bluuebunny/crossref_metadata_2025 huggingface dataset:
Administration of fibrinogen concentrate combined with prothrombin complex maintains hemostasis in children undergoing congenital heart repair (a long‐term propensity score‐matched study)
Authors: Velik‐Salchner Corinna , Tauber Helmuth , Rastner Verena , Pajk Werner , Mittermayr Markus , Wally Dieter , Kilo Juliane , Vondrys David , Fries Dietmar , Fritz Josef , Streif Werner
Published: June 2021

Background

Bleeding is a common problem in children with congenital heart disease undergoing major cardiac surgery requiring cardiopulmonary bypass (CPB). Little is known about optimal management with blood products.

Objective

To investigate clinical outcome and hemostatic effects of fibrinogen concentrate (FC) in combination with prothrombin complex concentrate (PCC) versus standard treatment with fresh frozen plasma (FFP) in children undergoing cardiac surgery.

Methods

For this single‐institution cohort study, data on 525 children were analyzed. Propensity score matching in 210 children was applied to reduce the impact of various baseline characteristics.

Results

Three children treated with FC/PCC developed surgical site bleeding requiring surgical revision. One child developed central venous line‐related thrombosis. Blood loss through chest tube drainage was independent of FC/PCC. Coagulation abnormalities were not present in any of these children. Time to extubation and ICU stay did not differ. In the FC/PCC group, children received (median, Q1, Q3) 52 mg/kg (32, 83) FC and 28IU/kg (13, 44) PCC. Fibrinogen concentration was comparable at baseline. On admission to the ICU, fibrinogen was higher in children receiving FC/PCC, namely, 232 mg/dL (196, 280), than in children receiving FFP (186 mg/dL, 149, 224; P < .001). On discharge from the ICU, values did not differ ((FC/PCC 416 mg/dL (288, 501)), non‐FC/PCC 418 mg/dL (272, 585; P = 1.000)).

Conclusion

FC/PCC was well tolerated and permitted hemostasis to be maintained, even in the very young. We were not able to detect a signal for inferiority of this treatment. We conclude that FC/PCC can safely replace FFP.
Pre‐hospital emergency anaesthesia in trauma patients treated by anaesthesiologist and nurse anaesthetist staffed critical care teams
Authors: Árnason Bjarni , Hertzberg Daniel , Kornhall Daniel , Günther Mattias , Gellerfors Mikael
Published: June 2021

Background

Pre‐hospital tracheal intubation in trauma patients has recently been questioned. However, not only the trauma and patient characteristics but also airway provider competence differ between systems making simplified statements difficult.

Method

The study is a subgroup analysis of trauma patients included in the PHAST study. PHAST was a prospective, observational, multicentre study on pre‐hospital advanced airway management by anaesthesiologist and nurse anaesthetist manned pre‐hospital critical care teams in the Nordic countries May 2015‐November 2016. Endpoints include intubation success rate, complication rate (airway‐related complication according to Utstein Airway Template by Sollid et al), scene time (time from arrival of the critical care team to departure of the patient) and pre‐hospital mortality.

Result

The critical care teams intubated 385 trauma patients, of which 65 were in shock (SBP <90 mm Hg), during the study. Of the trauma patients, 93% suffered from blunt trauma, the mean GCS was 6 and 75% were intubated by an experienced provider who had performed >2500 tracheal intubations. The pre‐hospital tracheal intubation overall success rate was 98.6% and the complication rate was 13.6%, with no difference between patients with or without shock. The mean scene time was significantly shorter in trauma patients with shock (21.4 min) compared to without shock (21.4 vs 25.1 min). Following pre‐hospital tracheal intubation, 97% of trauma patients without shock and 91% of the patients in shock with measurable blood pressure were alive upon arrival to the ED.

Conclusion

Pre‐hospital tracheal intubation success and complication rates in trauma patients were comparable with in‐hospital rates in a system with very experienced airway providers. Whether the short scene times contributed to a low pre‐hospital mortality needs further investigation in future studies.
A Woodcutter’s Story: Perceptions and Uses of Mathematics on the San Carlos Apache Reservation
Authors: Stevens Philip J.
Published: June 2021

This article introduces the term Apache mathematics to define mathematics used by Apache people. Using ethnographic, autoethnographic, and qualitative interviews, the author highlights the cultural production of mathematics in the San Carlos Apache community, contrasting hegemonic Eurocentric claims to mathematics. Findings contributes Apache perspectives on the cultural uses of mathematics, as strength and intelligence central for shifting school‐based pedagogy meted to Apache students in current contexts of gross educational inequities.
Evaluation of a novel C‐Arm draping technique to minimize surgical field contamination and surgery time
Authors: Darbandi Aria , Pujari Amit , Lin Carol
Published: June 2021

Background

The purpose of this study is to compare the sterility of three C‐Arm draping techniques: the clip‐drape, sterile pouch, and a novel drape tower method. We hypothesize that our novel technique will minimize floor contamination from reaching the surgical field while allowing the C‐Arm machine to rotate between lateral and anterior–posterior positions more quickly.

Methods

Five trials consisting of rotating the C‐Arm and simulating surgeon movement were run using each technique. Ultraviolet light illuminating melamine powder was used to represent floor contamination. Measurements of melamine powder encroachment on the drapes were taken using the top of the C‐Arm in lateral position as the reference point. The time needed to assemble, deploy, and retract the C‐Arm was measured for each technique. The gown, gloves, and mayo stand were also examined after each trial for contamination.

Results

Compared to the clip drape, the drape tower prevented contamination from reaching the C‐Arm by an additional 30.5 cm (95% confidence interval (CI): 17.0–43.9, P < 0.001). The drape tower had faster deployment and retraction times than both the clip drape (P < 0.001 and P < 0.001, respectively) and sterile pouch (P = 0.011 and P < 0.001, respectively). The clip drape and sterile pouch exhibited glove contamination in two (40%) simulations, while the drape tower showed no instances of contamination (P = 0.255).

Conclusions

The novel drape tower technique limits the encroachment of floor contamination onto sterile drapes. It should be considered as an alternative draping method for lower extremity surgery.
Opportunities, controversies, and challenges of extracorporeal hemoadsorption with CytoSorb during ECMO
Authors: Napp L. Christian , Lebreton Guillaume , De Somer Filip , Supady Alexander , Pappalardo Federico
Published: June 2021

Extracorporeal membrane oxygenation (ECMO) is frequently used in many centers around the globe for various indications. However, prognosis is often poor even with all supportive therapies, and in many cases, clinical deterioration is associated with inflammation. Hemoadsorption with CytoSorb is a novel approach to limit the inflammatory response, and the device can be safely and easily installed into ECMO circuits. CytoSorb has been used more than 130.000 times to date, but because randomized controlled trials are largely lacking, there is substantial debate on its use. Here, experts from critical care medicine, cardiology, cardiac surgery, and perfusion technology discuss the pros and cons of this novel therapy and outline the future aspects for its clinical application and research.
From a Pictogram to a Symbol: Working with a Transgender Patient in an NHS Gender Clinic Using Piera Aulagnier's Theory of Identity Formation
Authors: Zalewska Agnieszka
Published: June 2021

This article presents clinical work with a transgender patient who was attending a regional NHS gender clinic in England. It aims to link aspects of the patient's identity formation with the theoretical framework offered by the French psychiatrist and psychoanalyst Piera Aulagnier. Emphasizing the complexity of (gender) identity and its process of development, the concept of the ‘birth of the body’ is used to situate the development of gender identity as a process of the creation of an individual narrative, with the experience of embodiment based on unconscious fantasy as specifically troubling for transgender individuals. This struggle may be seen in the clinical material presented. Recommendations are made for working with transgender clients who suffer from a disturbance in creating and navigating relationships. By using the concept of the ‘word‐bearer’, an exploration may be opened up of the unconscious dynamics between the clinic as an object that offers understanding, and the service user who is seeking meaning and a remedy for subjective suffering.
Novel therapeutics for hydrocephalus: Insights from animal models
Authors: Wang Chuansen , Wang Xiaoqiang , Tan Changwu , Wang Yuchang , Tang Zhi , Zhang Zhiping , Liu Jingping , Xiao Gelei
Published: June 2021

Hydrocephalus is a cerebrospinal fluid physiological disorder that causes ventricular dilation with normal or high intracranial pressure. The current regular treatment for hydrocephalus is cerebrospinal fluid shunting, which is frequently related to failure and complications. Meanwhile, considering that the current nonsurgical treatments of hydrocephalus can only relieve the symptoms but cannot eliminate this complication caused by primary brain injuries, the exploration of more effective therapies has become the focus for many researchers. In this article, the current research status and progress of nonsurgical treatment in animal models of hydrocephalus are reviewed to provide new orientations for animal research and clinical practice.
Daily experiences of type 1 diabetes stress across adulthood
Authors: Kelly Caitlin S. , Berg Cynthia A. , Lee Tracy Eunjin , Staylor Kaitlyn , Thomas Amanda , Helgeson Vicki S.
Published: June 2021

Aims

Daily diabetes stressful events take a toll on individuals with type 1 diabetes, and these experiences may look different across adulthood. The aims of the current study were to understand the nature of daily diabetes stress across adulthood and explore whether these experiences differed by age.

Methods

In this qualitative study, adults with T1D (N = 199, Mage = 46.81 years) described the most stressful event related to their diabetes each evening as part of a 14‐day diary. Using a grounded theory approach, diabetes stressful events were coded for where they occurred, the source of stress (i.e. interpersonal or not), and content (e.g. sleep; blood glucose checking; frustration).

Results

Participants reported having a diabetes‐related stressful event on 58% (M = 0.58, SD = (0.25)) of days. Daily stressful events included issues of diabetes management, diabetes‐related interference to or from other areas of life, and negative impact on psychological well‐being, but rarely included a social component. Older adults were less likely to report having a diabetes‐related stressful event, but were more likely to report that stressful events occurred at home, compared to younger adults.

Conclusion

The lived experience of diabetes‐related stress appears similar across ages, with individuals continuing to experience generally the same types of diabetes‐related events in similar frequencies. Interventions to help improve diabetes outcomes or well‐being may benefit from targeting the most commonly experienced areas of stress, which includes reducing the interference of daily activities to and by diabetes management.
#NeverAgainMSD Student Activism: Lessons for Agonist Political Education in an Age of Democratic Crisis
Authors: Abowitz Kathleen Knight , Mamlok Dan
Published: June 2021

Abstract

In this essay, Kathleen Knight Abowitz and Dan Mamlok consider the arguments for agonist political education in light of a case study based in the events of the 2018 mass shooting at Stoneman Douglas High School in Parkland, Florida, and the subsequent activism of its survivors. We use this case to examine agonist expressions of citizenship, and to present an argument for framing agonist politics through the lens of Deweyan transactional communication combined with the critical concept of articulation. A major lesson in this case is the significance of citizenship learning that prioritizes challenging the political status quo along with working to reestablish new political relations on grounds that are more just. The authors argue that the endgame of agonist‐informed political education should be that which helps students, as present and future citizens, reconstruct existing political conditions. Knight Abowitz and Mamlok conclude with suggestions for four domains of knowledge and capacities that can productively shape agonist citizenship education efforts: political education, lived citizenship, critical political literacies, and critical digital literacies.
Therapeutic Justice ‐ What It Means for the Family Justice System in Singapore†
Authors: Loi Yarni , Chin Suzanne
Published: June 2021

For some time now, the family courts in Singapore have recognised that in the area of family disputes, a more conciliatory and less adversarial approach is required to achieve better outcomes for families. Hence, since the mid‐1990s, mediation and counselling programs have been incrementally introduced into the family justice process, culminating in compulsory court mediation and counselling for divorcing couples with minor children. Building on these efforts, and pursuant to the recommendations of an inter‐agency committee, a second wave of wide‐ranging reforms were introduced in 2014 to further transform the family justice system. The reforms included the setting up of a unified family court, namely, the Family Justice Courts (FJC), the introduction of a differentiated case management system and the introduction of the “judge‐led” approach to empower the judge to more effectively manage a case. Building on this momentum and in yet another milestone moment, Presiding Judge Debbie Ong recently announced in FJC's workplan speech in May 2020 that the family justice system in Singapore will seek to deliver “Therapeutic Justice.” Expressly embracing and articulating TJ at this point of FJC's journey provides an important organising framework within which, and lens through which, the family justice system can pull together the threads of its past efforts and, at the same time, collectively co‐create a truly transformative TJ vision for the future. Since her announcement, the apex court in Singapore has, in published case law, stated that “TJ is not merely an ideal it is a necessity. It is not merely theoretical but it is intensely practical. It is axiomatic that relationships constitute the very pith and marrow of a family. When familial relationships break down, those relationships (between spouses and between each spouse and the children) are damaged. Such damage cannot be repaired (completely at least) by way of material recompense; healing needs to take place.” TJ is now firmly established in the lexicon of family justice in Singapore. The challenge and task ahead is for all the family justice professionals including law and policy makers, universities, academics and teachers of family law, family judges, family lawyers, psychologists, counsellors and other allied mental health professionals who operate within the family justice eco‐system to work together, to build on what adopting TJ means for family justice in Singapore, in refining our TJ narrative and implementing TJ in practical terms, entailing both the therapeutic design of family law and the therapeutic application of family law.
Taking the Hit: Despite IRS Attempts, Domestic Abuse Victims Cannot Get Innocent Spouse Protection When their Partner's Commit Tax Fraud
Authors: Zagorski Breanna
Published: June 2021

The IRS offers an Innocent Spouse Protection provision allowing innocent spouses protection from the consequences of their partner's tax fraud if they filed a joint return. However, this protection fails to protect the most vulnerable innocent spouses – domestic abuse victims. The IRS has tried to help domestic abuse victims in tax fraud situations; however, their attempts have been unsuccessful as this protection is rarely granted, leaving innocent people liable for their partner's tax fraud. This Note proposes that the IRS amend their standard of review and code when admitting evidence of domestic abuse to better protect abuse victims.
Wildfire affects expression of male sexual plumage through suppressed testosterone circulation in a tropical songbird
Authors: Boersma Jordan , Barron Douglas G. , Baldassarre Daniel T. , Webster Michael S. , Schwabl Hubert
Published: June 2021

Natural disturbances like drought and wildfires are expected to increase in prevalence, so understanding how organisms are affected is a key goal for conservationists and biologists alike. While many studies have illustrated long‐term effects of perturbations on survival and reproduction, little is known of short‐term effects to physiology and sexual signal expression. Ornamental traits have been proposed as reliable indicators of environmental health, yet studies are lacking in the context of natural disturbances. Here we present short‐term (7–65 days) responses of male red‐backed fairywrens Malurus melanocephalus to wildfire near the onset of the typical breeding season. Young males of this species are characterized by plastic expression of sexual plumage phenotypes depending on circulating testosterone and body condition. Using two populations with fairywren captures before and after separate wildfires we illustrate that wildfire suppressed molt into ornamented plumage. Neither baseline plasma corticosterone or furcular fat stores were affected by fire. However, fire seemed to interfere with the termporal increase in plasma testosterone during the pre‐breeding season, leading to a lower proportion of males molting into ornamented plumage. Collectively, these findings suggest that wildfires inhibit or greatly delay acquisition of ornamentation in males through enduring suppression of testosterone circulation.
Buyers' role in innovation procurement: Evidence from US military R&D contracts
Authors: Decarolis Francesco , de Rassenfosse Gaétan , Giuffrida Leonardo M. , Iossa Elisabetta , Mollisi Vincenzo , Raiteri Emilio , Spagnolo Giancarlo
Published: June 2021

This study provides the first quantification of buyers' role in the outcome of R&D procurement contracts. We combine together four data sources on US federal R&D contracts, follow‐on patented inventions, federal public workforce characteristics, and perception of their work environment. By exploiting the observability of deaths of federal employees, we find that managers' death events negatively affect innovation outcomes: a 1% increase in the share of relevant public officer deaths causes a decline of 32.3% of patents per contract, 20.5% patent citations per contract, and 34.3% patent claims per contract. These effects are driven by the deaths occurring in the 6 months before the contract is awarded, thereby indicating the relevance of the design and award stage relative to ex post contract monitoring. Lower levels of self‐reported within‐office cooperation also negatively impact R&D outcomes.
The Sweet Land: Manufacturing “Tradition” in Small‐Town Bolivia
Authors: Babel Anna M.
Published: June 2021

Chronotopes have been described as “envelopes” of time and space that provide the setting for the circulation of particular types of characters or personae (Silverstein 2005, Agha 2007, Bakhtin 1981, 1986). In this article, I investigate how these narratives of time and space are used to produce meaning in conjunction with structured relationships between groups of social categories, particularly discourses of tradition and modernity. Specifically, I examine the ways in which local actors shape and imagine how Saipina, a small town in central Bolivia, is represented to outside audiences. Influential actors produce a set of artifacts that represent the town, as well as a series of narratives that overlay values such as hard work and agricultural roots with goods such as sugarcane and chancaca, a raw sugar product, in representing the town to outside audiences.
Paediatric playground and tree‐related injuries: Hospital admissions in the Midland region of New Zealand
Authors: Bentley Maria , Amey Janet , Smith Alastair , Christey Grant
Published: June 2021

Aim

To examine the incidence and outcomes of paediatric playground and tree‐related injuries in the Midland region of New Zealand.

Methods

A retrospective review of Midland Trauma Registry hospitalisation data between January 2012 and December 2018 was undertaken. Cases included children aged 0–14 years hospitalised for playground and tree‐related injuries. Demographic and event information, injury severity and hospital‐related outcomes were examined.

Results

Playground and tree‐related hospitalisations (n = 1941) occurred with an age‐standardised rate of 144.3/100 000 (confidence interval (CI) 127.3–161.3) and increased 1.4% (CI 1.3–4.2%) annually. The highest incidence was observed in 5–9‐year olds (248.8/100 000) with 0–4 and 10–14‐year olds at 86.0 and 89.2/100 000, respectively. Injuries most commonly occurred at home, school or pre‐school (77.1%), 93.7% were due to falls and, the upper extremity was the most frequently injured body region (69.9%), particularly due to forearm (55.6%) and upper arm (34.7%) fractures. Tree‐related incidents comprised 11.6% of all injuries and explained 57.1% of injuries classified as major severity. Fifty‐eight percent of children were hospitalised for 1 day and 97.0% for less than 5 days. Estimated hospital costs were NZ$1.2 million annually with a median of NZ$3898 per incident. Injuries classified as minor severity accounted for 86.5% of the total estimated cost.

Conclusion

Children aged 5–9 years' experience high rates of costly hospitalisation for playground and tree‐related injuries. Targeted injury prevention initiatives, particularly in the home and school environments, are imperative to reduce the incidence and burden of playground and tree‐related injuries to affected children, their families and hospital resources.
Reduction of Selenicereus stem cuttings weight by fungal plant pathogens during storage
Authors: Taguiam John Darby , Evallo Edzel , Balendres Mark Angelo
Published: June 2021

Dragon fruit (Selenicereus spp.) is a high‐value crop in the Philippines. It is commonly propagated using stem cuttings, which quality is essential for fruit production. Several pathogens have been reported to cause various diseases in dragon fruit worldwide. These diseases affect stem and fruit quality in the field, but the consequences during storage are unknown. This study aims to determine the effect of three pathogens (Neoscytalidium dimidiatum, Epicoccum sorghinum, and Nigrospora sphaerica) on Selenicereus stem cuttings in controlled storage conditions. Three weeks after inoculation, only N. dimidiatum significantly reduced Selenicereus stem weight in both cooler (air‐conditioned storage area/19‐25°C) and warmer (room temperature/28‐30°C) temperatures. Nonetheless, all pathogens induced symptoms on stems, which caused a loss in product quality. Neoscytalidium dimidiatum caused significantly more severe symptoms under controlled conditions. In general, symptoms were more severe on the stems kept in the air‐conditioned storage area. This study highlights the importance of disease‐free planting materials and adequate temperature in the storage area in the preparation and dissemination of high‐quality dragon fruit stem cuttings.
Resilience assessment of electrified road networks subject to charging station failures
Authors: Wang Hongping , Abdin Adam F. , Fang Yi‐Ping , Zio Enrico
Published: June 2021

The number of electric vehicles (EVs) and charging facilities is expected to increase significantly in the near future, further coupling the existing transportation system with the power system. This may bring new stresses and risks to such a system of systems. This paper presents a mathematical framework to analyze the resilience of an electrified road network (ERN) subject to potential failures of its supporting fast‐charging stations (FCSs). Within this framework, a novel linear optimization model is proposed for the first time to solve the system optimal dynamic traffic assignment problem of ERN. The characteristics considered in the modeling framework include the location, capacity, and charging speed of FCSs, as well as the driving range, charging time, and state of charge (SoC) of EVs. The linear model is proposed based on the cell transmission model. It is used as the first‐stage model to assign the traffic under normal FCS operations. A second‐stage model is, then, extended to minimize the total travel time after the stochastic occurrence of FCS failures, that is, in the failure and recovery phases. Two metrics are considered to quantify the ERN performance and the impacts of FCS failures. A numerical example is studied to illustrate the usefulness of the proposed framework for analyzing ERN resilience. The results show that deploying FCSs near the highway entrances and maintaining their operation are relevant factors to enhance the system's resilience. The analysis can provide guidelines to the system operators for effective management of the ERN operation and identify resilience‐critical FCSs for system resilience improvement.
The Hearths of Scriptural Reasoning
Authors: Ochs Peter
Published: June 2021

See "Mark Randal James, 'Peter Ochs and the Logic of Scriptural Reasoning'"
Esophageal mucosal sensory nerves and potential mechanoreceptors in patients with ineffective esophageal motility
Authors: Sawada Akinari , Lei Wei‐Yi , Zhang Mengyu , Lee Chung , Ustaoglu Ahsen , Chen Chien‐Lin , Sifrim Daniel
Published: June 2021

Background

Ineffective esophageal motility (IEM) is the most common motility disorder. However, little is known about its pathophysiology. Vagal afferent nerves convey esophageal intraluminal bolus information to solitary nucleus, which is likely to be involved with esophageal primary and secondary peristalsis (SP). We hypothesized that altered mucosal sensory afferents underlie the pathogenesis of IEM.

Methods

We prospectively collected esophageal biopsies from 38 patients with proton pump inhibitor‐refractory reflux symptoms from January to December 2019. All patients underwent high‐resolution manometry for the evaluation of primary and secondary peristalsis, and off‐PPI 24‐h impedance‐pH studies. Biopsies were analyzed using immunohistochemistry for identification of calcitonin gene‐related peptide‐immunoreactive (CGRP‐IR) nerves and qPCR for mRNA expression of potential mechanoreceptors.

Key Results

Overall 32 patients were finally analyzed which consisted of 11 patients with normal motility and 21 patients with IEM. The position of mucosal CGRP‐IR nerves from the esophageal lumen did not differ between the two groups (the proximal esophagus (p = 0.52), the mid‐esophagus (p = 0.92), the distal esophagus (p = 0.29)) with the similar reflux profile. No difference was seen in the position of CGRP‐IR nerves between patients with successful triggering of SP and those unable to trigger SP. There was also no difference in mRNA expression of each potential mechanoreceptors (TRPA1, TRPV1, TRPV4, ASIC1, ASIC3) between the two groups.

Conclusions and Inferences

Our study showed that mucosal sensory afferents nerve position and mRNA expression of potential mechanoreceptors did not correlate to weak esophageal contraction.
Host specificity and interaction networks of insects feeding on seeds and fruits in tropical rainforests
Authors: Basset Yves , Jorge Leonardo R. , Butterill Philip T. , Lamarre Greg P. A. , Dahl Chris , Ctvrtecka Richard , Gripenberg Sofia , Lewis Owen T. , Barrios Héctor , Brown John W. , Bunyavejchewin Sarayudh , Butcher Buntika A. , Cognato Anthony I. , Davies Stuart J. , Kaman Ondrej , Klimes Petr , Knížek Miloš , Miller Scott E. , Morse Geoffrey E. , Novotny Vojtech , Pongpattananurak Nantachai , Pramual Pairot , Quicke Donald L. J. , Sakchoowong Watana , Umari Ruma , Vesterinen Eero J. , Weiblen George , Wright S. Joseph , Segar Simon T.
Published: June 2021

In the tropics, antagonistic seed predation networks may have different properties than mutualistic pollination and seed dispersal networks, but the former have been considerably less studied. We tested whether the structure of antagonistic tripartite networks composed of host plants, insects developing within seeds and fruits, and their insect parasitoids could be predicted from plant phylogenetic distance and plant traits. We considered subsets of the networks (‘subnetworks') at three rainforest locations (Panama, Thailand, Papua New Guinea), based on insect families, plant families or plant functional groups. We recorded 3197 interactions and observed a low percentage of realized interactions, especially in Panama, where insect host specificity was higher than in Thailand or New Guinea. Several factors may explain this, including insect faunal composition, incidence of dry fruits, high fruit production and high occurrence of Fabaceae at the Panamanian site. Host specificity was greater among seed‐eaters than pulp‐eaters and for insects feeding on dry fruits as opposed to insects feeding on fleshy fruits. Plant species richness within plant families did not influence insect host specificity, but site characteristics may be important in this regard. Most subnetworks were extremely specialized, such as those including Tortricidae and Bruchinae in Panama. Plant phylogenetic distance, plant basal area and plant traits (fruit length, number of seeds per fruit) had important effects on several network statistics in regressions weighted by sampling effort. A path analysis revealed a weak direct influence of plant phylogenetic distance on parasitoid richness, indicating limited support for the ‘nasty host hypothesis'. Our study emphasizes the duality between seed dispersal and seed predation networks in the tropics, as key plant species differ and host specificity tends to be low in the former and higher in the latter. This underlines the need to study both types of networks for sound practices of forest regeneration and conservation.
Translingual delirium: Aleksandra Lun’sLos palimpsestos
Authors: Kellman Steven G.
Published: June 2021

Though literary translingualism—the phenomenon of writing in an adopted language—has a long history, it is only within the past three decades that it has received focused scholarly attention. Translingual writers have begun to see themselves as part of a tradition. More than isolinguals, they tend to be acutely and explicitly conscious of language as not only their medium but also their matter.Los palimpsestos, a comic novel by Aleksandra Lun, a native Polish speaker who writes in Spanish but lives in Belgium, interrogates the translingual tradition. Narrated in Spanish by a Pole confined to a psychiatric ward in Liège, where he undergoes “la terapia bartlebiana” (“Bartlebyan therapy”) designed to cure him of exophony, it is a screwball account of his unhappy career writing novels in the fictional language Antarctic. With cameo appearances by Samuel Beckett, Karen Blixen, E. M. Cioran, Joseph Conrad, Jerzy Kosiński, Ágota Kristóf, and Vladimir Nabokov, the novel situates its protagonist within the community of modern literary language‐switchers. It interrogates their varied motivations, their relations with their readers, and the complicated connections among language, nationality, and identity. It extends the tradition of literary translingualism by constituting metacommentary on a phenomenon that is already self‐conscious about language.
Rubidium isotope shift measurement using noisy lasers
Authors: Bucci Theodore J. , Feigert Jonathan , Crescimanno Michael , Chamberlain Brandon , Giovannone Alex
Published: June 2021

The data that students collect from the typical advanced undergraduate experiment on saturated absorption spectroscopy (SAS) of rubidium can be used to measure the isotope shift and thus lead to an estimate of the isotopic ground-state energy shift. This helps students refine their “picture” of the atomic ground state. We describe theoretically why SAS works well with free-running laser diodes, demonstrate this fact experimentally using free-running lasers tuned to either principal near-infrared transitions, and provide an extension of this experiment using the modulation transfer spectroscopy method.
Impact of CYP2C19 Phenotype and Drug-Drug Interactions on Voriconazole Concentration in Pediatric Patients
Authors: Tian Xueke , Zhang Congmin , Qin Zifei , Wang Dao , Yang Jing , Zhang Xiaojian
Published: June 2021

Voriconazole (VRC), a first-line agent for the treatment of invasive fungal infections, is mainly metabolized by human cytochrome P450 (CYP) 2C19. In this study, a retrospective analysis was performed to investigate the key factors that influence the plasma trough concentration (
C
min
) of VRC, and an appropriate dosing regimen for pediatric patients was drafted subsequently.
Amaryllidaceae Alkaloid Cherylline Inhibits the Replication of Dengue and Zika Viruses
Authors: Ka Seydou , Merindol Natacha , Sow Aïssatou Aïcha , Singh Amita , Landelouci Karima , Plourde Mélodie B. , Pépin Geneviève , Masi Marco , Di Lecce Roberta , Evidente Antonio , Seck Matar , Berthoux Lionel , Chatel-Chaix Laurent , Desgagné-Penix Isabel
Published: June 2021

Dengue fever, caused by dengue virus (DENV) is the most prevalent arthropod-borne viral disease and is endemic in many tropical and subtropical parts of the world, with an increasing incidence in temperate regions. The closely related flavivirus Zika virus (ZIKV) can be transmitted vertically
in utero
and causes congenital Zika syndrome and other birth defects.
Multiresistance to Nonazole Fungicides in Aspergillus fumigatus TR
34
/L98H Azole-Resistant Isolates
Authors: Gonzalez-Jimenez I. , Garcia-Rubio R. , Monzon S. , Lucio J. , Cuesta I. , Mellado E.
Published: June 2021

Drug resistance is a worldwide problem affecting all pathogens. The human fungal pathogen
Aspergillus fumigatus
coexists in the environment with other fungi targeted by crop protection compounds, being unintentionally exposed to the selective pressure of multiple antifungal classes and leading to the selection of resistant strains.
A. fumigatus
azole-resistant isolates are emerging in both clinical and environmental settings.
A Nonlethal Murine Flame Burn Model Leads to a Transient Reduction in Host Defenses and Enhanced Susceptibility to Lethal Pseudomonas aeruginosa Infection
Authors: Brammer Jerod , Choi Myeongjin , Baliban Scott M. , Kambouris Adrienne R. , Fiskum Gary , Chao Wei , Lopez Kerri , Miller Catriona , Al-Abed Yousef , Vogel Stefanie N. , Simon Raphael , Cross Alan S.
Published: June 2021

Of the 486,000 burn injuries that required medical treatment in the United States in 2016, 40,000 people were hospitalized, with >3,000 fatalities. After burn injury, humans are at increased risk of sepsis and mortality from infections caused by
Pseudomonas aeruginosa
, an opportunistic pathogen.
Reconstructing the tectono-sedimentary evolution of the Early–Middle Jurassic Tlaxiaco Basin in southern Mexico: New insights into the crustal attenuation history of southern North America during Pangea breakup
Authors: Zepeda-Martínez Mildred , Martini Michelangelo , Solari Luigi A. , Mendoza-Rosales Claudia C.
Published: June 2021

During Pangea breakup, several Jurassic extensional to transtensional basins were developed all around the world. The boundaries of these basins are major structures that accommodated continental extension during Jurassic time. Therefore, reconstructing the geometry of Jurassic basins is a key factor in identifying the major faults that produced continental attenuation during Pangea breakup. We reconstruct the tectono-sedimentary evolution of the Jurassic Tlaxiaco Basin in southern Mexico using sedimentologic, petrographic, and U-Pb geochronologic data. We show that the northern boundary of the Tlaxiaco Basin was an area of high relief composed of the Paleozoic Acatlán Complex, which was drained to the south by a set of alluvial fans. The WNW-trending Salado River–Axutla fault is exposed directly to the north of the northernmost fan exposures, and it is interpreted as the Jurassic structure that controlled the tectono-sedimentary evolution of the Tlaxiaco Basin at its northern boundary. The eastern boundary is represented by a topographic high composed of the Proterozoic Oaxacan Complex, which was exhumed along the NNW-trending Caltepec fault and was drained to the west by a major meandering river called the Tlaxiaco River. Data presented in this work suggest that continental extension during Pangea breakup was accommodated in Mexico not only by NNW-trending faults associated with the development of the Tamaulipas–Chiapas transform and the opening of the Gulf of Mexico, but also by WNW-trending structures. Our work offers a new perspective for future studies that aim to reconstruct the breakup evolution of western equatorial Pangea.
Specific Features of the Motor Potentials of the Leg Muscles Induced by Magnetic Stimulation under the Conditions of a Five-Day “Dry” Immersion in Healthy Volunteers
Authors: Nosikova I. N. , Ryabova A. M. , Dmitrieva L. E. , Zakirova A. Z. , Kitov V. V. , Tomilovskaya E. S. , Kozlovskaya I. B.
Published: June 2021

The aim of this study was to analyze the mechanisms of the development of hypogravitational hyperreflexia in the motoneuron pool of gravity-dependent muscles such as the gastrocnemius and soleus muscles of the leg under the conditions of five-day “dry” immersion in healthy volunteers using the method of transcranial and trans-spinal magnetic stimulation. The essence of the method lies in the stimulation of the areas of interest (motor areas of the cerebral cortex and lumbosacral thickening) with an electromagnetic stimulus. The study involved 10 subjects at the age of 29.9 ± 6.9 years, with no history of movement disorders or neurological diseases. The excitability of the motor neuron pool in both muscles was judged by the values of the thresholds and amplitudes of the motor response caused by transcranial and trans-spinal magnetic stimulations. A general pattern manifested in a significant decrease in thresholds and an increase in the amplitudes of motor responses caused by trans-spinal magnetic stimulation in both muscles gas been discovered. Specifically, the threshold of spinal evoked motor responses in both muscles decreased by 20%, and the amplitude increased by 150% after the end of immersion. The data obtained during the experiment confirm the spinal nature of the origin of hypogravitational hyperreflexia.
Fifteen-minute consultation: A structured approach to a child with primary spontaneous pneumothorax
Authors: Buckley Simon James , Adu John , Whitaker Donald , Gupta Atul
Published: June 2021

Primary spontaneous pneumothorax (PSP) is an uncommon presentation in children but may occur at any age and occurs in patients with no pre-existing lung disease. Management aims are to re-expand the collapsed lung, relieve pressure in the intrapleural space and avoid a tension pneumothorax. Correct management of PSP will avoid unnecessary intervention, reduce length of hospital stay and also reduce the risk of recurrence. There are no established guidelines for treating PSP in children and there is significant variation in management among centres and clinicians. This article provides a clear, evidence-based and structured approach to assessment and management of PSP in children and young people.
Bilateral macular drusen in acquired partial lipodystrophy with type 2 membranoproliferative glomerulonephritis
Authors: Tanner Alexander , Chan Hwei Wuen , Stears Anna , Moosajee Mariya
Published: June 2021

A 35-year-old woman with acquired partial lipodystrophy (PLD) and features of type 2 membranoproliferative glomerulonephritis (MPGN-II), presented with difficulty in her fine detailed vision over the past year. She had right amblyopia from a hypermetropic anisometropia with astigmatism, displaying a best-corrected visual acuity of 0.50 and 0.00 LogMAR, in the right and left eye, respectively. Funduscopy showed bilateral symmetrical drusenoid deposits most prominent in the temporal macula with clusters in the superior and inferior retina, outside the temporal vascular arcades. Multimodal retinal imaging was performed, which confirmed hyperautofluorescent drusen located between the retinal pigment epithelium and Bruch’s membrane. Electroretinography showed bilateral mild peripheral macular dysfunction, but normal central macular function on the pattern electroretinogram. Both PLD and macular drusen, are rare as distinct disease entities, but an association does exist and may be linked to MPGN-II.
Invasive mole presenting as a heavily bleeding vaginal lesion 3 weeks after uterine evacuation
Authors: Mamede Rita , Beja Mariana , Djokovic Dusan , Costa Cristina
Published: June 2021

Gestational trophoblastic disease occurs in 1–3:1000 gestations worldwide. Up to one-fifth of complete hydatidiform moles undergo malignant transformation, with 2%–4% manifesting as metastatic disease. Of these, a third present with vaginal metastases, which can cause bleeding and discharge. We describe the case of a 49-year-old primiparous woman presenting with syncope and intense bleeding from an anterior vaginal lesion, 3 weeks after uterine evacuation for a presumed spontaneous abortion. A vaginal metastatic nodule was suspected; haemostasis was achieved with vaginal packing, precluding the need for surgical intervention. The patient was ultimately diagnosed with invasive mole with vaginal and lung metastases (stage III high-risk gestational trophoblastic neoplasia (GTN)) and started on multiple-agent chemotherapy. Two months later the lesion had regressed completely, and remission was reached 2 weeks later. Clinicians should consider the possibility of metastatic GTN with vaginal involvement whenever heavy vaginal bleeding follows a recent history of failed pregnancy.
Recurrent severe respiratory infections with low CRP secondary to autoimmune IL-6 deficiency
Authors: Hackney Alexander , James Sunil , Karanam Surendra
Published: June 2021

C reactive protein (CRP) is an inflammatory protein that is often used in conjunction with the clinical presentation of a patient to help with quantifying infection severity and measuring treatment response. We report the case of a patient who presented with severe pneumonias but had a suboptimal CRP response, later diagnosed as having an underlying immunodeficiency. This case exemplifies the need to consider immunodeficiency as an underlying pathophysiological cause in patients presenting with complicated and severe infections.
Evaluating the provision of Further Enabling Care at Home (FECH+) for informal caregivers of older adults discharged home from hospital: protocol for a multicentre randomised controlled trial
Authors: Hill Anne-Marie , Moorin Rachael , Slatyer Susan , Bryant Christina , Hill Keith , Waldron Nicholas , Aoun Samar , Kamdar Ami , Grealish Laurie , Reberger Caroline , Jones Cindy , Bronson Mary , Bulsara Max K , Maher Sean , Claverie Tracey , Moyle Wendy
Published: June 2021

Introduction

There are personal and societal benefits from caregiving; however, caregiving can jeopardise caregivers’ health. The Further Enabling Care at Home (FECH+) programme provides structured nurse support, through telephone outreach, to informal caregivers of older adults following discharge from acute hospital care to home. The trial aims to evaluate the efficacy of the FECH+ programme on caregivers’ health-related quality of life (HRQOL) after care recipients’ hospital discharge.

Methods and analysis

A multisite, parallel-group, randomised controlled trial with blinded baseline and outcome assessment and intention-to-treat analysis, adhering to Consolidated Standards of Reporting Trials guidelines will be conducted. Participants (N=925 dyads) comprising informal home caregiver (18 years or older) and care recipient (70 years or older) will be recruited when the care recipient is discharged from hospital. Caregivers of patients discharged from wards in three hospitals in Australia (one in Western Australia and two in Queensland) are eligible for inclusion. Participants will be randomly assigned to one of the two groups. The intervention group receive the FECH+ programme, which provides structured support and problem-solving for the caregiver after the care recipient’s discharge, in addition to usual care. The control group receives usual care. The programme is delivered by a registered nurse and comprises six 30–45 min telephone support sessions over 6 months. The primary outcome is caregivers’ HRQOL measured using the Assessment of Quality of Life—eight dimensions. Secondary outcomes include caregiver preparedness, strain and distress and use of healthcare services. Changes in HRQOL between groups will be compared using a mixed regression model that accounts for the correlation between repeated measurements.

Ethics and dissemination

Participants will provide written informed consent. Ethics approvals have been obtained from Sir Charles Gairdner and Osborne Park Health Care Group, Curtin University, Griffith University, Gold Coast Health Service and government health data linkage services. Findings will be disseminated through presentations, peer-reviewed journals and conferences.

Trial registration number

ACTRN12620000060943.
Bridge study protocol: an international, observational cohort study on the transition of healthcare for adolescents with chronic conditions
Authors: Kosola Silja , Culnane Evelyn , Loftus Hayley , Tornivuori Anna , Kallio Mira , Telfer Michelle , Miettinen Päivi J , Kolho Kaija-Leena , Aalto Kristiina , Raivio Taneli , Sawyer Susan
Published: June 2021

Introduction

More than 10% of adolescents live with a chronic disease or disability that requires regular medical follow-up as they mature into adulthood. During the first 2 years after adolescents with chronic conditions are transferred to adult hospitals, non-adherence rates approach 70% and emergency visits and hospitalisation rates significantly increase. The purpose of the Bridge study is to prospectively examine associations of transition readiness and care experiences with transition success: young patients’ health, health-related quality of life (HRQoL) and adherence to medical appointments as well as costs of care. In addition, we will track patients’ growing independence and educational and employment pathways during the transition process.

Methods and analysis

Bridge is an international, prospective, observational cohort study. Study participants are adolescents with a chronic health condition or disability and their parents/guardians who attended the New Children’s Hospital in Helsinki, Finland, or the Royal Children’s Hospital (RCH) in Melbourne, Australia. Baseline assessment took place approximately 6 months prior to the transfer of care and follow-up data will be collected 1 year and 2 years after the transfer of care. Data will be collected from patients’ hospital records and from questionnaires completed by the patient and their parent/guardian at each time point. The primary outcomes of this study are adherence to medical appointments, clinical health status and HRQoL and costs of care. Secondary outcome measures are educational and employment outcomes.

Ethics and dissemination

The Ethics Committee for Women’s and Children’s Health and Psychiatry at the Helsinki University Hospital (HUS/1547/2017) and the RCH Human Research Ethics Committee (38035) have approved the Bridge study protocol. Results will be published in international peer-reviewed journals and summaries will be provided to the funders of the study as well as patients and their parents/guardians.

Trial registration number

NCT04631965.