bluuebunny/crossref_metadata_2025 huggingface dataset:
Meta Salud Diabetes for cardiovascular disease prevention in Mexico: a cluster-randomized behavioural clinical trial
Authors: Rosales Cecilia B , Denman Catalina A , Bell Melanie L , Cornejo Elsa , Ingram Maia , del Carmen Castro Vásquez María , Gonzalez-Fagoaga Jesús Eduardo , Aceves Benjamín , Nuño Tomas , Anderson Elizabeth J , Guernsey de Zapien Jill
Published: March 2021

Background

Healthy lifestyle interventions offered at points of care, including support groups, may improve chronic disease management, especially in low-resource populations. We assessed the effectiveness of an educational intervention in type 2 diabetes (T2D) support groups to reduce cardiovascular disease (CVD) risk.

Methods

We recruited 518 participants to a parallel, two-arm, cluster-randomized, behavioural clinical trial across 22 clinics in Sonora, Mexico, between August 2016 and October 2018. We delivered a 13-week secondary prevention intervention, Meta Salud Diabetes (MSD), within the structure of a support group (GAM: Grupo de Ayuda Mutua) in government-run (community) Health Centres (Centros de Salud). The primary study outcomes were difference in Framingham CVD risk scores and hypertension between intervention (GAM+MSD) and control (GAM usual care) arms at 3 and 12 months.

Results

CVD risk was 3.17% age-points lower in the MSD arm versus control at 3 months [95% confidence interval (CI): −5.60, −0.75, P = 0.013); at 12 months the difference was 2.13% age-points (95% CI: −4.60, 0.34, P = 0.088). There was no evidence of a difference in hypertension rates between arms. Diabetes distress was also lower at 3 and 12 months in the MSD arm. Post-hoc analyses showed greater CVD risk reduction among men than women and among participants with HbA1c < 8.

Conclusions

MSD contributed to a positive trend in reducing CVD risk in a low-resource setting. This study introduced an evidence-based curriculum that provides T2D self-management strategies for those with controlled T2D (i.e. HbA1c < 8.0) and may improve quality of life.
Development of COVID-19 vaccines utilizing gene therapy technology
Authors: Nakagami Hironori
Published: March 2021

There is currently an outbreak of respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Coronavirus disease 2019 (COVID-19) is caused by infection with SARS-CoV-2. Individuals with COVID-19 have symptoms that are usually asymptomatic or mild in most initial cases. However, in some cases, moderate and severe symptoms have been observed with pneumonia. Many companies are developing COVID-19 vaccine candidates using different technologies that are classified into four groups (intact target viruses, proteins, viral vectors and nucleic acids). For rapid development, RNA vaccines and adenovirus vector vaccines have been urgently approved, and their injection has already started across the world. These types of vaccine technologies have been developed over more than 20 years using translational research for use against cancer or diseases caused by genetic disorders but the COVID-19 vaccines are the first licensed drugs to prevent infectious diseases using RNA vaccine technology. Although these vaccines are highly effective in preventing COVID-19 for a short period, safety and efficiency evaluations should be continuously monitored over a long time period. As the time of writing, more than 10 projects are now in phase 3 to evaluate the prevention of infection in double-blind studies. Hopefully, several projects may be approved to ensure high-efficiency and safe vaccines.
The survival of non-traumatic osteonecrosis of femoral head at ARCO II with ring-shaped sclerotic zone: a mid-term follow-up retrospective study
Authors: Wu Zhong-Shu , Hong Guoju , Yang Peng , Yang Fan , Chen Zhen-Qiu , He Wei , Wei Qiu-Shi
Published: March 2021

The sclerotic zone in the osteonecrosis of femoral head (ONFH), containing condensed trabecular bone and abundant neovascularization, is the transition area between osteonecrosis and normal tissue. Due to the prominent feature in ONFH, the characteristics of the sclerotic zone might indicate the femoral head survival of the disease. Thirty ONFH patients (41 hips) with ring-shaped sclerotic zone at Association Research Circulation Osseous-II were recruited during 1996 to 2019, and the corresponding radiographic images in their follow-up are reviewed retrospectively. Two subtypes (type A and B) are defined to discriminate different locations of ring-shaped sclerotic zone in the femoral head (center or subchondral bone plate) in accordance with the radiographic images. The natural history of the enrolled subjects was followed up for average 9 years to record and compare their collapse incidences as well as the progress of hip symptoms. Chi-square test shows that the occurrence rates of symptomatic hip of type A are significantly lower than that of type B and differences between these two groups were significant (P < 0.05). Kaplan Meier survival curve analysis shows that the mean survival time of type A is 247.600 M (95% CI: 203.072 ∼ 292.128 M) and type B is 88.795 M (95% CI: 72.607 ∼ 104.984 M). The survival rate of femoral head of type A is significantly higher than that of type B (P < 0.005). This study demonstrates that type A shows a more satisfactory clinical outcomes and lower femoral head collapse rate in a mid-term follow-up.
#40: Next-generation Sequencing Improves the Diagnosis of Uncommon Infection in children with Hematologic Malignancies: A Case Series Study
Authors: Zhou Mi , Xiao Peifang , He Hailong , Lu Jun , Li Jie , Hu* Shaoyan
Published: March 2021

Background

Children with hematological malignancies are at high risk of infection. Various kinds of pathogens may cause infection in these patients. The effect of traditional methods on these patients is not ideal.

Methods

This was a case series study. The cases of five patients with clinical symptoms of pulmonary infection. Next-generation sequencing (NGS) was used to identify pathogens in these 5 patients.

Results

Uncommon pathogens were detected in five patients. Case information are shown in Table 1.

Conclusion

NGS may serve as a promising tool for rapid and accurate etiological diagnosis, which could greatly improve the diagnosis of uncommon infection in children with hematologic malignancies.
#18: Brincidofovir for the Treatment of Disseminated Human Adenovirus Infection in Pediatric Solid-organ Transplant Recipients
Authors: Londeree Jackson , Garro Rouba , Romero Rene , George Roshan , Winterberg Pamela , Liverman Rochelle , Serluco Anastacia , Shin Stella , Yildirim Inci
Published: March 2021

Background

Human adenovirus (HAdV) viremia can cause significant morbidity among pediatric patients undergoing solid-organ transplantation (SOT). Currently, there are no US Food and Drug Administration (FDA)-approved treatments for HAdV infections, and historically the mainstay of treatment has been decreasing immunosuppression with antiviral therapies reserved for those with severe disease. Brincidofovir (BCV) is an investigational antiviral drug with potency against HAdV. We describe four cases of disseminated HAdV infection treated with (BCV) among pediatric SOT patients.

Methods

We retrospectively reviewed 4 cases of severe disseminated HAdV infection, which occurred between 2018 and 2019, in a tertiary pediatric transplant center. HAdV infection was defined as a positive HAdV PCR from a clinical specimen. Baseline clinical characteristics, disease course, treatment, and outcomes were reviewed.

Results

Four pediatric SOT patients (2 kidneys, 1 dual kidney/liver, and 1 liver) ranging in age from 9 months to 19 years were diagnosed with HAdV infection (Table 1). Patients presented with varied symptoms from 12 to 912 days post-transplant. Peak HAdV viral load ranged from 37,000 to >1,000,000 copies/mL. All patients had disseminated disease with evidence of graft involvement and varying degrees of acute kidney injury (AKI) making them candidates for BCV therapy over cidofovir to avoid nephrotoxicity. Three out of four patients received cidofovir prior to conversion to BCV. IRB-approved compassionate use of BCV was dosed at 2 mg/kg (max 100 mg) twice weekly PO along with reduced immunosuppression. Resolution of symptoms and HAdV viremia was seen at a mean of 21.5 days (range 15–32) of therapy. All patients had resolution of AKI with a return to baseline creatinine after therapy.

Conclusions

Though HAdV infection in pediatric SOT patients is uncommon, a subset of patients experience severe disease, morbidity, and graft loss. Currently, HAdV is not routinely monitored in pediatric SOT transplant patients. Although supportive care and decreased immunosuppression remain as the most important component of therapy, BCV was well tolerated and efficacious in our series. Further research is needed to better understand risk factors for HAdV infection and potential antiviral treatment options to improve patient outcomes.
#30: Patterns of Post-Exposure Prophylaxis for Varicella-Zoster Virus in Pediatric Patients
Authors: Sun Shan , Patel Sameer , Jhaveri Ravi
Published: March 2021

Background

Varicella-Zoster virus (VZV) is still a significant threat for severe illness for patients in high-risk groups. These patients are candidates for post-exposure prophylaxis (PEP), but among adult providers there is significant variation on what agents are used for PEP. There are little data on PEP practices among pediatric providers.

Objective

We sought to define patterns of PEP for VZV exposure across children’s hospitals.

Methods

Using the Pediatric Health Information Systems database, we analyzed claims data for the relevant ICD-9/10 codes for VZV exposure from 2009 to 2018. We evaluated patients for subsequent VZV disease, and we also evaluated how frequently PEP was given, how many days after the exposure or admission, and what agent was used for PEP. We analyzed annual data and institutional-level data over the study period and looked for trends over time. We performed Kruskal–Willis testing when comparing more than two independent samples of equal or different sample sizes.

Results

Over the 10 years, we identified 1726 children with VZV exposure, 1622 of them with only one exposure. Of these 1662 children, 683 (42.1%) were prescribed some form of PEP after VZV exposure, while 75 (4.6%) ultimately developed some form of symptomatic VZV. Among the agents used for VZV PEP, acyclovir along was the most frequently used overall, but its use declined over time (45% in 2009 to 30% in 2018). Immunoglobulin was the second most used option (26–43%), while a consistent percentage (4–19%) of children also received the combination of acyclovir and IG. Varicella-specific immune globulin (VariZIG) was used sparingly before 2013, but its use was more frequent from 2015 to 2018 (23–27%). Most children receiving VZV PEP had some form of malignancy, with various newborn populations comprising most of the rest of PEP recipients. Efficacy in preventing VZV was significantly different: 27/218 (12.4%) of children with acyclovir PEP ultimately had a VZV-diagnosis code, compared with 1/148 (0.7%) and 1/112 (0.9%) treated, respectively, with either IG or VariZIG (P < 0.0001).

Conclusions

Increasing use of VariZIG likely corresponded to widespread US availability after a long market absence. Nonetheless, the management of VZV PEP in children with high-risk conditions varied considerably across institutions. As the CDC and AAP Red Book list VariZIG as the primary option for PEP, there is considerable room to optimize PEP practice and reduce breakthrough VZV infections.
#79: Modeling Zika Virus Tissue Tropism in Rhesus Macaques to Define the Risk of Donor-derived Transmission
Authors: Treadway Taylor A , Shepherd Phoenix M , Newman Christina M , Mohr Emma L , Dudley Dawn M , Breitbach Meghan E , Yamamoto Keisuke , Stewart Laurel M , Koenig Michelle R , Bliss Mason , Rybarczyk Sierra L , Weiler Andrea M , Semler Matthew R , Mitzey Ann , Razo Elaina , Schotzko Michele , Peterson Eric , Simmons Heather A , Mejia Andres , Golos Thaddeus G , Friedrich Thomas C , O’Connor David H
Published: March 2021

Background

Almost 115,000 people in the United States are currently on a transplant waitlist, which vastly exceeds the number of organ donors every year. This discrepancy emphasizes the need for retention of all possible donors. Those who have recently traveled to an area with an active outbreak of Zika virus (ZIKV) are often disqualified as a donor because immunosuppressed recipients would be at risk of a donor-derived ZIKV infection. Therefore, we define ZIKV tissue tropism and the risk of donor-derived transmission.

Methods

We subcutaneously inoculated 15 Indian-origin rhesus macaques (RM) with a Puerto Rican isolate of ZIKV (PRVABC59). All RMs were inoculated in mid to early gestation. We inoculated during pregnancy because plasma viremia is typically prolonged in pregnancy and we wanted to model tissue tropism for donor-derived transmission in the worst scenario of prolonged viremia. At 30, 65, and 105 days post-infection (dpi), the animals were euthanized and comprehensive necropsies were performed, which evaluated a minimum of 60 tissues per animal. ZIKV RNA was quantified in tissues via qRT-PCR.

Results

Plasma viremia duration was >10 days in 13 of 15 RMs. ZIKV RNA was most commonly detected in lymph nodes, with 19/45 lymph nodes that were vRNA positive in 5 RMs at 30 dpi. There were 15/45 vRNA positive lymph nodes at 60 dpi and 8/38 at 105 dpi. Reproductive and maternal fetal-interface (MFI) tissues were the second most commonly positive tissues. Twenty-five MFI tissues, including the amniotic/chorionic membrane, decidua, placenta, uterus, and placental bed, were positive, with 10/53 positive at 30 dpi, 14/24 positive at 60 dpi and 1/47 positive at 105 dpi. Other vRNA positive tissues included the primary bronchus, femoral vein, kidney, thyroid, lung, colon, mammary gland, pericardium, hand nerve, and sciatic nerve in 1–2 RMs at one of the three timepoints.

Conclusions

We found ZIKV RNA most frequently within lymph nodes. Lymph nodes are included in lung and small bowel transplants, indicating that these transplants could pose a risk of donor-derived ZIKV transmission. Virus detection within other commonly transplanted tissues, such as the kidney and blood vessels was much less common. We did not determine what fraction of vRNA comes from replication-competent virus in each tissue; some tissues with vRNA might not contain virions that could initiate new infections. Donor-derived Zika virus transmission from other commonly transplanted organs, such as the liver, seems unlikely since no viral RNA was detected in this organ.
#87: Association Between Healthcare-Associated Respiratory Viral Infections and Length of Stay at a Pediatric Hospital
Authors: Most Zachary , Sebert Michael , Jackson Patricia , Perl Trish M
Published: March 2021

Background

Healthcare-associated infections (HAI) are major preventable causes of morbidity and mortality. While there are fewer overall HAI in children, there is a greater potential impact in disability-adjusted life years. Healthcare-associated respiratory viral infections (HARVI) are not frequently tracked within institutions, yet the risk for such infections in pediatric hospitals is very high. Recent data demonstrate large inter-hospital variability of HARVI incidence that may depend on various factors including the number of immunocompromised patients in the hospital and the presence of shared rooms. We hypothesize that the burden of healthcare-associated respiratory viral infections and their impact on the length of stay (LOS) is substantial at a large urban pediatric hospital.

Methods

A cohort of all children with any HARVI admitted to a large urban pediatric hospital between July 2017 and June 2018 were included after obtaining IRB approval. We defined a HARVI as a respiratory infection with an onset of symptoms while the patient was hospitalized meeting three criteria: A positive microbiologic test for one of 8 viruses, presence of symptoms of a respiratory infection, and onset of symptoms after admission beyond the minimum incubation period for each virus. Infections with symptom onset after admission beyond the maximum incubation period were considered definite hospital onset whereas others were considered possible hospital onset. The electronic medical record provided data on demographics, underlying medical conditions, hospital length of stay prior to infection and hospital unit of infection, and consequences and outcome of HARVI. The at-risk population for calculation of the incidence of HARVI was all admitted patient-days at the hospital over this time period.

Results

Between July 2017 and June 2018 the incidence of HARVI (definite or possible hospital onset) was 1.2 infections per 1,000 admitted patient-days (60% due to rhinovirus/enterovirus, 12% due to respiratory syncytial virus, and 9% due to influenza). Overall, 48% of patients were under 2 years of age, 18% were between 2 and 5 years of age, and 34% were over 5 years of age. Twenty-one percent were immunocompromised and 35% had underlying lung disease. The median length of stay prior to symptom onset was 11 days (IQR 5–36 days) and the median total length of stay was 30 days (IQR 15–82.5 days). Eight individuals had more than one HARVI over this time period. Nineteen percent were transferred to the intensive care unit and 7% died during their hospital admission

Conclusion

HARVI occurs frequently in a pediatric hospital and often in patients with underlying comorbidities. The risk for HARVI increases substantially with increased length of stay. Such data support the need for tracking HARVI in high-risk institutions.
#8: Survival Analysis in Childhood Acute Myeloblastic Leukemia: Do Infection and Lymphocyte-Mediated Immune Response Play a Role?
Authors: Ardianto Bambang ,   Christine, Triasih Rina , Supriyadi Eddy , Widjajanto Pudjo Hagung , Mulatsih Sri , Pangarso Alexandra Widita Swipratami , Armytasari Inggar , Purwanto Ignatius ,   Sutaryo
Published: March 2021

Background

Acute myeloblastic leukemia (AML) is the second most prevalent cancer among Indonesian children. In contrast, to those of acute lymphoblastic leukemia (ALL), a number of studies reported unfavorable outcomes following the initiation of cytostatic protocols for childhood AML. In addition, our previous study showed that Gram-negative bacterial infection constitutes the major cause of treatment-related mortality in children with AML. These findings raised a question on the prognostic role of diagnostic lymphopenia, which represents the immunosuppressive state, as demonstrated in adult patients with solid tumors.

Methods

A retrospective cohort study, which involved children younger than 18 years of age with the newly diagnosed, non-M3 AML, was conducted. These children were admitted to Dr. Sardjito General Hospital, Yogyakarta, Indonesia, during the period of 2011–2019 and received National Pilot Protocol (2011–2016), Pediatric AML Protocol (2016–2018), and International Society of Pediatric Oncology (SIOP) Pediatric Oncology in Developing Countries (PODC) Protocol with prephase (2018–2019). One-year overall survival (OS) was analyzed, using diagnostic absolute lymphocyte counts (ALC0) of more than 4.5 × 109/L and less than 4.5 × 109/L as the determinants, in accordance with those reported in a number of studies on adult AML.

Results

Sixty-five children, which consisted of 41 (63%) children with ALC0 of more than 4.5 × 109/L and 24 (37%) children with ALC0 of less than 4.5 × 109/L, were eligible for this study. Of these 65 children, 56 (86%) children received Cytosine arabinoside in the first week of treatment (National Pilot Protocol and Pediatric AML Protocol), while 9 (14%) children did not (SIOP PODC Protocol with prephase). OS analysis showed that 44% and 19% of children with ALC0 of more than 4.5 × 109/L and ALC0 of less than 4.5×109/L, respectively, were alive within the first year of treatment. Cox-regression analysis, however, failed to reach statistical significance [hazard ratio (HR), 0.63; 95% confidence interval (95% CI), 0.33–1.18; P = 0.15].

Conclusion

Despite lacked statistical significance, our study showed the superior one-year OS in children with ALC0 of more than 4.5 × 109/L. Our findings, therefore, might indicate the prognostic role of infection and lymphocyte-mediated immune response in childhood AML.
#33: A Tale of Two Pneumos: the Impact of HIV Exposure or Infection Status on Pediatric Carriage of Streptococcus pneumoniae and Pneumocystis jirovecii, a Nested Case–control Analysis from the Pneumonia Etiology Research in Child Health (PERCH) study in Zambia
Authors: Camelo I , Mwananyanda L M , Thea D M , Seidenberg P , Gill C J , Weinstein J R
Published: March 2021

Background

Most pediatric HIV cases in Africa reflect maternal to child transmission (MTCT). The persistently high seroprevalence of HIV in pregnant women (16.6%) and the low rates of mother to child HIV transmission (~2%) have resulted in a high number of children who are HIV exposed but uninfected (HEU). HIV exposed but uninfected (HEU) children have increased rates of morbidity and mortality vs. HIV unexposed and uninfected (HUU).

Methods

To explore the mechanisms behind this phenomenon, each case and control was sampled using a nasopharyngeal NP swab and an oropharyngeal (OP). A multiplex real-time polymerase chain reaction (PCR) assay was used to determine the presence of Streptococcus pneumoniae and Pneumocystis jirovecii in the NP/OP specimens. We compared nasopharyngeal carriage rates of S. pneumoniae and P. jirovecii between HIV-infected, HEU, or HUU case (pneumonia) and control (without pneumonia) children. In bivariate analyses, using carriage as a dichotomous outcome, proportions we compared using chi-square or odds ratios with 95% confidence intervals. In multivariate models, we created logistic and linear regression models adjusting for nutritional status as possible mediators of carriage status.

Results

SP carriage rates were similar between cases and controls. However, density was increased among HIV-infected children vs. HEU or HUU children (15.8 vs. 4.7 vs. 3.6 × 105 copies/mL, respectively). Among cases, PJ carriage among HIV positive, HEU and HUU children was 31%, 15% and 10%,, respectively, (P < 0.05) and carriage density was 63.9, 20.9, and 4.8 × 103 copies/mL, respectively (P < 0.05). In adjusted logistic regression models, HIV-infected cases were slightly more likely to be an S. pneumoniae carrier compared with HUU cases (aOR = 1.1; 95% CI: 0.57–2.14). In contrast, all other case/exposure combinations were less likely to be S. pneumoniae carriers with the lowest adjusted odds among HIV-infected controls children (aOR = 0.34; 95% CI: 0.17–0.71). The odds of being a PJ carrier was almost 6 times higher in HIV-infected cases than in HIV unexposed cases (aOR = 6.63; 95% CI: 3.24–13.54).

Conclusions

We demonstrate that HIV infection and HIV exposure without infection each have an impact on carriage rates and density for S. pneumoniae and P. jirovecii, though the magnitude and nature of these effects differs substantially between the two pathogens. This may be explained in part by differences in immune responses to these two different pathogens. Our analysis provides further evidence of fundamental differences in immune function among HIV exposed but uninfected infants compared with HIV unexposed, uninfected infants.
#66: An Educational Needs Assessment of Oral Health Knowledge, Attitude and Practices Among Graduates of St. Jude Global Infectious Diseases Training Programs
Authors: Pardasani S , Homsi M , Mzayek F , Nolan V G , Caniza M
Published: March 2021

Background

Chemotherapy and radiotherapy for oncologic diseases can cause oral complications during therapy or thereafter. These oral complications and their consequences may interfere with cancer treatment, prolong hospital stay, and increase overall treatment costs. Therefore, oral examination of children with cancer by healthcare providers must be part of routine clinical examination. According to published literature, oral examination and recommendations of best oral care in children with cancer might not be routinely practiced and varies among providers. We suspect that personal knowledge, attitude and practice may play an important role in the routine practice of healthcare professionals and that the introduction of an oral health curriculum may complement existing practice. To tailor oral health training, we must know the healthcare professional’s educational needs and their attitude toward oral health.

Methods

Steps followed to build the needs assessment of our targeted learners included: (1) literature review of published surveys; (2) reviews of oral healthcare policies; (3) key-informant interviews with practicing healthcare providers regarding oral health training; (4) selection of essential survey items; (5) face validity; and (6) pilot testing. We used the ©2019Qualtrics® software to build this survey. Face validity was evaluated and approved by five subject matter and survey experts. Graduates of the St. Jude Global Infectious Disease training served as pilot testing subjects.

Results

Interviews indicated that information about oral health examination is often contained in institutional policies; training in oral health is cursory. Surveys published in the literature have assessed knowledge related to oral complications such as oral mucositis and dental caries. We have added gingival conditions to our survey, which is also one of the most prevalent oral manifestation in pediatric cancer patients. Our 31-item survey is comprised of multiple choice and Likert scale questions distributed in seven sections, namely: (1) demographics; (2) clinical settings; (3) participant’s view of own oral healthcare; (4) knowledge and practice on oral infections; (5) knowledge, attitude and practice of oral examination; (6)attitude and practice of oral healthcare preventive measures, and; (7) continuing education. Validity testing indicated two questions that required modifications—the definition of plaque, its causes, and oral infections and manifestations. The final survey tool will take participants approximately 15 minutes to complete.

Conclusion

We developed a 31-item survey tool that will be used for assessing the needs of global healthcare providers, from which we can develop targeted and appropriate educational programs.
An ontology of masters of the Babylonian Talmud
Authors: Giovannetti Emiliano , Albanesi Davide , Bellandi Andrea , Dattilo David , Del Grosso Angelo Mario , Marchi Simone
Published: March 2021

The purpose of this research is to build an ontology of the masters appearing in the Babylonian Talmud (BT). The ontology built so far has been shared as a Linked Open Data and it will be linked to existing vocabularies. This work has been developed in the context of the Babylonian Talmud Translation Project, where more than eighty Talmudists are working together, since 2012, at the translation (comprehensive of explicative notes and glossaries) of the Talmud into Italian. The construction of the resource has involved the application of tools leveraging on computational linguistics approaches. The ontology, already describing more than 500 masters, constitutes the first portion of a more comprehensive Talmudic Knowledge Base where the text itself, the terminology, the entities, and the concepts constituting the BT will be formalized and linked to each other.
Risk Area 4: Managing Challenging Behaviors
Authors: Burgio Louis D. , Wynn Matthew J.
Published: March 2021

This chapter describes one of the five risk areas, namely, managing challenging behaviors. The chapter begins with a description of the ABC Process of Behavior Management. Learning this process will help clinicians structure the development of individualized Action Plans and target behavior with the greatest likelihood of success. The chapter also includes instructions to format Challenging Behavior Action Plans as well as guidelines for presenting these Action Plans to the caregiver. The chapter ends with tips, reminders, and advice for clinicians on working with caregivers to reduce and manage challenging behaviors of the person with dementia.
Severe School Attendance Problems and Extended Time Out of School
Authors: Kearney Christopher A.
Published: March 2021

This chapter provides an overview of severe school attendance problems or those that have been recurring for more than several months and likely over a period of years. The chapter offers suggestions for pursuing alternative paths toward graduation that could include virtual or online learning, home-based instruction, alternative schools and academic programs, and accruing formal credits in nontraditional ways. Other suggestions include pursuing community support for mental health problems and family conflict that may need to be addressed prior to a new academic plan. The chapter also addresses circumstances under which a child may be out of school for an extended period of time due to crises beyond the family’s control, such as the current pandemic. Additional resources and final comments are provided as well.
Suppression of liquid–liquid phase separation by 1,6-hexanediol partially compromises the 3D genome organization in living cells
Authors: Ulianov Sergey V , Velichko Artem K , Magnitov Mikhail D , Luzhin Artem V , Golov Arkadiy K , Ovsyannikova Natalia , Kireev Igor I , Gavrikov Alexey S , Mishin Alexander S , Garaev Azat K , Tyakht Alexander V , Gavrilov Alexey A , Kantidze Omar L , Razin Sergey V
Published: March 2021

Liquid–liquid phase separation (LLPS) contributes to the spatial and functional segregation of molecular processes within the cell nucleus. However, the role played by LLPS in chromatin folding in living cells remains unclear. Here, using stochastic optical reconstruction microscopy (STORM) and Hi-C techniques, we studied the effects of 1,6-hexanediol (1,6-HD)-mediated LLPS disruption/modulation on higher-order chromatin organization in living cells. We found that 1,6-HD treatment caused the enlargement of nucleosome clutches and their more uniform distribution in the nuclear space. At a megabase-scale, chromatin underwent moderate but irreversible perturbations that resulted in the partial mixing of A and B compartments. The removal of 1,6-HD from the culture medium did not allow chromatin to acquire initial configurations, and resulted in more compact repressed chromatin than in untreated cells. 1,6-HD treatment also weakened enhancer-promoter interactions and TAD insulation but did not considerably affect CTCF-dependent loops. Our results suggest that 1,6-HD-sensitive LLPS plays a limited role in chromatin spatial organization by constraining its folding patterns and facilitating compartmentalization at different levels.
The promises, challenges and pathways to room-temperature sodium-sulfur batteries
Authors: Wang Lei , Wang Tao , Peng Lele , Wang Yiliu , Zhang Meng , Zhou Jian , Chen Maoxin , Cao Jinhui , Fei Huilong , Duan Xidong , Zhu Jian , Duan Xiangfeng
Published: March 2021

Room-temperature sodium-sulfur batteries (RT-Na-S batteries) are attractive for large-scale energy storage applications owing to their high storage capacity as well as the rich abundance and low cost of the materials. Unfortunately, their practical application is hampered by severe challenges, such as low conductivity of sulfur and its reduced products, volume expansion, polysulfide shuttling effect and Na dendrite formation, which can lead to rapid capacity fading. The review discusses the Na-S-energy-storage chemistry, highlighting its promise, key challenges and potential strategies for large-scale energy storage systems. Specifically, we review the electrochemical principles and the current technical challenges of RT-Na-S batteries, and discuss the strategies to address these obstacles. In particular, we give a comprehensive review of recent progresses in cathodes, anodes, electrolytes, separators and cell configurations, and provide a forward-looking perspective on strategies toward robust high-energy-density RT-Na-S batteries.
Photosystem II-based biomimetic assembly for enhanced photosynthesis
Authors: Xuan Mingjun , Li Junbai
Published: March 2021

Photosystem II (PSII) is a fascinating photosynthesis-involved enzyme, participating in sunlight-harvest, water splitting, oxygen release, and proton/electron generation and transfer. Scientists have been inspired to couple PSII with synthetic hierarchical structures via biomimetic assembly, facilitating attainment of natural photosynthesis processes, such as photocatalytic water splitting, electron transfer and ATP synthesis, in vivo. In the past decade, there has been significant progress in PSII-based biomimetic systems, such as artificial chloroplasts and photoelectrochemical cells. The biomimetic assembly approach helps PSII gather functions and properties from synthetic materials, resulting in a complex with partly natural and partly synthetic components. PSII-based biomimetic assembly offers opportunities to forward semi-biohybrid research and synchronously inspire optimization of artificial light-harvest micro/nanodevices. This review summarizes recent studies on how PSII combines with artificial structures via molecular assembly and highlights PSII-based semi-natural biosystems which arise from synthetic parts and natural components. Moreover, we discuss the challenges and remaining problems for PSII-based systems and the outlook for their development and applications. We believe this topic provides inspiration for rational designs to develop biomimetic PSII-based semi-natural devices and further reveal the secrets of energy conversion within natural photosynthesis from the molecular level.
National Prevalence of Influenza Diagnoses and Vaccination Rates Among Patients Presenting to United States Physician Offices and Hospital Outpatient Departments, 2009 to 2016
Authors: Young Eric H , Yap Alex G , Vargas Michelle N , Strey Kelsey A , Hao Alan , Reveles Kelly R
Published: March 2021

Background

Influenza health resource utilization studies are important to inform future public health policies and prevent outbreaks. This study aimed to describe influenza prevalence, vaccination, and treatment among outpatients in the United States and to evaluate population-level characteristics associated with influenza health resource utilization.

Methods

Data were extracted from the National Ambulatory and National Hospital Ambulatory Medical Care Surveys (2009 to 2016). Prevalence rates were described as influenza visits (defined by International Classification of Diseases, Ninth Revision, Clinical Modification or International Classification of Diseases, Tenth Revision code) per 1000 total visits overall and by flu year, month, region, race, and age group. Influenza vaccination and antiviral treatments were identified by Multum code(s) and presented as vaccination visits per 1000 total visits and the percentage of patients diagnosed with influenza receiving antiviral treatment.

Results

In more than 19.2 million patient visits, an influenza diagnosis was made with rates ranging from 1.2 per 1000 during 2014–2015 to 3.7 per 1000 during 2009–2010. Rates were highest in the South (3.6 per 1000), in December (5.2), among black patients (2.8), and those less than 18 years (6.8). Vaccination rates were highest during 2014–2015 (29.3 per 1000) and lowest during 2011–2012 (15.5 per 1000), in the West (23.4), in October (69.2), among “other race” patients (26.2), and age less than 18 years (51.4). Overall, 39.4% of patients with an influenza diagnosis received an antiviral.

Conclusions

Overall, there were no major changes in influenza diagnosis or vaccination rates. Patient populations with lower vaccination rates had higher influenza diagnosis rates. Future campaigns should promote influenza vaccinations particularly in underserved populations.
Severe Acute Respiratory Syndrome Coronavirus 2: Vaccine Hesitancy Among Underrepresented Racial and Ethnic Groups With HIV in Miami, Florida
Authors: Jones Deborah L , Salazar Ana S , Rodriguez Violeta J , Balise Raymond R , Starita Claudia Uribe , Morgan Kristiana , Raccamarich Patricia D , Montgomerie Emily , Nogueira Nicholas Fonseca , Barreto Ojeda Irma , Maddalon Marissa , Rodriguez Nicolle L Yanes , Brophy Theodora , Martinez Thais , Alcaide Maria L
Published: March 2021

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and human immunodeficiency virus (HIV) disproportionally affect underrepresented ethnoracial groups in the United States. Medical mistrust and vaccine hesitancy will likely impact acceptability of SARS-CoV-2 vaccines. This study examined SARS-CoV-2 vaccine hesitancy among underrepresented ethnoracial groups with HIV and identified factors that may reduce vaccine uptake.

Methods

We conducted a cross-sectional study of adults ≥18 years of age with HIV residing in Miami, Florida. Participants were invited to participate in the ACTION (A Comprehensive Translational Initiative on Novel Coronavirus) cohort study. A baseline survey was administered from April to August 2020 and followed by a coronavirus disease 2019 (COVID-19) vaccine hesitancy survey from August to November 2020. The COVID-19 vaccine hesitancy survey was adapted from the Strategic Advisory Group of Experts survey. Comparisons by race and ethnicity were performed using the Freedman-Haltmann extension of the Fisher exact test.

Results

A total of 94 participants were enrolled; mean age was 54.4 years, 52% were female, 60% were Black non-Latinx, and 40% were non-Black Latinx. Black non-Latinx participants were less likely to agree that vaccinations are important for health when compared to non-Black Latinx (67.8% vs 92.1%, P = .009), less likely to agree that vaccines are effective in preventing disease (67.8% vs 84.2%, P = .029), less likely to believe that vaccine information is reliable and trustworthy (35.7% vs 71.1%, P = .002), and less likely to believe vaccines were unnecessary because COVID-19 would disappear soon (11% vs 21%, P = .049).

Conclusions

Medical mistrust, vaccine hesitancy, and negative sentiments about SARS-CoV-2 vaccines are prevalent among underrepresented ethnoracial groups with HIV, particularly Black non-Latinx. Targeted strategies to increase vaccine uptake in this population are warranted.
Introduction
Authors: Schillig Michael
Published: March 2021

The Introduction provides a brief summary of the background for the reform legislation on recovery and resolution in the European Union and in the United States, with a particular focus on the ‘too-big-to-fail’ problem. It gives an overview of the content of the Bank Recovery and Resolution Directive, the Single Resolution Mechanisms for the eurozone, and the Orderly Liquidation Authority under the Dodd–Frank Act. It further seeks to provide some terminological and conceptual clarity as regards the subject matter of the book, notably with a view to delineating supervision, resolution, and corporate insolvency. The structure of the book is summarized in outline.
Recovery and Resolution Planning
Authors: Schillig Michael
Published: March 2021

Recovery and resolution planning represents an international consensus and is expected to significantly improve supervision, in particular with regard to systemically important institutions. With differences in detail on both sides of the Atlantic, the recovery and resolution planning regime is integrated into the ongoing supervision of an institution and essentially consists of recovery plans to be drawn up by institutions, resolution plans developed by resolution authorities, and the ongoing assessment of resolvability of institutions. Intra-group financial support agreements may play a significant role in this context. The chapter provides a critical assessment of these concepts with a focus on the political and cognitive obstacles (depiction-difficulty).
Corporate Rescue and Reorganization
Authors: Schillig Michael
Published: March 2021

The jurisdictions under consideration provide a range of options for effectuating corporate rescue or reorganization. Some of these procedures are long-standing and applicable across the board; others are new and financial institution-specific. In England and Wales, administration has been used successfully to restructure financial institutions in the past; the bank administration procedure is new and largely untested, whereas the investment bank special administration regime (SAR) has already been applied in several cases. Germany’s brand-new pre-insolvency procedures apply to credit institutions only, but do not look very promising when it comes to the restructuring of large, systemically important financial institutions. Chapter 11 of the US Bankruptcy Code is regarded as very effective. It was put to the test when Lehman Brothers filed for bankruptcy in the autumn of 2008. Many commentators believe that it has coped well. However, there is always room for improvement and an exciting reform debate is underway.
Contractual reliance damages
Authors: Burrows Andrew
Published: March 2021

The term ‘reliance interest’ was coined by Fuller and Perdue, whose classic article ‘The Reliance Interest in Contract Damages’ first clarified and explored the different possible objectives of damages for breach of contract. The aim of damages protecting the reliance interest is, according to Fuller and Perdue, ‘… to put the plaintiff in as good a position as he was in before the promise was made’. This can alternatively and preferably be expressed as aiming to put the claimant into as good a position as she would have been in if no contract had been made.
Principles limiting compensatory damages
Authors: Burrows Andrew
Published: March 2021

There can be said to be five principles limiting compensatory damages (ie which reduce the damages that full adherence to the compensatory aims would dictate) for both torts and breach of contract, and the role played by each can be briefly described as follows: The principal tests for remoteness centre on reasonable foreseeability or contemplation of the loss.
Form of compensatory damages, date for assessment, taxation
Authors: Burrows Andrew
Published: March 2021

The general rule can be expressed as follows: a court must assess in a lump sum all past, present, and future loss resulting from the particular tort or breach of contract being sued for, because no damages can be later given for a cause of action on which judgment has already been given. The classic authority is Fitter v Veal, where the claimant had been awarded £11 damages against the defendant in an action for assault and battery. His injuries proved to be more serious than at first thought and he had to undergo an operation on his skull. It was held that he could not recover for this further loss in a new action.
Pecuniary loss (except consequent on personal injury, death, or loss of reputation)
Authors: Burrows Andrew
Published: March 2021

Breach of contract damages are normally sought and awarded for this type of loss. It is therefore not surprising that there is a host of different ways of analysing and subdividing it. Here the approach adopted will be to divide between basic pecuniary loss, which will be primarily concentrated on, and which focuses on the benefit to which the claimant was contractually entitled and of which it has been wholly or partially deprived by the defendant’s breach, and additional pecuniary loss.
Mental distress or physical inconvenience (except consequent on personal injury or death)
Authors: Burrows Andrew
Published: March 2021

Mental distress covers, for example, disappointment, worry, anxiety, fear, upset, and annoyance. On the traditional approach taken by the courts, mental distress, along with ‘pain and suffering’ consequent on a personal injury and ‘bereavement’, compensated under the Fatal Accidents Act 1976, are the heads of non-pecuniary loss covering the claimant’s loss of happiness and distress in contrast to the other ‘objective’ non-pecuniary losses (such as ‘loss of amenity’ consequent on a personal injury and ‘loss of reputation’). On an alternative view, all non-pecuniary loss is regarded as ultimately dealing with distress or loss of happiness and ‘mental distress’ is seen as a residual head for distress not falling within any of the other heads.
Interest as damages and interest on damages
Authors: Burrows Andrew
Published: March 2021

The law on interest in English law is a tangled web. This is principally because the common law traditionally set itself against awards of interest and this has resulted in the piecemeal intervention of statutes which allow the award of interest in specific situations. In the leading modern case of Sempra Metals Ltd v IRC the House of Lords reformed the common law as regards awards of interest as compensatory damages for a tort or breach of contract (although the part of the decision that was concerned with interest as restitution of an unjust enrichment, which was the direct claim in question, was overruled by the Supreme Court in Prudential Assurance Co Ltd v HMRC). Sempra Metals was concerned with an award of compound interest (as damages or as restitution) which contrasts with the relevant statutes which allow awards of simple interest only.
Negotiating damages
Authors: Burrows Andrew
Published: March 2021

‘Negotiating damages’ are assessed according to the price which, prior to the wrong, the claimant could reasonably have charged the defendant for releasing the defendant from the duty that has been broken. In what is now the leading case of Morris-Garner v One Step (Support) Ltd, the view of the Supreme Court was that damages assessed in that way are best labelled ‘negotiating damages’.
Injunctions
Authors: Burrows Andrew
Published: March 2021

An injunction is an equitable remedy available for torts and breach of contract (and equitable wrongs) as well as being available in other situations outside the scope of this book. The approach adopted in this chapter will be to introduce briefly in this section the three important pairs of contrasting injunctions before going on in the next sections to examine in depth the principles governing the grant of each of the main types of injunction along with the function each performs as a remedy for torts and breach of contract. Although not an injunction, the final section of this chapter is considered the most appropriate place in this book to consider the remedy of the appointment of a receiver (and manager).
Cumulative Effect with Other Intellectual Property Rights
Authors: Stone David
Published: March 2021

Early debates discussed how best to overlay the proposed new rights with existing forms of intellectual property protection. Regimes differed in member states. Several, such as France, offered full cumulation of rights (unité de l’art). Most offered partial cumulation (for example, Germany and the United Kingdom). Italy prohibited cumulation under the principle of scindibilità. This chapter discusses Article 96 of the Regulation, which provides for overlap of rights, expressly mandating overlap with national copyright laws and allowing overlap with other forms of intellectual property protection.
Unitary Character of EU-wide Design Rights and Territorial Effect
Authors: Stone David
Published: March 2021

Community design rights are not bundles of national rights, but rather unitary rights that operate throughout the territory of the European Union. This chapter deals with the unitary character and geographic scope of the two EU-wide design rights—RCDs and unregistered Community designs. The nature and geographic extent of national (and Benelux) registered designs are not considered here.
Interpreting a Design
Authors: Stone David
Published: March 2021

In many cases, the tribunal is asked to assess the overall impression created on the informed user, not of a physical product made to the design, but rather a drawing, photograph, or other image (or series of drawings, photographs, or other images), which, in many cases, will have been crafted using various conventions such as dotted lines and shading.