bluuebunny/crossref_metadata_2025 huggingface dataset:
“There was no panic”—Nurse managers’ organising work for COVID‐19 patients in an outpatient clinic: A qualitative study
Authors: Jónsdóttir Helga , Sverrisdóttir Sólveig H. , Hafberg Anna , Ómarsdóttir Geirný , Ragnarsdóttir Erla D. , Ingvarsdóttir Steinunn , Ingadóttir Brynja , Hafsteinsdóttir Elín J. G. , Zoëga Sigríður , Blöndal Katrín
Published: December 2021

Aim

To provide insight into the contribution of nursing to the establishment and running of a hospital‐based outpatient clinic for COVID‐19 infected patients, and thereby to inform the development of similar nursing care and healthcare more generally.

Design

Qualitative descriptive study centred on collaboration between nurse managers and researchers.

Methods

Drawing on Donabedian’s model of quality health services and the work of Allen on “Nurses’ organising work”, data were collected using four semi‐structured, audio‐recorded, focus group interviews with five nurse managers. The interviews were conducted in May and June 2020, transcribed, and subsequently analysed using deductive and inductive content analysis into an overarching category, main categories, and sub‐categories.

Results

“There was no panic – challenged by the unprecedented” was a strong thread, which was reflected in two categories: (a) Everyone walked in step, containing the sub‐categories: Public officials set the tone, Creating order in disorder, and Mutual respect and teamwork, and (b) Inspired by extraordinary accomplishments, encompassing the sub‐categories: Realising one's potential and Unexpectedly rewarding. In exceptional circumstances the nurse managers’ decision‐making authority grew, material and manpower resources were sufficient, promptly constructed work procedures were in place, and tasks were completed instantly in trusting and respectful interdisciplinary collaboration. With sound support and trust from hospital directors, the nurse managers utilised their expertise to the fullest and they were proud of their work.

Conclusion

The findings portray the almost invisible work of nurse managers in organising complex care. Although the circumstances were exceptional the findings speak to the accomplishments that can be gained when nurse managers have autonomy and the opportunity to utilise their professional capacity to the fullest.

Impact

The findings reveal the almost invisible work of nurses in organising complex care and can inform the establishment of outpatient clinics for patients infected with COVID‐19 and of healthcare development more generally.
Men who self‐harm—A scoping review of a complex phenomenon
Authors: Tofthagen Randi , Gabrielsson Sebastian , Fagerström Lisbeth , Haugerud Lena‐Maria , Lindgren Bitt‐Marie
Published: December 2021

Background

To understand and care for men who self‐harm, it is important that healthcare professionals have understanding of how and why men self‐harm, men's experiences of self‐harm and what can be done to hinder or prevent self‐harm.

Aims

The aim of this study was to synthesize the existing knowledge on men who self‐harm, with a special emphasis on background, self‐harming methods, experiences and reported therapeutic interventions and/or care approaches.

Design

Scoping review of internationally published and grey literature, based on a methodological framework by Arksey and O’Malley.

Data sources

Systematic electronic database searches were conducted in CINAHL, MEDLINE (Ovid) and PsycINFO. From a total of 684 studies found, 24 studies met the inclusion criteria: full‐text, published in English, peer‐reviewed studies and grey literature including a focus on men who self‐harm, men aged between 18 and 65 years, and published between 2010 and 2019.

Results

Men's self‐harm was understood as being related to mental disorders, a means of affect regulation, a loss of self‐control, and a means of interpersonal communication. Self‐harm can be a positive or negative experience, and there is a wide variety in the methods that men use to self‐harm: sharp objects, injection, ingestion, without aids or riskful behaviour. Few studies reported on therapeutic interventions and/or care approaches for men who self‐harm.

Conclusion

Men's self‐harm should be understood as a complex, socially and culturally conditioned phenomenon and studied from a multitude of perspectives.

Impact

This scoping review concludes that self‐harm among men should be understood as a complex, socially and culturally conditioned phenomenon. To empower men and support their recovery from self‐harm, a person‐centred approach should be incorporated into research on the subject and practice.
The experience of workplace gender discrimination for women registered nurses: A qualitative study
Authors: Gauci Patricia , Peters Kath , O’Reilly Kate , Elmir Rakime
Published: December 2021

Aim

To explore the experiences of female registered nurses (RNs), who encounter workplace gender discrimination in nursing.

Design

This study used a qualitative exploratory design informed by feminist perspectives and was underpinned by social constructionism.

Methods

Women who were RNs (N = 10) and employed in New South Wales (NSW) were purposively selected to convey their experiences of workplace gender discrimination. Data were collected through semi‐structured interviews, between April and July 2020. Analysis was guided by the work of Anderson and Jack (Women's words; 1991) who recommend three ways of listening. Interviews were transcribed verbatim and Braun and Clarke's (Qualitative Research in Psychology, 3, 77–101; 2006) six‐step guide was used to develop themes.

Results

Thematic analysis revealed five overarching themes: It's a man's world; Gender stereotypes; Being a woman and nurse; Reluctance to call out gender discrimination and The status quo. Findings from this study highlighted that participants believed men's career progression in nursing were favoured over women.

Conclusion

Findings from this research highlight that socially constructed gendered norms continue to form the basis of inequality for women in the workplace. Fostering and sustaining workplace cultures that support family and work life balance, and that do not discriminate against women, is fundamental to ensuring equality for women.

Impact

There is limited qualitative research into women's experiences of workplace gender discrimination in nursing. This research highlights the need for workplace strategies to be implemented to ensure women are better supported and equally represented in leadership positions and advanced practice roles in nursing. All nurses should be given equal consideration based on experience and qualifications. Career development and progression opportunities should be fair, equitable and transparent with clearly documented criteria.
An 8‐year study of admissions and discharges to a specialist intellectual disability inpatient unit
Authors: Abraham Julie , Purandare Kiran , McCabe Joanne , Wijeratne Anusha , Eggleston Evelina , Oak Katy , Laugharne Richard , Roy Ashok , Shankar Rohit
Published: December 2021

Background

In the United Kingdom, policy change has led to specialist intellectual disability inpatient bed reduction. Little evidence exists assessing the results for patients admitted to such units. This study evaluates the outcomes of a specialist intellectual disability inpatient unit.

Method

Gender/age/ethnicity/intellectual disability severity/co‐morbid psychiatric/developmental disorders, treatment length and stay data were collected. The health of the nation outcome scales for people with learning disabilities (HoNOS‐LD) scores at admission, treatment completion and discharge were recorded. Analysis of these multiple variables and correlations within different patient groups was investigated using various statistical tests.

Results

Of 169/176 patients (2010–2018), admission to discharge, HoNOS‐LD global and all individual items score decreased significantly, for all patient categories. Treatment completion to discharge duration was significant for the whole cohort.

Conclusions

This is the largest study of intellectual disability inpatient outcomes. Discharge from the hospital appears not associated with duration of treatment. Using HoNOS‐LD to demonstrate treatment effectiveness is recommended.
γ‐Secretase modulators show selectivity for γ‐secretase–mediated amyloid precursor protein intramembrane processing
Authors: Weber Tobias A. , Lundkvist Johan , Wanngren Johanna , Kvartsberg Hlin , Jin ShaoBo , Larssen Pia , Wu Dan , Oliveira Daniel V. , Minta Karolina , Brinkmalm Gunnar , Zetterberg Henrik , Blennow Kaj , Nordvall Gunnar , Winblad Bengt , Portelius Erik , Karlström Helena
Published: December 2021

The aggregation of β‐amyloid peptide 42 results in the formation of toxic oligomers and plaques, which plays a pivotal role in Alzheimer's disease pathogenesis. Aβ42 is one of several Aβ peptides, all of Aβ30 to Aβ43 that are produced as a result of γ‐secretase–mediated regulated intramembrane proteolysis of the amyloid precursor protein. γ‐Secretase modulators (GSMs) represent a promising class of Aβ42‐lowering anti‐amyloidogenic compounds for the treatment of AD. Gamma‐secretase modulators change the relative proportion of secreted Aβ peptides, while sparing the γ‐secretase–mediated processing event resulting in the release of the cytoplasmic APP intracellular domain. In this study, we have characterized how GSMs affect the γ‐secretase cleavage of three γ‐secretase substrates, E‐cadherin, ephrin type A receptor 4 (EphA4) and ephrin type B receptor 2 (EphB2), which all are implicated in important contexts of cell signalling. By using a reporter gene assay, we demonstrate that the γ‐secretase–dependent generation of EphA4 and EphB2 intracellular domains is unaffected by GSMs. We also show that γ‐secretase processing of EphA4 and EphB2 results in the release of several Aβ‐like peptides, but that only the production of Aβ‐like proteins from EphA4 is modulated by GSMs, but with an order of magnitude lower potency as compared to Aβ modulation. Collectively, these results suggest that GSMs are selective for γ‐secretase–mediated Aβ production.
Position paper on a simplified histopathological classification of basal cell carcinoma: results of the European Consensus Project
Authors: Fernández‐Figueras M.T. , Malvehi J. , Tschandl P. , Rutten A. , Rongioletti F. , Requena L. , Kittler H. , Kerl K. , Kazakov D. , Cribier B. , Calonje E. , André J. , Kempf W. ,   Study Group Collaborators (Validation Group)
Published: December 2021

Background

Histopathological classification of basal cell carcinoma (BCC) has important prognostic and therapeutic implications, but reproducibility of BCC subtyping among dermatopathologists is poor.

Objectives

To obtain a consensus paper on BCC classification and subtype definitions.

Methods

A panel of 12 recognized dermatopathologists (G12) from nine European countries used a modified Delphi method and evaluated 100 BCC cases uploaded to a website. The strategy involved five steps: (I) agreement on definitions for WHO 2018 BCC subtypes; (II) classification of 100 BCCs using the agreed definitions; (III) discussion on the weak points of the WHO classification and proposal of a new classification with clinical insights; (IV) re‐evaluation of the 100 BCCs using the new classification; and (V) external independent evaluation by 10 experienced dermatopathologists (G10).

Results

A simplified classification unifying infiltrating, sclerosing, and micronodular BCCs into a single “infiltrative BCC” subtype improved reproducibility and was practical from a clinical standpoint. Fleiss’ κ values increased for all subtypes, and the level of agreement improved from fair to moderate for the nodular and the unified infiltrative BCC groups, respectively. The agreement for basosquamous cell carcinoma remained fair, but κ values increased from 0.276 to 0.342. The results were similar for the G10 group. Delphi consensus was not achieved for the concept of trichoblastic carcinoma. In histopathological reports of BCC displaying multiple subtypes, only the most aggressive subtype should be mentioned, except superficial BCC involving margins.

Conclusions

The three BCC subtypes with infiltrative growth pattern, characteristically associated with higher risk of deep involvement (infiltrating, sclerosing, and micronodular), should be unified in a single group. The concise and encompassing term “infiltrative BCCs” can be used for these tumors. A binary classification of BCC into low‐risk and high‐risk subtypes on histopathological grounds alone is questionable; correlation with clinical factors is necessary to determine BCC risk and therapeutic approach.
Investigating the phenology of juvenile potamodromous brown trout (Salmo trutta L.) in two large lake catchments
Authors: Kennedy Richard J. , Rosell Robert , Allen Michelle
Published: December 2021

There is growing interest in the phenology of juvenile Salmo trutta and evidence of significant downstream migration during the autumn in some anadromous populations. The present study used acoustic telemetry to examine the phenology of potamodromous trout parr across a region encompassing two large lake catchments. One hundred sixty‐seven trout parr were tagged in late summer across four lake tributaries between 2018 and 2020. In total, 75 tagged parr migrated into the lakes with 67 (89%) migrating between September and December and 8 (11%) migrating between March and June. Autumn migration was highly prevalent across all the tributaries, with 16%–66% of each tagged sample exhibiting autumn migration, and 0%–15% of each tagged sample exhibiting spring migration. Autumn migrants were significantly longer and heavier than spring migrants, but condition factor was similar. Autumn migrants were associated with higher river discharge levels and lower water temperatures than spring migrants. The management challenges posed by extensive autumn migration behaviour in migratory trout stocks are examined and discussed.
Governance in Romania: Exploring the determinants of corporate insider trading
Authors: Albu Cătălin N. , Albu Nadia , Hodgson Allan , Xiong Zhengling
Published: December 2021

Romania ranks at the extreme low end in Eastern Europe in terms of Hofstede cultural insights, rule of law, government effectiveness, and corruption—potentially limiting governance quality for restricting resource channeling. In this paper, we examine whether these shortcomings flow over into the degree of corporate insider trading profitability at the firm level. Consistent with high power distance, low individualism, and voice and accountability, executives and their family members extract higher returns. The conjectured monitoring constraint of equity ownership had little impact on reducing profitable trading. Second, media reporting of firm‐related scandals only restrained insider profitability in firms with government ownership—consistent with general forbearance of corruption and sanction from the use of politically controlled assets. Third, the global financial crisis revealed both a crisis of inept trading consistent with high uncertainty avoidance and also highly profitable trades for a limited set of executives who undertook short‐term reversal strategies. Our exploratory microanalysis suggests a prototype to highlight areas requiring governance and investor attention in Eastern European countries.
Experiences of parents of adolescents with intellectual disabilities regarding the transition to sexual development: A transitions theory‐based qualitative study
Authors: Karataş N. , İşler Dalgıç A.
Published: December 2021

Background

To describe of the experiences of parents regarding the transition to sexual development of their adolescents with intellectual disabilities who are 15–19 years old.

Methods

This study employs a descriptive interpretative approach and uses Meleis's transitions theory as its theoretical frame of reference. This study uses purposive sampling methods for recruitment. We collected data through individual semi‐structured interviews (n = 11) and researcher observations between February 2021 and April 2021 and employed an inductive content analysis approach.

Results

Three main themes emerged from the data: parental factors driving the transition process, parents' needs regarding the transition process, and outcomes of the transition process. In addition, most parents struggled to remodel their identities following the transition due to concerns over their adolescent's ability to cope with the challenges of adulthood.

Conclusion

Considered in the context of middle‐range transitions theory, we suggest that parental experiences regarding adolescents' transition to sexual development stem from varying levels of uncertainty and depend on the situation, preferences, and family needs of each individual parent. It is useful to utilise Meleis's transitions theory to understand deeply and explore the impact of the sexual development of adolescents with intellectual disabilities on parents.
Can maternal abdominal fat thickness predict antenatal insulin therapy in patients with gestational diabetes mellitus?
Authors: Akgöl Sedat , Budak Mehmet Şükrü , Oğlak Süleyman Cemil , Ölmez Fatma , Dilek Mehmet Emin , Kartal Serhat
Published: December 2021

Purpose

This study aimed to investigate the effectiveness of abdominal subcutaneous fat thickness (ASFT) in predicting antenatal insulin therapy (AIT) in patients with gestational diabetes mellitus (GDM).

Methods

A prospective study was conducted on patients with regulated blood sugar levels (n = 50) and those with unregulated blood sugar (n = 50) although medical nutrition therapy (MNT) was initiated and then AIT was applied. Using receiver operator characteristic (ROC) curve analysis, appropriate ASFT cut‐off point values were found for the prediction of cases that required AIT after MNT in GDM pregnancies.

Results

Patients with GDM who needed AIT had a significantly higher ASFT value compared to those with GDM who did not need AIT. The optimal ASFT cutoff was 21.7 mm in predicting cases that required AIT after MNT (sensitivity, specificity, negative, and positive predictive values were 68.0%, 64.0%, 65.8%, and 66.6%, respectively). The risk of AIT increased 3.77‐fold in those with ASFT > 21.7 mm in GDM pregnancies (p = 0.001).

Conclusion

The ASFT value was significantly higher in cases with GDM, with blood glucose levels not regulated despite MNT and AIT being then needed, compared to patients with blood glucose levels regulated by MNT, and who did not need AIT. Also, patients requiring AIT can be determined with moderate to high sensitivity and specificity using a cut‐off value of ASFT > 21.7 mm. The ASFT > 21.7 mm cut‐off point was seen to be more effective than BMI ≥ 30 kg/m2 in the determination of cases where AIT is required.
Divergent responses of functional diversity to an elevational gradient for vascular plants, bryophytes and lichens
Authors: Asplund Johan , van Zuijlen Kristel , Roos Ruben Erik , Birkemoe Tone , Klanderud Kari , Lang Simone I. , Wardle David A.
Published: December 2021

Question

Cold environments are stressful for vascular plants, and stress‐tolerant non‐vascular photoautotrophs, e.g. bryophytes and lichens, become relatively more important as competition from vascular plants decreases towards higher elevations. Under increasingly stressful climatic conditions, species assembly of vascular plants is commonly driven more by environmental filtering, and abiotic constraints may lead to increased similarity between species and thus low functional diversity. Because bryophytes and lichens are less constrained by harsh environments, environmental filtering may be less strong. Instead, reduced competition from vascular plants can potentially free up niche space for non‐vascular vegetation. Therefore, we hypothesized that functional diversity of vascular plants, bryophytes and lichens are likely to show contrasting responses to elevation.

Location

Finse Alpine Research Centre, Southern Norway.

Methods

We utilized measurements of species abundance and functional traits of the three groups along a 500‐m elevational gradient in alpine southern Norway and calculated multi‐trait and single‐trait functional dispersion.

Results

Functional diversity of vascular plants declined with elevation, indicating increased environmental filtering. By contrast, functional diversity of lichens and bryophytes increased along the same gradient, suggesting they are less exposed to environmental filtering, in line with our hypothesis. Instead, they likely benefit from the lower abundance of vascular plants at higher elevation.

Conclusions

Our findings suggest that different photoautotroph groups vary in how they respond to the same environmental gradient, which may contribute to contrasting community assembly processes across groups. These divergent responses likely occur because non‐vascular vegetation differs from vascular plants in terms of nutrient acquisition and water economy strategies, meaning that they respond differently to the same factors. This highlights the need to explicitly consider bryophytes and lichens in community‐level studies whenever these groups are abundant.
Plant diversity but not productivity is associated with community mycorrhization in temperate grasslands
Authors: Leon Daniela , Bueno C. Guillermo , Zobel Martin , Bennett Jonathan A. , Puglielli Giacomo , Davison John , Riibak Kersti , Pärtel Meelis , Moora Mari
Published: December 2021

Aims

Mycorrhizal symbiosis influences the performance of plant individuals. However, its impact on plant communities is less well understood. We used a database of plant mycorrhizal traits and investigated how community mycorrhization — the prevalence of mycorrhizal symbiosis in plant communities — is related to plant community productivity and diversity. We analysed: (a) how soil fertility affects community mycorrhization; (b) how plant productivity and diversity are related to community mycorrhization; and (c) whether community mycorrhization directly mediates the relationships between soil fertility and plant productivity and diversity.

Location

Twenty‐nine semi‐natural grasslands in the south of Estonia, representing a steep productivity gradient (80–500 g/m2).

Methods

We estimated the proportion of plant biomass associated with mycorrhizal symbiosis (arbuscular mycorrhization index, AMI). The relationships between soil fertility (soil nitrogen [N], phosphorus [P] and potassium [K], accounting for soil moisture and pH), AMI, plant diversity and productivity were analysed using model averaging and pairwise generalized linear models, and support for direct relationships was determined using path analysis.

Results

There was a positive linear relationship between soil nitrogen and AMI. In turn, plant biomass showed positive, and plant diversity negative linear relationships with AMI. Path analyses indicated that AMI mediates the relationship between soil nitrogen and plant diversity, but not the relationship between soil nitrogen and plant community productivity. Plant productivity and mycorrhization increased along the soil fertility gradient, but plant diversity decreased.

Conclusion

These results suggest that community mycorrhization, which is sensitive to soil fertility (N), can modulate community composition in temperate grasslands, probably by enhancing the most dominant plant species in the community.
Local adaptation of life cycles in a butterfly is associated with variation in several circadian clock genes
Authors: Lindestad Olle , Nylin Sören , Wheat Christopher W. , Gotthard Karl
Published: December 2021

Many insects exhibit geographical variation in voltinism, the number of generations produced per year. This includes high‐latitude species in previously glaciated areas, meaning that divergent selection on life cycle traits has taken place during or shortly after recent colonization. Here, we use a population genomics approach to compare a set of nine Scandinavian populations of the butterfly Pararge aegeria that differ in life cycle traits (diapause thresholds and voltinism) along both north–south and east–west clines. Using a de novo‐assembled genome, we reconstruct colonization histories and demographic relationships. Based on the inferred population structure, we then scan the genome for candidate loci showing signs of divergent selection potentially associated with population differences in life cycle traits. The identified candidate genes include a number of components of the insect circadian clock (timeless, timeless2, period, cryptochrome and clockwork orange). Most notably, the gene timeless, which has previously been experimentally linked to life cycle regulation in P. aegeria, is here found to contain a novel 97‐amino acid deletion unique to, and fixed in, a single population. These results add to a growing body of research framing circadian gene variation as a potential mechanism for generating local adaptation of life cycles.
Impairment of lysosomal function by Clostridioides difficile TcdB
Authors: Klepka Carmen , Sandmann Moritz , Tatge Helma , Mangan Matthew , Arens Annabel , Henkel Daniel , Gerhard Ralf
Published: December 2021

TcdB is a potent cytotoxin produced by pathogenic Clostridioides difficile that inhibits Rho GTPases by mono‐glucosylation. TcdB enters cells via receptor‐mediated endocytosis. The pathogenic glucosyltransferase domain (GTD) egresses endosomes by pH‐mediated conformational changes, and is subsequently released in an autoproteolytic manner. We here investigated the uptake, localization and degradation of TcdB. TcdB colocalized with lysosomal marker protein LAMP1, verifying the endosomal‐lysosomal route of the toxin. In pulse assays endocytosed TcdB declined to a limit of detection within 2 hr, whereas the released GTD accumulated for up to 8 hr. We observed that autoproteolytic deficient TcdB NXN C698S was degraded significantly faster than wildtype TcdB, suggesting interference of TcdB with lysosomal degradation process. In fact, TcdB reduced lysosomal degradation of endosome cargo as tested with DQ‐Green BSA. Lysosomal dysfunction was accompanied by perinuclear accumulation of LAMP1 and a weaker detection in immunoblots. Galectin‐8 or galectin‐3 was not recruited to lysosomes speaking against lysosome membrane damage. Changes in the autophagosomal marker LC3B suggested additional indirect effect of lysosomal dysfunction on the autophagic flux. In contrast to necrotic signaling induced in by TcdB, lysosomal dysfunction was not abolished by calcium channel blocker nifedipin, indicating separate cytopathogenic effects induced by TcdB during endo‐lysosomal trafficking.
FabR senses long‐chain unsaturated fatty acids to control virulence in pathogen Edwardsiella piscicida
Authors: Shao Shuai , Zhang Yi , Yin Kaiyu , Zhang Yuanxing , Wei Lifan , Wang Qiyao
Published: December 2021

Long‐chain unsaturated fatty acids (UFAs) can serve as nutrient sources or building blocks for bacterial membranes. However, little is known about how UFAs may be incorporated into the virulence programs of pathogens. A previous investigation identified FabR as a positive regulator of virulence gene expression in Edwardsiella piscicida. Here, chromatin immunoprecipitation‐sequencing coupled with RNA‐seq analyses revealed that 10 genes were under the direct control of FabR, including fabA, fabB, and cfa, which modulate the composition of UFAs. The binding of FabR to its target DNA was facilitated by oleoyl‐CoA and inhibited by stearoyl‐CoA. In addition, analyses of enzyme mobility shift assay and DNase I footprinting with wild‐type and a null mutant (F131A) of FabR demonstrated crucial roles of FabR in binding to the promoters of fabA, fabB, and cfa. Moreover, FabR also binds to the promoter region of the virulence regulator esrB for its activation, facilitating the expression of the type III secretion system (T3SS) in response to UFAs. Furthermore, FabR coordinated with RpoS to modulate the expression of T3SS. Collectively, our results elucidate the molecular machinery of FabR regulating bacterial fatty acid composition and virulence in enteric pathogens, further expanding our knowledge of its crucial role in host–pathogen interactions.
Aspergillus endocarditis in the recent years, report of cases of a multicentric national cohort and literature review
Authors: Valerio Maricela , Camici Marta , Machado Marina , Galar Alicia , Olmedo Maria , Sousa Dolores , Antorrena‐Miranda Isabel , Fariñas Maria Carmen , Hidalgo‐Tenorio Carmen , Montejo Miguel , Vena Antonio , Guinea Jesús , Bouza Emilio , Muñoz Patricia ,   the GAMES Study Group
Published: December 2021

Objectives

(1) To describe the incidence, clinical characteristics, treatment and outcome of Aspergillus Endocarditis (AE) in a nationwide multicentric cohort (GAMES). (2) To compare the AE cases of the GAMES cohort, with the AE cases reported in the literature since 2010. (3) To identify variables related to mortality.

Methods

We recruited 10 AE cases included in the GAMES cohort (January 2008‐December 2018) and 51 cases from the literature published from January 2010 to July 2019.

Results

4528 patients with infectious endocarditis (IE) were included in the GAMES cohort, of them 10 (0.2%) were AE. After comparing our 10 cases with the 51 of the literature, no differences were found. Analysing the 61 AE cases together, 55.7% were male, median age 45 years. Their main underlying conditions were as follows: prosthetic valve surgery (34.4%) and solid organ transplant (SOT) (19.7%). Mainly affecting mitral (36.1%) and aortic valve (29.5%). Main isolated species were as follows: Aspergillus fumigatus (47.5%) and Aspergillus flavus (24.6%). Embolisms occurred in 54%. Patients were treated with antifungals (90.2%), heart surgery (85.2%) or both (78.7%).

Overall, 52.5% died. A greater mortality was observed in immunosuppressed patients (59.4% vs. 24.1%, OR = 4.09, 95%CI = 1.26–13.19, p = .02), and lower mortality was associated with undergoing cardiac surgery plus azole therapy (28.1% vs. 65.5%, OR = 0.22, 95%CI = 0.07–0.72, p = .01).

Conclusions

AE accounts for 0.2% of all IE episodes of a national multicentric cohort, mainly affecting patients with previous valvular surgery or SOT recipients. Mortality remains high especially in immunosuppressed hosts and azole‐based treatment combined with surgical resection are related to a better outcome.
Impact of a white noise app on sleep quality among critically ill patients
Authors: Warjri Evansaralin , Dsilva Fatima , Sanal Thankappan S. , Kumar Abhishek
Published: December 2021

Background

Sleep disturbance negatively affects recovery and survival of patients in intensive care units (ICUs).

Aims and Objectives

This study aimed to measure the noise levels and evaluate the impact of a white noise app on the sleep quality of critically ill patients.

Design

A quasi‐experimental time series pre‐test–post‐test control group design with repeated measures was adopted.

Methods

The study was conducted in the high dependency unit (HDU) of a selected tertiary care hospital in Mangalore, Karnataka State, India. Conscious oriented patients with systolic blood pressure ranging from 100/70 to 140/90 mm Hg and hearing acuity of at most 20 dB in both ears were included in the study. Noise levels in the HDU were measured using calibrated sound level meter on weekdays/weekends in three different shifts and an average of 24 readings was obtained per shift. A 4‐point Likert scale was used to assess the sleep quality. The intervention included administration of white noise app twice a day, for three consecutive days by using different masking sounds such as white noise on day 1 which resembles to a humming AC conditioner, pink noise on day 2 which resembles to the sound of ocean waves and brown noise on day 3 which resembles a steady rainfall. The app was used with the help of JBL earphones C10SI an excellent noise cancellation and noise isolating earphone.

Results

Among the 54 subjects, the mean age of the patients was 40.28 years, majority 34 (63%) were males. The noise level in the ICU was more than 60 dB. There was a significant difference in the sleep quality after the application of the white noise app in the experimental group on Day 1 (Z = −3.996;P = .001), Day 2 (Z = −3.302;P = .001), and Day 3 (−2.822;P = .005) compared to the control group.

Conclusion

Adoption of technology driven noise reduction applications would enhance the quality of sleep among the ICU patients.

Relevance to clinical practice

The use of a technology‐driven application helps control noise levels which promotes improved sleep quality among critically ill patients in the intensive care units.
The Determinants of States' Interactions with China in the Belt and Road Initiative (BRI): Spatial Gravity Interaction
Authors: Liu Lina , Song Tianyang
Published: December 2021

The Belt and Road Initiative (BRI) is a far‐reaching initiative of China's active engagement in global affairs and is seen to determine the future fate of Eurasia. Previous studies about states' interactions with China in the BRI either give suggestions on further actions or selectively depict how participants interact with China in a non‐comparative way. With the BRI event data collected that covers multiple modes of BRI interactions, this paper takes the initiative to explore the determinants of states' interactions with China in the BRI. With the spatial gravity model, this paper finds that economic size, market quality, geographic proximity, and political and economic amity are closely associated with states' interactions with China in the BRI, which further contributes to the broad literature of the application of the gravity model as well as the interaction of states with China under the new era of China's more active, confidential, and assertive foreign policy.
First Strike Hypersonic Weapons: The End of the “MAD” Doctrine and Peace for Our Time?
Authors: Wong Wilson Kia Onn
Published: December 2021

Since the conclusion of the Second World War, the world's great powers (i.e., the United States, Russia, and China) have been locked in an escalating race to develop the next game‐changing weapon. The pivotal weapon examined in this paper is hypersonics. The desire to master hypersonic weaponry is particularly strong amongst the “lesser powers” or “Davids” (e.g., Iran and North Korea), as they hold the belief that hypersonics are the “Assassin's Mace” that will grant them the critical first strike advantage against the militarily superior great powers. This study examines the intensifying “hypersonics arms race” between these nations and more importantly, the potential of this increasingly contentious rivalry to destabilize the tenuous world peace purportedly effected by the “Mutual Assured Destruction” (“MAD”) doctrine. Even if this “hypersonics arms race” does not lead to another global conflict, it does serve to flame regional tensions in the Middle East and Northeast Asia, ultimately setting the scene for proxy wars, as the great powers could ply their respective allies with hypersonics technology, with the aim of furthering their own strategic agendas.
Review of the diagnosis and management of pediatric psychodermatologic conditions: Part I
Authors: Mosca Megan , Martin Kari , Hadeler Edward , Hong Julie , Brownstone Nicholas , Koo John
Published: December 2021

Pediatric psychodermatologic conditions encompass both primary dermatologic conditions with psychiatric comorbidities and primary psychiatric conditions with self‐induced dermatologic manifestations. Detection, diagnosis, and management of primary psychiatric conditions with dermatologic manifestations are challenging due to patient‐perceived stigma and lack of educational opportunities for dermatology providers. This two‐part series highlights the most up‐to‐date evidence‐based data and management techniques of some of the more common dermatoses of primary psychiatric conditions in children. Part I includes trichotillomania, skin‐picking disorder, and onychophagia, and part II covers dermatitis artefacta, body dysmorphic disorder, and delusions of parasitosis by proxy, with special considerations for family dynamics.
Graft‐versus‐host disease after pediatric liver transplantation: A diagnostic challenge
Authors: Attas Rabab Ali Al , Bader Razan M. , Mashhour Miral , AlQahtani Zuhoor A. , Mohammed Amani , Qahtani Masood , Arain Zahid B. , Faraidy Nadya , Awaji Mohammad , Mohammed Gamil , Alharbi Hassan A. , AlZahrani Mariam , Aqool Amal , Salim Ghandorah
Published: December 2021

Background

Graft‐versus‐host disease (GVHD) is a rare but serious complication after pediatric liver transplantation (LTx). Early diagnosis is difficult due to nonspecific presenting symptoms and non‐pathognomonic skin histopathological features. The aim of this article was to describe a case of pediatric GVHD after LTx and to review available data on pediatric GVHD highlighting the diagnostic difficulty. We also propose a diagnostic algorithm to improve the diagnostic capability and increase clinical awareness about this potentially fatal condition.

Methods

We did a comprehensive literatures review on studies on GvHD following pediatric LTx between 1990 and February 2021, chimerism study by short tandem repeat (STR), HLA typing by sequence‐specific oligonucleotide (SSO) method, and flowcytometry crossmatch.

Results

Our search yielded 23 case reports. The most common clinical manifestations were fever and rash (91%) followed by diarrhea. Mortality rate was 36.8% mainly due to sepsis and organ failure. Diagnosis was challenging and chimerism study to confirm donor engraftment was performed on only half of the cases. Prevalence of “donor dominant HLA one‐way matching” typically occurs in homozygous parents‐to‐child transplantation was 75% in cases with HLA testing.

Conclusion

So far, there are no available standard diagnostic criteria for GVHD following pediatric LTx. Recognition of multiple risk factors through proper laboratory assessment can predict the occurrence, and early chimerism study can confirm suggestive clinical manifestation. The strong likelihood of developing GVHD in “donor one‐way HLA match” and the severe problems imposed by this complication may justify avoidance of HLA homozygous parent's donation.
Revisiting the criticisms of rational choice theories
Authors: Herfeld Catherine
Published: December 2021

Theories of rational choice are arguably the most prominent approaches to human behaviour in the social and behavioral sciences. At the same time, they have faced persistent criticism. In this paper, I revisit some of the core criticisms that have for a long time been levelled against them and discuss to what extent those criticisms are still effective, not only in light of recent advancements in the literature but also of the fact that there are different variants of rational choice theories that have not been considered explicitly when criticizing them.
Reactivity of Singlet Oxygen with DNA, an Update†
Authors: Ravanat Jean‐Luc , Dumont Elise
Published: December 2021

The reactivity of singlet oxygen with DNA constituents and in particular with the guanine base has been studied during more than four decades but the exact mechanisms by which such a reactive oxygen species reacts with DNA is still a matter of debate. In this review article, a summary of the data that were obtained from several laboratories and using complementary experimental and theoretical approaches are presented. Reaction mechanisms of 1O2 with guanine and its oxidation product 8‐oxo7,8‐dihydroguanine are presented both at the nucleoside level and when the base is inserted into DNA since significant differences have been observed. Efforts have been made to propose tentative mechanisms to explain the conflicting results that were sometimes reported and hypotheses have been put forward to tentatively explain still contradictory observations.
Minimizing conditional value‐at‐risk under a modified basestock policy
Authors: Li Bo , Arreola‐Risa Antonio
Published: December 2021

Consider a single‐product, make‐to‐stock, risk‐averse company that manages its finished goods inventory by a basestock policy. Item demand is modeled as a Poisson process, and unit production time is modeled as an exponential random variable. Annual cost is equal to the sum over one year of the inventory‐holding and back‐ordering costs. The company wants to minimize the annual cost conditional value‐at‐risk by an appropriate basestock selection called the optimal basestock. After offering evidence that the optimal basestock is analytically intractable, we derive a closed‐form approximation of the optimal basestock. In two independent simulation experiments, we found that the average penalty for using the approximation is less than 1%; we believe this accuracy would be acceptable for practical applications. Leveraging the approximation's accuracy and simplicity, we establish several results that may serve as predictors of the company's appropriate basestock adjustments to changes in operational, economic, and risk aversion parameters. We illustrate how our research results were successfully applied in a Fortune 10 energy company. We extend the problem setting in two different directions to widen the applicability of our research results.
Combined influences of strategy and selection history on attentional control
Authors: Abbasi Hossein , Kadel Hanna , Hickey Clayton , Schubö Anna
Published: December 2021

Visual attention is guided by top‐down mechanisms and pre‐stimulus task preparation, but also by selection history (i.e., the bias to prioritize previously attended items). Here we examine how these influences combine. Two groups of participants completed two intermingled tasks. One task involved categorization of a unique target; one group categorized the target based on color, and the other based on shape. The other task involved searching for a target defined by unique shape while ignoring a distractor defined by unique color. Our expectation was that the search task would be difficult for the color‐categorization group because their categorization task required attentional resolution of color, but the search task required that they ignore color. In some experimental blocks, trials from the two tasks appeared predictably, giving the color‐categorization group an opportunity to strategically prepare by switching between color‐prioritizing and shape‐prioritizing attentional templates. We looked to pre‐stimulus oscillatory activity as a direct index of this preparation, and to reaction times and post‐stimulus ERPs for markers of resultant change in attentional deployment. Results showed that preparation in the color‐categorization group optimized attentional templates, such that these participants became less sensitive to the color distractor in the search task. But preparation was not sufficient to entirely negate the influence of selection history, and participants in the color‐categorization group continued to show a propensity to attend to the color distractor. These results indicate that preparatory effort can be scaled to the anticipated attentional requirements, but attention is nevertheless considerably biased by selection history.
Atomic Visitors from Outer Space: The Tunguska Nuclear Hypothesis in Soviet Technological Imagination
Authors: BRUNO ANDY
Published: December 2021

In the mid‐1940s an idea arose that a crash of an atomically‐powered alien spaceship had caused the mysterious Tunguska explosion of 1908 in Siberia. Initially expressed as fiction, this speculation evolved into an active hypothesis that inspired decades’ worth of amateur investigations. This article examines the history of the Tunguska nuclear hypothesis and what it reveals about nuclear and technological culture in the USSR. It argues that Soviet technological imagination had a tendency to place the country's developments into a cosmic perspective that drew parallels between contemporary circumstances on Earth and the possible existence of technologies among civilizations elsewhere in the universe. Seeing the country's communist project as part of a cosmic drama involved a form of universalism that aligned with Marxist ideology, but also possessed distinctive influences and afterlives. By concentrating on cosmic analogies at play in Soviet technological imagination about Tunguska, this article also underscores how the suspected link between otherworldly civilizations and earthly actions informed ways of conceptualizing race and ethnicity, the boundaries of scientific knowledge, and the natural environment.
A rich palette of Bible use: A theoretical and empirical contribution from the context of Protestant Christian secondary schools in the Netherlands
Authors: de Kock A. (Jos) , Sonnenberg P. M. (Ronelle) , Nagel‐Herweijer C. H. (Corina)
Published: December 2021

How the Bible functions in (Christian) education in the international discourse on religious education, particularly in the Dutch context, has rarely been empirically investigated. The purpose of this article is to gain insight into how the Bible is functioning in the context of Protestant secondary schools in the Netherlands. In addition to providing a theoretical account, it presents the results of an empirical, explorative, and qualitative study on how the Bible is used in Protestant Christian secondary education in the Netherlands, with a focus on exploring the perspectives of teachers, including religious educators. Seventeen focus group interviews with teachers and school administrators from six secondary schools revealed a variety of goals held by teachers with regard to the use of the Bible in education and identified a variety of divisions in terms of teacher–learner roles. This article reflects on these findings through the use of religious education literature and concepts from the field of Bible didactics.
Risk factors and outcomes of COVID associated mucormycosis in kidney transplant recipients
Authors: Bansal Shyam B. , Rana Abhyuday , Babras Mayur , Yadav Dinesh , Jha Pranaw , Jain Manish , Sethi Sidharth K.
Published: December 2021

Background

Invasive mucormycosis (IM) is a life‐threatening fungal infection occurring mostly in solid organ transplant (SOT) recipients, patients with hematological malignancies, and diabetes. A sudden spurt of mucormycosis has been reported in severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) pandemic in India; however, there is little data about coronavirus disease 2019 (COVID‐19) associated mucormycosis (CAM) in kidney transplant recipients (KTRs).

Methods

We describe the clinical presentations, risk factors, treatment and outcomes of 11 mucormycosis cases in KTRs post‐COVID‐19 infection from February 2020 to June 2021 at a single center in India.

Results

Mucormycosis was seen in 11/102 (10.7%) KTRs during the pandemic. Six patients had mild disease and rest five had moderate disease. Seven patients had pre‐existing diabetes mellitus and four developed new onset hyperglycemia after receiving steroids for COVID‐19 infection. All had poorly controlled sugars at the time of presentation. Most common presentation was rhino‐orbital‐cerebral mucormycosis (ROCM) in 10/11 (89%) patients and one has pulmonary mucormycosis. All patients received combination of amphotericin B and surgical debridement/excision of affected tissue followed by posaconazole prophylaxis. Nine patients recovered, however two patients succumbed to their illness after median of 14 (7–21) days from diagnosis. One patient developed acute T‐cell‐mediated rejection during the course of recovery. At last follow up, the mean serum creatinine was 2.05 mg/dl as compared to 1.4 mg/dl at presentation.

Conclusions

IM is a common fungal infection in transplant recipients in India after COVID‐19. Early diagnosis and prompt treatment with combination of surgical debridement and liposomal amphotericin B are key to better outcomes in CAM. Judicious use of steroids and control of hyperglycemia is key to avoid flaring up of the fungal infection.