bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk assessment of therapeutic agents under consideration to treat COVID‐19 in paediatric patients and pregnant women
Authors: Barrett Jeffrey S.
Published: October 2020

Aim

Repurposing strategies to address the COVID‐19 pandemic have been accelerated. As both pregnant and paediatric patients are likely to be excluded from most planned investigations, the list of repurposed options and the available data on these drugs and vaccines provide a baseline risk assessment and identify gaps for targeted investigation.

Methods

Clinical trials have been searched and reviewed; 23 repurposed drugs and drug combinations and nine candidate vaccines have been assessed regarding the availability of relevant data in paediatrics and pregnant women and to evaluate expected or unanticipated risk.

Results

Thirteen of the repurposed drugs or drug combinations are indicated for use in paediatrics in some age category albeit for indications other than COVID‐19; 10 of these are indicated for use in pregnant women. Even in cases where these drugs are indicated in the populations, source data from which safety and or dosing could be extrapolated for use in COVID‐19 is sparse. Vaccine trials are ongoing and generally exclude pregnant women; only in a few instances have paediatric subgroups been planned for enrolment. Data from individual case studies and RWD may suggest that subpopulations of both paediatric patients and pregnant women may be more at risk, particularly those in an increased inflammatory state.

Conclusion

In conjunction with more prospective collaboration, plans are evolving to ensure that we will be better prepared to address similar situations especially in paediatrics and pregnant women where experience is limited and actual practice relies heavily on leveraging data from other populations and indications.
“Someone will come in and say I'm doing it wrong.” The perspectives of fathers with learning disabilities in England
Authors: Symonds Jon , Abbott David , Dugdale Daryl
Published: October 2020

Accessible summary

When people with learning disabilities have children and become parents, they sometimes need good support to help them.

Research about parents with learning disabilities and the support they get is usually about mothers and not fathers. There is not very much written about dads with learning disabilities.

This paper is about interviews with eight dads with learning disabilities who told us about what it was like to be a dad and about the kind of support they had got.

We think more support needs to be given to parents with learning disabilities and that dads should be included in this.

Background

This article reports on the perspectives of fathers with a learning disability in England about being fathers and the support they have received. Although there is an established literature that considers parenting with a learning disability, few studies have focused on the perspectives of fathers.

Method

We adopted a qualitative approach for this study, using semi‐structured interviews with eight fathers with learning disabilities, recruited through learning disability organisations and social media. The data were analysed using thematic analysis.

Results

Being a father was important to participants and the findings are presented in three themes: descriptions of fatherhood; challenges of fatherhood; and support with fatherhood.

Conclusion

We discuss how fathers' perspectives on fatherhood relate to wider transformations of fatherhood in society, the impact of these on fathering with a learning disability and the implications for services.
Unfractionated heparin inhibits live wild type SARS‐CoV‐2 cell infectivity at therapeutically relevant concentrations
Authors: Tree Julia A. , Turnbull Jeremy E. , Buttigieg Karen R. , Elmore Michael J. , Coombes Naomi , Hogwood John , Mycroft‐West Courtney J. , Lima Marcelo A. , Skidmore Mark A. , Karlsson Richard , Chen Yen‐Hsi , Yang Zhang , Spalluto Cosma Mirella , Staples Karl J. , Yates Edwin A. , Gray Elaine , Singh Dave , Wilkinson Tom , Page Clive P. , Carroll Miles W.
Published: October 2020

Background and Purpose

Currently, there are no licensed vaccines and limited antivirals for the treatment of COVID‐19. Heparin (delivered systemically) is currently used to treat anticoagulant anomalies in COVID‐19 patients. Additionally, in the United Kingdom, Brazil and Australia, nebulised unfractionated heparin (UFH) is being trialled in COVID‐19 patients as a potential treatment. A systematic comparison of the potential antiviral effect of various heparin preparations on live wild type SARS‐CoV‐2, in vitro, is needed.

Experimental Approach

Seven different heparin preparations including UFH and low MW heparins (LMWH) of porcine or bovine origin were screened for antiviral activity against live SARS‐CoV‐2 (Australia/VIC01/2020) using a plaque inhibition assay with Vero E6 cells. Interaction of heparin with spike protein RBD was studied using differential scanning fluorimetry and the inhibition of RBD binding to human ACE2 protein using elisa assays was examined.

Key Results

All the UFH preparations had potent antiviral effects, with IC50 values ranging between 25 and 41 μg·ml−1, whereas LMWHs were less inhibitory by ~150‐fold (IC50 range 3.4–7.8 mg·ml−1). Mechanistically, we observed that heparin binds and destabilizes the RBD protein and furthermore, we show heparin directly inhibits the binding of RBD to the human ACE2 protein receptor.

Conclusion and Implications

This comparison of clinically relevant heparins shows that UFH has significantly stronger SARS‐CoV‐2 antiviral activity compared to LMWHs. UFH acts to directly inhibit binding of spike protein to the human ACE2 protein receptor. Overall, the data strongly support further clinical investigation of UFH as a potential treatment for patients with COVID‐19.
Suitability of transbronchial brushing cytology specimens for next‐generation sequencing in peripheral lung cancer
Authors: Furuya Naoki , Matsumoto Shingo , Kakinuma Kazutaka , Morikawa Kei , Inoue Takeo , Saji Hisashi , Goto Koichi , Mineshita Masamichi
Published: October 2020

Next‐generation sequencing (NGS) enables the diagnosis of large numbers of gene aberrations during one examination, and precision medicine has been developed for patients with advanced non–small cell lung cancer (NSCLC). However, peripheral lung lesions account for the majority of advanced lung cancers, especially lung adenocarcinoma. In these cases, it is difficult to obtain tissue samples which contain sufficient tumor cells by transbronchial biopsy (TBB) with forceps. Even when the target lesions are quite small, bronchial brushing can obtain enough tumor cells by endobronchial ultrasonography using guide sheath (EBUS‐GS). In this study, we investigate the suitability of bronchial brushing cytology specimens obtained by EBUS‐GS‐TBB to evaluate the correlation between the success rate of NGS and extracted DNA/RNA yields according to biopsy method. We prospectively collected 222 tumor samples obtained from patients with advanced lung cancer. All patients were enrolled in a prospective nationwide genomic screening project for lung cancer (LC‐SCRUM‐Japan/Asia). Genomic data were obtained from the clinico‐genomic database of LC‐SCRUM‐Japan/Asia. The extraction yields of DNA/RNA from samples obtained by EBUS‐GS‐TBB were relatively low compared with tissue samples. The success rate of DNA sequencing for EBUS‐GS‐TBB was 97.9%, with no significant differences between biopsy methods. The success rate of RNA sequencing for EBUS‐GS‐TBB was 80.4%, which was relatively low compared with surgical biopsy samples (P = 0.069). However, some rare oncogenic driver aberrations were detected from these specimens. This study demonstrated that cytology samples obtained by transbronchial brushing with EBUS‐GS‐TBB were suitable for NGS analysis.
WDR34, a candidate gene for non‐syndromic rod‐cone dystrophy
Authors: Solaguren‐Beascoa Maria , Bujakowska Kinga M. , Méjécase Cécile , Emmenegger Lisa , Orhan Elise , Neuillé Marion , Mohand‐Saïd Saddek , Condroyer Christel , Lancelot Marie‐Elise , Michiels Christelle , Demontant Vanessa , Antonio Aline , Letexier Mélanie , Saraiva Jean‐Paul , Lonjou Christine , Carpentier Wassila , Léveillard Thierry , Pierce Eric A. , Dollfus Hélène , Sahel José‐Alain , Bhattacharya Shomi S. , Audo Isabelle , Zeitz Christina
Published: October 2020

Rod‐cone dystrophy (RCD), also called retinitis pigmentosa, is characterized by rod followed by cone photoreceptor degeneration, leading to gradual visual loss. Mutations in over 65 genes have been associated with non‐syndromic RCD explaining 60% to 70% of cases, with novel gene defects possibly accounting for the unsolved cases. Homozygosity mapping and whole‐exome sequencing applied to a case of autosomal recessive non‐syndromic RCD from a consanguineous union identified a homozygous variant in WDR34. Mutations in WDR34 have been previously associated with severe ciliopathy syndromes possibly associated with a retinal dystrophy. This is the first report of a homozygous mutation in WDR34 associated with non‐syndromic RCD.
Impacts of rural to urban migration, urbanization, and generational change on consumption of wild animals in the Amazon
Authors: Chaves Willandia A. , Valle Denis , Tavares Aline S. , Morcatty Thais Q. , Wilcove David S.
Published: October 2020

For the first time in history, more people live in urban areas than in rural areas. This trend is likely to continue, driven largely by rural‐to‐urban migration. We investigated how rural‐to‐urban migration, urbanization, and generational change affect the consumption of wild animals. We used chelonian (tortoises and freshwater turtles), one of the most hunted taxa in the Amazon, as a model. We surveyed 1356 households and 2776 school children across 10 urban areas of the Brazilian Amazon (6 small towns, 3 large towns, and Manaus, the largest city in the Amazon Basin) with a randomized response technique and anonymous questionnaires. Urban demand for wild meat (i.e., meat from wild animals) was alarmingly high. Approximately 1.7 million turtles and tortoises were consumed in urban areas of Amazonas during 2018. Consumption rates declined as size of the urban area increased and were greater for adults than children. Furthermore, the longer rural‐to‐urban migrants lived in urban areas, the lower their consumption rates. These results suggest that wild meat consumption is a rural‐related tradition that decreases as urbanization increases and over time after people move to urban areas. However, it is unclear whether the observed decline will be fast enough to conserve hunted species, or whether children's consumption rate will remain the same as they become adults. Thus, conservation actions in urban areas are still needed. Current conservation efforts in the Amazon do not address urban demand for wildlife and may be insufficient to ensure the survival of traded species in the face of urbanization and human population growth. Our results suggest that conservation interventions must target the urban demand for wildlife, especially by focusing on young people and recent rural to urban migrants.

Article impact statement: Amazon urbanite consumption of wildlife is high but decreases with urbanization, over time for rural to urban migrants, and between generations.

Impactos de la Migración del Campo a la Ciudad, la Urbanización y del Cambio Generacional sobre el Consumo de Animales Silvestres en el Amazonas
Order Matters! Influences of Linear Order on Linguistic Category Learning
Authors: Hoppe Dorothée B. , van Rij Jacolien , Hendriks Petra , Ramscar Michael
Published: October 2020

Linguistic category learning has been shown to be highly sensitive to linear order, and depending on the task, differentially sensitive to the information provided by preceding category markers (premarkers, e.g., gendered articles) or succeeding category markers (postmarkers, e.g., gendered suffixes). Given that numerous systems for marking grammatical categories exist in natural languages, it follows that a better understanding of these findings can shed light on the factors underlying this diversity. In two discriminative learning simulations and an artificial language learning experiment, we identify two factors that modulate linear order effects in linguistic category learning: category structure and the level of abstraction in a category hierarchy. Regarding category structure, we find that postmarking brings an advantage for learning category diagnostic stimulus dimensions, an effect not present when categories are non‐confusable. Regarding levels of abstraction, we find that premarking of super‐ordinate categories (e.g., noun class) facilitates learning of subordinate categories (e.g., nouns). We present detailed simulations using a plausible candidate mechanism for the observed effects, along with a comprehensive analysis of linear order effects within an expectation‐based account of learning. Our findings indicate that linguistic category learning is differentially guided by pre‐ and postmarking, and that the influence of each is modulated by the specific characteristics of a given category system.
Alignment in Multimodal Interaction: An Integrative Framework
Authors: Rasenberg Marlou , Özyürek Asli , Dingemanse Mark
Published: October 2020

When people are engaged in social interaction, they can repeat aspects of each other’s communicative behavior, such as words or gestures. This kind of behavioral alignment has been studied across a wide range of disciplines and has been accounted for by diverging theories. In this paper, we review various operationalizations of lexical and gestural alignment. We reveal that scholars have fundamentally different takes on when and how behavior is considered to be aligned, which makes it difficult to compare findings and draw uniform conclusions. Furthermore, we show that scholars tend to focus on one particular dimension of alignment (traditionally, whether two instances of behavior overlap in form), while other dimensions remain understudied. This hampers theory testing and building, which requires a well‐defined account of the factors that are central to or might enhance alignment. To capture the complex nature of alignment, we identify five key dimensions to formalize the relationship between any pair of behavior: time, sequence, meaning, form, and modality. We show how assumptions regarding the underlying mechanism of alignment (placed along the continuum of priming vs. grounding) pattern together with operationalizations in terms of the five dimensions. This integrative framework can help researchers in the field of alignment and related phenomena (including behavior matching, mimicry, entrainment, and accommodation) to formulate their hypotheses and operationalizations in a more transparent and systematic manner. The framework also enables us to discover unexplored research avenues and derive new hypotheses regarding alignment.
Clinical analysis of human umbilical cord mesenchymal stem cell allotransplantation in patients with premature ovarian insufficiency
Authors: Yan Long , Wu Yixuan , Li Li , Wu Jun , Zhao Feiyan , Gao Zheng , Liu Wenjing , Li Tianda , Fan Yong , Hao Jie , Liu Jianqiao , Wang Hongmei
Published: October 2020

Objective

Premature ovarian insufficiency (POI) is a refractory disease that seriously affects female fertility. Growing body of evidence has indicated mesenchymal stem cells (MSCs) as promising resources in regenerative medicine. In this study, we treated POI patients with umbilical cord‐derived MSCs (UCMSCs) and then investigated the restoration of ovarian function and clinical outcomes through follow‐ups.

Materials and methods

Sixty‐one patients diagnosed with POI participated in this study. UCMSCs were isolated and cultured according to GMP standards, and then transplanted to the patients’ ovary by orthotopic injection under the guidance of vaginal ultrasound. We monitored side effects, vital signs and changes in clinical and collected haematological and imaging parameters during the follow‐ups.

Results

All patients showed normal clinical behaviour without serious side effects or complications relevant to the treatment. Transplantation of UCMSCs rescued the ovarian function of POI patients, as indicated by increased follicular development and improved egg collection. POI patients who experienced shorter amenorrhoea durations (<1 year) seemed to obtain mature follicles more easily after stem cell therapy, and patients with better ovarian conditions (pre‐operative antral follicles) were more likely to derive the better outcomes by UCMSC injection. Four successful clinical deliveries were obtained from POI patients after UCMSC transplantation, and all of these babies are developed normally.

Conclusions

The clinical trial result sugggests a possible therapy for POI by UCMSC transplantation.
Esophagogastroduodenoscopy procedure using disposable endoscope to detect the cause of melena in a patient with COVID‐19
Authors: Xu Fenghua , Yang Yunsheng , Ding Zhen
Published: October 2020

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A synthesis of the coast‐wide decline in survival of West Coast Chinook Salmon (Oncorhynchus tshawytscha,Salmonidae)
Authors: Welch David Warren , Porter Aswea Dawn , Rechisky Erin Leanne
Published: October 2020

We collated smolt‐to‐adult return rate (SAR) data for Chinook salmon from all available regions of the Pacific coast of North America to examine the large‐scale patterns of salmon survival. For consistency, our analyses primarily used coded wire tag‐based (CWT) SAR estimates. Survival collapsed over the past half century by roughly a factor of three to ca. 1% for many regions. Within the Columbia River, the SARs of Snake River populations, often singled out as exemplars of poor survival, are unexceptional and in fact higher than estimates reported from many other regions of the west coast lacking dams. Given the seemingly congruent decline in SARs to similar levels, the notion that contemporary survival is driven primarily by broader oceanic factors rather than local factors should be considered. Ambitious Columbia River rebuilding targets may be unachievable because other regions with nearly pristine freshwater conditions, such as SE Alaska and northern BC, also largely fail to reach these levels. Passive integrated transponder (PIT) tag‐based SAR estimates available for Columbia River Basin populations are generally consistent with CWT findings; however, PIT tag‐based SARs are not adjusted for harvest which compromises their intended use because harvest rates are large and variable. More attention is needed on how SARs should be quantified and how rebuilding targets are defined. We call for a systematic review by funding agencies to assess consistency and comparability of the SAR data generated and to further assess the implications of survival falling to similar levels in most regions of the west coast.
Stakeholder engagement from problem analysis to implementation strategies for a patient‐reported experience measure in disability care: A qualitative study on the process and experiences
Authors: van Rooijen Marjolein , Lenzen Stephanie , Dalemans Ruth , Beurskens Anna , Moser Albine
Published: October 2020

Background

In implementation science, vast gaps exist between theoretical and practical knowledge. These gaps prevail in the process of getting from problem analysis to selecting implementation strategies while engaging stakeholders including care users.

Objective

To describe a process of how to get from problem analysis to strategy selection, how to engage stakeholders, and to provide insights into stakeholders’ experiences.

Design

A qualitative descriptive design.

Setting and participants

The setting was a care organization providing long‐term care to people with acquired brain injuries who are communication vulnerable. Fourteen stakeholders (care users, professionals and researchers) participated. Data were collected by a document review, five interviews and one focus group. Inductive content analysis and deductive framework analysis were applied.

Intervention

Stakeholder engagement.

Main outcome measures

A three‐step process model and stakeholders experiences.

Results and conclusion

We formulated a three‐step process: (a) reaching consensus and prioritizing barriers; (b) categorizing the prioritized barriers and idealization; and (c) composing strategies. Two subthemes continuously played a role in how stakeholders were engaged during the process: communication supportive strategies and continuous contact. The experiences of stakeholder participation resulted in the following themes: stakeholders and their roles, use of co‐creation methods and communication supportive strategies, building relationships, stimulus of stakeholders to engage, sharing power, empowerment of stakeholders, feeling a shared responsibility and learning from one another. We conclude that the inclusion of communication‐vulnerable care users is possible if meetings are prepared, communication‐friendly presentations and reports are used, and relationship building is prioritized.
Epidemiological and clinical characteristics of community‐acquired and nosocomial influenza cases and risk factors associated with complications: A four season analysis of all adult patients admitted in a tertiary hospital
Authors: Fullana Barceló Maria Isabel , Asensio Rodriguez Javier , Artigues Serra Francisca , Ferre Beltran Adrian , Salva D’agosto Pilar , Almodovar Garcia Maria , Lopez Bilbao Maria del Carmen , Sanchis Cortés Pilar , Reina Prieto Jorge , Riera Jaume Melchor
Published: October 2020

Background

Information on the characteristics of patients with nosocomial influenza and associated complications is scarce. This study compared epidemiological and clinical characteristics of patients admitted with hospital‐acquired influenza (HAI) to those with community‐acquired influenza (CAI) and analyzed risk factors associated with complications.

Methods

This retrospective, observational study included all adult patients with confirmed influenza virus infection admitted to Son Espases University Hospital during the influenza season in Spain (October to May) from 2012‐2013 to 2015‐2016. Symptom onset before admission was included as CAI, and 2 days after admission or within 48 hours after previous discharge were considered as HAI.

Results

Overall, 666 patients with laboratory‐confirmed influenza were included; 590 (88.6%) and 76 (11.4%) had CAI and HAI, respectively. Baseline characteristics and vaccination rates were similar in both groups. Patients with HAI had significantly fewer symptoms, less radiological alterations, and earlier microbiological diagnosis than those with CAI. Eighty‐five (14.4%) and 20 (27.6%) CAI and HAI patients, respectively, experienced at least one complication, including septic shock, admission to the intensive care unit, mechanical ventilation or evolution to death (any one, P = .003). Univariate and multivariate binary logistic regression was performed to assess independent risk factors associated with the occurrence of complications: nosocomial infection, diabetes, oseltamivir treatment, having received no vaccination, microbiological delay, dyspnea, and the state of confusion were the most important significant factors.

Conclusions

Our study shows the need to implement microbiological diagnostic measures in the first 48 hours to reduce HAI frequency and associated complications.
Bicriterion scheduling with truncated learning effects and convex controllable processing times
Authors: Wang Ji‐Bo , Lv Dan‐Yang , Xu Jian , Ji Ping , Li Fuqiang
Published: October 2020

This paper investigates single‐machine scheduling in which the processing time of a job is a function of its position in a sequence, a truncation parameter, and its resource allocation. For a convex resource consumption function, we provide a bicriteria analysis where the first is to minimize total weighted flow (completion) time, and the second is to minimize total resource consumption cost. If the weights are positional‐dependent weights, we prove that three versions of considering the two criteria can be solved in polynomial time, respectively. If the weights are job‐dependent weights, the computational complexity of the three versions of the two criteria remains an open question. To solve the problems with job‐dependent weights, we present a heuristic (an upper bound) and a branch‐and‐bound algorithm (an exact solution).
Comparison of therapeutic effects between artificial dermis combined with autologous split‐thickness skin grafting and autologous intermediate‐thickness skin grafting alone in severely burned patients: A prospective randomised study
Authors: Shang Feng , Lu Yan‐Hua , Gao Jian , Hou Qiang
Published: October 2020

The purpose of this study was to evaluate the therapeutic effects of artificial dermis combined with autologous split‐thickness skin grafting (STSG) compared with autologous intermediate‐thickness skin grafting (ITSG) alone in severely burned patients. Fifty‐six severely burned patients admitted to our hospital from December 2017 to January 2019 were enrolled and evenly grouped according to the random number table method [AD‐STSG group: 28 patients, receiving the treatment of artificial dermis (AD) combined with autologous STSG; ITSG group: 28 patients, receiving autologous ITSG treatment alone]. The healing time and Vancouver Scar Scale (VSS) score of the donor area and graft area, survival rate and infection status of the autologous skin, psychological status (determined by Self‐rating Anxiety Scale and Self‐rating Depression Scale), and the activity of functional parts of all enrolled patients were included in the evaluation. General items of patients in AD‐STSG group and ITSG group, including age, sex, and degree of burn, were all comparable. A significantly shortened healing time of donor skin in AD‐STSG group was observed when compared with ITSG group (P < .05) while the recipient skin healed in the same tendency between the two groups. In addition, 21 days after the operation, AD‐STSG group presented with significantly higher survival rate of graft skin than ITSG group (P < .05) while same infection status was observed in the two groups. Significantly lower VSS scores were found in AD‐STSG group than that in ITSG group 3‐, 6‐ and 10‐months after operation (P < .05). Statistical difference regarding psychological status of patients from two groups was unobservable before operation while significantly lower Self‐rating Anxiety Scale (SAS) and Self‐rating Depression Scale (SDS) scores were found in AD‐STSG group than that in ITSG group 3‐, 6‐ and 10‐months after operation (P < .05). Also, AD‐STSG group presented improved mobility of functional part than that in ITSG group 10‐months after operation without statistical difference (P = .051). Artificial dermis combined with autologous split‐thickness skin grafting showed better therapeutic outcomes for the treatment of severely burned patients than autologous intermediate‐thickness skin grafting in terms of graft healing time, scar formation, psychological recovery, and perhaps in functional reconstruction.
Individual migration strategy fidelity but no habitat specialization in two congeneric seabirds
Authors: Merkel Benjamin , Descamps Sébastien , Yoccoz Nigel G. , Grémillet David , Daunt Francis , Erikstad Kjell E. , Ezhov Aleksey V. , Harris Mike P. , Gavrilo Maria , Lorentsen Svein‐Håkon , Reiertsen Tone K. , Steen Harald , Systad Geir H. , Þórarinsson Þorkell Lindberg , Wanless Sarah , Strøm Hallvard
Published: October 2020

Aim

In migratory species, individuals often use fixed and individual‐specific migration strategies, which we term individual migration strategy fidelity (IMSF). Our goal was to test if guillemots have flexible or fixed individual migration strategies (i.e. IMSF), if this behaviour is consistent across large parts of the genus’ range and if they were philopatric to geographical sites or a habitat feature.

Location

North Atlantic.

Taxon

Uriaspp.

Methods

We quantified consistent individual differences in inter‐annual spatial distribution and habitat occupied throughout the non‐breeding period using a large geolocator tracking dataset of 729 adult seabirds breeding at 13 colonies across the Northeast Atlantic and repeatedly tracked up to 7 years over a 9‐year period. Additionally, we used a similarity index to calculate relative fidelity to either geographical sites or habitats and linear mixed‐effects models to assess persistence of spatial site fidelity over multiple years.

Results

Both guillemot species exhibited IMSF across a large part of the genus’ range which persisted over multiple years. Individuals of both species and almost all colonies showed fidelity to geographical sites and not to specific habitats.

Main conclusions

Guillemots show IMSF that is best explained by site familiarity (fidelity to specific sites) rather than habitat specialization (fidelity to specific habitats). In the context of rapidly changing environments, favourable habitats may permanently shift locations and hence species displaying IMSF driven by site familiarity—such as the genusUria—may not be able to adjust their migration strategies sufficiently fast to sustain individual fitness and ensure population persistence.
Patient‐reported outcomes and subsequent management in atrial fibrillation clinical practice: Results from the Utah mEVAL AF program
Authors: Zenger Brian , Zhang Mingyuan , Lyons Ann , Bunch T. Jared , Fang James C. , Freedman Roger A. , Navaravong Leenhapong , Piccini Jonathan P. , Ranjan Ravi , Spertus John A. , Stehlik Josef , Turner Jeffrey L. , Greene Tom , Hess Rachel , Steinberg Benjamin A.
Published: October 2020

Background

Atrial fibrillation (AF) significantly reduces health‐related quality of life (HRQoL), previously measured in clinical trials using patient‐reported outcomes (PROs). We examined AF PROs in clinical practice and their association with subsequent clinical management.

Methods

The Utah My Evaluation (mEVAL) program collects the Toronto AF Symptom Severity Scale (AFSS) in AF outpatients at the University of Utah. Baseline factors associated with worse AF symptom score (range 0–35, higher is worse) were identified in univariate and multivariable analyses. Secondary outcomes included AF burden and AF healthcare utilization. We also compared subsequent clinical management at 6 months between patients with better versus worse AF HRQoL.

Results

Overall, 1338 patients completed the AFSS symptom score, which varied by sex (mean 7.26 for males vs. 10.27 for females; p < .001), age (<65, 9.73; 65–74, 7.66; ≥75, 7.58; p < .001), heart failure (9.39 with HF vs. 7.67 without; p < .001), and prior ablation (7.28 with prior ablation vs. 8.84; p < .001). In multivariable analysis, younger age (mean difference 2.92 for <65 vs. ≥75; p < .001), female sex (mean difference 2.57; p < .001), pulmonary disease (mean difference 1.88; p < .001), and depression (mean difference 2.46; p < .001) were associated with higher scores. At 6‐months, worse baseline symptom score was associated with the use of rhythm control (37.1% vs. 24.5%; p < .001). Similar cofactors and results were associated with increased AF burden and health care utilization scores.

Conclusions

AF PROs in clinical practice identify highly‐symptomatic patients, corroborating findings in more controlled, clinical trials. Increased AFSS score correlates with more aggressive clinical management, supporting the utility of disease‐specific PROs guiding clinical practice.
The stiffness‐controlled release of interleukin‐6 by cardiac fibroblasts is dependent on integrin α2β1
Authors: Gałdyszyńska Małgorzata , Bobrowska Justyna , Lekka Małgorzata , Radwańska Paulina , Piera Lucyna , Szymański Jacek , Drobnik Jacek
Published: October 2020

Cardiac fibroblasts are able to sense the rigidity of their environment. The present study examines whether the stiffness of the substrate in cardiac fibroblast culture can influence the release of interleukin‐6 (IL‐6), interleukin‐11 (IL‐11) and soluble receptor of IL‐6 (sIL‐6R). It also examines the roles of integrin α2β1 activation and intracellular signalling in these processes. Cardiac fibroblasts were cultured on polyacrylamide gels and grafted to collagen, with an elasticity of E = 2.23 ± 0.8 kPa (soft gel) and E = 8.28 ± 1.06 kPa (stiff gel, measured by Atomic Force Microscope). Flow cytometry and ELISA demonstrated that the fibroblasts cultured on the soft gel demonstrated higher expression of the α2 integrin subunit and increased α2β1 integrin count and released higher levels of IL‐6 and sIL‐6R than those on the stiff gel. Substrate elasticity did not modify fibroblast IL‐11 content. The silencing of the α2 integrin subunit decreased the release of IL‐6. Similar effects were induced by TC‐I 15 (an α2β1 integrin inhibitor). The IL‐6 levels in the serum and heart were markedly lower in α2 integrin‐deficient mice B6.Cg‐Itga2tm1.1Tkun/tm1.1Tkun than wild type. Inhibition of Src kinase by AZM 475271 modifies the IL‐6 level. sIL‐6R secretion is not dependent on α2β1 integrin. Conclusion: The elastic properties of the substrate influence the release of IL‐6 by cardiac fibroblasts, and this effect is dependent on α2β1 integrin and kinase Src activation.
Description of two new miniature species of Hylopanchax Poll & Lambert, 1965 (Cyprinodontiformes: Procatopodidae), from northeastern Gabon, with an updated diagnosis of the genus based on morphology, colouration and osteology
Authors: Bragança Pedro H. N. , van der Zee Jouke R. , Sonnenberg Rainer , Vreven Emmanuel J. W. M. N.
Published: October 2020

Two new species of the lampeye genus Hylopanchax are described from the Ivindo River basin in the Ogowe River drainage. Hylopanchax multisquamatus, new species, and Hylopanchax thysi, new species, differ from congeners by the presence of a hyaline urogenital male papilla with small black spots and a dark‐brown reticulate pattern on the flanks of both males and females in preserved specimens. Hylopanchax multisquamatus is distinguished from congeners by the number of scales on the mid‐longitudinal series (27–30 vs. 19–26, respectively) and by the relative anterior/posterior flank scale depth ratio (140%–150% vs. 170%–220%). Hylopanchax thysi is distinguished from all other congeners, except Hylopanchax paucisquamatus, by the presence of vertebrae (30 vs. 31–33) and is further distinguished from H. multisquamatus by the presence of a deeper caudal peduncle and much larger anterior flank scales. It is distinguished from H. paucisquamatus by the presence of a hyaline urogenital male papilla with small black spots and a dark‐brown reticulate pattern on the flanks of both males and females in preserved specimens. Osteological data of Hylopanchax are presented for the first time, and an updated diagnosis based on external morphology, colouration pattern and osteology is provided. An osteological comparison with closely related species belonging to the genera Procatopus, Hypsopanchax and “Hypsopanchax” is presented. (a) A truncate and slightly downward‐directed anterior process of the angulo‐articular and (b) a guitar‐shaped lachrymal with both its anterior and posterior margins sharply curved are here considered as diagnostic features of Hylopanchax.
Pre‐ampullary location and size ≥10 mm are independent predictors for high‐grade superficial non‐ampullary duodenal epithelial tumors
Authors: Matsueda Katsunori , Uedo Noriya , Kitamura Masanori , Iwagami Hiroyoshi , Shichijo Satoki , Maekawa Akira , Kanesaka Takashi , Takeuchi Yoji , Higashino Koji , Ishihara Ryu
Published: October 2020

Background and Aim

The incidence of identified superficial non‐ampullary duodenal epithelial tumors (SNADETs) has been increasing with recent advances in endoscopic diagnosis. Nevertheless, the clinical features of SNADETs with malignant potential remain unclear. The aim of the present study was to clarify the clinical characteristics of high‐grade SNADETs.

Methods

A total of 328 SNADETs that had been endoscopically or surgically resected between January 2013 and April 2019 were identified from an endoscopic and pathological database. Clinical characteristics were compared between mucosal low‐grade neoplasm (n = 154) and mucosal high‐grade neoplasm/submucosal carcinoma (HGN/SMC, n = 174).

Results

In univariate analysis, tumor size, pre‐ampullary tumor location, red color, and rough/nodular surface were significantly associated with HGN/SMC. In multivariate analysis (odds ratio [95% confidence interval]), large (≥10 mm) tumor size (odds ratio: 4.5, 95% confidence interval: 2.6–7.7, P < 0.001) and pre‐ampullary tumor location (odds ratio: 2.1, 95% confidence interval: 1.3–3.5, P = 0.004) were independent predictors for HGN/SMC. Analysis of histological phenotypes revealed that the proportion of tumors that were HGN/SMC was much greater for gastric‐type tumors (21/23 lesions, 91%) than for intestinal‐type tumors (150/302 lesions, 50%) (P < 0.001) and that all gastric‐type tumors were located in the pre‐ampullary portion.

Conclusions

Pre‐ampullary location and large tumor size are independent predictors for HGN/SMC SNADETs. Pre‐ampullary tumor location is significantly associated with gastric histological phenotype. These findings may help in decision making for endoscopic treatment, active indication for pre‐ampullary tumor or tumor ≥10 mm, and understanding the pathophysiology of SNADETs.
Reducing Hospital Transfers from Aged Care Facilities: A Large‐Scale Stepped Wedge Evaluation
Authors: Hullick Carolyn J. , Hall Alix E. , Conway Jane F. , Hewitt Jacqueline M. , Darcy Leigh F. , Barker Roslyn T. , Oldmeadow Christopher , Attia John R.
Published: October 2020

BACKGROUND/OBJECTIVES

Older people living in residential aged care facilities (RACFs) experience acute deterioration requiring assessment and decision making. We evaluated the impact of a large‐scale regional Aged Care Emergency (ACE) program in reducing hospital admissions and emergency department (ED) transfers.

DESIGN

A stepped wedge nonrandomized cluster trial with 11 steps, implemented from May 2013 to August 2016.

SETTING

A large regional and rural area of northern and western New South Wales, Australia.

PARTICIPANTS

Nine hospital EDs and 81 RACFs participated in the evaluation.

INTERVENTION

The ACE program is an integrated nurse‐led intervention underpinned by a community of practice designed to improve the capability of RACFs managing acutely unwell residents. It includes telephone support, evidence‐based algorithms, defining goals of care for ED transfer, case management in the ED, and an education program.

MEASUREMENTS

ED transfers and subsequent hospital admissions were collected from administrative data including 13 months baseline and 9 months follow‐up.

RESULTS

A total of 18,837 eligible ED visits were analyzed. After accounting for clustering by RACFs and adjusting for time of the year as well as RACF characteristics, a statistically significant reduction in hospital admissions (adjusted incident rate ratio = .79; 95% confidence interval [CI] = .68–.92); P = .0025) was seen (i.e., residents were 21% less likely to be admitted to the hospital). This was also observed in ED visit rates (adjusted incidence rate ratio = .80; 95% CI = .69–.92; P = .0023) (i.e., residents were 20% less likely to be transferred to the ED). Seven‐day ED re‐presentation fell from 5.7% to 4.9%, and 30‐day hospital readmissions fell from 12% to 10%.

CONCLUSION

The stepped wedge design allowed rigorous evaluation of a real‐world large‐scale intervention. These results confirm that the ACE program can be scaled up to a large geographic area and can reduce ED visits and hospitalization of older people with complex healthcare needs living in RACFs.
“Los chinos no beben vino”: Mercados, intermediarios y valor del vino argentino en China
Authors: Badaró Máximo
Published: October 2020

En este artículo analizo las relaciones comerciales entre América Latina y China desde la perspectiva de los intermediarios comerciales argentinos, europeos y chinos que promocionan vinos argentinos en China. En la última década, China se convirtió en uno de los mercados de consumo de vino importado de mayor crecimiento global y en un destino deseado por los intermediarios comerciales y las empresas extranjeras que buscan vender sus productos en este mercado, como es el caso de muchas bodegas argentinas. A partir de un estudio etnográfico que realicé en Shanghái en 2018, analizo las modalidades de atribución de valor que estos profesionales utilizan para la promoción de sus vinos en China. Sostengo que sus principales desafíos giran en torno a la construcción del valor relacional del vino argentino en China —esto es, el rol que cumple el vino en las relaciones sociales en este país.
Metamorphic evolution and SIMS U–Pb geochronology of orthopyroxene‐bearing high‐Psemipelitic granulite in the Fuping area, middle Trans‐North China Orogen
Authors: Liu Jia‐Hui , Zhang Qian W. L. , Wang Juan , Zhang Hui C. G. , Wu Chun‐Ming
Published: October 2020

The Fuping area lies in the middle part of the Trans‐North China Orogen, which is a critical region for understanding the metamorphic–tectonic evolution of this orogenic belt in the Precambrian. The newly discovered orthopyroxene‐bearing semipelitic granulite in this area is a coherent stratigraphic unit, among which three generations of metamorphic mineral assemblages (peak, post‐peak and cooling retrograde) have been identified based on petrographic observation and mineral chemical analysis. The peak metamorphic mineral assemblage mainly consists of porphyroblastic garnet plus matrix minerals including biotite, plagioclase, orthopyroxene, quartz as well as accessory minerals including pyrite, monazite, zircon and apatite. Geothermobarometry calculations and phase equilibria modelling confirm that the representative samples record differentP–Tconditions and metamorphic stages due to retrogressive metamorphism, with the highestP–Tconditions reaching high‐Pgranulite facies. The retrieved clockwise metamorphicP–Tpaths pass from 12.5 to 13.5 kbar/855–880℃ (peak stage) through 8.5–11 kbar/850–886℃ (post‐peak stage) and to a speculative cooling phase (retrograde stage), reflecting near isothermal decompression (ITD) followed by near isobaric cooling (IBC). ThisP–Tpath is interpreted to reflect a subduction and/or collision event followed by a rapid exhumation. Secondary ion mass spectrometry (SIMS) U–Pb dating on metamorphic monazite and zircon yielded metamorphic ages ranging from 1,825 to 1,815 Ma, possibly constraining a retrograde metamorphic age. Therefore, the semipelitic granulite in the Fuping area records the subduction/collision event between the Eastern and Western Blocks of the North China Craton during the Late Palaeoproterozoic.
The patient perspective of nurse‐led care in early rheumatoid arthritis: A systematic review of qualitative studies with thematic analysis
Authors: Sweeney Anne‐Marie Tetsche , McCabe Candy , Flurey Caroline A , Robson Joanna C , Berry Alice , Richards Pamela , Ndosi Mwidimi
Published: October 2020

Introduction

Management of rheumatoid arthritis has changed dramatically over the last decade and is characterised by early start of intensive treatment and tight monitoring of disease activity until remission. The role of nurse‐led care at early stage of disease is not well understood.

Aims

To develop an understanding of rheumatology nurse‐led care from the perspective of patients with early rheumatoid arthritis.

Methods

A systematic review of qualitative studies, reported in line with PRISMA checklist. In March 2019, the following databases were searched: MEDLINE, EMBASE, CINAHL, PsycINFO and OpenGrey. Studies were included if they: included adults with rheumatoid arthritis; were qualitative studies with data on patients’ perspectives of nurse‐led care; and published in peer‐reviewed journals, in English, between 2010–2019. Due to few studies in early rheumatoid arthritis, inclusion was extended to adults with established rheumatoid arthritis. Two reviewers screened abstracts and full texts. Joanna Briggs Institute Critical Appraisal Tool was used for quality assessment. Thematic synthesis was conducted according to the framework of Thomas and Harden (2008).

Results

The search identified 1034 records. After screening and assessing for eligibility, eight qualitative studies were included in the review (133 patients). Three themes were identified from the synthesis. Nurse‐led care was seen to provide professional expertise in planning and delivery of care. A person‐centred approach was used combined with good communication skills, thus creating a positive therapeutic environment. Nurse‐led care was described as providing a sense of empowerment and psychological support.

Conclusion

Patients with rheumatoid arthritis are supportive of nurse‐led care. They value its professionalism and person‐centred approach which provide a sense of security and confidence.

Relevance to Clinical Practice

The findings outline ingredients of nurse‐led care that are important to patients. These can inform nurses’ professional development plans, service improvement and the competence framework for rheumatology nursing.
Pediatric nurse practitioners' attitudes/beliefs and knowledge/perceived competence in caring for transgender and gender‐nonconforming youth
Authors: Collins Cathleen A.
Published: October 2020

Purpose

There is a growing number of youth and their parents seeking assistance from care providers related to gender dysphoria and transitional care for transgender and gender‐nonconforming (TGNC) youth. The purpose of this study was to determine pediatric nurse practitioners’ (PNP) attitudes/beliefs and knowledge/competence in caring for TGNC youth.

Design and Methods

This cross‐sectional descriptive study surveyed PNPs (N = 93) from eight states using two survey instruments to measure attitudes and beliefs and knowledge and perceived competence related to caring for TGNC youth.

Results

Eighty‐one percent of PNPs reported caring for TGNC youth in their practice. Despite this, only 15% of the PNPs received education related to transgender patients during their advanced practice education. Results showed that attending continuing education offerings related to caring for TGNC patients increases PNP perceived competence as well as knowledge. Attitudes and behaviors towards the transgender population were also more positive if the PNP had attended continuing nursing education offerings. Three themes emerged from a qualitative portion of the survey, asking the participant to share thoughts related to caring for transgender youth: lack of education for healthcare providers, the need to refer patients to comprehensive gender services, and the need for support for transgender patients and their families.

Practice Implications

Education plays an important part in nurses’ attitudes, beliefs, and perceived competence in caring for transgender patients. Because the PNP is likely to be exposed to patients with TGNC, it is imperative they seek out opportunities to learn about transgender issues and caring for transgender patients.