bluuebunny/crossref_metadata_2025 huggingface dataset:
May Measurement Month 2018: an analysis of blood pressure screening results in South Africa
Authors: Woodiwiss Angela J , Kruger Ruan , Norton Gavin R , Schutte Aletta E , Myburgh Caitlynd , Nkeh-Chungag Benedicta , Sewani-Rusike Constance R , Vally Muhammed , Jones Erika , Peterson Vernice , Marsh Justin , Gafane-Matemane Lebo F , Ahiante Blessing O , Phalane Edith , Beaney Thomas , Chis Ster Anca , Xia Xin , Poulter Neil R
Published: August 2020

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative of the International Society of Hypertension (ISH) aimed at raising awareness of high BP and acting as a temporary solution to the lack of screening programmes worldwide. As part of MMM, screening in South Africa in 2017 revealed that 24.5% of adults (mean age = 31 years) have hypertension and only half of those with hypertension had controlled BP. These data highlight the need for continued screening and awareness campaigns. An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May 2018. Blood pressure measurements, the definition of hypertension and statistical analyses followed the MMM protocol. The sites screened were general populations and university campuses in preference to hospitals and clinics, aiming to raise awareness and allow access to screening to those less likely to be aware of their BP. In total, 2965 individuals (age 40.5 ± 18.2 years) were screened. After multiple imputation for missing BP readings, 34.6% had hypertension, only 56.7% of those with hypertension were aware, 21.2% of those not receiving treatment for hypertension were hypertensive, and a large proportion (42.5%) of individuals receiving antihypertensive medication had uncontrolled BP. These results suggest that opportunistic screening campaigns can identify significant numbers with undiagnosed and uncontrolled hypertension. The high proportions of individuals with undiagnosed and treated uncontrolled hypertension highlight the need for hypertension awareness campaigns and more rigorous management of hypertension.
May Measurement Month 2018: an analysis of blood pressure screening results from Spain
Authors: Rodilla Enrique , Molinero Ana , Gijón-Conde Teresa , Tous Salvador , Fornós José A , Mera Inés , Martínez Fernando , Carreras Blanca , de Berardinis Bettina , Beaney Thomas , Ster Anca Chis , Poulter Neil R , Xia Xin , Ruilope Luis M
Published: August 2020

Elevated blood pressure (BP) is the single most important contributing risk factor to the global disease burden, leading to over 10 million deaths each year. In Spain, hypertension (HTN) affects around 20% of the adult population and remains the greatest attributable cause of cardiovascular mortality. May Measurement Month (MMM) is a worldwide initiative aimed at increasing awareness of HTN and to improve the lack of screening programmes worldwide. An opportunistic cross-sectional survey of volunteers aged 18 and over was carried out in May 2018. Blood pressure measurement, the definition of HTN and statistical analysis followed the standard MMM protocol. Anthropometric data and responses to questionnaires on demographic, lifestyle, and environmental factors were obtained as additional information. Screening sites mainly in community pharmacies, universities, primary care centres, HTN units, and cardiovascular departments in hospitals were set up across Spain as part of this initiative. In total, 7646 individuals (63.5% female) were screened during MMM18. After multiple imputation, 40.0% had HTN, of whom 74.4% were aware of their diagnosis and 69.6% were taking antihypertensive medication. Of individuals not receiving antihypertensive medication, 16.9% were hypertensive. Of individuals receiving antihypertensive medication, 36.4% had uncontrolled BP. MMM18 almost doubled the number of participants of MMM17 and was the largest BP screening campaign ever undertaken in Spain, showing that in the absence of systematic screening programmes for HTN, MMM can identify a great number of individuals at risk, increasing their awareness and attracting the interest of the healthcare system in Spain.
Does High-Frequency Chest Wall Oscillation Have an Impact on Improving Pulmonary Function in Patients With Smoke Inhalation Injury?
Authors: Allam Nesma M , Badawy Manar M
Published: August 2020

Smoke inhalation results in bronchospasm of the trachea, increasing secretion of mucus, casts formation, and improvement of blood flow of the airway. High frequency chest wall oscillation is a common modality used for clearing mucus secretion in patients suffering from hypersecretion of thick mucus and used also to help cough clearance. This study aimed to detect the effect of high frequency chest wall oscillation in improving pulmonary function in burn patients suffering from smoke inhalation. Sixty smoke inhalation injury patients were randomly distributed into two groups of equal size. Group A: received high frequency chest wall oscillation and conventional chest physical therapy (breathing exercises, early ambulation, and cough training) thrice per week for 8 weeks. Group B: received traditional chest physical therapy (breathing exercises, early ambulation, and cough training) thrice per week for 8 weeks. Pulmonary function test (forced vital capacity, forced expiratory volume in the first second and peak expiratory flow rate) was measured at enrollment and after 8 weeks by using spirometer. Pulmonary function increased significantly posttreatment when compared with that pretreatment in groups A and B (P > .001). Also, they increased significantly in group A compared with that of group B posttreatment (P > .05). High-frequency chest wall oscillation have an impact on improving pulmonary function and should be handled to be a part of the pulmonary rehabilitation plan for smoke inhalation injury patients.
Comparative Trends in the Distribution of Lung Cancer Stage at Diagnosis in the Department of Defense Cancer Registry and the Surveillance, Epidemiology, and End Results data, 1989–2012
Authors: Nations Joel A , Brown Derek W , Shao Stephanie , Shriver Craig D , Zhu Kangmin
Published: August 2020

Introduction

We compared the stage at diagnosis for non-small cell lung cancer (NSCLC) patients in the military healthcare system (MHS) and the general public to assess differences between these two groups as well as to assess the trends in stage at diagnosis in the recent past.

Method

This study was based on the non-identifiable data from the U.S. Department of Defense Automated Central Tumor Registry (ACTUR) and the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute. Patients diagnosed with NSCLC between 1989 and 2012 were included. The distributions of tumor stage at diagnosis and trends in tumor stage were compared between the two populations.

Results

The cohorts were predominately male in both ACTUR (65.3%) and SEER (55.1%) and white patients accounted for greater than 80% of patients in both ACTUR and SEER. Among 21,031 patients in ACTUR and 773,356 patients in SEER, stage IV lung cancers predominated (ACTUR 33.6%, SEER 40.5%) followed by stage III (ACTUR 26.1%, SEER 26.4%) and stage I (ACTUR 24.7%, SEER 20.6%). Notable differences between the two populations were the higher percentage of stage I and lower percentage of stage IV, along with a lower rate of unknown stage patients after 2004, in ACTUR than SEER. Between 1989 and 2012, the percentage of stage IV disease increased in ACTUR and SEER coincident with a decrease in unknown stage disease.

Conclusions

The majority of NSCLC patients in the MHS and general population are diagnosed with stage IV NSCLC and the percentage is increasing. Compared to the general population, NSCLC patients in the MHS have a higher percentage of stage I, a lower percentage of stage IV, and of unknown stage cancer. Universal care along with more rigorous staging across the MHS may play a role in these findings.
A Dynamic Response to Exposures of Health Care Workers to Newly Diagnosed COVID-19 Patients or Hospital Personnel, in Order to Minimize Cross-Transmission and the Need for Suspension From Work During the Outbreak
Authors: Schwartz Carmela , Oster Yonatan , Slama Carole , Benenson Shmuel ,   Hadassah COVID-19 Investigations Working Group, Cohen Adiel , Favor Ayelet , Gross Ilana , Luski Shahar , Ottolenghi Miriam , Parnasa Elchanan , Reichman Nechamat , Ronen Naama , Zeidel Einat
Published: August 2020

Background

During the coronavirus disease (COVID-19) epidemic, many health care workers (HCWs) have been exposed to infected persons, leading to suspension from work. We describe a dynamic response to exposures of HCWs at Hadassah Hospital, Jerusalem, to minimize the need for suspension from work.

Methods

We performed an epidemiological investigation following each exposure to a newly diagnosed COVID-19 patient or HCW; close contacts were suspended from work. During the course of the epidemic, we adjusted our isolation criteria according to the timing of exposure related to symptom onset, use of personal protective equipment, and duration of exposure. In parallel, we introduced universal masking and performed periodic severe acute respiratory syndrome coronavirus 2 screening for all hospital personnel. We analyzed the number of HCWs suspended weekly from work and those who subsequently acquired infection.

Results

In the 51 investigations conducted during March–May 2020, we interviewed 1095 HCWs and suspended 400 (37%) from work, most of them, 251 (63%), during the first 2 weeks of the outbreak. The median duration of exposure (interquartile range) was 30 (15–120) minutes. Only 5/400 (1.3%) developed infection, all in the first 2 weeks of the epidemic. After introduction of universal masking and despite loosening the isolation criteria, none of the exposed HCWs developed COVID-19.

Conclusions

Relatively short exposures of HCWs, even if only either the worker or the patient wears a mask, probably pose a very low risk for infection. This allowed us to perform strict follow-up of exposed HCWs in these exposures, combined with repeated testing, instead of suspension from work.
Considerations for the Selection and Use of Disinfectants Against SARS-CoV-2 in a Health Care Setting
Authors: Tyan Kevin , Levin Adriane , Avalos-Pacheco Alejandra , Plana Deborah , Rand Eleanor A , Yang Helen , Maliszewski Laura E , Chylek Lily A , Atta Lyla , Tye Mark A , Carmack Mary M , Oglesby N Synclaire , Burgin Susan , Yu Sherry H , LeBoeuf Nicole R , Kemp Jacqueline M
Published: August 2020

Proper disinfection using adequate disinfecting agents will be necessary for infection control strategies against coronavirus disease 2019 (COVID-19). However, limited guidance exists on effective surface disinfectants or best practices for their use against severe acute respiratory coronavirus 2. We outlined a process of fully characterizing over 350 products on the Environmental Protection Agency List N, including pH, method of delivery, indication for equipment sterilization, and purchase availability. We then developed a streamlined set of guidelines to help rapidly evaluate and select suitable disinfectants from List N, including practicality, efficacy, safety, and cost/availability. This resource guides the evaluation of ideal disinfectants amidst practical considerations posed by the COVID-19 pandemic.
The Smith-Robinson Approach to the Subaxial Cervical Spine: A Stepwise Microsurgical Technique Using Volumetric Models From Anatomic Dissections
Authors: Vigo Vera , Pastor-Escartín Félix , Doniz-Gonzalez Ayoze , Quilis-Quesada Vicent , Capilla-Guasch Pau , González-Darder José Manuel , De Bonis Pasquale , Fernandez-Miranda Juan Carlos
Published: August 2020

BACKGROUND

The Smith-Robinson
1
approach (SRA) is the most widely used route to access the anterior cervical spine. Although several authors have described this approach, there is a lack of the stepwise anatomic description of this operative technique. With the advent of new technologies in neuroanatomy education, such as volumetric models (VMs), the understanding of the spatial relation of the different neurovascular structures can be simplified.

OBJECTIVE

To describe the anatomy of the SRA through the creation of VMs of anatomic dissections.

METHODS

A total of 4 postmortem heads and a cervical replica were used to perform and record the SRA approach to the C4-C5 level. The most relevant steps and anatomy of the SRA were recorded using photogrammetry to construct VM.

RESULTS

The SRA was divided into 6 major steps: positioning, incision of the skin, platysma, and muscle dissection with and without submandibular gland eversion and after microdiscectomy with cage positioning. Anatomic model of the cervical spine and anterior neck multilayer dissection was also integrated to improve the spatial relation of the different structures.

CONCLUSION

In this study, we review the different steps of the classic SRA and its variations to different cervical levels. The VMs presented allow clear visualization of the 360-degree anatomy of this approach. This new way of representing surgical anatomy can be valuable resources for education and surgical planning.
Improved the biocompatibility of cancellous bone with compound physicochemical decellularization process
Authors: Ling You , Xu Weikang , Yang Lifeng , Liang Changyan , Xu Bin
Published: August 2020

Due to the unique microstructures and components of extracellular matrix (ECM), decellularized scaffolds had been used widely in clinical. The reaction of the host toward decellularized scaffolds depends on their biocompatibility, which should be satisfied before applied in clinical. The aim of this study is to develop a decellularized xenograft material with good biocompatibility for further bone repair, in an effective and gentle method. The existing chemical and physical decellularization techniques including ethylene diamine tetraacetic acid (EDTA), sodium dodecyl sulfate (SDS) and supercritical carbon dioxide (SC-CO2) were combined and modified to decellularize bovine cancellous bone (CB). After decellularization, almost 100% of ɑ-Gal epitopes were removed, the combination of collagen, calcium and phosphate was reserved. The direct and indirect contact with macrophages was used to evaluate the cytotoxicity and immunological response of the materials. Mesenchymal stem cells (MSCs) were used in the in vitro cells’ proliferation assay. The decellularized CB was proved has no cytotoxicity (grade 1) and no immunological response (NO, IL-2, IL-6 and TNF-α secretion inhibited), and could support MSCs proliferated continuedly. These results were similar to that of commercial decellularized human bone. This study suggests the potential of using this kind of combine decellularization process to fabricate heterogeneous ECM scaffolds for clinical application.
Integrated transcriptomic and proteomic study on the different molecular mechanisms of PC12 cell growth on chitosan and collagen/chitosan films
Authors: Lü Xiaoying , Huang Yan , Qu Yayun , Zhang Yiwen , Zhang Zequn
Published: August 2020

The purpose of this article is to integrate the transcriptomic analysis and the proteomic profiles and to reveal and compare the different molecular mechanisms of PC12 cell growth on the surface of chitosan films and collagen/chitosan films. First, the chitosan films and the collagen/chitosan films were prepared. Subsequently, the cell viability assay was performed; the cell viability of the PC12 cells cultured on the collagen/chitosan films for 24 h was significantly higher than that on the chitosan films. Then, with cDNA microarray, the numbers of differentially expressed genes of PC12 cells on the surface of chitosan and collagen/chitosan films were 13349 and 5165, respectively. Next, the biological pathway analysis indicated that the differentially expressed genes were involved in 40 pathways directly related to cell adhesion and growth. The integrated transcriptomic and our previous proteomic analysis revealed that three biological pathways—extracellular matrix–receptor interaction, focal adhesion and regulation of actin cytoskeleton—were regulated in the processes of protein adsorption, cell adhesion and growth. The adsorbed proteins on the material surfaces further influenced the expression of important downstream genes by regulating the expression of related receptor genes in these three pathways. In comparison, chitosan films had a strong inhibitory effect on PC12 cell adhesion and growth, resulting in the significantly lower cell viability on its surface; on the contrary, collagen/chitosan films were more conducive to promoting PC12 cell adhesion and growth, resulting in higher cell viability.
Exploration of key traction-running equipment and its problems on heavy-haul trains and research on technology development
Authors: Chen Chunyang , Li Wei , Liu Youmei , Wei Xiang
Published: August 2020

In recent years, heavy-haul train technology has seen a number of innovations worldwide, and train traction-running technology has also made great progress, resulting in a rich pool of experience and a range of promising applications. This paper summarizes the key technologies of traction running in heavy-haul combined trains, especially locomotive and rolling-stock technology, traction technology, braking technology, control technology, communication technology and safety technology. At the same time, based on an analysis of practical applications, this paper further explores the main problems and urgent needs of traction equipment on heavy-haul trains. With an eye to the future, the heavy-haul railway system will develop in the direction of informatization, automation and intelligence, in order to build a greener, more energy-saving, safer and more efficient railway. This paper therefore looks forward to the technical developments of heavy-haul combined trains, and provides a reference for the development of heavy-haul railways.
XII Literature 1780–1830: The Romantic Period
Authors: Coffey Bysshe Inigo , Davies Colette , Hawley-sibbett Ruby , Falk Michael , Greig Elias , Kiek Miranda
Published: August 2020

This chapter has four sections: 1. General and Prose; 2. The Novel; 3. Poetry; 4. Drama. Section 1 is by Bysshe Inigo Coffey; section 2 is by Colette Davies and Ruby Hawley-Sibbett; section 3 is by Michael Falk and Elias Greig; section 4 is by Miranda Kiek.
Genomic Sequence Resource of Alternaria alternata Strain B3 Causing Leaf Blight on Ophiopogon japonicus
Authors: Wang Mingshuang , Hou Xin , Wang Huizhong
Published: August 2020

Black spot of Ophiopogon japonicus is an economically important disease, which can result in significant losses of both yield and quality of this traditional Chinese medicinal plant. The disease is caused by the small-spored fungal pathogen Alternaria alternata, a necrotrophic fungus that is ubiquitously distributed in the environment. Here, we present the draft whole-genome sequence of A. alternata strain B3 that caused black spot on O. japonicus. The assembly consists of 76 contigs with an estimated genome size of 33.8 Mb. Furthermore, we identified genes that may be associated with the pathogenicity, such as carbohydrate-active enzymes, secreted proteins, and secondary metabolite gene clusters. This genome resource will provide a useful source for future research on the evolution of pathogenicity of A. alternata and phylogenomic analysis in delineating phylogenetic lineages within the genus Alternaria.
Surgical Intervention for Patients With Spinal Metastasis From Lung Cancer
Authors: Truong Van Tri , Shedid Daniel , Al-Shakfa Fidaa , Hattou Lotfi , Shen Jesse , Boubez Ghassan , Yuh Sung-Joo , Wang Zhi
Published: August 2020

Study Design:

This was a retrospective study.

Objective:

Evaluate the prognosis and surgical outcomes of patients with spinal metastasis from lung cancer undergoing surgical treatment.

Summary of Background Data:

The spine is the most common site of metastatic lesions in patients with lung cancer. There have been a few studies, all small cohorts studying prognosis and surgical outcomes and the results were discordant.

Materials and Methods:

A retrospective study on a prospectively collected database was conducted. Data collected were the following: age, tobacco use, tumor histology, American Spinal Injury Association score, revised Tokuhashi score, ambulatory status, perioperative complications, postoperative adjuvant treatment, and survival time. Univariate and multivariate analyses were performed to identify the prognostic factors of survival.

Results:

The authors studied 87 patients with a mean age of 61.3±1.9 years. Median survival was 4.1±0.8 months. Twenty-eight patients (32.2%) lived >6 months and 14 patients (16.1%) lived >12 months. The medical complication rate was 13.8% and the surgical complication rate was 5.7%. The 30-day mortality rate was 4.6%. Univariate analysis showed tobacco use, revised Tokuhashi score, preoperative and postoperative American Spinal Injury Association score, postoperative walking ability, postoperative radiotherapy, and postoperative chemotherapy were prognostic factors. There was no significant difference in survival between adenoma lung cancers, nonadenoma lung cancers, and small cell lung cancers (P=0.51). Multivariate analysis revealed tobacco use, revised Tokuhashi score, postoperative walking ability, postoperative radiotherapy, and postoperative chemotherapy affected the survival.

Conclusions:

This is the largest reported study of patients with spinal metastasis from lung cancer undergoing spinal surgery. It is the first study showing that tobacco use has a negative impact on survival. Spinal surgery improves the quality of life and offers nonambulatory patients a high chance of regaining walking ability with an acceptable risk of complications.
The role of adrenal venous sampling and computed tomography in the management of primary aldosteronism
Authors: Ma Delin , Liu Xiaming , Zeng Liwen , Yuan Penghui , Liu Zheng , Xie Junhui , Yuan Gang , Wang Shaogang , Yu Xuefeng , Yang Yan , Xu Anhui
Published: August 2020

Background:

The role of adrenal venous sampling (AVS) has been challenged by some recent evidence. This study aimed to compare the role of AVS and computed tomography (CT) in the management of primary aldosteronism.

Methods:

Patients who underwent unilateral adrenalectomy for primary aldosteronism at a single center between January 2015 and December 2018 were included, and postoperative outcomes of the patients who underwent surgery based on CT (n = 195) or AVS (n = 40) were compared. The data of all the patients who underwent AVS successfully (n = 75) during this period were also collected and analyzed.

Results:

There were no significant differences between the CT-guided and AVS-guided adrenalectomies in most of the postoperative outcomes, and the proportion of patients achieving cure of hypokalemia (CT vs. AVS, 98.3 vs. 96.4%) and alleviation of hypertension (89.2 vs. 92.9%) were similar between the two groups. However, since the baseline characteristics of the two groups were not identical, the AVS-guided group showed greater improvement in postoperative hypokalemia and greater reduction in the number of antihypertensive medications than the CT-guided group. In addition, for the 75 patients who underwent AVS successfully, the concordance rate between CT abnormalities and AVS lateralization was 60.0% in total, and 22.7% patients changed treatment plans according to the AVS results.

Conclusion:

Although the clinical outcomes were not significantly different between the CT-guided and AVS-guided group, the AVS-guided group seemed to benefit more from the surgery, and a considerable number of patients with primary aldosteronism would have received inappropriate treatment if they did not undergo AVS.
Neuroinflammatory Biomarkers Associated With Mild Traumatic Brain Injury History in Special Operations Forces Combat Soldiers
Authors: Powell Jacob R. , Boltz Adrian J. , DeCicco Jamie P. , Chandran Avinash , DeLellis Stephen M. , Healy Marshall L. , Kane Shawn F. , Lynch James H. , Means Gary E. , Hackney Anthony C. , Mihalik Jason P.
Published: August 2020

Background:

Special Operations Forces (SOF) combat soldiers are frequently exposed to blast and blunt neurotrauma, most often classified as mild traumatic brain injury (mTBI). Repetitive mTBI may increase the risk of developing long-term neurological sequelae. Identifying changes in neuroinflammatory biomarkers before chronic conditions emerge could serve as preliminary evidence of developing neuropathology.

Objective:

To determine the effects of mTBI history, lifetime mTBI incidence, and recency on blood biomarker concentrations of axonal protein neurofilament light (NfL), glycolytic enzyme neuron-specific enolase (NSE), astrocyte-expressed S100 calcium-binding protein B (S100B), and neurotrophic cytokine interleukin-6 (IL-6) in healthy, active duty SOF combat soldiers.

Methods:

Self-reported mTBI history/recency and fasted blood samples were collected in this cross-sectional study of 104 asymptomatic SOF combat soldiers. Biomarker concentrations were quantified using commercial enzyme-linked immunosorbent assays. Mann-Whitney U and Kruskal-Wallis tests were used to compare groups. Post hoc tests with appropriate corrections were conducted as warranted.

Results:

Soldiers with mTBI history had higher NSE concentrations than those without (z = −2.60, P = .01). We also observed significant main effects of lifetime mTBI incidence on NSE (χ2(3) = 9.52, P = .02) and S100B (χ2(3) = 8.21, P = .04) concentrations and a significant main effect of mTBI recency on NfL concentration (χ2(2) = 6.02, P = .049).

Conclusion:

The SOF combat soldiers with mTBI history had increased NSE. Longitudinal studies in this population are needed due to between-subject heterogeneity in biomarker concentrations. The NfL concentrations in our SOF combat soldiers—regardless of mTBI history or recency—were similar to values previously reported in civilian acute TBI patients.
Segmental Atrophy of Explanted Livers in Biliary Atresia
Authors: Santo Kenji , Nakano Noriyuki , Kasahara Mureo , Sakamoto Seisuke , Fukuda Akinari , Kanamori Yutaka , Fujino Akihiro , Horiike Masaki , Shibata Toshihiko , Muraji Toshihiro , Yoshioka Takako
Published: August 2020

Objectives:

Atrophy of the left lateral segment (LLS) is often encountered in liver transplantation (LT) for biliary atresia (BA). To clarify the meaning of the heterogeneous atrophy, we compared the pathological characteristics of the LLS with the right posterior segment (RPS) of BA livers obtained during LT.

Methods:

Among the 116 patients with BA who underwent LT at our hospital between 2014 and 2018, 63 patients with persistent cholestasis after the Kasai portoenterostomy (KP) were selected. Three pathologists evaluated tissues from the LLS and RPS for 5 pathological parameters. Positive areas in whole‐slide image observed as portal inflammation, fibrosis, cholestasis, and ductular reaction, were analyzed with automated image quantitation. Moreover, we examined the relationship between the pathological score and the Pediatric End‐stage Liver Disease (PELD) score.

Results:

The median age at LT was 7 months (range 4–26 months). Inflammation and fibrosis were significantly greater in the LLS than in the RPS (P < 0.001, for both); however, there were no differences in cholestasis, ductular reaction, and hepatocellular damage (P = 0.3, 0.3, and 0.82). The same results were obtained in automated image quantitation. Moreover, the sums of the 5 pathological scores in the LLS showed a significant positive correlation with the PELD score (P = 0.016, rs = 0.3).

Conclusions:

More severe inflammation and fibrosis without cholestasis were observed in the LLS. The segmental atrophy may not be associated with poor bile drainage, but with etiopathogenesis of BA. Moreover, the proper site for biopsy during KP could be the LLS.
Impact of an Educational Program on Nurses' Performance in Providing Peripherally Inserted Central Catheter Care for Neonates
Authors: Emamgholi Somayeh , Khanjari Sedigheh , Haghani Hamid
Published: August 2020

All nurses who care for neonates with peripherally inserted central catheters require enhanced awareness of the current practice guidelines and standards. This study evaluated the impact of an educational program on nurses' performance from May 2016 to July 2017 at 4 hospitals in Tehran, Iran. The performance of 80 nurses was observed and scored 3 times before the intervention. Four weeks after the last training session, their performance was observed with the same researcher, and the checklist was completed 3 times in different working shifts. Four 35- to 45-minute training sessions were completed with a 4-week follow-up. Results of the study indicated that training courses should be held every 6 months, including permanent or periodic feedback.
Advanced Practice Provider–Led Strategies to Improve Patient Discharge Timeliness
Authors: Younger Samuel J.
Published: August 2020

Hospitals are under increased pressure to address both financial and capacity constraints to improve their clinical operations. Effective capacity management programs have become a key driver of clinical operations for managing the flow of patients into and out of the hospital. Many high-functioning medical centers have developed capacity management programs to strategically address patient throughput. Discharging patients from the hospital is one fundamental, but complex, patient flow initiative for efficient patient throughput. Despite advances in optimizing patient flow, there is a lack of understanding associated with the structure and processes to efficiently discharge patients. This article outlines a discharge timeliness project where advanced practice providers are principal leaders of designing a safe and efficient patient discharge prototype. Design thinking was used to develop a patient discharge prototype that included 6 key areas that led to improved discharge times on a cardiac surgery step-down unit. High tech solutions were incorporated into the electronic medical record system to enhance communication across phases of care and inform the interdisciplinary team of patient progress.
Artificial Intelligence Forecasting Census and Supporting Early Decisions
Authors: Griner Todd E. , Thompson Michael , High Heidi , Buckles Jenny
Published: August 2020

Matching resources to demand is a daily challenge for hospital leadership. In interdisciplinary collaboration, nurse leaders and data scientists collaborated to develop advanced machine learning to support early proactive decisions to improve ability to accommodate demand. When hundreds or even thousands of forecasts are made, it becomes important to let machines do the hard work of mathematical pattern recognition, while efficiently using human feedback to address performance and accuracy problems. Nurse leaders and data scientists collaborated to create a usable, low-error predictive model to let machines do the hard work of pattern recognition and model evaluation, while efficiently using nurse leader domain expert feedback to address performance and accuracy problems. During the evaluation period, the overall census mean absolute percentage error was 3.7%. ALEx's predictions have become part of the team's operational norm, helping them anticipate and prepare for census fluctuations. This experience suggests that operational leaders empowered with effective predictive analytics can take decisive proactive staffing and capacity management choices. Predictive analytic information can also result in team learning and ensure safety and operational excellence is supported in all aspects of the organization.
Dynamics of organic matter and bacterial activity in the Fram Strait during summer and autumn
Authors: von Jackowski Anabel , Grosse Julia , Nöthig Eva-Maria , Engel Anja
Published: August 2020

The Arctic Ocean is considerably affected by the consequences of global warming, including more extreme seasonal fluctuations in the physical environment. So far, little is known about seasonality in Arctic marine ecosystems in particular microbial dynamics and cycling of organic matter. The limited characterization can be partially attributed to logistic difficulties of sampling in the Arctic Ocean beyond the summer season. Here, we investigated the distribution and composition of dissolved organic matter (DOM), gel particles and heterotrophic bacterial activity in the Fram Strait during summer and autumn. Our results revealed that phytoplankton biomass influenced the concentration and composition of semi-labile dissolved organic carbon (DOC), which strongly decreased from summer to autumn. The seasonal decrease in bioavailability of DOM appeared to be the dominant control on bacterial abundance and activity, while no temperature effect was determined. Additionally, there were clear differences in transparent exopolymer particles (TEP) and Coomassie Blue stainable particles (CSP) dynamics. The amount of TEP and CSP decreased from summer to autumn, but CSP was relatively enriched in both seasons. Our study therewith indicates clear seasonal differences in the microbial cycling of organic matter in the Fram Strait. Our data may help to establish baseline knowledge about seasonal changes in microbial ecosystem dynamics to better assess the impact of environmental change in the warming Arctic Ocean.

This article is part of the theme issue ‘The changing Arctic Ocean: consequences for biological communities, biogeochemical processes and ecosystem functioning’.
Low cost local food supplements could improve maternal and birth outcomes: a pilot randomized controlled trial
Authors: Susiloretni Kun A , Subandriani Dyah N , Ulfiana Elisa , Astuti Trina , Sunarto  , Smith Emily R
Published: August 2020

Objectives

Maternal nutrition plays a crucial role in influencing fetal growth and birth outcomes. The government of Indonesia has provided a manufactured fortified food supplementation program for undernourished pregnant mothers. We hypothesized a low-cost local food supplementation (LFS) would improve maternal and birth outcomes compared with government food supplementation (GFS).

Methods

We conducted a randomized control trial. We enrolled 54 pregnant mothers with MUAC<23.5cm who were assigned into two groups. The intervention group received LFS and multiple micronutrient supplements (MMS). The control group received the GFS and iron and folic acid supplements (IFA). LFS was a balanced energy protein food supplement made from nuts and fish. LFS and GFS contained approximately 500kcal energy and 10grams protein. We compared the effectiveness of these two interventions using logistic and linear regression.

Results

At the baseline, the two groups had similar characteristics. After 60 days of treatment, mothers in the LFS group were 2.28 folds more likely to increase MUAC (RR 2.28; 95%CI 1.58,3.27, p<0.001) and 4.73 folds to increase gestational weight (RR 4.73; 95%CI 1.37,16.3, p=0.015) than were mothers in the GFS group. For birth outcomes, in the LFS group had reduction of birthweight <3000grams (RR 0.15; 95%CI 0.023,0.98; p=0.048), short birth length (RR 0.068; 95%CI 0.005,0.93; p=0.044), and cesarean delivery (RR 0.11; 95%CI 0.022,0.61, p=011) as compared to the GFS group.

Conclusions for Practice

Local foods and MMS supplementation can improve maternal and birth outcomes. Therefore, local food supplements can be considered for food supplementation programs to undernourished pregnant mothers.

Significance Statement

What is already known on this subject?

Balanced protein-energy foods fortified with multiple micronutrients supplements has been known as an effective intervention to improve birth length and birth weight for underweight pregnant women.

What this study adds?

The provision of balanced energy protein of local foods supplements combined with multiple micronutrients supplements pills, showed the reduction on birth weight < 3000grams and short birth length. Surprisingly could reduce cesarean deliveries, and furthermore could give a chance to produce local food supplements by micro and small enterprises in community setting. Future studies should be conducted using better research design and embeded in the food and stunting reduction system.
Clinical Features Associated with COVID-19 Outcome in MM: First Results from International Myeloma Society COVID-19 Dataset
Authors: Chari Ajai , Samur Mehmet Kemal , Martinez-Lopez Joaquin , Cook Gordon , Biran Noa , Yong Kwee , Hungria Vania , Engelhardt Monika , Gay Francesca , Feria Ana García , Oliva Stefania , Oostvogels Rimke , Gozzetti Alessandro , Rosenbaum Cara , Kumar Shaji , Stadtmauer Edward A. , Einsele Hermann , Beksac Meral , Weisel Katja , Anderson Kenneth C. , Mateos María-Victoria , Moreau Philippe , San-Miguel Jesus , Munshi Nikhil C. , Avet-Loiseau Hervé
Published: August 2020

The primary cause of morbidity and mortality in patients with multiple myeloma (MM) is an infection. Therefore there is great concern about the susceptibility to the outcome of COVID-19 infected patients with multiple myeloma.

This retrospective study describes the baseline characteristics and outcome data of COVID-19 infection in 650 patients with plasma cell disorders (98 outpatinets and 538 hospitilized patinets), collected from 10 countries by the International Myeloma Society to understand the initial challenges faced by Myeloma patients during COVID-19 pandemic. Descriptive statistics, univariate logistic regression, and multivariate analysis were performed for hospitalized MM patinets.

The median age was 69 years, and nearly all patients (96%) had MM. Approximately 36% were recently diagnosed (2019-2020), and 54% of patients were receiving first-line therapy. Thirty-three percent of patients have died, with significant geographic variability, ranging from 27% to 57% of hospitalized patients. Univariate analysis identified age, ISS3, high-risk disease, renal disease, suboptimal myeloma control (active or progressive disease), and one or more comorbidities as risk factors for higher rates of death. Neither history of transplant, including within a year of COVID-19 diagnosis nor other anti-MM treatments were associated with outcomes. Multivariate analysis found that only age, high-risk MM, renal disease, and suboptimal MM control remained independent predictors of adverse outcome with COVID-19 infection.

The management of MM in the era of COVID-19 requires careful consideration of patient and disease-related factors to decrease the risk of acquiring COVID-19 infection, while not compromising the disease control through appropriate MM treatment. This study provides the data to develop recommendations for the management of MM patients at risk of COVID-19 infection.

Key Points

High but variable mortality for hospitalized MM patients (27% to 57%)

Optimal MM control was associated with COVID-19 associated death for MM patinets

Explanation of novelty

This study investigated the risk and outcome of COVID-19 infection in MM patients globally (10 countries)
Genomic assessment of within-host population variation inNeisseria gonorrhoeae: Implications for gonorrhoea transmission
Authors: Ashcroft Melinda M. , Chow Eric P. F. , Lee Darren Y.J. , De Petra Vesna , Soumilas Maree , Tschaepe Marlene , Zhang Lei , Ingle Danielle J. , Taiaroa George , Hicks Allison L. , Grad Yonatan H. , Howden Benjamin P. , Fairley Christopher K. , Williamson Deborah A.
Published: August 2020

Objectives

Mathematical modelling and genomic analyses are powerful methods for investigating the transmission dynamics ofNeisseria gonorrhoeae, however, often make the implicit assumption thatN. gonorrhoeaeisolates at different anatomical sites within the same individual are the same strain.

Methods

In this study, two approaches were used to explore genetic diversity. First, we examined a collection of stored, clinicalN. gonorrhoeaeisolates sourced from multiple anatomical sites of single individuals attending a sexual health clinic in Melbourne from 2011-2019. Second, we obtained multiple colony picks from primary clinical samples from individuals attending a sexual health clinic in Melbourne from 2019-2020. Whole genome sequencing and a variety of bioinformatics approaches were used to determine both within-host and within-sample genetic diversity.

Results

Thirty-seven individuals were identified that had culturedN. gonorrhoeaefrom two or more anatomical sites (urogenital, anorectal, or oropharyngeal), with a final dataset of 105 isolates. In 35/37 (94.6%) individuals, infections were highly similar at the genetic level, with identical MLST and NG-MAST profiles. Pairwise comparisons of isolates within each individual indicated that the maximum within-host pairwise SNP distance was 13 SNPs (median = 1, IQR: 0-3). Notably, four distinct multi-individual phylogenetic clusters were identified, where the maximum pairwise SNP distance was 19 SNPs (median = 6, IQR = 2-11). Similarly, comparisons of isolates within each primary sample indicated that the maximum pairwise SNP distance was 8 SNPs (median = 2, IQR:1-3).

Conclusions

This study suggests that in most cases of multi-site infection, the same strain ofN. gonorrhoeaecauses the infection at each anatomical site. However, WGS data alone cannot differentiate between the same infecting strain or (re)infections from the same transmission network. These data guide recommendations regarding optimal bioinformatic approaches to infer genetic relatedness ofN. gonorrhoeaeand will help inform future studies of gonorrhoea transmission and epidemiology.

KEY MESSAGES

In most cases of multi-site infection, the same strain ofN. gonorrhoeaecauses infection at each anatomical site (urogenital, anorectal, and oropharyngeal) within an individual.

It is not possible, using genomics alone, to determine if an infection is from a single individual or multiple individuals within the same sexual network.

Current literature reports an array of different bioinformatic methods for describing genetic diversity, highlighting that SNP thresholds are not directly transferable between studies.
Preliminary report on the development of a colorimetric loop-mediated isothermal amplification diagnostic assay for deer tick virus
Authors: Roy Brandon G. , Ryndock Eric J.
Published: August 2020

Deer tick virus (DTV) is an emerging pathogen in North America. This virus can cause nervous system complications such as encephalitis in humans. Further, no data has been surmounted around long-term effects of infection from DTV patients across variable age groups. Diagnostic tools of DTV used by government laboratories are based on RT-PCR using patient serum or ticks. This paper explores the feasibility of a colorimetric loop-mediated isothermal amplification (LAMP) assay to create a point-of-care diagnostic methodology for use in field and in primary care. LAMP consists of six primers that bind to target DNA and amplifies variable length nucleotide strands that can be visualized through side reactions or via electrophoresis. First, a viable LAMP primer set, and a primer set that dimerizes and amplifies DNA regardless of compatibility were created in silico and validated in vitro. Then, a specific LAMP assay was developed. Our findings showed his method can be performed within 30 minutes and can measure with limits of detection comparable to PCR.
Cerebrospinal Fluid Lactate as a Prognostic Marker of Disease Severity and Mortality in Cryptococcal Meningitis
Authors: Abassi Mahsa , Bangdiwala Ananta S , Nuwagira Edwin , Tadeo Kiiza Kandole , Okirwoth Michael , Williams Darlisha A , Mpoza Edward , Tugume Lillian , Ssebambulidde Kenneth , Hullsiek Kathy Huppler , Musubire Abdu K , Muzoora Conrad , Rhein Joshua , Meya David B , Boulware David R ,   ASTRO-CM team
Published: August 2020

Background

Cerebrospinal fluid (CSF) lactate levels can differentiate between bacterial and viral meningitis. We measured CSF lactate in individuals with cryptococcal meningitis to determine its clinical significance.

Methods

We measured point-of-care CSF lactate at the bedside of 319 HIV-infected Ugandan adults at diagnosis of cryptococcal meningitis. We summarized demographic variables and clinical characteristics by CSF lactate tertiles. We evaluated the association of CSF lactate with clinical characteristics and survival.

Results

Individuals with high CSF lactate >5 mmol/L at cryptococcal diagnosis more likely presented with altered mental status (p<.0001), seizures (p=.0005), elevated intracranial opening pressure (p=.03), higher CSF white cells (p=0.007), and lower CSF glucose (p=.0003) compared to those with mid-range (3.1 to 5 mmol/L) or low (≤3 mmol/L) CSF lactate levels. Two-week mortality was higher among individuals with high baseline CSF lactate >5 mmol/L (35%; 38/109) as compared to individuals with mid-range (22%; 25/112) or low CSF lactate (9%; 9/97; p=<.0001). After multivariate adjustment, CSF lactate >5mmol/L remained independently associated with excess mortality (adjusted Hazard Ratio = 3.41; 95%CI, 1.55-7.51; p=.002). We found no correlation between baseline CSF lactate levels and blood capillary lactate levels (p=.72).

Conclusions

Baseline point-of-care CSF lactate levels may be utilized as a prognostic marker of disease severity and mortality in cryptococcal meningitis. Individuals with an elevated baseline CSF lactate are more likely to present with altered mental status, seizures, elevated CSF opening pressures, and are at a greater risk of death. Future studies are needed to determine targeted therapeutic management strategy in persons with high CSF lactate.

In HIV-associated cryptococcal meningitis, baseline cerebrospinal fluid (CSF) lactate levels are associated with increased intracranial pressures, seizures, and altered mental status. Elevated CSF lactate levels, at baseline, are associated with increased 2-week mortality.
Multiple introductions followed by ongoing community spread of SARS-CoV-2 at one of the largest metropolitan areas in the Northeast of Brazil
Authors: Paiva Marcelo Henrique Santos , Guedes Duschinka Ribeiro Duarte , Docena Cássia , Bezerra Matheus Filgueira , Dezordi Filipe Zimmer , Machado Laís Ceschini , Krokovsky Larissa , Helvecio Elisama , Silva Alexandre Freitas da , Vasconcelos Luydson Richardson Silva , Rezende Antonio Mauro , Silva Severino Jefferson Ribeiro da , da Silva Sales Kamila Gaudêncio , Figueiredo de Sá Bruna Santos Lima , da Cruz Derciliano Lopes , Cavalcanti Claudio Eduardo , de Menezes Neto Armando , da Silva Caroline Targino Alves , Mendes Renata Pessôa Germano , da Silva Maria Almerice Lopes , da Silva Barros Michelle , Nascimento Wheverton Ricardo Correia do , Arcoverde Rodrigo Moraes Loyo , Bezerra Luciane Caroline Albuquerque , Filho Sinval Pinto Brandão , Ayres Constância Flávia Junqueira , Wallau Gabriel Luz
Published: August 2020

The emergence of SARS-CoV-2 in the human population has caused a huge pandemic that is still unfolding in many countries around the world. Multiple epicenters of the pandemic have emerged since the first pneumonia cases in Wuhan, first in Italy followed by the USA and Brazil. Up to now, Brazil is the second most affected country, however, genomic sequences of SARS-CoV-2 strains circulating in the country are restricted to some highly impacted states. Although the Pernambuco state, located in the Northeast Region, is the sixth most affected brazilian state and the second considering lethality rate, there is a lack of high quality genomic sequences from the strains circulating in this region. Here, we sequenced 38 strains of SARS-CoV-2 from patients presenting Covid-19 symptoms. Phylogenetic reconstructions revealed that three lineages were circulating in the state and 36 samples belong to B1.1 lineage. We detected two introductions from European countries and five clades, corroborating the community spread of the virus between different municipalities of the state. Finally, we detected that all except one strain showed the D614G spike protein amino acid change that may impact virus infectivity in human cells. Our study brought new light to the spread of SARS-CoV-2 strains in one of the most heavily impacted states of Brazil.