bluuebunny/crossref_metadata_2025 huggingface dataset:
Fish biophony in a Mediterranean submarine canyon
Authors: Bolgan Marta , Gervaise Cedric , Di Iorio Lucia , Lossent Julie , Lejeune Pierre , Raick Xavier , Parmentier Eric
Published: April 2020

Although several bioacoustics investigations have shed light on the acoustic communication of Mediterranean fish species, the occurrence of fish sounds has never been reported below −40 m depth. This study assessed the occurrence of fish sounds at greater depths by monitoring the soundscape of a Mediterranean submarine canyon (Calvi, France) thanks to a combination of Static Acoustic Monitoring (three stations, from −125 to −150 m depth, 3 km from coastline) and of hydrophone-integrated gliders (Mobile Acoustic Monitoring; from −60 to −900 m depth, 3–6 km from coastline). Biological sounds were detected in 38% of the audio files; ten sound types (for a total of more than 9.000 sounds) with characteristics corresponding to those emitted by vocal species, or known as produced by fish activities, were found. For one of these sound types, emitter identity was inferred at the genus level (Ophidion sp.). An increase of from 10 to 15 dB re 1 μPa in sea ambient noise was observed during daytime hours due to boat traffic, potentially implying an important daytime masking effect. This study shows that monitoring the underwater soundscape of Mediterranean submarine canyons can provide holistic information needed to better understand the state and the dynamics of these heterogeneous, highly diverse environments.
The Effectiveness of Nonoperative Treatment for Anterior Cruciate Ligament Rupture on Patient-Reported Outcomes and Muscular Strength: A Critically Appraised Topic
Authors: Hunt Emily R. , Parise Cassandra N. , Butterfield Timothy A.
Published: April 2020

Clinical Scenario: Anterior cruciate ligament (ACL) ruptures are one of the most common injuries in young athletic populations. The leading treatment for these injuries is ACL reconstruction (ACL-r); however, nonoperative treatments are also utilized. Following ACL-r, patients experience prolonged muscle weakness and atrophy of the quadriceps muscle group, regardless of rehabilitation. Nonoperative treatment plans following ACL injury exist, but their outcomes are less familiar, in spite of providing insight as a nonsurgical “control” for postsurgical rehabilitation outcomes. Therefore, the purpose of this critically appraised topic was to evaluate quadriceps strength and function following nonoperative ACL rehabilitation using objective and subjective measures including isokinetic dynamometry, the single-leg hop test, and the International Knee Documentation Committee (IKDC) subjective knee form. Focused Clinical Question: What are the effects of nonoperative treatment on peak isokinetic knee-extensor torque, the single-leg hop tests, and the IKDC in patients who have sustained an ACL rupture? Summary of Key Findings: Patients who underwent nonsurgical ACL treatment produced limb symmetry index, with the side-to-side torque difference expressed as a percentage, and values at or above 90% for all 4 single-leg hop tests and strength tests similar to ACL-r patients. All studies showed individuals had higher IKDC scores at baseline collection when compared with patients who underwent ACL-r but showed lower IKDC scores at long-term follow-up compared with ACL-r patients. Clinical Bottom Line: Nonoperative treatments of ACL injuries yield similar long-term results in quadriceps strength as ACL-r. Due to the quality of evidence and the absence of randomized controlled trials on this topic, these outcomes should be considered with caution. Strength of Recommendation: The Oxford Centre for Evidence-Based Medicine taxonomy recommends a grade of B for level 2 evidence with consistent findings.
LRRK2 inhibitors induce reversible changes in nonhuman primate lungs without measurable pulmonary deficits
Authors: Baptista Marco A. S. , Merchant Kalpana , Barrett Ted , Bhargava Sakshi , Bryce Dianne K. , Ellis J. Michael , Estrada Anthony A. , Fell Matthew J. , Fiske Brian K. , Fuji Reina N. , Galatsis Paul , Henry Anastasia G. , Hill Sue , Hirst Warren , Houle Christopher , Kennedy Matthew E. , Liu Xingrong , Maddess Matthew L. , Markgraf Carrie , Mei Hong , Meier William A. , Needle Elie , Ploch Stephen , Royer Christopher , Rudolph Karin , Sharma Alok K. , Stepan Antonia , Steyn Stefan , Trost Craig , Yin Zhizhang , Yu Hongshi , Wang Xiang , Sherer Todd B.
Published: April 2020

Morphological changes in the lungs of macaques induced by several different LRRK2 inhibitors are reversible and do not lead to lung deficits.
Blocking the death checkpoint protein TRAIL improves cardiac function after myocardial infarction in monkeys, pigs, and rats
Authors: Wang Yaohui , Zhang Hailong , Wang Zhizeng , Wei Yinxiang , Wang Mingli , Liu Meichen , Wang Xuance , Jiang Yinan , Shi Gongning , Zhao Dongmei , Yang Zhengyan , Ren Zhiguang , Li Jing , Zhang Zhenkai , Wang Zhenfeng , Zhang Bei , Zong Beibei , Lou Xueke , Liu Chengguo , Wang Zihui , Zhang Hao , Tao Ningya , Li Xuefang , Zhang Xingkun , Guo Yafei , Ye Yang , Qi Yu , Li Hui , Wang Man , Guo Rongxin , Cheng Guanchang , Li Shulian , Zhang Jun , Liu Guangchao , Chai Lihui , Lou Qiang , Li Xia , Cui Xiukun , Gao Erhe , Dong Zheng , Hu Yanzhong , Chen Youhai H. , Ma Yuanfang
Published: April 2020

TRAIL blockade limits cardiac cell death and reduces inflammation to improve cardiac function after myocardial infarction in rats, pigs, and monkeys.
Anidulafungin and Micafungin Concentrations in Cerebrospinal Fluid and in Cerebral Cortex
Authors: Marx Jana , Welte René , Gasperetti Tiziana , Moser Patrizia , Beer Ronny , Ortler Martin , Jeske Martina , Stern Ramona , Pomaroli Andreas , Joannidis Michael , Bellmann Romuald
Published: April 2020

Anidulafungin and micafungin were quantified in cerebrospinal fluid (CSF) of critically ill adults and in cerebral cortex of deceased patients. In CSF, anidulafungin levels (<0.01 to 0.66 μg/ml) and micafungin levels (<0.01 to 0.16 μg/ml) were lower than those in plasma concentrations (0.77 to 5.07 and 1.21 to 8.70 μg/ml, respectively) drawn simultaneously. In cerebral cortex, anidulafungin and micafungin levels were 0.21 to 2.34 and 0.18 to 2.88 μg/g, respectively.
The Potential Role of Schistosome-Associated Factors as Therapeutic Modulators of the Immune System
Authors: Li Junhui , Liu Hong , Jiang Jie , She Xingguo , Niu Ying , Ming Yingzi
Published: April 2020

The parasites and eggs of helminths, including schistosomes, are associated with factors that can modulate the nature and outcomes of host immune responses, particularly enhancing type 2 immunity and impairing the effects of type 1 and type 17 immunity. The main species of schistosomes that cause infection in humans are capable of generating a microenvironment that allows survival of the parasite by evasion of the immune response. Schistosome infections are associated with beneficial effects on chronic immune disorders, including allergies, autoimmune diseases, and alloimmune responses.
Defective Influenza A Virus RNA Products Mediate MAVS-Dependent Upregulation of Human Leukocyte Antigen Class I Proteins
Authors: Rahim Mir Munir A. , Parsons Brendon D. , Price Emma L. , Slaine Patrick D. , Chilvers Becca L. , Seaton Gregory S. , Wight Andrew , Medina-Luna Daniel , Dey Sayanti , Grandy Shannen L. , Anderson Lauryn E. , Zamorano Cuervo Natalia , Grandvaux Nathalie , Gaglia Marta M. , Kelvin Alyson A. , Khaperskyy Denys A. , McCormick Craig , Makrigiannis Andrew P.
Published: April 2020

Human leukocyte antigens (HLAs) are cell surface proteins that regulate innate and adaptive immune responses to viral infection by engaging with receptors on immune cells. Many viruses have evolved ways to evade host immune responses by modulating HLA expression and/or processing. Here, we provide evidence that aberrant RNA products of influenza virus genome replication can trigger retinoic acid-inducible gene I (RIG-I)/mitochondrial antiviral signaling (MAVS)-dependent remodeling of the cell surface, increasing surface presentation of HLA proteins known to inhibit the activation of an immune cell known as a natural killer (NK) cell. While this HLA upregulation would seem to be advantageous to the virus, it is kept in check by the viral nonstructural 1 (NS1) protein, which limits RIG-I activation and interferon production by the infected cell.
Serotonergic Drugs Inhibit Chikungunya Virus Infection at Different Stages of the Cell Entry Pathway
Authors: Bouma Ellen M. , van de Pol Denise P. I. , Sanders Ilson D. , Rodenhuis-Zybert Izabela A. , Smit Jolanda M.
Published: April 2020

The rapid spread of mosquito-borne viral diseases in humans puts a huge economic burden on developing countries. For many of these infections, including those caused by chikungunya virus (CHIKV), there are no specific treatment possibilities to alleviate disease symptoms. Understanding the virus-host interactions that are involved in the viral replication cycle is imperative for the rational design of therapeutic strategies. In this study, we discovered an antiviral compound, elucidated its mechanism of action, and propose serotonergic drugs as potential host-directed antivirals for CHIKV.
Genome Sequence of Serratia fonticola Strain S14, Isolated from the Mosquito Aedes triseriatus
Authors: Chen Shicheng , Walker Edward D.
Published: April 2020

The bacterium
Serratia fonticola
strain S14, isolated from the midgut of a female
Aedes triseriatus
mosquito, has a genome size of 6,176,978 bp. The genome includes genes responsible for acyl-homoserine lactone-mediated quorum sensing, enterobactin, and aerobactin.
The Complete Genome Sequence of
n
-Alkane-Degrading Desulfoglaeba alkanexedens ALDC Reveals Multiple Alkylsuccinate Synthase Gene Clusters
Authors: Marks Christopher R. , Callaghan Amy V. , Davidova Irene A. , Duncan Kathleen E. , Morris Brandon E. L. , McInerney Michael J. , Suflita Joseph M.
Published: April 2020

Anaerobic alkane metabolism is critical in multiple environmental and industrial sectors, including environmental remediation, energy production, refined fuel stability, and biocorrosion. Here, we report the complete gap-closed genome sequence for a model
n
-alkane-degrading anaerobe,
Desulfoglaeba alkanexedens
ALDC.
Trace-elemental and petrographic constraints on the severity of hydrographic restriction in the silled Midland Basin during the late Paleozoic ice age
Authors: Peng Junwen , Fu Qilong , Larson Toti E. , Janson Xavier
Published: April 2020

Enrichment of redox-sensitive trace elements in ancient marine shales is conventionally believed to be controlled by marine benthic redox conditions, whereas the influence of hydrographic conditions on trace element enrichment pattern has been rarely considered. Here, we present newly obtained data sets from the Upper Pennsylvanian organic-rich Cline Shale in the Midland Basin, Texas, to illustrate the influence of hydrographic circulation on the trace-element enrichment pattern and the stratigraphic record of mudrocks. Various lithofacies, including siliceous mudrocks, argillaceous mudrocks, skeletal-bearing argillaceous mudrocks, calcareous mudrocks, and wackestone, are identified in the Cline Shale. Significant changes in the trace-element enrichment pattern, mineral composition, texture of framboidal pyrite, and other bulk geochemical parameters in different lithofacies are interpreted to have been caused by high-amplitude and high-frequency glacio-eustatic sea-level oscillations in the silled Midland Basin during the late Paleozoic ice age. Specifically, glacio-eustatic sea-level falls generally resulted in the severe isolation of the Midland Basin from the Panthalassic Ocean, highly restricted hydrographic circulation, long deep-water renewal time, euxinic bottom-water conditions, depleted seawater Mo (molybdenum) in the silled basin, and low sediment Mo/TOC (total organic carbon), coupled with significant extrabasinal detrital quartz input, forming siliceous mudrocks. Enhanced phosphorus cycling and excellent preservation conditions are considered to be responsible for the high TOC observed in siliceous mudrocks. In contrast, glacio-eustatic sea-level rises substantially enhanced water exchange between the basin and the Panthalassic Ocean, created overall suboxic to anoxic bottom-water conditions, resupplied seawater Mo, elevated sediment Mo/TOC, and increased platform carbonate production in the basin, forming calcareous mudrocks and wackestone.
Ontology to identify pregnant women in electronic health records: primary care sentinel network database study
Authors: Liyanage Harshana , Williams John , Byford Rachel , de Lusignan Simon
Published: April 2020

Objective

To develop an ontology to identify pregnant women from computerised medical record systems with dissimilar coding systems in a primary care sentinel network.

Materials and methods

We used a three-step approach to develop our pregnancy ontology in two different coding schemata, one hierarchical and the other polyhierarchical. We developed a coding system–independent pregnancy case identification algorithm using the Royal College of General Practitioners Research and Surveillance Centre sentinel network database which held 1.8 million patients’ data drawn from 150 primary care providers. We tested the algorithm by examining individual patient records in a 10% random sample of all women aged 29 in each year from 2004 to 2016. We did an external comparison with national pregnancy data. We used χ2test to compare results obtained for the two different coding schemata.

Results

243 005 women (median age 29 years at start of pregnancy) had 405 591 pregnancies from 2004 to 2016 of which 333 689 went to term. We found no significant difference between results obtained for two populations using different coding schemata. Pregnancy mean ages did not differ significantly from national data.

Discussion

This ontologically driven algorithm enables consistent analysis across data drawn from populations using different coding schemata. It could be applied to other hierarchical coding systems (eg, International Classification of Disease) or polyhierarchical systems (eg, SNOMED CT to which our health system is currently migrating).

Conclusion

This ontological approach will improve our surveillance in particular of influenza vaccine exposure in pregnancy.
LAGOS: learning health systems and how they can integrate with patient care
Authors: McLachlan Scott , Dube Kudakwashe , Kyrimi Evangelia , Fenton Norman
Published: April 2020

Problem

Learning health systems (LHS) are an underexplored concept. How LHS will operate in clinical practice is not well understood. This paper investigates the relationships between LHS, clinical care process specifications (CCPS) and the established levels of medical practice to enable LHS integration into daily healthcare practice.

Methods

Concept analysis and thematic analysis were used to develop an LHS characterisation. Pathway theory was used to create a framework by relating LHS, CCPS, health information systems and the levels of medical practice. A case study approach evaluates the framework in an established health informatics project.

Results

Five concepts were identified and used to define the LHS learning cycle. A framework was developed with five pathways, each having three levels of practice specificity spanning population to precision medicine. The framework was evaluated through application to case studies not previously understood to be LHS.

Discussion

Clinicians show limited understanding of LHS, increasing resistance and limiting adoption and integration into care routine. Evaluation of the presented framework demonstrates that its use enables: (1) correct analysis and characterisation of LHS; (2) alignment and integration into the healthcare conceptual setting; (3) identification of the degree and level of patient application; and (4) impact on the overall healthcare system.

Conclusion

This paper contributes a theoretical framework for analysis, characterisation and use of LHS. The framework allows clinicians and informaticians to correctly identify, characterise and integrate LHS within their daily routine. The overall contribution improves understanding, practice and evaluation of the LHS application in healthcare.
Cerebral palsy information system with an approach to information architecture: a systematic review
Authors: Afzali Mina , Etemad Korosh , Kazemi Alireza , Rabiei Reza
Published: April 2020

Background

Long-term complications and high costs of cerebral palsy (CP) as well as inconsistency in data related to this disease reveal the need for extensive planning to obtain accurate and complete data for the effective management of patients.

Objective

The present study reviews the information architecture of CP information system.

Method

The relevant articles published from early 1988 to 31 July 2018 were extracted through searching PubMed, Scopus, Cochran, Web of Science and Embase databases conducted independently by two researchers.

Results

A total of 39 articles on CP information system were reviewed. Hospitals, rehabilitation centres and outpatient clinics were found to be the main organisations in charge of generating CP data. Each CP database used several data sources, with hospitals serving as the most important sources of information and the main generators of data. The main CP datasets were categorised into four groups of demographic data, diagnosis, motor function and visual impairment. The majority of data standards were related to the use of the International Classification of Functioning, Disability and Health and the Gross Motor Function Classification System. Finally, accuracy, completeness and consistency were the criteria employed in data quality control.

Conclusion

Developing a robust CP information system requires deploying the principles of information architecture when developing the system, as these can improve data structure and content of CP system, as well as data quality and data sharing.
Measuring the outcomes of using person-generated health data: a case study of developing a PROM item bank
Authors: Dimaguila Gerardo Luis , Gray Kathleen , Merolli Mark
Published: April 2020

Introduction

Patient-reported outcome measures (PROMs) allow patients to self-report the status of their health condition or experience independently. A key area for PROMs to contribute in building the evidence base is in understanding the effects of using person-generated health data (PGHD), and using PROMs to measure outcomes of using PGHD has been suggested in the literature. Key considerations inherent in the stroke rehabilitation context makes the measurement of PGHD outcomes in home-based poststroke rehabilitation, which uses body-tracking technologies, an important use case.

Objective

This paper describes the development of a preliminary item bank of a PROM-PGHD for Kinect-based stroke rehabilitation systems (K-SRS), or PROM-PGHD for K-SRS.

Methods

The authors designed a method to develop PROMs of using PGHD, or PROM-PGHD. The PROM-PGHD Development Method was designed by augmenting a key PROM development process, the Qualitative Item Review, and follows PROM development best practice. It has five steps, namely, literature review; binning and winnowing; initial item revision; eliciting patient input and final item Revision.

Results

A preliminary item bank of the PROM-PGHD for K-SRS is presented. This is the result of implementing the first three steps of the PROM-PGHD Development Method within the domains of interest, that is, stroke and Kinect-based simulated rehabilitation.

Conclusions

This paper has set out a case study of our method, showing what needs to be done to ensure that the PROM-PGHD items are suited to the health condition and technology category. We described it as a case study because we argue that it is possible for the PROM-PGHD method to be used by others to measure effects of PGHD utilisation in other cases of health conditions and technology categories. Hence, it offers generalisability and has broader clinical relevance for evidence-based practice with PGHD. This paper is the first to offer a case study of developing a PROM-PGHD.
Human factors challenges for the safe use of artificial intelligence in patient care
Authors: Sujan Mark , Furniss Dominic , Grundy Kath , Grundy Howard , Nelson David , Elliott Matthew , White Sean , Habli Ibrahim , Reynolds Nick
Published: April 2020

The use of artificial intelligence (AI) in patient care can offer significant benefits. However, there is a lack of independent evaluation considering AI in use. The paper argues that consideration should be given to how AI will be incorporated into clinical processes and services. Human factors challenges that are likely to arise at this level include cognitive aspects (automation bias and human performance), handover and communication between clinicians and AI systems, situation awareness and the impact on the interaction with patients. Human factors research should accompany the development of AI from the outset.
Using normalisation process theory to understand workflow implications of decision support implementation across diverse primary care settings
Authors: Mishuris Rebecca G , Palmisano Joseph , McCullagh Lauren , Hess Rachel , Feldstein David A , Smith Paul D , McGinn Thomas , Mann Devin M
Published: April 2020

Background

Effective implementation of technologies into clinical workflow is hampered by lack of integration into daily activities. Normalisation process theory (NPT) can be used to describe the kinds of ‘work’ necessary to implement and embed complex new practices. We determined the suitability of NPT to assess the facilitators, barriers and ‘work’ of implementation of two clinical decision support (CDS) tools across diverse care settings.

Methods

We conducted baseline and 6-month follow-up quantitative surveys of clinic leadership at two academic institutions’ primary care clinics randomised to the intervention arm of a larger study. The survey was adapted from the NPT toolkit, analysing four implementation domains: sense-making, participation, action, monitoring. Domains were summarised among completed responses (n=60) and examined by role, institution, and time.

Results

The median score for each NPT domain was the same across roles and institutions at baseline, and decreased at 6 months. At 6 months, clinic managers’ participation domain (p=0.003), and all domains for medical directors (p<0.003) declined. At 6 months, the action domain decreased among Utah respondents (p=0.03), and all domains decreased among Wisconsin respondents (p≤0.008).

Conclusions

This study employed NPT to longitudinally assess the implementation barriers of new CDS. The consistency of results across participant roles suggests similarities in the work each role took on during implementation. The decline in engagement over time suggests the need for more frequent contact to maintain momentum. Using NPT to evaluate this implementation provides insight into domains which can be addressed with participants to improve success of new electronic health record technologies.

Trial registration number

NCT02534987.
Effect of preoperative education and ICU tour on patient and family satisfaction and anxiety in the intensive care unit after elective cardiac surgery: a randomised controlled trial
Authors: Lai Veronica Ka Wai , Ho Ka Man , Wong Wai Tat , Leung Patricia , Gomersall Charles David , Underwood Malcolm John , Joynt Gavin Matthew , Lee Anna
Published: April 2020

Background

Preoperative education may help participants to psychologically prepare themselves for surgery, but the outcomes of such preparation have rarely been assessed in patients requiring postoperative care in the intensive care unit (ICU) as well as in family members.

Objective

To assess the effect of a preoperative multifaceted education intervention on patient and family satisfaction levels in the ICU and measures of perioperative patients’ anxiety and depression.

Trial design

Single-centre, two-armed, parallel, superiority, randomised controlled trial. Healthcare professionals in ICU and outcome assessor were blinded to treatment allocation.

Participants

100 elective coronary artery bypass grafting±valve surgery patients and their family members.

Interventions

Preoperative education comprising of a video and ICU tour in addition to standard care (treatment), versus standard care (control).

Outcomes

Patient and family satisfaction levels with ICU using validated PS-ICU23 and FS-ICU24 questionnaires (0–100), respectively; change in perioperative anxiety and depression scores between 1 day presurgery and 3 days postsurgery.

Results

Among 100 (50 treatment, 50 control) patients and 98 (49 treatment, 49 control) family members, 94 (48 treatment, 46 control) patients and 94 (47 treatment, 47 control) family members completed the trial. Preoperative education was associated with higher overall patient (mean difference (MD) 6.7, 95% CI 0.2 to 13.2) and family (MD 10.0, 95% CI 3.8 to 16.3) satisfaction scores. There was a weak association between preoperative education and a reduction in patient’s anxiety scores over time (MD −1.7, 95% CI −3.5 to 0.0). However, there was no evidence of a treatment effect on patient’s depression scores over time (MD −0.6, 95% CI −2.3 to 1.2).

Conclusion

Providing comprehensive preoperative information about ICU to elective cardiac surgical patients improved patient and family satisfaction levels and may decrease patients’ anxiety levels.

Trial registration number

ChiCTR-IOR-15006971.
Emergency surgical obstetrics simulation training: an ex vivo low-cost model using bovine uterus and porcine bladder for haemostatic uterine brace suture techniques
Authors: Sinclair Amy , Allam Mohamed Sayed , Ferguson Evelyn Jean , Mehasseb Mohamed Khairy
Published: April 2020

Postpartum haemorrhage remains a leading cause of maternal mortality and morbidity. While conventional obstetrics training curricula describe at length the management of postpartum haemorrhage, obstetrics trainees rarely have exposure to surgical management of postpartum haemorrhage in emergency situations due to reduced hours of training. Procedures such as the transverse or longitudinal haemostatic uterine brace sutures are recognised to be safe, simple and allow for the preservation of the uterus. Training during emergency situations is rarely practical or ideal. We describe a simple model that simulates the atonic postnatal uterus and allows trainees to practise the safe placement of the brace sutures. We use a bovine uterus model with attached broad ligament, bladder and ureters for the transverse haemostatic suture. For the longitudinal brace suture, we use a porcine bladder to simulate the uterus, with the ureters and bladder mesentery simulating the tubes and broad ligaments. The placement of the sutures can be practised with the uterus/bladder closed, or open akin to a caesarean section. Tissue dissection and feedback is almost similar to in vivo conditions. The sutures are inserted and driven using the material and correct placement used during real surgery. Our wet lab training model allows the acquisition, maintenance and enhancement of the required technical skills in a controlled environment, using inexpensive, reproducible and widely available specimens. The model has proved successful in both high and low-resource healthcare settings.
Trends in place of death in a small developing country: a population-level study using death certificate data
Authors: Jennings Nicholas , Chambaere Kenneth , Deliens Luc , Cohen Joachim
Published: April 2020

Background

Valuable information for planning future end-of-life care (EOLC) services and care facilities can be gained by studying trends in place of death (POD). Scarce data exist on the POD in small developing countries. This study aims to examine shifts in the POD of all persons dying between 1999 and 2010 in Trinidad and Tobago, to draw conclusions about changes in the distribution of POD over time and the possible implications for EOLC practice and policy.

Methods

A population-level analysis of routinely collected death certificate data of the most recent available fully coded years at the time of the study—1999 to 2010. Observed proportions for the POD of all deaths were standardised according to the age, sex and cause of death distribution in 1999. Trends for a subgroup of persons who died from causes indicative of a palliative care (PC) need were also examined.

Results

The proportion of deaths in government hospitals increased from 48.9% to 55.4% and decreased from 38.7% to 29.7% at private homes. There was little variation between observed and standardised rates. The decrease in home deaths was stronger when the PC subcategory was considered, most notably from cancer.

Conclusion

Internationally, the proportion of deaths at institutions is increasing. A national strategy on palliative and EOLC is needed to facilitate the increasing number of people who seek EOLC at government hospitals in Trinidad and Tobago, including an investigation into the reasons for the trend. Alternatives to accommodate out-of-hospital deaths can be considered.
Secondary prevention and outcomes in outpatients with coronary artery disease, atrial fibrillation or heart failure: a focus on disease overlap
Authors: Lamblin Nicolas , Ninni Sandro , Tricot Olivier , Meurice Thibaud , Lemesle Gilles , Bauters Christophe
Published: April 2020

Objective

To assess secondary prevention and outcomes in patients with chronic coronary artery disease (CAD), atrial fibrillation (AF) and heart failure (HF), focusing on disease overlap.

Methods

We analysed the data of 10 517 outpatients with a diagnosis of CAD, AF and/or HF included in a prospective cohort study. Follow-up (median 3.2 years) was achieved in 10 478 (99.6%) patients. Seven mutually exclusive patient groups were formed: CAD alone (n=4303), AF alone (n=2604), CAD+AF (n=700), HF alone (n=513), HF+CAD (n=728), HF+AF (n=1087) and HF+CAD+AF (n=582).

Results

Patients with disease overlaps represented 29.4% of the total population. The level of secondary prevention was high in all subgroups and in accordance with European class I – level A guidelines. Among patients with CAD, 99% received an antithrombotic and 91% received a statin. Among patients with AF, 81.7% were treated with an anticoagulant if indicated. Among HF patients with left ventricular ejection fraction <40%, 90.9% received a renin-angiotensin system antagonist and 91% a beta-blocker. Three-year all cause/cardiovascular mortality rates were: 6.4%/2%, 9.7%/3.3%, 15.6%/6.7%, 19.2%/9.4%, 24.3%/13.6%, 28%/15.7% and 35.4%/24.8%, for patients with CAD alone, AF alone, CAD+AF, HF alone, HF+CAD, HF+AF and HF+CAD+AF, respectively. In all groups with HF, observed all-cause mortality was higher (p<0.0001) than expected mortality for age-matched, gender-matched and geography-matched persons. In contrast, observed mortality was lower than expected for patients with CAD alone and AF alone (p<0.0001).

Conclusions

In a context of adequate secondary prevention, overlap between diseases is a frequent and high-risk situation with incremental increases in mortality. These patients deserve specific attention.
Cervical erector spinae plane block: a cadaver study
Authors: Elsharkawy Hesham , Ince Ilker , Hamadnalla Hassan , Drake Richard L , Tsui Ban C H
Published: April 2020

Background

Cervical erector spinae plane (ESP) block has been described to anesthetize the brachial plexus (BP), however, the mechanism of its clinical effect remains unknown. As the prevertebral fascia encloses the phrenic nerves, BP and erector spinae muscles to form a prevertebral compartment, a local anesthetic injected in the cervical ESP could potentially spread throughout the prevertebral compartment. This study utilizes cadaveric models to evaluate the spread of ESP injections at the C6 and C7 levels to determine whether the injection can reach the BP and its surrounding structures.

Methods

For each of the five cadavers, an ESP injection posterior to the transverse process of C6 was performed on one side, and an ESP injection posterior to the transverse process of C7 was performed on the contralateral side. Injections were performed under ultrasound guidance and consisted of a 20 mL mixture of 18 mL water and 2 mL India ink. After cadaver dissection, craniocaudal and medial-lateral extent of the dye spread in relation to musculoskeletal anatomy as well as direct staining relevant nerves was recorded. The degree of dye staining was categorized as “deep,” “faint,” or “no.”

Results

The phrenic nerve was deeply stained in 1 injection and faintly stained in 2 injections. Caudally, variable staining of C8 (100%) and T1 (50%) roots were seen. Faintly staining at C4 root was only seen in one sample (10%). There was variable staining of the anterior scalene muscles (40%) anterior to the BP and the rhomboid intercostal plane caudally (30%).

Conclusions

Ultrasound-guided cervical (C6 and C7) ESP injections consistently stain the roots of the BP and dorsal rami. This study supports the notion that the cervical ESP block has the potential to provide analgesia for patients undergoing shoulder and cervical spine surgeries.
Social isolation and loneliness as risk factors for hospital admissions for respiratory disease among older adults
Authors: Bu Feifei , Philip Keir , Fancourt Daisy
Published: April 2020

Rising hospital admissions due to respiratory disease (RD) are a major challenge to hospitals. This study explored modifiable social risk factors among 4478 older adults from the English Longitudinal Study of Ageing. Data were linked with administrative hospital records and mortality registry data (follow-up 9.6 years) and analysed using survival analysis accounting for competing risks. Living alone and social disengagement but not social contact or loneliness were associated with an increased risk of RD admissions, independent of socio-demographic, health and behaviour factors. Providing support for disengaged adults living alone who are at risk of RD admissions should be explored.
Overview of tobacco use transitions for population health
Authors: Hyland Andrew , Kasza Karin A , Borek Nicolette , Kimmel Heather L , Taylor Kristie A , Compton Wilson M , Day Hannah , Donaldson Elisabeth A , Sharma Eva , Anic Gabriella , Edwards Kathryn C , Halenar Michael J , Hull Lynn C , Kissin Wendy , Limpert Jean , Seaman Elizabeth L , Bansal-Travers Maansi , Gardner Lisa D , Hammad Hoda T , Stanton Cassandra A
Published: April 2020

The Family Smoking Prevention and Tobacco Control Act provided the US Food and Drug Administration authority to regulate tobacco products using a population health standard. Models have been developed to estimate the population health impacts of tobacco initiation, cessation and relapse transitions. Models should be informed by high-quality, longitudinal data to estimate these constructs. Simulation studies have generated data to predict the impact of various tobacco control interventions, including the influence of regulations on tobacco use behaviours and health. The purpose of this paper is to provide a high-level conceptual overview for understanding tobacco transition behaviours and correlates of these behaviours using data from the Population Assessment of Tobacco and Health (PATH) Study, a US nationally representative longitudinal tobacco study of about 46 000 persons aged 12+ years. The papers that follow in this journal issue build and expand on this conceptual overview using data from the first three waves of the PATH Study. These papers describe use patterns of different tobacco products and their correlates, and can serve as foundations for more in-depth papers that will help the research community better understand the population health impacts and drivers of different tobacco use patterns.
Longitudinal pathways of exclusive and polytobacco hookah use among youth, young adults and adults in the USA: findings from the PATH Study Waves 1–3 (2013–2016)
Authors: Sharma Eva , Bansal-Travers Maansi , Edwards Kathryn C , Halenar Michael J , Taylor Kristie A , Kasza Karin A , Day Hannah , Hammad Hoda T , Anic Gabriella , Limpert Jean , Gardner Lisa D , Borek Nicolette , Kimmel Heather L , Compton Wilson M , Hyland Andrew , Stanton Cassandra A
Published: April 2020

Objective

The goal of this study is to examine cross-sectional rates of use and longitudinal pathways of hookah use among US youth (ages 12-17), young adults (ages 18-24), and adults 25+ (ages 25 and older).

Design

Data were drawn from the first three waves (2013–2016) of the Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal cohort study of US adults and youth. Respondents with data at all three waves (youth, n=11 046; young adults, n=6478; adults 25+, n=17 188) were included in longitudinal analyses.

Results

Young adults had higher ever, past 12-month (P12M) and past 30-day cross-sectional prevalence of hookah use at each wave than youth or adults 25+. The majority of Wave 1 (W1) hookah users were P12M users of other tobacco products (youth: 73.9%, young adults: 80.5%, adults 25+: 83.2%). Most youth and adult W1 P12M hookah users discontinued use in Wave 2 or Wave 3 (youth: 58.0%, young adults: 47.5%, adults 25+: 63.4%). Most W1 P12M hookah polytobacco users used cigarettes (youth: 49.4%, young adults: 59.4%, adults 25+: 63.2%) and had lower rates of quitting all tobacco than exclusive hookah users or hookah polytobacco users who did not use cigarettes.

Conclusions

Hookah use is more common among young adults than among youth or adults 25+. Discontinuing hookah use is the most common pathway among exclusive or polytobacco hookah users. Understanding longitudinal transitions in hookah use is important in understanding behavioural outcomes at the population level.
Longitudinal pathways of exclusive and polytobacco smokeless use among youth, young adults and adults in the USA: findings from the PATH Study Waves 1–3 (2013–2016)
Authors: Sharma Eva , Edwards Kathryn C , Halenar Michael J , Taylor Kristie A , Kasza Karin A , Day Hannah , Gardner Lisa D , Anic Gabriella , Bansal-Travers Maansi , Limpert Jean , Hammad Hoda T , Borek Nicolette , Kimmel Heather L , Compton Wilson M , Hyland Andrew , Stanton Cassandra A
Published: April 2020

Objective

Use of smokeless tobacco (SLT) with other tobacco products is growing, yet gaps in understanding transitions among SLT and other product use remain. The aim of this study is to examine cross-sectional prevalence and longitudinal pathways of SLT use among US youth (12–17 years), young adults (18–24 years) and adults 25+ (25 years and older).

Design

Data were drawn from the first three waves (2013–2016) of the Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal cohort study of US youth and adults. Respondents with data at all three waves (youth, n=11 046; young adults, n=6478; adults 25+, n=17 188) were included in longitudinal analyses.

Results

Young adults had the highest current SLT use compared with other age groups. Among Wave 1 (W1) past 30-day youth and young adult SLT users, most were SLT and cigarette polytobacco users compared with adults 25+, who more often used SLT exclusively. Among W1 exclusive SLT users, persistent exclusive use across all three waves was more common among adults 25+, while transitioning from exclusive SLT use to SLT polytobacco use at Wave 2 or Wave 3 was more common among youth and young adults. Among W1 SLT and cigarette polytobacco users, a common pathway was discontinuing SLT use but continuing other tobacco use.

Conclusions

Our results showed distinct longitudinal transitions among exclusive and SLT polytobacco users. Deeper understanding of these critical product transitions will allow for further assessment of population health impact of these products.
Analytical study of the seismic performance of all-steel buckling-restrained braces with H-shaped cores
Authors: Mansouri Ali , Moosavi Ghasem
Published: April 2020

The seismic performance of an H-shaped core buckling-restrained brace (HBRB) is evaluated through detailed finite element analysis. The numerical model is validated against available experimental data and a parametric study is carried out to investigate the effect of influential parameters on the cyclic behavior and failure modes of HBRB. Several design parameters including the yielding length ratio, the constrained length, the presence of stiffeners and their thicknesses, the length of the transition region, and the gap size are considered in the parametric investigation. Based on the analysis results reducing the yielding length of HBRB increases its post-yield stiffness and the axial strain and stress of the H-section core. Since buckling of the unconstrained region was observed in HBRBs with insufficient stiffener thickness, an analytical method is proposed for evaluating the sufficiency of stiffeners by estimating the critical buckling load of HBRB as a three-segment stepped compression member.
Timing of magmatic crystallization and Sn–W–Mo greisen vein formation within the Mount Douglas Granite, New Brunswick, Canada
Authors: Mohammadi Nadia , McFarlane Christopher R.M. , Lentz David R. , Thorne Kathleen G.
Published: April 2020

U–Pb geochronology was applied to a combination of magmatic and hydrothermal minerals to help constrain the timing of emplacement of three units in the Mount Douglas Granite (MDG) and reveal their association with a complex mineralized hydrothermal system containing endogranitic Sn–W–Mo–Zn–Bi–U-bearing greisen/sheeted veins within the pluton. Magmatic monazite and zircon U–Pb ages obtained by LA–ICP–MS overlap at 368 Ma, recording a Late Devonian crystallization age for the MDG. Although discrimination, outside analytical error, of sequential pulses of magmatism is beyond the resolution of LA–ICP–MS U–Pb geochronology, geochemical variations of monazite accompanied by previous whole-rock geochemical analyses support a progressive fractional crystallization process starting from a parental magma (Dmd1), leading to the generation of Dmd2, and finally Dmd3 as the most fractionated unit. Hydrothermal uraninite, cassiterite, and monazite, collected from endogranitic greisen/sheeted veins, reveal evidence for syn-magmatic-related mineralization and a longer-lived post-magmatic hydrothermal system. The first stage is recorded by concordant uraninite dates at 367 ± 3 Ma and by an inverse isochron lower intercept of 362 ± 8 Ma for cassiterite. In contrast, hydrothermal monazite crystallized over a wider range of ages from 368 to 344 Ma, demonstrating post-magmatic hydrothermal activity within the MDG. These magmatic and hydrothermal ages combined with the geochemical signature of the MDG are similar to those documented for the nearby Mount Pleasant Sn–W–Mo–Bi–In granite-related deposit, which suggests that the two mineralizing systems occur at different levels of the same magmatic system.
The yeast, the antifungal, and the wardrobe: a journey into antifungal resistance mechanisms ofCandida tropicalis
Authors: Oliveira Jonathas Sales de , Pereira Vandbergue Santos , Castelo-Branco Débora de Souza Collares Maia , Cordeiro Rossana de Aguiar , Sidrim José Júlio Costa , Brilhante Raimunda Sâmia Nogueira , Rocha Marcos Fábio Gadelha
Published: April 2020

Candida tropicalis is a prominent non-Candida albicans Candida species involved in cases of candidemia, mainly causing infections in patients in intensive care units and (or) those presenting neutropenia. In recent years, several studies have reported an increase in the recovery rates of azole-resistant C. tropicalis isolates. Understanding C. tropicalis resistance is of great importance, since resistant strains are implicated in persistent or recurrent and breakthrough infections. In this review, we address the main mechanisms underlying C. tropicalis resistance to the major antifungal classes used to treat candidiasis. The main genetic basis involved in C. tropicalis antifungal resistance is discussed. A better understanding of the epidemiology of resistant strains and the mechanisms involved in C. tropicalis resistance can help improve diagnosis and assessment of the antifungal susceptibility of this Candida species to improve clinical management.
Modified black hole solution with a background Kalb–Ramond field
Authors: Lessa L. A. , Silva J. E. G , Maluf R. V. , Almeida C. A. S.
Published: April 2020

We study the gravitation effects on a static and spherically symmetric spacetime due to the vacuum expectation value (VEV) of a Kalb–Ramond field. The Kalb–Ramond VEV is a background tensor field which produces a local Lorentz symmetry breaking (LSB) of spacetime. Considering a non-minimal coupling between the Kalb–Ramond (VEV) and the Ricci tensor, we obtain an exact parameterdependent power-law modified black hole. For a particular choice of the LSB parameter, the Lorentz violation produces a solution similar to the Reissner–Nordstrom, despite the absence of charge. The near-horizon geometry is modified by including a new inner horizon and shifting the Schwarzschild horizon. Asymptotically, the usual Minkowski spacetime with a background tensor field is recovered. The vacuum configurations are studied considering the energy conditions and the Lorentz violating source properties. By means of the mercury perihelion test, an upper bound to the local Lorentz violation (LV) is obtained, and its corresponding effects on the black hole temperature is investigated.
The Tropes of Celebrity Environmentalism
Authors: Abidin Crystal , Brockington Dan , Goodman Michael K. , Mostafanezhad Mary , Richey Lisa Ann
Published: April 2020

Celebrity advocacy for environmental causes has grown dramatically in recent decades. An examination of this expansion and the rise of causes such as climate change reveals the shifting politics and organization of advocacy. We address these changes to the construction and interpretation of celebrity advocacy and detail how they have produced a rich variety of environmental celebrity advocates. We also account for differences between legacy (e.g., radio, TV, newspapers) and online celebrities and their practices (e.g., hashtag publics, brandjacking, online communities). Environmental celebrity advocates’ performances can be divided into nine tropes, each characterized in part by the particular varieties of environmentalism that they promote. We present the tropes and discuss their five cross-cutting themes. We conclude with a set of questions for future research on celebrity environmentalism.