bluuebunny/crossref_metadata_2025 huggingface dataset:
Cognitive phenotypes 1 month after ICU discharge in mechanically ventilated patients: a prospective observational cohort study
Authors: Fernández-Gonzalo Sol , Navarra-Ventura Guillem , Bacardit Neus , Gomà Fernández Gemma , de Haro Candelaria , Subirà Carles , López-Aguilar Josefina , Magrans Rudys , Sarlabous Leonardo , Aquino Esperanza Jose , Jodar Mercè , Rué Montse , Ochagavía Ana , Palao Diego J. , Fernández Rafael , Blanch Lluís
Published: October 2020

Background

ICU patients undergoing invasive mechanical ventilation experience cognitive decline associated with their critical illness and its management. The early detection of different cognitive phenotypes might reveal the involvement of diverse pathophysiological mechanisms and help to clarify the role of the precipitating and predisposing factors. Our main objective is to identify cognitive phenotypes in critically ill survivors 1 month after ICU discharge using an unsupervised machine learning method, and to contrast them with the classical approach of cognitive impairment assessment. For descriptive purposes, precipitating and predisposing factors for cognitive impairment were explored.

Methods

A total of 156 mechanically ventilated critically ill patients from two medical/surgical ICUs were prospectively studied. Patients with previous cognitive impairment, neurological or psychiatric diagnosis were excluded. Clinical variables were registered during ICU stay, and 100 patients were cognitively assessed 1 month after ICU discharge. The unsupervised machine learning K-means clustering algorithm was applied to detect cognitive phenotypes. Exploratory analyses were used to study precipitating and predisposing factors for cognitive impairment.

Results

K-means testing identified three clusters (K) of patients with different cognitive phenotypes: K1 (n = 13), severe cognitive impairment in speed of processing (92%) and executive function (85%); K2 (n = 33), moderate-to-severe deficits in learning-memory (55%), memory retrieval (67%), speed of processing (36.4%) and executive function (33.3%); and K3 (n = 46), normal cognitive profile in 89% of patients. Using the classical approach, moderate-to-severe cognitive decline was recorded in 47% of patients, while the K-means method accurately classified 85.9%. The descriptive analysis showed significant differences in days (p = 0.016) and doses (p = 0.039) with opioid treatment in K1 vs. K2 and K3. In K2, there were more women, patients were older and had more comorbidities (p = 0.001) than in K1 or K3. Cognitive reserve was significantly (p = 0.001) higher in K3 than in K1 or K2.

Conclusion

One month after ICU discharge, three groups of patients with different cognitive phenotypes were identified through an unsupervised machine learning method. This novel approach improved the classical classification of cognitive impairment in ICU survivors. In the exploratory analysis, gender, age and the level of cognitive reserve emerged as relevant predisposing factors for cognitive impairment in ICU patients.

Trial registration

ClinicalTrials.gov Identifier:NCT02390024; March 17,2015.
CXCL1 contributes to IL-6 expression in osteoarthritis and rheumatoid arthritis synovial fibroblasts by CXCR2, c-Raf, MAPK, and AP-1 pathway
Authors: Hou Sheng-Mou , Chen Po-Chun , Lin Chieh-Mo , Fang Mei-Ling , Chi Miao-Ching , Liu Ju-Fang
Published: October 2020

Background

Osteoarthritis (OA) and rheumatoid arthritis (RA) are common joint disorders that are considered to be different diseases due to their unique molecular mechanisms and pathogenesis. Chemokines and their corresponding receptors have been well characterized in RA progression, but less so in OA pathogenesis.

Methods

The human primary synovial fibroblasts (SFs) were obtained from human OA and RA tissue samples. The Western blot and qPCR were performed to analyze the expression levels of CXCL1, as well as CXCL-promoted IL-6 expression in both OASFs and RASFs. The signal cascades that mediate the CXCL1-promoted IL-6 expression were identified by using chemical inhibitors, siRNAs, and shRNAs.

Results

Here, we found that both diseases feature elevated levels of CXCL1 and interleukin (IL)-6, an important proinflammatory cytokine that participates in OA and RA pathogenesis. In OASFs and RASFs, CXCL1 promoted IL-6 expression in a dose- and time-dependent manner. In OASFs and RASFs overexpressing CXCL1 or transduced with shRNA plasmid, IL-6 expression was markedly upregulated. CXCR2, c-Raf, and MAPKs were found to regulate CXCL1-induced IL-6 expression in OASFs and RASFs. Finally, CXCL1 triggered the transcriptional activities of c-Jun (which regulates the expression of proinflammatory proteins) in OASFs and RASFs.

Conclusions

Our present work suggests that the CXCL1/CXCR2 axis helps to orchestrate inflammatory responses in OA and RA SFs.
ASP5094, a humanized monoclonal antibody against integrin alpha-9, did not show efficacy in patients with rheumatoid arthritis refractory to methotrexate: results from a phase 2a, randomized, double-blind, placebo-controlled trial
Authors: Takeuchi Tsutomu , Tanaka Yoshiya , Erdman Jay , Kaneko Yuichiro , Saito Masako , Higashitani Chieri , Smulders Ronald , Lademacher Christopher
Published: October 2020

Background

Rheumatoid arthritis (RA) is a chronic, debilitating autoimmune condition characterized by joint synovial inflammation. Current treatments include methotrexate (MTX), biologic agents, and Janus kinase (JAK) inhibitors. However, these agents are not efficacious in all patients and there are concerns regarding side effects and risk of infection as these treatments target immune-related pathways. Overexpression and activation of integrin alpha-9 (α9) on fibroblast-like synoviocytes are associated with RA disease onset and exacerbation. The humanized immunoglobulin G1 monoclonal antibody ASP5094 was designed to inhibit human α9 and is currently under investigation for the treatment of RA.

Methods

This phase 2a, multicenter, randomized, placebo-controlled, double-blind, parallel-group study (NCT03257852) evaluated the efficacy, safety, and biological activity of intravenous ASP5094 10 mg/kg in patients with moderate to severe RA that was refractory to MTX. Patients received ASP5094 or placebo every 4 weeks for a total of three administrations. Both treatment groups used concomitant MTX. The primary efficacy endpoint was the proportion of patients who responded per American College of Rheumatology 50% improvement using C-reactive protein (ACR50-CRP) after 12 weeks of treatment. Biological activity of ASP5094 was assessed via pharmacokinetics and pharmacodynamics of known downstream effectors of α9. Safety was also assessed.

Results

Sixty-six patients were enrolled and randomized to placebo (n = 33) or ASP5094 (n = 33). In the primary efficacy analysis, ACR50-CRP response rates were 6.3% and 18.2% at week 12 in the ASP5094 and placebo groups, respectively; a difference of − 11.9, which was not significant (2-sided P value = 0.258). No trends in ACR50 response rates were observed in subgroups based on demographics or baseline disease characteristics, and no significant differences between placebo and ASP5094 were identified in secondary efficacy or pharmacodynamic endpoints, despite achievement of target serum concentrations of ASP5094. Most treatment-emergent adverse events were mild to moderate in severity, and ASP5094 was considered safe and well tolerated overall.

Conclusion

Although no notable safety signals were observed in this study, ASP5094 was not efficacious in patients with moderate to severe RA with an inadequate response to MTX.

Trial registration

ClinicalTrials.gov, NCT03257852. Registered on 22 Aug. 2017
In vitro biological assessment of the stability of cigarette smoke aqueous aerosol extracts
Authors: Taylor Mark , Santopietro Simone , Baxter Andrew , East Nicole , Breheny Damien , Thorne David , Gaça Marianna
Published: October 2020

Objectives

Cigarette smoke aqueous aerosol extracts (AqE) have been used for assessing tobacco products, particularly with in vitro models such as oxidative stress and inflammation. These test articles can be generated easily, but there are no standardised methods for the generation and characterisation or stability. We investigated the effects of pro-oxidant smoke-derived chemicals by using 3R4F AqE generated under standardised conditioning and smoking regimes and assessed the stability over 31-week timeframe. Twenty batches generated from ten puffs per cigarette bubbled through 20 ml cell culture media were used fresh and thawed from frozen aliquots stored at – 80 ºC.

Results

Nicotine levels quantified by gas chromatography/mass spectrometry and optical density at 260 nm showed chemical and physical stability from week 0 (fresh sample) to weeks 1, 4, 8 and 31 (frozen samples). No significant change in H292 human bronchial epithelial cell viability or oxidative stress were observed between fresh AqE at week 0 and frozen AqE at 31 weeks. AqEs generated by our protocol were stable for up to 31 weeks for all tested end points, suggesting that it may not be necessary to use freshly generated AqE for each study, thus reducing batch-to-batch variability.
Sleep disturbances among physicians during COVID-19 pandemic
Authors: Alnofaiey Yasser H. , Alshehri Haneen A. , Alosaimi Maram M. , Alswat Shrooq H. , Alswat Raghad H. , Alhulayfi Rahaf M. , Alghamdi Meteb A. , Alsubaie Reem M.
Published: October 2020

Objectives

To assess prevalence and related factors of sleep disturbances among Saudi physicians during COVID-19 pandemic. Data were collected through a questionnaire including items about demographic characters, knowledge about covid-19 and items to assess sleep quality that were extracted from Pittsburgh Sleep Quality Index (PSQI) scale.

Results

Prevalence of sleep disorders was 43.9%, doctors in the age group of 31–40 years, associate consultants had a significant higher prevalence of sleep disorders. Medical interns and laboratory/pathology/microbiology doctors had a significant more difficulty in fall asleep during COVID-19, and internists and surgeons had a significant higher percent of those who used sleeping pills. Resident doctors had a significant higher percent of having trouble in staying awake, and residents and consultants had a significant higher percent of those who suffered decreased sleep duration. Sleep quality during COVID-19 was very good, fair good and very bad in 23.4%, 60% and 3.5% of HCW respectively. The study observed a negative impact of COVID-19 pandemic on HCW sleep quality. Hospitals administrations should provide optimal working hours with enough break and employ more doctors during the pandemic. Doctors experiencing sleep problems should have mandatory leaves.
Comparison of hospital worker anxiety in COVID-19 treating and non-treating hospitals in the same city during the COVID-19 pandemic
Authors: Milgrom Yael , Tal Yuval , Finestone Aharon S.
Published: October 2020

Background

The Hadassah Medical Organization operates two hospitals in Jerusalem. During the COVID-19 pandemic it made an administrative decision to operate one hospital as a COVID-19 treatment hospital (CTH) and to have the second function as a non-COVID-19 treating hospital (NCTH) offering general medical services. The purpose of this study was to assess how this decision affected hospital worker anxiety.

Methods

From April 27 to May 1, during the COVID-19 pandemic in Israel, while the country was under lock-down, an electronic questionnaire survey was carried out among hospital workers of the CTH and NCTH. The questionnaire includes personal demographics and attitudes about COVID-19 and assesses present anxiety state using the State-Trait Anxiety Inventory for Adults (STAI-S) validated questionnaire. A STAI-S score of ≥45 was considered to represent clinical anxiety.

Results

Completed questionnaires were received from 1570 hospital employees (24%). 33.5% of responders had STAI-S scores ≥45. Multivariable regression analysis showed that being a resident doctor (odds ration [OR] 2.13; 95% CL, 1.41–3.23; P = 0.0003), age ≤ 50 (OR, 2.08; 95% Cl, 1.62–2.67; P < .0001), being a nurse (OR, 1.29; 95% CL, 1.01–1.64; P = 0.039), female gender (OR, 1.63; 95% CL, 1.25–2.13; P = 0.0003) and having risk factors for COVID-19 (OR, 1.51; 95% CL, 1.19–1.91; P = 0.0007), but not hospital workplace (p = 0.08), were associated with the presence of clinical anxiety. 69% of the responders had been tested for COVID-19, but only nine were positive. CTH workers estimated that the likelihood of their already being infected with COVID-19 to be 21.5 ± 24.7% as compared to the 15.3 ± 19.5% estimate of NCTH workers (p = 0.0001). 50% (545/1099) of the CTH workers and 51% (168/330) of the NCTH workers responded that the most important cause of their stress was a fear of infecting their families (p = 0.7).

Conclusions

By multivariable analysis the creation of a NCTH during the COVID-19 pandemic was not found to be associated with a decrease in the number of hospital workers with clinical anxiety. Hospital worker support resources can be focused on the at-risk groups identified in this study.
Pseudo almost periodic synchronization of Clifford-valued fuzzy cellular neural networks with time-varying delays on time scales
Authors: Li Yongkun , Shen Shiping
Published: October 2020

At present, the research on discrete-time Clifford-valued neural networks is rarely reported. However, the discrete-time neural networks are an important part of the neural network theory. Because the time scale theory can unify the study of discrete- and continuous-time problems, it is not necessary to separately study continuous- and discrete-time systems. Therefore, to simultaneously study the pseudo almost periodic oscillation and synchronization of continuous- and discrete-time Clifford-valued neural networks, in this paper, we consider a class of Clifford-valued fuzzy cellular neural networks on time scales. Based on the theory of calculus on time scales and the contraction fixed point theorem, we first establish the existence of pseudo almost periodic solutions of neural networks. Then, under the condition that the considered network has pseudo almost periodic solutions, by designing a novel state-feedback controller and using reduction to absurdity, we obtain that the drive-response structure of Clifford-valued fuzzy cellular neural networks on time scales with pseudo almost periodic coefficients can realize the global exponential synchronization. Finally, we give a numerical example to illustrate the feasibility of our results.
Groundwater storage effects from restoring, constructing or draining wetlands in temperate and boreal climates: a systematic review protocol
Authors: Bring Arvid , Rosén Lars , Thorslund Josefin , Tonderski Karin , Åberg Charlotte , Envall Ida , Laudon Hjalmar
Published: October 2020

Background

Wetlands in many parts of the world have been degraded, as use of the land for food production and forestry for human needs have taken precedence. Drainage of wetlands has led to deteriorated wetland conditions and lowered water tables. Across the world, there are several programs for wetland restoration and construction, primarily to reintroduce lost habitats for wildlife, and to obtain nutrient retention functions. In Sweden, recent dry and hot summers have reinforced interest in the hydrological functions that wetlands may have, in particular as potential support for water storage in the landscape and added groundwater storage during dry periods. However, the agreement on substantial effects on groundwater is limited, and there are several critical knowledge gaps, including the extent to which such effects extend outside the wetland itself, and how they vary with local conditions, such as topography, soil, and climate. Therefore, this review will address the groundwater storage effect of restoring, constructing or draining wetlands in the boreo-temperate region.

Methods

We will conduct a systematic review of the evidence, drawing on both peer-reviewed and grey literature. Articles in English, Swedish, Norwegian, Danish, French, German and Polish will be retrieved from academic databases, Google Scholar, and websites of specialist organizations. We will screen literature in two stages, first at the title and abstract level and then in full text, the latter with blinded decisions by two independent reviewers for all articles. Articles will be included based on relevance criteria for a Swedish context: wetlands on previously glaciated soils in boreal and temperate climates. Data will be extracted from all included articles, including wetland type, intervention type, and hydrogeological setting. Studies will be subject to critical appraisal to evaluate their susceptibility to bias. Provided enough evidence of sufficient reliability, we will carry out meta-analyses of effect sizes in relation to various factors. The review will include a narrative synthesis in which we summarize the results of the review.
Colonization of a hand washing sink in a veterinary hospital by an Enterobacter hormaechei strain carrying multiple resistances to high importance antimicrobials
Authors: Kamathewatta Kanishka , Bushell Rhys , Rafa Fannana , Browning Glenn , Billman-Jacobe Helen , Marenda Marc
Published: October 2020

Background

Hospital intensive care units (ICUs) are known reservoirs of multidrug resistant nosocomial bacteria. Targeted environmental monitoring of these organisms in health care facilities can strengthen infection control procedures. A routine surveillance of extended spectrum beta-lactamase (ESBL) producers in a large Australian veterinary teaching hospital detected the opportunistic pathogen Enterobacter hormaechei in a hand washing sink of the ICU. The organism persisted for several weeks, despite two disinfection attempts. Four isolates were characterized in this study.

Methods

Brilliance-ESBL selective plates were inoculated from environmental swabs collected throughout the hospital. Presumptive identification was done by conventional biochemistry. Genomes of multidrug resistant Enterobacter were entirely sequenced with Illumina and Nanopore platforms. Phylogenetic markers, mobile genetic elements and antimicrobial resistance genes were identified in silico. Antibiograms of isolates and transconjugants were established with Sensititre microdilution plates.

Results

The isolates possessed a chromosomal Tn7-associated silver/copper resistance locus and a large IncH12 conjugative plasmid encoding resistance against tellurium, arsenic, mercury and nine classes of antimicrobials. Clusters of antimicrobial resistance genes were associated with class 1 integrons and IS26, IS903 and ISCR transposable elements. The blaSHV-12, qnrB2 and mcr-9.1 genes, respectively conferring resistance to cephalosporins, quinolones and colistin, were present in a locus flanked by two IS903 copies. ESBL production and enrofloxacin resistance were confirmed phenotypically. The isolates appeared susceptible to colistin, possibly reflecting the inducible nature of mcr-9.1.

Conclusions

The persistence of this strain in the veterinary hospital represented a risk of further accumulation and dissemination of antimicrobial resistance, prompting a thorough disinfection of the ICU. The organism was not recovered from subsequent environmental swabs, and nosocomial Enterobacter infections were not observed in the hospital during that period. This study shows that targeted routine environmental surveillance programs to track organisms with major resistance phenotypes, coupled with disinfection procedures and follow-up microbiological cultures are useful to control these risks in sensitive areas of large veterinary hospitals.
Development of a circular economy and evolution of working conditions and occupational risks—a strategic foresight study
Authors: Héry Michel , Malenfer Marc
Published: October 2020

The circular economy can be defined as an economic system of exchange and production intended to increase the efficiency of the use of resources at all stages of products’ life cycle (including goods and services). Since most natural resources are not inexhaustible, and fossil fuel consumption is considered one of the major factors of global warming, its development seems inevitable, even if it can only be progressive (spanning several decades) and may not apply to all sectors. The circular economy is likely to challenge work methods and working conditions. Consequently, a strategic foresight study has been conducted in order to assess the main consequences on occupational safety and health. In the practice of INRS which carried out this work, foresight is above all a tool to improve and facilitate thinking and decision-making.
Assessment of intestinal parasites in the coexisting Bombus terrestris (Apidae) and Xylocopa augusti (Apidae) in central Chile
Authors: Fernández Kiara , Alcaíno Jennifer , Sepúlveda Dionisia , Medel Rodrigo
Published: October 2020

Bombus terrestris is a European bumblebee extensively commercialized worldwide for crop pollination. In Chile, this species was introduced in 1997 and after confinement escape, it has spread and established in several localities of central-southern Chile and in the Argentine Patagonia. The South American carpenter bee Xylocopa augusti, in turn, has been recently reported in central Chile, and as B. terrestris, this species has become increasingly common, often found in sympatry with B. terrestris in some localities. While intestinal parasites such as the flagellate trypanosome Crithidia bombi, the microsporidium Nosema bombi, and the neogregarine protozoan Apicystis bombi, show high levels of specialization on the Bombus genus, parasites often increase their host range, especially after invading novel habitats, hence creating new infection disease scenarios. In this work, we used molecular techniques to detect the presence of the intestinal pathogens of B. terrestris in coexisting X. augusti from different localities in the Metropolitan Region of Chile. Our results revealed the presence of the three pathogens in B. terrestris only, with population prevalence broadly similar to that reported in other studies. The carpenter bee X. augusti did not show evidence of any of the three parasites examined, indicating that this invader species is not recipient of any of the parasite species present in B. terrestris.
Influence of rigidity of retainers on dynamic behavior of implant-supported removable partial dentures
Authors: Nogawa Toshifumi , Saito Masayasu , Murashima Naomichi , Takayama Yoshiyuki , Yokoyama Atsuro
Published: October 2020

Background

Implant-supported removable partial dentures (ISRPDs) are an effective treatment for partially edentulous patients. ISRPDs improve patients’ satisfaction and oral function to a greater extent than RPDs by improving denture stability and enhancing support. However, the effect of a type of direct retainer on displacement of the abutment teeth and dentures in ISRPDs remains unclear. Therefore, we made a resin mandibular model of unilateral mandibular distal-extension partial edentulism for mechanical simulation and compared the dynamic behavior of the abutment teeth and the denture base among different tooth-borne retainers with various rigidities for RPDs and ISRPDs.

Methods

A resin mandibular model for mechanical simulation that had unilateral mandibular distal-extension edentulism and was missing the first molar, second molar, first premolar, and second premolar, and a denture fabricated from the patient’s computed tomography images were used. Three types of direct retainers with different connecting rigidities were evaluated. The vertical displacement of the denture base and buccal and lingual sides and the mesial displacement of the abutment teeth were measured.

Results

Regardless of the rigidity of the direct retainers and loading positions, the displacement of the denture bases in the ISRPDs was significantly smaller than that in the RPDs (P < 0.001). There was no significant difference in vertical displacement of the denture bases among direct retainers with various connecting rigidities in the ISRPDs. Conversely, horizontal displacement of the abutment teeth in both the RPDs and ISRPDs tended to be larger with the cone crown telescope, which has high rigidity, than with the cast cingulum rest and wire clasp, which have much lower rigidities.

Conclusion

Our results suggested that cast cingulum rest and wire clasps as direct retainers are appropriate ISRPDs to minimize denture movement and suppress displacement of the remaining teeth in patients with unilateral mandibular distal-extension partial edentulism.
Detection and discrimination of multiple strains of Zika virus by reverse transcription-loop-mediated isothermal amplification
Authors: Aonuma Hiroka , Iizuka-Shiota Itoe , Hoshina Tokio , Tajima Shigeru , Kato Fumihiro , Hori Seiji , Saijo Masayuki , Kanuka Hirotaka
Published: October 2020

Background

Monitoring both invasion of Zika virus disease into free countries and circulation in endemic countries is essential to avoid a global pandemic. However, the difficulty lies in detecting Zika virus due to the large variety of mutations in its genomic sequence. To develop a rapid and simple method with high accuracy, reverse transcription-loop-mediated isothermal amplification (RT-LAMP) was adopted for the detection of Zika virus strains derived from several countries.

Results

Common primers for RT-LAMP were designed based on the genomic sequences of two standard Zika strains: African lineage, MR-766, and Asian lineage, PRVABC59. RT-LAMP reactions using a screened primer set, targeting the NS3 region, detected both Zika virus strains. The minimum detectable quantity was 3 × 10−2 ng of virus RNA. Measurable lag of reaction times among strains was observed. The RT-LAMP method amplified the target virus sequence from the urine and serum of a patient with a travel history in the Caribbean Islands and also provided a prediction about which lineage of Zika virus strain was present.

Conclusions

The RT-LAMP method using a well-optimized primer set demonstrated high specificity and sensitivity for the detection of Zika virus strains with a variety in genomic RNA sequences. In combination with the simplicity of LAMP reaction in isothermal conditions, the optimized primer set established in this study may facilitate rapid and accurate diagnosis of Zika fever patients with virus strain information.
A comparative study between dexmedetomidine and dexamethasone as an intrathecal adjuvant for prevention of perioperative shivering in cesarean section
Authors: Ismaiel Mohamed Abdul Mohsen Abdul Naiem , El Safty Omar Mohamed Taha , El-Agamy Ashraf El Sayed , Mohamed Omar Mohamed Zafer , Ali Mohamed Mourad Mohsen Mohamed
Published: October 2020

Background

One of the most common problems in parturients receiving regional anesthesia during cesarean section is shivering. It usually interferes with the readings of the oxygen plethysmography (SpO2) and electrocardiogram (ECG). It expands the needs for oxygen and increases creation of carbon dioxide about four folds.

The aim of this work is to compare the efficacy of dexamethasone and dexmedetomidine in prevention of perioperative shivering when added to hyperbaric bupivacaine intrathecally in cesarean sections (CS) and their effect on the intraoperative hemodynamics, intensity of the block, sedation, and postoperative analgesic requirement.

Results

Study included 60 obstetric patients who fulfilled all the inclusion criteria and were randomized into 2 equal groups, each consisting of 30 patients, namely group A (dexmedetomidine group) and B (dexamethasone group).

Group A patients received 5 μg dexmedetomidine with 12.5 mg hyperbaric bupivacaine 0.5% intrathecally.

Group B patients received 8 mg dexamethasone then 12.5 mg hyperbaric bupivacaine 0.5% intrathecally.

The comparison included assessment of intra- and postoperative hemodynamics, duration of surgery, assessment of sensory and motor block, assessment for shivering and sedation, and assessment of adverse events.

This study showed that there were a small number of patients complaining of shivering (five patients in group A and seven patients in group B) with no statistical difference between both groups in the incidence and intensity of shivering. Time to two segment regression (minutes) was longer in group B compared to group A, and also, time to first analgesic rescue was longer in group B compared to group A. For sedation intensity, there was statistical difference between both groups as all patients in group A were sedated compared to six patients only in group B. There was no statistical difference between both groups as regards incidence of adverse effects.

Conclusion

We concluded that both drugs can be added safely to bupivacaine, and both dexmedetomidine and dexamethasone decreased the incidence and the intensity of shivering. Dexamethasone was found to prolong the duration of sensory block and delay opioid requirements post-operatively, while dexmedetomidine is more effective in sedating the patients intra- and postoperatively.
Correction to: Early outcomes of tapering jejunoplasty by antimesenteric seromuscular stripping and mucosal inversion for proximal jejunal atresia
Authors: Marei Mahmoud Marei , Abouelfadl Mohamed Hamed , Rawwash Ahmed Arafa Elsayed , Seleim Hamed Mahmoud , Mahmoud Wesam Mohamed , Yassin Tamer Yassin Mohamed , El-Tagy Gamal Hassan
Published: October 2020

An amendment to this paper has been published and can be accessed via the original article.
COVID-19, medical education and the impact on the future psychiatric workforce
Authors: Greig Flora
Published: October 2020

Since the start of the COVID-19 pandemic the UK's National Health Service (NHS) has been transformed to meet the acute healthcare needs of infected patients. This has significantly affected medical education, both undergraduate and postgraduate, with potential long-term implications for psychiatric recruitment. This article discusses these ramifications, and the opportunities available to mitigate them as well as to enhance the profile of psychiatry.
The importance of water and hydraulic pressure in cell dynamics
Authors: Li Yizeng , Konstantopoulos Konstantinos , Zhao Runchen , Mori Yoichiro , Sun Sean X.
Published: October 2020

All mammalian cells live in the aqueous medium, yet for many cell biologists, water is a passive arena in which proteins are the leading players that carry out essential biological functions. Recent studies, as well as decades of previous work, have accumulated evidence to show that this is not the complete picture. Active fluxes of water and solutes of water can play essential roles during cell shape changes, cell motility and tissue function, and can generate significant mechanical forces. Moreover, the extracellular resistance to water flow, known as the hydraulic resistance, and external hydraulic pressures are important mechanical modulators of cell polarization and motility. For the cell to maintain a consistent chemical environment in the cytoplasm, there must exist an intricate molecular system that actively controls the cell water content as well as the cytoplasmic ionic content. This system is difficult to study and poorly understood, but ramifications of which may impact all aspects of cell biology from growth to metabolism to development. In this Review, we describe how mammalian cells maintain the cytoplasmic water content and how water flows across the cell surface to drive cell movement. The roles of mechanical forces and hydraulic pressure during water movement are explored.
High light alongside elevated PCO2 alleviates thermal depression of photosynthesis in a hard coral (Pocillopora acuta)
Authors: Mason Robert A. B. , Wall Christopher B. , Cunning Ross , Dove Sophie , Gates Ruth D.
Published: October 2020

The absorbtion of human-emitted CO2 by the oceans (elevated PCO2) is projected to alter the physiological performance of coral reef organisms by perturbing seawater chemistry (i.e. ocean acidification). Simultaneously, greenhouse gas emissions are driving ocean warming and changes in irradiance (through turbidity and cloud cover), which have the potential to influence the effects of ocean acidification on coral reefs. Here, we explored whether physiological impacts of elevated PCO2 on a coral–algal symbiosis (Pocillopora acuta–Symbiodiniaceae) are mediated by light and/or temperature levels. In a 39 day experiment, elevated PCO2 (962 versus 431 µatm PCO2) had an interactive effect with midday light availability (400 versus 800 µmol photons m−2 s−1) and temperature (25 versus 29°C) on areal gross and net photosynthesis, for which a decline at 29°C was ameliorated under simultaneous high-PCO2 and high-light conditions. Light-enhanced dark respiration increased under elevated PCO2 and/or elevated temperature. Symbiont to host cell ratio and chlorophyll a per symbiont increased at elevated temperature, whilst symbiont areal density decreased. The ability of moderately strong light in the presence of elevated PCO2 to alleviate the temperature-induced decrease in photosynthesis suggests that higher substrate availability facilitates a greater ability for photochemical quenching, partially offsetting the impacts of high temperature on the photosynthetic apparatus. Future environmental changes that result in moderate increases in light levels could therefore assist the P. acuta holobiont to cope with the ‘one–two punch’ of rising temperatures in the presence of an acidifying ocean.
First report of Evelineus mcintoshii (Langerhans, 1880) (Heteronemertea, Lineidae) from the Mediterranean Sea
Authors: HOFFMAN RAZY , KAJIHARA HIROSHI
Published: October 2020

The ribbon worm Evelineus mcintoshii is reported for the first time from the Mediterranean Sea. Observations that took place, during two algal surveys, on the intertidal abrasion platforms at the middle of the Levantine Sea of Israel indicated that this species is hiding inside a mixture of local and non-indigenous marine seaweeds. It is probably another alien species, one of many, that adopted the Levantine basin of the Eastern Mediterranean due to tropical environmental conditions that characterize this sea. We discuss the first record of this species and its possible origins as well as the first report of Notospermus geniculatus, the other marine nemertean species recently reported from Israel.
Alien and cryptogenic Foraminifera in the Mediterranean Sea: A revision of taxa as part of the EU 2020 Marine Strategy Framework Directive
Authors: STULPINAITE RUTA , HYAMS-KAPHZAN ORIT , LANGER MARTIN R.
Published: October 2020

The human-mediated translocation of marine alien species beyond their natural ranges started as early as people began navigating the sea and is of growing concern to nature conservation. The Mediterranean Sea is among the most severely affected areas by biological invasions, a phenomenon that has been fostered by the opening and recent extension of the Suez Canal, the transport and release of ballast water, aquaculture and aquarium trade, ichthyochory and other active or passive dispersal mechanisms. The increase of marine invasions has stimulated considerable research, but for some important groups, in particular microorganisms, data are still limited. In this paper we have reviewed the current status of marine alien foraminifera in the Mediterranean Sea. Our survey includes a comrephensive taxonomic revision of previously recognized alien taxa, and new information obtained from the fossil record and from molecular studies. Our survey and reexamination of alien benthic foraminifera yielded a total of 43 validly recognized species and two species of cryptogenic taxa and reduces the number of previous recordings. The revised list includes both larger symbiont-bearing and smaller benthic foraminifera, including 16 hyaline-perforate, 3 agglutinated and 24 porcelaneous taxa. The vast majority of alien foraminifera recorded so far have become established in the Eastern and Central Mediterranean Sea, indicative for translocation and introduction via the Suez Canal pathway. Only one species, Amphistegina lobifera, causes significant ecological impacts and fulfills the criteria to be considered as an invasive alien. This species is a prolific carbonate producer, and displays extreme forms of ecosystem invasibility with capabilities to reduce native diversity and species richness. The proliferation and rates of recently observed range extensions, track contemporary sea surface temperature increases, provide strong support for previous species distribution models, and corroborate findings that rising water temperatures, global climate change and the extension of climate belts are major drivers fueling the latitudinal range expansion of larger symbiont-bearing and smaller epiphytic foraminifera. Intensified efforts to study alien foraminifera on a molecular level, in dated cores and in ballast water are required to trace their source of origin, to identify vectors of introduction and to verify their status as true aliens.
Economic security
Authors: Gadzhiev Nazirhan , Gazimagomedov Magomed , Doronin Andrey , Ivlicheva Natal'ya , Konovalenko Sergey , Lebedev Sergey , Pilyugin Nikolay , Simonenko Dmitriy , Sokratova Irina , Trofimov Mihail , Harada Georgiy
Published: October 2020

The textbook contains 15 topics that reveal the specifics of the discipline Economic security". The systems of quantitative and qualitative indicators for assessing economic security are considered; the methodological principles of assessing financial and monetary policy as a sphere of economic security are studied; the conceptual foundations of the regional economic security program are formed; the theoretical foundations of economic security of enterprises are considered. The main problems of economic security are described in the light of national security issues. Security aspects such as the role of the financial system, foreign economic aspects, social security, and the impact of scientific and technical security on economic security are considered. Special attention is paid to the role of law enforcement agencies in ensuring economic security. Methods of ensuring economic security are described that allow combining the analysis of theoretical positions with real practice and providing a higher level of material assimilation by cadets and students. Meets the requirements of the Federal state educational standard of higher education of the latest generation in the specialty 38.05.01 "Economic security (specialty level)".
Features of investigation of fraud committed by Bank employees in the field of lending
Authors: Karagodin Valeriy , Karepanov Nikolay
Published: October 2020

The monograph is devoted to the study of legal, theoretical and forensic issues that arise in the investigation of fraud committed by Bank employees in the field of lending. The features of their solution are defined, specific recommendations are developed aimed at forming an effective mechanism for investigating the analyzed type of crimes. The results of the studied practical material are presented. It is a complete scientific study and is intended for forensic scientists, law enforcement officers, teachers, graduate students and students of law schools and faculties who are interested in the problems of investigating certain types of crimes.
Current parasitic and infectious diseases of horses
Authors: Belimenko Vladislav , Hristianovskiy Pavel , Gulyukin Aleksey , Alekseenkova Svetlana , Laishevcev Aleksey
Published: October 2020

The main infectious diseases of ungulates caused by helminths, ticks, insects, protozoa, bacteria and viruses are considered. The questions of etiology, biological features and resistance of pathogens, distribution and clinical manifestations of diseases are highlighted. Attention is paid to modern methods of diagnosis, treatment and prevention of infectious diseases of horses. Part 1 is written by Professor P. I. Khristianovsky, V. V. Belimenko, A. M. Gulyukin, A. I. Laishevtsev and E. V. Novosad; part 2 is written by Professor K. P. Yurov and S. V. Alekseenkova. It is intended for students studying in the specialty "veterinary medicine", practical veterinarians and a wide range of horse lovers.
Econometrics and econometric modeling in Excel and R
Authors: Babeshko Lyudmila , Orlova Irina
Published: October 2020

The textbook includes topics of modern econometrics, often used in economic research. Some aspects of multiple regression models related to the problem of multicollinearity and models with a discrete dependent variable are considered, including methods for their estimation, analysis, and application. A significant place is given to the analysis of models of one-dimensional and multidimensional time series. Modern ideas about the deterministic and stochastic nature of the trend are considered. Methods of statistical identification of the trend type are studied. Attention is paid to the evaluation, analysis, and practical implementation of Box — Jenkins stationary time series models, as well as multidimensional time series models: vector autoregressive models and vector error correction models. It includes basic econometric models for panel data that have been widely used in recent decades, as well as formal tests for selecting models based on their hierarchical structure. Each section provides examples of evaluating, analyzing, and testing models in the R software environment. Meets the requirements of the Federal state educational standards of higher education of the latest generation.

It is addressed to master's students studying in the Field of Economics, the curriculum of which includes the disciplines Econometrics (advanced course)", "Econometric modeling", "Econometric research", and graduate students."
Environmental monitoring of water bodies
Authors: Tihonova Irina , Kruchinina Nataliya
Published: October 2020

The tutorial covers issues related to water monitoring systems and assessment of anthropogenic impact on water bodies. The influence of hydrodynamic conditions on the distribution of pollutants, the tasks and principles of monitoring systems at the global and local levels, and comprehensive water quality assessments were studied. Mathematical models of water quality assessment and forecasting are presented. Additionally, information on biological monitoring of water bodies is highlighted. Meets the requirements of the Federal state educational standards of higher education of the latest generation. For University students studying in the areas of training 05.03.06 "Ecology and nature management", 18.03.02 "Energy and resource - saving processes in chemical technology, petrochemistry and biotechnology", 20.03.01 "Technosphere safety", 20.03.02 "nature management and water use".
Financial Difficulties in Families of Hospitalized Children
Authors: Bassett Hannah K , Coller Ryan J , Beck Jimmy , Hummel Kevin , Tiedt Kristin A , Flaherty Brian , Tchou Michael J , Kapphahn Kristopher , Walker Lauren , Schroeder Alan R
Published: October 2020

BACKGROUND

High costs of hospitalization may contribute to financial difficulties for some families.

OBJECTIVE

To examine the prevalence of financial distress and medical financial burden in families of hospitalized children and identify factors that can predict financial difficulties.

DESIGN, SETTING, AND PARTICIPANTS

Cross‐sectional survey of parents of hospitalized children at six children's hospitals between October 2017 and November 2018.

MAIN OUTCOMES AND MEASURES

The outcomes were high financial distress and medical financial burden. Multivariable logistic regression identified predictors of each outcome. The primary predictor variable was level of chronic disease (complex chronic disease, C‐CD; noncomplex chronic disease, NC‐CD; no chronic disease, no‐CD).

RESULTS

Of 644 invited participants, 526 (82%) were enrolled, with 125 (24%) experiencing high financial distress, and 160 (30%) reporting medical financial burden. Of those, 86 (54%) indicated their medical financial burden was caused by costs associated with their hospitalized child. Neither C‐CD nor NC‐CD were associated with high financial distress. Child‐related medical financial burden was associated with both C‐CD and NC‐CD (adjusted odds ratio [AOR], 4.98; 95% CI, 2.41‐10.29; and AOR, 2.57; 95% CI, 1.11‐5.93), compared to no‐CD. Although household poverty level was associated with both measures, financial difficulties occurred in all family income brackets.

CONCLUSION

Financial difficulties are common in families of hospitalized children. Low‐income families and those who have children with chronic conditions are at particular risk; however, financial difficulties affect all subsets of the pediatric population. Hospitalization may be a prime opportunity to identify and engage families at risk for financial distress and medical financial burden.
Imprinting Beyond the Founding Phase: How Sedimented Imprints Develop over Time
Authors: De Cuyper Lien , Clarysse Bart , Phillips Nelson
Published: October 2020

In this study, we build on the foundational observations of Selznick and Stinchcombe that organizations bear the lasting imprint of their founding context and explore how characteristics shaped during founding are coherently carried forward through time. To do so, we draw on an ethnography of a social venture where the entrepreneurs left soon after founding. In examining how an initial organizational imprint evolves beyond a venture’s founding phase, we focus on the actions and interactions of organizational members, the founders’ imprint, the venture’s new leadership, and the external environment. The process model we develop shows how the organizational imprint evolves as a consequence of the interplay between top-down and bottom-up forces. We first find that the initial imprint is transmitted through a bottom-up mechanism of imprint reinforcement, and second, that the venture is reimprinted after the founding period through two processes which we call imprint reforming and imprint coupling. The result of this is the formation of a sedimented imprint. Our findings further illuminate that, although the initial imprint sticks, its function and manifestation changes over time.
We Need Less Pressure
Authors: Baker Charlotte
Published: October 2020

The removal of exams due to Covid-19 has raised an important question: are tests and exams still the best way to assess children – particularly our youngest ones?
Latest Clinical Research
Authors: Greener Mark
Published: October 2020

Mark Greener summarises the latest studies relevant to primary care nurses