bluuebunny/crossref_metadata_2025 huggingface dataset:
Reproduction of Atlantic bluefin tuna
Authors: Medina Antonio
Published: July 2020

The reproductive success of fish populations depends on their reproductive potential and offspring survival to maturity. The reproductive potential affects recruitment and hence populations’ resilience and productivity. Extensive research carried out throughout the current century has improved our understanding of the reproductive biology of the Atlantic bluefin tuna (ABFT), Thunnus thynnus. Yet, crucial questions still remain unresolved. This paper examines key factors that drive ABFT reproductive performance (maturity, spawning frequency, fecundity, sex ratio, spawning habitat). Some reproductive variables (spawning at age, spawning omission, egg and offspring viability, parental effect) remain poorly investigated due to the enormous challenge of implementing the required research across the distribution range and over time. These fundamental traits of the reproductive life history, however, provide valuable information to fish stock assessment models and hence require further attention. There is a major debate as to the extent of similarity in reproductive traits between eastern and western ABFT stocks. Both stocks have been considered to display differing maturity schedules, which would result in different spawning rates and reproductive outputs. Yet, similarities have been found in major reproductive aspects suggesting that discrepancies between stocks may not be as broad as often assumed. Though substantial, the information acquired on ABFT reproduction over the years is still incomplete for adequately advising fisheries management. The present report provides a synthesis of the existing information on the reproductive biology of ABFT. It also identifies major research needs and analyses future research actions towards bridging current gaps in ABFT reproduction science.
Cultural Linguistics and ELT curriculum: The case of ‘Prospect’ English textbooks in Iran
Authors: Sahraee Juybari Mobina , Bozorgian Hossein
Published: July 2020

This study examines Iranian English language teaching (ELT)Prospecttextbooks in light of the recently developed discipline of Cultural Linguistics. Cultural Linguistics is a field of research that explores the relation between language and cultural conceptualisations. The Cultural Linguistics ethnographic‐conceptual text/visual analysis methodology is employed for the analysis of the cultural conceptualisations embedded across texts and visuals. It is revealed that lesson 3 ofProspect3 captures the Iranian cultural conceptualisations of Nowruz and represents it as an event for (a) renewal of human beings and reinforcement of human relationships, (b) joy, (c) wishing good luck and avoiding bad luck, and (d) visiting. The current research has significant implications for both research and pedagogy in ELT.
Cutaneous manifestations of Castleman disease
Authors: Chavez‐Alvarez Sonia , Villarreal‐Martinez Alejandra , Ocampo‐Candiani Jorge , Gomez‐Flores Minerva , Vazquez‐Martinez Osvaldo , Gonzalez‐Saldivar Gloria , Herz‐Ruelas Maira E.
Published: July 2020

Background

Castleman disease (CD) is a lymphoproliferative B‐cell disease that is diagnosed from lymphoid hyperplasia with vascular proliferation. Symptoms may include fever, night sweats, and weight loss. Cutaneous manifestations often may go unnoticed since little has been described in the literature regarding them.

Materials and Methods

A search of CD with cutaneous manifestations was performed in PUBMED, ProQuest, Ovid, Scopus, EMBASE, and Medline. All articles included patients over 18 years of age with a diagnosis of CD and cutaneous manifestations.

Results

A total of 68 articles were included. The most common cutaneous manifestations include paraneoplastic pemphigus and erythematous‐brown plaques, papules, or nodules. Patients presenting with these manifestations should always have a thorough physical exam, and clinicians should try to identify any palpable lymph nodes. A complete workup to rule out other neoplasias needs to be performed as well.

Conclusions

A better understanding of these skin manifestations of CD may help physicians promptly diagnose and reconsider the path of diagnostic tests to identify this entity.
Mixed‐method analysis of screening for Strongyloides stercoralis prior to immunosuppression: a problem of limited bandwidth?
Authors: Muhi Stephen , Ko Dong‐Kyoon , McGuinness Sarah L. , Biggs Beverley‐Ann , Mahanty Siddhartha , Delany Clare
Published: July 2020

Background

Guidelines recommend screening for strongyloidiasis prior to immunosuppression in those at epidemiological risk, as hyperinfection following immunosuppression is often fatal. The uptake of this recommendation is unknown and we aimed to explore this in our setting.

Aims

To determine the proportion of adult patients at epidemiological risk for strongyloidiasis who were screened prior to immunosuppression at the Royal Melbourne Hospital, and to explore the factors that influenced clinicians' decision to screen for strongyloidiasis prior to immunosuppression.

Methods

This study used a mixed‐methods approach. First, a 12‐month (1 January 2018 to 1 January 2019) retrospective observational study was used to quantify the proportion of those at epidemiological risk who were screened prior to immunosuppression, while also identifying variables that were positively or negatively associated with screening. Second, clinicians from relevant specialties were recruited for focus group sessions to explore factors that influenced their decision to screen according to an interpretivist framework.

Results

A total of 230 newly immunosuppressed patients at epidemiological risk of strongyloidiasis were identified, of whom 87 (37.8%) were screened prior to immunosuppression. In multivariate analysis, older patients, outpatients and people from non‐English‐speaking backgrounds were significantly less likely to be screened. In focus groups, several barriers and enablers to screening were identified. Notably, clinicians reported that a major barrier was the cognitive load required to clinically reason about this uncommon disease, in addition to other priorities.

Conclusions

We identified many missed opportunities to screen patients at risk of hyperinfection, particularly those most vulnerable. To improve screening, this study highlights the importance of reducing cognitive load by using decision‐support tools, which may facilitate screening in vulnerable patients and in time‐constrained settings.
Experimental study of metamorphic reactions and dehydration processes at the blueschist–eclogite transition during warm subduction
Authors: Cheng Nanfei , Jenkins David M.
Published: July 2020

The transition between blueschist and eclogite plays an important role in subduction zones via dehydration and densification processes in descending oceanic slabs. There are a number of previous petrological studies describing potential mineral reactions taking place at the transition. An experimental determination of such reactions could help constrain the pressure–temperature conditions of the transition as well as the processes of dehydration. However, previous experimental contributions have focused on the stability of spontaneously formed hydrous minerals in basaltic compositions rather than on reactions among already formed blueschist facies minerals. Therefore, this study conducted three groups of experiments to explore the metamorphic reactions among blueschist facies minerals at conditions corresponding to warm subduction, where faster reaction rates are possible on the time scale of laboratory experiments. The first group of experiments was to establish experimental reversals of the reaction glaucophane+paragonite to jadeite+pyrope+quartz+H2O over the range of 2.2–3.5 GPa and 650–820°C. This reaction has long been treated as key to the blueschist–eclogite transition. However, only the growth of glaucophane+paragonite was observed at the intersectional stability field of both paragonite and jadeite+quartz, confirming thermodynamic calculations that the reaction is not stable in the system Na2O–MgO–Al2O3–SiO2–H2O. The second set of experiments involved unreversed experiments using glaucophane+zoisite ±quartz in low‐Fe and Ca‐rich systems and were run at 1.8–2.4 GPa and 600–780°C. These produced omphacite+paragonite/kyanite+H2O accompanied by compositional shifts in the sodium amphibole, glaucophane, towards sodium–calcium amphiboles such as winchite (☐(CaNa)(Mg4Al)Si8O22(OH)2) and barroisite (☐(CaNa)(Mg3Al2)(AlSi7)O22(OH)2). This suggests that a two‐step dehydration occurs, first involving the breakdown of glaucophane+zoisite towards a paragonite‐bearing assemblage, then the breakdown of paragonite to release H2O. It also indicates that sodium–calcium amphibole can coexist with eclogite phases, thereby extending the thermal stability of amphibole to greater subduction zone depths. The third set of experiments was an experimental investigation at 2.0–2.4 GPa and 630–850°C involving a high‐Fe (Fe#=Fetotal/(Fetotal+Mg)≈0.36) natural glaucophane, synthetic paragonite and their eclogite‐forming reaction products. The results indicated that garnet and omphacite grew over most of these pressure–temperature conditions, which demonstrates the importance of Fe‐rich glaucophane in forming the key eclogite assemblage of garnet+omphacite, even under warm subduction zone conditions. Based on the experiments of this study, reaction between glaucophane+zoisite is instrumental in controlling dehydration processes at the blueschist–eclogite transition during warm subduction.
Prognostic significance of co‐existent adenomyosis on outcomes and tumor characteristics of endometrial cancer: A meta‐analysis
Authors: An Min , Duan Hua , Zhang Ying
Published: July 2020

Objective

Published data on the impact of co‐existent adenomyosis on the prognosis of patients with endometrial cancer remains elusive, with studies reporting conflicting results. We conducted this meta‐analysis to evaluate the prognostic significance of co‐existent adenomyosis on clinical outcomes and tumor characteristics of endometrial cancer patients.

Methods

A comprehensive literature review of multiple databases was conducted; quality assessment of eligible studies was performed by the Newcastle‐Ottawa scale (NOS). The outcomes of interest were compared in endometrial cancer patients with or without adenomyosis. Hazards ratios (HR) and Odds ratios (OR) with 95% confidence interval (CI) were calculated as a measure of effects.

Results

Fourteen retrospective observational studies comprising 1308 endometrial cancer patients with adenomyosis and 3734 patients without adenomyosis were included in this meta‐analysis. Results indicated that endometrial cancer patients with adenomyosis was significantly associated with an increased overall survival rate (HR = 0.51; 95% CI = 0.38–0.69; P < 0.00001), but not with disease‐free survival rate (HR = 0.68; 95% CI = 0.30–1.53; P = 0.35); besides, significantly associated with decreased ratio of deep myometrial invasion (OR = 0.45; 95% CI = 0.33–0.60; P < 0.00001), lymphovascular space invasion (OR = 0.44; 95% CI = 0.29–0.68; P = 0.0002), an increased ratio of histological grade 1 (OR = 1.84; 95% CI = 1.34–2.53; P = 0.0002) and FIGO I‐II (OR = 1.85; 95% CI = 1.49–2.30; P < 0.00001). However, there was no significant difference in pathological type and lymph node metastasis. There was a low to high heterogeneity with I2 ranging from 0 to 67%.

Conclusion

This meta‐analysis indicated that co‐existent adenomyosis with endometrial cancer is associated with favorable tumor characteristics and could serve as a potential protective factor for the prognosis of endometrial cancer.
Long‐term evaluation of renal function and neurogenic bladder following radical hysterectomy in patients with uterine cervical cancer
Authors: Komatsu Hiroaki , Oishi Tetsuro , Osaku Daiken , Kudoh Akiko , Shimogai Ruri , Chikumi Jun , Sato Shinya , Harada Tasuku
Published: July 2020

Objective

This study aimed to determine whether radical hysterectomy (RH) affects renal function.

Methods

Renal function was followed up in 83 patients with stage IB1–IIB cervical cancer who underwent RH during 2006–2015. Serum creatinine (sCre) levels were measured preoperatively and every year postoperatively. Estimated glomerular filtration rate (eGFR) was calculated using sCre levels. Patients who were unable to urinate by themselves or whose residual urine was ≥100 mL were referred to a urologist with the diagnosis of neurogenic bladder (NB). The relationship between NB occurrence and changes in sCre level or eGFR was evaluated respectively.

Results

Urological intervention was required in 45 patients (54.2%), and self‐urethral catheterization was performed in 41 (49.3%) patients. The NB and clean intermittent catheterization (CIC) groups exhibited significant increases in sCre levels, which were not observed in the non‐NB or non‐CIC groups. In the non‐NB group, eGFR did not change following surgery. However, in the NB group, significant decreases in eGFRs were observed at postoperative 2 and 3 years and at final follow‐up. There was no difference in the incidence of cardiovascular events between patients with and without NB.

Conclusion

In patients with NB following RH, a significant decrease in renal function was observed after postoperative 2 years.
Traumatic skull fractures in dogs and cats: A comparative analysis of neurological and computed tomographic features
Authors: Amengual‐Batle Pablo , José‐López Roberto , Durand Alexane , Czopowicz Michal , Beltran Elsa , Guevar Julien , Lazzerini Kali , De Decker Steven , Muñana Karen , Early Peter , Mariani Christopher , Olby Natasha , Petrovitch Nicholas , Gutierrez‐Quintana Rodrigo
Published: July 2020

Background

Traumatic skull fractures (TSF) are relatively frequent in dogs and cats, but little information is available regarding their clinical and imaging features.

Hypothesis/Objectives

To describe the neurological and computed tomographic (CT) features of a large cohort of dogs and cats with TSF.

Animals

Ninety‐one dogs and 95 cats with TSF identified on CT.

Methods

Multicenter retrospective comparative study. Signalment, cause of trauma, fracture locations and characteristics, presence of neurological deficits, and 1‐week survival were recorded. Fractures were classified according to the extent of fragmentation and displacement.

Results

The cranial vault was affected more frequently in dogs (P = .003), whereas the face and base of the cranium more often was affected in cats (P < .001). Cats presented with multiple fractures more frequently (P < .001). All animals with TSF in the cranial vault were more likely to develop neurological signs (P = .02), especially when depressed fractures were present (95% confidence interval [CI], 1.7‐8.2; P = .001). Animals with TSF located only in the facial region were less likely to have neurological signs (odds ratio with Mantel‐Haenszel's method [ORMH], 0.2; 95% CI, 0.1‐0.6; P = .004). Most affected animals (84.9%) survived the first week post‐trauma. Death was more likely with fractures of the cranial vault (P = .003), especially when fragmented (P = .007) and displaced (P = .004).

Conclusions and Clinical Importance

Traumatic skull fracture distribution and patterns are different between dogs and cats. Cranial vault fractures were associated with neurological deficits and worse survival. The presence of TSF alone should not be considered a negative prognostic factor because most affected animals survived the first week.
Maximum entropy model: Estimating the relative suitability of cetacean habitat in the northern Savu Sea, Indonesia
Authors: Putra Mochamad Iqbal Herwata , Mustika Putu Liza Kusuma
Published: July 2020

An understanding of cetacean distribution is necessary to gain insights into crucial ecological processes for species conservation management. However, cetacean habitat preference and distribution in the northern Savu Sea, Indonesia, are still poorly understood. We use maximum entropy modeling with five environmental predictors to describe habitat preference and distribution of seven cetacean species in the northern Savu Sea. Our study confirms that static predictors are the most important variables in explaining habitat preferences of seven cetacean species in the northern Savu Sea. Seasonally, each cetacean species has a different environmental preference.Globicephala macrorhynchusprefers the open nearshore areas adjacent to deep waters.Stenella attenuatais associated with nearshore habitats and higher productivity areas.Stenella longirostrisprefers nearshore habitat during coastal upwelling events.Tursiops truncatusprefers nearshore sheltered habitat.Grampus griseushabitats are highly related to depth and steep gradients around the isobaths of 200–1,000 m.Feresa attenuataare associated with deep waters and cooler sea temperature.Pseudorca crassidensprefers protective bays with productive waters. This study provides important information for reviewing marine spatial plans of the northern Savu Sea, specifically on managing species fisheries interaction, optimizing surveillance, and regulating marine traffic.
Building an integrated multidisciplinary swallowing disorder clinic: considerations, challenges, and opportunities
Authors: Starmer Heather M. , Dewan Karuna , Kamal Afrin , Khan Abraham , Maclean Julia , Randall Derrick R.
Published: July 2020

Dysphagia is a complex condition with numerous causes, symptoms, and treatments. As such, patients with dysphagia commonly require a multidisciplinary approach to their evaluation and treatment. Integrated multidisciplinary clinics provide an optimal format for a collaborative approach to patient care. In this manuscript, we will discuss considerations for teams looking to build a multidisciplinary dysphagia clinic, including what professionals are typically involved, what patients benefit most from this approach, what tests are most appropriate for which symptoms, financial issues, and traversing interpersonal challenges.
Vitamin D deficiency as a risk factor for renal scarring in recurrent urinary tract infections
Authors: Sürmeli Döven Serra , Erdoğan Semra
Published: July 2020

Background

Renal scarring is a serious complication in recurrent urinary tract infections (UTIs). Vitamin D deficiency has also been reported to be a risk factor for UTIs although, to date, no association between vitamin D deficiency and renal scarring has yet been identified. In the present study, it was investigated whether vitamin D deficiency may be a risk factor for renal scarring in patients with recurrent UTIs.

Methods

The study included patients between the ages of 1 and 18 years who were admitted to the pediatric nephrology department of the center between November 1, 2018 and November 1, 2019 and who were diagnosed with recurrent UTIs. The medical records of the patients were reviewed for the collection of demographic data, vitamin D levels, ultrasonography results and scintigraphic investigations with 99m‐technetium dimercaptosuccinic acid (99mTc‐DMSA). The patients were divided into two groups: those with and without renal scarring, diagnosed via99mTc‐DMSA. The vitamin D levels and other parameters of the two groups were compared.

Results

Vitamin D deficiency (<20 ng/mL) was observed in 73.9% of the patients without renal scarring, and in 94.1% of those with renal scarring (P= 0.015). A logistic regression analysis revealed vitamin D deficiency to be an independent risk factor for renal scarring in patients with recurrent UTIs (OR = 0.796 [0.691–0.917]).

Conclusions

Vitamin D deficiency is found to be a risk factor for renal scarring in patients with recurrent UTIs. Vitamin D treatment may contribute to the prevention of renal scarring in patients with recurrent UTI.
Development and validation of a Japanese version of the TRANSITION‐Q
Authors: Morisaki‐Nakamura Mayumi , Suzuki Seigo , Kobayashi Asuka , Kita Sachiko , Sato Iori , Iwasaki Miwa , Hirata Yoichiro , Sato Atsushi , Oka Akira , Kamibeppu Kiyoko
Published: July 2020

Background

The evaluation of transition readiness is indispensable for long‐term follow‐ups of adolescent patients with childhood‐onset chronic diseases (CCD). We developed a Japanese version of the TRANSITION‐Q (TRANSITION‐Q‐J) and used it to assess Japanese patients with CCD.

Methods

The TRANSITION‐Q‐J was developed through forward and backward translations followed by cognitive interviews with five adolescent patients. The field test was conducted with 125 adolescent patients, and a retest was conducted with 113 adolescent patients.

Results

Confirmatory factor analysis supported the two‐factor analysis model including F1 (communication and self‐management) and F2 (examination behavior). Sufficient internal consistency and test‐retest reliability were demonstrated among the total 14 items, F1, and F2 (Cronbach’s α > 0.80, intraclass correlation coefficient > 0.85). Convergent and discriminant validity for the 14 items and F1 were acceptable; however, F2 did not correlate significantly with the Rosenberg Self‐Esteem Scale and Independent Consciousness Scale. Regarding known‐groups validity, the older group had a significantly higher mean TRANSITION‐Q‐J score (50.05) than the younger group (43.28; P = 0.04). The same results were found for both F1 and F2.

Conclusions

The TRANSITION‐Q‐J for adolescent patients with CCD was developed and its reliability and validity were verified. This scale is easy to administer. In addition to being a tool for transition period support, it could be used to verify effective factors and in program outcome evaluation, including intervention studies.
The relations between maternal mental state talk and preschoolers’ behavioral adaptation and school readiness: moderation by emotion situation knowledge
Authors: Garner Pamela W. , Toney Tamera
Published: July 2020

This study investigated the extent to which associations between mothers' elaborated talk about mental states and preschoolers’ behavioral adaptation (i.e., social competence and internalizing and externalizing behavior) and school readiness were moderated by emotion situation knowledge. Families (N = 120) were mostly middle‐income and White and 70 of the preschoolers (M = 50.65 months, SD = 6.19) were boys. Results revealed a positive association between elaborated maternal mental state talk and social competence, but only for children average and high in emotion situation knowledge. For children low in emotion situation knowledge, there was a positive association between elaborated maternal mental state talk and internalizing behavior. There also was a negative relation between elaborated maternal mental state talk and school readiness for preschoolers low in emotion situation knowledge. Findings highlight the importance of considering emotion situation knowledge when examining associations between elaborated maternal mental state talk and young children’s social behavioral adaptation and readiness for school.
The continuous development of a complete and objective automatic grading system of facial signs from selfie pictures: Asian validation study and application to women of three ethnic origins, differently aged
Authors: Flament Frederic , Lee Yang Won , Lee Dong Hun , Passeron Thierry , Zhang Yuze , Jiang Ruowei , Prunel Anne , Dwivedi Seema , Kroely Camille , Park Youn Jung , Chuberre Bertrand , Aarabi Parham
Published: July 2020

Objective

To evaluate the capacity of the automatic detection system to accurately grade, from smartphones' selfie pictures, the severity of seven new facial signs added to the nine previously integrated.

Methods

A two‐step approach was conducted: first, to check on 112 Korean women, how the AI‐based automatic grading system may correlate with dermatological assessments, taken as reference; second, to confirm on 1140 women of three ancestries (African, Asian, and Caucasian) the relevance of the newly input facial signs.

Results

The sixteen specific Asian facial signs, detected automatically, were found significantly (P < .0001) highly correlated with the clinical evaluations made by two Korean dermatologists (wrinkles: r = .90; sagging: r = .75‐.95; vascular: r = .85; pores: r = .60; pigmentation: r = .50‐.80). When applied at a larger scale on women of different ethnicities, new signs were found of good accuracy and reproducibility, albeit depending on ethnicity. Due to contrast with the innate skin complexion, the facial signs dealing with skin pigmentation were found of a much higher relevance among Asian women than African or Caucasian women. The automatic gradings were even found of a slightly higher accuracy than the clinical gradings.

Conclusion

The previously used automatic grading system is now completed by adding new facial signs apt at being detected. The continuous development is now integrating some limitations with regard to the constitutive skin complexion of the self‐pictured subjects. Presenting reproducible assessments, highly correlated with medical grading, this system could change tremendously clinical researches, like in epidemiological studies, where it offers an easy, fast, affordable, and confidential approach in the objective quantification of facial signs.
Epidemiology and persistence of rhinovirus in pediatric lung transplantation
Authors: Ammerman Evan , Sweet Stuart C. , Storch Gregory A. , Buller Richard S. , Mason Sheila , Conrad Carol , Hayes Don , Faro Albert , Goldfarb Samuel B. , Melicoff Ernestina , Schecter Marc , Visner Gary , Heeger Peter S. , Mohanakumar Thalachallour , Williams Nikki , Danziger‐Isakov Lara
Published: July 2020

Background

Infection with rhinovirus (HRV) occurs following pediatric lung transplantation. Prospective studies documenting frequencies, persistence, and progression of HRV in this at‐risk population are lacking.

Methods

In the Clinical Trials in Organ Transplant in Children prospective observational study, we followed 61 lung transplant recipients for 2 years. We quantified molecular subtypes of HRV in serially collected nasopharyngeal (NP) and bronchoalveolar lavage (BAL) samples and correlated them with clinical characteristics.

Results

We identified 135 community‐acquired respiratory infections (CARV) from 397 BAL and 480 NP samples. We detected 93 HRV events in 42 (68.8%) patients, 22 of which (23.4%) were symptomatic. HRV events were contiguous with different genotypes identified in 23 cases, but symptoms were not preferentially associated with any particular species. Nine (9.7%) HRV events persisted over multiple successive samples for a median of 36 days (range 18‐408 days). Three persistent HRV were symptomatic. When we serially measured forced expiratory volume in one second (FEV1) in 23 subjects with events, we did not observe significant decreases in lung function over 12 months post‐HRV.

Conclusion

In conjunction with our previous reports, our prospectively collected data indicate that molecularly heterogeneous HRV infections occur commonly following pediatric lung transplantation, but these infections do not negatively impact clinical outcomes.
Early recognition of possible transfusion reactions using an electronic automatic notification system for changes in vital signs in patients undergoing blood transfusions
Authors: Lim Young Ae , Kim Jin , Park Chorong
Published: July 2020

Background

The study was designed to evaluate the ability of a novel electronic automatic notification system (EANS) to detect significant changes in transfusion‐associated vital signs (VSs) during transfusion and to determine whether the EANS improved acute transfusion reaction (ATR) detection rates and suspected ATR reporting rates.

Study Design and Methods

VSs were measured three times per unit or batch product transfused:—before, 15 minutes after commencement, and at the completion of the transfusion—and recorded on the EANS. Significant changes in VSs were defined as increased temperature (≥38°C or ≥1°C change in baseline temperature), 20 mm Hg or 20% increase or decrease in systolic blood pressure, or 20% increase in pulse rate. The 6‐month periods preceding and after the introduction of the EANS were defined as “before” and “after.” Data from these periods were used for comparison and evaluation.

Results

During the after period, 945 notifications were reported from the EANS and 521 suspected ATR were detected. The suspected ATR reporting rates for the before and after were 0.29% (73/25 213) and 2.06% (521/25 304, P < .001) and the ATR detection rates before and after were 0.13% (33/25 213) and 0.49% (116/25 304, P < .001), respectively. Among 116 ATR cases, 49.1% could be detected only by significant changes in VSs.

Conclusion

The EANS was very effective in detecting ATRs that could have been overlooked by medical staff. Further data are needed to demonstrate the extent to which the introduction of an EANS may improve the safety of transfused patients.
Use of a chronic soft tissue expansion device to facilitate blepharoplasty in a horse with lower‐lid cicatricial ectropion with a 14‐year follow‐up
Authors: Whittaker Cameron J. , Reynolds Benjamin D. , McCarthy Paul M. , Taylor Simon F. , Major Derek , Caruso Kelly A. , Smith Jeffrey
Published: July 2020

A 3‐year‐old Thoroughbred filly presented to a referral equine hospital for surgical correction of a severe cicatricial lateral lower eyelid ectropion OD, with secondary exposure keratitis. The severity of the ectropion deemed that conventional ectropion repairs would be unsuccessful. Therefore, a soft tissue expansion device was used to create sufficient local tissue for a rotational graft with tension‐relieving horizontal incisions to be performed to facilitate closure and acceptable eyelid apposition. The keratitis had resolved by two months postoperatively. There were no long‐term complications and only mild recurrence of the keratitis observed 14‐years postoperatively.
The Attitude of Jewish Sephardic Ladino Writers in the El Maccabeo Journal in Thessaloniki at the Beginning of the Twentieth Century towards the Situation of the Jews in the Various Parts of the Diaspora
Authors: Dori Nitsa
Published: July 2020

The contribution of the Sephardic-Jewish communities to historic-literacy processes shaping the image of the Jewish people was also expressed in periodicals. Ladino-speaking writers wrote in important newspapers in the Balkan lands and Eretz-Israel, and also published and edited their own newspapers. The purpose of this article is to introduce the topics featured in the El Maccabeo journal – published in Thessaloniki as an annual in the early twentieth century (1914-1931) – that discuss, identify and demonstrate solidarity and empathy with the situation of the Jews in other countries, particularly Europe, and compare their situation to that of the Jews in Thessaloniki. It can be learned from reading El Maccabeo that Sephardic Jews were well acquainted with the situation faced by the Ashkenazic Jews in their various communities, and their feelings about their Ashkenazic brethren wavered between pity and respect. They viewed them as their brothers with the phrase “our brothers” featuring in almost every article.
Synbiotic Matchmaking in Lactobacillus plantarum: Substrate Screening and Gene-Trait Matching To Characterize Strain-Specific Carbohydrate Utilization
Authors: Fuhren Jori , Rösch Christiane , ten Napel Maud , Schols Henk A. , Kleerebezem Michiel
Published: July 2020

Synbiotics combine prebiotics and probiotics to synergistically enhance the health benefits associated with these ingredients.
Lactobacillus plantarum
is encountered as a natural inhabitant of the gastrointestinal tract, and specific strains are marketed as probiotics based on their strain-specific health-promoting activities. Strain-specific stimulation of growth through prebiotic substrates could enhance the persistence and/or activity of
L. plantarum
in situ
. Our study establishes a high-throughput screening model for prebiotic substrate utilization by individual strains of bacteria, which can be readily employed for synbiotic matchmaking approaches that aim to enhance the intestinal delivery of probiotics through strain-specific, selective growth stimulation.
DNA Methylation Epigenetically Regulates Gene Expression in Burkholderia cenocepacia and Controls Biofilm Formation, Cell Aggregation, and Motility
Authors: Vandenbussche Ian , Sass Andrea , Pinto-Carbó Marta , Mannweiler Olga , Eberl Leo , Coenye Tom
Published: July 2020

CF patients diagnosed with
Burkholderia cenocepacia
infections often experience rapid deterioration of lung function, known as cepacia syndrome.
B. cenocepacia
has a large multireplicon genome, and much remains to be learned about regulation of gene expression in this organism. From studies in other (model) organisms, it is known that epigenetic changes through DNA methylation play an important role in this regulation. The identification of
B. cenocepacia
genes of which the expression is regulated by DNA methylation and identification of the regulatory systems involved in this methylation are likely to advance the biological understanding of
B. cenocepacia
cell adaptation via epigenetic regulation. In time, this might lead to novel approaches to tackle
B. cenocepacia
infections in CF patients.
Incidence of treatment for postabortion complications in India, 2015
Authors: Singh Susheela , Hussain Rubina , Shekhar Chander , Acharya Rajib , Stillman Melissa , Moore Ann M
Published: July 2020

Abortion has been legal under broad criteria in India since 1971. However, access to legal abortion services remains poor. In the past decade, medication abortion (MA) has become widely available in India and use of this method outside of health facilities accounts for over 70% of all abortions. Morbidity from unsafe abortion remains an important health issue. The informal providers who are the primary source of MA may have poor knowledge of the method and may offer inadequate or inaccurate advice on use of the method. Misuse of the method can result in women seeking treatment for true complications as well as during the normal processes of MA. An estimated 5% of all abortions are done using highly unsafe methods and performed by unskilled providers, also contributing to abortion morbidity. This paper provides new representative abortion-related morbidity measures at the national and subnational levels from a large-scale 2015 study of six Indian states—Assam, Bihar, Gujarat, Madhya Pradesh, Tamil Nadu and Uttar Pradesh. The outcomes include the number and treatment rates of women with complications resulting from induced abortion and the type of complications. The total number of women treated for abortion complications at the national level is 5.2 million, and the rate is 15.7 per 1000 women of reproductive age per year. In all six study states, a high proportion of all women receiving postabortion care were admitted with incomplete abortion from use of MA—ranging from 33% in Tamil Nadu to 65% in Assam. The paper fills an important gap by providing new evidence that can inform policy-makers and health planners at all levels and lead to improvements in the provision of postabortion care and legal abortion services—improvements that would greatly reduce abortion-related morbidity and its costs to Indian women, their families and the healthcare system.
Generational and occupational differences in human factors knowledge and awareness: a comparison study
Authors: Herron Jonathan Blair Thomas , Ferris CM , Gilliam AD
Published: July 2020

Introduction

Increasing healthcare sector litigation, accountability and governance has resulted in the identification of human factors (HF) as a common source of error. Both NHS and military doctors must have awareness of HF to enhance safety and productivity. There is limited published evidence examining knowledge of HF in these two healthcare professional groups.

Methods

Doctors of all grades and specialties across the NHS and 3 military groups including the Defence Deanery within the UK were invited to complete a 10-item web-based survey. Questions focused on training undertaken, HF knowledge and potential future training needs.

Results

The survey link was emailed to 250 military and 1400 NHS doctors, 191 military and 776 NHS responded (response rate: 76% and 55%, respectively). Military doctors above foundation trainees are more familiar with HF, have had more training and recognise a requirement for additional training. Military foundation trainees had similar responses to their NHS colleagues. Doctors who had not undertaken any HF training are less likely to appreciate its value, with almost 60% of senior NHS doctors reporting no training. Foundation trainees have more training in HF than their senior peers when military seniors are excluded and more frequently identified a need for further training. Junior doctors identified stress, fatigue, communication and leadership more frequently, with seniors identifying work environment and music in theatre correctly more often.

Conclusion

Non-training grade doctors are less likely to seek HF training. Military doctors are more familiar with HF and have undertaken more training. Given the role of HF in communication, human error, potential litigation, stress, conflict and gross negligence manslaughter convictions, further education is vital.
Characteristics and outcomes of patients with suspected heart failure referred in line with National Institute for Health and Care Excellence guidance
Authors: Zheng Alice , Cowan Elena , Mach Lukas , Adam Robert D , Guha Kaushik , Cowburn Peter James , Haydock Paul , Kalra Paul R , Flett Andrew , Morton Geraint
Published: July 2020

Objective

To describe the population, heart failure (HF) diagnosis rate, and 1-year hospitalisation and mortality of patients with suspected HF and elevated N-terminal pro B-type natriuretic peptide (NTproBNP) investigated according to UK National Institute for Health and Care Excellence (NICE) guidelines.

Methods

NICE recommends patients with suspected HF, based on clinical presentation and elevated NTproBNP, are referred for specialist assessment and echocardiography. Patients should be seen within 2 weeks when NTproBNP is >2000 pg/mL (2-week pathway: 2WP) or within 6 weeks when NTproBNP is 400–2000 pg/mL (6-week pathway: 6WP). This is a retrospective, multicentre, observational study of consecutive patients with suspected HF referred from primary care between 2014 and 2016 to dedicated secondary care HF clinics based on the NICE 2WP and 6WP. Data were obtained from hospital records and episode statistics. Mortality and hospitalisation rates were calculated 1 year from NTproBNP measurement.

Results

1271 patients (median age 80; IQR 73–85) were assessed, 680 (53%) of whom were female. 667 (53%) were referred on the 2WP and 604 (47%) on the 6WP. 698 (55%) were diagnosed with HF (369 HF with reduced ejection fraction) and 566 (45%) as not HF (NHF). 1-year mortality was 10% (n=129) and hospitalisation was 33% (n=413). Patients on the 2WP had higher mortality and hospitalisation rates than those on the 6WP, 14% vs 6% (p<0.001) and 38% vs 27% (p<0.001), respectively. All-cause mortality (11% vs 9%; p=0.306) and hospitalisation rates (35% vs 29%; p=0.128) did not differ between HF and NHF patients, respectively.

Conclusions

Outcomes using the NICE approach of short waiting time targets for specialist assessment of patients with suspected HF and raised NTproBNP are not known. The model identifies an elderly population a high proportion of whom have HF. Irrespective of diagnosis, patients have high rates of adverse outcomes. These contemporary real-world data provide a platform for discussions with patients and shaping HF services.
Establishing reference ranges for ambulatory electrocardiography parameters: meta-analysis
Authors: Williams Curtis B , Andrade Jason G , Hawkins Nathaniel M , Cheung Christopher , Krahn Andrew , Laksman Zachary W , Bennett Matthew T , Heilbron Brett , Chakrabarti Shanta , Yeung-Lai-Wah John A , Deyell Marc W
Published: July 2020

Objective

Despite the widespread and increasing use of ambulatory electrocardiography (ECG), there is no consensus on reference ranges for ambulatory electrocardiogram parameters to guide interpretation. We sought to determine population distribution-based reference ranges for parameters measured during ambulatory electrocardiogram in healthy adults, based on existing literature.

Methods

We searched multiple databases from 1950 to 2020. Articles reporting original data from ≥24-hour ambulatory electrocardiogram monitoring in healthy adults were included. Data extraction and synthesis were performed according to Meta-analysis of Observational Studies in Epidemiology guidelines. The prevalence/mean and SD for common parameters (sinus pauses, conduction abnormalities and ectopy) were extracted by age group (18–39, 40–59, 60–79 and 80+ years).

Results

We identified 33 studies involving 6466 patients. Sinus pauses of >3 s were rare (pooled prevalence <1%) across all ages. Supraventricular ectopy of >1000/24 hours increased with age, from 0% (95% CI 0% to 0%) in those aged 18–39 years to 6% (95% CI 0% to 17%) in those aged 60–79 years. Episodes of supraventricular tachycardia increased from 3% (95% CI 1% to 6%) in those aged 18–39 years to 28% (95% CI 9% to 52%) in those aged 60–79 years. Ventricular ectopy of >1000/24 hours also increased with age, from 1% (95% CI 0% to 2%) in those aged 18–39 years to 5% (95% CI 1% to 10%) in those aged 60–79 years. Episodes of non-sustained ventricular tachycardia ranged from 0% (95% CI 0% to 1%) in those aged 18–39 years to 2% (95% CI 0% to 5%) in those aged 60–79 years.

Conclusion

Despite the limitations of existing published data, this meta-analysis provides evidence-based reference ranges for ambulatory electrocardiogram parameters and highlights significant age-dependent differences that should be taken into account during interpretation.
11 The neuropsychiatry of nitrous oxide
Authors: Sheldon Rollo , Schon Fred , Poole Norman
Published: July 2020

Objectives/Aims

The abuse of nitrous oxide (N2O) may be increasing globally and users and clinicians may not be aware of harms. We highlight these potential harms through the case of a woman treated for psychotic disorder for 11 months before developing severe N2O induced myeloneuropathy which should have been preventable. We review the clinical literature regarding N2O abuse to raise the profile of this emerging neuropsychiatric disorder.

Methods

A case study was undertaken and a literature review performed of relevant databases for cases of N2O abuse presenting with psychiatric symptoms.

Results

In our case a 37 year old woman presented with florid polymorphic psychosis and subtle cognitive impairment two weeks after inhaling large amounts of N2O. This was treated with antipsychotics and her symptoms waxed and waned over eleven months by which time she had developed a severe myeloneuropathy, confirmed on MRI cervical spine, and a functional B12 deficiency confirmed by high homocysteine and methylmalonic acid (MMA) which was then treated with intramuscular B12. N2O has a variety of effects including the stimulation of endogenous opioids; GABAA receptor stimulation; NMDA receptor antagonism; BDNF receptor activation; cortical excitation and depression on the encephalogram; activation of the anterior cingulate and deactivation of the hippocampal and parahippocampal cortices; and importantly, the deactivation of Vitamin B12 leading to build up of toxic homocysteine and MMA. There are 13 cases excluding this described in the literature of N2O abuse presenting primarily with psychiatric symptoms. They range from 23–64 years old and 12 were male. The most common presenting psychiatric symptoms in the 13 cases were delusions (reported by 8 individuals); cognitive impairment (6); visual hallucinations (4); bizarre or inappropriate behaviour (4); affective lability (3); anxiety (3); and depression, mania or auditory hallucinations in two respectively. Investigations were inconsistently reported but where tested, B12 was mostly low or low normal, and homocysteine and MMA were raised. In nine out of ten cases reported, the outcome was favourable, following cessation of N2O, administration of intramuscular B12, and antipsychotics.

Conclusions

N2O abuse is widespread in the UK and may be increasing. Heavy users are at risk of psychosis, cognitive impairment and myeloneuropathy, which may be irreversible. Importantly, some patients initially present with psychiatric symptoms before myeloneuropathy, and N2O abuse should always be considered in cases of new onset psychosis or cognitive impairment. Testing of homocysteine, MMA and B12 should be considered in these cases, and intramuscular B12 given without delay.
5 Models of the world: from perception to hallucination
Authors: Fletcher Paul
Published: July 2020

Paul Fletcher is Wellcome Investigator and Bernard Wolfe Professor of Health Neuroscience at the University of Cambridge. He is also Director of Studies for Preclinical Medicine at Clare College and Honorary Consultant Psychiatrist with the Cambridgeshire and Peterborough NHS Foundation Trust. He studied Medicine, before carrying out specialist training in Psychiatry and taking a PhD in cognitive neuroscience. He researches human perception, learning and decision-making in health and mental illness.

We do not have direct contact with external reality. We must rely on messages from the sense organs, conveying information about the state of the world and our bodies. These messages are not easy to decipher, being noisy and ambiguous, but from them we have to construct models of the world. I will discuss this challenge and how we are very adept at creating a model of reality based on achieving a balance between what our senses are telling us and our expectations of what should be the case. This is often referred to as the predictive processing framework.

Relying on this balance comes at a cost, rendering us vulnerable to illusions and biases and, in more extreme cases, to creating a reality that diverges from that experienced by others. This can arise for a variety of reasons but, at the root, I suggest, lies the nature of the brain as a model-building organ. Though this divergence from reality – psychosis – often seems inexplicable and incomprehensible, I suggest that a few core principles can help us to understand it and offers ways of thinking about how phenomena like hallucinations can be understood. Interestingly, the framework suggests ways in which apparently similar phenomena like hallucinations can arise from distinct alterations to the function of a predictive processing system.
Calculation of reliable non-resonant Kα X-ray emission spectra of organic molecules and other small molecules
Authors: Chong Delano P.
Published: July 2020

For reliable calculation of vertical ionization energies (VIEs) of both core and valence electrons of gas-phase organic molecules and other small molecules, we developed DFT procedures in 1999 and 2009. The difference between core and valence VIEs give the energies for X-ray emission spectra (XES). The dipole matrix elements between core and valence electrons required for calculation of the XES intensities are now easily available. The simple procedure for calculation of reliable XES is demonstrated by comparison with known XES for H2O(g), NH3(g), CO(g), CO2(g), N2(g), and NNO(g). Consequently, the XES of H2CO(g), formamide(g), 1-nitrosamine(g), N-methylformamide(g), 1-nitrosoaziridine(g), and oxirane(g) are predicted with confidence.