bluuebunny/crossref_metadata_2025 huggingface dataset:
First fossil record of mite family Barbutiidae (Acari: Raphignathoidea) from late Eocene Rovno Amber, with a replacement name Hoplocheylus neosimilis nomen novum (Tarsocheylidae)

Authors: Khaustov Alexander A. , Vorontsov Dmitry D. , Perkovsky Evgeny E. , Klimov Pavel B.
Published: May 2021

The first fossil representative of the family Barbutiidae is recorded from late Eocene Rovno amber. Barbutia theroni sp. nov. is described based on deutonymph female. An updated key to deutonymph females of Barbutia is provided. For recently described fossil species Hoplocheylus similis Khaustov, Vorontsov, Perkovsky & Lindquist, 2021 a replacement name H. neosimilis nom. nov. is proposed.
Suppression of resist pattern collapse by crosslinker in ultraviolet nanoimprinting involving sequential infiltration synthesis with trimethylaluminum
Authors: Miyajima Chiaki , Ito Shunya , Nakagawa Masaru
Published: May 2021

The fabrication of resist patterns using UV nanoimprinting is required on consideration of the reduction of the use of hydrocarbons along recent amendments for environmental sustainability. In this study, we investigated the generation of resist pattern defects through UV nanoimprinting in a readily condensable trans-1,3,3,3-tetrafluoropropene (TFP) gas with a low global warming potential for elimination of nonfill defects arising from a bubble trap and subsequent sequential infiltration synthesis (SIS) to result in a vapor phase organic-inorganic hybridization for dry etching durability. A bisphenol A-based UV-curable imprint resin enabled the nanostructure fabrication of resist patterns without any nonfill defects in TFP; however, SIS consisting of subsequent mutual doses of trimethylaluminum and water caused a resist pattern collapse of 100-nm-height patterns with linewidths of <60 nm. A crosslinker with six acrylate moieties was selected based on its low TFP absorption. The crosslinker-containing imprint resin decreased the resist pattern collapse during SIS. Nanoindentation measurements suggest that the resist patterns made using the crosslinker-containing imprint resin were strengthened at 100 °C to carry out an SIS.
Effects of thickness on the wettability and electrical properties of Sn thin films
Authors: Kaur Jatinder , Jain Ravish K. , Khanna Atul , Chawla Amit K.
Published: May 2021

Sn films of four thicknesses, 50, 200, 500, and 1000 nm, were deposited on Si (111) substrates by a thermal evaporation technique, and the effects of thickness on the structural, surface morphology, electrical, and wettability properties were investigated. X-ray diffraction studies revealed the coexistence of predominantly β-Sn (metallic phase) and small concentration of α-Sn (semiconducting phase) in all samples except the 1000 nm thickness sample which is entirely β-Sn. The crystallite size and surface roughness enhance with thickness, and the 1000 nm film shows secondary nucleation growth which lowers the average crystallite size and the surface roughness of the sample. The 50 nm film shows semiconducting electrical properties while all other samples are metallic. The wettability studies found that Sn films are hydrophobic with a maximum water contact angle of 128° for the 1000 nm sample. It is concluded that the thickness critically determines the phase formation, surface topography, electrical properties, and hydrophobic properties of Sn films.
A Derivative of the D5 Monoclonal Antibody That Targets the gp41 N-Heptad Repeat of HIV-1 with Broad Tier-2-Neutralizing Activity
Authors: Rubio Adonis A. , Filsinger Interrante Maria V. , Bell Benjamin N. , Brown Clayton L. , Bruun Theodora U. J. , LaBranche Celia C. , Montefiori David C. , Kim Peter S.
Published: May 2021

Despite advances in antiretroviral therapy, HIV remains a global epidemic and has claimed more than 32 million lives. Accordingly, developing an effective HIV vaccine remains an urgent public health need.
Engineering the Modular Receptor-Binding Proteins ofKlebsiellaPhages Switches Their Capsule Serotype Specificity
Authors: Latka Agnieszka , Lemire Sebastien , Grimon Dennis , Dams Dorien , Maciejewska Barbara , Lu Timothy , Drulis-Kawa Zuzanna , Briers Yves
Published: May 2021

The antimicrobial resistance crisis has rekindled interest in bacteriophage therapy. Phages have been studied over a century as therapeutics to treat bacterial infections, but one of the biggest challenges for the use of phages in therapeutic interventions remains their high specificity.
Heterogenous Susceptibility to R-Pyocins in Populations of Pseudomonas aeruginosa Sourced from Cystic Fibrosis Lungs
Authors: Mei Madeline , Thomas Jacob , Diggle Stephen P.
Published: May 2021

R-pyocins have potential as alternative therapeutics against
Pseudomonas aeruginosa
in chronic infection; however, little is known about the efficacy of R-pyocins in heterogeneous bacterial populations.
P. aeruginosa
is known to become resistant to multiple antibiotics and to evolve phenotypic and genotypic diversity over time; thus, it is particularly difficult to eradicate in chronic cystic fibrosis (CF) lung infections. In this study, we found that
P. aeruginosa
populations from CF lungs maintain the same R-pyocin genotype but exhibit heterogeneity in susceptibility to R-pyocins from other strains.
Bacterial Outer Membrane Proteins Are Targeted to the Bam Complex by Two Parallel Mechanisms
Authors: Wang Xu , Peterson Janine H. , Bernstein Harris D.
Published: May 2021

Proteins that are embedded in the outer membrane of Gram-negative bacteria (OMPs) play an important role in protecting the cell from harmful chemicals. OMPs share a architecture and often contain a conserved sequence motif (β motif) of unknown function.
Targeted Quantification of Phosphorylation Sites Identifies STRIPAK-Dependent Phosphorylation of the Hippo Pathway-Related Kinase SmKIN3
Authors: Stein Valentina , Blank-Landeshammer Bernhard , Märker Ramona , Sickmann Albert , Kück Ulrich
Published: May 2021

Phosphorylation and dephosphorylation of proteins are fundamental posttranslational modifications that determine the fine-tuning of their biological activity. Involved in this modification process is the recently identified
str
iatin-
i
nteracting
p
hosphatase
a
nd
k
inase (STRIPAK) multisubunit complex, which is evolutionarily conserved from fungi to humans.
Proteomic and Transcriptomic Analysis of
Microviridae
φX174 Infection Reveals Broad Upregulation of Host Escherichia coli Membrane Damage and Heat Shock Responses
Authors: Wright Bradley W. , Logel Dominic Y. , Mirzai Mehdi , Pascovici Dana , Molloy Mark P. , Jaschke Paul R.
Published: May 2021

A major part of the healthy human gut microbiome is the
Microviridae
bacteriophage, exemplified by the model φX174 phage, and their
E. coli
hosts. Although much has been learned from studying φX174 over the last half-century, until this work, the
E. coli
host response to infection has never been investigated in detail.
Usnic Acid Treatment Changes the Composition of Mycobacterium tuberculosis Cell Envelope and Alters Bacterial Redox Status
Authors: Sieniawska Elwira , Sawicki Rafal , Truszkiewicz Wieslaw , Marchev Andrey S. , Georgiev Milen I.
Published: May 2021

The evaluation of mechanisms of mycobacterial response to natural products has been barely studied. However, it might be helpful to reveal bacterial adaptation strategies, which are eventually crucial for the discovery of new drug targets and, hence, understanding the resistance mechanisms.
A Phylogeny-Informed Analysis of the Global Coral-Symbiodiniaceae Interaction Network Reveals that Traits Correlated with Thermal Bleaching Are Specific to Symbiont Transmission Mode
Authors: Swain Timothy D. , Lax Simon , Gilbert Jack , Backman Vadim , Marcelino Luisa A.
Published: May 2021

Recent advances have revealed a complex network of interactions between coral and Symbiodiniaceae. Specifically, nonrandom association patterns, which are determined in part by restrictions imposed by symbiont transmission mode, increase the sensitivity of the overall network to thermal stress.
Bradyrhizobium diazoefficiens USDA110 Nodulation of Aeschynomene afraspera Is Associated with Atypical Terminal Bacteroid Differentiation and Suboptimal Symbiotic Efficiency
Authors: Nicoud Quentin , Lamouche Florian , Chaumeret Anaïs , Balliau Thierry , Le Bars Romain , Bourge Mickaël , Pierre Fabienne , Guérard Florence , Sallet Erika , Tuffigo Solenn , Pierre Olivier , Dessaux Yves , Gilard Françoise , Gakière Bertrand , Nagy Istvan , Kereszt Attila , Zivy Michel , Mergaert Peter , Gourion Benjamin , Alunni Benoit
Published: May 2021

Legume-rhizobium symbiosis is a major ecological process in the nitrogen cycle, responsible for the main input of fixed nitrogen into the biosphere. The efficiency of this symbiosis relies on the coevolution of the partners.
Hypocomplementemic urticarial vasculitis syndrome presenting with bilateral scleritis
Authors: Berry Ella Claire , Wells Jane , Morey Adrienne , Anantharajah Anthea
Published: May 2021

Hypocomplementemic urticarial vasculitis syndrome (HUVS) is a rare autoimmune disorder characterised by recurrent urticarial lesions and acquired hypocomplementemia with systemic manifestations. The authors present the case of a 70-year-old man who presented to the ophthalmology clinic with bilateral scleritis and ocular hypertension. He was diagnosed with HUVS after a 6-month period of bilateral scleritis, vestibulitis, significant weight loss, mononeuritis multiplex and recurrent urticarial vasculitis with pronounced persistent hypocomplementemia and the presence of anti-C1q antibodies. Disease control was eventually obtained with mycophenolate and prednisolone.
Pancreaticoduodenectomy for stricturing primary eosinophilic duodenitis
Authors: Jin Harry , Slater Kellee
Published: May 2021

A 59-year-old woman was referred to a specialist gastroenterologist following a year of intermittent abdominal bloating and worsening reflux. In the month prior to referral, the patient developed intermittent large volume vomiting consisting of bile-stained undigested food. This was accompanied by a 10 kg weight loss. Imaging and endoscopic investigations showed a circumferential thickening of the second part of the duodenum. Biopsy showed non-specific inflammatory changes with marked eosinophilic infiltrates. A pancreaticoduodenectomy was performed. Histopathological analysis of the resection sample showed primary eosinophilic duodenitis with no evidence of malignancy. Immunological testing was only positive for coeliac disease and an infectious cause was never identified. The patient’s symptoms resolved following the surgery and she was discharged from surgical follow-up after 8 years of no further symptoms.
Rapidly progressive cognitive decline associated with teprotumumab in thyroid eye disease
Authors: Hoang Thanh Duc , Nguyen Nguyen T , Chou Eva , Shakir Mohamed KM
Published: May 2021

Teprotumumab (Tepezza), an insulin-like growth factor type 1 receptor antagonist, was approved for treatment of thyroid eye disease in 2020. Teprotumumab is administered intravenously every 3 weeks for a total of eight doses. Common side effects include nausea, diarrhoea, muscle spasms, hearing impairment, dysgeusia, headaches, dry skin, infusion reactions and hyperglycaemia. We report here a 76-year-old man with Graves-related thyroid eye disease who developed a rapidly progressive cognitive decline after receiving four out of eight doses of teprotumumab (cumulative dose 4620 mg). He was admitted for workup and teprotumumab infusions were discontinued. Intravenous glucocorticoids and immunoglobulin were given which showed no improvement in clinical symptoms. He subsequently underwent plasmapheresis with resolution of his symptoms, suggesting a teprotumumab-induced encephalopathy. Further studies involving larger populations and longer durations are needed.
Multicentre, open-label, randomised, controlled clinical trial comparing
2% chlorhexidine–70% isopropanol and 5% povidone iodine–69% ethanol for skin
antisepsis in reducing surgical-site infection after cardiac surgery: the
CLEAN 2 study protocol
Authors: Boisson Matthieu , Corbi Pierre , Kerforne Thomas , Camilleri Lionel , Debauchez Mathieu , Demondion Pierre , Eljezi Vedat , Flecher Erwan , Lepelletier Didier , Leprince Pascal , Nesseler Nicolas , Nizou Jacques Yves , Roussel Jean Christian , Rozec Bertrand , Ruckly Stéphane , Lucet Jean-Christophe , Timsit Jean-François , Mimoz Olivier
Published: May 2021

Introduction

Surgical-site infection (SSI) is the second most frequent cause of
healthcare-associated infection worldwide and is associated with
increased morbidity, mortality and healthcare costs. Cardiac surgery is
clean surgery with low incidence of SSI, ranging from 2% to 5%, but with
potentially severe consequences.

Perioperative skin antisepsis with an alcohol-based antiseptic
solution is recommended to prevent SSI, but the superiority of
chlorhexidine (CHG)–alcohol over povidone iodine (PVI)–alcohol, the two
most common alcohol-based antiseptic solutions used worldwide, is
controversial. We aim to evaluate whether 2% CHG–70% isopropanol is more
effective than 5% PVI–69% ethanol in reducing the incidence of
reoperation after cardiac surgery.

Methods and analysis

The CLEAN 2 study is a multicentre, open-label, randomised,
controlled clinical trial of 4100 patients undergoing cardiac surgery.
Patients will be randomised in 1:1 ratio to receive either 2% CHG–70%
isopropanol or 5% PVI–69% ethanol for perioperative skin preparation.
The primary endpoint is the proportion of patients undergoing any
re-sternotomy between day 0 and day 90 after initial surgery and/or any
reoperation on saphenous vein/radial artery surgical site between day 0
and day 30 after initial surgery. Data will be analysed on the
intention-to-treat principle.

Ethics and dissemination

This protocol has been approved by an independent ethics committee
and will be carried out according to the principles of the Declaration
of Helsinki and the Good Clinical Practice guidelines. The results of
this study will be disseminated through presentation at scientific
conferences and publication in peer-reviewed journals.

Trial registration number

EudraCT 2017-005169-33 and NCT03560193.
Geriatric fracture centre vs usual care after proximal femur fracture in older patients: what are the benefits? Results of a large international prospective multicentre study
Authors: Blauth Michael , Joeris Alexander , Rometsch Elke , Espinoza-Rebmann Kathrin , Wattanapanom Pannida , Jarayabhand Rahat , Poeze Martijn , Wong Merng K , Kwek Ernest B. K. , Hegeman Johannes H , Perez-Uribarri Carlos , Guerado Enrique , Revak Thomas J , Zohner Sebastian , Joseph David , Gosch Markus
Published: May 2021

Objective

The aim of this study was to determine the effect of treatment in geriatric fracture centres (GFC) on the incidence of major adverse events (MAEs) in patients with hip fractures compared with usual care centres (UCC). Secondary objectives included hospital-workflow and mobility-related outcomes.

Design

Cohort study recruiting patients between June 2015 and January 2017. Follow-up was 1 year.

Setting

International (six countries, three continents) multicentre study.

Participants

281 patients aged ≥70 with operatively treated proximal femur fractures.

Interventions

Treatment in UCCs (n=139) or GFCs (n=142), that is, interdisciplinary treatment including regular geriatric consultation and daily physiotherapy.

Outcome measures

Primary outcome was occurrence of prespecified MAEs, including delirium. Secondary outcomes included any other adverse events, time to surgery, time in acute ward, 1-year mortality, mobility, and quality of life.

Results

Patients treated in GFCs (n=142) had a mean age of 81.9 (SD, 6.6) years versus 83.9 (SD 6.9) years in patients (n=139) treated in UCCs (p=0.013) and a higher mean Charlson Comorbidity Index of 2.0 (SD, 2.1) versus 1.2 (SD, 1.5) in UCCs (p=0.001). More patients in GFCs (28.2%) experienced an MAE during the first year after surgery compared with UCCs (7.9%) with an OR of 4.56 (95% CI 2.23 to 9.34, p<0.001). Analysing individual MAEs, this was significant for pneumonia (GFC: 9.2%; UCC: 2.9%; OR, 3.40 (95% CI 1.08 to 10.70), p=0.027) and delirium (GFC: 11.3%; UCC: 2.2%, OR, 5.76 (95% CI 1.64 to 20.23), p=0.002).

Conclusions

Contrary to our study hypothesis, the rate of MAEs was higher in GFCs than in UCCs. Delirium was revealed as a main contributor. Most likely, this was based on improved detection rather than a truly elevated incidence, which we interpret as positive effect of geriatric comanagement.

Trial registration number

ClinicalTrials.gov:NCT02297581.
Music intervention for sleep quality in critically ill and surgical patients: a meta-analysis
Authors: Kakar Ellaha , Venema Esmée , Jeekel Johannes , Klimek Markus , van der Jagt Mathieu
Published: May 2021

Objective

Sleep disruption occurs frequently in hospitalised patients. Given the potential of music intervention as a non-pharmacological measure to improve sleep quality, we aimed to assess and quantify current literature on the effect of recorded music interventions on sleep quality and quantity in the adult critical care and surgical populations.

Design

Systematic review and meta-analysis.

Data sources

Embase, MEDLINE Ovid, Cochrane Central, Web of Science and Google Scholar.

Eligibility criteria for studies

Randomised controlled trials assessing the effect of music on sleep quality in critically ill and surgical patients.

Methods

The electronic databases were systematically searched from 1 January 1981 to 27 January 2020. Data were screened, extracted and appraised by two independent reviewers. Primary outcomes were sleep quality and quantity, assessed with validated tools. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Random effects meta-analysis was performed, and pooled standardised mean differences (SMDs) with 95% CIs were reported.

Results

Five studies (259 patients) were included in qualitative (risk of bias) and quantitative analysis (meta-analysis). Pooled data showed a significant effect of recorded music on subjective sleep quality in the critical care and surgical population (SMD=1.21 (95% CI 0.50 to 1.91), p<0.01, excluding one non-English study; SMD=0.87 (95% CI 0.45 to 1.29), p<0.01). The SMD of 1.21 corresponded to a 27.1% (95% CI 11.2 to 42.8) increase in subjective sleep quality using validated questionnaires. A significant increase in subjective sleep quantity of 36 min was found in one study. Objective measurements of sleep assessed in one study using polysomnography showed significant increase in deeper sleep stage in the music group.

Conclusions

Recorded music showed a significant improvement in subjective sleep quality in some critical care and surgical populations. Therefore, its use may be relevant to improve sleep, but given the moderate potential for bias, further research is needed.

PROSPERO registration number

CRD42020167783.
Long-chain omega-3 fatty acid serum concentrations across life stages in the USA: an analysis of NHANES 2011–2012
Authors: Murphy Rachel A , Devarshi Prasad P , Ekimura Shauna , Marshall Keri , Hazels Mitmesser Susan
Published: May 2021

Objective

To determine reference ranges of circulating long-chain (LC) omega-3 fatty acids: eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA) and docosahexaenoic acid (DHA) in a nationally representative population of Americans. To provide context, serum concentrations of LC omega-3 were compared with concentrations associated with consuming the recommended amount of EPA and DHA by the Dietary Guidelines for Americans (DGA) and the Omega-3 Index (EPA+DHA).

Design

Cross-sectional population-based study.

Setting

The National Health and Nutrition Examination Survey 2011–2012 cycle.

Participants

Participants with fatty acids measured in serum: 945 children, age 3–19 years, and 1316 adults, age 20 and older.

Main measure

Serum EPA, DPA, DHA and sum of LC omega-3 fatty acids expressed as per cent of total fatty acids.

Results

Among children, mean (SE) serum concentrations of EPA, DHA and omega-3s were 0.28% (0.01), 1.07% (0.02) and 1.75% (0.03). Among adults, mean (SE) of EPA, DHA and omega-3s were 0.61% (0.02), 1.38% (0.05) and 2.43% (0.08), all of which were significantly higher than corresponding serum fatty acid concentrations in children (p<0.001). Despite recommendations for higher intake, pregnant and/or breastfeeding women had mean (SE) EPA, DHA and LC omega-3 concentrations of 0.34% (0.07), 1.52% (0.08) and 2.18% (0.15), which were comparable to women of childbearing age; p=0.17, p=0.10 and p=0.73. Over 95% of children and 68% of adults had LC omega-3 concentrations below those associated with the DGA recommendation. Approximately 89% of adults had an Omega-3 Index in the high cardiovascular risk category.

Conclusions

Contemporary reference ranges for circulating LC omega-3s are critical for setting public health recommendations. Our findings show the need for continued emphasis on regular consumption of LC omega-3s among Americans, particularly considering the importance of LC omega-3s in cardiovascular health, brain health and development throughout life.
Are weak or negative clinical recommendations associated with higher geographical variation in utilisation than strong or positive recommendations? Cross-sectional study of 24 healthcare services
Authors: Ulyte Agne , Wei Wenjia , Gruebner Oliver , Bähler Caroline , Brüngger Beat , Blozik Eva , von Wyl Viktor , Schwenkglenks M , Dressel Holger
Published: May 2021

Objectives

When research evidence is lacking, patient and provider preferences, expected to vary geographically, might have a stronger role in clinical decisions. We investigated whether the strength or the direction of recommendation is associated with the degree of geographic variation in utilisation.

Design

In this cross-sectional study, we selected 24 services following a comprehensive approach. The strength and direction of recommendations were assessed in duplicate. Multilevel models were used to adjust for demographic and clinical characteristics and estimate unwarranted variation.

Setting

Observational study of claims to mandatory health insurance in Switzerland in 2014.

Participants

Enrolees eligible for the 24 healthcare services.

Primary outcome measures

The variances of regional random effects, also expressed as median odds ratios (MOR). Services grouped by strength and direction of recommendations were compared with Welch’s t-test.

Results

The sizes of the eligible populations ranged from 1992 to 409 960 patients. MOR ranged between 1.13 for aspirin in secondary prevention of myocardial infarction to 1.68 for minor surgical procedures performed in inpatient instead of outpatient settings. Services with weak recommendations had a negligibly higher variance and MOR (difference in means (95% CI) 0.03 (−0.06 to 0.11) and 0.05 (−0.11 to 0.21), respectively) compared with strong recommendations. Services with negative recommendations had a slightly higher variance and MOR (difference in means (95% CI) 0.07 (−0.03 to 0.18) and 0.14 (−0.06 to 0.34), respectively) compared with positive recommendations.

Conclusions

In this exploratory study, the geographical variation in the utilisation of services associated with strong vs weak and negative vs positive recommendations was not substantially different, although the difference was somewhat larger for negative vs positive recommendations. The relationships between the strength or direction of recommendations and the variation may be indirect or modified by other characteristics of services. As initiatives discouraging low-value care are gaining attention worldwide, these findings may inform future research in this area.
Role of point-of-care tests in the management of febrile children: a qualitative study of hospital-based doctors and nurses in England
Authors: Li Edmond , Dewez Juan Emmanuel , Luu Queena , Emonts Marieke , Maconochie Ian , Nijman Ruud , Yeung Shunmay
Published: May 2021

Objectives

The use of rapid point-of-care tests (POCTs) has been advocated for improving patient management and outcomes and for optimising antibiotic prescribing. However, few studies have explored healthcare workers’ views about their use in febrile children. The aim of this study was to explore the perceptions of hospital-based doctors and nurses regarding the use of POCTs in England.

Study design

Qualitative in-depth interviews with purposively selected hospital doctors and nurses. Data were analysed thematically.

Setting

Two university teaching hospitals in London and Newcastle.

Participants

24 participants (paediatricians, emergency department doctors, trainee paediatricians and nurses).

Results

There were diverse views about the use of POCTs in febrile children. The reported advantages included their ease of use and the rapid availability of results. They were seen to contribute to faster clinical decision-making; the targeting of antibiotic use; improvements in patient care, flow and monitoring; cohorting (ie, the physical clustering of hospitalised patients with the same infection to limit spread) and enhancing communication with parents. These advantages were less evident when the turnaround for results of laboratory tests was 1–2 hours. Factors such as clinical experience and specialty, as well as the availability of guidelines recommending POCT use, were also perceived as influential. However, in addition to their perceived inaccuracy, participants were concerned about POCTs not resolving diagnostic uncertainty or altering clinical management, leading to a commonly expressed preference for relying on clinical skills rather than test results solely.

Conclusion

In this study conducted at two university teaching hospitals in England, participants expressed mixed opinions about the utility of current POCTs in the management of febrile children. Understanding the current clinical decision-making process and the specific needs and preferences of clinicians in different settings will be critical in ensuring the optimal design and deployment of current and future tests.
Evaluating quality in adolescent mental health services: a systematic review
Authors: Quinlan-Davidson Meaghen , Roberts Kathryn J , Devakumar Delan , Sawyer Susan M. , Cortez Rafael , Kiss Ligia
Published: May 2021

Objectives

To evaluate the quality of adolescent mental health service provision globally, according to the WHO Global Standards of adolescent mental health literacy, appropriate package of services and provider competencies.

Design and data sources

Systematic review of 5 databases, and screening of eligible articles, from 1 January 2008 to 31 December 2020.

Study eligibility criteria

We focused on quantitative and mixed-method studies that evaluated adolescent mental health literacy, appropriate package of services and provider competencies in mental health services, and that targeted depression, anxiety and post-traumatic stress disorder among adolescents (10–19 years). This included adolescents exposed to interventions or strategies within mental health services.

Study appraisal and synthesis methods

Study quality was assessed using the National Institutes for Health Study Quality Assessment Tools. Data were extracted and grouped based on WHO quality Standards.

Results

Of the 20 104 studies identified, 20 articles were included. The majority of studies came from high-income countries, with one from a low-income country. Most of the studies did not conceptualise quality. Results found that an online decision aid was evaluated to increase adolescent mental health literacy. Studies that targeted an appropriate package of services evaluated the quality of engagement between the therapist and adolescent, patient-centred communication, mental health service use, linkages to mental health services, health facility culture and intensive community treatment. Provider competencies focused on studies that evaluated confidence in managing and referring adolescents, collaboration between health facility levels, evidence-based practices and technology use.

Conclusions and implications

There is limited evidence on quality measures in adolescent mental health services (as conforms to the WHO Global Standards), pointing to a global evidence gap for adolescent mental health services. There are several challenges to overcome, including a need to develop consensus on quality and methods to measure quality in mental health settings.

PROSPERO registration number

CRD42020161318.
Barriers-enablers-ownership approach: a mixed methods analysis of a social intervention to improve surgical antibiotic prescribing in hospitals
Authors: Broom Jennifer , Broom Alex , Anstey Chris , Kenny Katherine , Young Sharon , Grieve David , Sowden David , Jangam Aishwarya , Henderson Andrew , Melon Alexandra , Tabone Renee , Farquhar Drew , Harding Henry , Panahi Seyed Ehsan , Chin Tyler , Abdullah Mariya , Waterhouse Louise , Lo Clarissa , Parker Rhiannon , Bui The Lan , Wallis Marianne C
Published: May 2021

Objectives

To assess an intervention for surgical antibiotic prophylaxis (SAP) improvement within surgical teams focused on addressing barriers and fostering enablers and ownership of guideline compliance.

Design

The Queensland Surgical Antibiotic Prophylaxis (QSAP) study was a multicentre, mixed methods study designed to address barriers and enablers to SAP compliance and facilitate engagement in self-directed audit/feedback and assess the efficacy of the intervention in improving compliance with SAP guidelines. The implementation was assessed using a 24-month interrupted time series design coupled with a qualitative evaluation.

Setting

The study was undertaken at three hospitals (one regional, two metropolitan) in Australia.

Participants

SAP-prescribing decisions for 1757 patients undergoing general surgical procedures from three health services were included. Six bimonthly time points, pre-implementation and post implementation of the intervention, were measured. Qualitative interviews were performed with 29 clinical team members. SAP improvements varied across site and time periods.

Intervention

QSAP embedded ownership of quality improvement in SAP within surgical teams and used known social influences to address barriers to and enablers of optimal SAP prescribing.

Results

The site that reported senior surgeon engagement showed steady and consistent improvement in prescribing over 24 months (prestudy and poststudy). Multiple factors, including resource issues, influenced engagement and sites/time points where these were present had no improvement in guideline compliance.

Conclusions

The barriers-enablers-ownership model shows promise in its ability to facilitate prescribing improvements and could be expanded into other areas of antimicrobial stewardship. Senior ownership was a predictor of success (or failure) of the intervention across sites and time periods. The key role of senior leaders in change leadership indicates the critical need to engage other specialties in the stewardship agenda. The influence of contextual factors in limiting engagement clearly identifies issues of resource distributions/inequalities within health systems as limiting antimicrobial optimisation potential.
Cross-sectional survey on physician burnout during the COVID-19 pandemic in Vancouver, Canada: the role of gender, ethnicity and sexual orientation
Authors: Khan Nadia , Palepu Anita , Dodek Peter , Salmon Amy , Leitch Heather , Ruzycki Shannon , Townson Andrea , Lacaille Diane
Published: May 2021

Objective

To determine the prevalence of physician burnout during the pandemic and differences by gender, ethnicity or sexual orientation.

Design, setting and participants

We conducted a cross-sectional survey (August–October in 2020) of internal medicine physicians at two academic hospitals in Vancouver, Canada.

Primary and secondary outcomes

Physician burnout and its components, emotional exhaustion, depersonalisation and personal accomplishment were measured using the Maslach Burnout Inventory.

Results

The response rate was 38% (n=302/803 respondents, 49% women,). The prevalence of burnout was 68% (emotional exhaustion 63%, depersonalisation 39%) and feeling low personal accomplishment 22%. In addition, 21% reported that they were considering quitting the profession or had quit a position. Women were more likely to report emotional exhaustion (OR 2.00, 95% CI: 1.07 to 3.73, p=0.03) and feeling low personal accomplishment (OR 2.26, 95% CI: 1.09 to 4.70, p=0.03) than men. Visible ethnic minority physicians were more likely to report feeling lower personal accomplishment than white physicians (OR 1.81, 95% CI: 1.28 to 2.55, p=0.001). There was no difference in emotional exhaustion or depersonalisation by ethnicity or sexual orientation. Physicians who reported that COVID-19 affected their burnout were more likely to report any burnout (OR: 3.74, 95% CI: 1.99 to 7.01, p<0.001) and consideration of quitting or quit (OR: 3.20, 95% CI: 1.34 to 7.66, p=0.009).

Conclusion

Burnout affects 2 out of 3 internal medicine physicians during the pandemic. Women, ethnic minority physicians and those who feel that COVID-19 affects burnout were more likely to report components of burnout. Further understanding of factors driving feelings of low personal accomplishment in women and ethnic minority physicians is needed.
Left ventricular twist predicts mortality in severe aortic stenosis
Authors: Erhart Ladina , Donati Thierry , Anwer Shehab , Schindler Matthias , Gremminger Miriam , Renzulli Melanie , Kuzo Nazar , Walther Anna L , Zürcher Dominik , Hosseini Sara , Eberhard Matthias , Stähli Barbara E , Tanner Felix C
Published: May 2021

Objective

Left ventricular (LV) twist is a major component of ventricular mechanics reflecting the helical orientation of cardiac fibres and compensating for afterload mismatch. However, it is not known whether it determines outcome after transcatheter aortic valve implantation (TAVI). This study sought to investigate TAVI-induced short-term changes of LV twist and to define its role in outcome prediction.

Methods

A total of 146 patients (median age 81.78 years, 50.7% male) undergoing TAVI for severe aortic stenosis were included. LV rotation and twist were determined by speckle tracking echocardiography within 3 months before and 2 weeks after TAVI. All-cause mortality at 2 years was defined as primary end point.

Results

Patients who survived exhibited a higher apical peak systolic rotation (APSR) (p<0.001), twist (p=0.003) and torsion (p=0.019) pre-TAVI compared with those who died (n=22). Within 2 weeks after TAVI, APSR, twist and torsion decreased in patients who survived (all p<0.001), while no change occurred in those who died. Cox regression analysis showed an association of pre-TAVI APSR (HR 0.92, p=0.010), twist (HR 0.93, p=0.018) and torsion (HR 0.68, p=0.040) with all-cause mortality and an even stronger association of the respective changes after TAVI (∆APSR: HR 1.15, p<0.001; ∆twist: HR 1.14, p<0.001; ∆torsion: HR 2.53, p<0.001). All the parameters determined outcome independently of global longitudinal strain (GLS) and LV ejection fraction (LVEF).

Conclusion

APSR, twist and torsion pre-TAVI as well as their change within 2 weeks after TAVI predict 2-year all-cause mortality after TAVI, adding incremental prognostic value to LVEF and GLS.
Cell-free DNA copy number variations predict efficacy of immune checkpoint inhibitor-based therapy in hepatobiliary cancers
Authors: Yang Xu , Hu Ying , Yang Keyan , Wang Dongxu , Lin Jianzhen , Long Junyu , Xie Fucun , Mao Jinzhu , Bian Jin , Guan Mei , Pan Jie , Huo Li , Hu Ke , Yang Xiaobo , Mao Yilei , Sang Xinting , Zhang Jiao , Wang Xi , Zhang Henghui , Zhao Haitao
Published: May 2021

Background

This study was designed to screen potential biomarkers in plasma cell-free DNA (cfDNA) for predicting the clinical outcome of immune checkpoint inhibitor (ICI)-based therapy in advanced hepatobiliary cancers.

Methods

Three cohorts including 187 patients with hepatobiliary cancers were recruited from clinical trials at the Peking Union Medical College Hospital. Forty-three patients received combination therapy of programmed cell death protein 1 (PD-1) inhibitor with lenvatinib (ICI cohort 1), 108 patients received ICI-based therapy (ICI cohort 2) and 36 patients received non-ICI therapy (non-ICI cohort). The plasma cfDNA and blood cell DNA mutation profiles were assessed to identify efficacy biomarkers by a cancer gene-targeted next-generation sequencing panel.

Results

Based on the copy number variations (CNVs) in plasma cfDNA, the CNV risk score model was constructed to predict survival by using the least absolute shrinkage and selection operator Cox regression methods. The results of the two independent ICI-based therapy cohorts showed that patients with lower CNV risk scores had longer overall survival (OS) and progression-free survival (PFS) than those with high CNV risk scores (log-rank p<0.01). In the non-ICI cohort, the CNV risk score was not associated with PFS or OS. Furthermore, the results indicated that 53% of patients with low CNV risk scores achieved durable clinical benefit; in contrast, 88% of patients with high CNV risk scores could not benefit from combination therapy (p<0.05).

Conclusions

The CNVs in plasma cfDNA could predict the clinical outcome of the combination therapy of PD-1 inhibitor with lenvatinib and other ICI-based therapies in hepatobiliary cancers.
uPAR+ extracellular vesicles: a robust biomarker of resistance to checkpoint inhibitor immunotherapy in metastatic melanoma patients
Authors: Porcelli Letizia , Guida Michele , De Summa Simona , Di Fonte Roberta , De Risi Ivana , Garofoli Marianna , Caputo Mariapia , Negri Antonio , Strippoli Sabino , Serratì Simona , Azzariti Amalia
Published: May 2021

Background

Emerging evidence has highlighted the importance of extracellular vesicle (EV)-based biomarkers of resistance to immunotherapy with checkpoint inhibitors in metastatic melanoma. Considering the tumor-promoting implications of urokinase-type plasminogen activator receptor (uPAR) signaling, this study aimed to assess uPAR expression in the plasma-derived EVs of patients with metastatic melanoma to determine its potential correlation with clinical outcomes.

Methods

Blood samples from 71 patients with metastatic melanoma were collected before initiating immunotherapy. Tumor-derived and immune cell-derived EVs were isolated and analyzed to assess the relative percentage of uPAR+ EVs. The associations between uPAR and clinical outcomes, sex, BRAF status, baseline lactate dehydrogenase levels and number of metastatic sites were assessed.

Results

Responders had a significantly lower percentage of tumor-derived, dendritic cell (DC)-derived and CD8+ T cell-derived uPAR +EVs at baseline than non-responders. The Kaplan-Meier survival curves for the uPAR+EV quartiles indicated that higher levels of melanoma-derived uPAR+ EVs were strongly correlated with poorer progression-free survival (p<0.0001) and overall survival (p<0.0001). We also found a statistically significant correlation between lower levels of uPAR+ EVs from both CD8+ T cells and DCs and better survival.

Conclusions

Our results indicate that higher levels of tumor-derived, DC-derived and CD8+ T cell-derived uPAR+ EVs in non-responders may represent a new biomarker of innate resistance to immunotherapy with checkpoint inhibitors. Moreover, uPAR+ EVs represent a new potential target for future therapeutic approaches.
Tocilizumab increases citrullinated histone 3 in non-ST segment elevation myocardial infarction
Authors: Helseth Ragnhild , Kleveland Ola , Ueland Thor , Wiseth Rune , Damas Jan Kristian , Broch Kaspar , Michelsen Annika , Bendz Bjørn , Gullestad Lars , Aukrust Pål , Seljeflot Ingebjørg
Published: May 2021

Objective

Beyond reducing inflammation and troponin T (TnT) release, the interleukin-6 receptor antagonist tocilizumab reduces neutrophil counts in patients with non-ST segment elevation myocardial infarction (NSTEMI). It is unclear if this is related to formation of neutrophil extracellular traps (NETs), carrying inflammatory and thrombotic properties.

Methods

In a placebo-controlled trial, 117 patients with NSTEMI were randomised to a single dose of tocilizumab (n=58) or placebo (n=59) before coronary angiography. The NETs related markers double-stranded DNA (dsDNA), myloperoxidase–DNA (MPO–DNA) and citrullinated histone 3 (H3Cit) were measured at five consecutive time points during hospitalisation (days 1–3).

Results

Our major findings were: (1) H3Cit levels were significantly higher in the tocilizumab compared with the placebo group at all time points (all p<0.05), and H3Cit area under the curve (AUC) was 2.3 fold higher in the tocilizumab compared with placebo group (p<0.0001). (2) MPO–DNA and dsDNA did not differ between the groups. (3) In both treatment arms, dsDNA AUC was associated with TnT AUC. (4) Neutrophil count AUC correlated inversely to H3Cit AUC (p=0.015) in the total population.

Conclusions

In patients with NSTEMI, treatment with tocilizumab is associated with increased circulating H3Cit levels, suggesting that tocilizumab enhances NETosis. Further studies should clarify whether NETosis is a relevant side effect of tocilizumab. Regardless of tocilizumab, dsDNA associated with TnT release, indicating a link between extracellular nuclear material and myocardial injury.
Penetrating deep pelvic injury due to “less-lethal” beanbag munitions: a case report and policy implications
Authors: Schenck Christopher S , Lokeshwar Soum D , Riedel Matthew D , Davis Kimberly A
Published: May 2021

“Less-lethal” munitions are designed to cause incapacitation and are often used by law enforcement officers. Although these munitions are not designed to cause severe injury, recent reports have demonstrated that they can cause severe injury, permanent disability, and death. The long-term consequences of injury due to less-lethal munitions are not well understood. We present a case of osteomyelitis and pelvic abscess secondary to a retained beanbag munition following penetrating injury in the setting of a patient with delayed presentation for care. The patient underwent surgical removal of the retained beanbag munition and irrigation and debridement of the osteomyelitis and pelvic abscess with an excellent functional outcome. We discuss the public health and policy implications of serious injury due to less-lethal munitions.
Joint kinematics and sealing capacity assessment of ductile iron pipes under abrupt transverse ground movements
Authors: Qin Xiaogang , Wang Yu , Fu Cuiwei
Published: May 2021

Joint kinematic behaviour, i.e., joint rotation and axial translation, can partially help pipelines to accommodate abrupt ground movements, and cause leaking if joint service limit is exceeded, even without any structural failure. Kinematic behaviour of bell-spigot jointed ductile iron (DI) pipes and its influence on joint sealing capacity under abrupt transverse ground movements are investigated in this study. Firstly, a beam-on-spring finite element analysis on joint kinematics of DI pipes is conducted, in which different fault–pipe crossing positions are implemented. Based on simulated results, a modified joint kinematic solution incorporating pipe deflection and joint shear force under different fault–pipe crossing positions is proposed. Then, a Monte Carlo simulation (MCS)-based reliability assessment procedure for joint sealing capacity is developed. Sensitivity analysis is subsequently conducted to investigate the effects of uncertainties associated with initial axial translation, soil properties, and crossing positions on the joint sealing capacity, and the effects of different deterministic solutions are compared. The proposed method allows engineers to effectively evaluate how the joint sealing capacity of DI pipes changes with consideration of uncertainties when abrupt transverse ground movements are encountered.
Driving impairment detection due to sun exposure and contrasting shadow of surface objects: an urban case study
Authors: Esmaeeli Hamed , Marandi Reza , Karimi Mohammad , Alecsandru Ciprian
Published: May 2021

A change in the driver’s vision quality might result in deterioration of their perception and effectiveness. The lack of an integrated algorithm to distinguish the location of driver vision impairment motivated this study. The proposed model benefits from a combination of several sub-algorithms such as sun positioning, glare detection, and contrasting shadow illustrator derived from raw geospatial data. The methodology is implemented through a case study involving a road network in a large metropolitan area, a digital elevation model, the associated hillshade geographic data, and weather data from Montreal, Canada. The methodology and corresponding data analysis were implemented in Python. The results revealed a geospatial model to estimate the boundaries of transition points between the glare and contrasting shadows created by changes in the roadway surroundings. The results provided by the model can be used as a tool to aid decision-makers in new road construction and urban planning by creating safety countermeasure strategies and design review of road geometry.
Comment on “Population genetics revealMyotis keenii(Keen’s myotis) andMyotis evotis(long-eared myotis) to be a single species”
Authors: Morales Ariadna E. , Fenton M. Brock , Carstens Bryan C. , Simmons Nancy B.
Published: May 2021

Genetic exchange and hybridization appear common among the western long-eared bats from North America. Multiple sources of evidence indicate that lineages within this group are evolving independently, despite genetic exchange. However, evidence of gene flow raises questions about the species-level status of some lineages. C.L. Lausen et al. (2019. Can. J. Zool. 97(3): 267–279) proposed that Myotis evotis (H. Allen, 1864) (long-eared myotis) and Myotis keenii (Merriam, 1895) (Keen’s myotis) are one species, not two. This conclusion is based on analyses of cytochrome b and microsatellite data suggesting gene flow between these taxa. Microsatellites are not reliable markers for identifying species because homoplasy can be a major confounding factor, which appears to be true in this case. We reanalyzed the dataset of C.L. Lausen et al. (2019) and show that it is not reliable to distinguish between gene flow or homoplasy, and that these data do not support the conclusion that M. evotis and M. keenii represent a single species. Previous morphological and genomic studies indicate that these are separate species despite previous genetic exchange between them. Failing to recognize that gene flow can occur between independently evolving lineages is counterproductive for conservation because it can lead to neglect of important independent lineages, and likewise failing to use proper tools to delimit species is counterproductive to efforts to quantify biodiversity and design conservation strategies.