bluuebunny/crossref_metadata_2025 huggingface dataset:
Synergistic interaction between the type III secretion system of the endophytic bacterium Pantoea agglomerans DAPP‐PG 734 and the virulence of the causal agent of olive knot Pseudomonas savastanoi pv. savastanoi DAPP‐PG 722
Authors: Moretti Chiaraluce , Rezzonico Fabio , Orfei Benedetta , Cortese Chiara , Moreno‐Pérez Alba , van den Burg Harrold A. , Onofri Andrea , Firrao Giuseppe , Ramos Cayo , Smits Theo H. M. , Buonaurio Roberto
Published: July 2021

The endophytic bacterium Pantoea agglomerans DAPP‐PG 734 was previously isolated from olive knots caused by infection with Pseudomonas savastanoi pv. savastanoi DAPP‐PG 722. Whole‐genome analysis of this P. agglomerans strain revealed the presence of a Hypersensitive response and pathogenicity (Hrp) type III secretion system (T3SS). To assess the role of the P. agglomerans T3SS in the interaction with P. savastanoi pv. savastanoi, we generated independent knockout mutants in three Hrp genes of the P. agglomerans DAPP‐PG 734 T3SS (hrpJ, hrpN, and hrpY). In contrast to the wildtype control, all three mutants failed to cause a hypersensitive response when infiltrated in tobacco leaves, suggesting that P. agglomerans T3SS is functional and injects effector proteins in plant cells. In contrast to P. savastanoi pv. savastanoi DAPP‐PG 722, the wildtype strain P. agglomerans DAPP‐PG 734 and its Hrp T3SS mutants did not cause olive knot disease in 1‐year‐old olive plants. Coinoculation of P. savastanoi pv. savastanoi with P. agglomerans wildtype strains did not significantly change the knot size, while the DAPP‐PG 734 hrpY mutant induced a significant decrease in knot size, which could be complemented by providing hrpY on a plasmid. By epifluorescence microscopy and confocal laser scanning microscopy, we found that the localization patterns in knots were nonoverlapping for P. savastanoi pv. savastanoi and P. agglomerans when coinoculated. Our results suggest that suppression of olive plant defences mediated by the Hrp T3SS of P. agglomerans DAPP‐PG 734 positively impacts the virulence of P. savastanoi pv. savastanoi DAPP‐PG 722.
I've got you under my skin: inflammatory response to elephant seal's lice
Authors: Leonardi M. S. , Krmpotic C. , Barbeito C. , Soto F. , Loza C. M. , Vera R. , Negrete J.
Published: July 2021

Seals (Phocidae) undergo an annual cycle of moulting that implies hair regeneration, and in the case of southern elephant seals, it also involves the superficial strata of the epidermis. Therefore, surviving the moulting period is crucial for their obligate and permanent ectoparasites. Throughout evolutionary time, sucking lice (Echinophtiriidae) have developed morphological, behavioural and ecological adaptations to cope with the amphibious lifestyle of their hosts. Lepidophthirus macrorhini, the Southern elephant seal louse species, faces the additional challenge of surviving attached to the host during the moulting period. Since lice live on the skin, L. macrorhini has developed a unique survival strategy by piercing the skin of their host, thus keeping them protected from moulting. During fieldwork in Patagonia and Antarctica, skin samples with lice within were collected for histological analysis to assess whether these parasites caused damage to the host. Lice generate an inflammatory process in the host's dermis, and these lesions could alter the normal chemical and mechanical protective properties of the skin facilitating secondary infections. Further studies that analyse the potential pathogens in those skin lesions are necessary to properly assess the real impact of ectoparasites on their host health.
Cross‐species analysis between the maize smut fungi Ustilago maydis and Sporisorium reilianum highlights the role of transcriptional change of effector orthologs for virulence and disease
Authors: Zuo Weiliang , Depotter Jasper R. L. , Gupta Deepak K. , Thines Marco , Doehlemann Gunther
Published: July 2021

The constitution and regulation of effector repertoires shape host–microbe interactions. Ustilago maydis and Sporisorium reilianum are two closely related smut fungi, which both infect maize but cause distinct disease symptoms. Understanding how effector orthologs are regulated in these two pathogens can therefore provide insights into the evolution of different infection strategies.

We tracked the infection progress of U. maydis and S. reilianum in maize leaves and used two distinct infection stages for cross‐species RNA‐sequencing analyses. We identified 207 of 335 one‐to‐one effector orthologs as differentially regulated during host colonization, which might reflect the distinct disease development strategies.

Using CRISPR‐Cas9‐mediated gene conversion, we identified two differentially expressed effector orthologs with conserved function between two pathogens. Thus, differential expression of functionally conserved genes might contribute to species‐specific adaptation and symptom development. Interestingly, another differentially expressed orthogroup (UMAG_05318/Sr10075) showed divergent protein function, providing a possible case for neofunctionalization.

Collectively, we demonstrated that the diversification of effector genes in related pathogens can be caused both by alteration on the transcriptional level and through functional diversification of the encoded effector proteins.
Effects of erector spinae plane block on postoperative pain in children undergoing surgery: A systematic review and meta‐analysis of randomized controlled trials
Authors: Luo Rong , Tong Xin , Yan Weidong , Liu Haibei , Yang Lei , Zuo Yunxia
Published: July 2021

Background

The erector spinae plane block is a novel regional anesthetic technique that is gaining popularity in pediatrics. However, the efficacy of erector spinae plane block in children is unclear. The aim of the systematic review and meta‐analysis was to investigate effects of erector spinae plane block on postoperative pain relief in children.

Methods

We searched MEDLINE, Cochrane Library, EMBASE, China National Knowledge Infrastructure, and Wan fang databases for randomized controlled trials that compared erector spinae plane block with no block or other types of block in pediatric patients undergoing surgeries. The primary outcomes were pain intensity at rest within 24 h postoperatively and the number of patients requiring rescue analgesics. Data were analyzed using the fixed‐ or random‐effects model, depending on whether the heterogeneity tested by the I2 statistic was >30%. We assessed the quality of evidence for the outcomes using the Grading of Recommendations, Assessment, Development, and Evaluation method.

Results

Seven randomized controlled trials involving 379 patients were reviewed. Compared with no block, erector spinae plane block slightly reduced the pain scores at 0 h (standardized mean difference [SMD]: −1.07; 95% confidence interval [CI]: −1.60 to −0.54; I2 = 52%), 6 h (SMD: −0.82; 95% CI: −1.39 to −0.25; I2 = 79%) postoperatively at rest and significantly reduced the need for rescue analgesics (odds ratio 0.09; 95% CI: 0.04 to 0.21; I2 = 16%). One trial demonstrated the analgesic effect of erector spinae plane block was similar to a quadratus lumborum block, while another trial demonstrated the analgesic effect of ESPB was superior to an ilioinguinal nerve block.

Conclusions

This review provides low‐quality evidence that erector spinae plane block exhibits superior analgesia compared to no block in children. Due to the limited data, evidence regarding the comparison with other regional blocks remains unclear. Future large‐sized and well‐designed randomized controlled trials are needed.
Inactivation of the germacrene A synthase genes by CRISPR/Cas9 eliminates the biosynthesis of sesquiterpene lactones in Cichorium intybus L.
Authors: Cankar Katarina , Bundock Paul , Sevenier Robert , Häkkinen Suvi T. , Hakkert Johanna Christina , Beekwilder Jules , van der Meer Ingrid M. , de Both Michiel , Bosch Dirk
Published: July 2021

Chicory (Cichorium intybus var. sativum) is an industrial crop species cultivated for the production of a fructose polymer inulin, which is used as a low‐calorie sweetener and prebiotic. Besides, inulin chicory taproots also accumulate sesquiterpene lactones (STLs). These are bitter tasting compounds, which need to be removed during inulin extraction, resulting in additional costs. In this work, we describe chicory lines where STL accumulation is almost completely eliminated. Genome editing using the CRISPR/Cas9 system was used to inactivate four genes that encode the enzyme that performs the first dedicated step in STL synthesis, germacrene A synthase (CiGAS). Chicory lines were obtained that carried null mutations in all four CiGAS genes. Lines lacking functional CiGAS alleles showed a normal phenotype upon greenhouse cultivation and show nearly complete elimination of the STL synthesis in the roots. It was shown that the reduction in STLs could be attributed to mutations in genetically linked copies of the CiGAS‐short gene and not the CiGAS‐long gene, which is relevant for breeding the trait into other cultivars. The inactivation of the STL biosynthesis pathway led to increase in phenolic compounds as well as accumulation of squalene in the chicory taproot, presumably due to increased availability of farnesyl pyrophosphate (FFP). These results demonstrate that STLs are not essential for chicory growth and that the inhibition of the STL biosynthesis pathway reduced the STL levels chicory which will facilitate inulin extraction.
Root submergence enhances respiration and sugar accumulation in the stem of flooded tomato plants
Authors: Mignolli Francesco , Barone Javier Orlando , Vidoz María Laura
Published: July 2021

Flooding is a major environmental constraint that obliges plants to adopt plastic responses in order to cope with it. When partially submerged, tomato plants undergo profound changes involving rearrangements in their morphology and metabolism. In this work, we observed that partial submergence markedly dampens root respiration and halts root growth. However, the flooded hypocotyl surprisingly enhances oxygen consumption. Previous results demonstrated that aerenchyma formation in the submerged tomato stem re‐establishes internal oxygen tension, making aerobic respiration possible. Indeed, potassium cyanide abruptly stops oxygen uptake, indicating that the cytochrome c pathway is likely to be engaged. Furthermore, we found out that leaf‐derived sugars accumulate in large amounts in hypocotyls of flooded plants. Girdling and feeding experiments point to sucrose as the main carbon source for respiration. Consistently, submerged hypocotyls are characterized by high sucrose synthase activity, indicating that sucrose is cleaved and channelled into respiration. Since inhibition of hypocotyl respiration significantly prevents sugar build‐up, it is suggested that a high respiration rate is required for sucrose unloading from phloem. As substrate availability increases, respiration is fuelled even more, leading to a maintained allocation of sugars to flooded hypocotyls.
Existential risk from AI and orthogonality: Can we have it both ways?
Authors: Müller Vincent C. , Cannon Michael
Published: July 2021

The standard argument to the conclusion that artificial intelligence (AI) constitutes an existential risk for the human species uses two premises: (1) AI may reach superintelligent levels, at which point we humans lose control (the ‘singularity claim’); (2) Any level of intelligence can go along with any goal (the ‘orthogonality thesis’). We find that the singularity claim requires a notion of ‘general intelligence’, while the orthogonality thesis requires a notion of ‘instrumental intelligence’. If this interpretation is correct, they cannot be joined as premises and the argument for the existential risk of AI turns out invalid. If the interpretation is incorrect and both premises use the same notion of intelligence, then at least one of the premises is false and the orthogonality thesis remains itself orthogonal to the argument to existential risk from AI. In either case, the standard argument for existential risk from AI is not sound.—Having said that, there remains a risk of instrumental AI to cause very significant damage if designed or used badly, though this is not due to superintelligence or a singularity.
How muscles maximize performance in accelerated sprinting
Authors: Pandy Marcus G. , Lai Adrian K. M. , Schache Anthony G. , Lin Yi‐Chung
Published: July 2021

We sought to provide a more comprehensive understanding of how the individual leg muscles act synergistically to generate a ground force impulse and maximize the change in forward momentum of the body during accelerated sprinting. We combined musculoskeletal modelling with gait data to simulate the majority of the acceleration phase (19 foot contacts) of a maximal sprint over ground. Individual muscle contributions to the ground force impulse were found by evaluating each muscle's contribution to the vertical and fore‐aft components of the ground force (termed “supporter” and “accelerator/brake,” respectively). The ankle plantarflexors played a major role in achieving maximal‐effort accelerated sprinting. Soleus acted primarily as a supporter by generating a large fraction of the upward impulse at each step whereas gastrocnemius contributed appreciably to the propulsive and upward impulses and functioned as both accelerator and supporter. The primary role of the vasti was to deliver an upward impulse to the body (supporter), but these muscles also acted as a brake by retarding forward momentum. The hamstrings and gluteus medius functioned primarily as accelerators. Gluteus maximus was neither an accelerator nor supporter as it functioned mainly to decelerate the swinging leg in preparation for foot contact at the next step. Fundamental knowledge of lower‐limb muscle function during maximum acceleration sprinting is of interest to coaches endeavoring to optimize sprint performance in elite athletes as well as sports medicine clinicians aiming to improve injury prevention and rehabilitation practices.
A note on the propagation of positional uncertainty in environmental models
Authors: van Zoest Vera , van Buul Jasper , Osei Frank , Stein Alfred
Published: July 2021

GPS sensors have an inherent positional uncertainty that is often neglected in environmental modeling. In this article we study the propagation of positional uncertainty in grid‐based geo‐information systems. The probability is obtained that a point has an actual position outside the raster cell in which it was observed. For multiple points, these probabilities serve as weights to update a raster value and adjust for positional uncertainty. We show the effect of positional uncertainty propagation by means of simulations using rasters with different levels of spatial autocorrelation, as well as an illustration of a real‐world example in which we estimate exposure to air pollution. We found that the propagated uncertainty was highest when the spatial autocorrelation is low, with a root mean squared error of 7% compared to 1% for the high spatial autocorrelation scenario. We conclude that positional uncertainty propagates through environmental models and propose a simple probabilistic method to account for it.
Survey to inform trial of low‐titer group O whole‐blood compared to conventional blood components for children with severe traumatic bleeding
Authors: Kolodziej Julia H. , Leonard Julie C. , Josephson Cassandra D. , Gaines Barbara A. , Wisniewski Stephen R. , Yazer Mark H. , Spinella Philip C.
Published: July 2021

Background

Low‐titer group O whole‐blood (LTOWB) is being used for children with life‐threatening traumatic bleeding. A survey was conducted to determine current LTOWB utilization and interest in participation in a randomized control trial (RCT) of LTOWB versus standard blood component transfusion in this population.

Study design and methods

Transfusion medicine (TM) directors and pediatric trauma directors at 36 US children's hospitals were surveyed by e‐mail in June 2020. Hospitals were selected by participation in the Massive Transfusion Epidemiology and Outcomes in Children Study or being among the largest 30 children's hospitals by bed capacity per the Becker Hospital Review.

Results

The response rate was 83.3% (30/36) from TM directors and 88.9% (32/36) from trauma directors. The median of massive transfusion protocol activations for traumatic bleeding was reported as 12 (IQR 5.8–20) per year by TM directors. LTOWB was used by 18.8% (6/32) of trauma directors. Survey responses indicate that 86.7% (26/30) of TM directors and 90.6% (29/32) of trauma directors either moderately or strongly agree that a LTOWB RCT is important to perform. About 83.3% (25/30) of TM directors and 93.8% (30/32) of trauma directors were willing to participate in the proposed trial. About 80% (24/30) of TM directors and 71.9% (23/32) of trauma directors would transfuse RhD+ LTOWB to male children, but fewer would transfuse Rh + LTOWB to females [20% (6/30) TM directors and 37.5% (12/32) of trauma directors].

Conclusions

A majority of respondents supported an RCT comparing LTOWB to component therapy in children with severe traumatic bleeding.
Efficacy of the compensatory reserve measurement in an emergency department trauma population
Authors: Schauer Steven G. , April Michael D. , Arana Allyson A. , Maddry Joseph K. , Escandon Mireya A. , Linscomb Carlissa D. , Rodriguez Dylan C. , Convertino Victor A.
Published: July 2021

Background

The Compensatory Reserve Measurement (CRM) is a novel method used to provide early assessment of shock based on arterial wave form morphology changes. We hypothesized that (1) CRM would be significantly lower in those trauma patients who received life‐saving interventions compared with those not receiving interventions, and (2) CRM in patients who received interventions would recover after the intervention was performed.

Study design and methods

We captured vital signs along with analog arterial waveform data from trauma patients meeting major activation criteria using a prospective study design. Study team members tracked interventions throughout their emergency department stay.

Results

Ninety subjects met inclusion with 13 receiving a blood product and 10 a major airway intervention. Most trauma was blunt (69%) with motor vehicle collisions making up the largest proportion (37%) of injury mechanism. Patients receiving blood products had lower CRM values just prior to administration versus those who did not (50% versus 58%, p = .045), and lower systolic pressure (SBP; 95 versus 123 mmHg, p = .005), diastolic (DBP; 62 versus 79, p = .007), and mean arterial pressure (MAP; 75 versus 95, p = .006), and a higher pulse rate (HR; 101 versus 89 bpm, p = .039). Patients receiving an airway intervention had lower CRM values just prior to administration versus those who did not (48% versus 58%, p = .062); however, SBP, DBP, MAP, and HR were not statistically distinguishable (p ≥ .645).

Conclusions

Our results support our hypotheses that the CRM distinguished those patients who received blood or an airway intervention from those who did not, and increased appropriately after interventions were performed.
In vitro characteristics and in vivo platelet quality of whole blood treated with riboflavin and UVA/UVB light and stored for 24 hours at room temperature
Authors: Lunde Turid Helen Felli , Hartson Lindsay , Bailey Shawn Lawrence , Hervig Tor Audun
Published: July 2021

Background

There is a global increase in whole blood usage and at the same time, emerging pathogens give cause for pathogen reduction technology (PRT). The Mirasol PRT has shown promising results for plasma and platelet concentrate products. Treatment of whole blood with subsequent platelet survival and recovery analysis would be of global value.

Study Design and Methods

A two‐arm, open‐label laboratory study was performed with 40 whole blood collections in four groups: non‐leukoreduced non‐PRT‐treated, non‐leukoreduced PRT‐treated, leukoreduced non‐PRT‐treated, and leukoreduced PRT‐treated.

Leukoreduction and/or PRT‐treatment was performed on the day of collection, then all WB units were stored at room temperature for 24 h. Sampling was performed after hold‐time and after 24‐h storage in RT. If PRT‐treatment or leukoreduction, samples were also taken subsequently after treatment.

Thirteen healthy volunteer blood donors completed the in vivo study per protocol. All WB units were non‐leukoreduced and PRT‐treated. Radioactive labeling of platelets from RT‐stored, PRT‐treated whole blood, sampling of subjects, recovery, and survival calculations were performed according to the Biomedical Excellence for Safer Transfusion Collaborative protocol.

Results

In vitro characteristics show that PRT‐treatment leads to increased levels of hemolysis, potassium, and lactate, while there are decreased levels of glucose, FVIII, and fibrinogen after 24 h of storage. All values are within requirements for WB.

In vivo recovery and survival of platelets were 85.4% and 81.3% of untreated fresh control, respectively.

Conclusions

PRT‐treatment moderately reduces whole blood quality but is well within the limits of international guidelines. Recovery and survival of platelets are satisfactory after Mirasol treatment.
Effect of parachute delivery on red blood cell (RBC) and plasma quality measures of blood for transfusion
Authors: Bates Mark , Watts Sarah , Doughty Heidi , Woolley Tom , Miles Andrew , Barry Liam , Jenner Dominic , Sedman Andrew , Purcell Robert , Kirkman Emrys
Published: July 2021

Background

Parachute airdrop offers a rapid transfusion supply option for humanitarian aid and military support. However, its impact on longer‐term RBC survival is undocumented. This study aimed to determine post‐drop quality of RBCs in concentrates (RCC), and both RBCs and plasma in whole blood (WB) during subsequent storage.

Study design and methods

Twenty‐two units of leucodepleted RCC in saline, adenine, glucose, mannitol (SAGM) and 22 units of nonclinical issue WB were randomly allocated for air transportation, parachute drop, and subsequent storage (parachute), or simply storage under identical conventional conditions (4 ± 2°C) (control). All blood products were 6–8 days post‐donation. Parachute units were packed into Credo Cubes, (Series 4, 16 L) inside a PeliCase (Peli 0350) and rigged as parachute delivery packs. Packs underwent a 4‐h tactical flight (C130 aircraft), then parachuted from 250 to 400 ft before ground recovery. The units were sampled aseptically before and after airdrop at weekly intervals. A range of assays quantified the RBC storage lesion and coagulation parameters.

Results

Blood units were maintained at 2–6°C and recovered intact after recorded ground impacts of 341–1038 m s−2. All units showed a classical RBC storage lesion and increased RBC microparticles during 42 days of storage. Fibrinogen and clotting factors decreased in WB during storage. Nevertheless, no significant difference was observed between Control and Parachute groups. Air transportation and parachute delivery onto land did not adversely affect, or shorten, the shelf life of fresh RBCs or WB.

Discussion

Appropriately packaged aerial delivery by parachute can be successfully used for blood supply.
Prehospital whole blood reduces early mortality in patients with hemorrhagic shock
Authors: Braverman Maxwell A. , Smith Alison , Pokorny Douglas , Axtman Benjamin , Shahan Charles Patrick , Barry Lauran , Corral Hannah , Jonas Rachelle Babbitt , Shiels Michael , Schaefer Randall , Epley Eric , Winckler Christopher , Waltman Elizabeth , Eastridge Brian J. , Nicholson Susannah E. , Stewart Ronald M. , Jenkins Donald H.
Published: July 2021

Background

Low titer O+ whole blood (LTOWB) is being increasingly used for resuscitation of hemorrhagic shock in military and civilian settings. The objective of this study was to identify the impact of prehospital LTOWB on survival for patients in shock receiving prehospital LTOWB transfusion.

Study design and methods

A single institutional trauma registry was queried for patients undergoing prehospital transfusion between 2015 and 2019. Patients were stratified based on prehospital LTOWB transfusion (PHT) or no prehospital transfusion (NT). Outcomes measured included emergency department (ED), 6‐h and hospital mortality, change in shock index (SI), and incidence of massive transfusion. Statistical analyses were performed.

Results

A total of 538 patients met inclusion criteria. Patients undergoing PHT had worse shock physiology (median SI 1.25 vs. 0.95, p < .001) with greater reversal of shock upon arrival (−0.28 vs. −0.002, p < .001). In a propensity‐matched group of 214 patients with prehospital shock, 58 patients underwent PHT and 156 did not. Demographics were similar between the groups. Mean improvement in SI between scene and ED was greatest for patients in the PHT group with a lower trauma bay mortality (0% vs. 7%, p = .04). No survival benefit for patients in prehospital cardiac arrest receiving LTOWB was found (p > .05).

Discussion

This study demonstrated that trauma patients who received prehospital LTOWB transfusion had a greater improvement in SI and a reduction in early mortality. Patient with prehospital cardiac arrest did not have an improvement in survival. These findings support LTOWB use in the prehospital setting. Further multi‐institutional prospective studies are needed.
A prehospital scoring system for predicting the need for emergent blood product transfusion
Authors: Avital Guy , Gelikas Shaul , Radomislensky Irina , Tsur Avishai M. , Sorkin Alex , Shinar Eilat , Bodas Moran , Yazer Mark H. , Cap Andrew P. , Chen Jacob , Glassberg Elon , Benov Avi
Published: July 2021

Background

Several tools have been proven to predict the need for massive transfusion in trauma casualties, yet tools that are easily applicable in the prehospital setting for predicting the need for any blood product transfusion in the emergency department (ED) are lacking.

Methods

A retrospective analysis of the cross‐referenced Israeli Defense Forces Trauma Registry and the Israeli National Trauma Registry databases was performed to identify predictors for any blood product transfusion in the ED. A scoring system was developed after internally validating the prediction model. Division to risk groups was performed.

Results

Seven variables (systolic blood pressure, heart rate, arterial oxygen saturation, trunk involvement, mechanism of injury, chest decompression, and tourniquet application) were included in the scoring system, ranging from 0 to 11.5. Risk groups for ED transfusion included very low (0.8%), low (3.2%), intermediate (8.5%), and high (31.2%) risk.

Conclusion

A scoring system for predicting the need for any blood product transfusion in the ED was developed, based on information readily available in the early stages of prehospital resuscitation, allowing the receiving medical facility to prepare for that need.
Emergency departments are higher‐risk locations for wrong blood in tube errors
Authors: Dunbar Nancy M. , Delaney Meghan , Murphy Michael F. , Pagano Monica B. , Saifee Nabiha Huq , Seheult Jansen , Yazer Mark , Kaufman Richard M. ,   the WBIT Study Investigators on behalf of the Biomedical Excellence for Safer Transfusion (BEST) Collaborative
Published: July 2021

Background

Wrong blood in tube (WBIT) errors can lead to ABO mistransfusions. It is unknown if WBIT errors are more likely in specific healthcare locations or if specific collection practices influence the commission of WBIT errors.

Study Design and Methods

Data on pretransfusion samples from calendar year 2019 were collected retrospectively by 39 transfusion services in nine countries. We compared the proportion of WBIT errors made in emergency departments (EDs), inpatient wards, and outpatient clinics.

Results

In total, 143 WBIT errors were detected among 1,394,862 samples for an unadjusted aggregate WBIT proportion of 1.03/10,000 samples. Using a pooled random effects model, the WBIT proportion was estimated to be significantly higher in EDs (1.23/10,000 samples, 95% CI 0.62–2.43) than inpatient wards (0.71/10,000, 95% CI 0.44–1.14; p < .001) or outpatient clinics (0.24/10,000, 95% CI 0.08–0.65; p < .001) and significantly higher in inpatient wards than outpatient clinics (p = .043). The use of electronic positive patient identification (ePPID) systems was associated with a significantly lower WBIT proportion in the ED (odds ratio, OR: 0.32, 95% CI: 0.11–0.96, p = .041), but not in inpatient wards (OR: 0.45, 95% CI: 0.20–1.01, p = .054) or outpatient clinics (OR: 1.95, 95% CI: 0.39–9.74, p = .415).

Discussion

Normalized for the number of samples drawn per location, the WBIT proportion in EDs was 1.7 times higher than inpatient wards and 5.1 times higher than outpatient clinics. EDs represent higher‐risk clinical locations for WBIT errors, and electronic positive patient identification (ePPID) may provide a greater impact on safety in EDs relative to other clinical areas.
HIV residual risk in Canada for apheresis source plasma donation without deferral for men who have sex with men
Authors: Aubé Eliana , Lewin Antoine , O'Brien Sheila F. , Grégoire Yves , Pillonel Josiane , Steele Whitney R. , Custer Brian , Davison Katy L. , Germain Marc , Seed Clive R. , Camirand Lemyre Félix ,   the Surveillance, Risk Assessment and Policy Subgroup of the ISBT Transfusion Transmitted Infectious Diseases Working Party
Published: July 2021

Background and Objectives

In Canada, men having sex with men (MSM) are deferred for 3 months from last sexual contact to reduce human immunodeficiency virus (HIV) risk to recipients. The aim of this paper was to model the Canadian residual risk of HIV‐positive source plasma incorporating pathogen inactivation (PI) under no MSM deferral scenarios for apheresis plasma donations.

Materials and Methods

A combined Bayesian network (BN) and Monte Carlo approach were implemented to estimate the HIV residual risk under 3‐month deferral compared with no deferral without quarantine scenarios for MSM donors. Models involve the stochastic generation of donation and its infection status based on its corresponding simulated donor profile. Viral load reduction conferred by PI used by source plasma fractionators was simulated. Model parameters were derived from Héma‐Québec and Canadian Blood Services data, viral loads in a large sample of HIV‐positive US blood donors, CSL Behring documentation and from published data.

Results

In the most likely scenario for the 3‐month deferral model, there were 2.71 positive donations per 1,000,000 donations (95% confidence interval [CI] 2.63–2.78). For the no‐deferral model, there were 3.01 positive donations per 1,000,000 donations (95% CI 2.94–3.09). For both scenarios, the risk of having an infectious pool was 0 in 300,000 pools (95% CI 0–0.0000123) after consideration of PI.

Conclusion

Based on simulation results, there would be a negligible HIV residual risk associated with the removal of a time‐based MSM deferral without quarantine for source plasma incorporating PI.
Hospital selection in emergency medical service systems: A literature review
Authors: Caicedo Rolón Alvaro Junior , Rivera Cadavid Leonardo
Published: July 2021

Emergency medical service (EMS) systems play a fundamental role in society by providing a vital service in initial emergency care. The purpose of this research is to present the first literature review of hospital selection operational decision within the context of the EMS system. The main findings were the following: The hospital selection problem is integrated with the location, dispatch, routing, and size of the ambulance fleet. The main selection criteria were closeness, hospital care capacities and the shortest queue or greatest number of free beds. The most used performance measures were the shortest transport and waiting time. Solution techniques include discrete event simulation, queuing models, mixed linear integer programming, and CPLEX and Arena software. The application of metaheuristics is scarce; mobile applications and Internet information systems have been implemented for real-time decision making. It is recommended that the design of hospital selection methods be implemented as well as the technological developments, considering the participation of the actors of the EMS system.
Procesos de determinación del derecho a la salud bucal de mujeres en post-parto y sus hijos. Bucaramanga y Medellín (Colombia), Santiago (Chile), 2017
Authors: De la Roche Colorado Valentina , Franco Cortés Ángela María , Cornejo Ovalle Marco Antonio , Espinoza Santander Iris Lucía , Gallego Gómez Clara Liliana , Fajreldin Chuaqui Valentina , Delgado Restrepo Oriana , Almario Barrera Andrea , Concha Sánchez Sonia Constanza
Published: July 2021

Introducción. Numerosos estudios abordan la situación de salud bucal y el acceso a la atención odontológica de las gestantes, sin embargo pocos continúan la observación en el postparto y mucho menos la situación de sus hijos durante los primeros años de vida. Objetivo. Identificar y comprender los procesos generales, particulares y singulares que limitan o favorecen el ejercicio del derecho a la salud bucal de la mujer postparto y su hijo durante el primer año de vida. Método. El estudio parte del enfoque de la Determinación Social de la Salud en dos ciudades colombianas, Medellín y Bucaramanga, y en Santiago de Chile. En cada ciudad participaron 26 binomios previo consentimiento informado. Se usaron técnicas cualitativas (entrevistas y grupos de discusión) y cuantitativas (encuesta y exámenes bucales) para la recolección de los datos. Resultados. Procesos generales de orden económico, político, y de género, unidos a dinámicas laborales, de consumo y socioculturales, de los modos de vida de las familias, determinan, positiva o negativamente, las oportunidades de acceso al cuidado de la salud bucal para ambos sujetos y el estado objetivo de la misma. Conclusión. Los procesos de nivel general, con algunas diferencias entre los dos países, limitan el ejercicio del derecho a la salud reconocido como fundamental por ambas constituciones políticas. Esos procesos del nivel general, subsumen los procesos particulares y singulares que también se comportan como limitantes en la mayoría de los casos.
Additive Manufacturing of Carbon Nanotube Reinforced Bioactive Glass Scaffolds for Bone Tissue Engineering
Authors: Dixit Kartikeya , Sinha Niraj
Published: July 2021

Scaffolds play an essential role in bone healing by providing temporary structural support to the native bone tissue and by hosting bone cells. To this end, several biomaterials and manufacturing methods have been proposed. Among the biomaterials, bio-active glasses have attractive properties as a scaffold material for bone repair. Simultaneously, additive manufacturing (AM) techniques have attracted significant attention owing to their capability of fabricating complex and patient-specific scaffolds. Accordingly, borosilicate bio-active glass (BG-B30) has been used to fabricate the scaffolds using an extrusion-based AM devices in this study. Pluronic F-127 was used as an ink carrier that showed suitable shear thinning behavior for fabrication. The pure BG-B30 scaffold had a compressive strength of 23.30 MPa and was reinforced further with functionalized multiwalled carbon nanotube (MWCNT-COOH) to reduce its brittleness and enhance its compressive strength. When compared to the conventional polymer foam replication technique, the combination of MWCNT-COOH reinforcement and AM resulted in an enhancement of the compressive strength by ∼646% (1.05 MPa to 35.84 MPa). Further, structural analysis using microcomputed tomography revealed that the scaffolds fabricated using AM had better control over strut size and pore size in addition to better network connectivity. Finally, in vitro experiments demonstrated its bio-active behavior by the formation of hydroxyapatite, and the cellular studies revealed good cell viability and osteogenesis initiation. These results are promising for the fabrication of patient-specific CNT-reinforced bio-active glass porous scaffolds for bone tissue engineering applications.
Compact Diesel Engine Waste-Heat-Driven Ammonia–Water Absorption Heat Pump Modeling and Performance Maximization Strategies
Authors: Keinath Christopher M. , Delahanty Jared C. , Garimella Srinivas , Garrabrant Michael A.
Published: July 2021

An investigation of the best ways to achieve optimal performance from a waste-heat-driven ammonia–water absorption heat pump over a wide range of operating conditions is presented. Waste heat from an 8-kWe diesel engine generator is recovered using an exhaust gas heat exchanger and delivered to the desorber by a heat transfer fluid loop. The absorber and condenser are hydronically coupled in parallel to an ambient heat exchanger for heat rejection. The evaporator provides chilled water for space-conditioning with a baseline cooling capacity of 2 kW. All heat and mass exchangers employ novel microscale geometries. A detailed thermodynamics model is developed to simulate performance and develop strategies to achieve the best performance in both cooling and heating modes over a range of operating conditions. These parametric studies show that improved coefficients of performance can be achieved by adjusting the coupling fluid temperatures in the evaporator and the condenser/absorber as the ambient temperature varies. With the varying return temperatures, the system is able to provide the 2-kW design cooling capacity for a wide range of ambient temperatures.
A Multiscale Simulation Approach for the Mechanical Response of Copper/Nickel Nanofoams With Experimental Validation
Authors: Ke Hang , Loaiza Alexandra , Jimenez Andres G. , Bahr David F. , Mastorakos Ioannis
Published: July 2021

Metallic nanofoams, cellular structures consisting of interlinked thin nanowires and empty pores, create low density, high surface area materials. These structures can suffer from macroscopically brittle behavior. In this work, we present a multiscale approach to study and explain the mechanical behavior of metallic nanofoams obtained by an electrospinning method. In this multiscale approach, atomistic simulations were first used to obtain the yield surfaces of different metallic nanofoam cell structures. Then, a continuum plasticity model using finite elements was used to predict the alloy nanofoam's overall strength in compression. The manufactured metallic nanofoams were produced by electrospinning a polymeric non-woven fabric containing metal precursors for alloys of copper–nickel and then thermally processing the fabric to create alloy metallic nanofoams. The nanofoams were tested with nanoindentation. The experimental results suggest that the addition of nickel increases the hardening of the nanofoams. The multiscale simulation modeling results agreed qualitatively with the experiments by suggesting that the addition of the alloying can be beneficial to the hardening behavior of the metallic nanofoams and helps to isolate the effects of alloying from morphological changes in the foam. This behavior was related to the addition of solute atoms that prevent the free dislocation movement and increase the strength of the structure.
Case Report: Heat Suit Training May Increase Hemoglobin Mass in Elite Athletes
Authors: Rønnestad Bent R. , Hansen Joar , Bonne Thomas C. , Lundby Carsten
Published: July 2021

Purpose: The present case report aimed to investigate the effects of exercise training in temperate ambient conditions while wearing a heat suit on hemoglobin mass (Hbmass). Methods: As part of their training regimens, 5 national-team members of endurance sports (3 males) performed ∼5 weekly heat suit exercise training sessions each lasting 50 minutes for a duration of ∼8 weeks. Two other male athletes acted as controls. After the initial 8-week period, 3 of the athletes continued for 2 to 4 months with ∼3 weekly heat sessions in an attempt to maintain acquired adaptations at a lower cost. Hbmass was assessed in duplicate before and after intervention and maintenance period based on automated carbon monoxide rebreathing. Results: Heat suit exercise training increased rectal temperature to a median value of 38.7°C (range 38.6°C–39.0°C), and during the initial ∼8 weeks of heat suit training, there was a median increase of 5% (range 1.4%–12.9%) in Hbmass, while the changes in the 2 control athletes were a decrease of 1.7% and an increase of 3.2%, respectively. Furthermore, during the maintenance period, the 3 athletes who continued with a reduced number of heat suit sessions experienced a change of 0.7%, 2.8%, and −1.1%, indicating that it is possible to maintain initial increases in Hbmass despite reducing the weekly number of heat suit sessions. Conclusions: The present case report illustrates that heat suit exercise training acutely raises rectal temperature and that following 8 weeks of such training Hbmass may increase in elite endurance athletes.
ExtrathymicAire-expressing cells support maternal-fetal tolerance
Authors: Gillis-Buck Eva , Miller Haleigh , Sirota Marina , Sanders Stephan J. , Ntranos Vasilis , Anderson Mark S. , Gardner James M. , MacKenzie Tippi C.
Published: July 2021

Maternal extrathymicAire-expressing cells support maternal-fetal tolerance and prevent intrauterine growth restriction in mice.
Communicating personalised statin therapy-effects as 10-year CVD-risk or CVD-free life-expectancy: does it improve decisional conflict? Three-armed, blinded, randomised controlled trial
Authors: Jaspers Nicole E M , Visseren Frank L J , van der Graaf Yolanda , Smulders Yvo M , Damman Olga C , Brouwers Corline , Rutten Guy E H M , Dorresteijn Jannick A N
Published: July 2021

Objective

To determine whether communicating personalised statin therapy-effects obtained by prognostic algorithm leads to lower decisional conflict associated with statin use in patients with stable cardiovascular disease (CVD) compared with standard (non-personalised) therapy-effects.

Design

Hypothesis-blinded, three-armed randomised controlled trial

Setting and participants

303 statin users with stable CVD enrolled in a cohort

Intervention

Participants were randomised in a 1:1:1 ratio to standard practice (control-group) or one of two intervention arms. Intervention arms received standard practice plus (1) apersonalised health profile, (2) educational videos and (3) a structured telephone consultation. Intervention arms received personalised estimates of prognostic changes associated with both discontinuation of current statin and intensification to the most potent statin type and dose (ie, atorvastatin 80 mg). Intervention arms differed in how these changes were expressed: either change in individual 10-year absolute CVD risk (iAR-group) or CVD-free life-expectancy (iLE-group) calculated with the SMART-REACH model (http://U-Prevent.com).

Outcome

Primary outcome was patient decisional conflict score (DCS) after 1 month. The score varies from 0 (no conflict) to 100 (high conflict). Secondary outcomes were collected at 1 or 6 months: DCS, quality of life, illness perception, patient activation, patient perception of statin efficacy and shared decision-making, self-reported statin adherence, understanding of statin-therapy, post-randomisation low-density lipoprotein cholesterol level and physician opinion of the intervention. Outcomes are reported as median (25th– 75th percentile).

Results

Decisional conflict differed between the intervention arms: median control 27 (20–43), iAR-group 22 (11–30; p-value vs control 0.001) and iLE-group 25 (10–31; p-value vs control 0.021). No differences in secondary outcomes were observed.

Conclusion

In patients with clinically manifest CVD, providing personalised estimations of treatment-effects resulted in a small but significant decrease in decisional conflict after 1 month. The results support the use of personalised predictions for supporting decision-making.

Trial registration

NTR6227/NL6080.
Satisfaction with maternity care among recent migrants: an interview questionnaire-based study
Authors: Bains Sukhjeet , Sundby Johanne , Lindskog Benedikte V. , Vangen Siri , Diep Lien M. , Owe Katrine M. , Sorbye Ingvil K.
Published: July 2021

Objective

To examine factors associated with recently migrated women’s satisfaction with maternity care in urban Oslo, Norway.

Design

An interview-based cross-sectional study, using a modified version of Migrant Friendly Maternity Care Questionnaire.

Setting

Face-to-face interview after birth in two maternity wards in urban Oslo, Norway, from January 2019 to February 2020.

Participants

International migrant women, ≤5 years length of residency in Norway, giving birth in urban Oslo, excluding women born in high-income countries.

Primary outcome

Dissatisfaction of care during pregnancy and birth, measured using a Likert scale, grouped into satisfied and dissatisfied, in relation to socio-demographic/clinical characteristics and healthcare experiences.

Secondary outcome

Negative healthcare experiences and their association with reason for migration.

Results

A total of 401 women answered the questionnaire (87.6% response rate). Overall satisfaction with maternal healthcare was high. However, having a Norwegian partner, higher education and high Norwegian language comprehension were associated with greater odds of being dissatisfied with care. One-third of all women did not understand the information provided by the healthcare personnel during maternity care. More women with refugee background felt treated differently because of factors such as religion, language and skin colour, than women who migrated due to family reunification.

Conclusions

Although the overall satisfaction was high, for certain healthcare experiences such as understanding information, we found more negative responses. The negative healthcare experiences and factors associated with satisfaction identified in this study have implications for health system planning, education of healthcare personnel and strategies for quality improvement.
Reducing COVID-19 quarantine with SARS-CoV-2 testing: a simulation study
Authors: Peng Bo , Zhou Wen , Pettit Rowland W , Yu Patrick , Matos Peter G , Greninger Alexander L , McCashin Julie , Amos Christopher I
Published: July 2021

Objective

To evaluate the effectiveness of SARS-CoV-2 testing on shortening the duration of quarantines for COVID-19 and to identify the most effective choices of testing schedules.

Design

We performed extensive simulations to evaluate the performance of quarantine strategies when one or more SARS-CoV-2 tests were administered during the quarantine. Simulations were based on statistical models for the transmissibility and viral loads of SARS-CoV-2 infections and the sensitivities of available testing methods. Sensitivity analyses were performed to evaluate the impact of perturbations in model assumptions on the outcomes of optimal strategies.

Results

We found that SARS-CoV-2 testing can effectively reduce the length of a quarantine without compromising safety. A single reverse transcription-PCR (RT-PCR) test performed before the end of quarantine can reduce quarantine duration to 10 days. Two tests can reduce the duration to 8 days, and three highly sensitive RT-PCR tests can justify a 6-day quarantine. More strategic testing schedules and longer quarantines are needed if tests are administered with less-sensitive RT-PCR tests or antigen tests. Shorter quarantines can be used for applications that tolerate a residual postquarantine transmission risk comparable to a 10-day quarantine.

Conclusions

Testing could substantially reduce the length of isolation, reducing the physical and mental stress caused by lengthy quarantines. With increasing capacity and lowered costs of SARS-CoV-2 tests, test-assisted quarantines could be safer and more cost-effective than 14-day quarantines and warrant more widespread use.