bluuebunny/crossref_metadata_2025 huggingface dataset:
The victorious battles of the lost war against aquatic invasive plants: “Fluid” categorisation and multiple forms of ordinary commitment
Authors: Le Floch Sophie , Ginelli Ludovic
Published: May 2021

Focusing on invasive plant species management issues, we propose an empirically based contribution to one of the main challenges of contemporary geography theory, that of materiality. In keeping with the aim of analysing how practitioners on the ground engage with invasive aquatic plants in the littoral lakes of Aquitaine (south‐west France), we endorse a relational approach to categorisation, one that specifically emphasises categorisation as a process embedding, and fashioning, materiality and material agency. Nevertheless, we advocate a still overlooked critical attention to the most vibrant trends in new materialist geography, namely, the risk of minimising the separation issue. The results of our ethnographic inquiry show that the process of categorisation recognises, on the one hand, the indeterminacy of plants’ behaviour, mobility, and various other characteristics – i.e., a process pervaded with ideas of fluidity. Moreover, our results show that the process of categorisation comes with a large array of contextualised management objectives, imbued with the determination of people to keep some control over spreading phenomena – i.e., a process pervaded with ideas of creativity and responsibility. These results suggest that a reasonably sustained critical attention, firmly grounded in empirical analysis, can enable research to open up to novel opportunities for operational engagement with rapidly changing environments. We discuss how participatory territorial governance mechanisms should give way to ordinary modes of relating and separating, a condition for successful implementation of everyday contextualised struggles against invasive species, far from vitalist or eradication rhetoric.
Foundation stone of empire: The role of Portland stone in ‘heritage’, commemoration, and identity
Authors: Butler‐Warke Alice , Warke Matthew R.
Published: May 2021

In 2013, Portland Stone, a creamy white limestone from the Isle of Portland in Dorset, was named the world’s first “Global Heritage Stone Resource” (GSHR) by the Heritage Stone Task Group, a sub‐commission of the International Union of Geological Sciences. The criteria for GSHR designation are ambiguous, with the Task Group championing Portland Stone’s “cultural value” and “heritage,” neither of which are critically interrogated. In this paper we undertake a detailed critical discourse analysis of Hansard entries mentioning Portland Stone between 1803 and 2020. We reveal that the use of Portland Stone is intertwined with colonial oppression, class subjugation, empire politics, structural racism, and a mythologised, England‐centric vision of British national identity. In celebrating the use of Portland Stone as part of Britain’s “heritage”, we are condoning a narrative of Britishness that is exclusionary and whitewashed, and that supports an elite rewriting of national and international history. Drawing on critical heritage literature, we argue that the Heritage Stone Task Group must urgently reconsider their uncritical appraisal of “heritage” and “culture” and consult with social science colleagues to ensure that all voices are heard. Our study shows that through the history and nature of their usage, the rocks beneath our feet, our natural foundation, can become imbued with notions of regional and national identity, belonging and exclusion, memory and loss – they can become a powerful manifestation of symbolic and unequal power structures. While British society’s attention is turned to the imprint of colonialism, empire, and race on our geographies, we urge further consideration of the built environment: the very stones that construct our towns and cities, the plinths on which statues are erected, tell stories of oppression and domination that are an important part of British history, culture, and heritage.
Waterhouse–Friderichsen syndrome in a cat with Klebsiella spp. infection
Authors: Cole Laura P. , Hardas Alexandros , Priestnall Simon L. , Tinson Erica W.
Published: May 2021

Objective

To describe a case of Waterhouse–Friderichsen syndrome of adrenocortical failure in a cat with Klebsiella spp. infection.

Case Summary

A 12‐year‐old male neutered domestic short‐haired cat was referred for respiratory failure requiring mechanical ventilation. The cat remained comatose despite successful weaning from the ventilator and developed a Klebsiella pneumoniae pneumonia. On day 4 of hospitalization, the cat acutely deteriorated with profound hypotension, azotemia, and hyperkalemia, which rapidly progressed to cardiac arrest. Necropsy findings revealed massive adrenal hemorrhage and intralesional bacteria, termed Waterhouse–Friderichsen syndrome. Waterhouse–Friderichsen syndrome was suspected to have been the cause of acquired adrenocortical insufficiency and sudden death of the cat.

New or Unique Information

To the authors’ knowledge, this is the first report of sepsis causing Waterhouse–Friderichsen syndrome in a veterinary species.
Trauma responsive care model: An Aotearoa New Zealand research informed practice model for residential group homes
Authors: Greer Andrea
Published: May 2021

INTRODUCTION: This article presents a research-informed model of trauma responsive care for use in residential care practice social work settings with children and young people in Aotearoa New Zealand. The model was developed from a qualitative project which sought to address the research question “Does the quality of relationships with staff members have a positive impact on outcomes for children who reside in group home settings?”METHODS: Using semi-structured, in-depth interviews, eight children were interviewed regarding their experience of relationships while living within supervised group homes (SGHs). In order to gain multiple perspectives on this topic, six biological parents and two legal guardians of children were interviewed and focus group discussions were held with staff members from three SGHs. Thematic analysis was used to identify key themes identified from the findings.FINDINGS: Five dominant themes were identified from the children’s and parent’s interviews. The central theme was the importance of relationships; that relationship is the key when working with children who have experienced trauma. Children who have experienced trauma need to feel safe in the context of relationships and benefit from bottom-up interventions in order to heal from their traumatic experiences.CONCLUSION: A research-informed model of trauma responsive care was constructed from study findings informed by two principal bodies of knowledge: (1) attachment theory; and (2) neuroscience. The resultant trauma responsive care model provides a framework of strategies for anyone working with children in residential care settings who have experienced trauma and/ or attachment difficulties.
Social work and public health – Logical collaborators
Authors: Canty Justin
Published: May 2021

This last year, our lives have been turned upside down by Covid-19 and the public health responses needed to keep our communities safe. Most of us probablyhad little awareness of public health before this. At the height of lockdown, and almost overnight, public health had become a topic of daily conversation; suddenly, everyone was talking about epidemiology, and disease modelling. The pandemic turned public health from obscurity into a focusof intense and life-saving relevance, taking public health professionals a bit by surprise; everyone from chief medical officers to epidemiologists were getting crash courses in media interviews and press conferences. Skilled health communicators such as Siouxie Wiles in Aotearoa New Zealand and Norman Swan in Australia became crucial interpreters for the wider community inthe face of complex information about the pandemic. While many social workers may not know a lot about public health, either as a discipline or specialisation of medical practice, there are substantial points of connection with our profession—enough to consider that social work and public health are logical collaborators.
Chemosensory systems in predatory mites: from ecology to genome

Authors: Su Yaozong , Zhang Bo , Xu Xuenong
Published: May 2021

The reception of chemical cues in the environment is essential for the survival of almost all organisms, including phytoseiid mites. Compared with the progress made in the field of insect olfaction, the understanding of how predatory mites perceive chemical compounds and react to their surroundings is merely fragmentarily documented in past decades. In this review, we provide a guide in the field from chemoecology of herbivore-induced plant volatiles (HIPVs) as early as 1980s to the advances made in comparative genomics of predatory mites in 2019. We present from three aspects, i.e., chemosensory-guided feeding behavior, sensory structures and chemoreceptors predicted from genomes. The molecular principles of chemosensory system remain exciting areas for future research, since insights into the mechanisms underlying the sensing of chemical signals will not only contribute to a better understanding of predator behavior and physiology but may also open new avenues for the development of more specific and sustainable approaches to control pests by manipulating behaviors in predators. We then suggest three directions for future research: 1) chemoreceptor gene identification and function verification; 2) neural response circuit to stimuli and 3) application of chemoperception on feeding behavior. The potential methods and techniques are provided as well.
Identification of sloshing noises using convolutional neural network
Authors: Siva Teja Golla , Saurav Vara Prasad Chennuri , Venkatesham B. , Sri Rama Murty K.
Published: May 2021

Sloshing in fuel tanks has become a new source of noise in hybrid and high-end vehicles in the wake of reduced noise from major sources like the engine. It occurs due to the interactions of fluid inside the tank under various driving conditions of the vehicle. Interactions of fluid with the tank walls cause hit noise, and the fluid-fluid interactions cause splash noise. As the generation mechanism is different, the hit and splash noises demand different noise controlling strategies. Thus, identifying these noises during the design stage is important for implementing effective solutions in designing a quieter fuel tank. This paper presents a convolutional neural network (CNN) based methodology for the identification of sloshing noises under different conditions of fill level, excitation, baffle configuration, etc. Data for training and testing the network are collected using a reciprocating test setup, which facilitates the generation of hit and splash noises in a rectangular tank. The identification accuracy of the features learned by CNN is compared with the hand-crafted features using support vector machines. The applicability of the proposed CNN model is tested for practical scenarios like vehicle braking, where different types of sloshing noises occur in quick succession.
Work–Life Balance in Athletic Training: A Perspective of the Athletic Trainer’s Spouse
Authors: Singe Stephanie Mazerolle , Mensch James
Published: May 2021

Informal support systems, such as spouses, friends, and family members, have been identified as possible facilitators to achieving a work–life balance (WLB) for athletic trainers. Little, however, is known about the spouse and their experiences facilitating a WLB. A total of 17 spouses (11 females and six males) of full-time athletic trainers completed our study. The participants journaled their responses to 14 open-ended questions that pertained to WLB. A general inductive approach revealed three major themes: (a) living in time blocks, (b) frequent work schedule changes, and (c) the duty of multiple roles within the family construct. Three more themes emerged as strategies that spouses utilize: (a) intentional planning, (b) adaptation, and (c) workplace integration. Although spouses face many challenges in their own lives, they acknowledge their support toward their spouse’s WLB. Spouses reported overall satisfaction with their current WLB but identified many ways it could be improved.
Sprinters Report Poorer Medial Tibial Stress Syndrome Outcomes Compared With Endurance Runners Over the Course of a Competitive Track Season
Authors: Balsamo Leah M. , Clark Kenneth P. , Morrison Katherine E. , Cattano Nicole M.
Published: May 2021

Context: Medial tibial stress syndrome (MTSS) is an overuse injury studied in endurance (ED) runners with minimal data on sprint (SP) athletes. Incorporating patient-reported outcome measures (PROMs) into clinical practice with running athletes may provide an objective way to track and treat MTSS. Purpose: To investigate PROMs as a means to monitor MTSS and general wellness in all running (i.e., ED and SP) track athletes during a competitive season. Results: The PROMs overall showed few MTSS symptoms and good global health (mean MTSS score: 0.35 ± 0.85, mean Global Health score: 33.6 ± 3.5). Sprinters reported significantly poorer MTSS scores and Global Health scores (0.544, 95% confidence interval, CI, [0.370, 1.050], p = .04]; 32.50, 95% CI [30.84, 34.16], p = .028) than ED runners (0.04, 95% CI [0.000, 0.041]; 35.5, 95% CI [33.29, 37.65]). There was a main deteriorating effect over time for the MTSS score (p = .047). Conclusions: Sprinters reported more symptoms than ED runners and need to be further researched as an independent population. The PROMs may be useful in tracking symptoms and modifying practices for individual track athletes.
Exercise Training and Neuromuscular Parameters in Patients With Type 1 Diabetes: Systematic Review and Meta-Analysis
Authors: Flores Eduardo B. , Reichert Thaís , Farinha Juliano B. , Kruel Luiz Fernando M. , Costa Rochelle R.
Published: May 2021

Background: The present study aimed to systematically review the literature on the effects of physical training on neuromuscular parameters in patients with type 1 diabetes mellitus (T1DM). Methods: The PubMed, Scopus, EMBASE, and COCHRANE databases were accessed in September 2020. Clinical trials that evaluated the effects of physical training on neuromuscular parameters (maximum strength, resistance strength, muscle power, muscle quality, and muscle thickness) of patients with T1DM compared with a control group were considered eligible. The results were presented as the standardized mean difference with 95% confidence intervals. Effect size (ES) calculations were performed using the fixed effect method, with α = .05. Results: Combined training increased the maximum strength levels in individuals with T1DM to a lesser extent than in healthy individuals (ES: 0.363; P = .038). Strength training increased the maximum strength (ES: 1.067; P < .001), as well as combined training (ES: 0.943; P < .001); both compared with aerobic training in patients with T1DM. Strength training increased the maximum strength in a similar magnitude to combined training in patients with T1DM (ES: −0.114; P = .624). Conclusion: Both combined training and strength training represent effective strategies for improving the maximum strength in individuals with T1DM.
Hand-Held Shoulder Strength Measures Correlate With Isokinetic Dynamometry in Elite Water Polo Players
Authors: Croteau Félix , Robbins Shawn M. , Pearsall David
Published: May 2021

Context: Previous authors suggest that lack of strength is an important risk factor for injuries in water polo. Hand-held dynamometers have potential as a clinical tool to measure strength, but they have not been validated in water polo players. Objective: The purpose of this study was to estimate intertrial variability and concurrent validity of hand-held dynamometer shoulder strength measurements in elite water polo players. Methods: A total of 19 male and 20 female elite water polo players performed isometric external (ER) and internal (IR) rotation strength tests against a hand-held dynamometer bilaterally in supine position with the shoulder in a 90–90 position. In addition, concentric IR and ER was captured at 90 deg/s with an isokinetic dynamometer, and torque values were determined near the 90–90 position. Main Outcome Measures: Spearman correlation coefficients were calculated for ER torque, IR torque, and ER/IR ratios between the devices. Two-way mixed-model intraclass correlations were used to assess intertrial variability. Results: Correlations between the devices were strong to very strong (ρ = .65–.82, P < .01) for absolute IR and ER but low for ER/IR ratios (ρ = .29, P = .07). There was less agreement at higher torque values. Intertrial variability was low with intraclass correlation values .88 to .93, P < .05. Conclusions: These results show that hand-held dynamometers are adequate clinical alternatives to measure absolute shoulder strength in water polo players. Stronger players may require stronger evaluators to resist the player’s push and obtain reliable results.
Examining Common and Specialized Soccer Content Knowledge and Demographic Variables of Chinese Physical Education Teachers
Authors: He Yaohui , Ward Phillip , Wang Xiaozan , Yang Guang
Published: May 2021

Purpose: To examine the relationships among demographic variables, common content knowledge (CCK), and specialized content knowledge (SCK) of Chinese physical education teachers in teaching soccer. Methods: One hundred twenty-nine physical education teachers’ CCK was assessed using 27 multiple choice questions, and SCK was assessed using content maps using an SCK index score. The data were analyzed using descriptive statistics, and multiple regression analyses were conducted to determine the relationships to demographic variables as predictors of CCK and SCK. A Spearman test assessed the associations between variables. Results: For CCK, 88.4% of the teachers scored at or above 60% correct in the test. The teacher’s gender (β = 0.22, t = −2.53, p < .05) and the number of soccer workshops attended (β = 0.33, t = 2.96, p < .001) significantly predicted CCK. About 92.2% of the teachers had an SCK index score of <2.9. The number of soccer workshops attended (β = 0.31, t = 2.74, p < .05) and teaching rank significantly predicted the SCK score. There was no relationship found between CCK and SCK. Conclusions: For these participants, their preservice education and their professional development did not serve them well in teaching CCK and SCK.
Relationship Between Imagery Ability, Performance, and Variables Related to Performance
Authors: Aikawa Satoshi , Takai Hideaki
Published: May 2021

Athletes believe imagery is essential for high-quality performance. It is essential to identify what type of imagery significantly contributes to performance. The purpose of this study was to examine the relationship between imagery ability and gymnastics performance, as well as self-efficacy and thoughts during competitions that are related to performance. Fifty-two gymnasts were recruited for this study. Participants were measured for imagery ability, self-efficacy, thoughts during competitions, and performance. Results indicated that skill imagery significantly predicts worry and disengagement in a negative manner, and mastery imagery is positively related to self-efficacy. Moreover, goal imagery has a significant positive relationship to self-efficacy, disengagement, confidence, and performance. In conclusion, the ability to easily image an ideal performance, such as the success of one’s performance or the image of a perfect performance, might increase confidence in the competition and lead to the success of the performance.
Assessing and Maximizing Collegiate Athletes’ Psychological Skills Under Constraints: A Preseason Brief Intervention Approach
Authors: Chu Tsz Lun (Alan) , Petrie Trent A.
Published: May 2021

Time and access to teams may be limited for sport psychology professionals, particularly those working in the college sport setting. Thus, learning how to intervene with teams and individual athletes within short, defined timeframes becomes essential for working effectively in this environment. In this article, using de Shazer’s solution-focused brief therapy along with Weinberg and Williams’s steps of psychological skills training, the authors describe the development and implementation of a brief intervention under time-limited circumstances (15 days, 15 min/day) through a preseason training program with a National Collegiate Athletic Association Division I women’s volleyball team. Then, they present data and evaluations based on the Athletic Coping Skills Inventory-28 and athlete feedback, which support program effectiveness. They further reflect on the program strengths (e.g., individualization) and challenges (e.g., limited coach involvement) to provide recommendations for intervening briefly, yet systematically and effectively, to maximize athletes’ psychological skills under constraints.
Optogenetic pacing of medial septum parvalbumin-positive cells disrupts temporal but not spatial firing in grid cells
Authors: Lepperød Mikkel Elle , Christensen Ane Charlotte , Lensjø Kristian Kinden , Buccino Alessio Paolo , Yu Jai , Fyhn Marianne , Hafting Torkel
Published: May 2021

Spatial code of grid cells is independent of theta oscillations and phase precession.
Epitranscriptomic regulation of insecticide resistance
Authors: Yang Xin , Wei Xuegao , Yang Jing , Du Tianhua , Yin Cheng , Fu Buli , Huang Mingjiao , Liang Jinjin , Gong Peipan , Liu Shaonan , Xie Wen , Guo Zhaojiang , Wang Shaoli , Wu Qingjun , Nauen Ralf , Zhou Xuguo , Bass Chris , Zhang Youjun
Published: May 2021

A cytochrome P450 that confers insecticide resistance in whitefly is regulated by an epitranscriptomic mechanism.
In situ cancer vaccination using lipidoid nanoparticles
Authors: Chen Jinjin , Qiu Min , Ye Zhongfeng , Nyalile Thomas , Li Yamin , Glass Zachary , Zhao Xuewei , Yang Liu , Chen Jianzhu , Xu Qiaobing
Published: May 2021

In situ cancer vaccination by lipidoid nanoparticles enhances antigen cross-presentation and STING activation.
Morphing pasta and beyond
Authors: Tao Ye , Lee Yi-Chin , Liu Haolin , Zhang Xiaoxiao , Cui Jianxun , Mondoa Catherine , Babaei Mahnoush , Santillan Jasio , Wang Guanyun , Luo Danli , Liu Di , Yang Humphrey , Do Youngwook , Sun Lingyun , Wang Wen , Zhang Teng , Yao Lining
Published: May 2021

Flat pasta with designed surface grooves can dynamically morph into three-dimensional shapes when boiled.
RETRACTED: A subset of PARP inhibitors induces lethal telomere fusion in ALT-dependent tumor cells
Authors: Mukherjee Joydeep , Pandita Ajay , Kamalakar Chatla , Johannessen Tor-Christian , Ohba Shigeo , Tang Yongjian , Dalle-Ore Cecilia L. , Bjerkvig Rolf , Pieper Russell O.
Published: May 2021

Tumor cells using the ALT mechanism to maintain telomeres are uniquely sensitive to PARP inhibitor–induced lethal chromosomal fusion.
RNA Helicase A/DHX9 Forms Unique Cytoplasmic Antiviral Granules That Restrict Oncolytic Myxoma Virus Replication in Human Cancer Cells
Authors: Rahman Masmudur M. , Gutierrez-Jensen Ami D. , Glenn Honor L. , Abrantes Mario , Moussatche Nissin , McFadden Grant
Published: May 2021

The cellular DHX9 has both proviral and antiviral roles against diverse RNA and DNA viruses. In this article, we demonstrate that DHX9 can form unique antiviral granules in the cytoplasm during myxoma virus (MYXV) replication in human cancer cells.
Characterization of the Molecular Interactions That Govern the Packaging of Viral RNA Segments into Rift Valley Fever Phlebovirus Particles
Authors: Tercero Breanna , Narayanan Krishna , Terasaki Kaori , Makino Shinji
Published: May 2021

Rift Valley fever phlebovirus, a bunyavirus, is a mosquito-borne, segmented RNA virus that can cause severe disease in humans and ruminants. An essential step in RVFV life cycle is the packaging of viral RNA segments to produce infectious virus particles for dissemination to new hosts.
The N-Terminal 5-68 Amino Acids Domain of the Minor Capsid Protein VP1 of Human Parvovirus B19 Enters Human Erythroid Progenitors and Inhibits B19 Infection
Authors: Zou Wei , Ning Kang , Xu Peng , Deng Xuefeng , Cheng Fang , Kleiboeker Steve , Qiu Jianming
Published: May 2021

Human parvovirus B19 infection causes severe hematological disorders, including transient aplastic crisis, pure red cell aplasia, and hydrops fetalis. A productive B19 infection is highly restricted to human erythroid progenitors in human bone marrow and fetal liver.
Unconventional p97/VCP-Mediated Endoplasmic Reticulum-to-Endosome Trafficking of a Retroviral Protein
Authors: Xu Wendy Kaichun , Gou Yongqiang , Lozano Mary M. , Dudley Jaquelin P.
Published: May 2021

Mouse mammary tumor virus is a complex retrovirus that encodes a regulatory/accessory protein, Rem. Rem is a precursor protein that is processed at the endoplasmic reticulum (ER) membrane by signal peptidase.
Near-Complete Genome Sequence of Ryegrass Mottle Virus from Irrigation Water in Ecuador
Authors: Guevara Fiama , Flores Francisco
Published: May 2021

In this work, we report the near-complete genome sequence of Ryegrass mottle virus identified in irrigation water through next-generation sequencing and
de novo
assembly. The genome is 4,247 bp long, arranged in five open reading frames with a 5′ untranslated region (UTR) of 87 nucleotides and a 3′ UTR of 247 nucleotides.
Genome Sequence of a Yunnan Orbivirus Isolated from a Dead Florida White-Tailed Deer (Odocoileus virginianus)
Authors: Viadanna Pedro H. O. , Rodrigues Thaís C. S. , Subramaniam Kuttichantran , Campos Krauer Juan M. , Lednicky John A. , Loeb Julia C. , Wisely Samantha M. , Waltzek Thomas B.
Published: May 2021

We report the complete coding sequences of a Yunnan orbivirus isolated from a dead white-tailed deer (
Odocoileus virginianus
) in Florida in 2019. The prevalence of Yunnan orbivirus and its role in disease among farmed white-tailed deer remains to be determined.
Whole-Genome Sequence of a Brucella pinnipedialis Sequence Type 54 Strain Isolated from a Hooded Seal (
Cystophora cristata
) from the North Atlantic Ocean, Norway
Authors: Zygmunt Michel S. , Vergnaud Gilles , Cloeckaert Axel
Published: May 2021

Since the 1990s,
Brucella
strains have been isolated from a wide variety of marine mammal species. We report the first complete genome sequence of a
Brucella
strain isolated from a hooded seal (
Cystophora cristata
),
Brucella pinnipedialis
strain 23a-1 of sequence type 54, found in the North Atlantic Ocean surrounding Norway.
Draft Genome Sequences of Four Aerobic Isobutane-Metabolizing Bacteria
Authors: Chen Weijue , Faulkner Nicholas , Smith Christy , Fruchte Megan , Hyman Michael
Published: May 2021

Here, we report the draft genome sequences of four aerobic gaseous alkane-oxidizing bacteria isolated from soil by enrichment culture using isobutane (2-methylpropane) as the sole carbon and energy source. The sequences all reveal microorganisms with multiple alkane-oxidizing monooxygenases, including soluble di-iron monooxygenases (SDIMOs), copper-containing monooxygenases (CuMMOs), and alkane hydroxylases (AHs).
Massive metoprolol overdose requiring ECMO: brief review of the evidence behind recommended treatments
Authors: Salam Shameen , Nornhold Brandon , Mallat Jihad
Published: May 2021

A man in his late 60s developed shock after ingesting 7500 mg of metoprolol tartrate that was refractory to all medical treatment including hyperinsulinaemic euglycaemia, intravenous lipid emulsion and dialysis, eventually needing rescue extracorporeal membrane oxygenation. A brief review of the recommended treatments in beta-blocker overdose is therefore warranted.
Epstein-Barr virus induced haemophagocytic lymphohistiocytosis
Authors: Zimmer Markie , Gill Inayat , Anusim Nwabundo , Gaikazian Susanna S
Published: May 2021

Haemophagocytic lymphohistiocytosis (HLH) is a rare condition of uncontrolled immune activation as a result of an inherited genetic defect or in response to malignancy, autoimmune disease, rheumatological disease, AIDS infection or post-transplant immunosuppression. Described here is the case of a 19-year-old Caucasian man who presented with complaints of worsening fever, new-onset jaundice and lethargy after failing treatment for suspected infectious mononucleosis. Physical examination was significant for fever and splenomegaly while laboratory results revealed transaminitis, cytopaenia, indirect hyperbilirubinaemia and elevated ferritin, raising the likelihood of both autoimmune haemolytic anaemia and HLH. He tested positive for Epstein-Barr virus (EBV), and bone marrow biopsy revealed hypercellular marrow with haemophagocytosis and no evidence of malignancy. High dose steroids were initiated with significant improvement in haemoglobin, resulting in a final diagnosis of HLH secondary to acute EBV infection. The patient was discharged on continued high-dose prednisone with planned taper and consideration of outpatient rituximab therapy for 4 weeks. High clinical suspicion and prompt evaluation were critical to early treatment and decreased morbidity.
Systematic review on the instruments used for measuring the association of the level of multimorbidity and clinically important outcomes
Authors: Lee Eng Sing , Koh Hui Li , Ho Elaine Qiao-Ying , Teo Sok Huang , Wong Fang Yan , Ryan Bridget L , Fortin Martin , Stewart Moira
Published: May 2021

Objectives

There are multiple instruments for measuring multimorbidity. The main objective of this systematic review was to provide a list of instruments that are suitable for use in studies aiming to measure the association of a specific outcome with different levels of multimorbidity as the main independent variable in community-dwelling individuals. The secondary objective was to provide details of the requirements, strengths and limitations of these instruments, and the chosen outcomes.

Methods

We conducted the review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO registration number: CRD42018105297). We searched MEDLINE, Embase and CINAHL electronic databases published in English and manually searched theJournal of Comorbiditybetween 1 January 2010 and 23 October 2020 inclusive. Studies also had to select adult patients from primary care or general population and had at least one specified outcome variable. Two authors screened the titles, abstracts and full texts independently. Disagreements were resolved with a third author. The modified Newcastle-Ottawa Scale was used for quality assessment.

Results

Ninety-six studies were identified, with 69 of them rated to have a low risk of bias. In total, 33 unique instruments were described. Disease Count and weighted indices like Charlson Comorbidity Index were commonly used. Other approaches included pharmaceutical-based instruments. Disease Count was the common instrument used for measuring all three essential core outcomes of multimorbidity research: mortality, mental health and quality of life. There was a rise in the development of novel weighted indices by using prognostic models. The data obtained for measuring multimorbidity were from sources including medical records, patient self-reports and large administrative databases.

Conclusions

We listed the details of 33 instruments for measuring the level of multimorbidity as a resource for investigators interested in the measurement of multimorbidity for its association with or prediction of a specific outcome.
Developing a systematic approach for Population-based Injury Severity Assessment (PISA): a million-person survey in rural Bangladesh
Authors: Alonge Olakunle , Agrawal Priyanka , Khatlani Khaula , Mashreky Saidur , Hoque Dewan Emdadul Md , Hyder Adnan A
Published: May 2021

Introduction

There is currently no defined method for assessing injury severity using population-based data, which limits our understanding of the burden of non-fatal injuries and community-based approaches for primary prevention of injuries. This study describes a systematic approach, Population-based Injury Severity Assessment (PISA) index, for assessing injury severity at the population level.

Methods

Based on the WHO International Classification of Functionality conceptual model on health and disability, eight indicators for assessing injury severity were defined. The eight indicators assessed anatomical, physiological, postinjury immobility, hospitalisation, surgical treatment, disability, duration of assisted living and days lost from work or school. Using a large population-based survey conducted in 2013 including 1.16 million individuals from seven subdistricts of rural Bangladesh, information on the eight indicators were derived for all non-fatal injury events, and these were summarised into a single injury severity index using a principal component analysis (PCA). Principal component loadings derived from the PCA were used to predict the severity (low, moderate, high) of non-fatal injuries, and were applied to the fatal injury data to assess the criterion validity of the index. The determinants of non-fatal injury severity were determined using ordered logistic regression.

Results

There were 119 703 non-fatal injuries and 14% were classified as high severity based on the PISA index. The PISA index accurately predicted 82% of all fatal injuries as highly severe. Non-fatal injuries of high severity were frequent with unintentional poisoning (57%) and violence (35%). Injuries of high severity were commoner among males (OR 1.16, 95% CI 1.12 to 1.21), adults 65 years and older (OR 1.30, 95% CI 1.23 to 1.36), lower socioeconomic status and intentional injuries. Education was associated with reduced odds of high severe injuries.

Conclusion

The PISA index provides a valid and systematic approach for assessing injury severity at the population level, and is relevant for improving the characterisation of the burden and epidemiology of injuries in non-health facility-based settings. Additional testing of the PISA index is needed to further establish its validity and reliability.
Geographical variation of emergency hospital admissions for ambulatory care sensitive conditions in older adults in Ireland 2012–2016
Authors: Walsh Mary E , Cronin Sinead , Boland Fiona , Ebell Mark H , Fahey Tom , Wallace Emma
Published: May 2021

Objective

Ambulatory care sensitive (ACS) conditions are those for which intensified primary care management could potentially prevent emergency admissions. This study aimed to quantify geographical variation in emergency admissions with ACS conditions in older adults and explore factors influencing variation.

Design

Repeated cross-sectional study.

Setting

34 public hospitals in the Ireland.

Participants

Adults aged ≥65 years hospitalised for seven ACS conditions between 2012 and 2016 (chronic obstructive pulmonary disease, congestive heart failure (CHF), diabetes, angina, pyelonephritis/urinary tract infections (UTIs), dehydration and pneumonia).

Primary outcome measure

Age and sex standardised emergency admission rates (SARs) per 1000 older adults.

Analysis

Age and sex SARs were calculated for 21 geographical areas. Extremal quotients and systematic components of variance (SCV) quantified variation. Spatial regression analyses was conducted for SARs with unemployment, urban population proportion, hospital turnover, supply of general practitioners (GPs), and supply of hospital-based specialists as explanatory variables.

Results

Over time, an increase in UTI/pyelonephritis SARs was seen while SARs for angina and CHF decreased. Geographic variation was moderate overall and high for dehydration and angina (SCV=11.7–50.0). For all conditions combined, multivariable analysis showed lower urban population (adjusted coefficient: −2.2 (−3.4 to −0.9, p<0.01)), lower GP supply (adjusted coefficient: −5.5 (−8.2 to −2.9, p<0.01)) and higher geriatrician supply (adjusted coefficient: 3.7 (0.5 to 6.9, p=0.02)) were associated with higher SARs.

Conclusions

Future research should evaluate methods of preventing admissions for ACS conditions among older adults, including how resources are allocated at a local level.
Oral health interventions for older people in residential aged care facilities: a protocol for a realist systematic review
Authors: Kenny Amanda , Dickson-Swift Virginia , Chan Carina Ka Yee , Masood Mohd , Gussy Mark , Christian Bradley , Hodge Brad , Furness Susan , Hanson Lisa C , Clune Samantha , Zadow Emma , Knevel Ron J
Published: May 2021

Introduction

Poor oral health among older people is a global problem impacting on health and well-being. The economic cost to the health system is significant. An ageing population is intensifying the urgency for action. However, poor oral health, particularly for those in residential aged care facilities, continues to be highly resistant to resolution. The overall aims of this realist review are to: (A) explore and synthesise evidence on oral health interventions for older people in residential aged care facilities, (B) produce a causal theory on how contextual factors and mechanisms interact to produce outcomes, and (C) produce guidelines/policies to inform high-quality oral health interventions to improve older people’s oral health in residential aged care facilities.

Methods and analysis

The review is guided by the RAMESES publication standards for realist synthesis. Participants include older people in residential aged care facilities, the aged care workforce, carers and families. Interventions include oral healthcare, oral health education, policy interventions and oral health promotion. The five-step realist review process of Pawsonet alwill guide the review: clarification of scope and development of initial framework, systematic searches, study appraisal and data extraction, synthesising evidence, drawing conclusions, and dissemination, implementation and evaluation. Expert input with key stakeholders will occur through a blog. Stakeholders will examine consistencies across studies and an explanatory causal theory will be developed to guide policy and practice.

Ethics and dissemination

Formal ethical approval was granted by the La Trobe University Ethics Committee HREC 20144. The developed theory will guide education, practice and policy decisions about interventions and the factors that impact on implementation. Using an integrated knowledge translation approach, traditional research outputs such as international conference presentations and publications will be supplemented with stakeholder forums, infographics, blogs, social media postings, webinars, podcasts and writing for web-based independent outlets.

PROSPERO registration number

CRD42021155658.
Key dimensions of post-traumatic stress disorder and endothelial dysfunction: a protocol for a mechanism-focused cohort study
Authors: Cleveland Shiloh , Reed Kristina , Thomas Jordan L , Ajijola Olujimi A , Ebrahimi Ramin , Hsiai Tzung , Lazarov Amit , Montoya Amanda K , Neria Yuval , Shimbo Daichi , Wolitzky-Taylor Kate , Sumner Jennifer A
Published: May 2021

Introduction

Both trauma exposure and post-traumatic stress disorder (PTSD) are associated with increased risk of cardiovascular disease (CVD), the leading cause of death in the USA. Endothelial dysfunction, a modifiable, early marker of CVD risk, may represent a physiological mechanism underlying this association. This mechanism-focused cohort study aims to investigate the relationship between PTSD (both in terms of diagnosis and underlying symptom dimensions) and endothelial dysfunction in a diverse, community-based sample of adult men and women.

Methods and analysis

Using a cohort design, 160 trauma-exposed participants without a history of CVD are designated to the PTSD group (n=80) or trauma-exposed matched control group (n=80) after a baseline diagnostic interview assessment. Participants in the PTSD group have a current (past month) diagnosis of PTSD, whereas those in the control group have a history of trauma but no current or past psychiatric diagnoses. Endothelial dysfunction is assessed via flow-mediated vasodilation of the brachial artery and circulating levels of endothelial cell-derived microparticles. Two higher order symptom dimensions of PTSD—fear and dysphoria—are measured objectively with a fear conditioning paradigm and attention allocation task, respectively. Autonomic imbalance, inflammation, and oxidative stress are additionally assessed and will be examined as potential pathway variables linking PTSD and its dimensions with endothelial dysfunction. Participants are invited to return for a 2-year follow-up visit to reassess PTSD and its dimensions and endothelial dysfunction in order to investigate longitudinal associations.

Ethics and dissemination

This study is conducted in compliance with the Helsinki Declaration and University of California, Los Angeles Institutional Review Board. The results of this study will be disseminated via articles in peer-reviewed journals and presentations at academic conferences and to community partners.

Trial registration number

NCT03778307; pre-results.
Hospital staff, volunteers’ and patients’ perceptions of barriers and facilitators to communication following stroke in an acute and a rehabilitation private hospital ward: a qualitative description study
Authors: D'Souza Sarah , Godecke Erin , Ciccone Natalie , Hersh Deborah , Janssen Heidi , Armstrong Elizabeth
Published: May 2021

Objectives

To explore barriers and facilitators to patient communication in an acute and rehabilitation ward setting from the perspectives of hospital staff, volunteers and patients following stroke.

Design

A qualitative descriptive study as part of a larger study which aimed to develop and test a Communication Enhanced Environment model in an acute and a rehabilitation ward.

Setting

A metropolitan Australian private hospital.

Participants

Focus groups with acute and rehabilitation doctors, nurses, allied health staff and volunteers (n=51), and interviews with patients following stroke (n=7), including three with aphasia, were conducted.

Results

The key themes related to barriers and facilitators to communication, contained subcategories related to hospital, staff and patient factors. Hospital-related barriers to communication were private rooms, mixed wards, the physical hospital environment, hospital policies, the power imbalance between staff and patients, and task-specific communication. Staff-related barriers to communication were staff perception of time pressures, underutilisation of available resources, staff individual factors such as personality, role perception and lack of knowledge and skills regarding communication strategies. The patient-related barrier to communication involved patients’ functional and medical status. Hospital-related facilitators to communication were shared rooms/co-location of patients, visitors and volunteers. Staff-related facilitators to communication were utilisation of resources, speech pathology support, staff knowledge and utilisation of communication strategies, and individual staff factors such as personality. No patient-related facilitators to communication were reported by staff, volunteers or patients.

Conclusions

Barriers and facilitators to communication appeared to interconnect with potential to influence one another. This suggests communication access may vary between patients within the same setting. Practical changes may promote communication opportunities for patients in hospital early after stroke such as access to areas for patient co-location as well as areas for privacy, encouraging visitors, enhancing patient autonomy, and providing communication-trained health staff and volunteers.
Healthy ageing and occupational therapy in South Asian countries: a scoping review protocol
Authors: Mehrotra Shashank , Pundir Prachi , Shetty Ranjitha S
Published: May 2021

Introduction

The increasing population of older adults is one of the most significant challenges faced by various countries across the world. South Asian region is accommodating almost a quarter of the world’s population, with nearly 6% of them being >65 years of age. There is a lack of awareness regarding the role of occupational therapists in community settings, the assessments and interventions used by occupational therapists to facilitate healthy ageing among community-dwelling older adults. This scoping review is planned to systematically identify the literature from the last two decades, related to various assessments and interventions provided by occupational therapists to promote healthy ageing among older adults in South Asia.

Methods

This scoping review will be based on the methodological framework given by Arksey and O’Malley and Levacet al.and will include data from January 2000 onwards. The following databases will be included in the search—SCOPUS, MEDLINE (PubMed), Web of Science, CINAHL, EBSCO, Clinical key, Wiley Online, ProQuest and Cochrane library. Screening of titles and abstracts and full texts will be carried out by two reviewers independently in consultation with the third reviewer. Both quantitative and qualitative data will be analysed separately to identify the assessments carried out, interventions provided and factors that influence healthy ageing among community-dwelling older adults aged ≥60 years in South Asia. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will be used for collating and reporting the results.

Ethics and dissemination

As this scoping review uses data from already available literature, it does not require ethics approval. Results will summarise and present the existing literature related to healthy ageing among community-dwelling older adults. We plan to disseminate the results through a peer-reviewed journal, targeting occupational therapists, other rehabilitation workers and researchers from South Asia.