bluuebunny/crossref_metadata_2025 huggingface dataset:
Occult and active hepatitis B virus detection in donated blood in São Paulo, Brazil
Authors: Nishiya Anna S. , Levi José E. , de Almeida‐Neto Cesar , Witkin Steven S. , Ferreira Suzete C. , Bassit Leda , Sabino Ester C. , Di‐Lorenzo‐Oliveira Claudia , Salles Nanci A. , Coutinho Adenilson S. , Bellesa Maria A. , Rocha Vanderson , Mendrone‐Jr Alfredo
Published: March 2021

Background

The present study determined the HBV antigen, antibody, and DNA status in blood donations deemed to be HBV positive. Individuals with an occult HBV infection (OBI), defined as being positive for HBV DNA but negative for HBV surface antigen (HBsAg), as well as those with active infection (HBsAg‐positive), were identified and characterized.

Study Design and Methods

From a total pool if 198,363 blood donations, we evaluated in a cross‐sectional study, 1106 samples that were positive in screening tests for antibody to HBV core antigen (HBcAb), HBsAg, and/or HBV DNA by nucleic acid testing (NAT‐HBV). The presence of genetic variants in the HBV pol/S gene in individuals with an active HBV infection was also determined.

Results

OBIs were detected in six of 976 samples (0.6%) that were positive only for HBcAb. The rate of HBV active infection was 0.024% (48/198,363) and there was a predominance of HBV sub‐genotype A1 (62.2%, 28/45), followed by D3 (17.8%, 8/45). Mutations in the S gene were found in 57.8% (26/45) and immune escape mutations in 37.8% (17/45) of active HBV‐infected donors. Among them, T123N, G145A, and D144G high‐impact immune escape mutations were identified.

Conclusion

Highly sensitive molecular tests improve the capacity to detect OBIs. When NAT is performed in pooled samples, HBcAb test has value in the detection of donors with OBI and improves transfusion safety. Mutations in the S gene are frequent in HBsAg‐positive blood, including those associated with diagnostic failure and vaccine escape mutations.
Exploration of COVID‐19 related fears deterring from blood donation in India
Authors: Sachdev Suchet , Kishore Kamal , Singh Lakhvinder , Lamba Divjot Singh , Hans Rekha , Dhawan Hari Krishan , Grover Sandeep , Sharma Ratti Ram
Published: March 2021

Introduction

The coronavirus pandemic (COVID‐19) has impacted and pushed the healthcare settings to extremes across the globe. It was extremely challenging to sustain blood donation, and strategies could be formulated on knowing fears hindering blood donation.

Methods

A cross‐sectional survey using Google Forms® through WhatsApp and email after obtaining the ethical clearance. The survey questionnaire was validated for content using the Delphi technique, and pilot tested for finalization.

Results

The survey was attempted by 1066 participants, and 749 participants who had not donated since pandemic were included in the study. A little more than half, 415 (55%) reported either one or more than one fear during the pandemic which hindered blood donation. They reported lack of confidence in the safety measures at the hospitals and fear of transmitting infection to family, in 415 (55%) of the participants each, respectively. The fear of COVID‐19 hospital infection risk and hospital entry was statistically significant across the age groups that are eligible for blood donation.

Conclusions

The clear and dedicated confidence building measures to sustain blood donation using all communication modalities clearly emerge as the most important strategies to augment blood donation in the COVID‐19 pandemic. The measures should include information about implementation of safety measures to mitigate COVID‐19 transmission at the blood centres and that the act of blood donation does not increase risk of COVID‐19 and therefore the risk of transmission of infection to family.
Three‐dimensional printed guides for screw placement in equine navicular bones
Authors: Perez‐Jimenez Erik E. , Biedrzycki Adam H. , Morton Alison J. , McCarrel Taralyn M.
Published: March 2021

Objective

To determine the influence of a custom 3D‐printed guide for placement of cortical bone screws in the equine navicular bone.

Study design

Ex vivo study.

Sample population

Eight pairs of normal adult equine forelimbs.

Methods

A 3.5 × 55 mm cortical screw was placed in the longitudinal axis of each intact navicular bone. Screws were placed with a 3D‐printed guide (3D) in one bone and with a traditional aiming device (AD) in the contralateral bone within each pair. Duration of surgery and the number of fluoroscopy images were compared between techniques. Screw placement was subjectively evaluated by gross examination and scored by three boarded veterinary surgeons.

Results

The use of a 3D‐printed guide reduced the duration of surgery by 6.6 min (±1.5 min) compared to traditional screw placement (20.7 min ± 4.8 min, p < .01). Fewer peri‐operative fluoroscopic images were obtained when the 3D guide was used (18 images ± 2.6 images vs. 40 images ± 5.1, p < .01). No difference was detected in navicular screw placement.

Conclusion

The use of a 3D guide decreased the time required to place screws and the number of intraoperative images taken without affecting screw placement in intact navicular bones.

Clinical relevance

3D‐printed guides can aid in the study, practice, and execution of surgical procedures reducing surgical time and radiation exposure throughout the operative period achieving similar results to those obtained with a conventional approach.
Impacto ecológico, social y económico de fincas certificadas en buenas prácticas agrícolas y comercio justo
Authors: CAVIEDES RUBIO DIEGO IVAN CAVIEDES RUBIO IVAN
Published: March 2021

Se realizó una revisión de diversos estudios enfocados para establecer el impacto ambiental generado en las fincas productoras de café certificadas con diferentes sellos de buenas prácticas agrícolas y socioeconómicas en las diversas regiones productoras del grano. De esta revisión se establecieron los impactos de mayor persistencia, así como los de mayor singularidad en todo el mundo.
Precios justos y tendencias de venta de productos agropecuarios mexicanos a intermediarios
Authors: Bojórquez Carrillo Ana Laura
Published: March 2021

El objetivo de este artículo es analizar el establecimiento de precios justos y las prácticas de venta a intermediarios, en el contexto de la problemática que aqueja a pequeños productores agropecuarios en ocho municipios de Yucatán, México. El enfoque de la investigación es mixto y, por este motivo, se aplicaron técnicas a nivel comparativo relacional, se construyeron modelos de regresión logística binaria y se realizaron entrevistas semiestructuradas. Los resultados obtenidos contradicen la idea de que estos productores se dirigen, principalmente, a los intermediarios para venderles sus productos, en caso de que estos tengan algún tipo de problema con respecto a la tierra, la producción, la comercialización, el transporte o la falta de precios justos.
Network- and Differential-Analyzer Solution of Torsional Oscillation Problems Involving Nonlinear Springs
Authors: Concordia C.
Published: March 2021

This paper (a) points out that, just as in the case of linear systems, the “alternating-current network analyzer” may he used to extend the graphical method to the direct solution of torsional-oscillation problems involving many masses and springs, more than one of which may he nonlinear, and (b) illustrates the use of the “differential analyzer” in solving steady-state vibration problems in which the approximate graphical method cannot be applied or does not give satisfactory solutions. In both of these methods the torque-amplification curves are determined simply and directly. It is indicated that the same methods apply to linearly vibrating systems with nonlinear springs as well as to systems having, for example, nonlinear damping or inertia coefficients.
Distribution of Tooth Load Along a Pinion
Authors: Poritsky H. , Sutton A. D. , Pernick A.
Published: March 2021

The distribution of load along a spur gear and pinion or among the teeth of a helical gear and pinion is of great interest in the design and performance of gears. If the load is unevenly distributed, certain parts are not carrying their due share of load, while the resulting concentration of load elsewhere may result in local failure. This paper is concerned with the calculation of load distribution, and the analysis of the factors responsible for the character of this distribution.
Cumulative Damage in Fatigue
Authors: Miner Milton A.
Published: March 2021

The phenomenon of cumulative damage under repeated loads was assumed to be related to the net work absorbed by a specimen. The number of loading cycles applied expressed as a percentage of the number to failure at a given stress level would be the proportion of useful life expended. When the total damage, as defined by this concept, reached 100 per cent, the fatigue specimen should fail. Experimental verification of this concept for an aluminum alloy, using different types of specimens, various stress ratios, and various combinations of loading cycles is presented. These data are also analyzed to provide information on different stress ratios when an S-N curve for any one ratio is known. Results of a sample analysis based on experiments are given. It is concluded that a simple and conservative analysis is possible using the concept of cumulative fatigue damage.
Experimental Study of the Effect of Intermittent Electromagnetic Stirring on the Columnar-Equiaxed Transition in Sn–10 wt % Pb Alloy Solidification
Authors: Abdelhakem Ab. , Hachani L. , Zaidat K. , Sari I. , Fautrelle Y.
Published: March 2021

Experimental analysis of stratification, electromagnetic stirring (EMS), and solidification were carried out for two solidification experiments for a binary Sn–10 wt % Pb alloy. The objective of this study is to examine the effect of forced convection driven by an intermittent traveling magnetic field on the solidification process. Several aspects were investigated, namely, thermal field, macrostructure, and finally segregation behavior, as well as morphology. The effect of the both thermal and solutal stratification on the intensity of the flow is discussed yet showed that stratification has a stabilizing effect for the flow, which can also slow the convective hydrodynamic movements generated by the buoyancy forces. The consequence of this stratification on macrosegregations and channel segregation, which develop during the solidification period, is experimentally analyzed. EMS by intermittent traveling magnetic promotes the development of the columnar-equiaxed transition mechanism (CET), more particularly the refinement of the grain size. The results illustrate, also, that EMS effectively diminish macrosegregations significantly, while remaining inactive for reducing channels segregation development.
Thermal Transport in Laminar Convective Flow of Ferrofluids in the Presence of External Magnetic Field
Authors: Shah Ram Krishna , Drave Jai Kumar , Khandekar Sameer
Published: March 2021

A three-dimensional (3D) numerical investigation is carried out to examine the effect of magnetic field (MF) on laminar forced convection of ferrofluids. Laminar flow (Reynolds number (Re) ≤ 100) of ferrofluid is modeled in a square mini-channel of 2 mm hydraulic diameter in the presence of the MF. A magnetic force is induced in ferrofluids because of the applied MF, which accelerates the upstream flow and decelerates the downstream flow with respect to the magnet's location. The acceleration/deceleration of the flow disrupts the hydrodynamic and thermal boundary layers (BLs), positively affecting the heat transfer. The extent of magnetic influence primarily depends on the Reynolds number and induced magnetic force. At low Re (= 25), where magnetic force dominates over inertial force, the flow of ferrofluid is strongly affected by the MF. This results in a higher augmentation in convective heat transfer. As the Re of the flow is increased to Re = 75, the inertial forces partially overcome the effect of the magnetic force, resulting in a smaller augmentation. The interaction of magnetic and inertia forces is expressed through a dimensionless magnetic Froude number (Frm). The effect of volumetric concentration of nanoparticles, Reynolds number, and the presence of multiple magnets placed along the flow channel on heat transfer is investigated through a parametric study. A correlation has also been proposed to predict the net enhancement in the Nusselt number due to the application of the MF based on the results of the present study.
Investigation and Application of Bio-Inspired Microscale Structures to Turbine Endwall for Enhancing Film Cooling Performance
Authors: Yang Xing , Zhao Qiang , Feng Zhenping
Published: March 2021

In this paper, inspired by micro-scale surface structure patterns of birds’ flight feather, a novel thermal-protection enhancement technique is proposed for a turbine endwall with cavity air leaked from an upstream realistic rim seal. The potential application of the micro-scale surface structures is demonstrated by using well-validated numerical simulations. Overall film cooling performance and total thermodynamic loss are examined to comprehensively evaluate the feasibility of the micro-scale surface patterns for three cavity air flowrates. Detailed thermal fields and flow structures involved in the coolant–mainstream interactions are also presented to reveal physical flow mechanisms behind. Comparisons with a smooth endwall and previously used ribbed endwall cases show that applying the micro-scale structures onto the turbine endwall generates a substantial increase in cooling effectiveness with a very slight aerodynamic penalty. Despite of enhanced heat transfer levels, the resulting heat loads into the endwall are significantly reduced. Detailed thermal fields and flow structures revealed that the addition of the micro-scale structures induces counter-rotating vorticities that mitigate the passage vortex and hence prevents the accumulation of coolant near the suction side. Besides, it is also noted that the grooves of the micro-scale structures have a transport effect that can convey the coolant to the far downstream areas of the endwall, and thus considerably increase the coverage in the chordwise direction. The findings of this work provide an evidence that the bio-inspired, micro-scale surface structures could be an alternative for enhancing turbine endwall cooling performance.
Eddy Current Flow Meter Performance in Liquid Metal Flows Inclined to the Sensor Axis
Authors: Krauter Nico , Galindo Vladimir , Wondrak Thomas , Eckert Sven , Gerbeth Gunter
Published: March 2021

The eddy current flow meter (ECFM) is a reliable and robust inductive sensor for the measurement of flow rates in liquid metal flows. This kind of sensor is usually being used in pipe flows where the flow is mostly parallel to the sensor axis. When this sensor is used as part of the safety instrumentation above the subassemblies in liquid metal cooled fast reactors, the flow angle may change rapidly according to the conditions within the reactor. In this paper, we investigate the performance of the ECFM in flows inclined to the sensor axis by numerical simulations as well as model experiments. We demonstrate that the ECFM yields reliable results for flow angles up to 30 deg while the sensitivity of the sensor is significantly reduced for larger angles.
In-Depth Exploration of the Multigrid Method to Simulate Elastohydrodynamic Line Lubrications With Smooth, Wavy, and Rough Surfaces
Authors: Liu Shuangbiao , Qiu Liangwei , Chen Xiaoyang
Published: March 2021

Due to high efficiency, multigrid (MG) algorithms developed by Lubrecht and Venner or others have been widely applied to solve the Reynolds equation in lubrication simulations. However, such algorithms are complex in nature and in-depth understandings and further development are of interest. This work proposes a new restriction operator of pressure to simplify the relaxation of the load balance equation and constructs several new relaxation processes based on key options of relaxations when either pressures or changes of pressure are evaluated from the Reynolds equation. In addition, effects of cycle types, treatments of cavitation boundary, line-solvers, relaxation factors, and differential schemes are revealed. This paper further implements a mass conservation algorithm into the MG code in order to deal with micro-cavitations. Characteristics of film thickness, pressure, flow continuity, and residuals, resulting from smooth, wavy, or rough surfaces are discussed. Finally, the results from the last correction cycles at various levels are recommended to be used for better accuracy.
Atomic layer deposition of sodium fluoride thin films
Authors: Kuraitis Sara , Kang Donghyeon , Mane Anil U. , Zhou Hua , Soares Jake , Elam Jeffrey W. , Graugnard Elton
Published: March 2021

The need for advanced energy conversion and storage devices remains a critical challenge amid the growing worldwide demand for renewable energy. Metal fluoride thin films are of great interest for applications in lithium-ion and emerging rechargeable battery technologies, particularly for enhancing the stability of the electrode-electrolyte interface and thereby extending battery cyclability and lifetime. Reported within, sodium fluoride (NaF) thin films were synthesized via atomic layer deposition. NaF growth experiments were carried out at reactor temperatures between 175 and 250 °C using sodium tert-butoxide and HF-pyridine solution. The optimal deposition temperature range was 175–200 °C, and the resulting NaF films exhibited low roughness (Rq ≈ 1.6 nm for films of ∼8.5 nm), nearly stoichiometric composition (Na:F = 1:1.05) and a growth per cycle value of 0.85 Å/cycle on SiO2 substrates. These results are encouraging for future applications of NaF thin films in the development of improved energy capture and storage technologies.
Correlation between electrical conductivity and luminescence properties in β-Ga2O3:Cr3+ and β-Ga2O3:Cr,Mg single crystals
Authors: Vasyltsiv Vyacheslav , Luchechko Andriy , Zhydachevskyy Yaroslav , Kostyk Lyudmyla , Lys Roman , Slobodzyan Dmytro , Jakieła Rafał , Pavlyk Bohdan , Suchocki Andrzej
Published: March 2021

The photoluminescence, excitation, and absorption spectra as well as the electrical conductivity of β-Ga2O3:Cr and β-Ga2O3:Cr,Mg single crystals were studied. The as-grown β-Ga2O3:Cr crystals had a green color, the conductivity at about 10−2–10−3 Ω−1 cm−1, and a low yield of Cr3+ impurity luminescence. Annealing in oxygen atmosphere led to a strong increase in Cr3+ red luminescence yield, increase in the resistivity, and changes in the absorption and excitation spectra. Similarly, increases in the Cr3+ luminescence yield and resistivity were observed after codoping of β-Ga2O3:Cr crystals with magnesium (Mg2+). The registered changes in the Cr3+ luminescence yield, electrical conductivity, and in the absorption and excitation spectra are considered to be due to the shift in the Fermi level. In the as-grown β-Ga2O3:Cr crystals, the Fermi level is located near the bottom of the conduction band, and most chromium ions are in the Cr2+ charge state. Annealing in an oxygen atmosphere as well as codoping of the crystals with chromium and magnesium impurities moves the Fermi level toward the middle of the bandgap and recharges the chromium ions to the Cr3+ state.
Detection of envelope modulation and direction of arrival estimation of multiple noise sources with an acoustic vector sensor
Authors: Stinco Pietro , Tesei Alessandra , Dreo Richard , Micheli Michele
Published: March 2021

The Detection of Envelope Modulation on Noise (DEMON) is an algorithm that is commonly applied to hydrophone data for the detection and classification of underwater noise produced by a ship. This algorithm utilizes modulation analysis to determine the frequencies that modulate the broadband cavitation noise produced by marine vessel propellers. In this paper, a DEMON demodulator for acoustic vector sensors (AVSs) that are directional hydrophones capable of acquiring both the acoustic pressure and the components of the particle velocity vector is defined. The proposed method is able to extract multiple modulating signals and measure their direction of arrival. The proposed receiver was validated with real data collected at sea with a moving buoyancy glider hosting an AVS.
The Influence of Neck Stiffness on Head Kinematics and Maximum Principal Strain Associated With Youth American Football Collisions
Authors: Cournoyer Janie , Koncan David , Gilchrist Michael D. , Hoshizaki T. Blaine
Published: March 2021

Understanding the relationship between head mass and neck stiffness during direct head impacts is especially concerning in youth sports where athletes have higher proportional head mass to neck strength. This study compared 2 neck stiffness conditions for peak linear and rotational acceleration and brain tissue deformations across 3 impact velocities, 3 impact locations, and 2 striking masses. A pendulum fitted with a nylon cap was used to impact a fifth percentile hybrid III headform equipped with 9 accelerometers and fitted with a youth American football helmet. The 2 neck stiffness conditions consisted of a neckform with and without resistance in 3 planes, representing the upper trapezius, the splenius capitis, and the sternocleidomastoid muscles. Increased neck stiffness resulted in significant changes in head kinematics and maximum principal strain specific to impact velocity, impact location, and striking mass.
Tibiofemoral Contact Measures During Standing in Toe-In and Toe-Out Postures
Authors: Hunt Michael A. , Cochrane Christopher K. , Schmidt Andrew M. , Zhang Honglin , Stockton David J. , Black Alec H. , Wilson David R.
Published: March 2021

Knee osteoarthritis is thought to result, in part, from excessive and unbalanced joint loading. Toe-in and toe-out gait modifications produce alterations in external knee joint moments, and some improvements in pain over the short- and long-term. The aim of this study was to probe mechanisms of altered joint loading through the assessment of tibiofemoral contact in standing with toe-in and toe-out positions using an open magnetic resonance scanner. In this study, 15 young, healthy participants underwent standing magnetic resonance imaging of one of their knees in 3 foot positions. Images were analyzed to determine contact in the tibiofemoral joint, with primary outcomes including centroid of contact and contact area for each compartment and overall. The centroid of contact shifted laterally in the lateral compartment with both toe-in and toe-out postures, compared with the neutral position (P < .01), while contact area in the medial and lateral compartments showed no statistical differences. Findings from this study indicate that changes in the loading anatomy are present in the tibiofemoral joint with toe-in and toe-out and that a small amount of lateralization of contact, especially in the lateral compartment, does occur with these altered lower limb orientations.
Dynamic Joint Motions in Occupational Environments as Indicators of Potential Musculoskeletal Injury Risk
Authors: Dufour Jonathan S. , Aurand Alexander M. , Weston Eric B. , Haritos Christopher N. , Souchereau Reid A. , Marras William S.
Published: March 2021

The objective of this study was to test the feasibility of using a pair of wearable inertial measurement unit (IMU) sensors to accurately capture dynamic joint motion data during simulated occupational conditions. Eleven subjects (5 males and 6 females) performed repetitive neck, low-back, and shoulder motions simulating low- and high-difficulty occupational tasks in a laboratory setting. Kinematics for each of the 3 joints were measured via IMU sensors in addition to a “gold standard” passive marker optical motion capture system. The IMU accuracy was benchmarked relative to the optical motion capture system, and IMU sensitivity to low- and high-difficulty tasks was evaluated. The accuracy of the IMU sensors was found to be very good on average, but significant positional drift was observed in some trials. In addition, IMU measurements were shown to be sensitive to differences in task difficulty in all 3 joints (P < .05). These results demonstrate the feasibility for using wearable IMU sensors to capture kinematic exposures as potential indicators of occupational injury risk. Velocities and accelerations demonstrate the most potential for developing risk metrics since they are sensitive to task difficulty and less sensitive to drift than rotational position measurements.
SARS-CoV-2 within-host diversity and transmission
Authors: Lythgoe Katrina A. , Hall Matthew , Ferretti Luca , de Cesare Mariateresa , MacIntyre-Cockett George , Trebes Amy , Andersson Monique , Otecko Newton , Wise Emma L. , Moore Nathan , Lynch Jessica , Kidd Stephen , Cortes Nicholas , Mori Matilde , Williams Rebecca , Vernet Gabrielle , Justice Anita , Green Angie , Nicholls Samuel M. , Ansari M. Azim , Abeler-Dörner Lucie , Moore Catrin E. , Peto Timothy E. A. , Eyre David W. , Shaw Robert , Simmonds Peter , Buck David , Todd John A. ,   on behalf of the Oxford Virus Sequencing Analysis Group (OVSG), Connor Thomas R. , Ashraf Shirin , da Silva Filipe Ana , Shepherd James , Thomson Emma C. ,   The COVID-19 Genomics UK (COG-UK) Consortium, Bonsall David , Fraser Christophe , Golubchik Tanya
Published: March 2021

Patterns and bottlenecks

A year into the severe acute respiratory syndrome coronavirus 2 pandemic, we are experiencing waves of new variants emerging. Some of these variants have worrying functional implications, such as increased transmissibility or antibody treatment escape. Lythgoe
et al.
have undertaken in-depth sequencing of more than 1000 hospital patients' isolates to find out how the virus is mutating within individuals. Overall, there seem to be consistent and reproducible patterns of within-host virus diversity. The authors observed only one or two variants in most samples, but a few carried many variants. Although the evidence indicates strong purifying selection, including in the spike protein responsible for viral entry, the authors also saw evidence for transmission clusters associated with households and other possible superspreader events. After transmission, most variants fizzled out, but occasionally some initiated ongoing transmission and wider dissemination.

Science
, this issue p.
eabg0821
Endogenous modification of the chemoattractant CXCL5 alters receptor usage and enhances its activity toward neutrophils and monocytes
Authors: Metzemaekers Mieke , Mortier Anneleen , Vacchini Alessandro , Boff Daiane , Yu Karen , Janssens Rik , Farina Floriana M. , Milanesi Samantha , Berghmans Nele , Pörtner Noëmie , Van Damme Jo , Allegretti Marcello , Teixeira Mauro M. , Locati Massimo , Borroni Elena M. , Amaral Flavio A. , Proost Paul
Published: March 2021

Proteolytic processing of CXCL5 potentiates its chemoattractant activity toward neutrophils and monocytes in vitro and in vivo.
Behind the Shield of Czc: ZntR Controls Expression of the Gene for the Zinc-Exporting P-Type ATPase ZntA inCupriavidus metallidurans
Authors: Schulz Vladislava , Schmidt-Vogler Christopher , Strohmeyer Phillip , Weber Stefanie , Kleemann Daniel , Nies Dietrich H. , Herzberg Martin
Published: March 2021

Zinc is an essential metal for numerous organisms, from humans to bacteria. The transportome of zinc uptake and efflux systems controls the overall cellular composition and zinc content in a double-feedback loop.
Complementation in
trans
of Porphyromonas gingivalis Lipopolysaccharide Biosynthetic Mutants Demonstrates Lipopolysaccharide Exchange
Authors: Glew Michelle D. , Gorasia Dhana G. , McMillan Paul J. , Butler Catherine A. , Veith Paul D. , Reynolds Eric C.
Published: March 2021

Porphyromonas gingivalis
is a keystone pathogen contributing to periodontitis in humans, leading to tooth loss. The oral microbiota is essential in this pathogenic process and changes from predominantly Gram-positive (health) to predominantly Gram-negative (disease) species.
P. gingivalis
uses its type IX secretion system (T9SS) to secrete and conjugate virulence proteins to anionic lipopolysaccharide (A-LPS).
A Double Portrait: The Contributions G.S. Golitsyn and P.J. Crutzen Made to Studying the Physics and Chemistry of the Atmosphere
Authors: Brenninkmeijer K. A. M. , Ginzburg A. S. , Elansky N. F. , Mokhov I. I.
Published: March 2021

This is the introductory article for the special issue ofIzvestia, Atmospheric and Oceanic Physicsdedicated to the 2019 Lomonosov Gold Medal of the Russian Academy of Sciences awarded to Academician Georgy Golitsyn “for making an outstanding contribution to the study of atmospheric physics of the Earth and planets and the development of the theory of climate and its changes” and to foreign member of the Russian Academy of Sciences Professor Paul Joseph Crutzen “for making an outstanding contribution to the chemistry of the atmosphere and assessing the role and biogeochemical cycles in climate formation.” This issue includes an article highlighting the contributions Golitsyn and Crutzen made to the study of physics and chemistry of the atmosphere, climate, and biogeochemical cycles, as well as articles written for this special issue with the participation or recommendation of the laureates.
Complete heart block in cardiac sarcoidosis reversed by corticosteroid therapy: time course of resolution
Authors: Tomdio Anna , Syed Huzaefah , Ellenbogen Kenneth , Kron Jordana
Published: March 2021

A 53-year-old man was admitted for recurrent syncope and found to have complete heart block (CHB). Cardiac magnetic resonance imaging MRI) showed extensive patchy late gadolinium enhancement in the apical and lateral walls, consistent with cardiac sarcoidosis (CS) but no scar in the septum. A fluorodeoxyglucose (FDG)–positron emission tomography showed FDG uptake in the septum and basal lateral walls. Imaging suggested active inflammation in the septum affecting atrioventricular (AV) conduction but no irreversible fibrosis. Diagnosis of isolated CS requires a high level of suspicion and multidisciplinary teamwork involving heart failure specialists, electrophysiologists and rheumatologists. After specialist and patient discussion, treatment of the disease was initiated with prednisone 40 mg daily, 11 months after presenting with CHB. Three weeks later, ECG with pacing inhibited showed second-degree AV block Mobitz type II and 4 weeks later, AV conduction recovery. This highlights the importance of immediate therapy in reversing AV conduction abnormalities in CS.
Economic, clinical and social impact of simple limbal epithelial transplantation for limbal stem cell deficiency
Authors: Thokala Praveen , Singh Aastha , Singh Vijay Kumar , Rathi Varsha M , Basu Sayan , Singh Vivek , MacNeil Sheila , Sangwan Virender Singh
Published: March 2021

Aims

To report the global uptake of simple limbal epithelial transplantation (SLET) and compare the economic, clinical and social outcomes of SLET with those of cultured limbal epithelial transplantation (CLET).

Methods

A comprehensive literature review and an online survey of eye surgeons were conducted to understand the efficacy and current uptake of SLET surgery. A de novo economic model was developed to estimate the cost savings with SLET compared with CLET. Our economic analysis is conducted from an Indian perspective, as this is where the technique originated. A scenario analysis using the UK cost data and a user-friendly Excel model is included to allow users to input the costs from their setting to estimate the cost savings with using SLET compared with using CLET

Results

The anatomical success with SLET in adults (72.6% (range 62%–80%)) was the same as CLET (70.4% (range 68%–80.9%)). For children, the outcome for SLET (77.8% (range 73%–83%)) was better than with CLET (44.5% (range 43%–45%)). In response to our informal questionnaire, 99 surgeons reported to have performed SLET on 1174 patients in total. They appreciated that SLET negates the requirement for costly tissue engineering facilities. Results of economic analysis suggested that SLET provided an estimated cost-savings of US$6470.88 for adults and US$6673.10 for children. In broad terms, the cost of SLET is approximately 10% of the cost of CLET for adults and 8% for children.

Conclusion

SLET offers a more accessible and financially attractive alternative to CLET to treat limbal stem cell deficiency.
Rapid implementation of Inpatient eConsult Programme addresses new challenges for patient care during COVID-19 pandemic
Authors: Rikin Sharon , Epstein Eric J , Gendlina Inessa
Published: March 2021

Introduction

At the early epicentre of the COVID-19 crisis in the USA, our institution saw a surge in the demand for inpatient consultations for areas impacted by COVID-19 (eg, infectious diseases, nephrology, palliative care) and shortages in personal protective equipment (PPE). We aimed to provide timely specialist input for consult requests during the COVID-19 pandemic by implementing an Inpatient eConsult Programme.

Methods

We used the reach, effectiveness, adoption, implementation and maintenance implementation science framework and run chart analysis to evaluate the reach, adoption and maintenance of the Inpatient eConsult Programme compared with traditional in-person consults. We solicited qualitative feedback from frontline physicians and specialists for programme improvements.

Results

During the study period, there were 46 available in-person consult orders and 21 new eConsult orders. At the peak of utilisation, 42% of all consult requests were eConsults, and by the end of the study period, utilisation fell to 20%. Qualitative feedback revealed subspecialties best suited for eConsults (infectious diseases, nephrology, haematology, endocrinology) and influenced improvements to the ordering workflow, documentation, billing and education regarding use.

Discussion

When offered inpatient eConsult requests as an alternative to in-person consults in the context of a surge in patients with COVID-19, frontline physicians used eConsult requests and decreased use of in-person consults. As the demand for consults decreased and PPE shortages were no longer a major concern, eConsult utilisation decreased, revealing a preference for in-person consultations when possible.

Conclusions

Lessons learnt can be used to develop and implement inpatient eConsults to meet context-specific challenges at other institutions.
Efficacy and safety of aliskiren combination therapy: a protocol for an umbrella review
Authors: Shen Jiantong , Feng Wenming , Wang Yike , Zhao Qiyuan , Flavorta Billong Laura , Lu Jingya
Published: March 2021

Introduction

Efficacy of aliskiren combination therapy with other antihypertensive has been evaluated in the treatment of patients with hypertension in recent systematic reviews. However, most previous reviews only focused on one single health outcome or one setting, none of them made a full summary that assessed the impact of aliskiren combination treatment comprehensively. As such, this umbrella review based on systematic reviews and meta-analyses is aimed to synthesise the evidences on efficacy, safety and tolerability of aliskiren-based therapy for hypertension and related comorbid patients.

Methods and analysis

A comprehensive search of PubMed, EMBASE, Cochrane Library, CNKI published from inception to August 2020 will be conducted. The selected articles are systematic reviews which evaluated efficacy, safety and tolerability of aliskiren combination therapy. Two reviewers will screen eligible articles, extract data and evaluate quality independently. Any disputes will be resolved by discussion or the arbitration of a third person. The quality of reporting evidence will be assessed using the Assessment of Multiple Systematic Reviews V.2 tool tool. We will take a mixed-methods approach to synthesising the review literatures, reporting summary of findings tables and iteratively mapping the results.

Ethics and dissemination

Ethical approval is not required for the study, as we would only collect data from available published materials. This umbrella review will be also submitted to a peer-reviewed journal for publication after completion.

PROSPERO registration number

CRD42020192131.
Sex differences and factors associated with disability among Ghana’s workforce: a nationally stratified cross-sectional study
Authors: Tetteh John , Asare Isaac Ofori , Adomako Isaac , Udofia Emilia Asuquo , Seneadza Nana Ayegua Hagan , Adjei-Mensah Evelyn , Calys-Tagoe Benedict N L , Swaray Swithin Mustapha , Ekem-Ferguson George , Yawson Alfred
Published: March 2021

Objective

This study was conducted to estimate the prevalence of disability and associated factors and further quantify the associated sex differential among Ghana’s workforce aged 15+ years.

Design

A nationally stratified cross-sectional study.

Setting

Ghana.

Participants

Individuals aged 15 years and above.

Outcome measure

Disability that limits full participation in life activities.

Methods

Three predictive models involving Poisson, logistic and probit regression were performed to assess the association between disability and covariates. Modified Poisson multivariate decomposition analysis method was employed to assess sex differential and associated factors using Stata V.16.

Results

The prevalence of disability was 2.1% (95% CI 1.2 to 2.4), and the risk of disability among males was approximately twice compared with females (Poisson estimate: adjusted prevalence ratio (95% CI)=1.94 (1.46 to 2.57); logistic estimate: aOR (95% CI)=2.32 (1.73 to 3.12)). Male sex increased the log odds of disability by 0.37 (probit estimate, aβ (95% CI)=0.37 (0.23 to 0.50)). The variability in age group, marital status, household (HH) size, region, place of residence, relationship to HH head, hours of work per week and asset-based wealth were significantly associated with disability-based sex differential. (Significant increased endowment: β×10−3(95% CI×10−3)=−37.48 (−56.81 to −18.16) and significant decreased coefficient: β×10−3(95% CI×10−3)=42.31 (21.11 to 63.49).) All disability participants were challenged with activities of daily living, limiting them in full participation in life activities such as mobility, work and social life.

Conclusion

The magnitude of experiencing disability among working males was nearly twice that of females. Sex differentials were significantly associated with age groups, marital status, HH size, region of residence, relationship to HH head, hours of work per week and wealth. Our findings amass the provisional needs of persons living with a disability that are indicators to consider to achieve the United Nations Convention on the Rights of Persons with Disabilities Article 10. In addition, formulation of workplace policies should adopt a gender-sensitive approach to reduce disparities and eliminate disability in the target population.
Brain structural alterations in MOG antibody diseases: a comparative study with AQP4 seropositive NMOSD and MS
Authors: Duan Yunyun , Zhuo Zhizheng , Li Haiqing , Tian De-Cai , Li Yuxin , Yang Liqin , Gao Chenyang , Zhang Tian , Zhang Xinghu , Shi Fu-Dong , Barkhof Frederik , Liu Yaou
Published: March 2021

Background

Brain structural alterations and their clinical significance of myelin oligodendrocyte glycoprotein antibody disease (MOGAD) have not been determined.

Methods

We recruited 35 MOGAD, 38 aquaporin 4 antibody positive neuromyelitis optica spectrum diseases (AQP4+ NMOSD), 37 multiple sclerosis (MS) and 60 healthy controls (HC) who underwent multimodal brain MRI from two centres. Brain lesions, volumes of the whole brain parenchyma, cortical and subcortical grey matter (GM), brainstem, cerebellum and cerebral white matter (WM) and diffusion measures (fractional anisotropy, FA and mean diffusivity, MD) were compared among the groups. Associations between the MRI measurements and the clinical variables were assessed by partial correlations. Logistic regression was performed to differentiate MOGAD from AQP4+ NMOSD and MS.

Results

In MOGAD, 19 (54%) patients had lesions on MRI, with cortical/juxtacortical (68%) as the most common location. MOGAD and MS showed lower cortical and subcortical GM volumes than HC, while AQP4+ NMOSD only demonstrated a decreased cortical GM volume. MS demonstrated a lower cerebellar volume, a lower FA and an increased MD than MOGAD and HC. The subcortical GM volume was negatively correlated with Expanded Disability Status Scale in MOGAD (R=−0.51; p=0.004). A combination of MRI and clinical measures could achieve an accuracy of 85% and 93% for the classification of MOGAD versus AQP4+ NMOSD and MOGAD versus MS, respectively.

Conclusion

MOGAD demonstrated cortical and subcortical atrophy without severe WM rarefaction. The subcortical GM volume correlated with clinical disability and a combination of MRI and clinical measures could separate MOGAD from AQP4+ NMOSD and MS.
DRB1–environment interactions in multiple sclerosis etiology: results from two Swedish case–control studies
Authors: Hedström Anna Karin , Hillert Jan , Brenner Nicole , Butt Julia , Waterboer Tim , Strid Pernilla , Kockum Ingrid , Olsson Tomas , Alfredsson Lars
Published: March 2021

Objective

We aimed to investigate the influence of environmental risk factors for multiple sclerosis (MS) in different genetic contexts, and study if interactions between environmental factors and human leucocyte antigen (HLA) genes differ in magnitude according to heterozygocity and homozygocity forHLA-DRB1*15:01.

Methods

Using population-based case–control studies (6985 cases, 6569 controls), subjects with different genotypes and smoking, EBNA-1 status and adolescent Body Mass status, were compared regarding MS risk, by calculating OR with 95% CI employing logistic regression. The interaction between different genotypes and each environmental factor was evaluated on the additive scale.

Results

The effect of eachDRB1*15:01allele on MS risk was additive on the log-odds scale for each additional allele. Interaction betweenDRB1*15:01and each assessed environmental factor was of similar magnitude regardless of the number ofDRB1*15:01alleles, although ORs were affected. When any of the environmental factors were present inDRB1*15:01carriers without the protectiveA*02:01allele, a three-way interaction occurred and rendered high ORs, especially amongDRB1*15:01homozygotes (OR 20.0, 95% CI 13.1 to 30.5 among smokers, OR 21.9, 95% CI 15.0 to 31.8 among those with elevated EBNA-1 antibody levels, and OR 44.3, 95% CI 13.5 to 145 among those who reported adolescent overweight/obesity).

Conclusions

The strikingly increased MS risk amongDRB*15:01homozygotes exposed to any of the environmental factors is a further argument in favour of these factors acting on immune-related mechanisms. The data further reinforce the importance of preventive measures, in particular for those with a genetic susceptibility to MS.
AI support for ethical decision-making around resuscitation: proceed with care
Authors: Biller-Andorno Nikola , Ferrario Andrea , Joebges Susanne , Krones Tanja , Massini Federico , Barth Phyllis , Arampatzis Georgios , Krauthammer Michael
Published: March 2021

Artificial intelligence (AI) systems are increasingly being used in healthcare, thanks to the high level of performance that these systems have proven to deliver. So far, clinical applications have focused on diagnosis and on prediction of outcomes. It is less clear in what way AI can or should support complex clinical decisions that crucially depend on patient preferences. In this paper, we focus on the ethical questions arising from the design, development and deployment of AI systems to support decision-making around cardiopulmonary resuscitation and the determination of a patient’s Do Not Attempt to Resuscitate status (also known as code status). The COVID-19 pandemic has made us keenly aware of the difficulties physicians encounter when they have to act quickly in stressful situations without knowing what their patient would have wanted. We discuss the results of an interview study conducted with healthcare professionals in a university hospital aimed at understanding the status quo of resuscitation decision processes while exploring a potential role for AI systems in decision-making around code status. Our data suggest that (1) current practices are fraught with challenges such as insufficient knowledge regarding patient preferences, time pressure and personal bias guiding care considerations and (2) there is considerable openness among clinicians to consider the use of AI-based decision support. We suggest a model for how AI can contribute to improve decision-making around resuscitation and propose a set of ethically relevant preconditions—conceptual, methodological and procedural—that need to be considered in further development and implementation efforts.
Should age matter in COVID-19 triage? A deliberative study
Authors: Kuylen Margot N I , Kim Scott Y , Ruck Keene Alexander , Owen Gareth S
Published: March 2021

The COVID-19 pandemic put a large burden on many healthcare systems, causing fears about resource scarcity and triage. Several COVID-19 guidelines included age as an explicit factor and practices of both triage and ‘anticipatory triage’ likely limited access to hospital care for elderly patients, especially those in care homes. To ensure the legitimacy of triage guidelines, which affect the public, it is important to engage the public’s moral intuitions. Our study aimed to explore general public views in the UK on the role of age, and related factors like frailty and quality of life, in triage during the COVID-19 pandemic. We held online deliberative workshops with members of the general public (n=22). Participants were guided through a deliberative process to maximise eliciting informed and considered preferences. Participants generally accepted the need for triage but strongly rejected ‘fair innings’ and ‘life projects’ principles as justifications for age-based allocation. They were also wary of the ‘maximise life-years’ principle, preferring to maximise the number of lives rather than life years saved. Although they did not arrive at a unified recommendation of one principle, a concern for three core principles and values eventually emerged: equality, efficiency and vulnerability. While these remain difficult to fully respect at once, they captured a considered, multifaceted consensus: utilitarian considerations of efficiency should be tempered with a concern for equality and vulnerability. This ‘triad’ of ethical principles may be a useful structure to guide ethical deliberation as societies negotiate the conflicting ethical demands of triage.