with few exceptions, reconsent for continued participation is required when minors gain capacity that would allow them to consent to the research in which they participate. A strict interpretation of this policy could require researchers to perform frequent capacity assessments, potentially presenting feasibility concerns. In addition, Canadian policy and law are generally consistent with the core principles of key international ethical standards from the United Nations and elsewhere.

In sum, reconsent of paediatric participants upon obtaining capacity should be explicit and informed in Canada, and should not be presumed from continued participation alone.
Rescue technique for trapped bone needle in cement cast
Authors: Dimancea Alexandru , Premat Kevin , Shotar Eimad , Cormier Evelyne , Chiaroni Pierre-Marie , Mahtout Jugurtha , Clarençon Frédéric
Published: January 2022

Avascular necrosis, or Kummel disease, is a potential complication of vertebral compression fractures. It is believed to arise as a result of a failed fracture healing process,1 2 leading to the formation of an air or fluid filled cavity within the vertebral body.3 Percutaneous vertebroplasty seems to provide both pain relief and increased spinal stability in avascular necrosis.4 In this technical video, we present the case of an osteoporotic patient with a complicated vertebroplasty, caused by trapping of the bone needle inside the intravertebral cement cast. Two methods were used sequentially, leading to retrieval of the bone needle. We identified several technical aspects, such as injection speed, quasi-filling of the vertebral cavity, and frequent rotation of the bone needle as essential for the success of the procedural. We suggest that improving these parameters may prevent intravertebral bone needle trapping in patients with avascular necrosis.

Video 1
Characteristics of circulatory failure after out-of-hospital cardiac arrest: a prospective cohort study
Authors: Langeland Halvor , Bergum Daniel , Løberg Magnus , Bjørnstad Knut , Skaug Thomas R , Nordseth Trond , Klepstad Pål , Skjærvold Nils Kristian
Published: January 2022

Background

Circulatory failure after out-of-hospital cardiac arrest (OHCA) as part of the postcardiac arrest syndrome (PCAS) is believed to be caused by an initial myocardial depression that later subsides into a superimposed vasodilatation. However, the relative contribution of myocardial dysfunction and systemic inflammation has not been established. Our objective was to describe the macrocirculatory and microcirculatory failure in PCAS in more detail.

Methods

We included 42 comatose patients after OHCA where circulatory variables were invasively monitored from admission until day 5. We measured the development in cardiac power output (CPO), stroke work (SW), aortic elastance, microcirculatory metabolism, inflammatory and cardiac biomarkers and need for vasoactive medications. We used survival analysis and Cox regression to assess time to norepinephrine discontinuation and negative fluid balance, stratified by inflammatory and cardiac biomarkers.

Results

CPO, SW and oxygen delivery increased during the first 48 hours. Although the estimated afterload fell, the blood pressure was kept above 65 mmHg with a diminishing need for norepinephrine, indicating a gradually re-established macrocirculatory homoeostasis. Time to norepinephrine discontinuation was longer for patients with higher pro-brain natriuretic peptide concentration (HR 0.45, 95% CI 0.21 to 0.96), while inflammatory biomarkers and other cardiac biomarkers did not predict the duration of vasoactive pressure support. Markers of microcirculatory distress, such as lactate and venous-to-arterial carbon dioxide difference, were normalised within 24 hours.

Conclusion

The circulatory failure was initially characterised by reduced CPO and SW, however, microcirculatory and macrocirculatory homoeostasis was restored within 48 hours. We found that biomarkers indicating acute heart failure, and not inflammation, predicted longer circulatory support with norepinephrine. Taken together, this indicates an early and resolving, rather than a late and emerging vasodilatation.

Trial registration

NCT02648061.