bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 293: Cardiac Arrest and Resuscitation Causes Immunodeficiency That Involves the Hypothalamic-Pituitary-Adrenal Axis
Authors: Shen Yuntian , Zhao Qiang , Wu Jiangbo , Wang Zhuoran , Yang Wei
Published: July 2021

Introduction:
Cardiac arrest (CA) is associated with high mortality and morbidity, which is in part due to infectious complications developed in CA patients. Infection complications, particularly pneumonia, occur in approximately 60% of CA patients. Given this high incidence, we hypothesized that after CA, the immune system is impaired, which increases the susceptibility of CA patients to potential infections. Therefore, in this study, we systematically examined the immune response in the brain and peripheral immune organs after CA.

Methods:
Mice were subjected to CA and cardiopulmonary resuscitation (CA/CPR). Flow cytometry, ELISA, immunohistochemistry, and quantitative PCR were used to analyze the immune response in various post-CA organs.

Results:
First, we characterized the time course of the immune response in the spleen after CA/CPR. CA/CPR induced significant changes in all major immune cell populations. Notably, B cell frequencies decreased, while T cell frequencies increased, in various organs on day 3 post-CA. Further, the levels of pro-inflammatory cytokines, eg IL-6, were markedly increased in the blood and brain after CA. Critically, we found that the lymphocyte counts in the spleen and thymus were dramatically lower in CA mice than in sham mice. Interestingly, CA/CPR caused progressive atrophy of the spleen and thymus. Since it has been shown that CA/CPR alters activity of the hypothalamic-pituitary-adrenal (HPA) axis, we speculated that CA-induced atrophy of lymphoid organs is mediated by the HPA axis. Thus, we treated CA mice with RU486, a glucocorticoid receptor antagonist. Indeed, this treatment reversed CA-induced organ atrophy and mitigated immune cell depletion, both in the thymus and spleen.

Conclusions:
We provided for the first time evidence that CA/CPR rapidly induced a systemic inflammatory response followed by impairment of the immune system, which eventually led to a massive loss of immune cells in the peripheral immune organs. This CA-induced immunodeficiency appears to be mediated by dysregulation of the HPA axis. Our findings here may be of high clinical significance, considering the high incidence of infectious complications in CA patients and their detrimental effects on CA outcome.
Abstract 305: German Resuscitation Registry Influence of Age on Short and Long-Term Outcome After Out-of-Hospital Cardiac Arrest or Should We Resuscitate the Elderly?
Authors: Seewald Stephan , Wnent Jan , Jakisch Barbara , Bohn Andreas , Fischer Matthias , Graesner Jan-Thorsten
Published: July 2021

Introduction:
Cardiac arrest is a common event and one of the leading causes of death. Especially within the elderly judgment on if the treatment will be in favor of the patient is a major challenge for the medical team. We evaluated the influence of the age on short and long-term survival after out-of- hospital cardiac arrest (OHCA).

Hypothesis:
Elderly people survive an out-of-hospital cardiac arrest with good neurological outcome.

Methods:
For this purpose, we analyzed data of 24,686 out-of-hospital cardiac arrest patients prospectively registered between 2008 and 2017 within the German Resuscitation Registry (GRR). The data records were divided according to different age groups and within the age group after shockable and non-shockable rhythms. The data sets were examined with regard to short and long-term survival. Short term survival was measured by expected and observed return-of-spontaneous circulation based on the RACA-score. The RACA-score is a previously published score to predict ROSC based on readily available variables after arrival of the emergency medical service (EMS) on scene. Long-term survival was differentiated in 24-hour survival, 30-day survival and hospital discharge with good neurological outcome (Cerebral Performance Category 1 and 2).

Results:
(Table 1)

Conclusions:
Our data shows that shockable rhythm and younger age are important factors of good neurological outcome after OHCA. Nevertheless, the few cases with shockable rhythms (411 out of 3227) in the elderly (>85 years) showed a favorable neurological outcome in 12.2% (77,2% of all patients with hospital discharge). In the non-shockable group 1.4% (58,3%) of the >85 year old had a good outcome. Data show that a resuscitation attempt in the elderly is not futile, especially if a shockable rhythm is detected. Further studies are necessary to maintain this decision.
Abstract 307: The Value of Intracranial Pressure Measurement via Lumbar Puncture as an Early Prognostic Predictor in Cardiac Arrest Patients Treated With Targeted Temperature Management
Authors: You Yeonho , Park Jung Soo , Min Jin Hong
Published: July 2021

Introduction:
We evaluated prognostic value of ICP measurement via lumbar puncture to predict outcome of cardiac arrest patients treated with TTM

Methods:
This was a single-center observational cohort study using paper sheets of patients from October 2012 to June 2017. The primary endpoint was the ability of the early ICP measurement to predict poor outcome within 24 h after cardiac arrest, compared to ONSD and GWR. Based on previous studies, 32 patients were needed to achieve the power of 0.90 at a significance level of 0.05. The ROC curves was used to compare the values of ONSD, GWR and ICP for predicting neurologic outcomes. Results were considered significant at P < 0.05.

Results:
103 patients were enrolled and good outcome group had 31 patients, while poor outcome group had 72 patients. The AUROC of ONSD and GWR were 0.64(0.54-0.73) and 0.63 (0.53-0.72) respectively in predicting poor neurologic outcome while the AUROC of ICP was 0.97(0.92-0.99) in predicting poor neurologic outcome (Fig. 2). As the cut off value of ICP was 200 mmH
2
O, sensitivity was 87.50% and specificity was 100.00% in predicting poor neurologic outcome. In ONSD, sensitivity was 78.43% and specificity was 41.86% in predicting poor neurologic outcome when cut off value was 5.50 mm. As the cut off value of GWR was 1.16, sensitivity was 59.72% and specificity was 74.19% in predicting poor neurologic outcome.

Conclusion:
In this study, we confirms that ICP measurement via lumbar puncture within the first 24 h after cardiac arrest is a valuable tool to evaluate the severity of post-cardiac arrest brain injuries and outcome in patients treated with TTM.
Abstract 316: Cardiac Arrest Rhythm Transitions in Drug Overdose-Related Resuscitation
Authors: Koller Allison C , Salcido David D , Menegazzi James J
Published: July 2021

Introduction:
The prehospital electrocardiogram (ECG) may inform treatment of out-of-hospital cardiac arrest (OHCA) patients regardless of etiology. While drug overdose (OD)-OHCA is increasingly common, little is known about the characteristics and utility of the intra-resuscitation OD-OHCA ECG signal. In this study, we sought to investigate the evolving ECG rhythm state of OD-OHCA patients to identify potentially informative patterns or phenomena.

Methods:
Case data, including electronic defibrillator files, for emergency medical services treated OD-OHCA were obtained from the Resuscitation Outcomes Consortium, a multi-site clinical research network in the US and Canada. OD-OHCA case status was previously established by site-level data abstractors reviewing prehospital and in-hospital electronic medical records for evidence of drug involvement. Continuous ECG traces were extracted and chest compression-free ECG segments were parsed with custom MATLAB (vR2017a) software. Each ECG segment was manually rhythm-classified by a research specialist. Rhythm transitions were identified as changes in rhythm between sequential analyzable rhythm segments. Transitions were tabulated and summarized by their rhythms and timing.

Results:
Complete prehospital ECG data were available for 130 patients, comprising 1,112 ECG segments of which 771 (69.3%) were analyzable. The mean (SD) age was 33.6 (11.3) years and 68.3% were male. The most commonly observed rhythm at the segment level was low amplitude (“fine”) ventricular fibrillation (VF), accounting for 44.1% of all segments, although at the case level asystole was the most common rhythm, present in 47.7% of all cases. We recorded 292 rhythm transitions, with a mean (SD) 2.5 (1.5) transitions per case. Mean (SD) time to first transition was 11.1 (6.9) minutes and mean (SD) time to last transition was 19.8(8.8) minutes. The most frequently observed transition was from asystole to low amplitude ventricular fibrillation (17.1%).

Conclusions:
The OD-OHCA ECG is varied and dynamic, presenting in numerous rhythms and transitioning between rhythms throughout the course of resuscitation.
Abstract 327: Attenuated Beta-Adrenergic Response in the Tric-a Knock Out Mice
Authors: Toyama Yuichi , Yonekura Manabu , Han Chong , Tomita Hirofumi , Takeshima Hiroshi , Murakami Manabu
Published: July 2021

Trimeric intracellular cation (TRIC) channels are expressed on the surface of sarcoplasmic reticulum (SR) and regulate calcium release from ryanodine receptors (RyRs). In a previous study, Tric-a knock out (KO) mice showed diminished calcium release from RyRs following increased calcium-influx via L-type calcium channels, which results in enhanced vascular resistance and non-dipper type hypertension. Decreased activation of RyR1 by PKA in skeletal myocytes in Tric-a KO mice is also known. However, physiological importance of TRIC channels on cardiac rhythm formation and its importance on the sympathetic nerve regulation are still obscure. Therefore, we aimed to clarify the effects of Tric-a ablation on cardiac pace making using Tric-a KO mice. We measured systolic blood pressure (SBP) with tail-cuff method, ECG and spontaneous action potential with microelectrode in the Tric-a KO and wild type (WT) mice. Isoproterenol or propranolol was used for sympathetic nerve manipulation. Furthermore, we evaluated heart rate variability (HRV). Tric-a KO mice tended to show limited responses to isoproterenol (0.3 mg/kg) than the WT mice (-27 ± 6 and -32 ± 6 mmHg,
n
= 10,
p
=0.70), and to propranolol (4 ± 6 and 13 ± 7 mmHg,
n
= 5~6,
p
=0.48). In ECG analysis, ablation of Tric-a gene resulted in significantly decreased heart rate changes to isoproterenol (23 ± 6 and 99 ± 15 bpm, Tric-a KO and WT mice, respectively, n = 9~10, p <0.001). Response to propranolol was also significantly decreased in the Tric-a KO mice (-28 ± 20 and -122 ± 14 bpm, Tric-a KO and WT mice, respectively,
n
= 9~10,
p
<0.001). In the action potential recordings, Tric-a KO mice showed significantly decreased sinus rate changes to 1 microM isoproterenol (35 ± 9 and 71 ± 10 bpm, Tric-a KO and WT mice, respectively,
n
= 6~8,
p
<0.05). In HRV analysis, low-frequency/high-frequency (LF/HF) ratio tended to be lower in the Tric-a KO mice than the WT mice under the administration of isoproterenol (0.22 ± 0.31 and 0.65 ± 0.16 bpm, Tric-a KO and WT mice, respectively,
n
= 9~11,
p
=0.16), suggesting lower sympathetic nerve tonus in the Tric-a KO mice. In conclusion, our data indicates that Tric-a KO mice showed attenuated responses to beta-adrenergic stimulus, which indicates involvement of TRIC-A channels in sympathetic nerve regulation.
Abstract 332: Controlling the Heart Rate After Resuscitation Decreases Duration of Survival in a Rat Model of Cardiac Arrest
Authors: Hu Zhangle , Yang Jin , Guo Qinyue , Wu Xiaobo , Bradley Jennifer , Peberdy Mary Ann , Ornato Joseph , Tang Wanchun
Published: July 2021

Introduction:
A high heart rate (HR) after return of spontaneous circulation (ROSC) due to increased sympathetic drive is a compensatory mechanism of postresuscitation myocardial dysfunction. However, it increases myocardial oxygen demand and impairs oxygen supply, and may increase the severity of myocardial ischemia.

Hypothesis:
Reduction of HR would improve postresuscitation myocardial dysfunction.

Methods:
Thirty-two male Sprague-Dawley rats weighing 450-550g were randomized into 2 groups: 1) Saline group: Ventricular fibrillation was induced and untreated for 6 min followed by 8 min of CPR. Rats received 0.9% NaCl solution administered from the femoral artery at 1h after return of spontaneous circulation (ROSC). 2) Drug group: Ventricular fibrillation was induced and untreated for 6 min followed by 8 min of CPR. Rats received Ivabradine (0.5ml/kg) solution administered from the femoral artery at 1h after ROSC. All catheters including the endotracheal tube were removed at PR 5h and animals were returned to their cages and closely monitored for the duration of survival.

Results:
For both groups, postresuscitation myocardial function as expressed by CO, EF, MPI was impaired compared to baseline values. However, the IVA group was significantly inferior to the SAL group with myocardial function index from PR 120’ to PR 300 (*p<0.01) (Figure 1).A significantly shortened duration of survival was observed in the IVA group compared to the SAL group (p<0.01) (Figure 2).

Conclusions:
Lowering HR significantly reduces myocardial function the duration of survival following successful resuscitation.
Implementation of the Convention on Rights of the Child (CRC) in Tanzania, 2005–2011: A Critical Review
Authors: Masabo Conrad John
Published: July 2021

This paper presents a critical review of the implementation of three selected articles of the Convention on the Right of the Child (CRC): Article 1 which defines of who is a child; Article 28 which stipulates the child’s rights to basic education; and Article 32, which calls on governments to protect the child from labour. Its analysis draws on the Tanzania 3rd, 4th, and 5th combined CRC implementation report, the CSO’s CRC implementation alternative report, and the CRC Committee’s observations. The findings suggest that, although there have been remarkable commitment and promising progress in making children’s rights a reality for Tanzanian children, there were still some challenges and dilemmas that emerged during their implementation. Thus, the study recommends for the harmonisation of the understanding of who is a child in addition to main-streaming work as an integral part of children’s childhood life.
European Support for Arab Parliaments: A Successful Way to Democracy?
Authors: Völkel Jan Claudius
Published: July 2021

This article contributes to the Special Issue “Parliaments in the Middle East and North Africa: A Struggle for Relevance.” In the Euro-Mediterranean region, several international parliamentary initiatives are engaged in parliamentary diplomacy and cooperation. Aside from the European Parliament, the Parliamentary Assembly of the Union for the Mediterranean (pa-UfM) and the Parliamentary Assembly of the Mediterranean (pam) cross the shores. In addition, a number of national European parliaments, as well as governmental and non-governmental organizations, cooperate with Arab parliaments in a bilateral manner.

Based on the author’s own research in Brussels, Amman, Cairo, Rabat, Tunis, and Valletta, the article analyzes cross-Mediterranean parliamentary relations and argues that parliamentary cooperation could facilitate an increase in Arab parliaments’ overall relevance, eventually leading to advanced democratization; however, the authoritarian regimes still in place in most Arab countries still successfully prevent a meaningful strengthening of national legislatures. International support offers thus require broader transformations in their partner countries before yielding success.
Jordan’s Election Law: Reinforcing Barriers to Democracy
Authors: Karmel E.J. , Linfield David
Published: July 2021

Since the 2016 introduction of a proportional open-list voting system to Jordan’s parliamentary elections, the Jordanian government has faced ongoing demands for reform. In response, the government has continually pointed to the many liberal democracies in Europe that use similar electoral systems. However, the issue is not that an undemocratic system is in place but rather that the system is unconducive to democratic reform given Jordan’s broader socio-political environment. This legal comment will explore the key facets of Jordan’s 2016 election law, discussing how the system – which could be effective in other contexts – impedes political change in Jordan and thus maintains the same patronage-fueled electoral dynamics that have prevailed since the reintroduction of parliamentary life in Jordan three decades ago.
A new species of Drupeus Lewis from eastern China (Coleoptera: Ptilodactylidae: Cladotominae)
Authors: HÁJEK JIŘÍ
Published: July 2021

Drupeus guadunensis sp. nov. is described from hygropetric habitats in Wuyishan National Nature Reserve, Fujian Province, China. The new species is similar in habitus and genitalia to its congeners; however, it can be distinguished based on the more distinctly flabellate antennae in the male, and greatly elongate antennomere III in the female; in addition the new species is characteristic with the presence of a well delimited dark spot in the anterior part of the pronotum. The diagnostic characters of the new species are illustrated, as well as habitus of both previously recorded Chinese Drupeus Lewis, 1895 species.
Three new species of Australian anthiadine fishes, with comments on the monophyly of Pseudanthias Bleeker (Teleostei: Serranidae)
Authors: GILL ANTHONY C. , POGONOSKI JOHN J. , JOHNSON JEFFREY W. , TEA YI-KAI
Published: July 2021

Three new species of anthiadine species are described from specimens trawled from Australian waters. Pseudanthias paralourgus n. sp. is described from five specimens collected off southeastern Queensland. It resembles P. elongatus (Franz, 1910) from Japan to the South China Sea, but differs in male live coloration. The remaining two species are assigned to the genus Tosana Smith & Pope, 1906, which is newly diagnosed to include the two new species and the type species from southern Japan to the South China Sea, T. niwae Smith & Pope, 1906. The two new species, T. dampieriensis n. sp. described from three specimens from off Western Australia and T. longipinnis n. sp. described from 42 specimens from off eastern Australia, differ from each other and from T. niwae in various meristic and morphometric details. Pseudanthias paralourgus co-occurs with T. longipinnis. Molecular phylogenetic analysis of mitochondrial COI yielded a tree with the three Tosana species forming the sister group of a clade consisting of P. paralourgus n. sp., P. elongatus and the type species of Pseudanthias Bleeker, 1871, P. pleurotaenia (Bleeker, 1857). Our preliminary phylogenetic analyses suggest that Pseudanthias comprises a polyphyletic assemblage of species that also includes Nemanthias Smith, 1954, Luzonichthys Herre, 1936, Tosanoides Kamohara, 1953, Odontanthias Bleeker, 1873, and Serranocirrhitus Watanabe, 1949, thus highlighting the need for a revised generic classification of species currently assigned to Pseudanthias.
Central Asian Precipitation Shaped by the Tropical Pacific Decadal Variability and the Atlantic Multidecadal Variability
Authors: Jiang Jie , Zhou Tianjun , Chen Xiaolong , Wu Bo
Published: July 2021

Known as one of the largest semiarid to arid regions in the world, central Asia and its economy and ecosystem are highly sensitivity to the changes in precipitation. The observed precipitation and related hydrographic characteristics have exhibited robust decadal variations in the past decades, but the reason remains unknown. Using the pacemaker experiments of the Community Earth System Model (CESM1.2), we find that the tropical Pacific decadal variability (TPDV) and the Atlantic multidecadal variability (AMV) are the main drivers of the interdecadal variations in central Asian precipitation during 1955–2004. Both the decadal-scale warming of the tropical Pacific and North Atlantic are favorable for wetter conditions over central Asia. The positive TPDV is accompanied with high sea level pressure (SLP) over the Indo–western Pacific warm pool. Southwesterly winds along the northwestern flank of the high SLP can transport more moisture to southeastern central Asia. The warm AMV can excite a circumglobal teleconnection (CGT) pattern. A trough node of the CGT to the west of central Asia drives an anomalous ascending motion and increased precipitation over this region. The results based on the CESM model are further demonstrated by the pacemaker experiments of MRI-ESM2-0. Based on the observational TPDV and AMV indices, we reasonably reconstruct the historical precipitation over central Asia. Our results provide hints for the decadal prediction of precipitation over central Asia.
Composition of Uroliths seen in patients in Abuja, Nigeria: a single centre retrospective analysis of 155 stones
Authors: Undie Celsus Ukelina , Nnana Ewomazino Ibanga , Torporo Kalenebari Raymond
Published: July 2021

Background

Uroliths are stones formed in the urinary tract. Analysis of stones helps to identify risk factors for their development and prevention of recurrence. Standard stone analysis using modern technology is not routinely done in Nigeria. This study sought to determine the chemical composition of urinary stones seen in Abuja, Nigeria.

Methods

This was a retrospective study on composition of uroliths. Urinary stones surgically removed from 155 patients through minimal access surgical procedures between January 2015 and August 2019 were analysed. Optical crystallography and infrared spectroscopy were used to determine the chemical composition of the urinary stones.

Results

A total of 155 urinary stones were assembled from the patients. More stones were removed from male patients and the male to female ratio was 1.9:1. Stones were rare in the extremes of age. The predominant location (89.7%) of stones was in the upper urinary tract. All stones were of mixed composition with calcium oxalate accounting for 93.55%. Calcium oxalate, calcium phosphate and uric acid stones were more common in the upper tract, while 2 of the 3 struvite stones were found in the lower tract.

Conclusion

Stones found in this study were of mixed composition with the most common constituent being Calcium oxalate and the least common, struvite.
The infant gut resistome is associated with E. coli and early-life exposures
Authors: Lebeaux Rebecca M. , Coker Modupe O. , Dade Erika F. , Palys Thomas J. , Morrison Hilary G. , Ross Benjamin D. , Baker Emily R. , Karagas Margaret R. , Madan Juliette C. , Hoen Anne G.
Published: July 2021

Background

The human gut microbiome harbors a collection of bacterial antimicrobial resistance genes (ARGs) known as the resistome. The factors associated with establishment of the resistome in early life are not well understood. We investigated the early-life exposures and taxonomic signatures associated with resistome development over the first year of life in a large, prospective cohort in the United States. Shotgun metagenomic sequencing was used to profile both microbial composition and ARGs in stool samples collected at 6 weeks and 1 year of age from infants enrolled in the New Hampshire Birth Cohort Study. Negative binomial regression and statistical modeling were used to examine infant factors such as sex, delivery mode, feeding method, gestational age, antibiotic exposure, and infant gut microbiome composition in relation to the diversity and relative abundance of ARGs.

Results

Metagenomic sequencing was performed on paired samples from 195 full term (at least 37 weeks’ gestation) and 15 late preterm (33–36 weeks’ gestation) infants. 6-week samples compared to 1-year samples had 4.37 times (95% CI: 3.54–5.39) the rate of harboring ARGs. The majority of ARGs that were at a greater relative abundance at 6 weeks (chi-squared p < 0.01) worked through the mechanism of antibiotic efflux. The overall relative abundance of the resistome was strongly correlated with Proteobacteria (Spearman correlation = 78.9%) and specifically Escherichia coli (62.2%) relative abundance in the gut microbiome. Among infant characteristics, delivery mode was most strongly associated with the diversity and relative abundance of ARGs. Infants born via cesarean delivery had a trend towards a higher risk of harboring unique ARGs [relative risk = 1.12 (95% CI: 0.97–1.29)] as well as having an increased risk for overall ARG relative abundance [relative risk = 1.43 (95% CI: 1.12–1.84)] at 1 year compared to infants born vaginally.

Conclusions

Our findings suggest that the developing infant gut resistome may be alterable by early-life exposures. Establishing the extent to which infant characteristics and early-life exposures impact the resistome can ultimately lead to interventions that decrease the transmission of ARGs and thus the risk of antibiotic resistant infections.
The genetic basis of adaptation in phenology in an introduced population of Black Cottonwood (Populus trichocarpa, Torr. & Gray)
Authors: Apuli Rami-Petteri , Richards Thomas , Rendón-Anaya Martha , Karacic Almir , Rönnberg-Wästljung Ann-Christin , Ingvarsson Pär K.
Published: July 2021

Background

Entering and exiting winter dormancy present important trade-offs between growth and survival at northern latitudes. Many forest trees display local adaptation across latitude in traits associated with these phenology transitions. Transfers of a species outside its native range introduce the species to novel combinations of environmental conditions potentially requiring different combinations of alleles to optimize growth and survival. In this study, we performed genome wide association analyses and a selection scan in aP. trichocarpamapping population derived from crossings between clones collected across the native range and introduced into Sweden. GWAS analyses were performed using phenotypic data collected across two field seasons and in a controlled phytotron experiment.

Results

We uncovered 584 putative candidate genes associated with spring and autumn phenology traits as well as with growth. Many regions harboring variation significantly associated with the initiation of leaf shed and leaf autumn coloring appeared to have been evolving under positive selection in the native environments ofP. trichocarpa. A comparison between the candidate genes identified with results from earlier GWAS analyses performed in the native environment found a smaller overlap for spring phenology traits than for autumn phenology traits, aligning well with earlier observations that spring phenology transitions have a more complex genetic basis than autumn phenology transitions.

Conclusions

In a small and structured introduced population ofP. trichocarpa, we find complex genetic architectures underlying all phenology and growth traits, and identify multiple putative candidate genes despite the limitations of the study population.
Screening tools to expedite assessment of frailty in people receiving haemodialysis: a diagnostic accuracy study
Authors: Zanotto Tobia , Mercer Thomas H. , van der Linden Marietta L. , Koufaki Pelagia
Published: July 2021

Background

Frailty is associated with multiple adverse outcomes in stage-5 chronic kidney disease (CKD-5) and upwards of one third of people receiving haemodialysis (HD) are frail. While many frailty screening methods are available in both uremic and non-uremic populations, their implementation in clinical settings is often challenged by time and resource constraints. In this study, we explored the diagnostic accuracy of time-efficient screening tools in people receiving HD.

Methods

A convenience sample of 76 people receiving HD [mean age = 61.1 years (SD = 14), 53.9% male] from three Renal Units were recruited for this cross-sectional study. Frailty was diagnosed by means of the Fried phenotype. Physical performance-based screening tools encompassed handgrip strength, 15-ft gait speed, timed up and go (TUG), and five-repetition sit to stand (STS-5) tests. In addition, participants completed the SF-36 Health Survey, the short-form international physical activity questionnaire and the Tinetti falls efficacy scale (FES) as further frailty-related measures. Outcome measures included the area under the curve (AUC), sensitivity, specificity, positive (PPV) and negative predictive values (NPV). The diagnostic performance of screening tools in assessing fall-risk was also investigated.

Results

Overall, 36.8% of participants were classified as frail. All the examined instruments could significantly discriminate frailty status in the study population. Gait speed [AUC = 0.89 (95%CI: 0.81–0.98), sensitivity = 75%, specificity = 93%] and TUG [AUC = 0.90 (95%CI: 0.80–0.99), sensitivity = 89%, specificity = 85%] exhibited the highest diagnostic accuracy. There was a significant difference in gait speed AUC (20%, p = 0.013) between participants aged 65 years or older (n = 36) and those under 65 years of age (n = 40), with better discriminating performance in the younger sub-group. The Tinetti FES was the only instrument showing good diagnostic accuracy (AUCs≥0.80) for both frailty (sensitivity = 82%, specificity = 79%) and fall-risk (sensitivity = 82%, specificity = 71%) screening.

Conclusions

This cross-sectional study revealed that time- and cost-efficient walking performance measures can accurately be used for frailty-screening purposes in people receiving HD. While self-selected gait speed had an excellent performance in people under 65 years of age, TUG may be a more suitable screening method for elderly patients (≥65 years). The Tinetti FES may be a clinically useful test when physical testing is not achievable.
Chronic kidney disease: prevalence and association with handgrip strength in a cross-sectional study
Authors: Cheng Yang , Liu Min , Liu Yu , Xu Haifeng , Chen Xiaotian , Zheng Hui , Wu Xiaojun , Shen Zhixiang , Shen Chong
Published: July 2021

Background

Poor physical function is strongly associated with mortality and poor clinical outcomes in adults with chronic kidney disease (CKD). Handgrip strength (HGS) is an important index for physical function in the general population, and the association between HGS and CKD is worth investigating.

Methods

From September to November 2015, we conducted a cross-sectional study consisting of 10,407 participants in Jurong City, China. Age-related and sex-specific HGS percentile curves were constructed using the GAMLSS method. In addition, logistic regression was applied to estimate the association between HGS and the presence of CKD with odds ratios (ORs) and 95 % confidence intervals (CIs).

Results

Participants with low HGS tended to be older and were more likely to have CKD (8.73 %). Smoothed centile curves of HGS showed a similar shape in both sexes: participants peaked at approximately 20–35 years old and gradually decreased after the age of 50. In addition, independent of age and other factors, the decreased presence of CKD was significantly identified in individuals with moderate (OR: 0.64, 95 % CI: 0.49–0.83) and high HGS (OR: 0.37, 95 % CI: 0.23–0.58).

Conclusions

We concluded that HGS was significantly negatively associated with CKD in Chinese community-dwelling persons.
The clinical and prognostic values of optic nerve sheath diameter and optic nerve sheath diameter/eyeball transverse diameter ratio in comatose patients with supratentorial lesions
Authors: Zhu Sha , Cheng Chao , Zhao Dianjiang , Zhao Yuanli , Liu Xianzeng , Zhang Jun
Published: July 2021

Background

The optic nerve sheath diameter (ONSD) and ONSD/eyeball transverse diameter (ETD) ratio have been proven to be correlated with intracranial pressure. This study aimed to evaluate the prognostic roles of ONSD and the ONSD/ETD ratio in comatose patients with supratentorial lesions and to determine the relationship of these two indices with the prognosis of such patients.

Methods

A total of 54 comatose patients with supratentorial lesions and 50 healthy controls were retrospectively included in this study. ONSD and ETD were measured by unenhanced computed tomography (CT). The differences in ONSD and the ONSD/ETD ratio between the two groups were compared. The prognosis of comatose patients was scored using the Glasgow Outcome Scale (GOS) at the 3-month follow-up, and these patients were classified into good (GOS score ≥ 3) and poor (GOS score < 3) prognosis groups. The differences in ONSD and the ONSD/ETD ratio were compared between comatose patients with good prognoses and those with poor prognoses.

Results

The ONSD and ONSD/ETD ratios in the comatose patients were 6.30 ± 0.60 mm and 0.27 ± 0.03, respectively, and both were significantly greater than those in the healthy controls (5.10 ± 0.47 mm, t = 11.426, P < 0.0001; 0.22 ± 0.02, t = 11.468, P < 0.0001; respectively). ONSD in patients with poor prognosis was significantly greater than that in patients with good prognosis (6.40 ± 0.56 vs. 6.03 ± 0.61 mm, t = 2.197, P = 0.032). The ONSD/ETD ratio in patients with poor prognosis was significantly greater than that in patients with good prognosis (0.28 ± 0.02 vs. 0.26 ± 0.03, t = 2.622, P = 0.011). The area under the receiver operating characteristic (ROC) curve, used to predict the prognosis of comatose patients, was 0.650 (95% confidence interval (CI): 0.486–0.815, P = 0.078) for ONSD and 0.711 (95% CI: 0.548–0.874, P = 0.014) for the ONSD/ETD ratio.

Conclusions

The ONSD and ONSD/ETD ratios were elevated in comatose patients. The ONSD/ETD ratio might be more valuable than ONSD in predicting the prognoses of comatose patients with supratentorial lesions.
Stillbirth as left truncation for early neonatal death in California, 1989–2015: a time-series study
Authors: Bruckner Tim A. , Gailey Samantha , Das Abhery , Gemmill Alison , Casey Joan A. , Catalano Ralph , Shaw Gary M. , Zeitlin Jennifer
Published: July 2021

Background

Some scholars posit that attempts to avert stillbirth among extremely preterm gestations may result in a live birth but an early neonatal death. The literature, however, reports no empirical test of this potential form of left truncation. We examine whether annual cohorts delivered at extremely preterm gestational ages show an inverse correlation between their incidence of stillbirth and early neonatal death.

Methods

We retrieved live birth and infant death information from the California Linked Birth and Infant Death Cohort Files for years 1989 to 2015. We defined the extremely preterm period as delivery from 22 to < 28 weeks of gestation and early neonatal death as infant death at less than 7 days of life. We calculated proportions of stillbirth and early neonatal death separately by cohort year, race/ethnicity, and sex. Our correlational analysis controlled for well-documented declines in neonatal mortality over time.

Results

California reported 89,276 extremely preterm deliveries (live births and stillbirths) to Hispanic, non-Hispanic (NH) Black, and NH white mothers from 1989 to 2015. Findings indicate an inverse correlation between stillbirth and early neonatal death in the same cohort year (coefficient: -0.27, 95% CI of − 0.11; − 0.42). Results remain robust to alternative specifications and falsification tests.

Conclusions

Findings support the notion that cohorts with an elevated risk of stillbirth also show a reduced risk of early neonatal death among extremely preterm deliveries. Results add to the evidence base that selectionin uteromay influence the survival characteristics of live-born cohorts.
Metacognition, social cognition, and mentalizing in psychosis: are these distinct constructs when it comes to subjective experience or are we just splitting hairs?
Authors: Lysaker P. H. , Cheli S. , Dimaggio G. , Buck B. , Bonfils K. A. , Huling K. , Wiesepape C. , Lysaker J. T.
Published: July 2021

Research using the integrated model of metacognition has suggested that the construct of metacognition could quantify the spectrum of activities that, if impaired, might cause many of the subjective disturbances found in psychosis. Research on social cognition and mentalizing in psychosis, however, has also pointed to underlying deficits in how persons make sense of their experience of themselves and others. To explore the question of whether metacognitive research in psychosis offers unique insight in the midst of these other two emerging fields, we have offered a review of the constructs and research from each field. Following that summary, we discuss ways in which research on metacognition may be distinguished from research on social cognition and mentalizing in three broad categories: (1) experimental procedures, (2) theoretical advances, and (3) clinical applications or indicated interventions. In terms of its research methods, we will describe how metacognition makes a unique contribution to understanding disturbances in how persons make sense of and interpret their own experiences within the flow of life. We will next discuss how metacognitive research in psychosis uniquely describes an architecture which when compromised – as often occurs in psychosis – results in the loss of persons’ sense of purpose, possibilities, place in the world and cohesiveness of self. Turning to clinical issues, we explore how metacognitive research offers an operational model of the architecture which if repaired or restored should promote the recovery of a coherent sense of self and others in psychosis. Finally, we discuss the concrete implications of this for recovery-oriented treatment for psychosis as well as the need for further research on the commonalities of these approaches.
Protocol of the Cologne Corona Surveillance (CoCoS) Study– a prospective population-based cohort study
Authors: Oberste Max , Pusch Lynn-Marie , Roth Rebecca , Shah-Hosseini Kija , Dewald Felix , Müller Claudia , Stach von Goltzheim Luise , Lehmann Clara , Buess Michael , Wolff Anna , Fätkenheuer Gerd , Wiesmüller Gerhard , Klein Florian , Hellmich Martin , Neuhann Florian
Published: July 2021

Background

Surveillance strategies are critical to cope with the current SARS-CoV-2 pandemic and to evaluate, as well as adjust government-imposed countermeasures. Incidence estimates are widely based on laboratory confirmed cases reported by health authorities. Prevalence and incidence data of SARS-CoV-2 is still scarce, along with demographic and behavioural factors associated with infection risk.

Methods

The Cologne Corona Surveillance Study will be conducted in the City of Cologne, which is the fourth-largest city in Germany with a population of approximately 1.1 million. Researchers will apply self-sampling surveillance to a rolling cohort of Cologne residents. Random samples of 6000 Cologne residents 18 years of age and older will be drawn from the registration office. Upon receiving the information and saliva sample kit, participants will be asked to fill out a questionnaire online or via phone, sign written informed consent, and send back written consent, as well as saliva sample. The saliva samples will be tested for SARS-CoV-2 by reverse PCR. The questionnaire will be administered to gather information about personal characteristics such as health status and risks. A second round of testing will take place 6 weeks after the first.

Discussion

Self-administered saliva sampling proved to be a legitimate and feasible alternative to nasopharyngeal swabs taken by health professionals. However, it is unclear whether the targeted response rate of 40% can be achieved and whether the results are representative of the population.

Trial registration

DRKS.de, German Clinical Trials Register (DRKS), Identifier: DRKS00024046, Registered on 25 February 2021.
Stigmatization of Chinese and Asian-looking people during the COVID-19 pandemic in Germany
Authors: Koller Julia E. , Villinger Karoline , Lages Nadine C. , Brünecke Isabel , Debbeler Joke M. , Engel Kai D. , Grieble Sofia , Homann Peer C. , Kaufmann Robin , Koppe Kim M. , Oppenheimer Hannah , Radtke Vanessa C. , Rogula Sarah , Stähler Johanna , Renner Britta , Schupp Harald T.
Published: July 2021

Background

The outbreak and global spread of COVID-19 was accompanied by an increase in reports of stigmatization of Chinese and Asian-looking people. The behavioral immune system provides a framework for stigmatization in response to infectious disease threats. Specifically, stigmatization might increase with rising levels of infectious disease threat. The present study aimed to examine this hypothesis during the early phase of the COVID-19 pandemic.

Methods

As part of the “EUCLID” project (https://euclid.dbvis.de), a total of 5011 persons from Germany were surveyed via an online-questionnaire between February 2nd and April 3rd, 2020, covering the progression of the COVID-19 pandemic over three time periods which were defined by critical events.

Results

There was no evidence for an increase in the stigmatization of Chinese and Asian-looking people across three topics, that is personal proximity, air travel, and medical measures upon arrival from China.

Conclusions

The present findings provide good news in that participants showed an adaptive response to the infectious disease threat rather than displaying increased stigmatization. Further research is necessary to specify the conditions that increase the risk of stigmatization in response to infectious disease threats.
Making patient blood management the new norm(al) as experienced by implementors in diverse countries
Authors: Hofmann Axel , Spahn Donat R. , Holtorf Anke-Peggy ,   PBM Implementation Group, Isbister James , Hamdorf Jeff , Campbell Linda , Benites Bruno , Duarte Gustavo , Rabello Guillermo , Ji Hongwen , Wei Lihui , Ivancan Visnja , Kovac Natasa , Tomic Mahecic Tina , Matsouka Chara , Aggeliki Bairaktari , Anthi Gafou , Charalabopoulos Alexandros , Attalah David , Jebara Samia , Chahine Rabih , Pérez Calatayud Ángel Augusto , Galvan Garcia Ángel Fernando , Ayala Miguel , Torres Pérez Bettina , Park Jong Hoon , Kim Young Woo , Lee Jeong Jae , Um Tae Hyun , A.Al-Humaidan Hind , Al Sughayir Ammar , Batarfi Khalid , Hindawi Salwa , Louw Vernon , Thompson Jackie , Alkis Neslihan , Gunaydin Serdar , Gunaydin Berrin
Published: July 2021

Background

Patient blood management (PBM) describes a set of evidence-based practices to optimize medical and surgical patient outcomes by clinically managing and preserving a patient’s own blood. This concepts aims to detect and treat anemia, minimize the risk for blood loss and the need for blood replacement for each patient through a coordinated multidisciplinary care process. In combination with blood loss, anemia is the main driver for transfusion and all three are independent risk factors for adverse outcomes including morbidity and mortality. Evidence demonstrates that PBM significantly improves outcomes and safety while reducing cost by macroeconomic magnitudes. Despite its huge potential to improve healthcare systems, PBM is not yet adopted broadly. The aim of this study is to analyze the collective experiences of a diverse group of PBM implementors across countries reflecting different healthcare contexts and to use these experiences to develop a guidance for initiating and orchestrating PBM implementation for stakeholders from diverse professional backgrounds.

Methods

Semi-structured interviews were conducted with 1–4 PBM implementors from 12 countries in Asia, Latin America, Australia, Central and Eastern Europe, the Middle East, and Africa. Responses reflecting the drivers, barriers, measures, and stakeholders regarding the implementation of PBM were summarized per country and underwent qualitative content analysis. Clustering the resulting implementation measures by levels of intervention for PBM implementation informed a PBM implementation framework.

Results

A set of PBM implementation measures were extracted from the interviews with the implementors. Most of these measures relate to one of six levels of implementation including government, healthcare providers, funding, research, training/education, and patients/public. Essential cross-level measures are multi-stakeholder communication and collaboration.

Conclusion

The implementation matrix resulting from this research helps to decompose the complexity of PBM implementation into concrete measures on each implementation level. It provides guidance for diverse stakeholders to design, initiate and develop strategies and plans to make PBM a national standard of care, thus closing current practice gaps and matching this unmet public health need.
The plasma membrane calcium ATPase 4 does not influence parasite levels but partially promotes experimental cerebral malaria during murine blood stage malaria
Authors: Villegas-Mendez Ana , Stafford Nicholas , Haley Michael J. , Pravitasari Normalita Eka , Baudoin Florence , Ali Adnan , Asih Puji Budi Setia , Siregar Josephine E. , Baena Esther , Syafruddin Din , Couper Kevin N. , Oceandy Delvac
Published: July 2021

Background

Recent genome wide analysis studies have identified a strong association between single nucleotide variations within the human ATP2B4 gene and susceptibility to severe malaria. The ATP2B4 gene encodes the plasma membrane calcium ATPase 4 (PMCA4), which is responsible for controlling the physiological level of intracellular calcium in many cell types, including red blood cells (RBCs). It is, therefore, postulated that genetic differences in the activity or expression level of PMCA4 alters intracellular Ca2+ levels and affects RBC hydration, modulating the invasion and growth of the Plasmodium parasite within its target host cell.

Methods

In this study the course of three different Plasmodium spp. infections were examined in mice with systemic knockout of Pmca4 expression.

Results

Ablation of PMCA4 reduced the size of RBCs and their haemoglobin content but did not affect RBC maturation and reticulocyte count. Surprisingly, knockout of PMCA4 did not significantly alter peripheral parasite burdens or the dynamics of blood stage Plasmodium chabaudi infection or reticulocyte-restricted Plasmodium yoelii infection. Interestingly, although ablation of PMCA4 did not affect peripheral parasite levels during Plasmodium berghei infection, it did promote slight protection against experimental cerebral malaria, associated with a minor reduction in antigen-experienced T cell accumulation in the brain.

Conclusions

The finding suggests that PMCA4 may play a minor role in the development of severe malarial complications, but that this appears independent of direct effects on parasite invasion, growth or survival within RBCs.
Coverage versus response time objectives in ambulance location
Authors: Jánošíková Ľudmila , Jankovič Peter , Kvet Marek , Zajacová Frederika
Published: July 2021

Background

This paper deals with the location of emergency medical stations where ambulances waiting to be dispatched are parked. The literature reports a lot of mathematical programming models used to optimize station locations. Most studies evaluate the models only analytically applying the same simplifying assumptions that were used in the modelling phase. In addition, they concentrate on systems operating one type of emergency units in homogeneous urban areas. The goal of our study is to identify which optimization criterion the emergency medical service (EMS) outcomes benefit from the most and which model should be used to design tiered systems in large urban–rural areas.

Methods

A bi-criteria mathematical programming model is proposed. The criteria include the accessibility of high-priority patients within a short time limit and average response time to all patients. This model is being compared to the p-median model with a single response time objective and to a hierarchical pq-median model that considers two different vehicle types. A detailed computer simulation model is used to evaluate the solutions. The methodology is verified in the conditions of the Slovak Republic using real historical data on 149,474 ambulance trips performed in 2015.

Results

All mathematical models improve EMS performance by relocating some stations compared to the current distribution. The best results are achieved by the hierarchical median-type model. The average response time is reduced by 58 s, the number of calls responded to within 15 min is increased by 5% and the number of high-priority calls responded to within 8 min by 6%.

Conclusions

The EMS systems operating in heterogeneous areas should be designed to minimize response times, and not to maximize the number of calls served within a given time limit.