bluuebunny/crossref_metadata_2025 huggingface dataset:
Associations between objective afternoon and evening physical activity and objective sleep in patients with fibromyalgia and insomnia
Authors: McGovney Kevin D. , Curtis Ashley F. , McCrae Christina S.
Published: October 2020

Patients with fibromyalgia (FM) suffer from chronic pain, which limits physical activity and is associated with disturbed sleep. However, the relationship between physical activity, pain and sleep is unclear in these patients. This study examined whether actigraphic (Actiwatch‐2, Philips Respironics) afternoon and evening activity and pain are associated with actigraphic sleep. Adults with FM and insomnia complaints (n = 160, mean age [Mage] = 52, SD = 12, 94% female) completed 14 days of actigraphy. Activity levels (i.e., activity counts per minute) were recorded, and average afternoon/evening activity for intervals 12:00–3:00 PM, 3:00–6:00 PM and 6:00–9:00 PM was computed. Multiple linear regressions examined whether afternoon/evening activity, pain (daily evening diaries from 0 [no pain sensation] to 100 [most intense pain imaginable]), or their interaction, predicted sleep onset latency (SOL), wake time after sleep onset (WASO), total sleep time (TST) and sleep efficiency (SE). Greater afternoon activity was independently associated with lower SE (B = −0.08, p < .001), lower TST (β = −0.36, standard error [SE] = 0.06, p < .001) and longer WASO (B = 0.34, p < .001). Greater early evening activity was independently associated with lower SE (B = −0.06, p < .001), lower TST (β = −0.26, SE = 0.06, p < .001) and longer WASO (B = 0.23, p < .001). Self‐reported pain intensity interacted with afternoon and early evening physical activity, such that associations between higher activity and lower SE were stronger for individuals reporting higher pain. Late evening activity was not associated with sleep outcomes. Results suggest that in FM, increased afternoon and early evening physical activity is associated with sleep disturbance, and this relationship is stronger in individuals with higher pain.
Hemorrhage and complications associated with percutaneous ultrasound guided liver biopsy in dogs
Authors: Reece Jonjo , Pavlick Michelle , Penninck Dominique G. , Webster Cynthia R. L.
Published: October 2020

Background

Liver biopsy is often necessary to obtain a diagnosis in dogs with hepatobiliary disease. Hemorrhage after biopsy is a concern.

Objective

To describe the extent of hemorrhage and incidence of complications after percutaneous ultrasound guided liver biopsy (PUGLB) in dogs and to examine risk factors for hemorrhage or complications.

Animals

One hundred two client owned dogs with suspected hepatobiliary disease that underwent PUGLB.

Methods

Medical records were retrospectively reviewed. Using human guidelines, major hemorrhage was defined as an absolute decrease in the PCV (ΔPCV)≥6%. Complications were defined separately as clinically relevant physiologic compromise that necessitated intervention or death. The relationship between ΔPCV and the occurrence of complications and the initial PCV, coagulation variables, serum activity of liver‐derived enzymes, serum bilirubin concentration, number of biopsies, biopsy needle gauge, radiologist experience, histological diagnosis, and ultrasound variables were compared.

Results

Before PUGLB, most aberrations in coagulation variables were mild. After biopsy a decrease in PCV occurred in 87/102 (85.3%) dogs. The mean ΔPCV was −7.2% ± 4.5%. Major hemorrhage occurred in 43/102 (42.2%) dogs and complications in 2/102 (1.9%). ΔPCV was significantly positively correlated with PCV before biopsy (r= .47,P= .004). There was no correlation between ΔPCV or complications with any of the variables examined.

Conclusion and Clinical Importance

Percutaneous ultrasound guided liver biopsy in the population of dogs in the current study, with normal or mild abnormalities in coagulation, results in a high incidence of clinically silent, major hemorrhage (42.5%), but few complications (1.9%).
Prediction and measurement of diuretic responsiveness after oral administration of furosemide to healthy dogs and dogs with congestive heart failure
Authors: Loughran Kerry A. , Larouche‐Lebel Éva , Huh Terry , Testani Jeffrey M. , Rao Veena S. , Oyama Mark A.
Published: October 2020

Background

In human patients, cumulative urine volume (uVol) and urine sodium (uNa) can be predicted using spot urine samples and these quantitative measures help detect low diuretic responsiveness (LDR).

Hypothesis/objectives

Formulas using spot urine samples predict cumulative uVol and uNa output after oral administration of furosemide to dogs.

Animals

Eight healthy dogs, 6 dogs with congestive heart failure (CHF).

Methods

Prospective interventional study. Spot urine samples at 180 and 270 minutes after furosemide (3 mg/kg PO) were used to predict cumulative uVol and uNa output over 7 hours. Differentiation of dogs fulfilling predefined criteria for LDR was examined using receiver operating characteristic (ROC) curves.

Results

Predicted uNa output at 180 minutes (rs= 0.763, [95% confidence interval [CI], 0.375‐0.923],P= .002) and 270 minutes (r= 0.816, [95% CI, 0.503‐0.940],P< .001) was highly correlated to 7‐hour uNa output. Predicted uVol at 180 minutes (r= 0.598, [95% CI, 0.098‐0.857],P= .02) and 270 minutes (r= 0.791, [95% CI, 0.450‐0.931],P< .001) was moderately correlated to 7‐hour uVol. Predicted uNa using 180‐minute (area under the curve [AUC], 0.933 [95% CI, 0.804‐1.000]) and 270‐minute (AUC, 0.911 [95% CI, 0.756‐1.000]) samples identified dogs with LDR (n = 5) with high accuracy.

Conclusions and Clinical Importance

Urinary Na excretion and uVol are complementary but distinct aspects of diuretic responsiveness in dogs. Quantification of diuretic responsiveness in the clinical setting opens new diagnostic, treatment, and monitoring strategies.
Rainbow's end: The structure, character, and content of conscious experience
Authors: Ashby Brandon
Published: October 2020

Separatism, representationalism, and phenomenal intentionalism are the primary views on the relationship between the phenomenality and intentionality of experience. I defend a novel position that is incompatible with separatism, can enrich representationalism and phenomenal intentionalism, but can also be accepted independently of those views. I call itphenomenal schematics: The phenomenal characters of our experiences have structures that place a priori, formal, and sometimes semantic constraints on our experience's possible intentional contents. Phenomenal structures are like the grammar of a language (or the compositional rules governing maps, models, and diagrams). Unlike words, however, phenomenal characters possess their “grammatical properties” essentially.
Validation of the Finnish Person‐Centered care Climate Questionnaire‐Patient and testing the relationship with individualised care
Authors: Stolt Minna , Koskenvuori Janika , Edvardsson David , Katajisto Jouko , Suhonen Riitta
Published: October 2020

Aims

The aim of the study was two‐fold: (1) to test the psychometric properties of the Person‐Centered care Climate Questionnaire‐Patient‐Finnish version (PCQ‐P‐Fin), and (2) to examine the associations between older patients’ perceptions of the PCC climate and their perceptions of individuality in care delivered within acute care settings for older people.

Design

An exploratory, correlational, cross‐sectional survey design.

Methods

The study was conducted within acute care settings for older people with heart failure (n = 111, response rate 54%). Data were collected with self‐completed questionnaires, the Person‐Centered care Climate Questionnaire‐Patient version (PCQ‐P‐Fin) and the Individualized Care Scale‐Patient (ICS‐Patient‐B), between 6/2016 and 5/2017. Data were analysed using descriptive statistics, Pearson's correlation coefficients, exploratory factor analysis and a Rasch analysis.

Results

The PCQ‐P‐Fin showed satisfactory structural, construct and concurrent validity and high reliability. The ICS‐B‐Patient and the PCQ‐P‐Fin correlated strongly positive suggesting an association between the perceptions of individuality in care and the care climate.

Conclusion

The PCQ‐P‐Fin is a useful, reliable and valid tool. Characteristics of the care environment, especially the climate and the extent to which this is perceived to be person‐centred, may be used to enhance perceptions of individualised care.
Learning to see the wood for the trees: machine learning, decision trees, and the classification of isolated theropod teeth
Authors: Wills Simon , Underwood Charlie J. , Barrett Paul M.
Published: October 2020

Taxonomic identification of fossils based on morphometric data traditionally relies on the use of standard linear models to classify such data. Machine learning and decision trees offer powerful alternative approaches to this problem but are not widely used in palaeontology. Here, we apply these techniques to published morphometric data of isolated theropod teeth in order to explore their utility in tackling taxonomic problems. We chose two published datasets consisting of 886 teeth from 14 taxa and 3020 teeth from 17 taxa, respectively, each with five morphometric variables per tooth. We also explored the effects that missing data have on the final classification accuracy. Our results suggest that machine learning and decision trees yield superior classification results over a wide range of data permutations, with decision trees achieving accuracies of 96% in classifying test data in some cases. Missing data or attempts to generate synthetic data to overcome missing data seriously degrade all classifiers predictive accuracy. The results of our analyses also indicate that using ensemble classifiers combining different classification techniques and the examination of posterior probabilities is a useful aid in checking final class assignments. The application of such techniques to isolated theropod teeth demonstrate that simple morphometric data can be used to yield statistically robust taxonomic classifications and that lower classification accuracy is more likely to reflect preservational limitations of the data or poor application of the methods.
What are the career implications of “seeing eye to eye”? Examining the role of leader–member exchange (LMX) agreement on employability and career outcomes
Authors: Epitropaki Olga , Marstand Anders Friis , Van der Heijden Beatrice , Bozionelos Nikos , Mylonopoulos Nikolaos , Van der Heijde Claudia , Scholarios Dora , Mikkelsen Aslaug , Marzec Izabela , Jędrzejowicz Piotr ,   The Indicator Group
Published: October 2020

Are there career benefits to leaders and followers agreeing about the quality of their leader–member exchange (LMX) relationship? Is LMX disagreement always detrimental for a follower's career? Can the examination of LMX agreement as a substantive variable help us cast new light on some of the inconclusive findings of past research on LMX and career outcomes? These questions motivate our research. Using theories of social exchange and sponsorship, and responses from 967 leader–follower dyads of Information and Communication Technology (ICT) professionals in seven European countries, we examined the role of LMX agreement on subjective and objective career outcomes. After conducting polynomial regression combined with response surface analysis, we found that both follower‐rated and leader‐rated employability were higher when the leader agreed with the follower at a high level of LMX (vs. a low level of LMX). In case of disagreement, strong support was found for leader‐rated employability being higher when the leader's perceptions of LMX exceeded those of their follower. Furthermore, follower‐rated employability was found to mediate the relationship between LMX (dis)agreement and perceived career success, promotions, salary, and bonuses. Support was also found for the mediating role of leader‐rated employability in the case of perceived career success, promotions, and salary but not for bonuses. Our findings highlight the importance of LMX (dis)agreement for career outcomes and further point to the possibility of employability offering an alternative explanation for the mixed findings of past LMX–career research.
The role of basophils in acquired protective immunity to tick infestation
Authors: Yoshikawa Soichiro , Miyake Kensuke , Kamiya Atsunori , Karasuyama Hajime
Published: October 2020

Ticks are blood‐feeding ectoparasites that transmit a variety of pathogens to host animals and humans, causing severe infectious diseases such as Lyme disease. In a certain combination of animal and tick species, tick infestation elicits acquired immunity against ticks in the host, which can reduce the ability of ticks to feed on blood and to transmit pathogens in the following tick infestations. Therefore, our understanding of the cellular and molecular mechanisms of acquired tick resistance (ATR) can advance the development of anti‐tick vaccines to prevent tick infestation and tick‐borne diseases. Basophils are a minor population of white blood cells circulating in the bloodstream and are rarely observed in peripheral tissues under steady‐state conditions. Basophils have been reported to accumulate at tick‐feeding sites during re‐infestation in cattle, rabbits, guinea pigs and mice. Selective ablation of basophils resulted in a loss of ATR in guinea pigs and mice, illuminating the essential role of basophils in the manifestation of ATR. In this review, we discuss the recent advance in the elucidation of the cellular and molecular mechanisms underlying basophil recruitment to the tick‐feeding site and basophil‐mediated ATR.
Sedentary behaviour and physical activity across pregnancy and birth outcomes
Authors: Jones Melissa A. , Catov Janet M. , Jeyabalan Arun , Whitaker Kara M. , Barone Gibbs Bethany
Published: October 2020

Background

Shorter gestation or smaller birth size are indicators of a suboptimal fetal environment and negatively impact short‐ and long‐term offspring health. Understanding how modifiable maternal behaviours, such as moderate‐to‐vigorous intensity physical activity (MVPA) or sedentary behaviour (SED), improve fetal outcomes could inform strategies to improve health across the lifespan.

Objectives

The objective of this study was to examine the association of MVPA and SED across pregnancy trimesters on gestational age at delivery and newborn anthropometrics.

Methods

The MoM Health Study measured SED (thigh‐mounted activPAL3 micro) and MVPA (waist‐worn Actigraph GTX3) in each trimester of pregnancy. Birth outcomes (gestational age at delivery, birthweight, birth length, and head circumference) were abstracted from medical records and used to calculate ponderal index (grams*100/cm3) and size‐for‐gestational age percentiles. Associations of group‐based trajectories and trimester‐specific SED and MVPA with birth outcomes were analysed using regression models.

Results

Low, medium, and high trajectory groups were generated SED and MVPA in 103 and 99 pregnant women, respectively. High vs low SED trajectory was associated with earlier gestational age at delivery (β −1.03 weeks, 95% CI −2.01, −0.06), larger head circumference (β 0.83 cm, 95% CI 0.24, 1.63), longer birth length (β 1.37 cm, 95% CI 0.09, 2.64), and lower ponderal index (β −0.24 g*100/cm3, 95% CI −0.42, −0.06), after adjustment for demographics, pre‐pregnancy BMI, and (for newborn anthropometric outcomes) gestational age. The association of high SED with lower ponderal index was the most robust across progressively adjusted models (β −0.25 g*100/cm3, 95% CI −0.44, −0.07). SED trajectory was not associated with birthweight or size‐for‐gestational age. High vs low MVPA trajectory was only associated with smaller head circumference (β −0.86 cm, 95% CI −1.70, −0.02).

Conclusions

Higher SED during pregnancy may result in shorter gestation and inhibited fetal growth. Further research evaluating the effect of reducing SED during pregnancy on birth outcomes is warranted.
The effect of US stress tests on monetary policy spillovers to emerging markets
Authors: Niepmann Friederike , Schmidt‐Eisenlohr Tim , Liu Emily
Published: October 2020

This paper explores the transmission of US monetary policy through US banks to emerging market economies (EMEs) and the role that stress tests play in this transmission. Data on US banks’ monthly commercial and industrial loan originations shows that: (a) US bank lending to EMEs was sensitive to domestic monetary policy changes during the zero‐lower bound period. (b) Effects of monetary easing were heterogeneous across banks and depended on banks’ stress test results, a proxy for their capital strength. Only banks that comfortably passed the stress tests issued more loans to EME borrowers. (c) Effects of monetary tightening were more similar across banks. (d) Banks shifted their lending to safer borrowers within EMEs in response to monetary easing, leaving the risk of their overall loan books unchanged. These results support the hypothesis that bank capital affects the transmission of easier monetary policy, including across borders. We conjecture that bank lending to EMEs during the zero‐lower bound period would have been even higher had the United States not introduced stress tests for their banks.
Impaired recovery is associated with increased injury and illness: A retrospective study of 536 female netball athletes
Authors: Horgan Barry G. , Drew Michael K. , Halson Shona L. , Piromalli Laura E. , Drinkwater Eric J. , Chapman Dale W. , Haff G. Gregory
Published: October 2020

Sport science and medicine practitioners are interested in the relationships between training load, injury, and illness. The extent to which training preparedness is associated with workload‐related injury and illness risk is debated. Therefore, this study applied multi‐level mixed effect logistic regression to investigate time‐dependent (±7‐ and ±28‐day) relationships between training preparedness (fatigue, mood, motivation, soreness, stress, sleep duration, and quality), training load, injury, and illness in 536 elite and pre‐elite female netball athletes. Absolute risk (AR ± 95% CI) of sustaining an injury (0.98 ± 0.06%, n = 1122 injuries, N = 254 athletes) or illness (1.09 ± 0.10%, n = 2881, N = 432 athletes) was calculated. All training preparedness variables combined resulted in an absolute risk of 0.88%‐5.88% and 0.87%‐20% for injury and illness, respectively. Injury and illness had significant (P < .05) bidirectional (ie, both increased and decreased) associations with physical (soreness) and physiological (sleep duration and quality), while illness also had negative (mood, motivation) and positive (stress) associations with psychological training preparedness variables. Low sleep duration in the 48‐h period prior was associated (P = .005) with increased injury risk (OR = 0.91 ± 0.03; AR = 4.00%), while “very poor” sleep quality (OR = 0.59 ± 0.02; AR = 7.83%) or extremes of too little (<5 hours, OR = 1.01 ± 0.03; AR = 3.13%‐14.29%) and too much (>10 hours, OR = 1.01 ± 0.03; AR = 2.61%‐10.98%) sleep had bidirectional associations (P < .001) with an increased illness risk. Changes in training preparedness variables demonstrated bidirectional associations with injury and illness. These outcomes suggest that sport science and medicine practitioners should monitor sleep, physical, and psychological recovery status, to aid early detection and intervention regarding injury and illness symptomology.
Two novel HLA‐DRB1 alleles detected in inhabitants from the island of Crete
Authors: Mavroudi Irene , Latsoudis Helen , Zamanakou Maria , Kanterakis Alexandros , Papadaki Helen A.
Published: October 2020

Characterization of the novel HLA‐DRB1*04:311 and HLA‐DRB1*11:277 alleles in two Greek individuals of Cretan origin.
Agromonas: a rapid disease assay for Pseudomonas syringae growth in agroinfiltrated leaves
Authors: Buscaill Pierre , Sanguankiattichai Nattapong , Lee Yoon Joo , Kourelis Jiorgos , Preston Gail , van der Hoorn Renier A. L.
Published: October 2020

The lengthy process to generate transformed plants is a limitation in current research on the interactions of the model plant pathogen Pseudomonas syringae with plant hosts. Here we present an easy method called agromonas, where we quantify P. syringae growth in agroinfiltrated leaves of Nicotiana benthamiana using a cocktail of antibiotics to select P. syringae on plates. As a proof of concept, we demonstrate that transient expression of PAMP receptors reduces bacterial growth, and that transient depletion of a host immune gene and transient expression of a type‐III effector increase P. syringae growth in agromonas assays. We show that we can rapidly achieve structure−function analysis of immune components and test the function of immune hydrolases. The agromonas method is easy, fast and robust for routine disease assays with various Pseudomonas strains without transforming plants or bacteria. The agromonas assay offers a reliable approach for further comprehensive analysis of plant immunity.
Manipulation System for Measuring Heat Flux in Radioactive Melt
Authors: Knedlík Michal , Rot David , Hrbek Jan
Published: October 2020

This article is focused on introducing of the manipulation system, which is used to insert equipment or measuring probes into the chamber of a cold crucible during experimental induction skull melting. The measuring probe could be, e.g., calorimeter for measuring heat flux from a melt, which is created in the cold crucible by electromagnetic induction. The first part describes the technical parameters of the manipulator and the possibilities of manipulator controlling. The manipulation system is controlled by the algorithm implemented in the programmable logic controller CompactRIO or by mechanical controller called manual pulse generator, which is independent of the programmable logic controller. Different control methods increase the safety of the system. The next part contents basic information about the control algorithm based on LabVIEW software and the user interface of the touch screen. The article also deals with testing the manipulator, which was used in an experiment simulating corium behavior under conditions of the severe accident of a nuclear power plant. The last part describes simulations of electromagnetic field and temperature field in the chamber of the cold crucible, which were confirmed with real measuring. The goal of the simulations was to determine the effect on the manipulation system and calculation of Joule's losses in the calorimeter before immersion into the melt. The most significant heat transfer to the calorimeter was the radiation from a melt, which was also calculated.
Septal GABAergic inputs to CA1 govern contextual memory retrieval
Authors: Sans-Dublanc Arnau , Razzauti Adrià , Desikan Srinidhi , Pascual Marta , Monyer Hannah , Sindreu Carlos
Published: October 2020

Septal GABAergic projections to CA1 interneurons support the recall of a past memory evoked by experience.
Cross-talk between CDK4/6 and SMYD2 regulates gene transcription, tubulin methylation, and ciliogenesis
Authors: Li Linda Xiaoyan , Zhou Julie Xia , Wang Xiaodong , Zhang Hongbing , Harris Peter C. , Calvet James P. , Li Xiaogang
Published: October 2020

CDK4 and CDK6 regulate ciliogenesis and Hedgehog signaling via their novel substrate SMYD2.
An Early Cretaceous subduction-modified mantle underneath the ultraslow spreading Gakkel Ridge, Arctic Ocean
Authors: Richter Marianne , Nebel Oliver , Maas Roland , Mather Ben , Nebel-Jacobsen Yona , Capitanio Fabio A. , Dick Henry J. B. , Cawood Peter A.
Published: October 2020

Ocean floor lavas from an active spreading ridge keep a geochemical memory of an Early Cretaceous subduction zone.
ACSL3–PAI-1 signaling axis mediates tumor-stroma cross-talk promoting pancreatic cancer progression
Authors: Rossi Sebastiano Matteo , Pozzato Chiara , Saliakoura Maria , Yang Zhang , Peng Ren-Wang , Galiè Mirco , Oberson Kevin , Simon Hans-Uwe , Karamitopoulou Evanthia , Konstantinidou Georgia
Published: October 2020

Pharmacological inhibition of PAI-1 strongly enhances chemo- and immunotherapeutic response against PDAC.
Structural basis of trehalose recycling by the ABC transporter LpqY-SugABC
Authors: Liu Fengjiang , Liang Jingxi , Zhang Bing , Gao Yan , Yang Xiuna , Hu Tianyu , Yang Haitao , Xu Wenqing , Guddat Luke W. , Rao Zihe
Published: October 2020

Four cryo-EM structures of LpqY-SugABC complex reveal the mechanism of trehalose transport across the membrane to cytoplasm.
ERK phosphorylates chromosomal axis component HORMA domain protein HTP-1 to regulate oocyte numbers
Authors: Das Debabrata , Chen Shin-Yu , Arur Swathi
Published: October 2020

ERK phosphorylates meiosis component HTP-1 to regulate oocyte numbers.
The United States’ contribution of plastic waste to land and ocean
Authors: Law Kara Lavender , Starr Natalie , Siegler Theodore R. , Jambeck Jenna R. , Mallos Nicholas J. , Leonard George H.
Published: October 2020

Plastic waste from the United States contaminates the environment domestically and in countries processing material for recycling.
Pharmacometric Analysis of Tribendimidine Monotherapy and Combination Therapies To Achieve High Cure Rates in Patients with Hookworm Infections
Authors: Brussee Janneke M. , Neodo Anna , Schulz Jessica D. , Coulibaly Jean T. , Pfister Marc , Keiser Jennifer
Published: October 2020

In the treatment of hookworm infections, pharmacotherapy has been only moderately successful and drug resistance is a threat. Therefore, novel treatment options including combination therapies should be considered, in which tribendimidine could play a role. Our aims were to (i) characterize the pharmacokinetics of tribendimidine’s metabolites in adolescents receiving tribendimidine monotherapy or in combination with ivermectin or oxantel pamoate, (ii) evaluate possible drug-drug interactions (DDI), (iii) link exposure to response, and (iv) identify a treatment strategy associated with high efficacy, i.
Repurposing Nucleoside Analogs for Human Coronaviruses
Authors: Zandi Keivan , Amblard Franck , Musall Katie , Downs-Bowen Jessica , Kleinbard Ruby , Oo Adrian , Cao Dongdong , Liang Bo , Russell Olivia O. , McBrayer Tamara , Bassit Leda , Kim Baek , Schinazi Raymond F.
Published: October 2020

Coronavirus disease 2019 (COVID-19) is a serious illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or CoV-2). Some reports claimed certain nucleoside analogs to be active against CoV-2 and thus needed confirmation. Here, we evaluated a panel of compounds and identified novel nucleoside analogs with antiviral activity against CoV-2 and HCoV-OC43 while ruling out others. Of significance, sofosbuvir demonstrated no antiviral effect against CoV-2, and its triphosphate did not inhibit CoV-2 RNA polymerase.
SHERLOCK and DETECTR: CRISPR-Cas Systems as Potential Rapid Diagnostic Tools for Emerging Infectious Diseases
Authors: Mustafa Mujahed I. , Makhawi Abdelrafie M.
Published: October 2020

Infectious diseases are one of the most intimidating threats to human race, responsible for an immense burden of disabilities and deaths. Rapid diagnosis and treatment of infectious diseases offers a better understanding of their pathogenesis. According to the World Health Organization, the ideal approach for detecting foreign pathogens should be rapid, specific, sensitive, instrument-free, and cost-effective. Nucleic acid pathogen detection methods, typically PCR, have numerous limitations, such as highly sophisticated equipment requirements, reagents, and trained personnel relying on well-established laboratories, besides being time-consuming.
Validation of Swab Sampling and SYBR Green-Based Real-Time PCR for the Diagnosis of Cutaneous Leishmaniasis in French Guiana
Authors: Blaizot Romain , Simon Stéphane , Ginouves Marine , Prévot Ghislaine , Blanchet Denis , Ravel Christophe , Couppie Pierre , Demar Magalie , Nabet Cécile
Published: October 2020

Recent studies have highlighted the interest in noninvasive sampling procedures coupled with real-time PCR methods for the detection of
Leishmania
species in South America. In French Guiana, the sampling method still relied on skin biopsies. Noninvasive protocols should be tested on a large annual cohort to improve routine laboratory diagnosis of cutaneous leishmaniasis. Therefore, we evaluated the performance of a new
Leishmania
detection and species identification protocol involving cotton swabs and SYBR green-based real-time PCR of the Hsp70 gene, coupled with Sanger sequencing.
Twin girls with hypophosphataemic rickets and papilloedema
Authors: Migliarino Vanessa , Magnolato Andrea , Barbi Egidio
Published: October 2020

A 7 year-old twin girl with hypophosphataemic rickets was evaluated for a recent onset of mild strabismus.

She was a homozygous twin sister with hypophosphataemic rickets diagnosed at the age of 2 years, with a mutation in intron 21 of the PHEX gene, which was also present in her sister.

The girls’ clinical histories were remarkable for an important lower limb varus that progressively improved after starting phosphate supplementation with a galenical solution (Joulies solution 1 mmol phosphate/ml) and vitamin D 1,25 OH.

During the examinations, both girls were in good general condition. Physical examinations were unremarkable, except for tibial varus, bilateral fifth finger clinodactyly and bilateral syndactyly of the third and fourth foot fingers. No major head shape abnormalities were noticeable except for a high forehead.

One patient presented with a slight strabismus, normal isochoric isocyclic and reactive pupils, no signs of cranial nerve deficit, and no alterations in the rest of the neurological examination. An ophthalmological evaluation showed bilateral papilloedema. A cerebral MRI scan was then performed, suspecting elevated intracranial pressure (figure 1). The same examination was performed on the asymptomatic sister which also demonstrated papilloedema with similar findings on cranial MRI too.

Figure 1

Sagittal MR T1-weighted imaging shows a 12 mm cerebellar tonsillar herniation (shown by the white arrow) and bulb-medullary junction herniation. The apex of the epistropheus tooth almost reaches the occipital clivus (shown by the white line) and imprints the bulb.

Questions

Which is the most likely diagnosis?

Craniosynostosis

Pseudotumor cerebri

Drusen

Arnold-Chiari malformation

How should these patients be managed?

Acetazolamide treatment

Third to fourth ventricle cystostomy

Wait and see with periodical visual evoked potential follow-up

Neurosurgery

How should patients with X linked hypophosphataemic rickets (XLH rickets) be managed for the risk of craniosynostosis?

Monitor cephalic anthropometric measures

Perform a MRI scan if clinical signs of craiosynostosis or intracranial hypertension are present

Perform a skull X-ray every 2 years

Perform an MRI scan every 2 years

Answers can be found on page 02.
Observational study of parental opinion of deferred consent for neonatal research
Authors: Sloss Samantha , Dawson Jennifer Anne , McGrory Lorraine , Rafferty Anthony Richard , Davis Peter G , Owen Louise S
Published: October 2020

Objective

To evaluate the opinions of parents of newborns following their infant’s enrolment into a neonatal research study through the process of deferred consent.

Design

Mixed-methods, observational study, interviewing 100 parents recently approached for deferred consent.

Setting

Tertiary-level neonatal intensive care unit, Melbourne, Australia.

Results

All 100 parents interviewed had consented to the study/studies using deferred consent; 62% had also experienced a prospective neonatal consent process. Eighty-nine per cent were ‘satisfied’ with the deferred consent process. The most common reason given for consenting was ‘to help future babies’. Negative comments regarding deferred consent mostly related to the timing of the consent approach, and some related to a perceived loss of parental rights. A deferred approach was preferred by 51%, 24% preferred a prospective approach and 25% were unsure. Those who thought prospective consent would not have been preferable cited impaired decision-making, inappropriate timing of an approach before birth and their preference for removal of the decision-making burden via deferred consent. Seventy-seven per cent thought they would have given the same response if approached prospectively; those who would have declined reported that a prospective approach under stressful conditions was unwelcome and too overwhelming.

Conclusion

In our sample, 89% of parents of infants enrolled in neonatal research using deferred consent considered it acceptable and half would not have preferred prospective consent. The ability to make a more considered decision under less stressful circumstances was key to the acceptability of deferred consent.
Non-compressive myelopathy: an unusual presentation of a patient with acute B lymphoblastic leukaemia
Authors: Shukla Avaneesh , Verma Shailendra Prasad , Verma Durga Prasad , Yadav Geeta
Published: October 2020

A 21-year-old woman was admitted to the department of haematology with fever, generalised body ache and swelling of the feet. She also presented with band-like tightness over the abdomen and was unable to walk for the last 2 days. There was no history of trauma. She was diagnosed as a case of B-cell acute lymphoblastic leukaemia based on flow cytometry and bone marrow studies. MRI of the thoracolumbar spine revealed signal intensity alteration in the spinal cord from D1−2 to D5−6. Her serum vitamin B12and folate levels were normal. Autoimmune workup including antinuclear antibody and viral serology, and reverse transcriptase PCR for herpes simplex virus, Epstein-Barr virus and cytomegalovirus were negative. Her cerebrospinal fluid was negative for malignant cells. She was started on Berlin-Frankfurt-Munster 95 protocol and her condition improved along with partial improvement in the power of her limbs at the time of discharge. The neurological diagnosis of non-compressive myelopathy due to myelitis was considered.
Recurrent bilateral breast abscess due toMycobacterium abscessusin an immune-competent woman
Authors: Bala Kiran , Kumari Sanjana , Guleria Randeep , Singh Urvashi
Published: October 2020

Mycobacterium abscessusis a rapidly growing, non-tubercular mycobacteria, often associated with skin and soft tissue infections. We report a case of 57-year-old immune-competent woman who suffered recurrent bilateral breast infection for 6 years. She did not benefit from repeated surgical interventions and multiple courses of antibiotics, and one course of empirical antitubercular therapy. Chronicity of the presentation and non-response to varied treatment interventions prompted further microbiological investigations. The patient was diagnosed withM. abscessusand treated with rifabutin, clarithromycin daily for 6 months and injection amikacin for 1 month. Amikacin was replaced with oral levofloxacin due to bilateral sensory-neural hearing loss for higher frequencies after 6 months. Suspicion and identification of NTM are important as the treatment involves long-term combination antibacterial therapy along with surgical debridement for extensive infection or when implants are involved.
Abdominal apoplexy during pregnancy
Authors: Kumari Jasmeet , Harkin Rosemary
Published: October 2020

We report a case of idiopathic spontaneous intraperitoneal haemorrhage (ISIH) in a 31-year-old patient at 37 weeks gestation in her second pregnancy. The patient presented to the labour ward with abdominal pain and uterine contractions. The initial complain was of sudden onset, severe sharp pain in left iliac fossa. She started having uterine contractions within 30 min of her presentation. Examination confirmed early labour with a footling breech presentation. Urgent caesarean section was performed that confirmed peritoneal bleeding of unknown origin with safe delivery of the baby. Mother and baby were safely discharged on day 5. ‘Abdominal apoplexy’ (ISIH), is a rare obstetric emergency with increased risk of fetal and maternal morbidity and mortality. With various clinical presentations as a possibility, diagnosis is challenging. High index of suspicion with prompt management of suspected cases can be pivotal life saving measure for the fetus and mother.
Embryonal rhabdomyosarcoma masquerading as a left vocal cord granuloma
Authors: Linton Stefan , Stapleton Emma , Penney Susannah , Sharma Manu-Priya
Published: October 2020

Embryonal rhabdomyosarcoma (ERMS) of the larynx in adults is an extremely rare diagnosis with insidious onset and progression. Only six reports (including this one) have been documented in the literature. Clinical presentation is dependent on the site, size, subtype of ERMS and growth rate. Hoarseness is the usual first symptom, followed by stridor and dyspnoea, with dysphagia being late in onset. Accurate staging and risk stratification is necessary to avoid overtreating/undertreating patients and should be guided by local Head and Neck/Sarcoma Multidisciplinary Teams. Treatment has moved away from radical therapeutic regimens to less-invasive, organ-preserving therapies. Long-term follow-up is required due to the risk of late recurrence.
Foreign body episcleral suture granulomas mimicking nodular anterior scleritis
Authors: Khoo Lin Wei , Srinivasan Sathish , Roberts Fiona
Published: October 2020

Scleritis is an idiopathic condition that may sometimes be associated with systemic immunological like disorders rheumatoid arthritis, Wegener’s granulomatosis and systemic lupus erythematosus. A variety of foreign material has been reported to result in granuloma formation in various parts of the body. We report a case of inflamed episcleral granulomas mimicking severe nodular anterior scleritis in a healthy Caucasian woman who underwent strabismus surgery in her childhood. Foreign body reaction on the episcleral/scleral surface is rare. It is extremely unusual for a non-absorbable suture that was used for childhood strabismus surgery to incite an acute inflammatory episode mimicking nodular anterior scleritis as in our case. As the strabismus surgery was performed 37 years prior to her presentation with anterior scleritis, we were unable to obtain any details of this surgical procedure. We presume that a non-absorbable suture like braided polyester or prolene may have been used.
Epidemiological study of opioid use disorder in French emergency departments, 2010–2018 from OSCOUR database
Authors: Gallien Yves , Martin Adrien , Caserio-Schönemann Céline , Le Strat Yann , Thiam Marie Michèle
Published: October 2020

Objectives

Opioid consumption in France has remained stable over the last 15 years, with much lower levels than in the USA. However, few data are available on patients who consume opioids and their use of the health system. Emergency department (ED) data has never been used as a source to investigate opioid use disorder (OUD) in France.

Design/settings/participants

We used the OSCOUR national surveillance network, collecting daily ED data from 93% of French ED, to select and describe visits and hospitalisations after an OUD-related ED visit between 2010 and 2018 using International Classification of Diseases, version 10 (ICD10) codes. We described the population of interest and used binomial negative regressions to identify factors significantly associated with OUD such as gender, age, administrative region, year of admission and ICD10 codes. We also analysed the related diagnoses.

Primary outcome measure

Trend in ED visits for an OUD-related ED visit.

Results

We recorded 34 362 OUD-related visits out of 97 892 863 ED visits (36.1/100 000 visits). OUD-related visits decreased from 39.2/100 000 visits in 2010 to 32.9/100 000 visits in 2018, resulting in an average yearly decrease of 2.1% (95% CI 1.5% to 2.7%) after multivariate analysis. We recorded 15 966 OUD-related hospitalisations out of 20 359 574 hospitalisations after ED visits (78.4/100 000 hospitalisations) with an increase from 74.0/100 000 hospitalisations in 2010 to 81.4/100 000 hospitalisations in 2018. The analysis of related diagnoses demonstrated mostly polydrug abuse in this population.

Conclusions

While the proportion of OUD visits decreased in the time frame, the hospitalisation proportion increased. The implementation of a nationwide surveillance system for OUD in France using ED visits would provide prompt detection of changes over time.
A realist synthesis of pharmacist-conducted medication reviews in primary care after leaving hospital: what works for whom and why?
Authors: Luetsch Karen , Rowett Debra , Twigg Michael J
Published: October 2020

Background

Medication reviews for people transitioning from one healthcare setting to another potentially improve health outcomes, although evidence for outcome benefits varies. It is unclear when and why medication reviews performed by pharmacists in primary care for people who return from hospital to the community lead to beneficial outcomes.

Objective

A realist synthesis was undertaken to develop a theory of what works, for whom, why and under which circumstances when pharmacists conduct medication reviews in primary care for people leaving hospital.

Methods

The realist synthesis was performed in accordance with Realist And MEta-narrative Evidence Syntheses: Evolving Standards reporting standards. An initial programme theory informed a systematic literature search of databases (PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature, International Pharmaceutical Abstracts, OpenGrey, Trove), augmented by agency and government sources of information. Documents were synthesised by exploring interactions between contexts, intervention, outcomes and causal mechanisms.

Results

The synthesis identified 9 contexts in which 10 mechanisms can be activated to influence outcomes of pharmacist medication reviews conducted in primary care postdischarge. For a medication review to take place these include trust patients have in healthcare professionals, their healthcare priorities postdischarge, capacity to participate, perceptions of benefit and effort, and awareness required by all involved. For the medication review process, mechanisms which issue an invitation to collaborate between healthcare professionals, enable pharmacists employing clinical skills and taking responsibility for medication review outcomes were linked to more positive outcomes for patients.

Conclusions

Medication reviews after hospital discharge seem to work successfully when conducted according to patient preferences, programmes promote coordination and collaboration between healthcare professionals and establish trust, and pharmacists take responsibility for outcomes. Findings of this realist synthesis can inform postdischarge medication review service models.
Orthostatic hypotension: a pragmatic guide to diagnosis and treatment
Authors: Gibbon Jake Ryan , Frith James
Published: October 2020

Topics for DTB review articles are selected by DTB’s editorial board to provide concise overviews of medicines and other treatments to help patients get the best care. Articles include a summary of key points and a brief overview for patients. Articles may also have a series of multiple choice CME questions.
Evaluation of a novel approach to recognising community-acquired paediatric sepsis at ED triage by combining an electronic screening algorithm with clinician assessment
Authors: Gomes Sylvester , Wood Darryl , Ayis Salma , Haliasos Nikolaos , Roland Damian
Published: October 2020

Objective

We report the utilisation and impact of a novel triage-based electronic screening tool (eST) combined with clinical assessment to recognise sepsis in paediatric ED.

Methods

An electronic sepsis screening tool was implemented in the paediatric EDs of two large UK secondary care hospitals between June 2018 and January 2019. Patients eligible for screening were children < 16 years of ages excluding those with minor injuries or who were brought directly to resuscitation. Subsequently, a retrospective evaluation was performed to determine the performance of the tool alone and in combination with clinical assessment after triage, to identify septic patients, using sensitivity, specificity, positive, negative predictive values (PPV and NPV) and likelihood ratios.

Results

19 912 children were triaged during the study period, of whom 90 (0.45%) were classified as having sepsis. 99% of all eligible patients were screened. The eST alerted for 2651 (13.3%) patients. After immediate physician assessment, 151 were treated for sepsis in the ED, of whom 70 had a final diagnosis of sepsis. Eight patients who were not thought to be septic returned with sepsis within 24 hours. The eST showed a sensitivity of 86.7% (95% CI 77.5% to 92.6%), specificity 87.0% (95% CI 86.5% to 87.5%), PPV 2.94% (95% CI 2.35% to 3.68%), NPV 99.9% (95% CI 99.8% to 99.9%) which improved with combined clinical assessment to a sensitivity of 90.0% (95% CI 81.4% to 95.0%), specificity 99.4 (95% CI 99.3% to 99.5%), PPV 42.0 (95% CI 35.0% to 49.3%) and NPV 99.9% (95% CI 99.9% to 99.9%).

Conclusion

Utilisation of a novel triage-based eST allowed sepsis screening in over 99% of eligible patients. The screening tool showed good accuracy to recognise sepsis at triage in the ED, which was augmented further by combining it with clinician assessment. The screening tool requires further refinement through multicentre evaluation to avoid missing sepsis cases.
Paediatric patients seen in 18 emergency departments during the COVID-19 pandemic
Authors: Goldman Ran D , Grafstein Eric , Barclay Neil , Irvine Michael A , Portales-Casamar Elodie
Published: October 2020

Background

Public health mitigation strategies in British Columbia during the pandemic included stay-at-home orders and closure of non-essential services. While most primary physicians’ offices were closed, hospitals prepared for a pandemic surge and emergency departments (EDs) stayed open to provide care for urgent needs. We sought to determine whether ED paediatric presentations prior and during the COVID-19 pandemic changed and review acuity compared with seasonal adjusted prior year.

Methods

We analysed records from 18 EDs in British Columbia, Canada, serving 60% of the population. We included children 0–16 years old and excluded those with no recorded acuity or discharge disposition and those left without being seen by a physician. We compared prepandemic (before the first COVID-19 case), early pandemic (after first COVID-19 case) and peak pandemic (during public health emergency) periods as well as a similar time from the previous year.

Results

A reduction of 57% and 70% in overall visits was recorded in the children’s hospital ED and the general hospitals EDs, respectively. Average daily visits declined significantly during the peak-pandemic period (167.44±40.72) compared with prepandemic period (543.53±58.8). Admission rates increased mainly due to the decrease in the rate of visits with lower acuity. Children with complaints of ‘fever’ and ‘gastrointestinal’ symptoms had both the largest overall volume and per cent reduction in visits between peak-pandemic and prior year (79% and 74%, respectively).

Conclusion

Paediatric emergency medicine attendances were reduced to one-third of normal numbers during the 2020 COVID-19 lockdown in British Columbia, Canada, with the reduction mainly seen in minor illnesses that do not usually require admission.