bluuebunny/crossref_metadata_2025 huggingface dataset:
Multilevel mHealth Intervention Increases Physical Activity of Older Adults Living in Retirement Community
Authors: Hosteng Katie R. , Simmering Jacob E. , Polgreen Linnea A. , Cremer James F. , Segre Alberto M. , Francis Shelby L. , Whitaker Kara M. , Polgreen Philip M. , Carr Lucas J.
Published: May 2021

Background: Regular physical activity is crucial for healthy aging, but older adults are the least active age group. This study explored the feasibility, acceptability, and efficacy of a multilevel mHealth intervention for increasing physical activity of older adults living in a retirement community. Methods: Participants included 54 older adults (mean age = 81.2 y, 77.8% female, 98.1% white) living in a retirement community. Participants received a Fitbit Zip and access to a multilevel mHealth physical activity intervention (MapTrek Residential) for 8 weeks. Physical activity (in steps per day) and intervention compliance (days worn) were measured objectively with the Fitbit for 12 weeks (8-wk intervention plus 4-wk follow-up). Psychosocial outcomes (social support, self-efficacy, and outcome expectations) were assessed at baseline and 8 weeks. Acceptability outcomes were assessed with an open-ended process evaluation survey and focus groups. Descriptive statistics and linear mixed models were used to examine intervention effects. Results: Participants increased daily steps from 5438 steps per day at baseline (95% CI, 4620 to 6256) to 6201 steps per day (95% CI, 5359 to 7042) at week 8 (P < .0001) but this was not maintained at 12 weeks (P = .92). Conclusions: Our multilevel mHealth physical activity intervention was effective for increasing physical activity older adults over 8 weeks. Additional research focused on maintaining physical activity gains with this approach is warranted.
Inhibition of immune hemolysis: serological assay for the heat-labile enterotoxin of Excherichia coli
Authors: Evans D J , Evans D G
Published: May 2021

Sheep erythrocytes sensitized by incubation with the heat-labile enterotoxin (LT) of Escherichia coli are hemolyzed in the presence of anti-LT antiserum and complement. The Microtiter (Cooke Laboratory Products) technique was used to titrate anti-LT antibody in serum by this immune hemolysis reaction. Immune hemolysis was inhibited by preexposure of the anti-LT antiserum to soluble LT before addition of the LT-sensitized sheep cells. E. coli mini-extract preparations were obtained by the polymyxin release technique and assayed for LT by the lysis inhibition test (LIT) and by the adrenal cell assay. All 75 adrenal cell-positive E. coli isolates were positive in the LIT assay. Eight of 318 adrenal cell-negative isolates tested were positive in the LIT assay, possibly indicating the presence of biologically inactive toxin.
Dermatophyte isolation media: quantitative appraisal using skin scales infected with Trichophyton mentagrophytes and Trichophyton rubrum
Authors: Sinski J T , Kelley L M , Flynt P M , Miegel J
Published: May 2021

Various dermatophyte isolation media were quantitatively appraised by colony counts for their ability to support growth when suspensions of trypsin-treated infected-skin scales were used as inocula. Evaluation included guinea pig skin scales infected with a granular Trichophyton mentagrophyton mentagrophytes, and one trial was conducted using human skin scales infected with Trichophyton rubrum. No differences in the ability to support growth were observed among Taplin Dermatophyte Test medium, Dermatophyte Test Medium (Schering Diagnostics, Port Reading, N.J.),Sabouraud medium plus cycloheximide and chloramphenicol, Youssef medium for dermatophytes product no. 103S semisynthetic lots no. 106 and no. 107. With skin scales not grossly contaminated with bacteria, similar counts were obtained with Littman oxgall agar without antibiotics. Youssef medium for dermatophytes product no. 103N natural lot no. 109 was significantly different from the other media in that lower counts were obtained.
Failure of cyclophosphamide to significantly enhance isolation of Rickettsia tsutsugamushi from wild Philippine rats
Authors: van Peenen P F , Ho C M , See R
Published: May 2021

Treatment of wild rats from a known scrub typhus focus in the Philippines with cyclophosphamide did not significantly enhance the isolation rate of Rickettsia tsutsugamushi using mouse inoculation techniques. Similarly, cyclophosphamide treatment of mice inoculated with organs of wild rats did not increase the recovery of rickettsiae, and isolation of rickettsiae was about equal from biopsies obtained before and after immunosuppression of wild rats.
Occurrence and significance of Cryptococcus neoformans in the respiratory tract of patients with bronchopulmonary disorders
Authors: Randhawa H S , Pal M
Published: May 2021

Cryptococcus neoformans was cultured from 13 (3%) of 469 clinical specimens examined from the respiratory tract of patients with bronchopulmonary diseases. These isolations came from 5 (2%) of 207 patients; 11 isolates were from sputum and 1 each were from bronchoscopic aspirate and empyema pus. The fungus was not cultured from the oropharyngeal washings of 101 apparently healthy volunteers. Of the 5 patients, 3 had pulmonary tuberculosis, including one with pyopneumothorax and 2 with allergic bronchopulmonary aspergillosis as the underlying disease. In the tuberculosis patient with pyopneumothorax and C. neoformans in empyema pus, the fungus was presumably a tissue invader, whereas its role could not be unequivocally ascertained in the remaining 4 patients from whom it was isolated from sputum or bronchial aspirate on at least two consecutive occasions. The question of C. neoformans being a transient resident, commensal, or incitant of benign minimal lesions in the tracheobronchial tree is discussed. A comprehensive laboratory and clinical follow-up is warranted in patients from whose sputum or bronchial aspirate C. neoformans may be cultured even though definitive signs of cryptococcosis may be lacking.
Radiometric detection of bacteremia: requirement for terminal subcultures
Authors: Strauss R R , Throm R , Friedman H
Published: May 2021

A radiometric procedure for rapid detection of bacteria in clinical blood specimens was utilized over a period of 1 year in this laboratory. Although in initial studies it was felt that all positive bacteremias would be detected by radiometric examination of cultures for 14CO2 evolution over a 7-day period, we found in the present study that a significant number of bacteria were not detected, except by blind subculturing on day 7 before discarding the culture sample. Microorganisms were detected in 490 individual specimens from 348 patients after examination of 6,200 individual blood specimens, both anaerobically and aerobically. All but 30 of the positive specimens were detected by the radiometric procedure, with an average detection time of 30.5 h. Thirty organisms, representing 6% of the total organisms isolated, were not detected by the BACTEC apparatus. The predominating organisms missed by the radiometric method were group D streptococci, both enterococcal and non-enterococcal species. These isolates represented two-thirds of the total number of organisms not detected by the radiometric procedure. A majority of bacteria detected only upon terminal subculture were isolates from a very small number of patients, suggesting that these organisms might have specific properties that preclude their detection by radiometric assay. Nevertheless, our study results indicate that it is essential that all radiometrically examined blood culture specimens be subcultured prior to discard in order to lessen the likelihood of missing a microbial pathogen.
Use of stable, sensitized cells in an indirect microhemagglutination test for melioidosis
Authors: Hambie E A , Larsen S A , Felker M , Jones W L , Feeley J C
Published: May 2021

Two evaluations were carried out in this study. The first was a comparison of the standard tube test with the automated microtitration test for the detection of antibodies to Pseudomonas pseudomallei by the indirect hemagglutination method. Data from this comparison indicated that the tests were equivalent. The second evaluation consisted of reproducibility studies on two lots of pyruvic aldehyde-stabilized sensitized erythrocytes in comparison with freshly prepared sensitized erythrocytes in the automated microtitration test. The influence of different types of the microtitration plates used was also examined. Results indicated that the use of stabilized antigens is feasible, and these antigens offer the advantage of being ready for immediate use.
Comparisons between direct microscopic and cultural methods for recognition of Corynebacterium vaginale in women with vaginitis
Authors: Smith R F , Rodgers H A , Hines P A , Ray R M
Published: May 2021

The frequency with which clue cells could be detected in Gram-stained vaginal smears and/or cervical Papanicolaou (Pap) smears was compared with the frequency of Corynebacterium vaginale (Haemophilus vaginalis) isolation in a group of 236 female patients, of whom 221 had vaginitis. Vaginal clue cells were found most often in women from whom C. vaginale was isolated (P = 0.00006) whereas, conversely, clue cells in cervical Pap smears were reported more frequently in women with negative cultures for this organism (P = 0.006). C. vaginale isolations were made more frequently from women with both vaginal and cervical clue cells reported (P = 0.000088). However, the combined false positive-false negative vaginal clue cell rate in the patients studied was 36.5%. Neither the detection of vaginal clue cells nor the isolation of C. vaginale was significantly affected by whether or not patients had trichomoniasis (P = 0.25). Trichomonas vaginalis detection in cervical Pap smears and vaginal isolation were related (P = 0.00005), whereas the same relationship was not significant for fungi (P = greater than 0.05).
Evaluation of the rapid hippurate hydrolysis test with enterococcal group D streptococci
Authors: Lee M R , Ederer G M
Published: May 2021

The rapid hippurate hydrolysis test was evaluated with the conventional test, using 17 group A streptococci, 9 non-enterococcal group D streptococci, 108 enterococcal group D streptococci, and 2 strains of Listeria monocytogenes. There was complete correlation between the rapid and conventional tests with all organisms except enterococcal group D. The rapid hippurate hydrolysis method was more sensitive with the enterococci; 95.4% were positive with the rapid method, and 9.3% were positive with the conventional method. Thin-layer chromatography (TLC) was performed on all isolates to determine if the end product of hydrolysis, glycine, was indeed present. The TLC results were in agreement with the rapid and conventional methods for group A streptococci, nonenterococcal group D streptococci, and L. monocytogenes. TLC results were in total agreement with the rapid hippurate hydrolysis test for the enterococcal group D isolates, thus verifying the accuracy of this more sensitive test. Trace amounts of glycine were found in the substrate, indicating the need for including an uninoculated substrate control as well as stock strains of group A and B beta-hemolytic streptococci (negative and positive controls, respectively) each time the rapid hippurate hydrolysis test is performed.
Smear results in the diagnosis of mycobacterioses using blue light fluorescence microscopy
Authors: Pollock H M , Wieman E J
Published: May 2021

Examination of 6,880 sputum specimens from untreated patients disclosed that 3.1% were positive for mycobacteria by fluorescence microscopy, and 92.5% of these has positive cultures. There was a positive correlation between the number of organisms seen on smear and growth on culture. All specimens with positive smears and negative cultures contained rare or few acid-fast bacilli on the smear. Eighty-two percent of the specimens with positive cultures and negative smears yielded less than 25 colonies, whereas there were greater than 25 colonies from 93% of the specimens with positive smears and cultures. In a low prevalence, general hospital population, the primary acid-fast smear continued to be a reliable diagnostic tool.
Evaluation of the Single Radial Hemolysis Test for Measuring Hemagglutinin- and Neuraminidase-Specific Antibodies to H3N2 Influenza Strains and Antibodies to Influenza B
Authors: Farrohi Khosrow , Farrohi Fakhrissadat K. , Noble Gary R. , Kaye Harold S. , Kendal Alan P.
Published: May 2021

Antibodies to the H3 hemagglutinin of influenza A virus could be specifically measured by single radial hemolysis (SRH) when test antigens were recombinant viruses containing the relevant H3 hemagglutinin antigen and irrelevant Neq1 neuraminidase of A/equine/Prague/1/56 virus. Antibodies to influenza B virus could also be measured by the SRH technique. Antibody rises to influenza A or B virus measured by SRH agreed with results of hemagglutination inhibition (HI) tests for about 80% of the sera tested, including sera from volunteers receiving killed influenza vaccine and sera from patients naturally infected with influenza. Correlation between antibody titers measured by SRH and HI was also good. Antibodies to the N2 neuraminidase of influenza A virus could be specifically measured by SRH when test antigens were recombinant viruses containing the relevant N2 neuraminidase antigen and irrelevant Heq1 hemagglutinin of A/equine/Prague/1/56 virus. The SRH test for neuraminidase antibodies was more strain specific than was the SRH test for hemagglutinin antibodies. Probably for this reason, agreement between neuraminidase antibody determinations in human sera by the SRH test and by the neuraminidase inhibition test was poorer than agreement between the SRH test for hemagglutinin antibodies and the HI test.
Correlation of cytopathic effect, fluorescent-antibody microneutralization, and plaque reduction test results for determining avian infectious bronchitis virus antibodies
Authors: Wooley R E , Brown J
Published: May 2021

A microneutralization fluorescent-antibody (MFA) test was effective in determining the level of antibodies to avian infectious bronchitis virus. A comparison of the MFA test with the cytopathic effect microneutralization (MNT) test and 50% plaque reduction (PR) test resulted in positive correlations that were significant (P less than 0.001). The PR test was more sensitive than either the MFA or the MNT test, but there was no significant difference between the sensitivities of the MFA and MNT tests. The MFA test has advantages over the PR test in the capacity to test large numbers of sera in a shorter period of time. The MFA test also can be completed in one-half the time required for the MNT test.
Purification of infectious feline leukemia virus from large volumes of tissue culture fluids
Authors: Mathes L E , Yohn D S , Olsen R G
Published: May 2021

Feline leukemia virus from tissue culture fluids was concentrated 100 times by continuous-flow molecular filtration. Virus concentrates retained 100% of their original infectivity. Further purification was accomplished by a single sucrose density gradient centrifugation.
Mycoplasma growth inhibition by arginine
Authors: Washburn L R , Somerson N L
Published: May 2021

Arginine enhances the growth of nonfermenting mycoplasmas. However, arginine can restrict the growth of glucose-fermenting mycoplasmas and should not be added to media used to cultivate these species.
Effect of Carbohydrate Source on Kanagawa-Type Hemolysis of
Vibrio parahaemolyticus
Authors: Chun Doki , Chung Jae K. , Cho Dong T. , Seol Sung Yong , Tak Ryunbin
Published: May 2021

Almost all strains of
Vibrio parahaemolyticus
produced Kanagawa-type hemolysis on media of high salt content in the presence of fermentable carbohydrates.
PH metric method for the determination of nicotinic acid in plasma
Authors: Gravesen J
Published: May 2021

The acidimetric method for the determination of nicotinic acid (NA) using Lactobacillus plantarum ATCC 8014 (Lactobacillus arabinosus 17-5) has been simplified and thus made less time consuming, and the sensitivity has been increased fivefold by replacement of the titration by a pH determination. As the regression of the decrease in pH on the amount of NA was found linear within a range of 1 to 4 ng of NA per ml, the calculations were performed according to the slope-ratio principle. The NA concentration of plasma was determined with a coefficient of variation of 5 to 7%, which rose to about 10% at low NA concentrations. Assays of fasting plasma samples from 13 hyperlipidemic male patients showed a group mean NA concentration of 80 +/- 55 ng/ml (mean +/- 2 standard deviation), before treatment, and 705 +/- 544 ng/ml (mean +/- 2 standard deviation) during therapy with sustained release NA preparations, of which a single dose, ingested during steady-state conditions, doubled or tripled the plasma concentration within 1 to 3 h.
Further evaluation of the test for detection of antibody-coated bacteria in urine sediment
Authors: Jones S R , Johnson J
Published: May 2021

To assess the reproducibility of the test for detection of antibody-coated bacteria in urine sediment as it might be used in a diagnostic laboratory for classification of urinary tract infections, multiple urine specimens from 83 patients were tested. The results were reproducible and consistent, or if inconsistent potentially explainable, in all but four patients. The explanation for inconsistencies include the immune response to the infecting bacteria, nonspecificity of the antibody coating the bacteria, antibody in prostatic secretions, and antibody-coated bacteria contaminating the urine specimens.
Comparison of antibody-dependent cellular cytotoxicity and complement-dependent antibody lysis of herpes simplex virus-infected cells as methods of detecting antiviral antibodies in human sera
Authors: Subramanian T , Rawls W E
Published: May 2021

An antibody-dependent cellular cytotoxicity (ADCC) assay was used to detect antibodies to the herpes simplex viruses in humans sera. The assay utilized the release of 51Cr from BHK-21 cells infected with the viruses, hamster peritoneal exudate cells as effector cells, and antiviral antibodies in human sera. The technique was found to be far more sensitive than complement-dependent antibody lysis of infected cells and virus neutralization. The ADCC assay was useful in detecting antibodies in sera that had low titers or no antibodies detectable by other methods. In a sample of 100 sera from university students, 40 were positive by complement-dependent lysis whereas 73 were positive by ADCC. Of 400 sera from women with cervical cancer, 17 did not have detectable antibodies by microneutralization or complement-dependent lysis; however, all sera were positive by ADCC, suggesting that all of the women had been infected in the past with one or both types of herpes simplex virus.
Recovery of anaerobic, facultative, and aerobic bacteria from clinical specimens in three anaerobic transport systems
Authors: Helstad A G , Kimball J L , Maki D G
Published: May 2021

With aspirated specimens from clinical infections, we evaluated the recovery of anaerobic, aerobic, and facultative bacteria in three widely used transport systems: (i) aspirated fluid in a gassed-out tube (FGT), (ii) swab in modified Cary and Blair transport medium (SCB), and (iii) swab in a gassed-out tube (SGT). Transport tubes were held at 25 degrees C and semiquantitatively sampled at 0, 2, 24, and 48 h. Twenty-five clinical specimens yielded 75 anaerobic strains and 43 isolates of facultative and 3 of aerobic bacteria. Only one anaerobic isolate was not recovered in the first 24 h, and then, only in the SGT. At 48 h, 73 anaerobic strains (97%) were recovered in the FGT, 69 (92%) in the SCB, and 64 (85%) in the SGT. Two problems hindered the recovery of anaerobes in the SCB and SGT systems: first die-off of organisms, as evidenced by a decrease in colony-forming units of 20 strains (27%) in the SCB and 25 strains (33%) in the SGT, as compared with 7 strains (9%) in the FGT, over 48 h; and second, overgrowth of facultative bacteria, more frequent with SCB and SGT. The FGT method was clearly superior at 48 h to the SCB and SGT systems in this study and is recommended as the preferred method for transporting specimens for anaerobic culture.
Evaluation of a new bacteriophage set for typing of Staphylococcus epidermidis strains
Authors: Heczko P B , Pulverer G , Kasprowicz A , Klein A
Published: May 2021

A new set of typing phages was evaluated for typing 821 Staphylococcus epidermidis strains isolated from normal human skin and from acne lesions. This method was compared with two different systems for biochemical differentiation of S. epidermidis. Distinct subgroups of cocci, which differed in phage susceptibility as well as in biochemical properties, were found. A tentative subdivision of S. epidermidis strains by use of 16 phages arranged into four groups is proposed, together with additional biochemical differentiation of non-typable strains.
Comparative recovery of Streptococcus mutans on ten isolation media
Authors: Little W A , Korts D C , Thomson L A , Bowen W H
Published: May 2021

The ability of Streptococcus mutans (Bratthall serotypes a through e) to grow on 10 isolation media was examined. The number and morphology of the colonies were observed to vary on different media. The use of blood-sucrose media consistently produced the highest recoveries. Mitis salivarius agar (MS) and higher recovery values than modified medium 10 (MM10SB), Trypticase-yeast extract-cystine medium (TYC), or MS with 1% tellurite (MST). MST with 40% sucrose (MS40S), MST with 20% sucrose and 0.2 U of bacitracin per ml (MSB), and Carlsson medium with 1% sulfasoxazole (MC), media formulated for the selection of S. mutans, were the most inhibitory for all serotypes. The morphology of several S. mutans strains was atypical on MC and MS40S, making positive identification difficult. Absence of growth of serotype a strains on MSB and serotype d strains on MC were the two major differences observed among the serotypes. Results are discussed in terms of the difficulties in making quantitative determinations from cultural data.
Electron capture gas chromatography detection and mass spectrum identification of 3-(2'-ketohexyl)indoline in spinal fluids of patients with tuberculous meningitis
Authors: Brooks J B , Choudhary G , Craven R B , Alley C C , Liddle J A , Edman D C , Converse J D
Published: May 2021

A basic, extractable, indolic type of compound, which was derivatized with heptafluorobutyric anhydride and pyridine, was obtained from the cerebrospinal fluids of patients with acute tuberculous meningitis. The compound was detected by frequency-pulsed, modulated electron capture gas-liquid chromatography, and it was tentatively identified by mass spectrometry as 3-(2'-ketohexyl)indoline. The compound was found to be valuable for differentiating between tuberculous, cryptococcal, and aseptic meningitides.
Selective and enhanced recovery of group A and B streptococci from throat cultures with sheep blood agar containing sulfamethoxazole and trimethoprim
Authors: Gunn B A , Ohashi D K , Gaydos C A , Holt E S
Published: May 2021

Sheep blood agar containing 23.75 microgram of sulfamethoxazole and 1.25 microgram of trimethoprim (SXT-BA) per ml was compared with conventional sheep blood agar (SBA) for isolating group A and B streptococci from throat cultures. This selective medium allowed much better recovery of group A and B streptococci and suppressed the growth of the normal flora, including "viridans" streptococci. In an initial study of 700 throat cultures, SXT-BA recovered 42% more group A and 49% more group B streptococci than did SBA. When SXT-BA was introduced into the routine microbiology laboratory and used by a number of medical technologists. SXT-BA recovered 28% more group A and 37% more group B streptococci than did SBA. In addition, the selective medium inhibited 83% of the non-group A and B streptococci that were recovered by SBA.
Supplemental Material: Sr isotopes in the Tortonian-Messinian Lake Bira and Gesher marshes, Northern Valleys of Israel: Implications for hydroclimate changes in East Mediterranean–Levant margins
Authors: Rozenbaum A.G. , al. et
Published: May 2021

A description of 7 stratigraphic sections, 3 tables, 10 figures and 2 plates.
Rare presentation of antisynthetase syndrome complicated by myocarditis resulting in sustained ventricular tachycardia
Authors: Asad Mehak , Viswesvaraiah Rajavarma
Published: May 2021

We report a complex case of a 66-year-old female patient with a diagnosis of interstitial lung disease (ILD) that was later correctly identified as an antisynthetase syndrome. This was only diagnosed after an episode of sustained ventricular tachycardia secondary to myocarditis. In this case report, we focus on the clinical features of this rare autoimmune condition and aim to provide useful tips to both general medical professionals and cardiologists to achieve correct differential diagnosis according to the updated international guidelines and recommendations. Early diagnosis is especially important due to the possible arrhythmogenic complications and the high mortality and morbidity associated with ILD and cardiac abnormalities.
Anti-VEGF-resistant subretinal fluid is associated with better vision and reduced risk of macular atrophy
Authors: Zarbin Marco A , Hill Lauren , Maunz Andreas , Gliem Martin , Stoilov Ivaylo
Published: May 2021

Background/aim

To evaluate relationships between subretinal fluid (SRF), macular atrophy (MA) and visual outcomes in ranibizumab-treated neovascular age-related macular degeneration (nAMD).

Methods

This post hoc HARBOR trial (NCT00891735) analysis included ranibizumab-treated (0.5 or 2.0 mg, monthly or as-needed, all treatment arms pooled) eyes with nAMD and baseline (screening, baseline and week 1) SRF. SRF presence, SRF thickness (0, >0–50, >50–100 and >100 µm) and subretinal fluid volume (SRFV) were determined by spectral domain optical coherence tomography (SD-OCT). Best-corrected visual acuity (BCVA) was assessed. MA was identified using fluorescein angiograms and colour fundus photographs, as well as SD-OCT.

Results

Seven hundred eighty-five of 1097 eyes met analysis criteria. In eyes without baseline MA, residual versus no SRF at month (M) 3 was associated with lower MA rates at M12 (5.1% vs 22.1%) and M24 (13.3% vs 31.2%) (both p<0.0001); MA percentages at M12/M24 were similar among patients with residual SRF at M6. Higher baseline SRFV was associated with a lower MA rate. Greater mean BCVA was observed with residual SRF of any thickness (>0–50 µm, 71.2 letters; >50–100 µm, 71.3 letters; >100 µm, 69.2 letters) versus no SRF (63.6 letters), but the change in BCVA from baseline to M12 or M24 was the same for eyes with or without treatment-resistant subretinal fluid (TR-SRF) at M3 or M6.

Conclusion

TR-SRF was not detrimental to vision outcomes over 2 years, regardless of thickness. MA rates were significantly higher without TR-SRF.
Preparation for the next major incident: are we ready? Comparing major trauma centres and other hospitals
Authors: Mawhinney Jamie A , Roscoe Henry W , Stannard George A J , Tillman Sophie R , Freemantle Nick , Cosker Thomas D
Published: May 2021

Objectives

A major incident is any emergency requiring special arrangements by the emergency services. All hospitals are required by law to keep a major incident plan (MIP) detailing the response to such events. In 2006 and 2019, we assessed the preparedness and knowledge of key individuals in hospitals across England and found a substantial gap in responding to the MIP. In this report, we compare responses from doctors at major trauma centres (MTCs) and other hospitals (non-MTCs).

Methods

We identified trusts in England that received over 30 000 patients through the ED in the fourth quarter of 2016/2017. We contacted the on-call anaesthetic, emergency, general surgery and trauma and orthopaedic registrar at each location and asked three questions assessing their confidence in using their hospital’s MIP: (1) Have you read your hospital’s MIP? (2) Do you know where you can access your hospital’s MIP guidelines? (3) Do you know what role you would play if an MIP came into effect while you are on call?

We compared data from MTCs and non-MTCs using multinomial mixed proportional odds models.

Results

There was a modest difference between responses from individuals at MTCs and non-MTCs for question 2 (OR=2.43, CI=1.03 to 5.73, p=0.04) but no evidence of a difference between question 1 (OR=1.41, CI=0.55 to 3.63, p=0.47) and question 3 (OR=1.78, CI=0.86 to 3.69, p=0.12). Emergency medicine and anaesthetic registrars showed significantly higher preparedness and knowledge across all domains. No evidence of a systematic difference in specialty response by MTC or otherwise was identified.

Conclusions

Confidence in using MIPs among specialty registrars in England remains low. Doctors at MTCs tended to be better prepared and more knowledgeable, but this effect was only marginally significant. We make several recommendations to improve education on major incidents.
Needs assessment of resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with major haemorrhage: a cross-sectional study
Authors: Godø Bård Neuenkirchen , Brede Jostein Rodseth , Krüger Andreas Jorstad
Published: May 2021

Background

Resuscitative endovascular balloon occlusion of the aorta (REBOA) can be used as an adjunct treatment in traumatic abdominopelvic haemorrhage, ruptured abdominal aortic aneurysms, postpartum haemorrhage (PPH), gastrointestinal bleeding and iatrogenic injuries during surgery. This needs assessment study aims to determine the number of patients eligible for REBOA in a typical Norwegian population.

Methods

This was a retrospective cross-sectional study based on data obtained from blood bank registries and the Norwegian Trauma Registry for the years 2017–2018. Patients who received ≥4 units of packed red blood cells (PRBCs) within 6 hours and met the anatomical criteria for REBOA or patients with relevant Abbreviated Injury Scale codes with concurrent hypotension or transfusion of ≥4 units of PRBCs within 6 hours were identified. A detailed two-step chart review was performed to identify potentially eligible REBOA candidates. Descriptive data were collected and compared between subgroups using non-parametric tests for statistical significance.

Results

Of 804 patients eligible for inclusion, 53 patients were regarded as potentially REBOA eligible (corresponding to 5.7 per 100 000 adult population/year). Of these, 19 actually received REBOA. Among the identified eligible patients, 44 (83%) had a non-traumatic aetiology. Forty-two patients (79%) were treated at a tertiary care hospital. Fourteen (78%) of the REBOA procedures were due to PPH.

Conclusion

The number of patients potentially eligible for REBOA after haemorrhage is low, and most cases are non-traumatic. Most patients were treated at a tertiary care hospital. The exclusion of non-traumatic patients results in a substantial underestimation of the number of potentially REBOA-eligible patients.
Statistics: an introduction to basic principles
Authors: Welsby Philip D , Weatherall Mark
Published: May 2021

The essential principles of statistics as applied to surveys, studies, sampling, epidemiology, screening, and trials are described and explained.
Safety and tolerability of subcutaneous trastuzumab and intravenous pertuzumab as adjuvant treatment for HER2 positive breast cancer: a pilot study
Authors: Wong Chi Yan , Leung Roland , Kwok Gin Wai , Tsang Josephine , Li Bryan , Yau Thomas , Chiu Joanne
Published: May 2021

Background

Subcutaneous (SC) trastuzumab is similar to intravenous trastuzumab in terms of pharmacokinetics, efficacy and tolerability. The use of dual anti-HER2 agents trastuzumab and pertuzumab has become the new standard for node-positive HER2-positive breast cancers at adjuvant setting, but the safety and tolerability of combining SC trastuzumab and intravenous pertuzumab is not well studied.

Methods

This was a prospective single-arm pilot study with locally advanced HER2-positive breast cancer who received adjuvant SC trastuzumab and intravenous pertuzumab after standard anti-HER2 treatment with chemotherapy. Primary outcomes included adverse events (AEs), severe AEs and cardiac AEs. Secondary outcome was invasive disease-free survival (iDFS).

Results

With a median follow-up of 21.7 months, 20 patients were enrolled. One patient (5%) developed asymptomatic drop in left ventricular ejection fraction from 69% to 53%. Two patients (10%) developed grade 1 injection site reaction related to SC trastuzumab. There were no grade 2 or above AEs. All AEs were transient. No new AEs were observed. The 1-year iDFS was 90% (95% CI 0.656 to 0.974)

Conclusions

Combination of SC trastuzumab and intravenous pertuzumab for HER2-positive breast cancer is a safe and well-tolerated option in adjuvant setting.
Systematic identification and replication of factors associated with human papillomavirus vaccine initiation among adolescents in the United States using an environment-wide association study approach
Authors: Nasserie Tahmina , Bendavid Eran
Published: May 2021

Objective

Human papillomavirus (HPV) vaccination coverage is low among adolescents in the USA. Identification of factors associated with HPV vaccine initiation (receipt of ≥1 dose) is critical for improving uptake. Our objective was to systematically investigate all eligible factors available in a nationally representative sample of adolescents to identify drivers of HPV vaccine initiation using a novel methodological approach.

Methods

We performed multiple cross-sectional analyses using data from the adolescent component of the National Immunization Surveys (NIS)-Teen between 2014 and 2019. Study participants were parents or caregivers of adolescents aged 13–17 years. Exposure variables measured sociodemographic and geographical characteristics, health conditions and healthcare provision. We tested the association between each factor and HPV vaccine initiation using univariate logistic regression and multivariate logistic regression adjusted for mother’s age, mother’s education level, mother’s marital status, poverty status and adolescent’s sex. We validated findings for each type of analysis within surveys, between surveys (across years 2014–2019) and across several subgroups (age, sex, poverty status and race/ethnicity).

Results

Six factors were replicated in the multivariate analysis. Most replicated factors characterised the role of healthcare providers and healthcare-seeking behaviours. After adjustment, provider HPV recommendation remained the most strongly associated with HPV vaccine initiation (2019 NIS-Teen: OR 13.4, 95% CI 11.3 to 17.3, p<0.001). The variance explained by a full model including replicated factors was 0.39.

Conclusions

This is the first study to explore the association between all available factors in the NIS-Teen and HPV vaccine initiation in a systematic manner. Our study suggests that healthcare-seeking behaviours and interactions with the health system may be drivers of HPV vaccine initiation and warrant further study. Addressing these factors could improve the rate of HPV vaccine initiation among adolescents in the USA.
Three-dimensional flux vacua from IIB on co-calibrated G2 orientifolds
Authors: Emelin Maxim , Farakos Fotis , Tringas George
Published: May 2021

We derive the 3D N = 1 superpotential for the closed string sector of type IIB supergravity on toroidal O5 orientifolds with co-calibrated G2 structure and RR background flux. We find that such compactifications can provide full closed string moduli stabilization on supersymmetric $$\hbox {AdS}_3$$

AdS
3

vacua, and once we include brane-supersymmetry-breaking we also find indication for the existence of classical 3D de Sitter solutions. The latter however are rather difficult to reconcile with the “shape” moduli stabilization and flux quantization. We also discuss the possibility of achieving scale separation in $$\hbox {AdS}_3$$

AdS
3

and $$\hbox {dS}_3$$

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vacua, but such effects seem to be hindered by the geometric flux quantization.
A conversation with Kashyap Tumkur
Authors: Anjum Bushra
Published: May 2021

Ubiquity's senior editor Dr. Bushra Anjum chats with Kashyap Tumkur, a software engineer at Verily Life Sciences, the healthcare and life sciences arm of Alphabet. They discuss how the notion of "precision medicine" has gained popularity in recent times. Next, the focus turns to Tumkur's work, where he, along with his team, is working on collecting and integrating continuous time-series data to create a map of human health.
Blood Vessel Segmentation of Fundus Retinal Images Based on Improved Frangi and Mathematical Morphology
Authors: Tian Feng , Li Ying , Wang Jing , Chen Wei
Published: May 2021

An improved blood vessel segmentation algorithm on the basis of traditional Frangi filtering and the mathematical morphological method was proposed to solve the low accuracy of automatic blood vessel segmentation of fundus retinal images and high complexity of algorithms. First, a global enhanced image was generated by using the contrast-limited adaptive histogram equalization algorithm of the retinal image. An improved Frangi Hessian model was constructed by introducing the scale equivalence factor and eigenvector direction angle of the Hessian matrix into the traditional Frangi filtering algorithm to enhance blood vessels of the global enhanced image. Next, noise interferences surrounding small blood vessels were eliminated through the improved mathematical morphological method. Then, blood vessels were segmented using the Otsu threshold method. The improved algorithm was tested by the public DRIVE and STARE data sets. According to the test results, the average segmentation accuracy, sensitivity, and specificity of retinal images in DRIVE and STARE are 95.54%, 69.42%, and 98.02% and 94.92%, 70.19%, and 97.71%, respectively. The improved algorithm achieved high average segmentation accuracy and low complexity while promising segmentation sensitivity. This improved algorithm can segment retinal vessels more accurately than other algorithms.
Early Changes in [18F]FDG Uptake as a Readout for PI3K/Akt/mTOR Targeted Drugs in HER-2-Positive Cancer Xenografts
Authors: Dockx Yanina , Vangestel Christel , Van den Wyngaert Tim , Huizing Manon , De Bruycker Sven , Pauwels Patrick , Staelens Steven , Stroobants Sigrid
Published: May 2021

We investigated the potential use of [18F]FDG PET as a response biomarker for PI3K pathway targeting therapies in two HER-2-overexpressing cancer models. Methods. CD-1 nude mice were inoculated with HER-2-overexpressing JIMT1 (trastuzumab-resistant) or SKOV3 (trastuzumab-sensitive) human cancer cells. Animals were treated with trastuzumab, everolimus (mTOR inhibitor), PIK90 (PI3K inhibitor), saline, or combination therapy. [18F]FDG scans were performed at baseline, two, and seven days after the start of the therapy. Tumors were delineated on CT images and relative tumor volumes (RTV) and maximum standardized uptake value (SUVmax) were calculated. Levels of pS6 and pAkt on protein tumor lysates were determined with ELISA. Results. In the SKOV3 xenografts, all treatment schedules resulted in a gradual decrease in RTV and delta SUVmax ( ΔSUVmax). For all treatments combined, ΔSUVmax after 2 days was predictive for RTV after 7 days ([Formula: see text], [Formula: see text]). In JIMT1 tumors, monotherapy with everolimus or PIK90 resulted in a decrease in RTV ([Formula: see text] and [Formula: see text], respectively) and ΔSUVmax ([Formula: see text] and [Formula: see text], respectively) after 7 days of treatment, but not earlier, while trastuzumab resulted in nonsignificant increases compared to control. Combination therapies resulted in RTV and ΔSUVmax decrease already at day 2, except for trastuzumab+everolimus, where an early flare was observed. For all treatments combined, ΔSUVmax after 2 days was predictive for RTV after 7 days ([Formula: see text], [Formula: see text]), but the correlation could be improved when combination with everolimus ([Formula: see text], [Formula: see text]) or trastuzumab ([Formula: see text], [Formula: see text]) was excluded. Conclusion. Reduction in [18F]FDG after 2 days correlated with tumor volume changes after 7 days of treatment and confirms the use of [18F]FDG PET as an early response biomarker. Treatment response can however be underestimated in schedules containing trastuzumab or everolimus due to temporary increased [18F]FDG uptake secondary to negative feedback loop and crosstalk between different pathways.
Challenges in Patients with Trisomy 21: A Review of Current Knowledge and Recommendations
Authors: Robinson Jennifer , Pompe Manca Tekavčič , Gerth-Kahlert Christina
Published: May 2021

Purpose. To summarize and review the common ophthalmic anomalies in children with trisomy 21 (Down syndrome) in order to propose an update to current clinical recommendations. Methods. A retrospective chart review, systemic literature review, and international survey of the frequency of ocular abnormalities, screening schedules, and challenging aspects examining children with trisomy 21. The chart review included patients treated at the Department of Ophthalmology at the University Hospital of Zurich over a two-year period. The international survey was submitted to the members of the Swiss Society of Ophthalmology, Slovenian Ophthalmological Society, and European Pediatric Ophthalmology Society. Results. Analysis of 52 patient records during the study period revealed refractive errors (astigmatism: 54% of patients, hyperopia: 26%, and myopia: 15%) as the most common diagnosis, whereas childhood cataract was reported in 5%. This is in concordance with the extended literature review of 249 publications, although congenital cataracts were reported to be higher than at our institution. The survey participants reported great challenges in taking care of these patients, despite their long professional experience (73% with over 10 years of experience). Conclusion. Care and treatment of children with trisomy 21 continues to be demanding for paediatric ophthalmologists. We recommend the following examination schedule for these patients: first, ophthalmological examination at 6–12 months of age, then once in 3–6 months for children under 2 years of age, once in 6 months for children 2–5 years of age, annually for children 5–10 years of age, and thereafter, to be decided on an individual basis depending on the presenting ocular abnormalities of the patient.
Smarandache Ruled Surfaces according to Darboux Frame in

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3
Authors: Ouarab Soukaina
Published: May 2021

This paper presents a new approach of constructing special ruled surfaces and aims to study their developability and minimalist conditions. Our concept opens opportunities for application in engineering, surface modeling, and architectural design. The principle of our study is to introduce the original definitions of Smarandache ruled surfaces according to Darboux frame of a curve lying on an arbitrary regular surface in

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. It concerns

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-Smarandache ruled surface,

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-smarandache ruled surface, and

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-Smarandache ruled surface. New theorems giving necessary and sufficient conditions for those surfaces to be developable and minimal are investigated. Finally, an example with illustrations is presented.
Key Algorithms for Segmentation of Copperplate Printing Image Based on Deep Learning
Authors: Zhang Ye , Xie Qiu , Zhang Canlin
Published: May 2021

As a branch of the field of machine learning, deep learning technology is abrupt in various computer vision tasks with its powerful functional learning functions. The deep learning method can extract the required features from the original data and dynamically adjust and update the parameters of the neural network through the backpropagation algorithm so as to achieve the purpose of automatically learning features. Compared with the method of extracting features manually, the recognition accuracy is improved, and it can be used for the segmentation of copperplate printing images. This article mainly introduces the research on the key algorithm of the copperplate printing image segmentation based on deep learning and intends to provide some ideas and directions for improving the copperplate printing image segmentation technology. This paper introduces the related principles, watershed algorithm, and guided filtering algorithm of copperplate printing image synthesis process and establishes an image segmentation model. As a result, a deep learning-based optimization algorithm mechanism for the segmentation of copper engraving printing images is proposed, and experimental steps such as main color extraction in the segmentation of copper engraving printing images, adaptive main color extraction based on fuzzy set 2, and main color extraction based on fuzzy set 2 are proposed. Experimental results show that the average processing time of each image segmentation model in this paper is 0.39 seconds, which is relatively short.
Assessing the impediments to e-learning utilization by higher institution students
Authors: Thomas Olutola Adekunle , Ademola Olatoye Rafiu , Omotoke Olatoye Olufunke
Published: May 2021

This study assessed the impediments to e-learning utilization by higher institution students in Katsina State, Nigeria. Survey type of descriptive research design was used in the study. There were 381 students randomly selected in four higher institutions. A questionnaire with test-retest reliability coefficient of 0.88 was used to gather data from the respondents. The researchers used Frequencies, percentages, means and t-test to analyze the data collected for the study. Findings revealed that all the fifteen impediments investigated in this study affect the e-learning utilization by higher institution students in Katsina State, Nigeria in varying degrees. The foremost factor is money to purchase e-learning resources followed by limited electricity supply. Moreover, significant difference was not found in the impediments to e-learning utilization by higher institution students on the basis of gender (t=-.796, Df=397, P0.05) but significant difference was found in the factors affecting the use of e-learning by students’ of Universities and Colleges of Education (t=-2.969, P0.05). It was recommended that all the identified impediments affecting the e-learning utilization by higher institution students in Katsina State, Nigeria should be addressed by the government.
A scrapbook of child stories as a media to improving the story-telling skill
Authors: Fellasufah Fetty , Mustadi Ali
Published: May 2021

This research aimed to determine the effect of scrapbook child stories as a media for storytelling skills for elementary school students. This type of research was a quasi-experimental quantitative study with a pretest-posttest group design. The population of this research was second grade elementary school students of Candimulyo sub-district, involving two classes as the control class and the experimental class. The test results were then analyzed using the prerequisite test and hypothesis testing. The prerequisite test consists of the normality test using the Kolmogorov Smirnov test and the homogeneity test using the One Way Anova. Hypothesis testing using t-test with independent sample t-test. The results of the analysis were then tested using a significance level of 0.05. The results of this result showed that the control class and the experimental class had a normal and homogeneous distribution. The t-test results showed a significance level 0.05. It means that there was a significant effect of scrapbook child stories to improve storytelling skills.