bluuebunny/crossref_metadata_2025 huggingface dataset:
Genetics and the question of purity in cutthroat trout restoration
Authors: Biermann Christine , G. Havlick David
Published: August 2021

As molecular techniques become more advanced, scientists and practitioners are calling for restoration to leverage genetic and genomic approaches. We address the role of genetics in the restoration and conservation of cutthroat trout in the western United States, where new genetic insights have upended previous assumptions about trout diversity and distribution. Drawing on a series of examples, we examine how genetically pure trout populations are identified, protected, and produced through restoration practices. In landscapes that have been profoundly impacted by human activities, genetics can offer seemingly objective metrics for restoration projects. Our case studies, however, indicate that (1) genetic purity is fragile and contingent, with notions of what genetics are “pure” for a given species or subspecies continually changing, and (2) restoration focused on achieving “genetically pure” native populations can deliberately or inadvertently obscure the socioecological histories of particular sites and species, even as (3) many “genetically pure” trout populations have endured on the landscape as a result of human modifications such as roads and dams. In addition to raising conceptual questions, designations of genetic purity influence policy. These include tensions between restoring connectivity and restoring genetic purity, influencing Wild and Scenic River Act designations, and the securing of water rights. Cutthroat trout restoration would benefit from adopting a broader, more holistic framework rather than fixating exclusively or primarily on genetic purity and hybridization threats.
Formal adult education and socioeconomic inequality: Second chances or Matthew Effects?
Authors: Kosyakova Yuliya , Bills David B.
Published: August 2021

In countries around the world, population aging, technological change, and labor market transformations are leading to an increasing incidence of mismatch between the skills and credentials held by workers and those required by their jobs. This is leading large numbers of people to return to schooling to enhance their prospects in the workplace. Access to adult education is highly stratified, and the returns to educational re‐entry vary across social categories. This state‐of‐the‐art paper focuses on two aspects. First, it examines the degree to which adult education (specifically, degree‐bearing education) most benefits the less advantaged and thus mitigates socioeconomic inequality (second chance effects). Second, it addresses the degree to which the benefits of adult education go primarily to those who are already advantaged (Matthew Effects). Our review adopts the perspective of the socioeconomic life course and is explicitly cross‐nationally comparative.
SNARE proteins VAMP721 and VAMP722 mediate the post‐Golgi trafficking required for auxin‐mediated development in Arabidopsis
Authors: Zhang Liang , Ma Jingwen , Liu Huan , Yi Qian , Wang Yanan , Xing Jingjing , Zhang Peipei , Ji Shengdong , Li Mingjun , Li Jingyuan , Shen Jinbo , Lin Jinxing
Published: August 2021

The plant hormone auxin controls many aspects of plant development. Membrane trafficking processes, such as secretion, endocytosis and recycling, regulate the polar localization of auxin transporters in order to establish an auxin concentration gradient. Here, we investigate the function of the Arabidopsis thaliana R‐SNAREs VESICLE‐ASSOCIATED MEMBRANE PROTEIN 721 (VAMP721) and VAMP722 in the post‐Golgi trafficking required for proper auxin distribution and seedling growth. We show that multiple growth phenotypes, such as cotyledon development, vein patterning and lateral root growth, were defective in the double homozygous vamp721 vamp722 mutant. Abnormal auxin distribution and root patterning were also observed in the mutant seedlings. Fluorescence imaging revealed that three auxin transporters, PIN‐FORMED 1 (PIN1), PIN2 and AUXIN RESISTANT 1 (AUX1), aberrantly accumulate within the cytoplasm of the double mutant, impairing the polar localization at the plasma membrane (PM). Analysis of intracellular trafficking demonstrated the involvement of VAMP721 and VAMP722 in the endocytosis of FM4‐64 and the secretion and recycling of the PIN2 transporter protein to the PM, but not its trafficking to the vacuole. Furthermore, vamp721 vamp722 mutant roots display enlarged trans‐Golgi network (TGN) structures, as indicated by the subcellular localization of a variety of marker proteins and the ultrastructure observed using transmission electron microscopy. Thus, our results suggest that the R‐SNAREs VAMP721 and VAMP722 mediate the post‐Golgi trafficking of auxin transporters to the PM from the TGN subdomains, substantially contributing to plant growth.
Positivity of Hodge bundles of abelian varieties over some function fields
Authors: Yuan Xinyi
Published: August 2021

The main result of this paper concerns the positivity of the Hodge bundles of abelian varieties over global function fields. As applications, we obtain some partial results on the Tate–Shafarevich group and the Tate conjecture of surfaces over finite fields.
Numerical Evaluation and High-Speed Rotating Test on Circular Arc Spring Dampers for Centrifugal Compressors
Authors: Takeuchi Ryota , Ishimaru Hidetsugu , Yamashita Hideaki , Inoue Takahiko , Yabui Shota , Inoue Tsuyoshi
Published: August 2021

A circular arc spring damper (CASD) is a recently proposed fluid-film damper that has two or more arc-shaped centering springs and dual radial clearances formed by wire electric discharge machining (WEDM). CASD requires less space and weight than a conventional cage-centered squeeze-film damper (SFD). It provides linear stiffness and stable damping force in rotor-bearing systems to attenuate vibration due to imbalance or to improve rotordynamic stability. The authors have been investigated the dynamic characteristics of CASD in component-level experiments. However, their performance and applicability to real machines have not been confirmed in system-level experiments. Additionally, a theoretical means of evaluation for CASD should be established to predict its dynamic coefficients and to understand the mechanism of dynamic force generation. In the first part of this study, a numerical evaluation method using two-way fluid–structure interaction (FSI) analysis and its theoretical background is presented. Transient structural analysis and fluid-film flow analysis with a simple homogeneous cavitation model are coupled in the commercial multiphysics platform ansys. The accuracy of the method was validated by comparing the damping and added-mass coefficients with results from previous experiments. Furthermore, several aspects of the force generation mechanism and the difference from conventional SFD were studied numerically. The second part of the study addresses the application of CASD in a multistage centrifugal compressor. A combined 4-in. diameter, five-pad tilting pad journal bearing (TPJB) with four-arc type CASD was newly designed and manufactured. To prove the applicability of the developed damper bearing, a series of rotating tests were conducted at a high-speed balancing facility with a full-scale dummy rotor with a critical speed ratio (CSR) of approximately 3.1. The measured unbalance response showed a much lower amplification factor (AF) than that of the conventional TPJB without the damper, which infers a significant improvement in the stability. The measured responses agreed with the rotordynamic analysis, which uses the dynamic coefficients of CASD derived from the proposed numerical evaluation method.
Modeling of Turbulent Premixed CH4/H2/Air Flames Including the Influence of Stretch and Heat Losses
Authors: Kutkan Halit , Amato Alberto , Campa Giovanni , Ghirardo Giulio , Tay Wo Chong Luis , Æsøy Eirik
Published: August 2021

This paper presents a Reynolds averaged Navier Stokes turbulent combustion model for CH4/H2/air mixtures which includes the effect of heat losses and flame stretch. This approach extends a previous model concept designed for methane/air mixtures and improves the prediction of flame stabilization when hydrogen is added to the fuel. Heat loss and stretch effects are modeled by tabulating the consumption speed of laminar counterflow flames in a fresh-to-burnt configuration with detailed chemistry at various heat loss and flame stretch values. These computed values are then introduced in the turbulent combustion model by means of a turbulent flame speed expression which is derived as a function of flame stretch, heat loss, and H2 addition. The model proposed in this paper is compared to existing models on experimental data of spherical expanding turbulent flame speeds. The performance of the model is further validated by comparing computational fluid dynamics predictions to experimental data of an atmospheric turbulent premixed bluff-body-stabilized flame fed with CH4/H2/air mixtures ranging from pure methane to pure hydrogen.
Ultrasound imaging and Fascial Manipulation® for rigid retinacula in two cases of complex regional pain syndrome
Authors: Pirri Carmelo , Stecco Antonio , Stecco Carla , Özçakar Levent
Published: August 2021

Complex regional Pain Syndrome (CRPS) is a complex disease with articulate impact on the quality of life and its management is challenging. Ultrasound imaging can identify/assess different musculoskeletal structures that might have role in its pathogenesis. We present two cases of CRSP in whom B-mode ultrasonography and sonoelastography showed rigid retinacula associated with the symptomatology. Both patients were also/successfully treated with Fascial Manipulation®.
How to perform shear wave elastography. Part II
Authors: Ferraioli Giovanna , Barr Richard G , Farrokh André , Radzina Maija , Cui Xin Wu , Dong Yi , Rocher Laurence , Cantisani Vito , Polito Eleonora , D’Onofrio Mirko , Roccarina Davide , Yamashita Yasunobu , Dighe Manjiri K. , Fodor Daniela , Dietrich Christoph F.
Published: August 2021

Recently a series of papers was introduced describing on “how to do” certain techniques. More specifically we published on how to perform strain imaging using the transcutaneous and endoscopic ultrasound approach and shear wave elastography (SWE). In the first part we describe how to optimize the examination technique, discussing normal values, pitfalls, artefacts and specific tips for applying SWE to specific organs (liver, breast, thyroid, salivary glands) as part of a diagnostic US examination. In part II, the use of SWE in the pancreas, spleen, kidney, prostate, scrotum, musculoskeletal system, lymph nodes and future developments are discussed.
Plasma-enhanced atomic layer deposition of SiO2 film using capacitively coupled Ar/O2 plasmas: A computational investigation
Authors: Qu Chenhui , Sakiyama Yukinori , Agarwal Pulkit , Kushner Mark J.
Published: August 2021

Plasma-enhanced atomic layer deposition (PE-ALD) is widely used for dielectric deposition in semiconductor fabrication due to its ability to operate at low temperatures while having high precision control. The PE-ALD process consists of two subcycles: precursor dosing and plasma exposure with gas purging and filling in between. In the PE-ALD of SiO2, a Si-containing precursor is first deposited on the surface, usually in a plasma-free environment. The surface is then exposed to an oxygen-containing plasma during which the residual components of the precursor are removed and the Si oxidized. Various factors affect the outcome of SiO2 PE-ALD, such as exposure times during each step, steric hindrance of the Si precursor, and plasma properties, such as the energy of ions incident onto the film. The results from computational investigations of the first layers of SiO2 PE-ALD at both reactor (cm) and feature (nm) scales are discussed in this paper. The example system uses bis(tertiary-butylamino)silane, SiH2[NH(C4H9)]2 as the silicon precursor during dosing and plasmas operating in Ar/O2 gas mixtures during the oxidation step. Parametric studies were performed for blanket deposition, as well as deposition in trenches and vias while varying power, pressure, plasma exposure time, aspect ratio, and ligand retention in the film. The general trends show that conditions that reduce the fluence of reactive oxygen species typically decrease the O/Si ratio, increase the vacancies in the films, and decrease the order of the film. Conditions that result in higher ion fluxes having higher energies produce the same result due to sputtering. The retention of ligand groups from the precursor significantly decreased growth rates while increasing vacancies and reducing the O/Si ratio.
Case Study: Comparison of Swimsuits and Wetsuits Through Biomechanics and Energetics in Elite Female Open Water Swimmers
Authors: Zacca Rodrigo , Mezêncio Bruno , de Souza Castro Flávio A. , Nakamura Fábio Y. , Pyne David B. , Vilas-Boas João Paulo , Fernandes Ricardo J.
Published: August 2021

Aim: The authors investigated how the Arena Powerskin R-EVO Closed Back swimsuit and Arena Carbon Triwetsuit (full-sleeve wetsuit), both approved by the Fédération Internationale de Natation (FINA) regulations, affect biomechanics and energetics of 3 elite female open water (OW) swimmers at maximal and 4 submaximal swimming intensities. Methods: Three elite female OW swimmers (OW1 = 24 y, 1.64 m, 60 kg; OW2 = 23 y, 1.69 m, 65 kg; OW3 = 27 y, 1.63 m, 64.5 kg) were tested 1 week prior to a FINA/CNSG (China National Sports Group) Marathon Swim World Series event and 40 days before the 18th FINA World Championships 2019. Each OW swimmer completed 2 identical testing sessions, one with a swimsuit and other with a wetsuit, involving shoulder flexion power output assessed from medicine-ball throw, maximal performance and drag coefficient assessment, and an incremental intermittent swim test at 4 different relative intensities. Results: Estimated peak oxygen uptake was 4.4 L·min−1 for OW1, 5.6 L·min−1 for OW2, and 5.0 L·min−1 for OW3. Despite a distinct behavior observed on index of coordination for OW3, a null index of synchronization, increased stroke rate (mean difference = 2%–8%), reduced drag factor (minimum = −14%; maximum = −30%), lower energy cost (mean difference = −2% to −6%), and faster performance (mean difference = 2% to 3%) were observed with the wetsuit compared with swimsuit for all elite OW swimmers. Conclusion: The wetsuit enhances submaximal swimming performance, and this increase is dependent on the OW swimmer’s characteristics. The higher stroke rate and lower stroke length detected with wetsuit could be related to movement constraints imposed by the suit.
Jack and Jill Went to Instill: Did the Educative Teacher Performance Assessment Cause Them to Falter?
Authors: Baxter Deborah S. , Sinelnikov Oleg A.
Published: August 2021

Purpose: This study examined and deconstructed socialization experiences relative to the educative teacher performance assessment (edTPA) process of preservice teachers during their physical education (PE) teacher education program and induction year as a PE teacher. Method: Utilizing a multiple case study design, two PE teachers were purposefully selected and investigated from a PE teacher education program requiring a passing score on the edTPA. Interviews and stimulated recall sessions served as data sources. Results: The following themes were identified: (a) initial interactions and impetus for teaching—engaging and fun; (b) instruction in PE teacher education—learning a ton; (c) internship—gauging, I’m stunned; (d) implementation of edTPA—raging, I’m done; and (e) induction—waging has begun. Discussion/Conclusions: Although participants in this study were able to note several positives of the assessment, a majority of the findings corroborate previous research suggesting that edTPA may serve as a subtractive experience for PE preservice teachers.
Intercellular cross-talk curbs Alzheimer’s disease
Authors: Foley John F.
Published: August 2021

Astrocyte-derived IL-3 activates microglia to clear amyloid-β aggregates in a mouse model of Alzheimer’s disease.
Microbial Diversity and Function in Shallow Subsurface Sediment and Oceanic Lithosphere of the Atlantis Massif
Authors: Goordial J. , D’Angelo T. , Labonté J. M. , Poulton N. J. , Brown J. M. , Stepanauskas R. , Früh-Green G. L. , Orcutt B. N.
Published: August 2021

The subsurface rock beneath the ocean is one of the largest biospheres on Earth, and microorganisms within influence global-scale nutrient cycles. This biosphere is difficult to study, in part due to the low concentrations of microorganisms that inhabit the vast volume of the marine lithosphere.
Captive Common Marmosets (Callithrix jacchus) Are Colonized throughout Their Lives by a Community ofBifidobacteriumSpecies with Species-Specific Genomic Content That Can Support Adaptation to Distinct Metabolic Niches
Authors: Zhu Lifeng , Yang Qinnan , Suhr Van Haute Mallory J. , Kok Car Reen , Gomes-Neto Joao Carlos , Pavlovikj Natasha , Pillai Resmi , Sinha Rohita , Hassenstab Haley , Mustoe Aaryn , Moriyama Etsuko N. , Hutkins Robert , French Jeffrey , Benson Andrew K.
Published: August 2021

Bifidobacteriumspecies are recognized as important, beneficial microbes in the human gut microbiome, and their ability colonize individuals at different stages of life is influenced by poorly understood interactions between host, dietary, environmental, and ecological factors. The common marmoset is an emerging nonhuman primate model with a short maturation period, making this model amenable to study of the microbiome throughout a life history.
Sulfation of Arabinogalactan Proteins Confers Privileged Nutrient Status to Bacteroides plebeius
Authors: Munoz-Munoz Jose , Ndeh Didier , Fernandez-Julia Pedro , Walton Gemma , Henrissat Bernard , Gilbert Harry J.
Published: August 2021

Dietary manipulation of the HGM requires knowledge of how glycans available to this ecosystem are metabolized. The variable structures that decorate the core component of plant AGPs may influence their utilization by specific organisms within the HGM.
The Dissection of SNAREs Reveals Key Factors for Vesicular Trafficking to the Endosome-like Compartment and Apicoplast via the Secretory System in Toxoplasma gondii
Authors: Cao Shinuo , Yang Juan , Fu Jiawen , Chen Heming , Jia Honglin
Published: August 2021

SNAREs are essential for the fusion of the transport vesicles and target membranes and, thus, provide perfect targets for obtaining a global view of the vesicle transport system. In this study, we report that a novel Qc-SNARE (TgStx19) instead of Use1p is located at the ER and acts as a partner of TgStx18 in
T. gondii
.
The Mammalian Membrane Microenvironment Regulates the Sequential Attachment of Bacteria to Host Cells
Authors: Pierrat Xavier , Wong Jeremy P. H. , Al-Mayyah Zainebe , Persat Alexandre
Published: August 2021

Microbial adhesion to host cells is the initial step toward many infections. Despite playing a pivotal role in the onset of disease, we still know little about how bacteria attach in an
in vivo
-like context.
The Curious Case of Nonrepetitive Centromeric DNA Sequences in Candida auris and Related Species
Authors: Lorenz Alexander , Papon Nicolas
Published: August 2021

2009 saw the first description of
Candida auris
, a yeast pathogen of humans.
C. auris
has since grown into a global problem in intensive care settings, where it causes systemic infections in patients with underlying health issues. Recent whole-genome sequencing has discerned five
C. auris
clades with distinct phenotypic features which display genomic divergence on a DNA sequence and a chromosome structure level.
Metabolic Features of Ganjang (a Korean Traditional Soy Sauce) Fermentation Revealed by Genome-Centered Metatranscriptomics
Authors: Chun Byung Hee , Han Dong Min , Kim Hyung Min , Park Dongbin , Jeong Da Min , Kang Hyun Ah , Jeon Che Ok
Published: August 2021

The taste and quality of soy sauce, a popular fermented liquid condiment worldwide, is greatly influenced by microbial metabolism during fermentation. Spontaneous fermentation of ganjang (a Korean traditional soy sauce) in a nonsterile environment leads to the growth of diverse bacteria and fungi during fermentation, making it difficult to understand the mechanism of ganjang fermentation.
Cell Growth Model with Stochastic Gene Expression Helps Understand the Growth Advantage of Metabolic Exchange and Auxotrophy
Authors: Dutta Dibyendu , Saini Supreet
Published: August 2021

Cooperative behaviors are highly prevalent in the wild, but their evolution is not understood. Metabolic flux models can demonstrate the viability of metabolic exchange as cooperative interactions, but steady-state growth models cannot explain why cooperators grow faster.
Nonclimatic and extrabasinal processes controlled pedogenesis in paleosols of the Paleocene Nacimiento Formation, New Mexico, USA
Authors: Hobbs Kevin M. , Fawcett Peter J.
Published: August 2021

Paleosols can represent intervals of nondeposition in sedimentary packages and are used with increasing frequency as proxies for paleoenvironmental conditions during basin filling. However, the complexities of factors both internal and external to pedogenesis require consideration of paleosols in any basin or sedimentary package in a broader context than is often assumed. With this in mind, we measured and analyzed pedogenic features, stratigraphic position, geochemical composition, and petrography of paleosols in the Nacimiento Formation to gain insight into the paleoenvironmental conditions of the early Paleocene in the San Juan Basin. During this interval, the San Juan Basin was located in middle northern latitudes (~40°N) and saw rapid terrestrial siliciclastic sedimentation related to Laramide tectonism. Evidence from earlier researchers suggests that prevailing climate conditions during Nacimiento Formation deposition were warm and humid. We used morphological properties of paleosols to categorize paleosols into pedotypes indicative of distinct pedogenic conditions. The general stratigraphic distribution of these pedotypes shows an up-section increase in soil drainage conditions through the Nacimiento Formation that cannot be correlated with known climate changes. We suggest that fluvial system evolution was the major control on pedogenic conditions. We investigated Nacimiento Formation paleosols with widely used paleosol geochemical climate analyses, which provided paleoclimate estimates that are in disaccord with independently derived estimates. We show that in alluvial depositional systems with source areas in weathered sedimentary rocks, these analyses can be difficult to interpret and likely lead to estimates that do not reflect true pedogenic conditions during the postdepositional near-surface alteration of sediments. Petrographic analysis of Nacimiento Formation paleosols showed that some likely formed under semiarid to subhumid conditions that allowed pedogenic accumulation and illuviation of smectite clays yet did not substantially chemically alter primary detrital plagioclase feldspar grains in paleosol B horizons. The paleosols of the Nacimiento Formation, when analyzed at the basin scale, show that sedimentary aggradational processes can overpower climate processes in creation of a sequence of paleosols in a stratigraphic section. In addition, the incorporation of clays from sedimentary rocks in a basin's source area can drastically skew the geochemical signatures and therefore interpretations of paleosols in that basin.
Supplemental Material: Subduction and exhumation slip accommodation at depths of 10–80 km inferred from field geology of exhumed rocks: Evidence for temporal-spatial localization of slip
Authors: Wakabayashi John
Published: August 2021

Figures 7, 8, 10, 11, 12, and 13 for zoom-in viewing.
The role of paediatricians in specialist nurse training: a community child health example
Authors: Ni Bhrolchain Cliona
Published: August 2021

Specialist and advanced nursing roles have started to emerge in paediatrics and paediatricians may be asked to support nurses through their training. While there are specific training programmes for some areas of practice eg, neonatology, there are currently no programmes for others. Paediatricians may therefore find themselves being asked to train nurse specialists outside a formal training programme, or to provide the clinical specialty component linked to a generic MSc course, where the paediatrician may be required to devise a training curriculum specific to their area of practice. Using community child health as an example, this paper outlines how paediatricians might approach this, based on the experience of the author. However, the principles outlined can apply to any area of paediatrics.
Monitoring of carbon dioxide in ventilated neonates: a prospective observational study
Authors: Werther Tobias , Aichhorn Lukas , Stellberg Sina , Cardona Francesco Stefano , Klebermass-Schrehof Katrin , Berger Angelika , Schmölzer Georg M , Wagner Michael
Published: August 2021

Objective

To assess the reliability, accuracy and precision of distal end-tidal capnography (detCO2) in neonates compared with transcutaneous (tcCO2) carbon dioxide measurements.

Design

Observational, prospective clinical study.

Setting

Neonatal intensive care unit at Medical University of Vienna.

Participants

Conventionally ventilated neonates with a body weight between 1000 g and 3000 g.

Intervention

End-tidal partial pressure of CO2was measured in distal position using the separate lumen of a double-lumen endotracheal tube connected to an external side-stream capnometer. Three consecutive detCO2and tcCO2values were recorded simultaneously and compared with simultaneous arterialised partial pressure of CO2(paCO2) measurements in each patient.

Main outcome measures

Reliability, accuracy and precision of detCO2and tcCO2measurements compared with paCO2in neonates.

Results

Twenty-five neonates were included with a median (range) weight at enrolment of 1410 (1010–2980) g, from which 81 simultaneous measurements of detCO2, tcCO2and paCO2were obtained. The mean (SD) of paCO2, detCO2and tcCO2was 45.0 (8.6) mmHg, 42.4 (8.4) mmHg and 50.4 (20.4) mmHg, respectively. The intraclass correlation between paCO2and detCO2and between paCO2and tcCO2reached 0.80 (95% CI 0.71 to 0.87, p<0.001) and 0.59 (95% CI 0.43 to 0.72, p<0.001), respectively. In the Bland-Altman analysis, bias and precision of detCO2with respect to paCO2amounted to −2.68 mmHg and 10.62 mmHg (95% CI 8.49 to 14.51), respectively. Bias and precision of tcCO2with respect to paCO2amounted to 5.39 mmHg and 17.22 mmHg (95% CI 13.21 to 23.34), respectively.

Conclusion

DetCO2had better reliability, accuracy and precision with paCO2than tcCO2in ventilated neonates without severe lung diseas.

Trial registration number

NCT03758313.
Complex case of COVID-19 and infective endocarditis
Authors: Alizadeh Katrin , Bucke Danielle , Khan Sadia
Published: August 2021

A 50-year-old man with no medical history of note presented with new onset of confusion and dyspnoea. He tested positive for coronavirus (COVID-19), and subsequently, was admitted to the intensive care unit due to severe sepsis and acute renal failure requiring haemodialysis. Shortly afterwards, he was intubated due to haemodynamic instability. His blood culture was positive forStaphylococcus aureusbacteraemia, and echocardiogram showed evidence of vegetation in the aortic valve area. He was commenced on intravenous antibiotics for infective endocarditis (IE). Following extubation, he underwent an MRI of the spine due to increasing back pain. This was suggestive of L5–S1 discitis, likely secondary to septic emboli from IE. A few days later, he developed acute ischaemia of the left toes and extensive thrombosis of the right cubital and left iliac veins. Following a prolonged hospital admission, he was discharged home and later underwent an elective forefoot amputation from which he made a good recovery.
Fingolimod-associated central serous chorioretinopathy in a young girl
Authors: Pratima Gajanan Chavhan , Benita Doris , Sarkar Sandip , Deb Amit Kumar
Published: August 2021

Fingolimod is a sphingosine-1-phosphate analogue used for the treatment of multiple sclerosis. We, hereby, report a rare case of fingolimod-associated central serous chorioretinopathy (CSCR) in a 21-year-old woman who presented with blurring of vision in the right eye 3 weeks after initiation of oral fingolimod. On examination, best-corrected visual acuity was 20/20 in both the eyes. Fundus examination revealed shallow, serous macular neurosensory detachment in the right eye, and it was confirmed with spectral domain optical coherence tomography. Left eye fundus was normal. Fluorescein angiography showed focal retinal pigment epithelium leak inferior to the fovea. A diagnosis of fingolimod-associated CSCR was made. Oral fingolimod was discontinued. Subsequent follow-up visits showed partial resolution of CSCR at 2 weeks and at 1 month and complete resolution of the subretinal fluid at 2 months. CSCR is, therefore, a rare adverse effect of oral fingolimod treatment. Baseline eye examination and subsequent follow-up at regular intervals are recommended for patients on fingolimod.
Effective use of monoclonal antibodies for treatment of persistent COVID-19 infection in a patient on rituximab
Authors: Rabascall Carlos X , Lou Becky X , Navetta-Modrov Brianne , Hahn Stella S
Published: August 2021

As we are over a year into the COVID-19 pandemic, we have made many forward strides in therapeutics. These treatments, such as monoclonal antibodies, have help mitigate the detrimental and often fatal consequences of COVID-19. The current indication for the use of monoclonal antibodies is mild to moderate COVID-19 infection within 10 days of symptom onset in those who are at high risk of progression to severe disease. However, their role in patients with prolonged symptoms is not clear. We present a unique case of monoclonal antibodies use after 54 days of symptom onset in an immunosuppressed patient with persistent COVID-19 infection despite standard treatment. This case illustrates the potential use of monoclonal antibodies outside of the current recommended therapeutic window in immunosuppressed patients, who may have difficulty with viral clearance.
Accuracy of automated machine learning in classifying retinal pathologies from ultra-widefield pseudocolour fundus images
Authors: Antaki Fares , Coussa Razek Georges , Kahwati Ghofril , Hammamji Karim , Sebag Mikael , Duval Renaud
Published: August 2021

Aims

Automated machine learning (AutoML) is a novel tool in artificial intelligence (AI). This study assessed the discriminative performance of AutoML in differentiating retinal vein occlusion (RVO), retinitis pigmentosa (RP) and retinal detachment (RD) from normal fundi using ultra-widefield (UWF) pseudocolour fundus images.

Methods

Two ophthalmologists without coding experience carried out AutoML model design using a publicly available image data set (2137 labelled images). The data set was reviewed for low-quality and mislabeled images and then uploaded to the Google Cloud AutoML Vision platform for training and testing. We designed multiple binary models to differentiate RVO, RP and RD from normal fundi and compared them to bespoke models obtained from the literature. We then devised a multiclass model to detect RVO, RP and RD. Saliency maps were generated to assess the interpretability of the model.

Results

The AutoML models demonstrated high diagnostic properties in the binary classification tasks that were generally comparable to bespoke deep-learning models (area under the precision-recall curve (AUPRC) 0.921–1, sensitivity 84.91%–89.77%, specificity 78.72%–100%). The multiclass AutoML model had an AUPRC of 0.876, a sensitivity of 77.93% and a positive predictive value of 82.59%. The per-label sensitivity and specificity, respectively, were normal fundi (91.49%, 86.75%), RVO (83.02%, 92.50%), RP (72.00%, 100%) and RD (79.55%,96.80%).

Conclusion

AutoML models created by ophthalmologists without coding experience can detect RVO, RP and RD in UWF images with very good diagnostic accuracy. The performance was comparable to bespoke deep-learning models derived by AI experts for RVO and RP but not for RD.
Myopia incidence and lifestyle changes among school children during the COVID-19 pandemic: a population-based prospective study
Authors: Zhang Xiujuan , Cheung Stephanie S L , Chan Hei-Nga , Zhang Yuzhou , Wang Yu Meng , Yip Benjamin H , Kam Ka Wai , Yu Marco , Cheng Ching-Yu , Young Alvin L , Kwan Mike Y W , Ip Patrick , Chong Kelvin Kam-Lung , Tham Clement C , Chen Li Jia , Pang Chi-Pui , Yam Jason C S
Published: August 2021

Background

The impacts of social restrictions for COVID-19 on children’s vision and lifestyle remain unknown.

Aims

To investigate myopia incidence, spherical equivalent refraction (SER) and lifestyle changes among schoolchildren during the COVID-19 pandemic.

Methods

Two separate longitudinal cohorts of children aged 6–8 years in Hong Kong were included. The COVID-19 cohort was recruited at the beginning of the COVID-19 outbreak, whereas the pre-COVID-19 cohort was recruited before the COVID-19 pandemic. All children received ocular examinations, and answered a standardised questionnaire relating to their lifestyle, including time spent on outdoor activities and near work, both at baseline and at follow-up visits.

Results

A total of 1793 subjects were recruited, of whom 709 children comprised the COVID-19 cohort with 7.89±2.30 months of follow-up, and 1084 children comprised the pre-COVID-19 cohort with 37.54±3.12 months of follow-up. The overall incidence was 19.44% in the COVID-19 cohort, and 36.57% in pre-COVID-19 cohort. During the COVID-19 pandemic, the change in SER and axial length was –0.50±0.51 D and 0.29±0.35 mm, respectively; the time spent on outdoor activities decreased from 1.27±1.12 to 0.41±0.90 hours/day (p<0.001), while screen time increased from 2.45±2.32 to 6.89±4.42 hours/day (p<0.001).

Conclusions

We showed a potential increase in myopia incidence, significant decrease in outdoor time and increase in screen time among schoolchildren in Hong Kong during the COVID-19 pandemic. Our results serve to warn eye care professionals, and also policy makers, educators and parents, that collective efforts are needed to prevent childhood myopia—a potential public health crisis as a result of COVID-19.
Long-term efficacy and safety of oral semaglutide and the effect of switching from sitagliptin to oral semaglutide in patients with type 2 diabetes: a 52-week, randomized, open-label extension of the PIONEER 7 trial
Authors: Buse John B , Bode Bruce W , Mertens Ann , Cho Young Min , Christiansen Erik , Hertz Christin L , Nielsen Morten A , Pieber Thomas R
Published: August 2021

Introduction

The PIONEER 7 trial demonstrated superior glycemic control and weight loss with once-daily oral semaglutide with flexible dose adjustment versus sitagliptin 100 mg in type 2 diabetes. This 52-week extension evaluated long-term oral semaglutide treatment and switching from sitagliptin to oral semaglutide.

Research design and methods

A 52-week, open-label extension commenced after the 52-week main phase. Patients on oral semaglutide in the main phase continued treatment (n=184; durability part); those on sitagliptin were rerandomized to continued sitagliptin (n=98) or oral semaglutide (n=100; initiated at 3 mg) (switch part). Oral semaglutide was dose-adjusted (3, 7, or 14 mg) every 8 weeks based on glycated hemoglobin (HbA1c) (target <7.0% (<53 mmol/mol)) and tolerability. Secondary endpoints (no primary) included changes in HbA1cand body weight.

Results

In the durability part, mean (SD) changes in HbA1cand body weight from week 0 were –1.5% (0.8) and –1.3% (1.0) and –2.8 kg (3.8) and –3.7 kg (5.2) at weeks 52 and 104, respectively. In the switch part, mean changes in HbA1cfrom week 52 to week 104 were –0.2% for oral semaglutide and 0.1% for sitagliptin (difference –0.3% (95% CI –0.6 to 0.0); p=0.0791 (superiority not confirmed)). More patients achieved HbA1c<7.0% with oral semaglutide (52.6%) than sitagliptin (28.6%; p=0.0011) and fewer received rescue medication (9% vs 23.5%). Respective mean changes in body weight were –2.4 kg and –0.9 kg (difference –1.5 kg (95% CI –2.8 to –0.1); p=0.0321). Gastrointestinal adverse events were the most commonly reported with oral semaglutide.

Conclusions

Long-term oral semaglutide with flexible dose adjustment maintained HbA1creductions, with additional body weight reductions, and was well tolerated. Switching from sitagliptin to flexibly dosed oral semaglutide maintained HbA1creductions, helped more patients achieve HbA1ctargets with less use of additional glucose-lowering medication, and offers the potential for additional reductions in body weight.

Trial registration number

NCT02849080.
Projecting sex imbalances at birth at global, regional and national levels from 2021 to 2100: scenario-based Bayesian probabilistic projections of the sex ratio at birth and missing female births based on 3.26 billion birth records
Authors: Chao Fengqing , Gerland Patrick , Cook Alex Richard , Guilmoto Christophe Z , Alkema Leontine
Published: August 2021

Introduction

Skewed levels of the sex ratio at birth (SRB) due to sex-selective abortions have been observed in several countries since the 1970s. They will lead to long-term sex imbalances in more than one-third of the world’s population with yet unknown social and economic impacts on affected countries. Understanding the potential evolution of sex imbalances at birth is therefore essential for anticipating and planning for changing sex structures across the world.

Methods

We produced probabilistic SRB projections from 2021 to 2100 based on different scenarios of sex ratio transition and assessed their implications in terms of missing female births at global, regional and national levels. Based on a comprehensive SRB database with 3.26 billion birth records, we project the skewed SRB and missing female births with a Bayesian hierarchical time series mixture model. The SRB projections under reference scenario S1 assumed SRB transitions only for countries with strong statistical evidence of SRB inflation, and the more extreme scenario S2 assumed a sex ratio transition for countries at risk of SRB inflation but with no or limited evidence of ongoing inflation.

Results

Under scenario S1, we projected 5.7 (95% uncertainty interval (1.2; 15.3)) million additional missing female births to occur by 2100. Countries affected will be those already affected in the past by imbalanced SRB, such as China and India. If all countries at risk of SRB inflation experience a sex ratio transition as in scenario S2, the projected missing female births increase to 22.1 (12.2; 39.8) million with a sizeable contribution of sub-Saharan Africa.

Conclusion

The scenario-based projections provide important illustrations of the potential burden of future prenatal sex discrimination and the need to monitor SRBs in countries with son preference. Policy planning will be needed in the years to come to minimise future prenatal sex discrimination and its impact on social structures.
30 years of polio campaigns in Ethiopia, India and Nigeria: the impacts of campaign design on vaccine hesitancy and health worker motivation
Authors: Neel Abigail H , Closser Svea , Villanueva Catherine , Majumdar Piyusha , Gupta S D , Krugman Daniel , Akinyemi Oluwaseun Oladapo , Deressa Wakgari , Kalbarczyk Anna , Alonge Olakunle
Published: August 2021

Introduction

The debate over the impact of vertical programmes, including mass vaccination, on health systems is long-standing and often polarised. Studies have assessed the effects of a given vertical health programme on a health system separately from the goals of the vertical programme itself. Further, these health system effects are often categorised as either positive or negative. Yet health systems are in fact complex, dynamic and tightly linked. Relationships between elements of the system determine programme and system-level outcomes over time.

Methods

We constructed a causal loop diagram of the interactions between mass polio vaccination campaigns and government health systems in Ethiopia, India and Nigeria, working inductively from two qualitative datasets. The first dataset was 175 interviews conducted with policymakers, officials and frontline staff in these countries in 2011–2012. The second was 101 interviews conducted with similar groups in 2019, focusing on lessons learnt from polio eradication.

Results

Pursuing high coverage in polio campaigns, without considering the dynamic impacts of campaigns on health systems,costcampaign coverage gains over time in weaker health systems with many campaigns. Over time, the systems effects of frequent campaigns, delivered through parallel structures, led to a loss of frontline worker motivation, and an increase in vaccine hesitancy in recipient populations. Co-delivery of interventions helped to mitigate these negative effects. In stronger health systems with fewer campaigns, these issues did not arise.

Conclusion

It benefits vertical programmes to reduce the construction of parallel systems and pursue co-delivery of interventions where possible, and to consider the workflow of frontline staff. Ultimately, for health campaign designs to be effective, they must make sense for those delivering and receiving campaign interventions, and must take into account the complex, adaptive nature of the health systems in which they operate.
Reducing late-onset neonatal sepsis in very low birthweight neonates with central lines in a low-and-middle-income country setting
Authors: Batthula Vinay , Somnath Sanjana H , Datta Vikram
Published: August 2021

Background

Late-onset neonatal sepsis (LONS) is a significant contributor to morbidity and mortality in very low birthweight (VLBW) neonates with indwelling central lines. Compliance to central line care bundles is suboptimal in low-and-middle-income country settings. Point of care quality improvement (POCQI) method may be used to improve the compliance gap. We used the POCQI method to achieve an improvement in compliance to central line care bundles with an aim to reduce LONS in a subset of VLBW neonates.

Methods

A pre and post-intervention study consisting of three phases was conducted in a tertiary care neonatal intensive care unit. A root-cause analysis was undertaken to find the causes of LONS in VLBW babies with central lines. Multiple change ideas were identified and tested using sequential Plan-Do-Study-Act (PDSA) cycles to address the issue of reduced compliance to the central line care bundles. The change ideas tested in PDSA cycles which were successful were adopted. Compliance to the insertion and maintenance bundles was measured as process indicators. LONS, central line associated bloodstream infections and all-cause mortality rates were measured as outcome indicators.

Results

A total of 10 PDSA cycles testing multiple change ideas (staff education, audio-visual aids, supply issues) were undertaken during the study duration. Bundles were not being used in the study setting prior to the initiation of the study. Insertion bundle compliance was above 90% and maintenance bundle compliance increased from 23.3% to 42.2% during the intervention and sustenance phases, respectively. A 43.3% statistically significant reduction in LONS rates was achieved at the end of the study. No effect on mortality was seen.

Conclusion

POCQI method can be used to improve compliance to central line care bundles which can lead to a reduction of LONS in VLBW neonates with central lines in situ.
Establishing the practice of birth companion in labour ward of a tertiary care centre in India—a quality improvement initiative
Authors: Bharti Juhi , Kumari Aprajita , Zangmo Rinchen , Mathew Sonia , Kumar Sunesh , Sharma Aparna K
Published: August 2021

Background

Birth companion is a key component for providing respectful maternity care and has been recommended by WHO and Government of India. It is a low-cost beneficial intervention that is vital in improving quality of care during labour and delivery.

Local problem

Despite the available evidence on benefits of birth companion, there was no policy on allowing birth companion at our hospital in the past.

Methods and interventions

We aimed to establish the practice of allowing birth companions in all eligible women in labour ward from existing 0% to 50% in 6 weeks’ duration. This study was conducted in the Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi. A quality improvement (QI) team was formed, and after obtaining the baseline data, problems were analysed using fish bone chart. A new policy of allowing birth companion was made and efforts made to sensitise and train the doctors and nurses posted in labour ward. Changed ideas were executed in multiple plan-do-study-act (PDSA) cycles. Simple interventions such as dress code for birth companions, curtains for ensuring privacy, display of posters and frequent reminders on WhatsApp groups were planned .

Results

The median value of women accompanied by birth companion marginally increased to 25% after the first PDSA cycle. Implementation of further changed ideas led to increase in median, which reached 66.6%. Thereafter, there was a decline, but by the end of 6 months, it was possible to attain the goal and sustain it.

Conclusions

Simple steps of QI methodology can be used to address the prevalent problems in our healthcare. Implementation of any new practice comes with major challenges, but we could achieve our goal because of a motivated team working together on multiple changed ideas applied sequentially in PDSA cycles.
Improving donor human milk collection in a hospital without a human milk bank: a quality improvement initiative at an urban tertiary-care teaching hospital
Authors: Garegrat Reema , Malshe Nandini , Suryawanshi Pradeep , Patnaik Suprabha K
Published: August 2021

Feed intolerance and necrotising enterocolitis (NEC) are challenges while treating sick neonates. These can be reduced by giving human milk, but adequate availability of mother’s own milk or pasteurised donor human milk (PDHM) is a challenge in neonatal setups, like ours, without an attached human milk bank. Hence, this quality improvement initiative was taken to improve donor human milk collection in our urban tertiary-care teaching hospital, to at least 500 mL per week in 4 weeks. After analysing the problem, our quality improvement team identified a shortage of human milk donation that was due to low awareness among the stakeholders and lack of a system to collect and store human milk and transport it to a milk bank. The team first established a system of supplies needed for milk collection, storage and transportation. It then tested change idea of information, education and counselling to increase milk donation. The team carried out a few plan-do-study-act cycles (individual and group counsellings, and usage of videos and information leaflets) to test the change ideas and adapted a few and abandoned some. During this journey, the milk collection increased to above the target amount. Various challenges were addressed, and there was a need for constant motivation of the stakeholders, especially the mothers, and now there is sustained milk donation in the setup. This is incorporated in the standard operating procedure and as a quality indicator of the unit for sustaining the changes in the unit. Our initiative can be replicated in other setups for increasing collection of donor human milk. Greater PDHM availability for sick neonates will, in effect, reduce NEC and feeding intolerance rates, leading to reduced hospital stay, morbidity, mortality and economic burden.