bluuebunny/crossref_metadata_2025 huggingface dataset:
Compassionate Use of Hydroxychloroquine in Clinical Practice for Patients With Mild to Severe COVID-19 in a French University Hospital
Authors: Paccoud Olivier , Tubach Florence , Baptiste Amandine , Bleibtreu Alexandre , Hajage David , Monsel Gentiane , Tebano Gianpiero , Boutolleau David , Klement Elise , Godefroy Nagisa , Palich Romain , Itani Oula , Faiçal Antoine , Valantin Marc-Antoine , Tubiana Roland , Burrel Sonia , Calvez Vincent , Caumes Eric , Marcelin Anne-Geneviève , Pourcher Valérie
Published: June 2020

Background

Data from nonrandomized studies have suggested that hydroxychloroquine could be an effective therapeutic agent against coronavirus disease 2019 (COVID-19).

Methods

We conducted an observational, retrospective cohort study involving hospitalized adult patients with confirmed, mild to severe COVID-19 in a French university hospital. Patients who received hydroxychloroquine (200 mg 3 times daily dosage for 10 days) on a compassionate basis in addition to standard of care (SOC) were compared with patients without contraindications to hydroxychloroquine who received SOC alone. A propensity score-weighted analysis was performed to control for confounders: age, sex, time between symptom onset and admission ≤ 7 days, Charlson comorbidity index, medical history of arterial hypertension, obesity, National Early Warning Score 2 (NEWS2) score at admission, and pneumonia severity. The primary endpoint was time to unfavorable outcome, defined as: death, admission to an intensive care unit, or decision to withdraw or withhold life-sustaining treatments, whichever came first.

Results

Data from 89 patients with laboratory-confirmed COVID-19 were analyzed, 84 of whom were considered in the primary analysis; 38 patients treated with hydroxychloroquine and 46 patients treated with SOC alone. At admission, the mean age of patients was 66 years, the median Charlson comorbidity index was 3, and the median NEWS2 severity score was 3. After propensity score weighting, treatment with hydroxychloroquine was not associated with a significantly reduced risk of unfavorable outcome (hazard ratio, 0.90 [95% confidence interval, .38–2.1], P = .81). Overall survival was not significantly different between the 2 groups (hazard ratio, 0.89 [0.23; 3.47], P = 1).

Conclusion

In hospitalized adults with COVID-19, no significant reduction of the risk of unfavorable outcomes was observed with hydroxychloroquine in comparison to SOC. Unmeasured confounders may have persisted however, despite careful propensity-weighted analysis and the study might be underpowered. Ongoing controlled trials in patients with varying degrees of initial severity on a larger scale will help determine whether there is a place for hydroxychloroquine in the treatment of COVID-19. In hospitalized adults with COVID-19, no significant reduction of the risk of unfavorable outcomes was observed with hydroxychloroquine in comparison to SOC.
James Buchanan on the nature of choice: ontology, artifactual man and the constitutional moment in political economy
Authors: Lewis Paul , Dold Malte
Published: June 2020

Historians of economic thought are paying greater attention to issues of social ontology (i.e. to the assumptions that economists make about the nature of social reality). We contribute to this burgeoning literature by exploring the hitherto neglected way in which James Buchanan invoked ontological considerations, concerning in particular the nature of human choice, both in criticising neoclassical economics and also in setting out his own contributions to constitutional political economy. We focus on Buchanan’s account of man as an artifactual being who has the capacity to choose the kind of person he wishes to become, in particular by selecting the kind of preferences he wishes to have and the kinds of rules under which he wishes to live. We discuss how Buchanan’s thinking on this issue was shaped by Frank Knight and G. L. S. Shackle and explain why Buchanan explicitly described his argument as ontological in nature. Finally, we contend that Buchanan’s approach would have benefited from further ontological elaboration, in two ways: first, because his arguments would have been stronger had he said more about the attributes of the human agent that help to secure their engagement in thinking creatively about themselves and the rules of society (‘the constitutional moment’), and second because his account would benefit from a deeper discussion of the interplay between human agency and social structure, especially with regard to the question of which structures might constrain or facilitate creative choices of the kind by which he set such great store.
Efficacy and safety of direct oral anticoagulants vs. low molecular weight heparin for cancer-related venous thromboembolism: a meta-analysis of randomized trials
Authors: Elbadawi Ayman , Shnoda Mina , Mahmoud Karim , Elgendy Islam Y
Published: June 2020

Aims

To examine the efficacy and safety of direct oral anticoagulants (DOACs) vs. low molecular weight heparin (LMWH) in patients with cancer-related venous thromboembolism (VTE).

Methods and results

An electronic search of the MEDLINE, SCOPUS, and Cochrane databases without language restrictions was performed through April 2020 for randomized controlled trials that compared the outcomes with DOACs vs. LMWH among patients with cancer-related VTE. Summary estimates were reported using random effects model. The main efficacy outcome was VTE recurrence, while the main safety outcome was major bleeding . The final analysis included four randomized trials with a total of 2907 patients. The weighted mean follow-up was 6.1 months. Compared with LMWH, DOACs were associated with lower incidence of VTE recurrence [5.7% vs. 9.1%, risk ratio (RR) 0.62; 95% confidence interval (CI) 0.44–0.87; P = 0.01], driven by lower incidence of deep venous thrombosis (RR 0.60, 95% CI 0.39–0.93; P = 0.02). There was no difference in the incidence of major bleeding between DOACs and LMWH (4.8% vs. 3.6%, RR 1.33; 95% CI 0.84–2.11; P = 0.23). The incidence of all-cause mortality was similar (RR 0.99; 95% CI 0.84–1.16; P = 0.91). Subgroup analysis suggested no differences according to the type of DOAC regarding recurrent VTE or major bleeding (Pinteraction = 0.53 and Pinteraction = 0.11, respectively).

Conclusion

Among patients with cancer-related VTE, DOACs were associated with lower incidence of VTE recurrence and no difference in the incidence of major bleeding compared with LMWH. Future studies examining the subset of cancer patients who drive the most benefit are encouraged.
Simultaneous Search for Differentiated Products: The Impact of Search Costs and Firm Prominence
Authors: Moraga-González José L , Sándor Zsolt , Wildenbeest Matthijs R
Published: June 2020

We extend the literature on simultaneous search by allowing for differentiated products and search cost heterogeneity. We show conditions under which a symmetric price equilibrium exists. We provide a necessary and sufficient condition under which an increase in search costs may result in a lower, equal or higher equilibrium price. We extend this analysis to the case with more than two firms. The effects of prominence on equilibrium prices are also studied. The prominent firm charges a higher price than the non-prominent firm and both their prices are below the symmetric equilibrium price. Consequently, market prominence increases the consumers’ surplus.
ELF awareness in the task-based classroom: a way forward
Authors: Kordia Stefania
Published: June 2020

The article discusses ELF-aware pedagogy as a possible way to integrate English as a lingua franca (ELF) in English language classrooms and explores the extent to which task-based language teaching (TBLT) could contribute to this end. ELF-aware pedagogy involves enriching teaching practices with appropriate metalinguistic and reflective activities that help learners develop as competent ELF users. The article makes the case that, when viewed from an ELF-aware perspective, TBLT may provide a coherent methodological framework for creating an authentic communicative environment in the classroom, within which the learners may develop as ELF communicators. To provide an example of how this could be achieved in practice, the author presents an ELF-aware task she has designed and taught in her own classroom. The task integrates metalinguistic and reflective elements and focuses on promoting the learners’ pragmatic competence and sense of themselves as true owners of English.
Effect of dapagliflozin according to baseline systolic blood pressure in the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure trial (DAPA-HF)
Authors: Serenelli Matteo , Böhm Michael , Inzucchi Silvio E , Køber Lars , Kosiborod Mikhail N , Martinez Felipe A , Ponikowski Piotr , Sabatine Marc S , Solomon Scott D , DeMets David L , Bengtsson Olof , Sjöstrand Mikaela , Langkilde Anna Maria , Anand Inder S , Chiang Chern-En , Chopra Vijay K , de Boer Rudolf A , Diez Mirta , Dukát Andrej , Ge Junbo , Howlett Jonathan G , Katova Tzvetana , Kitakaze Masafumi , Ljungman Charlotta E A , Verma Subodh , Docherty Kieran F , Jhund Pardeep S , McMurray John J V
Published: June 2020

Aims

Concern about hypotension often leads to withholding of beneficial therapy in patients with heart failure and reduced ejection fraction (HFrEF). We evaluated the efficacy and safety of dapagliflozin, which lowers systolic blood pressure (SBP),according to baseline SBP in Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure trial (DAPA-HF).

Methods and results

Key inclusion criteria were: New York Heart Association Class II−IV, left ventricular ejection fraction ≤ 40%, elevated N-terminal pro-B-type natriuretic peptide level, and SBP ≥95 mmHg. The primary outcome was a composite of worsening heart failure or cardiovascular death. The efficacy and safety of dapagliflozin were examined using SBP as both a categorical and continuous variable. A total of 1205 patients had a baseline SBP <110 mmHg; 981 ≥ 110 < 120; 1149 ≥ 120 < 130; and 1409 ≥ 130 mmHg. The placebo-corrected reduction in SBP from baseline to 2 weeks with dapagliflozin was −2.54 (−3.33 to −1.76) mmHg (P < 0.001), with a smaller between-treatment difference in patients in the lowest compared to highest SBP category. Patients in the lowest SBP category had a much higher rate (per 100 person-years) of the primary outcome [20.6, 95% confidence interval (95% CI) 17.6–24.2] than those in the highest SBP category (13.8, 11.7–16.4). The benefit and safety of dapagliflozin was consistent across the range of SBP; hazard ratio (95% CI) in each SBP group, lowest to highest: 0.76 (0.60–0.97), 0.76 (0.57–1.02), 0.81 (0.61–1.08), and 0.67 (0.51–0.87), P interaction = 0.78. Study drug discontinuation did not differ between dapagliflozin and placebo across the SBP categories examined.

Conclusion

Dapagliflozin had a small effect on SBP in patients with HFrEF and was superior to placebo in improving outcomes, and well tolerated, across the range of SBP included in DAPA-HF.

Clinical Trial Registration:

ClinicalTrials.gov NCT03036124.
Promoters for lipogenesis-specific downregulation in Yarrowia lipolytica
Authors: Kamineni Annapurna , Chen Shuyan , Chifamba Gamuchirai , Tsakraklides Vasiliki
Published: June 2020

Yarrowia lipolytica is a non-conventional yeast with potential applications in the biofuel and biochemical industries. It is an oleaginous yeast that accumulates lipids when it encounters nutrient limitation in the presence of excess carbon. Its molecular toolbox includes promoters for robust constitutive expression, regulated expression through the addition of media components and inducible expression during lipid accumulation. To date, no promoters have been identified that lead to downregulation at the transition from growth to lipid accumulation. We identified four native Y. lipolytica promoters that downregulate the expression of genes at this natural transition. Using the fatty acid desaturase genes FAD2 and OLE1 as reporter genes for these promoters, we correlated repression of desaturase transcript levels with a reduction of desaturated fatty acids at the transition to lipid accumulation. These promoters can restrict to the growth phase an essential or favorable activity that is undesirable during lipid accumulation under traditional fermentation conditions without media additions. This expression pattern results in lipogenesis phase-specific changes that could be useful in applications relating to optimizing lipid yield and composition.
Expression Pattern of the Pneumocystis jirovecii Major Surface Glycoprotein Superfamily in Patients with Pneumonia
Authors: Schmid-Siegert Emanuel , Richard Sophie , Luraschi Amanda , Mühlethaler Konrad , Pagni Marco , Hauser Philippe M
Published: June 2020

Background

The human pathogen Pneumocystis jirovecii harbors 6 families of major surface glycoproteins (MSGs) encoded by a single gene superfamily. MSGs are presumably responsible for antigenic variation and adhesion to host cells. The genomic organization suggests that a single member of family I is expressed at a given time per cell, whereas members of the other families are simultaneously expressed.

Methods

We analyzed RNA sequences expressed in several clinical samples, using specific weighted profiles for sorting of reads and calling of single-nucleotide variants to estimate the diversity of the expressed genes.

Results

A number of different isoforms of at least 4 MSG families were expressed simultaneously, including isoforms of family I, for which confirmation was obtained in the wet laboratory.

Conclusion

These observations suggest that every single P. jirovecii population is made of individual cells with distinct surface properties. Our results enhance our understanding of the unique antigenic variation system and cell surface structure of P. jirovecii.
COVID-19 pandemic: a time for collaboration and a unified global health front
Authors: Vervoort Dominique , Ma Xiya , Luc Jessica G Y
Published: June 2020

Coronavirus disease 2019 has, in the span of weeks, immobilized entire countries and mobilized leading institutions worldwide in a race towards treatments and preventions. Although several solutions such as telemedicine and online education platforms have been implemented to reduce human contact and further transmission, countries need to favour collectivism both within and beyond their borders. Inspired by experiences of previous outbreaks such as SARS in 2003 and Ebola in 2014–2015, global solidarity is a must in order to prevent further morbidity and mortality. Examples in leadership and collaborations ranging from research funds from the Bill and Melinda Gates Foundation to mask donations by the Jack Ma Foundation should be celebrated as examples to follow. Open communication and transparency will be crucial in monitoring the evolution of the disease in the global effort of flattening the curve. This crisis will challenge the integrity and fuel innovation of health systems worldwide, whilst posing a new quality chasm that warrants increased recognition.
Do Walls Work? The Effectiveness of Border Barriers in Containing the Cross-Border Spread of Violent Militancy
Authors: Linebarger Christopher , Braithwaite Alex
Published: June 2020

Since the end of the Cold War, walls, fences, and fortifications have been constructed on interstate borders at a rapid rate. It remains unclear, however, whether these fortifications provide effective security. We explore whether border fortifications provide security against the international spread of violent militancy. Although barriers can reduce the likelihood that militant activity diffuses across international borders, their effectiveness is conditional upon the roughness of the terrain on which they are built and the level of infrastructure development in their proximity. Barriers require intensive manpower to monitor and patrol, and so conditions like rough terrain and poor infrastructure render security activity more difficult. However, rebels and other militants prefer to operate in such difficult areas, ultimately reducing the effectiveness of barriers in containing the international spread of violent militancy. Analyses on newly collated data on interstate border fortifications within a global sample of contiguous-state directed-dyad-years show that border fortifications are only effective in limiting the diffusion of militancy in contexts in which states can plausibly monitor and police their borders. This paper has significant implications for the academic literatures on national security and intrastate conflict, and it also speaks to the broader policy debate over border walls and fences.
Dispersive Liquid-Liquid Microextraction Based Preconcentration of Selected Pesticides and Escitalopram Oxalate, Haloperidol, and Olanzapine from Wastewater Samples Prior to Determination by GC-MS
Authors: Dalgıç Bozyiğit Gamze , Fırat Ayyıldız Merve , Chormey Dotse Selali , Onkal Engin Güleda , Bakırdere Sezgin
Published: June 2020

Background

Determination of emerging pollutants including pharmaceuticals, pesticides, industrial chemicals and hormones in different environmental samples is very important for human health.

Objective

Experimental design enabled parameters to be evaluated for their effects onextraction output as well as their interactive effects.

Method

A multivariate experimental design was used to attain optimum conditions of a dispersive liquid-liquid microextraction method for preconcentration of pesticides and pharmaceuticals for determination by GC-MS.

Results

The optimum parameters suggested by the design model were 200 µL of chloroform, 1.96 mL of ethanol, and 40 s vortexing period. LOD and LOQ were calculated using linear calibration plots of the analytes developed in the standard concentration range of 2.0 μg/L–2.0 mg/L.

Conclusions

Enhancement in detection power of the analytes recorded by the optimized method with respect to direct GC-MS determination (based on LOD values) was in the range of 3.6 and 539 folds. Spiked recovery experiments for municipal, medical, and synthetic wastewater samples yielded low recovery results when calculated against aqueous standard solutions. Matrix matched calibration standards were used to mitigate interferences from the waste samples and the percent recoveries obtained were close to 100%. This established accuracy and applicability of the developed method.

Highlights

The detection limits were found between 0.50 ng/mL and 37 ng/mL. An accurate, simple and sensitive analytical method was developed for the analytes.
Empirical bolometric correction coefficients for nearby main-sequence stars in the Gaia era
Authors: Eker Z , Soydugan F , Bilir S , Bakış V , Aliçavuş F , Özer S , Aslan G , Alpsoy M , Köse Y
Published: June 2020

Nearby detached double-lined eclipsing binaries with most accurate data were studied and 290 systems were found with at least one main-sequence component having a metallicity of 0.008 ≤ Z ≤ 0.040. Stellar parameters, light ratios, Gaia Data Release 2 trigonometric parallaxes, extinctions and/or reddening were investigated and only 206 systems were selected as eligible to calculate empirical bolometric corrections. NASA/IPAC Galactic dust maps were the main source of extinctions. Unreliable extinctions at low Galactic latitudes |b| ≤ 5° were replaced with individual determinations, if they exist in the literature, else associated systems were discarded. The main-sequence stars of te remaining systems were used to calculate the bolometric corrections (BCs) and to calibrate the BC–Teff relation, which is valid in the range 3100–36 000 K. De-reddened (B − V)0 colours, on the other hand, allowed us to calibrate two intrinsic colour–effective temperature relations; the linear one is valid for $T_{\rm eff}\gt 10\, 000$ K, while the quadratic relation is valid for $T_{\rm eff}\lt 10\, 000$ K; that is, both are valid in the same temperature range in which the BC–Teff relation is valid. New BCs computed from Teff and other astrophysical parameters are tabulated, as well.
IRAM 30-m-EMIR redshift search of z = 3–4 lensed dusty starbursts selected from the HerBS sample
Authors: Bakx T J L C , Dannerbauer H , Frayer D , Eales S A , Pérez-Fournon I , Cai Z-Y , Clements D L , De Zotti G , González-Nuevo J , Ivison R J , Lapi A , Michałowski M J , Negrello M , Serjeant S , Smith M W L , Temi P , Urquhart S , van der Werf P
Published: June 2020

Using the Eight MIxer Receiver (EMIR) instrument on the Institut de RadioAstronomie Millimétrique (IRAM) 30-m telescope, we conducted a spectroscopic redshift search of seven zphot ∼ 4 submillimetre bright galaxies selected from the Herschel Bright Sources sample with fluxes at 500 μm greater than 80 mJy. For four sources, we obtained spectroscopic redshifts between 3.4 < z < 4.1 through the detection of multiple CO-spectral lines with J ≥ 3. Later, we detected low-J transitions for two of these sources with the Green Bank Telescope including the CO(1–0) transition. For the remaining three sources, more data are needed to determine the spectroscopic redshift unambiguously. The measured CO luminosities and line widths suggest that all these sources are gravitationally lensed. These observations demonstrate that the 2 mm window is indispensable to confirm robust spectroscopic redshifts for z < 4 sources. Finally, we present an efficient graphical method to correctly identify spectroscopic redshifts.
Turbulent mixing of r-process elements in the Milky Way
Authors: Beniamini Paz , Hotokezaka Kenta
Published: June 2020

We study turbulent gas diffusion affects on r-process abundances in Milky Way stars, by a combination of an analytical approach and a Monte Carlo simulation. Higher r-process event rates and faster diffusion, lead to more efficient mixing corresponding to a reduced scatter of r-process abundances and causing r-process enriched stars to start appearing at lower metallicities. We use three independent observations to constrain the model parameters: (i) the scatter of radioactively stable r-process element abundances, (ii) the largest r-process enrichment values observed in any solar neighborhood stars, and (iii) the isotope abundance ratios of different radioactive r-process elements (244Pu/238U and 247Cm/238U) at the early Solar system as compared to their formation. Our results indicate that the Galactic r-process rate and the diffusion coefficient are respectively r < 4 × 10−5 yr−1, D > 0.1 kpc2 Gyr−1 (r < 4 × 10−6 yr−1, D > 0.5 kpc2 Gyr−1 for collapsars or similarly prolific r-process sources) with allowed values satisfying an approximate anticorrelation such that D ≈ r−2/3, implying that the time between two r-process events that enrich the same location in the Galaxy, is τmix ≈ 100−200 Myr. This suggests that a fraction of ∼0.8 (∼0.5) of the observed 247Cm (244Pu) abundance is dominated by one r-process event in the early Solar system. Radioactively stable element abundances are dominated by contributions from ∼10 different events in the early Solar system. For metal poor stars (with [Fe/H] ≲ −2), their r-process abundances are dominated by either a single or several events, depending on the star formation history.
Deciphering the properties of the central engine in GRB collapsars
Authors: Petropoulou M , Beniamini P , Vasilopoulos G , Giannios D , Barniol Duran R
Published: June 2020

The central engine in long gamma-ray bursts (GRBs) is thought to be a compact object produced by the core collapse of massive stars, but its exact nature (black hole or millisecond magnetar) is still debatable. Although the central engine of GRB collapsars is hidden to direct observation, its properties may be imprinted on the accompanying electromagnetic signals. We aim to decipher the generic properties of central engines that are consistent with prompt observations of long GRBs detected by the Burst Alert Telescope (BAT) on board the Neil Gehrels Swift Observatory. Adopting a generic model for the central engine, in which the engine power and activity time-scale are independent of each other, we perform Monte Carlo simulations of long GRBs produced by jets that successfully breakout from the star. Our simulations consider the dependence of the jet breakout time-scale on the engine luminosity and the effects of the detector’s flux threshold. The two-dimensional (2D) distribution of simulated detectable bursts in the gamma-ray luminosity versus gamma-ray duration plane is consistent with the observed one for a range of parameter values describing the central engine. The intrinsic 2D distribution of simulated collapsar GRBs peaks at lower gamma-ray luminosities and longer durations than the observed one, a prediction that can be tested in the future with more sensitive detectors. Black hole accretors, whose power and activity time are set by the large-scale magnetic flux through the progenitor star and stellar structure, respectively, are compatible with the properties of the central engine inferred by our model.
No evidence for interstellar planetesimals trapped in the Solar system
Authors: Morbidelli A , Batygin K , Brasser R , Raymond S N
Published: June 2020

In two recent papers published in MNRAS, Namouni and Morais claimed evidence for the interstellar origin of some small Solar system bodies, including: (i) objects in retrograde co-orbital motion with the giant planets and (ii) the highly inclined Centaurs. Here, we discuss the flaws of those papers that invalidate the authors’ conclusions. Numerical simulations backwards in time are not representative of the past evolution of real bodies. Instead, these simulations are only useful as a means to quantify the short dynamical lifetime of the considered bodies and the fast decay of their population. In light of this fast decay, if the observed bodies were the survivors of populations of objects captured from interstellar space in the early Solar system, these populations should have been implausibly large (e.g. about 10 times the current main asteroid belt population for the retrograde co-orbital of Jupiter). More likely, the observed objects are just transient members of a population that is maintained in quasi-steady state by a continuous flux of objects from some parent reservoir in the distant Solar system. We identify in the Halley-type comets and the Oort cloud the most likely sources of retrograde co-orbitals and highly inclined Centaurs.
A Targeted Screening Program for Latent Tuberculosis Infection Among Hematopoietic Cell Transplant Recipients
Authors: Sosa-Moreno Andrea , Narita Masahiro , Spitters Christopher , Swetky Michelle , Podczervinski Sara , Lind Margaret L , Holmberg Leona , Liu Catherine , Edelstein Raleigh , Pergam Steven A
Published: June 2020

Background

US hematopoietic cell transplantation (HCT) recipients have a low prevalence of latent tuberculosis infection (LTBI), but if latently infected they are at risk for progression to active tuberculosis. At our center, all HCT recipients underwent LTBI testing pretransplant by tuberculin skin testing (TST) until 2013 when we implemented a targeted screening program. Our objective was to assess the utility of our screening program that incorporated a pretransplant LTBI questionnaire to target TST and QuantiFERON TB Gold (QFT) testing.

Methods

We performed a retrospective cohort study of HCT recipients undergoing first transplant from 2014 to 2016. Patients with positive, indeterminate, and a subset with negative QFT results underwent electronic medical record (EMR) review to assess TST results and risk factors for LTBI.

Results

Among 1290 eligible recipients, 457 (35%) had at least 1 risk factor for LTBI on the pretransplant questionnaire; nonwhites were more likely to undergo LTBI testing (P < .0001). Overall, 16 of 1290 (1.2%) had at least 1 positive LTBI test. Of those screened by QFT, 14 of 457 (3%) were positive and 52 (11%) were indeterminate. Among those undergoing EMR review, 123 of 267 (46%) had TST records; 4 of 123 (3%) positive by both TST and QFT, and 2 (2%) by TST alone. Two or more risk factors were reported among the majority of LTBI-positive patients (15 of 16 [94%]). All patients with at least 1 positive test for LTBI (n = 16) were evaluated, and 11 of 16 (69%) were recommended to receive treatment.

Conclusions

Incorporating a pretransplant LTBI questionnaire allowed for an approximate 65% reduction in LTBI testing when compared with universal testing among this low prevalence population.
Le rôle des fibres alimentaires et des prébiotiques dans le régime en pédiatrie
Authors: Boctor Dana
Published: June 2020

Les fibres alimentaires résistent à la digestion et à l’absorption. Les prébiotiques sont des fibres alimentaires fermentescibles (qui peuvent fermenter) qui sont bénéfiques pour la santé grâce à leurs effets sur la composition et l’activité du microbiome. La consommation de fibres alimentaires confère toute une série de bienfaits physiologiques. Les enfants encouragés à manger des aliments riches en fibres apprennent à adopter un régime à forte teneur en nutriments. L’introduction de sources variées de fibres alimentaires chez les jeunes enfants contribue à cristalliser leurs futurs choix alimentaires et à diversifier leur microbiote intestinal. Une faible consommation de fibres est reliée à une plus forte prévalence de constipation et d’obésité.
Anterior High-Intensity Zone in Lumbar Discs: Prevalence and Association with Low Back Pain
Authors: Wang Zi-Xuan , Hou Zeng-Tao , Hu You-Gu
Published: June 2020

Objectives

To explore the features of high-intensity zone (HIZ) in anterior annulus fibrosus and assess the association of anterior HIZ with low back pain (LBP).

Design, Setting, and Subjects

A retrospective study of 5,940 discs in 1,188 individuals was conducted.

Methods

Subjects’ information and LBP symptoms confirmed by an orthopedic surgeon were acquired from the medical record. Magnetic resonance (MR) image reading and analysis were performed by two experienced blinded radiologists.

Results

Two hundred eighty individuals exhibited 355 anterior HIZs in 355 discs. The prevalence was 23.57%; 88.45% were located in the inferior part of the annulus fibrosus. It frequently occurred in the middle and upper segments of lumbar spine, especially at L3/4 (45.63%). Of the 355 anterior HIZs, only 79 (22.25%) were consecutive-slides HIZ. Round type (63.38%) was the most common shape of anterior HIZs. The highest prevalence was found in individuals aged 60–69 years. LBP was confirmed in 141 anterior-HIZ individuals. The incidence of LBP in anterior-HIZ individuals was significantly higher than in non-HIZ subjects (50.36% vs 35.24%, χ2 = 18.314, P < 0.001).

Conclusions

Anterior HIZ is a lower-prevalence, age-related sign on lumbar MR images. The spatial distribution of anterior HIZ can be distinguished from posterior HIZ. The number of consecutive anterior HIZ slides might suggest fewer Dallas grade 4 anterior annular disruptions in this sample. Anterior HIZ was correlated with LBP.
From Harrods to billionaires’ row: unexplained wealth orders after Hajiyeva and Baker
Authors: Fletcher Thomas
Published: June 2020

This article considers the jurisdiction in England to grant unexplained wealth orders which are contained in the Proceeds of Crime Act 2002. It particularly focuses on the implications of the recent judgments in Hajiyeva v National Crime Agency [2020] EWCA Civ 108 and Baker v National Crime Agency [2020] EWHC 822 (Admin) for trusts and trustees. It concludes by identifying and commenting on the key issues in this context which may well fall to be considered in future cases.
Disseminated Sporotrichosis: An Important Differential Diagnosis for Venous Ulcers
Authors: Alvarez-Rivero Valeria , Hernandez-Castro Rigoberto , Moreno-Coutiño Gabriela , Lozano-Platonoff Adriana
Published: June 2020

The authors present the case of a 45-year-old immunosuppressed man with lower extremity ulcers. Initially treated as venous ulcers, the wounds were later correctly diagnosed as cutaneous disseminated sporotrichosis. After appropriate treatment with systemic antifungals was initiated, the patient healed within 4 months.
Oxygen-Sensing Biomaterial Construct for Clinical Monitoring of Wound Healing
Authors: Tavakol Daniel Naveed , Schwager Samantha C. , Jeffries Lindsay A. , Bruce Anthony , Corliss Bruce A. , DeRosa Christopher A. , Fraser Cassandra L. , Peirce Shayn M. , Cottler Patrick S.
Published: June 2020

OBJECTIVE

Oxygen is essential to wound healing; therefore, accurate monitoring can guide clinical decisions. Clinical wound assessment is often subjective, and tools to monitor wound oxygen are typically expensive, indirect, and highly variable. This study demonstrates the utility of a novel, low-cost oxygen-sensing thin film for serial assessment of wound oxygenation.

DESIGN

Dual-layer films were fabricated with boron oxygen-sensing nanoparticles (BNPs) impregnated into a chitosan-polycaprolactone layer for direct wound bed contact with a relatively oxygen impermeable calcium alginate surface layer. The BNPs are a dual-emissive difluoroboron β-diketonate dye incorporated into poly(lactic acid) nanoparticles. Under UV excitation, the BNPs emit fluorescence based on concentration and oxygen-sensitive phosphorescence. The fluorescence/phosphorescence ratio is directly proportional to oxygen concentration.

METHODS

A series of in vitro oxygen challenges and in vivo murine and porcine wound healing models were used to validate the utility of the film in sensing wound oxygenation.

MAIN RESULTS

In vitro testing demonstrated the oxygen-sensing capability of the BNP film and its ability to shield ambient oxygen to isolate wound oxygen. In vivo testing demonstrated the ability of the film to accurately monitor relative oxygen changes in a murine wound over time, measuring a 22% fluorescence/phosphorescence increase during acute healing.

CONCLUSIONS

This study presents a low-cost, noninvasive, direct, and serial oxygen mapping technology to detect spatial differences in wound oxygenation. Clinical use of the films has the potential to monitor wound healing trajectories and guide wound care decisions.
Terminology, communication, and information systems in nonoperating room anaesthesia in the COVID-19 era
Authors: Jelly Christina A. , Ende Holly B. , Freundlich Robert E.
Published: June 2020

Purpose of review

Nonoperating room anaesthesia (NORA) is a rapidly growing and important area of anaesthesia care. We would contend that anaesthesia informatics principles and innovations that have been widely applied in numerous diverse domains could be successfully applied in NORA environments, resulting in significant improvements in anaesthesia care delivery.

Recent findings

We highlight key recent studies from the perioperative and informatics literature, placing each in the context of how it has, or how it may conceivably be applied to, improved NORA care.

There is significant opportunity for anaesthesiologists and clinical informaticians to collaborate and apply major advances in the perioperative informatics field to NORA environments, particularly given rapid recent changes in the field during the COVID-19 epidemic. Given the complexity of NORA patients and care delivered in NORA environments, applied clinical informatics has the potential to drastically improve care delivered.
Substance Use Disorders in Recently Hospitalized Patients With Cirrhosis
Authors: Haque Lamia Y. , Jakab Simona , Deng Yanhong , Ciarleglio Maria M. , Tetrault Jeanette M.
Published: June 2020

Objectives:

Cirrhosis is often a consequence of substance use disorders (SUD) and can lead to significant morbidity, mortality, and hospitalizations. We aimed to determine presence and impact of SUD in recently hospitalized patients with cirrhosis, which has not been previously described.

Methods:

This is a retrospective study of consecutive patients with cirrhosis seen at a post-discharge hepatology clinic. The presence of clinically-recognized SUD and documented establishment of addiction treatment, as noted in routine clinical care, was determined through medical record review. Number of hospitalizations, 30-day readmissions, and all-cause mortality at 1 year were also examined.

Results:

Among 99 patients, 72% were male and the median age was 55 years. The most common etiologies of cirrhosis were alcohol-related liver disease and hepatitis C infection. Alcohol use disorder was documented in 71%. Nearly all patients with clinically-recognized SUD underwent social work evaluation during hospitalization and 65% were referred to addiction treatment. Establishment of addiction care at follow up was documented in 35%. Documented SUD was associated with greater odds of hospitalization over 1 year (adjusted odds ratio 5.77, 95% confidence interval [1.36, 24.49], P = 0.017), but not with 30-day readmissions or mortality.

Conclusions:

Clinically-recognized SUD was common in recently hospitalized patients with cirrhosis and associated with at least 1 other hospitalization within a year. Establishment of addiction treatment was documented in only a minority of patients. Further research is needed to determine whether patients with cirrhosis and SUD experience unique barriers to addiction treatment and if integration of SUD care in hepatology settings may be beneficial.
Bupivacaine Pharmacokinetics and Breast Milk Excretion of Liposomal Bupivacaine Administered After Cesarean Birth
Authors: Mustafa Hiba J. , Wong Henry L. , Al-Kofahi Mahmoud , Schaefer Malinda , Karanam Ashwin , Todd Michael M.
Published: June 2020

OBJECTIVE:

To evaluate bupivacaine concentrations in maternal plasma and transfer into breast milk in women undergoing liposomal bupivacaine infiltration in the transversus abdominis plane after cesarean birth.

METHODS:

Prospective cohort study of healthy pregnant women who underwent cesarean birth at term followed by a transversus abdominis plane block using 52 mg bupivacaine hydrochloride 0.25% (20 mL) and 266 mg liposomal bupivacaine 1.3% (20 mL). Simultaneous blood and milk samples were collected in a staggered fashion, three to four samples per patient at the following timepoints after block administration: 2, 6, 12, 24, 48, 72, and 96 hours. Quantification of bupivacaine was performed by liquid chromatography–tandem mass spectrometry. Neonatal drug exposure was modeled by calculating milk/plasma area under the curve (AUC) ratios, neonatal dosage, and relative neonatal dosage of bupivacaine at each sampling time.

RESULTS:

Thirty patients were enrolled. Concentrations in breast milk peaked at 6 hours (mean 58 ng/mL), followed by constant and steady decline to low levels at 96 hours (mean 5.2 ng/mL). Maternal plasma concentrations had two peaks, first at 6 hours (mean 155.9 ng/mL) and then at 48 hours (mean 225.8 ng/mL), followed by steady decline. Milk/plasma AUC0-t ratios ranged between AUC0-2 of 0.45 (80% CI 0.38–0.52) and AUC0-96 of 0.15 (80% CI 0.14–0.17). Neonatal dosage ranged between a mean of 355.9 ng/kg at 0–2 hours and a mean of 15,155.4 ng/kg at 0–96 hours. Relative neonatal dosage was less than 1% at all time intervals. No serious adverse reactions occurred in any neonate.

CONCLUSION:

Bupivacaine is excreted in breast milk after local infiltration of liposomal bupivacaine and bupivacaine hydrochloride mixture into transversus abdominis plane blocks after cesarean birth. Relative neonatal dosages of less than 1% (less than 10% is considered to be unlikely to be of clinical concern) suggest minimal risks for breastfeeding healthy, term neonates after the administration of this combination of local anesthetics to mothers.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT03526419.
A Low-Cost Platform for Laparoscopic Simulation Training
Authors: Ulrich Amanda P. , Cho Maureen Y. , Lam Clarissa , Lerner Veronica T.
Published: June 2020

BACKGROUND:

With the new requirement for Fundamentals of Laparoscopic Surgery certification among graduating obstetrics and gynecology residents, there has been an increased interest in simulation training. The Fundamentals of Laparoscopic Surgery curriculum uses a commercial laparoscopic box trainer to practice and assess laparoscopic skills. We created a low-cost, space-efficient, portable and versatile training platform that allows for the breakdown of complex tasks, and we studied its user acceptability.

METHOD:

A rectangular piece of pine wood purchased at a hardware store was used as a base; metal eye hooks were used as ports, and a blueprint was created to simulate placement of Fundamentals of Laparoscopic Surgery inserts. In addition to the Fundamentals of Laparoscopic Surgery skills, this platform can be used for any laparoscopic task (such as hysterectomy or cuff closure). Additionally, this platform can be used with or without a camera to allow for task breakdown into simpler components for faster learning.

EXPERIENCE:

A usability and acceptability survey was administered to a convenient sample of faculty and trainees. Trainees and faculty responded favorably to the model. Residents, fellows, and attendings felt that the laparoscopic platform closely simulated the feel of performing live laparoscopy surgery.

CONCLUSION:

This is a novel low-cost laparoscopic platform to add to the gynecologic surgical education simulation toolkit.
Cost of Elective Labor Induction Compared With Expectant Management in Nulliparous Women
Authors: Einerson Brett D. , Nelson Richard E. , Sandoval Grecio , Esplin M. Sean , Branch D. Ware , Metz Torri D. , Silver Robert M. , Grobman William A. , Reddy Uma M. , Varner Michael ,   for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network
Published: June 2020

OBJECTIVE:

To compare the actual health-system cost of elective labor induction at 39 weeks of gestation with expectant management.

METHODS:

This was an economic analysis of patients enrolled in the five Utah hospitals participating in a multicenter randomized trial of elective labor induction at 39 weeks of gestation compared with expectant management in low-risk nulliparous women. The entire trial enrolled more than 6,000 patients. For this subset, 1,201 had cost data available. The primary outcome was relative direct health care costs of maternal and neonatal care from a health system perspective. Secondary outcomes included the costs of each phase of maternal and neonatal care. Direct health system costs of maternal and neonatal care were measured using advanced costing analytics from the time of randomization at 38 weeks of gestation until exit from the study up to 8 weeks postpartum. Costs in each randomization arm were compared using generalized linear models and reported as the relative cost of induction compared with expectant management. With a fixed sample size, we had adequate power to detect a 7.3% or greater difference in overall costs.

RESULTS:

The total cost of elective induction was no different than expectant management (mean difference +4.7%; 95% CI −2.1% to +12.0%; P=.18). Maternal outpatient antenatal care costs were 47.0% lower in the induction arm (95% CI −58.3% to −32.6%; P<.001). Maternal inpatient intrapartum and delivery care costs, conversely, were 16.9% higher among women undergoing labor induction (95% CI +5.5% to +29.5%; P=.003). Maternal inpatient postpartum care, maternal outpatient care after discharge, neonatal hospital care, and neonatal care after discharge did not differ between arms.

CONCLUSION:

Total costs of elective labor induction and expectant management did not differ significantly. These results challenge the assumption that elective induction of labor leads to significant cost escalation.
Essentials in Minimally Invasive Gynecology Manual Skills Construct Validation Trial
Authors: Munro Malcolm G. , Advincula Arnold P. , Banks Erika H. , Auguste Tamika C. , Chahine E. Britton , Grace Chen Chi Chiung , Curlin Howard L. , Jorgensen Elisa M. , Kim Jin Hee , King Cara R. , Lucas Joelle , Milad Magdy P. , Mourad Jamal , Siedhoff Matthew T. , Solnik M. Jonathon , Destephano Christopher C. , Thayn Kim ,   for the Essentials in Minimally Invasive Gynecology (EMIG) Steering Committee
Published: June 2020

OBJECTIVE:

To establish validity evidence for the Essentials in Minimally Invasive Gynecology laparoscopic and hysteroscopic simulation systems.

METHODS:

A prospective cohort study was IRB approved and conducted at 15 sites in the United States and Canada. The four participant cohorts based on training status were: 1) novice (postgraduate year [PGY]-1) residents, 2) mid-level (PGY-3) residents, 3) proficient (American Board of Obstetrics and Gynecology [ABOG]–certified specialists without subspecialty training); and 4) expert (ABOG-certified obstetrician–gynecologists who had completed a 2-year fellowship in minimally invasive gynecologic surgery). Qualified participants were oriented to both systems, followed by testing with five laparoscopic exercises (L-1, sleeve-peg transfer; L-2, pattern cut; L-3, extracorporeal tie; L-4, intracorporeal tie; L-5, running suture) and two hysteroscopic exercises (H-1, targeting; H-2, polyp removal). Measured outcomes included accuracy and exercise times, including incompletion rates.

RESULTS:

Of 227 participants, 77 were novice, 70 were mid-level, 33 were proficient, and 47 were experts. Exercise times, in seconds (±SD), for novice compared with mid-level participants for the seven exercises were as follows, and all were significant (P<.05): L-1, 256 (±59) vs 187 (±45); L-2, 274 (±38) vs 232 (±55); L-3, 344 (±101) vs 284 (±107); L-4, 481 (±126) vs 376 (±141); L-5, 494 (±106) vs 420 (±100); H-1, 176 (±56) vs 141 (±48); and H-2, 200 (±96) vs 150 (±37). Incompletion rates were highest in the novice cohort and lowest in the expert group. Exercise errors were significantly less and accuracy was greater in the expert group compared with all other groups.

CONCLUSION:

Validity evidence was established for the Essentials in Minimally Invasive Gynecology laparoscopic and hysteroscopic simulation systems by distinguishing PGY-1 from PGY-3 trainees and proficient from expert gynecologic surgeons.
Potential impact of epidural labor analgesia on the outcomes of neonates and children
Authors: Liu Zhi-Hua , Wang Dong-Xin
Published: June 2020

This review summarizes recent evidences regarding the potential influences of epidural labor analgesia (ELA) on the outcomes of neonates and children. Terms and relevant words including “ELA,” “ELA and neonatal outcomes,” “ELA and children's development,” and “ELA and children's neurocognitive development” were used to search articles published in PubMed database up to October 2019. Original articles and reviews regarding potential influences of ELA on neonates and children were identified. Relevant references of the selected articles were also screened. The anesthetics used during ELA can be absorbed, enter the fetus, and produce neonatal depression; however, these effects are less severe than those during systematic opioid analgesia. The impact of anesthetic exposure during ELA on children's neurodevelopment has not been fully studied, but would be mild if any. ELA increases the risk of intrapartum maternal fever; the latter may be harmful to neonatal outcomes. The use of ELA may increase birth injury by increasing instrumental delivery, although long-term adverse events are rare. On the other hand, ELA may reduce maternal depression and, thus, produce favorable effects on neurocognitive development in childhood; but evidences are still lacking in this aspect. ELA may produce both favorable and unfavorable effects on neonates and children. These effects should be discussed with parturient women before making decisions. The potential harmful effects should be carefully managed. The overall impacts of ELA on neonatal and children's outcomes need to be studied further.