bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum Concentrations of Cotinine and Trans-3′-Hydroxycotinine in US Adults: Results From Wave 1 (2013–2014) of the Population Assessment of Tobacco and Health Study
Authors: Sosnoff Connie S , Caron Kevin , Akins J Ricky , Dortch Kristin , Hunter Ronald E , Pine Brittany N , Feng June , Blount Benjamin C , Li Yao , van Bemmel Dana M , Kimmel Heather L , Edwards Kathryn C , Goniewicz Maciej L , Hatsukami Dorothy K , de Castro B Rey , Bernert John T , Arnstein Stephen , Borek Nicolette , Deng-Bryant Ying , Mishina Elena , Lawrence Charles , Hyland Andrew , Hecht Stephen S , Conway Kevin P , Pirkle James L , Wang Lanqing
Published: November 2021

Introduction

The Population Assessment of Tobacco and Health (PATH) Study is a nationally representative cohort of tobacco product users and nonusers. The study’s main purpose is to obtain longitudinal epidemiologic data on tobacco use and exposure among the US population.

Aims and Methods

Nicotine biomarkers—cotinine (COT) and trans-3′-hydroxycotinine (HCT)—were measured in blood samples collected from adult daily tobacco users and nonusers during Wave 1 of the PATH Study (2013–2014; n = 5012; one sample per participant). Participants’ tobacco product use and exposure to secondhand smoke were categorized based on questionnaire responses. Nonusers were subdivided into never users and recent former users. Daily tobacco users were classified into seven tobacco product use categories: exclusive users of cigarette, smokeless tobacco, electronic cigarette, cigar, pipe, and hookah, as well as polyusers. We calculated sample-weighted geometric mean (GM) concentrations of cotinine, HCT, and the nicotine metabolite ratio (NMR) and evaluated their associations with tobacco use with adjustment for potential confounders.

Results

The GMs (95% confidence intervals) of COT and HCT concentrations for daily tobacco users were 196 (184 to 208) and 72.5 (67.8 to 77.4) ng/mL, and for nonusers they were 0.033 (0.028 to 0.037) and 0.021 (0.018 to 0.023) ng/mL. Exclusive smokeless tobacco users had the highest COT concentrations of all user groups examined. The GM NMR in daily users was 0.339 (95% confidence interval: 0.330 to 0.350).

Conclusions

These nationally representative estimates of serum nicotine biomarkers could be the basis for reference ranges characterizing nicotine exposure for daily tobacco users and nonusers in the US adult population.

Implications

This report summarizes the serum nicotine biomarker measurements in Wave 1 of the PATH Study. We are reporting the first estimates of HCT in serum for daily tobacco users and nonusers in the noninstitutionalized, civilian US adult population; the first nationally representative serum COT estimates for daily exclusive users of different tobacco products and daily polyusers; and the first nationally representative estimate of the serum NMR in daily tobacco users by age, race/ethnicity, and sex.
The emerging contours of a post-Brexit Britain
Authors: Adam Christopher
Published: November 2021

This paper introduces a set of papers analysing the likely economic impact of Brexit across key aspects of the UK economy as the country comes to the end of its first full year outside the European Union. The Brexit vote in 2016 was not just a vote on the UK’s relations with the institutions of the European Union but was also a referendum on the fractured state of the UK as a nation. The resulting conflation of Brexit with domestic economic policy debates is reflected in this issue. A first cluster of papers focuses on the consequences of choosing to abandon the ‘four freedoms’ enshrined in the Treaty of Europe, the free movement of goods, services, capital, and labour across the EU, and a second is concerned with the indirect effects of Brexit in those areas of domestic policy that have been opened up by the Brexit decision. The economic consequences of Brexit are only just emerging, but these papers provide an informed perspective on the state of debate, and the likely implications of Brexit across a range of policy areas, both international and domestic.
Changes in phytoplankton composition hinder the recovery from eutrophication in a perialpine lake (Lake Lugano, Switzerland and Italy)
Authors: Lepori Fabio , Capelli Camilla , Foresti Danilo
Published: November 2021

We investigated the factors shaping the response of summer phytoplankton biomass to declining phosphorus (P) concentrations in a lake undergoing restoration (South basin of Lake Lugano, Switzerland and Italy). During 1989–2019, summer P concentrations declined from values typical of eutrophic lakes (>30 μg L−1) to values typical of mesotrophic lakes (10–30 μg L−1). Contrary to expectations, this decline was not followed by a decline in phytoplankton biomass. Instead, phytoplankton biomass showed the highest values in summers with lowest P concentrations. This paradoxical effect was associated with a change in phytoplankton composition. Higher P concentrations were associated with higher relative biomass of green algae, lower P concentrations with higher biomass of cyanobacteria and diatoms. We interpreted this change as a shift from edible and P-demanding phytoplankton to inedible and P-efficient phytoplankton, leading to different trophic structures. The pattern observed may be prompted by the particular conditions of deep lakes approaching mesotrophy, including occurrence of deep-water P reserves and high N concentrations, which can benefit inedible metalimnetic cyanobacteria. To attain reductions in summer phytoplankton biomass, restoration efforts may need to further reduce P concentrations and, possibly, address N enrichment.
A multi-organ metabolic model of tomato predicts plant responses to nutritional and genetic perturbations
Authors: Gerlin Léo , Cottret Ludovic , Escourrou Antoine , Genin Stéphane , Baroukh Caroline
Published: November 2021

Predicting and understanding plant responses to perturbations require integrating the interactions between nutritional sources, genes, cell metabolism, and physiology in the same model. This can be achieved using metabolic modeling calibrated by experimental data. In this study, we developed a multi-organ metabolic model of a tomato (Solanum lycopersicum) plant during vegetative growth, named Virtual Young TOmato Plant (VYTOP) that combines genome-scale metabolic models of leaf, stem and root and integrates experimental data acquired from metabolomics and high-throughput phenotyping of tomato plants. It is composed of 6,689 reactions and 6,326 metabolites. We validated VYTOP predictions on five independent use cases. The model correctly predicted that glutamine is the main organic nutrient of xylem sap. The model estimated quantitatively how stem photosynthetic contribution impacts exchanges between the different organs. The model was also able to predict how nitrogen limitation affects vegetative growth and the metabolic behavior of transgenic tomato lines with altered expression of core metabolic enzymes. The integration of different components, such as a metabolic model, physiological constraints, and experimental data, generates a powerful predictive tool to study plant behavior, which will be useful for several other applications, such as plant metabolic engineering or plant nutrition.
UNFERTILIZED EMBRYO SAC 12 phosphorylation plays a crucial role in conferring salt tolerance
Authors: He Zihang , Wang Zhibo , Nie Xianguang , Qu Ming , Zhao Huimin , Ji Xiaoyu , Wang Yucheng
Published: November 2021

Arabidopsis (Arabidopsis thaliana) UNFERTILIZED EMBRYO SAC 12 (AtUNE12) belongs to the basic helix–loop–helix DNA-binding superfamily of proteins. However, its function is not well known. Here, we found that AtUNE12 plays an important role in mediating salt tolerance. AtUNE12 is a transcriptional activator located in the nucleus whose expression is induced by NaCl, mannitol, and abscisic acid. In addition to binding to the G-box “CACGTG”, AtUNE12 also binds to the low temperature responsive element 15 (LTRE15) “CCGAC”. Furthermore, the serine residue at position 108 of AtUNE12 is phosphorylated during the salt stress response, enabling AtUNE12 to trigger gene expression by binding to G-box and/or LTRE15 motifs. Phosphorylated AtUNE12 regulates the expression of the genes involved in ion transport leading to reduced Na+ accumulation and K+ loss. At the same time, phosphorylation of AtUNE12 also induces the expression of AtMYB61 to decrease stomatal aperture, leading to a reduced transpiration rate. Overall, AtUNE12 serves as a transcriptional activator that is induced and phosphorylated upon salt stress, and the induction and phosphorylation of AtUNE12 in turn activate the salt-overly-sensitive pathway and decrease the stomatal aperture, enabling improved salt tolerance.
Research funding randomly allocated? A survey of scientists’ views on peer review and lottery
Authors: Philipps Axel
Published: November 2021

The bold idea of random grant allocation is heatedly discussed as an alternative to peer review. The debate centers on advantages and disadvantages of the established measures to control scientific quality, compared to funding by chance. Recently, studies also investigated acceptance of lotteries in the scientific field. However, they provide only inconclusive findings due to their restricted scope. This paper examines scientists’ views on current funding conditions and the idea of random grant distribution. An online survey of PhD holders reveals that most participants are against pure randomness, although they would try random elements if such procedures were combined with peer review. Moreover, while fewer established and recognized scientists differ in their assessments of peer review and expectancies on lotteries’ impact, they hardly vary in their positions on random elements. Funding organizations therefore should be encouraged to further experiment with, and closely examine, practiced lotteries.
Vapor Cannabis Exposure Generationally Affects Male Reproductive Functions in Mice
Authors: Shi Mingxin , Langholt Esther M , Butler Logan C , Harvey Madeleine E , Wheeler Emma C , Zhao Liang , MacLean James A , Oh Yeongseok , Sabrowsky Emily , Yu Sue , Watson Shane , Davis Jon F , Hayashi Kanako
Published: November 2021

This study was performed to examine whether vapor exposure to cannabis plant matter negatively impacts male reproductive functions and testis development in mice. Adult CD-1 male mice (F0) were exposed to air (control) or 200 mg of vaporized cannabis plant matter 3×/day over a 10-day period. Subsequently, F0 males were bred with drug-naïve CD-1 females to generate F1 males, and F1 offspring were used to generate F2 males. Cannabis vapor exposure decreased sperm count and/or motility in F0 and F1 males and disrupted the progression of germ cell development, as morphometric analyses exhibited an abnormal distribution of the stages of spermatogenesis in F0 males. Although plasma levels of testosterone were not affected by cannabis exposure in any ages or generations of males, dysregulated steroidogenic enzymes, Cyp11a1 and Cyp19a1, were observed in F0 testis. In the neonatal testis from F1 males, although apoptosis was not altered, DNA damage and DNMT1, but not DNMT3A and DNMT3B, were increased in germ cells following cannabis exposure. In contrast, the alterations of DNA damage and DNMT1 expression were not observed in F2 neonatal males. These results suggest that cannabis vapor exposure generationally affects male reproductive functions, probably due to disruption of spermatogenesis in the developing testis.
Persistent high prevalence of pulmonary tuberculosis in a resource-limited setting: threat to India's TB Free campaign
Authors: Bhat Jyothi , Sharma Ravendra K , Yadav Rajiv , Mishra Prashant , Nigam Samridhi , Lingala Mercy Aparna , Rao V G
Published: November 2021

Background

Tuberculosis (TB) is a major public health problem among Saharia, a particularly vulnerable tribal group residing in remote rural areas in central India. This article presents the findings from the baseline survey among Saharias and provides comprehensive prevalence data of pulmonary TB (PTB) in this marginalised community.

Methods

A community-based cross-sectional PTB prevalence survey was carried out during January–May 2019 in selected villages using multistage stratified cluster sampling. All eligible adults (≥15 years of age) were screened for the symptoms of PTB. Sputum samples were collected and processed for microscopy and culture for Mycobacterium tuberculosis.

Results

A total of 20 114 eligible individuals were screened for symptoms of PTB. Among these, 3001 (14.9%) individuals reported at least one PTB symptom and sputum was collected from 2890 (96.3%) individuals. Among these, 273 (9.4%) were bacteriologically positive for PTB. The overall prevalence was 1357 per 100 000 population.

Conclusions

The findings indicate that TB continues to be a major health problem in this marginalised community despite large investments by the government for TB control. This emphasizes the need to look into the causes and barriers in implementation of the TB elimination programme in the community, especially in view of India's TB elimination goal by 2025.
Local steroid injection versus surgical release for treatment of persistent De Quervain’s stenosing tenosynovitis (DQST): a prospective comparative study
Authors: Mazrou Ibrahim , Ramadan Mohamed , Atef Ashraf , El Elemy Ahmed
Published: November 2021

Background:

De Quervain’s stenosing tenosynovitis (DQST) can prevent patients from performing minor tasks as opening jars and texting. It is common in pregnant women and nursing mothers. The etiology is thought to be from repetitive manual work with thumb abduction and wrist ulnar deviation. The aim of this study was to compare steroid injection versus surgical release results for treatment of persistent DQST.

Methods:

Thirty-one hands of 30 patients with DQST who fulfilled the study selection criteria and treated during 2020 were included in this prospective study after institutional ethics committee approval. Patients were grouped into the mini-injection (group A) or surgical category (group B). Retrograde injection parallel to the tendons was used for injection. Transverse skin incision followed by longitudinal dissection and incision of the extensor retinaculum was used for surgical release. Clinical assessment of patients was done using a functional De Quervain’s score modified after the Disabilities of the Arm, Shoulder and Hand Score and Michigan Hand Outcome Questionnaire.

Results:

At the final follow-up, 13 out of 16 hands in group A improved. The mean score was 14±12.38, with nine, four, one, and two hands having excellent, good, fair, and absolute disability results, respectively. All 15 hands of group B improved. The mean score was 9.87±5.17, with nine, five, and one hands having excellent, good, and fair results, respectively.

Conclusions:

Both corticosteroid injection and surgical release were effective in persistent DQST treatment with insignificant differences, therefore the less invasive injection would be preferred.

Level of Evidence:

Level II.
Activation of Silent Information Regulator 6 Signaling Attenuates Myocardial Fibrosis by Reducing TGFβ1-Smad2/3 Signaling in a Type 2 Diabetic Animal Model
Authors: Yu Liming , Wang Jian , Dong Xue , Hu Yue , Luo Linyu , Xue Xiaodong , Wang Yang
Published: November 2021

Objective:

Long-term diabetes can result in ventricular hypertrophic remodeling, tissue fibrosis, myocardial metabolic defection, and eventually, heart failure. Silent information regulator 6 (SIRT6) exerts beneficial effects against cardiovascular diseases. This study is aimed to investigate whether the direct regulation of myocardial SIRT6 signaling affects cardiac performance in the case of diabetes. Meanwhile, we sought to explore the underlying mechanisms.

Methods:

Sprague Dawley (SD) rats were used in this experiment. Briefly, type 2 diabetic animal model was generated by streptozotocin administration along with feeding a high-fat diet. The SD rats were randomly assigned to non-diabetic group, diabetic group, diabetic injected with empty adenoviral vectors group and diabetic injected with adenoviral vectors expressing SIRT6 group (n = 10, respectively). The animals were kept for another 4 weeks before sacrifice. Cardiac performance was evaluated by echocardiography. Myocardial fibrosis was determined by Masson's trichrome staining. Myocardial SIRT6 signaling and fibrosis related molecules were measured by western blotting.

Results:

The diabetic myocardium exhibited markedly enhanced TGFβ1-Smad2/3-induced myocardial fibrosis and reduced SIRT6 and AMP-activated protein kinase (AMPK) signaling. After 4 weeks of SIRT6 adenoviral vector infection, myocardial tissues exhibited markedly enhanced SIRT6 and AMPK signaling. Additionally, myocardial fibrosis and TGFβ1-Smad2/3 signaling were both attenuated in the diabetic injected with adenoviral vectors expressing SIRT6 group.

Conclusions:

SIRT6-AMPK signaling suppressed the progression of tissue fibrosis in diabetes mellitus rats by inhibiting TGFβ1 and its downstream effector Smad2/3. SIRT6 might serve as an alternative therapeutic target for diabetes-related cardiovascular diseases.
Normal-Weight Abdominal Obesity: A Risk Factor for Hypertension and Cardiometabolic Dysregulation
Authors: Sun Jinyu , Qu Qiang , Yuan Yue , Sun Guozhen , Kong Xiangqing , Sun Wei
Published: November 2021

Objective:

This study aimed to examine the associations of waist circumference with hypertension and cardiometabolic dysregulation among normal-weight adults.

Methods:

This cross-sectional study included 8795 normal-weight participants aged 20 to 79 years from the 2009–2018 US National Health and Nutrition Examination Survey. The demographic characteristics and cardiometabolic risk factors across waist circumference quartiles were summarized. We used adjusted multivariate logistic regression models, subgroup analysis, and restricted cubic spline to analyze the association between waist circumference and the prevalence of hypertension. Thereafter, we used the random forest supervised machine learning method, together with least absolute shrinkage and selection operator regression, to select hypertension-related features and created a predictive model based on regression analysis to identify hypertension in normal-weight individuals.

Results:

Waist circumference was positively correlated with hypertension in the non-adjusted, minimally adjusted, and fully adjusted models, with odds ratios (95% confidence interval) of 2.28 (2.14–2.44), 1.27 (1.12–1.44), and 1.27 (1.12–1.44), respectively. In the fully adjusted model, participants in the highest waist circumference quartile had a higher risk of hypertension relative to those in the lowest quartile, with an odds ratio (95% confidence interval) of 3.87 (1.59–10.34). Sensitivity analysis demonstrated the robustness of the association. In the testing set, the predictive model exhibited good performance, with an area under the curve of 0.803, sensitivity of 0.72, specificity of 0.76, and negative predictive value of 0.84.

Conclusions:

Measuring waist circumference may improve the evaluation of the risk of hypertension and help to manage cardiometabolic risk in normal-weight individuals.
The UnProcessed Pantry Project (UP3)
Authors: Byker Shanks Carmen , Vanderwood Karl , Grocke Michelle , Johnson Nick , Larison LeeAnna , Wytcherley Beryl , Yaroch Amy L.
Published: November 2021

Low-income populations are more likely to experience food and nutrition insecurity and suffer a greater burden of noncommunicable disease than the general population. The UnProcessed Pantry Project (UP3) is an intervention aimed to reduce ultra-processed food availability and consumption of food pantry clients accessing the emergency food system. The pilot study included nutrition education, food boxes, and social support for 16 weeks at 2 food pantries. Data collection included the ASA24 dietary recall to calculate Healthy Eating Index-2015 (HEI-2015) scores, biomarkers (hemoglobin A1c, total cholesterol, blood pressure, waist circumference, body mass index [BMI]), and a demographic and psychosocial survey. Dietary quality among 43 participants significantly (P < .05) improved as measured by the HEI-2015 for total HEI-2015, whole grains, total protein foods, and added sugars scores. BMI, total cholesterol, and waist circumference also significantly improved across study participants. Findings indicate that the emergency food system may be an effective access point to apply frameworks including UP3 to address ultra-processed food consumption, dietary quality, and noncommunicable chronic disease risk among food-insecure populations. Programs and policies that limit the amount of ultra-processed food in the emergency food system should be further tested and could be efficacious in addressing inequities among vulnerable populations.
Predictors of Depressive Symptoms in Caregivers of Children With Poorly Controlled Asthma
Authors: Kub Joan E. , DePriest Kelli N. , Bellin Melissa H. , Butz Arlene , Lewis-Land Cassie , Morphew Tricia
Published: November 2021

Children residing in low-income neighborhoods are disproportionately affected by asthma morbidity and mortality. Neighborhood violence has been explored in relationship to child morbidity and health and developmental outcomes, but less is known about the relationship of violence to caregiver mental health. The purpose of this study was to examine the relationship of neighborhood violent crime victimization (objective and subjective measures), perceptions of community well-being and support, and depressive symptoms among a sample of primarily single female caregivers of children with uncontrolled asthma. This is a secondary analysis of baseline data obtained from a randomized controlled trial of a home-based environmental control intervention for children aged 3 to 12 years, who were primarily African American, and diagnosed with persistent, uncontrolled asthma. Results showed that both objective and subjective measures of crime, particularly in those with relatively low life stress (P < .001), limited education of the caregiver (P < .001), and fewer children (P < .01) in the household had direct associations with depressive symptoms in caregivers of children with uncontrolled asthma. Neighborhood perceptions of satisfaction and a sense of community, as well as perceptions of social support, were not associated with depressive symptoms. Our findings emphasize the need to screen for depressive symptoms, life stress, as well as both objective and subjective perceptions of neighborhood violence among caregivers of children with poorly controlled asthma. Furthermore, when providing holistic care to these caregivers, stress reduction and the provision of mental health resources are paramount.
Simplifying the Combined Use of Fibula Flap and Anterolateral Thigh Flap for Oromandibular Reconstruction
Authors: Tsai Hsu-Yun , Lee Yao-Chou
Published: November 2021

Although the preferred technique for reconstruction of extensive composite oromandibular defects involves the use of a fibula flap for the inner mucosal lining and mandibular bone reconstruction and an anterolateral thigh flap for outer skin coverage and soft tissue replenishment, this approach is complicated and manpower-dependent. It also often involves prolonged operations requiring nighttime surgery with insufficient manpower in an era of restricted working hours for residents, which can negatively affect the surgical outcomes. Traditionally, the mucosal defect is first defined and the fibula flap is then dissected to ensure a size-matching skin flap for the inner lining. This flap is transferred first after mandibulectomy is completed, but is delayed by the fibula bone shaping process. Finalizing the flap inset is a sophisticated process involving the fibula bone, fibula skin, and anterolateral thigh skin. Thus, we developed a strategy to overcome the late start of fibula flap harvest, the delayed initiation of defect-site reconstruction, and the troublesome flap inset. Briefly, we dissected both flaps sequentially or simultaneously from contralateral limbs before the mucosal defect was defined, so that the flaps were ready in the daytime. Once the mandibulectomy was completed, we transferred the anterolateral thigh flap first while the fibula bone was shaped, and simplified the flap inset by using the anterolateral thigh skin for the inner lining and outer coverage and the fibula skin as a monitoring flap. We employed this approach in five patients and completed postmandibulectomy reconstruction in as fast as 4 hours.
A tale of two balloons: technical and procedural difference between cryoballoon systems
Authors: Tomaiko-Clark Emrie , Bai Rong , Khokhar Mateen , Su Wilber W.
Published: November 2021

Purpose of review

The cryoballoon catheter has been an option for the treatment of atrial fibrillation for over a decade. The most widely used device is the Medtronic Arctic Advance cryoballoon catheter. Recently, Boston Scientific has released the POLARx cryoballoon catheter. Here we review the major changes in the catheter system's design and its implications for procedural practice.

Recent findings

The POLARx cryoballoon catheter has been approved for use in Europe. Some studies have been published detailing the first clinical experiences in vivo with this newest technology.

The changes to the POLARx cryoballoon catheter, particularly its ability to maintain balloon size and pressure, will improve occlusion and theoretically improve procedural outcomes.
Mindfulness for Outpatient Oncology Nurses
Authors: Qualls Brandon W. , Payton Emily M. , Aikens Laura G. , Carey Mary G.
Published: November 2021

This prospective pre-/posttest pilot studied a mindfulness-based stress reduction (MBSR) intervention first, to reduce self-reported stress and improve compassion satisfaction; and second, to reduce physiological indices of stress. Even small interventions of MBSR before a shift effectively reduces the physiological indices of stress and may help reduce compassion fatigue and burnout in nurses.
A Qualitative Exploration of the Psychological Experience of Patients Hospitalized With COVID-19
Authors: Wang Jing-Yuan , Wei Li-Li , Li Huan-Ting , Zhang Yan , Li Qian-Qian , Pan Yue-Shuai , Wang Gang , Wei Holly
Published: November 2021

This qualitative study describes the psychological experience of patients hospitalized with COVID-19. These patients went through 3 psychological stages: extremely uncertainties during the initial diagnostic stage, complicated feelings of negativity during the treatment stage, and positive growth in the recovery stage. It is important for nurses to provide holistic care.
Rotational thromboelastometry for diagnosis of fibrinolysis induced by urokinase in an in-vitro model
Authors: Bevilacqua Sergio , Paniccia Rita , Galeotti Ilaria , Viappiani Anna , Dimizio Fabio , Bartolozzi Carlo , Marcucci Rossella , Stefàno Pierluigi
Published: November 2021

Fibrinolysis can be abnormally activated in several critical care settings but it's often misdiagnosed by standard laboratory tests. Although rotational thromboelastometry can assess the whole coagulative process, its ability to detect fibrinolysis has been questioned. Aim of this study was to investigate the ability of thromboelastometry in detecting induced fibrinolysis in an in-vitro model. Whole blood samples were taken from 18 healthy volunteers. Each sample was split and added with increasing urokinase concentrations till to reach 0, 50, 75 and 100 IU/ml. Thromboelastometry tests, extem and aptem, were performed on the obtained samples. If significant lysis at 50 IU/ml was recorded, also 10, 25 and 35 IU/ml drug concentrations were tested. No lytic effects were detected in 10 IU/ml samples. Lysis variables were the most sensitive in detecting fibrinolysis even at 25 IU/ml (P < 0.05). Clot firmness parameters were also affected by urokinase, but only at the two highest drug concentrations (P < 0.05). Extem/aptem ratio enhanced the sensitivity of these parameters only if lysis was more marked. Analysing groups of different lysis severity, the time to achieve maximum clot firmness could anticipate an ongoing fulminant or intermediate lysis with 100% sensitivity and 100% specificity (P < 0.05) when lower than 1341.5 s. Rotational thromboelastometry could detect fibrinolysis when it was induced in vitro by 25 IU/ml urokinase or more. Apart from the parameters specific for lysis, time to achieve maximum clot firmness appeared as the earliest indicator of fibrinolysis with high sensitivity and specificity especially if a more intense lysis was going on.
Incontinence and Incontinence-Associated Dermatitis in Acute Care
Authors: Kayser Susan A. , Koloms Kimberly , Murray Angela , Khawar Waqaar , Gray Mikel
Published: November 2021

PURPOSE:

To evaluate the prevalence of incontinence and treatment of incontinence-associated dermatitis (IAD) and associations with outcomes including total cost of care, length of stay (LOS), 30-day readmission, sacral area pressure injuries present on admission and hospital acquired pressure injuries, and progression of all sacral area pressure injuries to a higher stage.

DESIGN:

Retrospective analysis.

SUBJECTS AND SETTINGS:

Data were retrieved from the Premier Healthcare Database and comprised more than 15 million unique adult patient admissions from 937 hospitals. Patients were 18 years or older and admitted to a participating hospital between January 1, 2016, and December 31, 2019.

METHODS:

Given the absence of an IAD International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code, we categorized patients treated for IAD by selecting patients with a documented incontinence ICD-10-CM code and a documented charge for dermatology products used to treat IAD. The t test and χ2 tests determined whether incontinence and treatment for IAD were associated with outcomes.

RESULTS:

Incontinence prevalence was 1.5% for the entire sample; prevalence rate for IAD among incontinent patients was 0.7%. As compared to continent patients, incontinent patients had longer LOS (6.4 days versus 4.4 days), were 1.4 times more likely to be readmitted, 4.7 times more likely to have a sacral pressure injury upon admission pressure injury, 5.1 times more likely to have a sacral hospital-acquired pressure injury, and 5.8 times more likely to have a sacral pressure injury progress to a severe stage. As compared to incontinent patients without IAD treatment, those with IAD treatment had longer LOS (9.7 days versus 6.4 days), were 1.3 times more likely to be readmitted, and were 2.0 times more likely to have a sacral hospital-acquired pressure injury. Total index hospital costs were 1.2 times higher for incontinent patients and 1.3 times higher for patients with IAD treatment.

CONCLUSIONS:

Incontinence and IAD prevalence are substantially lower than past research due to underreporting of incontinence. The lack of an ICD-10-CM code for IAD further exacerbates the underreporting of IAD. Despite low prevalence numbers, our results show higher health care costs and worse outcomes for incontinent patients and patients with IAD treatment.
Epidemiology of personality disorders in individuals with gender dysphoria
Authors: Furlong Yulia , Janca Aleksandar
Published: November 2021

Purpose of review

Prevalence estimates of personality disorders (PD) in individuals with gender dysphoria (GD) are variable and heterogeneous, as psychiatric comorbidity and long-term follow-up data from gender-diverse samples are still limited. This review aims to assess prevalence rates across age groups and discuss potential reasons for variability in PD prevalence estimates among transgender people.

Recent findings

International epidemiological data from several countries indicate that the best available estimates of the prevalence of any PD diagnosis in transgender youth are around 20% for adolescents and tend to increase to nearly 50% in trans-adults. The paucity of available data on personality dysfunction in children and adolescents with GD precluded us from definitive conclusions on the trends of emerging PDs in this population. Estimates of PD prevalence in transgender and gender-diverse people seem to be highly affected by methodological characteristics of the studies with no universally agreed reference standards for this population.

The review of epidemiological studies on PD among gender-diverse people highlights the need for using more standardized study methodologies to make findings comparable. Nevertheless, international epidemiological data seem to support the link association between the development of PD and GD.
Multimorbidity and its associated risk factors among the older adults in India
Authors: Khan Mohd Rashid , Malik Manzoor Ahmad , Akhtar Saddaf Naaz , Yadav Suryakant
Published: November 2021

Health at older ages is a key public health challenge especially among the developing countries. Older adults are at greater risk of vulnerability due to their physical and functional health risks. With rapidly rising ageing population and increasing burden of non-communicable diseases elderly in India are at a greater risk for multi-morbidities. Therefore, to understand this multimorbidity transition and its determinants we used a sample of older Indian adults to examine multimorbidity and its associated risk factors among the Indian elderly aged 45 and above. Using the sample of 72250 older adults this study employed the multiple regression analysis to study the risk factors of multimorbidity. Multimorbidity was computed based on the assumption of elderly having one or more than one of the diseases risks. Our results confirm the emerging diseases burden among the older adults in India. One of the significant findings of the study was the contrasting prevalence of multimorbidity among the wealthiest groups, which diverges from some earlier studies in developing countries examining the multimorbidity. Thus, given the contrasting results and rise of multimorbidity among older adults India, there is paper argues for an immediate need for proper policy measures and health system strengthening to ensure the better health of older adults in India.

Highlights

Multimorbidity is emerging as key challenge especially in the developing countries.

There is a significant association between multimorbidity and its associated demographic and socio-economic key risk factors.

Contrasting prevalence of multimorbidity among the affluent groups as compared to earlier studies.

Increasing longevity has significant consequences on morbidity pattern of older adult requiring an immediate policy attention to avert the challenges of morbidity, disability and death at older ages.
The challenge of SARS-CoV-2 environmental monitoring in schools using floors and portable HEPA filtration units: Fresh or relic RNA?
Authors: Zuniga-Montanez Rogelio , Coil David A. , Eisen Jonathan A. , Pechacek Randi , Guerrero Roque G. , Kim Minji , Shapiro Karen , Bischel Heather N.
Published: November 2021

Testing surfaces in school classrooms for the presence of SARS-CoV-2, the virus that causes COVID-19, can provide public-health information that complements clinical testing. We monitored the presence of SARS-CoV-2 RNA in five schools (96 classrooms) in Davis, California (USA) by collecting weekly surface-swab samples from classroom floors and/or portable high-efficiency particulate air (HEPA) units. Twenty-two surfaces tested positive, with qPCR cycle threshold (Ct) values ranging from 36.07–38.01. Intermittent repeated positives in a single room were observed for both floor and HEPA filter samples for up to 52 days, even following regular cleaning and HEPA filter replacement after a positive result. We compared the two environmental sampling strategies by testing one floor and two HEPA filter samples in 57 classrooms at Schools D and E. HEPA filter sampling yielded 3.02% and 0.41% positivity rates per filter sample collected for Schools D and E, respectively, while floor sampling yielded 0.48% and 0% positivity rates. Our results indicate that HEPA filter swabs are more sensitive than floor swabs at detecting SARS-CoV-2 RNA in interior spaces. During the study, all schools were offered weekly free COVID-19 clinical testing. On-site clinical testing was offered in Schools D and E, and upticks in testing participation were observed following a confirmed positive environmental sample. However, no confirmed COVID-19 cases were identified among students associated with classrooms yielding positive environmental samples. The positive samples detected in this study appeared to reflect relic viral RNA from individuals infected before the monitoring program started and/or RNA transported into classrooms via fomites. The high-Ct positive results from environmental swabs further suggest the absence of active infections. Additional research is needed to differentiate between fresh and relic SARS-CoV-2 RNA in environmental samples and to determine what types of results should trigger interventions.
Individual factors influencing public’s perceptions about the importance of COVID-19 immunity certificates: a cross-sectional online questionnaire survey in the UK
Authors: Niculaescu Corina-Elena , Sassoon Isabel Karen , Landa-Avila Irma Cecilia , Colak Ozlem , Jun Gyuchan Thomas , Balatsoukas Panagiotis
Published: November 2021

Objectives

To assess what were the main individual factors influencing people’s perception of the importance of using COVID-19 immunity certificates.

Design

Cross-sectional online survey.

Setting

Nationally representative survey in the UK, conducted on the 3rdof August 2021.

Participants

Responses from 534 participants, aged 18 and older, residents of the UK.

Interventions

This was a cross-sectional survey and each participant replied to the same set of questions.

Primary outcome measure and independent variables

The primary outcome measure (dependent variable) was the participants’ perceived importance of using immunity certificates, computed as an index of six items. The following individual drivers were used as the independent variables: a) personal beliefs about COVID-19 (using constructs adapted from the Health Belief Model), b) personal views on vaccination, c) willingness to share immunity status with service providers, and d) variables related to respondents’ lifestyle and socio-demographic characteristics.

Results

Perceived importance of immunity certificates was higher among respondents who felt that contracting COVID-19 would have a severe negative impact on their health(β=0.2564, p=0.0000)and felt safer if vaccinated(β =0.1552, p=0.0000). The prospect of future economic recovery positively influenced perceived importance of immunity certificates. Respondents who were employed or self-employed(β=-0.2412, p=0.0010), or experienced an increase in income after the COVID-19 pandemic(β=-0.1287, p=0.0020)perceived less important the use of immunity certificates compared to those who were unemployed or had retired or those who had experienced reduction in their income during the pandemic.

Conclusions

The findings of our survey suggest that more vulnerable members in our society (unemployed or retired and those believing that COVID-19 would have a severe impact on their health) and people who experienced a reduction in income during the pandemic perceived the severity of not using immunity certificates in their daily life as higher.
Using the Health Belief Model to design a questionnaire aimed at measuring people’s perceptions regarding COVID-19 immunity certificates
Authors: Niculaescu Corina-Elena , Sassoon Isabel Karen , Landa-Avila Irma Cecilia , Colak Ozlem , Jun Gyuchan Thomas , Balatsoukas Panagiotis
Published: November 2021

The present short communication paper describes the methodological approach of applying the Health Belief Model to the use COVID-19 immunity certificates in the UK. We designed an online survey including an adaptation of the following Health Belief Model constructs: perceived COVID-19 susceptibility, perceived COVID-19 severity, perceived benefits of using immunity certificates, perceived barriers from using immunity certificates, perceived severity of not using immunity certificates, and perceived vaccination views. The online cross-sectional survey conducted on the 3rdof August 2021 gathered responses from 534 participants aged 18 and older, representative of the UK population in terms of gender, age, and ethnicity.
Updated vaccine protects from infection with SARS-CoV-2 variants, prevents transmission and is immunogenic against Omicron in hamsters
Authors: Sharma Sapna , Vercruysse Thomas , Sanchez-Felipe Lorena , Kerstens Winnie , Rasulova Madina , Abdelnabi Rana , Foo Caroline S , Lemmens Viktor , Van Looveren Dominique , Maes Piet , Baele Guy , Weynand Birgit , Lemey Philippe , Neyts Johan , Thibaut Hendrik Jan , Dallmeier Kai
Published: November 2021

Current first-generation COVID-19 vaccines are based on prototypic spike sequences from ancestral 2019 SARS-CoV-2 strains. However, the ongoing pandemic is fueled by variants of concern (VOC) that threaten to escape vaccine-mediated protection. Here we show in a stringent hamster model that immunization using prototypic spike expressed from a potent YF17D viral vector (1) provides vigorous protection against infection with ancestral virus (B lineage) and VOC Alpha (B.1.1.7), however, is insufficient to provide maximum protection against the Beta (B.1.351) variant. To improve vaccine efficacy, we created a revised vaccine candidate that carries an evolved spike antigen. Vaccination of hamsters with this updated vaccine candidate provides full protection against intranasal challenge with all four VOCs Alpha, Beta, Gamma (P.1) and Delta (B.1.617.2) resulting in complete elimination of infectious virus from the lungs and a marked improvement in lung pathology. Vaccinated hamsters did also no longer transmit the Delta variant to non-vaccinated sentinels. Hamsters immunized with our modified vaccine candidate also mounted marked neutralizing antibody responses against the recently emerged Omicron (B.1.1.529) variant, whereas the old vaccine employing prototypic spike failed to induce immunity to this antigenically distant virus. Overall, our data indicate that current first-generation COVID-19 vaccines need to be urgently updated to cover newly emerging VOCs to maintain vaccine efficacy and to impede virus spread at the community level.

Significance Statement

SARS-CoV-2 keeps mutating rapidly, and the ongoing COVID-19 pandemic is fueled by new variants escaping immunity induced by current first-generation vaccines. There is hence an urgent need for universal vaccines that cover variants of concern (VOC). In this paper we show that an adapted version of our vaccine candidate YF-S0* provides full protection from infection, virus transmission and disease by VOCs Alpha, Beta, Gamma and Delta, and also results in markedly increased levels of neutralizing antibodies against recently emerged Omicron VOC in a stringent hamster model. Our findings underline the necessity to update COVID-19 vaccines to curb the pandemic, providing experimental proof on how to maintain vaccine efficacy in view of an evolving SARS-CoV-2 diversity.
Putative novel avian paramyxoviruses identified from wild bird surveillance (United States, 2016‒2018) and retrospective analysis of APMV-2s and APMV-6s in GenBank
Authors: Young Kelsey T. , Stephens Jazz Q. , Poulson Rebecca L. , Stallknecht David E. , Dimitrov Kiril M. , Butt Salman L. , Stanton James B.
Published: November 2021

Avian paramyxoviruses (APMVs) (subfamily Avulavirinae) have been isolated from over 200 species of wild and domestic birds from around the world. The International Committee on Taxonomy of Viruses (ICTV) currently defines 22 different APMV species, with Avian orthoavulavirus 1 (whose viruses are designated as APMV-1) being the most frequently studied due to its economic burden to the poultry industry. Less is known about other APMV species, including limited knowledge on the genetic diversity in wild birds and there is a paucity of public whole genome sequences for APMV-2 to -22. The goal of this study was to use MinION sequencing to genetically characterize APMVs isolated from wild bird swab samples collected during 2016–2018 in the United States. Multiplexed MinION libraries were prepared using a random strand-switching approach using 37 egg-cultured, influenza-negative, hemagglutination-positive samples. Thirty-five APMV isolates that had complete polymerase coding sequences were speciated using ICTV’s current Paramyxoviridae phylogenetic methodology. Viruses from APMV-1, -4, -6, -8 were classified, one putative novel species (Avian orthoavulavirus 23) was identified from viruses isolated in this study, two putative new APMV species (Avian metaavulavirus 24 and 27) were identified from viruses isolated in this study and from retrospective GenBank sequences, and two putative new APMV species (Avian metaavulavirus 25 and 26) were identified solely from retrospective GenBank sequences. Furthermore, co-infections of APMVs were identified in a subset of the samples. The potential limitations of the branch length being the only speciation criterion and the potential benefit of a group pairwise distance analysis are discussed.

Importance

Most species of APMVs are understudied and/or underreported and many species were incidentally identified from asymptomatic wild birds; however, the disease significance of APMVs in wild birds is not fully determined. The rapid rise in high-throughput sequencing coupled with avian influenza surveillance programs have identified 12 different APMV species in the last decade and have challenged the resolution of classical serological methods to identify new viral species. Currently, ICTV’s only criterion for Paramyxoviridae species classification is the requirement of a branch length >0.03 using a phylogenetic tree constructed from polymerase (L) amino acid sequences. The results from this study identify one new APMV species, propose four additional new APMV species, and highlight that the criterion may have insufficient resolution for APMV species demarcation and that refinement or expansion of this criterion may need to be established for Paramyxoviridae speciation.
AI/ML Models to Aid in the Diagnosis of COVID-19 Illness from Forced Cough Vocalizations: Good Machine Learning Practice and Good Clinical Practices from Concept to Consumer for AI/ML Software Devices
Authors: Kelley K. , Kelley M. , Kelley S. C. , Sakara A.A. , Ramirez M.A.
Published: November 2021

From a comprehensive and systematic search of the relevant literature on signal data signature (SDS)-based artificial intelligence/machine learning (AI/ML) systems designed to aid in the diagnosis of COVID-19 illness, we identified the highest quality articles with statistically significant data sets for a head-to-head comparison to our own model in development. Further comparisons were made to the recently released “Good Machine Learning Practice (GMLP) for Medical Device Development: Guiding Principles” and, in conclusions, we proposed supplemental principles aimed at bringing AI/ML technologies in closer alignment GMLP and Good Clinical Practices (GCP).