bluuebunny/crossref_metadata_2025 huggingface dataset:
Qualitative research methods and its application in nephrology
Authors: Guha Chandana , Viecelli Andrea K. , Wong Germaine , Manera Karine , Tong Allison
Published: May 2021

Chronic kidney disease is associated with an increased risk of mortality, comorbidities and life‐threatening complications. Invasive treatments including dialysis or transplantation, complex pharmacological therapies, dietary restrictions and the ongoing need to attend follow‐up appointments can place a substantial treatment burden on patients and carers and impair quality of life. This highlights the need for care that is responsive to the needs of patients and involves them in decision‐making to achieve the most appropriate healthcare outcomes. Shared decision‐making and collaborative approaches to care require a deep awareness of the lived experiences and goals of patients. Qualitative research methods can provide insights into patients' experiences, values and priorities and inform practice and policy by uncovering their preferences for care. Qualitative methods are increasingly being used in standalone projects or in mixed methods studies (complementing quantitative studies) to make valuable contributions to patient‐centred research. Patient‐centred care, collaborations between patient and care provider, and shared decision‐making that integrates with the patient's goals are central to quality healthcare. The efficacy of qualitative research lies in its ability to elicit patients' perspectives, values, priorities and goals that underpin shared decision making and care. This article discusses examples of how qualitative research has informed practice and policy in nephrology, provides a summary of qualitative research methods and outlines a guide on how to appraise, interpret and apply qualitative data.
Olfactory neuroblastoma associated with extensive “in situ” lesion and aberrant glandular and rhabdomyosarcomatous differentiation
Authors: Shintaku Masayuki , Ohta Makoto , Kataoka Kenichi , Okabe Hidetoshi
Published: May 2021

A case of olfactory neuroblastoma (ONB) associated with extensive intraepithelial neoplastic proliferation, evidenced by an “in situ” lesion, in the overlying olfactory epithelium and aberrant glandular and rhabdomyosarcomatous differentiation is reported. The tumor was a polypoid lesion that involved the upper nasal cavity and ethmoid sinus of a 63‐year‐old woman and consisted of an ONB surrounded by and mixed with a proliferative lesion of rhabdomyoblastic cells, consistent with an embryonal rhabdomyosarcoma. A few small foci of tubular glands with mucus‐producing cells were also observed. In the olfactory epithelium covering the polypoid lesion, a nested or band‐like arrangement of primitive‐appearing small cells was found, and the tumor cells were immunoreactive for epithelial cell adhesion molecule (detected with Ber‐EP4) and low‐molecular weight cytokeratin (detected with CAM5.2) but not for synaptophysin or calretinin. The intraepithelial lesion was contiguous with the subepithelial cell nests of ONB and appeared to invade the subjacent stroma and show transition to ONB, and some tumor cell nests of ONB also contained small aggregates of similar primitive‐appearing cells. The intraepithelial growth was considered to represent a preinvasive precursor lesion of ONB. Previous descriptions of an “in situ” lesion in ONB are limited. The aberrant glandular and rhabdomyosarcomatous differentiation noted in this case is also an exceptionally rare phenomenon of ONB.
The role of structure in dietary approaches for the treatment of pediatric overweight and obesity: A critical review
Authors: Griffiths Lauren A. , Douglas Steve M. , Raynor Hollie A.
Published: May 2021

A multicomponent approach for the treatment of pediatric overweight/obesity, which includes behavioral strategies to alter diet and physical activity/sedentary behavior, has graded recommendations for its use. Dietary interventions to be used within this approach do not. In adults, research indicates that strongly graded dietary interventions providing greater structure (or more control over the types/amount of food consumed) produce better weight outcomes. For this critical review, dietary interventions recommended by the Expert Committee for the treatment of pediatric overweight/obesity were categorized according to their potential degree of dietary structure, and their impact on weight outcomes was described. Four levels of dietary structure were reviewed, operationalized as alterations to the following: food groups, such as fruits and vegetables (low structure); daily eating occasions, such as meals (moderate structure); large nutrients, such as energy (high structure); and energy plus additional dietary alterations (very high structure). In total, 24 interventions (four low, three moderate, five high, and 12 very high structure structure) were identified and reviewed. Reductions in standardized body mass index increased with increasing structure, and interventions ≥6 months had better outcomes than interventions <6 months. Future research should empirically test dietary intervention structure to determine its impact on weight status during pediatric overweight/obesity treatment.
Use of a Double Reverse Traction Repositor versus a Traction Table for the Treatment of Intertrochanteric Femur Fractures: A Comparative Study
Authors: Yan Mingming , Kuang Letian , Ni Jiangdong , Ding Muliang , Wang Junjie , Huang Jun , Song Deye
Published: May 2021

Objective

The aim of the present study was to compare the clinical results for unstable femoral intertrochanteric fractures treated with a double reverse traction repositor (DRTR) and those treated using a traction table with the Asia proximal femoral nail antirotation (PFNA‐II).

Methods

A retrospective study was performed including 95 patients with AO/OTA type 31‐A2 and 31‐A3 unstable femoral intertrochanteric fractures who underwent DRTR or traction table‐facilitated PFNA‐II nailing from April 2015 to December 2018 in our traumatic center. Demographics, duration of operation, blood loss, part loading time after surgery, fracture healing time, and early and late complications were assessed. Clinical and radiological outcomes were collected to compare the differences between the two groups.

Results

A total of 95 unstable intertrochanteric fracture patients treated with the PFNA‐II were analyzed. Of these cases, 56 patients were treated with a DRTR and the other 39 patients were treated using a traction table to achieve fracture reduction. No patients died during surgery and hospitalization. There were no significant differences in respect to demographics and fracture characteristics of cases enrolled. The total operative time was significantly longer in the traction table group than in the DRTR group (72.5 ± 6.1 min for the traction table and 63.0 ± 4.1 min for the DRTR group, P < 0.001). No significant differences were observed in intraoperative blood loss and duration of hospitalization. The periods of follow up ranged from 12 to 31 months among all patients. At the last follow up, the Harris hip score (HHS) in the DRTR group was excellent in 10 patients (17.9%), good in 36 (64.3%), fair in 8 (14.3%), and poor in 2 (3.6%). These scores were comparable to those in the traction table group, which were: excellent in 8 patients (20.5%), good in 24 (61.5%), fair in 6 (15.4%), and poor in 1 (2.6%). Regarding the radiological evaluation, excellent rates of reduction rate were achieved in 39 cases (69.6%) in the DRTR group, which was comparable to 19 cases (48.7%) in the traction table group. In addition, the mean fracture healing time after surgery was 20.6 ± 2.3 weeks in the DRTR group and 21.4 ± 3.4 weeks in the traction table group, which did not reach a significant difference (P = 0.18). During the follow up, 6 cases of thigh pain, 4 cases of deep vein thrombosis, and 1 case of fracture of the anterior superior iliac spine were reported in the DRTR group. In the traction table group, there were 2 cases of deep vein thrombosis and 3 cases of thigh pain.

Conclusion

When using the PFNA‐II for unstable intertrochanteric fractures, the DRTR was superior to the traction table in respect to operative time and duration of patient position, despite an additional ipsilateral anterior superior iliac spine (ASIS) incision and drilling of the ASIS and the femur condyle.
Chinese adolescents’ sexual and reproductive health education: A quasi‐experimental study
Authors: Ma Xing , Yang Yuanyuan , Chow Ka Ming , Zang Yuli
Published: May 2021

Objective

This study investigated the effectiveness of an interactive sexual and reproductive health education program in aspects of knowledge, attitudes, and self‐efficacy among adolescents.

Design

Quasi‐experimental study underpinned by social cognitive theory.

Sample

A stratified cluster sample of 469 students from the two‐branch middle school in a city in eastern China who were assigned to the experimental (n = 233) and control (n = 236) groups.

Measurements

Students’ sexual knowledge, attitudes, and refusal self‐efficacy were assessed before (T0), immediately after (T1), and 1 month after the intervention (T2), respectively.

Intervention

Students in the experimental group received two 40‐min sessions of the educational program while the control group received the usual mode of sexual and reproductive health education.

Results

Compared with the control group, students in the experimental group acquired more sexual knowledge (p < .01), and developed more positive sexual attitudes (p < .05) and stronger sexual self‐efficacy (p < .05) across the study period.

Conclusions

The proposed sexual and reproductive health education program incorporating various interactive activities was effective and could be used for school‐based implementation led by nurses and other health care workers.
The Dynamics of Social Identity: Evidence from Deliberating Groups
Authors: Myers C. Daniel
Published: May 2021

The last three decades have seen increased affective polarization in the American public, as social identification with a political party leads Americans to hate and fear members of the other party. Yet, over the same period, the public‐deliberation movement reports remarkable success in bringing together politically diverse groups of people for substantively rich and mutually respectful discussions of political issues. I argue that deliberative minipublics succeed in an era of heightened partisanship because the deliberative process creates a new object for social identification, the deliberating group itself. Identification with the deliberating group reduces the salience of other social identities, especially partisan social identity, and encourages behaviors consistent with the new identity, such as listening respectfully and compromising. While the process of public deliberation is in many ways extraordinary, these results suggest that scholars should pay more attention to how the effect of social identities on politics is fluid and context dependent as well as how the content of these identities is constructed and reconstructed by political processes.
Rapid setup and management of medical device design and manufacturing consortia: experiences from the COVID‐19 crisis in the UK
Authors: von Behr Carl‐Magnus , Semple Georgia Anne , Minshall Tim
Published: May 2021

The COVID‐19 pandemic caused severe ventilator shortages in many healthcare systems worldwide. The UK government reacted to this with a three‐pronged approach of importing, up‐scaling existing production and supporting new design projects. The latter two parts – labelled the UK Ventilator Challenge – included over 50 companies from various sectors including the automotive and aerospace industries. Nine multi‐partner consortia and five single‐company projects were initiated with varying approaches. This study explores lessons learned during the setup and management of these medical device designs and manufacturing consortia. A qualitative survey methodology was employed, and 32 semi‐structured stakeholder interviews were conducted. The primary data was triangulated through the collection of 42 secondary data sources such as webinars and radio interviews. Transcription and a three‐step data analysis process of thematic coding identified six lessons learned. The analysis of the data showed that a strong, appealing common goal can enable employee motivation and trust as well as align priorities across all companies involved. This facilitates the involvement and fruitful collaboration of companies with varying sizes and fields of expertise. Furthermore, selecting the most suitable employees with specialist knowledge for high‐priority projects and empowering them to make decisions can have a positive effect on project performance. The findings from the study complement existing literature on new product development and crisis management processes. In addition, the results uncover potential long‐term effects such as more openness for cross‐sector collaborations, which can serve as interesting sources for further research.
Relationships influencing caring in first‐line nursing leadership: A visual hermeneutic study
Authors: Solbakken Rita , Bondas Terese , Kasén Anne
Published: May 2021

Aim

To explore and interpret relationships that influence caring in nursing leadership, in the context of Nordic municipal health care, from first‐line nurse managers’ perspectives.

Design and method

We chose a visual hermeneutic design. A three‐stage interpretation process outlined by Drew and Guillemin, based on Rose, was used to analyse drawings and the following reflective dialogue from three focus groups, with a purposive sample of 11 first‐line nurse managers. The study was conducted from February to May 2018.

Results

The findings demonstrated that first‐line nurse managers struggled to balance their vision with administrative demands. Caring for patients implied caring for staff; however, they often felt as if they were drowning in contradictory demands. First‐line nurse management could be a lonely position, where the first‐line nurse managers longed for belonging based on increased self‐awareness of their position within an organisation. Superiors’ support enabled first‐line nurse managers’ in their primary aim of caring for patients.

Conclusion

First‐line nurse managers showed deep roots to their identities as nurses. Caring for patients included caring for staff and was their main concern, despite demanding reforms and demographic changes affecting leadership. Superiors’ support was important for FLNMs’ self‐confidence and independence in leadership, so the first‐line nurse managers can enact their vision of the best possible patient care. This study adds knowledge of the significance of caring in nursing leadership and the caritative leadership theory.

Impact

In order to recognise FLNMs as vulnerable human beings and provide individual confirmation and support, a caring organisational culture is needed. FLNMs need knowledge based on caring and nursing sciences, administration and participation in formal leadership networks. These findings can serve as a foundation for developing educational programmes for nurse leaders at several organisational levels.
Developing eHealth in neonatal care to enhance parents’ self‐management
Authors: Strand Annica Sjöström , Johnsson Björn , Hena Momota , Magnusson Boris , Hallström Inger Kristensson
Published: May 2021

Background

Discharge from a neonatal care unit is often experienced as a vulnerable time for parents. By communicating through digital technology, it may be possible to improve the support for parents and thereby make the transition from hospital to home less stressful.

Aim

To develop an eHealth device supporting the transition from hospital to home for parents with a preterm‐born child in Sweden using participatory design.

Method

Employing a framework of complex interventions in health care using participatory design. Parents of preterm‐born infants and professionals at a neonatal department identified specific technical requirements for an eHealth device to be developed in the context of neonatal care and neonatal home care. The prospective end‐users – parents and professionals – were continuously involved in the process of designing solution prototypes through meetings, verbal and written feedback, and interviews. The interviews were analysed using thematic analysis.

Results

Technical development was carried out with the perspectives of professionals and parents in mind, resulting in an eHealth application for computer tablets. The findings from the interviews with the parents and professionals revealed three categories: The tablets felt secure, easy to use and sometimes replaced visits to hospital and at home.

Conclusion

The use of participatory design to develop an eHealth device to support a safe transition from hospital to home can benefit parents, the child, the family, and professionals in neonatal care.
Sedimentological and carbonate isotope signatures to identify fluvial processes and catchment changes in a supposed impact ejecta‐dammed lake (Miocene, Germany)
Authors: Zeng Lingqi , Ruge Dag B. , Berger Günther , Heck Karin , Hölzl Stefan , Reimer Andreas , Jung Dietmar , Arp Gernot
Published: May 2021

The identification and distinction of fluvial from lacustrine deposits and the recognition of catchment changes are crucial for the reconstruction of climate changes in terrestrial environments. The investigated drill core succession shows a general evolution from red–brown claystones to white–grey marlstones and microcrystalline limestones, which all have previously been considered as relict deposits of an impact ejecta‐dammed lake, falling within the mid‐Miocene Climate Transition. However, recent mammal biostratigraphic dating suggests a likely pre‐impact age. Indeed, no pebbles from impact ejecta have been detected; only local clasts of Mesozoic formations, in addition to rare Palaeozoic lydites from outside of the study area. Lithofacies analysis demonstrates only the absence of lacustrine criteria, except for one charophyte‐bearing mudstone. Instead, the succession is characterized by less diagnostic floodplain fines with palaeosols, palustrine limestones with root voids and intercalated thin sandstone beds. Carbonate isotope signatures of the mottled marlstones, palustrine limestones and mud‐supported conglomerates substantiate the interpretation of a fluvial setting. Low, invariant δ18Ocarbreflects a short water residence time and highly variable δ13Ccarbindicates a variable degree of pedogenesis. Carbonate87Sr/86Sr ratios of the entire succession show a unidirectional trend from 0.7103 to 0.7112, indicating a change of the solute provenance from Triassic to Jurassic rocks, identical to the provenance trend from extraclasts. The increase in carbonate along the succession is therefore independent from climate changes but reflects a base‐level rise from the level of the siliciclastic Upper Triassic to the carbonate‐bearing Lower to Middle Jurassic bedrocks. This study demonstrates that, when information on sedimentary architecture is limited, a combination of facies criteria (i.e. presence or absence of specific sedimentary structures and diagnostic organisms), component provenance, and stable and radiogenic isotopes is required to unequivocally distinguish between lacustrine and fluvial sediments, and to disentangle regional geological effects in the catchment and climate influences.
A giant lacustrine flood‐related turbidite system in the Triassic Ordos Basin, China: Sedimentary processes and depositional architecture
Authors: Chen Peng , Xian Benzhong , Li Meijun , Liang Xiaowei , Wu Qianran , Zhang Wenmiao , Wang Junhui , Wang Zhen , Liu Jianping
Published: May 2021

Turbidites have been regarded as an important sedimentary infilling component in both oceans and lakes, but limited studies have been performed on the mechanisms governing the initiation and development of lacustrine turbidite systems. The present study offers unique insight into the controls and potential extent of ancient lacustrine turbidite systems by an investigation of the Triassic Ordos Lake, where a large turbidite system had been traced across >25 653 km2. This article shows by comparison that the Triassic Ordos Lake turbidite system is larger than all known modern and ancient lacustrine counterparts. The exceptionally large intracontinental sag basin provided a relatively unconfined environment for the development of the turbidite system, explaining its vast extent. Extraordinary flood events formed during the Carnian Pluvial Episode facilitated continuous sediment supply into the turbidite system, supporting its accumulation. Lacustrine flood‐related turbidity currents travelled as sediment‐laden turbulent flows, showing an increase in the proportion of suspended‐load deposits and a decrease in the proportion of bed‐load deposits downstream from the river mouth. Five architectural elements have been revealed, reflecting a distinctive assemblage of erosional bedforms and depositional bedforms in channel‐lobe systems, and their recognition criteria were established. This study changes the traditional understanding of lacustrine turbidite systems, generally interpreted as having smaller sizes, and demonstrates likewise in the lacustrine realm, that extreme flood events can generate a world‐class deep‐water turbidite system, which can even be comparable with its submarine counterparts. This study also confirms that the combination of low‐gradient slopes and a long‐lived, mixed‐load, prograding fluvial feeder system can produce exceptionally large‐scale deep‐lake flood‐related turbidites. Furthermore, it has implications for the prediction of facies and reservoir quality in ancient lacustrine turbidite systems.
Extracorporeal photopheresis to attenuate decline in lung function due to refractory obstructive allograft dysfunction
Authors:   The EPI Study Group, Hage Chadi A. , Klesney‐Tait Julia , Wille Keith , Arcasoy Selim , Yung Gordon , Hertz Marshall , Chan Kevin M. , Morrell Matt , Goldberg Hilary , Vedantham Suresh , Derfler Mary Clare , Commean Paul , Berman Keith , Spitznagel Ed , Atkinson Jeff , Despotis George
Published: May 2021

Background

This study was designed to prospectively evaluate the efficacy of extracorporeal photopheresis (ECP) to attenuate the rate of decline of FEV1 in lung transplant recipients with refractory bronchiolitis obliterans. Due to an observed higher than expected early mortality, a preliminary analysis was performed.

Study Design and Methods

Subjects from 10 lung transplant centres were assigned to ECP treatment or to observation based on spirometric criteria, with potential crossover for those under observation. The primary endpoint of this study was to assess response to ECP (i.e., greater than a 50% decrease in the rate of FEV1 decline) before and 6 months after initiation of ECP. Mortality was also evaluated 6 and 12 months after enrolment as a secondary endpoint.

Results

Of 44 enrolled subjects, 31 were assigned to ECP treatment while 13 were initially assigned to observation on a non‐random basis using specific spirometric inclusion criteria (seven of the observation patients subsequently crossed over to receive ECP). Of evaluable patients, 95% of patients initially assigned to treatment responded to ECP with rates of FEV1 decline that were reduced by 93% in evaluable ECP‐treated patients. Mortality rates (percentages) at 6 and 12 months after enrolment was 32% and 41%, respectively. The most common (92%) primary cause of death was respiratory or graft failure. Significantly (p = 0.002) higher rates of FEV1 decline were observed in the non‐survivors (−212 ± 177 ml/month) when compared to the survivors (−95 ± 117 ml/month) 12 months after enrolment. In addition, 18 patients with bronchiolitis obliterans syndrome (BOS) diagnosis within 6 months of enrolment had lost 38% of their baseline lung function at BOS diagnosis and 50% of their lung function at enrolment.

Conclusions

These analyses suggest that earlier detection and treatment of BOS should be considered to appreciate improved outcomes with ECP.
Clinical Techniques: When and how to do a myringotomy – a practical guide
Authors: Cole Lynette , Nuttall Tim
Published: May 2021

A myringotomy is a surgical incision made in the tympanic membrane (TM). This gives access to the middle ear for sampling, flushing and instilling topical therapy. It should be considered whenever the TM is intact and there is clinical evidence of otitis media, abnormal TMs and/or abnormal diagnostic imaging. Samples should be collected for cytological investigation and culture, and then the external ear should be cleaned and dried (if required). Myringotomies should be performed under general anaesthesia and, wherever possible, using a video otoscope; the enhanced view and instrument ports facilitate the technique and reduce the risk of complications. The myringotomy incision should be made in the caudoventral quadrant of the TM using an appropriately sized urinary catheter to collect samples and flush the middle ear cavity. A thorough understanding of the anatomy, technique and potential ototoxicity of topical therapy is needed to minimize the risk of neurological and other complications. The TM usually heals within 35 days if kept free of infection.
Limited Enhancement of Subatmospheric Boiling on Treated Structured Surfaces With Biphilic Pattern
Authors: Shen Biao , Iwata Naoki , Hidaka Sumitomo , Takahashi Koji , Takata Yasuyuki
Published: May 2021

Boiling heat transfer suffers deteriorations under subatmospheric conditions, which can be attributed to a shortage of viable nucleation sites at declining pressures. In this work, the possibility of enhancing low-pressure saturated boiling of water using a combination of wettability patterning and structural modifications was experimentally explored. The copper test surface, comprised of an array of circular “dimples” (0.3 mm in depth, 0.5 mm in diameter, and 3.0 mm in pitch), was spray-coated by polytetrafluoroethylene (PTFE) coatings so as to form a matching biphilic pattern with the surface cavities. The resulting dimpled biphilic surface showed appreciable heat transfer enhancement—with a maximum 60% increase of the average heat transfer coefficient of nucleate boiling compared with a flat biphilic surface—down to about 9.5 kPa. Further lowering the pressure to 7.8 kPa, however, was found to lead to diminished performance gains. The visualization study of the bubble departure dynamics revealed signs of additional vapor trapping of the hydrophobic-coated cavities, which can induce uninterrupted bubble regeneration with zero waiting time and explain the qualified enhancement of subatmospheric boiling. Thanks to a potential secondary pinning of contact line inside the hydrophobic cavities, incomplete bubble detachment could prevail at somewhat lower pressures than was otherwise possible without the dimple structure, leaving behind significantly more vapor residues. However, the vapor-trapping capacity was found to decrease with pressure, which provided clues with regard to the reduced efficacy of the surface at even lower pressures.
Erosion Wear Characteristics of Tee Tubes With Gas–Solid Two-Phase Flow
Authors: Zhang J. , Zhang Hao , Liu Yang , Zhang Chuan
Published: May 2021

Pressure manifold is prone to failure caused by cuttings and gravels included in the underground natural gas and shale gas. In particular, the tee tubes are one of the most easily failed components. In order to study the erosion wear mechanism of tee tubes. T-tube, Y-tube, and y-tube pressure manifolds are systematically studied. The results show that structure and gas inlet affect the tube's field distribution and erosion. After gas shunts (separated flow), high-pressure areas are concentrated on junction and downstream, while high-pressure areas are concentrated downstream after the gas conflates (sink flow). Erosion area and particle trajectory of the tee tubes under the effect of shunting and confluence are analyzed. Overall erosion of Y-tube is the most severe. Taking erosion wear degree into account, y-tube is a better choice.
Influence of geometry on acoustic end-corrections of slits in microslit absorbers
Authors: Aulitto Alessia , Hirschberg Avraham , Lopez Arteaga Ines
Published: May 2021

The acoustic behavior of individual slits within microslit absorbers (MSAs) is investigated to explore the influence of porosity, edge geometry, slit position, and plate thickness. MSAs are plates with arrays of slit-shaped perforations, with the height of the order of the acoustic viscous boundary layer thickness, for optimized viscous dissipation. Due to hydrodynamic interaction, each slit behaves as confined in a rectangular channel. The flow within the slit is assumed to be incompressible. The viscous dissipation and the inertia are quantified by the resistive and the inertial end-corrections. These are estimated by using analytical results and numerical solutions of the linearized Navier–Stokes equations. Expressions for the end-corrections are provided as functions of the ratio of the slit height to viscous boundary layer thickness (shear number) and of the porosity. The inertial end-correction is sensitive to the far-field behavior of the flow and for low porosities strongly depends on the porosity, unlike for circular perforations. The resistive end-correction is dominated by the edge geometry of the perforation. The relative position of the slit with respect to the wall of the channel is important for distances to the wall on the order of the slit height. The plate thickness does not have a significant effect on the end-corrections.
Neuromuscular Fatigue After Long-Duration Adventure Racing in Adolescent Athletes
Authors: Birat Anthony , Garnier Yoann M. , Bourdier Pierre , Dupuy Alexis , Dodu Alexandre , Grossoeuvre Claire , Dupont Anne-Charlotte , Blazevich Anthony J. , Rance Mélanie , Morel Claire , Nottin Stéphane , Ratel Sébastien
Published: May 2021

Purpose: To characterize the acute effects of a long-duration adventure race on knee extensor (KE) fatigue and the knee functional ratio in adolescent athletes. Methods: Twenty trained male adolescents (aged 14–17 y) performed an adventure race of 68.5 km. Maximal voluntary isometric contraction (MVIC) KE and knee flexor torques were measured before and immediately after the race. Central and peripheral components of neuromuscular fatigue were quantified from the maximal voluntary activation level and the doublet peak torque (Tw100), respectively. The peak eccentric knee flexor torque to concentric KE torque ratio was also measured to determine functional ratio. Results: The race completion time was 05:38 (00:20) hours. Significant reductions in MVICKE (−14.7%, P < .001) and MVICKF (−17.0%, P < .01) were observed after the race. Voluntary activation level decreased by 8.3% (P < .001) while Tw100 remained unchanged. Peak eccentric knee flexor torque decreased 16.0% (P < .001) while peak concentric KE torque did not change. This resulted in a significant reduction in functional ratio (−12.0%, P < .01). Conclusion: The adventure race induced a moderate fatigue, which was mainly explained by central factors without significant peripheral fatigue. However, particular attention should be paid to the knee muscular imbalance incurred by the race, which could increase the risk of ligament injury in adolescent athletes.
Is India's coronavirus death ‘paradox’ vanishing?
Authors: Cohen Jon
Published: May 2021

Limited evidence suggests in 2020 the country had relatively low COVID-19 mortality.
Simultaneous cross-evaluation of heterogeneous
E. coli
datasets via mechanistic simulation
Authors: Macklin Derek N. , Ahn-Horst Travis A. , Choi Heejo , Ruggero Nicholas A. , Carrera Javier , Mason John C. , Sun Gwanggyu , Agmon Eran , DeFelice Mialy M. , Maayan Inbal , Lane Keara , Spangler Ryan K. , Gillies Taryn E. , Paull Morgan L. , Akhter Sajia , Bray Samuel R. , Weaver Daniel S. , Keseler Ingrid M. , Karp Peter D. , Morrison Jerry H. , Covert Markus W.
Published: May 2021

Testing biochemical data by simulation

Can a bacterial cell model vet large datasets from disparate sources? Macklin
et al.
explored whether a comprehensive mathematical model can be used to verify or find conflicts in massive amounts of data that have been reported for the bacterium
Escherichia coli
, produced in thousands of papers from hundreds of labs. Although most data were consistent, there were data that could not accommodate known biological results, such as insufficient output of RNA polymerases and ribosomes to produce measured cell-doubling times. Other analyses showed that for some essential proteins, no RNA may be transcribed or translated in a cell's lifetime, but viability can be maintained without certain enzymes through a pool of stable metabolites produced earlier.

Science
, this issue p.
eaav3751
Diverse variola virus (smallpox) strains were widespread in northern Europe in the Viking Age
Authors: Mühlemann Barbara , Vinner Lasse , Margaryan Ashot , Wilhelmson Helene , de la Fuente Castro Constanza , Allentoft Morten E. , de Barros Damgaard Peter , Hansen Anders Johannes , Holtsmark Nielsen Sofie , Strand Lisa Mariann , Bill Jan , Buzhilova Alexandra , Pushkina Tamara , Falys Ceri , Khartanovich Valeri , Moiseyev Vyacheslav , Jørkov Marie Louise Schjellerup , Østergaard Sørensen Palle , Magnusson Yvonne , Gustin Ingrid , Schroeder Hannes , Sutter Gerd , Smith Geoffrey L. , Drosten Christian , Fouchier Ron A. M. , Smith Derek J. , Willerslev Eske , Jones Terry C. , Sikora Martin
Published: May 2021

Viking smallpox diversity

Humans have a notable capacity to withstand the ravages of infectious diseases. Smallpox killed millions of people but drove Jenner's invention of vaccination, which eventually led to the annihilation of this virus, declared in 1980. To investigate the history of smallpox, Mühlemann
et al.
obtained high-throughput shotgun sequencing data from 1867 human remains ranging from >31,000 to 150 years ago (see the Perspective by Alcamí). Thirteen positive samples emerged, 11 of which were northern European Viking Age people (6th to 7th century CE). Although the sequences were patchy and incomplete, four could be used to infer a phylogenetic tree. This showed distinct Viking Age lineages with multiple gene inactivations. The analysis pushes back the date of the earliest variola infection in humans by ∼1000 years and reveals the existence of a previously unknown virus clade.

Science
, this issue p.
eaaw8977
; see also p.
376
Cell growth dilutes the cell cycle inhibitor Rb to trigger cell division
Authors: Zatulovskiy Evgeny , Zhang Shuyuan , Berenson Daniel F. , Topacio Benjamin R. , Skotheim Jan M.
Published: May 2021

A cell size sensor

Efforts continue to uncover the long-sought mechanism by which cells coordinate growth and cell division to maintain a constant size. Zatulovskiy
et al.
propose that human cells sense the concentration of the retinoblastoma family protein Rb. Rb itself acts on transcription factors to inhibit progression through the cell cycle. As cells grow, the concentration of Rb decreases by dilution, and the cell can then divide. In mice heterozygous or homozygous for an Rb gene deletion, the size of liver hepatocytes decreased—and variability in cell size increased—as each Rb allele was lost.

Science
, this issue p.
466
An evolution-based model for designing chorismate mutase enzymes
Authors: Russ William P. , Figliuzzi Matteo , Stocker Christian , Barrat-Charlaix Pierre , Socolich Michael , Kast Peter , Hilvert Donald , Monasson Remi , Cocco Simona , Weigt Martin , Ranganathan Rama
Published: May 2021

Learning from evolution

Protein sequences contain information specifying their three-dimensional structure and function, and statistical analysis of families of sequences has been used to predict these properties. Building from sequence data, Russ
et al.
used statistical models that take into account conservation at amino acid positions and correlations in the evolution of pairs of amino acids to predict new artificial sequences that will have the properties of the protein family. For the chorismate mutase family of metabolic enzymes, the authors demonstrate experimentally that the artificial sequences display natural-like catalytic function. Because the models access an enormous space of diverse sequences, such evolution-based statistical approaches may guide the search for functional proteins with altered chemical activities.

Science
, this issue p.
440
Fossil apes and human evolution
Authors: Almécija Sergio , Hammond Ashley S. , Thompson Nathan E. , Pugh Kelsey D. , Moyà-Solà Salvador , Alba David M.
Published: May 2021

A distinctive ancestor

There has been much focus on the evolution of primates and especially where and how humans diverged in this process. It has often been suggested that the last common ancestor between humans and other apes, especially our closest relative, the chimpanzee, was ape- or chimp-like. Almécija
et al.
review this area and conclude that the morphology of fossil apes was varied and that it is likely that the last shared ape ancestor had its own set of traits, different from those of modern humans and modern apes, both of which have been undergoing separate suites of selection pressures.

Science
, this issue p.
eabb4363
The COVID-19 pandemic and human fertility
Authors: Aassve A. , Cavalli N. , Mencarini L. , Plach S. , Livi Bacci M.
Published: May 2021

Birth trends in response to the pandemic will vary according to socioeconomic conditions
Evolution of vision and hearing modalities in theropod dinosaurs
Authors: Choiniere Jonah N. , Neenan James M. , Schmitz Lars , Ford David P. , Chapelle Kimberley E. J. , Balanoff Amy M. , Sipla Justin S. , Georgi Justin A. , Walsh Stig A. , Norell Mark A. , Xu Xing , Clark James M. , Benson Roger B. J.
Published: May 2021

Revealing behavioral secrets in extinct species

Extinct species had complex behaviors, just like modern species, but fossils generally reveal little of these details. New approaches that allow for the study of structures that relate directly to behavior are greatly improving our understanding of the lifestyles of extinct animals (see the Perspective by Witmer). Hanson
et al.
looked at three-dimensional scans of archosauromorph inner ears and found clear patterns relating these bones to complex movement, including flight. Choiniere
et al.
looked at inner ears and scleral eye rings and found a clear emergence of patterns relating to nocturnality in early theropod evolution. Together, these papers reveal behavioral complexity and evolutionary patterns in these groups.

Science
, this issue p.
601
, p.
610
; see also p.
575
Mapping out a future for ungulate migrations
Authors: Kauffman Matthew J. , Cagnacci Francesca , Chamaillé-Jammes Simon , Hebblewhite Mark , Hopcraft J. Grant C. , Merkle Jerod A. , Mueller Thomas , Mysterud Atle , Peters Wibke , Roettger Christiane , Steingisser Alethea , Meacham James E. , Abera Kasahun , Adamczewski Jan , Aikens Ellen O. , Bartlam-Brooks Hattie , Bennitt Emily , Berger Joel , Boyd Charlotte , Côté Steeve D. , Debeffe Lucie , Dekrout Andrea S. , Dejid Nandintsetseg , Donadio Emiliano , Dziba Luthando , Fagan William F. , Fischer Claude , Focardi Stefano , Fryxell John M. , Fynn Richard W. S. , Geremia Chris , González Benito A. , Gunn Anne , Gurarie Elie , Heurich Marco , Hilty Jodi , Hurley Mark , Johnson Aran , Joly Kyle , Kaczensky Petra , Kendall Corinne J. , Kochkarev Pavel , Kolpaschikov Leonid , Kowalczyk Rafał , van Langevelde Frank , Li Binbin V. , Lobora Alex L. , Loison Anne , Madiri Tinaapi H. , Mallon David , Marchand Pascal , Medellin Rodrigo A. , Meisingset Erling , Merrill Evelyn , Middleton Arthur D. , Monteith Kevin L. , Morjan Malik , Morrison Thomas A. , Mumme Steffen , Naidoo Robin , Novaro Andres , Ogutu Joseph O. , Olson Kirk A. , Oteng-Yeboah Alfred , Ovejero Ramiro J. A. , Owen-Smith Norman , Paasivaara Antti , Packer Craig , Panchenko Danila , Pedrotti Luca , Plumptre Andrew J. , Rolandsen Christer M. , Said Sonia , Salemgareyev Albert , Savchenko Aleksandr , Savchenko Piotr , Sawyer Hall , Selebatso Moses , Skroch Matthew , Solberg Erling , Stabach Jared A. , Strand Olav , Suitor Michael J. , Tachiki Yasuyuki , Trainor Anne , Tshipa Arnold , Virani Munir Z. , Vynne Carly , Ward Stephanie , Wittemyer George , Xu Wenjing , Zuther Steffen
Published: May 2021

Limited mapping of migrations hampers conservation
Environmental robustness of the global yeast genetic interaction network
Authors: Costanzo Michael , Hou Jing , Messier Vincent , Nelson Justin , Rahman Mahfuzur , VanderSluis Benjamin , Wang Wen , Pons Carles , Ross Catherine , Ušaj Matej , San Luis Bryan-Joseph , Shuteriqi Emira , Koch Elizabeth N. , Aloy Patrick , Myers Chad L. , Boone Charles , Andrews Brenda
Published: May 2021

Environmental impacts on gene networks

A phenotype can be affected by genes interacting with other genes, the environment, or both other genes and the environment (a differential interaction). To better understand how these interactions function in yeast, Costanzo
et al.
mapped gene-gene interactions using single- and double-mutant deletions and temperature-sensitive alleles under 14 environmental conditions. Many deleted or temperature-sensitive nonessential genes affected yeast fitness both positively and negatively under at least one of the environmental conditions tested. In these cases, up to 24% of yeast genes were affected. A minority of these differential interactions point to previously unknown genetic connections across functional networks, informing on how genetic architecture responds to environmental variation.

Science
, this issue p.
eabf8424
Oxygen Generation via Water Splitting by a Novel Biogenic Metal Ion-Binding Compound
Authors: Dershwitz Philip , Bandow Nathan L. , Yang Junwon , Semrau Jeremy D. , McEllistrem Marcus T. , Heinze Rafael A. , Fonseca Matheus , Ledesma Joshua C. , Jennett Jacob R. , DiSpirito Ana M. , Athwal Navjot S. , Hargrove Mark S. , Bobik Thomas A. , Zischka Hans , DiSpirito Alan A.
Published: May 2021

The discovery that MB will couple the oxidation of H
2
O to metal ion reduction and the release of O
2
suggests that methanotrophs expressing MB may be able to maintain their activity under hypoxic/anoxic conditions through the “self-generation” of dioxygen required for the initial oxidation of methane to methanol. Such an ability may be an important factor in enabling methanotrophs to not only colonize the oxic-anoxic interface where methane concentrations are highest but also tolerate significant temporal fluctuations of this interface.
Genomic Elucidation of a COVID-19 Resurgence and Local Transmission of SARS-CoV-2 in Guangzhou, China
Authors: Jia Hong-Ling , Li Peng , Liu Hong-Jie , Zhong Jia-Yong , Qin Peng-Zhe , Su Wen-Zhe , Zheng Ying-Feng , Li Kui-Biao , Zeng Qing , Li Jin-Hui , Li Li-Zhong , Cao Lan , Wu Ji-Bin , Chen Yi-Yun , Jia Lei-Li , Song Hong-Bin , Zhang Qi-Wei , Yang Guang , Jing Chun-Xia , Bo Xiao-Chen , Zhang Zhou-Bin , Di Biao , Xiao Chuan-Le , Ni Ming
Published: May 2021

While China experienced a peak and decline in coronavirus disease 2019 (COVID-19) cases at the start of 2020, regional outbreaks continuously emerged in subsequent months. Resurgences of COVID-19 have also been observed in many other countries.
Bibliography of published COVID-19 in children literature
Authors: Stilwell Philippa Anna , Munro Alasdair P. S. , Basatemur Emre , Talawila Da Camara Nishanthi , Harwood Rachel , Roland Damian
Published: May 2021

Background

The COVID-19 pandemic is the biggest worldwide health challenge in this century. Research concerning the role of children in the spread of SARS-CoV-2, and investigating the clinical effects of infection in children, has been vital. This paper describes the publication trend for pertinent scientific literature relating to COVID-19 in children during the first 6 months of the pandemic.

Methods

A comprehensive search of preprint and published literature was conducted daily across four databases (PubMed, Scopus, Ovid-Embase and MedRXiv) between 1 January 2020 and 30 June 2020. Titles and abstracts were screened against predefined inclusion and exclusion criteria.

Findings

Over the study period, a total of 45 453 papers were retrieved, of which 476 met our inclusion criteria. The cumulative number of children described in included publications totalled (at most) 41 396. The median number of children per paper was 6 (IQR 1–33). Nearly one-third of papers (30.2%) reported on a single child, and a further 28.3% reported on between 1 and 9 children. Half of all the publications originated from Asia.

Interpretation

Our prospective bibliographic analysis of paediatric COVID-19 publications demonstrated a steady increase in the number of papers over time. Understanding and policy evolved with new information that was gathered over the course of the study period. However, over half of publications were individual case reports or small case series, which may have had a limited contribution to advancement of knowledge. During a pandemic, literature should be interpreted with great caution, and clinical/policy decisions should be continually reviewed in light of emerging evidence.
Effective use of switching biologics for ulcerative colitis complicated with pyoderma gangrenosum and primary sclerosing cholangitis
Authors: Iwahashi Kenta , Kuroki Yuichiro , Takano Yuichi , Nagahama Masatsugu
Published: May 2021

Although prednisolone, granulocyte/monocyte apheresis, calcineurin inhibitor and anti-tumour necrosis factor (TNF) therapy are generally used, no treatment strategy for inflammatory bowel disease complicated with pyoderma gangrenosum (PG) has been established yet. Herein, we present the case of a 29-year-old man with ulcerative colitis (UC) complicated with primary sclerosing cholangitis. When UC relapsed and PG developed, prednisolone and granulocyte/monocyte apheresis were used; however, their therapeutic effects were deemed insufficient. After 2 weeks, adalimumab (ADA) induced remission; however, his UC and PG relapsed 20 weeks later. As a result of switching to infliximab, since a loss of response to ADA was deemed to have occurred, remission was reintroduced and subsequently maintained for 40 weeks. We conclude that anti-TNF-α antibodies might be selected as the first choice when PG and UC are refractory to treatment, and a switch to anti-TNFs should be considered when the effect is still insufficient.