bluuebunny/crossref_metadata_2025 huggingface dataset:
Teacher Reactions to Trauma Disclosures from Syrian Refugee Students
Authors: Mayor Christine
Published: April 2021

Despite the growing interest in creating trauma-informed schools, including for trauma-affected refugee students, little research has focused on the perspectives of teachers supporting these youths. This qualitative study focused on one school district in southwestern Ontario, Canada; it examined 11 narratives from seven teachers that centered on Syrian refugee student trauma disclosures in the classroom. Two full narratives are provided to illustrate the key thematic findings: teachers feel unsettled by unexpected disclosures, teachers are disturbed by students’ lack of affect, tension exists between emotional expression and containment, and teachers engage in meaning making when hearing the stories students want to tell. These findings are discussed within the wider research context of emotional labor, vicarious trauma, and burnout, and indicate that additional support is needed for teachers given the reported professional and personal strain that trauma disclosures can cause. This is not only important for the well-being of teachers but is also critical for Syrian refugee and other trauma-affected students to learn within a more equitable educational environment. School social workers are discussed as a possible resource for providing this ongoing training and support for teachers.
Prevalence, distribution, and determinants of pulmonary venous systolic flow reversal in severe mitral regurgitation
Authors: Itakura Kiho , Utsunomiya Hiroto , Takemoto Hajime , Takahari Kosuke , Ueda Yusuke , Izumi Kanako , Ikenaga Hiroki , Hidaka Takayuki , Fukuda Yukihiro , Nakano Yukiko
Published: April 2021

Aims

This study aimed to evaluate the prevalence and distribution of pulmonary venous systolic flow reversal (PVSFR) in patients with severe mitral regurgitation (MR), and to examine the relationship between PVSFR profile and cardiac parameters.

Methods and results

A total of 125 patients with severe MR who had transoesophageal echocardiography (TOE) performed were reviewed. Of these, 121 (96.8%) patients showed all four pulmonary venous (PV) flows by TOE. They were categorized into three groups by the MR aetiology: degenerative MR (DMR) (n = 72), ventricular functional MR (V-FMR) (n = 20), and atrial functional MR (A-FMR) (n = 16). Eighteen (16.7%) patients had PVSFR in all four PVs. Twenty-nine (26.9%) had PVSFR in three PVs, 23 (21.3%) in two PVs, and 23 (21.3%) in one PV. PVSFR appeared at right PVs more frequently compared with left PVs. A high number of PVSFR was significantly correlated with higher pulmonary capillary wedge pressure (PCWP) and 3D vena contracta area (3D-VCA). With regard to MR aetiology, the number of PVSFRs was correlated with high 3D-VCA in patients with DMR and A-FMR, while it was correlated with high PCWP in patients with V-FMR. Laminar-type PVSFR appeared more frequently in FMR compared with DMR, and it had a relationship with higher PCWP and lower right ventricular fractional area change (RVFAC).

Conclusion

All four PV were detected in 96.8%, and 16.8% patients had PVSFR in all four PVs. PCWP and 3D-VCA were correlated with the number of PVSFRs in severe MR patients. Laminar-type PVSFR was related to higher PCWP and lower RVFAC.
Volatile organic compounds: from figurants to leading actors in fungal symbiosis
Authors: Minerdi Daniela , Maggini Valentina , Fani Renato
Published: April 2021

Symbiosis involving two (or more) prokaryotic and/or eukaryotic partners is extremely widespread in nature, and it has performed, and is still performing, a key role in the evolution of several biological systems. The interaction between symbiotic partners is based on the emission and perception of a plethora of molecules, including volatile organic compounds (VOCs), synthesized by both prokaryotic and eukaryotic (micro)organisms. VOCs acquire increasing importance since they spread above and below ground and act as infochemicals regulating a very complex network. In this work we review what is known about the VOCs synthesized by fungi prior to and during the interaction(s) with their partners (either prokaryotic or eukaryotic) and their possible role(s) in establishing and maintaining the symbiosis. Lastly, we also describe the potential applications of fungal VOCs from different biotechnological perspectives, including medicinal, pharmaceutical and agronomical.
Population structure and genetic diversity of the Pee Dee cotton breeding program
Authors: Billings Grant T , Jones Michael A , Rustgi Sachin , Hulse-Kemp Amanda M , Campbell B Todd
Published: April 2021

Accelerated marker-assisted selection and genomic selection breeding systems require genotyping data to select the best parents for combining beneficial traits. Since 1935, the Pee Dee (PD) cotton germplasm enhancement program has developed an important genetic resource for upland cotton (Gossypium hirsutum L.), contributing alleles for improved fiber quality, agronomic performance, and genetic diversity. To date, a detailed genetic survey of the program’s eight historical breeding cycles has yet to be undertaken. The objectives of this study were to evaluate genetic diversity across and within-breeding groups, examine population structure, and contextualize these findings relative to the global upland cotton gene pool. The CottonSNP63K array was used to identify 17,441 polymorphic markers in a panel of 114 diverse PD genotypes. A subset of 4597 markers was selected to decrease marker density bias. Identity-by-state pairwise distance varied substantially, ranging from 0.55 to 0.97. Pedigree-based estimates of relatedness were not very predictive of observed genetic similarities. Few rare alleles were present, with 99.1% of SNP alleles appearing within the first four breeding cycles. Population structure analysis with principal component analysis, discriminant analysis of principal components, fastSTRUCTURE, and a phylogenetic approach revealed an admixed population with moderate substructure. A small core collection (n < 20) captured 99% of the program’s allelic diversity. Allele frequency analysis indicated potential selection signatures associated with stress resistance and fiber cell growth. The results of this study will steer future utilization of the program’s germplasm resources and aid in combining program-specific beneficial alleles and maintaining genetic diversity.
Incident Dementia, Glycated Hemoglobin (HbA1c) Levels, and Potentially Preventable Hospitalizations in People Aged 65 and Older With Diabetes
Authors: Zaslavsky Oleg , Yu Onchee , Walker Rod L , Crane Paul K , Gray Shelly L , Sadak Tatiana , Borson Soo , Larson Eric B
Published: April 2021

Background

This study was aimed to determine whether incident dementia and HbA1c levels are associated with increased rates of potentially preventable hospitalizations (PPHs) in persons with diabetes.

Method

A total of 565 adults aged 65+ ever treated for diabetes were enrolled from Adult Changes in Thought study. PPHs were from principal discharge diagnoses and included diabetes PPH (dPPH), respiratory PPH (rPPH), urinovolemic PPH (uPPH), cardiovascular PPH, and other PPH. Poisson generalized estimating equations estimated rate ratios (RRs) and 95% confidence intervals (CIs) for the associations between dementia or HbA1c measures and rate of PPHs.

Results

A total of 562 individuals contributed 3 602 dementia-free years, and 132 individuals contributed 511 dementia follow-up years. One hundred twenty-eight (23%) dementia-free individuals had 210 PPH admissions and a crude rate of 58 per 1 000 person-years, while 55 (42%) individuals with dementia had 93 PPH admissions and a crude rate of 182 per 1 000 person-years. The adjusted RR (95% CI) comparing rates between dementia and dementia-free groups were 2.27 (1.60, 3.21) for overall PPH; 5.90 (2.70, 12.88) for dPPH; 5.17 (2.49, 10.73) for uPPH; and 2.01 (1.06, 3.83) for rPPH. Compared with HbA1c of 7%–8% and adjusted for dementia, the RR (95% CI) for overall PPH was 1.43 (1.00, 2.06) for >8% HbA1c and 1.18 (0.85, 1.65) for <7% HbA1c. The uPPH RR was also increased, comparing >8% and <7% HbA1c levels.

Conclusion

Incident dementia is associated with higher rates of PPHs among people with diabetes, especially PPHs due to diabetes, urinary tract infection (UTI), and dehydration. Potential evidence suggested that HbA1c levels of >8% versus lower levels are associated with higher rates of overall PPHs and UTI- and dehydration-related PPHs.
The effectiveness of national-level containment and closure policies across income levels during the COVID-19 pandemic: an analysis of 113 countries
Authors: Pincombe Morgan , Reese Victoria , Dolan Carrie B
Published: April 2021

Despite heterogeneity in income levels, countries implemented similarly strict containment and closure policies to mitigate the COVID-19 pandemic. This research assesses the effectiveness of these containment and closure policies, which we defined as larger decreases in mobility and smaller COVID-19 case and death growth rates. Using daily data for 113 countries on mobility and cumulative COVID-19 case and death counts over the 130 days between February 15, 2020 and June 23, 2020, we examined changes in mobility, morbidity, and mortality growth rates across the World Bank’s income group classifications. Containment policies correlated with the largest declines in mobility in higher income countries. High-income countries also achieved lower COVID-19 case and death growth rates than low-income countries. This study finds better epidemiological outcomes of containment and closure policies for higher income countries than lower income countries. These findings urge policymakers to consider contextual differences, including levels of economic activity and the structure of the economy, when crafting policies in response to public health emergencies.
Inertial Tail Effects during Righting of Squirrels in Unexpected Falls: From Behavior to Robotics
Authors: Fukushima Toshihiko , Siddall Robert , Schwab Fabian , Toussaint Séverine L D , Byrnes Greg , Nyakatura John A , Jusufi Ardian
Published: April 2021

Arboreal mammals navigate a highly three dimensional and discontinuous habitat. Among arboreal mammals, squirrels demonstrate impressive agility. In a recent “viral” YouTube video, unsuspecting squirrels were mechanically catapulted off of a track, inducing an initially uncontrolled rotation of the body. Interestingly, they skillfully stabilized themselves using tail motion, which ultimately allowed the squirrels to land successfully. Here we analyze the mechanism by which the squirrels recover from large body angular rates. We analyzed from the video that squirrels first use their tail to help stabilizing their head to visually fix a landing site. Then the tail starts to rotate to help stabilizing the body, preparing themselves for landing. To analyze further the mechanism of this tail use during mid-air, we built a multibody squirrel model and showed the righting strategy based on body inertia moment changes and active angular momentum transfer between axes. To validate the hypothesized strategy, we made a squirrel-like robot and demonstrated a fall-stabilizing experiment. Our results demonstrate that a squirrel’s long tail, despite comprising just 3% of body mass, can inertially stabilize a rapidly rotating body. This research contributes to better understanding the importance of long tails for righting mechanisms in animals living in complex environments such as trees.
The role of institutional trust in preventive practices and treatment-seeking intention during the coronavirus disease 2019 outbreak among residents in Hubei, China
Authors: Wong Li Ping , Wu Qunhong , Hao Yanhua , Chen Xi , Chen Zhuo , Alias Haridah , Shen Mingwang , Hu Jingcen , Duan Shiwei , Zhang Jinjie , Han Liyuan
Published: April 2021

Background

We aimed to investigate the association between institution trust and public responses to the coronavirus disease 2019 (COVID-19) outbreak.

Methods

An Internet-based, cross-sectional survey was administered on 29 January 2020. A total of 4393 adults ≥18 y of age and residing or working in the province of Hubei, central China were included in the study.

Results

The majority of the participants expressed a great degree of trust in the information and preventive instructions provided by the central government compared with the local government. Being under quarantine (adjusted odds ratio [OR] 2.35 [95% confidence interval {CI} 1.80 to 3.08]) and having a high institutional trust score (OR 2.23 [95% CI 1.96 to 2.53]) were both strong and significant determinants of higher preventive practices scores. The majority of study participants (n=3640 [85.7%]) reported that they would seek hospital treatment if they suspected themselves to have been infected with COVID-19. Few of the participants from Wuhan (n=475 [16.6%]) and those participants who were under quarantine (n=550 [13.8%]) expressed an unwillingness to seek hospital treatment.

Conclusions

Institutional trust is an important factor influencing adequate preventive behaviour and seeking formal medical care during an outbreak.
Performance and serum parameters of calves (Bos taurus) subject to milk restriction associated with supplementation with 2-hydroxy-4-(methylthio)butanoic acid
Authors: Brito Rosiane F , França Aldi F S , Pansani Aline P , Castro Carlos H , Colugnati Diego B , Souza Luciano F , Rabelo Luiza A , Nunes-Souza Valéria , Xavier Carlos H , Oliveira Graciele A , Corrêa Daniel S , Ramos Adriano T , Macedo Larissa M , Ferreira Reginaldo N
Published: April 2021

Our aim with this study was to evaluate the consumption, performance, quantitative characteristics of carcasses, biochemical profile, plasma levels of ghrelin and leptin, expression of the receptor for ghrelin (GHS-R1a) in the hypothalamus and duodenum, and the number of goblet cells in the duodenum of calves subjected to milk volume restriction and supplemented with 2-hydroxy-4-(methylthio)butanoic acid (HMTBa). We used 21 Holstein mixed-breed calves, aged between 3 and 15 d with an average weight of 36.8 kg, and housed in pens with troughs for hay, concentrate, and water. The study included two consecutive experimental periods (first period [P1] and second period [P2]) of 21 d each, with 7 d of adaptation to the diet and facilities. The calves were distributed in a completely randomized design in three treatments with seven repetitions. 1) Control: 6 liters of milk/d during P1 and 6 liters of milk/day during P2; 2) RES (milk restriction): 3 liters of milk/day during P1 and 6 liters of milk/day during P2; and 3) RES + HMTBa: 3 liters of milk/day during P1 and 6 liters of milk/day during P2 + 3.3 g of HMTBa/day in both periods. HMTBa was supplied in milk, and the amount of concentrated ration and hay provided and leftovers were recorded daily to estimate dry matter (DM) and crude protein consumption. Mean daily weight gain (DWG), final weight (FW), and feed conversion (FC) were obtained at the beginning and at the end of each 21-d period. Plasma concentrations of ghrelin and leptin, triglycerides, total protein, urea, lactate, creatinine, alkaline phosphatase, and cholesterol were measured for P1 and P2 at the end of each 21-d period. At the end of P2, animals were slaughtered; sections of the duodenum were collected to evaluate the expression of GHS-R1a and quantity of goblet cells; hypothalamus was used to evaluate the expression of GHS-R1a; rumen was used to evaluate the thickness of epithelium and keratin and the density, height, and width of ruminal papillae. In P1, total DM consumption, FW, DWG, glucose, and triglycerides were lower in the RES and RES + HMTBa groups (P < 0.001). In P2, there was an improvement in the FC of the RES + HMTBa group (compared with Control and RES groups) and a lower urea concentration in the RES group (compared with Control and RES + HMTBa groups) (P < 0.001). No differences were observed among groups regarding hormonal concentrations, histological parameters, and GHS-R1a expression in the duodenum and hypothalamus. Therefore, milk restriction combined with HMTBa supplementation promoted greater compensatory gain by a mechanism independent of changes in GHS-R1a expression and hormone levels of ghrelin and leptin.
Complications of Cranioplasty in Relation to Material: Systematic Review, Network Meta-Analysis and Meta-Regression
Authors: Henry Jack , Amoo Michael , Taylor Joseph , O’Brien David P
Published: April 2021

BACKGROUND

Cranioplasty is a ubiquitous neurosurgical procedure consisting of reconstruction of a pre-existing calvarial defect. Many materials are available, including polymethylmethacrylate in hand-moulded (hPMMA) and prefabricated (pPMMA) form, hydroxyapatite (HA), polyetheretherketone (PEEK) and titanium (Ti).

OBJECTIVE

To perform a network meta-analysis (NMA) to assess the relationship between materials and complications of cranioplasty.

METHODS

PubMed/MEDLINE, Google Scholar, EMBASE, Scopus, and The Cochrane Library were searched from January 1, 1990 to February 14, 2021. Studies detailing rates of any of infections, implant exposure, or revision surgery were included. A frequentist NMA was performed for each complication. Risk ratios (RRs) with 95% CIs were calculated for each material pair.

RESULTS

A total of 3620 abstracts were screened and 31 full papers were included. Surgical revision was reported in 18 studies and occurred in 316/2032 cases (14%; 95% CI 11-17). PEEK had the lowest risk of re-operation with a rate of 8/157 (5%; 95% CI 0-11) in 5 studies, superior to autografts (RR 0.20; 95% CI 0.07-0.57), hPMMA (RR 0.20; 95% CI 0.07-0.60), Ti (RR 0.39; 95% CI 0.17-0.92), and pPMMA (RR 0.14; 95% CI 0.04-0.51). Revision rate was 131/684 (19%; 95% CI 13-25; 10 studies) in autografts, 61/317 (18%; 95%CI 9-28; 7 studies) in hPMMA, 84/599 (13%; 95% CI 7-19; 11 studies) in Ti, 7/59 (9%; 95% CI 1-23; 3 studies) in pPMMA, and 25/216 (12%; 95% CI 4-24; 4 studies) in HA. Infection occurred in 463/4667 (8%; 95% CI 6-11) and implant exposure in 120/1651 (6%; 95% CI 4-9).

CONCLUSION

PEEK appears to have the lowest risk of cranioplasty revision, but further research is required to determine the optimal material.
VipariNama: RNA viral vectors to rapidly elucidate the relationship between gene expression and phenotype
Authors: Khakhar Arjun , Wang Cecily , Swanson Ryan , Stokke Sydney , Rizvi Furva , Sarup Surbhi , Hobbs John , Voytas Daniel F
Published: April 2021

Synthetic transcription factors have great promise as tools to help elucidate relationships between gene expression and phenotype by allowing tunable alterations of gene expression without genomic alterations of the loci being studied. However, the years-long timescales, high cost, and technical skill associated with plant transformation have limited their use. In this work, we developed a technology called VipariNama (ViN) in which vectors based on the tobacco rattle virus are used to rapidly deploy Cas9-based synthetic transcription factors and reprogram gene expression in planta. We demonstrate that ViN vectors can implement activation or repression of multiple genes systemically and persistently over several weeks in Nicotiana benthamiana, Arabidopsis (Arabidopsis thaliana), and tomato (Solanum lycopersicum). By exploring strategies including RNA scaffolding, viral vector ensembles, and viral engineering, we describe how the flexibility and efficacy of regulation can be improved. We also show how this transcriptional reprogramming can create predictable changes to metabolic phenotypes, such as gibberellin biosynthesis in N. benthamiana and anthocyanin accumulation in Arabidopsis, as well as developmental phenotypes, such as plant size in N. benthamiana, Arabidopsis, and tomato. These results demonstrate how ViN vector-based reprogramming of different aspects of gibberellin signaling can be used to engineer plant size in a range of plant species in a matter of weeks. In summary, ViN accelerates the timeline for generating phenotypes from over a year to just a few weeks, providing an attractive alternative to transgenesis for synthetic transcription factor-enabled hypothesis testing and crop engineering.
Giving the Public in Public Administration Its Due
Authors: Frederickson H George
Published: April 2021

This is the second of four Last Lectures delivered by George Frederickson before his death in 2020. In “Giving the Public in Public Administration Its Due,” Frederickson explores the changing, if not dissolving boundaries between the public and private sectors. He admonishes us to be more careful in our understanding and articulation of the meaning of “public” and the extent to which this matters for future theory building as well as practice.
Inquiry, Not Science, as the Source of Secularization in Higher Education
Authors: Evans John H
Published: April 2021

The traditional claim in the literature on religion and science is that exposure to science leads to secularity because the claims about the natural world in the two systems are incompatible. More recently, research has narrowed this claim and shown that conflict over knowledge in the USA is primarily limited to one religion—conservative Protestantism—and only to a few fact claims. In this paper, I test this claim using longitudinal data from matched surveys taken in students’ first and fourth year of university. I find no evidence that the science is more secularizing than nonscience. I then turn to a distinction in university majors long used by sociologists of education—between majors focused on inquiry versus those focused on applying knowledge—and find that majors focused on inquiry are more likely to secularize than those focused on application. I interpret this to mean that learning to inquire secularizes.
Introgression and Species Delimitation in the Longear Sunfish Lepomis megalotis (Teleostei: Percomorpha: Centrarchidae)
Authors: Kim Daemin , Bauer Bruce H , Near Thomas J
Published: April 2021

Introgression and hybridization are major impediments to genomic-based species delimitation because many implementations of the multispecies coalescent framework assume no gene flow among species. The sunfish genus Lepomis, one of the world’s most popular groups of freshwater sport fish, has a complicated taxonomic history. The results of ddRAD phylogenomic analyses do not provide support for the current taxonomy that recognizes two species, Lepomis megalotis and Lepomis peltastes, in the L. megalotis complex. Instead, evidence from phylogenomics and phenotype warrants recognizing six relatively ancient evolutionary lineages in the complex. The introgressed and hybridizing populations in the L. megalotis complex are localized and appear to be the result of secondary contact or rare hybridization events between nonsister species. Segregating admixed populations from our multispecies coalescent analyses identifies six species with moderate to high genealogical divergence, whereas including admixed populations drives all but one lineage below the species threshold of genealogical divergence. Segregation of admixed individuals also helps reveal phenotypic distinctiveness among the six species in morphological traits used by ichthyologists to discover and delimit species over the last two centuries. Our protocols allow for the identification and accommodation of hybridization and introgression in species delimitation. Genomic-based species delimitation validated with multiple lines of evidence provides a path towards the discovery of new biodiversity and resolving long-standing taxonomic problems.[ddRAD; genealogical divergence index; hybridization; integrative species delimitation; phylogeny; secondary contact; systematics; taxonomy.]
Acute Kidney Injury in Hospitalized Children with COVID19
Authors: Chopra Sanya , Saha Abhijeet , Kumar Virendra , Thakur Archana , Pemde Harish , Kapoor Dipti , Ray Sandip , Das Aditi , Pandit Kaveri , Gulati Anu , Sharma Ankita Goel , Singh Preeti , Sodani Ravitanya
Published: April 2021

Background

Acute kidney injury (AKI) has been recognized as a significant risk factor for mortality among adults with severe acute respiratory syndrome coronavirus infection.

Aim

The aim of this study is to assess the prevalence and risk factors for AKI and mortality in children with coronavirus disease 2019 (COVID19) from a resource-limited setting.

Methods

Cross-sectional analysis of laboratory confirmed COVID19 children admitted from 1 March to 30 November 2020 in a tertiary care hospital in New Delhi, India was done. Clinical features and associated comorbidities of COVID19 were noted. Baseline serum creatinine (height-independent Hoste’s equation) and peak serum creatinine were used for staging of AKI by the 2012 Kidney Disease Improving Global Outcomes serum creatinine criteria. Univariate analysis and Kaplan–Meier survival analysis were used to compare the overall outcome in the AKI vs. the non-AKI group.

Results

A total of 64 810 children between 1 month and 18 years visited the hospital; 3412 were tested for suspected COVID19, 295 tested positive and 105 (54% boys) were hospitalized. Twenty-four hospitalized children (22.8%) developed AKI; 8 in Stage 1 (33.3%), 7 in Stage 2 (29.2%) and 9 in Stage 3 (37.5%) respectively. Overall, three patients received KRT. Highest reported mortality was (66.6%) in AKI Stage 3. Risk factors for AKI included associated sepsis (OR 95% CI, 1.22-9.43, p < 0.01), nephrotic syndrome (OR 95% CI, 1.13-115.5, p < 0.01), vasopressor support (OR 3.59, 95% CI, 1.37–9.40, p value< 0.007), shock at presentation (OR 2.98, 95% CI, 1.16–7.60, p value 0.01) and mechanical ventilation (OR 2.64, 95% CI, 1.04–6.71, p value< 0.03). Mortality (25.71%) was higher in the AKI group (OR 95% CI, 1.14-8.35, p < 0.023) with shock (OR 45.92; 95% CI, 3.44–612.0, p value <0.004) and ventilation (OR 46.24; 95% CI, 1.6–1333.0 p value< 0.02) as significant risk factors for mortality.

Conclusion

AKI is an important modifiable risk factor for mortality in children with COVID19 in a resource-limited setting. Our study supports the strengthening of kidney replacement therapy and its timely initiation to reduce the progression of AKI and thus mortality in children.
Snake Bite Management: A Scoping Review of the Literature
Authors: Russell Jeffrey J. , Schoenbrunner Anna , Janis Jeffrey E.
Published: April 2021

Background:

Around the world, snake bite envenomation remains an underreported human health hazard. Envenomation can cause local and systemic complications, especially when there is a lack of antivenom availability. Although there are established guidelines regarding snake bite management acute care, there is a paucity of data regarding surgical intervention and the plastic surgeon’s role treating this unique patient population.

Methods:

A review was conducted identifying relevant published articles involving snake bite management and treatment in PubMed and EMBASE.

Results:

One hundred ten articles were identified and 77 met inclusion criteria. Snake bite envenomation can result in complications that are dependent upon a variety of variables. The literature has shown the best field treatment to be timely transportation to the nearest medical facility, along with antivenom administration. The cytotoxic, hemotoxic, and neurotoxic effects of venom can cause a variety of local soft tissue and systemic complications. Surgical interventions such as fasciotomies, wound debridements, skin grafts, and tissue flaps may be necessary in these patients to optimize functional and aesthetic outcomes. Disparities in access to care in resource limited settings are discussed.

Conclusions:

Global health disparities and insufficient antivenom distribution create an inequality of care in snake bite patients. Plastic surgeons have an important role in managing acute and chronic complications of snake bite envenomations that can lead to improved patient outcomes.
Safety of Silk-elastin Sponges in Patients with Chronic Skin Ulcers: A Phase I/II, Single-center, Open-label, Single-arm Clinical Trial
Authors: Noda Kazuo , Kawai Katsuya , Matsuura Yoshitaka , Ito-Ihara Toshiko , Amino Yoko , Ushimaru Mika , Kinoshita Akemi , Tada Harue , Abe Hiroyasu , Morita Satoshi , Shimizu Akira , Tsuge Itaru , Sakamoto Michiharu , Morimoto Naoki
Published: April 2021

Background:

Although traditional wound dressings such as collagen scaffolds promote granulation tissue formation, the efficacy of these dressings in chronic wounds is limited because of high susceptibility to bacterial growth. Biomaterials that can be applied to chronic wounds should have an anti-bacterial function. We previously reported that administering a silk-elastin solution that forms moisturizing hydrogels to wound surfaces of diabetic mice reduced bacterial growth and promoted granulation tissue formation compared with control or carboxymethyl cellulose hydrogels. We hypothesized that silk-elastin promotes wound healing in human chronic wounds by suppressing bacterial growth.

Methods:

An open-label, clinical case series was conducted with a prospective, single-arm design at Kyoto University Hospital in Kyoto, Japan. In this study, 6 patients with chronic skin ulcers of any origin (2 < ulcer area (cm2) < 25) on their lower extremities were included; patients with critical ischemia were excluded. Silk-elastin sponges were applied and covered with a polyurethane film without changing the dressing for 14 days. Inflammation triggered treatment discontinuation due to fear of infection. The primary study endpoint was adverse events, including inflammation and infection.

Results:

Poor hydrogel formation, possibly due to continuous exudation, was observed. No serious adverse events were noted. Two patients discontinued treatment on day 6 and day 7, respectively, due to inflammation, but they were not infected. The other 4 patients completed the 14-day silk-elastin sponge treatment without infection.

Conclusion:

Silk-elastin sponge is safe for chronic skin ulcers, and its ability to promote wound healing should be determined by confirmatory clinical trials.
Selecting β-thalassemia Patients for Gene Therapy: A Decision-making Algorithm
Authors: Baronciani Donatella , Casale Maddalena , De Franceschi Lucia , Graziadei Giovanna , Longo Filomena , Origa Raffaella , Rigano Paolo , Pinto Valeria , Marchetti Monia , Gigante Antonia , Iolascon Achille ,   (on behalf of, & Chair of, the EHA Scientific Working Group on Red Cells and Iron), Forni Gian Luca
Published: April 2021

This expert opinion originally developed by a panel of the Italian Society of Thalassemias and Hemoglobinopathies (SITE), reviewed and adopted by the European Hematology Association (EHA) through the EHA Scientific Working Group on Red Cells and Iron, has been developed as priority decision-making algorithm on evidence and consensus with the aim to identify which patients with transfusion-dependent beta-thalassemia (TDT) could benefit from a gene therapy (GT) approach. Even if the wide utilized and high successful allogeneic hematopoietic stem-cell transplantation provides the possibility to cure several patients a new scenario has been opened by GT. Therefore, it is important to establish the patients setting for whom it is priority indicated, particularly in the early phase of the diffuse use outside experimental trials conducted in high selected centers. Moreover, actual price, limited availability, and resources disposal constitute a further indication to a rational and progressive approach to this innovative treatment. To elaborate this algorithm, the experience with allogeneic transplantation has been used has a predictive model. In this large worldwide experience, it has been clearly demonstrated that key for the optimal transplant outcome is optimal transfusion and chelation therapy in the years before the procedure and consequently optimal patient’s clinical condition. In the document, different clinical scenarios have been considered and analyzed for the possible impact on treatment outcome. According to the European Medicine Agency (EMA) for the GT product, this expert opinion must be considered as a dynamic, updatable, priority-based indications for physicians taking care of TDT patients.
Fedratinib Improves Myelofibrosis-related Symptoms and Health-related Quality of Life in Patients with Myelofibrosis Previously Treated with Ruxolitinib: Patient-reported Outcomes from the Phase II JAKARTA2 Trial
Authors: Harrison Claire N. , Schaap Nicolaas , Vannucchi Alessandro M. , Kiladjian Jean-Jacques , Jourdan Eric , Silver Richard T. , Schouten Harry C. , Passamonti Francesco , Zweegman Sonja , Talpaz Moshe , Verstovsek Srdan , Tang Derek , Abraham Pranav , Lord-Bessen Jennifer , Rose Shelonitda , Guo Shien , Liao Weiqin , Mesa Ruben A.
Published: April 2021

Myelofibrosis symptoms compromise health-related quality of life (HRQoL). Ruxolitinib can reduce myelofibrosis symptom severity, but many patients discontinue ruxolitinib due to loss of response or unacceptable toxicity. Fedratinib is an oral, selective JAK2 inhibitor approved in the United States for treatment of patients with intermediate-2 or high-risk myelofibrosis. The single-arm, phase II JAKARTA2 trial assessed fedratinib 400 mg/d (starting dose) in patients with myelofibrosis previously treated with ruxolitinib. Patient-reported changes in myelofibrosis symptom severity using the modified Myelofibrosis Symptom Assessment Form (MFSAF), and overall HRQoL and functional status using the EORTC QLQ-C30, were evaluated at each cycle. Clinically meaningful changes from baseline HRQoL scores were based on effect sizes. Ninety patients were MFSAF-evaluable. Myelofibrosis symptoms were mild-to-moderate at baseline. Patients showed statistically significant and clinically meaningful improvements in total symptom scores from baseline on the MFSAF at all post baseline visits through the end of cycle 6 (EOC6). Baseline global health status/QoL and functional domain scores on the EORTC QLQ-C30 were meaningfully worse than in the general population. At EOC6, 44% of patients reported clinically meaningful improvements in global health status/QoL, and 30%–53% of patients experienced clinically meaningful improvement in QLQ-C30 functional domains across post baseline timepoints. Over 80% of ongoing patients perceived fedratinib as beneficial on the Patient’s Global Impression of Change questionnaire. Fedratinib effects were consistent among prognostically relevant patient subgroups. Patients with myelofibrosis previously treated with ruxolitinib experienced clinically meaningful improvements in myelofibrosis symptom burden, overall HRQoL, and functional status in the first 6 months of fedratinib treatment.
Rapid Atrial Fibrillation Masquerade
Authors: Sweeney Michael
Published: April 2021

A 63-year-old man presented to the emergency department for fluttering in the chest. The initial electrocardiogram (ECG) suggested rapid atrial fibrillation with nonspecific RS- and ST-segment abnormalities. Treatment with intravenous β-blocker resulted in conversion to a normal sinus rhythm. The repeat ECG revealed conversion to normal sinus rhythm with an inferior lateral myocardial infarction. This case presentation identifies the importance of an algorithmic approach to identifying narrow complex tachyarrhythmias considering both cardiac and noncardiac causes. Furthermore, evaluating ECG changes when varying rates and rhythms exist on differing ECGs. Identifying the importance of serial ECGs is emphasized by the case presented, concluding with an understanding of arrhythmias associated with myocardial infarctions and clinical pearls.
Improving Patient Flow and Decreasing Patient Length of Stay in the Pediatric Emergency Department Through Implementation of a Fast Track
Authors: Martin Heather A. , Noble Marcy , Wilmarth Jaclyn
Published: April 2021

Increased utilization of the emergency department (ED) for low acuity concerns saturates EDs, leading to overcrowding. As the ED becomes crowded, the quality of care threatens patient safety and increases length of stay. To improve the efficiency of evaluation and discharge of low acuity patients in the pediatric ED, a performance improvement project was implemented to develop a Fast Track. An interdisciplinary team developed the process of Fast Track, as well as guidelines for low acuity patients who would be evaluated in the designated area by an advanced practice provider and registered nurse team. Within 14 months of operating, length of stay of low acuity patients triaged an emergency severity illness score of 4 or 5 dropped 36% (from 144 to 92 min). Pediatric patients who present to the ED with low acuity concerns can be effectively and efficiently cared for in a timely fashion in a pediatric ED Fast Track.
Racial Bias Among Emergency Providers
Authors: Brockett-Walker Camille , Lall Michelle , Evans Dian Dowling , Heron Sheryl
Published: April 2021

The Research to Practice column presents an analysis of current and controversial research findings with implications for practice change relevant to emergency care settings. This review critiques Johnson et al.'s (2016) investigation, titled “The Impact of Cognitive Stressors in the Emergency Department on Physician Implicit Racial Bias,” that examined emergency department characteristics and stressors and their effects on physician racial bias and decision making. Their findings suggest that unconscious biases can affect clinical decisions when providers experience increased cognitive stress. The implications are significant for emergency providers as resources are especially strained during the COVID-19 pandemic and as the adverse effects of unconscious bias on health disparities and patient outcomes have become clearly apparent. Implicit bias training (IBT) is recommended for emergency providers and has significant implications for medical and nurse educators in executing and evaluating IBT outcomes.
Sulfasalazine maintains blood–brain barrier integrity and relieves lipopolysaccharide-induced inflammation in hCMEC/D3 cells
Authors: Chang Sheng , Cao Yang
Published: April 2021

Sulfasalazine is a recognized therapy for inflammatory bowel disease and is of paramount importance for maintaining intestinal barrier homeostasis. However, its effects on blood–brain barrier (BBB) function and inflammation have not yet been explored. We sought to examine whether sulfasalazine has anti-inflammatory and antiapoptotic effects on the BBB. hCMEC/D3 cells are a well-established BBB in vitro model, were treated with 1 μg/mL Escherichia coli O111:B4 lipopolysaccharide for 12 h. The cell counting kit-8 assay was used to assess cell viability. The cells were also treated with gradient concentrations of sulfasalazine for 12 h. The levels of apoptosis-related proteins and inflammatory factors (IL-1χ and TNF-α IL-6) were measured by western blotting. ZO-1 and F-actin expression was measured by immunofluorescence staining. This study confirmed that 5 mM sulfasalazine improved the maintenance of BBB integrity and relieved lipopolysaccharide-induced inflammatory apoptosis and showed that sulfasalazine might be an effective treatment for BBB disruption.
Interleukin-33 modulates lipopolysaccharide-mediated inflammatory response in rat primary astrocytes
Authors: Liu Jing , Jiang Sha-Sha , Huang Si-Jian , Nite Weibuzi , Ren Fei , Yan Jian-Qin , Luo Jian-Gang
Published: April 2021

Astrocytes have a crucial role in the modulation of the neuroinflammatory response. However, the underlying mechanisms have yet to be fully defined. Interleukin-33 (IL-33) is constitutively expressed in astrocytes, which has been found to orchestrate inflammatory responses in a large variety of immune-mediated and inflammatory diseases of the nervous system. Thus, the purpose of this study was to elucidate the potential effect of IL-33 in the regulation of inflammatory response in primary cultured astrocytes. We investigated the role of IL-33 in the regulation of inflammatory responses in the lipopolysaccharide-stimulated astrocytes. This study utilized lentiviral short hairpin RNA vectors to target IL-33 (LV-shIL-33) for gene silencing. After lipopolysaccharide stimulation, the expression levels of interleukin-1β (IL-1β), IL-6, and tumor necrosis factor-α (TNF-α), as well as the activation of nuclear factor-kappa B (NF-κB) and extracellular signal-regulated kinase (ERK) signaling pathways, were evaluated to elucidate the mechanisms related to the contributions of IL-33 to the inflammatory response in astrocytes. We found that the expression IL-33 has increased in rat primary cultured astrocytes after lipopolysaccharide stimulation. Administration of LV-shIL-33 knocked down the expression of IL-33 and markedly reduced the overexpression of spinal IL-1β, IL-6, and TNF-α, and attenuated the activation of ERK and NF-κB/p65. This study shows that IL-33 participates in regulating inflammatory responses in primary cultured astrocytes, which might provide additional targets for controlling inflammatory responses following neurological diseases.

See Video abstract, http://links.lww.com/WNR/A627.
Protaetiibacter larvae sp. nov. and Agromyces intestinalis sp. nov., isolated from the gut of larvae of Protaetia brevitarsis seulensis, reclassification of Lysinimonas yzui as Pseudolysinimonas yzui comb. nov. and emended description of the genus Pseudolysinimonas
Authors: Lee Shin Ae , Heo Jun , Kim Mi Ae , Tamura Tomohiko , Saitou Satomi , Kwon Soon-Wo , Weon Hang-Yeon
Published: April 2021

Two bacterial strains, FWR-8T and CFWR-9T, were isolated from the gut of larvae of Protaetia brevitarsis seulensis that were raised at the National Institute of Agricultural Sciences, Wanju-gun, Republic of Korea. Both strains were strictly aerobic, Gram-stain-positive and non-motile. Strain FWR-8T possessed the highest sequence similarity (98.7 %) to that of

Protaetiibacter intestinalis

2DFWR-13T and the phylogenetic tree revealed that strain FWR-8T formed a cluster with Ptb. intestinalis 2DFWR-13T.

Pseudolysinimonas kribbensis

MSL-13T and

Lysinimonas yzui

N7XX-4T shared a high 16S rRNA gene sequence similarity (97.8 %) and formed a cluster adjacent to the cluster that included Ptb. intestinalis 2DFWR-13T. The 16S rRNA gene sequence of strain CFWR-9T exhibited the highest similarity (97.7 %) to that of

Agromyces binzhouensis

OAct353T and the phylogenetic tree indicated that strain CFWR-9T formed one independent cluster with

A. binzhouensis

OAct353T that was within the radius of the genus

Agromyces

. The peptidoglycan type, major fatty acids, major menaquinones and total polar lipids of strain FWR-8T were characterized as type B1, iso-C16 : 0, anteiso-C15 : 0 and anteiso-C17 : 0, MK-15, MK-16 and MK-14, and diphosphatidylglycerol, phosphatidylglycerol, two unidentified glycolipids and one unidentified lipid, respectively. Those from strain CFWR-9T were type B1, iso-C16 : 0, anteiso-C15 : 0 and anteiso-C17 : 0, MK-11, MK-12 and MK-10, and diphosphatidylglycerol, phosphatidylglycerol, two unidentified glycolipids and one unidentified lipid, respectively. Based on the phenotypic and genotypic data, strains FWR-8T and CFWR-9T each represent a novel species within the genera

Protaetiibacter

and

Agromyces

, respectively. For these species, the names Protaetiibacter larvae sp. nov. and Agromyces intestinalis sp. nov. have been proposed, with the type strains FWR-8T (=KACC 19322T=NBRC 113051T) and CFWR-9T (=KACC 19306T=NBRC 113046T), respectively. Our results also justify a reclassification of

Lysinimonas yzui

as Pseudolysinimonas yzui comb. nov. and an emended description of the genus

Pseudolysinimonas

isprovided.
Previously infected vaccinees broadly neutralize SARS-CoV-2 variants
Authors: Leier Hans C. , Bates Timothy A. , Lyski Zoe L. , McBride Savannah K. , X. Lee David , Coulter Felicity J. , Goodman James R. , Lu Zhengchun , Curlin Marcel E. , Messer William B. , Tafesse Fikadu G.
Published: April 2021

We compared the serum neutralizing antibody titers before and after two doses of the BNT162b2 COVID-19 vaccine in ten individuals who recovered from SARS-CoV-2 infection prior to vaccination to 20 individuals with no history of infection, against clinical isolates of B.1.1.7, B.1.351, P.1, and the original SARS-CoV-2 virus. Vaccination boosted pre-existing levels of anti-SARS-CoV-2 spike antibodies 10-fold in previously infected individuals, but not to levels significantly higher than those of uninfected vaccinees. However, neutralizing antibody titers increased in previously infected vaccinees relative to uninfected vaccinees against every variant tested: 5.2-fold against B.1.1.7, 6.5-fold against B.1.351, 4.3-fold against P.1, and 3.4-fold against original SARS-CoV-2. Our study indicates that a first-generation COVID-19 vaccine provides broad protection from SARS-CoV-2variants in individuals with previous infection.
Determinants of Obesity in West Africa: A Systematic Review
Authors: Agyemang Kingsley , Pokhrel Subhash , Victor Christina , Anokye Nana Kwame
Published: April 2021

Objectives

Obesity prevalence is increasing in West Africa. This study explores obesity determinants in West Africa to inform policy.

Methods

Scopus, Web of Science and PsycINFO were searched for relevant papers from March to April 2020. The search strategy included combinations of key words specific to each database. Eligibility criteria included studies on obesity determinants conducted in West Africa, and involving participants aged eighteen years and above. The quality of the studies was appraised using the Agency for Healthcare Research and Quality checklist. Data was synthesized qualitatively.

Results

Sixty-three (63) papers were selected. Majority of the studies originated from Ghana (n=22) and Nigeria (n=19). All included studies used cross-sectional study design. In all, 36 determinants were identified, of which 20 were demographic, socio-economic, lifestyle and biological factors, and sixteen 16 were environmental factors, like physical proximity to fast food outlets. Increasing age (OR=0.09, 95% CI= 0.12 to 65.91) and being a woman (OR=1.38, 95% CI=1.18 to 55.40) were the common determinants of obesity in West Africa.

Conclusion

Obesity in West Africa is determined by complex multi-faceted factors. There is an urgent need for robust engagement with wider stakeholder groups to develop obesity prevention and control policies in West Africa.
Loss of lamin-B1 and defective nuclear morphology are hallmarks of astrocyte senescencein vitroand in the aging human hippocampus
Authors: Matias Isadora , Diniz Luan Pereira , Damico Isabella Vivarini , da Silva Neves Laís , Bergamo Araujo Ana Paula , Vargas Gabriele , Leite Renata E. P. , Suemoto Claudia K. , Nitrini Ricardo , Jacob-Filho Wilson , Grinberg Lea T. , Hol Elly M. , Middeldorp Jinte , Alcantara Gomes Flávia Carvalho
Published: April 2021

The increase in senescent cells in tissues, including the brain, is a general feature of normal aging and age-related pathologies. Senescent cells exhibit a specific phenotype, which includes an altered nuclear morphology and transcriptomic changes. Astrocytes undergo senescencein vitroand in age-associated neurodegenerative diseases, but little is known about whether this process also occurs in physiological aging. Here, we investigated astrocyte senescencein vitro, in old mouse brains and inpost-mortemhuman brain tissue of elderly. We identified a significant loss of lamin-B1, a major component of the nuclear lamina, as a hallmark of senescent astrocytes. We showed a severe reduction of lamin-B1 in the dentate gyrus of aged mice, including in hippocampal astrocytes, and in the granular cell layer of the hippocampus ofpost-mortemhuman tissue from non-demented elderly. Interestingly, the lamin-B1 reduction was associated with nuclear deformations, represented by an increased incidence of invaginated nuclei and loss of nuclear circularity in senescent astrocytesin vitroand in the aging human hippocampus. In conclusion, our findings show that reduction of lamin-B1 is a conserved hallmark of astrocyte aging, as well as shed light on significant defects in nuclear lamina structure, which may impact astrocyte function during human aging.