bluuebunny/crossref_metadata_2025 huggingface dataset:
American Enterprise Institute Roundtable: Government Policies Reshape the Banking System
Authors: Kupiec Paul H. , Sylla Richard , Pollock Alex J. , Calomiris Charles W. , Ely Bert
Published: January 2022

The U.S. federal government response to the 2008 financial crisis, including new laws, prudential regulations, and Federal Reserve monetary policies, has left a lasting impact on the U.S. banking industry. Along with a nearly 50% drop in the number of independent depository institutions since 2000, the industry has become much more concentrated in a few large “systemically important” institutions. At the same time, the largest banks have responded to incentives provided by increased regulatory requirements and the Fed's zero interest rate policy by reducing their lending to the private sector and increasing both their real estate holdings and their reliance on deposits to fund them.

For the five well‐known banking scholars who take part in this AEI‐organized discussion, such recent changes have troubling consequences for both the industry and the broader economy. After economic historian Richard Sylla describes a 100‐year movement of U.S. banking toward a system characterized by a few large banks with extensive branch systems, bank authority Alex Pollock points to the growing role and influence of the Federal Reserve and government‐sponsored enterprises in the “banking credit system.” And bank consultant Bert Ely points to a number of large and growing industry risks. Along with their unprecedented real estate holdings, Ely notes the massive holdings of U.S. government debt by both the Fed—which is identified as having an enormous interest rate mismatch and exposure—and the banks it supervises. At the same time, low interest rates have been squeezing banks’ margins and reducing their capital cushions to absorb losses that may arise from the pandemic.

Charles Calomiris, who recently stepped down as Chief Economist of the OCC, views such extreme consolidation as an unhealthy trend—one that, along with banks’ growing dependency on deposits (and hence government guarantees and support) and reliance on real estate lending have become the main components of a “three‐legged stool” that are making large banks and banking systems throughout the world ever more subject to government influence. As a result of such dependence, the U.S. banking system is becoming more vulnerable to economy‐wide “shocks” such as the expected effects of a sharp increase in interest rates or a sudden plummeting of real estate prices. As Calomiris argued in his famous book (with Stephen Haber), U.S. banks—and indeed banks in most nations, thanks to “political bargains” with their governments that seem inevitable—appear to be becoming ever more “fragile by design.”
Two new species of the butterflyfish genus Roa (Perciformes: Chaetodontidae)
Authors: Matsunuma Mizuki , Motomura Hiroyuki
Published: January 2022

Two new species of Roa (Chaetodontidae) are described. Roa semilunaris sp. nov., based on six specimens from the Mascarene Ridge (south‐western Indian Ocean), is most similar to Roa jayakari (Norman, 1939), distributed in the Red Sea and the northern Indian Ocean, in having scales on the upper jaw, interrupted pale lines within the second dark body band, and similar coloration and shape of the pelvic fin. However, the former is readily distinguished from R. jayakari by a wider whitish interspace between the second and third black bands [width of interspace at lateral line level 15.9%–18.5% of standard length (SL) in R. semilunaris sp. nov. (vs. 5.1%–8.5% of SL in R. jayakari)], with 9 or 10 pored lateral‐line scales in the interspace (vs. 3–5); an oval or semicircular ocellated blotch on the soft‐rayed portion of the dorsal fin (vs. a circular blotch); the head higher and longer [head length 35.0%–36.7% of SL (vs. 40.8%–44.1% of SL), head height 48.1%–50.5% of SL (vs. 52.0%–56.9% of SL)], and postorbital length 14.0%–15.1% of SL (vs. 17.0%–20.5% of SL). Roa uejoi sp. nov., based on three specimens from Guam (Mariana Islands), is most similar to Roa excelsa (Jordan, 1921) (now restricted to the Hawaiian Islands and Johnston Island), but is distinguished from the latter by having a circular dorsal‐fin ocellated spot (vs. spot distinctly oval in the latter) and a much more elongate, filamentous first pelvic‐fin soft ray, of length 119.0%–123.4% of 2nd ray (vs. not obviously filamentous, 104.9%–105.8%). A key to the eight valid species of Roa is provided.
Postpartum Health Experiences of Women with Newborns in Intensive Care: The Desire to Be by the Infant Bedside as a Driver of Postpartum Health
Authors: Ferrari Renée M. , McClain Erin K. , Tucker Christine , Charles Nkechi , Verbiest Sarah , Lewis Virginia , Bryant Katherine , Stuebe Alison M.
Published: January 2022

Introduction

Women with infants in a neonatal intensive care unit (NICU) encounter multiple challenges following childbirth, including greater burden of chronic disease and increased risk for depression, compared with women with well infants. At the same time, they are confronted with the trauma of a hospitalized infant while also managing their postpartum recovery. Limited research exists describing the health needs of these women, despite the many numbers living this experience daily. This study aimed to better understand postpartum health needs of women with infants in the NICU in the 90 days following birth and to propose actionable system improvements to address identified needs.

Methods

The authors conducted in‐depth individual interviews with 50 postpartum women of infants admitted to the NICU at a quaternary care hospital. Eligible women were aged at least 18 years, spoke English or Spanish, and had infants in the NICU longer than 3 days. Interview topics included NICU experience, recommended and desired health care, and suggestions for improvement. Interviews were audiotaped and transcribed verbatim. The authors used qualitative description techniques including memo‐writing, coding, matrices, diagramming, and team discussion to analyze the data.

Results

Women reported significant intrapartum health conditions and concerns (eg, preeclampsia, emergency cesarean birth, anxiety) and described unmet social, emotional, mental, and physical health needs. Unmet practical needs while in the NICU (eg, a place to rest, affordable parking, access to food, childcare) caused considerable burden. Despite disease burden and emergent health needs, few women reported regular monitoring of their postpartum health by maternal health care providers. Women frequently minimized and delayed care for their health needs so as to remain by the infant bedside.

Discussion

Women with infants in the NICU would benefit from patient‐centered care that provides greater attention to their postpartum health and recovery while also supporting their drive to remain close to their hospitalized infant.
Neurofibromatosis type 2 versus sporadic vestibular schwannoma: The utility of MR diffusion and dynamic contrast‐enhanced imaging
Authors: Ota Yoshiaki , Liao Eric , Capizzano Aristides A. , Baba Akira , Kurokawa Ryo , Kurokawa Mariko , Srinivasan Ashok
Published: January 2022

Background and Purpose

The goal of this study was to assess the utility of diffusion‐weighted imaging (DWI) and dynamic contrast‐enhanced magnetic resonance imaging (DCE‐MRI) to distinguish sporadic vestibular schwannomas (VSs) from those related to neurofibromatosis type 2 (NF2).

Methods

We retrospectively reviewed 265 patients pathologically diagnosed with VSs between January 2015 and October 2020 in a single institution. There were 28 patients (male: 19, female: 9; age 11‐67 years) including 23 sporadic and five NF2‐related VSs, who had pretreatment DWI and DCE‐MRI. Normalized mean apparent diffusion coefficient (nADCmean) and DCE‐MRI parameters along with tumor characteristics were compared between sporadic and NF2‐related VSs as appropriate. The diagnostic performances were calculated based on the receiver operating characteristic curve analysis for the values that showed significant differences. To identify significant modalities, multivariate logistic regression analysis was performed using nADCmean and the combination of statistically significant DCE‐MRI parameters.

Results

NADCmean, fractional volume of extracellular space (Ve), and forward volume transfer constant (Ktrans) were significantly different between sporadic and NF2‐related VSs (nADCmean: median 1.62 vs. 1.16, P = .002; Ve: median 0.40 vs. 0.66, P = .007; Ktrans: median 0.17 vs. 0.33, P = .007), whereas fractional plasma volume (Vp), reverse reflux rate constant (Kep), and tumor characteristics were not. The diagnostic performances of nADCmean, Ve, and Ktrans were 0.93, 0.90, and 0.90 area under the curves with cutoffs of 1.46, 0.51, and 0.29, respectively. nADCmean and the combination of Ve and Ktrans were both chosen as significant differentiators by multivariate logistic regression analysis (P = .027).

Conclusions

DWI and DCE‐MRI are both promising modalities to distinguish sporadic and NF2‐related VSs.
Critical Consciousness Socialization at School: Classroom Climate, Perceived Societal Islamophobia, and Critical Action Among Adolescents
Authors: Schwarzenthal Miriam , Juang Linda P. , Moffitt Ursula , Schachner Maja K.
Published: January 2022

Schools are key contexts for the development of adolescents’ critical consciousness. We explored how three dimensions of the classroom cultural diversity climate (critical consciousness, color‐evasion, and multiculturalism) related to adolescents’ critical reflection (i.e., perceived societal Islamophobia) and intended critical action (i.e., political activism). Our sample included adolescents experiencing high (second generation, Muslim, N = 237) versus low (non‐immigrant descent, non‐Muslim, N = 478) stigmatization in Germany. Multilevel analyses revealed that for both groups a critical consciousness climate, but not a color‐evasive or a multicultural climate, was positively associated with perceived societal Islamophobia and intended critical action. Thus, to promote adolescents’ critical consciousness, schools should go beyond emphasizing a common humanity and celebrating cultural diversity and include explicit discussions of social inequity.
Leishmaniosis in a cat with chronic diarrhea as the only clinical manifestation
Authors: Tabar María‐Dolores , Naranjo Carolina , Dehesa Alexandra , Rodríguez Mari‐Carmen
Published: January 2022

A 10‐year‐old male domestic shorthaired cat was presented with chronic diarrhea unresponsive to treatment. Laboratory testing identified hyperglobulinemia and mild nonregenerative anemia, and nongastrointestinal causes of diarrhea were ruled out. Gastrointestinal endoscopy and biopsy were performed and disclosed diffuse generalized granulomatous and lymphoplasmocytic inflammatory reaction in all segments of gastrointestinal tract evaluated, with numerous Leishmania spp. amastigotes within the cytoplasm of macrophages. The organism also was detected in spleen and bone marrow and Leishmania spp. serology was positive (immunofluorescence assay 1 : 160). A diagnosis of granulomatous enteritis secondary to leishmaniosis was made. Gastrointestinal signs resolved after treatment with allopurinol and a dietary supplement of nucleotides and active hexose‐correlated compounds (N‐AHCC), but seropositivity and gammopathy persisted 8 months later. The cat died of unrelated causes after an additional 3 months and permission for necropsy was not granted. Leishmaniosis as a cause of chronic diarrhea has not been reported previously in cats and should be considered in endemic areas in cats with chronic gastrointestinal signs.
Dependence on clade II bHLH transcription factors for nursing of haploid products by tapetal‐like cells is conserved between moss sporangia and angiosperm anthers
Authors: Lopez‐Obando Mauricio , Landberg Katarina , Sundberg Eva , Thelander Mattias
Published: January 2022

Clade II basic helix–loop–helix transcription factors (bHLH TFs) are essential for pollen production and tapetal nursing functions in angiosperm anthers. As pollen has been suggested to be related to bryophyte spores by descent, we characterized two Physcomitrium (Physcomitrella) patens clade II bHLH TFs (PpbHLH092 and PpbHLH098), to test if regulation of sporogenous cells and the nursing cells surrounding them is conserved between angiosperm anthers and bryophyte sporangia.

We made CRISPR‐Cas9 reporter and loss‐of‐function lines to address the function of PpbHLH092/098. We sectioned and analyzed WT and mutant sporophytes for a comprehensive stage‐by‐stage comparison of sporangium development.

Spore precursors in the P. patens sporangium are surrounded by nursing cells showing striking similarities to tapetal cells in angiosperms. Moss clade II bHLH TFs are essential for the differentiation of these tapetal‐like cells and for the production of functional spores.

Clade II bHLH TFs provide a conserved role in controlling the sporophytic somatic cells surrounding and nursing the sporogenous cells in both moss sporangia and angiosperm anthers. This supports the hypothesis that such nursing functions in mosses and angiosperms, lineages separated by c. 450 million years, are related by descent.
Evaluation of suicide probability in children and adolescents with epilepsy
Authors: Yıldız Miniksar Dilşad , Kılıç Betül , Kılıç Mahmut , Miniksar Ökkeş Hakan , Topçu Yasemin , Aydın Kürşad
Published: January 2022

Background

We aimed to examine suicide probability, factors affecting suicide, and personality traits of children and adolescents diagnosed with epilepsy, and to compare their results with those of children without epilepsy.

Methods

Fifty‐six children diagnosed with epilepsy and 56 control children, aged 11–16 years, were evaluated by using the Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria, the Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version, the Child Depression Inventory, the Suicide Probability Scale (SPS), and the Personality Inventory for DSM‐5 – Brief Form – Children (PID‐5‐BF) scales. Factors predicting suicide risk in children with epilepsy were analyzed.

Results

The mean age, SPS total score, and hopelessness subscale score, PID‐5‐BF total score as well as disinhibition and psychoticism subscale scores of the epilepsy group were significantly higher than those of the control group (P < 0.05). There was no significant difference between the groups in terms of the Child Depression Inventory, and other subscales of the Suicide Probability Scales and PID‐5‐BF scales. The SPS total score was higher in patients with comorbid psychiatric diseases, those using psychiatric drugs, and girls (P < 0.05). An ANCOVA analysis indicated that the most important factor that predicted the probability of suicide and its subscale scores was the level of depression, and the presence of epilepsy was not predictive.

Conclusions

We found a high probability of suicide and personality pathology in children with epilepsy but the main predictor of suicide probability was the level of depression, not the presence of epilepsy.
Seropositivity for cytomegalovirus and PCR‐EBV monitoring: Protective factors for posttransplant lymphoproliferative disorder in pediatric liver transplant
Authors: Éboli Lígia Patrícia de Carvalho Batista , Tannuri Ana Cristina Aoun , Tannuri Uenis
Published: January 2022

Background

PTLD is a clinical condition with high mortality. Monitoring EBV replication can be a useful tool to avoid the development of PTLD.

Materials and Methods

This was a retrospective analysis of 428 pediatric patients who underwent liver transplantation between 1989 and 2016. The patients were divided into 2 groups (transplanted before 2006, when PCR‐EBV was not monitored, and after 2006, when PCR‐EBV monitoring was started). Patients with continuous PCR measurements for EBV were evaluated for the impact of a reduction in immunosuppression or a change in immunosuppressants on the number of viral copies. A logistic regression model was applied to evaluate factors related to PTLD.

Results

The prevalence of PTLD was 4.2%. After monitoring patients with PCR for EBV levels, a predominance of the most severe, monomorphic form of lymphoproliferative disorder was observed (p = .009). The PTLD mortality was 5%. There was a change in the PCR level after tacrolimus reduction (p = .002) and after tacrolimus exchange for mTOR (p = .008). The number of EBV copies was significantly higher (p = .029) in patients who developed PTLD. In the multiple regression model, seropositivity for CMV was an independent protective factor for lymphoproliferative disorder (OR=0.09; 95% CI 0.02–0.42), reducing the chance of having PTLD adjusted by serology for EBV by 91%.

Conclusions

Monitoring the EBV viral load by PCR seems to prevent the emergence of milder forms of lymphoproliferative disorder. Pretransplant seropositivity for CMV is a protective factor for PTLD.
Adaptive management of large‐scale ecosystem restoration: increasing certainty of habitat outcomes in the Columbia River Estuary, U.S.A.
Authors: Littles Chanda , Karnezis Jason , Blauvelt Katie , Creason Anne , Diefenderfer Heida , Johnson Gary , Krasnow Lynne , Trask Phil
Published: January 2022

Ecological restoration programs in dynamic coastal environments can benefit from adaptive management, including an iterative process for identifying and addressing critical uncertainties. We highlight key developments under the three pillars that have increased the rate of restoration by the Columbia Estuary Ecosystem Restoration Program (CEERP) over 20 years: science, coordination, and management. We show how such programs can be institutionalized to ensure that estuary ecosystems are better understood, conserved, and restored. The principal conservation effort under CEERP is to reconnect historical floodplain wetlands to the mainstem. The program also supports other restoration actions that demonstrate a high potential to benefit ecosystem function and endangered salmon populations; however, there is greater uncertainty regarding these less‐utilized techniques. Through adaptive management, we address technical uncertainty regarding benefits to the environmental resource and programmatic uncertainty pertaining to decision‐making. Here, we examine three periods of CEERP growth to establish how complementary research and restoration actions have improved program outcomes over time. We highlight the tools and processes that were developed and integrated into the program to refine program strategy, improve project design, and maximize ecological benefits. CEERP supported 77 restoration projects and reconnected over 7,000 acres of floodplain habitat to the lower Columbia River between 2004 and 2021. Building on these successes, we outline current plans to better engage landowners and local communities, solicit new project types, and maintain enough flexibility within the program to adapt to new priorities.
A note about the invariance of the basic reproduction number for stochastically perturbed SIS models
Authors: Bernardi Enrico , Lanconelli Alberto
Published: January 2022

In Gray et al. [A stochastic differential equation SIS epidemic model, SIAM J. Appl. Math. 71 (3) (2011) 876–902] a susceptible‐infected‐susceptible (SIS) stochastic differential equation (SDE), obtained via a suitable random perturbation of the disease transmission coefficient in the classic SIS model, has been studied. Such random perturbation enters via an informal manipulation of stochastic differentials and leads to an Itô's‐type SDE. The authors identify a stochastic reproduction number, which differs from the standard one for the presence of those additional parameters that describe the employed random perturbation, and show that, similarly to the deterministic case, the stochastic reproduction number rules the asymptotic behavior of the solution. Aiming to make that random perturbation rigorous, we suggest an alternative approach based on a Wong–Zakai approximation argument thus arriving at a different stochastic model corresponding to the Stratonovich version of the Itô equation analyzed in Gray et al. Rather surprisingly, the asymptotic behavior of this alternative model turns out to be governed by the same reproduction number as the deterministic SIS equation. In other words, the random perturbation does not modify the threshold for extinction and persistence of the disease.
Efficient numerical solution of one‐phase linear inverse Stefan and Cauchy–Stefan problems in two dimensions: A posteriori error control
Authors: Nanda Phalguni , Reddy Gujji Murali Mohan
Published: January 2022

The efficient numerical solution of the one‐phase linear inverse Stefan and Cauchy–Stefan problems is a delicate task owing to the problems' susceptibility to the perturbation of the given data. In this context, heuristic a posteriori error indicators are constructed for such inverse problems with noisy data in two dimensions (2D). Given a fixed computational effort, the estimator controls the error due to discretization by the method of fundamental solution (MFS). It is accomplished through two mean‐driven double‐filtering algorithms. Numerical results substantiate the effectiveness of the algorithms.
Information‐Motivation‐Behavioural Skills Model‐based intervention effectively improved hygiene‐related self‐efficacy and practice among the primary caregivers of the under‐three indigenous children in Malaysia
Authors: Minhat Halimatus Sakdiah , Zakaria Liyanatul Najwa
Published: January 2022

Poor hygiene practice has been an ongoing issue among the Orang Asli community in Malaysia and is strongly linked to poor child growth and malnutrition. A theory‐based intervention was developed and implemented to improve the knowledge, attitude, self‐efficacy and practice related to hygiene among the primary caregivers of the under‐three Orang Asli children. A single blinded clustered randomized control trial was conducted involving random allocation of five government health clinics into intervention and control groups, using random block method. Using the Information‐Motivation‐Behaviour Skills (IMB) model, an intervention was developed and delivered in the form of health talks, video presentation, group counselling and guided practical sessions. Knowledge (information) and attitude (motivation) on hygiene, self‐efficacy (behavioural skills) towards practising good hygiene and hygiene practice were measured at baseline, 1 and 3 months follow‐up. A total of 166 participants were recruited for the study. The overall between groups comparison showed significant different between mean scores for self‐efficacy (MD = 1.22 [0.36, 2.10]) and hygiene practice (MD = 1.70 [0.47, 2.93]), with moderate effect size of 0.3 and 0.36 respectively. Self‐efficacy and hygiene practice had significant different in mean scores at 2 time points (at 1‐ and 3‐month post‐intervention) with the highest effect size is observed for practice at 1‐ month post‐intervention (ES = 0.74). Within the intervention group, significant improvement of knowledge (MD = 1.06 [0.49–1.63]), attitude (MD = 1.04 [−0.56, 2.65]) and hygiene practice (MD = 1.78 [0.04, 3.52]) mean scores were observed at 3‐month post‐intervention as compared to the baseline measurement. IMB‐based intervention was found to effectively improved self‐efficacy and practice related to hygiene among the primary caregivers of the Orang Asli children. However, the moderate effect size may reflect the needs to revise the intervention in order to increase its impact and transferability.
Plant Biology Experimental Courses in Universities: Status Quo, Limitations and Prospects
Authors: Huang Zibin
Published: January 2022

Plant biology, as a significant compulsory course for biological science students, is intuitive and practical, which plays a unique role in improving students' comprehensive quality and cultivating their innovation ability. Because of its strong practical characteristics, the experimental course is of great necessity in the study of this course. This paper analyzes the traditional teaching mode of plant biology experiment, as well as its shortcomings in modern teaching, and puts forward diversified reform methods based on the development of contemporary plant biology to promote the teaching mode of plant biology experiment to meet the needs of contemporary students on this subject. Based on the rapid development of modern science and technology, this paper includes the teaching contents, teaching methods, and assessment system of plant biology experiments, and discusses them respectively. This paper aims to improve the teaching efficiency of modern plant biology experiments and help to achieve the goal of efficiently improving students' innovation and scientific research ability.
Evaluation of a Statistically Targeted Forcing Method for Synthetic Turbulence Generation in Scale-Resolving Simulations
Authors: Shobayo Olalekan O. , Walters D. Keith
Published: January 2022

Computational fluid dynamics (CFD) results are presented for synthetic turbulence generation by a proposed statistically targeted forcing (STF) method. The new method seeks to introduce a fluctuating velocity field with a distribution of first and second moments that approximate a user-specified target mean velocity and Reynolds stress tensor, by incorporating deterministic time-dependent forcing terms into the momentum equation for the resolved flow. The STF method is formulated to extend the applicability of previously documented methods and provide flexibility in regions where synthetic turbulence needs to be generated or sustained, for use in engineering level large eddy and hybrid large eddy/Reynolds-averaged Navier–Stokes CFD simulations. The objective of this study is to evaluate the performance of the proposed STF method in large-eddy simulation (LES) simulations of isotropic and anisotropic homogeneous turbulent flow test cases. Results are interrogated and compared to target statistical velocity and turbulent stress distributions and evaluated in terms of energy spectra. Analysis of the influence of STF model parameters, mesh resolution, and LES subgrid stress model on the results is investigated. Results show that the new method can successfully reproduce desired statistical distributions in a homogeneous turbulent flow.
Unusual case of ascites secondary to unilateral distal ureteric obstruction in an infant
Authors: Chinnadurai Amirtha Vahini , Hong Joyce Soo Synn , Abdul Latif Hasniah
Published: January 2022

Congenital obstructive uropathy is a rare cause of ascites in infants. Majority of reported cases of genitourinary causes of ascites were due to posterior urethral valve. Here, we report a 6-month-old boy who presented with progressive tense ascites and peritonitis attributed by unilateral left distal ureteric obstruction and acute pyonephrosis. He underwent left nephrostomy placement, after which there was a remarkable improvement of ascites. He then underwent left ureteral diversion procedure a month later with a tentative plan for ureteral reanastomosis in 6 months. To date, there are no reports describing ascites secondary to distal ureteric obstruction beyond the neonatal period. The objective of this case report is to highlight unilateral urinary tract obstruction as a potential cause of transudative ascites. Additionally, the superimposed infection in the obstructed collecting system can lead to acute peritonitis likely due to translocation of bacteria into the peritoneal cavity.
NovelCACNA1Smutation in hypokalaemic periodic paralysis
Authors: Luís Telma , Linhares Maria Inês , Silva Sónia Regina , Rodrigues Filipa
Published: January 2022

A 15-year-old girl was admitted to emergency department with an acute flaccid tetraparesis with no other symptoms. A history of recurrent similar episodes with spontaneous recovery was reported and no family history was known. Laboratory tests revealed severe hypokalaemia and hypokaluria. Symptoms resolution occurred after potassium replacement. The diagnosis of hypokalaemic periodic paralysis (HPP) was confirmed by genetic testing, which revealed a not previously described mutation inCACNA1Sgene (c.3715C>G p.Arg1239Gly). HPP is a rare neuromuscular disorder that causes episodic attacks of flaccid paralysis with concomitant hypokalaemia. Primary forms of the disease are skeletal muscle ion channelopathies. HPP occurs due to a problem in potassium distribution rather than a total body potassium deficiency. Therefore potassium replacement should be carefully performed because of the risk of rebound hyperkalaemia. Knowing this rare entity is important in order to avoid diagnostic delays and so that proper treatment can be initiated to reduce morbidity and mortality.
Successful outcome of severe COVID-19 in pregnancy: individualised approach
Authors: Dave Anupama , Joshi Priyansha , Jaiswal Sunil , Kapdeo Pradnya
Published: January 2022

A 32-year-old homemaker, 28 weeks pregnant, was admitted to a dedicated COVID-19 hospital with a history of dyspnoea for 1 day; oral and nasopharyngeal swabs were positive for SARS-CoV-2 on real-time PCR. She had type 1 respiratory failure and oxygen saturation of 88%, so was put on non-invasive ventilation. Treatment as per guidelines was started. Given her deteriorating condition, a decision to deliver was taken and induction of labour was done. Her condition improved after delivery; but on day 5, she was suspected to have rhino-orbital mucormycosis and antifungals were started. Her condition improved gradually and she was discharged home. This case highlights the importance of individualised decision-making in cases with COVID-19 infection in pregnancy and that prompt treatment of the complications like mucormycosis would be lifesaving.
Transfemoral transcatheter aortic valve implantation in a patient with chronic type B aortic dissection
Authors: Tsuda Masaki , Egami Yasuyuki , Nishino Masami , Tanouchi Jun
Published: January 2022

A 70s woman with a history of open-heart surgery presented with severe aortic stenosis (AS). CT showed chronic type B aortic dissection (TBAD) between the distal aortic arch and the left common iliac artery. After careful consideration, we planned transfemoral (TF)-transcatheter aortic valve implantation (TAVI) using a 20-Fr long sheath to minimise number of contacts with the false lumen of the aorta. TAVI was performed under general anaesthesia, guided by transoesophageal echocardiography (TEE). A transcatheter aortic valve was successfully implanted. TEE immediately after valve implantation showed no remarkable changes in the descending thoracic aorta. Repeated postprocedural CT examinations showed no obvious changes in the aorta. The patient was stable without sequelae at the 12-month follow-up. This case demonstrates that TF-TAVI using a long sheath under TEE guidance can be a treatment option for patients with severe AS and chronic TBAD.
Complementary role of cardiac CT in the diagnosis and management of mechanical aortic valve thrombosis with a novel low-dose, ultraslow thrombolysis treatment strategy
Authors: Senior Jonathan , Mahoney Luke , Gangil Nishant , Khan Jamal Nasir
Published: January 2022

A 31-year-old man presented to our emergency department with a 3-day history of progressive breathlessness, fatigue and exertional angina. His history included a mechanical aortic valve replacement (mAVR) for rheumatic heart disease at age 19 years. He could no longer afford medication prescription costs and consequently had not taken oral anticoagulation for 2 months. Transthoracic echocardiography (TTE) demonstrated mechanical prosthetic valve obstruction (PVO) and severe left ventricular (LV) systolic dysfunction; however, valve visualisation was limited by mAVR-related artefact. The patient declined transoesophageal echocardiography. Valve haemodynamics failed to improve despite a prolonged course of parenteral anticoagulation. Multidetector cardiac CT scan was performed which confirmed prosthetic valve thrombosis. A novel low-dose, ultraslow thrombolysis regimen was administered to mitigate the associated bleeding and embolic stroke risk. The patient made an excellent recovery and was discharged on day 30, with repeat cardiac CT scan showing complete resolution of mechanical PVO and normalisation of valve and LV function on TTE.
IgG4-related lung disease as a differential diagnosis of a lymphoproliferative disease: atypical presentation of an atypical disease
Authors: Vargas Camilo , Velásquez Carolina , Mancilla Edgardo , Aracena Joaquín
Published: January 2022

IgG4-related disease (IgG4-RD) is an immunomodulated inflammatory disease that usually affects the pancreas and parotid glands. Although lung involvement is rare, it has been recently reported and could mimic various other diagnoses. We present a case of IgG4-RD whose symptoms and images raised the suspicion of a malignant lymphoproliferative lung neoplasm. It is imperative to differentiate both diseases, since their treatment and prognosis vary.
Prognostic impact of depressive symptoms on all-cause mortality in individuals with abdominal aortic aneurysm and in the general population: a population-based prospective HUNT study in Norway
Authors: Nyrønning Linn Å , Hultgren Rebecka , Albrektsen Grethe , Mattsson Erney , Stenman Malin
Published: January 2022

Background

Abdominal aortic aneurysm (AAA) is a potentially life-threatening disease but the high mortality rate is linked to high age and comorbidity pattern. Depression is associated with increased mortality in the general population and individuals with cardiovascular diseases, but this is sparsely studied for AAA. The aim was to examine the prognostic impact of depressive symptoms on all-cause mortality in individuals with AAA and compare with findings in a general population of the same age and risk profile.

Methods

Population-based prospective study including 36 616 participants (52.1% women) from the Trøndelag Health Study in Norway. A total of 9428 individuals died during a median follow-up of 10 years at ages 60–90 years. Depressive symptoms were defined by a Hospital Anxiety and Depression Scale-Depression score ≥8. Data on AAA diagnoses and death were obtained from medical records and national registers. HRs from Cox proportional hazard regression models are reported.

Results

A total of 4832 (13.2%) individuals reported depressive symptoms, whereas 583 (1.6%) AAAs were identified. The adjusted hazard of death was 2.66 times higher in persons with AAA compared with the general population (95% CI 2.39 to 2.97). Overall, there was no significant adverse effect of depressive symptoms in individuals with AAA (HR 1.15;95% CI 0.88 to 1.51), whereas an increased risk was seen in the general population (HR 1.23;95% CI 1.17 to 1.30).

Conclusion

The overall risk of death was considerably higher in individuals with AAA compared with a general population of the same age and risk profile. Depressive symptoms did not significantly influence the risk of death in the AAA group.
Clinical assessment of pelvic floor and abdominal muscles 3 months post partum: an inter-rater reliability study
Authors: Vesting Sabine , Olsen Monika Fagevik , Gutke Annelie , Rembeck Gun , Larsson Maria E H
Published: January 2022

Objectives

Evaluation of the inter-rater reliability of clinical assessment methods for pelvic floor muscles and diastasis recti abdominis post partum.

Design

A multicentre inter-rater reliability study.

Setting

Three primary care rehabilitation centres in Sweden.

Participants

A total of 222 participants were recruited via advertising at Swedish maternity care units and social media. Eligibility for participation included female gender, ≥18 years, at maximum 3 months after childbirth. Exclusion criteria were chronic pelvic girdle pain and/or low back pain and/or pelvic floor tear grade III/IV. At each centre, 2 physiotherapists, with training and experience in pelvic floor assessment, assessed the 222 women according to a standardised protocol in random order.

Outcome measures

Inter-rater reliability of the assessment of pelvic floor muscle function (involuntary and voluntary contraction and voluntary relaxation) and diastasis recti abdominis (width, depth and bulging).

Results

Vaginal palpation of maximal voluntary contraction revealed a kappa value of 0.69 (95% CI 0.62 to 0.76). Assessments of involuntary contraction and voluntary relaxation yielded inconsistent results, with slight-to-moderate weighted kappa values ranging from 0.10 to 0.51. After 2 months of training in applying this method, diastasis recti abdominis width measured at the umbilicus by calliper yielded an intraclass correlation coefficient value of 0.83 (95% CI 0.76 to 0.87). Assessments of diastasis recti abdominis depth and bulging showed moderate kappa values, with reservation for some inconsistency between the centres.

Conclusions

Vaginal palpation of pelvic floor muscle strength is a reliable method for the postpartum muscle assessment. Additional research is needed to identify reliable assessment method for other pelvic floor muscle functions like involuntary contraction and voluntary relaxation. With some training, a calliper is a reliable instrument for measuring the postpartum diastasis recti abdominis width. This study provides novel thoughts about how to measure diastasis recti abdominis depth and bulging.

Trial registration number

NCT03703804.
Protective and resilience factors to promote mental health among Indigenous youth in Canada: a scoping review protocol
Authors: Carrier Leah , Shin Hwayeon Danielle , Rothfus Melissa A , Curran Janet A
Published: January 2022

Introduction

Many mental health concerns emerge in adolescence and young adulthood, making this a critical period to initiate early interventions for mental health promotion and illness prevention. Although Indigenous young people in Canada are at a higher risk of mental health outcomes and faced with limited access to appropriate care and resources, they have unique strengths and resilience that promote mental health and wellness. Furthermore, resilience has been described as a ‘healing journey’ by Indigenous peoples, and interventions that account for the culture of these groups show promise in promoting mental health and wellness. As such, there is a need for innovative mental health interventions for Indigenous youth that transcend the Western biomedical model, use a strengths-based approach, and account for the cultural practices and belief systems of Indigenous peoples. This scoping review aims to explore the resilience and protective factors that promote mental health and wellness for Indigenous youth in present-day Canada with the aim of compiling and summarising the available literature on this topic to date.

Methods and analysis

The review will follow Joanna Briggs Institute methodology for conducting scoping reviews. The reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews checklist and guidelines. We will include both published and unpublished grey literature and search the following databases: PubMed, CINAHL, PsycINFO, Education Resources Information Center, Embase and Scopus. The search of all databases was conducted on 26 August 2021. Further, we will use government and relevant Indigenous organisation websites. Two reviewers will independently screen and select the articles and extract the data.

Ethics and dissemination

No ethical approval is required for this study. We will share the results through conference presentations and an open-access publication in a peer-reviewed journal. A lay-language report will be created and disseminated to community organisations that work with Indigenous youth.
Prevalence and forms of gender discrimination and sexual harassment among medical students and physicians in French-speaking Switzerland: a survey
Authors: Najjar Iris , Socquet Jennifer , Gayet-Ageron Angele , Ricou Bara , Le Breton Julien , Rossel Anne , Abdulcadir Jasmine , Soroken Cindy , Tessitore Elena , Gerstel Caroline , Halimi Julie , Frasca Polara Giulia , Coen Matteo , Niyibizi Eva
Published: January 2022

Objectives

The aim of this study was to determine the prevalence and forms of gender discrimination and sexual harassment experienced by medical students and physicians in French-speaking part of Switzerland.

Design and setting

We conducted an online survey using a questionnaire of 9 multiple-choice and 2 open questions between 24 January 2019 and 24 February 2019. Our target population was medical students and physicians working at hospitals and general practitioners from the French-speaking part of Switzerland. The online survey was sent via social media platforms and direct emails. We compared answers between male-determined and female-determined respondents using either χ2 or Fisher’s exact tests.

Results

Among 1071 responders, a total of 893 were included (625 females, 264 males, 4 non-binary and 1 non-binary and male). 178 were excluded because they did not mention their working place or were working only outside Switzerland. Because of the small number of non-binary participants, they were not contemplated in further statistical analysis. Of 889 participants left, 199 (31.8%) women and 18 (6.8%) men reported having personally experienced gender discrimination, in terms of sexism, difficulties in career development and psychological pressure. Among women, senior attendings were the most affected (55.2%), followed by residents (44.1%) and junior attendings (41.1%). Sexual harassment was equally observed among women (19.0%) and men (16.7%). Compared with men (47.0%), women (61.4%) expressed the need to promote equality and inclusivity in medicine more frequently (p<0.001), as well as the need for support in their professional development (38.7% women and 23.9% men; p<0.001).

Conclusions

Gender discrimination in medicine in French-speaking Switzerland affects one-third of women, in particular, those working in hospital settings and senior positions.
Multisite, mixed methods study to validate 10 maternal health system and policy indicators in Argentina, Ghana and India: a research protocol
Authors: Jolivet R Rima , Gausman Jewel , Adanu Richard , Bandoh Delia , Belizan Maria , Berrueta Mabel , Chakraborty Suchandrima , Kenu Ernest , Khan Nizamuddin , Odikro Magdalene , Pingray Veronica , Ramesh Sowmya , Saggurti Niranjan , Vázquez Paula , Langer Ana
Published: January 2022

Introduction

Most efforts to assess maternal health indicator validity focus on measures of service coverage. Fewer measures focus on the upstream enabling environment, and such measures are typically not research validated. Thus, methods for validating system and policy-level indicators are not well described. This protocol describes original multicountry research to be conducted in Argentina, Ghana and India, to validate 10 indicators from the monitoring framework for the ‘Strategies toward Ending Preventable Maternal Mortality’ (EPMM). The overall aim is to improve capacity to drive and track progress towards achieving the priority recommendations in the EPMM strategies. This work is expected to contribute new knowledge on validation methodology and reveal important information about the indicators under study and the phenomena they target for monitoring. Validating the indicators in three diverse settings will explore the external validity of results.

Methods and analysis

This observational study explores the validity of 10 indicators from the EPMM monitoring framework via seven discrete validation exercises that will use mixed methods: (1) cross-sectional review of policy data, (2) retrospective review of facility-level patient and administrative data and (3) collection of primary quantitative and qualitative cross-sectional data from health service providers and clients. There is a specific methodological approach and analytic plan for each indicator, directed by unique, relevant validation research questions.

Ethics and dissemination

The protocol was approved by the Office of Human Research Administration at Harvard University in November 2019. Individual study sites received approval via local institutional review boards by January 2020 except La Pampa, Argentina, approved June 2020. Our dissemination plan enables unrestricted access and reuse of all published research, including data sets. We expect to publish at least one peer-reviewed publication per validation exercise. We will disseminate results at conferences and engage local stakeholders in dissemination activities in each study country.
What prevents pregnant women from adhering to the continuum of maternal care? Evidence on interrelated mechanisms from a cohort study in Kenya
Authors: Aksünger Nursena , De Sanctis Teresa , Waiyaiya Emma , van Doeveren Rianne , van der Graaf Mark , Janssens Wendy
Published: January 2022

Objectives

To examine the determinants of the continuum of maternal care from an integrated perspective, focusing on how key components of an adequate journey are interrelated.

Design

A facility-based prospective cohort study.

Setting

25 health facilities across three counties of Kenya: Nairobi, Kisumu and Kakamega.

Participants

A total of 5 879 low-income pregnant women aged 13–49 years.

Outcome measures

Ordinary least squares, Poisson and logistic regression models were employed, to predict three key determinants of the continuum of maternal care: (i) the week of enrolment at the clinic for antenatal care (ANC), (ii) the total number of ANC visits and (iii) utilisation of skilled birth attendance (SBA). The interrelationship between the three outcome variables was assessed with structural equation modeling.

Results

Each week of delayed enrolment in ANC reduced the number of ANC visits by 3% (incidence rate ratio=0.967, 95% CI 0.965 to 0.969). A higher number of ANC visits increased the relative probability of using SBA (odds ratio=1.28, 95% CI 1.22 to 1.34). The direct association between late enrolment and SBA was positive (odds ratio=1.033, 95% CI 1.02 to 1.04). Predisposing factors (age, household head’s education), enabling factors (wealth, shorter distance, rural area) and need factors (risk level of pregnancy, multigravida) were positively associated with adherence to ANC.

Conclusion

The results point towards a domino-effect and underscore the importance of enhancing the full continuum of maternal care. A larger number of ANC visits increases SBA, while early initiation of the care journey increases the number of ANC visits, thereby indirectly supporting SBA as well. These beneficial pathways counteract the direct link between enrolment and SBA, which is partly driven by pregnant teenagers who both enrol late and are at heightened risk of complications, stressing the need for specific attention to this vulnerable population.