bluuebunny/crossref_metadata_2025 huggingface dataset:
Context‐dependent dispersal determines relatedness and genetic structure in a patchy amphibian population
Authors: Unglaub Bianca , Cayuela Hugo , Schmidt Benedikt R. , Preißler Kathleen , Glos Julian , Steinfartz Sebastian
Published: September 2021

Dispersal is a central process in ecology and evolution with far reaching consequences for the dynamics and genetics of spatially structured populations (SSPs). Individuals can adjust their decisions to disperse according to local fitness prospects, resulting in context‐dependent dispersal. By determining dispersal rate, distance and direction, these individual‐level decisions further modulate the demography, relatedness and genetic structure of SSPs. Here, we examined how context‐dependent dispersal influences the dynamics and genetics of a great crested newt (Triturus cristatus) SSP. We collected capture–recapture data of 5564 individuals and genetic data of 950 individuals across an SSP in northern Germany. We added genetic data from six sites outside this SSP to assess genetic structure and gene flow at a regional level. Dispersal rates within the SSP were high but dispersal distances were short. Dispersal was context‐dependent: individuals preferentially immigrated into high‐quality ponds where breeding probabilities were higher. The studied SSP behaved like a patchy population, where subpopulations at each pond were demographically interdependent. High context‐dependent dispersal led to weak but significant spatial genetic structure and relatedness within the SSP. At the regional level, a strong hierarchical genetic structure with very few first‐generation migrants as well as low effective dispersal rates suggest the presence of independent demographic units. Overall, our study highlights the importance of habitat quality for driving context‐dependent dispersal and therefore demography and genetic structure in SSPs. Limited capacity for long‐distance dispersal seems to increase genetic structure within a population and leads to demographic isolation in anthropogenic landscapes.
Association between plant nutrients, the development of Huanglongbing and abnormal growth symptoms in navel orange
Authors: Dong Z.‐H. , Low W. , K. Srivastava A. , Liu X.‐D. , Riaz M. , Tan Q.‐L. , Sun X.‐C. , Hu C.‐X.
Published: September 2021

Huanglongbing (HLB) causes extensive damage in citrus orchards worldwide. Symptoms include blotchy mottle leaf (BML) and little leaf chlorosis (LLC), and nutrient deficiency usually occurs concurrently. However, the relationship between plant mineral content and infection with Candidatus Liberibacter asiaticus (CLas) is not clearly established.

We sampled 7‐month‐old autumn shoots with three characteristic phenotypes, asymptomatic leaf (AL), BML and LLC, representing HLB disease progression, and further divided samples into CLas‐infected and uninfected based on PCR analysis.

HLB infection decreased transfer coefficients of Mg and K from leaf to phloem tissues through regulation of the transporter genes Cs3g03790.1 and PtrMGT5, increasing the content of leaf Mg and K. HLB infection also decreased leaf Zn, xylem Ca and phloem Ca and Zn content. Leaf Ca, Mg, Zn and B content decreased while leaf K content increased significantly as symptoms progressed from AL to LLC. The transport of P from leaf to phloem tissue, as evaluated by the transfer coefficient, was regulated by the transporter CsiPT2, resulting in irregular levels of leaf P.

Our results provide insights into the nutrient dynamics in Citrus in response to CLas infection and the progression of HLB symptoms.
A Framework that Considers the Impacts of Time, Cost, and Uncertainty in the Determination of the Cost Effectiveness of Toxicity‐Testing Methodologies
Authors: Price Paul S. , Hubbell Bryan J. , Hagiwara Shintaro , Paoli Greg M. , Krewski Daniel , Guiseppi‐Elie Annette , Gwinn Maureen R. , Adkins Norman L. , Thomas Russell S.
Published: September 2021

Regulatory agencies are required to evaluate the impacts of thousands of chemicals. Toxicological tests currently used in such evaluations are time‐consuming and resource intensive; however, advances in toxicology and related fields are providing new testing methodologies that reduce the cost and time required for testing. The selection of a preferred methodology is challenging because the new methodologies vary in duration and cost, and the data they generate vary in the level of uncertainty. This article presents a framework for performing cost‐effectiveness analyses (CEAs) of toxicity tests that account for cost, duration, and uncertainty. This is achieved by using an output metric—the cost per correct regulatory decision—that reflects the three elements. The framework is demonstrated in two example CEAs, one for a simple decision of risk acceptability and a second, more complex decision, involving the selection of regulatory actions. Each example CEA evaluates five hypothetical toxicity‐testing methodologies which differ with respect to cost, time, and uncertainty. The results of the examples indicate that either a fivefold reduction in cost or duration can be a larger driver of the selection of an optimal toxicity‐testing methodology than a fivefold reduction in uncertainty. Uncertainty becomes of similar importance to cost and duration when decisionmakers are required to make more complex decisions that require the determination of small differences in risk predictions. The framework presented in this article may provide a useful basis for the identification of cost‐effective methods for toxicity testing of large numbers of chemicals.
Sedimentology of a hypertidal point bar (Mont‐Saint‐Michel Bay, north‐western France) revealed by combining lidar time‐series and sedimentary core data
Authors: Cosma Marta , Lague Dimitri , D’Alpaos Andrea , Leroux Jerome , Feldmann Baptiste , Ghinassi Massimiliano
Published: September 2021

Intertidal meanders developed on salt marshes are known to expand and produce inclined heterolithic stratification rich in fine‐grained sediments and to bear evidence for rhythmic deposition in the upper part of the inner meander bend (i.e. the upper part of the point bar). This occurs because the lower point‐bar deposits are washed by strong currents, which remove mud drapes and develop discontinuous record of tidal cycles. Although these criteria are widely accepted, facies models for tidal point bars still lack a three‐dimensional perspective and overlook the along‐bend variability of sediment distribution. The present study focuses on a hypertidal point bar belonging to the upper‐intertidal domain of the Mont‐Saint‐Michel Bay (France), and it analyses the sedimentology of a 3D time‐framed accretionary package formed between 28 March 2012 and 29 November 2012 by means of lidar topographic data, geomorphological field surveys and sedimentological core data. To define the 3D time‐framed accretionary package, data from thirteen lidar (light detection and ranging) topographic surveys were used to create the point‐bar synthetic stratigraphy. Data show that over the study period the point bar expanded alternating deposition along its seaward and landward sides, pointing out the occurrence of depositional patterns more complex than a simple progressive expansion of the bend. The thickest deposits were accumulated in the point‐bar‐apex zone, where the largest amount of mud was also stored. High sediment accretion in the bend‐apex zone is ascribed to the development of low‐energy conditions due to flow and bed configuration. High accretion rate of the point‐bar‐apex zone promoted also a better preservation of rhythmites, which are almost missing from deposits accumulated along the point‐bar sides. This study remarks that preservation of mud and tidal rhythmites within intertidal‐point‐bar deposits is controlled, not only by their elevation with respect to the tidal range, but also by their location along the point bar.
Nearshore microfossil assemblages in a Caribbean reef environment show variable rates of recovery following Hurricane Irma
Authors: Mitchell Stephen , Pilarczyk Jessica E. , Spiske Michaela , Jaffe Bruce
Published: September 2021

Modern microfossil distributions reflect site‐specific habitats and provide an opportunity to assess sediment transport pathways in the nearshore environment. When applied to overwash deposits in the geological record, they provide insight into sediment provenance and transport, factors important for understanding patterns of frequency and intensity of past storms and tsunamis. Modern distribution studies are rare and often the first established ones occur immediately after an overwash event as part of a post‐event field survey. This is problematic because it is unclear what effect overwash events have on nearshore microfossil assemblages and what time interval is necessary for them to return to pre‐event conditions. This study documents the impacts of Hurricane Irma on nearshore sediments off the coast of Anegada, British Virgin Islands, using distributions of Homotrema rubrum, an encrusting foraminifer with a defined provenance in coral reefs. At four sampling intervals spanning two years, from six months pre‐Hurricane Irma to eighteen months after, surface sediment was collected from three transects on the northern and southern shores of the island. Partitioning Around Medoids cluster analysis revealed that Hurricane Irma introduced an influx of well‐preserved fragments into the reef flat and made the sediments more uniform, limiting the foraminifer’s utility as a known sediment transport indicator. The mixing of sediments along the two northern transects (reef proximal) persisted for seven to eighteen months before returning to near pre‐hurricane conditions. However, the southern transect (absence of reef), where Homotrema rubrum concentrations are significantly less, failed to recover within the time period assessed by this study, indicating a variable recovery period between Atlantic Ocean and Caribbean Sea facing shorelines. Results from this study suggest that a waiting period of at least eighteen months after a major storm is recommended before collecting surface sediment from the nearshore environments of reef‐dominated coastlines.
Global gendered anti‐Black belonging and racial ideology
Authors: Curington Celeste Vaughan , Bailey‐Hall Miara
Published: September 2021

We review theorizations of gendered anti‐Blackness and the scholarship on the politics of belonging. Bridging together this literature, we propose gendered anti‐Black non‐belonging as an alternative framework for addressing African descendant women's expressions and realities of belonging in the United States and Portugal. We select these two cases for their remarkably distinct—yet related—racial ideologies of the state. In the United States, colorblindness is the main ideology of the state whereas in Portugal anti‐racial ideology pervades. As we will highlight, the experiences of belonging among African descendant women in the United States and Portugal challenge the veracity of these racial ideologies which work to render gendered anti‐Black oppression invisible. In both cases, anti‐Black non‐belonging means that African descendant women are vulnerable to gendered state violence and racist practices impacting their individual and group belonging; as a result, the right for Black bodies to be in a particular place and space is constantly contested, and, often, violently regulated and disciplined. Yet, anti‐Black belonging is both a matter of oppression and resistance. African‐descendant women draw from their everyday knowledge of domination to employ resistance. In doing so, as we will argue, they rewrite the national narrative of race, gender and belonging in Portugal and the United States.
Group over need: Convergence in the influence of recipient characteristics on children's sharing in Iran and Canada
Authors: Keshvari Fatemeh , Hartlin Stephanie , Capozzi‐Davis Olivia , Moore Chris , Corbit John
Published: September 2021

Children are remarkably concerned with fairness, yet social evaluations often lead to partiality in fairness behavior. For instance, children share more generously with in‐group peers and allocate resources based on the material need of recipients. The goal of the present study was to examine how children developing in Canada and Iran privilege group status and recipient need when allocating resources. We assigned children (5–6 years of age) from Canada (n = 42) and Iran (N = 46) to teams using the minimal group paradigm and allowed them to allocate resources between themselves and recipients who varied in terms of need (high and low) and group status (in‐group and out‐group). No effect of recipient need was found in either society. In both societies, children were not impacted by need, but were more likely to give up a personal advantage and allocate resources equally with in‐group recipients. Our findings reveal convergence across diverse societies in the influence of in‐group bias on children's resource allocation decisions.
Wilful Non‐Compliance and the Threat of Disintegration in the EU’s Legal Order
Authors: Scicluna Nicole
Published: September 2021

This article focuses on the problem of wilful non‐compliance with EU law and the threat it poses of (partial) disorderly disintegration within the EU’s legal order. Taking the example of migration and asylum policy following on from the 2015 migration crisis, I positdifferentiated integration (DI), which occurs through processes that are formally mediated and collective, andnon‐compliance, which is unmediated and unilateral, as alternative strategies for member states which are unwilling to accept further integrative steps. While DI does carry costs, including the risk of legal fragmentation, I argue that it is a valuable tool for pre‐empting wilful non‐compliance – a phenomenon which both exposes and compounds the normative limits of EU law and is, consequently, more corrosive of the EU’s legal order. Thus, the article suggests that the EU ought to be more open to DI, especially when legislating in policy areas that are highly politicised.
Does marriage protect mental health? Evidence from the COVID‐19 pandemic
Authors: Jace Clara E. , Makridis Christos A.
Published: September 2021

Using weekly variation from April 23 to June 23 2020, we exploit the surge in unemployment over the coronavirus pandemic to identify the effects on mental health outcomes and the role of marital status as a protective factor for households. We find that married respondents are 1–2 percentage points less likely, relative to their unmarried counterparts, to experience mental health problems following declines in work‐related income since the start of the pandemic. Our results suggest that the combination of intrafamily substitution and the psychological benefits of marriage helps insure against unanticipated fluctuations in job and income loss.
Rhythmic neuronal activities of the rat nucleus of the solitary tract are impaired by high‐fat diet – implications for daily control of satiety
Authors: Chrobok Lukasz , Klich Jasmin D , Sanetra Anna M , Jeczmien‐Lazur Jagoda S , Pradel Kamil , Palus‐Chramiec Katarzyna , Kepczynski Mariusz , Piggins Hugh D , Lewandowski Marian H
Published: September 2021

Temporal partitioning of daily food intake is crucial for survival and involves the integration of internal circadian states and external influences such as the light–dark cycle and dietary composition. These intrinsic and extrinsic factors are interdependent with misalignment of circadian rhythms promoting body weight gain, while consumption of a calorie‐dense diet elevates the risk of obesity and blunts circadian rhythms. Recently, we defined the circadian properties of the dorsal vagal complex of the brainstem, a structure implicated in the control of food intake and autonomic tone, but whether and how 24 h rhythms in this area are influenced by diet remains unresolved. Here we focused on a key structure of this complex, the nucleus of the solitary tract (NTS). We used a combination of immunohistochemical and electrophysiological approaches together with daily monitoring of body weight and food intake to interrogate how the neuronal rhythms of the NTS are affected by a high‐fat diet. We report that short‐term consumption of a high‐fat diet increases food intake during the day and blunts NTS daily rhythms in neuronal discharge. Additionally, we found that a high‐fat diet dampens NTS responsiveness to metabolic neuropeptides, and decreases orexin immunoreactive fibres in this structure. These alterations occur without prominent body weight gain, suggesting that a high‐fat diet acts initially to reduce activity in the NTS to disinhibit mechanisms that suppress daytime feeding.

image

Key points

The dorsal vagal complex of the rodent hindbrain possesses intrinsic circadian timekeeping mechanisms

In particular, the nucleus of the solitary tract (NTS) is a robust circadian oscillator, independent of the master suprachiasmatic clock

Here, we reveal that rat NTS neurons display timed daily rhythms in their neuronal activity and responsiveness to ingestive cues

These daily rhythms are blunted or eliminated by a short‐term high‐fat diet, together with increased consumption of calories during the behaviourally quiescent day

Our results help us better understand the circadian control of satiety by the brainstem and its malfunctioning under a high‐fat diet
Ecosistemas colombianos. Amenazas y riesgos
Authors: Etter Andrés , Andrade Ángela , Zúñiga Mateo
Published: September 2021

La Lista Roja de Ecosistemas (LRE) proporciona un nuevo estándar unificado de carácter global, desarrollado por la UICN (Union Internacional de Conservación de la Naturaleza), cuyo propósito es orientar procesos de evaluación de riesgo que sean comparables y compatibles, acerca del estado de todos los ecosistemas del mundo, que pueda ser aplicado de manera coherente desde el nivel global, hasta los niveles regional, nacional o local. Esta metodología permite valorar y comparar la situación de riesgo de los ecosistemas, según criterios cuantitativos estandarizados, para por ejemplo hacer seguimiento de la efectividad de cumplimiento de acuerdos o políticas, o prever los riesgos e impactos de futuros proyectos de desarrollo. Aquí presentamos una primera evaluación nacional de los ecosistemas terrestres continentales de Colombia aplicando esta metodología, con el fin de aportar a la orientación de la planificación ambiental del país.
Echinocandins Accelerate Particle Transport Velocity in the Murine Tracheal Epithelium: Dependency on Intracellular Ca
2+
Stores
Authors: Müller Sabrina , Droll Maximilian Carl , Koch Christian , Weiterer Sebastian , Weigand Markus A. , Sander Michael , Henrich Michael
Published: September 2021

The mucociliary clearance of lower airways is modulated by different physiologic stimuli and also by pathophysiologic agents like polluting substances or pharmaceutical molecules. In the present investigation, we measured the particle transport velocity (PTV) of mouse tracheae as a surrogate for mucociliary clearance.
Identification of a Region in Shigella flexneri WzyB Disrupting the Interaction with Wzz
pHS2
Authors: Leo Vincenzo , Teh Min Yan , Tran Elizabeth N. H. , Morona Renato
Published: September 2021

Complex polysaccharide chains are synthesized by bacteria, usually at a regulated number of repeating units, which has broad implications for bacterial pathogenesis. One example is the O antigen (Oag) component of lipopolysaccharide that is predominantly synthesized by the Wzy-dependent pathway.
The Ubiquitin Sensor and Adaptor Protein p62 Mediates Signal Transduction of a Viral Oncogenic Pathway
Authors: Wang Ling , Howell Mary E. A. , Sparks-Wallace Ayrianna , Zhao Juan , Hensley Culton R. , Nicksic Camri A. , Horne Shanna R. , Mohr Kaylea B. , Moorman Jonathan P. , Yao Zhi Q. , Ning Shunbin
Published: September 2021

As a ubiquitin sensor and a signal-transducing adaptor, p62 is crucial for NF-κB activation, which involves the ubiquitin machinery in diverse contexts. However, whether p62 is required for EBV LMP1 activation of NF-κB is an open question.
Beyond Self-Resistance: ABCF ATPase LmrC Is a Signal-Transducing Component of an Antibiotic-Driven Signaling Cascade Accelerating the Onset of Lincomycin Biosynthesis
Authors: Koberska Marketa , Vesela Ludmila , Vimberg Vladimir , Lenart Jakub , Vesela Jana , Kamenik Zdenek , Janata Jiri , Balikova Novotna Gabriela
Published: September 2021

Resistance proteins are perceived as mechanisms protecting bacteria from the inhibitory effect of their produced antibiotics or antibiotics from competitors. Here, we report that antibiotic resistance proteins regulate lincomycin biosynthesis in response to subinhibitory concentrations of antibiotics.
Retroviruses of Bats: a Threat Waiting in the Wings?
Authors: Hayward Joshua A. , Tachedjian Gilda
Published: September 2021

Bats are infamous reservoirs of deadly human viruses. While retroviruses, such as human immunodeficiency virus (HIV), are among the most significant of virus families that have jumped from animals into humans, whether bat retroviruses have the potential to infect and cause disease in humans remains unknown.
LncRNA XR_001779380 Primes Epithelial Cells for IFN-γ-Mediated Gene Transcription and Facilitates Age-Dependent Intestinal Antimicrobial Defense
Authors: Gong Ai-Yu , Wang Yang , Li Min , Zhang Xin-Tian , Deng Silu , Chen Jessie M. , Lu Eugene , Mathy Nicholas W. , Martins Gislaine A. , Strauss-Soukup Juliane K. , Chen Xian-Ming
Published: September 2021

Epithelial cells along the mucosal surface provide the front line of defense against luminal pathogen infection in the gastrointestinal tract. These epithelial cells represent an integral component of a highly regulated communication network that can transmit essential signals to cells in the underlying intestinal mucosa that, in turn, serve as targets of mucosal immune mediators.
Mechanisms and Evolution of Heritable Microbial Density in Insect Hosts
Authors: Parker Benjamin J.
Published: September 2021

Within-host density is a critically important aspect of vertically transmitted symbioses that influences the fitness of both hosts and microbes. I review recent studies of symbiont density in insects, including my laboratory’s work on pea aphids and maternally transmitted bacteria.
Ecology and Medicine Converge at the Microbiome-Host Interface
Authors: Harrington Valerie , Lau Lilian , Seddu Kumba , Suez Jotham
Published: September 2021

The human body is home to a dense and diverse population of bacteria, viruses, and eukaryotes, collectively termed the microbiome. Research on host-microbiome interactions continuously demonstrates the importance of this microbial community to human physiology and its involvement in a myriad of diseases.
Microbiome Management for the 21st Century and Beyond
Authors: Hryckowian Andrew J.
Published: September 2021

As we learn about the sophisticated and far-reaching impacts that our resident microbiomes have on our biology, it is apparent that the tools we have for managing our microbiomes are rudimentary at best. For example, though antibiotics rid our microbiomes of bacterial pathogens, they target pathogens and commensals alike.
Hepatic sarcoidosis resembling primary sclerosing cholangitis
Authors: Chen Ying , Ciobanu Camelia , Mohrmann Laurel
Published: September 2021

We report the case of a 29-year-old man who presented with progressive weight loss, night sweats, abdominal pain and pruritus who was found to have obstructive jaundice and cholestatic pattern of liver injury on laboratory workup. Though findings on magnetic resonance cholangiopancreatography were initially concerning primary sclerosing cholangitis, he was ultimately diagnosed with biliary sarcoidosis after a liver biopsy. This case brings attention to the rare phenomenon of hepatic sarcoidosis causing hyperbilirubinemia and highlights the importance of reaching the correct diagnosis early, as the patient’s symptoms improved after initiation of steroids.
Whooping cough complicating pulmonary hypertension in pregnancy
Authors: Wong Tiffany Tuck Chin , Ng Yang Huang Grace , Yan Limin , Wright Ann
Published: September 2021

We report a case of a previously fit woman who presented at 26 weeks into her fourth pregnancy with a dry cough. Following a nasopharyngeal swab, she was diagnosed with apertussisinfection, and treated with antibiotics. A chest X-ray showed right atrial dilatation and an echocardiogram was scheduled outpatient. However, after re-presenting with worsening cough and dyspnoea, an inpatient echocardiogram was performed which suggested elevated pulmonary pressures with significant tricuspid regurgitation, as confirmed by subsequent cardiac catheterisation. She had an elective caesarean section at 34 weeks and underwent repeat right heart catheterisation which revealed persistent, and likely pre-existing, pulmonary arterial hypertension. This case highlights the importance of thorough assessment of non-obstetric symptoms in pregnancy in formulating alternative differentials, even after a diagnosis has been made, to prevent potentially life-threatening conditions from being missed. It also shows that although often associated, respiratory and cardiac causes may coexist separately.
Effects of 12-week full body resistance exercise on vertical jumping with and without military equipment in Slovenian Armed Forces
Authors: Kozinc Žiga , Šarabon N , Kovčan B , Simenko J , Pori P , Vodičar J , Hadzic V
Published: September 2021

Introduction

Jumping ability is one of the most important physical qualities in military personnel. Previous training intervention studies have shown equivocal effects on jumping ability. In this study, we assessed the effect of a 12-week resistance exercise programme on countermovement jump (CMJ) performance with and without military equipment.

Methods

Ninety-six members of the Slovenian Armed Forces (age range 20–47 years) were allocated to the intervention (n=65) and the control (n=32) group. The intervention group performed 2 sessions of full body resistance exercise per week for 12 weeks, while the control group continued with their regular training routine. Before and after the intervention, CMJ assessment using force plates was conducted with and without military equipment.

Results

CMJ testing with and without equipment both exhibited high to excellent relative and absolute reliability. The intervention elicited statistically significant (p=0.011–0.026; η2=0.05–0.06), but small improvements in CMJ height when performed without equipment (from 28.2±3.8 cm to 29.5±3.3 cm) and with equipment (from 25.3±3.7 cm to 27.1±6.1). Other variables showed even smaller or trivial changes.

Conclusions

This study suggests that CMJ with equipment could be a reliable tool to assess jumping performance specific to requirements of military work, which would increase the ecological validity of the testing. The present structured full-body training intervention showed modest improvements in jumping ability in both testing conditions.

Trial registration number

NCT0341546.
Reviewing the needs of forward deployed critical care: South Sudan and the future
Authors: Bulleid Victoria , Hooper T , Nordmann G
Published: September 2021

The UK military medical treatment facility (MTF) that deployed to the United Nations Mission in South Sudan in 2017 was based on a facility that can provide damage control surgery and resuscitation for soldiers with ballistic trauma injuries. It had to be supplemented with additional medical equipment and drugs that could support a peacekeeping mission in Africa. The clinicians used this experience and opportunity to review the critical care capability of UK Army Medical Services forward MTFs and recommend changes to reflect the increasing contemporaneous need on recent deployments to support more casualties with medical, infectious diseases and other non-battle injuries and illnesses. A concurrent review of the facility’s critical care transfer equipment was also undertaken and allowed it to be adapted for use as either transfer equipment or as a critical care surge capability, to increase the facility’s critical care capacity.
In-hospital gastrointestinal bleeding in patients with acute myocardial infarction: incidence, outcomes and risk factors analysis from China Acute Myocardial Infarction Registry
Authors: Shi Wence , Fan Xiaoxue , Yang Jingang , Ni Lin , Su Shuhong , Yu Mei , Yang Hongmei , Yu Mengyue , Yang Yuejin
Published: September 2021

Objective

To investigate the incidence of gastrointestinal bleeding (GIB) in patients with acute myocardial infarction (AMI), clarify the association between adverse clinical outcomes and GIB and identify risk factors for in-hospital GIB after AMI.

Design

Retrospective cohort study.

Setting

108 hospitals across three levels in China.

Participants

From 1 January 2013 to 31 August 2014, after excluding 2659 patients because of incorrect age and missing GIB data, 23 794 patients with AMI from 108 hospitals enrolled in the China Acute Myocardial Infarction Registry were divided into GIB-positive (n=282) and GIB-negative (n=23 512) groups and were compared.

Primary and secondary outcome measures

Major adverse cardiovascular and cerebrovascular events (MACCEs) are a composite of all-cause death, reinfarction and stroke. The association between GIB and endpoints was examined using multivariate logistic regression and Cox proportional hazards models. Independent risk factors associated with GIB were identified using multivariate logistic regression analysis.

Results

The incidence of in-hospital GIB in patients with AMI was 1.19%. GIB was significantly associated with an increased risk of MACCEs both in-hospital (OR 2.314; p<0.001) and at 2-year follow-up (HR 1.407; p=0.0008). Glycoprotein IIb/IIIa (GPIIb/IIIa) receptor inhibitor, percutaneous coronary intervention (PCI) and thrombolysis were novel independent risk factors for GIB identified in the Chinese AMI population (p<0.05).

Conclusions

GIB is associated with both in-hospital and follow-up MACCEs. Gastrointestinal prophylactic treatment should be administered to patients with AMI who receive primary PCI, thrombolytic therapy or GPIIb/IIIa receptor inhibitor.

Trial registration number

NCT01874691.
Delay in the induction of labour process: a retrospective cohort study and computer simulation of maternity unit workload
Authors: Robertson Katherine , Hardingham Ian , D'Arcy Rhiannon , Reddy Aparna , Clacey Joe
Published: September 2021

Objectives

Delay in the induction of labour (IOL) process is associated with poor patient experience and adverse perinatal outcome. Our objective was to identify factors associated with delay in the IOL process and develop interventions to reduce delay.

Design and settings

We performed a retrospective cohort study of maternity unit workload in a large UK district general hospital. Electronic hospital records were used to quantify delay in the IOL process and linear regression analysis was performed to assess significant associations between delay and potential causative factors. A novel computer maternity unit simulation model, MUMSIM (Maternity Unit Management SIMulation), was developed using real-world data and interventions were tested to identify those associated with a reduction in delay.

Participants

All women giving birth at Stoke Mandeville Hospital, Buckinghamshire National Health Service (NHS) Trust in 2018 (n=4932).

Primary outcome measure

Delay in the IOL process of more than 12 hours.

Results

The retrospective analysis of real-world maternity unit workload showed 30% of women had IOL and of these, 33% were delayed >12 hours with 20% delayed >24 hours, 10% delayed >48 hours and 1.3% delayed >72 hours. Delay was significantly associated with the total number of labouring women (p=0.008) and the number of booked IOL (p=0.009) but not emergency IOL, spontaneously labouring women or staffing shortfall. The MUMSIM computer simulation predicted that changing from slow release 24-hour prostaglandin to 6-hour prostaglandin for primiparous women would reduce delay by 4% (p<0.0001) and that additional staffing interventions could significantly reduce delay up to 17.9% (p<0.0001).

Conclusions

Planned obstetric workload of booked IOL is associated with delay rather than the unpredictable workload of women in spontaneous labour or emergency IOL. We present a novel maternity unit computer simulation model, MUMSIM, which allows prediction of the impact of interventions to reduce delay.
Protocol for ‘virtual presence’: a qualitative study of the cultural dialectic between loneliness and technology
Authors: Johannessen Lars E F , Engebretsen Eivind , Greenhalgh Trisha , Hughes Gemma , Köhler-Olsen Julia , Rasmussen Erik Børve , Haldar Marit
Published: September 2021

Introduction

Most research on loneliness comes from the health sciences, statistically seeking to measure the health-related effects of feeling alone or isolated. There is a need to expand on this understanding and explore loneliness as a more complex social phenomenon. In this article, we present a qualitative design for studying the intersection between loneliness, technology and culture. Conceptualising this as the cultural dialectic between loneliness and technology, we aim to unpack the reciprocal ways by which understandings of loneliness shape technology, while technologies also affect society’s understandings of loneliness. In elucidating this dialectic, we aim to develop new knowledge and a novel theoretical framework for understanding loneliness and its technological solutions, which, in turn, can enable better solutions to contemporary problems of loneliness.

Methods and analysis

We will adopt a qualitative approach that combines interviews, participant observation and textual analysis to explore loneliness and its technological solutions from the perspectives of policy-makers, producers, professionals and users in Norway and the UK. The data will be analysed through an analytical framework combining insights from discourse theory and philosophical debates on presence, which will allow us to capture and rethink fundamental assumptions about loneliness and technology. Outcomes will be revised understandings of loneliness, relevant to researchers, entrepreneurs, policy-makers, clinicians, educators and the broader public.

Ethics and dissemination

The project has been evaluated and approved by the data protection officer at Oslo Metropolitan University and by the Norwegian Social Science Data Services. Additional ethical approval for data collection in the UK has been provided by the University of Oxford Interdivisional Research Ethics Committee. Informed consent will be obtained from all participants. Findings will be disseminated through peer-reviewed publications, international conference presentations and lay media.
Instruments for assessing the preferences for everyday living of older people with various care needs: protocol for an evidence map
Authors: Rommerskirch-Manietta Mike , Purwins Daniel , Van Haitsma Kimberly , Abbott Katherine , Roes Martina
Published: September 2021

Introduction

Consideration of the preferences for everyday living of older people with various care needs is a prerequisite for person-centred and evidence-based nursing care. Knowledge of and respect for these preferences by nursing staff are associated with better care outcomes for older people with various care needs. To assess preferences in a structured way, instruments focusing on different topics of everyday living appear to be useful. It is unclear which instruments exist for assessing preferences for everyday living. The aim of this planned review is to identify relevant instruments for assessing the preferences for everyday living of older people with various care needs in the form of an evidence map. Additionally, gaps requiring further research will be presented.

Methods and analysis

To identify the different instruments, we will conduct a systematic search in the electronic databases MEDLINE (via PubMed), CINAHL and PsycINFO (via EBSCO). In addition, we will perform backward and forward citation tracking via reference lists and Google Scholar. The identified records will be independently screened (title/abstract and full text) by two reviewers. Data from the included studies will be extracted independently by the same two reviewers. In all three steps, the results will be checked for deviations, and if there are any deviations, they will be discussed. If no consensus can be achieved through discussion, a third reviewer will be engaged. All study designs will be included, and there will be no limitations regarding the publication status or time period. We will include all studies published in English and German that use instruments focusing on the assessment of preferences for everyday living in people older than 60 years of age with various care needs. For data charting, we will extract the number, categories and types of preferences, the care setting for which the instrument was developed and, if available, psychometric properties. Finally, the various extracted results will be presented in the form of tables and a bubble plot.

Ethics and dissemination

There are no ethical concerns related to the construction of an evidence map, and ethical approval was given by the Witten/Herdecke University (application number 226/2020). We will discuss our results with practitioners in the field of nursing care and persons with various care needs. We will also make our results available to practitioners in an upcoming Project (PELI-D II) and to the public at (inter)national conferences and in the form of practice and peer-reviewed articles.
Early outcomes of a rural-oriented physician education programme against rural physician shortages in Guangxi province: a prospective cohort study
Authors: Shen Ying , Huang Xing , Li Hong , Chen Enran , Kong Yan , Yu Jia , Liu Xiaoyun , Mobarak Siam AI , Zuo Yanli
Published: September 2021

Objectives

This study aimed to investigate early outcomes of one of the first medical undergraduate education programmes with a goal of mitigating severe rural physician shortages in China, which was developed by Guangxi Medical University (GXMU) and was called the Rural-oriented Free Tuition Medical Education (RTME)-GXMU programme.

Design

A prospective cohort study comprising a baseline investigation and follow-up research was conducted to dynamically observe the evolution of the RTME-GXMU programme that began since 2010.

Participants

380 RTME-GXMU graduates and 383 non-RTME-GXMU graduates from GXMU who completed trainings between 2015 and 2018 were recruited in the baseline investigation. Among them, 285 RTME-GXMU and 283 non-RTME-GXMU graduates responded to the follow-up research.

Main outcome measures

Graduate practice location, registered specialty, passing rate of the National Medical Licensing Examination (NMLE), specialty of residency programme and contract compliance for the RTME-GXMU graduates.

Results

By the end of 2018, 100% of the 2015 RTME-GXMU graduates enrolled in this study practised in rural township health centres and registered themselves as general practitioners (GPs). All the RTME-GXMU graduates had completed or were attending residency programmes of general practice (GP). The above data stood in stark contrast to that of the non-RTME-GXMU graduates among whom as few as 1.06% worked in rural areas, 2.13% registered as GPs and less than 3% chose GP residency programmes. No significant differences were detected on passing rates of the NMLE between the two groups. Only one RTME-GXMU graduate broke the contract and dropped off the programme.

Conclusions

The RTME-GXMU programme has achieved encouraging early outcomes. Reduced entry score and proper usage of urban primary care institutions are two key approaches contributing to these positive early results.
Maternal experience of intermittent kangaroo mother care for late preterm infants: a mixed-methods study in four postnatal wards in China
Authors: Zhang Bo , Yue Jieya , Duan Zhiying , Zhao Yingxi , Williams Sarah , Huang Limin , Zhang Xiaoqin , Wu Wenli , Zhang Lin , Liu Jun , Zhao Gengli
Published: September 2021

Objective

To describe how mothers of late preterm infants experienced the provision of intermittent kangaroo mother care (KMC) in four postnatal wards in different hospitals in China, under a pilot KMC project.

Design

A concurrent mixed-methods approach incorporating quantitative maternal questionnaires and qualitative semistructured interviews.

Setting

Four postnatal wards in level-III hospitals based in different provinces of Southeast and Northwest China.

Participants

All 752 mothers who provided intermittent KMC to their late preterm newborns in the four participating postnatal wards consented to participate in the study (quantitative component), as well as six nurses, two obstetricians and two mothers from two of the participating postnatal wards (qualitative component).

Outcome measures

Maternal KMC experiences during a hospital stay, patients’ perceptions of KMC initiation, processes, benefits and challenges.

Results

Most mothers had not heard of KMC before being introduced to it in the postnatal ward. On average, mothers and newborns stayed in postnatal wards for 3.6 days; during their stay, mothers provided an average of 3.5 KMC sessions, which is an average of 1.1 sessions a day. Each KMC session lasted an average of 68 min, though there was much variation in the length of a session. Common reasons given for discontinuing a KMC session included restroom use, infant crying and perceived time limitations. Some mothers would have preferred to provide KMC for longer periods of time and nurses encouraged this. Most mothers experienced no difficulty providing KMC, received support from family and medical staff and intended to continue with KMC postdischarge.

Conclusion

In order to improve the maternal experience of KMC, it is recommended that raising awareness of KMC should be included in antenatal care and after birth. Longer periods of KMC provision should be encouraged, greater privacy should be provided for mothers providing KMC in postnatal wards and family members should be encouraged to support KMC.
Primary healthcare system readiness to prevent and manage non-communicable diseases in Bangladesh: a mixed-method study protocol
Authors: Kabir Ashraful , Karim Md Nazmul , Billah Baki
Published: September 2021

Introduction

The burden of non-communicable diseases (NCDs) is rapidly increasing in Bangladesh. Currently, it contributes to 67% of annual deaths, and accounts for approximately 64% of the disease burden. Since 70% of the Bangladeshi population residing in the rural area rely on the primary healthcare system, assessment of its capacity is crucial for guiding public health decisions to prevent and manage NCDs. This protocol is designed to recognise and assess the Bangladeshi health system’s readiness for NCDs at the primary level.

Methods and analysis

The study will use a mixed-method design. Numerical data will be collected using households and health facilities surveys, while qualitative data will be collected by interviewing healthcare providers, policy planners, health administrators and community members. The WHO’s Service Availability and Readiness Assessment (SARA) methodology and Package of Essential Non-communicable (PEN) Disease Interventions for Primary Healthcare reference manuals will be used to assess the readiness of the primary healthcare facilities for NCD services. Furthermore, Health System Dynamics Framework will be used to examine health system factors. Using the supportive items outlined in the WHO PEN package, and indicators proposed in WHO SARA methodology, a composite score will be created to analyse facility-level data. Two independent samples t-test, analysis of variance and χ2test methods will be used for bivariate analysis, and multiple regression analysis will be used for multivariable analysis. Complementarily, the thematic analysis approach will be used to analyse qualitative data.

Ethics and dissemination

The project has been approved by the Monash University Human Research Ethics Committee (Project ID: 27112), and Bangladesh Medical Research Council (Ref: BMRC/NREC/2019-2022/270). The research findings will be shared through research articles, conference proceedings or in other scientific media. The reports or publications will not have any information that can be used to identify any of the study participants.
Could a D-dimer/fibrinogen ratio have a role in ruling-out venous thromboembolism?
Authors: Marcianò Teodoro , Franchini Stefano
Published: September 2021

Background

Diagnosis of venous thromboembolism (VTE) requires chest CT angiography for pulmonary embolism and venous ultrasound for deep vein thrombosis. To reduce imaging, guidelines recommend D-dimer levels to rule-out VTE in patients with a low pre-test probability. The most widely used D-dimer cut-off is 500 ng/mL. This cut-off has low specificity, meaning many patients without disease require imaging.

Methods

In this retrospective chart review, we evaluated the diagnostic performance of the D-dimer/fibrinogen ratio (DFR) for identifying thromboembolism and compared it to the performance of two different D-dimer cut-offs (500 ng/mL and 1000 ng/mL) in patients who underwent a chest CT angiography or a venous ultrasound in the ED of San Raffaele Hospital, Italy, in 2017. Patients had a retrospective Wells score calculated after chart review, identifying both high-risk and low-risk pre-test probability patients for this study and low probability patients were further stratified into low-risk of deep vein thrombosis or pulmonary embolism.

Results

Enrolled patients included 92 with suspected pulmonary embolism and 154 with suspected deep vein thrombosis; of whom 67 (27%) were diagnosed with VTE. The most accurate cut-off for DFR in terms of discriminative power was 2.65. In the whole sample and in low-risk patients, this cut-off had the same sensitivity values of the 500 ng/mL D-dimer cut-off (97% (95% CI: 89.8% to 99.2%)), while slightly lower sensitivity values were found for the 1000 ng/mL D-dimer cut-off (95.5% (95% CI: 87.6% to 98.5%)). Specificity was higher for the 2.65 DFR cut-off (55.3% (95% CI: 48.0% to 62.4%)) in the whole sample compared with both 500 ng/mL D-dimer cut-off (22.9% (95% CI: 17.4% to 29.6%)) and 1000 ng/mL D-dimer cut-off (45.8% (95% CI: 38.7% to 53.1%)). Similar results were found in all subgroups.

Conclusion

A DFR, with a cut-off of 2.65, may improve the specificity for VTE patients when compared with D-dimer alone in high-risk VTE emergency medicine populations. This is exploratory information only, needing evaluation in prospective, multicentre studies, prior to consideration for use in routine clinical work.
Comparative clinicopathological and immunohistochemical study of micronodular thymoma and micronodular thymic carcinoma with lymphoid stroma
Authors: Liu Ping Ping , Su Yun Chao , Niu Yun , Shi Yan Fen , Luo Jie , Zhong Ding Rong
Published: September 2021

Aim

To elucidate the clinicopathological and immunohistochemical characteristics of micronodular thymomas (MNTs) and micronodular thymic carcinomas (MNCs) with lymphoid stroma.

Methods

We examined four cases of MNTs and three cases of MNCs pathologically and immunohistochemically.

Results

There were prominent cystic changes infive of the seven cases. The neoplasms contained epithelial tumour cells arranged in a micronodular growth pattern lined by cystic walls and separated by abundant lymphoid stroma. Only the tumour cell component of MNCs showed signs of malignancy characterised by cytological atypia and increased mitotic activity. Neoplastic MNC epithelial cells showed strong positivity for CD5 and CD117. However, no immature lymphocytes (TdT-positive and CD99-positive) were present in and around the tumour nodules. None of the patients died or suffered from disease due to MNTs or MNCs.

Conclusion

MNTs and MNCs are rare and less aggressive forms of thymic tumours and can be differentially diagnosed by immunohistochemistry.