bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Case 11—Acute multivessel coronary artery thrombi: an unusual presentation of STEMI and management dilemma in a young patient with COVID-19
Authors: Higgisson Emma , Vaughan Carl
Published: October 2022

Mr DC is a fit and healthy 32-year-old gentleman who presented on day 13 of his mild COVID-19 illness with sudden onset central chest discomfort, diaphoresis and vomiting following exercise. He had no past medical history, no significant cardiovascular risk factors and a normal physical exam. ECG showed ST elevation in anterior and inferior leads.

Mr DC underwent coronary angiogram which revealed a large semi-occlusive thrombus in the proximal LAD and moderate thrombus in the proximal RCA. There was no significant stenosis or plaque in any vessel. The diagnosis was therefore STEMI secondary to multivessel proximal coronary artery thrombi. We hypothesise that the patient's concurrent COVID-19 infection, hypercoagulable state post exercise and possible plaque rupture led to the development of these thrombi.

This is a very unusual case and presented a management dilemma. We decided to manage him conservatively with therapeutic heparin, dual antiplatelet therapy, bisoprolol and high dose statin therapy.

Following one week of conservative management, we performed a repeat coronary angiogram which showed complete resolution of all intracoronary thrombi and yielded an excellent angiographic result.

The patient was discharged to complete 1 year of dual antiplatelet therapy and has done very well.

Learning points include: risk factors and management options for coronary artery thrombosis, successful conservative management strategy, interval of repeat diagnostic imaging, coronary artery thrombosis associated with COVID-19 infection, the potential for mild clinical COVID-19 illness but significant cardiovascular complications, more research needed on anticoagulation and antiplatelet treatment of ACS in the context of COVID-19.
Clinical Case 13—An unusual culprit: challenging diagnosis, easy solution
Authors: Ribeiro Mané Fernando Guilherme , Flores Rui , Conde Inês , Silva Rodrigo , Pires Carla Marques , Medeiros Paulo , Oliveira Cátia , Costa João , Marques Jorge
Published: October 2022

Presentation

A 59-year-old woman, with multiple cardiovascular risk factors, a history of CABG (left internal mammary artery—obtuse marginal artery; right internal mammary artery—left anterior descending artery) and PAD; presented to the emergency department with prolonged thoracic pain (3 hours) associated with dyspnea. She was hypertense at admission, but the remaining physical exam was unremarkable. Initial electrocardiogram showed descendent segment ST depression in the lateral leads (DI, aVL and V4-V6). Blood test showed a rise in troponin I 0.6 → 8.3 ng/mL). Cardiac catheterization demonstrated patency of both bypasses. However, a calcified stenosis (70–80%) of the left subclavian artery proximal to the emergence of the left internal mammary artery was observed.

Diagnosis

The findings suggested a possible coronary subclavian steal syndrome (CSSS).

Management

The patient was reevaluated and was found to have a systolic blood pressure differential of 18mmHg between the two arms. Despite anti-anginal therapeutic optimization, episodes of angina upon minimal exertion continued. Consequently, she was submitted to percutaneous subclavian artery angioplasty with symptom resolution and was discharged under dual antiplatelet therapy and high-intensity statin.

Learning points

CSSS complicates 0.2–6.8% of the patients who have undergone CABG with a left internal mammary graft. Peripheral artery disease is its strongest predictor and atherosclerosis is the main pathogenic mechanism. In patients with suspected CSSS, physical examination is paramount, often showing a systolic blood pressure differential. Subclavian artery angiography should be performed, whenever it is relevant, during the coronary angiography. First-line therapy includes percutaneous angioplasty and optimal medical therapy.
Clinical Case 15—Warburg effect and pulmonary embolism: a confounding clinical case
Authors: Ferreira Gonçalo Rafael Marques , Correia Joana , Fiuza João , Santos João Miguel , Neto Vanda , Cunha Joana , Fernandes Filipe , Pires Inês , Marmelo Bruno , Cabral Costa
Published: October 2022

Presentation

A 61 year old man with a history of multiple lymph node metastasis of unknown primary cancer was admitted in the Emergency Room with sudden dyspnea preceded by left leg swelling. Physical examination revealed a blood pressure of 91/70mmHg, tachycardia, tachypnea and signs of deep vein thrombosis (DVT).

Diagnosis and management

Blood analysis showed increased serum lactate (SL) (5,5 mmol/L), a slight increase of cardiac enzymes and hypoglycemia, and imagiologic tests showed signs of bilateral pulmonary embolism (PE) and an increase of the right cardiac chambers. The patient was hospitalized with the diagnosis of intermediate-high risk PE. Because the patient presented persistent elevated SL and borderline hypotension, fibrinolysis was performed. However, the patient maintained high SL levels and hypotensive profile. After receiving the lymph node's biopsy result, which pointed towards a follicular lymphoma, the persistent hyperlactatemia, together with the hypoglycemic profile, was interpreted as a consequence of the Warburg Effect. Luckily, the patient didn't had any side effects of the fibrinolytic treatment.

Learning points

Acute high risk PE is marked by the presence of haemodynamic instability at presentation, and the finding of increased SL suggests peripheral hypoperfusion. Systemic thrombolytic therapy is indicated in most of patients with high risk PE. However, there are other causes of hyperlactatemia which the physician must be aware, as it can act as a confounder of PE risk assessment. The Warburg Effect may cause elevated SL in patients with cancer, which in turn are at risk of developing PE.
Clinical Case 18—Management of patient with cancer and confirmed systemic thrombosis and rectal bleeding
Authors: Kateryna Moskalenko , Evgeny Levenko , Zoreslava Lysak , Myroslava Doronina , Oleh Yukish
Published: October 2022

A 55-year-old patient has been suffering from prostate cancer since February 2020. He received radiotherapy and developed disease progression in June 2021. Pt was started on chemotherapy with positive dynamic per CT scan. There was a worsening of anemia, and erythropoietin was prescribed, with not significant improvement.

During planned CT scan monitoring, pulmonary embolism of medial and distal segments of the left and distal parts of the right pulmonary artery was revealed. Pt had dyspnea on mild exertion, tachycardia at rest and left leg edema (which was present earlier and considered as lymphedema that time). Thrombosis of the left popliteal vein was confirmed. Pt was started on rivaroxaban 15 mg BID. In 5 days, he reported rectal bleeding. Hb was 71 g/l. Rivaroxaban was stopped. Proctological examination was not informative, due to bleeding. Tranexamic acid and IV iron were started. The attempt to add prophylaxis dose of enoxaparin increased bleeding and was stopped immediately. In 5 days, he underwent colonoscopy. Disease progression, severe hemorrhoids were excluded. Findings were considered as radiation proctitis. Sulfasalazine was added. In 2 weeks Hb = 91 g/l, however, patient has episodes of the rectal bleeding 1–2 times per week. He doesn’t receive recurrent PE prevention with no worsening of clinical picture. Our strategy is to reassess bleeding risk after 1 month of treatment with sulfasalazine and to start prevention doses of DOACs.

Conclusion: In complex clinical situations prevention of thrombosis should be based on patient-related risk factors, must be flexible and reviewed more often and thoroughly.
Clinical Case 22—When the unusual appears
Authors: Temtem Ana Margarida de Abreu , Sá Débora , Santos Marina , Leça Sofia , Rodrigues Ricardo , Serrão Gomes , Silva Bruno , Caires Graça , Brazão António , Rodrigues João Manuel , Freitas Drumond
Published: October 2022

Clinical case

A 57 years old female, smoker, presented to emergency department with a constrictive chest and epigastric pain lasting for 30 minutes. Admission electrocardiogram showed a sinus bradycardia and ST elevation in the inferior leads. Inferior STEMI was assumed and was referred for primary coronary intervention. Coronary angiography revealed a right coronary artery (RCA) occluded at ostial level and primary angioplasty was performed with drug eluting stent implantation. After angioplasty, the chest pain didn´t relief, although the procedure had no complications. Transthoracic echocardiogram revealed a ‘flap’ on the ascending aorta (AAo), suggesting dissection of the AAo; left ventricular systolic function preserved, with hypokinesia of the inferior wall; right ventricular dysfunction; aortic regurgitation and no pericardial effusion. Emerging angio CT confirmed type A aortic dissection extending to abdominal aorta. The patient was then admitted to the operating room and a supracoronary conduit (hemiarch) and a bypass (saphenous vein/RCA) procedure was done. She had progressive clinical improvement and was discharged on the 17th day.

Learning points

Acute aortic dissection is the most common acute aortic syndrome (AAoS), being more prevalent in males and in the elderly, presenting high mortality rate. Acute type A aortic dissection can be difficult to diagnose and can mimic STEMI. RCA is more often involved when myocardial infarction is present. What appeared to be a linear STEMI turned out to be an AAoS that could have a catastrophic outcome. This was a successful case of this unusual diagnosis that surprised the entire team.
Clinical validation of a 13-lead electrocardiogram derived from a self-applicable 3-lead recording for diagnosis of myocardial supply ischaemia and common non-ischaemic electrocardiogram abnormalities at rest
Authors: Van Heuverswyn Frederic , De Schepper Céline , De Buyzere Marc , Coeman Mathieu , De Pooter Jan , Drieghe Benny , Kayaert Peter , Timmers Liesbeth , Gevaert Sofie , Calle Simon , Kamoen Victor , Demolder Anthony , El Haddad Milad , Gheeraert Peter
Published: October 2022

Aims

In this study, we compare the diagnostic accuracy of a standard 12-lead electrocardiogram (ECG) with a novel 13-lead ECG derived from a self-applicable 3-lead ECG recorded with the right exploratory left foot (RELF) device. The 13th lead is a novel age and sex orthonormalized computed ST (ASO-ST) lead to increase the sensitivity for detecting ischaemia during acute coronary artery occlusion.

Methods and results

A database of simultaneously recorded 12-lead ECGs and RELF recordings from 110 patients undergoing coronary angioplasty and 30 healthy subjects was used. Five cardiologists scored the learning data set and five other cardiologists scored the validation data set. In addition, the presence of non-ischaemic ECG abnormalities was compared. The accuracy for detection of myocardial supply ischaemia with the derived 12 leads was comparable with that of the standard 12-lead ECG (P = 0.126). By adding the ASO-ST lead, the accuracy increased to 77.4% [95% confidence interval (CI): 72.4–82.3; P < 0.001], which was attributed to a higher sensitivity of 81.9% (95% CI: 74.8–89.1) for the RELF 13-lead ECG compared with a sensitivity of 76.8% (95% CI: 71.9–81.7; P < 0.001) for the 12-lead ECG. There was no significant difference in the diagnosis of non-ischaemic ECG abnormalities, except for Q-waves that were more frequently detected on the standard ECG compared with the derived ECG (25.9 vs. 13.8%; P < 0.001).

Conclusion

A self-applicable and easy-to-use 3-lead RELF device can compute a 12-lead ECG plus an ischaemia-specific 13th lead that is, compared with the standard 12-lead ECG, more accurate for the visual diagnosis of myocardial supply ischaemia by cardiologists.
Classifying End-of-Life Patterns: Evidence From the National Health and Aging Trends Study
Authors: Bhagianadh Divya , Arora Kanika
Published: October 2022

Background and Objectives

End-of-life (EOL) care quality encompasses multiple domains, which are typically studied in silos. This paper explores interrelationships across domains and how they simultaneously shape patterns of EOL care quality.

Research Design and Methods

Secondary analysis using National Health and Aging Trends Study. Latent class analysis was used to identify subgroups of decedents according to quality of symptoms and needs management, care experience, care processes, and site of death. Multinomial logistic regression was employed to investigate the association between decedent characteristics and class membership.

Results

Five groups of decedents were identified. Multiple sites of death with high care coordination (Class 4: 35%) comprised decedents with least concerns regarding symptom management and care experience. Decedents in Predominantly home deaths with no hospice use (Class 1: 26%), predominantly hospital deaths with low hospice use (Class 2: 18%), and multiple sites of death with hospice use (Class 3: 7%) presented similar symptom management and care experience patterns. Multiple sites of death with low care coordination (Class 5: 14%) comprised decedents experiencing poor quality EOL care across multiple domains. Non-Hispanic Black and Hispanic decedents were more likely to be in Class 2 and decedents with dementia diagnosis in Class 4.

Discussion and Implications

There is considerable heterogeneity in EOL care patterns. Assessing quality based on discrete metrics in silos may lead to unintended consequences like stinting of necessary care or increased caregiving burden on families. There is a need for greater focus on patient-centeredness and how care processes and structures interact in the context of shifting care patterns, care preferences, and payment reforms.
12. Limits on Exploitation
Authors: Bently L. , Sherman B. , Gangjee D. , Johnson P.
Published: October 2022

This chapter is concerned with the restrictions placed on the copyright owners’ ability to exploit and use their work. It first considers the various mechanisms that are used to regulate contracts between authors and entrepreneurs and then assesses the impact of competition law on the ability of copyright owners to exploit their works. It also looks at the ways in which copyright contracts are regulated with respect to users of copyright, along with the issue of orphan works. The chapter concludes by outlining the different controls that are imposed on collecting societies.
14. Introduction to Patents
Authors: Bently L. , Sherman B. , Gangjee D. , Johnson P.
Published: October 2022

This chapter introduces the reader to patents, how they work, and the laws governing them. It begins with a history of the patent system in the UK up to 1977. This is followed by a discussion of various justifications that have been proposed in support of the patent system, such as the natural rights of inventors to their work and the public benefits that flow from the grant of patent monopolies. It also considers the current regulatory regime governing the creation and use of patents in the UK and Europe, with particular reference to the European Patent Convention and the Patents Act 1977. Finally, the chapter discusses the impact of the European Commission on patent law and some of the international treaties that have influenced British patent law, including the Patent Cooperation Treaty, the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), and the Convention on Biological Diversity. The chapter also speculates on the impact of Brexit on UK patent law.
19. Inventive Step
Authors: Bently L. , Sherman B. , Gangjee D. , Johnson P.
Published: October 2022

This chapter examines the requirement that an invention is patentable if it involves an ‘inventive step’ or ‘non-obviousness’, that is, the invention is not obvious to a person skilled in the art, and the difficulty of deciding whether an invention is obvious (non-inventive) or non-obvious (inventive). It first considers the approach used by the European Patent Office to deal with the obviousness of a patent and compares it with that in the UK. It then explains the concept of the state of the art in an obviousness examination before concluding with an assessment of the way in which the inventive step has been addressed in a number of different circumstances.
44. Is the Information Capable of Being Protected?
Authors: Bently L. , Sherman B. , Gangjee D. , Johnson P.
Published: October 2022

This chapter looks at the type of information that is capable of being protected by the action for breach of confidence. More specifically, it examines four limitations that are placed on the type of information that may be protected under the action: where the information is trivial, immoral, vague, or in the public domain. The chapter also considers the notion of ‘relative secrecy’ along with issues associated with encrypted information and the so-called `springboard’ doctrine.
Safety Surveillance of Varicella Vaccines in the Vaccine Adverse Event Reporting System, United States, 2006–2020
Authors: Moro Pedro L , Leung Jessica , Marquez Paige , Kim Yeowon , Wei Shaokui , Su John R , Marin Mona
Published: October 2022

Background

. The Vaccine Adverse Event Reporting System (VAERS) is the United States national passive vaccine safety surveillance system. We updated the data on the safety of single-antigen varicella vaccine (VAR) and assessed the safety of combination measles, mumps, rubella, and varicella vaccine (MMRV) licensed in the United States using VAERS data.

Methods

US VAERS reports received after administration of VAR and MMRV during 2006–2020 were identified. Reports were analyzed by vaccine type, age, seriousness, most common adverse events (AEs), and concomitant vaccines. We reviewed medical records of selected reports of AEs of special interest and conducted empirical Bayesian data mining to identify disproportionally reported AEs.

Results

During 2006–2020, approximately 132.8 million VAR doses were distributed; 40 684 reports were received in VAERS (30.6/100 000 doses distributed), with 4.1% classified as serious (1.3/100 000 doses distributed). Approximately 35.5 million MMRV doses were distributed; 13 325 reports were received (37.6/100 000 doses distributed) with 3.3% classified as serious (1.3/100 000 doses distributed). The most common adverse health events after both VAR and MMRV were injection site reactions (31% and 27%), rash (28% and 20%), and fever (12% and 14%), respectively. Vaccination errors accounted for 23% of reports after VAR administration and 41% after MMRV administration, but ≥95% of them did not describe an adverse health event. AEs associated with evidence of vaccine strain varicella-zoster virus (vVZV) infection included meningitis, encephalitis, herpes zoster, and 6 deaths (all in immunocompromised persons with contraindications for vaccination). No new or unexpected AE was disproportionally reported.

Conclusions

No new or unexpected safety findings were detected for VAR and MMRV given as recommended, reinforcing the favorable safety profiles of these vaccines. Providers should obtain specimens for viral testing and strain-typing for serious AEs if they consider vVZV as the possible causative agent.
Carbon storage in plants: a buffer for temporal light and temperature fluctuations
Authors: Zepeda Ana Cristina , Heuvelink Ep , Marcelis Leo F M
Published: October 2022

Carbon (C) storage allows a plant to support growth whenever there is a temporal asynchrony between supply (source strength) and demand of carbon (sink strength). This asynchrony is strongly influenced by changes in light and temperature. In most crop models, C storage is included as a passive process that occurs whenever there is an excess of C from photosynthesis compared with the demand of C for metabolism. However, there are numerous studies that challenged this concept, and provided experimental evidence that C storage is an active process that allows buffering of environmental fluctuations and supports long-term plant growth. We propose that an active C pool needs to be included in simulation models for a better understanding of plant growth patterns under fluctuating environment. Specifically, we propose that the two main mechanisms actively regulating C storage in plants are the partitioning of assimilates between soluble sugars and starch and the degradation and remobilization of storage compounds. The insights gained here are important to optimize crop performance under fluctuating conditions and thus for developing more resource-efficient crop production systems.
Efficacy of a Novel LAM Femoral Cutaneous Block Technique for Acute Donor Site Pain
Authors: Hill David M , Ly Austin , Desai Jay P , Atmeh Kais R , Velamuri Sai R , Jones Jerry
Published: October 2022

Patients with severe burn injuries often require split-thickness skin grafting to expedite wound healing with the thigh being a common donor site. Uncontrolled pain is associated with increased opioid consumption, longer lengths of stay, and delay in functional recovery. Peripheral nerve blocks are increasing in popularity although supportive literature is limited, and techniques vary. The purpose of this case series is to assess the safety, feasibility, and clinical efficacy of a recently demonstrated novel continuous LAM (lateral, anterior, medial) femoral cutaneous block technique in a larger cohort. The study was a dual IRB approved, observational case series from a single verified burn center. The electronic health record was retrospectively reviewed for patients admitted between June 2018 and May 2021 who had the continuous LAM block performed for donor site pain by the acute pain service team. Demographics were reported with descriptive statistics and morphine milligram equivalents (MME) were analyzed via Friedman analysis of variance. Forty-seven patients had a total of 53 blocks placed, where 2 patients received the LAM block on two separate occasions and 4 patients had bilateral LAM blocks placed. Most were African–American males, but mechanism of injury varied. Over half had a neurologic (17%) or psychiatric history (34%) outside of substance use. Almost three-quarters had a history of substance use with 17% being opioids, and a quarter had a history of polysubstance use. Median day from admission to LAM was 7 (2.5, 11.5) with a median duration of 4 (3, 5) days. Temperature and pressure sensation were reduced at the donor site. Quadricep strength remained intact, and median day until first ambulation after LAM placement was 2 (1, 3) days. Pain was adequately controlled, and there were no significant adverse events associated with the block. There was a significant reduction in MME after block placement (p < .001). Continuous peripheral nerve blocks offer an advantageous means of analgesia, while reducing potential adverse events associated with opioids or multimodal regimens. The novel LAM technique reduced sensation and pain without inhibiting early ambulation, and patients were able to fully participate in their rehabilitation.
Distance and Alternative Signals of Status: A Unifying Framework
Authors: Bellezza Silvia
Published: October 2022

In the past decades, as traditional luxury goods and conspicuous consumption have become more mainstream and lost some of their signaling value, new alternative signals of status (e.g., vintage, inconspicuous consumption, sustainable luxury) have progressively emerged. This research applies the grounded theory method to establish a novel framework that systematically unifies existing conceptualizations, findings, and observations on alternative signals of status. The proposed framework organizes alternative signals in terms of their distance from traditional status symbols and categorizes them along six focal dimensions: time (new/old), quantity (many possessions/few possessions), conspicuousness (conspicuous/inconspicuous), aesthetics (beautiful/ugly), culture (highbrow/lowbrow), and pace of life (slow/fast). This parsimonious framework captures various consumption phenomena related to status signaling, unifies existing theories, and generates a fruitful agenda for future research.
A Molecular Diagnostic Assay for the Discrimination of Aphid Species (Hemiptera: Aphididae) Infesting Citrus
Authors: Kapantaidaki Despoina Ev , Krokida Afroditi , Evangelou Vasiliki , Milonas Panagiotis , Papachristos Dimitrios P
Published: October 2022

Aphid species (Hemiptera: Aphididae) are among the most serious pests for citrus cultivation throughout the world causing substantial crop damages. Accurate identification of aphids to the species level can be difficult, though being crucial for their effective management. In this study, a molecular diagnostic assay for distinguishing eleven aphid species was developed. A fragment of the mitochondrial Cytochrome Oxidase I (mtCOI) gene was used and a Polymerase Chain Reaction–Restriction Fragment Length Polymorphism (PCR–FLP) analysis with five restriction enzymes, based on DNA sequence polymorphisms, was applied to differentiate the eleven aphid species. This molecular technique allows aphid species at any life stage to be discriminated accurately and simply and can be a useful tool for monitoring the populations of economically important aphid species.
Executive Control of Agency Adjudication: Capacity, Selection, and Precedential Rulemaking
Authors: Hausman David K , Ho Daniel E , Krass Mark S , McDonough Anne
Published: October 2022

While the volume of adjudication by federal agencies far outstrips the volume of cases decided by the federal judiciary, researchers have devoted relatively little attention to agency adjudication and political control thereof. We study three mechanisms of presidential control of immigration adjudication: capacity-building, selection, and precedential rulemaking. First, consistent with work on bureaucratic capacity, the Trump administration achieved its goal of increasing removals of noncitizens through an unprecedented increase in total hiring of immigration judges (IJs). Second, contrary to expectations from the literatures on judicial behavior and bureaucratic politics, we find little evidence of partisan effects in IJ selection. Third, we demonstrate the substantial power of what we call “precedential rulemaking”—the power by the Attorney General to select cases in which to issue binding precedent. These results illustrate the importance of incorporating mechanisms of supervisory and legal control into the study of administrative courts.
Identification of Forensically Important Carrion Beetles (Coleoptera: Staphilinidae) in China Based on COI and COII
Authors: Luo Yifei , Meng Fanming
Published: October 2022

Unambiguous and speedy necrophagous insect species identification is common task in forensic entomological study. Carrion beetles (Staphilinidae: Silphinae) belong to a small group of Coleoptera with less than 200 species worldwide. Some species are commonly found on dead body during forensic entomological investigation. Despite some species are hard to be categorized morphologically, present DNA-based technologies offer a potential identification strategy. Here, 37 carrion beetle specimens were collected from 15 locations throughout Chinese mainland. The cytochrome oxidase subunit I (COI) and II (COII) genes among all specimens were successfully sequenced, which provided reliable markers for precise identification. Mostly, the interspecific distance could clarify the capability of these genes for identifying included carrion beetle species. Exceptions existed between close species in Nicrophorus genus (Fabricius 1775). The sequenced gene’s phylogenetic analysis revealed that all carrion beetle specimens were correctly classified into eight genera, and most have relatively high supporting values (>90%). Our data gives genetic diversity and a reference for global forensically important carrion beetle species identification, as well as a conductive significance for future application of Chinese carrion beetles in forensic entomology.
Novel Borrelia Genotypes from Brazil Indicate a New Group of Borrelia spp. Associated with South American Bats
Authors: Jorge Felipe R , Muñoz-Leal Sebastián , de Oliveira Glauber M B , Serpa Maria Carolina A , Magalhães Meylling M L , de Oliveira Lorena M B , Moura Francisco B P , Teixeira Bruno M , Labruna Marcelo B
Published: October 2022

The bacterial genus Borrelia comprises vector-borne spirochetes that have been classified into three major groups: the relapsing fever group (RFG), the Borrelia burgdorferi Johnson, Schmid, Hyde, Steigerwalt & Brenner sensu lato group (Bbsl), and the reptile-monotreme group (RMG). All three groups have been associated mainly with ticks and wild animals, especially rodents, birds, and reptiles. Here, we searched for Borrelia infection among 99 vampire bats [Desmodus rotundus (É. Geoffroy)] (Chiroptera: Phyllostomidae) from the Brazilian semiarid region. Through molecular investigation of bat internal organs, haplotypes of a potentially novel Borrelia organism were detected in 5% (5/99) of the bats. Borrelia DNA was detected in the liver, blood, spleen, kidney and brain, suggesting a systemic infection. Phylogenetic analyses inferred from partial sequences of the borrelial rrs and flaB genes indicated that the vampire bat-associated Borrelia sp. of this study form a monophyletic group with a newly reported Borrelia associated with a Colombia bat, distinct from the three main currently recognized groups of Borrelia spp., Bbsl, RFG, and RMG. These novel bat-associated Borrelia spp. from South America might have arisen through an independent event along the borrelial evolutionary history, since previous molecular reports of Borrelia organisms in bats or bat-associated ticks from Africa, Europe, and North America were all classified in the RFG.
Backlighting and Occlusion
Authors: Overgaard Søren
Published: October 2022

In the philosophy of perception, objects are typically frontlit. But according to Roy Sorensen, backlit objects have surprising lessons to teach us about perception. In backlit conditions, ‘the principles of occlusion are reversed’, Sorensen (2008, p. 25) maintains. In particular, he claims we see the back surfaces of backlit objects. But as I argue in this paper, Sorensen’s arguments in support of those claims are flawed. After criticizing Sorensen’s arguments, I attempt to address a residual puzzle about backlit objects. The upshot of the paper is that cases of backlighting do have important philosophical lessons to teach us after all – lessons concerning the notion of perceptual occlusion.
RNA cytometry of single-cells using semi-permeable microcapsules
Authors: Leonaviciene Greta , Mazutis Linas
Published: October 2022

Analytical tools for gene expression profiling of individual cells are critical for studying complex biological systems. However, the techniques enabling rapid measurements of gene expression on thousands of single-cells are lacking. Here, we report a high-throughput RNA cytometry for digital profiling of single-cells isolated in liquid droplets enveloped by a thin semi-permeable membrane (microcapsules). Due to the selective permeability of the membrane, the desirable enzymes and reagents can be loaded, or replaced, in the microcapsule at any given step by simply changing the reaction buffer in which the microcapsules are dispersed. Therefore, complex molecular biology workflows can be readily adapted to conduct nucleic acid analysis on encapsulated mammalian cells, or other biological species. The microcapsules support sequential multi-step enzymatic reactions and remain intact under different biochemical conditions, freezing, thawing, and thermocycling. Combining microcapsules with conventional FACS provides a high-throughput approach for conducting RNA cytometry of individual cells based on their digital gene expression signature.
ICEscreen: a tool to detect Firmicute ICEs and IMEs, isolated or enclosed in composite structures
Authors: Lao Julie , Lacroix Thomas , Guédon Gérard , Coluzzi Charles , Payot Sophie , Leblond-Bourget Nathalie , Chiapello Hélène
Published: October 2022

Mobile Genetic Elements (MGEs) are integrated in bacterial genomes and key elements that drive prokaryote genome evolution. Among them are Integrative and Conjugative Elements (ICEs) and Integrative Mobilizable Elements (IMEs) which are important for bacterial fitness since they frequently carry genes participating in important bacterial adaptation phenotypes such as antibiotic resistance, virulence or specialized metabolic pathways. Although ICEs and IMEs are widespread, they are as yet almost never annotated in public bacterial genomes. To address the need of dedicated strategies for the annotation of these elements, we developed ICEscreen, a tool that introduces two new features to detect ICEs and IMEs in Firmicute genomes. First, ICEscreen uses an efficient strategy to detect Signature Proteins of ICEs and IMEs based on a database dedicated to Firmicutes and composed of manually curated proteins and Hidden Markov Models (HMM) profiles. Second, ICEscreen includes a new original algorithm that detects composite structures of ICEs and IMEs that are frequent in genomes of Firmicutes but are currently not resolved by any other tool. We benchmarked ICEscreen on experimentally supported elements and on a public dataset of 246 manually annotated elements including the genomes of 40 Firmicutes and demonstrate its efficiency to detect ICEs and IMEs.
Making Friends and Making ‘Asia’: Sino-Indian Friendship, 1947–1957
Authors: Nasser Yasser Ali
Published: October 2022

Despite their different political and economic systems throughout the 1950s, state and non-state actors in India pursued a fragile policy of friendship towards the People’s Republic of China. Instead of focusing on the failures of this relationship or its naivety, this article examines the intellectual moorings and political aspirations of its major organizational advocate, the India–China Friendship Association (ICFA). Through dynamic transnational exchanges of ideas, the ICFA imagined India’s friendship with China as the harbinger of an Asia that could overthrow imperialism and navigate the complexities of Cold War bloc politics. In doing so, it drew a contrast between a horizontal friendship that respected differences and saw them as productive in the shared struggle for nation-building and upholding regional peace, and the more hierarchical relationship augured by the Cold War’s security pacts and military alliances. Drawing on a rich collection of sources across numerous countries, this article argues that by invoking both countries’ colonial past and dreams of a shared postcolonial future, the ICFA and its backers in the Indian state promoted Sino-Indian friendship as the blueprint for a peaceful, decolonized Asia capable of creating a better world. At the same time, these visions of Asia were mediated by local renderings that both reinforced and complicated the ICFA’s vision.
12 Reliability of Two-Person Anthropometric Measurement of Young Children with Parent Facilitator
Authors: Rae Sarah , Ong Frank , Pullenayegum Eleanor , Carsley Sarah , Hamilton Jill , Maguire Jonathon , Dennis Cindy-Lee , Birken Catherine
Published: October 2022

Background

Body Mass Index is recommended by the World Health Organization for the measurement of growth and the diagnosis of overweight and obesity in children. The reliability of anthropometric measurements is important for assessment of child growth due to the challenges faced when measuring younger children, including the difficulty of having the child remain still during measurement collection. The current gold-standard for anthropometric measurement collection in children in a clinical research setting, set by the World Health Organization, requires the use of two trained anthropometrists.

Objectives

The purpose of this study was to determine the reliability of anthropometric measurements between two trained anthropometrists working in a pair and one trained anthropometrist working with a child’s parent/caregiver in a primary healthcare setting.

Design/Methods

An observational study to determine measurement reliability was conducted in a primary care child research network in Canada. 76 children 0 – 5 years old had their length/height, weight, head, arm, and waist circumference measured a total of four consecutive times: twice by two trained anthropometrists working in a pair (researcher-researcher team) and twice by one trained anthropometrist working with a child’s parent/caregiver (researcher-parent team). Inter- and intra- observer reliability was calculated using the technical error of measurement (TEM), relative TEM (%TEM) and the coefficient of reliability (R).

Results

The %TEM values across both age groups, children 0 - < 2 and 2 – 5 years of age, for length/height and weight were < 2% and the R coefficient values were >0.99, indicating a high degree of inter- and intra- observer reliability. The TEM values were greater for inter- and intra- observer reliability across all age groups for length/height in comparison to other anthropometric measurement parameters, with greater variation seen in the length for children 0 - < 2 years of age. The TEM values across both age groups for inter- and intra- observer reliability of arm circumference was outside of the acceptable range of < 2%, indicating greater measurement error. There was greater variation seen in waist circumference across both age groups.

Conclusion

This study suggests that anthropometric measurement, including length/height and weight, taken by one trained anthropometrist with the assistance of a parent/caregiver is reliable. These findings can be used to encourage the utilization of a child’s parent/caregiver to assist with anthropometric measurement collection in clinical setting(s) to enhance feasibility and efficiency and reduce the research costs of including a second trained anthropometrist.
14 Understanding the Paediatric Workforce in British Columbia: A Survey of B.C. Paediatricians
Authors: Miller Kirsten , Ward Valerie
Published: October 2022

Background

In some areas of British Columbia, accessing consulting paediatric care is particularly challenging. Attracting paediatricians to all regions of the province is critical to ensure equitable access.

Objectives

In order to understand the current and intended future work patterns of B.C.’s community general paediatricians better, the BC Pediatric Society developed an online survey.

Design/Methods

A 22-question survey was distributed electronically in late 2019 to 427 paediatricians (BC Pediatric Society members and University of British Columbia Department of Pediatrics clinical faculty). The survey asked respondents about what factors influenced where they chose to practice, the nature of their clinical work, engagement in administration and education, time spent on various work responsibilities, source(s) of income, future practice plans and plans for retirement. The data was evaluated as a whole and was stratified based on gender, region of practice, size of community, and number of years in practice.

Results

153 surveys were completed (response rate 35.8%). Surveys completed by general paediatricians practicing in locations other than BC Children’s Hospital and not working in a locum capacity were included. 94 (61.4%) completed surveys met inclusion criteria. 70% of these respondents identified as female. 72% worked in communities with populations of 300,000 or less (16% in communities of 50,000 or less and 56% in communities of 50,001 to 300,000). 25% had been in practice for 0 to 5 years, 40% for 6 to 20 years and 28% for over 20 years. Of the 94 respondents, only 7.4% were providing primary care paediatrics. The median reported time spent on various aspects of work were: 55 hours per week total time spent working, 19 days per month direct clinical care, and 25 hours per month indirect clinical care. The responses identified some differences based on community size; paediatricians in small communities (population 50,000 or less) reported the median time spent “on call” was 168 hours per month, compared to 48 hours per month reported by those in large communities (population over 300,000). 36% of respondents stated that they planned to retire within the next 10 years; this was true for only 23% of those in large communities (population >300,000).

Conclusion

This study provides information about the nature of B.C. community general paediatricians’ work and identifies some differences between paediatricians in large cities and those in medium-sized or small communities. The results should inform discussions about the paediatric workforce and how best to address potential future gaps in in B.C.
19 Quality Improvement bundled approach reduces the use of inotropes in extremely premature babies
Authors: Venkata Sujith Kumar Reddy Gurram , Srivastava Ankur , Murthy Prashanth , Scott James , Zein Hussein , Leijser Lara , Ghosh Anirban , Momin Sarfaraz , Thomas Sumesh , Mohammad Khorshid
Published: October 2022

Background

Consensus on definition and management of hypotension in preterm neonates is lacking. Owing to this, there are wide variations in the reported incidence of hypotension in premature infants, especially during first week of life. Inotropes can often cause vasoconstriction, which may alter brain perfusion especially in the absence of established cerebral autoregulation. Use of these drugs is associated with multiple short- and long-term morbidities.

Objectives

To evaluate the effect of quality improvement (QI) bundle on rate of inotrope use and associated morbidities.

Design/Methods

Inborn preterm neonates born at <29weeks gestational age (GA) and admitted to level III NICU were included. Neonates with major congenital malformations, congenital heart diseases, antenatal diagnosed genetic defects, and neonates admitted after 72 hours of age were excluded from the study. We implemented a QI bundle (Figure 1) focussing on first 72hours from birth which included delayed cord clamping, avoidance of routine echocardiography, addition of clinical criteria to define hypotension, factoring iatrogenic causes of hypotension (ruling out lung hyperinflation), and standardization of respiratory management. Rate of use of inotropes in the first 72hours of life along with acute brain injury and mortality before and after implementation of the QI bundle were compared. The balancing measure was the rate of ischemic lesions in the form of cPVL. Cranial ultrasound was performed to screen for brain injury. Study was approved by the local research ethics board (REB14-1466).

Results

We included 671 neonates (301 before and 364 after the implementation of the bundle) among which 6 neonates were excluded based on the criteria. QI bundle implementation was associated with significant reduction in overall use of inotropes (24% vs 7%, p<0.001), dopamine (18% vs 5%, p<0.001), and dobutamine (17% vs 4%, p<0.001). Rate of acute brain injury decreased significantly: Acute brain injury of any grade (34% vs 20%, p<0.001) and severe brain injury (15% vs 6%, p<0.001). There was no difference in incidence of cPVL (1% vs 1.4%, p=0.66). Associations remained significant after adjusting for confounding factors. The QI bundle implementation was associated with a significant reduction in the use of inotropes when analyzed based on the 6 monthly time intervals (p = 0.006) (Figure 2)

Conclusion

Our QI bundled approach resulted in reduction in inotrope use and associated brain morbidities in premature babies. Follow-up studies evaluating the impact of this initiative on long-term outcomes in survivors are required to complement findings of improved short-term outcomes seen in this study.
22 Neonatal regional outreach education in Quebec – a formal needs assessment
Authors: Assaad Michael-Andrew , Filion-Ouellet Emilie , Khouzam Yasmine , Lynch Bonnie
Published: October 2022

Background

In Montreal (Quebec, Canada), newborn care is provided in either highly specialized hospitals for complex/critically ill patients or community hospitals for healthier patients. Community health care practitioners (CHP) have varying levels of comfort and competency in newborn care. Also, because of the unpredictable nature of obstetrics, CHP will need to manage critically ill newborns throughout their careers. Such high acuity, low frequency events can be difficult to manage even in experienced hands. Therefore, there is an imperative to develop a neonatal training curriculum for CHP, with an emphasis on critical newborns.

Objectives

As a first step, the objective of this study was to perform a comprehensive needs assessment of neonatal outreach education for CHP working in the Greater Montreal Area (Quebec, Canada).

Design/Methods

Using a mixed methods design (figure), the needs assessment was divided in 3 sections. First, the felt educational needs of the target population (CHP) using an online questionnaire. Second, through focus group discussion, the normative needs of the medical personnel who transport critical newborns. Third, the expressed educational needs of CHP through analysis of neonatal transport data between 2017-2020. Quantitative data was analyzed using descriptive statistics, including means and medians. Qualitative data was coded using conventional content analysis, with the primary technique being descriptive and pattern coding.

Results

The questionnaire reached 158 participants across 13 community hospitals. CHP are seeking training with procedures, critical situations, and resuscitation. Also, resource sharing, more field expertise, and additional resources for training (time, credits) were identified. Three focus groups (15 participants) also revealed that procedural training, critical newborn management and ventilation were important, as well as Crisis Resource Management (CRM) training. Both the questionnaire and focus groups identified specific medical conditions of interest. The expressed needs (transport data, 947 transports) helped reinforce felt and normative needs. Simulation was identified as a key educational technique.

Conclusion

A neonatal educational outreach curriculum will need to include procedural training, CRM teaching and certain specific medical conditions including extreme prematurity, hypoxic-ischemic encephalopathy (HIE) and pneumothorax. Procedural training and the principles of ventilation are also critically important. Simulation should be integral, in situ and with varied content. The fear of being judged is omnipresent and should be recognized during outreach education. Educational resources should be shared on an easily accessible, central website.