bluuebunny/crossref_metadata_2025 huggingface dataset:
Making prospective entrustment decisions: Knowing limits, seeking help and defaulting
Authors: Schumacher Daniel J. , Michelson Catherine , Winn Ariel S. , Turner David A. , Elshoff Ethan , Kinnear Benjamin
Published: March 2022

Introduction

Many studies focused on entrustment have not considered prospective entrustment decisions, where clinical competency and entrustment committees determine how much supervision trainees will require in the future for tasks occurring in not completely known contexts. The authors sought to explore factors that influence and determine prospective entrustment decisions made by members of such committees in graduate medical education (GME) and undergraduate medical education (UME).

Methods

The authors conducted a constructivist grounded theory study with 23 faculty participants from GME and UME clinical competency and entrustment committees in the United States between October 2020 and March 2021. Interviews sought to explore factors and considerations participants weigh in making prospective entrustment decisions about trainees. Data collection and analysis occurred in an iterative fashion, ensuring constant comparison. Theoretical sampling was used to confirm, disconfirm and elaborate on the evolving results.

Results

Trainees' ability to know limits and seek help is the foundation of participants' prospective entrustment decision making. Most participants, however, describe a presumption of trainee readiness to progress and describe commonly making default prospective entrustment decisions unless ‘red flags’ in performance are present. Although participants desire sufficient and trusted data about trainee performance to inform decisions, they often lack it. Finally, the perceived permanence and consequences of prospective entrustment decisions influence how participants weigh other factors contributing to prospective entrustment decisions.

Conclusion

Trainees' ability to know limits and seek help appears to be the foundation of prospective entrustment decision making. Training programmes should strive to collect and employ robust data supporting and questioning the presence of these attributes.
A jacalin‐like lectin domain‐containing protein of Sclerospora graminicola acts as an apoplastic virulence effector in plant–oomycete interactions
Authors: Kobayashi Michie , Utsushi Hiroe , Fujisaki Koki , Takeda Takumi , Yamashita Tetsuro , Terauchi Ryohei
Published: March 2022

The plant extracellular space, including the apoplast and plasma membrane, is the initial site of plant–pathogen interactions. Pathogens deliver numerous secreted proteins, called effectors, into this region to suppress plant immunity and establish infection. Downy mildew caused by the oomycete pathogen Sclerospora graminicola (Sg) is an economically important disease of Poaceae crops including foxtail millet (Setaria italica). We previously reported the genome sequence of Sg and showed that the jacalin‐related lectin (JRL) gene family has significantly expanded in this lineage. However, the biological functions of JRL proteins remained unknown. Here, we show that JRL from Sg (SgJRL) functions as an apoplastic virulence effector. We identified eight SgJRLs by protein mass spectrometry analysis of extracellular fluid from Sg‐inoculated foxtail millet leaves. SgJRLs consist of a jacalin‐like lectin domain and an N‐terminal putative secretion signal; SgJRL expression is induced by Sg infection. Heterologous expression of three SgJRLs with N‐terminal secretion signal peptides in Nicotiana benthamiana enhanced the virulence of the pathogen Phytophthora palmivora inoculated onto the same leaves. Of the three SgJRLs, SG06536 fused with green fluorescent protein (GFP) localized to the apoplastic space in N. benthamiana leaves. INF1‐mediated induction of defence‐related genes was suppressed by co‐expression of SG06536‐GFP. These findings suggest that JRLs are novel apoplastic effectors that contribute to pathogenicity by suppressing plant defence responses.
Community variability in pond metacommunities: interactive effects of predators and isolation on stochastic community assembly
Authors: Pelinson R. M. , Leibold Mathew A. , Schiesari Luis
Published: March 2022

In the absence of environmental heterogeneity, spatial variation among local communities can be mostly attributed to random dispersal, demographic stochasticity and species interactions causing historical contingency in colonization (e.g. priority effects). The consequences of demographic stochasticity and random dispersal are highly dependent on community size, regional richness and local richness, which, along with historical contingency can be strongly affected by spatial isolation and the presence of predators. Here, we tested whether and how the presence of a generalist predatory fish and spatial isolation can change spatial community variability in artificial ponds by manipulating the presence/absence of fish (redbreast tilapia) at three different distances from a source wetland. We then used null models to compute how much the observed community variability within treatments deviates from the expected from randomly reassembled communities (i.e. beta‐deviation). We found that spatial isolation can have both negative and positive effects on community variability, and their importance may depend on the presence of predatory fish. Negative effects likely occurred because predatory insects cannot always successfully colonize highly isolated ponds, causing the abundance of herbivores and detritivores to increase, consequently increasing community size, which is known to decrease the importance of demographic stochasticity. However, when fish are absent, the more isolated communities exhibit more community variability than is expected from random community assembly. We believe that such an increase in variability is most likely due to an increase in the importance of historical contingency in colonization, generating more distinct communities in isolated ponds. Such effects were absent in the presence of generalist predatory fish, likely because fish prevented any early colonizing taxa from becoming too abundant. Our findings show that the presence of generalist predators can change how community variability responds to spatial isolation.
Ventricular arrhythmia burden and implantable cardioverter‐defibrillator outcomes in transthyretin cardiac amyloidosis
Authors: Brown Matthew T. , Yalamanchili Sreeram , Evans Sean T. , Ram Pradhum , Blank Evan A. , Lyle Melissa A. , Merchant Faisal M. , Bhatt Kunal N.
Published: March 2022

Background

As targeted treatments for amyloid transthyretin cardiomyopathy (ATTR‐CM) are becoming available, we aim to characterize the rates of ventricular arrhythmias (VAs), implantable cardioverter‐defibrillator (ICD) utilization, and their impact on survival.

Methods

This is a retrospective cohort study of 130 patients with ATTR‐CM diagnosed at Emory University's Cardiac Amyloidosis Center between April 2012 and September 2020. VAs were defined as nonsustained or sustained ventricular tachycardia and ventricular fibrillation.

Results

Of 130 patients, 42 had wild‐type disease (wtATTR) and 88 had hereditary variants (hATTR), most commonly Val122Ile (89%). At ATTR‐CM diagnosis, 80 (62%) patients had EF ≤ 40% consistent with systolic heart failure. Of the 69 (53%) patients with documented VAs significantly higher rates occurred among those with EF ≤ 40% compared with EF > 40% (67% vs. 28%, p = .001). Thirty‐two patients (25 hATTR, 7 wtATTR) had primary prevention ICDs implanted. Eight (25%) of these patients received appropriate ICD therapy while two (6%) experienced inappropriate therapy. Comparing patients with EF ≤ 35% with and without ICDs did not reveal any survival difference (3.3 ± 0.5 vs. 2.8 ± 0.4 years, p = .699).

Conclusions

High rates of VAs and appropriate ICD therapy were found among a unique cohort of largely hereditary ATTR‐CM patients with a high rate of systolic heart failure.
Evaluation of candidate genotype of GH gene associated with growth, production and reproduction traits in Dairy Cows
Authors: Anamika  , Magotra Ankit , Bangar Yogesh C. , Malik B. S. , Garg Asha Rani
Published: March 2022

Growth hormone (GH) is a major regulator of postnatal growth and metabolism in mammals and plays a critical role in growth, production and fertility in cattle. The present study was conducted in dairy cattle to find the association of g.48769565 C > T mutation with growth, production and reproduction traits in Sahiwal and Hardhenu cattle. PCR‐RFLP was performed to genotype g.48769565 C > T mutation using the MspI restriction enzyme in our resource cattle population. In Hardhenu cattle, the frequencies of C and T alleles were 0.59 and 0.41, respectively, while genotypic frequencies were 0.33, 0.53 and 0.14 for CC, CT and TT respectively. The frequencies of the C and T alleles were 0.24 and 0.76, respectively, in Sahiwal cattle and it was observed that the highest frequency was for the TT genotype (0.58) and the lowest was for the CC genotype (0.06). Chi‐square analysis showed that g.48769565C>T SNP loci meet with the Hardy–Weinberg equilibrium in Sahiwal and Hardhenu cattle. From the least‐squares analysis, it was observed that CC genotype was significantly associated with total milk yield (TMY), 300 days milk yield (300D MY), lactation length (LL), dry period (DP) and artificial insemination (AI)/conception (p < .05). We also observed a significant association (p < .05) of genotype CT with 3‐month calves body weight. Cows with TT genotype revealed comparatively favourable service period (SP) and calving interval (CI) in our resource population. These observed differences in their allelic and genotypic frequencies in association with the traits underlying production and fertility can be utilized for genetic improvement in dairy cattle.
Aboveground biomass accumulation and tree size distribution in seasonal Atlantic Forest restoration sites
Authors: Arcanjo Fátima A. , Torezan José M. D.
Published: March 2022

Tropical forests undergoing restoration can present high biomass accumulation rates, especially in the first 20 years. However, native species reforestations often present a bias toward fast growth, low wood density, and small maximum adult size species, contrasting with most mature forest species. Since tree species adult size and wood density are key traits that influence biomass accumulation, these induce uncertainty regarding carbon uptake capabilities of restoration projects in the long term. We compared the density of individuals (DI), basal area (BA), aboveground biomass (AGB), and weighted average wood density (WDW) in 13–14‐year‐old restoration sites and in mature seasonal Atlantic Forest fragments. We also assessed the contribution of pioneer and non‐pioneer and planted and non‐planted species on these variables at restoration sites. Furthermore, we investigated the DI and WDW for saplings and seedlings, in order to foresee changes in forest structure that may result from natural recruitment of dense‐wood mature species. The BA and WDW at restoration sites were similar to forest fragments, except for large trees (DBH ≥50 cm). Restoration sites recovered AGB to the level of forest fragments only for the smaller size class (DBH 5–19.9 cm). Planted pioneer and non‐pioneer species accumulated the greatest AGB (93%), BA (94%), and DI (90%) at restoration sites. The DI of non‐planted non‐pioneer species with higher WDW increased among saplings and seedlings at restoration sites. The presence of species with a larger adult size and higher WD may indicate long‐term increase in biomass accumulation at restoration sites.
Guiding Principles and Special Laws†
Authors: Díez José A. , Moulines C. Ulises
Published: March 2022

We analyse the structuralist notion of a guiding principle in empirical science in order to show its fruitfulness to tackle some central issues belonging both to the general as well as to the special philosophy of science, while also providing some clues to understand recent developments in the philosophy of science. We shall conclude by laying out the core characteristics of guiding principles.
Modeling Sand Particulate Flows Through Angled Apertures and Surfaces in Concentrated Solar-Thermal Power Receivers
Authors: Aurora Akarsh
Published: March 2022

Concentrated solar-thermal power towers are increasingly migrating toward sand-based particle receiver designs to improve thermal efficiency and reach temperatures above 1000 °C for air Brayton power cycles and supercritical CO2 power cycles. However, utilizing sand affords complexities in modeling particle flow characteristics due to variable geometric shape, size, and composition. Thus, the objective of this study is to model the particle flow characteristics of sand through variable angled chevron shapes and receiver hoppers to help formulate robust modeling for flow dynamics. Treating the chevrons as an array of apertures, a novel method of calculating sand particle mass flowrate across angled apertures and surfaces is developed. Employing high-speed photography and particle imaging velocimetry techniques, our results incorporate the impact of effective angles upon velocity, residence time, and breakage profiles of falling sand particles. This study determines that a Beverloo equation incorporating effective angles for velocity and aperture size effectively predicts mass flowrate through chevrons, which can serve as a reference for future particulate flow modeling in this field. Furthermore, increasing hopper and chevron tip angles resulted in a more significant decrease in particle diameter and curtain opacity after sand flow trials.
Nonlinear Random Vibrations Using Second-Order Adjoint and Projected Differentiation Methods
Authors: Papadimitriou Dimitrios , Mourelatos Zissimos P. , Hu Zhen
Published: March 2022

This paper proposes a new computationally efficient methodology for random vibrations of nonlinear vibratory systems using a time-dependent second-order adjoint variable (AV2) method and a second-order projected differentiation (PD2) method. The proposed approach is called AV2–PD2. The vibratory system can be excited by stationary Gaussian or non-Gaussian random processes following the traditional translation process model. A Karhunen–Loeve (KL) expansion expresses each input random process in terms of standard normal random variables. A second-order adjoint approach is used to obtain the required first- and second-order output derivatives accurately by solving as many sets of equations of motion (EOMs) as the number of KL random variables. These derivatives are used to compute the marginal cumulative distribution function (CDF) of the output process with second-order accuracy. Then, a second-order projected differentiation method calculates the autocorrelation function of each output process with second-order accuracy, at an additional cost of solving as many sets of EOMs as the number of outputs of interest, independently of the time horizon (simulation time). The total number of solutions of the EOM scales linearly with the number of input KL random variables and the number of output processes. The efficiency and accuracy of the proposed approach are demonstrated using a nonlinear Duffing oscillator problem under a quadratic random excitation and a nonlinear half-car suspension example.
Semiclassical black holes and horizon singularities
Authors: Dahal Pravin K. , Murk Sebastian , Terno Daniel R.
Published: March 2022

In spherical symmetry, solutions of the semiclassical Einstein equations belong to one of two possible classes. Both classes contain solutions that—depending on the dynamic behavior of the horizon—describe evaporating physical black holes or expanding white holes (trapped/anti-trapped regions that form in finite time of a distant observer). These solutions are real-valued only if the null energy condition (NEC) is violated in the vicinity of the Schwarzschild sphere. We review their properties and describe the only consistent black hole formation scenario. While the curvature scalars are finite on the outer apparent/anti-trapping horizon, it is still a weakly singular surface. This singularity manifests itself in a mild firewall. Near the inner apparent horizon, the NEC is satisfied. Models of static regular black holes are known to be unstable, but since dynamic models of regular black holes are severely constrained by self-consistency requirements, their stability requires further investigation.
Preconditioning Activities to Enhance Repeated High-Intensity Efforts in Elite Rugby Union Players
Authors: Vachon Adrien , Berryman Nicolas , Mujika Iñigo , Paquet Jean-Baptiste , Bosquet Laurent
Published: March 2022

Purpose: To assess the effect of a rugby-specific high-intensity interval-training (HIITRugby) protocol on the repeated high-intensity-effort ability of young elite rugby union players and to verify the influence of 2 preconditioning sequences composed either of physical contacts (ie, tackles) or of additional runs on the magnitude of improvement. Method: Fourteen players (19 [1] y; 183.5 [8.6] cm; 95.6 [15.6] kg) underwent an HIITRugby protocol, consisting of 7 supervised training sessions over 4 weeks, each session including 3 or 4 sets of 1 to 2 minutes with 1-minute recovery. Prior to HIITRugby training, players underwent a preconditioning contact sequence or a preconditioning running sequence, to assess their influence on subsequent interval-training sessions. Results: The overall group showed a moderate improvement in total sprint time, sprints ≥90% of the best, and 20-m sprint (−3.91% [2.68%], P = .0002; 74.6% [123.7%], P = .012; −3.22% [3.13%], P = .003, respectively) and a large improvement in percentage decrement (−23.1% [20.5%], P = .005) following the 4-week training block. Relative improvements were similar between groups in total sprint time, 20-m sprint, and perceived difficulty, but the preconditioning running-sequence group exhibited a larger magnitude of gains in percentage decrement (−28.6% [20.2%] vs −17.6% [20.7%]; effect size = −1.01 vs −0.73). Conclusion: An HIITRugby training block was effective to improve repeated high-intensity-effort ability. A preconditioning contact sequence prior to HIITRugby can reduce subsequent long-interval running activity, which may attenuate the improvement of repeated high-intensity-effort indices related to the aerobic system.
Development and Initial Evaluation of the Athlete Eating Psychopathology Observation Questionnaire for Sport Professionals
Authors: Sandgren Sebastian S. , Haycraft Emma , Plateau Carolyn R.
Published: March 2022

Eating psychopathology symptoms are common in athletes; however, it is unknown which symptoms are detected and to what extent by sport professionals. This study aimed to develop and evaluate a self-report questionnaire to explore which features of eating psychopathology in athletes are detected by sport professionals, and how observation of these symptoms might vary. Thirty-one questions were developed and 232 sport professionals (56% male) participated in the study. Exploratory Factor Analysis revealed a 20-item, five-factor solution (Negative Affect, Dieting Practices, Fear of Eating in Social Contexts, Bingeing and Purging, and Compulsive Exercise). Participants most frequently reported observing athletes’ dieting practices, while symptoms of a fear of eating in social contexts were observed least frequently. This study has developed and preliminarily tested the Athlete Eating Psychopathology Observation Questionnaire (AEPOQ), which now requires further validation. The findings provide important directions for education initiatives with sport professionals regarding identification of eating psychopathology symptoms.
Identification of a conserved chemokine receptor motif that enables ligand discrimination
Authors: Larsen Olav , van der Velden Wijnand J. C. , Mavri Maša , Schuermans Sara , Rummel Pia C. , Karlshøj Stefanie , Gustavsson Martin , Proost Paul , Våbenø Jon , Rosenkilde Mette M.
Published: March 2022

Extensive ligand-receptor promiscuity in the chemokine signaling system balances beneficial redundancy and specificity. However, this feature poses a major challenge to selectively modulate the system pharmacologically. Here, we identified a conserved cluster of three aromatic receptor residues that anchors the second extracellular loop (ECL2) to the top of receptor transmembrane helices (TM) 4 and 5 and enables recognition of both shared and specific characteristics of interacting chemokines. This cluster was essential for the activation of several chemokine receptors. Furthermore, characteristic motifs of the ß
1
strand and 30s loop make the two main CC-chemokine subgroups—the macrophage inflammatory proteins (MIPs) and monocyte chemoattractant proteins (MCPs)—differentially dependent on this cluster in the promiscuous receptors CCR1, CCR2, and CCR5. The cluster additionally enabled CCR1 and CCR5 to discriminate between closely related MIPs based on the N terminus of the chemokine. G protein signaling and β-arrestin2 recruitment assays confirmed the importance of the conserved cluster in receptor discrimination of chemokine ligands. This extracellular site may facilitate the development of chemokine-related therapeutics.
Interleukin-27 (IL-27) Promotes Chlamydial Infection in the Female Genital Tract
Authors: Zhao Yujie , Huo Zhi , Zhou Zengzi , Cervantes Christian , Chen Jianlin , Xu Zhenming , Zhong Guangming
Published: March 2022

Intravaginal infection of mice withChlamydia muridarumhas been used for investigating the mechanisms ofChlamydia trachomatis-induced pathogenicity and immune responses. In the current study, the mouse model was used to evaluate the impact of interleukin-27 (IL-27) and its receptor signaling on the susceptibility of the female genital tract to chlamydial infection.
RfaH May Oppose Silencing by H-NS and YmoA Proteins during Transcription Elongation
Authors: Wang Bing , Mittermeier Maura , Artsimovitch Irina
Published: March 2022

Horizontally acquired DNA drives bacterial evolution, but its unregulated expression may harm the recipient. Xenogeneic silencers recognize foreign genes and inhibit their transcription.
Use of an Interspecies Chimeric Receptor for Inducible Gene Expression Reveals that Metabolic Flux through the Peptidoglycan Biosynthesis Pathway is an Important Driver of Cephalosporin Resistance in Enterococcus faecalis
Authors: Mascari Carly A. , Djorić Dušanka , Little Jaime L. , Kristich Christopher J.
Published: March 2022

Enterococci are dangerous opportunistic pathogens with the potential to cause life-threatening infections due in part to their intrinsic resistance to cephalosporin antibiotics. Elucidating the molecular mechanisms that provide this resistance is critical for the development of strategies to both prevent and treat enterococcal infections.
Microbial Diversity and Sulfur Cycling in an Early Earth Analogue: From Ancient Novelty to Modern Commonality
Authors: Hahn C. Ryan , Farag Ibrahim F. , Murphy Chelsea L. , Podar Mircea , Elshahed Mostafa S. , Youssef Noha H.
Published: March 2022

Life on earth evolved in an anoxic setting; however, the identity and fate of microorganisms that thrived in a preoxygenated earth are poorly understood. In Zodletone spring, the prevailing geochemical conditions are remarkably similar to conditions prevailing in surficial earth prior to oxygen buildup in the atmosphere.
Electronic Cigarette Use Promotes a Unique Periodontal Microbiome
Authors: Thomas Scott C. , Xu Fangxi , Pushalkar Smruti , Lin Ziyan , Thakor Nirali , Vardhan Mridula , Flaminio Zia , Khodadadi-Jamayran Alireza , Vasconcelos Rebeca , Akapo Adenike , Queiroz Erica , Bederoff Maria , Janal Malvin N. , Guo Yuqi , Aguallo Deanna , Gordon Terry , Corby Patricia M. , Kamer Angela R. , Li Xin , Saxena Deepak
Published: March 2022

Electronic cigarette (e-cig) use is gaining in popularity and is often perceived as a healthier alternative to conventional smoking. Yet there is little evidence of the effects of long-term use of e-cigs on oral health.
Interferon α/β Decoy Receptor Encoded by a Variant in the Dryvax Smallpox Vaccine Contributes to Virulence and Correlates with Severe Vaccine Side Effects
Authors: Liu Ruikang , Americo Jeffrey L. , Earl Patricia L. , Villani Jack , Cotter Catherine A. , Moss Bernard
Published: March 2022

Attenuated live viruses make effective vaccines, although concerns exist due to infrequent complications, particularly in individuals with immunological defects. Such complications occurred with smallpox vaccines, which were shown to be comprised of populations of variants.
Polymicrobial Aggregates in Human Saliva Build the Oral Biofilm
Authors: Simon-Soro Aurea , Ren Zhi , Krom Bastiaan P. , Hoogenkamp Michel A. , Cabello-Yeves Pedro J. , Daniel Scott G. , Bittinger Kyle , Tomas Inmaculada , Koo Hyun , Mira Alex
Published: March 2022

Microbes in biological fluids can be found as aggregates. How these multicellular structures bind to surfaces and initiate the biofilm life cycle remains understudied.
Y-Box Binding Protein 1 Interacts with Dengue Virus Nucleocapsid and Mediates Viral Assembly
Authors: Diosa-Toro Mayra , Kennedy Debbie R. , Chuo Vanessa , Popov Vsevolod L. , Pompon Julien , Garcia-Blanco Mariano A.
Published: March 2022

The global incidence of dengue virus (DENV) infections has steadily increased over the past decades representing an enormous challenge for public health. During infection, DENV viral RNA interacts with numerous host RNA binding proteins (RBPs) that aid viral replication and thus constitute potential molecular targets to curb infection.
Gonococcal Clinical Strains Bearing a Common
gdhR
Single Nucleotide Polymorphism That Results in Enhanced Expression of the Virulence Gene
lctP
Frequently Possess a
mtrR
Promoter Mutation That Decreases Antibiotic Susceptibility
Authors: Ayala Julio C. , Schmerer Matthew W. , Kersh Ellen N. , Unemo Magnus , Shafer William M.
Published: March 2022

We report the frequent appearance of a novel SNP in the
gdhR
gene (
gdhR6
) possessed by
Neisseria gonorrhoeae
. The resulting amino acid change in the GdhR protein resulted in enhanced expression of a virulence gene (
lctP
) that has been suggested to promote gonococcal survival during infection.
Maize Field Study Reveals Covaried Microbiota and Metabolic Changes in Roots over Plant Growth
Authors: Bourceret Amelia , Guan Rui , Dorau Kristof , Mansfeldt Tim , Omidbakhshfard Amin , Medeiros David B. , Fernie Alisdair R. , Hofmann Joerg , Sonnewald Uwe , Mayer Jochen , Gerlach Nina , Bucher Marcel , Garrido-Oter Ruben , Spaepen Stijn , Schulze-Lefert Paul
Published: March 2022

Plant roots are inhabited by microbial communities called the root microbiota, which supports plant growth and health. We show in a maize field study that the root microbiota consists of stable and dynamic members. The dynamics of the microbial community appear to be driven by changes in the metabolic state of the roots over the life cycle of maize.
The Psychrotrophic Pseudomonas lundensis, a Non-
aeruginosa
Pseudomonad, Has a Type III Secretion System of the Ysc Family, Which Is Transcriptionally Active at 37°C
Authors: Ravi Keerthikka , Falkowski Nicole R. , Scales Brittan S. , Akulava Volha D. , Valentovich Leonid N. , Huffnagle Gary B.
Published: March 2022

P. lundensis
strains have been isolated from environments that are distinct and diverse in both nutrient availability and environmental pressures (cold food spoilage, Antarctic melt ponds, cystic fibrosis lungs). As a species, this bacterium can grow in diverse niches that markedly vary in available nutrients and temperature, and in our study, we show that these various strains share greater than 99% sequence similarity.
Stagnation and tearing of the subducting northwest Pacific slab
Authors: Sun Muchen , Yu Youqiang , Gao Stephen S. , Liu Kelly H.
Published: March 2022

Despite numerous observational and geodynamic modeling studies, the presence of the northwest Pacific slab tear and its influence on mantle dynamics remain controversial. By imaging the mantle transition zone (MTZ) discontinuities beneath the Japan Sea and adjacent areas, we demonstrate an ESE-WNW elongated zone with significant MTZ thinning extending from central Honshu, Japan, to the Korean Peninsula, which provides additional supporting evidence for the existence and distribution of a large-scale slab tear. Our results, when combined with other geophysical and geochemical evidence, indicate that the hot mantle material oceanward of the slab may flow through the slab tear and contribute to surface volcanism. Substantial MTZ thickening is widely observed in the region south of the slab tear and suggests the existence of slab stagnation, possibly related to the strong resistance at the bottom of the MTZ.
XEN-related hypotonous maculopathy from iatrogenic cyclodialysis cleft treated with argon laser gonio-cyclopexy
Authors: Hamidovic Lamia , Khatib Tasneem , Dimitriou Chrysostomos , Lin Zhiheng
Published: March 2022

We present a previously undescribed case of a persistent hypotony maculopathy secondary to an iatrogenic cyclodialysis cleft created during XEN-45 gel stent insertion. We present this case as a further analysis of theKarimi et alcase of cyclopexy by the corresponding surgeon. Following right XEN-45 implantation, our patient developed immediate and persistent postoperative hypotony for 4 weeks. Gonioscopy revealed a small cyclodialysis cleft at the 1–2 o’clock position. The cyclodialysis cleft was sealed with direct gonioscopic argon laser cyclopexy. Two months after laser treatment and total of 6 months post XEN-45 insertion, right eye visual acuity returned to 6/4 with intraocular pressure 11 mm Hg without any glaucoma medication. Here, we present details of the non-invasive safe and successful management of hypotony maculopathy secondary to the cleft using Argon laser gonio cyclopexy, with no requirement of return to theatre.
Effect of epidural analgesia on cancer outcomes after gastric cancer resection: a single-centre cohort study in Taiwan
Authors: Hsu Fu-Kai , Chang Wen-Kuei , Lin Kuan-Ju , Chu Tan-Ju , Fang Wen-Liang , Chang Kuang-Yi
Published: March 2022

Objective

To investigate the influence of epidural anaesthesia and analgesia (EA) on cancer recurrence and overall survival after surgery for gastric cancer.

Study design and setting

A retrospective study which involved patients with stage I–III gastric cancer undergoing curative resection in a medical centre from January 2012 to December 2017 and followed up until December 2019 through electronic medical chart review. Patient demographics, anaesthetic and surgical characteristics and pathologic features were also gathered.

Primary and secondary outcome measures

The effects of EA on postoperative cancer recurrence and overall survival were evaluated using proportional hazards regression models with inverse probability of treatment weighting (IPTW). Multivariable Cox regression analyses were conducted for sensitivity analysis as well.

Results

Among the 413 patients with median follow-up of 38.5 months (IQR: 22.1–59.7), 66 (16.0%) received EA after gastric cancer surgery. EA was not associated with greater cancer recurrence (IPTW-adjusted HR: 0.55, 95% CI: 0.27 to 1.13, p=0.102) or cancer specific (IPTW- adjusted HR: 0.53, 95% CI: 0.27 to 1.04, p=0.07) and all-cause mortality (IPTW-adjusted HR: 0.65, 95% CI: 0.37 to 1.16, p=0.143) after gastric cancer resections. For sensitivity analysis, multivariable Cox regression analysis also generated non-significant EA effects on cancer recurrence and survival after surgery.

Conclusions

There was no significant association between EA and cancer recurrence or overall survival in patients with stage I–III gastric cancer receiving surgical resection of primary tumour. Prospective study should be considered to elucidate the relationship between EA and cancer outcomes after gastric cancer surgery.
Medical expenditure of women during pregnancy, childbirth and puerperium at the beginning of China’s universal two-child policy enactment: a population-based retrospective study
Authors: Zang Shuang , Zhao Meizhen , Zhu Yalan , Zhang Ying , Chen Yu , Wang Xin
Published: March 2022

Objectives

To describe and explore women’s medical expenditures during pregnancy, childbirth and puerperium at the beginning of the universal two-child policy enactment in China.

Design

Population-based retrospective study.

Setting

Dalian, China.

Participants

Under the System of Health Accounts 2011 framework, the macroscopic dataset was obtained from the annual report at the provincial and municipal levels in China. The research sample incorporated 65 535 inpatient and outpatient records matching International Classification of Diseases, 10th Revision codes O00–O99 in Dalian city from 2015 through 2017.

Primary and secondary outcome measures

The study delineates women’s current curative expenditure (CCE) during pregnancy, childbirth and puerperium at the beginning of the universal two-child policy in China. The temporal changes of medical expenditure of women during pregnancy, childbirth and puerperium at the beginning of China’s universal two-child policy enactment were assessed. The generalised linear model and structural equation model were used to test the association between medical expenditure and study variables.

Results

Unlike the inverted V-shaped trend in the number of live newborns in Dalian over the 3 studied years, CCE on pregnancy, childbirth and puerperium dipped slightly in 2016 (¥260.29 million) from 2015 (¥263.28 million) and saw a surge in 2017 (¥288.65 million). The ratio of out-of-pocket payment/CCE reduced year by year. There was a rapid increase in CCE in women older than 35 years since 2016. Length of stay mediated the relationship between hospital level, year, age, reimbursement ratio and medical expenditure.

Conclusions

The rise in CCE on pregnancy, delivery and puerperium lagged 1 year behind the surge of newborns at the beginning of China’s universal two-child policy. Length of stay acted as a crucial mediator driving up maternal medical expenditure. Reducing medical expenditure by shortening the length of stay could be a feasible way to effectively address the issue of cost in women during pregnancy, childbirth and puerperium.
Effectiveness of educational interventions to develop patient safety knowledge, skills, behaviours and attitudes in undergraduate nursing students: a systematic review protocol
Authors: De Rezende Helena , Vitorio Aline Mirema F , Morais Alexandre Souza , Garzin Ana Claudia A , Nicole Andressa Garcia , Quadrado Ellen Regina Sevilla , Lourenção Daniela Campos de Andrade , Martins Maristela Santini
Published: March 2022

Introduction

Patient safety is a healthcare discipline that aims to prevent and reduce patient harm, risks and errors during the provision of healthcare. Given the size of the nursing workforce in the healthcare system the inclusion of patient safety in the undergraduate nursing curriculum is necessary to enhance a safe culture in the daily work of their future careers. To this end, it is essential to apply effective teaching strategies to develop patient safety competencies. This review will aim to evaluate the effectiveness of educational interventions in developing patient safety knowledge, skills, behaviours and attitudes in undergraduate nursing students within the existing topic areas of the WHO Multi-professional Patient Safety Curriculum Guide.

Methods and analysis

The databases Medline, CINAHL, Scopus, Education Research Complete, The Cochrane Central Register of Controlled Trials, LILACS, Medes and Grey literature such as ClinicalTrials.gov, Google Scholar, DART-Europe, ProQuest Dissertations, CAPES thesis and dissertations, The Virginia Henderson Global e-Repository, Mednar and Thesis Canada will be searched from July 2011 to January 2022. Two independent reviewers will conduct the search, extract the data and assess the risk of bias for the included studies, using standardised critical appraisal instruments from the Joanna Briggs Institute. The quality of the evidence will be assessed using the Grading of Recommendations, Assessment Development and Evaluation methodology. Studies will be pooled in the meta-analysis. Alternatively, the findings will be presented in narrative form, including tables and figures, to aid in data presentation.

Ethics and dissemination

This study raises no ethical issues. The findings will be disseminated through presentations at professional conferences and publications in a peer-reviewed journal.

PROSPERO registration number

CRD42021254965.
Clarity and applicability of adverse drug reaction-related monitoring instructions in clinical practice guidelines for children and adolescents treated with antipsychotic drugs: a review of six clinical practice guidelines
Authors: Minjon Lenneke , Aarts Juul W , van den Ban Els , Egberts Toine CG , Heerdink Eibert R
Published: March 2022

Objectives

Monitoring instructions related to adverse drug reactions (ADRs) are not always clearly described in clinical practice guidelines (CPGs) and not always easily applicable in daily clinical practice. The aim of this study was to assess the clarity of presentation and the applicability of ADR-related monitoring instructions in CPGs for children and adolescents treated with antipsychotic drugs.

Setting

Guidelines from different countries were selected, and monitoring instructions for 13 ADR-related parameters were assessed.

Primary and secondary outcome measures

To assess the clarity and the applicability of the sections concerning monitoring instructions in each CPG, the Appraisal of Guidelines for Research and Evaluation instrument was used. To assess the clarity and the applicability of the monitoring instructions for each ADR-related parameter, the Systematic Information for Monitoring score was used.

Results

Six CPGs were included. Overall, the presentation of the monitoring instructions in the different CPGs was clear; three CPGs scored >75%. All CPGs scored lower on applicability, as, for example, the barriers and facilitators were poorly described. The number of ADR-related parameters included in the CPGs varied between 8 and 13. Why and what to monitor was always described for each parameter. When to start monitoring was also often described (90.2%), but when to stop monitoring was less frequently described (37.4%).

Conclusions

The CPGs differed on the parameters that needed to be monitored. Overall, the monitoring instructions were clearly presented, but improvement in their applicability is required. By improving the monitoring instructions, CPGs can provide better guidance on monitoring ADRs in daily clinical practice.
Randomised comparative effectiveness trial of Pulmonary Embolism Prevention after hiP and kneE Replacement (PEPPER): the PEPPER trial protocol
Authors: Pellegrini, Jr Vincent D , Eikelboom John William , Evarts C McCollister , Franklin Patricia D , Garvin Kevin L , Goldhaber Samuel Z , Iorio Richard , Lambourne Carol Ann , Magaziner Jay , Magder Laurence
Published: March 2022

Introduction

More than 1 million elective total hip and knee replacements are performed annually in the USA with 2% risk of clinical pulmonary embolism (PE), 0.1%–0.5% fatal PE, and over 1000 deaths. Antithrombotic prophylaxis is standard of care but evidence is limited and conflicting. We will compare effectiveness of three commonly used chemoprophylaxis agents to prevent all-cause mortality (ACM) and clinical venous thromboembolism (VTE) while avoiding bleeding complications.

Methods and analysis

Pulmonary Embolism Prevention after HiP and KneE Replacement is a large randomised pragmatic comparative effectiveness trial with non-inferiority design and target enrolment of 20 000 patients comparing aspirin (81 mg two times a day), low-intensity warfarin (INR (International Normalized Ratio) target 1.7–2.2) and rivaroxaban (10 mg/day). The primary effectiveness outcome is aggregate of VTE and ACM, primary safety outcome is clinical bleeding complications, and patient-reported outcomes are determined at 1, 3 and 6 months. Primary data analysis isper protocol, as preferred for non-inferiority trials, with secondary analyses adherent tointention-to-treatprinciples. All non-fatal outcomes are captured from patient and clinical reports with independent blinded adjudication. Study design and oversight are by a multidisciplinary stakeholder team including a 10-patient advisory board.

Ethics and dissemination

The Institutional Review Board of the Medical University of South Carolina provides central regulatory oversight. Patients aged 21 or older undergoing primary or revision hip or knee replacement are block randomised by site and procedure; those on chronic anticoagulation are excluded. Recruitment commenced at 30 North American centres in December 2016. Enrolment currently exceeds 13 500 patients, representing 33% of those eligible at participating sites, and is projected to conclude in July 2024; COVID-19 may force an extension. Results will inform antithrombotic choice by patients and other stakeholders for various risk cohorts, and will be disseminated through academic publications, meeting presentations and communications to advocacy groups and patient participants.

Trial registration

NCT02810704.
Agreement of implantable collamer lens sizes using parameters from different devices
Authors: Nonpassopon Manachai , Jongkhajornpong Passara , Phimpho Prae , Cheewaruangroj Nontawat , Lekhanont Kaevalin , Chuckpaiwong Varintorn
Published: March 2022

Objective

To assess agreement and repeatability of white-to-white (WTW) and anterior chamber depth (ACD), and agreement of implantable collamer lens (ICL) size using these measurements from different devices.

Methods and analysis

A retrospective review of 83 eyes with ICL implantation (42 patients) was conducted. The agreement of WTW (measured with WaveLight Topolyzer and Orbscan IIz) and ACD (measured with WaveLight Oculyzer and Orbscan IIz) was analysed. Correlation of ICL sizes and difference of eyes with unacceptable vaults between two data sets (WaveLight platform; Topolyzer and Oculyzer and Orbscan IIz) were assessed.

Results

Average WTW measured by Orbscan IIz and Topolyzer demonstrated good agreement (Ρ 0.884) with low systematic bias (−0.03±0.1 mm) and narrow 95% limits of agreement (LoA) of −0.28 to 0.22. Average ACD measured by Orbscan IIz and Oculyzer also showed good agreement (Ρ 0.903) with low systematic bias (−0.04±0.1 mm) and relatively narrow 95% LoA (0.2 to 0.12). ICL size selected according to two data sets showed moderate to strong level of agreement (Kappa=0.81). There was a statistically significant difference (p<0.001) in the proportion of eyes with unacceptable postoperative vaults when using the Wavelight platform data set (five eyes, 6.02%) and the Orbscan IIz data set (12 eyes, 14.46%).

Conclusion

Although the agreement of WTW and ACD between devices was good, there was a significant difference in proportion of eyes with unacceptable postoperative vaults when using two data sets. Therefore, Topolyzer and Oculyzer might not be suitable for operating interchangeably with Orbscan IIz for ICL size selection.
Are we overlooking alcohol use by younger children?
Authors: Skylstad Vilde , Babirye Juliet Ndimwibo , Kiguli Juliet , Skar Ane-Marthe Solheim , Kühl Melf-Jakob , Nalugya Joyce Sserunjogi , Engebretsen Ingunn Marie Stadskleiv
Published: March 2022

Alcohol use is a leading contributor to the burden of disease among youth. Early-onset use is associated with later life dependency, ill health and poor social functioning. Yet, research on and treatment opportunities for alcohol use among younger children are scarce. Despite knowledge that alcohol intake occurs in childhood, and the fact that children understand alcohol related norms and develop alcohol expectancies from age 4, younger children are rarely included in studies on alcohol use.Patterns of early alcohol use vary greatly across the globe and are part of complex interplays between sociocultural, economic and health-related factors. Family influence has proven important, but genetic factors do not seem to play a crucial role at this age. Stressful circumstances, including mental health problems and sociocultural factors can entice alcohol use to cope with difficult situations. The World Health Organization has developed guidelines for effective strategies to reduce the harmful use of alcohol, including preventative and treatment interventions, but important gaps in implementation remain. An increased focus on research, policy and implementation strategies related to early alcohol use is warranted, granted its wide-ranging implications for public health and social functioning. In this summary of literature on alcohol use among younger children and adolescents, we show that younger children (aged 10 and younger) tend to be systematically overlooked. However, research, interventions and policy implementation strategies need to include younger children to mitigate the global burden of harmful alcohol use more effectively.
Population-based study of influenza and invasive meningococcal disease among Greek children during the COVID-19 pandemic
Authors: Ktena Danai , Kourkouni Eleni , Kontopidou Flora , Gkolfinopoulou Kassiani , Papadima Kalliopi , Georgakopoulou Theano , Magaziotou Ioanna , Andreopoulou Anastasia , Tzanakaki Georgina , Zaoutis Theoklis , Papaevangelou Vassiliki
Published: March 2022

Background

Aiming to the containment of the coronavirus disease 2019 (COVID-19) pandemic, governments worldwide have implemented a series of non-pharmaceutical interventions. Many of them and especially school closures have impacted the circulation of multiple airborne pathogens among children and adolescents. This study investigates the incidence of influenza and invasive meningococcal disease among children aged 0–14 years in Greece during the COVID-19 pandemic.

Methods

Data regarding the number of influenza-like illness cases, influenza-related paediatric intensive care unit (PICU) admissions and invasive meningococcal disease cases among children 0–14 years old were obtained from the National Public Health Organization. The incidence of the two diseases during the COVID-19 pandemic period (2020/2021) was compared with that of the six preceding seasons (2014–2019).

Results

A notable decrease was observed in both influenza and invasive meningococcal disease cases during the period 2020/2021 compared with the years 2014–2019. The mean annual rate of influenza-like illness cases and influenza-related PICU admissions in children 0–14 years old has reduced by 66.9% and 100%, respectively, while the mean annual invasive meningococcal disease rate has declined by 70%. Both weekly influenza-like illness and monthly invasive meningococcal disease rates were significantly decreased.

Conclusions

The activity of influenza and invasive meningococcal disease in the children and adolescents of Greece has decreased during the COVID-19 pandemic period. Reduced transmission is likely related to the public health measures that were implemented to control the pandemic. The value of these measures may have relevance to the future management of influenza or invasive meningococcal disease epidemics.