bluuebunny/crossref_metadata_2025 huggingface dataset:
Reduction in solar photovoltaic generation due to aerosol pollution in megacities in western China during 2014 to 2018
Authors: Zhang Liyuan , Yi Xiaoxiao , Zhao Min , Gu Zhaolin
Published: July 2020

Installed solar photovoltaic generation is expanding fast in western China, with total capacity accounting for >15% of global photovoltaic capacity. However, severe aerosol pollution over western China has weakened the solar radiation reaching the panels. We assessed the impact of aerosol pollution on photovoltaic power generation at the city level in western China from 2014 to 2018. Over northwestern China, severe aerosol pollution regions, aerosols reduced annual average photovoltaic generation by 0.15–0.31 kWh/m2/day relative to clean air conditions, a decrease of 4.8–9.0%. The impact had significant seasonal variations. Aerosols can exert an influence even as important as clouds in winter in northwestern China, with the reduction of 11.2–17.4% in December. Photovoltaic generation can be benefited from the improvement of aerosol pollution and can further improve the air quality by providing clean power.
Effects of visible greenness, quantity and distance of indoor plants on human perceptions and physical parameters
Authors: Han Ke-Tsung
Published: July 2020

The main purpose of this study was to examine the influence of visible greenness rate, green coverage ratio and distance from plants on human perceptions and parameters of the physical environment. A secondary purpose was to explore the correlation between parameters of physical environment and human perceptions when indoor plants were present. A randomized controlled trial was conducted. Experimental treatments were administered by placing either three or eight pots of Radermachera hainanensis Merr. in a room. Sixty students of a technology university in central Taiwan were recruited as participants, and their perceptions were collected using a questionnaire. Physical parameter data were collected using two air quality detectors. The results indicated the following: when the visible greenness rate was identical, different green coverage ratios and plant–participant distances did not exert different effects on participants' perceptions. Different green coverage ratios and distances from plants exerted differing effects on physical parameters. However, the distance from indoor plants had stronger and more consistent effects on physical parameters than the green coverage ratio. The environmental comfort of the participants increased with the CO2 level, and the lower the level of total volatile organic compound, the higher is the level of surprise.
Inquiry on territorial governance in Brittany and Wales: reanalysis of qualitative data by using CAQDAS in a comparative setting
Authors: Cole Alistair , Rioufreyt Thibault
Published: July 2020

This article elucidates the methodological issues around reanalysis, by comparing the treatment of a corpus of 52 interviews in two European regions by two researchers. The primary data were initially analysed by the principal investigator using a method similar to content analysis and with the help of NVivo 12. It was then reanalysed by a second researcher who did not participate in the interview campaign, using a more inductive method of qualitative discourse analysis assisted by Atlas-ti 8. The overarching conclusion confirms the usefulness of combining these methods of analysis. The article is a contribution to the literature on the use of CAQDAS in the context of the reuse of data.
Links between adverse childhood experiences, psychopathological symptoms and recidivism risk in juvenile delinquents
Authors: Guarnaccia Cinzia , De Vita Elisa , Sortino Loredana , Giannone Francesca
Published: July 2020

Research in the field of developmental psycho-criminology shows that conduct disorders and deviant behaviours are frequently associated with traumatic and adverse developmental experiences. Personality traits and psychopathological symptoms also increase the risk of criminality. However, the role of psychopathological symptoms in the relationship between adverse childhood experiences and offending has rarely been researched. The present study was designed to throw further light on these issues by analysing risk factors in a group of adolescents and young adults in a juvenile detention centre in southern Italy. Results support the idea that the accumulation of risk factors is a major factor in recidivism and highlight the key role played by the contexts and emotional environments in which children and adolescents grow up. They also underline the link between paternal antipathy and hostile behaviours and the potential impact of paternal antipathy and hostility on triggering delinquent trajectories. Our study’s main limitations are its small sample size and the absence of longitudinal measures. Nevertheless, combining detailed measures of a wide variety of factors with risk assessments drawn up by professionals who work with young offenders provided insights into the most suitable interventions for young delinquents. More precisely, because young offenders are victims of adverse childhood experiences as well as perpetrators of delinquent acts, interventions aimed at changing their life courses must adopt a global perspective that encompasses both their personal characteristics and their family circumstances, in order to provide an external environment conducive to non-recidivism.
Overcoming an Irrational Fear of Falling: A Case Study
Authors: Thiamwong Ladda , Decker Veronica B.
Published: July 2020

Irrational fear of falling is defined by the high degree of psychological fear a person has of falling when in reality, that person is at low physiological risk of falling. It is a significant problem in older people and may manifest from previous falls or fall-related depression and/or anxiety. If untreated, it may lead to increased falling, decreased mobility, social isolation, and decreased participation in daily activities. A mixed-methods, home-based, 8-week, physio-feedback/exercise program was developed for an older adult to help mitigate her irrational fear of falling. In this pilot case study, the quantitative independent variables of fear of falling, static balance, dynamic balance, fall risk factors, and fall risk appraisal were assessed pre- and post-intervention. A qualitative semi-structured interview was also conducted to help assess the participant’s reaction to the intervention. Data from quantitative, qualitative, and integrated viewpoints converged to indicate the intervention improved fear of falling, shifted the participant’s perception from irrational to rational fall risk appraisal and increased participation in daily activities.
Combined Gaze Metrics as Stress-Sensitive Indicators of Microsurgical Proficiency
Authors: Koskinen Jani , Bednarik Roman , Vrzakova Hana , Elomaa Antti-Pekka
Published: July 2020

Background. Evaluation of microsurgical proficiency is conventionally subjective, time consuming, and unreliable. Eye movement–based metrics have been promising not only in detection of surgical expertise but also in identifying actual cognitive stress and workload. We investigated if pupil dilations and blinks could be utilized in parallel to accurately classify microsurgical proficiency and its moderating features, especially task-related stress. Methods. Participants (n = 11) were divided into groups based on prior experience in microsurgery: novices (n = 6) with no experience and trained microsurgeons (n = 5). All participants conducted standardized suturing tasks with authentic instruments and a surgical microscope. A support vector machine classifier was used to classify features of microsurgical expertise based on percentage changes in pupil size. Results. A total of 109 successful sutures with 1090 segments were recorded. Classification of expertise from sutures achieved accuracies between 74.3% and 76.0%. Classification from individual segments based on these same features was not feasible. Conclusions. Combined gaze metrics are applicable for classifying surgical proficiency during a defined task. Pupil dilation is also sensitive to external stress factors; however, the usefulness of blinks is impaired by low blink rates. The results can be translated to surgical education to improve feedback and should be investigated individually in the context of actual performance and in real patient operations. Combined gaze metrics may be ultimately utilized to help microsurgeons monitor their performance and workload in real time—which may lead to prevention of errors.
Decolonizing Qualitative Research With Rural People With Disabilities: Lessons From a Cross-Cultural Health Systems Study
Authors: Sherry Kate , Dabula Xakathile , Duncan Eve Madeleine , Reid Steve
Published: July 2020

Decolonization of research is nowhere more pressing than in post-apartheid South Africa, where cross-cultural encounters characterize every aspect of society. The health system plays a critical role in realizing the rights of marginalized populations, particularly rural communities and people with disabilities. However, cultural divides between service users and health care workers render health care provision unexpectedly complex. Such divides likewise obscure the meanings embedded in qualitative data, rendering research interpretations challenging. A study of the engagement between rural isiXhosa-speaking people with disabilities and primary health care workers was conducted by the first author, a White English-speaking female health care worker, in partnership with the second author, a Xhosa male research implementer. Ethnographic and narrative methods were used to create an embedded case study of 11 households of people with disabilities. Lessons on conducting ethical and culturally congruent research with this population are presented, important limitations in the qualitative paradigm raised, and alternative stances explored.
A New Explanation for the Conflict Between Constructivist and Objectivist Grounded Theory
Authors: Coşkun Kerem
Published: July 2020

The purpose of this article is to produce a new explanation for the conflict between constructivist grounded theory and objectivist grounded theory. Grounded theory (GT) has drawn much attention because it enables qualitative researchers to produce theoretical explanations about what is going on. Since Glaser and Strauss invented the term “grounded theory,” there have been debates about what grounded theory is and what are its components. In this article, epistemological, ontological, and methodological beliefs about constructivist and objectivist grounded theory are explained and compared, and definitional analytical aspects of the two approaches are addressed by emphasizing their paradigmatic roots. As a result, it was concluded that objectivistic grounded theory is an agreement between positivism and the naturalistic approach advocating that researchers can be value laden but must stay as objective as possible. On the other hand, it is proposed that constructivist grounded theory is a value-laden logical operation in producing theoretical explanations.
The inseparable connection between leadership, agency, power and collaboration in a primary educational setting
Authors: Humphreys Deborah M , Rigg Clare
Published: July 2020

This paper critiques the empirically supported normative argument that distributed leadership allows for shared accountability and responsibility. Through the means of cognitive mapping and semi-structured interviews, we engaged in understanding how practices and structural conditions of distributed leadership within two English state primary school settings were established and accepted and where the inseparable connections between leadership, agency, power and collaboration positioned some members less well to participate and exercise influence than others. Our study utilises Foucault’s critical concepts of power as an interaction of social relations and his concept of ‘technologies of self’ whereby individuals undertake practices in order to shape themselves in particular ways to be accepted. Furthermore, drawing upon Bourdieu’s concepts of capital, habitus and field, findings indicate how within a distributed model of leadership individuals can be disconnected from the collective but enabled to feel good about this. We conclude by discussing the implications of these findings for distributed leadership and the necessity to problematise power more generally within a distributed model of leadership.
Presynaptic glutamatergic transmission and feedback system of oxytocinergic neurons in the hypothalamus of a rat model of adjuvant arthritis
Authors: Fujitani Teruaki , Matsuura Takanori , Kawasaki Makoto , Suzuki Hitoshi , Nishimura Haruki , Baba Kazuhiko , Yamanaka Yoshiaki , Ohnishi Hideo , Ueta Yoichi , Sakai Akinori
Published: July 2020

The neurohypophysial hormone oxytocin (OXT) is synthesized in the hypothalamic paraventricular and supraoptic nuclei. Recently, some studies have considered OXT to be important in sensory modulation and that the OXT protein is upregulated by acute and chronic nociception. However, the mechanism by which OXT is upregulated in neurons is unknown. In this study, we examined the resting membrane potentials and excitatory postsynaptic currents in OXT-ergic neurons in the paraventricular nucleus in adjuvant arthritis rat model, a model of chronic inflammation, using whole-cell patch-clamping. Transgenic rats expressing OXT and monomeric red fluorescent protein 1 (mRFP1) fusion protein to visualize the OXT-ergic neurons were used, and the OXT-mRFP1 transgenic rat model of adjuvant arthritis was developed by injection of heat-killed Mycobacterium butyricum. Furthermore, the feedback system of synthesized OXT was also examined using the OXT receptor antagonist L-368,899. We found that the resting membrane potentials and frequency of miniature excitatory postsynaptic currents and spontaneous excitatory postsynaptic currents in OXT-monomeric red fluorescent protein 1 neurons in the paraventricular nucleus were significantly increased in adjuvant arthritis rats. Furthermore, L-368,899 dose-dependently increased the frequency of miniature excitatory postsynaptic currents and spontaneous excitatory postsynaptic currents in OXT-ergic neurons. Following bath application of the GABAA receptor antagonist picrotoxin and the cannabinoid receptor 1 antagonist AM 251, L-368,899 still increased the frequency of miniature excitatory postsynaptic currents. However, following bath application of the nitric oxide synthase inhibitor Nω-Nitro-L-arginine methyl ester hydrochloride, L-368,899 did not alter the miniature excitatory postsynaptic current frequency. Thus, it is suggested that OXT-ergic neuron activity is upregulated via an increase in glutamate release, and that the upregulated OXT neurons have a feedback system with released endogenous OXT. It is possible that nitric oxide, but not GABA, may contribute to the feedback system of OXT neurons in chronic inflammation.
Communities of affect: A Freirean utopia?
Authors: Paiva Raquel
Published: July 2020

This article considers a few concepts and methodologies proposed by Paulo Freire and evaluates the contemporary importance of these elements in accordance with the notion of ‘community of affect’. One of the most up-to-date elements in Freire's theoretical and empirical work lies in his concern with sensory aspects. The sensorium, or the sensible, was first introduced in early communication studies. It is understood as a structure which is parallel to reason. The present article intends to debate the extent to which the idea of the sensible relates to Freire, as he first approaches it in the concept of ‘touching’ the subject or the group during the educational process. This sensible corresponds to the link among people. It connects to what one calls the community of affect, in which the environment and the space assume an educational dimension.
Strength of side-to-side and step-cut repairs in tendon transfers: biomechanical testing of porcine flexor tendons
Authors: Strandenes Eivind , Ellison Peter , Mølster Anders O. , Gjerdet Nils R. , Moldestad Irene O. , Høl Paul J.
Published: July 2020

The aim of the study was to compare side-to-side with step-cut repairs to determine how much of the width it is possible to remove and still keep the repair strong enough to start active mobilization. Porcine flexor tendons were used to create side-to-side, one-third step-cut and half step-cut repairs. There were 15 repairs in each group. The tensile properties of the constructs were measured in a biomechanical testing machine. All repairs failed by the sutures splitting the tendon longitudinally. The maximum load and stiffness were highest in the side-to-side group. Our findings suggest that the half step-cut repair can withstand the forces exerted during active unrestricted movement of the digits in tendons of this size. The advantage of the step-cut repair is reduced bulkiness and less friction, which might compensate for the difference in strength.
Atezolizumab in a

C

o

H

ort of pretreated, advanced, non-small cell lung cancer patients with rare HistologiCal Subtyp

E

s (CHANCE trial)
Authors: Gelsomino Francesco , Lamberti Giuseppe , Tiseo Marcello , Rocco Danilo , Pasello Giulia , Cecere Fabiana Letizia , Chella Antonio , Grilli Giada , Mandruzzato Marcella , Tognetto Michele , Garassino Marina Chiara , Macerelli Marianna , Novello Silvia , Roila Fausto , Colantonio Ida , Grossi Francesco , Fiorentino Michelangelo , Ardizzoni Andrea
Published: July 2020

Background:

Although immunotherapy with immune-checkpoint inhibitors (ICIs) has profoundly changed the therapeutic scenario in the treatment of advanced non-small cell lung cancer (NSCLC), trials of ICIs only enrolled NSCLC patients with common histology. Atezolizumab was approved by the United States Food and Drug Administration (US FDA) in October 2016 and by the European Medicines Agency (EMA) in September 2017 for the treatment of patients with metastatic NSCLC whose disease progressed during or following platinum-containing chemotherapy, regardless of PD-L1 expression.

Methods:

We designed a single-arm, multicenter, two-stage phase II study and plan to enroll 43 patients. The primary objective of the study is to evaluate the antitumor activity of atezolizumab in advanced NSCLC patients with rare histology subtypes. Patients with prior atezolizumab or ICI treatment and with untreated, symptomatic, or progressing brain metastases will be excluded. The primary endpoint is disease control rate. Secondary objectives are toxicity and safety, overall response rate, progression-free survival, overall survival, and time to progression. Diagnosis of NSCLC with rare histology will be confirmed by central pathology revision, and will include: colloid carcinoma, fetal adenocarcinoma, non-endocrine large cell carcinoma, sarcomatoid carcinoma, salivary gland-type tumor, lymphoepithelioma-like carcinoma, and NUT-nuclear protein in testis carcinoma. Archival tumor tissue is required for correlative studies of PD-L1 expression on tumor cells and tumor infiltrating lymphocytes.

Conclusions:

Therapeutic options in NSCLC with rare histology subtypes, to be assessed in specifically designed trials, are an unmet need. This trial will help elucidate the role of atezolizumab as a viable option in this setting.
Learning by Doing: A Daily Life Study of Principal Interns’ Leadership Activities During the School Year
Authors: Drake Timothy A.
Published: July 2020

Clinical experiences, including the full-time principal internship, are considered to be one of the most important components in principal preparation. Yet research on the principal internship is limited to surveys and interviews. I use a daily life methodology to explore full-time principal interns’ experiences during an academic school year. I find that interns’ activities approximate the work of a school principal in many aspects of the job, including administrative activities and instructional leadership. I also find that variation between interns’ activities is consistent with the literature, in that their activities vary based on personal background and school context.
Tips for medical educators on how to conduct effective online teaching in times of social distancing
Authors: Dong Chaoyan , Lee Deanna Wai-Ching , Aw Derrick Chen-Wee
Published: July 2020

During the current coronavirus disease 2019 pandemic, with the Singapore government mandating social distancing, all educational activities in medical schools have been affected. Medical students from our three medical schools have been banned from all clinical environments (polyclinics and hospitals). Online teaching and meetings became the norm. Although medical educators are generally good clinicians and educational tutors, many are not used to teaching and learning on an electronic platform due to various barriers such as time constraints, poor technical skills, inadequate infrastructure and a lack of institutional support. In this article, we collate tips from published work in online learning, and we also share our own experiences in conducting online teaching.
Effective treatment of refractory acquired pure red blood cell aplasia with eltrombopag and sirolimus: a case report
Authors: Huang Yuzhou , Jiang Xianyong , Han Bing
Published: July 2020

Acquired pure red cell aplasia (aPRCA) is a kind of anemia characterized by severe reticulocytopenia and reduced bone marrow erythroblastic cells. For patients who are refractory to the first-line therapy (cyclosporin A with/without glucocorticoids), second-line therapy is considered less effective. We report on a patient with primary aPRCA who was refractory to cyclosporin A, glucocorticoids, and several second-line regimens. The patient was treated with sirolimus for 10 months with no improvement in hemoglobin but complete response was achieved after adding eltrombopag at a dosage of 25 mg/day. Eltrombopag was well tolerated with no evidence of clonal evolution at the end of follow up. This case provided a new attempt at treating patients with refractory/relapse aPRCA with eltrombopag, probably in combination with sirolimus.
Building an innovation system of medical devices in China: Drivers, barriers, and strategies for sustainability
Authors: Cheong Sok Teng , Li Jian , Ung Carolina Oi Lam , Tang Daisheng , Hu Hao
Published: July 2020

Objectives:

This article aimed to discuss the emergence of medical device sector in China from a sectoral innovation system perspective, to explore the drivers and barriers to the successful building of an innovation system of medical devices, and to highlight the policy implications and suggestions for sustainable innovation of medical devices.

Methods:

A theoretical framework of sectoral systems of innovation was applied in the analysis of data, and materials were collected from multiple sources with particular attention paid to the evolutionary phases, structure, and function of the innovation system.

Results:

The evolution of medical device sector in China could be divided into four phases: initialization (1960s–1970s); exploration (1980s); steady growth (1990s); and rapid growth (since 2000). Through analyzing the innovation system’s structural components of technology, actors, and networking, as well as institutions, this study indicated that the government policy decision was the most important driver that affected the virtuous cycle of the Chinese medical device innovation system, followed by market demand and entrepreneurial activities. However, barriers against the innovation cycle such as knowledge base development and diffusion, legitimacy, and resource mobilization still remained.

Conclusion:

In its endeavor to build an innovation system, the Chinese medical device sector had made some progress in meeting the local medical demands and improving its industrial competence. Although a Chinese innovation system for medical devices was initiated under the guidance of the government, knowledge advancement and diffusion had become the main challenges for the sustainability of innovation in this sector. The future development depends on China’s effort and ability to establish education and health research systems specific to medical devices.
Rigorous Hand Hygiene Practices Among Health Care Workers Reduce Hospital-Associated Infections During the COVID-19 Pandemic
Authors: Roshan Rozina , Feroz Anam Shahil , Rafique Zohra , Virani Nazleen
Published: July 2020

The experiences of these recent months have left us with as many new questions as they have given us new solutions. The main question that infection prevention and control department is having these days is “Why have hospital-associated infections (HAIs) reduced during COVID-19 pandemic?” What is the one unique strategy that has brought decline in increasing HAIs? Would it be appropriate to say that rigorous hand hygiene practices among health care workers (HCWs) have reduced HAIs in a tertiary care hospital of Pakistan? This commentary is written to understand the effect of rigorous hand hygiene among HCWs on number of HAIs during COVID-19 pandemic. Given the seriousness of this outbreak, it was observed that the hand hygiene has occupied a new place of importance in the minds of HCWs. We observed 4 times increase in the consumption of hand sanitizers after COVID-19 outbreak. The increased consumption of hand sanitizers was reflected in improved hand hygiene practices. A reduction was observed in the number of HAIs after the COVID-19 outbreak, and we assume that the dip in HAIs is associated with the improvement in hand hygiene practices in the recent months. In the wake of COVID-19 pandemic, these trends reassure us that hand hygiene compliance by HCWs alone can be effective in reducing HAIs in a hospital setting.
Series of 55 pregnancies following ulipristal acetate treatment of symptomatic uterine fibroids
Authors: Costa Ana R , Carvalho Ana P , Martins Diana R , Carvalho Maria J , Silva Pedro T , Roque Sílvia C , Silva Daniel P
Published: July 2020

Introduction:

Treatment with ulipristal acetate effectively controls excessive bleeding due to uterine fibroids and reduces their size. Uterine fibroid size reduction is expected to improve the results of the myomectomy and the reproductive prospects of the patient.

Methods:

Retrospective and descriptive analysis of a series of 53 patients who achieved pregnancy after being treated for symptomatic uterine fibroids. The primary endpoints were pregnancy and birth outcomes in women with symptomatic uterine fibroids that conceived following at least one course of therapy with ulipristal acetate 5 mg/day. The secondary endpoints were time until pregnancy, reasons for ulipristal acetate treatment, number of treatment courses completed, hemorrhagic control achievement, hemoglobin levels, fibroid FIGO classification, largest fibroid diameter, and type of myomectomy (if any).

Results:

Fifty-five pregnancies were registered in 53 patients following ulipristal acetate therapy (43 live births, 9 miscarriages, and 3 ongoing pregnancies). Half of the patients became pregnant without interval surgery. Bleeding control was achieved in 96% of the cases. A significant increase (p < 0.001) in hemoglobin levels and a reduction (p < 0.001) in uterine fibroid size was observed after treatment. No malformations were reported among newborns after ulipristal acetate therapy.

Conclusion:

So far, this is the largest case series reporting both pregnancy and birth outcomes following ulipristal acetate therapy for uterine fibroids. Our data support favorable outcomes after therapy for this population subset.
Mitochondrial DNA haplogroup H association with endometriosis and possible role in inflammation and pain
Authors: Asally Razan , Markham Robert , Manconi Frank
Published: July 2020

Introduction:

Endometriosis is an inflammatory disease characterised by the presence of endometrial-like tissue outside the uterus and affects approximately 10%–15% of women in their reproductive years. Pain is one of the predominant symptoms of the disease. Oxidative stress is involved in the pathophysiology of endometriosis and develops when there is an imbalance between the reactive oxygen species and reactive nitrogen species production, and the elimination capacity of antioxidants in the reproductive tract. High levels of reactive oxygen species can induce pain indirectly through oxidative stress-associated inflammation or directly through sensitising the nociceptive neurons that transmit the signals to the cerebral sensory cortex which are perceived as a feeling of pain. Mitochondria are the main source of reactive oxygen species, which generate through oxidative phosphorylation. Given that the mitochondria are involved in reactive oxygen species formation and energy production, which are required for the activation and proliferation of peripheral lymphocytes, it has been suggested that mitochondrial DNA variants are involved in the pathogenesis of endometriosis. This study has provided a better understanding of maternally inherited risk factors which contribute to the pain mechanisms associated with endometriosis.

Results:

Mitochondrial DNA haplogroup H was found to be significantly higher in women with endometriosis. This study was the first to report the association between the European mitochondrial haplogroup H and the risk of pain associated with endometriosis.

Discussion:

The results suggest that there are maternally inherited risk factors in women with endometriosis causing high reactive oxygen species production and oxidative stress, which facilitate pain generation in women with endometriosis.
Trends in Digital Replantation: 10 Years of Experience at a Large Canadian Tertiary Care Center: Les tendances de la replantation digitale : dix ans d’expérience d’un grand centre canadien de soins tertiaires
Authors: Solaja Ogi , Retrouvey Helene , Baltzer Heather
Published: July 2020

Background:

Since 1965, the practice of digital replantation has seen great technical strides and become commonplace worldwide. However, some American authors have recently reported declining rates of replantation. We set out to characterize the patient population and describe treatment patterns from 2005 to 2016 at a large Canadian regional replantation center.

Methods:

A retrospective cohort of all patients undergoing digital replantation and revascularization from 2005 to 2016 was identified. Data were collected on demographics, injuries, procedures, and outcomes. Descriptive statistics were performed, followed by a comparison of two 5-year periods to evaluate temporal trends.

Results:

A total of 234 patients were treated with 146 replantation and 204 revascularization procedures. Patients were largely male, healthy, and worked as manual labourers. Overall, the failure rate of individual repairs was 28.7%. Over time, there was a trend toward more crush or avulsion and multidigit injuries, and surgeries performed after 2011 were significantly longer. There was a significant downward trend in the number of patients treated at our center each year. Additionally, there was a statistically significant decrease in the proportion of replanted to revised digits in multidigit cases.

Discussion:

Our observation of declining replantation rates is in line with recent American observations. The reason for this is not obvious but may represent a change in injury characteristics or surgeon attitudes.

Conclusion:

We suspect that these changes represent a change in workplace safety and injury characteristics, but further studies are needed to assess patient and surgeon treatment decisions.
Health Professional Student Awareness and Attitudes Toward Poverty
Authors: Thompson Jessica R. , Boak Brandi , Elias Thistle I.
Published: July 2020

Poverty simulations are used increasingly in academic settings to expose health professional students to experiences of those living in poverty; therefore, the impact, content, and context of these simulations should be examined. Bridging the Gaps-Pittsburgh uses a full-day poverty simulation (Experiential Poverty [EP] Exercise) to expose health professional students to structural realities and experiences of those living in poverty in the United States as part of an intensive, interdisciplinary, community-partnered summer internship program. Students engage in the EP Exercise in one of 8 weekly didactic and reflective sessions throughout the 8-week, full-time internship. To measure the impact of the EP Exercise on student learning, Bridging the Gaps-Pittsburgh developed a measure (Poverty Attitude, Awareness, and Understanding Survey [PAAUS]), including seven questions to explore student awareness of aspects of poverty and two questions regarding attitudes about poverty students carry into their future practice. Using five cohorts of PAAUS data over 5 years, we analyzed the changes in attitudes and understanding about poverty among health professional students pre- and postparticipation in this program. For one recent cohort, we conducted an additional posttest to assess the impact of the poverty simulation as distinct from other programmatic experiences. Finally, we share qualitative feedback from student evaluations following the EP Exercise. We provide evidence of the statistically significant impact of the EP Exercise on students’ awareness, attitudes, and understanding of poverty and indicate the importance of considering the context of poverty simulations to improve health professional student preparation to work with populations experiencing poverty.
Outcomes of COVID-19 in patients with CLL: a multicenter international experience
Authors: Mato Anthony R. , Roeker Lindsey E. , Lamanna Nicole , Allan John N. , Leslie Lori , Pagel John M. , Patel Krish , Osterborg Anders , Wojenski Daniel , Kamdar Manali , Huntington Scott F. , Davids Matthew S. , Brown Jennifer R. , Antic Darko , Jacobs Ryan , Ahn Inhye E. , Pu Jeffrey , Isaac Krista M. , Barr Paul M. , Ujjani Chaitra S. , Geyer Mark B. , Berman Ellin , Zelenetz Andrew D. , Malakhov Nikita , Furman Richard R. , Koropsak Michael , Bailey Neil , Hanson Lotta , Perini Guilherme F. , Ma Shuo , Ryan Christine E. , Wiestner Adrian , Portell Craig A. , Shadman Mazyar , Chong Elise A. , Brander Danielle M. , Sundaram Suchitra , Seddon Amanda N. , Seymour Erlene , Patel Meera , Martinez-Calle Nicolas , Munir Talha , Walewska Renata , Broom Angus , Walter Harriet , El-Sharkawi Dima , Parry Helen , Wilson Matthew R. , Patten Piers E. M. , Hernández-Rivas José-Ángel , Miras Fatima , Fernández Escalada Noemi , Ghione Paola , Nabhan Chadi , Lebowitz Sonia , Bhavsar Erica , López-Jiménez Javier , Naya Daniel , Garcia-Marco Jose Antonio , Skånland Sigrid S. , Cordoba Raul , Eyre Toby A.
Published: July 2020

Given advanced age, comorbidities, and immune dysfunction, chronic lymphocytic leukemia (CLL) patients may be at particularly high risk of infection and poor outcomes related to coronavirus disease 2019 (COVID-19). Robust analysis of outcomes for CLL patients, particularly examining effects of baseline characteristics and CLL-directed therapy, is critical to optimally manage CLL patients through this evolving pandemic. CLL patients diagnosed with symptomatic COVID-19 across 43 international centers (n = 198) were included. Hospital admission occurred in 90%. Median age at COVID-19 diagnosis was 70.5 years. Median Cumulative Illness Rating Scale score was 8 (range, 4-32). Thirty-nine percent were treatment naive (“watch and wait”), while 61% had received ≥1 CLL-directed therapy (median, 2; range, 1-8). Ninety patients (45%) were receiving active CLL therapy at COVID-19 diagnosis, most commonly Bruton tyrosine kinase inhibitors (BTKi’s; n = 68/90 [76%]). At a median follow-up of 16 days, the overall case fatality rate was 33%, though 25% remain admitted. Watch-and-wait and treated cohorts had similar rates of admission (89% vs 90%), intensive care unit admission (35% vs 36%), intubation (33% vs 25%), and mortality (37% vs 32%). CLL-directed treatment with BTKi’s at COVID-19 diagnosis did not impact survival (case fatality rate, 34% vs 35%), though the BTKi was held during the COVID-19 course for most patients. These data suggest that the subgroup of CLL patients admitted with COVID-19, regardless of disease phase or treatment status, are at high risk of death. Future epidemiologic studies are needed to assess severe acute respiratory syndrome coronavirus 2 infection risk, these data should be validated independently, and randomized studies of BTKi’s in COVID-19 are needed to provide definitive evidence of benefit.
Smoking status and second-hand smoke biomarkers in COPD, asthma and healthy controls
Authors: Bradicich Matteo , Schuurmans Macé M.
Published: July 2020

Introduction

Tobacco smoke worsens COPD and asthma. For healthy individuals, quantifying active and second-hand smoke (SHS) exposure clarifies the epidemiology of tobacco consumption and the efficacy of nonsmoking measures. Identifying tobacco exposure biomarkers and cut-offs might allow the creation of sensitive and specific tests.

Aim

We describe the state-of-the-art serum, urinary cotinine and exhaled carbon monoxide (CO) cut-offs for assessing smoking status and SHS exposure in adult patients with COPD or asthma, and healthy controls.

Methodology

After a keyword research in the PubMed database, we included papers reporting on the cut-offs of the investigated biomarkers in one of the populations of interest. Papers published before 2000, not in English, or reporting only data on nonadult subjects or on pregnant women were excluded from the analysis. 14 papers were included in the final analysis. We summarised diagnostic cut-offs for smoking status or SHS exposure in COPD, asthmatic and healthy control cohorts, reporting sensitivity and specificity when available.

Conclusion

Serum and urinary cotinine and exhaled CO are easy-to-standardise, affordable and objective tests for assessing smoking status and SHS exposure. Evidence on cut-offs with good sensitivity and specificity values is available mainly for healthy controls. For COPD and asthmatic patients, most of the currently available evidence focuses on exhaled CO, while studies on the use of cotinine with definite sensitivity and specificity values are still missing. Solid evidence on SHS exposure is available only for healthy controls. An integrated approach with a combination of these markers still needs evaluation.
Regulatory review of the environmental risk assessment of veterinary medicinal products in the European Union, with particular focus on the centralised authorisation procedure
Authors: Fabrega Julia , Carapeto Ricardo
Published: July 2020

In the EU, the requirement for a two-tier-based environmental risk assessment for a veterinary medicinal product applies for marketing authorisations submitted since 1993. This article outlines the framework for conducting environmental risk assessments and provides information about the outcomes and type of substances that often require a higher tier assessment due to environmental concerns, and the tools available within the relevant regulation to reassess potential risks from products already authorised (i.e., referral procedures (under Article 33(4), Article 35 of Directive 2001/82/EC and Article 30(3) of Regulation (EC) No 726/2004)). The majority of pharmaceutical veterinary medicinal products (> 95%) are considered to have a limited environmental release, and their risk assessment ends in the lowest tier (Phase I). To date, 19 referrals have been triggered as a result of environmental concerns, with the outcome from two out of the 19 concluding with an overall benefit/risk balance being negative, and resulting in the withdrawal of products from the market. The way environmental risk assessment for veterinary products will be addressed when the new veterinary regulation (Regulation (EU) 2019/6) comes into force on 28 January 2022 is also presented, and ongoing initiatives and published reports are discussed. The latter recommending policy actions to address water pollution by pharmaceutical residues and advocating a robust international cooperation and the establishment of a ‘One Health’ approach.
SpectralTAD: an R package for defining a hierarchy of topologically associated domains using spectral clustering
Authors: Cresswell Kellen G. , Stansfield John C. , Dozmorov Mikhail G.
Published: July 2020

Background

The three-dimensional (3D) structure of the genome plays a crucial role in gene expression regulation. Chromatin conformation capture technologies (Hi-C) have revealed that the genome is organized in a hierarchy of topologically associated domains (TADs), sub-TADs, and chromatin loops. Identifying such hierarchical structures is a critical step in understanding genome regulation. Existing tools for TAD calling are frequently sensitive to biases in Hi-C data, depend on tunable parameters, and are computationally inefficient.

Methods

To address these challenges, we developed a novel sliding window-based spectral clustering framework that uses gaps between consecutive eigenvectors for TAD boundary identification.

Results

Our method, implemented in an R package, SpectralTAD, detects hierarchical, biologically relevant TADs, has automatic parameter selection, is robust to sequencing depth, resolution, and sparsity of Hi-C data. SpectralTAD outperforms four state-of-the-art TAD callers in simulated and experimental settings. We demonstrate that TAD boundaries shared among multiple levels of the TAD hierarchy were more enriched in classical boundary marks and more conserved across cell lines and tissues. In contrast, boundaries of TADs that cannot be split into sub-TADs showed less enrichment and conservation, suggesting their more dynamic role in genome regulation.

Conclusion

SpectralTAD is available on Bioconductor, http://bioconductor.org/packages/SpectralTAD/.
GenAPI: a tool for gene absence-presence identification in fragmented bacterial genome sequences
Authors: Gabrielaite Migle , Marvig Rasmus L.
Published: July 2020

Background

Bacterial gene loss and acquisition is a well-known phenomenon which contributes to bacterial adaptation through changes in important phenotypes such as virulence, antibiotic resistance and metabolic capability. While advances in DNA sequencing have accelerated our ability to generate short genome sequence reads to disentangle phenotypic changes caused by gene loss and acquisition, the short-read genome sequencing often results in fragmented genome assemblies as a basis for identification of gene loss and acquisition events. However, sensitive and precise determination of gene content change for fragmented genome assemblies remains challenging as analysis needs to account for cases when only a fragment of the gene is assembled or when the gene assembly is split in more than one contig.

Results

We developed GenAPI, a command-line tool that is designed to compare the gene content of bacterial genomes for which only fragmented genome assemblies are available. GenAPI, unlike other available tools of similar purpose, accounts for imperfections in sequencing and assembly, and aims to compensate for them. We tested the performance of GenAPI on three different datasets to show that GenAPI has a high sensitivity while it maintains precision when dealing with partly assembled genes in both simulated and real datasets. Furthermore, we benchmarked the performance of GenAPI with six popular tools for gene presence-absence identification.

Conclusions

Our developed bioinformatics tool, called GenAPI, has the same precision and recall rates when analyzing complete genome sequences as the other tools of the same purpose; however, GenAPI’s performance is markedly better on fragmented genome assemblies.
Determinants of translation efficiency in the evolutionarily-divergent protist Trichomonas vaginalis
Authors: Wang Shuqi E. , Brooks Anna E. S. , Poole Anthony M. , Simoes-Barbosa Augusto
Published: July 2020

Background

Trichomonas vaginalis, the causative agent of a prevalent urogenital infection in humans, is an evolutionarily divergent protozoan. Protein-coding genes in T. vaginalis are largely controlled by two core promoter elements, producing mRNAs with short 5′ UTRs. The specific mechanisms adopted by T. vaginalis to fine-tune the translation efficiency (TE) of mRNAs remain largely unknown.

Results

Using both computational and experimental approaches, this study investigated two key factors influencing TE in T. vaginalis: codon usage and mRNA secondary structure. Statistical dependence between TE and codon adaptation index (CAI) highlighted the impact of codon usage on mRNA translation in T. vaginalis. A genome-wide interrogation revealed that low structural complexity at the 5′ end of mRNA followed closely by a highly structured downstream region correlates with TE variation in this organism. To validate these findings, a synthetic library of 15 synonymous iLOV genes was created, representing five mRNA folding profiles and three codon usage profiles. Fluorescence signals produced by the expression of these synonymous iLOV genes in T. vaginalis were consistent with and validated our in silico predictions.

Conclusions

This study demonstrates the role of codon usage bias and mRNA secondary structure in TE of T. vaginalis mRNAs, contributing to a better understanding of the factors that influence, and possibly regulate, gene expression in this human pathogen.
Comparative population genomic analysis uncovers novel genomic footprints and genes associated with small body size in Chinese pony
Authors: Asadollahpour Nanaei Hojjat , Esmailizadeh Ali , Ayatollahi Mehrgardi Ahmad , Han Jianlin , Wu Dong-Dong , Li Yan , Zhang Ya-Ping
Published: July 2020

Background

Body size is considered as one of the most fundamental properties of an organism. Due to intensive breeding and artificial selection throughout the domestication history, horses exhibit striking variations for heights at withers and body sizes. Debao pony (DBP), a famous Chinese horse, is known for its small body size and lives in Guangxi mountains of southern China. In this study, we employed comparative population genomics to study the genetic basis underlying the small body size of DBP breed based on the whole genome sequencing data. To detect genomic signatures of positive selection, we applied three methods based on population comparison, fixation index (FST), cross population composite likelihood ratio (XP-CLR) and nucleotide diversity (θπ), and further analyzed the results to find genomic regions under selection for body size-related traits.

Results

A number of protein-coding genes in windows with the top 1% values of FST (367 genes), XP-CLR (681 genes), and log2 (θπ ratio) (332 genes) were identified. The most significant signal of positive selection was mapped to the NELL1 gene, probably underlies the body size and development traits, and may also have been selected for short stature in the DBP population. In addition, some other loci on different chromosomes were identified to be potentially involved in the development of body size.

Conclusions

Results of our study identified some positively selected genes across the horse genome, which are possibly involved in body size traits. These novel candidate genes may be useful targets for clarifying our understanding of the molecular basis of body size and as such they should be of great interest for future research into the genetic architecture of relevant traits in horse breeding program.