bluuebunny/crossref_metadata_2025 huggingface dataset:
Implementation of an Online External Ventricular Drain Training Module—An Educational Initiative to Improve Proficiency of Perioperative Health Care Providers: Results of a Retrospective Study
Authors: Lele Abhijit V. , Takala Riikka S.K. , Athiraman Umeshkumar , Schloemerkemper Nina , Gollapudy Suneeta , Vagnerova Kamila , Vincent Anita , Roberts Katherine E. , Wahlster Sarah , Vavilala Monica S.
Published: October 2021

Background:

An external ventricular drain (EVD) training module may improve the knowledge and proficiency of perioperative health care providers (HCPs).

Methods:

We examined knowledge gaps, self-reported comfort in managing EVDs, and improvement in self-assessment scores among HCPs from 7 academic medical centers based on an online EVD training module.

Results:

Of the 326 HCPs who completed the module, 207 (70.6%) reported being uncomfortable managing EVDs. The median pretest scores were 6 (interquartile range=2), and posttest scores were 8 (interquartile range=1), out of a maximum possible score of 9. The most frequent incorrectly answered questions were: (a) maximum allowed hourly cerebrospinal fluid volume drainage (51%), (b) the components of a normal intracranial pressure waveform (41%), and (c) identifying the correct position of the stopcock for accurate measurement of intracranial pressure (41%). The overall gain in scores was 2 (interquartile range=2) and highest among HCPs who had managed 1 to 25 EVDs (2.51, 95% confidence interval: 2.23-2.80), and without self-reported comfort in managing EVDs (2.26, 95% confidence interval: 1.96-2.33, P<0.0001). The majority of participants (312, 95.7%) reported that the training module helped them understand how to manage EVDs, and 276 (84.7%) rated the module 8 or more out of 10 in recommending it to their colleagues.

Conclusions:

This online EVD training module was well-received by participants. Overall, improved scores reflect enhanced knowledge among HCPs following completion of the module. The greatest benefit was observed in those reporting less experience and feeling uncomfortable in managing EVDs. The impact on the reduction in EVD-associated adverse events deserves further examination.
Fracture Mapping of Both-Column Acetabular Fractures
Authors: Yin Yingchao , Zhang Ruipeng , Hou Zhiyong , Fan Shicai , Zhuang Yan , Yi Chengla , Chen Hua , Zhang Yingze
Published: October 2021

Objectives:

To characterize the location and frequency of the fracture lines and comminution zones of both-column fractures using fracture mapping.

Methods:

Both-column fractures were retrospectively reviewed in 4 Level 1 trauma centers. Mimics software was used to reconstruct the both-column fractures and simulate the fracture reduction. Then, the fracture lines and the intra-articular and extra-articular comminution zones were drawn on a 3-dimensional innominate bone template. The distribution of fracture lines and fracture fragments were also mapped on the two-dimensional template of the acetabulum. All the included patients were divided into low-variety group and high-variety group according to the anterior column fracture line above or below the anterior superior spine. The anatomical characteristics of the posterior wall fragment were also analyzed in these 2 groups.

Results:

Seventy-eight patients with both-column fracture were included. The T type or inverted Y type main fracture lines divided the innominate bone into low-variety (n = 11) and high-variety (n = 67) both-column fractures. The extra-articular comminution zones are usually distributed between the posterior iliac fragment and anterior column fragment. High-variety type both-column fractures are usually combined with high and sharp posterior wall fragments, whereas low-variety type both-column fractures are usually accompanied by low and flat posterior wall fragments. The comminution zones in the acetabulum are mostly concentrated in the anterior and inferior parts of the acetabulum.

Conclusions:

The innominate bone is divided into 3 major parts in the both-column fracture, and the fracture center is located at the proximal of the acetabular dome. The both-column fractures are divided into low-variety and high-variety patterns. The location of the anterior column fracture determined the characteristics of the posterior wall fragment.
Optimal Teicoplanin Dosing Regimen in Neonates and Children Developed by Leveraging Real-World Clinical Information
Authors: Yamada Takaaki , Emoto Chie , Fukuda Tsuyoshi , Motomura Yoshitomo , Inoue Hirosuke , Ohga Shouichi , Ieiri Ichiro
Published: October 2021

Background:

Teicoplanin is a glycopeptide antibiotic used for the treatment of methicillin-resistant Staphylococcus aureus infections. To ensure successful target attainment, therapeutic drug monitoring–informed dosage adjustment is recommended. However, it relies on the experience of the clinician and the frequency of drug measurements. This study aimed to design a new optimal dosing regimen of teicoplanin with a maintenance dosing strategy for neonates and children based on their physiological characteristics.

Methods:

Data from teicoplanin-treated patients (n = 214) were collected from electronic medical records. Covariate analyses were performed using population pharmacokinetic (PK) modeling with 399 serum teicoplanin concentrations from 48 neonates and 166 children. Multiple PK simulations were conducted to explore optimal dosing regimens that would allow control of the trough concentration to the target of 15–30 mg/L quicker than the current standard regimen.

Results:

Allometrically scaled body weight, postmenstrual age (PMA), renal function, and serum albumin were implemented as substantial covariates for teicoplanin clearance in a two-compartment PK model. Covariate analyses and comprehensive simulation assessments recommended the following modifications to the current regimen: (1) decreased dose for premature babies (PMA ≤28 weeks), (2) decreased dose for children with renal dysfunction, and (3) increased dose for children (0.5–11 years) with an estimated glomerular filtration rate of ≥90 mL/min/1.73 m2.

Conclusions:

This study leverages real-world clinical information and proposes new optimal dosing regimens for teicoplanin in neonates and children through PK modeling and simulation analyses, taking into account the age, including PMA, and renal function of patients.
Perceptions of secondary school teachers towards school expulsion of pregnant adolescents at Igunga District, Tanzania—a qualitative study
Authors: Nkata Hamida , Marques Sandra C.S. , Nyamhanga Tumaini , Barros Henrique
Published: October 2021

Background:

In Tanzania, adolescent pregnancy results in a denial of the girl's fundamental right to education. School expulsion of pregnant adolescents is a common practice exercised by teachers in this country for decades. This study aimed to explore the perceptions and feelings of secondary school teachers towards this practice.

Methods:

The study used a qualitative approach comprising focus groups and individual semistructured interviews with a purposive sample of sixteen teachers and nine headmasters (n = 25) from nine secondary schools of the rural Igunga district, in Tabora region, Tanzania. Data was collected in March to June 2017 and submitted to thematic analysis.

Results:

Though most participants were not satisfied with the practice, their role on the expulsion of pregnant students was perceived as mandatory by law and regulations. Main argument in favor was its deterrent effect, yet the review of schools’ registries did not sustain that perception. Stigma and fear of contamination added a relevant contribution to its implementation. Conflicting feelings among teachers were also disclosed.

Conclusion:

This study was of most value to understand current perceptions and feelings of those who exercise the practice of banning pregnant adolescents from school in Tanzania, while having identified some of the cultural and social believes acting as influential factors in its pervasiveness. International and national human rights organizations should increase their efforts and campaigns in order to strength social awareness of the benefit of females’ education to society as a whole and of adopting policies and practices in support of their equal right to education.
Frostbite in Southwest China: A Single-Center Retrospective Analysis
Authors: Xiao Yue , Wen Ding-Ke , Hao Dan , Li Yan-Mei , Jiang Xian
Published: October 2021

Objective:

The current study aimed to profile the demographics, hematological index, and extrinsic factors of patients treated for frostbite in a single center in Southwest China.

Methods:

We collected the clinical data of patients with frostbite admitted to a regional hospital from January 1st, 2009 to January 1st, 2019. The baseline information was summarized, and the causes and hematological indexes of frostbite were analyzed.

Results:

The study cohort comprised 27 patients. The median patient age was 22 years (range 14–81 years). All frostbite injuries occurred between September 22nd and April 27th. Half of the patients were Tibetans. Cold injuries in Tibetan patients were associated with pilgrimage (70%, 9/13) and grazing (15%, 2/13), while the leading causes of frostbite in Han residents of the Southwest China basin were mandatory fieldwork without protection (36%, 5/14) and loss of consciousness (36%, 5/14). The hematological examination findings did not significantly differ between amputees and those who did not undergo amputation. Several hematological indexes significantly differed between patients with good outcomes versus those with poor outcomes.

Conclusion:

To avoid severe frostbite damage, routine mandatory activities like pilgrimage should be conducted under proper protection in extreme weather. Hematological indexes such as the red blood cell count, hematocrit, and hemoglobin level should be monitored closely by first-line medical personnel during hospitalization, as these indexes might indicate the outcome of frostbite. Further research is needed to improve the management of patients with frostbite in Southwest China.
The Cochlear Implant Use Questionnaire: Assessing Habits and Barriers to Use
Authors: Holder Jourdan T. , Mayberry Lindsay S. , Gifford René
Published: October 2021

Objective:

The objective was to design a questionnaire to identify daily cochlear implant (CI) use habits and barriers to daily CI use and to administer this questionnaire to adult CI users. We hypothesized that recipients who reported a greater number of barriers to daily CI use would show lower daily CI use.

Study Design:

Questionnaire.

Setting:

Academic medical center.

Patients:

Hundred adult CI recipients.

Main Outcome Measures:

Questionnaire responses and amount of CI use per day as measured from the CI software.

Results:

The cochlear implant use questionnaire (CIUQ) was created and responses were obtained from 100 participants. The CIUQ yielded an average overall score of 23 (range, 3–54) out of 100; responses were variable, and CI recipients experienced different barriers to using their CI processor. The CIUQ overall score was significantly correlated with recipients’ daily CI use (h/d) (r
s = –0.561, p < 0.0001, 95% confidence interval [–0.694, –0.391]), which provides evidence of construct validity. Responses were immediately useful for identifying and overcoming barriers to consistent CI use with our study participants.

Conclusions:

Increasing evidence suggests that daily CI use is correlated with speech recognition outcomes. To optimize outcomes, clinicians should consider implementing this questionnaire to identify and overcome barriers to consistent, full-time CI processor use.
Basic life support and systems saving lives
Authors: Olasveengen Theresa Mariero , Semeraro Federico
Published: October 2021

Purpose of review

To describe recent science in basic life support (BLS) after cardiac arrest and how evolving knowledge in resuscitation is changing current guidelines and practices.

Recent findings

The core elements of BLS have remained mostly unchanged since 2005 when Cardiopulmonary Resuscitation recommendations were changed from 2 ventilations to 15 compressions and up to three stacked shocks for shockable rhythms, to 30 compressions to 2 ventilations and single shocks. Since 2010, basic life support has largely focused on the importance of providing high-quality CPR for professional and lay rescuers alike. The most recent resuscitation updates has seen an increased focus on the systems perspective. The ‘Systems Saving Lives’ concept emphasizes the interconnection between community and Emergency Medical Services (EMS). The main changes in current resuscitation practice are within three important basic life support domains: recognition of cardiac arrest, interaction between rescuers and EMS and improving resuscitation quality.

This review highlights the importance of strengthening both community and emergency medical services efforts to improve outcomes in cardiac arrest. Strategies that enhance the communication and collaboration between lay rescuers and professional resuscitation systems are important new avenues to pursue in developing systems that save more lives.
A 3-Dimensional Coculture Model to Visualize and Monitor Interaction Between Pancreatic Cancer and Islet β Cells
Authors: Kumar Sandeep , Jach Daria , Macfarlane Wendy , Crnogorac-Jurcevic Tatjana
Published: October 2021

Objectives

To facilitate exploring a link between pancreatic ductal adenocarcinoma (PDAC) and diabetes mellitus, we constructed a novel 3-dimensional (3D) in vitro coculturing system for studying interactions between PDAC and islet cells.

Methods

Adopting a 3D rotary cell culture system, we have cocultured several PDAC cell lines and MIN6 islet β cells. The cellular morphology and viability of both cell types were investigated by time-lapse imaging, confocal and scanning electron microscopy, and immunohistochemistry.

Results

The developed coculture method enabled the formation of 3D PDAC and β-cell spheroids (pseudo islets). We showed that surface morphology and growth of cultured cells mimicked their in vivo appearance. In addition, the coculture demonstrated the affinity of the PDAC cells to grow around and invade the pseudo islets.

Conclusions

Using rotary cell culture system, we have established a simple in vitro 3D pancreatic model. It is a flexible culture system that can easily be expanded with the addition of various stromal/neural components to further mimic in vivo conditions, thus enabling holistic investigation of the endocrine and exocrine pancreas.
Clinical Significance of Postoperative Antibiotic Treatment for Positive Islet Cultures After Total Pancreatectomy With Islet Autotransplantation
Authors: Naples Robert , Perlmutter Breanna C. , Thomas Jonah D. , McMichael John , Bottino Rita , Solomina Julia , Trucco Massimo , Augustin Toms , Simon Robert , Walsh R. Matthew
Published: October 2021

Objectives

Islet cultures are routinely performed in total pancreatectomy with islet autotransplantation (TPIAT), and the need for empiric antibiotic treatment based on culture results is unknown. We evaluated the effect of postoperative antibiotic treatment for positive islet cultures on clinical infection.

Methods

Seventy-nine patients undergoing TPIAT were reviewed. Prophylactic perioperative ceftriaxone and metronidazole were administered, and transplanted islet preparations included ciprofloxacin. Postoperative antibiotics were not routinely given for positive cultures unless a clinical infection was suspected. The primary end point was 30-day infectious complications.

Results

Fifty-one patients (65%) had a positive culture. Overall, 39 patients (87%) had organisms susceptible to our perioperative antibiotic regimen. There was no difference in the infectious complication rate between those with positive compared with negative cultures (16% vs 29%, P = 0.17). Patients with a positive culture had similar 30-day postoperative infectious complication rates whether receiving postoperative antibiotics (n = 7) or not (14% vs 16%, P = 0.91). Only 1 patient had a correlation of clinical and islet cultures.

Conclusions

Beyond prophylactic antibiotics, empiric antibiotic treatment for a positive culture is not warranted and provides a rationale for the abandonment of routine cultures in TPIAT.
Impact of Different Patterns of Organ Failure on Mortality in Acute Necrotizing Pancreatitis
Authors: Singh Anupam K. , Samanta Jayanta , Shukla Jayendra , Birda Chhagan Lal , Dhar Jahnvi , Gupta Pankaj , Kumar-M Praveen , Gupta Vikas , Yadav Thakur Deen , Sinha Saroj K. , Kochhar Rakesh
Published: October 2021

Objectives

Organ failure (OF) and infected necrosis (IN) are the most important predictors of mortality in necrotizing acute pancreatitis (AP). We studied the relationship between timing (onset and duration) and patterns of OF with mortality and the impact of IN on mortality.

Methods

Consecutive patients with necrotizing AP between January 2017 and February 2020 were analyzed retrospectively for OF and its impact on outcome. Organ failure was divided as single OF, simultaneous multiple OF (SiMOF) and sequential multiple OF (SeMOF). Mortality was compared for timing of onset, total duration and patterns of OF.

Results

Among 300 patients with necrotizing AP, 174 (58%) had OF. Mortality was not associated with onset of OF (P = 0.683) but with duration of OF (P = 0.006). Mortalities for single OF, SiMOF, and SeMOF were 11.8%, 30.4%, and 69.2% respectively (P < 0.001). On Cox proportional hazard analysis, adjusted hazard ratio of risk of mortality for OF with IN versus IN, SiMOF versus single OF and SeMOF versus single OF was 3.183, 2.878, and 8.956, respectively (P = 0.023, <0.030, and <0.001, respectively).

Conclusions

Duration of OF was associated with increased mortality and SeMOF had worse outcome than single OF and SiMOF.
Early Detection of Pancreatic Cancer
Authors: Kenner Barbara J. , Abrams Natalie D. , Chari Suresh T. , Field Bruce F. , Goldberg Ann E. , Hoos William A. , Klimstra David S. , Rothschild Laura J. , Srivastava Sudhir , Young Matthew R. , Go Vay Liang W.
Published: October 2021

The potential of artificial intelligence (AI) applied to clinical data from electronic health records (EHRs) to improve early detection for pancreatic and other cancers remains underexplored. The Kenner Family Research Fund, in collaboration with the Cancer Biomarker Research Group at the National Cancer Institute, organized the workshop entitled: “Early Detection of Pancreatic Cancer: Opportunities and Challenges in Utilizing Electronic Health Records (EHR)” in March 2021. The workshop included a select group of panelists with expertise in pancreatic cancer, EHR data mining, and AI-based modeling. This review article reflects the findings from the workshop and assesses the feasibility of AI-based data extraction and modeling applied to EHRs. It highlights the increasing role of data sharing networks and common data models in improving the secondary use of EHR data. Current efforts using EHR data for AI-based modeling to enhance early detection of pancreatic cancer show promise. Specific challenges (biology, limited data, standards, compatibility, legal, quality, AI chasm, incentives) are identified, with mitigation strategies summarized and next steps identified.
Refractive Error of Students (15- to 18-year-olds) in Northwest Mexico
Authors: Teran Emiliano , Ramírez-Jaime Rosalía , Martínez-Gaytán Carlos , Romo-García Efrain , Costela Francisco M.
Published: October 2021

SIGNIFICANCE

We assessed the prevalence of refractive error in a sample of children of Northern Mexico using the Refractive Error Study in Children protocol of the World Health Organization, which allows for the comparison with other global studies.

PURPOSE

Uncorrected refractive error is the main cause of visual impairment in children. The purpose of this study was to assess the refractive error and visual dysfunctions of students (15 to 18 years old) in the upper-middle school system of Sinaloa, Mexico.

METHODS

A total of 3468 students in Sinaloa's high school system participated in the study from 2017 to 2019. Optometrists and student clinicians from the Optometry Program of the Autonomous University of Sinaloa conducted the testing. Tests included visual acuities and static retinoscopy. We did not use a cycloplegic agent.

RESULTS

The results showed a high prevalence of uncorrected refractive errors. Myopia, defined as a refractive error ≤−0.50 D, had a prevalence of 36.11% (95% confidence interval, 33.47 to 38.83%); hyperopia, defined as a refractive error ≥+2.00 D, had a prevalence of 1.49% (95% confidence interval, 0.09 to 2.33%); and astigmatism, defined as a refractive error with a cylinder ≥0.75 D, had a prevalence of 29.17% (95% confidence interval, 26.60 to 31.76%). We found a significant effect of sex on visual acuity.

CONCLUSIONS

Our results are consistent with a high prevalence of myopia reported in adolescents worldwide and in Mexico's northern regions. The results suggest that students attending high school and entering universities should be required to have an optometric eye examination. Additional studies are needed to investigate the prevalence of refractive errors in children in Mexico.
Case Series: Glioblastoma Highlighting the Eye Care Provider's Role
Authors: Weiler Danielle L. , Rowan Sean P. , Engelke Carla B. , Powell Jason R.
Published: October 2021

SIGNIFICANCE

Although the incidence of glioblastoma is relatively low, patients presenting with this malignant central nervous system tumor will typically experience visual symptoms. Eye care providers are uniquely positioned to assist with the diagnosis of glioblastoma and to manage its associated visual symptoms.

PURPOSE

This case series will review the pathophysiology, diagnosis, treatment, and management of glioblastoma while highlighting the eye care provider's role over the course of the disease process.

CASE REPORTS

Three patients with glioblastoma are presented: a 63-year-old White man with new onset of headache and blurred vision upon awakening, a 65-year-old White man with a weeklong history of peripheral vision deficit and neurological symptoms, and a 65-year-old White woman with visual field deficit and visual perception difficulties related to a known history of glioblastoma.

CONCLUSIONS

It is incumbent upon eye care providers to recognize examination findings such as new neurological symptoms and/or visual field defects that may warrant additional workup. In addition, eye care providers can serve a palliative role by maximizing the patient's remaining visual function and thereby quality of life.
Photographic Depiction of the Field of View with Spectacles-mounted Low Vision Aids
Authors: Jung Jae-Hyun , Kurukuti Nish Mohith , Peli Eli
Published: October 2021

SIGNIFICANCE

Photographic depiction helps to illustrate the primary and secondary field of view effects of low vision devices along with their utility to clinicians, patients, and caretakers. This technique may also be helpful for designers and researchers in improving the design and fitting of low vision devices.

PURPOSE

The field of view through spectacles-mounted low vision devices has typically been evaluated using perimetry. However, the perimetric field diagram is different from the retinal image and often fails to represent the important aspects of the field of view and visual parameters. We developed a photographic depiction method to record and veridically show the field of view effects of these devices.

METHODS

We used a 3D-printed holder to place spectacles-mounted devices at the same distance from the empirically determined reference point of the field of view in a camera lens (f = 16 mm) as they would be from an eye, when in use. The field of view effects of a bioptic telescope, a minifier (reverse telescope), and peripheral prisms were captured using a conventional camera, representing retinal images. The human eye pupil size (adjusting the F number: f/2.8 to f/8 and f/22 in the camera lens) and fitting parameters (pantoscopic tilt and back vertex distance) varied.

RESULTS

Real-world indoor and outdoor walking and driving scenarios were depicted as retinal images illustrating the field of view through low vision devices, distinguishing optical and obscuration scotomas, and demonstrating secondary effects (spatial distortions, viewpoint changes, diplopia, spurious reflection, and multiplexing effects) not illustrated by perimetric field diagrams.

CONCLUSIONS

Photographic depiction illustrates the primary and secondary field of view effects of the low vision devices. These images highlight the benefit and possible trade-offs of the low vision devices and may be beneficial in education and training.
Continuous Glucose Monitoring Reveals Perioperative Hypoglycemia in Most Patients With Diabetes Undergoing Major Surgery
Authors: Carlsson Christian J. , Nørgaard Kirsten , Oxbøll Anne-Britt , Søgaard Mette I.V. , Achiam Michael P. , Jørgensen Lars N. , Eiberg Jonas P. , Palm Henrik , Sørensen Helge B.D. , Meyhof Christian S. , Aasvang Eske K.
Published: October 2021

Objective:

To investigate the frequency and duration of hypo- and hyperglycemia, assessed by continuous glucose monitoring (CGM) during and after major surgery, in departments with implemented diabetes care protocols.

Summary Background Data:

Inadequate glycemic control in the perioperative period is associated with serious adverse events, but monitoring currently relies on point blood glucose measurements, which may underreport glucose excursions.

Methods:

Adult patients without (A) or with diabetes [non-insulin-treated type 2 (B), insulin-treated type 2 (C) or type 1 (D)] undergoing major surgery were monitored using CGM (Dexcom G6), with an electrochemical sensor in the interstitial fluid, during surgery and for up to 10 days postoperatively. Patients and health care staff were blinded to CGM values, and glucose management adhered to the standard diabetes care protocol. Thirty-day postoperative serious adverse events were recorded. The primary outcome was duration of hypoglycemia (glucose <70 mg/dL). Clinicaltrials.gov: NCT04473001.

Results:

Seventy patients were included, with a median observation time of 4.0 days. CGM was recorded in median 96% of the observation time. The median daily duration of hypoglycemia was 2.5 minutes without significant difference between the 4 groups (A-D). Hypoglycemic events lasting ≥15 minutes occurred in 43% of all patients and 70% of patients with type 1 diabetes. Patients with type 1 diabetes spent a median of 40% of the monitoring time in the normoglycemic range 70 to 180 mg/dL and 27% in the hyperglycemic range >250 mg/dL. Duration of preceding hypo- and hyperglycemia tended to be longer in patients with serious adverse events, compared with patients without events, but these were exploratory analyses.

Conclusions:

Significant duration of both hypo- and hyperglycemia was detected in high proportions of patients, particularly in patients with diabetes, despite protocolized perioperative diabetes management.
Co-existing bipolar disease and 17q12 deletion: a rare case report
Authors: Bulu Ersel , Kalayci Yigin Aysel , Agirbasli Deniz , Demirel Omer Faruk , Aksoy Poyraz Cana , Seven Mehmet
Published: October 2021

Background

17q12 microdeletion syndrome is a rare autosomal dominant chromosomal anomaly, caused by the deletion of a 1.4 Mb–spanning DNA sequence on the long arm of chromosome 17. Herein, we report the first bipolar disease (BPD) case with a 1.6-Mb deletion in the 17q11.2-17q12 chromosome region.

Materials and methods

Physical examination of the case was performed. Karyotype and microarray analyses were performed for the case and the parents.

Results

Physical examination revealed mild dysmorphic features such as high and forehead, full cheeks, slightly depressed nasal bridge and arched eyebrow. Chromosomal analysis of the patient revealed 46, XX, del(17)(q12) karyotype, and parents’ karyotype were normal. In the microarray analysis of patient, 1.6 megabases deletion was detected in the 17q12 region [arr(hg19) 17q12 (34,611,352–36,248,918) ×1]. The microarray analysis of the mother was normal. The father’s microarray showed 473 kilobases duplication in the 11p11.12 region.

Conclusion

Although 17q12 deletion syndrome has been associated with bipolar disorder, very few such cases have been described in the literature. Genetic counseling should be considered in patients with remarkable phenotype, complex symptomatology, neurodevelopmental disorder and additional conspicuous medical conditions.
The SARS-CoV-2 pandemic: remaining uncertainties in our understanding of the epidemiology and transmission dynamics of the virus, and challenges to be overcome
Authors: Anderson Roy M. , Vegvari Carolin , Hollingsworth T. Déirdre , Pi Li , Maddren Rosie , Ng Chi Wai , Baggaley Rebecca F.
Published: October 2021

Great progress has been made over the past 18 months in scientific understanding of the biology, epidemiology and pathogenesis of SARS-CoV-2. Extraordinary advances have been made in vaccine development and the execution of clinical trials of possible therapies. However, uncertainties remain, and this review assesses these in the context of virus transmission, epidemiology, control by social distancing measures and mass vaccination and the effect on all of these on emerging variants. We briefly review the current state of the global pandemic, focussing on what is, and what is not, well understood about the parameters that control viral transmission and make up the constituent parts of the basic reproductive numberR0. Major areas of uncertainty include factors predisposing to asymptomatic infection, the population fraction that is asymptomatic, the infectiousness of asymptomatic compared to symptomatic individuals, the contribution of viral transmission of such individuals and what variables influence this. The duration of immunity post infection and post vaccination is also currently unknown, as is the phenotypic consequences of continual viral evolution and the emergence of many viral variants not just in one location, but globally, given the high connectivity between populations in the modern world. The pattern of spread of new variants is also examined. We review what can be learnt from contact tracing, household studies and whole-genome sequencing, regarding where people acquire infection, and how households are seeded with infection since they constitute a major location for viral transmission. We conclude by discussing the challenges to attaining herd immunity, given the uncertainty in the duration of vaccine-mediated immunity, the threat of continued evolution of the virus as demonstrated by the emergence and rapid spread of the Delta variant, and the logistics of vaccine manufacturing and delivery to achieve universal coverage worldwide. Significantly more support from higher income countries (HIC) is required in low- and middle-income countries over the coming year to ensure the creation of community-wide protection by mass vaccination is a global target, not one just for HIC. Unvaccinated populations create opportunities for viral evolution since the net rate of evolution is directly proportional to the number of cases occurring per unit of time. The unit for assessing success in achieving herd immunity is not any individual country, but the world.
Disease transmission and control modelling at the science–policy interface
Authors: McCabe Ruth , Donnelly Christl A.
Published: October 2021

The coronavirus disease 2019 (COVID-19) pandemic has disrupted the lives of billions across the world. Mathematical modelling has been a key tool deployed throughout the pandemic to explore the potential public health impact of an unmitigated epidemic. The results of such studies have informed governments' decisions to implement non-pharmaceutical interventions to control the spread of the virus. In this article, we explore the complex relationships between models, decision-making, the media and the public during the COVID-19 pandemic in the United Kingdom of Great Britain and Northern Ireland (UK). Doing so not only provides an important historical context of COVID-19 modelling and how it has shaped the UK response, but as the pandemic continues and looking towards future pandemic preparedness, understanding these relationships and how they might be improved is critical. As such, we have synthesized information gathered via three methods: a survey to publicly list attendees of the Scientific Advisory Group for Emergencies, the Scientific Pandemic Influenza Group on Modelling and other comparable advisory bodies, interviews with science communication experts and former scientific advisors, and reviewing some of the key COVID-19 modelling literature from 2020. Our research highlights the desire for increased bidirectional communication between modellers, decision-makers and the public, as well as the need to convey uncertainty inherent in transmission models in a clear manner. These aspects should be considered carefully ahead of the next emergency response.
Imaging and visualizing SARS-CoV-2 in a new era for structural biology
Authors: Leigh Kendra E. , Modis Yorgo
Published: October 2021

The SARS-CoV-2 pandemic has had a global impact and has put scientific endeavour in the spotlight, perhaps more than any previous viral outbreak. Fortuitously, the pandemic came at a time when decades of research in multiple scientific fields could be rapidly brought to bear, and a new generation of vaccine platforms was on the cusp of clinical maturity. SARS-CoV-2 also emerged at the inflection point of a technological revolution in macromolecular imaging by cryo-electron microscopy, fuelled by a confluence of major technological advances in sample preparation, optics, detectors and image processing software, that complemented pre-existing techniques. Together, these advances enabled us to visualize SARS-CoV-2 and its components more rapidly, in greater detail, and in a wider variety of biologically relevant contexts than would have been possible even a few years earlier. The resulting ultrastructural information on SARS-CoV-2 and how it interacts with the host cell has played a critical role in the much-needed accelerated development of COVID-19 vaccines and therapeutics. Here, we review key imaging modalities used to visualize SARS-CoV-2 and present select example data, which have provided us with an exceptionally detailed picture of this virus.
New ways: the pandemics of science fiction
Authors: Morgan Glyn
Published: October 2021

In unprecedented times, people have turned to fiction both for comfort and for distraction, but also to try and understand and anticipate what might come next. Sales and rental figures for works of fiction about pandemics and other disease outbreaks surged in 2020, but what can pandemic science fiction tell us about disease? This article surveys the long history of science fiction's engagement with disease and demonstrates the ways in which these narratives, whether in literature or film, have always had more to say about other contemporary cultural concerns than the disease themselves. Nonetheless, the ideas demonstrated in these texts can be seen perpetuating through the science fiction genre, and in our current crisis, we have seen striking similarities between the behaviours of key individuals, and the manner in which certain events have played out. Not because science fiction
predicts
these things, but because it anticipates the social structures which produce them (while at the same time permeating the culture to the extent that they become the touchstones with which the media choose to analyse current events). This paper demonstrates that science fiction can be a valuable tool to communicate widely around a pandemic, while also acting as a creative space in which to anticipate how we may handle similar events in the future.
Imagining pandemics now, and then: a century of medical failure
Authors: Honigsbaum Mark
Published: October 2021

Ever since the devastating 1918–1919 influenza pandemic, policy makers have employed mathematical models to predict the course of epidemics and pandemics in an effort to mitigate their worst impacts. But while Britain has long been a pioneer of predictive epidemiology and disease modellers occupied influential positions on key committees that advised the government on its response to the coronavirus pandemic, as in 1918 Britain mounted one of the least effective responses to Covid-19 of any country in the world. Arguing that this ‘failure of expertise’ was the result of medical and political complacency and over-reliance on disease models predicated on influenza, this paper uses the lens of medical history to show how medical attitudes to Covid-19 mirrored those of the English medical profession in 1918. Rather than putting our faith in preventive medicine and statistical technologies to predict the course of epidemics and dictate suppressive measures in future, I argue we need to cultivate more profound forms of imaginative engagement with infectious disease outbreaks that take account of the long history of quarantines and the lived experiences of pandemics. A useful starting point would be to recognize that while measures such as the R° may be useful for calculating the reproductive rate of a virus, they can never capture the full risks of pandemics or their social complexity.
Acquiring infection: the challenges of collecting epidemics and pandemics, past, present and future
Authors: Emmens S. , McEnroe N.
Published: October 2021

Curators of the history of medicine are now facing one of the greatest challenges of their careers—how to collect and preserve objects that convey the impacts of COVID-19 on science, medicine and wider society, while that same pandemic rages around them. But in such a rapidly changing situation, might looking back help us in going forward? Using the world-famous Medicine collections at London's Science Museum, we will explore how both presences and absences in the museum record can shed light on the challenges and dynamics of collecting around pandemic and infectious diseases, as well as the broader field of public health. Most strikingly, we examine why the 1918–19 Spanish flu pandemic left little material culture behind, in sharp contrast with other epidemic diseases. In recent years, so-called ‘rapid response’ collecting has become a tool used frequently by museums to capture ongoing developments and current research. To collect COVID-19 presents unique challenges, both practical and ethical, not least because to collect with a view to posterity is an action that remains highly subjective and is dependent on the decisions and personal interests of the curator as well as the influence of major external events.
Our mutual fiends: cancer research in a time of COVID-19
Authors: Dabin K.
Published: October 2021

The impact of the COVID-19 pandemic on health services in the UK and around the world cannot be understated. Cancer care services, patient and cancer research communities have been particularly affected. Screening services, treatment and clinical trials have been halted. Research laboratories have been closed or repurposed to tackle the pandemic. Despite these profound setbacks, there are ways in which the pandemic is accelerating areas of cancer research. In the context of a new cancer research exhibition planned by the Science Museum Group,
Cancer Revolution: Science, innovation and hope
, this essay draws out some remarkable parallels between cancer science and the remarkable research effort seeking to tackle the COVID-19 pandemic. Knowledge and therapeutic approaches from seemingly unrelated fields of medical research are opening up new possibilities to control both diseases. As the race to control COVID-19 has shown, the more research angles, disciplines and tools and people we can bring together to tackle the challenge cancer poses, the better our chances of staying ahead of this disease for more of us now and in future.
Understanding fast-ion conduction in solid electrolytes
Authors: Morgan Benjamin J.
Published: October 2021

The ability of some solid materials to exhibit exceptionally high ionic conductivities has been known since the observations of Michael Faraday in the nineteenth century (Faraday M. 1838Phil. Trans. R. Soc.90), yet a detailed understanding of the atomic-scale physics that gives rise to this behaviour remains an open scientific question. This theme issue collects articles from researchers working on this question of understanding fast-ion conduction in solid electrolytes. The issue opens with two perspectives, both of which discuss concepts that have been proposed as schema for understanding fast-ion conduction. The first perspective presents an overview of a series of experimental NMR studies, and uses this to frame discussion of the roles of ion–ion interactions, crystallographic disorder, low-dimensionality of crystal structures, and fast interfacial diffusion in nanocomposite materials. The second perspective reviews computational studies of halides, oxides, sulfides and hydroborates, focussing on the concept offrustrationand how this can manifest in different forms in various fast-ion conductors. The issue also includes five primary research articles, each of which presents a detailed analysis of the factors that affect microscopic ion-diffusion in specific fast-ion conducting solid electrolytes, including oxide-ion conductorsGd2Zr2O7andBi4V2O11, lithium-ion conductorsLi6PS5BrandLi3OCl, and the prototypical fluoride-ion conductorβ-PbF2.

This article is part of the Theo Murphy meeting issue ‘Understanding fast-ion conduction in solid electrolytes’.
Decoding ionic conductivity and reordering in cation-disordered pyrochlores
Authors: Annamareddy Ajay , Eapen Jacob
Published: October 2021

The ordered structure A
2
B
2
O
6
O’ in pyrochlores engenders twin rows of inequivalent anion sublattices each centred on alternating cations. While it is known that cation antisite disorder augments the ionic conductivity by several orders of magnitude, the local cation environment around the anions and the dynamic anion reordering during the cation disordering are not well-elucidated. Using atomistic simulations on Gd
2
Zr
2
O
7
, we first show that the anions engage in concerted hops to the neighbouring tetrahedral sites mostly along with the 〈1 0 0〉 direction while completely avoiding the octahedral sites. While the initially vacant 8
a
sites start accommodating oxygen ions with increasing cation disorder, they show noticeable reluctance even at significant levels of disorder. We have also tracked both the distribution of available oxygen sites following random cation disorder, which is dependent only on cation disordering, and the probability of occupation of these sites. Interestingly, the available oxygen sites show a non-monotonic dependence on the number of B ions in the nearest neighbouring shell while the occupation probability of all the available oxygen sites increases monotonically. A tetrahedral oxygen site thus has a better probability of being occupied when it has a greater number of second neighbour B ions.

This article is part of the Theo Murphy meeting issue 'Understanding fast-ion conduction in solid electrolytes'.
Cooperative excitations in superionic PbF
2
Authors: Mohn Chris E. , Krynski Marcin , Kob Walter , Allan Neil L.
Published: October 2021

Links between dynamical Frenkel defects and collective diffusion of fluorides in
β
-PbF
2
are explored using Born–Oppenheimer molecular dynamics. The calculated self-diffusion coefficient and ionic conductivity are 3.2 × 10
−5
 cm
2
 s
−1
and 2.4 Ω
−1
 cm
−1
at 1000 K in excellent agreement with pulsed field gradient and conductivity measurements. The calculated ratio of the tracer-diffusion coefficient and the conductivity-diffusion coefficient (the Haven ratio) is slightly less than unity (about 0.85), which in previous work has been interpreted as providing evidence against collective ‘multi-ion’ diffusion. By contrast, our molecular dynamics simulations show that fluoride diffusion is highly collective. Analysis of different mechanisms shows a preference for direct collinear ‘kick-out’ chains where a fluoride enters an occupied tetrahedral hole/cavity and pushes the resident fluoride out of its cavity. Jumps into an occupied cavity leave behind a vacancy, thereby forming dynamic Frenkel defects which trigger a chain of migrating fluorides assisted by local relaxations of the lead ions to accommodate these chains. The calculated lifetime of the Frenkel defects and the collective chains is approximately 1 ps in good agreement with that found from neutron diffraction.

This article is part of the Theo Murphy meeting issue ‘Understanding fast-ion conduction in solid electrolytes’.
Candida utilis: a rare cause of septicemia in children
Authors: T. S. Sreelekshmi , Ninan Marilyn M. , Premanand Arul , Chacko Anila , Sahni Rani Diana , Michael Joy S.
Published: October 2021

Candida utilis is an emerging fungal pathogen in blood. The main aim of this study was to describe the prevalence, methods of speciation and antifungal susceptibility of Candida utilis at a tertiary care centre.

Methods. This was a retrospective study carried out at a tertiary care centre in South India. Over a period of 1 year, three Candida utilis were isolated from blood culture identified by MALDI–TOF MS Version 3.2 and were confirmed by ITS sequencing. Susceptibility testing was carried out by micro broth dilution.

Results. All three patients had a common risk factor of prolonged ICU stay but the source of infection could not be identified. Candida utilis isolates were identified by MALDI–TOF and confirmed by ITS sequencing. They were pansusceptible to all tested antifungal drugs. Among these, two patients who were treated in hospital had good clinical outcome and response to antifungal drugs. A third patient was lost to follow up.

Conclusion.
Candida utilis was predominantly seen between 0–3 month olds. Conventional methods of speciation were unable to identify C. utilis to species level. Rapid identification was done by MALDI–TOF MS and confirmed by sequencing. Rapid identification leads to prompt treatment and favours a good clinical outcome.
Pontibacter flavimaris sp. nov., of the family Hymenobacteraceae, isolated from marine sediment
Authors: Liu Di , Xiong Qin , Zhao Juanjuan , Fang Zhenjuan , Zhang Guishan
Published: October 2021

A Gram-stain-negative, ovoid or rod-shaped, non-flagellated, motile-by-gliding and aerobic bacteria, designated S10-8T, was isolated from marine sediment of the Yellow Sea. Colonies of strain S10-8T had a pink-red pigmentation and its cells were approximately 0.5–0.8 μm×1.0–2.5 μm in size. Growth occurred at 10–45 °C (optimally at 33–37 °C), in the presence of 0–12.0 % NaCl (optimally at 2.0–5.0 %, w/v) and at pH 5.0–8.5 (optimally at pH 7.0–7.5). Phylogenetic analysis of the 16S rRNA gene indicated that strain S10-8T is a member of the genus

Pontibacter

within the family

Hymenobacteraceae

, and the 16S rRNA gene sequence similarity of strain S10-8T to its closest relative

Pontibacter actiniarum

KCTC 12367T was 96.9 %. Strain S10-8T contained MK-7 as the predominant menaquinone and summed feature 4 (iso-C17:1 I and/or anteiso-C17:1 B) and iso-C15:0 as the major fatty acids. The major polar lipids were phosphatidylethanolamine, an unidentified aminophospholipid and an unidentified lipid. The size of the draft genome was 4 623 791 bp and the G+C content was 53.5 mol%. There were low DNA-DNA hybridization values (<48.3±5.2 %) and average nucleotide identity values (<86.5 %) between strain S10-8T and the most closely related recognized

Pontibacter

species. Therefore, we propose a novel species in the genus

Pontibacter

to accommodate the novel isolate: Pontibacter flavimaris sp. nov. (type strain S10-8T=KCTC 42769T=ACCC 19859T).