bluuebunny/crossref_metadata_2025 huggingface dataset:
Post‐Influenza vaccine‐induced acute hemorrhagic leukoencephalitis treated with plasma exchange—A case report
Authors: Koenig Zachary , Prasad Apoorv , Altaweel Laith , Sriwastava Shitiz
Published: July 2021

Acute Hemorrhagic Leukoencephalitis (AHLE) is a rare but devastating and fatal form of Acute Disseminated Encephalomyelitis. Very rarely, this can be a complication of vaccination. There is currently no consensus on the optimal treatment strategy of AHLE. We present a rare case of AHLE after seasonal influenza vaccine promptly diagnosed with magnetic resonance imaging (MRI) brain, which showed significant areas of hemorrhage with vasogenic edema including involvement of the pons. The patient was aggressively treated with plasma exchange and corticosteroids and had a favorable outcome.
Comparison of hospitalization outcomes for delivery and resource utilization between pregnant women with kidney transplants and chronic kidney disease in the United States
Authors: Chewcharat Api , Kattah Andrea G. , Thongprayoon Charat , Cheungpasitporn Wisit , Boonpheng Boonphiphop , Gonzalez Suarez Maria L. , Craici Iasmina M. , Garovic Vesna D.
Published: July 2021

Background

This study aimed to assess outcomes of delivery hospitalizations, including acute kidney injury (AKI), obstetric and foetal events and resource utilization among pregnant women with kidney transplants compared with pregnant women with no known kidney disease and those with chronic kidney disease (CKD) Stages 3–5.

Method

Hospitalizations for delivery in the US were identified using the enhanced delivery identification method in the National Inpatient Sample dataset from the years 2009 to 2014. Diagnoses of CKD Stages 3–5, kidney transplantation, along with obstetric events, delivery methods and foetal events were identified using ICD‐9‐CM diagnosis and procedure codes. Patients with no known kidney disease group were identified by excluding any diagnoses of CKD, end stage kidney disease, and kidney transplant. Multivariable logistic regression accounting for the survey weights and matched regression was conducted to investigate the risk of maternal and foetal complications in women with kidney transplants, compared with women with no kidney transplants and no known kidney disease, and to women with CKD Stages 3–5.

Result

A total of 5, 408, 215 hospitalizations resulting in deliveries were identified from 2009 to 2014, including 405 women with CKD Stages 3–5, 295 women with functioning kidney transplants, and 5, 405, 499 women with no known kidney disease. Compared with pregnant women with no known kidney disease, pregnant kidney transplant recipients were at higher odds of hypertensive disorders of pregnancy (OR = 3.11, 95% CI [2.26, 4.28]), preeclampsia/eclampsia/HELLP syndrome (OR = 3.42, 95% CI [2.54, 4.60]), preterm delivery (OR = 2.46, 95% CI [1.75, 3.45]), foetal growth restriction (OR = 1.74, 95% CI [1.01, 3.00]) and AKI (OR = 10.46, 95% CI [5.33, 20.56]). There were no significant differences in rates of gestational diabetes or caesarean section. Pregnant women with kidney transplants had 1.30‐times longer lengths of stay and 1.28‐times higher costs of hospitalization. However, pregnant women with CKD Stages 3–5 were at higher odds of AKI (OR = 5.29, 95% CI [2.41, 11.59]), preeclampsia/eclampsia/HELLP syndrome (OR = 1.72, 95% CI [1.07, 2.76]) and foetal deaths (OR = 3.20, 95% CI [1.06, 10.24]), and had 1.28‐times longer hospital stays and 1.37‐times higher costs of hospitalization compared with pregnant women with kidney transplant.

Conclusion

Pregnant women with kidney transplant were more likely to experience adverse events during delivery and had longer lengths of stay and higher total charges when compared with women with no known kidney disease. However, pregnant women with moderate to severe CKD were more likely to experience serious complications than kidney transplant recipients.
BURIAL IN EARLY MEDIEVAL WALES: IDENTIFYING MULTIFUNCTIONAL CEMETERIES
Authors: Shiner Marion R.
Published: July 2021

Burial grounds and secular settlements in early medieval Wales (fifth to eleventh centuries AD) are understood to have been in geographically separate locations. In contrast, it is known that in England and on the Continent during this period burial began to be integrated within settlements. Changes in burial practice also occurred in Ireland, where early medieval ‘cemetery settlements’ with integrated burial and non‐funerary activity are a relatively recent discovery. This paper presents a reassessment of the archaeological evidence from five published early medieval Welsh cemeteries and one recently‐excavated example. It will demonstrate that these Welsh cemeteries share a number of attributes with Irish cemetery settlements and will critically evaluate the significance of this for our understanding of early medieval Wales. The paper will conclude that such sites are better conceptualized as ‘multifunctional cemeteries’, rather than ‘cemetery settlements’.
Identification and characterization of a UbK family kinase in Porphyromonas gingivalis that phosphorylates the RprY response regulator
Authors: Perpich John D. , Yakoumatos Lan , Johns Parker , Stocke Kendall S. , Fitzsimonds Zackary R. , Wilkey Daniel W. , Merchant Michael L. , Miller Daniel P. , Lamont Richard J.
Published: July 2021

Phosphorylation of proteins is a key component of bacterial signaling systems that can control important functions such as community development and virulence. We report here the identification of a Ubiquitous bacterial Kinase (UbK) family member, designated UbK1, in the anaerobic periodontal pathogen, Porphyromonas gingivalis. UbK1 contains conserved SPT/S, Hanks‐type HxDxYR, EW, and Walker A motifs, and a mutation analysis established the Walker A domain and the Hanks‐type domain as required for both autophosphorylation and transphosphorylation. UbK1 autophosphorylates on the proximal serine in the SPT/S domain as well as the tyrosine residue within the HxDxYR domain and the tyrosine residue immediately proximal, indicating both serine/threonine and tyrosine specificity. The orphan two‐component system response regulator (RR) RprY was phosphorylated on Y41 in the receiver domain by UbK1. The ubk1 gene is essential in P. gingivalis; however, overexpression of UbK1 showed that UbK1‐mediated phosphorylation of RprY functions predominantly to augment its properties as a transcriptional enhancer. These results establish that P. gingivalis possesses an active UbK kinase in addition to a previously described Bacterial Tyrosine family kinase. The RR RprY is identified as the first transcriptional regulator controlled by a UbK enzyme.
Phenotypic identification of near isogenic maize teosinte lines (Zea spp.) involved for resistance to gray leaf spot
Authors: Guerrero‐Corona Abraham , Santacruz Ruvalcaba Fernando , Alberto Sánchez Nuño José , Moya Raygoza Gustavo , Ariel Ruiz Corral José , De la Cruz Larios Lino
Published: July 2021

Wild germplasm of Zea is a source of variation that could be used in plant breeding to improve maize resistance to diseases such as gray leaf spot (GLS). The objectives were to develop a set of near‐isogenic lines (NILs) carrying introgressions from almost all known wild teosinte taxa in a common maize inbred line background (CML311) and to identify NILs expressing superior resistance to GLS. We developed 2,208 BC3‐derived NILs representing 79 different teosinte populations of 10 taxa as donor parents. We compared the means of NILs grouped by donor to the recurrent and identified donor population El Saucito, (Zea mays ssp. parviglumis race Balsas) as the donor source of NILs with highest mean resistance to GLS. Among the 2,208 NILs, 116 representing diverse introgressions of Zea donors were significantly more resistant than CML311. The most resistant individual line was T1662, derived from San Antonio Tlaltecahuacan donor (Zea mays ssp. mexicana, race Chalco). NILs were characterized for flowering time and yield, and we identified correlations between resistance to GLS and later flowering and lower grain yield.
Arabidopsis root growth and development under metal exposure presented in an adverse outcome pathway framework
Authors: van Dijk Jesper R. , Kranchev Mario , Blust Ronny , Cuypers Ann , Vissenberg Kris
Published: July 2021

Due to human activities, soils become more and more polluted with metals, which imposes risks for human health and wildlife welfare. As most of the metals end up in the food chain through accumulation in plants, we need to establish science‐based environmental criteria and risk management policies. To meet these necessities, a thorough understanding is required of how these metals accumulate in and affect plants. Many studies have been conducted towards this aim, but strikingly, only a few entries can be found in ecotoxicological databases, especially on Arabidopsis thaliana, which serves as a model species for plant (cell) physiology and genetic studies. As experimental conditions seem to vary considerably throughout literature, extrapolation or comparison of data is rather difficult or should be approached with caution. Furthermore, metal‐polluted soils often contain more than one metal, yet limited studies investigated the impact of metal mixtures on plants. This review aims to compile all data concerning root system architecture under Cu, Cd and Zn stress, in single or multi‐metal exposure in A. thaliana, and link it to metal‐induced responses at different biological levels. Global incorporation into an adverse outcome pathway framework is presented.
Poll position: A sampling of statistical edutainment
Authors: Pearl Dennis K. , Lesser Lawrence M.
Published: July 2021

Jokes, cartoons, songs, videos, and quotes can be useful ways to engage students in discussion and learning key concepts about polling.
Treatment of indolent cutaneous T‐cell lymphoma with hypofractionated radiation therapy in three cats
Authors: Chadsey Laura E. , Cook Matthew R. , Green Eric E. , Jennings Ryan N. , Moore Peter F. , Vernau William , Kisseberth William C. , Diaz Sandra F.
Published: July 2021

Background

Feline indolent cutaneous T‐cell lymphoma (ICL) is an uncommon neoplastic disease. There is currently no consensus on treatment recommendations for ICL.

Objective

To report the clinical outcome of three cats with ICL treated with hypofractionated electron‐beam radiotherapy (RT).

Animals

Three privately owned cats with ICL.

Materials and methods

Medical records and client surveys were reviewed. A diagnosis of probable ICL was based on history, clinical presentation and histopathological findings, and confirmed using CD3 immunohistochemical analysis and PCR for antigen receptor gene rearrangement (PARR). All cats were treated with hypofractionated RT (four fractions of 8 Gy).

Results

All cats presented with skin lesions characterised by erythema and alopecia that were refractory to previous treatment with systemic glucocorticoids. Before hypofractionated RT treatment, lesions were histologically described as having diffuse infiltration of the dermis with CD3+ T cells. Molecular clonality analysis revealed clonal T‐cell receptor gamma gene rearrangement. After RT, two cats showed histological improvement defined by decreased infiltration of lymphocytes, with cellular infiltrate present only in the deeper dermis; one cat had near complete histological resolution of lesions with only minimal residual lymphocytes. One cat was determined to have a complete clinical response while the other showed partial responses. No acute adverse effects of radiation were observed; chronic effects included leukotrichia, partial alopecia and mild fibrosis. All clients reported improvement in quality of life for their cats.

Conclusions and clinical importance

Clinical and histological improvement in these cats suggests that hypofractionated RT can be a useful treatment modality for cats with ICL
Cranial translation of the elevated prepuce in dogs before and after two modifications: A cadaveric study
Authors: Yiapanis Christos , Atamna Raya , Gan El Mirit , Shipov Anna , Chochlios Tryfon , Milgram Josh
Published: July 2021

Objective

To quantify cranial translation of the prepuce after elevating it from the ventral body wall and to compare it to the cranial translation achieved after each of two modifications expected to increase cranial translation.

Study design

Cadaveric study.

Sample population

Ten male dogs.

Methods

All procedures were performed with dogs in dorsal recumbency. A urinary catheter with an attached millimeter scale was secured in the urethra and the penis was sutured to the ventral body wall to eliminate relative movement between the penis and prepuce. Three preplaced sutures between the prepuce and linea alba, at increasing distances from the prepuce, were used to translate the prepuce cranially. The prepuce was tested after elevating it from the ventral body wall, and after sequentially releasing the skin caudal to the prepuce (modification 1) and the attachment of the lamina interna to the penis (modification 2). The preplaced sutures were tightened and loosened sequentially from caudal to cranial, and the location of the dorsal aspect of the preputial opening on the millimeter scale was noted prior to, and after tightening each of the sutures.

Results

Maximum mean (range) cranial translation of the prepuce after elevating the prepuce, and after modifications 1 and 2, was 15 mm (5–26 mm), 25 mm (15–30 mm), and 37 mm (24–50 mm), respectively.

Conclusion

Modifications described increased cranial translation of the prepuce.

Clinical significance

Modifications described in this study may provide alternate strategies for the treatment of dogs with severe paraphimosis.
Climate Change Adaptation in the British Columbia Wine Industry Can Carbon Sequestration Technology Lower the BC Wine Industry’s Greenhouse Gas Emissions?
Authors: Cartier Lee , Lembke Svan
Published: July 2021

This paper measures the benefits and costs of using biochar, a carbon sequestration technology in the British Columbia (BC) wine industry. It was found that the use of biochar, produced from wine industry waste, can reduce greenhouse gas emissions, and make a significant economic contribution to the BC wine industry.  An economic model was developed to calculate the value-added from each of the three sectors that comprise the BC Wine industry value chain. The model uses biochar, produced from grape prunings and pomace, as a soil amendment in the vineyards. Grapes produced from these vineyards are used to produce wine. The assumptions for each variable used in this study are drawn from the literature and prior research by the authors. In addition to achieving the industry’s sustainability goals, each sector of the wine value chain is potentially profitable, however producing biochar as a profitable independent business is likely minimal compared to what could be achieved along the value chain with increased yields of the same quality.  Biochar as a soil amendment is a long-term investment for farmers with results best assessed after multiple years.  Future research is needed to better understand the biochar production process as an integral part of the BC wine industry, the carbon sequestration benefits, the specific increases in long-term grape yields and wine production.  Also, the industry willingness to re-evaluate and change present industry practices, and other important benefits that can be derived from marketing climate friendly wine to BC consumers needs to be understood.
Hide and seek in a pandemic: review of SARS‐CoV‐2 infection and sequelae in children
Authors: Clark John A. , Pathan Nazima
Published: July 2021

New Findings

What is the topic of this review?

A description of the current literature relating to COVID‐19 infection in children and the associated inflammatory condition, paediatric multi‐inflammatory syndrome temporally associated with SARS‐CoV‐2 (PIMS‐TS).

What advances does it highlight?

Children with SARS‐CoV‐2 infection have a distinct clinical phenotype when compared to adults. This may relate to relative differences in their adaptive immunity and in the degree and distribution of expression of the SARS‐CoV‐2 receptor (angiotensin‐converting enzyme 2). There are several similarities between PIMS‐TS, Kawasaki disease shock syndrome and other known inflammatory disorders such as macrophage activation syndrome. Few data are available to date regarding vaccination responses of children against COVID‐19.

Children infected with SARS‐CoV‐2 have a clinical phenotype that is distinct from that observed in adult cases. They can present with a range of respiratory, gastrointestinal and neurological symptoms, or with a delayed hyperinflammatory syndrome (paediatric multisystem inflammatory system temporally associated with SARS‐CoV‐2; PIMS‐TS) that frequently requires treatment in an intensive care unit. These manifestations may be related to unique expression of transmembrane receptors and immune physiology in children. The clinical features and inflammatory profile of PIMS‐TS are similar to other inflammatory disorders that occur in children such as Kawasaki disease, macrophage activation syndrome and sepsis. Given children are infected less frequently and have less severe disease due to COVID‐19 compared to adults, their physiological profile is of great interest. An understanding of the unique mechanisms of infection and disease in children could aid the identification of potential therapeutic targets. Like adults, children can have long‐term complications of SARS‐CoV‐2 infection, including neurological and cardiac morbidity. Vaccination against SARS‐CoV‐2 is not yet authorised in children aged <12 years, and hence we anticipate ongoing paediatric presentations of COVID‐19 in the coming months.
Función docente ideal/real en las representaciones sociales del profesorado
Authors: Vecina-Merchante Carlos , San Román-Gago Sonsoles
Published: July 2021

Esta investigación analiza representaciones sociales del profesorado y su función, para conocer si existen discursos justificativos y cuál es su  estructura. Emplea una metodología cualitativa de técnicas de análisis del discurso y grupos de discusión. Los resultados indican tres representaciones sobre su función docente ideal, contrapuestas a las representaciones sobre las que se materializa la práctica, que van desde una tipología de docentes de la ortodoxia instrumental hasta el aperturismo vital del alumnado. Como conclusión, se plantea que es necesario considerar esa diversidad interiorizada en el profesorado, tanto en el diseño como en la implementación de las políticas educativas.
Reseña del libro Bordes, límites y fronteras. Encuentros etnográficos con niños, niñas y adolescentes, editado por Alba Lucy Guerrero, Ángeles Clemente, Diana Milstein & Maria Dantas-Whitney
Authors: Bácares-Jara Camilo , Bertoli Anny
Published: July 2021

El libro que reseñamos a continuación no es casual ni está desconectado de un proyecto mayor. A ciencia cierta, es el segundo volumen publicado por los miembros de la Red Internacional de Etnografía con Niños, Niñas, Adolescentes   y Jóvenes (RIENN) sobre etnografía colaborativa y niñez, compilado por varias  de las mismas autoras y Michael Higgins (Milstein, Clemente, Dantas-Whitney, Guerrero & Higgins, 2001). Así, lo que se podría nombrar como una antropología de la infancia —en este caso más aplicada al campo educativo— es, quizás, junto a la historia de la infancia y la sociología de la infancia (Castillo, 2015; Gaitán, 2006; Rodríguez-Pascual, 2007; Sosenski, 2016), una de las vertientes disciplinares que más se han intere- sado por plantear que los niños, las niñas y los adolescentes (NNA) resultan ser productores de conocimiento, quienes, sobre terreno y en su propio contexto, pueden ver los fenómenos de otra manera, sin las ataduras y los códigos de los adultos.
Dark tone quality and vocal tract shaping in soprano song production: Insights from real-time MRI
Authors: Lynn Elisabeth , Narayanan Shrikanth S. , Lammert Adam C.
Published: July 2021

Tone quality termed “dark” is an aesthetically important property of Western classical voice performance and has been associated with lowered formant frequencies, lowered larynx, and widened pharynx. The present study uses real-time magnetic resonance imaging with synchronous audio recordings to investigate dark tone quality in four professionally trained sopranos with enhanced ecological validity and a relatively complete view of the vocal tract. Findings differ from traditional accounts, indicating that labial narrowing may be the primary driver of dark tone quality across performers, while many other aspects of vocal tract shaping are shown to differ significantly in a performer-specific way.
A Self-Determined Exploration of Adolescents’ and Parents’ Experiences Derived From a Multidimensional School-Based Physical Activity Intervention
Authors: Ferriz Roberto , Jiménez-Loaisa Alejandro , González-Cutre David , Romero-Elías María , Beltrán-Carrillo Vicente J.
Published: July 2021

Purpose: Adolescents’ and parents’ experiences within a multidimensional school-based physical activity intervention grounded on self-determination theory were explored. Method: Qualitative data from 29 adolescents (aged 15–17 years) and three parents on behalf of the total students’ families were collected via participant observation (research diary), semistructured interviews, and focus groups. Results: Adolescents perceived that the application of motivational strategies, based on self-determination theory, satisfied their basic psychological needs for autonomy, competence and relatedness, favored self-determined motivation, and gave rise to adaptive consequences (improved physical activity knowledge, creation of affective bonds, and increased leisure-time physical activity). These results were supported by the information reported by the students’ parents. Discussion/Conclusions: The findings support the implementation of self-determination theory-based multidimensional interventions to promote adolescents’ physical activity participation. This study also presents several motivational strategies which could be useful for the design and implementation of future school-based physical activity interventions.
Light, strong, and stable nanoporous aluminum with native oxide shell
Authors: Yang Wei , Luo Zhao-Ping , Bao Wei-Kang , Xie Hui , You Ze-Sheng , Jin Hai-Jun
Published: July 2021

A stable and strong nanoporous aluminum-alumina core-shell composite is self-organized in a galvanic replacement reaction.
Warming and elevated ozone induce tradeoffs between fine roots and mycorrhizal fungi and stimulate organic carbon decomposition
Authors: Qiu Yunpeng , Guo Lijin , Xu Xinyu , Zhang Lin , Zhang Kangcheng , Chen Mengfei , Zhao Yexin , Burkey Kent O. , Shew H. David , Zobel Richard W. , Zhang Yi , Hu Shuijin
Published: July 2021

Warming and elevated ozone alter root traits and mycorrhizal fungal community and stimulate organic carbon decomposition.
Organic carbon burial is paced by a ~173-ka obliquity cycle in the middle to high latitudes
Authors: Huang He , Gao Yuan , Ma Chao , Jones Matthew M. , Zeeden Christian , Ibarra Daniel E. , Wu Huaichun , Wang Chengshan
Published: July 2021

The ~173-ka obliquity–related cycle indicated a nonlinear interaction between orbital forcing and climate system.
Bubbles in superfluid helium containing six and eight electrons: Soft, quantum nanomaterial
Authors: Yadav Neha , Sen Prosenjit , Ghosh Ambarish
Published: July 2021

We observe few-electron bubbles in liquid helium-4, forming a soft nanomaterial with quantum interactions.
Something is killing U.S. birds. It's not cicadas
Authors: Malakoff David , Stokstad Erik
Published: July 2021

Birds with crusty eyes and neurological damage found in nine states and Washington, D.C.
Quantifying host-microbiota interactions
Authors: Zimmermann-Kogadeeva Maria
Published: July 2021

Modeling the microbiome increases understanding of its role in drug metabolism
Host genetics influence the gut microbiome
Authors: Cortes-Ortiz Liliana , Amato Katherine R.
Published: July 2021

Longitudinal data from nonhuman primates reveal widespread gut microbiome heritability
Richard Ernst (1933–2021)
Authors: Bodenhausen Geoffrey
Published: July 2021

Chemist who made magnetic resonance a powerful tool
Save Earth's global observatories
Authors: Likens Gene E. , Wagner David L.
Published: July 2021

Sitting at the interface of human societies and the natural environment are sentinels tracking environmental change. Across the globe, field stations and marine laboratories (FSMLs) amass crucial information about climate, biodiversity, environmental health, and emerging diseases, anchoring multidecadal data sets needed to solve environmental challenges of the Anthropocene. These observatories are now in danger of being shut down—part of the collateral damage of the COVID-19 pandemic.
NF-κB–dependent IRF1 activation programs cDC1 dendritic cells to drive antitumor immunity
Authors: Ghislat Ghita , Cheema Ammar S. , Baudoin Elodie , Verthuy Christophe , Ballester Pedro J. , Crozat Karine , Attaf Noudjoud , Dong Chuang , Milpied Pierre , Malissen Bernard , Auphan-Anezin Nathalie , Manh Thien P. Vu , Dalod Marc , Lawrence Toby
Published: July 2021

NF-κB and IRF1 coordinate intratumoral cDC1 maturation and control of immunogenic tumor growth.
Liver failure from delayed hepatitis B reactivation in anti-HBc-positive patient following rituximab for B-cell lymphoma
Authors: Borojevic Branko , Chauhan Ayushi , Patterson Scott
Published: July 2021

A 93-year-old man was admitted with 1 week of frank jaundice and abdominal pain. His medical history included diffuse large B-cell lymphoma treated with rituximab and cyclophosphamide, hydroxydaunomycin, oncovin and prednisolone (R-CHOP) chemotherapy 10 months prior. His investigations revealed marked hyperbilirubinemia with a total bilirubin of 355 μmol/L, along with a 17-fold elevation in alanine transaminase and impaired hepatic synthetic function. He tested hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (HBsAb) negative, hepatitis B core antibody (HBcAb) positive and had elevated hepatitis B virus DNA level at 13 691 IU/L. This was in the setting of radiological evidence of suspected cirrhosis. He was later found to have tested positive for HBcAb and negative for HBsAg and HBsAb prior to chemotherapy, but had not received antiviral prophylaxis. He was diagnosed with fulminant hepatitis secondary to delayed hepatitis B reactivation in the setting of rituximab. Hepatitis B reactivation and the role of screening and antiviral prophylaxis in isolated HBcAb-positive patients is reviewed.
Pay for performance in primary care: the contribution of the Programme for Improving Access and Quality of Primary Care (PMAQ) on avoidable hospitalisations in Brazil, 2009–2018
Authors: Russo Letícia Xander , Powell-Jackson Timothy , Maia Barreto Jorge Otavio , Borghi Josephine , Kovacs Roxanne , Gurgel Junior Garibaldi Dantas , Gomes Luciano Bezerra , Sampaio Juliana , Shimizu Helena Eri , de Sousa Allan Nuno Alves , Bezerra Adriana Falangola Benjamin , Stein Airton Tetelbom , Silva Everton Nunes
Published: July 2021

Background

Evidence on the effect of pay-for-performance (P4P) schemes on provider performance is mixed in low-income and middle-income countries. Brazil introduced its first national-level P4P scheme in 2011 (PMAQ-Brazilian National Programme for Improving Primary Care Access and Quality). PMAQ is likely one of the largest P4P schemes in the world. We estimate the association between PMAQ and hospitalisations for ambulatory care sensitive conditions (ACSCs) based on a panel of 5564 municipalities.

Methods

We conducted a fixed effect panel data analysis over the period of 2009–2018, controlling for coverage of primary healthcare, hospital beds per 10 000 population, education, real gross domestic product per capita and population density. The outcome is the hospitalisation rate for ACSCs among people aged 64 years and under per 10 000 population. Our exposure variable is defined as the percentage of family health teams participating in PMAQ, which captures the roll-out of PMAQ over time. We also provided several sensitivity analyses, by using alternative measures of the exposure and outcome variables, and a placebo test using transport accident hospitalisations instead of ACSCs.

Results

The results show a negative and statistically significant association between the rollout of PMAQ and ACSC rates for all age groups. An increase in PMAQ participating of one percentage point decreased the hospitalisation rate for ACSC by 0.0356 (SE 0.0123, p=0.004) per 10 000 population (aged 0–64 years). This corresponds to a reduction of approximately 60 829 hospitalisations in 2018. The impact is stronger for children under 5 years (−0.0940, SE 0.0375, p=0.012), representing a reduction of around 11 936 hospitalisations. Our placebo test shows that the association of PMAQ on the hospitalisation rate for transport accidents is not statistically significant, as expected.

Conclusion

We find that PMAQ was associated with a modest reduction in hospitalisation for ACSCs.
Development of a customised data management system for a COVID-19-adapted colorectal cancer pathway
Authors: Miller Janice , Gunn Frances , Dunlop Malcolm G , Din Farhat VN , Maeda Yasuko
Published: July 2021

Objectives

A customised data management system was required for a rapidly implemented COVID-19-adapted colorectal cancer pathway in order to mitigate the risks of delayed and missed diagnoses during the pandemic. We assessed its performance and robustness.

Methods

A system was developed using Microsoft Excel (2007) to retain the spreadsheets’ intuitiveness of direct data entry. Visual Basic for Applications (VBA) was used to construct a user-friendly interface to enhance efficiency of data entry and segregate the data for operational tasks.

Results

Large data segregation was possible using VBA macros. Data validation and conditional formatting minimised data entry errors. Computation by the COUNT function facilitated live data monitoring.

Conclusion

It is possible to rapidly implement a makeshift database system with clinicians’ regular input. Large-volume data management using a spreadsheet system is possible with appropriate data definition and VBA-programmed data segregation. The described concept is applicable to any data management system construction requiring speed and flexibility in a resource-limited situation.
Comparison of injuries between US Army paratroopers and their non-paratrooper soldier counterparts
Authors: Hauschild Veronique D , Rappole C A , Forrest L J , Dada E O , Beymer M R , Grier T , Jones B H
Published: July 2021

Introduction

Military studies have investigated acute injuries associated with parachute jumps, but the literature does not address paratroopers’ cumulative microtraumatic (CMT) injury risk, nor does it compare injury risks between paratroopers and the rest of the military population. This study determined whether US active duty Army paratroopers experienced greater injury risks than their non-paratrooper soldier counterparts and whether their injuries cost more to treat suggesting greater injury severity.

Methods

This retrospective study evaluated electronic medical records (2016–2018) for 31 621 paratroopers and a randomly selected comparison group of 170 715 non-paratrooper soldiers. Analyses included univariate and multivariate regression to quantify odds of injuries associated with risk variables and additional descriptive statistics.

Results

Paratroopers had a 57% increase in the odds of experiencing one or more injuries (OR=1.57, 95% CI: 1.52 to 1.62) after controlling for sex, race and age, with a greater proportion of acute injuries (OR=1.38, 95% CI: 1.34 to 1.42), relative to comparison group soldiers. Injury types proportionally higher among paratroopers included head trauma and shoulder injuries. Average injury cost among paratroopers was 13% lower than for non-paratroopers ($2470 vs $2830 per injury). Among both populations, acute injury costs were notably higher than for CMT injuries (paratroopers, $1710/$630; non-paratroopers, $1860/$880 per injury).

Conclusions

Paratroopers were more likely to incur injury, especially an acute injury, than non-paratroopers. However, paratroopers’ average injury costs were less. This may be due to higher return-to-duty motivations, fitness levels, and/or facility-specific cost of care. Future studies should investigate causes of injuries found to be proportionally higher among paratroopers.
Study protocol: epidemiological and clinical characteristics of acute viral hepatitis in Brazilian health services
Authors: Sitnik Roberta , Maluf Maira Marranghello , Oliveira Ketti G , Siqueira Ricardo Andreotti , Ferreira Carlos Eduardo dos Santos , Mangueira Cristóvão Luis Pitangueira , Azevedo Raymundo Soares , Ferraz Maria Lucia Cardoso Gomes , Correa Maria Cassia Jacintho Mendes , Ferreira Paulo Roberto Abrão , Mendes Pereira Gerson Fernando , de Souza Flávia Moreno Alves , Pimenta Cristina , Pinho João Renato Rebello
Published: July 2021

Introduction

Acute viral hepatitis is a disease of great clinical importance. This study proposes actions to better characterise cases of acute hepatitis in Brazil and to provide relevant information to institutionalised health policies within the Unified Health System. Available data on acute hepatitis in Brazil need to be re-evaluated regarding the different hepatotropic agent (hepatitis A to E virus) frequencies, as well as other agents that can cause similar clinical conditions, such as Herpes Simplex Virus 1 and 2(HSV1, HSV2), Varicella Zoster Virus (VZV), Cytomegalovirus (CMV), Epstein Barr Virus (EBV), Human Herpes Virus 6 and 7 (HHV6, HHV7), arbovirus (yellow fever, dengue, chikungunya, Zika), parvovirus B19, adenovirus, parechovirus, enterovirus, HIV, leptospirosis, toxoplasmosis and syphilis, in addition to autoimmune hepatitis. In this context, the primary aim of this study is the clinical-epidemiological and molecular characterisation of acute viral hepatitis in Brazilian health services from all geographical regions of the country. The present article describes the study protocol.

Methods and analysis

This study will evaluate 2280 patients with symptoms and/or signs suggestive of acute liver disease in Brazilian health institutions in all five geographic Brazilian regions. Demographic, epidemiological and clinical data will be collected, as well as blood samples to be analysed at Hospital Israelita Albert Einstein Clinical Laboratory.

Ethics and dissemination

Ethics approval was obtained at the national research ethics committee (Conselho Nacional de Ética em Pesquisa— CONEP–CAAE 00952818.4.1001.0071) and at all participating sites. Results will be published in journals and presented at scientific meetings.
Interventional treatments for chronic, axial or radicular, non-cancer, spinal pain: a protocol for a systematic review and network meta-analysis of randomised trials
Authors: Wang Xiaoqin , Martin Grace , Sadeghirad Behnam , Darzi Andrea J , Couban Rachel J , Florez Ivan D , Crandon Holly N , Kum Elena , Chang Yaping , Esfahani Meisam Abdar , Sivananthan Laxsanaa , Mehrabi Fatemeh , Sengupta Neil K , Rathod Preksha , Morsi Rami Z , Buckley D Norman , Guyatt Gordon H , Rampersaud Y Raja , Standaert Christopher J , Agoritsas Thomas , Busse Jason W
Published: July 2021

Introduction

Chronic, non-cancer, axial or radicular spinal pain is a common condition associated with considerable socioeconomic burden. Clinicians frequently offer patients various interventional procedures for the treatment of chronic spine pain; however, the comparative effectiveness and safety of available procedures remains uncertain.

Methods

We will conduct a systematic review of randomised controlled trials that explores the effectiveness and harms of interventional procedures for the management of axial or radicular, chronic, non-cancer, spine pain. We will identify eligible studies through a systematic search of Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials and Web of Science from inception without language restrictions. Eligible trials will: (1) enrol primarily adult patients (≥18 years old) with axial or radicular, chronic, non-cancer, spine pain, (2) randomise patients to different, currently available, interventional procedures or to an interventional procedure and a placebo/sham procedure or usual care, and (3) measure outcomes at least 1 month after randomisation.

Pairs of reviewers will independently screen articles identified through searches and extract information and assess risk of bias of eligible trials. We will use a modified Cochrane instrument to evaluate risk of bias. We will use frequentist random-effects network meta-analyses to assess the relative effects of interventional procedures, and five a priori hypotheses to explore between studies subgroup effects. We will use the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty in evidence for each outcome, including direct, indirect and network estimates.

Ethics and dissemination

No research ethics approval is required for this systematic review, as no confidential patient data will be used. We will disseminate our findings through publication in a peer-reviewed journal and conference presentations, and our review will support development of aBMJRapid Recommendations providing contextualised clinical guidance based on this body of evidence.

PROSPERO registration number

CRD42020170667.
Current status of health systems financing and oversight for end-stage kidney disease care: a cross-sectional global survey
Authors: Yeung Emily , Bello AK , Levin Adeera , Lunney Meaghan , Osman Mohamed A , Ye Feng , Ashuntantang Gloria , Bellorin-Font Ezequiel , Benghanem Gharbi Mohammed , Davison Sara , Ghnaimat Mohammad , Harden Paul , Jha Vivekanand , Kalantar-Zadeh Kamyar , Kerr Peter , Klarenbach Scott , Kovesdy Csaba , Luyckx Valerie , Neuen Brendon , O'Donoghue Donal , Ossareh Shahrzad , Perl Jeffrey , Ur Rashid Harun , Rondeau Eric , See Emily , Saad Syed , Sola Laura , Tchokhonelidze Irma , Tesar Vladimir , Tungsanga Kriang , Turan Kazancioglu Rumeyza , Wang Angela Yee-Moon , Wiebe Natasha , Yang Chih-Wei , Zemchenkov Alexander , Zhao Minhui , Jager Kitty J , Caskey Fergus , Perkovic Vlado , Jindal Kailash , Okpechi Ikechi G , Tonelli Marcello , Feehally John , Harris David CH , Johnson David
Published: July 2021

Objectives

The Global Kidney Health Atlas (GKHA) is a multinational, cross-sectional survey designed to assess the current capacity for kidney care across all world regions. The 2017 GKHA involved 125 countries and identified significant gaps in oversight, funding and infrastructure to support care for patients with kidney disease, especially in lower-middle-income countries. Here, we report results from the survey for the second iteration of the GKHA conducted in 2018, which included specific questions about health financing and oversight of end-stage kidney disease (ESKD) care worldwide.

Setting

A cross-sectional global survey.

Participants

Key stakeholders from 182 countries were invited to participate. Of those, stakeholders from 160 countries participated and were included.

Primary outcomes

Primary outcomes included cost of kidney replacement therapy (KRT), funding for dialysis and transplantation, funding for conservative kidney management, extent of universal health coverage, out-of-pocket costs for KRT, within-country variability in ESKD care delivery and oversight systems for ESKD care. Outcomes were determined from a combination of desk research and input from key stakeholders in participating countries.

Results

160 countries (covering 98% of the world’s population) responded to the survey. Economic factors were identified as the top barrier to optimal ESKD care in 99 countries (64%). Full public funding for KRT was more common than for conservative kidney management (43% vs 28%). Among countries that provided at least some public coverage for KRT, 75% covered all citizens. Within-country variation in ESKD care delivery was reported in 40% of countries. Oversight of ESKD care was present in all high-income countries but was absent in 13% of low-income, 3% of lower-middle-income, and 10% of upper-middle-income countries.

Conclusion

Significant gaps and variability exist in the public funding and oversight of ESKD care in many countries, particularly for those in low-income and lower-middle-income countries.
Psychological distress and trauma in doctors providing frontline care during the COVID-19 pandemic in the United Kingdom and Ireland: a prospective longitudinal survey cohort study
Authors: Roberts Tom , Daniels Jo , Hulme William , Hirst Robert , Horner Daniel , Lyttle Mark David , Samuel Katie , Graham Blair , Reynard Charles , Barrett Michael , Foley James , Cronin John , Umana Etimbuk , Vinagre Joao , Carlton Edward ,   on behalf of TheTrainee Emergency Research Network (TERN),   Paediatric Emergency Research in the UK and Ireland (PERUKI)
Published: July 2021

Objectives

The psychological impact of the COVID-19 pandemic on doctors is a significant concern. Due to the emergence of multiple pandemic waves, longitudinal data on the impact of COVID-19 are vital to ensure an adequate psychological care response. The primary aim was to assess the prevalence and degree of psychological distress and trauma in frontline doctors during the acceleration, peak and deceleration of the COVID-19 first wave. Personal and professional factors associated with psychological distress are also reported.

Design

A prospective online three-part longitudinal survey.

Setting

Acute hospitals in the UK and Ireland.

Participants

Frontline doctors working in emergency medicine, anaesthetics and intensive care medicine during the first wave of the COVID-19 pandemic in March 2020.

Primary outcome measures

Psychological distress and trauma measured using the General Health Questionnaire-12 and the Impact of Events-Revised.

Results

The initial acceleration survey distributed across networks generated a sample of 5440 doctors. Peak and deceleration response rates from the original sample were 71.6% (n=3896) and 56.6% (n=3079), respectively. Prevalence of psychological distress was 44.7% (n=1334) during the acceleration, 36.9% (n=1098) at peak and 31.5% (n=918) at the deceleration phase. The prevalence of trauma was 23.7% (n=647) at peak and 17.7% (n=484) at deceleration. The prevalence of probable post-traumatic stress disorder was 12.6% (n=343) at peak and 10.1% (n=276) at deceleration. Worry of family infection due to clinical work was the factor most strongly associated with both distress (R2=0.06) and trauma (R2=0.10).

Conclusion

Findings reflect a pattern of elevated distress at acceleration and peak, with some natural recovery. It is essential that policymakers seek to prevent future adverse effects through (a) provision of vital equipment to mitigate physical and psychological harm, (b) increased awareness and recognition of signs of psychological distress and (c) the development of clear pathways to effective psychological care.

Trial registration number

ISRCTN10666798.
The Standardisation of handoffs in a large academic paediatric emergency department using I-PASS
Authors: Chladek Melissa Sydow , Doughty Cara , Patel Binita , Alade Kyetta , Rus Marideth , Shook Joan , LIttle-Weinert Kim
Published: July 2021

Background and objectives

Despite the American College of Emergency Physicians and American Academy of Pediatrics recommendations for standardised handoffs in the emergency department (ED), few EDs have an established tool. Our aim was to improve the quality of handoffs in the ED by establishing compliance with the I-PASS handoff tool.

Methods

This is a quality improvement (QI) initiative to standardise handoffs in a large academic paediatric ED. Following review of the literature and focus groups with key stakeholders, I-PASS was selected and modified to fit departmental needs. Implementation throughPlan–Do–Study–Act cycles included the development of educational materials, reminders and real-time feedback. Required use of I-PASS during designated team sign-out began in June 2016. Compliance with the handoff tool and handoff deficiencies was measured through observations by faculty trained in I-PASS. As a balancing measure, time to complete handoff was monitored and compared with preintervention data.

Results

Compliance with I-PASS reached 80% within 6 months, 100% within 7 months and sustained at 100% during the remainder of the study period. The average percent of omissions of crucial information per handoff declined to 8.3%, which was a 53% decrease. Average percentage of tangential information and miscommunications per handoff did not show a decline. The average handoff took 20 min, which did not differ from the preintervention time. Survey results demonstrated a perceived improvement in patient safety through closed-loop communication, clear action lists and contingency planning and proper patient acuity identification.

Conclusions

I-PASS is applicable in the ED and can be successfully implemented through QI methodology contributing to an overall culture of safety.
Bark charcoal powder containing wood vinegar liquid can shorten the time to shipping of broilers raised in tropical areas by activating performance and intestinal function
Authors: Sittiya Janjira , Yamauchi Koh-en , Yamauchi Kohsyo
Published: July 2021

The effect of dietary bark charcoal containing vinegar liquid (BCV) on the growth performance, carcass and visceral organs, intestinal histology, fecal ammonia nitrogen, and nutrient digestibility were investigated in a total of 350 one-day-old unsexed Ross 308 broilers raised under a high environmental temperature (heat stress) from 0 to 42 d of age. They were divided into 0% (control group), 1%, 2%, 3%, and 4% dietary BCV groups. Compared with the control group, the body weight gain (BWG) of the 1% dietary BCV group at 21–42 d of age and the feed efficiency of the 2% dietary BCV group at 0–42 d of age increased (P < 0.05). The carcasses of the 1% and 3% dietary BCV groups significantly decreased (P < 0.05). The digestibility of dry matter and gross energy of the 4% dietary BCV group improved at 21 d (P < 0.05). The duodenum of the 3% and 4% dietary BCV groups was significantly heavier than those in the control groups (P < 0.05). This result suggests that BCV can shorten the time to shipping date for broilers to before 42 d of age and can contribute to the development of poultry production in tropical regions.
Differential DNA methylation analysis reveals key genes in Chinese Qingyu and Landrace pigs
Authors: Wang Kai , Wu Pingxian , Wang Shujie , Ji Xiang , Chen Dong , Xiao Weihang , Gu Yiren , Zeng Yangshuang , Xu Xu , Tang Guoqing
Published: July 2021

The Chinese Qingyu pig is a typical domestic fatty pig breed and an invaluable indigenous genetic resource in China. Compared with the Landrace pig, the Qingyu pig has unique meat characteristics, including muscle development, intramuscular fat, and other meat quality traits. At present, few studies have explored epigenetic differences due to DNA methylation between the Qingyu pig and the Landrace pig. In this study, 30 Qingyu pigs and 31 Landrace pigs were subjected to reduced representation bisulfite sequencing (RRBS). Genome-wide differential DNA methylation analysis was conducted. Six genomic regions, including regions on Sus scrofa chromosome (SSC) 1: 266.09–274.23 Mb, SSC5: 0.88–10.68 Mb, SSC8: 41.23–48.51 Mb, SSC12: 45.43–54.38 Mb, SSC13: 202.15–207.95 Mb, and SSC14: 126.43–139.85 Mb, were regarded as key regions that may be associated with phenotypic differences between the Qingyu pig and the Landrace pig. Furthermore, according to further analysis, five differentially methylated genes (ADCY1, FUBP3, GRIN2B, KIT, and PIK3R6) were identified as key candidate genes that might be associated with meat characteristics. Our findings provide new insights into the differences in DNA methylation between the Qingyu pig and the Landrace pig. These results enrich the epigenetic research of the Chinese Qingyu pig.