bluuebunny/crossref_metadata_2025 huggingface dataset:
Diurnal Cycle of Tropical Oceanic Mesoscale Cold Pools
Authors: Garg Piyush , Nesbitt Stephen W. , Lang Timothy J. , Priftis George
Published: August 2021

Tropical convection regimes range from deep organized to shallow convective systems. Mesoscale processes such as cold pools within tropical convective systems can play a significant role in the evolution of convection over land and open ocean. Although cold pools are widely observed, their diurnal properties are not well understood over tropical oceans and land. The oceanic cold pool identification metric applied herein uses the gradient feature (GF) technique and is compared with diurnally-resolved buoy-identified thermal cold pools. This study provides a first-ever diurnal climatology of GF number, area, and attributed TRMM 3B42 precipitation using a space-borne scatterometer (RapidScat). Buoy data over the Pacific, Atlantic, and Indian Ocean have been used to validate and examine the RapidScat-identified diurnal cycle of GF number and precipitation. Buoy-observed cold pool duration, precipitation, temperature, and wind speed is analyzed to understand thein situcold pool properties over tropical oceans. GF- and buoy-observed cold pool number and precipitation exhibits a similar bimodal diurnal variability with a morning and afternoon maxima, thus establishing confidence in using GF as a proxy to observe cold pools over tropical oceans. The morning peak is attributed to cold pools associated with deep moist convection while the afternoon peak is related to shallower clouds in relatively drier environments resulting in smaller cold pools over global tropical oceans.
Convective Cloud Clusters and Squall Lines along the Coastal Amazon
Authors: Sousa A. C. , Candido L. A. , Satyamurty P.
Published: August 2021

Mesoscale convective cloud clusters develop and organize in the form of squall lines along the coastal Amazon in the afternoon hours and propagate inland during the evening hours. The frequency, location, organization into lines, and movement of the convective systems are determined by analyzing the “precipitation features” obtained from the TRMM satellite for the period 1998–2014. The convective clusters and their alignments into Amazon coastal squall lines are more frequent from December to July, and they mostly stay within 170 km of the coastline. Their development and movement in the afternoon and evening hours of about 14 m s−1are helped by the sea breeze. Negative phase of Atlantic dipole and La Niña combined increase the frequency of convective clusters over the coastal Amazon. Composite environmental conditions of 13 large Amazon coastal squall-line cases in April show that conditional instability increases from 0900 to 1200 LT and the wind profiles show a jet-like structure at low levels of the atmosphere. The differences in the vertical profiles of temperature and humidity between the large-squall-line composites and no-squall-line composites are weak. However, appreciable increase in the mean value of CAPE from 0900 to 1500 LT is found in the large-squall-line composite. The mean mixing ratio of the mixed layer at 0900 LT in La Niña situations is significantly larger in the large-squall-line composite. Thus, CAPE and mixed-layer mixing ratio are considered to be promising indicators of the convective activity over the coastal belt of the Amazon basin.
Multicut technology used in WEDM machining of Mar-M247
Authors: Mouralova Katerina , Polzer Ales , Benes Libor , Bednar Josef , Zahradnicek Radim , Kalivoda Milan , Fries Jiri
Published: August 2021

Wire electrical discharge machining (WEDM) technology is often used for the final machining of parts to the required surface quality without further finishing operations. At the same time, WEDM has a significant advantage over other machining technologies, and in the fact, it is possible to machine all materials, regardless of their hardness or toughness, it only needs to be at least electrically conductive. Aviation nickel superalloy Mar-M247, which is usually machined to the final form by parts using WEDM, was the subject of research in this study. In order to find the optimal setting of machine parameters (Pulse on time, Pulse off time, and Discharge current) for multicut machining, an extensive design of experiment was performed with a total of 54 circles, which optimized the cutting speed in the first and second cuts and the topography of the machined surface was taken into account in the third cut. Subsequently, an analysis of the topography and morphology of the machined samples was performed, including an analysis of the condition of the subsurface layer. The study also included the analysis of the lamella in a transmission electron microscope. It was found that with the maximization of the cutting speed in the third cut, the surface topography deteriorates proportionally, but it also leads to the complete removal of all cracks formed in the first cut.
Midwifery students' experiences of support for ethical competence
Authors: Honkavuo Leena
Published: August 2021

Background:

Midwifery students are confronted with several ethical dilemmas and challenging situations during clinical midwifery care practice. Since ethical competence of midwifery students is under development, it is important to support the students’ learning progress of ethical issues from diverse viewpoints.

Objective:

From the perspective of didactics of caring science and the context of midwifery students, to explore how midwifery students’ experience supports for ethical competence in midwifery education and investigate how ethically challenging situations have been carried out during clinical midwifery care practice.

Design:

Qualitative, explorative and descriptive design with inductive nature.

Methods:

Focus group interviews with nine Swedish midwifery students. Hans-Georg Gadamer’s philosophical hermeneutics was applied to guide the interpretation.

Ethical considerations:

Ethical principles and scientific guidelines were followed. Informed consent was obtained from the participants. Confidentiality was respected and quotations anonymised.

Results:

Receiving support when ethically challenging situations occur in clinical midwifery practice is important and necessary. One main theme, such as support is a human and caring factor in the midwifery students’ Bildung process on ethical competence, and four subthemes, such as supporting through trust and responsibility; supporting through dignity and respect; supporting through truthfulness and justice; and supporting through dialogue and reflection, were created from the hermeneutical interpretation.

Discussion:

Teaching ethics should be carefully planned, consistent and continue throughout the midwifery education. There is dispersion in the pedagogy of ethical situations, the methods and perceptions associated with it, and in obtaining possible support for students. Developing well-experienced methods could benefit the support of midwifery students’ ethical competence when they experience ethically challenging situations in midwifery care practice.
Mycobacterium fortuitum abortion in a sow
Authors: Cole Allysa L. , Kirk Natalie M. , Wang Leyi , Hung Chien-Che , Samuelson Jonathan P.
Published: August 2021

Two aborted Chester White pig fetuses were presented to a veterinary diagnostic laboratory in Illinois. Postmortem examination identified no gross abnormalities. Histologic evaluation revealed multifocal necrosis of chorionic epithelial cells, coalescing areas of mineralization in the placenta, and focal accumulations of viable and degenerate neutrophils in the lung. Intra- and extracellular acid-fast bacilli were identified in the lesions in both the placenta and lungs. Bacterial culture of stomach contents yielded heavy growth of Mycobacterium fortuitum, a rapidly growing nontuberculous mycobacterium (NTM), which was further confirmed through whole-genome sequencing. NTM are opportunistic pathogens commonly found in the soil and in contaminated water supplies. In animals, M. fortuitum is typically introduced through cutaneous wounds leading to infections limited to the skin, with systemic infection being uncommon. To our knowledge, abortion caused by M. fortuitum has not been reported previously.
The Buffering Effects of Subordinates’ Forgiveness and Communication Openness on Abusive Supervision and Voice Behavior
Authors: Liu Chenlin , Sun Siwei , Dube Francisca N. Mapiye
Published: August 2021

Abusive supervision is a type of dysfunctional leadership that fosters continuous verbal or nonverbal infractions on subordinates and undoubtedly negatively impacts various work outcomes. Past literature has explored the underlying rules of how this form of destructive leadership influences employees’ negative working attitudes. However, research focusing on exploring factors that buffer abusive supervision’s harmful effects on voice behavior is relatively scarce. Distinctively, this study seeks to examine under a lens the process through which abusive supervision will harm voice behavior while taking into account emotional exhaustion as a mediator. According to the conservation of resources theory, we propose a cross-domain buffering approach of the negative effect of abusive supervision on voice behavior by considering subordinates’ forgiveness and communication openness acting as the moderators. We test the hypotheses by analyzing 430 sample data from an enterprise in Zhejiang Province, China, using Mplus and SPSS software. The results reveal that emotional exhaustion plays a mediating role in the path analysis of abusive supervision and voice behavior. Moreover, subordinates’ forgiveness and communication openness negatively moderate the mediation path. We enrich current literature by investigating the mechanism of abusive supervision and the impact of this kind of dysfunctional leadership on voice behavior and how to minimize the negative effects. The suggestions proposed can be referred to by practitioners and researchers in establishing a positive working environment.
Poverty and Paternal Education Associated With Infant Safe Sleep Intentions in a Peri-Urban Community in Ecuador
Authors: Feld Hartley , Ceballos Osorio Janeth , Bahamonde Marisol , Young Thomas , Boada Pablo , Rayens Mary Kay
Published: August 2021

Ecuador’s annual mortality rate from SIDS is 0.4 per 100 000 people, 4 times higher than neighboring countries Peru, Bolivia, and Brazil. Modifying the infant sleep environment toward safe practice has been demonstrated to be the most effective risk reduction strategy in reducing mortality from SIDS and little is known about sleep practices in Ecuador. The purpose of this study is to describe baseline infant sleep intentions of pregnant women in a peri-urban, low resource community in Ecuador. We also aim to identify demographic and psychosocial factors associated with suboptimal sleep practices in this context to develop long-term strategies to identify infants with high risk for SIDS/SUID. A cross-sectional study design was employed with 100 women in their third trimester of pregnancy. The majority of women were partnered (82%), both parents had approximately 8 years of education, and over half reported that their incomes met or exceeded their basic needs (55%). Significant predictors of safer sleep intention included years of paternal education ( P = .019) and income meeting their basic needs ( P = .0049). For each additional year of paternal education, families were 23% more likely to report safer intended infant sleep practices. Compared to those whose income did not allow for basic needs, those who had sufficient income to meet (or exceed) basic needs were 425% more likely to report safer intended sleep practices. Targeted interventions to high-risk populations may reduce the burden of SIDS/SUID in this community.
Prognostic impact of CEBPA bZIP domain mutation in acute myeloid leukemia
Authors: Wakita Satoshi , Sakaguchi Masahiro , Oh Iekuni , Kako Shinichi , Toya Takashi , Najima Yuho , Doki Noriko , Kanda Junya , Kuroda Junya , Mori Shinichiro , Satake Atsushi , Usuki Kensuke , Ueki Toshimitsu , Uoshima Nobuhiko , Kobayashi Yutaka , Kawata Eri , Tajika Kenji , Nagao Yuhei , Shono Katsuhiro , Shibusawa Motoharu , Tadokoro Jiro , Kayamori Kensuke , Hagihara Masao , Uchiyama Hitoji , Uchida Naoyuki , Kubota Yasushi , Kimura Shinya , Nagoshi Hisao , Ichinohe Tatsuo , Kurosawa Saiko , Motomura Sayuri , Hashimoto Akiko , Muto Hideharu , Sato Eriko , Ogata Masao , Mitsuhashi Kenjiro , Ando Jun , Marumo Atsushi , Omori Ikuko , Fujiwara Yusuke , Terada Kazuki , Yui Shunsuke , Arai Kunihito , Kitano Tomoaki , Miyata Miho , Kurosawa Akiyo , Mizoguchi Ayumi , Komatsu Norio , Fukuda Takahiro , Ohashi Kazuteru , Kanda Yoshinobu , Inokuchi Koiti , Yamaguchi Hiroki
Published: August 2021

Mutations of CCAAT/enhancer–binding protein alpha (CEBPAmu) are found in 10% to 15% of de novo acute myeloid leukemia (AML) cases. Double-mutated CEBPA (CEBPAdm) is associated with a favorable prognosis; however, single-mutated CEBPA (CEBPAsm) does not seem to improve prognosis. We investigated CEBPAmu for prognosis in 1028 patients with AML, registered in the Multi-center Collaborative Program for Gene Sequencing of Japanese AML. It was found that CEBPAmu in the basic leucine zipper domain (bZIP) was strongly associated with a favorable prognosis, but CEBPAmu out of the bZIP domain was not. The presence of CEBPAmu in bZIP was a strong indicator of a higher chance of achieving complete remission (P < .001), better overall survival (OS; P < .001) and a lower risk of relapse (P < .001). The prognostic significance of CEBPAmu in bZIP was also observed in the subgroup with CEBPAsm (all patients: OS, P = .008; the cumulative incidence of relapse, P = .063; patients aged ≤70 years and with intermediate-risk karyotype: OS, P = .008; cumulative incidence of relapse, P = .026). Multivariate analysis of 744 patients aged ≤70 years showed that CEBPAmu in bZIP was the most potent predictor of OS (hazard ratio, 0.3287; P < .001). CEBPAdm was validated as a cofounding factor, which was overlapping with CEBPAmu in bZIP. In summary, these findings indicate that CEBPAmu in bZIP is a potent marker for AML prognosis. It holds potential in the refinement of treatment stratification and the development of targeted therapeutic approaches in CEBPA-mutated AML.
Evaluation of the Genmark ePlex® and QIAstat-Dx® respiratory pathogen panels in detecting bacterial targets in lower respiratory tract specimens
Authors: van Asten Suzanne A. V. , Boers Stefan A. , de Groot Jolanda D. F. , Schuurman R. , Claas Eric C. J.
Published: August 2021

Background

The ePlex® and QIAstat-Dx® respiratory pathogen panels detect multiple respiratory pathogens, mainly viruses but alsoLegionella pneumophila,Mycoplasma pneumoniaeandBordetella pertussis. The assays have been marketed for use in nasopharyngeal swab specimens. For diagnosing bacterial pneumonia, lower respiratory tract (LRT) specimens are indicated. Aim of this study was to evaluate the performance of these syndromic panels for these three bacterial targets in samples from the LRT. Fifty-six specimens were collected from our repositories, five negative samples and fifty-one samples which had been previously tested positive with the routine diagnostic real-time PCR assays forLegionellaspp. (N = 20),Bordetellaspp. (N = 16) orM. pneumoniae(N = 15).

Results

The QIAstat-Dx Respiratory Panel V2 (RP) assay detected all of theL. pneumophilaandB. pertussispositive samples but only 11/15 (73.3 %) of theM. pneumoniaetargets. The ePlex Respiratory Pathogen Panel (RPP) assay detected 10/14 (71.4 %) of theL. pneumophilatargets, 8/12 (66.7 %) of theB. pertussispositive samples and 13/15 (86.7 %) of theM. pneumoniaetargets.

Conclusions

No false-positive results were reported for all three bacterial pathogens by both assays. The clinical performance of both assays depended highly on the bacterial load in the sample and the type of specimen under investigation.
Outcomes of women with congenital heart disease admitted to acute-care hospitals for delivery in Japan: a retrospective cohort study using nationwide Japanese diagnosis procedure combination database
Authors: Nitta Manabu , Shimizu Sayuri , Kaneko Makoto , Fushimi Kiyohide , Ueda Shinichiro
Published: August 2021

Background

The number of women with congenital heart disease (CHD) who are of childbearing age is increasing due to advancements in medical management. Nonetheless, data on the outcomes of delivery in women with CHD remain limited. Therefore, we conducted a retrospective cohort study using a nationwide database of deliveries by women with CHD.

Methods

Deliveries by women with CHD discharged from acute-care hospitals between April 2017 and March 2018 were identified based on the Diagnosis Procedure Combination database which covers almost all acute-care hospitals in Japan. By using this database, we tried to include relatively high-risk deliveries by women with CHD. Subjects were divided into three groups according to the underlying disease complexity: simple, moderate, and great complexity. The clinical characteristics and incidence of peripartum cardiovascular events were compared among the three groups.

Results

A total of 249 deliveries from 107 hospitals were included. The largest facility had 29 deliveries per year. Given the uncertainty of underlying cardiac anomalies, 48 women were excluded, and the remaining 201 women (median age, 32 years) were analyzed. In-hospital maternal death, use of extracorporeal membrane oxygenation, intra-aortic balloon pump, pacemaker, and direct current cardioversion were not observed. Nine patients (4.5%) required intravenous diuretic administration. However, the difference in the frequency of diuretic use was not significant among the three groups (simple, 1.9%; moderate, 7.2%; great, 6.9%; P = 0.204). One participant required valve replacement surgery at 22 days after a successful cesarean section. As the disease complexity increased, deliveries occurred more frequently at university hospitals (simple, 41.7%; moderate, 52.2%; great, 72.4%; P = 0.013) and the length of hospitalization was significantly longer, with median durations of 9.0 (interquartile range [IQR] 7.0–11.0) days, 10.0 (IQR 8.0–24.0) days, and 11.0 (IQR 8.0–36.0) days in the simple, moderate, and great complexity groups, respectively (P = 0.002).

Conclusions

Appropriate patient selection and management by specialized tertiary institutions may contribute to positive outcomes in pregnancies in women with CHD.
Cardiology providers’ recommendations for treatments and use of patient decision aids for multivessel coronary artery disease
Authors: Nichols Elizabeth L. , Elwyn Glyn , DiScipio Anthony , Sidhu Mandeep S. , O’Malley A. James , Matlock Daniel D. , Alam Shama , Ross Cathy S. , Coylewright Megan , Malenka David J. , Brown Jeremiah R.
Published: August 2021

Background

Rates of recommending percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) vary across clinicians. Whether clinicians agree on preferred treatment options for multivessel coronary artery disease patients has not been well studied.

Methods and results

We distributed a survey to 104 clinicians from the Northern New England Cardiovascular Study Group through email and at a regional meeting with 88 (84.6%) responses. The survey described three clinical vignettes of multivessel coronary artery disease patients. For each patient vignette participants selected appropriate treatment options and whether they would use a patient decision aid. The likelihood of choosing PCI only or PCI/CABG over CABG only was modeled using a multinomial regression. Across all vignettes, participants selected CABG only as an appropriate treatment option 24.2% of the time, PCI only 25.4% of the time, and both CABG or PCI as appropriate treatment options 50.4% of the time. Surgeons were less likely to choose PCI over CABG (RR 0.14, 95% CI 0.03, 0.59) or both treatments over CABG only (RR 0.10, 95% CI 0.03, 0.34) relative to cardiologists. Overall, 65% of participants responded they would use a patient decision aid with each vignette.

Conclusions

There is a lack of consensus on the appropriate treatment options across cardiologists and surgeons for patients with multivessel coronary artery disease. Treatment choice is influenced by both patient characteristics and clinician specialty.
Nerve root herniation with entrapment in the facet joint gap after lumbar decompression surgery: a case presentation
Authors: Popadic Branko , Scheichel Florian , Themesl Melanie , Decristoforo Ingo , Sherif Camillo , Marhold Franz
Published: August 2021

Background

An incidental dural tear is a well-known complication during spine surgery. A rare consequence is a postoperative nerve root herniation. The purpose of this report is to describe a case of such a herniation with entrapment in the facet gap joint and to present the first MR images of this rare surgical complication.

Case presentation

We report a case of a patient who underwent lumbar decompression surgery and afterwards suffered a sudden intractable sciatica. Postoperative MRI showed a new facet joint gap effusion. During revision surgery an entrapped nerve root was found in the facet joint gap. In retrospective, the herniated nerve root is visible on postoperative MRI.

Conclusion

This case report highlights a rare complication during spine surgery. This finding is important as signs suggestive for nerve root herniation can easily be overlooked on MRI. Furthermore, this represents the first MRI documentation of this complication.
The compensatory mechanisms for global sagittal balance in degenerative spinal kyphosis patients: a radiological analysis of muscle-skeletal associations
Authors: Xia Weiwei , Wang Weiyan , Zhu Zhenqi , Liu Chenjun , Xu Shuai , Meng Fanqi , Liu Haiying , Wang Kaifeng
Published: August 2021

Background

The position of the head relative to the spine can be used to evaluate the true global balance in patients with degenerative spinal kyphosis (DSK). However, it is still not clear how the position of the head is related to the spinal-pelvic parameters and lumbar muscles, which are most commonly considered.

Methods

Sixty-seven patients with DSK admitted in the hospital from January 2017 to January 2019 were retrospectively analyzed. All patients had whole spine X-ray and lumbar MRI. The head position parameters include: the angles of both lines joining the center of acoustic meati (CAM) to the center of the bi-coxofemoral axis (BA) (CAM-BA) and the most superior point of dentiform apophyse of C2 odontoid (OD) to BA (OD-BA) with the vertical line; the distance between the vertical line passing CAM and the posterior upper edge of the S1 (CAM-SVA). The spinal parameters include: C7 sagittal vertical axis (C7-SVA), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), and lumbar lordosis (LL). The pelvic parameters include: pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). The relative cross-sectional area (RCSA) of bilateral multifidus, erector spinae and psoas muscle at L3/4 and L4/5 segments were measured. The correlations between head position parameters and the spinal-pelvic parameters and RCSA of lumbar muscles were analyzed, respectively.

Results

Significant positive correlations were found between each two of CAM-SVA, C7-SVA, CAM-BA and OD-BA (p < 0.001). SS was found to be significantly positively correlated with CAM-BA (r = 0.377, p = 0.034) and OD-BA (r = 0.402, p = 0.023). CAM-BA was found to be significantly negatively correlated with TK (r = − 0.367, p = 0.039). Significant positive correlations were found between RCSA of multifidus at L3/4 level and CAM-SVA (r = 0.413, p = 0.021), CAM-BA (r = 0.412, p = 0.019) and OD-BA (r = 0.366, p = 0.04).

Conclusions

Our study showed that the head position relative to the spine were significantly correlated to some spinal-pelvic parameters, and the lower lumbar multifidus muscle. The compensatory mechanisms of the global sagittal balance status should also involve the head position area.
COVID-19 and the impact of cash transfers on health care use in Togo
Authors: Tossou Yaovi
Published: August 2021

Background

Cash transfer program during pandemics provide a social protection mechanism to improve the health of the most vulnerable households. This article analysis the impact of cash transfers on household demand for health care during Covid-19.

Methods

Using data from the survey conducted from 8th to 17th July 2020 covering all 44 districts in the 6 health regions of Togo under the direction of the United Nations Office for Project Services (UNOPS), we used propensity score matching and the ESR model. These models allow us to analysis the impact of cash transfers on health care use during Covid-19.

Results

Analysis of the results shows a positive impact of cash transfers on the use of health care services in Togo for beneficiary households. In addition, the health insurance promotes the use of health care among households’ socio-economic factors.

Conclusion

This cash transfer program is an effective approach to improving access to health care services for the most vulnerable households, particularly in the most disadvantaged settings. Thus, policy makers need to extend these cash transfers to a large part of the population during this Covid-19 health crisis as it has a positive impact on the demand for health care.
The role of the odorant receptors in the formation of the sensory map
Authors: Francia Simona , Lodovichi Claudia
Published: August 2021

In the olfactory system, odorant receptors (ORs) expressed at the cell membrane of olfactory sensory neurons detect odorants and direct sensory axons toward precise target locations in the brain, reflected in the presence of olfactory sensory maps. This dual role of ORs is corroborated by their subcellular expression both in cilia, where they bind odorants, and at axon terminals, a location suitable for axon guidance cues. Here, we provide an overview and discuss previous work on the role of ORs in establishing the topographic organization of the olfactory system and recent findings on the mechanisms of activation and function of axonal ORs.
Pre-existing health conditions and severe COVID-19 outcomes: an umbrella review approach and meta-analysis of global evidence
Authors: Treskova-Schwarzbach Marina , Haas Laura , Reda Sarah , Pilic Antonia , Borodova Anna , Karimi Kasra , Koch Judith , Nygren Teresa , Scholz Stefan , Schönfeld Viktoria , Vygen-Bonnet Sabine , Wichmann Ole , Harder Thomas
Published: August 2021

Background

This study applies an umbrella review approach to summarise the global evidence on the risk of severe COVID-19 outcomes in patients with pre-existing health conditions.

Methods

Systematic reviews (SRs) were identified in PubMed, Embase/Medline and seven pre-print servers until December 11, 2020. Due to the absence of age-adjusted risk effects stratified by geographical regions, a re-analysis of the evidence was conducted. Primary studies were extracted from SRs and evaluated for inclusion in the re-analysis. Studies were included if they reported risk estimates (odds ratio (OR), hazard ratio (HR), relative risk (RR)) for hospitalisation, intensive care unit admission, intubation or death. Estimated associations were extracted from the primary studies for reported pre-existing conditions. Meta-analyses were performed stratified for each outcome by regions of the World Health Organization. The evidence certainty was assessed using GRADE. Registration number CRD42020215846.

Results

In total, 160 primary studies from 120 SRs contributed 464 estimates for 42 pre-existing conditions. Most studies were conducted in North America, European, and Western Pacific regions. Evidence from Africa, South/Latin America, and the Eastern Mediterranean region was scarce. No evidence was available from the South-East Asia region. Diabetes (HR range 1.2–2.0 (CI range 1.1–2.8)), obesity (OR range 1.5–1.75 (CI range 1.1–2.3)), heart failure (HR range 1.3–3.3 (CI range 0.9–8.2)), COPD (HR range 1.12–2.2 (CI range 1.1–3.2)) and dementia (HR range 1.4–7.7 (CI range 1.2–39.6)) were associated with fatal COVID-19 in different regions, although the estimates varied. Evidence from Europe and North America showed that liver cirrhosis (OR range 3.2–5.9 (CI range 0.9–27.7)) and active cancer (OR range 1.6–4.7 (CI range 0.5–14.9)) were also associated with increased risk of death. Association between HIV and undesirable COVID-19 outcomes showed regional heterogeneity, with an increased risk of death in Africa (HR 1.7 (CI 1.3–2.2)). GRADE certainty was moderate to high for most associations.

Conclusion

Risk of undesirable COVID-19 health outcomes is consistently increased in certain patient subgroups across geographical regions, showing high variability in others. The results can be used to inform COVID-19 vaccine prioritisation or other intervention strategies.
Interventions to control nosocomial transmission of SARS-CoV-2: a modelling study
Authors: Pham Thi Mui , Tahir Hannan , van de Wijgert Janneke H. H. M. , Van der Roest Bastiaan R. , Ellerbroek Pauline , Bonten Marc J. M. , Bootsma Martin C. J. , Kretzschmar Mirjam E.
Published: August 2021

Background

Emergence of more transmissible SARS-CoV-2 variants requires more efficient control measures to limit nosocomial transmission and maintain healthcare capacities during pandemic waves. Yet the relative importance of different strategies is unknown.

Methods

We developed an agent-based model and compared the impact of personal protective equipment (PPE), screening of healthcare workers (HCWs), contact tracing of symptomatic HCWs and restricting HCWs from working in multiple units (HCW cohorting) on nosocomial SARS-CoV-2 transmission. The model was fit on hospital data from the first wave in the Netherlands (February until August 2020) and assumed that HCWs used 90% effective PPE in COVID-19 wards and self-isolated at home for 7 days immediately upon symptom onset. Intervention effects on the effective reproduction number (RE), HCW absenteeism and the proportion of infected individuals among tested individuals (positivity rate) were estimated for a more transmissible variant.

Results

Introduction of a variant with 56% higher transmissibility increased — all other variables kept constant — RE from 0.4 to 0.65 (+ 63%) and nosocomial transmissions by 303%, mainly because of more transmissions caused by pre-symptomatic patients and HCWs. Compared to baseline, PPE use in all hospital wards (assuming 90% effectiveness) reduced RE by 85% and absenteeism by 57%. Screening HCWs every 3 days with perfect test sensitivity reduced RE by 67%, yielding a maximum test positivity rate of 5%. Screening HCWs every 3 or 7 days assuming time-varying test sensitivities reduced RE by 9% and 3%, respectively. Contact tracing reduced RE by at least 32% and achieved higher test positivity rates than screening interventions. HCW cohorting reduced RE by 5%. Sensitivity analyses show that our findings do not change significantly for 70% PPE effectiveness. For low PPE effectiveness of 50%, PPE use in all wards is less effective than screening every 3 days with perfect sensitivity but still more effective than all other interventions.

Conclusions

In response to the emergence of more transmissible SARS-CoV-2 variants, PPE use in all hospital wards might still be most effective in preventing nosocomial transmission. Regular screening and contact tracing of HCWs are also effective interventions but critically depend on the sensitivity of the diagnostic test used.
DDX56 modulates post-transcriptional Wnt signaling through miRNAs and is associated with early recurrence in squamous cell lung carcinoma
Authors: Wu Qingqing , Luo Xiaoyang , Terp Mikkel G. , Li Qingrun , Li Yuan , Shen Lei , Chen Ying , Jacobsen Kirstine , Bivona Trever G. , Chen Haiquan , Zeng Rong , Ditzel Henrik J.
Published: August 2021

Background

Early recurrence is a major obstacle to prolonged postoperative survival in squamous cell lung carcinoma (SqCLC). The molecular mechanisms underlying early SqCLC recurrence remain unclear, and effective prognostic biomarkers for predicting early recurrence are needed.

Methods

We analyzed primary tumor samples of 20 SqCLC patients using quantitative proteomics to identify differentially-expressed proteins in patients who experienced early versus late disease recurrence. The expression and prognostic significance of DDX56 was evaluated using a SqCLC tumor tissue microarray and further verified using different online databases. We performed in vitro and in vivo experiments to obtain detailed molecular insight into the functional role of DDX56 in SqCLC.

Results

We found that DDX56 exhibited increased expression in tumors of patients who experienced early versus late disease recurrence. Increased DDX56 expression in SqCLC tumors was subsequently confirmed as an independent prognostic factor of poor recurrence-free survival in independent SqCLC cohorts. Functionally, DDX56 promotes SqCLC cell growth and migration in vitro, and xenograft tumor progression in vivo. Mechanistically, DDX56 post-transcriptionally promotes expression of multiple Wnt signaling pathway-related genes, including CTNNB1, WNT2B, and represses a subset of miRNAs, including miR-378a-3p, a known suppressor of Wnt signaling. Detailed analysis revealed that DDX56 facilitated degradation of primary miR-378a, leading to down-regulation of mature miR-378a-3p and thus derepression of the target gene WNT2B.

Conclusion

We identified DDX56 as a novel independent prognostic biomarker that exerts its oncogenic effects through miRNA-mediated post-transcriptional regulation of Wnt signaling genes to promote early SqCLC recurrence. DDX56 may assist in identifying SqCLC patients at increased risk of early recurrence and who could benefit from Wnt signaling-targeted therapies.
Return to work in patients with lumbar disc herniation undergoing fusion
Authors: Protzer Lauren A. , Glassman Steven D. , Mummaneni Praveen V. , Bydon Mohamad , Bisson Erica F. , Djurasovic Mladen , Carreon Leah Y.
Published: August 2021

Background

Lumbar disc herniation (LDH) is a common problem. When surgical treatment is required, the intervention is typically decompression without fusion. Successful return-to-work (RTW) is a standard expectation with these limited procedures. Occasionally, the size or location of the disc herniation suggests the need for fusion, but the inability to RTW is a significant concern in these cases. The purpose of this study is to determine if the addition of lumbar fusion, as compared to decompression alone, will substantially diminish RTW in patients with lumbar disc herniation.

Methods

This is a longitudinal cohort study using prospectively collected data from the Quality and Outcomes Database (QOD). Patients with LDH, eligible to RTW (not retired, a student, or on disability) with complete 12-month follow-up data, were identified. Standard demographic and surgical variables, patient-reported outcomes (PROs), and RTW status at 3 and 12 months were collected.

Results

Of the 5062 patients identified, 4560 (90%) had decompression alone and 502 (10%) had a concurrent fusion. Age and gender were similar in the two groups. The fusion group had worse back pain (NRS 6.52 vs. 5.96) and less leg pain (6.31 vs. 7.01) at baseline compared to the no fusion group. Statistically significant improvement in all PROs was seen in both groups. RTW at 3 months post-op was seen in 85% of decompression cases and 66% of cases with supplemental fusion. At 12 months post-op, RTW increased to 93% and 82%, respectively.

Conclusion

The need for fusion in LDH cases is unusual, seen in only 10% of cases in this series. The addition of fusion decreased the RTW rate from 85 to 66% at 3 months and from 93 to 82% at 12 months post-op. While the difference is significant, the ultimate deterioration in RTW may be less than anticipated. A reasonable RTW rate can still be expected in the rare patient who requires fusion as part of their treatment for LDH.
Factors affecting the outcome of lower extremity osteomyelitis treated with microvascular free flaps: an analysis of 65 patients
Authors: Thai Duy Quang , Jung Yeon Kyo , Hahn Hyung Min , Lee Il Jae
Published: August 2021

Background

Free flaps have been a useful modality in the management of lower extremity osteomyelitis particularly in limb salvage. This study aimed to determine the factors affecting the outcome of free flap reconstruction in the treatment of osteomyelitis.

Methods

This retrospective study assessed 65 osteomyelitis patients treated with free flap transfer from 2015 to 2020. The treatment outcomes were evaluated in terms of the flap survival rate, recurrence rate of osteomyelitis, and amputation rate. The correlation between outcomes and comorbidities, causes of osteomyelitis, and treatment modalities was analyzed. The following factors were considered: smoking, peripheral artery occlusive disease, renal disease, diabetic foot ulcer, flap types, using antibiotic beads, and negative pressure wound therapy.

Result

Among the 65 patients, 21 had a severe peripheral arterial occlusive disease. Osteomyelitis developed from diabetic foot ulcers in 28 patients. Total flap failure was noted in six patients, and osteomyelitis recurrence was noted in eight patients, for which two patients underwent amputation surgery during the follow-up period. Only end-stage renal disease had a significant correlation with the recurrence rate (odds ratio = 16.5, p = 0.011). There was no significant relationship between outcomes and the other factors.

Conclusion

This study showed that free flaps could be safely used for the treatment of osteomyelitis in patients with comorbidities and those who had osteomyelitis developing from diabetic foot ulcers. However, care should be taken in patients diagnosed with end-stage renal disease.
Tracheostomy for COVID-19: evolving best practice
Authors: Williams Thomas , McGrath Brendan A.
Published: August 2021

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2021. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2021. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from https://link.springer.com/bookseries/8901.
To prone or not to prone ARDS patients on ECMO
Authors: Roca Oriol , Pacheco Andrés , García-de-Acilu Marina
Published: August 2021

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2021. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2021. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from https://link.springer.com/bookseries/8901.
Spindle cell squamous cell carcinoma exhibiting prominent neutrophil phagocytosis: a case report
Authors: Yamazaki Manabu , Maruyama Satoshi , Abé Tatsuya , Sumita Yoshimasa , Katsumi Yuji , Nikkuni Yutaka , Hayashi Takafumi , Tanuma Jun-ichi
Published: August 2021

Background

Spindle cell squamous cell carcinoma is an uncommon variant of squamous cell carcinoma; its diagnosis is sometimes challenging because it histopathologically resembles neoplastic or reactive spindle cell lesions of mesenchymal origins. Here, we report a rare case of spindle cell squamous cell carcinoma exhibiting prominent neutrophil phagocytosis.

Case presentation

A 69-year-old Japanese man presented with pain and a polypoid mass on the lower left gingiva. He had received chemoradiotherapy for squamous cell carcinoma of the buccal mucosa 15 years prior to this consultation. In addition, he was treated for mandibular osteonecrosis 6 years after chemoradiotherapy without evidence of cancer recurrence. A biopsy revealed atypical spindle or pleomorphic cells scattered in the edematous and fibrin-rich stroma; however, no malignant squamous components were apparent. These atypical cells frequently contained neutrophils within their cytoplasm that formed cell-in-cell figures. Immunohistochemically, the atypical cells were negative for cytokeratins, epithelial membrane antigen, and E-cadherin, but positive for p63, vimentin, and p53. Although these findings suggested spindle cell squamous cell carcinoma, it was difficult to reach a definitive diagnosis. Based on a clinical diagnosis of a malignant tumor, the patient underwent a hemimandibulectomy. The surgically resected specimen had a typical spindle cell squamous cell carcinoma histology consisting of biphasic spindle cells and conventional squamous cell carcinoma components. Moreover, the surgical specimen also exhibited spindle tumor cells that frequently included neutrophils, around which intense staining for lysosomal-associated membrane protein 1 and cathepsin B was observed. This suggested that the cell-in-cell figures represent active neutrophil phagocytosis by tumor cells, and not emperipolesis.

Conclusion

The presence of neutrophil phagocytosis may be a potent indicator of malignancy.
A new competency ontology for learning environments personalization
Authors: Paquette Gilbert , Marino Olga , Bejaoui Rim
Published: August 2021

Competency is a central concept for human resource management, training and education. We define a competency as the capacity of a person to display a generic skill with a certain level of performance when applied to one or more knowledge entities. Competencies, and competency referentials grouping competencies, are essential elements for user models, e-Portfolios, adaptive learning, and personalization in Technology-based learning. But to be processed both by humans and by software tools, competencies should be represented in a formal, non-ambiguous model called an ontology. Moreover, this model should use a shared vocabulary to describe the generic skills and the knowledge entities. Defining and linking shared vocabularies is the purpose of ontologies in the semantic web. The goal of our research is to develop a competency ontology for the semantic web to be used as a shared referential in the description of competencies and competency profiles. We analysed five previous competency models and developed COMP2, a new competency ontology that integrates important elements of previous models and the richness of the semantic web vocabulary. COMP2 provides processing capabilities both to humans and computers. Its graphic model is highly readable by humans for design, evaluation and communication purposes. It also translates, together with its data sets, to standard semantic Web code for machine processing. The ontology is composed of five stages that are interlinked with other ontologies in use within the web of linked open data. We will present an example for the use of the ontology for competency-based personalization in learning environments.
Validation of the Mathematics Motivation Questionnaire (MMQ) for secondary school students
Authors: Fiorella Logan , Yoon So Yoon , Atit Kinnari , Power Jason R. , Panther Grace , Sorby Sheryl , Uttal David H. , Veurink Norma
Published: August 2021

Background

Motivation is critical for supporting persistence and achievement in science, technology, engineering, and mathematics (STEM) disciplines. In this study, we focus on the assessment of mathematics motivation among secondary school students. We provide validity and reliability evidence for the Mathematics Motivation Questionnaire (MMQ)—adapted from the Science Motivation Questionnaire designed for college students—using data from 2551 secondary students from seven states across the United States.

Results

Exploratory and confirmatory factor analyses confirmed five latent factors of the MMQ indicated by 19 items: intrinsic value, self-regulation, self-efficacy, utility value, and test anxiety. The nonlinear SEM reliability coefficients of the five constructs ranged from 0.76 to 0.91. To assess criterion validity, analyses using a subset of the data that included students’ mathematics standardized scores (n = 536) indicated that intrinsic value, self-regulation, and self-efficacy were significantly positively correlated with mathematics achievement, whereas test anxiety was significantly negatively correlated with mathematics achievement.

Conclusions

The MMQ provides a reliable, valid, and feasible measure of the specific factors underlying mathematics motivation among secondary students.
Methods of 3D printing models of pituitary tumors
Authors: Gillett Daniel , Bashari Waiel , Senanayake Russell , Marsden Daniel , Koulouri Olympia , MacFarlane James , van der Meulen Merel , Powlson Andrew S. , Mendichovszky Iosif A. , Cheow Heok , Bird Nick , Kolias Angelos , Mannion Richard , Gurnell Mark
Published: August 2021

Background

Pituitary adenomas can give rise to a variety of clinical disorders and surgery is often the primary treatment option. However, preoperative magnetic resonance imaging (MRI) does not always reliably identify the site of an adenoma. In this setting molecular (functional) imaging (e.g. 11C-methionine PET/CT) may help with tumor localisation, although interpretation of these 2D images can be challenging. 3D printing of anatomical models for other indications has been shown to aid surgical planning and improve patient understanding of the planned procedure. Here, we explore the potential utility of four types of 3D printing using PET/CT and co-registered MRI for visualising pituitary adenomas.

Methods

A 3D patient-specific model based on a challenging clinical case was created by segmenting the pituitary gland, pituitary adenoma, carotid arteries and bone using contemporary PET/CT and MR images. The 3D anatomical models were printed using VP, MEX, MJ and PBF 3D printing methods. Different anatomical structures were printed in color with the exception of the PBF anatomical model where a single color was used. The anatomical models were compared against the computer model to assess printing accuracy. Three groups of clinicians (endocrinologists, neurosurgeons and ENT surgeons) assessed the anatomical models for their potential clinical utility.

Results

All of the printing techniques produced anatomical models which were spatially accurate, with the commercial printing techniques (MJ and PBF) and the consumer printing techniques (VP and MEX) demonstrating comparable findings (all techniques had mean spatial differences from the computer model of < 0.6 mm). The MJ, VP and MEX printing techniques yielded multicolored anatomical models, which the clinicians unanimously agreed would be preferable to use when talking to a patient; in contrast, 50%, 40% and 0% of endocrinologists, neurosurgeons and ENT surgeons respectively would consider using the PBF model.

Conclusion

3D anatomical models of pituitary tumors were successfully created from PET/CT and MRI using four different 3D printing techniques. However, the expert reviewers unanimously preferred the multicolor prints. Importantly, the consumer printers performed comparably to the commercial MJ printing technique, opening the possibility that these methods can be adopted into routine clinical practice with only a modest investment.
The fishermen inhabiting the Xuande and Yongle Islands in Xisha Islands
Authors: Liu Li
Published: August 2021

Hainan Island fishermen have been engaged in fishing in Nanhai Zhudao (the Nanhai Islands) since ancient times. From sailing to the emergence of motorboats, the South China Sea fishermen have experienced different seafaring eras. Fishermen who work and live on the islands and reefs also have experienced living on islands seasonally to long-term. This article uses the inhabiting fishermen groups of the Xuande and Yongle Islands in Xisha Qundao (the Xisha Islands) as examples to demonstrate the unique livelihoods of the fishermen and reveal their role in the use of marine ecology to achieve sustainable development.