bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and assessment of an indirect vision training programme for operatory dentistry: Effects on working posture
Authors: Garcia Patrícia Petromilli Nordi Sasso , Pugliesi Priscila Mi Suh , Wajngarten Danielle , Neves Tamíris da Costa , Pazos Júlia Margato , Dovigo Lívia Nordi
Published: February 2021

Objectives

Students experience difficulty working with indirect vision and often adopt inadequate working postures because of it. This study created and then assessed the effects of an indirect vision preclinical training programme on dental students’ working posture.

Methods

The study enrolled students in the third year of the 5‐year undergraduate programme in dentistry in the School of Dentistry of São Paulo State University (UNESP), Araraquara (N = 54). The programme consisted of four training sessions in which students performed different types of activities in which only a mirror was used to see the procedure they were performing. To evaluate posture, students were asked to perform class III cavity preparations (distal‐palatal and mesial‐palatal preparations) on upper central and lateral incisors in a dental mannequin (tooth numbers 11, 12, 21 and 22) both before and after the indirect vision training programme. Photographs were taken of the students’ working postures. The photographs were assessed by a duly trained researcher using the Compliance Assessment of Dental Ergonomic Posture Requirements. A descriptive statistical analysis was performed, and the assumptions of normality were verified. Student's paired t test was also performed. The significance level adopted was 5%.

Results

A significant difference was found between the percentages of correct ergonomic postures adopted before and after the training programme (p = 0.039).

Conclusions

The preclinical training programme for indirect vision was found to have a positive effect on the working postures of the students evaluated herein.
Floral resource diversification promotes solitary bee reproduction and may offset insecticide effects – evidence from a semi‐field experiment
Authors: Klaus Felix , Tscharntke Teja , Bischoff Gabriela , Grass Ingo
Published: February 2021

Pollinator declines in agricultural landscapes are driven by multiple stressors, but potential interactions of these remain poorly studied. Using a highly replicated semi‐field study with 56 mesocosms of varying wild plant diversity (2–16 species) and oilseed rape treated with a neonicotinoid, we tested the interacting effects of resource diversity and insecticides on reproduction of a solitary wild bee. Compared to mesocosms with oilseed rape monocultures, availability of resources from wild plants complementing oilseed rape doubled brood cell production. In addition, bee reproduction increased due to plant diversity and identity effects. Exposure to neonicotinoid‐treated oilseed rape reduced bee larval to adult development by 69%, but only in mesocosms with oilseed rape monocultures. Availability of complementary flower resources can thus offset negative effects of neonicotinoid‐treated oilseed rape on wild bee reproduction. Policy should encourage the implementation of diverse floral resources mitigating negative effects of crop monocultures and insecticides, thereby sustaining solitary bee populations in agricultural landscapes.
Growth properties and immunogenicity of a virus generated by reverse genetics for an inactivated equine influenza vaccine
Authors: Ohta Minoru , Bannai Hiroshi , Kambayashi Yoshinori , Tamura Norihisa , Tsujimura Koji , Yamayoshi Seiya , Kawaoka Yoshihiro , Nemoto Manabu
Published: February 2021

Background

Keeping vaccine strains up to date is the key to controlling equine influenza (EI). Viruses generated by reverse genetics (RG) are likely to be effective for quickly updating a vaccine strain.

Objectives

To evaluate the growth properties of an RG virus in embryonated chicken eggs, and to evaluate antibody responses to a formalin‐inactivated vaccine derived from the RG virus in Thoroughbred horses.

Study design

In vitro and in vivo experiments.

Methods

Wild‐type (WT) viruses (A/equine/Ibaraki/1/2007) or RG viruses (consisting of haemagglutinin [HA] and neuraminidase genes derived from A/equine/Ibaraki/1/2007 and the six other genes derived from high‐growth A/Puerto Rico/8/34) were inoculated into embryonated chicken eggs, and the allantoic fluids were harvested at every 24 hours after inoculation. WT and RG viruses were inactivated by formalin for vaccine use. Ten unvaccinated yearlings (five each for WT or RG vaccine) received the first two doses of a primary vaccination course 4 weeks apart followed by their third dose 12 weeks later. Twenty vaccinated adult horses (10 each for WT or RG vaccine) received a single dose of a booster vaccination.

Results

The RG virus had high growth properties in embryonated chicken eggs. Unvaccinated yearlings responded poorly to the first vaccination, especially those that received the RG vaccine, but mounted better responses to the second and the third vaccinations, and maintained relatively high haemagglutination inhibition (HI) titres up to 28 weeks after the first vaccination. Vaccinated adult horses did not respond remarkably to the booster vaccination, but no horses showed titres below their pre‐booster values even at 12 weeks after vaccination. The RG virus elicited immunogenicity in horses adequate for vaccine use.

Main limitations

No virus challenge study was performed.

Conclusions

The RG viruses are useful as an EI vaccine strain, and quick updates of an EI vaccine strain can be achieved by using RG techniques.
Portfolios of actively managed mutual funds
Authors: Riley Timothy B.
Published: February 2021

Investors should focus on the performance of portfolios of active funds, not on the performance of individual active funds. Taking this portfolio approach with respect to active U.S. equity mutual funds, I build an optimized portfolio of funds that subsequently has low idiosyncratic volatility and a large, positive, statistically significant alpha. Consistent with a Berk and Green equilibrium, that outperformance is short lived if the optimized portfolio is not rebalanced often, as investors allocate substantial capital—in excess of that expected based on past performance—to the funds with a large weight in the optimized portfolio.
Delineating pan‐Africanism from contemporary conceptual deflections
Authors: Araoye Ademola
Published: February 2021

Is pan‐Africanism relevant today? Against the background of challenges to its continued relevance through assaults on its fundamental tenets, this intervention reaffirms the integrity and undiminished salience of pan‐Africanism as a philosophy of radical action for emancipation of black humanity. Pan‐Africanism represents the complexities of black political and intellectual thought over 200 years. Politically inspired conceptual deflections of the authentic tenets of pan‐Africanism threaten the essences of the ancient struggle of black humanity as one people for holistic emancipation. As configured, Africa is confronted with widespread foreign security deployments on its soil that it is unable to check. There is internal connivance in the new scramble to partition the continent. Meeting the challenges implied by the axiomatic commonality of identity, inexorable destiny, and the singularity of the ultimate interest of black humanity has remained the enduring challenge of pan‐Africanism. In the face of this challenge have emerged conceptual deflections to provide respectability to attempts to diminish the depth and scope of pan‐Africanism. The criticality of the continued integrity of the precepts of pan‐Africanism is imperative because intellectual traditions matter in shaping organizing principles directing any struggle. Finally, it is affirmed that the greatest disincentive to pan‐African consolidation is the reality of African statehood as private enterprises of a few political‐entrepreneurial “poliprenuer” families. The way forward is to consolidate Africa into a continental republic.
A highly resistant structure between the cuticle and the cortex of human hair III: Characterzation of the structure CARB
Authors: Takahashi Toshie
Published: February 2021

Objective

It was previously reported that a highly resistant structure, which functions as a barrier against the penetration of dyes, is present at the interface between the cuticle and the cortex of human hair. That structure was named CARB, cuticle anchored resistant base. The goal of this study was to clarify the formation and composition of the structure CARB.

Methods

Cuticular substructures were observed from the keratinized area of each hair to its root end. The positions where the CARB structure appeared were isolated, and the barrier ability before and after that structure was evaluated. The distributions of glycolipid and cystine were measured using a nano‐IR and a transmission electron microscope (TEM).

Results

Cuticular substructures were fully constructed several mm from the hair bulb of the hairs observed. The results show that keratinization at the distal side of the cuticle cell precedes that of the proximal side, and CARB is fully constructed last among the substructures. Glycolipid was preferentially distributed at CARB in the keratinized area. The cystine content of CARB is lower than that of the A‐layer; however, it is slightly higher than that of the exocuticle and the inner layer.

Conclusion

These results demonstrate that CARB is produced in the final stage of keratinization of the cuticle layers. The rich contents of glycolipid and cystine might contribute to its resistant property.
Preserving dentine in minimally invasive access cavities does not strengthen the fracture resistance of restored mandibular molars
Authors: Silva E. J. N. L. , Lima C. O. , Barbosa A. F. A. , Augusto C. M. , Souza E. M. , Lopes R. T. , De‐Deus G. , Versiani M. A.
Published: February 2021

Aim

To evaluate the correlation between the volume of dental hard tissues removed and the fracture resistance of mandibular molar teeth with ultraconservative (UltraAC) or traditional (TradAC) access cavity preparations.

Methodology

Sixty recently extracted and intact mandibular first molars were scanned in a microcomputed tomographic (micro‐CT) device, anatomically matched and assigned at random to 2 groups (n = 30), according to the access cavity type: UltraAC or TradAC. After access preparation, mesial and distal canals were prepared using Reciproc instruments and a new scan was taken. The volumes of pulp chamber and dental hard tissues in each specimen were measured before and after the experimental procedures, and the percentage volume reduction of hard tissues calculated for the entire tooth and for the crown separately. Teeth were then root filled, restored and subjected to fracture resistance tests in an universal testing machine. The force required to fracture was recorded in Newtons (N). The adherence of the variables to a Gaussian curve was verified using a Shapiro–Wilk test. Skewed data were analysed with nonparametric Wilcoxon signed rank or Spearman correlation tests, whilst the normally distributed data were analysed with a dependent samples Student t‐test. Level of significance was set at 5%.

Results

Pre‐operatively, no difference was observed between groups regarding the volume of pulp canal space or dental hard tissues (P > 0.05). After access preparation, volumes of the removed hard tissues from the entire tooth and from the crown were significantly greater in teeth prepared with TradAC than with UltraAC (P < 0.05). No significant difference was observed in the fracture resistance values between TradAC (902.9 ± 347.8 N) and UltraAC (948.7 ± 405.7 N) groups (P = 0.975). The Spearman test was unable to identify a correlation between fracture resistance and percentage volume of removed dental hard tissues in the entire root (P = 0.525, r = −0.084) or only in the crown (P = 0.152, r = −0.187).

Conclusion

The volume of hard dental tissues removed, although greater in teeth with TradAC compared to UltraAC, did not correlate with the fracture resistance results, indicating that a minimally invasive access cavity did not increase the resistance of restored mandibular first molars to fracture.
Influence of the replacement of silica by boron trioxide on the properties of bioactive glass scaffolds
Authors: Schuhladen Katharina , Pantulap Usanee , Engel Kristin , Jeleń Piotr , Olejniczak Zbigniew , Hupa Leena , Sitarz Maciej , Boccaccini Aldo R.
Published: February 2021

The dissolution properties and bioactivity of bioactive glasses (BGs) are mainly determined by their composition and glass network structure. Silicate BGs are arguable the most popular representatives of BGs. However, borate BGs have gained increasing interest due to their faster degradation rate. By adding boron trioxide in the silicate network, borosilicate BGs can be fabricated with controlled degradation rates. Since the kind and amount of network former determines the resulting BG properties, the aim of this study was to examine the glass structure of silicate, borosilicate and borate BGs. Also, the effect of changing the network former on the ability to fabricate BG scaffolds by the foam replica method was investigated. The resulting silicate, borosilicate, and borate scaffolds were further examined on their chemical, morphological, mechanical, and bioactive properties. Structural analyses showed that the introduction of boron trioxide into silicate BGs leads to the depolymerization of the silicate network. Accordingly, the ion release profile and the ability to form hydroxyapatite of the different scaffolds were affected. Thus, this study shows that tailored BG compositions with case‐specific properties can be designed and used to fabricate 3D scaffolds for potential use in bone tissue engineering.
Distribution of HLA‐DQA1, ‐DQB1 and ‐DRB1 genes and haplotypes in Han, Uyghur, Kazakh and Hui populations inhabiting Xinjiang Uyghur Autonomous Region, China
Authors: Zhou Chunyan , Xu Mengyu , Xiao Zhiwen , Yuan Juanli , Wu Yong , Gao Beiyao , Hui Wenjia , Gao Feng , Chen Hongbing
Published: February 2021

Genetic polymorphisms of human leucocyte antigen (HLA)‐DRB1, ‐DQA1 and ‐DQB1 among four main ethnic groups including Han (n = 70), Uyghur (n = 71), Kazakh (n = 52) and Hui (n = 40) subjects from Xinjiang Uyghur Autonomous Region were investigated using a polymerase chain reaction—sequence‐based typing (PCR‐SBT). In total, 32 HLA‐DRB1 alleles, eight HLA‐DQA1 alleles and 14 HLA‐DQB1 alleles were identified. The most predominant HLA‐DRB1, ‐DQA1 and ‐DQB1 alleles were DRB1*15:01 (12.50%), DQA1*01:02 (21.43%) and DQB1*03:01 (19.29%) in Han; DRB1*07:01 (18.48%), DQA1*05:01/03/05 (24.65%) and DQB1*02:01/02 (31.69%) in Uyghur; and DRB1*13:01 (13.64%), DQA1*05:01/03/05 (28.85%) and DQB1*02:01/02 (27.88%) in Kazakh, respectively. In Hui, DRB1*07:01, DRB1*11:01 and DRB1*14:01 were the most dominant alleles with the same frequency of 11.8%, while the predominant DQA1 and DQB1 alleles were DQA1*03:01/02/03 (23.75%) and DQB1*02:01/02 (16.25%), respectively. In addition, the most common two‐locus haplotypes were DQA1*05:01/03/5‐DQB1*03:01 (10.0%) in Han; DQA1*02:01‐DQB1*02:01/02 (18.31%) in Uyghur; DQA1*05:01/03/05‐DQB1*02:01/02 (15.38%) in Kazakh; and DQA1*03:01/02/03‐DQB1*03:03 (11.25%) in Hui. The phylogenetic dendrograms constructed based on the allele frequencies of HLA‐DRB1, ‐DQA1 and ‐DQB1 in 13 populations (e.g. Asian, Central Asian and European) revealed that the Han and Hui populations were clustered together and closest to Han population from China, while the Kazakh and Uyghur populations were closest to each other and two ethnic groups were clustered together with Central Asian and European populations.
New treatments for patients with non‐metastatic castration‐resistant prostate cancer: A nursing perspective
Authors: Olivier Kara M. , Floyd Rebecca , Smith Matthew R. , Shore Neal D. , Sutton Jennifer
Published: February 2021

Globally, prostate cancer (PC) is a leading cause of death in men. Although androgen deprivation therapy (ADT) is the cornerstone of treatment for the disease, most patients eventually develop castration‐resistant PC (CRPC). Patients with non‐metastatic (nm) CRPC, the earliest clinical manifestation of castration resistance, are at risk of progressing to metastatic CRPC, which is associated with reduced life expectancy and poor quality of life. The nmCRPC treatment landscape has recently been transformed by the approval of three next‐generation oral androgen receptor (AR) inhibitors: apalutamide, enzalutamide and darolutamide. This review addresses available new treatment options for nmCRPC that target the AR, considering the effects of adverse event (AE) profiles and drug‐drug interactions (DDIs) when tailoring patient‐centric treatment to individual need, and discussing management strategies and nursing interventions for patients who experience drug‐related AEs. While no head‐to‐head comparisons of apalutamide, enzalutamide and darolutamide have been conducted to date, all three drugs have demonstrated comparable efficacy and maintained quality of life in phase III clinical trials, with differing AE profiles. The three treatments also demonstrate different potential for DDIs with other common medications that may be taken simultaneously. With the availability of new AR‐targeted options for nmCRPC, oncology nurses play a crucial role in the decision‐making process, educating and supporting patients on managing their PC, and ensuring that they receive the most appropriate treatment. As patients with nmCRPC are largely asymptomatic from their disease (with the exception of urinary/erectile symptoms), maintaining quality of life becomes a major objective when prescribing pharmacotherapy. Therefore, weighing treatment efficacy against the respective drug safety profile and examining the potential for adverse drug interactions with concomitant medications are important clinical considerations. Oncology nurses educate patients on potential treatment‐emergent AEs and their management and serve as advocates to ensure that patients receive optimal care based on their individual therapeutic requirements. They also provide information on available auxiliary services for patients and caregivers. This article provides an overview for the oncology nurse of the efficacy, safety, quality of life and DDI potential of these new AR‐targeted therapies in the nmCRPC setting, highlighting considerations for tailoring patient‐centric treatment to individual need. The importance of the oncology nurse in managing adverse drug reactions associated with ADT and AR inhibitors is highlighted and recommendations provided.
Insulin’s other life: an autoantigen in type 1 diabetes
Authors: Mannering Stuart I , Bhattacharjee Pushpak
Published: February 2021

One hundred years ago, Frederick Banting, John Macleod, Charles Best and James Collip, and their collaborators, discovered insulin. This discovery paved the way to saving countless lives and ushered in the “Insulin Era.” Since the discovery of insulin, we have made enormous strides in understanding its role in metabolism and diabetes. Insulin has played a dramatic role in the treatment of people with diabetes; particularly type 1 diabetes (T1D). Insulin replacement is a life‐saving therapy for people with T1D and some with type 2 diabetes. T1D is an autoimmune disease caused by the T‐cell‐mediated destruction of the pancreatic insulin‐producing beta cells that leads to a primary insulin deficiency. It has become increasingly clear that insulin, and its precursors preproinsulin (PPI) and proinsulin (PI), can play another role—not as a hormone but as an autoantigen in T1D. Here we review the role played by the products of the INS gene as autoantigens in people with T1D. From many elegant animal studies, it is clear that T‐cell responses to insulin, PPI and PI are essential for T1D to develop. Here we review the evidence that autoimmune responses to insulin and PPI arise in people with T1D and discuss the recently described neoepitopes derived from the products of the insulin gene. Finally, we look forward to new approaches to deliver epitopes derived from PPI, PI and insulin that may allow immune tolerance to pancreatic beta cells to be restored in people with, or at risk of, T1D.
Stressed parents, happy parents. An assessment of parenting stress and family quality of life in families with a child with Phelan‐McDermid syndrome
Authors: Droogmans Gilles , Vergaelen Elfi , Van Buggenhout Griet , Swillen Ann
Published: February 2021

Background

Individuals with Phelan–McDermid syndrome (PMS) are characterised by phenotypical traits that can be experienced as challenging by their environment. This study assessed parenting stress and Family Quality of Life (FQOL) in parents of individuals with PMS and identified potential contributing variables.

Method

Mothers (n = 14) and fathers (n = 13) of individuals with PMS (n = 14; 6 females, 8 males; age 2–37, M = 20, SD = 11.92) completed questionnaires on parenting stress, FQOL, adaptive behaviour and background characteristics.

Results

Mothers and fathers experienced high, similar and related levels of parenting stress and FQOL satisfaction. Parenting stress and FQOL satisfaction were inversely related. High and low ratings were retrieved for subscales measuring feelings of parental role restriction and emotional well‐being, respectively. The adaptive skills of the individuals with PMS were related to fathers’ parenting stress and FQOL satisfaction.

Conclusions

Clinical practice is encouraged to be attentive to family dynamics and grasp opportunities to interact with these dynamics.
Peri‐implant radiographic bone level and associated factors in Spain
Authors: Carral Cristina , Flores‐Guillén Juan , Figuero Elena , Rodrigo Daniel , Sanz‐Sánchez Ignacio , Llodra Juan Carlos , Bravo Manuel , Caffesse Raul G. , Vallcorba Nuria , Guerrero Adrián , Bujaldón Antonio , Herrera David
Published: February 2021

Objectives

To evaluate radiographic bone level (RxBL) at dental implants and its associated factors in Spain.

Material and methods

This cross‐sectional study was performed by a network of sentinel dentists from regions of Spain. RxBL was defined as the distance from the implant shoulder to the first clearly visible contact between the implant surface and the bone. Radiographic measurements were performed by two trained and experienced periodontists. Implant and patient data were also collected. Descriptive, bivariate, discriminative and multivariate analyses were done.

Results

A total of 49 sentinel dentists provided data 275 patients. Mean RxBL from 474 implants (5–13 years) was 1.87 mm (range: 0.00–13.17 mm). Statistically significant associations between RxBL and clinical output variables (bleeding on probing, oedema, plaque, probing depth, suppuration, keratinized tissue) were found. In the multiple regression analysis, statistically significant associations for RxBL were found for smoking habit, implant diameter, years of follow‐up and type of prosthesis (p < 0.01).

Conclusions

Peri‐implant RxBL ranged from 0 to 13.17 mm. It was significantly associated with clinical output variables and with some potentially predictor variables, at patient‐ (smoking >10 cigarettes/day) and implant‐ (diameter, years of follow‐up, Toronto bridge) levels.
Assessment of hypoxia avoidance behaviours in a eurythermal fish at two temperatures using a modified shuttlebox system
Authors: Ern Rasmus , Esbaugh Andrew J.
Published: February 2021

Behavioural avoidance responses of red drum (Sciaenops ocellatus) to aquatic hypoxia were investigated at 22 and 30°C using a modified shuttlebox system. Fish movement between a control side maintained at normoxia and a hypoxic side with stepwise decreasing water oxygen tension was analysed for entries into the hypoxic side, residence time per entry into the hypoxic side and total time in the hypoxic side. Acclimation to 30°C increased the oxygen threshold for the onset of hypoxia avoidance behaviours for entries and total time, while residence time per entry was unchanged.
Development and evaluation of colloidal gold immunochromatography test strip for rapid diagnosis of nervous necrosis virus in golden grey mullet (Chelon aurata)
Authors: Hassantabar Fatemeh , Zorriehzahra Mohammad J. , Firouzbakhsh Farid , Thompson Kim D.
Published: February 2021

A lateral flow immunochromatography strip test, based on antibody–gold nanoparticles specific for nervous necrosis virus (NNV), was developed for rapid, on‐site detection of the virus in fish stocks. A monoclonal antibody against NNV was conjugated with colloidal gold as the detector antibody. A rabbit anti‐NNV polyclonal antibody and goat anti‐mouse IgG antibody were blotted onto the nitrocellulose membrane as the capture antibodies on the test line and control line, respectively. The reaction could be seen by the eye within 15 min and did not cross‐react with the other viruses tested. The detection limit of the strip was approximately 103 TCID50/ml and had good stability after storage at 4°C for 8 months. When brains of 70 naturally infected golden grey mullet, Chelon aurata, were tested with the strip test, the diagnostic specificity and sensitivity of the test compared to real‐time RT‐PCR were 100% and 74%, respectively. Therefore, the one‐step test strip developed here had high specificity, reproducibility, and stability. This, together with its simplicity to use and rapid detection, without the requirement of sophisticated equipment or specialized skills, makes the strip suitable for pond‐side detection of NNV in farmed fish.
Government Bailout Funds: Balancing Rules and Discretion
Authors: GRADSTEIN MARK
Published: February 2021

This paper studies government bailout design in the face of economic failures by multiple firms, with ensuing threats to economic stability. Assuming that a commitment to a bailout magnitude is possible, yet cannot be made contingent on unforeseen circumstances, it is argued that the optimal policy consists of stipulating a bailout fund whose upper limit cannot be exceeded. Such an equilibrium policy provides a balance between flexibility to adjust to future circumstances and restraint of moral hazard incentive faced by the firms. An extension to the baseline model considers the case where corporate interests, divergent from those of the public, play a role, and the cap on bailout spending matters for the bargaining outcome between those interests.
Monetary Policy and Reaching for Income
Authors: DANIEL KENT , GARLAPPI LORENZO , XIAO KAIRONG
Published: February 2021

Using data on individual portfolio holdings and on mutual fund flows, we find that low interest rates lead to significantly higher demand for income‐generating assets such as high‐dividend stocks and high‐yield bonds. We argue that this “reaching‐for‐income” phenomenon is driven by investors who follow the “living off income” rule‐of‐thumb. Our empirical analysis shows that this preference for current income affects both household portfolio choices and the prices of income‐generating assets. In addition, we explore the implications of reaching for income for capital allocation and the effectiveness of monetary policy.
Different forms of bystander cardiopulmonary resuscitation in out‐of‐hospital cardiac arrest
Authors: Riva G. , Hollenberg J.
Published: February 2021

Out‐of‐hospital cardiac arrest (OHCA) is a major cause of death in the Western world with an estimated number of 275 000 treated with resuscitation attempts by the Emergency Medical Services (EMS) in Europe each year. Overall survival rates remain low, and most studies indicate that around 1 out 10 will survive to 30 days. Amongst the strongest factors associated with survival in OHCA is first recorded rhythm amendable to defibrillation, early defibrillation and prompt initiation of cardiopulmonary resuscitation (CPR). Overall, CPR started prior to EMS arrival has repeatedly been shown to be associated with survival rates 2–3 times higher compared with no such initiation. The primary goal of CPR is to generate sufficient blood flow to vital organs, mainly the brain and heart, until restoration of spontaneous circulation can be achieved. Barriers to the initiation of CPR by bystanders in OHCA include fear of being incapable, causing harm, and transmission of infectious diseases. Partly due to these barriers, and low rates of CPR, the concept of CPR with compression only was proposed as a simpler form of resuscitation with the aim to be more widely accepted by the public in the 1990s. But how reliable is the evidence supporting this simpler form of CPR, and are the outcomes after CO‐CPR comparable to standard CPR?
Paediatric appendicitis during the COVID‐19 pandemic
Authors: Sheath Chloe , Abdelrahman Mohamed , MacCormick Andrew , Chan David
Published: February 2021

Aim

The repercussions of the pandemic on patients without COVID‐19 have been well documented. Although there is evidence that adult patients present later with complicated appendicitis, the impact on the paediatric population is unknown. Therefore, the aim of this study was to assess the impact of the COVID‐19 pandemic on the presentation and management of paediatric appendicitis.

Methods

Data from consecutive paediatric patients admitted with right iliac fossa pain to a teaching hospital from 1 March 2020 until 30 June 2020 (COVID‐19) were compared with patients admitted from 1 March 2019 until 30 June 2019 (control).

Results

One hundred and seventy‐two patients were admitted with right iliac fossa pain (control = 97, COVID‐19 = 75). Seven patients had a normal diagnostic laparoscopy in the control group compared with none in the COVID‐19 group. The proportion of patients diagnosed with appendicitis was significantly higher during the COVID‐19 pandemic (24% vs. 10%, P = 0.03). They presented later (3 days vs. 1 day, P < 0.01) with higher inflammatory markers (white cell count 15.8 vs. 13.2 × 109 cells per litre, P = 0.02; C‐reactive protein 53 vs. 27 mg/L P = 0.04). The majority of patients underwent surgery within 1 day of admission (94% COVID‐19 vs. 70% control, P = 0.13). Although there was a trend towards a greater proportion of complicated appendicitis (22% vs. 10%, P = 0.6) during COVID‐19, this did not affect outcomes (no morbidity in both groups, length of hospital stay 4 vs. 2.5 days, P = 0.29).

Conclusion

Despite presenting later during COVID‐19, paediatric patients with appendicitis were treated expediently with good outcomes.
Pasteurised donor human milk audit: What is happening in the neonatal critical care unit?
Authors: Page Denise , Gilroy Melissa , Joseph Ria , van der Meij Barbara
Published: February 2021

Aim

Human milk with fortification, providing additional energy, protein and micronutrients, is considered the optimal form of nutrition for preterm infants as it provides protection against infections and improves outcomes. Mothers' own milk (MOM) is the preferred choice, however in situations where MOM is insufficient or contraindicated; Pasteurised donor human milk (PDHM) is the preferred alternative. This study aimed to identify whether PDHM during neonatal critical care unit (NCCU) admission is associated with discharge nutrition in preterm infants.

Methods

A retrospective observational cohort study was conducted over a 12‐month period in 2017. This included all inborn infants admitted to the NCCU with gestational age ≤ 28 weeks or ≤ 1000 g birthweight, who survived until discharge. Multivariate logistic models were used to detect the association between study groups (PDHM vs.No PDHM) and discharge nutrition.

Results

Seventy‐seven infants were included; 35 infants received PDHM during admission. At discharge, infants who received PDHM were significantly more likely to be on infant formula (IF) (86%) than infants who did not receive PDHM (26%). In contrast, infants who did not receive PDHM (No PDHM) were significantly more likely to be receiving MOM exclusively at discharge (74%), than those who did receive PDHM (14%). The odds of an infant being discharged on IF were 16.91 times higher if they received PDHM.

Conclusion

In this study, infants born at ≤28 weeks or ≤ 1000 g who received PDHM were more likely to receive IF at NCCU discharge than infants who did not receive PDHM.
Secondary pollen presentation: More than to increase pollen transfer precision
Authors: Xu Yuan‐Qing , Luo Zhong‐Lai , Wang Jia , Pei Nan‐Cai , Zhang Dian‐Xiang
Published: February 2021

Pollination precision and efficiency have been deemed to be important driving forces in floral evolution. Herkogamy reduction is a main mechanism to increase pollination precision. Secondary pollen presentation (SPP), by which pollen is presented on other floral organs especially pistils, has been widely accepted as a special mechanism to increase pollen transfer precision through spatial reduction of the anther–stigma distance, that is, minimized herkogamy. This overlooks a potential driving force, that is expanding the pollination niche through converting pollen thieves and nectar robbers into effective pollinators. We selected two species as study models with typical pistillate SPP, Pavetta hongkongensis Bremek. (Rubiaceae) and Scaevola taccada (Gaertn.) Roxb. (Goodeniaceae). In both species, two distinct pollinator functional groups were recognized. Short‐tongued bees and flies fed on pollen on stigmas but also stole pollen from anthers and robbed nectar, whereas long‐tongued hawkmoths and butterflies only collected nectar. Emasculation had no influence on long‐tongued pollinators, but significantly decreased the visitation frequency of short‐tongued visitors and fruit set, compared to intact flowers, demonstrating short‐tongued visitors did not effectively pollinate and acted merely as pollen thieves or nectar robbers when SPP was absent. Data from the two plant species clearly indicated pistillate SPP has additional adaptive advantages of converting ineffective visitors into pollinators and consequently widening the pollination niche, which could help plants overcome environmental stochasticity. Our results suggest that multiple selective forces drive the evolution of SPP and the minimization of herkogamy.
Diagnostic accuracy of a point‐of‐care test using voided urine samples for detection of bacteriuria in dogs with signs of lower urinary tract disease
Authors: Grant David C. , Nappier Michael T. , Corrigan Virginia Kiefer
Published: February 2021

Background

Bacterial urine culture is recommended in dogs suspected of having urinary tract infection (UTI), but there is expense and delay in obtaining such results.

Hypothesis/Objective

To determine the diagnostic performance of a rapid immunoassay (RIA) dipstick for detection of bacteriuria using voided urine from dogs with clinical signs of lower UTI.

Animals

Twenty‐four client‐owned dogs.

Methods

Voided urine was collected and the RIA performed within 30 minutes. Urine collected by cystocentesis was submitted for aerobic urine culture. McNemar's test and kappa coefficient were calculated to determine agreement between the 2 tests.

Results

Nine of 21 dogs (43%) had UTI verified by aerobic urine culture. There was 1 false‐negative and no false‐positive RIA results. Sensitivity, specificity, positive predictive value, and negative predictive value of the RIA were 89%, 100%, 100%, and 92%, respectively.

Conclusions and Clinical Importance

This RIA is promising for correctly identifying whether or not voided urine samples from dogs with lower urinary tract clinical signs have true bacteriuria in a rapid, inexpensive manner. Additional patients should be enrolled in a similar study to determine if diagnostic performance is robust in a large population.
Hypercoagulability in dogs with chronic enteropathy and association with serum albumin concentration
Authors: Dixon Amy , Hall Edward J. , Adamantos Sophie , Kathrani Aarti , McGrath Ciara , Black Vicki
Published: February 2021

Background

Dogs with protein‐losing enteropathy (PLE) are at risk of developing a hypercoagulable state, but the prevalence of hypercoagulability in dogs with chronic enteropathies (CE) and normal serum albumin concentration is unknown.

Hypothesis

Dogs with CE are predisposed to a hypercoagulable state as assessed by thromboelastography (TEG) independent of serum albumin concentration.

Methods

Dogs with chronic gastrointestinal signs from suspected inflammatory CE between 2017 and 2019 were included. Thirty‐eight were evaluated; every dog had a CBC, serum biochemistry panel, and abdominal imaging performed. The Canine Inflammatory Bowel Disease Activity Index (CIBDAI) was calculated. Thromboelastography was performed at presentation, and reaction time (R), kinetic time (K), α‐angle, maximal amplitude (MA), and global clot strength (G) were recorded. Dogs were considered hypercoagulable if the G value was ≥25% above the reference interval.

Results

Seventeen of 38 (44.7%; 95% confidence interval [CI], 28.6‐61.7%) dogs with CE were hypercoagulable. The G value did not differ between the 19 dogs with normal (≥28 g/L) serum albumin concentrations (9.05 kdyn/cm2; 95% CI, 7.26‐10.84; SD 3.71) and 19 dogs with hypoalbuminemia (11.3 kdyn/cm2; 95% CI, 9.04‐13.6, SD; 4.7; P = .11). The G value was negatively correlated with hematocrit, serum albumin concentration, and duration of signs and positively correlated with age.

Conclusions and Clinical Importance

Dogs with CE and normal serum albumin concentration can be hypercoagulable as measured by TEG.
Understanding Critical Thinking Practice in Everyday Life Through Stages of Critical Thinking Skills and Disposition
Authors: Tunjungsari Harini , Takwin Bagus
Published: February 2021

Previous publications used the term critical thinking (CT) skills and critical thinking practice interchangeably. This article describes the difference between them, defining skills as prerequisite abilities, while practices as real activities. People may have skills, but they do not always use them in everyday life. The question is what triggers people to practice CT given they already have skills and dispositions. To answer this, we will need to understand the roles of CT skills and dispositions in each stage of CT process. This article explains the position of the skill dimension as described by Halpern and twelve dispositions (derived from Dwyer's research) in the three stages of CT process (Pennycook, Fugelsang, and Koehler). Realizing the implication of practicing CT when people were in the detecting conflict stage is important to determine whether a person is going to think critically or not.
Skeptical self‐regulation: Resident experiences of uncertainty about uncertainty
Authors: Ilgen Jonathan S. , Regehr Glenn , Teunissen Pim W. , Sherbino Jonathan , de Bruin Anique B. H.
Published: February 2021

Objectives

Managing uncertainty is central to expert practice, yet how novice trainees navigate these moments is likely different than what has been described by experienced clinicians. Exploring trainees’ experiences with uncertainty could therefore help explicate the unique cues that they attend to, how they appraise their comfort in these moments and how they enact responses within the affordances of their training environment.

Methods

Informed by constructivist grounded theory, we explored how novice emergency medicine trainees experienced and managed clinical uncertainty in practice. We used a critical incident technique to prompt participants to reflect on experiences with uncertainty immediately following a clinical shift, exploring the cues they attended to and the approaches they used to navigate these moments. Two investigators coded line‐by‐line using constant comparison, organising the data into focused codes. The research team discussed the relationships between these codes and developed a set of themes that supported our efforts to theorise about the phenomenon.

Results

We enrolled 13 trainees in their first two years of postgraduate training across two institutions. They expressed uncertainty about the root causes of the patient problems they were facing and the potential management steps to take, but also expressed a pervasive sense of uncertainty about their own abilities and their appraisals of the situation. This, in turn, led to challenges with selecting, interpreting and using the cues in their environment effectively. Participants invoked several approaches to combat this sense of uncertainty about themselves, rehearsing steps before a clinical encounter, checking their interpretations with others and implicitly calibrating their appraisals to those of more experienced team members.

Conclusions

Trainees’ struggles with the legitimacy of their interpretations impact their experiences with uncertainty. Recognising these ongoing struggles may enable supervisors and other team members to provide more effective scaffolding, validation and calibration of clinical judgments and patient management.
Advances in translational imaging of the microcirculation
Authors: Guerraty Marie , Bhargava Akanksha , Senarathna Janaka , Mendelson Asher A. , Pathak Arvind P.
Published: February 2021

The past few decades have seen an explosion in the development and use of methods for imaging the human microcirculation during health and disease. The confluence of innovative imaging technologies, affordable computing power, and economies of scale have ushered in a new era of “translational” imaging that permit us to peer into blood vessels of various organs in the human body. These imaging techniques include near‐infrared spectroscopy (NIRS), positron emission tomography (PET), and magnetic resonance imaging (MRI) that are sensitive to microvascular‐derived signals, as well as computed tomography (CT), optical imaging, and ultrasound (US) imaging that are capable of directly acquiring images at, or close to microvascular spatial resolution. Collectively, these imaging modalities enable us to characterize the morphological and functional changes in a tissue's microcirculation that are known to accompany the initiation and progression of numerous pathologies. Although there have been significant advances for imaging the microcirculation in preclinical models, this review focuses on developments in the assessment of the microcirculation in patients with optical imaging, NIRS, PET, US, MRI, and CT, to name a few. The goal of this review is to serve as a springboard for exploring the burgeoning role of translational imaging technologies for interrogating the structural and functional status of the microcirculation in humans, and highlight the breadth of current clinical applications. Making the human microcirculation “visible” in vivo to clinicians and researchers alike will facilitate bench‐to‐bedside discoveries and enhance the diagnosis and management of disease.
Revisiting the Phlebotominae subfamily records in Bahia, Brazil
Authors: Cova B. O. , Santos R. F. , Dias‐Lima A. G. , Monte‐Alegre A. F. , Schriefer A.
Published: February 2021

Brazil is one of the countries that concentrates 90% of all tegumentary and visceral leishmaniases cases and Bahia is one of the highly affected states. In the present report, we consolidated secondary data from several complementary databases that allowed us to record the sand fly species identified including areas of Leishmania spp. transmission in the state of Bahia. We then overlayed the geographical distribution data onto maps of vegetational aspects found across the state. Overall, 21 602 records of phlebotomine sand flies occurrence between 1949 and 2016 were analysed, encompassing 85% of Bahia's municipalities. Seventy‐six sand fly species under 17 genera were enlisted. Among described species, 27 were proven or putative Leishmania spp. vectors and three were considered exclusively endemic in the state. Lutzomyia longipalpis, Nyssomyia intermedia and Nyssomyia whitmani were found in 74, 29 and 27% of municipalities, respectively. Salvador, the state capital and major city presented records for 21 different sand fly species, including known vectors for leishmaniasis. In particular, a wide distribution of Evandromyia sallesi was detected for this city. This consolidated account on phebotomine fauna and distribution may be explored for improving the planning and deployment of vector‐focused leishmaniasis control measures in affected areas of Bahia.
Neurosyphilis presenting as herpes simplex virus encephalitis
Authors: Li Fang‐Zhou , Tian Jun , Zhang Yun , Wu Zhi‐Ying
Published: February 2021

A 63‐year‐old woman was admitted to our hospital complaining of sudden slow response and irrelevant answer for three days. The brain magnetic resonance imaging revealed a left‐sided hyperintense lesion and moderate expansiveness involving the hippocampus, insular cortex, and temporal lobe, which mimicking herpes simplex virus encephalitis. Her cerebrospinal fluid examination disclosed the Treponema pallidum particle agglutination assay and rapid plasma regain test were both positive. A diagnosis of neurosyphilis was made, and the patient was benefited from penicillin therapy.
Identification of circ_0089153/miR‐608/EGFR p53 axis in ameloblastoma via MAPK signaling pathway
Authors: Liu Jinwen , Qiao Xue , Liu Jiayi , Zhong Ming
Published: February 2021

Objectives

This study investigated the role of circular RNAs (circRNAs) in the pathogenesis of ameloblastoma (AB), identifying potential novel targets for future targeted therapy.

Materials and Methods

CircRNA and microRNA (miRNA) profiling in AB were built with microarrays. Six novel circRNAs were validated, circ‐miRNA networks were delineated. Hsa‐miR‐608 was filtered over cross‐comparison between database screening, miRNA microarray and validated. Circ‐miRNA binding sponge was validated via luciferase reporter assay. Downstream mRNAs were screened. Regulation between miRNAs and mRNAs was confirmed in vitro. Gene interaction networks and circRNA–miRNA–mRNA interaction pathway enrichment analyses were established.

Results

Six differentially expressed circRNAs were selected and validated. According to miRNAs and pathways predicted, six correlated miRNAs were selected, hsa‐miR‐608 was filtered and validated. The hsa_circ_0089153/hsa‐miR‐608 binding sponge was validated. Downstream gene interaction networks showed that EGFR and p53 had the strongest co‐expression. In vitro transfection results confirmed the suppressive function of miR‐608 and EGFR p53. Hsa_circ_0089153/hsa‐miR‐608/EGFR p53 interaction pathway enrichment analysis confirmed functions mainly enriched in MAPK and related signaling pathways regulating AB progression.

Conclusions

Six novel circRNAs were identified. Hsa_circ_0089153/hsa‐miR‐608 sponging was validated, hsa‐miR‐608 downregulated EGFR and p53, which might further regulate cell proliferation, differentiation, apoptosis, and cell cycle processes via the MAPK signaling pathway.