bluuebunny/crossref_metadata_2025 huggingface dataset:
Antibiotic prescribing patterns in patients hospitalized with COVID-19: lessons from the first wave
Authors: O’Kelly Brendan , Cronin Colm , Connellan David , Griffin Sean , Connolly Stephen Peter , McGrath Jonathan , Cotter Aoife G , McGinty Tara , Muldoon Eavan G , Sheehan Gerard , Cullen Walter , Doran Peter , McHugh Tina , Vidal Louise , Avramovic Gordana , Lambert John S
Published: May 2021

Background

A high proportion of hospitalized patients with COVID-19 receive antibiotics despite evidence to show low levels of true bacterial coinfection.

Methods

A retrospective cohort study examining antibiotic prescribing patterns of 300 patients sequentially diagnosed with COVID-19. Patients were grouped into 3 sub-cohorts: Group 1 received no antibiotics, Group 2 received antibiotics for microbiologically confirmed infections and Group 3 was empirically treated with antibiotics for pneumonia. The primary aim was to identify factors that influenced prescription and continuation of antibiotics in Group 3. Secondary aims were to examine differences in outcomes between groups.

Results

In total, 292 patients were included (63 Group 1, 35 Group 2, 194 Group 3), median age was 60 years (IQR 44–76) and the majority were ethnically Irish (62%). The median duration of antibiotics was 7 days (IQR 5–10). In Group 3, factors associated with prescription IV antibiotics on admission were raised C-reactive protein (CRP) (P = 0.024), increased age (P = 0.023), higher quick SOFA (P = 0.016) score and fever >37.5 °C (P = 0.011). Factors associated with duration of antibiotic course were duration of hypoxia (P < 0.001) and maximum respiratory support requirement (P = 0.013). Twenty-one patients in Group 3 had one or more antibiotic escalation events, most (n = 139) had no escalation or de-escalation of therapy.

Conclusions

Duration of hypoxia and need for respiratory support may have acted as surrogate measures of improvement where usual response measures (CRP, neutrophilia, culture clearance) were absent. Continuous review of antibiotic prescriptions should be at the forefront of clinical management of hospitalized patients with COVID-19.
Novel welding distortion analysis method for large welded structures using orthotropic thermal expansion coefficients
Authors: Seo Hyun-Duk , Lee Jae Min
Published: May 2021

This paper proposes an effective numerical method to predict welding distortion for large welded structures. To predict welding distortions, inherent strain-based methods are computationally efficient and widely used in engineering fields. However, there are some drawbacks such as the generation of undesirable longitudinal forces and the use of vector-type input variables. Equivalent loads are derived through finite element formulation considering orthotropic thermal expansion conditions. Unlike previous methods, the proposed method predicts transverse shrinkage and angular distortion accurately, removing the undesirable longitudinal forces. In addition, scalar-type input variables are employed, which results in a convenient design procedure. The performance of the proposed method is verified through various examples including complex and large welded structures.
Charismatic Entrainment: How Brand Leaders and Consumers Co-Create Charismatic Authority in the Marketplace
Authors: Wieser Verena E , Luedicke Marius K , Hemetsberger Andrea
Published: May 2021

How do CEOs, entrepreneurs, managers, celebrity bloggers, and other brand leaders acquire charismatic authority in the marketplace? Grounded in a multi-perspective, in-depth case study of the charismatic CEO of an Austrian shoe manufacturer, this article introduces a sociocultural mechanism called charismatic entrainment. Charismatic entrainment involves brand leaders staging charismatic authority by promoting polarized worldviews and taking personal risks to demonstrate their ability to lead social change. It further involves consumer-followers publicly validating and consumer-critics challenging brand leaders’ claims to charismatic authority, encouraging further entrainment via their support, but also their criticism. Brand leaders, consumer-followers, and consumer-critics draw on social media, marketplace sentiments, and brand manifestations as entrainment resources to more effectively endow brand leaders with charismatic authority in the marketplace. The article contributes a market-based, multi-stakeholder—versus an organizational, leader-centric—theory of charisma co-creation to the literature on charismatic authority. It also adds to theories of iconic branding, risk consumption, and societal morality plays, sensitizing readers to the constructive but also destructive potential of market-based charisma co-creation.
Legal Pluralism and the Future of Personal Family Laws in Africa
Authors: Diala Anthony Chima
Published: May 2021

A notable aspect of Africa’s struggle with its colonial legacies is the co-existence of indigenous laws that emerged in agrarian settings with state laws that emerged in industrial settings. Given the dissonance in their origins, clashes frequently occur between traditionalists and change agents, especially over the property and succession rights of women, girls, and younger male children. Spurred by the judicial handling of these clashes, scholars categorise African customary laws into ‘official’ and ‘living’ versions. However, this categorisation does not account properly for the influence of globalisation on the normative behaviour of Africans. Based on multi-country field research, this article introduces adaptive legal pluralism as the framework for managing the co-existence of indigenous laws and state laws in sub-Saharan Africa. By explaining the influence of globalisation on the behaviour of people subject to indigenous laws, the article draws attention to the imitative character of normative interaction in this region. It presents adaptive legal pluralism as not only a crystal bowl for charting the future of indigenous family laws, but also the theoretical pathway to integrated state and indigenous laws.
Hubble Space Telescope[O iii] emission-line kinematics in two nearby QSO2s: a case for X-ray feedback
Authors: Trindade Falcão Anna , Kraemer S B , Fischer T C , Crenshaw D M , Revalski M , Schmitt H R , Maksym W P , Vestergaard M , Elvis M , Gaskell C M , Hamann F , Ho L C , Hutchings J , Mushotzky R , Netzer H , Storchi-Bergmann T , Turner T J , Ward M J
Published: May 2021

We present a dynamical study of the narrow-line regions in two nearby type 2 quasars (QSO2s). We construct dynamical models based on detailed photoionization models of the emission-line gas, including the effects of internal dust, to apply to observations of large-scale outflows from these active galactic nuclei (AGNs). We use Mrk 477 and Mrk 34 in order to test our models against recent Hubble Space Telescope (HST) Space Telescope Imaging Spectrograph (STIS) observations of [O iii] emission-line kinematics, since these AGNs possess more energetic outflows than found in Seyfert galaxies. We find that the outflows within 500 pc are consistent with radiative acceleration of dusty gas, however the outflows in Mrk 34 are significantly more extended and may not be directly accelerated by radiation. We characterize the properties of X-ray winds found from the expansion of [O iii]-emitting gas close to the black hole. We show that such winds possess the kinetic energy density to disturb [O iii] gas at ∼1.8 kpc, and have sufficient energy to entrain the [O iii] clouds at ∼1.2 kpc. Assuming that the X-ray wind possesses the same radial mass distribution as the [O iii] gas, we find that the peak kinetic luminosity for this wind is 2 per cent of Mrk 34’s bolometric luminosity, which is in the 0.5–5 per cent range required by some models for efficient feedback. Our work shows that, although the kinetic luminosity as measured from [O iii]-emitting gas is frequently low, X-ray winds may provide more than one order of magnitude higher kinetic power.
Mechanistic insights into translation inhibition by aminoglycoside antibiotic arbekacin
Authors: Parajuli Narayan Prasad , Mandava Chandra Sekhar , Pavlov Michael Y , Sanyal Suparna
Published: May 2021

How aminoglycoside antibiotics limit bacterial growth and viability is not clearly understood. Here we employ fast kinetics to reveal the molecular mechanism of action of a clinically used, new-generation, semisynthetic aminoglycoside Arbekacin (ABK), which is designed to avoid enzyme-mediated deactivation common to other aminoglycosides. Our results portray complete picture of ABK inhibition of bacterial translation with precise quantitative characterizations. We find that ABK inhibits different steps of translation in nanomolar to micromolar concentrations by imparting pleotropic effects. ABK binding stalls elongating ribosomes to a state, which is unfavorable for EF-G binding. This prolongs individual translocation step from ∼50 ms to at least 2 s; the mean time of translocation increases inversely with EF-G concentration. ABK also inhibits translation termination by obstructing RF1/RF2 binding to the ribosome. Furthermore, ABK decreases accuracy of mRNA decoding (UUC vs. CUC) by ∼80 000 fold, causing aberrant protein production. Importantly, translocation and termination events cannot be completely stopped even with high ABK concentration. Extrapolating our kinetic model of ABK action, we postulate that aminoglycosides impose bacteriostatic effect mainly by inhibiting translocation, while they become bactericidal in combination with decoding errors.
Integration of single-cell datasets reveals novel transcriptomic signatures of β-cells in human type 2 diabetes
Authors: Bosi Emanuele , Marselli Lorella , De Luca Carmela , Suleiman Mara , Tesi Marta , Ibberson Mark , Eizirik Decio L , Cnop Miriam , Marchetti Piero
Published: May 2021

Pancreatic islet β-cell failure is key to the onset and progression of type 2 diabetes (T2D). The advent of single-cell RNA sequencing (scRNA-seq) has opened the possibility to determine transcriptional signatures specifically relevant for T2D at the β-cell level. Yet, applications of this technique have been underwhelming, as three independent studies failed to show shared differentially expressed genes in T2D β-cells. We performed an integrative analysis of the available datasets from these studies to overcome confounding sources of variability and better highlight common T2D β-cell transcriptomic signatures. After removing low-quality transcriptomes, we retained 3046 single cells expressing 27 931 genes. Cells were integrated to attenuate dataset-specific biases, and clustered into cell type groups. In T2D β-cells (n = 801), we found 210 upregulated and 16 downregulated genes, identifying key pathways for T2D pathogenesis, including defective insulin secretion, SREBP signaling and oxidative stress. We also compared these results with previous data of human T2D β-cells from laser capture microdissection and diabetic rat islets, revealing shared β-cell genes. Overall, the present study encourages the pursuit of single β-cell RNA-seq analysis, preventing presently identified sources of variability, to identify transcriptomic changes associated with human T2D and underscores specific traits of dysfunctional β-cells across different models and techniques.
Cystatin C kidney functional reserve: a simple method to predict outcome in chronic kidney disease
Authors: Christiadi Daniel , Simpson Charles , O’brien Kate , Taylor Kylie , Luxton Grant , Rossleigh Monica , Erlich Jonathan , Endre Zoltán H
Published: May 2021

Background

Kidney functional reserve (KFR), the only clinical kidney stress test, is not routinely measured because the complexity of measurement has limited clinical application. We investigated the utility of plasma cystatin C (CysC) after oral protein loading (PL) to determine KFR in Stages 3 and 4 chronic kidney disease (CKD).

Methods

Following a 24-h low-protein diet, KFR was measured after oral protein by hourly plasma CysC and compared with simultaneous creatinine clearance (CrCl) and radionuclide 99technetium diethylenetriaminepentaacetatic acid (Tc-99m-DTPA) measured glomerular filtration rate (mGFR) measurement in an observational, single-centre cohort study of adults with CKD Stages 3 and 4. Subjects were followed for 3 years for fast (F) or slow (S) CKD progression, dialysis requirement or death or a combination of major adverse kidney events (MAKEs).

Result

CysC, CrCl and Tc-99m-DTPA mGFR measurements of KFR in 19 CKD Stage 3 and 21 CKD Stage 4 patients yielded good agreement. KFR was not correlated with baseline kidney function. Eight CKD Stage 3 (42%) and 11 CKD Stage 4 (52%) subjects reached their lowest serum CysC concentration 4 h after PL. CysC KFR and baseline serum creatinine (sCr) predicted death or dialysis or MAKE-F with a respective area under the curve (AUC)  of 0.73 [95% confidence interval (CI) 0.48–0.89] and 0.71 (95% CI 0.51–0.84). Including CysC KFR, age, baseline sCr and nadir CysC predicted a decrease in sCr-estimated GFR >1.2 mL/min/year (MAKE-S) with an AUC of 0.89.

Conclusions

Serial CysC avoided timed urine collection and radionuclide exposure and yielded equivalent estimates of KFR. Serial CysC may facilitate monitoring of KFR in clinical practice.
Predictors and outcomes of acute kidney injury during autologous stem cell transplantation in AL amyloidosis
Authors: Nader Ralph , Zhen Aileen , Angel-Korman Avital , Pavlovich Stephanie S , Pogrebinsky Alexander , Doros Gheorghe , Menn-Josephy Hanni , Stern Lauren , Sanchorawala Vaishali , Havasi Andrea
Published: May 2021

Background

Acute kidney injury (AKI) is a common complication after high-dose melphalan and autologous stem cell transplantation (HDM/SCT) in patients with light chain (AL) amyloidosis. However, its incidence, predictors and outcomes are not well known.

Methods

This observational study included 223 patients with AL amyloidosis who underwent HDM/SCT. AKI was defined as an increase in serum creatinine to ≥1.5 times the baseline occurring within the first 30 days of HDM/SCT.

Results

The median age was 58 years (range: 30–77). Kidney and cardiac involvement were present in 86.1% and 56.8%, respectively. The median estimated glomerular filtration rate (eGFR) was 83.5 mL/min/1.73 m2 (range: 9–213) and proteinuria was 2899 mg/day (range: 0–19 966). AKI occurred in 29.1% of patients. Dialysis was initiated in 15 patients (6.7%) and of these 12 (80%) were able to discontinue dialysis. Most of the episodes of AKI occurred within the first 2 weeks; with a median follow-up of 4.5 years (range: 0.1–16.5), AKI was associated with increased overall mortality [hazard rato (HR) = 4.53, 95% confidence interval (CI) 2–10.23]. The 10-year overall survival was 87.1% without AKI, versus 56.9% with AKI. AKI was also associated with an increased risk for end-stage kidney disease (ESKD) (HR = 4.6, 95% CI 1.44–14.38). The risk of developing ESKD at 10 years was 18.9% with AKI, versus 8.1% without AKI. Several risk factors were found and using multivariate logistic regression, a prediction model was developed that included three readily available variables: eGFR <60 mL/min/1.73 m2, interventricular septal thickness in diastole >12 mm and albumin <3 g/dL. This model was able to predict AKI development with an area under the curve of 0.8.

Conclusions

AKI is common in the post-HDM/SCT period and it leads to increased risk for ESKD and death. Our prediction model is an easily deployable tool in clinical settings as part of the discussion with patients who are being prepared for HDM/SCT.
Spatial concordance of DNA methylation classification in diffuse glioma
Authors: Verburg Niels , Barthel Floris P , Anderson Kevin J , Johnson Kevin C , Koopman Thomas , Yaqub Maqsood M , Hoekstra Otto S , Lammertsma Adriaan A , Barkhof Frederik , Pouwels Petra J W , Reijneveld Jaap C , Rozemuller Annemieke J M , Beliën Jeroen A M , Boellaard Ronald , Taylor Michael D , Das Sunit , Costello Joseph F , Vandertop William Peter , Wesseling Pieter , de Witt Hamer Philip C , Verhaak Roel G W
Published: May 2021

Background

Intratumoral heterogeneity is a hallmark of diffuse gliomas. DNA methylation profiling is an emerging approach in the clinical classification of brain tumors. The goal of this study is to investigate the effects of intratumoral heterogeneity on classification confidence.

Methods

We used neuronavigation to acquire 133 image-guided and spatially separated stereotactic biopsy samples from 16 adult patients with a diffuse glioma (7 IDH-wildtype and 2 IDH-mutant glioblastoma, 6 diffuse astrocytoma, IDH-mutant and 1 oligodendroglioma, IDH-mutant and 1p19q codeleted), which we characterized using DNA methylation arrays. Samples were obtained from regions with and without abnormalities on contrast-enhanced T1-weighted and fluid-attenuated inversion recovery MRI. Methylation profiles were analyzed to devise a 3-dimensional reconstruction of (epi)genetic heterogeneity. Tumor purity was assessed from clonal methylation sites.

Results

Molecular aberrations indicated that tumor was found outside imaging abnormalities, underlining the infiltrative nature of this tumor and the limitations of current routine imaging modalities. We demonstrate that tumor purity is highly variable between samples and explains a substantial part of apparent epigenetic spatial heterogeneity. We observed that DNA methylation subtypes are often, but not always, conserved in space taking tumor purity and prediction accuracy into account.

Conclusion

Our results underscore the infiltrative nature of diffuse gliomas and suggest that DNA methylation subtypes are relatively concordant in this tumor type, although some heterogeneity exists.
Potential Use of Adjuvant Bacteriophage Therapy With Debridement, Antibiotics, and Implant Retention Surgery to Treat Chronic Prosthetic Joint Infections
Authors: Doub James B , Ng Vincent Y , Johnson Aaron , Amoroso Anthony , Kottilil Shyamasundaran , Wilson Eleanor
Published: May 2021

The number of arthroplasties conducted annually continues to increase; however, approximately 1%–2% of all knee and hip arthroplasties will become infected. These prosthetic joint infections are costly, difficult to treat, and cause significant morbidity and mortality as a direct result of conventional surgical and medical managements. In this perspective, we discuss factors that make these infections arduous to treat as well as the potential use of adjuvant bacteriophage therapy with debridement, antibiotics, and implant retention surgery to cure these infections without removing the infected prosthesis. We also provide rationale as to why future clinical trials evaluating this novel therapeutic will need to be designed as noninferiority trials, and we compare this approach to 2-stage revision surgery. If bacteriophage therapy continues to show effectiveness, this could revolutionize the treatment of prosthetic joint infections and pioneer new treatments for similar infections.
Remdesivir Versus Standard-of-Care for Severe Coronavirus Disease 2019 Infection: An Analysis of 28-Day Mortality
Authors: Olender Susan A , Walunas Theresa L , Martinez Esteban , Perez Katherine K , Castagna Antonella , Wang Su , Kurbegov Dax , Goyal Parag , Ripamonti Diego , Balani Bindu , De Rosa Francesco G , De Wit Stéphane , Kim Shin-Woo , Diaz George , Bruno Raffaele , Mullane Kathleen M , Lye David Chien , Gottlieb Robert L , Haubrich Richard H , Chokkalingam Anand P , Wu George , Diaz-Cuervo Helena , Brainard Diana M , Lee I-Heng , Hu Hao , Lin Lanjia , Osinusi Anu O , Bernardino Jose I , Boffito Marta
Published: May 2021

Background

Remdesivir is approved by the US Food and Drug Administration for the treatment of patients hospitalized with coronavirus disease 2019 (COVID-19) and has been shown to shorten time to recovery and improve clinical outcomes in randomized trials.

Methods

This was the final day 28 comparative analysis of data from a phase 3, randomized, open-label study comparing 2 remdesivir regimens (5 vs 10 days, combined for this analysis [remdesivir cohort]) and a real-world retrospective longitudinal cohort study of patients receiving standard-of-care treatment (nonremdesivir cohort). Eligible patients, aged ≥18 years, had confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), oxygen saturation ≤94% on room air or required supplemental oxygen, with pulmonary infiltrates. Propensity score matching (up to 1:10 ratio) was used to ensure comparable populations. We assessed day 14 clinical recovery (determined using a 7-point ordinal scale) and day 28 all-cause mortality (coprimary endpoints).

Results

A total of 368 (remdesivir) and 1399 (nonremdesivir) patients were included in the matched analysis. The day 14 clinical recovery rate was significantly higher among the remdesivir versus the nonremdesivir cohort (65.2% vs 57.1%; odds ratio [OR], 1.49; 95% confidence interval [CI], 1.16–1.90; P = 0.002). The day 28 mortality rate was significantly lower in the remdesivir cohort versus the nonremdesivir cohort (12.0% vs 16.2%; OR, 0.67; 95% CI, 0.47–.95; P = .03).

Conclusions

Remdesivir was associated with significantly higher rates of day 14 clinical recovery, and lower day 28 mortality, compared with standard-of-care treatment in hospitalized patients with COVID-19. These data, taken together, support the use of remdesivir to improve clinical recovery and decrease mortality from SARS-CoV-2 infection.
Acute Liver Failure and Fever of Unknown Origin
Authors: Marryshow Terry A , McQuillen Daniel P , Wener Kenneth M , Freiman J Morgan
Published: May 2021

We describe a case of acute liver failure in a woman in whom a diagnosis was initially unable to be established. The patient rapidly deteriorated, requiring admission to the intensive care unit, and was placed under consideration for liver transplantation. On consultation with the infectious disease service, thorough history taking was performed that uncovered salient epidemiologic information pointing toward the eventual diagnosis of disseminated histoplasmosis. We discuss aspects of diagnosis and management, including the management of immune reconstitution syndrome which complicated treatment.
Prey selection of polar bears in Foxe Basin, NU, Canada: evidence of dietary flexibility in a specialized predator
Authors: Galicia M P , Thiemann G W , Dyck M G , Ferguson S H , Stirling I
Published: May 2021

Ecological flexibility of a species reflects its ability to cope with environmental change. Although polar bears (Ursus maritimus) are experiencing changes in foraging opportunities due to sea ice loss, regional prey availability and environmental conditions will influence the rate and severity of these effects. We examined changes in polar bear diet and the influence of sea ice characteristics in Foxe Basin over an 18-year period. We combined previous fatty acid data from bears harvested from 1999 to 2003 (n = 82) with additional data from 2010 to 2018 (n = 397). Polar bear diets were diverse; however, ringed seal (Pusa hispida) was the primary prey throughout the sample period. Prey contribution varied temporally and spatially, and by intrinsic factors, while the frequency of prey in diets varied over time suggesting that diet estimates reflect the variability in available prey. Bowhead whale (Balaena mysticetus), although still a minor dietary component, has more than doubled in frequency of occurrence in diets in recent years in association with increased scavenging opportunities. Higher dietary levels of beluga whale (Delphinapterus leucas) and harbour seal (Phoca vitulina) were linked to later breakup date suggesting heavier ice conditions may promote access to both prey species. The flexible foraging strategies of bears in Foxe Basin may help mitigate their vulnerability to changes in prey distribution and habitat conditions. Our results provide insights into the importance of alternative and supplemental food sources for polar bears during phenological changes in ice conditions that will likely have consequences to Arctic community structure as warming continues.
An assessment of the psychometric properties of the Stoplight Pain Scale in a Canadian paediatric emergency department
Authors: Ali Samina , Morrison Ellen , Shwetz Seyara , Yaskina Maryna , Rajagopal Manasi , Estey Andrea , Drendel Amy L
Published: May 2021

Objective

This study aimed to validate a novel, three faced, colour-coded, action-oriented tool: The Stoplight Pain Scale (SPS).

Methods

A prospective observational cohort study was conducted at a Canadian paediatric emergency department from November 2014 to February 2017. Patients aged 3 to 12 years and their caregivers were asked to rate pain using the SPS and the Faces Pain Scale-Revised (FPS-R). Pain was measured just before analgesia administration, 30 minutes after analgesia administration, and immediately following a painful procedure.

Results

A total of 227 patients were included; 26.9% (61/227) were 3 to 5 years old while 73.1% (166/227) were 6 to 12 years old. Using Cohen’s κ, agreement for SPS and FPS-R was ‘fair’ for children (0.28 [95% confidence interval {CI} 0.20 to 0.36]) and ‘poor’ for caregivers (0.14 [95% CI 0.07 to 0.21]), at initial measurement. The SPS had ‘fair’ agreement between child and caregiver scores, (0.37 [95% CI 0.27 to 0.47]), compared to FPS-R which showed ‘poor’ agreement (0.20 [95% CI 0.12 to 0.29]). Absolute agreement between child and caregiver SPS scores improved with repeat exposure; 30 minutes after analgesia administration, caregivers and children had fair agreement (κ=0.38, 95% CI 0.28 to 0.48); they had moderate agreement directly following painful procedures (κ=0.46, 95% CI 0.34 to 0.59). Overall, 72.4% (139/192) of children and 60.2% (118/196) of caregivers preferred SPS over FPS-R.

Conclusion

The SPS demonstrates fair agreement with FPS-R for children and fair-moderate agreement between children and caregivers; agreement improved with repeat use. The SPS is simple and easy to use; it may have a role in empowering direct child and family involvement in pain management.
Loss ofTHIN EXINE2disrupts multiple processes in the mechanism of pollen exine formation
Authors: Wang Rui , Dobritsa Anna A.
Published: May 2021

Exine, the sporopollenin-based outer layer of the pollen wall, forms through an unusual mechanism involving interactions between two anther cell types: developing pollen and tapetum. How sporopollenin precursors and other components required for exine formation are delivered from tapetum to pollen and assemble on the pollen surface is still largely unclear. Here, we characterized an Arabidopsis (Arabidopsis thaliana) mutant, thin exine2 (tex2), which develops pollen with abnormally thin exine. The TEX2 gene (also known as REPRESSOR OF CYTOKININ DEFICIENCY1 (ROCK1)) encodes a putative nucleotide–sugar transporter localized to the endoplasmic reticulum. Tapetal expression of TEX2 is sufficient for proper exine development. Loss of TEX2 leads to the formation of abnormal primexine, lack of primary exine elements, and subsequent failure of sporopollenin to correctly assemble into exine structures. Using immunohistochemistry, we investigated the carbohydrate composition of the tex2 primexine and found it accumulates increased amounts of arabinogalactans. Tapetum in tex2 accumulates prominent metabolic inclusions which depend on the sporopollenin polyketide biosynthesis and transport and likely correspond to a sporopollenin-like material. Even though such inclusions have not been previously reported, we show mutations in one of the known sporopollenin biosynthesis genes, LAP5/PKSB, but not in its paralog LAP6/PKSA, also lead to accumulation of similar inclusions, suggesting separate roles for the two paralogs. Finally, we show tex2 tapetal inclusions, as well as synthetic lethality in the double mutants of TEX2 and other exine genes, could be used as reporters when investigating genetic relationships between genes involved in exine formation.
The COVID-19 pandemic and its impact on mental health services: the provider perspective
Authors: Nair Sapna , Kannan Preethi , Mehta Kaustav , Raju Ananya , Mathew John , Ramachandran Padmavati
Published: May 2021

Background

The impact of coronavirus disease 2019 on mental health of populations is in focus recently but few studies focus on service adaptations to ensure care provision for the mentally ill. In India, where community-based mental healthcare is led by non-government organizations (NGOs), this is a crucial time to gather evidence on how these organizations adapted to the challenges.

Methods

We explored provider perspectives in an NGO providing mental health services to communities using in-depth interviews and a focus group discussion to understand the impact on services and adaptations during the COVID 19 pandemic.

Results

Three elements of service provision were highlighted: established relationships with communities, responsiveness to the patient needs, and resilience in ensuring continuity. Responding to the end-to-end care needs of the clients and continual adaptations were vital for ensuring continued services. Telemedicine enabled expansion of service and clientele as well as efficiency, but there were issues of casualization of therapy and poor privacy.

Conclusions

The study provides an understanding of adaptations to ensure continuity of care to mentally ill during disruptions. Insights from strategies are crucial to help plan for resilient community-based mental health care services.
Trust registries, discretionary trusts and beneficial owners: a dubious gift from civil lawyers?
Authors: Glover John
Published: May 2021

Registries have lately been introduced in several jurisdictions for the purpose of identifying the beneficial owners of trust property. This article examines the design of the UK registry from an Australian perspective. Problems of coherence and over-inclusion are identified in the way that the registry applies to discretionary trusts. “Control over the trust” senses of “beneficial owner” are examined in the light of good drafting criteria and authoritative statements of trusts law. Whether legislation enacting the registry will withstand future judicial scrutiny is questioned.
A Veterans' Bachelor of Science in Nursing Initiative: Ten Valuable Tips
Authors: Cox Catherine Wilson , Wiersma Gretchen Michele
Published: May 2021

This article describes a funded grant project whereby 10 tips are shared for those considering starting a veterans' bachelor of science in nursing initiative: secure the support of the institution; establish a point person for the initiative; maximize student success resources; acknowledge past academic work and military experience; hire prior-service Armed Forces Nurse Corps officers as faculty; deliver training opportunities for nonmilitary faculty to learn about veterans; offer students the opportunity to learn and socialize with their noncivilian peers; capitalize on the assets veterans bring to the classroom; provide a structured learning environment; and generate data-based publications.
Promoting high-functioning mental health treatment teams in the context of low staffing ratios
Authors: Miller Christopher J. , Sullivan Jennifer L. , Harvey Kimberly L. L. , Williamson Alicia K. , Stadnick Nicole A.
Published: May 2021

Background

Many previous studies of health care teamwork have taken place in clinical teams with high staffing ratios (i.e., high ratios of staff to patients).

Purpose

The aim of this study was to identify clinicians’ viewpoints of foundational resources necessary to support good team functioning in the context of low staffing ratios.

Methodology

We used administrative data, validated with local mental health chiefs, to identify mental health teams that had achieved high team functioning despite low staffing ratios in U.S. Department of Veterans Affairs medical centers. Guided by a recently developed model of team effectiveness, the Team Effectiveness Pyramid, we conducted qualitative interviews with 21 team members across three teams within two medical centers. Interview questions focused on the resources needed to support good team functioning despite low staffing ratios. We used directed content analysis to analyze results.

Results

We found there were several domains of relevant resources: material, staffing, temporal, organizational, and psychological. These represent an expansion of the domains originally included in the Team Effectiveness Pyramid.

Conclusions

Within the five domains, we identified key tensions to be addressed when forming teams, including the balances between providing care for new versus established patients, emphasizing shared caseloads within the team versus matching patients to clinicians based on individual expertise, and establishing reporting structures by clinical discipline versus team membership.

Practice Implications

Establishing high-functioning health care teams in the context of low staffing ratios requires attention to key resource domains and fundamental trade-offs in how teams are structured.
Caring for Pediatric Hidradenitis Suppurativa Patients in the Emergency Department
Authors: Patel Kavina , Leszczynska Maria , Peña-Robichaux Venessa , Diaz Lucia Z.
Published: May 2021

Hidradenitis suppurativa (HS) is a chronic and recurrent inflammatory skin condition resulting in the formation of nodules, sinus tracts, and abscesses in intertriginous areas. We provide recommendations for the management of children presenting to the emergency department with acute HS flares, based on a review of literature and insights from our own clinical experience. The purpose of the recommendations is to educate clinicians on specific considerations that should be made when caring for children with HS.
Cranial Suture Evaluation in Pediatric Head Trauma
Authors: Kriss Spencer , Morris James , Martich Vesna
Published: May 2021

Objectives

Pediatric skull fracture association with the cranial sutures (crossing, widening, or contacting 2 or more cranial sutures) is suggestive of abusive injury. We studied the efficacy of head computed tomography (CT) versus skull radiographs in identifying pediatric skull fracture association with cranial sutures and reviewed head CT literature recommendations for pediatric head trauma.

Methods

Retrospective review was performed of skull radiographs and head CT at a tertiary care, free-standing children's hospital (2012–2019). Statistical 2-proportion Z test determined efficacy of head CT versus skull radiographs in assessing cranial suture involvement with fractures.

Results

Forty-seven children with 56 abusive skull fractures and 47 children with 54 accidental skull fractures were evaluated, ages 1 to 36 months. Of the 110 total skull fractures evaluated, 51 abusive and 41 accidental skull fractures had terminal ends contacting cranial sutures for a total of 92 (84%). Twelve abusive fractures (24%) crossed sutures; no accidental fractures crossed sutures (P < 0.01). Of the 12 abusive cases with skull fractures that crossed sutures, 7 were definitively identified only on CT (P < 0.01). Widened sutures were documented in 4 (8%) of the abusive cases with skull fracture; none in the accidental cases. All 4 of these cases were equally identified on both skull radiography and CT imaging. In 21 of 47 abusive versus 5 of 47 accidental cases, CT identified skull fractures lines that extended to cranial sutures that were not definitive on skull radiography (P = 0.00022).

Conclusions

Cranial suture involvement with pediatric skull fractures is common. Head CT significantly aided in the identification of skull fractures contacting and crossing cranial sutures in abusive cases, supporting eliminating concurrent skull radiographs.
Biomechanical demands of percussive techniques in the context of early stone toolmaking
Authors: Macchi R. , Daver G. , Brenet M. , Prat S. , Hugheville L. , Harmand S. , Lewis J. , Domalain M.
Published: May 2021

Recent discoveries in archaeology and palaeoanthropology highlight that stone tool knapping could have emerged first within the generaAustralopithecusorKenyanthropusrather thanHomo. To explore the implications of this hypothesis determining the physical demands and motor control needed for performing the percussive movements during the oldest stone toolmaking technology (i.e. Lomekwian) would help. We analysed the joint angle patterns and muscle activity of a knapping expert using three stone tool replication techniques: unipolar flaking on the passive hammer (PH), bipolar (BP) flaking on the anvil, and multidirectional and multifacial flaking with free hand (FH). PH presents high levels of activity forBiceps brachiiand wrist extensors and flexors. By contrast, BP and FH are characterized by high solicitation of forearm pronation. The synergy analyses depict a high muscular and kinematic coordination. Whereas the muscle pattern is very close between the techniques, the kinematic pattern is more variable, especially for PH. FH displays better muscle coordination and conversely lesser joint angle coordination. These observations suggest that the transition from anvil and hammer to freehand knapping techniques in early hominins would have been made possible by the acquisition of a behavioural repertoire producing an evolutionary advantage that gradually would have been beneficial for stone tool production.
Fin sweep angle does not determine flapping propulsive performance
Authors: Zurman-Nasution Andhini N. , Ganapathisubramani Bharathram , Weymouth Gabriel D.
Published: May 2021

The importance of the leading-edge sweep angle of propulsive surfaces used by unsteady swimming and flying animals has been an issue of debate for many years, spurring studies in biology, engineering, and robotics with mixed conclusions. In this work, we provide results from three-dimensional simulations on single-planform finite foils undergoing tail-like (pitch-heave) and flipper-like (twist-roll) kinematics for a range of sweep angles covering a substantial portion of animals while carefully controlling all other parameters. Our primary finding is the negligible 0.043 maximum correlation between the sweep angle and the propulsive force and power for both tail-like and flipper-like motions. This indicates that fish tails and mammal flukes with similar range and size can have a large range of potential sweep angles without significant negative propulsive impact. Although there is a slight benefit to
avoiding
large sweep angles, this is easily compensated by adjusting the fin’s motion parameters such as flapping frequency, amplitude and maximum angle of attack to gain higher thrust and efficiency.
Fractional-order viscoelastic model of musculoskeletal tissues: correlation with fractals
Authors: Guo Jianqiao , Yin Yajun , Peng Gang
Published: May 2021

Self-similar fractals are widely obtained from biomaterials within the human musculoskeletal system, and their viscoelastic behaviours can be described by fractional-order derivatives. However, existing viscoelastic models neglect the internal correlation between the fractal structure of biomaterials and their fractional-order temporal responses. We further expanded the fractal hyper-cell (FHC) viscoelasticity theory to investigate this spatio-temporal correlation. The FHC element was first compared with other material elements and spring–dashpot viscoelastic models, thereby highlighting its discrete and fractal nature. To demonstrate the utility of an FHC, tree-like, ladder-like and triangle-like FHCs were abstracted from human cartilage, tendons and muscle cross-sections, respectively. The duality and symmetry of the FHC element were further discussed, where operating the duality transformation generated new types of FHC elements, and the symmetry breaking of an FHC altered its fractional-order viscoelastic responses. Thus, the correlations between the staggering patterns of FHCs and their rheological power-law orders were established, and the viscoelastic behaviour of the multi-level FHC elements fitted well in stress relaxation experiments at both the macro- and nano-levels of the tendon hierarchy. The FHC element provides a theoretical basis for understanding the connections between structural degeneration of bio-tissues during ageing or disease and their functional changes.
Superconductivity and nucleation from fractal anisotropy and product-like fractal measure
Authors: El-Nabulsi Rami Ahmad
Published: May 2021

Superconductivity is analysed based on the product-like fractal measure approach with fractal dimensionαintroduced by Li and Ostoja-Starzewski in their attempt to explore anisotropic fractal elastic media. Our study shows the emergence of a massless state at the boundary of the superconductor and the simultaneous occurrence of isothermal and adiabatic processes in the superconductor depending on the position of the electrons. Several physical quantities were found to be position-dependent comparable with those arising in heavy doping andp–njunction. At the boundary of the superconductor, a shrinkage of the magnetic field was observed, leading to a scenario equivalent to the Meissner–Ochsenfeld effect. An enhancement of the London penetration depth is revealed and such an improvement was observed in pnictides at the onset of commensurate spin-density-wave order inside the superconducting phase at zero temperature. The Bardeen–Cooper–Schrieffer theory was also analysed and the appearance of zero-energy states is detected. Nucleation of superconductivity in a bulk was also studied. The system acts as a quantum damped harmonic oscillator and our analysis showed that type-I superconductivity occurs whenκ<2/(1+α), whereas type II occurs forκ>2/(1+α), whereκis the Ginzburg–Landau parameter. The transition at the passage from the ‘genuine’ to the ‘intermediate’ type-I estimates0.767767<α≤1.
Another perspective on elastic and plastic anisotropy of textured metals
Authors: Zubelewicz Aleksander
Published: May 2021

In textured metals, the elastic directionality reflects the crystallographic organization, while the plastic flow follows the preferential pathways of deformation beyond the elastic limit. In here, the elastic and plastic anisotropies are characterized by two observers. One of them is immersed into the material and, while there, is unaware of the texture-induced reorganizations, still, is in a position to detect elastic distortions. Another observer is located outside the material, monitors the elastic strain too and realizes that texture makes the elastic responses directional. The externally measured elastic strain will be called the texture strain. The key idea is to determine the transformation rules that correlate the elastic strains seen by the two observers. In what follows, the rules are derived by projecting the texture-distorted basis onto the basis of the external observations. It turns out that the rules reproduce directionality of elastic properties and include constraints that result from the limits imposed by the yield stress. The elastic anisotropy is linked to the strain that is free of the plasticity-induced constraints. By contrast, the constraints enable complete characterization of the plastic flow directionality. The concept is derived in the framework of tensor representations discussed in the electronic supplementary material.
Non-vertical cultural transmission, assortment and the evolution of cooperation
Authors: Cohen Dor , Lewin-Epstein Ohad , Feldman Marcus W. , Ram Yoav
Published: May 2021

Cultural evolution of cooperation under vertical and non-vertical cultural transmission is studied, and conditions are found for fixation and coexistence of cooperation and defection. The evolution of cooperation is facilitated by its horizontal transmission and by an association between social interactions and horizontal transmission. The effect of oblique transmission depends on the horizontal transmission bias. Stable polymorphism of cooperation and defection can occur, and when it does, reduced association between social interactions and horizontal transmission evolves, which leads to a decreased frequency of cooperation and lower population mean fitness. The deterministic conditions are compared to outcomes of stochastic simulations of structured populations. Parallels are drawn with Hamilton’s rule incorporating relatedness and assortment.
Complexity and diversity of motion amplification and control strategies in motile carnivorous plant traps
Authors: Bauer Ulrike , Müller Ulrike K. , Poppinga Simon
Published: May 2021

Similar to animals, plants have evolved mechanisms for elastic energy storage and release to power and control rapid motion, yet both groups have been largely studied in isolation. This is exacerbated by the lack of consistent terminology and conceptual frameworks describing elastically powered motion in both groups. Iconic examples of fast movements can be found in carnivorous plants, which have become important models to study biomechanics, developmental processes, evolution and ecology. Trapping structures and processes vary considerably between different carnivorous plant groups. Using snap traps, suction traps and springboard-pitfall traps as examples, we illustrate how traps mix and match various mechanisms to power, trigger and actuate motions that contribute to prey capture, retention and digestion. We highlight a fundamental trade-off between energetic investment and movement control and discuss it in a functional-ecological context.
Experimental evolution can enhance benefits of rhizobia to novel legume hosts
Authors: Quides Kenjiro W. , Weisberg Alexandra J. , Trinh Jerry , Salaheldine Fathi , Cardenas Paola , Lee Hsu-Han , Jariwala Ruchi , Chang Jeff H. , Sachs Joel L.
Published: May 2021

Legumes preferentially associate with and reward beneficial rhizobia in root nodules, but the processes by which rhizobia evolve to provide benefits to novel hosts remain poorly understood. Using cycles of
in planta
and
in vitro
evolution, we experimentally simulated lifestyles where rhizobia repeatedly interact with novel plant genotypes with which they initially provide negligible benefits. Using a full-factorial replicated design, we independently evolved two rhizobia strains in associations with each of two
Lotus japonicus
genotypes that vary in regulation of nodule formation. We evaluated phenotypic evolution of rhizobia by quantifying fitness, growth effects and histological features on hosts, and molecular evolution via genome resequencing. Rhizobia evolved enhanced host benefits and caused changes in nodule development in one of the four host–symbiont combinations, that appeared to be driven by reduced costs during symbiosis, rather than increased nitrogen fixation. Descendant populations included genetic changes that could alter rhizobial infection or proliferation in host tissues, but lack of evidence for fixation of these mutations weakens the results. Evolution of enhanced rhizobial benefits occurred only in a subset of experiments, suggesting a role for host–symbiont genotype interactions in mediating the evolution of enhanced benefits from symbionts.
Class-Modeling of Septic Shock With Hyperdimensional Computing
Authors: Watkinson Neftali , Givargis Tony , Joe Victor , Nicolau Alexandru , Veidenbaum Alexander
Published: May 2021

Sepsis arises when a patient’s immune system has an extreme reaction to an infection. This is followed by septic shock if damage to organ tissue is so extensive that it causes a total systemic failure. Early detection of septic shock among septic patients could save critical time for preparation and prevention treatment. Due to the high variance in symptoms and patient state before shock, it is challenging to create a protocol that would be effective across patients. However, since septic shock is an acute change in patient state, modeling patient stability could be more effective in detecting a condition that departs from it. In this paper we present a one-class classification approach to septic shock using hyperdimensional computing. We built various models that consider different contexts and can be adapted according to a target priority. Among septic patients, the models can detect septic shock accurately with 90% sensitivity and overall accuracy of 60% of the cases up to three hours before the onset of septic shock, with the ability to adjust predictions according to incoming data. Additionally, the models can be easily adapted to prioritize sensitivity (increase true positives) or specificity (decrease false positives).