bluuebunny/crossref_metadata_2025 huggingface dataset:
Can listening provide a useful clinical estimate of low vision reading parameters?
Authors: Latham Keziah , Subhi Hikmat
Published: March 2022

Purpose

The purpose of this study was to determine whether a clinician can assess critical print size (CPS) and/or reading fluency by listening to a visually impaired patient reading aloud across a range of print sizes on an MNREAD chart, rather than needing to plot and analyse reading speed data as a function of print size.

Methods

Fifty‐six low vision participants were audio‐recorded reading an MNREAD chart under standard conditions. Two experienced raters listened to the recordings and made judgments of the CPS (logMAR), and of the level of reading fluency achieved at large print sizes on a 4‐point rating scale. Reading times were plotted as a function of print size to determine the CPS as the smallest print size that supported the participant's maximum reading speed (MRS) by inspection, and the MRS as the mean reading speed across print sizes including, and larger than, the CPS.

Results

Listened CPS judgments made for each rater were slightly larger than the CPS values obtained by inspection (mean differences 0.04logMAR (p = 0.06), 0.08logMAR (p < 0.01); limits of agreement (LoA) ±0.28logMAR, ±0.39logMAR, respectively). CPS judgments were consistent both between raters (mean difference 0.04logMAR [p = 0.18]; LoA ±0.42logMAR) and between two judgments made by each rater (mean differences 0.00logMAR (p = 1.0), 0.03logMAR (p < 0.05); LoA ±0.23logMAR, ±0.17logMAR). Reading fluency could be categorised as ‘functional’ (MRS > 80 wpm) or ‘non‐functional’ (MRS < 80 wpm) with a sensitivity of 88%–90% and a specificity of 100%.

Conclusions

Experienced raters listening to a patient reading an MNREAD chart can determine a clinically useful estimate of critical print size and can discriminate maximum reading speeds that are above and below that likely to provide sustained reading ability. Listening to a patient reading an MNREAD chart is an option for the low vision clinician's armoury of assessments.
Ink test: A useful technique to enhance extragenital lichen sclerosus diagnosis
Authors: Ramos‐Rodríguez Daniel , Arteaga‐Henríquez María , Lukoviek Vania , Markthaler Marcella
Published: March 2022

Lichen sclerosus (LS) is a rare and chronic autoimmune disease, and extragenital LS is particularly challenging to diagnose in children. Histopathology is the gold standard for diagnosis. Dermoscopy is a useful tool when follicular plugs (FP) are observed, though FP are sometimes hard to recognize. The ink test may provide a useful technique to enhance FP visualization and support a diagnosis of extragenital LS, thereby avoiding diagnostic delays or biopsy.
The Heaviest Drop of Blood: Black Exceptionalism Among Multiracials
Authors: Leslie Gregory John , Sears David O.
Published: March 2022

We leverage the emerging multiracial population to reexamine prominent theories of the American color line. A Black exceptionalism hypothesis suggests that Black heritage will be more restrictive of biracials' social and political assimilation prospects than Asian or Latino heritage. Black exceptionalism better explains biracials' sorting into the racial hierarchy than does classic assimilation theory or a people‐of‐color hypothesis. In the American Community Survey, Black heritage dominates subjective racial self‐identification among biracial adults and identity assignments to children of interracial marriages. In the 2015 Pew Survey of Multiracials, Black‐White biracials' social identity, social networks, perceptions and experiences of discrimination, and political attitudes relevant to race resemble those of monoracial Blacks, whereas Latino‐Whites and Asian‐Whites are more similar to monoracial Whites than to their minority‐group counterparts. Results suggest that even in a more racially mixed future, Black Americans will continue to be uniquely situated behind a most impermeable color line.
Verification of water‐use efficiency estimates via carbon isotope discrimination in potato under varying nutrient statuses and CO2 conditions
Authors: Yi Yan , Yano Katsuya
Published: March 2022

Elevated CO2 (eCO2) has the potential to increase plant biomass while decreasing water demand due to enhanced water‐use efficiency (WUE), which interacts with nutritional status. Carbon isotope discrimination (Δ13C) has been shown to be a valid proxy for estimating WUE; however, its validity is uncertain for plants in an environment where the interaction between CO2 and nutrition strongly affects WUE. Using a single potato cultivar (Irish Cobbler), we examined its validity through three independent trials with varying levels of P, N, or K (Trial P, N, and K, respectively) in growth chambers at two CO2 concentrations. WUE at the plant level varied with CO2 conditions and nutrient supply rates. Plant biomass was positively regressed against WUE in Trials P and K, and water use in Trial N. WUE was negatively regressed against Δ13C across various nutrient supply rates within each CO2 environment. However, the relationship between WUE and Δ13C was altered with CO2 enrichment by elevating the intercept along the y‐axis (WUE) without affecting the slope, implying the involvement of isotopic discrimination in respiration or photorespiration. These results suggest that Δ13C can be used to estimate WUE across various nutrient statuses, not only at the current CO2 but also at eCO2 when the comparisons are made within each CO2 condition.
Oral health status and the etiology and prevention of nonventilator hospital‐associated pneumonia
Authors: Scannapieco Frank A. , Giuliano Karen K. , Baker Dian
Published: March 2022

Nonventilator hospital‐associated pneumonia has recently emerged as an important preventable hospital‐associated infection, and is a leading cause of healthcare‐associated infection. Substantial accumulated evidence links poor oral health with an increased risk of pneumonia, which can be caused by bacterial, viral, or fungal pathogens, each with their own distinct mechanisms of transmission and host susceptibility. These infections are frequently polymicrobial, and often include microbes from biofilms in the oral cavity. Evidence documenting the importance of oral care to prevent nonventilator hospital‐associated pneumonia is continuing to emerge. Reduction of oral biofilm in these populations will reduce the numbers of potential respiratory pathogens in the oral secretions that can be aspirated, which in turn can reduce the risk for pneumonia. This review summarizes up‐to‐date information on the role of oral care in the prevention of nonventilator hospital‐associated pneumonia.
Periodontal microorganisms and Alzheimer disease – A causative relationship?
Authors: Jungbauer Gert , Stähli Alexandra , Zhu Xilei , Auber Alberi Lavinia , Sculean Anton , Eick Sigrun
Published: March 2022

In the initiation or exacerbation of Alzheimer disease, the dissemination of oral microorganisms into the brain tissue or the low‐level systemic inflammation have been speculated to play a role. However, the impact of oral microorganisms, such as Porphyromonas gingivalis, on the pathogenesis of Alzheimer disease and the potential causative relationship is still unclear. The present review has critically reviewed the literature by examining the following aspects: (a) the oral microbiome and the immune response in the elderly population, (b) human studies on the association between periodontal and gut microorganisms and Alzheimer disease, (c) animal and in vitro studies on microorganisms and Alzheimer disease, and (d) preventive and therapeutic approaches. Factors contributing to microbial dysbiosis seem to be aging, local inflammation, systemic diseases, wearing of dentures, living in nursing homes and no access to adequate oral hygiene measures. Porphyromonas gingivalis was detectable in post‐mortem brain samples. Microbiome analyses of saliva samples or oral biofilms showed a decreased microbial diversity and a different composition in Alzheimer disease compared to cognitively healthy subjects. Many in‐vitro and animal studies underline the potential of P gingivalis to induce Alzheimer disease‐related alterations. In animal models, recurring applications of P gingivalis or its components increased pro‐inflammatory mediators and β‐amyloid in the brain and deteriorated the animals' cognitive performance. Since periodontitis is the result of a disturbed microbial homoeostasis, an effect of periodontal therapy on the oral microbiome and host response related to cognitive parameters may be suggested and should be elucidated in further clinical trials.
Bringing back reindeer pastures in cutaway peatlands
Authors: Tarvainen Oili , Hökkä Hannu , Kumpula Jouko , Tolvanen Anne
Published: March 2022

European Union and national carbon neutrality targets entail the release of hundreds of hectares of cutaway peatlands annually from energy peat extraction in Finland, creating opportunities to reclaim them as reindeer (Rangifer tarandus tarandus) summer pastures and support an important local traditional livelihood hampered by intensive land use. To our knowledge, this is the first study to test whether reindeer summer pastures can be reclaimed. In 2017, we established a field experiment to investigate whether machinery transplanting of native plant species and sowing of seed mixtures promoted the establishment of forage plants preferred by reindeer. The transplanted species were Eriophorum vaginatum, Equisetum fluviatile, and Menyanthes trifoliata. Two tested seed mixtures contained different varieties of Phleum pratense which were surveyed. Plant cover and biomass growth, and growth‐influencing factors like peat properties and water level, were surveyed during 2018–2020. Eriophorum vaginatum tolerated transplanting well, doubling its cover during the study. Equisetum fluviatile was slower to establish. Mechanical transplanting of M. trifoliata failed; manual planting was promising. Sowing seed mixtures provided forage more quickly, generating larger cover than the transplanted natural plants. However, transplanting and sowing face problems. Transplanting is expensive and technically demanding, and removing plants from their growing sites may harm the surrounding vegetation. Meanwhile, the required regular maintenance of P. pratense is costly. Although the short monitoring period limits conclusions, our results suggest that a suitable combination of transplanting, sowing, and natural succession may be a solution for reclaiming former reindeer summer pastures.
Cultural diversity and inclusion in UK medical schools
Authors: Forrest Dominique , George Sherie , Stewart Vanessa , Dutta Nina , McConville Kevin , Pope Lindsey , Kumar Sonia
Published: March 2022

Background

Racially minoritised groups across the globe continue to experience differential outcomes in both health and education. Medical schools can play an instrumental role in addressing both these disparities, by creating inclusive student communities and ensuring that tomorrow's doctors can care for our increasingly diverse populations.

Objectives

This collaborative, qualitative study led by three United Kingdom (UK) institutions aimed to explore the perspectives of Heads of Primary Care Teaching (HOTs) on cultural diversity and inclusion across UK medical schools.

Methods

In December 2020, five focus groups were conducted remotely with 23 HOTs, or a nominated deputy. We explored participants' opinions regarding opportunities and barriers to cultural diversity and inclusion in medical education, ways to overcome these challenges and shared examples of best practice. Data were transcribed verbatim and thematically analysed by three researchers.

Results

Investigators identified six themes from the data: lack of faculty diversity, tokenistic faculty training, institutional mindset, diversifying the formal and hidden curricula, intersectionality and student voice.

Conclusion

Medical schools worldwide face similar challenges, uncertainties and opportunities when integrating diversity and inclusion throughout the learning environment. Although the importance of the topic is increasingly acknowledged, current efforts are viewed as being passive and tokenistic, hindered by challenges at multiple levels. Partnership with students and collaboration within and between institutions nationally and internationally will enable us to move forwards with both local and global positive, sustainable change.
Comparison of three hematocrit measurement methods in the southern white rhinoceros (Ceratotherium simum simum)
Authors: Steyrer Christof , Pohlin Friederike , Meyer Leith C. R. , Buss Peter , Hooijberg Emma H.
Published: March 2022

Background

Hematocrit (HCT) determination is an integral part of health and disease assessments in captive and wild white rhinoceroses. Several affordable automated hematology analyzers have been developed for in‐clinic and field use and have the advantage of being able to measure a large number of additional measurands. However, the accuracy of these analyzers for rhinoceros HCT measurements has not yet been investigated.

Objectives

We aimed to compare the HCT results generated by the EPOC portable analyzer system and the Abaxis VetScan HM5 with the gold standard of a manual packed cell volume (PCV) measured using the microhematocrit method.

Methods

Hematocrits were measured with the EPOC and the Abaxis VetScan HM5 (bovine setting) and compared with the PCVs of 69 white rhinoceros whole blood samples. Results were compared using Bland–Altman difference plots and Passing‐Bablok regression analysis. A total allowable analytical error of 10% was set as the performance goal.

Results

A significant positive bias, with a mean of 7.7% for the EPOC and 17.9% for the Abaxis, was found compared with the manual PCV method.

Conclusions

The allowable error goal of 10% was not exceeded with the EPOC analyzer. Although not analytically equivalent to the gold standard, the EPOC results could therefore be used as approximations in critical situations where manual measurements cannot be performed. The Abaxis exceeded this allowable error and overestimated HCTs in rhinoceroses. Therefore, method‐specific reference intervals should be used.
Epidemiological survey and risk factors associated with hepatitis E virus in small ruminants in southern Spain
Authors: Caballero‐Gómez Javier , García‐Bocanegra Ignacio , Jiménez‐Martín Débora , Cano‐Terriza David , Risalde María A. , López‐López Pedro , Jiménez‐Ruiz Saúl , Rivero Antonio , Rivero‐Juarez Antonio
Published: March 2022

Autochthonous cases of hepatitis E (HE) associated with zoonotic genotypes HEV‐3 and HEV‐4 have significantly increased in industrialized countries over the last decade. Suidae are generally recognized as the main reservoirs of these genotypes. Susceptibility to HE virus (HEV) infection and zoonotic potential have also been confirmed in other species, including sheep and goat. However, the information about their role in the epidemiology of HEV remains very scarce. The objective of this study was to assess the prevalence, spatial distribution and risk factors associated with HEV exposure in sheep and goats in southern Spain, the country with the highest census of small domestic ruminants in the European Union. Blood samples from 240 sheep and 240 goats were collected between 2015 and 2017. Sera were analysed in parallel using a commercial double‐antigen ELISA and real‐time PCR. A total of 38 (7.9%; 95%CI: 5.5–10.3) out of 480 sampled animals showed anti‐HEV antibodies. By species, the seroprevalences found in sheep and goats were 2.1% (5/240; 95%CI: 0.3–3.9) and 13.8% (33/240; 95%CI: 9.4–18.1) respectively. Anti‐HEV antibodies were found on 19 (59.4%; 95%CI: 42.4–76.4) of the 32 sampled farms. The GEE model showed that species (goat) and number of small ruminants in the farm (≤348 animals and ≥538 animals) were risk factors potentially associated with HEV exposure in small ruminants in the study area. HEV RNA was not detected in any of the 480 (0.0%; 95%CI: 0.0–0.8) tested animals. Our results confirm that sheep and goats are naturally, but not equally exposed to HEV and indicate the widespread spatial distribution of HEV among small ruminant populations in southern Spain. Further studies are required to elucidate the role of sheep and goat in the epidemiology of HEV and their potential implications for public health.
Características del síndrome post cuidado intensivo: revisión de alcance
Authors: Henao Castaño Ángela María , Villamil Buitrago Angie Vanessa , Marín Ramírez Sebastián , Cogollo Hernandez Camila Andrea
Published: March 2022

Objetivo: identificar la evidencia disponible de las características del síndrome post unidad de cuidado intensivo en el paciente que egresa de la unidad de cuidado intensivo. Método: revisión de alcance con la metodología del Joanna Briggs Institut, en cinco bases de datos con la estrategia de búsqueda ([PostIntensive AND Care AND Syndrome] [Nursing AND Care AND PICS]). Se incluyeron estudios primarios publicados entre los años 2010 y 2020, disponibles en texto completo. Resultados: después del análisis de los 48 estudios primarios se extrajeron seis categorías temáticas así: aspecto cognitivo en el síndrome post UCI, osteomusculares, psicoemocionales, estrategias de prevención con modelos de sobrevivientes de UCI, síndrome post unidad cuidado intensivo en la familia y herramientas de evaluación. Conclusiones: mejorar la calidad de atención de los pacientes que presentan este síndrome, prevenir la aparición y aumentar la calidad de vida prestada a los sobrevivientes de UCI y sus familias. La evidencia reporta que entre los cuidadores se pueden desencadenar distintos trastornos que disminuyen su calidad de vida. La enfermería juega un papel crucial en la prevención de la aparición del síndrome mediante estrategias en la UCI e interdisciplinares; los planes de egreso y seguimiento a los pacientes pueden lograr que estos se rehabiliten más rápido y eviten discapacidades o secuelas a largo plazo.
Estado de la investigación en enfermería de América Latina: una revisión de la literatura
Authors: Álvarez del Rio Rusbert Fernando , Escobar Tobón Ana Ligia , Salazar Maya Angela María
Published: March 2022

Introducción: la enfermería requiere analizar la producción de conocimiento para identificar la situación actual de la investigación en América Latina y los desafíos que surgen en el ejercicio profesional. Método: revisión integrativa que contempló la producción científica entre los años 2014 y 2018, según Whittemore, y Whittemore y Knafl, quienes proponen: identificación del problema, búsqueda de literatura, evaluación, análisis, reducción y presentación de resultados. Resultados: emergieron el cuidado de enfermería —humanizado, seguro y culturalmente congruente—, APS y promoción de la salud, cuidado durante el ciclo vital, formación, educación y liderazgo en los servicios de salud y salud en el trabajo. Discusión: el cuidado de enfermería durante todas las etapas del ciclo vital humano requiere la comprensión e investigación de las dimensiones filosófica, disciplinar, heurística, hermenéutica y política que sustenta la práctica científica. Conclusiones: se develan las necesidades por un cuidado humanizado y seguro, que comprenda la diversidad cultural, el fomento de la APS y promoción de la salud, el cuidado durante el ciclo vital, y la búsqueda de un ejercicio digno y seguro, con liderazgo y fortaleza política.
Factores constituyentes identitarios en la maestra de educación infantil
Authors: Robinson-Seisdedos María Soledad , Tejada-Fernández José , Blanch-Gelabert Sílvia
Published: March 2022

El presente artículo analiza los factores claves que inciden en la construcción identitaria de la educadora infantil en sus primeros años de trabajo y en diferentes realidades educativas. La metodología aplicada consistió en un estudio de caso múltiple, con particularidades de tipo biográfico-narrativo, y la recogida de información se realizó a través de relatos de vida, específicamente incidentes críticos y biogramas, junto con entrevistas semiestructuradas y grupos focales. Los resultados dan cuenta de tres grandes dimensiones: biográfica, formación inicial y ejercicio profesional. Los hallazgos permiten concluir que el proceso de construcción identitaria resulta ser complejo, relacional, contextual y variable.
La identidad del educador infantil desde las narrativas biográficas
Authors: Hernández-Prados María de los Ángeles , Ayala de la Peña Amalia
Published: March 2022

El trabajo presenta el análisis de 123 entrevistas semiestructuradas realizadas a profesionales de educación infantil de la región de Murcia (España), durante el curso 2019/2020, con la finalidad de identificar los factores que inciden en la construcción identitaria del docente.El contenido se trató de forma sistemática, cualitativa y cuantitativamente, siguiendo las fases de Cisterna (2005), midiendo la frecuencia de aparición de las categorías establecidas mediante triangulación. Los resultados muestran la relevancia de las experiencias de la infancia-adolescencia, la docencia con los alumnos, la formación permanente y la capacidad de adaptabilidad, en contraposición al paso por la universidad y los aspectos normativos.
Wellbore Stability Analysis of Horizontal Wells for Shale Gas With Consideration of Hydration
Authors: Mao Liangjie , Lin Haoyu , Cai Mingjie , Zhang Juan
Published: March 2022

With the wide application of extended reach wells and horizontal wells, the geological conditions faced during the drilling process have become increasingly complicated, and the resulting wellbole collapse problem has become serious. Based on an L-1 horizontal well, this study provides a method for calculating collapse pressure considering the influence of formation hydration. This method is used to obtain the stress distribution around the well and collapse situation at 4100 m underground. The wellbore stability can be evaluated by the method. The factors affecting the stress and collapse of the well are analyzed by changing the construction parameters and geological parameters. Studies have shown that the rock near the well has collapsed to a certain extent and shale hydration increases the formation Poisson's ratio, resulting in more serious collapse. The study also found that hydration, drilling fluid density, and borehole size have the greatest impact on the stability of the borehole wall, followed by the well deviation angle, and the bedding angle the least. Carefully exploring the situation of the shale gas reservoir in the drilling design stages, considering the impact of hydration, and selecting appropriate construction parameters are necessary to avoid the collapse of the shaft wall and affect the shale gas production process. This study can provide a reference for ensuring the stability of the wellbore.
A Bioreactor for Controlled Electrical and Mechanical Stimulation of Developing Scaffold-Free Constructs
Authors: Van Houten Sarah K. , Bramson Michael T. K. , Corr David T.
Published: March 2022

Bioreactors are commonly used to apply biophysically relevant stimulations to tissue-engineered constructs in order to explore how these stimuli influence tissue development, healing, and homeostasis, and they offer great flexibility because key features of the stimuli (e.g., duty cycle, frequency, amplitude, and duration) can be controlled to elicit a desired cellular response. However, most bioreactors that apply mechanical and electrical stimulations do so to a scaffold after the construct has developed, preventing study of the influence these stimuli have on early construct development. To enable such exploration, there is a need for a bioreactor that allows the direct application of mechanical and electrical stimulation to constructs as they develop. Herein, we develop and calibrate a bioreactor, based on our previously established modified Flexcell system, to deliver precise mechanical and electrical stimulation, either independently or in combination, to developing scaffold-free tissue constructs. Linear calibration curves were established, then used to apply precise dynamic mechanical and electrical stimulations, over a range of physiologically relevant strains (0.50%, 0.70%, 0.75%, 1.0%, and 1.5%) and voltages (1.5 and 3.5 V), respectively. Following calibration, applied mechanical and electrical stimulations were not statistically different from their desired target values and were consistent whether delivered independently or in combination. Concurrent delivery of mechanical and electrical stimulation resulted in a negligible change in mechanical (<2%) and electrical (<1%) values, compared to their independently delivered values. With this calibrated bioreactor, we can apply precise, controlled, reproducible mechanical and electrical stimulations, alone or in combination, to scaffold-free, tissue-engineered constructs as they develop.
Long-term within-speaker consistency of filled pauses in native and non-native speech
Authors: de Boer Meike M. , Quené Hugo , Heeren Willemijn F. L.
Published: March 2022

Filled pauses are widely considered as a relatively consistent feature of an individual's speech. However, acoustic consistency has only been observed within single-session recordings. By comparing filled pauses in two recordings made >2.5 years apart, this study investigates within-speaker consistency of the vowels in the filled pauses uh and um, in both first language (L1) Dutch and second language (L2) English, produced by student speakers who are known to converge in other speech features. Results show that despite minor within-speaker differences between languages, the spectral characteristics of filled pauses in L1 and L2 remained stable over time.
Toward a better understanding of nonoccupational sound exposures and associated health impacts: Methods of the Apple Hearing Study
Authors: Neitzel Richard L. , Smith Lauren , Wang Linyan , Green Glenn , Block Jennifer , Carchia Michael , Mazur Kuba , DePalma Glen , Azimi Reza , Villanueva Blanca
Published: March 2022

Globally, noise exposure from occupational and nonoccupational sources is common, and, as a result, noise-induced hearing loss affects tens of millions of people. Occupational noise exposures have been studied and regulated for decades, but nonoccupational sound exposures are not well understood. The nationwide Apple Hearing Study, launched using the Apple research app in November 2019 (Apple Inc., Cupertino, CA), is characterizing the levels at which participants listen to headphone audio content, as well as their listening habits. This paper describes the methods of the study, which collects data from several types of hearing tests and uses the Apple Watch noise app to measure environmental sound levels and cardiovascular metrics. Participants, all of whom have consented to participate and share their data, have already contributed nearly 300 × 106 h of sound measurements and 200 000 hearing assessments. The preliminary results indicate that environmental sound levels have been higher, on average, than headphone audio, about 10% of the participants have a diagnosed hearing loss, and nearly 20% of the participants have hearing difficulty. The study’s analyses will promote understanding of the overall exposures to sound and associated impacts on hearing and cardiovascular health. This study also demonstrates the feasibility of collecting clinically relevant exposure and health data outside of traditional research settings.
The Defender’s Vision—Gaze Behavior of One-on-One Defenders in Basketball
Authors: Meyer Johannes , Fasold Frowin , Schul Karsten , Sonnenschein Matthias , Klatt Stefanie
Published: March 2022

In fast-paced team sports, anticipation is one important element in defense strategies. The primary objective of this study was to examine the recommendation for action and use of defensive gaze strategies by defensive players in basketball. Four national-level expert-basketball coaches were interviewed and a field study with mobile eye-tracking devices was conducted on 16 expert and 16 novice players defending in a one-on-one situation. Differences in relative fixation times between experts and novices were elaborated for the predetermined gaze zones—head, ball, torso, and feet—as given by the expert coaches. This was done for three phases of the movement sequence: receiving, dribbling, and shooting. The results of the interviews with expert coaches indicated that the existing coaching doctrine instructs players to look at the torso of an opponent to avoid being vulnerable to fakes. Surprisingly, our findings with the players showed a discrepancy in the evaluated gaze behavior of the experts and novices. For the receiving and dribbling phase, experts mainly fixated their gaze on the head while novices focused on the ball. For the final shooting phase, both the groups mainly fixated their gaze on the ball. Fixating the gaze on the ball or head makes the player potentially vulnerable to deceptive movements, as video-based research has shown. Expert coaches also indicated that peripheral vision is of importance to defenders, contradicting the existing assumption in the literature that focusing on the task-relevant areas is key for anticipation performance.
Plantar Venous Pump Activity, Generalized Joint Hypermobility, and Foot Mobility in Ballerinas: A Case–Control Study
Authors: Kablan Nilüfer , Uzun Selda , Kulalı Fatma , Tatar Yaşar
Published: March 2022

Context: The plantar venous pump (PVP) is a vascular network located between the muscles of the foot arch. It has been suggested foot mobility is critical for PVP activation. Objective: This study investigates the effect of generalized joint hypermobility (GJH) on foot mobility and PVP activity in ballerinas and to determine how a short-term warm-up exercise impacts these parameters in the presence of GJH. Design: Prospective study. Methods: Twelve ballerinas (age = 16.73 [1.8] y) and 15 non-dancer-matched controls (age = 16.31 [2.1] y) were included. When performing weight-bearing activities, venous return parameters (diameter, velocity, and flow volume) from the posterior tibial vein were measured using color and spectral Doppler ultrasonography. Foot mobility was determined using navicular drop test. The participants performed a 10-minute cycling exercise to reveal its effect on reducing tissue stiffness. All measurements were performed synchronously and twice—before and after the cycling exercise. Results: The results showed the navicular height obtained before and after exercise in the ballerinas was significantly different compared with that obtained in the sitting position, and the values obtained in the 3 measurement positions in the nondancer group were significantly different from each other (P < .05). The difference between the venous diameter values measured before and after exercise and the reference value was significant in both groups (P < .001). There was a significant decrease in venous velocity following exercise in the nondancer group (P = .044). The venous volume values obtained after exercise were significantly different between the groups (P = .039). Conclusions: The GJH has no distinctive effect on foot mobility and PVP activity in ballerinas. The presence of GJH did not influence the effect of short-term warm-up exercise on foot mobility and PVP activity. We believe that measuring the navicular drop and venous return with a more precise synchronization may provide additional information regarding the link between arch tension and venous return.
Single-cell transcriptional profiling informs efficient reprogramming of human somatic cells to cross-presenting dendritic cells
Authors: Rosa Fábio F. , Pires Cristiana F. , Kurochkin Ilia , Halitzki Evelyn , Zahan Tasnim , Arh Nejc , Zimmermannová Olga , Ferreira Alexandra G. , Li Hongzhe , Karlsson Stefan , Scheding Stefan , Pereira Carlos-Filipe
Published: March 2022

Type 1 conventional dendritic cells (cDC1s) are rare immune cells critical for the induction of antigen-specific cytotoxic CD8
+
T cells, although the genetic program driving human cDC1 specification remains largely unexplored. We previously identified PU.1, IRF8, and BATF3 transcription factors as sufficient to induce cDC1 fate in mouse fibroblasts, but reprogramming of human somatic cells was limited by low efficiency. Here, we investigated single-cell transcriptional dynamics during human cDC1 reprogramming. Human induced cDC1s (hiDC1s) generated from embryonic fibroblasts gradually acquired a global cDC1 transcriptional profile and expressed antigen presentation signatures, whereas other DC subsets were not induced at the single-cell level during the reprogramming process. We extracted gene modules associated with successful reprogramming and identified inflammatory signaling and the cDC1-inducing transcription factor network as key drivers of the process. Combining IFN-γ, IFN-β, and TNF-α with constitutive expression of cDC1-inducing transcription factors led to improvement of reprogramming efficiency by 190-fold. hiDC1s engulfed dead cells, secreted inflammatory cytokines, and performed antigen cross-presentation, key cDC1 functions. This approach allowed efficient hiDC1 generation from adult fibroblasts and mesenchymal stromal cells. Mechanistically, PU.1 showed dominant and independent chromatin targeting at early phases of reprogramming, recruiting IRF8 and BATF3 to shared binding sites. The cooperative binding at open enhancers and promoters led to silencing of fibroblast genes and activation of a cDC1 program. These findings provide mechanistic insights into human cDC1 specification and reprogramming and represent a platform for generating patient-tailored cDC1s, a long-sought DC subset for vaccination strategies in cancer immunotherapy.
Bile acid–sensitive tuft cells regulate biliary neutrophil influx
Authors: O’Leary Claire E. , Sbierski-Kind Julia , Kotas Maya E. , Wagner Johanna C. , Liang Hong-Erh , Schroeder Andrew W. , de Tenorio Jeshua C. , von Moltke Jakob , Ricardo-Gonzalez Roberto R. , Eckalbar Walter L. , Molofsky Ari B. , Schneider Christoph , Locksley Richard M.
Published: March 2022

Inflammation and dysfunction of the extrahepatic biliary tree are common causes of human pathology, including gallstones and cholangiocarcinoma. Despite this, we know little about the local regulation of biliary inflammation. Tuft cells, rare sensory epithelial cells, are particularly prevalent in the mucosa of the gallbladder and extrahepatic bile ducts. Here, we show that biliary tuft cells express a core genetic tuft cell program in addition to a tissue-specific gene signature and, in contrast to small intestinal tuft cells, decreased postnatally, coincident with maturation of bile acid production. Manipulation of enterohepatic bile acid recirculation revealed that tuft cell abundance is negatively regulated by bile acids, including in a model of obstructive cholestasis in which inflammatory infiltration of the biliary tree correlated with loss of tuft cells. Unexpectedly, tuft cell–deficient mice spontaneously displayed an increased gallbladder epithelial inflammatory gene signature accompanied by neutrophil infiltration that was modulated by the microbiome. We propose that biliary tuft cells function as bile acid–sensitive negative regulators of inflammation in biliary tissues and serve to limit inflammation under homeostatic conditions.
Multiple simultaneous venous flow-through free flap salvage for multifinger revascularisations
Authors: Bashorun Olatunde H , Anderson Spencer R , Mulenga Chilando M , Wimalawansa Sunishka M
Published: March 2022

A 22-year-old man presented with traumatic crush-avulsion injuries to the left index, ring and small fingers resulting in complex soft tissue loss and acute three-finger ischaemia. The patient underwent immediate revascularisation and soft tissue resurfacing of the three digits using three separate venous flow-through free flaps performed in a single-stage operation. Continued follow-up after 9 months confirmed successful salvage of these three digits. Multiple simultaneous venous flow-through free flaps can be considered as a viable alternative reconstructive modality for traumatic multi-digit ischaemia where both graft-based digital artery reconstruction and soft tissue coverage are required for multiple digits.
Disseminated tuberculosis associated with autoimmune haemolytic anaemia and adrenal deficiency: a rare association
Authors: Venkitakrishnan Rajesh , Augustine Jolsana , Paul Mobin , Abraham Latha
Published: March 2022

Tuberculosis (TB) is one of the greatest masqueraders in medical practice and can have manifestations involving any organ or organ systems of the body. The presentation of disseminated TB can range from typical features like fever, weight loss and fatigue to protean manifestations. We share the case of an elderly man who presented to us with weight loss, anaemia, weakness and lymphadenopathy involving thoracic and intraabdominal locations. Work up of anaemia revealed features of Coombs-positive autoimmune haemolytic anaemia (AIHA) and evaluation of weakness showed laboratory results consistent with adrenal insufficiency. Biopsy of the abdominal lymphnode yielded caseating granulomas with CB-NAAT positivity forMycobacterium tuberculosis. Anti-TB chemotherapy with short-term replacement dose of systemic steroids corrected the haemolysis, anaemia and addisonian crisis. The case alerts clinicians regarding the uncommon association of TB with Coombs positive AIHA and adds one more aetiology to the pathogenesis of anaemia in TB. Furthermore, the occurrence of AIHA and hypoadrenalism in the same patient with TB is exceedingly rare and has not been reported.
Sex differences in glycemic measures, complications, discharge disposition, and postdischarge emergency room visits and readmission among non-critically ill, hospitalized patients with diabetes
Authors: Patel Neeti , Swami Janya , Pinkhasova Diana , Karslioglu French Esra , Hlasnik Deborah , Delisi Kristin , Donihi Amy , Siminerio Linda , Rubin Daniel J , Wang Li , Korytkowski Mary T
Published: March 2022

Introduction

The purpose of this prospective observational cohort study was to examine sex differences in glycemic measures, diabetes-related complications, and rates of postdischarge emergency room (ER) visits and hospital readmissions in non-critically ill, hospitalized patients with diabetes.

Research design and methods

Demographic data including age, body mass index, race, blood pressure, reason for admission, diabetes medications at admission and discharge, diabetes-related complications, laboratory data (hematocrit, creatinine, hemoglobin A1c, point-of-care blood glucose measures), length of stay (LOS), and discharge disposition were collected. Patients were followed for 90 days following hospital discharge to obtain information regarding ER visits and readmissions.

Results

120 men and 100 women consented to participate in this study. There were no sex differences in patient demographics, diabetes duration or complications, or LOS. No differences were observed in the percentage of men and women with an ER visit or hospital readmission within 30 (39% vs 33%, p=0.40) or 90 (60% vs 49%, p=0.12) days of hospital discharge. More men than women experienced hypoglycemia prior to discharge (18% vs 8%, p=0.026). More women were discharged to skilled nursing facilities (p=0.007).

Conclusions

This study demonstrates that men and women hospitalized with an underlying diagnosis of diabetes have similar preadmission glycemic measures, diabetes duration, and prevalence of diabetes complications. More men experienced hypoglycemia prior to discharge. Women were less likely to be discharged to home. Approximately 50% of men and women had ER visits or readmissions within 90 days of hospital discharge.

Trial registration number

NCT03279627.
First in-human trial and prospective case series of an articulated laparoscopic camera system in minimally invasive surgery in gynecology: an IDEAL stage 1 and 2a study
Authors: Ng Tong Yow , Ngu Siew Fei , Kam Tat Yan Deyoung , Ng Sai Yan , Lo Ping Lai Benny
Published: March 2022

Objectives

Precision Robotics’ Sirius Robotic Flexible Endoscopic System is a new, fully integrated, compact three-dimensional laparoscopic camera system with a disposable single-use flexible tip that can change its viewing direction. This IDEAL Stage 1 and 2a study assessed its safety, reliability and potential efficacy particularly for single incision laparoscopic surgery and vaginal natural orifice transluminal endoscopic surgery.

Design

Prospective single-institution, single-surgeon study.

Setting

The study was conducted in a multispecialty hospital.

Participants

Women aged 18–70 years scheduled for gynecological laparoscopic surgery were invited to participate. An information sheet and consent was available for the women and an informed consent was obtained. Thirteen participants completed this study.

Interventions

The laparoscopic procedures were done in the usual manner. The only difference was the Sirius System was used in place of the conventional laparoscope. All other procedures and instruments remained the same.

Main outcome measures

Primary outcome was the proportion of women who successfully completed the intended procedure using the Sirius System without conversion to another camera system, camera users and surgeon’s view and experience, and iterations and modifications to the system. Secondary outcomes were the incidence of intraoperative and postoperative complications during the first 6 weeks following surgery, and duration of surgery.

Results

85% (11/13) of women had their procedure completed successfully using the Sirius System. Two women required immediate conversion to the conventional laparoscope due to technical issues. There were no intraoperative complications. Users agreed that the improved field of view was beneficial for laparoscopic surgery. Iterative improvements were made in the imaging quality, user interface and manufacturing quality.

Conclusions

Sirius System has early indications for safety and efficacy for intermediate and major minimally invasive laparoscopic procedures in gynecology. Further studies are needed to confirm it can replace a conventional laparoscope in the surgical workflow.

Trial registration number

NCT05048407.
Association between mirtazapine use and serious self-harm in people with depression: an active comparator cohort study using UK electronic health records
Authors: Joseph Rebecca M , Jack Ruth H , Morriss Richard , Knaggs Roger David , Butler Debbie , Hollis Chris , Hippisley-Cox Julia , Coupland Carol
Published: March 2022

Background

Studies report an increased risk of self-harm or suicide in people prescribed mirtazapine compared with other antidepressants.

Objectives

To compare the risk of serious self-harm in people prescribed mirtazapine versus other antidepressants as second-line treatments.

Design and setting

Cohort study using anonymised English primary care electronic health records, hospital admission data and mortality data with study window 1 January 2005 to 30 November 2018.

Participants

24 516 people diagnosed with depression, aged 18–99 years, initially prescribed a selective serotonin reuptake inhibitor (SSRI) and then prescribed mirtazapine, a different SSRI, amitriptyline or venlafaxine.

Main outcome measures

Hospitalisation or death due to deliberate self-harm. Age–sex standardised rates were calculated and survival analyses were performed using inverse probability of treatment weighting to account for baseline covariates.

Results

Standardised rates of serious self-harm ranged from 3.8/1000 person-years (amitriptyline) to 14.1/1000 person-years (mirtazapine). After weighting, the risk of serious self-harm did not differ significantly between the mirtazapine group and the SSRI or venlafaxine groups (HRs (95% CI) 1.18 (0.84 to 1.65) and 0.85 (0.51 to 1.41) respectively). The risk was significantly higher in the mirtazapine than the amitriptyline group (3.04 (1.36 to 6.79)) but was attenuated after adjusting for dose.

Conclusions

There was no evidence for a difference in risk between mirtazapine and SSRIs or venlafaxine after accounting for baseline characteristics. The higher risk in the mirtazapine versus the amitriptyline group might reflect residual confounding if amitriptyline is avoided in people considered at risk of self-harm.

Clinical implications

Addressing baseline risk factors and careful monitoring might improve outcomes for people at risk of serious self-harm.
Bleeding Ectopic Varices: Clinical Presentation, Natural History, and Outcomes
Authors: Broussard Kent A , Rockey Don C
Published: March 2022

Bleeding complications from ectopic varices are often difficult to manage. We aimed to study the natural history and outcomes of bleeding ectopic varices to better understand appropriate clinical management. This retrospective cohort study included patients admitted to the hospital with bleeding ectopic or esophageal varices from 2010 through 2019. Study subjects were identified through searching the Medical University of South Carolina's electronic medical record, and complete demographic, clinical, and procedural data were abstracted. 25 patients with gastrointestinal bleeding from ectopic varices and a matched group of 50 patients with bleeding esophageal varices were identified. Bleeding ectopic varices were identified in the following locations: duodenum (n=5), jejunum/ileum (n=5), colon (n=2), rectum (n=6), and anastomotic sites (n=7). Model for End-Stage Liver Disease scores (patients with cirrhosis), need for intensive care unit admission, and administration of octreotide and antibiotics were significantly higher in patients with esophageal variceal bleeding than those with ectopic varices. All-cause 1-year mortality of patients with ectopic varices was significantly lower than those with bleeding esophageal varices (8% vs 35%, p<0.05). Patients with ectopic varices and cirrhosis bled at lower hepatic venous pressure gradients than patients with bleeding esophageal varices (17 mm Hg vs 24 mm Hg, p<0.01). Transjugular intrahepatic portosystemic shunts (TIPS) were performed in two-thirds of patients with ectopic varices and one patient rebled due to TIPS dysfunction. The clinical features of patients with ectopic varices and those with esophageal varices were similar, but patients with ectopic varices had significantly lower 1-year mortality after bleeding events.
Telomere Length in Patients with Alcohol-Associated Liver Disease: A Brief Report
Authors: Huda Nazmul , Kusumanchi Praveen , Perez Kristina , Jiang Yanchao , Skill Nicholas J , Sun Zhaoli , Ma Jing , Yang Zhihong , Liangpunsakul Suthat
Published: March 2022

The intact telomere structure is essential for the prevention of the chromosome end-to-end fusions and maintaining genomic integrity. The maintenance of telomere length is critical for cellular homeostasis. The shortening of telomeres has been reported in patients with chronic liver diseases. The telomere length has not been systemically studied in patients with alcohol-associated liver disease (ALD) at different stages, such as alcoholic hepatitis and alcoholic cirrhosis. In this brief report, we observed evidence of telomere shortening without changes in the telomerase activity in the liver of patients with alcoholic hepatitis and alcoholic cirrhosis when compared with controls. The alterations in the genes associated with telomere binding proteins were only observed in patients with alcoholic cirrhosis. Future studies are required to determine the mechanism of how alcohol affects the length of the telomere and if the shortening impacts the disease progression in ALD.