bluuebunny/crossref_metadata_2025 huggingface dataset:
Allostery of DNA nanostructures controlled by enzymatic modifications
Authors: Yan Qi , Wang Yaqi , Shi Jile , Wei Bryan
Published: May 2020

Allostery is comprehensively studied for natural macromolecules, such as proteins and nucleic acids. Here, we present controllable allostery of synthetic DNA nanostructure–enzyme systems. Rational designs of the synthetic allosteric systems are based on an in-depth understanding of allosteric sites with several types of strand placements, whose varying stacking strengths determine the local conformation and ultimately lead to a gradient level of allosteric transition. When enzymes in a molecular cloning toolbox such as DNA polymerase, exonuclease and ligase are applied to treat the allosteric sites, the resulting local conformational changes propagate through the entire structure for a global allosteric transition.
Edge superconductivity in multilayer WTe2 Josephson junction
Authors: Huang Ce , Narayan Awadhesh , Zhang Enze , Xie Xiaoyi , Ai Linfeng , Liu Shanshan , Yi Changjiang , Shi Youguo , Sanvito Stefano , Xiu Faxian
Published: May 2020

WTe2, as a type-II Weyl semimetal, has 2D Fermi arcs on the (001) surface in the bulk and 1D helical edge states in its monolayer. These features have recently attracted wide attention in condensed matter physics. However, in the intermediate regime between the bulk and monolayer, the edge states have not been resolved owing to its closed band gap which makes the bulk states dominant. Here, we report the signatures of the edge superconductivity by superconducting quantum interference measurements in multilayer WTe2 Josephson junctions and we directly map the localized supercurrent. In thick WTe2 ($\sim 60{\rm{\ nm}})$, the supercurrent is uniformly distributed by bulk states with symmetric Josephson effect ($| {I_c^ + ( B )} | {=} | {I_c^ - ( B )} |\ $). In thin WTe2 (10 nm), however, the supercurrent becomes confined to the edge and its width reaches up to $1.4{\rm{\ \mu m\ }}$and exhibits non-symmetric behavior $| {I_c^ + ( B )} | \ne | {I_c^ - ( B )} |$. The ability to tune the edge domination by changing thickness and the edge superconductivity establishes WTe2 as a promising topological system with exotic quantum phases and a rich physics.
Impact of omega-3 fatty acid DHA and EPA supplementation in pregnant or breast-feeding women on cognitive performance of children: systematic review and meta-analysis
Authors: Lehner A , Staub K , Aldakak L , Eppenberger P , Rühli F , Martin Robert D , Bender N
Published: May 2020

Introduction

The omega-3 long-chain polyunsaturated fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are important for brain development and cognitive performance. Because they are semi-essential fatty acids, they must be obtained from food. However, the dietary reference intakes of DHA and EPA have not yet been established. In women, a low DHA and/or EPA serum level during pregnancy or breastfeeding might negatively affect their children. For this study, we conducted a systematic review and meta-analysis of randomized control trials on the association between the consumption of fish oil supplements in pregnant and/or breastfeeding women and the cognitive performance of their children.

Methods

The PubMed, Embase, and Central literature databases were systematically searched. We included and extracted relevant studies in duplicate and assessed study quality. Cognitive outcomes were grouped according to published criteria and according to time elapsed after the intervention. We performed fixed-effects meta-analyses for each cognitive outcome and for birth weight. We assessed potential confounding with meta-regressions and sensitivity analyses.

Results

A total of 11 trials were included. No significant association was found between DHA/EPA supplementation and any of the assessed cognitive parameters or birth weight.

Discussion

Our results confirm previous reviews on the studied topic. Reasons for inconclusive results may be small sample sizes for each assessed category, questionable quality of included studies, and the difficulty of reliably measuring cognitive performance in small children. Blood levels of omega-3 long-chain polyunsaturated fatty acids were mostly not comparable. Furthermore, the influence of genetic and environmental factors could not be assessed. Studies in this field should address such shortcomings.
National guidelines on nutrient reference values for the healthy adult population and for pregnant or lactating women are based on heterogeneous sources of evidence: review of guidelines
Authors: Willi Sandra , Stamm Lea , Aldakak Lafi , Staub Kaspar , Rühli Frank , Bender Nicole
Published: May 2020

Many countries provide dietary guidelines for health practitioners and/or the general population. However, there is no general, international guideline serving as a template for national dietary guidelines, and there is little to no consensus regarding reference values for different nutrients. The present review compared 27 national dietary guidelines for healthy adults as well as for pregnant and/or breastfeeding women, and analysed their quality and the evidence behind their recommendations. The guidelines were evaluated for their quality using the instrument Agree II, and found to be heterogeneous (overall quality score 14%–100%) and often insufficient (quality score < 50%) due to missing information about their methodology and sources of evidence. We analysed the evidence (number of studies, study types and publication years) of reference values of a number of nutrients using the five guidelines that provided the highest scores in the Agree II assessment. The reference values varied among guidelines, were rarely based on up-to-date meta-analyses, and were often based on insufficiently reported evidence (22/27 guidelines with quality score < 50%). We recommend systematic reviews of high quality studies to formulate future guidelines, and to use guidelines on how to write guidelines.
Impact of Opioid Restrictions During a Critical Drug Shortage Period: Interrupted Time Series for Institutional Opioid Utilization
Authors: Brokenshire Samantha A , Lemon Stephen J , Staley Benjamin , Voils Alissa , Hincapie-Castillo Juan M
Published: May 2020

Objectives

This study aimed to evaluate the impact of intravenous opioid product restrictions at an academic medical institution in an urban setting during the time of critical opioid shortages. We assessed the effect of ordering restrictions on inpatient opioid utilization measured by 1) changes in intermittent oral and injectable opioid product administration; 2) changes in total institutional opioid administration; and 3) changes in the utilization of individual restricted opioid agents.

Methods

This study is a single-center retrospective analysis by interrupted time series of institutional opioid utilization from 07/2017 to 06/2018. Utilization was quantified using milligrams of intravenous morphine equivalent administered or dispensed per admitted patient. Restrictions were grouped into 10 distinct phases, which informed the interruptions in linear regression models.

Results

Sequential restrictions during the study period led to shifts in use of individual agents but did not have a significant impact on overall total opioid utilization. “Soft” restrictions did not have a direct, statistically significant impact on medication use but did decrease utilization over time. In situations where a product was restricted with a “soft stop” followed by a “hard stop,” the “hard stop” directly reduced usage.

Conclusions

Targeted ordering restrictions allowed the institution to redirect drug use according to clinical need without affecting the overall utilization. Clinical decision support led providers to choose therapeutically equivalent alternatives. The demonstrated effect of restrictions will guide institutions in the selection of “hard stop” or “soft stop” restrictions in response to future shortages.
Modulation of Exercise-Induced Hypoalgesia Following an Exercise Intervention in Healthy Subjects
Authors: Hansen Simon , Dalgaard Rasmus Christiansen , Mikkelsen Pernille Schlosser , Sørensen Mathias Brandhøj , Petersen Kristian Kjær
Published: May 2020

Background

Exercise is recommended to promote and maintain health and as treatment for more than 25 diseases and pain conditions. Exercise-induced hypoalgesia (EIH), a measure of descending pain inhibitory control, has been found to be impaired in some chronic pain conditions, but it is currently unclear if EIH is modifiable. This study investigated whether a long-term exercise intervention could modulate EIH in healthy subjects.

Methods

In 38 healthy subjects, EIH was assessed as change in pressure pain threshold (PPT) after a three-minute isometric wall squat within the first week and after approximately seven weeks of military training (MT). Further, temporal summation of pain (TSP) and Knee injury and Osteoarthritis Outcome Score (KOOS) were assessed. Physical performance capacity was assessed using the Endurance 20-m shuttle run fitness test (20MSR). Hypoalgesic (EIH > 0.0 kPa) and hyperalgesic (EIH ≤ 0.0 kPa) subgroups were defined based on baseline EIH. Change in EIH following MT was used as the primary outcome.

Results

Increased EIH (P = 0.008), PPT (P < 0.003), and 20MSR (P < 0.001) were found following MT, with no changes in TSP and KOOS (P > 0.05). Subjects with a hyperalgesic EIH response at baseline (26% of the participants) presented significantly improved EIH following MT (P = 0.010). Finally, an association between 20MRS change and EIH change was found (r = 0.369, P = 0.023).

Conclusions

MT increased EIH, especially in subjects who demonstrated a hyperalgesic response at baseline. Improvement in physical performance capacity was associated with an improvement in EIH, indicating that improvement in physical performance capacity may improve central pain mechanisms.
Community–Police Dialogues: Evaluating the Effects on Adult, Youth, and Police Participants
Authors: Perez Nicholas M , Nguyen Trinh , Vogel Brenda
Published: May 2020

Improving the relationship between the police and the public is a major focus of American police agencies. Community–police dialogues represent a potential avenue to facilitate positive interactions and promote the four pillars of procedural justice (voice, neutrality, respect, and impartiality). Recent funding has allowed one agency to host six community–police dialogues (three with adult community members and three with youth community members). These events allow citizens to participate in a community building circle with police to build community and discuss various concerns relevant to their city. Using pre- and post-test data from dialogue participants, the current study seeks to determine the effects of the community–police dialogue on community perceptions of voice, trust, respect, and empathy towards their police department. Following participation, community members reported a greater willingness to work with police to improve relationships, greater trust and respect towards police officers, and a greater awareness of the challenges faced by police officers. Some key differences emerged depending on the age group of the participant. Similarly, police officers reported higher levels of respect for and trust in the community and greater feelings of respect from residents. These findings highlight the potential for dialogue events to promote procedural justice and enhance community partnerships, especially for youth community members.
Time Between an Emergency Department Visit and Initiation of Physical Therapist Intervention: Health Care Utilization and Costs
Authors: Magel John , Kim Jaewhan , Fritz Julie M , Freburger Janet K
Published: May 2020

Objective

The aim of this study was to examine the association between the length of time between an emergency department (ED) visit and the subsequent initiation of physical therapist intervention for low back pain (LBP) on 1-year LBP-related health care utilization (ie, surgery, advanced imaging, injections, long-term opioid use, ED visits) and costs.

Methods

This retrospective cohort study focused on individuals who consulted the ED for an initial visit for LBP. Claims from a single statewide, all-payers database were used. LBP-related health care use and costs for the 12 months after the ED visit were extracted. Poisson and general linear models weighted with inverse probability treatment weights were used to compare the outcomes of patients who attended physical therapy early or delayed after the ED visit.

Results

Compared with the delayed physical therapy group (n = 94), the early physical therapy group (n = 171) had a lower risk of receiving lumbar surgery (relative risk [RR] = 0.47, 95% CI = 0.26–0.86) and advanced imaging (RR = 0.72, 95% CI = 0.55–0.95), and they were less likely to have long-term opioid use (RR = 0.45, 95% CI = 0.28–0.76). The early physical therapy group incurred lower costs (mean = $3,806, 95% CI = $1,998–$4,184) than those in the delayed physical therapy group (mean = $8,689, 95% CI = $4,653–$12,727).

Conclusion

Early physical therapy following an ED visit was associated with a reduced risk of using some types of health care and reduced health care costs in the 12 months following the ED visit.

Impact Statement

The ED is an entry point into the health care system for patients with LBP. Until now, the impact of the length of time between an ED visit and physical therapy for LBP has not been well understood. This study shows that swift initiation of physical therapy following an ED visit for LBP is associated with lower LBP-related health utilization for some important outcomes and lower LBP-related health care costs.
Consequences of Group Style for Differential Participation
Authors: Carlsen Hjalmar Bang , Toubøl Jonas , Ralund Snorre
Published: May 2020

This article proposes a theory of how interaction in groups influences differential participation in political activism and interrogates this theory through an empirical analysis of online Facebook group interaction. We study the refugee solidarity movement in a mixed methods design employing online ethnography, survey, and “big” social media data. Instead of conceptualizing the group as a social network or social movement organization (SMO), we argue that the group’s culture emerges as patterns of interaction that have implications for what kind of activities in which group members participate. Based on observations from our online ethnography, we suggest that group interaction influences differential individual participation through processes of (1) encoding different habits and (2) attuning the activist to different aspects of situations. We support our theoretical propositions with six statistical tests of the relationship between the group-level variable of contentious group style and the individual-level variable of participation in political protest. The dependent variable, political protest, and a comprehensive set of controls stem from an original survey of the Danish refugee solidarity movement with 2,283 respondents. We link the survey data with “big” social media data used to estimate the focal explanatory variable, contentious group style, generated from content analysis of online interaction in 119 Facebook groups quantified with supervised machine learning. The results show that group style has a consistently positive relationship with the individual’s degree of participation independent of networks, SMO framing, and individual attributes.
Normalization criteria determine the interpretation of nitrogen effects on the root hydraulics of pine seedlings
Authors: Toca Andrei , Villar-Salvador Pedro , Oliet Juan A , Jacobs Douglass F
Published: May 2020

Plant hydraulics is key for plant survival and growth because it is linked to gas exchange and drought resistance. Although the environment influences plant hydraulics, there is no clear consensus on the effect of nitrogen (N) supply, which may be, in part, due to different hydraulic conductance normalization criteria and studied species. The objective of this study was to compare the variation of root hydraulic properties using several normalization criteria in four pine species in response to three contrasting N fertilization regimes. We studied four closely related, yet ecologically distinct species: Pinus nigra J.F. Arnold, Pinus pinaster Ait., Pinus pinea L. and Pinus halepensis Mill. Root hydraulic conductance (Kh) was measured with a high-pressure flow meter, and values were normalized by total leaf area (leaf specific conductance, Kl), xylem cross-section area (xylem specific conductance, Ks), total root area (root specific conductance, Kr) and the area of fine roots (fine root specific conductance, Kfr). Controlling for organ size differences allowed comparison of the hydraulic efficiency of roots to supply or absorb water among fertilization treatments and species. The effect of N on the root hydraulic efficiency depended on the normalization criteria. Increasing N availability reduced Kl and Ks, but increased Kh, Kr and especially Kfr. The positive effect of N on Kr and Kfr was positively related to seedling relative growth rate and was also consistent with published results at the interspecific level, whereby plant hydraulics is positively linked to photosynthesis and transpiration rate and fast growth. In contrast, normalization by leaf area and xylem cross-sectional area (Kl and Ks) reflected opposite responses to Kr and Kfr. This indicates that the normalization criteria determine the interpretation of the effect of N on plant hydraulics, which can limit species and treatment comparisons.
An outbreak of acute skin and soft tissue infections including necrotizing fasciitis in Kalwala village, India, 2018: Public health implications for the lymphatic filariasis elimination program
Authors: Maramraj Kiran Kumar , ML Kavitha Latha , Dikid Tanzin , Choudhary Sushma , Reddy Sukrutha , Jain Sudhir Kumar , Singh Sujeet Kumar
Published: May 2020

Background

A cluster of 15 acute skin and soft tissue infections (SSTIs), including two cases of necrotizing fasciitis, reported in July 2018 from Kalwala village, led us to investigate and describe their epidemiology and to provide recommendations.

Methods

Cases, defined as localized painful swelling and redness in Kalwala residents from 1 December 2017 to 20 August 2018, were identified from hospital records and house-to-house surveys. We conducted an unmatched case-control study to identify risk factors for severity. We cultured wound samples and environmental samples from wound-dressing stations.

Results

We identified 36 cases (median age: 55 [range 17–80] y; 78% male), village attack rate 1% (36/4337) and no deaths. In 34 cases (94%), lower limbs were involved. Lymphatic filariasis (LF) was a common predisposing condition (67%). Comorbidities (diabetes or hypertension) (OR=9; 95% CI 2.0 to 41.1), poor limb hygiene (OR=16; 95% CI 2.8 to 95.3) and poor health-seeking behavior (OR=5; 95% CI 1.6 to 30.8) were associated with severity. All seven wound samples and 8/11 samples from wound-dressing stations showed atypical polymicrobial growth (Pseudomonas, Proteus, Klebsiella, Escherichia coli and Clostridium).

Conclusion

The outbreak of SSTIs among older males with LF was due to secondary bacterial infections and severity was associated with comorbidities, poor hygiene and health-seeking behavior, and likely contamination during wound-dressing. The LF elimination program managers was alerted, programmatic interventions were scaled up, home/facility-based morbidity and comorbidity management was facilitated and the outbreak was rapidly contained.
Integrating morphological and genetic data at different spatial scales in a cosmopolitan marine turtle species: challenges for management and conservation
Authors: Álvarez-Varas Rocío , Heidemeyer Maike , Riginos Cynthia , Benítez Hugo A , Reséndiz Eduardo , Lara-Uc Mónica , Godoy Daniel A , Muñoz-Pérez Juan Pablo , Alarcón-Ruales Daniela E , Vélez-Rubio Gabriela M , Fallabrino Alejandro , Piovano Susanna , Alfaro-Shigueto Joanna , Ortiz-Alvarez Clara , Mangel Jeffrey C , Esquerré Damien , Zárate Patricia , Medrano Carol , León Miranda Fabiola , Guerrero Felipe , Vianna Juliana A , Véliz David
Published: May 2020

Patterns of genetic structure in highly mobile marine vertebrates may be accompanied by phenotypic variation. Most studies in marine turtles focused on population genetic structure have been performed at rookeries. We studied whether genetic and morphological variation of the endangered green turtle (Chelonia mydas) is consistent geographically, focusing on foraging grounds. An association between population genetic structure and body shape variation at broad (inter-lineage) and fine (foraging grounds) scales was predicted and analysed using mitochondrial DNA and geometric morphometrics. Although genetic and phenotypic differentiation patterns were congruent between lineages, no fine-scale association was found, suggesting adaptive divergence. Connectivity among Pacific foraging grounds found here suggests that temperatures of ocean surface currents may influence the genetic structure of C. mydas on a broad scale. Our results suggest that vicariance, dispersal, life-history traits and ecological conditions operating in foraging grounds have shaped the intraspecific morphology and genetic diversity of this species. Considering a range of geographic and temporal scales is useful when management strategies are required for cosmopolitan species. Integrating morphological and genetic tools at different spatial scales, conservation management is proposed based on protection of neutral and adaptive diversity. This approach opens new questions and challenges, especially regarding conservation genetics in cosmopolitan species.
A Clone Resource of Magnaporthe oryzae Effectors That Share Sequence and Structural Similarities Across Host-Specific Lineages
Authors: Petit-Houdenot Yohann , Langner Thorsten , Harant Adeline , Win Joe , Kamoun Sophien
Published: May 2020

The blast fungus Magnaporthe oryzae (syn. Pyricularia oryzae) is a destructive plant pathogen that can infect about 50 species of both wild and cultivated grasses, including important crops such as rice and wheat. M. oryzae is composed of genetically differentiated lineages that tend to infect specific host genera. To date, most studies of M. oryzae effectors have focused on the rice-infecting lineage. We describe a clone resource of 195 effectors of Magnaporthe species predicted from all the major host-specific lineages. These clones are freely available as Golden Gate–compatible entry plasmids. Our aim is to provide the community with an open source effector clone library to be used in a variety of functional studies. We hope that this resource will encourage studies of M. oryzae effectors on diverse host species.
Diversity, Pathogenicity, and Fungicide Sensitivity of Colletotrichum Species Associated with Apple Anthracnose in South Korea
Authors: Kim Chi Hyun , Hassan Oliul , Chang Taehyun
Published: May 2020

Apple fruits with anthracnose symptoms were collected from commercial apple orchards in different regions of the Republic of Korea, and isolations were made on potato dextrose agar to isolate the causal agents. The fungal isolates were identified based on their morphological characteristics, growth rates, and multigene sequences. Nine isolates were identified via phylogenetic analysis: three Colletotrichum fructicola, two C. fioriniae, one C. gloeosporioides sensu stricto (s.s.), two C. nymphaeae, and one C. siamense isolates. The pathogenicity of the Colletotrichum isolates was tested using detached apple fruits under laboratory conditions. This study also reidentified six Colletotrichum isolates responsible for apple anthracnose, which were deposited in the Korean Agricultural Culture Collection. Among the six isolates, three were identified as C. siamense (deposited as C. gloeosporioides s.s.), and three were C. nymphaeae (deposited as C. acutatum s.s.). All the Colletotrichum species identified in this study were highly sensitive to tebuconazole in terms of inhibition of mycelial growth (EC50 value of 0.12 to 2.1 μg/ml).
Influence of Leaf Wetness Duration and Temperature on Infection of Grape Leaves by Elsinoë ampelina under Controlled and Vineyard Conditions
Authors: Carisse Odile , Levasseur Audrey , Provost Caroline
Published: May 2020

On susceptible varieties, indirect damage to vines infected by Elsinoë ampelina range from reduced vigor to complete defoliation while, on berries, damage ranges from reduced quality to complete yield loss. Limited knowledge about the relationship between weather conditions and infection makes anthracnose management difficult and favors routine application of fungicides. The influence of leaf wetness duration and temperature on infection of grape leaves by E. ampelina was studied under both controlled and vineyard conditions. For the controlled conditions experiments, the five youngest leaves of potted vines (Vidal) were inoculated with a conidia suspension and exposed to combinations of six leaf wetness durations (from 0 to 24 h) and six constant temperatures (from 5 to 30°C). A week after each preset infection period, the percent leaf area diseased (PLAD) was assessed. At 5°C, regardless of the leaf wetness duration, no disease developed. At 10 and at 15 to 30°C, the minimum leaf wetness durations were 4 and 6 h, respectively. Above the minimum wetness duration, at temperatures from 10 to 30°C, PLAD increased linearly, with increasing leaf wetness up to 12 h, and then at a lower rate from 12 to 24 h. The optimal temperature for infection was 25°C. Relative infection was modeled as a function of both temperature and wetness duration using a Richards model (R2 = 0.93). The predictive capacity of the model was evaluated with data collected in experimental vineyard plots exposed to natural wetness durations or artificial wetness durations created using sprinklers. In total, 264 vineyard infection events were used to validate the controlled experiments model. There was a linear relationship between the risk of infection estimated with the model and the observed severity of anthracnose (R2 = 90); however, the model underestimated disease severity. A risk chart was constructed using the model corrected for vineyard observations and three levels of risk, with light, moderate, and severe risks corresponding to ≤5, >5% to ≤25, and >25% leaf area diseased, respectively. Overall, 93.9% of 132 independent observations were correctly classified, with 100, 29.4, and 9.4% of the light, moderate, and severe risks, respectively.
Determination of Virulence Phenotypes of Plasmopara halstedii in the United States
Authors: Gilley Michelle A. , Gulya Thomas J. , Seiler Gerald J. , Underwood William , Hulke Brent S. , Misar Christopher G. , Markell Samuel G.
Published: May 2020

Downy mildew, caused by Plasmopara halstedii (Farl.) Berl. and de Toni, is an economically important disease in cultivated sunflowers, Helianthus annuus L. Resistance genes incorporated into commercial hybrids are used as an effective disease management tool, but the duration of effectiveness is limited as virulence evolves in the pathogen population. A comprehensive assessment of pathogen virulence was conducted in 2014 and 2015 in the U.S. Great Plains states of North Dakota and South Dakota, where approximately 75% of the U.S. sunflower is produced annually. The virulence phenotypes (and races) of 185 isolates were determined using the U.S. standard set of nine differentials. Additionally, the virulence phenotypes of 61 to 185 isolates were determined on 13 additional lines that have been used to evaluate pathogen virulence in North America and/or internationally. Although widespread virulence was identified on several genes, new virulence was identified on the Pl8 resistance gene, and no virulence was observed on the PlArg, Pl15, Pl17 and Pl18 genes. Results of this study suggest that three additional lines should be used as differentials and agree with previous studies that six lines proposed as differentials should be used in two internationally accepted differential sets. For effective disease management using genetic resistance, it is critical that virulence data be relevant and timely. This is best accomplished when pathogen virulence is determined frequently and by using genetic lines containing resistance genes actively incorporated into commercial cultivars.
Patient Deterioration in the Adult Progressive Care Unit
Authors: Krom Zachary R.
Published: May 2020

Background

The American Heart Association set a goal in 2010 to double the percentage of hospitalized adult patients who survive cardiac arrest by 2020. Because of acuity and interventions, progressive care patients are a population of interest to address this goal. The state of the literature involving patient deterioration, which can lead to cardiac arrest, in the progressive care setting has yet to be explored.

Objective

A scoping review was done to investigate the literature involving patient deterioration in adult progressive care units in order to map knowledge, identify themes, and discover areas for research potential.

Methods

The scoping review began with an extensive literature search and a multistep review. The characteristics of the final group of studies were charted and grouped according to common themes.

Results

There were 13 studies in the final group. All studies were conducted in the United States and most by interprofessional teams. Three themes were evident in the review, training methods, surveillance, and monitoring systems.

Discussion

Patient deterioration in the progressive care unit may benefit from team-based training methods involving checklists or protocols. Nurses can use surveillance, including physical assessment and technology, to recognize early warning signs. Lastly, the use of systems that identify patterns in vital signs can be useful to reduce patient harm. Further research in this area care is warranted and could potentially improve patient outcomes and nursing practice.
Intensive Care Unit Delirium, Clinical Observations, and Patients' Statements
Authors: Granberg-Axèll Anetth , Bergbom Ingegerd
Published: May 2020

Background

In clinical practice, nurses use their clinical gaze and make observations in order to assess patients' medical conditions and care needs. However, signs of developing intensive care unit delirium (ICUD) are often difficult to determine, as communication with patients is usually limited because of intubation and the seriousness of their medical condition(s). Usually, ICUD is screened and diagnosed with different, mainly nonverbal instruments, which presupposes that the observer is skilled and experienced in recognizing symptoms and signs of delirium.

Objectives

The objectives were to investigate if there was a concordance between data from continuous clinical observations described in the researcher's logbook and patients' statements of their experiences of delirium during their ICU stay.

Methods

Inclusion criteria were that the patients had been mechanically ventilated and had stayed in the ICU for a minimum of 36 hours. From this, a multiple-case design (n = 19), based on 1 to 3 hours of observations in the ICU and 2 interviews, was used. The first interview was conducted at the hospital approximately 6 to 14 days after discharge from the ICU, and the second, 4 to 8 weeks following the first interview in patients' homes. Two typical cases were identified and described by a cross-case procedure.

Results

A concordance between observations and patients' statements was found. Subtle, as well as obvious, signs of delirium were possible to detect by attentive observations over time and listening to what patients were trying to convey with their speech and body language. Experiencing delirium seemed to indicate existential suffering where the abnormal became the normal and not being able to distinguish between reality and fantasies.

Conclusion

A continuity of skilled observations and listening to patients' statements are vital for detection of ongoing ICU delirium or experiences of delirium.
Noise Level and Comfort in Healthy Subjects Undergoing High-Flow Helmet Continuous Positive Airway Pressure
Authors: Lucchini Alberto , Bambi Stefano , Gurini Silvia , Di Francesco Enrico , Pace Luigino , Rona Roberto , Fumagalli Roberto , Foti Giuseppe , Elli Stefano
Published: May 2020

Aim

The aim of this study was to assess the noisiness levels produced by different gas source systems, breathing circuits setup, and gas flow rates during continuous positive airway pressure (CPAP) delivered through helmet.

Methods

This was a crossover design study. Ten healthy subjects received helmet CPAP at 5 cm H2O in random order with different gas flow rates (60 and 80 L/min), 3 diverse gas source systems (A: Venturi system, B: oxygen and air flowmeters, C: electronic Venturi system), and 3 different breathing circuit configurations. During every step of this study, a heat and moisture exchanger (HME) was placed on the helmet inlet gas port to measure the effects on noise production. Noise intensity level was recorded through a sound-level meter. Participants scored their noisiness perception on a visual analog scale.

Results

The noise level inside the helmet ranged between 76 ± 4 and 117 ± 1 Decibel A. The gas source and the gas flow rate always affected the noise level inside and outside the helmet (P< .001). The different “breathing circuit setup” did not change the noise levels inside the helmet (P= .244), but affected the noise level outside, especially when a Venturi system was used (P< .001). An HME filter placed at the junction between the inspiratory limb of the breathing circuit and the helmet significantly decreased the noise intensity inside the helmet (mean dBA without HME, 99.56 ± 13.30 vs 92.26 ± 10.72 with HME;P< .001) and outside (mean dBA without HME, 68.16 ± 12.05 vs 64.97 ± 12.17 with HME;P< .001). The perception of noise inside the helmet was lower when an HME filter was placed on the inspiratory inlet gas port (median, 6 [interquartile range, 4–7] vs 7 [5–8];P<.001).

Conclusions

When helmet CPAP is delivered through gas flow rates up to 50 L/min, an HME placed on the helmet inlet gas port should be used to reduce noise inside the helmet and to improve patients' comfort.
Development of a Patient Centered Outcome Set for Patients With Multiple Myeloma to be Used in Clinical Practice
Authors: Oerlemans Simone , Bennink M. Christine , Levin Mark David , Broijl Annemiek , Van der Klift Marjolein , Van Deursen Judith , Vogels Daphne , Van de Poll‐Franse Lonneke V. , Sonneveld Pieter , Hazelzet Jan A. , Tick Lidwine W.
Published: May 2020

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Varicella Zoster Reactivation Causing Aseptic Meningitis in Healthy Adolescents
Authors: Barry Rachel , Prentice Michael , Costello Daniel , O’Mahony Olivia , DeGascun Cillian , Felsenstein Susanna
Published: May 2020

We describe 3 cases of adolescent varicella-zoster virus reactivation, complicated by aseptic meningitis, presenting to our institution in a 3-year period. These cases highlight varicella-zoster virus reactivation as an important cause of aseptic meningitis in the differential diagnosis of healthy adolescents, even in the absence of a characteristic exanthem. Evidence-based management recommendations are needed.
Epidemiologic and Molecular Characteristics of Staphylococcus aureus Strains Isolated From Hospitalized Pediatric Patients
Authors: Arikan Kamile , Karadag-Oncel Eda , Aycan Ahmet Emre , Yuksekkaya Serife , Sancak Banu , Ceyhan Mehmet
Published: May 2020

Background:

We aimed to determine molecular characteristics of Staphylococcus aureus isolates cultured from hospitalized pediatric patients.

Methods:

All accessible S. aureus isolates cultured from hospitalized pediatric patients were analyzed for staphylococcal cassette chromosome mec (SCCmec) types, Panton-Valentine Leukocidin (PVL) encoding genes and antibiotic resistance patterns.

Results:

A total of 132 S. aureus isolates, 102 methicillin-susceptible S. aureus (MSSA) (81.8%), 30 methicillin-resistant S. aureus (MRSA) (18.2%) were included in the study. Sixty of 132 (45.5%) S. aureus isolates were cultured from skin and soft tissue infections (SSTIs), 50 (37.9%) from bloodstream infections, 11 (8.3%) from bone infections and 11 (8.3%) from other sterile sites. Fifty-three of 102 (52%) MSSA isolates were cultured from SSTI, 35 (34.3%) from bloodstream infections, 7 (6.9%) from bone infections and 7 (6.9%) from other sterile sites (P = 0.083). Fifteen MRSA isolates (50%) were cultured from blood culture, 7 from (23.3%) SSTI, 4 (13.3%) from bone infections and 4 from (13.3%) other sterile sites. Nine PVL gene harboring S. aureus isolates were isolated from SSTI (75%), 2 from blood culture (16.7%) and 1 from other sterile site (8.3%). Three MRSA (6.7%) isolates were found to be positive for SCCmec type III and 16 MRSA isolates (53.3%) were found to be positive for SCCmec type IV. Three MRSA isolates harboring SCCmec type III was isolated from blood culture, 11 of 16 MRSA isolates harboring SCCmec type IV was isolated from blood culture, 3 isolates were isolated from bone infections and 2 isolates were isolated from SSTI (P < 0.001). Five of 72 (6.9%) hospital-acquired S. aureus isolates and 7 of 60 (11.7%) community-acquired S. aureus isolates were PVL gene positive. Twenty-two of 72 (30.6%) hospital-acquired S. aureus infections and 8 of 60 (13.3%) community-acquired S. aureus isolates were MRSA (P = 0.015). All of the 3 SCCmec III harboring MRSA isolates and 11 of 16 SCCmec IV carrying MRSA isolates were hospital acquired. Hospitalization in the past 1 year was found to increase MRSA infections 3.95 times (P = 0.038, 95% confidence interval: 1.078–14.48).

Conclusions:

As distribution of virulence genes differs among S. aureus isolates from different regions, it is necessary to monitor the emergence of genes encoding PVL, SCCmec in both MRSA and MSSA throughout the world. Our results show a high prevalence of PVL in community-onset S. aureus infections in children. SCCmec type IV was more commonly isolated in hospital-acquired MRSA isolates, and PVL gene was more commonly isolated in community-acquired S. aureus infections.
Not an epidemic, but a global problem: the authorities’ construction of HIV/AIDS in Russia
Authors: Yasaveev Iskender
Published: May 2020

The article deals with the ways Russian authorities have constructed the social problem of HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome) in Russia. The statistical construction of HIV/AIDS includes data indicating the significant rise of HIV prevalence in Russia since 2000. The study focuses on what and how Russian authorities speak about HIV/AIDS, while there are official data on the rapid spread of the virus in the country. The work is based on a discourse analysis of the authorities’ rhetoric about HIV/AIDS. During his first presidential terms, Vladimir Putin constructed HIV/AIDS not as an epidemic in the country, but as a “global problem,” representing Russia as a participant in international efforts to combat AIDS. The president problematized the HIV spread through the rhetoric of endangerment but without its crucial term “epidemic,” while at the same time de-problematized HIV in Russia by the strategy of naturalizing (“this is a problem that all countries face”). The Russian authorities appealed to traditional moral values and spoke about marginal or risk groups, rather than risk practices. After the deterioration of relations with Western countries since 2007, the Russian president excluded HIV/AIDS problem from his public agenda, despite the existence of the data on steep HIV growth in Russia. The Russian president's traditionalism, de-problematization, and silence concerning HIV/AIDS lead to the absence of the HIV/AIDS issues in media agenda, the agenda of local authorities, and consequently the personal agendas of Russian citizens. The consequences are ignorance, fears, stigmatization of people living with HIV, semi-legal status of needle, and syringe exchange programs for intravenous drug users, low antiretroviral therapy coverage, and the continuing HIV epidemic.
All-cause mortality and the risk of stroke with selective aspiration thrombectomy in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention
Authors: Tung Ying-Chang , See Lai-Chu , Chang Shu-Hao , Tu Hui-Tzu , Chan Yi-Hsin , Chang Chi-Jen
Published: May 2020

Few data exist on the clinical outcomes of selective aspiration thrombectomy during primary percutaneous coronary intervention (PPCI).

This was a nationwide retrospective cohort study. Patients who were diagnosed with ST-elevation myocardial infarction (STEMI) and received primary percutaneous coronary intervention (PCI) from July 2009 to December 2011 were identified from the National Health Insurance Research Database of Taiwan. Propensity score weighting was used to balance the covariates between the 2 study groups. The primary endpoints were all-cause mortality and stroke during hospitalization and at 30 days and 1 year of follow-up. Subgroup analyses were performed based on the hospital and physician volume of primary PCI.

A total of 9100 ST-elevation myocardial infarction patients (29.4% of patients receiving aspiration thrombectomy and conventional PPCI vs 70.6% receiving PPCI alone) were identified. The incidence rates of all-cause mortality were comparable between the 2 groups during hospitalization (21.0 vs 27.37/100 person-months; P = .29) and 1-year follow-up (0.81 vs 1.26/100 person-months; P = .85). There were no significant differences in the stroke rates between the 2 groups during hospitalization (1.1 vs 2.34/100 person-months; P = .3) and 1-year follow-up (0.09 vs 0.15/100 person-months; P = .85). For the patients who survived to discharge, the post-discharge 1-year mortality was lower in the aspiration thrombectomy group of patients in whom the procedures were performed by physicians with a high volume of PPCI (hazard ratio: 0.47; 95% confidence interval: 0.24–0.94; P = .03).

In this nationwide cohort study, selective aspiration thrombectomy at the operation's discretion had a comparable mortality rate compared with PCI alone and did not increase the risk of stroke. In the patients treated by physicians with a high volume of PPCI, aspiration thrombectomy appeared to have a beneficial effect on post-discharge survival at 1 year.
Clinical implications of thoracic duct dilatation in patients with chronic liver disease
Authors: Park Seung Woon , Kim Tae Hyung , Ham Soo-Youn , Um Soon Ho , Goh Hyun Gil , Lee SunHye , Lee Han Ah , Yim Sun Young , Seo Yeon Seok , Yim Hyung Joon , An Hyunggin , Oh Yu-Whan
Published: May 2020

This study aimed to investigate the association between the degree of thoracic duct dilatation and the progression of chronic liver disease.

In this cross-sectional and retrospective study, 179 patients (mean age, 60.9 years; 114 men) with chronic liver disease who underwent chest CT were enrolled. Dilatation of the left distal thoracic ducts (DTD) was measured and divided into the following 3 grades according to the maximum transverse diameter: grade 0, invisible thoracic duct; grade 1, visible duct with <5-mm diameter; grade 2, diameter of ≥5 mm. Statistical analyses were conducted using the binary logistic regression model.

The proportion of grade 2 DTD was notably higher as the chronic liver disease progressed to cirrhosis. Visible DTD on chest CT was significantly related to the presence of cirrhosis (odds ratio [OR], 3.809; P = .027) and significant varix (OR, 3.211; P = .025). Grade 2 DTD was observed more frequently in patients with ascites (OR, 2.788; P = .039). However, 40% of patients with cirrhosis and ascites still exhibited no visible DTD while demonstrating significant amount of ascites, and their ascites were more predominant of recent onset and transient than that observed in other patients (85.7% vs 48.4%, P = .010 and 66.7% vs 29.0%, P = .009, respectively).

The degree of thoracic duct dilatation is significantly associated with progression to cirrhosis and advancement of portal hypertension. Further, insufficient lymph drainage to DTD might contribute to the development of ascites.
Study on efficacy and safety of Huangqi Guizhi Wuwu decoction treatment for oxaliplatin induced peripheral neurotoxicity
Authors: Wei Xiao-Man , Chen Xiao-Feng , Shu Peng , Jiang Zhi-Wei , Wu Xiao-Yu , Zou Xi , Chen Kai , Shen Bo , Hu Wen-Wei , Lu Wei , Shen Wei-Xing , Li Liu , Wang Jun-Yi , Zhao Feng-Jiao , Yin Qing-Feng , Cheng Hai-Bo , Gu Yan-Hong
Published: May 2020

Background:

Oxaliplatin can cause severe peripheral neurotoxicity, which is an important reason for clinical oxaliplatin reduction and cessation of treatment. Oxaliplatin induced peripheral neurotoxicity (OIPN) can cause paresthesia and dysesthesia, even affect the quality life of patients. So far, there are no recognized and effective measures to prevent OIPN. Huangqi Guizhi Wuwu decoction is a classical prescription of ancient Chinese medicine recorded in “the synopsis of the Golden Chamber,” which can be used in the treatment of various neurotoxicity. However, there is a lack of large-scale and high-quality clinical studies on the prevention of OIPN by Huangqi Guizhi Wuwu decoction. The purpose of this study is to evaluate the efficacy and safety of Huangqi Guizhi Wuwu decoction on preventing OIPN.

Methods/design:

This study is a randomized, controlled, double-blind, and multicenter clinical trial. Three hundred sixty patients will be randomly assigned into Huangqi Guizhi Wuwu decoction group and Huangqi Guizhi Wuwu decoction mimetic agent group. Patients will receive chemotherapy with FOLFOX of 8 cycles of 3 weeks with Traditional Chinese Medicine (TCM) for 6 months and 1-year follow-up. The primary outcome measure is the differences in the incidence of chronic neurotoxicity of grade 2 and above during and after treatment. The secondary outcome measure is the improvement in other symptoms associated with chemotherapy. Four methods will be used to evaluate the efficacy of neurotoxicity, including oxaliplatin specific toxicity grading standard (Levi classification); CTCAE4.02 version; EORTC QLQ-CIPN20 scale, EORTC QLQ C30 scale, and EORTC QLQ-CR29 scale are used at the same time; Electromyography.

Discussion:

This study will provide objective evidences to evaluate the efficacy and safety of Huangqi Guizhi Wuwu Decoction on preventing OIPN.

Trial registration:

Clinical Trials.gov (Identifier: NCT04261920).