bluuebunny/crossref_metadata_2025 huggingface dataset:
Multi-function PtCo nanozymes/CdS nanocrystals@graphene oxide luminophores and K2S2O8/H2O2 coreactants-based dual amplified electrochemiluminescence immunosensor for ultrasensitive detection of anti-myeloperoxidase antibody
Authors: Yang Wei , Zhou Zheng , Wu Haiping , Liu Changjin , Shen Bo , Ding Shijia , Zhou Yonglie
Published: July 2021

Background

Anti-myeloperoxidase antibody (anti-MPO) is an important biomarker for anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitides (AAVs). However, the complicated operation procedures and insufficient sensitivity of conventional anti-MPO detection methods limit their application in monitoring efficacy of AAVs in clinical diagnosis. Herein, a dual amplified electrochemiluminescence (ECL) immunosensor based on multi-function PtCo nanozymes/CdS nanocrystals@graphene oxide (PtCo/CdS@GO) luminophores and K2S2O8/H2O2coreactants has been fabricated for ultrasensitive detection of anti-MPO.

Results

PtCo/CdS@GO luminophores as novel signal amplification labels and nanocarriers to load rabbit anti-mouse IgG were synthesized by co-doping with Pt and Co nanozymes simultaneously with several considerable advantages, including astonishing peroxidase-like catalytic activity, high-efficiency luminescence performance and superior stability in aqueous solutions. Meanwhile, upon the K2S2O8/H2O2coreactants system, benefiting from the efficient peroxidase-like activity of the PtCo/CdS@GO toward H2O2, massive of transient reactive intermediates could react with K2S2O8, thus obtaining higher ECL emission. Therefore, the developed ECL immunosensor for anti-MPO detection displayed good analytical performance with good concentration linearity in the range of 0.02 to 1000 pg/mL and low detection limit down to 7.39 fg/mL.

Conclusions

The introduction of multi-function PtCo/CdS@GO luminophores into the established ECL immunoassay not only was successfully applied for specific detection of anti-MPO in clinical serum samples, but also provided a completely new concept to design other high-performance luminophores. Meaningfully, the ECL immunoassay strategy held wide potential for biomarkers detection in clinical diagnosis.

Graphic abstract
Imaging features associated with idiopathic normal pressure hydrocephalus have high specificity even when comparing with vascular dementia and atypical parkinsonism
Authors: Fällmar David , Andersson Oliver , Kilander Lena , Löwenmark Malin , Nyholm Dag , Virhammar Johan
Published: July 2021

Background

Vascular dementia (VaD) and atypical parkinsonism often present with symptoms that can resemble idiopathic normal pressure hydrocephalus (iNPH) and enlarged cerebral ventricles, and can be challenging differential diagnoses. The aim was to investigate frequencies of imaging features usually associated with iNPH and their radiological diagnostic accuracy in a sample containing the relevant differential diagnoses VaD, progressive supranuclear palsy (PSP), multiple system atrophy parkinsonian type (MSA-P), and healthy controls.

Methods

Nine morphological imaging features usually associated with iNPH were retrospectively investigated in MR images of 55 patients with shunt-responsive iNPH, 32 patients with VaD, 30 patients with PSP, 27 patients with MSA-P, and 39 age-matched healthy controls. Logistic regression and receiver operating characteristic curves were used to assess diagnostic accuracy, sensitivity, and specificity for each imaging finding.

Results

In a logistic regression model using iNPH diagnosis as a dependent variable, the following imaging features contributed significantly to the model: callosal angle (OR = 0.95 (0.92–0.99), p = 0.012), Evans’ index * 100 (OR = 1.51 (1.23–1.86), p < 0.001), enlarged Sylvian fissures (OR = 6.01 (1.42–25.40), p = 0.015), and focally enlarged sulci (OR = 10.18 (1.89–55.02), p = 0.007). Imaging features with 95% specificity for iNPH were: callosal angle ≤ 71°, temporal horns ≥ 7 mm, Evans’ index ≥ 0.37, iNPH Radscale ≥ 9, and presence of DESH, bilateral ventricular roof bulgings or focally enlarged sulci. A simplified version of the iNPH Radscale with only four features resulted in equally high diagnostic accuracy as the original iNPH Radscale.

Conclusions

There is a notable overlap between some of the commonly used imaging markers regarding iNPH, VaD and atypical parkinsonism, such as PSP. However, this study shows that the specificity of imaging markers usually associated with iNPH was high even when comparing with these challenging differential diagnoses. The callosal angle was the single imaging feature with highest diagnostic accuracy to discriminate iNPH from its mimics. A simplified rating scale using only a few selected features could be used with retained specificity.
Efficient isolation and purification of tissue-specific protoplasts from tea plants (Camellia sinensis (L.) O. Kuntze)
Authors: Xu Xue-feng , Zhu Hai-yan , Ren Yin-feng , Feng Can , Ye Zhi-hao , Cai Hui-mei , Wan Xiao-chun , Peng Chuan-yi
Published: July 2021

Background

Plant protoplasts constitute unique single-cell systems that can be subjected to genomic, proteomic, and metabolomic analysis. An effective and sustainable method for preparing protoplasts from tea plants has yet to be established. The protoplasts were osmotically isolated, and the isolation and purification procedures were optimized. Various potential factors affecting protoplast preparation, including enzymatic composition and type, enzymatic hydrolysis duration, mannitol concentration in the enzyme solution, and iodixanol concentration, were evaluated.

Results

The optimal conditions were 1.5% (w/v) cellulase and 0.4–0.6% (w/v) macerozyme in a solution containing 0.4 M mannitol, enzymatic hydrolysis over 10 h, and an iodixanol concentration of 65%. The highest protoplast yield was 3.27 × 106protoplasts g−1fresh weight. As determined through fluorescein diacetate staining, maximal cell viability was 92.94%. The isolated protoplasts were round and regularly shaped without agglomeration, and they were less than 20 μm in diameter. Differences in preparation, with regard to yield and viability in the tissues (roots, branches, and leaves), cultivars, and cultivation method, were also observed.

Conclusions

In summary, we reported on a simple, efficient method for preparing protoplasts of whole-organ tissue from tea plant. The findings are expected to contribute to the rapid development of tea plant biology.
Distinct patterns of disease activity over time in patients with active SLE revealed using latent class trajectory models
Authors: Reynolds John A. , Prattley Jennifer , Geifman Nophar , Lunt Mark , Gordon Caroline , Bruce Ian N. ,   on behalf of the MASTERPLANS Consortium
Published: July 2021

Background

Systemic lupus erythematosus (SLE) is a heterogeneous systemic autoimmune condition for which there are limited licensed therapies. Clinical trial design is challenging in SLE due at least in part to imperfect outcome measures. Improved understanding of how disease activity changes over time could inform future trial design. The aim of this study was to determine whether distinct trajectories of disease activity over time occur in patients with active SLE within a clinical trial setting and to identify factors associated with these trajectories.

Methods

Latent class trajectory models were fitted to a clinical trial dataset of a monoclonal antibody targeting CD22 (Epratuzumab) in patients with active SLE using the numerical BILAG-2004 score (nBILAG). The baseline characteristics of patients in each class and changes in prednisolone over time were identified. Exploratory PK-PD modelling was used to examine cumulative drug exposure in relation to latent class membership.

Results

Five trajectories of disease activity were identified, with 3 principal classes: non-responders (NR), slow responders (SR) and rapid-responders (RR). In both the SR and RR groups, significant changes in disease activity were evident within the first 90 days of the trial. The SR and RR patients had significantly higher baseline disease activity, exposure to epratuzumab and activity in specific BILAG domains, whilst NR had lower steroid use at baseline and less change in steroid dose early in the trial.

Conclusions

Longitudinal nBILAG scores reveal different trajectories of disease activity and may offer advantages over fixed endpoints. Corticosteroid use however remains an important confounder in lupus trials and can influence early response. Changes in disease activity and steroid dose early in the trial were associated with the overall disease activity trajectory, supporting the feasibility of performing adaptive trial designs in SLE.
Choriocarcinoma brain metastasis in a patient in the third trimester: a case report
Authors: Shen Chunjuan , Ai Ling , Li Kai , Cao Yunfei , Wu Hanbing , Sun Dandan
Published: July 2021

Background

Metastatic choriocarcinoma in the third trimester of pregnancy is extremely rare.

Case presentation

A 25-year-old Chinese woman (gravida 3, para 0) who was 28 weeks pregnant was admitted for sudden convulsion, aconuresis, and unconsciousness. The decision was made to perform an emergency cesarean delivery and craniotomy, hematoma clearance, and decompression. Pathological examination confirmed choriocarcinoma with brain metastasis. The patient underwent chemotherapy with the etoposide, cisplatin (EP) and etoposide, methotrexate and dactinomycin alternating with cyclophosphamide and vincristine (EMACO) regimens. A satisfactory result was achieved.

Conclusions

When encountering intracranial mass or bilateral pulmonary nodules in a pregnant woman, especially one in the third trimester, metastatic choriocarcinoma should be considered.
Successful amnioinfusion for severe fetal growth restriction with umbilical cord complications: two case reports
Authors: Katsura Daisuke , Takahashi Yuichiro , Iwagaki Shigenori , Chiaki Rika , Asai Kazuhiko , Koike Masako , Tsuji Shunichiro , Kimura Fuminori , Murakami Takashi
Published: July 2021

Background

There is no established treatment for fetal growth restriction during pregnancy. We report two cases that represent an example of an amnioinfusion-based management strategy for severe fetal growth restriction with umbilical cord complications.

Case presentation

We encountered two cases of fetal growth restriction with abnormal fetal Doppler velocity. In one case, fetal ultrasound revealed a hypercoiled umbilical cord with a single umbilical artery and oligohydramnios, while fetal Doppler revealed a reversed end-diastolic flow in the umbilical artery and reversed a-waves of the ductus venosus. Umbilical cord compression was confirmed at 22 weeks and 2 days of gestation, and nine amnioinfusions were performed to relieve the umbilical cord compression. A cesarean section was performed at 31 weeks and 2 days of gestation because of severe preeclampsia. The Asian infant is now a normally developed 6-month-old. In another Asian case, fetal ultrasound revealed a hypercoiled cord, while fetal Doppler revealed a reversed end-diastolic flow in the umbilical artery and intermittent reversed a-waves of the ductus venosus. Umbilical cord compression was confirmed at 24 weeks and 5 days of gestation, and seven amnioinfusions were performed. A cesarean section was performed at 31 weeks and 1 day of gestation because of nonreassuring fetal status. At the age of 1 month, the Asian infant was stable on respiratory circulation. In both cases, fetal Doppler findings improved significantly following amnioinfusions.

Conclusions

Amnioinfusion is a symptomatic treatment for umbilical cord compression. However, to determine the therapeutic effect of amnioinfusion, complete resolution of the umbilical cord compression should be ascertained by ultrasonography.
Antimicrobial and antioxidant potentials of non-cytotoxic extracts of corticolous lichens sampled in Armenia
Authors: Sargsyan Razmik , Gasparyan Arsen , Tadevosyan Gohar , Panosyan Hovik
Published: July 2021

Due to wide range of secondary metabolites, lichens were used from antiquity as sources of colorants, perfumes and medicaments. This research focuses on exploring the antioxidant, antimicrobial and cytotoxic activities of methanol, ethanol, acetone extracts and aqueous infusions of corticolous lichens sampled from Armenia. Methanol, ethanol and acetone extracts from all tested lichens were active against Gram-positive bacterial strains. The most effective solvent to retrieve antimicrobial compounds was methanol. Aqueous infusions of tested lichens didn’t show any significant antibacterial and antifungal activity. The highest antimicrobial activity was observed for methanol extract ofRamalina sinensis. The minimum inhibitory concentration of methanol extract ofRamalina sinensiswere 0.9–1.8 mg mL− 1.Pseudevernia furfuraceademonstrated antifungal activity (Ø 12 mm). Methanol extract ofParmelia sulcatademonstrated largest 1,1-diphenyl-2-picryl-hydrazil (DPPH) radical scavenging activity (71 %). The cytotoxicity was measured on human HeLa (cervical carcinoma) cell lines using microculture tetrazolium test assay. The IC50values estimated for methanol extracts ofPeltigera praetextata, Evernia prunastri, Ramalina sinensisandRamalina farinaceaspecies in HeLa cell line were within 1.8–2.8 mg mL− 1and considered as non-cytotoxic. Obtained results suggest that studied lichens can be prospective in biotechnologies as alternative sources of antimicrobial and antioxidant substances.
Seasonal burden of severe influenza virus infection in the critically ill patients, using the Assistance Publique-Hôpitaux de Paris clinical data warehouse: a pilot study
Authors: Fartoukh Muriel , Voiriot Guillaume , Guérin Laurent , Ricard Jean Damien , Combes Alain , Faure Morgane , Benghanem Sarah , de Montmollin Etienne , Tandjaoui-Lambiotte Yacine , Vieillard-Baron Antoine , Maury Eric , Diehl Jean-Luc , Razazi Keyvan , Lemiale Virginie , Trouiller Pierre , Planquette Benjamin , Savale Laurent , Heming Nicholas , Marey Jonathan ,   AP-HP Clinical Data Warehouse, Carrat Fabrice , Lapidus Nathanael ,   The EPIcuFLU_APHP Group, Djibré Michel , Teboul Jean Louis , Messika Jonathan , Demoule Alexandre , Mira Jean Paul , Timsit Jean-François , Cohen Yves , Page Bernard , Mekontso Dessap Armand , Azoulay Elie , Sanchez Olivier , Humbert Marc , Annane Djillali , Roche Nicolas
Published: July 2021

Purpose

At the critical care level, the flu surveillance system is limited in France, with heterogeneous regional modalities of implementation.

Materials, patients and methods

We aimed at assessing the relevance of the Assistance Publique-Hôpitaux de Paris (AP-HP) clinical data warehouse for estimating the burden of the influenza epidemic on medical adult critical care units of the AP-HP, and outcome of patients during the flu season 2017–2018. This exploratory multi-site epidemiological study comprised all consecutive adult stays (n = 320) in 18 medical intensive care units (ICU) or intermediate care wards (ICW) for probable or confirmed Influenza virus infection during the 2017–2018 flu season.

Results

Patients admitted to ICU/ICW had low vaccination coverage (21%), required life support in 60% of cases, stayed in the ICU for a median of 8 days, and had high 28-day mortality rate (19.7%; 95% confidence interval 15.5–24.5). Early prognostic factors included age, core temperature, the acute organ failures score, and the early administration of antiviral therapy.

Conclusions

Data directly extracted from the electronic medical records stored in the data warehouse provide detailed clinical, care pathway and prognosis information. The real-time availability should enable to detect and assess the burden of the most severe cases. By a firmer and more acute monitoring and adjustment of care and patient management, hospitals could generate more ICU/ICW capacities, sensitize their emergency department and contribute to the recommendations from health authorities. This pilot study is of particular relevance in the context of emerging epidemics of severe acute respiratory diseases.
Hyers–Ulam stability of first-order linear differential equations using Aboodh transform
Authors: Murali Ramdoss , Selvan Arumugam Ponmana , Baskaran Sanmugam , Park Choonkil , Lee Jung Rye
Published: July 2021

The main aim of this paper is to investigate various types of Ulam stability and Mittag-Leffler stability of linear differential equations of first order with constant coefficients using the Aboodh transform method. We also obtain the Hyers–Ulam stability constants of these differential equations using the Aboodh transform and some examples to illustrate our main results are given.
Fractional dynamic system simulating the growth of microbe
Authors: Hadid Samir B. , Ibrahim Rabha W.
Published: July 2021

There are different approaches that indicate the dynamic of the growth of microbe. In this research, we simulate the growth by utilizing the concept of fractional calculus. We investigate a fractional system of integro-differential equations, which covers the subtleties of the diffusion between infected and asymptomatic cases. The suggested system is applicable to distinguish the presentation of growth level of the infection and to approve if its mechanism is positively active. An optimal solution under simulation mapping assets is considered. The estimated numerical solution is indicated by employing the fractional Tutte polynomials. Our methodology is based on the Atangana–Baleanu calculus (ABC). We assess the recommended system by utilizing real data.
Origins and pathways of deeply derived carbon and fluids observed in hot spring waters from non-active volcanic fields, western Kumamoto, Japan
Authors: Hosono Takahiro , Yamanaka Chikashige
Published: July 2021

Natural springs containing volcanic and magmatic components occur in association with these activities. However, features of deeply originated fluids and solutes were less documented from fields, where active volcanic and magmatic activities are not distributed. To characterize the presence of deep components and identify their major pathways 28 groundwater samples (~ 1230 m deep) were collected from hot spring sites located at western coast of Kumamoto, southwestern Japan, where the typical subduction related magmatisms are absent. The samples were measured for dissolved ion concentrations and stable isotope ratios (δ2HH2O, δ18OH2O, δ13CDIC and δ34SSO4) that were compared with data of 33 water samples from vicinity surface systems. The groundwaters were classified into three types based on major hydrochemistry: high Cl− fluid, low concentration fluid, and high HCO3− fluid. Our data set suggests that the high Cl− fluid was formed by saline water mixing with aquifer waters of meteoric origin and subsequently evolved by reverse cation exchange. The low concentration fluid is identical to regional aquifer water of meteoric origin that was subjected to cation exchange. The high HCO3− fluid showed the highest HCO3− concentrations (~ 3,888 mg/l) with the highest δ13CDIC (up to − 1.9‰). Based on our carbon mixing model and observed δ2HH2O and δ18OH2O shifts, it is suggested that dissolved carbon of mantle origin and small fraction of fluids generated in deep crust were transported towards surface through structural weakness under open tectonic setting. These deeply derived components were then mixed with waters in the surface systems and diluted. Their impacts on surface hydrological systems were limited in space except few locations, where deeply connected pathways are anticipated along active structural deformations.
High-level de novo biosynthesis of glycosylated zeaxanthin and astaxanthin in Escherichia coli
Authors: Chen Xixian , Lim Xiaohui , Bouin Aurélie , Lautier Thomas , Zhang Congqiang
Published: July 2021

Because of wide applications in food, feed, pharmaceutical and cosmetic industries, the carotenoid market is growing rapidly. Most carotenoids are hydrophobic, which limits their bioavailability. Glycosylation is a natural route that substantially increases the water solubility, as well as the bioavailability, photostability and biological activities of carotenoids. Here, we report metabolic engineering efforts (e.g., promoter and RBS engineering, optimization of carbon sources and supplementation of bottleneck genes) to produce glycosylated carotenoids in Escherichia coli. By fine-tuning the carotenoid-biosynthetic genes (crtX, crtZ and crtY), our strain produced up to 47.2 mg/L (~ 11,670 ppm) of zeaxanthin glucosides, ~ 78% of the total carotenoids produced. In another construct with mevalonate, astaxanthin pathway and crtX genes, the strain produced a mixture of carotenoid glucosides including astaxanthin and adonixanthin glucosides with a total yield of 8.1 mg/L (1774 ppm). Our work demonstrated a proof-of-concept study for the microbial biosynthesis of glycosylated carotenoids.
Curriculum design for social, cognitive and emotional engagement in Knowledge Building
Authors: Zhu Gaoxia , Raman Preeti , Xing Wanli , Slotta Jim
Published: July 2021

Knowledge Building has been advanced as a pedagogy of engaged learning where students identify as a community whose purpose is to advance their shared ideas. This approach, which has been studied for three decades (Scardamalia & Bereiter, in: K. Sawyer (ed) Cambridge handbook of the learning sciences, Cambridge University Press, 2014), includes cognitive, social constructivist, and emotional elements (Zhu et al. in User Modeling and User-Adapted Interaction, 29: 789–820, 2019b). This paper investigates how refining Knowledge Building activities based on students’ feedback impacts their social, cognitive, and emotional engagement. Using a design-based research method, we refined successive course activities based on feedback from 23 Masters of Education students. With successive iterations, we found that the density of students’ reading networks increased; they theorized more deeply, introduced more authoritative resources, and made greater efforts to integrate ideas within the community knowledge base. As well, their level of negative affect decreased. These findings suggest that soliciting students’ input into course design can benefit their engagement and disposition toward learning, with implications for curriculum design.
Intussusception in a child with Acute Lymphoblastic Leukemia: a remarkable presentation with literature review – a case report
Authors: Majumder Ankur , Misra Sunayana , Kumar Vijay , Arora Shilpa Khanna
Published: July 2021

Background

Gastrointestinal complications are not uncommon in patients of Acute Leukemia. Intussusception as a complication in leukemia, although described, is exceedingly rare. Also, it is usually seen after chemotherapy and not as a part of the native disease process. This case report aims to highlight such a rare association which warrants clinical and pathological attention.

Case presentation

A 14 year old male presented with an acute abdomen. Initial routine investigations revealed a deranged blood picture. On further examination of bone marrow aspirate, biopsy and detailed immunohistochemical studies a diagnosis of B-Acute Lymphoblastic Leukemia (B-ALL) was made. Concurrent ultrasound of the abdomen to find a cause for severe abdominal pain revealed an Ileo-colic intussusception. The patient was started on steroids; however he succumbed to his illness after two days, before surgery could be attempted.

Conclusion

Rare presentations of relatively common diseases are a hurdle for timely and effective medical intervention. Although a rare condition in itself in leukemic patients, the occurrence of Intussusception in this particular patient, especially when no chemotherapy was initiated, is a very rare event. This case report was made to add to the relatively scarce literature available on this particular association. As it is a surgically treatable condition and since delay in diagnosis may lead to poorer prognosis, possibility of co-existence of ALL and intussusception should be borne in mind by all treating physicians and hematopathologists for effective patient care.
Added value of contrast-enhanced spectral mammogram in assessment of suspicious microcalcification and grading of DCIS
Authors: Shetat Ola Magdy Mohamed , Moustafa Amr Farouk Ibrahim , Zaitoon Sara , Fahim Mohamed Ibrahim Ibrahim , Mohamed Ghada , Gomaa Mohammed Mohammed
Published: July 2021

Background

Breast microcalcifications are one of the most difficult mammographic findings to assess. The purpose of this study is to assess the ability of contrast-enhanced spectral mammography in the assessment of suspicious microcalcification and in predicting the grade of DCIS.

Methods

Three hundred and forty cases with suspicious microcalcification were reviewed in this study. We excluded 160 cases associated with masses. We enrolled 180 cases for analysis of suspicious microcalcification on mammograms with no underlying masses. We reviewed the microcalcification for their morphology, distribution, and associated pathological enhancement according to BI-RADS lexicon with pathology results reviewed and classified into benign and malignant which subdivided into low, intermediate, or high-grade DCIS or invasive carcinoma.

Results

Three hundred and forty cases with suspicious microcalcification were reviewed in this study. We excluded 160 cases associated with masses. Forty-five of 180 cases were benign, and 135/180 cases were malignant. Twenty-five of 135 cases were diagnosed as invasive breast carcinomas while 110/135 were ductal carcinoma in situ. From the latter, 110 patients with DCIS, 22/110 cases were low grade, 11/110 cases were intermediate grade, and 77/110 cases were high grade (44 with micro-invasion). A total of 25 invasive carcinomas showed pathological non-mass enhancement, 76/77 cases of high-grade DCIS, and 6/11 cases of intermediate-grade DCIS. No abnormal enhancement appeared with benign entities, low-grade DCIS, and 5/11 cases of intermediate DCIS. The diagnostic performance of CESM in anticipation of high grade in DCIS patients was sensitivity of 98%, specificity of 81.8%, and accuracy of 93.1%. CESM sensitivity, specificity, and accuracy in prediction of invasiveness or high-grade DCIS were 98.5%, 81.8%, and 87.5%, respectively.

Conclusion

CESM can provide a fundamental contribution in the evaluation of suspicious microcalcification as high-grade DCIS or invasive component can present by non-mass enhancement, but enhancement paucity is favorable to diagnose benign lesion or non-invasive/low-grade DCIS.
Microbial etiologies of ventilator-associated pneumonia (VAP) in intensive care unit of Beni-Suef University’s Hospital
Authors: Maebed Al Zahraa M. , Gaber Yasser , Bakeer Walid , Dishisha Tarek
Published: July 2021

Background

Ventilator-associated pneumonia (VAP) is a major health problem for people intubated in intensive care units (ICUs), leading to increased mortality rates, hospital stay, and treatment costs. In the present study, the core pathogens causing VAP in Beni-Suef University's Hospital, Egypt, was investigated over a study period of 2 years (2017–2019).

Results

Of a total of 213 patients subjected to mechanical ventilation, 60 have developed VAP during their stay in the ICU. The mortality rate reached 41.7% among VAP patients. Sixty bacteria were isolated from an endotracheal aspirate of hospitalized patients. The different isolates were cultured followed by running biochemical tests, sensitivity assays, and automated VITEK®2 System analysis. Unexpectedly, all the isolates were Gram-negative bacteria.Klebsiella pneumoniaewere the main pathogen encountered (27/60 isolates) followed byAcientobacter baumannnii(7/60) and other microorganisms belonging to the generaMoraxella,Escherichia, andPseudomonas(11/60). Antibiotic sensitivity testing was performed via the VITEK®2 System using up to 16 different antibiotics representing 8 different antibiotic classes and subclasses (aminoglycosides, carbapenems, fluoroquinolones, penicillin/β-lactamase inhibitor, extended-spectrum cephalosporins, aminopenicillins, aminopenicillins/β-lactamase inhibitor, folic acid synthesis inhibitor). Majority of the isolates (28/60) showed a remarkable extensive drug resistance (XDR) pattern, while 15 isolates were multi-drug resistant (MDR) and only 6 were pan-drug resistant (PDR) with regard to antibiotics under evaluation.

Conclusion

The association of VAP with multi-drug-resistant bacteria is alarming, and rapid management is crucial. Identification of core pathogens is essential for identifying the most appropriate technique for infection control.
The universal unambiguous discriminator between two unknown qudit states
Authors: Wang Wenshi , Zhou Tao
Published: July 2021

In this work, the unambiguous discrimination between two unknown states in d-dimensional

Hilbert space is investigated. To achieve this goal, the Hilbert space of the states is divided into a series of subspaces, where the components of the two states projected in some of these subspaces can be unambiguously distinguished, and then the unambiguous discriminator between two unknown qudit states can be constructed. Moreover, the optimal success probability of the discrimination between two unknown states is obtained and the form of detection operators is given.
Segmentation and patterning of the vertebrate hindbrain
Authors: Krumlauf Robb , Wilkinson David G.
Published: July 2021

During early development, the hindbrain is sub-divided into rhombomeres that underlie the organisation of neurons and adjacent craniofacial tissues. A gene regulatory network of signals and transcription factors establish and pattern segments with a distinct anteroposterior identity. Initially, the borders of segmental gene expression are imprecise, but then become sharply defined, and specialised boundary cells form. In this Review, we summarise key aspects of the conserved regulatory cascade that underlies the formation of hindbrain segments. We describe how the pattern is sharpened and stabilised through the dynamic regulation of cell identity, acting in parallel with cell segregation. Finally, we discuss evidence that boundary cells have roles in local patterning, and act as a site of neurogenesis within the hindbrain.
A study protocol for the development of a SPIRIT extension for trials conducted using cohorts and routinely collected data (SPIRIT-ROUTINE)
Authors: McCarthy Megan , O'Keeffe Linda , Williamson Paula R. , Sydes Matthew R. , Farrin Amanda , Lugg-Widger Fiona , Davies Gwyneth , Avery Kerry , Chan An-Wen , Kwakkenbos Linda , Thombs Brett D. , Watkins Alan , Hemkens Lars G. , Gale Chris , Zwarenstein Merrick , Langan Sinead M. , Thabane Lehana , Juszczak Edmund , Moher David , Kearney Patricia M.
Published: July 2021

Background: Protocols are an essential document for conducting randomised controlled trials (RCTs). However, the completeness of the information provided is often inadequate. To help improve the content of trial protocols, an international group of stakeholders published the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) Initiative in 2013. Presently, there is increasing use of cohorts and routinely collected data (RCD) for RCTs because these data have the potential to improve efficiencies by facilitating recruitment, simplifying, and reducing the cost of data collection. Reporting guidelines have been shown to improve the quality of reporting, but there is currently no specific SPIRIT guidance on protocols for trials conducted using cohorts and RCD. This protocol outlines steps for developing SPIRIT-ROUTINE, which aims to address this gap by extending the SPIRIT guidance to protocols for trials conducted using cohorts and RCD. 

Methods: The development of the SPIRIT-ROUTINE extension comprises five stages. Stage 1 consists of a project launch and a meeting to finalise the membership of the steering group and scope of the extension. In Stage 2, a rapid review will be performed to identify possible modifications to the original SPIRIT 2013 checklist. Other key reporting guidelines will be reviewed to identify areas where additional items may be needed, such as the Consolidated Standards of Reporting Trials (CONSORT) extension for trials conducted using cohorts and RCD (CONSORT-ROUTINE). Stage 3 will involve an online Delphi exercise, consisting of two rounds and involving key international stakeholders to gather feedback on the preliminary checklist items. In Stage 4, a consensus meeting of the SPIRIT-ROUTINE steering group will finalise the items to include in the extension. Stage 5 will involve the publication preparation and dissemination of the final checklist. 

Conclusion: The SPIRIT-ROUTINE extension will contribute to improving design of trials using cohorts and RCD and transparency of reporting.
Identifying the Sickest During Triage: Using Point‐of‐Care Severity Scores to Predict Prognosis in Emergency Department Patients With Suspected Sepsis
Authors: Prasad Priya A , Fang Margaret C , Martinez Sandra P , Liu Kathleen D , Kangelaris Kirsten N
Published: July 2021

BACKGROUND

Sepsis progresses rapidly and is associated with considerable morbidity and mortality. Bedside risk stratification scores can quickly identify patients at greatest risk of poor outcomes; however, there is lack of consensus on the best scale to use.

OBJECTIVE

To compare the ability of quick Sequential Organ Failure Assessment (qSOFA), the National Early Warning System (NEWS2), and the Shock Index–which does not require mental status assessment–to predict poor outcomes among patients with suspected sepsis during triage.

DESIGN, SETTING, AND PARTICIPANTS

Retrospective cohort study of adults presenting to an academic emergency department (ED) from June 2012 to December 2018 who had blood cultures and intravenous antibiotics within 24 hours.

MAIN OUTCOMES AND MEASURES

Clinical data were collected from the electronic health record. Patients were considered positive at qSOFA ≥2, Shock Index >0.7, or NEWS2 ≥5 scores. We calculated test characteristics and area under the receiver operating characteristics curves (AUROCs) to predict in‐hospital mortality and ED‐tointensive care unit (ICU) admission.

RESULTS

We included 23,837 ED patients; 1,921(8.1%) were qSOFA‐positive, 4,273 (17.9%) Shock Index‐positive, and 11,832 (49.6%) NEWS2‐positive. There were 1,427 (6.0%) deaths and 3,149 (13.2%) ED‐to‐ICU admissions in the sample. NEWS2 had the highest sensitivity for in‐hospital mortality (76.0%) and ED‐to‐ICU admission (78.9%). qSOFA had the highest specificity for in‐hospital mortality (93.4%) and ED‐to‐ICU admission (95.2%). Shock Index exhibited the highest AUROC for in‐hospital mortality (0.648; 95 CI, 0.635‐0.662) and ED‐to‐ICU admission (0.680; 95% CI, 0.617‐0.689). Test characteristics were similar among those with sepsis.

CONCLUSIONS

Institution priorities should drive score selection, balancing sensitivity and specificity. In our study, qSOFA was highly specific and NEWS2 was the most sensitive for ruling out patients at high risk. Performance of the Shock Index fell between qSOFA and NEWS2 and could be considered because it is easy to implement.
Improving Healthcare Value: Effectiveness of a Program to Reduce Laboratory Testing for Non‐Critically‐Ill Patients With COVID‐19
Authors: Abdul‐Moheeth Mustafa , Valencia Victoria , Schaefer Stewart , Brode W Michael , Nieto Kirsten , Moriates Christopher
Published: July 2021

Avoiding routine, repetitive inpatient laboratory testing is a Choosing Wisely® recommendation, with benefits that may be even more pronounced in the setting of the COVID‐19 pandemic, considering the need to limit unnecessary exposure, use of personal protective equipment, and laboratory resources. However, the COVID‐19 pandemic presented a unique challenge: how to efficiently develop and standardize care for a disease process that had yet to be fully characterized. This article describes the development of a local committee to critically review evidence‐based practices, reach consensus, and guide practice patterns, with the aim of delivering high‐value care. Following the local introduction of recommendations and electronic health record order sets, non‐critically‐ill COVID‐19 patients at our hospital had more inpatient days where they did not receive laboratory tests, achieving sustained special cause variation on statistical process control charts. The principles of Choosing Wisely® can be applied even within novel and rapidly evolving situations.
Antyamerykańska trauma i nostalgia za komunizmem we włoskiej wojnie o pamięć na przykładzie twórczości Giorgia Gabera
Authors: Podemski Piotr
Published: July 2021

Anti-American Trauma and Nostalgia for Communism in the Italian Memory War as Presented in Giorgio Gaber’s Work

Although the contemporary Italian memory war originally stems from a debate around the trauma of the 1943-1945 civil war between Italian Fascists and the Resistance, it’s almost equally crucial aspect remains that of the two conflicting narratives of the early Cold War period (1945-1948). One of those is the dominant memory pattern, imposed by the ruling Christian Democratic Party (pro-American and anti-Communist), opposed by the alternative and marginalized view promoted by the Communists (anti-American and pro-Communist). Giorgio Gaber (1939-2003), a famous Italian cantautore (singer-songwriter), is one the exponents of anti-American trauma and nostalgia for communism within the latter narrative. In his two famous texts, America and Some used to be Communists, he offers precious insights into these aspects of his generation’s own memory and their ancestors’ post-memory of the post-war period.
How Do Shocks Arise and Spread Across Stock Markets? A Microstructure Perspective
Authors: Bongaerts Dion , Roll Richard , Rösch Dominik , van Dijk Mathijs , Yuferova Darya
Published: July 2021

We study intraday, market-wide shocks to stock prices, market liquidity, and trading activity on international stock markets and assess the relevance of recent theories on “liquidity dry-ups” in explaining such shocks. Market-wide price shocks are prevalent and large, with rapid spillovers across markets. However, price shocks are predominantly driven by information; they do not revert and are often associated with macroeconomic news. Furthermore, liquidity shocks are typically isolated and transitory. Overall, we find little evidence for liquidity effects fomenting price shocks or non-fundamental contagion, nor for alternative explanations. Market-wide liquidity dry-ups are thus of little concern to international investors.

This paper was accepted by Karl Diether, finance.
O cuírlombo da palavra: aquilombamento queer na poesia de tatiana nascimento
Authors: Gabriel Alice De barros , Dos Santos Juliely Nóbrega
Published: July 2021

O presente texto pretende discutir ocuirlombismona poesia de tatiana nascimento como proposta afrofuturista. Para isso, o texto segue mostrando como os passos de tatiana vem de longe, seguindo as pegadas de Beatriz Nascimento e Abdias Nascimento, uma linhagem interpretativa que entende o quilombismo em seu laço íntimo com o passado e o futuro de pessoas negras.
O processo de alteridade em “Beyond the Pale”, de Rudyard Kipling
Authors: Alves dos Santos João Alexandre , Astride Barzotto Leoné
Published: July 2021

Tendo como suporte teórico os estudos pós-coloniais, este artigo investiga a aplicabilidade do conceito de alteridade (BONNICI, 2005, p. 15) em “Beyond the Pale”, uma das consagradas narrativas de Rudyard Kipling (1865-1936). O escritor hindo-britânico, filho de pais ingleses, nasceu no ápice da Índia colonizada, testemunhando o impacto e a força do aparato imperialista inglês na região, e sua obra se tornou, igualmente, testemunha deste fato histórico. Em consonância com outros conceitos da teoria pós-colonial, que serão discutidos ao longo deste trabalho, a ideia de alteridade consegue fortalecer as explícitas denúncias sobre a violência durante a invasão de caráter colonial na Índia, cujas alterações socioculturais se fazem presentes em peso neste conto de Kipling como características narrativas centrais do autor. Ao resgatar a questão colonial da Índia – o processo instaurado durante quase 250 anos pelos ingleses –, pretendemos reinterpretar o papel da mulher indiana durante esse período, quem, protagonizada por Bisesa, parece estar relegada a uma condição social duas vezes subalterna, portanto, triplamente sem voz nem oportunidade ou direito à fala (GUHA, 1983; SPIVAK, 1988 apud FIGUEIREDO, 2010): a de nativa em uma sociedade colonizada, a de mulher em uma sociedade machista e a de viúva nesta mesma sociedade. O diálogo íntimo entre a denúncia de Kipling e a perspectiva pós-colonial de apuração das reverberações do colonialismo aguçam a necessidade de se reavaliar obras em que fica clara a exploração cultural, social, econômica e, sobretudo, mental/identitária sofrida pelas populações de países colonizados, recuperando registros indispensáveis para a compreensão do que foi na prática a investida colonial europeia, no ângulo, é claro, daqueles que foram as vítimas e a quem por séculos foi forçado o silêncio.
Terrenos - Cantos pra Empestar o Latifúndio do Conhecimento
Authors: Cavalcante Dora Moreira barreto , Furtado Ana Aline
Published: July 2021

o presente artigo traz experimentos de escritas calcados em submetodologias e sublínguas afim de propor desmantelamentos do edifício dos saberes ocidentais hegemônicos que constituem as bases da academia como a conhecemos.
EXPEDIENTE - v21n2
Authors: Mattos Amana
Published: July 2021

EXPEDIENTE - v21n2
Adaptação Acadêmica de Estudantes de Primeiro Ano de Psicologia
Authors: Soares Adriana Benevides , Lima Claudio De Almeida , Monteiro Marcia Cristina , Sousa Bruno De Alcântara , Santos Giselle Glória Balbino dos , Rodrigues Isabela Da Silva
Published: July 2021

O objetivo do estudo foi verificar se as variáveis expectativas acadêmicas, satisfação com a experiência acadêmica, maturidade para a escolha profissional e habilidades sociais (HS) explicam a variável critério adaptação acadêmica. Participaram 212 universitários de primeiro ano do curso de Psicologia. Utilizou-se os seguintes instrumentos: Questionário de Vivências Acadêmicas (QVA-r), Escala de Expectativas Acadêmicas de Estudantes Ingressantes na Educação Superior (EEAEIES), Escala de Satisfação com a Experiência Acadêmica (ESEA), Inventário de Habilidades Sociais (IHS) e Escala de Maturidade para Escolha Profissional (EMEP). Utilizou-se para a análise dos dados a Regressão Linear Múltipla. Constatou-se que as expectativas acadêmicas, a satisfação com a experiência acadêmica e as HS impactaram positivamente nas vivências acadêmicas. Houve impacto positivo dos fatores Curso da ESEA e Autoconhecimento da EMEP e impacto negativo do fator Determinação. O presente estudo contribuiu principalmente mostrando a importância do comportamento das variáveis do modelo testado. Por ser a adaptação acadêmica um construto multideterminado, os resultados alcançados podem apontar para ações de intervenções no acolhimento de universitários ingressantes, considerando aspectos como autoconhecimento, determinação, expectativas acadêmicas, conhecimento da realidade e satisfação com a graduação.
Promoção das Habilidades Sociais de Futuros Professores com foco na Educação Inclusiva
Authors: Quiterio Patricia Lorena , Nunes Leila Regina d'Oliveira de Paula , Camelo Bruna De Lima , Silva Jenniffer Pires da , Carmo Marwin Machay Indio do Brasil do
Published: July 2021

O desenvolvimento das habilidades sociais de futuros professores é fator essencial para a inclusão de alunos com deficiência. O objetivo deste estudo foi avaliar os efeitos de um Programa de Promoção de Habilidades Sociais com foco na inclusão, voltado para estudantes universitários do curso de Pedagogia. Participaram 10 estudantes universitárias (idade entre 18 e 56 anos). Os instrumentos de avaliação foram: (a) Inventário de Habilidades Sociais (pré, Pós-intervenção e seguimento), (b) Questionário Diagnóstico (pré e Pós-intervenção) e (c) Diário de Campo (processual). Os escores de Pós-intervenção do Inventário de Habilidades Sociais foram significativamente maiores do que os escores pré-intervenção e comparações post hoc indicaram médias maiores, estatisticamente significantes, para os escores no seguimento, em relação à pré-intervenção, no Escore Total. A análise do questionário diagnóstico constatou maior compreensão do papel do interlocutor e ampliação dos conceitos teóricos e sua aplicabilidade. As vivências e dinâmicas evidenciaram o desenvolvimento das subclasses de habilidades sociais das graduandas, especialmente da assertividade e da empatia. Os escores obtidos no seguimento revelaram que a melhora nos fatores de habilidades sociais se manteve no intervalo de dois anos, indicando que as futuras professoras desenvolveram de modo adequado as habilidades sociais, contribuindo para sua atuação no contexto educativo.
O Imperativo da Autonomia: Uma Leitura Crítica a partir da Psicanálise
Authors: Buchaúl Suéllen Pessanha , Fortes Maria Isabel
Published: July 2021

O presente artigo apresenta a questão sobre o modo imperativo com o qual se instituiu a figura da autonomia no discurso social e a crítica da psicanálise enunciada por Jacques Lacan. Para isso faremos algumas considerações acerca da noção de autonomia: primeiro como herança da modernidade e depois como um modo de subjetivação na cultura contemporânea, investido de intenso sentimento de angústia. A aspiração moderna pela autonomia converteu-se na atualidade como um imperativo, promovendo efeitos no sujeito. O ensino lacaniano, em seu início, aponta à ineficiência sobre a promoção social da autonomia, uma vez que a concepção de sujeito do inconsciente subverte a ideia de indivíduo autônomo. A partir da relação entre demanda e desejo, considerando a divisão do sujeito pela ordem da linguagem e o eu situado no registro do imaginário, a psicanálise intenta o imperativo social em busca da autonomia como um discurso delirante ao sujeito do inconsciente.
Estresse, Ansiedade, Depressão e Inflexibilidade Psicológica em Estudantes Universitários de Graduação e Pós-Graduação
Authors: Zancan Renata Klein , Machado Antônio Bonfada Collares , Boff Natália , Oliveira Margareth Da Silva
Published: July 2021

Este estudo tem como objetivo examinar a prevalência de estresse, ansiedade, depressão, inflexibilidade psicológica, dados sociodemográficos, clínicos e acadêmicos e a relação entre essas variáveis, em uma amostra de estudantes de graduação e pós-graduação do Rio Grande do Sul, além de comparar esses dois grupos quanto aos resultados. Participaram da pesquisa 574 estudantes, com idade a partir de 18 anos, de diferentes cursos e universidades, sendo 357 da graduação e 217 da pós-graduação. Trata-se de um estudo transversal, de levantamento, com questionários de autorrelato e coleta online. Os Instrumentos utilizados foram: Ficha de dados sociodemográficos e acadêmicos; Escala de Ansiedade, Depressão e Estresse; Escala de Estresse Percebido; Questionário de Aceitação e Ação para Estudantes Universitários. Os níveis de estresse, ansiedade e depressão foram considerados altos nesta amostra. A inflexibilidade psicológica mostrou uma correlação significativa com essas variáveis e mostrou-se preditiva de estresse percebido. Os estudantes de graduação apresentaram índices de estresse mais elevados que os de pós-graduação. Sugere-se investir em estudos que incluam a inflexibilidade psicológica e o estresse como variáveis investigadas e também como foco de intervenções com esta população.
Psicologia Social a partir da América Central: Desafios e Perspectivas. Entrevista com Ignacio Martín-Baró
Authors: Oropeza Ignacio Dobles , Rosa Marcela Pereira
Published: July 2021

A entrevista traz importantes apontamentos realizados por Ignacio Martín-Baró. Nas respostas por ele oferecidas encontramos sínteses primordiais acerca de conceitos-chave e proposições centrais de seu pensamento, o que faz dela um importante material de estudo para aqueles que buscam compreender e apreender as proposições baronianas e, como o fez o autor, colocar a Psicologia em um horizonte de compromisso crítico com as maiorias populares.