bluuebunny/crossref_metadata_2025 huggingface dataset:
A global meta‐analysis of temperature effects on marine fishes’ digestion across trophic groups
Authors: Knight Nicole S. , Guichard Frédéric , Altieri Andrew H.
Published: February 2021

Aim

The temperature constraint hypothesis proposes that marine herbivorous fishes are rare at high latitudes relative to carnivorous fishes because low temperatures impair the digestion of plant material. To test this hypothesis, we compared the effects of temperature on the digestive performance and investment in digestion of marine fishes across trophic groups.

Location

Global marine ecosystems.

Major taxa studied

Marine fishes.

Methods

We analysed data from 304 species consuming a range of diets to quantify the effects of temperature on three indicators of digestive performance and investment: gut passage time, absorption efficiency, and gut length.

Results

Decreasing temperatures increase gut passage time in fishes consuming macroalgae more than fishes consuming other fish or invertebrates. Low temperatures do not impair absorption efficiency in fishes regardless of diet, but herbivores have lower absorption efficiencies than carnivores overall. Gut length decreases with decreasing temperature in all trophic groups.

Main conclusions

Our analyses reveal limited evidence to support the temperature constraint hypothesis. Low temperatures slow digestion more in fishes consuming macroalgae than those consuming animal prey; however, this may not reflect a meaningful disadvantage for herbivores but rather could be explained by greater representation of fishes relying on microbial fermentation at high latitudes. Herbivorous fishes absorb nutrients and energy from their food in similar proportions regardless of temperature, in contrast to the expectations of the temperature constraint hypothesis. Decreased gut length was associated with decreasing temperature across all trophic groups, likely due to improved food quality at high latitudes, which should benefit all trophic groups by reducing their required investment in gut tissues. Altogether, our findings run counter to the general hypothesis that low temperatures disadvantage the digestion of plant material and suppress the diversity and abundance of herbivorous fishes at high latitudes.
Can technical indicators predict the Chinese equity risk premium?
Authors: Sun Mingwei , Glabadanidis Paskalis
Published: February 2021

We find that technical indicators have substantial predictive power over the Chinese equity risk premium. Technical indicators complement macroeconomic variables in predicting the Chinese equity risk premium. The predictive power is more pronounced at a weekly frequency rather than a monthly frequency as suggested by the out‐of‐sample tests. Furthermore, weekly‐level technical indicators can predict the firm‐level excess returns while monthly‐level indicators cannot. The weekly‐level indicators can also predict sorted portfolio excess return and risk factors. Overall, in comparison with the US stock market, the Chinese stock market seems to have higher‐frequency price trends. The cross‐sectional predictive power of the technical indicators is closely related to market capitalization rather than volatility.
Psychometric properties of a brief self‐reported health‐related quality of life measure (HRQoL‐IDD) for persons with intellectual and developmental disabilities
Authors: Pett Marjorie A. , Guo Jia‐Wen , Cardell Beth , Johnson Erin P. , Guerra Nichole , Clark Lauren
Published: February 2021

Background

To encourage self‐determination and address health disparities among persons with intellectual and developmental disabilities, clinicians and researchers rely on self‐reported measures like health‐related quality of life (HRQoL). This study evaluated the psychometric properties of a theory‐driven self‐reported HRQoL measure for adults requiring mild to moderate support related to intellectual and developmental disabilities.

Method

224 volunteers completed 42 quality of life items developed with extensive input from persons with intellectual and developmental disabilities, family members/caregivers, and providers. The 5‐point Likert scale format with visual images of fluid‐filled cups represented the range of responses.

Results

Exploratory and Unrestricted Factor Analyses yielded 16 HRQoL items with 4 subscales: Functional Well‐Being, Emotional Well‐Being, Social Well‐Being, and Healthy Decision‐making. The HRQoL‐IDD explained 62.8% of variance, had satisfactory internal consistency (0.73–0.83), stability of reponses, and reading level (2nd grade, ages 7‐8).

Conclusions

The HRQoL‐IDD is a promising measure of self‐reported HRQoL for use in community‐based settings for persons requiring mild to moderate support related to intellectual and developmental disabilities.
Safety of combining cosmetic injectables with radiofrequency microneedling: A 4.5‐year review
Authors: Wang Jordan V. , Valiga Alexander , Albornoz Christian A. , Geronemus Roy G.
Published: February 2021

Pairing energy‐based treatments, including radiofrequency microneedling, with either injectable neuromodulators or soft‐tissue fillers can be an effective therapy for facial rejuvenation. However, there remains concerns by some physicians that this combination may add new risks for adverse events. Theoretical risks of combining energy‐based treatment with neuromodulator injections include unintentional spread, which may result in eyelid ptosis and asymmetry. Potential risks with soft‐tissue fillers include unexpected loss of filler volume, necrosis, burn, and product migration. In order to shed more light on this topic, we performed a retrospective chart review of single‐session facial treatments with radiofrequency microneedling and cosmetic injectables over a 4.5 year period. We found no documented adverse events recorded related to combination treatment. This is important information that adds to the patient safety literature.
1540‐nm fractional erbium: Glass laser is a safe and effective modality for nonablative facial rejuvenation
Authors: Solomon‐Cohen Efrat , Lapidoth Moshe , Mimouni Daniel , Akerman Lehavit , Slodownik Dan , Hodak Emmilia , Levi Assi
Published: February 2021

Background

Laser treatments for facial rejuvenation are common, with ablative modalities being of more common use for this indication. Efficient nonablative modalities are of rising demand.

Aim

Our aim was to determine the safety and efficacy of high‐fluence, nonablative 1540‐nm fractional Erbium:glass laser for facial rejuvenation.

Patients and Methods

A retrospective study of patients treated with 3‐4 treatments using the 1540‐nm fractional Erbium:glass laser for facial rejuvenation, using 2500‐3000 mJ/stacked pulses (51‐61 mJ per pixel). Patients were followed‐up for 3 months following their last treatment. Before and after photos were independently blindly evaluated by 2 dermatologists, who graded them using a scale from 0 (exacerbation) to 4 (76%‐100% improvement) for 2 different facial regions (frontal face region and lateral canthal region). Pain perception and adverse effects as well as patient satisfaction were documented throughout the study.

Results

Sixteen patients completed both treatment and follow‐up period. At the 3‐months posttreatment follow‐up visit, moderate‐to‐significant improvement in rhytids appearance (mean grade of improvement: 2.93 for frontal face and 3 for lateral canthal region) was observed. Patients’ satisfaction was high (4.25). Patients reported mild and transient erythema posttreatment with no other adverse effects.

Conclusion

The high‐fluence 1540‐nm fractional Erbium:glass laser is a safe and effective nonablative modality for facial rejuvenation.
Role of inflammatory markers in polycystic ovaries syndrome: In relation to insulin resistance
Authors: Alissa Eman M. , Algarni Samiah A. , Khaffji Azza J. , Al Mansouri Nisma M.
Published: February 2021

Objective

To evaluate the relationship between plasma levels of the inflammatory markers tumor necrosis factor‐alpha (TNF‐α), C reactive protein (CRP), and interlukin‐6 (IL‐6) with insulin resistance in Saudi women with polycystic ovaries syndrome (PCOS).

Methods

One hundred eighty Saudi women with and without PCOS, aged 22–38 years, were randomly recruited in this age and body mass index matched case–control study. Clinical assessment, anthropometric measurements, and biochemical parameters were determined for all study participants.

Results

Levels of TNF‐α, IL‐6, hs‐CRP, insulin, and insulin resistance indices were significantly higher among PCOS group than their age and BMI matched controls (p < 0.05). Results showed that only QUICK‐I (β = −0.247, p < 0.0001, 95% CI: −3.009 to −0.977) independently predicted TNF‐α levels after adjustment for potential confounders.

Conclusions

Elevated plasma levels of TNF‐ α and IL‐6 among PCOS women reflects a state of chronic inflammation with potential implication for insulin resistance, independent of obesity.
Degenerative type of placental chorioangioma requiring fetal blood transfusion
Authors: Iwahata Hideyuki , Iwahata Yuriko , Homma Chika , Kurasaki Akiko , Hasegawa Junichi , Suzuki Nao
Published: February 2021

We experienced a case with fetal hydrops, polyhydramnios, and a well‐defined oval anechoic lesion of approximately 9 cm in size, without blood flow at 26 weeks' gestation. As increased middle cerebral artery peak systolic velocity, the fetal hydrops was caused by a placental tumor such as a chorioangioma; however, the tumor was atypical. Fetal blood hemoglobin was 8.3 g/dl on percutaneous umbilical cord blood sampling. After erythrocytes transfusion to the fetus, the mother normally delivered at 38 weeks' gestation. The placental tumor was histologically diagnosed as a necrotic chorioangioma. Obstetricians should note such atypical chorioangiomas when differential diagnosis of placental tumors.
Mechanisms of niche‐neutrality balancing can drive the assembling of microbial community
Authors: Wang Lixiao , Han Maozhen , Li Xi , Yu Bingbing , Wang Huading , Ginawi Amjed , Ning Kang , Yan Yunjun
Published: February 2021

One hotspot of present community ecology is to uncover the mechanisms of community succession. In this study, two popular concepts, niche‐neutrality dynamic balancing and co‐occurrence network analysis, were integrated to investigate the dispersal dynamics of microbial communities in a freshwater river continuum in subtropical China. Results showed that when habitat conditions were mild and appropriate, such as in the clean upstream river, free of heavy pollution or long‐lasting extreme disturbances, stochastic processes could increase species diversities, and organize communities into relatively loosely linked and stable networks with higher modularity and more modules. However, when conditions became degraded under heavy pollution, the influence of neutrality diminished, and niche‐based selection imposed more constraints on communities and guided the assembling processes in certain directions: depleting species richness, strengthening interspecies connections and breaking boundaries of modules. Consequently, communities became more sensitive to fluctuations so as to deal with the harsh conditions efficiently. Another interesting finding was that, both as keystone taxa of communities, module hubs were mostly neutrally distributed generalists with high abundances, and were beneficial to many related operational taxonomic units. In contrast, connectors were less abundant and their distributions were more subjected to the environments. Therefore, connectors were probably responsible for the information transmission between microbial communities and environments, as well as between different modules, and thus could restrict the dispersal of microbes and guide the direction of community assembly.
Clinical learning environment and graduating nursing students' competence: A multi‐country cross‐sectional study
Authors: Visiers‐Jiménez Laura , Suikkala Arja , Salminen Leena , Leino‐Kilpi Helena , Löyttyniemi Eliisa , Henriques Maria Adriana , Jiménez‐Herrera Maria , Nemcová Jana , Pedrotti Daniel , Rua Marília , Tommasini Cristina , Zeleníková Renáta , Kajander‐Unkuri Satu
Published: February 2021

The purpose of this study was to explore nursing students' perceptions of their final clinical learning environment and its association with their self‐assessed competence, satisfaction with nursing education, and turnover intentions at graduation in six European countries. A multi‐country comparative cross‐sectional study was conducted with nursing students (n = 1746) from the Czech Republic, Finland, Italy, Portugal, Slovakia, and Spain using the Nurse Competence Scale and the Clinical Learning Environment and Supervision scale. Nursing students' overall perceptions of their final clinical learning environment and supervision were positive in all the countries studied. The correlation between the students' perceptions of their final clinical learning environment and competence was statistically significant and positive. Satisfaction with the nursing program and clinical practicum and no consideration of career change were related to positive perceptions of the final clinical learning environment. Highlighting the importance of the supervisory relationship and pedagogical atmosphere, nursing students' positive perceptions of the final clinical learning environment and supervision contribute to a better level of self‐assessed competence and satisfaction with the nursing program and clinical practicum, leading to lower turnover intentions.
Chronic constipation in adults: Contemporary perspectives and clinical challenges. 2: Conservative, behavioural, medical and surgical treatment
Authors: Corsetti Maura , Brown Steven , Chiarioni Giuseppe , Dimidi Eirini , Dudding Thomas , Emmanuel Anton , Fox Mark , Ford Alexander C. , Giordano Pasquale , Grossi Ugo , Henderson Michelle , Knowles Charles H. , O’Connell P. Ronan , Quigley Eamonn M. M. , Simren Magnus , Spiller Robin , Whelan Kevin , Whitehead William E. , Williams Andrew B. , Scott S. Mark
Published: February 2021

Background

Chronic constipation is a prevalent disorder that affects quality of life of patients and consumes resources in healthcare systems worldwide. In clinical practice, it is still considered a challenge as clinicians frequently are unsure as to which treatments to use and when. Over a decade ago, a Neurogastroenterology and Motility journal supplement devoted to the investigation and management of constipation was published (Neurogastroenterol Motil 2009;21(Suppl 2):1). In October 2018, the 3rd London Masterclass, entitled “Contemporary management of constipation” was held. The faculty members of this symposium were invited to write two reviews to present a collective synthesis of talks presented and discussions held during this meeting. The first review addresses epidemiology, diagnosis, clinical associations, pathophysiology, and investigation.

Purpose

The present is the second of these reviews, providing contemporary perspectives and clinical challenges regarding behavioral, conservative, medical, and surgical treatments for patients presenting with constipation. It includes a management algorithm to guide clinical practice.
Racial residential segregation and economic disparity jointly exacerbate COVID‐19 fatality in large American cities
Authors: Yu Qinggang , Salvador Cristina E. , Melani Irene , Berg Martha K. , Neblett Enrique W. , Kitayama Shinobu
Published: February 2021

The disproportionately high rates of both infections and deaths among racial and ethnic minorities (especially Blacks and Hispanics) in the United States during the COVID‐19 pandemic are consistent with the conclusion that structural inequality can produce lethal consequences. However, the nature of this structural inequality in relation to COVID‐19 is poorly understood. Here, we hypothesized that two structural features, racial residential segregation and income inequality, of metropolitan areas in the United States have contributed to health‐compromising conditions, which, in turn, have increased COVID‐19 fatalities; moreover, that these two features, when combined, may be particularly lethal. To test this hypothesis, we examined the growth rate of confirmed COVID‐19 cases and deaths in an early 30‐day period of the outbreak in the counties located in each of the 100 largest metropolitan areas in the United States. The growth curves for cases and deaths were steeper in counties located in metropolitan areas where Blacks and Hispanics are residentially segregated from Whites. Moreover, the effect of racial residential segregation was augmented by income inequality within each county. These data strongly suggest that racial and economic disparities have caused a greater death toll during the current pandemic. We draw policy implications for making virus‐resilient cities free from such consequences.
Ups and downs of belemnite diversity in the Early Jurassic of Western Tethys
Authors: Neige Pascal , Weis Robert , Fara Emmanuel
Published: February 2021

Although belemnites form a major clade of extinct cephalopods, the early stage of their diversification remains poorly known in time and space. Here we investigate the first diversification episodes of belemnites (order Belemnitida) using a new species‐level database encompassing the Hettangian–Aalenian interval (Early Jurassic – earliest Middle Jurassic) and covering the Western Tethys. Rarefied richness shows a four‐fold increase from the Planorbis chronozone to the Ibex chronozone, a strong decrease between the Margaritatus and Spinatum chronozones, followed by a drop in the Spinatum–Serpentinum interval that is coeval with the second‐order Toarcian biological crisis. The Bifrons chronozone records a high richness that departs significantly from those of the surrounding chronozones. A last richness peak in the Dispansum chronozone precedes a decrease towards the Aalenian. Biogeographical analyses do not reveal any clear large‐scale provincialism for belemnites, in sharp contrast with ammonoids. Such a long‐term homogeneous spatial distribution of belemnites is probably due to: (1) the relatively poorly‐documented fossil record of belemnites, especially in Mediterranean localities; and (2) contrasted dispersal abilities of belemnites compared to ammonoids over the studied time interval.
Isoprene and β‐caryophyllene confer plant resistance via different plant internal signalling pathways
Authors: Frank Lena , Wenig Marion , Ghirardo Andrea , van der Krol Alexander , Vlot A. Corina , Schnitzler Jörg‐Peter , Rosenkranz Maaria
Published: February 2021

Isoprene and other terpenoids are important biogenic volatile organic compounds in terms of atmospheric chemistry. Isoprene can aid plant performance under abiotic stresses, but the fundamental biological reasons for the high emissions are not completely understood. Here, we provide evidence of a previously unrecognized ecological function for isoprene and for the sesquiterpene, ß‐caryophyllene. We show that isoprene and ß‐caryophyllene act as core components of plant signalling networks, inducing resistance against microbial pathogens in neighbouring plants. We challenged Arabidopsis thaliana with Pseudomonas syringae, after exposure to pure volatile terpenoids or to volatile emissions of transformed poplar or Arabidopsis plants. The data suggest that isoprene induces a defence response in receiver plants that is similar to that elicited by monoterpenes and depended on salicylic acid (SA) signalling. In contrast, the sesquiterpene, ß‐caryophyllene, induced resistance via jasmonic acid (JA)‐signalling. The experiments in an open environment show that natural biological emissions are enough to induce resistance in neighbouring Arabidopsis. Our results show that both isoprene and ß‐caryophyllene function as allelochemical components in complex plant signalling networks. Knowledge of this system may be used to boost plant immunity against microbial pathogens in various crop management schemes.
The relations of reflective and intuitive thinking styles with task performance: A meta‐analysis
Authors: Alaybek Balca , Wang Yi , Dalal Reeshad S. , Dubrow Samantha , Boemerman Louis S. G.
Published: February 2021

We conducted a meta‐analysis to examine the relations of individual differences in reflective (or rational) and intuitive thinking styles with workplace task performance. We meta‐analyzed 113 effect sizes from 71 independent samples (N = 11,713). Results indicate that reflective thinking style has a positive and non‐zero meta‐analytic relation with task performance (ρ = .213). This positive relation is stronger in environments characterized by higher task complexity, greater importance of creativity and innovation for work tasks, and higher time pressure associated with work tasks. Intuitive thinking style, conversely, has a very small but positive meta‐analytic relation with task performance (ρ = .051), and this relation is stronger in environments characterized by higher task complexity. Finally, incremental validity analyses reveal that reflective thinking style explains unique variance in task performance, beyond conscientiousness and intelligence (general mental ability). Overall, this meta‐analysis demonstrates that reflective thinking style is an important antecedent to task performance.
Photosynthesis on the Ultrafast Time Scale within the Confinements of Quantum Nanostructured Photosystems
Authors: Sordillo Laura A. , Budansky Yury , Alfano Robert R.
Published: February 2021

Fundamental information on the behavior of excited chlorophyll molecules packed within the confinements of nanosized photosystems I and II, following absorption of light, is presented. Using a 100 femtosecond laser with nanojoule (nJ) pulse energy and a one picosecond streak camera, we observed the light emitted from the nanostructured photosystems without oscillations or hops. The fluorescent exponential decay profiles and high efficiency within the nanostructure suggest that light coherently drains out as a unit. This implies that "quantumness" is linked to quantum confinement on the nano scale.
The Influence of Residents’ Resilience on the Recovery in the Torrential Rain in Western Japan in 2018
Authors: Ohtomo Shoji , Kimura Reo
Published: February 2021

In 2018 torrential rain caused serious human suffering and damage to property in western Japan. Following such disasters, the investigation of residents’ subsequent recovery process is important to determine the support required in affected areas and disaster risk management. This study examines the effects of psychological resilience on residents’ life recovery following the torrential rain. We conducted a web survey with 1,000 residents in 13 districts of Hiroshima prefecture and 6 districts of Okayama prefecture that suffered the most damage caused by the torrential rain. The survey used the “recovery calendar” approach to assess residents’ life recovery from the disaster. Results indicated that residents who had suffered relatively little damage began to recover during the “disaster utopia” phase up to 2 months after the disaster. However, residents who had suffered serious damage began to recover during the “reentry to everyday life” phase up to 6 months after the disaster. Moreover, older residents or residents with strong psychological resilience who suffered serious damage were likely to recover sooner than those with weaker psychological resilience. Therefore, this study indicates the importance of an approach to disaster recovery according to the level of damage, phased time period, and psychological resilience.
Crossing Kingdoms: How the Mycobiota and Fungal-Bacterial Interactions Impact Host Health and Disease
Authors: Santus William , Devlin Jason R. , Behnsen Judith
Published: February 2021

The term “microbiota” invokes images of mucosal surfaces densely populated with bacteria. These surfaces and the luminal compartments they form indeed predominantly harbor bacteria.
A Combination of Anti-PD-L1 Treatment and Therapeutic Vaccination Facilitates Improved Retroviral Clearance via Reactivation of Highly Exhausted T Cells
Authors: Knuschke Torben , Kollenda Sebastian , Wenzek Christina , Zelinskyy Gennadiy , Steinbach Philine , Dittmer Ulf , Buer Jan , Epple Matthias , Westendorf Astrid M.
Published: February 2021

Despite significant efforts, vaccines are not yet available for every infectious pathogen, and the search for a protective approach to prevent the establishment of chronic infections, i.e., with HIV, continues. Immune checkpoint therapies targeting inhibitory receptors, such as PD-1, have shown impressive results against solid tumors.
Noc Corrals Migration of FtsZ Protofilaments during Cytokinesis in Bacillus subtilis
Authors: Yu Yuanchen , Zhou Jinsheng , Gueiros-Filho Frederico J. , Kearns Daniel B. , Jacobson Stephen C.
Published: February 2021

In bacteria, a condensed structure of FtsZ (Z-ring) recruits cell division machinery at the midcell, and Z-ring formation is discouraged over the chromosome by a poorly understood phenomenon called nucleoid occlusion. In
B. subtilis
, nucleoid occlusion has been reported to be mediated, at least in part, by the DNA-membrane bridging protein, Noc.
Sirtuin 3 Downregulation in
Mycobacterium tuberculosis
-Infected Macrophages Reprograms Mitochondrial Metabolism and Promotes Cell Death
Authors: Smulan Lorissa J. , Martinez Nuria , Kiritsy Michael C. , Kativhu Chido , Cavallo Kelly , Sassetti Christopher M. , Singhal Amit , Remold Heinz G. , Kornfeld Hardy
Published: February 2021

Tuberculosis, the disease caused by the bacterium
M. tuberculosis
, remains one of the top 10 causes of death worldwide. Macrophages, the first cells to encounter
M. tuberculosis
and critical for defense against infection, are hijacked by
M. tuberculosis
as a protected growth niche.
M. tuberculosis
-infected macrophages undergo metabolic reprogramming where key mitochondrial pathways are modulated, but the mechanisms driving this metabolic shift is unknown.
A Novel Enterococcus faecalis Heme Transport Regulator (FhtR) Senses Host Heme To Control Its Intracellular Homeostasis
Authors: Saillant Vincent , Lipuma Damien , Ostyn Emeline , Joubert Laetitia , Boussac Alain , Guerin Hugo , Brandelet Géraldine , Arnoux Pascal , Lechardeur Delphine
Published: February 2021

Enterococcus faecalis
, a normal and harmless colonizer of the human intestinal flora can cause severe infectious diseases in immunocompromised patients, particularly those that have been heavily treated with antibiotics. Therefore, it is important to understand the factors that promote its resistance and its virulence.
E. faecalis
, which cannot synthesize heme, an essential but toxic metabolite, needs to scavenge this molecule from the host to respire and fight stress generated by oxidants.
Evaluation of CRISPR Diversity in the Human Skin Microbiome for Personal Identification
Authors: Toyomane Kochi , Yokota Ryo , Watanabe Ken , Akutsu Tomoko , Asahi Ai , Kubota Satoshi
Published: February 2021

Microbial community diversity analysis can be utilized to characterize the personal microbiome that varies between individuals. CRISPR sequences, which reflect virome structure, in the human skin environment may be highly personalized similar to the structures of individual viromes.
Multiple thromboembolic events associated with bilateral superior vena cava and anomalous drainage into the left atrium
Authors: Karavassilis Maria Elizabeth , Haji-Coll Michael , Keenan Niall G
Published: February 2021

A 49-year-old female patient presented with acute-on-chronic chest pain. She was diagnosed with multiple systemic thromboemboli, including myocardial infarctions, bilateral chronic pulmonary emboli, ischaemic stroke, deep venous thrombosis and superficial thrombophlebitis. She had a background of sickle cell trait. Cardiac magnetic resonance showed bilateral superior vena cava (SVC). The right-sided SVC (RSVC) was joined by the right upper pulmonary vein and drained anomalously into the left atrium. This caused a small volume right to left shunt. The persistent left SVC drained into the right atrium (RA) via a dilated coronary sinus. The overall clinical impression was recurrent paradoxical emboli due to anomalous venous anatomy with a thrombophilia secondary to sickle cell trait. In the normal embryo, the right common cardinal vein develops to become the RSVC, which drains into the RA by term.
Ureaplasmaseptic polyarthritis in a young woman with neuromyelitis optica receiving rituximab
Authors: Harold Rachel , Simon Gary L , Akselrod Hana , Siegel Marc O , Roberts Afsoon
Published: February 2021

We report a case of septic polyarthritis caused byUreaplasma urealyticumin a woman with neuromyelitis optica who was receiving rituximab. Her case exemplifies some of the unique characteristics of invasiveUreaplasmainfections that can lead to delayed diagnosis as well as treatment challenges including recurrence following antibiotic discontinuation.
Rare cause of extravasation from implantable venous access device
Authors: Manimaran Ponmani Agasthiya , Agarwal Prakash , Ramasundaram Madhu , Sundaram Jegadeesh
Published: February 2021

Implantable venous access devices are routinely used, but they are not without complications. A 4-year-old male child with B cell acute lymphoblastic leukaemia was planned for chemotherapy. Chemo port was accessed through the right internal jugular vein. Check X-ray was done, which showed the correct placement of the catheter. Two months after chemo port insertion when the patient underwent chemotherapy, he developed a fever and he was started on intravenous antibiotics. On the next two admissions, the patient had a fever with chamber site oedema for which culture was done, which revealed Pseudomonas and Candida, which responded to antibiotic and antifungal therapies. In the successive admission, the patient had immediate local oedema on injecting chemotherapy. Exploration was done, which revealed chamber base perforation. It is an infrequent complication and has been reported in only three studies.
Cohort profile: Dementia in the Registry of Senior Australians
Authors: Cations Monica , Lang Catherine E , Ward Stephanie A , Crotty Maria , Whitehead Craig , Maddison John , Inacio Maria
Published: February 2021

Purpose

Clinical quality registries (CQRs) are being established in many countries to monitor, benchmark, and report on the quality of dementia care over time. Case ascertainment can be challenging given that diagnosis occurs in a variety of settings. The Registry of Senior Australians (ROSA) includes a large cohort of people with dementia from all Australian states and territories identified using routinely collected aged care assessment data. In ROSA, assessment data are linked to information about aged and health service use, medicine dispensing, hospitalisations and the National Death Index. The ROSA dementia cohort was established to capture people for the Australian dementia CQR currently in development who may not be identified elsewhere.

Participants

There were 373 695 people with dementia identified in aged care assessments from 2008 to 2016. Cross-sectional analysis from the time of cohort entry (e.g. when first identified with dementia on an aged care assessment) indicates that individuals were 84.1 years old on average, and 63.1% were female. More than 44% were first identified at entry to permanent residential aged care. The cohort recorded more severe cognitive impairment at entry than other international dementia registries.

Findings to date

The cohort has so far been used to demonstrate a declining prevalence of dementia in individuals entering the aged care sector, examine trends in psychotropic medicine prescribing, and to examine the impact of dementia on aged care service use and outcomes.

Future plans

The ROSA dementia cohort will be updated periodically and is a powerful resource both on its own and as a contributor to the Australian dementia CQR. Integration of the ROSA dementia cohort with the dementia CQR will ensure that people with dementia using aged care services can benefit from the ongoing monitoring and benchmarking of care that a registry can provide.
Exploratory study into the relationship between the symptoms of chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) and fibromyalgia (FM) using a quasiexperimental design
Authors: Mckay Pamela G , Walker Helen , Martin Colin R , Fleming Mick
Published: February 2021

Objective

To explore the relationship between symptoms of chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) and fibromyalgia (FM). The hypothesis predicated that there would be no significant differences between the group’s symptom experience.

Design

A quasiexperimental design. Structural equation modelling (SEM) and invariance testing.

Participants

Males (M) and females (F) >16 with a confirmed diagnosis of CFS/ME or FM by a general practitioner or specialist. CFS/ME (n=101, F: n=86, M: n=15, mean (M) age M=45.5 years). FM (n=107, F: n=95, M: n=12, M=47.2 years).

Outcome measures

Diagnostic criteria: the American Centers for Disease Control and Prevention (CDC) for CFS/ME and the American College of Rheumatology (ACR) criteria for FM. Additional symptom questionnaires measuring: pain, sleep quality, fatigue, quality of life, anxiety and depression, locus of control and self-esteem.

Results

Invariance was confirmed with the exception of the American CDC Symptom Inventory, Fibromyalgia Impact Questionnaire and Hospital Anxiety and Depression Scale (p<0.05) based on five questions. Consequently, it was erroneous to conclude differences. Therefore, the Syndrome Model was created. SEM could not have tested the ACR previously, as it comprised a single data point. Thus, it was combined with these three questionnaires, increasing the data points, to create this new measurable model. Results confirmed no significant differences between groups (p=0.07 (p<0.05)).

Conclusion

Participants responded in a similar manner to the questionnaire, confirming the same symptom experience. It is important to consider this in context with differing criteria and management guidelines, as this may influence diagnosis and the trajectory of patient’s management. With the biomedical cause currently unclear, it is the symptom experience and the impact on quality of life that is important. These findings are meaningful for patients, clinicians and policy development and support the requirement for future research.
Implementation of a multicomponent intervention sign to reduce delirium in orthopaedic inpatients (MIND-ORIENT): a quality improvement project
Authors: Reppas-Rindlisbacher Christina , Siddhpuria Shailee , Wong Eric Kai-Chung , Lee Justin Yusen , Gabor Christopher , Curkovic Alexandra , Khalili Yasmin , Mavrak Caroline , De Freitas Sandra , Eshak Kristeen , Patterson Christopher
Published: February 2021

Delirium is a serious and common condition that leads to significant adverse health outcomes for hospitalised older adults. It occurs in 30%–55% of patients with hip fractures and is one of the most common postoperative complications in older adults undergoing orthopaedic surgery. Multicomponent, non-pharmacological interventions can reduce delirium incidence by up to 30% but are often challenging to implement as part of routine care. We identified a gap in the delivery of non-pharmacological interventions on an orthopaedic unit. This project aimed to implement a bedside sign on an orthopaedic unit to reduce the occurrence of delirium by prompting staff to use multicomponent evidence-based delirium prevention strategies for at-risk older adults. Quality improvement methods were used to integrate and optimise the use of a bedside ‘delirium prevention’ sign on an orthopaedic unit.

The sign was implemented in four target rooms and sign completion rates increased from 47% to 83% (95% CI 71.7% to 94.9%; p<0.001) over a 10-month period. The sign did not have a significant impact on delirium prevalence. The mean Confusion Assessment Method (CAM)+ rate during the baseline period was 8% with an absolute increase in the intervention period to 11.4% (95% CI 7.2% to 15.8%; p=0.31). There were no significant shifts or trends in the run chart for the proportion of patients with CAM+ scores over time. The sign was well received by staff, who reported it was a worthwhile use of time and prompted use of non-pharmacological interventions. This quality improvement project successfully integrated a novel, low-cost, feasible and evidence-based approach into routine clinical care to support staff to deliver non-pharmacological interventions. Given the increased pressures on front-line staff in hospital, tools that reduce cognitive load at the bedside are important to consider when caring for a vulnerable older adult patient population.
Are we Athens or Florence? COVID-19 in historical context
Authors: Doolittle Benjamin R
Published: February 2021

We have been here before. In 430 BCE, a plague struck Athens, killing as much as 25% of the population. In 1347 CE, the bubonic plague afflicted western Europe for 4 years, killing as much as 50% of the population. The plague of Athens led to a collapse of their religion, cultural norms and democracy. In contrast, the bubonic plague led eventually to the Renaissance, a growth of art, science and humanism. As we contend with the COVID-19 global pandemic, will we become Athens or Florence?
Gluten-induced RNA methylation changes regulate intestinal inflammation via allele-specific XPO1 translation in epithelial cells
Authors: Olazagoitia-Garmendia Ane , Zhang Linda , Mera Paula , Godbout Julie K , Sebastian-DelaCruz Maialen , Garcia-Santisteban Iraia , Mendoza Luis Manuel , Huerta Alain , Irastorza Iñaki , Bhagat Govind , Green Peter H , Herrero Laura , Serra Dolors , Rodriguez Jose Antonio , Verdu Elena F , He Chuan , Bilbao Jose Ramon , Castellanos-Rubio Ainara
Published: February 2021

Objectives

Coeliac disease (CD) is a complex autoimmune disorder that develops in genetically susceptible individuals. Dietary gluten triggers an immune response for which the only available treatment so far is a strict, lifelong gluten free diet. Human leucocyte antigen (HLA) genes and several non-HLA regions have been associated with the genetic susceptibility to CD, but their role in the pathogenesis of the disease is still essentially unknown, making it complicated to develop much needed non-dietary treatments. Here, we describe the functional involvement of a CD-associated single-nucleotide polymorphism (SNP) located in the 5’UTR of XPO1 in the inflammatory environment characteristic of the coeliac intestinal epithelium.

Design

The function of the CD-associated SNP was investigated using an intestinal cell line heterozygous for the SNP, N6-methyladenosine (m6A)-related knock-out and HLA-DQ2 mice, and human samples from patients with CD.

Results

Individuals harbouring the risk allele had higher m6A methylation in the 5’UTR of XPO1 RNA, rendering greater XPO1 protein amounts that led to downstream nuclear factor kappa B (NFkB) activity and subsequent inflammation. Furthermore, gluten exposure increased overall m6A methylation in humans as well as in in vitro and in vivo models.

Conclusion

We identify a novel m6A-XPO1-NFkB pathway that is activated in CD patients. The findings will prompt the development of new therapeutic approaches directed at m6A proteins and XPO1, a target under evaluation for the treatment of intestinal disorders.
STING agonist-based treatment promotes vascular normalization and tertiary lymphoid structure formation in the therapeutic melanoma microenvironment
Authors: Chelvanambi Manoj , Fecek Ronald J , Taylor Jennifer L , Storkus Walter J
Published: February 2021

Background

The degree of immune infiltration in tumors, especially CD8+ T cells, greatly impacts patient disease course and response to interventional immunotherapy. Enhancement of tumor infiltrating lymphocyte (TIL) is a critical element of efficacious therapy and one that may be achieved via administration of agents that promote tumor vascular normalization (VN) and/or induce the development of tertiary lymphoid structures (TLS) within the tumor microenvironment (TME).

Methods

Low-dose stimulator of interferon genes (STING) agonist ADU S-100 (5 µg/mouse) was delivered intratumorally to established subcutaneous B16.F10 melanomas on days 10, 14 and 17 post-tumor inoculation. Treated and control tumors were isolated at various time points to assess transcriptional changes associated with VN and TLS formation via quantitative PCR (qPCR), with corollary immune cell composition changes in isolated tissues determined using flow cytometry and immunofluorescence microscopy. In vitro assays were performed on CD11c+ BMDCs treated with 2.5 µg/mL ADU S-100 or CD11c+ DCs isolated from tumor digests and associated transcriptional changes analyzed via qPCR or profiled using DNA microarrays. For T cell repertoireβ-CDR3 analyses, T cell CDR3 was sequenced from gDNA isolated from splenocytes and enzymatically digested tumors.

Results

We report that activation of STING within the TME leads to slowed melanoma growth in association with increased production of antiangiogenic factors including Tnfsf15 (Vegi) and Cxcl10, and TLS-inducing factors including Ccl19, Ccl21, Lta, Ltb and Light. Therapeutic responses resulting from intratumoral STING activation were characterized by improved VN, enhanced tumor infiltration by CD8+ T cells and CD11c+ DCs and local TLS neogenesis, all of which were dependent on host expression of STING. Consistent with a central role for DC in TLS formation, ADU S-100-activated mCD11c+ DCs also exhibited upregulated expression of TLS promoting factors including lymphotoxin-α (LTA), interleukin (IL)-36, inflammatory chemokines and type I interferons in vitro and in vivo. TLS formation in ADU S-100-treated mice was associated with the development of a highly oligoclonal TIL repertoire enriched in expanded T cell clonotypes unique to the TME and not detected in the periphery.

Conclusions

Our data support the premise that i.t. delivery of low-dose STING agonist promotes VN and a proinflammatory TME supportive of TLS formation, enrichment in the TIL repertoire and tumor growth control.
The incidence of pelvic fractures with traumatic lower limb amputation in modern warfare due to improvised explosive devices
Authors: Cross AM , Davis C , Penn-Barwell J , Taylor DM , De Mello WF , Matthews JJ
Published: February 2021

Aims

A frequently-seen injury pattern in current military experience is traumatic lower limb amputation as a result of improvised explosive devices (IEDs). This injury can coexist with fractures involving the pelvic ring. This study aims to assess the frequency of concomitant pelvic fracture in IED-related lower limb amputation.

Methods

A retrospective analysis of the trauma charts, medical notes, and digital imaging was undertaken for all patients arriving at the Emergency Department at the UK military field hospital in Camp Bastion, Afghanistan, with a traumatic lower limb amputation in the six months between September 2009 and April 2010, in order to determine the incidence of associated pelvic ring fractures.

Results

Of 77 consecutive patients with traumatic lower limb amputations, 17 (22%) had an associated pelvic fracture (eleven with displaced pelvic ring fractures, five undisplaced fractures and one acetabular fracture). Unilateral amputees (n=31) had a 10% incidence of associated pelvic fracture, whilst 30 % of bilateral amputees (n=46) had a concurrent pelvic fracture. However, in bilateral, trans-femoral amputations (n=28) the incidence of pelvic fracture was 39%.

Conclusions

The study demonstrates a high incidence of pelvic fractures in patients with traumatic lower limb amputations, supporting the routine pre-hospital application of pelvic binders in this patient group.
Alcohol dependence in the naval service
Authors: Dickie AK , Coetzee RH
Published: February 2021

Alcohol misuse is a significant occupational health issue in the United Kingdom Armed Forces. Dependence associated with alcohol misuse represents the severe end of the clinical and occupational consequences of sustained alcohol misuse. This article aims to explore the diagnosis, management and occupational considerations of alcohol dependence in the Naval Service environment.
Leishmaniasis and its relevance to UK Armed Forces
Authors: Preedy HC , Bailey MS
Published: February 2021

Leishmaniasis is an infectious disease caused byLeishmaniaprotozoa, transmitted by the bite of phlebotomine sandflies. It causes a spectrum of clinical syndromes, of which the most common are cutaneous and visceral leishmaniasis. Clinical presentation is highly variable and is dependent on multiple factors, such asLeishmaniaspecies and patient characteristics (including immune competence). The relationship between these variables is poorly understood, and there is no single, evidence-based treatment for the disease. Currently management focuses on identification of the species, but this requires specialist tests which are often unavailable, particularly on military operations. Leishmaniasis is of particular relevance to military medical personnel as it is endemic in many tropical and sub-tropical regions of the world, including Belize, Iraq and Afghanistan where UK Armed Forces may be deployed. It can present a potentially serious threat to military personnel deployed in endemic areas due to the possibility of long-term sequelae of infection.
The management of the acutely swollen ankle
Authors: Howes RJ , Wood AM , Calder A , Cowan H , Burrows H
Published: February 2021

Patients presenting with an acutely swollen ankle are common in both the military and civilian settings. Accurate diagnosis is vital, as there are various potentially serious causes. This article aims to review the common causes of an acutely swollen ankle, as well as the rarer causes, with their significant consequences.
Contingency: the likely spectrum of injuries based upon a review of three recent undeveloped theatres of operations - CORPORATE, TELIC 1 and HERRICK 4
Authors: Lewin I J S
Published: February 2021

Contingency operations are by their nature unpredictable and high-risk, with undeveloped logistical support, and medical provision is no exception. Can the contingency experiences of the last three decades help to predict the type of casualties that may be seen in future contingency operations? By reviewing published casualty statistics available from Operations CORPORATE, TELIC 1 and HERRICK 4 it can be demonstrated, unsurprisingly, that gunshot wounds and blast injuries dominate battle injuries, but that disease non-battle injuries also constitute a significant draw on medical provision, particularly gastrointestinal illness in hot environments. Planning for medical support for future contingency operations should anticipate this. Disease non-battle injuries have the potential to render a large proportion of a force combat-ineffective, requiring preventative measures to avoid overwhelming the available medical facilities. When operations occur in populated areas civilian casualties are likely to pose difficulties to medical support, due to issues with onward evacuation and a wider case mix, such as paediatrics.
Sports & Exercise Medicine
Authors: Heil K M , Keenan A C M
Published: February 2021

In recent years, small scale counter-insurgency and expeditionary operations have frequently taken place in mountainous, high-altitude areas. Preparation of soldiers for these environments has typically focussed on extended stays at altitude to ensure physiological acclimatisation. However, with the likelihood that future UK deployments may be unpredictable and thus with little time for preparation, is there a means by which the same acclimatisation may be achieved? The field of athletics has been researching such adaptations since the rise of the elite North African long-distance runners in the 1960s. These athletes all lived high above sea level and had become accustomed to performing in the relatively hypoxic environment found at high altitudes. The research has focussed on eliciting physiological acclimatisation in as short a time as possible, while maintaining the ability to train at the correct intensity. In the following review of altitude training we highlight areas for future investigation and assess whether protocols developed for athletes can be applied to military personnel.