bluuebunny/crossref_metadata_2025 huggingface dataset:
From Rana Plaza to COVID‐19: Deficiencies and opportunities for a new labour governance system in garment global supply chains
Authors: FRENKEL Stephen J. , SCHUESSLER Elke S.
Published: April 2021

The 2013 Rana Plaza disaster highlighted the failure of labour regulation in global garment value chains. Eight years on, in the midst of the COVID‐19 pandemic, what changes have occurred in labour regulation and with what consequences for workers? Using the concept of a labour governance system (LGS), the authors show that, despite improvements in building and worker safety regulation, the garment LGS remains weak and wages, working hours and the treatment of workers show little improvement. The pandemic appears to have exacerbated these deficiencies but it may also offer an opportunity to strengthen the LGS along lines proposed in this article.
Reply to: Comment on: Non‐esterified fatty acids and risks of frailty, disability, and mobility limitation in older adults: The cardiovascular health study
Authors: Ahiawodzi Peter , Mukamal Kenneth J.
Published: April 2021

This letter comments on the letter by Ilkin M. Naharci.
“No One is Poor in Himachal”: Cultivating Stateless Agency in an Indian Village Assembly
Authors: Carlan Hannah
Published: April 2021

This article examines the bedrock of rural governance in India—the village assembly, orgram sabha—and the deliberative process whereby citizens are designated as “below the poverty line” (BPL). I examine onegram sabhain Himachal Pradesh wherein BPL status was eradicated altogether, leaving hundreds of people ineligible for a vast array of state aid programs. I argue that this outcome relied on an interactional achievement whereby state actors (bureaucrats and elected representatives) rendered village residents into a collectivized agent while erasing their own role and responsibility from the proceedings. These semiotic processes of collectivization and erasure underlie what I call “stateless agency.” I trace three linguistic resources that cultivate stateless agency: (i) causative verbs that distribute agency across multiple grammatically encoded participant roles; (ii) code switches from the local language, Kangri, into a register of English‐infused Hindi that invokes what I call the “bureaucratic voice”; and (iii) metapragmatic statements that explicitly attribute agency to other speaker(s). This investigation builds on studies of grammar and political agency (Duranti 1990; 1994) and bureaucratic agency (Hull 2003; 2012) by demonstrating how linguistic resources mediate the paradoxical erasure of state actors from bureaucratic and democratic practice, with often drastic consequences for rural livelihoods.
Adaptation and reliability of ‘Nutrition Screening Tool for Every Preschooler’ (NutriSTEP) for use as a parent administered questionnaire in New Zealand
Authors: Wham Carol , Edge Breanna , Kruger Rozanne
Published: April 2021

Aim

To adapt the validated Canadian Nutrition Screening Tool for Every Pre‐schooler (NutriSTEP), for use in New Zealand and test its reliability to identify nutrition risk in pre‐school children aged 2–5 years, as a parent administered questionnaire.

Methods

Adaptations to the Canadian NutriSTEP were undertaken by three registered dietitians (expert review), followed by intercept interviews with pre‐schooler parents (n = 26). A second expert review was conducted to finalise the adaptions for online reliability testing. A further 79 pre‐schooler parents completed online administrations of the Canadian and adapted NutriSTEP tools, 4 weeks apart in a blinded manner. Intraclass correlation coefficients (ICCs) were used to verify test–retest reliability between the administrations. Individual questionnaire items were verified for reliability between administrations through Cohen's κ statistic (κ), Pearson's χ2 value and Fisher's exact test.

Results

Online administrations of the Canadian and adapted NutriSTEP tools were determined to be reliable (ICC = 0.91; P < 0.001). Between NutriSTEP administrations, 13 out of 17 questionnaire items had adequate (κ > 0.5) agreement, one item had excellent agreement (κ > 0.75) with a significant relationship (P < 0.05) between all items. Sensitivity for the adapted NutriSTEP was higher for pre‐schoolers at nutrition risk (31.6%) versus the Canadian version (20.3%). Risk items were highest for low intake of breads and cereals (58.2%), milk and milk products (51.9%), meat and meat alternatives (40.5%), child controlling the amount consumed (35.4%) and vegetable intake (34.2%).

Conclusion

The Canadian NutriSTEP and the adapted NutriSTEP were reliable between online administrations when completed by parents in the community. The adapted NutriSTEP identified an additional nine preschoolers at increased nutrition risk, demonstrating increased sensitivity in comparison to the Canadian NutriSTEP. Nutrition risk can be identified in early childhood to prevent the development of chronic disease. The adapted NutriSTEP should be considered for future use to identify preschoolers at increased nutrition risk and guide appropriate nutrition intervention.
One vaccine for life: Lessons from immune ontogeny
Authors: Brophy‐Williams Sam , Fidanza Mario , Marchant Arnaud , Way SingSing , Kollmann Tobias R
Published: April 2021

There remains a general misconception that the immune status of the fetus and neonate is immature or insufficient. However, emerging research in immune ontogeny prompts reconsideration of this orthodoxy, reframing this period instead as one of unique opportunity. Vaccine responses (qualitative and quantitative) vary between individuals, and across demographic cohorts. Elements of baseline immune status and function predict vaccine response – some of these factors are well described, others remain a subject of ongoing research, especially with the rapidly expanding field of ‘omics’ research, enabled by development of highly granular immune profiling techniques and increasing computational capacity. Age is one of the strongest predictive factors associated with variability in the response to vaccination; and predictable variation in response to vaccination is a key to identify the crucial underlying mechanisms. Specifically, circulating maternal antibody in the young infant can modulate immune response to vaccination, acting as an ‘undercover adjuvant’ that, counter to current dogma, may offer a pathway to longer lasting, higher quality immune response to vaccination. Exciting avenues for novel research in this area have the potential to dramatically alter how we protect the world's most vulnerable population – the very young.
Under pressure: Effects of instrumentation methods on fur seal pelt function
Authors: Nankey Paige , Filippi Nadine , Kuhn Carey E. , Dickerson Bobette , Liwanag Heather E. M.
Published: April 2021

Tracking marine mammals with electronic devices enables researchers to better understand animal movements and at‐sea behavior. For pinnipeds, instruments are typically glued to the animal's hair, either directly to the pelage or via a fabric patch. These instruments are retrieved by cutting the pelage or cutting through the patch. The impact of these modifications to the pelage is presumed to be minimal and short‐lived, but this has never been explicitly investigated. This study examined effects of instrument attachment on northern fur seal pelts. To assess thermal consequences of instrumentation, we determined thermal resistance of pelts in water for instruments glued directly to the pelage or with a neoprene base. For each attachment method, we measured the pelt unmodified, with instrument attached, and with instrument removed. Using a hyperbaric chamber, we measured the extent to which water could penetrate the pelt's air layer during diving. Removing the tag by cutting the pelage reduced thermal function of the pelt in water and allowed more air to escape under pressure. In contrast, a neoprene patch better maintained the insulation in water and reduced air loss under pressure. Our results suggest the use of neoprene may reduce negative consequences of instrumentation in fur seals.
Impact of nursing care on lung functional residual capacity in acute respiratory distress syndrome patients
Authors: Burey Julien , Guitard Pierre‐Gildas , Girard Noémie , Cassiau Florence , Veber Benoît , Clavier Thomas
Published: April 2021

Background

The respiratory consequences of daily nursing care interventions in patients with acute respiratory distress syndrome (ARDS) are not clearly established.

Aims and objectives

The main objective of this study was to assess the feasibility of alveolar collapse analysis by the measurement of lung impedance distribution technique during nursing care in patients with ARDS.

Design

Prospective observational pilot physiologic study in a surgical intensive care unit of a tertiary care hospital including adult intubated patients with moderate‐to‐severe ARDS.

Methods

Each patient was monitored for 12 hours using a chest impedance device. Daily care interventions studied were as follows: endotracheal suctioning, mouth care, bed‐bathing, and blood sampling. The primary endpoint was the variation in end‐expiratory lung impedance (reflecting functional residual capacity) before and 1, 5, 15, and 30 minutes after nursing care interventions. Data are presented as median (interquartile‐range).

Results

One hundred and eight events were collected in 18 patients. Endotracheal suctioning (n = 42), mouth care (n = 26), and bed‐bathing (n = 23) induced a significant decrease in lung impedance after care: endotracheal suctioning (−40.0 [−53.8; −28.6]% at 1 minute [P < .001], −10.4 [−27.9; 1.8]% at 30 minutes [P = .03]; mouth care −17.9 [−45.4; −14.6]% at 1 minute [P < .001], −10.4 [−21.3; 3.4]% at 30 minutes [P = .01]; bed‐bathing −40.2 [−53.5; −14.3]% at 1 minute [P < .001], −10.6 [−36.4; 1.6]% at 30 minutes [P = .01]). Blood sampling (n = 17) did not induce significant changes in lung impedance.

Conclusions

The lung impedance distribution technique during nursing care appears feasible in the majority of patients with ARDS. Some daily nursing care in ARDS patients (including bed‐bathing and mouth care) resulted in a prolonged decrease in lung functional residual capacity and therefore could be associated with pulmonary de‐recruitment.

Relevance to clinical practice

A caregiver who has to assess the functional residual capacity of these patients should probably be informed of the schedules of the nursing care interventions.
Can nursing educators learn to trust the world’s most trusted profession?
Authors: Darbyshire Philip , Thompson David R.
Published: April 2021

Nursing and nursing education face a paradox whereby the world's most trusted profession seems not to trust its own students and practitioners. Much of nursing education has adopted what has been memorably described as the ‘cop shit’ approach. This is the panoply of surveillance, anti‐plagiarism and proctoring technologies that appear to be used more for policing and punishment of an inherently dishonest student body than to develop ethical and scholarly writing among future peers and colleagues. Nurses in practice may experience similar levels of distrust as they face growing micromanagement and control of both their appearance and nursing practice. We propose that these practices of distrust emerge, not from malice, but rather from the omnipresent neoliberalism and managerialism that engulf almost every aspect of health and university life. Neoliberalism's success has been to reformat academia and practice to the point where such ingrained mistrust has become merely a neutral recognition of ‘the real world’. Dismantling nursing and education's ‘cop shit’ culture and replacing it with the trust and respect that the world's most trusted profession is accorded by wider society will not be easy, but it is vital for the future of nursing.
Oaks provide new perspective on seed microbiome assembly
Authors: U’Ren Jana M. , Zimmerman Naupaka B.
Published: April 2021

This article is a Commentary on Fort et al. (2021), 230: 1594–1608.
Keratoconus in Africa: A systematic review and meta‐analysis
Authors: Akowuah Prince Kwaku , Kobia‐Acquah Emmanuel , Donkor Richard , Adjei‐Anang Joseph , Ankamah‐Lomotey Stephen
Published: April 2021

Purpose

The aim of this review is to evaluate the prevalence of and factors associated with keratoconus in Africa.

Method

A systematic online literature search was conducted for articles on keratoconus in Africa. Meta‐analysis was performed to estimate the prevalence of keratoconus in Africa. The Freeman‐Tukey double arcsine transformation was used to minimize the effects of studies with extremely high or low prevalence estimates on the overall pooled estimates. Leave‐one‐out sensitivity analysis was used to assess the robustness of the pooled effects and potential outliers. Meta‐regression was performed to explore associations between keratoconus, gender and age.

Results

Twelve studies were included in the review; 5 from Egypt, 2 from South Africa, 2 from Kenya, 1 from Sudan, 1 from Ghana and 1 from Nigeria. Two studies were conducted in allergic conjunctivitis patients, 4 in keratoconus patients, 1 in contact lens service seekers, 1 in pre‐LASIK patients, 1 in refractive patients and 1 in a student population. Eight studies were included in the meta‐analysis. The overall prevalence estimate of keratoconus in Africa was 7.9% (95% CI: 2.5%–16.0%). The prevalence of keratoconus among males and females in Africa was estimated to be 9.3% (95% CI: 2.5%–19.5%) and 5.8% (95% CI: 1.5%–12.7%) respectively. The estimated prevalence of unilateral and bilateral keratoconus was 2.6% (95% CI: 0.4%–6.5%) and 5.8% (95% CI: 1.6%–12.3%), respectively. The estimated prevalence of mild keratoconus was 2.2% (95% CI: 0.7%–4.7%), moderate keratoconus was 3.5% (95% CI: 0.0%–11.8%) and severe keratoconus was 4.0% (95% CI: 0.0%–19.6%). There was no significant association between gender and the prevalence of keratoconus in Africa (p = 0.63), and age and the prevalence of keratoconus in Africa (p = 0.78).

Conclusion

The estimated prevalence of keratoconus reported here is higher than prevalence values reported in other meta‐analyses or different geographical locations. This is mainly because studies included in this meta‐analysis were either conducted on a cohort at high risk of keratoconus or a population with high possibility of finding keratoconus patients. There is a dearth of well‐designed population‐based studies on keratoconus in Africa, resulting in a lack of epidemiological information. This highlights the urgent need for research on keratoconus in Africa.
Clinical Efficacy of Ruxolitinib Monotherapy and Haploidentical Hematopoeitic Stem Cell Transplantation in a Child with Philadelphia Chromosome‐like Relapsed/Refractory acute lymphoblastic leukemia
Authors: Bayram Nihan , Yaman Yöntem , Özdilli Kürşat , Telhan Leyla , Nepesov Serdar , Bilgen Hülya , Elli Murat , Behar Sude Sema , Anak Sema
Published: April 2021

Introduction

(Ph‐like) ALL is a subset of leukemia which has a gene expression profile similar to Ph+disease, but without the presence of BCR‐ABL1 translocation.

Case description

We reported an exceptional case of a child with relapsed Ph‐like ALL with IKZF1 gene deletion treated with high‐dose ruxolitinib as monotherapy, after multi‐agent chemotherapy. He remains in continued MRD‐negative leukemia remission with full donor chimerism at 12 months post‐HSCT.

Discussion

The circumstance that makes our case featured is the usage of ruxolitinib as monotherapy. This report, we believe, is a pioneering report for a frequent disease with a high risk of failure for the outcome.
Community development for improved housing, health equity, and education in rural Honduras
Authors: Reifsnider Elizabeth , Packer Phebe W. , Argent‐DeLorme Autumn , Suarez Christina
Published: April 2021

This paper describes an international, long‐term, population health project in rural Honduras among Mayan villagers, focused on collaboration, community building, partnership formation, and improvement of their living situation. Improved housing, health checks, education for their children, and clean water were chosen by the Honduran residents as the projects they thought were most important to improve their health and living conditions. During the short mission trips, the North Americans (NAs) and the villagers worked side‐by‐side on house building and participated in village life. The Hondurans organized into communities that mutually decided on which families received homes and together worked on each other's homes with the NAs' assistance. Nurse‐led health clinics and scholarships for students were provided by the visitors during their time in the villages. Health has improved from better housing and periodic health checks, and most significantly, sustainable community organizing occurred. Public Health Nurses can work towards health equity and population health improvement by basing efforts on what the community partners request and create outcomes through relationships with those who stand to benefit from the improvement.
Humanitarian Response to Disasters with Funding Uncertainty: Alleviating Deprivation with Bridge Finance
Authors: Chakravarty Amiya K.
Published: April 2021

Agencies that provide relief to disaster survivors raise funds from diversified sources, such as foundations, private donors, and lenders. The output of a relief operation, such as lives saved, is a function of several factors: disaster intensity, relief agency's effectiveness, and the size of donor fund. In an uncertain funding environment with delays, a stop‐gap loan can help decrease deprivation at the onset of disaster. When funding materializes, surplus fund net of loan and interest facilitates a second relief operation. We analyze a multistage framework in a game‐theoretic context to study the decisions of the parties involved: relief agency (loan sought and effectiveness), lender (interest rate), and donor (funding level). We find that the size of loan increases in funding delay, even though the lender increases interest rate. The donor increases funding to ensure a larger fund availability (net of loan and interest). While the uncertainty in funding delay motivates the relief agency to seek a larger loan, we find that the maximum number of survivors receiving aid decreases. In case of logistics delays, we find that the speed of response decreases in disaster intensity, enabling a larger number of survivors to receive aid as the cost of logistics decreases. It also increases the loan size and donor funding. However, the relief agency fails to cover all survivors if the disaster intensity is large as the response speed does not decrease below a threshold.
Wastewater treatment by microalgae
Authors: Plöhn Martin , Spain Olivia , Sirin Sema , Silva Mario , Escudero‐Oñate Carlos , Ferrando‐Climent Laura , Allahverdiyeva Yagut , Funk Christiane
Published: April 2021

The growth of the world's population increases the demand for fresh water, food, energy, and technology, which in turn leads to increasing amount of wastewater, produced both by domestic and industrial sources. These different wastewaters contain a wide variety of organic and inorganic compounds which can cause tremendous environmental problems if released untreated. Traditional treatment systems are usually expensive, energy demanding and are often still incapable of solving all challenges presented by the produced wastewaters. Microalgae are promising candidates for wastewater reclamation as they are capable of reducing the amount of nitrogen and phosphate as well as other toxic compounds including heavy metals or pharmaceuticals. Compared to the traditional systems, photosynthetic microalgae require less energy input since they use sunlight as their energy source, and at the same time lower the carbon footprint of the overall reclamation process. This mini‐review focuses on recent advances in wastewater reclamation using microalgae. The most common microalgal strains used for this purpose are described as well as the challenges of using wastewater from different origins. We also describe the impact of climate with a particular focus on a Nordic climate.
The Impact of Inheritance on the Distribution of Wealth: Evidence from China
Authors: Wei Hongyao , Yang Zhengyi
Published: April 2021

Using the China Health and Retirement Longitudinal Study, we investigate household inheritances’ structural characteristics and their effects on wealth distribution. First, we find that the proportion of households receiving inheritances in China is slightly lower than that of some European countries and the United States, and the inheritance scale, especially the proportion of inheritances in household net worth, is much lower. Second, inheritances can significantly promote wealth accumulation, and wealthy households are more likely to receive larger‐scale inheritances. Therefore, inheritances can aggravate class stratification and reduce social mobility. Third, inheritances reduce relative wealth inequality but widen the absolute wealth gap. This effect’s duality is that although wealthy households have inheritances on a larger scale, the relative importance of the inheritance is more significant for poorer households, who inherit more relative to their household net worth. Altruistic motivations of inheritance donors can help explain this phenomenon.
“Out” on the Farm: Queer Farmers Maneuvering Heterosexism and Visibility*
Authors: Hoffelmeyer Michaela
Published: April 2021

In agriculture, heterosexual and cisgender farmers benefit from merging the public and private spheres through the “family farm” model. In comparison, heterosexist expectations relegate queerness to the private sphere and burden queer farmers with the work of gaining acceptance among rural and agrarian communities. Based on interviews with 20 queer farmers in the northeastern United States, this article examines the role of queerness in shaping farmers' participation in agriculture. Findings show that queer farmers actively maneuver their identity based on presumptions of heterosexism, illustrating how queerness, as an aspect of identity, is widely overlooked as a critical vector that influences participation in farming. Through daily interactions with customers, other farmers, and community members, queer farmers develop strategies to mitigate heterosexism's negative implications. Queer farmers participated in alternative agriculture, leveraged the rural politics of recognition, and selectively outed themselves. As a structural issue, however, heterosexism remains an embodied hardship for queer farmers. Queer farmers' experiences offer new pathways for understanding rural community development in the agrarian transition. These results illustrate that agricultural organizations, farm policy, and rural community theorizing would benefit from viewing queerness as a critical axis of consideration in farming rather than a private matter not suitable for farming spaces.
Dynamic Fairness: Mobility, Inequality, and the Distribution of Prospects*
Authors: Peng Baochun , Yuan Haidong
Published: April 2021

A society is fairer when the income of the family into which individuals are born, over which they have no control, plays a smaller role in determining their prospects. We examine the nature of dynamic fairness based on the distribution of prospects using a generalized concentration curve. We find that dynamic fairness is jointly determined by inequality and exchange mobility, with inequality reducing fairness and exchange mobility enhancing it. Moreover, any degree of dynamic fairness can be obtained from one of the many pairs of inequality and exchange mobility. Our results can help compare different economic environments through the distribution of their economic opportunities.
Strategic Shirking in Bilateral Trade*
Authors: Lülfesmann Christoph
Published: April 2021

In this paper, I study bilateral trade, where the seller can undertake specific investments before the binary trade transaction takes place. I identify a novel reason for hold‐up and contractual inefficiency in this canonical setting. The investing party can shirk for strategic reasons; that is, exert an effort so low that trade becomes inefficient and is being rescinded. Under a fixed‐price contract (the second‐best mechanism in the absence of the shirking problem), strategic shirking can arise regardless of the initially contracted trade price. Moreover, if a fixed‐price contract leads to strategic shirking, there exists no general revelation mechanism to restore equilibrium trade. I show that the shirking problem is more severe when the parties trade after having learned the buyer's valuation, as opposed to the case of an “experience good” where trade is finalized before this information materializes. Finally, when both buyer and seller undertake specific investments, shirking and non‐shirking equilibria are shown to coexist.
Loan Financing as a Tool for Nonincumbent House Candidates
Authors: Baker Anne E.
Published: April 2021

Objective

More than 50 percent of nonincumbent candidates competing in each of the 2010–2016 election cycles for seats in the House used loans to supplement their campaign revenue streams but their use remains understudied.

Method

Using both summary and quarterly campaign reports from the U.S. Federal Election Commission 2010–2016, I examine the frequency, timing, and the types of loans utilized by nonincumbent House campaigns. I investigate which candidate characteristics and conditions lead to loan financing. And in a matching analysis, I test the impact of loaning financing at different points in time on inexperienced nonincumbent House candidates’ competitiveness.

Results

I find loan financing in the primary election has a greater positive impact on inexperienced House candidates’ vote margins than loan financing later in the election cycle.

Conclusion

The results suggest a number of best practices for nonincumbent candidates’ use of loans.
Resolving the ambiguity of random‐effects models with singular precision matrix
Authors: Lee Woojoo , Piepho Hans‐Peter , Lee Youngjo
Published: April 2021

Random walks, intrinsic autoregression, state‐space models, smoothing splines, and so on have been widely used in various areas of statistics. However, practitioners wanting to fit these models using existing packages for random‐effects models are often faced with the difficulty that their covariance matrices are not uniquely determined. Unfortunately, different specifications of the model lead to different covariance structures, giving different analyses. Even if we make a decision on specification it is not immediately obvious how to make inferences from these models. There have been various suggestions on how to overcome such difficulties. However, they differ, implying that there is as yet no agreed remedy. In this article we provide a unified view on these alternatives and show how the analysis can be made invariant with respect to the choice of covariance by inclusion of a suitable set of covariates. Several examples are used to illustrate the approach.
Rolling spinners on the water surface
Authors: Gorce Jean-Baptiste , Bliokh Konstantin Y. , Xia Hua , Francois Nicolas , Punzmann Horst , Shats Michael
Published: April 2021

Fast-spinning discs on a liquid surface propagate along arbitrarily shaped boundaries, making a new type of surface vehicles.
Nonreciprocal second harmonic generation in a magnetoelectric material
Authors: Toyoda Shingo , Fiebig Manfred , Arima Taka-hisa , Tokura Yoshinori , Ogawa Naoki
Published: April 2021

Nearly perfectly unidirectional second harmonic generation of light is realized in a magnetoelectric material.
Netrin-1 receptor UNC5C cleavage by active δ-secretase enhances neurodegeneration, promoting Alzheimer’s disease pathologies
Authors: Chen Guiqin , Kang Seong Su , Wang Zhihao , Ahn Eun Hee , Xia Yiyuan , Liu Xia , Sandoval Ivette M. , Manfredsson Fredric P. , Zhang Zhaohui , Ye Keqiang
Published: April 2021

Netrin-1 reduction activates AEP that cleaves UNC5C receptor, contributing to AD pathogenesis.
SRSF1 serves as a critical posttranscriptional regulator at the late stage of thymocyte development
Authors: Qi Zhihong , Wang Fang , Yu Guotao , Wang Di , Yao Yingpeng , You Menghao , Liu Jingjing , Liu Juanjuan , Sun Zhen , Ji Ce , Xue Yuanchao , Yu Shuyang
Published: April 2021

RNA binding protein SRSF1 controls the development of late thymocytes via posttranscriptional regulation.
The SARS-CoV-2 Spike variant D614G favors an open conformational state
Authors: Mansbach Rachael A. , Chakraborty Srirupa , Nguyen Kien , Montefiori David C. , Korber Bette , Gnanakaran S.
Published: April 2021

Symmetrization of contacts in D614G SARS-CoV-2 Spike favors greater probability of infection-capable conformation.
The Trojan-horse mechanism: How networks reduce gender segregation
Authors: Arvidsson M. , Collet F. , Hedström P.
Published: April 2021

A mechanism is identified that shows how networks contribute to a less gender-segregated labor market.
The shared susceptibility epitope of HLA-DR4 binds citrullinated self-antigens and the TCR
Authors: Lim Jia Jia , Jones Claerwen M. , Loh Tiing Jen , Ting Yi Tian , Zareie Pirooz , Loh Khai L. , Felix Nathan J. , Suri Anish , McKinnon Murray , Stevenaert Frederik , Sharma Ravi K. , Klareskog Lars , Malmström Vivianne , Baker Daniel G. , Purcell Anthony W. , Reid Hugh H. , La Gruta Nicole L. , Rossjohn Jamie
Published: April 2021

Citrullination of a fibrinogen peptide influences HLA-DR4 binding and TCR usage by neoepitope-reactive T cells in rheumatoid arthritis.
Evaluation of Total Body Weight versus Adjusted Body Weight Voriconazole Dosing in Obese Patients
Authors: Diller Elizabeth , Krekel Tamara , Spec Andrej , Klaus Jeff
Published: April 2021

This retrospective single-center study of a cohort of adult patients who received voriconazole with a steady-state trough concentration measured during therapy evaluated the rate of therapeutic trough attainment using adjusted body weight (AdjBW)-based and total body weight (TBW)-based dosing in overweight and obese patients. Of the 130 patients included, 45 patients received TBW-based dosing and 85 patients received AdjBW-based dosing.
Effect of Clofazimine Concentration on QT Prolongation in Patients Treated for Tuberculosis
Authors: Abdelwahab Mahmoud Tareq , Court Richard , Everitt Daniel , Diacon Andreas H. , Dawson Rodney , Svensson Elin M. , Maartens Gary , Denti Paolo
Published: April 2021

Clofazimine is classified as a WHO group B drug for the treatment of rifampin-resistant tuberculosis. QT prolongation, which is associated with fatal cardiac arrhythmias, is caused by several antitubercular drugs, including clofazimine, but there are no data quantifying the effect of clofazimine concentration on QT prolongation.
Feeding disorders in children with oesophageal atresia: a cross-sectional study
Authors: Pham Aurélie , Ecochard-Dugelay Emmanuelle , Bonnard Arnaud , Le Roux Enora , Gelas Thomas , Rousseau Véronique , Thomassin Nadège , Cabon-Boudard Isabelle , Nicolas Audrey , Guinot Audrey , Rebeuh Julie , Le Mandat Aurélie , Djeddi Djamal-Dine , Fouquet Virginie , Boucharny Aurélie , Irtan Sabine , Lemale Julie , Comte Aurélie , Bridoux-Henno Laure , Dupont-Lucas Claire , Dimitrov Georges , Turquet Anne , Borderon Corinne , Pelatan Cécile , Chaillou Legault Emilie , Jung Camille , Willot Stéphanie , Montalva Louise , Mitanchez Delphine , Gottrand Frederic , Bellaiche Marc
Published: April 2021

Introduction

With advances in surgical and neonatal care, the survival of patients with oesophageal atresia (OA) has improved over time. Whereas a number of OA-related conditions (delayed primary anastomosis, anastomotic stricture and oesophageal dysmotility) may have an impact on feeding development and although children with OA experience several oral aversive events, paediatric feeding disorders (PFD) remain poorly described in this population. The primary aim of our study was to describe PFD in children born with OA, using a standardised scale. The secondary aim was to determine conditions associated with PFD.

Methods

The Feeding Disorders in Children with Oesophageal Atresia Study is a national cohort study based on the OA registry from the French National Network. Parents of children born with OA between 2013 and 2016 in one of the 22 participating centres were asked to complete the French version of the Montreal Children’s Hospital Feeding Scale.

Results

Of the 248 eligible children, 145 children, with a median age of 2.3 years (Q1–Q3 1.8–2.9, min–max 1.1–4.0 years), were included. Sixty-one children (42%) developed PFD; 13% were tube-fed (n=19). Almost 40% of children with PFD failed to thrive (n=23). The presence of chronic respiratory symptoms was associated with the development of PFD. Ten children with PFD (16%) had no other condition or OA-related complication.

Conclusion

PFD are common in children with OA, and there is no typical profile of patients at risk of PFD. Therefore, all children with OA require a systematic screening for PFD that could improve the care and outcomes of patients, especially in terms of growth.
Emergency TAVI in cardiogenic shock and cardiorenal syndrome secondary to severe bicuspid aortic stenosis
Authors: Byrne Luke , Wheen Peter , O'Connor Stephen
Published: April 2021

A 78-year man with severe aortic stenosis awaiting elective surgical aortic valve replacement presented with worsening New York Heart Association IV shortness of breath. Despite appropriate heart failure treatment, he deteriorated and developed cardiogenic shock and cardiorenal syndrome which progressed despite inotropic support. A non-contrast-gated CT coronary angiogram was arranged in light of acute renal failure which revealed a bicuspid aortic valve. Three-dimensional transoesophageal echocardiography guidance was used to assist annulus sizing. An emergency transcatheter aortic valve replacement (eTAVI) was carried out 5 days into admission with a 34 mm Core Valve Evolut Pro valve with a no contrast technique. The patient’s blood pressure and urine output improved and no procedural complications were encountered. He was discharged after 21 days and has remained well subsequently. This case highlights the utility of eTAVI and demonstrates the feasibility of a no contrast approach.
Development of central precocious puberty following cannabinoid use for paediatric epilepsy: causal or coincidence?
Authors: Krishnan Aditya , Agwu Juliana Chizo , Kallappa Chetana , Pandey Rajesh
Published: April 2021

Research suggests a role for cannabidiol oil in managing certain forms of paediatric onset epilepsy. However, studies on the impact of cannabis on the hypothalamo-pituitary-gonadal (HPG) axis have conflicting results. Delta-9-tetrahydrocannabinol (Δ9-THC) acutely inhibits gonadotropin-releasing hormone in the hypothalamus, reducing testosterone levels by 65% in rhesus monkeys. Additionally, there have been reports of pubertal arrest and delayed puberty in male cannabis users. In contrast, other studies have reported higher testosterone levels following long-term cannabis use.

A 2-year-old boy presented with testicular enlargement, increased penile length and growth of coarse pubic hair developing over 6 months. His mother procured cannabidiol oil online, which he started taking 7 months earlier for severe epilepsy refractory to medical management. Subsequent investigations confirmed central precocious puberty. While it is unclear whether the precocious puberty is a direct consequence of HPG axis activation by Δ9-THC, this case demonstrates a temporal association between cannabis use and development of precocious puberty.
The effectiveness of maternity waiting homes in reducing perinatal mortality: a case–control study in Ethiopia
Authors: Dalla Zuanna Teresa , Fonzo Marco , Sperotto Milena , Resti Carlo , Tsegaye Ademe , Azzimonti Gaetano , Manenti Fabio , Putoto Giovanni , Bertoncello Chiara
Published: April 2021

Background

The 2030 Agenda for Sustainable Development aims to reduce neonatal mortality to at least 12 per 1000 live births. Most of the causes can be prevented or cured. Access to quality healthcare during pregnancy and labour is the key to reduce perinatal deaths, and maternity waiting homes (MWHs) may have an impact, especially for women who live far from the healthcare system. We conducted a case–control study to evaluate the effectiveness of MWH in reducing perinatal mortality in a secondary hospital in Ethiopia.

Methods

We did a nested case–control study from January 2014 through December 2017. The enrolled cases were mothers whose childbirth resulted in stillbirth or early neonatal death. The controls were mothers with an alive baby at 7 days or with an alive baby on discharge. We collected demographic, anamnestic, pregnancy-related and obstetric-related data. The effectiveness of the MWH on perinatal death was assessed by a logistic regression model, adjusted for all other variables investigated as potential confounders. We also did a sensitivity analysis to explore the role of twin pregnancies.

Results

We included 1175 cases and 2350 controls. The crude analysis showed a protective effect of the MWH towards perinatal mortality (OR=0.700; 95% CI: 0.505 to 0.972), even more protective after adjustment for confounders (adjusted OR (AOR)=0.452; 95% CI: 0.293 to 0.698). Sensitivity analyses showed a consistent result, even excluding twin pregnancies (AOR=0.550; 95% CI: 0.330 to 0.917).

Conclusion

MWHs appear to reduce perinatal mortality by 55%. Our findings support the decision to invest in MWH to support pregnant women with higher quality and more comprehensive healthcare strategy, including quality antenatal care in peripheral primary care clinics, where risk factors can be recognised and women can be addressed for admission to MWH.
Early prediction of serious infections in febrile infants incorporating heart rate variability in an emergency department: a pilot study
Authors: Chong Shu-Ling , Ong Gene Yong-Kwang , Allen John Carson , Lee Jan Hau , Piragasam Rupini , Koh Garion Zhi Xiong , Mahajan Prashant , Liu Nan , Ong Marcus Eng Hock
Published: April 2021

Background

Early differentiation of febrile young infants with from those without serious infections (SIs) remains a diagnostic challenge. We sought to (1) compare vital signs and heart rate variability (HRV) parameters between febrile infants with versus without SIs, (2) assess the performance of HRV and vital signs with reference to current triage tools and (3) compare HRV and vital signs to HRV, vital signs and blood biomarkers, when predicting for the presence of SIs.

Methods

Using a prospective observational design, we recruited patients <3 months old presenting to a tertiary paediatric ED in Singapore from December 2018 through November 2019. We obtained patient demographic characteristics, triage assessment (including the Severity Index Score (SIS)), HRV parameters (time, frequency and non-linear domains) and laboratory results. We performed multivariable logistic regression analyses to predict the presence of an SI, using area under the curve (AUC) with the corresponding 95% CI to assess predictive capability.

Results

Among 203 infants with a mean age of 38.4 days (SD 27.6), 67 infants (33.0%) had an SI. There were significant differences in the time, frequency and non-linear domains of HRV parameters between infants with versus without SIs. In predicting SIs, gender, temperature and the HRV non-linear parameter Poincaré plot SD2 (AUC 0.78, 95% CI 0.71 to 0.84) performed better than SIS alone (AUC 0.61, 95% CI 0.53 to 0.68). Model performance improved with the addition of absolute neutrophil count and C reactive protein (AUC 0.82, 95% CI 0.76 to 0.89).

Conclusion

An exploratory prediction model incorporating HRV and biomarkers improved prediction of SIs. Further research is needed to assess if HRV can identify which young febrile infants have an SI at ED triage.

Trial registration number

NCT04103151.
Actinic keratoses contiguous with squamous cell carcinomas are mostly non-hyperkeratotic and with severe dysplasia
Authors: Heerfordt Ida M , Poulsen Thomas , Wulf Hans Christian
Published: April 2021

Aims

Actinic keratosis (AK) is a precursor of cutaneous squamous cell carcinoma (SCC). No validated parameters can predict which AKs will progress into SCCs, but especially thick AKs are under suspicion. The clinical and histopathological thickness of AKs is strongly correlated. This study aimed to investigate the thicknesses and degree of dysplasia of AKs contiguous with SCCs assuming these AKs represent the AKs that have undergone malignant transformation.

Methods

Files of the Pathology Department, Hospital of Southern Jutland, Denmark, were reviewed. 111 cases met the inclusion criteria: a skin biopsy containing an invasive SCC. All SCCs merged with an AK at the edge. Degree of dysplasia, epidermal thickness and stratum corneum thicknesses of AKs were measured.

Results

All AKs showed severe dysplasia. Most AKs had a stratum corneum thickness under 0.1 mm and an epidermal thickness under 0.5 mm, corresponding to clinically thin and non-hyperkeratotic AKs.

Conclusions

Our result suggests malignant progression potential of AKs regardless of thickness.
Effect of nurse-led care on outcomes in patients with ACPA/RF-positive rheumatoid arthritis with active disease undergoing treat-to-target: a multicentre randomised controlled trial
Authors: Hoeper Juliana Rachel , Zeidler Jan , Meyer Sara Eileen , Gauler Georg , Steffens-Korbanka Patricia , Welcker Martin , Wendler Jörg , Schuch Florian , von Hinüber Ulrich , Schwarting Andreas , Witte Torsten , Meyer-Olson Dirk , Hoeper Kirsten
Published: April 2021

Objective

To determine the non-inferiority of nurse-led care (NLC) in patients with anticitrullinated protein antibody (ACPA)-positive and/or rheumatoid factor (RF)-positive rheumatoid arthritis (RA) with active disease who are starting disease-modifying antirheumatic drug therapy, following treat-to-target (T2T) recommendations.

Methods

A multicentre, pragmatic randomised controlled trial was conducted to assess clinical effectiveness, anxiety, depression and patient satisfaction following a non-inferiority design. The participants were 224 adults with ACPA/RF-positive RA who were randomly assigned to either NLC or rheumatologist-led care (RLC). The primary outcome was the Disease Activity Score in 28 Joints measured with C reactive protein (DAS28-CRP) assessed at baseline and after 3, 6, 9 and 12 months. A DAS28-CRP difference of 0.6 was set as the non-inferiority margin. Mean differences between the groups were assessed following per-protocol and intention-to-treat strategies.

Results

Demographic data and baseline characteristics of patients in the NLC group (n=111) were comparable to those of patients in the RLC group (n=113). The improvement in disease activity (change in DAS28-CRP, primary outcome) over the course of 12 months was significant in both groups (p<0.001). No significant differences were observed between the NLC and RLC groups (p=0.317). Non-inferiority of NLC was shown for the primary outcome and all secondary outcomes.

Conclusion

This study supported the non-inferiority of NLC in managing T2T and follow-up care of patients with RA with moderate to high disease activity and poor prognostic factors in addition to RLC.

Trial registration number

DRKS00013055.
Attributable mortality of acute respiratory distress syndrome: a systematic review, meta-analysis and survival analysis using targeted minimum loss-based estimation
Authors: Torres Lisa K , Hoffman Katherine L , Oromendia Clara , Diaz Ivan , Harrington John S , Schenck Edward J , Price David R , Gomez-Escobar Luis , Higuera Angelica , Vera Mayra Pinilla , Baron Rebecca M , Fredenburgh Laura E , Huh Jin-Won , Choi Augustine M K , Siempos Ilias I
Published: April 2021

Background

Although acute respiratory distress syndrome (ARDS) is associated with high mortality, its direct causal link with death is unclear. Clarifying this link is important to justify costly research on prevention of ARDS.

Objective

To estimate the attributable mortality, if any, of ARDS.

Design

First, we performed a systematic review and meta-analysis of observational studies reporting mortality of critically ill patients with and without ARDS matched for underlying risk factor. Next, we conducted a survival analysis of prospectively collected patient-level data from subjects enrolled in three intensive care unit (ICU) cohorts to estimate the attributable mortality of critically ill septic patients with and without ARDS using a novel causal inference method.

Results

In the meta-analysis, 44 studies (47 cohorts) involving 56 081 critically ill patients were included. Mortality was higher in patients with versus without ARDS (risk ratio 2.48, 95% CI 1.86 to 3.30; p<0.001) with a numerically stronger association between ARDS and mortality in trauma than sepsis. In the survival analysis of three ICU cohorts enrolling 1203 critically ill patients, 658 septic patients were included. After controlling for confounders, ARDS was found to increase the mortality rate by 15% (95% CI 3% to 26%; p=0.015). Significant increases in mortality were seen for severe (23%, 95% CI 3% to 44%; p=0.028) and moderate (16%, 95% CI 2% to 31%; p=0.031), but not for mild ARDS.

Conclusions

ARDS has a direct causal link with mortality. Our findings provide information about the extent to which continued funding of ARDS prevention trials has potential to impart survival benefit.

PROSPERO Registration Number

CRD42017078313
Pulse arrival time, a novel sleep cardiovascular marker: the multi-ethnic study of atherosclerosis
Authors: Kwon Younghoon , Wiles Christopher , Parker B Eugene , Clark Brian R , Sohn Min-Woong , Mariani Sara , Hahn Jin-Oh , Jacobs David R , Stein James H , Lima Joao , Kapur Vishesh , Wellman Andrew , Redline Susan , Azarbarzin Ali
Published: April 2021

Background

Pulse arrival time (PAT) is commonly used to estimate blood pressure response. We hypothesised that PAT response to obstructive respiratory events would be associated with increased cardiovascular risk in people with obstructive sleep apnoea.

Methods

PAT, defined as the time interval between electrocardiography R wave and pulse arrival by photoplethysmography, was measured in the Multi-Ethnic Study of Atherosclerosis Sleep study participants. The PAT response to apnoeas/hypopnoeas was defined as the area under the PAT waveform following respiratory events. Cardiovascular outcomes included markers of subclinical cardiovascular disease (CVD): left ventricular mass, carotid plaque burden score and coronary artery calcification (CAC) (cross-sectional) and incident composite CVD events (prospective). Multivariable logistic and Cox proportional hazard regressions were performed.

Results

A total of 1407 participants (mean age 68.4 years, female 47.5%) were included. Higher PAT response (per 1 SD increase) was associated with higher left ventricular mass (5.7 g/m2 higher in fourth vs first quartile, p<0.007), higher carotid plaque burden score (0.37 higher in fourth vs first quartile, p=0.02) and trended to greater odds of CAC (1.44, 95% CI 0.98 to 2.15, p=0.06). A total of 65 incident CVD events were observed over the mean of 4.1 (2.6) years follow-up period. Higher PAT response was associated with increased future CVD events (HR: 1.20, 95% CI 1.02 to 1.42, p=0.03).

Conclusion

PAT is independently associated with markers of subclinical CVD and incident CVD events. Respiratory-related PAT response is a novel and promising polysomnography metric with cardiovascular implications.
Electronic structure modification in two-dimensional pentagonal PdS2 by external strain
Authors: Sharma Mridu , Singh Ranber
Published: April 2021

We investigated the electronic structure modifications in two-dimensional (2D) pentagonal PdS2 materials by external strains. In the absence of external strain, the 2D pentagonal PdS2 materials are indirect band gap semiconductors. The band gap decreases with an increase in the number of stacking PdS2 monolayers. The external uniaxial and biaxial strains significantly modify the contributions of p-orbitals of S atoms and d-orbitals of Pd atoms to the conduction and valence band edges. It consequently modifies the electronic structures of 2D pentagonal PdS2 materials. This strain tunability of electronic structures of 2D pentagonal PdS2 materials may be useful for their electro-mechanical applications.