bluuebunny/crossref_metadata_2025 huggingface dataset:
817 A Proactive Feeding Regimen on Meeting Caloric Goals with Continuous Enteral Nutrition Support: A Quality Improvement Project
Authors: Lu Elizabeth
Published: March 2020

Introduction

Severe burn injuries are characterized by elevated metabolic demands. Numerous studies have documented iatrogenic underfeeding of critical care patients, which can lead to malnutrition, impaired wound healing, weakened immune response, and increased risk of infections. Enteral nutrition (EN) support is often utilized to help meet the increased caloric demands of burn patients. However, discrepancies between prescribed and delivered EN can occur due to frequent interruptions, delays initiating EN, gradual advancement of EN rate, and/or physician directed changes. The objective of this quality improvement project is to assess whether a proactive calculation of EN regimens can improve the provision of calories compared to a traditional calculation method.

Methods

A retrospective review of patients in a pediatric acute burn unit that received continuous EN for greater than three days was performed. The pre-protocol group consisted of patients from January 1st, 2017 to November 30th, 2017 who had continuous EN rates calculated by the dietitian based on 24 hours per day. This group was compared to patients from September 1st, 2018 to July 31st, 2019 who had EN rates calculated by the dietitian based on 23 hours per day (post-protocol group). Periods in which parenteral nutrition was administered or the EN regimen was prescribed in a non-continuous fashion were excluded. The primary outcome measure was the percentage of admissions in which patients met at least 85% of calorie estimations. This project was undertaken as a Quality Improvement initiative and, as such, was not formally supervised by an Institutional Review Board.

Results

A total of 132 patients (73 pre- and 59 post-protocol) from 134 separate inpatient admissions (73 pre- and 61 post-protocol) were identified. The average total body surface area burn was 40.9% (SD 18.8) vs. 49.4% (SD 19.8) and average age was 8.6 years (SD 5.9) vs. 7.9 years (SD 5.4) in the pre- and post-protocol groups, respectively. Continuous EN ran for an average of 20 hours a day (SD 2.2, median = 21) vs. 21 hours a day (SD 2.7, median = 22) in the pre- and post-protocol groups, respectively. The average number of days on continuous EN was comparable in both groups. The post-protocol group had 75% of admissions meet at least 85% of calorie estimations compared to the pre-protocol group with 52% of admissions having met the goal.

Conclusions

Due to the heightened metabolic demands of burn patients and the barriers to meeting caloric goals, it is important to minimize calorie deficits with EN support. Although a seemingly small change, calculating continuous EN rates based on 23 hours per day can yield improved caloric provisions compared to rates based on 24 hours per day.

Applicability of Research to Practice

A proactive approach to calculating continuous EN support should be considered to help decrease caloric deficits.
818 A Themed Approach to Decreasing CAUTI
Authors: Ladwig Melanie R
Published: March 2020

Introduction

In 2017 a high incidence of Catheter Associated Urinary Tract Infection (CAUTI) was recognized in the burn unit. Initially, when there were 4 CAUTIs recognized, analysis of the factors that led to the CAUTIs was done by the practice council and leadership team.

Methods

Initially, education specific to burn catheter use and areas of improvement was disseminated and included the CDC’s research on biofilm formation, variables that cause CAUTI, and the key factors to prevent CAUTI. This was followed by a test to assess for knowledge retention. In addition, one on one education was provided to each Burn staff member to ensure appropriate performance and documentation of insertion, pericare, urinary catheter care, and the significance of discontinuation of urinary catheter utilization at the earliest possible time. This education was then disseminated in a hospital wide campaign called “CAUTI Task Force: May the “Force” be with us”. This was a Star Wars themed initiative that featured a video of Star Wars clad task force members battling the CAUTI. Emphasis was placed on pericare, documentation, and decreasing the urinary catheter standard utilization ration based on a hospital acceptable reasons to continue catheter use. Urinary catheter utilization was addressed by staff daily at morning multidisciplinary rounds. Self-audits and audits by nursing leadership were performed to evaluate for improvement of the main education points of pericare, documentation, and early urinary catheter removal/necessity of catheter use.

Results

Successes were noted by continuing to count how many weeks since the last CAUTI and were celebrated with “Pee Parties” that had yellow themed food and drinks. A total of 36.5 weeks (8.5 months) without a CAUTI was recognized at 12 weeks and at 6 months. Ultimately, here was a reduction in CAUTIs from 6 in 2017 to 1 in 2018. The standard utilization ratio for catheter use decreased from 1.66 in 2017 to 1.18 in 2018.

Conclusions

There was great momentum and staff interest in the Star Wars theme and the recognition with “Pee Parties”. Further work is ongoing to decrease the standard utilization ratio for catheter use to below 1. This initiative has continued into 2019 to add other methods to reduce utilization use of a hospital wide data tool to detect usage of catheters in place longer than 4 days.

Applicability of Research to Practice

The interventions chosen were all focused on increased awareness, focus, and placing importance on improving a problem that nurses knew was harmful to their patients. There were negligible costs other than staff time for implementation, audits, and education. The results achieved are statistically significant. The implementation had great benefit with little risk. Engagement and entertainment helped to increase nurse retention and focus on the actions that would achieve results.
825 Electrical Injuries as a Result of Solar Panels: A New Trend
Authors: Halleluyan Ran , Kopari Nicole M
Published: March 2020

Introduction

Solar panels are associated with a number of potential injuries from manufacturing through installation. Among these are electrical injuries, which increased in frequency with the recent increase in the production of photovoltaic panels. The burn literature is currently limited regarding these injuries, the aim of this study was to summarize our institutional experience with electrical injuries from solar panels.

Methods

A retrospective review of all electrical injuries evaluated at an ABA verified Burn Center from 2014–2018 was performed. Electrical burns unrelated to solar were excluded from analysis. Data collected included demographics, injury severity, and associated morbidity and mortality.

Results

A total of 39 electrical burns were treated during the study duration, 5 of which (13%) were related to solar panel production or installation. Two patients were burned while working in a solar factory, two while installing solar panels, and one while cleaning solar panels. The average age was 29 years (range 20–47) and all were male. All patients had < 5% TBSA; 1 patient had burns to the face, 1 had burns to the foot, 2 patients had burns to the hand/finger, and 1 patient had burns including the hands, abdomen, and thigh. One patient developed v-fib following his injury. He had a prolonged hospital stay of 74 days complicated by pneumonia, encephalitis, and acute kidney injury with rhabdomyolysis causing compartment syndrome of the hand which required fasciotomy. When excluding this outlier, the average length of stay was 2 days and none required ICU care. One patient required toe amputations and one presented with corneal abrasions, but no other significant complications including cardiac arrhythmias. All 5 patients survived.

Conclusions

Electrical burns from solar panels make up a significant proportion of electrical burns cared for at our institution. With the recent and continued rise in solar panel production and installation, burn centers should expect to see an increase in patients presenting with electrical burns associated with these products, especially in states seeing a greater push to adopt this technology.

Applicability of Research to Practice

Burn center staff should be aware of this emerging pattern and prepared to care for the patient injured though this mechanism.
839 Early Ambulation After a Lower Limb Burn Is Associated with Reduced Length of Stay: A Quantitative Longitudinal Study
Authors: Edgar Dale W , Hince Dana A , Edwick Dale O , Wood Fiona M
Published: March 2020

Introduction

A lower limb burn arguably has a significantly greater effect than an upper limb burn due to the detrimental impact on ambulation and return to daily roles and function. The patterns of functional recovery following a lower limb burn are poorly understood and has only been studied in small cohorts. It was hypothesized that patients, following an early ambulation pathway will have a reduced length of stay (LOS), and improved functional outcomes compared to patients with delayed ambulation after burn or after surgery.

Methods

The study aimed to explore if the timing of ambulation after lower limb burn and after skin grafting influenced acute LOS and functional outcomes. The study examined patients between 2011–2019 who sustained a lower limb burn injury in two phases. In Phase I, a preliminary sample (2011–2016) of 1209 lower limb burn patients with 1215 burn events was extracted and their date of ambulation confirmed retrospectively from the digital medical record. Phase II, in progress since 2017, prospectively collected the dates of ambulation. The definition of ‘early ambulation’ varies significantly and is poorly described in the literature. This study defined early and late ambulation through the categorization of four ambulatory pathways in surgically managed patients. The outcomes measured were acute LOS, and the Lower Limb Functional Index (LLFI-10) at six weeks after the burn. Conservatively managed patients were described as a reference only and not further analysed.

Results

Ambulatory data was available for 95% of cases, and the cohort had a mean age of 37.3 years; 65.6 % were male; and, 57% required surgery. Late ambulation was associated with TBSA; presence of a foot burn; and, when patients burn occurred in a rural area. Phase I results confirmed early ambulation, particularly after surgery, was significantly associated with reduced LOS (p< 0.001). Excluding ICU cases (n=33), median LOS increase was 2 days where ambulation was delayed after surgery. Phase I results indicated a similar trend in LLFI-10 data. The pooling and analysis of Phase I and Phase II data underway now, will substantially increase the sample size and allow definitive understanding of the influence of sub-groups such as ICU patients on the outcomes of interest.

Conclusions

Ambulation by 48 hours after lower limb grafting surgery is associated with reduced acute burn unit length of stay.

Applicability of Research to Practice

Where appropriate, achieving early ambulation within two days after surgery will assist patients to progress more rapidly on their journey towards desired participation goals.
844 The alpha-7 Nicotinic Acetylcholine Receptor Mediates a Uniquely Human Response to Burn Injury
Authors: Costantini Todd W , Williams Elliot C , Cohen Olga , Eliceiri Brian P , Baird Andrew
Published: March 2020

Introduction

CHRFAM7A is a uniquely human gene that is a dominant negative inhibitor of the alpha-7 nicotinic acetylcholine receptor (a7nAchR). The relative balance of CHRFAM7A and a7nAchR expression may play an important role in mediating the human immune response to injury. We have previously shown that CHRFAM7A expression increased the hematopoietic stem cell reservoir in bone marrow and altered emergency myelopoiesis after injury. Here, we hypothesized that loss of the a7nAchR would produce a phenotype similar to CHRFAM7A overexpression, with an increased bone marrow reservoir of stem cells that would modulate myeloid cell mobilization after burn injury.

Methods

a7nAchR knockout (KO) mice (CHRNA7-/-) underwent 30% TBSA steam burn and were compared to age- and sex-matched wild-type mice. Bone marrow and blood were harvested 24 hours following burn injury for flow cytometry analysis. To measure bone marrow hematopoietic stem cells (HSC) we used flow cytometry to measure Lin−Sca1+c-Kit+ (LSK) cell expression. Bone marrow short term (ST) and long term (LT) HSCs were identified with CD48 and CD150. Immune cells were identified with myeloid markers including CD45, CD11b, Gr1, Ly6C, and Ly6G.

Results

a7nAchR KO mice have an increased bone marrow reservoir of LSK HSCs compared to WT. While bone marrow expression of ST-HSC and LT-HSC decreased after severe burn injury in WT mice, a7nAchR KO prevented the burn-induced depletion of ST-HSC and LT-HSC leaving a bone marrow HSC reservoir similar to sham. a7nAchR KO attenuated burn-induced mobilization of CD11b+ monocytes and CD11b+Ly6CHi inflammatory monocytes into the systemic circulation compared to WT.

Conclusions

Loss of the a7nAchR increases myeloid cell mobilization into the circulation after severe burn injury. There is significant variability in CHRFAM7A expression between individuals, suggesting that the relative balance of CHRFAM7A and a7nAchR expression may alter the host inflammatory response and influence human resilience after injury.

Applicability of Research to Practice

Understanding the factors that mediate the human response to burn injury could give important insights into variability in the inflammatory response between individuals and lead to therapeutics targeting the uniquely human response to burn injury.
851 Hidradenitis Suppurativa: Our Institutional Experience over the Last 6 Months with Improved Definitive Management and Quality of Life
Authors: Pang Alan , Van Hoorebeke Justin , Kopari Nicole M
Published: March 2020

Introduction

Hidradenitis suppurativa (HS) has prevalence of 0.05–4.1% and is more common in women, with an onset typically occurring after puberty. HS is often under-recognized, mismanaged, and is associated with comorbidities and decreased quality of life. Currently, management is tailored to the phase of the disease; medically treating the inflammatory phase and surgically managing the fibrotic phase. The tissue-sparing surgery can be disfiguring and may not protect against recurrence. The aim of this case series is to highlight a novel therapy as a treatment option for chronic, recalcitrant HS.

Methods

Four HS patients underwent a novel treatment in the burn unit at our institution. Patients underwent excision of wounds, dermal regenerative template (DRT) placement, and were dressed with a silver-impregnated negative pressure therapy wound vac. On hospital day 5 the wound vac was changed and on day 10 the patient returned to the operating room for removal of the silastic layer of the DRT with formal split thickness skin grafting (STSG) over the neodermis and replacement of the silver-impregnated negative pressure therapy wound vac. On hospital day 15, the VAC was taken down, the graft site was transitioned to daily xeroform and bacitracin dressing, and the patients were discharged home.

Results

Four patients with ages ranging from 27–60 years with an average disease duration of six-years underwent the novel treatment at our institution. Two patients had HS more prominent on the buttock with the other two patients presenting with axilla involvement. One patient had limited range of motion to the shoulders secondary to chronic contractures. All patients had failed multiple local incision and drainage procedures as well as complex medical therapies including but not limited to chronic antibiotic suppression and immunotherapies. Each patient underwent two operative procedures with three patients requiring one additional bedside wound vac change. All patients were discharged home within fifteen days from the initial procedure with acceptable wound coverage.

Conclusions

Four patients with HS underwent a novel therapy; tolerated the procedures well, had excellent adherence, and were satisfied with the results. This provides evidence for the validity of this therapy utilizing the above described staged operative approach resulting in definitive management and acceptable cosmetic results.

Applicability of Research to Practice

By utilizing this novel approach and the multidisciplinary burn team, patients who suffer from long-standing HS may have improved quality of life.
855 Reconstruction of Severe Burns to the Breast in Pediatric Patients: A Ten-year Experience
Authors: Sadeq Farzin , Cauley Ryan , Depamphilis Matthew A , Driscoll Daniel N , Ehrlichman Richard J
Published: March 2020

Introduction

The breast and anterior chest are the most commonly burned part of the trunk. Burn injuries to the breast can be associated with pain, asymmetries, and significant social stigma. Burns to the breast bud in the young female may inhibit normal breast development, and result in either significant asymmetries or amastia, making the treatment of breast burn injuries challenging.

Methods

A retrospective chart review was conducted on all female patients under the age of 21 years admitted to our institution for breast burn injuries from January 1st 2008 – December 30th 2018.This project was undertaken at our institution as an exempt project under 45 CFR 46.101 and, as such, it was not formally supervised by an Institutional Review Board. Patients were included if they had follow-up reconstructive procedures for breast burn injuries many days after their acute phase treatment.

Results

Ninety-six patients aged 1 to 20 years have been admitted to our institution with burned breast injuries. The mean age of this cohort (n=96) was 6.4 ±4.8 years with a mean percent TBSA of 36.3 ±21.4 and a mean time since injury from admission of 2279.1 ±2284.1 days. Flame burns (66.8%) were the most common etiology for breast burn injuries, followed by scald burns (22.8%), in this cohort. The mean body mass index was 22.7 ±6.3 kg/m2. Follow up for reconstructive procedures was 7.2 ±5.6 years after injury date.

Conclusions

Our institution’s ten-year experience of 96 female patients with severe burn injuries has enhanced our understanding of reconstructive techniques. The location, size, anatomic extent, type of deformity, and symmetry must all be assessed before any treatment plans, which may need to include a combination of modalities.

Applicability of Research to Practice

Most importantly, surgeons must preserve viable breast bud tissue during debridement. Scar contractures should be released once there are signs of breast development, and the scar contracture significantly impairs normal breast development. Treatment of these contractures with a combination of release and grafting, local flaps or tissue expansion can reduce breast asymmetry. Reduction mammoplasty may be used safely in burned female patients with minimal risks, if key principles are followed.
860 Impact of Orally Administered Tramadol Combined with Self-selected Music on Adult Outpatients with Burns Undergoing Dressing Change: A Randomized Controlled Trial
Authors: Zhang Xiu-Hang , Yu Jia-Ao , Chen Xin-Xin
Published: March 2020

Introduction

Burn injuries have significant physiological and psychological consequences. Dressing changes have been considered the most painful among all non-surgical procedures. Anxiety, which is closely associated with pain, is a part of the burn and wound-healing process and can cause delays in wound healing and recovery procedures. In addition, anxiety may have a devastating mental and physical influence on patients.What’s more,patients whose symptoms were not adequately alleviated are likely to suffer more in their subsequent dressing changes. Pharmacological treatment is the primary approach for relieving pain and anxiety related to burns. In comparison with traditional analgesics, tramadol is a more manageable drug under clinical conditions. However, due to the variability of the intensity of pain and anxiety in patients, the two symptoms remain under-treated. Recently, much attention has been paid to pain management approaches that combine pharmacological treatments with non-pharmacological therapies. In this regard, this study was designed to analyze the effect of tramadol and its combination with self-selected music on burn patient.

Methods

To investigate the effects of music and/or tramadol on pain and anxiety in burn outpatients undergoing dressing changes. Patients (N = 180) with burns on up to 10%-30% of the total body surface area (TBSA). The patients were selected using a convenience sampling method and randomly allocated to 4 equal-sized groups as follows: 1) tramadol group (TG), patients received 100 mg of tramadol orally 20 min before the dressing change; 2) music group (MG), patients listened to self-selected music during the dressing change; 3) music-plus-tramadol group (MTG), patients received tramadol and listened to self-selected music; and 4) control group (CG), patients received a routine dressing change only. All patients underwent the interventions once per day for 2 days. McGill Pain Questionnaire Short Form (MPQ-SF) (primary outcome), McGill Pain Persian version of Burn Specific Pain Anxiety Scale (BSPAS) (primary outcome), and heart rate (HR) and overall patient satisfaction (secondary outcomes).

Results

The results showed that MTG had better outcomes with respect to pain and anxiety management during dressing changes.

Conclusions

In comparison with music or tramadol alone, the integration of music and tramadol offers a secure and favorable treatment choice to relieve pain and anxiety, ultimately improving the satisfaction levels of burn outpatients during dressing changes.

Applicability of Research to Practice

The findings showed that the combined approach was more effective in reducing pain and anxiety among the outpatients, as the findings outline the potential use of this technique in the management of dressing changes in burn outpatients.
865 Assessing Opioid Administration in Pediatric Burn Patients with Nonsurgical Management
Authors: Richards Holden , Shi Junxin , Thakkar Rajan , Giles Sheila , Wheeler Krista K , Fabia Renata
Published: March 2020

Introduction

Despite the vast literature studying the opioid crisis, there is sparse data in the pediatric burn population. This study sought to assess patient-level characteristics and their potential effects on opioid administration in nonsurgical pediatric burn inpatients.

Methods

Admitted burn patients from 2013–2018 with nonsurgical management at an American Burn Association (ABA) verified pediatric burn center were retrospectively identified. Morphine milligram equivalents by weight (MME/kg) per admission were evaluated through a multiple loglinear regression with race, sex, age, total body surface area burned (TBSA), and burn depth as predictors. Simple linear regression was used to evaluate the temporal trend of median opioid utilization.

Results

A total of 806 patients (55% White, 35% Black, 5% Hispanic, 5% Other) were included. In an adjusted analysis, no differences in opioid administration were seen by sex, burn degree, or for Blacks and Hispanics when compared with Whites. Increased MME/kg was associated with older age (10–18 years; p< 0.0001) and larger burns (>5% TBSA burned; p< 0.0001). From 2013 to 2018, median MME/kg per admission declined significantly (2013:0.21, 2018:0.09; p=0.0103).

Conclusions

Nonsurgical burn patients who were older and presented with larger TBSA experienced marked increases in opioid utilization. Overall, opioid administration decreased over time.

Applicability of Research to Practice

Future pediatric burn research should evaluate disparities in opioid administration based on injury location and surgical management. Further, the accuracy of pain scores for non-verbal pediatric burn patients should be studied as discrepancies in opioid utilization exist.
Inverse mass hierarchy of light scalar mesons driven by anomaly-induced flavor breaking
Authors: Kuroda Yoshiki , Harada Masayasu , Matsuzaki Shinya , Jido Daisuke
Published: March 2020

We propose a novel mechanism to reproduce the observed mass hierarchy for scalar mesons lighter than 1 GeV (called the inverse hierarchy), regarding them as mesons made of a quark and an anti-quark ($q\bar{q}$ mesons). The source is provided by the SU(3) flavor-symmetry breaking induced by the U(1) axial anomaly. In particular, the anomaly term including the explicit chiral symmetry breaking plays a significant role in the light scalar meson spectrum. To be concrete, we construct a linear sigma model for scalar mesons of $q\bar{q}$ type together with their pseudoscalar chiral partners, including an anomaly-induced explicit chiral symmetry-breaking term. We find that, due to the proposed mechanism, the inverse hierarchy, i.e., $m\left[ a_0 (980) \right] \simeq m\left[ f_0 (980) \right] > m \left[ K_0^\ast (700) \right] > m \left[ f_0(500) \right]$, is indeed realized. Consequently, the quark content of $f_0 (500)$ is dominated by the isoscalar $\bar uu+ \bar dd$ component, and $f_0 (980)$ by the strange quark bilinear one, $s\bar{s}$.
Latent Profiles of Parenting among Women Exposed to Intimate Partner Violence
Authors: Grogan-Kaylor Andrew , Galano Maria M , Stein Sara F , Clark Hannah M , Graham-Bermann Sandra A
Published: March 2020

Intimate partner violence (IPV) continues to be a widely prevalent problem and has strong negative consequences for women and children. Parenting effectively (for example, practicing warm and supportive parenting and refraining from the use of physical discipline) may be very difficult for women who have experienced IPV and who have children. At the same time, parenting behaviors such as the use of warm and supportive parenting or the use of physical discipline, have consequences for children’s mental and emotional well-being and also for their development. Latent profile analysis was used to examine parenting behavior using data from 184 participants in a study of women and children exposed to IPV. The results of this analysis suggested two closely similar underlying latent profiles of parenting behavior. The article concludes with a discussion of the implications, including possible new directions for reducing stigma and decreasing rates of child maltreatment.
Lactobacillus enshiensis sp. nov., a novel arsenic-resistant bacterium
Authors: Zhang Zhendong , Wang Yurong , Hou Qiangchuan , Zhao Huijun , Li Weicheng , Sun Zhihong , Guo Zhuang
Published: March 2020

A lactic acid bacterial strain, HBUAS57009T, isolated from traditionally fermented food (Zha-Chili) in China, was characterized to clarify its taxonomic status using a polyphasic approach. Strain HBUAS57009T was phylogenetically closely related to

Lactobacillus koreensis

DCY50T,

Lactobacillus fujinensis

218-6T,

Lactobacillus mulengensis

112-3T,

Lactobacillus cerevisiae

TUM BP 140423000-2250T,

Lactobacillus tongjiangensis

218-10T and

Lactobacillus yonginensis

THK-V8T with sequence similarities of 98.6–99.3 %. The genome-to-genome distance and average nucleotide identity values between the genomes of strain HBUAS57009T and type strains of closely related

Lactobacillus

species were less than 32.0 and 86.0 %, respectively; this is below the threshold for species boundaries. The major cellular fatty acids (>10 %) were C16 : 0, C18 : 1
 ω9c and iso-C19 : 0. The G+C content of the genomic DNA of strain HBUAS57009T was 47.8 mol%. Examination of the functional categories of the genome revealed that strain HBUAS57009T could perform both homolactic and heterolactic fermentation processes to produce lactic acid via complete glycolysis and the pentose phosphate pathway. The putative biosynthesis pathway of butane-2,3-diol and acetoin, two important flavour compounds in the food industry, were identified using kegg mapper analysis. Based on its genotypic and phenotypic features, strain HBUAS57009T (=GDMCC 1.1664T=KACC 21424T) is designated as the type strain of a novel species, for which the name Lactobacillus enshiensis sp. nov. is proposed.
Dynamics of within-hostMycobacterium tuberculosisdiversity and heteroresistance during treatment
Authors: Nimmo Camus , Brien Kayleen , Millard James , Grant Alison D. , Padayatchi Nesri , Pym Alexander S. , O’Donnell Max , Goldstein Richard , Breuer Judith , Balloux François
Published: March 2020

Background

Studying within-host genetic diversity ofMycobacterium tuberculosis(Mtb) in patients during treatment may identify adaptations to antibiotic and immune pressure. Understanding the significance of genetic heteroresistance, and more specifically heterozygous resistance-associated variants (RAVs), is clinically important given increasing use of rapid molecular tests and whole genome sequencing (WGS).

Methods

We analyse data from six studies in KwaZulu-Natal, South Africa. Most patients (>75%) had baseline rifampicin-resistance. Sputum was collected for culture at baseline and at between two and nine intervals until month six. Positive cultures underwent WGS. Mixed infections and reinfections were excluded from analysis.

Findings

BaselineMtboverall genetic diversity (at treatment initiation or major change to regimen) was associated with cavitary disease, not taking antiretroviral therapy if HIV infected, infection with lineage 2 strains and absence of second-line drug resistance on univariate analyses. Baseline genetic diversity was not associated with six-month outcome. Genetic diversity increased from baseline to weeks one and two before returning to previous levels. Baseline genetic heteroresistance was most common for bedaquiline (6/10 [60%] of isolates with RAVs) and fluoroquinolones (9/62 [13%]). Most patients with heterozygous RAVs on WGS with sequential isolates available demonstrated persistence or fixation (17/20, 85%). New RAVs emerged in 9/286 (3%) patients during treatment. We could detect low-frequency RAVs preceding emergent resistance in only one case, although validation of deep sequencing to detect rare variants is required.

Interpretation

In this study of single-strainMtbinfections, baseline within-host bacterial genetic diversity did not predict outcome but may reveal adaptations to host and drug pressures. Predicting emergent resistance from low-frequency RAVs requires further work to separate transient from consequential mutations.

Funding

Wellcome Trust, NIH/NIAID
Honey bee suppresses the parasitic mite Vitellogenin by antimicrobial peptide
Authors: Wu Yunfei , Liu Qiushi , Weiss Benjamin , Kaltenpoth Martin , Kadowaki Tatsuhiko
Published: March 2020

The negative effects of honey bee parasitic mites and deformed wing virus (DWV) on honey bee and colony health have been well characterized. However, the relationship between DWV and mites, particularly viral replication inside the mites, remains unclear. Furthermore, the physiological outcomes of honey bee immune responses stimulated by DWV and the mite to the host (honey bee) and perhaps the pathogen/parasite (DWV/mite) are not yet understood. To answer these questions, we studied the tripartite interactions between the honey bee,Tropilaelaps mercedesae, and DWV as the model.T. mercedesaefunctioned as a vector for DWV without supporting active viral replication. Thus, DWV negligibly affected mite fitness. Mite infestation induced mRNA expression of antimicrobial peptides (AMPs), Defensin-1 and Hymenoptaecin, which correlated with DWV copy number in honey bee pupae and mite feeding, respectively. FeedingT. mercedesaewith fruit fly S2 cells heterologously expressing honey bee Hymenoptaecin significantly downregulated miteVitellogeninexpression, indicating that the honey bee AMP manipulates mite reproduction upon feeding on bee. Our results provide insights into the mechanism of DWV transmission by the honey bee parasitic mite to the host, and the novel role of AMP in defending against mite infestation.
Lymphopenia predicts disease severity of COVID-19: a descriptive and predictive study
Authors: Tan Li , Wang Qi , Zhang Duanyang , Ding Jinya , Huang Qianchuan , Tang Yi-Quan , Wang Qiongshu , Miao Hongming
Published: March 2020

Background

Coronavirus disease-2019 (COVID-19) is a rapidly escalating epidemic caused by SARS-CoV-2. Identification of a simple and effective indicator to assess disease severity and prognosis is urgently needed.

Methods

Dynamic changes of blood lymphocyte percentage (LYM%) in 15 death cases, 15 severe cases as well as 40 moderate cases of COVID-19 patients were retrospectively analyzed. A Time-LYM% model (TLM) was established according to the descriptive studies and was validated in 92 hospitalized cases.

Results

Results from death and severe cases showed that LYM% in blood tests were inversely associated with the severity and prognosis of COVID-19. LYM% in moderate type of patients with COVID-19 remained higher than 20% 10-12 days after symptom onset. In contrast, LYM% was lower than 20% in severe cases. However, LYM% in severe cases was higher than 5% 17-19 days after the onset of the disease, while it fell below 5% in death cases. Accordingly, we established a Time-LYM% model (TLM), which was validated as an independent criterion of disease classification in another 92 hospitalized patients with COVID-19.

Conclusion

Lymphopenia can be used as an indicator of disease severity and prognosis of COVID-19 patients. TLM is worth of application in the clinical practice.
Transcriptional down-regulation of metabolic genes by Gdown1 ablation induces quiescent cell re-entry into the cell cycle
Authors: Jishage Miki , Ito Keiichi , Chu Chi-Shuen , Wang Xiaoling , Yamaji Masashi , Roeder Robert G.
Published: March 2020

Liver regeneration and metabolism are highly interconnected. Here, we show that hepatocyte-specific ablation of RNA polymerase II (Pol II)-associated Gdown1 leads to down-regulation of highly expressed genes involved in plasma protein synthesis and metabolism, a concomitant cell cycle re-entry associated with induction of cell cycle-related genes (includingcyclin D1). and up-regulation ofp21through activation of p53 signaling. In the absence of p53, Gdown1-deficient hepatocytes show a severe dysregulation of cell cycle progression, with incomplete mitoses, and a pre-malignant-like transformation. Mechanistically, Gdown1 is associated with elongating Pol II on the highly expressed genes and its ablation leads to reduced Pol II recruitment to these genes, suggesting that Pol II redistribution may facilitate hepatocyte re-entry into the cell cycle. These results establish an important physiological function for a Pol II regulatory factor (Gdown1) in the maintenance of normal liver cell transcription through constraints on cell cycle re-entry of quiescent hepatocytes.
Essential PBP1-associated proteins ofTrypanosoma brucei
Authors: Nascimento L. , Terrao M. , Marucha KK. , Liu B. , Egler F. , Clayton C.
Published: March 2020

Control of gene expression in kinetoplastids depends heavily on RNA-binding proteins that influence mRNA decay and translation. We previously showed that MKT1 interacts with PBP1, which in turn recruits LSM12 and poly(A) binding protein. MKT1 is recruited to mRNA by sequence-specific RNA-binding proteins, resulting in stabilisation of mRNA. We here show that PBP1, LSM12 and an additional 117-residue protein, XAC1 (Tb927.7.2780), are present in complexes that contain either MKT1 or MKT1L (Tb927.10.1490). All five proteins are present predominantly in the complexes, and there was evidence for a minor subset of complexes that contained both MKT1 and MKT1L. MKT1 appeared to be associated with many mRNAs, with the exception of those encoding ribosomal proteins. XAC1-containing complexes reproducibly contained RNA-binding proteins that were previously found associated with MKT1. In addition, however, XAC1- or MKT1-containing complexes specifically recruit one of the six translation initiation complexes, EIF4E6-EIF4G5; and yeast 2-hybrid assay results indicated that MKT1 interacts with EIF4G5. The C-terminus of MKT1L resembles MKT1: it contains MKT1 domains and a PIN domain that is probably not active as an endonuclease. MKT1L, however, also has an N-terminal extension with regions of low-complexity. Although MKT1L depletion inhibited cell proliferation, we found no evidence for specific interactions with RNA-binding proteins or mRNA. Deletion of the N-terminal extension, however, enabled MKT1L to interact with EIF4E6. We speculate that MKT1L may either enhance or inhibit the functions of MKT1-containing complexes.
Making Good Choices: Social Interaction in Mice Mitigates Chronic Stress-Induced Adaptive Changes in Decision Making
Authors: Rakshasa Arish Mudra , Tong Michelle T.
Published: March 2020

Chronic stress can impact decision-making and lead to a preference for immediate rewards rather than long-term payoffs. Factors that may mitigate these effects of chronic stress on decision-making are under-explored. Here we used a mouse model to investigate the changes in decision-making caused by the experience of chronic stress and the role of social interaction in attenuating these changes. To test decision-making, mice were trained to perform a Cost-Benefit Conflict (CBC) task on a T-maze, in which they could choose between a high-reward, high-risk alternative and a low-reward, low-risk alternative. Mice were either housed in groups or alone throughout the experiment. Both groups of mice underwent a seven-day period of repeated immobilisation to induce chronic stress. Stress levels were confirmed using behavioural (open field test) and physiological (urine corticosterone ELISA) measures. We found a significant increase in frequency of high-risk decisions after exposure to chronic stress among both socially- and individually-housed mice. Crucially, socially-housed mice showed a significantly smaller increase in high-risk decision-making compared to singly-housed mice. These findings suggest that although chronic stress leads to an increase in high-risk decision-making in mice, access to social interaction may mitigate this stress effect.
Personality traits change after an opportunity to mate
Authors: Monestier Chloé , Bell Alison M.
Published: March 2020

There is growing evidence that personality traits can change throughout the life course in humans and nonhuman animals. However, the proximate and ultimate causes of personality trait change are largely unknown, especially in adults. In a controlled, longitudinal experiment, we tested whether a key life event for adults – mating – can cause personality traits to change in female threespine sticklebacks. We confirmed that there are consistent individual differences in activity, sociability and risk taking, and then compared these personality traits among three groups of females: 1) control females; 2) females that physically mated; 3) females that socially experienced courtship but did not mate. Both the physical experience of mating and the social experience of courtship caused females to become less willing to take risks and less social. To understand the proximate mechanisms underlying these changes, we measured levels of excreted steroids. Both the physical experience of mating and the social experience of courtship caused levels of dihydroxyprogesterone (17α,20β-P) to increase, and females with higher 17α,20β-P were less willing to take risks and less social. These results provide experimental evidence that personality traits and their underlying neuroendocrine correlates are influenced by formative social and life-history experiences well into adulthood.
HRM as an ongoing struggle for legitimacy
Authors: Mahadevan Jasmin , Schmitz Anja P.
Published: March 2020

Purpose

This study shows how presumed “HR-trends,” such as the recent promotion of Employee Experience (EX) design, are never value-free ideas of a presumably objective “best practice”, but rather a vehicle for legitimizing HR in the organization, and investigate the implications.

Design/methodology/approach

This study is rooted in critical HRM studies. Our methodology is the critical discourse analysis (CDA) of online job postings concerning “EX-positions.”

Findings

EX is a new vehicle for HR's ongoing struggle for legitimacy. By repositioning HR managers as “EX-designers,” it promises to integrate the previously conflicting roles of HR as advocate of the individual employee and as strategic partner on the organizational level. Yet, it also raises the question of what is at stake for HR and might even decrease the organizational involvement of HR.

Research limitations/implications

This study highlights the relevance of a critical HRM perspective for moving beyond disciplinary blind spots. It shows the value of CDA for gathering insights into the hidden assumptions underlying HRM theory and practice.

Practical implications

EX design has been put forward as a new best-practice HR trend, promoting the relevance of HR in the organization. This paper shows that this trend is associated with potential gains as well as with potential losses. Practitioners need to be aware of these risks in order to increase the likelihood for a positive impact when implementing EX design.

Originality/value

The authors show how HR trends, such as EX, are manifestations of HR's ongoing struggle for legitimacy. Specifically, the authors uncover the legitimization agenda underlying EX, its implications for HR roles and responsibilities and the knowledge claims associated with it.
Crisis management in high-reliability organizations: lessons from Brazilian air disasters
Authors: Meyer Jr Victor , Cunha Miguel Piña e , Mamédio Diórgenes Falcão , Nogueira Danillo Prado
Published: March 2020

Purpose

The focus of this study was to analyze crisis management in a context of high-reliability organizations (HRO) evidenced in two cases of Brazilian air disasters. Aspects of human and technological natures were examined, addressing the complex sociotechnical system.

Design/methodology/approach

This in-depth case study addressed the two most serious air disasters on Brazilian territory. The first case involved a midair collision between Gol Flight 1907 and the Legacy jet. In the second case, TAM flight 3054 had difficulty braking when landing at the airport and crashed into a building. Data were collected from official disaster documents.

Findings

The results revealed that the management and operational activities aimed to maintain the necessary conditions that prioritize a high level of reliability. High reliability mainly involves concern over failure, reluctance to accept simplified interpretations, sensitivity to operations, commitment to resilience and detailed structure specifications.

Practical implications

The implications are based on alerting highly reliable organizations, emphasizing the focus on managing more reliably, resiliently and conscientiously. Changes will be required in the operations of organizations seeking to learn to manage unexpected events and respond quickly to continually improve the responsiveness of their services.

Originality/value

In the perspective of an intrinsic case study for crisis management in a context of HRO and disaster risk management, the originality of this study lies in its examination of the paradoxical nature of control within the systems of dangerous operations in complex organizations, as well as their contradictions in a high-reliability system.
Anticipation of work–life conflict in higher education
Authors: Pasamar Susana , Johnston Karen , Tanwar Jagriti
Published: March 2020

Purpose

This paper aims to further the understanding about the relationship between work–life conflict and possible barriers to career progression due to the perception of anticipated work–life conflict, considering the unbounded nature of academic work through features such as its intensity, flexibility and perception of organizational support.

Design/methodology/approach

The model was tested using survey data from academics in a public university in the south of Spain. Hierarchical regression analyses were used to test the hypotheses.

Findings

The results reveal that current work–life conflict, job intensity and perception of support have a direct effect on the anticipation of work–life conflict in the event of progression in academic careers. The flexibility that academics enjoy is not sufficient to prevent the expected conflict. Academics' age is relevant, but gender or having childcare responsibilities have no significant effect of the anticipation of conflict.

Research limitations/implications

This study addresses the gap in the literature on anticipated work–life conflict, expanding the focus to nonfamily commitments in unbounded jobs such as academic posts. The authors are not aware of any other study that focuses on the anticipation of work–life conflict in the case of career advancement among current employees with professional experience or accurate knowledge of what job they will be doing instead of students. Work–life balance should not be restricted to women with caring responsibilities, as conflict is no longer only related to gender roles.

Originality/value

This paper not only explores existing work–life conflict but also empirically analyzes anticipated work–life conflict in unbounded careers such as academia. It represents a significant contribution in an underresearched field and may lead to future research in other settings.
Activation of wood surface by Pd pulsed laser deposition for Ni electroless plating
Authors: Amer Jamal , Alkhawwam Anas , Jazmati Abdul Kader
Published: March 2020

Purpose

Different types of wood (ash, oak and beech) have been activated by new activation method. The aim of this work is to study the effect of different types of wood on the physical and chemical properties of Ni/Pd coatings.

Design/methodology/approach

The wood was activated by ablation of the Pd target using pulsed laser deposition (PLD) technique. Different diagnostic techniques such as X-ray photoelectron spectroscopy (XPS), attenuated total reflection (ATR) spectroscopy and energy dispersed X-ray spectroscopy (EDS), in parallel with scanning electron microscopy (SEM) were used to achieve this goal.

Findings

The XPS technique confirmed that the highest concentration of Pd was found in the Pd/beech sample, which is associated to the texture of the beech wood substrate surface. EDS results confirmed the absence of any contamination related to electroless plating method. It is concluded that the wood morphology and its surface roughness play a conclusive role to obtain different quantity of metal by PLD and electroless plating methods.

Originality/value

Although several works have been performed to study the influence of substrates on the coated metals and away of the traditional methods in activating non-catalytic surface, in this paper, PLD method is used to obtain a good quantity of Pd distributed on the entire surface and inside the porous of the wood. This study could be considered as a step investigation for understanding the role of the wood substrate morphology on the physical and chemical properties of films. To our knowledge, there are no works of combining a coated Ni/Pd by electroless plating and PLD methods on wood.