bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiac Hypertrophy in Obesity Model Induced by High Fat Diet: Participation of Immune System
Authors: Gasler Silva Fernanda , Christoffolete Marcelo , Carneiro Ramos Marcela
Published: June 2021

Aim

As the world population has become more sedentary more often have become obesity and diabetes mellitus, known risk factors for cardiovascular diseases leading to increased risk of sudden death. It is also well established that inflammatory factors play a role in obesity. The aims of this study are to investigate obesity related inflammatory mechanisms and their relationship to the development of cardiac hypertrophy.

Methods

C57Bl/6 mice were divided in two groups, one group was fed with a high fat diet containing 23% of protein, 35,5% of carbohydrate and 35,9% of fat for 68 days, the other group was fed with a normal diet containing 19% of protein, 56% of carbohydrate, 3,5% of fat. Heart weight/tibia length was measured. Biometrics parameters and blood chemistry was analyzed in all animals. Gene expression analysis: Alfa‐actin, TLR2, TLR4 and gp130 were evaluated by Q‐PCR. Results were expressed as mean±SD.

Results

As expected, High Fat animals showed higher weight gain than chow, about 7 times. mRNA levels of alfa‐actin, a hypertrophy marker was significant increased in high fat animals. Gp130 and TLR4 mRNA levels in cardiac tissue were modulated.

Conclusion

These results show that our model was able to evoke obesity induced cardiac hypertrophy. Gene markers suggests a putative local immune system role mediating cardiac hypertrophy.Financial Support: FAPESP 2008/10175‐4, 2008/10700‐1.
Maximal and Submaximal Handgrip Exercise Stimulates Thrombocytosis
Authors: Walsh Jeremy , Bentley Robert , Tschakovsky Michael
Published: June 2021

Introduction

Blood platelets sequester, store, and release a majority of blood‐borne brain‐derived neurotrophic factor (BDNF), which is a major orchestrator of exercise‐induced brain plasticity. Exercise involving large muscle mass transiently increases platelet and serum BDNF levels in an intensity‐dependent manner. During exercise, augmented sympathetic outflow causes splenic contractions, which increases platelet levels in the blood (exercise‐induced thrombocytosis). Interestingly, very brief (60 s) submaximal activation of small muscle mass induces splenic constriction and a 2% elevation in platelet levels. If small muscle exercise is sufficient enough of a stimulus to increase platelet levels, then by extension, it could stand as a viable strategy for increasing BDNF availability; however, the platelet response to dynamic handgrip exercise (HGEX) is currently unknown.

Purpose

To examine the response of platelets following both short‐duration maximal and prolonged submaximal intensity dynamic HGEX.

Methods

Healthy males (n = 6; 21.7 ±2.5 yrs old) have been recruited. Exercise protocols were performed on separate days. The high‐intensity exercise was a critical power test (CP), consisting of maximal squeezing for 10 minutes. Submaximal exercise (SE) consisted of HGEX performed at 15% below critical power for 30 minutes. Both protocols used a 2:2 contraction:relaxation duty cycle. Platelets were derived from a complete blood count analysis performed by a haematology lab.

Results

Platelets increased by 8% from rest to CP (n = 6; 217.9 vs. 236.4 x109/L; p < .05) and 6% from rest to SE (n = 3; 193.3 vs. 206 x109/L, p = .06).

Conclusion

Preliminary data demonstrate that platelets increase in a similar fashion to HGEX, regardless of exercise intensity.
Facial skin blood flow response during exposure to emotionally‐charged movie
Authors: Ishii Kei , Ito Momoka , Endo Kana , Liang Nan , Idesako Mitsuhiro , Matsukawa Kanji
Published: June 2021

While it is known that emotional arousal affects skin sympathetic nerve activity of a limb, an influence of emotional challenge on facial skin blood flow regulated by sympathetic and parasympathetic nerve was still unclear. We examined the facial skin blood flow response to audiovisually‐elicited emotion using two dimensional laser Doppler imaging. The facial skin blood flow, as well as forearm skin blood flow, heart rate (HR), and mean arterial blood pressure (MAP), was measured during 2 min of neutral (landscape) and positive (comedy) movies in nine subjects. The subjective extent of pleasantness or unpleasantness was estimated using rating scores from ‐5 (the most unpleasant) to 5 (the most pleasant). The average facial skin blood flow decreased (P<0.05) during comedy movie, while the facial skin blood flow did not change significantly during landscape movie. The decrease in facial skin blood flow during comedy movie was significantly correlated with the subjective rating of the pleasantness. The forearm skin blood flow, HR, and MAP did not change significantly during the two movies. These results suggest that the more emotion becomes positive, the more neurally‐mediated vasoconstriction occurs in facial skin blood vessels. Furthermore, facial skin blood flow rather than limb skin blood flow, HR, and MAP may help us to assess emotion quantitatively.
Passing the Certified Nurse Educator Exam: Innovative Strategies
Authors: Basley Sandra A. , Erickson-Owens Debra , McGrane Christine , Palmer Michelle , Cloud Mary E. , Dugas Joan R.
Published: June 2021

Certification in nursing education demonstrates expertise in teaching. The National League for Nursing Certified Nurse Educator credential is a hallmark of excellence. Six academic nurse educators obtained a 100 percent first-time pass rate as the result of a novel cohort model built upon accountability. This article’s purpose is to share innovative approaches that can lead to successfully passing the exam.
Association Between Hemoglobin A1C and Midurethral Sling Complications in Diabetic Women: A Cohort Study
Authors: Ortega Marcus V. , Bangura Marie , Ayati Elnaz , James Kaitlyn , Mitchell Caroline , Weinstein Milena M. , Von Bargen Emily
Published: June 2021

(Abstracted from Female Pelvic Med Reconstr Surg 2021;27:159–162)

Stress urinary incontinence (SUI), affecting up to one third of the US adult population of women, is treated with pelvic floor muscle training, physical therapy, supportive devices including pessary, and surgery. The midurethral sling (MUS) is considered a standard of care surgical treatment given its low risk of complication and high success rate.
Surgical site infections in gynecology: the latest evidence for prevention and management
Authors: Seaman Sierra J. , Han Esther , Arora Chetna , Kim Jin Hee
Published: June 2021

Purpose of review

Surgical site infection (SSI) remains one of the most common postoperative surgical complications. Prevention and appropriate treatment remain paramount.

Recent findings

Evidence-based recommendations include recognition and reduction of preoperative risks including hyperglycemia and smoking, treatment of preexisting infections, skin preparation with chlorhexidine gluconate, proper use of preoperative antibiotics, and implementation of prevention bundles. Consideration should be given to the use of dual antibiotic preoperative treatment with cephazolin and metronidazole for all hysterectomies.

Despite advancements, SSI in gynecologic surgery remains a major cause of perioperative morbidity and healthcare cost. Modifiable risk factors should be evaluated and patients optimized to the best extent possible prior to surgery. Preoperative risks include obesity, hyperglycemia, smoking, and untreated preexisting infections. Intraoperative risk-reducing strategies include appropriate perioperative antibiotics, correct topical preparation, maintaining normothermia, and minimizing blood loss. Additionally, early recognition and prompt treatment of SSI remain crucial.
Minimally invasive management of retained products of conception and the adherent placenta
Authors: Namazi Golnaz , Haber Hilary R. , Tavcar Jovana , Clark Nisse V.
Published: June 2021

Purpose of review

Retained products of conception (POC) may occur independently or as a consequence of placenta accreta spectrum (PAS). Managing these conditions depends on the clinical scenario, and in some cases, can involve the use of minimally invasive techniques. This review presents the role of hysteroscopy and laparoscopy in the treatment of retained POC and the adherent placenta.

Recent findings

Hysteroscopic resection of retained POC is reported to have favorable outcomes compared to blind dilation and curettage, including higher success rates and a lower risk of intrauterine adhesion formation. Hysteroscopic and laparoscopic techniques for managing PAS are limited to select cases where uterine preservation is desired, or a laparoscopic gravid or postpartum delayed hysterectomy is feasible. Data on these methods are limited to case reports.

A hysteroscopic approach is preferred over dilation and curettage for retained POC. Minimally invasive surgery may have a role in unique cases of PAS.
Circadian blood pressure profile and blood pressure changes following oral appliance therapy for obstructive sleep apnoea
Authors: Sutherland Kate , Dissanayake Hasthi U. , Trzepizur Wojciech , Gagnadoux Frederic , Cistulli Peter A.
Published: June 2021

Objectives:

Oral appliance therapy for obstructive sleep apnoea (OSA) reduces blood pressure (BP) but there is little information on relationship to circadian BP pattern (nocturnal BP dipping or non-dipping). The aims of this study were to determine whether nocturnal dipping pattern influences BP changes following oral appliance therapy, and to determine the effect of oral appliance therapy on circadian BP pattern.

Methods:

Participants in two randomized trials of oral appliance therapy (1–2 months) with 24-h ambulatory BP monitoring (ABPM) data were included (N = 152). Nocturnal BP Dippers (nocturnal/diurnal SBP ratio <0.9) and non-dippers were compared for BP changes following oral appliance therapy and the effect of oral appliance therapy on nocturnal BP dipping was assessed.

Results:

Of 152 participants, 64.5% were dippers. Dippers were on average younger and less likely to be hypertensive (42 vs. 82.7%, P < 0.001). Nondippers showed greater reduction in nocturnal BP measures, related to higher BP measures at baseline. There was no difference in the relationship between treatment effectiveness and BP changes between groups. Oral appliance therapy converted only 23% of baseline non-dippers to a nocturnal dipping profile.

Conclusion:

Baseline circadian BP profile influenced the BP response to oral appliance therapy, largely because of higher baseline BP in the non-dipper subgroup. Oral appliance therapy did not convert OSA patients to a more favourable circadian BP profile. Further work is required to understand the effect of oral appliance therapy on circadian BP profile and of the individuals who will receive cardiovascular benefit from oral appliance therapy.
Cryptococcus neoformans Infective Endocarditis After Lung Transplantation
Authors: Fountain John H. , Rajagopalan Kartik N. , Carroll Maggie , Robbins Hilary , Benvenuto Luke J. , Shimbo Daichi , Marboe Charles C. , Arcasoy Selim M. , Pereira Marcus R.
Published: June 2021

Cryptococcus neoformans infective endocarditis is rarely reported. In this report, we present a case of infective endocarditis secondary to C. neoformans in a lung transplant recipient and review the relevant literature. A 65-year-old man was hospitalized with hypoxemic respiratory failure and underwent left-sided single lung transplantation. In the setting of worsening hypoxemia, blood cultures were drawn, which grew C. neoformans. Lumbar puncture was performed, and cerebrospinal fluid (CSF) polymerase chain reaction (PCR) was also positive for Cryptococcus. Further exposure history revealed that he had raised chickens while living in Peru. Transesophageal echocardiography showed an aortic valve vegetation, and he was diagnosed with cryptococcal infective endocarditis. He received liposomal amphotericin B and flucytosine for 2 weeks and was later transitioned to fluconazole. This case highlights the need for thorough social history before lung transplantation, as pulmonary colonization with C. neoformans may result in infective endocarditis after immunosuppression.
High-Dose Oral Vancomycin for Treatment of Clostridioides difficile Is Associated With High Risk of Subsequent Cultures With Gram-Negative Organisms
Authors: Bader Mazen S. , Someili Ali , Alosali Abdulmajeed , Hadzic Amir , Irfan Neal , Leto Daniela , Mertz Dominik , Brooks Annie A.
Published: June 2021

Background

Vancomycin is associated with disruption of the indigenous microbiota, potentially predisposing patients to overgrowth of endogenous pathogens. Our objective was to determine whether high-dose oral vancomycin is associated with cultures growing gram-negative organisms in adult patients with Clostridioides difficile infection (CDI).

Methods

This is a retrospective cohort study of 632 adult patients with CDI from January 2015 to December 2017. The primary outcome was prevalence of cultures growing gram-negative organisms within 6 months after onset of the first episode of CDI. A multivariate logistic regression analysis was used to determine predictors of the outcome.

Results

One hundred fifty-three patients (24.2%) had cultures growing gram-negative organisms after onset of CDI, where urine (97, 63.4%) and blood (27, 17.7%) were the most common sources. The most commonly isolated gram-negative organisms were Escherichia coli (49, 32.0%) and Klebsiella species (34, 22.2%). A total of 38 (38/100, 38.0%) and 48 (48/199, 24.1%) of the patients who received high- and standard-dose oral vancomycin, respectively, had gram-negative organism growth on culture (odds ratio [OR], 2.22, 95% confidence interval [CI], 1.41–3.5; P = 0.02). The multivariate analysis showed that high-dose oral vancomycin (OR, 2.21; 95% CI, 1.29–3.79; P = 0.004) and recent use of antibiotic therapy within 3 months (OR, 2.11; 95% CI, 1.27–3.52; P = 0.004) were associated with positive cultures growing gram-negative organisms.

Conclusions

High-dose oral vancomycin therapy for CDI was associated with increased risk of gram-negative organisms probably throughout disruption of the indigenous microbiota.
Substance Use Disorders and Diabetes Care
Authors: Forthal Sarah , Choi Sugy , Yerneni Rajeev , Zhang Zhongjie , Siscovick David , Egorova Natalia , Mijanovich Todor , Mayer Victoria , Neighbors Charles
Published: June 2021

Background:

Individuals that have both diabetes and substance use disorder (SUD) are more likely to have adverse health outcomes and are less likely to receive high quality diabetes care, compared with patients without coexisting SUD. Care management programs for patients with chronic diseases, such as diabetes and SUD, have been associated with improvements in the process and outcomes of care.

Objective:

The aim was to assess the impact of having coexisting SUD on diabetes process of care metrics.

Research Design:

Preintervention/postintervention triple difference analysis.

Subjects:

Participants in the New York State Medicaid Health Home (NYS-HH) care management program who have diabetes and a propensity-matched comparison group of nonparticipants (N=37,260).

Measures:

Process of care metrics for patients with diabetes: an eye (retinal) exam, HbA1c test, medical attention (screening laboratory measurements) for nephropathy, and receiving all 3 in the past year.

Results:

Before enrollment in NYS-HH, individuals with comorbid SUD had fewer claims for eye exams and HbA1c tests compared with those without comorbid SUD. Diabetes process of care improvements associated with NYS-HH enrollment were larger among those with comorbid SUD [eye exam: adjusted odds ratio (AOR)=1.08; 95% confidence interval (CI): 1.01–1.15]; HbA1c test: AOR=1.20 (95% CI: 1.11–1.29); medical attention for nephropathy: AOR=1.21 (95% CI: 1.12–1.31); all 3: AOR=1.09 (95% CI: 1.02–1.16).

Conclusions:

Individuals with both diabetes and SUD may benefit moderately more from care management than those without comorbid SUD. Individuals with both SUD and diabetes who are not enrolled in care management may be missing out on crucial diabetes care.
Clinical impact of targeted single-photon emission computed tomography/computed tomography (SPECT/CT) bone scintigraphy on the assessment of bone metastasis in cancer patients
Authors: Kapsoritakis Nikolaos , Stathaki Maria , Bourogianni Olga , Tsaroucha Angeliki , Papadaki Emmanouela , Simos Panagiotis , Koukouraki Sophia
Published: June 2021

Objectives

We investigated the clinical impact of single-photon emission computed tomography/computed tomography (SPECT/CT) bone scintigraphy combined with 16-slice CT on metastatic workup and treatment planning in a large cancer patient series.

Methods

Between January 2019 and January 2020, a total of 600 cancer patients were prospectively evaluated with whole-body planar bone scan (wbPBS) for staging or restaging purposes. 272/600 had equivocal lesions on wbPBS and 265/272 underwent additionally a targeted SPECT/CT bone scintigraphy on designated regions. Findings were classified as benign (score 1), metastatic (score 2) and inconclusive (score 3). Findings from SPECT/CT bone scintigraphy were compared with the results of wbPBS.

Results

A total of 668 lesions were considered as unclear οn wbPBS and were re-evaluated through targeted SPECT/CT bone scintigraphy. Definite diagnostic findings on SPECT/CT bone scintigraphy were obtained in 227/265 (85.7%) patients and in 592/668 (88.6%) lesions vs. 15.4% of wbPBS alone. On per-patient analyses, 38.9% of patients were considered definitely nonmetastatic and 46.8% as definitely metastatic. On per lesion analyses using SPECT/CT bone scintigraphy, corresponding diagnostic rates were 47.5 and 41.2%. Although the addition of SPECT/CT bone scintigraphy significantly reduced the rate of equivocal wbPBS results (83.1%), it failed to provide a conclusive diagnosis in a relatively small proportion of lesions 76/668 (11.4%) in 38 patients.

Conclusions

SPECT/CT bone scintigraphy afforded a significant reduction of the number of patients with equivocal findings who needed further evaluation with other imaging modalities, preventing unnecessary delays in diagnosis and potential changes in disease staging and treatment planning. Moreover, SPECT/CT bone scintigraphy slightly increased diagnostic sensitivity.
New drugs for difficult bugs: management of multidrug-resistant gram-negative infections in solid organ transplant recipients
Authors: Pouch Stephanie M.
Published: June 2021

Purpose of review

Multidrug-resistant Gram-negative bacteria remain a significant threat to patient and allograft survival. Management of these infections in solid organ transplant (SOT) recipients remains challenging due to a limited antimicrobial pipeline and reliance on novel agents, which have not been systematically evaluated in the transplant population.

Recent findings

Novel antimicrobials, including the second-generation β-lactam/β-lactamase inhibitors, cefiderocol, plazomicin and eravacycline, have been developed to combat infections due to multidrug-resistant Gram-negative infections, but each has microbiologic and therapeutic niches and warrant further study in SOT recipients.

This review summarizes therapeutic options for extended-spectrum β-lactamase-producing Enterobacterales, carbapenem-resistant Enterobacterales and Pseudomonas aeruginosa with difficult-to-treat resistance in SOT recipients and emphasizes recently approved antimicrobial agents.
Patient-reported outcomes and health-related quality of life after urinary diversions
Authors: Nuijens Siberyn T. , Cobussen-Boekhorst Hanny , Heesakkers John P.F.A. , Witjes J. Alfred
Published: June 2021

Purpose of review

To study the recent literature on health-related quality of life (HRQOL) in patients after radical cystectomy followed by urinary diversion.

Recent findings

General consensus regarding, which urinary diversion is superior in terms of HRQOL has not been reached. Although there is an increase in studies favoring the orthotopic neobladder, overall quality of these studies is poor. Other studies suggest that HRQOL outcomes in different types of urinary diversions is similar and that other factors, such as age, comorbidities and sex are more important instead. Patient choice, in consultation with the treating surgeon should be the determinant of which urinary diversion is performed. Furthermore, sexual function can play an important role in HRQOL. However, practice shows that counselling on the option of sexual-preserving techniques is still not implemented in routine clinical practice. Furthermore, studies regarding differences in HRQOL after urinary diversion between male and female individuals are lacking.

Thorough preoperative counselling on the different types of urinary diversion and options for sexual-preserving techniques decreases decision regret and increases HRQOL in patients after radical cystectomy.
HIV-1 viral blips are associated with repeated and increasingly high levels of cell-associated HIV-1 RNA transcriptional activity
Authors: Suzuki Kazuo , Levert Angelique , Yeung Julie , Starr Mitchell , Cameron Jane , Williams Raffaella , Rismanto Nikolas , Stark Tayla , Druery Dylan , Prasad Salzeena , Ferrarini Cristina , Hanafi Imelda , McNally Leon Patrick , Cunningham Philip , Liu Zhixin , Ishida Takaomi , Huang Chin-Shiou , Oswald Velma , Evans Louise , Symonds Geoffrey , Brew Bruce James , Zaunders John
Published: June 2021

Objective:

Some HIV+ patients, virally suppressed on ART, show occasional ‘blips’ of detectable HIV-1 plasma RNA. We used a new highly sensitive assay of cell-associated HIV-1 RNA to measure transcriptional activity in PBMCs and production of infectious virus from the viral reservoir, in patients with and without ‘blips’.

Design/methods:

RNA and DNA extracted from cells in 6 ml of peripheral blood, from suppressed patients with one to two ‘blip’ episodes over the past 2 years of ART (n = 55), or no ‘blips’ (n = 52), were assayed for HIV-1 RNA transcripts and proviral DNA targeting the highly conserved ‘R’ region of the LTR. Follow-up samples were also collected. Purified CD4+ T cells were cultured with anti-CD3/CD28/CD2 T-cell activator to amplify transcription and measure replication competent virus.

Results:

HIV-1 RNA transcripts ranged from 1.3 to 5415 copies/106 white blood cells. ‘Blip’ patients had significantly higher levels vs. without blips (median 192 vs. 49; P = 0.0007), which correlated with: higher levels of inducible transcripts after activation in vitro, sustained higher HIV-1 transcription levels in follow-up samples along with increasing HIV-1 DNA in some, and production of replication-competent HIV-1.

Conclusion:

Viral ‘blips’ are significant reflecting higher transcriptional activity from the reservoir and contribute to the reservoir over time. This sensitive assay can be used in monitoring the size and activity of the HIV-1 reservoir and will be useful in HIV-1 cure strategies.
Colorectal Cancer Survivors
Authors: Morrow Linda , Greenwald Beverly
Published: June 2021

Overall cancer death rates have fallen since a peak in 1991 due to declining death rates for lung, colorectal, breast, and prostate cancers. A “cancer survivor” is defined as anyone with a cancer diagnosis. Their numbers are increasing for several reasons including better screening, earlier detection, and improved treatments. The American Cancer Society's projections for colorectal cancer in 2020 are 147,950 new cases and 53,200 deaths. By 2024, there will be an estimated 1.71 million colorectal cancer survivors (17% of all cancer survivors) and many will experience long-term consequences. These problems may be the result of one or more treatment options: surgical resection, systemic chemotherapy, and radiation therapy. Problems include issues with bowel, ostomy, bladder, sexual health, peripheral neuropathy, and mental health. Colorectal cancer survivors are especially receptive to making lifestyle changes to improve their long-term health. Gastroenterology nurses can utilize evidence-based recommendations for weight management, diet, physical activity, and lifestyle with the goal of preventing recurrence and a second primary cancer and promoting overall long-term health.
Prospective Clinical, Virologic, and Immunologic Assessment of COVID-19 in Transplant Recipients
Authors: Marinelli Tina , Ferreira Victor H. , Ierullo Matthew , Ku Terrance , Lilly Les , Kim S. Joseph , Schiff Jeffrey , Sidhu Aman , McDonald Michael , Hosseini-Moghaddam Seyed M. , Husain Shahid , Rotstein Coleman , Majchrzak-Kita Beata , Kulasingam Vathany , Humar Atul , Kumar Deepali
Published: June 2021

Background.

Several studies have described the clinical features of COVID-19 in solid-organ transplant recipients. However, many have been retrospective or limited to more severe cases (hospitalized) and have not routinely included serial virological sampling (especially in outpatients) and immunologic assessment.

Methods.

Transplant patients diagnosed with COVID-19 based on a respiratory sample PCR were prospectively followed up to 90 d. Patients provided consent for convalescent serum samples and serial nasopharyngeal swabs for SARS-CoV-2 antibody (antinucleoprotein and anti-RBD) and viral load, respectively.

Results.

In the 161 SOT recipients diagnosed with COVID-19, the spectrum of disease ranged from asymptomatic infection (4.3%) to hospitalization (60.6%), supplemental oxygen requirement (43.1%), mechanical ventilation (22.7%), and death (15.6%). Increasing age (OR, 1.031; 95% CI, 1.001-1.062; P = 0.046) and ≥2 comorbid conditions (OR, 3.690; 95% CI, 1.418-9.615; P = 0.007) were associated with the need for supplemental oxygen. Allograft rejection was uncommon (3.7%) despite immunosuppression modification. Antibody response at ≥14 d postsymptoms onset was present in 90% (anti-RBD) and 76.7% (anti-NP) with waning of anti-NP titers and stability of anti-RBD over time. Median duration of nasopharyngeal positivity was 10.0 d (IQR, 5.5–18.0) and shedding beyond 30 d was observed in 6.7% of patients. The development of antibody did not have an impact on viral shedding.

Conclusions.

This study demonstrates the spectrum of COVID-19 illness in transplant patients. Risk factors for severe disease are identified. The majority form antibody by 2 wk with differential stability over time. Prolonged viral shedding was observed in a minority of patients. Reduction of immunosuppression was a safe strategy.
Energizing ASTM lap joint fracture standards
Authors: Kendall Kevin
Published: June 2021

Several ASTM standards on the fracture of glued and welded joints need attention because they do not consider the Griffith energy criterion of cracking which was proposed a century ago. It is almost as if Griffith never existed because the ASTM definition of failure is the stress criterion postulated by Galileo in 1638 in which stress at failure (i.e. strength = force/area) is defined as the determinant of fracture. Irene Martinez Villegas (Villegas, Rans 2021Phil. Trans. R. Soc. A376, 20200296. (doi:10.1098/rsta.2020.0296)) shows in this volume that attempts to use ASTM D5868 to standardize welded composite (carbon fibre reinforced polymer, CFRP) lap joints reveal major problems. First, the test is a low angle bend–peel test; not shear. Second, the energy required to break the joint is not emphasized so that joints may have high strength properties but also low toughness; third, the fracture force is not proportional to the lap joint area so the concept of strength independent of sample size is false; fourth, as the CFRP panels are made thicker, the strength rises at constant overlap area so the strength can be any value you want; fifth, the strength of larger joints goes down; this is the size effect noted in many bend-cracking tests, much as Galileo suggested for bent beam fracture in his famous book ‘the larger the machine, the greater its weakness'. The purpose of this paper is to demonstrate that poor ASTM ‘shear strength’ standards should be replaced by a definition of welded lap joint performance based on Griffith's energy conservation argument in which fracture surface energy is the main parameter resisting failure. The foundation of this Griffith-style lap joint analysis for long cracks goes back to 1975 but has been largely ignored until now because it does not fit the Griffith equation for cracked sheets, has no ‘stress intensity factor’, and travels at constant speed, not accelerating like the standard Griffith tension crack. This study of tensile delamination shows that a long lap crack is not driven by stress near the crack but by changes in stored elastic energy in the stretched strips remote from the crack tip, while strain energy release rate is negative. It would be more appropriate to call this lap failure a tensile delamination crack.

This article is part of a discussion meeting issue ‘A cracking approach to inventing new tough materials: fracture stranger than friction’.
A Markov chain-based model for structural vulnerability assessmentof corrosion-damaged reinforced concrete bridges
Authors: Dizaj Ebrahim Afsar , Padgett Jamie E. , Kashani Mohammad M.
Published: June 2021

The deterioration and cracking of reinforced concrete (RC) bridges due to the chloride-induced corrosion of steel reinforcement is an inherently time-dependent stochastic phenomenon. In the current practice of bridge management systems, however, the determination of the condition states of deteriorated bridges is highly dependent on the opinion of experienced inspectors. Taking such complexity into account, the current paper presents a new stochastic predictive methodology using a non-homogeneous Markov process, which directly relates the visual inspection data (corrosion rate and crack widths) to the structural vulnerability of deteriorated concrete bridges. This methodology predicts the future condition of corrosion-induced damage (concrete cracking) by linking structural vulnerability analysis and a discrete-time Markov chain model. The application of the proposed methodology is demonstrated through a case-study corrosion-damaged RC bridge pier.

This article is part of a discussion meeting issue ‘A cracking approach to inventing new tough materials: fracture stranger than friction’.
The dangers of single-lap shear testing in understanding polymer composite welded joints
Authors: Villegas Irene Fernandez , Rans Calvin
Published: June 2021

Single-lap shear (SLS) joints are straightforward to manufacture. This makes them especially attractive for testing polymer composite welded joints. Owing to local heating, which is characteristic of composite welding processes, the production of more geometrically intricate joints (such as double-lap or scarfed joints) or bigger joints (such as end-notched flexure or double cantilever beam) typically entails significant complexity in the design of the welding process. Testing of SLS joints is also uncomplicated and, even though, owing to mixed-mode loading and uneven stress distribution, it does not provide design values, it is widely acknowledged as a valuable tool for comparison. Even so, comparing different aspects of composite welded joints through their corresponding SLS strength values alone can be deceptive. This paper shows that comparison of different welding processes, adherend materials, process parameters or different types of joining techniques through SLS testing is only meaningful when strength values are combined with knowledge on other aspects of the joints such as joint mesostructure, failure modes and joint mechanics.

This article is part of a discussion meeting issue ‘A cracking approach to inventing new tough materials: fracture stranger than friction’.
Explicit transformation between non-adhesive and adhesive contact problems by means of the classical Johnson–Kendall–Roberts formalism
Authors: Perepelkin Nikolay V. , Borodich Feodor M.
Published: June 2021

The classic Johnson–Kendall–Roberts (JKR) contact theory was developed for frictionless adhesive contact between two isotropic elastic spheres. The advantage of the classical JKR formalism is the use of the principle of superposition of solutions to non-adhesive axisymmetric contact problems. In the recent years, the JKR formalism has been extended to other cases, including problems of contact between an arbitrary-shaped blunt axisymmetric indenter and a linear elastic half-space obeying rotational symmetry of its elastic properties. Here the most general form of the JKR formalism using the minimal number of
a priori
conditions is studied. The corresponding condition of energy balance is developed. For the axisymmetric case and a convex indenter, the condition is reduced to a set of expressions allowing explicit transformation of force–displacement curves from non-adhesive to corresponding adhesive cases. The implementation of the developed theory is demonstrated by presentation of a two-term asymptotic adhesive solution of the contact between a thin elastic layer and a rigid punch of arbitrary axisymmetric shape. Some aspects of numerical implementation of the theory by means of Finite-Element Method are also discussed.

This article is part of a discussion meeting issue ‘A cracking approach to inventing new tough materials: fracture stranger than friction’.
The impact of temperature on the transmission potential and virulence of COVID-19 in Tokyo, Japan
Authors: Yamasaki Lisa , Murayama Hiroaki , Hashizume Masahiro
Published: June 2021

Background

Assessing the impact of temperature on COVID-19 epidemiology is critical for implementing non-pharmaceutical interventions. However, few studies have accounted for the nature of contagious diseases, i.e., their dependent happenings.

Aim

We aimed to quantify the impact of temperature on the transmissibility and virulence of COVID-19 in Tokyo, Japan. We employed two epidemiological measurements of transmissibility and severity: the effective reproduction number (Rt) and case fatality risk (CFR).

Methods

We used empirical surveillance data and meteorological data in Tokyo to estimate the Rt and time-delay adjusted CFR and to subsequently assess the nonlinear and delay effect of temperature on Rt and time-delay adjusted CFR.

Results

For Rt at low temperatures, the cumulative relative risk (RR) at first temperature percentile (3.3°C) was 1.3 (95% confidence interval (CI): 1.1-1.7). As for the virulence to humans, moderate cold temperatures were associated with higher CFR, and CFR also increased as the temperature rose. The cumulative RR at the 10th and 99th percentiles of temperature (5.8°C and 30.8°C) for CFR were 3.5 (95%CI: 1.3-10) and 6.4 (95%CI: 4.1-10.1).

Conclusions

This study provided information on the effects of temperature on the COVID-19 epidemiology using Rt and time-delay adjusted CFR. Our results suggest the importance to take precautions to avoid infection in both cold and warm seasons to avoid severe cases of COVID-19. The results and proposed framework will also help in assessing possible seasonal course of COVID-19 in the future.
Observed and self-reported COVID-19 health protection behaviours on a university campus and the impact of a single simple intervention
Authors: Davies Rachel , Weinman John , Rubin G James
Published: June 2021

Objectives

Hygiene behaviours had been an essential component of attempts to slow the spread of SARS-CoV-2. Most data on adherence to these behaviours is collected via self-reporting, which can differ from observed behaviours. We quantified this discrepancy among a university sample and tested the impact of simple intervention on observed behaviour.

Study design

Cross-sectional questionnaire of behaviour on campus compared to direct observation on one day without, and one day with, additional signage.

Methods

We circulated an email inviting all staff and students at our university to complete a questionnaire asking how often they wear a mark or practice hand hygiene when entering campus buildings, and how often they practiced social distancing within campus buildings. We observed all entrants to the main building on one campus on a baseline day and on a day after installing a large sign reminding people that these behaviours were mandatory.

Results

In our survey, 172 out of 252 respondents (68%) reported always cleaning their hands, 225 out of 251 (90%) reported always wearing a face covering, and 124 out of 252 (49%) reported always maintaining social distancing. On the baseline day of observation, 50 out of 311 people (16.1%) cleaned their hands and 256 (82.3%) wore a face covering correctly. Out of 119 people whom we could assess, 9 (7%) maintained social distance from others. The signage was associated with significant improvements for cleaning hands (104 / 375 people: 27.7%), wearing a face covering (374 / 375; 99.8%) and maintaining social distance (79 / 144; 54.8%).

Conclusions

Greater use of observational methods will provide a more accurate measure of behaviour than the current reliance on self-report and allow interventions to be robustly tested.
Association of opioid use disorder with healthcare utilization and cost in a public health system
Authors: Miron Oren , Barda Noam , Balicer Ran , Kor Ariel , Lev-Ran Shaul
Published: June 2021

Background and objectives

To quantify the healthcare costs associated with opioid use disorder among members in a public healthcare system, and compare them to healthcare costs in the general population.

Methods

Retrospective cohort study in inpatient and outpatient care settings of Israel’s largest public healthcare provider (that covers 4.7 million members).

Participants included 1,173 members who had a diagnosis of opioid use disorder in the years between 2013 and 2018. Each patient was matched with 10 controls based on age and sex. The main outcome was monthly healthcare costs.

Results

The mean monthly healthcare cost of members with opioid use disorder was $1,102 compared to $211 among controls (5.2-fold difference; 95% confidence interval [CI]: 4.6-6.0). After excluding members with heroin related diagnoses before the index date (in order to focus on prescription opioids), this healthcare cost ratio did not substantially change (4.6-fold; 95%-CI: 3.9-5.4). Members with opioid use disorder under the age of 65 years had a cost difference of 6.1-fold (95%-CI: 5.2-7.1), while those 65 years and older experienced cost difference of 3.4-fold (95%-CI: 2.6-4.5). The category with the highest cost for members with opioid use disorder was inpatient services, which was 8.7-fold (95%-CI 7.2-10.4) greater than among controls.

Conclusions

Healthcare costs among individuals with opioid use disorder in a public health system were substantially higher than among controls, at least partially attributed to prescription opioid use disorder. Differences were greater among individuals younger than 65 years, highlighting the importance of preventing and treating opioid use disorder among younger adult populations.
BNT162b2 COVID-19 VACCINATION AND ITS EFFECT ON BLOOD PRESSURE
Authors: Tan Toh Leong , Salleh Sharifah Azura , Man Zuraidah Che , Peng Tan Michelle Hwee , Kader Rashid , Jarmin Razman
Published: June 2021

This study aims to explore the trends of systolic blood pressure (SBP), diastolic BP (DBP), mean arterial pressure (MAP) and pulse pressure (PP) before and 15-minutes after two doses of the BNT162b2 vaccine, which were administered 21 days apart. This vaccine safety active surveillance study was carried out on 15th-16th March (first dose) and 5th-6th April 2021 (second dose), in academic hospital.. Vaccinees above 18 years old, SBP, DBP, MAP and PP pre- and 15 minutes post-vaccination for both doses were analysed. Study outcomes were mean of BP, mean of BP changes, and BP trends measurements. A total of 287 vaccinees were included. A quarter (n=72) had decreased DBP ≥ 10mmHg (mean DBP deceased: 15mmHg, 95%CI: 14-17mmHg) after the first dose, and 12.5% post-second dose (mean DBP decreased: 13mmHg, 95%CI: 12-15mmHg). Post-first dose, 28.6% (n= 82) were found to have widened PP > 40mmHg. After the first dose, those who had elevated and decreased SBP ≥ 20mmHg were 5.2% and 4.9%, respectively. Eleven percent (n = 32) had decreased SBP ≥ 20mmHg post-second dose, nevertheless the psychology effect cannot be ruled out. The BNT162b2 vaccine was generally well tolerated. BP changes after vaccination emphasizes the need for monitoring.
Completion of electronic nursing documentation of inpatient admission assessment: insights from Australian metropolitan hospitals
Authors: Shala Danielle Ritz , Jones Aaron , Fairbrother Greg , Tran Duong Thuy
Published: June 2021

Introduction

Electronic nursing documentation is an essential aspect of inpatient care and multidisciplinary communication. Analysing data in electronic medical record (eMR) systems can assist in understanding clinical workflows, improving care quality, and promoting efficiency in the healthcare system. This study aims to assess timeliness of completion of an electronic nursing admission assessment form and identify patient and facility factors associated with form completion in three metropolitan hospitals.

Materials and Methods

Records of 37,512 adult inpatient admissions (November 2018-November 2019) were extracted from the hospitals’ eMR system. A dichotomous variable descriptive of completion of the nursing assessment form (Yes/No) was created. Timeliness of form completion was calculated as the interval between date and time of admission and form completion. Univariate and multivariate multilevel logistic regression were used to identify factors associated with form completion.

Results

An admission assessment form was completed for 78.4% (n=29,421) of inpatient admissions. Of those, 78% (n=22,953) were completed within the first 24 hours of admission, 13.3% (n=3,910) between 24-72 hours from admission, and 8.7% (n=2558) beyond 72 hours from admission. Patient length of hospital stay, admission time, and admitting unit’s nursing hours per patient day were associated with form completion. Patient gender, age, and admitting unit type were not associated with form completion.

Discussion

Form completion rate was high, though more emphasis needs to be placed on the importance of timely completion to allow for adequate patient care planning. Staff education, qualitative understanding of delayed form completion, and streamlined guidelines on nursing admission and eMR use are recommended.

Statement on conflicts of interest

Declarations of interest: none

Summary Table

What was already known on the topic

Electronic clinical documentation is an essential aspect of inpatient care and multidisciplinary communication

Timely completion of documentation enables prompt team communication and facilitates quality patient care planning

Australian hospitals are moving towards fully adopting eMR-based technologies to manage patient care processes and multidisciplinary communication

What this study added to our knowledge

The timeliness of electronic nursing documentation can be improved

There are patient- and facility-related factors which influence the completion of electronic nursing forms

The application of advanced modelling techniques to existing eMR data assists in understanding clinician practices, processes and workflows
Sources of variability in methods for processing, storing, and concentrating SARS-CoV-2 in influent from urban wastewater treatment plants
Authors: Steele Joshua A. , Zimmer-Faust Amity G. , Griffith John F. , Weisberg Stephen B.
Published: June 2021

The rapid emergence of wastewater based surveillance has led to a wide array of SARS-CoV-2 RNA quantification methodologies being employed. Here we compare methods to store samples, inactivate viruses, capture/concentrate viruses, and extract/measure viral RNA from primary influent into wastewater facilities. We found that heat inactivation of the viruses led to a 1-3 log10decrease compared to chemical inactivation. Freezing influent prior to concentration caused a 1-4 log10decrease compared to processing fresh samples, but viral capture by membrane adsorption prior to freezing was robust to freeze-thaw variability. Concentration vs. direct extraction, and PCR platform also affected outcome, but by a smaller amount. The choice of nucleocapsid gene target had nearly no effect. Pepper mild-mottle virus was much less sensitive to these methodological differences than was SARS-CoV-2, which challenges its use as a population-level control among studies using different methods. Better characterizing the variability associated with different methodologies, in particular the impact of methods on sensitivity, will aid decision makers in following the effects of vaccination campaigns, early detection of future outbreaks, and potentially monitoring the appearance of SARS-CoV-2 variants in the population.
School teachers’ self-reported fear and risk perception during the COVID-19 pandemic – a nationwide survey in Germany
Authors: Weinert Stefanie , Thronicke Anja , Hinse Maximilian , Schad Friedemann , Matthes Harald
Published: June 2021

Background

With COVID-19 cases peaking, COVID-19 vaccination programs starting and health systems reaching their limits in winter 2020/21, schools remained closed in many countries despite ever-recurring debates. To better understand teachers’ fear of infection and risk perception we conducted a survey in Germany.

Methods

Participants were recruited through various associations and invited to take part in a cross-sectional COVID-19 specific online survey. Anonymous demographic and self-reported data were collected from those who gave their informed consent. Descriptive statistical analysis was performed. To evaluate with fear associated factors of contracting SARS-CoV-2, an adjusted multivariable regression analysis was performed.

Results

6.753 teachers gave their informed consent to answer the online survey. The median age of the teachers was 43 years with 77% being female. Most teachers worked in high schools (29%) and elementary schools (26%). Most participants (73%) feared to contract SARS-CoV-2 at school while 77% intended to be vaccinated against COVID-19. 98% considered students to pose the greatest risk. Multivariable regression analysis revealed that female and younger teachers were significantly more anxious to get infected with SARS-CoV-2 and that the odds teachers were more anxious was 9 times higher for those who favored re-opening of schools the least (p < 0.001).

Conclusions

To the authors’ knowledge, this is the first study to describe teachers fear and risk perception of COVID-19 and their attitude towards vaccinations in a nationwide survey. The anxiety correlates to the COVID-19 protection measures demanded. Teachers’ fear is the driving factor and not a rational logic.