bluuebunny/crossref_metadata_2025 huggingface dataset:
State earned income tax credits and general health indicators: A quasi‐experimental national study 1993‐2016
Authors: Morgan Erin R. , Hill Heather D. , Mooney Stephen J. , Rivara Frederick P. , Rowhani‐Rahbar Ali
Published: July 2020

Objective

To assess the relationship between the presence and generosity of state‐level Earned Income Tax Credits (EITC) and multiple self‐reported measures of general health.

Data Sources

Data on state‐level tax credits and covariates were obtained from the National Bureau of Economic Research and University of Kentucky Center for Poverty Research, respectively. These data were merged with Behavioral Risk Factor Surveillance System survey records from 1993‐2016.

Study Design

Using difference‐in‐differences approaches and survey‐weighted Poisson regression that accounted for clustering of observations and included state and year fixed‐effects, we assessed relationships between EITC and self‐reported overall health, frequent mental distress, and frequent poor physical health in the prior 30 days. Covariates included state minimum wage, state GDP, and adoption of Medicaid expansion. Sensitivity analyses revealed that parallel trends were plausible; there were no significant lead and lag effects.

Data Extraction Methods

Analyses were restricted to respondents with no more than a high school diploma or equivalent because less‐educated adults are more likely to be low‐wage earners and therefore qualify for EITC.

Principal Findings

Among adults with no education beyond high school (n = 2 884 790), each additional 10‐percentage‐point increase in the generosity of state EITC—relative to the federal credit—was associated with fewer reports of frequent mental distress (−97.3 per 100 000; 95% CI: −237.2, 42.6) and frequent poor physical health (−149.6 per 100 000; 95% CI: −284.4, −14.9). When restricted to individuals interviewed during the three months when tax rebates are commonly disbursed, the magnitude of the association between EITC and prevalence of reported frequent mental distress was greater (−329.7 per 100 000; 95% CI: −636.0, −23.5).

Conclusions

The generosity of state EITC policies is positively associated with significant reductions in frequent mental distress and poor physical health, especially during months when the credit is received. Interventions to reduce poverty may positively impact health by reducing material hardship and stress.
Propofol suppresses hypoxia‐induced esophageal cancer cell migration, invasion, and EMT through regulating lncRNA TMPO‐AS1/miR‐498 axis
Authors: Gao Meng , Guo Rui , Lu Xihua , Xu Gang , Luo Suxia
Published: July 2020

Background

Propofol has been reported to be related to the migration, invasion, and epithelial‐mesenchymal transition (EMT) of esophageal cancer (EC) cells. However, the detailed mechanism has not yet been fully reported. The purpose of this research was to elucidate the function of long non‐coding RNA TMPO antisense RNA 1 (lncRNA TMPO‐AS1) and microRNA‐498 (miR‐498) in propofol‐regulated EC.

Methods

Transwell assay was performed to assess cell migratory and invasive abilities. Western blot assay was employed to determine the levels of EMT markers and hypoxia inducible factor‐1 (HIF‐1α). Quantitative real‐time polymerase chain reaction (qRT‐PCR) was carried out to detect the levels of TMPO‐AS1 and miR‐498. Moreover, the interaction between TMPO‐AS1 and miR‐498 was predicted by starBase, and then confirmed by the dual‐luciferase reporter assay and RNA immunoprecipitation (RIP) assay.

Results

Propofol suppressed hypoxia‐induced EC cell migration, invasion, and EMT. Both TMPO‐AS1 overexpression and miR‐498 knockdown weakened the effect of propofol on hypoxia‐induced EC cell progression. Interestingly, TMPO‐AS1 targeted miR‐498 and suppressed miR‐498 expression. TMPO‐AS1 regulated EC cell progression via downregulating miR‐498 expression.

Conclusions

Collectively, our findings demonstrated that propofol inhibited hypoxia‐induced EC cell mobility through modulation of the TMPO‐AS1/miR‐498 axis, providing a theoretical basis for the treatment of EC.
The effect of successful trabeculectomy on the ocular surface and tear proteomics—a prospective cohort study with 1‐year follow‐up
Authors: Vaajanen Anu , Nättinen Janika , Aapola Ulla , Gielen Fabian , Uusitalo Hannu
Published: July 2020

Purpose

To report changes in the ocular surface and tear proteomics after discontinuation of chronic glaucoma medication.

Methods

Patients requiring trabeculectomy were recruited from the glaucoma clinic of Tampere University Hospital, Finland. Fifty‐seven patients with previous history of anti‐glaucomatous eye drops (8.1 ± 6.8 years) and having undergone a successful trabeculectomy were included in this report. Outcomes of interest were conjunctival redness grading, tear secretion (Schirmer I) and tear film proteomics (SWATH‐MS) in addition to thorough clinical examination. The protocol included five time points: preoperative visit and postoperative visits at month 1, 3, 6 and 12. All parameters measured were compared to the corresponding preoperative levels of each individual eye.

Results

Conjunctival redness and irritation were significantly reduced during follow‐up, while tear production remained unchanged. Protein profiles of the tear film indicated significant changes in the ocular surface. Lipid transport was increased while several pro‐inflammatory proteins were consistently decreased after the surgery.

Conclusion

Clinical signs as well as the proteomics results indicated that the trabeculectomy and resulting cessation of topical glaucoma medication were very beneficial to the ocular surface. The state of the conjunctiva improved throughout the 1‐year follow‐up while the levels of pro‐inflammatory proteins decreased and lipid transport‐associated functions were increased.
Monitoring the community use of antibiotics in Italy within the National Action Plan on antimicrobial resistance
Authors: Cangini Agnese , Fortinguerra Filomena , Di Filippo Aurora , Pierantozzi Andrea , Da Cas Roberto , Villa Federico , Trotta Francesco , Moro Maria Luisa , Gagliotti Carlo
Published: July 2020

Background

In Italy both the consumption of antibiotics and the prevalence of bacterial resistance are higher than in other European countries. In 2017, the first National Action Plan on Antimicrobial Resistance (PNCAR) was adopted in Italy. In response to the PNCAR two national reports on antibiotic use in the human setting have been published. This article's aim is to describe the pattern of antibiotic consumption in the community setting in Italy from 2013 to 2018.

Methods

To analyse the consumption for reimbursed antibiotics dispensed by community pharmacies different data sources were used. Consumption was measured in terms of defined daily dose (DDD), prescriptions or prevalence of use.

Results

In 2018, the consumption of antibiotics in Italy amounted to 16.1 DDD per 1000 inhabitants per day. The rates of consumption by geographical area were: 12.7 DDD in the north, 16.9 in the centre and 20.4 in the south. The use was greater in the extreme age groups than in the population aged from 20 to 64 years. The consumption was higher in winter season, with high peaks in the incidence of flu syndromes. In the paediatric population, a utilization rate of 1010 prescriptions per 1000 children, with a prevalence of use of 40.8%, was found.

Conclusion

The study provides useful information on the geographical variability of antibiotic use in Italy to guide decision makers in the introduction of tailored interventions, as suggested by PNCAR, aimed at promoting a more rational use of antibiotics for humans and reducing antimicrobial resistance.
Remote Working during the Pandemic: A Q&A with Gillian Isaacs Russell
Authors: Isaacs Russell Gillian
Published: July 2020

In this interview by email, Gillian Isaacs Russell, author of the influential Screen Relations: The Limits of Computer‐Mediated Psychoanalysis and Psychotherapy, responds to a set of questions from the BJP. The interview focuses on the impact of remote working during the coronavirus epidemic, starting with the question of whether an effective therapeutic process can occur without physical co‐presence. Isaacs Russell shares her immediate thoughts about the virtually overnight changes to our practice that came with the epidemic, and the work of the American Psychoanalytic Association's Covid‐19 Advisory Team, on which she sits. Her responses are informed by recent cross‐disciplinary and neuropsychological research on the digital age. She considers what happens to free association, evenly suspended attention and reverie when working by phone or online; the loss of the consulting room as a containing physical space for both clinician and patient; the relationship between place and time; and whether (and how) we can maintain a focus on transference and countertransference in the presence of the threat of death. The interview ends with her thoughts on whether we should assume that the landscape of analytic therapy will be permanently altered by Covid‐19, and with her hope that general awareness of the impact of trauma on our mental health has been raised.
Nevus cell aggregates massively occupying parenchyma of an external iliac lymph node: A case report and review of the literature
Authors: Hu Jue , Ren Min , Cai Xu , Zhang Yan , Lv Jiao‐Jie , Kong Yun‐Yi
Published: July 2020

We report a case of nevus cell aggregates (NCAs) in an external iliac lymph node from a patient with a compound congenital nevus in the corresponding drainage skin. Melanocytes in parenchyma were in band, nest‐like or nodular fashion, and partly continuous with those in capsule and trabeculae. The largest nodule in parenchyma measured 6.5 mm. Melanocytes mostly exhibited benign appearance identical to cutaneous nevus. A few regions abundant in cells displayed atypical features, including increased nucleo‐cytoplasmic ratio, small nucleoli, and occasional mitotic figures. Immunohistochemistry showed that melanocytes stained positive for p16, but negative for HMB‐45 and nestin. Ki‐67 labeling was less than 1% and reticulin mainly surrounded individual melanocytes. Besides, Vysis melanoma fluorescence in situ hybridization (FISH) plus another 2 probes targeting 9p21(CDKN2A) and 8q24(MYC) showed normal results. The patient is alive without malignant tumor after 52‐month follow up. Our case provides a new evidence for the existence of intraparenchymal NCAs in deep lymph node and indicates that melanocytes with some atypical features can occur in nodal nevi. Nevus cells in parenchyma connected to those in capsule and trabeculae are a significant clue to distinguish nodal nevi from metastatic melanomas. Additionally, immunohistochemistry and FISH assay are useful in differential diagnosis.
Basic immunology may lead to translational therapeutic rationale: SARS‐CoV‐2 and rheumatic diseases
Authors: Gremese Elisa , Ferraccioli Edoardo Sean , Alivernini Stefano , Tolusso Barbara , Ferraccioli Gianfranco
Published: July 2020

COVID‐19 pandemia is a major concern for patients and healthcare systems. The fear of infection by patients with concomitant rheumatic diseases (either adult or children) and connective tissue diseases is arising worldwide, because of their immunological background and immunological therapies. Analysing the basic biology of single diseases, the data suggest that there is an "immunological umbrella" that seems to protect against the infection, through IFN type 1 and NK cell function. To date, reports from China, United States and Europe did not reveal an higher risk of infection, either for rheumatoid arthritis, juvenile idiopathic arthritis nor for lupus erythematosus. Antimalarials, anti‐IL6‐Anti‐IL6 receptor, anti‐IL1, anti‐GM‐CSF receptor and JAK1/2/3 inhibitors, are under investigation in COVID‐dedicated clinical trials to control the inflammation raised by SARS‐CoV‐2 infection. Initial reports on the occurrence of autoimmune phenomena in the convalescence phase of SARS‐CoV‐2 infection suggests that the immunological consequences of the infection need to be strictly understood. Reporting of the study conforms to broad EQUATOR guidelines (Simera et al January 2010 issue of EJCI).
Estimating the savings associated with a migraine‐free life: results from the Spanish Atlas
Authors: Irimia P. , Garrido‐Cumbrera M. , Santos‐Lasaosa S. , Braçe O. , Colomina I. , Blanch C. , Pozo‐Rosich P.
Published: July 2020

Background and purpose

Migraine is a common and costly neurological disorder. The aims of this study were to quantify the costs of chronic (CM) and episodic migraine (EM) in Spain, evaluating the impact of psychiatric comorbidities and disability, and to estimate the economic savings associated with reducing the number of migraine‐days by 50%.

Methods

This was an observational, cross‐sectional analysis of data from migraine patients who participated in the Spanish Migraine Atlas. The participants were invited to complete a structured questionnaire including the following scales: the Headache Needs Assessment, the Hospital Anxiety and Depression Scale, and the Migraine Disability Assessment Scale (MIDAS).

Results

A total of 475 patients were included, of whom 187 had CM (39.4%). Total costs per patient/year were: €16 578.2 ± €34 568.1 for CM and €6227.8 ± €6515.7 for EM. A higher degree of disability, according to MIDAS, significantly increased the total cost of migraine, while the presence of psychiatric comorbidity increased costs for EM patients only. A reduction of 1 migraine‐day per month decreased average total costs by €744.14 per patient/year for EM and €663.20 per patient/year for CM, while a reduction in the number of migraine‐days by 50% would result in economic savings of €2232.44 per patient/year (R2 = 0.927) for EM and €6631.99 per patient/year (R2 = 0.886) for CM.

Conclusions

The costs associated with migraine were driven by migraine frequency and the degree of disability, whereas psychiatric comorbidity only influenced the cost of EM. These results highlight the need to optimize migraine management to reduce the economic migraine burden. Future studies are needed to confirm our results.
Do bond yields follow the hierarchy of risk post BRRD?
Authors: Cucinelli Doriana , Gai Lorenzo , Ielasi Federica
Published: July 2020

With a sample of 4,065 bonds issued by 63 banks from 12 euro area countries during 2013–2017, this study investigates how introducing bail‐in regulation has influenced bond yields in secondary markets, by distinguishing between non‐bail‐inable and different classes of bail‐inable bonds. The bail‐in risk premium does not follow the hierarchy of risk; it is stronger for less risky bonds. The effect on the spread between senior unsecured and non‐bail‐inable bonds is much higher than for subordinated bonds. Regarding subordinated bonds, the impact is higher for securities excluded from regulatory capital than for those included.
Half a century of Scots pine forest ecosystem monitoring reveals long‐term effects of atmospheric deposition and climate change
Authors: Prietzel Jörg , Falk Wolfgang , Reger Birgit , Uhl Enno , Pretzsch Hans , Zimmermann Lothar
Published: July 2020

At two forest sites in Germany (Pfaffenwinkel, Pustert) stocked with mature Scots pine (Pinus sylvestris L.), we investigated changes of topsoil chemistry during the recent 40 years by soil inventories conducted on replicated control plots of fertilization experiments, allowing a statistical analysis. Additionally, we monitored the nutritional status of both stands from 1964 until 2019 and quantified stand growth during the monitoring period by repeated stand inventories. Moreover, we monitored climate variables (air temperature and precipitation) and calculated annual climatic water balances from 1991 to 2019. Atmospheric nitrogen (N) and sulfur (S) deposition between 1964 and 2019 was estimated for the period 1969–2019 by combining annual deposition measurements conducted in 1985–1987 and 2004 with long‐term deposition records from long‐term forest monitoring stations. We investigated interrelations between topsoil chemistry, stand nutrition, stand growth, deposition, and climate trends. At both sites, the onset of the new millennium was a turning point of important biogeochemical processes. Topsoil acidification turned into re‐alkalinization, soil organic matter (SOM) accumulation stopped, and likely turned into SOM depletion. In the new millennium, topsoil stocks of S and plant‐available phosphorus (P) as well as S and P concentrations in Scots pine foliage decreased substantially; yet, age‐referenced stand growth remained at levels far above those expected from yield table data. Tree P and S nutrition as well as climate change (increased temperature and drought stress) have replaced soil acidification as major future challenges for both forests. Understanding of P and S cycling and water fluxes in forest ecosystems, and consideration of these issues in forest management is important for successfully tackling the new challenges. Our study illustrates the importance of long‐term forest monitoring to identify slow, but substantial changes of forest biogeochemistry driven by natural and anthropogenic global change.
Relationships of illness representation and quality of life in patients with end‐stage renal disease receiving haemodialysis
Authors: Chen Yu‐Chun , Lin Chun‐Liang , Lee Bih‐O
Published: July 2020

Aim and Objectives

To examine the relationship between illness representations and quality of life and to test whether illness representations can predict quality of life, in patients with haemodialysis.

Background

Illness representations are interpretations of and actions taken by individuals when faced with threats to their health. Exploring relationship of illness representations and quality of life in patients with haemodialysis may help patients self‐manage their illness and improve their quality of life.

Methods

A cross‐sectional correlation design was used (the checklist STROBE was chosen for this study). The study setting was a haemodialysis centre in a teaching hospital. A total of 172 surveys were completed. The inventory comprised demographic data, illness data, the Brief Illness Perception Questionnaire and the World Health Organization Quality of Life.

Results

The illness representations of the surveyed patients fell in the middle range of being not too optimistic or pessimistic. Overall quality of life of patients is moderate. The predictors of quality of life included living status, source of income and two illness representation elements.

Conclusions

This study revealed an association between illness representations and quality of life in patients with haemodialysis. New knowledge provided by this study can assist healthcare professionals caring for patients with a Chinese cultural background.

Relevance to clinical practice

Illness representation assessment could be added to clinical care standards, and patients living with family or without family could be given different interventions.
Effect of exercise on slowing breastfeeding‐induced bone loss: A meta‐analysis and trial sequential analysis
Authors: Lee Ling‐Ling , Huang Sen‐Fang , Lai Pei‐Chun , Huang Yen‐Ta
Published: July 2020

Aim

This study systematically reviewed evidence regarding the effectiveness of exercise in slowing breastfeeding‐induced bone loss.

Methods

The evidence‐based approach of a systematic review (PROSPERO registration No. CRD42019111623) was adopted. The inclusion criteria were randomized controlled trials or observational studies. Study samples were breastfeeding women, the intervention was any form of exercise, and bone mineral density (BMD) of the total body, lumbar spine and hip/femur neck before 6 months and at 1 year were the outcome measures. Meta‐analyses were performed using a random effect model, and calculations of mean differences of BMD change and 95% confidence intervals (CIs) were carried out. Studies were further evaluated through trial sequential meta‐analysis (TSA), and the ‘Grading of Recommendations Assessment, Development and Evaluation’ methodology was used to assess the certainty of evidence (CoE).

Results

A total of 1049 studies were screened, and 4 met the inclusion criteria. Weight‐bearing aerobic exercise and resistance training before the 6‐month evaluation slowed breastfeeding‐induced bone loss in the lumbar spine (1.62% BMD change [95% CI = 0.53–2.71]; I2 = 8%). The TSA Z‐curve revealed crossing of the TSA boundary and line of information size, indicating sufficient sampling and significance. The CoE of exercise benefit in the lumbar spine at 6 months was low, whereas the CoE for other areas ranged from low to very low.

Conclusion

This first systematic review and meta‐analysis provided some evidence of the advantages of exercise for slowing breastfeeding‐induced bone loss. However, additional randomized controlled trials are warranted to generate more conclusive evidence.
Can variability of serum electrophoretic fractions during pregnancy provide knowledge about maternal and fetal health
Authors: Strawa Agnieszka , Skarżyńska Ewa , Zborowska Hanna , Jakimiuk Artur , Lisowska‐Myjak Barbara
Published: July 2020

Aim

Characteristics of variability of concentrations total protein and its electrophoretic fractions in serum of healthy pregnant women between successive trimesters and post‐partum for initial classification of proteins involved in specific metabolic processes associated with pregnancy.

Methods

Total serum protein concentrations were measured by biuret method and serum protein fractions were electrophoretically separated in 166 serum samples collected from healthy pregnant women in three trimesters of pregnancy (1st, n = 55; 2nd, n = 42; 3rd, n = 39) and in post‐partum (n = 30), and in 20 samples from nonpregnant controls.

Results

Across pregnancy, there were gradual, but occurring at different rates, decreases over time in serum total protein, albumin and gamma globulins compared to controls (P < 0.05). In 1st trimester, serum concentrations of total protein, albumin and gamma globulins were <10% lower than in nonpregnant state, with further decreases in 2nd and 3rd trimesters and in post‐partum. The concentrations of alpha‐1‐, alpha‐2‐, beta‐1‐ and beta‐2‐globulins were elevated compared to controls (P < 0.05) with different dynamics of change and with the highest percentage increase for alpha‐1‐globulin.

Conclusion

Pregnancy‐associated alterations in the serum concentrations of total protein and in its individual electrophoretic protein fractions in each trimester of pregnancy and differences versus normal ranges in nonpregnant healthy females could be a simple screening method for classification useful laboratory parameters that help obstetricians and gynecologists to make multidirectional judgments about the state of health of pregnant women.
Predicting inadequate treatment response in children with chronic spontaneous urticaria
Authors: Park Yu‐Mi , Oh Min‐Su , Kwon Ji‐Won
Published: July 2020

Background

We aimed to investigate the treatment response and associated factors for loss of control in children with chronic spontaneous urticaria (CSU).

Methods

A total of 240 CSU patients (aged 0‐17 years) were enrolled in a single‐center study in Korea from May 2014 to May 2019. We retrospectively reviewed the medical records and compared the duration of treatment and step of medications using the urticaria control test (UCT, range 0‐16 points). Serum total immunoglobulin levels, eosinophil count, allergic sensitization, autologous serum skin test, antinuclear antibody, thyroid function test, erythrocyte sedimentation rate, and C‐reactive protein were measured. The patients were divided into well‐controlled (sustained UCT ≥12), partly controlled (fluctuating UCT around 12), and poorly controlled (sustained UCT <12) groups.

Results

Of the 240 children, 150 (62.5%) achieved well‐controlled status; 74 (30.8%), partly controlled; and 16 (6.7%), poorly controlled. Longer duration (adjusted odds ratio: 1.09, 95% confidence interval: 1.05‐1.13, P < .001) and higher treatment steps (5.61, 2.82‐11.14, P < .001) for reaching the initial 12 points or more of UCT score, initial urticaria activity score (UAS) score (1.06, 1.03‐1.09, P < .001), and food sensitization (1.88, 1.03‐3.46, P = .041) were associated with inadequate treatment response. The mean duration to symptom free for 1 month without medication was 14.6 months in the well‐controlled group and 22.1 months in the partly controlled group (P = .002).

Conclusion

Children with CSU have a good treatment response. Longer duration and higher treatment step until the initial disease control, higher initial UAS7 score, and food sensitization can predict inadequate treatment response.
Representation of women in pediatric dermatology leadership and research: Trends over the past 45 years
Authors: Baker Catherine , Dwan Dennis , Fields Alexandra , Mann Julianne A. , Pace Nicole C. , Hamann Carsten R.
Published: July 2020

Background/Objectives

The representation of women among practicing dermatologists has increased over the last several decades. Here, we analyze the evolving representation of women in the Society for Pediatric Dermatology (SPD) and the Pediatric Dermatology Research Alliance (PeDRA), with particular focus on the role of women as society leaders, researchers, and annual meeting speakers.

Methods

A retrospective review of SPD and PeDRA professional society leaders (SPD presidents, PeDRA co‐chairs, PeDRA executive committee members), grant recipients (pilot grant recipients, team/collaborative grant recipients, William Weston Research Grant recipients), and annual meeting speakers (named lecturers at the SPD Annual Meeting, plenary lecturers at the PeDRA Annual Conference) was performed. Authors of research articles in Pediatric Dermatology were reviewed at three‐year intervals from 1983 through 2019. The percentage of women among all leadership, grant, authorship, and lectureship categories was analyzed over time.

Results

Women have represented 70% of SPD presidents since 2011 and 75% of PeDRA co‐chairs since 2013. The percentage of women among first and senior authors of research articles in Pediatric Dermatology increased significantly from 1983 to 2019 (Cochran Armitage test for trend, P < .01), and women earned the majority of SPD/PeDRA pilot project grants (2008‐2018), collaborative team grants (2016‐2018), and William Weston Research Grants (1995‐2015). At SPD Annual meetings from 2010 to 2019, women comprised 44% of named lecturers but accounted for approximately 78% of the pediatric dermatology workforce (P < .01).

Conclusion

Despite the widespread influence of women in pediatric dermatology leadership and research, gender discrepancies remain among named lecturer positions at national pediatric dermatology meetings.
Bronchoscopic treatments for early‐stage peripheral lung cancer: Are we ready for prime time?
Authors: Steinfort Daniel P. , Herth Felix J.F.
Published: July 2020

Lung cancer is the leading cause of cancer‐related death worldwide and surgical lobectomy remains the preferred therapy for patients with early‐stage NSCLC. Medical comorbidities and advanced age preclude resection in many patients and minimally invasive ablative therapies are needed for treatment. Stereotactic ablative radiation is established as an effective modality in this patient group, although may be contraindicated in some patients with prior radiation exposure, comorbidities or centrally positioned tumours. Percutaneous ablative methods are available, although are frequently associated with significant complications. Numerous endoscopic ablative techniques are under evaluation. With a more favourable safety profile and the ability to provide diagnosis and staging information potentially within a single procedure, there is a strong rationale for development of bronchoscopic ablative modalities. In the following article, the authors aim to explore the role bronchoscopic ablation may play in treatment of peripheral lung tumours, and to describe a pathway to establishing these modalities as part of routine care. The current status of several bronchoscopic ablative options is discussed in detail.
Immunohematological work‐up, severity analysis and transfusion support in autoimmune hemolytic anemia patients
Authors: Ray Gopal Krushna , Mahapatra Smita , Mishra Debasish , Parida Pankaj , Jena Rabindra Kumar , Panigrahi Rashmita
Published: July 2020

Background and Objective

Autoimmune haemolytic anaemia (AIHA) is a clinical condition of reduced red cell survival by binding of antibodies (IgG/IgM) to self‐antigen and classified as warm, cold or mixed type. AIHA patients frequently have sufficient severity of anaemia as to require a blood transfusion. But little is known from India about the distribution and severity of AIHA. The objective of the study was to find out the type of AIHA, severity of haemolysis and the hindrances in transfusing these patients.

Materials and methods

Ninety‐four cases were included in the study. All the laboratory parameters (Hb, bilirubin, LDH, reticulocyte count) were analysed from the case sheet. All the immunohaematological workup like direct antiglobulin test, antibody screening/identification, elution–adsorption and compatibility testing were performed as per the American Association of Blood Banking (AABB) methods.

Result

Warm AIHA was a more common type (61·4%) followed by mixed (23·7%) and cold type (14·9%). Fifty‐three (56%) cases were secondary AIHA. Females (68%) were more affected than males. The severity of haemolysis was found to be a significant correlation with the strength of DAT only, not with gender, type of AIHA or autoagglutinin. Thirty‐eight cases of AIHA required transfusion support, and best‐match blood units were issued to fourteen cases.

Conclusion

In this region, the mixed type is more common after warm type and presented with very severe haemolysis. DAT strength directly related to the severity of haemolysis. AIHA patients with underlying alloantibody could be transfused corresponding antigen‐negative best‐match unit.
Structural Design Space Exploration Using Principal Component Analysis
Authors: Bunnell Spencer , Gorrell Steven , Salmon John , Thelin Christopher , Ruoti Christopher
Published: July 2020

Design space exploration (DSE) is the process whereby a designer seeks to understand some results across a set of design variations. Structural DSE of turbomachinery compressor blades is often challenging because the large number of design variables make it difficult to learn the effect that each variable has upon the stress contours. Principal component analysis (PCA) of the stress contours is used as a way to understand how the stress contours change over the design space. Two methods are introduced to address the challenge of understanding how the stress changes over a large number of variables. First, a two-point correlation is applied to relate the design variables to the scores of each principal component. Second, a coupling of the stress and coordinate location of each node in PCA is developed which also indicates how the stress variations relate to geometric variations. These provide insight to how design variables influence the stress. It is shown how these methods use PCA as DSE tools to better explore the structural design space of compressor blades. Better DSE can improve compressor blades and the computational cost needed for their design.
Exploring the source of human brain fluids
Authors: Silva-Vargas Violeta , Doetsch Fiona
Published: July 2020

Human organoid cultures can be used to probe secretion and drug permeability into and out of the brain
Flavin Adenine Dinucleotide-Dependent Halogenase XanH and Engineering of Multifunctional Fusion Halogenases
Authors: Kong Lingxin , Wang Qing , Deng Zixin , You Delin
Published: July 2020

Halogenation is important in medicinal chemistry and plays an essential role in the biosynthesis of active secondary metabolites. Halogenases have evolved to catalyze reactions with high efficiency and selectivity, and engineering efforts have been made to engage the selective reactivity in natural product biosynthesis. The enzymatic halogenations are an environmentally friendly approach with high regio- and stereoselectivity, which make it a potential complement to organic synthesis. FDHs constitute one of the most extensively elucidated class of halogenases; however, the inventory awaits to be expanded for biotechnology applications and for the generation of halogenated natural product analogues. In this study, XanH was found to reduce flavin and halogenated the freely diffusing natural substrate with an angular fused hexacyclic scaffold, findings which were different from those for the exclusively studied FDHs. Moreover, the FDR-XanH fusion protein E1 with comparable reactivity to that of XanH serves as a successful example of genetic fusions and sets an important stage for future protein engineering.
Rhizobium leguminosarum bv. trifolii NodD2 Enhances Competitive Nodule Colonization in the Clover-Rhizobium Symbiosis
Authors: Ferguson Shaun , Major Anthony S. , Sullivan John T. , Bourke Scott D. , Kelly Simon J. , Perry Benjamin J. , Ronson Clive W.
Published: July 2020

Establishment of the rhizobium-legume symbiosis requires a highly specific and complex signal exchange between both participants. Rhizobia perceive legume flavonoid compounds through LysR-type NodD regulators. Often, rhizobia encode multiple copies of
nodD
, which is one determinant of host specificity. In some species of rhizobia, the presence of multiple copies of NodD extends their symbiotic host-range. Here, we identified and characterized a second copy of
nodD
present in some strains of the clover microsymbiont
Rhizobium leguminosarum
bv. trifolii. The second
nodD
gene contributed to the competitive ability of the strain on white clover, an important forage legume. A screen for strains containing
nodD2
could be utilized as one criterion to select strains with enhanced competitive ability for use as inoculants for pasture production.
Delivering water, sanitation and hygiene interventions to women and children in conflict settings: a systematic review
Authors: Als Daina , Meteke Sarah , Stefopulos Marianne , Gaffey Michelle F , Kamali Mahdis , Munyuzangabo Mariella , Shah Shailja , Jain Reena P , Radhakrishnan Amruta , Siddiqui Fahad J , Ataullahjan Anushka , Bhutta Zulfiqar A
Published: July 2020

Background

Access to safe water and sanitation facilities and the adoption of effective hygiene practices are fundamental to reducing maternal and child morbidity and mortality globally. In armed conflict settings, inadequate water, sanitation and hygiene (WASH) infrastructure poses major health risks for women and children. This review aimed to synthesise the existing information on WASH interventions being delivered to women and children in conflict settings in low-income and middle-income countries (LMICs) and to identify the personnel, sites and platforms being used to deliver such interventions.

Methods

We conducted a systematic search for publications indexed in four databases, and grey literature was searched through the websites of humanitarian agencies and organisations. Eligible publications reported WASH interventions delivered to conflict-affected women or children. We extracted and synthesised information on intervention delivery characteristics, as well as barriers and facilitators.

Results

We identified 58 eligible publications reporting on the delivery of WASH interventions, mostly in Sub-Saharan Africa. Non-Governmental Organization (NGO)/United Nations (UN) agency staff were reported to be involved in delivering interventions in 62% of publications, with the most commonly reported delivery site being community spaces (50%). Only one publication reported quantitative data on intervention effectiveness among women or children.

Discussion

This review revealed gaps in the current evidence on WASH intervention delivery in conflict settings. Little information is available on the delivery of water treatment or environmental hygiene interventions, or about the sites and personnel used to deliver WASH interventions. Limited quantitative data on WASH intervention coverage or effectiveness with respect to women or children are important gaps, as multiple factors can affect how WASH services are accessed differently by women and men, and the hygiene needs of adolescent girls and boys differ; these factors must be taken into account when delivering interventions in conflict settings.

PROSPERO registration number

CRD42019125221
‘Only twice a year’: a qualitative exploration of 6-month antiretroviral treatment refills in adherence clubs for people living with HIV in Khayelitsha, South Africa
Authors: Keene Claire Marriott , Zokufa Nompumelelo , Venables Emilie C , Wilkinson Lynne , Hoffman Risa , Cassidy Tali , Snyman Leigh , Grimsrud Anna , Voget Jacqueline , von der Heyden Erin , Zide-Ndzungu Siphokazi , Bhardwaj Vinayak , Isaakidis Petros
Published: July 2020

Objective

Longer intervals between routine clinic visits and medication refills are part of patient-centred, differentiated service delivery (DSD). They have been shown to improve patient outcomes as well as optimise health services—vital as ‘universal test-and-treat’ targets increase numbers of HIV patients on antiretroviral treatment (ART). This qualitative study explored patient, healthcare worker and key informant experiences and perceptions of extending ART refills to 6 months in adherence clubs in Khayelitsha, South Africa.

Design and setting

In-depth interviews were conducted in isiXhosa with purposively selected patients and in English with healthcare workers and key informants. All transcripts were audio-recorded, transcribed and translated to English, manually coded and thematically analysed. The participants had been involved in a randomised controlled trial evaluating multi-month ART dispensing in adherence clubs, comparing 6-month and 2-month refills.

Participants

Twenty-three patients, seven healthcare workers and six key informants.

Results

Patients found that 6-month refills increased convenience and reduced unintended disclosure. Contrary to key informant concerns about patients’ responsibility to manage larger quantities of ART, patients receiving 6-month refills were highly motivated and did not face challenges transporting, storing or adhering to treatment. All participant groups suggested that strict eligibility criteria were necessary for patients to realise the benefits of extended dispensing intervals. Six-month refills were felt to increase health system efficiency, but there were concerns about whether the existing drug supply system could adapt to 6-month refills on a larger scale.

Conclusions

Patients, healthcare workers and key informants found 6-month refills within adherence clubs acceptable and beneficial, but concerns were raised about the reliability of the supply chain to manage extended multi-month dispensing. Stepwise, slow expansion could avoid overstressing supply and allow time for the health system to adapt, permitting 6-month ART refills to enhance current DSD options to be more efficient and patient-centred within current health system constraints.
Furosemide in end-stage heart failure: community subcutaneous infusions
Authors: Brown Andrew , Westley Katharine , Robson Judith , Armstrong Leonie , Matthews Iain , Runnett Craig , Ripley David , Thomas Honey
Published: July 2020

Background

In chronic heart failure many patients have recurrent hospital admissions and it is the leading cause of admission in people aged over 65 years. In those with end-stage heart failure, there is limited evidence that furosemide can be given subcutaneously to relieve symptoms and avoid hospital admission.

Method

We initiated a community-based continuous subcutaneous infusion (CSCI) furosemide service for the treatment of advanced heart failure. We aimed to increase patient choice, offer an alternative to hospital admission and, in patients at the end of their life, allow them to die at their preferred place of care with symptom alleviation. We retrospectively reviewed case notes.

Results

36 consecutive episodes of CSCI of treatment were recorded in 28 patients. 15 patients (54%) survived beyond the initial treatment course with 13 patients (87%) avoiding acute hospital admission. There was a reduction in mean hospital admission rates from 2.87 to 0.73 (p<0.001) in the 6-month periods either side of the first episode of CSCI furosemide. A median reduction of 4 kg weight loss was recorded. 13 patients died during the initial treatment course. 12 (92%) died at home and 1 died at the hospital palliative care unit. All had symptoms controlled.

Conclusion

Subcutaneous furosemide can be successfully delivered in the community. In addition to palliation in the final days of life, community subcutaneous furosemide can be an effective treatment leading to weight loss and improved symptoms with survival for several months.
Expert consensus on prevention and control of COVID-19 in the neurological intensive care unit (first edition)
Authors: Wang Furong , Liu Jingyi , Zhang Ping , Jiang Wen , Zhang Le , Zhang Meng , Teng Junfang , Wang Jinquan , Xie Xiaoqi , Cao Jie , Li Wei , Wu Yongming , Zhou Hao , Su Yingying , Pan Suyue , Liu Liping
Published: July 2020

During the COVID-19 epidemic, the treatment of critically ill patients has been increasingly difficult and challenging. During the epidemic, some patients with neurological diseases also have COVID-19, which could be misdiagnosed and cause silent transmission and nosocomial infection. Such risk is high in a neurological intensive care unit (NCU). Therefore, prevention and control of epidemic in critically ill patients is of utmost importance. The principle of NCU care should include comprehensive screening and risk assessment, weighing risk against benefits and reducing the risk of COVID-19 transmission while treating patients as promptly as possible.
Comparison of Fused Deposition Modeling and Color Jet 3D Printing Technologies for the Printing of Mathematical Geometries
Authors: Fatma Nosheen , Haleem Abid , Javaid Mohd , Khan Shahbaz
Published: July 2020

Many mathematical geometries act as an optimal structure for functional applications and have always been an area of interest in the research field. Their topology offers properties which are crucial and can be used effectively in various domains. Apart from that, some have a resemblance to naturally occurring compounds which can help us to study their different transformations and behavior. In this paper, we present two such geometries, first, gyroid, which is an iso-minimal surface and second a three-crossing knot, also known as trefoil knot. The structure of gyroid makes it unique and is considered suitable in developing energy-absorbing, structural and lightweight applications. Similarly, some types of knots resemble the DNA structure and have found use in molecular chemistry. This paper discusses different application areas of these geometries. Further, this paper presents modeling and printing by using fused deposition modeling (FDM) and color jet printing (CJP). Comparative analysis has been done by considering various parameters. This paper discusses the potential of these two rapid prototyping technologies and their suitability for specific printing applications.
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Authors: García-Montes Mariel
Published: July 2020

Can developers make communication software more usable for at-risk users they are never likely to meet?
Adaptive Discretization for Episodic Reinforcement Learning in Metric Spaces
Authors: Sinclair Sean R. , Banerjee Siddhartha , Lee Yu Christina
Published: July 2020

We present an efficient algorithm for model-free episodic reinforcement learning on large (potentially continuous) state-action spaces. Our algorithm is based on a novel Q-learning policy with adaptive data-driven discretization. The central idea is to maintain a finer partition of the state-action space in regions which are frequently visited in historical trajectories, and have higher payoff estimates. We demonstrate how our adaptive partitions take advantage of the shape of the optimal Q-function and the joint space, without sacrificing the worst-case performance. In particular, we recover the regret guarantees of prior algorithms for continuous state-action spaces, which additionally require either an optimal discretization as input, and/or access to a simulation oracle. Moreover, experiments demonstrate how our algorithm automatically adapts to the underlying structure of the problem, resulting in much better performance compared both to heuristics and Q-learning with uniform discretization.
Simple Near-Optimal Scheduling for the M/G/1
Authors: Scully Ziv , Harchol-Balter Mor , Scheller-Wolf Alan
Published: July 2020

We consider the problem of preemptively scheduling jobs to minimize mean response time of an M/G/1 queue. When we know each job's size, the shortest remaining processing time (SRPT) policy is optimal. Unfortunately, in many settings we do not have access to each job's size. Instead, we know only the job size distribution. In this setting the Gittins policy is known to minimize mean response time, but its complex priority structure can be computationally intractable. A much simpler alternative to Gittins is the shortest expected remaining processing time (SERPT) policy. While SERPT is a natural extension of SRPT to unknown job sizes, it is unknown whether or not SERPT is close to optimal for mean response time.
Understanding (Mis)Behavior on the EOSIO Blockchain
Authors: Huang Yuheng , Wang Haoyu , Wu Lei , Tyson Gareth , Luo Xiapu , Zhang Run , Liu Xuanzhe , Huang Gang , Jiang Xuxian
Published: July 2020

EOSIO has become one of the most popular blockchain platforms since its mainnet launch in June 2018. In contrast to the traditional PoW-based systems (e.g., Bitcoin and Ethereum), which are limited by low throughput, EOSIO is the first high throughput Delegated Proof of Stake system that has been widely adopted by many decentralized applications. Although EOSIO has millions of accounts and billions of transactions, little is known about its ecosystem, especially related to security and fraud. In this paper, we perform a large-scale measurement study of the EOSIO blockchain and its associated DApps. We gather a large-scale dataset of EOSIO and characterize activities including money transfers, account creation and contract invocation. Using our insights, we then develop techniques to automatically detect bots and fraudulent activity. We discover thousands of bot accounts (over 30% of the accounts in the platform) and a number of real-world attacks (301 attack accounts). By the time of our study, 80 attack accounts we identified have been confirmed by DApp teams, causing 828,824 EOS tokens losses (roughly $2.6 million) in total.