bluuebunny/crossref_metadata_2025 huggingface dataset:
Resilience among caregivers of patients with heart failure: a convergent mixed methods study
Authors: Durante A , Younas A , Cuoco A , Boyne J , Juarez-Vela R , Brawner B , Vellone E
Published: July 2021

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): HFA Nurse training Fellowship Award Center for Excellence for Culture and Nursing Research (CECRI)Nursing Scholarship OPI Rome Italy

Introduction

Resilience is a dynamic process of utilising abilities to harness personal, social, and spiritual resources and coping characteristics and developing regulatory flexibility to manage challenges and bounce back from emotional and physical distress. Caregivers of patients with heart failure are prone to increased stress and reduced resilience while assisting their family members in meeting self-care needs, activities of daily living, and complex medical and dietary regimens. To date, limited research exists on resilience and its predictors among caregivers of people with heart failure.

Purpose

To develop a comprehensive understanding of resilience and its predictors among caregivers of patients with heart failure. 

Methods

A convergent mixed methods design was used. In total, 50 caregivers completed the Connor-Davidson Resilience Scale (CDRS) (score range: 0–100, with higher scores indicating higher resilience), the Caregiver Burden Inventory (CBI) (higher scores indicate greater caregiver burden; there are no cut-off points for classifying burden), and the Hospital Anxiety and Depression Scale (HADS) (two subscales, range score 0 and 21 per each subscale; higher scores mean worse anxiety and depression) and participated in semi-structured face-to-face interviews. Data were analysed using multiple regression, qualitative content analysis, and joint displays. 

Results

The caregivers’ mean age was 62.8 ± 12.83 years. The CDRS mean score was 62.37 ± 24.2, and the mean HADS scores for anxiety and depression were 12.38 ± 2.74 and 8.54 ± 2.49, respectively. The mean CBI score was 16.82 ± 17.12. Regression analysis showed that the resilience score was only predicted by depression (B = -1.491, p = 0.031). Qualitative analysis generated three resilience-inhibiting factors (psychological outlook, physical weariness, and affective state) and two promoting factors (community interconnectedness and self-comforting activities). Mixed analysis confirmed that depression decreased caregivers’ resilience.  

Conclusions

Caregivers of people with heart failure are likely to experience extreme stress and anxiety that affect their resilience to provide better care for their family members. This study identified that depression, hopelessness, pessimism, powerlessness, physical fatigue, and fluctuating emotional states affected negatively caregivers’ resilience. However, self-comforting activities and community interconnectedness improved caregivers’ resilience. Community care organizations and hospitals could establish alliances to develop programs for enhancing caregivers’ resilience.
Patient experiences of shared decision-making are associated with implantable cardioverter defibrillator recipients" openness to discuss device deactivation at end-of-life
Authors: Oh OJ , Lee KS , Miller J , Hammash M , Thompson DR , Ski CF , Cameron J , Moser DK
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): In Australia, this study received funding from a faculty grand by Australian University Faculty of Health Sciences Research grant. In the United States, the study was funded by a research professor award from University of Kentucky.

Background. Shared decision-making is important for ICD recipients to fully contemplate and rationally decide about ICD deactivation at end-of-life. Although discussions about device deactivation at end-of-life are recommended to be held before ICD implantation and throughout the illness trajectory, such discussions rarely occur in clinical practice.

Purpose. To identify whether ICD recipients’ experiences of end-of-life discussions with clinicians are associated with openness to discussing ICD deactivation at end-of-life.

Methods. This cross-sectional study included 293 ICD recipients living in the United States, Australia, and South Korea (mean age 59, 22.5% female, mean ICD implantation 10 years). Hierarchical logistic regression was used to determine whether patients’ experiences of shared decision-making were associated with openness to discuss device deactivation at end-of-life after controlling for relevant covariates (i.e. age, gender, ICD implantation years, ICD shock experience, general ICD experience, ICD knowledge, and concerns related to the ICD).

Results. About half of the participants (57.7%) were open to discussing ICD deactivation at end-of-life with clinicians. Almost one-quarter (23.5%) had no prior experience of discussing any end-of-life issues with clinicians. Patients’ past experiences of end-of-life discussions with clinicians were significantly associated with openness to discuss device deactivation at end-of-life (OR: 1.30) after adjusting for covariates.

Conclusion. Our results highlight that clinicians’ willingness to discuss sensitive end-of-life issues such as battery replacement and deactivation of defibrillation therapy empowers patients to actively engage in end-of-life discussions.
A moderated moderation of living arrangements and social support on the relationship between depressive symptoms and medication adherence in patients with heart failure
Authors: Lindsay-Rahman R , Lennie TA , Moser DK , Chung ML
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute of Nursing Research grant

Background

Medication adherence is essential to improve health outcomes in patients with heart failure (HF). Depressive symptoms contribute to decrease adherence behaviors. Although social support is helpful to improving medication adherence, perceived social support (PSS) may differ by living arrangement. How social support and living arrangement contribute to the relationship between depressive symptoms and medication adherence is not well understood in patients with heart failure.

Purpose

The purpose of this study was to determine whether perceived social support and living arrangement moderated the association between depressive symptoms and medication adherence.

Methods

This was a secondary analysis from outpatients with HF. Depressive symptoms were measured by the Patient Health Questionnaire-9. Perceived social support was assessed using Multidimensional Scale of Perceived Social Support, and patients were grouped into high and low PSS groups using a score of 79, the upper tertile value. Medication adherence was measured objectively by a medication event monitoring system for 3-months. Living arrangement was classified as (1) living with a spouse, (2) living with non-spouse family or friend, or (3) living alone. Moderated moderation analysis was conducted using PROCESS macro (Model 3) in SPSS with 5,000 bootstrap samples.

Results

Of the total of 208 patients (mean age = 61 ± 11.5 years, 64% male), 60% lived with spouse, 22% lived with non-spousal family or friend, and 26% lived alone. Three-way interaction (depressive symptoms*living arrangement*PSS) was significant (p = 0.0324, Figure 1). The effect of depressive symptoms on medication adherence was only significant for two groups (Figure 2): the living alone group with high PSS (effect = - 4.1855, p = 0.0021), and the living with a non-spousal family group with low PSS (effect = -1.0180, p = 0.0349). For these groups, their depressive symptoms were inversely associated with medication adherence. Conclusions: These results suggest that living arrangement and perceived social support are factors to be considered in medication adherence when planning care for patients with depressive symptoms. Future research is needed to explore whether the combined intervention of improving depressive symptoms and social support focusing on instrumental social support effectively increases medication adherence.
Who cares? Perception of loneliness in patients treated for coronary heart disease
Authors: Blakoe M , Berg SK , Hoejskov IE , Palm P , Bernild C
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): University hospital of Copenhagen, Rigshospitalet research grant

Background

When patients are treated for Coronary heart disease (CHD), social support is known to be essential for them to adapt mentally and behaviourally to this critical event (1, 2). However, a substantial part of the CHD population experience loneliness in their everyday life, which places them in a vulnerable situation in the early rehabilitation period, as this period is characterized by an increased need for practical, informational and emotional support (3, 4) .

Aim

To provide insight into the nuances and complexity of loneliness, as well as the impact on health behaviour, in the early rehabilitation period following CHD treatment.

Method

This qualitative study has a philosophical hermeneutic approach. Patients classified as lonely during hospitalization in a social support questionnaire, were interviewed 8-12 weeks following discharge in either focus group (n = 7) or individual interview (n = 10) sessions. The empirical material was analysed using inductive content analysis.

Results

The analysis of the data produced three themes: i) A life in loneliness, ii) The changed, but unmet, need for social support, iii) Symmetry and asymmetry in relationships. Each theme contained of three sub-themes. A consistent finding was participants’ experience of shock related to the CHD event and the fundamental uncertainty to which it led, which increased the feeling of loneliness as an emotional pain. Participants experienced loneliness, not in relation to the lack of quantity of social network members, but in relation to the deficient quality of the relationships. In this regard, they described mutual and complimentary mechanisms that impacted how and from whom they could receive adequate social support. Participants described how dyadic relational mechanisms could either promote or limit who they could ask for social support as they experienced a need for reciprocity in the relationship, in order to receive practical and emotional support. Furthermore, a main finding was the participants experience on how loneliness affected their abilities to adapt to the critical event and manage health behavioural changes in the rehabilitation period.

Conclusion

In patients with coronary heart disease, loneliness is experienced as an emotional pain that negatively influenced the ability to adapt to the critical event and manage health behavioural changes. Participants assessed societal, dyadic and psychological mechanisms to impact their access to support from social network members.

Perspective

Insight into the patients’ experience of loneliness and the mechanisms mediating loneliness can enhance nursing care practice and inform future social support interventions.
Feasibility of the TARGET-EFT trial in frail and pre-frail cardiovascular inpatients
Authors: Ahmad F , Fountotos R , Munir H , Lantagne S , Hagerty K , Hedzazi MM , Volynsky F , Marsala J , Goldfarb M , Afilalo J
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Older adults are at risk for hospital-acquired disability and deconditioning, often leading to the "post-hospitalization syndrome" of accelerated functional decline. We hypothesized that this syndrome could be prevented by a pragmatic multi-faceted intervention, and now report the initial experience and feasibility of our ongoing randomized clinical trial.

Methods

Patients admitted to the cardiovascular ward at a single academic center are screened with the Essential Frailty Toolset (EFT). Those ≥65 years with frailty (EFT: 3-5) or pre-frailty (EFT: 1-2) are eligible for the TARGET-EFT trial, in which they are randomly allocated to usual care or intervention. The intervention is targeted such that patients with physical weakness receive supervised exercise sessions (in addition to clinically-indicated physiotherapy), those with cognitive impairment receive stimulation activities, those with iron deficiency anemia receive intravenous iron sucrose, and those with malnutrition-related hypoalbuminemia receive protein supplements. The outcome is a composite score representing mobility, disability, activity, discomfort, and mood (EQ-5D-5L) ascertained by a blinded observer on the day of discharge and at 30 days post-hospitalization.

Results

To date, 77 out of a planned 144 patients have been randomized. The most common reasons for exclusion are age <65 years, expected discharge within <3 days and patient refusal. The median age is 80 years and length of stay is 8 days. In each group, 1 patient withdrew and 1 died. There were no intervention-related adverse events. Of the 39 intervention patients, 36 qualified for exercise and received an average of 6 sessions (46% of sessions were deferred because patients were away for tests, were bedrest post-procedures, or refused), 18 received cognitive stimulation, 15 received intravenous iron sucrose, and 16 received protein supplements.

Conclusion

The TARGET-EFT intervention is feasible and appears safe for frail and pre-frail patients hospitalized with acute cardiovascular disease. Given that nursing staff, physiotherapists, nutritionists and clinicians already address basic cognitive orientation, mobilization and nutritional/iron supplementation needs, it appears that adding targeted interventions for patients’ specific frailty deficits is feasible when shared amongst allied health professionals.
Surgical Wound Nursing Assessment and Clinical Outcomes in Patients with Cardiac Implantable Electronic Devices
Authors: Do Carmo J , Maria Joao Ferreira MJF , Ana Filipa Carvalho AFC , Catarina Oliveira CO , Antonio Pinto AP , Pedro Silva Cunha PSC , Rui Ferreira RF , Mario Oliveira MO
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Centro Hospitalar Universitário Lisboa Central / Hospital Santa Marta

With the gains in life expectancy of patients (P) with heart disease, population with cardiac implantable electronic devices (CIED) therapy for the treatment of heart failure and life-threatening arrhythmias has increasingly became a challenge, regarding the number of complications following an implantation. Aim: To analyze clinical outcomes of P with CIED participating in an integrated nursing approach in an outpatient clinic of a tertiary center. Methods: Systematic review of clinical follow-up data of P undergoing CIED implantation who were observed by a specialized nursing team after discharge. Data regarding complications related to the surgical wound, treatment, timings and outcomes were collected. Results: In 2020, out of 927 P treated with CIED in our center, 157 were referred to the nursing outpatient clinic due high risk features such as anticoagulation and frailty, previously identified surgical wound related complications or advanced hearth failure. The CIED observed were replaced devices (17%), cardioverter defibrillator (41%), cardiac resynchronization therapy with defibrillator (27%), pacemakers (11%), and event recorders (4%). In average, the first appointment took place 16 days after the procedure. In 73 cases, presenting with pocket complaints (hematoma - 34%, local edema or pain - 10%, wound scab - 36%, exteriorized suture or staple - 20%), the average number of days until medical discharge was 36 days, with an average of 5 appointments per patient. In this group, 42% were under oral coagulants, 38% under antiaggregant drugs and 11% under both. Treatment options included antibiotic prescription in 25% of the cases, cryotherapy in 22%, dressing of the surgical wound in 10% and absorbable suture or staple removal in 10%. Four P (0.43%) were submitted to complete system removal due to CIED infection. Conclusions: Surgical wound related complaints in CIED P are relatively common and represent a factor of morbidity and increase in public health spending. An integrated trained team may aid in the prompt identification and management of these complications.
Symptomatic arterial hypertension in extrasystolic arrythmia
Authors: Germanova O , Germanov AV , Galati G , Shchukin YV
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Within the main causes of the secondary arterial hypertensions the main roles play renal, endocrine and hemodynamic. In the list of reasons of the secondary hemodynamic arterial hypertension there’re no extrasystoles.

Purpose. To determine the relationship between different types of  extrasystoles and the the secondary hemodynamic arterial hypertension.

Materials and methods.  We observed 132 patients with supraventricular and ventricular extrasystoles. Extrasystoles were divided into groups due to the moment of their appearance in cardiocycle:

1. Extrasystoles before the mitral valve opening.

2,3.  Exstrasystoles in phase of fast ventricules filling before and after the peak of transmitral blood flow.

4. Extrasystoles in slow ventricules filling phase. 

5. Other extrasystoles (allorrhythmias and group extrasystoles). 

The reason for that dividing was the different contribution of each type into the hemodynamics and heart output. We analyzed the regular, extraordinary and first post-extrasystolic contractions. Intra-arterial blood flow was estimated by ultrasound-doppler. The moment of extrasystoles appearance was determined by echocardiography, electrocardiography and 24-hours ECG monitoring. The kinetics of vessel wall was calculated by sphygmograms and included speed, acceleration, power and work parameters.

The BP measuring was made by Korotkov method that the moment of measuring was in the first post-extrasystolic wave on sphygmogram. We duplicated it after the normalization and calibration of carotid arteries sphygmograms.

Results. The main importance to the hemodynamic changes has the moment of extrasystole appearance in cardio cycle and the ability of the first post-extrasystolic contraction to reestablish an adequate resulting blood flow. It is characterized by: stroke volume rising from 5 to 40%; systolic BP increase up to 30% (with formation of the secondary hemodynamic AH) compared with the systolic BP with normal heart rate; rising of arterial walls kinetic parameters (speed, acceleration, power, work); blood flow velocity rising; grown arterial wall deformation.  The maximum of these parameters was in first post-extrasystolic contraction with extrasystoles before the mitral valve opening and extrasystoles before the transmitral peak blood outflow.

The special hemodynamic situation appears when there’re allorrhythmias when, for example, in case of constant bigeminia, BP is increased in 50% of time, and in case of trigimenia – in 1/3 of time.

Conclusion. We believe it’s necessary to include extrasystoles into the list of the reasons of  the  secondary hemodynamic arterial hypertension. The main features of this type of AH are: unstable BP rising, prevalence growth of systolic BP, direct relationship with extrasystoles’ appearance moment. The risen blood flow of first post-extrasystolic contraction can be the reason of additional arterial walls deformation and complications that may cause the any AH.
A prospective longitudinal study of health-related quality of life and psychological wellbeing after an implantable cardioverter defibrillator in patients with genetic heart diseases
Authors: Van Den Heuvel LM , Sarina T , Sweeting J , Yeates L , Bates K , Spinks C , O"donnell C , Sears SF , Mcgeechan K , Semsarian C , Ingles J
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NHMRC Project Grant National Heart Foundation Future Leader Fellowship

OnBehalf

Cardio Genomics Program

Introduction

Genetic heart diseases, often affecting young people, can be clinically heterogeneous and pose an increased risk of sudden cardiac death (SCD). The implantable cardioverter defibrillator (ICD) is a lifesaving therapy. Impact on prospective and long-term psychological and health-related quality of life (HR-QoL) after ICD implant in patients with genetic heart diseases is unknown.

Purpose

We aimed to investigate the psychological functioning and HR-QoL over time in patients with genetic heart diseases who receive an ICD and to identify risk factors for poor psychological functioning and HR-QoL.

Methods

A prospective longitudinal design was used. Patients diagnosed with a genetic heart disease for which they received an ICD, were eligible. Anxiety, depression, health-related quality of life and device acceptance were measured using validated questionnaires. Baseline surveys were completed prior to ICD implantation with five-year follow-up after ICD implant.

Results

Forty patients with an inherited cardiomyopathy or arrhythmia syndrome (mean age 46.3 ± 14.2 years; 65.0% males) were included. Mean psychological and HR-QoL measures were within normative ranges during follow-up. We observed significant overall improvements from baseline to first follow-up with variability increasing after 36 months. The presence of comorbidities predicted worse physical HR-QoL (p = 0.014). Other predictors were not statistically significant, although lower education and female gender seemed to be an interesting predictor for higher anxiety and less mental HR-QoL, and the presence of comorbidities for less physical HR-QoL.

Conclusion

While the majority of patients with a genetic heart disease adjust well to their ICD implant, a subset of patients experiences poor psychological and HR-QoL outcomes.
Reducing Resistance: The Impact of Nonfollowers’ and Followers’ Parasocial Relationships with Social Media Influencers on Persuasive Resistance and Advertising Effectiveness
Authors: Breves Priska , Liebers Nicole , Motschenbacher Bernadette , Reus Leonie
Published: July 2021

Although social media influencers have become popular brand endorsers, previous research on this new form of advertising has neglected to analyze how the followers of these influencers are persuaded. Based on a key mechanism proposed by the entertainment overcoming resistance model, long-term parasocial relationships (PSRs) should reduce the amount of persuasive resistance in the forms of reactance and counterarguing. Consequently, the persuasive effects should be enhanced. To empirically test these assumptions, two online studies were conducted. The first experimental study (N = 151) confirmed that followers experienced stronger PSRs than did nonfollowers, which resulted in higher perceived source trustworthiness and reduced levels of both perceived freedom threat and counterarguing after exposure to a sponsored Instagram post. The second study (N = 225) further confirmed the enhanced persuasive impact of PSRs in terms of brand evaluations and behavioral intentions. The theoretical and practical implications for advertisers, consumer advocates, and future research are discussed.
Variation in hospital performance measures from the Turkey Ministry of Health
Authors: Saluvan Mehmet , Milliren Carly E , Graham Dionne A , Simsekler Mecit Can Emre , Babacan Akin Merve , Koçatakan Pinar , Gören Mustafa , Ozonoff Al
Published: July 2021

Background

The Turkish healthcare system has seen broad population-based improvements in expanded health insurance coverage and access to healthcare services. Hospital performance in this national system is understudied. We aimed to identify trends in hospital performance over time following implementation of the Health Transformation Program and describe how regional outcomes correlate with regional vital statistics.

Objective

We examine hospital performance data collected by the PHA from 2013 to 2015. We aim to identify the temporal variation in hospital performance for nearly 30 individual measures and to describe the relationship between hospital-level performance measures and regional vital statistics.

Methods

We conducted a retrospective cohort study of 674 public hospitals in Turkey using baseline data from 2013 and follow-up data from 2014–15 collected by the Turkish Statistical Institution and the Public Hospital Agency. We report demographic and socioeconomic data across 12 geographic regions and analyze 29 hospital-level performance measures across four domains: (i) health services; (ii) administrative services; (iii) financial services and (iv) quality measures. We examine temporal variation, and study correlation between performance measures and regional vital statistics. We fit mixed-effects linear regression models to estimate linear trend over time accounting for within-hospital residual correlation. We prepared our manuscript in accordance with guidelines set by the STROBE statement for cohort studies.

Results

During the 3 years of study period, 21 of 29 measures improved and 8 measures worsened. All but three measures demonstrated significant differences across regions of the country. Several measures, including inpatient efficiency, patient satisfaction and audit score, are associated with regional infant mortality and life expectancy.

Conclusions

Evidence of temporal improvement in hospital-level performance may suggest some positive changes within the Turkish national healthcare system. Correlation of some measures with regional level health outcomes suggests a quality measurement strategy to monitor performance changes in the future. Although hospital-level functions have improved performance, the results of our study may help achieve further improvement for the health of the country’s citizens.
A cross-species comparison of antiretroviral penetration into lymph nodes using novel physiologically based pharmacokinetic models
Authors: Scholz Erin M B , Cao Yanguang , Kashuba Angela D M
Published: July 2021

Background

Investigating antiretroviral (ARV) penetration and pharmacology in lymph nodes is crucial to understanding mechanisms of HIV persistence in tissue, but sampling these tissues in humans is invasive and costly. Physiologically based pharmacokinetic (PBPK) modelling is a non-invasive solution for understanding lymph node penetration of ARVs across multiple species.

Objectives

To develop customized PBPK models with a novel lymph node compartment, and use these models to describe the distribution of three ARVs—tenofovir, emtricitabine and efavirenz—into the plasma and lymph nodes of non-human primates (NHPs) and humans.

Materials and methods

In this analysis, we utilized standard monkey and human PBPK models in PK-Sim, and added a novel lymph node compartment using MoBi. We used these models to describe the distribution of tenofovir, emtricitabine and efavirenz into NHP and human plasma and lymph nodes, and compared model-predicted versus observed AUC and Cmax.

Results

For all three ARVs, population simulations using the base and final models reasonably characterized observed plasma and tissue data in NHPs and humans, with predicted/observed AUC and Cmax ratios within 0.7–2.0.

Conclusions

Overall, our novel PBPK model provides a framework for understanding lymph node penetration of ARVs or future HIV cure therapies.
An Exploratory Study Demonstrating That Salivary Cytokine Profiles Are Altered in Children With Small Area Thermal Injury
Authors: Carlton Morgan , Voisey Joanne , Jones Lee , Parker Tony J , Punyadeera Chamindie , Cuttle Leila
Published: July 2021

Serum can be used to investigate changes in cytokine concentration following burn injury in children; however, for children receiving treatment in an outpatient setting, blood is not routinely collected and therefore cannot be used for monitoring. The aim of this study was to investigate the use of saliva as a noninvasive tool for predicting burn outcomes by measuring the concentration of salivary cytokines in children with small area burns. A multiplex cytokine assay was used to measure 17 cytokines in the saliva of pediatric patients with burns (n = 20) and healthy controls (n = 20). After the removal of cytokines that had >30% of samples below the assay lower detection limit, six cytokines including IL-1β, IL-4, IL-7, IL-8, MCP-1, and TNFα were analyzed for association with burns. IL-1β and IL-4 were found to be significantly elevated in the pediatric burn patients compared to healthy controls. Interestingly, IL-1β was also significantly elevated in scald burns, compared to contact burns. In addition, biologically meaningful differences in cytokine concentration were identified in patients with different burn characteristics, which warrant further investigation. This exploratory study provides evidence that cytokines can be detected in the saliva of children and that salivary cytokine profiles differ between healthy controls and children with burns. Overall, this study demonstrates the value of saliva for the investigation of cytokines and its potential application in pediatric diagnostics, specifically in situations where blood collection is not appropriate.
miR825-5p targets the TIR-NBS-LRR geneMIST1and down-regulates basal immunity againstPseudomonas syringaein Arabidopsis
Authors: López-Márquez Diego , Del-Espino Ángel , López-Pagán Nieves , Rodríguez-Negrete Edgar A , Rubio-Somoza Ignacio , Ruiz-Albert Javier , Bejarano Eduardo R , Beuzón Carmen R
Published: July 2021

Plants encode numerous intracellular receptors known as nucleotide-binding leucine-rich repeat receptors (NLRs) that recognize pathogen-derived effectors or their activity to activate defenses. miRNAs regulate NLR genes in many species, often triggering the production of phased siRNAs (phasiRNAs). Most such examples involve genes encoding NLRs carrying coiled-coil domains, although a few include genes encoding NLRs carrying a Toll/interleukin-1 domain (TNL). Here, we characterize the role of miR825-5p in Arabidopsis, using a combination of bioinformatics, transgenic plants with altered miRNA levels and/or reporters, small RNAs, and virulence assays. We demonstrate that miR825-5p down-regulates the TNL MIST1 by targeting for endonucleolytic cleavage the sequence coding for TIR2, a highly conserved amino acid motif, linked to a catalytic residue essential for immune function. miR825-5p acts as a negative regulator of basal resistance against Pseudomonas syringae. miR825-5p triggers the production from MIST1 of a large number of phasiRNAs that can mediate cleavage of both MIST1 and additional TNL gene transcripts, potentially acting as a regulatory hub. miR825-5p is expressed in unchallenged leaves and transcriptionally down-regulated in response to pathogen-associated molecular patterns (PAMPs). Our results show that miR825-5p, which is required for full expression of PAMP-triggered immunity, establishes a link between PAMP perception and expression of uncharacterized TNL genes.
The proline cycle as an eukaryotic redox valve
Authors: Zheng Yao , Cabassa-Hourton Cécile , Planchais Séverine , Lebreton Sandrine , Savouré Arnould
Published: July 2021

The amino acid proline has been known for many years to be a component of proteins as well as an osmolyte. Many recent studies have demonstrated that proline has other roles such as regulating redox balance and energy status. In animals and plants, the well-described proline cycle is concomitantly responsible for the preferential accumulation of proline and shuttling of redox equivalents from the cytosol to mitochondria. The impact of the proline cycle goes beyond regulating proline levels. In this review, we focus on recent evidence of how the proline cycle regulates redox status in relation to other redox shuttles. We discuss how the interconversion of proline and glutamate shuttles reducing power between cellular compartments. Spatial aspects of the proline cycle in the entire plant are considered in terms of proline transport between organs with different metabolic regimes (photosynthesis versus respiration). Furthermore, we highlight the importance of this shuttle in the regulation of energy and redox power in plants, through a particularly intricate coordination, notably between mitochondria and cytosol.
Modelling of ionizing feedback with smoothed particle hydrodynamics and Monte Carlo radiative transfer on a Voronoi grid
Authors: Petkova Maya A , Vandenbroucke Bert , Bonnell Ian A , Kruijssen J M Diederik
Published: July 2021

The ionizing feedback of young massive stars is well known to influence the dynamics of the birth environment and hence plays an important role in regulating the star formation process in molecular clouds. For this reason, modern hydrodynamics codes adopt a variety of techniques accounting for these radiative effects. A key problem hampering these efforts is that the hydrodynamics are often solved using smoothed particle hydrodynamics (SPH), whereas radiative transfer is typically solved on a grid. Here we present a radiation-hydrodynamics (RHD) scheme combining the SPH code phantom and the Monte Carlo radiative transfer (MCRT) code cmacionize, using the particle distribution to construct a Voronoi grid on which the MCRT is performed. We demonstrate that the scheme successfully reproduces the well-studied problem of D-type H ii region expansion in a uniform density medium. Furthermore, we use this simulation setup to study the robustness of the RHD code with varying choice of grid structure, density mapping method, and mass and temporal resolution. To test the scheme under more realistic conditions, we apply it to a simulated star-forming cloud reminiscing those in the Central Molecular Zone of our Galaxy in order to estimate the amount of ionized material that a single source could create. We find that a stellar population of several $10^3~\rm {M_{\odot }}$ is needed to noticeably ionize the cloud. Based on our results, we formulate a set of recommendations to guide the numerical setup of future and more complex simulations of star forming clouds.
Towards realistic modelling of the astrometric capabilities of MCAO systems: detecting an intermediate-mass black hole with MAVIS
Authors: Monty Stephanie , Rigaut François , McDermid Richard , Baumgardt Holger , Cranney Jesse , Agapito Guido , Mendel J Trevor , Plantet Cédric , Greggio Davide , Stetson Peter B , Fiorentino Giuliana , Haynes Dionne
Published: July 2021

Accurate astrometry is a key deliverable for the next generation of multiconjugate adaptive optics (MCAO) systems. The MCAO-Assisted Visible Imager and Spectrograph (MAVIS) is being designed for the Very Large Telescope Adaptive Optics Facility and must achieve 150 $\mu$as astrometric precision (50 $\mu$as goal). To test this before going on-sky, we have created MAVIS Image Simulator (mavisim), a tool to simulate MAVIS images. mavisim accounts for three major sources of astrometric error: high- and low-order point spread function (PSF) spatial variability, tip–tilt residual error, and static field distortion. When exploring the impact of these three error terms alone, we recover an astrometric accuracy of 50 $\mu$as for all stars brighter than m = 19 in a 30 s integration using PSF-fitting photometry. We also assess the feasibility of MAVIS detecting an intermediate-mass black hole (IMBH) in a Milky Way globular cluster. We use an N-body simulation of an NGC 3201-like cluster with a central 1500 M⊙ IMBH as input to mavisim and recover the velocity dispersion profile from proper motion measurements. Under favourable astrometric conditions, the dynamical signature of the IMBH is detected with a precision of ∼0.20 km s−1 in the inner ∼4 arcsec of the cluster where Hubble Space Telescope (HST) is confusion limited. This precision is comparable to measurements made by Gaia, HST, and Multi Unit Spectroscopic Explorer (MUSE) in the outer ∼60 arcsec of the cluster. This study is the first step towards building a science-driven astrometric error budget for an MCAO system and a prediction of what MAVIS could do once on sky.
Context-sensitivity of isosteric substitutions of non-Watson–Crick basepairs in recurrent RNA 3D motifs
Authors: Khisamutdinov Emil F , Sweeney Blake A , Leontis Neocles B
Published: July 2021

Sequence variation in a widespread, recurrent, structured RNA 3D motif, the Sarcin/Ricin (S/R), was studied to address three related questions: First, how do the stabilities of structured RNA 3D motifs, composed of non-Watson–Crick (non-WC) basepairs, compare to WC-paired helices of similar length and sequence? Second, what are the effects on the stabilities of such motifs of isosteric and non-isosteric base substitutions in the non-WC pairs? And third, is there selection for particular base combinations in non-WC basepairs, depending on the temperature regime to which an organism adapts? A survey of large and small subunit rRNAs from organisms adapted to different temperatures revealed the presence of systematic sequence variations at many non-WC paired sites of S/R motifs. UV melting analysis and enzymatic digestion assays of oligonucleotides containing the motif suggest that more stable motifs tend to be more rigid. We further found that the base substitutions at non-Watson–Crick pairing sites can significantly affect the thermodynamic stabilities of S/R motifs and these effects are highly context specific indicating the importance of base-stacking and base-phosphate interactions on motif stability. This study highlights the significance of non-canonical base pairs and their contributions to modulating the stability and flexibility of RNA molecules.
Vitamin K & D Deficiencies Are Independently Associated With COVID-19 Disease Severity
Authors: Desai Ankita P , Dirajlal-Fargo Sahera , Durieux Jared C , Tribout Heather , Labbato Danielle , McComsey Grace A
Published: July 2021

Background

We investigated the association of vitamin K and vitamin D with coronavirus disease 2019 (COVID-19) outcomes.

Methods

Levels of inactive vitamin K–dependent dephosphorylated uncarboxylated matrix Gla protein (dp-ucMGP; marker of vitamin K status) and 25-hydroxyvitamin D (25(OH)D; vitamin D status) were measured in plasma samples from participants with confirmed acute COVID-19 and were age- and sex-matched to healthy controls. Unadjusted odds ratios and adjusted odds ratios (AORs) with 95% CIs were computed using cumulative logistic regression.

Results

One hundred fifty subjects were included, 100 COVID-19+ and 50 controls. The median age (interquartile range) was 55 (48–63) years, and 50% were females. Thirty-four percent had mild COVID-19 disease, 51% moderate disease, and 15% severe. Dp-ucMGP levels were higher (ie, worse K status) in COVID-19+ vs controls (776.5 ng/mL vs 549.8 ng/mL; P < .0001) with similar 25(OH)D between groups (25.8 vs 21.9 ng/mL; P = .09). Participants who were vitamin D deficient (<20 ng/mL) had the worse vitamin K status (dp-ucMGP >780 ng/mL) and experienced the most severe COVID-19 outcomes. In adjusted models, every 1-unit increase in the log2 dp-ucMGP nearly doubled the odds of acute critical disease or death (AOR, 1.84; 95% CI, 1.01–3.45), and every 1-unit decrease in the natural log 25(OH)D was associated with >3 times the likelihood of severe COVID-19 disease (AOR, 0.29; 95% CI, 0.11–0.67).

Conclusions

Early in acute COVID-19, both vitamin K and vitamin D deficiency were independently associated with worse COVID-19 disease severity, suggesting a potential synergistic interplay between these 2 vitamins in COVID-19.
Understanding the Psychophysiological Mechanisms Related to Widespread Pressure Pain Hyperalgesia Underpinning Carpal Tunnel Syndrome: A Network Analysis Approach
Authors: Liew Bernard X W , de-la-Llave-Rincón Ana I , Arias-Buría José L , Ortega-Santiago Ricardo , Fernández-de-las-Peñas César
Published: July 2021

Objective

Current evidence suggests that carpal tunnel syndrome (CTS) involves widespread pressure pain sensitivity as a manifestion of central sensitization. This study aimed to quantify mechanisms driving widespread pressure pain hyperalgesia in CTS by using network analysis.

Design

Cross-sectional.

Setting

Urban hospital.

Subjects

Women with CTS (n=120) who participated in a previous randomized clinical trial.

Methods

Pain intensity, related function, symptom severity, depressive levels, and pressure pain threshold (PPTs) over the median, radial, and ulnar nerves, as well as the cervical spine, the carpal tunnel, and the tibialis anterior, were collected. Network analysis was used to quantify the adjusted correlations between the modeled variables and to determine the centrality indices of each variable (i.e., the degree of connection with other symptoms in the network).

Results

The estimated network showed several local associations between clinical variables and the psychophysical outcomes separately. The edges with the strongest weights were those between the PPT over the median nerve and the PPT over the radial nerve (P=0.34), between function and depressive levels (P=0.30), and between the PPT over the carpal tunnel and the PPT over the tibialis anterior (P=0.29 ). The most central variables were PPT over the tibialis anterior (the highest Strength centrality) and PPT over the carpal tunnel (the highest Closeness and Betweenness centrality).

Conclusions

This is the first study to apply network analysis to understand the multivariate mechanisms of individuals with CTS. Our findings support a model in which clinical symptoms, depression, and widespread pressure pain sensitivity are connected, albeit within separate clusters. The clinical implications of the present findings, such as the development of treatments targeting these mechanisms, are also discussed.
The Proper Formulation of the Minimalist Theory of Truth
Authors: Schindler Thomas , Schlöder Julian J
Published: July 2021

Minimalism about truth is one of the main contenders for our best theory of truth, but minimalists face the charge of being unable to properly state their theory. Donald Davidson incisively pointed out that minimalists must generalize over occurrences of the same expression placed in two different contexts, which is futile. In order to meet the challenge, Paul Horwich argues that one can nevertheless characterize the axioms of the minimalist theory. Sten Lindström and Tim Button have independently argued that Horwich’s attempt to formulate minimalism remains unsuccessful. We show how to properly state Horwich’s axioms by appealing to propositional functions that are given by definite descriptions. Both Lindström and Button discuss proposals similar to ours and conclude that they are unsuccessful. Our new suggestion avoids these objections.
Federal Constitutional Values and Citizen Attitudes to Government: Explaining Federal System Viability and Reform Preferences in Eight Countries
Authors: Brown A J , Deem Jacob , Kincaid John
Published: July 2021

This study presents a measure of federal constitutional values as a dimension of federal political culture derived from four key features of federal systems. Tested in six federal and two non-federal countries, we find the measure is stable and taps enduring values, including confirmation that citizens who support devolutionary reform have stronger federal constitutional values. Defining federalism success as a system where citizens have strong federal constitutional values and high satisfaction with their current polycentric system, our results find Switzerland and Canada being the most viable, followed by the United States, Australia, and Germany, while Belgium is not very successful. In the non-federal countries, substantial support for devolution and possibly federalism is found in France, but devolution is more contested in the United Kingdom. The results affirm the importance of public attitudes and political culture in understanding the performance of federal political systems and public support for federalist-type reforms.
Academic human capital in universities: definition and proposal of a measurement scale
Authors: García-Carbonell Natalia , Guerrero-Alba Félix , Martín-Alcázar Fernando , Sánchez-Gardey Gonzalo
Published: July 2021

Academic human capital (AHC) is a key element in the explanation of scientific productivity. However, few studies have analysed this topic in the academic context, and their conclusions about composition and measurement remain ambiguous. This study proposes a measurement scale to assess AHC, following a systemic procedure composed of two steps: qualitative and quantitative phases. First, the Delphi technique was applied to reach a consensus on the AHC factors, resulting in a scale of 22 items. Second, exploratory and confirmatory factor analyses were conducted to determine the underlying factorial structure of the scale, using a sample of 2,223 researchers in Spanish universities. The results provided a five-dimensional structure of AHC, measuring the knowledge and abilities required to perform research activities, as well as skills related to the organisation of scientific processes, alertness to research opportunities, and the openness to provide and receive criticism. This study poses interesting challenges for knowledge management in universities.
Factors That Drive Annual Variation in Pediatric Elbow Fracture Occurrence, Severity, and Resource Utilization
Authors: Schultz Jacob D. , Rees Andrew B. , Wollenman Lucas C. , McKeithan Lydia J. , Tadepalli Vaibhav R. , Wessinger Bronson C. , Attipoe Graham , Gay James C. , Martus Jeffrey E. , Moore-Lotridge Stephanie N. , Schoenecker Jonathan G.
Published: July 2021

Background:

Elbow fractures are the most common pediatric fractures requiring operative treatment. To date, few studies have examined what annual factors drive pediatric elbow fracture incidence and no studies have examined which annual factors drive elbow fracture severity or resource utilization. The goal of this study was to not only document the annual patterns of pediatric elbow fracture incidence and severity but also the impact of these patterns on resource utilization in the emergency department, emergency medical service transportation, and the operating room (OR).

Methods:

Retrospective cohort study of 4414 pediatric elbow fractures from a single tertiary hospital (2007 to 2017). Exclusion criteria included outside treatment or lack of diagnosis by an orthopaedist. Presentation information, injury patterns, transport, and treatment requirements were collected. Pearson correlations were used to analyze factors influencing fracture incidence, severity, and resource utilization.

Results:

Pediatric elbow fracture incidence positively correlated with monthly daylight hours, but significantly fewer elbow fractures occurred during summer vacation from school compared with surrounding in school months. While fewer overall fractures occurred during summer break, the fractures sustained were greater in severity, conferring higher rates of displacement, higher risk of neurovascular injury, and greater needs for emergency transportation and operative treatment. Yearly, elbow fractures required 320.6 OR hours (7.7% of all pediatric orthopaedic OR time and 12.3% of all pediatric orthopaedic operative procedures), 203.4 hospital admissions, and a total of 4753.7 miles traveled by emergency medical service transportation to manage. All-cause emergency department visits were negatively correlated with daylight hours, inversing the pattern seen in elbow fractures.

Conclusion:

Increased daylight, while school was in session, was a major driver of the incidence of pediatric elbow fractures. While summer vacation conferred fewer fractures, these were of higher severity. As such, increased daylight correlated strongly with monthly resource utilization, including the need for emergency transportation and operative treatment. This study provides objective data by which providers and administrators can more accurately allocate resources.

Level of Evidence:

Level III—Retrospective comparative study.