bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictive value of systemic inflammatory response‐related indices for survival in tongue cancer
Authors: Li Liangbo , Li Zhanbo , Feng Xuanqi , Yang Zhao , Jin Nenghao , Zhu Liang , Zang Xiaoyi , Xing Lejun , Ren Yipeng , Zhang Haizhong
Published: August 2022

Objectives

We assessed the potential prognostic significance of the preoperative systemic inflammation index, platelet‐to‐lymphocyte ratio, and neutrophil‐to‐lymphocyte ratio in patients who underwent surgical resection.

Subjects and Methods

This retrospective study included 224 patients with clinicopathologically confirmed squamous carcinoma of the tongue who underwent surgery between August 2009 and December 2017. The optimal cut‐off values for the indices were determined by receiver operating characteristic curves. Correlations between the indices and clinicopathological variables were determined by Pearson chi‐square or Fisher exact tests. The Kaplan–Meier test was used to compare overall survival between groups (high and low values); the log‐rank or Breslow test was used to assess differences in survival. Univariate and multivariate Cox regression models were used to analyze predictive values of the indices as independent indicators of overall survival. Bilateral p values of <0.05 were considered statistically significant.

Results

Significant association was found between the indices and sex, tissue grade, tumor location, and lymph nodes metastases (p < 0.05). On Kaplan–Meier analysis, patients with lower values of the indices had longer overall survival (p < 0.05). Univariate and multivariate Cox regression models identified age, lymph node metastases, and neutrophil‐to‐lymphocyte ratio as independent predictors of overall survival.

Conclusion

The studied indices have potential prognostic significance in patients with squamous tongue cancer.
Virtual reality in pediatrics, effects on pain and anxiety: A systematic review and meta‐analysis update
Authors: Tas Floris Q. , van Eijk Cynthia A. M. , Staals Lonneke M. , Legerstee Jeroen S. , Dierckx Bram
Published: August 2022

Introduction

Medical procedures are often accompanied by pain and anxiety in pediatric patients. A relatively new technique to reduce pediatric pain and anxiety is virtual reality. Virtual reality is both applied as a distraction tool and as an exposure tool to prepare patients for medical procedures. Research into the application of virtual reality in medical settings is rapidly evolving. This meta‐analysis is an update of the meta‐analysis of Eijlers et al. investigating the effectiveness of virtual reality as an intervention tool on pain and anxiety in pediatric patients undergoing medical procedures.

Methods

We searched the databases Embase, Medline, Web of Science Core Collection, Cochrane Central Register of Controlled Trials and PsycINFO. For each of these databases, different search strategies were developed. The search period from the meta‐analysis from Eijlers et al., reaching until April 2018, was extended to December 2020. Pain and anxiety outcomes during medical procedures were compared for virtual reality and standard care conditions for various medical procedures.

Results

The search yielded 1824 articles, of which 13 met our inclusion criteria. Combined with 13 articles of Eijlers' review study, this resulted in 26 articles. Virtual reality was applied as distraction (n = 23) during medical procedures or as exposure (n = 4) before medical procedures. The effect of virtual reality distraction was mostly studied in patients during venous access (n = 10). The overall weighted standardized mean difference for virtual reality distraction was −0.67 (95% CI, −0.89 to −0.45; p < .001) on patient‐reported pain (based on 21 studies) and −0.74 (95% CI, −1.00 to −0.48; p < .001) on patient‐reported anxiety (based on 10 studies). The effect of virtual reality as an exposure tool on patient‐reported anxiety was significant too (standardized mean difference = −0.58; 95% CI, −1.15 to −0.01; p < .05).

Discussion

The current updated systematic review and meta‐analysis indicates that virtual reality is a useful tool to reduce pain and anxiety in pediatric patients undergoing a range of medical procedures as it significantly decreases pain and anxiety outcomes when compared to care as usual.
Comparison of Phosphorescent Pt(II) Complexes with C^N^N vs N^N^N Chelators and Caffeine‐Based NHC‐co‐ligands†
Authors: Kirse Thomas M. , Lüke Joschua , Maisuls Iván , Hepp Alexander , Strassert Cristian A.
Published: August 2022

In this work, we explored coordination compounds featuring caffeine‐based carbene co‐ligands and tridentate dianionic pincer luminophores derived from 2,6‐bis(1H‐1,2,4‐triazol‐5‐yl)pyridine (N), as well as from 2‐phenyl‐6‐(1H‐1,2,4‐triazol‐5‐yl)pyridine (C), bearing either Ad (adamantyl) or tBu (tertiary butyl) substituents. The new 2‐phenyl‐6‐(1H‐1,2,4‐triazol‐5‐yl)pyridine‐based ligand precursors along with four Pt(II) complexes, namely Pt(C‐tBu), Pt(C‐Ad), Pt(N‐tBu) and Pt(N‐Ad) were characterized. Further on, the influence of the different substituents at the chelating luminophores and of the caffeine‐based NHC‐co‐ligand on the photophysical properties (including photoluminescence quantum yields (ΦL), excited‐state lifetimes (τ), radiative (kr), and non‐radiative (knr) deactivation rate constants) was assessed in fluid solutions at room temperature (RT) and in frozen glassy matrices at 77 K. All four luminophores perform equivalently well within the experimental uncertainty. In deoxygenated fluid solutions at RT, photoluminescence quantum yields reaching up to 24 ± 2% and excited‐state lifetimes of around 12 μs were found. The generally long excited‐state lifetimes and only minor blue shift upon cooling to 77 K along with mostly well‐resolved vibrational progressions point to metal‐perturbed ligand‐centered excited states. Notably, the yield of the complexation reaction in case of Pt(C‐tBu) and Pt(C‐Ad) was almost two times higher compared to Pt(N‐tBu) and Pt(N‐Ad). Cyclometallation is not an essential feature to achieve high photoluminescence quantum yields, but it can improve the synthetic efficiency. In summary, it can be observed that coordination chemical concepts based on natural products can lead to stable phosphorescent species with interesting excited‐state properties.
Increased risk of emergency department presentations for bronchiolitis in infants exposed to air pollution
Authors: Gallo Elisa , Bressan Silvia , Baraldo Simonetta , Bottigliengo Daniele , Geremia Sara , Acar Aslihan Senturk , Zagolin Luca , Marson Giovanna , Da Dalt Liviana , Gregori Dario
Published: August 2022

Air pollution has been linked to an increased risk of several respiratory diseases in children, especially respiratory tract infections. The present study aims to evaluate the association between pediatric emergency department (PED) presentations for bronchiolitis and air pollution. PED presentations due to bronchiolitis in children aged less than 1 year were retrospectively collected from 2007 to 2018 in Padova, Italy, together with daily environmental data. A conditional logistic regression based on a time‐stratified case‐crossover design was performed to evaluate the association between PED presentations and exposure to NO2, PM2.5, and PM10. Models were adjusted for temperature, relative humidity, atmospheric pressure, and public holidays. Delayed effects in time were evaluated using distributed lag non‐linear models. Odds ratio for lagged exposure from 0 to 14 days were obtained. Overall, 2251 children presented to the PED for bronchiolitis. Infants’ exposure to higher concentrations of PM10 and PM2.5 in the 5 days before the presentation to the PED increased the risk of accessing the PED by more than 10%, whereas high concentrations of NO2 between 2 and 12 days before the PED presentation were associated with an increased risk of up to 30%. The association between pollutants and infants who required hospitalization was even greater. A cumulative effect of NO2 among the 2 weeks preceding the presentation was also observed. In summary, PM and NO2 concentrations are associated with PED presentations and hospitalizations for bronchiolitis. Exposure of infants to air pollution could damage the respiratory tract mucosa, facilitating viral infections and exacerbating symptoms.
High biochar rates may suppress rice (Oryza sativa) growth by altering the ratios of C to N and available N to P in paddy soils
Authors: Nguyen Binh Thanh , Nguyen Vinh Ngoc , Nguyen Tong Xuan , Nguyen My Hoang , Dong Hao Phu , Dinh Gai Dai , Van Nguyen Nghia , Pham Tan‐Viet
Published: August 2022

Although most studies have indicated that biochar can boost rice (Oryza sativa) growth, the material may also suppress it, depending on ratios of carbon (C) to nitrogen (N) and available N to available phosphorous (P). The current study sought to examine the impacts of biochar on rice growth and to identify underlying mechanisms. A pot experiment was conducted using two soils of high (3.05%) and low (0.54%) organic carbon (OC) content, mixed with 0, 1.5, 3, 6, and 12% biochar and planted with rice. Rice growth components, five rice tissue nutrients, and nine soil properties were measured. The results showed that the response of rice growth to biochar rates could be described using an exponential‐growth function in high‐OC soil but an inverted U‐shaped curve in low‐OC soil. In high‐OC soil, the 12% biochar rate led to the greatest total biomass, increased by 47%, whereas in low‐OC soil, the 3 and 6% rates exhibited the highest total biomass, increased by 44%, compared to the no‐biochar added soils. Biochar elevated the C:N ratio from 11.5 to 39.1, with an optimal range of 20–30 corresponding to the highest rice growth. Biochar declined the ratio of NH4‐N to Mehlich‐1 P, causing N deficiency. In brief, high biochar rates may suppress rice growth when the soil C:N ratio exceeds 30. The applied biochar rate should be considered based on soil properties typically OC and N content to obtain the C:N ratio between 20 and 30 for optimal rice growth.
Investigating trial spaces: Thinking through legal spatiality beyond the court
Authors: Schliehe Anna , Jeffrey Alex
Published: August 2022

This paper examines how the spaces through which legal trials take place shape attitudes towards justice. There has been a growing academic interest in the role of courts in configuring the relationships between trial participants and consequently reproducing pre‐established hierarchies of power. This paper builds on this work to consider the spatiality of trials from the perspective of a particular group of court users: defendants. Drawing on qualitative data drawn from a longitudinal study conducted in prisons in England and Wales, the paper examines how defendants perceive trial spaces, exploring in particular how such insights expand beyond the narrow focus on the courtroom to draw in experiences of transportation, holding cells, bodily restrictions, and the provision of food. In doing so, we seek to contribute to debates concerning penal consciousness, whereby the subjectivity and embodiment of individual participants illuminate differential experiences of the material and legal nature of trial processes. The paper concludes by emphasising how a focus on penal consciousness can help to address perceptions of the injustice of trial outcomes while improving the accessibility of courts.
In vitro storage characteristics of neonatal platelet concentrates after addition of 20% PAS‐E
Authors: Saunders Christine V. , Pearce Nicola B. , George Chloe
Published: August 2022

Background and Objectives

An observed decline in end‐of‐storage pH in plateletpheresis‐derived platelet concentrates for neonatal use suspended in 100% autologous plasma was expected to be reversed by the addition of a platelet additive solution, (PAS)‐E, increasing unit volume by approximately 20%. This study determined the impact on other in vitro storage parameters to ensure the expected increase in pH did not mask an adverse impact on component quality.

Study Design and Methods

For each replicate, one of a pair from a double adult dose plateletpheresis collection had approximately 50 ml of PAS‐E added on Day 3 of storage. Its unmodified twin served as a control. Each adult dose was split into four neonatal storage packs and tested on Days 3, 6, 7 and 8. Three of 12 replicates were from donors with a history of low pH at end of storage and reflected the worst‐case scenario for the new components. A further experiment evaluated whether any differences were simply due to the increased unit volume.

Results

In the nine randomly selected collections, pH on Day 8 was approximately 0.4 units higher in the test units. Platelet activation tended to be lower, with CD62P surface expression on Day 8 of 54.6 ± 9.9% compared to 65.8 ± 10.7% for controls (p < 0.001). Test units from donors with historically low pH retained pH22°C levels above 6.8 compared to controls (<6.4 on Day 8).

Conclusion

The addition of 20% PAS‐E by volume increased the buffering capacity of the units whilst maintaining other in vitro storage characteristics.
History of Japanese Art after 1945
Authors: Kitazawa Noriaki  , Kuresawa Takemi  , Mitsuda Yuri
Published: August 2022

History of Japanese Art after 1945 is a compilation of essays that surveys the development of art in Japan since WWII. The original Japanese work, which has become essential reading for those with an interest in modern contemporary Japanese art and is a foundational resource for students and researchers, spans the 150 years from the 1850s to the 2010s. Each chapter is dedicated to a specific period and written by a specialist on the subject matter. For this English edition, overseen by Art Platform Japan, three chapters on the post-1945 era were selected. The first discusses the formation and evolution of Japanese contemporary art from 1945 to the late 1970s; the second deals with the rise of the fine art museum, which ran from the late 1970s to the 1990s, during which this idea came into focus; and the last chapter covers recent art from the 1990s to the 2010s. These three chapters are preceded by a new introduction, which briefly comments on the English edition, provides a contextual overview of the Japanese edition, and elaborates on the formation of the concept of art (bijutsu) in modern Japan. This edition provides valuable reading material that offers a deeper insight into contemporary Japanese art.
Sesgo político en la distribución de recursos durante la pandemia en Chile: evidencia para un país centralizado
Authors: Livert Felipe , Pressacco Carlos Fabian , Cienfuegos Spikin Ignacio
Published: August 2022

La investigación analiza la influencia política en la distribución de transferencias corrientes del nivel central a los municipios durante la primera ola de la pandemia. A partir de un análisis de datos de panel y efectos fijos, podemos identificar un sesgo electoral en la distribución de recursos. Municipios donde el alcalde y el presidente son del mismo partido político, recibieron en promedio un 61 %más de transferencias, siendo mayor en la medida en que aumenta el margen de victoria. La distribución de recursos durante la pandemia siguió criterios estratégicos para favorecer los intereses del gobierno nacional, lo cual deja en evidencia la importancia de fortalecer el sistema de financiamiento municipal y, específicamente, los recursos que el gobierno central puede transferir discrecionalmente, introduciendo criterios transparentes que contribuyan a disminuir las brechas de desigualdad territorial. En este sentido, la recomendación es utilizar transferencias basadas en fórmulas con indicadores estadísticos relacionados con los objetivos de la transferencia. Los indicadores no deberían ser susceptibles de ser manipulados y deberían ser fácilmente verificables. Las fórmulas deberían mantenerse por varios años y estar sujetas a revisión y adaptación, preferiblemente a partir de un análisis de sus impactos sobre los objetivos de las transferencias.
Efectividad de la tibolona e incidencia de efectos adversos en mujeres posmenopáusicas. Estudio cuasiexperimental en Armenia (Colombia), 2012-2015
Authors: Espitia De La Hoz Franklin José
Published: August 2022

Objetivo: establecer el efecto de la tibolona en la sintomatología menopáusica y la función sexual, así como la incidencia de efectos adversos, en mujeres posmenopáusicas. Material y métodos: estudio de cohorte, en 127 mujeres posmenopáusicas mayores de 40 años, con síntomas climatéricos y último período menstrual al menos 2 años antes de ingresar al estudio, con pareja estable. En una clínica privada de carácter universitario en Armenia (Quindío), Colombia, entre 2012 y 2015. Se utilizaron como instrumentos la escala de calidad de vida “Menopause Rating Scale (MRS)” y el “Índice de Función Sexual Femenino (IFSF)”. Se hizo muestreo aleatorio simple. Se utilizó estadística descriptiva. Resultados: la edad promedio fue de 56,91 ± 7,34 años. Al final del estudio se alcanzó una mejoría de la sintomatología menopáusica del 94,48 % (p<0,05), con una disminución en la puntuación de la escala MRS de 15,91 ± 3,21 a 6,18 ± 3,75 puntos (p<0,05). Las disfunciones sexuales reportaron una mejoría del 86,56 %; el IFSF pasó de 23,19 ± 6,41 puntos a 28,02 ± 6,63 (p<0,05). Los efectos adversos se hicieron presentes desde los primeros 3 meses de inicio de la terapia, siendo los más frecuentes: amenorrea (85,82 %), mastalgia (18,89 %) y edema (17,32 %). Conclusiones: La administración de tibolona tiene un positivo efecto en el tratamiento de la sintomatología de la menopausia, reduciendo tanto la cantidad como la severidad de la misma. Asociándose a franca mejoría de la función sexual, con efectos adversos leves, tolerables y transitorios. Se requieren ensayos clínicos controlados aleatorizados, sobre su eficacia y seguridad en poblaciones de mayor edad y más numerosas.
Position Tracking Constrained Adaptive Output Feedback Control of Robotic Manipulators
Authors: Gul Samet , Zergeroglu Erkan , Tatlicioglu Enver
Published: August 2022

This work presents the design and the corresponding stability analysis of a model-based, joint position tracking error constrained, adaptive output feedback (OFB) controller for robot manipulators. Specifically, provided that the initial joint position tracking error starts within a predefined region, the proposed controller algorithm ensures that the joint tracking error remains inside this region and asymptotically approaches zero, despite the lack of joint velocity measurements and uncertainties associated with the system dynamics. The constraint imposed on the position tracking error term ensures predictable overshoot for the overall system and enables a predetermined transient performance. The need for the joint velocity measurements is removed via the use of a surrogate filter formulation in conjunction with the use of desired model compensation. The stability and the convergence of the closed-loop system are proved via a barrier Lyapunov function (BLF)-based argument. Extensive numerical simulations and experimental studies performed on a two-link, direct-drive robotic manipulator are provided to illustrate the feasibility and effectiveness of the proposed method.
Experimental Investigation and Optimizing the Parameters of a Solar Air Heater Having Broken Arc-Shaped Ribs Using Hybrid Entropy-VIKOR Technique
Authors: Jain Sheetal Kumar , Misra Rohit , Agrawal Ghanshyam Das
Published: August 2022

In this article, thermal performance of a solar air heater (SAH) having broken arc-shaped ribs has been investigated experimentally, and then, performance parameters have been optimized. Study reveals that the use of artificial roughness enhances both heat transfer rate and pumping power requirement, and hence, the overall performance of solar air heater increases. Thus, it is imperative to optimize the performance-defining criteria viz. Nusselt number enhancement ratio, friction factor enhancement ratio, and thermohydraulic performance parameter, to propose an optimal set of flow and roughness parameters. The hybrid entropy-VIKOR technique has been employed to outline the optimal set of parameters using performance-defining criterions, to obtain maximum profit with the minimum incurred cost. The optimal set of parameters attained using entropy-VIKOR approach among all the alternatives is as follows: relative gap width = 4, relative roughness pitch = 10, and arc angle = 45 deg at Reynolds number = 9000.
Kinesio Taping Versus Athletic Taping in Managing Chronic Golfer’s Elbow in Male Athletes
Authors: Abdelmonem Asmaa F. , Ameer Mariam A. , Ghuiba Karim , Al Abbad Ammar M.
Published: August 2022

Medial epicondylalgia is a repetitive stress condition. The aim of this study was to assess whether Kinesio taping offers any superiority over athletic taping for chronic medial epicondylalgia management. The results show statistically significant differences in isokinetic and patient self-reported variables between each group: (a) Group A: Kinesio tape with rehabilitation; (b) Group B: athletic taping with rehabilitation; and (c) group C: only rehabilitation. Although no significant differences in preintervention group assessments (p > .05) were found, only Group (A) showed statistically significant posttreatment improvements. Kinesio taping over athletic taping appears effective for treating chronic medial epicondylalgia and facilitating pain reduction and isokinetic improvements.
COP1 dynamics integrate conflicting seasonal light and thermal cues in the control of
Arabidopsis
elongation
Authors: Nieto Cristina , Catalán Pablo , Luengo Luis Miguel , Legris Martina , López-Salmerón Vadir , Davière Jean Michel , Casal Jorge J. , Ares Saúl , Prat Salomé
Published: August 2022

As the summer approaches, plants experience enhanced light inputs and warm temperatures, two environmental cues with an opposite morphogenic impact. Key components of this response are PHYTOCHROME B (phyB), EARLY FLOWERING 3 (ELF3), and CONSTITUTIVE PHOTOMORPHOGENIC 1 (COP1). Here, we used single and double mutant/overexpression lines to fit a mathematical model incorporating known interactions of these regulators. The fitted model recapitulates thermal growth of all lines used and correctly predicts thermal behavior of others not used in the fit. While thermal COP1 function is accepted to be independent of diurnal timing, our model shows that it acts at temperature signaling only during daytime. Defective response of
cop1-4
mutants is epistatic to
phyB-9
and
elf3-8
, indicating that COP1 activity is essential to transduce phyB and ELF3 thermosensory function. Our thermal model provides a unique toolbox to identify best allelic combinations enhancing climate change resilience of crops adapted to different latitudes.
PDIA3 epitope-driven immune autoreactivity contributes to hepatic damage in type 2 diabetes
Authors: Clement Cristina C. , Osan Jaspreet , Buque Aitziber , Nanaware Padma P. , Chang Yoke-Chen , Perino Giorgio , Shetty Madhur , Yamazaki Takahiro , Tsai Wanxia Li , Urbanska Aleksandra M. , Calvo-Calle J. Mauricio , Ramsamooj Shakti , Ramsamooj Shakti , Vergani Diego , Mieli-Vergani Giorgina , Terziroli Beretta-Piccoli Benedetta , Gadina Massimo , Montagna Cristina , Goncalves Marcus DaSilva , Sallusto Federica , Galluzzi Lorenzo , Soni Rajesh K. , Stern Lawrence J. , Santambrogio Laura
Published: August 2022

A diet rich in saturated fat and carbohydrates causes low-grade chronic inflammation in several organs, including the liver, ultimately driving nonalcoholic steatohepatitis. In this setting, environment-driven lipotoxicity and glucotoxicity induce liver damage, which promotes dendritic cell activation and generates a major histocompatibility complex class II (MHC-II) immunopeptidome enriched with peptides derived from proteins involved in cellular metabolism, oxidative phosphorylation, and the stress responses. Here, we demonstrated that lipotoxicity and glucotoxicity, as driven by a high-fat and high-fructose (HFHF) diet, promoted MHC-II presentation of nested T and B cell epitopes from protein disulfide isomerase family A member 3 (PDIA3), which is involved in immunogenic cell death. Increased MHC-II presentation of PDIA3 peptides was associated with antigen-specific proliferation of hepatic CD4
+
immune infiltrates and isotype switch of anti-PDIA3 antibodies from IgM to IgG3, indicative of cellular and humoral PDIA3 autoreactivity. Passive transfer of PDIA3-specific T cells or PDIA3-specific antibodies also exacerbated hepatocyte death, as determined by increased hepatic transaminases detected in the sera of mice subjected to an HFHF but not control diet. Increased humoral responses to PDIA3 were also observed in patients with chronic inflammatory liver conditions, including autoimmune hepatitis, primary biliary cholangitis, and type 2 diabetes. Together, our data indicated that metabolic insults caused by an HFHF diet elicited liver damage and promoted pathogenic immune autoreactivity driven by T and B cell PDIA3 epitopes.
Draft Genome Sequence of Multidrug Resistant Klebsiella pneumoniae Strain C43 Isolated from Environmental Water Sample
Authors: Wee Soon Keong , Yap Eric Peng Huat
Published: August 2022

Here, we report the genome of ESBL-producing
Klebsiella pneumoniae
strain C43, which was isolated from an environmental water sample. The genome is 5,614,412 bp in size with GC content of 56.86% with multidrug antimicrobial resistance genes and several metal resistance gene operons.
Draft Genome Sequence of the Multiple Antibiotic Resistant Pseudomonas aeruginosa PAO1-UB Subline
Authors: Chua Kah-Ooi , Norton Paul , Trus Pavlos , Katsikogianni Maria , Thornton M. Julie , Chan Kok-Gan , Chang Chien-Yi
Published: August 2022

We report the draft genome sequence and antibiotic susceptibility of
Pseudomonas aeruginosa
strain PAO1-UB, a subline of the common reference strain PAO1. This strain was sequenced in order to provide information on the genome dynamics of PAO1 sublines and their genes conferring resistance to multiple antibiotics.
The β-Grasp Domain of Proteasomal ATPase Mpa Makes Critical Contacts with the Mycobacterium tuberculosis 20S Core Particle to Facilitate Degradation
Authors: Xiao Xiansha , Feng Xiang , Yoo Jin Hee , Kovach Amanda , Darwin K. Heran , Li Huilin
Published: August 2022

The Pup-proteasome system in
Mycobacterium tuberculosis
is critical for this species to cause lethal infections in mice. Investigating the molecular mechanism of how the Mpa ATPase recruits and unfolds pupylated substrates to the 20S proteasomal core particle for degradation will be essential to fully understand how degradation is regulated, and the structural information we report may be useful for the development of new tuberculosis chemotherapies.
Emergence of a Novel NDM-5-Producing Sequence Type 4523 Klebsiella pneumoniae Strain Causing Bloodstream Infection in China
Authors: Jia Peiyao , Jia Xinmiao , Zhu Ying , Liu Xiaoyu , Yu Wei , Li Rui , Li Xue , Kang Mei , Xu Yingchun , Yang Qiwen
Published: August 2022

Klebsiella pneumoniae
is a significant infectious pathogen causing bloodstream infections. Due to the dissemination of carbapenemase genes, the incidence of carbapenem-resistant
K. pneumoniae
(CRKP) has increased, with high morbidity and mortality rates in immunocompromised patients.
Cooccurrence of Antibiotic Resistance and Hypervirulence in High-Risk Carbapenem-Resistant K14.K64 and Wzi209 Klebsiella pneumoniae Strains Driven by Plasmids and Their Derivatives
Authors: Zhu Weinan , Liu Ying , Chen Feng , Chen Shiyu , Zhu Yongqiang , Li Hu , Wang Jiawei , Liu Jingxian , Li Yuanrui , Yu Jiajia , Guan Hongyan , Yu Jing , Shen Lisong
Published: August 2022

Currently, an increasing number of hv-CRKP strains have been reported and pose a substantial threat to public health worldwide, because these strains are considered to be simultaneously hypervirulent, carbapenem resistant, and transmissible. In this study, we provided a complete transition process of CRKP and hv-CRKP from their early emergence to outbreak in 10 years.
Promising Trends in Ice Core Research
Authors: Kutuzov S. S. , Mikhalenko V. N. , Legrand M. , Khairedinova A. G. , Vorob’ev M. A. , Vinogradova M. M.
Published: August 2022

An overview of modern studies on ice cores from nonpolar regions of the Earth is presented. As an example of complex research on the territory of Russia, a description of the main results of the study of ice cores from Elbrus is given. The seasonally resolved data on the chemical and isotopic composition of the Elbrus core cover 1774–2009 reconstructed various aspects of atmospheric pollution in southeastern Europe from preindustrial times to the present day. The necessity of studying several ice cores from different regions to reconstruct the composition of the atmosphere, its pollution, and the reaction of vegetation to climate change and forest fires in Russia is shown.
Perivascular epithelioid cell tumour-mimicking retroperitoneal leiomyosarcoma
Authors: Siddiqi Shirin , Mesropyan Lusine
Published: August 2022

A young man in his 40s was evaluated in the emergency department for abdominal and right flank pain. A CT scan of the abdomen and pelvis showed a solid, well-circumscribed lesion measuring 7.1×8.1×5.4 cm, which was arising from the retroperitoneum and extending from the third portion of the duodenum towards the right kidney. A percutaneous core biopsy was obtained, demonstrating an atypical smooth muscle neoplasm suggestive of a low-grade leiomyosarcoma. The patient underwent surgery for an en-block resection of the mass and the final pathology confirmed a perivascular epithelioid cell neoplasm without significant pleomorphism, mitosis or necrosis. Our case adds to the small number of perivascular epithelioid cell tumour cases reported in the literature and we present it in order to increase our understanding of this tumour and to assist in its appropriate diagnosis and management.
Recurrent vesico-acetabulo-cutaneous fistula: lessons to be learnt
Authors: Wadhwa Pankaj , Goel Sunny , Talwar Harkirat Singh , Zafar Feroz
Published: August 2022

A man in early 40s met with an accident with a complex pelvic fracture and extraperitoneal bladder injury and posterior urethral disruption 16 years ago. He additionally had left lumbar spinal segment mixed nerve injury, resulting in a foot drop. He underwent laparotomy and a diverting cystostomy at the time with a primary perineal urethroplasty a year later. He later developed pseudoarthrodesis of the hip joint, and poorly compliant bladder with complete block at bulbar urethra. A redo anastomotic urethroplasty was performed, hyperreflexive neurogenic bladder was managed with intravesical botox injections and underwent a hip replacement. Having defaulted botox injections, he developed a vesico-acetabulo-cutaneous fistula and the hip prosthesis was explanted. Later he underwent a ileal cystoplasty and a revision hip replacement. Ten years later, he presented with a recurrent fistula due to poor compliance with clean intermittent catheterisation. A challenging exploration with fistula excision was done with a primary bladder repair.
Concomitant occurrence of advanced fibrocavitary pulmonary sarcoidosis and chronic pulmonary aspergillosis
Authors: Khor Si Yuan , Gullapalli Keerthi , Sharma Akhil , Garces Christopher Cantoria
Published: August 2022

An African American man in his 30s presented with haemoptysis associated with chronic productive cough, exertional dyspnoea, weight loss and skin lesions. Physical examination was notable for multiple cutaneous plaques over upper extremities and face. CT chest showed bilateral upper lobes cavitations and left upper lobe mass like consolidation. Further workup revealed positive serum aspergillus IgG, respiratory culture grewAspergillus fumigatus, skin biopsy showed non-caseating granuloma. A final diagnosis of concomitant chronic pulmonary aspergillosis and advanced fibrocavitary pulmonary sarcoidosis with cutaneous involvement was made. The patient was initiated on antifungal therapy without steroids due to the concern of worsening the fungal infection. However, he presented later with worsening haemoptysis requiring bronchial artery embolisation. Surgical intervention was recommended but the patient eventually declined. The patient continued to be followed up closely in the clinic and repeated chest imaging showed stable findings 3 months after initial presentation.
Enhancing referral processes within an integrated fall prevention pathway for older people: a mixed-methods study
Authors: Flannery Caragh , Dennehy Rebecca , Riordan Fiona , Cronin Finola , Moriarty Eileen , Turvey Spencer , O'Connor Kieran , Barry Patrick , Jonsson Agnes , Duggan Eoin , O’Sullivan Liz , O'Reilly Éilis , Sinnott Sarah-Jo , McHugh Sheena
Published: August 2022

Objectives

Multifactorial interventions, which involve assessing an individual’s risk of falling and providing treatment or onward referral, require coordination across settings. Using a mixed-methods design, we aimed to develop a process map to examine onward referral pathways following falls risk assessment in primary care.

Setting

Primary care fall risk assessment clinics in the South of Ireland.

Participants

Focus groups using participatory mapping techniques with primary care staff (public health nurses (PHNs), physiotherapists (PT),and occupational therapists (OT)) were conducted to plot the processes and onward referral pathways at each clinic (n=5).

Methods

Focus groups were analysed in NVivo V.12 using inductive thematic analysis. Routine administrative data from January to March 2018 included details of client referrals, assessments and demographics sourced from referral and assessment forms. Data were analysed in Stata V.12 to estimate the number, origin and focus of onward referrals and whether older adults received follow-up interventions. Quantitative and qualitative data were analysed separately and integrated to produce a map of the service.

Results

Nine staff participated in three focus groups and one interview (PHN n=2; OT n=4; PT n=3). 85 assessments were completed at five clinics (female n=69, 81.2%, average age 77). The average number of risk factors was 5.4 out of a maximum of 10. Following assessment, clients received an average of three onward referrals. Only one-third of referrals (n=135/201, 33%) had data available on intervention receipt. Primary care staff identified variations in how formally onward referrals were managed and barriers, including a lack of client information, inappropriate referral and a lack of data management support.

Conclusion

Challenges to onward referral manifest early in an integrated care pathway, such as clients with multiple risk factors sent for initial assessment and the lack of an integrated IT system to share information across settings.
Prospective multicentre observational cohort to assess quality of life, functional outcomes and cost-effectiveness following minimally invasive surgical techniques for rectal cancer in ‘dedicated centres’ in the Netherlands (VANTAGE trial): a protocol
Authors: Geitenbeek Ritch , Burghgraef Thijs , Hompes Roel , Zimmerman David , Dijkgraaf Marcel , Postma Maarten , Ranchor Adelita , Verheijen Paul , Consten Esther
Published: August 2022

Introduction

Total mesorectal excision is the standard of care for rectal cancer, which can be performed using open, laparoscopic, robot-assisted and transanal technique. Large prospective (randomised controlled) trials comparing these techniques are lacking, do not take into account the learning curve and have short-term or long-term oncological results as their primary endpoint, without addressing quality of life, functional outcomes and cost-effectiveness. Comparative data with regard to these outcomes are necessary to identify the optimal minimally invasive technique and provide guidelines for clinical application.

Methods and analysis

This trial will be a prospective observational multicentre cohort trial, aiming to compare laparoscopic, robot-assisted and transanal total mesorectal excision in adult patients with rectal cancer performed by experienced surgeons in dedicated centres. Data collection will be performed in collaboration with the prospective Dutch ColoRectal Audit and the Prospective Dutch ColoRectal Cancer Cohort. Quality of life at 1 year postoperatively will be the primary outcome. Functional outcomes, cost-effectiveness, short-term outcomes and long-term oncological outcomes will be the secondary outcomes. In total, 1200 patients will be enrolled over a period of 2 years in 26 dedicated centres in the Netherlands. The study is registered at https://www.trialregister.nl/9734 (NL9734).

Ethics and dissemination

Data will be collected through collaborating parties, who already obtained approval by their medical ethical committee. Participants will be included in the trial after having signed informed consent. Results of this study will be disseminated to participating centres, patient organisations, (inter)national society meetings and peer-reviewed journals.
Electronic medical record-related burnout in healthcare providers: a scoping review of outcomes and interventions
Authors: Li Calandra , Parpia Camilla , Sriharan Abi , Keefe Daniel T
Published: August 2022

Objective

Healthcare provider (HCP) burnout is on the rise with electronic medical record (EMR) use being cited as a factor, particularly with the rise of the COVID-19 pandemic. Burnout in HCPs is associated with negative patient outcomes, and, therefore, it is crucial to understand and address each factor that affects HCP burnout. This study aims to (a) assess the relationship between EMR use and burnout and (b) explore interventions to reduce EMR-related burnout.

Methods

We searched MEDLINE (Ovid), CINAHL and SCOPUS on 29 July 2021. We selected all studies in English from any publication year and country that discussed burnout in HCPs (physicians, nurse practitioners and registered nurses) related to EMR use. Studies must have reported a quantitative relationship to be included. Studies that implemented an intervention to address this burnout were also included. All titles and abstracts were screened by two reviewers, and all full-text articles were reviewed by two reviewers. Any conflicts were addressed with a third reviewer and resolved through discussion. Quality of evidence of all included articles was assessed using the Quality Rating Scheme for Studies and Other Evidence.

Findings

The search identified 563 citations with 416 citations remaining after duplicate removal. A review of abstracts led to 59 studies available for full-text assessment, resulting in 25 studies included in the scoping review. Commonly identified associations between EMR-related burnout in HCPs included: message and alert load, time spent on EMRs, organisational support, EMR functionality and usability and general use of EMRs. Two articles employed team-based interventions to improve burnout symptoms without significant improvement in burnout scores.

Conclusions and relevance

Current literature supports an association between EMR use and provider burnout. Very limited evidence exists for burnout-reducing interventions that address factors such as time spent on EMRs, organisational support or EMR design.
Early calcium and phosphorus supplementation in VLBW infants to reduce metabolic bone disease of prematurity: a quality improvement initiative
Authors: Krithika MV , Balakrishnan Umamaheswari , Amboiram Prakash , Shaik Mohammed Shafi Jan , Chandrasekaran Ashok , Ninan Binu
Published: August 2022

Objective

To reduce the incidence of metabolic bone disease (MBD) among very low birthweight (VLBW) infants admitted to neonatal intensive care unit from baseline of 35% by 50% over 2 years by implementing a quality improvement (QI) initiative.

Methods

A multidisciplinary QI team used evidence-based interventions and the healthcare improvement model to reduce MBD rate in VLBW infants. The specific interventions included routine enteral supplementation of calcium and phosphorus using Human Milk Fortifier (HMF) to expressed breast milk by day 14 of life (Plan/Do/Study/Act (PDSA) cycle 1), parenteral and early enteral supplementation of calcium and phosphorus (PDSA cycles 2 and 3). We included VLBW infants admitted within the study period at birth and excluded babies with congenital malformations, skeletal disorders and those who died before 2 weeks of age. Compliance with adding HMF by day 14, compliance with adding calcium and phosphorus in total parenteral nutrition (TPN) from day 1 of life and compliance with starting HMF when the baby reached 100 mL/kg/day of feeds were used as process indicators. The incidence of MBD was used as an outcome indicator during the study. The incidence of MBD was tracked using the Statistical Process Control methodology.

Results

The baseline MBD rate in 2015 was 35%. After the first PDSA cycle, 20% developed MBD (p=0.02). The same was sustained for a period of 1 year with the rate of 22%. After the second and third PDSA cycles, there was a drop in the MBD rate to 17%, and sustained for 3 months with 21%.

Conclusion

Implementation of QI initiatives decreased the MBD rate from 35% to <20%. Early parenteral calcium and phosphorus supplementation in TPN and optimising enteral supplementation with multicomponent fortifiers appear to have significant reduction in the incidence of MBD.
A better way: training for direct observations in healthcare
Authors: Alfred Myrtede , Del Gaizo John , Kanji Falisha , Lawton Samuel , Caron Ashley , Nemeth Lynne S , Alekseyenko A V , Shouhed Daniel , Savage Stephen , Anger Jennifer T , Catchpole Ken , Cohen Tara
Published: August 2022

Direct observation is valuable for identifying latent threats and elucidating system complexity in clinical environments. This approach facilitates prospective risk assessment and reveals workarounds, near-misses and recurrent safety problems difficult to diagnose retrospectively or via outcome data alone. As observers are an instrument of data collection, developing effective and comprehensive observer training is critical to ensuring the reliability of the data collection and reproducibility of the research. However, methodological rigour for ensuring these data collection properties remains a key challenge in direct observation research in healthcare. Although prior literature has offered key considerations for observational research in healthcare, operationalising these recommendations may pose a challenge and unless guidance is also provided on observer training. In this article, we offer guidelines for training non-clinical observers to conduct direct observations including conducting a training needs analysis, incorporating practice observations and evaluating observers and inter-rater reliability. The operationalisation of these guidelines is described in the context of a 5-year multisite observational study investigating technology integration in the operating room. We also discuss novel tools developed during the course our project to support data collection and examine inter-rater reliability among observers in direct observation studies.
Individual-level income and out-of-hospital cardiac arrest survival in men and women
Authors: van Dongen Laura H , Smits Robin L A , van Valkengoed Irene G M , Elders Petra , Tan Hanno L , Blom Marieke T
Published: August 2022

Objective

Area-level socioeconomic factors are known to associate with chances to survive out-of-hospital cardiac arrest (OHCA survival). However, the relationship between individual-level socioeconomic factors and OHCA survival in men and women is less established. This study investigated the association between individual-level income and OHCA survival in men and women, as well as its contribution to outcome variability and mediation by resuscitation characteristics.

Methods

A cross-sectional cohort study using data from a Dutch community-based OHCA registry was performed. We included 5395 patients aged≥25 years with OHCA from a presumed cardiac cause. Household income, derived from Statistics Netherlands, was stratified into quartiles. The association between survival to hospital discharge and household income was analysed using multivariable logistic regression adjusting for age, sex and resuscitation characteristics.

Results

Overall women had lower household income than men (median €18 567 vs €21 015), and less favourable resuscitation characteristics. Increasing household income was associated with increased OHCA survival in both men and women in a linear manner (Q4 vs Q1: OR 1.63 95% CI (1.24 to 2.16) in men, and 2.54 (1.43 to 4.48) in women). Only initial rhythm significantly changed the ORs for OHCA survival with>10% in both men and women. Household income explained 3.8% in men and 4.3% in women of the observed variance in OHCA survival.

Conclusion

Both in men and women, higher individual-level household income was associated with a 1.2-fold to 2.5-fold increased OHCA survival to hospital discharge, but explained only little of outcome variability. A shockable initial rhythm was the most important resuscitation parameter mediating this association. Our results do not support the need for immediate targeted interventions on actionable prehospital resuscitation care characteristics.
Radiation and the nervous system
Authors: Kosmin Michael , Rees Jeremy
Published: August 2022

Radiation therapy is widely used for benign and malignant brain tumours as it is effective and well tolerated. However, damage to the surrounding healthy nervous system tissue leads to a variety of complications both in the short term and long term, ranging from mild and self-limiting to irreversible and fatal. Radiation neurotoxicity is due to a combination of early inflammation and oligodendroglial damage followed later by brain tissue necrosis, white matter damage, accelerated vascular disease and the development of secondary tumours. This article explains the basic principles of radiation physics, the different modalities used in clinical practice, how radiotherapy is planned and delivered and the scientific basis of radiation damage. The main body of the article focuses on the clinical features of radiation toxicity in the brain, spinal cord, cranial and peripheral nerves with an emphasis on the distinction between early and delayed complications.
Separating the effects of childhood and adult body size on inflammatory arthritis: a Mendelian randomisation study
Authors: Zhao Sizheng Steven , Bowes John , Barton Anne , Davey Smith George , Richardson Tom
Published: August 2022

Objectives

Using Mendelian randomisation (MR), we examined whether childhood body size affects risk of rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), gout and systemic lupus erythematosus (SLE) after accounting for the effect of adult body size.

Methods

Genetic instruments for childhood (age 10 years) and adult body size were derived using data from 453 169 individuals from the UK Biobank study (313 and 580 variants respectively), which have been previously validated using body mass index data from three independent populations. Genome-wide association data comprised 22 350 RA, 9069 AS, 3609 PsA, 13 179 gout and 5201 SLE cases. For each outcome, we conducted univariable MR to estimate the total effects of childhood and adult body size, and multivariable MR to examine the independent effect of childhood body size after accounting for adult body size.

Results

Genetically predicted childhood body size had a total effect on risk of PsA (OR 2.18 per change in body size category; 95% CI 1.43 to 3.31), gout (OR 2.18; 95% CI 1.43 to 3.31) and SLE (OR 2.44; 95% CI 1.14 to 5.22), but not RA (OR 0.95; 95% CI 0.70 to 1.29) or AS (OR 0.96; 95% CI 0.61 to 1.52). After accounting for adult body size, the direct effect of childhood body size was little changed for PsA (OR 1.92; 1.14 to 3.25) and SLE (OR 2.69; 1.24 to 5.87) but was attenuated for gout (OR 1.40; 95% CI 0.94 to 2.09).

Conclusions

Our findings suggest that, for PsA and SLE, the risk conferred from having a larger body size during childhood may not be fully reversable even when a healthy size is achieved in adulthood.