bluuebunny/crossref_metadata_2025 huggingface dataset:
Reducing seclusion and restraint in a child and adolescent inpatient area: implementation of a collaborative problem-solving approach
Authors: Black Valerie , Bobier Candace , Thomas Baiju , Prest Fiona , Ansley Chris , Loomes Barbara , Eggleston Glenda , Mountford Helen
Published: May 2020

Objective:

The aim of this study was to determine whether implementation of a collaborative problem-solving approach would be associated with a decrease in seclusion and restraint in a child and adolescent inpatient unit.

Method:

A collaborative problem-solving (CPS) approach was implemented. Seclusion and restraint, length of treatment, clinician- and patient/parent-rated outcomes and staff utility and acceptability were surveyed pre and post implementation.

Results:

The number of restrictive events significantly decreased, including full restraint, partial restraint and seclusion. Length of treatment and routine clinician-rated outcome measures remained consistent. Patient or parent-rated outcomes showed greater reduction post implementation. Despite some initial scepticism, the staff found this approach useful.

Conclusions:

A CPS approach was successfully implemented, and in this naturalistic study was associated with a significant decrease in seclusions and restraints.
Informal Teacher Leaders: Who They Are, What They Do, and How They Impact Teaching and Learning
Authors: Gordon Stephen P. , Jacobs Jennifer , Croteau Susan M. , Solis Rachel
Published: May 2020

Educators in PK–12 schools were surveyed to seek their perceptions of colleagues who they considered informal teacher leaders, defined as leaders who were not appointed to a leadership role by a school or district administrator. The survey asked administrators, educational specialists, and teachers working in PK–12 schools across four states to share their perceptions of informal teacher leaders’ leadership activities, personal and professional attributes, relationships with other educators, and impact. Open, axial, and selective coding were used to analyze the respondents’ open-ended survey responses, and themes were developed relative to research topics. The respondents reported that the informal teacher leaders they identified engaged in important leadership activities at the individual, team, and school levels. The informal teacher leaders were described by respondents as passionate, caring, efficient, open to others, and professional. A variety of specific types of leadership knowledge and skills were attributed to the informal teacher leaders. Relationships of the informal teacher leaders with other educators were characterized as respectful, trusting, and warm, and the informal leaders’ working relationships with other teachers and school administrators were considered positive. The respondents reported a variety of positive impacts of informal teacher leaders on students, teachers, and the school. Although many of the leadership activities, attributes, relationships, and impacts of informal teacher leaders parallel those of formal teacher leaders, a number of distinctions also were identified indicating some differentiation of roles and functions. Recommendations are made for educator programs, principals, and future research.
Small-Cell Carcinoma of the Uterine Cervix Discovered With Quadriplegia Caused by Cervical Spine Metastasis
Authors: Oishi Tomoko , Nishida Masakazu , Takebayashi Kanetoshi , Nasu Kaei , Narahara Hisashi
Published: May 2020

Small-cell carcinoma of the uterine cervix is a rare and aggressive tumor, and the prognosis is poor compared with those of squamous cell carcinoma and adenocarcinoma of the uterine cervix, even when discovered at an earlier stage. We treated a patient with progressive small-cell carcinoma of the uterine cervix that metastasized to the cervical spine. The patient, a 73-year-old woman, presented with the symptom of numbness in her limbs. As she had difficulty moving her limbs (ie, quadriplegia), she was carried to an emergency room. A metastatic cervical spine tumor from the uterine cervical cancer was revealed by a computed tomography scan, and the patient was then transferred to our hospital’s neurosurgery department for treatment. We performed a resection of the cervical spine tumor and fixation of the spinal bone. Because the patient’s performance status was 4 and she remained bedridden 24 h/day, we could not perform systemic chemotherapy. We thus provided palliative care, including palliative radiotherapy, pain control, and rehabilitation to improve her limbs’ functioning. The patient died of the uterine cancer within approx. 6 months after the initiation of treatment. There is no established treatment for small-cell carcinoma as a gynecological lesion. For patients with progressive uterine cancer, the optimal treatments, including palliative care, must be determined.
Noise in an inpatient hospital ward in New Zealand
Authors: Hulland Thomas , Su Andy , Kingan Michael
Published: May 2020

This article describes an investigation into the noise levels which patients are exposed to in a general inpatient hospital ward in New Zealand. An initial noise survey was conducted over a period of nine consecutive days in order to establish the noise levels in the ward. It was identified that noise levels increased dramatically between 4:00 a.m. and 7:00 a.m. In order to identify the sources of noise during this period, three noise surveys were undertaken between 4:30 a.m. and 7:00 a.m. on typical weekdays using a microphone placed inside a shared bedroom. During the noise survey, an observer identified the noise sources and their locations for significant noise events. Noise sources were then categorised into three main groups based on the character of the source (machine, staff or patient). Staff noise was found to account for 64% of the total duration of significant noise events (29% of the number of events) which occurred during the observations compared with 20% from patients (43% of the number of events) and 16% from machines (28% of the number of events). It was found that many staff and machine noise events could be mitigated or eliminated. Methods for mitigating noise are suggested and an experimental method was used to estimate the likely reduction in noise which could be attained by moving a staff conversation from the corridor outside the observed bedroom to other locations on the ward.
Human needs in COVID-19 isolation
Authors: Matias Thiago , Dominski Fabio H , Marks David F
Published: May 2020

To reduce the spread of COVID-19, the World Health Organization and the majority of governments have recommended that the entire human population should ‘stay-at-home’. A significant proportion of the population live alone or are vulnerable to mental health problems yet, in the vast majority of cases, individuals in social isolation have no access to mental healthcare. The only resource is people themselves using self-help, self-medication and self-care. During prolonged COVID-19 isolation, an in-built system of homeostasis can help rebalance activity, thought and feeling. Increased physical activity enables a reset of physical and mental well-being. During periods of lockdown, it is recommended that exercise should be as vigorously promoted as social distancing itself.
Co-opting the nation brand: The politics of cross-cultural co-production
Authors: Noh Susan Soomin
Published: May 2020

This paper analyzes the political implications of aesthetic mimicry in the popular mobile game, Onmyoji. Created by the Chinese company, NetEase, Onmyoji takes advantage of the expansive network of signifiers revolving around the historical Japanese figure, Abe-no-Seimei, and co-opts this network to display a recognizable Japanese popular aesthetic. By remixing elements of Japanese culture, Onmyoji presents a commodifiable and mediated image of Japanese cultural authenticity that is recognizable globally. Mimicry and the co-opting of another nation’s cultural signifiers initiates a negotiated process of ambivalent national self-empowerment that has since resulted in shifting labor flows within the digital entertainment industries in East Asia. The malleability of cultural signifiers allows for the purposeful framing of global media texts. Such multivalent encodings of recognizable symbols emerge from the provocative slippages between media boundaries. This, in turn, engages with the dialectical processes of nation branding within the framework of transnational co-production models.
‘The new oratory’: Public speaking practice in the digital, neoliberal age
Authors: Rossette-Crake Fiona
Published: May 2020

This study discusses the paradigm shift that has occurred in public speaking practice in the first two decades of the 21st century, conceptualised under the term ‘the New Oratory’. The New Oratory is a product of the digital revolution in that it brings together formats that are typically relayed via videos uploaded to the Internet, and serves as a vector of the new, digital economy. Drawing on previous critical work linking language and discourse to what is referred to as the new economy, late or new capitalism or neoliberalism, the study focuses on two aspects of discourse practice that can be explained due to developments within the current economic climate: (1) the entrepreneurial speaker ethos that is embodied by the start-up generation of entrepreneurs, finds a resonance in Anglo communication culture and is closely linked to the neoliberal emphasis on branding; (2) the model of horizontal knowledge or information-sharing (in which the Internet has played a major role), whereby a move from specialist to non-specialist target audiences is shifting the frontiers of discourse communities and leading to their reorganisation. These two phenomena are illustrated via examples taken from two formats: the investor pitch and the three-minute-thesis presentation. The first belongs to the corporate sector, the second to academia. The study highlights the neoliberal forces at work outside the corporate sector per se which have come to influence most spheres of professional, social and personal lives, as well as the way these forces are ultimately being promoted by the emergence of a new, fairly homogeneous discursive setup.
Grammatical conformity in question-answer sequences: The case of meiyou in Mandarin conversation
Authors: Wang Wei
Published: May 2020

This article probes into grammatical conformity in Mandarin by examining meiyou, a multifunctional negative form, in question-answer sequences. Using a conversation analysis approach, it discovers that, as a conforming answer to polar questions, meiyou acquiesces to all the terms and constraints of the question and maximizes the progressivity of the sequence. As a non-conforming response to polar questions, it mitigates the disagreement by avoiding a pointed syntactic negation. Meiyou can also respond to Q-word questions, problematizing the inference incorporated in the question. This study not only contributes to the cross-linguistic research on negative particles in talk-in-interaction but also reveals that grammatical conformity is a crucial dimension in Mandarin response design, providing further confirmation of the link between grammar, action, and sequence organization.
Numerical modelling of the asymmetric behaviour of concrete
Authors: Lopes Carla V , Cardoso Rui P , Melo Francisco Q
Published: May 2020

This article analyses the conditions for the yield stress state of concrete subjected to generalised loads. For this purpose, a limit stress state criterion, initially developed for the assessment of magnesium and respective alloys, is here adapted and implemented as a simulation model to assess the structural integrity of concrete components. In fact, materials as magnesium and concrete exhibit a similar mechanical behaviour, presenting a non-symmetric limit state domain for biaxial stress combinations, where it is observed a considerably larger strength to yield or rupture in a compression stress state than in a tensile one. The Cazacu yield stress state criterion has shown to be an accurate and realistic model to define the ultimate strength, either of concrete and magnesium alloys, as mentioned. The Cazacu criterion was implemented in a finite element program as a ‘user-defined’ subroutine. The numerical validation of that criterion was carried out on adjusting its limit stress state points to corresponding ones obtained by experiments of standard tensile or compression tests of concrete test specimens.
Inventing other spaces for European education: Summer School in European Education Studies as a laboratory for educational research in Europe
Authors: Landri Paolo , Grimaldi Emiliano
Published: May 2020

This editorial introduces the European Educational Research Journal special issue that hosts four articles co-authored by emerging researchers in the field of educational research in Europe who participated in the Summer School in European Education Studies. We present the Summer School in European Education Studies project, its history and approach, and its ambition to establish a laboratory for inventing ‘other spaces’ for educational research in Europe and beyond. In sharp contrast to the contemporary pressures towards the ‘technicization’ of educational research, the Summer School in European Education Studies is described as a project whose aspiration is to reaffirm the significance of theory and theorizing, and its generative power for the production of alternative outlooks on education and educational research. The aim of the summer school is, thus, to support the discursive construction of new communal spaces in which to reinvent the politics of educational research and the role of education in the nurturing of the European project. The articles published in this special issue are presented as an example of the kind of text work/identity work for which a space such as the Summer School in European Education Studies creates the conditions of possibility.
Ethico-legal aspects and ethical climate: Managing safe patient care and medical errors in nursing work
Authors: Aly Nagah Abd El-Fattah Mohamed , El-Shanawany Safaa M , Ghazala Ayman Mohamed Abou
Published: May 2020

Background

The nursing profession requires ethical and legal regulations to guide nurses’ performance. Ethical climate plays a part in shaping nurses’ ethical practice. Therefore, ethico-legal aspects and ethical climate contribute to improving nurses’ ethical practice and competencies with reducing medical errors in hospital settings.

Objective

This study examined the effect of ethico-legal aspects and ethical climate on managing safe patient care and medical errors among nurses.

Materials and methods

A cross-sectional correlational study was carried out on 548 nurses. Data were collected through self-administered questionnaires about nurses’ knowledge in both ethical and legal aspects, ethical practice, competencies, ethical climate and experience with medical error.

Results

The main sources of nurses’ knowledge of ethical and legal aspects were undergraduate lectures, job experience and colleagues. Nurses’ knowledge in both ethical and legal aspects, nurses’ ethical practice and competencies were insufficient. Nurses fairly perceived their ethical climate. Also, nurses experienced medical errors about 22.6% in their units. Nurses’ knowledge of ethical and legal aspects, as well as the ethical climate were positive predictors of inadequate nurses’ ethical practice and competencies. Additionally, nurses’ knowledge in both ethical and legal aspects, ethical climate and practice had a negative influence on the occurrence of medical errors.

Conclusion

Enhancing nurses’ knowledge in both ethical and legal aspects as well as ethical climate could significantly influence improving nurses’ ethical practice, competencies and reducing medical errors in the study units. Therefore, planning for enhancing the nurses’ ethico-legal learning and ethical climate seems to be mandatory.
Anthocyanin Profile and Antioxidant Property of Anti-asthma Flowers of Cordyline terminalis (L.) Kunth (Agavaceae)
Authors: Adaku Christopher , Skaar Irene , Byamukama Robert , Jordheim Monica , Andersen Øyvind M.
Published: May 2020

Cordyline terminalis flower is traditionally used to treat asthma and the purple color of the flower is suggestive of anthocyanins. The purpose of this study was to characterize and determine the antioxidant property of anthocyanins from C. terminalis purple flowers. Five anthocyanins, cyanidin 3,5-di- O-β-glucopyranoside (2.6 ± 0.2 mg/g fr. wt) (1), peonidin 3,5-di- O-β-glucopyranoside (2.8 ± 0.3 mg/g fr. wt) (2), cyanidin 3- O-β-(6″- O- E- p-caffeoylglucopyranoside)-5- O-β-glucopyranoside (3.2 ± 0.2 mg/g fr. wt) (3), cyanidin 3- O-β-(6″- O- E- p-coumaroylglucopyranoside)-5- O-β-glucopyranoside (6.2 ± 0.4 mg/g fr. wt) (4), and peonidin 3- O-β-(6″- O- E- p-coumaroylglucopyranoside)-5- O-β-glucopyranoside (9.8 ± 0.2 mg/g fr. wt) (5), were isolated from the flowers of C. terminalis by a combination of chromatographic techniques. Their structures were established by UV-visible, NMR, and ESI-MS. The extract exhibited appreciable antioxidant activity (IC50 ± SD = 13.1 ± 0.8 μg/mL) against quercetin (IC50 ± SD = 4.5 ± 0.4 μg/mL) compared to the individual anthocyanins (IC50 ± SD = 13.8 ± 0.5 to 16.4 ± 0.7 μg/mL) when measured using the 2,2-diphenyl-1-picryl-hydrazyl method. Cordyline terminalis flowers extract may be justified for use and standardization as herbal remedy for asthma.
Diagnostic challenge of aleukemic leukemia cutis preceding acute myelogenous leukemia: A case report
Authors: Du Amy X , Hung Tawny , Surmanowicz Philip , Gniadecki Robert
Published: May 2020

Aleukemic leukemia cutis is a rare condition in which malignant white cells invade the skin before they appear in the peripheral blood or bone marrow. It is often associated with a poor prognosis. The condition presents a diagnostic challenge as its manifestations are quite variable terms of lesion type. It can manifest as papules, nodules, and/or plaques, and in rare cases erythematous macules, blisters, and ulcers. The most commonly affected areas of the body are the lower extremities, followed by the upper extremities, back, trunk, and face. Due to the non-specific presentation of the disease, skin biopsy and comprehensive immunohistochemical testing can be extremely helpful in the diagnostic work-up. We describe a case of leukemia cutis presenting prior to acute myelogenous leukemia that was initially misdiagnosed as hyper-IgG4 disease.
Refractory chylous effusions in lymphangioleiomyomatosis patient post lung transplant
Authors: Jacob Samuel , Ali Mojahid , El-Sayed Ahmed Magdy M , Itkin Maxim , Narula Tathagat , Pham Si , Erasmus David
Published: May 2020

Lymphangioleiomyomatosis is a rare systemic disorder of unknown etiology that affects young women almost exclusively. Chylous effusions are known to be associated with lymphangioleiomyomatosis and may be difficult to treat. We present the case of a 37-year-old female who received bilateral lung transplantation for lymphangioleiomyomatosis complicated by refractory chylothorax and chylous ascites, ultimately controlled through repeated, open surgical procedures and percutaneous lymphatic embolization interventions. The combined surgical and interventional radiological approach, while not novel in their own right, suggests that a multi-modal interventional approach may be required in refractory cases.
Diagnosis and management of urethro-cavernosal fistulas
Authors: Han Jullet , Ghodoussipour Saum , Kreydin Evgeniy I , Doumanian Leo
Published: May 2020

Objective:

To present a case series of urethro-cavernosal fistulas evaluating their diagnostic work-up and management.

Methods:

A literature search was performed using key words including “urethro-cavernosal fistula,” “urethral fistula,” and “cavernosal fistula.”

Results:

In total 10 case reports were identified and reviewed for information regarding clinical diagnosis, management, and long-term outcomes including success rates and complications.

Conclusion:

Urethro-cavernosal fistula is a rare urological condition. With few cases reported to date, there is considerable variation in diagnostic work-up and management. Both conservative and surgical approaches can be utilized in the management of urethro-cavernosal fistulas with good long-term outcomes.

Level of evidence:

Not applicable for this multicentre audit.
Pilot Trial of a Noninvasive Closed-Loop Neurotechnology for Stress-Related Symptoms in Law Enforcement: Improvements in Self-Reported Symptoms and Autonomic Function
Authors: Tegeler Catherine L , Shaltout Hossam A , Lee Sung W , Simpson Sean L , Gerdes Lee , Tegeler Charles H
Published: May 2020

Background

Law enforcement officers have decreased life expectancy, attributed to work-related exposure to traumatic stress and circadian disruption. Autonomic dysregulation is reported with traumatic stress and chronic insomnia.

Objective

We explore potential benefits for reduced symptoms related to stress and insomnia and improved autonomic function associated with open label use of high-resolution, relational, resonance-based, electroencephalic mirroring (HIRREM®), in a cohort of sworn law enforcement personnel.

Methods

Closed-loop noninvasive therapies utilizing real-time monitoring offer a patient-centric approach for brain-based intervention. HIRREM® is a noninvasive, closed-loop, allostatic, neurotechnology that echoes specific brain frequencies in real time as audible tones to support self-optimization of brain rhythms. Self-report symptom inventories done before and after HIRREM included insomnia (ISI), depression (CES-D), traumatic stress (PCL-C), anxiety (GAD-7), perceived stress (PSS), and quality of life (EQ-5D). Ten-minute recordings of heart rate and blood pressure allowed analysis of baroreflex sensitivity (BRS) and heart rate variability (HRV).

Results

Fifteen participants (1 female), mean (SD) age 45.7 (5.6), received 12.2 (2.7) HIRREM sessions, over 7.9 in-office days. Data were collected at baseline, and at 22.8 (9.2), and 67.2 (14.1) days after intervention. All symptom inventories improved significantly ( P < .01), with durability for 2 months after completion of the intervention. The use of HIRREM was also associated with significant increases ( P < .001) in HRV measured as rMSSD and BRS measured by high-frequency alpha index. There were no serious adverse events or drop outs.

Conclusion

These pilot data provide the first report of significant symptom reductions, and associated improvement in measures of autonomic cardiovascular regulation, with the use of HIRREM in a cohort of law enforcement personnel. Randomized clinical trials are warranted.
The Femoral Head “Divot” Sign: A Useful Arthroscopic Sign of Hip Microinstability
Authors: Rosinsky Philip J. , Mayo Ben C. , Kyin Cynthia , Shapira Jacob , Maldonado David R. , Meghpara Mitchell B. , Lall Ajay C. , Domb Benjamin G.
Published: May 2020

Background:

A femoral head “divot” is a rare finding during hip arthroscopy. A linear chondral indentation can be observed on the femoral head, just lateral and parallel to the acetabular labrum.

Purpose/Hypothesis:

The purpose of this study was to describe a novel arthroscopic sign and retrospectively review patients with this finding. We hypothesized that this sign would be found in patients with characteristics consistent with hip microinstability.

Study Design:

Case series; Level of evidence, 4.

Methods:

Intraoperative images of patients undergoing primary hip arthroscopy between July 2017 and July 2019 were reviewed for evidence of a femoral head divot. Preoperative characteristics, physical examination findings, radiographic measurements, and magnetic resonance imaging (MRI) findings were described.

Results:

Of 690 available cases, 14 cases (13 patients; 2.0%) had evidence of a femoral head divot. The mean patient age was 29.1 years, and all but 1 patient (92.3%) were female. Ligamentous laxity was present in 81.8% of patients, anterior apprehension test was positive in 78.6%, and painful internal snapping was present in 50.0%. The mean lateral center-edge angle, anterior center-edge angle, and Tönnis angle were 19.2°, 20.3°, and 12.4°, respectively. The divot was identified in 5 of 12 available MRI scans, most commonly on axial proton density sequence. Intraoperatively, all hips had labral tears, iliopsoas bursitis was demonstrated in 78.6%, and the ligamentum teres was damaged in 42.9%. Labral repair was performed in 12 of the 14 hips, with 2 patients undergoing labral reconstruction. Iliopsoas fractional lengthening was performed in 50.0%, capsular plication was performed in 78.6%, and capsular repair was performed in the remainder.

Conclusion:

The femoral head divot sign is a rare arthroscopic finding during hip arthroscopy. The results of this study demonstrated that patients who have a divot also present with characteristic radiographic or physical examination findings of hip microinstability due to either acetabular dysplasia or ligamentous laxity. Recognition of a femoral head divot may be valuable for the diagnosis of microinstability during hip arthroscopy and may help guide appropriate management, such as capsular plication. Further studies are needed to determine the exact prevalence of the femoral head divot in patients with microinstability and to evaluate the effect of this finding on patient outcomes.
Using unsupervised learning to partition 3D city scenes for distributed building energy microsimulation
Authors: Zakhary Sameh , Rosser Julian , Siebers Peer-Olaf , Mao Yong , Robinson Darren
Published: May 2020

Microsimulation is a class of Urban Building Energy Modeling techniques in which energetic interactions between buildings are explicitly resolved. Examples include SUNtool and CitySim+, both of which employ a sophisticated radiosity-based algorithm to solve for radiation exchange. The computational cost of this algorithm increases in proportion to the square of the number of surfaces of which an urban scene is comprised. To simulate large scenes, of the order of 10,000 to 1,000,000 surfaces, it is desirable to divide the scene to distribute the simulation task. However, this partitioning is not trivial as the energy-related interactions create uneven inter-dependencies between computing nodes. To this end, we describe in this paper two approaches ( K-means and Greedy Community Detection algorithms) for partitioning urban scenes, and subsequently performing building energy microsimulation using CitySim+ on a distributed memory High-Performance Computing Cluster. To compare the performance of these partitioning techniques, we propose two measures evaluating the extent to which the obtained clusters exploit data locality. We show that our approach using Greedy Community Detection performs well in terms of exploiting data locality and reducing inter-dependencies among sub-scenes, but at the expense of a higher data preparation cost and algorithm run-time.
Hepatic transferrin plays a role in systemic iron homeostasis and liver ferroptosis
Authors: Yu Yingying , Jiang Li , Wang Hao , Shen Zhe , Cheng Qi , Zhang Pan , Wang Jiaming , Wu Qian , Fang Xuexian , Duan Lingyan , Wang Shufen , Wang Kai , An Peng , Shao Tuo , Chung Raymond T. , Zheng Shusen , Min Junxia , Wang Fudi
Published: May 2020

Although the serum-abundant metal-binding protein transferrin (encoded by the Trf gene) is synthesized primarily in the liver, its function in the liver is largely unknown. Here, we generated hepatocyte-specific Trf knockout mice (Trf-LKO), which are viable and fertile but have impaired erythropoiesis and altered iron metabolism. Moreover, feeding Trf-LKO mice a high-iron diet increased their susceptibility to developing ferroptosis-induced liver fibrosis. Importantly, we found that treating Trf-LKO mice with the ferroptosis inhibitor ferrostatin-1 potently rescued liver fibrosis induced by either high dietary iron or carbon tetrachloride (CCl4) injections. In addition, deleting hepatic Slc39a14 expression in Trf-LKO mice significantly reduced hepatic iron accumulation, thereby reducing ferroptosis-mediated liver fibrosis induced by either a high-iron diet or CCl4 injections. Finally, we found that patients with liver cirrhosis have significantly lower levels of serum transferrin and hepatic transferrin, as well as higher levels of hepatic iron and lipid peroxidation, compared with healthy control subjects. Taken together, these data indicate that hepatic transferrin plays a protective role in maintaining liver function, providing a possible therapeutic target for preventing ferroptosis-induced liver fibrosis.
Late-onset “acute fibrinous and organising pneumonia” impairs long-term lung allograft function and survival
Authors: Vanstapel Arno , Verleden Stijn E. , Weynand Birgit , Verbeken Eric , De Sadeleer Laurens , Vanaudenaerde Bart M. , Verleden Geert M. , Vos Robin
Published: May 2020

Acute fibrinous and organising pneumonia (AFOP) after lung transplantation is associated with a rapid decline in pulmonary function. However, the relation with chronic lung allograft dysfunction (CLAD) remains unclear. We investigated the association between detection of AFOP in lung allograft biopsies with clinically important endpoints.

We reviewed lung allograft biopsies from 468 patients who underwent lung transplantation at the University Hospitals Leuven (2011–2017). AFOP was categorised as early new-onset (≤90 days post-transplant) or late new-onset (>90 days post-transplant); and associated with CLAD-free survival, graft survival, donor-specific antibodies, airway and blood eosinophilia.

Early and late AFOP was detected in 24 (5%) and 30 (6%) patients, respectively. CLAD-free survival was significantly lower in patients with late AFOP (median survival 2.42 years; p<0.0001) compared with patients with early or without AFOP and specifically associated with development of restrictive allograft syndrome (OR 28.57, 95% CI 11.34–67.88; p<0.0001). Similarly, graft survival was significantly lower in patients with late AFOP (median survival 4.39 years; p<0.0001) compared with patients with early AFOP or without AFOP. Late AFOP was furthermore associated with detection of circulating donor-specific antibodies (OR 4.75, 95% CI 2.17–10.60; p=0.0004) compared with patients with early or without AFOP, and elevated airway and blood eosinophilia (p=0.043 and p=0.045, respectively) compared with early AFOP patients.

Late new-onset AFOP is associated with a worse prognosis and high risk of CLAD development, specifically restrictive allograft syndrome. Our findings indicate that late new-onset AFOP might play a role in the early pathogenesis of restrictive allograft syndrome.
Prehospital reversal of profound respiratory acidosis and hypercapnic coma by non-invasive ventilation: a report of two cases
Authors: Fubini PE , Suppan L
Published: May 2020

Background

In chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure (ARF), non-invasive ventilation (NIV) is generally recommended and has proven its benefits by reducing endotracheal intubation (ETI) rates, intensive care unit (ICU) admissions, complications, and mortality. Choosing between immediate ETI or NIV trial is often difficult when such patients present with an altered mental status. Some guidelines recommend avoiding NIV when consciousness is impaired given the risk of aspiration, and some authors suggest that a pH < 7.25 is highly predictive of NIV failure. Though clinical response to a well-adjusted NIV treatment can be both swift and spectacular, these contraindications probably encourage physicians to proceed to immediate ETI. Some studies indeed report that NIV was not even considered in as many as 60% of patients who might have benefited from this therapy, though ETI related complications might have been avoided had NIV been successfully applied.

Case presentation

We report two cases of ARF in COPD patients who were successfully treated by NIV in prehospital setting and avoided ETI despite contraindications (altered mental status with a Glasgow Coma Scale < 8) and failure risk factors (severe respiratory acidosis with pH < 7.25).

Conclusion

In COPD patients presenting ARF, NIV trial could be considered even when relative contraindications such as an altered level of consciousness or a severe respiratory acidosis are present.
What are the factors and needs promoting mobility-as-a-service? Findings from the Swiss Household Energy Demand Survey (SHEDS)
Authors: Hoerler Raphael , Stünzi Anna , Patt Anthony , Del Duce Andrea
Published: May 2020

Mobility-as-a-Service (MaaS) is a service that supports customers’ transportation needs by providing information and ticketing for a multitude of transport modes in one interface; thus, buy potentially fostering multimodality and public transport, it represents an important lever to reduce negative transportation impacts such as emissions and congestion. By means of an online survey conducted in Switzerland, we try to understand potential user needs as well as factors that would motivate the use of MaaS. Comparing the openness to use MaaS for specific trip purposes like commuting and leisure activities, we find the lowest level of openness for commuting and the highest for weekend leisure trips. Intention to reduce car usage was positively related to openness to MaaS in commuting. On the other hand, factors that positively influence openness to using MaaS for leisure activities include a higher education degree, experience with carsharing and the use of transport-related climate policy announcements directly affecting consumers. These findings suggest focusing specifically on either commuting or leisure activities when designing policy measures.
The whole-transcriptome landscape of muscle and adipose tissues reveals the ceRNA regulation network related to intramuscular fat deposition in yak
Authors: Wang Hui , Zhong Jincheng , Zhang Chengfu , Chai Zhixin , Cao Hanwen , Wang Jikun , Zhu Jiangjiang , Wang Jiabo , Ji Qiumei
Published: May 2020

Background

The Intramuscular fat (IMF) content in meat products, which is positively correlated with meat quality, is an important trait considered by consumers. The regulation of IMF deposition is species specific. However, the IMF-deposition-related mRNA and non-coding RNA and their regulatory network in yak (Bos grunniens) remain unknown. High-throughput sequencing technology provides a powerful approach for analyzing the association between transcriptome-related differences and specific traits in animals. Thus, the whole transcriptomes of yak muscle and adipose tissues were screened and analyzed to elucidate the IMF deposition-related genes. The muscle tissues were used for IMF content measurements.

Results

Significant differences were observed between the 0.5- and 2.5-year-old yaks. Several mRNAs, miRNAs, lncRNAs and circRNAs were generally expressed in both muscle and adipose tissues. Between the 0.5- and 2.5-year-old yaks, 149 mRNAs, 62 miRNAs, 4 lncRNAs, and 223 circRNAs were differentially expressed in muscle tissue, and 72 mRNAs, 15 miRNAs, 9 lncRNAs, and 211 circRNAs were differentially expressed in adipose tissue. KEGG annotation revelved that these differentially expressed genes were related to pathways that maintain normal biological functions of muscle and adipose tissues. Moreover, 16 mRNAs, 5 miRNAs, 3 lncRNAs, and 5 circRNAs were co-differentially expressed in both types of tissue. We suspected that these co-differentially expressed genes were involved in IMF-deposition in the yak. Additionally, LPL, ACADL, SCD, and FASN, which were previously shown to be associated with the IMF content, were identified in the competing endogenous RNA (ceRNA) regulatory network that was constructed on the basis of the IMF deposition-related genes. Three ceRNA subnetworks also revealed that TCONS-00016416 and its target SIRT1 “talk” to each other through the same miR-381-y and miR-208 response elements, whereas TCONS-00061798 and its target PRKCA, and TCONS-00084092 and its target LPL “talk” to each other through miR-122-x and miR-499-y response elements, respectively.

Conclusion

Taken together, our results reveal the potential mRNA and noncoding RNAs involved in IMF deposition in the yak, providing a useful resource for further research on IMF deposition in this animal species.
A case report of fatal disseminated fungal sepsis in a patient with ARDS and extracorporeal membrane oxygenation
Authors: Prohaska Stefanie , Henn Philipp , Wenz Svetlana , Frauenfeld Leonie , Rosenberger Peter , Haeberle Helene A.
Published: May 2020

Background

With the following report we want to present an unusual case of a patient suffering from acute respiratory distress syndrome with early discovery of bacterial pathogens in bronchoalveolar liquid samples that developed a fatal undiscovered disseminated fungal infection.

Case presentation

A 67-year-old man was admitted to our university hospital with dyspnea. Progressive respiratory failure developed leading to admission to the intensive care unit, intubation and prone positioning was necessary. To ensure adequate oxygenation and lung protective ventilation veno-venous extracorporeal membrane oxygenation was established. Despite maximal therapy and adequate antiinfective therapy of all discovered pathogens the condition of the patient declined further and he deceased. Postmortem autopsy revealed Mucor and Aspergillus mycelium in multiple organs such as lung, heart and pancreas as the underlying cause of his deterioration and death.

Conclusion

Routine screening re-evaluation of every infection is essential for adequate initiation and discontinuation of every antiinfective therapy. In cases with unexplained deterioration and unsuccessful sampling the possibility for diagnostic biopsies should be considered.
Perturbation-based gait training to improve daily life gait stability in older adults at risk of falling: protocol for the REACT randomized controlled trial
Authors: Rieger Markus M. , Papegaaij Selma , Steenbrink Frans , van Dieën Jaap H. , Pijnappels Mirjam
Published: May 2020

Background

The European population is rapidly ageing. There is an urgent need for innovative solutions to reduce fall risk in older adults. Perturbation-based gait training is a promising new method to improve reactive balance responses. Whereas positive effects on task-specific dynamic balance recovery during gait have been shown in clinical or laboratory settings, translation of these effects to daily life gait function and fall risk is limited. We aim to evaluate the effect of a 4-week perturbation-based treadmill training on daily-life dynamic gait stability, assessed with inertial sensor data. Secondary outcomes are balance recovery performance, clinical balance and gait assessment scores, the amount of physical activity in daily life and falls incidence during 6 months follow-up.

Methods

The study is a monocenter assessor-blinded randomized controlled trial. The target study sample consists of 70 older adults of 65 years and older, living in the community and with an elevated risk of falling. A block-randomization to avoid seasonal effects will be used to allocate the participants into two groups. The experimental group receives a 4-week, two times per week perturbation-based gait training programme on a treadmill, with simulated slips and trips, in combination with cognitive dual tasks. The control group receives a 4-week, two times per week treadmill training programme under cognitive dual-task conditions without perturbations. Participants will be assessed at baseline and after the 4-weeks intervention period on their daily-life gait stability by wearing an inertial sensor on the lower back for seven consecutive days. In addition, clinical balance and gait assessments as well as questionnaires on falls- and gait-efficacy will be taken. Daily life falls will be followed up over 6 months by a fall calendar.

Discussion

Whereas perturbation-based training has shown positive effects in improving balance recovery strategies and in reducing laboratory falls, this study will contribute to investigate the translation of perturbation-based treadmill training effects in a clinical setting towards improving daily life gait stability and reducing fall risk and falls.

Trial registration

NTR7703/ NL66322.028.18, Registered: January 8, 2019; Enrolment of the first participant April 8, 2019.
Novel mutations of the SRF gene in Chinese sporadic conotruncal heart defect patients
Authors: Mengmeng Xu , Yuejuan Xu , Sun Chen , Yanan Lu , Fen Li , Kun Sun
Published: May 2020

Background

Conotruncal heart defects (CTDs) are a group of congenital heart malformations that cause anomalies of cardiac outflow tracts. In the past few decades, many genes related to CTDs have been reported. Serum response factor (SRF) is a ubiquitous nuclear protein that acts as transcription factor, and SRF was found to be a critical factor in heart development and to be strongly expressed in the myocardium of the developing mouse and chicken hearts. The targeted inactivation of SRF during heart development leads to embryonic lethality and myocardial defects in mice.

Methods

To illustrate the relationship between SRF and human heart defects, we screened SRF mutations in 527 CTD patients, a cross sectional study. DNA was extracted from peripheral leukocyte cells for target sequencing. The mutations of SRF were detected and validated by Sanger sequencing. The affection of the mutations on wild-type protein was analyzed by in silico softwares. Western blot and real time PCR were used to analyze the changes of the expression of the mutant mRNA and protein. In addition, we carried out dual luciferase reporter assay to explore the transcriptional activity of the mutant SRF.

Results

Among the target sequencing results of 527 patients, two novel mutations (Mut1: c.821A > G p.G274D, the adenine(A) was mutated to guanine(G) at position 821 of the SRF gene coding sequences (CDS), lead to the Glycine(G) mutated to Asparticacid(D) at position 274 of the SRF protein amino acid sequences; Mut2: c.880G > T p.G294C, the guanine(G) was mutated to thymine (T) at position 880 of the SRF CDS, lead to the Glycine(G) mutated to Cysteine (C) at position 294 of the SRF protein amino acid sequences.) of SRF (NM_003131.4) were identified. Western blotting and real-time PCR showed that there were no obvious differences between the protein expression and mRNA transcription of mutants and wild-type SRF. A dual luciferase reporter assay showed that both SRF mutants (G274D and G294C) impaired SRF transcriptional activity at the SRF promoter and atrial natriuretic factor (ANF) promoter (p < 0.05), additionally, the mutants displayed reduced synergism with GATA4.

Conclusion

These results suggest that SRF-p.G274D and SRF-p.G294C may have potential pathogenic effects.
The effects of combination treatments on drug resistance in chronic myeloid leukaemia: an evaluation of the tyrosine kinase inhibitors axitinib and asciminib
Authors: G. Lindström H. Jonathan , Friedman Ran
Published: May 2020

Background

Chronic myeloid leukaemia is in principle a treatable malignancy but drug resistance is lowering survival. Recent drug discoveries have opened up new options for drug combinations, which is a concept used in other areas for preventing drug resistance. Two of these are (I) Axitinib, which inhibits the T315I mutation of BCR-ABL1, a main source of drug resistance, and (II) Asciminib, which has been developed as an allosteric BCR-ABL1 inhibitor, targeting an entirely different binding site, and as such does not compete for binding with other drugs. These drugs offer new treatment options.

Methods

We measured the proliferation of KCL-22 cells exposed to imatinib–dasatinib, imatinib–asciminib and dasatinib–asciminib combinations and calculated combination index graphs for each case. Moreover, using the median–effect equation we calculated how much axitinib can reduce the growth advantage of T315I mutant clones in combination with available drugs. In addition, we calculated how much the total drug burden could be reduced by combinations using asciminib and other drugs, and evaluated which mutations such combinations might be sensitive to.

Results

Asciminib had synergistic interactions with imatinib or dasatinib in KCL-22 cells at high degrees of inhibition. Interestingly, some antagonism between asciminib and the other drugs was present at lower degrees on inhibition. Simulations revealed that asciminib may allow for dose reductions, and its complementary resistance profile could reduce the risk of mutation based resistance. Axitinib, however, had only a minor effect on T315I growth advantage.

Conclusions

Given how asciminib combinations were synergistic in vitro, our modelling suggests that drug combinations involving asciminib should allow for lower total drug doses, and may result in a reduced spectrum of observed resistance mutations. On the other hand, a combination involving axitinib was not shown to be useful in countering drug resistance.
LncRNA IGBP1-AS1/miR-24-1/ZIC3 loop regulates the proliferation and invasion ability in breast cancer
Authors: Chen Deqin , Fan Yangfan , Wan Fang
Published: May 2020

Background

Breast cancer (BC) is one of the malignant solid tumors with the highest morbidity in the world. Currently, the therapeutic outcome of different types of treatment can be unsatisfactory. Novel lncRNA biomarkers in BC remains to be further explored.

Methods

Different expression of lncRNAs among BC tissues and adjacent normal tissues were identified with microarray analyses. A series of in vivo and in vitro gain-of-function laboratory procedures were conducted to study the biological functions of IGBP1-AS1. The prognostic effects on IGBP1-AS1 survival were evaluated by using in situ hybridization and survival analysis. In addition, other experiments including RNA pull down analysis, RNA immunoprecipitation, luciferase reporter assays, and chromatin immunoprecipitation as well as validating assays conducted in vivo were applied to identify the target and regulatory mechanisms of IGBP1-AS1.

Results

Significant down-regulation of IGBP1-AS1 was discovered in the cell lines and tissues of BC. With respect to its biological function, overexpression of IGBP1-AS1 had inhibitory effects on the invasion and proliferation of BC cells in vivo as well as in vitro. Analysis of the samples obtained from BC patients indicated a positive effect of IGBP1-AS1 on survival outcomes. LncRNA IGBP1-AS1/miR-24-1/ZIC3 axis as a loop can regulate the proliferation and invasion of BC cells.

Conclusions

IGBP1-AS1 could have inhibitory impact on the invasion and proliferation of BC and may serve as a promising biomarker for BC.