bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of natural trypsin inhibitor from soybean on texture deterioration of the bay scallop (Argopecten irradians) during cold storage and its mechanism
Authors: Liu Bing , Liu Yu‐xin , Liu Zi‐qiang , Yu Man‐man , Liu Hui‐lin , Qin Lei , Zhou Da‐yong , Zhu Bei‐wei
Published: June 2020

In this study, the inhibitory effects of natural trypsin inhibitor from soybean (SBTI) on texture deterioration of adductor muscle of scallop (AMS) during cold storage and its mechanism were revealed by determining the changes of structural proteins of AMS in situ and in vitro, respectively. Results indicated that the endogenous proteolysis resulted in the disintegration of connective tissue proteins, the degradation of myosin and actin, as well as the reduction of α‐helix, the increase of β‐sheet and amino acid side chains, and the exposure of tryptophan residues of isolated myofibrillar proteins (MPs). These changes in structural proteins contribute to the texture deterioration of AMS as reflected in a significant decrease in hardness, chewiness, adhesiveness and springiness, but a significant increase in cohesiveness. SBTI significantly inhibited the conformational changes of structural proteins caused by endogenous proteolysis, improved the MP gel‐forming ability and consequently retarded the texture deterioration of AMS.
Evolving concepts of pathogenesis of heparin‐induced thrombocytopenia: Diagnostic and therapeutic implications
Authors: Chong Beng H.
Published: June 2020

Heparin‐induced thrombocytopenia (HIT) is an immune reaction to heparin. It often causes severe thrombosis which may lead to limb gangrene and thrombosis‐associated death. The concept of its pathogenesis has been evolving during the past five decades. Initially, HIT was thought to be caused by disseminated intravascular coagulation. Later it became clear that HIT was mediated by an immune mechanism whereby an IgG antibody induced platelet aggregation, release of procoagulant materials and consequently thrombus formation. The antigen comprises Platelet Factor 4 (PF4) and heparin which have a tendency to form ultralarge complexes. The HIT immune response has atypical features. IgG antibody appears early without IgM precedence and lasts transiently. One explanation is that there is prior priming by bacterial infection. Another unique characteristic is that it is processed as if it is a particulate antigen involving complement activation and B cells. Antigen‐presenting cells/monocytes are also involved but the role of T cells is controversial. Recent advances have provided new insights into the underlying mechanisms of HIT‐related thrombosis. Previously, platelets were believed to play a central role; their activation and consequently the induction of blood coagulation was the basis of the hypercoagulability in HIT. More recently, several studies have provided clear evidence that neutrophil and NETosis, monocytes and endothelial cells contribute significantly to the thrombosis in HIT. These new insights may result in development of better diagnostic laboratory assays and more effective treatments for HIT.
Influenza vaccination strategies targeting the hemagglutinin stem region
Authors: Fukuyama Hidehiro , Shinnakasu Ryo , Kurosaki Tomohiro
Published: June 2020

Influenza is one of the best examples of highly mutable viruses that are able to escape immune surveillance. Indeed, in response to influenza seasonal infection or vaccination, the majority of the induced antibodies are strain‐specific. Current vaccine against the seasonal strains with the strategy of surveillance‐prediction‐vaccine does not cover an unmet virus strain leading to pandemic. Recently, antibodies targeting conserved epitopes on the hemagglutinin (HA) protein have been identified, albeit rarely, and they often showed broad protection. These antibody discoveries have brought the feasibility to develop a universal vaccine. Most of these antibodies bind the HA stem domain and accumulate in the memory B cell compartment. Broadly reactive stem‐biased memory responses were induced by infection with antigenically divergent influenza strains and were able to eradicate these viruses, together indicating the importance of generating memory B cells expressing high‐quality anti‐stem antibodies. Here, we emphasize recent progress in our understanding of how such memory B cells can be generated and discuss how these advances may be relevant to the quest for a universal influenza vaccine.
Association of scar distribution with epicardial electrograms and surface ventricular tachycardia QRS duration in nonischemic cardiomyopathy
Authors: Park Jaeseok , Desjardins Benoit , Liang Jackson J. , Zghaib Tarek , Xie Shuanglun , Lucena‐Padros Irene , Zado Erica , Santangeli Pasquale , Frankel David S. , Callans David J. , van der Geest Rob J. , Marchlinski Francis E. , Nazarian Saman
Published: June 2020

Introduction

The association of late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) with epicardial and surface ventricular tachycardia (VT) electrogram features, in nonischemic cardiomyopathy (NICM), is unknown. We sought to define the association of LGE and viable wall thickness with epicardial electrogram features and exit site paced QRS duration in patients with NICM.

Methods

A total of 19 patients (age 53.5 ± 11.5 years) with NICM (ejection fraction 40.2 ± 13.2%) underwent CMR before VT ablation. LGE transmurality was quantified on CMR and coregistered with 2294 endocardial and 2724 epicardial map points.

Results

Both bipolar and unipolar voltage were associated with transmural signal intensity on CMR. Longer electrogram duration and fractionated potentials were associated with increased LGE transmurality, but late potentials or local abnormal ventricular activity were more prevalent in nontransmural versus transmural LGE regions (p < .05). Of all critical VT sites, 19% were located adjacent to regions with LGE but normal bipolar and unipolar voltage. Exit site QRS duration was affected by LGE transmurality and intramural scar location, but not by wall thickness, at the impulse origin.

Conclusions

In patients with NICM and VT, LGE is associated with epicardial electrogram features and may predict critical VT sites. Additionally, exit site QRS duration is affected by LGE transmurality and intramural location at the impulse origin or exit.
Catheter ablation of orthodromic reciprocating tachycardia and atrioventricular nodal reentrant tachycardia in children with hypoplastic left heart syndrome
Authors: Malkar Manish , Kannankeril Prince J. , Radbill Andrew E. , Fish Frank A.
Published: June 2020

Introduction

Experience with catheter ablation of orthodromic reciprocating tachycardia (ORT) and atrioventricular nodal reentrant tachycardia (AVNRT) in young children with hypoplastic left heart syndrome (HLHS) is limited. We report the feasibility, safety, and outcomes of catheter ablation of ORT and AVNRT in children with HLHS.

Methods and Results

This was a retrospective review of patients with HLHS who underwent catheter ablation for reentrant supraventricular tachycardias (excluding atrial tachycardias) between 2005 and 2017 at a single center. Descriptive data including demographics, clinical history, procedural data, and outcomes were recorded. Ten children with HLHS underwent eleven catheter ablation procedures. Median age and weight at ablation were 2.7 years (range: 0.1–10.5) and 11.4 kg (range: 3.6–30.4), respectively. Tachycardia mechanism was AVNRT in four, ORT in five (two with preexcitation), and both in one. Acute procedural success was 100% and there was no spontaneous recurrence of tachycardia orpreexcitationin median 92 months (range: 21–175 months) follow‐up. Five patients underwent subsequent EP studies at catheterization (intracardiac) or after surgery (via epicardial wires): three were noninducible, one after AVNRT ablation had inducible atrial tachycardia, and one after initial ORT ablation had inducible ORT at fenestration closure and underwent successful repeat ablation. Thus, long‐term freedom from clinical tachycardia was 100% and from inducible AVNRT or ORT was 80%.

Conclusion

Transcatheter ablation for ORT and AVNRT in children with HLHS can be performed with excellent acute and long‐term success without major complications.
Graduate education and long‐term inventive performance: Evidence from undergraduates' choices during recessions
Authors: Onishi Koichiro , Nagaoka Sadao
Published: June 2020

Using individuals' life‐cycle invention data, we investigate how graduate education affects inventive performance and inventors' abilities to absorb and combine diverse knowledge sources. To control for the endogeneity of educational choice, we use the status of college labor markets as an instrumental variable (IV), specifically the difference between the unemployment rate and its long‐run average rate by academic field. We find that graduate education, induced by the IV, significantly enhances inventive performance and the scope of exploited knowledge, exceeding the levels implied by ordinary least squares. Graduate education can have a significant causal effect on inventive capability and performance.
Water in garnet of garnetite (metarodingite) and eclogite from the Erzgebirge and the Lepontine Alps
Authors: Schmädicke Esther , Gose Jürgen
Published: June 2020

Little is known about water in nominally anhydrous minerals of orogenic garnet peridotite and enclosed metabasic rocks. This study is focused on peridotite‐hosted eclogite and garnetite (metarodingite) from the Erzgebirge (EG), Germany, and the Lepontine Alps (LA), Switzerland. Newly discovered, peridotite‐hosted eclogite in the Erzgebirge occurs in the same ultra‐high pressure (UHP) unit as gneiss‐hosted coesite eclogite, from which it is petrologically indistinguishable. Garnet is present in all mafic and ultramafic high pressure (HP) rocks providing for an ideal proxy to compare the H2O content of the different rock types. Garnet composition is very similar in EG and LA samples and depends on the rock type. Garnet from garnetite, compared to eclogite, contains more CaO (garnetite: 10.5–16.5 wt%; eclogite: 5–11 wt%) and is also characterized by an anomalous REE distribution. In contrast, the infrared (IR) spectra of garnet from both rock types reveal the same OH absorption bands that are also identical to those of previously studied peridotitic garnet from the same locations. Two groups of IR bands, SW I (3,650 ± 10 cm−1) and SW II (3,570–3,630 cm−1) are ascribed to structural hydroxyl (colloquially ‘water’). A third, broad band is present in about half of the analysed garnet domains and related to molecular water (MW) in submicroscopic fluid inclusions. The primary content of structural H2O, preserved in garnet domains without fluid inclusions (and MW bands), varies systematically—depending on both the location and the rock type. Garnet from EG rocks contains more water compared to LA samples, and garnet from garnetite (EG: 121–241 wt.ppm H2O; LA: 23–46 wt.ppm) hosts more water than eclogitic garnet (EG: 84 wt.ppm; LA: 4–11 wt.ppm). Higher contents of structural water (SW) are observed in domains with molecular water, in which the SW II band (being not restricted to HP conditions) is simultaneously enhanced. This implies that fluid influx during decompression not only led to fluid inclusions but also favoured the uptake of secondary SW. The results signify that garnet from all EG and LA samples was originally H2O‐undersaturated. Combining the data from eclogite, garnetite and previously studied peridotite, H2O and CaO are positively correlated, pointing to the same degree of H2O‐undersaturation at peak metamorphism in all rock types. This ubiquitous water‐deficiency cannot be reconciled with the derivation of any of these rocks from the lowermost part of the mantle wedge that was in contact with the subducting plate. This agrees with the previously inferred abyssal origin for part of the rocks from the LA (Cima di Gagnone). A similar origin has to be invoked for the Erzgebirge UHP unit. We suggest that all mafic and ultramafic rocks of this unit not only shared the same metamorphic evolution but also a common protolith origin, most probably on the ocean floor. This inference is supported by the presence of peridotite‐hosted garnetite, representing metamorphosed rodingite.
R‐index critical value
Authors: Bi Jian , O'Mahony Michael
Published: June 2020

The R‐index is a sound methodology, which has been introduced, developed, and used in the sensory and consumer fields for several decades. The R‐index methodology can be used both to measure and to test sensory difference and consumer preference. This paper provides an R code for calculation of the R‐index critical value for difference testing, which is a supplement to or an alternative for the published table in Bi & O'Mahony (2007) (Journal of Sensory Studies, 22, 713–720).

Practical applications

The R code provided in the short contributions overcomes the limitation of the previously published table of R‐index critical values in Bi & O'Mahony (2007) (Journal of Sensory Studies, 22, 713–720) with its limited number of sample sizes and required equal size for the control sample and test sample.
Alterations in internetwork functional connectivity in patients with chronic migraine within the boundaries of the Triple Network Model
Authors: Trufanov Artem , Markin Kirill , Frunza Daria , Litvinenko Igor , Odinak Miroslav
Published: June 2020

Background

Alterations in large‐scale functional connectivity have widely been used to understand migraine pathophysiology and to find any imaging markers. The successful use of the Triple Network Model for many mental and neurological diseases has prompted us to consider chronic migraine under the prism of this model for the first time in the literature.

Aim

To evaluate alterations in functional connectivity between large‐scale networks using resting‐state fMRI in chronic migraine patients and their correlation with clinical features within the boundaries of the Triple Network Model.

Methods

Twenty‐five chronic migraine patients underwent 1,5T resting‐state functional magnetic resonance imaging (RS‐fMRI) scanning during the interictal phase and were compared to a group of 25 healthy controls. Functional connectivity was assessed using region‐of‐interest to region‐of‐interest (ROI‐to‐ROI) analysis between 8 networks and 15 subcortical areas, conventionally assigned to salience network.

Results

Compare to healthy controls, patients had increased functional connectivity between salience network (SN) and sensorimotor network (SMN) and dorsal attention network (DAN), between nucleus accumbens and default mode network (DMN) and within DMN and also between thalamus and DAN. Decreased functional connectivity was registered between nucleus accumbens and DAN, and also within DAN. A higher depression scale score was positively correlated with an increase in FC within DMN.

Conclusion

Taken together, our results show that patients with chronic migraine could be characterized by specific dysfunctional interactions between the SN, SMN, DAN, and DMN during resting state.
On the origin of giant seeds: the macroevolution of the double coconut (Lodoicea maldivica) and its relatives (Borasseae, Arecaceae)
Authors: Bellot Sidonie , Bayton Ross P. , Couvreur Thomas L. P. , Dodsworth Steven , Eiserhardt Wolf L. , Guignard Maïté S. , Pritchard Hugh W. , Roberts Lucy , Toorop Peter E. , Baker William J.
Published: June 2020

Seed size shapes plant evolution and ecosystems, and may be driven by plant size and architecture, dispersers, habitat and insularity. How these factors influence the evolution of giant seeds is unclear, as are the rate of evolution and the biogeographical consequences of giant seeds.

We generated DNA and seed size data for the palm tribe Borasseae (Arecaceae) and its relatives, which show a wide diversity in seed size and include the double coconut (Lodoicea maldivica), the largest seed in the world. We inferred their phylogeny, dispersal history and rates of change in seed size, and evaluated the possible influence of plant size, inflorescence branching, habitat and insularity on these changes.

Large seeds were involved in 10 oceanic dispersals. Following theoretical predictions, we found that: taller plants with fewer‐branched inflorescences produced larger seeds; seed size tended to evolve faster on islands (except Madagascar); and seeds of shade‐loving Borasseae tended to be larger.

Plant size and inflorescence branching may constrain seed size in Borasseae and their relatives. The possible roles of insularity, habitat and dispersers are difficult to disentangle. Evolutionary contingencies better explain the gigantism of the double coconut than unusually high rates of seed size increase.
Intraspecific trait variation in personality‐related movement behavior promotes coexistence
Authors: Milles Alexander , Dammhahn Melanie , Grimm Volker
Published: June 2020

Movement behavior is an essential element of fundamental ecological processes such as competition and predation. Although intraspecific trait variation (ITV) in movement behaviors is pervasive, its consequences for ecological community dynamics are still not fully understood. Using a newly developed individual‐based model, we analyzed how given and constant ITVs in foraging movement affect differences in foraging efficiencies between species competing for common resources under various resource distributions. Further, we analyzed how the effect of ITV on emerging differences in competitive abilities ultimately affects species coexistence. The model is generic but mimics observed patterns of among‐individual covariation between personality, movement and space use in ground‐dwelling rodents. Interacting species differed in their mean behavioral types along a slow–fast continuum, integrating consistent individual variation in average behavioral expression and responsiveness (i.e. behavioral reaction norms). We found that ITV reduced interspecific differences in competitive abilities by 5–35% and thereby promoted coexistence via an equalizing mechanism. The emergent relationships between behavioral types and foraging efficiency are characteristic for specific environmental contexts of resource distribution and population density. As these relationships are asymmetric, species that were either ‘too fast’ or ‘too slow’ benefited differently from ITV. Thus, ITV in movement behavior has consequences for species coexistence but to predict its effect in a given system requires intimate knowledge on how variation in movement traits relates to fitness components along an environmental gradient.
Kangaroo mother care alters chromogranin A and perfusion index in preterm babies
Authors: Endo Tomohiro , Sampei Mari , Fukuda Seiji
Published: June 2020

Background

While providing various benefits, concerns about the potential risks of kangaroo mother care, or skin‐to‐skin contact (SSC), between mother and her preterm infant hinder its widespread implementation in some resource‐ rich countries. In neonates, salivary chromogranin A (s‐CgA) is elevated upon exposure to stress, whereas the perfusion index (PI) is associated with hemodynamics and peripheral perfusion. Here, we investigated the effects of SSC on s‐CgA and the PI in preterm infants.

Methods

Twelve infants were enrolled in the study. Factors associated with baseline s‐CgA were analyzed. Baseline s‐CgA and the level after SSC were compared. Secreted IgA in the saliva was compared as the control. The PI before, throughout, and after SSC were compared.

Results

Baseline s‐CgA was significantly lower in infants who were supplemented with baby formula milk in addition to breast milk before SSC (n = 2) compared with those fed with their mother's breast milk alone (n = 10,P = 0.03). SSC significantly decreased s‐CgA in babies who were fed breast milk only before SSC (n = 10,P = 0.01) but not in those supplemented with formula milk before SSC (n = 2). Secreted IgA in saliva was not affected by SSC. The PI was significantly elevated during SSC (P = .01).

Conclusion

Our data indicate that SSC can reduce s‐CgA levels when combined with mother's breast milk and increase the PI in preterm infants, thereby providing additional evidence of the benefit of SSC.
Muscle loss contributes to higher morbidity and mortality in COPD: An analysis of national trends
Authors: Attaway Amy H. , Welch Nicole , Hatipoğlu Umur , Zein Joe G. , Dasarathy Srinivasan
Published: June 2020

Background and objective

COPD is the third most common cause of death worldwide and fourth most common in the United States. In hospitalized patients with COPD, mortality, morbidity and healthcare resource utilization are high. Skeletal muscle loss is frequent in patients with COPD. However, the impact of muscle loss on adverse outcomes has not been systematically evaluated. We tested the hypothesis that patients hospitalized for COPD exacerbation with, compared to those without, a secondary diagnosis of muscle loss phenotype (all ICD‐9 codes associated with muscle loss including cachexia) will have higher mortality and cost of care.

Methods

The NIS database of hospitalized patients in 2011 (1 January–31 December) in the United States was used. The impact of a muscle loss phenotype on in‐hospital mortality, LOS and cost of care for each of the 174 808 hospitalizations for COPD exacerbations was analysed.

Results

Of the subjects admitted for a COPD exacerbation, 12 977 (7.4%) had a secondary diagnosis of muscle loss phenotype. A diagnosis of muscle loss phenotype was associated with significantly higher in‐hospital mortality (14.6% vs 5.7%, P < 0.001), LOS (13.3 + 17.1 vs 5.7 + 7.6, P < 0.001) and median hospital charge per patient ($13 947 vs $6610, P < 0.001). Multivariate regression analysis showed that muscle loss phenotype increased mortality by 111% (95% CI: 2.0–2.2, P < 0.001), LOS by 68.4% (P < 0.001) and the direct cost of care by 83.7% (P < 0.001) compared to those without muscle loss.

Conclusion

In‐hospital mortality, LOS and healthcare costs are higher in patients with COPD exacerbations and a muscle loss phenotype.
Media Exposure to Terrorism and Perception of Immigrants as a Threat: The Role of Emotional Intelligence and Psychophysiological Self‐Regulation
Authors: Rubaltelli Enrico , Priolo Giulia , Scrimin Sara , Moscardino Ughetta
Published: June 2020

To better understand how media exposure to terrorism‐related images can lead to perceiving immigrants as more threatening, in the present study we manipulated participants’ exposure to media coverage of terrorist attacks and investigated how this may influence people's perception of Arab immigrants. Considering the important role of regulatory abilities when facing stressful events like terrorist attacks, we measured individual differences in both trait emotional intelligence and resting heart rate variability (HRV). Results showed that participants perceived Arab immigrants as more threatening in the media exposure condition than in the control condition. Importantly, there were moderating effects of both trait emotional intelligence and HRV. People with lower trait emotional intelligence or lower HRV at rest felt more threatened in the media exposure condition compared to the control condition, whereas this effect was not observed among participants with higher trait emotional intelligence or higher resting HRV. The present study highlights some of the complexities related to how media exposure to terrorism‐related images influences people's reactions to, and evaluations of, an outgroup that is related to the perpetrators of the attacks.
The Sources of Belief in Personal Capability: Antecedents of Self‐Efficacy in Private Adaptation to Flood Risk
Authors: Seebauer Sebastian , Babcicky Philipp
Published: June 2020

Self‐efficacy is one of the strongest and most consistent drivers of private flood mitigation behavior; however, the factors influencing self‐efficacy in the context of flooding remain unclear. The present study examines three potential antecedents of self‐efficacy: personal and vicarious experiences of floods or building‐related events, social norms for private flood preparedness, and personal competencies such as technical abilities and social skills. While controlling for other drivers in a protection motivation theory (PMT) framework, these antecedents are tested as precursors of self‐efficacy and intentions to improve flood resilience. Structural equation modeling is applied to conduct mediation analyses with survey data of 381 flood‐prone households in Austria. Contrary to theoretical expectations, personal and vicarious experiences do not predict self‐efficacy, presumably because rare flood events and changing hazard characteristics do not facilitate generalizable performance accomplishments. Social norms strongly and consistently influence self‐efficacy, especially for actions observable by others, and also directly influence protective responses. Personal competencies increase self‐efficacy and support protective action, particularly with regard to preventive and structural measures. The strength and direction of the antecedents of self‐efficacy as well as of other PMT determinants vary between general and specific protective responses. This study provides important insights for risk managers, suggesting that interventions involving social norms and personal competencies can be effective in stimulating self‐efficacy and, in turn, private flood mitigation. Interventions and research should clearly differentiate between general intention and the implementation of specific measures, and should address cumulative, synergistic, or tradeoff interrelations between multiple measures.
Donor hemovigilance: a call to arms
Authors: Storch Emily K.
Published: June 2020

See article on page 1231–1242, in this issue
A review of physical relationships between form and function in wastewater biotreatment and a new theory relating activated sludge and biofilm systems behaviour
Authors: Palmer Stephen , Noone Gerald , Hoyland Garry
Published: June 2020

In this review paper, a physical systems analysis based on thermodynamics has been applied to the observed behaviour of activated sludge as a physical system. The origin of the microecology of activated sludge and its relationship to biofilms and the metabolic consequences of the extracellular polysaccharide (EPS) formation are explained for the first time. Feast‐famine conditions are shown to be the leading candidate for the evolution of the ability of biofilm forming bacteria and activated sludge ‘floc‐formers’ to form EPS. The basis for competition for RBCOD between low F:M filamentous heterotrophic bacteria and ‘floc‐forming’ heterotrophic is presented and its relationship to activated sludge bulking described.
A Pressure Model for Open Rotor–Stator Cavities: An Application to an Adjustable-Speed Centrifugal Pump With Experimental Validation
Authors: Gu Yandong , Pei Ji , Yuan Shouqi , Zhang Jinfeng
Published: June 2020

For a centrifugal pump, the interaction between the leakage and the pressure profile in the side chambers is crucial to the performance and reliability of the pump. However, existing theoretical models for directly predicting the flow in the pump side chambers suffer from nonself closure, low accuracy, and slow convergence, and hardly any research presents such predictions for the adjustable-speed centrifugal pump. A pressure model for the simplified geometric configuration of the side chambers in turbomachinery, specifically the open rotor–stator cavity, is established by introducing Poncet's K formula. With the application of this theoretical model, as well as the consideration of the static pressure rises in the impeller and the pressure drops through seals and balance holes, a new one-dimensional (1D) pressure model is built and developed as a design tool for solving the flow in the pump side chambers. Compared with the pressure measurements on the casing wall of an adjustable-speed centrifugal pump, the predictions made by the new 1D pressure model indicate good accuracy and are better than the predictions made by the pressure model using the conventional constant K. It is found that the thrust acting on the shrouds varies almost linearly with the squared rotating speed, whereas the rotating speed hardly influences the volumetric efficiency. Since only the flow rate, rotating speed, and geometric parameters are required, the new 1D pressure model can be readily applied to other pumps, and it is preferred for good and fast prediction in the preliminary design stage.
Adsorption behavior of cobalt phthalocyanine submonolayer coverages on B-Si(111)-3×3R30°
Authors: Kubicki Milan , Lindner Susi , Franz Martin , Eisele Holger , Dähne Mario
Published: June 2020

The molecular arrangement and electronic properties of submonolayer coverages of cobalt phthalocyanine (CoPc) molecules on the deactivated B-Si(111)-3×3R30° surface are analyzed using scanning tunneling microscopy and spectroscopy. On the ideal surface, the dangling bonds, which typically prevent an ordered growth of molecules on semiconductors, are removed. However, the presence of single defects enables the opportunity to study the influence of their dangling bonds on the adsorption behavior in detail. Here, we focus on coverage densities below and above the Si-Si(S5) defect density. Our data demonstrate that for all submonolayer coverages, the CoPc molecules adsorb in a flat-lying geometry, with either a circular or a four-leaf cloverlike appearance. Initially, each CoPc molecule adsorbs on top of a Si-Si(S5) defect, while later, also passivated Si adatoms become occupied. For the adsorption on Si-Si(S5) defects, hybridization between its pz orbital and the dz2 orbital of the Co atom of the molecule occurs, leading to additional hybridization states observed in the tunneling spectra.
Field performance of sterile male mosquitoes released from an uncrewed aerial vehicle
Authors: Bouyer J. , Culbert N. J. , Dicko A. H. , Pacheco M. Gomez , Virginio J. , Pedrosa M. C. , Garziera L. , Pinto A. T. Macedo , Klaptocz A. , Germann J. , Wallner T. , Salvador-Herranz G. , Herrero R. Argiles , Yamada H. , Balestrino F. , Vreysen M. J. B.
Published: June 2020

An automatic adult mosquito release device operated from a drone released sterile males without reducing their quality.
Clinical and Genomic Epidemiology of Carbapenem-Nonsusceptible
Citrobacter
spp. at a Tertiary Health Care Center over 2 Decades
Authors: Babiker Ahmed , Evans Daniel R. , Griffith Marissa P. , McElheny Christi L. , Hassan Mohamed , Clarke Lloyd G. , Mettus Roberta T. , Harrison Lee H. , Doi Yohei , Shields Ryan K. , Van Tyne Daria
Published: June 2020

Carbapenem-nonsusceptible
Citrobacter
spp. (CNSC) are increasingly recognized as health care-associated pathogens. Information regarding their clinical epidemiology, genetic diversity, and mechanisms of carbapenem resistance is lacking. We examined microbiology records of adult patients at the University of Pittsburgh Medical Center (UMPC) Presbyterian Hospital (PUH) from 2000 to 2018 for CNSC, as defined by ertapenem nonsusceptibility. Over this time frame, the proportion of CNSC increased from 4% to 10% (
P = 
0.
Persistent Challenges of Interassay Variability in Transplant Viral Load Testing
Authors: Hayden R. T. , Caliendo A. M.
Published: June 2020

While quantification of viruses that cause important infections in transplant recipients has been the standard of care for years, important challenges related to standardization remain. The issues are wide ranging, and until they are adequately addressed, the full impact of viral load testing regarding clinical management decisions will not be realized. This review focuses on a broad array of problems, including the lack of available FDA-approved/cleared tests, limited uptake of international standards, accurate quantification of secondary standards, specific assay characteristics, and commutability.
Recurrent diabetic ketoacidosis and cognitive function among older adults with type 1 diabetes: findings from the Study of Longevity in Diabetes
Authors: Lacy Mary E , Gilsanz Paola , Eng Chloe W , Beeri Michal S , Karter Andrew J , Whitmer Rachel A
Published: June 2020

Introduction

Diabetic ketoacidosis (DKA) is a serious complication of diabetes. DKA is associated with poorer cognition in children with type 1 diabetes (T1D), but whether this is the case in older adults with T1D is unknown. Given the increasing life expectancy in T1D, understanding the role of DKA on brain health in older adults is crucial.

Research design and methods

We examined the association of DKA with cognitive function in 714 older adults with T1D from the Study of Longevity in Diabetes. Participants self-reported lifetime exposure to DKA resulting in hospitalization; DKA was categorized into 0 hospitalization, 1 hospitalization or ≥2 hospitalizations (recurrent DKA). Global and domain-specific cognition (language, executive function/psychomotor speed, episodic memory and simple attention) were assessed. The association of DKA with cognitive function was evaluated via linear and logistic regression models.

Results

Twenty-eight percent of participants (mean age=67 years; mean age at diagnosis=28 years; average duration of diabetes=39 years) reported a lifetime history of DKA resulting in hospitalization (18.5% single DKA; 9.7% recurrent DKA). In fully adjusted models, those with recurrent DKA had lower global cognitive function (β=−0.13; 95% CI −0.22 to 0.02) and lower scores on the executive function/psychomotor speed domain (β=−0.34; 95% CI −0.51 to 0.17). Individuals with recurrent DKA were also more likely to have the lowest level of cognitive function on the executive function/psychomotor speed domain (defined as 1.5 SD below the population mean; OR=3.26, 95% CI 1.43 to 7.42).

Conclusions

Among 714 older adults with T1D, recurrent DKA was associated with lower global cognitive function, lower scores on the executive function/psychomotor speed domain and 3.3 times greater risk of having the lowest level of cognitive function in our sample on the executive function/psychomotor speed domain. These findings suggest that recurrent DKA may negatively impact the brain health of older patients with T1D and highlight the importance of DKA prevention.
Innovative financing to fund surgical systems and expand surgical care in low-income and middle-income countries
Authors: Reddy Ché L , Peters Alexander W , Jumbam Desmond Tanko , Caddell Luke , Alkire Blake C , Meara John G , Atun Rifat
Published: June 2020

Strong surgical systems are necessary to prevent premature death and avoidable disability from surgical conditions. The epidemiological transition, which has led to a rising burden of non-communicable diseases and injuries worldwide, will increase the demand for surgical assessment and care as a definitive healthcare intervention. Yet, 5 billion people lack access to timely, affordable and safe surgical and anaesthesia care, with the unmet demand affecting predominantly low-income and middle-income countries (LMICs). Rapid surgical care scale-up is required in LMICs to strengthen health system capabilities, but adequate financing for this expansion is lacking. This article explores the critical role of innovative financing in scaling up surgical care in LMICs. We locate surgical system financing by using a modified fiscal space analysis. Through an analysis of published studies and case studies on recent trends in the financing of global health systems, we provide a conceptual framework that could assist policy-makers in health systems to develop innovative financing strategies to mobilise additional investments for scale-up of surgical care in LMICs. This is the first time such an analysis has been applied to the funding of surgical care. Innovative financing in global surgery is an untapped potential funding source for expanding fiscal space for health systems and financing scale-up of surgical care in LMICs.
Rapid urban health security assessment tool: a new resource for evaluating local-level public health preparedness
Authors: Boyce Matthew R , Katz Rebecca
Published: June 2020

Urbanisation will be one of the defining demographic trends of the 21st century—creating unique opportunities for sustainable capacity development, as well as substantial risks and challenges for managing public health and health emergencies. Plans and policies for responding to public health emergencies are generally framed at higher levels of governance, but developing, improving and sustaining the capacities necessary for implementing these policies is a direct function of local-level authorities. Evaluating local-level public health capacities is an important process for identifying strengths and weaknesses that can impact the preparedness for, detection of and response to health security threats. However, while various evaluations and assessments exist for evaluating capacities at other levels, currently, there are no readily available health security assessments for the local-level. In this paper, we describe a tool—the Rapid Urban Health Security Assessment (RUHSA) Tool—that is based on a variety of other relevant assessments and guidance documents. Assessing capacities allow for local-level authorities to identify the strengths and weaknesses of their local health security systems, create multiyear action plans and prioritise opportunities for improving capacities, effectively engage with development partners to target resources effectively and develop compelling narratives and a legacy of leadership. While the RUHSA Tool was not designed to be used in the midst of a public health emergency, such as the ongoing COVID-19 pandemic, it may also be adapted to inform a checklist for prioritising what capacities and activities a city needs to rapidly develop or to help focus requests for assistance.
‘I’ve got a little list’—the scourge of a surgical junior. A quality improvement project to change the surgical patient list in a district general hospital
Authors: Khan Hiba , Flesher Elizabeth , Marshman James , Harding Alexander , Bethune Rob , Lawday Samuel
Published: June 2020

Background

Junior doctors at the Royal Devon and Exeter Hospital spend hours every day creating and updating patient lists for all surgical specialties on Microsoft Excel spreadsheets. This not only consumes time that should be spent on clinical tasks, it allows for human errors, system errors and patient safety concerns. Our aim was to reduce time spent on the list and reduce the chance for error.

Methods

We measured the time junior doctors spent creating and updating the surgical lists for one specialty, and on-call shifts. Our first Plan-Do-Study-Act (PDSA) cycle was to introduce clinical secretaries; this reduced the time spent by ward teams on the list but had no effect on the on-call team. We then worked with the hospital application developer to adapt software currently used to suit all surgical teams. Once completed, this software was rolled out alongside the existing spreadsheet method with a view to a switch after a transition period.

Results

The introduction of clinical secretaries reduced the time spent on the colorectal surgery list from 99.22 min a day to 43.38 min. The on-call team however did not benefit from this intervention. Following the introduction of the new software, the day on-call team time spent on the list changed from 121 min a day to 4.66 min. The night on-call team time changed from 91 min to 7.38 min.

Conclusion

Reducing the time juniors spend compiling surgical lists has clear benefits to patients with extra time for junior doctors to clerk patients. The use of an automated system removes the chance of error in transcription of blood results. Due to the success of this project, colorectal, upper gastrointestinal, urology, vascular and on-call teams have adopted the new list permanently.
Undertriage of the elderly major trauma patient continues in major trauma centre care: a retrospective cohort review
Authors: Hoyle Antonia C , Biant Leela C , Young Mike
Published: June 2020

Background

Major trauma (Injury Severity Score (ISS) ≥16) in older people is increasing, but concerns persist that major trauma is not always recognised in older patients on triage. This study compared undertriage of older and younger adult major trauma patients in the major trauma centre (MTC) setting to investigate this concern.

Methods

A retrospective review of Trauma Audit and Research Network data was conducted for three MTCs in the UK for 3 months in 2014. Age, ISS, injury mechanism and injured areas were examined for all severely injured patients (ISS ≥16) and appropriate major trauma triage rates measured via the surrogate markers of trauma team activation and the presence of a consultant first attender, as per standards for major trauma care set by National Confidential Enquiry into Patient Outcomes and Deaths, Royal College of Surgeons of England and the British Orthopaedic Association. Trends in older (age ≥65) and younger (ages 18–64) adult major trauma presentation, triage and reception were reviewed.

Results

Of 153 severely injured patients, 46 were aged ≥65. Older patients were significantly less likely to receive the attention of a consultant first attender or trauma team. Similar trends were also seen on subgroup analysis by mechanism of injury or number of injured body areas. Older major trauma patients exhibit a higher mortality, despite a lower median ISS (older patient ISS=20 (IQR 16–25), younger patient ISS=25 (IQR 18–29)).

Conclusion

Older major trauma patients are at greater risk of undertriage, even in the MTC environment. Existing hospital trauma triage practices should be further investigated to explain and reduce undertriage of elderly trauma patients.
Paramedic experiences of using an enhanced stroke assessment during a cluster randomised trial: a qualitative thematic analysis
Authors: Lally Joanne , Vaittinen Anu , McClelland Graham , Price Christopher I , Shaw Lisa , Ford Gary A , Flynn Darren , Exley Catherine
Published: June 2020

Background

Intravenous thrombolysis is a key element of emergency treatment for acute ischaemic stroke, but hospital service delivery is variable. The Paramedic Acute Stroke Treatment Assessment (PASTA) multicentre cluster randomised controlled trial evaluated whether an enhanced paramedic-initiated stroke assessment pathway could improve thrombolysis volume. This paper reports the findings of a parallel process evaluation which explored intervention paramedics’ experience of delivering the enhanced assessment.

Methods

Interviewees were recruited from 453 trained intervention paramedics across three UK ambulance services hosting the trial: North East, North West and Welsh Ambulance Services. A semistructured interview guide aimed to (1) explore the stroke-specific assessment and handover procedures which were part of the PASTA pathway and (2) enable paramedics to share relevant views about expanding their role and any barriers/enablers they encountered. Interviews were audiorecorded, transcribed verbatim and analysed following the principles of the constant comparative method.

Results

Twenty-six interviews were conducted (11 North East, 10 North West and 5 Wales). Iterative data analysis identified four key themes, which reflected paramedics’ experiences at different stages of the care pathway: (1) Enhanced assessment at scene: paramedics felt this improved their skillset and confidence. (2) Prealert to hospital: a mixed experience dependent on receiving hospital staff. (3) Handover to hospital team: standardisation of format was viewed as the primary benefit of the PASTA pathway. (4) Assisting in hospital and feedback: due to professional boundaries, paramedics found these aspects harder to achieve, although feedback from the clinical team was valued when available.

Conclusion

Paramedics believed that the PASTA pathway enhanced their skills and the emergency care of stroke patients, but a continuing clinical role postadmission was challenging. Future studies should consider whether interdisciplinary training is needed to enable more radical extension of professional boundaries for paramedics.
Predicting sudden cardiac death in adults with congenital heart disease
Authors: Oliver Jose M , Gallego Pastora , Gonzalez Ana Elvira , Avila Pablo , Alonso Andres , Garcia-Hamilton Diego , Peinado Rafael , Dos-Subirà Laura , Pijuan-Domenech Antonia , Rueda Joaquín , Rodriguez-Puras Maria-Jose , Garcia-Orta Rocio , Martínez-Quintana Efrén , Datino Tomas , Fernandez-Aviles Francisco , Bermejo Javier
Published: June 2020

Objectives

To develop, calibrate, test and validate a logistic regression model for accurate risk prediction of sudden cardiac death (SCD) and non-fatal sudden cardiac arrest (SCA) in adults with congenital heart disease (ACHD), based on baseline lesion-specific risk stratification and individual’s characteristics, to guide primary prevention strategies.

Methods

We combined data from a single-centre cohort of 3311 consecutive ACHD patients (50% male) at 25-year follow-up with 71 events (53 SCD and 18 non-fatal SCA) and a multicentre case–control group with 207 cases (110 SCD and 97 non-fatal SCA) and 2287 consecutive controls (50% males). Cumulative incidences of events up to 20 years for specific lesions were determined in the prospective cohort. Risk model and its 5-year risk predictions were derived by logistic regression modelling, using separate development (18 centres: 144 cases and 1501 controls) and validation (two centres: 63 cases and 786 controls) datasets.

Results

According to the combined SCD/SCA cumulative 20 years incidence, a lesion-specific stratification into four clusters—very-low (<1%), low (1%–4%), moderate (4%–12%) and high (>12%)—was built. Multivariable predictors were lesion-specific cluster, young age, male sex, unexplained syncope, ischaemic heart disease, non-life threatening ventricular arrhythmias, QRS duration and ventricular systolic dysfunction or hypertrophy. The model very accurately discriminated (C-index 0.91; 95% CI 0.88 to 0.94) and calibrated (p=0.3 for observed vs expected proportions) in the validation dataset. Compared with current guidelines approach, sensitivity increases 29% with less than 1% change in specificity.

Conclusions

Predicting the risk of SCD/SCA in ACHD can be significantly improved using a baseline lesion-specific stratification and simple clinical variables.
SETD1B-associated neurodevelopmental disorder
Authors: Roston Alexandra , Evans Dan , Gill Harinder , McKinnon Margaret , Isidor Bertrand , Cogné Benjamin , Mwenifumbo Jill , van Karnebeek Clara , An Jianghong , Jones Steven J M , Farrer Matthew , Demos Michelle , Connolly Mary , Gibson William T ,   CAUSES Study
Published: June 2020

Background

Dysfunction of histone methyltransferases and chromatin modifiers has been implicated in complex neurodevelopmental syndromes and cancers.SETD1Bencodes a lysine-specific methyltransferase that assists in transcriptional activation of genes by depositing H3K4 methyl marks. Previous reports of patients with rare variants inSETD1Bdescribe a distinctive phenotype that includes seizures, global developmental delay and intellectual disability.

Methods

Two of the patients described herein were identified via genome-wide and exome-wide testing, with microarray and research-based exome, through the CAUSES (Clinical Assessment of the Utility of Sequencing and Evaluation as a Service) Research Clinic at the University of British Columbia. The third Vancouver patient had clinical trio exome sequencing through Blueprint Genetics. The fourth patient underwent singleton exome sequencing in Nantes, with subsequent recruitment to this cohort through GeneMatcher.

Results

Here we present clinical reports of four patients with rare coding variants inSETD1Bthat demonstrate a shared phenotype, including intellectual disability, language delay, conserved musculoskeletal findings and seizures that may be treatment-refractory. We include supporting evidence from next-generation sequencing among a cohort of paediatric patients with epilepsy.

Conclusion

Rare coding variants inSETD1Bcan cause a diagnosable syndrome and could contribute as a risk factor for epilepsy, autism and other neurodevelopmental phenotypes. In the long term, some patients may also be at increased risk for cancers and other complex diseases. Thus, longitudinal studies are required to further elucidate the precise role of SETD1B in neurodevelopmental disorders and other systemic disease.