bluuebunny/crossref_metadata_2025 huggingface dataset:
Teaching With Picture Books on Deaf and Hard-of-Hearing Students’Creativity
Authors: Wang Chonggao , Fu Wangqian , Cheng Li , Wang Yan , Duan Shifei
Published: November 2020

Studies have shown that teaching with picture books can help improve creativity development of deaf and hard-of-hearing (DHH) students. A quasi-experimental research design was applied in this study. Deaf and hard-of-hearing students in grades 3–6 from two cities, B and T, were selected as the samples in a pilot study. The Evaluation of Potential Creativity (EPoC) test tool (Ver. A) was applied to measure creativity through student performance on individual tests of divergent and integrative thinking. Following thirty 40-min lessons over 10 weeks, the EPoC test tool (Ver. B) was used to measure student creativity in the experimental and control groups. The results showed the following: (1) the performance of DHH students was better on graphic divergence than on verbal divergence, (2) performance on the divergent dimensions of creativity was significantly higher for DHH students from the experimental group than the control group, and (3) there was no difference in integrative thinking between the two groups in the posttest. In practice, teachers could use picture books in their lesson plans to improve the creativity of DHH students that results from divergent thinking. Future research should focus on the development of creativity in DHH students through integrative thinking with a longer teaching intervention.
Excess mortality from COVID-19: weekly excess death rates by age and sex for Sweden and its most affected region
Authors: Modig Karin , Ahlbom Anders , Ebeling Marcus
Published: November 2020

Background

Sweden has one of the highest numbers of COVID-19 deaths per inhabitant globally. However, absolute death counts can be misleading. Estimating age- and sex-specific mortality rates is necessary in order to account for the underlying population structure. Furthermore, given the difficulty of assigning causes of death, excess all-cause mortality should be estimated to assess the overall burden of the pandemic.

Methods

By estimating weekly age- and sex-specific death rates during 2020 and during the preceding 5 years, our aim is to get more accurate estimates of the excess mortality attributed to COVID-19 in Sweden, and in the most affected region Stockholm.

Results

Eight weeks after Sweden’s first confirmed case, the death rates at all ages above 60 were higher than for previous years. Persons above age 80 were disproportionally more affected, and men suffered greater excess mortality than women in ages up to 75 years. At older ages, the excess mortality was similar for men and women, with up to 1.5 times higher death rates for Sweden and up to 3 times higher for Stockholm. Life expectancy at age 50 declined by <1 year for Sweden and 1.5 years for Stockholm compared to 2019.

Conclusions

The excess mortality has been high in older ages during the pandemic, but it remains to be answered if this is because of age itself being a prognostic factor or a proxy for comorbidity. Only monitoring deaths at a national level may hide the effect of the pandemic on the regional level.
Hospitalization Trajectories in Home- and Community-Based Services Recipients: The Influence of Physician and Social Care Density
Authors: Kim Min Hee , Xiang Xiaoling
Published: November 2020

Objectives

Repeated hospitalizations among older adults receiving Home- and Community-Based Services (HCBS) may indicate unmet medical and social needs. This study examined all-cause hospitalization trajectories and the association between area-level resource density for medical and social care and the trajectory group membership.

Methods

The study participants included 11,223 adults aged 60 years or older who were enrolled in public HCBS programs in Michigan between 2008 and 2012. Data sources included the Michigan interRAI-Home Care, Dartmouth Atlas of Health Care Data, the American Community Survey, and the County Business Patterns from the Census Bureau. The group-based trajectory modeling was used to identify trajectories of hospitalization over 15 months. Correlates of the trajectories were examined using multinomial logistic regression.

Results

Four distinct hospitalization trajectory groups emerged: “never” (43.1%)—individuals who were rarely hospitalized during the study period, “increasing” (19.9%)—individuals who experienced an increased risk of hospitalization, “decreasing” (21.6%)—individuals with a decreased risk, and “frequent” (15.8%)—individuals with frequent hospitalizations. Older adults living in areas with a higher number of social service organizations for older adults and persons with disability were less likely to be on the “frequent” trajectory relative to the “decreasing” trajectory. The density of primary care physicians was not associated with the trajectory group membership.

Discussion

Area-level social care resource density contributes to changes in 15-month hospitalization risks among older adult recipients of HCBS.
Contribution of CD3+CD8- and CD3+CD8+ T Cells to TNF-α Overexpression in Crohn Disease–Associated Perianal Fistulas and Induction of Epithelial-Mesenchymal Transition in HT-29 Cells
Authors: Bruckner Ramona S , Spalinger Marianne R , Barnhoorn Marieke C , Feakins Roger , Fuerst Alois , Jehle Ekkehard C , Rickenbacher Andreas , Turina Matthias , Niechcial Anna , Lang Silvia , Hawinkels Lukas J A C , van der Meulen-de Jong Andrea E , Verspaget Hein W , Rogler Gerhard , Scharl Michael
Published: November 2020

Background

Fistulas represent a frequent and severe complication in patients with Crohn disease (CD). Tumor necrosis factor-alpha (TNF-α), transforming growth factor-beta, and interleukin (IL)-13 are known to trigger epithelial-mesenchymal transition (EMT), promoting fistula formation. Here, we investigated the role of T-lymphocytes (T cells) in fistula pathogenesis.

Methods

CD3+CD8-, CD3+CD8+, or CD45+CD3- cells from healthy volunteers, patients with CD, and patients with CD with perianal fistula were co-cultured with HT-29 cells. The EMT, cytokine production, and mRNA expression were analyzed. Perianal CD fistula specimens were immunohistochemically stained for cytokines and their receptors. The effect of cytokines on EMT induction was investigated using an EMT spheroid model.

Results

Patients with CD with fistula revealed more CD3+CD8- and less CD3+CD8+ T cells in blood than healthy control patients and patients with CD without fistula. In perianal fistula specimens, CD4+ cells—and to a lesser extent CD8+ cells—were highly present around fistula tracts. When co-cultured with HT-29 cells, both cell subsets promoted EMT-related gene expression and TNF-α production in a time-dependent manner. The CD3+CD8- T cells from patients with CD with fistula also produced higher amounts of IL-13 than cells from healthy control patients or patients with CD without a fistula. We found that IL-22 and IL-22Rα1 were highly expressed in perianal CD fistula specimens and that IL-22 cotreatment potentiated TNF-α-induced EMT in HT-29 spheroids.

Conclusions

Our data indicate that both CD3+CD8- and CD3+CD8+ T cells play an important role in the pathogenesis of perianal CD fistulas by the secretion of TNF-α. Our data support clinical evidence indicating that anti-TNF-α therapy is effective in fistula treatment and identify IL-13 and IL-22 as possible novel therapeutic targets for fistula therapy.
Predictors of Ustekinumab Failure in Crohn’s Disease After Dose Intensification
Authors: Dalal Rahul S , Njie Cheikh , Marcus Jenna , Gupta Sanchit , Allegretti Jessica R
Published: November 2020

Background

Many patients with Crohn’s disease (CD) who lose response to the standard ustekinumab dose interval of every 8 weeks (q8w) undergo dose intensification to q4w or q6w. However, baseline factors that predict success or failure after dose intensification are unknown. We sought to identify predictors of failure of ustekinumab after dose intensification for patients with CD.

Methods

This was a retrospective cohort study of adult CD patients undergoing ustekinumab dose intensification at a tertiary referral center between January 1, 2016, and January 31, 2019. Electronic health records were reviewed to obtain patient demographics, CD history, and laboratory data. The primary outcome was failure to achieve corticosteroid-free remission (Harvey-Bradshaw Index <5) within 12 months after intensification. The secondary outcome assessed was time to new biologic therapy after dose intensification. We used multivariable logistic regression and Cox regression to identify predictors of these outcomes.

Results

We included 123 patients who underwent ustekinumab dose intensification to q4w (n = 64), q5w (n = 1), q6w (n = 55), or q7w (n = 3). Multivariable logistic regression demonstrated that perianal disease, Harvey-Bradshaw Index, and opioid use at time of intensification were associated with failure to achieve remission. Cox regression demonstrated that perianal disease and corticosteroid use at time of intensification were associated with shorter time to a new biologic.

Conclusion

Perianal disease, Harvey-Bradshaw Index, current opioid use, and current corticosteroid use are associated with ustekinumab failure after dose intensification in CD. Larger, prospective studies are needed to corroborate these findings and guide therapeutic strategies for patients who lose response to standard ustekinumab dosing.
The urban–rural education gap: do cities indeed make us smarter?
Authors: van Maarseveen Raoul
Published: November 2020

Despite the large urban–rural education gap observed in most countries, little attention has been paid to whether cities actually enjoy a comparative advantage in the production of human capital. Using Dutch administrative data, this paper finds that children growing in urban regions consistently attain higher levels of human capital compared with children in rural regions, conditional on observed cognitive ability and various family characteristics. The elasticity of university attendance with respect to population density is 0.07, which is robust across a variety of specifications. Hence, the paper offers a different explanation to explain the recent success of cities.
Assessing improvements in metastatic renal cell carcinoma systemic treatments from the pre-cytokine to the immune checkpoint inhibitor eras: a retrospective analysis of real-world data
Authors: Ishihara Hiroki , Takagi Toshio , Kondo Tsunenori , Fukuda Hironori , Tachibana Hidekazu , Yoshida Kazuhiko , Iizuka Junpei , Kobayashi Hirohito , Okumi Masayoshi , Ishida Hideki , Tanabe Kazunari
Published: November 2020

Objective

Studies assessing outcome improvements over a long period according to systemic therapy strategies for metastatic renal cell carcinoma using real-world data, including the results of the recent era of immune checkpoint inhibitors, are limited. Herein, we retrospectively evaluated patients who were diagnosed with metastatic renal cell carcinoma over a 40-year span.

Methods

Patients were classified into four groups based on when their metastases were diagnosed as follows: (i) the pre-cytokine era (1980–1986), (ii) the cytokine era (1987–2007), (iii) the molecular-targeted therapy (mTT) era (2008 to August 2016) and (iv) the immune checkpoint inhibitor era (September 2016 to 2018). The immune checkpoint inhibitor era consisted of second- or later-line nivolumab. Overall survival from the diagnoses of metastases was evaluated.

Results

In total, 576 patients were evaluated, including 22 (3.82%), 231 (40.1%), 253 (43.9%) and 70 (12.2%) patients from the pre-cytokine, cytokine, molecular-targeted therapy and immune checkpoint inhibitor eras, respectively. The overall survival significantly improved with each successive era (median: 13.1 vs. 24.5 vs. 44.4 months vs. not reached in pre-cytokine vs. cytokine vs. molecular-targeted therapy vs. immune checkpoint inhibitor eras, P < 0.0001). The implementation of molecular-targeted therapy improved overall survival compared with that of cytokine (cytokine vs. molecular-targeted therapy eras, P < 0.0001). Multivariate analysis demonstrated that the era was an independent factor for overall survival (P < 0.0001), together with histopathological type; metastasis status (i.e. synchronous or metachronous); systemic therapy status (i.e. absence or presence) and bone, liver or lymph node metastasis status (all, P < 0.05).

Conclusion

This retrospective study of real-world data indicated that metastatic renal cell carcinoma outcomes improved with successive systemic therapy paradigms.
Synanthropy of Sarcophaginae (Diptera: Sarcophagidae) From Southern Brazil and Its Sanitary Implications
Authors: Souza Carina M , Madeira-Ott Tais , Masiero Franciele S , Bunde Paulo R S , Ribeiro Gladis A , Thyssen Patricia J
Published: November 2020

Although different feeding habits have been reported for Sarcophaginae (Diptera, Sarcophagidae), most species are associated with decomposing organic matter such as feces and decaying corpses. This study provides the synanthropy index for males of species of Sarcophaginae collected during a 12-mo period in three different environments (urban, rural, and wild) of the state of Rio Grande do Sul, in Southern Brazil, linking this parameter with the sanitary issue. This article also investigated the presence of pathogenic bacteria on the external surface of Oxysarcodexia paulistanensis (Mattos), the most abundant species collected using a sanitized entomological net. Almost all the species collected most abundantly, including O. paulistanensis (n = 241), Ravinia advena (Walker) (n = 87), and O. thornax (Walker) (n = 58), were classified as synanthropic; O. thornax was the species with the highest synanthropy index (+80.3). Escherichia coli (Escherich), Shigella spp. (Enterobacteriaceae), and Staphylococcus aureus (Rosenbach) (Staphylococcaceae) were isolated and identified from the external surface of O. paulistanensis. The isolation and identification of pathogenic bacteria, and their synanthropic behavior, adds weight to potential role of some flesh flies, as O. paulistanensis, in a sanitary context.
Snorting the Brain Away: Cerebral Damage as an Extension of Cocaine-Induced Midline Destructive Lesions
Authors: García-Pérez Daniel , Ruiz-Ortiz Mariano , Panero Irene , Eiriz Carla , Moreno Luis Miguel , García-Reyne Ana , García Alfredo , Martín-Medina Patricia , Salvador-Álvarez Elena , Hernández-Lain Aurelio , Serrano Antonio , Gil-Etayo Francisco Javier , Castaño-León Ana María , Paredes Igor , Pérez-Núñez Ángel
Published: November 2020

Cocaine consumption is associated with a variety of clinical manifestations. Though cocaine intranasal inhalation always determines nasal mucosal damages, extensive septum perforations, and midline destructions—known as cocaine-induced midline destructive lesions (CIMDL)—affect only a limited fraction of patients. CIMDL is viewed as a cocaine-associated autoimmune phenomenon in which the presence of atypical anti-neutrophil cytoplasmic antibody (ANCA) promotes and/or defines the disease phenotype. A 51-year-old man presented with an intracranial tumor-like lesion by its space-occupying effect. CT also revealed the destruction of the nasal septum and skull base. A diagnosis of CIMDL was made in light of the patient’s history as well as findings of the physical and endoscopic examinations, imaging studies, and laboratory testing. There was no evidence of other pathologies. Histopathological results from cerebral biopsy led us to consider the intracranial pathology as an extension of the CIMDL. CIMDL is the result of a necrotizing inflammatory tissue response triggered by cocaine abuse in a subset of predisposed patients. The reported case is the first CIMDL consistent with brain extension mimicking a tumor-like lesion. While the presence of atypical ANCA seems to promote and/or define the disease phenotype, the specific role of these and other circulating autoantibodies needs further investigation.
Shaping leaf vein pattern by auxin and mechanical feedback
Authors: Burian Agata , Raczyńska-Szajgin Magdalena , Pałubicki Wojtek
Published: November 2020

This article comments on:

Kneuper I, Teale W, Dawson JE, Tsugeki R, Katifori E, Palme K, Ditengou FA. 2021. Auxin biosynthesis and cellular efflux act together to regulate leaf vein patterning. Journal of Experimental Botany 72, 1151–1165.
Developmental differences in genome replication program and origin activation
Authors: Rausch Cathia , Weber Patrick , Prorok Paulina , Hörl David , Maiser Andreas , Lehmkuhl Anne , Chagin Vadim O , Casas-Delucchi Corella S , Leonhardt Heinrich , Cardoso M Cristina
Published: November 2020

To ensure error-free duplication of all (epi)genetic information once per cell cycle, DNA replication follows a cell type and developmental stage specific spatio-temporal program. Here, we analyze the spatio-temporal DNA replication progression in (un)differentiated mouse embryonic stem (mES) cells. Whereas telomeres replicate throughout S-phase, we observe mid S-phase replication of (peri)centromeric heterochromatin in mES cells, which switches to late S-phase replication upon differentiation. This replication timing reversal correlates with and depends on an increase in condensation and a decrease in acetylation of chromatin. We further find synchronous duplication of the Y chromosome, marking the end of S-phase, irrespectively of the pluripotency state. Using a combination of single-molecule and super-resolution microscopy, we measure molecular properties of the mES cell replicon, the number of replication foci active in parallel and their spatial clustering. We conclude that each replication nanofocus in mES cells corresponds to an individual replicon, with up to one quarter representing unidirectional forks. Furthermore, with molecular combing and genome-wide origin mapping analyses, we find that mES cells activate twice as many origins spaced at half the distance than somatic cells. Altogether, our results highlight fundamental developmental differences on progression of genome replication and origin activation in pluripotent cells.
Critical Role of NdhA in the Incorporation of the Peripheral Arm into the Membrane-Embedded Part of the Chloroplast NADH Dehydrogenase-Like Complex
Authors: Yamamoto Hiroshi , Sato Nozomi , Shikanai Toshiharu
Published: November 2020

The chloroplast NADH dehydrogenase-like (NDH) complex mediates ferredoxin-dependent plastoquinone reduction in the thylakoid membrane. In angiosperms, chloroplast NDH is composed of five subcomplexes and further forms a supercomplex with photosystem I (PSI). Subcomplex A (SubA) mediates the electron transport and consists of eight subunits encoded by both plastid and nuclear genomes. The assembly of SubA in the stroma has been extensively studied, but it is unclear how SubA is incorporated into the membrane-embedded part of the NDH complex. Here, we isolated a novel Arabidopsis mutant chlororespiratory reduction 16 (crr16) defective in NDH activity. CRR16 encodes a chloroplast-localized P-class pentatricopeptide repeat protein conserved in angiosperms. Transcript analysis of plastid-encoded ndh genes indicated that CRR16 was responsible for the efficient splicing of the group II intron in the ndhA transcript, which encodes a membrane-embedded subunit localized to the connecting site between SubA and the membrane subcomplex (SubM). To analyze the roles of NdhA in the assembly and stability of the NDH complex, the homoplastomic knockout plant of ndhA (ΔndhA) was generated in tobacco (Nicotiana tabacum). Biochemical analyses of crr16 and ΔndhA plants indicated that NdhA was essential for stabilizing SubA and SubE but not for the accumulation of the other three subcomplexes. Furthermore, the crr16 mutant accumulated the SubA assembly intermediates in the stroma more than that in the wild type. These results suggest that NdhA biosynthesis is essential for the incorporation of SubA into the membrane-embedded part of the NDH complex at the final assembly step of the NDH–PSI supercomplex.
Determining Grades in the Internal Medicine Clerkship: Results of a National Survey of Clerkship Directors
Authors: Hernandez Caridad A. , Daroowalla Feroza , LaRochelle Jeffrey S. , Ismail Nadia , Tartaglia Kimberly M. , Fagan Mark J. , Kisielewski Michael , Walsh Katherine
Published: November 2020

Purpose

Trust in and comparability of assessments are essential in clerkships in undergraduate medical education for many reasons, including ensuring competency in clinical skills and application of knowledge important for the transition to residency and throughout students’ careers. The authors examined how assessments are used to determine internal medicine (IM) core clerkship grades across U.S. medical schools.

Methods

A multisection web-based survey of core IM clerkship directors at 134 U.S. medical schools with membership in the Clerkship Directors in Internal Medicine was conducted in October through November 2018. The survey included a section on assessment practices to characterize current grading scales used, who determines students’ final clerkship grades, the nature/type of summative assessments, and how assessments are weighted. Respondents were asked about perceptions of the influence of the National Board of Medical Examiners (NBME) Medicine Subject Examination (MSE) on students’ priorities during the clerkship.

Results

The response rate was 82.1% (110/134). There was considerable variability in the summative assessments and their weighting in determining final grades. The NBME MSE (91.8%), clinical performance (90.9%), professionalism (70.9%), and written notes (60.0%) were the most commonly used assessments. Clinical performance assessments and the NBME MSE accounted for the largest percentage of the total grade (on average 52.8% and 23.5%, respectively). Eighty-seven percent of respondents were concerned that students’ focus on the NBME MSE performance detracted from patient care learning.

Conclusions

There was considerable variability in what IM clerkships assessed and how those assessments were translated into grades. The NBME MSE was a major contributor to the final grade despite concerns about the impact on patient care learning. These findings underscore the difficulty in comparing learners across institutions and serve to advance discussions for how to improve accuracy and comparability of grading in the clinical environment.
Harmonizing Heterogeneous Endpoints in Coronavirus Disease 2019 Trials Without Loss of Information
Authors: von Cube Maja , Grodd Marlon , Wolkewitz Martin , Hazard Derek , Wengenmayer Tobias , Canet Emmanuel , Lambert Jêrome
Published: November 2020

OBJECTIVES:

Many trials investigate potential effects of treatments for coronavirus disease 2019. To provide sufficient information for all involveddecision-makers (clinicians, public health authorities, and drug regulatory agencies), a multiplicity of endpoints must be considered. The objectives are to provide hands-on statistical guidelines for harmonizing heterogeneous endpoints in coronavirus disease 2019 clinical trials.

DESIGN:

Randomized controlled trials for patients infected with coronavirus disease 2019.

SETTING:

General methods that apply to any randomized controlled trial for patients infected with coronavirus disease 2019.

PATIENTS:

Coronavirus disease 2019 positive individuals.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We develop a multistate model that is based on hospitalization, mechanical ventilation, death, and discharge. These events are both categories of the ordinal endpoint recommended by the World Health Organization and also within the core outcome set of the Core Outcome Measures in Effectiveness Trials initiative for coronavirus disease 2019 trials. To support our choice of states in the multistate model, we also perform a brief review of registered coronavirus disease 2019 clinical trials. Based on the multistate model, we give recommendation for compact, informative illustration of time-dynamic treatment effects and explorative statistical analysis. A majority of coronavirus disease 2019 clinical trials collect information on mechanical ventilation, hospitalization, and death. Using reconstructed and real data of coronavirus disease 2019 trials, we show how a stacked probability plot provides a detailed understanding of treatment effects on the patients’ course of hospital stay. It contributes to harmonizing multiple endpoints and differing lengths of follow-up both within and between trials.

CONCLUSIONS:

All ongoing clinical trials should include a stacked probability plot in their statistical analysis plan as descriptive analysis. While primary analysis should be on an early endpoint with appropriate capability to be a surrogate (parameter), our multistate model provides additional detailed descriptive information and links results within and between coronavirus disease 2019 trials.
Technique for Sutured Scleral Fixation of One-Piece Hydrophobic Acrylic Intraocular Lenses Dislocated Into the Vitreous
Authors: Czajka Marcin P. , Frajdenberg Agata , Johansson Björn
Published: November 2020

Purpose:

To present a suturing technique for safe refixation of posteriorly dislocated one-piece hydrophobic acrylic intraocular lenses (IOLs).

Method:

Retrospective data analysis of a series of 12 cases operated with vitrectomy, followed by IOL relocation to the retropupillary area, after which polypropylene sutures are passed through the optic–haptic junctions of the dislocated IOL and subsequently secured to the sclera.

Results:

In all cases, the IOL remained centered throughout the follow-up period (mean 10.5 months, range 3 weeks–36 months). One case was complicated by vitreous hemorrhage the first postoperative day and later cystoid macular edema. Visual acuity was not compromised at the end of follow-up.

Conclusion:

The presented technique is safe and provides long-term stable refixation in cases of late posterior dislocation of a one-piece hydrophobic acrylic IOL. The risk that sutures looped around haptics will slip off the haptic is thereby avoided.
Nurses and Medicolegal Death Investigation
Authors: Drake Stacy A. , Tabor Pamela , Hamilton Harriet , Cannon Annette
Published: November 2020

Forensic nurses currently serve in medicolegal death investigation settings nationwide, yet registered nurses seldom recognize death investigation as a career option. The purpose of this article is to describe medicolegal death investigation in the United States and the roles nurses can achieve, depending upon state and agency job requirements. Duties and qualifications for job positions, whether filled by election, appointment, or staff hiring, are described to provide examples of nurses’ roles within the medicolegal death investigation setting and to present career options. Forensic nurses have the educational preparation, medical skills, and forensic knowledge to serve within death investigation systems as a chief officer (e.g., coroner), deputy officer, or staff investigator.
Factors Associated With Burnout in Trauma Nurses
Authors: Higgins Jacob T. , Okoli Chizimuzo , Otachi Janet , Lawrence Jessica , Bryant Elizabeth D. , Lykins Amanda , Seng Sarret
Published: November 2020

Background

Burnout is a psychological syndrome resulting from repeated stressors experienced in the workplace that centers on emotional exhaustion, detachment from the job, and a sense of ineffectiveness. It has been previously demonstrated that burnout exists in the health care workforce, but there has been limited investigation of burnout in nurses who primarily provide care for patients who have been traumatically injured. The purpose of this study was to explore factors associated with burnout reported by trauma nurses.

Methods

This was a secondary analysis of a cross-sectional survey distributed at a large, academic Level I trauma center that serves both adult and pediatric patients. For this analysis, only the Burnout subscale of the Professional Quality of Life scale Version 5 (ProQOL) was used. Multivariate hierarchical regression was used to determine factors associated with burnout reported by trauma nurses.

Results

Protective factors included being female, being married, and better quality of sleep. Risk factors included having a mental health diagnosis and working with adult populations.

Conclusions

These results provide an important contribution to the burnout risk profile for trauma nurses and may provide insight into future investigations as well as development and testing of tailored interventions to mitigate burnout in trauma nurses.
Barriers and Facilitators to the Implementation of Injury Prevention Programs: A Qualitative Exploration and Model Development
Authors: Newcomb Anna B. , Zadnik Mary , Carlini Anthony R. , Francis Molly M. , Frey Katherine P. , Heins Sara E. , McNamara Leslie , Staguhn Elena D. , Castillo Renan C.
Published: November 2020

Background:

In 2006, the American College of Surgeons Committee on Trauma mandated implementation of injury prevention programs as a requirement for Level I and II trauma center designation. Little is known about the factors that facilitate or create barriers to establishing evidence-based injury prevention program implementation. The purpose of this research is to generate hypotheses regarding processes used to implement injury prevention programs at trauma centers, identify the factors that facilitate and serve as a barrier to implementation, and develop a model reflecting these factors and relationships.

Methods:

This is a qualitative study of injury prevention programs at trauma centers. Study participants were chosen from 24 sites representing trauma centers of different patient volumes, geographic regions, and settings in the United States. Subjects participated in phone interviews based on guides developed from pilot interviews with prevention coordinators. Transcribed interviews from eight subjects were analyzed using a system of member checking to code; analysis informed the identification of factors that influence the establishment of evidence-based injury prevention programs.

Results:

Five themes emerged from the data analysis: external factors, internal organizational factors, program capacity, program selection, and program success. Analysis revealed that successful program implementation was related to supportive leaders and collaborative, interdepartmental relationships. Additional themes indicated that while organizations were motivated primarily by verification requirements (external factor), strong institutional leadership (internal factor) was lacking. Employee readiness (program capacity) was hindered by limited training opportunities, and programs were often chosen (selection) based on implementation ease rather than evidence base or local data.

Conclusions:

Data analysis reveals five emerging themes of program implementation; using these data, we suggest an initial model of barriers and facilitators for implementing evidence-based injury prevention programs that could serve as the springboard for additional research involving a larger representative sample.
Biventricular Support Using ProtekDuo Cannula in a Child
Authors: Tan Christian , Mauchley David C. , Byrnes Jonathan W. , Carlo Waldemar F. , Law Mark A. , O’Meara L. Carlisle , Timpa Joseph G. , Pearce F. Bennett
Published: November 2020

We report a successful pediatric bridge to transplant following application of the ProTekDuo Cannula to provide right ventricular support in a 12-year-old child with biventricular cardiomyopathy and on left ventricular assist device support. We are unaware of any other reports of pediatric use of this device in the medical literature.
Nutrients to mitigate osteosarcopenia: the role of protein, vitamin D and calcium
Authors: Kirk Ben , Prokopidis Konstantinos , Duque Gustavo
Published: November 2020

Purpose of review

Osteosarcopenia (the joint loss of bone density and muscle mass and function) is an emerging geriatric syndrome, which associates with poor health outcomes. Several nutrients including protein, vitamin D and calcium interact (directly or through absorption properties) to regulate muscle and bone metabolism. We provided an update on the efficacy of these nutrients on musculoskeletal outcomes in older adults with, or at risk of, osteosarcopenia.

Recent findings

Randomized trials show that correcting vitamin D and calcium deficiencies to meet the recommended dietary allowance (RDA) increases bone density and reduces fracture (but not falls) risk. Supplementing above the RDA with protein supports gains in lean mass and lumbar-spine bone density; however, there is inconclusive evidence for muscle strength, physical function or other bone density sites. A likely explanation for this relates to the significant heterogeneity between trials regarding protein dose, type and timing, as well as baseline protein intake. Further high-quality trials are needed in older osteosarcopenic adults to investigate the effects of protein (while correcting vitamin D and calcium deficiencies) on clinically meaningful outcomes such as activities of daily living, falls and fractures.

An adequate intake of protein (1.2–1.5 g/kg/day), vitamin D (800 IU/day) and calcium (1000–1200 mg/day), is well tolerated and effective at mitigating some aspects of osteosarcopenia such as lean mass, bone density and fracture risk.
Diagnosis of primary immunodeficiencies in Peru
Authors: Aldave-Becerra Juan C. , Veramendi-Espinoza Liz E. , Rentería-Valdiviezo Claudia A.
Published: November 2020

Purpose of review

Primary immunodeficiencies (PIDs) are human inborn errors of immunity, leading to an increased susceptibility to infections, inflammatory manifestations, and malignancy. We estimate around 16 000 individuals with PIDs living in Peru who are still undiagnosed. The purpose of this review is to make a situational analysis of the diagnosis of PIDs in Peru.

Recent findings

There is an evident underdiagnosis of PIDs in Peru. Insufficient awareness and lack of diagnostic tools can be solved partially by expanding the number and expertise of Clinical Immunologists and specialized medical centers. The availability of molecular testing at reasonable costs is mandatory to improve the diagnostic approach to patients with suspected PID. The development of didactic and innovative educational tools has been a critical strategy to improve PID awareness and diagnosis in Peru.

Developing countries like Peru still have critical limitations to diagnose patients with PIDs such as insufficient awareness in physicians, lack of specialized reference centers, and unavailability of confirmatory genetic testing. Joint work between government, health professionals, patient organizations, and society is essential to overcome these limitations and provide a better future for patients with inborn errors of immunity.
Long-term Outcomes After Facial Allotransplantation: Systematic Review of the Literature
Authors: Tchiloemba Bianief , Kauke Martin , Haug Valentin , Abdulrazzak Obada , Safi Ali-Farid , Kollar Branislav , Pomahac Bohdan
Published: November 2020

Background.

Facial vascularized composite allotransplantation (fVCA) represents a reconstructive approach that enables superior improvements in functional and esthetic restoration compared with conventional craniomaxillofacial reconstruction. Outcome reports of fVCA are usually limited to short-term follow-up or single-center experiences. We merge scientific literature on reported long-term outcome data to better define the risks and benefits of fVCA.

Methods.

We conducted a systematic review of PubMed/MEDLINE databases in accordance with PRISMA guidelines. English full-text articles providing data on at least 1 unique fVCA patient, with ≥3 years follow-up, were included.

Results.

The search yielded 1812 articles, of which 28 were ultimately included. We retrieved data on 23 fVCA patients with mean follow-up of 5.3 years. More than half of the patients showed improved quality of life, eating, speech, and motor and sensory function following fVCA. On average, the patients had 1 acute cell-mediated rejection and infectious episode per year. The incidence rates of acute rejection and infectious complications were high within first-year posttransplant but declined thereafter. Sixty-five percent of the patients developed at least 1 neoplastic or metabolic complication after transplantation. Chronic vascular rejection was confirmed in 2 patients, leading to allograft loss after 8 and 9 years. Two patient deaths occurred 3.5 and 10.5 years after transplant due to suicide and lung cancer, respectively.

Conclusions.

Allograft functionality and improvements in quality of life suggest a positive risk-benefit ratio for fVCA. Recurrent acute rejection episodes, chronic rejection, immunosuppression-related complications, and heterogeneity in outcome reporting present ongoing challenges in this field.
Peripheral Vascular Disease and Kidney Transplant Outcomes: Rethinking an Important Ongoing Complication
Authors: Hernández Domingo , Vázquez Teresa , Armas-Padrón Ana María , Alonso-Titos Juana , Casas Cristina , Gutiérrez Elena , Jironda Cristina , Cabello Mercedes , López Verónica
Published: November 2020

Peripheral vascular disease (PVD) is highly prevalent in patients on the waiting list for kidney transplantation (KT) and after transplantation and is associated with impaired transplant outcomes. Multiple traditional and nontraditional risk factors, as well as uremia- and transplant-related factors, affect 2 processes that can coexist, atherosclerosis and arteriosclerosis, leading to PVD. Some pathogenic mechanisms, such as inflammation-related endothelial dysfunction, mineral metabolism disorders, lipid alterations, or diabetic status, may contribute to the development and progression of PVD. Early detection of PVD before and after KT, better understanding of the mechanisms of vascular damage, and application of suitable therapeutic approaches could all minimize the impact of PVD on transplant outcomes. This review focuses on the following issues: (1) definition, epidemiological data, diagnosis, risk factors, and pathogenic mechanisms in KT candidates and recipients; (2) adverse clinical consequences and outcomes; and (3) classical and new therapeutic approaches.
Angel in the House, Angel in the Scientific Empire: Women and Colonial Botany During the Eighteenth and Nineteenth Centuries
Authors: Hong Jiang
Published: November 2020

‘Angel in the house’ is an idealized icon of Victorian women, who unconditionally loved, supported and submitted to their husbands. Borrowing this metaphor, I discuss three kinds of angels in colonial botany, which was intrinsically patriarchal. The first consists of metropolitan women, who never travelled, but celebrated and consumed trophies of colonial botany in their domestic life in Europe, such as planting exotics in backyards, cooking foreign diets in kitchens, reading botanical and travel literature, collecting foreign specimens in cabinets and sponsoring naturalists. The second covers elegant botanical wives in colonies, accomplished in domestic responsibilities while engaging in botany as polite learning. The third is made up of voyaging botanical women, exempted from domestic responsibilities and completely devoted to botany. These angels often corresponded with elite botanists, botanized under their instruction and made contributions to botanical science. All three categories endorsed the agenda of imperialism and their study of botany was facilitated by its power.
Nanobiofertilization as a novel technology for highly efficient foliar application of Fe and B in almond trees
Authors: Rios J. J. , Yepes-Molina L. , Martinez-Alonso A. , Carvajal M.
Published: November 2020

Nanofertilization is postulated as a new technology to deal with the environmental problems caused by the intensive use of traditional fertilizers. One of the aims of this new technology is to improve foliar fertilization, which has many environmental advantages, but currently there are numerous factors that limit its efficiency. In this research, the objective was to study the potential of membrane vesicles derived from plant material as nanofertilizers of iron (Fe) and boron (B) for foliar application in almond trees
(Prunus dulcis
L.). The results show that the application of vesicles caused invaginations in the plasma membrane of the leaf cells. Also, the increase in leaf B and Fe was greater when these elements were applied in an encapsulated form rather than in a non-encapsulated form. The distribution of these elements in leaf tissues indicated the existence of an intracellular element transport pathway and accumulation areas, enabling greater element entry and mobility.
How surface stress transforms surface profiles and adhesion of rough elastic bodies
Authors: Hui Chung-Yuen , Liu Zezhou , Bain Nicolas , Jagota Anand , Dufresne Eric R. , Style Robert W. , Kiyama Ryuji , Gong Jian Ping
Published: November 2020

The surface of soft solids carries a surface stress that tends to flatten surface profiles. For example, surface features on a soft solid, fabricated by moulding against a stiff-patterned substrate, tend to flatten upon removal from the mould. In this work, we derive a transfer function in an explicit form that, given any initial surface profile, shows how to compute the shape of the corresponding flattened profile. We provide analytical results for several applications including flattening of one-dimensional and two-dimensional periodic structures, qualitative changes to the surface roughness spectrum, and how that strongly influences adhesion.
Delayed Leidenfrost phenomenon during impact of elastic fluid droplets
Authors: Dhar Purbarun , Mishra Soumya Ranjan , Gairola Ajay , Samanta Devranjan
Published: November 2020

This article highlights the role of non-Newtonian (elastic) effects on the droplet impact phenomenon at temperatures considerably higher than the boiling point, especially at or above the Leidenfrost regime. The Leidenfrost point (LFP) was found to decrease with an increase in the impact Weber number (based on the velocity just before the impact) for fixed polymer (polyacrylamide) concentrations. Water droplets fragmented at very low Weber numbers (approx. 22), whereas the polymer droplets resisted fragmentation at much higher Weber numbers (approx. 155). We also varied the polymer concentration and observed that, up to 1000 ppm, the LFP was higher than that for water. This signifies that the effect can be delayed by the use of elastic fluids. We have shown the possible role of elastic effects (manifested by the formation of long lasting filaments) during retraction in the increase of the LFP. However, for 1500 ppm, the LFP was lower than that for water, but had a similar residence time during the initial impact. In addition, we studied the role of the Weber number and viscoelastic effects on the rebound behaviour at 405°C. We observed that the critical Weber number up to the point at which the droplet resisted fragmentation at 405°C increased with the polymer concentration. In addition, for a fixed Weber number, the droplet rebound height and the hovering time period increased up to 500 ppm, and then decreased. Similarly, for fixed polymer concentrations like 1000 and 1500 ppm, the rebound height showed an increasing trend up to certain a certain Weber number and then decreased. This non-monotonic behaviour of rebound heights was attributed to the observed diversion of the rebound kinetic energy to rotational energy during the hovering phase. Finally, a relationship between the non-dimensional Leidenfrost temperature and the associated Weber and Weissenberg numbers is developed, and a scaling relation is proposed.
Individual variability and versatility in an eco-evolutionary model of avian migration
Authors: Delmore Kira E. , Van Doren Benjamin M. , Conway Greg J. , Curk Teja , Garrido-Garduño Tania , Germain Ryan R. , Hasselmann Timo , Hiemer Dieter , van der Jeugd Henk P. , Justen Hannah , Lugo Ramos Juan Sebastian , Maggini Ivan , Meyer Britta S. , Phillips Robbie J. , Remisiewicz Magdalena , Roberts Graham C. M. , Sheldon Ben C. , Vogl Wolfgang , Liedvogel Miriam
Published: November 2020

Seasonal migration is a complex and variable behaviour with the potential to promote reproductive isolation. In Eurasian blackcaps (Sylvia atricapilla), a migratory divide in central Europe separating populations with southwest (SW) and southeast (SE) autumn routes may facilitate isolation, and individuals using new wintering areas in Britain show divergence from Mediterranean winterers. We tracked 100 blackcaps in the wild to characterize these strategies. Blackcaps to the west and east of the divide used predominantly SW and SE directions, respectively, but close to the contact zone many individuals took intermediate (S) routes. At 14.0° E, we documented a sharp transition from SW to SE migratory directions across only 27 (10–86) km, implying a strong selection gradient across the divide. Blackcaps wintering in Britain took northwesterly migration routes from continental European breeding grounds. They originated from a surprisingly extensive area, spanning 2000 km of the breeding range. British winterers bred in sympatry with SW-bound migrants but arrived 9.8 days earlier on the breeding grounds, suggesting some potential for assortative mating by timing. Overall, our data reveal complex variation in songbird migration and suggest that selection can maintain variation in migration direction across short distances while enabling the spread of a novel strategy across a wide range.
New Caledonian crows plan for specific future tool use
Authors: Boeckle M. , Schiestl M. , Frohnwieser A. , Gruber R. , Miller R. , Suddendorf T. , Gray R. D. , Taylor A. H. , Clayton N. S.
Published: November 2020

The ability to plan for future events is one of the defining features of human intelligence. Whether non-human animals can plan for specific future situations remains contentious: despite a sustained research effort over the last two decades, there is still no consensus on this question. Here, we show that New Caledonian crows can use tools to plan for specific future events. Crows learned a temporal sequence where they were (a) shown a baited apparatus, (b) 5 min later given a choice of five objects and (c) 10 min later given access to the apparatus. At test, these crows were presented with one of two tool–apparatus combinations. For each combination, the crows chose the right tool for the right future task, while ignoring previously useful tools and a low-value food item. This study establishes that planning for specific future tool use can evolve via convergent evolution, given that corvids and humans shared a common ancestor over 300 million years ago, and offers a route to mapping the planning capacities of animals.